Florid cemento-osseous dysplasia in a young Chinese man. Case report

Florid cemento-osseous dysplasia refers to a group of fibro-osseous lesions which are exuberant, multiquadrant and arise from the tooth-bearing area of the jaws. It is classically described as a condition occurring almost exclusively in middle-aged black women. A case of florid cemento-osseous dysplasia occurring in a young Chinese male is reported which was rare in regard to race and sex. This 20 year old Chinese man presented with huge symmetrical bony lesions in all four quadrants of the jaws. Clinical presentation, radiological findings and histological features of the excised specimens are described. Treatment of the lesions was unusual. Curettage was first done with minimal benefit and it was followed by mandibular recontouring to improve facial appearance. The outcome of these procedures will be discussed.     

Intermittent chyluria in a young man

Chyluria is the passage of chylus into urine resulting in fistulization through the lymphatic system and the urinary system. This rare condition is usually caused by filaria infestation or malformations, neoplasia or trauma. We report a case of a 18-year-old man. The patient presented milky urine which had appeared after angiography following minor leg trauma. Physical examination revealed asymmetry of the face and cutaneous dyschromia. Blood tests revealed hypogammaglobulinemia and altered CD4/CD8 ratio (0.6). Urine tests showed proteinuria (30 mg/dl), lipiduria (triglycerides 750 mg/dl) and density of 1025. Renal function was normal. Abdomen computed tomography and urography were normal. Cystoscopy revealed the presence of milky urine in the bladder and selective catheterization revealed that the origin was the right ureter alone. Ascendent pyelography did not reveal any malformation of the urinary tract; but after this the chyluria spontaneously disappeared. The patient was rehospitalized 3 months later for recurrence. Lymphography was then performed and revealed a dilated lymphatic network with minute lacunar images projecting into the right kidney. Chyluria again disappeared spontaneously and recurred sporadically over the next two years in a patient who remained in good physical condition. The etiology of chyluria in a patient without filaria infestation is problematic, particularly when the most common causes (tuberculosis, neoplasia, trauma) are excluded as in our case. The asymmetry of the face, together with cutaneous dyschromia and the presence of a subarachnoidea cyst in the right temporal region suggested our patient had multiple congenital malformations.     

Case of the month. September 1996--new onset hemiparesis

A 44 year old woman developed left hemiparesis. CT scan showed a contrast enhancing lesion in the right periventricular area. A stereotactic biopsy was performed. The initial impression was that of an astrocytic neoplasm, however the presence of perivascular lymphocytes and numerous foamy macrophages led to consultation. Special studies demonstrated demyelination and lymphocytic infiltrate with relative axonal preservation consistent with multiple sclerosis. Additional history from the patient revealed a flu-like illness one week prior to the hemiparesis and a history of transitory visual problems, possibly early manifestations of her multiple sclerosis.     

Case of the month: March 1998--48 year old man with back pain and weakness

A 48 year old man with long history of end stage renal disease (ESRD) and secondary hyperparathyroidism presented with back pain and incontinence. MRI and CT showed T2 expansion with bony destruction and spinal cord compression. Other vertebral bodies showed destructive lesions as well. Microscopic examination showed a brown tumor composed of multinucleated giant cells and bone uninvolved by tumor showed "tunneling" resorption. Brown tumors are an exaggerated form of "local" osteitis fibrosa cystica in patients with ESRD and secondary hyperparathyroidism, but spinal cord compression is rare.     

Case of the month: April 1997--a 32 year old man with mental status changes and a severe occipital headache

A 32 year old man with symptoms of an upper respiratory infection one week prior presented with mental status changes, diffuse hyperreflexia, and bilateral extensor plantar responses. An MRI scan showed multifocal areas of high signal intensity predominantly in the parietal and occipital white matter, unassociated with mass affect. Despite aggressive treatment, the patient's symptoms rapidly progressed and he was declared brain dead. Post-mortem examination revealed acute hemorrhagic leukoencephalopathy. The clinical and pathologic features of this disorder are reviewed.