Craniocaudal Dimensions Research Articles

8043 IgG4-related disease with isolated involvement of the pituitary gland: case report

Abstract Disclosure: J.M. Ramos: None. Female patient, 36 years old, presented to our service complaining of a headache lasting five weeks, mainly in the frontal and left periorbital region, radiating to the occipital region. The pain was intense and intermittent, lasting about 40 minutes. No nausea or vomiting was reported, but the patient experienced dizziness and double vision. During the symptomatic interview, the patient mentioned increased thirst and urinary volume. In her medical history, she denied comorbidities, with only frequent episodes of tension-type headaches. She had no continuous medication use and no known drug allergies. The patient had undergone two cesarean sections, with the last one in December 2021. On physical examination, she had horizontal binocular double vision in all three gazes to the left, accompanied by pain during eye movement. Increased facial sensitivity on the left in branches V1 and V2 was observed. The rest of the physical examination showed no abnormalities. Initial general laboratory tests were normal. Evaluation of pituitary function was mostly normal, except for slightly elevated prolactin. A cranial MRI revealed an expansive lesion with sellar and suprasellar components measuring 1.2x1.1x1.2cm. Additional imaging of the sella turcica showed an intra- and suprasellar expansive lesion, predominantly isointense on T1, hyperintense on T2, with discreetly heterogeneous enhancement with gadolinium. In consultation with the neuroradiology team, a hypointensity on T2 at the left margin of the pituitary was noted, suggesting an inflammatory etiology. Based on this, laboratory tests were conducted, and treatment with methylprednisolone 1g per day for 7 days was initiated. After treatment completion, the IgG4 level was found to be 146.7 mg/dL (upper limit of reference: 86 mg/dL). A follow-up MRI, five days after the steroid pulse therapy, showed a reduction in lesion size to 0.8 cm in the cranio-caudal dimension, with a preserved appearance of the optic chiasm. The patient experienced considerable symptom improvement and was discharged with oral corticosteroids and a scheduled initiation of rituximab. The patient meets criteria confirming the diagnosis of IgG4-related hypophysitis, a rare condition representing 30% of hypophysitis cases. Isolated pituitary involvement is even rarer, and its association with diabetes insipidus has been described. Treatment involves corticosteroids, and rituximab can be considered, especially in recurrent cases. Presentation: 6/3/2024

8386 The Evolving Face of The Great Masquerader - Panhypopituitarism Associated with Neurosyphilis

Abstract Disclosure: M. Yabe: None. Z. Lin: None. F. Joseph: None. G. Philip: None. R. Silver: None. L. Callejas: None. J. Giunta: None. Untreated syphilis is on the rise in the United States. The CDC reported syphilis cases in newborns have increased 10-fold over a decade in November 2023, signifying the emergence of untreated infections. Pituitary involvement in syphilis is a very rare phenomenon, and endocrinological investigation is often overlooked. This will be the second reported case of neurosyphilis with pituitary involvement in a non-HIV infected patient. A 45-year-old female with no significant past medical history was admitted to the hospital with progressive neurological symptoms of intermittent left-side headache, hearing loss with tinnitus, and gait instability. Postcontrast MRI Brain revealed multifocal leptomeningeal enhancement involving supratentorial and infratentorial regions. Thickening of the enhanced pituitary infundibulum was also noted. Subsequent RPR titer showed 1:16 and lumbar puncture revealed CSF-VDRL titer 1:32, with pleocytosis 83 cells/uL, CSF-glucose 19 mg/dL, and CSF-protein 370 mg/dL. The patient completed Penicillin G 4 million/units intravenous every 4 hours for 14 days, with repeat MRI showing significant interval decrease in previously described extensive supratentorial and infratentorial leptomeningeal enhancement. However, there is no record of her sexual partner receiving treatment. The patient was readmitted one year later after a fall while displaying dysmetria. MRI Brain with contrast revealed a small subacute infarct along the right frontal corona radiata and pituitary gland measuring up to 1.2 cm in craniocaudal dimension compared to 0.4 cm on the prior exam. This prompted evaluation of pituitary hormones: FSH 0.8 IU/L, LH <0.3 IU/L, and ACTH 6.3 pg/mL, with normal serum growth hormone and prolactin levels. Further investigation revealed morning cortisol 2.5 ug/dL, thyrotropin < 0.2 uIU/mL, and free thyroxine 0.63 ng/dL. Radiological evidence is suspicious of inflammatory etiology of the pituitary gland. The patient was discharged with endocrinology follow-up and plan to perform a pituitary gland biopsy as an outpatient for confirmatory result. The association of neurosyphilis and hypophysitis leading to panhypopituitarism in a non-HIV infected patient was first reported in 2015. Since then, there remains limited research regarding their association due to rarity of pituitary involvement in neurosyphilis. With untreated syphilis on the rise and increased availability of MRI, clinicians should expect to encounter more cases of neurosyphilis with pituitary involvement in the future. Early detection of panhypopituitarism in those with positive CSF-VDRL titer could lead to better clinical outcomes. It is paramount that these cases are documented to emphasize pituitary involvement in neurosyphilis and encourage a low threshold to initiate endocrinological testing in the future. Presentation: 6/3/2024

