Management and treatment of four cases of oral carcinoma cuniculatum.

Objectives: Oral carcinoma cuniculatum (OCC) is a rare variant of squamous cell carcinoma (SCC). It has similar clinicopathological characteristics to SCC and verrucous carcinoma (VC). We present a case series of OCC and analyse its unique features, diagnosis, and management. Patients and. Methods: We retrospectively reviewed the medical records of oral cancer patients treated by Oral and Maxillofacial Surgery department from 2009 to 2020 with OCC biopsy findings. The clinicopathological characteristics and management of the OCC cases were analysed. Results: Four patients were identified with histologic findings of OCC, including three on the alveolar ridge mucosa and one on the tongue. Imaging revealed that two of the lesions located in the maxilla had osseous lysis. All four patients were all treated with radical excision, and the histopathology showed findings of SCC cuniculatum. It was decided that no further treatment was necessary. None of the patients has experienced recurrence during follow-up. Conclusion: OCC is a distinct entity that is more locally aggressive than VC but is associated with good prognosis. Radical surgical removal is considered appropriate for OCC. Emphasis should be given on an early diagnosis, as it remains challenging.

Enlarged Reactional Periostitis of the Peroneal Tubercle Mimicking Osteochondromatosis of the Calcaneus: A Case Report.

Foot and ankle tumors are relatively rare. Nevertheless, the calcaneus is a prevalent location accommodating various lesions. Reactional periostitis of the lateral wall is rarely encountered but can potentially mimic a wide variety of tumors. We present a case of excessive proliferation due to chronic compression of the peroneal tendons against the calcaneus in a female patient with a history of diminished foot control, treated successfully by tumor excision and peroneal restoration via the tubularization technique. This study aimed to underline the mimicking potential of reactional periostitis and its effect on the peroneal tendons and hindfoot motion.

Spinal angiolipoma: Presentation of two cases and review of the literature for the years 2012-2017.

INTRODUCTION AND OBJECTIVES: Angiolipomas of the spinal canal are a rare condition of unknown origin. They are considered histologically benign; however, some have the potential to infiltrate adjacent structures. The aim of this systematic review was to suggest a potential mechanism for the pathogenesis of spinal angiolipomas, along with a useful approach for their preoperative management. MATERIALS AND METHODS: A literature review of cases of spinal angiolipoma was performed. In addition, two of the cases encountered in our practice are presented. The first case refers to a 35-year-old male patient with a history of spinal fusion because of a T9 fracture, while the second concerns a 46-year-old male patient with an epidural mass extending outside the spinal canal, who underwent fine needle biopsy and embolisation of its feeding vessel. RESULTS: From the review of the literature performed, we were unable to identify any correlation between the infiltrative potential and the patients' demographic and tumour characteristics. CONCLUSIONS: Angiolipomas are considered to be sporadic, yet theories concerning their pathogenesis include reaction to harmful stimuli and congenital malformation of the adipose tissue. Fine needle biopsy may be mistakenly considered non-diagnostic, due to the presence of well-differentiated adipocytes.

RANKL, OPG, TRAIL, KRas, and c-Fos expression in relation to central lymph node metastases in papillary thyroid carcinoma.

PURPOSE: RANKL, OPG and TRAIL have long been pursued in cancer. Mutated KRas proteins and c-Fos overexpression - well-recognized oncogenic events - have been conceived as coordinators of RANKL, OPG and TRAIL pathways. Considering the paucity in the relevant literature, the purpose of the present study was to investigate whether the expression of these molecules configures a distinct papillary thyroid carcinoma (PTC) subgroup with adverse clinicopathological characteristics. METHODS: RANKL, OPG, TRAIL, KRas, and c-Fos immunohistochemical expression in relation to clinicopathological characteristics of PTC was assessed retrospectively in paraffin-embedded PTC specimens from 114 patients who underwent total thyroidectomy with simultaneous central lymph node dissection (CLND). RESULTS: Expression of RANKL, OPG, TRAIL, Kras and c- Fos was revealed in 78.6, 63.2, 61.4, 47.4, and 73.7% of PTC, respectively. As predominant KRas-expressing PTC histotype emerged the classical PTC (cPTC), comprising 66.7% of PTC. A significant correlation was demonstrated of RANKL, OPG, and TRAIL expression with central lymph node metastasis CLNM (p=0.007, p<0.001, and p=0.002, respectively), concerning especially cPTC as regards to RANKL (p=0.027) and OPG (p=0.006), and both cPTC (p=0.043) and follicular variant of PTC (FVPTC) (p=0.049) with regard to TRAIL. OPG expression associated significantly with multifocality (p=0.045). Multivariable-adjusted logistic regression models characterized TRAIL as independent predictor of CLNM (OR=10.335, 95% CI: 1.23-86.87). CLNM correlated significantly with six pairs of coexpressions: TRAIL-KRas (p=0.011), TRAIL-c-Fos (p=0.006), OPG-c-Fos (p=0.024), RANKL-TRAIL (p<0.001), RANKL-OPG (p<0.001), TRAIL- OPG (p<0.001). CONCLUSION: The present study suggested for the first time that OPG, RANKL, TRAIL expressions, either alone or in concert involving c-Fos and KRas expression, are related to CLNM. Further research is warranted to elucidate whether the examined molecules can be endorsed as indicators of aggressive PTC behavior and guide a personalized therapeutic intervention.

Unusual case of intraluminal cecal recurrence of a low grade appendiceal mucinous neoplasm (LAMN)-Case report and brief literature review.

INTRODUCTION: Appendiceal mucinous neoplasms exhibit a wide spectrum of clinical behavior, ranging from neoplasms which are relatively slow-growing but with considerable risk for recurrence and eventual death and those neoplasms that are highly aggressive with increased likelihood of early death. Clinical behavior depend mainly on mucinous neoplasms grading and staging. PRESENTATION OF CASE: We present the incidental finding of a mucinous appendiceal neoplasm in a 52 years old woman during her follow up for an operated breast carcinoma. The patient underwent appendectomy and a low grade appendiceal mucinous neoplasm (LAMN) confined into the appendiceal wall was diagnosed. Resection margin showed fibrous replacement of the appendiceal wall and some acellular intraluminal mucin. Three months later the tumor recurred inside the cecal lumen and a right hemicolectomy was performed showing again a LAMN confined into the bowel wall. DISCUSSION: According to the latest AJCC eighth edition patients with pTis LAMN, as in our case, (LAMN confined to the muscularis propria after histologic examination of the entire appendix) have essentially no risk of recurrence. Moreover, some authors suggest follow up for LAMN confined into the appendix even with a positive surgical margin. CONCLUSION: Rarely, LAMN may recur in the form of a polypoid protrusion into the cecal lumen and this recurrence may originate from the buried stump of the appendix, especially when the surgical margin is positive.

A large neglected pleomorphic adenoma of the lung: Report of a rare case.

Primary pleomorphic adenomas of the lung are very rare tumors that have peculiar clinical and oncologic features. We report here on the diagnostic and therapeutic approach for a patient with a large neglected pulmonary pleomorphic adenoma that presented initially as pneumonia.

Fatal nucleoside-associated lactic acidosis in an obese woman with human immunodeficiency virus type 1 infection on a very low-calorie diet.

This study reports the case of an obese woman with human immunodeficiency virus type 1 (HIV-1) infection who developed fatal nucleoside-associated lactic acidosis 10 d after she started a weight-loss dietary regimen containing 600 kcal/d. This case suggests that very low-calorie diets may be life threatening for HIV-infected patients receiving nucleoside analogues.