Mortality associated with odontogenic infection!

Odontogenic causes are the most common source for spreading maxillo-facial infections. These infections can develop into life threatening events. However a fatal outcome is fortunately rare and is generally associated with an immunocompromised status. This case report highlights a spreading maxillo-facial infection, which resulted in massive haemorrhage from the subclavian vein into the pleural cavity and subsequent death of a young fit male patient.

An unusual cause of thigh pain in colonic cancer. Inflammatory oncotaxis?

Colonic carcinoma metastasis in order of frequency to the liver, lung, bone and brain. Metastases elsewhere are unusual. We report a very rare case of metastatic spread to skeletal muscle and skin. There follows a review of the theories of anomalous metastatic localization. Inflammatory oncotaxis is offered as the most likely explanation of this phenomenon. The importance of good history taking in colorectal cancer follow up clinics is emphasised.

Inflammatory pseudotumour of lymph nodes.

AIM: To describe the clinical, histological and immunohistochemical features in four cases of an uncommon benign lymph node lesion which may mimic a neoplastic process. METHODS: Four cases of inflammatory pseudotumour of lymph nodes were studied using conventional staining (haematoxylin and eosin, PAS, Gordon and Sweets reticulin stain, and the Ziehl-Neelsen stain) and with immunohistochemical techniques using a variety of antibodies (CD3, L26, CD15, CD21, CD30, KP1, MAC 387, vimentin, alpha SMA, HHF-35, D33, CD34, and S100). RESULTS: The lesion comprises a proliferation of spindle cells expanding the connective tissue framework of lymph nodes and is associated with a plasma cell and small lymphocyte infiltrate. There are variable numbers of macrophages, neutrophils and eosinophils, and varying degrees of fibrosis. Vascular changes are common but vary in degree and type. CONCLUSIONS: Inflammatory pseudotumour of lymph nodes is an uncommon benign reaction pattern which may be misdiagnosed as a neoplastic or even a malignant process. Increased awareness of its histological features should help prevent such misdiagnoses.

Analysis of ras point mutations and human papillomavirus 16 and 18 in cervical carcinomata and their metastases.

Paraffin-wax-embedded samples of normal cervical tissue and of primary cervical carcinomata and nodal metastases were obtained from each of 15 patients. They were analyzed for the presence of ras point mutations and human papillomavirus (HPV) types 16 and 18 using the polymerase chain reaction (PCR) and hybridization to oligomer probes. Only 1 patient was found to have a ras mutation: a codon 13 mutation of Ki-ras which was present in only two lymph node metastases, but not in the primary tumor or in a third metastasis. These results suggest that ras point mutation is not a common factor in the development of primary or metastatic cervical cancer. HPV 16 was detected in 7 of the 15 patients and was present in both primary and metastatic tumors in 6 of these 7 cases. HPV 18 was not detected in any of the 15 patients. These results do not suggest a role for HPVs 16 and 18 in producing metastatic behavior.

Osteoradionecrosis of the petrous bone and recurrent cerebrospinal fluid otorrhoea.

A case is reported of delayed necrosis of the petrous bone following a course of radiotherapy for a well-differentiated squamous cell carcinoma in a 60-year-old female who presented with recurrent intractable cerebrospinal fluid otorrhoea, meningitis and pneumocephalus. Multiple attempts at surgical repair of the necrosed dural deficit and tegmental fistula failed and eventually petrousectomy was necessary leading to a successful outcome.