Juvenile Ossifying Fibroma - WHO Type

Juvenile ossifying fibroma is an uncommon clinical entity, its aggressive local behaviour and high recurrence rate mean that it is important to make an early diagnosis, apply the appropriate treatment and, especially, follow the patient up over the long term. In the current article we report a case of juvenile ossifying fibroma-WHO type in 12yr old patient which was clinical and histopathologically challenging as it was asymptomatic and at an unusual location.
Juvenile ossifying fibroma (JOF) term is used for a rare actively growing lesion that mainly affects individuals' younger than15 years of the age [1]. This lesion behaves in an aggressive fashion, reaching massive proportions with extensive cortical expansion. Over time, lesions with this morphology have been variously described as juvenile ossifying fibroma [2],active juvenile ossifying fibroma [3], aggressive ossifying fibroma [4], reticular desmo-osteoblastoma [5] or active fibrous dysplasia [6]. This lesion most commonly involves the paranasal sinuses and periorbital bones, where it may cause exopthalmous, proptosis, sinusitis and nasal symptoms. This rare tumor behaves in a more aggressive fashion than does ossifying fibroma, may be mistaken as low grade osteosarcoma, which may alter the treatment.

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Clinical Characteristics of Metastatic Gastric Tumors: A Report of 8 Cases in a Single Hospital

Metastatic gastric tumors (MGTs) mean the tumor cells that attack the stomach and grow there through blood vessel, lymph vessel, and other pathway, consistent with the primary tumor in phenotype, which are clinically uncommon, and information on MGTs is generally limited to single case reports. Here we present a clinical series of 8 cases with MGTs, in attention to discuss the clinical characteristics, diagnosis and treatment, and prognosis of MGTs. Our data showed that MGTs are rare, with a male predominance, and the cause of death was multiple organ metastases in most cases. Heterochromous MGTs showed a significantly better prognosis than simultaneous MGTs, and a long interval between initial radical excision of the primary tumor and appearance of gastric metastasis was found to be associated with good prognosis.

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Prostate Cancer - Double Vision but Solitary Lesion

A 53 year old man with a background of castrate-sensitive prostate cancer on intermittent androgen deprivation therapy (ADT) presented with right sixth nerve palsy secondary to a solitary right petroclival lesion involving adjacent dura and bone. The clinical and imaging characteristics of the lesion were consistent with a number of differential diagnoses (including metastatic prostate cancer, meningioma and chondrosarcoma). The patient initially declined biopsy and ADT was recommenced but the lesion continued to enlarge despite an excellent biochemical response. A subsequent biopsy of the petroclival mass demonstrated a WHO grade I meningioma and the patient proceeded to have definitive stereotactic radiotherapy. This case illustrates an unusual solitary skull base lesion in a man with prostate cancer. Whilst bony metastases, usually multiple, in the skeleton are common, solitary skull or brain lesions should be investigated as alternate diagnoses are likely in such circumstance.

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Feasibility Analysis of Autogenous Tooth-based Bone Graft Material after Guided Bone Regeneration Technique

Background: We set out to determine the possibility of radiographically evaluating the degree of marginal bone loss in humans after functional loading of implants at sites of guided bone regeneration (GBR) with autogenous tooth-based bone graft (ATBBG) material (AutoBT®, Korea Tooth Bank, Seoul, Korea).
Materials and Methods: Using ATBBG material, GBR procedures were performed on the extraction sockets with bone defects such as buccal dehiscence and 6 months of healing was allowed. Dental implants were installed and prosthetic procedures were done after another 6 months of healing. Marginal bone levels (MBLs) were radiographically measured following functional loading (mean duration, 10 months; range, 4–18 months) in 10 patients among 19 patients initially enrolled in this study (4 men and 6 women; age range, 39–65 years; mean age, 55.4 years) who maintained follow-up visits after entire surgical and prosthetic procedures.
Results: No significant MBL differences were noted immediately after GBR, implant placement and prosthesis delivery (F=0.245, P>0.05). Changes in the MBLs were not affected by gender.
Conclusion: The ATBBG material is viable for GBR and can yield a stable MBL even after functional loading of implants. The degree of marginal bone loss after loading with ATBBG is stable.

