Clinical Impression Research Articles

Autoavaliação de pacientes e médicos em relação à estabilidade clínica em transtornos mentais graves: um estudo transversal

ABSTRACT Objective This study explores the relationship between patients’ self-assessment and physicians’ evaluation regarding clinical stability. Methods This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient’s physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician’s global clinical impression over the six previous months. The patients’ self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients’ self-evaluation was considered as our standard. Results The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians’ evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. Conclusion The data analysis confirms our hypothesis that the self-assessment made by patients with SMD was accurate regarding their health condition, and that the self-assessment made by patients who considered themselves stable agree with the physicians’ evaluation.

The Causes and Complications of Urinary Retention in Adult Males Managed at Pakistan Institute of Medical Sciences Islamabad Pakistan

Background: urinary retention is characterized as body inability to empty the bladder completely by voluntary micturition. The UR is highly observed in the male adult. But the limited and sufficient knowledge is present about its causes and associated complication. Objective: It is most common urological emergency in hospitals. The study aimed to evaluate the causes and associated complications of urinary retention. Material and Methods: This prospective hospital based study was conducted on 176 patients visited the emergency department of Pakistan Institute of Medical Sciences Islamabad over a period of 06 months. The review board and ethical committee of the hospital approved the study. Informed consent was taken from all patients included in study. A brief history and examination was done to establish the diagnosis. Urinary retention was relived either by per urethral or supra-pubic cathrterization followed by detailed history, examination and investigations. The urine sample of each patient was taken for urinalysis. Baseline investigations were done on every patients. Depending on the clinical impression the investigations were individualized. The results were retrieved from the collected data. The data was statistically analyzed by using SPSS software. Results: 176 patients were recruited during this research time. The patients mean age was 58.81±17.36SD. The maximum number of patients encountered in age group of 55-74years. Most common cause of urinary retention was enlarge prostate 67.04%, followed by urethral stricture 18.75% and impacted urethral/Urinary bladder stone 14.20%. Acute urinary retention was diagnosed in 62.50% while 37.50% were diagnosed as chronic urinary retention. The 65.34% patients were treated with per urethral catheterization and 34.66% were treated with supra-pubic catheterization. In 62.50% patients no complication were observed while in other 19.88% were diagnosed with urinary tract infection and 17.62% with the renal insufficiency. Conclusion: Urinary retention is common in adult patients. Enlarge prostate was the one of the main cause of urinary retention. The most common type of retention was acute urinary retention. Complications were mostly associated with chronic urinary retention. Keywords: Urinary retention, Complications, adult male, Enlarge Prostate and acute urinary retention.

Use of levodopa-carbidopa intestinal gel to treat patients with multiple system atrophy

BackgroundLevodopa-carbidopa intestinal gel (LCIG) is an effective treatment for late-stage Parkinson's disease (PD) but had not been evaluated in levodopa-responsive patients with the parkinsonian variant of multiple system atrophy (MSA-P) and motor fluctuations. We aimed to assess the safety of LCIG in MSA-P patients. MethodsIn a retrospective, single-center study, we analyzed clinical and treatment-related data for all patients with MSA-P or PD treated with LCIG between December 2004 and November 2017. Adverse events (AEs) were classified into three classes: AEs related to gastrointestinal effects or to the PEG-J procedure, AEs related to the device, and AEs related to the pharmacological effect of LCIG. Results7 MSA-P and 63 PD patients had been treated with LCIG for a median [interquartile range] period of 31 [16;43] and 19 [8;45] months, respectively. There were no significant intergroup differences in safety. Enteral nutrition was introduced at the same time as LCIG treatment in 4 (57%) MSA-P patients. In the MSA-P and PD groups, LCIG was associated with a better Global Clinical Impression score and discontinuation of oral anti-parkinsonian drugs (in 43% and 27% of cases, respectively). ConclusionsLCIG treatment is feasible in MSA-P patients with severe motor complications. The safety profile is similar to that seen in PD.

