Surgical Repair of Unidirectional Palatopharyngeal Epignathus: Case Report and Review of Literature

Epignathus is an extremely rare, benign, congenital teratoma that arises from within the oral cavity and may be attached to the mandible, palate, or base of the skull. Because of its location, it can cause airway and feeding problems, as well as secondary defects due to the presence of an intraoral tumor. This tumor usually causes death in neonates, due to airway obstruction. Surgical removal is usually impossible, especially in large tumors (Stone, 1951; Bennett, 1970).

A patient with a neonatally diagnosed nonobstructive palatopharyngeal epignathus is described. It was associated with a shortened palate, cleft uvula, and velopharyngeal insufficiency, and was successfully excised surgically.

T cell non-Hodgkin's lymphoma with colesional mucormycosis presenting as palatal perforation: a case report

Non-Hodgkin's lymphoma (NHL) is predominantly a disease of lymph nodes, but extranodal involvement is not very uncommon. Palatal involvement by NHL is rare. Mucormycosis is a devastating fungal infection commonly seen in immunocompromised individuals, including those with NHL, but it is affecting the same region has been reported very rarely. Simultaneous infiltration of hard palate by NHL and mucormycosis is extremely unusual. Herein we describe a patient who presented with palatal hole with histopathological examination revealing presence of lymphoma with colesional mucormycosis. The identification of mucor was vital because chemotherapy alone in the absence of antifungals would have had devastating consequences as the mortality of untreated mucormycosis is high.

Rehabilitation of an extraoral and intraoral defect complicated with microstomia. A study case

A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.

Granulocytic sarcoma of palate. Case report and review of literature

A rare case of granulocytic sarcoma of the hand and palate, also known as chloroma, occurring in an adolescent patient is presented. Diagnostic clinical criteria, along with treatment pictures, are also reviewed.

Bilateral cystic pulmonary glial heterotopia and palatinal teratoma causing respiratory distress in an infant

We report on a male infant with extensive, bilateral cystic and solid lung lesions who presented postnatally with respiratory distress caused by bilateral cystic lung lesions. Parenchyma-sparing resections were performed. Histology revealed the presence of neuroglial cell-lined cysts and glial nodules. In addition, a neural element containing palatinal teratoma was detected and excised. Based on previously published cases, the pathogenesis and clinical features of pulmonary neuroglial heterotopia are discussed.

Fibrolipoma associated with a mucus retention cyst in the palate: a case report

Fibrolipomas are benign mesenchymal neoplasms of the fatty tissue rarely encountered in the oral cavity. They account for around 1% to 5% of all neoplasms affecting the mouth and occur as raised, slow-growing, painless lesions of normal or yellow coloration and uncertain etiology. In contrast, mucus retention cysts are epithelium-lined cavities originated from a salivary gland. They are also raised, asymptomatic, slow-growing lesions, located on the floor of the mouth, buccal mucosa and lips. This article reports a diagnostic and a surgical treatment of a rare fibrolipoma case associated with a mucus retention cyst located in the palate.

Solitary neurofibroma of the palate. A case report

The neurofibroma is a benign tumor of neuronal origin not frequently located in the oral cavity. The possible association of this neoplasia with systemic pathologies, such as Von Recklinghausen's disease and multiple endocrine neoplasia, makes its diagnosis fundamental. The diagnosis is, in most cases, quite complex, because of the neurofibroma's strong similarities with a great number of benign neoformations of the connective tissue, of the epithelium, and of the bone. The histology represents, therefore, the fundamental diagnostic criterion, in particular, through the use of appropriate immunohistochemical analysis. This articles presents the case of a solitary neurofibroma, subtype I (common Schwann cell type), detected on the left-hand side of the posterior region of the palate in a 56-year-old woman, which presented itself as an otherwise non-symptomatic ulcerated mass. After a careful anamnesis, an incisional biopsy was performed in order to establish the histological nature of the neoformation. The immunohistochemical test, which resulted positive for S-100 and negative for the epithelial membrane antigen and keratin, allowed the diagnosis of a presumably benign lesion deriving from a neural differentiation. The surgical excision of the entire mass was accompanied by the extraction of the upper left-hand second molar, which was attached to the mass through its palatal root.

