Diagnostic imaging modalities of osteoblastic metastases

Methods to quantify radiograph images are needed to improve the identification of metastases

Advances in medical imaging applied to bone metastases

Bone metastases are the result of a primary cancer invasion which spreads into the bone marrow through the lymphogenous or hematogenous pathways. Bone metastases are a common complication of cancer.The primary cancers that most frequently metastasize to bone are breast and prostate cancer (65 - 75 %) amongst many others (thyroid 42 %, lung 36 % or kidney 35 %) (Suva et al., 2011). Although the exact incidence of bone metastases is unknown given its dependence on the type of primary cancer, it is estimated that 350,000 people die of bone metastases annually in the United States.

A Quantitative method for the characterization of lytic metastases of the bone from radiographic images

The aim of our study was to assess the diagnostic usefulness of the gray level parameters to distinguish osteolytic lesions using radiological images. Materials and Methods: A retrospective study was carried out. A total of 76 skeletal radiographs of osteolytic metastases and 67 radiographs of multiple myeloma were used. The cases were classified into nonflat (MM1 and OL1) and flat bones (MM2 and OL2). These radiological images were analyzed by using a computerized method. The parameters calculated were mean, standard deviation, and coefficient of variation (MGL, SDGL, and CVGL) based on gray level histogram analysis of a region-of-interest.Diagnostic utility was quantified bymeasurement of parameters on osteolyticmetastases andmultiplemyeloma, yielding quantification of area under the receiver operating characteristic (ROC) curve (AUC). Results: Flat bone groups (MM2 and OL2) showed significant differences in mean values of MGL ( = 0.048) and SDGL ( = 0.003). Their corresponding values of AUC were 0.758 for MGL and 0.883 for SDGL in flat bones. In nonflat bones these gray level parameters do not show diagnostic ability. Conclusion: The gray level parametersMGL and SDGL show a good discriminatory diagnostic ability to distinguish between multiple myeloma and lytic metastases in flat bones.

El exilio de la razón: Isabel de Bohemia y Simone Weil ante la ciencia cartesiana

Casi 300 años distancian la correspondencia de Isabel de Bohemia con Descartes de la lectura que del autor hace Simone Weil. Las dos, sin embargo, muestran una sutil comprensión de la aportación cartesiana y un empeño por hacerse cargo del significado de la misma en la constitución de la ciencia moderna, considerando las implicaciones de la sustitución de la geometría por el álgebra. Las dos subrayan también las dificultades queencuentran en el cartesianismo a la hora de enfocar la relación entre autoconocimiento einvestigación del mundo natural, un problema cuyas consecuencias centrarán buena partedel debate teórico del siglo XX.La investigación de las posibles coincidencias entre estas lecturas pretende aportar una perspectiva en la que se clarifican aspectos decisivos tanto del interés de estas autoras por la fundarnentación de la ciencia, como de los términos en los que, desde su origen, seplantean problemas que continúan abiertos.Casi 300 años distancian la correspondencia de Isabel de Bohemia con Descartes de la lectura que del autor hace Simone Weil. Las dos, sin embargo, muestran una sutil comprensión de la aportación cartesiana y un empeño por hacerse cargo del significado de la misma en la constitución de la ciencia moderna, considerando las implicaciones de la sustitución de la geometría por el álgebra. Las dos subrayan también las dificultades que encuentran en el cartesianismo a la hora de enfocar la relación entre autoconocimiento einvestigación del mundo natural, un problema cuyas consecuencias centrarán buena partedel debate teórico del siglo XX.La investigación de las posibles coincidencias entre estas lecturas pretende aportar una perspectiva en la que se clarifican aspectos decisivos tanto del interés de estas autoras por la fundarnentación de la ciencia, como de los términos en los que, desde su origen, seplantean problemas que continúan abiertos.

El exilio de la razón: Isabel de Bohemia y Simone Weil ante la ciencia cartesiana

Casi 300 años distancian la correspondencia de Isabel de Bohemia con Descartes de la lectura que del autor hace Simone Weil. Las dos, sin embargo, muestran una sutil comprensión de la aportación cartesiana y un empeño por hacerse cargo del significado de la misma en la constitución de la ciencia moderna, considerando las implicaciones de la sustitución de la geometría por el álgebra. Las dos subrayan también las dificultades queencuentran en el cartesianismo a la hora de enfocar la relación entre autoconocimiento einvestigación del mundo natural, un problema cuyas consecuencias centrarán buena partedel debate teórico del siglo XX.La investigación de las posibles coincidencias entre estas lecturas pretende aportar una perspectiva en la que se clarifican aspectos decisivos tanto del interés de estas autoras por la fundarnentación de la ciencia, como de los términos en los que, desde su origen, seplantean problemas que continúan abiertos.Casi 300 años distancian la correspondencia de Isabel de Bohemia con Descartes de la lectura que del autor hace Simone Weil. Las dos, sin embargo, muestran una sutil comprensión de la aportación cartesiana y un empeño por hacerse cargo del significado de la misma en la constitución de la ciencia moderna, considerando las implicaciones de la sustitución de la geometría por el álgebra. Las dos subrayan también las dificultades que encuentran en el cartesianismo a la hora de enfocar la relación entre autoconocimiento einvestigación del mundo natural, un problema cuyas consecuencias centrarán buena partedel debate teórico del siglo XX.La investigación de las posibles coincidencias entre estas lecturas pretende aportar una perspectiva en la que se clarifican aspectos decisivos tanto del interés de estas autoras por la fundarnentación de la ciencia, como de los términos en los que, desde su origen, seplantean problemas que continúan abiertos.

