Superficial Type Research Articles

Analysis of onset and clinical characteristics in Japanese patients with infantile hemangioma.

Infantile hemangioma (IH) is a common benign tumor during infancy, although the detailed mechanism behind it has not been fully elucidated. Based on previous studies, we hypothesized that formation of hemangioma might be triggered by secondary physiological events (perinatal hypoxia or mechanical stress during delivery) in patients carrying germline risk mutations. We aimed to clarify the mechanism by evaluating whether head and neck lesions were more frequent in patients in who IH appeared after birth compared with those in who it was present at birth. Clinical data of 62 lesions in 51 patients with IH were collected. All patients were analyzed for correlation of onset with gender, localization, family histories, gestational age, birth weight, and clinical subtypes. Distribution of lesions on the head and neck was slightly more frequent in the after-birth IH group, compared with those with IH present at birth, but without significant difference (47.6% vs. 40.0%, p = 0.32). On the other hand, the ratio of superficial and deep type IH at birth was significantly altered compared with that in IH after birth (19:0 vs. 26:7, p = 0.039). In addition, IHs appearing after birth tended to more commonly have multiple lesions than those with IH present at birth, with statistically significant difference (25.8% vs. 0%, p = 0.0164). There may therefore be different triggers for IHs at birth and IH after birth. Further studies with greater number of patients are necessary to validate these findings.

Gastric Cancer Imaging: Computed Tomographic Pneumogastrography

Objective: to reveal technical nuances for obtaining high-quality images using a computed tomography protocol with pneumogastrography and virtual gastroscopy, which contribute to the detection and assessment of the morphological type of gastric cancer and to the determination of its localization and invasion depth.Material and methods. The investigation enrolled 250 patients with both early (24.8%) and locally advanced (75.2%) gastric cancer treated in Petrov National Medical Research Center for Oncology from 2015 to 2018. Preoperative chemotherapy was performed in 142 (56.8%) patients and was not done in 108 (43.2%). All the patients underwent preoperative computed tomography with pneumogastrography and virtual gastroscopy. All the patients were radically operated on through subtotal or total gastric resection.Results. Computed tomography with pneumogastrography and virtual gastroscopy was used to detect gastric cancer in 98.4% of patients; the cases with early T1a and T1b invasion depth cancers were 23.2%. The tumor could not be significantly differentiated in 4 (1.6%) patients. This group consisted of: 3 (1.2%) and 1 (0.4%) patients with pT1a and pT1b invasion depth tumors, respectively. All non-visualized tumors had a superficial morphological type of growth (Type 0–II (3 cases with 0–IIa and 1 case with 0–IIb); their sizes were less than 2 cm. Three tumors were localized in the antral portion of the stomach; one was in its cardiac portion.Conclusion. Computed tomography with pneumogastrography and virtual gastroscopy is an effective technique to detect gastric cancer, including its early types of category T1, which makes it possible to assess its localization, morphological type, and invasion depth.

The effectiveness of an electronic clinical-decision support tool embedded into the patient medical record at the point of care to guide Mohs surgery utilization: A cohort study

The effectiveness of an electronic clinical-decision support tool embedded into the patient medical record at the point of care to guide Mohs surgery utilization: A cohort study

Arterial blood supply patterning of the mammary sentinel lymph nodes with special reference to the relation of the formation mechanism of the superficial subscapular artery.

