Maxillofacial diagnostic features of the enigmatic metastasizing pleomorphic adenoma.

Considering the confusion in the literature regarding local recurrence, spread, or metastases of pleomorphic adenoma (PA) in the head and neck region, the aim of this study was to enhance understanding of the characteristics of metastasizing pleomorphic adenoma (MPA) by reviewing the literature and presenting a case. English language articles with proof of metastases were included in the literature review. Of the 80 cases in the literature with MPA, 46 were female and 33 were male (sex missing for one case). Thirty-five percent of the neoplasms affected the bones; the maxilla was affected in five cases and the mandible in three. The parotid was the primary site in 72.5% of cases and the submandibular gland in 16.2% of cases. The local recurrence rate was 70%. The mean interval between primary PA and MPA was 15.52 years. The total mortality rate was 8.7%. A case of PA of the submandibular gland that recurred after surgical excision and metastasized (confirmed by the presence of intact cortical borders) to the ipsilateral mandibular body, upper lip, and neck is described. The high mortality rate in a histologically defined benign disease that metastasizes demands that management include careful primary excision and long-term clinical follow-up.

Age-associated inflammation connects RAS-induced senescence to stem cell dysfunction and epidermal malignancy.

Aging is the single biggest risk factor for malignant transformation. Among the most common age-associated malignancies are non-melanoma skin cancers, comprising the most common types of human cancer. Here we show that mutant H-Ras activation in mouse epidermis, a frequent event in cutaneous squamous cell carcinoma (SCC), elicits a differential outcome in aged versus young mice. Whereas H-Ras activation in the young skin results in hyperplasia that is mainly accompanied by rapid hair growth, H-Ras activation in the aged skin results in more dysplasia and gradual progression to in situ SCC. Progression is associated with increased inflammation, pronounced accumulation of immune cells including T cells, macrophages and mast cells as well as excessive cell senescence. We found not only an age-dependent increase in expression of several pro-inflammatory mediators, but also activation of a strong anti-inflammatory response involving enhanced IL4/IL10 expression and immune skewing toward a Th2 response. In addition, we observed an age-dependent increase in the expression of Pdl1, encoding an immune suppressive ligand that promotes cancer immune evasion. Moreover, upon switching off oncogenic H-Ras activity, young but not aged skin regenerates successfully, suggesting a failure of the aged epidermal stem cells to repair damaged tissue. Our findings support an age-dependent link between accumulation of senescent cells, immune infiltration and cancer progression, which may contribute to the increased cancer risk associated with old age.

Clinical characteristics of lichen and dysplasia vs lichen planus cases and dysplasia cases.

OBJECTIVES: To compare the clinical characteristics of lichen planus with dysplasia (LD) cases with oral dysplasia (DYS), and LP/lichenoid reaction (LP/LR). METHODS: Patients treated at the Department of Oral Medicine with a histological diagnosis were included. Patient information (age, gender, ethnicity, smoking habits, and medical status) and parameters of oral manifestation (lesions' distribution, site, and type) were compared. RESULTS: Two hundred and thirty five patients were included. 54% were never smokers and 25% were current smokers. The LD group (n = 79) had more bilateral cases when compared to the DYS group (n = 30), 70% to 40.7%, respectively (P = 0.008), and a lower average age [56-62, respectively (P = 0.043)]. All other parameters were similar. When compared to LR patients, the LD group had a higher percentage of men [41.8-27.9%, respectively (P = 0.08)] while all other parameters were similar. CONCLUSIONS: As clinical characteristics of LD are more similar to the LP and LR group than to dysplasia, these findings may indicate that LD should be considered as part of the lichen planus disorder spectrum rather than a separate entity, although further analysis of larger groups is warranted. These results support the need for clinical follow-up among patients diagnosed with lichenoid changes.

Cytochrome P450 3 A expression in pigs livers after 24-hour preservation in Biolasol solution depending on the type of transgenesis.

