Sinonasal angioleiomyoma with adipocyte differentiation: clinicopathologic study of 2 cases and review of the literature

Angioleiomyoma (ALM) is a benign tumor of the skin and soft tissues composed of well differentiated smooth muscle cells arranged around and among many vascular channels. Few cases have been reported in the sinonasal region, where ALM may show a variable amount of mature adipose tissue that may make hard the distinction from angiomyolipoma. We report here two cases that presented with a three- and six-month history of left nasal obstruction respectively. In both patients, clinical examination and imaging studies failed to reveal features of tuberous sclerosis complex and demonstrated a mass obliterating the nasal cavity arising from the inferior turbinate. Both masses were endoscopically excised. Pathologic analysis revealed highly vascularized tumors composed of well differentiated smooth muscle cells intermingled with a variable number of mature adipocytes. Immunostaining for melanocytic markers was negative. Based on these findings, both tumors were diagnosed as sinonasal-ALM with adipocytic differentiation. These two cases indicate that both clinical data (i.e. absence of features of tuberous sclerosis complex) and immunohistochemistry (i.e. absence of melanocytic markers) are mandatory for the recognition of sinonasal-ALM with adipocytic differentiation. The term angiomyolipoma to identify these lesions is confusing and should be abandoned

Hearing loss in Takayasu's arteritis: a role for hyperbaric oxygen therapy?

In the scientific community, there is growing interest regarding associated symptoms in Takayasu’s arteritis (TA), an autoimmune condition that mainly affects the medium and large arteries. Hearing loss (HL) is a rare complication of TA that is often overlooked and has severe consequences on the quality of life. HL mainly presents as sudden sensorineural hearing loss (SSNHL) and responds to corticosteroid therapy. In the authors’ opinion, the reasons for misdiagnosing HL in patients with TA are lack of evidence re- garding this rare complication and because TA involves large caliber arteries, instead of small vessels that are typical of the inner ear. We recently used HBOT for a 36-year-old woman with TA, who had two SSNHL episodes in different ears in an 11-month period and observed a significant improvement in the patient's hearing. Although this was a single case finding and HBOT was administered together with steroid therapy, the significant recovery of HL in both ears following this therapeutic approach may be worth sharing with the scientific community. In conclusion, we recommend that awareness for inner ear involvement in TA should increase and that HL should be considered a possible complication of TA and should be treated with corticosteroid therapy and, after collecting further evidence, HBOT

Optimal management of Cogan’s syndrome: a multidisciplinary approach

Cogan's syndrome (CS) is a rare disorder characterized by nonsyphilitic interstitial keratitis (IK) and audio-vestibular symptoms. CS affects mainly young Caucasian adults, mostly during their first three decades of age, and may develop into typical and atypical variants. Typical CS manifests primarily with IK and hearing loss, whereas atypical CS usually presents with inflammatory ocular manifestations in association with audio-vestibular symptoms but mostly different Ménière-like symptoms and, more frequently, with systemic inflammation (70%), of which vasculitis is the pathogenic mechanism. CS is considered as an autoimmune- or immune-mediated disease supported mainly by the beneficial response to corticosteroids. Using well-developed assays, antibodies to inner ear antigens, anti-Hsp70, and antineutrophil cytoplasmic antibodies were found to be associated with CS. Corticosteroids represent the first line of treatment, and multiple immunosuppressive drugs have been tried with variable degrees of success. Tumor necrosis factor-alpha blockers and other biological agents are a recent novel therapeutic option in CS. Cochlear implantation is a valuable rescue surgical strategy in cases with severe sensorineural hearing loss unresponsive to intensive and/or innovative immunosuppressive regimens

What drives the greater or lesser usage of forbearance measures by banks?

AbstractAfter the subprime crisis, with the worsening of asset quality all around Europe, a lack of harmonization emerged concerning credit classification, monitoring, provisioning and writing-off in the banking industry. A wave of analysis and new regulations by the Supervising Authorities aimed at highlighting best practices and creating a common standard, in order to enhance transparency and accounting data comparability across the European Union. A point of particular attention concerned the usage of forbearance measures and the classification and provisioning of forborne positions. This paper deep-dives into this issue leveraging on the public dataset disclosed by the European Banking Authority, following the 2018 EU-wide Transparency Exercise. The purpose of this paper is twofold. On one side, we want to gauge the extension of the forbearance measures' usage among a sample of major European banks and the drivers of this usage. On the other side, we want to analyze which main factors impact on the loan loss provisioning of forborne positions

Mucoepidermoid carcinoma associated with osteosarcoma in a true malignant mixed tumor of the submandibular region

True malignant mixed tumor, also known as carcinosarcoma, is a rare tumor of the salivary gland composed of both malignant epithelial and malignant mesenchymal elements. Frequently carcinosarcoma arises in the background of a preexisting pleomorphic adenoma; however, if no evidence of benign mixed tumor is present, the lesion is known as carcinosarcoma "de novo." We reported the first case of true malignant mixed tumor of the submandibular gland composed of high grade mucoepidermoid carcinoma associated with osteosarcoma. Case Presentation. A 69-year-old Caucasian male came to our department complaining of the appearance of an asymptomatic left submandibular neoformation progressively increasing in size over 3 months. We opted for surgical treatment. Histological examination confirmed the diagnosis of carcinosarcoma with the coexistence of high grade mucoepidermoid carcinoma and osteosarcoma. Conclusion. To the best of our knowledge, in the true malignant mixed tumor of the submandibular gland, mucoepidermoid carcinoma associated with osteosarcoma has never been previously reported