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Paranasal sinus mucoceles are epithelium-lined cystic masses usually resulting from obstruction of sinus ostia. They most frequently occur in the frontal and ethmoid sinuses. While ophthalmologic symptoms are most common, patients also report rhinological or neurological complaints. The close proximity of paranasal sinus mucoceles to the orbit and skull base predisposes the patient to significant morbidity. Computed tomography displays a non-enhancing homogenous mass with expansion of bony walls. Magnetic resonance imaging reveals variable intensity of T1-weighted images and a hyperintense mass on T2-weighted images. Histopathologically mucoceles have features of respiratory mucosa with areas of reactive bone formation, hemorrhage, fibrosis, and granulation tissue. Surgical excision is the standard treatment with trends towards endoscopic techniques.Keywords Paranasal sinus mucocele Á Magnetic resonance Á Computed tomography Á Blindness Á Ophthalmologic Á Optic neuropathy Á Cranial neuropathy Á Osteolysis Á Inflammatory infiltrate HistoryA 54-year-old female with a history of cataracts was referred by an ophthalmologist to the Otolaryngology Clinic for acute worsening of visual acuity and diplopia in the right eye. Symptoms began 5 months prior and were described as a 'white curtain' in her vision. Her ophthalmologic exam showed proptosis and chemosis of the eye and her visual acuity ipsilaterally was 20/100 (baseline 20/25). The optic disc was pink and healthy on exam. Cranial nerves III, IV, V, and VI were intact, with only minimal impairment of extraocular muscle movement. Radiographic FeaturesA non-contrast computerized tomographic (CT) scan of the head and orbits showed a 4.4 cm 9 4.2 cm 9 3.3 cm well-circumscribed expansile mass in the right ethmoid sinus. The medial orbital wall was expanded with evidence of mass effect upon the medial rectus muscle and optic nerve (Fig. 1). Nuclear magnetic resonance images (MRI) of the head with and without contrast demonstrated a hyperintense mass on T2-weighted images (WI) and a hypointensity on T1WI. The MR fluid attenuation inversion recovery (FLAIR) sequence suggested proteinaceous fluid (Fig. 2). TreatmentThe mass was emergently decompressed through an endoscopic approach in the operating room. Resistance to retropulsion of the right eye resolved immediately and the patient's visual acuity returned to baseline within 24-h of surgery.

External auditory canal (EAC) osteomas are rare, benign bony neoplasms that occur in wide range of patients. While chronic irritation and inflammation have been suggested as causal factors in several cases, significant data is lacking to support these suspicions. Symptoms are rare and can include hearing loss, vertigo, pain and tinnitus. Diagnosis is made based on a combination of clinical history and examination, radiographic imaging, and histopathology. Osteomas of the EAC are usually found incidentally and are unilateral and solitary. Computed tomography reveals a hyperdense, pedunculated mass arising from the tympanosquamous suture and lateral of the isthmus. Histopathologically, EAC osteomas are covered with periosteum and squamous epithelium, and consist of lamalleted bone surrounding fibrovascular channels with minimal osteocysts. Osteomas have historically been compared and contrasted with exostoses of the EAC. While they share similarities, more often than not it is possible to distinguish the two bony neoplasms based on clinical history and radiographic studies. Debate remains in the medical literature as to whether basic histopathology can distinguish osteomas of the EAC from exostoses. Surgical excision is the standard treatment for EAC osteomas, however close observation is considered acceptable in asymptomatic patients.Keywords Osteoma Á External auditory canal Á Exostosis Á Radiology Á Pathology HistoryA 28-year-old male was referred to the Otorhinolaryngology clinic for a left ear mass that was incidentally found during a routine audiology evaluation. The patient related that his primary care physician had first noticed the lesion 2 years prior. He denied a history of trauma to the ear or hearing loss, but stated recurrent left-sided otitis media as well as frequent cerumen impactions. Clinical examination revealed a hard, irregularly shaped mass of the left anterior auditory canal measuring approximately 2.0 mm. The mass and surrounding skin were normal in color and no surface ulcerations were noted. The right ear showed no abnormalities. The patient's health history was otherwise unremarkable and he denied participating, more than occasionally, in water sports. Radiographic FeaturesA non-contrast computerized tomographic (CT) scan of the skull base and temporal bones was obtained using 1 mm axial and coronal slices. The CT scan was remarkable for a non-obstructing, partially pedunuclated, hyperdense mass of the left anterior external auditory canal (Fig. 1). Review of the sections demonstrated the mass originated at the tympanosquamous suture (Fig. 2). The mass measured 1.0 cm by 0.6 cm, which was best appreciated on the axial images. The remainder of the structures of the middle and external ear were unremarkable, and the right ear showed no pathologic changes.

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A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT), fluoroscopic upper gastrointestinal (GI) evaluation, endoscopic ultrasound (EUS), and positron emission tomography (PET) evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas.

