MULTIPLE BASAL-CELL NEVI SYNDROME. AN ANALYSIS OF A SYNDROME CONSISTING OF MULTIPLE NEVOID BASAL-CELL CARCINOMA, JAW CYSTS, SKELETAL ANOMALIES, MEDULLOBLASTOMA, AND HYPORESPONSIVENESS TO PARATHORMONE

The Advent of Studies on Jaw Cysts with Keratinization: A Review of Overlooked Papers on Odontogenic Keratocyst and Orthokeratinized Odontogenic Cyst

Previous reports of odontogenic keratocyst (OKC) and orthokeratinized odontogenic cyst (OOC) with coverage of the old literature have tended to overlook the underlying theme of the first description. From a historical viewpoint, a French paper "kyste butyreux du sinus maxillaire simulant un cancer encéphaloid" published in 1855 by Maisonneuve popularized the notion of so-called "buttery cyst", which ultimately became known as jaw cyst with a keratinized lining. Soon after in 1856, Nélaton presented a case of OKC at the Anatomical Society of Paris, but his brief communication provided little information about its histopathology. It was Mikulicz who conducted, in 1876, a pioneering descriptive pathological study of OKC. In 1886, 10 years after Mikulicz's German report, OOC was first described in detail by Jeannel of Toulouse. The mid to late decades of the nineteenth century saw notable European contributions on the topic.

CDK7 inhibition suppresses aberrant hedgehog pathway and overcomes resistance to smoothened antagonists

The aberrant hedgehog (Hh) pathway plays important roles in multiple cancer types, therefore serving as a promising drug target. Current clinically available hedgehog-targeted drugs act mostly by antagonizing the upstream component smoothened; however, both primary and acquired resistance to FDA-approved smoothened inhibitor (SMOi) drugs have been described. We have recently demonstrated that the BET inhibitor effectively suppresses SMOi-resistant Hh-driven cancers through antagonizing transcription of GLI1 and GLI2, the core transcriptional factors of Hh pathway, suggesting epigenetic or transcriptional targeted therapy represents an anti-Hh therapeutic strategy that can overcome SMOi resistance. Here we performed an unbiased screening of epigenetic or transcriptional targeted small molecules to test their inhibitory effects on GLI1 and GLI2 transcription or cell viability of Hh-driven tumor lines. THZ1, a covalent inhibitor of cyclin-dependent kinase 7 (CDK7), is identified as the top hit in our screening. We then confirmed that antagonizing CDK7 by either small-molecule inhibitors or the CRISPR-Cas9 approach causes substantial suppression of GLI1 and GLI2 transcription, resulting in effective inhibition of Hh-driven cancers in vitro and in vivo. More importantly, antagonizing CDK7 retains inhibitory activity against Hh-driven cancers with almost all so-far described primary or acquired SMOi resistance. Furthermore, we reveal a synergy between CDK7 inhibition and BET inhibition on antagonizing aberrant Hh pathway and Hh-driven cancers that are either responsive or resistant to SMOi. Our results illustrate transcriptional inhibition through targeting CDK7 as a promising therapeutic strategy for treating Hh-driven cancers, especially those with primary or acquired resistance to SMOi drugs.

Uncommon hereditary gynaecological tumour syndromes: pathological features in tumours that may predict risk for a germline mutation

