Head Region Research Articles

Institutional Review and Clinicopathologic Correlation of Head and Neck Sarcomas

Abstract Introduction/Objective Head and neck sarcomas are challenging to diagnose and treat. Sarcomas in the head and neck region cause significant morbidity and mortality due to the vital structures affected. The rare nature of head and neck sarcomas also creates challenges in studying these entities. Methods/Case Report We performed a retrospective review of 40 cases of head and neck sarcomas at our institution from January 2000 to December 2023. Cases of metastatic sarcoma to the head and neck region were excluded. Skin and thyroid primary cases were also excluded. Results (if a Case Study enter NA) The initial age of diagnosis ranged from 2 years to 86 years with an average age of 39.2 years old. Thirteen pediatric patients were identified with the most common diagnosis being embryonal rhabdomyosarcoma and the most common location being the pharynx. The most common diagnosis among adult patients was chondrosarcoma with the most common location being the sinuses. Most patients presented at stage T2N0M0 and had an average survival of 4.4 years. Pediatric patients had a slightly greater average survival of 8.4 years. Adult patients had an average survival of 2.1 years. Conclusion Overall, head and neck sarcomas show poor prognosis and arise more commonly in the pharynx in pediatric patients and the sinuses in adult patients.

Ganglioneuroma in Head and Neck: A Case Report of a Laryngeal Ganglioneuroma and a Systematic Review of the Literature.

Introduction: Ganglioneuroma (GN) is a rare, benign tumor of the autonomic nervous system. It is seldom located in the head and neck (HN) region. GN typically presents as a slow-growing, painless mass, often leading to delayed diagnosis. Case report: We report a unique case of laryngeal-originating GN in a 43-year-old female who presented with worsening dysphonia and dyspnea. Imaging revealed a large mass originating from the larynx. Histological examination confirmed the diagnosis. The tumor was surgically excised with preservation of key structures in the neck. At the follow-up, the patient experienced a significant improvement in symptoms. Material and methods: A systematic literature review following PRISMA guidelines was conducted in January 2024 to investigate the common sites of GN in the HN region and the complications associated with its treatment. Results: In a total of 58 articles, we studied 65 patients, mostly under 30 years old. Surgical excision remains the primary treatment, and post-operative complications were mostly neurological. Discussion: GNs are generally slow-growing and asymptomatic, but they can reveal themselves when compressing nearby structures, especially in the HN region. In symptomatic cases or when the tumor exhibits significant growth or hormonal activity, surgical resection is required. The lateral cervical approach is the most common one. The risk of postoperative complications and recurrence underscores the need for careful surgical planning and long-term follow-up. Conclusion: This unique laryngeal GN case highlights the importance of considering GN in the differential diagnosis of HN masses. Further large-scale studies are warranted to establish evidence-based protocols for their management, especially in the HN region.

All that is squamoid is not squamous: A rare case of Squamoid Eccrine Ductal Carcinoma presenting as an intranasal mass

Abstract Introduction/Objective Squamoid eccrine ductal carcinoma (SEDC) is a rare adnexal tumor that poses diagnostic challenges because of the rarity, variable clinical presentation, and misdiagnosis on superficial biopsy sampling. Methods/Case Report We report a 52-year-old immunosuppressed male, status-post kidney and heart transplants who presented with an anterior nasal mass, the biopsy of which was interpreted as squamous cell carcinoma (SCC). Resection revealed a 2.5cm intranasal mass eroding through the hard palate. Histology showed a biphasic tumor arising from nasal vestibular skin with a superficial squamoid component (p40 positive) and a deeply invasive component demonstrating ductal differentiation (CEA positive) consistent with SEDC. SEDC has a predilection towards skin of head and neck region but SEDC presenting as an intranasal mass has not been reported. In our case, the tumor arose from nasal vestibular skin with destructive bony invasion within the nasal cavity. The patient’s long- term immunosuppression likely played a role in the etiopathogenesis and aggressive progression of this tumor. Interestingly, he also had history of multiple sebaceous carcinomas and cutaneous T-cell lymphoma with no known genetic predisposition, further implicating immunosuppression as the key risk factor for development of his cutaneous malignances. Results (if a Case Study enter NA) N/A Conclusion This case exemplifies the potential diagnostic pitfalls in squamoid lesions of the head and neck. Given the overwhelming prevalence of conventional SCC, rarer tumors with squamous differentiation often are not considered in the differential diagnosis, especially of an intranasal mass. A superficial biopsy often is misdiagnosed as SCC due to the lack of representation of deep-seated ductal components. A high index of suspicion and adequate examination of deeper aspects of the lesion are imperative for accurate diagnosis.

