Salivary gland anlage tumour of the nasopharynx: A case report and review for histopathological characteristics.

INTRODUCTION: Congenital salivary gland anlage tumour of the nasopharynx is a lesion which usually presents with nasal and upper respiratory tract obstruction in the neonatal period. Timely diagnosis is essential to prevent the occurrence of respiratory complications in later childhood. CASE REPORT: We present a 8-year-old boy complaining from difficulty in breathing and breastfeeding in the neonatal period due to an adenoid-like nasopharyngeal mass. Histological examination revealed solid and cystic squamous nests and numerous duct-like structures within collagenised stroma. Both epithelial and myoepithelial differentiation were noted in the tubular component. DISCUSSION: A review of the clinical and histopathological features of published cases revealed that ancient lesions showed more prominent and complex epithelial component and more collagen rich stroma. We would like to suggest the possibility of salivary gland anlage tumour to be considered in the differential diagnosis of neonatal respiratory distress cases.

Case of osseous dysplasia with an unusual concentric, circular, radiological appearance.

Osseous dysplasia is an idiopathic process that is characterised by the replacement of normal bone with fibrous tissue and metaplastic bone. On radiographic images it may be predominantly radiolucent, predominantly radio-opaque, or mixed. We present a focal osseous dysplastic lesion with an unusual concentric, circular, radiographic appearance.

A case of a sinonasal adenocarcinoma with metaplastic ossification.

Sinonasal adenocarcinomas are rare tumours, with three subtypes. They are mostly low-grade tumours, although they can also be aggressive. In this case report, we describe a 34-year-old patient with sinonasal adenocarcinomas. Within his nasal cavity was found an irregular mass. Given the intratumoral calcification and bone, the mass was thought to be a bone-producing tumour, such as an osteosarcoma. The pathological diagnosis was a sinonasal adenocarcinoma with extensive metaplastic bone. To the best of our knowledge, this is the first case of a sinonasal adenocarcinoma with metaplastic ossification.

Oral mucosal involvement in Langerhans' cell histiocytosis: long-term follow-up of a rare case.

Langerhans' cell histiocytosis (LCH) is a rare disease where different organs and systems may be affected. Oral involvement generally consists of mucosal ulceration associated with lesions of the underlying bone. Many reports exist about the misdiagnosis of this disease. Various symptoms may lead the clinician to an incorrect diagnosis, especially with multiple organ involvement. Oral manifestations are common, and dentists should be aware of this disease and evaluate intraoral findings accordingly. This study presents an LCH case characterized by oral mucosal ulcerations with no involvement of the underlying bone. A definitive diagnosis was made by open biopsy from the oral mucosa.

Case report: nodular fasciitis of the parotid region.

OBJECTIVE: To demonstrate the clinical and histopathological features of nodular fasciitis in the parotid region. CASE REPORT: A 24-year-old man presented with a palpable mass in the superior border of the parotid gland. The mass was firm and immobile, with a smooth surface. Fine needle aspiration cytology revealed proliferating fibroblasts, macrophages and adipocytes among the blood cells. Although a superficial parotidectomy was initially planned, a total excision was performed, as the mass was observed to be located in the periphery of the parotid tissue. Nodular fasciitis was diagnosed, based on the results of immunohistochemical analysis. CONCLUSION: Nodular fasciitis very rarely occurs in the parotid region. These lesions grow quickly, and may be misdiagnosed as sarcoma. Trauma may play a role in their aetiology. Total excision is adequate as treatment.

The effect of external beam irradiation timing on skin graft survival.

BACKGROUND: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. METHODS: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, A(c), B(c), C(c) and D(c)). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups A(c), B(c), C(c) and D(c) were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt(60) irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. RESULTS: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. CONCLUSIONS: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Osseous choristoma of the submandibular region: case report.

This report presents a case of osseous choristoma in the submandibular region of a 33-year-old female. Her chief complaint was painless swelling in the submandibular region. Panoramic radiography showed a well-defined, round, radiopaque lesion near the inferior border of the right mandibular angle. Coronal and sagittal tomographic images indicated a high-density area in the right submandibular region with no bony connection. The lesion was diagnosed as an osseous choristoma based on histopathological examination of the surgical specimen. A 1-year follow-up period was uneventful.

Human cytomegalovirus in peripheral giant cell granuloma.

