A primary oral mucosal melanoma of the hard palate with no recurrence: Report of a 10 years follow-up.

BACKGROUND: Primary oral mucosal melanoma (OMM) represents an extremely rare and aggressive tumor that arises from malignant transformation and clonal expansion of melanocytes in the oral cavity. The prognosis of patients affected by OMM is quite unfavorable, with survival rates lower than those described for patients with cutaneous melanoma. CASE REPORT: Here, we report a case of OMM in a 59-year-old Caucasian woman, who was referred for evaluation of a large asymptomatic pigmented lesion on the left side of the hard palate under the removable total denture. Incisional biopsy was performed, and histopathological analysis revealed the proliferation of spindle-shaped and pigmented epithelioid cells, with cellular pleomorphism. These cells were positive for Melan A, S-100, HMB-45, SOX-10, and Ki-67 confirming the diagnosis of OMM. The patient underwent partial maxillectomy and adjuvant radiotherapy. After treatment, she was rehabilitated with a palatal obturator prosthesis and has been in follow-up for 10 years with no evidence of disease. Due to the rarity in the oral cavity and the nonspecific signs and symptoms, the diagnosis of OMM is difficult and often overlooked. CONCLUSION: Therefore, multidisciplinary management from diagnosis, treatment, and rehabilitation is important to increase the expectation of cure.

Expression of mitochondrial dynamics markers during melanoma progression: Comparative study of head and neck cutaneous and mucosal melanomas.

BACKGROUND: Head and neck mucosal melanomas (MMs) are rare tumors with adverse outcomes and poorer prognoses than their more common cutaneous counterparts (cutaneous melanomas-CMs). Few studies have compared the expression of mitochondrial dynamic markers in these tumors. This study aimed to assess the correlations of mitochondrial markers with melanoma progression and their potential as predictors of lymph node involvement and distant metastasis. METHODS: Immunohistochemistry against anti-mitochondrial (AMT), dynamin-related protein 1 (DRP1), mitochondrial fission protein 1 (FIS1), mitofusin-1 (MFN1), and mitofusin-2 (MFN2) antibodies was performed in 112 cases of head and neck CM and MM. A Cox regression multivariate model was used to assess the correlation of AMT, FIS1, and MFN2 expressions considering the risk for nodal and distant metastasis. RESULTS: All markers studied presented higher staining in tumor cells than normal adjacent tissues. Higher mitochondrial content was observed in MM than in CM, and it was significantly associated with nodal metastasis in oral melanomas. Both FIS1 and DRP1 expressions were related to advanced Clark's levels in CM, and they were overexpressed in oral melanomas. Moreover, increased immunoexpression of MFN2 was significantly associated with a higher risk of metastasis in CM, and it was also overexpressed in sinonasal melanomas. CONCLUSIONS: Our results suggest that mitochondrial fission and fusion processes can play an important role during multiple stages of tumorigenesis and the development of nodal and distant metastasis in cutaneous and mucosal melanomas.

Prognostic importance of mitochondrial markers in mucosal and cutaneous head and neck melanomas.

Mitochondrial dysfunction is caused by an imbalance in the fission and fusion processes, and it has been implicated in the pathogenesis of several human cancers. However, the role of mitochondrial markers in melanomas still remains poorly understood. In this study, the authors assessed the expression of 3 mitochondrial markers (antimitochondrial, fission protein 1 [FIS1], and mitofusin 2 [MFN2]) in a series of head and neck mucosal and cutaneous melanomas. Patients with cutaneous (n = 56) and mucosal (oral, n = 30, sinonasal, n = 26) melanomas of the head and neck region were enrolled in this study. Clinical and follow-up data were retrieved from medical records. The expression of 3 mitochondrial markers was assessed by the immunohistochemistry, and then digitally quantified and correlated with clinicopathological data and outcome information. In the multivariate model, high mitochondrial content was identified as an independent prognostic value for disease-free survival (DFS) in cutaneous melanomas and overall survival in oral melanomas. FIS1 expression was significantly associated with lower overall survival rates in patients with oral melanomas and strictly correlated with vascular invasion in mucosal melanomas. MFN2 was associated with high risk of distant metastasis in patients with cutaneous melanomas. In summary, the authors demonstrated that mitochondrial content, along with FIS1 and MFN2 expressions, is correlated with important clinicopathological characteristics in patients with cutaneous and mucosal head and neck melanomas.

Phosphorylated Akt1 expression is associated with poor prognosis in cutaneous, oral and sinonasal melanomas.

