Intramandibular plexiform schwannoma presenting as a nonspecific benign lesion: How specific can we be? A case report with a review of the literature

Schwannoma, a benign nerve sheath tumor, is quite rare and more so in jawbones. We report a rare case of a plexiform variant of mandibular schwannoma in a 12-year-old female with a swelling in the left mandible. Clinical features were suggestive of dentigerous cyst as a result of missing premolars and canine. Occlusal and panoramic radiography revealed an osteolytic lesion with scalloping margins, bicortical plate expansion, and agenesis of several teeth. Odontogenic keratocyst, central giant cell granuloma, odontogenic myxoma, and ameloblastic fibroma were given as radiological differential diagnoses. Histopathological examination revealed features of plexiform schwannoma which was given as the final diagnosis. The lesion was treated with surgical excision. Although odontogenic cysts/tumors are often thought of in differential diagnosis whenever well-defined radiolucencies in the jaw are encountered, it is prudent to include schwannoma. This exceptional case adds light to the fact that schwannoma should not be overlooked though it is a rare possibility and must be included in differential diagnosis of odontogenic cysts/tumors

Manifestaciones psiquiátricas de la neurosífilis: reporte de un caso de parálisis / Psychiatric manifestations of neurosyphilis: A case report of progressive general paralysis

A pesar de que la neurosífilis es poco frecuente en la actualidad, esta entidad no ha desaparecido. Las manifestaciones psiquiátricas de la parálisis general progresiva se pueden presentar a través de una gran variedad de síndromes tales como psicosis, manía y demencia. Se presenta el caso de un varón de 56 años de edad con inicio insidioso de delirios de daño y de grandeza, alucinaciones auditivas y alteraciones conductuales tales como reacciones impulsivas y agresividad. Los análisis serológicos y de líquido cefalorraquídeo (LCR) revelaron la presencia de Treponema pallidum. El paciente recibió tratamiento antibiótico, así como psicofarmacológico, con mejoría notable de los síntomas psicóticos, maniacos y conductuales. Este caso enfatiza la importancia de descartar neurosífilis en presencia de manifestaciones psiquiátricas pleomórficas y evolución atípica, así como deterioro de funciones mentales superiores.

Although neurosyphilis is infrequently seen nowadays, it cannot be said that it has disappeared. The psychiatric manifestations of syphilis-related progressive general paralysis can adopt a wide variety of presentations, including psychosis, mania and dementia. The case of a 56-year-old male patient is presented; it has an insidious onset of delusions of damage and grandiosity, auditory hallucinations and behavioral changes such as increased impulsivity and aggressiveness. Serological and cerebrospinal fluid laboratory analyses revealed the presence of Treponema pallidum. The patient received antibiotic and psychopharmacological treatment, showing significant improvement of all his symptoms. This case emphasizes the importance of ruling out neurosyphilis in the presence of pleomorphic or atypical psychiatric manifestations of atypical clinical course as well as a decline of superior mental functions.

Hiperparatiroidismo primario asintomático en mujeres / Asymptomatic primary hyperparathyroidism in women

El hiperparatiroidismo primario puede tener diferentes características. Una de ellas es la forma asintomática. Esta es una variante leve del hiperparatiroidismo primario hipercalcémico, que se caracteriza por una calcemia no mayor a 1 mg/dl sobre el límite superior del método, hormona paratiroidea intacta (PTHi) elevada, ausencia de litiasis renal, deterioro de la función renal y de osteoporosis, edad menor de 50 años, y calciuria menor a 400 mg/día. No es una entidad quirúrgica, pero en su evolución puede llegar a serlo. Se estudiaron 24 mujeres postmenopáusicas, todas mayores de 50 años, con diagnóstico de hiperparatiroidismo asintomático, se describieron las manifestaciones clínicas, los cambios densitométricos, los parámetros bioquímicos y del remodelado óseo y se compararon los resultados con las variantes clásica y normocalcémica de la enfermedad. Se establecieron los criterios diagnósticos y se observó que solo 2 (8.3%) de las pacientes, durante un seguimiento de 44 ± 12 meses tuvo necesidad de paratiroidectomía. En definitiva, el hiperparatiroidismo primario asintomático es una alteración benigna, de seguimiento clínico periódico que, en pocas ocasiones, durante el seguimiento puede requerir cirugía.