BACKGROUND: The peripheral giant cell granuloma is a relatively common non-neoplastic inflammatory lesion of gingiva, but the etiopathogeny remains unknown. This study aimed to evaluate the importance of human cytomegalovirus and Epstein-Barr virus in a peripheral giant cell granuloma of a 47-year-old female. METHODS: The lesion was studied clinically, histopathologically, immunologically and virologically using established procedures. RESULTS: The gingival growth was located at the mesial surface of the maxillary left canine having a vital pulp. The mass was 12 x 21 mm in size and exhibited a smooth surface with no evidence of fluctuation on palpation. An excisional biopsy revealed giant cells in a fibrohistiocytic stroma with areas of haemorrhage. Serum protein levels and lymphocyte subsets were within normal limits, except CD3(+) and CD4(+) cells were below normal ranges. Polymorphonuclear leukocytes expressed p150,95 (CD11c/CD18) and CXCR-2 receptors within normal ranges, but the CXCR1 receptor showed decreased density, and CD15 were below normal range. A virological sample of the tooth surface adjacent to the gingival swelling yielded 7.6 x 10(3) copy-counts of cytomegalovirus and 4.3 x 10(3) copy-counts of Epstein-Barr virus. CONCLUSIONS: The clinical and histological findings were consistent with the diagnosis of peripheral giant cell granuloma. Cytomegalovirus has the potential to induce multinucleated giant cells, and the possibility that the virus contribute to the development of peripheral giant cell granuloma merits further study.

Histomorphometric evaluation of delayed changes in masseter muscle after lengthening the rabbit mandible by distraction osteogenesis.

OBJECTIVE: The aim of the study was to evaluate the delayed responses and changes of gradually lengthened masseter muscles of rabbit mandibles. STUDY DESIGN: Unilateral lengthening of rabbit mandibles was performed in 18 New Zealand rabbits for 7 days at the rate of 1 mm day(-1). Mandibles of animals were removed at months 3, 4, and 6 after distraction. Biopsy samples of distracted and contralateral side masseter muscles were histopathologically evaluated and mean area of muscle fibers (MAF) was evaluated with histomorphometric methods. Results were statistically analyzed. RESULTS: Mild to moderate atrophy of the fibers, and necrosis and myophagocytosis in some areas were the leading features at month 3 and which were decreased at month 4 in distracted side-muscle specimens, with no statistically significant differences when compared with non-distracted side muscles at the same periods. Almost completely, normal fibers were detected in distracted muscle specimens at month 6. Evidence of myopathic changes was found to disappear at month 6 and no significant difference was found in the MAF of distracted side muscles. CONCLUSION: This study showed that the masseter muscle could adapt to gradual lengthening of the mandible within 6 months. Regenerative features and some degree of atrophic changes that could be observed at months 3 and 4 disappeared at month 6, with adaptation of the fibers.

Rosai Dorfman disease of the parotid and submandibular glands: salivary gland scintigraphy and oral findings in two siblings.

Rosai-Dorfman disease (RDD) is an unusual clinical entity characterized by benign pseudolymphomatous proliferation with significant histiocytic infiltration. In the present paper, extranodal RDD of the major salivary glands causing salivary hypofunction and the results of salivary gland scintigraphy and ultrasound are presented in two siblings. Case 1: a 10-year-old boy with bilateral painless masses around the parotid and submandibular glands was referred. Ultrasound examination showed bilateral, well-defined, hypoechoic solid mass lesions within both parotid glands with minimal normal parenchyma in the upper poles. Both submandibular glands were markedly hypoechoic and heterogeneous. Mass lesions within the parotid glands appeared as cold lesions with regular contours on scintigraphy. Dynamic images showed normal uptake and normal response to secretion in the upper poles of the parotid glands, corresponding with ultrasonographically normal parenchyma. Both submandibular glands showed markedly diminished uptake and secretion. Case 2: a 9-year-old boy presented with mass lesions around the submandibular glands. Ultrasound examination showed normal parotid glands and markedly hypoechoic and heterogeneous submandibular glands. Salivary gland scintigraphy showed normal uptake and secretion of parotid glands with markedly diminished uptake and secretion in both submandibular glands. There were severe carious lesions in both patients due to salivary hypofunction. Treatments of the two patients' teeth were performed. Major salivary gland involvement of RDD is important for dentists as it may cause xerostomia and can mimic dental abscess. Functional evaluation of salivary glands with scintigraphy, besides radiological and pathological techniques, will help to explain whether salivary glands are affected or not and improve the diagnostic effectiveness.

