1/39. E.N.T. manifestations of Von Recklinghausen's disease.Von Recklinghausen's disease (VRD) is a neurocutaneous, systemic disease characterized by CNS tumors and disorders, cafe-au-lait spots, generalized cutaneous neurofibromata, skeletal deformities, and somatic and endocrine abnormalities. It is an autosomal dominant, hereditary disorder found in approximately 1:2500 to 3300 births. There are many manifestations of this disease in the head and neck region of interest to the otolaryngologist. case reports of three patients with multiple ENT involvements are detailed. A review of the literature is presented with a brief discussion of diagnosis and treatment. The most common intracranial tumor in the adult is the acoustic neuroma, usually bilateral, while in the child it is the astrocytoma. A defect in the sphenoid bone is common and may produce temporal lobe herniation into the orbit causing pulsatile exophthalmos. Involvement of the facial bones usually causes radiolucent defects secondary to neurofibromata within nerve pathways, and a variety of asymmetrical changes, especially within the mandible. "elephantiasis" of the face is a hypertrophy of the soft tissues overlying a neurofibroma, often quite extensive and disfiguring. Laryngeal and neck involvement may compromise the airway and early and repeated surgical intervention is required. The over-all malignancy rate approaches 30%, indicating that the patient with VRD may be predisposed to developing a malignancy. There appears to be an increased surgical risk in these patients, with some demonstrating abnormal responses to neuromuscular blockade.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/39. hypopigmentation of a papillary carcinoma arising in a black thyroid.We report a case of an unpigmented papillary carcinoma arising in a black thyroid induced by minocycline. Black thyroid syndrome is an unusual pigmented change seen almost exclusively in patients on minocycline, apparently resulting from an oxidative interaction between thyroid peroxidase and the drug. Twenty-six cases have previously been reported in the English literature, nine of which described an associated thyroid neoplasm. Four of these nine neoplasms were described as pale or hypopigmented. The nature of the lesion against the background of pigmentation suggests diminished function of the thyroid peroxidase in this clonal population.- - - - - - - - - - ranking = 2.6503515413737keywords = neoplasm (Clic here for more details about this article) |
3/39. Primary meningeal rhabdomyosarcoma in a child with hypomelanosis of Ito.Intracranial rhabdomyosarcomas are rare neoplasms, and those thought to be primary meningeal tumors are even more rare. Hypomelanosis of Ito is a neurocutaneous disorder believed to involve a defect in cells of neural crest origin. We report the case of a 15-month-old boy with hypomelanosis of Ito who developed a primary meningeal rhabdomyosarcoma. The patient initially presented with hydrocephalus and 2 months later developed neurologic signs localizing to the spinal cord. Radiologic studies revealed widespread leptomeningeal enhancement with compression of the spinal cord at C5-C7. A brain biopsy revealed a tumor diffusely involving the meninges. Microscopically, the tumor was composed of rhabdomyoblasts, many of which showed prominent cross-striations on routine hematoxylin-eosin staining. To the best of our knowledge, this is the first reported case of meningeal rhabdomyosarcoma in a patient with hypomelanosis of Ito and the fourth reported case of a primary meningeal rhabdomyosarcoma reported in the world literature.- - - - - - - - - - ranking = 1.3251757706869keywords = neoplasm (Clic here for more details about this article) |
4/39. An ultrastructural study of pigmented purpuric dermatitis with special reference to fibrous long-spacing collagen.A case of pigmented purpuric dermatitis (PPD) in a Japanese man aged 59 years is reported with an interesting ultrastructural finding. Clinically, the lesions, which consisted of telangiectatic puncta and pigmentation, were irregular in shape and occurred predominantly on the lower legs without pruritus. Histologically, lymphocytic perivascular infiltrates and extravasation of red blood cells were observed in the papillary dermis. Ultrastructurally, endothelial cells with ovoid nuclei showed swelling and the lumen of the capillary became narrowed. Several banded structures, so-called fibrous long-spacing collagen (FLSC), were observed in the cytoplasm. They were spindle shaped, about 5 microm in length, and showed crossbands of 300-nm-wide intervals with fine intraperiodic bands. These structures were not observed in dermal connective tissue and fibroblasts. These results suggested that FLSC was synthesized in endothelial cells rather than being phagocytosed by endothelial cells, which might be helpful in investigating the etiology of PPD.- - - - - - - - - - ranking = 23.331146565711keywords = connective (Clic here for more details about this article) |
5/39. minocycline-induced staining of torus palatinus and alveolar bone.BACKGROUND: minocycline hydrochloride, an analog of tetracycline, is widely used in the treatment of acne. Its use has been associated with discoloration of teeth, bone, and other tissues. methods: A case is presented involving a patient with minocycline-induced staining of the torus palatinus and alveolar bone. RESULTS: No treatment was rendered since the patient was not concerned with the appearance of the discoloration. The patient's dermatologist elected to change antibiotics. CONCLUSIONS: patients on long-term minocycline therapy should be made aware of the possibility of pigmentation of bone and soft tissue that may be reversible with discontinuation of therapy; however, minocycline-induced staining of the permanent dentition may not be reversible.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
6/39. An amalgam tattoo of the soft palate: a case report with energy dispersive X-ray analysis.A pigmented lesion of the soft palate was excised to exclude melanoma. The histology suggested an amalgam tattoo which was confirmed on energy dispersive X-ray analysis by the detection of silver and copper. This represents a very rare mimic of melanoma of the soft palate.- - - - - - - - - - ranking = 6keywords = soft (Clic here for more details about this article) |