Assessment of Interrater Reliability and Accuracy of Cerebral Aneurysm Morphometry Using 3D Virtual Reality, 2D Digital Subtraction Angiography, and 3D Reconstruction: A Randomized Comparative Study.

Detailed morphometric analysis of an aneurysm and the related vascular bifurcation are critical factors when determining rupture risk and planning treatment for unruptured intracranial aneurysms (UIAs). The standard visualization of digital subtraction angiography (DSA) and its 3D reconstruction on a 2D monitor provide precise measurements but are subject to variability based on the rater. Visualization using virtual (VR) and augmented reality platforms can overcome those limitations. It is, however, unclear whether accurate measurements of the aneurysm and adjacent arterial branches can be obtained on VR models. This study aimed to assess interrater reliability and compare measurements between 3D VR, standard 2D DSA, and 3D DSA reconstructions, evaluating the reliability and accuracy of 3D VR as a measurement tool. A pool of five neurosurgeons performed three individual analyses on each of the ten UIA cases, measuring them in completely immersed 3D VR and the standard on-screen format (2D DSA and 3D reconstruction). This resulted in three independent measurements per modality for each case. Interrater reliability of measurements and morphology characterization, comparative differences, measurement duration, and VR user experience were assessed. Interrater reliability for 3D VR measurements was significantly higher than for 3D DSA measurements (3D VR mean intraclass correlation coefficient [ICC]: 0.69 ± 0.22 vs. 3D DSA mean ICC: 0.36 ± 0.37, p = 0.042). No significant difference was observed between 3D VR and 2D DSA (3D VR mean ICC: 0.69 ± 0.22 vs. 2D DSA mean ICC: 0.43 ± 0.31, p = 0.12). A linear mixed-effects model showed no effect of 3D VR and 3D DSA (95% CI = -0.26-0.28, p = 0.96) or 3D VR and 2D DSA (95% CI = -0.02-0.53, p = 0.066) on absolute measurements of the aneurysm in the anteroposterior, mediolateral, and craniocaudal dimensions. 3D VR technology allows for reproducible, accurate, and reliable measurements comparable to measurements performed on a 2D screen. It may also potentially improve precision for measurements of non-planar aneurysm dimensions.

Optico-Chiasmatic Distortions in Pituitary Adenomas: Correlation Between Postoperative Morphological Reversal and Follow-Up Functional Visual Recovery

