Abdomen mass - Large Biopsy 3-6 cm

Biopsy

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Large tissue biopsy of abdominal mass for histopathology.

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Abdomen Mass - Large Biopsy 3-6 cm

Why is it done?
- Obtaining tissue diagnosis from abdominal masses measuring 3-6 cm in greatest diameter to determine the nature of the lesion (benign vs malignant)
- Differentiating between primary malignancies, secondary metastases, lymphoma, sarcoma, and benign lesions such as cysts, fibromas, or lipomas
- Characterizing masses incidentally discovered on imaging (CT, MRI, or ultrasound) that are indeterminate or suspicious for malignancy
- Guiding treatment planning and determining prognosis when malignancy is suspected or confirmed
- Performed when imaging characteristics are inconclusive and a definitive tissue diagnosis is needed before initiating treatment
- Typically performed when clinical suspicion of malignancy is moderate to high or when imaging features are concerning
Normal Range
- Normal findings:
  - Benign histology: Normal tissue appropriate to the organ of origin (e.g., fat, muscle, fibrous tissue, cyst contents)
  - No malignant cells identified
  - No evidence of dysplasia or atypia
  - Adequate cellularity with representative sampling
- Abnormal findings:
  - Positive for malignancy: Identification of malignant cells with features of adenocarcinoma, squamous cell carcinoma, lymphoma, sarcoma, or other cancers
  - Suspicious for malignancy: Atypical cells with features suggestive of malignancy but not definitively diagnostic
  - Inconclusive: Inadequate sampling, non-diagnostic tissue, or findings requiring additional immunohistochemical or molecular testing
Interpretation
- Benign diagnosis: Mass is non-malignant (lipoma, hemangioma, cyst, inflammatory lesion). May be managed conservatively with follow-up imaging or observation as clinically indicated
- Malignant diagnosis: Confirms presence of cancer. Pathology report includes histologic type, grade (if applicable), and may include immunohistochemistry results, molecular markers, or stage. Requires immediate staging and treatment planning
- Suspicious/Atypical findings: Cells present with concerning features but diagnosis not definitively established. May require repeat biopsy with larger bore needle, open surgical biopsy, or excision
- Inconclusive/Non-diagnostic: Insufficient tissue or inadequate sampling. Repeat biopsy with different technique (core needle, fine needle, or surgical biopsy) generally recommended
- Immunohistochemistry and molecular testing: Results help classify specific malignancy type, predict prognosis, and guide targeted therapy selection (e.g., HER2 status, hormone receptors, EGFR mutations, PD-L1 expression)
- Factors affecting interpretation: Prior treatment, tissue necrosis, inflammation, sampling location within heterogeneous mass, and patient factors (immunosuppression, prior malignancy)
Associated Organs
- Primary organ systems involved:
  - Gastrointestinal tract: Stomach, small intestine, colon, rectum
  - Liver and hepatobiliary system
  - Pancreas
  - Genitourinary organs: Kidneys, adrenal glands, bladder, ovaries, uterus, prostate
  - Lymph nodes and lymphoid tissue
  - Peritoneum and omentum
- Common diagnoses associated with abnormal results:
  - Primary malignancies: Gastric cancer, colorectal cancer, pancreatic cancer, hepatocellular carcinoma, renal cell carcinoma, ovarian cancer, endometrial cancer
  - Lymphoproliferative disorders: Lymphoma (Hodgkin and non-Hodgkin), leukemias with nodal involvement
  - Sarcomas: Gastrointestinal stromal tumors (GIST), leiomyosarcoma, liposarcoma, fibrosarcoma
  - Metastatic disease: Secondary cancers from primary sites (lung, breast, melanoma)
  - Benign masses: Lipomas, cysts, hemangiomas, fibromas, leiomyomas, inflammatory lesions
  - Infectious and inflammatory conditions: Abscesses, tuberculosis, fungal infections
