Subsequent Enucleation Research Articles

Conservative treatment of large unicystic ameloblastoma in a young patient: a 7-year follow-up

The unicystic ameloblastoma is an odontogenic tumor that is frequently found in young patients and usually affects the posterior region of the mandible. This paper aimed to describe a case report and 7-year follow-up of a young patient. The 12-year-old patient presented with increased volume in the lower third of the right hemiface with a duration of 6 months. Radiographic examination showed a unilocular radiolucent lesion extending along the body, angle and right mandibular ramus. An incisional biopsy was performed and a histological diagnosis of luminal unicystic ameloblastoma was obtained, opting for a conservative treatment with decompression and subsequent complete enucleation of the lesion. The patient has been under follow-up for 7 years, with a good evolution of the condition and without clinical and radiographic signs of recurrence of the lesion. Thus, it is ratified that timely conservative intervention and conservative surgical treatment should be the first choice for ameloblastoma management in young patients.

Quantitative Diffusion-Weighted MR Imaging: Is There a Prognostic Role in Noninvasively Predicting the Histopathologic Type of Uveal Melanomas?

Histopathologically, uveal melanomas (UMs) can be classified as spindle cell, mixed cell and epithelioid cell type, with the latter having a more severe prognosis. The aim of our study was to assess the correlation between the apparent diffusion coefficient (ADC) and the histologic type of UMs in order to verify the role of diffusion-weighted magnetic resonance imaging (DWI) as a noninvasive prognostic marker. A total of 26 patients with UMs who had undergone MRI and subsequent primary enucleation were retrospectively selected. The ADC of the tumor was compared with the histologic type. The data were compared using both one-way analysis of variance (ANOVA) (assessing the three histologic types separately) and the independent t-test (dichotomizing histologic subtypes as epithelioid versus non-epithelioid). Histologic type was present as follows: the epithelioid cell was n = 4, and the spindle cell was n = 11, the mixed cell type was n = 11. The mean ADC was 1.06 ± 0.24 × 10−3 mm2/s in the epithelioid cells, 0.98 ± 0.19 × 10−3 mm2/s in the spindle cells and 0.96 ± 0.26 × 10−3 mm2/s in the mixed cell type. No significant difference in the mean ADC value of the histopathologic subtypes was found, either when assessing the three histologic types separately (p = 0.76) or after dichotomizing the histologic subtypes as epithelioid and non-epithelioid (p = 0.82). DWI-ADC is not accurate enough to distinguish histologic types of UMs.

Complications of a Giant Cavernous Carotid Artery Aneurysm

Cavernous carotid aneurysms (CCAs) differ from other intracranial aneurysms in that most are asymptomatic and are generally considered benign as there is a low risk of rupture. More common than complications from rupture are complications from the mass effect of the aneurysm itself on nearby structures.1,2 This report describes a case of a giant right CCA that progressed in size despite multiple surgical repairs that resulted in near- complete ophthalmoplegia and neurotrophic keratitis which led to a perforated corneal ulcer and subsequent enucleation.

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics - A Case Series.

The purpose of this study was to investigate the clinical features, tumor characteristics, including histopathology and cytogenetic analysis, and management of patients with uveal ring melanoma in New Zealand. A retrospective review was conducted on all uveal melanoma cases treated in a single national oncology center in New Zealand. The study period was from January 1, 2013 to December 31, 2022 (10 years). Written consent was obtained from all patients included in this case series. Uveal ring melanoma of ciliary body origin (n = 4) comprised 0.7% of all uveal melanomas (n = 571). Ethnicity distribution was three patients of New Zealand European ancestry and one patient of Chinese/Pasifika ancestry. Three patients (75%) were symptomatic at presentation (spontaneous hyphema, glaucoma, and cataract), whereas one was asymptomatic but subsequently developed painful refractory glaucoma. All eyes underwent enucleation. Three eyes had primary iris biopsies with subsequent enucleation for refractory glaucoma and pain and one eye underwent primary enucleation. All cases demonstrated malignant tumor characteristics including diffuse 270 to 360-degree ciliary body ring growth pattern, epithelioid-cell type and presence of either BAP-1 expression loss or gain of MYC gene. Two cases (50%) developed distant organ metastasis - liver, parotid gland, and breast. Of those, one patient was deceased at the time of follow-up whereas one had completed treatment for metastases. Uveal ring melanoma is a rare tumor that is highly invasive and malignant. When detected, prompt definitive treatment should be advocated, and patient counselling should be given regarding the high risk of developing a painful, blind eye with increased risk of metastasis in the absence of treatment.

