Case for diagnosis. Multinucleated cell angiohistiocytoma

Abstract: Multinucleate cell angiohistiocytoma is a rare idiopathic benign fibrohistiocytic and vascular proliferation usually presenting as multiple asymptomatic papules, red to violaceous in colour, primarily located on the extremities of middle-aged females. This entity is probably underdiagnosed due to the lack of recognition by clinicians and pathologists. We describe a patient with a multinucleate cell angiohistiocytoma of the face, a less frequent localization, in order to increase awareness of this entity and elucidate its clinical, histopathological, and immunohistochemistry features.

Neurofibroma solitario: informe de caso clínico / Solitary neurofibroma: report of a clinical case report

Objetivo: Informar, a partir de la descripción de un caso clínico, la presencia de un neurofiboma solitario, lesión poco frecuente en cavidad bucal.Caso clínico: Un paciente de sexo masculino, de 47 años de edad, reconsultó por un bulto asintomático en la zona posterior de mucosa yugal izquierda. A partir de los datos de la historia clínica y de estudios complementarios, se procedió a efectuar la extirpación quirúrgica de la lesión, para luego realizar la biopsia y la anatomía patológica. Los resultadosconfirmaron la presencia de un neurofibroma solitario en cavidad bucal, en un sitio poco frecuente, como lo es la mucosa yugal. Conclusión: Si bien el neurofibroma es una lesión poco frecuente en cavidad bucal, su diagnóstico y su tratamiento oportuno son fundamentales para evitar posibles recidivas o transformaciones malignas.

Aim: To report and describe the presence of a solitaryneurofiboma, infrequent injury in the oral cavity, from the reportof a clinical case.Case report: A 47-year-old male patient consulted froman asymptomatic lump in the posterior area of the left jugularmucosa. From the data of the clinical history and complementarystudies, the surgical excision of the lesion was carriedout, after which the biopsy and the pathological anatomystudy were performed. The results confirmed the presence ofa solitary neurofibroma in the oral cavity, in a rare site, suchas the jugular mucosa.Conclusion: Although the neurofibroma is a rare lesionin the oral cavity, its diagnosis and timely treatment are fundamentalto avoid possible recurrences or malignant transformations.

The effect of hippophae rhamnoides extract on oral mucositis induced in rats with methotrexate

ABSTRACT Objective: To investigate the effect of HRE (Hippophae rhamnoides extract) on oral mucositis induced in rats with MTX. Material and Methods: Experimental animals were divided into groups as healthy (HG), HRE+MTX (HMTX), and control group, which received MTX (MTXC). HMTX group received 50 mg/kg HRE while MTXC and HG groups received equivolume distilled water with gavage once a day. After one hour of HRE and distilled water administration, HMTX and MTXC groups received a single dose of oral MTX 5 mg/ kg. This procedure was repeated for one month. Results: The levels of MDA, IL-1β, and TNF-α were found to be significantly higher in the cheek, lower lip, and tongue tissue of the animals receiving MTX, compared with HG and HMTX groups; however, these parameters were lower in the cheek and low lip tissue, and a milder damage ocurred in these tissues, compared with the tongue tissue in MTXC group. No histopathologic damage was observed in the cheek, lower lip, and tongue tissues of the rats treated with HRE. Conclusion: This findings indicate that HRE as a natural product is an important advantage compared with synthetic drugs for prophylaxis of oral mucositis developed due to MTX.