BACKGROUND: An insufficient number of organs for transplantation shows the need for the development of new technologies. Xenotransplantation might be the answer. OBJECTIVE: To determine if the type of transgenesis influences the level of CYP3A4, which takes an active part in xenobiotics metabolism in livers after 24-hour storage, depending on the kind of solution used for preservation. MATERIALS AND METHODS: The experiment was carried out on 30 livers of Polish White Landrace divided into 5 groups depending on transgene type. The following human genes were transferred: α1,2-fucosyltransferase (groups I and II), α-galactosidase (III), combined α1,2-fucosyltransferase/α-galactosidase transgene (IV), and livers without modification (V). The livers were perfused and subsequently stored for 24 hours in Ringer's solution (group I) or Biolasol solution (II-V). Reperfusion/reflush was performed. CYP3A29 isomer concentration was analyzed in liver specimens collected twice: 30 minutes after perfusion and 30 minutes after reperfusion/reflush. Expression of mRNA CYP3A29 was marked using RT-PCR analysis and of protein CYP3A29 using Western blotting technique. RESULTS: The most significant decrease in protein CYP3A29 expression after 24-hour preservation was observed in group I (55.88% decrease), while the least significant was observed in group IV (10.44% decrease). mRNA expression evaluation was similar: the most significant decrease was observed in group I (87.8% decrease) and the least significant in group III (4.6% decrease). CONCLUSION: α1,2-Fcosyltransferase transgene seems to influence mRNA and protein CYP3A expression in case of liver grafting and preservation for transplantation. CYP3A expression was also influenced by the kind of preservation solution used.

Interleukin-6 concentration in the transgenic pig's liver preserved for 24 hours in Biolasol solution.

INTRODUCTION: Increasing the human lifespan contributes to a higher number of patients with end-stage organ failure, which in turn stimulates the search for alternative sources. Xenotransplantation seems to be a promising approach in this respect. OBJECTIVE: Analysis of changes in interleukin (IL)-6 concentration during 24-hour preservation of transgenic swine livers, depending on the kind of transgenesis and preservation solution used. MATERIALS AND METHODS: The experiment was carried out in swine livers with transferred human genes that were divided into 5 groups. The following human genes were transferred: α1,2-fucosyltransferase (group I and II), α-galactosidase (III), combined α1,2-fucosyltransferase/α-galactosidase transgene (IV), and livers without modification (V). The livers were perfused and subsequently stored for 24 hours in Ringer's (group I) or Biolasol solutions (II-V). Reflush was then performed. IL-6 concentration was analyzed in the solution samples collected at the beginning and end of perfusion, and after 24 hours of preservation. ELISA was used to evaluate IL-6 concentration. RESULTS: In liver homogenates from group I, IL-6 concentration after 24 hours of preservation increased by 8.24% compared to the levels observed after perfusion, whereas in the other groups IL-6 concentration decreased. The most significant decrease, 49.51%, was observed in group II; the least significant in group IV, 10.72%. In case of supernatants, a statistically significant increase of AUC0-30min level in relation to perfusion was observed in every group after 24-hour preservation and reperfusion. The highest values of AUC0-30min were observed in group I (α1,2-fucosyltransferase, Ringer's solution). CONCLUSION: The study indicates the hepatoprotective action of Biolasol solution.

Morphometrical study of minor salivary gland in xerostomic patients with altered lipid metabolism.

OBJECTIVE: To evaluate the correlation between dyslipidemia in patients with oral dryness and the development of non-specific histopathological findings in their labial salivary gland biopsies. METHODS: Thirty seven patients suffering from oral dryness (18 patients with dyslipidemia and 19 age-matched patients with normal lipid blood levels) underwent labial salivary gland biopsy. Total acinar area (TAA), acinar cell number, acinar lumen area (ALA), duct lumen area (DLA), area occupied by cells in acinus (AoCA), and area of one acinar cell (OAC) were calculated. RESULTS: A significantly (P < 0.05) increased AoCA, OAC, and DLA in labial glands from patients with impaired lipid metabolism, compared to controls, were found. CONCLUSION: A positive relationship between dyslipidemia and morphological changes in labial salivary glands was obtained.

Tropism of herpes simplex virus type 1 to nonmelanoma skin cancers.

