Oral Kaposi's sarcoma in Tanzania: presentation, immunopathology and human herpesvirus-8 association

Oral Kaposi's sarcoma (OKS) from Tanzanian patients (78) at Muhimbili National Hospital/Muhimbili University College of Health Sciences corresponding to approximately 10% of KS registered during 1990-2005, were diagnosed (ELISA) as HIV-infected (OAKS) (74/78) and endemic KS (4/78). Females were 69.2% (54/78) with median age 31 and males 30.8% (24/78) with median age 38. More males (50%) had systemic KS than females (37%) and 4-times more multicentric OKS. All tested (34) oral KS patients sera had HHV-8 antibodies. Available (31/78) blood showed very low CD4+ T-lymphocyte counts. Most OKS (61.5%) had nodular histology. Immunostaining showed adult male nodular OAKS to have a significantly higher frequency of viral LANA+, endothelial CD34+ tumour spindle-cells (SC) and more Ki-67+ (median =24.1%) proliferating cells compared to females (17.2%). Juvenile nodular OAKS had more LANA+ and Ki-67+ cells than corresponding adult cases. Significantly more LANA+ and Ki-67+ cells were found in nodular OAKS compared to cutaneous HIV/AIDS Kaposi's sarcoma (CAKS). A positive correlation (60%) was found between the proliferation index (Ki-67+ cell frequency) and LANA+/CD34+ SC. OKS in Tanzania is since 1990, mostly seen in females, associated with HIV/AIDS and advanced (nodular) histopathology. Males have more systemic tumour burden while more females develop primary OAKS. HHV-8+ cells were more frequent in nodular male than female and in juvenile than adult nodular OAKS than cAKS. Higher tumoral HHV-8 content appeared to be correlated to proliferation index.     

Poster presentation

Various studies examined the relationship between human epidermal growth factor receptor 2 (HER-2/neu) overexpression and the clinical outcome in patients with ovarian cancer, but yielded conflicting results. Electronic databases updated in May 2013 were searched to find relevant studies. A meta-analysis was conducted with eligible studies which quantitatively evaluated the relationship between HER-2/neu overexpression and survival of patients with ovarian cancer. Survival data were aggregated and quantitatively analyzed. We conducted a final analysis of 3,055 patients from 20 eligible studies and evaluated the correlation between HER-2/neu overexpression and survival in patients with ovarian cancer. Combined hazard ratios suggested that HER-2/neu overexpression was not associated with a significant impact on survival, with the hazard ratio (HR) and 95 % confidence interval (CI) being 1.05 and 0.92–1.19, respectively, overall. When grouped according to the study design type, a statistically significant combined HR was found in retrospective studies (HR?=?1.44, 95 % CI 1.14–1.75) and no statistically significant combined HR was found (HR?=?0.96, 95 % CI 0.81–1.11) for prospective studies. HER-2/neu overexpression seems to have no significant impact on survival of ovarian cancer patients. However, a statistically significant combined HR was found in retrospective studies, but not in prospective studies.     

Oral biopsy: Oral pathologist's perspective

Many oral lesions may need to be diagnosed by removing a sample of tissue from the oral cavity. Biopsy is widely used in the medical field, but the practice is not quite widespread in dental practice. As oral pathologists, we have found many artifacts in the tissue specimen because of poor biopsy technique or handling, which has led to diagnostic pitfalls and misery to both the patient and the clinician. This article aims at alerting the clinicians about the clinical faults arising preoperatively, intraoperatively and postoperatively while dealing with oral biopsy that may affect the histological assessment of the tissue and, therefore, the diagnosis. It also reviews the different techniques, precautions and special considerations necessary for specific lesions.     

SISI test presentation

A study comparing the presentation level of the test tone with SISI score reveals the test to be effective even when presented at levels less than 20 dB above threshold. In normal individuals the score rises gradually with increase of the carrier tone to reach 100% at 60 dB above threshold. In sensory deafness the maximum was reached with carrier tone at 30 db above threshold.     

Vestibular presentation in platybasia

The platybasia consists of an upward bulge or invagination of the occiput near the foramen magnum. These patients mostly presents with neurological symptoms. The present case is a rare variant presenting with vestibular disorders only.     

Cyst vallecula unusual presentation

Laryngeal cysts, particularly cyst vallecula are generally benign lesions which cause mild dysphagia or change in voice. We report here a case of cyst vallecula that caused soreness of throat, dysphagia and change in voice. A 22-year male presented with progressive dysphagia and muffled voice secondary to a large cystic mass involving entire vallecula and during coughing presented in oral cavity. Per oral marsupilization done and the problem resolved.