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Tonsilloliths, also known as tonsil stones or tonsillar calculi are clusters of calcified material that form in crypts of palatine tonsil. They are usually of small size. Large or giant tonsilloliths are rare. We report a case of giant tonsillolith in left palatine tonsil and literature is reviewed. Keywords: Tonsillolith, Tonsil stone.

Background Three Nordic countries have national breeding programs to reduce the frequency of intervertebral disc disease in dachshunds. The programs include a radiographic examination of the vertebral column and dachshunds with more than four calcified discs visible on radiographs (CDVR) are discouraged from use in breeding. However, disc extrusion is also diagnosed in dachshunds without CDVR. The utility of the breeding programs is therefore questioned. Results A prospective study of 25 dachshunds surgically treated for disc extrusion was conducted. For all the dogs, preoperative radiographs were evaluated for detectable disc calcifications and preoperative computed tomography (CT) scans were evaluated for presence of calcified material in the vertebral canal. Postoperatively, extruded disc material was examined for degeneration and calcification by histology. Diagnostic imaging and histology were done independently. Radiographically visible calcification was identified in 17 (68.0%) of 25 extruded discs. Calcification was seen in the disc space for all these 17 discs, and for eight of the 17, there was also calcified material visible in the vertebral canal. Extruded material from all the 25 discs was found to be calcified, both by CT and histopathology. Conclusions In dachshunds with acute disc extrusion, radiographically visible calcification will frequently be found in the affected disc space, but not all affected disc spaces contain radiographically visible calcification. Using histopathology as the gold standard, a sensitivity of 0.3 (8/25) for radiography and 1.0 (25/25) for CT was found for detecting calcified disc material in the vertebral canal. Further, a sensitivity of 0.7 (17/25) was found for radiography for detecting remaining calcified material in the disc space. Thus, extruded disc material should be considered to be calcified, even in the absence of radiographically visible calcification.

Objective The aim of this paper is to provide information on the morphology and composition of gallstones based on clinical samples in order to assist paleopathologists and bioarchaeologists in recognizing their presence in archaeological contexts. Materials and Methods 270 gallstones were extracted and macerated from autopsies conducted at the Istituto di Medicina Legale in Milan (Italy) in order to simulate a dry bone recovered from archaeological contexts. Morphological, histological, and elemental variation was documented. Results Gallstones vary in size, shape, color and texture. The cross-sectional surface correlates with chemical composition and is a valuable tool for classification into subcategories of stones. Histological analysis can confirm the classification. Elemental analysis yielded a higher frequency of carbon, calcium and phosphorus. Conclusions Although identification of gallstones in archaeological contexts can be challenging, familiarity with morphological, histological, and elemental variation can assist researchers in the field and laboratory. Significance Identifying gallstones in archaeological populations will assist researchers in estimating their frequency in the past and the environmental, cultural, and biological conditions leading to their presence. Limitations Small sample size derived from a modern and limited autopsy population may minimize the types and degree of variation present in the past. Effects of climate, soil, and taphonomy were not evaluated. Suggestions for Further Research Examination of larger samples derived from diverse populations may reveal greater variation or more diagnostic aspects of stones.

A case of central odontogenic fibroma (COF) of the epithelium-rich type (granular cell variant) is reported. A 46-year-old female, demonstrated a multilocular, septated radiolucency below and between the roots of the teeth in 44–47 region. On microscopy the lesion revealed an odontogenic fibroma of the epithelium-rich type with areas characterized by lobules of spherical cells of varying size containing fine S-100 negative granules. In addition, scattered foci of cementoid/osteoid calcified material occurred. Based on several studies, the present authors entertain the hypothesis that supports a histiocystic origin the granular cells. Therapy consisted of curettage of the lesion. The defect was filled with spongeous bone. No recurrence occurred after follow-up of two years.

The rationale of debulking prior to stenting is to improve acute and long-term results of complex lesion angioplasty by reduction of plaque burden and/or reduction of calcified material prior to stenting, thus, allowing subsequent optimized stent-implantation and expansion. There are several registries analyzing the effect of various debulking-strategies prior to stenting in groups of selected patients and in high-risk subgroups. The majority of these studies performed DCA prior to stenting. In summary, these studies showed a reduction in restenosis rates and need for reintervention at long-term follow-up. The total TLR-rate (PCI, CABG) during a mean follow-up of 6 to 14 months is reported to be 4 to 14 %; the rate of restenosis is given as 7 to 14 %. However, until now, no large scale randomised “debulking prior to stenting” versus “conventional stenting without debulking” study has been published in detail. Several studies suggest benefit for debulking prior to stenting in complex lesion subsets, e. g., total chronic occlusions, ostial lesions, bifurcation lesions and saphenous vein grafts, but as of now, no convincing strategy has evolved.