7/39. Exaggerated pigmented granulomatous reaction to the artificial joint implant mimics metastatic melanoma.Total joint replacement is a common orthopedic procedure. An artificial joint implant may fail due to mechanical mishap and a granulomatous reaction can be induced by the artificial joint debris after the mechanical failure. We report a case of an exaggerated pigmented granulomatous tissue response to metallic artificial joint implant debris in a 72-yr-old male that was mistaken for metastatic melanoma. The mass was soft, pigmented, ill-defined, and located in the right inguinal region. Fine-needle aspiration revealed numerous black-pigment laden cells. The cellular features were frequently obscured by the heavy pigmentation. Occasional cells exhibited atypia and prominent nucleoli. There were also abundant extracellular irregular small black particles dispersed in the background. The diagnosis of melanoma involving a lymph node was made. Since there was no prior history of melanoma, it was presumed that this represented metastatic melanoma from an unknown primary. A subsequent exploration of the groin was performed with the intent to resect the disease. At exploration, the mass was found to be contiguous with the hip joint and the frozen section of the mass revealed no evidence of melanoma. The final tissue diagnosis confirmed the frozen section report and showed a granulomatous reaction. This report underscores the diagnostic dilemma associated with the exaggerated pigmented granulomatous reaction due to an artificial prosthesis.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/39. Pigmented lesions of the oral cavity: review, differential diagnosis, and case presentations.Pigmented lesions are commonly found in the mouth. Such lesions represent a variety of clinical entities, ranging from physiologic changes to manifestations of systemic illnesses and malignant neoplasms. Evaluation of a patient presenting with a pigmented lesion should include a full medical and dental history, extraoral and intraoral examinations and, in some cases, biopsy and laboratory investigations. In this paper, an algorithm is proposed for the assessment of pigmented lesions of the oral cavity, and 3 patients with such lesions are described.- - - - - - - - - - ranking = 1.3251757706869keywords = neoplasm (Clic here for more details about this article) |
9/39. minocycline-associated intra-oral soft-tissue pigmentation: clinicopathologic correlations and review.BACKGROUND: Intra-oral minocycline staining of alveolar bone and teeth is well-described in the literature. minocycline-induced discoloration of oral soft tissues is less common and has been often attributed to staining of the underlying bone. AIM: This report documents the clinical and histopathologic features of a case of actual oral soft tissue minocycline-induced pigmentation. The patient, a 45-year-old Caucasian female, presented with pigmentation of the gingiva, lips, and nail beds of recent onset. The past medical history revealed initiation of minocycline therapy 6 months earlier for dermatological concerns. Histopathologic examination of biopsy specimens from the gingiva and lip showed evidence of increased melanin/melanocytes in the epithelium and melanin/melanophages in the connective tissue. A working diagnosis of drug-associated pigmentation was determined and the patient discontinued immediately minocycline therapy. Nine months after cessation of minocycline the patient exhibited a marked reduction in pigmentation. CONCLUSION: Systemic minocycline treatment has the potential to induce significant and esthetically objectionable discoloration of the gingiva and oral mucosa. A brief review of the literature is presented to help understand this uncommon finding that should be included in the differential diagnosis of spontaneous discoloration of intra-oral soft tissues.- - - - - - - - - - ranking = 30.331146565711keywords = connective, soft (Clic here for more details about this article) |
10/39. Use of a subepithelial connective tissue graft to treat an area pigmented with graphite.BACKGROUND: Pigmentations of the oral cavity are commonly noted in clinical practice and may have physiologic, non-physiologic, or pathologic etiologies. The most common non-physiologic localized pigmentation is the amalgam tattoo; another, less common, non-physiologic pigmentation is the graphite tattoo. graphite tattoos may easily be confused with amalgam tattoos but have only infrequently been reported in the literature. methods: This case report discusses a patient with a localized pigmented lesion involving the free gingiva, attached gingiva, and alveolar mucosa. The patient was referred for esthetic enhancement of the area in question. Dental history revealed trauma to the area involving falling on a pencil as a child. The lesion was excised and submitted for histologic examination; a subepithelial connective tissue graft was harvested and utilized to prevent an esthetic defect. RESULTS: Histologic evaluation confirmed graphite within the soft tissue as the etiology of the discoloration. At the 2-month postoperative appointment, a highly esthetic outcome was obtained utilizing a connective tissue graft. CONCLUSIONS: Although less common than the amalgam tattoo, the graphite tattoo may be encountered in the course of routine dental examinations and should be included in a differential diagnosis of any localized pigmented lesion. Although histologic evaluation is necessary to rule out pathology, if the dental history is consistent with the clinical impression of a nonpathologic lesion, such as the graphite tattoo in this case report, treatment with an autogenous connective tissue graft at the time of excision can produce a highly esthetic result and avoid additional surgical procedures in the future.- - - - - - - - - - ranking = 164.31802595998keywords = connective, soft (Clic here for more details about this article) |
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