Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

Objective@#To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL).@*Methods@#Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People′s Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases.@*Results@#This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma.@*Conclusions@#BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Comparison of radiological and clinicopathological features of craniofacial fibro-osseous lesions / 中华病理学杂志

To investigate the clinicopathological and radiological features of benign fibro-osseous lesion (BFOL). Sixty-five cases of craniofacial BFOL, eight cases of peripheral ossifying fibroma (POF) and one case of low-grade central osteosarcoma diagnosed at Sichuan Provincial People's Hospital between January 2010 and March 2019 were collected. The clinicopathologic features, hematoxylin-eosin and immunohistochemical (IHC) staining and radiographic features were analyzed. MDM2 gene amplification was detected by FISH in difficult borderline cases. This cohort of BFOLs included 50 cases of fibrous dysplasia (FD), 12 cases of ossifying fibroma (OF), and three cases of juvenile psammomatoid ossifying fibroma (JPOF). The average ages of patients with FD,OF and JPOF were 31.7, 39.2 and 26.0 years respectively. The male to female ratio was 1.0∶1.8.The average age of POF was 47.0 years, with male to female ratio of 1∶7. Patient of low-grade central osteosarcoma was a 48-year-old man. Twenty-seven cases of FD were located in the jaw, and 23 cases were in other craniofacial bones. Nine cases of OF were located in the jaw, and three cases were in the nasal cavity. Two cases of JPOF were in the nasal sinus, and one was in the jaw. All POF were located in the gingiva, and low-grade central osteosarcoma was located in the mandible. The imaging features of FD were luffa-like or ground-glass like signal shadows with poorly defined borders with expansion. OF had clear borders or sclerosing margins. Both JOF and low-grade central osteosarcoma were expansile intraosseously and with focally invasive nodular masses with ground-glass like signal shadows; and POF showed soft tissue mass with bone formation. Histological features of BFOLs showed mixed fibrous and irregular osteoid lesions. FD had no clear relationship with the host bone and no osteoblasts surrounded the bone trabeculae. Osteoblasts rimming was found in OF, and the boundaries of the host bone were clear. JPOF and low-grade central osteosarcoma infiltrated the host bone focally, and the latter showed mild cellular atypia. MDM2 amplification was detected in low-grade central osteosarcoma. BFOLs are a group of fibro-osseous lesions with similar morphology in the head and neck and face, but their clinical features and prognosis are different; and their imaging and histological characteristics are also slightly different. Attentions should be given to the combination of clinical, imaging and pathologic features of BFOLs, especially the differential diagnosis between BFOLs and low-grade central osteosarcoma. Molecular detection could be used to assist the diagnosis in difficult cases.

Espiradenoma écrino gigante associado à síndrome de Brooke-Spiegler / Giant eccrine spiradenoma associated with Brooke-Spiegler syndrome

A síndrome de Brooke-Spiegler é doença genética autossômica dominante rara, com predisposição a diversos tumores anexiais, dentre eles tricoepitelioma, cilindroma e espiradenoma. Os tumores surgem na segunda década de vida, aumentam progressivamente com a idade e sua prevalência é maior em mulheres. É causada por mutação no gene CYLD, localizado no cromossomo 16q12-q13. Relatamos caso exuberante de espiradenoma écrino gigante associado a essa síndrome.

Brooke-Spiegler syndrome is a rare autosomal dominant genetic disease with predisposition to many adnexal tumors, including trichoepithelioma, cylindroma and spiroadenoma. Tumors appear in the second decade of life, progressively increase with age, and their prevalence is higher in women. It is caused by a mutation in the CYLD gene, localized in the chromosome 16q12-q13. We report a exuberant case of giant eccrine spiradenoma associated to this syndrome.

Lentigo maligno na face: um desafio na conduta / Lentigo maligna on the face: a challenging conduct

Resumo O lentigo maligno é um melanoma in situ, de crescimento radial e lento, que acomete áreas fotoexpostas principalmente em idosos. Quando acomete a pálpebra, devido à proximidade a um órgão nobre, a conduta é controversa, porém a cirurgia é o método mais usado, com margens que variam de acordo com a referência utilizada. Terapias conservadoras são descritas, como o imiquimode 5% e a radioterapia. O presente relato tem como objetivo demonstrar a escassez de estudos sobre a margem cirúrgica e citar opções de tratamentos não cirúrgicos para o lentigo maligno da face.

Abstract Lentigo maligna is a melanoma in situ, of slow radial growth, which affects sun-exposed areas, especially in the elderly. When it affects the eyelid, due to the proximity to a noble organ, the conduct is controversial, but surgery is the method most commonly used, with with margins varying according to the reference used. Conservative treatments are described, such as imiquimod 5% and radiotherapy. This report aims to demonstrate the lack of studies on the surgical margin, and to name nonsurgical treatment options for lentigo maligna of the face.

O to Z flaps in facial reconstructions

Local flaps are the standard procedure to reconstruct facial defects. As it occurs in any surgical procedure, the incision should be planned so that scars are located in the minimum skin tension lines. We report two cases of O to Z flaps in the supra and infraciliary regions. One of them is a hatchet flap.