0356 Does Unconscious Socioeconomic Bias Influence Tele-evaluation of Obstructive Sleep Apnea? A Tele-Equity Exploratory Analysis

Abstract Introduction Telemedicine, once of limited scope, has become common and widespread due to the present and ongoing SARS-CoV-2 pandemic. Center to home delivery, the most common model, allows for convenient and efficient care. Concurrent with this groundshift, there is increasing attention to disparities in medical services, and how these disparities may impact patient outcomes. Telemedicine could be used to help bridge barriers to timely quality care, however, patient access and longstanding institutional biases may limit the potential. Healthcare providers must actively develop systems to ensure that telemedicine is optimized for people across the income spectrum. This exploratory analysis examined how economic disparities in patients being evaluated for obstructive sleep apnea may be associated with providers’ clinical impressions. The objective was to study the inter-method reliability of pre-test probability of obstructive sleep apnea assessed via telemedicine and in-person evaluations, and to compare that reliability between income classes. Methods This is a secondary analysis of a pre-pandemic interrater reliability study, conducted between March 2017 and January 2019. Our researchers completed a randomized, blinded study comparing the pre-test probability of obstructive sleep apnea between an in-person physician and a separate physician seeing the same patient via televideo conferencing. Patients referred to the University of Rochester (UR) Sleep Center were eligible for the study. Women and men 30-70 years old were invited to participate. The patients were not necessarily referred to the center for evaluation of sleep disordered breathing. Patients with dementia, hearing or visual loss, severe psychiatric or developmental illness, or not fluent in English were excluded. Patients had adequate computer literacy, access to high speed internet, and a computing device with appropriate video camera and microphone.The primary objective of the original study was to assess the interrater reliability between the in-person and telemedicine raters for pre-test probability of sleep apnea (high, moderate, or low). Providers used clinical judgement from the history and examination to determine pre-test probabilityFor this present analysis, we assessed the inter-method reliability separately for strata defined by reported annual income level: low income (< $50,000), middle income ($50,000-$100,000), and high income (> $100,000). Reliability was quantified for each stratum using weighted kappa statistics given the ordinal nature of the outcome variable, pre-test probability of obstructive sleep apnea (high, moderate, or low). Weighted kappa statistics were compared between the income strata (high vs. middle, high vs. low, middle vs. low). The operant statistic assumed an approximate standard normal distribution under the null hypothesis of equal kappa values in the two income strata. The Bonferroni method was used to adjust the p-values for the three pairwise comparisons performed among the three income strata. Results Data from 53 patients were avaiable for this analysis. 11 of these patients were in the low income group, 22 in the middle income, and 16 were in the high income group. 9 patients did not include their income bracket, and were not included in the analysis. Inter-method reliabilities, assessed using weighted kappa, were 0.83 (low income), 0.24 (middle income), and 0.66 (high income). When comparing between the strata, the kappa statistics were significantly different (p=0.005) between the low and moderate income groups. There was a trend between the high and moderate income groups that did not meet statistical significance (p=0.07). Conclusion The intermethod reliability was substantial in the low income stratum, moderate in the high income stratum, and slight in the middle income group based on the kappa statistic. There was a significant difference in the reliability values of telemedicine versus in-person assessments between the low and middle income brackets, and there was a trend between the high and moderate groups. Since the raters were unaware of the patients’ income levels, this association might suggest possible unconscious bias in evaluating for OSA. It may also suggest that beyond access to telemedicine technology, the quality of the care may also be influenced by socioeconomic factors. With telemedicine in its early stages, it is important to develop this technology that will minimize biases that could result from patients’ economic fortunes. Support (If Any) The study was funded by a grant from the American Academy of Sleep Foundation (AASM Foundation grant #163-FP-17).

