Neonatal choristoma of the tongue containing glial tissue: diagnosis and surgical considerations

There are only six case reports documenting the presence of glial tissue in the tongue. Because of the small number of cases, the presentation and biologic behavior of these lesions is poorly characterized. We present the case of a 10-day-old male infant who arrived at the University of Michigan Medical Center with a history of positional dyspnea, with resultant cyanosis and bradycardia, dysphagia, and a mass at the base of the tongue. Histopathologically, this lesion was initially labeled as a hamartoma, but was ultimately defined as a choristoma based on the exclusive presentation of glial tissue in the specimen. This paper will discuss the presentation, diagnostic evaluation, and therapeutic management of this case. In addition, the role of intraoperative electrodiagnostic monitoring to preserve neuromuscular function will be addressed.     

Sphenoid sinus brown tumor of secondary hyperparathyroidism: case report

OBJECTIVE AND IMPORTANCE: Brown tumor is a misnomer for a reparative cellular process caused by primary or, less commonly, secondary or tertiary hyperparathyroidism. Atypical involvement of the base of the cranium in the area of the sphenoid sinus and the orbit is exceedingly rare and may produce a neurological deficit as a primary clinical presentation. Those neurosurgeons dealing with cranial base and pituitary lesions should be aware of this disease entity, and it should be listed in the differential diagnosis. CLINICAL PRESENTATION: A 21-year-old woman with end-stage renal failure on chronic dialysis was referred to the Department of Neurosciences at King Faisal Specialist Hospital and Research Centre with a 4-month history of progressive impairment of vision, associated with headache and nausea. Computed tomography and magnetic resonance imaging demonstrated an expansive mass lesion in the sphenoid sinus with erosion of the sellar floor and posterior medial wall of the orbit causing compression of the optic nerves. The biochemical laboratory studies showed elevation of parathyroid hormone and confirmed the diagnosis of hyperparathyroidism. INTERVENTION: The transnasal-transsphenoidal approach was used for extensive microsurgical removal of the lesion. The postoperative course was uneventful, and the improvement in vision was dramatic. CONCLUSION: Brown tumor, although rare, should be listed in the differential diagnosis of expansive mass lesions in the area of the sphenoid sinus and cranial base. The management is multidisciplinary, and therapeutic options should target the underlying cause.     

Purification and partial characterization of (6-4) photoproduct DNA photolyase from Xenopus laevis

Liposarcomas of the head and neck are exceedingly rare, and fewer than 90 cases have been reported in the literature. Liposarcoma of the oral cavity is an even less common entity, and to our knowledge only nine cases have been reported to date. We report the clinical and pathologic findings of a case of well-differentiated liposarcoma of the base of tongue and tonsillar fossa. The patient is a 76-year-old white man with a long-standing history of a mass in the oral cavity and hypopharynx. The mass had been resected several times over the span of 23 years, and diagnoses of lipoma, neurofibroma, mesenchymoma, and angiofibrolipoma have been rendered on different occasions. At the last admission, a polypoid mass of the left tonsillar fossa and base of tongue was resected. The tumor was multinodular and measured 2.5 cm in greatest diameter. Histologically the tumor was ill-defined with infiltrating borders and was composed predominantly of mature adipose tissue with occasional lipoblasts. A small proportion of the tumor consisted of clusters of spindle cells and pleomorphic lipoblasts. Mitotic activity was not seen. The pleomorphic cells were positive for S100 protein and negative for muscle-specific markers. Ultrastructural analysis confirmed the nature of the lipoblasts. Our case depicts the typical natural history and histologic features of liposarcoma of the oral cavity. This tumor is usually well differentiated and has a high recurrence rate and almost no tendency for metastasis. Based on our case and review of the literature, it appears that well-differentiated liposarcoma of the oral cavity can occasionally be underdiagnosed because of the low mitotic activity and long latent period between the original diagnosis and first recurrence.     

