Background: Giant cell tumour of bone (GCTB) is a locally aggressive neoplasm that may recur after treatment and, in uncommon cases, metastasise to the lungs. This report describes pulmonary metastases following recurrent GCTB of the proximal tibia. Case Presentation: A 43-year-old man had previously undergone curettage and bone cement filling for GCTB of the right proximal tibia. Local recurrence developed one year after the initial diagnosis and was treated with subcutaneous denosumab for five months. The patient discontinued treatment without medical advice. Subsequent enlargement of the recurrent mass prompted further imaging and lower-limb amputation. Approximately one year later, he presented with progressive dyspnoea and persistent cough. Chest imaging demonstrated a left mediastinal–pulmonary mass and multiple lesions with a cannonball appearance. Flexible bronchoscopy showed no endobronchial tumour. Histopathological examination of a computed tomography-guided transthoracic needle biopsy identified mononuclear stromal cells and multinucleated giant cells, supporting pulmonary metastasis from GCTB. Clinical and radiological assessment found no recurrence at the amputation site. Following multidisciplinary review, denosumab was selected for further treatment. Conclusion: This case illustrates pulmonary metastatic disease following recurrent proximal tibial GCTB despite extensive local treatment. It supports consideration of continued clinical surveillance and individualised assessment of pulmonary lesions. The temporal association between treatment discontinuation and disease progression does not establish causality.
Haemophilia A and B are X-linked bleeding disorders caused by deficiency of coagulation factor VIII and factor IX, respectively. Therapeutic options have changed more in the past decade than in the preceding half-century, with subcutaneous substitution and rebalancing agents, ultra-extended factor concentrates and liver-directed gene transfer all entering routine or near-routine use. This critical narrative review examines how far that therapeutic transformation is matched by the underlying evidence, and where the clinical and conceptual foundations of haemophilia care remain unsettled. Literature was identified through structured searching of bibliographic and open scholarly sources, supplemented by citation tracking and authoritative institutional reporting, and was appraised for design, measurement validity, representativeness and consistency rather than catalogued descriptively. Several conclusions are robust: factor activity determines broad bleeding risk but predicts individual phenotype only loosely; early prophylaxis prevents structural joint damage whereas prophylaxis begun after arthropathy is established improves function without reversing structure; and all currently licensed bleed-prevention strategies reduce bleeding rates substantially when compared with episodic treatment. Other widely held positions are weaker than their citation frequency suggests. The relative immunogenicity of plasma-derived and recombinant factor VIII remains contested between a randomised trial and large observational cohorts whose discrepancy is not fully explained by design alone. Annualised bleeding rate, the endpoint on which almost all regulatory evidence rests, is insensitive to subclinical joint bleeding and to the outcomes patients prioritise. Gene therapy produces durable but declining and highly variable factor expression, and its comparative position against modern non-factor prophylaxis has not been tested directly. Across every domain, the evidence base is geographically narrow, drawn predominantly from high-income settings in which fewer than one in five people with haemophilia worldwide receive care. Priorities for the next decade include head-to-head comparisons of bleed-prevention strategies, joint-structure endpoints with demonstrated measurement properties, prospective evaluation of thrombotic risk with rebalancing agents, and evidence generated in the settings where most undiagnosed disease resides.
Background: Accurate shade assessment supports aesthetic dental restoration, but information about associations between age, sex and tooth shade components among younger adults remains limited. Aims: The study aimed to determine the influence of age and sex on tooth shade and its components in young adults aged 16–30 years. Study Design: Cross-sectional study. Place and Duration of Study: Port Harcourt, Rivers State, Nigeria, between January 2021 and December 2024. Methodology: The study included 150 young adults from the Ogoni ethnic group in Rivers State, Nigeria, who had good oral hygiene, normal teeth, and no conditions that could affect tooth shade selection. The participants were divided into the 16–19- and 20–30-year age groups. A Tooth Colour Comparator (Model YS-TCC-A) was used to determine tooth shade and its components objectively (chroma, hue, value) following the manufacturer’s instructions. Three experienced dental surgeons, including one woman, independently determined the tooth shades visually according to the standard protocol. The VITA 3D-Master shade guide was used to match the shade of the upper right central incisor. Participants who were unwilling to remove their bright make-up or jewellery were excluded from the study. IBM SPSS Statistics software version 20.0 (Armonk, NY: IBM Corp.) was used to analyse the data. The chi-square test (Monte Carlo) was used to assess the relationship between sociodemographic variables and tooth shade and its components. The threshold for statistical significance was set at p < 0.05. Results: Of the 150 participants, those aged 20–30 years (79; 52.7%) and female participants (98; 65.3%) constituted the majority. The chi-square test showed a statistically significant association between age group and tooth shade and between sociodemographic variables and chroma when the instrument-based method was used, but no such associations were found with the visual method. Conclusion: Sociodemographic variables may be associated with tooth shade and one or more of its components even among individuals aged 16–30 years.
Background: Managing paediatric patients with special health care needs (SHCN) presents significant behavioural and operational challenges in clinical dentistry. Although medical and functional classification systems are available, they may not directly reflect the adaptations and care settings required for dental treatment. Aim: To introduce a four-category stratified clinical framework for classifying children with SHCN according to anticipated dental management requirements. Technical Design: The proposed framework comprises four categories: Category I (Routine Dental Care), for children who can receive care in routine dental settings with minor support; Category II (Modified Dental Care), for children requiring additional behavioural, environmental, communication or accessibility adaptations; Category III (Advanced Dental Care), for children requiring specialised techniques, multidisciplinary coordination or referral to hospital-based dental services; and Category IV (Comprehensive/Complex Dental Care), for children with profound disabilities or life-threatening systemic conditions requiring complex hospital-based dental management. Classification is based on anticipated treatment complexity and necessary modifications to dental care rather than diagnosis alone. Conclusion and Clinical Significance: The proposed four-category framework may support individualised treatment planning, clinical adaptations, referral decisions and communication among dental teams, caregivers and other healthcare professionals. As a conceptual proposal, the framework requires formal validation before its reliability and clinical utility can be established.
Background:Ameloblastic fibroma is an uncommon benign mixed odontogenic tumour composed of epithelial and ectomesenchymal elements. It usually affects younger patients and more frequently involves the posterior mandible than the maxilla. This report describes an adult patient with posterior maxillary involvement and a clinical suspicion of recurrent unicystic ameloblastoma. Case Presentation: A 30-year-old man presented with swelling and pain in the left upper posterior jaw approximately two years after surgery for unicystic ameloblastoma. Examination demonstrated a solitary swelling of the left posterior maxillary/alveolar region extending towards the palate, with focal erythema and ulceration. Radiographic examination revealed a well-defined, expansile, unilocular radiolucency involving the region of teeth 25–28, measuring approximately 35.49 mm superoinferiorly and 33.62 mm anteroposteriorly. Imaging showed cortical expansion, thinning and perforation, with extension towards the infraorbital floor, maxillary sinus, adjacent nasal cavity and oral cavity. Histopathological examination of submitted tissue fragments demonstrated cords, strands and islands of odontogenic epithelium within a hypercellular primitive ectomesenchymal stroma. Peripheral palisading, reverse polarity, stellate-reticulum-like cells and focal myxoid changes were also observed. The overall findings were suggestive of ameloblastic fibroma. Conclusion: This case illustrates the importance of correlating clinical and radiographic impressions with histopathological findings when assessing an unusual posterior maxillary lesion, particularly in a patient with a history of odontogenic tumour surgery.
