Peripheral Osteoma of Mandibular Angulus: Analysis of the Literature and Report of a New Case / Osteoma periférico del ángulo mandibular: Análisis de la literatura e informe de un nuevo caso

Abstract Osteoma is a benign osteogenic neoplasm originating from the continuous proliferation of compact and/or cancellous mature bone. The tumor can be classified as peripheral, central or extra-skeletal regarding location and it commonly seen in the cranio-facial region especially at the skull and paranasal sinuses. The exact etiology of the tumor is still controversial; however, it is considered that infection, trauma, muscle activity contributes the occurrence of the tumor. Due to the slow growing nature of osteoma, it is coincidentally detected on radiographs or when the tumor reaches a large size enough to trigger symptoms and cause facial disfigurement. Although mainly detected in the craniofacial bones, osteomas are rarely located in the jaw bones. The purpose of this review, is to present the diagnosis and treatment plan of a peripheral osteoma in the mandibular angulus region of an 8-year-old boy together with a review of published cases of peripheral osteomas of mandibular angulus.

Resumen El osteoma es una neoplasia osteogénica benigna que se origina de la proliferación continua de hueso maduro compacto y/o esponjoso. El tumor se puede clasificar como periférico, central o extraesquelético con respecto a la ubicación y se ve comúnmente en la región craneofacial, especialmente en el cráneo y los senos paranasales. La etiología exacta del tumor sigue siendo controvertida; sin embargo, se considera que la infección, el trauma y la actividad muscular contribuyen a la aparición del tumor. Debido a la naturaleza de crecimiento lento del osteoma, se detecta casualmente en las radiografías o cuando el tumor alcanza un tamaño grande lo suficiente como para desencadenar síntomas y causar desfiguración facial. Aunque se detecta principalmente en los huesos craneofaciales, los osteomas rara vez se localizan en los huesos de la mandíbula. El objetivo de esta revisión es presentar el diagnóstico y el plan de tratamiento de un osteoma periférico en la región angular mandibular de un niño de 8 años junto con una revisión de casos publicados de osteomas periféricos de angulación mandibular.

Expression of Glypican 3 in low and high grade urothelial carcinomas.

BACKGROUND: Glypican-3 (GPC3) is an oncofetal protein which is encoded by GPC3 gene and takes role in the regulation of cell division and apoptosis. Overexpression of GPC3 has been reported in some types of cancer such as hepatocellular carcinoma (HCC), melanoma, squamous cell carcinoma of the lungs and testicular germ cell tumors. The aim of this study was to investigate the immunohistochemical expression of GPC3 in the non-neoplastic urothelium and in urothelial carcinoma (UC). We also aimed to explore the alterations in the GPC3 expression according to the grade and the invasiveness of UC. METHODS: GPC3 expression was studied in 108 UC cases by using immunohistochemistry. Each section was evaluated in terms of the extensiveness and intensity of GPC3 staining. Scores of immunostaining were correlated with tumor grade and stage. RESULTS: GPC3 expression was observed in 38 cases (35.2%). GPC3 expression was positive in 43.6% of high and in 13.3% of low grade UC (p: 0.003). In 19 UC cases biopsy also harbored non-neoplastic urothelium which showed no staining for GPC3. The difference in staining percentages between low and high grade UCs, suggests that GPC3 staining could be used as an adjunctive marker in cases where the distinction between the low and high grade tumors is difficult. In addition, lack of staining in the non-neoplastic urothelial areas in 19 cases raises the possibility of the use of GPC3 staining for the distinction between neoplastic and non-neoplastic urothelium, especially in punch biopsy samples. CONCLUSIONS: Based on our results potential role of GPC3 in urothelial carcinogenesis warrants further investigation, especially the potential use of GPC3 for therapeutic and diagnostic purposes. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2260833001522844.

Distribution of pediatric bone and soft tissue tumors in the central Black Sea region.

This study aimed to evaluate pediatric cases treated surgically for an initial diagnosis of bone and soft tissue tumor between January 1987 and January 2012. This retrospective study evaluated 328 patients with pathologically confirmed tumor from a total of 374 patients hospitalized with an initial diagnosis of tumor. The cases were analyzed with respect to frequency, age, gender, and localization. One hundred and eighty (54.8%) males and 148 (45.2%) females, with a mean age of 13 years (range: 1-18 years), were included in the study. The tumors were determined as 258 (78.6%) bone tumors and 70 (21.4%) soft tissue tumors. The most common benign bone tumor was observed to be osteochondroma (n=61, 30.7%), and the most common malignant bone tumor was osteosarcoma (n=31, 52.6%). The most common benign soft tissue tumor was hemangioma, which is a vascular tumor (n=28, 43.8%), and the most common malignant soft tissue tumor was rhabdomyosarcoma (n=5, 83.3%). It is thought that similar studies will serve to form larger series and facilitate inter-regional comparisons by collecting data from centers that surgically treat bone and soft tissue tumors, thereby benefitting both pediatric and public health.