This study aimed to conduct a detailed anatomical examination of the arterial supply to level Ib lymph nodes corresponding to mammary sentinel lymph nodes. This was achieved by focusing on the relationship with course changes of the axillary artery trunk using 41 cadavers (49 axillae). The course patterns of the axillary artery were classified as: "Standard type," which penetrate the brachial plexus (occurrence rate, 51%); "Superficial brachial artery type," which ran along the superficial layer of the brachial plexus (2%); "Superficial subscapular artery (SSbsA) type," which entered the deep layer without penetrating the brachial plexus (42.9%); and others (4.1%). The lateral thoracic artery, thoracodorsal artery, inferior pectoral artery, and superficial thoracic artery were distributed in a regular pair relationship according to each running type of the axillary artery for the Ib lymph nodes. Comparing blood supply ratio to the Ib lymph nodes, using SSbsA occurrence as a reference, showed that significant differences were observed with the inferior pectoral artery control for the standard subscapular artery group and the lateral thoracic artery control for the SSbsA group (p < 0.0001). It was suggested that in selective modeling of vascular networks during upper limb developments, two formation tendencies occur. The standard axillary and SSbsA axillary artery trunks are induced when the inferior pectoral artery-derived feeding arteries in the superficial brachial artery system are selected for Ib lymph nodes, or lateral thoracic artery-derived feeding arteries, which are closely related to the SSbsA pathway, are acquired.

CLINICOPATHOLOGIC STUDY OF BASAL CELL CARCINOMA: A SINGLE-CENTRE RETROSPECTIVE STUDY

Background: Basal cell carcinoma (BCC) is the most common malignant neoplasm in fair-skinned individuals and accounts for about two-thirds of all skin cancers in Caucasians. BCC rarely metastasizes or causes death, but it can result in extensive morbidity through local invasion and tissue destruction. Objective: To evaluate the clinicopathologic features of basal cell carcinoma in Egyptian population. Patients and methods: Our study included 80 patients with BCCs from January 2015 to December 2019. A retrospective analysis of baseline clinical and histopathological data was for all subjects incorporated in the study. Data needed for the study were obtained from the case files. Patients were histologically diagnosed at Dermatopathology unit of Department of Dermatology and Venereology, Al-Hussein University Hospital, Cairo, Egypt. Results: The present study showed that the clinical types of BCC of the involved patients were 41 lesions (39%) of ulcerative type, 39 lesions (37.1%) of nodular non pigmented type, 13 lesions (12.4%) of nodular pigmented type, 9 lesions (8.6%) of superficial type, and 3 lesions (2.9%) of advanced type. As regards the histological subtypes, 52 lesions (49.5%) were nodular, 11 lesions (15.9%) were pigmented, 9 lesions (8.6%) were adenoid, 9 lesions (8.6%) were superficial, 8 lesions (7.67%) were infiltrative, 7 lesions (6.7%) were micro-nodular, 6 lesions (5.7%) were nodulo-cystic and 3 lesions (4.3%) were baso-squamous. Conclusion: Based on our findings, BCC was strongly associated with exposure to ultraviolet (UV) radiations. Tumors developed mainly on the sun-exposed skin of elderly individuals. Nodular BCC was the most common clinical and histological subtype.

Molecular alterations in basal cell carcinoma subtypes

A number of genes have been implicated in the pathogenesis of BCC in addition to the Hedgehog pathway, which is known to drive the initiation of this tumour. We performed in-depth analysis of 13 BCC-related genes (CSMD1, CSMD2, DPH3 promoter, PTCH1, SMO, GLI1, NOTCH1, NOTCH2, TP53, ITIH2, DPP10, STEAP4, TERT promoter) in 57 BCC lesions (26 superficial and 31 nodular) from 55 patients and their corresponding blood samples. PTCH1 and TP53 mutations were found in 71.9% and 45.6% of BCCs, respectively. A high mutation rate was also detected in CSMD1 (63.2%), NOTCH1 (43.8%) and DPP10 (35.1%), and frequent non-coding mutations were identified in TERT (57.9%) and DPH3 promoter (49.1%). CSMD1 mutations significantly co-occurred with TP53 changes (p = 0.002). A significant association was observed between the superficial type of BCC and PTCH1 (p = 0.018) and NOTCH1 (p = 0.020) mutations. In addition, PTCH1 mutations were significantly associated with intermittent sun exposure (p = 0.046) and the occurrence of single lesions (p = 0.021), while NOTCH1 mutations were more frequent in BCCs located on the trunk compared to the head/neck and extremities (p = 0.001). In conclusion, we provide further insights into the molecular alterations underlying the tumorigenic mechanism of superficial and nodular BCCs with a view towards novel rationale-based therapeutic strategies.

