Osteosarcoma of the temporal bone occurring 40 years after radiotherapy: A technical case report presenting en bloc resection of intra- and extracranial lesions followed by a one-stage reconstruction.

BACKGROUND: Osteosarcoma (OS) is a malignant tumor of the bone, which rarely occurs in the head-and-neck regions as a primary or a secondary malignancy. Adequate surgical resection is currently the mainstay of treatment for head-and-neck OS; however, en bloc resection and reconstruction can be difficult because the anatomies of these regions are complex. We present a case of an OS arising from the temporal bone 40 years after radiation therapy, which was successfully treated with en bloc resection and a one-stage reconstruction using intraoperative tissue expansion technique. CASE DESCRIPTION: A 62-year-old woman who underwent surgery and radiotherapy for a left temporal lesion 40 years before presentation was hospitalized for aphasia and a right hemiparesis. She had a 4 × 3 cm subcutaneous mass in the left temporal area of the head. Computed tomography imaging showed destruction of the left temporal bone and a partially calcified mass. Magnetic resonance imaging showed an enhancing mass with intracranial and extracranial cystic components (5 cm and 3 cm in diameter, respectively). Due to rapid growth of the lesion, a semi-urgent surgery was performed. In this operation, a continuous narrow craniectomy was performed around the tumor using a ruler. Then, en bloc resection of the tumor, with adjacent skin, temporal muscle, skull, dura mater, and cerebral cortex, was achieved. Subsequently, a one-stage reconstruction of the dura mater, skull, and skin of the head was performed using fascia lata, artificial bone, and a local skin flap combined with intraoperative tissue expansion using a 20-French Foley catheter. Postoperative histological examinations revealed the tumor to be an OS. CONCLUSION: We have presented a rare case of an OS occurring from the temporal bone 40 years after radiation therapy. We describe our experience and the surgical methods in this case to provide options for surgical strategies in patients with head-and-neck OS.

Observation of Microstructure Formation During Freeze-Drying of Dextrin Solution by in-situ X-ray Computed Tomography.

In-situ X-ray computed tomography (CT) was used to observe microstructure formations during freeze-drying of a dextrin solution. A specially designed freeze-drying stage was equipped at the X-ray CT stage. Frozen and dried microstructures were successfully observed. The CT images of the frozen solution clarified the ice crystal size increase and obvious boundary formation between the ice and freeze-concentrated phases upon performing post-freezing annealing at -5°C. These structural modifications emerged owing to Ostwald ripening and glassy phase relaxation. During the freeze-drying, pore microstructures formed as a consequence of water removal. The pores were replicas of the original ice microstructures; some pore microstructures newly formed by the removal of water. The latter mechanism was more obvious in the non-annealed sample than in the annealed sample. The glassy phase in the non-annealed solution was not perfectly freeze-concentrated; water was rapidly removed from this phase, losing its original microstructure. At this moment, the freeze-concentrated region piled up to new pore walls, which consequently thickened the pore walls. An image analysis estimated that the mean pore wall thicknesses for the non-annealed and annealed samples were 13.5 and 8.6 µm, respectively. It was suggested that the advantages of annealing are not only to reduce drying time owing to the modification of ice crystal morphologies but also to avoid quality loss related to the structural deformation of the glassy matters.

Observation of glassy state relaxation during annealing of frozen sugar solutions by X-ray computed tomography.

