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A case of clear-cell odontogenic tumor with unusual histological features is presented. A 61-year-old Japanese man was admitted because of swelling of the left premolar-molar region of the mandible. Radiological examination revealed a multilocular radiolucency with irregular margins. Histological examination of the resected specimen showed infiltrative proliferation of both clear and eosinophilic cells into the adjacent soft tissue without encapsulation, suggesting the malignant potential of the tumor. The tumor cells sporadically formed cystic lesions. In addition, several tumor cell nests showed duct-like characteristics, and many eosinophilic dentin-like structures were attached to the tumor cell nests, suggesting the potential for epithelial-mesenchymal induction. Histochemically, the clear tumor cells possessed cytoplasmic glycogen granules. Both clear and eosinophilic tumor cells showed positive immunoreactivities for cytokeratin 19, epithelial membrane antigen and filaggrin, indicating an odontogenic epithelial origin. [ABSTRACT FROM AUTHOR]

The authors describe autopsy cases of primary extranodal non-Hodgkin's lymphoma of the oral regions in 11 (8%) of 134 patients: 10 were clinical stage I[SUBE], and one was II[SUBE]. Histologic subtypes of each lymphoma included the diffuse large cell type (8 cases), diffuse mixed type (2 cases) and Burkitt's type (1 case) according to the Japanese Lymphoma Study Group (JLSG) classification. All patients received anti-lymphomatous chemotherapy and/or radiotheraphy. Nine cases had active disease, 3/9 manifesting leukemia. Nodes were involved. There was involvement of cervical lymph nodes in 7 (64%). Viscera most commonly involved were, in order of decreasing frequency: lung, kidney, pancreas, liver, spleen, heart, gastrointestinal tract, bone marrow, and adrenal gland. It is apparent that primary extranodal non-Hodgkin's lymphomas of the oral region arise in a single focus, and extensions of the disease are not random. The primary lesions spread to regional lymph nodes by way of lymphatic channels, and to extranodal organs of the intrathoracic and intraabdominal regions by contiguous direct invasion of adjacent organs and by blood-borne metastases. Wide spread dissemination at the time of death was found in 6 cases and 3 modes of spreading were observed. [ABSTRACT FROM AUTHOR]

The clinical, morphologic and immunohistochemical features of 10 cases of the low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of salivary glands are described. Although the initial histologic diagnosis in nine of these cases was myoepithelial sialadenitis, the diagnosis of primary salivary gland MALT lymphoma was based on the demonstration of light chain restriction and on morphologic characteristics. Histologic study showed a characteristic cytology, which included centrocytoid cells (composed of small centrocytes and monocytoid B cells) and a varying degree of plasma cell differentiation; the occurrence of epithelial or acinar invasion by neoplastic centrocytoid cells; and the presence of reactive lymph follicles among the neoplastic cells. Furthermore, multinucleate giant cells resembling Warthin-Finkeldey cells were detected in seven cases. In the light of these findings, cases previously diagnosed as myoepithelial sialadenitis require careful assessment and nine out of 32 cases are, in reality, examples of primary salivary gland MALT lymphomas. Immunohistochemical analysis of paraffin sections revealed the following characteristic immunophenotype of MALT lymphoma: L26, KiB3 and LN2 positive, and a monotypic immunoglobulin pattern (predominantly IgM/kappa). It was of interest that salivary gland parenchyma, infiltrated by neoplastic centrocytoid cells, reacted with LN3 for cells expressing human leukocyte antigen-DR (HLA-DR) antigens. Whereas salivary gland epithelia devoid of a neoplastic invasion were invariably negative for LN3. This suggests a lymphocyte-mediated role in salivary epithelial HLA-DR expression. It appears that HLA-DR expression is an inducible phenomenon in MALT lymphomas of salivary gland. [ABSTRACT FROM AUTHOR]

gSeventy cases (47M, 23F) of primary extranodai non-Hodgkin's lymphoma of the oral region were studied to determine tumor characteristics. The most frequent disease sites were the palate (21 cases), gingiva (17 cases) and parotid gland (13 cases). Each lymphoma was classified according to the criteria of the Working Formulation for Clinical Usage. Only 5.7% of cases were follicular lymphomas while diffuse lymphomas had a high incidence. Histologic subtypes included small lymphocytic (1%), small cleaved cell (7%), mixed small and large cell (20%), large cell (43%), large cell, immunoblastic (17%), lymphoblastic (9%) and small non-cleaved cell lymphoma (3%). Immunologic study utilizing the avidin-biotinylated horseradish peroxidase complex (ABC) technique demonstrated the presence of intracytoplasmic monoclonal immunoglobulin in 24 (34%) of the suggested B-cell lymphoma cases, 20 tumors (28%) were classified as T-cell lymphoma based on a positive reaction for mouse monoclonal antibody (UCHL-1) to T-cell related membrane antigen, 11 tumors (16%) contained intracytoplasmic &alpha,l-antitrypsin, suggesting true histiocytic lymphoma, 15 tumors (22%) did not contain immunoglobulin, UCHL-1 or &alpha,l-antitrypsin positive cells and showed no definite characteristics. [ABSTRACT FROM AUTHOR]

