Lesions Of Cavity Research Articles

IETA Ultrasonic Features Combined with GI-RADS Classification System and Tumor Biomarkers for Surveillance of Endometrial Carcinoma: An Innovative Study.

Objectives: We were the first to combine IETA ultrasonic features with GI-RADS and tumor biomarkers for the surveillance of endometrial carcinoma. The aim was to evaluate the efficacy of single IETA ultrasonography GI-RADS classification and combined tumor biomarkers in differentiating benign and malignant lesions in the uterine cavity and endometrium. Methods: A total of 497 patients with intrauterine and endometrial lesions who had been treated surgically between January 2017 and December 2021 were enrolled; all of them had undergone ultrasound examinations before surgery. We analyzed the correlation between the terms of ultrasonic signs of the uterine cavity and endometrial lesions defined by the expert consensus of IETA and the benign and malignant lesions and then classified these ultrasonic signs by GI-RADS. In addition, the tumor biomarkers CA125, CA15-3, CA19-9 and HE4 were combined by adjusting the classification. The results of the comprehensive analysis were compared with pathological results to analyze their diagnostic efficacy. Results: (1) The statistic analysis confirmed that there were seven independent predictors of malignant lesions, including thickened endometrium (premenopause ≥ 18.5 mm, postmenopause ≥ 15.5 mm), non-uniform endometrial echogenicity (heterogeneous with irregular cysts), endometrial midline appearance (not defined), the endometrial-myometrial junction (interrupted or not defined), intracavitary fluid (ground glass or "mixed" echogenicity), color score (3~4 points) and vascular pattern (focal origin multiple vessels or multifocal origin multiple vessels). (2) In traditional ultrasound GI-RADS (U-T-GI-RADS), if category 4a was taken as the cut-off value of benign and malignant, the diagnostic sensitivity, specificity, PPV, NPV and diagnostic accuracy were 97.2%, 65.2%, 44.0%, 98.8% and 72.2%, respectively, and the area under the ROC curve (AUC) was 0.812. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 88.1%, 92.0%, 75.6%, 96.5% and 91.2%, 0.900, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.5%, 93.2%, 93.4%, 93.4% and 0.868, respectively, when taking category 5 as the cutoff point. In modified ultrasound GI-RADS (U-M-GI-RADS), if 4a was taken as the cut-off value, The diagnostic efficacy was the same as U-T-GI-RADS. If 4b was taken as the cut-off value, the diagnostic sensitivity, specificity, PPV, NPV, diagnostic accuracy and AUC were 88.1%, 92.3%, 76.2%, 96.5%, 91.3% and 0.902, respectively. If 4c was taken as the cutoff point, the diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 75.2%, 98.7%, 94.3%, 93.4%, 93.6% and 0.870, respectively. The diagnostic sensitivity, specificity, PPV, NPV diagnostic accuracy and AUC were 66.1%, 99.7%, 98.6%, 91.3%, 92.4% and 0.829, respectively, if taking category 5 as the cutoff point. (3) In the comprehensive diagnostic method of U-T-GI-RADS combined tumor biomarkers results, the AUC of class 4a, 4b and 5 as the cutoff value was 0.877, 0.888 and 0.738, respectively. The AUC of class 4a, 4b, 4c and 5 as the cutoff value in the comprehensive diagnostic method of U-M-GI-RADS combined tumor biomarkers results was 0.877, 0.888, 0.851 and 0.725, respectively. There was no significant difference in diagnostic efficiency between the two comprehensive diagnostic methods. Conclusions: In this study, no matter which diagnostic method was used, the best cutoff value for predicting malignant EC was ≥GI-RADS 4b. The GI-RADS classification had good performance in discriminating EC. The tumor biomarkers, CA125, CA19-9, CA15-3 and HE4, could improve the diagnostic efficacy for preoperative endometrial carcinoma assessment.

Tuberculosis and COVID-19 co-infection in Serbia: Pandemic challenge in a low-burden country.

