Olfactory Neuroblastoma Is Not Always Located at the Roof of the Nasal Cavity.

Objectives: To evaluate the imaging characteristics of the tumor, emphasizing its location, and to determine the frequency of typical and atypical locations of olfactory neuroblastoma (ONB). Materials and Methods: We retrospectively reviewed the computed tomography and magnetic resonance imaging findings of patients with pathologically proven ONB between April 2000 and April 2023. Demographic information, chief complaints, tumor location, and tumor extension were extracted. Results: Of the 58 patients, 50 (86.2%) had the epicenter of the mass at the superior part of the nasal cavity, while eight patients (13.8%) had the epicenter at other atypical locations: seven patients (12.1%) at the middle part of the nasal cavity and one patient (1.7%) within both sphenoid sinuses. Conclusion: ONB is not always present in the upper part or the roof of the nasal cavity, and a significant number of ONBs are occasionally found in the rest of the nasal cavity and other atypical locations.

Susceptibility-weighted imaging is helpful in diagnosis of cerebral gnathostomiasis.

PURPOSE: To describe the role of SWI compared with other MR imaging sequences and CT in diagnosis of cerebral gnathostomiasis. MATERIALS AND METHODS: CTs and MRIs of patients with cerebral gnathostomiasis were retrospectively reviewed. The types of intracranial hemorrhage, including intraparenchymal hemorrhage (IPH), subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), and their locations were recorded. RESULTS: Four patients proven as cerebral gnathostomiasis were included. Intracranial hemorrhage was detected in all patients. There was IPH in all patients, SAH in 2 patients, and SDH in 2 patients. All patients (4/4) revealed hemorrhagic tracts which were very conspicuously seen on SWI. Other imaging sequences could also reveal hemorrhagic tracts in 3 patients (3/4) but are less conspicuously seen than SWI. None of the CT brains could detect hemorrhagic tracts. CONCLUSIONS: Intracranial hemorrhage associated with hemorrhagic tract, best demonstrated by SWI, is the key imaging characteristic in diagnosis of cerebral gnathostomiasis.

Prevertebral fat in Madelung disease mimicking cervical spine injury: A case report.

Madelung disease is defined by multiple symmetric fatty accumulations, usually involving the upper trunk, and may sometimes have excessive fat deposition in the prevertebral space. On magnetic resonance imaging (MRI), findings of fat that are hyperintense on T1w and T2w images, may simulate subacute hematoma and mimic cervical spine injury. This is the first reported case of Madelung disease with prevertebral fat deposition mimicking prevertebral hematoma found in cervical spine injury on MRI. Fat suppression techniques are helpful in order to differentiate between these two conditions, which should be taken into consideration during routine clinical practice.

Tumor volume as a prognostic factor on the median survival in locally advanced oral cancer treated with definitive chemoradiotherapy.

BACKGROUND: Surgery has been the mainstay treatment for oral cancer. Those patients, who do not receive surgery are generally treated with concurrent chemoradiotherapy (CCRT). Many factors play a role in patients' survival; tumor volume might be one of those factors. This study aims to determine the effect of the pretreatment tumor volume on the survival of oral cancer. METHODS: Retrospective study of patients with histological confirmed squamous cell carcinoma, stage III-IV oral cancer, who received definitive CCRT. Tumor volume from pretreatment computed tomography (CT) scans were reviewed and analyzed. The optimal cut-off tumor volume was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: From 67 patients, half of the primary tumor sites were oral tongue. The median total tumor volume (TTV) was 73.25 cm3, while the median survival was 12.5 months (95% CI 10.9-20.3). The optimal cut-off TTV =52.9 cm3 (P < 0.0001). The median survival of the patients, who had tumor volume <52.9 cm3 were 34.4 months, and for tumor volume =52.9 cm3 were 8.6 months (P < 0.0001). Multivariate analysis showed that TTV =52.9 cm3, and intensity-modulated radiotherapy (IMRT) or volumetric modulated arc (VMAT) technique had significantly influenced on the overall survival. CONCLUSIONS: TTV had an influence on the overall survival of locally advanced oral cancer. In addition, TTV may be considered as a factor in selecting the appropriate treatment option for these patients.

