Secondary orbital melanomas: analysis of 15 cases.

Orbital melanomas comprise a heterogeneous group of pigmented tumours originating from melanocytes of the ophthalmic tissues, or represent distant metastases of cutaneous melanomas to the orbit. They can be classified into primary and secondary orbital melanomas. Whereas primary orbital melanomas are extremely rare, secondary orbital melanomas are seen more often and usually represent massive extrascleral extensions of uveal melanomas. Their diagnosis is difficult and controversy exists both about the treatment policy and regarding the prognosis. In an effort to clarify some of the aspects of the biological behaviour of these intriguing lesions, we retrospectively reviewed all orbital melanomas treated in our departments during the last eight years. The records of 15 patients with massive secondary orbital melanomas treated surgically were reviewed and analysed. Eleven of the patients were female and four were male. The mean age at the time of surgery was 68 years. Presenting features included unilateral orbital mass, often with painless proptosis, conjuctival bleeding, acute glaucoma crisis, decreased visual acuity and intermittent diplopia. The site of origin was the uveal tract in nine cases, the conjunctiva in three, the eyelids in two and the skin of the lower extremity in one patient. All patients were treated surgically with various types of orbital exenteration. Additional treatment included radiotherapy and chemotherapy. Two patients died from intracranial extension of the disease and 10 died from distant metastases. Three patients are alive with no evidence of disease. The longest survival was 33 months and the mean survival was 16.6 months. Early diagnosis and proper management of ocular melanoma prevents orbital extension and prolongs patient survival. Surgical treatment of secondary orbital melanoma with or without adjuvant radiotherapy and/or chemotherapy does not seem to improve patient survival when compared with conservative treatment used in other reports. However, orbital exenteration is effective for local control of the disease.

Epidermal nevus syndrome with development of a mandibular ameloblastoma.

Epidermal nevus syndrome (ENS) is a hamartoneoplastic syndrome characterized by the association of epidermal nevi with abnormalities in other organ systems. We report a 32-year-old woman with ENS that, in addition to cutaneous manifestations, showed red plaques on the maxillary and mandibular labial alveolar mucosa and a papillomatous lesion of the midline posterior hard palate. Radiographic examination of the jaws was noncontributory. Approximately 5 years later, a follicular ameloblastoma developed in the mandible. The tumor showed duct-like cystic spaces, continuity with the overlying epithelium, and globular myxomatous areas in the connective tissue. The palatal lesion was diagnosed as papilloma, whereas the maxillary plaques showed nonspecific mucositis. The association of ameloblastoma with ENS is discussed. This is the second case of ENS associated with ameloblastoma reported in the medical literature.

The use of the buccal fat pad for reconstruction of oral defects: review of the literature and report of 15 cases.

PURPOSE: Although the buccal fat pad (BFP) was originally used as an alternative method for the closure of small to medium-sized oroantral and oronasal communications, its use has now been extended to use after excision of oral malignancies. This report describes experience with this technique. PATIENTS AND METHODS: The BFP was used as a pedicled graft to reconstruct medium-sized surgical defects of the oral soft and hard tissues in 15 patients suffering from oral malignant tumors. Six of the defects were in the maxilla, 3 in the retromandibular area, and 6 in the cheek and oral commissure. The BFP was left uncovered to epithelialize in 14 patients, and in one it was covered with lyophilized dura. RESULTS: The BFP healed without complications within 3 to 4 weeks in 13 patients, whereas in 2 patients with maxillary defects there was partial loss of the graft, requiring the additional use of an obturator in 1 case and a tongue flap in another to prevent oronasal leakage. Harvesting the graft proved to be extremely easy, and care was only necessary to avoid severing the supporting vascular plexus and the thin capsule covering the BFP. CONCLUSIONS: The findings support the view that the BFP is a useful, easy, and uncomplicated alternative method for the reconstruction of small to medium-sized surgical defects of the oral hard and soft tissues.

Tumours of the head and neck in the elderly: analysis of 190 patients.

