This document describes a case of multiple intraneural perineuriomas (a rare benign nerve sheath tumor) in an 18-year-old female patient with left hemifacial hyperplasia. The patient presented with enlarged facial structures on the left side since birth. During examination, two nodules were discovered on her left buccal mucosa and histopathological examination revealed a proliferation of neural tissue forming pseudo-onion bulb patterns, characteristic of intraneural perineurioma. Immunohistochemical staining showed positivity for epithelial membrane antigen in the perineurial cells and S-100 protein in the residual Schwann cells. The patient later underwent surgery to correct facial asymmetry, where lipomatous
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Two Way Approach For Enucleation Of Maxillary Radicular Cyst.iosrjce
This document describes a case study of a 39-year-old male patient who presented with pain and swelling in the left upper back tooth region. Clinical and radiographic examination revealed a large radicular cyst extending from the upper left canine to third molar region. The cyst was initially enucleated through an intraoral approach. Later, a functional endoscopic sinus surgery was performed through the maxillary antrum to inspect for any residual cyst lining, since the patient also had a deviated nasal septum requiring septoplasty. No residual cyst was observed during endoscopy. This case report demonstrates that large maxillary radicular cysts can be effectively treated through both conventional intraoral enucleation and an end
This document presents a case report of a 55-year-old man with a sinonasal paraganglioma. He presented with episodes of epistaxis and a nasal mass. Imaging showed a mass involving the frontal sinus and ethmoids bilaterally. He underwent surgical excision of the mass along with cranialization of the frontal sinus using a fascia lata graft. Histopathology confirmed paraganglioma. The patient was followed for 1 year without signs of recurrence. Paragangliomas are rare tumors that can present in the sinonasal tract. Complete surgical excision is usually curative for benign cases.
Abstract: We report a case of sinonasal paraganglioma presenting with episodes of epistaxis. A 55 year old male presented with a
nasal mass. It is an uncommon site of presentation and in an uncommon age group. A high grade of suspicion is required to diagnose
sino nasal paraganglioma. However, CT Scan and histopathology helps in early diagnosis and treatment. Surgical excision done with
cranialization of frontal sinus with fascia lata graft, followed up for 1 year without any evidence of disease recurrence.
Keywords: Sinonasal; Paraganglioma; Fascia Lata.
This document reports a case study of a 55-year-old man diagnosed with sinonasal paraganglioma, a rare tumor arising from paraganglionic tissue. The man presented with episodes of epistaxis (nosebleeds) and a nasal mass. Imaging including CT and MRI scans confirmed a mass involving the frontal and ethmoid sinuses extending into surrounding areas. The tumor was surgically excised and pathology confirmed paraganglioma. The man recovered well after surgery without signs of recurrence after one year of follow up. Paragangliomas are rare tumors in the nasal cavity that can be difficult to diagnose but surgery is typically curative for benign cases.
This document summarizes a case report of a rare case of bilateral squamous cell carcinoma of the temporal bones in a 30-year-old male patient who presented with extensive late-stage disease. Imaging showed large lesions destroying bone structure in the right temporal bone and a smaller lesion in the left. Biopsy confirmed squamous cell carcinoma in both ears. The right-sided tumor was deemed unresectable and the patient received palliative radiotherapy, with a poor prognosis. Bilateral temporal bone cancer is exceptionally rare and this represents one of the few reported cases.
Leiomyoma is a benign tumor that originates from smooth
muscle cell. The most common sites are the uterus, gastrointestinal tract & skin. Leiomyoma is a relatively uncommon smooth muscle tumor rarely found in the head and neck. Enzinger and Weiss (1995), analyzed a total of 7748 leiomyomas, 95% of the tumors occurred in the female genitalia (uterus), 3% in the skin, 0.9% in the gastrointestinal tract and the remainder at various sites including skull base.
Journal of Pathology & Microbiology is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pathology & Microbiology.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all areas of Pathology & Microbiology. Journal of Pathology & Microbiology accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of pathology & microbiology.
