The malignant tumours of the lip account for nearly 1-2% of the cervicofacial neoplasms. These lesions are frequently spinous cell carcinomas and basal cell carcinomas (25% of all oral cancers). The spinous cell carcinoma is mainly located in the lower lip, the basal cell carcinoma is more common in the upper lip. The incidence of lip cancer in males is much high than in females. The etiopathogenesis of these lesions is connected with exposure to sun, smoking, genetics predisposition (mutation of the p53 suppressor factor) and with the evolution of precancerous lesions (radiodermatitis, chronic cheilitis, xeroderma pigmentosum). Some Authors emphasized the viral etiopathogenesis: HPV16, HPV24, HSV1, HSV2. The treatment of lip carcinoma is surgical: excision and reconstruction. The numerous reconstructive techniques are mostly the cutaneous local sliding flaps and the rotation flaps. The lip reconstruction require a remarkable diligence for preserve, as much possible, the shape and functions of lip. The Authors report their experience about the surgical treatment of 19 patients with lip carcinoma (16 spinous cell carcinomas, 3 basal cell carcinomas) and describe the main surgical reconstructive techniques to preserve the feeding, phonation and mimic expression.
The thyroid gland harbours many diseases which require a surgical treatment; the gland may also be involved by some secondary malignant neoplasms. Such type of involvement by laryngeal and hypopharyngeal cancers is more often due to direct extension rather than metastases. In this paper the Authors report their experience of tumoral involvement of the thyroid gland in 35 patients with laryngeal or hypopharyngeal cancer observed from 1986 to 1990. All patients had an epidermoid carcinoma of the larynx or hypopharynx that required an hemithyroidectomy (always plus isthmectomy) or an isthmectomy associated to laryngectomy. On pathologic examination 5 thyroid specimens revealed tumoral involvement in patients with laryngeal neoplasms: 1 case of solitary metastasis and 4 cases of direct extension. In patients with hypopharyngeal lesions, on the contrary, the gland was, in all cases, undamaged. For this very interesting and uncommon finding the Authors agree with Harrison's proposal suggesting total thyroidectomy is necessary in case of subglottic lesions while in all the other laryngeal and hypopharyngeal lesions the homolateral lobe of the thyroid gland and the isthmus should be removed with the specimen also performing a frozen section examination of the contralateral lobe. In this study tumoral involvement of the thyroid gland appeared to be a very important negative prognostic factor and was higher in the subglottic and anterior commissure lesions.
An HLA-B27 genetic profile patient is fully investigated by molecular analyses after an anamnestic assessment of multi-site ecosystems, following the holistic vision of human being.VDRL and Widal-Wright (WWR) resulted positive, showing at Wrights reaction a title of 1:40. Of all the enzymatic activities measured, only the ALP enzymatic pool activities showed a low increasing value of 297 U/L. Of all later acute phase proteins, Only C3 c protein value (127 mg/dL) and fibrinogen (376 mg/dL) were altered. Cultural and molecular oropharyngeal ecosystem investigation resulted significantly positive to Mycoplasmas(Mhand Uu) and Chlamydia trachomatis(Ct) together with a spread of saprophytic flora. From an accurate anamnesis, several and severe uro-genital clinical symptomatology emerged from birth until the beginning of rheumatologic symptomatologies that were confirmed by oldest Mh, Uu and Ctsilent chronic infections between these ecosystems. The molecular HPV research was negative, while the Thin prep pap-test was indicative of vaginosis and cellular reactive changes associated with inflammation. Parasitological research resulted positive for presence of 5-7 newly-formed G. lambliacysts for microscopic field, while digestibility test was positive for presence of several free fatty acid crystals. The remarkable presence of indigested meat fibre and several mucous dense filaments were observed. The pH value was 6.5, while blood faecal test was positive. The values observed were: ferritin 12 microg/L (10-120), total iron-binding capacity (TIBC) 310 &mgr;g/dL (300+-20), unsaturated iron-binding capacity (UIBC) 286 microg/dL (200-220) and iron seric level 24 microg/dL (60-130). Faecal research highlighted a very scarce presence of E. coli, resulting in 102 UFC/g of stool. Of all enteroinvasive pathogens, researched by molecular analyses, only Yersinia spp. was positive. After several specific cycles of antibiotic and antinflammatory therapies, the patient improved its general health condition considerably and showed almost complete regression of aching inguinal lymph node inflammation. In a picture of a worsening inflammatory process, produced by pathogens like Mycoplasmas, chronic silent or low grade inflammation atypical agents, in young HLA-B27 positive patient, VDRL test resulted positive. This value represents the first non-specific unique spy to reveal the precocious immunological signal in order to register the beginning of early innate immune system decay, keeping in mind that mycoplasmal and chlamydial infections are the triggering of cancer in patients genetically susceptible.
