In Situ Melanoma of the Gingiva Associated with Dense Inflammation and Pigment Deposition: A Potential Diagnostic Pitfall in Evaluating Stromal Invasion

Abstract

Melanoma is a highly aggressive neoplasm in which the neoplastic cells display melanocytic differentiation. Less than 1 % of all melanomas arise in the mucosal surfaces of the oral cavity, with purely in situ lesions being exceedingly rare tumors, but with a favorable prognosis compared with invasive lesions. We describe the clinical, histopathological and immunohistochemical findings in an uncommon case of in situ mucosal melanoma of the oral cavity with intense tumor-associated pigment deposition and inflammation complicating the morphological assessment of infiltrative areas.

http://ift.tt/2edhwwH

A Case of Cutaneous Malakoplakia in the Head and Neck Region and Review of the Literature

Abstract

Malakoplakia is a rare inflammatory condition that typically occurs in the urinary tract. The cutaneous form is less prevalent, and most commonly occurs in the perianal or genital regions. Here we present a 61 year old lady with cutaneous malakoplakia of the neck, which was successfully treated with surgical excision and a prolonged course of ciprofloxacin. We follow our case report with a discussion and literature review of all seventeen previously reported cutaneous head and neck malakoplakia cases from the literature. A diagnosis of cutaneous malakoplakia should be considered in nodular, ulcerated or discharging lesions that are refractory to treatment. Histology is essential, not only to diagnose malakoplakia, but also to exclude other important differential diagnoses, such as malignancy. Combined surgical excision and prolonged antibiotic courses appear to have the highest success rate. Antibiotics should be culture specific, but quinolones appear to be the best empirical choice.

http://ift.tt/2eI4gnq

Next-Generation Sequencing in Salivary Gland Basal Cell Adenocarcinoma and Basal Cell Adenoma

Abstract

Basal cell adenoma and basal cell adenocarcinoma represent basaloid salivary gland neoplasms that show cyto-morphologic similarity but differ at the histologic level by their invasive qualities, as adenocarcinomas show invasion beyond their capsule, a finding not seen in the adenomas. Due to the low incidence of these tumors, the molecular mechanism underlying their pathogenesis is poorly understood. We sought to further delineate these neoplasms through mutation profiling by targeted next-generation sequencing (NGS). Twenty cases (basal cell adenocarcinoma = 10; basal cell adenoma = 10) were retrospectively selected from a previous analysis. NGS was performed using the Ion AmpliSeq™ Cancer Hotspot Panel v2 (Life Technologies, Carlsbad, CA). The data was analyzed using the Ion Torrent Suite Software (Life Technologies) followed by a laboratory-developed pipeline. One of eight cases of basal cell adenocarcinoma had a mutation, which was an activating mutation in PIK3CA (c.3140A>G, p.H1047R). No mutations were detected in the remaining basal cell adenocarcinomas. In the basal cell adenomas, the CTNNB1 p.I35T mutation was identified in three of nine (3/9) cases. A missense mutation in the ATM gene (c.2572T>C, p.F858L) was seen in a basal cell adenoma with an allele frequency of 53 %, raising the possibility of a germline mutation. The overall findings suggest that although there is cytomorphologic similarity, differences exist between these two tumors at the histologic and genetic level. Although the numbers of cases are limited, the aberrations in genes affecting different signaling pathways in the basal cell adenocarcinoma versus the basal cell adenomas suggest that basal cell adenocarcinoma likely arises de novo and not from basal cell adenoma.

http://ift.tt/2eTERDp

Intraoral Pseudo-Onion Bulb Intraneural Proliferations in a Patient with Hemimandibular Hyperplasia: A Case Report and Review of the Literature

Abstract

This report and review of the literature describes a case of benign intraoral lesions of perineurial origin in a patient with symptomatic hemimandibular hyperplasia causing partial denture soreness. Perineuriomas are a benign peripheral nerve sheath tumor composed of perineurial cells. Intraoral perineuriomas are an extremely rare entity. Two main types of perineuriomas have been described: intraneural and extraneural perineuriomas. A third, similar entity, called an intraneural pseudoperineuriomatous proliferation, has recently been proposed in the literature as a separate and distinctive diagnosis. This report describes the histologic and clinical presentation of intraneural pseudoperineuriomatous proliferations in a patient with hemimandibular hyperplasia.

http://ift.tt/2eI60Nf

Küttner Tumor: IgG4-Related Disease of the Submandibular Gland

Abstract

Küttner tumor/chronic sclerosing sialadenitis is a fibroinflammatory process that characteristically involves the submandibular gland of patients with IgG4-related disease. Histologic examination is often important to make the diagnosis because of its nonspecific clinical and radiologic findings. Microscopically, Küttner tumor should be distinguished from other entities such as extranodal marginal zone lymphoma, Sjögren's syndrome, and lymphoepithelial sialadenitis. The lesion is histologically well-demarcated with lobular architecture, extensive fibrosis, marked lymphoplasmacytic inflammation, formation of lymphoid follicles, acinar atrophy, and obliterative phlebitis, without the presence of lymphoepithelial lesions. The IgG4-to-IgG positive plasma cell ratio of >40 % is also an important feature to support the diagnosis of Küttner tumor. Moreover, flow cytometry is helpful to exclude a lymphoproliferative process. Clinicians and pathologists should consider the diagnosis of Küttner tumor in patients with elevated serum IgG4 level. Timely and accurate diagnosis is important for appropriate management.