Journal of Pathology & Microbiology strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
Two Way Approach For Enucleation Of Maxillary Radicular Cyst.iosrjce
This document describes a case study of a 39-year-old male patient who presented with pain and swelling in the left upper back tooth region. Clinical and radiographic examination revealed a large radicular cyst extending from the upper left canine to third molar region. The cyst was initially enucleated through an intraoral approach. Later, a functional endoscopic sinus surgery was performed through the maxillary antrum to inspect for any residual cyst lining, since the patient also had a deviated nasal septum requiring septoplasty. No residual cyst was observed during endoscopy. This case report demonstrates that large maxillary radicular cysts can be effectively treated through both conventional intraoral enucleation and an end
This document presents a case report of a 55-year-old man with a sinonasal paraganglioma. He presented with episodes of epistaxis and a nasal mass. Imaging showed a mass involving the frontal sinus and ethmoids bilaterally. He underwent surgical excision of the mass along with cranialization of the frontal sinus using a fascia lata graft. Histopathology confirmed paraganglioma. The patient was followed for 1 year without signs of recurrence. Paragangliomas are rare tumors that can present in the sinonasal tract. Complete surgical excision is usually curative for benign cases.
Abstract: We report a case of sinonasal paraganglioma presenting with episodes of epistaxis. A 55 year old male presented with a
nasal mass. It is an uncommon site of presentation and in an uncommon age group. A high grade of suspicion is required to diagnose
sino nasal paraganglioma. However, CT Scan and histopathology helps in early diagnosis and treatment. Surgical excision done with
cranialization of frontal sinus with fascia lata graft, followed up for 1 year without any evidence of disease recurrence.
Keywords: Sinonasal; Paraganglioma; Fascia Lata.
This document reports a case study of a 55-year-old man diagnosed with sinonasal paraganglioma, a rare tumor arising from paraganglionic tissue. The man presented with episodes of epistaxis (nosebleeds) and a nasal mass. Imaging including CT and MRI scans confirmed a mass involving the frontal and ethmoid sinuses extending into surrounding areas. The tumor was surgically excised and pathology confirmed paraganglioma. The man recovered well after surgery without signs of recurrence after one year of follow up. Paragangliomas are rare tumors in the nasal cavity that can be difficult to diagnose but surgery is typically curative for benign cases.
This document summarizes a case report of a rare case of bilateral squamous cell carcinoma of the temporal bones in a 30-year-old male patient who presented with extensive late-stage disease. Imaging showed large lesions destroying bone structure in the right temporal bone and a smaller lesion in the left. Biopsy confirmed squamous cell carcinoma in both ears. The right-sided tumor was deemed unresectable and the patient received palliative radiotherapy, with a poor prognosis. Bilateral temporal bone cancer is exceptionally rare and this represents one of the few reported cases.
Atypical ameloblastoma – an enigma in diagnosis review of literature and rep...Quách Bảo Toàn
This case report describes an atypical ameloblastoma presenting diagnostic challenges. Histologically, the lesion showed features of both benign and malignant ameloblastoma. While areas displayed typical ameloblastoma characteristics, other areas showed epithelial dedifferentiation like cellular pleomorphism and atypical mitoses. However, these atypical features were not sufficient to classify it as ameloblastic carcinoma. The case was therefore diagnosed as an atypical ameloblastoma and close follow up was recommended due to its ambiguous nature between benign and malignant pathology. The report also briefly reviews the classification and literature on odontogenic malignancies.
A case of childhood Burkitt's lymphoma with gingival swelling as the first sy...komalicarol
This case report describes a 4-year-old child who presented with gingival swelling as the initial symptom of Burkitt's lymphoma. The child was eventually diagnosed with stage IV Burkitt's lymphoma/leukemia based on bone marrow and genetic testing. After initial chemotherapy, the gingival swelling and right cheek swelling recurred, indicating disease recurrence. The child received further chemotherapy but ultimately passed away half a year later. This case highlights that gingival swelling can be an early oral symptom of systemic disease like Burkitt's lymphoma. Dentists and oral physicians play an important role in identifying signs of systemic conditions through oral examinations.
