Salivary gland tumors, the second most common neoplasm of the mouth after squamous cell carcinoma, account for a significant proportion of tumors of the oral and perioral regions. An unusual case of adenoma presented as a solitary intraoral palatine mass in a 32-year-old woman is reported here. The tumor was interpreted as an unusual pleomorphic adenoma because of the presence of exuberant squamous metaplasia, clinically mimicking squamous cell carcinoma. Moreover, the presence of cystic structures filled with keratinized material was also salient feature. Pleomorphic adenomas may occasionally display focal squamous metaplastic changes; when extensive, it presents the potential for misinterpretation of the histology as indicative of well-differentiated squamous cell carcinoma.
Abstract. p16 and Ki-67 immunohistochemistry can be used as an ancillary method for the diagnosis of squamous intraepithelial lesion (SIL) versus atrophic change and atypical squamous metaplasia. The aim of the present study was to evaluate the efficacy of these two immunohistochemical markers in the accurate interpretation of cervical biopsies and correlate this data with human papilloma virus (HPV) infection status. The study included 103 formalin-fixed cervical punch and cone biopsy samples, with corresponding HPV DNA test data. Histopathological staining with hematoxylin and eosin, and immunohistochemical staining for p16 and Ki-67 were reviewed by two pathologists. The positivity of p16 and Ki-67 increased significantly with the severity of the cervical lesion in patients with a high-risk-HPV (HR-HPV) infection status (P<0.001). However, there was discordance in the HPV-negative group. Furthermore, concomitant diffuse, strong and block positive staining of p16, and a high Ki-67 index were implicated in high-grade SIL in the HR-HPV group. Thus, the two markers were efficient in advancing the diagnostic accuracy of cervical biopsies in the HR-HPV group; however, application of immunohistochemical results should be carefully considered in the HPV-negative group.
ABSTRACT. Synovial chondromatosis of the temporomandibular joint is a rare benign joint disorder that has been reported in only a few studies. However, we recently encountered a pathologically proven case of this disorder. This case also showed the typical imaging findings on panoramic radiographs and on CT and MR images. Therefore, we report this case and the imaging and pathological findings. Synovial chondromatosis (SC) is an uncommon articular disorder characterised by synovial metaplasia with intra-articular proliferation of cartilaginous nodules originating from the synovial membrane [1][2][3]. This disorder usually affects large joints and is rarely observed in the temporomandibular joint (TMJ). SC was originally described by Ambroise Pare in 1558 and the involvement of the TMJ was described in 1933 by Auhausen [3,4]. CT, MRI and arthroscopy facilitate the clinical diagnosis of SC; however, pathological analysis is mandatory to confirm the disease [2]. To our knowledge, most cases were assessed on the basis of CT or MR images and few studies have reported findings from all imaging modalities, including plain radiography. We report a case of SC in the TMJ, which was confirmed by histopathological analysis, and present the typical imaging findings, including CT, MR and plain radiography findings. Case reportA 49-year-old man who had been experiencing pain on the right TMJ region for several years was referred to Wonkwang University Hospital, Iksan, Jeonbuk, Korea, because of acute exacerbation of symptoms 5 days previously. He complained of pain and a clicking sound while opening his mouth.Physical examination revealed tenderness and swelling in the TMJ region; he could not open his mouth more than 27 mm because of the pain.A panoramic radiograph showed multiple calcified loose bodies around the right mandibular condyle (Figure 1). Axial CT images showed widening of the TMJ space and multiple calcifications around it (Figure 2a). The images also showed bony erosion with sclerotic changes in the adjacent articular eminence and glenoid fossa (Figure 2b).MRI was subsequently performed and showed a soft tissue mass expanding into the joint space and multiple nodules in the intra-articular soft tissue mass. The intraarticular mass had high signal intensity (SI) and the small nodules had low SI on T 1 weighted images (WI). Anterior displacement of TMJ disc was also observed. Gadolinium-enhanced T 1 WI showed wall enhancement representing synovial thickening (Figure 3a,b).A presumptive radiological diagnosis of synovial chondromatosis was made.Surgical exploration of the mass via a preauricular approach was performed under general anaesthesia.
We describe an epidermoid cyst arising from an accessory spleen of the pancreas. A 56-year-old female with iron deficiency anemia presented with dizziness. During the clinical workup, a 2×4 cm-sized mass was incidentally detected in the tail of the pancreas in a computed tomography (CT) scan. Under a clinical diagnosis of pancreatic cystic malignant tumor, a distal pancreatectomy was carried out. Grossly, the lesion was composed of a solid and cystic portion. Microscopic analysis revealed that the solid portion was an intrapancreatic accessory spleen and the cystic portion was an epidermoid cyst. An epidermoid cyst in an intrapancreatic accessory spleen is extremely rare and hence difficult to diagnose pre-operatively. Taking into account the possibility of such a cyst in the differential diagnosis of intrapancreatic cystic lesion is recommended.
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