The most common hereditary gynaecological tumour syndromes are hereditary breast and ovarian cancer syndrome and Lynch syndrome. However, pathologists also may encounter gynaecological tumours in women with rare hereditary syndromes. Many of these tumours exhibit distinctive gross and microscopic features that are associated with a risk for an inherited gene mutation. The sensitivity and specificity of these tumour pathology features for predicting an inherited mutation vary depending on the syndrome. By recognising these tumour features, pathologists may potentially contribute to the diagnosis of an unsuspected syndrome by recommending referral of the patient for formal risk assessment by genetic counselling. Patients additionally benefit from diagnosis of an inherited syndrome because many also carry a lifetime risk for developing primary malignancies outside of the gynaecological tract. Early diagnosis of an inherited syndrome permits early screening, detection, and management of additional malignancies associated with the syndrome. This review highlights these rare syndromes and their tumour pathology, including Peutz-Jeghers syndrome (gastric type mucinous carcinoma of the cervix; ovarian sex cord tumour with annular tubules); hereditary leiomyoma renal cell carcinoma syndrome (uterine leiomyoma); tuberous sclerosis complex (uterine PEComa; uterine lymphangioleiomyomatosis); DICER1 syndrome (ovarian Sertoli-Leydig cell tumour; cervical embryonal rhabdomyosarcoma); rhabdoid tumour predisposition syndrome 2 (small cell carcinoma of the ovary, hypercalcaemic type); Cowden syndrome (endometrial endometrioid adenocarcinoma); naevoid basal cell carcinoma syndrome (ovarian fibroma); and Von Hippel-Lindau syndrome (clear cell papillary cystadenoma of the broad ligament).

Childhood cancer predisposition syndromes-A concise review and recommendations by the Cancer Predisposition Working Group of the Society for Pediatric Oncology and Hematology

Heritable predisposition is an important cause of cancer in children and adolescents. Although a large number of cancer predisposition genes and their associated syndromes and malignancies have already been described, it appears likely that there are more pediatric cancer patients in whom heritable cancer predisposition syndromes have yet to be recognized. In a consensus meeting in the beginning of 2016, we convened experts in Human Genetics and Pediatric Hematology/Oncology to review the available data, to categorize the large amount of information, and to develop recommendations regarding when a cancer predisposition syndrome should be suspected in a young oncology patient. This review summarizes the current knowledge of cancer predisposition syndromes in pediatric oncology and provides essential information on clinical situations in which a childhood cancer predisposition syndrome should be suspected.

Desmoplastic Ameloblastoma Arising in a Dentigerous Cyst - A Case Report and Discussion

Dentigerous cyst is a fairly common odontogenic cyst with an uncomplicated prognosis. However, reports of odontogenic and non-odontogenic tumors arising from the cysts have been published for many years. Therefore, the importance of thorough histopathological examination and regular follow-up cannot be overemphasized. Here is a case report of a possible development of desmoplastic ameloblastoma from a dentigerous cyst. This case is unique for two main reasons. Firstly, to our knowledge such a case has not been reported previously. Secondly, the tumor seemed to arise from the capsule and not from lining of the dentigerous cyst. Transformation of odontogenic rests into cysts is known to occur in the syndromic cases of odontogenic keratocysts (resulting in recurrent and daughter cysts) but not in dentigerous cysts. This case report may prompt greater interest in the role of the supposedly inactive odontogenic nests in the capsule of these cysts.

Skeletal stigmata as keys to access to the composite and ancient Gorlin-Goltz syndrome history: The Egypt, Pompeii and Herculaneum lessons

There are several genetic diseases with a wide spectrum of congenital bone stigmata in association to cutaneous and visceral benign and malignant neoplasms. Gorlin-Goltz syndrome, also named nevoid basal cell carcinoma syndrome, is an autosomal dominant systemic disease with almost complete penetrance and high intra-familial phenotypic variability, caused by germline mutations of the gene PTCH1. The syndrome is characterized by unusual skeletal changes and high predisposition to the development of multiple basal cell carcinomas, odontogenic keratocysts tumors and other visceral tumors. The Gorlin syndrome, clinically defined as distinct syndrome in 1963, existed during Dynastic Egyptian times, as revealed by a costellation of skeletal findings compatible with the syndrome in mummies dating back to 3000years ago and, most likely, in the ancient population of Pompeii. These paleogenetic and historical evidences, together with the clinical and biomolecular modern evidences, confirm the quite benign behavior of the syndrome and the critical value of the multiple and synchronous skeletal anomalies in the recognition of these rare and complex genetic disease.