The Mastoid Compartment of Middle Ear Cleft-A Clinic Pathological Study in Patients with Chronic Otitis Media-Mucosal Type by George MV in Experiments in Rhinology & Otolaryngology
https://crimsonpublishers.com/ero/fulltext/ERO.000525.php
Pleomorphic adenoma of the buccal salivary glandPrashant Munde
Salivary gland swellings can result from tumors, an inflammatory process
or cysts. It can sometimes be difficult to establish; whether pathology arises
from the salivary gland itself or adjacent structures. Neoplasms of the salivary
glands account for less than 1% of all tumors, 3–5% of all head and neck
tumors and benign pleomorphic adenoma (PA) of minor salivary glands arising
de novo is very rare. PA is the most common tumor of the salivary gland. While
the majority arises from the parotid gland, only a small percentage arises from
the buccal minor salivary gland. A case of PA of minor salivary glands in the
buccal mucosa in a 70‑year‑old female is discussed. It includes review of
literature, clinical features, histopathology, radiological findings and treatment
of the tumor; with emphasis on diagnosis.
This case report describes a 19-year-old female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft. This occurrence is considered very unusual. The lesion was removed surgically and reconstruction was performed using a fibula graft to restore function and anatomy. At a 24 month follow up there was no recurrence of the lesion and normal joint function had returned.
Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic...Quách Bảo Toàn
This study evaluated the diagnostic ability to differentiate between ameloblastoma and odontogenic keratocyst using different imaging modalities and observers with varying levels of experience. Six oral radiologists diagnosed 83 cases using panoramic radiograph only, CT only, or both combined. Their ability to differentiate the lesions was assessed using ROC analysis. Experienced observers performed best when using both panoramic and CT images together, followed by CT only, and worst with panoramic only. Less experienced observers performed worst with CT only. Combining imaging modalities and experience level of observers can improve accurate differentiation of these lesions.
This case report describes the surgical treatment of a 36-year-old male patient with an ameloblastoma tumor in the right side of the lower jaw. The tumor was excised via a trapezoidal flap surgery under general anesthesia. Histopathological examination found it to be an acanthomatous ameloblastoma. A reconstruction plate was fixed to prevent mandible fracture. The patient recovered well after surgery and was discharged after 3 days. Ameloblastomas are odontogenic tumors that commonly affect young people and have varying presentations depending on location and histological subtype.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding structures. The tumour was removed endoscopically and pathology confirmed a small cell neuroendocrine carcinoma. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive tumour that is difficult to diagnose but requires
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding areas. The tumour was removed endoscopically and found to be a small cell neuroendocrine carcinoma based on histology and immunohistochemistry. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive
2010 ahmed-bilateral transverse facial cleft as an isolated and asyndromic de...Klinikum Lippe GmbH
This case report describes a rare case of bilateral transverse facial cleft (macrostomia) as an isolated, non-syndromic deformity in a 7-year-old male child. Examination found wide mouth bilaterally lined with skin and buccal mucosa internally, with normal dentition and no other abnormalities. The defect was repaired using a W-plasty technique, which involves incisions in the shape of a W, to close the skin and reconstruct the orbicularis oris muscle and oral sphincter integrity. This achieved symmetric lips and commissures with minimal scarring. Follow-up at 3 months found marked improvement in appearance and function. Bilateral isolated transverse facial cleft is uncommon
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
Surgical disaster in temporomandibular joint: Case reportlpfeilsticker
This case report describes a surgical disaster that occurred during treatment of a young woman's congenital bilateral temporomandibular joint ankylosis. During surgery to remove the ankylosis and place prosthetic joints, the patient suffered iatrogenic injuries including facial nerve palsy, deafness on the right side, and a cerebrospinal fluid leak from trauma to the structures of the external, middle, and inner ear on the right side. Computed tomography scans showed extensive destruction of the lateral skull base region involving the middle and inner ear and middle fossa floor on the right side. The patient was left with permanent deafness on the right side, limited mouth opening, and right facial palsy.