Diagnosis and Management of Cavernous Hemangioma of the Tongue with Sclerosing Agents: A Case Report and Review of Literature

Vascular anomalies pose as one of the most difficult diagnostic and therapeutic enigma in the maxillofacial region. They comprise of two categories i.e hemangioma and vascular malformation. Hemangiomas are tumors of blood vessels which present after birth, undergo a proliferative phase with rapid growth and then undergo a stationary period followed by a period of involution. In contrast vascular malformations are always present at birth and enlarge in proportion to growth of an individual, do not involute and present throughout patient’s life. Haemangioma is the most common benign tumour of vascular origin of the maxillofacial region. Despite its benign origin and behaviour, it is always of clinical importance to the dental professionals and requires appropriate management as it may lead to an early or continuous loss of function or lifetime esthetic impairment. Hemangioma can be subdivided into superficial type also known as capillary hemangioma which presents as bright red macular masses; and deep hemangioma known as cavernous hemangioma which presents as soft, non-fluctuant, poorly defined, dome like, bluish and occasionally bosselated nodule. Herein, we present a case of a 65 year old female presenting with deep or cavernous hemangioma on the lateral border of the tongue treated with 1% sodium tetradecyl sulphate with successful remission of the lesion. Usually such patients require surgical removal of the lesion. But in consideration to the massive surgical procedure, this therapeutic approach may reduce the chances of the surgical requirement.

Update on infantile hemangioma.

The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5%–10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dosage of 2–3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, may be used for small superficial type IHs at a dosage of 1–2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.

Molecular Genetics in a Cohort of Patients With Concurrent PTC and Melanoma

PTC and melanoma are known to harbour common mutations, but this has not been extensively investigated. Targeted therapies for BRAF and PD-L1 have been used for melanoma and there are ongoing clinical trials for use of PD-L1 inhibitors in PTC but its utility is uncertain. Additionally, many of these patients have multiple cancers, so, whether they have a tumour predisposition syndrome is also unclear. Both germline and somatic mutations in BRCA1-associated protein 1 (BAP1) are associated with a wide spectrum of tumours. We hypothesized that a common genetic link may be present in our cohort of patients who have both PTC and melanoma.The aim of this study was to elucidate molecular genetics, specifically BRAF, NRAS, KRAS, KIT using OncoFocus Mass Array System as well as expression of PD-L1 and BAP1, using a standard antibody (SP263) and C-4 respectively, in an Australian cohort with concurrent PTC and melanoma.In our cohort of 21 patients (43% females, all Caucasian), melanoma was diagnosed about 8 years prior to PTC (50.3 ± 18.3 vs. 58.6 ± 12.8 years). The most common mutation was BRAFV600E seen in 88% of PTC, followed by NRAS mutation in 12% of PTC. Majority of the PTC (68%) stained negative for PD-L1. There was no significant association between PD-L1 tumour status and clinicopathologic outcomes. Interestingly, majority of multifocal, bilateral and both bilateral and multifocal PTC were PD-L1 negative (85%,69% and 69% respectively, P<0.05); only extrathyroidal extension was found to be associated with positive (≥1%) PD-L1 staining (83.3 vs.30.8; p=0.057). Regarding melanoma, clinicopathologic and mutation data were obtained for 15/21 patients and 8/15 patients respectively. Superficial spreading type of melanoma was present in 50% patients. The BRAFV600E and NRAS mutation were present in 3/8 patients each, and 2/8 patients had no mutations. PD-L1 staining was negative in 7/12 (58%) of melanoma tissues. Of the 5 cases that stained positive for PD-L1, 4 were at >25%, a much higher degree of staining compared to PTC group. Among 7 patients where data were available for both tissues, concordant mutations were found in only 2 patients (both BRAFV600E). In addition, 11 of the 21 patients had at least one other cancer apart from PTC and melanoma. Nine of the 11 patients who had more than one cancer were BRAF positive. BAP1 staining was retained in the majority of PTCs and melanoma tissues, indicating no loss of BAP1 protein.PTC and melanoma both share molecular markers including BRAF, NRAS, PD-L1 as shown in our cohort. This is the largest study describing the mutation status of both PTC and melanoma. It is also the only study describing the PD-L1 and BAP1 expression in PTC and melanoma. BRAFV600E was the most common mutation. Majority of the PTC and melanoma stained negative for PD-L1. BAP1 expression was retained in both either PTC and melanoma tissues thus making presence of BAP1 tumour predisposition syndrome unlikely.

