Submandibular Area Research Articles

Interesting False Positive Radioiodine Uptake on I-131 Whole Body Scintigraphy with Different Mechanisms in Two Patients Diagnosed Differentiated Thyroid Carcinoma: A Review of Literature

Introduction: Radioiodine total body scan is used to detect recurrent differentiated thyroid cancer in neck and metastatic lesions. We recently encounter cases of false positive in two veteran: one suffered from shrapnel wound 45 years ago in the back; while another veteran had focal contamination underneath his Dutch beard. Cases Report: The first case was a 69-years-old Vietnam War male veteran with paraplegia and a history of papillary thyroid carcinoma, he was s/p total thyroidectomy 5/2013 (T3, N1). He received 143 mCi following the surgery. Ultrasound examination revealed recurrence, which was treated with left neck dissection and followed with a dose of 254 mCi of I-131 on 8/2014. A postRAI treatment scan revealed a focal uptake in the posterior component of T10/T11 vertebra, which, in retrospect, was present in the prior post-ablation scan in 7/2013 without any interval change. A chest CT in 9/2014 revealed a sub-centimeter metallic density in the same site; likely shrapnel deposited 45 years ago. Thus, focal radioiodine uptake likely relates to inflammatory/ benign etiology. Suppressed Tg was 3.9 in 8/2015, decreased from 5.3 ng/mL in 2/2015. The second case was a 41-years-old male veteran s/p total thyroidectomy with central neck dissection in 10/2018 and found one positive LN on left. Final path report was papillary thyroid cancer - staging T1a, N1. The patient received 75.9 mCi of I-131 for remnant ablation in 12/2018 and followed with a total body scan, which showed a focal activity subjacent to left submandibular gland. The activity persisted in a repeat scan after the patient claiming had thoroughly washed his Dutch-style beard. The SPECT/CT revealed the focal activity was not in the left submandibular area and might represent a contamination in the adjacent mustache. This was confirmed by a repeat planar image performed after the beard was shaved off. Discussion: Focal radioiodine uptake is a sensitive marker for detection of recurrence of differentiated thyroid cancer, s/p total thyroidectomy and RAI ablation. However, radioiodine ptake is not specific for thyroid tissue. It can also be seen in healthy tissue, including thymus, breast, liver, and gastrointestinal tract, or in benign diseases, such as cysts and inflammation, or in a variety of benign and malignant non-thyroidal tumors, which could be mistaken for thyroid cancer. These case studies provide examples of potential false-positive uptake of radioiodine in the whole-body scan and illustrate how such unexpected findings can be appropriately evaluated. Chronic trauma may recruit leukocytes that known to induce iodide organification by means of a myeloperoxidase. Therefore, retention of radioiodine in leukocytes of posttraumatic tissues may also explain various reports of false-positive uptake in sites of inflammation. Secretion of mucin containing iodide salts has also been suggested as another possible mechanism of iodine accumulation associated with chronic inflammatory conditions. Since radioiodine, normally concentrates in saliva, in-patient with beard should always watch for hidden contamination. Conclusion: Wounds caused by shrapnel fragments could be a common problem for veterans returning from overseas. Recognizing that false positive results could occur in RAI total body scan is clinically important.

Recurrent Squamous Cell Carcinoma of the Submandibular Region after Surgery in a Dog: A Case Report

Squamous cell carcinoma (SCC) is a malignant tumor that has been reported in several organs of different dog breeds. An 8-year-old Shih Tzu, an intact male dog, came to an animal clinic in the Thonburi area, Bangkok Province, Thailand, and a mass of 4.5 × 4.5 cm (width × length) by size was found at the submandibular area. Surgical excision to remove the mass and subsequent histological examination identified the mass as SCC. After conducting the surgery and follow-up, the mass was recurrent at the same location after 33 days and a dog died. Therefore, one of the possible reasons for the death of the dog could be SCC metastasis.

