Clinical Differential Diagnosis Research Articles

Dermoscopy Training Course Improves Ophthalmologists’ Accuracy in Diagnosing Atypical Pigmented Periorbital Skin Lesions

Background/Objectives: Facial pigmented skin lesions are extremely common, starting from the fourth to fifth decades, especially in South-European countries, often located in the periorbital region. These include malignant forms, Lentigo maligna (LM) and lentigo maligna melanoma (LMM), characterized by growing incidence, and a series of benign simulators, including solar lentigo (SL), pigmented actinic keratosis (PAK), seborrheic keratosis (SK) and lichen planus-like keratosis (LPK). The clinical differential diagnosis of atypical pigmented skin lesions (aPFLs) can be difficult, even for dermatologists, leading to inappropriate skin biopsies with consequent aesthetic impacts. Dermoscopy of the facial area is a specific dermoscopic field that requires dedicated training and proved to increase diagnostic accuracy in dermatologists. Since these lesions are often seen by ophthalmologists at first, we aimed to evaluate the effect of a focused dermoscopy training course on a group of ophthalmologists naïve to the use of a dermatoscope. Methods: A set of 80 periorbital pigmented skin lesions with both clinical and dermoscopic images was selected and evaluated by six ophthalmologists before and after a one-day intensive dermoscopic training course. They were required to evaluate 80 periorbital lesions one month before and after a one-day intensive dermoscopic training course, illustrating second-level diagnostic options such as reflectance confocal microscopy (RCM), obtaining a total of 480 evaluations. Specifically, they had to provide, for each case, a punctual diagnosis and a management option among dermoscopic follow-up/skin biopsy/RCM/LC-OCT. Descriptive statistics were carried out, and the accuracy (ACC), sensitivity (SE), and specificity (SP), with their 95% confidence interval (95% CI), were estimated. Results: In the pre-course test, ophthalmologists achieved 84.0% SP, 33.3% SE and 63.7% ACC, while after the course, SE increased by +9% (i.e., 41.7%), SP decreased by 4%, and ACC remained comparable, i.e., 64.6%. In the management study, the percentage of benign lesions for which a close dermoscopic follow-up was suggested significantly decreased (51.6% versus 22.2%), in parallel with an increase in the number of lesions referred for RCM. As for malignant cases, the reduction in responses “close dermoscopic follow-up” decreased from 37.0% to 9.9%, (−27%), in favor of RCM (+15%) and skin biopsy (+12%). Conclusions: The ophthalmologists proved to be very receptive in quickly metabolizing and putting into practice the concepts learned during the one-day intensive dermoscopy training course. Indeed, after only a one-day lesson, they were able to increase their SE by 9% and to improve their management strategy. The present findings highlight the importance of providing training ophthalmologists in dermoscopy during residency programs, in terms of benefits for the correct patient care.

Clinicopathologic feature and treatment progress of high-grade ovarian neuroendocrine tumors.

High-grade Ovarian neuroendocrine tumors represent a rare subset of ovarian neoplasms characterized by aggressive behavior, poor prognosis, and early metastasis. Despite their clinical significance, the management of these tumors lacks consensus due to their low incidence. This comprehensive review encompasses literature spanning from 1991 to 2024, focusing on the clinical presentation, diagnostic criteria, differential diagnosis, prognostic indicators, treatment modalities, and recent advancements in the understanding of this condition. Notably, a substantial proportion of affected individuals present during the perimenopausal period with unilateral lesions displaying mixed histological components. Biomarkers such as CA125, CA199, and NSE hold promise for aiding in the diagnosis and screening of ovarian neuroendocrine tumors. Unfortunately, patients exhibit a dismal prognosis even diagnosed at an early stage. Primary treatment strategies predominantly involve surgical intervention coupled with etoposide-cisplatin combination chemotherapy. In cases of recurrence, second-line chemotherapeutic agents including paclitaxel, irinotecan, and doxorubicin are commonly employed alongside localized radiotherapy. While specific genetic mutations remain elusive, emerging evidence suggests potential therapeutic effect involving mTOR inhibitors, PD-1 monoclonal antibodies, and antiangiogenic agents based on isolated case reports. The exploration of representative set of mutations will help for precise targeted therapies and remains a focal point of our ongoing research efforts.

