Association of inflammatory pseudotumor of the liver and Papillon-Lefevre syndrome--case report

Subsiding of Periodontitis in the Permanent Dentition in Individuals with Papillon-Lefèvre Syndrome through Specific Periodontal Treatment: A Systematic Review

Papillon-Lefèvre syndrome (PLS) is a rare hereditary disease characterized by palmoplantar hyperkeratosis (PPK) and periodontitis in the primary and permanent dentition, usually resulting in edentulism in youth. Subsiding of PLS-associated periodontitis through specific therapy has occasionally been reported. We aimed to systematically assess periodontal treatment strategies that may decelerate disease progression. A systematic literature search was conducted at PubMed/LIVIVO/Ovid (Prospero registration number CRD42021223253). Clinical studies describing periodontal treatment success-defined as loss of ≤four permanent teeth because of periodontitis and the arrest of periodontitis or probing depths ≤ 5 mm-in individuals with PLS followed up for ≥24 months. Out of the 444 primarily identified studies, 12 studies reporting nine individuals were included. The timely extraction of affected or, alternatively, all primary teeth, compliance with oral hygiene instructions, supra- and subgingival debridement within frequent supportive periodontal care intervals, and-in eight patients-adjunctive systemic antibiotic therapy (mostly amoxicillin/metronidazole) effected a halt in disease progression. The suppression of Aggregatibacter actinomycetemcomitans below the detection limit was correlated with the subsiding of periodontitis. Successful controlling of PLS-associated periodontitis may be achieved if high effort and patient compliance are provided.

Inflammatory myofibroblastic tumour of the jaw: A rare presentation

Inflammatory Myofibroblastic Tumour (IMT) is a rare entity of unknown aetiology and pathogenesis. It was initially described in the lung, although there have been reported cases affecting extra-pulmonary sites. The aetiology of IMT remains unclear, with current evidence suggesting that IMTs are neoplastic processes resulting from chromosomal translocations that often cause an overexpression of ALK tyrosine kinase. Histologically, a variably cellular myxoid morphology is common in these tumours, with the presence of inflammatory cell infiltrate. Clinically, symptoms are non-specific, although the presence of a swelling is frequently reported. Imaging studies are not very useful in the diagnosis, as they only describe the presence of a mass, and do not provide a definitive diagnosis. This article presents a case, of Inflammatory Myofibroblastic Tumour of the jaw, in a male patient aged 16 years.

Oral inflammatory myofibroblastic tumor: case report and review of literature

Inflammatory myofibroblastic tumor (IMT) is a rarely described tumor of unknown etiology and pathogenesis. It occurs primarily in the lungs, but has occurred in other extra-pulmonary sites. Histologically these lesions appear as an inflammatory infiltrate within a variably myofibrotic background. Current evidence shows that inflammatory myofibroblastic tumors are neoplastic processes resulting from chromosomal translocations that often cause an overexpression of ALK kinase, which is often assessed using immunohistochemical studies. Currently, the biological behavior of oral inflammatory myofibroblastic tumor is still uncertain. This article describes the clinical, histological, and operative features of a case of IMT of the oral cavity.

A case of Papillon-Lefevre syndrome associated with xanthogranulomatous pyelonephritis and hepatitis

Papillon-Lefevre syndrome (PLS) is an autosomally recessive palmoplantar keratoderma accompanied by psoriasiform plaques on the extensor surfaces of extremities and leading to premature loss of deciduous and permanent teeth by progressive periodontitis. Patients with PLS may exhibit mental retardation, intracranial ectopic calcifications, nail dystrophies and a tendency to various infectious disorders, in addition to skin and oral findings. Herein, we report a 26-year-old man with PLS, who had experienced xanthogranulomatous pyelonephritis and hepatitis during childhood and adolescence. To the best of our knowledge, this is the first report of PLS associated with xanthogranulomatous inflammation.

Inflammatory pseudotumor of the liver associated with malignant disease: report of two cases and a review of the literature

