Misdiagnosed long-standing unilateral nasal obstruction: ossifying fibroma of the inferior turbinate

A man in his 20s presented with complaints of unilateral nasal obstruction for the past 6 years that progressively worsened leading to irrational use of over-the-counter nasal decongestants. With the worsening of symptoms, a non-contrast CT was done. It showed a dense expansile sclerotic lesion of the right inferior turbinate, which was excised endoscopically. Cemento-ossifying fibromas of the inferior turbinate are rare and require assessment and surgical excision to relieve the symptom of nasal obstruction. It derives its name from the variable proportions of fibrous and mineralised tissue present in it and exclusively develops in the craniofacial region. It can be surgically managed by an endoscopic, an endonasal non-endoscopic (with a speculum) or an open approach (lateral rhinotomy, sublabial approach or mid-facial degloving). Here, we present how such a case was detected and managed surgically by the endoscopic approach, which is a minimally invasive option with shorter hospital stay and early recovery.

Kaposiform hemangioendothelioma of skull base with dura invasion in a pediatric patient: a case report

Kaposiform hemangioendothelioma is an extremely rare vascular tumor which shows aggressive local growth. We present a case of rapid growing vascular skull tumor with dura invasion in a pediatric patient with neurofibromatosis type 1. A 14-year-old male complained of headache and dizziness for 1 month after minor head trauma. Brain magnetic resonance imaging (MRI) revealed a 5-cm-sized tumor in the left frontotemporal bone with internal hemorrhage and cystic changes. The gross total resection of tumor was done. At the 7-month follow-up, brain MRI revealed a recurrent skull tumor with intracranial dura mass. He underwent second surgery, and the pathologic diagnosis was suggestive of Kaposiform hemangioendothelioma. For this vascular proliferative tumor, mTOR inhibitor was treated for 6 months, and there was the recurred nodular-enhancing mass along the sphenoid ridge. After additional 2 months of medication, the following MRI revealed a decreased nodular-enhancing mass.

Genomic Profiling of the Craniofacial Ossifying Fibroma by Next-Generation Sequencing

BACKGROUND

Ossifying fibroma (OF) of the craniofacial skeleton is a fibro-osseous lesion characterized by various patterns of bone formation in a cellular fibroblastic stroma. The molecular landscape of OF remains mostly unknown. There are a few known pathogenic abnormalities in OF, including HRPT2 mutations in conventional OF and SATB2 translocations in juvenile psammomatoid OF. On the other hand, conflicting reports exist regarding MDM2 gene amplification and chromosomal copy number alterations (CNA) in OF.

METHODS

Surgically removed biopsies and curettage specimens from OF patients were obtained. Clinical, radiographic, and pathologic features of tumors were reviewed. Genomic DNA was extracted from formalin-fixed, paraffin-embedded blocks of tumor tissue. Capture-based DNA next-generation sequencing targeting the coding regions 529 cancer genes and select introns was performed.

RESULTS

We identified 17 OF cases from 8 male and 8 female patients with mean age of 22 years (range 1-58 years). Nine case occurred in the gnathic bones and 8 in the extragnathic craniofacial bones. These cases included 3 juvenile psammomatoid OF, 6 conventional OF and 8 juvenile trabecular OF. Large-scale CNAs were present in 6 of 17 cases. Seven cases (41%) had focal amplifications including FOSB (n = 2, 11%), FOS (n = 4, 23%), COL1A1 (n = 4, 23%) and TBX3 (n = 5, 29%). Three cases (17%) had pathogenic CDC73 mutations. No cases showed focal MDM2 amplification.

CONCLUSIONS

Here, we provided a comprehensive molecular characterization of OF that reveals a heterogeneous genetic profile with occasional large-scale CNAs (n = 6, 35%). FOS, FOSB, and TBX3 genes that regulate AP-1 transcriptional complex are frequently altered in OF (n = 7, 41%), chiefly in juvenile trabecular OF. These genes encode transcription factors that act as downstream effectors of the MAP kinase signaling pathway. MDM2 amplification is an exceedingly rare event in OF, if present at all, so identification of this event should continue to raise concern for low-grade gnathic osteosarcoma. In summary, our findings suggest that OF represents a heterogeneous group of tumors at the genetic level but dysregulation of the AP-1 pathway may play a role in pathogenesis of juvenile trabecular OF.

Sul Trattamento Radioterapico delle Metastasi Craniche da Carcinoma del Collo Uterino

Two cases of cranial metastases from a uterine carcinoma are described. In one case there was a large and very precocious metastatic diffusion to the skeleton, in the other case the bone metastases appeared after 5 years since the clinical recovery of the primary lesion. The X-rays treatment exerted a prolonged delay in the further metastic diffusion.