Secondary syphilis develops in approximately 25 % of patients infected with the spirochete bacterium Treponema pallidum. It typically develops several weeks to several months after the primary infection, which is recognized by a painless chancre. Secondary syphilis is characterized by systemic symptoms, such as malaise and fever as well as a maculopapular rash involving the trunk and extremities including the palms and soles. Condyloma lata, which are raised, fleshy lesions, tend to develop at the site of the primary chancre. Diagnosis is achieved primarily through screening and confirmational serologic testing. Histologic findings seen in condyloma lata are largely nonspecific. Therefore, a high index of suspicion should be maintained and immunohistochemical stains specific for T. pallidum should be utilized.Keywords Secondary syphilis Á Condyloma lata Á Treponema pallidum Á Immunohistochemical HistoryA 29 year-old MSM (men who have sex with men) presented to his primary care provider for a solitary nonpainful ''blister'' involving his palate. At this appointment the patient recounted a sexual encounter with a new partner 2 weeks prior to the development of this lesion. A review of his medical history was significant for numerous sexually transmitted infections. Treatments for previous infections were well documented and the patient stated all his symptoms had resolved. Physical exam at the time revealed a solitary, well-circumscribed, one centimeter ulcerated lesion on the hard palate and white patches on the dorsal tongue. No laboratory tests were performed and the patient was treated for oral candidiasis. The patient continued to be concerned about changes in his palate and 6 weeks later he was evaluated by an otorhinolaryngologist. At that time, he complained of a 1-month history of an enlarging mass involving the hard and soft palate and a rash on his buttocks. Physical exam now revealed a nonulcerated verruciform, fleshy lesion with focal erythema involving the hard and soft palate (Fig. 1) and a papular rash involving his buttocks. Biopsies of the palatal lesion were performed and submitted to pathology. Concurrent serologic testing for rapid plasma reagin (RPR) was positive and the fluorescent treponemal antibody absorption (FTA-ABS) confirmatory test was reactive. DiagnosisHistologic examination of hematoxylin and eosin stained slides show a non-ulcerated papillomatous lesion. The epithelium shows marked hyperplasia and a diffuse acute inflammatory infiltrate. There is a perivascular and

The rise in popularity of "bath salts" as safe alternatives to MDMA, methamphetamine, and other illicit substances has resulted in increased scrutiny of the contents and toxicology associated with these products. We report a case of sudden death related to the synthetic cathinone methylone in a previously healthy 19-year-old man. While several fatal case reports have been published involving methylone and other synthetic cathinones, this is the first reported case of sudden cardiac death associated with methylone use. Our report suggests that methylone toxicity has been greatly underestimated by users of this synthetic cathinone. Toxicology analysis was performed on the decedent's urine and central blood. Drugs-of-abuse immunoassays were performed to screen for amines, cocaine, tetrahydrocannabinol, phencyclidine, barbiturates, 3,4-methylenedioxy-N-methylamphetamine (MDMA), oxycodone, benzodiazepines, 6-acetylmorphine, and opiates. Qualitative analysis was performed on the decedent's urine for forensic volatiles by gas chromatography/mass spectrometry with a full scan detection method. Identification of known and unknown compounds was then accomplished by referencing the American Academy of Forensic Science library and the Armed Forces Medical Examiner System library. Derivatized methylone was further analyzed from urine and central blood using GC-MS in a selected ion monitoring (SIM) mode. A standard curve, a positive control, and the blood and urine for this case were analyzed, which provided quantitative analysis. Methylone was initially detected in the urine, and quantitative analysis revealed a blood concentration of 0.07 mg/dL. No other drugs were detected in the urine or central blood. To our knowledge, our report is the first documented case of sudden death following methylone use. Given that the postmortem blood concentration of methylone was lower than that reported in MDMA deaths, our case suggests the possibility that methylone toxicity has been greatly underestimated. It is important that the potentially severe toxicity of synthetic cathinones be recognized. More diligent reporting of bath salt cases may increase public awareness of the dangers involved with the use of this class of drugs. Furthermore, toxicology screening and reference libraries will require thorough investigation and updating as the number of novel synthetic cathinones continues to grow. Category:Chemistry

The rise in popularity of "bath salts" as safe alternatives to MDMA (3,4-methylenedioxymethamphetamine), methamphetamine, and other illicit substances has resulted in increased scrutiny of the contents and toxicology associated with these products. We report a case of sudden death related to the synthetic cathinone methylone (3,4-methylenedioxy-N-methylcathinonmethylone) in a previously healthy 19-year-old man. Although several fatal case reports have been published involving methylone and other synthetic cathinones, this is the first reported case of sudden cardiac death associated with methylone use. Although lack of published data prevented a comparison of blood methylone concentrations between our case and existing reports, the amount of methylone we detected postmortem (0.07 mg/dL) is below those reported in MDMA-related fatalities. Our report suggests that methylone toxicity has been greatly underestimated by users of this synthetic cathinone.