COVID-19 and tuberculosis (TB) represent global threats to the public health system. The impact of COVID-19 on TB results in a reduction in the number of notified TB cases, delayed diagnosis and treatment, and increased case fatality and mortality rates. The aim of the study was to analyze the TB/COVID-19 co-infected cohort in Serbia as a low-burden country and compare it to the global TB/COVID-19 cohort. A retrospective analysis was done on 53 TB and COVID-19 co-infected patients treated in COVID hospital "Batajnica" in Belgrade and Special Hospital for Pulmonary Diseases "Ozren" Sokobanja in the period from 6 March 2020 to 1 April 2022. A comparative analysis with the global cohort published recently was also performed. TB/COVID-19 cohort in Serbia included significantly fewer migrants and diabetes cases, but more cases with chronic respiratory diseases compared to the global. Descriptive analysis of TB cases in the Serbian TB/COVID-19 cohort showed fewer cases diagnosed with sputum smear and Gene Xpert/HAIN, fewer EPTB and mono-resistant cases, and more cases diagnosed with solid culture, unilateral pulmonary infiltrate (with bilateral cavity lesions), and bilateral pulmonary infiltrate (no cavities) compared to TB/COVID-19 cases worldwide. Nasal congestion and fever were more common COVID-19 symptoms in the global cohort. Radiology was more commonly used for the diagnosis of COVID-19 in Serbia. Typical bilateral ground opacities were less common among Serbian patients. Serbian patients spent fewer days in the hospital and achieved a higher PCR conversion rate and TB treatment success rate. The Serbian TB/COVID-19 cohort achieved a higher treatment success rate compared to the global cohort. Encouraging vaccination against SARS-CoV-2 for people with a current or past TB disease, as well as rapid diagnosis and targeted treatment of TB in highly specialized pulmonology institutions, presents key points to avoid excessive morbidity and mortality.

The mast cell reaction in premalignant and malignant lesions of the head and neck.

Head and neck squamous cell carcinoma (HNSCC) is one of the most frequent and aggressive neoplasms of this anatomical region. Many studies evaluated the neoplastic cells, but few works focused on the tumor microenvironment. In the present study, we investigated the distribution and mast cell density (MCD) in malignant and premalignant lesions of the oral cavity, tongue, pharynx, and larynx. There were analyzed 52 specimens of HNSCC, and 15 biopsies taken from patients with dysplasia. Results were compared with those found in a control group of 10 biopsies of oral mucosa from patients with inflammatory diseases. Slides stained with Hematoxylin-Eosin were used for the histopathological diagnosis and grade, and mast cells (MCs) were identified by immunohistochemistry, using anti-MC tryptase. MCs were counted using a method similar to that proposed for microvessel density. We found a significant increase in the number of MCs from the normal oral mucosa until overt carcinoma. Unlike normal tissues, in HNSCC, many MCs were found between tumor cells. We found no relationship between MCs and blood vessels in the tumor area. A significant statistical correlation was found between dysplastic and malignant tumors, but not between tumors with a different grade. Also, it was not found relationship between MCD and the anatomical location of the tumor. Based on these results, we believe that MCD evaluated by anti-MC tryptase is an independent factor of prognosis and reflects an unfavorable outcome.

Reticular Oral Lichen Planus: A Clinical Experience of ENT Surgeons.

Reticular Oral lichen planus (OLP) is a chronic autoimmune disease that presents as fine, white, linear and lacelike lesions of the oral cavity referred to as Wickham striae. The clinical characteristics of 30 patients with reticular oral lichen planus is presented so that cases are not missed/misdiagnosed by ENT surgeons. The clinical records noted for each patient were gender, ageandclinical presentation of reticular OLP (site affected, presence of symptoms and extraoral manifestations of the disease, smoking habit, and consumption of alcoholic beverages). Twenty patients were females (66.7%) and 10 (33.3%) were males giving a female to male ratio of 2:1. Majority of patients (50%) among both males and females were in the age group of 31-40years followed by 41-50years (20%). Oral discomfort/burning sensation was the chief symptom in 24 (80%) patients followed by asymptomatic oral white patches in 5 (16.6%).The buccal (cheek) mucosa was the site most affected (76.8%) followed by the buccal mucosa plus retromolar trigone mucosa (10%) and tongue (6.6%), Extraoral lesions were observed in 2 (6.6%) of patients at presentation with oral lesions and were on the nails in 1 patient and wrist in 1 patient. Tobacco smoking, alcohol use, diabetes and hypertension were reported in 3 (10%), 0%, 2 (6.7%) and 4 (13.3%) patients respectively. ENT surgeons routinely see patients with oral discomfort/oral ulcerations and as such they should be well versed with classical clinical characteristics of reticular oral lichen planus.