http://ift.tt/2eTDDbp

Osseous Dysplasia with Gross Jaw Expansion: A Review of 18 Lesions

Abstract

Fourteen cases with 18 grossly expansive lesions diagnosed over a period of 15 years as either "familial gigantiform cementoma" or "osseous dysplasia with jaw expansion" in an African population sample were reviewed. Eight lesions occurred in the anterior mandible, the maxilla was affected by four, three patients presented with more than one lesion and the most common associated pathologies were tooth displacement, conventional non expanding florid osseous dysplasia and simple bone cyst. No history of similar lesions in relatives of the diseased were recorded. The radiolucent fibrous component contained globular bone deposits and cellular osteoid with trabecular differentiation which matured into radiodense mineralized masses. Resorption of the cellular bone created cavities which are proposed to represent the early stage of simple bone cyst formation. It is recommended that "expansive osseous dysplasia" replace the out-dated term "familial gigantiform cementoma". The differential diagnoses of expansive osseous dysplasias are discussed.

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Regarding “Dedifferentiated Chondrosarcoma of the Larynx”

http://ift.tt/2eTGhhb

Lysozyme Expression Can be Useful to Distinguish Mammary Analog Secretory Carcinoma from Acinic Cell Carcinoma of Salivary Glands

Abstract

Lysozyme is an enzymatic marker of acinar and intercalated duct cells of normal salivary glands. The aim of this study was to verify whether lysozyme expression could be useful to distinguish acinic cell carcinoma (ACC) from its main mimic, mammary analog secretory carcinoma (MASC). For comparison, DOG1 expression was analyzed as well. Seventeen cases of ACC, 15 MASC, and 125 other salivary tumors were studied. Lysozyme expression was found in tumor cells as well as in secreted material of MASC (86.6 % of cases) and in ductal cells of epithelial–myoepithelial carcinoma (EMC-53.8 %), pleomorphic adenoma (PA-29.1 %) and polymorphous low-grade adenocarcinoma (PLGA-23.8 %). However, in ACC, lysozyme was not expressed. Three patterns of DOG1 staining were seen: apical–luminal, cytoplasmic, and mixed cytoplasmic/membranous. The apical–luminal pattern was detected in ductal cells of ACC (58.8 % of cases), EMC (38.4 %), adenoid-cystic carcinoma (AdCC-35.3 %), PA (8.3 %), and PLGA (4.8 %). These tumors also showed mixed membranous/cytoplasmic staining for DOG1. MASC, mucoepidermoid, and salivary duct carcinomas exhibited only DOG1 cytoplasmic staining. In conclusion, lysozyme cannot be used as a marker of acinar differentiation in salivary tumors. However, lysozyme expression can be helpful to distinguish MASC from ACC due to its high frequency in the former and absence in ACC. It is likely that in MASC, lysozyme expression may reflect a lactational-like secretory differentiation since lysozyme belongs to breast milk proteins. Regarding DOG1 expression, the apical–luminal pattern is related to acinar and intercalated duct differentiation whereas the cytoplasmic staining does not seem to be associated with a specific cellular phenotype.

http://ift.tt/2eI4cDW

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Abstract

The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87 years (mean 31.3 years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n = 67) was twice as common in pediatric as adult patients. The average cyst size was 2.4 cm (range 0.4–9.9 cm) by imaging studies and 2.6 cm (range 0.2–8.5 cm) by pathologic examination; pediatric patients had smaller cysts (mean 2.1 cm) than adults (mean 2.8 cm). Histologically, 257 (38 %) TGDC were lined by respiratory epithelium alone, 68 (10 %) squamous epithelium alone, 347 (51 %) exhibited both respiratory and squamous epithelium, and 13 (1 %) had no identifiable epithelial lining. Four hundred eighty-four (71 %) TGDC had associated thyroid gland tissue present within the cyst wall (n = 282), skeletal muscle (n = 71), adipose tissue (n = 34), or a combination of these sites (n = 97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n = 647), cystectomy (n = 31), or thyroidectomy/thyroid lobectomy (n = 7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3 %) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2 %) TGDC. In summary, TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10 %. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71 % of cases (0.45 cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2 %). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications (1 %) and recurrence (3 %).

http://ift.tt/2dYWYud

Sclerosing Microcystic Adenocarcinoma of the Head and Neck Mucosa: A Neoplasm Closely Resembling Microcystic Adnexal Carcinoma