Disseminated Kaposi's sarcoma and HCV infection: only a casual relationship? A case report

The authors present a case of disseminated Kaposi's sarcoma in a male patient, HIV negative and Hepatitis C virus (HCV) positive. Although it is well-known that in HCV positive patients the onset of cutaneous diseases such as porphyria cutanea tarda, mixed essential cryoglobulinemia, lichen planus, polyarteritis nodosa, itch/prurigo, is possible, papers on its association with disseminated Kaposi's sarcoma in HIV negative patients are rare in the literature. Such an association is probably not a matter of chance: in fact, the changes to the immune system induced by the HCV virus, in synergy with those induced by the Human Herpetic virus-8, could likewise play a role in the development of Kaposi's sarcoma as happens in patients with immunodeficiency .

Haemangioma of the uvula causing loud habitual snoring--a rare entity

Mucosal haemangiomas are unusual and typically involve frequently traumatised areas such as the lip, buccal mucosa and lateral borders of the tongue. Uvular haemangioma is rare and to our knowledge, has never been reported to cause obstructive sleep apnoea (OSA). We report an unusual case of uvular haemangioma causing loud habitual snoring and symptoms suggestive of OSA. This case report illustrates a rare cause of OSA and demonstrates the efficacy of surgery for obvious obstructive lesions of the pharynx.

Epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma: Report of a case

A case of epignathus combined with cleft palate, lobulated tongue, and lingual hamartoma is reported. A newborn female presented with a large skin-covered mass arising from the palate, cleft palate, and lobulated tongue with a soybean-sized lingual lesion. The palatal and lingual masses were removed on the 9th day after birth. A cystic lesion was also found on the nasal septum after removal of the palatal mass; this lesion was resected at its base. Glossoplasty was performed after excision of the lingual lesion. Histologically, the palatal mass was diagnosed as epignathus. The cystic lesion was suspected to be meningothelial tissues on the basis of hematoxylin-eosin (HE) and immunohistochemical staining: Vimentin and epithelial membrane antigen were positive, and factor VIII was negative. The mass of the tongue dorsum was diagnosed as hamartoma. No recurrence of epignathus or evidence of meningocele have been observed after 5 years of follow up.

Palatal Neurofibroma Associated With Localized Periodontitis

BACKGROUND

Neurofibromatosis type 1 (NF1) is the most common form of neurofibromatosis. While typically considered a dermatologic disorder, intraoral signs of neurofibromatosis occur quite commonly. This clinical entity can be confused with periodontitis because of the presence of periodontal pockets. In this report, we present the case of a palatal neurofibroma with radiographic involvement in a patient with NF1.

METHODS

A 40-year-old female patient was referred from her general dentist to evaluate advanced periodontitis in the maxillary left quadrant. The patient's medical history was significant for a soft tissue lesion excised from her back 11 years previously and diagnosed as a neurofibroma. Subsequent medical examination at that time confirmed a systemic diagnosis of NF1. A comprehensive periodontal evaluation was performed, and panoramic and periapical radiographs were taken. Teeth were tested for vitality. An incisional biopsy was completed for histopathologic examination.

RESULTS

The periodontal evaluation revealed the presence of 6 to 9 mm probing depths adjacent to teeth #14 and #15. Panoramic and periapical radiographs showed a circumscribed 0.8x0.9-cm unilocular radiolucency superimposed over the root of tooth #13 and extensive horizontal bone loss on the distal side of #15. Incisional biopsy confirmed the presence of a neurofibroma, and because of the extent of the lesion, the patient was referred to the Oral and Maxillofacial Surgery service for complete excision.

CONCLUSIONS

Neurofibromas can cause extensive destruction of alveolar bone, mimicking periodontitis. Due to the potential systemic and genetic implications, the diagnosis of neurofibroma requires appropriate medical referral.

The potentially fatal vascular anomaly and orthodontic treatment--a case report

Oral vascular lesions are of clinical importance to the dental profession because they pose serious bleeding risks. A case report is presented here where a patient with a complex palatal vascular malformation was successfully treated with fixed appliances. The problems encountered during treatment are discussed.