Clinicopathological analysis of basal cell carcinoma – A retrospective study

Objectives: The objective of the study was to analyze the demographic profile, histopathological features, risk factors, and recurrence rates in patients with basal cell carcinoma. Materials and Methods: A retrospective study was conducted from 2012 to October 2018 in 29 patients with histopathologically confirmed basal cell carcinoma. All the patients had undergone either excision or cryotherapy as per the institution protocol. Information on the history of the disease, occupation, history of sun exposure and clinical and histopathological features were collected and analyzed. Results: A female preponderance was found (n = 18, 62.1%), majority of the patients were unemployed (44.8%), 19 patients (65.5%) gave a history of sun exposure, and the nose was the most common site of disease. Ten females (34.5%) did not have any excessive exposure to the sun, but gave a history of exposure to heat and fumes in the kitchen. Six patients (20.7%) had a preexisting nevus at the same site and superficial spreading type was the most common histopathological type (n = 24, 82.8%). Excision gave the best result. Four patients (13.8%) had recurrence of the disease. Limitations: Small sample size was the major limitation. The risk factors and occupation could not be analyzed objectively. Conclusion: This is a pioneer study from Kerala. A female preponderance (62.1%) was observed. The role of heat, fumes, type of oven, and use of reheated oil in cooking as risk factors for the development of BCC needs analysis in future studies. Superficial spreading type was the most common pattern observed in histopathology slides (82.8%). Excision gives near-complete clearance and a good cosmetic result with less risk of recurrence.

Superficial spreading type of early gastric cancer coexisting with multiple hyperplastic polyps

We encountered a rare case that involved the superficial spreading type of early gastric cancer coexisting with multiple hyperplastic polyps. An 81-year-old Japanese woman with a history of Helicobacter pylori infection was diagnosed with gastric cancer (cT1bN0M0), which presented as a wide, nodular, aggregated protrusion that was associated with multiple pedunculated and sessile polyps. Distal gastrectomy was performed, and the resected specimen involved an 8cm × 4cm nodular aggregated protruding lesion and 15 polyps that were 2-20mm in size. Histopathological examination revealed that the nodular aggregated protruding lesion was a mucosal adenocarcinoma and that the multiple polyps were hyperplastic. The coexistence of multiple hyperplastic polyps and mucosal adenocarcinoma with nodular aggregated protrusions suggested that the mucosal adenocarcinoma had developed from a fusion of multifocal hyperplastic lesions. This may have occurred via a hyperplasia-carcinoma sequence related to the Helicobacter pylori infection. The superficial spreading type of early gastric cancer has a potential developed from a fusion of multifocal hyperplastic polyps.

Methyl aminolevulinate photodynamic therapy after partial debulking in the treatment of superficial and nodular basal cell carcinoma: 3-years follow-up.