Simultaneous occurrence of keratocystic odontogenic tumor and ameloblastoma in the mandible: A case report

Keratocystic odontogenic tumors (KCOTs) and ameloblastomas are benign odontogenic tumors that primarily occur in the molar region of the mandible. However, it is uncommon for these tumors to arise simultaneously in a patient's jaw. The present study reported the diagnostic process and features of a rare case of the simultaneous occurrence of KCOT and ameloblastoma in the mandible of a 45-year-old male. Image-based diagnosis was challenging due to several conditions, including the intactness of the teeth and bone cortex as well as the sizes and locations of the lesions. Based on radiographic evidence, the patient was initially misdiagnosed and underwent a biopsy for a radicular cyst and a simple bone cyst prior to the correct diagnoses of KCOT and ameloblastoma, respectively. In addition, the present study discussed the diagnostic process of the present case and reviewed previous literature regarding the simultaneous occurrence of benign tumors of the jaw.

Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family

We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.

Metastatic Basal cell carcinoma accompanying gorlin syndrome

Gorlin-Goltz syndrome or basal cell nevus syndrome is an autosomal dominant syndrome characterized by skeletal anomalies, numerous cysts observed in the jaw, and multiple basal cell carcinoma of the skin, which may be accompanied by falx cerebri calcification. Basal cell carcinoma is the most commonly skin tumor with slow clinical course and low metastatic potential. Its concomitance with Gorlin syndrome, resulting from a mutation in a tumor suppressor gene, may substantially change morbidity and mortality. A 66-year-old male patient with a history of recurrent basal cell carcinoma was presented with exophthalmus in the left eye and the lesions localized in the left lateral orbita and left zygomatic area. His physical examination revealed hearing loss, gapped teeth, highly arched palate, and frontal prominence. Left orbital mass, cystic masses at frontal and ethmoidal sinuses, and multiple pulmonary nodules were detected at CT scans. Basal cell carcinoma was diagnosed from biopsy of ethmoid sinus. Based on the clinical and typical radiological characteristics (falx cerebri calcification, bifid costa, and odontogenic cysts), the patient was diagnosed with metastatic skin basal cell carcinoma accompanied by Gorlin syndrome. Our case is a basal cell carcinoma with aggressive course accompanying a rarely seen syndrome.

Epigenetic targeting of Hedgehog pathway transcriptional output through BET bromodomain inhibition

Hedgehog signaling drives oncogenesis in several cancers and strategies targeting this pathway have been developed, most notably through inhibition of Smoothened. However, resistance to Smoothened inhibitors occurs via genetic changes of Smoothened or other downstream Hedgehog components. Here, we overcome these resistance mechanisms by modulating GLI transcription via inhibition of BET bromodomain proteins. We show the BET bromodomain protein, BRD4, regulates GLI transcription downstream of SMO and SUFU and chromatin immunoprecipitation studies reveal BRD4 directly occupies GLI1 and GLI2 promoters, with a substantial decrease in engagement of these sites upon treatment with JQ1, a small molecule inhibitor targeting BRD4. Globally, genes associated with medulloblastoma-specific GLI1 binding sites are downregulated in response to JQ1 treatment, supporting direct regulation of GLI activity by BRD4. Notably, patient- and GEMM-derived Hedgehog-driven tumors (basal cell carcinoma, medulloblastoma and atypical teratoid/rhabdoid tumor) respond to JQ1 even when harboring genetic lesions rendering them resistant to Smoothened antagonists.

Gorlin syndrome

Gorlin Syndrome, a rare genodermatosis, otherwise known as Nevoid basal cell carcinoma syndrome (NBCCS) is a multisystem disease affecting skin, nervous system, eyes, endocrine glands, and bones. It is characterized by multiple basal cell carcinomas, palmoplantar pits, jaw cysts, and bony deformities like kyphoscoliosis and frontal bossing. We would like to report a case of Gorlin syndrome with classical features, as this is a rare genodermatosis.

