Chronic orbital hematic cysts: a case for craniofacial correction

Chronic hematic cysts are rare conditions that usually present to the ophthalmic surgeons with displacement of the globe. There is usually no, or minimal, bone involvement. Two patients with unusual presentations of chronic orbital hematic cysts are reported. These cysts resulted in significant expansion and erosion of the bony orbits. The presentation, operative findings, and reconstruction are reported and discussed.     

Isolated epithelial cysts of the uvula in children: a report of three cases

Epidermoid cysts are unusual benign cysts that occur in the oral cavity less than 2% of the time. Epidermoid cysts isolated to the uvula are rare. A review of the literature has revealed only three confirmed cases of isolated uvular epidermoid cysts. We present a series of three such cases, two of which presented with significant symptomatology. The diagnosis and management of these unusual lesions will be discussed, as well as the differential diagnosis.     

Luteinized ovarian cysts in Mediterranean striped dolphins

The morbillivirus epizootic during 1990 to 1992 in Mediterranean striped dolphins (Stenella coeruleoalba) off the Mediterranean coast of Spain diminished these populations directly through mortalities, and indirectly through loss of normal fecundity. High levels of polychlorinated biphenyls (PCB's) also were detected in stranded animals. In addition to high numbers of abortions during the epidemic, unusual cystic structures were noted in the ovaries of several morbillivirus-infected dolphins with high PCB levels. These structures were identified as multiple luteinized cysts from their gross and histomorphologic characteristics. No morbillivirus antigens were detected in the lesions by immunohistochemistry. Because luteinized cysts occur when ovulation is impeded, either an effect of morbillivirus or PCB's on hypothalamic/pituitary function or an effect of PCB's on ovarian responsiveness are proposed as pathogenic mechanisms. These cysts may impede population recovery from the epidemic if similar cysts occurred on surviving dolphins.     

Hemorrhage into a lumbar synovial cyst causing an acute cauda equina syndrome. Case report

Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3-4 synovial cyst causing an acute cauda equina syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.     

Isotretinoin: which dosage?

Milia are small subepidermal keratin cysts. They may arise either spontaneously or in the course of bullous diseases or trauma. We describe an unusual case of multiple eruptive milia on the posterior neck and back and review the classification of milia.     

Invasive squamous cell carcinoma arising from asymptomatic choristomatous cysts of the orbit. Two cases and a review of the literature

BACKGROUND: Epithelial choristomatous cysts are common orbital lesions, the most frequent of which are dermoid or epidermoid tumors. Massive enlargement or extraorbital extension of these benign lesions may occur. Malignant transformation of the epithelial lining of epidermoid cysts is rarely reported. METHODS: Two patients are presented in whom the epithelial lining of a previously asymptomatic choristomatous cyst of the orbit underwent malignant transformation to produce invasive squamous cell carcinoma. The unusual origin and clinical presentation of the lesions caused a delay in the diagnosis and therapy in both patients. Metastatic workup was negative in both patients, who underwent resection of their tumors via orbital exenteration with craniofacial resection. Reported cases of malignant transformation in analogous choristomatous cysts elsewhere in the cranium are reviewed. RESULTS: One patient is alive and well without recurrent disease 40 months postoperatively. The second patient died of a pulmonary embolus 2 months postoperatively. Autopsy showed no residual tumor. Overall, only 3 of 18 reported patients with epidermoid choristoma of the head and orbit with malignant transformation were alive when reported. CONCLUSIONS: Malignant squamous metaplasia is believed to be a rare complication of orbital dermoid or epidermoid cysts, with only two previously reported cases. However, malignant transformation is relatively frequent in analogous epidermoid cysts found elsewhere in the cranial vault, especially after incomplete excision. These reports encourage the complete removal of epithelial choristomas of the orbit.     

Synergistic effect of counterregulatory hormones during insulin-induced hypoglycemia in rats: participation of lipolysis and gluconeogenesis to hyperglycemia

Aneurysmal bone cyst of the long bones in a purely intracortical or subperiosteal location is unusual. Three such cases are reported, and the radiographic and pathologic differential diagnoses are discussed. Those subperiosteal or intracortical aneurysmal bone cysts with radiographic features similar to the intramedullary variety should suggest the same diagnosis. However, the radiographic features may be less specific, so that a diagnosis of aneurysmal bone cyst must be entertained when considering a subperiosteal or intracortical lytic lesion.     

Effect of Trasina, an Ayurvedic herbal formulation, on pancreatic islet superoxide dismutase activity in hyperglycaemic rats

Hydatid disease has a high incidence in Turkey and causes significant complications. A case is reported here of unusual localization of hydatidosis, with involvement of hydatid cysts of the seminal vesicle, kidney and gluteus muscle. A review of the literature is also included.     