Pigmented Lesions of the Oral Cavity: A Review

The term “pigmentation of oral mucosa” is applied to a wide range of lesions or conditions featuring a change of color of oral tissues. Common causes of mucosal coloration including petechiae, purpura, ecchymoses, hematomas, vascular tumors and exogenous substances are not true pigmented lesions. In contrast, melanin which is synthesized by melanocytes, is a true pigment and usually imparts a brown, blue or black appearance of the mucosa. Oral pigmentation affects about 3% of the total population and most likely in those with dark skin, more prevalent in females than males during the 3rd or 4th decade of life. In this review, we are describing the oral manifestation and dental considerations associated with common pigmented disorders which will allow the practitioner to have a holistic approach in diagnosis and management of these patients.

The role of altered microRNAexpression in premalignant and malignant head and neck lesions with epithelial origin.

The premalignant lesions of the oral cavity carry a risk of transformation to malignancy. Hence, early diagnosis followed by timely intervention remarkably affects the prognosis of patients. During tumorigenesis, particular microRNAs (miRNAs) show altered expressions and because of their post transcriptionally regulatory role could provide favorable diagnostic, therapeutic, or prognostic values in head and neck cancers. In this review, we have demonstrated diagnostic, prognostic, and potential therapeutic roles of some miRNAs associated with oral premalignant and malignant lesions based on previous validate studies. It is previously documented that dysregulation of miRNAs contributes to cancer development and progression. MiRNAscould be tumor suppressors that normally suppress cell proliferation, differentiation, and apoptosis or play as oncogenes that improved tumorigenesis process. Altered expression of miRNAs has also been reported in premalignant oral epithelial lesions such as leukoplakia, oral submucous fibrosis, oral lichen planus and some malignant carcinoma like oral squamous cell, verrucous, spindle cell, Merkel cell carcinoma and basal cell. Some of miRNAs could be new therapeutic candidates in miRNA-based target gene therapy. Although more investigations are required to identify the most favorable miRNA candidate, altered expression of some miRNAs could be used as biomarkers in premalignant lesions and oral cancers with high sensitivity and specificity.

Establishment and evaluation of a CT-based radiomic model for AIDS-associated pulmonary cryptococcosis

BackgroundEstablish a CT-based diagnostic radiomic model for AIDS complicated with pulmonary cryptococcosis and evaluate the diagnostic efficacy of this model.MethodsThis retrospective study enrolled 98 AIDS patients with pulmonary cryptococcosis and 103 AIDS patients with other infections or neoplastic lesions, comprising a total of 699 lesions. Patients were randomly divided into a training group and test group at a ratio of 2.75:1. Features from all lesions, cavity lesions and solid nodule lesions were extracted, and two kinds of radiomic models (6 types) were established. ROC curves were drawn, and the sensitivity and specificity were calculated to compare the SVM model and LR model, radiologists’ empirical diagnoses and the combination of these empirical diagnoses with the radiomic model.ResultsThe AUCs of senior radiologist for all lesions and cavity lesions were lower than those of the SVM and LR models. The diagnostic efficacy of primary radiologist was lower than that of both of the other model types. The diagnostic efficacy of the LR model was relatively stable, with the highest diagnostic efficiency of the 3 model/radiologist groups. The AUCs of intermediate radiologist in combination with the LR radiomic model for all lesions, nodular lesions and cavity lesions were 0.88, 0.84, and 0.9, respectively, which were the highest among all models and radiologists.ConclusionsThe CT-based radiomic LR model of AIDS-associated pulmonary cryptococcosis exhibits good diagnostic performance, which was similar to that of senior radiologists and higher than that of the primary radiologist. With the help of a radiomic model, radiologists can achieve improved diagnostic accuracy compared to that when only an empirical diagnosis is used.