Ameloblastoma: a neglected criterion for nevoid basal cell carcinoma (Gorlin) syndrome

Ameloblastomas are considered to be aggressive and locally invasive neoplasms derived from odontogenic epithelium with a tendency for recurrence and bone destruction. Although the relationship between nevoid basal cell carcinoma syndrome (NBCCS) and ameloblastoma is less frequent, it might constitute a peculiar stigmata of this hereditary disorder. The objective of the current study was to evaluate whether a combined clinical and biomolecular approach could be useful for the identification of NBCCS among patients with a diagnosis of ameloblastoma. The authors collected ameloblastoma tumors recorded in the databases of the Pathology Departments of the University of Modena during the period 1991-2011. Family trees were drawn for all 41 patients affected by these specific odontogenic tumors. Two patients with ameloblastoma were also affected by multiple basal cell carcinomas and odontogenic keratocysts tumors (OKCTs) achieving the requested clinical criteria for the diagnosis of NBCCS. The clinical diagnoses were confirmed by the identification of two different novel PTCH1 germline mutations (c.2186A > T [p.K729 M]; c.931insA) in those unrelated patients. Clinical ameloblastoma findings can be used as screening for the identification of families at risk of NBCCS. Ameloblastomas diagnosis warrants the search for associated cutaneous basal cell carcinomas and other benign and malignant tumors related to NBCCS. Thus, we propose the inclusion of ameloblasoma as criterion for the identification of NBCCS.

Keratocystic odontogenic tumours of the jaws and associated pathologies: a 10-year clinicopathologic audit in a referral teaching hospital in Kenya

AIM

To establish the pattern of occurrence and the clinicopathological features of keratocystic odontogenic tumour (KCOT) over a 10-year period.

MATERIALS AND METHOD

Patients from the University of Nairobi Dental Hospital treated for KCOT were included in the study over a 10-year period. The study highlights the demographic, clinico-radiological and histological features of these tumours.

RESULTS

A total of 22 confirmed cases of KCOTs were recorded with equal gender prevalence; (M:F = 1.44:1). The age range of the patients was from 10 to 69 years with a peak in the second decade of life (mean = 27.5 yrs). Of the 22 cases, 15 (68.2%) occurred in the mandible of which eight (53.3%) involved the body, five (33.4%) the angle and ramus. Six (27.3%) occurred in the maxilla, and one (4.5%) was in both jaws and was associated with Gorlin-Goltz Syndrome. The most common presenting complaint in most patients was swelling 54.6%, and in 18.2% was incidental finding. Eight (36.4%) cases showed satellite cysts upon pathologic evaluation. Thirteen (59.1%) cases were managed by surgical excision, while nine (40.9%) were managed by enucleation.

CONCLUSION

Based on the outcome of this study, KCOT present mostly in body, angle and ramus of the mandible and its peak is in the second decade of life.

[Diagnosis and treatment management of basal cell skin carcinoma - guidelines analysis]

Basal cell carcinoma (BCC) is the most frequent skin cancer in France. BCC has above all a local evolution with an important locoregional morbidity. BCC are found in 80% in the cervicofacial region. Surgery is currently recognized to be the most reliable treatment. The surgeon needs to achieve an in sano excision and must recover the defect with the less aesthetic consequences. The aim of this work is to combine and to get-at-able the recommandations of the "Haute Autorité de santé" of 2004, and also to supply some details for the clinical practice of the plastic surgeon.

Cutaneous malignancies: melanoma and nonmelanoma types

This article reviews melanoma and nonmelanoma cutaneous malignancies.

MMP-13 expression in keratocyst odontogenic tumour associated with NBCCS and sporadic keratocysts

OBJECTIVE

To investigate the matrix metalloproteinase (MMP)-13 expression in associated and non-nevoid basal cell carcinoma syndrome (NBCCS) Odontogenic Keratocysts (OCKs) in order to contribute to a better understanding of the differences in the growth pattern between them.

MATERIALS AND METHODS

Thirty-nine paraffin-embedded blocks of OCKs, 26 sporadic OCKs and 11 NBCCS-associated KCOTs were studied by immunohistochemistry to evaluate MMP-13 expression both in epithelial and stromal layers. A semi-quantitative scale was used to evaluate immunostaining. Obtained data were compared between the two groups, using Fischer's exact test and the chi-square test.

RESULTS

Only 13 of 26 sporadic OCKs showed a positive immunostaining, whilst 11 KCOTs resulted in positive labelling for MMP-13 expression. Moreover, syndromic cysts displayed a more intense and diffuse MMP-13 labelling of the stromal tissue. Instead, in non-syndromic forms, the staining pattern of MMP-13 in stromal tissue was completely absent. Fisher's exact test showed a statistically significant greater prevalence of KCOTs-immunolabelled cysts with respect to sporadic OCKs.