Primary hyperparathyroidism may have different characteristics. One is the asymptomatic form. This is a mild variant of hypercalcemic hyperparathyroidism, characterized by a calcemia not greater than 1 mg/dl above the upper limit of the method, a high intact parathyroid hormone (iPTH), absence of renal stones, renal function impairement, and osteoporosis, less than 50 years of age, and less than 400 mg/day calciuria. It is not a surgical entity, but its evolution may require it. Twenty-four postmenopausal women, all older than 50 years, with a diagnosis of asymptomatic hyperparathyroidism, were studied. Clinical manifestations, densitometric changes, biochemical parameters and bone remodeling were analyzed and the results were compared with the classic and normocalcemic variants of the disease. Diagnostic criteria were established and observed that only 2 (8.3%) of patients, during a follow up of 44 ± 12 months, had need for a parathyroidectomy. In conclusion, the asymptomatic primary hyperparathyroidism is a benign disorder, of periodic clinical follow-up, which rarely may require surgery.

Foreign Body in Jugal Mucosa

Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.(AU)

Clinicopathological features of three cases of spindle cell rhabdomyosarcoma and review of literatures / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and differential diagnosis of spindle cell rhabdomyosarcoma ( SCRM) . Methods Three cases of SCRMs were analyzed by gross examination, microscopy and immunohistochemistry. Relevant lit-eratures were reviewed to summarize the diagnostic features of SCRM and its differential diagnosis. Results All the 3 cases were male infants aged from 2 days to 4 years. 2 cases were located in paratesticular and 1 in back. Tumors were all well-circumscribed but unen-capsulated, with white-gray cut surface, firmed and sized 2. 0 to 6. 0 cm in diameter. Histologically, tumors displayed invasive growth but were well-circumscribed. Tumor cells were spindle to round with eosinophilic cytoplasm and fascicular, storiform, wavy appear-ance. Horizontal structure and striated muscle brood cells were observed in some cells or local regions. A small amount of collagen fi-brils were observed in the mesenchymal components. The nucleus were long or fine wavy with unconspicuous nuclear atypia, mitosis could be occasional observed. Immunohistochemically, tumor cells were positive for vimentin, desmin, myogenin and MyoD1. CK,α-inhabin, AFP, CD34 and S-100 were negative. Conclusions SCRM is a rare and new type of rhabdomyosarcoma that commonly oc-curred in infant. It should be differentiated from other tumors, such as infantile fibromatosis, congenital fibrosarcoma, fibrosarcoma, leiomyosarcoma, triton tumor, malignant melanoma of promoting the fibrous tissues.

Nonsebaceous lymphadenoma of salivary gland:report of two cases and review of the litera-ture / 临床与实验病理学杂志

Purpose To investigate clinicopathological features, diagnosis and differential diagnosis of non-sebaceous lymphadenoma of the parotid gland. Methods The histopathological morphology, immunohistochemical profiles and clinicopathological features were an-alyzed in two cases of NSL, along with review the related literatures. Results Two patients were female adults. Microscopically, The tumor was a well-circumscribed mass surrounded by a fibrous capsule of variable thickness and comprised a mixture of proliferating epi-thelium accompanied by a prominent lymphoid component, reactive lymphoid follicles were found in lymphoid stroma. The epithelial component took the form of anastomosing trabeculae, glands, solid basaloid islands or cyst formation. The cysts and glands were lined with luminal cells and abluminal cells, filled with eosinophilic secretions with occasional histiocytes. The epithelial cell was no seba-ceous differentiation, significant cytological atypia and mitotic activity. A fibrous capsule with subcapsular sinus was seen around the mass in one case. Immunohistochemically, the abluminal cells were positive for p63, CK34βE12 and CK5/6, while the epithelial cells were positive for CK(AE1/AE3) and CK7. Conclusion NSL is a very rare benign of salivary gland, which occuring in the lymph node lesions are less reported, knowledge of the wide histological spectrum of this rare tumor is important in order to avoid misdiagno-sis, particularly as malignant tumor.