Surgical Treatment of a Large Residual Cyst Followed by Implant Rehabilitation: A Case Report

A cyst is defined as a pathological cavity, which may be fluid-filled, with well-defined boundaries lined by an epithelium. Although it is usually asymptomatic, it can cause pain through secondary infectious processes or when an increase in volume of the fluid causes local nerve compression. The diagnosis is made through correlation of clinical and imaging findings and confirmed by histopathology. Depending on its features, the treatment methods range from endodontic treatment of the involved teeth to its surgical enucleation. Marsupialisation is a surgical technique indicated for large cystic lesions or cystic lesions close to noble structures. It involves connecting the cystic wall and the oral cavity; this causes decompression and regression of the cyst allowing enucleation. This study aims presents the satisfactory outcomes of a residual inflammatory cyst treated by the conservative technique of marsupialisation with subsequent enucleation, followed by rehabilitation with implants at the regeneration site.

Validation of uterine artery embolization before surgical laparoscopic myomenucleation compared to single surgical laparoscopic myomenucleation for the treatment of large fibroids and uterus myomatosus.

To determine the efficacy of preoperative uterine artery embolization (uterine artery embolization; UAE) prior to elective laparoscopic fibroid removal compared to single laparoscopic fibroid removal in women with large uterine fibroids and women with uterus myomatosus. A total of 202 women with symptomatic uterine fibroids who were scheduled for elective fibroid enucleation were included in this retrospective, monocentric, non-randomized study. Two procedures were compared: women who received percutaneous UAE 24 h prior to elective laparoscopic fibroid eviction for large uterine fibroids (>6 cm) and uterus myomatosus. And women who received laparoscopic fibroid enucleation alone for large uterine fibroids and uterus myomatosus. Outcome parameters for effectiveness were the hospital stay, the operating time and the intraoperative blood loss. Women who underwent preoperative percutaneous embolization of the uterine arteries, both for large fibroids and uterus myomatosus, had significantly less blood loss, shorter hospital stays, and shorter operating times. Especially women with large uterine fibroids and women with uterus myomatosus after having children can benefit from the combination therapy of preoperative percutaneous uterine embolization with subsequent laparoscopic myoma enucleation.

Plaque brachytherapy in unresectable medulloepithelioma with anterior chamber seeding and review of literature

Medulloepithelioma is a rare nonhereditary tumor seen most often in children, usually in the first decade. In this paper, we present a case of extensive unresectable medulloepithelioma with neovascular glaucoma and anterior chamber seeding, which was confirmed histopathologically by performing biopsy and successfully managed using plaque brachytherapy along with a review of literature on brachytherapy in medulloepithelioma. The unique features in our case are extensive tumor, with anterior chamber seeding and neovascular glaucoma which have been successfully managed with brachytherapy. Also, the placement of brachytherapy plaque over the corneal surface has not been described previously for managing extensive medulloepithelioma. So far, brachytherapy has been tried in only three cases with concomitant neovascular glaucoma, of which two cases required subsequent enucleation.

Heterochromatin rewiring and domain disruption-mediated chromatin compaction during erythropoiesis.

Mammalian erythropoiesis involves progressive chromatin compaction and subsequent enucleation in terminal differentiation, but the mechanisms underlying the three-dimensional chromatin reorganization remain obscure. Here, we systematically analyze the higher-order chromatin in purified populations of primary human erythroblasts. Our results reveal that heterochromatin regions undergo substantial compression, with H3K9me3 markers relocalizing to the nuclear periphery and forming a significant number of long-range interactions, and that ~58% of the topologically associating domain (TAD) boundaries are disrupted, while certain TADs enriched for markers of the active transcription state and erythroid master regulators, GATA1 and KLF1, are selectively maintained during terminal erythropoiesis. Finally, we demonstrate that GATA1 is involved in safeguarding selected essential chromatin domains during terminal erythropoiesis. Our study therefore delineates the molecular characteristics of a development-driven chromatin compaction process, which reveals transcription competence as a key indicator of the selected domain maintenance to ensure appropriate gene expression during the extreme compaction of chromatin.