Abstract

Microcystic adnexal carcinoma (MAC) occurs predominantly in the centrofacial skin and has been only rarely reported in mucosal surfaces. We here present a 5 case series of tumors closely resembling MAC occurring in the mucosal surfaces of the head and neck, which we have termed sclerosing microcystic adenocarcinomas. These tumors showed a predilection for women (4:1) with an average patient age of 52.6 years (range 41–73 years). Location included the tongue (n = 2), the floor of the mouth (n = 2), and the nasopharynx/clivus (n = 1). One occurred after radiation therapy and another occurred in the setting of immune compromise. Immunohistochemistry highlighted a dual cell population with luminal cells showing positivity for high and low-molecular weight keratins and surrounding myoepithelial cells showing S100 and smooth muscle actin staining. No cases had nodal involvement, and the single patient with clinical follow-up was alive and free of disease 34 months after diagnosis and definitive radiochemotherapy. Differential diagnoses for all cases diverged from those provoked by MAC in the skin and included a variety of salivary gland neoplasms such as adenoid cystic carcinoma, polymorphous low grade adenocarcinoma, and mucoepidermoid carcinoma. Recognition of sclerosing microcystic adenocarcinoma in the head and neck mucosa is critical given its bland appearance and subtle infiltration pattern, infrequency of nodal involvement, and behavioral differences from the other entities on the differential.

http://ift.tt/2eTAWqa

Adenosquamous Carcinoma of the Head and Neck: A Case–Control Study with Conventional Squamous Cell Carcinoma

Abstract

Adenosquamous carcinoma (AdSC) is considered a rare variant of squamous cell carcinoma (SCC) which is considered to be more clinically aggressive. Data is very limited with very little case matched data on outcomes in the literature. It is also unknown whether the quantity of the adenocarcinoma component affects outcomes. A retrospective case–control study with 23 cases of AdSC and 1137 SCC controls was conducted. Cases were matched by anatomic subsite, treatment, and, for oropharynx, by p16 status. The following variables were adjusted for in the analysis: T classification (T1/T2 vs. T3/T4), N classification (N0–N2a vs. N2b–N3), age, and smoking. The adenocarcinoma component was quantified by the number of high power fields containing glands as low, moderate, or high. AdSCs had a significantly greater risk of disease recurrence but largely, the differences were not statistically significant. The quantity of adenocarcinoma did not correlate with disease recurrence or survival. This case–control study on AdSC shows modestly more clinically aggressive behavior than conventional SCC, even while controlling for p16 status for oropharyngeal cases. Further, it suggests the current definition of AdSC, with no minimum requirement for gland formation, is clinically accurate.

http://ift.tt/2eI4ZVo

Tuberous Sclerosis with Severe Cutaneous Manifestation and Multiples Facial Angiofibromas

Abstract

Tuberous sclerosis is an extremely variable disease that can affect virtually any organ in the body. The most common findings are cutaneous manifestations, that are critical features in helping to establish diagnosis. We present a case of young man with diagnosis of tuberous sclerosis presenting multiple shagreen patches around the trunk, in the neck and genital region; large plaques with uneven surfaces on the right side of the lower back; and multiple papular lesions in his face, particularly around the nasolabial region, eyebrows and forehead. Considering that tuberous sclerosis is a disease with a highly variable clinical presentation, thus dentists and doctors should be aware of the different manifestations that may be found.

http://ift.tt/2eTDB3b

Epidemiological trends and clinicopathological features of cutaneous melanoma in sporadic and xeroderma pigmentosum Tunisian patients

Abstract

Background

Epidemiological features and trends of cutaneous melanoma (CM) in North-African populations remain unclear. Those populations are of particular interest as they belong to a mosaic of various other origins (sub-Saharan, European Ancestry, and North-African Berbers). The aim of this study is to draw epidemiological profile and clinicopathological features of CM in the Tunisian population.

Methods

Incidence analyses were based on data from regional cancer registries. Clinical data were collected from dermatological departments and xeroderma pigmentosum (XP) referral centers and provided CM clinicopathological characteristics and progression. Statistical analyses were achieved using R packages and SPSS 20.0.

Results

The incidence of CM in Tunisia is relatively low (0.5–0.7 per 100,000 inhabitants per year). Gender differences were observed regarding anatomical distribution (P = 0.004). Acral lentiginous melanoma (ALM) was the most frequent histological subtype (32.3%); however, nodular melanoma (NM) was the most aggressive and responsible for 54.8% of deaths. CM in XP patients develops at a median age that is 42 years earlier than sporadic cases, with preferential localization on the head and neck (P < 0.001). Finally, male patients exhibited survival disadvantages compared with females (adjusted hazard ratio (HR) = 2.22, 95% CI: 1.05–4.68, P = 0.037).

