Calcified Mass Research Articles

Massive lung calcifications in a four times renal transplanted patient: the fight against dialysis, hyper and hypoparathyroidism.

article: Massive lung calcifications in a four times renal transplanted patient: the fight against dialysis, hyper and hypoparathyroidism - Minerva Endocrinology 2021 Nov 08 - Minerva Medica - Journals

Calcified Small Bowel Mass.

Calcified Small Bowel Mass.

A Case Report of Autopsy: Large Mass of Pulmonary Metastatic Calcification in a Patient with End-Stage Renal Disease

Abstract Introduction/Objective Metastatic calcifications are reported in patients with end-stage renal disease (ESRD) in radiology literature but there are no pathologic reports regarding this clinical scenario in autopsy. Methods/Case Report We report the case of a 27-year-old African American man with nephrotoxic injury secondary to gentamicin treatment at a young age leading to ESRD requiring dialysis who then later developed congestive heart disease and arrhythmia. Prior to the patient’s last hospitalization, he had normal breath sounds with no signs of respiratory distress, rales, or wheezing. Imaging of the chest showed a patchy density in the right lung and a large parenchymal calcification. During autopsy, the patient was found to have bilateral markedly small and atrophic kidneys (left kidney weight: 27.5 g, size: 5.7 x 4.4 x 3.0 cm and right kidney weight: 30.6 g, size: 5.9 x 4.4 x 3.1 cm). Microscopically, the kidneys showed diffuse global glomerulosclerosis, atrophy of cortex, severe interstitial fibrosis, and tubular atrophy with thickened arteries as well as many foci of calcifications. A large mass measuring 3.5 x 2.4 x 1.9 cm was identified in the right middle lobe of the lung. Sections of the mass revealed large calcifications which were confirmed microscopically. In addition, concentric heart hypertrophy was identified with heart weight of 925 g and left ventricle measuring up to 2.2 cm. Calcifications (ranging from 0.2 – 0.5 mm) were also identified on the left atrial wall as well as a 1.2 x 0.8 x 0.6 cm mitral valve nodule along with additional microcalcifications within the myocardium. Results (if a Case Study enter NA) NA Conclusion In conclusion, our autopsy case supports previous radiologic reports that metastatic calcification can be dramatically present in the lung in patients with ESRD.

Gender distribution in patients treated with rotablation – analysis of 5,177 percutaneous coronary interventions based on a large national registry from between 2014 and 2020

Abstract Background Patients undergoing percutaneous coronary intervention (PCI) procedures using rotational atherectomy (RA) are a special group of patients characterised by the presence of massive calcifications in the coronary arteries. Due to a significant increase regarding the frequency of these procedures in recent years and the distinctiveness of this narrow group of patients among all patients undergoing PCIs, we have characterised the group according to gender. Aims The aim of analysis was to assess the gender percentage share in following years and differences between both groups of Polish patients undergoing PCI with rotational RA between 2014 and 2020. Methods Based on the Polish National Registry of Percutaneous Coronary Interventions (ORPKI), we analysed 751,113 patients treated with PCI between 2014 and 2020. Then, we extracted 5,177 (0.7%) treated with PCI and RA, 3,552 of them (68.6%) were males. Selected indices among the two groups were compared using the t-test for continuous variables, the χ2 test or the likelihood-ratio test for nominal variables where appropriate. To compare means of samples in the following years, one-way ANOVA test was used. Results The results of the study indicate an upward RA tendency in successive years (p<0.001). Moreover, this tendency and its increase was greater between the years 2016–2019 (Fig. 1). Almost twice as many RA procedures pertain to men, while the percentage share did not undergo a significant change in following years (Fig. 2). The mean age was 72±9 years in the overall group. In the total group, there were 2,873 patients (55.49%) with chronic coronary syndrome, 1,033 (19.95%) with unstable angina, 654 (12.63%) with non-ST segment elevation myocardial infarction (NSTEMI) and 494 (9.54%) with ST segment elevation myocardial infarction (STEMI). Females were significantly older in comparison to males [75.2±8.3 vs. 70.5±9.2, p<0.001], more often diabetics [613 (37.72%) vs. 1,068 (30.07%), p<0.001], less often smokers [173 (10.6%) vs. 635 (17.9%), p<0.001] and were significantly more often treated due to acute coronary syndrome [780 (48.8%) vs. 1,401 (40.5%), p<0.001]. Considering periprocedural complications among females, there were more cardiac arrests [13 (0.8%) vs. 10 (0.28%), p=0.01] and deaths [11 (0.68%) vs. 6 (0.17%), p=0.006] when compared to males. Conclusion The percentage of RA among overall PCIs has been still growing in recent years in Poland. The majority of patients treated with RA are men. Gender distribution did not change significantly among patients treated with PCI and RA during the analysed period of time. Funding Acknowledgement Type of funding sources: None.