The increase in the number of basal cell carcinoma (BCC) lesions has prompted use of minimally invasive therapies, including Photodynamic therapy (PDT). . The objective of the present work was to analyze the efficacy of methyl aminolevulinate-mediated photodynamic therapy (MAL-PDT) in patients suffering from superficial or nodular BCCs. A total of 220 BCC lesions (76 superficial and 144 nodular), clinically diagnosed and confirmed by histopathology analysis, were treated in 174 patients (mean age 72.5). Debulking using curettage was performed before two or three MAL-PDT sessions (λ = 630 nm; 90 J/cm2; 23 min) at 4-week intervals. Analyses of clinical clearance and cosmetic outcome were carried out by direct examination, dermoscopy, photographs, as well as by fluorescence diagnosis using a Wood's lamp. Evaluations were carried out at the different PDT sessions and follow-ups over a 3-year period. MAL-PDT was safe and highly tolerated. After an average of 2.6 MAL-PDT sessions, the overall clearance rate at 3-year follow-up was 96.1 % (95 % confidence interval [CI] 100 %-92 %) for superficial BCCs and 95.2 % (95 % [CI] 99 %-92 %) for nodular BCCs after an average of 2.7 sessions. Minimal side effects such as crushing, erythema and edema were reported. All BCC lesions showed excellent or good cosmetic results. The protocol followed in the present study has shown that MAL-PDT is a safe and effective treatment for superficial and nodular types of BCC.

A Retrospective Study of Superficial Type Atypical Lipomatous Tumor.

Atypical lipomatous tumor (ALT) has been defined as a well-differentiated liposarcoma exhibiting a higher frequency of a local recurrence after surgical resection. ALT is mainly classified into deep type and superficial type. Compared with deep type ALT, superficial type ALT is rarely observed. One of the most important issues is that little has been known about superficial type ALT and it is not easy to predict the presence of superficial type ALT before surgical resection. To clarify the clinical manifestations of superficial type ALT, we examined 15 cases with superficial type ALT and 118 cases with benign lipoma, and analyzed their differences in clinical characteristics and the findings of MRI test. In clinical characteristics, the tumor size of superficial type ALT was significantly greater than that of benign lipoma, and superficial type ALT showed a significantly higher frequency of the tumor size of more than 4 cm. Superficial type ALT exhibited poor tumor mobility and hardness with elastic soft. In addition, a significantly higher frequency of tumor location of superficial type ALT was observed in extremities. Among tumor sites at the trunk, buttocks, and shoulder were high frequent location in superficial type ALT. In an MRI examination, superficial type ALT exhibited a significantly higher frequency of the septal structures compared with benign lipoma. The combinations of clinical characteristics, including physical examinations, MRI, and histological examinations, are helpful for the diagnosis of superficial type ALT.

Drugs associated with development of porokeratosis: A systematic review.

Porokeratosis is a rare disorder characterized by atrophic macules or patches, with a well-defined ridge-like hyperkeratotic border called cornoid lamella. Although the exact pathogenesis is unknown, drug associated cases have recently been reported in the literature. As such, we systematically reviewed and identified drugs associated with drug-induced porokeratosis, their resultant effects, and whether there was a casual relationship between the use of a drug and the development of porokeratosis. We searched for articles which reported drug-induced porokeratosis in MEDLINE and Embase in June 2020. After full-text review, 25 studies were included for analysis. We identified 26 patients with drug-induced porokeratosis. The most common therapies associated with development of porokeratosis is biologic use, phototherapy, and radiotherapy. The most common clinical variants were the disseminated superficial or actinic types (60%), which occurred in psoriasis patients undergoing phototherapy, and eruptive disseminated type (24%) which occurred in the context of biologic therapies. The Naranjo score ranged from possible to probable for the identified treatments. Clinicians should consider drug reactions as possible triggering events for porokeratosis, especially for patients taking biologics, phototherapy, and radiotherapy. Large-scale studies are required to confirm our findings and further explore the pathogenesis for drug-induced porokeratosis.

