Interdigitating reticulum cell tumor of lymph node: a case report and literature review

Interdigitating reticulum cell (IRC) tumor is a rare tumor arising from the antigen-presenting cell - interdigitating reticulum cell. A 41-year-old male presented with lumps in the left neck and bone pain. Further investigations revealed multiple left neck and para-aortic lymphadenopathy, and multiple bony lesions. Histological examination of the lymph node showed proliferation of unusual, large, round neoplastic cells mimicking large cell lymphoma. Immunophenotypic and ultrastructural studies confirmed this tumor to be arising from an interdigitating reticulum cell. A review of reported IRC tumors illustrates the variability of this tumor in clinical and pathological features, which differ from other dendritic reticulum cell tumors.     

Endocrine factors associated with recurrent spontaneous abortion

The role of endocrine factors as a cause of recurrent spontaneous abortion is controversial. Diabetes mellitus and thyroid disease do not represent a significant risk factor for recurrent pregnancy loss. Luteal-phase defect has been questioned because there are no accurate methods for diagnosis and no convincing evidence of correction with treatment exists. The corpus luteum is an unusual endocrine gland, highly diverse in function and important for successful reproduction in all mammalian species. Much controversy exists about the luteal function in humans and how defects in luteal function affects reproduction. Disagreement has been due to lack of accurate diagnosis and controlled studies to determine whether correction of the luteal-phase defect is worthwhile when treating female reproductive problems. The donor egg recipient model from assisted reproductive technology programs has shown that corpus luteum function can be replaced by estrogen and progesterone administration. The mechanism by which these steroids stimulate a uterus to be receptive to implantation of the embryo is not known. Several proteins produced by the endometrium are candidate markers for uterine receptivity. Further work needs to be done to correlate these markers with subsequent pregnancy outcome. A noninvasive marker for uterine receptivity is ultrasonographic evaluation of the endometrium. Although the sensitivity of this test is high (100%), its specificity is low (only 20% to 60%).     

Importance of endocrine imaging methods in multiple endocrine neoplasia type 2A proved by mutation analysis

Multiple endocrine neoplasias are rare, inherited disorders. The authors describe a case history of a patient with multiple endocrine neoplasia type 2A, who presented with unusual clinical manifestations. The diagnosis of phaeochromocytoma, which was the first manifestation of the disorder, was greatly facilitated with radiologic imaging methods. The authors review, on the basis of recent data from the literature, the importance of radiologic methods, which improved due to methodological advance. Finally, the authors emphasize the importance of follow-up for early diagnosis.     

Intrapelvic migration of a threaded Steinmann pin in Parkinson's disease

Intrapelvic migration of a threaded Steinmann pin complicated internal fixation of a displaced femoral neck fracture in an elderly man with untreated Parkinson's disease. Parkinsonian tremors may have contributed to this unusual complication. This case, in the light of a review of the literature, suggests that transfixation pins and wires should not be used in patients with Parkinson's disease. Endoprosthetic replacement combined with chemotherapy is better tolerated by femoral neck fractures in patients with Parkinsonism.     

Polyneuropathy caused by tuberculostatics. Study of motor nerve conduction in 29 patients

This paper presents the reconstruction of an unusual case of suicide. After raiding a branch-bank a robber fled shooting with his Sauer-Western revolver caliber .44 magnum at the pursuing policemen and succeeded in wrestling a pistol Walther caliber 7,65 mm from them. Under the fire of sub-machine guns he destroyed himself by a shot to the neck. Our investigations concerned a textile damage at the front of the sweater of the deceased surrounded by primer residue, showing characteristics of a close-up shot. The damage was identified as effect of explosion gases exhausting far-off the muzzle. The distance between this injury and the bullet hole corresponded with the length of the barrel of the Sauer-Western revolver and could be used for identification; it confirmed the diagnosis of a close-up shot at the neck, too. Collateral experiments with shots from distant ranges developed spadiceous melt figures of textile fibers around the bullet hole, the appearance of which is considered proof for a close-up shot commonly.     

Branchial cyst of unusual localization: report of a case and considerations on organogenesis

We report a case of branchial cyst of unusual location. A asymptomatic 41-year-old man had a nontender deeply located left neck mass. Sonography, CT scan, and MRI showed a cystic lesion posterior to the sternocleidomastoid muscle. The diagnosis of branchial cyst much debated because of this atypical location was confirmed by histologic analysis after surgical resection. During organogenesis, the important caudal proliferation of the second branchial arch generates a transient cavity, the cervical sinus, which finally becomes obliterated. The incomplete obliteration of which can result in a sinus, fistula or cyst. Such cysts typically lie at the level of the mandibular angle, anterior to the sternocleidomastoid muscle. This location has been regarded as a major diagnosis criteria, but it is not absolute. The sternocleidomastoid muscle develops apart from the branchial apparatus, caudally and anteriorly. As a result the cysts which are located on an inferior portion of the cervical sinus can lie posterior to this muscle.     