Apico-aortic shunt: a support technique during surgery on the descending thoracic aorta

Although colloid cysts of the third ventricle are unusual in children, we have recently encountered six examples. Histologically they were lined by cuboidal, pseudostratified or columnar ciliated and mucous-secreting epithelial cells. Two cases showed small microcysts within the fibrovascular stroma surrounding the main cyst. The outermost layer consisted of a glial-ependymal envelope, in keeping with the postulated supraventricular origin of colloid cysts. Scanning electron microscopy showed 10-40% ciliated cells, and no ballooning of non-ciliated cells. Aspiration of cyst contents was performed in three patients, two of whom subsequently required surgical resection 4 months and 8 years after drainage, respectively. In adults colloid cysts may be asymptomatic, whereas in children they have not been documented as incidental findings at autopsy. Two of our six cases died, both before a diagnosis was established. A colloid cyst of the third ventricle must be included in the evaluation of acute neurological deterioration in children, in whom they are more frequently lethal.     

Influence of leukemia inhibitory factor (LIF) on the survival, proliferation and differentiation of human erythroid progenitor cells. In vitro studies under serum free conditions

This article describes the long-term follow-up of Bioplant HTR Synthetic bone (HTR: hard tissue replacement) in the human organism, as revealed by clinical, radiological and histological examinations and observations over a period of 5 years. Twenty-nine patients with lesions, 9 keratocysts, 16 radicular cysts, 3 traumatic cysts and 1 odontome were followed continuously during this period. All patients selected for follow-up had two criteria in common: the initial intervention had been performed at least 5 years previously; and the largest diameter of the bone defect was at least 2 cm. In all cases, when large bone defects were filled with HTR, the cavity was eventually filled with newly formed and remodelled bone. The process of ossification was relatively slow. In these cases, complete bony regeneration took up to 5 years. Ossification did not continue in the soft parts around the bone cavity. The histological pictures confirmed complete bone healing over the time.     

Intraosseous tophaceous pseudotumor in the trigonal process of the talus

Primary gout with destructive tophaceous pseudotumor development rarely occurs in juvenile patients with asymptomatic hyperuricemia. An expansile, intraosseous tophaceous pseudotumor on the posterior process of the talus was verified in a 14-year-old boy with posterior ankle impingement and asymptomatic hyperuricemia. A review of the literature found no similar cases had been reported. The pathogenesis of this intraosseous tophaceous pseudotumor on the trigonal process probably was caused by the penetration of urate crystals from the periosteum into the posterior process of the talus. However, the time that this intraosseous tophaceous pseudotumor developed probably was close to the time that the second ossification center of the talus fused to the talus. Thus, it cannot be ruled out that the intraosseous tophaceous pseudotumor had formed during the fusion process of the second ossification center as a possible pathogenic mechanism in this unusual case.     

An unusual spinal intradural arachnoid cyst

Spinal intradural arachnoid cysts are seen most frequently in the thoracic region, particularly near the midline posteriorly. A thoracic intradural arachnoid cyst in this typical location is reported, with the additional unusual finding of herniation of the spinal cord through an anterior defect in the dura matter. The MRI findings are described.     

Recurrent bronchogenic cyst with rupture into the pericardium. A case report

A case of tamponnade due to intrapericardial rupture of a recurrent bronchogenic cyst, presenting as pericarditis, is described. This case is unique because it demonstrates the possibility of rupture of a bronchogenic cyst into the pericardium and by the unusual mode of presentation. It also shows that bronchogenic cysts may recur many years after incomplete ablation. Bronchogenic cysts are benign dysembrioplasic formations characterised by their respiratory epithelial lining. The usual presentation in the adult is by haemorrhage or infection, but our case shows that recurrent pericarditis without an obvious cause may be due to bronchogenic cyst, which should be systematically excluded. The diagnosis suspected after medical imaging (chest X-ray, scanner, magnetic resonance imaging) is confirmed by histology. Total surgical ablation is the treatment of choice and may be curative.     

A clinical evaluation of an operational postanesthesia care unit source control system

Ossifying fibromyxoid tumor of soft parts is an unusual benign neoplasm, with a tendency for local recurrence. Its typical microscopic appearance is that of a multinodular proliferation of round to spindle shaped cells separated by fibrous bands in which bone formation is often seen. Herein, we present the clinicopathologic features of 17 examples of this tumor with particular emphasis on some unusual histopathologic features that may place pitfalls in the diagnosis of this tumor, including satellite micronodules, mucinous microcysts, absence of myxoid areas, crush artifact, multiple microcalcifications, epidermoid cysts, atypical chondroid differentiation with binucleate lacunar cells, pericytic growth pattern, and malignant change. Awareness of these unusual morphologic features should lead to a search for areas displaying the more typical features of ossifying fibromyxoid tumor to arrive at a correct diagnosis.     

