Malignant melanoma of the jaws—A clinicopathological study

Malignant melanoma of the oral cavity is rare and only 1.5% of all melanoma occurs in the oral cavity. Two cases of malignant melanoma of the jaw are reported because of its rarity. Various aspects of the cases are discussed.     

Amelanotic Melanoma of the nose

A rare case of Amelanotic Melanoma of the nose is presented with a brief review of literature and discussion. Malignant melanoma arising from the mucosa of the nose and paranasal sinuses are relatively rare. Malignant melanoma may is histologically mimic many type of tumours and thus a correct diagnosis is often delayed. This is especially true when the tumor appears to lack pigment and special stains are required to reveal the true nature of the pigment and confirm the diagnosis. Holdcraft and Gallagher (1968) reported that about 31 percent of melanomas arising from mucosal surface are without pigment.     

Primary malignant melanoma of the oral cavity. A review of 177 cases

Malignant melanoma of the oral cavity is rare, accounting for about 1% to 8% of all melanomas. There have been no prospective studies of melanoma in this location, and all previous papers have reported small numbers of cases or have retrospectively reviewed case reports from the literature. The authors report six new cases and review 171 cases published since the last major review in 1975. The classification of oral melanomas with radial growth phases is discussed.     

Malignant melanoma of the nose and paranasal sinuses

Two cases of Malignant melanoma, of the nose and paranasal sinuses, are reported.     

Germline CDKN2A mutations in Brazilian patients of hereditary cutaneous melanoma

Approximately 10 % of all cutaneous melanoma cases occur in a familial context. The major susceptibility gene for familial melanoma is CDKN2A. In Latin America, genetic studies investigating melanoma predisposition are scarce. The aim of this work was to investigate germline CDKN2A point mutations and genomic rearrangements in a cohort of 59 Brazilian melanoma-prone patients. Screening of CDKN2A alterations was performed by sequencing and multiplex ligation probe amplification. Germline CDKN2A mutations affecting p16^INK4a were detected in 8 unrelated probands (13.6 %), including 7 familial cases and one patient with multiple melanomas; 4 out of 8 mutation carriers met the criteria for familial melanoma and had multiple primary lesions. Although this study adds to the literature on melanoma susceptibility in Latin America, it is limited by the small size of the cohort. Our findings suggest that stringent inclusion criteria led to a substantially increased rate of CDKN2A mutation detection. This consideration should be taken into account when referring patients for genetic screening in a setting of limited budget, such as in developing countries.     

Duodenal and gallbladder metastasis of regressive melanoma: a case report and review of the literature

Background

Malignant melanoma involving the gastrointestinal (GI) tract may be primary or metastatic. Small bowel is the commonest site of GI metastases from cutaneous malignant melanoma, metastatic lesion in the gallbladder is extremely rare.

Case presentation

This case report describes the presentation of metastatic melanoma in duodenum and gallbladder. A 45-year-old man has presented melena with intermittent abdominal pain. On physical examination we found a small lesion between the fourth and fifth toes, associated with inguinal lymph node. An Abdominal ultrasound revealed diffuse duodenal thickening. Upper endoscopy was performed and discovered an ulcerative lesion in the second part of the duodenum. The biopsy with immunohistochemical stains was in favor of a duodenal location of melanoma. Computed tomography (CT) revealed many circumferential thickening of ileal loops associated with a nodular lesion in the anterior wall of the gallbladder. The patient was treated by palliative chemotherapy.

Discussion

Malignant melanoma of the GI tract may be primary or secondary. The small bowel is the most affected, but it’s rare in the gallbladder. The clinical presentation can mimic the other intestinal tumors, and the diagnosis is based on imaging; CT scan and GI endoscopy have a key role on the diagnosis, and the treatment depends on the location and the number of lesions.

Conclusions

Metastases of melanoma in the GI tract are uncommon, the diagnosis must be suspected in any patient with a history of melanoma with digestive signs.     