PurposeTo objectively correlate distortions of optic apparatus morphology in patients with visual outcomes in patients with pituitary adenomas (PAs) undergoing trans-sphenoidal surgery. MethodsIn this retrospective analysis, visual acuity (VA), visual field (VF) and total visual (TV) function was objectively scored in patients selected from an institutional cohort of PAs The following imaging measures of optico-chiasmatic morphology were recorded preoperatively, and at 3 months after surgery: chiasm area (CA), mid-chiasm height (CH), optic nerve-canal bending angle (BA), and optic nerve kinking angle (ONKA). Receiver operator characteristic (ROC) analysis was performed to establish optimal thresholds for achieving a ‘normal’ TV score of 200 at 1-year follow-up. ResultsSeventy-one eyes were individually studied. VA, VF and TV scores significantly improved after surgery, both at the 3-month and at the 1-year follow-up visits (p<0.001). Cranio-caudal tumor dimension was significantly associated with VA, VF and TV scores, both pre- and post-operatively. There were significant changes in CH (p<0.001), BA (p<0.001) and ONKA (p<0.001) at 3 months after surgery, but not in CA (p=0.061). Baseline VA, VF and TVS scores were positively correlated with preoperative CH and ONKA, while VF and TV scores also demonstrated significant negative correlations with preoperative BA. VF scores at 1-year follow-up were significantly correlated with preoperative and change in BA values, as well as with preoperative and change in ONKA values. ROC analysis revealed that only the preoperative ONKA was found to have acceptable discrimination (AUC>0.7) for predicting ‘normal’ TV score. Chiasm sag was noted in 45.8% of patients at one year follow-up, but was not associated with delayed visual deterioration in any case. ConclusionsAnatomic realignment of the optic apparatus 3 months following trans-sphenoidal surgery predicts VF scores, but not VA or TV scores at 1 year follow-up. Patients with preoperative ONKA values of more than 139.3° have a 76% chance of achieving normal TV scores one year after surgery. Postoperative chiasm sag appears to be clinically irrelevant at short term follow-up.

A Prospective Study of Patients Presenting With Pre-sternal Keloids.

Keloid represents a pathological form of scarring. They are very common in the anterior chest area; nearly 50% of all keloids occur in this location. One of the reasons for this is that folliculitis and acne, known for triggering the development of keloids, are common on the anterior chest. The other reason is the tension load in this area due to the frequent movements of the upper limbs and the respiratory movements. These movements stretch the skin of the anterior chest horizontally. When this cyclical tension is imposed on the anterior chest wounds, there is an exacerbation and prolongation of the inflammation in the reticular dermis of the wound. These stresses induce the growth of keloids along the prevailing lines of skin tension. We performed a prospective study in which patients were recruited over a period of one year. Patients presenting with symptomatic pre-sternal keloids and requesting treatment but were unwilling to undergo surgical intervention were included in this study. Patients with a history of previous thoracic surgery were excluded. Baseline assessment and documentation of the lesion were performed. The study patients received three sessions of intralesional injections of a combination of triamcinolone acetonide and hyaluronidase at four weekly intervals. The final assessment was performed four weeks after the third session. The study included 47 lesions in 47 patients with ages of the patients ranging from 16 to 70 years. Pre-sternal keloids were found to be more common among males than females, with a male-to-female ratio of 2.35:1. Patients presented with pre-sternal keloids that had been present for varying periods ranging from three to 81 months. All of our 47 patients completed the three sessions of the treatment. Following the treatment, there was an improvement in the patient's symptoms, as evidenced by the reduction in the mean pruritis scores and pain scores. There was an overall reduction in the size of the lesion. The decrease in the height of the lesions was more evident than the reduction in the craniocaudal or transverse dimensions of the lesions. There were improvements in Vancouver Scar Scale(VSS) vascularity scores and pliability scores following the treatment. We conclude that pre-sternal keloids should be considered as a distinct clinico-pathological entity. There are differences with regard to pathogenesis, clinical presentation, and management when compared to keloids elsewhere. Treatment with intralesional injections of a combination of triamcinolone acetonide and hyaluronidase effectively relieves the symptoms and may be considered in patients not willing to undergo surgical intervention. Recurrences can occur and need further treatments.

High-grade prostate cancer demonstrates preferential growth in the cranio-caudal axis and provides discrimination of disease grade in an MRI parametric model.