Combined surgical ablation with superpulsed CO2 laser for treatment of facial basel cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancers in face region. The most concern for surgeons is success of treatment with high cure rate and good cosmetic result. There are several methods for treatment , including laser therapy. The objectives of the present study were to evaluate the healing of wounds (recurrence and cosmetic outcome) after treatment by surgical ablation and irradiation by superpulsed mode of laser CO2.A total of 18 patients with BCC, age between 58-71 years, from both gender (7 males and 11 females) were included in the study. The tumorous mass was ablated firstly, then the tumor bed was irradiated using 5-8W Pulsed CO2 laser. The wounds were left open to secondary epithelization. Recurrence and cosmetic outcomes were observed after one year follow-up. The mean age of the participants was 66 years (range 58-71 years). The mean size (maximal diameter of lesion) was 9.3 mm (range: 7.2-11.3mm). 12 tumors (66.6%) were of the superficial type, 6 tumors (33.3%) were of the nodular type. No recurrence was observed one year after surgery. Slight scar was found in 3 cases (16.6%). There were no complications during the wound healing period .The present study showed that the surgical ablation combined with superpulsed CO2 laser is an effective option to treat BCC and to achieve high cure rates and good esthetic outcomes.

Gastric adenocarcinoma of the fundic gland type: clinicopathological features of eight patients treated with endoscopic submucosal dissection

BackgroundGastric adenocarcinoma of the fundic gland type (GA-FG) has been added to the 2019 edition of the World Health Organization’s list of digestive system-associated cancers. This lesion differentiates toward the fundic gland and mostly involves chief cell-predominant differentiation with low-grade cytology. Clinicians and pathologists are still unaware of this rare disease; consequently, some cases are incorrectly diagnosed. This study aimed to investigate the clinicopathological features of GA-FG using retrospective analyses of endoscopic and pathological findings.Materials and methodsSamples were collected from patients diagnosed with GA-FG. The clinical courses of all patients were monitored prospectively and reviewed retrospectively. Available clinical information, endoscopic features, pathological appearance, and follow-up data were assessed. Immunohistochemistry [mucin (MUC) 2, MUC5, MUC6, P53, CDX2, Ki67, SYN, CD56, CGA, β-catenin, and pepsinogen-I] was examined using Envision two-step method.ResultsEight cases of endoscopic submucosal dissection (ESD) were obtained from our institution. Patient age ranged from 48 to 80 years (mean, 65 years). Some patients were on acid-suppressing medication. Most lesions were located in the upper third (n = 7) and one was in the middle third of the stomach. Six lesions were of the superficial flat type, whereas two were of the superficial elevated type. Narrow-band imaging using magnifying endoscopy showed irregular microvascular patterns (MVPs) in four cases and regular MVPs in the remaining cases. All lesions were primarily solitary and ~ 6 mm in diameter (largest, 12 mm). The main body of the tumors were localized in the mucosal layer, of which six cases invade into the submucosal layer. Well-formed glands of chief cells were predominant. Tumor cells were positive for pepsinogen-I, MUC6, SYN, and CD56. Lymphatic and vascular infiltration and metastatic and recurrent disease were not observed in any case.ConclusionGA-FG, a well-differentiated adenocarcinoma with mild atypia, can be completely removed using ESD, with a favorable prognosis in patients.

Optimal Initial Workup in Patients With Superficial Primary Gastric MALT Lymphoma.

The prognosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is favorable, especially in the absence of lymph node metastasis (LNM). We investigated LNM incidence and location in superficial type gastric MALT lymphoma. We performed a retrospective analysis of 450 patients newly diagnosed with gastric MALT lymphoma with tumor infiltration confined to the mucosa or submucosa as evidenced by endoscopic ultrasonography. LNM incidence and location were evaluated. Of the 450 patients, most patients (434, 96.4%) were initially LNM negative as confirmed by computed tomography (CT) scanning. Sixteen patients (3.6%) were LNM positive. There was no difference in clinical characteristics between the 2 groups except for the extent of lymphoma involvement and endoscopic findings. Among 41 patients undergoing abdominal/pelvic CT (APCT) only, LNM was detected in 1 (2.4%). There were 8 LNM cases among 238 patients undergoing both APCT and chest CT (3.4%). Among 171 patients undergoing APCT, chest CT, and neck CT, 7 cases of LNM were detected (4.1%). The detection rates for each CT were as follows: abdominal CT, 13/450 (2.9%); chest CT, 6/408 (1.5%); and neck CT, 1/171 (0.6%). Among 6 patients with chest CT-positive findings, 3 showed no evidence of LNM on APCT. LNM was an infrequent finding in gastric MALT lymphoma patients with tumor infiltration confined to the mucosa or submucosa. Besides endoscopy and endoscopic ultrasonography, APCT and chest CT are considered as optimal initial workup modalities in patients with assumed primary superficial gastric MALT lymphoma.