BACKGROUND: Current treatments for nonmelanoma skin cancer include surgery, Mohs micrographic surgery, radiation, cryosurgery, photodynamic therapy, local chemotherapy and application of immunomodulators such as imiquimod. However, all have a 5-year recurrence rate of 1-40%. Gene therapy for the treatment of skin cancers is a promising new approach, as delivery of the vectors to the skin is simple and safety issues can be properly addressed. OBJECTIVES: To develop an ex-vivo organ culture system for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) tumours, and to test the feasibility of applying oncolytic viruses to these tumours. METHODS: We first optimized conditions for the maintenance of BCC and SCC tissues in organ culture, and demonstrated viability of the tissues ex vivo for 3-7 days. The tropism of two potential oncolytic viral vectors, herpes simplex virus type 1 (HSV-1) and adenovirus (AD), was next evaluated. RESULTS: Immunohistological analysis revealed that HSV-1 targeted tumour cells that expressed p63 and did not express keratin 15 or keratin 14 markers of keratinocytes. Further examination indicated that uninfected BCC and SCC tissues express two isoforms of p63 mRNA, and HSV-1 infection specifically enhanced expression of the TAp63 isoform. Furthermore, following infection, both HSV-1 and AD induced apoptosis in the BCC and SCC cells as indicated by the induction of activated caspase-3. CONCLUSIONS: The results indicated a specific pattern of viral tropism to skin cancer cells that are critical for maintenance of the tumour. This new experimental system should aid in the analysis of new therapeutic modalities, such as oncolytic viruses, for future treatment of these skin tumours.

Intravascular papillary endothelial hyperplasia of the lower lip: surgical approach and review of the literature.

OBJECTIVE: A review of the literature for intravascular papillary endothelial hyperplasia is presented along with a case report of a geriatric patient. REVIEW OF THE LITERATURE: Intravascular papillary endothelial hyperplasia (IPEH) is a reactive benign lesion of vascular origin, which is caused by an excessive proliferation of endothelial cells. Only a few cases with IPEH in the oral cavity have been recorded in the literature, reporting the lower lip as the main site. The treatment of choice mentioned in the literature is simple excision. CASE REPORT: In this case, an IPEH of the lower lip of a 79-year-old male was treated by a sclerosing agent, which was injected into the lesion, causing compression and fibrosis of the blood vessels, followed by a careful dissection and excision. Intra-operatively no bleeding occurred. Post-operatively an excellent aesthetic result was achieved, without recurrence. CONCLUSION: The use of sclerotherapy followed by surgery in mixed type intravascular papillary endothelial hyperplasia can provide an acceptable aesthetic result with minimal intra-operative bleeding.

Lesions of the caruncle: a description of 42 cases and a review of the literature.

Lesions of the caruncle are uncommon. On account of the histological composition of the caruncle, which includes, in addition to conjunctiva, hair follicles, sebaceous glands, sweat glands, and accessory lacrimal tissue, the caruncle may develop lesions that may be similar to those found in the skin, conjunctiva, or lacrimal gland. Clinical preoperative diagnosis is very difficult and reached only in about half of the cases. The vast majority of lesions of the caruncle are benign, mainly nevi. Reported malignant lesions are very rare but can be potentially fatal. Although malignancy is clinically overestimated, any suspected malignant lesion should be excised and examined histopathologically by an experienced pathologist. This study presents the clinical and histological data of 42 consecutive caruncular lesions processed at our laboratory and reviews previously reported cases of caruncular lesions.

Did volume of lymphocele after kidney transplantation determine the choice of treatment modality?

INTRODUCTION: Lymphocele is a lymph collection that forms after surgery following injury to lymph nodes and vessels. The aim of the study was to perform a retrospective analysis of different treatment modalities of lymphocele in patients after kidney transplantation. MATERIAL AND METHODS: A lymphocele located in renal graft area was observed in 25 of 386 transplanted patients (6.5%). Mean patient age was 45 (95% confidence interval [CI], 40 to 50) years. Mean observation time was 35 (95% CI, 27 to 43) months. RESULTS: Mean time from transplantation to diagnosis of lymphocele was 29 days (range, 4 to 127). In 13 patients (54.2%), the lymphocele was symptomatic, requiring initial treatment by repeated needle aspirations or percutaneous drainage. Among 7 patients with persistence of the lesion treatment by sclerotherapy with doxycycline, povidone-iodine, and/or ethanol was successful in 4 cases who showed maximal lymphocele volume of 500 mL. Three other patients, namely, volumes of 120, 874, and 2298 mL were referred for surgery; in two cases, internal marsupialization was performed and in one case external drainage was necessary due to abscess formation. Mean time from the diagnosis to recovery in patients requiring surgical treatment was 15 (range, 8 to 24) weeks. Eleven patients with asymptomatic lymphoceles (mean volume 45 mL; range, 8 to 140) were monitored to resolution after a mean of 4 (range, 1 to 11) weeks. CONCLUSION: All lymphoceles with the maximal volume exceeding 140 mL were clinically symptomatic. Initial percutaneous drainage with or without sclerotherapy was an effective method of treatment. Punctures, drainage, and sclerotherapy were not effective in patients with lymphoceles (>500 mL).