SCID and Other Inborn Errors of Immunity with Low TRECs — the Brazilian Experience

Severe combined immunodeficiency, SCID, is a pediatric emergency that represents the most critical group of inborn errors of immunity (IEI). Affected infants present with early onset life-threatening infections due to absent or non-functional T cells. Without early diagnosis and curative treatment, most die in early infancy. As most affected infants appear healthy at birth, newborn screening (NBS) is essential to identify and treat patients before the onset of symptoms. Here, we report 47 Brazilian patients investigated between 2009 and 2020 for SCID due to either a positive family history and/or clinical impression and low TRECs. Based on clinical presentation, laboratory finding, and genetic information, 24 patients were diagnosed as typical SCID, 14 as leaky SCID, and 6 as Omenn syndrome; 2 patients had non-SCID IEI, and 1 remained undefined. Disease onset median age was 2months, but at the time of diagnosis and treatment, median ages were 6.5 and 11.5months, respectively, revealing considerable delay which affected negatively treatment success. While overall survival was 51.1%, only 66.7% (30/45) lived long enough to undergo hematopoietic stem-cell transplantation, which was successful in 70% of cases. Forty-three of 47 (91.5%) patients underwent genetic testing, with a 65.1% success rate. Even though our patients did not come from the NBS programs, the diagnosis of SCID improved in Brazil during the pilot programs, likely due to improved medical education. However, we estimate that at least 80% of SCID cases are still missed. NBS-SCID started to be universally implemented in the city of São Paulo in May 2021, and it is our hope that other cities will follow, leading to early diagnosis and higher survival of SCID patients in Brazil.

MO669: Predictive Parameters of Automated PD Cycler Software for Diagnosis of Catheter Dysfunction

Abstract BACKGROUND AND AIMS An adequately functioning catheter is of vital importance for successful long-term treatment and technique survival to peritoneal dialysis (PD) patients. According to the 2021 International Society of Peritoneal Dialysis guidelines on membrane function, catheter drainage problems should be suspected first in patients with low ultrafiltration (UF) capacity. Catheter dysfunction and the consequent decrease in UF are frequent complications in PD patients associated with significant negative clinical outcomes. METHOD We introduce the use of a combination of parameters obtained from daily measurements of the cycler software PD Link (Baxter) for predicting catheter dysfunction in automated peritoneal dialysis (APD) patients. Out of 117 APD patients treated at the Medical University of Vienna from 2015 to 2021, we identified all patients with verified catheter malposition and dysfunction (n = 14, cases) and compared them to controls without clinical evidence of mechanical problems and a recent X-ray confirming position of the PD catheter tip in the recto-vesical/recto-uterine space (n = 19). We retrieved cycler data for 7 days each and tested parameters predictive capability of catheter dysfunction. RESULTS Total number of alarms/week >7 as single predictive parameter of catheter dislocation identified 85.7% (sensitivity) of patients with dislocated catheter and 31.6% (1—specificity) of control patients. A combination of two out of three parameters (number of alarms/week >7, drain time >22 min, UF of last fill <150 mL) identified the same proportion of patients with catheter dislocation, but was more accurate in identifying controls (21% false positive). CONCLUSION We confirmed our clinical impression that number of alarms, total drain time at the end of cycler session and UF of last fill are good predictors for mechanical drainage problems. In contrast to yearly peritoneal equilibration test measurements, these data provide valuable information for clinical management of PD patients on a daily base and will be easily available in new APD cyclers with devices connected to remote monitoring platforms.

Reversible Dementia With Rapid Recovery to Normal Cognition: A Case Report

We report the case of a 54-year-old female who was diagnosed with clinical dementia and recovered to normal cognition in only 11 days through appropriate intervention. The patient was on a complicated regimen of psychiatric medications for underlying depression and panic disorder. The patient noted increased deterioration in executive function gradual memory impairment starting in early 2020. As a result of the neuroimaging, prominent neurodegeneration and in vivo brain pathology were not observed. During outpatient clinic follow-up, severe obstructive sleep apnea (OSA) was confirmed. Based on the diagnostic results, a clinical impression was made for reversible dementia due to psychiatric drugs and OSA. During hospitalization for 10 days, the patient’s regimen of psychiatric medications with anticholinergic effects was changed, and long-acting benzodiazepines were reduced. The patient also underwent continuous positive airway pressure titration to ameliorate OSA. The patient reported subjective cognitive improvement and a comprehensive neuropsychiatric test performed at discharge later showed a normal range in all cognitive domains, and the patient s activity of daily living evaluated at the outpatient clinic after discharge had recovered.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Hematemesis From Varices in a 14-year-old Without Hepatobiliary Disease: A "Wandering" Diagnosis.