Molecular pathology of skin fragility

The skin's barrier function is primarily maintained by the cohesion of its layers and the specialized stratum corneum. Genetic and autoimmune disorders that result in skin fragility have significantly contributed to understanding the role of various molecular components in the skin. These conditions, characterized by blisters, erosions, wounds, and impaired wound healing, are rare but must be considered in clinical differential diagnoses. Key cutaneous adhesion structures include the epidermal basement membrane, anchoring fibrils, cell-matrix adhesions (e.g., hemidesmosomes and focal adhesions), and cell-cell adhesions (e.g., desmosomes and corneodesmosomes). These multiprotein suprastructures not only provide structural support but also participate in signaling processes and physiological or pathological conditions such as skin aging and wound healing. Additionally, dermal connective tissue plays astructural role and serves as areservoir for proteases, growth factors, and cytokines. Modern techniques like single-cell and spatial transcriptomics, combined with artificial intelligence algorithms, are advancing the molecular mapping of human skin. Moreover, this review highlights the molecular composition of adhesion structures and the specific diseases associated with deficiencies in these components.

Patchy Dermal Melanocytosis: Differential Diagnosis and Management.

Nevus of Ito and Mongolian spots are distinct clinical presentations of patchy dermal melanocytosis, characterized by similar dermatological manifestations that can pose diagnostic difficulties for clinicians. This review aims to consolidate current understanding and research advancements on these conditions to facilitate clinical diagnosis, differential diagnosis, and management. A comprehensive search of databases including PubMed and Google Scholar was conducted, along with an analysis of pertinent literature retrieved from reference lists spanning nearly four decades. Epidemiological, clinical, and pathological profiles exhibit nuanced differences between the two conditions, with unique expressions under electron microscopy and the regression possibility. It is noteworthy that most Mongolian spots naturally fade with advancing age, in contrast to nevus of Ito, which persist and may potentially evolve into malignant lesions. While picosecond laser treatment has shown greater efficacy than nanosecond lasers, the lower-energy approach holds particular promise in pediatric cases. The therapeutic landscape for patchy dermal melanocytosis is evolving, shifting from selective photothermal action to photomechanical or subcellular photothermal modalities. This review underscores the importance of meticulous clinical assessment and the potential of innovative therapeutic approaches in managing these conditions.

Metastatic Mesothelioma of the Tunica Vaginalis Presenting as Scrotal and Abdominal Nodules: A Case Report and Review of the Literature.

Mesothelioma of the tunica vaginalis testis (MMTVT) is a rare neoplasm comprising <3% of all cases of malignant mesothelioma (MM). MMTVT derives from the tunica vaginalis testis, an outpouching of the mesothelial-lined abdominal peritoneum that detaches from the abdominal cavity after the descent of the testis. Similar to pleural mesothelioma, asbestos exposure is a known risk factor. However, MMTVT has a better prognosis than pleural mesothelioma. Cutaneous metastases from MMTVT are exceedingly rare. Herein, we describe a case of a 67-year-old man with a history of asbestos exposure presenting with scrotal pain and indurated plaques on his lower abdomen and scrotum. Histologic sections showed a sheet-like dermal proliferation comprising epithelioid cells with necrosis and increased mitotic activity. The clinical and histologic differential diagnosis was broad, including metastatic carcinoma, melanoma, sarcoma, germ cell tumor, hematologic malignancy, neuroendocrine carcinoma, and malignant mesothelioma. By immunohistochemistry, the neoplastic cells were positive for WT1, D2-40, and AE1/AE3, with rare positivity for calretinin, consistent with a diagnosis of mesothelioma. Additional immunohistochemical studies provided no support for the other diagnostic considerations listed above. BAP1 showed retained nuclear expression (normal) by immunohistochemistry. A DNA sequencing panel identified copy number losses in CDKN2A, MTAP, CDKN2B, and NF2, which are frequently identified genetic alterations in malignant mesothelioma. Subsequent testicular imaging demonstrated a diffusely thickened scrotal wall with an enlarged left testicle. Overall, this represents a case of malignant mesothelioma presenting with cutaneous metastases to the scrotum and lower abdomen, with clinical and imaging features suggestive of primary MMTVT. The International Mesothelioma Interest Group recommends using at least 2 mesothelial markers, such as calretinin, WT1, CK5/6 or D2-40, and 2 epithelial markers, such as claudin-4, CEA, MOC-31, as well as a broad-spectrum cytokeratin stain (AE1/AE3) as part of an initial immunohistochemical panel. Metastatic mesothelioma should be included in the differential diagnosis of malignant epithelioid dermal tumors with unusual staining patterns.