A large pleomorphic adenoma of soft palate causing sleep apnea syndrome--a case report

Pleomorphic adenoma of soft palate is extremely rare. A large tumour in soft palate is reported with sleep apnea syndrome. Diagnosis was made by fine needle aspiration cytology and intraoperative consultation by imprint smears, which were confirmed by histopathological and immunohistochemical studies.

Human papillomavirus, type 40-associated papilloma, and concurrent Kaposi's sarcoma involving the anterior hard palate of an HIV-positive man

A number of oral lesions have been reported in association with HIV, including lesions caused by other viruses such as the epitheliotropic human papillomavirus (HPV). More than 90 types of HPV have been identified, with the less commonly encountered strains of HPV tending to show association with immunodeficiency states. In addition, HIV-infected patients may have Kaposi's sarcoma develop, a malignancy thought to be caused by human herpes virus, type 8. Recent evidence suggests a sexual mode of transmission for this virus. We report an HIV-positive man with a large, HPV type 40-associated papilloma of the anterior palate and a previously undiagnosed focus of Kaposi's sarcoma.

Von Recklinghausen neurofibromatosis with palatal localization. Diagnostic and surgical problems in two clinical cases

This paper illustrates the clinical findings and aims at report surgical matters observed in 2 patients affected by neurofibromatosis type I with a rare palatal localization. By means of retrospective analysis 2 cases of neurofibromatosis type I with a palatal mass are selected. Both cases were surgically treated and underwent 12 months follow-up. Patients underwent surgical removal of the palatal neurofibroma. At 12 months follow-up a good local condition without any recurrence was observed. Malignant transformation was very rarely reported in oral neurofibromata and can follow incomplete removal. Surgical treatment of neurofibromata requires the sacrifice of the nerve trunk from where they originate, together with the complete removal of the mass with security margins. Therefore, risks and benefits from surgery should be carefully weighted in each patient and where surgery is not performed clinical and radiographic trials are advisable.

Impacted supernumerary tooth developed under palatal polyp

We present a rare case of an infant's palatal polyp associated with an impacted supernumerary tooth. We have previously reported three cases of palatal polyps in infants [1]. In one case, after surgical removal of the palatal polyp at the age of 1 year and 8 months, the lesion subsequently began swelling. A periapical radiograph at the age of 2 years and 9 months revealed a small calcified mass in the maxillary left incisor region. The swelling was kept under observation, the calcified mass developed gradually and was removed surgically at the age of 5 years and 5 months. The removed calcified mass was clinically diagnosed as an impacted supernumerary tooth and this was confirmed histologically. Histological findings did not indicate any relationship between the palatal polyp and the impacted supernumerary tooth.

[Rare palate tumors: treatment and results]

8 patients (7 male and 1 female) treated between 1991-1998 in Szczecin centre due to the tumours different than carcinoma planoepithelial of the palate were presented. Their age ranged from 30 to 81 years. The dimension of the tumour ranged from 1 to 5 cm. The diagnosis of those tumours was: adenoid cystic carcinoma--2 cases, rare (unnamed) tumour of low malignancy probably of salivary gland origin--1 case, cystis lined with cylindrical epithelium--1 case. 7/8 patients were treated by surgery and in 3 cases RTG therapy followed surgery. One patient refused the treatment. 6/8 patients are alive. One patient died 2 years after surgery. There is no information about the one, who wasn't operated on. 3 patients remain without complains. 3 developed rhinolalia aperta and one from them (following RTG therapy) complain of dryness in the oral cavity. None from the operated on reports any swallowing problems.

Lipoma of the cleft soft palate: a case report of a rare congenital anomaly

OBJECTIVE

Congenital tumors of the oral cavity are extremely uncommon. The teratoid tumors (epiganthi, dermoid, and hairy polyps) account for almost all of the reported cases and are not infrequently associated with cleft of the soft palate. Of the remaining tumors in the pediatric cleft palate population, infantile lipoma of the oral cavity is exceedingly rare. A case of a congenital lipoma associated with a cleft of the soft palate is presented. The review of the literature, the description of the lesion, the diagnosis, and the management of this finding are outlined.