Microvascular decompression for a unique case of glossopharyngeal neuralgia with provokable symptomatic bradycardia: 2-Dimensional operative video

Background: Glossopharyngeal neuralgia is a rare neurovascular compression syndrome that can lead to paroxysmal craniofacial pain and sometimes cardiovascular symptoms.[1,2] The characteristic pathology involves a vessel (commonly a branch/loop of PICA) compressing the nerve at the root entry/exit zone at the brainstem.[1] Microvascular decompression is a commonly used treatment approach for patients that have failed conservative measures.[2]Case Description: A 72-year-old male presented to the ED following four episodes of syncope. The patient had a multi-year history of right-sided burning/stabbing pain involving the submandibular area and posterior throat. His syncope was related to symptomatic bradycardia that would occur during episodes of pain. His pain was exacerbated by speaking and swallowing and could be triggered by placing his finger in the right external auditory meatus. Interestingly, this maneuver would also trigger his bradycardia. The patient had failed previous pharmacotherapy, and a pacemaker had been placed to protect him from periods of hypotension. MRI/MRA of the brain and cervical spine were unremarkable. Due to his profoundly symptomatic status, the patient was offered a right retrosigmoid craniotomy for microvascular decompression of the right glossopharyngeal nerve. The patient had complete resolution of his pain and bradycardia immediately post-operatively. He was discharged on the second postoperative day and his pacemaker was ultimately removed. The patient continues to be pain free and off medication.Conclusion: Here we present a video case report of microvascular decompression with favorable outcome for an interesting presentation of glossopharyngeal neuralgia. The patient gave informed consent for surgery and video recording.

Role of Selective Neck Dissection in Primary T<sub>1</sub>, T<sub>2</sub>, N<sub>0</sub> Neck Oral Tongue Carcinoma

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value <0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among <50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

Hydatid Cyst in Left Sub-Mandibular Space, an Unusual Location.

Hydatid cysts in the neck area are considered as very rare and few cases have been reported in endemic areas. In the present study, we reported a 38-year-old female that underwent surgical operation for extraction of simple cyst in the submandibular area and the diagnosis of hydatid cyst was established by laboratory examinations. The patient was later diagnosed with hepatic hydatid cyst and received systemic treatments. We recommend that physicians should pay more attention to the possibilities of hydatid cysts in unusual areas in endemic regions especially Middle East.

A rare anatomical variation of the submental artery.

The submental artery usually runs anteriorly on the inferior surface of the mylohyoid muscle, giving branches to that muscle and to the anterior belly of the digastric muscle, finally supplying the submental skin. Branches of it often perforate the mylohyoid muscle and enter the sublingual space. During a routine anatomy dissection, we encountered a case in which the main trunk of the submental artery perforated the mylohyoid muscle, where the sublingual artery usually runs. No branches coursed anteriorly to supply the submental skin. To our knowledge, this submental artery variation has not been reported in the English literature. Any surgical procedure in the submandibular area, such as the axial pattern submental local flap, requires knowledge of such arterial variations.

Submandibular lymph node metastasis of occult thyroid carcinoma first suspected to be a salivary gland tumor: a case report

BackgroundWhen diagnosing and treating neck masses, various diseases need to be considered, including benign or malignant tumors, lymph node-related diseases, and cysts. Thus, there may be cases in which making a definitive diagnosis is difficult on the basis of blood testing and imaging alone.Case presentationThe patient was an 80-year-old Japanese female who presented with swelling in the right submandibular area. Magnetic resonance imaging and ultrasonography revealed a solid tumor with inhomogeneous content continuous with the submandibular gland. Therefore, the clinical diagnosis was salivary gland tumor. Surgical treatment was performed, and intraoperative frozen-section examination demonstrated submandibular lymph node metastasis of thyroid carcinoma. After surgical treatment, blood test for thyroid gland function yielded normal results except for increased thyroglobulin levels. Further positron-emission tomography–computed tomography and ultrasonography were performed, in addition to fine-needle aspiration biopsy of the thyroid gland and other tests; however, no other thyroid abnormalities were observed. Fine-needle aspiration biopsy revealed no carcinomatous components. Close observational follow-up has been continued without thyroid gland treatment, and as of approximately 8 years postoperation, no recurrence, metastases, or thyroid carcinoma have developed.ConclusionThe mass was lymph node metastasis of occult thyroid carcinoma. In general, occult thyroid carcinoma metastasizes to level II–V. To the best of our knowledge, this is the first report of submandibular lymph node metastasis alone of occult thyroid carcinoma.