Decompression procedure as a successful initial approach to large maxillary dentigerous cyst in 12- year-old boy - a case report

Introduction. A dentigerous cyst is a pathological lesion associated with the crown of the unerupted or impacted tooth. Decompression is proposed as the initial treatment for large cysts, especially in younger patients. The aim of this study was to present clinical, radiological, histopathological, and therapeutical aspects of the large dentigerous cyst in the maxilla. Case report. A 12-year-old boy with a large dentigerous cyst in the maxilla was referred to our clinic. A dentigerous cyst was associated with the crown of the unerupted maxillary left canine. Management of the cyst included initial decompression with biopsy, followed by secondary enucleation after 9 months and orthodontic treatment. Histopathological examination confirmed the definitive diagnosis of the dentigerous cyst. Conclusion. Initial decompression with a subsequent enucleation proved to be an effective treatment of choice for the large dentigerous cyst.

Three cases of GFAP astrocytopathy, one with bilateral ovarian teratoma

AbstractGlial fibrillary acidic protein (GFAP) astrocytopathy is a novel autoimmune meningoencephalomyelitis. Case 1 is a 26–year‐old (yo) woman with a bilateral ovarian teratoma. She presented neck stiffness, hyperreflexia, bilateral postural tremor, and urinary retention. Three courses of a methylprednisolone pulse and subsequent enucleation of the bilateral ovarian teratoma improved her neurological symptoms with no recurrence. Case 2 is a 46‐year‐old man who showed infectious‐like symptoms with elevated creatine kinase. Case 3 is a 76‐year‐old man with preceding weight loss, a hyperintensity lesion in the hypothalamus, and increased uptake of the spinal cord, assessed by Fluorine18 fluorodeoxyglucose positron emission tomography (18F‐FDG PET). We compared the clinical features of the present three cases with previous reports. Consciousness disturbance, neck stiffness, tremors, and urinary dysfunction were observed in all three cases. These findings suggest widespread damage of the brain and spinal cord.

Odontogenic keratocyst: diagnostic characteristics and conservative surgical treatment

Keratocyst is a benign odontogenic lesion with aggressive behavior, probably derived from the dental lamina. It is frequently located in the posterior part of the mandibular bone in the area of ​​the third molar, mandibular angle and can progress towards the ramus and the body, presenting a direct association with retained dental organs. There is a wide variety of techniques for the treatment of this lesion, such as decompression, marsupialization, enucleation, and en bloc resection, as well as the combination of these with adjuvant methods. The interest in this lesion stems from its high recurrence rate, which is estimated to be 20-30% in the general population, however, at present the use of conservative treatments such as marsupialization and decompression has been chosen. demonstrated greater effectiveness and less recurrence. This is why after treating the lesions it is important to give a long-term follow-up. The objective of the publication is to present the report of a clinical case of a 21-year-old male patient with a diagnosis of odontogenic keratocyst treated with a decompression technique for five months for subsequent surgical enucleation. It has been proven that decompression treatment followed by enucleation and accompanied by adjuvant methods is an adequate therapeutic management for keratocysts as it demonstrates its lower rate of recurrence and its noble behavior with neighboring vital structures. However, in all cases, regular monitoring should be carried out to prevent recurrence of the lesion.

What's in an Eye?

What's in an Eye?

Mitochondrial localization and moderated activity are key to murine erythroid enucleation

Mammalian red blood cells (RBCs), which primarily contain hemoglobin, exemplify an elaborate maturation process, with the terminal steps of RBC generation involving extensive cellular remodeling. This encompasses alterations of cellular content through distinct stages of erythroblast maturation that result in the expulsion of the nucleus (enucleation) followed by the loss of mitochondria and all other organelles and a transition to anaerobic glycolysis. Whether there is any link between erythroid removal of the nucleus and the function of any other organelle, including mitochondria, remains unknown. Here we demonstrate that mitochondria are key to nuclear clearance. Using live and confocal microscopy and high-throughput single-cell imaging, we show that before nuclear polarization, mitochondria progressively move toward one side of maturing erythroblasts and aggregate near the nucleus as it extrudes from the cell, a prerequisite for enucleation to proceed. Although we found active mitochondrial respiration is required for nuclear expulsion, levels of mitochondrial activity identify distinct functional subpopulations, because terminally maturing erythroblasts with low relative to high mitochondrial membrane potential are at a later stage of maturation, contain greatly condensed nuclei with reduced open chromatin–associated acetylation histone marks, and exhibit higher enucleation rates. Lastly, to our surprise, we found that late-stage erythroblasts sustain mitochondrial metabolism and subsequent enucleation, primarily through pyruvate but independent of in situ glycolysis. These findings demonstrate the critical but unanticipated functions of mitochondria during the erythroblast enucleation process. They are also relevant to the in vitro production of RBCs as well as to disorders of the erythroid lineage.