Neurofibromatosis of von Recklinghausen with Wide Cutaneous, Skeletal and Visceral Involvement

A case of von Recklinghausen's neurofibromatosis, hospitalized for progressive anemia, secondary to chronic hemorrhage from the digestive tract, is reported. The imponent involvement of the skin (innumerable nodules of different size and volume), skeleton (marked cifoskoliosis giving a monstruous aspect to the patient) and visceral organs (multiple localizations of the digestive and urinary tract) is illustrated. A functional study of endocrine system suggested by a marked somatic hypoevolutism and right testis retention failed to show any pathological change.

[Inflammatory myofibroblastic tumor of the temporal bone with case report and literature review]

OBJECTIVE

To study the clinical presentation, imaging characteristics, intraoperative findings, and histopathologic features of inflammatory myofibroblastic tumor of the temporal bone.

METHOD

The clinical information of 1 case was reported and the literatures were also reviewed. The specimens were prepared for immunohistochemical staining and light microscopy.

RESULT

The lesions were locally aggressive with extensive bony erosion. Histologically, the tumor was composed of spindle cells and large number of chronic inflammatory cells. Immunohistochemical stains demonstrated Vimentin, SMA and CD68 were positive meanwhile S-100 and CK were negative.

CONCLUSION

Inflammatory myofibroblastic tumor of the temporal bone are rare lesions with a potential of local recurrence. Therapy should consists of surgical excision with steroids reserved for residual or intracranial disease or in patients in whom surgery is not an option.

[Pituitary tumors]

Pituitary adenomas have been reported to be the most common benign intracranial neoplasms. Recent radiological advancement has resulted in incidental diagnosis of pituitary tumors such as pituitary adenomas and Rathke's cleft cysts. The most common location of pituitary adenomas is intrasellar region with or without suprasellar extension. Pituitary tumors in unusual site, however, have been reported previously, including the sphenoid sinus, suprasellar region, clivus, nasal cavity, or something like that. The sources of ectopic pituitary tumors have been thought to be migration of pituitary cells in pituitary adenomas and of squamous epithelial cell remnants of the obliterated craniopharyngeal canal in craniopharyngiomas. We describe ectopic pituitary tumors and recent knowledge of etiology and pathology of pituitary tumors. Furthermore, we mention recent advancement of endonasal transsphenoidal surgery to treat pituitary tumors.

Monstrous skull osteomas in a probable Gardner's syndrome: case report

BACKGROUND

Gardner's syndrome includes a clinical triad of familial polyposis coli, osteomas, and soft tissue tumors.

METHODS

We present a very unusual case of probable isolated Gardner's syndrome characterized by extremely voluminous osteomas in the occipital and frontal areas associated with diffuse subcutaneous lipomas and without colic abnormality.

RESULTS

The neurosurgical management included resection of the osteomas for cosmetic reasons. After a follow-up period of 5 years, the patient remains free of digestive complaints and the resected osteomas did not recur.

CONCLUSIONS

The special clinical presentation of our case of possible Gardner's syndrome is discussed.

DIMETHYL MYLERAN THERAPY COMBINED WITH ABDOMINAL AORTIC OCCLUSION

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Dentigerous cysts in animals

This article is a review of the literature on dentigerous cysts in animals. Three different lesions have been referred to in the veterinary literature as dentigerous cysts. The first of these cysts, similar to those that occur in human beings, is extremely rare. The second lesion, an odontogenic cyst located in the anterior mandibles of mature sheep, is quite common in New Zealand and parts of Britain. The third is actually a teratoma that contains teeth and is found in the temporal region of young horses; it is also rare.

Maxillary ameloblastoma: case report

Ameloblastoma of the maxilla is an unusual epithelial tumor of odontogenic origin. Although it is considered benign, it can behave in a slowly growing infiltrative fashion, with multiple recurrences and eventual intracranial, or even distant, spread. Information on this tumor consists, to a large extent, of case reports presented in the oral surgery literature. This study is a retrospective review of our combined institutional experience with nasomaxillary tumors from 1980 to 1988. Among these cases were four patients with maxillary ameloblastoma, two males and two females, ranging in age from 16 to 66 years at presentation. Disease extent varied from ameloblastoma localized to a cyst in the maxillary sinus to extensive maxillary and ethmoid involvement. Follow-up ranged from 2 to 13 years, and disease course varied from apparent disease control to persistent intracranial tumor, despite attempts at extirpation. An analysis of this experience and the related literature is presented, along with recommendations for radical therapy, when appropriate, to best ensure control.

Extracranial skull base chondrosarcoma

Chondrosarcoma of the skull base is a rare neoplasm. The most common presenting symptoms are hoarseness, dysphagia, and diplopia, which is associated with palsies of cranial nerves X, IX, and VI. The temporal bone is the most common site of tumor origin, followed by the sphenoid bone. These tumors must be differentiated from chordoma, chondroid chordoma, osteogenic sarcoma, enchondroma, and meningioma. Diagnosis is made by patient history, radiologic imaging, and biopsy. The treatment is surgical excision followed by radiation therapy. Five-year survival rates for grades I, II, and III are 90, 81, and 43%, respectively.