Nasopalatine duct cyst: report of 22 cases and review of the literature

Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case.

Osteolytic metastasis detected by F18-FDG PET in a patient with lung carcinoma

We present a 53-year-old man with a vocal cord paralysis observed as a primary manifestation of lung carcinoma. Tc-99m MDP whole body bone scan were performed and resulted a normal scintiscan. The bone scan does not revealed suspicious foci of uptake. The possibility of bone metastasis was taken into consideration. A whole body F18-FDG-PET scan showed intense uptake in the left upper lung corresponding to the primary tumor. A bronchial biopsy confirmed infiltration by small cell lung carcinoma (SCLC). SCLC is composed of poorly differentiated, rapidly growing cells with disease usually occurring centrally rather than peripherally. It metastasizes early. The whole-body F18-FDG-PET scan clearly demonstrated a focus of increased uptake in the second lumbar vertebral body suspicious for osteolytic metastasis. A lytic bone metastasis was confirmed by MRI. The patient then received therapy and underwent follow up abdominal CT. The scan showed blastic changes in the L2 vertebra suggesting response to treatment.

Nasopalatine duct cyst: report of 22 cases and review of the literature

Objectives: Nasopalatine duct cysts (NPDCs) are the most common developmental, epithelial and non-odontogenic cysts of the maxillae. The present study describes the clinicopathological characteristics of 22 NPDCs and discusses their etiology, incidence, treatment and prognosis, with a review of the literature on the subject. Study design: A retrospective observational study was made comprising a period of 36 years (1970-2006), and yielding a series of 22 patients with histopathological confirmation of NPDC. Surgical treatment was carried out under local anesthesia and comprised the dissection and removal of the cyst adopting a usually palatine approach, with the preparation of an enveloping flap from 1.4 to 2.4. Results: No statistically significant correlation was observed between the size of the lesion and patient age, although the size of the cyst differed according to patient gender, with a mean NPDC diameter of 16 mm in males and 12 mm in females. In no case did we observe root reabsorption or loss of vitality of the upper incisors following surgery. The X-ray image was rounded in 15 cases and heart-shaped in the remaining 7 cases. In the majority of cases panoramic X-rays and periapical and occlusal X-rays sufficed to identify the lesion, though computed tomography was used in cases of doubt. Conclusions: The etiology of NPDC is unclear. Simple surgical resection is recommended, followed by clinical and radiological control to ensure correct resolution of the case.

Retrospective study of 145 supernumerary teeth

Objective: The goal of the present retrospective study is to describe the distribution of the supernumerary teeth in a population of patients that have been attended at the Public Clinic of the Department of Oral Surgery. Background: Supernumerary teeth and multiple hyperdontia are usually associated with different syndromes, such as Gardner syndrome, or with facial fissures; however, they can appear in patients without any pathology. Their prevalence oscillates to 0.5-3.8% in patients with permanent teeth and to 0.35-0.6% in patients with primary teeth. Patients and Methods: A total of 36,057 clinical histories of patients that were admitted at the clinic between September of 1991 and March of 2003 were revised. The following data were extrapolated: age, sex, number of extracted supernumerary teeth, localization, morphology and type of supernumerary teeth. Consequently, 102 patients were included into the present study. Results: Of the 147 supernumerary teeth identified in the oral cavities of patients 145 were extracted. The most frequent supernumerary teeth identified were mesiodens (46.9%), followed by premolars (24.1%) and fourth molars or distal molars (18%). As for location, 74.5% of the supernumerary teeth were found in the superior maxillary bone and 46.9% of the supernumerary teeth were present in the palatine/lingual area. Heteromorphology was found in two thirds of the supernumerary teeth, with conical shape being the most frequent. Finally, 29.7% of the supernumerary teeth had occlusion with permanent teeth, and mesiodens were the predominating type of supernumerary teeth that showed this feature. Conclusions: Mesiodens very frequently cause retention of permanent incisors, which erupt spontaneously after the extraction of supernumerary teeth, if there is sufficient space in the dental arch and if they conserve the eruptive force. Generally, supernumerary premolars are eumorphic and are casually discovered during radiological exam, if not producing any symptomology.

Ewing sarcoma of the rib: respiratory tract infection as initial symptoms in a 14-year-old boy. Functional medical imaging findings

Ewing sarcoma or primitive neuroectodermal tumor (PNET) of bone is the second most common pediatric malignant bone tumor. The median age at diagnosis is 15 years and there is a male predilection of 1.5/1. The authors present the case of a 14-year-old boy with Ewing sarcoma situated on the left ninth rib which was being investigated for respiratory tract infection. Pleurisy is the most common misdiagnosis. Our case illustrates the importance of recognizing exceptional features when interpreting FDG PET or scintigraphy to prevent the misinterpretation of metastases as other etiologies, such as infection.