Cardiac myxoma shedding leads to lower extremity arterial embolism: A case report

BACKGROUND

Left cardiac myxoma (CM) is the most common benign tumor of primary cardiac tumors, but because of its special position caused by pathological physiology change, caused by the complications of the heavier, the surface is often accompanied by blood clots, once fall out, it causes peripheral vascular embolization, such as acute lower limb artery embolization, harmfulness is large, high morbidity, and easy to occur repeatedly.

CASE SUMMARY

A 67-year-old male patient suddenly appeared numbness and weakness of the left lower limb and could not walk without obvious incentive. The patient was finally diagnosed as left CM complicated with acute lower limb arterial embolism after completing cardiac ultrasound, computer tomography angiography, and histopathological analysis, such as hematoxylin-eosin stain staining, immunohistochemistry and special staining including alcian blue staining and periodic acid schiff staining. Arterial thrombosis was removed successfully by femoral artery thrombectomy, postoperative numbness and weakness of the patient's left lower limb disappeared, skin temperature became warm, and dorsal foot artery pulsation was accessible. The patient was readmitted to the hospital 8 mo after discharge for left atrial mass resection, and was diagnosed as CM by postoperative histopathological examination.

CONCLUSION

Although CM is rare, it may be considered as the source of embolism in patients with acute limb ischemia. Repeated loss of thrombus on the tumor and its surface may lead to repeated embolism of peripheral vessels. Cardiac ultrasound is helpful for early diagnosis. Here, we use this case report to highlight left CM as an important cause of acute limb ischemia and to report our experience in the diagnosis and treatment of lower limb arterial embolism caused by CM detachment.

Ectopic bronchogenic cyst of liver misdiagnosed as gallbladder diverticulum: A case report

BACKGROUND

Ectopic bronchogenic cysts are a type of congenital cystic tumor that are extremely difficult to diagnose and can be ectopically located in various organs, with the possibility of malignant transformation. Here we report a case of an ectopic bronchogenic cyst in the liver initially misdiagnosed as a gallbladder diverticulum.

CASE SUMMARY

The patient was a middle-aged woman whose chief complaint was intermittent pain in the upper abdomen. Imaging examination revealed a cystic space in the left inner lobe of the liver. She was admitted to our hospital for treatment. Based on abdominal examination and imaging findings, the initial diagnosis was gallbladder diverticulum with cholestasis combined with chronic cholecystitis. However, following intraoperative observations and postoperative pathologic assessment, the diagnosis was revised to ectopic bronchogenic cyst of the liver.

CONCLUSION

Radiologists, hepatobiliary and pancreatic surgeons, gastrointestinal surgeons, urologists, and even neurosurgeons should be aware and consider a possible diagnosis of ectopic bronchogenic cysts, especially when other types of cyst, cystadenoma, and other diseases are excluded. The disease and its complications should be detected and correctly diagnosed and treated as early as possible in order to avoid adverse outcomes.

Transoral endoscopic thyroidectomy by vestibular approach in Viet Nam: surgical outcomes and long-term follow-up

BACKGROUND

The transoral endoscopic thyroidectomy by vestibular approach (TOETVA) has been developed for early-stage thyroid cancer treatment as well as benign thyroid nodules worldwide including Viet Nam, with low rate of complications and excellent results. However, there has not been any comprehensive studies with a large number of patients and long-term follow-up in our country. Therefore, we conducted this study to evaluate the results of treatment by TOETVA for benign and malignant lesions of thyroid gland in Viet Nam.

METHODS

A prospective study was performed on 326 eligible patients who underwent TOETVA due to thyroid cancer and benign thyroid nodules in Department of Oncology and Palliative Care, Hanoi Medical University Hospital from July 2018 to April 2021. The clinical, surgical, and pathological characteristics, postoperative complications, and visual analog scale (VAS, 0-10 cm) score in day 1, 4, and 7 after surgery, long-term oncological and surgical outcomes were recorded.

