Odontogenic myxoma: A case report of a rare tumor.

Odontogenic myxoma is a rare and aggressive tumor. Identifying the tumor based on imaging characteristics can pose a challenge due to similarities in features with other tumors, such as ameloblastomas and aneurysmal bone cysts. We report a 33-year-old female who presented with a palpable, tender mass in the lower right jaw. A computed tomography scan revealed a multicystic tumor which was proved to be an odontogenic myxoma. The patient underwent partial surgical resection followed by CO2 laser-assisted evaporation. During 1-year follow-up, the patient showed satisfactory results and no signs of tumor growth. This case report highlights the diagnostic challenges associated with odontogenic myxoma, emphasizing age as a key diagnostic feature.

Prevalence and risk factors of unruptured intracranial aneurysms in ischemic stroke patients - A global meta-analysis.

Background: Unruptured intracranial aneurysms (UIAs) have an estimated global prevalence of 2.8% in the adult population; however, UIA was identified among more than 10% of ischemic stroke patients. Many epidemiological studies and reviews have pointed to the presence of UIA among patients with ischemic stroke; yet, the extent of this association is not fully known. We performed a systematic review and meta-analysis to determine the prevalence of UIA in patients admitted to hospitals with ischemic stroke and transient ischemic attack (TIA) at both global and continental levels and evaluate factors associated with UIA in this population. Methods: We identified, in five databases, all studies describing UIA in ischemic stroke and TIA patients between January 1, 2000, and December 20, 2021. Included studies were of observational and experimental design. Results: Our search yielded 3581 articles of which 23 were included, with a total of 25,420 patients. The pooled prevalence of UIA was 5% (95% confidence interval [CI] = 4-6%) with stratified results showing 6% (95% CI = 4-9%), 6% (95% CI = 5-7%), and 4% (95% CI = 2-5%) in North America, Asia, and Europe, respectively. Significant risk factors were large vessel occlusion (odds ratios [OR] = 1.22, 95% CI = 1.01-1.47) and hypertension (OR = 1.45, 95% CI = 1.24-1.69), while protective factors were male sex (OR = 0.60, 95% CI = 0.53-0.68) and diabetes (OR = 0.82, 95% CI = 0.72-0.95). Conclusion: The prevalence of UIA is notably higher in ischemic stroke patients than the general population. Physicians should be aware of common risk factors in stroke and aneurysm formation for appropriate prevention.

Reduced versus standard dose contrast volume for contrast-enhanced abdominal CT in overweight and obese patients using photon counting detector technology vs. second-generation dual-source energy integrating detector CT.

PURPOSE: To compare image quality of contrast-enhanced abdominal-CT using 1st-generation Dual Source Photon-Counting Detector CT (DS-PCD-CT) versus 2nd-generation Dual-Source Energy Integrating-Detector CT (DS-EID-CT) in patients with BMI ≥ 25, applying two different contrast agent volumes, vendor proposed protocols and different virtual monoenergetic images (VMI). METHOD: 68 overweight (BMI ≥ 25 kgm2) patients (median age: 65 years; median BMI 33.3 kgm2) who underwent clinically indicated, portal-venous contrast-enhanced abdominal-CT on a commercially available 1st-generation DS-PCD-CT were prospectively included if they already have had a pre-exam on 2nd-generation DS-EID-CT using a standardized exam protocol. Obesity were defined by BMI-calculation (overweight: 25-29.9, obesity grade I: 30-34.9; obesity grade II: 35-39.9; obesity grade III: > 40) and by the absolute weight value. Body weight adapted contrast volume (targeted volume of 1.2 mL/kg for the 1st study and 0.8 mL/kg for the 2nd study) was applied in both groups. Dual Energy mode was used for both the DS-PCD-CT and the DS-EID-CT. Polychromatic images and VMI (40 keV and 70 keV) were reconstructed for both the DS-EID-CT and the DS-PCD-CT data (termed T3D). Two radiologists assessed subjective image quality using a 5-point Likert-scale. Each reader drew ROIs within parenchymatous organs and vascular structures to analyze image noise, contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). RESULTS: Median time interval between scans was 12 months (Min: 6 months; Max: 36 months). BMI classification included overweight (n = 10, 14.7 %), obesity grade I (n = 38, 55.9 %), grade II (n = 13, 19.1 %) and grade III (n = 7, 10.3 %). The SNR achieved with DS-PCD-CT at QIR level 3was 12.61 vs. 11.47 (QIR 2) vs. 10.53 (DS-EID-CT), irrespective of parenchymatous organs. For vessels, the SNR were 16.73 vs. 14.20 (QIR 2) vs. 12.07 (DS-EID-CT). Moreover, the obtained median noise at QIR level 3 was as low as that of the DS-EID-CT (8.65 vs. 8.65). Both radiologists rated the image quality higher for DS-PCD-CT data sets (p < 0.05). The highest CNR was achieved at 40 keV for both scanners. T3D demonstrated significantly higher SNR and lower noise level compared to 40 keV and 70 keV. Median CTDIvol and DLP values for DS-PCD-CT and DS-EID-CT were 10.90 mGy (IQR: 9.31 - 12.50 mGy) vs. 16.55 mGy (IQR: 15.45 - 18.17 mGy) and 589.50 mGy * cm (IQR: 498.50 - 708.25 mGy * cm) vs. 848.75 mGy * cm (IQR: 753.43 - 969.58 mGy * cm) (p < 0.001). CONCLUSION: Image quality can be maintained while significantly reducing the contrast volume and the radiation dose (27% and 34% lower DLP and 31% lower CDTIvol) for abdominal contrast-enhanced CT using a 1st-generation DS-PCD-CT. Moreover, polychromatic reconstruction T3D on a DS-PCD-CT enables sufficient diagnostic image quality for oncological imaging.