Accumulation of cadmium in and its effect on bank vole tissues after chronic exposure

Primary adrenal lymphoma (PAL) is extremely uncommon. We describe a case of clinically silent non-Hodgkin's B-cell lymphoma of diffuse large cell type with exclusive left adrenal localization. The tumor was discovered by computed tomography (CT) as a 2.5-cm dense mass and diagnosed at autopsy. Literature concerning this unusual neoplasm is reviewed. During the early stage, particularly when the lesion is small, PAL is likely to be missed. This unusual entity should be included in the differential diagnosis of adrenal masses so that early diagnosis may be made and intervention might dramatically affect the clinical outcome.     

Mediastinal lipomatosis

Mediastinal lipomatosis is a benign condition characterized by a large amount of mature adipose tissue within the mediastinum. It widens the mediastinum and may simulate mass lesions, thus leading to diagnostic errors. We describe a new case of a huge mediastinal lipomatosis and review 36 cases previously reported in the literature. Computed tomography has an important role in the diagnosis of this disease. To avoid invasive and unnecessary procedures, this diagnosis should be considered in any patient with Cushing's syndrome.     

Six antimicrobial peptide genes of the cathelicidin family map to bovine chromosome 22q24 by fluorescence in situ hybridization

Seven patients with acute or chronic unilateral hypoglossal nerve lesions were evaluated by magnetic resonance imaging and computed tomography. In patients with acute to subacute tongue paralysis, the base of the ipsilateral side of the tongue appeared expanded and showed increased signal intensity on T2-weighted images. This appearance was suggestive of an infiltrative mass lesion within the tongue. These radiographic findings are due to the pathophysiological process of nerve injury and muscle denervation.     

Eosinophilic ulcer of the tongue

Two cases of tongue ulcers are presented. Histopathologic examination of biopsy specimens obtained from each case showed marked submucosal and muscular infiltration of polymorphonuclear eosinophils compatible with the diagnosis of eosinophilic ulcer of the tongue. The disease entity appears to be uncommon, yet, it should be recognized as benign since in both instances, healing was spontaneous.     

Diagnosis of dermoid cyst of the floor of the mouth by fine-needle aspiration cytology: a case report

A case of a dermoid cyst in the floor of the mouth in a 17-yr-old male is described. The diagnosis was made by fine-needle aspiration cytology and supported by histologic examination of the subsequently excised tissue. Dermoid cysts are benign lesions that can occur in the floor of the mouth. This case is presented to increase awareness of this entity and its occurrence in this location, and to demonstrate the feasibility of diagnosis by fine-needle aspiration. The cytologic and histologic features of dermoid cysts are described and discussed.     

A monomorphic adenoma of the minor salivary glands presenting at the base of the tongue: a case report and review of the literature

A case of a monomorphic adenoma of the minor salivary glands situated at the base of the tongue in a 49-year-old female is reported. The patient had a prolonged clinical course of eight years' duration. The histopathologic, immunohistologic and ultra-structural findings are described. A review of the literature concerning minor salivary gland tumors and their location in the oral cavity is presented. This is the first case, to our knowledge, of a monomorphic adenoma presenting at the base of the tongue. The difficulties in its diagnosis are discussed specifically in regard to its location.     

Radionecrosis of the brain presenting as a mass lesion: a case report

A case of radionecrosis of the brain in a patient previously treated for squamous cell carcinoma of the scalp is presented. Cerebral angiography revealed a mass effect primarily in the right frontal area. Computed tomography showed extensive hemispheric oedema. A frontal lobectomy was performed, and the recovery was excellent. The lower limit for brain tolerance for irradiation is about 5000 rads given in five weeks. This dose should not be exceeded when extracranial lesions are treated. Although computed tomography cannot diagnose brain necrosis, specifically, it should, along with the clinical history, be very helpful.     

