Undiagnosed squamous cell carcinoma of the forehead presenting as a Tolosa-Hunt syndrome.

Squamous cell carcinoma (SCC) is the second most common periocular skin cancer. We describe a case of invasive squamous cell carcinoma arising from actinic keratosis and causing orbital and intracranial invasion via perineural spread. Perineural invasion (PNI) is a known feature of SCC and very rarely basal cell carcinomas of the head and neck. A high degree of clinical suspicion is necessary to diagnose PNI. Varied clinical presentations have been described for this form of dissemination, including orbital apex syndrome as in our case. Prognosis is poor, with death resulting in over 50% of cases at 5 years.

Polymorphous low-grade adenocarcinoma of the nasal fossa.

An unusual case of a T4N2CMx polymorphous low grade adenocarcinoma located in the nasal fossae and extending to the pterygoid area is presented. The primary tumor was excised through a Lefort I maxillotomy and the neck was managed with a supraomohyoid neck dissection. Adjuntive postoperative radiotherapy was also administered to the patient.

Adenocarcinoma Polimorfo de Bajo Grado de fosa nasal / Polymorphous low-grade adenocarcinoma of the nasal fossa

Se presenta un inusual caso de Adenocarcinoma Polimorfo de Bajo Grado en estadio IV (T4N2CMx) localizado en la fosa nasal con extensión hacia región pterigoidea. El tumor primario fue tratado mediante una resección del mismo a través una osteotomía de maxilar superior tipo Lefort I y a nivel cervical se realizó un vaciamiento ganglionar cervical supraomohioideo homolateral. Posteriormente recibió tratamiento coadyuvante con radioterapia postoperatoria

An unusual case of a T4N2CMx polymorphous low grade adenocarcinoma located in the nasal fossae and extending to the pterygoid area is presented. The primary tumor was excised through a Lefort I maxillotomy and the neck was managed with a supraomohyoid neck dissection. Adjuntive postoperative radiotherapy was also administered to the patient

Metalloproteinase-2 and -9 in giant cell arteritis: involvement in vascular remodeling.

BACKGROUND: Both matrix metalloproteinase-2 (MMP-2) and -9 (MMP-9) have been postulated to play roles in the pathophysiology of giant cell arteritis (GCA) because of their ability to degrade elastin. Understanding the specific mediators of arterial damage in GCA could lead to new therapeutic targets in this disease. METHODS AND RESULTS: Temporal artery biopsy specimens were obtained from 147 consecutive patients suspected of GCA. Clinical and histopathological data were collected according to protocol. Using immunohistochemistry, we compared the expression of MMP-2 and MMP-9 in the temporal artery biopsies of both GCA cases (n=50) and controls (n=97). MMP-9 was found more frequently in positive than in negative temporal artery biopsies (adjusted odds ratio [OR], 3.20; P=0.01). In contrast, the frequency of MMP-2 was not significantly different between positive and negative biopsies (adjusted OR, 2.18; P=0.22). Both MMP-2 and MMP-9 were found in macrophages and giant cells near the internal elastic lamina and in smooth muscle cells and myofibroblasts of the media and intima. MMP-9 was also found in the vasa vasorum. MMP-9 but not MMP-2 was associated with internal elastic lamina degeneration, intimal hyperplasia, and luminal narrowing, even after adjustment for possible confounding variables. CONCLUSIONS: MMP-9 appears more likely than MMP-2 to be involved in the pathophysiology of GCA. MMP-9 not only participates in the degradation of elastic tissue but also is associated with intimal hyperplasia, subsequent luminal narrowing, and neoangiogenesis. The expression of MMP by smooth muscle cells implicates these cells as potential secretory cells in GCA.

No detection of parvovirus B19 or herpesvirus DNA in giant cell arteritis.

BACKGROUND: Compelling arguments exist for a role of infectious agent in giant cell arteritis (GCA). Parvovirus B19 and several herpesviruses have focussed the attention in recent years, but the few studies to date have yielded inconsistent results. OBJECTIVES: To study the relationship between the presence of parvovirus B19 DNA or major known herpesviruses and the histopathological features of GCA. STUDY DESIGN: Between January 1997 and March 2002, 147 consecutive temporal artery biopsies were performed in our center because of a clinical suspicion of GCA. Using polymerase chain reaction (PCR) procedures validated by the World Health Organization and employed routinely by our laboratory, we examined the paraffin-embedded specimens for DNA from parvovirus B19, herpes simplex viruses (HSV) 1 and 2, Epstein-Barr virus (EBV), varicella-zoster virus (VZV), human cytomegalovirus (HCMV), and human herpesvirus 6 (HHV-6). We investigated positive results further with immunohistochemistry studies. RESULTS: Fifty of the 147 temporal artery biopsies (34%) showed histological features of GCA. Three biopsies (2.5%) were initially PCR positive for parvovirus B19. None of the herpesvirus PCR assays were positive. Upon repeat testing by both PCR and immunohistochemistry, none of the three initially positive parvovirus B19 assays were confirmed. The results of both positive and negative control assays in these studies validated these findings. We confirmed the presence of amplifiable DNA in the temporal artery biopsy specimens using PCR primers for beta-globin and indoleamine 2,3-dioxygenase (IDO). CONCLUSIONS: The results of our study do not support a role in the etiopathogenesis of GCA for either parvovirus B19 or any of these six herpesviruses.

Carcinoma escamoso gingival: caso clínico y diagnóstico diferencial / Gingival squamous cell carcinoma: a clinical case and differential diagnosis

Se presenta el caso clínico de una mujer de 59 años que consulta por presentar una lesión tumoral en la encía del segundo cuadrante, de unas 6 semanas de evolución. Se presentan los resultados del estudio histopatológico y se plantea el diagnóstico diferencial. Se comentan las entidades más probables del diagnóstico diferencial (granuloma piógeno, carcinoma escamoso y metástasis gingivales), discutiéndose asimismo la importancia de los aspectos radiológicos. Se concluye que el diagnóstico definitivo exige la concordancia entre los aspectos clínicos, radiológicos e histopatológicos (AU)