Management of intraorbital infections in the pediatric emergency department.

The decision to treat intraorbital infections at our institutions appears to be based on clinical impression of disease severity rather than radiologic findings. This suggests a need for further interdisciplinary studies to clarify optimal management. •Orbital c ellulitis is associated with significant potential complications, necessitating rapid diagnosis and treatment. • Present literature provides insufficiently clear guidance on emergency department management. •Consideration of all relevant factors (clinical features, laboratory findings, timing of imaging, and conservative vs. surgical management) in a single retrospective cohort. • Our findings suggest that decision-making in practice may be guided by clinical impression rather than imaging.

New opportunities in the treatment of asthenic symptoms after a new coronavirus infection

Introduction. Asthenia is an urgent problem during the pandemic of new coronavirus infection (COVID-19) because of its high frequency regardless of the severity of the disease.The purpose of this subanalysis of data from the multicenter controlled randomized clinical trial TONUS was to evaluate the efficacy and safety of meldonium therapy for аsthenia in COVID-19 survivors.Materials and methods. A total of 880 patients with asthenia who underwent COVID-19 within the last 6 months were included in the analysis. The efficacy of asthenia therapy was assessed by the MFI-20 scale, Schulte tables, and the General Clinical Impression (CGI) scale. All patients were previously randomized in two parallel branches of the TONUS study, including patients without concomitant disease in TONUS-1 (who received meldonium 500 mg/day for 14 days in the main group) and patients with cardiovascular or cerebrovascular disease in TONUS-2, who received meldonium at a dose of 1000 mg/day for 42 days in the main group. In both arms of the study, the drugs in the comparison groups were multivitamin complexes.Results. For the TONUS-1 groups.In the group of patients receiving meldonium compared with the control group (p < 0.001): total MFI-20 score decreased and was 31 (25; 40); MFI-20 –35 (–46; 23); performance value –5 (–11; –2) seconds; proportion of patients with significant improvement (by CGI-I) by the end of follow-up was 92.8%. For TONUS-2 groups.In the group of patients receiving meldonium compared with the control group (p < 0.001): total MFI-20 score decreased to 35 (27; 44); MFI-20 –34 (–46; –21), performance value –5 (–11; –2), proportion of patients with significant improvement (by CGI-I) by end of follow-up – 90.8%.Conclusion. Significant positive dynamics and regression of asthenia were noted in the groups of patients receiving meldonium in comparison with the control groups.

Clinical Evaluations of Macular Structure-Function Concordance With and Without Drasdo Displacement.

PurposeThe purpose of this study was to compare concordance between ganglion cell-inner plexiform layer (GCIPL) data from the Cirrus optical coherence tomographer (OCT) Ganglion Cell Analysis (GCA) and visual fields (VFs), with and without Drasdo displacement.MethodsFrom 296 open-angle glaucoma participants, GCIPL deviation and raw thickness data were extracted over locations per the 10-2 VF test grid, with and without application of Drasdo displacement, with global and eccentricity-dependent sensitivities and specificities calculated for both. With OCT and VF data classified as within or outside normative limits, pattern deviation values were compared using paired t-tests and Spearman correlations. Regression models were applied to pattern deviation values as a function of GCIPL thickness, and differences in model performance with and without displacement were compared using extra sums-of-squares F tests.ResultsThere were small but significant improvements in global specificity without displacement (0.58–0.59 with displacement and 0.61 without displacement), without notable differences in sensitivity (0.77–0.78 with displacement and 0.76–0.78 without displacement). At abnormal VF locations and without displacement, a higher proportion of correct OCT classifications (P = 0.0008) and significant correlation with worsening pattern deviation values were observed (r = 0.50, P = 0.002). Regression models indicated significantly steeper slopes with Drasdo displacement centrally (P = 0.002–0.04).ConclusionsWith GCA deviation maps, small improvements in structure-function concordance were observed without displacement, which are unlikely to be clinically meaningful. Using GCIPL thickness data, significantly better structure-function concordance was observed centrally with Drasdo displacement.Translational RelevanceApplying Drasdo displacement on probability-based reports is unlikely to alter clinical impressions of structure-function concordance, but applying displacement with GCIPL thickness data may improve detection of structure-function concordance.