Fascin and EMMPRIN expression in primary mucinous tumors of ovary: a tissue microarray study.

OBJECTIVES: The aim of this study was to compare the expressions of fascin and EMMPRIN in primary malignant, borderline and benign mucinous ovarian tumors, and to investigate the relationship of these markers with tumor progression and their applicability to differential diagnosis. MATERIALS AND METHODS: An immunohistochemical study was performed for fascin and EMMPRIN using the tissue microarray technique. Eighty-one cases were included in the study; there were 37 benign, 25 borderline and 19 malignant primary mucinous ovarian tumors. For each case, a total staining score was determined, consisting of scores for extent of staining and intensity of staining. The cases were allocated to negative, weakly positive and strongly positive staining categories, according to the total staining score. RESULTS: Both of the markers were significantly negative in benign tumors as compared with borderline and malignant tumors. There was no significant difference between borderline and malignant groups for both markers. Sixty-eight percent of malignant tumors were stained positive by fascin, while this rate was 40% for borderline mucinous tumors. All malignant tumors were strongly stained positive for EMMPRIN, while this rate was 92% for borderline mucinous tumors. The rest of the cases stained weakly positive. No significant difference in staining score was found between fascin and EMMPRIN expression. CONCLUSIONS: In ovarian primary mucinous tumors, fascin and EMMPRIN may play an important role in tumor progression from benign tumor to carcinoma. In that context, EMMPRIN and fascin expression may have potential application in the differential diagnosis of some diagnostically problematic mucinous ovarian tumors. However, the differential diagnostic applicability of EMMPRIN appears to be more limited than that of fascin due to its wide spectrum of staining in mucinous ovarian tumors.

Distribution and evaluation of bone and soft tissue tumors in the middle Black Sea Region.

OBJECTIVE: The aim of this study was to evaluate the characteristics of bone and soft tissue tumors operated on at the Department of Orthopedics and Traumatology at Ondokuz Mayis University Faculty of Medicine Hospital between January 1987 and January 2012. METHODS: This descriptive study retrospectively evaluated 1,925 patients hospitalized with a preliminary diagnosis of tumor. Patients were analyzed for age, gender, tumor incidence and localization. Three hundred and forty-nine patients found to have non-tumor causes. The 94 patients discharged at their own request or deceased during follow-up were not included in the tumor group. RESULTS: Of the 1,482 (76.9%) patients diagnosed with tumor, 687 (46.4%) were bone tumors, 586 (39.5%) soft tissue tumors and 209 (14.1%) metastatic tumors. The most common benign bone tumor was osteochondroma (118; 25%), followed by enchondroma (68; 14.4%) and giant cell tumor (59; 12.5%), and the most common malignant bone tumor was osteosarcoma (58; 27%), followed by chondrosarcoma (36; 16.7%) and Ewing's sarcoma (33; 15.3%). The most common benign soft tissue tumor was cystic hygroma (96; 22%), followed by lipoma (75; 17.2%) and hemangioma (52; 11.9%), and the most common malignant soft tissue tumors were pleomorphic cell tumor (29; 19.3%) and liposarcoma (29; 19.3%), followed by pleomorphic undifferentiated sarcoma (21; 14%). Seventy (33.5%) of the metastatic tumors were of pulmonary origin, 36 (17.2%) were of breast origin and the primary site of the tumor was not clearly determined in 58 (27.8%) patients. CONCLUSION: The distribution of bone and soft tissue tumors appear to have certain characteristics but can show regional differences. We believe that the establishment of a larger series through the collection of these types of studies from centers in which bone and soft tissue tumor surgery is performed will provide important information on the epidemiological features of bone and soft tissue tumors.

Gastrointestinal stromal tumor: a very rare cause of jejunoileal intussusception in a 6-year-old girl.

