Радиолошка и имунохистохемијска анализа хиперостозе фронталне кости: мултидисциплинаран приступ у расветљавању настанка овог феномена

Hyperostosis frontalis interna (HFI) is the overgrowth of bony tissue on the inner plate of the frontal bone. Females manifest significantly higher prevalence of HFI compared to males, with the peak incidence in postmenopausal women. Etiopathogenesis of HFI is still ambigous. Different hormonal imbalances i.e. prolonged estrogen stimulation during reproductive period, or abnormal progesterone effect on the ovaries, or inadequate androgen stimulation are pointed out in the literature as the most probable causes of HFI, due to its high prevalence and severity in the females, as well as the fact that in males only those with hypogonadism manifest advanced stages of HFI. Several models have tried to provide an adequate explanation of HFI developement. The most recent is the „global model“ which states that neovascularization originating from dura, might be one of the key processes in its formation. Some studies suggested that women with HFI tend to develop more robust skull characteristics. However, there are no studies that investigated whether HFI is accompanied by changes in bone thickness or density in postcranial skeleton. Present macroscopical classification of HFI is based on morphological characteristics and extension of frontal bone involvement and includes four different types of HFI. Relatively low percentage of radiological recordings of HFI may ocure due to the fact that present macroscopical method of identification and classification encompasses multiplanar reconstruction of head CT scans, which makes it complicated for routine radiological practice. Additionally, it remains unclear whether different macroscopic stages of HFI can be regarded as successive phases in the process of HFI development...Hyperostosis frontalis interna (HFI tj. ХФИ), представља нагомилавање коштаног ткива локализовано на унутрашњој површини фронталне кости. Чешће се јавља код особа женског пола са највишом инциденцом забележеном код жена у постменопаузи. Етипатогенеза ХФИ и даље није разјашњена. Различити хормонски дисбалaнси као што је пролонгирана естрогена стимулација током репродуктивног периода, поремећена продукција прогестерона од стране оваријума или неадекватна андоргена стимулација су у литератури наведени као највероватнији узрочници настанка ХФИ, имајући у виду високу преваленцу и израженију манифестацију ХФИ код жена, као и чињеницу да се само код мушкараца са хипогонадизмом јављају изражене форме ХФИ. Неколико модела је понуђено као могуће објашњење процеса настанка ХФИ. Најновији је “глобални модел“, по коме неоваскуларизација, пореклом из дуре, може бити један од кључних процеса у настанку ХФИ. У појединим студијама примећено је да жене са ХФИ могу развити робусније морфолошке карактеристике лобање у односу на оне без ХФИ. Међутим, не постоје студије које су испитивале да ли је ХФИ праћена променама у коштаној густини и спољашњој морфологији и у посткранијалном делу скелета. Постојећа макроскопска класификација ХФИ је базирана на морфолошким карактеристикама и обиму захваћености фронталне кости и обухвата четири различита типа ХФИ (А, Б, Ц и Д). Релативно низак проценат бележења ХФИ од стране радиолога, може се објаснити чињеницом да постојећи макроскопски метод класификације и идентификације ХФИ обухвата тродимензионалну реконструкцију прегледа главе начинјених методом компјутеризоване томографије (CT), и да је као такав, сувише компликован за рутинску радиолошку праксу. Такође, и даље није познато да ли различити макроскопски типови ХФИ могу бити посматрани као сукцесивне фазе у процесу настанка ХФИ..

