Radioiodine Therapy: Alternative for the Treatment of Complicated Thyroid Ectopia

Thyroid ectopy is the presence of thyroid tissue outside its normal cervical location. Clinical manifestations of thyroid ectopy are varied. The latter complications can be life-threatening. Emergency treatment is often surgical or endoscopic. We report a case of a 26-year-old man with tracheal thyroid ectopy, complicated by respiratory distress, in whom conventional treatments were not feasible. The patient was treated with radioiodine-131 administered in liquid form. The final control showed the complete resolution of the intra-tracheal mass. Intra-tracheal thyroid ectopy is a rare anomaly in which surgery is the traditional treatment. In certain cases where surgery is not feasible or refused, treatment with iodine-131 is a safe and effective alternative for the removal of ectopic thyroid tissue. The aim of our work is to show the significant efficiency of radioiodine therapy as an alternative for the treatment of complicated thyroid ectopia.

Ectopic gastric mucosa in the submucosa of the stomach: A case report

Under normal circumstances, gastric mucosa only exists within the stomach. However, in certain situations, gastric mucosal tissue may undergo ectopia, commonly occurring in the esophagus and intestine, with rare occurrences within the stomach itself. A comprehensive literature review was performed to understand the distinct characteristics of ectopic gastric mucosa (EGM) in the stomach and investigate a rare incident of this disease, providing an in-depth analysis of the clinical, histopathologic, and differential diagnostic findings. The case was a 47-year-old man with acid reflux, heartburn, abdominal distension, and diarrhea (5-10 times daily) for >10 years. A gastroscope indicated a submucosal protuberance lesion in the gastric body that felt hard with biopsy forceps. A well-defined nodule under the mucosal muscle was revealed microscopically, composed of epithelial elements and no atypia. Immunohistochemical staining demonstrated similar EGM expression patterns compared with normal gastric mucosa. The present case report highlights the importance of accurate EGM diagnosis and understanding.

Imaging features of renal ectopia and fusion in 13 cats

CASE SERIES SUMMARY

A retrospective multicenter case series of renal fusion anomalies in cats was investigated. The aim of this study was to describe the imaging characteristics (radiography, ultrasonography and CT) of renal ectopia and fusion in cats. A total of 13 feline patients (median age 9 years) were included in this multicentric retrospective study. Ultrasound was available in 12/13 cases, radiographs in 4/13 cases and CT in 3/13 cases. Of the 13 cases, seven were left to right fusions, four were right to left fusions, one was on the midline and one was in the pelvic inlet. Adopting a human classification system, there were five lump kidneys, four disc kidneys, one horseshoe kidney, one caudal ectopia, one L-shaped kidney and one pelvic kidney. In 2/13 cases, additional congenital malformations were noted, including an azygous continuation of the caudal vena cava and a peritoneal-pericardial diaphragmatic hernia.

RELEVANCE AND NOVEL INFORMATION

This study provides further description of the imaging findings in feline patients with fused renal ectopia. The morphologic characteristics of the fused kidneys in cats appear similar to what is published in the human literature. Renal fusion might be an incidental finding in cats, but further investigations are necessary to determine their clinical relevance.

[Basicervical ectopic goiter associated with a eutopic thyroid gland: a case report]

Thyroid gland is an endocrine gland playing a major role in energy and phosphocalcic metabolism, among others. It commonly occurs in the anterior cervical and pretracheal region. Ectopic thyroid is quite rare. It is dominated by ectopic basilingual thyroid. We here report the case of a patient with goiter in normal cervical position (eutopic) and ectopic thyroid tissue in basicervical position. Cervicotomy revealed the ectopic nodule and the diagnosis was confirmed by histology. This clinical case illustrates a differential diagnosis of cervical masses.

Cranial vs. Cervical Spine MRI in Adult CM-1 diagnostics: Is There a Difference in Tonsil Ectopia Length?

BACKGROUND

Chiari malformation type 1 (CM-1) diagnosis is based on measurement of the cerebellar tonsils on cranial or cervical spine MRI. However. imaging parameters of cranial and cervical spine MRIs could differ because spine MRIs have greater resolution.

METHODS

We conducted a retrospective chart review of 161 patients of a single neurosurgeon for Adult CM-I consultation between February 2006 and March 2019. Patients were selected based on receiving both cranial and cervical spine MRIs within a month of each other to determine tonsillar ectopia length for CM-1. Ectopias were measured to determine if differences in values were statistically significant.

