ABSTRACT
An emaciated, adult, free-ranging roe deer (Capreolus capreolus) presenting a large mandibular mass, was shot by a game warden in Sissach, Switzerland. The head of the roe deer was submitted to the Center for Fish and Wildlife Health for examination. Grossly, the mass consisted of a 6 × 7 × 4 cm mandibular exophytic growth, associated with loss of incisors teeth. On cut section, a hard, light-tan core was rimmed by a thick layer of soft tissue. Computed tomography examination confirmed the mandibular origin of the mass. Histologically, the mass consisted of an unencapsulated fibro-osseous neoplasm. The bony portion was composed of multiple haphazardly arranged spicules rimmed by osteoblasts with no associated periosteal layer. Embedding the bony spicules were short anastomosing and branching streams and bundles of spindled cells. The overlaying partially ulcerated mucosa, showed prominent rete ridges deepening into the submucosa. In addition to the mandibular mass, multiple soft cauliflower-like proliferations were expanding from the gingival surface. Histologically, these masses were arranged in papillary elements composed of pluristratified squamous epithelium with long rete ridges extending into a rich underlying fibrovascular supportive stroma. Neither papillomaviral DNA nor antigen could be identified in association with the oral masses. The gross, histological and radiological features of the mandibular mass are consistent with an ossifying fibroma, while the cauliflower oral masses were diagnosed as papillomas.
ABSTRACT
OBJECTIVE: The purpose was to evaluate the presence of gas in the tissue adjacent to the laryngeal structures, "the gas bubble sign", in cases of hanging as a diagnostic indicator of neck trauma. METHODS: In this study, post-mortem CT (PMCT) scans and autopsies of 35 victims of hanging were examined to reveal age-dependent changes, laryngeal fracture, fracture location and the presence of gas. A matched group with cardiac arrest or intoxication was used as controls (n = 35). An autopsy was performed in each case. RESULTS: Incomplete suspension was the most common method in hanging. The thyroid horns (90.5%) were identified as the most vulnerable location for fractures. Laryngeal deformity and dislocation, which was only detected on PMCT, was observed in 57.1% and was concomitant with fractures in 83.3%. Laryngeal fractures are more common with advanced age (>40 years, 88.9%) and less common in younger subjects (<40 years, 29.4%). The gas bubble sign with regard to laryngeal fractures yielded a sensitivity of 79.2%, a positive predictive value of 95%, a specificity of 90.9%, a negative predictive value of 34.5% and an accuracy of 83%. CONCLUSION: The complex evaluation of the larynx is profoundly supported by PMCT and the detection of the gas bubble sign as a diagnostic indicator of neck trauma. This relevant diagnostic finding might aid in not only post-mortem cases but also clinical cases, for patients who survive an assault to the neck. Advances in knowledge: (1) The gas bubble sign is a diagnostic indicator of neck trauma in not putrefied bodies. (2) PMCT supports evaluation of trauma to the neck in hanging tremendously. (3) The diagnostic finding of gas located at the laryngeal structures may not only aid in post-mortem cases but also clinical cases of people who survive an assault to the neck.