Rhinocerebral Mucormycosis in Patients with Diabetes Mellitus After a New Coronavirus Infection (COVID-19): СT and MRI Patterns Data

Objective: to study the computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of rhinocerebral mucormycosis (RCM) in patients with diabetes mellitus and new coronavirus infection, to develop attentive attitude of radiologists for early detection of this pathology, rapid surgery and followup examinations.Material and methods. Totally 53 head (facial skull, soft facial tissues and brain) CT and MRI studies were performed in 13 patients with RCM. The number of CT and MRI studies varied from 1 to 9 per one patient, depending on the severity of his condition and clinical indications; the follow-up period was 1–4 months. All patients received surgical aid; diagnosis was verified by microscopy of surgical samples of excised necrotic tissues. A detailed descriptive analysis of pathological changes on CT and MRI characterizing RCM was carried out. The sequence of pathological signs manifestations was described, the prevalence of the lesion was estimated for planning the scope of surgical intervention. A comparative analysis of the identified RCM signs with the literature data was performed.Results. Lesions of the nasal cavity and paranasal sinuses in RCM were found in 100% of our observations, with approximately equal single and bilateral lesions of 54% and 46%, respectively. Lesions of the perimaxillar fatty tissue and pterygoid fossa were determined in 77% of patients, unilateral orbital lesions – in 23%, superior orbital vein and cavernous sinus thrombosis – in 31%, facial soft tissue lesion – in 15.5%, intracranial spread through the perineural spaces – in 7.7%, internal carotid artery arteritis – in 15.5%. Brain substance and meninges involvement in the pathological process was observed in the form of cerebritis in 23% of patients and meningitis in 46%. The formation of brain abscess was noted in follow up examinations in 15.5% of patients, skull bones osteomyelitis was diagnosed in 46%. The mortality rate was 15%. In cases of long-term observation, the manifestations of pathological changes started from the nasal cavity, then spreaded in the perimaxillary adipose tissue and orbit, and were followed by the development of intracranial complications.Conclusion. The accumulated experience in identifying the combination of CT and MRI signs and patterns of RCM combined with clinical and anamnestic data allows to increase the alertness of clinicians and radiologists for earlier diagnosis and selection of the optimal volume of surgical intervention.

Correlation Between CD4 Cell Count, HIV Viral Load, and Chest CT Findings of AIDS-associated Pulmonary Cryptococcosis