CONCLUSIONS

Results from this study point out that the biological behaviour of these cysts could be related not only to the epithelial layer but also to stromal tissue in that... MMP-13 overexpression in stromal tissue of NBCCS-associated KCOTs could clarify the higher aggressiveness of these cysts.

Parental exposure to pesticides and childhood brain cancer: U.S. Atlantic coast childhood brain cancer study

BACKGROUND

The etiology of childhood brain cancer remains largely unknown. However, previous studies have yielded suggestive associations with parental pesticide use.

OBJECTIVES

We aimed to evaluate parental exposure to pesticides at home and on the job in relation to the occurrence of brain cancer in children.

METHODS

We included 526 one-to-one-matched case-control pairs. Brain cancer cases were diagnosed at < 10 years of age, and were identified from statewide cancer registries of four U.S. Atlantic Coast states. We selected controls by random digit dialing. We conducted computer-assisted telephone interviews with mothers. Using information on residential pesticide use and jobs held by fathers during the 2-year period before the child's birth, we assessed potential exposure to insecticides, herbicides, and fungicides. For each job, two raters independently classified the probability and intensity of exposure; 421 pairs were available for final analysis. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using conditional logistic regression, after adjustment for maternal education.

RESULTS

A significant risk of astrocytoma was associated with exposures to herbicides from residential use (OR = 1.9; 95% CI, 1.2-3.0). Combining parental exposures to herbicides from both residential and occupational sources, the elevated risk remained significant (OR = 1.8; 95% CI, 1.1-3.1). We observed little association with primitive neuroectodermal tumors (PNET) for any of the pesticide classes or exposure sources considered.

CONCLUSIONS

Our observation is consistent with a previous literature reporting suggestive associations between parental exposure to pesticides and risk of astrocytoma in offspring but not PNET. However, these findings should be viewed in light of limitations in exposure assessment and effective sample size.

Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas

OBJECTIVE

The objective of the study was to identify the incidence, diagnosis, and therapeutic and histological particularities of ovarian fibromas and fibrothecomas.

STUDY DESIGN

This was a retrospective study of 24 patients who underwent surgical treatment for ovarian fibromas and fibrothecomas between January 1994 and December 2006. Clinical, ultrasonographic, tumor marker, therapeutic, and histologic data were analyzed.

RESULTS

The mean age of patients was 49 years. Thirteen patients were menopausal. Ultrasonographic findings were ovarian echogenic tumor in 6 cases, hypoechogenic tumor in 12 cases, mixed tumor in 6 cases, and anechogenic tumor in 1 case. Cancer antigen-125 level measured in 21 cases was abnormal in 3 cases. Twenty-one patients underwent laparotomy. Three patients underwent laparoscopy; however, 1 was converted to laparotomy because of a suspected tumor. Histological findings were 16 fibromas and 9 fibrothecomas.

CONCLUSION

Ovarian fibromas and fibrothecomas are uncommon, accounting for 3.3% of ovarian tumors. These lesions often occur in perimenopausal and menopausal patients. Clinical, ultrasonographic, and tumor marker data remain the best preoperative approach currently available for ovarian tumors. However, the diagnosis remains histological.

Keratocystic odontogenic tumor: a 10-year retrospective study of 83 cases in an Iranian population

A retrospective analysis was conducted on patients diagnosed with and treated for keratocystic odontogenic tumor (KCOT) at Mashhad School of Dentistry between 1996 and 2006. The patients comprised 44 men and 30 women with a mean age of 27.08 years. Among the total of 83 lesions, 56 (67.5%) occurred in the mandible and 27 (32.5%) in the maxilla. Swelling tended to be the most common complaint (45.8%), while 24.1% of the lesions were diagnosed incidentally. Six patients (8.1%) with a total of 15 lesions had nevoid basal cell carcinoma syndrome; 28 lesions (33.7%) were associated with an impacted tooth, and 12 (14.5%) presented daughter cysts. Sixty-six KCOTs were treated by enucleation [5 recurrences (7.6%)], 6 by marsupialization [2 recurrences (33.3%)] and 11 by marsupialization followed by enucleation (no recurrences). KCOTs in the mandible showed a higher recurrence rate than those in the maxilla (10.7% vs 3.7%). Although the demographics of Iranian patients are closely similar to those of other nationalities, in this series KCOTs tended to develop in younger patients with a peak in teenagers. The posterior region of the mandible showed the highest likelihood of KCOT occurrence and recurrence. Marsupialization followed by enucleation resulted in the lowest recurrence rate.