The application of free flap in oral-maxillofacial defects in head and neck tumors / 中国基层医药

Objective To investigate the free tissue flap in oral and maxillofacial surgery in head and neck cancer defects application value .Methods 154 cases of oral and maxillofacial tissue defects ,50 cases of tongue-mouth floor area defects ,13 cases of cheek palate defect ,35 cases of maxillary defect ,27 cases for the mandible , 28 cases of maxillary defects were selected .All patients underwent defect for free flap surgery oral and maxillofacial defects,of which 43 cases of forearm flap,fibula composite flap 15 cases,24 cases of diaphragmatic bone flap ,antero-lateral thigh flap flap 26 cases,free chest major muscle flap in 12 cases,15 cases of fibula flap,the other free flap, 34 patients were retrospectively analyzed the survival rate and postoperative complications .Results 154 cases of free flap,the survival rate was 96.75%.Which forearm flap survival rate was 97.67%;phrenic bone flap survival rate was 95.83%;anterolateral thigh flap survival rate was 96.15%;free pectoralis major flap survival rate was 91.67%;fibu-la flap survival was 93.33%;anterolateral thigh flap survival rate was 100.00%.Determination of the language defini-tion,154 patients,138 patients more than 90.00%clarity,while 16 patients more than 70.00%speech intelligibility. Conclusion Oral and maxillofacial traumatic tissue defects using free tissue flap reconstruction has certain safety and efficacy,the most common forearm free flap and fibula .Traumatic soft tissue defects in the early positive selection of free flap can effectively prevent tissue deformation and shift repair success rate ,postoperative language function recov-ery is good,it is worthy of clinical application .

Control study on submental island flap and free skin graft in buccal reconstruction of buccal defects after resection of buccal cancers by in aged patients / 重庆医学

Objective To observe and evaluate the clinical effect of submental island myocutaneous flap(SIMF) and free skin graft(FSG) for the reconstruction of buccal defect resulted from the buccal carcinomas .Methods Forty-four aged aging patients di-agnosed with the buccal carcinomas were operated by the total dissection of primary tumor and selective neck dissection and recon-structed simultaneously with SIMF(19 cases) and FSG(25 cases) .The degree of postoperative cheek shape ,limitation of mouth o-pening ,speech sound ,and function of chewing were observed and analyzed .Results Eighteen SIMFs were completely survived .The residual muscle flap had a good blood supply after the debridement of skin island in one case ,the successful rate of flaps was 94 .7%(18/19) while 100% (25/25) .The donor site of SIMF was sutured directly .Follow-up was taken in 12 months for all patients .In SIMF group ,the degree of postoperative cheek shape ,limitation of mouth opening ,speech sound ,and function of chewing were bet-ter than those of FSG group in FSG group(P0 .05) .Conclusion The submental island flap is an excellent choice for the reconstruction of cheek defects in aging patients af-ter resection of buccal carcinoma .With acceptable cosmetic ,functional results and reasonable oncological saftety ,SIMF has a prom-ising prospect in head and neck surgery .

Lower Lip Reconstruction after Wide Excision of a Malignancy with Barrel-Shaped Excision or the Webster Modification of the Bernard Operation

BACKGROUND: Because there are numerous methods for reconstruction of the lower lip, it is not easy to choose the optimal method. In choosing the surgical method for lower lip reconstruction, we obtained acceptable outcomes based on our treatment strategy, which included either a barrel-shaped excision or the Webster modification of the Bernard operation. We report on the surgical outcomes based on our treatment strategy. METHODS: This study included 26 patients who underwent lower lip reconstructive surgery from September 1996 to September 2010. The operation was done using either a barrel-shaped excision or the Webster modification, considering the location of the defect, the size of the defect, and the amount of residual tissue on the lateral side of the vermilion after excision. RESULTS: In our series, 3 patients underwent a single barrel-shaped excision, and nine patients underwent a double barrel-shaped excision. In addition, the unilateral Webster modification was performed on in 6 patients, and there were eight cases of bilateral Webster modification. All of the patients except one were satisfied with the postoperative shape of the lip. In one case both recurrence and dehiscence occurred. One patient had a good postoperative lip shape, but had difficulty wearing a denture, and also underwent commissuroplasty. Furthermore, there were two patients who complained of drooling, and 4 with paresthesia. CONCLUSIONS: A soft tissue defect resulting from wide excision of a lower lip malignancy can be successfully reconstructed using only one of two surgical methods: the barrel-shaped excision or the Webster modification of the Bernard operation.

The facial nevi associated with hydrocephalus and intracranial anomalous venous return of 3 case reports / 中华神经科杂志

Objective To study the clinical manifestation of intracranial anomalous venous return associated with the facial nevi and hydrocephalus. Methods Along with reviewing of the literatures, the clinical records of 3 patients suffered from the facial nevi and hydrocephalus were analyzed. Results All of 3 patients also have sinovenous occlusion, which affect cerebral venous return. Conclusions Intracranial anomalous venous return, which is induced by extensive sinovenous occlusion, has been considered to be the main cause of hydrocephalus in the facial nevi. The formation of sinovenous occlusion and anomalous venous return may be due to developmental defect in the embryonic stage.

Expression of vascular endothelial growth factor in carcinoma of cheek and its significance / 吉林大学学报(医学版)

Objective To study the expression of vascular endothelial growth factor(VEGF) in carcinoma of cheek in order to investigate the relation with carcinogenesis and development of carcinoma of cheek.Methods The expression levels of VEGF were determined by S-P method of immunohistochemistry technique in 40 tissues of carcinoma of cheek,30 para-carcinoma and 10 normal mucosa.Results The expression rates of VEGF in the tissues of carcinoma of cheek,para-carcinoma and normal mucosa were 85.0%,26.7%,10.0%,respectively.There was remarkable difference in the statistic(?~2=32.26,P