Short term prophylaxis against heterotopic bone after cementless hip replacement

The aim of the current study was to reveal whether 7 days of indomethacin treatment sufficiently prevents heterotopic ossification after cementless total hip arthroplasty. One group received indomethacin for 14 days (n = 102), and the second for 7 days (n = 99) after cementless total hip arthroplasty. At followup 1 year postoperatively, the average Harris Hip Score was 91 points in the 14-day treatment group and 89 points in the 7-day treatment group. The incidence of heterotopic ossification as outlined by Brooker was similar in both groups. Ninety-six patients in the 14-day treatment group had heterotopic ossification Grades 0 or 1, and 6 patients had Grade II heterotopic ossification; whereas in the 7-day treatment group, 95 patients had Grades 0 or 1 heterotopic ossification and 4 patients had Grade II ossification. None of the patients had Grades III or IV heterotopic ossification. In the 14-day treatment group, headache, dizziness, or gastritic disorders develop in 10 patients, and in the 7-day treatment group, 7 patients had these effects. This study shows that treatment with 100 mg indomethacin daily for 7 days is not significantly different than 14 days of treatment for the prevention of formation of severe heterotopic ossification after cementless hip arthroplasty.     

Odontogenic keratocyst: an unusual cause of unilateral nasal swelling

The odontogenic keratocyst is the least common of all odontogenic cysts which usually presents to the maxillofacial surgeon. An unusual case is described which presented to the ENT department with a rapidly enlarging unilateral intranasal mass. The clinical and radiological features of this lesion are presented and attention is drawn to the need for aggressive surgical excision because of its high recurrence rate.     

Jaundice associated with polycystic liver disease. Relief by surgical decompression of the cysts

Jaundice is an unusual feature of polycystic liver disease. In a 46-year-old woman with polycystic liver disease and jaundice, the bilirubin level was 42.0 mg/100 ml. Because of the rapid rise in bilirubin level, relief of supposed obstruction of intrahepatic bile ducts was attempted by unroofing the hepatic cysts. Following operation the bilirubin level returned to normal, and the patient has remained well since.     

Cystic mass at the suprasternal notch of a newborn: congenital suprasternal dermoid cyst

We report a case of a newborn female with an unusual suprasternal simple cystic mass found to be a dermoid cyst. Dermoid cysts of the head and neck are rare lesions, but a midline location is characteristic for these congenital masses. A dermoid cyst should be high on the list of differential diagnoses given a unilocular midline cyst in a neonate even if no fat elements are demonstrated on imaging studies.     

National Workshop on Health Surveillance, 25 October 1994. The opening words of Dr. Abelardo Ramírez Márquez

In this histologic-radiologic investigation of 32 feet of 16 fetuses and newborns ranging in age from 15 to 44 weeks, two types of ossification, i.e., endochondral ossification through primary ossification center and intramembraneous ossification through periosteal bone formation (PBF), were found to coexist in both calcaneus and talus. In addition, Ranvier's grooves (RG), or perichondral ossification groove, also was observed as a shallow, saucer-like or semicircular structure. As with PBFs, there are three and two RGs in the calcaneus and talus, respectively. RG and PBF appeared in time order and were located regularly in the concave areas of the adult calcaneus and talus. The findings support the hypothesis that one function of PBF and RG is to limit the growth of the calcaneus and talus. Thus, they are responsible for the irregular contour of the calcaneus and talus.     

Correlation between ossification of the stylohyoid ligament and osteophytes of the cervical spine

OBJECTIVE: To investigate the correlation between ligamentous ossification or osteophytes of the cervical spine and ossification of the styloid process and stylohyoid ligament, and to determine any relation between diffuse idiopathic skeletal hyperostosis (DISH) of the thoracic spine and ossification of the styloid process and stylohyoid ligament. METHODS: Four patients having cervical spine DISH, an elongated styloid process and/or variable patterns of stylohyoid ligament ossification, and clinical findings compatible with Eagle's syndrome are described. Cervical computed tomography scans of 100 patients who also had lateral radiographs of the thoracic spine were reviewed. Point biserial and Spearman rank correlation analysis, McNemar test, chi-squared test, and Fisher's exact test were used to determine correlation between elongation of the styloid process and/or ossification of the stylohyoid ligament and (1) ligamentous ossification or osteophytes of the cervical spine (the characteristic spinal manifestation of DISH), and/or (2) DISH of the thoracic spine. RESULTS: (1) Elongation of the styloid process and variable patterns of ossification of the proximal, middle, and distal parts of the stylohyoid ligament, and (2) enlargement of this ligament were significantly correlated with transverse and anteroposterior dimensions of ligamentous ossification or osteophytes of the cervical spine at various levels. The prevalence of such abnormalities of this process and ligament was not significantly different between the patients with and without thoracic spine DISH. CONCLUSION: Variable types of styloid process-stylohyoid ligament complex abnormalities have significant correlation with ligamentous ossification and osteophytes of the cervical spine.