Relationships between the expression of adipocytokine genes and the calcification of coronary arteries in patients with coronary artery disease

Dysfunctional changes and remodeling of adipose tissue (АT) are associated with the formation of microcalcifications in the vascular wall. Biologically active substances synthesized by АT (adipocytokines) can act as promoters and inhibitors of vascular calcification development. The few available experimental and clinical studies do not fully explain the possible mechanisms of these effects.Aim. To study the relationships between the adipocytokine profiles of adipocytes in epicardial and perivascular AT with the severity of coronary artery calcification in patients with coronary artery disease (CAD).Material and Methods. A total of 125 patients with CAD aged 59 (53; 66) years were examined. The isolated adipocytes of subcutaneous adipose tissue (SAT), epicardial adipose tissue (EAT), and perivascular adipose tissue (PVAT), obtained during coronary artery bypass grafting, were used to determine gene expression and secretion of adipocytokines (adiponectin, leptin, and IL-6). Expression of adipocytokine genes was assessed using quantitative PCR with detection of products in real time (real-time qPCR); the concentration of adipocytokines in the culture medium was determined by enzyme-linked immunosorbent assay using R&D Systems kits (Canada). Coronary artery (CA) calcification degree was assessed by multislice spiral computed tomography (MSCT) method. The calcium index of CA was determined by the Agatston method using the Syngo Calcium Scoring software package (Siemens AG Medical Solution, Germany).Results. Massive coronary calcification (CC) had the highest prevalence (58.8%) in patients with CAD. The highest level of expression of the ADIPOQ gene in all types of fat stores was observed in patients with moderate/medium CС compared to those with massive CС; the maximum expression of ADIPOQ was observed in the culture of PVAT adipocytes. Expression of the LEP and IL6 genes in massive CC was higher, with the maximum values in the culture of EAT adipocytes relative to SAT and PVAT adipocytes. Decreases in the levels of ADIPOQ mRNA and its secretion, increases in the levels of mRNA of LEP and IL6 and their secretion in adipocytes of the EAT and PVAT were associated with the development of СС in patients with CAD.Conclusion. Proinflammatory adipokines produced by adipocytes of patients with CAD during hypoxia induced vascular calcification by stimulating oxidative stress, osteoblast differentiation, apoptosis, and proliferation of smooth muscle cells. Endothelial cells, when stimulated with proinflammatory adipocytokines, tended to transform into osteoblasts, which further aggravated the degree of vascular inflammation and calcification.