To determine if multiparametric MRI prostate cancer (PC) lesion dimensions in different axes could distinguish between PC, grade group (GG) >2, and GG >3 on targeted transperineal biopsy and create and validate a predictive model on a separate cohort. The maximum transverse, anterio-posterior, and cranio-caudal lesion dimensions were assessed against the presence of any cancer, GG >2, and GG >3 on biopsy by binary logistic regression. The optimum multivariate models were evaluated on a separate cohort. One hundred and ninety-three lesions from 148 patients were evaluated. Increased lesion volume, Prostate Specific Antigen (PSA), Prostate Imaging Reporting and Data System score, and decreased Apparent Diffusion Coefficient (ADC) were associated with increased GG (P < .001). The ratio of cranio-caudal to anterior-posterior lesion dimension increased from 1.20 (95% CI, 1.14-1.25) for GG ≤ 3 to 1.43 (95% CI, 1.28-1.57) for GG > 3 (P = .0022). The cranio-caudal dimension of the lesion was the strongest predictor of GG >3 (P = .000, area under the receiver operator characteristic curve [AUC] = 0.81). The best multivariate models had an AUC of 0.84 for cancer, 0.88 for GG > 2, and 0.89 for GG > 3. These models were evaluated on a separate cohort of 40 patients with 61 lesions. They demonstrated an AUC, sensitivity, and specificity of 0.82, 82.3%, and 55.5%, respectively, for the detection of cancer. For GG > 2, the models achieved an AUC of 0.84, sensitivity of 91.7%, and specificity of 69.4%. Additionally, for GG > 3, the models showed an AUC of 0.92, sensitivity of 88.9%, and specificity of 98.1%. Cranio-caudal lesion dimension when used in conjunction with other parameters can create a model superior to the Prostate Imaging Reporting and Data Systems score in predicting cancer. Higher-grade PC has a propensity to grow in the cranio-caudal direction, and this could be factored into MRI-based predictive models of prostate biopsy grade.

Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair

Background: The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. Hypothesis: Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. Study Design: Case-control study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. Results: In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P = .022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P = .052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P = .003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. Conclusion: Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions.

Correlation between Portal Vein Diameter and Esophageal Varices Grades in Chronic Liver Disease Patients using Ultrasonography and Endoscopy as a Diagnostic Tool

Background: Chronic liver disease accounts for 2.2% of deaths and 1.5% of disability-adjusted life years. Variceal bleeding is one of the preventable caused of death in chronic liver disease. About 30-40% of patients with compensated cirrhosis and 85% of those with decompensated cirrhosis are found to possess EV on screening endoscopy.Objective: To determine the correlation between Portal Vein Diameter (PVD) on ultrasound examination and grades of Esophageal Varices (EV) on endoscopy in patients with Chronic liver disease (CLD). Material and Methods: This was a cross-sectional, correlational study, carried out in the Department of Diagnostic Radiology in collaboration with the Department of Gastroenterology, at Lady Reading Hospital Peshawar, Pakistan. A total of sixty patients were sampled via consecutive random sampling from Jan 2022 to Sept 2022. The criteria used for dilated portal vein was = 13mm and = 13 cm for splenomegaly. Results: Out of total 60 patients with CLD, PVD ranged from 10 to 18mm, mean PVD being 14.1mm ±1.4. The splenic sizes ranged from 10 to 23 cm, with the mean splenic cranio-caudal dimension being 14.9 cm ± 2.1. The highest association is between the large EV and PVD &gt; 15 mm i.e., 52% of total large EVs. The differences between PVD to EV groups were statistically significant as determined by one-way ANOVA (F (2,57) =8.281, p= 0.001) and correlation was also statistically significant on Pearson's Correlation test (rs)[60] = 0.490, p &lt; 0.001.Conclusion: As there is a significant positive correlation between PVD and grades of EV in CLD patients. The PVD on ultrasound should be utilized where an endoscopic facility is not available, or is overburdened, to prevent life threatening esophageal variceal bleed. Keywords: Chronic liver disease, Esophageal varices, Portal vein diameter.

