Delayed diagnosis of a primary intraosseous squamous cell carcinoma: A case report

Primary intraosseous squamous cell carcinoma is a rare malignant central jaw tumor derived from odontogenic epithelial remnants. Predominantly, it affects mandible, although both jaw bones may be involved. This report describes a 60-year-old man who was initially misdiagnosed with a periapical infection related to the right lower wisdom tooth. After four months, the patient presented to a private dental clinic with a massive swelling at the right side of the mandible. Panoramic radiographs and advanced imaging revealed a lesion with complete erosion of the right ramus, which extended to the orbital floor. A biopsy from the mandibular angle revealed large pleomorphic atypical squamous cells, which is the primary microscopic feature of a poorly differentiated squamous cell carcinoma.

Rare finding of Eustachian tube calcifications with cone-beam computed tomography

Soft tissue calcification is a pathological condition in which calcium and phosphate salts are deposited in the soft tissue organic matrix. This study presents an unusual calcification noted in the cartilaginous portion of the Eustachian tube. A 67-year-old woman presented for dental treatment, specifically for implant placement, and cone-beam computed tomography (CBCT) was performed. The CBCT scan was reviewed by a board-certified oral and maxillofacial radiologist and revealed incidental findings of 2 distinct calcifications in the cartilaginous portion of the Eustachian tube. To the authors' knowledge, no previous study has reported the diagnosis of Eustachian tube calcification using CBCT. This report describes an uncommon variant of Eustachian tube calcification, which has a significant didactic value because such cases are seldom illustrated either in textbooks or in the literature. This case once again underscores the importance of having CBCT scans evaluated by a board-certified oral and maxillofacial radiologist.

Incidental occurrence of an unusually large mastoid foramen on cone-beam computed tomography and review of the literature

The incidental finding of an enlarged mastoid foramen on the right posterior mastoid region of temporal bone is reported, together with a discussion of its clinical significance. A 67-year-old female underwent the pre-implant assessment of a maxillary left edentulous region. A cone-beam computed tomographic (CBCT) image was acquired and referred for consultation. Axial CBCT slices revealed a unilateral, well-defined, noncorticated, low-attenuation, transosseous defect posterior to the mastoid air cells in the right temporal bone. The borders of the osseous defect were smooth and continuous. No other radiographic signs suggestive of erosion or sclerosis were noted in the vicinity. The density within the defect was homogenous and consistent with a foramen and/or soft tissue. The patient's history and physical examination revealed no significant medical issues, and she was referred to a neuroradiologist for a second opinion. The diagnosis of an enlarged mastoid foramen was made and the patient was reassured.

Fossa navicularis magna detection on cone-beam computed tomography

Herein, we report and discuss the detection of fossa navicularis magna, a close radiographic anatomic variant of canalis basilaris medianus of the basiocciput, as an incidental finding in cone-beam computed tomography (CBCT) imaging. The CBCT data of the patients in question were referred for the evaluation of implant sites and to rule out pathology in the maxilla and mandible. CBCT analysis showed osseous, notch-like defects on the inferior aspect of the clivus in all four cases. The appearance of fossa navicularis magna varied among the cases. In some, it was completely within the basiocciput and mimicked a small rounded, corticated, lytic defect, whereas it appeared as a notch in others. Fossa navicularis magna is an anatomical variant that occurs on the inferior aspect of the clivus. The pertinent literature on the anatomical variations occurring in this region was reviewed.

Evaluation of canalis basilaris medianus using cone-beam computed tomography

The aim of this report is to present two cases of canalis basilaris medianus as identified on cone-beam computed tomography (CBCT) in the base of the skull. The CBCT data sets were sent for radiographic consultation. In both cases, multi-planar views revealed an osseous defect in the base of the skull in the clivus region, the sagittal view showed a unilateral, well-defined, non-corticated, track-like low-attenuation osseous defect in the clivus. The appearance of the defect was highly reminiscent of a fracture of the clivus. The borders of osseous defect were smooth, and no other radiographic signs suggestive of osteolytic destructive processes were noted. Based on the overall radiographic examination, a radiographic impression of canalis basilaris medianus was made. Canalis basilaris medianus is a rare anatomical variant and is generally observed on the clivus. Due to its potential association with meningitis, it should be recognized and reported to avoid potential complications.

