Calcified cerebral toxoplasmosis associated with recurrent perilesional edema causing neurological manifestations in an HIV-infected individual: case report with a decade-long follow-up

ABSTRACT Four cases of people living with HIV/AIDS (PLWHA) with calcified cerebral toxoplasmosis associated with perilesional edema causing a single episode of neurological manifestations have recently been reported. Here, we describe the first detailed description of perilesional edema associated with calcified cerebral toxoplasmosis causing three episodes of neurological manifestations in a PLWHA, including seizures in two of them. These recurrences occurred over approximately a decade. Throughout this period, the patient showed immunological and virological control of the HIV infection, while using antiretroviral therapy regularly. This case broadens the spectrum of an emerging presentation of calcified cerebral toxoplasmosis, mimicking a well-described finding of neurocysticercosis in immunocompetent hosts.

Clinical Implication of Intraoperative Sonography in Localized Excision Biopsy for Mammographic Microcalcifications

PURPOSE: Ultrasonography plays a supplementary role in detecting breast microcalcifications as localizing these microcalcifications without mammographic aid is not always successful. This study aimed to evaluate the clinical implications of intraoperative sonography (IOUSG) in localized excisions after mammographically guided wire insertion. METHODS: Between May 2011 and December 2017, 90 localized excisional biopsies were included. All excisions were preceded by mammographically guided wire insertion. We divided them into two groups according to the use of IOUSG and compared the surgical outcomes between the two groups. RESULTS: Of the 90 localized excisions analyzed, IOUSG was performed in 40 (the USG group) localized excisions and not in the remaining 50 (the no USG group) localized excisions. The median cluster size of the target microcalcifications and the median specimen volume were smaller in the USG group than that in the no USG group (1.4 cm vs. 2.0 cm, p=0.02; 10.9 cm3 vs. 30.3 cm3, p<0.001, respectively). Additional excisions due to the incomplete coverage of the target microcalcifications on the specimen mammography were more frequent in the no USG group than in the USG group (30% vs. 15%, respectively, p<0.001). In the multivariate analyses, performing an IOUSG was the only significant risk factor, reducing the need for additional excision after adjusting the other risk factors (adjusted hazard ratio, 0.203; 95% confidence interval, 0.078–0.529). Performing an IOUSG significantly reduced the specimen volume excised after adjusting the cluster size of the microcalcifications. CONCLUSION: IOUSG could be helpful in improving the accuracy of surgical excision for breast microcalcifications localized with mammographically guided wire insertion.

Calcinosis cutis idiopática universal / Calcinosis cutis idiopathic universal

La calcinosis cutis es un trastorno raro causado por el depósito anormal de sales de calcio en la piel y tejido subcutáneo. Clínicamente se caracteriza por pápulas, placas o nódulos calcificados. Según su etiopatogenia se distinguen cinco tipos clínicos: distrófica, metastásica, iatrogénica, idiopática y calcifilaxis.Comunicamos el caso clínico de un paciente en edad pediátrica con una calcinosis cutis idiopática universal, sin afectación extra-cutánea. Esta publicación reviste importancia debido a lo infrecuente de esta enfermedad y a que su diagnóstico nos permite detectar padecimientos asociados, que son determinantes para el pronóstico y tratamiento.

Cutaneous calcinosis is a rare disorder caused by the deposit of abnormal calcium salts in the skin and subcutaneous tissue. Itpresents with calcified papules, plaques or nodules. Five clinical types are distinguished: dystrophic, metastatic, iatrogenic, idiopathic and calcifilaxis. This paper reports a pediatric patient with aidiopathic calcinosis cutisuniversalis, without extracutaneous manifestations. This publication is important because of the rarity of this disease. The diagnosis allows us to investigate the possible associated diseases that determine patient prognosis and treatment.

A Case of Angiocentric Glioma with Unusual Clinical and Radiological Features

Angiocentric glioma was recently recognized as a distinct clinicopathological entity in the 2007 World Health Organization classification of tumors of the central nervous system. Typically, it presents with seizure in children and young adults. However, our patient did not have a history of seizure. Seizure did not occur up to 6 months after operation. Although it usually does not have calcification brain magnetic resonance imaging in our patient showed T1-hyperintense and T2-hypointense signals with calcification.

Odontogenic keratocyst with dystrophic calcifications in the maxilla / 대한구강악안면방사선학회지

Odontogenic keratocyst (OKC) with secondary inflammation involving the maxillary sinus was presented. Radiological diagnosis of this case was made based on the various findings from the cone-beam computed tomography, computed tomography and magnetic resonance images. There were calcified materials and impacted tooth within the lumen of the lesion, which is not uncommon in OKC. Histopathologic findings confirmed this lesion as OKC with secondary inflammation.

Mandibular Enlargement, Metastatic Pulmonary Calcification and Gastric Mucosal Calcinosis in a Patient with Chronic Kidney Disease-mineral Bone Disorder / 대한신장학회지

Secondary hyperparathyroidism is one of the most common complications of patients with chronic kidney disease (CKD). Mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis are rare complications in these patients. The defect of calcium and phosphorus metabolism may precipitate pathologic calcification at diverse organs and soft tissue, and change bone architecture. In case of involving periarticular area, patients usually present with localized swelling, pain, and reduced mobility in affected sites. However, in case of organ involvement, except in an advanced stage of disease, there are no specific symptoms. Among these patients, treatment strategies include tight control of calcium and phosphate levels, parathyroidectomy for hyperparathyroidism, renal transplantation, and local excision of calcific lesions. We report a case of mandibular enlargement, metastatic pulmonary calcification, and gastric mucosal calcinosis due to CKD with improvement 3 months after medical and surgical treatment.