Pilomatrix carcinoma: a rare cutaneous adnexal tumor.

Pilomatrix carcinoma is a rare tumor that is generally not diagnosed clinically. An 80-year-old man presented with a 5-month history of rapidly growing nodule of the submandibular area. Histological examination revealed a pilomatrix carcinoma, an aggressive malignancy with metastatic potential.

Pleomorphic Adenoma of the Submandibular Gland in a 10-Year-Old Child: A Case Report.

We report the case of a 10-year-old girl with a painless slowly growing mass that had developed over the course of 2 years in the left submandibular area. Physical examination revealed a firm painless submandibular mass with no other associated signs. Ultrasound graphics were in favor of a sebaceous cyst. Fine-needle aspiration and magnetic resonance images (MRI) concluded to a pleomorphic adenoma of the submandibular gland. The patient underwent left submandibulectomy. Histopathological examination confirmed the diagnosis of pleomorphic adenoma arising from the submandibular gland. The postoperative course was uneventful. Pleomorphic adenoma of the submandibular gland represents a diagnostic and therapeutic dilemma in children. Preoperative evaluation, including MRI and fine-needle aspiration, is recommended. Total submandibulectomy is also recommended to minimize recurrences and to avoid malignant transformation.

Deep neck infections with mediastinum abscess and respiratory failure in a pediatric patient

Abstract Rationale: Deep neck infections are infections of the potential fascial planes and spaces of the head and neck. They can be life-threatening due to complications of upper airway compression or obstruction, sepsis or septic shock or acute respiratory syndrome. The most common pathogens are Streptococcus viridans and Staphylococcus aureus. Patient concerns: A one-year one-month-old girl was admitted to our pediatric emergency department due to fever, rhinorrhea, and erythematous swelling in the right preauricular area for 3 days. A day later, she had dyspnea, dysphagia, decreased activity, and the swelling extended to the right neck area. Diagnosis: The initial soft neck tissue radiograph showed prevertebral soft tissue thickening, and neck sonography revealed hypoechoic nodes, which were highly suggestive of a deep neck infection. Subsequent computed tomography of the neck and chest showed an abscess of the right deep neck spaces over the parapharyngeal, carotid, parotid, and submandibular areas with intrathoracic extension, as well as an abscess over the anterior mediastinum and bilateral empyema. Interventions: Drainage from deep neck incisions and thoracoscopic decortication of the right-side pleura were performed. Outcomes: After appropriate surgical interventions, critical care with antibiotics and ventilator support, the patient's condition stabilized and was discharged home. Lessons: Complications of deep neck infections are potentially fatal, especially in children. Clinicians should be aware of such infections in children and should not underestimate their potential severity. Children with deep neck infections should be more closely monitored throughout their hospitalization.

Сравнительная оценка динамики патогистологической картины гнойной раны экспериментальных животных с моделью фурункула в области головы и шеи при стандартном лечении и при использовании электрорефлексотерапии