Case series of Adenomatoid Odontogenic Tumors: Clinical, Radiographic, and Histologic Features

<h3>Objective</h3> We present a case series of adenomatoid odontogenic tumor (AOT), a benign odontogenic tumor from a large biopsy service. AOT has a limited growth potential and is often seen in children and young adults, between the ages of 10-19 years. AOT has uncertain pathogenesis and studies suggest enamel organ, reduced enamel epithelium, and rests of Malassez as potential sources. Clinically, AOT's are asymptomatic and identified upon routine radio- graphic examination. <h3>Methods</h3> Information was collected from the University of Florida Oral Pathology Biopsy Service archives (1994-2019). The clinical and demographic data along with any accompanying radiographic images and original slides were evaluated. <h3>Results</h3> A total of 26 cases of AOT were identified, with a mean age of 22.3 years (range: 12-67). A slight female predilection was noted (57.7%, n=15). Most cases presented in the anterior region of the jaw (73%, n=19) and a slight maxillary predilection was observed (61.5%, 16 cases). Most patients were aged under 20 (69.2%, n=18). Clinical impression included dentigerous cyst, lateral periodontal cyst, and odontogenic keratocyst (57.7%, n=15). Radiographs were available for six cases and all presented as a unilocular radiolucency. The histologic diagnosis was consistent with AOT in 24 cases and peripheral AOT in two cases.One case had a fo- cal area of CEOT that tested positive with a Congo Red stain. <h3>Conclusion</h3> In almost all cases within the study the clinical impression of AOT was not rendered. This implied that AOT is rarely considered in the differential of such lesions. In addition, while most patients were children or young adults, there were a few outliers above thirty (19.2%, n=5). This may suggest that AOT is diagnosed late in some cases due to its benign nature. Clinicians should be sentient of this lesion as the treatment and prognosis differs from other odontogenic cysts and tumors.

Metastatic Lesions to the Oral Soft Tissues and Bones: A Seventeen-Year Retrospective Study

<h3>Introduction</h3> Metastatic neoplasms to the oral soft tissues and bones are exceedingly rare and are associated with poor prognosis. Clinically, metastatic lesions exhibit a strong predilection to the jaw bones, specifically the posterior mandible, while soft tissue involvement includes the gingiva and tongue. Metastatic tumors may pose diagnostic challenges since their histopathologic appearance varies. Herein, we report the clinico-epidemiologic and histopathologic characteristics of forty-one metastatic lesions to the oral mucosa and jaws. <h3>Material and methods</h3> Cases diagnosed as metastatic lesions during the period 2003-2020 were retrieved. The demographic features (age and gender of the patients), clinical impression and location, as well as primary site and histologic type of the neoplasms were recorded. <h3>Results</h3> Among 126,229 biopsy specimens, only 41 (0.03%) comprised metastases. The patients' mean age was 67.6 years (age range=18-94 years) without any apparent gender bias (male: female ratio=21:20). The possibility of metastasis was considered in only half (21, 51%) of the cases. Twenty-two cases affected the gingiva (54%); six (27.3%) presented with tautochronous bone involvement. Ten cases (24%) were exclusively intraosseous and manifested as ill-defined, unilocular, mandibular radiolucencies. Other anatomic sites included the alveolar mucosa and hard palate (3 each, 7.3%), tongue (2, 5%) and soft palate (1, 2.4%). Collectively, the most common primary site was the lung (12, 29%) followed by the colon (6, 15%), breast and kidney (4 each, 10%), pancreas (2, 5%), and prostate, heart, esophagus, sublingual gland, adrenal, bone and CNS (1 each, 2.4%). In six cases (15%) the primary was unknown. In both men and women, lung was the most common primary site (33.3% and 25%, respectively). <h3>Conclusions</h3> Metastases to the oral cavity and jaws are rare. When present, they show a predilection for the gingiva and mandible. Clinicians should remain aware about metastatic neoplasms since they can frequently mimic reactive pathoses.

