1/22. Melanin pigmented oncocytic metaplasia of the nasopharynx.A 64-year-old man presented with a history of discomfort of the throat of a few weeks' duration. Nasoscopic examination revealed multiple small, brown pigmentations at the left suprapharynx, the base of the left nasal cavity and the pharyngeal openings of the auditory tube on both sides. Microscopically, the lesion showed a glandular pattern of oncocytic epithelium with abundant pigmented granules and melanophages in the surrounding stroma. Immunohistochemically, the dendritic cells in the basal layer were positive for S-100 protein. Electron microscopic study revealed numerous fully melanized melanosomes and hypertrophied mitochondria in the oncocytic cells. Oncocytic cells do not produce melanin for themselves, melanin granules apparently being transferred from the adjacent dendritic cells to the oncocytic cells.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/22. Proliferative verrucous leukoplakia: report of two cases and a discussion of clinicopathology.Proliferative verrucous leukoplakia (PVL) is a recently delineated but poorly recognized form of multifocal leukoplakia that is premalignant and of unproven origin. PVL generally presents as a simple benign form of hyperkeratosis that tends to spread and become diffuse. Although slow-growing, the disease is persistent and irreversible. Clinically, PVL often presents as an exophytic wart-like form of leukoplakia that appears to be resistant to nearly all forms of therapy. PVL of the oral cavity is best-defined as a continuum of oral epithelial disease with hyperkeratosis at one end of a clinical and microscopic spectrum and verrucous carcinoma or squamous cell carcinoma at the other. The microscopic findings associated with PVL are dependent on the stage of the disease and the adequacy of the biopsy. Microscopic findings can be markedly variable. PVL is a clinicopathologic disorder that includes the microscopic entity known as verrucous hyperplasia as a component of its histopathologic progression. This article reports on two cases of PVL, describes the clinicopathology of the disease process, and presents therapeutic and etiologic considerations.- - - - - - - - - - ranking = 6.2952534444564keywords = oral cavity, cavity (Clic here for more details about this article) |
3/22. Strain persistence of invasive candida albicans in chronic hyperplastic candidosis that underwent malignant change.OBJECTIVES: The aim of this study was to assess persistence and tissue invasion of candida albicans strains isolated from a 65 year-old patient with chronic hyperplastic candidosis (CHC), that subsequently developed into squamous cell carcinoma (SCC). MATERIALS AND methods: C. albicans (n=7) were recovered from the oral cavity of the patient over seven years. Confirmation of CHC and SCC in this patient was achieved by histopathological examination of incisional biopsy tissue. dna fingerprinting was performed on the seven isolates from the CHC patient together with a further eight isolates from patients with normal oral mucosa (n=2), chronic atrophic candidosis (n=1), SCC (n=1) and CHC (n=4). Genotyping involved the use of inter-repeat PCR using the eukaryotic repeat primer 1251. Characterisation of the tissue invasive abilities of the isolates was achieved by infecting a commercially available reconstituted human oral epithelium (RHE; SkinEthic, Nice, france). After 24 h, C. albicans tissue invasion was assessed by histopathological examination. RESULTS: dna fingerprinting demonstrated strain persistence of C. albicans in the CHC patient over a seven year period despite provision of systemic antifungal therapy. The strain of C. albicans isolated from this patient was categorised as a high invader within the RHE compared to other isolates. CONCLUSIONS: Candidal strain persistence was evident in a patient with CHC over seven years. This persistence may be due to incomplete eradication from the oral cavity following antifungal therapy or subsequent recolonisation from other body sites or separate exogenous sources. The demonstration of enhanced in vitro tissue invasion by this particular strain may, in part, explain the progression to carcinoma.- - - - - - - - - - ranking = 12.590506888913keywords = oral cavity, cavity (Clic here for more details about this article) |
4/22. Inverted papilloma invading the orbit.Inverted papilloma is an unusual entity for many ophthalmologists. We report a case of inverted papilloma of the nasal cavity and sinuses, invading the orbit in a 33-year-old man. The patient presented with a right medial canthal mass, proptosis, diminution of vision, epiphora and nasal obstruction. In the past, he underwent multiple procedures for surgical removal of the tumor with frequent recurrences. A computed tomographic scan revealed a mass filling both the nasal cavities and sinuses, destroying adjacent bones and invading the medial aspect of the orbit, leading to proptosis. Excision of the tumor was performed by a lateral rhinotomy approach. The tumor proved to be an inverted papilloma with focal transformation to transitional cell carcinoma. Post-operative CT scan revealed residual tumor, which responded to radiotherapy, with no recurrence over six months. Histopathologically, these tumors are benign, but locally invasive. The tumors that invade the orbit are usually locally aggressive, highly malignant and recur frequently. Radical excision of the tumor is technically difficult and often incomplete, so radiotherapy should be considered as an adjunct to surgery.