Retrospective and prospective studies of high resolution cross sectional echocardiograms were undertaken in order to establish an ultrasonic method for the non-invasive estimation of degeneration and fibrosis of the endomyocardium in cases of cardiomyopathy. When the echocardiograms of the ventricular wall were compared with the histological specimens intense abnormal echoes were seen at the sites of myocardial degeneration and fibrosis of the ventricular wall. The abnormal echoes classified into five types: types I, II, III-1, III-2, and III-3. Type I and type III-1 echoes were the strongest followed by those of types II and III-2, and then those of type III-3. The intensity of the abnormal echoes was 5-20 decibels stronger than that from intact tissue and was closely related to the consistency and density of the diseased tissue. These findings strongly suggest that the boundary between degeneration or fibrosis and the intact normal myocardium was the source of the abnormal myocardial echoes and that the extent and the pattern of the distribution of the sites of degeneration and fibrosis in the myocardium were reflected in the echo patterns. Thus the tissue characteristics of the sites of degeneration or fibrosis of the myocardium may be determined non-invasively by measuring the echo intensity. [ABSTRACT FROM PUBLISHER]

A lesion of the lumbar posterior endplate is sometimes identified in the spinal canal of children and adolescents; it causes symptoms similar to those of a herniated disc. However, the pathology of the endplate lesion and the pathology of the herniated disc are different. We present a rare case of a 23-year-old woman who developed progressive palsy of the lower leg caused by huge lumbar posterior endplate lesion after recurrent disc herniation.

This study compared the 1-year clinical outcomes and disc degeneration rates after transforaminal full-endoscopic lumbar discectomy (TF-FED), condoliase injection, open discectomy (OD), and microendoscopic discectomy (MED) for lumbar disc herniation (LDH). In total, 279 patients with LDH were divided into four treatment groups: TF-FED, OD, MED, and condoliase injection. Outcomes were evaluated on the basis of the complication rate, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS) scores, and the modified MacNab criteria. Surgical and hospital costs were assessed. Disc degeneration and endplate bone marrow edema were evaluated using magnetic resonance images. The mean postoperative JOABPEQ, VAS, or modified MacNab scores among the four groups had no significant differences. Additionally, the nerve injury or reoperation rate among the TF-FED, OD, and MED groups had no significant difference. However, the reoperation rate with condoliase injection was high because of residual disc herniation. Surgical and hospital costs were lower with condoliase injection and higher with OD and MED than those with TF-FED. With TF-FED and condoliase injection, the Pfirrmann grade progressed, and the disc height was significantly smaller than that with OD and MED. Endplate bone marrow edema was more common with condoliase injection and TF-FED. All groups had good outcomes. TF-FED and condoliase injection may reduce the burden of surgery because they can be performed under local anesthesia with little blood loss and low medical costs but tend to be associated with disc degeneration and endplate bone marrow edema. A randomized controlled study with a larger sample is needed.