Tumours of the head and neck represent approximately 5% of human neoplasms. More than 50% of the patients are above 65 years of age. During the years 1991-1996, 190 patients aged 65 or more and suffering from oro-facial neoplasms were treated in our department. They represent 48.6% of the total number of hospitalized tumour patients. One hundred and ten were male and 80 female. Benign tumours were found in 42 patients whereas 148 patients presented with malignant tumours. Of the malignant tumours, squamous cell carcinoma occurred in 103 patients and salivary gland tumours were the most frequently encountered benign tumours (12 patients). All patients with benign tumours were treated surgically. Of the 148 patients with malignant neoplasms, 116 were treated by surgery alone or in combination with radiotherapy and/or chemotherapy, and the remaining 32 with radiotherapy. Mortality from cancer was 28.1% and mortality from other causes was 5.8%. Postoperative morbidity in the benign tumour group of patients was minimal. In the malignant tumour group of patients, where the magnitude of surgical treatment was greater, there were no intraoperative or immediate postoperative deaths. Five patients died postoperatively whilst in hospital. Deaths were attributed to pre-existing medical problems. It is concluded that the age of the patient is not an important factor in determining the extent of surgical treatment in patients with tumours of the head and neck.

[Polymorphous low-grade adenocarcinoma of the minor salivary glands. A case report and review of the literature]. / Polymorpho chameles kakoetheias adenokarkinoma ton elassonon sialogonon adenon. Anakoinose periptoseos kai anaskopese tes bibliographias.

Polymorphous low-grade adenocarcinoma is a distinct type of salivary gland carcinoma arising most often intraorally and primarily in the palate. It is characterized by bland nuclear chromatin, variation in histomorphology and low-grade malignancy. We report a case of this recently described entity in a 66 year old male, presenting most of the characteristic clinical and histologic features. A short review of the current literature concerning this tumor is included.

Lateral periodontal cyst. Review of the literature and report of a case.

The lateral periodontal cyst is a rare odontogenic cyst of developmental origin. It occurs on the lateral periodontal region of a vital tooth and has specific histologic features. In this paper a case of a lateral periodontal cyst is presented and cases previously reported in the literature are reviewed. The present case concerns a 50-year old woman who presented for an asymptomatic gingival swelling of the left canine mandibular region of 2 month's duration. X-ray examination showed a well circumscribed radiolucency with a radiopaque margin lying between the roots of the lateral incisor and canine. The associated teeth were vital. Enucleation of the lesion was performed. The histologic examination of the specimen showed a cyst lined by thin non-keratinized epithelium with focal thickenings containing clear cells.

Polymorphous low-grade adenocarcinoma of the palate: report of a case with electron microscopy.

A case of polymorphous, low-grade adenocarcinoma of the palate is presented with special emphasis on the histologic and ultrastructural features of this recently described entity.

Peripheral giant cell granuloma. Clinicopathologic study of 224 new cases and review of 956 reported cases.

The clinical and histopathological features of 224 new cases of peripheral giant cell granuloma were studied. In addition, the data from 956 previously reported cases in the literature were evaluated and compared with the present series. Females were found to be more commonly affected than males. All age groups were found to be affected with a relative predilection from 40 to 60 years of age. The mandible was more often affected than the maxilla. Clinically, the lesions were red in color, had a smooth surface and were rubbery or with a soft consistency. The most characteristic histologic features included a non-encapsulated highly cellular mass with abundant giant cells, inflammation, interstitial hemorrhage, hemosiderin deposits, mature bone or osteoid.

The therapeutic effect of an aromatic retinoid (RO-109359) on hamster buccal pouch carcinomas.

Forty male hamsters were divided into three groups. Group 1 (16 animals) received topical applications with a 0.5% solution of DMBA in liquid paraffin on the right buccal pouch for 16 weeks. Group 2 (16 animals) received DMBA for 16 weeks, plus the retinoid RO-109359 three times during the 17th week in doses of 200 mg/kg. Group 3 (8 animals) remained untreated for 16 weeks and, during the 17th week, received the retinoid as in group 2. After administration of the retinoid, a marked regression in the size of the carcinomas of the right pouch in group 2 animals was observed clinically. Histologically, these tumors consisted mostly of large necrotic areas and showed an excessive keratin loss. Although the hypervitaminosis A symptoms could not be avoided, the findings suggest that high doses have a therapeutic effect on hamster buccal pouch carcinomas.