Coronary Artery Calcification Measured by Multi-Detector Computed Tomography in Systemic Sclerosis / 대한류마티스학회지

OBJECTIVE: There is some controversy regarding the early onset or high incidence of coronary atherosclerosis in patients with systemic sclerosis (SSc). Measurements of the coronary calcification score (CCS) by multi-detector computed tomography (MDCT) is an accurate and non-invasive method for detecting coronary atherosclerosis, and a high level of CCS (> or =160) can predict coronary events. This study examined the CCS using MDCT and evaluated the risk of coronary events in patients with SSc. METHODS: The clinical and laboratory characteristics of 35 patients with SSc were examined. The CCS was measured by MDCT, and the risk of coronary events were evaluated by CCS and the Framingham risk score (FRS). RESULTS: In 35 patients (2 males and 33 females, 20 with limited and 15 with diffuse type), the mean age was 52+/-12 years and the disease duration was 8+/-7 years. The mean CCS was 10.1+/-30.8, the CCS of 28 patients (80%) was 0, and all patients had a CCS<160. The CCS had no significant correlation with the clinical and laboratory characteristics. The FRS was evaluated in 29 patients. Twenty eight patients were categorized into the low-risk group (FRS<10%) and only one was classified into the moderate-risk group (FRS=13%). CONCLUSION: These results suggest that the risk of coronary events due to coronary atherosclerosis might not be high in patients with SSc.

Distribution of Coronary Artery Calcification in an Asymptomatic Korean Population: Association with Risk Factors of Cardiovascular Disease and Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Coronary artery calcification (CAC) has been used as surrogate marker for coronary atherosclerosis. We developed a set of age-and gender-stratified CAC distribution and risk factors for CAC in a population of asymptomatic Korean subjects. SUBJECTS AND METHODS: Between 2003 and 2007, 3,961 asymptomatic subjects without a history of ischemic heart disease (male 64%, mean age 56+/-10 years) were screened for CAC by the use of multi-detector computed tomography. RESULTS: The total CAC score was assigned to a percentile according to age and gender. The prevalence of CAC and mean CAC score increased with age [p or =90 cm in males; > or =80 cm in females) was 1.445 (95% CI 1.222-1.709). CONCLUSION: This study reports the distribution of CAC score by age and gender. It will serve as a reference standard for the clinical interpretation of CAC results in the asymptomatic Korean population.

A Case Of Adrenal Ganglioneuroma Secreting Catecholamines / 대한내과학회지

Ganglioneuromas is a rare benign neoplasm that originates from the sympathetic ganglia and the adrenal medulla. It belongs to the group of neurogenic tumors, which also include ganglioneuroblastoma and neuroblastoma. Most of them are asymptomatic and diagnosed by chance, rarely because of their hormonal activity or metaiodobenzylguanidine (MIBG) uptake. We here report a case of adrenal ganglioneuroma secreting catecholamine. A 22-year old male presented with incidentally detected calcifications in the left upper quadrant of the abdomen. Abdominal CT and MRI revealed an about 8-cm adrenal mass with eggshell and punctuate calcifications. Increased urinary catecholamine metabolites and MIBG uptake in the tumor leaded to the preoperative diagnosis of adrenal pheochromocytoma. His blood pressure was normal and the typical symptoms of catecholamine excess were not observed during the admission period. Surgical resection and histologic examination of the tumor confirmed the diagnosis of ganglioneuroma originating from the left adrenal gland. Characteristic radiologic and histologic findings are presented with review of the literature.

Dystrophic Endocardial Calcification Associated with Prior Myocardial Infarction

Myocardial calcification is usually classified as either dystrophic or metastatic. Dystrophic calcification is more common and usually occurs in the area of prior myocardial infarction. It is found in 8% of patients who have been survived longer than 6 years after myocardial infarction. The most common site of calcification is in the anterior wall of the left ventricle or apical and anterolateral aspect in the aneurysm of the left ventricle. We report the case of a 50-years old man with a typical dystrophic calcification of the endocardium in area of myocardial necrosis.

A Case Report of Tumoral Calcinosis / 대한정형외과학회잡지

Tumoral calcinosis was coined by Inclan in 1943 and thereafter about 40 cases have been reported in the literature, but there has not been reported on a case which involved knee joints. The majority of cases hitherto reported were found in Negro. There was no report in yellow race. Authors presented a case of tumoral calcinosis that involved boih knee joints of a 55 years old Korean housewife. On physical examination chronic draining sinuses with spontaneous extrusion of calcific material was noted on the left infrapatellar region. A radiograph of the both knees showed dense, multinodular deposits of calcium. The masses were confined to the soft tissues; the contiguous joint showed no pathological change. En-block excisianal biopsy was done. The histological section of the excised mass disclosed the foreign-body giant cell with inflamed connective tissue surrounding calcific deposits.