Testing the Validity of Patellar Measurements in Sex Estimation – A Computed Tomography Study in a Contemporary Polish Population

Introduction and purpose: Human skeleton-based sex estimation is a major topic of interest for forensic anthropologists. Various bones have been examined for sex heterogeneity. The most commonly used include skull and pelvis, however they may not always be used due to damage or fragmentation. The patella has been shown to be resistant to postmortem changes, which creates a potential use for determining the sex of unknown human remains.&#x0D; Materials and methods: The samples were gathered from patients examined by computed tomography angiography (CTA) of lower extremities in University Hospital No. 4 in Lublin. Exclusion criteria included patellar fractures, knee replacement and advanced osteoporosis. A total of 120 CTA examinations of 65 males and 55 females, were included in the analysis. Four measurements for every patella: craniocaudal patella dimension (CCP), transverse dimension (TP), anteroposterior dimension (APP) and patellar angle (PA), were obtained from CTA images.&#x0D; Results: The statistical analysis proved that sex differences of all variables, except for PA, were statistically significant (p &lt; 0,001).&#x0D; Conclusions: Patellar measurements can be helpful in sex determination in the Polish population. CT is a useful tool for skeleton-based sex identification.

Accuracy of Radiology Reports for Obstructing Ureteral Stone Size in the Emergency Department

To evaluate the number of dimensions of obstructing ureteral stones in the emergency department (ED) described in present-day radiology computed tomography reports and assess for measurement discrepancies between radiologist and urologist review. We conducted a single-center retrospective study of patients who presented to the ED with unilateral, solitary, obstructing ureteral stones from March 2018 to March 2021. Stone size in each reported dimension recorded by the radiologist was extracted from the chart and then compared to size independently measured by one of our urologists for all 3 stone dimensions. Our primary outcome was the number of stone dimensions included in the radiology report. In total, 181 patients were included for analysis. 82.3% of radiology reports described the stone in one dimension, 15% in two dimensions, and 2.7% in three dimensions. There was a significant difference in median maximal stone size between radiologist and urologist measurement (5.5 vs 6.5 mm, respectively, P < .001). One hundred fourteen stones (62%) had the maximal measurement recorded in the craniocaudal (CC) dimension by urologist review. Only 26% of radiology reports had the CC measurement included in the radiology report. Ureteral stone size in a present-day ED cohort is still frequently measured in only 1 or 2 dimensions. In many cases, this is associated with an absence of a reported CC measurement. Inadequate characterization of stone size may affect acute management. This study hopes to encourage reporting of all three dimensions of obstructing ureteral stones in the ED setting for improvements in patient management.

SPLENULE FREQUENCY ON COMPUTED TOMOGRAPHY SCANS IN CHILDREN, PRESENTING TO THE EMERGENCY DEPARTMENT

Objectives: Accessory spleen, also known as “splenule”, is the presence of splenic tissue in ectopic localisations. The presence of splenule is important, especially in patients planned for splenectomy, as it may cause refractory symptoms. The aim of the present study is to define the frequency of splenule(s) in children (0-17 years) who received non-contrast and contrast enhanced computed tomography (NECT and CECT) protocols in the emergency department.&#x0D; Material and methods: 748 children (aged 0 to 17 years) who were admitted to the emergency department between May 2015 – September 2022 and had NECT and CECT abdominal scans were included in the study. Patients whose CT protocols were incomplete and cases with traumatic splenic injury and / or cases with poor image quality and patients with a history of splenectomy or hematologic pathology were excluded from the study (n: 100). A total of 648 patients were included in the cohort. NECT and CECT scans of all patients were assessed; the localisation of splenules as well as the antero-posterior (AP), medio-lateral (ML) and cranio-caudal (CC) dimensions of each splenule were measured.&#x0D; Results: A total of 648 cases with 467 males (72.1%) and 181 females (27.9%) were included in the study. Splenules were observed in 131 (20.2%) cases. More than one splenule was observed in 21 of these 131 cases. A total number of 159 splenules were observed in total, with a mean volume of 0,72 ±0,95 ml. The most common location was found to be the splenic hilus (n=55, 41.9%). &#x0D; Conclusion: Our study have stated that splenules are common anatomical variants, seen at a rate of 20,2% in this age cohort. A cross-sectional imaging should be performed to determine the presence, location, and number of the splenules before a planned splenectomy.