Imaging manifestations and misdiagnosis of liposclerosing myxofibroma fumor

To focus on the imaging features of liposclerosing myxofibrous tumor (LSMFT) and diagnostic challenges to enhance clinical recognition and differential diagnosis accuracy. Retrospective analysis was conducted on the imaging and pathological data from 21 cases diagnosed with LSMFT between January 2014 and November 2022, including 14 males and 7 females (aged from 21 to 73 years; the course of disease ranged from 4 to 48 months). Patient demographics, clinical presentations, and imaging modalities including X-ray, CT, and MRI were reviewed. Pathological findings were correlated with imaging features to delineate diagnostic criteria and identify causes of misdiagnosis. All 21 patients represented primary lesions, located in 14 bilateral femurs [9 on the right and 5 on the left; 12 proximal femurs (intertrochanteric and peripheral) and 2 distal femurs], 2 proximal tibia, 2 proximal humerus, 1 proximal radius, and 1 ilium and 1 calcaneus. On X-ray and CT, all lesions showed cartographical or quasi-circular osteolytic destruction with distinct and sclerotic margins, continuous bone cortex, absence of periosteal reaction and surrounding soft tissue mass. Calcification, bone ridge and varying degrees of fat components were observed in 16 lesions, displaying mixed density;5 lesions showed ground-glass density with minimal bone ridge. On MRI, the signal intensity of the lesion was heterogeneous. T1-weighted imaging showed iso-to slightly high signal intensity, while T2-weighted imaging demonstrated unevenly high signal intensity. Fat-suppressed sequences depicted significantly elevated signal intensity within lesions, with post-contrast enhancement showing uneven patterns. 5 Cases were initially misdiagnosed as fibrous dysplasia. LSMFT is an uncommon benign bone tumor, typically localized in the proximal femur but occasionally found in other skeletal sites. Understanding its distinct imaging characteristics is crucial for accurate diagnosis. Typical cases exhibit identifiable imaging patterns, whereas atypical presentations may lead to misdiagnosis as fibrous dysplasia.

Atypical PC-BPPV – Cupulolithiasis and Short-Arm Canalithiasis: A Retrospective Observational Study

Background and Purpose: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis. Methods: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP). Results: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, “floating” sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm. Discussion and Conclusion: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487).

Rapidly Progressive Primary Cutaneous Gamma Delta T-Cell Lymphoma With FYN Gene Alteration.

Primary cutaneous gamma delta T-cell lymphoma (PCGDTCL) is a rare type of non-Hodgkin lymphoma accounting for <1% of primary cutaneous T-cell lymphomas. The exact cause of PCGDTCL is not known, however, it is thought that chronic antigen exposure in the skin may lead to immune dysregulation at the site, resulting in abnormal proliferation of mature, post-thymic cytotoxic gamma delta T cells. Mutations are the most common genetic alteration seen in PCGDTCL, while structural abnormalities such as gene fusions are not common. We report a case of PCGDTCL with atypical immunophenotypic features, including expression of CD5 with lack of cytotoxic marker expression, and a structural alteration leading to FYN deletion at exon 8. Recently, it was described that a deletion of the area between FYN exon 8 and TRAF3IP2 intron 2 results in a novel FYN::TRAF3IP2 fusion in peripheral T-cell lymphoma, not otherwise specified. We describe our patient's clinical course, differential diagnosis, and potential implications of FYN deletion on disease pathogenesis. To our knowledge, this is the first report of an FYN structural alteration to be described in PCGDTCL.

Myopathy in glycogen storage disease type IV: case report of a family

Aim. To study the clinical presentation and differential diagnosis of a rare hereditary disease glycogen storage disease type IV with progressive skeletal myopathy in a case report of a family.Materials and methods. Two patients were followed up in the specialized neurology unit of the regional clinical hospital and in the outpatient setting.Results. Long-term follow-up and examination in two clinically similar cases of myopathy in siblings allowed us to diagnose a hereditary metabolic disease. The congenital muscular form of glycogen storage disease type IV was manifested by myopathy and peripheral tetraparesis with the development of bone deformities. Difficulty in the diagnosis was due to isolated myopathy progression with no signs of liver involvement. The diagnosis was established with account of clinical manifestations, the progressive course of the disease, electromyography findings, and the results of molecular genetic testing for pathogenic mutations associated with hereditary neuromuscular diseases.Conclusion. Glycogen storage disease type IV can clinically manifest itself by progressive myopathy without liver involvement and changes in blood biochemistry. The presented clinical cases in siblings are identical. Myopathy does not have clinical features that are significant for the differential diagnosis with other hereditary neuromuscular diseases. Genetic testing identified a mutation in the GBE1 gene and is considered as the main diagnostic criterion of the disease.