- Potential complications associated with abnormal results:
  - Malignant findings: Requires urgent oncologic consultation, staging studies, and initiation of treatment; prognosis depends on cancer type, grade, and stage
  - Disease progression: Delay in diagnosis can lead to disease advancement and metastasis
  - Biopsy-related complications: Infection, bleeding, peritonitis, visceral perforation, tumor seeding (rare)
Follow-up Tests
- If malignancy is confirmed:
  - Staging studies: CT chest/abdomen/pelvis, MRI, or PET-CT depending on cancer type
  - Tumor markers: CEA, CA 19-9, PSA, CA-125, or other organ-specific markers
  - Molecular testing: Gene mutations (KRAS, TP53, BRCA), microsatellite instability (MSI), tumor mutational burden (TMB)
  - Laboratory studies: Complete blood count, comprehensive metabolic panel, lactate dehydrogenase (LDH)
  - Surgical consultation: For potential resection or definitive treatment planning
- If benign findings:
  - Follow-up imaging: Ultrasound or CT at 6-12 months to confirm stability
  - Clinical observation: Monitoring for symptoms if mass remains asymptomatic
  - Surgical excision: May be considered if symptoms develop or diagnostic uncertainty persists
- If results are inconclusive or suspicious:
  - Repeat biopsy: Using different technique (larger bore needle, CT or ultrasound-guided core biopsy, or open surgical biopsy)
  - Advanced imaging: Diffusion-weighted MRI, dynamic contrast-enhanced imaging, or PET-CT for metabolic evaluation
  - Multidisciplinary tumor board: Discussion with radiology, pathology, oncology, and surgery
  - Surveillance imaging: Short-interval follow-up (4-8 weeks) if mass remains indeterminate
- Ongoing monitoring:
  - Regular imaging surveillance: Every 3-6 months initially, then every 6-12 months depending on diagnosis and clinical context
  - Laboratory monitoring: Serial tumor markers and blood work as indicated by specific diagnosis
  - Clinical follow-up: Periodic physical examination and assessment for recurrence or progression
Fasting Required?
- Fasting requirement: Yes
- Fasting duration: NPO (nothing by mouth) for 6-8 hours before the procedure. For morning procedures, NPO after midnight. For afternoon procedures, light breakfast may be permitted 6-8 hours prior
- Fluids: Clear liquids may be permitted up to 2-3 hours before procedure (confirm with proceduralist)
- Medication management:
  - Anticoagulants (warfarin, dabigatran): Hold 3-5 days before procedure; INR should be <1.5
  - Antiplatelet agents (aspirin, clopidogrel): Discuss with physician; may need to hold 5-7 days before
  - Direct oral anticoagulants (apixaban, rivaroxaban): Hold 24-48 hours before procedure
  - Metformin: Hold day of procedure and 48 hours after (if contrast used)
  - Other medications: Generally continue regular medications with sips of water (discuss with proceduralist)
- Pre-procedure preparation:
  - Laboratory tests: Coagulation studies (PT/INR, PTT), complete blood count, renal function if contrast planned
  - Imaging: Review prior imaging studies to identify mass location and optimal approach
  - Consent: Informed consent discussing procedure, risks (bleeding, infection, perforation), and benefits
  - Patient position: Arrangements for sedation/anesthesia if planned
  - Antibiotics: Prophylactic coverage may be given if immunocompromised or high-risk infection scenario
  - Driver arrangement: Patient must arrange ride home due to sedation effects
- Post-procedure care:
  - Rest period: Allow recovery time; most patients can return to normal activities within 24 hours
  - Diet: Resume normal diet as tolerated
  - Activity: Avoid heavy lifting and strenuous activity for 1-3 days
  - Pain management: Acetaminophen or NSAID for mild discomfort; avoid aspirin for 3-5 days
  - Monitoring: Watch for signs of infection (fever, increasing pain), bleeding, or peritoneal signs; contact physician if symptoms develop

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