Periradicular and Peri-Implant Lesions Associated with Apical Impact of Osseointegrated Implants in Tooth Roots: Clinical Case Reports

This clinical case report aims to describe the development of periradicular and perimplant cystic lesions resulted from the intimate contact of the apical region of osseointegrated implants of dental roots, and discuss the reasons fo r failure of the guided bone regeneration procedure associated with platelet rich fibrin and leukocytes, this process was used to the treatment of the first case. Case Reports. Three cases were reported, two cases described the close contact between the tooth roots and the osseointegrated implants and another with a distance of 1.08 mm. All cases realized a radiographic, and they had not periapical lesions before contact with the apical region of the osseointegrated implants on the roots of the teeth. In the case with the largest cystic extension, the procedure was: removal of the osseointegrated implant with apicectomy of the neighboring teeth, excisional biopsy of the lesion, and grafting using the technique of guided bone regeneration associated with L-PRF. All three cases, endodontic treatment was performed on the neighboring teeth within 2 years of survival of the osseointegrated implants in order to reverse the existing lesion. Results. The diagnostic hypothesis of the three cases was periradicular and peri-implant lesion, arising from a contact of the apical region of the osseointegrated implant with the adja cent tooth. The distance of 1.08 mm between the apices did not ensure normality of the periradicular and peri-implant tissues. The intimate contact caused lesions of different extents and root fractures. Conclusion. Premature contact of the osseointegrated implant with the root region of the neighboring tooth may lead to the development of periradicular and peri-implant lesions, suggesting that it is not possible to control this infectious process with endodontic treatment of the injured tooth.

Este reporte de caso clínico tuvo como objetivo describir el desarrollo de lesiones quísticas perirradiculares y periimplantarias resultantes del contacto íntimo de la región apical de implantes osteointegrados de raíces dentales, y además discutir las razones del fracaso del procedimiento de regeneración ósea guiada asociado a fibrina rica en plaquetas y leucocitos. Este proceso se utilizó para el tratamiento del primer caso. Se reportaron tres casos, en dos casos se describieron el estrecho contacto entre las raíces de los dientes y los implantes osteointegrados y en el otro se determinó una distancia de 1,08 mm. En los tres casos se realizó una radiografía y se determinó que no existían lesiones periapicales, antes del contacto con la región apical de los implantes osteointegrados, en las raíces de los dientes. En el caso de mayor extensión quística, el procedimiento fue: extracción del implante osteointegrado con apicectomía de los dientes vecinos, biopsia excisional de la lesión e injerto mediante la técnica de regeneración ósea guiada asociada a L-PRF. En los tres casos, el tratamiento de endodoncia se realizó en los dientes vecinos dentro de los 2 años de supervivencia de los implantes osteointegrados para revertir la lesión existente. La hipótesis diagnóstica de los tres casos fue lesión perirradicular y periimplantaria, originada por un contacto de la región apical del implante osteointegrado con el diente adyacente. La distancia de 1,08 mm entre los ápices no aseguraba la normalidad de los tejidos perirradiculares y periimplantarios. El contacto íntimo provocó lesiones de diferente extensión y fracturas radiculares. El contacto prematuro del implante osteointegrado con la región radicular del diente vecino puede conducir al desarrollo de lesiones perirradiculares y periimplantarias, lo que sugiere que no es posible controlar este proceso infeccioso con tratamiento endodóntico del diente lesionado.

Diagnosis and treatment of intrahepatic biliary cystadenoma / 中华肝胆外科杂志

Objective:To study the clinical features of intrahepatic biliary cystadenoma (BCA), with the aim to improve its treatment results.Methods:The clinical data and follow-up results of 86 patients with BCA treated at our department from March 2010 to January 2021 were retrospectively analyzed. Of 86 patients, there were 15 males and 71 females, with age of (48.4±13.1) years old. According to the surgical procedures carried out, 44 patients were divided into the minimally invasive group and 42 into the open group. Clinical data including imaging data, blood biochemistry, and tumor markers were collected. The follow-up data of these patients was collected in outpatient clinics or by telephone review.Results:Of 86 patients, 19(22.1%) patients had a monocystic lesion while 67(77.9%) patients had a multicystic lesion, 64 patients (74.4%) had intracapsular segregation, and 12(14.0%) patients had solid structures. Eighty-six patients with BCA were misdiagnosed as hepatic cysts in 9 patients (10.4%), hepatic echinococcosis in 2 patients (2.3%), biliary hamartoma in 1 patient (1.2%), and hepatic hemangioma in 1 patient (1.2%) before surgery. The tumor size [(6.5±3.2) vs. (9.0±4.0) cm], operative time [115(88, 185) vs. 195(160, 254) min], intraoperative blood loss [50(20, 162) vs. 300(200, 600) ml], and postoperative hospital stay [4(3, 6) vs. 8(7, 10) d] were significantly lower in the minimally invasive group than the open group. The differences were statistically significant ( P<0.05). In the 73 patients with complete follow-up, (median follow-up 63.5 months), 4 patients had developed tumor recurrence. Conclusion:Intrahepatic bile duct cystadenoma lacks specific clinical manifestations, and has a high rate of misdiagnosis and mistreatment. Early radical hepatectomy improved clinical outcomes.