Double Cervical Adjacent Hydrated Nucleus Pulposus Extrusion (HNPE) in a Yorkshire Terrier

A 9-year-old Yorkshire terrier was brought to the emergency department for inability to maintain the correct station with acute onset. Neurological examination showed a non-ambulatory tetraparesis, spontaneous proprioceptive deficit in all limbs, and decreased flexor reflex in the forelimbs. The neurological symptoms suggested a cranial cervical spinal cord with suspicion of spinal shock. The clinical differential diagnoses included degenerative (intervertebral disc extrusion), vascular, inflammatory, or neoplastic disease. No pathological findings were evident in the hematobiochemical tests or in the radiograph examination. MRI examination of the cervical spine showed the presence of two adjacent hydrated nucleus pulposus extrusions at C3-C4 and C4-C5 tracts. Treatment included analgesic and non-steroidal anti-inflammatory therapy; movement restriction was initially necessary, followed by physiotherapy. Follow-up at 4 weeks showed complete recovery. A telephone follow-up after 3 months with the owner confirmed the absence of symptoms. This article reports the first double cervical HNPE case in a dog, adding the possibility that the disease may present in this form and the success of conservative treatment as described in the literature.

Pediatric mediastinal lymphatic malformation: misdiagnosis analysis and literature review

ObjectivesMediastinal cystic lymphatic malformation (MCLM) in children is prone to misdiagnosis as cystic teratoma. We compared the clinical and radiologic features between the two diseases and performed a cross-comparison with previous research on adult cases. This study aims to identify characteristic pediatric manifestations to improve diagnostic accuracy.MethodsA retrospective study of clinical and radiologic data was conducted on 12 MCLM and 20 cases of cystic teratomas confirmed by pathology or intervention biopsy. Clinical characters and radiology features (mass location and morphology, density, component, secondary complication) were recorded and compared. We reviewed clinical studies on MCLM published in the past decades, analyzing radiological differences and comparing pediatric MCLM cases at our hospital with those in the literature.ResultsGroup comparison in pediatrics between MCLM and cystic teratomas: There were significant age differences (p = 0.036), shape (p = 0.003), CT difference value (p < 0.001), CT difference ratio (p < 0.001), calcification (p < 0.001), fat (p < 0.001), and typing (p < 0.001) between the two diseases. An analysis of literature data on MCLM cases involved 16 studies.ConclusionThe absence of internal fat or irregular morphology, along with a minimal CT difference value, may suggest the diagnosis of MCLM. In pediatric cases, anterior mediastinal diseases tend to extend toward the neck, and the presence of the thymus can complicate the component analysis, thereby increasing the risk of misdiagnosis. Clinical diagnosis and differential diagnosis of pediatric MCLM rely heavily on imaging evaluation.

Acute Vision Impairment Caused by Internal Carotid Artery Plaque Hemorrhage Combined With Thrombosis.

Atherosclerosis (As) is an important pathologic basis for ischemic cerebrovascular disease and easily causes stenosis of the origin of the internal carotid artery (ICA). As the main source of intracranial blood supply, the ICA accounts for 70% to 80% of blood flow. This stenosis can cause various ocular symptoms in patients. In the existing literature, it is rare to report cases with only acute vision loss caused by ICA plaque hemorrhage combined with thrombosis. The authors report a case of acute vision impairment caused by ICA plaque hemorrhage. The clinical manifestations, imaging characteristics, differential diagnosis, and treatment methods were discussed based on relevant literature, and the diagnosis and differentiation of the disease were considered to deepen the understanding of the disease.

Differential diagnosis of parenchymal jaundice

The article presents to the attention of interested specialists (infectious disease specialists, gastroenterologists, pediatricians) information on the definition and classification of jaundice, the physiology of bilirubin metabolism, pathogenetic mechanisms of the development of hepatic forms of jaundice syndrome and the syndromes observed in this case, as well as diseases, both infectious and somatic, in which parenchymal jaundice occurs. Using aspecific clinical example, the features of the clinical course, diagnosis and differential diagnosis, and tactics of treatment of hepatic jaundice developed in a16-year-old teenager with chronic viral hepatitis C and Gilbert’s syndrome are analyzed in detail.