Clinical and Radiological Characteristics to Differentiate Between EGFR Exon 21 and Exon 19 Mutations in Patients With Lung Adenocarcinoma: A Systematic Literature Review and Meta-Analysis.

Epidermal Growth Factor Receptor (EGFR) mutations in lung adenocarcinoma have been previously associated with specific clinical characteristics and Computed Tomography (CT) patterns. However, associations among individual EGFR mutations have not been evaluated. We aim to differentiate if the most common EGFR mutations (exon 21 and 19) are related to specific clinical characteristics or CT patterns. A systematic review and meta-analysis of 5 databases were conducted with literature from January 2002 to July 2021. Eligible studies were of an experimental or observational design that included lung adenocarcinoma patients with confirmed EGFR exon mutations (21 and 19) and associated clinical characteristics and CT imaging patterns. Quality was assessed using the QUADAS-2 tool. The association between clinical and CT patterns and EGFR exon mutations 21 and 19 was evaluated using odds ratios (OR) and then pooled and analyzed with a fixed or random-effects model. This study follows the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A total of 12 retrospective diagnostic accuracy studies were included. Pooled analysis showed that characteristics such as absence of smoking status (OR 1.29 [95% CI 0.97 - 1.70]), and female sex (OR 1.23 [95% CI 0.83 - 1.82]); and CT patterns such as Ground Glass Opacities (GGO) (OR 1.03 [95% CI 0.78 -1.34]), air bronchogram (OR 0.78 [95% CI 0.44 -1.39]), pleural retraction (OR 0.83 [95% CI 0.53 - 1.28]), and spiculation (OR 0.80 [95% CI 0.48 - 1.31]) were not significantly associated to a specific mutation. Specific EGFR exon 21 and 19 mutations cannot be differentiated through characteristics (absence of smoking status and female sex) or radiological patterns (GGO, air bronchogram, pleural retraction, and speculation). There is limited data to assess if early disease stage or vascular convergence aids in differentiating exon 21 from 19 mutations in patients with lung adenocarcinoma.

Advanced Lymph Node Staging With Ex Vivo Intra-arterial Indigo Carmine Injection After Transanal Total Mesorectal Excision for Rectal Cancer: A Retrospective Cohort Study.

