SIMPLE BONE CYST OF THE MANDIBLE: A CASE REPORT AND LITERATURE REVIEW

Simple bone cyst is a benign pseudo cystic cavity in the bone that is less commonly associated in the maxillofacial region. The other synonyms are traumatic bone cyst or idiopathic bone cyst. These cysts are devoid of an epithelial lining and usually contain straw-colored fluid or is empty. Simple bone cyst is mainly seen in young individuals, frequently during the first and second decade of life. Here we report a case of simple bone cyst of a mandibular anterior region in a 21-year-old patient.

Capillary Hemangioma of the Testis: A Case Report and Literature Review

Introduction/Objective Testicular capillary hemangioma is a rare benign vascular tumor and typically occurs in patients younger than 20 years. Study suggests that the mean age of these patients is usually 25.1 ± 22.7 years. We report a case of a 63-year-old man who underwent an uncomplicated radical orchiectomy for scrotal irritation and testicular fullness. Methods/Case Report Clinically he was found to have a large testicular mass. Ultrasound showed cystocele and an intratesticular tumor. Increased LDH was also found. Gross examination showed a single large cystic cavity containing yellow-colored fluid and a well-circumscribed tan-brown nodule measuring 2.5 × 1.8 × 1.0 cm within the testicular parenchyma. There was no extension into the tunica albuginea. Microscopic examination showed groups of capillaries of varying sizes in a lobular arrangement with bland spindle-like endothelial cells lining these capillary structures. The circumscribed vascular lesion was well-demarcated from the testicular parenchyma by a fibrous 0.1-cm pseudocapsule. The benign nature of this lesion was suggested by the lack of any mitotic activity, anaplasia, or dysplasia. Immunohistochemical staining was strongly positive for endothelial markers (CD31 and CD 34), and negative for mesothelial (WT1) and lymphatic markers (D2-40), excluding an adenomatoid tumor. Based on these characteristic morphological and immunohistochemical findings, the diagnosis of testicular capillary hemangioma was made. After 6 months of follow-up, the patient was well without any clinical evidence of recurrence. Results (if a Case Study enter NA) NA Conclusion While rarity of testicular capillary hemangioma impedes significant changes in how we approach adult testicular masses, the possibility of a benign tumor should always be in mind to consider. This is especially pertinent when patients fall outside the typical age range for germ-cell tumors, and for patients with a solitary testicular mass.

Plunging Ranula as Initial Manifestation of HIV-AIDS: A Case Report and Literature Review

Introduction: Ranulas are defined as the extravasation of mucus into an intraoral cystic cavity produced by an injury to the excretory ducts or the acini of the sublingual gland. Plunging ranulas are generated when the salivary collection penetrates the mylohyoid through a dehiscence of its fibers, invading the submandibular space. The close relationship between these lesions and HIV-AIDS infection has been reported since 2004, with a 75.88% rate of positive cases. The objective of this article is to present the management of patient with a plunging ranula, which made it possible to address the diagnosis of HIV-AIDS. Case Report: A 28-year-old male patient presented with a painless and fluctuating swelling in the laterocervical space and the floor of the mouth, which produced dysphagia and dyslalia. Serological tests for HIV were carried out and had a reactive result. Surgical treatment was performed via intraoral approach, with a favorable evolution at 12 months of follow-up. Conclusion: Ranulas, and particularly plunging ranulas, should be considered in the group of oral lesions associated with HIVAIDS infection, as they may even be the initial manifestation of the disease.

Decompression effects on bone healing in rat mandible osteomyelitis

Osteomyelitis (OM) of the jaw is usually caused by a chronic odontogenic infection. Decompression is the release the intraluminal pressure in the cystic cavity allowing gradual bone growth from the periphery. The aim of this study was to analyze the effectiveness of decompression in an OM jaw model. A 4-mm-diameter defect was made on mandibles of fourteen Sprague–Dawley rats and inoculated with S. aureus (20 μl of 1 × 107 CFU/ml) injection. Two weeks later, four groups were made as non-treatment (C1), only curettage (C2), curettage and decompression (E1), and curettage and decompression with normal saline irrigation (E2). After four weeks, each group was analyzed. Most micro-CT parameters, including bone mineral density [0.87 (± 0.08) g/cm3] with bone volume [0.73 (± 0.08) mm3] was higher in E2 group than that of C1 group (p = 0.04, p = 0.05, respectively). E2 group in histology showed the highest number of osteocytes than those of control groups, 91.00 (± 9.90) (p = 0.002). OPN were expressed strongly in the E1 (“5”: 76–100%) that those of other groups. Decompression drains induced advanced bone healing compared to that of curettage alone. Therefore, it could be recommended to use decompressive drain for enhancing the jaw OM management.