RESULTS

The mean age was 36.9 ± 9.8 years. 231 patients (70.9%) were diagnosed with differentiated cancer and 95 patients (29.1%) were diagnosed benign tumors of thyroid gland. In the cancer group, 12 patients (5.2%) undergone TOETVA had T3b-intraoperative-stage diagnosis, 219 patients (92.2%) were diagnosed T1 according to AJCC 8th. After 1 month of surgery, among thyroid cancer patients, there was no abnormality reported by thyroid scintigraphy and neck ultrasound as well as in unstimulated-Tg and anti-Tg values. The mean number lymph-node dissected in the cancer group was 6.1 ± 4.1 (range 0-21 nodes). However, only 2.6 ± 1.8 metastasis nodes were discovered (range 1-8 nodes), and the maximum size of these nodes was less than 2 mm. 81 patients presented occult lymph-node metastasis among thyroid cancer patients with cN0 stage (account for 35%). The occult lymph-node metastasis was 34.2% and 50% in patients diagnosed with T1 and T3b groups, respectively. The median postoperative hospital stay was 5.4 ± 0.7 days. Postoperatively, transient hypoparathyroidism was recorded in 12 patients (4.8%), transient hoarse was noted in 9 patients (3.6%), and numb chin was identified in 7 patients (2.8%). No permanent complication was noted. VAS score on first postoperative day was 4.5 ± 0.8. Median follow-up time was 12 (3-25) months. No recurrence was recorded.

CONCLUSIONS

TOETVA is an innovative and revolutionary technique in the treatment of benign thyroid nodules, as well as early-stage differentiated thyroid cancer. The results of oncology, postoperative complications, and satisfied outcomes supported the wide application of TOETVA in Viet Nam.

Carbon ion radiotherapy for recurrent ameloblastoma: A case report

Ameloblastoma is a kind of benign, odontogenic tumor of epithelial origin, and surgery is mainstay treatment method; however, recurrence is common, and usually the treatment for recurrence is still surgery. We report on a patient of recurrent ameloblastoma treated with carbon ion radiation therapy and achieved a good efficacy. A 25-year-old female with relapse of an ameloblastoma was referred to the Wuwei Heavy Ion Center for carbon ion therapy. She had been initially diagnosed with ameloblastoma 8 years ago and underwent operation of right mandible ameloblastoma. After she transferred to our center, she accepted a dose of 60 GyE carbon ion radiation therapy, and the efficacy is good. Carbon ion radiation therapy can be an effective treatment option for ameloblastoma.

Diagnosis and treatment of hand tumors

Hand tumors are a very common problem in hand surgery. While these lesions are most often benign, malignant lesions often have an atypical presentation and are discovered late, very often during an inappropriate treatment. To optimize the care of hand tumors and to reduce diagnostic and treatment errors, we will review the broad diagnostic and therapeutic principles and the most common clinical presentations.

Unusual presentation of lateral sural cutaneous nerve schwannoma: An exceptional case report

Introduction

Schwannoma is the most common benign nerve sheath tumor. Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic.

Case presentation

We report the case of a misleading clinical presentation of lateral sural cutaneous nerve schwannoma.

Discussion

To the best of our knowledge, no case has been reported about the location of schwannoma in the lateral sural cutaneous nerve. MRI and anatomopathologic assessment, after microscopic enucleation, are required to confirm diagnosis.

Conclusion

Care must be taken to not miss a schwannoma of lateral sural cutaneous nerve by meticulous clinical examination and appropriate imaging using MRI in unexplained L5 sciatica.

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Schwannoma is the most common benign nerve sheath tumor

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Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic

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MRI shows isointense or decreased signal relative to the skeletal muscle on T1-weighted images and heterogeneously increased signal intensity on T2-weighted images

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Microscopic enucleation is treatment of choice

Large lumbosacral schwannoma in a young female- a case report from Afghanistan

INTRODUCTION

Mobile Schwannoma is a rare soft tissue tumor that commonly involves the elderly population. It has no cellular material and grows as solitary, firm, oval, encapsulated benign tumors from the sensory (dorsal) nerve root. If multiple, they are usually associated with Neurofibromatosis type 2 (NF-2). The initial sign and symptoms include segmental pain and paresthesia. It may lead to myelopathy if the tumor expands.

CASE PRESENTATION

We present a twenty-year-old female with chronic lower backache radiating to the ipsilateral thigh with no urinary or fecal incontinence. On physical examination, the ankle reflex was hypoactive on the left side, and the straight leg raise test was positive. A large 32 × 15 × 14 mm heterogeneous enhancing focal lesion was found on the posterior side of L5 and S1 vertebrae with severe central canal stenosis. A diagnosis of nerve sheath tumor was made based on contrast MRI pre-operatively. The underlying cause was a nerve sheath tumor. A total bilateral laminectomy at the L1-S5 level and mass excision was performed, preserving nerve roots. The postoperative period was uneventful, and no tumor re-growth was noticed.