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/22. Ectopic pituitary adenoma with malignant transformation.We report here a case of ectopic pituitary adenoma with malignant transformation after repeated relapses. First, an ectopic pituitary adenoma producing follicle-stimulating hormone was found in the nasal cavity extending to the frontal cranial fossa. Despite repeated surgical resections of the tumor, it recurred three times in 2 years. The tumor gradually showed cellular atypia, mitosis, and necrosis. Immunohistochemical analyses revealed that the expressions of proliferating cell nuclear antigen and MIB-1 increased progressively. Moreover, the expression of p53 was detected at the second recurrence. Finally, at the third recurrence the tumor showed dissemination to the subarachnoid space and multiple metastases in the brain. The patient died of the tumor 10 months after the last resection. These findings indicate that the ectopic pituitary adenoma became malignant. To our knowledge, this is the first report on malignant transformation of ectopic pituitary adenoma. It is important to know that ectopic pituitary adenomas show malignant transformation and that the above parameters (proliferating cell nuclear antigen, MIB-1, and p53) may be useful indicators of the malignant potential of both ectopic and sellar pituitary tumors.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/22. epidermodysplasia verruciformis: 14 members of a pedigree with an intriguing squamous cell carcinoma transformation.A 38-year-old farmer was apparently well until 5 years of age. At this age, the patient's mother found mildly itchy, raised eruptions over the scalp during combing of the scalp hair. Since then, the eruptions have progressed insidiously to involve the face and other parts of the body, with a preponderance over the face, upper back, and chest, including the palms. The soles, oral cavity, and genital tract were unaffected. The lesions were persistent in nature and showed no remission or exacerbation. Mild to moderate pruritus/discomfort was experienced following sunlight exposure. A prominent, raised eruption appeared on the right side of the forehead 9 years ago, 25 years after the initial eruptions, which in due course ulcerated. It was progressive in nature and acquired a large size. Two years later, it was diagnosed as squamous cell carcinoma, for which liquid nitrogen cryosurgery was performed. There was a recurrence of the lesion at the site of surgery, which was excised 4 months later. Subsequently, there was a sudden flare up at the same site. It was badly infected with maggot infestation. The relentless course of the disease was evident by the appearance of two similar lesions, one on the right half of the nose and the other on the left preauricular region. A short while ago, fatigue and loss of weight were also recorded. Bladder and bowel functions were normal and there was no loss of appetite, hoarseness of voice, or breathlessness. Four of the patient's six children (three sons and one daughter) were reported to have similar lesions all over the body. In addition, nine other relatives were also affected. Accordingly, a total of 14 (12 males and two females) family members were found to be affected from amongst 41 individuals (26 males and 15 females) spread across several generations (Fig. 1). There was a second-degree consanguinity of marriage, with the patient's grandmother and wife's father being brother and sister. skin surface examination was marked by multiple, discrete, flat-topped, scaly, brownish-black papules of diverse morphology, from hypopigmented macules to verrucous lesions, with a few coalescing to form plaques. The scales were brown, dry, and adherent (Fig. 2a). The lesions were conspicuous by their presence over the face, neck, and front and back of the chest. The extremities were also affected. Nevertheless, the soles and genitalia were spared. The oral mucosae, hair, and nails were normal. Koebner's phenomenon was explicit, whereas Auspitz's sign was not demonstrable. In addition, a perceptible nodulo-ulcerative lesion (size, 3 in x 2 in) with indurated, raised, averted margins was encountered on the right side of the forehead. The ulcer was tender and had a fetid discharge. Necrotic slough was prominent over its base. Similar lesions were located on the left preauricular region and right half of the nose. hematoxylin and eosin-stained sections prepared from biopsies taken from representative lesions of epidermodysplasia verruciformis and squamous cell carcinoma revealed their diagnostic features. epidermodysplasia verruciformis showed features of hyperkeratosis and acanthosis with hardly any papillomatosis. Marginal elongation of the rete ridges was present. Extensive vacuolization was a remarkable feature, and was largely confined to the upper stratum Malpighian and the granular cell layer. Some of the vacuolated cells were fairly large; their nuclei were located in the center and had variable pyknosis. The granular cell layer was uniformly thickened, whereas the stratum corneum had a loosely felted (basket-weave) appearance. The dermis was apparently normal (Fig. 2b,c). The other microsection(s) from squamous cell carcinoma were conspicuous by the presence of hyperkeratosis, acanthosis, and irregular masses of epidermal cells, proliferating downwards and invading the dermis. Varying proportions of differentiated squamous cells formed their bulk. These cells were atypical, characterized by variations in size and shape, hyperplasia and hyperchromasia of the nuclei, absence of prickles, chas, characterization of individual cells, and the presence of both mitotic and atypical mitotic figures (Fig. 3b).- - - - - - - - - - ranking = 6.2952534444564keywords = oral cavity, cavity (Clic here for more details about this article) |