A 6-year-old girl was admitted to the emergency department with abdominal pain and bilious vomiting of 3 days in duration. Abdominal ultrasound examination showed an 8-cm-long intussuscepted intestinal segment with a target sign. There was a 26 × 28 × 23 mm nonperistaltic anechoic cystic mass suggestive of a duplication cyst. At laparotomy, the ileocecal region was normal with many enlarged lymph nodes from which biopsies were taken. There was a 20-cm-long intussuscepted segment at the proximal ileum close to the jejunum. After manual reduction, a 2-cm-long edematous segment resembling a duplication cyst served as the lead point. The segment was excised, and a primary bowel anastomosis was performed. She was discharged on the fifth postoperative day. The histopathologic examination revealed that the excised segment contained a gastrointestinal stromal tumor measuring 2.5 cm, with a mitotic rate of 2 to 3 mitoses per 50 high-power fields (low-risk group) showing an infiltrative growth pattern. On immunohistochemistry assay, some of the tumor cells were CD117 and CD34 positive, whereas all of them were smooth muscle actin and S-100 positive but CD10 negative. Staining index with Ki-67 was 5%. Surgical margins were free of tumor. The lymph nodes showed reactive hyperplasia. She was referred to the pediatric oncology department for further evaluation. Gastrointestinal stromal tumors are common in adults and may lead to intussusception. To the best of our knowledge, this is the first childhood case of gastrointestinal stromal tumor causing jejunoileal intussusception in the literature.

An unusual case of an osteosarcoma arising in a leiomyoma of the uterus.

Leiomyoma is the most common uterine neoplasm. It has several histological variants such as atypical, cellular, myxoid, and epithelioid. Leiomyoma with heterologous elements is a rare variant of leiomyoma, which may contain heterologous elements such as fat, skeletal muscle, and chondroid and osseous tissues. The heterologous sarcomatous differentiation is also rarely seen. We report on a 53-year-old woman who was admitted with abnormal vaginal bleeding and symptoms related to an abdominal mass. She had a huge uterine leiomyoma that contained osteosarcomatous differentiation in several foci. Although malignant progression for leiomyoma is exceedingly rare, when it occurs it may result not only in a leiomyosarcoma but also in a heterologous sarcomatous differention. We have reported histopathological, immunohistochemical, and clinical features of this rare case and reviewed the published studies.

Comparison of mesenchymal stem cells and autogenous cortical bone graft in the treatment of class II furcation defects in dogs.

The purpose of this study was to compare the effectiveness of mesenchymal stem cells (MSCs) with platelet-rich plasma (PRP) as scaffold and autogenous cortical bone (ACB) graft with and without PRP in the regenerative treatment of class II furcation defects in dogs. The mandibular second, third, and fourth premolars (P2, P3, P4) and maxillary P3 and P4 of both sides in three dogs were selected for experimentation. Class II furcation defects (5 mm in height and 2 mm in depth) were surgically created. Five weeks after the first operation, scaling + root planning (group 1), PRP (group 2), ACB (group 3), combination of ACB/PRP (group 4), and combination of MSCs/PRP (group 5) treatments were performed during open flap debridement. The percentage of cementum and alveolar bone formation was evaluated by histomorphometric analysis after a healing period of 8 weeks. There was new cementum along with periodontal ligament and coronal growth of alveolar bone in all groups. Cementum formation was significantly higher in groups 3, 4, and 5 compared to the control group (P < 0.05) with no significant difference between groups 2, 3, 4, and 5. Alveolar bone formation was similar in all groups (P > 0.05). It can be concluded that periodontal regeneration with complete filling of class II furcation defects with cementum, alveolar bone, and periodontal ligament is obtained 8 weeks after ACB, ACB/PRP, and MSCs/PRP treatments; however, efficacy of none is higher than another.

The impact of dietary induced hyperparathyroidism on healthy and diseased periodontia: an experimental study in rats.