Tumoral calcinosis (TC) is a rare condition named by Inclan in 1943 and is characterized by a large calcified mass occurring predominantly in the juxta-articular region of the extremity. This paper presents a 63-year-old man with TC of the gluteal region. Histopathological examination revealed deposits of amorphous calcified material surrounded by dense fibrous material. They were stained black with von Kossa stain. The diagnosis of TC was a source of confusion in the present research. Recently several reports reveal that the clinical and pathological features of the calcification of hemodialysis patients are quite typical of TC, but this is called calcification simulating tumoral calcinosis. We regard TC as a form of idiopathic calcification and should exclude the calcification of hemodialysis patients and small calcifications of the calcinosis cutis.

Objective: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). Subjects and methods: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. Results: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: −95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on Tl and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from −13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. Conclusion: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

BACKGROUND AND OBJECTIVE To describe the sonographic features of senile scleral calcification using ultrasound biomicroscopy. PATIENTS AND METHODS Four patients in whom senile scleral calcifications were found incidentally on computed tomography studies underwent ultrasound biomicroscopy examination. RESULTS The senile scleral calcification was bilateral in three patients and unilateral in one patient. In all patients, the calcified material created the anterior shadowing typical of calcified lesions. The ultrasound biomicroscopy study localized the senile scleral calcification to the subconjunctival layer, superficially above the sclera, and anterior to the horizontal muscles. CONCLUSIONS This is the first description of the ultrasound biomicroscopy features of senile scleral calcification. Ultrasound biomicroscopy may serve as a good tool for the accurate localization of the plaque. [Ophthalmic Surg Lasers Imaging 2007;38:115-117.] AUTHORS From the Department of Ophthalmology (NG-C, IB, DB), Rabin Medical Center, Beilinson Campus, Petah Tiqva; the Sackler Faculty of Medicine (NG-C, IB, DB), Tel Aviv University, Tel Aviv; and the Department of Ophthalmology (EN) and the Section of Neuroradiology (YS, IIR-G), Department of Imaging, Sourasky Medical Center, Tel Aviv, Israel. Accepted for publication December 20, 2005. The authors thank Irith I. Reider-Groswasser, MD, for her contributions to this article. Address correspondence to Nitza Goldenberg-Cohen, MD, Department of Ophthalmology, Rabin Medical Center, Petah Tiqva, 49100 Israel.

The ultrastructural features of calcification in a case of calcifying odontogenic cyst (COC) were studied. Scanning electron microscopic examination of the inner parts of the cyst wall revealed many short microvilli, and X-ray microanalysis of the high-density masses in the intercellular parts showed prominent calcium peaks, which meant that these masses were calcified materials. On transmission electron microscopic observations, many calcifications exhibited a distinctive ring formation around the periphery of a central core that consisted of an amorphous structure. These calcifications were observed with necrotic remnants of nuclear material and many identifiable mitochondria, thin fibers, and epithelial cells. The cytoplasm of ghost cells consisted of numerous short electron-dense tonofilament bundles. Needle-like structures were shown in the tonofilament bundles. X-ray diffraction analysis showed that the needle-like crystals were hydroxyapatite. It is suggested that calcification in a COC may be related to degenerative mitochondria and tonofilament bundles of ghost cells.

To the Editor: The recent article by Rockson, et al1 presents the results of a phase I trial of photodynamic therapy in patients with peripheral arterial disease. This report seems to be based on preliminary data that do not provide convincing evidence to support its conclusion, ie, that photoangioplasty holds promise as an alternative intervention for flow-limiting atherosclerosis. The lack of a control group and limiting the intervention to a single lesion that is not necessarily a flow-limiting stenosis are especially problematic. Smooth muscle cells constitute no more than 2% to 5% of the volume of the atherosclerotic plaque. Consequently, there is no basis for assuming that the cytotoxic effect of photodynamic therapy would reduce the plaque volume sufficiently to be hemodynamically significant. Even if these cells are killed and lysed, an explanation as to what happened afterward to the major extracellular components of the plaque (cholesterol deposits and fibrous and calcified material) seems necessary and important. Because there are …

This report describes a 31-year-old female patient with six impacted teeth. The crowns of the impacted teeth were surrounded with cyst-like lesions with a mixed internal structure and well-defined cortical borders. Microscopic examination of the specimen obtained from the follicle of the left mandibular third molar tooth revealed loose to moderately dense collagenous connective tissue with abundant calcified material and sparse epithelial islands. A diagnosis of multiple calcifying hyperplastic dental follicles was made. © 2013 by Korean Academy of Oral and Maxillofacial Radiology.

A 35 year-old male presented with multiple asymptomatic, tense, cystic to firm, skin-colored nodules within the scrotal skin with a provisional clinical diagnosis of a sebaceous cysts of the scrotum. Fine needle aspiration cytology (FNAC) was performed and a diagnosis of idiopathic calcinosis of the scrotum was suggested as no epithelial cells were found around amorphous, basophilic, calcified material. Histopathological examination confirmed the diagnosis. We report this case for its rarity.