Cervical Spinal Stenosis - Modern Approaches to Diagnosis and Treatment

The article analyzes in detail the scientific literature on the etiology, classification, diagnosis, clinical picture and treatment of spinal canal stenosis in the cervical spine. Special attention is paid to the clinical picture, diagnosis and differential diagnosis of the causes of cervical myelopathy. Further, the work presents all modern methods of treatment of cervical spinal stenosis. The researchers divided the methods into ventral and dorsal. The advantages and disadvantages of each type of operation are described. In conclusion, the authors summarized the indications and contraindications for each type of surgical aid.

An Unusual Case of Blastomycosis Presenting as "Punched Out" Ulcerations

Background: Cutaneous blastomycosis commonly presents as verrucous, hyperkeratotic nodules or plaques. Less commonly, it presents as ulcerations with accompanying scale crusting or verrucous features. Case Report: A healthy 34-year-old incarcerated male with a history of drug abuse presented with several, well-defined (punched out), deep ulcerating cutaneous lesions with undermined borders. There was no crusting, or verrucous features. The clinical differential diagnoses included pyoderma, vasculitic ulcers, and pyoderma gangrenosum. The histopathology from a gluteal ulceration demonstrated pseudoepitheliomatous hyperplasia with acute, chronic, and granulomatous inflammation. PAS stain of the specimen exhibited thick-walled yeast demonstrating broad-based budding typical of blastomycosis and tissue cultures grew Blastomyces dermatitidis after one month. Conclusion: Ulceration without verrucous features can portend cutaneous blastomycosis. Diagnosis using fungal culture of the wound or tissue takes weeks to result. A prompt biopsy and histopathologic examination or broad-range PCR testing of a wound swab, tissue or urine specimen can lead to a prompt diagnosis.

Cytomegalovirus Retinitis: Clinical Manifestations, Diagnosis and Treatment.

Cytomegalovirus (CMV) retinitis is the most common eye disease associated with CMV infection in immunocompromised individuals. The CMVR may initially be asymptomatic; however, relatively mild vitreous inflammation at the onset may be an important differential point from other diseases in HIV patients. Fundus photography, CD4 T-cell count, and telemedicine could be used to screen and monitor the high-risk population, particularly in resource-limited regions. Retinitis generally starts in the peripheral retina and advances toward the posterior pole, which could develop to the characteristic "pizza pie" appearance marked by central retinal necrosis and intraretinal hemorrhage. CMVR causes vision loss if left untreated, and early antiviral therapy significantly reduces the risk of vision loss. Alongside traditional antiviral treatments, immunotherapies including CMV-specific adoptive T-cell therapy and CMV immunoglobulin (CMVIG) are emerging as promising treatment options due to their favorable tolerability and reduced mortality. This review comprehensively examines CMV retinitis, encompassing the clinical features, differential diagnosis, laboratory tests, and updated treatment strategies to inform clinical management.

Sinonasal Tumors: Clinical and Morphological Characteristics and Differential Diagnosis

Malignant sinonasal tumors are rare and account for 1% of all neoplasms. Most of these carcinomas are poorly differentiated or undifferentiated tumors. Due to overlapping features, both young and experienced physicians encounter difficulties in their diagnosis. We present 2 cases of 2 tumors of the sinonasal tract, which belong to small round blue cell tumors: sinonasal small cell neuroendocrine tumor and esthesioneuroblastoma.

Metastatic Renal-Cell Carcinoma of the Oro-Facial Tissues: A Comprehensive Review of the Literature with a Focus on Clinico–Pathological Findings