[Calcification of the falx cerebri. A pathognomonic symptom of Gorlin-Goltz syndrome]

BACKGROUND

Gorlin-Goltz syndrome is an autosomal dominant disorder with variable penetration characterized primarily by keratocysts of the jaws, multiple basal cell carcinomas, skeletal abnormalities and intracranial calcifications.

METHOD

In this study, 4787 radiographs with occipitomental x-rays from the hospital archives for oral and maxillofacial surgery of the Christian Albrechts University Kiel were examined for calcifications in the area of the falx cerebri.

RESULTS

Four characteristic alterations in the falx cerebri could be assigned to four groups of structures. Those in group 4 could be found only within Gorlin-Goltz syndrome patients, and differed significantly in form and extent from the remaining three groups.

CONCLUSION

The plurilamellar appearance of this group could be rated as a pathognomonic symptom of the Gorlin-Goltz syndrome.

Radiological features in 82 patients with nevoid basal cell carcinoma (NBCC or Gorlin) syndrome

PURPOSE

Nevoid Basal Cell Carcinoma Syndrome (NBCCS) is an autosomal-dominant disorder characterized by multiple basal cell carcinomas, jaw cysts, palmar/plantar pits, calcification of the falx cerebri, and spine and rib anomalies. NBCCS is due to mutations in PTCH1, the human homologue of the Drosophila segment polarity gene patched. Mutations are detected in approximately 60% to 85% of individuals tested by sequencing of PTCH1; therefore, clinical examination and x-rays remain important in diagnosis of NBCCS.

METHODS

We studied 82 NBCCS patients and 38 of their unaffected siblings at the NIH between 1985 and 1994. Chest, rib, spine, skull, hand and foot x-rays, brain MRI or CT, and pelvic ultrasound (in females) were obtained in the affected individuals and compared to their unaffected relatives.

RESULTS

The following features were significantly more frequent in those with NBCCS: calcification of the falx cerebri, the most frequent radiological feature, was present in 79% of patients > 20 years and in 37% <20 years, calcification of the tentorium cerebellum was present in 20%, bridging of the sella in 68%, and abnormal frontal sinus aeration in 18% of affected individuals. Bifid ribs most often involving the third, fourth, and fifth ribs were seen in 26%; splayed, fused, and misshapen ribs in a further 16%, and widened ends of clavicles in 12%. Spine X-rays revealed calcification of the nuchal ligament in 18%, fusion of vertebrae in 10%, and hemivertebrae in 15%. Flame-shaped lucencies of the metacarpals and/or phalanges were present in 30%, modeling deformities of the phalanges in 14%, and polydactyly of the feet in 4%. The frequency of scoliosis, cervical ribs, absent or rudimentary ribs, spina bifida occulta, or short 4th metacarpal was not higher in the affected individuals as compared to their unaffected relatives. Except for falx calcification, the frequency of radiological manifestations was similar in different age groups. Cranial CT or MRI in 42 affected individuals revealed asymmetric or dilated ventricles in 24%, cerebral atrophy in 10%, cavum septum pellucidum in 19%, dysgenesis or agenesis of the corpus callosum in 10%, and meningioma in 5%. Ovarian fibromas were detected in 17% of females.

CONCLUSIONS

This study reports the varied radiological manifestations of NBCCS. In the absence of major features such as basal cell carcinomas, jaw cysts, or falx calcification, which is often not evident until the teen years, other radiological manifestations of the disorder can permit early diagnosis of NBCCS in childhood. This will allow optimum surveillance for medulloblastoma and other neoplasms (cardiac fibromas and basal cell carcinomas) associated with NBCCS.