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9 +/- 18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive

Hyoid Bone and Thyroid Cartilage Metastases from Sigmoid Colon Adenocarcinoma: A Case Report

Background: Secondary tumours of the hyoid bone and thyroid cartilage are extremely rare. In this paper, we present a case of the hyoid bone and thyroid cartilage metastases in a patient treated for sigmoid colon adenocarcinoma. Case Report: Four years after sigmoid colon adenocarcinoma was diagnosed and treated with surgery and chemotherapy, the patient developed bone metastases in the left sacroiliac joint and right proximal humerus. Although the patient did not complain of any related symptoms, in a bone scintigraphy the accumulation of Technetium-99m was incidentally detected in the two sites of the anterior neck. On ultrasound examination there were two hyperechoic and heterogeneous masses with calcifications placed in front of the hyoid bone and thyroid cartilage. Computerized tomography demonstrated massive hyoid bone and thyroid cartilage destruction. Conclusion: In patients with progressive sigmoid colon adenocarcinoma, destruction of the hyoid bone and thyroid cartilage could be suspected for metastases

3D-Microarchitectural patterns of Hyperostosis frontalis interna: a micro-computed tomography study in aged women

Although seen frequently during dissections and autopsies, Hyperostosis frontalis interna (HFI) - a morphological pattern of the frontal bone thickening - is often ignored and its nature and development are not yet understood sufficiently. Current macroscopic classification defines four grades/stages of HFI based on the morphological appearance and size of the affected area; however, it is unclear if these stages also depict the successive phases in the HFI development. Here we assessed 3D-microarchitecture of the frontal bone in women with various degrees of HFI expression and in an age- and sex-matched control group, hypothesizing that the bone microarchitecture bears imprints of the pathogenesis of HFI and may clarify the phases of its development. Frontal bone samples were collected during routine autopsies from 20 women with HFI (age: 69.9 +/- 11.1years) and 14 women without HFI (age: 74.1 +/- 9.7years). We classified the HFI samples into four groups, each group demonstrating different macroscopic type or stage of HFI. All samples were scanned by micro-computed tomography to evaluate 3D bone microarchitecture in the following regions of interest: total sample, outer table, diploe and inner table. Our results revealed that, compared to the control group, the women with HFI showed a significantly increased bone volume fraction in the region of diploe, along with significantly thicker and more plate-like shaped trabeculae and reduced trabecular separation and connectivity density. Moreover, the inner table of the frontal bone in women with HFI displayed significantly increased total porosity and mean pore diameter compared to controls. Microstructural reorganization of the frontal bone in women with HFI was also reflected in significantly higher porosity and lower bone volume fraction in the inner vs. outer table due to an increased number of pores larger than 100m. The individual comparisons between the control group and different macroscopic stages of HFI revealed significant differences only between the control group and the morphologically most pronounced type of HFI. Our microarchitectural findings demonstrated clear differences between the HFI and the control group in the region of diploe and the inner table. Macroscopic grades of HFI could not be distinguished at the level of bone microarchitecture and their consecutive nature cannot be supported. Rather, our study suggests that only two different types of HFI (moderate and severe HFI) have microstructural justification and should be considered further. It is essential to record HFI systematically in human postmortem subjects to provide more data on the mechanisms of its development

Радиолошка и имунохистохемијска анализа хиперостозе фронталне кости: мултидисциплинаран приступ у расветљавању настанка овог феномена