White matter: A good reference for the signal intensity evaluation in magnetic resonance imaging for the diagnosis of uveal melanoma.

BACKGROUND: Comparing the signal intensity (SI) of an ocular mass to that of the vitreous body has been suggested. Most ocular lesions show a hyper-intense signal compared to the vitreous body on T1-weighted (T1w) images, and malignant melanomas have been almost always determined as 'cannot be excluded' in reports. PURPOSE: This study aimed to determine the accuracy of magnetic resonance imaging (MRI) in the diagnosis of uveal melanoma by using normal white matter as reference tissue for SI evaluation on T1w images and vitreous body on T2w compared to the conventional method using the vitreous body as a reference on both T1w and T2w images. METHODS: The MRIs of 43 patients (between August 2006 and July 2018) sent to rule out uveal melanoma were blindly reviewed by two radiologists. By using white matter as a reference for SI evaluation on T1w images and vitreous body as a reference on T2w images, uveal melanomas were suggested by hyper-intense signal on T1w and hypo-intense signal on T2w with homogeneous enhancement. The accuracy of diagnosis of uveal melanoma using white matter as a reference on T1w was compared to the conventional method using the vitreous body as a reference on both T1w and T2w images. RESULTS: The diagnosis of uveal melanoma using white matter as a reference gave a sensitivity of 92.31% (95% confidence interval (CI) 63.97-99.81) and specificity of 100.0% (95% CI 88.43-100.0). By using the vitreous body as a reference, sensitivity as high as 100.0% (95% CI 100.0-100.0) was obtained, but specificity was low at 53.33% (95% CI 34.33-71.66). CONCLUSIONS: White matter is a good reference for the diagnosis of uveal melanoma, with high sensitivity and much higher specificity than conventional methods using the vitreous body as a reference.

Correlation between Serum Squamous Cell Carcinoma Antigen Level and Tumor Volume in Head and Neck Cancer.

PURPOSE OF STUDY: An association of squamous cell carcinoma antigen (SCC-Ag) level with cancer prognosis has been reported in many studies. Our investigators conducted the first study determining a correlation between the SCC-Ag level and the tumor volume in head and neck cancer. PROCEDURES: The SCC-Ag level of patients were measured from the serum, whilst the tumor volume was calculated by the ellipsoid formula and verified by logistic software on radiology. The correlation between SCC-Ag level and tumor volume was analyzed. RESULTS: Fifty-two patients were studied, with the mean age of 62.4 years. Tumor types were: oral cavity cancer (11 cases, 21.6%), oropharyngeal cancer (21 cases, 40.38%), hypopharyngeal cancer (8 cases, 15.7%), and laryngeal cancer (12 cases, 23.5%). Mean tumor volume was 20.01 mL (range 0.02-91.46 mL). Mean SCC-Ag level was 2.69 ng/mL (range 0.5-14.6 ng/mL). The critical point of SCC-Ag was 5.8 ng/mL. The Pearson's correlation coefficient between SCC-Ag level and tumor volume was 0.524 (p = 0.0002). CONCLUSIONS: SCC-Ag moderately correlates with tumor volume in head and neck cancer patients, with statistical significance. We suggest that using tumor volume, rather than a one-dimensional measurement such as tumor size, to analyze correlation with SCC-Ag offers a more accurate means of cancer prognosis.

Development and validation of a breast cancer risk prediction model for Thai women: a cross-sectional study.