BACKGROUND AND OBJECTIVE: Nutrition may be a potential modifying factor in periodontal conditions. The present study investigated this phenomenon for dietary induced hyperparathyroidism (dHPT) by revealing the histopathological and histomorphometrical profiles of healthy and diseased periodontia in dHPT. METHODS: Dietary induced hyperparathyroidism was induced in 12 rats by dietary calcium/phosphorous imbalance and 12 rats were fed standard diet (SD). Periodontitis was induced on the right mandibular molar teeth (mmt) of these rats by injecting an endotoxin + saline solution whereas injecting pure saline to the left mmt. Thus, four study groups were created: dHPT + saline (group 1), dHPT + endotoxin (group 2), SD + endotoxin (group 3) and SD + saline (group 4). Histological sections were obtained from the second mmt and examined using light microscope. RESULTS: Group 1 demonstrated inflammatory and degenerative alterations in periodontium without pocket formation. Periodontitis was evident in groups 2 and 3. Group 2 revealed the highest amounts of gingival inflammatory cell and vessel counts (group 2 > group 3 > group 1 > group 4), attachment and bone losses (group 2 > group 3 > groups 1 > group 4) and osteoclast count (group 2 > group 3 > group 1 > group 4) (p < 0.05). CONCLUSION: These results propose that dHPT may impair the health status of periodontium and may worsen the pathobiology of periodontal diseases.

Two cases of fetus in fetu.

Fetus in fetu (FIF) is a rare cause of abdominal mass in children. One of the malformed monozygotic diamniotic twins is located in the body of other twin. It is differentiated from teratoma by the presence of vertebral organization with limb buds and other organ systems. Diagnosis is based on radiologic findings. Surgical excision is the treatment of choice, leading to the complete removal of the mass. To our knowledge, less than 200 cases have been described in the literature. Herein, we report 2 cases of FIF, a newborn who was diagnosed antenatally and a three-and-half-year- old boy diagnosed with mediastinal FIF after admission for recurrent respiratory tract infections.

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

Solitary rectal ulcer causing lower gastrointestinal bleeding is extremely rare in children. Rare presentation, non-specific symptoms, insufficient experience, and characteristics mimicking other rectal diseases may cause misdiagnosis or delay of diagnosis in some pediatric patients. Here, we report a 10-year-old boy with solitary rectal ulcer diagnosed two years after onset of the symptoms who responded well to the conservative therapy, including high-fiber diet, laxatives, defecation training, and sucralfate enema.

Vascular endothelial growth factor (VEGF), matrix metalloproteinase-9 (MMP-9), and thrombospondin-1 (TSP-1) expression in urothelial carcinomas.

Angiogenesis is a multistep process that depends on the balance of proangiogenic factors and inhibitors as well as on interactions with the extracellular matrix. We examined the immunohistochemical expression of the defining angiogenic agents, vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9), and the antiangiogenic agent thrombospondin-1 (TSP-1) in 131 patients with urothelial carcinoma and correlated their expression levels with clinicopathological parameters. VEGF and MMP-9 expression was higher in high-grade tumors than in low-grade tumors (p=0.000 and p=0.001, respectively), whereas the reverse was true for TSP-1 (p=0.000). VEGF and MMP-9 expression was higher in deeper tumors compared to superficial tumors and in invasive tumors compared to non-invasive tumors (p=0.001 and p=0.001, respectively), while TSP-1 was lower (p=0.000). We could differentiate 22 of 41 muscle-invasive (T2) cases as superficial (T2a; n=7) or deep (T2b; n=15), but no difference was found between them regarding VEGF, MMP-9, or TSP-1 expression (p=0.783, p=0.289, and p=0.783, respectively). There was a positive correlation between VEGF and MMP-9 expression (p=0.008, r=0.23) but a negative correlation between MMP-9 and TSP-1 expression (p=0.014, r=-0.21). Increased VEGF and MMP-9 expression as well as decreased TSP-1 expression may play considerable roles in the invasion and differentiation of urothelial carcinoma.

Amyloid goiter: two cases and a review of the literature.

Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is an extremely rare occurrence. We describe two cases of amyloid goiter and review the relevant literature. The first case was systemic amyloidosis secondary to familial Mediterranean fever. The second case was a chronic renal failure patient who presented with an enlarged thyroid and upper airway obstructive symptoms. To date, true amyloid goiter secondary to amyloidosis associated with familial Mediterranean fever has only been reported in twelve patients.

Comparison of platelet pellet with or without guided tissue regeneration in the treatment of class II furcation defects in dogs.

The purpose of this study was to compare histological effectiveness of platelet pellet (PP), which has higher platelet content than platelet-rich plasma, and the combination of PP/guided tissue regeneration (GTR) for class II furcation defects in dogs. The mandibular second, third, and fourth premolars of both sides in four dogs were used. Class II furcation defects (5 mm in height and 2 mm in depth) were surgically created. Five weeks after the first operation, second premolars were treated with scaling and root planing (group 1); right third and fourth premolars received PP (group 2), and left premolars received the combination of PP/GTR (group 3). Percentage of cementum and alveolar bone formation were evaluated by histometric analysis after a healing period of 12 weeks. There was new cementum along with periodontal ligament and coronal growth of alveolar bone in all groups. Cementum formation was significantly higher in groups 2 and 3 compared to the control group (P < 0.05) with no significant difference between groups 2 and 3. Limited alveolar bone formation was statistically similar in all groups (P > 0.05). It is concluded that both PP and the combination of PP/GTR are effective in the treatment of class II furcation defects in dogs. PP thus appears to be a suitable alternative material in the regenerative periodontal therapy.