[Metastatic malignant lymphoma of the skull with extradural and extracranial extension. Case report]

A 72-year-old male was hospitalized because of a steadily growing mass (4 x 4 x 2 cm) in the frontal region, noticed following head injury. Six months earlier, he had declined treatment for malignant lymphoma (small non-cleaved cell type), discovered upon evaluation of a subcutaneous mass in his forearm. Neurological examination on admission was negative. Plain skull films revealed a large, osteolytic lesion with an irregular margin. Bone scintigraphy disclosed no uptake other than in the frontal bone. Computed tomography (CT) showed a large, homogeneously enhanced mass with both extradural and extracranial extension, which had destroyed the left frontal bone. The skull tumor was totally resected, and the diagnosis was malignant lymphoma, large cell, immunoblastic and plasmacytoid type. Postoperative combined chemotherapy with vincristine, cyclophosphamide, prednisolone, and adriamycin resulted in the complete disappearance of liver metastases. The patient was readmitted 2 months later, however, because of headache and gradually progressive impairment of consciousness. A CT scan disclosed brain metastasis in the paraventricular region. Radiation therapy (20 Gy) was administered but no further treatment was given. Skull metastasis is not uncommon in cases of malignant lymphoma, but a large mass with both extradural and extracranial extension is rare. Although aggressive chemotherapy was effective, prophylactic irradiation of the brain should have been considered in this case.

Invasive basal cell carcinoma of the temporal bone

Basal cell carcinomas involving the ear represent a spectrum of diseases, from a small superficial auricular lesion to an advanced destructive malignancy invading the temporal bone. The biologic activity of the morphea-form basal cell carcinoma variant of tumor and a postauricular location predispose to an aggressive biologic pattern. Management requires a thorough evaluation with determination of the degree of cranial and possible intracranial invasion. These lesions usually can be managed with partial temporal bone resections, although prognosis for patients with advanced lesions may be poor.

[Report of a case of intraosseous meningioma]

Cases of intraosseous meningioma appear to be very rare. In the present paper, we report such a case and discuss its etiological histogenesis on the basis of a review of 26 cases previously reported. A 71-year-old female was admitted to our department because of a painless mass in the right parietal region. Neurological findings were normal. Plain skull radiograph showed a 6 X 5-cm osteolytic lesion in the right fronto-parietal bone. CT scan demonstrated this lesion as a mass showing homogeneous enhancement with contrast medium. A right common carotid angiogram showed an avascular area in the parietal region and no tumor stain. The tumor, which was partly attached to the underlying dura, was totally removed surgically, and the postoperative course was uneventful. Histological examination of the specimen revealed fibroblastic meningioma, which was limited only to the outer membrane of the dura. The inner membrane was intact and free of tumor invasion. The histogenesis of intraosseous meningioma is still controversial but the following theories seem to be widely accepted: (1) The tumor arises from a part of the dura which has become trapped in a suture during embryological development. (2) The tumor arises from a part of the dura which has become trapped in a suture due to pressure on the head during delivery. (3) The tumor arises from a part of the dura which has become trapped in the bone due to trauma. (4) The dura which has become trapped in a suture during embryological development may undergo neoplastic change following traumatic stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoid cystic carcinoma with orbital and cranial metastases: case report

Adenoid cystic carcinoma of the paranasal sinuses was demonstrated in a patient who subsequently developed a metastatic lesion to both orbits resulting in total blindness. While there are reports of extension of adenoid cystic carcinoma of the lacrimal gland to the adjacent orbit, this patient is an example of orbital extension of an adenoid cystic carcinoma of minor salivary gland originating in a paranasal sinus. The frequency and classification of this tumor also is reviewed.

[A case of atypical bone metastasis from breast carcinoma]

Clinical and radiographical data are presented for a case of suspected pathological fracture of the right ulna in a 66-yr-old women mastectomised two years previously. Multiple skeletal lesions were noted, often morphologically different from those usually observed in metastasis of breast cancer, with a fibrous and cystic appearance reminiscent of von Recklinhausen's disease. However, indisputable serohumoral data, the histological picture on biopsy, and repair of bone as a result of immuno-antiblastic management showed that true metastases were involved. The radiographical picture and the response to therapy make it clear that atypical bone pictures must be carefully watched, since metastasis from breast cancer may be responsible for special morphological and structural features requiring close differential investigation.

Dedifferentiation and invasive growth of an eosinophil pituitary adenoma

This report concerns the course of an eosinophil pituitary adenoma in an acromegalic female (16 years of age when first symptoms appeared) over a period of ten years. The case was complicated by craniocerebral trauma and CSF rhinorrhoea. After several operations, dedifferentiation, and invasive growth into the orbit and the petrous bone were observed with walling in of the VIIIth cranial nerve. The possible causes of the dedifferentiation of the adenoma are discussed.