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Giant Mesenteric Cyst - Cause of Abdominal Distension Managed with Laparotomy-A Case Report

This case report describes the diagnosis and management of a large mesenteric cyst in a 55 year old lady who presented with abdominal distension & with mass in the left upper quadrant. Mesenteric cysts are rare, benign, abdominal tumors to which <1000 cases have been reported in the literature. While 40% of cases are incidental findings found either through physical examination or imaging, they can cause non-specific abdominal symptoms including pain, altered bowel habits, nausea/vomiting or anorexia. Less commonly, 10% of cases can present with bowel obstruction, volvulus, torsion or shock. In general, the lack of characteristic clinical and radiological features presents as a diagnostic difficulty.
The mainstay in imaging is computerized tomography (CT). CT identifies and helps aid the decision to pursue a laparoscopic or open laparotomy approach, where complete surgical resection is the ultimate goal. In our patient a CT Abdomen & Pelvis showed a large, loculated cystic mass measuring 30cm in cranio-caudal length and 16cm in the transverse and anterior/posterior diameter. While different approaches have been described in the literature to surgically resect such cysts, our approach was largely reflective of size and adherence to surrounding structures in this case. A laparotomy was performed using an upper mid-line 7 cm incision; 4500cc of fluid was aspirated from the cyst which was found to originate from the small bowel mesentery. A complete resection of the multi-loculated cystic sac was done that included the resection of the middle mesenteric vein. The post-operative period was uneventful. The patient was discharged on post-operative day 2. The Histopathology identified the mass as a multi-loculated peritoneal inclusion-type cyst.

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Unusual Presentation of CML in Pregnancy

A 30 year old primigravida was admitted to our hospital with antepartum haemorrhage at 33 weeks of gestation. On examination she was anaemic and had a blood pressure of 160/100mmHg. Abdominal examination revealed massive splenomegaly and live intrauterine foetus with fundal height corresponding to 32 weeks with a tense and tender uterus classical of abruption and she was in active labour. Her peripheral smear revealed a haemoglobin of 4.5gm/dL with marked leukocytosis with 54% neutrophils, (6% blasts, 4% promyelocytes, 15% myelocytes, 10% metamyelocytes) and 8% basophils; a picture suggestive of chronic myelogenous leukaemia (CML). Her liver and renal function tests were normal. She had an INR of 2.94 at admission which was corrected with fresh frozen plasma transfusion. Her anaemic status was corrected with 2 units of packed cell transfusion. With oxytocin augmentation she delivered a live, preterm baby of 30 weeks maturity weighing 1.54 kg which was shifted to nursery for preterm care. Her postnatal period was complicated by the development of an infralevator hematoma which was drained. Her blood pressure in the post natal period was controlled with calcium channel blockers. She otherwise remained stable. Bone marrow aspiration and biopsy were carried out on the fifth post natal day. It showed a hypercellular marrow with florid myeloid hyperplasia. Myeloid to erythroid ratio was found to be 30:1. This picture was consistent with the diagnosis of CML. She was started on Imatinib and is being followed up in our hematology clinic.

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Rocky Mountain Spotted Fever, A Reemerging Disease in Arizona and Sonora- Case Study

Rocky Mountain spotted fever, Rickettsia Rickettsii (RMSF) is a reoccurring disease in Arizona and Sonora and a public health problem due to the high risk medical complications it provokes. In the region it is transmitted by the bite of the Rhipicephalus sanguineus tick, found in dogs. This tick transmits Rickettsia rickettsii bacteria. Following an incubation period of 3-14 days, it causes acute, non-specific effects early on (fever, headache and rash) that -if not diagnosed and treated in time can be serious or cause death. Death is primarily associated with two factors: (a) delay in diagnosis, and (b) doxycycline, a highly effective antibiotic treatment which is inexpensive and simple to administer is delayed. If doxycycline is not provided before the 5th day after the symptoms begin, the patient can worsen and present with dark purple spots on the body, mostly hands and soles, wrists and ankles as well as have heart, hepatitis, renal, central nervous symptoms and other multiple organ complications. RMSF should be considered a medical priority and a public health problem at the regional level with a network of underlying factors. To prevent and control RMSF in Arizona and Sonora, public health interventions will need to address medical challenges associated with a number of social, political, and environmental factors.

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