A case of desmoplastic leiomyosarcoma: a rare variant of cutaneous leiomyosarcoma.

Desmoplastic leiomyosarcoma is a rare histologic variant of cutaneous leiomyosarcoma seen more commonly in men in their 50s and 60s. This neoplasm typically presents as a solitary, enlarging red-pink nodule or plaque on the extensor surfaces of lower extremities. Its unusual histology mimics other cutaneous desmoplastic lesions and the knowledge of this entity and use of an appropriate immunohistochemical panel is essential to arrive at the correct diagnosis. We report a rare case of desmoplastic leiomyosarcoma of the left flank in a 66-year-old male who presented with itching and pain in a long-standing skin lesion. Histopathology showed the presence of individual and small aggregates of spindle to pleomorphic cells with numerous mitoses in a densely fibrotic stroma. Immunohistochemically, the cells were positive for smooth muscle actin, heavy chain myosin, and desmin, confirming their smooth muscle origin. A diagnosis of desmoplastic leiomyosarcoma was made. We discuss the case with a short review of the literature.

Anterior vertical osteotomy for mandibular narrowing: assessing short-term outcome.

BACKGROUND: The management of transverse maxillomandibular discrepancies, clinically known as crossbites, is a controversial and rarely discussed topic in both orthodontic and surgical literature. To evaluate the short-term stability of mandibular narrowing after the combination of anterior vertical symphyseal and bilateral sagittal split osteotomies, a prospective cohort study was completed. METHODS: Between December 1996 and June 2006, 40 patients underwent mandibular narrowing for the correction of substantial transverse maxillomandibular discrepancies resulting primarily from relative mandibular widening. Stability assessment was done on 26 patients who returned for the final evaluation. RESULTS: Follow-up periods ranged from 5 to 109 months (mean, 18 mo; N = 26). The stability of mandibular narrowing was evaluated by comparison of preoperative clinical assessment, lower dental impression, posteroanterior cephalogram, and occlusographic analysis with studies completed in the immediate postoperative period and at 6 to 12 months. At the short-term time point, mean mandibular location had relapsed 4.7 degrees in 21 patients. CONCLUSIONS: Although various methods of mandibular narrowing are well described, very little literature has examined its stability. Using an occlusographic analysis based on angular mandibular movement in a large patient cohort, we were able to demonstrate and quantify, for the first time, the relapse. It occurs in 81% of the patients, with a mean of 4.7 degrees.

A novel occlusographic analysis for assessment of mandibular narrowing.

Accurate evaluation of transverse mandibular dimension is a controversial and rarely addressed topic. Although mandibular narrowing via symphyseal osteotomy and bilateral ramus sagittal split was initially described more than 30 years ago, the development of a simple and effective clinical tool to assess the outcome of such procedures remains elusive. Although many quantitative modalities, such as frontal cephalogram, tomography, and interdental distance measurement, are in current use, each possesses significant liabilities. Prompted by a need for improved accuracy, simplicity, and reliability in the clinical setting, we developed and used a novel occlusographic analysis. The Madjidi occlusographic analysis does not rely on the position or tilt of moveable teeth; therefore, orthodontic changes do not influence quantification of mandibular position. Contours and mandibular relationships of interest are seen clearly, radiation is unnecessary, and occlusographic analysis can be quickly reproduced in the clinical setting using widely available materials. Although the evaluation of transverse mandibular dimension after surgical narrowing is frequently more controversial than accurate, the Madjidi occlusographic analysis is a reliably simple solution to an often complex problem.

Digital acrometastasis: a rare initial sign of occult pulmonary squamous cell carcinoma.

Digital metastases as the initial presenting sign of an occult pulmonary squamous cell carcinoma are very rare. While many tumours do progress to involve the digits in advanced stages, diagnosis of underlying lung cancer based on the initial presentation of a digital mass is very unusual. Clinically, metastasis to the phalanges typically results in notable tenderness, swelling, warmth and dull, throbbing pain. While nail avulsion with curettage and local tumour excision has been used in attempts to save the digit, amputation of the involved finger is by far the most frequent surgical methodology. Unfortunately, by this time, the primary tumour has invariably spread to diffusely involve other organs, and survival periods average only a few months. Management should be targeted to patient comfort, prevention of infection, and maintenance of function.