Aicardi syndrome associated with palatal hemangioma

An 1-day-old female newborn who had typical clinical features of Aicardi syndrome, such as agenesis of the corpus callosum, ocular abnormalities and infantile spasm associated with a palatal hemangioma is reported. The intraoral mass, which occluded incompletely the oropharynx and right side of the nasopharynx, was partially excised under general anesthesia. This is the first reported patient with Aicardi syndrome with palatal hemangioma, according to the med-line search.

Duplication of pituitary gland

We present a case of duplication of the pituitary gland with associated clefts of the hard palate and body of the sphenoid and a midline palatine dermoid. This is an extremely rare malformation with only six previous case reports in the literature. Imaging findings are discussed and literature reviewed for possible morphogenesis, including its association with partial twinning and midline cleft face syndrome.

Atypical palatal ulceration

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Successful treatment of concomitant acute myeloblastic leukaemia and adenoid cystic carcinoma of the palate

The case of a 55-year old man who was affected simultaneously by acute myeloblastic leukaemia (AML) and adenoid cystic carcinoma of the palate is reported. The carcinoma was removed after induction chemotherapy for AML and the patient subjected to consolidation therapy. No reports are evident of other cases in which acute leukaemia and other malignancies were treated simultaneously, and in which the patient was cured of both. It is suggested that this case may serve as a reference for future similar cases.

[Garcin syndrome. Clinical aspects and diagnosis of a rare cranial nerve syndrome with special reference to computerized tomography and nuclear magnetic resonance image findings]

Garcin syndrome is an ipsilateral step-by-step deterioration of all 12 brain cranial nerves, first described in 1927. The underlying cause is usually a sarcoma or carcinoma of the skull base. The pathogenesis of the Garcin syndrome is chiefly determined by the slow localized growth of these tumors, rather than by their histology and primary localisation. The prognosis is as a rule unfavourable. The findings on computed and magnetic resonance tomography are important for an early diagnosis. Two cases of Garcin syndrome are reported, one of which was probably due to a tonsillar carcinoma, while the other was caused by a mucinous adenocarcinoma of the nasopharynx.

Squamous cell carcinoma of the maxillary sinus and palate in epidermolysis bullosa: CT demonstration

Extracutaneous squamous cell carcinoma is an unusual complication of epidermolysis bullosa (EB). We present a patient with long-standing EB who developed squamous cell carcinoma involving the palate and the maxillary sinus, and we describe the findings on CT.

Mature presacral sacrococcygeal teratoma associated with a sacral "epignathus"

We report an example of sacrococcygeal teratoma presenting as a "supernumerary limb" in the left gluteal area with a rudimentary hemipelvis, femur, tibia, fibula, and tarsal bones. This monocephalus tripus dibrachius-appearing complex with associated with a deep seated but separate pararectal mature teratoma. This combination of a well-developed external limb with a deep but separate teratoma has been described.

Squamous cell carcinoma as a cause of dyspnea and blindness in a horse

An 8-year-old Quarter Horse mare was examined for chronic nasal discharge and obstruction of both nasal passages. A solid mass lesion was identified in the maxillary sinuses, soft palate, nasal and pharyngeal cavities. Palliative surgery was used to debulk the lesion and facilitate nasal airflow. Squamous cell carcinoma was diagnosed from surgical biopsies. Approximately 7-8 weeks after surgery, the mare was observed to be acutely blind. Ophthalmologic examination revealed central origin blindness and active retinitis. The squamous cell carcinoma had reobstructed the nasal passages. Pressure by the expanding tumor deformed the ethmoid and sphenoid bones resulting in compression of the optic tracts. No bony invasion by the tumor was present.