CLINICAL DISCUSSION

Schwannoma is a slow-growing tumor; benign; usually, less than 8 cm in diameter tumor, commonly found in the head and neck region. It is the 3rd most common soft tissue tumor and the 2nd most common intradural extramedullary tumor. In our report, a young, non-Caucasian female patient is diagnosed with schwannoma, which is quite rare. In our case, a larger tumor of size 32 × 15 × 14 mm was noted, affecting the posterior body of L5 and S1 vertebrae in the left lateral recess with impingement of the left S1 traversing nerve root. Around 29% of spinal root nerve tumors are schwannomas. As the tumor grows slowly, the diagnosis may be delayed.

CONCLUSION

Schwannoma is a slow-growing solitary, firm, oval, encapsulated benign tumor arising from the sensory (dorsal) nerve root. Histopathology plays a vital role in diagnosis, and overall, the disease has a favorable prognosis. Therefore, an appropriate approach is necessary to rule out the disease.

It smells and tastes like cancer but it's not cancer: A case report of aggressive benign lung neoplasm

Desmoid tumors are rare, locally aggressive benign tumors with a high rate of recurrence even after complete resection. Only twenty percent are intrathoracic and they are often painless or minimally painful with slow growth. Rarely they can grow quite rapidly, mimicking a malignant tumor. Here we present a rare case of a rapidly growing, intrathoracic desmoid tumor mimicking lung malignancy in an elderly male ex-smoker. This case demonstrates the importance of including desmoid tumors in the differential diagnosis of lung masses, raising awareness of benign tumors mimicking malignant behavior, and emphasizing the potential benefit of timely follow-up and early diagnosis.

Isolated Focal Infantile Hemangioma of the Alveolar Ridge with Glucose Transporter-1 Reactivity: An Aberrant Presentation

Aim and objective

To give dental practitioners an insight into the unusual presentation of focal infantile hemangioma on the alveolar ridge showing immunoreactivity to glucose transporter-1 (GLT1). We also recommend the importance of using standardized terminologies to describe the type of hemangioma.

Background

One of the most commonly seen and misdiagnosed vascular tumors of the skin and soft tissues of the head and neck region in children are infantile hemangiomas. Infantile hemangiomas developing at extracutaneous locations such as the oral cavity are rare, especially without cutaneous involvement.

Case description

A 9-month-old infant girl presented to the Pediatric Dental Department with a swelling over the maxillary alveolar ridge. The solitary exophytic mass appeared after birth and gradually enlarged in size with episodes of bleeding during feeding. Clinical examination revealed a reddish-pink pedunculated mass that bled profusely on palpation. The lesion was excised by electrocautery and was found to be express glucose transporter-1 confirming the diagnosis of infantile hemangioma. The patient was followed up for 1 year and showed no recurrence.

Conclusion

Hemangiomas are usually misinterpreted to be pyogenic granulomas, vascular malformation, reactive granulation tissue, or congenital granular cell tumor. This report highlights the use of glucose transporter-1 when there is suspicion of hemangioma for immunohistochemical distinction from other histologically similar vascular lesions of the oral cavity.

Clinical significance

Dental surgeons treating vascular lesions of the oral cavity should advocate for surgical management techniques that also produce hemostasis due to the risk of intraoperative bleeding.

How to cite this article

Natarajan D, Muthukali S, Nachiappan N, et al. Isolated Focal Infantile Hemangioma of the Alveolar Ridge with Glucose Transporter-1 Reactivity: An Aberrant Presentation. Int J Clin Pediatr Dent 2021;14(2):319–322.