Evaluation of pituitary gland dimensions by age and gender in healthy individuals in the Turkish population

Aim: Evaluating pituitary gland dimensions in varying age ranges and genders is essential for determining average values in MRI examinations. Therefore, the main objective of our study is to create normative data for pituitary gland size in the Turkish population.&#x0D; Material and Method: Anteroposterior (AP), transverse (TR), and craniocaudal (CC) dimensions of the pituitary glands of 200 patients over 18 years of age, who underwent Brain MRI examination in our centre between November 2022 and March 2023, did not have any known endocrine disease, did not use hormonal therapy, were not pregnant or breastfeeding, had no history of radiotherapy or chemotherapy were measured from their sagittal and axial MRI sequences. The Kolmogorov-Smirnov test was used for normality analyses. The Mann-Whitney U test was used to compare the non-normally distributed numerical variables between the two groups. Spearman correlation was applied to determine the relationship between age and pituitary gland measurement values.&#x0D; Results: Anteroposterior and craniocaudal measurements of the pituitary gland of female patients included in the study were significantly higher than males (p=0.011 and p

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Postmortem Identification of Vascular Ehlers-Danlos Syndrome in a Lung Transplant Recipient.

Can Supine Breast Magnetic Resonance Imaging After a Dynamic Contrast-Enhanced Breast Magnetic Resonance Imaging Provide Information for Supine Procedures?

A retrospective analysis was conducted on 75 lesions in 50 patients with pathologically proven breast cancer who underwent MRI in prone and supine positions between December 2019 and December 2020. The transverse, anteroposterior, and craniocaudal dimensions (in millimeters) of the tumor in the x -, y -, and z -axes were measured. Distances from the center of the tumor to the chest wall and the adjacent skin were measured on transverse and reformatted sagittal images. In cases where multifocal lesions were present, the transverse, anteroposterior, and craniocaudal distances between the tumor centers in the x -, y -, and z -axes were measured. Differences between measurements in supine and prone MRI were evaluated with the Mann-Whitney U and the Wilcoxon tests. P values of less than 0.05 were considered to indicate a statistically significant difference. The analysis revealed 31 MRIs with 1 and 20 with multifocal lesions. The x -axis dimension of the lesions in prone and supine positions did not significantly differ ( P = 0.198) between the 2 positions. A significant difference in the y - and z -axes dimensions was observed between the prone and supine position ( P = 0.00 for both). The distance from the tumor to the chest wall and the adjacent skin showed significant difference ( P = 0.00 for both). For multifocal lesions, the distance between the lesions showed a significant difference on the y -axis ( P = 0.00). This study showed a significant difference in the tumor size, location, and tumor-to-tumor distances due to change of patient position, from the standard prone MRI to the supine position in the operating room, resulting in distortion, spatial repositioning, and convergence of the lesions. Supine MRI may be considered in providing a less extensive surgery.

A Clinicopathological Evaluation of the Correlation of Carcinoma Oral Tongue (Anterior Two Thirds) with Cervical Nodal Metastasis to Assess the Level of Neck Dissection: A Hospital Based Prospective Study.