Biomechanical study of cystic lesions of the mandible based on a three-dimensional finite element model / 南方医科大学学报

OBJECTIVE@#To analyze the biomechanics of cystic lesions in the mandibular body in a three-dimensional (3D) finite element model.@*METHODS@#A 3D finite element model of cystic lesion of the mandibular body was constructed based on the CT images of the mandible of a healthy adult female volunteer with normal occlusion. The size of the cyst and the residual bone wall were analyzed when the lesion area approached the stress peak under certain constraints and loading conditions.@*RESULTS@#When the size of the cyst reached 37.63 mm×11.32 mm×21.45 mm, the maximal von Mises stress in the lesion area reached 77.295 MPa, close to the yield strength of the mandible with a risk of pathological fracture. At this point, the remaining bone thickness of the buccal and lingual sides and the lower margin of the mandible in the lesion area was 1.52 mm, 0.76 mm and 1.04 mm, respectively.@*CONCLUSIONS@#Residual bone mass is an important factor to affect the risk of pathological fracture after curettage of cystic lesions. A thickness as low as 1 mm of the residual bone cortex in the cystic lesion area of the mandibular body can be used as the threshold for a clinical decision on one-stage windowing decompression combined with two- stage curettage.

Metastatic Renal Cell Carcinoma Masquerading As Benign Cystic Lesion on Cytology

Clear Cell-Renal Cell Carcinoma (CC-RCC), the mostcommon subtype, accounting for 75% of all RCCs, canmetastasize to any part of the body. Nodal metastasis iscommonly noted in the pulmonary, tracheal andretroperitoneal lymph nodes. However, metastasis tocervical/supraclavicular lymph nodes is extremelyrare. Moreover, these metastatic nodal deposits areusually solid, but may become cystic, which warrants adifferential diagnosis of metastatic lesion in an elderlypatient. So, here we report a case of metastatic RCCpresenting as left supraclavicular lymphadenopathywithout any clinical manifestations of the primarywhich was misdiagnosed as a benign cystic lesion oncytology.

Imaging classification diagnosis and maxillary sinus floor augmentation of maxillary sinus cystic lesions / 华西口腔医学杂志

Maxillary sinus cystic lesions can often be found in cone-beam computed tomography (CBCT) images. However, whether this change affects the implementation of maxillary sinus floor augmentation remains unclear. Combining the common cystic change performance of CBCT, image classification diagnosis of maxillary sinus cystic change was introduced, and the indications and surgical methods of maxillary sinus floor augmentation and postoperative radiographic changes of mucous were analyzed. This procedure may help clinicians evaluate the feasibility and methods of maxillary sinus augmentation in maxillary sinus cystic changes.

Sjogren syndrome appeared as diffuse pulmonary cystic lesion accompanied with hemoptysis: A case report and literature review / 吉林大学学报(医学版)

Objective: To analyze the clinical features of Sjogren syndrome (SS) patient by investigating the diagnosis and treatment of one SS patient and perform the review of relative literatures, and to improve the understanding of the clinicians for the rare clinical symptoms and imaging features of SS. Methods: The patient was a 23-year-old woman with dyspnea associated with cough and expectoration for 1 month, and went to the hospital after hemoptysis for 3 d. The physical examination results showed pale conjunctiva and there were no other obvious positive signs. The chest CT results showed there were multiple cystic changes in both lungs. Further bronchoscopic biopsy, labial gland biopsy and rheumatism examinations and other assistant examinations were performed. The patient received related treatment. Results: The patient was initially diagnosed as lymphangioleiomyomatosis (LAM) and eventually diagnosed as SS by related examinations. The patient was treated with oral glucocorticoids and immunosuppressive agents. The symptoms of the patient were improved after treatment. The dyspnea was relieved, hemoptysis was not found, and the lung diffusion function was improved significantly. There were no significant changes in chest CT examination of the patient 2 months after treatment. Conclusion: There is rarely patients with hemoptysis and multiple cystic lesions in both lungs simultaneously among the SS patients, SS mainly occur in the women with childbearing age and it should be differentiated from LAM.

