Oral verrucous carcinoma: a 24-year epidemiological study and case report

Introduction: Verrucous carcinoma is a non-metastatic variant of squamous cell carcinoma. It was first reported by Ackerman in 1948. It is a verrucous exophytic tumor and, although it is a rare lesion, it mainly affects the oral cavity, with slow growth and can be locally invasive. Objective: To report a case and present an observational and retrospective analysis of medical records containing biopsy data from patients diagnosed with oral verrucous carcinoma (OVC) in an oral diagnostic referral service for a period of 24 years. Material and methods: The following data were collected: age, sex, ethnicity, anatomical location and management. Result: Eight cases of OVC were found, all in Caucasian patients (n = 8, 100%), aged between 57 and 102 years. 62% of the injuries affected women. The most affected region was the jugal mucosa (n = 4, 50%). In addition, Smoking patients were not found. In all cases, incisional biopsy was performed and referral to the head and neck surgeon. Conclusion: Caucasian women in the sixth and seventh decades of life were the most affected by OVC. The absence of smoking patients corroborates the literature, which reports that cigarettes appear to be unrelated to this injury. The dentist's role is to recognize the disease early, diagnose it and refer it for medical treatment.

Giant Congenital Blue Nevus Presenting as Cutis Verticis Gyrata: A Case Report and Review of the Literature

Objectives: Cerebriform intradermal nevus and giant congenital blue nevi are rarely reported melanocytic nevi with clinical and histopathologic similarities. Both are known to produce cutis verticis gyrata. We report a significantly large occipital scalp congenital blue nevus with secondary cutis verticis gyrata. The aim of this report is to increase clinical awareness of this entity, highlight histopathologic and mutational features of cerebriform intradermal nevi and giant congenital blue nevi, and stress the importance of clinicopathologic correlation for diagnosis. Methods: Case report and review of the literature. Results: A 20-year-old Asian male presented with a long-standing, large (20 cm × 30 cm), exophytic tumor at the occipital scalp and posterior neck. The skin overlying the lesion was arranged in thick folds resembling the surface of the brain, devoid of hair follicles, and discolored by salt-and-pepper pattern hyperpigmentation. After correlating the clinical and histopathologic findings, we diagnosed giant congenital blue nevus with secondary cutis verticis gyrata. Staged surgical excision was performed with subsequent treatment for hypertrophic scarring and occipital alopecia. Conclusions: Cerebriform intradermal nevus and giant congenital blue nevus have overlapping histologic and clinical features. Head and neck surgeons should be aware that nomenclature of these tumors is subjective and often imprecise. Diagnosis requires correlation of clinical findings, patient history, and histopathology. Surgical excision is advised due to rare malignant transformation potential.

Cervical intramedullary solitary fibrous tumor: Case report and review of the literature

Background: Solitary fibrous tumors (SFTs) are benign tumors derived from mesenchymal tissues that predominantly occur in the pleura. Establishing the diagnosis of these very rare intramedullary spinal lesions, with no clear-cut pathognomonic radiographic characteristics, is particularly challenging. Case Description: Two males, 30 and 41 years of age, presented with progressive cervical myelopathies attributed to a cervical intramedullary exophytic tumor with associated spinal cord edema. One patient showed that the lesion was highly vascularized. Both patients underwent surgical excision of firm, solid, focal, and, particularly in one of them, very vascular/hemorrhagic tumors; at surgery, there was some adherence between the tumors and the cord tissue, but gross-total resections were achieved in both cases, demonstrated on postoperative MR scans. Histological and immunohistochemical findings confirmed the diagnosis of SFT (WHO Grade I). After a 6-month postoperative period, both patients neurologically improved and had no MR evidence of tumor recurrence. Conclusion: Intramedullary cervical exophytic SFTs are extremely rare. Although these solid tumors may present with hemorrhagic features and at surgery demonstrate significant adherence to the pial/cord surface, complete surgical resections are feasible resulting in good outcomes.