Fracture of the sella turcica

Fracture involving the sella turcica is a rare complication of head trauma, but extremely important due to its strategic location adjacent to vital vascular and nervous structures. Of 14 cases reviewed, nine had at least one cranial nerve paralysis, with endocrine abnormalities and cerebrospinal fluid otorrhea seen to a lesser degree. The radiographic findings of sphenoid sinus fluid (13 of 14 cases), pneumocephalus, and unusual vascular occlusions are discussed.     

Ultrasonography of the fetal neck in the first and early second trimesters. Part 1. Normal appearance

The soft tissues of the neck of 196 normal fetuses were examined with ultrasonography during the first and early second trimesters, and the criteria for normality are described here. The dorsal pseudomembrane is the most important feature of this area in a normal fetus. This feature appears as a single echogenic line lying parallel to the occiput and the upper cervical spine but separated from them by an anechoic area, which should be less than 2.8 mm deep before 18 weeks gestational age. The membrane is best observed when the fetus is in the "neck-up" position with the neck flexed. Although the superior-inferior extent of the membrane is variable, the occurrence of lateral extension, septations or hydrops or a bulbous appearance indicates abnormality. The membrane should move freely with the motion of the neck, which allows it to be differentiated from the normal amnion, amniotic bands or synechiae.     

Retropharyngeal abscess after blunt trauma in an adolescent

Retropharyngeal abscess is an unusual infection in teenagers, and it is rarely associated with blunt trauma. We present the case of 17-year-old male who developed signs and symptoms of retropharyngeal abscess soon after being struck by a car. The case illustrates that retropharyngeal abscess should be considered, even in an adolescent, if the patient has fever, neck stiffness, and sore throat with symptoms out of proportion to the oropharyngeal findings.     

Usage and adverse effects of Chinese herbal medicines

Oestrogen receptor (ER) expression in breast cancer is regarded as a phenotype that may change during the natural history of the disease or during endocrine therapy. It has been suggested that in up to 70% of tumours that show acquired resistance the mechanism may be changed in ER status from positive to negative. This paper proposes an alternative hypothesis that ER expression in a stable phenotype in breast cancer. The paper reviews the literature on ER expression during the natural history of breast cancer in patients and also presents data on the effect of endocrine therapy on ER expression. If the alternative hypothesis is true it has important implications for treatment from chemoprevention to acquired endocrine resistance in advanced disease. Equally, if the hypothesis is true, attempts to develop laboratory models of endocrine resistance where ER-positive tumours become ER negative need to be re-evaluated.     

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.     

Subclavian pseudoaneurysm mimicking recurrent head and neck cancer

Vascular blowouts are devastating complications of head and neck oncologic surgery that are easily diagnosed with oropharyngeal or external bleeding. We present herein a case of a pseudoaneurysm of the subclavian artery that mimicked recurrent head and neck carcinoma. Vascular lesions arising in the base of the neck may present with few signs of vascular injury. Head and neck surgeons should be aware of this unusual complication to avoid a potentially life-threatening event. We report difficulties in diagnosing subclavian pseudoaneurysm, a review of the vascular injuries related to this condition, as well as approaches to bleeding at the base of the neck.     

Monoclonal gammopathy (IgA: lambda) after autologous T-cell-depleted bone marrow transplantation in a patient with non-Hodgkin''s lymphoma

We present an unusual case of sphenoid sinus mucocele with severe intracranial extension, which was diagnosed and treated at the AHEPA General Hospital, University of Thessaloniki, Greece. The patient was a 54-year-old female who presented with endocrine, nasal and ophthalmological symptoms, and headache. She was successfully treated by surgery using an intranasal approach. While presenting this case, we briefly review the literature on the subject of sphenoid sinus mucoceles.     

Nonadenomatous thymic unencapsulated parathyroid tissue as a cause of persistent primary hyperparathyroidism

Primary hyperparathyroidism may be caused by ectopic intrathymic parathyroid adenomas or hyperplastic parathyroid glands. The association of the ectopic inferior parathyroid glands and the thymus is due to their common embryologic origin from the third pharyngeal pouch. We report a case of primary hyperparathyroidism due to an unusual pathologic parathyroid gland formation: nonadenomatous thymic unencapsulated parathyroid tissue. Two unsuccessful neck exploration revealed only two normal parathyroid glands within the cervical area. Radiologic imaging studies failed to localize an ectopic parathyroid adenoma. Mediastinal exploration and thymectomy showed one small focus of unencapsulated hypercellular parathyroid tissue expanding peripherally along the septa of thymic adipose tissue. The hyperparathyroidism resolved with the surgical procedure.     

