METHODS: This was an observational, retrospective cross-sectional study of computed tomography (CT) scan of paranasal sinus that had been performed on patients in Hospital Universiti Sains Malaysia and Hospital Sultanah Bahiyah done from January 2009 until December 2016. The presence of frontal recess cells variation was compared with other populations.
RESULTS: A total of 312 sides from 156 patients' CT scan images were analyzed. Left and right sinuses were considered individually. A total of 63 sides showed evidence of frontal sinusitis, 37 were male and 26 were female, whereas 249 sides were clear from frontal sinus disease. It was not much difference in mean age for frontal sinusitis patient (46.51±14.00) and patients without frontal sinusitis (48.73±16.44). The percentage was almost equal for CRS and non-CRS groups regardless of side and gender. In our study, the frontal recess cell such as agger nasi cell was found in almost all patients 98.1%, frontal ethmoidal cell type 1, type 2, type 3 and type 4 comprised of 28.8%, 31.1%, 14.4% and 0% respectively. Whereas, suprabullar cell can be seen in 40.3%, supraorbital ethmoid cells 16.7%, frontal bullar cell 33.0% and inter-frontal sinus septal cells 10.8%. There was a statistically significant association between the presence of frontal bullar cell and the development of frontal sinusitis (p value<0.001).
CONCLUSION: The frontal recess cells variation in Malaysian subjects were almost similar to those reported in other Asian populations such as Japanese, Taiwanese, Chinese and Korean. Our study found that frontal bullar cells had a significant association with the development of frontal sinusitis than other frontal recess cells. The understanding of the frontal recess anatomical structures was very important as this would lead to a successful treatment of CRS and at the same time it helped the surgeon to have a better plan of endoscopic sinus surgery to prevent the disease recurrence and surgical complication.
PRESENTATION OF CASE: A 19-year-old lady presented with a bleeding, fungating breast mass worsened with topical herbal concoction. Examination revealed a 10 × 15 cm fungating breast mass that obliterated her nipple- areolar complex (NAC). Computed Tomography (CT) scan reported a huge heterogeneously enhancing mass 10.6 × 14.5 × 15.1 cm with loss of normal fat plane with the overlying skin but a clear fat plane with the pectoralis muscle posteriorly.
DISCUSSION: Giant breast masses that fungate and ulcerate usually indicate a sinister pathology. Traditional remedies have been reported to exacerbate growth. In cases where most of the breast parenchyma and NAC has been destroyed, it is no longer possible to proceed with breast conserving techniques. Breast reconstruction is crucial in adolescents and should be tailored to the patient's existing breast size as well as body habitus.
CONCLUSION: In juvenile giant fibroadenomas where breast parenchyma and NAC has been destroyed, breast reconstruction is the goal. The lack of consensus in both diagnosis and management further compounds the difficulty in dealing with this sensitive population. Awareness needs to be raised regarding negative effects related to traditional medicine.
METHODS: CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured.
RESULTS: There were statistically significant differences between males and females for all measurements except for CTa (p 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability.
CONCLUSION: This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure.
CASE REPORT: We describe two unusual and diverse incidental adrenal gland lesions, an adenomatoid nodule and a mature ganglioneuroma. Both are deemed 'indeterminate' on radiological assessment. On histology, an adenomatoid nodule is composed of variably-dilated thin-walled cysts lined by bland flattened cells and solid areas of tubules lined by eosinophilic cells with plump nuclei and prominent nucleoli. The lining cells are immunoreactive for calretinin and WT1 while negative for CK5/6, ERG and CD31. Mature ganglioneuroma features fascicles of bland spindle cells with intermixed mature ganglion cells disposed within a background myxoid stroma with no immature neuroblastic component. These spindled Schwann cells are S100 positive.
DISCUSSION: Both adenomatoid nodule and mature ganglioneuroma are rare benign adrenal tumours that need to be differentiated from other, more common adrenal lesions. The management of adrenal incidentalomas is challenging. Surgical excision is indicated if an adrenal incidentaloma is more than 4 cm in size, shows malignant features on imaging or evidence of hormone excess.