The most common neodontogenic infectious and inflammatory processes affecting the skin are furuncles in the maxillofacial area. The task of effective treatment of patients with this disease is now becoming increasingly urgent which is largely due to the deterioration of the environmental situation, changes in the nature of nutrition and chronic stress. The purpose of the study is to make a comparative assessment of the results of the standard method of postoperative treatment and complex treatment using electroacupuncture based on the dynamics of the pathohistological picture of a purulent wound in experimental animals with a model of a boil in the head and neck. Materials and methods. Experimental studies were carried out on 20 guinea pigs of the same age and body weight, on which a model of a boil in the submandibular area was created. The boil was formed within 3 days, after which all experimental animals under local infiltration anesthesia underwent primary surgical treatment of the infectious and inflammatory focus with wound drainage. Then the animals were divided into two series. Series 1 received a standard treatment package in the postoperative period (antibiotics, daily dressings with mandatory drainage changes, instillation of the wound with antiseptic solutions). For series 2 of animals, the standard treatment was combined with an electroacupuncture treatment. The material for pathohistological examination was collected in the following terms: 3, 7, 14 and 21 days after the operation. Serial sections were made according to the standard procedure. The micro-preparations were examined using a light microscope. For comparison a descriptive method was used. Results and discussion. The most significant differences were found on the 21st day of observation when diffuse mononuclear cell infiltration of all layers of the dermis was detected in most of the series 1 micro-preparations which indicated the presence of productive inflammation. During the same period of observation, all the micro-preparations of series 2 showed a multilayered flat keratinizing epithelium without violating the integrity throughout. The papillary and reticular layers of the dermis showed no signs of inflammation. The appendages of the skin were traced throughout the entire field of vision without visible pathological changes. All of the above indicated no signs of inflammation. Conclusion. The results obtained clearly indicate the positive effect of electroacupuncture on both wound cleansing and the course of the processes of reparative regeneration of the skin

Modeling Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia in Transgenic Mice Using Human MYD88L256P Mutated Protein

Lymphoplasmacytic lymphoma (LPL)/Waldenström macroglobulinemia (WM) is a B-cell disorder resulting from the accumulation of cloncal lymphoplasmacytic cells in the bone marrow (BM) along with excessive secretion of immunoglobulin M paraprotein. Despite recent advances in treatment LPL/WM remains incurable. Generating a refined LPL/WM mouse model that would facilitate studying this disease as well as enable stringent in vivo validation of potential therapeutic approaches has been a long-sought goal for the filed. Interestingly, among the most common mutations identified by recent high-throughput studies there was a single gain of function point mutation in the MYD88 gene, with a predicted non-synonymous amino acid (L265P) change, found in over 91% of patients. Therefore, we hypothesized that generation of transgenic mice overexpressing MYD88L256Pcould recapitulate the human setting of LPL/WM.To overcome problems inherently related to embryonic lethality, we generated MYD88WT and MYD88L256P conditional transgenic mice expressing human proteins. To remove a transcriptional stop cassette and activate MYD88 expression in vivo, we mated the conditional mice with mice expressing Cre recombinase under the control of Activation-Induced Cytidine Deaminase (AID) gene promoter to generate AIDCre/-;MYD88WT/- and AIDCre/-;MYD88L256P/- double-mutant mice. Recombinase activity driven by the AID gene promoter caused removal of the stop cassette and expression of MYD88 in germinal center (GC) and post-GC B cells, the appropriate B-cell compartment from which LPL/WM clones are thought to originate in humans. Young (up to 30 weeks of age) AIDCre/-;MYD88WT/- and AIDCre/-;MYD88L256P/- mice where indistinguishable from AIDCre/- mice as assessed by external physical examination. Moreover, obvious histologic and IHC differences in spleens, lymph nodes, and bone marrows between the mutant genotypes and the AIDCre/- control mice were not found. No clonal bands for the IgH gene, nor M-spikes were detected in Southern blots and serum protein electrophoresis, respectively. However, after 30 weeks of age, and at variable times thereafter, some of the AIDCre/-; MYD88L256P/- aging cohort (n=27) mice developed skin rash and excoriation as well as loss of hair in the submandibular areas. A fraction of AIDCre/-; MYD88L256P/- animals that weren't sacrificed because of the severe dermatitis had enlarged lymph nodes and appeared sick. To assess whether MYD88 transgenic mice develop B-cell lymphomas or major pathologic alterations consistent with the diagnosis of LPL/WM, animals were euthanized at different ages and lymphoid organs were rigorously examined. In spleens and lymph nodes of 8 of the AIDCre/-; MYD88L256P/- animals, a nodular lymphoid infiltrate composed predominantly of small atypical cells varyingly infiltrated with CD138+ plasma cells was observed. Lymphoid cells infiltrated other organs including the BM. Enhanced expression of MYD88 and activation of NF-κB activity within atypical lymphoid nodules in diseased transgenic mice was documented by IHC staining for MYD88 and p65. However, no clonal bands of the IgH gene were detected in Southern blots, suggesting that overexpression of MYD88L256P/- mutant protein in activated B-cells gave rise to a polyclonal lymphoproliferative disorder. Consistently, serum protein electrophoresis analysis showed diffuse, polyclonal increase in γ-globulins. Moreover, stains of peripheral blood smears revealed rouleaux formation suggesting increased concentrations of plasma proteins. In addition, one of AIDCre/-; MYD88L256P/- animals developed a more aggressive monoclonal disease resembling human diffuse large B-cell lymphoma. However, large atypical lymphoid cells in this mouse lacked expression of MYD88 and nuclear p65. All AIDCre/- controls and AIDCre/-; MYD88WT/- mice lacked described phenotypes and were histologically unremarkable.Taken together, these results demonstrate that although MYD88L256P/- alone might not be sufficient to induce a malignant transformation in the mature B-cell compartment, it gave rise to a low-grade mature non-clonal B-cell lymphoproliferative disorder with some of the characteristic futures of LPL/WM. Therefore, the MYD88L256P/- mutation might be necessary but not sufficient for LPL/WM development and must be present with concomitant “second hit” genetic alterations for a neoplasm to develop. DisclosuresTreon:Pharmacyclics: Consultancy, Research Funding.

