Pseudomyogenic Hemangioendothelioma Arising in the Maxillary Sinus, an Uncommon and Misdiagnosed Tumor: A Case Report.

Pseudomyogenic hemangioendothelioma (PMHE) is a rare vascular neoplasm with an intermediate to low-grade malignant potential. Only 5% of PMHEs occur in the head and neck. This tumor exhibits different histological patterns and mimics other vascular tumors, myoid tumors, or carcinomas. The distinction between these tumors can be a very challenging situation for pathologists. In this article, we report the first case, to our knowledge, of PMHE arising in the maxillary sinus, to highlight this uncommon entity and discuss differential diagnoses.

Sinonasal angiosarcoma.

INTRODUCTION: Angiosarcoma is a malignant tumour arising from endothelial cells that accounts for 1% of all sarcomas. The sinonasal site of angiosarcoma is exceptional. CASE REPORT: The authors report a case of sinonasal angiosarcoma in a 53-year-old man. Despite wide resection by open surgery and postoperative chemoradiotherapy, several tumour recurrences were observed, requiring multiple operations. DISCUSSION: Only histological examination with immunohistochemistry is able to confirm the diagnosis (factor VIII, CD34 and CD31 antigens). Standard treatment consists of surgery with wide resection followed by radiotherapy. The authors discuss the treatment modalities and prognosis of this tumour.

Solitary plasmocytoma: ghost tumour?

Solitary plasmocytoma is a rare tumour that belongs to the myeloid dysplasia group. The authors present an unusual evolution of this pathology through a clinical case. A 42-year-old patient was diagnosed with solitary nasosinusal plasmocytoma following biopsy of the right nasal fossa process; several weeks after this the tumour spontaneously regressed. Extramedullar plasmocytoma is a myeloid dysplasia that seldom evolves into multiple myeloma. Spontaneous regression has been described for some malignancies, implying immunological factors, but not previously for extramedullary plasmocytoma.

[Florid cemento-osseous dysplasia of the jaws]. / Dysplasie cémento-osseuse floride des maxillaires.

INTRODUCTION: Florid cemento-osseous dysplasia is a benign and rare tumor of the jaws. It is more commonly seen in middle-aged black women. Most cases are asymptomatic and are found during routine radiographic examination. OBSERVATIONS: We report two complicated cases of florid cemento-osseous dysplasia, one with facial deformity and the other with chronic osteitis. DISCUSSION: The diagnosis of florid cemento-osseous dysplasia is based on clinical and radiological features. The lesions are commonly bilateral and symmetrical.

[Orbital exenteration]. / L'exentération orbitaire.

PURPOSE: Orbital exenteration is a disfiguring surgery. The surgery is mostly performed for advanced neoplasms of the eyelid in an attempt to achieve cure with tumor free margins. Reconstruction is a real challenge, especially in elderly patients with significant comorbidities. PATIENTS AND METHODS: We operated 15 patients presenting with palpebral and orbital tumors, between January 2000 and December 2007. We collected the clinical data concerning patients, tumor, treatment, and recurrences. RESULTS: Ten male and five female patients with a mean age of 56 years at diagnosis presented with ulcerative palpebral malignant tumor, and impaired ocular motility. Basal cell carcinoma was the most common (80%). All patients underwent exenteration, (subtotal three, total eight, and extended four patients). The cavity was filled with a temporal muscle flap in ten cases, Mustardé flap in three cases, latissimus dorsi myocutaneous free flap in one case, and a jugal V-Y flap in one case. The mean follow-up was 23 months with good healing without radiotherapy tissue alteration. Four patients had a recurrence and one patient died from metastases. DISCUSSION: The goals of reconstruction are functional and esthetic. Given the initial tumoral extension, we choose to use a regional or microsurgical flap for functional reconstruction. The flap provides a good cutaneous coverage, rapid healing, closure of orbital nasal and sinus communications, or of orbital and cranial communications. It is not damaged by radiotherapy.

[Intramasseteric hemangioma operated by intraoral approach]. / Hémangiome du masséter opéré par voie intra-orale.