A CALCIFIED CARCINOID TUMOR

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary carcinoid tumor is a neuroendocrine tumor of enterochromaffin cells representing about 1–5% of all lung malignancies. It usually presents in never smokers typically in proximal airways. Patients present with chronic cough, hemoptysis, and bronchial obstruction. These tumors show a low to moderate activity on PET scan. We present a case of a calcified carcinoid tumor. CASE PRESENTATION: A 49-year-old never-smoker male with medical history known for obesity, diabetes mellitus, hypothyroidism and exposure to welding presented complaining from progressive dyspnea with cough, wheezing and a history of mild hemoptysis. A Pulmonary function test (PFT) was performed which showed a FEV1/FVC ratio of 73% (post-bronchodilator), FEV1 77%, TLC 112%, RV 152% and DLCO of 77%. Findings were suggestive of a moderate obstructive lung defect and no significant bronchodilator response associated with decreased diffusion capacity and air trapping. The patient was started on umeclidium-vilanterol and a Chest X-ray was performed that showed atelectasis with prominence of the right hilum suggestive of pulmonary artery enlargement or potentially underlying lymphadenopathy/nodule. Thus, a Chest computer topography (CT) was scheduled. However, the patient developed an episode of hemoptysis and presented to the emergency department (ED) acutely prior to performing the chest CT. Chest CT was performed upon presentation to the ED which showed a calcified right hilar mass. Upon presentation the patient denied having any other complaints. He was started on antibiotics and steroids. A bronchoscopy with endobronchial ultrasound was performed that showed an endobronchial mass at the level of the secondary carina between the right upper lobe and bronchus intermedius bulging into the bronchus intermedius with about 85% obstruction of the bronchus intermedius not allowing the bronchoscope to pass distally with cobblestone mucosa. A transbronchial needle aspiration from the right hilar mass was performed as well as an endobronchial biopsy from right lung mass and lateral wall of the bronchus intermedius. Brushing from the right lung mass in the bronchus intermedius and bronchioalveolar lavage from bronchus intermedius was done. Pathology from the right upper lobe biopsy was positive for a neuroendocrine tumor (carcinoid). BAL, brushing, and lymph nodes were negative. A PET CT scan was done which confirmed the presence of a partially calcified right posterior hilar soft tissue mass with low FDG uptake and no definite metastatic disease. Patient underwent a right pneumonectomy. DISCUSSION: Calcifications has been reported in mesenteric carcinoid tumors, however, no prior cases of pulmonary carcinoid calcification were reported in the literature. This case describes an unusual presentation of pulmonary carcinoid tumor. CONCLUSIONS: This presentation highlights the importance of proper evaluation of a calcified mass. REFERENCE #1: https://pubmed.ncbi.nlm.nih.gov/7839976/ DISCLOSURES: No relevant relationships by Ahmad Albalbissi, source=Web Response No relevant relationships by Girendra Hoskere, source=Web Response No relevant relationships by AYA MASADEH, source=Web Response

A Newborn With a Mass on the Brain.

A Newborn With a Mass on the Brain.

18F-Sodium Fluoride (NaF) Uptake in Calcified Bladder Carcinoma: Double Density Sign

18F-Sodium fluoride (NaF) is primarily a skeletal imaging agent which can be localized in extraosseous calcified foci. Here, we describe a case of a 48-year-old man with bladder carcinoma referred for staging using 18F-NaF positron emission tomography/computed tomography (PET/CT). 18F-NaF PET/CT detected a calcified soft tissue mass in the urinary bladder. Extraosseous 18F-NaF uptake is often encountered and these non-osseous findings could possibly provide important diagnostic information. Thus, recognition of extraosseous 18F-NaF activity has implications for accurate staging and management.