Being an important prognostic predictor in carcinoma oral tongue, neck metastasis poses an adverse impact on prognosis.The management of neck is still controversial. Neck metastasis depends on features like tumor thickness, depth of invasion, lymphovascular invasion and perineural invasion. Thus by correlating these features with the level of nodal metastasis and by correlating clinical and pathological staging, a preoperative assumption for a more conservative neck dissection may be done. To correlate clinical staging, pathological staging and depth of invasion (DOI) of tumor with cervical nodal metastasis, for a preoperative assumption of a more conservative neck dissection.To study the correlation of additional prognostic features like lymphovascular invasion, perineural invasion, positive resection margin, worst pattern of invasion, lymphocytic infiltration and presence of necrosis with that of cervical nodal metastasis. The study was conducted on 24 patients of carcinoma oral tongue who underwent resection of the primary with an appropriate neck dissection and their clinical, imaging, and postoperative histopathological findings were correlated. We found a significant association of the CC (craniocaudal) dimension and radiologically determined DOI (depth of invasion) with the pN also significant association of clinical and radiological DOI with histological DOI. The probability of occult metastasis was found to be more when the MRI-DOI is > 5mm. The sensitivity and specificity of cN staging were 66.67% and 73.33% respectively. The accuracy of cN was 70.8%. In the present study a good sensitivity, specificity and accuracy of cN (clinical nodal stage) was found. Craniocaudal (CC) dimension and DOI of the primary tumor measured by MRI is a strong predictor of the disease extension and nodal metastasis. MRI-DOI > 5mm warrants an elective neck dissection of level I-III. For tumors MRI DOI < 5mm observation can be recommended with adherence to a strict follow-up.

Computed Tomography Findings Affecting the Decision of Sternotomy in Substernal Goiter.

Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.

Computed tomography for ventral hernia: Need for a standardised reporting format.

Computed tomography for ventral hernia: Need for a standardised reporting format.

Rare Case Report of Mature Mesenteric Teratoma in a 35-Year-Old Female

Teratomas are germ cell tumors that usually occur in the gonads, and present in early age group. Mesenteric teratoma is rare. Patients with mesenteric teratoma may remain asymptomatic or may present with compressive symptoms. Teratomas contain derivatives of all three germ layers, hence may contain diverse tissues. Computed tomography (CT) scan is ideal to establish the diagnosis of mesenteric teratoma, and reveal fluid, fat, calcifications, fat-fluid level. This is a case of 35-year-old female, who presented with upper abdominal pain for 2 months. She underwent Computed Tomography (CT) scan which revealed large well circumscribed mass in left upper abdomen, containing fluid, fat, and globular calcifications. Size of the lesion was: craniocaudal dimension= 12 centimeter, transverse diameter = 10 centimeter, anteroposterior diameter = 10 centimeter. Patient was managed by complete surgical resection. Histopathological examination confirmed the diagnosis of mature teratoma of mesentery.

OR08-5 Associations Between Signal Transducer and Activator of Transcription (STAT) Mutations and Galactorrhea

Abstract Background Prolactin (PRL) is responsible for the development of mammary glands and milk production. STAT1 and STAT3 are genes that express transcription factors that mediate PRL's intracellular signaling, but an association between their function and galactorrhea has not yet been identified. Here we describe three patients with somatic STAT mutations and galactorrhea. A 27-year-old woman with hyper-IgE syndrome (Job's Syndrome) due to a STAT3 deletion mutation (p.Val463del) associated with recurrent infections reported thin, white, bilateral discharge with breast manipulation beginning in adolescence. She did not have spontaneous leakage or pain. At presentation, PRL was slightly elevated to 27.9 (ref. 2.0-25.0 mcg/L) with otherwise normal levels of anterior pituitary hormones. She was not on any drugs known to cause hyperprolactinemia. MRI showed a 5×4 mm microadenoma without any mass effect. A 32-year-old woman also with Job's syndrome due to a heterozygous loss-of-function STAT3 mutation (p.R382Q) associated with recurrent infections and papillary thyroid cancer described unilateral, chronic, thin, white nipple discharge with light touch of her right breast for "as long as she could remember." She had a history of breast abscesses, but at presentation there was no evidence of abscess or infection. PRL was 15.1 mcg/L, and other anterior pituitary hormones were normal. MRI showed a structurally normal pituitary. A 22-year-old woman with a STAT1 activating mutation (p.E235A) associated with recurrent infections, autoimmune hypothyroidism, T1DM, and hypogonadotropic hypogonadism requiring pubertal induction at age 12y reported bilateral galactorrhea starting at age 18y. A white, milky discharge could be expressed with light manipulation, but no discharge was produced spontaneously. PRL was 16.2 mcg/L with serial dilution and has consistently been in the reference range. Anterior pituitary evaluation was normal except for elevated TSH of 12.5 (ref. 0.27-4.2) consistent with autoimmune hypothyroidism. MRI revealed a diffusely enlarged pituitary gland (12mm in the cranio-caudal dimension) without focal hypo-enhancement. Conclusions It is known that PRL signaling involves the JAK/STAT pathway, and an analysis of human milk cells showed upregulated STAT3 and downregulated STAT1 during lactation (PMID 26909879). These three cases provide clinical evidence for a mechanistic connection between STAT signaling and galactorrhea and suggest that STAT3 and STAT1 function in opposite directions to regulate lactation. In our cases, increased STAT1 or decreased STAT3 activity are associated with normal-PRL, inducible galactorrhea. Beyond understanding the specific intracellular signaling pathways leading to galactorrhea, these observations may be utilized for developing therapies for those with impaired lactation. Presentation: Saturday, June 11, 2022 12:30 p.m. - 12:45 p.m.

