ABSTRACT
Fingolimod is a commonly used treatment for highly active relapsing-remitting multiple sclerosis (MS). We describe the case of a 50-year old man on fingolimod since 2011 who presented, in April 2017, with a voluminous swelling of the left tonsil. A left tonsillectomy was performed, and histological exam disclosed a papillary squamous cell carcinoma of the palatine tonsil, with an in situ hybridization positive for human papillomavirus (HPV)-16 DNA. Neither lymph nodes involvement nor other metastases were detected. Fingolimod was stopped as a precautionary measure in May 2017, and the patient currently continues his follow up at our Department. Immunocompromised patients are at risk for developing HPV-related malignancies probably in light of the suppression of T-cell immunity, therefore an increased risk for HPV activation in MS patients treated with disease modifying therapies (DMTs) characterized by a more pronounced immunosuppressant activity cannot be excluded. Given the absence of studies on larger cohorts of MS patients exposed to DMTs, additional monitoring for HPV infection during fingolimod treatment is not currently recommended. However, vigilance for this possible association is warranted.
Subject(s)
Carcinoma, Squamous Cell/etiology , Fingolimod Hydrochloride/adverse effects , Immunosuppressive Agents/adverse effects , Papillomavirus Infections/etiology , Tonsillar Neoplasms/etiology , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Fingolimod Hydrochloride/therapeutic use , Human papillomavirus 16 , Humans , Immunocompromised Host , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Multiple Sclerosis, Relapsing-Remitting/drug therapy , Papillomavirus Infections/diagnostic imaging , Papillomavirus Infections/pathology , Papillomavirus Infections/surgery , Tonsillar Neoplasms/diagnostic imaging , Tonsillar Neoplasms/pathology , Tonsillar Neoplasms/surgeryABSTRACT
AMONG ALL THE POSSIBLE COMPLICATIONS OF AESTHETIC RHINOPLASTY, A RARE ONE IS THE DEVELOPMENT OF CYSTIC MASSES ON THE NASAL DORSUM: several theories suggest that cysts develop commonly by entrapment of nasal mucosa in the subcutaneous space, but they can also originate from foreign body reactions. This report deals with two cases of nasal dorsum cysts with different pathogenesis: both patients had undergone aesthetic rhinoplasty in the past (26 years ago and 14 years ago, resp.). Both cystic masses were removed via a direct open approach and nasal reconstruction was performed successfully with autologous vomer bone. The pathologic investigations showed a foreign body inclusion cyst associated with latex rubber in the first case and a sequestration of a mucosal-lined nasal bone was not removed at the time of primary rhinoplasty in the second case. A brief review of the literature focuses on the pathophysiology and treatment options for nasal dorsal cysts following aesthetic rhinoplasty.
