Malignant peripheral nerve sheath tumor (MPNST) arising from angiosarcoma: a rare case report.

PURPOSE: An extremely rare case of divergent differentiation of a cutaneous angiosarcoma to a malignant peripheral nerve sheath tumor (MPNST) is presented. METHODS: A 62-year-old male patient presented with an angiosarcoma of the left buccal region, which was excised with wide surgical margins. Four months after the operation, the tumor recurred locally as a MPNST. The recurrent tumor was treated with surgical excision followed by postoperative radiotherapy. Four years later, the patient presented with solitary lung metastasis. The patient underwent upper right lobectomy. RESULTS: The patient is alive and disease-free 2 years after the lobectomy and 6 years after initial presentation. CONCLUSIONS: Divergent differentiation of an angiosarcoma to a neurosarcoma supports the theory that cells of the neural crest capable of differentiating both to neuroectoderm and to mesenchyme give origin to these tumors.

Head and neck Merkel cell carcinoma: a retrospective case series and critical literature review with emphasis on treatment and prognosis.

OBJECTIVE: Merkel cell carcinoma (MCC) is a rare cutaneous malignancy with a high recurrence and mortality rates. More than half of MCCs occur in the head and neck region. This paper aims to present a retrospective case series study of primary MCCs of the head and neck treated in our department over 12 years. STUDY DESIGN: Six patients were identified, and their characteristics, treatment modalities, and outcomes are reported. A critical review of the current literature is also included to provide up-to-date information on MCCs with special emphasis on treatment modalities and disease prognosis. RESULTS: Management of head and neck MCCs requires early and accurate diagnosis and includes surgery, radiotherapy, and/or combination chemotherapy. Accurate cervical nodal staging is of paramount importance before establishing the definite treatment plan. CONCLUSIONS: The results of both our case series and literature data review indicate that elective management of regional lymph nodes is recommended instead of an observation approach for patients with no identifiable disease in the lymph nodes (cN0). Because the majority of MCCs arise in the head and neck region, oral and maxillofacial surgeons are likely be the first professionals who will encounter this disease and should therefore be aware of the current diagnostic and treatment modalities.

A Simplified Reconstructive Technique for Full-thickness Central Defects of the Auricle with the Use of a Post-auricular Folded Flap.

BACKGROUND: Post-auricular flaps have proved very effective in the reconstruction of most types of partial auricular defects. However, few reports exist regarding the reconstruction of centrally located perforating defects of the auricle. OBJECTIVES: This paper aimed to describe a one-stage technique including a post-auricular folded flap (PAFF) for reconstruction of full-thickness defects of central auricular sites. PATIENTS AND METHODS: Between March 2010 and November 2014, five male patients were treated with this reconstructive technique under local anaesthesia. At the time of surgery, patients' age ranged from 76 to 86 years (mean age, 79.8). The patients suffered from a central and full-thickness defect owing to surgical excision of a skin malignancy or failed reconstruction procedures secondary to surgical excision of a skin malignancy. RESULTS: Healing was uneventful for all the included patients, without signs of dehiscence, necrosis, hematoma and infection. The defects were completely repaired, without the need of further operations. During the follow-up period, all the patients remained satisfied with the aesthetic outcome. CONCLUSIONS: This technique constitutes an immediate, effective and low-morbidity procedure to repair full-thickness central defects of the auricle. Since PAFF requires only one surgical operation under local anaesthesia, patients with burdened medical history may profit from this technique.

Carotid-Cavernous Fistula as a Complication of Facial Trauma: A Case Report.

Posttraumatic carotid-cavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. Symptoms involve headache, diplopia, ptosis of the upper lid, conjunctival chemosis, pulsating exophthalmos, and ophthalmoplegia. Diagnosis can be challenging because various pathologic entities can present with similar symptoms such as superior orbital fissure syndrome, orbital apex syndrome, retrobulbar hematoma, and cavernous sinus syndrome. However, accurate and early diagnosis is of utmost importance because treatment delay may lead to blindness or permanent neurologic deficits. In this article, a case of posttraumatic carotid-cavernous fistula that was twice misdiagnosed is presented.

Metastatic Tumours to the Oral Cavity: Report of Three Cases.

BACKGROUND: Metastatic tumours to the oral cavity from distant organs are uncommon and represent approximately 1 - 3% of all oral malignancies. Such metastases can occur to the bone or to the oral soft tissues. Almost any malignancy from any site is capable of metastasis to the oral cavity and a wide variety of tumours have been reported to spread to the mouth. METHODS: Careful examination of the oral cavity and a high degree of clinical suspicion as well as a multidisciplinary approach are suggested. RESULTS: In this article we present three patients, a female and two males with metastatic tumours to the oral cavity, who were referred to our Department. The primary tumours were invasive lobular breast carcinoma, gastric adenocarcinoma and small cell lung carcinoma respectively. CONCLUSIONS: Metastases to the oral cavity are quite uncommon among population. They usually present with symptoms similar to odontogenic infections and benign tumours, causing a delayed diagnosis and treatment.