Glikojen depo hastalığı Tip 3’ün dil tutulumu ile likenoid infiltrasyon birlikteliği

Glycogen storage disease (GSD) type III is an autosomal recessive metabolic disorder and inborn error of metabolism characterized by a deficiency of glycogen debranching enzymes which is affecting 1/100000 every live birth. Clinical presentation is classified into four groups according to the muscular and liver involvement. GSD IIIa, the most common form of GSD III, primarily affects the liver, cardiac muscle, and skeletal muscle. Treatment mainly involves a high-protein diet, to facilitate gluconeogenesis. A 28-year-old male presented to our outpatient clinic with a 2-month history of white asymptomatic lesions on his tongue. He was diagnosed with GSD type 3 when he was six months old, and he has no other systemic disease, drug use or smoking history. A punch biopsy was performed, in superficial dermis band type lymphohistiocytic lichenoid infiltration was detected, also vacuolization of muscle cells and positive PAS staining were seen histologically. Topical high potent corticosteroids and dietary recommendations were offered to him. We want to present this case because of the rarity of lingual muscle involvement in glycogen storage disorders.

VITOM 3D System in Parotid Gland Surgery: Our Experience.

In this report, we present our experience with the VITOM 3D system for parotid gland surgery. A retrospective review of 9 consecutive VITOM 3D-assisted parotidectomies was carried out. All of the cases included had benign pathology. Eight of the tumors were in the superficial lobe whereas one case arose in the deep lobe. Superficial parotidectomy type II, according to the ESGS classification, was performed in 5 cases (55.6%): type I-II in 2 cases (22.2%), type I and III in 1 case respectively (11.1%). The postoperative period was uneventful for all of the patients, and no cases of postoperative temporary or definite facial nerve palsy or other complications were reported. The mean operating time was 145 minutes (range 135-165 minutes). Asthenopia never occurred, and there were no cases in which the first surgeon, the assistants, or the nurses needed to interrupt the 3D vision. VITOM 3D has been demonstrated to be safe and effective for parotid gland surgery. The main advantages of VITOM 3D are improved visualization, ergonomics, versatility, training, and education. The drawbacks are related to asthenopia and the learning curve, even though, in our experience, the impact of these factors is minimal.

Endoscopic and Endosonographic Features of Histologically Proven Gastric Ectopic Pancreas by Endoscopic Resection.

Distinguishing gastric ectopic pancreas (GEP) from malignant tumors is relatively difficult. This study evaluated the endosonography findings of pathologically proven GEP. Thirty-one patients diagnosed with GEP based on a histopathological analysis from January 2004 to July 2018 were enrolled in this study. All patients underwent EUS and an endoscopic resection. Seventeen patients were female, and the median age was 41.1 years (range, 14-74). The lesions were localized most commonly in the antrum. The mean size of the GEP was 10.6 mm (range, 7-15). Superficial type lesions, lesions with heterogeneous echogenicity, mixed pattern lesions, and lesions with indistinct borders were commonly observed on EUS. Calcification, anechoic duct-like structures, and thickening of the muscularis propria were observed in some patients. Endoscopic mucosal resection (41.9%) and endoscopic submucosal dissection (58.1%) were performed. The mean procedure time was 22.5 minutes. Complete resection was achieved for 71% of patients. No statistically significant results between the endosonography findings and complete resection rates were obtained. The mean follow-up esophagogastroduodenoscopy duration was 4.5 months. None of the patients presented with residual lesions on subsequent endoscopy. EUS can help identify the features of GEP. Careful observations of the EUS findings can avoid unnecessary removal of GEP.