Two cases of inflammatory pseudotumor (IPT) of the liver associated with gastrointestinal tract cancer are reported. In addition, the etiological correlation between IPT and abscesses of the liver in cancer patients is discussed. The first patient was a 63-year-old woman who underwent distal gastrectomy and partial hepatectomy under a diagnosis of stomach cancer with liver metastasis. The second patient was a 66-year-old man who had undergone surgery for rectal cancer 6 years previously and underwent partial hepatectomy under a diagnosis of metastasis of rectal cancer to the liver. The gastric cancer was a papillary adenocarcinoma limited to the mucosa, and the rectal cancer was a moderately differentiated adenocarcinoma limited to the subserosa. The resected liver tumor in the first case measured 5.5 x 5.0 x 4.0 cm and was 2.5 x 1.9 x 1.6 cm in the second. The cut surface showed that both masses were well circumscribed and divided into lobules by fibrous tissue. They were yellowish white in color and there was no evidence of necrosis or hemorrhage. Histologically the masses consisted of fibrous areas and cellular areas, and the cellular areas consisted of fascicles of plump spindle cells mingled with varying numbers of plasma cells, lymphocytes, and histiocytes. The masses were diagnosed as IPTs. Obliterating phlebitis suggesting infection via the portal vein was seen in the adjacent liver tissue in both cases. According to previous cases reported in the literature, there are three types of cancers associated with hepatic IPT: gastrointestinal tract cancer, biliary tract cancer, and cancers that need strong systemic chemotherapy. The underlying cancer types of IPT of the liver are almost similar to those associated with pyogenic liver abscesses suggesting the etiological correlation between IPT and abscesses of the liver.

Abdominal inflammatory masses mimicking neoplasia in children-experience of two centers

Despite progress in modern imaging, some inflammatory masses are difficult to distinguish clinically from neoplastic processes. In such cases the pathology report has a great distinctive value, but even then the final diagnosis may be difficult to reach. Eight patients with abdominal tumors of inflammatory origin were treated in two institutions, the Department of Pediatric Surgery of the Medical University of Gdansk, Poland, and Helios Center of Pediatric Surgery in Berlin, Germany, during the last 10 years. Four tumors were located in the pelvis, two in the liver, and two in the colonic mesentery. Five of them were inflammatory pseudotumors (two subclassified as inflammatory fibrosarcoma), one had nonspecific inflammatory changes, one was diagnosed as idiopathic retroperitoneal fibrosis, and one was diagnosed as bacillary angiomatosis. All patients underwent surgical tumor biopsy, excisional in four and incisional in four. All but two children underwent macroscopically complete tumor excision (four primarily, two secondarily). In one case the tumor resolved with antibiotherapy. Surgery in retroperitoneal masses was often extensive and associated with significant complications because of invasive tumor growth. In conclusion, intraabdominal inflammatory lesions may closely mimic neoplasia in children. Clinical doubts result in repeated biopsies, and for this reason excisional biopsy should be preferred. In some cases, when excisional biopsy is not feasible due to invasive growth of the tumor, delayed complete mass excision should follow, despite occasional significant morbidity. The etiology and exact nature of inflammatory pseudotumors are still obscure, and it is unknown whether they represent inflammatory lesions or true neoplasia.

Dermatologic and oral findings in a cohort of 47 patients with Papillon-Lefèvre syndrome

Papillon-Lefèvre syndrome is an autosomal recessive disorder characterized by palmoplantar hyperkeratosis and early development of aggressive periodontal infection. The aims of this study were to rank the severity of dermatologic and oral affections using a semiquantitative scoring system, and to evaluate whether the severity of the dermatologic changes were correlated to age, degree of periodontal infection, or both. The study included 47 patients with Papillon-Lefèvre syndrome. With no exception both skin and oral changes developed early in life. The dermatologic involvement showed no correlation with age, whereas the periodontal infection was significantly worse in young children with deciduous teeth. A strong correlation was found between the condition of feet and hands, although the scores for the feet were significantly higher. No significant correlation could be demonstrated between the level of periodontal infection and severity of skin affections, supporting the concept that these 2 major components of Papillon-Lefèvre syndrome are unrelated to each other.

Papillon-Lefèvre syndrome: mutations and polymorphisms in the cathepsin C gene

The Papillon-Lefèvre syndrome, inherited in an autosomal recessive pattern, manifests with palmoplantar keratoderma and early, destructive periodontitis. Recently, mutations in the gene encoding cathepsin C have been disclosed in a limited number of families with Papillon-Lefèvre syndrome. We have examined two multiplex families with Papillon-Lefèvre syndrome, and evaluated the gene encoding cathepsin C for mutations. The mutation detection strategy consisted of polymerase chain reaction amplification of all seven exons and flanking intronic sequences, followed by direct nucleotide sequencing. This strategy identified two missense mutations, W39S and G301S, affecting highly conserved amino acid residues within the cathepsin C polypeptide. The affected individuals were homozygotes whereas heterozygous carriers of the mutations were clinically unaffected, confirming the recessive nature of the mutations. Addition of these cathepsin C gene mutations into the expanding Papillon-Lefèvre syndrome mutation database allows further development of genotype/phenotype correlations towards understanding this severe genodermatosis.