Malignant Peripheral Nerve Sheath Tumor of the Pancreas with Molecular Confirmation: A Case Report with Comprehensive Histopathologic and Molecular Characterization

Abstract Introduction/Objective Malignant peripheral nerve sheath tumors (MPNSTs) are rare soft tissue sarcomas arising from a peripheral nerve or exhibiting nerve sheath differentiation. They are often associated with neurofibromatosis type 1, and most often arise in the trunk, extremities, or head and neck region. In patients without neurofibromatosis type 1, sporadic de novo or radiotherapy-associated MPNSTs can pose a diagnostic challenge. MPNSTs arising from visceral organs are exceedingly rare. Here we report a case of MPNST arising in the pancreas. Methods/Case Report The patient is a 75-year-old female, MUTYH mutation carrier, with prior history of breast and bladder cancers, each treated with respective local excision and radiation therapy. Magnetic resonance imaging (MRI) performed for pancreatic cancer screening showed a 4.7 cm heterogeneous mass in the pancreatic tail suggestive of pancreatic neoplasm. Fine needle aspiration cytology was non-diagnostic. However, due to the radiologic concern for malignancy, the patient proceeded with surgical resection by distal pancreatectomy with splenectomy. Macroscopically, a 6.5 cm, tan-white, partially necrotic mass was identified in the pancreatic tail. Microscopic examination showed a spindle cell neoplasm arranged in a vague fascicular fashion with moderate nuclear pleomorphism, geographic necrosis, and frequent mitotic figures (15 per 10 high power fields). Fifteen lymph nodes were negative for metastasis. The tumor was confined to the pancreas grossly and microscopically. Immunohistochemical stains showed the neoplastic spindle cells to be positive for TLE1 (diffuse) and S100 (patchy), while negative for SOX10, CD117, DOG1, desmin, actin, MyoD1, ERG, STAT6, and ALK1. In addition, H3K27me3 showed loss of nuclear expression. Next generation sequencing (NGS) revealed gene mutations in NF1, TP53, PIK3CA, and PTEN, and copy number losses involving CDKN2A and CDKN2B. Genome-wide DNA methylation analysis was performed which revealed copy number losses of CDKN2A/B and gains of PTCH1 and MDM2. However, the Sarcoma DNA Methylation Classifier did not provide any diagnostic matches. Overall, the morphologic features, loss of H3K27me3 expression, presence of NF1 and TP53 mutations, and copy number losses in CDKN2A/B supported a diagnosis of high-grade MPNST. The patient has been followed clinically without adjuvant therapy. Results (if a Case Study enter NA) N/A Conclusion We report an extremely rare case of MPNST of the pancreas with molecular confirmation.

Giant pilomatricoma with atypical features: report of a case of aggressive pilomatricoma in an adult