Decompression Effects on Suppurative and Sclerosing Osteomyelitis in the Jaw

Background: Osteomyelitis (OM) of the jaw is usually caused by a chronic odontogenic infection. Decompression is the release the intraluminal pressure in the cystic cavity allowing gradual bone growth from the periphery. The aim of this study was to analyze the effectiveness of decompression in an OM jaw model.Methods: A 4-mm-diameter defect was made on mandibles of fourteen Sprague-Dawley rats and inoculated with S. aureus (20 μl of 1x107 CFU/ml) injection. Two weeks later, four groups were made as non-treatment (C1), only curettage (C2), curettage and decompression (E1), and curettage and decompression with normal saline irrigation (E2). After four weeks, each group was analyzed.Results: Most micro-CT parameters of C1 and C2 were significantly lower, and bone mineral density with bone volume was enhanced in E2. E1 and E2 groups in histology showed prominent bone healing with a significantly high number of osteocytes, E2 had the weakest expression of IL-6 compared to that of C1. TNF-α and OPN were expressed strongly in the E1.Conclusion: Decompression drains induced advanced bone healing compared to that of curettage alone in an OM jaw model. Therefore, it could be recommended to use decompressive drain for the enhancement of jaw OM management.

Endoscope-assisted microsurgical repair in trigeminal meningocele: case report

Trigeminal meningocele is a rare disease that results in rhinorrhea. Treatments with endoscopic approaches and open craniotomies have high recurrence rates, and controversy regarding the most effective surgical strategy for trigeminal meningocele is ongoing. The authors report a case of a 13-year-old female patient with a diagnosis of trigeminal meningocele determined after she presented with a history of intermittent headaches, suspected rhinorrhea, and recurrent meningitis. In addition to the conventional method of covering the efflux point of CSF and filling the inside of the meningocele with fascial tissues, the authors selectively closed the influx point of CSF from the prepontine cistern to the meningocele using an anterior transpetrosal approach. On the basis of the preoperative images, the authors hypothesized that the influx point of CSF could not be observed under the microscopic direct view and instead used a flexible endoscope. A check valve–like structure with one-way communication of CSF from the prepontine cistern into the cystic cavity was identified and was closed. At the time of this report, 36 months postoperatively, the patient had no indications of recurrence. Although cases of trigeminal meningoceles are infrequently encountered and require a tailored approach, the results in this case thus far indicate that the use of an endoscope and open craniotomy is an effective strategy for surgical treatment.

Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11 years follow-up

Background Partial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth. Methods A retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years. Results Overall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group. Conclusions Double T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.

Folliculosebaceous Cystic Hamartoma: A Rare Entity

Folliculosebaceous Cystic Hamartoma (FSCH) is an uncommon cutaneous hamartomatous lesion. It is basically a tumour like malformations exhibiting abnormal overgrowth of biphasic elements i.e., epithelial and mesenchymal components that are normally found in the skin. Few other hamartomas of pilosebaceous origin are trichofolliculoma, trichodiscoma, fibrofolliculoma and pilar sheath acanthoma. Though distinct, this entity shares similar histological features to Sebaceous Trichofolliculoma (STF). Hence, a proper histological examination is must in differentiating it from STF and other clinical and histological entities. Authors hereby, describes a case of FSCH in a 37-year-old male who presented with a slow growing cystic mass on his left earlobe, an uncommon location for such lesion. The mass was excised, and a detailed histological evaluation showed a characteristic multinodular growth pattern with lobules of pilosebaceous glands forming nodules around cystically dilated follicular infundibular structures. No hair shafts were seen in the cystic cavity ruling out differential diagnosis of sebaceous hyperplasia which could have been a close mimic. The intervening stroma revealed dense collagen, sheets and lobules of adipocytes, many vascular channels filled with fibrinous deposits. Perivascular adipocytes were also noted along with few nerve tissues (perineurium). A detailed clinicopathological work-up helped in arriving at a final diagnosis of FSCH with neural component. The patient was doing well till last six months of follow-up. No recurrence of similar lesion was noted in the patient.

Case Report: Sudden death related to unrecognized cardiac hydatid cyst

Echinococcosis, also known as hydatid disease, is a common parasitic human infestation found in sheep-breeding areas. It is caused by the larvae stage of Echinococcus granulosus, and cysts develop mostly in the lungs and the liver. Cardiac involvement is unusual and silent until acute complications or a fatal outcome occurs. Herein, we report an autopsy case of a young healthy adult who died suddenly. The autopsy revealed an external bulging on the right heart ventricle outlet with a fluid-filled cystic cavity discovered on sectioning. Dissection of other organs did not reveal other cyst locations. Histological examination ascertained the diagnosis of hydatid cyst, and death was attributed to cardiac arrhythmias. Pathologists should keep in mind that hydatid cysts can develop anywhere in the body. Solitary cardiac cyst is rare and can simulate a “silent bomb”. Unfortunately, sudden death remains the frequent manner of revelation of this disease in endemic areas.