MR Imaging–Pathologic Correlation of Uveal Melanomas Undergoing Secondary Enucleation after Proton Beam Radiotherapy

Background: Currently, radiotherapy represents the most widely employed therapeutic option in patients with uveal melanoma. Although the effects of proton beam radiotherapy on uveal melanoma end ocular tissues have been histologically documented, their appearance at MR imaging is still poorly understood. The purpose of our study was to elucidate the magnetic resonance (MR) semiotics of radiotherapy-induced changes to neoplastic tissues and ocular structures in patients with uveal melanoma undergoing secondary enucleation after proton beam radiotherapy. Methods: Nine patients with uveal melanoma who had undergone proton beam radiotherapy, MR imaging, and subsequent secondary enucleation were retrospectively selected. The histopathologic findings evaluated for irradiated tumors were necrosis, fibrosis, and viable tumor, while the histopathologic findings evaluated for extratumoral ocular/periocular tissues were radiation-related intraocular inflammation, vitreous hemorrhage, optic nerve degeneration, iris neovascularization, and periocular fibrotic adhesions. On MR images, the appearance of the abovementioned histologic features was assessed on conventional and diffusion-weighted sequences. Results: T2-weighted sequences performed better in detecting radiation-induced necrosis, fibrosis, optic nerve degeneration, and periocular fibrotic adhesions. T1-weighted sequences were preferable for identifying cataracts, vitreous hemorrhage, and inflammatory complications. Contrast-enhanced T1-weighted sequences were irreplaceable in assessing iris neovascularization, and in confirming inflammatory complications. Conclusions: In the light of their increasing role in the multidisciplinary management of patients with uveal melanoma, radiologists should be aware of the MR appearance of the effects of radiotherapy on neoplastic and ocular tissue, in order to improve the accuracy of follow-up MR examinations.

Unilateral Retinoblastoma Presentation in a Latin-American Teenager: A Case Report and Literature Review

<i>Background:</i> Retinoblastoma is the most common intraocular mass in children—typically presenting in infants under 5 years of age—with a mean age of 24 months in unilateral cases, and 12 months in bilateral cases. Late-onset retinoblastoma and its presentation in adults is extremely rare; however, it should always be considered for the differential diagnosis of an intraocular mass originating from the retina. Due to the life-threatening nature of this disease, early diagnosis and prompt treatment are crucial for a good prognosis<i>. Objective</i>: A tumor case presentation and multidisciplinary study of a female young adult. <i>Method: </i>A case presentation study of a Hispanic teenager with a unilateral retinoblastoma and vitreous exudation resembling a large snowbank. The patient underwent complete ophthalmological examination and subsequent enucleation, with histopathological confirmation of retinoblastoma accompanied by chemotherapy. <i>Conclusion:</i> Retinoblastoma presenting as an intraocular mass in a young adult should always be considered as a differential diagnosis. Echography is crucial to obtaining a diagnosis, as well as dictating precise and adequate treatment. We review the literature regarding cases of retinoblastoma, demonstrating that most exhibited differentiated characteristics and were sporadic in nature; in most cases, the eye could not be saved. Review of late-onset retinoblastomas was therefore conducted to enrich our existing knowledge, as well as to prevent making the same mistakes when facing a similar difficult diagnosis.

CONSERVATIVE TREATMENT OF UNICYSTIC AMELOBLASTOMA IN THE MANDIBLE: A CASE REPORT

Ameloblastoma is the benign tumor of clinically significant odontogenic origin. About 13% of the cases are unicystic, being observed more frequently in young patients, usually associated with third molars retained. A female patient, melanoderma, 18 years old, presented with a complaint of “face growth” with about 1 year and 6 months’ of evolution. On physical examination, a hardened volume increase, asymptomatic, was observed in the left mandibular region. Radiographic examination revealed a unilocular radiolucent image associated with the retained tooth 38, with histopathologic result of ameloblastoma, after incisional biopsy. We performed conservative surgical treatment by decompression, with subsequent enucleation and curettage. No clinical-radiographic signs of lesion recurrence were observed after 2 years’ of follow-up. The unicystic variant seems to respond well to conservative treatment. Ameloblastoma is the benign tumor of clinically significant odontogenic origin. About 13% of the cases are unicystic, being observed more frequently in young patients, usually associated with third molars retained. A female patient, melanoderma, 18 years old, presented with a complaint of “face growth” with about 1 year and 6 months’ of evolution. On physical examination, a hardened volume increase, asymptomatic, was observed in the left mandibular region. Radiographic examination revealed a unilocular radiolucent image associated with the retained tooth 38, with histopathologic result of ameloblastoma, after incisional biopsy. We performed conservative surgical treatment by decompression, with subsequent enucleation and curettage. No clinical-radiographic signs of lesion recurrence were observed after 2 years’ of follow-up. The unicystic variant seems to respond well to conservative treatment.