Abstract Introduction/Objective Pilomatricoma, also known as pilomatrixoma or calcifying epithelioma of Malherbe, is a relatively common, benign tumor of the hair matrix. It typically presents as a small (~1cm), dermal based mass in the head and neck region of children and young adults (under 20 years) with predominance for males, but can occur in any age. In contrast, malignant pilomatricoma is typically larger (1 to 10 cm) and occurs later in life (50-60 years). Aggressive pilomatricoma is a variant of pilomatricoma that tends to occur in children and demonstrates atypical features such as increased matrical cells and nuclear atypia, but insufficient for a classification as pilomatrical carcinoma. Here, we presented a case of a large (14.5 cm) aggressive/atypical pilomatricoma that occurred in an adult. Methods/Case Report A 45 year-old-female presented to the emergency department with a posterior neck mass which has been slowly enlarging for years. Recently, it became painful with sanguineous discharge which prompted her to seek medical attention. CT scan revealed a lobulated, pedunculated mass with fat and fluid components. An excision was performed. Gross examination revealed an ulcerated mass measured 14.5 cm in greatest dimension. Scattered calcifications were present. Microscopically, nests of basaloid cells with scattered shadow cells are present consistent with matrical differentiation. A multinodular growth pattern with central necrosis was evident. Nuclear atypia characterized by prominent nucleoli and nuclear overlapping was identified. Results (if a Case Study enter NA) NA Conclusion Histopathologic criteria to reliably differentiate between benign and malignant pilomatrical tumors are not well-established. Tumor ulceration, asymmetry, irregular borders, multinodular growth pattern, marked cytologic atypia, prominent necrosis, lymphovascular invasion, and perineural invasion may be used in favor of malignancy. Our case showed focal confluent necrosis, ulceration, multinodular growth pattern, and cellular atypia but lacked other features that indicative of unequivocal malignancy. The resection margins were negative for tumor. Clinical followup was negative for signs of recurrence or metastasis after two years. We presented this case to show the large size that aggressive pilomatricoma can reach and to emphasize the difficulty in differentiating benign from malignant pilomatrical tumors in borderline cases.

The single-strand DNA-binding protein SSB1 is involved in the expression of salivary gland radiation injury repair.

Single-strand DNA-binding protein 1 (SSB1) plays a crucial role in the cellular response to DNA damage. This study aimed to explore the expression and regulation of SSB1 in normal rat salivary gland tissues and tissues following radiation, with a specific emphasis on its involvement in the repair of salivary gland injury. A total of 45 adult SD rats were randomly assigned to one control group or eight experimental groups. In the control group, five rats were euthanized without irradiation, and their parotid gland tissues were collected for analysis. The experimental groups received a dose of 6Gy of radiation targeting the head and neck region; subsequently, five rats from each group were euthanized hly to collect parotid gland tissue samples, resulting in a total of eight experimental groups. The expression levels of SSB1, γ-H2AX, and PARP1 in the parotid gland tissues were assessed via immunohistochemistry, while changes in SSB1 gene expression were quantified via RT-qPCR. No significant morphological differences were observed between the two groups following HE staining. In the immunohistochemistry (IHC) analysis, notable tissue-specific variation in SSB1 expression was identified, with higher levels detected in the ducts than in the acini and connective tissue. The expression of SSB1 gene initially increased post-radiation before subsequently decreasing, ultimately returning to baseline levels, as corroborated by the RT-qPCR results. In contrast, γ-H2AX and PARP1 exhibited minimal expression in the control group; however, their expression peaked at 1h in the experimental group before gradually declining to levels comparable to those of the control group. Radiation induces time-dependent upregulation of SSB1 expression in rat salivary glands, indicating that SSB1 may play a role in radiation-induced repair processes.

Preoperative Ultrasound-guided Head and Neck Non-palpable Tumor Detection

Objective: Preoperative ultrasound-guided breast cancer detection was developed in the 1980s for non-palpable breast cancers. This technique was applied to neck surgery in 5 specific cases. Methods: Retrospective study to assess the efficacy and safety of this technique. Results: The mean surgical time was 35.2 ± 15.2 min. There were no complications of this percutaneous target location procedure. All surgical procedures allowed easy target retrieval without any complications. All targets were later confirmed to be the site of cancer. Conclusion: This adaptation of a senology technique to the head and neck region allows us to improve neck procedures by enhancing diagnostic precision, safety, and surgical efficiency.