Hyperostosis frontalis interna (HFI) is the overgrowth of bony tissue on the inner plate of the frontal bone. Females manifest significantly higher prevalence of HFI compared to males, with the peak incidence in postmenopausal women. Etiopathogenesis of HFI is still ambigous. Different hormonal imbalances i.e. prolonged estrogen stimulation during reproductive period, or abnormal progesterone effect on the ovaries, or inadequate androgen stimulation are pointed out in the literature as the most probable causes of HFI, due to its high prevalence and severity in the females, as well as the fact that in males only those with hypogonadism manifest advanced stages of HFI. Several models have tried to provide an adequate explanation of HFI developement. The most recent is the „global model“ which states that neovascularization originating from dura, might be one of the key processes in its formation. Some studies suggested that women with HFI tend to develop more robust skull characteristics. However, there are no studies that investigated whether HFI is accompanied by changes in bone thickness or density in postcranial skeleton. Present macroscopical classification of HFI is based on morphological characteristics and extension of frontal bone involvement and includes four different types of HFI. Relatively low percentage of radiological recordings of HFI may ocure due to the fact that present macroscopical method of identification and classification encompasses multiplanar reconstruction of head CT scans, which makes it complicated for routine radiological practice. Additionally, it remains unclear whether different macroscopic stages of HFI can be regarded as successive phases in the process of HFI development...Hyperostosis frontalis interna (HFI tj. ХФИ), представља нагомилавање коштаног ткива локализовано на унутрашњој површини фронталне кости. Чешће се јавља код особа женског пола са највишом инциденцом забележеном код жена у постменопаузи. Етипатогенеза ХФИ и даље није разјашњена. Различити хормонски дисбалaнси као што је пролонгирана естрогена стимулација током репродуктивног периода, поремећена продукција прогестерона од стране оваријума или неадекватна андоргена стимулација су у литератури наведени као највероватнији узрочници настанка ХФИ, имајући у виду високу преваленцу и израженију манифестацију ХФИ код жена, као и чињеницу да се само код мушкараца са хипогонадизмом јављају изражене форме ХФИ. Неколико модела је понуђено као могуће објашњење процеса настанка ХФИ. Најновији је “глобални модел“, по коме неоваскуларизација, пореклом из дуре, може бити један од кључних процеса у настанку ХФИ. У појединим студијама примећено је да жене са ХФИ могу развити робусније морфолошке карактеристике лобање у односу на оне без ХФИ. Међутим, не постоје студије које су испитивале да ли је ХФИ праћена променама у коштаној густини и спољашњој морфологији и у посткранијалном делу скелета. Постојећа макроскопска класификација ХФИ је базирана на морфолошким карактеристикама и обиму захваћености фронталне кости и обухвата четири различита типа ХФИ (А, Б, Ц и Д). Релативно низак проценат бележења ХФИ од стране радиолога, може се објаснити чињеницом да постојећи макроскопски метод класификације и идентификације ХФИ обухвата тродимензионалну реконструкцију прегледа главе начинјених методом компјутеризоване томографије (CT), и да је као такав, сувише компликован за рутинску радиолошку праксу. Такође, и даље није познато да ли различити макроскопски типови ХФИ могу бити посматрани као сукцесивне фазе у процесу настанка ХФИ..

Radiological evaluation of Hyperostosis frontalis interna: is it of clinical importance?

Hyperostosis frontalis interna (HFI) presents irregular thickening of the frontal bone. Even though HFI is frequently seen during routine radiological imaging, it usually remains unrecorded owing to a common belief that it just represents an incidental finding or anatomical variant. Recent studies implied that HFI may be clinically relevant. Etiology of HFI is still debated, while presumptions are mainly based on altered sex steroids impact on skull bone growth. Some authors implied that frontal bone might be particularly affected by this condition due to specificity of its underlying dura. In this paper we present a 27-years old female patient with a treatment resistant headache. Head CT showed massive, irregular bony mass, with lobulated contours arising from the right frontal bone, but did not cross the fronto-parietal suture, spearing the superior sagittal sinus and skull midline. After surgery, histopathological analysis of the frontal bone sample in our patient showed thickening pattern similar to those described in micro-CT studies of HFI. Furthermore, in an attempt to test speculation of the possible role of estrogen in pathogenesis of HFI, we investigated the expression of a-estrogen receptors on dura of the frontal region. These analyses confirmed nuclear expression of estrogen on frontal region dural tissue, supporting previous speculation of the development mechanisms of HFI and contributing to a better understanding of this common condition of the frontal bone. Additionally, the presence of HFI may result in severe symptomatology, which could be misinterpreted and related to other disorders if HFI is not radiologicaly recognized and reported

Demographic and imaging features of oral squamous cell cancer in Serbia: a retrospective cross-sectional study

