Solitary lesion

Surgery plays a key role in the management of patients with brain metastases, particularly patients whose systemic disease is well controlled and in those with solitary lesions. Surgery also may benefit patients with multiple metastatic sites who have a single dominant lesion with current or impending neurologic sequelae. 

Peptic ulcers are chronic, most often solitary lesions that occur in any part of GIT exposed to the aggressive action of acid-peptic juices. 

M. gypseum cosmopolitan soil solitary lesions of skin and scalp (ectothrix but Wood s light negative)... 

Pityriasis rosea, commonly mistaken for ringworm, is a unique disorder that usually begins as a single, large, round or oval pinkish patch known as the mother or herald patch. The most common sites for this solitary lesion are the chest, the back, or the abdomen. This is followed in about 2 weeks by a blossoming of small, flat, round or oval, scaly patches of similar color, each with a central collarette scale, usually distributed in a Christmas tree pattern over the trunk and, to a lesser degree, the extremities. This eruption seldom itches and usually limits itself to areas from the neck to the knees. 

AVMs typically present as solitary lesion. Multiple brain AVMs occur in approximately 0.3%-3.2% of all cases. Surprisingly enough, Willinsky et al. (1990) reported 11 cases of multiple AVMs among 203 patients (6%). Although multiple AVMs may occur spontaneously, they are frequently associated with cutaneous or extracranial vascular anomalies (Salcman et al. 1992), such as Rendu-Osler-Weber disease and Wyburn-Mason syndrome. However, the clinical mode of presentation, age and sex of the patient, and anatomic distribution of the lesions are the same as those in patients with single arteriovenous malformations. 

Percutaneous ethanol injection (PBI) is a technique for the treatment of HCC which is now considered to represent a reliable alternative to surgical resection. Bthanol shows selective diffusion in HCC, due to the softer consistency and hypervascularity of these lesions it carries little or no risk to the remaining parenchyma. Livraghi et al. (1999), in a multicentric trial involving nine centers, observed in patients with solitary lesions of less than 5 cm diameter a 3-year survival rate of 79%, and a 5-year survival rate of 47%. The results obtained with PBI certainly compete with the results of surgery and are influenced by the size of the lesions and the severity of cirrhosis (Livraghi et al. 1995). 

In 1997 SoLBiATi et al. (1997) published a study of 29 patients with 44 liver metastases (size 1.3-5 cm) of colorectal, gastric, breast, and pancreatic carcinomas. Among them were 20 patients with solitary lesions. The operation took place using cooled systems, and a complete tumor ablation was achieved in... 

A majority (65%) of cases are radiographically solitary lesions measuring from 2 to 5 cm the remainder cases have two or occasionally several lesions. Chest... 

The vast majority of leiomyomas in the stomach occur as solitary lesions, but multiple tumours are present in 1-2% of patients. Leiomyomas may be found in the antrum, body, or fundus of the stomach. Gastric leiomyomas may vary in size from tiny lesions of a few millimetres to enormous masses that significantly encroach on the lumen. 

In most cases it is a solitary lesion, but sometimes may appear multiple this was the case in 16% of our patients, who showed fi-om two to four nodules at imaging techniques (personal observation) and up to 30% in other case series. Pathological fea-... 

Fig. 19.14a,b. Follow-up of a small solitary lesion in a patient with known colon cancer, a Baseline CT study shows a small solid lesion less than 1 cm in diameter (arrow). The lesion could not be characterized reliably. Follow-up in 6 months was recommended, but the patient was lost to follow-up. b At 3 years later, follow-up CT shows considerable growth of the previously small lesion. Biopsy revealed metastasis of colon cancer... 

Presence of at least one measurable lesion. In case of a solitary lesion, its neoplastic nature should be confirmed by cytology/histology... 

SoLBiATi et al. (1997) published a study of 29 patients with 44 liver metastases (size 1.3-5 cm) of colorectal, stomach, breast, and pancreatic carcinomas. Among them there were 20 patients with solitary lesions. The operation took place using cooled systems, and a complete tumor ablation was achieved in 91% of cases. At the 3- and 6-month check-up 66% of the treated lesions were still inactive. A survival rate of 100%, 94% and 86% after 6, 12, and 18 months was documented (Solbiati et al. 1997). Livraghi et al. (1997) tried an approach using conventional systems and simultaneous irrigation with NaCl solution in 14 patients with 24 liver... 

Solitary or multiple violaceous or brown flat-topped papules resembling lesions of lichen planus. 

Mastocytomas and diffuse cutaneous mastocytosis are further manifestations of cutaneous mastocytosis (CM) [9]. Solitary mastocytomas are common in children. Most are present at birth or develop in infancy. These lesions are flat or mildly elevated, well demarcated, solitary yellowish red-brown plaques or nodules, typically 2-5 cm in diameter. Diffuse cutaneous mastocytosis is a rare disorder characterized by diffuse mast cell infiltration of large areas of the skin that presents in infants in the first year of life. Severe edema and leathery indurations of the skin leads to accentuation of skin folds (pseudo-lichenified skin) and a peau-dbrange-like appearance. Systemic complications include hypotension and gastrointestinal hemorrhage. Infants and young children with considerable mast cell infiltration of the skin sometimes exhibit blister formation in the first 3 years of life. MPCM and other forms of CM have been classified in a consensus nomenclature (table 1) [10]. 

Malignancy. The property or condition of being resistant to treatment (malignant). Mastocytoma. A nodular cutaneous mast cell infiltrate, which is usually present at birth or soon after as a solitary nodule, although three to four lesions may occur. Le-... 

Structures implicated in the production or maintenance of sleep include the nucleus of the solitary tract, dorsal medullary reticular formation, raphe nuclei, thalamus, anterior hypothalamus, preoptic area, basal forebrain, orbitofrontal cortex, caudate nucleus, basal ganglia, and cerebral cortex. None of these structures are individually necessary for sleep. No lesion has produced a long lasting total insomnia. After some sleep-reducing lesions, sleep returns toward normal if sufficient time is allowed for recovery. 

In 1972 we found that injections of propionitrile (Figure 1) consistently produced solitary, often perforating duodenal ulcers in the rat (5.). These lesions occurred 3-5 mm from the pylorus of the stomach, mostly - as in humans - on the anterior wall of the duodenum. The ulcers developed 24-48 h after the initial administration of propionitrile and frequently penetrated into the liver or pancreas ( ). 

Co-trimoxazole was the offender in 75% of 64 cases of fixed drug eruption. The eruption was mainly located on male genitalia, but unusual findings included familial occurrence, symmetrical and asymmetrical non-pigmen-ted lesions, linear lesions, a solitary plaque on the cheek, and wandering lesions (131). 

Palliative radiotherapy with chemotherapy may be used in selected patients to control local and systemic disease and to reduce disease-related symptoms. Brain metastases are also commonly treated with radiotherapy in the case of a solitary brain lesion, surgical resection may be used. 

The BCL-2 (B-cell lymphoma-2) proteins are anti-apoptotic polypeptides that are differentially expressed in some soft tissue lesions. Those that commonly label immunohistologically include solitary fibrous tumor, spindle-cell lipoma, Kaposi s sarcoma, and monophasic... 

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