Melanomas are highly aggressive tumours derived from melanocytes, which occur most commonly in the skin. Occasionally, these tumours may appear in oral and sinonasal mucous membranes. In this study, we performed a comparative analysis of the Phosphorylated Akt1 (p-Akt1) expression in 144 patients affected by cutaneous (CM), 34 oral cavity (OM), and 31 sinonasal melanomas (SNM). Similar to the metastatic cutaneous melanomas, p-Akt1 was overexpressed in 17/34 of the oral cavity and 20/31 of the sinonasal melanomas. In addition, the p-Akt1-nuclear expression was associated with poorer cancer-specific survival in cutaneous (P < .0001), oral (P < .0001), and sinonasal (P = .001) melanomas. Multivariate analysis showed p-Akt1 to be an independent prognostic marker in oral (P = .041) and sinonasal (P < .0001) melanomas patients. In conclusion, p-Akt1 overexpression is an independent prognostic marker in mucosal melanomas and is significantly up-regulated in sinonasal melanomas. As both mucosal and metastatic cutaneous melanomas showed high frequency of p-Akt1 expression, these findings suggest that mucosal melanomas have a biological behaviour, similar to the aggressive cutaneous melanomas.

Hodgkin lymphoma diagnosed during dental treatment: the importance of neck palpation.

Hodgkin lymphoma (HL) is a malignant lymphoproliferative disease that originates from alterations in germinal center B cells. HL generally affects cervical and supraclavicular nodes, and the most common clinical presentation is adenopathy. It can be symptomatic and detected by the patient or asymptomatic and identified during a physical examination. This article reports the case of a 17-year-old girl who was diagnosed with HL during dental treatment, highlighting the importance of a complete physical examination in dental practice.

Cribriform adenocarcinoma of the soft palate with multiple lymph node metastasis and long-term follow-up.

INTRODUCTION: Cribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a recently described entity, with most cases previously published as polymorphous low-grade adenocarcinoma (PLGA). Typical cases share some main characteristics, such as oral sites (mainly tongue), regional lymph node metastasis, and morphology resembling solid and follicular variants of papillary thyroid carcinoma. OBJECTIVE: To present a CATMSG and emphasize the importance of reclassifying PLGAs with unusual behavior. CASE REPORT: A 78-year-old male presented with an ulcerated mass in the soft palate treated as PLGA. The patient developed 5 regional metastases over 11 years of follow-up, all diagnosed as PLGA. He died due to the disease, and because of the very aggressive behavior of PLGA, all histopathologic slides were revised and the tumor was reclassified as CATMSG. CONCLUSION: This report emphasizes the importance of reevaluating aggressive PLGA and contributes to a better understanding of CATMSG.

Epithelial-myoepithelial carcinoma of the minor salivary glands: a case report and review of the literature.

Epithelial-myoepithelial carcinoma (EMC) is a rare tumor, especially in the minor salivary glands. This case report describes a 40-year-old man who presented with an EMC on the palate. Histologically, the tumor was characterized by a biphasic structure consisting of duct-lining cuboidal cells in the inner layer and clear myoepithelial cells in the outer layer. The clear cells predominated, and the diagnosis was confirmed with immunohistochemical staining. The inner cuboidal epithelial cells were positive for cytokeratins, whereas the outer cells were positive for S-100 protein and smooth muscle actin. The patient was treated with a wide surgical excision, and no recurrence or metastasis was observed at a 10-year follow-up. A literature review found only 30 well-documented cases of EMC in the intraoral minor salivary glands.

Maxillary desmoplastic fibroma with initial symptoms suggestive of sinusitis.

Desmoplastic fibroma (DF) is a benign intra-osseous neoplasm characterized by the formation of abundant collagen fibers. It arises most commonly in the jaws and exhibits local aggressiveness and high recurrence rates after local resection. An uncommon case of expansive DF involving the right maxilla, maxillary sinus, and inferior orbital wall of a 49-year-old man whose initial symptoms were similar to acute sinusitis is presented, and the criteria for diagnosis and clinical management are discussed.

Labial mucosa metastasis of fibule giant cell-rich osteosarcoma: an unusual presentation.

Oral metastases from osteosarcoma are rare, particularly in the soft tissues of the oral cavity. The aim of the current case is to present a patient with labial mucosa metastasis from a long bone osteosarcoma and review the literature. A 55-year-old man who had a recent leg amputation because of a giant cell tumor presented a lesion in the lower labial mucosa. After histopathologic and immunohistochemical analysis the diagnosis was of an undifferentiated sarcoma. The patient quickly developed other lesions on the scalp and on the hand, and biopsy of one of these lesions rendered the diagnosis of a giant cell-rich osteosarcoma. Reviewing all information, it was concluded that the leg tumor was the primary giant cell-rich osteosarcoma misdiagnosed as a giant cell tumor. This case emphasizes the importance of the general clinicians' multidisciplinary approach and association of information to arrive at the proper diagnosis, particularly in rare and difficult situations.

Reactive post-radiotherapy bone formation in the maxilla.