Application of iodine staining technique for tumor identification in Micro-CT of mouse model with skull base-infratemporal fossa tumor

Objective To establish an animal model with malignant tumor in the skull base-infratemporal region, and to explore the role of iodine staining technique in identifying tumor tissues with Micro-CT data. Methods Sedation anesthesia was carried out on 12 BABL/c nude mice using inhaled isoflurane, and then WSU-HN6 cells that cultured and immortalized from human tongue squamous cell carcinoma were injected into the right infratemporal fossa via the submandibular area. The procedure was carried out under ultrasonographic guidance. The nude mice were sacrificed after 3 weeks observation. The head specimens were fixed and scanned by Micro-CT, and repeated scans were performed after staining with 3.75% compound iodine solution. Following decalcification in 20% EDTA for 2-4 weeks, the head specimens were embedded and sectioned. Hematoxylin and eosin staining and Pan-Keratin immunohistochemical staining were carried out. Bright-field microscopy and stereomicroscopy were used to visualize. The Micro-CT data were analyzed using iPlan software (Brainlab). Results Non-traumatic ultrasonography was used to guide HN-6 cells injection and confirm skull-base tumor formation in all the animals. Ultrasonographic guidance reduced the risk of cervical vessel injury when transferring tumor cells into the skull base space. An obvious asymmetrical appearance was detected via ultrasonography 3 weeks after tumor cell injection. The Micro-CT analysis showed that the bone was obviously damaged on the right side of the skull base, but the soft tissue image was unrecognizable. After four days staining with compound iodine solution, the morphology of the tumor and surrounding soft tissue could be clearly identified. Hematoxylin and eosin staining showed the tumor formation of the right infratemporal fossa region accompanied by bone destruction. Human keratin immunohistochemical staining showed that the tumor tissue originated from human squamous cell carcinoma, and the polynuclear osteoclasts could be seen at the margin of the skull base bone resorption. Conclusion The animal model with malignant tumor in the skull base-infratemporal region could be successfully established via submandibular injection under ultrasound-guidance. Bone changes of the skull were easily observed on Micro-CT, but the tumor counter was not able to be distinguished from surrounding soft tissue. The 3.75% compound iodine staining of the head specimen could help discern the tumor and surrounding soft tissue in more details.