Glassy phase formation in a frozen product determines various properties of the freeze-dried products. When an aqueous solution is subjected to freezing, a glassy phase forms as a consequence of freeze-concentration. During post-freezing annealing, the relaxation of the glassy phase and the ripening of ice crystals (i.e. Ostwald ripening) spontaneously occur, where the kinetics are controlled by the annealing and glass transition temperatures. This study was motivated to observe the progress of glassy state relaxation separate from ice coarsening during annealing. X-ray computed tomography (CT) was used to observe a frozen and post-freezing annealed solutions by using monochromatized X-ray from the synchrotron radiation. CT images were successfully obtained, and the frozen matrix were analyzed based on the gray level values that were equivalent to the linear X-ray attenuation coefficients of the observed matters. The CT images obtained from rapidly frozen sucrose and dextrin solutions with different concentrations gave clear linear relationships between the linear X-ray attenuation coefficients values and the solute concentrations. It was confirmed that the glassy state relaxation progressed as increasing annealing time, and this trend was larger in the order of the glass transition temperature of the maximally freeze-concentrated phase. The sucrose-water system required nearly 20 h of annealing time at -5 °C for the completion of the glassy phase relaxation, whereas dextrin-water systems required much longer periods because of their higher glass transition temperatures. The trends of ice coarsening, however, did not perfectly correspond to the trends of the relaxation, suggesting that the glassy phase relaxation and Ostwald ripening would jointly control the ice crystal growth/ripening kinetics, and the dominant mechanism differed by the annealing stage.

Cholecystectomy in a heifer.

A 10-month-old female Japanese black heifer presenting with sudden loss of appetite was diagnosed with extreme extension of the gallbladder. Laparotomy reaching from the right part of the 10th rib to the right flank showed an extended gallbladder greater than 50 cm in diameter. Cholecystectomy was performed as follows: 1) complete removal of the gallbladder distally from the base; 2) flushing via a catheter inserted into the common bile duct; and 3) covering of the hole opened in the common bile duct with a double-suturing method using the mucous membrane and muscular layers of the remaining gallbladder structures. Serum levels of total bilirubin gradually decreased from 7.5 mg/dl preoperatively to 4.7 mg/dl, 1.6 mg/dl and 0.6 mg/dl at 3, 8 and 34 days postoperatively, respectively. The heifer showed 1 month of clinical improvements, grew normally and finally became pregnant. To the best of our knowledge, this represents the first clinical report to describe cholecystectomy in cattle.

Nasal tissue-derived hamartoma in the maxillary gingiva of a calf.

BACKGROUND: All of oral hamartomas has been previously found in mandibular gingiva in younger calves, and were histologically diagnosed as a vascular hamartoma. This is the first case report describing a calf with a mass in the maxillary gingiva that was histologically diagnosed as a nasal tissue-derived hamartoma. CASE PRESENTATION: A 13-day-old male Holstein calf presented with a horn-like mass in the left rostral maxillary gingiva. Surgical removal revealed that the mass had a dual structure composed of cartilaginous and soft tissues and extended deeply toward the nasal cavity. Excised tissues mainly consisted of two types of mature cells without mitotic figures and atypia: 1) the cartilage-like structures consisted of an island and a meandering massive focus of mature cartilaginous tissues, and 2) tubular structures consisting of stratified ciliated mucosal columnar cells with gland-like structures and aggregated goblet cells. The mass was diagnosed as a nasal tissue-derived hamartoma because these two types of structures were histologically identical to nasal structures. The present case had no recurrence at 1 year after surgery. CONCLUSIONS: To our knowledge, this is the first description of the calf with nasal tissue-derived hamartoma in the maxillary gingiva.

Epstein-Barr virus-positive diffuse large B-cell primary central nervous system lymphoma associated with organized chronic subdural hematoma: a case report and review of the literature.

We here report on a rare case of Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) detected in both brain parenchyma and in an organized chronic subdural hematoma (OCSH). A 96-year-old man diagnosed with asymptomatic OCSH in the left frontal convexity was referred to our hospital because of a de novo mass lesion just beneath the OCSH on contrast-enhanced magnetic resonance imaging. The size of the OCSH remained stable. We diagnosed the lesion as a malignant tumor. At surgery, the organized hematoma and the soft fragile tumor were removed. Histological examinations revealed pleomorphic lymphoid cells not only in the brain tissue but also in the OCSH component with tumor necrosis, and these were immunopositive for B-cell markers. In situ hybridization revealed positive signals for EBV-encoded small RNAs, consistent with EBV-positive DLBCL. Since the membranes of the subdural hematoma were fibrous and the tumor progression resulted in necrosis of the tumor, the DLBCL may have originally developed in the OCSH and infiltrated into the brain parenchyma. We believe that this rare case provides crucial information for the understanding of DLBCLs associated with OCSH.