Study Design: A cross-sectional and observational study., Objective: To investigate the incidence of bidirectional lumbar facet tropism and its relationship with lumbar spine disease in adolescents., Summary of Background Data: There is limited information on facet joint asymmetry in the sagittal plane in adolescents., Materials and Methods: The orientation of all lumbar facet joints was measured in the bidirectional planes on computed tomographic images for 191 patients with low back pain. The patients were divided into 4 groups according to age (<15 or ≥15 yr) and sex. The facet joint angle and tropism rate were compared among the groups. Facet tropism was defined as a difference in bilateral angle of >10° in the axial plane and >5° in the sagittal plane. Facet joint orientation was compared among groups using a one-way analysis of variance and Tukey honestly significant difference test or Games-Howell post hoc test and the incidence of facet tropism using the Kruskal-Wallis test with Bonferroni correction. The association of facet tropism with disease was investigated further by analyzing facet joint orientation and the incidence of facet tropism in 116 patients with single-level lumbar disease., Results: Facet tropism was observed in 8.7% of axial views and 7.5% of sagittal views. The incidence of axial facet tropism was significantly higher in male patients aged ≥15 years, especially at L4/5. Facet joint morphology in the axial plane was more coronal at L3/4 and L4/5 in male patients ≥15 years than in those <15 years. Facet joint morphology in the sagittal plane was unchanged at around 15 years of age in both sexes. Axial facet tropism was found at L4/5 in 55.6% of patients with herniated nucleus pulposus. There was a significant difference in sagittal facet orientation in patients with spondylolysis at L5. The facet angle was significantly larger in patients with L5 spondylolysis at L3/4 and L4/5., Conclusions: Facet tropism in adolescents is similar in the axial and sagittal planes. Facet tropism and specific morphology may be related to lumbar disk herniation and spondylolysis in this age group., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Both scapular dynamics and static scapular position are important in the treatment of shoulder dysfunction. This study aimed to create an index that can evaluate scapular position on plain radiographs and evaluate the relation between scapular position and posture accurately., Methods: Using four fresh frozen cadavers, we developed a glenoid angle grade based on the degree of overlap between the shadow of the coracoid inflection point and the upper edge of the scapula on frontal plain radiographs: grade 1, no overlap; grade 2, overlaps by less than half of the shadow; grade 3, overlaps by more than half. We then performed a retrospective cohort study that included 329 shoulders of 329 patients who underwent spine surgery. Spine alignment parameters (SPAPs), including cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured on standing lateral plain radiographs. Glenoid anterior tilt (GAT) and glenoid anteversion angle (GAVA) were calculated on frontal radiographs and three-dimensional computed tomography scans. Correlations between SPAPs and each angle were investigated, and independent influencing factors were sought in multivariate analysis. Individual factors, GAT, GAVA, and SPAPs were compared among the grades., Results: SPAPs associated with GAT were sagittal vertical axis (R = 0.14, P  = .011), TK (R = 0.12, P  = .026), and LL (R = -0.11, P  = .046). Multivariate analysis identified TK and LL as independent influencing factors (TK, P  = .001; LL, P  = .008). SPAPs associated with GAVA were CL (R = 0.17, P  = .002), TK (R = 0.29, P < .001), and LL (R = 0.25, P < .001). Multivariate analysis identified CL, TK, and LL as independent influencing factors (CL, P  = .01; TK, P  = .03; LL, P  = .03). There were 183, 127, and 19 cases categorized as grades 1, 2, and 3. GAT (grade 1, 24.0 ± 7.8; 2, 32.4 ± 7.0; 3, 41.0 ± 7.8), GAVA (1, 29.3 ± 7.6; 2, 33.7 ± 9.5; 3, 31.5 ± 8.3), and TK (1, 30.6 ± 13.6; 2, 35.1 ± 14.2; 3, 43.1 ± 20.4) differed significantly according to grade., Conclusion: We identified factors that influence scapular position and demonstrated that scapular position can be estimated by a grading system using plain radiographs., (© 2024 The Author(s).)

Background:  Full-endoscopic spine surgery (FESS) is a well-established procedure for herniated nucleus pulposus. It is a minimally invasive surgery that can be performed under local anesthesia through only an 8-mm skin incision. With improvements in surgical equipment such as high-speed drills, the indications for FESS have expanded to include lumbar spinal stenosis (LSS). We perform a transforaminal full-endoscopic ventral facetectomy (TF-FEVF) for unilateral nerve root-type lateral recess stenosis (LRS) using a transforaminal approach under local anesthesia.The aim of this study was to examine the postoperative results of TF-FEVF for LRS and to identify factors associated with poor surgical outcomes. 85 patients who underwent TF-FEVF for LRS under local anesthesia. Clinical outcomes were determined by visual analog scale (VAS) and the modified MacNab criteria. Evaluation was performed using magnetic resonance imaging (MRI), computed tomography (CT), and flexion-extension radiographs., Methods:  This study involved 85 patients (47 males and 38 females) who underwent TF-FEVF for LRS. The mean age was 70.5 years and the mean follow-up duration was 14.8 months. Data were collected on sex, age, level of operation, diagnosis, history of spine surgery at the same level, and duration of follow-up. The diagnosis was categorized as LSS with or without disk bulging. Clinical evaluation was performed using the VAS and modified MacNab criteria. MRI was used to evaluate the degree of disk degeneration, vertebral endplate degeneration, disk height, thickening of the ligamentum flavum, and stenosis. Bony stenosis was evaluated using CT. Sagittal translation and sagittal angulation were also measured by flexion-extension radiographs, and the Cobb angle was measured using a standing front view radiograph. All variables were compared between patients with excellent/good outcomes (E/G group) and those with fair/poor outcomes (F/P group) using the modified MacNab criteria., Results:  Postoperative VAS showed that leg pain decreased from 59.0 ± 28.6 preoperatively to 17.9 ± 27.2 at the final follow-up ( p  < 0.01) and that lower back pain also decreased from 60.7 ± 26.6 preoperatively to 27.3 ± 28.6 at final follow-up ( p  < 0.01). According to the modified MacNab criteria, the results during the final follow-up were excellent in 39 cases, good in 21 cases, fair in 13 cases, and poor in 12 cases. There were no significant differences in sex, age, diagnosis, history of spine surgery, and duration of follow-up periods between the 60 cases (70.6%) in the E/G group and the 25 cases (29.4%) in the F/P group. Imaging evaluation revealed statistically significant differences between the E/G group and the F/P group in intervertebral angle flexion (3.2 vs. 0.4 degrees; p  < 0.05), sagittal angulation (4.3 vs. 8.1 degrees; p  < 0.05), slip in flexion (0.9 vs. 2.8 mm; p  < 0.05), sagittal translation (0.7 vs. 1.6 mm; p  < 0.05), and Cobb angle (-0.5 vs. -1.9 degrees; p  < 0.05)., Conclusion:  Midterm results of TF-FEVF were generally favorable; factors contributing to good or poor TF-FEVF outcomes were large sagittal angulation, large sagittal translation, and concave side., Competing Interests: None declared., (Thieme. All rights reserved.)