RESULTS

From the 161 total patients, 81 had cranial and cervical spine MRIs for a total of 162 tonsil ectopia measurements (81 cranial and 81 spinal). Average ectopia length on a cranial MRI was 9.1 mm (±5.2 mm); average ectopia length on a spinal MRI was 8.9 mm (±5.3 mm). Average cranial and spinal MRI values were found to be less than 1 standard deviation apart. Two-tailed, non-equal variances t-test determined that differences between the cranial and spinal ectopia measurements were insignificant (P = 0.2403).

CONCLUSION

This study confirmed that the added resolution offered by spine MRIs did not make better or more refined measurements over cranial MRIs that could lead to measurement differences, which can instead be attributed to chance. Cranial and cervical spine MRIs can be used to determine the degree of the tonsil ectopia.

Complete mesocolic malposition of the gallbladder: An unusual case report with literature's review

Anatomic variations and congenital anomalies involving the gallbladder position, shape, and number are frequently encountered on routine abdominal imagings and at surgery. However, most have no clinical significance, but their recognition is important because they may predispose to gallbladder diseases, serve as a potential source of confusion and diagnostic pitfalls for radiologists and surgeons, and increase the risk of inadvertent injury during biliary tract surgery or intervention. We observed an intra-mesocolic gallbladder found unexpectedly during the cholecystectomy in a 65-year-old male patient who was being operated on for acute calculous cholecystitis. An abdominal ultrasonography and computed tomography scan reported no anomalous or malpositioned gallbladder pre-operatively. As the location of this organ could not be definitely clarified in his previous operation elsewhere, we performed an explorative lapa-rotomy. There was no gallbladder at the normal position. The organ was found embedded deeply within the proximal portion of the transverse mesocolon, and then it was successfully excised. We established the diagnosis of an ectopic gallbladder in mesocolic position.

Cutaneous ectopia of lung, located on back and neck: Hitherto undescribed presentation

Ectopia is defined as the presence of a normal-appearing tissue in an abnormal location, where it is not normally found. In the literature, it is also referred to as heterotopia and is described as choristoma when it forms a mass. Lung tissue ectopia is a rare anomaly and is characterized by the presence of mature lung tissue comprising well-formed bronchi, bronchioles, and alveoli at an abnormal location. Occurrence of ectopic lung tissue in the skin is an extremely rare entity and the diagnosis is mostly established by histopathologic examination. This report documents a rare occurrence of cutaneous ectopic lung tissue at two locations (neck and back). Cutaneous ectopia at multiple sites has not been described in the literature till date.

Repression of Irs2 by let-7 miRNAs is essential for homeostasis of the telencephalic neuroepithelium

Structural integrity and cellular homeostasis of the embryonic stem cell niche are critical for normal tissue development. In the telencephalic neuroepithelium, this is controlled in part by cell adhesion molecules and regulators of progenitor cell lineage, but the specific orchestration of these processes remains unknown. Here, we studied the role of microRNAs in the embryonic telencephalon as key regulators of gene expression. By using the early recombiner Rx-Cre mouse, we identify novel and critical roles of miRNAs in early brain development, demonstrating they are essential to preserve the cellular homeostasis and structural integrity of the telencephalic neuroepithelium. We show that Rx-Cre;Dicer^F/F mouse embryos have a severe disruption of the telencephalic apical junction belt, followed by invagination of the ventricular surface and formation of hyperproliferative rosettes. Transcriptome analyses and functional experiments in vivo show that these defects result from upregulation of Irs2 upon loss of let-7 miRNAs in an apoptosis-independent manner. Our results reveal an unprecedented relevance of miRNAs in early forebrain development, with potential mechanistic implications in pediatric brain cancer.

[Combination of toxic multinodular goiter and primary hyperparathyroidism with rare ectopia of parathyroma]

A well-known feature of primary hyperparathyroidism (PHPT) is possible ectopic localization of parathyroid adenoma that can significantly complicate diagnostic process. Ectopia in the aortic window is extremely rare and accounts only 1% of ectopic parathyroid adenomas in the mediastinum and 0.24% among all parathyroid adenomas. Combination of multinodular toxic goiter and primary hyperparathyroidism with a rare variant of ectopia makes this observation very valuable from scientific and practical point of view.