Intraosseous angiolipoma of the mandible: case report of a rare entity

<h3>Background</h3> Intraosseous angiolipoma is a benign adipocytic lesion that may occur at any bony site, with predilec- tion for the long bones, ribs, vertebrae, and the head and neck region. As the name suggests, the lesion is character- ized by the presence of mature adipocytes associated with increased vascularity. Intraosseous angiolipoma of the mandible is an exceedingly rare condition first described by Polte in 1976. Until the present date, only four cases were documented in the English literature. Case description: We report a case of a 58 year-old woman presenting with an asymptomatic lesion of the mandible. CBCT examination shows a hypodense area extending from the api- cal region of the mandibular first molar to the mid portion of the mandibular ramus, right side. Lesion is localized, multilocular, with scalloped borders and partially corticated. There is thinning of the facial and lingual cortices, with focal areas of expansion and bone discontinuity. The cortices of the inferior alveolar canal are not visual- ized in some portions. No root resorption is identified. The clinical impression was ameloblastoma. Enucleation and curettage was performed. Microscopic examination reveals the presence of mature adipocytes surrounded by fibrous connective tissue septa featuring numerous vascular channels. Scattered chronic inflammatory cells includ- ing mast cells are seen. No cellular atypia or increased mitotic activity are identified. <h3>Conclusion</h3> We present the fifth case of an intraosseous angiolipoma involving the mandible. The lesion has been classified as either a hyper- plastic process or a benign neoplasm. The differential diagnosis often includes vascular lesions, benign odontogenic entities, central giant cell granuloma, or low-grade intraosseous malignancies. Due to the scarcity of case reports, the nature of the lesion as well as its preferred treatment method are still to be determined.

Oral Melanoacanthoma: A series of 33 cases and Review of the Literature

<h3>Background</h3> Oral Melanoacanthoma (OM) is an unusual, likely reactive heavily pigmented, benign epithelial proliferation. OM often grows rapidly mimicking melanoma and leading to anxiety for both the patient and the clinician. We present a large series of OM including demographics, description of clinical appearance and characteristics, histology, and literature review. To the best of our knowledge, this is the largest series of OM reported to date. <h3>Materials and Methods</h3> Following IRB approval, OM cases from the University of Florida Oral Pathology Biopsy Service archives (1998-2020) were included. Demographics and clinical features were collected and slides were reviewed. <h3>Results</h3> 33 cases were included with a mean age of 38 years, female: male ratio of 2.6:1. The most common location was buccal mucosa (n = 16, 48.48%), followed by palate (n = 11, 33.33%), tongue and labial mucosa (n = 2 each, 6.06%), maxillary and mandibular gingiva (n = 1 each, 3.03%). Most lesions are dark black/brown, and often described as macular in nature. Duration ranged from one week to twelve months, and all cases were asymptomatic. The clinical impression in the majority of cases were that of a benign melanotic lesion. Ethnicity was only documented in 6/33 cases, of which five cases were African American and one was Caucasian. Histomorphologically, majority of cases (n=27, 81.8%) were hyperplastic/acanthotic, while atrophic epithelium cases were (n=4, 12.1%) and less commonly, spongiotic epithelium cases were (n=2, 6.06%). <h3>Conclusion</h3> The findings of this study are consistent with those in the literature concerning demographics and clinical presentation. Histologically, presence of dendritic melanocytes extending into the spinous cell layer along with acanthosis of the spinous cell layer is diagnostic for OM when combined with the clinical presentation. However, it is important to add cases of OM to the literature so clinicians can be more aware of this lesion.