Clinical thinking and evidence-based for decompression of cystic lesions in the jaw bone / 口腔疾病防治

@#Decompression is an effective and widely used treatment for jawbone cystic lesions that can, to a great extent, preserve the function and appearance of the jawbone. However, some problems exist with its clinical application, such as the inappropriate determination of indication and the lack of standardized operational guidelines, resulting in treatment ineffectiveness or even failure. This paper aimed to summarize the clinical value of decompression for jawbone cystic lesions in terms of mechanism, scientific evidence, advancement, indications and effective evaluation by reviewing relevant literature and our clinical experience.

Value of MRI in the diagnosis of benign and malignant of breast cystic lesion with thin-wall / 中华放射学杂志

Objective To investigate the value of differential diagnosis of benign and malignant of breast cystic lesion with thin-wall in MRI. Methods Retrospective analysis from January 2012 to December 2016 Liaoning Cancer Hospital diagnosis confirmed by surgery and pathology, and a total of 81 lesions (76 patients) of breast cystic lesions with thin-wall on MRI enhanced images (thickness no more than 5 mm, mural node less than 10 mm and solid position less than 50％)were enrolled. All patients underwent bilateral breast plain scan and dynamic contrast-enhanced scan. Using MRI breast imaging reporting and data system (BI-RADS) standard to analyze the MRI plain scan and dynamic contrast-enhanced scan images. Analysis of the margin of the lesion, internal enhancing features and time signal intensity curve (TIC) type and other characteristics. The feature of wall margin, thickness and enhancement form, mural nodules and internal septation morphological were analysed by Chi-square test. TIC type and wall nodule position were analysed by Fisher method. Wall nodule sizes were analysed by using independent sample t test. Results Of the 81 lesions, 67 were benign lesions and 14 were malignant. Among benign lesions, 56 were with well-defined margin, 58 were with uniform wall thickness and 7 were with mural nodule. Among malignant lesions, 5 were with well-defined margin, 8 were with uniform wall thickness and 9 were with mural nodule, which showed statistically significant difference between benign and malignant lesions (P<0.05). Of the 9 malignant lesions with wall nodules, 7 were located outside the wall, 1 between the wall, and 1 within the wall. Of the 7 benign lesions with wall nodules, 4 were located between the wall, 1 within the wall and 2 outside the wall, which were significant difference in the location of nodules between benign and malignant lesion (χ2=6.228,P=0.043). There was no significant difference between benign and malignant lesions in the homogeneous enhancing, internal separations and wall nodule size (P>0.05). Nine lesions can not obtain TIC to analyse enhancement degree due to thin linear enhancement of cyst wall. Through the analysis of TIC type of 58 benign lesions and 14 malignant lesions, Type Ⅰ and type Ⅱ TIC were more commonly presented in benign lesions. Type Ⅱ and type Ⅲ were more commonly found in malignant lesions, and TIC types were statistically different (P<0.05). There was no significant difference in the degree of cystic wall enhancement (P>0.05). Conclusion Most of breast cystic lesion with thin-wall are benign lesion, cystic wall enhancement characteristics combined with time-signal intensity curve helps to find malignant lesion.

Differential diagnosis of asymptomatic patients with pancreatic small cystic lesions / 中华普通外科杂志

Objective To analyze the differences between benign and potential malignant small pancreatic cystic lesions.Methods We retrospectively analyzed the clinical and pathological data of asymptomatic patients with pancreatic small cystic lesions and divided them into benign group (including serous cystic neoplasms,lymphoepithelial cyst and pseudocyst) and potential malignant group (including mucinous cystic neoplasms,intraductal papillary mucinous neoplasms and solid pseudopapillary neoplasms).Comparison of clinical data was made between the two groups.Results 46 patients with pathological results were included (22 cases in benign group and 24 cases in potential malignant group).No difference was detected on demographic data and lab results between the two groups.Compared with benign patients,patients in the potential malignant group were more likely to show thicken wall (P =0.000),mural nodule (P =0.000),solid constituents inside the cyst (P =0.001),wall enhancement (P =0.003) and uneven wall on CT scan (P =0.024).The diagnostic sensitivity,specificity and accuracy of the combination of above mentioned CT features for potential malignant diseases were 91.7％,77.3％ and 84.8％,respectively.Conclusions Pancreatic cystic lesions with thicken wall,mural nodule,wall enhancement,solid parts inside the cyst and uneven wall on CT were more likely of potential malignant entities.

