A primary intraosseous squamous cell carcinoma case report and literature review. The new WHO classification

Abstract Aim: Cyst-like lesions in the mandible rarely develop into malignancies, and the re- ported incidence is between 0.3% and 2%. The present study describes a rare case of primary intraosseous squamous cell carcinoma of the mandible arising from an odon- togenic cyst. Materials and Methods: An 80-year-old male was referred to Trieste University Maggiore Hospital (Trieste, Italy), with acute pain in the left retromolar area. An initial examination revealed extra oral swelling without paresthesia of the IAN. Following an intraoral examination, the oral mucosa was edematous, percussion pain was experienced on the lower left second molar. Panoramic radiography revealed a re- tained lower left wisdom tooth and an irregular radiolucent area between the lower left second molar and the mandibular angle with clear margins. Computed tomography re- vealed diffuse bone resorption and an extensive loss of cortical bone on the lingual side. Results: A biopsy was performed during the surgery to remove the second lower left molar and the wisdom tooth, the pathological diagnosis was of squamous cell carcinoma arising from the epithelial lining of the odontogenic cyst. MRI with contrast agent was also performed. Shortly after the patient has been proposed a complete resective surgery of the mass including the infiltrated areas and then a reconstructive part to restore the function and aesthetic. Conclusion: The follow-up of a large inflammatory cyst is essential for early diagnosis of malignant neoplasm. This approach allows lower invasive treatments and major survival of these patients

Missed Diagnosis of Cancer in Critically Ill Patients: A Single-Center Experience

Abstract Purpose and methods: In order to evaluate the rate of missed diagnoses (MD) of tumors in critically ill patients died in our Intensive Care Unit (ICU) and correlate them with the outcome, all the autopsy records from January 1st, 1996 and December 31st, 2014 have been reviewed. When the tumor was not diagnosed during the admission but discovered only at the post-mortem examination, the effect of the MD on the outcome was classified according to the Goldman\u2019s criteria. Results: A total of, 1045 autopsies were examined; a solid or hematological cancer was discovered in 74 cases (7%, 50 M, 24 F, age 75.5, IQR 29-90 years). Major discrepancies occurred in 42 patients, but only in one of them (2.4%) a class 1 error was identified; in the other cases the MD did not influence the outcome (class 2 errors) due to the underlying conditions determining the ICU admission and/or the very short length of stay in the ICU; for another 32 patients the MD were considered without clinical relevance. Conclusions: In our experience, autopsy remains an extremely valuable tool to detect MD and to improve the clinical and diagnostic procedures

Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature

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Acute myocardial infarction in non-cardiac critically ill patients: a clinical-pathological study.

Background: in patients admitted to the Intensive Care Unit (ICU) for non cardiac disease, the diagnosis of acute coronary syndromes can be challenging. The aim of the study was to define the rate of discrepancies concerning the diagnosis of acute myocardial infarction and to evaluate the presence of risk factors that could be helpful in identifying patients at higher risk of missed diagnosis. Methods: we compared clinical and autopsy records of 600 critically ill patients who died in our ICU in a 10-years period. We identified patients in whom acute myocardial infarction was reported as the cause of death on the clinical records or was discovered only at post-mortem examination. These subjects were subsequently divided into two Groups: patients in Group 1 underwent diagnostic evaluation for acute myocardial infarction whereas those in Group 2 were not investigated for. Results: In Group 1, a definite clinical diagnosis was reached in 11 patients (14,7%) but remained undetermined in 37 patients (48%). The diagnosis was totally missed in 8 patients in Group 1 (10,6%) and in 20 patients of Group 2 (26,6%). The diagnostic discrepancy was higher in septic patients, in whom the correct diagnosis of acute myocardial infarction was established at a rate lower than 50% in respect to non-septic patients. Conclusions: Our experience strengthens the role of post-mortem examination as a source of feed-back of the overall diagnostic and therapeutic approach especially in septic patients, where the diagnostic error is more frequent

Reactivation of Hepatitis B in a Patient with Breast Cancer Treated Using Capecitabine

Reactivation of hepatitis B virus (HBV) is a well-recognized complication following immunosuppressive drug therapy in patients with past infection. The International Guidelines for HBV screening before cytotoxic or immunosuppressive therapy are controversial, there is only agreement on the use of biological agent such as anti-CD 20. The literature data do not report HBV reactivation due to capecitabine and therefore the international guidelines do not recommend prophylaxis in that condition. In this paper, we describe the history of HBV reactivation of hepatitis B in a female patient with breast cancer treated using capecitabine observed in a Unit of Infectious Diseases of north-est of Italy