Thyroid Follicular Carcinoma in a Fourteen-year-old Girl with Graves' Disease.

Here we present the case of a 14-yr-old girl who developed thyroid follicular carcinoma accompanied by Graves' disease. She was diagnosed with Graves' disease at 10 yr of age and soon achieved a euthyroid state after starting treatment. When she was 13 yr of age, her hyperthyroidism and goiter worsened despite medical therapy. Multiple nodules were found in her enlarged thyroid gland by ultrasonography. Her serum Tg level seemed within the normal range. She underwent near-total thyroidectomy for control of thyroid function. Histopathological study demonstrated that multiple oxyphilic follicular neoplasms were surrounded by the thyroid tissue compatible with Graves' disease. Capsular invasion was identified in one of the nodules, and thus the histological diagnosis was minimally invasive follicular carcinoma. She did not have signs suggesting metastasis, and has had no relapse for 18 mo after the operation. Although some previous studies showed a high prevalence of thyroid cancer with an aggressive nature in adult patients with Graves' disease, few reports about thyroid cancer accompanied by Graves' disease are available in children. The present case, however, suggests that careful investigation is needed when we detect thyroid nodules or progressive thyroid enlargement, especially in children with Graves' disease.

Dedifferentiated liposarcoma of the spermatic cord with a hemangioendothelioma-like component: a case report and review of the literature.

Atypical lipomatous tumor or well-differentiated liposarcoma/dedifferentiated liposarcoma (DDLPS) is the most frequent subtype of malignant adipocytic tumor. This tumor typically presents in late adult life, most commonly in the retroperitoneum, extremities, or spermatic cord. It has been reported that the dedifferentiated component consists mainly of high-grade sarcoma, including undifferentiated pleomorphic sarcoma, fibrosarcoma, and myxofibrosarcoma, and it has been recently reported that the dedifferentiated component can be also made up of a low-grade sarcomatous component. Therefore, the dedifferentiated areas exhibit a wide morphological spectrum that commonly includes fibroblastic/myofibroblastic and fibrohistiocytic tumors but very rarely includes vascular tumors. We present here the first reported case of DDLPS with a hemangioendothelioma-like component in the spermatic cord.

So-called 'adenosarcoma' of the kidney a novel adult renal tumor with a cystic appearance.

We describe a novel cystic renal tumor consisting of benign epithelial and malignant stromal components in a 56-year-old woman who was admitted to hospital with macroscopic hematuria. Enhanced computed tomography revealed a multilocular 3.4 × 2.7-cm tumor in the center of the left kidney. After total left nephrectomy, the excised tumor appeared extensively cystic with a well defined border on the cut surface. Histologically, the tumor was composed of biphasic a benign epithelial lining on tubules or cysts with a typically hobnailed appearance, and anaplastic sarcomatous stroma with frequent mitosis. Periepithelial cuffing of the sarcoma cells was evident without an epithelial-stromal transition. Carcinomatous nests, blastemic elements, ovarian-like stroma or differentiated mesenchyme were not evident in the stroma. The epithelial cells were reactive with cytokeratins, epithelial membrane antigen (EMA), vimentin and transducin-like enhancer protein 1 (TLE1). Stromal cells were reactive with vimentin, CD99 and TLE1, partly reactive with CD34 and CD10, and non-reactive with cytokeratins, EMA, Wilm's tumor protein (WT-1), estrogen receptor (ER), progesterone receptor (PgR), CD57, HMB45 or Bcl2. SYT-SSX fusion gene was not detected with reverse transcription polymerase chain reaction. Because these findings did not coincide with established descriptions of cystic renal neoplasms, we preferred the term, 'adenosarcoma'. This could become a new classification for adult cystic renal tumors.