Dermoscopic and clinical features of head and neck melanoma

AbstractBACKGROUND:The dermoscopic criteria of extrafacial melanomas are well-known.OBJECTIVE:To determine the frequency of dermatoscopic findings in head and neck melanomas (HNM) and to assess the distinguishing dermoscopic criteria of facial and extrafacial melanoma.METHODS:This observational study included 108 patients with HNM (63% male, mean age 64 years). Participants underwent individual dermoscopic imaging of clinically melanoma. All lesions were excised, and histopathological examination was performed on all specimens.RESULTS:Drawing on histopathological analysis, lentigo maligna melanoma or lentigo maligna was diagnosed in 60 lesions, superficial spreading melanoma in 18, nodular in 10, desmoplastic in 8, superficial spreading melanoma in situ in 12. The most frequent location for head and neck melanoma was the cheek (60 patients, 55.6%). Eight prominent dermatoscopic features were observed in facial melanoma: annular-granular pattern (18%); rhomboidal structures (29%); pseudonetwork (29%); asymmetrical, pigmented, follicular openings (51%); obliterated hair follicles (8%); red rhomboidal structures (18%); increased density of the vascular network (32%); scar-like depigmentation (59%).CONCLUSIONS:HNM has specific dermoscopic features, and classical extrafacial dermoscopic rules are less useful for diagnosis of facial melanoma. In our study, further characteristic dermatoscopic findings were detected in facial melanoma such as low frequencies of irregular dots, 2 or fewer colors in lesions, the presence of pseudonetwork, increased density of the vascular network, red rhomboidal structures, in addition to dermatoscopic findings of extrafacial melanoma. Thus, it is concluded that the prediction and identification of HNM may be evident with the help of these signs.

Associação de retalho mucoso e retalho cutâneo local na reconstrução de perda de substância em região da bochecha / Mucosal and local skin flap reconstruction for loss of substance in the cheek region

A face representa uma estrutura importante nos seres humanos, devido a ser a parte mais visível do corpo e conter elementos delicados e complexos, que são essenciais em termos de beleza e funcionalidade. As reconstruções faciais, em áreas de grandes perdas de substâncias, permanecem como um desafio para os cirurgiões. Apresentam várias opções de reparo, todas com suas vantagens e desvantagens. Mostramos o caso de um paciente apresentando perda de substância de espessura total em região de bochecha, que foi submetido à associação de retalho mucoso e retalho cutâneo local, apresentando bom resultado e preservação funcional.

The face is an important structure, because it is the most visible part of the body and contains delicate and complex elements that are essential for aesthetics and functionality. Facial reconstruction of areas with substantial substance loss remains a surgical challenge. There are several repair options, with corresponding advantages and disadvantages. We present a case of a patient with substance loss of the total thickness of the cheek region who received mucosal and local skin flap surgery, with good results and functional preservation.

Pleomorphic Adenoma in Cheek: An Uncommon Finding.

Pleomorphic adenoma (PA), also called benign mixed tumor, is the most common benign salivary gland neoplasm. About 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands. Review of literature, clinical features, pathology, radiological fi ndings, and treatment of these tumors are discussed. We report a case of PA of minor salivary gland of cheek in 16-year-old female patient.

Pyostomatitis vegetans

Pyostomatitis vegetans [PV] is a rare chronic inflammatory disease of unknown etiology. Oral appearance are the first symptoms. One of the less common clinical features is erosions which tend of form granulation tissue, and finally develop a vegetative looking, especially in the skin folds and heal and face. In clinical examination diffuse vegetation and snail tract was found

Quantification of AgNOR expression in exfoliated oral mucosal cells of tobacco chewers with and without lesion.

Background: Nucleolar organizer regions (NOR) are associated with proliferative activity and represent a diagnostic and prognostic marker. Materials and Methods: Smears were taken from smokers, tobacco chewers, oral squamous cell carcinoma patients, and normal subjects and evaluated by 2 silver-staining nucleolar organizer region (AgNOR) counting methods: (1) mean number of AgNORs per nucleus (mAgNOR); and (2) percentage of nuclei with >3 and >5 AgNORs (pAgNOR). Results: A statistically significant difference was observed between normal subjects, smokers, tobacco chewers, and oral cancer patients and between tobacco chewers with and without lesion. No significant difference was observed between tobacco chewers and smokers except in the percentage of >5 criteria. Conclusions: AgNOR enumeration using noninvasive methods, such as the cytobrush appears to be useful technique in distinguishing between normal mucosa, mucosa with and without lesions exposed to carcinogens, such as tobacco and frank oral carcinoma.