Krok 1 - 2014 Question Paper (Stomatology)Eneutron
The document contains a test with multiple choice questions covering various topics in medicine and dentistry. Some of the questions relate to identifying parasitic protozoa found in carious cavities, the genetic cause of sickle cell disease, and the chromosomal abnormality associated with Turner's syndrome. Other questions address identifying anatomical structures, classifying histological specimens, and interpreting laboratory test results.
Basal cell ameloblastoma a rare case report and review of literatureQuách Bảo Toàn
The document reports on a rare case of basal cell ameloblastoma occurring in a 12-year-old patient. Basal cell ameloblastoma is believed to be the rarest histologic subtype of ameloblastoma and typically occurs in adults aged 30-40 years. Only 6 previous cases had been reported in the literature. Microscopic examination of the lesion showed uniform basaloid cells without stellate reticulum, consistent with basal cell ameloblastoma. Considering the rarity of this lesion in such a young patient, this case highlights the importance of histopathological examination for diagnosing odontogenic tumors.
This document provides information on the classification, diagnosis, and treatment of odontogenic tumors. It begins by classifying odontogenic tumors into three categories based on their origin: tumors of odontogenic epithelium, mixed odontogenic tumors, and tumors of odontogenic ectomesenchyme. Ameloblastoma is then discussed in detail as the most common odontogenic tumor. The document outlines the clinical features, histologic features, diagnosis, and treatment considerations for solid/multicystic ameloblastoma. Complete surgical removal with adequate margins is indicated as the primary treatment approach to prevent recurrence of this locally invasive tumor.
This document provides information on Hemifacial Microsomia (HFM), including terminology, etiology, features, classification systems, differential diagnosis, management, and treatment options. HFM is a congenital condition characterized by underdevelopment of the lower half of the face on one side. It can affect structures from the first and second branchial arches. Treatment depends on the severity and may involve functional appliances, distraction osteogenesis of the ramus, or autogenous grafts to replace an absent condyle. Early intervention is important to address issues like airway, hearing, and facial nerve function.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
Abstract—This study was aimed to present a case report of a case of peripheral ossifying fibroma which is a rare case. This case was a 30 years non smoker male with the chief complaint of growth of gum tissue, moderately large in the mandibular posterior region. On intraoral examination, a peduncalated growth of 17 x 12 x 6 mm on marginal and attached gingiva with respect to tooth number 47 considerably hard in consistency and movable was seen. The lesion was erythmatous having a smooth non ulcerated surface. It was asymptomatic with no sign of pain. Intra oral periapical radiograph was taken which revealed slight erosion of crest of bone which was later confirmed during surgical excision. The possible reason of crestal bone erosion may be constant pressure of the growth. Differential diagnosis of irritation fibroma, pyogenic granuloma and peripheral giant cell granuloma was considered. However, clinical appearance and consistency was of a hard fibrous growth, which therefore led to a provisional diagnosis of peripheral ossifying fibroma or peripheral odontogenic fibroma.
1. The patient presented with a palatal swelling and MRI revealed another parotid lesion. Biopsies found polymorphous adenocarcinoma in the palate and pleomorphic adenoma in the parotid gland.
2. Both lesions were surgically removed. Post-operative radiation was recommended for the palatal tumor due to perineural invasion.
3. Having multiple salivary gland tumors is unusual but not unheard of. MRI proved useful for detecting the additional concealed parotid lesion in this case. Each tumor requires separate diagnosis and treatment.
