Zarina I. Lockhat

Toothy craniopharyngioma: a literature review and case report of craniopharyngioma with extensive odontogenic differentiation and tooth formation

A young child presenting with a craniopharyngioma (pituitary adamantinoma) demonstrated the rare phenomenon of pronounced odontogenic elements/tooth formation on imaging. The origin of the craniopharyngioma from primitive stomatodeum theoretically facilitates odontogenesis [1]. Theories of the genesis of this tumour include remnants of the craniopharyngeal duct, squamous metaplasia of anterior pituitary cells and misplaced tissue of the embryonic enamel organ [2]. A literature review documents six cases of craniopharyngioma with tooth formation although none appear to be as extensive as the case presented. Craniopharyngioma should be added to teratoma in the differential diagnosis of suprasellar odontogenic elements demonstrated by imaging studies.

The thoracic surface anatomy of adult black South Africans

Surface landmarks or planes taught in anatomy curricula derive from standard anatomical textbooks. Although many surface landmarks are valid, clear age, sex, and population differences exist. We reappraise the thoracic surface anatomy of black South Africans. We analyzed 76 (female = 42; male = 34) thoracoabdominal CT‐scans. Patients were placed in a supine position with arms abducted. We analyzed the surface anatomy of the sternal angle, tracheal, and pulmonary trunk bifurcation, azygos vein termination, central veins, heart apex, diaphragm, xiphisternal joint, and subcostal plane using standardized definitions. Surface anatomy landmarks were mostly within the normal variation limits described in previous studies. Variation was observed where the esophagus (T9) and inferior vena cava (IVC) (T8/T9/T10) passed through the diaphragm. The bifurcations of the trachea and pulmonary trunk were inferior to the sternal angle. The subcostal plane level was positioned at L1/L2. The origin of inferior mesenteric artery was mostly inferior to the subcostal plane. Sex differences were noted for the plane of the xiphisternal joint (P = 0.0082), with males (36%) intersecting at T10 and females (36%) intersecting at T9. We provide further evidence for population variations in surface anatomy. The clinical relevance of surface anatomical landmarks depends on descriptions of normal variation. Accurate descriptions of population, sex, age, and body type differences are essential. Clin. Anat. 29:1018–1024, 2016.

The thoracic surface anatomy of adult black South Africans: A Reappraisal From CT Scans.

Surface landmarks or planes taught in anatomy curricula derive from standard anatomical textbooks. Although many surface landmarks are valid, clear age, sex, and population differences exist. We reappraise the thoracic surface anatomy of black South Africans. We analyzed 76 (female = 42; male = 34) thoracoabdominal CT‐scans. Patients were placed in a supine position with arms abducted. We analyzed the surface anatomy of the sternal angle, tracheal, and pulmonary trunk bifurcation, azygos vein termination, central veins, heart apex, diaphragm, xiphisternal joint, and subcostal plane using standardized definitions. Surface anatomy landmarks were mostly within the normal variation limits described in previous studies. Variation was observed where the esophagus (T9) and inferior vena cava (IVC) (T8/T9/T10) passed through the diaphragm. The bifurcations of the trachea and pulmonary trunk were inferior to the sternal angle. The subcostal plane level was positioned at L1/L2. The origin of inferior mesenteric artery was mostly inferior to the subcostal plane. Sex differences were noted for the plane of the xiphisternal joint (P = 0.0082), with males (36%) intersecting at T10 and females (36%) intersecting at T9. We provide further evidence for population variations in surface anatomy. The clinical relevance of surface anatomical landmarks depends on descriptions of normal variation. Accurate descriptions of population, sex, age, and body type differences are essential. Clin. Anat. 29:1018–1024, 2016.