PORCELAIN PLEURA: A RARE CASE OF METASTATIC CHONDROSARCOMA WITH EXTENSIVE PLEURAL CALCIFICATION

TOPIC: Disorders of the Pleura TYPE: Fellow Case Reports INTRODUCTION: Calcified pleural lesions have both benign and malignant etiologies. Benign lesions can originate from previous trauma, prior pleural infections, hemothorax, or asbestos exposures, and are often focal and limited1,2. Malignant lesions often involve metastatic disease from mesenchymal tumor origin, such as osteosarcoma, chondrosarcoma, or mesothelioma1,3. We describe a case of a patient with metastatic chondrosarcoma manifesting with extensive calcification of the parietal and visceral pleura. CASE PRESENTATION: A 67 year old man was referred to pulmonary for a new subcarinal soft tissue mass on chest CT. He had been previously diagnosed with chondrosarcoma in 2016 and underwent treatment via a radical right proximal humerus excision and shoulder arthroplasty, with final pathology revealing grade 2 conventional chondrosarcoma, mixed hyaline and myxoid, without metastatic foci.Screening chest CT in 2020 noted a new, partially calcified subcarinal soft tissue mass and adjacent lymphadenopathy with moderate hypermetabolism on a positron emission tomography scan (PET/CT). Bronchoscopy with endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) subcarinal lymph node and adjacent posterior mass confirmed metastatic disease.He subsequently developed rapidly progressive dyspnea on exertion over the following month. Repeat chest CT revealed extensive development of circumferential nodularity and calcification of the right visceral and parietal pleura with a large pleural effusion. Thoracentesis improved dyspnea despite limited reexpansion of the lung and noted loculation of the effusion. Pleuroscopic evaluation of the complicated space was undertaken to remove loculations and optimize placement of an indwelling pleural catheter (IPC) for his malignant effusion. Despite difficulty with trocar insertion into the calcified pleural space, placement of the IPC was successful with improvement in his dyspnea. DISCUSSION: Metastatic pleural involvement of chondrosarcoma is rare, and can occur in the setting of direct extension in locoregional disease or hematogenous spread from other sites of primary involvement. Metastatic disease has been noted to be more prevalent in the dedifferentiated and mesenchymal subtypes4. Manifestations of metastatic pleural involvement are typically pleural calcifications that can be profound in the rapid evolution and extent of calcified involvement. Management is often palliative, as in this case, with drainage of any associated pleural effusions and attempts to mitigate accompanying dyspnea. CONCLUSIONS: This case of metastatic chondrosarcoma with extensive visceral and parietal pleural involvement is rare and infrequently noted in the literature. Palliative management with thoracentesis and IPC placement was complicated by the pervasive pleural calcification that prevented ultrasound imaging and made access to the pleural space difficult and dangerous. REFERENCE #1: Sureka B, Thukral BB, Mittal MK, Mittal A, Sinha M. Radiological review of pleural tumors. Indian J Radiol Imaging. 2013;23(4):313-320 DISCLOSURES: No relevant relationships by Robert Browning, source=Web Response, value=Grant/Research Support Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Robert Browning, source=Web Response, value=Consulting fee Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Robert Browning, source=Web Response, value=Consulting fee Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Sean McKay, source=Web Response No relevant relationships by Philip Mullenix, source=Web Response No relevant relationships by Caitlin Nickens, source=Web Response No relevant relationships by John Shumar, source=Web Response

A COMMON SYMPTOM YIELDING AN UNCOMMON DIAGNOSIS: THE IMPORTANCE OF CHEST IMAGING WHEN EVALUATING A PATIENT WITH CHEST PAIN

