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We show the benefits of denosumab as adjuvant treatment of gnathic central giant cell granulomas (CGCGs) in 3 female patients, ages 18 to 65. This case series contributes to the growing experience in the medical therapy of these aggressive lesions, and demonstrates denosumab’s potential to decrease surgical morbidity. Central giant cell lesions of the jaw can be locally aggressive and thereby result in severe tissue destruction. Several medications have been evaluated as adjuvant therapy for CGCGs, with investigation of denosumab being the most recent. Our goal was to definitively treat patients with large CGCGs while minimizing unnecessary tissue and function loss. All 3 patients were offered adjuvant therapy with denosumab, since surgical resection alone would have resulted in large segmental defects requiring jaw reconstruction with free tissue transfer. Treatment instead consisted of lesion curettage and adjuvant denosumab therapy. The denosumab treatment protocol we used was based on what is currently recommended for unresectable giant cell tumors of bone (GCTB). Patients have been monitored for 40 months with clinical and radiographic exams, and 2 of them have also had histological evaluation following initiation of denosumab treatment. The 3 patients improved subjectively after the first few denosumab injections and had objective clinical and radiographic improvement after less than 6 months of therapy. Medication treatment length ranged from 10 to 15 months. Radiographic exams showed cortical thickening, resolution of cortical perforations, and calcification within a previously radiolucent region. Our findings are consistent with previous reports, and further support for the use of denosumab in locally aggressive central giant cell lesions. Our patients have thus far avoided large segmental resections, temporomandibular joint disarticulation, and sensory loss which would have resulted from surgical treatment alone. These 3 cases show that denosumab can be effective as adjuvant therapy in the treatment of aggressive gnathic CGCGs.

Background Liquid based cytology (LBC) specimens are increasingly utilized for molecular analysis, as results are comparable to molecular analysis performed on traditional specimens (biopsy or cell block). However, there are few studies demonstrating the long-term viability of DNA in LBC samples. Methods In this study, a 50-gene next generation sequencing (NGS) panel was performed on DNA isolated from post-centrifuged supernatant LBC samples of cases of non-small-cell lung carcinoma. Comparison was made to results of an identical NGS panel performed on a concurrent clinical sample (biopsy or cell block). Quality parameters including DNA concentration, total reads, amplicons with reads under 450 and 350, and variant allele fraction were also compared. For a subset of LBC samples, DNA was isolated after being held for varying extended lengths of time after collection (up to 41 days) at 5°C and results compared. Results Results of NGS mutation analysis were concordant between LBC samples and clinical samples. DNA concentration was on average higher in the LBC samples compared to the clinical samples. The remaining metrics were more variable, but illustrated the adequacy of LBC samples for NGS testing. DNA isolated from LBC samples held for longer periods of time was of good concentration. NGS analysis was successfully performed on all samples, with concordance with results of clinical samples. Conclusion DNA isolated directly from LBC fluid is suitable for NGS analysis. DNA is also stable in LBC preservative for extended periods of time before isolation and NGS analysis can subsequently be successfully performed.

The mesiodens is the most common kind of supernumerary tooth; it is found in the midline of the maxilla. Horizontal orientation is the least common, accounting for about 6% of cases. During osteological analysis of the skeleton of a 3 to 5 year old child recovered from Hank's site (41RB109) in the northern Texas panhandle, an impacted horizontal, conical mesiodens was identified. The skeleton dates to the Plains Village period, ca. A.D. 1,200 to 1,500, when village-based peoples practiced a mixed hunter-gatherer/horticulture subsistence. This mesiodens is located in the right maxilla, just lateral to the midline of the hard palate and parallel to the intermaxillary suture. The root projects ventrally and protrudes through the external alveolar bone between the central incisors. The crown is conical. Although sometimes found in association with certain congenital disorders, the mesiodens appears to be idiopathic in this case. While possibly painful due to its proximity to the nasopalatine nerve, no sequela from the tooth growth and impaction are evident.

Most giant cell tumors of bone (GCTs) occur in patients aged 20 to 40 years. We analyzed features of GCT in patients 55 years or older.GCTs were examined for fibrosis, matrix, cystic change, histiocytes, mitoses, and necrosis. Clinical/radiologic data were collected.Thirty-four (5%) of 710 GCTs occurred in patients older than 55 years (14/20 male/female; 56-83 years) in long bones (n = 24), vertebrae (n = 6), pelvis (n = 3), and metacarpal (n = 1). Imaging was classic in 26 of 27 cases; one case appeared malignant. Morphologic patterns included fibrosis (n = 29), bone formation (n = 19), cystic change (n = 8), necrosis (n = 8), foamy histiocytes (n = 7), and secondary aneurysmal bone cyst formation (n = 1). Mitoses ranged from 0 to 18 per 10 high-power fields. Six recurred; one patient developed metastasis. Four of five cases harbored H3F3A mutations.GCTs in patients 55 years or older share pathologic characteristics with those arising in younger adults. Fibrosis and reactive bone are common, potentially leading to diagnostic confusion in this population. No histologic features correlate with adverse outcome.

A search for unmarked graves in the state-owned right of way and underneath the pavement of State Highway 332 resulted in the discovery and archeological excavation of 11 unmarked graves associated with Pioneer Cemetery, an African American burial ground in Brazoria, Texas. Prewitt and Associates, Inc., conducted the fieldwork for the Texas Department of Transportation’s Archeological Studies Program. Between 2008 and 2012, the 11 unmarked graves were discovered, exhumed, analyzed, and then reinterred in Pioneer Cemetery in September 2012. This report describes the bioarcheological investigations of those burials along with 3 other unmarked burials that were previously exhumed and reburied in 2003. The mortuary remains, especially the manufacturing dates on the coffin hardware, indicate that the 14 exhumed burials date to the late-nineteenth century and early-twentieth centuries. Based on the osteological evidence, the deceased persons were 5 women, 2 men, 2 indeterminate adults, and 5 children. Seven of the 14 individuals display skeletal traits indicating that they are of African descent, but 2 indeterminate adults and 5 children do not. Based on historical evidence, it is likely that all 14 individuals were African Americans, and several of the older individuals may have been born into slavery. These 14 burials do not constitute a representative sample of the African Americans in Brazoria County or the town of Brazoria, but they are an interesting and historically significant burial population nonetheless. The overall health status of these people was generally good, with no evidence of abnormally high pathologies. However, skeletal remains of several older individuals exhibited evidence of various forms of degenerative joint disease indicative of lives spent doing hard labor. One adult male had an amputated leg and an iron and wooden prosthesis; it is not known if the loss of his leg was due to violence, accidental trauma, or disease. Several of the Pioneer burials exhibit traits that may represent mortuary behaviors of African origin. Three individuals had vaulted burials, with the casket or coffin located inside a shaft under a protective wooden arch. One adult female was buried with a complete whiteware saucer and a bird talon that was partially wrapped in gold plating and may have been worn as a necklace.

Five corner tang bi/aces were recovered as grave inclusions with two burials, a young adult male and a child, at the Silo site (41KA102), a Late-Transitional Archaic mortuary and habitation locale in the northern portion of south Texas. Analysis of these corner tangs suggests their specific manufacture as grave goods. The association of grave goods with individuals of varying age and sex categories has led to a general assumption of relatively egalitarian societies inhabiting south and southeast Texas during the period. However, a review of the comparative literature and of social and subsistence patterns during the Late Archaic suggests instead that peoples at the Silo site, as well as across the region, were not entirely egalitarian. In particular, the interment ofhigh quality and rare grave goods, like the corner tangs, were part of both status display and status competition during this period.