7/22. Midline malignant B-cell lymphoma with leukemic transformation.This article presents a case of lethal midline granuloma on the palate of a 44-year-old woman, which had been identified histologically as B-cell lymphoma with leukemic transformation in the terminal stages. At the first visit, physical and laboratory examinations showed no remarkable findings except for a necrotizing ulcer of the palate, and the biopsy specimens only showed massive inflammatory cell infiltration and necrosis of the granulation tissue. There was a short-term resolution after treatment with cyclophosphamide and prednisolone, but the disease reactivated and the necrotic ulcerative lesion progressively advanced into the nasal cavity. Specimens from the third biopsy exhibited histologic features that were consistent with malignant lymphoma of the diffuse, mixed B-cell type. Chemotherapy with the regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone was adopted but was interrupted after a short time because of bone marrow suppression. Subsequently, large numbers of enlarged abnormal lymphocytes with a few vacuoles in the cytoplasm appeared in the circulating blood, indicating leukemic transformation of the midline lymphoma. The patient died on the seventh day after the initiation of chemotherapy. In the presentation of this case, the authors mention clinically important matters regarding midline lethal lymphoma and briefly discuss the pathophysiology and pathogenesis.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/22. Middle ear carcinoma originating from a primary acquired cholesteatoma: a case report.OBJECTIVES: To describe middle ear carcinoma originating from the matrix of primary acquired cholesteatoma in a 43-year-old man and to discuss the relationship between middle ear carcinoma and cholesteatoma. STUDY DESIGN: Case report. SETTING: Department of otolaryngology, Head and neck Surgery of Niigata University Medical and Dental Hospital, which is a tertiary care center, Niigata, japan. PATIENT: A 43-year-old man demonstrated symptoms resembling those of cholesteatoma: facial palsy, gradually progressive hearing loss, and chronic draining of the right ear. Other objective findings also supported a finding of cholesteatoma, but a computed tomographic scan and magnetic resonance imaging scan showed a well-enhanced mass and extensive bony erosion in the middle ear. At surgery, a granulous tumor in the mastoid cavity was diagnosed as squamous cell carcinoma, and closely coexisting cholesteatoma was found. Surgical specimen demonstrated carcinoma and cholesteatoma in the same field. INTERVENTION: radiation and chemotherapy were performed followed-up by mastoidectomy. CONCLUSION: Because middle ear carcinoma has a poor prognosis, it is important to detect lesions early. It is necessary to consider that middle ear carcinoma arises from not only chronic otitis media or surgical invasion but also from primary acquired cholesteatoma.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/22. Dedifferentiated liposarcoma of the oral cavity with angiosarcomatous dedifferentiation.We report a unique case of a 42-year-old woman with a dedifferentiated liposarcoma of the soft tissue of the oral cavity with angiosarcomatous dedifferentiation. Liposarcomas compromising the head and neck region are very unusual, and most of the cases in oral cavity show a well-differentiated pattern. Dedifferentiation in liposarcomas occurs in about 10% of the cases and, when it occurs, the dedifferentiated areas usually resemble high-grade fibrosarcoma or pleomorphic sarcoma. Divergent differentiation might also occur. To the best of our knowledge, there are only nine cases of dedifferentiated liposarcoma of the oral cavity, none of which show an angiosarcomatous dedifferentiation.- - - - - - - - - - ranking = 44.066774111195keywords = oral cavity, cavity (Clic here for more details about this article) |
10/22. Extrauterine mullerian adenosarcoma associated with endometriosis and rectal villotubular adenoma: report of a case and review of the literature.Extrauterine mullerian adenosarcoma is rare and is thought to arise from endometriotic deposits or pluripotent mesothelial and mesenchymal cells of the pelvic cavity. Concomitant colon-rectal neoplasm was reported but the relationship between extrauterine adenosarcoma and colon tumor was not studied. We describe an extrauterine adenosarcoma with a concomitant rectal tubulovillous adenoma. The patient had a long-term history of endometriosis and unopposed estrogen therapy. Immunohistochemical study was performed to investigate the origin and nature of the adenosarcoma. Immunostaining provided the evidence to distinguish between rectal tumor and adenosarcoma. Extrauterine adenosarcoma may arise from endometriosis, and hormone replacement therapy may have some role in the malignant transformation process. adenosarcoma should be considered in the differential diagnosis of a new pelvic tumor in a patient with a history of endometriosis.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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