European Laryngological Society position paper on laryngeal dysplasia Part I: aetiology and pathological classification

Purpose of review To give an overview of the current knowledge regarding the aetiology, epidemiology, and classification of laryngeal dysplasia (LD) and to highlight the contributions of recent literature. As most cases of dysplasia occur at the glottic level and data on diagnosis and management are almost exclusively from this location, laryngeal dysplasia in this position paper is taken to be synonymous with dysplasia of the vocal folds. Summary LD has long been recognized as a precursor lesion to laryngeal squamous cell carcinoma (SCC). Tobacco and alcohol consumption are the two single most important etiological factors for the development of LD. There is currently insufficient evidence to support a role of reflux. Although varying levels of human papillomavirus have been identified in LD, its causal role is still uncertain, and there are data suggesting that it may be limited. Dysplasia has a varying presentation including leukoplakia, erythroleukoplakia, mucosal reddening or thickening with exophytic, “tumor-like” alterations. About 50% of leukoplakic lesions will contain some form of dysplasia. It has become clear that the traditionally accepted molecular pathways to cancer, involving accumulated mutations in a specific order, do not apply to LD. Although the molecular nature of the progression of LD to SCC is still unclear, it can be concluded that the risk of malignant transformation does rise with increasing grade of dysplasia, but not predictably so. Consequently, grading systems are inherently troubled by the weak correlation between the degree of the dysplasia and the risk of malignant transformation. The best data on LD grading and outcomes come from the Ljubljana group, forming the basis for the World Health Organization classification published in 2017.

Initial Diagnosis and Detection of Very Late Local Recurrence of a Ductal Prostate Cancer due to a Ureteral Stone

We report the case of a 74-year-old patient in whom a ductal prostate cancer was incidentally endoscopically diagnosed in the course of ureteral stenting due to a left distal ureteral stone. The initial PSA was 0.8 μg/l and the digital rectal examination was not suspicious. A radical prostatectomy was performed, and the ensuing follow-up was unremarkable with no signs of recurrence. Fourteen years later, the patient presented with an obstructive pyelonephritis due to a left-sided ureteral stone requiring ureteral stenting. An exophytic tumor was seen in the lining of vesicourethral anastomosis and surgically excised after the pyelonephritis subsided. The histopathological and immunohistochemical analysis revealed a ductal cancer of the prostate consistent with a late local recurrence. Serum PSA was below the limit of detection. Re-staging performed by an MRI of the pelvis, thoracoabdominal CT scan, and gallium-68 PSMA-PET did not reveal any other signs of disease. The ensuing follow-up is planned with regular flexible cystoscopy and computed thoracoabdominopelvic CT scans.

An Unusual Cervical Mass in the Hyoid Bone: Intermediate-Grade Chondrosarcoma

We describe a case of a 31-year-old woman with a chondrosarcoma of the hyoid bone. The patient presented with a mass in the left submandibular region. Fine-needle aspiration cytology suggested chondroma, but further imaging investigation with CT revealed an exophytic tumor originating from the body of the hyoid bone. Histopathology of the surgical specimen confirmed the diagnosis of a intermediate-grade chondrosarcoma. Chondrosarcomas account for 11% of all bone cancers. Primary sites of the head and the neck include the nasal cavity, the skull base, the maxilla, the mandible. Chondrosarcomas of the hyoid bone are very rare, with only 23 cases previously reported in the literature.

ANTICANCER STUDY OF MYRISTICA FRAGRANS HOUTT. (MACE) EXTRACT ON 4-NITROQUINOLINE-1-OXIDE-INDUCED ORAL CANCER IN RATS

Objective: Oral cancer is the most common forms of malignancy diagnosed in men and women and the mortality rate is very high in the developing countries. Therefore, the study was conducted to evaluate the potential role of Myristica fragrans Houtt (mace) acetone extract (MAE) on experimentally induced oral cancer in rats.Methods: Oral cancer was experimentally induced to rats by administering 4NQO (carcinogenic agent) at a concentration of 30 ppm in drinking water and treated with three different doses of mace extract (100, 250, 500mg/kg body weight) dissolved in water and given orally as a single dose and another group treated with the standard 5-fluorouracil for 14 weeks.Results: All the experimental groups had an incremental weight gain, except NQO alone induced group showed body weight loss and also showed low survival rate denoting the NQO carcinogenic toxicity in them. The exophytic tumor volume showed gradual increase and reached 30 mm3 at the 14 weeks time point. Tumor incidence and tumor multiplicity values of mace extract treatment (100, 250, 500 mg/kg body weight) showed gradual reduction in the size of tumor significantly compared with that of the standard drug. The histopathological examination of oral tumor mucosal tissue illustrated well differentiated squamous cell carcinoma in NQO induced group and also declining the risk of carcinoma changes in MAE treated groups.Conclusions: These experimental results unveil that MAE possesses effective role in curing oral cancer.