Síndrome de amplificação dolorosa no idoso: relato de caso e revisão da literatura / Pain amplification syndrome in the elderly: case report and literature review

JUSTIFICATIVA E OBJETIVOS: Pouquíssimas são as publicações sobre a síndrome de amplificação dolorosa no idoso (SAD), a despeito da sua importância para aqueles indivíduos, pois pode ter múltiplas consequências no envelhecimento. O objetivo deste estudo foi relatar um caso de SAD no idoso; representada pela fibromialgia (FM), descrevendo sua abordagem diagnóstica e seu manuseio terapêutico, bem como apresentar uma revisão bibliográfica do assunto. RELATO DO CASO: Paciente do gênero feminino, 73 anos, há 4 anos iniciando um quadro de moderada dor muscular difusa, rigidez matinal fugaz, anedonia, tristeza, ansiedade, importante fadiga e distúrbio do sono. Inicialmente, diagnosticada polimialgia reumática, assim, vinha fazendo uso regular de prednisona, apesar de progressiva piora da sua capacidade funcional e qualidade de vida (QV). Há um ano, no nosso serviço, foi revisto o diagnóstico, e verificado tratar-se de SAD, espectro da FM. Suspendeu-se, então, a prednisona e orientado terapia não farmacológica com programa de autogerenciamento em dor, e farmacológica multimodal com analgésicos não opioide o clonixinato de lisina e opioide o tramadol, e um modulador da dor, a duloxetina. Após 6 meses de tratamento verificou-se grande melhora na dor, sono, depressão, ansiedade, capacidade funcional e QV. CONCLUSÃO: É de suma importância o diagnóstico correto e uma intervenção terapêutica adequada nos casos de SAD, especialmente tratando-se da população idosa e da FM, a qual apresenta características peculiares naquela população. Há grandes probabilidades de melhora sintomática, funcional, e na QV dos idosos com SAD ao se atentar aos diagnósticos diferenciais, bem como ao se introduzir terapêuticas adequadas.

BACKGROUND AND OBJECTIVES: There are very few publications on pain amplification syndrome in the elderly (PAS), in spite of its importance for them, because it may have multiple consequences during aging. This study aimed at reporting a case of PAS in the elderly represented by fibromyalgia (FM), describing its diagnostic approach and therapeutic management, and at presenting a literature review on the subject. CASE REPORT: Female patient, 73 years old, with moderate diffuse muscle pain, fleeting morning stiffness, anhedonia, sadness, anxiety, major fatigue and sleep disorders for four years. She was initially diagnosed as rheumatic polymyalgia and was under regular prednisone in spite of the progressive worsening of her functional capacity and quality of life (QL). One year ago her diagnosis was reviewed by our service and we confirmed it was PAS, spectrum of FM. Prednisone was then withdrawn and non-pharmacological therapy was indicated with pain self-management program; multi-176 modal pharmacological therapy was also instituted with non-opioid (lysine clonixinate) and opioid (tramadol) analgesics and a pain modulator (duloxetine). Six months later there has been major pain, sleep, depression, anxiety, functional capacity and QL improvement. CONCLUSION: Accurate diagnosis and adequate therapeutic intervention are paramount for PAS cases, especially in the elderly population with FM, which has unique characteristics in such population. There are major probabilities of symptomatic, functional and QL improvement in the elderly with PAS if we pay attention to differential diagnoses and introduce adequate therapies.

Fenómenos visuales como parte de un síndrome migrañoso. revisión de la literatura / Visual phenomenon as part of the migraine syndrome. literature review

Teniendo en cuenta los múltiples síntomas que suelen acompañar los episodios de migraña, son los síntomas visuales los que adquieren mayor porcentaje de presentación, los cuales pueden estar acompañados o no de cefalea. Estos síntomas pueden ubicarse dentro de un síndrome migrañoso específico como lo son la migraña con aura, aura típica sin cefalea, migraña retiniana y migraña oftalmoplégica. Se revisan y se presentan sus criterios diagnósticos y su manejo.

Visual phenomenon as part of the migraine syndrome.Literature review. Among the multiple symptoms, usually accompanying, the migraine episodes, there are the visual symptoms, which account for the highest incidence. These symptoms may or may no be accompanied by headache. These symptoms can be located into a specific migraine syndrome, such as “migraine with aura”, “aura without migraine”, “retinal migraine” and the “ophthalmoplegic migraine”. In this article we provide a topic review, as well as the diagnostic criteria and the management of this entity.