Anterior Clinoid Process Mucocele: A Case Presenting with Sudden Vision Loss

Background: Mucoceles are benign encapsulated lesions filled with mucus located in parasinus cavities. The occurrence rate of the anterior clinoid process is varying significantly in different studies. Visual disturbances, diplopia, and retrobulbar pain are among the common manifestations of anterior clinoid process mucocele. To our knowledge, 17 cases of Anterior clinoid process mucocele with visual involvements have previously been reported. Aim: We aim to report a rare case of a middle-aged man with a large sphenoid mucocele admitted due to the loss of vision in his left eye. Case presentation: A 46-year-old man with a sudden vision loss in his left eye was admitted to Loghman Hakim Hospital. In physical examination positive relative afferent pupillary defect (RAPD) was evident. The visual acuity of his right eye was normal, while his left eye had no light perception. Moreover, his visual field was normal on the right side. He had no other medical complaints. Conclusion: Clinoid mucoceles causing cranial neuropathy are extremely rare. The proper diagnosis and prompt treatment are necessary to avoid permanent complications. With proper surgical intervention, recurrence of the mucoceles can be avoided

Diagnostic accuracy of frozen section in Central nervous system lesions, a 10-year study.

How to Cite This Article: Khoddami M, Akbarzadeh A, Mordai A, Bidari Zerehpoush F, Alipour H, Samadzadeh S, Alipour B.Diagnostic Accuracy of Frozen Section of Central Nervous System Lesions: A 10-Year Study. Iran J Child Neurol. 2015 Winter;9(1):25-30. AbstractObjectiveDefinitive diagnosis of the central nervous system (CNS) lesions is unknown prior to histopathological examination. To determine the method and the endpoint for surgery, intraoperative evaluation of the lesion helps the surgeon.In this study, the diagnostic accuracy and pitfalls of using frozen section (FS) ofCNS lesions is determined.Materials & MethodsIn this retrospective study, we analyzed the results of FS and permanent diagnoses of all CNS lesions by reviewing reports from 3 general hospitals between March 2001 and March 2011.Results273 cases were reviewed and patients with an age range from 3 to 77 years of age were considered. 166 (60.4%) had complete concordance between FS and permanent section diagnosis, 83 (30.2%) had partial concordance, and 24 cases (9.5%) were discordant. Considering the concordant and partially concordant cases, the accuracy rate was 99.5%, sensitivity was 91.4%, specificity was 99.7%, and positive and negative predictive values were 88.4% and 99.8%, respectively.ConclusionOur results show high sensitivity and specificity of FS diagnosis in the evaluation of CNS lesions. A Kappa agreement score of 0.88 shows high concordance for FS results with permanent section. Pathologist’s misinterpretation, small biopsy samples (not representative of the entire tumor), suboptimal slides, and inadequate information about tumor location and radiologic findings appear to be the major causes for these discrepancies indicated from our study. ReferencesTaxy JB, Anthony G. Biopsy interpretation: the frozen section. 1st ed. China: Lippincott Williams & Wilkins; 2010. P.301-3.Somerset HL, Kleinschmidt-DeMasters BK. Approach to the intraoperative consultation for neurosurgical specimens. Adv Anat Pathol 2011; 18:446-9. doi: 10.1097/ PAP.0b013e3182169934.Regragui A, Amarti Riffi A, Maher M, El Khamlichi A, Saidi A. Accuracy of Intraoperative diagnosis in central nervous system tumors: report of 1315 cases. Neurochirurgie 2003; 49(2-3 Pt 1):67-72.Plesec TP, Prayson RA. Frozen section discrepancy in the evaluation of central nervous system tumors. Arch Pathol Lab Med 2007; 131:1532-40.Savargaonkar P, Farmer PM. Utility of intra-operative consultations for the diagnosis of central nervous system lesions. Ann Clin Lab Sci 2001; 31:133-9.Talan-Hraniloviæ J, Vuèiæ M, Ulamec M, Belicza M. Intraoperative frozen section analysis in of the central nervous system and pituitary gland pathology. Acta Clin Croat 2005; 44:217-21.Roessler K, Dietrich W, Kitz K. High diagnostic accuracy of cytologic smears of central nervous system tumors. A 15-year experience based on 4,172 patients. Acta Cytol 2002; 46:667-74.Ud Din N, Memon A, Idress R, Ahmad Z, Hasan S. Central Nervous System Lesions: Correlation of  Intraoperative and Final Diagnoses, Six Year Experience at a Referral Centre in a Developing Country, Pakistan. Asian Pac J Cancer Prev 2011; 12:1435-7.Burger PC, Scheithauer BW. Tumors of the Central Nervous System. In: AFIP Atlas of Tumor Pathology Series 4. Washington DC: American Registry of Pathology; 2007.Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol. 2007; 114: 97–109. doi: 10.1007/s00401- 007-0243-

Detection of Helicobacter pylori in Oral Lesions

Background and aims. Helicobacter pylori is a microaerophilic gram-negative spiral organism. It is recognized as the etiologic factor for peptic ulcers, gastric adenocarcinoma and gastric lymphoma. Recently, it has been isolated from dental plaque and the dorsum of the tongue. This study was designed to assess the association between H. pylori and oral lesions such as ulcerative/inflammatory lesions, squamous cell carcinoma (SCC) and primary lymphoma. Materials and methods. A total of 228 biopsies diagnosed as oral ulcerative/inflammatory lesions, oral squamous cell carcinoma (OSCC) and oral primary lymphoma were selected from the archives of the Pathology Department. Thirty-two samples that were diagnosed as being without any pathological changes were selected as the control group. All the paraffin blocks were cut for hematoxylin and eosin staining to confirm the diagnoses and then the samples were prepared for immunohistochemistry staining. Data were collected and analyzed. Results. Chi-squared test showed significant differences between the frequency of H. pylori positivity in normal tissue and the lesions were examined (P=0.000). In addition, there was a statistically significant difference between the lesions examined (P=0.042). Chi-squared test showed significant differences between H. pylori positivity and different tissue types except inside the muscle layer as follows: in epithelium and in lamina propria (P=0.000), inside the blood vessels (P=0.003), inside the salivary gland duct (P=0.036), and muscle layer (P=0.122). Conclusion. There might be a relation between the presence of H. pylori and oral lesions. Therefore, early detection and eradication of H. pylori in high-risk patients are suggested

Primary Cutaneous Actinomycosis along with the Surgical Scar on the Hand

Primary cutaneous actinomycosis is a rare clinical form with variable presentation. The tumoral presentation of actinomycosis as pseudocarcinomatous or sarcomatous masses is completely rare. The management of cutaneous actinomycosis needs proper antibiotic treatment and surgical resection would not be adequate alone. Herein, we report a case of primary cutaneous actinomycosis on the dorsal surface of the hand as draining and infiltrated lesions along with the scar of previous tumor excision that had not received proper antibiotics after the surgery