Locally Aggressive and Recurrent Facial Inflammatory Myofibroblastic Tumor in a Pediatric Patient

Inflammatory myofibroblastic tumor (IMT) is a rare tumor type with a prognosis ranging from benign to locally aggressive. Initially described as a reactive lesion most commonly of the lungs, cases of IMT have now been reported in rare instances in the head and neck, which may be more aggressive than other tumor locations. IMT frequently afflicts children and adolescents, but pediatric cases of IMT in the head and neck region are rare. This report serves to describe a rare presentation of a recurrent and locally aggressive facial IMT in a pediatric patient that required multiple surgical resections alongside medical management.

Crystal-Storing Histiocytosis of the Stomach

Abstract Introduction/Objective Crystal-storing histiocytosis (CSH) is an infrequently seen lesion comprised of eosinophilic histiocytes filled with refractile crystalline structures that most often have been characterized as IgG kappa restricted monoclonal immunoglobulins. The etiology for the mechanism of accumulation of the immunoglobulins is incompletely elucidated but numerous mechanisms have been postulated, including overproduction, faulty secretion, and impaired breakdown. Though CSH itself is a benign lesion, it has repeatedly been noted to be a harbinger of a concurrent or developing lymphoproliferative disorder. Literature review revealed a wide age range of presentations with no gender predilection and reports of this lesion occurring most commonly in the bone, kidneys, lungs, lymph nodes, and head and neck region. The gastrointestinal tract is uncommonly involved, with the stomach being the most frequently cited location. Reports of CSH in this setting have noted simultaneous infections with Helicobacter pylori and a range of associated lymphomas. Methods/Case Report We report a lesion from the stomach of a 45 year old female endoscopically described as containing patchy atrophic and nodular mucosa that was biopsied for gastric mapping in a patient with a reported history of autoimmune atrophic gastritis but without confirmatory antibodies on serology. Immunohistochemical stains highlighted a CD68 positive, smooth muscle myosin and cytokeratin negative, population of cells with cytoplasmic kappa positivity. CSH was diagnosed in a background of chronic inactive gastritis of both the antrum and fundus without evidence of H. pylori via staining or associated extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue on biopsy. Recent imaging revealed no concerning lymphadenopathy, lytic lesions, or masses. Results (if a Case Study enter NA) NA Conclusion Increasing pathologists’ awareness of this entity and its potential to be a paraneoplastic lesion is crucial, as further work-up is needed to exclude an underlying hematolymphoid neoplastic process.

Development of a novel rabbit model for femoroacetabular impingement through surgically induced acetabular overcoverage.

There is a lack of validated small animal models for femoroacetabular impingement (FAI) that induce intra-articular lesions and cause osteoarthritis (OA) progression. The gene expression profile of articular cartilage in patients with FAI has not been characterized in animal studies. The purpose of this study is to describe a novel rabbit model for FAI with validated induction of intra-articular lesions and OA progression and to characterize the gene expression pattern in impinged cartilage using this model. Thirty 6-month-old New Zealand White rabbits underwent unilateral endobutton implant placement at the acetabular rim to surgically create overcoverage. Radiological assessment confirmed secure placement of endobutton at the acetabular rim for all operated hips with a mean alteration in lateral center-edge angle (ΔLCEA) of 16.2 ± 6.6°. Gross inspection revealed secondary cartilage injuries in the anterosuperior region of the femoral head for the operated hips. Cartilage injuries were shown to exacerbate with increased impingement duration, as demonstrated by the modified Outerbridge scores and Mankin scores. Immunostaining and quantitative real-time polymerase chain reaction revealed elevated expression of inflammatory, anabolic and catabolic genes in impinged cartilage. RNA sequencing analysis of cartilage tissue revealed a distinct transcriptome profile and identified C-KIT, CD86, and CD68 as central markers. Our study confirmed that the novel rabbit FAI model created acetabular overcoverage and produced articular cartilage injury at the impingement zone. Cartilage from the impingement zone demonstrated a heightened metabolic state, corroborating with the gene expression pattern observed in patients with FAI.