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: We present a patient who had localized chest pain for at least five years and was diagnosed with clear cell chondrosarcoma as an incidental finding on a chest roentgenogram obtained for reasons unrelated to his chest pain. CASE PRESENTATION: A 56-year-old male was seen in primary care for acute on chronic right breast pain. He had multiple prior encounters with atypical chest pain in the same area over the previous five years. He was referred for EKG and cardiac stress testing, which he never completed. Physical exam was notable for right gynecomastia and pseudo-folliculitis. No further evaluation was recommended; he was advised to use warm compresses. As part of a worker's compensation case after exposure to generator fumes, a chest roentgenogram demonstrated a right mid-lung zone partially calcified mass. CT chest revealed an expansile right fourth rib lesion near the costochondral junction measuring 9.8 cm x 7.4 cm. CT guided biopsy demonstrated a mesenchymal neoplasm with epithelioid cells and clear cells. Immunostaining was strongly positive for S100, vimentin, H3 K36M, and clusterin; ALK1 and CD138 negative. A definitive diagnosis could not be made, favored to be chondroblastoma with atypical features, although clear cell chondrosarcoma could not be excluded due to H3 K36M staining. He underwent successful chest wall resection and reconstructive surgery with negative tumor margins. Final pathology was clear cell chondrosarcoma based on the presence of clear cells and areas of invasion. Surveillance CT chest 9 months post-op was negative for signs of recurrence. DISCUSSION: Clear cell chondrosarcoma is a rare, low-grade bone sarcoma, occurring in 2-3% of all chondrosarcoma patients. It tends to involve long bones (90%) and the epiphysis as opposed to chondrosarcomas which involve the pelvis, hip, shoulder, metaphysis and diaphysis. Due to its low-grade activity and indolent course, diagnosis is often delayed a year or longer. It may be difficult to distinguish from chondroblastoma, but clear cell chondrosarcomas occurs mostly in older patients (3rd to 5th decade) as opposed to children and young adults (chondroblastoma). H3 K36M staining occurs primarily in chondroblastoma, but can occur in chondrosarcoma. The most common presenting symptom is localized pain. This patient's intermittent symptoms and missed diagnostic studies delayed his diagnosis, which would have been facilitated with a routine chest roentgenogram. Clear cell chondrosarcomas are notoriously resistant to chemotherapy and radiation; wide surgical resection represents definitive therapy. CONCLUSIONS: Clear cell chondrosarcoma is a challenging tumor to diagnose clinically and pathologically; immunostaining for H3 K36M may help. This case underscores the importance of chest radiography in evaluating any patient with chest pain. REFERENCE #1: Itälä, A., et al., An Institutional Review of Clear Cell Chondrosarcoma. Clinical Orthopaedics and Related Research®, 2005. 440: p. 209-212. REFERENCE #2: Bjornsson, J., et al., Clear cell chondrosarcoma of bone. Observations in 47 cases. Am J Surg Pathol, 1984. 8(3): p. 223-30. REFERENCE #3: Nakayama, R., et al., What Factors Are Associated with Treatment Outcomes of Japanese Patients with Clear Cell Chondrosarcoma? Clin Orthop Relat Res, 2020. 478(11): p. 2537-2547. DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: $5001 - $20000 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: $5001 - $20000 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Pharmaceuticals Please note: 2014-Present Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Vapotherm, Inc Please note: 2019-Present Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria Advisory Committee Member relationship with Vapotherm, Inc Please note: 2020 Added 04/21/2021 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Christopher Miller, source=Web Response Stock Holder relationship with Merck Please note: $5001 - $20000 by Guy Soo Hoo, source=Web Response, value=Stock Holder Stock holder relationship with Amgen Please note: $5001 - $20000 by Guy Soo Hoo, source=Web Response, value=Stock Holder Stock Holder relationship with GlaxoSmithKline (GSK) Please note: $5001 - $20000 by Guy Soo Hoo, source=Web Response, value=Stock Holder Stock holder relationship with Pfizer Please note: $5001 - $20000 by Guy Soo Hoo, source=Web Response, value=Stock holder Stock holder relationship with XOMA Please note: $1001 - $5000 by Guy Soo Hoo, source=Web Response, value=Stock holder No relevant relationships by Caitlin Yumori, source=Web Response No relevant relationships by Jin Zhong, source=Web Response

Vascular uptake on 18F-sodium fluoride positron emission tomography: precursor of vascular calcification?