Lymphoepthelial cyst of submandibular region: a case report

BackgroundThe oral lymphoepithelial cyst (LEC) is a rare, soft-tissue, developmental cyst, initially presented by Gold in 1962 as a “branchial cleft cyst”. It may occur in the pancreas, tongue, neck, and other regions of the oral cavity. No study has been reported in Pakistan and Karachi reporting a case of lymphoepithelial cyst in the submandibular region. This rare case of LEC has been reported to help the clinicians to bring LEC into their differential diagnosis for lesions affecting the submandibular region.Case presentationWe report a case of 57 years old female reported to the Maxillofacial OPD of a tertiary care hospital with the complaint of swelling on the right side of the neck for 3 weeks which was rapidly increasing in size. She was having difficulty in mastication. On extra-oral examination, there was swelling on the right side in the submandibular area. The overlying skin is normal with no evidence of pus and discharge. On palpation, the swelling was soft, non-tender, non-fluctuant, non-displaceable into the submandibular area. Lymph nodes were impalpable. Excision of the lesion performed under general anesthesia and biopsy revealed lymphoepithelial cyst associated with submandibular gland. Here we present an attention-grabbing case of swelling in the right submandibular region which was provisionally diagnosed as a malignant submandibular lymph node however later evidence histopathologically as a lymphoepithelial cyst of the submandibular gland.ConclusionAn unusual cause of swelling in the neck is lymphoepithelial cysts. Submandibular gland appearance is not usual and can prove to be a clinical problem.

English

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic & granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) & ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible & submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.

Clinicopathological Study on TB Lymphadenopathy Case

Background: Tuberculosis in the form of pulmonary and extrapulmonary TB is common in developing countries like Bangladesh. Among extrapulmonary TB, lymphnode TB is still common in our setting. So, the objectives of the present study were to evaluate theclinicopathological findings among the lymphnode TB cases in our context.
 Materials and methods: This observational study was done from January 2017 to December 2019 among 300 lymphnode TB cases in a tertiary care hospital during a three-year study period. Patients were selected after obtaining informed written consent and clinical evaluation. Then enlarged lymphnodes were evaluated by FNAC or histopathology. If lymphnode TB features were found then the patients were included in our study.Other findings like metastasis, lymphoma or pyogenic lymphadenitis were excluded from this study. After collection, data was recorded and analyzed by Microsoft Excel.
 Results: Among 300 cases of TB lymphadenitis subjects were commonly within the age groups 11-20 years (Male 63 and female 51) and 21-30 years(male 45 and female 42) with amale: female ratioof 1.22:1. Regarding different clinical signs and symptoms,low grade fever was found in 21(7%) cases, local lymphnode pain and tenderness was found in 67 (22%) and 63(21%) of subjects. Discharging sinuses was present in 33(11%) patients, 35(12%) had history of weight loss, 39 (13%) had anorexia and 42(14%) had history of night sweats. Regarding locationof different lymph node areas, 125(41.67%) patients had deep cervical nodes, 65(21.67%) had supraclavicular lymph nodes, 60(20%) had lymph nodes in the posterior triangle 33 (11%) in jugulo-omohyoid and 17 (5.66%) in submandibular area. Among all cases, 83% cases showed bilateral and 17% showed unilateral involvement.Regarding nature of lymph nodes, firm, matted multiple lymphnodes were found in 130(43%) cases, single discrete nodes were found in 70(23.33%) cases, others were found as suppurative noded with single and multiple sinuses. Cytopathological and histopathological findings revealed caseating granuloma with epithelioid cell with Langerhans type giant cell was found in 220(73%) cases, caseating granuloma with epithelioid cell was found in 47(16%) epithelioid cell was found in 20(7%) cases and epitheliod cells with smear positive AFB was found in 13(4%) cases.
 Conclusion: TB lymphadenitis is still a common form of extrapulmonary tuberculosis and it has variable clinical and pathological presentations.
 Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 77-80

Maxillofacial Infections: A 5-Year Assessment of the Epidemiology and Etiology in an Iranian Population

The purpose of this study was to assess the epidemiologic factors associated with maxillofacial infections in a sample of Iranian patients. A number of 209 patients, who admitted to Kamyab hospital due to maxillofacial infections, were recruited in this 5-year cross-sectional study. Multiple variables including the offending tooth, type of abscess, clinical signs and symptoms, the type of prescribed antibiotic, type of anesthesia, employed surgical technique, period of hospitalization, and postoperative complications were analyzed using SPSS software. 123 males and 86 females, with an average age of 35.45 ± 14.19 years, were studied. It was noticed that 27.8% of patients had a habit of smoking or tobacco use, 16.8% had been diagnosed with an underlying disease and 12.4% were alcohol consumers. It was reported that the mandibular third molar was the most offending tooth (26.8%) and the submandibular area was most infected site (51.6%). Swelling and Ludwig's angina were the most frequent symptom and complication, respectively. Clindamycin was the empirical antibiotic of choice. Facial space abscesses can rapidly progress and cause irreversible consequences. Patients with a systemic disease and also those suffering from pterygomandibular and submasseteric infections had a longer hospital stay compared to others.