Calcifying Epithelial Odontogenic Tumor: A Case Series Spanning 25 years

The calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor, is a rare benign neoplasm which makes up less than 1% of all odontogenic tumors. The purpose of this study is to describe a series of cases of CEOT spanning 25 years. METHODS: With IRB approval, all cases diagnosed as CEOT between 1994 and 2019 were retrieved from the archives of the UF Oral Pathology Biopsy Service. RESULTS: A total of 22 cases were included in the study. Patient age ranged from 8 years to 70 years with an average of 40 years. Females were affected slightly more often (55%, n=12) than males (45%, n=10). The mandible was a more common location (55%, n=12) than the maxilla (45%, n=10) by a small margin. A clinical impression was provided by the clinician in 17 cases, of which the most common (53%, n=9) was that of a cystic lesion (including dentigerous/follicular cyst, periapical/inflammatory cyst, lateral periodontal cyst and odontogenic keratocyst). Radiographs were available for 7 cases and the most common radiographic presentation was a unilocular mixed radiolucent/radiopaque lesion (43%, n=3). Lesion du- ration was provided in 9 cases and the range was from 3 months to 10 years. The histologic diagnosis of CEOT was made for all cases. One case was believed to represent a recurrent tumor. Also included were the variants "incip- ient CEOT" (8%, n=2) and "peripheral CEOT" (8%, n=2). One case exhibited features of adenomatoid odontogenic tumor in addition to CEOT. Congo red staining for amyloid was performed in 14 cases, all of which were positive. CONCLUSION: CEOT is an uncommon tumor with a variable presentation and affects patients across a wide age range. Although most cases are intraosseous, the peripheral counterpart is occasionally encountered.

A SINGLE-CENTER CASE SERIES OF ORAL CAVITY SARCOMAS

<h3>Introduction</h3> Oral cavity sarcomas are rare and account for 1% of all malignancies in this site. This study aims to evaluate the prevalence, variety and distribution of soft tissue and gnathic sarcoma in the oral cavity. <h3>Methods</h3> An IRB approved retrospective review encompassing years 2010-2020 of the University of Florida Oral Pathology Biopsy Service was performed. All histologically proven sarcomas occurring in the oral and maxillofacial area were retrieved. Demographics, clinical data, immunohistochemical analysis, and microscopic diagnoses were recorded and analyzed. <h3>Results</h3> A total of 34 oral sarcomas were identified. The most prevalent were osteosarcoma (10 cases; 29.4%) followed by Kaposi sarcoma (9 cases; 26.4%) followed by undifferentiated sarcoma (3 cases; 8.8%). Three cases were unclassifiable due to lack of evidence of any specific lineage. Additional examples of sarcoma included; angiosarcoma, synovial sarcoma, low grade myxofibrosarcoma, rhabdomyosarcoma and chondrosarcoma. Molecular testing was performed on two cases. Age range was 11 to 82 (mean 42.35 years). Males were more affected than females (73.5% and 26.5% respectively). Central lesions accounted for 58.8% of the cases and 41.2 % were soft tissue sarcoma. All patients presented with primary tumors. The most commonly affected sites were mandible (13 cases; 65%), maxilla (11 cases; 32.4%), and tongue (4 cases; 11.8%). Malignant neoplasm was the most common reported clinical impression by submitting clinicians (18 cases; 52.9%). Lesion evolution time ranged from 3 weeks to one year. The most commonly reported symptoms with soft tissue tumors were localized pain, swelling, and bleeding. Most of the central lesions were radiolucent and caused cortical expansion. <h3>Conclusion</h3> Oral cavity sarcomas are rare neoplasms; however, they should be considered in the differential diagnosis whenever a large expansile, destructive, ill-defined or rapidly growing lesion is seen in a relatively young individual or paresthesia is reported.