INTRODUCTION: Hemangiomas are benign vascular tumors, of unknown origin. Skeletal muscle localization account for less than 1% of cases. Masseter muscle localization is most common in head and neck (36%). In this case, treatment is usually surgery via an extra-oral approach which imposes parotidectomy with dissection of facial nerve branches. We report a case of intramasseteric hemangioma operated via an intraoral approach and we describe the benefits of this approach. CASE REPORT: A 34-year-old male patient with no prior history of trauma consulted for left masseter swelling having evolved for several years. Clinical examination revealed a soft, painless, well-defined swelling, about 5cm long, with a positive Wattle sign in the left cheek. The CT exam suggested a vascular lesion, located in the deep bundle of the masseter muscle. Preoperative embolization was followed by surgical exeresis via an intraoral approach. The post-operative evolution was uneventful. No recurrence was observed at one year of follow-up. DISCUSSION: Intraoral intramasseteric hemangioma exeresis is possible and does not seem to lead to more complications than with the facial approach. It prevents the significant drawbacks due to cutaneous incision, parotidectomy, and dissection of facial nerve branches via a facial approach.

[Maxilla-mandibular brown tumors as a first sign of parathyroid adenoma]. / Tumeurs brunes maxillomandibulaires révélant un adénome parathyroïdien.

OBJECTIVES: Through a novel observation of parathyroid adenoma revealed by brown tumors of the jaws and a review of the literature, the authors describe this rare mode of primary hyperparathyroidism discovery. MATERIAL AND METHODS: The patient was a 23-year-old woman who consulted for a recurrent tumefaction of the maxillary; histology showed reparative giant cell granuloma. RESULTS: The clinical examination found an osseous tumefaction in continuity with the zygomatic bone and a gingival tumefaction on the mandible symphysis. The radiological findings showed two osteophytic lesions: mandibular and maxillary. The phosphocalcic metabolism was disturbed and the parathormone rate was high. The etiologic search consisted of a MRI of the neck, which showed a mass behind the thyroid gland, suggesting a parathyroid adenoma. The diagnosis was confirmed at surgical exploration. After removal of this tumor, the blood calcium rate dropped sharply and the bone tumefaction progressively regressed. CONCLUSION: Brown tumors are a rare mode of parathyroid adenoma discovery, and the jaw location is exceptional. The diagnosis is based on the parathormone rate, and radiological exams generally find the etiology. Treatment is based on surgery of the parathyroid adenoma.

[Compressive retropharyngeal hematoma in a hemophiliac patient]. / Hématome compressif rétropharyngé chez un patient hémophile.

INTRODUCTION: The retropharyngeal hematoma is rare and usually due to trauma, anticoagulation therapy complication or ascending aortic dissection. This presentation is extremely rare in hemophiliac patients. OBSERVATION: A 23-year-old hemophiliac patient presented with a spontaneous onset large retropharyngeal hematoma extended to the floor of the mouth associated with dyspnea, dysphagia and dysphonia. The patient underwent adequate and successful medical treatment. DISCUSSION: Hemophilia A is characterized by a deficit in factor VIII. Clinical symptoms are not specific and vary with the level of the intrinsic factor. Hematoma of the cervical region is a rare but potentially life-threatening event. The treatment requires transfusion of the specific factor and education of the patient and his relatives.

[Post syphilitic oro-nasal communication]. / Communication bucco-nasale post-syphilitique.

INTRODUCTION: Oro-nasal communication occurs due to a lack of bone and mucous membranes between the oral cavity and the nasal fossae, rarely subsequent to tertiary syphilis. CASE REPORT: A 27 year-old woman with a history of an untreated genital chancre which developed 7 years earlier, presented hard palate necrosis surrounded with granulation tissue. Syphilitic gum of the hard palate was diagnosed. After antibiotic treatment, the palatine lesion healed with persistence of an oro-nasal fistula. Physical examination of the oral cavity demonstrated median oro-nasal communication of the hard palate measuring 0,5 cm in diameter. HIV and syphilitic serologies were negative. The treatment consisted in surgical closure of the oro-nasal communication by the refection of nasal and oral plans. The follow-up was good. DISCUSSION: Oro-nasal communication due to syphilis is exceptional, of easy diagnosis and generally needs surgical treatment.