BackgroundMicrocalcifications cannot be identified with the present resolution of CT; however, 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) imaging has been proposed for non-invasive identification of microcalcification. The primary objective of this study was to assess whether 18F-NaF activity can assess the presence and predict the progression of CT detectable vascular calcification. Methods and ResultsThe data of two longitudinal studies in which patients received a 18F-NaF PET-CT at baseline and after 6 months or 1-year follow-up were used. The target to background ratio (TBR) was measured on PET at baseline and CT calcification was quantified in the femoral arteries at baseline and follow-up. 128 patients were included. A higher TBR at baseline was associated with higher calcification mass at baseline and calcification progression (β = 1.006 [1.005-1.007] and β = 1.002 [1.002-1.003] in the studies with 6 months and 1-year follow-up, respectively). In areas without calcification at baseline and where calcification developed at follow-up, the TBR was .11–.13 (P < .001) higher compared to areas where no calcification developed. ConclusionThe activity of 18F-NaF is related to the amount of calcification and calcification progression. In areas where calcification formation occurred, the TBR was slightly but significantly higher.

A calcified pelvic mass in a girl with cloacal anomalies

A 15-year-old girl, who had been experiencing right lower abdominal pain for 24 h, visited our emergency department. She had a history of cloacal anomalies, including duplication of the vagina and uterus, for which she underwent rectal and vaginal reconstruction at the age of 1 year. Coexisting anomalies included left kidney agenesis, neurogenic bladder with right grade I vesicoureteral reflux, and tetralogy of Fallot after corrective repair. She has been receiving clean intermittent catheterization for neurogenic bladder since the age of 2 years.

Surgery is like a box of chocolate. You never know what you're gonna get: a fibrous calcified pelvic mass.

Surgery is like a box of chocolate. You never know what you're gonna get: a fibrous calcified pelvic mass.

Fibroma cementoossificante bilateral mandibular apresentando diferentes estágios de maturação: relato de caso clínico / Bilateral ossifying fibroma of the jaw with different maturation stages: a case report

The ossifying fibroma (OF) is characterized as a benign neoplasm originated from the mesenchymal periodontal membrane, being composed of different amounts of mineralized material and fibrocellular stroma, leading to a mixed aspect. More commonly found as solitary lesions, the OF can be multiple in rare cases, normally associated with hyperparathyroidism-jaw tumor syndrome (HPT-JT). The aim of this study is to report a case of bilateral OF in the mandible with different stages of maturation, not associated with HPT-JT. This case shows a 20-year-old female patient with asymptomatic intraoral hard swelling in both sides of the mandible, presenting a slight expansion in the buccal bone cortex, near to the molars, hard to palpation. CBCT showed a unilocular, well-circumscribed hypodense image, with calcified masses only on the right side. Incisional biopsies were performed and a diagnosis of bilateral OF was reached. Due to the different stages of maturation of the lesions, two different surgical approaches were performed, curettage in the left side and surgical resection in the right side with extraction of the lower second premolar and lower first molar. These areas were restored with bone grafts and the left first molar was unresponsive to the pulp vitality test and endodontic treatment was performed. The patient is undergoing periodic clinical and radiographic follow-up, and after 12 months no signs or evidence of recurrence were observed.

A “polymorphous low-grade neuroepithelial tumor of the young (PLNTY)” diagnosed in an adult. Report of a case and review of the literature

Background: Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a rare neuropathological entity, recently introduced in neuro-oncology. These tumors, histologically similar to oligodendrogliomas, cause epilepsy, occurring in children and young adults. Only few cases of PLNTY have been described in literature and all reported cases invariably focused on the onset of these tumors in children and young adults.Case Description: We report the case of a 50-year-old woman suffering from epilepsy since the 1st year of her life. Computed tomography scan and magnetic resonance imaging of the brain documented the presence of a calcified mass involving left temporal lobe. The tumor was surgically excised and the histological examination showed a hypocellular and massively calcified neoplasm with morphological and immunohistochemical features consistent with the diagnosis of “PLNTY.”Conclusion: A review of the literature revealed that there are 31 cases of PLNTY reported in literature, most of which are children or young adults. The present case represents the second PLNTY diagnosed in a middle-aged adult to the best of our knowledge, suggesting that PLNTY should always be included in the differential diagnosis of low-grade brain tumors, also in adult patients.