Background: The computed tomography (CT) features of acquired immune deficiency syndrome (AIDS)-associated pulmonary cryptococcosis (PC) are correlated with the viral load of human immunodeficiency virus (HIV). An increase in CD4-positive T lymphocyte (CD4) cell count in peripheral blood after a highly active antiretroviral therapy (HAART) can reflect the morphological changes of lung lesions. Objectives: This study aimed to evaluate the correlation between CT features and HIV viral load and to determine a cut-off value for CD4 cell count increment to investigate the prognosis of PC. It also aimed to examine the morphology of PC lesions and their prognosis following HAART. Patients and Methods: Sixty-two patients with AIDS-associated PC, confirmed by pathology or follow-up, were enrolled in this study. The CT findings were recorded and classified as nodular, cavitary, and consolidation groups and their subtypes. Forty HIV patients who had undergone HAART were screened in this study, and the outcomes of lung lesions were recorded in a follow-up of 3 - 6 months. The participants were divided into improvement and progression groups. The correlation analysis and the receiver operator characteristic (ROC) curve analysis were used to examine the correlation between CT morphology and HIV viral load and to determine the cut-off value for CD4 cell count increment. The intraclass correlation coefficient (ICC) for inter-observer agreement was also calculated. Results: In the nodular group, patients with miliary nodules had the highest HIV viral load in peripheral blood (miliary nodules vs. solitary nodules, P = 0.009; miliary nodules vs. multiple nodules; P = 0.024). In the cavitary group, thick-walled cavity lesions had a higher HIV viral load than thin-walled cavity lesions (thin-walled vs. thick-walled cavity lesions, P = 0.036). Changes in the morphology of lesions, indicating the progression or improvement of PC, had a positive correlation with the CD4 cell count increment (F = 4.260, P = 0.045). The cut-off value for CD4 cell count increment to differentiate the two outcomes (progression and improvement) was 44/µL. The area under the curve (AUC) was 0.851, and sensitivity, specificity, and accuracy were estimated at 0.815, 0.714, and 0.764, respectively. Conclusion: In AIDS-associated PC, different types of lesions were related to the HIV viral load, and CD4 cell count increment following HAART was associated with the morphological changes of lesions. This finding can be helpful for clinicians and radiologists to make an accurate diagnosis and evaluate the treatment outcomes, as well as disease progression.

Case Description of Oral Cavity Hard Tissue Disease in Banjarmasin 2017-2020

Disease that rank first from the list of ten major diseases that are often complained by Indonesian people is oral cavity diseases. The Hard Tissue of oral cavity lesions can be in the form od caries, periodontal disease, periapical abnormalities, cysts, and tumor in the oral cavity. Based on the Riset Kesehatan Dasar (Riskesdas) in 2018 the prevalence of dental and oral problem in Indonesia in South Kalimantan was 59,6%. The purpose of this study is to determine the description of oral hard tissue lesions in Banjarmasin city in 2017-2020. This research is descriptive study using a cross sectional approach. The variables on this study were oral hard tissue disease and gender, the data used were secondary data that obtained from the recording and reporting of the LB-1 form at Banjarmasin Community Health Center. The results showed that the most common type of disease on oral hard tissue case in 2017-2020 was pulp and periapical tissue disease, in 2017 it was 12,640 cases (78.37%), in 2018 it was 18,184 cases (51,45%). In 2019 it was 22,493 cases (57.07%) and in 2020 it was 3,220 cases (58.59%). In 2017, the most cases were in men with total of 7,887 cases (62.50%),while in 2018, 2019, and 2020, the most cases were in women with a total of 11,621 cases (64,29%), 14,285 cases (63.51%) and 1,892 cases (58.76%). It is necessary to prevent oral hard tissue disease, especially in pulp and periapical tissue disease.

DENTAL CARIES MANAGEMENT IN YOUNG CHILDREN WITH INTERIM THERAPEUTIC RESTORATION

Caries are the most common case in every individual, including children who are still at an early age. Caries in primary teeth can occur in the early period of tooth eruption, which begins with the presence of white spot lesions. Dental caries are known as Early Childhood Caries (ECC) at an early age. ECC is used for caries in primary teeth up to 71 months. Many factors trigger the occurrence of ECC. Early treatment is very important to prevent comprehensive damage. Usually, the operator will face conditions that are not conducive to treatment. Young children generally will behave uncooperatively, have very high mobility, cry, and have difficulty opening their mouths, so it will be difficult for the operator to give treatment. One of the most therapy is dental restoration. The treatment approach will depend on the severity of the case; treatment can be in the form of non-operative therapy, dental restoration, or the last stage extraction if the teeth cannot be maintained. This case report will discuss the treatment of primary tooth cavity lesions without pulp involvement in young children through Interim therapeutic Restoration (ITR) and strategies that need to be implemented to support the success of treatment and prevent the damage from worsening. The result showed that ITR wa successfully performed in young children with cooperative behavior to prevent more extensive tooth decay.