Clinical features and risk factors for HIV encephalopathy in children.

A prospective cohort study was conducted to determine the incidence of progressive encephalopathy (PE) and its associated clinical manifestations amongst a cohort of HIV infected children attending the HIV/AIDS clinic of the Pediatric Institute, Kuala Lumpur Hospital, Malaysia. Neurological and neurobehavioral assessments were performed in 55 children with HIV over a 24-month study period. Parameters assessed were physical and neurological assessments, CD4 counts, CD4 percentages, RNA viral loads and an IQ assessment at four monthly intervals. PE was diagnosed when patient developed at least one of the definitive criteria for PE based on the Consensus of Pediatric Neurology/Psychology Working Group, AIDS Clinical Trial 1996. The incidence of encephalopathy was 18.2% (n = 10) in 2002. All the patients had hepatosplenomegaly, lymphadenopathy, abnormal deep tendon reflexes and five had impairment in brain growth. The CD4 counts and CD4 percentages were more likely to be associated with PE compared to the non-PE group.

Assessment of tubal patency in infertile women: can hycosy be performed in place of Hysterosalpingography?

To determine the advantages and accuracy of hysterosalpingo-contrastsonography [HyCoSy] in the assessment of tubal patency with regards to conventional hysterosalpingography [HSG]. Interventional study. The study was conducted at Lady Willingdon Hospital Lahore. One year, from November 2003 to October 2004. Thirty infertile women were examined with hysterosalpingo-contrastsonography [HyCoSy] using air and saline as contrast medium. The results were compared with those obtained from conventional hysterosalpingography. [HSG]. Altogether 30 patients were included in the study. They were examined with both HyCoSy and conventional hysterosalpingo graphy [HSG] and the results were calculated. Of the patients investigated by salpingo-contrastsonography, 22 were found to have patent tubes whereas 8 were having blocked tubes. Unilaterality of bilaterality could not be detected by this method. Bilateral tubal patency was found by hysterosalpingography in 22 cases. Unilateral tubal patency was found in 5 cases. Bilateral tubal occlusion was detected in 3 cases using either technique. Sensitivity and specificity of HyCoSy was 90.9% and 89.4% respectively. Positive predictive value was 83.3% and negative predictive value was 55.55%. The outcome of the study shows that HyCoSy with combination of air and saline is cost effective, reliable and safe method and can replace conventional hystero salpingography as base line investigation of infertility on out patient basis

Serum thyroxine and thyroid stimulating hormone levels in maternal circulation and cord blood at the time of delivery

The aim of this study was to know whether the alterations of maternal thyroid function were also present in the newborn at birth. Retrospective study of thyroid related hormones in pregnant mothers at time of delivery and their cord blood samples. Department of Obstetrics and Gynecology, Government Mian Munshi Hospital and Centre for Nuclear Medicine [CENUM], Mayo Hospital, Lahore. 175 women delivered during the year 2001. maternal and cord serum T[4] and TSH. The mean age of women was 27.5 +/- 4.7 years and average weight of their babies was 3.3 +/- 0.6 kg. The median T[4] and TSH concentrations of mothers, particularly T[4], at delivery were significantly higher than controls [p<0.001 and p<0.01 respectively]. T[4] levels were negatively correlated to TSH levels in both mothers and neonates with low degrees of correlation. The median T[4] was significantly lower and median TSH was significantly higher in neonates as compared to mothers [p<0.001]. A relatively higher degree of correlation was observed among T[4] levels of mothers and neonates. The neonates of mothers having TSH levels below 0.35% mIU/L exhibited a heterogeneous patter of T[4] and TSH levels, which were not consistent with their mothers. In mothers who had TSH level within normal euthyroid range [0.36-4.0 mIU/L] neonates had T[4] levels within normal euthyroid range but 13.7% of them had TSH levels above 10 mIU/L. Overall 13.1% neonates had TSH level above 10mIU/L which indicated mild degree of iodine deficiency in Lahore. Neonates of about 13% pregnant women are at risk of iodine deficiency. Iodine supplementation in women of reproductive age is required before pregnancy as mild iodine deficiency is prevalent in Lahore