Benign hyperplasia of duct-associated lymphoid tissue: Report of a case and review of literature.

Focal lymphoid tissue is ubiquitously present in the oral mucosa and serves as a barrier for entrapment of antigens. The mucosa-associated lymphoid tissue is generally dispersed and sometimes associated with the ducts of the minor salivary glands. Proliferation of the duct-associated lymphoid tissue (DALT) is rarely reported, though probably of common occurrence. We report a case of benign hyperplasia of DALT in the buccal mucosa of a 58-year-old male. The histogenesis and pathological implications of this tissue are discussed and the need for recognition of this entity is stressed.

Diffuse inflammatory facial swelling secondary to local anesthetic injections in patient with polyalkylimide gel used for cheek augmentation

Nowadays the uses of cosmetic fillers have increased dramatically including those placed in the facial region. Although commercial advertisements claim that injectable fillers are biologically inert and pose no significant health risks, we report a case of a patient with bilateral cheek augmentation using Polyalkylimide gel fillers presented with recurrent episodes of facial swelling following routine dental treatment. The clinical scenario presented here highlighted the significance of the interference of the facial gel fillers with the routine dental treatment

Non-invasive 3D facial analysis and surface electromyography during functional pre-orthodontic therapy: a preliminary report

OBJECTIVES: Functional orthodontic devices can modify oral function thus permitting more adequate growth processes. The assessment of their effects should include both facial morphology and muscle function. This preliminary study investigated whether a preformed functional orthodontic device could induce variations in facial morphology and function along with correction of oral dysfunction in a group of orthodontic patients in the mixed and early permanent dentitions. MATERIAL AND METHODS: The three-dimensional coordinates of 50 facial landmarks (forehead, eyes, nose, cheeks, mouth, jaw and ears) were collected in 10 orthodontic male patients aged 8-13 years, and in 89 healthy reference boys of the same age. Soft tissue facial angles, distances, and ratios were computed. Surface electromyography of the masseter and temporalis muscles was performed, and standardized symmetry, muscular torque and activity were calculated. Soft-tissue facial modifications were analyzed non-invasively before and after a 6-month treatment with a functional device. Comparisons were made with z-scores and paired Student's t-tests. RESULTS: The 6-month treatment stimulated mandibular growth in the anterior and inferior directions, with significant variations in three-dimensional facial divergence and facial convexity. The modifications were larger in the patients than in reference children. In several occasions, the discrepancies relative to the norm became not significant after treatment. No significant variations in standardized muscular activity were found. CONCLUSIONS: Preliminary results showed that the continuous and correct use of the functional device induced measurable intraoral (dental arches) and extraoral (face) morphological modifications. The device did not modify the functional equilibrium of the masticatory muscles.

Carcinoma cheek: regional pattern and management

Oral cancer varies globally and regionally, and is closely linked with geographical, social, economical, biological, ethnic, dietary and environmental factors. In western countries it accounts for about 2-5% while in the south-east Asia for about 40% of all cancers. In Pakistan it is second commonest tumour after bronchogenic carcinoma in males and breast carcinoma in females. The objectives of this study were to find out the pattern of carcinoma cheek in our region, its etiological associations, management and prognosis. This study was conducted in the Otolaryngology and Head and Neck Surgery Department of Civil Hospital, Karachi from April 1995 to December 1998. It was prospective study. Forty-five cases of primary carcinoma cheek were diagnosed and investigations including OPG and CT scan were carried out along with other required investigations to evaluate the extension of tumour, bony erosion and metastasis. TNM staging was done. All patients were treated surgically, sent for post-operative radiotherapy or chemoradiation and followed up for 3 years. Among 45 cases of oral cancer, 28 were females and 17 were males. Common presenting symptom was growth or ulcer. It was more common in 41-50 years of age. Squamous cell carcinoma [SCC] was found in 95.5% of the cases. Most of the patients 31[68%] were in T4 stage. Surgical excision was done in all cases with reconstruction in 23 cases and neck dissection in 39 cases. In the follow up for 3 years, 30 patient remained disease free. Carcinoma cheek is a common entity in our region and now it is seen in relatively younger patients. Oral cancer is a self preventable disease. What is required is to develop awareness of oral hygiene and discourage the habit of social carcinogens use. Early diagnosis and treatment offers better chance of cure whereas advance disease has a poor prognosis