Ovarian fibroma in a 7-month-old infant: a case report and review of the literature

Ovarian fibroma rarely occurs in prepubertal girls. We report an ovarian fibroma in a 7-month-old female infant presenting as a right abdominal mass. The tumour was composed of oval-to-spindle cells forming interlacing fascicles and intermingling with collagen fibres. Immunohistochemically, the tumour cells were weakly positive for estrogen receptor and progesterone receptor but negative for inhibin. To the best of our knowledge, this is the youngest case of ovarian fibroma up-to-date in the English literature. Because Gorlin's syndrome was not present in the patient's family, other factors such as germline or somatic mutations may predispose the occurrence of this ovarian fibroma in infancy.

Free Fibula Flap Mandible Reconstruction in Benign Mandibular Lesions

The mandible may be affected by a variety of pathological conditions such as ameloblastomas, odontogenic keratocysts, central giant cell granulomas, fibro-osseous lesions, and osteomas. They generally are benign, and conservative treatment can be enough in most of the cases. However, they can be clinically aggressive, and especially ameloblastomas, odontogenic keratocysts, and fibro-osseous lesions are prone to recur. The method of treatment remains a matter of controversy in these cases. The aim of this analysis was to study 100 patients who had been treated for benign mandibular lesions, and to emphasize the importance of free fibula flap in the treatment of such lesions.

Multiple familial trichoepithelioma caused by mutations in the cylindromatosis tumor suppressor gene

The recessive oncogene cylindromatosis (CYLD) mapping on 16q12-q13 is generally implicated in familial cylindromatosis, whereas a gene region for multiple familial trichoepithelioma has been assigned to 9p21. Markers from both chromosome intervals were subjected to linkage analysis in a large family with multiple hereditary trichoepithelioma (TE) from Algeria. Linkage to 9p21 was excluded, whereas CYLD remained as a candidate. Mutation analysis identified a single bp germ-line deletion expected to result in truncation or absence of the encoded protein, which segregated with the multiple TE phenotype. In individual tumors, loss of heterozygosity at 16q or a somatic point mutation in the CYLD gene was detected. Hence, mutations of the tumor suppressor gene CYLD at 16q12-q13 may give rise to familial TE indistinguishable from the phenotype assigned to 9p21.

[Ovarian fibrothecal tumors. Apropos of 12 cases]

OBJECTIVE

To identify diagnosis, therapeutic and histological particularities of ovarian fibro-thecomas.

STUDY DESIGN

A retrospective study of 12 patients who underwent surgical treatment for ovarian fibro-thecoma between January 1994 and December 1999 was reported. Clinical, ultRasonographic, tumour marker, therapeutic and histologic data were analysed.

RESULTS

Mean age of patients was 46.83 years. Three patients were in perimenopausal period and six were menopausal. Ultrasonographic findings were: ovarian echogenic tumor in six cases, hypoechogenic tumor in three cases, mixed tumor in three cases and anechogenic tumour in one case. CA 125 level measured in 11 cases was normal. Nine patients underwent laparotomy. Three patients underwent laparoscopy, however, one was converted to laparotomy due to a suspected tumour. A conservative treatment was performed for three patients and radical treatment for nine patients. Histological findings were eight fibromas and five fibro-thecomas.

CONCLUSION

Ovarian fibro-thecoma is uncommon. These lesions occur often in perimenopausal and menopausal patients. Clinical, ultrasonographic and tumour marker data remains the best preoperative approach currently available for ovarian tumours. However, the diagnosis remains histological. Tumorectomy is well indicated for young patients, however radical treatment is indicated for perimenopausal and menopausal patients.