Submandibular lipoblastoma: Case report of a rare tumor in childhood

Lipoblastoma is a rare, benign tumor usually occurring in childhood. It is essentially localized in the extremities and trunk, with few cases reported in the neck. We report the case of a 2-year-old girl with a rapidly enlarging, painless neck mass. Magnetic resonance imaging (MRI) revealed a 3-cm mass in the right submandibular region. Review of literature, diagnostic methods, and genetics of lipomatous tumors are discussed. Complete surgical excision via a lateral cervical approach demonstrated a white soft tissue with an adherent ganglion. Histology and immunohistochemistry confirmed the diagnosis of lipoblastoma. Cervical lipoblastoma is rare, and typically asymptomatic, rarely causing nerve compression or airway obstruction. MRI can help identifying the lipomatous nature of the mass, but the findings can be inconsistent due to variable maturity of fat cells and the mesenchymal content of the tumor. Diagnosis is always based on pathological examination. Further chromosomal analysis is useful in differentiating lipoblastoma from liposarcoma. Complete surgical excision is the recommended treatment.

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor: A case report

BACKGROUND

Duodenal papillary tumor is a rare tumor of the digestive tract, accounting for about 0.2% of gastrointestinal tumors and 7% of periampullary tumors. The clinical manifestations of biliary obstruction are most common. Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage. Surgical resection is the only treatment for duodenal papillary tumors. At present, the methods of operation for duodenal papillary tumors include pancreatoduodenectomy, duodenectomy, ampullectomy, and endoscopic resection.

CASE SUMMARY

A 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously. Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia. Therefore, we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed. After surgery, the patient underwent a follow-up period of 5 yr. No recurrence or metastasis occurred.

CONCLUSION

According to our experience with a duodenal papillary tumor, compared with pancreaticoduodenectomy, the use of pancreas-preserving duodenectomy can preserve pancreatic function, maintain gastrointestinal structure and function, reduce tissue damage and complications, and render the postoperative recovery faster. Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.

Symptoms and signs of parotid tumors and their value for diagnosis and prognosis: a 20-year review at a single institution

BACKGROUND

Detailed clinical features other than parotid mass have not been investigated in detail for parotid tumors. Symptoms and signs are useful for the differentiation of benign versus malignant, and may also be of value to determine the grade of malignancy and histological type as well as the assessment of prognosis.

METHODS

We reviewed symptoms and signs of 965 patients with benign tumors and 200 patients with malignant tumors. Symptoms and signs included pain/tenderness, adhesion to surrounding tissues, and facial nerve palsy. We reviewed the incidence in benign and malignant tumors, in histological type of benign tumors, and in grade and histology of malignant tumors. For each symptom or sign, covariates were analyzed, and their correlation with the prognosis was investigated.

RESULTS

The incidence of symptoms and signs was significantly higher in malignant than benign tumors, and more frequent in higher grade of malignancy. Facial nerve palsy was observed in 18.0% of malignant tumor cases, while none occurred in benign tumor cases. Pain/tenderness was more commonly observed in adenoid cystic carcinoma, while adhesion to surrounding tissues and facial nerve palsy were most frequently noted in salivary duct carcinoma. The prognosis of patients with these symptoms and signs was significantly poor.

CONCLUSION

A detailed investigation of symptoms and signs in parotid gland tumors is the first step that leads to the diagnosis of malignant tumors. Symptoms and signs are also useful for estimating the grade of malignancy and histological type, and they are important information for predicting prognosis.

Ameloblastic Fibroma in Mandibular Anterior Tooth Region: A Case Report

An ameloblastic fibroma (AF) is a proliferative mixed tumor which includes components of both odontogenic epithelium and mesenchymal tissue. It is a relatively rare neoplasm, accounting for approximately only 1.5－4.5% of odontogenic tumors. This case report describes an AF that occurred in the mandibular anterior tooth region in a 9-year-old girl who presented with the chief complaint of swelling in the left mandibular anterior tooth region. Intraoral examination revealed a swelling along the labial gingiva, extending from the left mandibular lateral incisor region to the left mandibular canine. Upon palpation, the swelling appeared to comprise a hard tissue. Computed tomography revealed a supernumerary impacted tooth; soft tissue density in the bone surrounding the region extending from the left mandibular lateral incisor to the left mandibular canine; labial bone expansion; and thinning of the labial cortical bone. A biopsy was performed under local anesthesia and the lesion subsequently diagnosed as an AF. Tumor resection and extraction of the supernumerary impacted tooth were carried out under general anesthesia. At 2 years postoperatively the prognosis is good. Although relapse with an AF is rarer than that with an ameloblastoma, strict follow-up is required, as malignant transformation to an ameloblastic fibrosarcoma has been reported in relapsed cases.