Background: Metastatic tumors of the oro-facial tissuesare rare, with an incidence ranging between 1% and 8% of all oral malignant tumors. Generally reported with a peak of incidence in the 5–7th decades but possibly occurring at any age, metastases may represent the first sign of an occult cancer or manifest in patients with an already known history of a primary carcinoma, mostly from the lungs, kidney, prostate, and colon/rectum in males, and the uterus, breast, lung, and ovary in females. In the oro-facial tissues, the most involved sites are the oral mucosa, gingiva/jawbones, tongue, and salivary glands. Methods: A broad and deep literature review with a comprehensive analysis of the existing research on oro-facial metastases from renal-cell carcinoma (RCC) was conducted by searching the most used databases, with attention also paid to the clear-cell histological variant, which is the most frequent one. Results: Among the 156 analyzed studies, 206 cases of oro-facial metastases of renal cancer were found in patients with an average age of 60.9 years (145 males, 70.3%; 61 females, 29.6%). In almost 40% of the cases, metastasis represented the first clinical manifestation of the primary tumor, and 122 were histologically diagnosed as clear-cell renal-cell carcinoma (ccRCC) (59.2%). The tongue was involved in most of the cases (55 cases, 26.7%), followed by the gingiva (39 cases, 18.9%), mandible (35 cases, 16.9%), maxilla (23 cases, 11.1%), parotid gland (22 cases, 10.6%), buccal mucosa (11 cases, 5.3%), lips (7 cases, 3.3%), hard palate (6 cases, 2.8%), soft palate, masticatory space, and submandibular gland (2 cases, 0.9%), and lymph nodes, tonsils, and floor of the mouth (1 case, 0.4%). Among the 122 ccRCCs (84 males, 68.8%; 38 females, 31.1%), with an average age of 60.8 years and representing in 33.6% the first clinical manifestation, the tongue remained the most frequent site (31 cases, 25.4%), followed by the gingiva (21 cases, 17.2%), parotid gland (16 cases, 13.1%), mandibular bone (15 cases, 12.2%), maxillary bone (14 cases, 11.4%), buccal mucosa and lips (6 cases, 4.9%), hard palate (5 cases, 4%), submandibular gland and soft palate (2 cases, 1.6%), and lymph nodes, tonsils, oral floor, and masticatory space (1 case, 0.8%). The clinical presentation in soft tissues was mainly represented by a fast-growing exophytic mass, sometimes accompanied by pain, while in bone, it generally presented as radiolucent lesions with ill-defined borders and cortical erosion. Conclusions: The current comprehensive review collected data from the literature about the incidence, site of occurrence, age, sex, and survival of patients affected by oro-facial metastases from renal-cell carcinoma, with particular attention paid to the cases diagnosed as metastases from clear-cell renal-cell carcinoma, which is the most frequent histological variant. Clinical differential diagnosis is widely discussed to provide clinicians with all the useful information for an early diagnosis despite the effective difficulties in recognizing such rare and easily misdiagnosed lesionsTheir early identification represents a diagnostic challenge, especially when the clinical work-up is limited to the cervico–facial region. Nevertheless, early diagnosis and recently introduced adjuvant therapies may represent the key to better outcomes in such patients. Therefore, general guidelines about the clinical and radiological identification of oro-facial potentially malignant lesions should be part of the cultural background of any dentist.

Clinical Management of Endometriosis in Menopause: A Narrative Review.

Endometriosis, an inflammatory disease primarily affecting the pelvis and peritoneum, manifests with pelvic pain, dysmenorrhea, dyschezia, dyspareunia, and infertility. Despite its ubiquity, the management of endometriosis is challenging due to its heterogeneous presentation, limitations in diagnostic methods, variable therapeutic responses, and personal and socio-cultural impact on quality of life. This review attempts to consolidate the current literature on endometriosis occurring during and beyond menopause, and to present details regarding management strategies that take into account individual outcomes and goals when managing this condition. The topics included in this review are the clinical features and differential diagnosis of pelvic pain in postmenopausal patients, imaging considerations, serum and laboratory biomarkers, indications for surgery, the principles of hormone replacement therapy, the de novo development of endometriosis after menopause, and malignant transformation. Each topic includes a summary of the current literature, utilizing clinical research, case reports, and expert opinion. Despite a better understanding of the impact of endometriosis beyond menopause, there are many limitations to this condition, specifically with regard to cancer risk and indications for surgery. The existing evidence supports the use of shared decision making and the incorporation of patient preferences in guiding clinical management. Future research endeavors must shed light on the natural history of postmenopausal endometriosis through longitudinal studies in order to foster a deeper understanding of its complicated disease course across women's lifespans.

Clinical diagnosis of group A streptococcal pharyngitis and progress in the application of scoring systems

Pharyngitis can be caused by various pathogens, including viruses and bacteria. Group A streptococcus (GAS) is the most common bacterial cause of pharyngitis. However, distinguishing GAS pharyngitis from other types of upper respiratory tract infections is challenging in clinical settings. This often leads to empirical treatments and, consequently, the overuse of antimicrobial drugs. With the advancement of antimicrobial drug management and healthcare payment reform initiatives in China, reducing unnecessary testing and prescriptions of antimicrobial drugs is imperative. To promote standardized diagnosis and treatment of GAS pharyngitis, this article reviews various international guidelines on the clinical diagnosis and differential diagnosis of GAS pharyngitis, particularly focusing on clinical scoring systems guiding laboratory testing and antimicrobial treatment decisions for GAS pharyngitis and their application recommendations, providing a reference for domestic researchers and clinical practitioners.