BACKGROUND: Breast cancer risk prediction models are widely used in clinical practice. They should be useful in identifying high risk women for screening in limited-resource countries. However, previous models showed poor performance in derived and validated settings. Therefore, we aimed to develop and validate a breast cancer risk prediction model for Thai women. MATERIALS AND METHODS: This cross-sectional study consisted of derived and validation phases. Data collected at Ramathibodi and other two hospitals were used for deriving and externally validating models, respectively. Multiple logistic regression was applied to construct the model. Calibration and discrimination performances were assessed using the observed/expected ratio and concordance statistic (C-statistic), respectively. A bootstrap with 200 repetitions was applied for internal validation. RESULTS: Age, menopausal status, body mass index, and use of oral contraceptives were significantly associated with breast cancer and were included in the model. Observed/expected ratio and C-statistic were 1.00 (95% CI: 0.82, 1.21) and 0.651 (95% CI: 0.595, 0.707), respectively. Internal validation showed good performance with a bias of 0.010 (95% CI: 0.002, 0.018) and C-statistic of 0.646(95% CI: 0.642, 0.650). The observed/expected ratio and C-statistic from external validation were 0.97 (95% CI: 0.68, 1.35) and 0.609 (95% CI: 0.511, 0.706), respectively. Risk scores were created and was stratified as low (0-0.86), low-intermediate (0.87-1.14), intermediate-high (1.15-1.52), and high-risk (1.53-3.40) groups. CONCLUSIONS: A Thai breast cancer risk prediction model was created with good calibration and fair discrimination performance. Risk stratification should aid to prioritize high risk women to receive an organized breast cancer screening program in Thailand and other limited-resource countries.

Gradenigo's syndrome secondary to chronic otitis media on a background of previous radical mastoidectomy: a case report.

INTRODUCTION: Gradenigo's syndrome is nowadays a rare condition characterized by a triad of otorrhea, facial pain with trigeminal nerve involvement and abducens nerve palsy. Most cases are caused by medial extension of acute otitis media into a pneumatized petrous apex and surgical drainage is usually the treatment of choice. We present a case highlighting the pathological mechanism of this disease, demonstrate rare radiological findings associated with this patient, and showcase successful medical treatment without surgical intervention. CASE PRESENTATION: A 63-year-old Thai man presented with complete Gradenigo triad as a complication of chronic otomastoiditis in spite of clinical history of previous radical mastoidectomy and a nonpneumatization of the petrous apex. Magnetic resonance imaging showed abnormal prominent enhancement at the roof of his right temporal bone, and the dura overlying the floor of right middle cranial fossa and right cavernous sinus. Magnetic resonance imaging also detected right petrous apicitis. With the use of intravenous antibiotics and topical antibiotic eardrops, recovery was observed within 5 days with complete resolution within 2 months. CONCLUSIONS: Although there is little evidence to support the use of medical therapy in the treatment of Gradenigo's syndrome resulting from chronic ear disease, we here demonstrate successful conservative treatment of Gradenigo's syndrome following chronic otitis media in a patient who underwent previous radical mastoidectomy.

Risk factors of breast cancer: a systematic review and meta-analysis.

The etiology of breast cancer might be explained by 2 mechanisms, namely, differentiation and proliferation of breast epithelial cells mediated by hormonal factors. We performed a systematic review and meta-analysis to update effects of risk factors for both mechanisms. MEDLINE and EMBASE were searched up to January 2011. Studies that assessed association between oral contraceptives (OC), hormonal replacement therapy (HRT), diabetes mellitus (DM), or breastfeeding and breast cancer were eligible. Relative risks with their confidence intervals (CIs) were extracted. A random-effects method was applied for pooling the effect size. The pooled odds ratios of OC, HRT, and DM were 1.10 (95% CI = 1.03-1.18), 1.23 (95% CI = 1.21-1.25), and 1.14 (95% CI = 1.09-1.19), respectively, whereas the pooled odds ratio of ever-breastfeeding was 0.72 (95% CI = 0.58-0.89). Our study suggests that OC, HRT, and DM might increase risks, whereas breastfeeding might lower risks of breast cancer.

Retrograde cavernous sinus thrombosis and orbital cellulitis secondary to meningitis in immunocompetence child.

A case of cavernous sinus thrombosis is usually a complication of severe orbital cellulitis and meningitis. The authors reported a retrograde cavernous sinus thrombosis and orbital cellulitis in an immunocompetence child, due to meningitis.

Isolated orbital neurofibroma in NF-1 negative patients.

Isolated orbital neurofibroma unassociated with systemic neurofibromatosis is relatively rare and may be difficult to clinically differentiate from other orbital tumors. The authors report a case of isolated orbital neurofibroma without neurofibromatosis type 1.