[Ankylosis of the temporomandibular joint: a rare manifestation of ankylosing spondylitis]. / Ankylose de l'articulation temporo-mandibulaire: rare manifestation de la spondylarthrite ankylosante.

INTRODUCTION: The ankylosing spondylitis is a chronic inflammatory rheumatoid disease with predilection in the axial structures. The temporomandibular joint (TMJ) is involved in 10 to 24% of cases. Ankylosis of the TMJ is exceptional, only 11 cases being reported to date. OBSERVATION: A 48-year-old patient had been followed since 1987 for severe ankylosing spondylitis. The patient, known to be positive for tissue antigen HLA B27, was admitted for limitation of mouth opening. At physical examination, mouth opening was reduced to 1cm with no mandibular movements and a stiffness of the cervical spine in flexion. Computed tomography of the TMJs highlighted a bilateral lesion with ankylosis of the left joint and of C1-C2. Surgical treatment consisted in block resection of the two TMJs using a cartilaginous rib. With a follow up of 9 months, results have been satisfactory. DISCUSSION: Complementary explorations should be undertaken in ankylosing spondylitis patients with clinical symptoms suggestive of TMJ lesions in order to establish the diagnosis and initiate treatment and avoid the development of ankylosic forms.

[Synovial sarcoma of the head and neck: two cases report]. / Synovialosarcome cervico-facial: à propos de deux observations.

UNLABELLED: Synovial sarcomas are soft tissue tumors that rarely occur in the head and neck The purpose of this report is to accrue data on this sarcoma at a rare site, and to highlight the histopathological differential diagnosis with other cervical tumors. MATERIALS AND METHODS: Two cases of cervico-facial tumors were reported in 26 and 27 year old women. RESULTS: Histologically, these tumors were classified into monophasic and biphasic variants. Immunohistochemistry plays a major part in the differential diagnosis, enabling the demonstration of epithelial differentiation. Radical surgery was the mainstay of treatment with post-operative radiotherapy for residual disease in one case. Local recurrence was developed in the patient who had only surgical treatment. DISCUSSION: Synovial sarcomas are a rare soft tissue malignancies and the head and neck region location accounts for 3-5% of them. The rarity of this tumor in the head and neck and its multitude of his histopathologic features are responsible for frequent initial misdiagnosis. Histologic, immunohistochemic and characteristic chromosomal translocation findings are necessary for diagnosis. The poor prognosis of this sarcoma justified a radical surgery with post-operative radiotherapy.

[Non-Hodgkin's malignant lymhoma of mental soft tissue: a case report]. / Lymphome malin non hodgkinien (LMNH) des parties molles du menton. A propos d'un cas.

Non-Hodgkin's malignant lymphoma is rarely located in the soft tissue of the chin making diagnosis difficult. Clinical signs are non-specific: progressive weight loss, asthenia, fever, an inflammatory tumefaction unresponsive to medical treatment. Imaging shows a homogeneous tumefaction of the soft tissues. Pathology and immunohistochemistry establish the diagnosis.

[A very unusual complication of the extraction of a wisdom tooth]. / Complication très particulière de l'extraction d'une dent de sagesse.

We report here a case of a 42-year-old man who presented a major complication during wisdom tooth extraction. Secondarily after an extraction attempt to tooth migrated into the temporal fossa which required hemi-coronal surgical removal. We present a description of the surgical technique.

[Mutilation of the lower lip. Repair using the Karapandjic technic. Apropos of 2 cases]. / Les multilations de la lèvre inférieure. Réparation par la technique de Karapandjic. A propos de 2 cas.

Many processes of repairing concerning the mutilation of the lower lip were described with their advantages and drawbacks. The Karapandjic process which has been described since 1974 is simple to realize, leaving no after-effects provided the loss of the substance is not very important. This process is illustrated regarding two cases.