An Unsuspected Case of Aortic Dissection

Aortic dissection is a rare life-threatening condition that typically presents with acute onset of severe chest, abdominal, or back pain. Some patients might present with atypical symptoms and findings, such as neurological syndromes, making it difficult to make the diagnosis. Here, we report a case of a painless acute aortic rupture over an already existing Stanford type A chronic aortic dissection in a 59-year-old patient, with prevalence of neurological symptoms. The aortic dissection presented as recurrent episodes of dizziness/syncope and transient amnesia. We believe it is important to report this case because of the rare clinical presentation of aortic dissection, raising the awareness and diagnosing level of atypical aortic dissections

Fulminant Cerebral Fat Embolism: Case Description and Review of the Literature

The release of fat and bone marrow fragments is a common occurrence following traumatic and nontraumatic events. In most cases, they go symptomless or cause only minor disturbances, but occasionally they can determine a multiorgan dysfunction whose severity ranges from mild to fatal. The authors describe the case of a patient who became deeply comatose and ultimately died after a traffic accident in which he suffered the exposed right femoral and tibial fracture in the absence of other injuries. He underwent the external fixation of the fractured bones 2 hours after the admission under general anesthesia. Three hours later, he failed to awake at the suspension of the anesthetic agents and became anisocoric; a CT scan demonstrated a diffuse cerebral edema with the herniation of the cerebellar tonsils; these abnormalities were unresponsive to the treatment and the brain death was one day later. The causes, the mechanisms, the symptoms, the prevention, and the treatment of the syndrome are reviewed and discussed

Endomyocardial biopsy in the clinical context: current indications and challenging scenarios

Endomyocardial biopsy (EMB) is an invasive procedure originally developed for the monitoring of heart transplant rejection. Over the year, this procedure has gained a fundamental complementary role in the diagnostic work-up of several cardiac disorders, including cardiomyopathies, myocarditis, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Major advances in EMB equipment and techniques for histological analysis have significantly improved diagnostic accuracy of EMB. In recent years, advanced imaging modalities such as echocardiography with three-dimensional and myocardial strain analysis, cardiac magnetic resonance and bone scintigraphy have transformed the non-invasive approach to diagnosis and prognostic stratification of several cardiac diseases. Therefore, it emerges the need to re-define the current role of EMB for diagnostic work-up and management of cardiovascular diseases. The aim of this review is to summarize current knowledge on EMB in light of the most recent evidences and to discuss current indications, including challenging scenarios encountered in clinical practice

Small annular lesions on the nose of a young Caucasian woman

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A case report of isolated cardiac light chain amyloidosis without clinically overt heart failure: an under-recognized presentation

Background: Cardiac involvement in amyloid light-chain (AL) amyloidosis usually represents a brick in the wall of a multi-system disease. The presence of cardiac deposition of free light chains (FLCs) is the main determinant of survival. Isolated cardiac AL is an uncommon scenario characterized by a challenging diagnostic and therapeutic workup. Case summary: A 57-year-old asymptomatic man was presented for an incidental finding of myocardial necrosis at the electrocardiogram (ECG) performed for newly diagnosed arterial hypertension. Alongside signs of previous myocardial infarction, transthoracic echocardiography showed a severely increased left ventricular (LV) wall thickness not consistent with ECG voltages, segmental akinaesia with normal LV systolic function with 'apical sparing' pattern. Laboratory assessment showed an unexpectedly high level of natriuretic peptide and persistently abnormal troponin in the absence of symptoms or signs of heart failure or ongoing ischaemia. Coronary angiogram confirmed the coronary artery disease. Before revascularization, a complete diagnostic workup was carried. Serum electrophoresis detected a monoclonal gammopathy that was further investigated by serum immunofixation, revealing high lambda FLCs concentration. Fat pad, bone marrow, and salivary glands biopsies resulted negative for amyloid deposition. Finally, endomyocardial biopsy was consistent with AL amyloidosis. Urgent percutaneous revascularization was performed, and the patients was timely started on chemotherapy. Discussion: The diagnosis of isolated cardiac AL amyloidosis is challenging and carries important therapeutic implications. As the short-term prognosis might be severely compromised, an accurate diagnostic flowchart has to be systematically pursued to obtain a precise diagnosis and address the optimal, tailored management