Histomorphometrical analysis of new bone obtained by distraction osteogenesis and osteogenesis by periosteal distraction in rabbits.

The aim of this study was to compare histomorphometrically the new bone tissue obtained using two different distraction methods, and evaluate these two methods in terms of their advantages and disadvantages. In 36 New Zealand adult male rabbits, divided into two groups, a gradual distraction was performed using a device placed on the lateral surface of the mandibular corpus. In one group osteotomy was not performed and osteogenesis by periosteal distraction (OPD) only was used. In the other group, conventional distraction osteogenesis (DO) was performed. After a 7-day latent phase, the same distraction protocol was applied to both groups. Each group of rabbits was further divided into three sub-groups killed on the 15th, 30th and 60th days of the consolidation period, and histological analysis was performed. The mean extent of newly formed bone tissue was 14.4 mm2 in the OPD groups and 25.4 mm2 in the DO groups. When compared statistically, there were significant differences between all the DO and OPD sub-groups. The newly formed bone tissue obtained by OPD was rich in interstitial fatty tissue. These results indicate that bone tissue newly formed by OPD is not suitable for occlusal forces.

Cyclooxygenase-2 (cox-2) expression and angiogenesis in intracranial ependymomas.

AIM: Cyclooxygenase-2 (Cox-2), the inducible key enzyme in the biosynthesis of prostaglandins, appears to play a role in the regulation of progression, invasiveness and angiogenesis of various neoplasms including some glial tumors. Little is known about the role of Cox-2 in angiogenesis and proliferation of ependymomas. We studied Cox-2 expression, Ki-67 labeling index (Ki-67 LI) and microvessel density (MVD) in 30 intracranial ependymomas and analyzed the relationship among these parameters to evaluate their importance in the tumor biology of ependymomas. RESULTS: The mean Ki-67 LI for all tumors ranged from 1 - 50% (mean 9%). Statistically significant difference was present for Ki-67 LI between ependymomas (grade II, WHO) and anaplastic ependymomas (grade III, WHO) (p < 0.001) (mean Ki-67 LI for ependymoma, 2.8%, for anaplastic ependymomas, 15.6%). Anaplastic ependymomas did not demonstrate a greater vascularization than ependymomas, and the MVD values were 84.5 +/- 39.7 for ependymomas, and 90.6 +/- 61.4 for anaplastic ependymomas. Cox-2 immunohistochemical expression was observed in 19 tumors (63%). Although Cox-2 expression was slightly higher in anaplastic ependymomas, it was not statistically significant. No correlation was found between Cox-2 expression and MVD and Ki-67 LI. CONCLUSION: Similar to morphologic and prognostic heterogeneity in ependymomas, Cox-2 expression, MVD and Ki-67 LI also show a great variability. Other factors may be more important for the proliferation and angiogenesis of ependymomas.

Malignant fibrous histiocytoma of the mandible.

We report a case of malignant fibrous histiocytoma (MFH) primary within the mandible of a 32-year-old female. The mandible is a rare location of MFH, accounting for only 3% of all tumours of this type occurring within bone. The clinical, pathological and radiographic features are discussed with special emphasis on the radiographic features of this lesion.

Hepatitis B complicated focal segmental glomerulosclerosis.

After the initial report of membranous glomerulopathy due to hepatitis B virus infection by Combes et al, other glomerular diseases - but rarely focal segmental glomerulosclerosis (FSGS) association with HBV infection - have been reported. Herein we present an 8-year-old boy with chronic HBV infection complicated FSGS. The patient was initially regarded as idiopathic FSGS and started on an immunosuppressive schedule. The elevation of liver transaminases in the course of the therapy revealed the immunotolerated perinatal HBV infection. It was considered that immunosuppressive agents have induced viral replication. The treatment was changed to lamivudine alone. The nephrotic syndrome has already been improved with the seroconversion of anti-HBeAg and reduced liver functional tests by the tenth month of the treatment. This case is peculiar for the seldom association of FSGS with chronic HBV infection and treatment modality particularly for the countries where this viral infection is endemic.

Chondrosarcoma of the parapharyngeal space. A case report.

