Caceres’ Corner Case 142 (Update: Solution)


Dear Friends,

Welcome back! To start the academic year I would like to show a case seen by Dr. Pepe while I was vacationing in Minorca.

Radiographs belong to a 35-year-old woman with pain in the mandible for the last two years. CT of the mandible before biopsy and pre-op PA chest radiograph are shown. After seeing both, Dr Pepe suggested a diagnosis. What do you think?

Check the images below, leave your thoughts in the comments section, and come back on Friday for the answer.

CT mandible

CT mandible

PA chest

PA chest

Click here for the answer to case #142

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    Sep 2016
    DISCUSSION 23 Comments

    23 Responses to : Caceres’ Corner Case 142 (Update: Solution)

    1. genchi bari italia says:

      ….pregiatissimo Professore, displasia fibrosa della mandibola ed opacità micronodulari al polmone sono suggestive per sclerosi tuberosa e linfangioleiomiomatosi….un saluto, in abbraccio…..

    2. Jose Caceres says:

      Welcome, old friend!
      To early to offer a comment. Wait till Friday

    3. GS says:

      Histiocytosis LCH

    4. Ania says:

      Paget’s disease

    5. UFTM radiogroup says:

      Hi, Profesor, welcome back!!
      There are some nodular lesions in pulmonary apices and lytic lesions in mandibule. We think in Histiocytosis LCH. Is this person a smoker?

    6. Ilu says:

      Could be unusual case of sarcoid though? lytic bony lesions and some pulmonary nodules..

    7. Ilu says:

      Whenever I look a this case, cannot stop thinking about gorlin goltz syndrome.
      I know it is neither common nor highly testable stuff and we shall all go for the most common first but the history of the young lady makes me actually think so..

    8. Ilu says:

      Is there a spina bifida th1 Professor? Dont see well on the cell phone..if yes thats my gorlin then. However , lets just forget the suspected finding, I could be wrong. I only wanna say that – Someone could even show us a picture of a zara t- shirt, after such history, this syndrome should be somewhere on our differential list anyway. Thats my last comment I promise as I do not want to take the whole floor.

    9. Jose Caceres says:

      Glad to have yu back!
      Yes, she smokes

    10. Diogo says:

      It´s great to have you back, professor!!

    11. uli says:

      So it is not the Gorlin Syndrome? It is super cool case I think. Thank U.

    12. 19medicus83 says:

      ovoid and elliptical subcortical, well-defined, lytic lesions in the mandible combined with reticulo-nodular opacities in the lung apices in an otherwise normal lung x-ray.
      LCH would be a good diagnosis as the patient is a smoker, keeping in mind multiple myeloma and paget`s disease.
      best greetings from austria, professor…

    13. Jose Caceres says:

      As far as I remember, Gorlin’s does not affect the lung. It’s a nice diagnosis, though

    14. uli says:

      Would it be fine to add an unusual manifestation of sarcoidosis of mandible and sarcoid lung to our ddx list? I ve seen a gorlin syndrome with lung mets once but now I see this one is not the case. Is that LCH path – proven already? Superwork Professor.

      • Jose Caceres says:

        Your opinions are welcome and enrich the discussion. Don’t see any spina bifida. Anyway, non-united posterior neural arches are not uncommon and are non-specific.
        I would expect sarcoidosis to have enlarged lymph nodes at this stage. Or else, fibrosis with hilar retraction.
        In summary: if you hear hoofbeats, think horses, no zebras 😉

        • Ilu says:

          Got it, we shall go for the most common and everything would rather be a common horse until proven otherwise. Uncommon zebras as ddx of exclusion. And a holiday on Minorca would be a good idea for all those who think zebras, no horses 😉

    15. MK says:

      I think Langerhans Histiocitosis is a good diagnosis because of a lytic lesion in the mandible angle. In the PA rx I see an enlargement of the lower portion of the vascular hilum and a intersticial thikening in the upper lobes wifi a nodule in the URL.

    16. Joe Lowry says: