RARE LARYNGEAL HAMARTOMA: A CASE REPORT.

Hamartoma (from the Greek language, where hamartia means defect or an error and -oma denoting a tumor or neoplasm) is a benign tumor-like mass composed of mature tissue or cells that are present in abnormal proportions or show a disorganized arrangement. Hamartomas are rarely seen in the head and neck area and especially rare in the larynx. Only few cases of laryngeal hamartoma have been reported in the literature so far. They are usually manifested by stridor, dysphonia and symptoms associated with airway obstruction. The diagnosis must be confirmed histologically and the method of choice in treatment is complete excision of the lesion. The authors present a case of laryngeal hamartoma of a 43-year-old woman treated for hoarseness and paralysis of the left vocal cord.

Inter-laboratory comparison of Ki-67 proliferating index detected by visual assessment and automated digital image analysis.

BACKGROUND: Proliferation rate is a major determinant of the biologic behavior of the tumor and provides information that can be used to guide treatment decisions. METHODS: This ring study included 27 pathologists from 14 Institutions, in order to assess inter-observer concordance between pathologists in Croatia. We analyzed Ki-67 proliferative index on ten randomly selected breast cancer samples comparing consistency between visual assessment using light microscopy compared to digital image analyses results from one central laboratory as a referral value. RESULTS: When we analyzed Ki-67 as numeric value high concordance rate was found between Ki-67 score visually assessed in all participating Institutions compared to referral value assessed by digital image analysis (ICC 0.76, 95% CI 0.58-0.91), and Krippendorff's alpha was 0.79 (95% CI 0.58-1.00). Concordance was better in slides with higher Ki-67 values. When we categorized Ki-67 values according to generally accepted 20% cut-off value we noticed the lower concordance rate among participants in our study. CONCLUSION: Proliferation remains one of the most important parameters for tumor characterization helpful in making clinical decisions, but it should be used with great caution. Standardization of the Ki-67 assessment is essential and proliferating index should be expressed as exact numeric value. For patients with proliferative index near the cut-off value, other factors must be considered in making clinical decisions.

Colorectal Adenocarcinoma Metastasizing to the Oral Mucosa of the Upper Jaw.

INTRODUCTION: Metastases to the oral cavity are uncommon, accounting for only 1% of all oral malignant tumors. When they occur they mostly originate from primary tumors of the lungs, kidney, breast and prostate. Oral metastases from the primary colorectal carcinoma are much more infrequent. CASE OUTLINE: We present an unusual case of a 78-year-old man with a soft tissue oral metastasis originating from the primary colorectal carcinoma.The patient was referred to the Department of Otorhinolaryngology, Head and Neck Surgery with an intraoral mass on the right side of the maxilla. The diagnosis was confirmed by histopathologic examination and immunohistochemical analysis. CONCLUSION: Oral metastases occur rarely and often can mimic much more common benign lesions, therefore they should be considered as a possibility in a differential diagnosis.

Vascular endothelial growth factor in a recipient cornea acts as a prognostic factor for corneal graft reaction development.

PURPOSE: To evaluate whether the vascular endothelial growth factor A (VEGF-A) in the recipient cornea measured at the time of penetrating keratoplasty (PK) can act as a prognostic factor for corneal graft reaction development. METHODS: The study included 25 eyes (of 25 patients) scheduled for PK. According to preoperative clinical finding, patients were divided into three groups: inflammatory with neovascularization (n = 11); inflammatory without neovascularization (n = 7); and non-inflammatory (n = 7). One half of the recipient cornea was analyzed for the levels of VEGF-A protein using a commercial enzyme-linked immunosorbent assay; the other half was analyzed to determine the loci of VEGF-A production by immunohistochemistry. The frequencies of corneal graft reaction and rejection were recorded, together with the improvement of visual acuity. Twenty-five donor corneas obtained from cadaver eyes represented the control group (n = 25). RESULTS: There was a statistically significant difference in the levels of VEGF-A protein between the recipient corneal buttons obtained from eyes with inflammatory changes and neovascularization, and those from the non-inflammatory group and controls (p < 0.01). The level of VEGF-A was 287.74 pg/ml (standard deviation [SD] = 129.181) in the inflammatory with corneal neovascularization group, 227.64 pg/ml (SD = 85.590) in the inflammatory without neovascularization group, 115.37 pg/ml (SD = 105.93) in the non-inflammatory group, and 142.28 pg/ml (SD = 93.081) in the control group. Graft reaction/rejection rate was 54.5%/45.5% in the inflammatory with neovascularization group, 14.3%/0% in the inflammatory without neovascularization group, and 14.3%/14.3% in non-inflammatory group. Patients who developed clinical signs of graft reaction during the postoperative follow-up had a significantly higher level of VEGF-A (307.4 pg/ml, SD = 100.058) compared with those without any signs of graft reaction (182.8 pg/ml, SD = 124.987). CONCLUSION: Our results suggest that both graft reaction and final graft rejection occur more often in patients with increased levels of VEGF-A in a recipient cornea at the time of PK.

Extranodal lymphomas of head and neck with emphasis on NK/T-cell lymphoma, nasal type.

PURPOSE: To determine the occurrence, clinical course and outcome of our patients with natural killer/T-cell lymphoma (NKTCL), nasal type. The nasal type of natural killer/T-cell lymphoma (NKTCL), is rare in the European population but is more frequent in Asia, Central and South America where it accounts for 15-20% of all non-Hodgkin lymphomas (NHL). This type of lymphoma is characterized by tissue necrosis and destruction of the nasal cavity and upper aero-digestive tract. The disease is closely associated with Epstein-Barr virus (EBV) infection and has an aggressive clinical course, poor clinical outcome and high resistance to chemotherapy. PATIENTS: 63 patients with NHL were treated in our department between 2006 and 2011. Eleven patients were diagnosed with extranodal lymphoma, 6 in the area of head and neck. Three of them belonged to NKTCL, nasal type group (4.7%), 1 was diffuse large B cell lymphoma and 2 were marginal zone lymphomas. CONCLUSION: Two out of 3 patients with nasal type NKTCL, had extremely aggressive disease resistant to applied chemotherapy (anthracycline containing regimen), while 1 patient remains in complete remission 6 years after diagnosis.

Supernumerary breast in an adolescent boy.

We present an adolescent boy with unilateral supernumerary breast. It was a V type by Leung Clasification. Despite the average occurence between 0.22% and 6% in a normal population we have not had other cases in the last 20 years. The patient was an asthenic boy of sixteen in the IV stage of puberty. Sometimes he felt swelling and tenderness in this breast tissue two years ago. These symptoms became worse two months ago. At the admission he was symptom free. In the right hypochondrium inferomedially he had a nipple and areola with a small part of the glandular tissue. The axilla was empty. After an excision we got a 15 x 10 x 8 mm specimen. Pathohistological report described incompletely formed mammary lobule with smooth muscles and lactiferous ducts of nipple in dermis. This was consistent with the diagnosis of ectopic breast tissue. He wanted it removed for esthetic reasons. His hormonal state was normal. All blood checks were normal. Kidney ultrasound was normal. His grandmother had pyelon duplex and frequent uroinfections. As it is known, there is an association between supernumerary breast tissue and renal malformations. Since he did not have it, we think that a routine screening of the uropoetic system should be performed in any patient with supernumerary breast.

Harmonic scalpel surgical treatment of the tongue angioleomyoma--case report and review of the literature.

Angioleiomyoma is benign soft tissue tumor composed of smooth muscle cells and vascular endothelium, characterized with slow growth, unspecific symptoms and rare malignant transformation. It is very rare in the head and neck region and complete surgical excision is the gold standard for diagnosis and treatment. We present a very rare case of angoleomyoma of the tounge base treated with partial glosectomy with harmonic scalpel which shortened surgical procedure, reduced bleeding and postoperative complications.

Gastric adenocarcinoma metastases to the alveolar mucosa of the mandible: a case report and review of the literature.

Malignant tumours rarely metastasize to the oral cavity. When they do, such metastases may arise from various locations including the lung, breast, kidney, prostate and colon. Soft tissue oral metastasis from gastric adenocarcinoma is extremely rare, and limited information exists regarding the presentation and work-up of metastatic gastric carcinoma into the oral soft tissue. We present an unusual case of a 70-year-old man and review the records of 17 cases of soft tissue oral metastasis from gastric carcinoma in the English and Japanese literature. Metastatic lesions from all sources are typically diagnosed in patients in their fifth to seventh decade, with the most common sites of soft tissue metastasis being the gingiva and alveolar mucosa of the mandible. In almost one quarter of patients a metastatic lesion in the oral cavity is the first manifestation of an undiscovered primary malignancy. They grow rapidly and tend to bleed and ulcerate. Because of their rarity and clinical characteristics, gastric metastatic tumours in the oral cavity are challenging to diagnose. Inflammatory and reactive lesions are common in the oral cavity and they should be considered in the differential diagnosis. Careful examination with a high degree of clinical suspicion, as well as a multidisciplinary approach is suggested.