RESUMEN
An aneurysmal bone cyst is a locally destructive benign lesion that predominately affects the long bones. Sphenoid body involvement is rare. To date, only 19 primary aneurysmal bone cysts of the sphenoid body have been reported. We describe the case of an 18-year-old male with a one-week history of severe right eye pain and lacrimation, right-sided diplopia, right-sided headache, photophobia, nausea, and vomiting. Magnetic resonance imaging (MRI) demonstrated a lobulated lesion centered in the sphenoid body with expansion into the cavernous sinus, sellar region, and clivus. The lesion had a homogenous hyperintense T2 signal with enhancing sidewalls and minimal septations. Computed tomography (CT) angiography revealed a hypoattenuating lesion containing a substance of nine Hounsfield units, compatible with water density. The clinicoradiologic findings were consistent with a craniopharyngioma. Intraoperatively, the lesion was confirmed to contain clear fluid and have prominent arterial feeding vessels. The extradural tumor was then excised with intralesional curettage. The histopathologic analysis resulted in a diagnosis of an aneurysmal bone cyst. This case highlights the potentially non-specific and variable appearance of aneurysmal bone cysts and the need to consider it in the differential diagnosis of sphenoid bone lesions.
RESUMEN
INTRODUCTION: Lingual squamous cell carcinoma (LSCC) is an aggressive malignancy that carries significant mortality risk and the potential for cardiac metastasis. The authors performed a systematic review designed to characterize disease progression of LSCC cardiac metastasis by evaluating patient demographics, characteristics, management, and clinical outcomes. METHODS: Two authors independently screened articles in Embase, PubMed, and Cochrane Database of Systematic Reviews up until December 2019 for study eligibility. Demographic data, patient symptomatology, imaging findings, management strategies, and patient outcomes were obtained and analyzed. The Oxford Centre for Evidence Based Medicine (OCEBM) Levels of Evidence categorization was implemented to determine the quality of studies selected in this review. RESULTS: From this review, a total of 28 studies met inclusion criteria and received an OCEBM Level 4 evidence designation. Thirty-one patients were identified with cardiac metastasis from LSCC. Shortness of breath (29.0%) and chest pain (29.0%) were the most common presenting symptoms, and pericardial effusion (29.2%) and right ventricular outflow tract obstruction (25.0%) were the predominant echocardiogram findings. Cardiac metastases most often presented in the right ventricle (56.7%), followed by the left ventricle (43.3%). Palliative intervention (68.2%) or chemotherapy (40.9%) were typically implemented as treatments. All sample patients expired within one year of metastatic cancer diagnosis in cases that reported mortality outcomes. CONCLUSIONS: Patients presenting with shortness of breath, tachycardia, and a history of squamous cell carcinoma of the tongue may indicate evaluation for LSCC cardiac metastasis. Although LSCC cardiac metastases typically favor the right and left ventricles, they are not exclusive to these sites. Palliative care may be indicated as treatment due to high mortality and overall poor outcomes from current interventions.