Jejunal diverticulitis with localized perforation and intramesenteric abscess

We report a rare case of a 69-yr-old white man with jejunal diverticulitis with localized perforation and intramesenteric abscess formation. This entity is often overlooked as a cause of acute abdominal pain in the elderly. Although the clinical diagnosis is difficult, a high index of suspicion should warrant a computed tomography scan or enteroclysis.     

Usefulness of FDG-PET in diagnosing primary lymphoma of the liver

This case report shows for the first time the usefulness of positron emission tomography (PET) with 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) in the diagnosis of primary non Hodgkin's lymphoma of the liver. Results of FDG-PET, which in contrast to other imaging techniques offers the advantage of screening the whole body, demonstrated a high glycolytic activity of a solitary mass in the liver with central necrosis (loss of glycolytic activity), but no spread of lymphoma to the body. These results were confirmed by ultrasound, computed tomography, magnetic resonance imaging and were biopsy proven. From our findings we conclude that in patients with liver masses with high uptake of FDG, lack of liver dysfunction and absence of signs indicating other malignancies, a primary lymphoma of the liver should be considered as a possible diagnosis.     

Spindle-cell hemangioendothelioma with monomelic and multifocal form in a child

BACKGROUND: Spindle-cell hemangioendothelioma is a soft tissue skin tumor recently identified histologically. It can occur at all ages but generally is seen in young adults. The lesion usually occurs as a subcutaneous mass involving the limbs. CASE REPORT: A particular case of spindle-cell hemangioendothelioma was observed in an 18-month-old child. The lesions progressed with a monomelic distribution on the upper limb. Histological diagnosis of spindle-cell hemangioendothelioma was achieved at the age of 6 years. DISCUSSION: The age of the patient and the monomelic distribution is particular in this case of spindle-cell hemangioendothelioma, inciting a nosological discussion on this disease and other vascular tumors of childhood and the relationship of these types of lesions with Maffucci's syndrome. Although no anomalies have been detected to date, radiological surveillance is needed as cases of Maffucci's syndrome associated with spindle-cell hemangioendothelioma is described in the literature.     

A case of idiopathic iliopsoas hematoma associated with liver cirrhosis

We report a rare case of intratracheal thyroid ectopia in the setting of papillary thyroid carcinoma, resulting in the preoperative clinical impression of an aggressive, high-stage tumor. A 24-year-old opera singer presented with complaints of a gagging or choking sensation. The results of computed tomography revealed a mass in the left thyroid lobe with multiple small calcifications consistent with papillary thyroid carcinoma as well as a soft tissue mass in the adjacent left tracheal lumen thought to be direct invasion by the thyroid tumor. A total thyroidectomy was performed including excision of half of the first and second tracheal cartilages and the lower portion of the hemicricoid cartilage. The final histological findings revealed that the intratracheal component was composed of benign thyroid tissue and strands of benign thyrocytes coursed through the first tracheal membrane. Intratracheal thyroid ectopia is a rare symptomatic occurrence with a striking female predisposition. We have identified 23 cases of intratracheal thyroid ectopia from the literature. They occur most often at the level of the cricoid, usually posteriorly with a slight predisposition for the left side. Continuity between the intratracheal component and the thyroid lobe may be seen. Clinicians and pathologists must be aware of this entity to avoid mistaking it for evidence of thyroid invasion by a malignant neoplasm.     

Electronic fetal monitoring in predicting cerebral palsy

A 58 year old man was admitted to the accident and emergency department following an industrial accident in which he sustained a three part fracture dislocation of his right humerus. Chest radiography revealed a large mass in the right upper hemithorax and, when the patient became hypotensive, an emergency thoracotomy was performed. The mass was found to be a massive intrathoracic lipoma. This case shows how preexisting intrathoracic lesions may be mistaken for subclavian or great vessel trauma following violent shoulder girdle injury. The differential diagnosis of traumatic and non-traumatic intrathoracic mass lesions in chest radiography should be considered carefully.     