Solitary intraosseous neurofibroma of the mandible: Report of an extremely rare histopathologic feature

Neurofibroma (NF) is a benign tumor derived from the peripheral nerve sheath. Neurofibromas may present either as solitary lesions or as part of the generalized syndrome of neurofibromatosis or von Recklinghausen's disease of the skin. The intraosseous variant of NF is very rare. We report a case of a 32-year-old female who was diagnosed with a solitary intraosseous neurofibroma of the mandible. The present case is rare with respect to its unique histopathologic feature.

Large irritation fibroma of hard palate: a case report of a rare clinical entity

Fibromas are benign tumors of connective tissue common in the oral cavity but rare on hard palate. This paper reports on an asymptomatic, slowly growing mass on the hard palate of a 90-year-old lady, with a reported use of denture for two decades. The patient presented with a 2.2cm, smooth-surfaced, well-circumscribed nodule attached with a stalk to the palatal mucosa. After excision, the histopathological examination revealed a mass of fibrous connective tissue, covered by stratified squamous epithelium with focal low-medium grade hyperplasia and hyperkeratosis. These findings were consistent with irritation fibroma of hard palate, a rare entity, which should be considered as a possible diagnosis for tumors of the area by every physician.

Benign macrocystic serous cystadenoma of the pancreas

Serous cystadenoma is a rare benign cystic lesion of pancreas. They are mostly known as benign cystic tumors of pancreas but malign transformation as serous cystadenocarcinoma is also reported. It is more commonly observed in women with the mean age of onset is 62 years. The majority of patients present nonspecific symptoms such as abdominal pain, weight loss, nausea, vomiting, fever, and melena. One-third of the patients are asymptomatic. A 60-year-old woman presents with abdominal pain and nausea for 1 month was admitted. Physical and laboratory findings were normal. Abdomen computed tomography scan confirmed a large number of millimetric cysts of 45 × 47 × 50 mm in size at the head of the pancreas. Due to patient's symptoms and mass effect, Whipple procedure was performed. In the gross examination, a nodular area of 5 × 5 × 4 cm was observed in the head of the pancreas. The microscopic examination of the material revealed cystic structures with fibrous stroma dotted with single layered cuboidal epithelium in the pancreatic tissue. The pathology report confirmed benign macrocystic serous cystadenoma. Serous cystadenomas are rare benign cystic lesions of the pancreas. Although they are benign lesions, it is crucial to differentiate them from other cystic lesions of the pancreas and malignant serous cystadenocarcinomas.

Benign multicystic peritoneal mesothelioma (BMPM) presenting with ambiguous symptoms: A rare case report

Introduction

Benign multicystic peritoneal mesothelioma (BMPM) represents a very rare clinical entity, with only 130 registered cases in the medical literature, therefore it is usually overlooked from the list of differential diagnoses. The treatment consists of surgery and other authors suggest complementing it with hyperthermic intraperitoneal chemotherapy.

Presentation of case

A 25-year-old multiparous female experienced periodic abdominal discomfort for two weeks. She developed constipation, urinary urgency, and irregular menstruation. Family history was remarkable for endometrial and breast cancer. Abdominal examination revealed a palpable mass. Abdominal ultrasound and computed tomography scan identified the multicystic appearance of the mass. The diagnosis was unclear, therefore exploratory laparotomy was performed, which revealed multiple grape-like clusters of cysts that were excised immediately. BMPM was diagnosed based on the pathology report. Eventually, the follow-up did not reveal any recurrence.

Discussion

Mesothelial tumors include three pathological entities, including Benign multicystic peritoneal mesothelioma (BMPM). BMPM is an uncommon neoplasm and has a high recurrence rate after surgery. BMPM consists of clear cysts that take the shape of a grape-like cluster. Clinically, BMPM resembles a tangible abdominal mass and it is challenging to be diagnosed, due to its numerous differential diagnoses.

Conclusion

The definitive diagnosis of intraperitoneal cystic masses is usually challenging. Therefore, BMPM -although very rare- should always be thought of when dealing with an intraperitoneal cystic mass, especially in women in the reproductive years. In our case cytoreductive surgery solely was sufficient to achieve a disease free follow up, however, further studies regarding treatment and follow-up are required.