OBJECTIVE: High-dose radiation therapy affects bone metabolism, and therefore post-radiotherapy bone formation is an uncommon finding. This case describes an unusual ossification in the maxillary region identified after head and neck radiotherapy. RESULTS: A 45-year-old female patient was submitted to maxillary surgical resection and orbital exenteration due to squamous cell carcinoma. Radiotherapy post-surgery was performed because of compromised surgical margins. After 4 months of the conclusion of radiotherapy, the patient presented a bone exposition at surgical site. Surprisingly, the oral examination and computed tomography revealed a new formation of the right palatine vault and bone formation filling the nasal and orbital cavity. The incisional biopsy discarded residual disease or osteoradionecrosis and showed normal tissue. CONCLUSIONS: To the best of the authors' knowledge, this is the first case of wide bone formation as an early effect of head and neck radiotherapy.

Primary synovial sarcoma involving the submandibular gland.

Synovial sarcoma represents 5.6%-10% of all soft-tissue sarcomas. Adolescents and young adults are most frequently affected, mainly in the deep soft tissue of the extremities. Only 10% of synovial sarcomas affect the head and neck region; most of these are biphasic. We describe a case of an 18-year-old man who complained of a mass in the right submandibular region that had been present for approximately 12 months. On surgical removal, microscopic analysis showed a tumor formed by sheets of malignant spindle cells involving the submandibular gland. Immunohistochemistry displayed positivity for AE1/AE3, CK18/8, epithelial membrane antigen, CD99, CD56, and TLE-1. Based on these immunohistochemical and histopathologic features, a diagnosis of monophasic synovial sarcoma was rendered. The patient was treated with adjuvant radiotherapy and after 1 year was free of disease. To the best of our knowledge, this is the first reported case of synovial sarcoma involving the submandibular gland.

Synchronous oral paracoccidioidomycosis and oral squamous cell carcinomas with submandibular enlargement.

Oral paracoccidioidomycosis and oral squamous cell carcinoma may occur in the same patient. As both lesions may present similar clinical and histopathological features, the diagnosis is sometimes challenging. This paper describes the case of a 54-year-old male who was a farm worker and heavy alcohol and tobacco user. He developed paracoccidioidomycosis and two lesions of squamous cell carcinoma in the oral cavity. During the follow-up, the patient presented enlargement of the submandibular lymph nodes, which was thought to be regional metastasis but was diagnosed as paracoccidioidomycosis. Therefore, the significance of this association is emphasized and discussed.

Bazex syndrome (acrokeratosis paraneoplastica) diagnosed in a patient with oral persistent ulcerations.

Paraneoplastic syndromes associated with head and neck cancer are rare and have been reported under dermatological, endocrine, hematological, neurological and rheumatological disorders. Bazex syndrome is an intriguing paraneoplasia that can be associated with head and neck squamous cell carcinomas. A range of symmetrical dermatological manifestations, with a clear predilection to extremities, that encompasses erythematous squamous plaques, skin scaling and nail dystrophy can provide a psoriasiform pattern in Bazex syndrome. In addition to these tricky clinical features, the rarity of the disease and the lack of understanding on Bazex syndrome generally make such cases to be mismanaged as psoriasis or lichen planus, causing an important delay in the diagnosis of the underlying malignancy. The authors describe a case of Bazex syndrome that occurred in a patient with a recently diagnosed tongue squamous cell carcinoma. Clinicians should consider paraneoplasia when assessing skin and/or oral persistent lesions.

Arterial branches to the temporal muscle.

UNLABELLED: The temporal muscle is greatly used for forming myofascial flaps and transposition in cases of reconstructive and reparative plastic surgery of the face and neck. Despite this important application, lack of success has been reported, probably because of lack of knowledge of the anatomical characteristics of this muscle, such as variations in its blood supply. OBJECTIVES: To investigate the blood supply of the temporal muscle in order to provide an anatomical basis for reconstructive and reparative surgery of the face using flaps from the temporal muscle. This study was conducted by dissecting 21 half faces from cadavers of children (13 male and 8 female) that had been injected with neoprene latex through the common carotid artery. The temporal muscle usually received three or four arterial branches coming from the maxillary and superficial temporal arteries. The branches of the maxillary artery could be separate (anterior deep temporal, posterior deep temporal and accessory deep temporal arteries) or together with other branches of the maxillary artery, forming trunks. The branches of the superficial temporal artery were always separate (middle temporal artery). The anterior deep temporal artery originated in front of the coronoid process and the posterior deep temporal artery behind it. The numbers of arterial branches in the anterior and middle thirds of the muscle were similar and slightly greater than the number in the posterior third. The most frequent arterial branch in the anterior third was the anterior deep temporal artery; in the middle third, it was the posterior deep temporal artery; and in the posterior third, it was the middle temporal artery. The most frequent patterns of arterial branch presence in the temporal muscle were: a) anterior deep temporal, posterior deep temporal and middle temporal arteries; and b) anterior deep temporal, posterior deep temporal, accessory deep temporal and middle temporal arteries. The accessory deep temporal artery is a direct branch from the maxillary artery that originates at the level of the coronoid process of the mandible and participates in irrigating the anterior and middle thirds of the muscle.