Constitutional Court Decision No.60/Puu-XXII/2024 Protects the Constitutional Rights of Citizens and Political Parties in Simultaneous Regional Elections in the Regions

Since Indonesia's establishment and independence, the process of filling the seats or positions of Regional Heads has changed many times, starting from the Old Order era, the New Order, and the reform period. These changes are actually in accordance with the needs of the times and not motivated by the interests of maintaining power. The decision of the Constitutional Court (MK) Number 60/PUU-XXII/2024 is right for now. At least it saves democracy from the cartel politics being played by the political elites in the country. The Constitutional Court's decision, which changed the threshold to resemble or almost the same as the requirements for individual candidates, opened the faucet for competition to become even more alive. This includes guaranteeing the constitutional rights of non-parliamentary political parties (without seats) to be able to nominate candidates for Regional Heads who were originally unable to as specified in Article 40 of Law 10 of 2016 concerning Pilkada. However, for the sustainability of democracy in the future, the author views that this decision is not optimal or still leaves problems. In the future, the implementation or application of a threshold or minimum requirement of support for the nomination of candidates for Regional Heads and even the President is no longer appropriate. In the future, an open nomination system should be applied, in which all political parties participating in the elections that pass the KPU verification are automatically entitled to propose candidates for Regional Heads. Some countries that adhere to the Presidential system do not recognize the term threshold. America, Brazil, Peru, Mexico, Colombia, and Kyrgyzstan.

When Giant Lymphangioma Meets Hydrops Fetalis: An Uncommon Case Report of Lower Extremity Involvement

Abstract Approximately 75% of lymphangiomas manifest in the head and neck region, with limb and bone involvement observed in only 2% of cases. This case report presents a rare instance of fetal lymphangioma associated with hydrops fetalis, affecting the left lower extremity and abdomen. A 22-year-old secundigravida woman was referred to the gynecology department at 31.2 weeks of gestation. Initial fetal ultrasound revealed a live fetus with a large lymphangioma involving the left lower extremity, gluteal region, and abdomen. Additional ultrasound findings included subcutaneous edema, pericardial effusion, ascites, placentomegaly, and tricuspid regurgitation. Postnatal clinical examination confirmed the diagnosis of lymphatic malformation. Notably, only one other similar case has been reported in the English-language PubMed database. This report adds to the medical literature as a rare instance of prenatally diagnosed lymphangioma-associated hydrops fetalis.

Analyzing the Anatomical Characteristics of the Facial Artery Branches: A Human Cadaveric Study.

The facial artery is the predominant branch of the external carotid artery supplying blood to the head and neck regions. Knowledge regarding the anatomical path and distribution of each facial artery's branches is essential. The aim of the study is to assess the levels, establish the reference positions of each branch of the facial artery to reliable landmarks in the face and neck regions, andevaluate the outer diameter and linear measurement. A prospective single-center cadaveric study was done on 60 hemifaces from 30 properly embalmed and formalin-fixed male cadavers. The statistical analysis was carried out using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States). Descriptive statistics and inferential statistics have been applied. Nonparametric analysis and the tests of normality were used. The Wilcoxon signed-ranktest was used to compare the various parameters between the left and right sides of each branch of the facial artery. The average length and diameter of each branch of the facial artery measured in millimeters are as follows: superior labial, 27.3 ± 9.17 mm and 1.6 ± 0.2 mm; inferior labial, 31.5 ± 7.86 mm and 1.3 ± 0.6 mm; lateral nasal, 10.6 ± 4.55 mm and 0.74 ± 0.2 mm; angular,29.65 ± 7.93 mm and 0.8 ± 0.2 mm; and submental,35.9 ± 5.3 mm and 0.9 ± 0.4 mm. Statistically, there is no remarkable variation between the left and right sides except the submental artery, which shows a remarkable difference based on the origin between the left side and right side with a p-value of 0.039. This study's findings will enable surgeons to more efficiently plan and design reconstructive flaps based on the facial artery, pertaining to this specific ethnic population (Indianorigin), which is not available in published history untilnow.