Abstract Background The mortality of oral squamous cell cancer (OSCC) in Serbia increased in the last decade. Recent studies on the Serbian population focused mainly on the epidemiological aspect of OSCC. This study aimed to investigate the demographic and imaging features of OSCC in the Serbian population at the time of diagnosis. Methods We retrospectively analyzed computed tomography (CT) images of 276 patients with OSCC diagnosed between 2017 and 2022. Age, gender, tumor site, tumor volume (CT-TV, in cm3), depth of invasion (CT-DOI, in mm), and bone invasion (CT-BI, in %) were evaluated. TNM status and tumor stage were also analyzed. All parameters were analyzed with appropriate statistical tests. Results The mean age was 62.32 ± 11.39 and 63.25 ± 11.71 for males and females, respectively. Male to female ratio was 1.63:1. The tongue (36.2%), mouth floor (21.0%), and alveolar ridge (19.9%) were the most frequent sites of OSCC. There was a significant gender-related difference in OSCC distribution between oral cavity subsites (Z=-4.225; p < 0.001). Mean values of CT-TV in males (13.8 ± 21.5) and females (5.4 ± 6.8) were significantly different (t = 4.620; p < 0.001). CT-DOI also differed significantly (t = 4.621; p < 0.001) between males (14.4 ± 7.4) and females (10.7 ± 4.4). CT-BI was detected in 30.1%, the most common in the alveolar ridge OSCC. T2 tumor status (31.4%) and stage IVA (28.3%) were the most dominant at the time of diagnosis. Metastatic lymph nodes were detected in 41.1%. Conclusion Our findings revealed significant gender-related differences in OSCC imaging features. The predominance of moderate and advanced tumor stages indicates a long time interval to the OSCC diagnosis

Feasibility of using cross-sectional area of masticatory muscles to predict sarcopenia in healthy aging subjects

Abstract Determination of sarcopenia is crucial in identifying patients at high risk of adverse health outcomes. Recent studies reported a significant decline in masticatory muscle (MM) function in patients with sarcopenia. This study aimed to analyze the cross-sectional area (CSA) of MMs on computed tomography (CT) images and to explore their potential to predict sarcopenia. The study included 149 adult subjects retrospectively (59 males, 90 females, mean age 57.4 ± 14.8 years) who underwent head and neck CT examination for diagnostic purposes. Sarcopenia was diagnosed on CT by measuring CSA of neck muscles at the C3 vertebral level and estimating skeletal muscle index. CSA of MMs (temporal, masseter, medial pterygoid, and lateral pterygoid) were measured bilaterally on reference CT slices. Sarcopenia was diagnosed in 67 (45%) patients. Univariate logistic regression analysis demonstrated a significant association between CSA of all MMs and sarcopenia. In the multivariate logistic regression model, only masseter CSA, lateral pterygoid CSA, age, and gender were marked as predictors of sarcopenia. These parameters were combined in a regression equation, which showed excellent sensitivity and specificity in predicting sarcopenia. The masseter and lateral pterygoid CSA can be used to predict sarcopenia in healthy aging subjects with a high accuracy

Hyperostosis frontalis interna in postmenopausal womenPossible relation to osteoporosis

To improve our understanding of hyperostosis frontalis interna (HFI), we investigated whether HFI was accompanied by changes in the postcranial skeleton. Based on head CT scan analyses, 103 postmenopausal women were divided into controls without HFI and those with HFI, in whom we measured the thickness of frontal, occipital, and parietal bones. Women in the study underwent dual energy x-ray absorptiometry to analyze the bone density of the hip and vertebral region and external geometry of the proximal femora. Additionally, all of the women completed a questionnaire about symptoms and conditions that could be related to HFI. Women with HFI had a significantly higher prevalence of headaches, neurological and psychiatric disorders, and a significantly lower prevalence of having given birth. Increased bone thickness and altered bone structure in women with HFI was localized only on the skull, particularly on the frontal bone, probably due to specific properties of its underlying dura. Bone loss in the postcranial skeleton showed the same pattern in postmenopausal women with HFI as in those without HFI. Recording of HFI in medical records can be helpful in distinguishing whether reported disorders occur as a consequence of HFI or are related to other diseases, but does not appear helpful in identifying women at risk of bone loss