Non-invasive, in vivo, characterization of cutaneous metastases using a novel multimodal RCM-OCT imaging device: a case-series.

BACKGROUND: Cutaneous metastases (CM) diagnosis is clinically challenging, requiring an invasive biopsy for confirmation. A novel, RCM-OCT device combines the advantage of horizontal high-resolution reflectance confocal microscopy (RCM) images and vertical deeper optical coherence tomography (OCT) images to aid in non-invasive diagnosis of CM from breast cancers. OBJECTIVE: Characterize CM from breast cancers using RCM-OCT device. METHODS: Seven patients suffering from breast cancers with suspicious CM were consented and imaged with RCM-OCT device. CM features were defined by comparing with histopathology. Tumour depths were measured on OCT and on H&E-images and correlated using statistical analysis Pearson test. 3D-OCT images were reconstructed to enhance tumour visualization. RESULTS: 6/7 lesions were CM from breast cancers, and one was vascular ectasia, on histopathology. CM appeared as greyish-darkish oval to round structures within the dermis on RCM and OCT-images. On RCM, individual tumour cells were seen, enabling identification of even small tumour foci; while, on OCT deeper tumours were detected. Inflammatory cells, dilated vessels and coarse collagen were identified in the dermis. Pearson correlation had an r2 of 0.38 and a significant P-value <0.004 for depth measurements. CM from breast cancers could be differentiated from ecstatic vessels on 3D-reconstructed OCT image. LIMITATION: Small sample size and lack of clinical mimickers. CONCLUSION: RCM-OCT can detect CM and has potential in aiding non-invasive diagnosis and management.

Pathology of the carotid space.

The complex anatomy of the carotid space within a small confined area is unique to the head and neck and allows for a vast array of pathology. This paper will review the anatomy of the carotid space from the skull base to the thorax, defining its borders at multiple levels, as well as its contents. The paper will also describe the myriad of mass lesions and vascular pathologies that may occur within the carotid space. The discussion will include anatomic considerations in differential diagnoses, imaging features, and lesion characteristics across multiple imaging modalities including CT, MRI, ultrasound, and conventional angiography. Entities discussed include paragangliomas, nerve sheath tumors, meningioma, fibromuscular dysplasia, carotidynia, thrombus, dissection, pseudoaneurysm, and pathology of the deep cervical chain lymph nodes. Understanding the complex and unique anatomy of the carotid space, as well as the nuances of navigating a broad differential, will empower the reader to make an accurate diagnosis.

Leber congenital amaurosis associated with Chiari I malformation: Two cases and a review of the literature.

OBJECTIVE: Leber congenital amaurosis (LCA) is a rare, clinically and genetically heterogeneous disorder characterized by severe loss of vision in the first year of life, affecting approximately 3000 people in the United States. Some LCA patients manifest developmental abnormalities of the central nervous system (CNS) and neuroradiological studies have revealed a variety of cerebral anomalies in association with LCA; however, Chiari I malformations (CMI) have never been described. CASE DESCRIPTION: We report two sisters who were referred to the pediatric neurosurgery clinic for evaluation of CMI. The elder sister presented with convergence nystagmus from 3 months of age and magnetic resonance imaging (MRI) demonstrated evidence of significant CMI. Her younger sister began developing nystagmus at 4 months of age. Both had symptomatic progression and underwent suboccipital decompression. Both were subsequently diagnosed with LCA. Case specifics and imaging findings are presented. CONCLUSIONS: CMI have been found in association with several genetic syndromes, but not with LCA. These patients represent the first reported cases of CMI with LCA and suggest an additional potential CNS anomaly. The unique occurrence in siblings and the association with another inherited disorder are suggestive of a genetic basis for CMI.