ASPECTOS ORAIS DO ABUSO SEXUAL INFANTIL E CONDUTA DO CIRURGIÃO DENTISTA: REVISÃO DE LITERATURA

The study presents a literature review, the aim of which was to point out the main characteristics for detecting cases of child sexual abuse from the point of view of dentistry, as well as to highlight the importance of the dental surgeon in identifying and reporting cases of suspected child maltreatment and/or abuse. The bibliographic research was carried out in different databases, such as SciELO, Bireme, LILACS and PubMed, selecting studies that addressed the descriptors provided by the DECS database: children, child sexual abuse and dentistry, published between 2015 and 2023. To prepare the literature review, 40 articles were found. However, national and international articles that met the inclusion criteria were selected for the expanded abstract. The literature shows the importance of identifying child mistreatment and abuse in the dental field, listing the main manifestations of injuries in the head and neck region. This research is linked to increasing dental surgeons’ knowledge of child violence, so that professionals are better able to recognize the signs of abuse or neglect in children, which is crucial for identifying cases of violence and taking the necessary measures. Therefore, this paper aims to point out the main characteristics of child sexual abuse, as well as what the dental surgeon’s conduct should be when faced with this occurrence.

Comparison of Diffusion-weighted MRI using Singe-Shot Echo-planar Imaging (SS-EPI) and Split Acquisition of Fast Spin Echo Signal (SPLICE) Imaging, a non-EPI technique, in Tumors of the Head and Neck.

Diffusion-weighted imaging (DWI) using single-shot echo planar imaging (DW-EPI) is susceptible to distortions around air-filled cavities and dental fillings, typical for the head and neck area. Non-EPI, Split acquisition of fast spin echo signals for diffusion imaging (DWSPLICE) could reduce these distortions and enhance image quality, thereby potentially improving recurrence assessment in squamous cell carcinoma (SCC) of the head and neck region. This study evaluated whether DW-SPLICE is a viable alternative to DW-EPI through quantitative and qualitative analyses. The DW-SPLICE sequence was incorporated into the standard 3.0T head and neck MRI protocol with DW-EPI. Retrospective analysis was conducted on two subgroups: firstly benign or malignant lesions, and secondly post-treatment SCC recurrence. In both subgroups Image quality and distortion were scored by two independent radiologists, blinded for DW-technique, and evaluated using mixed-effect linear models. Lesion apparent diffusion coefficient (ADC) values were assessed with inter-class correlation (ICC) and Bland-Altman analyses. DWI's delineation geometric similarity to T1-weighted post-contrast (T1Wc) MRI was evaluated using the Dice Similarity Coefficient (DSC) before and after registration. Recurrence in post-treatment SCC scans was evaluated by the same two radiologists blinded for DW-technique. Recurrence detection rates were then compared between DW-SPLICE and DW-EPI using mixed logistic regression at six months and at one-year post-scan follow-up data. From August 2020 to January 2022, 55 benign or malignant lesion scans (55 patients) and 74 post-treatment SCC scans (66 patients) were analyzed. DW-SPLICE scored better on image quality and showed less overall distortion than DW-EPI (0.04<p<0.001). There was high ADC measurement reliability (ICC=0.93, p<0.001), though a proportional bias was also observed (β=0.11, p=0.03), indicating the bias increases as ADC values rise. DWSPLICE exhibited greater geometric similarity to T1Wc before registration (DSC 0.63 vs 0.47, p<0.001) and outperformed DW-EPI by more accurately identifying recurrences after one year (OR=0.96, p=0.05) but not after six months (OR=0.72, p=0.13). DW-SPLICE surpasses DW-EPI on image distortion and quality and improves diagnostic reliability for detecting recurrent or residual SCC on 3T MRI of the HN. Consistent use of one method for follow-up is advised, as ADC values are not completely interchangeable. Integrating DW-SPLICE can significantly improve tumor assessments in clinical practice. ANTs = Advanced Normalization Tools; DSC = Dice Similarity Coefficient; DW-EPI = Diffusion-weighted single-shot echo planar imaging; DW-MS-EPI = Diffusion-weighted multi-shot echo planar imaging; DW-SPLICE = Diffusion-weighted split acquisition of fast spin echo signals for diffusion imaging; DW-TSE = Diffusion-weighted Turbo Spin Echo; ICC = Intraclass Correlation Coefficient; ROC = Receiver Operating Characteristic; SCC = Squamous cell carcinoma; T1WIc = T1 weighted imaging with gadolinium contrast.