Primary malignant melanoma of oral cavity —Ultrastructure with review of literature

Primary Malignant Melanoma of Oral Cavity is a rare Neoplasm. Here a case of this condition is reported in light of existing review of Literature and Ultrastructural study.     

Metastatic melanoma: an unusual presentation

In this report we describe a case of a malignant cutaneous melanoma metastasizing to the pleural surface and peritoneal cavity 5 years after surgical resection of the primary lesion. Malignant cutaneous melanoma is a very aggressive cancer able to metastasize anywhere in the body. Pleural secondary lesions represent a rare event described only in a small number of patients and the association with peritoneal localizations may suggest an uncommon pattern of spread that we discuss.     

Pancreatic Resection for Metastatic Melanoma. Case Report and Review of the Literature

Introduction

Pancreatic metastasis from several malignancies are increasingly encountered in clinical practice, and the usefulness of surgical resection has been suggested for certain neoplasms. Isolated pancreatic metastasis from malignant melanoma is a rare occurrence, and the role of surgery as an adjunct to systemic therapy for melanoma metastatic to a solitary or multiple sites is still debated.

Case Report

We report a patient with melanoma of unknown primary site metastatic simultaneously to the lung and pancreas 3 years after axillary lymph node dissection. Distal pancreatectomy with splenectomy and video thoracoscopic assisted resection of pulmonary metastasis were performed. The postoperative course was uneventful, but 6 months after surgery, the patient experienced single pulmonary recurrence. During chemotherapy with different drugs, pulmonary lesion remained stable for 1 year, and no abdominal recurrence occurred. After then, the size of the lesion progressively increased and a second metastasis occurred in the lung. Five months later, brain metastases occurred, and the patients died 24 months after surgery. Sixteen pancreatic resections for metastatic malignant melanoma, reported with adequate clinical details, were also retrieved from the literature.

Conclusion

In spite of the very limited experience, it appears that surgical resection is only a palliative procedure, because long-term survival is a rare event. However, considering the lack of effective systemic therapy, surgery may be considered as a part of an aggressive multidisciplinary approach in selected cases with malignant melanoma metastatic to single or multiple visceral sites.     

Endemic (African) Kaposi sarcoma: Presenting as pathological fracture of left tibia and fibula

Kaposi sarcoma is a malignant vascular tumour of multifocal origin from undifferentiated vasoformative spindle cell. It presents frequently as cutaneous lesions, and musculoskeletal involvement is rare. Presented is a 52-year-old male farmer with inability to walk and pain of two months duration with cutaneous lesion noticed 3 years prior to presentation. Clinical, radiological and histopathological evaluation revealed cutaneous Kaposi sarcoma with a rare complication of pathological fracture of the left tibia and fibula with dystrophic calcification of the adjoining soft tissue. He had cytotoxic chemotherapy with poor outcome in cutaneous and skeletal lesions. Kaposi sarcoma if neglected presents with significant morbidity. Health promotion on early presentation and diagnosis are recommended for improved outcome.     

Malignant melanoma in a child with oculocutaneous albinism.

Malignant melanoma is extremely rare in patients with albinism. To date, in the English language literature, there have been only sixteen documented cases of malignant melanoma in albino patients. These cases include thirteen cutaneous, one oral, one ocular, and one anal; only one of these was in a child. Here, we present the case of the youngest known albino patient to have cutaneous malignant melanoma.     

Congenital Crocodile Tear with Duane’s Syndrome

Congenital Crocodile Tear Syndrome is rare. There are 21 cases reported in literature. We add one more case to the list. All cases except one are associated with Duane’s Syndrome. Our case had an associated anomaly of the cervical spine. The relevant literature is reviewed.     

Malignant haemangiopericytoma of the Maxilla

A case of Malignant haemangiopericytoma of the Maxilla is reported along with a review of literature.     