Case reports of neuro-Chikungunya in southern Thailand.

There has been a recent increase in reports of neurologic complications as major causes of morbidity and mortality in chikungunya virus infection. As a part of 2004-2009 global outbreaks, an unprecedented large chikungunya epidemic occurred in Southern Thailand during 2008-2009 in which 49,069 cases were reported. During this period, we encountered two patients with meningoencephalitis and another patient with myeloneuropathy among 1,018 cases diagnosed as chikungunya in our hospital. The clinical pictures are presented and the key points are used to recognize and differentiate chikungunya from Japanese encephalitis virus, dengue virus, and herpesvirus infections, which are more common causes of meningoencephalitis and myelitis in this region.

Bilateral septic cavernous sinus thrombosis following the masticator and parapharyngeal space infection from the odontogenic origin: a case report.

Neglect of odontogenic infections can have serious consequences. If they spread through fascial planes and intracranially they can cause an abscess, orbital cellulitis, and eventually cavernous sinus thrombosis. The authors report a case of rapid progressive bilateral orbital cellulitis and cavernous sinus thrombosis that originated from dental caries. Septic cavernous sinus thrombosis is a medical emergency. Early recognition and prompt treatments direct to the underlying sources of infection are crucial. Broad-spectrum intravenous antibiotics are the mainstay of treatment to reduce morbidity and mortality from this lethal condition. Management should be based on early diagnosis and prompt management with intravenous broad-spectrum antibiotics and surgical intervention.

Three years experience of suprasellar tumors in neuro-ophthalmology clinic.

OBJECTIVE: To examine pre-treatment ophthalmic presentations and treatment results and to identify factors that may influence improved visual outcomes in patients with suprasellar tumor MATERIAL AND METHOD: The medical records of patients with suprasellar tumors who were diagnosed between July 2005 and June 2008 in the neuro-ophthalmology clinic of Songklanagarind Hospital were retrospectively reviewed by two ophthalmologists. Pre-treatment ophthalmic presentations and treatment results were analyzed. Determinants of improved visual outcomes were identified by using univariate and multivariate regression analysis. RESULTS: Of 40 patients, 55% were male and 45% were female, with a median age of 38 years. The most common pre-treatment ophthalmic presentations were blurred vision (92.5%), headache (10%) and eye pain (5%). The most common tumor was pituitary adenoma (macroadenoma and prolactinoma). Visual improvement was achieved in pituitary adenoma in 20 of 25 eyes (80%), meningioma in 8 of 12 eyes (67%) and other tumors in 2 of 5 eyes (40%). No determinants related to better visual outcomes were found. CONCLUSION: The most common presentation of suprasellar tumor was blurred vision. There were no pre-treatment factors that related to visual outcomes in the present study.

A variety of atypical manifestations in giant cell arteritis.

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of large and medium size vessels in the elderly. A new-onset headache is the most frequent symptom. An anterior ischemic optic neuropathy (AION) is one of the most common causes of permanent visual loss. There are four cases with unusual presentation of giant cell arteritis, scalp abscess, prolonged transient monocular visual loss (TMVL), bilateral central retinal artery occlusion (CRAO), and chronic ear pain. All patients had pathologically proven giant cell arteritis, and three of them progressed to blindness in the end. Scalp abscess is a rare sign in GCA. Delay in diagnosis because confusion of the abscess after scalp ischemia with other cutaneous lesions may result in death. TMVL is the forewarning symptom of AION or CRAO in GCA. Early recognition of TMVL is important to make early diagnosis of GCA to prevent blindness. Spontaneous ear pain is extremely rare, and reports have documented delay in diagnosis of GCA resulting in irreversible blindness.

When should MRI be recommended for the accurate clinical staging of base of tongue carcinoma?