Bicycle helmets are associated with fewer and less severe head injuries and fewer neurosurgical procedures

PurposeThis study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre.MethodInformation on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry for patients with bicycle-related injuries from 2005 through 2016. Outcomes were serious head injury defined as maximum AIS severity score ≥ 3 in the AIS region Head, any cranial neurosurgical procedure, and 30-day mortality.ResultsA total of 1256 hospitalized bicyclists were included. The median age was 41 years (quartiles 26–53), 73% were male, 5.3% had severe pre-injury comorbidities, and 54% wore a helmet at the time of injury. Serious head injury occurred in 30%, 9% underwent a cranial neurosurgical procedure, and 30-day mortality was 2%. Compared to non-helmeted bicyclists, helmeted bicyclists were older (43 years, quartiles 27–54, vs. 38 years, quartiles 23–53, p = 0.05), less often crashed during night-time (21% vs. 38%, p < 0.001), less frequently had serious head injury (22% vs. 38%, OR 0.29, 95% CI 0.22–0.39), and less often underwent cranial neurosurgery (6% vs. 14%, OR 0.36, 95% CI 0.24–0.54). No statistically significant difference in 30-day mortality between the two groups was found (1.5% vs. 2.9%, OR 0.50, 95% CI 0.22–1.11).ConclusionHelmet use was associated with fewer and less severe head injuries and fewer neurosurgical procedures. This adds evidence to the protective capabilities of bicycle helmets.

Cutting the Gordian Knot: Rare Presentation of Nodular Fasciitis as Supraclavicular Swelling with Muscular Involvement in 68Ga-FAPI-PET/CT

Background: Nodular fasciitis is a benign, singularly occurring nodular fibroblastic/myofibroblastic neoplasia. Due to the rapid growth and cellular atypia, this rare differential diagnosis in the head and neck region can be mistaken for malignant sarcomas. Methods: We present a 40-year-old female patient with an unclear, rough, and poorly displaceable supraclavicular swelling on the right as part of a medical check-up. Sonographically, the lump was poorly circumscribed with little vascularization. A consecutive core needle biopsy of the lesion yielded inconclusive results showing spindle-shaped tumor cells. 68Ga-FAPI-PET/CT showed an intensive uptake of the right supraclavicular lesion in addition to postoperative changes in the right tonsil. Subsequent operative partial excision of the lesion confirmed the histopathological diagnosis of nodular fasciitis. Results: Nodular fasciitis is the most prevalent pseudosarcoma found in soft tissues. This case is the first description of 68Ga-FAPI-PET/CT in nodular fasciitis. Surgical removal is advised; nevertheless, the tumor frequently diminishes on its own, and recurrence is rare. Extensive surgical therapy is not necessary. Conlcusions: The recognition of nodular fasciitis and its benign characteristics is crucial to prevent diagnostic errors and the subsequent unnecessary operative treatment of the patient.

Pediatric-type follicular lymphoma and pediatric nodal marginal zone lymphoma: additional evidence to support they are a single disease with variation in the histologic spectrum.

