Bilateral hypertrophy of masseteric and temporalis muscles, our fifteen patients and review of literature.

OBJECTIVE: The association of bilateral hypertrophy of temporalis and masseteric muscles is a rare clinical entity. The origin of the condition is unclear, causing cosmetic problems, pain, and functional impairment. PATIENTS AND METHODS: In this paper we analyzed 15 patients treated at the Department of Maxillo-Facial Surgery of the University of Naples Federico II, from 2000 to 2013, for temporalis and/or masseteric muscle hypertrophy, and in particular, a rare case of a patient with a marked bilateral swelling of the temporalis and masseteric region, in conjunction with a review of the literature. RESULTS: Fourteen patients have not any kind of postoperatively problems. The last patient had been aware of the swelling for many years and complained of recurrent headaches. We adopted a new protocol fort this patients and the patient was very pleased with the treatment results, and reported a reduction in headaches and a continuation of his well-being, in addition to greater self-confidence. The last follow-up was performed three years after the first treatment, and the patient showed a complete resolution of his symptoms, and just a small increase of the swelling. CONCLUSIONS: The treatment of temporalis and masseteric hypertrophy with Botulin toxin could be an effective option compared to conservative treatment or surgical intervention, although the review of the literature shows that this is only a temporary treatment. In fact, surgery still remains the best option. The treatment must be repeated every 4/6 months for 2-3 consecutive years before having stable benefits. To overcome this problem, an association with a bite treatment allowed us to achieve more lasting and more stable results over time without a recurrence of symptoms between the treatments. Furthermore, this association has enabled us to obtain a more rapid reduction of the hypertrophy.

Early detection of encephalitis with (18)F-FDG PET/CT.

Encephalitis is a relatively rare condition for which making an accurate diagnosis can be challenging. In fact, clinical features are not specific and structural imaging can be normal in a considerable number of cases. However, an early diagnosis is important as many forms of treatment are effective if started promptly. Even though recent guidelines do not recommend (18)F-FDG PET/CT for patients with suspected encephalitis, the case presented suggests that (18)F-FDG PET/CT may play a relevant role for the early diagnosis of this clinical condition.

[Aggressive digital papillary adenocarcinoma: a case report]. / Adenocarcinoma digitale papillare aggressivo: descrizione di un caso.

AIM: We describe a case of Aggressive Digital Papillary Adenocarcinoma, a rare skin neoplasm with acral location. RESULTS: The patient, a 66 year old man, presented with an ulcerated mass of the fifth toe of the left foot, 4.4 cm in size. Histologically the tumour was characterized by a solid-cystic structure, with extensive papillary component, comedo necrosis and focal eccrine differentiation. Immunohistochemistry showed diffuse positivity for cytokeratins AE1/AE3 and 7, and, focal staining for Muscle Specific Actin, Vimentin and EMA. Chest CT scan showed the presence of a single pulmonary node, whose cytological features were consistent with a metastatic disease. CONCLUSIONS: The clinico-pathological features of the present are similar to those previously reported in the literature and confirms the aggressive nature of this neoplasm.

Endometriosis on laparotomy scar. A three-case report.

Endometriosis of surgical scar is a rare late complication of cesarean section. 3 cases of endometriosis after Pfannenstiel-type laparotomy are reported. The typical surgical presentation, present in all 3 cases, is a nodule on laparotomy scar after cesaren section, spontanously painful during the menstrual period. Ultrasound, performed in two cases, and cytological examination, performed in one, proved to be ineffective in establishing the diagnosis. The histopathological analysis of surgical specimens revealed in all cases multiple foci of well developed endometrial tissue scattered in a sclerotic stroma. Both stromal and glandular components of the endometrial mucosa were present showing the typical changes of the various phases of the menstrual cycle. In our opinion, an accurate clinical history should directly lead the surgeon to the excision with inclusion of the needle tract, whenever biopsy is performed. Surgical excision is at present the most appropriate diagnostic and therapeutic procedure.