Examine your orofacial cleft patients for Gorlin-Goltz syndrome

The Gorlin-Goltz syndrome is characterized by four primary symptoms: multiple nevoid basal cell epitheliomas that usually undergo malignant transformation; jaw keratocysts that show constant growth; skeletal anomalies; and intracranial calcifications. A myriad of additional findings may also be noted. Among the most frequent are: palmar and plantar pits, a characteristic flattened facies and broad nasal root, frontal and parietal bossing, mandibular prognathia, hypertelorism, strabismus, dystrophia of the canthi, and clefts of the lip, alveolus, and/or palate. In this study, we review the literature and our 25 cases of Gorlin-Goltz syndrome patients, questioning their incidence of cleft formations (8.5%) as compared to the general population (0.1%). It is our contention that all patients who present with an orofacial cleft warrant deeper investigation as to the presence of additional signs indicative of Gorlin-Goltz syndrome. The nevi turn malignant with time, and thus, early diagnosis, follow-up, and treatment are imperative.

Odontogenic keratocysts: review of the literature and report of a case

The odontogenic keratocyst is a common odontogenic cyst which accounts for 10% of all oral cysts. Odontogenic keratocysts are believed to arise from remnants of the dental lamina and are found in locations which may be encountered by periodontists. keratocysts have a distinctive histopathologic appearance and are known to be locally aggressive and have a high recurrence rate, thus requiring close long-term follow-up. Odontogenic keratocysts are one component of the basal cell nevus syndrome and all patients with odontogenic keratocysts should be evaluated for this syndrome. This paper reviews odontogenic keratocysts and presents a case treated by conservative enucleation and ultrasonic debridement of the cystic cavity with no evidence of recurrence at five years.

Molecular analysis of medulloblastomas occurring simultaneously in monozygotic twins

We report male monocygotic twins with concordant desmoplastic medulloblastoma diagnosed at the age of 20 months. Both tumours were completely removed. As chromosomal loci 17p13 and 9q31 are frequently altered in medulloblastoma these regions were analysed in both tumours in detail using restriction fragment length polymorphism and microsatellite analysis. No common aberration was found. The c-myc gene on chromosome 8q21 was not amplified.

CONCLUSION

Although a common genetic defect has not been found in our patients' tumours the clinical presentation supports the assumption of an inherited genetic predisposition to develop medulloblastoma in at least some cases.

Odontogenic keratocyst involving the maxillary sinus: report of two cases

The occurrence of odontogenic keratocysts in the maxilla is relatively rare, and invasion of the maxillary sinus unusual. Such cysts are normally small and unilocular. Two large keratocysts with different clinical features and radiological appearances, which had invaded the sinus, are discussed in the case reports presented here. It is suggested that if clinical signs and symptoms are absent, the radiological appearance on both conventional and panoramic radiography may be misinterpreted.

Treating nevoid basal cell carcinoma syndrome

More than 100 anomalies are associated with this syndrome. In this case, a cyst removed from a 15-year-old male was diagnosed as an odontogenic keratocyst. The long history of this syndrome with its associated problems is described.

Basal cell carcinoma of the eyelid and periocular skin

Basal cell carcinoma is the most common human malignancy. This locally invasive tumor rarely metastasizes, but can cause considerable morbidity when on the eyelids and periocular skin. The successful management of BCC requires an awareness of its broad clinical spectrum and knowledge of the risk factors associated with therapeutic failure. The optimal therapy for basal cell carcinoma is controversial. Treatment strategy is formulated on an individual basis, taking into account tumor size, anatomic location, and growth pattern. The immune status and life expectancy of the patient also must be considered. While complete eradication of the tumor is desirable, this can be challenging since basal cell carcinomas often extend beyond their apparent clinical margins. Since prevention is preferable to treatment, the public needs to be informed that the incidence of periocular skin cancers can be reduced with the longterm use of sunscreens, sunglasses, and hats with brims.

Medulloblastoma: I. Clinical, diagnostic, and therapeutic overview

Medulloblastoma, the most common embryonal tumor of the central nervous system, affects both children and adults. It poses a significant therapeutic challenge in that age-dependent differences exist, not only in their pathobiology, but in the efficacy of chemotherapy and radiotherapy. This is particularly the case in very young children, whose still developing nervous system exhibits a low tolerance to radiotherapy. We review the epidemiology, clinical presentation, radiologic features, and current therapeutic concepts relative to this unique neoplasm. Efforts are made to highlight clinical controversies.