Primary Diffuse Large B-Cell Lymphoma of the Mandible: Case Report and Review of the Literature

In the oral cavity, extranodal non-Hodgkin''s lymphoma can occur in the periapical region either in the maxilla or mandible. Also, it can mimic inflammatory lesions that arise around the teeth apices such as periapical granuloma, radicular cyst and osteomyelitis. Misdiagnosis of lymphomas in the jaws may reduce the chance of successful treatment and worsen the prognosis. Therefore, any growth of periapical tissue must be submitted for histopathological evaluation to avoid a delay in the diagnosis. We present a case of extranodal non-Hodgkin''s lymphoma of a 53-year-old male in the right posterior mandible that was initially misdiagnosed as a reactive periapical lesion. This case illustrates the importance for both the pathologist and the clinician of considering malignant lesions such as lymphoma in the differential diagnosis of periapical radiolucency.Key Words: Mandible, Non-Hodgkin''s lymphoma, Periapical lesion, Oral cancer, Oral cavity, Swelling     

Malignant lymphoma—Middle ear

Two cases of Malignant lymphoma affecting the ear are reported. Two boys aged 9 and 10 years presented with an aural mass and offensive purulent discharge of 6 months and 1 month’s duration respectively and a lower motor neurone type of facial paralysis. The aural mass rapidly increased in size. The systemic medical, haematological and radiological examinations revealed no other abnormality. Histopathological examination of the aural mass was reported to be malignant lymphoma. The problem of diagnosis in malignant lesions of the middle ear is discussed.     

Primary Pharyngeal Malignant Melanoma

A case of Primary Malignant Melanoma of the Pharynx in a young adult is presented for its rarity.     

Primary oral melanoma: population-based incidence

Primary oral melanoma (POM) is a rare form of melanoma, generally diagnosed at a late stage and has poor prognosis. Epidemiological information has scarcely been reported in the literature over the past 40 years. Analyzing the Cancer Incidence in Five Continents volume IX (CI5-IX) database we found a total of 124,436 oral cavity cancers reported from all population-based cancer registries and 319 cases of POM reported by 67 cancer registries. To our knowledge this is the largest number of POM cases analyzed and accounts for 0.26% of all oral cavity cancers. ASR(W) for POM do not exceed 0.01 per 100,000 persons-year in all regions. The most common anatomic sites were palate (47%) and gum (27.6%) and a detailed oral mucosa examination and biopsies of nodular or macular lesions in these sites, especially on elderly patients, is advised to be routinely performed.     

Osteoma of paranasal air sinuses—A clinical review

Osteoma of the paranasal air sinuses are rare lesions. This comparative study indicates that osteoma of the sinuses occur more in a younger age group of Indians as compared to the Caucasians. Radiological and tomographical evaluation provides a reliable clue to the extent of the lesion in three dimensional planes, to influence the route of access and the degree of excision. Recurrence, however, occurs more in the younger age group.     

Ectopic lymphoid structures in primary cutaneous melanoma

Ectopic lymphoid structures have been described in several tumor types including metastatic lesions, but not primary tumors, of patients with melanoma. Here we present evidence of B-cell follicles in primary cutaneous melanomas, being present in 39 of 147 cases (27 %). B-cell clusters were associated with T lymphocytes, most of which belonging to CD45RO⁺ memory T cells. A network of CD21⁺ follicular dendritic cells was demonstrated in 8 of 22 cases studied (36 %). MECA-79⁺ HEV-like venules were observed in the neighborhood of the follicles in the majority of cases, however, their presence was not confined to tumors hosting ectopic lymphoid structures. The appearance of B-cell aggregates did not show association with the outcome of the disease, although a trend for their higher prevalence was observed in thicker tumors. Our results show that neogenesis of lymphoid structures does occur in primary melanomas, albeit with lower frequency compared to that reported in metastases.     

Alcohol consumption and site-specific cancer risk: a comprehensive dose–response meta-analysis

Background:

Alcohol is a risk factor for cancer of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx and female breast, whereas its impact on other cancers remains controversial.

Methods:

We investigated the effect of alcohol on 23 cancer types through a meta-analytic approach. We used dose–response meta-regression models and investigated potential sources of heterogeneity.

Results:

A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for those neoplasms there was a clear dose–risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin''s and Non-Hodgkin''s lymphomas were inversely associated.

Conclusions:

Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.