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The incidence of Benign multicystic peritoneal mesothelioma (BMPM) is exceptionally rare.

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Pathological evaluation is considered the best technique to diagnose.

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BMPM is most common in women in reproductive age.

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BMPM should be considered as a differential diagnosis for abdominal masses.

A clinico-pathological and neuro-radiological study of angiomatous meningioma: Aggressive look with benign behaviour

Angiomatous meningioma is a rare variant tumor classified as WHO grade 1 meningioma and accounts for about 2.1% of all meningioma. Their clinical presentation, surgical management, and prognosis are almost similar to the classical meningioma. Despite of benign nature and being comparatively small in size, they look aggressive on radiology images like massive peritumoral edema and intense contrast enhancement. Being a unique subtype of meningioma, the studies on angiomatous meningioma are very limited. In this cross sectional retrospective study, we described the clinical presentation, radiology, histopathological features and differential diagnosis of 30 cases of angiomatous meningioma from a single centre. The clinical parameters include demographic profile, symptoms and radiological findings including location, extent, pattern, histopathology with World Health Organization (WHO) grade-2016, extent of tumour excision, recurrence and surgical outcome. Incidence of angiomatous meningioma in our study was 2.46% with male predominance. The most common location in our study was convexity. 27 out of 30 had histopathology reports of angiomatous meningioma and 3 had lipoangiomatous meningioma. The high vascularity and disproportionate peri-tumoral edema makes it a surgical challenge for excision. The complications and surgical outcome were analysed. The radiological anticipation of tumour subtype, meticulous pre-operative planning and intraoperative precautions remains a key for success.

Osseous mass in a maxillary sinus of an adult male from the 16th-17th-century Spain: Differential diagnosis

OBJECTIVE

To undertake a differential diagnosis of a large mass found in the left maxillary sinus of a cranium dated to the 16th-17th-century, and to expand knowledge of the diagnosis of osseous tissue formation in osteoarchaeological studies.

MATERIAL

A cranium recovered from the cemetery of San Salvador de Palat de Rey church, León (Spain).

METHODS

Macroscopic analysis, CT scanning.

RESULTS

Macroscopic analysis indicated that the individual was probably a male over 30 years old with an ossified mass in the left maxillary sinus, measuring 24 × 19 × 24 mm, occupying approximately 27 % of the maxillary antrum. Computed tomography revealed a well-demarcated radiolucent unilocular mass with some radiopaque areas, with no communication with the alveoli of the premolars or molars. No erosive lesions or signs of inflammation were found.

CONCLUSIONS

Neither the macroscopic, nor the radiological characteristics are compatible with inflammatory or malignant pathology, favoring a diagnosis of ossifying fibroma.

SIGNIFICANCE

This case adds to the few reported cases in the osteoarchaeological literature, especially since there is limited relevant reference data to assist diagnosis. The CT scans and 3D reconstruction presented here facilitate differential diagnosis in future paleopathological studies.

LIMITATIONS

Destructive methods were not authorized.

SUGGESTIONS FOR FURTHER RESEARCH

In the future, micro-CT analysis, which was not performed in the current study, may add new and valuable information.

Calcification segmentation based on a different scales superpixels saliency detection algorithm

Accurate detection of breast tumor calcifications is of great significance in assisting doctors' diagnosis to improve the accuracy of breast cancer early detection. In this article, a different scale of superpixels saliency detection algorithm is used to segment calcifications in breast tumor ultrasound images based on a simple linear iterative cluster. First, a multi-scale saliency segmentation algorithm was used to divide the tumor region of different sizes and weak calcification (Wca) was extracted according to uneven gray distribution and texture contrast between regions. Second, based on single-scale superpixel segmentation of the original image, the strong calcification extraction map was calculated by measuring gray value difference and calcification gray distance features. Finally, the final calcification extraction map was obtained by combining the strong and weak calcification extraction maps. The detection algorithm proposed in this article could effectively detect calcifications in breast ultrasound images.

Predictors of readmission after craniotomy for meningioma resection: a nationwide readmission database analysis

BACKGROUND

Meningiomas are the most common benign primary brain tumors. The mainstay of treatment, surgical resection, is often curative. Given the excellent prognosis of these lesions, minimizing perioperative complications is of the utmost importance. With the establishment of the National Readmissions Database (NRD), researchers are now able to identify variables associated with postoperative complications beyond the index admission.