Kimura's Disease Involving the Ipsilateral Face and Extraocular Muscles

Kimura's disease (KD) is a rare, chronic inflammatory disorder, which is characterized by tumor-like masses mainly located in the head and neck region. Extraocular muscle involvement in KD is uncommon. We report a case of KD that involved both the extraocular muscles and buccal area. A 13-year-old male presented to our clinic with a two-year history of exophthalmos of the left eye and facial swelling. Facial CT and MRI showed a 1.5 x 1.5 cm2 soft tissue mass located at the left masticator and buccal area, exophthalmos of the left eye, and diffuse thickening of the left extraocular muscles. We performed a lateral rectus muscle incisional biopsy of the left eye. Oral methylprednisolone therapy was initiated and tapered following the incisional biopsy.

Histopathological study of apparently normal oral mucosa in lepromatous leprosy.

In lepromatous leprosy, it may be postulated that apparently normal areas of skin are the probable sites of future extension of the pathological process and the events taking place in these site might represent the earlier stages of such an extension. Thus the present study has been done to evaluate any such changes in the apparently normal oral mucous membrane of the lepromatous leprosy patients, since oral involvement is common in these patients. Twenty two cases of lepromatous leprosy were studied histologically to see changes in apparently normal oral mucosa. Out of the 22 patients, apparently normal skin biopsies were taken from 13 patients and 5 lesional biopsies were taken from the same patients. Apparently normal oral mucosal biopsies were done for all patients. Biopsies of 22 cases of apparently normal oral mucosa did not show granulation formation of acid-fast bacilli histologically. The only change present was mild inflammation.

Chronic maxillary sinusitis with an unusual presentation

Maxillary sinus is the most commonly affected sinus. Complications arise due to spread of infection beyond the bony walls of sinus. It is rare to see a maxillary cutaneous fistula in the absence of dental disease in this modern era. This is a case report of a 40 years old female presenting as a I cm diameter open fistula on the cheek secondary to maxillary sinusitis along with osteomyelitis. Pus culture and sensitivity revealed resistant strains of staphylococcus aureus and pseudomonas aeruginosa. Once osteomyelitis was settled with antibiotics, diseased sinus mucosa was removed, inferior meatal antrostomy carried out, fistulous tract excised, anterior maxillary wall repaired with iliac crest bone graft and wound repaired in layers

Fibrohistiocitoma maligno sobre radiodermitis / Malignant fibrous histiocytoma over radiodermitis

Se prsentan dos casos clínicos de fibrohistiocitoma maligno sobre radiodermitis. El primer caso se trata de un paciente de sexo masculino que presenta una lesión tumoral en mejilla derecha, zona de radiodermatitis crónica provocada por tratamiento de acné 25 años atrás. Luego de la escisión quirúrgica la lesión recidivaal año. En el segundo caso una paciente de sexo femenino portadora de carcinoma mamario presenta una lesión tumoral compatible con fibrohistiocitoma maligno localizada en cara anterior de tórax, sobre una radiodermitis crónica por tratamiento de cobalto realizado por su patología de base 23 años atrás. Se derivó al srvicio de cirugía, pero la paciente fallece antes por metástasis del carcinoma. Dada la escasa frecuencia de esta patología se realiza una revisión bibliográfica del tema