Research status of acinar cell cystadenoma of the pancreas / 中华消化外科杂志

Acinar cell cystadenoma (ACA),also referred to as acinar cystic transformation,is a rare and newly recognized cystic lesion of the pancreas.This cystic lesion displaying apparent acinar cell differentiation and lacking of distinct cellular atypia was accepted as the benign counterpart of acinar cystadenocarcinoma.However,the exact etiopathogenesis of ACA is still not clear.

Eruption of impacted permanent teeth associated with cystic lesions of the jaws after fenestrating decom-pression in adolescents / 实用口腔医学杂志

Objective:To investigate the eruption of cystic lesion associated impacted permanent teeth(CAIPT)of the jaws after fe-nestrating decompression in adolescents and to analyze the related factors that affect the eruption of CAIPT.Methods:32 cases of CAIPT were examined restrospectively by panoramic radiographs.The subjects were divided into erupted group(n =22),and nonerupt-ed group(n =10).Patient age,angulation of the CAIPT,the cusp depth,eruption space and the level of dental root formation meas-ured on intial panoramic radiograph,were subjected to statistical analysis.Results:The eruption of the impacted mandibular molar was significantly related to the cusp depth,level of dental root formation and the patient's age(P 0.05).Conclusion:The patient's age,angulation of impacted permanent teeth,cusp depth,eruption space,level of dental root formation should be considered in the management of CAIPT.

Application of contrast enhanced ultrasound in the diagnosis of pancreatic cystic lesions:comparison with MRI and pathology / 中华超声影像学杂志

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.

A Case of an Isolated Abscess in an Extraocular Muscle

PURPOSE: To report the case of an isolated abscess in an extraocular muscle. CASE SUMMARY: We report a case of an isolated abscess in an extraocular muscle in a patient who was treated with systemic chemotherapy for precursor B lymphoblastic leukemia. A 54-year-old female who had undergone systemic chemotherapy for precursor B lymphoblastic leukemia presented with right ocular pain and limited eye movements. On ophthalmic examination, she had elevated intraocular pressure (IOP) and limited upward and downward gaze. MRI (magnetic resonance imaging) examination revealed an isolated abscess in right inferior rectus muscle. Although the patient was treated with empirical intravenous antibiotics and IOP-lowering agents, the size of the abscess increased, as confirmed by MRI findings. Therefore, we performed a pus drainage procedure by the transconjunctival approach. We were not able to find any residual abscess lesions on CT scans 3 months postoperatively. The patient's ocular pain disappeared and the limited eye movements improved significantly 6 months postoperatively. CONCLUSIONS: There have been no case reports of an isolated abscess in an extraocular muscle in Korea. For immunocompromised patients unresponsive to systemic empirical antibiotic treatment, an early pus drainage procedure by the transconjunctival approach may be a useful and effective therapeutic method in the management of an idiopathic isolated abscess in an extraocular muscle.

Management of Aggressive Form of Cherubism.

Cherubism is a rare non-neoplastic hereditary disease related to genetic mutations characterized by symmetrically swollen cheeks, particularly over the angles of the mandible, and an upward turning of the eyes. The affected mandible and maxilla begin to swell in early childhood, and are gradually increased until the age of puberty. Apparently, surgical intervention is unnecessary unless significant functional, esthetic, or emotional disturbances develop. The purpose of the present paper is to report a case of cherubism in which all the classic features of the ailment were seen to a degree exceeding even that of the grade 3 classification.

Large, Multilocular Cystic Mass in the Uterine Cervix Mimicking Adenoma Malignum / 대한폐경학회지

Multilocular cystic lesions in the uterine cervix can vary widely from benign to malignant. Pseudoneoplastic glandular lesions are benign lesions that are often histologically and radiographically confused with adenoma malignum, which is a rare variant of mucinous adenocarcinoma of the uterine cervix. The benign lesions include uterine cervicitis, tunnel cluster, deep endocervical glands, deep nabothian cysts, endocervical hyperplasia, infectious and reactive atypias. It is crucial but difficult to differentiate between an adenoma malignum and the benign cystic lesions. We report two cases of large nabothian cysts mimicking adenoma malignum. Radiologic findings, signs, and symptoms of these cases are described.