BACKGROUND: Exact lymph node staging is essential in rectal cancer therapy. OBJECTIVE: The aim of the study was to assess the impact of intra-arterial indigo carmine injection after transanal total mesorectal excision on the number of retrieved lymph nodes. DESIGN: This was a retrospective, nonrandomized study. SETTINGS: The study was conducted at a tertiary hospital by a multidisciplinary team. PATIENTS: Patients who underwent transanal total mesorectal excision for suspected rectal cancer between 2013 and 2019 were included. INTERVENTIONS: Rectal cancer specimens received ex vivo intra-arterial indigo carmine injection to stain lymph nodes. MAIN OUTCOME MEASURES: Outcome measures included the number of retrieved lymph nodes with or without staining. RESULTS: Specimens of 189 patients were analyzed, of which 108 (57.1%) were stained with indigo carmine. A mean of 19.8 ± 6.1 lymph nodes was identified in stained samples compared to 16.0 ± 4.9 without staining ( p < 0.001). Multivariable analysis showed that 3.2 additional lymph nodes were found in stained specimens (95% CI: 1.0 to 5.3; p = 0.02). In stained specimens the adequate lymph node count (≥12) was increased in univariable (odds ratio: 3.24, 95% CI: 1.13 to 10.65; p = 0.03) but not in multivariable analysis. Indigo carmine injection had no effect on the number of positive lymph nodes or the nodal stage. Chemoradiotherapy reduced the lymph node count by 2.5 ( p = 0.008). After staining, 95.0% of patients with chemoradiotherapy had ≥12 lymph nodes retrieved. The median follow-up of patients was 24.2 months with a local recurrence rate of 3.3%. LIMITATIONS: The study is limited by its retrospective design and the nonrandomized allocation. CONCLUSIONS: Ex vivo intra-arterial indigo carmine injection increases the number of isolated lymph nodes after transanal total mesorectal excision regardless of neoadjuvant chemoradiotherapy. Indigo carmine injection is not associated with nodal upstaging or an increased number of tumor-positive lymph nodes. See Video Abstract at http://links.lww.com/DCR/B839 . ESTADIFICACIN AVANZADA DE LOS GANGLIOS LINFTICOS CON INYECCIN INTRAARTERIAL EX VIVO,DE NDIGO CARMN,DESPUS DE LA ESCISIN TOTAL DEL MESORRECTO POR VA TRANSANAL PARA CNCER DE RECTO UN ESTUDIO DE COHORTE RETROSPECTIVO: ANTECEDENTES:La estadificación exacta de los ganglios linfáticos es esencial en la tratamiento del cáncer de recto.OBJETIVO:El objetivo del estudio fue evaluar el impacto de la inyección intraarterial de índigo carmín después de la escisión total del mesorrecto por vía transanal con relación al número de ganglios linfáticos recuperados en el espécimen quirúrgico..DISEÑO:Estudio retrospectivo no aleatorizado.AJUSTE:El estudio se llevó a cabo en un hospital de tercer nivel por un equipo multidisciplinario.PACIENTES:Pacientes a quienes se les practicó escisión total del mesorrecto por vía transanal por sospecha de cáncer de recto entre 2013 y 2019.INTERVENCIONES:Al espécimen quirúrgico que se obtuvo, se le practicó inyección intraarterial ex vivo, de índigo carmín para teñir los ganglios linfáticos.PRINCIPALES MEDIDAS DE RESULTADO:El número de ganglios linfáticos recuperados con o sin tinción.RESULTADOS:Se analizaron muestras de 189 pacientes, de los cuales 108 (57,1%) fueron teñidos con índigo carmín. Se identificó una media de 19,8 ± 6,1 ganglios linfáticos en las muestras teñidas en comparación con 16,0 ± 4,9 sin tinción ( p < 0,001). El análisis multivariado mostró que se encontraron 3.2 ganglios linfáticos adicionales en las muestras teñidas (intervalo de confianza del 95%: 1,0 a 5,3; p = 0,02). En las muestras teñidas, el recuento adecuado de ganglios linfáticos (≥12) aumentó en el análisis univariado (razón de posibilidades: 3,24, intervalo de confianza del 95%: 1,13 a 10,65; p = 0,03) pero no en el multivariado. La inyección de índigo carmín no tuvo ningún efecto sobre el número de ganglios linfáticos positivos o el estadio ganglionar. La quimiorradioterapia redujo el recuento de ganglios linfáticos en 2,5 ( p = 0,008). Después de la tinción, en el 95,0% de los pacientes con quimiorradioterapia se recuperaron ≥12 ganglios linfáticos. La mediana de seguimiento de los pacientes fue de 24,2 meses con una tasa de recurrencia local del 3,3%.LIMITACIONES:El estudio está limitado por su diseño retrospectivo y la asignación no aleatoria.CONCLUSIONES:La inyección ex vivo de índigo carmín intraarterial aumenta el número de ganglios linfáticos aislados después de la escisión total del mesorrectal por vía transanal a pesar de la quimiorradioterapia neoadyuvante. La inyección de índigo carmín no se asocia con un aumento del estadio de los ganglios ni con un mayor número de ganglios linfáticos positivos para tumor. Consulte Video Resumen en http://links.lww.com/DCR/B839 . (Traducción-Eduardo Londoño-Schimmer ).

Fournier's Gangrene With Retroperitoneal Extension as the First Manifestation of the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS).

Fournier's gangrene (FG) is an atypical, life-threatening polymicrobial infection characterized by the rapid destruction of soft tissue, predominantly in the perineal region. Retroperitoneal spread of FG represents an uncommon condition described in a few case reports, and its presentation as the first manifestation of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is even more infrequent. Here, we present the case of a 40-year-old male who was admitted to the emergency department with a low-grade fever of 37.8°C, abdominal pain, and four-day history of sharp, bilateral testicular pain and swelling. On physical examination, the patient was hypotensive with necrotic tissue in the perineum. A computed tomography study displayed an extensive retroperitoneal spread of suspected FG. Due to the massive spread of the infection, an HIV test was requested, yielding positive results, which indicated that HIV/AIDS had first manifested as FG with retroperitoneal extension. This is an extremely rare initial presentation of HIV/AIDS. To treat the patient and address the severe necrosis, a peritoneal lavage, surgical debridement, right orchiectomy, and colostomy were performed. After the procedure, antiretroviral therapy was established with tenofovir, emtricitabine, and efavirenz.