Conclusions

Cutaneous melanoma features in Tunisia are closer to those of non-Caucasians, even though gender differences that are similar to those observed in Caucasians were uncovered. This study also emphasizes the aggressiveness of NM and its effect on melanoma patient deaths. Xeroderma pigmentosum stands as the major predisposing host factor.

http://ift.tt/2eTDAMO

Phase I Platinum Based Chemotherapy Plus Indomethacin

Conditions:   Colorectal Neoplasms;   Esophageal Neoplasms;   Ovarian Neoplasms
Intervention:   Drug: Indomethacin
Sponsor:   UMC Utrecht
Recruiting - verified October 2016

http://ift.tt/2eHTUUy

Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis

by Séverine Deguen, Wahida Kihal, Maxime Jeanjean, Cindy Padilla, Denis Zmirou-Navier

Background

We conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs).

Methods

We searched MEDLINE from its inception to December 20^th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models.

Results

Out of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61).

Conclusion

In spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association.

http://ift.tt/2eME3C1

Correlation between digital epiluminescence microscopy parameters and histopathological changes in lentigo maligna and solar lentigo: A dermoscopic index for the diagnosis of lentigo maligna

The clinical and dermoscopic differentiation between lentigo maligna (LM) and solar lentigo (SL)/initial seborrheic keratosis (SK) may be difficult.

http://ift.tt/2ewOTxj

Cardiovascular event risk assessment in psoriasis patients treated with tumor necrosis factor-α inhibitors versus methotrexate

Psoriasis is associated with increased risk for cardiovascular disease.

http://ift.tt/2eNd49q

Erythromelalgia: Identification of a corticosteroid-responsive subset

Corticosteroids (CS) may benefit certain patients with erythromelalgia.

http://ift.tt/2eNvGGe

Impact of scalp location on survival in head and neck melanoma: A retrospective cohort study

Scalp melanomas have more aggressive clinicopathological features than other melanomas and mortality rates more than twice that of melanoma located elsewhere.

http://ift.tt/2ewP5Nm

Sex differences in the association of cutaneous melanoma incidence rates and geographic ultraviolet light exposure

Cutaneous melanoma (CM) incidence rates continue to increase, and the reasons are unknown. Previously, we reported a unique age-specific sex difference in melanoma that suggested additional causes other than solar ultraviolet (UV) radiation.

http://ift.tt/2eNzbfY

Viral exanthems: An update on laboratory testing of the adult patient

Although classic viral exanthems of childhood are well described, they are rarely differentiated in adults. Laboratory techniques for viral identification have advanced without substantial literature to suggest how a dermatologist ought to conduct a cost-effective and diagnostic viral panel. Certain clinical features such as petechiae, vesicles, and dusky macular or morbilliform exanthems point strongly toward a viral exanthem. Differentiation of drug and viral causes of morbilliform eruptions has proven difficult.

http://ift.tt/2ewQaod

Correction

Ferrara G, Cacitti V, Improta G, Lo Re G, Corradin MT. Epidermotropic progression of melanoma during therapy with dabrafenib and trametinib. J Am Acad Dermatol. 2016;75:e133-5

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Horner’s syndrome: an unusual complication of thyroidectomy: a case report

Horner's syndrome is a very rare complication following surgery of the thyroid gland with only a handful of cases reported in the literature. Exact pathophysiology of post-thyroidectomy Horner's syndrome is no...

http://ift.tt/2dJDviI

Bile duct carcinoma recurrence in the papillary region in a long-term survivor of hilar cholangiocarcinoma: a case report

Because of its high rate of early recurrence and its poor prognosis, long-term survival after cholangiocarcinoma is rare; therefore, only limited information on patients surviving more than 5 years after surgi...

http://ift.tt/2eHqanB

Lung metastasectomy in adenoid cystic cancer: Is it worth it?

Adenoid cystic carcinoma (ACC), a rare malignant tumor with an incidence of 3–4.5 cases per million, represents 1% of all head and neck malignancies [1]. Adenoid cystic carcinoma typically affects minor and major salivary glands, such as parotid, submandibular, and sublingual salivary glands. Less frequently, it can also affect the lacrimal and serous glands or respiratory mucosa. Altogether, it represents about 10% of all tumors of the salivary glands [2]. The clinical behavior of this tumor usually has been described as indolent; however, it has been shown that ACC is correlated with an inauspicious prognosis when it invades perineural tissues.