The clinical and histological findings of our six cases of CEOT support the previously reported deta for this tumor. Regarding the ossification in this lesion it might be suggested that the degenerative calcified material induces dentinoid tissue formation.

A case of a high excitation threshold that occurred 2 years 5 months after the initial implantation of pacemaker electrodes is described in a girl 4 years 3 months of age. This complication was considered to be due to calcification of the platinum-iridium electrode spurs. The calcified material was shown to be a kind of apatite using the X-ray powder diffraction method. This complication is rare, but it must be kept in mind since battery longevity has markedly improved in recent years.

A case of adenomatoid odontogenic tumor involving the right upper cuspid region of a 17-year-old girl is described. In light microscopy, liminal structures and rosette-like structures were found in the parenchyma of the tumor. Electron microscopic observations revealed that the rosette-like structures were less organized than the luminal structures; the luminal structures are supposed to be associated with secretory activities including the formation of calcified material which show the apatite pattern by electron diffraction. The origin and differentiation of cells constituting the tumor are discussed.

THE ULTRASTRUCTURE of nondecalcified supragingival and subgingival calculus was studied in mature deposits. To facilitate sectioning of the embedded material, a thin reinforcing film of plastic was painted on the block. A new film was applied for each section. Light microscopy showed that supragingival calculus was heterogeneous with islets of calcified material within the covering plaque and with noncalcified areas within the calculus. Under transmission electron microscopy supragingival calculus was heterogeneous, dominated by microorganisms, small needle-shaped crystals and large ribbon-like crystals. In the covering soft plaque small crystals were often scattered in the intermicrobial matrix. In the supragingival calculus itself noncalcified microorganisms were surrounded with densely packed small crystals. There were also rosettes and bundles of large crystals. Subgingival calculus was homogeneous in light microscopy. The covering plaque contained no calcified material and only calcified material was seen within the calculus itself. Transmission electron microscopy of subgingival calculus revealed crystals of small size only. Subgingivally very few noncalcified microorganisms were seen within the calculus. The bacterial cell wall seemed to be the structure that was last calcified, both supragingivally and subgingivally.

In seven new cases of cervical intervertebral-disc calcification of unknown etiology, all but one patient (Case 4) had an acute episode of pain in the neck, limitation of motion, and torticollis. The similarity to calcific tendinitis is suggested. Trauma or infection may initiate the symptomatic episode. Three of our patients also had calcified material in the prevertebral tissues; this did not alter the favorable prognosis. Very rapid regression of the calcification was noted in most of our patients. This syndrome is probably a much more common entity than the few reports in the literature would suggest.

A jaw tumour in a child presented diagnostic difficulties because of the presence of myxomatous elements and actively forming cementum-like calcified material. The 5-year follow-up suggests that this was an unusual benign odontogenic tumour.

The literature on pulpal calcifications has been reviewed. The incidence of calcified bodies in human dental pulps is probably higher than most studies have suggested because of the problem of underreporting. Two possible modes of development exist: initial calcification of isolated pulp tissue components, which may occur anytime and anywhere in the pulp tissue, and epithelio-mesenchymal interactions during odontogenesis, which may occur only in the furcation areas and near the root sheath. The composition of the calcified bodies varies.They may be composed of “ortho” dentin, nontubular “fibro” dentin or irregular calcified material. Frequently the calcified bodies are conglomerates of these different tissues. The traditional classification of true and false denticles, based on histological characteristics, is difficult to maintain in view of this complexity of composition. Clinically, pulpal calcifications most likely are symptoms, not the cause of pathosis.

Cortical calcifications, seen on X-ray in the brain of a child suffering from leukaemia, were submitted to morphological and chemical analysis. The morphology was studied by a combination of low temperature ashing and microscanning. The calcification principally affected axons and capillary walls and consisted of spherules amalgamated into hollow cylinders. The results of chemical analysis of the calcified material were compared to those obtained in a case of Fahr's disease. The mineral composition and structure of both types of calcification were similar, but the Mn concentration was higher in the case of Fahr's disease. X-ray diffraction showed that the calcification consisted of amorphous calcium phosphate and acid calcium orthophosphate, most probably precursors of hydroxyapatite.

Summary Nephrocalcinosis was diagnosed as an incidental histopathological finding in 2 Sprague-Dawley rats of ISO g bodyweight, The calcified material was located along the entire corticomedullary junction. Dietary and other causes of nephrocalcinosis are discussed. Nephrocalcinosis is commonly found in older rats, but only infrequently reported in young ones, although the lesions have been seen in animals as young as 2-3 months of age (Casey, Ayers & Robinson, 1978; Paterson, 1979). This report describes the incidental finding of nephrocalcinosis in young Sprague-Dawley rats.