P398 COVID-19-associated pulmonary aspergillosis: Species distribution and susceptibility profiles

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesThis study aimed to investigate the species distribution and susceptibility profiles of Aspergillus species isolated from patients admitted to the intensive care unit with severe COVID-19 in Isfahan, Iran, between April 2021 and March 2022.MethodsThis retrospective study included intubated patients with COVID-19 in three referral COVID-19 hospitals. Tracheal aspirate (TA) samples were taken from 267 patients to investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defined according to the 2020 European Confederation of Medical Mycology/International Society of Human and Animal Mycosis consensus criteria. Aspergillus species obtained from samples were characterized based on conventional and molecular assays. In vitro antifungal susceptibility testing was performed on the obtained isolates according to the guidelines from the Clinical and Laboratory Standards Institute.ResultsThe mean age of the patients was 61.73 ± 12.69 years. The mean length of hospitalization and admission in ICU were 18.77 ± 12.94 and 13.51 ± 9.83 days, respectively. A total of 61 (22.9%) patients presented with a single cavity lesion. Pulmonary artery pseudoaneurysm was seen in seven patients and post-COVID-19 changes were seen in all patients. Based on the conventional and molecular techniques, 72 isolates of Aspergillus species (26.9%), including A. flavus (10.1%%), A. fumigatus (8.6%%), A. niger (3.3%), A. tubingensis (2.9%), A. terreus (1.1%), A. luchuensis (0.37%) A. quadrillineatus, and (0.37%), were obtained from 267 patients. MIC results showed that all Aspergillus species were susceptible to all tested antifungal drugs.ConclusionAccess to priority clinical groups, improving the care of patients with simultaneous pulmonary aspergillosis with COVID-19, and identifying Aspergillus species are essential steps in the care cascade to manage those affected by them.

Comparison of Effectiveness as well as Advantages and Disadvantages of Different Dimensions of Hysterosalpingo-Contrast Sonography for Diagnosis of Lesions Associated with Female Infertility.

Methods Forty subjects who underwent routine two-dimensional (2D) vaginal ultrasound, three-dimensional HyCoSy (3D-HyCoSy), and four-dimensional HyCoSy (4D-HyCoSy) examinations from January 2021 to July 2022 at the ultrasound department of Pukou Branch of Jiangsu Province Hospital were enrolled to this study. Fallopian tubal recanalization by hydrotubation (FTRH) was used as the gold standard to compare the efficacy of 2D vaginal ultrasound, 3D-HyCoSy, and 4D-HyCoSy in assessing the subjects for the presence of polyps, myomas, and other occupants in the uterine cavity or uterine adhesions. Results A total of 18 cases of uterine cavity lesions, 11 of pelvic lesions, and 11 of ovarian lesions were identified by FTRH, while 80 fallopian tubes were found in 40 patients and 71 tubal obstructions were detected by FTRH. Vaginal ultrasound assessment of uterine cavity, pelvis, ovarian lesions, and tubal obstruction was moderately consistent with FTRH (Kappa = 0.616, 0.673, 0.654, and 0.640), 3D-HyCoSy was in good agreement with FTRH (Kappa = 0.812, 0.910, 0.906, and 0.894), and 4D-HyCoSy was in good agreement with FTRH (Kappa = 0.914, 0.903, 1.000, and 0.942), with 4D-HyCoSy being in good agreement with FTRH had the highest agreement. Conclusion 4D-HyCoSy can be used as an effective tool for clinical diagnosis of female tubal obstruction infertility and provide a reference basis for the design of subsequent clinical treatment plans.

MRI-Guided Electrode Implantation for Chronic Intracerebral Recordings in a Rat Model of Post-Traumatic Epilepsy-Challenges and Gains.

Brain atrophy induced by traumatic brain injury (TBI) progresses in parallel with epileptogenesis over time, and thus accurate placement of intracerebral electrodes to monitor seizure initiation and spread at the chronic postinjury phase is challenging. We evaluated in adult male Sprague Dawley rats whether adjusting atlas-based electrode coordinates on the basis of magnetic resonance imaging (MRI) increases electrode placement accuracy and the effect of chronic electrode implantations on TBI-induced brain atrophy. One group of rats (EEG cohort) was implanted with two intracortical (anterior and posterior) and a hippocampal electrode right after TBI to target coordinates calculated using a rat brain atlas. Another group (MRI cohort) was implanted with the same electrodes, but using T2-weighted MRI to adjust the planned atlas-based 3D coordinates of each electrode. Histological analysis revealed that the anterior cortical electrode was in the cortex in 83% (25% in targeted layer V) of the EEG cohort and 76% (31%) of the MRI cohort. The posterior cortical electrode was in the cortex in 40% of the EEG cohort and 60% of the MRI cohort. Without MRI-guided adjustment of electrode tip coordinates, 58% of the posterior cortical electrodes in the MRI cohort will be in the lesion cavity, as revealed by simulated electrode placement on histological images. The hippocampal electrode was accurately placed in 82% of the EEG cohort and 86% of the MRI cohort. Misplacement of intracortical electrodes related to their rostral shift due to TBI-induced cortical and hippocampal atrophy and caudal retraction of the brain, and was more severe ipsilaterally than contralaterally (p < 0.001). Total lesion area in cortical subfields targeted by the electrodes (primary somatosensory cortex, visual cortex) was similar between cohorts (p > 0.05). MRI-guided adjustment of coordinates for electrodes improved the success rate of intracortical electrode tip placement nearly to that at the acute postinjury phase (68% vs. 62%), particularly in the posterior brain, which exhibited the most severe postinjury atrophy. Overall, MRI-guided electrode implantation improved the quality and interpretation of the origin of EEG-recorded signals.

A series of six uncanny orthokeratinized odontogenic cysts: Revisiting the literature

Orthokeratinized odontogenic cyst is a rare odontogenic cyst which was considered to be a variant of odontogenic keratocyst, but has been recognized as a separate entity due to its varied behavior and histology. Commonly associated with an unerupted tooth in the posterior mandible, it mimics various lesions like dentigerous cyst, odontogenic keratocyst, unicystic ameloblastoma etc. Orthokeratinized odontogenic cyst was thought to be less destructive compared to odontogenic keratocyst. This case series highlights the clinically aggressive nature of Orthokeratinized odontogenic cyst.In this case series six cases of diagnosed Orthokeratinized Odontogenic cyst have been described along with one case of multiple Orthokeratinized odontogenic cysts in a female patient. The clinical, radiographic and histopathologic features have been described in great detail in order to correlate with the previous literature and highlight their clinically aggressive behavior.Orthokeratinized odontogenic cyst can be deceptive and should be diagnosed appropriately to avoid aggressive treatment protocol. Most of these cysts are associated with inflammation which makes it harder to be diagnosed as the epithelium and connective tissue would have undergone structural changes. Differentiating the cystic lesions of the oral cavity is utmost important to devise appropriate treatment suitable for the patient and for assessing the prognosis, recurrence and rehabilitation to improve the quality of life.

Oral Lipoma: A Case Report

Lipomas are the most frequent benign neoplasms of mesenchymal origin, and they mostly occur in various anatomical sites, including the palate, lip, buccal mucosa and vestibule, tongue, and floor of the mouth. Lipomas have a low incidence between 1 to 4% of benign oral cavity lesions. The clinical presentation of lipomas is generally characterized as a neoformation with well-demarcated borders. In this clinical case report, a 66-year-old female patient presented with pain and an inflamed region in the oral cavity. In intraoral clinical examination, a neoformation of 1 centimeter in diameter was observed and located in the jugal mucosa of the right side of the oral cavity. Furthermore, an excisional biopsy was chosen as the treatment method, and a postoperative histopathological study was conducted. Surgical excision is the treatment of choice for preventing recurrence in patients with oral lipomas.