OBJECTIVE

In this study, we sought to identify the leading causes for non-elective readmission and variables associated with increased likelihood of readmission at 30 and 90 days after discharge following a craniotomy for meningioma resection.

METHODS

Adult inpatients who underwent craniotomy for meningioma resection between 2010 and 2014 were queried from the NRD. All-cause readmissions following craniotomy at 30 and 90 days were identified, and a multivariable logistic regression model was used to characterize independent risk factors.

RESULTS

Among 26,034 patients who received craniotomy for meningioma resection, 2825 (10.9%) were readmitted at 30 days and 3436 (16.1%) were readmitted at 90 days. Postoperative wound infection was the most common readmission diagnosis, occurring in 9.32% and 10.2% of 30- and 90-day readmissions respectively. Patient factors associated with increased likelihood of readmission included male gender, greater illness severity, non-routine discharge, index length of hospitalization, and having Medicare or Medicaid insurance.

CONCLUSIONS

Readmission following craniotomy for meningioma resection occurs at a clinically significant rate. Several patient factors were identified in association with all-cause 30- and 90-day readmissions. Further studies are required to identify means for preventing complications following discharge in these vulnerable patient populations.

Effectiveness of intraoperative facial nerve monitoring and risk factors related to postoperative facial nerve paralysis in patients with benign parotid tumors: A 20-year study with 902 patients

OBJECTIVE

We examined the incidence, risk factors, and recovery time for postoperative facial nerve paralysis in patients with benign parotid tumors and also investigated the usefulness of intraoperative facial nerve monitoring (FNM).

METHODS

Subjects were 902 patients with benign parotid tumors. Univariate and multivariate analyses were conducted for risk factors of postoperative facial nerve paralysis. We investigated the relationship between intraoperative FNM and postoperative facial nerve paralysis, and the recovery time for postoperative facial nerve paralysis according to tumor site.

RESULTS

Postoperative facial nerve paralysis occurred in 179 (19.8%) of 902 patients. Among them, 15.1%, 15.8%, and 37.5% had tumors in the superficial lobe, lower pole, and deep lobe, respectively. Paralysis risk factors were deep tumors, large tumors, long operation times, extensive bleeding, and non-use of FNM. Multivariate analysis determined female patients, deep tumors, and long operation times as significant risk factors, and female patients and deep tumors had an odds ratio of nearly 2. Use of intraoperative FNM resulted in a significantly lower incidence of facial nerve paralysis and was particularly useful in patients with superficial lobe tumors. Time to recovery from facial nerve paralysis was 6 months in 88% of the patients.

CONCLUSION

The incidence of paralysis should be kept as low as possible to enhance the postoperative quality of life of patients. The use of intraoperative FNM significantly lowered the incidence of paralysis in female patients with superficial tumors.

Assessment of YKL-40, lipid profile, antioxidant status, and some trace elements in benign and malignant breast proliferation

Breast cancer is mainly the common form of cancer in women and is a leading cause of death worldwide associated with cancer. The objective of this study was to assess the possible association of lipid profiles (total cholesterol TC, low-density lipoprotein LDL, very-low-density lipoprotein VLDL, high-density lipoprotein HDL, non-HDL and triglyceride TG), Chitinase-3-Like Protein1 (YKL-40) and changes in the levels of certain trace elements (Cu, Mg, Fe, and Zn), antioxidant status (TAC) and nitric oxide (NO) in benign and breast cancer in Egyptian females population. For 56 females with a benign breast tumor, 58 females with breast cancer, besides 52 healthy controls, Serum lipid profile, YKL-40, TAC, NO, Cu, Fe, Zn, and Mg have been determined. Our results showed a significant difference in lipid profile and a significant increase in, YKL-40, NO, and iron in breast benign tumor and cancer patients compared to control one. Besides, there is a significant reduction in serum magnesium and TAC levels in the patients' group compared to the healthy group. There is also a significant correlation between serum YKL-40 level and TC, LDL-C, VLDL-C, non-HDL-C, and TG in the breast cancer group; although only YKL-40 and VLDL-C showed a significant positive correlation in benign tumor patients. It is recommended that non-HDL-cholesterol, TAC, and Mg be used as biomarkers for breast cancer and its progression.