Unusual Physiologic Melanin Pigmentation of the Tongue

A patient had extensive congenital oral hyperpigmentation of the tongue. The clinical and histologic features set this case apart from any well-delineated disease. Clinically, the congenital onset, the appearance of large black-brownish lesions, the lack of associated systemic abnormalities, and the histologic findings of prominent deposition of melanin in the basal layer support the diagnosis of physiologic melanosis. The macular lesions of the tongue represent discrete depositions of melanin and exemplify soft tissue pigmentation of developmental origin.     

Studies on the Level of Natural Antibodies Reactive with Various Tumor Cells during Urethane Carcinogenesis in BALB/c Mice

Serum from young normal BALB/c mice was found to contain IgM antibodies able tomediate complement-dependent lysis of certain syngeneic or allogeneic tumor target cells. The titer of such naturally occurring antitumor antibodies (NATA) was found to increase with aging.A longitudinal serological study comparing the cytotoxicity potential of NATA fromnormal and from urethan-treated BALB/c mice was performed. It was found that urethan-treated mice that did not develop primary lung-adenomas within the duration of the experi-ment had significantly lower NATA titers, against one out of 4 target cells assayed, than urethan-treated animals that developed lung adenomas. This difference was evident in two independent experiments. The results suggested that the lower NATA activity of the urethan-treated mice that did not develop tumors existed even before exposure to the carcinogenic insult. This raises the possibility that certain populations could be segregated according to their natural antibody profile into those individuals which will develop primary tumors within a certain period if exposed to a subthreshold amount of carcinogen, and those which will not.     

Peritoneal cyst--a case report

Peritoneal cysts are rare benign tumors of the abdominal and pelvic peritoneum. We present a case of 26 year old patient with a peritoneal cyst treated operatively.     

Radiological features of glandular odontogenic cyst

OBJECTIVES: To present five new cases of glandular odontogenic cyst (GOC) and to review the radiological features at presentation as reported in the English literature. METHODS: From 1993 to 2002, five patients in our department were diagnosed with GOC based on histopathological findings and supported by radiography and CT. The radiographic features of the new GOC cases were analysed in addition to 51 literature cases. RESULTS: There were 31 male and 25 female patients, aged 14-90 years (mean 50 years). The mandible was involved in 80% and the maxilla in 20%; most of the lesions were located in the anterior jaw. Radiographically, 52% of the lesions were unilocular and 48% were multilocular; 94.5% showed well defined borders, which were sclerotic in 7.7% and scalloped in 13%. Information on cortical plate integrity was available in only 24 cases: 50% showed perforation, 8.3% erosion of the cortical plates and 8.3% thinning of the cortical plates. Root resorption was reported in 22% of patients and tooth displacement in 24.4%. CONCLUSIONS: Data collected indicate that GOC has potentially aggressive behaviour, with expansion and perforation in a significant number of cases. We recommend the use of multiple plane radiographs, with CT reserved for large lesions, especially those that are multilocular or involve extragnathic structures.     

The effect of neck dissection on human fat transport

This study examines the effect of neck dissection and thoracic duct ligation on lipid metabolism. Included were 23 patients undergoing neck dissection with thoracic duct ligation. The results showed a temporary reduction in lipid metabolism in approximately half the patients who had a left neck dissection. This effect subsided within 6 months, possibly because of the development of alternative lymph channels. The reduction in fat metabolism in selected cases may have therapeutic effects on patients with morbid hypertriglyceridemia or those who receive chemopreventive regimens. To the best of our knowledge, no similar studies have been reported heretofore in humans.     

A case of undifferentiated (embryonal) sarcoma of the liver: fine needle aspiration cytology diagnosis by one cell type

We present the first case in Bulgaria of cytologically verified undifferentiated (embryonal) sarcoma of the liver. A 10-year-old girl was admitted to the hospital with abdominal pain, extreme hepatomegaly, one-month fever, anemia and highly elevated erythrocyte sedimentation rate (95 mm). A large formation was found in the right liver lobe on ultrasound examination, which was polycystic on CT scan. Neither bone marrow abnormalities nor elevation of serum alpha-fetoprotein was found. In the scanty specimen obtained by fine-needle aspiration biopsy under ultrasound control a characteristic prevalence of polygonal cells within mesenchyme tissue was found. The cells had eccentric hyperchromic nuclei which were pushed to the periphery by large clusters of PAS-positive, diastase-resistant granules. Vimentin and alpha 1-antitrypsyn were expressed immunohistochemically. The cells are pathognomonic of undifferentiated (embryonal) sarcoma of the liver. After preoperative chemotherapy with ifosfamide, vincristine and actinomycin D (CEVAIE, CWS--96) resection of the tumor including IV, V, VI and VII liver segments was performed. A 30 x 30-cm soft gray-whitish tumor with fine capsule was found. The cytological diagnosis was histologically verified. The patient had a mechanical subileus episode after the 6th course of chemotherapy. One year after the surgery she is in good condition. The histogenesis of this rare tumor is discussed regarding its unique cytology, immunohistochemical constellation and ultrastructure. A literature review is presented. The case indicates that the unique cell appearance in embryonal sarcoma of the liver provides a correct diagnosis even in a scanty specimen.     

Gorham's disease affecting the maxillofacial skeleton

Twenty-one cases of Gorham's disease in the maxillofacial region are described in the literature. This case is an additional one. The disease has a slight male predominance. All cases involved either the mandible alone or in association with the maxilla or other bones of the head and neck. The most common symptoms were pain, tooth mobility, mandibular pathological fractures, and facial deformity. The mean duration of symptoms prior to diagnosis was 6.4 years. Treatment included surgery, radiotherapy, and various medications, alone or combined. Four patients died of their disease. The diagnosis of the initial biopsy was incorrect in 45% of these cases. The current case appears to be the only one successfully treated by excision and autogenous bone graft reconstruction. In order to make an accurate diagnosis, the histologic features should be correlated with the clinical features.     

Head, neck, and maxillofacial childhood Burkitt's lymphoma: a retrospective analysis of 31 patients

Thirty-one children with Burkitt's lymphoma of the head, neck, and maxillofacial region diagnosed between 1976 and 1988 were reviewed. The age range was 2 to 17 years (median, 7.2 years), and 77.4% were males. The most common presenting symptoms were detectable masses, floating and/or painful teeth, enlarged cervical lymph nodes, sore throat, and neurologic signs. The predominant primary tumor sites were the jaws and tonsils. All patients were staged by a clinical staging system, 17 of them having stage I-II, and 14 stage III-IV. Levels of lactate dehydrogenase and ferritin were the only significant laboratory parameters correlating with initial staging and disease-free survival. Radiologic features in the jaws were poorly circumscribed destructive lytic lesions with migration and crypt destruction of unerupted teeth buds. Complete disappearance of these findings was noted after successful chemotherapy and clinical regression of the tumor. Eighteen (58.1%) patients attained complete remission with a follow-up of 5 to 100 months. Stage was the most significant variable affecting outcome, with 90.2% disease-free survival of stage I patients, 72.4% of stage II, and 18.2% of stage III-IV. Based on these results, it is concluded that localized (stage I and II) Burkitt's lymphoma is responsive to chemotherapy and thus has a favorable prognosis.