http://ift.tt/2ewxWTZ

Lesiones otorrinolaringológicas secundarias al sexo oral

Publication date: Available online 25 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Claudia Fernández-López, Carmelo Morales-Angulo
IntroducciónEn los últimos años han aumentado de manera significativa las manifestaciones orales y faríngeas secundarias a la práctica de sexo oral. Sin embargo, no hemos encontrado ningún artículo de revisión relacionado con el tema en la literatura médica.El objetivo de nuestro estudio fue identificar las manifestaciones otorrinolaringológicas asociadas al contacto orogenital/oroanal tanto en pacientes adultos como en niños en el contexto de sexo consentido o de abusos sexuales.MétodosSe realizó una revisión de la bibliografía de la patología otorrinolaringológica asociada a la realización de sexo oral en la base de datos PubMed publicada en los últimos 20 años.ResultadosLas manifestaciones otorrinolaringológicas secundarias a práctica de sexo oral en adultos pueden ser infecciosas, tumorales o traumáticas. Las manifestaciones infecciosas más frecuentes encontradas en la literatura son la infección por el virus del papiloma humano (sobre todo, condilomas acuminados y papilomas), sífilis oral o faríngea, faringitis gonocócica, faringitis por Chlamydia trachomatis e infecciones por el virus del herpes simple. Por otra parte, ha aumentado de forma alarmante la incidencia de carcinoma orofaríngeo secundario al virus del papiloma humano.En niños, fuera del periodo neonatal, la presencia de condilomas acuminados, sífilis, gonococia o equimosis en el paladar (esta última no justificada por otras causas) nos deben hacer sospechar la presencia de abusos sexuales.ConclusionesEl cambio de los hábitos sexuales en países occidentales ha dado lugar a la aparición de patologías otorrinolaringológicas excepcionales previamente, por lo que es importante su conocimiento por parte de los médicos de atención primaria para realizar un correcto diagnóstico y tratamiento posterior. Por otra parte, algunos casos de abusos sexuales en niños pueden ser sospechados gracias al conocimiento de las manifestaciones características orofaríngeas secundarias a los mismos.IntroductionOver the last few years, oral and pharyngeal signs and symptoms due to oral sex have increased significantly. However, no review articles related to this subject have been found in the medical literature.The objective of our study was to identify otorhinolaryngological manifestations associated with orogenital/oroanal contact, both in adults and children, in the context of consensual sex or sexual abuse.MethodsWe performed a review of the medical literature on otorhinolaryngological pathology associated with oral sex published in the last 20 years in the PubMed database.ResultsOtorhinolaryngological manifestations secondary to oral sex practice in adults can be infectious, tumoral or secondary to trauma. The more common signs and symptoms found in the literature were human papillomavirus infection (above all, condyloma acuminata and papilloma/condyloma), oral or pharyngeal syphilis, gonococcal pharyngitis, herpes simplex virus infection and pharyngitis from Chlamydia trachomatis. The incidence of human papillomavirus -induced oropharyngeal carcinoma has dramatically increased.In children past the neonatal period, the presence of condyloma acuminatus, syphilis, gonorrhoea or palatal ecchymosis (the last one, unless justified by other causes) should make us suspect sexual abuse.ConclusionsSexual habits have changed in the last decades, resulting in the appearance of otorhinolaryngological pathology that was rarely seen previously. For this reason, it is important for primary care physicians to have knowledge about the subject to perform correct diagnosis and posterior treatment. Some sexual abuse cases in children may also be suspected based on the knowledge of the characteristic oropharyngeal manifestations secondary to them.



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Cóndilo mandibular bífido bilateral

Publication date: Available online 25 October 2016
Source:Acta Otorrinolaringológica Española
Author(s): Carlos Prol, Julio Álvarez, Josu Mendiola




http://ift.tt/2dLJFK0

Predictive Factors of Acute Oral Mucositis Induced by Chemo-radiotherapy for Local Advanced Nasopharyngeal Carcinoma

Conditions:   Nasopharyngeal Neoplasms;   Stomatitis
Intervention:  
Sponsor:   Zhejiang Cancer Hospital
Recruiting - verified October 2016

http://ift.tt/2eMO6XM

Quarterback 2 - Sequential Therapy With Reduced Dose Chemoradiotherapy for HPV Oropharynx Cancer

Condition:   Locally Advanced HPV Positive Oropharynx Cancer
Interventions:   Radiation: PTV56;   Radiation: PTV50.4
Sponsor:   Icahn School of Medicine at Mount Sinai
Recruiting - verified October 2016

http://ift.tt/2dJhkZT

Trial Evaluating Maintenance Chemotherapy for Metastatic Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Conventional chemotherapy;   Drug: Maintenance chemotherapy 1;   Drug: Maintenance chemotherapy 2
Sponsors:   Shanghai Proton and Heavy Ion Center;   Fudan University;   Eye & Ent Hospital of Fudan University;   The First Affiliated Hospital of Xiamen University;   Jiangxi Provincial Cancer Hospital;   Taichung Veterans General Hospital;   First Affiliated Hospital of Fujian Medical University;   Cancer Hospital of Guangxi Medical University;   National Cancer Centre, Singapore;   West China Hospital;   Beijing Cancer Hospital;   Tongji Hospital;   People's Hospital of Guangxi
Recruiting - verified October 2016

http://ift.tt/2eMLbhD

SElf-SAMpling in Cervical Cancer Screening; SESAM Study

Condition:   Cervical Cancer
Intervention:   Device: HPV testing of Evalyn®Brush, FloqSwab and Colli-Pee specimens
Sponsors:   Oslo University Hospital;   Ostfold Hospital Trust
Recruiting - verified October 2016

http://ift.tt/2dJlm4g

Response to Intermittent Pneumatic Compression Therapy in Head and Neck Cancer-related Lymphedema