USE OF CARNOY’S SOLUTION AS A CO-ADJUVANT IN THE TREATMENT OF ODONTOGENIC KERATOCYST

Carnoy’s solution, a cauterizing agent, has been used in the elimination of epithelial remnants and dental lamina post enucleation and curettage, in different odontogenic lesions, with the aim to reduce or completely avoid its recurrence. A female patient, 51 years old, sought care complaining that I have a cyst in the maxilla. Physical examination revealed a slight increase in volume in the left maxilla region. Imaging examination showed a radiolucent area with well-defined sclerotic margins, extending from the element 24 to the tuberosity of the maxilla, also invading the space of the maxillary sinus. An incisional biopsy, followed by histopathology, confirmed the diagnostic hypothesis of odontogenic keratocyst. Initially, the treatment consisted of marsupialization and subsequent enucleation followed by the application of Carnoy’s solution at the site. After 2 years, the patient was reevaluated and the absence of clinical signs or an image of recurrence of the previously removed lesion noted.

DECOMPRESSION TREATMENT OF ODONTOGENIC KERATOCYST IN ANTERIOR MANDIBLE

Odontogenic keratocyst (OK) accounts for 3% to 11% of all odontogenic cysts. Most occur between the first and fourth decade of life, with a slight prevalence for men, and the posterior mandible is more affected. This study aims to report a case of OK in the region of ment with 2-year follow-up without relapses. A female patient with leukoderma and edentulism complained of swelling in the mental protuberance region, which avoided the use of prosthesis, and in the symphyseal region with integrity of the underlying mucosa. Decompression is an approach that reduces cystic fluid pressure, which allows the volume of the cavity to reduce and, thus, allows for bone apposition around the walls of the lesion, avoiding more invasive treatments. The treatment of OK with decompression and subsequent enucleation and curettage allowed the preservation of the cortical bone and mucous membranes and was considered a successful approach.

Nuclear expression of BAP-1 in transvitreal incisional biopsies and subsequent enucleation of eyes with posterior choroidal melanoma

BackgroundAs a majority of patients with choroidal melanoma do not undergo enucleation, tumour tissue for prognostic testing has to be obtained with alternate methods. Transvitreal incisional biopsies enable histological examination...

Iris biopsy to investigate feline iris hyperpigmentation.

To evaluate the benefit of iris biopsy in cats with iris hyperpigmentation to differentiate melanosis from early feline diffuse iris melanoma (FDIM). The medical records of cats with unilateral iris hyperpigmentation that had undergone iris biopsy between February 2013 and September 2016 at Willows Veterinary Centre & Referral Service were reviewed. Seven cats with unilateral iris hyperpigmentation were included in this retrospective study. The biopsy procedure was performed under general anesthesia (n=7) with neuromuscular blockade (n=6) following pre-operative topical miotic therapy (n=5). One to six biopsy samples per eye were harvested from areas of hyperpigmentation. The samples were partial thickness (n=4 eyes) and full thickness (n=3 eyes). Complications were minor: mild intra-operative hemorrhage (n=4), fibrin clot (n=2), corneal ulcer (n=1), post-operative ocular hypertension (n=1), dyscoria (n=1), and pseudopolycoria (n=2). The first biopsy was diagnostic in six cats; a repeat biopsy was necessary in one cat. Histopathology was consistent with melanosis in five cats and with early FDIM in two cats. Screening for signs of metastatic disease (thoracic computed tomography and abdominal ultrasonography) was negative in the two cats with a preliminary diagnosis of early FDIM. Subsequent enucleation and histopathology confirmed the initial diagnosis in both cases. Iris biopsy in cats with iris hyperpigmentation can be beneficial to differentiate melanosis from early FDIM and thereby help to justify the decision for early enucleation.