Early Esophageal Squamous Cell Carcinoma and Precancerous Lesions can be Detected by White Light Endoscopy with the Aid of White Substance

Objective: To investigate the diagnostic value of white substance in the detection of flat esophageal mucosal lesions and precancerous lesions associated with early esophageal squamous cell carcinoma Methods: Clinical and pathological data of patients diagnosed with flat esophageal mucosal disease were collected. The lesions were divided into a neoplastic group and a non-neoplastic group, and the clinicopathological differences between the groups were analyzed. The patients were also divided into two groups based on the presence of white substance after endoscopic examination: a “white substance” group and a “non-white substance” group. The differences between the two groups were analyzed. The diagnostic value of white substance for detection of early esophageal squamous cell carcinoma and related precancerous lesions was calculated and the pathological nature of white substance inferred. Results: In total, 183 patients with flat esophageal mucosal lesions were enrolled, including 92 (50.3%) with neoplastic lesions and 91 (49.7%) with non-neoplastic lesions. Forty-nine cases (26.8%) presented white substance in the esophageal mucosa. White substance was mainly found in female patients (57.1%), middle esophagus (75.5%), and 60-69-year-old patients (51.0%). Moreover, white substance was more frequently found in neoplastic than in non-neoplastic lesions (43.5% vs. 11.0%, p < 0.05). Consistently, neoplastic lesions were more represented in the white substance group than in the non-white substance group and the difference was statistically significant (79.6 vs. 20.4%, p < 0.05). 51% of the patients in the white substance group, but only 26.1% of those in the non-white substance group, had hyperkeratosis and necrosis, and the difference was statistically significant (p < 0.05). The diagnostic sensitivity of white substance for detection of early esophageal squamous cell carcinoma and precancerous lesions was 42.4% (95% CI, 32.8%–52.6%),the specificity 89.0% (95% CI, 80.8%–94.1%).Conclusions: White substance in the mucosa of flat esophageal lesions exhibited high specificity for the diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Thus, the presence of white substance in the esophageal mucosa, even in the absence of obvious lesions, may reflect the presence of latent early esophageal squamous cell carcinoma and precancerous lesions. White substance was associated with hyperkeratosis and necrosis.

Intranasal Ectopic Tooth- A Rare Case Report

Presence of ectopic tooth in the nasal cavity of an adult is a rare phenomenon. Exact etiology of this condition is yet to be confirmed. We report a case of a 40-year-old woman, who presented to us with the history of left nasal obstruction of one-year duration along with pain in the left side of face revealing an on examination. Intranasal tooth was removed by surgical intervention with Luc’s forceps. The patient’s nasal obstruction and facial pain subsided after the treatment. We need to suspect an intranasal tooth when there is a white substance mimicking bone in the nasal cavity in patients presenting to us with facial pain and nasal obstruction Keywords: intranasal tooth; nasal obstruction; surgical extraction

Early Esophageal Squamous Cell Carcinoma and Precancerous Lesions can be Detected by white Light Endoscopy with the Aid of White Substance

Previous studies have shown that the presence of white substance on the esophageal mucosa is associated with tumor lesions of the flat esophageal mucosa. Since the early lesions of esophageal mucosa are mostly flat, we reasoned that the white substance might also be indicative of early esophageal squamous cell carcinoma and precancerous lesions. Objective: To investigate the diagnostic value of white substance in the detection of flat esophageal mucosal lesions and precancerous lesions associated with early esophageal squamous cell carcinoma Methods: Clinical and pathological data of patients diagnosed with flat esophageal mucosal disease were collected. The lesions were divided into a neoplastic group and a non-neoplastic group, and the clinicopathological differences between the groups were analyzed. The patients were also divided into two groups based on the presence of white substance after endoscopic examination: a “white substance” group and a “non-white substance” group. The differences between the two groups were analyzed. The diagnostic value of white substance for detection of early esophageal squamous cell carcinoma and related precancerous lesions was calculated and the pathological nature of white substance inferred. Results: In total, 183 patients with flat esophageal mucosal lesions were enrolled, including 92 (50.3%) with neoplastic lesions and 91 (49.7%) with non-neoplastic lesions. Forty-nine cases (26.8%) presented white substance in the esophageal mucosa. White substance was mainly found in female patients (57.1%), middle esophagus (75.5%), and 60-69-year-old patients (51.0%). Moreover, white substance was more frequently found in neoplastic than in non-neoplastic lesions (43.5% vs. 11.0%, p < 0.05). Consistently, neoplastic lesions were more represented in the white substance group than in the non-white substance group and the difference was statistically significant (79.6 vs. 20.4%, p < 0.05). 51% of the patients in the white substance group, but only 26.1% of those in the non-white substance group, had hyperkeratosis and necrosis, and the difference was statistically significant (p < 0.05). The diagnostic sensitivity of white substance for detection of early esophageal squamous cell carcinoma and precancerous lesions was 42.4% (95% CI, 32.8%–52.6%),the specificity 89.0% (95% CI, 80.8%–94.1%).Conclusions: White substance in the mucosa of flat esophageal lesions exhibited high specificity for the diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Thus, the presence of white substance in the esophageal mucosa, even in the absence of obvious lesions, may reflect the presence of latent early esophageal squamous cell carcinoma and precancerous lesions. White substance was associated with hyperkeratosis and necrosis.