The document discusses the histopathology of pseudoxanthoma elasticum (PXE) and related disorders. It describes the histological hallmarks of PXE as fragmentation and mineralization of elastic fibers in affected tissues like skin, blood vessels, and the eye. Elastic fibers in the skin show polymorphous, mineralized and fragmented fibers in the middermis. Electron microscopy reveals mineral deposits in the core of elastic fibers. Similar changes are seen in Bruch's membrane of the eye and blood vessels. A murine model of PXE also shows mineralization of elastic fibers in blood vessels and Bruch's membrane. Differential diagnoses that can resemble PXE histologically are also discussed.
This case report describes a 31-year-old man with amicrobial pustulosis associated with autoimmune diseases (APAD). He suffered from IgA nephropathy and Sjögren's syndrome. His skin symptoms included multiple pustules over his entire body that improved with corticosteroids but relapsed after tapering. Skin biopsies showed neutrophilic infiltration without microorganisms. He achieved complete remission of his skin symptoms after corticosteroid pulse therapy and tonsillectomy. This clinical presentation adds to the limited reports of APAD associated with defined systemic autoimmune diseases.
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Atypical ameloblastoma – an enigma in diagnosis review of literature and rep...Quách Bảo Toàn
This case report describes an atypical ameloblastoma presenting diagnostic challenges. Histologically, the lesion showed features of both benign and malignant ameloblastoma. While areas displayed typical ameloblastoma characteristics, other areas showed epithelial dedifferentiation like cellular pleomorphism and atypical mitoses. However, these atypical features were not sufficient to classify it as ameloblastic carcinoma. The case was therefore diagnosed as an atypical ameloblastoma and close follow up was recommended due to its ambiguous nature between benign and malignant pathology. The report also briefly reviews the classification and literature on odontogenic malignancies.
A case of childhood Burkitt's lymphoma with gingival swelling as the first sy...komalicarol
This case report describes a 4-year-old child who presented with gingival swelling as the initial symptom of Burkitt's lymphoma. The child was eventually diagnosed with stage IV Burkitt's lymphoma/leukemia based on bone marrow and genetic testing. After initial chemotherapy, the gingival swelling and right cheek swelling recurred, indicating disease recurrence. The child received further chemotherapy but ultimately passed away half a year later. This case highlights that gingival swelling can be an early oral symptom of systemic disease like Burkitt's lymphoma. Dentists and oral physicians play an important role in identifying signs of systemic conditions through oral examinations.
The Mastoid Compartment of Middle Ear Cleft-A Clinic Pathological Study in Patients with Chronic Otitis Media-Mucosal Type by George MV in Experiments in Rhinology & Otolaryngology
https://crimsonpublishers.com/ero/fulltext/ERO.000525.php
Pleomorphic adenoma of the buccal salivary glandPrashant Munde
Salivary gland swellings can result from tumors, an inflammatory process
or cysts. It can sometimes be difficult to establish; whether pathology arises
from the salivary gland itself or adjacent structures. Neoplasms of the salivary
glands account for less than 1% of all tumors, 3–5% of all head and neck
tumors and benign pleomorphic adenoma (PA) of minor salivary glands arising
de novo is very rare. PA is the most common tumor of the salivary gland. While
the majority arises from the parotid gland, only a small percentage arises from
the buccal minor salivary gland. A case of PA of minor salivary glands in the
buccal mucosa in a 70‑year‑old female is discussed. It includes review of
literature, clinical features, histopathology, radiological findings and treatment
of the tumor; with emphasis on diagnosis.
This case report describes a 19-year-old female patient with a central giant cell granuloma in the left mandibular condyle, treated with en bloc resection and reconstruction with fibula graft. This occurrence is considered very unusual. The lesion was removed surgically and reconstruction was performed using a fibula graft to restore function and anatomy. At a 24 month follow up there was no recurrence of the lesion and normal joint function had returned.
