ABSTRACT
During routine blood work, a 53-year-old female patient was noted to have asymptomatic hypercalcemia and subsequently found to have hyperparathyroidism. Localization studies for a suspected parathyroid adenoma included 99mTc Sestamibi scintigraphy, Single Photon Emission Computed Tomography (SPECT)/computed tomography (CT) study, and ultrasound of the neck, which were initially read as negative for parathyroid adenoma. A contrast-enhanced CT scan of the neck was performed to locate the suspected parathyroid adenoma and demonstrated a soft tissue lesion within the right piriform sinus. Flexible fiber optic nasolaryngoscopy revealed a submucosal lesion in the right piriform sinus. Following these findings, the initial 99mTc Sestamibi scintigraphy and SPECT/CT were reviewed with confirmation of a focal area of increased activity superior to the right thyroid lobe, corresponding to a nodule in the right piriform sinus that demonstrated increased activity on SPECT/CT. The patient was brought to the operating room for surgical management where a laryngoscope and operating microscope were utilized. The encapsulated lesion was dissected and excised in total. The parathyroid hormone and ionized calcium levels normalized postoperatively. Pathology confirmed a parathyroid adenoma. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. Sixteen percent of parathyroid adenomas can be situated in an ectopic location. Ectopic parathyroid adenomas in the piriform sinus are rare with only a few previously documented cases. We document a rare case of ectopic parathyroid adenoma in the piriform sinus overlooked on initial imaging studies. These lesions can be challenging to localize, however, an understanding of embryology, close scrutiny of possible ectopic locations, and the application of complementary imaging techniques may prove useful for surgeons and clinicians.
Subject(s)
Adenoma/pathology , Choristoma/pathology , Parathyroid Glands , Pharyngeal Neoplasms/pathology , Pyriform Sinus/pathology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: Radiologic assessment of mandibular bone invasion is critical in evaluating the extent of bone resection required in patients with oral cancer. There are a few reports of improved sensitivity with cone-beam CT (CBCT) over conventional CT. METHODS: A prospective cohort study of patients with oral squamous cell carcinomas adjacent to the mandible requiring marginal or segmental mandibular resection was performed. Patients were treated based on clinical assessment and conventional cross-sectional imaging. Patients and surgeons were blinded to the results of CBCT performed preoperatively. Pathologic examination served as the gold standard. RESULTS: Forty-five patients were included in the study. Thirty-three percent of the patients underwent segmental mandibulectomy and 37% had bone invasion. The sensitivity and specificity of CBCT were 91% and 60%, respectively, compared to 86% and 68% for CT with bone windows. CONCLUSION: A CBCT offers marginally improved sensitivity at the cost of reduced specificity for assessment of bone invasion compared to CT.
Subject(s)
Carcinoma, Squamous Cell/pathology , Head and Neck Neoplasms/pathology , Mandibular Neoplasms/secondary , Mouth Neoplasms/pathology , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/diagnostic imaging , Cohort Studies , Female , Head and Neck Neoplasms/diagnostic imaging , Humans , Male , Mandible/pathology , Mandible/surgery , Mandibular Neoplasms/diagnostic imaging , Mandibular Neoplasms/surgery , Mandibular Osteotomy/methods , Middle Aged , Mouth Neoplasms/diagnostic imaging , Neoplasm Invasiveness , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity , Squamous Cell Carcinoma of Head and NeckABSTRACT
Pituitary adenomas presenting in uncommon anatomical locations are commonly misdiagnosed. Dramatic clinical presentation with hemorrhage and infarction, along with a lack of endocrine symptoms may further confound the diagnosis in some patients as illustrated in one of our two previously reported cases of non-small cell neuroendocrine carcinoma of the sinonasal tract and nasopharynx. This report presents the clinical progress of case number 2, which has a revised diagnosis of giant lactotroph pituitary adenoma. Common clinical, radiological and pathological pitfalls in diagnosis of neuroendocrine neoplasms of the sinonasal tract and base of skull are discussed.
Subject(s)
Carcinoma, Neuroendocrine/diagnosis , Paranasal Sinus Neoplasms/diagnosis , Pituitary Neoplasms/diagnosis , Prolactinoma/diagnosis , Adult , Carcinoma, Neuroendocrine/pathology , Diagnostic Errors , Humans , Male , Paranasal Sinus Neoplasms/pathology , Pituitary Neoplasms/pathology , Prolactinoma/pathology , Skull Base Neoplasms/diagnosis , Skull Base Neoplasms/pathologyABSTRACT
OBJECTIVE: To demonstrate subacute progression of brain atrophy (from 4.5-29mo postinjury) in moderate to severe traumatic brain injury (TBI) using structural magnetic resonance imaging (MRI). DESIGN: Within-subjects, repeated-measures design. SETTING: Inpatient neurorehabilitation program and teaching hospital (MRI department). PARTICIPANTS: Adults (N=14) with moderate to severe TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Neuroradiologist readings and volumetric measurements (total brain cerebrospinal fluid and hippocampus) at 4.5 months and 2.5 years postinjury. RESULTS: Ten of 14 patients showed visible atrophy progression. Significant increase in cerebrospinal fluid (CSF) volume (t(13)=-4.073, P<.001) and decrease in right and left hippocampal volumes (t(13)=4.221, P<.001 and t(13)=3.078, P<.005, respectively) were observed from 4.5 months to 2.5 years. Compared with published normative data, patients with TBI showed significantly more pathologic percent annual volume change for the hippocampi (t(26)=-3.864, P<.001, right; and t(26)=-2.737, P<.01, left), and a trend for CSF (t(26)=1.655, P=.059). CONCLUSIONS: This study provides strong MRI evidence for subacute progression of atrophy, as distinct from early, acute neurologic changes observed.