Pediatric-type follicular lymphoma (PTFL) and pediatric nodal marginal zone lymphoma (PNMZL) are two rare indolent B-cell lymphomas with overlapping features. Recently, cases showing hybridizing features of PTFL and PNMZL have been reported. Herein, we retrospectively analyzed the clinicopathologic features of 59 patients, including 39 with PTFL, 5 with PNMZL, and 15 with mixed-type tumors (MTT). And next-generation sequencing analysis was performed on 3 PTFL, 2 PNMZL, and 2 MTT cases. In addition, previously published mutational data of 96 PTFLs, 25 PNMZLs, and 46 MTTs were also analyzed. There were 52 male and 7 female patients, with a median age of 17years. Most patients (96.6%) had lymph node involvement in the head and neck region and were diagnosed with stage I disease. Among the 50 patients (85%) with telephone follow-up, 44 (88%) adopted a watch-and-wait strategy after surgical resection of the lesions. Only one PTFL patient experienced a relapse 6months after diagnosis. Microscopically, not only the MTT cases showed a composite form of enlarged follicles and interfollicular lymphocytic proliferation producing a progressively transformed germinal center (PTGC) pattern, but also focal follicles with a PTGC-like pattern were observed in PTFL cases. Genetically, the most frequently mutated genes were TNFRSF14 (in 3 PTFLs and 2 MTTs), MAP2K1 (in 2 PTFLs, 1 PNMZL and 1 MTT), and IRF8 (in 2 MTTs and 1 PNMZL). Based on the similar or overlapping clinical, pathologic, and genetic features, PTFL and PNMZL are likely to represent two different histologic patterns of the same disease.

The clinical significance of the lymph node ratio as a recurrence indicator in ampullary cancer after curative pancreaticoduodenectomy.

The clinical significance of the lymph node ratio (LNR), the number of metastatic lymph nodes per dissected lymph node, has not been sufficiently clarified in ampullary cancer. Among patients diagnosed histopathologically with ampullary cancer between 1980 and 2018, the study included 106 who underwent pathological radical resection by pancreaticoduodenectomy. The relationships between the LNR and metastatic lymph node sites and prognosis were examined. Multivariate analysis revealed that sex and lymph node metastasis were independent prognostic factors. In the 46 patients (43%) with metastatic lymph nodes, the LNR in the recurrence group was significantly higher than that in the non-recurrence group (0.15 ± 0.11 vs. 0.089 ± 0.071, p = 0.025). The receiver operating characteristic curve demonstrated that the LNR cut-off value, 0.07 (area under the curve = 0.70, sensitivity 81%, specificity 56%), was a significant indicator for recurrence (22% vs. 61%, p = 0.016) and prognosis (5-year survival: 48% vs. 83%, p = 0.028). Among the metastatic lymph node sites in the 46 positive cases, lymph node metastases developed from the peripancreatic head region (80%, 37/46) to the superior mesenteric artery (33%, 15/46) and para-aortic (11%, 5/46) regions. Lymph node metastasis is an independent prognostic factor, and the LNR is a significant indicator for recurrence and prognosis in patients with ampullary cancer.

Kimura Disease of the Head and Neck Region.

Objective: We analyzed the clinical characteristics and treatment results in surgical patients with a final diagnosis of Kimura disease. Patients and Methods: A total of 8 patients with a final diagnosis of Kimura disease of the head and neck region after surgery from January 2007 to December 2022 were enrolled. Results: The most common symptom was a mass in the head and neck region (n = 7), followed by incidental detection (n = 1). Multiple head and neck lesions were observed except for 1 patient with Kimura disease in the buccal space. Kimura disease could not be diagnosed in 5 patients who underwent preoperative fine-needle aspiration cytology. All patients underwent surgical resection. No major complications after surgery occurred. Six patients received steroids after surgery, with 1 patient undergoing radiotherapy as a side effect of steroid treatment. During the follow-up period, 5 patients relapsed. Of the parameters assessed, only longer symptom duration was statistically significant with relapse of Kimura disease. Conclusion: Clinicians should suspect Kimura disease based on asymptomatic masses, peripheral blood eosinophilia, and imaging examinations and make a definitive diagnosis via surgery.