Atypical lipomatous tumors of the tongue: report of six cases.

The occurrence of liposarcoma in the tongue is rare with only 34 cases published so far. We report six new cases of atypical lipomatous tumor (ALT) of the tongue, and detection of mdm-2 and CDK4 expression by immunohistochemistry and fluorescence in situ hybridization (FISH), respectively, was performed. The series comprised three males and three females, aged 11-78 years. The tumors arose at the lateral side of the tongue, and in one case, multiple tumor nodules were noted. Follow-up information in five cases (range from 4 to 159 months) revealed one local recurrence at 6 months. Microscopically, four cases had features of lipoma-like ALT, whereas two cases displayed patterns of sclerosing ALT. Immunohistochemically, tumor cells revealed expression of vimentin (five of five), S100 (five of five), mdm-2 (three of five), and CDK4 (four of five). Two cases were also examined by FISH; amplification of mdm-2 gene was found in both cases, whereas amplification of CDK4 gene was present in one case only. To the best of our knowledge, this is the third largest series reporting occurrence of ALT in the tongue and the first one where analysis of mdm-2 and CDK4 proteins/genes expression/amplification was performed. Both these markers may be of help in the differential diagnosis of ALT versus lipoma. Although most ALTs of the tongue behave in the nonaggressive fashion, they may recur locally. Based on current data, the term ALT is strongly recommended for tumors occurring in the tongue to prevent inadequate treatment.

Influence of discoplasty and discectomy of the temporomandibular joint on elimination of pain and restricted mouth opening.

The retrospective study was based on 36 open joint surgeries done in 33 consecutive patients with anterior disc dislocation without reduction with severe signs and symptoms and unsuccessful nonsurgical treatment lasting at least 6 months. The patients underwent either discoplasty or discectomy followed by auricular cartilage graft implantation and were evaluated for amount of interincisal mouth opening, severity of pain on VAS scores preoperatively and as well as 12 months postsurgically. The minimum pain levels were preoperatively 50 on VAS for the discoplasty group and 60 on VAS for the discectomy group. After the surgery, the VAS values lower than 20 were reported on 69.4% of 25 sides (72.7% in the discoplasty group, 68.0% in the discectomy group). Using the cutoff point for maximal interincisal opening of more than 35 mm, only 6 patients (16.6%) fulfilled the criterion at the baseline. Interincisal distance measured vertically 12 months after the operation increased in all but five patients. In three of the five subjects, the opening was at the same level as before the surgery. Almost ninety-one percent of the patients (90.9%) in discoplasty group and 81.8% in discectomy group, respectively reached 35 mm or more of vertical opening after the operation. Applying the 1984 Criteria for classification of postoperative results (AAOMS), 12 months after surgery, 24 patients (72.7%) displayed good results, 6 patients (18.2%) were evaluated with acceptable results, and in 3 cases (9.1%) we observed bad results. Although only short-term evaluation is presented, our findings show that both discoplasty and discectomy are effective methods for surgical treatment of patients suffering from severe temporomandibular pain and limited mouth opening. Discoplasty should be reserved only for patients without severe changes of the disc.