Chondrosarcomas are the malignant cartilagenous tumors and they are seen rarely in the head and neck area. They are usually slow growing lesions. The head and neck chondrosarcomas may show an aggressive course and the occurrence of this malignant cartilagenous tumor in the parapharyngeal space is only a few. They are mostly located in relation with jaw bones and base of the skull. Chondrosarcomas of the parapharyngeal space are limited in number and among them there is no low-grade one. In this case report, a case of low-grade chondrosarcoma which was treated with a simple excision without neck dissection was reported.

MIB-1 expression in odontogenic epithelial rests, epithelium of healthy oral mucosa and epithelium of selected odontogenic cysts. An immunohistochemical study.

The aim of this study is to investigate the proliferative potential of rests of odontogenic epithelium found in follicles of unerupted teeth, epithelium of oral mucosa and epithelial linings of various odontogenic cysts. MIB-1 expression was studied in the rests of odontogenic epithelium (n=10), healthy oral mucosa (n=10), odontogenic keratocysts (n=10) and other odontogenic cysts (n=10) using an avidin-biotin peroxidase technique on paraffin sections. The number of positively stained cells was counted on 10 representative areas of epithelium using a x40 objective. The average number of MIB-1 positive cells in each group was calculated. No MIB-1 positive cells were seen in the rests of odontogenic epithelium. The mean numbers of MIB-1 positive cells detected within the epithelium of oral mucosa, and of radicular and dentigerous cysts were similar. The number of MIB-1 positive cells was found to be increased in the presence of marked inflammatory cell infiltration. The highest number of MIB-1 positive cells was seen in the keratocysts. These findings suggest that removal of an unerupted tooth to prevent the possibility of neoplastic transformation of rests of odontogenic epithelium is not a justifiable rationale.

Botryoid odontogenic cyst: report of a case with extensive epithelial proliferation.

Botyroid odontogenic cyst (BOC) is considered a rare multilocular variant of the lateral periodontal cyst. In this report; clinical and histopathological features of a case of BOC found in mandibular mental region of a 32-year-old woman is presented. There was a multilocular radiolucency extending from the roots of the right premolar to the left premolar, involving almost the whole height of the mandible. Histologically, there was extensive intraluminal epithelial proliferation in the lining and MIB-1 positive cells were noted in the basal layer.

DNA ploidy and nuclear morphometry in adult intracranial ependymomas.

The identification of prognostic parameters in ependymomas remains an important but controversial issue in particular to the significance of histopathological features. Intracranial location is a rare presentation for adult ependymomas. DNA ploidy status and nuclear morphometric features of ependymomas are not well-established. We retrospectively studied the clinicopathologic features of 12 adult intracranial ependymomas and performed image cytometric DNA analysis with nuclear morphometry. The overall survival rate was 75%. Two cases were anaplastic ependymomas. Statistically, histology failed to demonstrate a correlation with clinical outcome or overall survival. DNA ploidy (p = 0.033), DNA index (p = 0.016) and 5c exceeding rate (p = 0.017) were statistically correlated with clinical outcome, but not correlated with overall survival. Nuclear morphometric features measured using 3 different data selection methods were not correlated with clinical outcome or overall survival. It is difficult to identify prognostic factors in a series of cases with limited number. The problem is complicated by the fact that the common criteria used for recognizing malignancy in gliomas are not completely reliable in ependymomas. Nuclear morphometric findings support the general impression that ependymomas are morphologically highly variable tumors. In spite of the small sample size of our series and other factors influencing survival such as the extent of resection and malignant histology, aneuploidy can be suggested as a promising factor, which may reflect potential aggressiveness of the tumor in adult intracranial ependymomas.

Dysembryoplastic neuroepithelial tumor in the left lateral ventricle.

Extracortical location of dysembryoplastic neuroepithelial tumor (DNT) is rare. We present a case of DNT localized in the left lateral ventricle of a 21-year-old female patient. Magnetic resonance imaging of the brain showed a round mass lesion in the floor of the anterior horn of the left lateral ventricle. The lesion was hypointense on T (1)-weighted images and slightly hyperintense on T (2)-weighted images without contrast enhancement. Total removal of the yellowish-white colored soft tumor was performed through a transcallosal approach. Histologically, the tumor was of simple type of DNT that was composed of small oligodendrogliocytes clustered tightly about perivascular spaces with neurons floating in mucoid pools showing an eosinophilic fibrillary matrix in the background. The recognition of DNT with an unusual location in lateral ventricle has therapeutic and prognostic significance since DNT is curable by surgical excision and radiation therapy is of no obvious benefit.