Giant Epidermoid Cyst of the Thigh

Epidermoid cyst is a common benign cutaneous swelling frequently encountered in surgical practice. It usually presents as a painless lump frequently occurring in hairbearing areas of the body particularly the scalp, scrotum, neck, shoulder and back. Giant epidermoid cysts commonly occur in hairy areas such as the scalp. We present here the case of a rare occurrence of a giant epidermoid cyst in the less hairy area of the right upper thigh mimicking a soft tissue sarcoma. Steps are highlighted for the management of this unusual cyst.

Ultrasound findings of benign intratesticular cystic lesions.

Ultrasonography (US) is usually the initial modality to evaluate pathological conditions of testes including benign intratesticular cysts. US allows characterization of intratesticular cysts and differentiation from a solid mass. A simple intratesticular cyst is usually not palpable in contrast to a peripherally located cyst of tunica albuginea. An epidermoid cyst has a classic onion-ring appearance. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. Color doppler US is helpful to diagnose intratesticular varicocele and intratesticular abscesses.

Pancreatic cystic lesion-Surgery or follow-up evaluation / 대한내과학회지

The decision of surgical treatment for pancreatic cystic lesions may mainly depend on the malignant potential of each lesion. Surgical excision is the most optimal treatment for the mucinous cystic neoplasm due to its high malignant potential. On the other hand, intraductal papillary mucinous neoplasm (IPMN) is divided into main duct type and branch-duct type. Main duct IPMN has high risk of malignant transformation. Therefore, surgical resection has been recommended for all main duct IPMN. Branch duct IPMN has relatively low malignant potential, and usually shows slow progression. A branch duct IPMN that is asymptomatic, less than 3 cm in size and without mural nodules may be followed-up without resection. Serous cystic neoplasm is usually benign in nature. Surgical treatment for serous cystic neoplasm should be considered when definitive diagnosis being uncertain, larger than 4 cm in size, or presence of symptoms. Solid pseudopapillary neoplasm also has low malignant potential which needs surgical excision. Surgical treatment for pancreatic pseudocyst is considered in limited cases with complication, such as infection or bleeding, and which is not controlled with non-surgical treatment. Management strategy for pancreatic cystic lesions should be individualized, and the decision to resect or follow-up a lesion should be based on factors such as the presence or absence of symptoms, patient age, cyst size, grading of malignant potential, location of the lesion, and the surgical risk of the patient.

Incidental Intraductal Papillary Mucinous Neoplasms(IPMN) of the Pancreas after Liver Transplantation

PURPOSE: The incidence and risk of malignancy are elevated in solid organ transplant recipients compared to persons in the general population. Epidemiological data reveal that the length of exposure to immunosuppressive therapy and the intensity of therapy are clearly related to the post-transplant risk of malignancy. The purpose of this study was to investigate the course of incidental intraductal papillary mucinous neoplasms (IPMN) of the pancreas after liver transplantation. METHODS: We retrospectively reviewed the medical records of 17 patients with IPMNs of the pancreas who underwent liver transplantation between January 2000 and December 2006. The mean follow-up duration was 29.6 +/- 22.8 months. RESULTS: The mean patient age was 55.2 +/- 7.2 years, and the male to female ratio was 14:3. All patients had branch duct type IPMNs. The lesions were located principally in the head (64.7%) and body (52.9%) of the pancreas. The mean tumor size was 13.0 +/- 6.2 mm. There were no newly developed symptoms associated with these lesions, and none of the lesions enlarged during the follow-up period. No patients underwent surgical resection of their lesions. CONCLUSION: The course of each of the incidental small IPMNs of the pancreas was uneventful for more than 2 years after liver transplantation. Therefore, patients with incidental small IPMNs of the pancreas are not immediate candidates for surgical pancreas resection. However, a longterm follow-up study with a larger sample size will be required to establish treatment guidelines in immunosuppressed patients.

A Case of Systemic Sclerosis Complicated with Multifocal Osteoarticular Tuberculosis / 대한류마티스학회지

Multifocal skeletal tuberculosis is defined as osteoarticular lesions that occur simultaneously at two or more locations. Cystic lesions of multiple bones in tuberculosis are encountered less frequently in adults than in children. The multifocal cystic skeletal tuberculosis involving hands and feet is rare, particularly. We report a case of systemic sclerosis that was treated with glucocorticoid and antirheumatic drug for many years and complicated with multifocal cystic skeletal tuberculosis. This case was misled to the diagnosis of staphylococcal pyogenic abscess by the first microbial culture of the draining pus. The sonographic finding suggested rather metastatic bone lesion or systemic inflammatory arthritis such as rheumatoid arthritis. Although it is rare, tuberculosis should be included in the differential diagnosis of multiple cystic systemic skeletal lesions in immunocompromised patients.