Helical CT of the breast: detection of intraductal spread and multicentricity of breast cancer

PURPOSE: This study was performed to evaluate the clinical utility of postcontrast helical CT (HCT) scan for the detection of intraductal spread (DS) and multicentricity of breast cancer. MATERIALS AND METHODS: DS and multicentricity in 84 patients with invasive ductal carcinoma were evaluated by preoperative postcontrast HCT. The HCT protocol of 3-mm section width and 3 mm/sec table speed was used with the patients in a supine position. Scanning started 70sec after beginning the intravenous injection of 90 ml (27 gI) of contrast material at the rate of 1.5 ml/sec. The three-dimensional images were displayed. RESULTS: Eighty-four of 84 main tumors (100%) were shown as enhanced masses by postcontrast HCT. The sensitivity and specificity of HCT for the detection of DS and multicentricity were 60.0% (18/30) and 88.9% (48/54), and 88.9% (16/18) and 90.9% (60/66), respectively. When DS and multicentric lesions were combined, the sensitivity and the specificity were 76.3% (29/38) and 89.1% (41/46), respectively. CONCLUSION: HCT of the breast is effective in detecting DS and multicentric lesions of breast cancer and might be useful in helping surgeons to successfully perform breast-conserving surgery.     

Angiolymphoid hyperplasia with eosinophilia of the parapharyngeal space

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign condition characterized by cutaneous nodules with a predeliction for the head and neck region. Extracutaneous involvement is rare. We report a 44-year-old woman who had a large submucosal ALHE tumour in the parapharyngeal space. Our patient is of interest because of the unusual, and as far as we are aware from the literature, unique site and presentation of her lesion.     

Tracheoesophageal and aortoesophageal fistulae complicating corrosive esophagitis

Horse spleen ferritin, injected into the blood of the octopus, leaves the capillaries via pericyte junctions and windows. One hour after the administration, ferritin has entered the optic gland main cells; three hours later, it is accumulated in dense-bodies. The evidence for resorption supports earlier papers reporting that the ultrastructure of the organ is unusual for an endocrine gland.     

The only paper I ever wrote

Atlanto-occipital assimilation is one of the most common congenital anomalies of the craniovertebral junction, and it usually is asymptomatic. We report a case of this malformation with unusual neurological symptoms which correlate with radiological findings. The anomaly caused the so-called foramen magnum syndrome, which was difficult to localize with neurological examination. The patient also had atlanto-axial dislocation, which was thought to enhance the symptoms with change of head/neck position.     

Mucoepidermoid carcinoma of the parotid gland: a rare presentation in a young child

Although mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland neoplasm in childhood and adolescence, it is rarely found in children under the age of 10. A 6-year-old girl had an asymptomatic neck mass for 5 months. Clinical examination findings showed a 1.5-cm smooth and firm but mobile nontender mass located in the upper left anterior cervical triangle, clinically separate from the parotid gland. Ultrasound examination findings showed a vascular mass, with a cystic component, possibly within the tail of the parotid gland. An excisional biopsy was performed and frozen section showed a low-grade MEC. A left superficial parotidectomy was then performed. Final histopathologic examination showed one positive resection margin. Subsequently, reexcision of the surgical site and an upper modified neck dissection was undertaken. This unusual presentation of MEC as a neck mass in one of the youngest reported patients illustrates that the anatomic region for parotid tumors is large. Possibly some of these tumors may arise from heterotopic or accessory parotid tissue.     

Deletion mapping by FISH with BACs in patients with partial monosomy 22q13

We describe three siblings with hyperparathyroidism due to multiple parathyroid adenomas without evidence of other endocrinological abnormalities. A 22-year-old woman had two parathyroid adenomas complicated by multiple ossifying jaw fibromas. Her sister, aged 29, also suffered from primary hyperparathyroidism associated with two parathyroid adenomas one of which was also suspected to be a carcinoma. These two female patients had unusual multiple small uterine polyps, which were diagnosed as adenomyomatous polyps. Their brother, aged 17, had two parathyroid adenomas complicated by urolithiasis. These three patients are characterized by young adult-onset familial isolated hyperparathyroidism due to multiple adenomas with various complications including ossifying jaw fibroma and uterine adenomyomatous polyps. These clinical features are different from those of familial hyperparathyroidism associated with multiple endocrine neoplasia.