Metastatic spiradenocarcinoma occurring in an 8-year-old boy.

We recently saw the case of an 8-year-old boy with histologic findings of spiradenocarcinoma. Malignant adnexal tumors in children are exceedingly rare, and cases of spiradenocarcinoma in children are absent in the literature. We report the case of an 8-year-old boy with metastatic spiradenocarcinoma. A biopsy 2 years before his presentation at our institution was interpreted as a benign lesion, but when the lesion regrew, a repeat biopsy was performed that demonstrated ominous findings, prompting a reexcision. This reexcision demonstrated an area with significant necrosis, many mitoses, and cellular pleomorphism apparently arising out of a sharply demarcated, adjacent, lower-grade area. The histologic features of this patient's biopsies were those of spiradenocarcinoma, potentially arising out of a preexisting spiradenoma, a finding that has not been documented previously in this age group. Staging studies demonstrated multiple bilateral pulmonary nodules, which were confirmed using thoracoscopic biopsy to be metastatic disease. His chemotherapy regimen has included several cycles of cisplatin and 5-flourouracil, with ongoing disease progression of pulmonary disease. It has been 16 months since he presented to our institution (>3 years since the appearance of his initial lesion). Imaging studies demonstrate a slowly increasing size and number of pulmonary lesions. The long-term prognosis is guarded.

Long-term outcome of trigeminal nerve injuries related to dental treatment.

PURPOSE: There is little information available on the long-term effects on patients of permanent involvement of the inferior alveolar or lingual nerve because of dental treatment. This study has attempted to document this information from patients who were reviewed between 3 and 9 years after injury. MATERIALS AND METHODS: All patients with an ICD-9 diagnosis of 951.2 (injury to the trigeminal nerve) because of dental treatment, seen in the Oral and Maxillofacial Surgery Clinic at the University of California, San Francisco between January 1, 2001 and December 31, 2006, were contacted in an attempt to complete a telephone survey of long-term effects. RESULTS: Of the 727 patients who were eligible for the study, 145 patients (95 female and 50 male) completed the telephone surveys. Many patients had sought both conventional and alternative treatments after consultation at University of California, San Francisco. A small number of patients had undergone subsequent surgery elsewhere. Many patients reported significant life changes, including adverse effects on employment (13%), relationship changes (14%), depression (37%), problems speaking (38%), and problems eating (43%). In general, however, patients reported improvement over time, often using a number of different coping mechanisms. Males had a greater decrease in symptoms than females, and those older than 40 years reported more pain in the long term than those under 40. Lingual nerve symptoms improved more than inferior alveolar nerve symptoms. CONCLUSIONS: Although most patients continue to have long-term problems that affect the overall quality of life, for most patients there has been improvement in symptoms over time.