Histopathologic changes in dental and oral soft tissues in 2-butoxyethanol-induced hemolysis and thrombosis in rats*.

BACKGROUND: 2-Butoxyethanol (2-BE; ethylene glycol monobutyl ether) is extensively used as a solvent in surface coatings, such as lacquers, enamels, and varnishes in industrial and household cleaning products. Its major toxicity is manifested in the circulation, as it induces hemolytic anemia and thrombosis in various organs. While 2-BE has been implicated in the induction of anemia in different species, the rat has proven most sensitive, especially the female of this species. The purpose of this study was to document the effects of 2-BE on dentition, the periodontal ligament, the tongue, the salivary glands, and the oral mucosa in male and female Fischer 344 rats. METHODS: The experiment included 40 rats divided into five groups. Four groups were exposed to 2, 3, or 4 daily doses of 2-BE, and a fifth group served as control. The rats were killed on days 2, 3, 4, and 29. The teeth and soft oral tissues were prepared for histopathologic observation. RESULTS: The histopathologic analysis showed that the major effect of 2-BE was exerted on the odontoblasts of the incisors and on molars, with greater effect on the incisors. Foci of damaged muscle cells in the tongue were also observed. The blood vessels were dilated and congested, and a primary thrombosis was seen in the dental pulp. CONCLUSIONS: The results of this study revealed a resemblance between the dental injuries in this rat model and those seen in sickle cell anemia in humans. This 2-BE animal model holds potential to assist in the discovery of preventive measures and/or treatment for dental injuries that occur in human diseases with hemolytic anemia.

Silver-sulfadiazine eschar pigmentation mimics invasive wound infection: a case report.

A 3-year-old girl with 52% TBSA scalds, mostly partial thickness, was treated topically with 5% mafenide acetate solution and 1% silver sulfadiazine cream. All blood cultures and wound swabs were negative for the first 5 days. On day 6 gram-negative bacteria and yeast forms were isolated from her wounds. High fever and leukocytosis were present and the child was treated with intravenous ampicillin and gentamicin according to sensitivity bacteriogram. The bacteria were identified as Pseudomonas aeruginosa and the yeast was Candida tropicalis. On day 7, Escherichia coli was identified in blood cultures and intravenous cefixime was added. Amphotericin B was added on day 9 when blood cultures grew Candida tropicalis and Burkholderia cepacia. On day 13 dark pigmentation foci developed on some areas of partial-thickness burns in the back, resembling invasive wound infection. White blood cell count was 14,300 cells/mm3, and her body temperature reached 39.7 degrees C. Cultures from the pigmented areas were negative, and biopsies revealed deposits of silver. Most of the areas healed uneventfully, and only about 8% TBSA needed grafting, including some of the pigmented areas. No residual pigmentation remained on discharge.

Nodular fasciitis of the breast: report of a case initially diagnosed by fine needle aspiration cytology.

BACKGROUND: Nodular fasciitis is a rare benign pseudosarcomatous proliferation of fibroblasts in the breast, in which the clinical examination and mammographic findings may closely mimic mammary carcinoma. CASE: A case of nodular fasciitis was diagnosed by fine needle aspiration. A 15-year-old girl was admitted to our hospital with a recently noticed, rapidly growing mass in the right breast. The aspirate contained cohesive groups of fusiform cells with elongated and oval nuclei, regular nuclear membranes and inconspicuous nucleoli, intermingled with scattered lymphocytes, red blood cells and characteristic granular background substance. A cytologic diagnosis of nodular fasciitis was made and confirmed histologically. CONCLUSION: Mammary nodular fasciitis is often clinically suspicious for carcinoma and rarely diagnosed by fine needle aspiration cytology. A literature search yielded only five reported cases. The cytologic diagnosis of this entity helps to choose the correct surgical procedure, preventing psychological trauma to the patient.