[Synchronous association of carcinoma of the superior aerodigestive ways and lymph node metastasis of papillary adenocarcinoma of the thyroid: presentation of 6 cases]

Six cases are reported of an unusual synchronous association between aerodigestive squamous cell carcinoma and papillary carcinoma of the thyroid. Six males (47-62 years) were observed until 1975 at the Department of Head and Neck Surgical Oncology of the Istituto Nazionale Tumori, Milan. All were affected by aerodigestive cancer: oral cavity (1), pyriform sinuses (1), larynx (2), lip (1) and oropharynx (1). Clinical examination of the thyroid was always negative. For this reason they underwent surgery, complete surgical approach to aerodigestive neoplasm; one hemithyroidectomy and one total thyroidectomy were also performed. Unexpectedly pathological examination of the dissected lymph nodes indicated the presence of metastases of papillary carcinoma of the thyroid. Three of the six cases had only metastases of thyroid papillary carcinoma while the others presented both squamous cell and papillary carcinoma metastases. Excluding the 2 patients who had undergone thyroid surgery during aerodigestive cancer therapy, in 3 of the 6 patients, two total thyroidectomies and one hemithyroidectomy were performed after the metastases were discovered. In all cases, primary thyroid cancers were demonstrated. One patient did not undergo any subsequent surgery on the thyroid gland because of negative thyroid scanning and bad prognosis due to aerodigestive cancer. Two of the 6 patients died of aerodigestive cancer at 54 and 34 months, 2 are still alive and free of both diseases while one was lost after a 43 month follow-up.

A squamous cell papilloma as a cause of dysphagia and vomiting

Squamous cell papillomas occur relatively commonly intra-orally. Patients are usually unaware of their presence. A case is described of a squamous cell papilloma arising from the uvula, which presented as an unusual cause of dysphagia and vomiting.

Sinus histiocytosis with massive lymphadenopathy and malignant lymphoma. An unreported association

Sinus histiocytosis with massive lymphadenopathy is a benign disorder often characterized by spontaneous remission. Although immunologic abnormalities are common and high Epstein Barr virus titers have been reported, to date no case has been associated with malignant lymphoma. The authors report here the first case of this association.

Parapharyngeal mass presenting with sleep apnoea

A 60-year-old man presented with a history of progressive sleep disturbance due to an intraoral parapharyngeal salivary gland tumour. The sleep study performed post-operatively showed rapid resolution of nocturnal hypoxic episodes. This appears to be the first recorded case of a parapharyngeal mass causing sleep apnoea and we review the current literature on obstructive sleep apnoea.

Bilateral hypoglossal palsies: a late complication of curative radiotherapy

A 57 year old man developed bilateral hypoglossal nerve palsies 6 years after radiotherapy for carcinoma of the uvula. Follow-up over 2 years has demonstrated no evidence of tumour recurrence and no sign of neurological improvement. Reactive fibrosis and vascular insufficiency secondary to radiation and may have lead to hypoglossal nerve compression and infarction.

Infantile vomiting due to a disappearing hairy polyp

Infantile vomiting can occur from many causes. A mass in the nasopharynx is an obscure reason for emesis. Maternal detection of an intermittently visible mass secured a diagnosis that had eluded observation, even after the patient had been hospitalized. "Hairy polyp" has received almost no attention in the Pediatrics literature. This report is both for information about the unusual tumor and for reaffirmation of the value of parental observation.

Orbital inflammatory pseudotumor associated with multifocal systemic neoplastic immunoincompetence

A 52-year-old man developed proptosis from an orbital mass which was documented histopathologically to be an inflammatory orbital pseudotumor. When the lesion failed to resolve after six months of adrenocorticosteroid treatment, a second biopsy showed an inflammatory mass with nests of eosinophilic granuloma. The patient soon developed a lymphoma of the soft palate and a glioblastoma multiforme which led to the patient's rapid demise. Eosinophilic granuloma is known to represent the more benign end of the spectrum of histiocytic disorders in which a proliferation of Langerhans' cells and an abnormality of T-suppressor cells occur. Our case represents the first report of multifocal tumor immunoincompetence occurring with eosinophilic granuloma in an orbital inflammatory pseudotumor.

Amyloid tumor of the spleen

An unusual case of amyloid tumor of the spleen that developed in a patient with malignant lymphoma is reported. A splenectomy performed for a persistent splenic lesion after an otherwise complete response to chemotherapy revealed the amyloid tumor. To our knowledge, amyloid tumor has not been previously described in the spleen.

