A 72 year-old male, seven years later the first diagnosis of rectal adenocarcinoma, referred a trouble in hard palate. Clinical examination evidenced a whitish coloured projecting area, not painful at palpation and with the largest diameter of 2 cm. The first biopsy suggested a neoplastic lesion but it was not resolutive for diagnosis. Another biopsy was executed. The second histological report evidenced a neoplastic infiltration of poorly differentiated adenocarcinoma, with mucinous aspects and necrosis. Immunophenotype was compatible with diagnosis of metastasis of adenocarcinoma originated from large bowel. The pathological diagnosis was confirmed by a second pathologist.
A case of squamous cell carcinoma of the base of tongue presenting initially as a cystic metastasis in the contralateral neck is described. The patient complained of a painless mass in the left neck, which was removed and histologically diagnosed as cystic malignancy. One year and seven months after the removal, a squamous cell carcinoma of the right tongue base and cystic metastases of the right neck were discovered. The histologic similarity among these three lesions strongly indicated the cystic metastases in the bilateral neck were from the squamous cell carcinoma of the tongue base.
A case of tongue cancer developing in a 33-year-old man 7 years and 7 months after allogenic bone mallow transplantation (BMT) for acute myeloid leukemia is presented. The patient received chemotherapy and total body irradiation of a total dose of 12 Gy in a conditioning regimen. He was affected with chronic graft-versus-host disease after BMT, but had not complained of symptom in the oral cavity. Oral examination showed an ulcerative mass with induration at the right lateral border of the tongue. The mass was diagnosed as a squamous cell carcinoma by biopsy. The tumour was surgically removed. There was no evidence of recurrence or metastasis 9 months after surgery. The necessity of long-term follow-up of the oral cavity in recipients undergoing BMT is emphasized.
Kuttner tumor (KT) was first described in 1896 by Kuttner. It occurs mainly in the submandibular gland and usually presents as a firm and painful swelling. An important aspect of KT is its clinical resemblance to a salivary gland neoplasm. Histologically, the disease is characterized by progressive periductal sclerosis, acinar atrophy, and gland infiltration by lymphocytes. However, for a reliable diagnosis of KT an immunohistochemical analysis of lymphocyte subtypes is required. We report a case of KT that involved minor salivary glands of a patient that was undergoing radiotherapy in the head and neck region.
We herein report a case of the effectiveness of 4 Gy single fraction high-dose-rate mold brachytherapy in the palliative treatment of a painful recurrent soft palate carcinoma in a previously irradiated field. A 73-year-old man with a painful recurrent squamous cell carcinoma in the right soft palate in a previously irradiated field was treated with high-dose-rate mold brachytherapy. Although only 4 Gy could be delivered, the patient showed a reduction in the degree of pain in the right soft palate after the treatment. Unfortunately, the patient died of interrecurrent disease with pleural metastases five months after the brachytherapy.
A case of odontogenic sarcoma with smooth muscle differentiation arising in a 70-year-old woman is described. The lesion grew out of an extraction socket and enlarged rapidly. Radiographically, a large radiolucent lesion with ill-defined margins was observed in the left posterior mandible. Histopathologically, islands of odontogenic epithelium with a surrounding malignant mesenchymal proliferation were noted. The latter exhibited hyperchromatic oval and spindle-shaped cells with 3–4 mitoses in some high-power fields and foci of necrosis. Lesional cells demonstrated immunoreactivity with vimentin and alpha smooth muscle actin, but were negative for antibodies directed against S100, CD34 and CD31. Cytokeratins highlighted the epithelial islands, but did not react with the mesenchymal proliferation. To date, fewer than 70 cases of odontogenic sarcoma have been described in the literature. To our knowledge, this is the first report of an odontogenic malignancy showing smooth muscle differentiation.
Papillary cystadenocarcinoma is an extremely rare malignant neoplasm characterized by cysts and papillary endophytic projections. It was first defined in 1991 by WHO. We presented a case of papillary cystadenocarinoma arising from the submandibular gland in a 78-year-old male patient, and discussed the clinical, histopathological and treatment features of this rare entity in the light of the current literature.
Kaposi’s sarcoma (KS) has been considered the most common malignancy associated with human immunodeficiency virus (HIV) infection because of its propensity to develop in such individuals.This article, reports an unusual presentation of a disseminated oral KS lesion with extensive visceral involvement in an otherwise healthy young African-American male leading to a positive diagnosis of HIV.
Malignant fibrous histiocytoma (MFH) of the maxilla is a rare neoplasm. A round 61 cases reported in the international literature since 1974. We present a rare case of primary MFH of the maxilla in the unusual location of maxilla in a 64-year-old man. The tumor was located in the left tuberosity of maxilla extending from the junction between soft and hard palate towards premolar area of edentulous ridge, and measured 7cm×6cm. Histologically, it consisted of spindle-shaped, pleomorphic malignant cells in a storiform pattern associated with histiocyte-like cells and giant cells. Mitotic figures were frequent Immunohistochemically, most of the tumor cells were strongly positive for vimentin, and negative with S-100 protein, cytokeratin, actin, desmin, HMB45 and epithelial membrane antigen. Ultra structurally, the tumor have clearly shown spindle shaped fibroblastic and giant cells with well-known pleomorphic multi-segmented nuclei, prominent branching and often dilated rough endoplasmic reticulum (RER). Histopathological and ultra structural findings are consistent with high-grade MFH of the storiform/pleomorphic subtype. Four months later the patient came with residual/recurrent tumor that was confirmed histopathologically. The literature is briefly reviewed.