Conditions:   Head and Neck Neoplasms;   Head and Neck Lymphedema;   Head and Neck Cancer
Interventions:   Device: Head and neck garments for pneumatic compression device.;   Drug: NIRFLI with ICG
Sponsor:   Tactile Medical
Recruiting - verified October 2016

http://ift.tt/2ebJZmH

Ketogenic Diet Phase 1 for Head & Neck Cancer

Condition:   Head and Neck Neoplasms
Intervention:   Dietary Supplement: Ketogenic diet
Sponsors:   University of Iowa;   National Institutes of Health (NIH);   National Cancer Institute (NCI);   Nutricia North America;   Holden Comprehensive Cancer Center
Recruiting - verified October 2016

http://ift.tt/2dJgvQD

Elevated leukocyte count is associated with periodontitis in Korean adults: The 2012-2014 KNHANES

Abstract

Objective

Both an elevated leukocyte count and periodontitis share well-recognized associations with cardiometabolic diseases. This cross-sectional study aimed to identify whether the leukocyte count is associated with periodontitis in a nationally-representative Korean adult population.

Materials and Methods

Data from 9,391 participants (3,659 males and 5,732 females) enrolled in 2012-2014 Korean National Health and Nutrition Examination Survey were analyzed. Leukocyte quartiles were categorized as follows: 3000 ≤ Q1 ≤4870; 4880 ≤ Q2 ≤ 5790; 5800 ≤ Q3 ≤ 6840 and 6850 ≤ Q4≤ 10000 cells/μL. Periodontitis was defined as scoring greater than or equal to "code 3" in at least one site according to the WHO's Community Periodontal Index (CPI). The odds ratios (ORs) and 95% confidence intervals (95% CIs) for periodontitis in each leukocyte count quartile were calculated using multiple logistic regression analyses.

Results

The prevalence of periodontitis was directly correlated with increasing leukocyte quartiles: 19%, 20.4%, 24.3%, and 30.3%. Compared with the lowest leukocyte quartile group, the OR (95% CI) for periodontitis of the highest leukocyte quartile was 1.558 (1.285-1.891) after controlling for confounding factors.

Conclusion

An elevated leukocyte count was positively associated with the presence of periodontitis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2dKU1tX

SATB1 promotes tumor metastasis and invasiveness in oral squamous cell carcinoma

Abstract

Objective

Our aim is to evaluate the expression of SATB1 in human oral squamous cell carcinomas (OSCC) and its role in the invasiveness and metastasis of OSCC.

Subjects and methods

A human OSCC tissue microarray was used to evaluate the expression pattern of SATB1. SATB1 mRNA knockdown was performed in human OSCC cell lines SCC25 and Cal27 to assess the function of SATB1 in the invasiveness and metastasis of OSCC.

Results

SATB1 is highly expressed in human OSCC determined by immunohistochemistry and its nuclear/cytoplasmic ratio of histoscore is significantly correlated with patients' prognosis. Reduced cell motility, invasiveness, expression of epithelial to mesenchymal transition (EMT) markers (N-cadherin and β-catenin) and elevated expression of epithelial markers were observed in SATB1-knockdown cells in in vitro studies. Depletion of SATB1 also restored a cobblestone-like morphology in TGF-β1 treated cells.

Conclusions

These findings suggest SATB1 may play an important role in OSCC invasiveness and metastasis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2dX8A0V

Effects of Endurance Training on the Skeletal Muscle Nitric Oxide Metabolism in Insulin-Independent Type 2 Diabetic Men—A Pilot Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Endocarditis and monocular blindness

A man aged 77 years with postrenal transplant lymphoproliferative disease was admitted with high fever, elevated inflammatory markers and a heart murmur. Blood cultures grew Enterococcus faecalis and he was found to have mitral valve endocarditis on echocardiogram and subsequently started on appropriate antibiotics. 5 days into treatment, he developed ocular symptoms and 3 days later, he had irreversible monocular visual loss. He was seen by the ophthalmology team who diagnosed endogenous endopthalmitis secondary to bacteraemic spread from his endocarditis. Despite treatment with intravitreal antibiotics and prolonged systemic antibiotics, his sight did not recover. Although septic emboli are common in endocarditis, endogenous endophthalmitis is rarely reported and frequently results in visual loss. Early treatment confers an improved prognosis.

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Amyloidosis: an unusual cause of upper gastrointestinal bleeding

We report a rare case of upper gastrointestinal bleeding in a 55-year-old man with monoclonal gammopathy of unknown significance presenting with abdominal pain, weight loss and melaena. Gastroscopy was unremarkable, but melaena persisted, with the development of symptomatic anaemia. While colonoscopy excluded a lower gastrointestinal aetiology, CT revealed jejunitis, confirmed at capsule endoscopy. Histopathological examination of specimens obtained at single balloon enteroscopy revealed an unusual aetiology: small bowel AL-amyloidosis. We review his clinical presentation, radiological, endoscopic and histological findings and review the literature of this unusual condition.