Diagnostic ability of differential diagnosis in ameloblastoma and odontogenic...Quách Bảo Toàn
This study evaluated the diagnostic ability to differentiate between ameloblastoma and odontogenic keratocyst using different imaging modalities and observers with varying levels of experience. Six oral radiologists diagnosed 83 cases using panoramic radiograph only, CT only, or both combined. Their ability to differentiate the lesions was assessed using ROC analysis. Experienced observers performed best when using both panoramic and CT images together, followed by CT only, and worst with panoramic only. Less experienced observers performed worst with CT only. Combining imaging modalities and experience level of observers can improve accurate differentiation of these lesions.
This case report describes the surgical treatment of a 36-year-old male patient with an ameloblastoma tumor in the right side of the lower jaw. The tumor was excised via a trapezoidal flap surgery under general anesthesia. Histopathological examination found it to be an acanthomatous ameloblastoma. A reconstruction plate was fixed to prevent mandible fracture. The patient recovered well after surgery and was discharged after 3 days. Ameloblastomas are odontogenic tumors that commonly affect young people and have varying presentations depending on location and histological subtype.
The antralpseudocyst originates from the accumulation of serous inflammatory exudate in the sinus membrane without a specific etiology, this cyst has not of age group or gender preference. Radiographically, it is associated with a soft dome-shaped radiopaque pattern. This case is about a male patient of 58 years of age, with increased volume in the malar and left genic region of smooth, fluctuating consistency, which crackles at the pressure. Intraorally with the corresponding increase in volume in the sac, without changes in the oral mucosa. The tomography showed a radiolucent lesion that occupies and destroys left jaw and orbital fl oor. Thus, complete enucleation of the lesion and reconstruction of adjacent structures were performed. Clinical and imaging follow-up was carried out without postoperative complications and 8 years free of injury. It is of vital importance a correct diagnosis to guide the treatment adequately, however it is not necessary to underestimate the behavior of benign lesions and described as non-invasive.
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding structures. The tumour was removed endoscopically and pathology confirmed a small cell neuroendocrine carcinoma. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive tumour that is difficult to diagnose but requires
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding areas. The tumour was removed endoscopically and found to be a small cell neuroendocrine carcinoma based on histology and immunohistochemistry. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive
2010 ahmed-bilateral transverse facial cleft as an isolated and asyndromic de...Klinikum Lippe GmbH
This case report describes a rare case of bilateral transverse facial cleft (macrostomia) as an isolated, non-syndromic deformity in a 7-year-old male child. Examination found wide mouth bilaterally lined with skin and buccal mucosa internally, with normal dentition and no other abnormalities. The defect was repaired using a W-plasty technique, which involves incisions in the shape of a W, to close the skin and reconstruct the orbicularis oris muscle and oral sphincter integrity. This achieved symmetric lips and commissures with minimal scarring. Follow-up at 3 months found marked improvement in appearance and function. Bilateral isolated transverse facial cleft is uncommon
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
Surgical disaster in temporomandibular joint: Case reportlpfeilsticker
This case report describes a surgical disaster that occurred during treatment of a young woman's congenital bilateral temporomandibular joint ankylosis. During surgery to remove the ankylosis and place prosthetic joints, the patient suffered iatrogenic injuries including facial nerve palsy, deafness on the right side, and a cerebrospinal fluid leak from trauma to the structures of the external, middle, and inner ear on the right side. Computed tomography scans showed extensive destruction of the lateral skull base region involving the middle and inner ear and middle fossa floor on the right side. The patient was left with permanent deafness on the right side, limited mouth opening, and right facial palsy.
Krok 1 - 2014 Question Paper (Stomatology)Eneutron
The document contains a test with multiple choice questions covering various topics in medicine and dentistry. Some of the questions relate to identifying parasitic protozoa found in carious cavities, the genetic cause of sickle cell disease, and the chromosomal abnormality associated with Turner's syndrome. Other questions address identifying anatomical structures, classifying histological specimens, and interpreting laboratory test results.