Idiopathic carpal tarsal osteolysis (ICTO) with additional elbow involvement

ICTO is a rare congenital disorder characterized by bone resorption affecting mainly the carpal and tarsal bones [1]. Previously it was known as idiopathic multicentric osteolysis and was first described in 1838 by this term [2]. Tyler et al. also preferred the term idiopathic multicentric osteolysis (1976) as this encompassed the wide array of descriptive terminology used to describe this condition in the literature [3]. The term idiopathic carpal tarsal osteolysis was first used by Froelich and Coerret in 1937 [1, 4]. It is also known as multicentric carpal-tarsal osteolysis with and without nephropathy, and the association of renal failure was first described by Marie et al. in 1951 [2, 4]. The condition may occur sporadically or is inherited as an autosomal dominant or recessive condition [4]. Knowledge about the genetics of this condition is still evolving. It was divided into five subtypes by Hardegge et al. in 1985. Type I is inherited as an autosomal dominant condition and is infrequently associated with renal involvement. Type II is inherited as autosomal recessive with no renal involvement. Type III is sporadic with frequent renal involvement [2]. Type IV is also known as Gorhams disease and is unicentric and caused by haemangiomatosis. Type V is also known as Winchester syndrome and is associated with a different clinical presentation, corneal clouding, contractures, and skin lesions [2, 3]. Patients with ICTO present in early childhood with progressive acromelic joint pain, limitation of movement, swelling, and deformity [2, 4]. The onset of disease usually begins around age 2 or 3. Laboratory findings are normal with no evidence of inflammatory, metabolic, or autoimmune diseases [2, 4]. This was the case with our patient. The radiologic findings are characteristic with osteolysis of the carpal and tarsal bones and adjacent tubular bones [2]. The involvement of the adjacent metacarpals is described as “sucked candy” [3]. Osteolysis of the distal ulna (more than the radius) causes ulna deviation of the hand. Similar findings in the feet cause clubfoot deformity [2]. In this case there was asymmetry of the involvement of the hands. The changes on the right side were much more pronounced with the sucked candy appearance of the proximal metacarpals in contrast to the truncated appearance on the opposite sides. In contrast there was more The case presentation can be found at doi:10.1007/s00256-011-1233-0.

Facial approximations: Characteristics of the eye in a South African sample

Although guidelines for facial approximations, including those for the eye, are in use in South Africa, limited data on African populations exist to confirm its validity. As precise placement of the eyes in facial approximations is of importance for facial recognition, this study tested established guidelines by measuring specific instrumental dimensions. Forty-nine cadavers from the Sefako Makgatho Health Sciences University and the University of Pretoria were dissected to determine the position of the canthi and the size and position of the eyeball in the orbit. Thirty cone beam computer tomography scans and 30 computer tomography scans from the Oral and Dental and Steve Biko Hospitals respectively were used to determine the size of the eyeball. Results from this study were compared to the published guidelines. The most prominent discrepancies included a more rectangular shape of the orbit, an oval shaped eyeball and a different position of the canthi. In African faces, the medial canthus was found to be located higher than the lateral canthus. The distance between the endocanthion and superior orbital margin was 17.7mm and the exocanthion and superior orbital margin 19.5mm. Inter-population differences may have an effect on facial approximations and its accuracy as is often demonstrated in practice. The findings of this study should be taken into consideration when designing population specific guidelines for reconstruction of the eye in South Africans of African ancestry.

Isolated posterior fossa involvement of progressive multifocal leucoencephalopathy in HIV: A case series with review of the literature

Progressive multifocal leucoencephalopathy (PML) is a progressive demyelinating condition resulting from infection with the John Cunningham virus and precipitated by immunocompromised states. The HIV pandemic, especially in sub-Saharan Africa, has resulted in an increase in the number of patients presenting with PML. Imaging plays an important role in diagnosis and the distribution of the disease is predominantly supratentorial. Isolated posterior fossa involvement is a rare finding with very few cases described in the literature. We present the largest case series of patients described in the literature, with isolated posterior fossa involvement of PML, in HIV-positive patients.