BACKGROUND AND PURPOSE: According to the American Joint Committee on Cancer (AJCC) cancer staging criteria (6th edition), cross-sectional imaging for base of tongue carcinoma is recommended when the deep tissue extent of a primary tumor is in question. The aim of this study was to establish which group of patients MRI might most benefit from accurate clinical staging of base of tongue carcinomas. PATIENTS AND METHODS: The clinical stagings of 33 patients with pathologically proven squamous cell carcinomas of the base of tongue were performed by two otorhinolaryngologic surgeons. Their results were compared with the results from MRI interpreted by a neuroradiologist and the numbers of patients being upstaged, downstaged or with an unchanged stage were recorded and analyzed. RESULTS: The tumor stages were changed in 13 of 33 patients (39.4%, 95% CI: 23.9-57.87%) and the overall stage groupings were changed in 10 (30.3 %, 95%CI: 15.6-48.7%) after performing MRI. Mis-staging by clinical examination in the overall stage grouping was as high as 83.3% (95%CI: 35.9-99.6%) in stages II and III and 85.7% (95% CI: 42.1-99.6%) in T3. CONCLUSION: MRI should be recommended in base of tongue carcinoma whenever clinical examination suggests overall stage groupings II, III or tumor stage T3.

Accuracy of the mammographic report category according to BIRADS.

OBJECTIVE: To determine the accuracy and predictive value of the mammographic report according to the BIRADS categories in Songklanagarind University Hospital. MATERIAL AND METHOD: Mammograms of 1000 women who came to Songklanagarind University Hospital from June 1998 to September 1999 were reported and placed in category 1 for negative results, category 2 for benign lesions, category 3 for probably benign lesions, category 4 for suspicious lesions and category 5 for highly suspicious lesions. Accuracy was determined by either histology or by unchanged follow-up mammography within 24 months. RESULTS: The total accuracy was 97.8%, sensitivity 62.5% and specificity 98.1%.

Meningioma of the internal auditory canal: a case report.

Meningioma of the internal auditory canal is very rare. There are only 15 previous reports of intracanalicular meningioma. The authors add a case report of a patient with meningioma of the internal auditory canal. A 31-year-old woman presented with a one-year history of headache, dizziness, hearing loss and left facial paralysis. An MRI of the temporal bone demonstrated a tiny isointense intracanalicular tumor with inhomogeneous enhancement. In the operative field carried out by translabyrinthine approach, the tumor was found in the IAC without intracranial involvement. Pathology revealed a meningioma. The patient was followed up for 2 years without recurrence.

ICP threshold in CPP management of severe head injury patients.

BACKGROUND: Elevated intracranial pressure (ICP) is significantly associated with high mortality rate in severe head injury (SHI) patients. However, there is no absolute agreement regarding the level at which ICP must be treated. The objective of this study was to compare the outcomes of severe head injury patients treated by setting the ICP threshold at >or=20 mm Hg or >or=25 mm Hg. METHODS: Treatment protocol in this study consisted of therapeutic maneuvers designed to maximize cerebral profusion pressure (CPP) and control ICP. Twenty-seven patients with severe head injury and intracranial hypertension (ICP >or=20 mm Hg) were enrolled and fourteen cases were allocated to the group of ICP threshold >or=25 mm Hg. Six-month clinical outcomes were evaluated using the Glasgow Outcome Score (GOS). RESULTS: There were no statistically significant differences in clinical parameters between the groups. Logistic regression identified the presence of basal cisterns on the initial computed tomography (CT) scan as a significant predictor of good outcome. ICP threshold did not influence outcome. CONCLUSIONS: This study supported a recommended ICP threshold of 20 to 25 mm Hg in SHI management. However, in cases with an absence of basal cisterns on initial CT scan, the probability of good outcome may be higher using an ICP threshold of >or=20 mm Hg.

Talked and deteriorated head injury patients: how many poor outcomes can be avoided?

The objective of this study was to assess the effectiveness of head injury management on the incidence and outcome of talked and deteriorated patients. Of 337 severe head injury patients admitted to Songklanagarind Hospital during 1994 to 1997, 30 were identified as 'talked and deteriorated'. Most deterioration was due to intracranial haematomas. The incidence (8.9%) and poor outcome (40%) were lower than those from a previous study in 1990 (incidence 15.8% and poor outcome 50%). The poor outcome in this group should not be more than 10%, which may be achieved by appropriate practice guidelines combined with a multidisciplinary team approach in caring for head injury patients, and the collaboration of hospitals within a regional trauma system.