Problems/objectives: Malignant peripheral nerve sheath tumours are uncommon soft tissue tumours originating from Schwann cells or nerve sheath cells.Malignant epithelioid schwannoma is an aggressive variant of malignant peripheral nerve sheath tumour, and unfortunately is related with a high rate of recurrence and poor prognosis.Methodology: In this study we present a rare case of malignant epithelioid schwannoma of the parotid gland and we discuss its origin, unusual presentation, and possible treatments options.Results: Patient underwent total parotidectomy without neck dissection.Postoperative radiotherapy and chemotherapy management were not necessary.Conclusion: Patients with malignant epithelioid schwannomas typically present with pain and/or rapid enlargement of a pre-existing lesion but the diagnosis of these tumours remains diffi cult as it is based primarily on clinical suspicion.There is no recognized management for this tumour yet while the prognosis seems to correlate best with the extent of surgical resection (Fig. 4, Ref. 16).
Warthin's tumor is the second most common salivary gland tumor preceded only by pleomorphic adenoma. In most cases it involves the parotid gland and can, at times, be bilateral. It can also arise in ectopic salivary tissue in the latero-cervical and para-parotid lymph nodes. This neoplasm consists of two histologic components: one epithelial, the other lymphoid. Malignant transformation involving each of these tissues has been reported. However, few cases give clear-cut examples of the epithelial malignant change. Therefore, primary malignant transformation of Warthin's tumor is extremely rare. This event appears related to the initial time of tumor onset and/or past radiotherapy for other malignant cervico-facial lesions. The authors report a case of epidermoid carcinoma arising on an ectopic Warthin's tumor in a 57-year-old male. Physical examination revealed a recent, smooth tumor mass on the left, located near the laryngeal thyroid cartilage. Fine needle aspiration cytology was suspicious of a malignant epithelial neoplasm. Functional latero-cervical dissection, modified by excision of the digastric and sternohyoid muscles plus a 2 x 2 cm section of the overlying skin, was performed in this case. Histology and immunocytochemical tests on the surgical specimen revealed a 14 cytokeratin-positive, malignant epidermoid neoplasm arising from the adjacent 14 cytokeratin-negative, oncocytic epithelium. This relationship may rule out metastasis and may, therefore, be a case of Warthin's tumor associated with an epidermoid carcinoma or a case of branchial cyst.
The Authors report their personal data based on several studies carried out on cellular cultures of otosclerotic bones in order to clarify some pathogenetic aspects of the disease. Besides structural differences observed on the cytoskeleton, and some components of extracellular matrix (GAGs) of otosclerotic cells, the most interesting data arise from the different responses to hormonal stimulations using calcitonin, parathormone, steroid hormones and interleukin-1. This research leads the Authors to believe that transduction mechanisms in otosclerotic cells could be altered as a result of genetically induced receptorial changes, which become more evident after certain pathological events.
Through a review of three cases, the etiopathogenetic, clinical-diagnostic, and therapeutic aspects of ectopic thyroid tissue are herein discussed to highlight the main presentations of this polymorphous disease.The first case involved an ectopic thyroid gland in the lingual area in a 45-year-old Caucasian woman who presented with dysphagia and midline swelling at the base of the tongue. The second case involved a 22-year-old Caucasian woman with a submandibular mass comprising ectopic thyroid tissue. The third case involved a 33-year-old Caucasian man with a typical thyroglossal duct cyst characterized by the presence of thyroid tissue upon histological analysis.Surgery seems to be the most appropriate treatment for patients with ectopic thyroid tissue showing clinical signs of upper airway obstruction or when the lesion shows signs of infection or malignant degeneration. When a site of ectopic thyroid tissue is the only such site in the body, removal of this tissue will usually lead to hypothyroidism that requires medical thyroid hormone replacement.
Mucormycosis is a severe fungal disease. It can present in two clinical forms: localized or disseminated. The most common, often lethal, form is localized rhinocerebral mucormycosis and is associated with diabetes, debilitation and immunologic deficiencies. The primary location is generally found in the nasal cavity, paranasal sinuses or hard palate. The infective process can extend into the orbita, the cavernosus sinus, the pterygium-palatine and infratemporal fossae with generation of mycotic emboli that can plug the cerebral arteries and, in certain circumstances, can lead to death if it goes untreated. This work describes a clinical case of a 76-years-old patient with a previous history of alcoholism and glucose intolerance, affected by rhinocerebral mucormycosis with extension to the lungs. A general medicine division sent the patient for observation by a specialist since, at the time of hospitalization, objective testing showed signs of an ulcerating lesion of the alveolar edge of the left hemipalate associated with a bilateral pulmonary neoformation suspected to be neoplastic. The patient underwent pulmonary and maxillo-facial surgical resection and medical therapy. The authors discuss the appropriateness of diagnosis and treatment procedures in cases of mucormycosis in association with other pathologies, that can complicate the clinical picture, delaying diagnosis and treatment. The authors point out the need to perform in a short time an adequate medical and surgical treatment of mucormycosis, because of the risk of intracranial extension, leading to an increased mortality, even as high as 80%. The longer it takes to reach a diagnosis the more radical the surgical treatment will need to be.