Does radiotherapy prior to surgery improve long term prognosis in pediatric colorectal cancer in lower- and upper-middle income countries with limited resources? Our experience and literature review

Colorectal carcinoma in children and adolescents is extremely rare, with an annual incidence <0.3 cases per million, most frequently reported in the second decade of life. It accounts for severe morbidity and poor prognosis owing to the low index of suspicion, delayed diagnosis, advanced stage at presentation and the aggressive tumor nature. Patients present with abdominal pain, vomiting, constipation, abdominal distension, rectal tenesmus, iron-deficiency anemia, change in bowel habit and weight loss. Rectal bleeding is an uncommon presentation in children. Bowel obstruction presents frequently in children compared to adults. In 90% of pediatric cases, colorectal carcinoma occurs sporadically. In 10%, predisposing conditions and syndromes are identified. We present a case study of a 12-year-old female with advanced colorectal cancer without a predisposing disease or syndrome, who received radio-chemotherapy ten weeks prior to radical abdominopelvic surgery, followed by radio-chemotherapy postoperatively, with a positive outcome.

Challenges of cancer imaging in Africa

Africa as a continent is subdivided into different regions, Northern, Eastern, Western, Middle and Southern Africa. Sub-Saharan Africa refers to the combined Eastern, Middle, Southern, and Western regions. These subdivisions are important as the disease and cancer spectrum found in specific regions is quite different. Similar to the differences found between Africa and the developed world, cancer incidence and mortality patterns vary remarkably across regions within Africa because of the substantial differences in economic development, and social, cultural and other environmental factors, including major known risk factors [1].The occurrence of cancer in Africa varies remarkably by type of major cancer, stage at diagnosis, survival, incidence and mortality rates. This is largely due to differences in exposure to major risk factors, detection practices (availability of diagnostic and screening services), awareness of early signs and symptoms, and availability of treatment [1]. The cancer burden of each region will be discussed and some of the factors related to cancer imaging and the challenges faced will be highlighted. Recent statistics and data for some parts of Africa are lacking, relatively representative in other parts, however more available for sub-Saharan Africa, which will probably be the greater focus of the discussion. There are many significant global organisations that are constantly working to alleviate the cancer burden, and conduct research. There is significant vendor interest and investment in imaging equipment, and therapeutic modalities in scattered parts of Africa, although more focused in certain parts of Africa. There is major local and international focus in establishing cancer centres in Africa, yet the predicted increase in the cancer burden, is phenomenal. Collaborative and novel solutions are being explored through initiatives that involve international, regional and local organisations. These programmes include the procurement, installation, and maintenance of diagnostic and therapeutic imaging equipment. There is much to be done, in the realm of screening, diagnosis, training, teaching, treatment and research, and this has to be an on-going, focused, enthusiastic effort by all countries in sub-Saharan Africa, the entire continent of Africa and key global cancer bodies. Much has been done in the last few years however much more still has to be done. As Victor Kgomoeswana highlights in his book “Africa is open for business”, Africa needs investment.

Potential pitfalls - pips or polyps?

28 SA JOURNAL OF RADIOLOGY • March 2006 A variety of pips and chewed nuts can simulate disease by appearing as multiple filling defects on the double-contrast barium enema. The unwary and untrained eye might interpret these filling defects as multiple polyps, leading to the wrong diagnosis and unnecessary further investigations or treatment. A case of multiple linseeds mimicking polyposis coli on doublecontrast barium enema has been described by Petty and Mannion. The following similar cases were noted. Case 1. A 73-year-old woman presented with abdominal pain. A double-contrast barium enema showed multiple pointed oval-shaped filling defects (Fig. 1a, white arrows). On retrospective enquiry, the patient confirmed taking linseed regularly for constipation and also ingested grapes during the 3 days prior to the examination. The filling defects noted were not consistent with linseed size and shape, and most likely represent filling defects from grape seed. To simulate the picture of linseed and grape pip filling defects, linseeds (Figs 1b and c), grape pips (Fig. 1d) and liquid barium were placed in latex surgical gloves and Xrayed to simulate double-contrast barium study. Prior to the study, the linseeds and grape pips were soaked overnight in tepid water to account for natural seed swelling occurring during bowel transit. Case 2: Two cases of mealie pips simulating polyps (Figs 2a c, white arrows) were seen during double-contrast barium enema studies. Both male patients confirmed ingestion of mealies prior to the investigation. Case 3: A 54-year-old-female patient underwent a double-contrast barium enema study for rectal bleeding and change in bowel habits folPotential pitfalls – pips or polyps?