Stafne?s bone defect in a metastatic prostate cancer patient : a diagnostic conundrum

Stafne?s bone defect (SBD) is an uncommon bone alteration that affects the mandible and usually presents as an asymptomatic radiolucency located in the posterior region of body or angle of the mandible, below the alveolar canal. Although clinical and radiographic features are more often sufficient for the diagnosis, other lesions and bone alterations have been described in the differential diagnosis and may lead to a misinterpretation and an incorrect diagnosis. Herein, we report a case of an 89-yearold man with metastatic prostate cancer to multiple bones, presenting an asymptomatic solitary well-defined radiolucent image on the right side of the posterior body of the mandible, in close contact with its inferior border. A bone depression was confirmed by computed tomography scans of the mandible and a metastatic inclusion was ruled out by bone scintigraphy with a final diagnosis of SBD. The aim of this report was to highlight the importance of differentiating SBD from metastases in cancer patients and to reinforce the usefulness of multiple imaging modalities in the differential diagnosis of SBD

Tongue metastasis of cutaneous melanoma : report of two cases and literature review

Malignant metastases to the oral cavity are rare and metastatic melanomas of the tongue are considered exceptionally uncommon, with less than 10 cases published in the English literature so far. Two female patients in the 7th decade of life presented to our dental service with nodules in the tongue. Both patients had multiple metastases at the time of oral diagnosis and primary melanoma originated on the skin. An intra-oral incisional biopsy was performed under local anesthesia and the histopathologic analysis was characterized by the proliferation of atypical epithelioid cells displaying a poorly delimited cytoplasm and hyperchromatic nucleus which contained eosinophilic macronucleoli. Immunohistochemistry was performed in both cases to confirm the clinical hypothesis of metastatic melanoma. After the diagnosis of oral metastatic melanoma, the patients were maintained under palliative care and close medical follow-up. Both patients died four and a half months and 20 months after the diagnosis of tongue metastasis. Although rare, metastatic melanoma should be included in the differential diagnosis of tongue lesions detected in patients with a previous medical history of cutaneous melanoma

Orbital apex syndrome affecting head and neck cancer patients : a case series

Orbital apex syndrome (OAS) is a complex and uncommon disorder that typically damages multiple cranial nerves in association with optic nerve dysfunction. OAS is associated with several different pathologies, however; only a few cases have been reported in association with head and neck cancer (HNC) so far. A case series of HNC patients diagnosed with OAS is described including clinicopathological data, image findings, and disease outcome. Ptosis and diplopia were diagnosed in four male patients with mean age of 61.2 years who were undergoing treatment for late-stage carcinomas of the tongue, larynx, and nasopharynx, eventually leading to the diagnosis of OAS. The mean overall survival rate after the diagnosis of OAS was 9.5 months. The current study reinforces evidence that OAS indicates poor prognosis and highlights the importance of early diagnosis

Radiation-related superficial oral mucoceles : an under-recognized acute toxicity in head and neck cancer patients

Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy

Calcified carotid artery atheromas on panoramic radiographs of head and neck cancer patients before and after radiotherapy

The aims of this study were to verify if head and neck radiotherapy (RT) is able to induce calcified carotid artery atheroma (CCAA) in a large head and neck cancer (HNC) population and also to compare the socio-demographic and clinical findings of patients with and without CCAA detected on panoramic radiographs. Panoramic radiographs taken before and after head and neck radiotherapy (RT) of 180 HNC patients were selected and analyzed in order to identify the presence of CCAA. In addition, CCAA presence or absence on panoramic radiographs were compared and correlated with clinicopathological findings. A high overall prevalence of CCAA was found on panoramic radiographs (63 out of 180 = 35%) of HNC patients. No significant difference of CCAA before and after RT was observed. There were also no differences between groups (with and without CCAA) regarding age, gender, tobacco and alcohol use, arterial hypertension, diabetes mellitus, acute myocardial infarction, hypercholesterolemia, tumor location, clinical stage of disease and RT dose. However, there was a greater prevalence of strokes in patients with CCAA (p<0.05). Although CCAA were frequently found in panoramic radiographs of patients with HNC, RT seems not to alter the prevalence of these calcifications

Morphological patterns of circumpulpal dentin affected by radiation-related caries