Resident Perspectives 56-5

Resident Perspectives 56-5

Massive myocardial calcification: a heart of stone!

Abstract A 71-year-old female was admitted in the emergency room after effort-related syncope. She had past medical history of obesity and hypertension treated with lercanidipine. No relevant family history. Physical examination revealed systolic murmur (grade 2/6). ECG showed sinus rhythm and left bundle brunch block (Supplementary figure). Lab results were unremarkable including troponin I. Transthoracic echocardiography (TTE) revealed moderate left ventricular (LV) hypertrophy [septal thickness 14 mm (normal: 6–9mm)], extensive mitral annulus calcification (MAC) with exuberant myocardial calcification at the level of posterior leaflet that invaded adjacent LV walls, systolic anterior motion of the anterior mitral leaflet causing LV outflow tract (LVOT) obstruction (maximum gradient 34 mmHg) and moderate mitral regurgitation (MR) (Panel A). Exercise echocardiogram provoked LVOT gradient &amp;gt;100mmHg and severe MR. Continuous ECG monitoring during 13 days demonstrated no arrhythmic events. Cardiac CT showed multiple calcifications extending from mitral annulus to LV anterior and lateral walls and cardiac MRI was compatible with caseous MAC (Panels B-F). Coronary angiography showed 50% stenosis of mid left anterior descending artery. Normal thoracic CT and ACE, and negative IGRA excluded sarcoidosis and tuberculosis. Comprehensive study, including calcium metabolism and autoantibodies, excluded metabolic and inflammatory aetiologies of myocardial calcification, which was assumed as dystrophic in the context of MAC. No syncope occurred after bisoprolol 2.5 mg, oral rehydration and discontinuation of lercanidipine. However, rest and exercise TTE failed to show improvement of LVOT gradient or MR and patient remained on NYHA class II-III, despite maximal tolerated dose of bisoprolol (5 mg), being therefore referred to cardiac surgery.

What's in an Eye?

What's in an Eye?

Metastatic Extraskeletal Mesenchymal Chondrosarcoma of the Pancreas: Report of an Unusual Case with Review of Literature

Extraskeletal mesenchymal chondrosarcoma (ESMC) metastasizing to the pancreas in isolation is a rare occurrence. We report a 49-year-old gentleman who had undergone excision of an ESMC of the thigh in 2009 and presented with sudden onset abdominal pain and icterus in 2019. Radiological imaging revealed calcified mass of the pancreas with multiple nodules with extension into the adipose tissue. Distal pancreatectomy was performed and the pathology revealed a bimorphic tumor composed of undifferentiated round blue cells with abrupt transition to hyaline cartilage, typical of mesenchymal chondrosarcoma. To the best of our knowledge, there are only seven prior cases of metastatic ESMC of the pancreas in the English literature. Surgical intervention appears to be the preferred modality of treatment for metastatic pancreatic tumors. These patients may have long latency period before metastasizing and seem to have a good survival period post excision.

Micromorphological Analysis of Primary Second Molar with Molar-incisor Malformation : A Case Report

Molar-incisor malformation (MIM) is characterized by malformation in the root with a normal crown. While MIM mostly occurs in the permanent first molar, it has also been reported in the maxillary central incisor and the primary second molar (PSM), but anatomical analysis of the primary teeth with MIM has not been studied to date. In this case report, a patient with MIM was reported, and an extracted PSM with MIM was analyzed with micro computed tomography (CT). A cervical constriction morphology of the cementoenamel junction (CEJ) can be observed in extracted PSM. In micro CT analysis, characteristics such a mineralized plate (cervical mineralized diaphragm) in the CEJ area, complex root canal morphologies, a calcified mass inside the pulp chamber, and constricted pulp chamber of crown portion were observed.