Biopsy of a brain mass to obtain histologic verification of metastasis is rarely required when there are multiple parenchymal brain lesions in a patient with known active systemic malignancy, particularly if there are metastases to other organs. In contrast, biopsy is almost always indicated when the brain lesion is solitary (the patient's only known tumor) and non-surgical treatment is planned. The need for biopsy of a single brain lesion in a patient with known systemic cancer depends on several factors. Although one study of biopsy results found that 11% of single brain lesions thought to be metastases based upon enhanced CT were a different pathology , current high resolution MRI is often quite specific. Systemic disease in recession (a primary histology that infrequently spreads to the brain) and an atypical radiographic appearance favor biopsy. Active systemic disease, a primary histology that commonly spreads to the brain and a typical radiographic appearance mitigate the need for biopsy. Current stereotactic biopsy techniques permit retrieval of diagnostic tissue in approximately 95% of cases, with a morbidity from hemorrhage, seizure, worsened neurologic deficit and infection of 3% and a mortality of 0.6% . A highly vascular appearance on neuroimaging and a primary histology associated with a tendency for brain metastases to bleed is a relative contraindication to biopsy.
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.