Basal cell ameloblastoma a rare case report and review of literatureQuách Bảo Toàn
The document reports on a rare case of basal cell ameloblastoma occurring in a 12-year-old patient. Basal cell ameloblastoma is believed to be the rarest histologic subtype of ameloblastoma and typically occurs in adults aged 30-40 years. Only 6 previous cases had been reported in the literature. Microscopic examination of the lesion showed uniform basaloid cells without stellate reticulum, consistent with basal cell ameloblastoma. Considering the rarity of this lesion in such a young patient, this case highlights the importance of histopathological examination for diagnosing odontogenic tumors.
This document provides information on the classification, diagnosis, and treatment of odontogenic tumors. It begins by classifying odontogenic tumors into three categories based on their origin: tumors of odontogenic epithelium, mixed odontogenic tumors, and tumors of odontogenic ectomesenchyme. Ameloblastoma is then discussed in detail as the most common odontogenic tumor. The document outlines the clinical features, histologic features, diagnosis, and treatment considerations for solid/multicystic ameloblastoma. Complete surgical removal with adequate margins is indicated as the primary treatment approach to prevent recurrence of this locally invasive tumor.
This document provides information on Hemifacial Microsomia (HFM), including terminology, etiology, features, classification systems, differential diagnosis, management, and treatment options. HFM is a congenital condition characterized by underdevelopment of the lower half of the face on one side. It can affect structures from the first and second branchial arches. Treatment depends on the severity and may involve functional appliances, distraction osteogenesis of the ramus, or autogenous grafts to replace an absent condyle. Early intervention is important to address issues like airway, hearing, and facial nerve function.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
Abstract—This study was aimed to present a case report of a case of peripheral ossifying fibroma which is a rare case. This case was a 30 years non smoker male with the chief complaint of growth of gum tissue, moderately large in the mandibular posterior region. On intraoral examination, a peduncalated growth of 17 x 12 x 6 mm on marginal and attached gingiva with respect to tooth number 47 considerably hard in consistency and movable was seen. The lesion was erythmatous having a smooth non ulcerated surface. It was asymptomatic with no sign of pain. Intra oral periapical radiograph was taken which revealed slight erosion of crest of bone which was later confirmed during surgical excision. The possible reason of crestal bone erosion may be constant pressure of the growth. Differential diagnosis of irritation fibroma, pyogenic granuloma and peripheral giant cell granuloma was considered. However, clinical appearance and consistency was of a hard fibrous growth, which therefore led to a provisional diagnosis of peripheral ossifying fibroma or peripheral odontogenic fibroma.
1. The patient presented with a palatal swelling and MRI revealed another parotid lesion. Biopsies found polymorphous adenocarcinoma in the palate and pleomorphic adenoma in the parotid gland.
2. Both lesions were surgically removed. Post-operative radiation was recommended for the palatal tumor due to perineural invasion.
3. Having multiple salivary gland tumors is unusual but not unheard of. MRI proved useful for detecting the additional concealed parotid lesion in this case. Each tumor requires separate diagnosis and treatment.
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Este documento describe un caso de perineuroma maligno (tumor maligno de vaina nerviosa periférica con diferenciación perineural) en una mujer de 58 años. Histológicamente, el tumor presentaba áreas compactas con células fusiformes formando estructuras verticiladas, así como áreas laxas con células alargadas en estructuras paralelas. Las células tumorales fueron positivas para EMA, Glut-1 y Claudina-1, marcadores de diferenciación perineural, pero negativas para S-100. Este caso propor
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
3. The patient was seen regularly for follow-up, and surgical
correction of the facial asymmetry was planned once growth
had ceased. The patient was seen regularly also for orthodon-
tic treatment since the age of 8 years. The upper left second
premolar was congenitally missing, and the teeth on the left
side were larger than on the right side. Development and
eruption of the dentition was premature on the left side
compared with the right side. There was crowding in both
upper and lower dentition and scissors bite on the left side.