Osteosarcoma of the Jaws: A report of 23 cases and a review of the literature

Osteosarcoma of the jaws (OSJ) comprise 6% of total cases of osteosarcoma. With the goal of better characterizing these tumors, we reviewed the files at the Oral Pathology Lab, NYPQ from 1984-2021 and identified 23 cases of OSJ. Of the 23 cases, a male predilection (56.5%) was identified with peak ages occurring in the 3^rd (22%) and 6^th (26%) decades. Seventeen cases were intramedullary, 6 cases in the maxilla and 11 in the mandible. One maxillary and 2 mandibular lesions were described as gingival lesions attached to the bone, but medullary or periosteal origin could not be determined. Three lesions were reported as gingival soft tissue masses. Intramedullary OS demonstrated a mandibular (64.7%) predilection with most occurring posteriorly (81.8%). Clinical impressions ranged from benign to malignant. Paresthesia (8.7%), pain (13.0%) and bony swelling (43.5%) were the most common presenting features. Four cases had been previously treated by either endodontic therapy, extraction or incision and drainage. Radiographs were not retrievable for all cases, but 3 cases were described as radiolucent, 1 as radiopaque and 1 with calcifications. Histologic subtypes included osteoblastic (15), chondroblastic (7), and fibroblastic (1). The osteoblastic OS had a male predilection (60.0%), while the chondroblastic OS had a female (57%) predilection. The fibroblastic OS occurred in a male. The osteoblastic OS age range spanned the 3^rd-8^th decade with relatively equal distribution. The chondroblastic OS spanned the 2^nd-6^thdecade with a peak in the 6^th decade. The fibroblastic OS occurred in the 1^st decade. Only the osteoblastic OS had clinical presentations of pain and/or paresthesia. OSJ accounts for approximately 1% of all head and neck malignancies but was not included in the differential diagnosis on first presentation of 22 of our 23 cases. Therefore, despite their rarity, we emphasize the importance for clinicians to consider OSJ in their differential diagnosis.

Dysplastic Lesions of the Gingiva: Prevalence and Risk Factors Including Human Papillomavirus (HPV) Infection

<h3>Background</h3> Verrucous gingival lesions are common within the spectrum of proliferative verrucous leukoplakia (PVL), and the gingiva is not an unusual location for oral carcinoma. However, non-PVL associated dysplastic gingival lesions appear to be less common and may not progress directly to malignancy. In addition, it appears HPV likely plays a limited etiologic role in any form of dysplasia of the gingiva. <h3>Materials and Methods</h3> Following IRB approval, all "dysplasia" cases between 2009-2019 were identified from the archives of the University of Florida Oral Pathology Biopsy Service. Exclusion criteria included verrucous lesions, lesions from multiple sites compatible with PVL, and cases diagnosed as mild atypia/dysplasia. The remaining gingival dysplasia cases were evaluated for age, gender, contributory history, clinical appearance/impression, symptoms, duration, and p16INK4a immunohistochemistry (IHC) results. <h3>Results</h3> A total of 72 biopsies were included in our database from 54 patients. The mean age was 70.3 years (range of 27 - 90), with a female: male ratio of 1.4:1. 69.4% (n=50) were located on the posterior gingiva and 62.5% (n=45) the mandibular gingiva. Reported contributing histories included smoking (n=9, 12.5%), previous oral dysplasia (n=9, 12.5%), or oral cavity malignancy (n=24, 33.3%). The two most common clinical impressions were leukoplakia (n=16, 16.7%) and carcinoma (n=18, 25%). Twenty-five of the 72 cases (34.7%) were symptomatic with pain, swelling and/or bleeding. The most recent biopsy from 32 of the patients was low-grade dysplasia, 34 had high-grade dysplasia, and 6 koilocytic dysplasia. Only 4 of 6 koilocytic dysplasia cases were positive for p16, with no low-grade or high-grade lesions demonstrating positivity. <h3>Conclusion</h3> This study confirms that p16 expression is rarely present in dysplastic lesions of the gingiva, unless koilocytic dysplasia is also present.

Neurocryptococcosis and leptomeningeal carcinomatosis in metastatic prostate adenocarcinoma: differential diagnoses or overlapping symptoms?

Acute headaches with red flags in patients with cancer may indicate metastasis or infection. This report describes a case of acute headache with red flags in a patient with metastatic prostate adenocarcinoma who presented a positive latex fixation test without pleocytosis in cerebrospinal fluid (CSF) analysis. Antifungal treatment was initiated based on the test's high accuracy combined with the patient’s clinical condition and radiological impression of infectious meningitis, although we could not exclude associated secondary neoplastic involvement. Clinical improvement was first observed on D4 of treatment. On D14, CSF examination revealed therapeutic efficacy but positive oncotic cytology. The patient subsequently had new episodes of headache with warning signs and magnetic resonance imaging showed leptomeningeal carcinomatosis. Although neurocryptococcosis and leptomeningeal carcinomatosis are rare neurological complications, they may coexist with overlapping symptoms.