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Systemic sarcoidosis first manifesting in a tattoo in the setting of immune checkpoint inhibition

The use of immune checkpoint inhibitors is revolutionising the treatment of cancer. However, their unique toxicity profile is substantially different from what has been observed with traditional chemotherapy, resulting in a novel learning curve for medical oncologists. Early recognition of these toxicities can make a substantial impact in ameliorating these side effects in the oncological and medical–surgical fields. Here, we present a case of Lofgren syndrome sarcoidosis, which first manifested in a tattoo in a patient with metastatic urothelial cancer on therapy with anti-CTLA-4 (ipilimumab) and anti-PD1 (nivolumab).

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Commonly forgotten complication of Hashimoto's thyroiditis

Hashimoto's thyroiditis (HT) is a frequently encountered condition in clinical practice and management is generally uncomplicated with patients on a stable dose of thyroxine supplementation. However, complications of thyroid lymphoma can develop, though it is rare and hence commonly forgotten by physicians. We present a case of a patient with HT who developed thyroid lymphoma. A 61-year-old woman presented with an enlarged goitre complicated by compressive symptoms and was diagnosed with HT. She was treated with stable dose of thyroxine but her constitutional symptoms of weight loss prompted further investigations and diagnosis of diffuse large B-cell lymphoma was eventually made. She underwent chemotherapy and adjuvant radiotherapy and is currently in remission 1 year post-treatment. There should be an increased index of suspicion of primary thyroid lymphoma in patients with HT for early diagnosis and treatment for better outcomes.

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Young man with sudden severe hip pain secondary to femoral neck stress fracture

Femoral neck stress fractures have been described in military recruits and athletes. Early recognition and aggressive treatment are important, as femoral neck stress fractures have a high potential for complications and even uncomplicated fractures require an extensive course of rehabilitation. Tension-side (superolateral) stress fractures of the femoral neck are at high risk for complications such as displacement, non-union and avascular necrosis, and need to be treated surgically, while compression-side (inferomedial) fractures can be treated conservatively. We describe a case illustrating a typical presentation of insidious hip pain culminating in sudden onset of severe hip pain in a healthy young man. We perform a literature review of studies showing epidemiology, treatment algorithms and rehabilitation.

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Disseminated pilomyxoid astrocytoma in infancy with novel MUTYH mutation

Description

A 3-month-old girl presented with 5 days of abnormal eye movements. Neurological examination was significant for axial hypotonia. MRI of the brain revealed extensive T2 prolongation and enhancement within the optic chiasm, optic nerves, bilateral basal ganglia, cerebellum and temporal lobes (figure 1). MRI of the spine showed extensive enhancement along the cervicomedullary junction and cervical and thoracic cord consistent with leptomeningeal metastatic disease (figure 2). The patient underwent right frontotemporal craniotomy for debulking of the tumour and biopsy. Neuropathology revealed a moderately cellular tumour with uniform nuclei, small amounts of myxoid material and perivascular clearing consistent with pilomyxoid astrocytoma (PMA) (figure 3). Molecular analysis demonstrated a novel MUTYH Y165C mutation. The patient died 17 months after diagnosis despite multimodal chemotherapy regimens due to disease progression.

Figure 1

T2-weighted axial (A, B), sagittal (C) and coronal (D) MRI of the brain shows...

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Takotsubo cardiomyopathy with severe bradyarrhythmia following epidural insertion

We present a case of takotsubo cardiomyopathy (TTC) with ventricular stand still and atrioventricular block. TTC can mimic ST elevation myocardial infarction and heart failure, but in this case resulted in a severe cardiac conduction disorder and ventricular standstill. This is a recognised but unusual presentation and serves as a lesson to those undertaking anaesthetics to be vigilant for TTC.

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Bilateral primary adrenal lymphoma with adrenal insufficiency

Primary adrenal lymphoma is an extremely rare condition. We describe a case of bilateral adrenal lymphoma in a man aged 55 years who was admitted to our hospital. He had a 3-month history of left flank pain, nausea and vomiting with weight loss. A CT scan at a private hospital revealed bilateral large adrenal masses; the patient was referred to our centre based on these findings. He was evaluated for pheochromocytoma by an endocrinology team; however, all findings were negative. In addition, a cosyntropin stimulation test indicated adrenal insufficiency. A Trucut biopsy of the adrenal gland revealed diffuse large B-cell lymphoma of the adrenal glands, and the patient responded extremely well to chemotherapy.

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Cotrimoxazole treats fluoroquinolone-resistant Salmonella typhi H58 infection

A woman aged 20 years presented with fever and no localising signs. She was treated with cotrimoxazole and the subsequent blood culture was positive for Salmonella typhi (S. typhi), which was resistant to fluoroquinolones but susceptible to cotrimoxazole. Genotyping identified an FQ-R subclade of H58 S. typhi. Fever clearance time was 4 days after starting the antibiotics, and no relapses were noted on 2 months of follow-up. This inexpensive, well-known and easily available antimicrobial could be suitably redeployed for fluoroquinolone-resistant enteric fever in South Asia.

