Simple dichotomous assessment of cranial artery inflammation by conventional 18F-FDG PET/CT shows high accuracy for the diagnosis of giant cell arteritis: a case-control study.

PURPOSE: To estimate the diagnostic accuracy of conventional 18F-FDG PET/CT of cranial arteries in the diagnosis of giant cell arteritis (GCA). METHODS: The study was a retrospective case-control study. The reference diagnosis was fulfillment of the 1990 ACR criteria for GCA. All patients had new-onset GCA. Conventional 18F-FDG PET/CT was performed before glucocorticoid treatment. Controls were age- and sex-matched patients with a previous history of malignant melanoma (MM) undergoing surveillance PET/CT >6 months after MM resection. PET images were evenly cropped to include only head and neck and were assessed in random order by four nuclear medicine physicians blinded to reference diagnosis. Temporal (TA), maxillary (MA) and vertebral (VA) arteries were visually rated for 18F-FDG uptake. Interreader agreement was evaluated by Fleiss kappa. RESULTS: A total of 44 patients and 44 controls were identified. In both groups, the mean age was 69 years (p = 0.45) and 25/44 were women. 35/41 GCA patients were temporal artery biopsy positive (TAB). Considering only FDG uptake in TA and/or MA, diagnostic sensitivity and specificity was 64 and 100%. Including VA, sensitivity increased to 82% and specificity remained 100%. Interreader agreement was 91% and Fleiss kappa 0.82 for the PET diagnosis based on the cranial arteries. CONCLUSION: Conventional 18F-FDG PET/CT is an accurate and reliable tool to diagnose cranial arteritis in glucocorticoid-naïve GCA patients. The high diagnostic specificity suggests that TAB can be omitted in patients with 18F-FDG uptake in cranial arteries. 18F-FDG PET/CT performed in patients with suspected vasculitis should always include the head and neck.

Non-melanoma skin cancer excision with frozen section histology.

INTRODUCTION: We aimed to determine any risk factors associated with 12-month recurrence and non-radical tumour excision of non-melanoma skin cancer where the tumour has been excised with intraoperative, frozen-section (FS) histopathological assessment; and to examine if FS histopathological assessment may be recomended in certain patient categories. METHODS: The study was a single-centre retrospective cohort study based on information obtained from patient charts on those treated primarily with FS-aided excision in the 2017-2019 period. A multiple logistic regression model was used to identify risk factors related to non-radical excision. RESULTS: A total of 655 patients were included; 521 patients presented with basal cell carcinoma (BCC) and 134 patients presented with squamous cell carcinoma (SCC). Superficial, morpheaform and infiltrative BCC subtypes were less likely to be radically excised at first surgical removal than were nodular BCC - most significantly for infiltrative BCC with odds ratio (OR) = 0.48 (95% confidence interval (CI): 0.29-0.77), p less-than 0.01. BCC on the ear was less likely to be excised completely at primary surgery than were tumours in the face, OR = 0.33 (95% CI: 0.16-0.68, p = 0.002). No significant correlation was found for SCC between complete excision and tumour characteristics. CONCLUSION: Our study suggests that compared with patients with nodular BCC, patients with superficial, morpheaform and especially infiltrative BCC tumours may require FS. Non-radical BCC removal is more frequent on the ear, and FS should generally be considered in this location since delayed re-excision is undesirable. FUNDING: none. TRIAL REGISTRATION: not relevant.

[Treatment of traumatic injuries of the peripheral facial nerve].

This review summarises the current knowledge of treatment strategies in traumatic extracranial facial nerve injuries. Facial nerve injuries cause significant psychologic and functional morbidity. We present a guideline for the clinical management including physical examination and surgical treatment. To regain mimetic function after facial nerve injuries it is crucial to ensure that microsurgical reconstruction is completed preferably within 24 hours, and no later than 72 hours from the time of accident.

[Microsurgical reconstruction after traumatic lesion of the peripheral facial nerve].

In this case report, a 17-year-old female underwent microsurgical exploration and neurorrhaphy after a glass pane accident resulting in traumatic lesion of the right temporal facial nerve branch. Nine months after reconstruction she had regained function of the frontalis muscle. When patients with traumatic facial nerve injuries are admitted to hospital, it is crucial to consult with a microsurgical center to ensure that reconstruction is completed within 24-72 hours from the time of accident to regain mimetic function.

[Breast implant-associated anaplastic large cell lymphoma].

Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a serious complication in patients with breast implants. In this case report, a 38-year-old woman who was diagnosed with BIA-ALCL presented with seroma in her left breast eight years after her breast implantation surgery. The purpose of this case report is to draw attention to the fact that "late-onset" seroma in patients with breast implants can be a sign of malignancy. A multidisciplinary approach in the diagnosis and treatment of these patients is important. Manifestations, investigation and management of the disease are reviewed.

[Diagnostics and treatment of lipomas].

In this case report, a woman of 55 years suddenly developed foot pain and swelling 13 years after treatment for breast cancer. X-ray was found to be normal, and the symptoms were in three months interpreted as ligamentous sprains. Due to persistent pain and functional impairment together with a renewed X-ray suspicious for malignancy, an MRI scan was performed and signs of malignancy were confirmed. A biopsy from talus showed metastasis from a breast carcinoma, and the patient was treated with an amputation.

[Ipilimumab treatment of metastatic melanoma]. / Ipilimumab til behandling af metastaserende melanoma.

Until recently metastatic melanoma was a disease with limited treatment options and a poor prognosis. However, new promising products have been developed. Ipilimumab, a full human anti-cytotoxic T-lymphocyte antigen-4 antibody, has shown improved survival in several clinical trials and is now a part of the standard treatment options for this disease in Denmark. In this case report we present a 78-year-old man with metastatic melanoma who had complete remission after treatment with ipilimumab.

[Post-traumatic dislocation of the ulnar nerve in the cubital tunnel]. / Posttraumatisk dislokation af nervus ulnaris i kubitalkanalen.

Traumatic luxation of the ulnar nerve is not uncommon (the incidence is 16.2%). The aetiologies are congenital, fracture of the medial epicondyle or from a luxation of the elbow. Complications such as friction neuritis or neuropalsy may be seen. Deep intramuscular implantation seems superior to subcutaneous replacement of the nerve. In a 45-year-old woman with a continuous history of neuropalsy of the ulnar nerve, the injury was successfully treated with deep implantation of the nerve into its cubital groove.

[Giant metastatic melanoma arising from an unknown primary site]. / Kæmpemetastase ved malignt melanom med ukendt primær lokalisation.

Metastatic melanoma arising from an unknown primary site (MUP) accounts for 1-8% of all melanomas. MUP is characterized by a better survival compared to a melanoma with known primary site. We report a case with a 55-year-old male with MUP and a 1.7 kg axillary lymph node metastasis, which was successfully excised. The patient was fully functional and alive 12 months after surgery. The reported favorable post-operative long-term survival of patients with MUP supports that these patients should be treated with an aggressive surgical approach with curative intent.

Primary cutaneous myoepithelial carcinoma: a case report and review of the literature.

This study describes a case of primary myoepithelial carcinoma of the skin and reviews the available literature on this topic. Myoepitheliomas and carcinomas arise most frequently from myoepithelial cells within the salivary glands but are found in many anatomical locations. We documented a case of an 80-year-old man with a 2 × 2 × 1 cm tumour located on the scalp. This tumour emerged over a period of 2 months. The tumour was radically excised, and histological examination revealed a cutaneous myoepithelial carcinoma. At an 18-month follow-up, no recurrence of the tumour was found. A systematic literature search identified 23 papers that reported 58 cases of cutaneous myoepitheliomas and myoepithelial carcinomas. All cases are reviewed in the presented paper. This case report and literature review serves to increase awareness regarding myoepithelial carcinomas. These tumours exhibit high metastatic potential, and it is thus very important to perform radical surgery.

[Arsenical keratosis treated by dermatome shaving].

Cutaneous malignancy in association with arsenic exposure is a rare but well-documented phenomenon. Signs of chronic arsenic exposure are very rare in Denmark today. However, arsenic was used in the medical treatment of psoriasis vulgaris up till the 1980's and several patients suffer from this arsenic treatment today. This case report shows that arsenical keratosis can be treated by dermatome shaving, a superficial destructive therapy.

[Fat transplantation for postoperative cicatricial pain relief]. / Fedttransplantation som smertebehandling ved kroniske smerter fra arvæv.

This case report presents a successful treatment with fat transplantation to painful scar tissue in the neck and back region after excision of a proliferative myositis (pseudosarcoma) and reconstruction with a trapezius flap in 1983. The patient had chronic pain, social disabilities and a visual analogue scale (VAS) score of 8 preoperatively. At a postoperative control six months later the patient experienced no pain any longer, the VAS score was 1 and he was working full time.