Distribution of lanthanum carbonate in the gastric mucosa confirmed by electron microscopy with a magnified endoscopy: a case report and literature review

We describe the case of a 70-year-old man with diabetic nephropathy undergoing hemodialysis. Four years following hemodialysis, he started taking lanthanum carbonate 1500 mg/day and lansoprazole 30 mg/day. Nine years following hemodialysis, he underwent screening esophagogastroduodenoscopy, which demonstrated the presence of the whitish cobblestone-like mucosa in the gastric corpus and multiple reddish depressed lesions with annular whitish mucosa in the antrum. With magnified narrow-band imaging endoscopy, a yellowish–white substance was observed in the villous structure, and subepithelial vessels were observed on the yellowish–white substance. Biopsies were taken from the whitish cobblestone-like mucosa of the upper corpus, a reddish depressed part of the antrum. Histologically, aggregates of cells containing amphophilic fine granular material were found in the mucosal interstitium. These cells stained positive for CD68 and were identified as histiocytes. Since he had been taking lanthanum carbonate for 5 years, we considered the possibility of histiocyte-mediated phagocytosis of lanthanum. Digital mapping via scanning electron microscopy with energy-dispersive X-ray spectrometry showed the presence of lanthanum and phosphorus in the interstitium and cytoplasm of histiocytes. The white, rough mucosa in the gastric body appeared 6 months following the commencement of lanthanum administration and still exists 3 years and 5 months after discontinuation of lanthanum.

Conservation issues and chemical study of the causes of alteration of a part of the Stave Church in Hopperstad (Norway)

An unidentified white substance was observed on the exterior parts of the southern side of Hopperstad Stave Church, located in Vik in Sogn and Fjordane (Norway). One of the 28 remaining stave churches in the country, Hopperstad Stave Church was built between 1130 and 1150 and it constitutes an important part of Norwegian cultural heritage. Such a substance was observed for the first time in 2009 and serious concerns about its harmfulness and origin have been raised. A comprehensive study involving non-invasive (portable XRF) and micro-invasive analyses (SEM, ICP-OES, TOC) was undertaken to investigate the physico-chemical nature of this white substance. Tarring, salt migration from the nearby cemetery, atmospheric agents, leakages from the roof, biological infestation, previous treatments with pesticides are among the possible causes of the phenomenon. This work—employing a unique approach in conservation/conservation science—indicates that the white substance is mainly inorganic and crystalline. It was, therefore, possible to exclude some of the possible causes, hence, clarifying some of the conservation issues of the church.

A Case of Esophageal Xanthoma with Epithelial Reactive Inflammation with a Characteristic Finding of Narrow-Band Imaging Magnifying Endoscopy

A 75-year-old woman had a 5 mm slightly elevated yellowish lesion in her thoracic esophagus. Narrow-band imaging magnifying endoscopy (NBI-ME) revealed aggregations of a tiny white substance beneath each intrapapillary capillary loop with weaving, dilatation, and a different shape. In this case, an irregular caliber was absent. The biopsy specimen taken from the lesion showed cells with large nuclei and increased chromatin clumping in the basal layer. These cells were positive for p53. Endoscopic submucosal dissection was performed for the purpose of excisional biopsy. Finally, it was diagnosed as an esophageal xanthoma with a benign epithelial reactive inflammation. This is the first report of esophageal xanthoma showing the characteristic NBI-ME finding of esophageal xanthoma. Further studies are required to determine whether the characteristic finding of NBI-ME is generally found in esophageal xanthomas.

Digital flexion contracture caused by tophaceous gout in flexor tendon

Gouty tophus is an unusual cause of digital flexion contracture. Awareness of this pathophysiology will lead to more confidence in proper treatment and surgical management of this rare condition. This report describes a case of digital flexion contracture by tophaceous gout distinguished between trigger finger and locking of the metacarpophalangeal joint. We found the flexor tendon with a deposited chalky white substance suggestive of gouty tophus intraoperatively. We performed tenosynovectomy and removed the chalky white substance to the greatest degree possible. Histological findings confirmed the diagnosis of gout. Postoperatively, the patient recovered nearly to a full range of motion of the affected digits. When meeting with the patient who has had hyperuricemia and who is unable to extend the affected digits suddenly, one must keep in mind digital flexion contracture caused by tophaceous gout.

Endophthalmitis Following Exposure of a Haptic After Sutureless Intrascleral Intraocular Lens Fixation

An 88-year-old woman who had undergone sutureless intrascleral fixation of the intraocular lens (IOL) 3 years previously was seen at an eye clinic because of ocular pain and loss of vision 2 days prior to this visit. She was diagnosed with endophthalmitis and referred to our hospital. At her first presentation here, the best-corrected visual acuity (BCVA) was 0.01 in the left eye, and conjunctival hyperemia and hypopyon were apparent. A haptic was exposed outside the conjunctiva at the nasal upper quadrant, with a white substance around the haptic. The fundus was not visible. We diagnosed endophthalmitis. That same day, we performed vitrectomy and IOL removal, immediately followed by intravitreal injection of antibiotic. The inflammation resolved gradually, and at the 1-year follow-up her BCVA had recovered to 0.6. Patients should receive careful, long-term follow-up after sutureless intrascleral IOL fixation.