[Arthroplasty for the treatment of joint degeneration caused by ochronosis in two cases]. / Iki olguda okronozise bagli eklem dejenerasyonunda artroplasti uygulamalari.

Ochronosis is a rare metabolic disease caused by the deficiency of the homogentisic acid oxidase enzyme. With increasing age, accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We presented two female patients, with ages 55 and 60 years, who underwent staged bilateral uncemented total hip and bilateral cemented total knee arthroplasty, respectively, for osteoarthritis caused by ochronosis. Both patients had no significant complaints at final follow-up examinations made 12 months and 10 months after the second operation in the hip and knee, respectively. Plain radiographs did not show any abnormality in the components of the prostheses. Histopathologic examination of surgical specimens showed brown-black pigment deposits in the connective tissue and cartilage tissue.

Bcl-2 positivity in B and C hepatitis and hepatocellular carcinomas.

BACKGROUND/AIMS: This study aims to investigate the expression of bcl-2 in the chronic hepatitis B, C and hepatocellular carcinoma. METHODOLOGY: In this study, 23 chronic hepatitis C, 17 chronic hepatitis B and 29 hepatocellular carcinoma cases were examined. Liver biopsies have been immunohistochemically stained for the expression of bcl-2. Positive staining was semi-quantitatively graded from + to +++. RESULTS: Two out of 23 hepatitis C cases and 3 out of 17 hepatitis B cases were found to express bcl-2, staining was more intense in areas adjacent to active inflammatory process. Of the 29 hepatocellular carcinoma cases 6 stained positively for bcl-2; 9 biopsies in this group had also non-neoplastic liver tissue, and, of these 6 stained positively for bcl-2. Of the latter 6 bcl-2 positive biopsies 3 also showed tumoral staining while in the remaining 3, neoplastic elements were bcl-2 negative. CONCLUSIONS: As the present study is a cross-sectional study, no causative relation between bcl-2 positivity and hepatocellular carcinoma can be implied, however high incidence of bcl-2 activity in the non-neoplastic liver parenchyma of the HCC cases suggest that bcl-2 activation may be involved in the development of at least some cases of hepatocellular carcinoma. Case control and/or prospective studies are needed to show whether bcl-2 positivity in a chronic hepatitis case has a predictive value for the development of hepatocellular carcinoma.

Results of alcohol and albendazole injections in hepatic hydatidosis: experimental study.

BACKGROUND: Percutaneous drainage with alcohol injection for hydatid cysts has been commonly used in the last two decades. Albendazole is the drug of choice in the medical treatment of hydatidosis, and has also been used as an intraoperative scolicidal solution. The side-effects of its local application are not well known and have not been investigated. The purpose of the present study was to investigate the effects of the intracystic injections of alcohol and albendazole solutions on the hydatid cysts and hepatobiliary system of rabbits. METHODS: There were three groups of eight rabbits: a control group, an alcohol group and an albendazole group. In all groups hepatic hydatidosis was obtained. The control group received no therapeutic procedure. Cyst liquid was aspirated, and alcohol or albendazole solutions were injected in the other two study groups. alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) levels, echinococcus indirect hemagglutination (IHA) tests, and the size and volume of the residual cysts were investigated. Liver was histopathologically evaluated. RESULTS: The ALT, AST, GGT, and alkaline phosphatase (ALP) levels were significantly higher in the alcohol group, whereas echinococcus IHA level was highest in the control group than in the study groups. Albendazole had similar effects but of a lesser degree (P < 0.01). After therapy, the cyst volume was greater in the control than in the albendazole group (P < 0.01). In histopathological evaluation hepatocellular necrosis, portal inflammation and fibrosis were most severe in the alcohol group (P < 0.01). CONCLUSIONS: Alcohol and albendazole solutions are effective as scolicidal solutions. Higher scolicidal effect and lesser side-effects on hepatobiliary system are the advantages of albendazole solution.