A Malignant Solitary Fibrous Tumor of the Parotid Gland: A Case Report

A Solitary Fibrous Tumor (SFT) is a soft tissue tumor that appears exceedingly rare in the parotid gland. The literature review suggested that approximately 12%-22% of these cases behave aggressively. Besides, only 4 cases of histological malignant parotid gland SFT are reported in the English literature. We presented a 65-year-old cigarette-smoker man with a fix and tender mass over the left parotid and submandibular areas. On physical examination, the marginal branch of the facial nerve was paralyzed. The left total parotidectomy and neck dissection levels 1 and 2 were performed with preoperative embolization procedure and adjuvant radiotherapy for the patient. The results of the follow-up examination were unremarkable after 11 months. In this case report, we aimed to increase awareness on SFTs, although rare, among clinicians and pathologists. Accordingly, it should be considered in the differential diagnosis of soft-tissue tumors in the major salivary glands for better management.

Manual Strangulation of a stray cat

Veterinary forensic pathology plays a crucial role in animal death investigations. Recent years have seen increased attention given to this field in Taiwan. Here we report a grave crime that aroused public indignation in Taiwan, when in December 2015, a missing free-roaming cat was allegedly strangled by a suspect, according to witnesses. Surveillance video footage of the cruel incident surfaced that showed the cat, without visible signs of struggle, strangled by both hands of the suspect and kicked in the abdomen’s left side. The body was stored in a travel bag when found in the suspect’s motorcycle trunk three days after the cat had been missing. The radiographs revealed a suspected luxation of cervical vertebrae 6 and 7 (C6–C7). At forensic necropsy and histopathology, neck compression with subcutaneous hemorrhage at the left submandibular area, bruising of the neck, tears in the wall of the left external jugular vein, and pulmonary lesions were identified, all consistent with asphyxiation. Hemorrhages of the epidural space of the C7 vertebra, the spinal nerve at the level of C7, and surrounding soft tissues were noted. The pathological findings were in line with the suspect’s confession, the witnesses’ statements, and the video footage. The process and outcome of this case reflected society’s growing awareness of animal welfare and the increased attention that the authorities are giving crimes against animals in Taiwan, and the link between pathologic findings and the crime.

Gluten-free diet modulates inflammation in salivary glands and pancreatic islets.

A lifelong gluten-free (GF) diet ameliorates autoimmune diabetes in non-obese diabetic (NOD) mice and most likely in humans. Besides diabetes, NOD mice develop focal sialadenitis, as seen in Sjögren's syndrome (SS). In humans, type 1 diabetes (T1D) is also linked to SS. Here, we investigated whether a lifelong GF diet influences the immune cell infiltration in the salivary glands and pancreatic islets in NOD mice. NOD mice were fed a lifelong (i.e. 13weeks) GF or gluten-containing standard (STD) diet. Insulitis and sialadenitis were scored on H&E-stained paraffin-embedded sections of pancreas and submandibular glands. Immune cell specificity and distribution were investigated immunohistochemically. There were fewer CD68+and CD4+cells in submandibular gland areas with focal sialadenitis as well as reduced insulitis and fewer VEGFR2+cells in pancreatic islets in mice on GF versus STD diet. The degree of sialadenitis was not significantly lower in GF mice, but sialadenitis and insulitis correlated strongly. Lung weight was lower in GF mice. In NOD mice, a lifelong GF diet reduces infiltration of monocytes/macrophages and T cells in salivary glands and inflammation in pancreatic islets, possibly by reducing VEGFR2, indicating that the linked autoimmune diseases, T1D and SS, may be alleviated by a GF diet.