Jejunal Occlusion Caused by Heterotopic Gastric and Duodenal Mucosa: A Late Complication of a Complex Intestinal Malformation

We report a rare case of late complication of a complex intestinal malformation. At day 1 of life, a baby girl underwent resection of an atretic jejunal segment, associated with an enteric duplication harboring foci of gastric and duodenal heterotopia. After an asymptomatic period of 19 years, the patient presented with acute bowel obstruction. Recurrence of the jejunal occlusion at the previous anastomotic site was caused by mucosa hyperplasia in association with heterotopic gastric and duodenal tissue. A Wnt/β-catenin pathway deregulation was hypothesized but not confirmed by CTNNB1 exon 3 mutation analysis. This case illustrates a rare association of 3 pathologies-namely, intestinal atresia, enteric duplication, and heterotopia, with a late-occurring acute complication.

Residua of thymus in the mediastinum - clinical aspects - cadaveric study

The main goal of this study was to investigate possible residua of thymic tissue in 100 adult cadavers with no thoracic pathology known before, by dissection of standard locations of thymic tissue in perithyroid, periaortic, peritracheal and retrotracheal spaces, as well as areas located next to the course of phrenic, vagus and left recurrent laryngeal nerves. Thus obtained tissue samples were studied by two pathologists independently. The remnants of the thymic tissue were found in 61 out of 100 specimens studied. It means that residua of ectopic thymic tissue is common, which may have a huge impact on the results of treatment of many diseases i.e. myasthenia gravis in course of thymoma.

Gallstone ectopia in the lungs: case report and literature review

Gallstone ectopia in the lungs is relatively rare, which accounts for its frequent misdiagnosis. This paper reports a case found in a suspicious lung cancer surgery. The patient received intrahepatic duct stone removal surgery and partial hepatectomy five months prior to the report. He started showing symptoms of cough and hemoptysis without any apparent cause one month before this report. Enhanced computed tomography showed a solid mass in the lower lobe of the right lung, which was considered as hamartoma or lung cancer. A wedge-shaped excision was then performed in the lower lobe of the right lung. After the surgery, postoperative findings and pathological examination results showed gallstone ectopia in the lung. This case reminds us that gallstones that overflow into the intraperitoneal section can enter the thoracic cavity through diaphragmatic weakness and travel to the lung, thus forming an inflammatory mass. The case also reminds us of the following points in clinical diagnosis: 1) remove gallstones to the greatest extent during cholelithiasis surgery to prevent the stones from migrating from the intraperitoneal area, which causes intraperitoneal and thoracic cavity complications; 2) conduct routine chest imaging examination after cholelithiasis surgery during the clinical follow-up period to facilitate early detection and timely treatment of intrathoracic complications; 3) inquire whether the patients suffering from a solid mass of the lower lobe of right lung, have cholelithiasis history to facilitate clinical diagnosis and avoid misdiagnosis, mistreatment, and treatment delay.

Robotic-assisted laparoscopic extravesical ureteroneocystostomy for management of adult ureteral duplication with upper pole prostatic urethral insertion

A 55-year-old male presented with progressive lower urinary tract symptoms and renal colic. The workup revealed a complete left ureteral duplication with a hydronephrotic upper pole moiety inserting into the prostatic urethra. Using a 5-port transperitoneal robotic-assisted laparoscopic technique, an extravesical upper pole ureteroneocystostomy was performed. Clinical follow-up and repeat imaging documented symptomatic and radiographic improvement. Robotic-assisted laparoscopic reconstructive techniques are feasible and efficacious in the management of adult ureteral anomalies.

Neuronal hypertrophy in the neocortex of patients with temporal lobe epilepsy

The underlying cause of neocortical involvement in temporal lobe epilepsy (TLE) remains a fundamental and unanswered question. Magnetic resonance imaging has shown a significant loss in temporal lobe volume, and it has been proposed that neocortical circuits are disturbed functionally because neurons are lost. The present study used design-based stereology to estimate the volume and cell number of Brodmann's area 38, a region commonly resected in anterior temporal lobectomy. Studies were conducted on the neocortex of patients with or without hippocampal sclerosis (HS). Results provide the surprising finding that TLE patients have significant atrophy of neocortical gray matter but no loss of neurons. Neurons are also significantly larger, dendritic trees appear sparser, and spine density is noticeably reduced in TLE specimens compared with controls. The increase in neuronal density we found in TLE patients is therefore attributable to large neurons occupying a much smaller volume than in normal brain. Neurons in the underlying white matter are also increased in size but, in contrast to other reports, are not significantly elevated in number or density. Neuronal hypertrophy affects HS and non-HS brains similarly. The reduction in neuropil and its associated elements therefore appears to be a primary feature of TLE, which is not secondary to cell loss. In both gray and white matter, neuronal hypertrophy means more perikaryal surface area is exposed for synaptic contacts and emerges as a hallmark of this disease.