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Primary hepatic Burkitt's lymphoma as first manifestation of HIV-AIDS in a hepatitis B seropositive adult: when defences fail

Description

A previously well 32-year-old heterosexual man presented with progressive wasting syndrome, jaundice, night sweats, vomiting and abdominal pain for 1 month. There was no history of recreational drug use or exposure to hepatotoxins. Examination showed normal vital signs, a body mass index of 18 kg/m², generalised muscle atrophy, oral thrush and no lymphadenopathy with an enlarged liver 14 cm below the costal margin at the midclavicular line. The physical examination was otherwise normal.

Serology for HIV enzyme-linked immune sorbent assay (ELISA), Western blot immunoassay tests and hepatitis B surface antigen were all seropositive confirming new onset HIV–AIDS with hepatitis B coinfection. Extensive investigations for other diseases were negative and relevant results are shown (table 1). The HIV viral load was high at 300 392 RNA copies/mL and the CD4+ T-cell count was low at 116 cells/µL (reference values 410–1590). Serum creatinine was also high at 4.2 mg/dL and blood urea...

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Crizotinib in ROS1 rearranged non-small cell lung cancer (NSCLC), from response to resistance

We examined an immediate, but short-lived, response to crizotinib, a drug with a new indication for ROS1 rearranged non-small cell lung cancer (NSCLC) in a middle-aged non-smoker. The patient presented with metastatic NSCLC and extensive disease in multiple organs. He was treated with crizotinib 250 mg twice a day. Within 2–3 days, his condition rapidly improved, which was evident in a CT scan 2 months later. However, after 3 months of treatment, his condition deteriorated dramatically. The patient did not respond to ceritinib, a second-line drug that targets anaplastic lymphoma kinase, and died shortly after. This case demonstrated an impressive but brief response to crizotinib.

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Invasive thymoma presenting as classic superior vena cava syndrome: a case of venous spread metastasis

The approach to an intrinsic cause of superior vena cava syndrome (SVCS) is usually difficult but rewarding. We report a case of a middle-aged man who presented with progressive oedema of the upper half of the body, dyspnoea, cough and weight loss for a 1-year duration. He was a non-smoker without prior hospitalisation. Chest radiography showed right-sided pleural effusion with an apparent normal superior mediastinum. Contrast-enhanced CT of the chest revealed a right atrial mass extending and completely obliterating to superior vena cava. The differentials were tuberculosis, invasive fungal granuloma, sarcoidosis, primary vasculitis, chronic venous thrombosis, cardiac sarcoma/lymphoma and metastatic thyroid tumour or thymoma. He underwent transvenous (femoral approach) biopsy of the mass and then cardiothoracic surgery after haemodynamic instability. Pathology showed invasive thymoma type B3. This case highlights the approach to an intrinsic cause of SVCS, a complication of the transvenous approach, and importantly a noble finding of venous spread metastasis.

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Resolution of left ventricular postinfarction thrombi in patients undergoing percutaneous coronary intervention using rivaroxaban in addition to dual antiplatelet therapy

Left ventricular (LV) thrombus is usually seen in situations with reduced LV function, and is mostly seen in patients with large anterior ST-elevation myocardial infarction (MI). Most embolic events, in patients with LV thrombus formation, occur within the first 3–4 months, thus the recommendations regarding the duration of anticoagulant therapy. According to guidelines, an oral vitamin K antagonist, warfarin, is being used as an anticoagulant for this period. Novel oral anticoagulants were found to be either non-inferior or superior compared with warfarin in prevention of thromboembolism in patients with non-valvular atrial fibrillation. However, the data about their role in the management of LV thrombus are limited to case reports. Here, we report on the dissolution of LV apical thrombus in 3 patients with anterior ST-elevation MI receiving dual antiplatelet therapy and rivaroxaban on a reduced dose for 3 months.

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Phaeochromocytoma presenting as an acute coronary syndrome

A 44-year-old Caucasian man presented to the emergency department in acute cardiogenic shock, with pulmonary oedema, secondary to an acute myocardial infarction and in a hyperosmolar hyperglycaemic state. The previous day he had undergone a colonoscopy, which revealed features of colitis, and was started on prednisolone. He had been previously diagnosed with type 2 diabetes, migraine and anxiety attacks. While awaiting a coronary angiogram he developed abdominal pain and a CT scan was performed and found a large right adrenal mass. Plasma-free metadrenaline levels were elevated. After 4 months, a right adrenalectomy was performed successfully. He made a good recovery with normalisation of his heart function and resolution of his diabetes. The diagnosis was delayed for years due to his episodic symptoms being attributed to other more common diagnoses. Although a rare diagnosis in itself, there are case reports of phaeochromocytoma initially presenting with an acute coronary syndrome.

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