Mammographic findings after stereotaxic biopsy of the breast performed with large-core needles

Colorectal cancer generally affects men and women in the later decades of life. Typically patients present with bowel obstruction and/or chronic anemia. The epidemiology, presentation, and prognosis of cecal carcinoma, the third most common colorectal cancer, is similar to other cancers of the large bowel. Cecal and other colorectal cancers rarely present in adolescence. In this case report, we describe a 19-year-old woman presenting with a pelvic mass and elevated tumor markers with the presumed diagnosis of ovarian cancer, who was found to have cecal carcinoma at laparotomy. This case illustrates that colorectal cancer, although rare, should be considered in the differential diagnosis of a pelvic mass in young women who present with anemia, constitutional symptoms, and elevated tumor markers.     

Subclavian mycotic aneurysm presenting as mediastinal abscess

A 60-year-old man was admitted to a hospital for evaluation of intermittent fever, dysphagia, hoarseness, and general chest discomfort. Great vessel mycotic aneurysm was suspected when antibiotic trials failed and chest X-ray showed paraaortic mass with pleural effusion mimicking mediastinitis. Although the correct diagnosis of mycotic aneurysm of innominate artery was made thereafter and vigorous treatment was initiated immediately, this patient succumbed to overwhelming sepsis, probably due to a 2-week delay in another hospital. This case is reported to remind readers of the possibility of this unusual location of mycotic aneurysm. A high index of suspicion should be maintained to make an earlier diagnosis and obtain better prognosis. Computed tomography and 3D magnetic resonance angiography also significantly improve the diagnosis when mycotic aneurysm location is unusual and presentation is equivocal.     

The safety of pramoxine hydrochloride when used as a topical (surface) anesthetic

The correct diagnosis of pathological lesions of endodontic origin should allow for differentiation from those arising from other sources. A case of periapical cemental dysplasia (cementoma) is presented, whereby incorrect diagnosis resulted in not only inappropriate treatment, but an endodontic mishap and the superimposition of acute apical periodontitis in a previously disease-free site. This case report highlights the need for appropriate examination, simple special tests and diagnosis prior to management of lesions of questionable aetiology.     

Acute and chronic sphenoid sinusitis. Review of the literature

Isolated involvement of the sphenoid sinus is a relatively uncommon entity. We present a review of the most important series. Acute and chronic diseases are separated. Acute sphenoid sinusitis is a potentially catastrophic infectious disease. It is frequently initially misdiagnosed, and, due to the severe intracranial complications, a genuine medical and surgical treatment is recommended. Chronic sphenoid lesions may pose a problem of etiologic diagnosis. It may be difficult to differentiate between benign and malignant lesions. The most common presenting symptom is headache, followed by visual symptoms and cranial nerves palsies. Radiographically, computed tomography is the gold standard. Treatment includes antibiotic therapy and surgical drainage. This drainage is now done through an endoscopic approach.     

Oral manifestations of sarcoidosis

OBJECTIVE: To report two new cases of sarcoidosis of the buccal mucosa and to analyze the literature on oral manifestations of sarcoidosis. STUDY DESIGN: Oral lesions with histologic features of sarcoidosis were analyzed according to their location and appearance. RESULTS: Analysis of 45 cases of oral sarcoidosis (43 from the literature and the 2 new presented cases) revealed 12 lesions in the jaws, 10 in the buccal mucosa, 6 in the gingiva, 5 in the lips, 5 in the floor of the mouth, 4 in the tongue, and 3 in the palate. Sarcoidosis in the jaw was located in the alveolar bone and presented as an ill-defined radiolucency. Submucosal nodules were observed in sarcoidosis affecting the buccal mucosa, palate, and lip. Swelling was the main manifestation in the gingiva. In the floor of the mouth, sarcoidosis presented as ranula and that of the tongue as induration. In most of the cases, the lesions in the buccal mucosa, gingiva, and tongue were the first clinical manifestation of the disease. CONCLUSION: Oral sarcoidosis lesions should be considered in the differential diagnosis of oral soft tissue swellings and jaw lesions.