The aim of this work was to evaluate the microscopic characteristics through polarized light microscopy, scanning electron microscopy and the mineral content of circumpulpal dentin of irradiated (IT) and non-irradiated teeth (NIT), with deep caries that reached the root canal. A total of 25 IT were analyzed macroscopically, and radiographed. 5 NIT were used as controls. Two 100-?m-thick sections, per specimen, were evaluated in a polarized light microscopy and a scanning electron microscope. Demographics and clinical data were collected. The results did not demonstrate distinct morphology of the IT compared with NIT. Mineral content values by weight percentage of Ca and P were also similar, corresponding to 66.65% and 33.21% in the IT and 66.60% and 33.29% in the NIT. The Ca/P ratio did not show statistical differences between groups being respectively 2.74 and 2.72, in the IT and NIT (p> 0.05). Radiotherapy does not change morphology and mineral content of circumpulpal dentin in IT

The barriers dentists face to communicate cancer diagnosis:self-assessment based on SPIKES protocol

This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient?s emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. The lack of training and low confidence in dealing with patients? emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals

External memory BWT and LCP computation for sequence collections with applications

Sequencing technologies produce larger and larger collections of biosequences that have to be stored in compressed indices supporting fast search operations. Many compressed indices are based on the Burrows-Wheeler Transform (BWT) and the longest common prefix (LCP) array. Because of the sheer size of the input it is important to build these data structures in external memory and time using in the best possible way the available RAM.ResultsWe propose a space-efficient algorithm to compute the BWT and LCP array for a collection of sequences in the external or semi-external memory setting. Our algorithm splits the input collection into subcollections sufficiently small that it can compute their BWT in RAM using an optimal linear time algorithm. Next, it merges the partial BWTs in external or semi-external memory and in the process it also computes the LCP values. Our algorithm can be modified to output two additional arrays that, combined with the BWT and LCP array, provide simple, scan-based, external memory algorithms for three well known problems in bioinformatics: the computation of maximal repeats, the all pairs suffix-prefix overlaps, and the construction of succinct de Bruijn graphs.ConclusionsWe prove that our algorithm performs O(nmaxlcp) sequential I/Os, where n is the total length of the collection and maxlcp is the maximum LCP value. The experimental results show that our algorithm is only slightly slower than the state of the art for short sequences but it is up to 40 times faster for longer sequences or when the available RAM is at least equal to the size of the input.14CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESUniversity of Eastern Piedmont project Behavioural Types for Dependability Analysis with Bayesian Networks; Sao Paulo Research Foundation (FAPESP)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [2017/09105-0, 2018/21509-2]; PRIN grant [201534HNXC]; INdAM-GNCS Project 2019 Innovative methods for the solution of medical and biological big data; Brazilian agency Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)National Council for Scientific and Technological Development (CNPq); Brazilian agency Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES)CAPE

Panoramic and skull imaging may aid in the identification of multiple myeloma lesions

The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately. All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions

Postradiation Matrix Metalloproteinase-20 Expression and Its Impact on Dental Micromorphology and Radiation-Related Caries

Recent evidence suggests that head-and-neck radiotherapy (HNRT) increases active forms of matrix metalloproteinase-20 (MMP-20) in human tooth crowns, degrading the dentin-enamel junction (DEJ) and leading to enamel delamination, which is a pivotal step in the formation of radiation-related caries (RRC). Additional participation of enzymatic degradation of organic matrix components in caries progression was attributed to MMP-20 in dentin. Therefore, the current study tested the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes to the enamel and dentin. Thirty-six teeth were studied, including 19 post-HNRT specimens and 17 nonirradiated controls. Optical light microscopy was used to investigate the micromorphological components of the DEJ, dentin-pulp complex components, and carious dentin. The samples were divided into 2 subgroups: nondemineralized ground sections (n = 20) and demineralized histological sections (n = 16). In addition, immunohistochemical analysis using the immunoperoxidase technique was conducted to semiquantitatively assess MMP-20 expression in the DEJ, dentin-pulp complex components, and carious dentin. No apparent damage to the DEJ microstructure or other dentin-pulp complex components was observed and no statistically significant differences were detected in MMP-20 expression (p > 0.05) between the irradiated and control groups. This study rejected the hypothesis that MMP-20 is overexpressed in the DEJ, dentin-pulp complex components, and carious dentin of post-HNRT patients, leading to detectable micromorphological changes. Hence, direct effects of radiation may not be regarded as an independent factor to explain aggressive clinical patterns of RRC. (C) 2017 S. Karger AG, BaselPeer reviewe