Presently, the invasiveness of direct repair surgery for lumbar spondylolysis is relatively high. Thus, high school and junior high school students who play sports often cannot return to sports before graduation because of the invasiveness. The use of a robotic system enabled an accurate and minimally invasive procedure. Robotic-assisted minimally invasive direct pars repair surgery is useful for young patients with progressive spondylolysis., Competing Interests: None declared., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2024.)

Background: Full-endoscopic spine surgery via a transforaminal approach (TF-FESS) is minimally invasive and could help athletes quickly return to play. When treating professional athletes, we have to consider their season schedule. In this study, we investigated the characteristics of Japanese professional baseball players who underwent TF-FESS and examine how the timing of surgery influenced their postoperative course., Methods: Ten players who underwent TF-FESS (discectomy, foraminoplasty, or thermal annuloplasty according to their diagnosis) under local anesthesia were analyzed. Multilevel surgeries were performed at the same time in patients with lesions at multiple levels. The patients were divided into three groups according to timing of surgery (pre/during/post-season). Time to complete return to play and duration of official game loss were compared between the three groups., Results: All players (100 %) could return to their original level of professional play after FESS surgery. Seven of the 10 patients underwent two-level surgery. The mean time until complete return to play was 4.6 months (range, 2-8 months) and the mean duration of game loss was 1.5 months (range, 0-4 months). The mean duration of game loss was shorter in the post-season group than in the other groups (0.9 vs 2,4 months), and 4 of 6 patients in the post-season group did not miss any games., Conclusions: TF-FESS is a good technique for achieving a quick return to play in professional baseball players. In particular, surgery performed during the post-season could allow players to return to play after adequate rehabilitation with no game loss., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare that are relevant to the content of this article., (Copyright © 2024. Published by Elsevier B.V.)

Background: Many professional baseball players experience low back pain, a major cause of which is lumbar facet joint arthropathy., Purpose: To evaluate the relationship between the dominant hand side and facet joint morphology in baseball movement., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Participants were 25 Japanese professional baseball players (11 pitchers and 14 fielders) with low back pain and lower limb symptoms. Player age, hand dominance, and length of professional playing experience were recorded, and the lateral diameter of all lumbar facet joints was determined from the axial computed tomography scans. We defined the facet joints ipsilateral and contralateral to the dominant hand as dominant and nondominant, respectively. The nondominant-to-dominant (N/D) ratio of the lateral diameter was calculated, and differences between the pitchers and fielders were analyzed using the unpaired t test., Results: The average player age and length of professional playing experience were 26.9 years (range, 19-37 years) and 7.2 years (range, 1-15 years), respectively. The right hand was dominant in 9 pitchers and 5 fielders, while the left hand was dominant in 2 pitchers and 9 fielders. In pitchers, the average lateral facet joint diameter on the nondominant side was significantly larger than on the dominant side at all vertebral levels except L1 to L2 ( P < .05 for all). The N/D ratio for each facet joint was 1.06 (L1-L2), 1.11 (L2-L3), 1.10 (L3-L4), 1.12 (L4-L5), and 1.12 (L5-S1). In fielders, the average lateral facet joint diameter on the dominant side was significantly larger than on the nondominant side at L3 to L4 ( P < .05), with N/D ratios of 0.98 (L1-L2), 0.96 (L2-L3), 0.94 (L3-L4), 0.97 (L4-L5), and 0.98 (L5-S1). The N/D ratio was significantly larger in pitchers than in fielders at all levels ( P < .05 for all)., Conclusion: The facet joints of professional baseball players were enlarged asymmetrically, with different tendencies observed between pitchers and fielders. Although pitching and batting are movements that transmit the rotation from the lower limbs to the upper limbs, the effects of rotation and lateral flexion were associated significantly with facet joint hypertrophy., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Support was received from the Japan Orthopaedics and Traumatology Research Foundation (grant J4437). AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)