Exposing a Critical Gap in Dental Student's Education: A Survey of Dental Student’s Confidence in Performing Biopsies

A dental student’s time in dental school is spent studying basic clinical sciences, learning hand skills, and improving clinical confidence. Although dental students are taught to identify many lesions of the oral cavity and the importance of biopsy for these various lesions, unfortunately, not all students are taught how to properly sample these lesions. Dental students are often taught to perform minor surgical procedures, and taking a simple biopsy would likely be within their capabilities. This vital procedure plays a critical role in the early detection and management of various oral pathologies and could make a significant difference in patients’ lives.

EXFOLIATIVE CYTOPATHOLOGY IN THE DIAGNOSIS OF LESIONS OF THE ORAL CAVITY

<h3>Objectives</h3> Early diagnosis is a priority activity to perform less aggressive treatments and improve survival in oral cancer. An activity that can contribute to the early diagnosis of lesions is exfoliative cytology. The aim of this study was to evaluate the efficacy of the use of exfoliative cytology for the diagnosis of oral cavity lesions. <h3>Study Design</h3> This was a prospective, observational, cross-sectional, descriptive study of a series of cases, aiming to determine the contribution of exfoliative cytopathology in the preoperative diagnosis of lesions of the oral cavity. <h3>Results</h3> The study sample included 50 patients. In 70% of cases, the lesions were histologically interpreted as benign and 30% as malignant. When comparing the 2 methods of cytology, traditional and liquid-based, we obtained 100% sensitivity, 97% specificity, 97% accuracy, kappa = 0.91. Regarding the accuracy of the cytologic and histopathologic diagnosis, sensitivity was 86.6%, specificity 100%, positive predictive value 100%, negative predictive value 94.5%, kappa = 0.958, and accuracy 96%. <h3>Conclusions</h3> Traditional and liquid-based cytology methods were able to identify and classify cell changes with characteristics of malignancy. Cytology techniques have proven reproducible and, if well indicated, can be routinely used for the early detection of malignant lesions.

IMMUNOHISTOCHEMICAL MARKERS FOR THE DIAGNOSIS OF ORAL SPINDLE CELL LESIONS: A REVIEW

<h3>Objectives</h3> To review the useful immunohistochemical markers in the diagnosis of spindle cell lesions of the oral cavity. <h3>Study Design</h3> A narrative review of the literature was carried out in PubMed and Portal Periódicos CAPES databases. Immunohistochemical profiles of myofibroblastic (myofibroma, inflammatory myofibroblastic tumor, low-grade myofibroblastic sarcoma), fibroblastic (solitary fibrous tumor, fibromatosis, nodular fasciitis, fibrosarcoma), and muscular (leiomyoma, angioleiomyoma, leiomyosarcoma) lesions was collected. <h3>Results</h3> A graphic summary of the results was elaborated. Of notice, h-caldesmon and smooth muscle myosin are helpful to differentiate myofibroblastic and muscular lesions. CD34, bcl-2, and CD99 are useful for diagnosing solitary fibrous tumor. The lack of desmin expression in myofibroma may help in the differentiation from leiomyoma. p53 and Ki-67 may help in the diagnosis of malignant lesions. <h3>Conclusions</h3> Immunohistochemistry is often useful to stablish the histopathologic diagnosis of oral spindle cell lesions of myofibroblastic, fibroblastic, and muscular origin, though a large panel can be necessary. H-caldesmon, smooth muscle actin, smooth muscle myosin, desmin, and muscle-specific actin are of great importance. Other markers such as CD99 and ALK-1 are useful for specific lesions.

Osseous choristoma: Report of two cases in oral cavity

Osseous choristoma is the formation of normal mature bone at an abnormal position. These are rare benign tumor-like growth usually asymptomatic except growth or swelling as the clinical presentation. In oral cavity, osseous choristoma is rare and commonly found in posterior third of the tongue. Clinically it is misdiagnosed as malignancy because of its hardness. Clinically, it is also mistaken for other oral cavity lesions, especially those of minor salivary gland lesions of oral cavity. Hence, awareness amongst clinicians, general practitioners and oral pathologists about oral osseous choristomas is necessary. Here, we report two cases of osseous choristoma in the oral cavity located at sites other than tongue.