Intraosseous mucoepidermoid carcinoma (MEC) is a rare neoplasm, generally presenting in the posterior mandible and occurring in the 3rd-5th decade. This condition may mimic ameloblastoma both clinically and radiologically, with challenges in diagnosis. We present the case of a 51-year-old female who presented with a history of swelling over her jaw for one month. On examination, the mass involved the outer table of the mandible, from the right canine to the left first premolar. The swelling was hard, non-tender, with a nodular surface. A PET CT scan showed a multiloculated cystic lesion in the anterior mandible. An orthopantomogram (OPG) depicted a lytic lesion in the anterior mandible with outer table involvement and was suspected to be ameloblastoma. The patient underwent segmental mandibulectomy, neo-mandible reconstruction surgery with an osteomyocutaneous free fibular flap (from the right leg), and split skin grafting over the donor site. The patient recovered well. However, contrary to our suspected diagnosis, the final histopathological report showed features suggestive of mucoepidermoid carcinoma. Hence, mucoepidermoid carcinoma can be misdiagnosed as ameloblastoma due to similar clinico-radiological features. Histopathology is confirmatory and needs to be reviewed to confirm the diagnosis.
Objective: Today laparoscopic cholecystectomy (LC) is the treatment of choice for acute cholecystitis. However, the presence of severe inflammation makes it challenging for the surgeons to accurately recognize the Calot’s triangle which increases the risk of intraoperative complications. The aim of this study was to explore the validity of a scoring system used to predict difficult LC and to analyse the risk factors associated with difficult cholecystectomy in the setting of acute calculous cholecystitis. Material and Methods: An observational study was conducted between December 2018 and December 2020 among 132 patients diagnosed with acute cholecystitis, who underwent laparoscopic cholecystectomy. A scoring system by Randhawa et al. was used preoperatively for all of these patients to predict difficult LC, which was correlated to intraoperative difficulties in actual surgery. Data were analysed using the SPSS version 26.0. Results: Mean age was 43.63 ± 13.37, with almost equal representation from both sexes. History of previous attacks of cholecystitis, impacted stone, thickness of GB wall were statistically significant in calculating preoperative difficulty of laparoscopic cholecystectomy. The scoring system had a sensitivity and specificity of 82.6% and 63.5%, respectively. The conversion rate to open cholecystectomy was 6.9%. Conclusion: Analysing the significant risk factors before operating in the presence of an inflamed gallbladder can reduce the overall mortality and morbidity. An accurate preoperative scoring system will enable the operating surgeon to be well prepared with adequate resources and time. The patient attenders can also be counselled regarding the risk involved beforehand.
Introduction: Endoscopic ultrasoundguided liver biopsy (EUS-LB) is a well-established technique for liver biopsy in adult patients due to direct visualization and real-time guidance, feasibility in obese patients, patient tolerance and comfort, and decreased recovery time. The applicability in pediatric patients is still underreported. Methods: This is a single center retrospective review to assess the safety and utility of EUS-LB in the evaluation of pediatric NAFLD at Community Regional Medical Center in California's Central Valley. An analysis of the biopsy sample including quality, features, and interpretability was performed. To fully critique the utility of EUS-LB in assessing liver steatosis and fibrosis, we compared other forms of hepatic assessment including laboratory values and imaging. Results: A total of 15 pediatric patients (7 female) ages ranging from 7 -18 years old (median age 16 years) were included in the review. Twelve patients underwent only transgastric fine needle biopsy (FNB), with an average of 1.92 (range 1-3) passes. Two patients only underwent transduodenal FNB passes with an average of 1.33 (range 1-2) passes. One patient underwent both transgastric and transduodenal FNB passes. The shortest specimen length was 0.7 cm and the longest was 2 cm in length with a median of 1.3 cm. All biopsies performed were technically successful. All biopsy specimen was adequate for histopathologic evaluation and diagnostic yield was 100%. By diagnostic criteria for NAFLD, 86.67% (46.15% female, 92% Hispanic) were diagnosed with NAFLD and of those, 61.54% of patients found to have NASH. No major or minor post-procedural complications were identified or reported. Conclusion: Noninvasive investigation such as labs and imaging may be useful for screening and identifying patients with likely diagnosis of NAFLD, however noninvasive methods have limitations. Accurate staging, histologic review, and prognostication for NAFLD are best characterized by liver biopsy. EUS-LB is a efficacious and safe procedure that should be considered to be the primary method when pursuing liver biopsy in pediatric patients. We recognize limitations of the study, including small sample size and largely homogenous patient population.
Tuberculosis (TB) is a deadly infection that can lead to disseminated disease in children <15years of age exhibiting risk factors such as low host immunity, concurrent infection(s), and/or malnutrition. A case involving a 14-year-old boy diagnosed with disseminated tuberculosis is reported. On investigation, the patient was positive for coronavirus disease 2019 (COVID-19) antibodies, GeneXpert (Cepheid, Sunnyvale, CA) positive for TB with multisystem involvement, lymphopenia, and highly elevated inflammatory markers, indicating multisystem inflammatory syndrome in children (MIS-C) and disseminated TB. The patient was started on antitubercular treatment (ATT), steroids, and supportive treatment. His condition improved over the ensuing few days, and he was discharged with ATT and antiepileptics. Although a few studies involving adults have established a connection between the progression of TB and COVID-19, this case report establishes a similar clinical picture in a child, which has not yet been reported.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.