Systemic Mastocytosis and surgery a potential disaster

Abstract

different from that of a ranula, this raises the question of whether we should be more comprehensive in our preoperative assessment.Some have argued that a cystic mass of the head and neck warranted routine radiological assessments, 1 and needed computed tomography (CT) or magnetic resonance imaging if any atypical features were found. 2 Some advocated CT, even as early as 1987, 3 for the evaluation of all clinical cystic lesions. Others further recommended fine needle aspiration prior to surgical excision. 4 In the absence of a randomized trial, the best treatment protocol is yet to be developed. When solely discussing the pickup rate of an epidermoid cyst from a clinical lesion, the number needed to treat (NNT) is 15. Our opinion is that the NNT might be justifiable for routine noninvasive investigations, for example, ultrasound References 1. Turetschek K, Hospodka H, Steiner E. Epidermoid cyst of the floor of the mouth: diagnostic imaging by sonography, computed tomography and magnetic resonance imaging. Br. J. Radiol. 1995; 68: 205-7. 2. Woo EK, Connor SEJ. Computed tomography and magnetic resonance imaging appearances of cystic lesions in the suprahyoid neck: a pictorial review. Dentomaxillofac. Radiol. 2007; 36: 451-8. 3. Coit WE, Harnsberger HR, Osborn AG, Smoker WRK, Stevens MH, Lufkin RB. Ranulas and their mimics: CT evaluation. Radiology 1987; 163: 211-6. 4. Walstad WR, Solomon JM, Schow SR, Ochs MW. Midline cystic lesion of the floor of the mouth.

Adult-onset mastocytosis in the skin is highly suggestive of systemic mastocytosis

“…Severe and even fatal intra-and postoperative complications also pose an important threat. [31][32][33] In addition, patients with systemic mastocytosis should be monitored closely for osteopenia and osteoporosis, which may lead to pathological fractures. 34 In summary, we demonstrate, for the first time, that almost all patients with adult-onset mastocytosis in the skin, usually presenting as urticaria pigmentosa, suffer from systemic mastocytosis as defined by the diagnostic WHO criteria.…”

Critical care management of systemic mastocytosis: when every wasp is a killer bee

“…Hymenoptera stings mostly cause severe anaphylactic reactions (grade III), whereas foods and medication lead to milder systemic reactions (grade II). However, fatal cases of drug hypersensitivity have been described in the literature [ 7 , 8 ]. Medications that are potential initiators of mastocyte degranulation on the basis of case reports and drugs associated with histamine release in general are listed in Table 4 .…”

“…Anaphylaxis may be the result of a variety of triggers. Several case reports described anaphylaxis following regional or general anaesthesia as the first presentation of mastocytosis [ 8 , 9 ]. The diagnosis may be difficult as anaphylaxis may develop with a delay of hours [ 10 ].…”