Massive oropharyngeal papillomatosis causing obstructive sleep apnea in a child

Obstructive sleep apnea in children is most often secondary to severe adenotonsillar hypertrophy. A 5 1/2-year-old boy presented with loud snoring, increasing dysphagia, nocturnal choking, and apnea. Extensive papillomatosis of the uvula, soft palate, and nasopharynx was found to be causing the obstruction. Although multiple papillomas of the larynx and tracheobronchial tree are well known, the occurrence of extensive papillomas of the oral cavity is rare. The unusual clinical presentation and pathologic significance are discussed.

Carcinoma of maxillary sinus, palate and maxillary gingiva: occurrence of jaw destruction

A comparison was made between the frequency of alveolar bone-palate destruction caused by carcinomas originating in the maxillary sinus (31 patients), palate (15) and maxillary gingiva (9). Radiographic examination included conventional sinus projections, supplemented with hypocycloid tomography (47), computed tomography (28) and orthopantomography (11). Almost every second tumor presenting with alveolar bone involvement appeared to be a maxillary sinus cancer. Gingival and palatal cancers also caused frequent bone destruction. Radiographic examination, including tomography, was of great value in demonstrating the extent of these tumors. Three cases clinically diagnosed as gingival cancers proved to originate in the maxillary sinus.

Kaposi's sarcoma in a patient with acquired immune deficiency syndrome

A case of Kaposi's sarcoma, which first appeared as an erythematous oral lesion, in a patient with AIDS is presented. Current concepts regarding these disease entities are reviewed, and recommendations for protection of personnel when providing care for AIDS patients are outlined.

Pityriasis rotunda. A cutaneous sign of malignant disease in two patients

The term pityriasis rotunda refers to strikingly circular scaly lesions, with the histologic appearance of ichthyosis vulgaris. Pityriasis rotunda has been described in the Japanese, South African blacks, and West Indian blacks. The condition occurs only in association with certain serious systemic illnesses, usually tuberculosis, or malignant neoplasms or less severe diseases of the female genital tract (eg, fibroids, ovarian cyst). We describe two South African blacks with pityriasis rotunda and neoplasms. The cutaneous lesions cleared when the primary neoplasm was treated.

Hematologic malignancies occurring in patients with urticaria pigmentosa

Six patients had hematologic malignancies and coincident urticaria pigmentosa, five with the disseminated maculopapular form and one with the plaque form. Two patients had the juvenile-onset variety; the remainder had the adult eruptive variety. None of the patients complained of symptoms that could be attributed to liberation of histamine. In the two patients with juvenile-onset urticaria pigmentosa, the hematologic malignancies developed at the age of 17 years; one had Hodgkin's disease, and the other had acute myelomonocytic leukemia. In three patients with adult eruptive urticaria pigmentosa, the cutaneous lesions developed within 12 months of the diagnoses of lymphocytic lymphoma (two patients) and evolving myelomonocytic leukemia (one patient). In the remaining patient, cutaneous lesions developed many years before chronic lymphocytic leukemia was diagnosed. None of the patients had systemic mastocytosis. Skin biopsy specimens from all six patients showed an increase in dermal and perivascular round cells, and mast cells were seen in specimens from five of the six patients. In patients who received cytotoxic drugs for the hematologic malignancy, there was no change in the urticaria pigmentosa.

Adenocarcinoma of the palate associated with nephrotic syndrome and epimembranous carcinoembryonic antigen deposition

A 42-year-old male presented with adenocarcinoma of the palate and nephrotic syndrome. Renal biopsy demonstrated membranous glomerulopathy in which carcinoembryonic antigen was demonstrated. Carcinoembryonic antigen was also found in the palatal tumor. This is the first instance of this association with this particular tumor.

Central nervous system heterotopia in association with cleft palate

A case of central nervous system heterotopia, in association with a unique cleft palate deformity, is presented and discussed. Only two cases of such palatal lesions in association with cleft palates have been previously reported. The subject of pharyngeal and palatal central nervous system heterotopia is reviewed, and hypotheses to account for their clinical behavior are presented.

Epignathus with placental hydrops

A stillborn male infant with massive epignathus showed placental enlargement, hydramnios, and hydrops. These changes are thought to be due to cardiac decompensation from circulation of the large vascular tumor mass. Y bodies present in the tumor suggest a mitotic origin for epignathi from host cells.