Soft tissue has been recently recognized as a primary site for myoepithelial tumour and only a small number has been reported to occur in the head and neck. Although the majority of myoepithelial tumours of the soft tissue are benign, some can be aggressive and develop distant metastases.
Adult rhabdomyoma (AR) is a rare benign tumor of the skeletal muscle that usually occurs in the head and neck region. AR present in a mean age of 50 years and occur commonly in males than females (4:1). Treatment is excision and recurrence is rare. The aim of this paper is to describe the clinicopathologic features of an AR and its differential diagnosis to avoid unnecessary aggressive treatment and present the fifth AR occurred in a child.
The adenoid pattern seen in Basaloid squamous carcinoma (BSC) and adenoid cystic carcinoma (ACC) of head neck region may form a major portion in biopsies and pose diagnostic difficulties. In the present case histology of tongue swelling revealed an adenoid pattern with squamous differentiation and keratin pearls in some of these adenoid spaces. The overlying mucosa showed an in situ squamous carcinoma. Immunohistochemical (IHC) stains showed CK and EMA positivity in squamous and adenoid areas, CEA was positive only in squamous areas while Vimentin and S100 protein were negative. These IHC stains thus helped in the distinction of BSC from ACC as ACC is clinically less aggressive.
The authors presented a second reported case of dedifferentiated liposarcoma of the pyriform sinus in a 50-year old male, with a history of heavy smoking, airway obstruction and dysphagia. A computed tomography (CT) of the neck and thorax revealed a retroesophageal lobulated heterogenous mass. A laryngoscopic examination disclosed sessile polypoid mass in the right pyriform sinus. Microscopically, the neoplasm consisted of areas of well-differentiated liposarcoma and a non-lipogenic component (dedifferentiated component). These two parts were co-mingled, giving a mosaic pattern. Well-differentiated liposarcoma was characterized by adipocytes with a great variation in size, and multivacuolated lipoblasts. Immunohistochemical studies showed positive reactivity with vimentin and smooth muscle actin in non-lipogenic component. This neoplasm shows histological and immunohistochemical features of dedifferentiated liposarcoma with myogenic differentiation.
Leiomyoma of the nasal cavity is an extremely rare tumor and a search of the literature revealed only 24 prior reports. We present two cases of leiomyomas arising from the wall of the nasal cavity with the symptom of nasal obstruction, which they were treated by complete surgical excision.
A rare case of chondrosarcoma of the mandibular symphyseal region in a 39-year-old man is presented. The patient complained of a recurring and growing mass on the labial side of the mandibular gingiva extending from the right lateral incisor to the left canine. Radiographs showed irregularly shaped osteoblastic lesion with radiopacity corresponding to the mass. MR images showed the lesion to be well-defined and adjacent to the labial cortex without bone marrow invasion. The mass was histologically diagnosed as grade 2 chondrosarcoma. Nineteen months after marginal resection with tumour-free margins, there was no evidence of recurrence or metastasis.
Spindle cell lipoma is a benign tumour composed of mature fat cells, spindle cells, and a myxoid matrix separated by thick bands of birefringent collagen. Oral spindle cell lipoma is a very rare lesion. We report a case of spindle cell lipoma of the cheek. A 42-year-old woman was referred to our department because of a painless swelling on the left cheek. Clinical examination revealed a mobile, well-demarcated mass of the cheek. The tumour was removed surgically under general anaesthesia. A histopathological specimen revealed a spindle cell lipoma. Following surgery, no evidence of recurrence has been observed.
Ancient schwannoma rarely occurs in the oral cavity. Reviewing the literature, only six intra-oral cases of ancient schwannoma have been reported in the English-language medical literature. Here we present an intra-oral ancient schwannoma in a male patient with, to our knowledge, the longest reported duration: 18 years. In addition, a brief review of the pertinent literature is included.
The odontogenic keratocyst (OKC) is well known for its tendency to recur, potential aggressive behaviour and defined histopathological feature. OKC occurrence in the maxilla is unusual and its appearance in the maxillary sinus very uncommon. This article reports two distinct cases of OKCs associated with unerupted molars in the maxillary sinus of two boys. The lesions were surgically treated and no recurrence has been observed on follow-up. OKC clinical features and treatment are discussed.
Adenomatoid odontogenic tumor (AOT) is a benign (hamartomatous), non-invasive lesion with slow but progressive growth. There are three variants of AOT: follicular, extrafollicular, and peripheral. This report illustrates an unusual case of AOT, i.e., arising within the periodontal ligament. A boy was brought in by his parents for evaluation of a gingival swelling. Periapical radiograph revealed thickening of the periodontal ligament with foci of calcification. Clinical diagnosis was peripheral ossifying fibroma. Biopsy was performed and microscopic examination revealed the presence of an AOT. The patient has been followed-up for eleven months without recurrence.
This article describes the importance of proper intraoral surgical management of an HIV positive patient who had previously received radiation therapy for the treatment of squamous cell carcinoma (SCCA). The report discusses the risk of developing osteoradionecrosis (ORN) following radiation therapy, additional oral complications and dental management documenting the need for the oral health care provider to understand these sequelae in order to best treat HIV positive patients post radiation therapy.