PMON80 Case of Cushing's Disease That Presented as Diabetic Ketoacidosis and Successfully Treated With Stereotactic Radiosurgery During the COVID-19 Pandemic

Abstract Background Although Cushing's disease is known to impair glucose metabolism, diabetic ketoacidosis (DKA) as its initial presentation has been reported in only a few case reports. The first-line treatment for Cushing's disease is transsphenoidal surgery, but safety concerns during the COVID-19 pandemic has led to the utilization of other treatment options. We present a case of Cushing's disease that presented initially as DKA and was successfully treated with stereotactic radiosurgery. Case Presentation Our patient was a 36-year-old female known to have diabetes mellitus and hypertriglyceridemia for one year. She presented with one-week history of generalized weakness, blurring of vision, and elevated blood pressure. Her blood glucose level was high at 523 mg/dL, associated with ketosis and metabolic acidosis. She was diagnosed with diabetic ketoacidosis which resolved after hydration and intravenous insulin administration. Further history revealed that she has been experiencing progressive weight gain and infertility for the past five years. She had cushingoid features including obesity, scalp hair thinning, moon facies, acne, hirsutism, and buffalo hump. Midnight salivary cortisol was high at 9.34 ng/mL (0.20-4. 00 ng/mL). Low dose dexamethasone suppression test showed an unsuppressed serum cortisol level at 31.2 mcg/dL (&amp;lt;1.8 mcg/dL). Adrenocorticotropic hormone (ACTH) level was high at 88.5 pg/mL (&amp;lt;46 pg/mL) and pituitary magnetic resonance imaging (MRI) showed an enlarged pituitary gland measuring 13.4 mm in the craniocaudal dimension with leftward displacement of the pituitary stalk. She was diagnosed with Cushing's disease and was initially advised transsphenoidal surgery. Due to concerns of COVID-19 transmission, the team and the patient decided to do stereotactic radiosurgery (SRS). The procedure was performed without complication. At 2 months follow-up, there was noted improvement of blurring of vision, normalization of cortisol level to 20.72 mcg/dL (4.30-22.40 mcg/dL), and a decreased ACTH level at 62.19 pg/mL. There was a 4 mm decrease in the craniocaudal dimension of the pituitary gland on repeat pituitary MRI. Thyroid stimulating hormone (TSH) level normalized from 0.209 to 0.647 uIU/mL (0.55-4.78 uIU/mL), and the glycohemoglobin decreased from 11.5% to 6.3%. Hypertension was controlled on one medication. Conclusion Stereotactic radiosurgery is usually reserved as a secondary option to transsphenoidal surgery. On average, normalization of cortisol levels after SRS takes 14 months. In our patient, the serum cortisol decreased to within normal levels at only 2 months after SRS. While a longer follow-up is desirable in order to assess the durability of control of hypercortisolemia, our case demonstrates that stereotactic radiosurgery is a safe and effective treatment option for Cushing's disease during the COVID-19 pandemic, when safety protocols and decreased hospital and patient resources might hinder the performance of transsphenoidal surgery. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.