Asymmetry in the upper and lower midlines was noted.
The patient complained of impaired vision at the age of 14
years. She was found to have myopia, astigmatism, and, in the
left eye, amblyopia. Movements of the eyes were normal.
Occasional nasal obstruction occurred, and there was devia-
tion of the nasal septum to the left. Pigmented macules had
been present on the skin of the left cheek and neck since early
childhood. On a recent consultation with a dermatologist,
these lesions were diagnosed as epidermal nevi (Fig. 1, C).
There were no signs of neurofibromatosis on the skin.
Several imaging studies were done during the course of
treatment and follow-up. Computerized tomography showed
enlarged maxillary and mastoid air sinuses, enlarged zygo-
matic bone, and narrowing of the nasal cavity on the left side
(Fig. 1, D). Increased activity was observed on the bone scans
in the left maxilla and in the area of zygomatic bone. Mag-
netic resonance imaging showed increased size of maxillary
sinus, zygomatic bone, and masseter muscle as well as in-
creased thickness of the subcutaneous fat tissue on the left
side. Left cerebellar hemisphere was larger than the right side
and contained abnormally structured cortex with white matter
strands running from center to periphery (Fig. 1, E). Pan-
oramic x-ray at the age of 19 years showed mandibular bone
to be hyperplastic in the region of the lower left molars and
angle of mandibula. The mandibular canal was enlarged.
Posteroanterior view showed the processus coronoideus to be
slightly longer and the area of zygomatic bone to be denser on
the left side.
On a visit in January 2005, 2 nodules of about 2 cm in
diameter were observed on the left buccal mucosa (Fig. 1, F).
The lesions were clinically suspicious for neurofibromatosis.
One of the nodules was excised, and histopathologic exami-
nation revealed a hypertrophic proliferation of neural tissue in
a pseudo–onion bulb pattern (Fig. 2, A and B). In these “onion
bulbs” small number of S-100 protein–positive cells were
Fig. 1. A and B, The patient at the ages of 8 years (A) and 18 years (B), with marked left hemifacial hyperplasia: enlarged lower
lip, cheek, cheek bone, and lower rim of the orbita. C, Epidermal nevi on the left side of cheek and neck. D, Computerized
tomography of head at the age of 17 years, showing marked asymmetry of the facial structures: enlarged left maxillary sinus,
mastoid air sinus and zygomatic bone, and narrowing of the left nasal cavity. E, Magnetic resonance imaging of face and brain
(age 18 years), showing increased size of maxillary sinus, zygomatic bone, and masseter muscle as well as increased thickness
of the subcutaneous fat tissue on the left side. The left cerebellar hemisphere is larger than the right and contains abnormally
structured cortex: white matter strands running from center to periphery. F, Two submucosal masses on the left buccal mucosa
near corner of mouth.
OOOOE
Volume 104, Number 1 Siponen et al. e39
4. noted centrally. The surrounding concentrically arranged
spindle cells were positive only for EMA (Fig. 2, C and D).
The patient was operated on in December 2005 to correct
the facial asymmetry. Before the surgery, a 3-dimensional
stereolythic skull model was made to better visualize the
relative hard and soft tissue contributions to the facial asym-
metry and to help accurately plan the hard tissue reduction
surgery. The soft tissues of the left side of the face contained
a spongy yellowish lipomatous material with some discrete
nodules. Extensive removal of the tissue was deemed impos-
sible, because the spongy yellowish lesional tissue encased
the branches of the facial nerve. Instead, the hyperplastic
frontal and temporal bones, zygoma, and maxilla were con-
toured through coronal, subciliary, and intraoral incisions.
Soft tissue specimens were obtained from the left infraorbital
and suprazygomatic areas. The microscopic findings from the
tissue of the infraorbital area were identical to previous bi-
opsy from left buccal mucosa, showing features of intraneural
Fig. 2. A and B, Hypertrophic neural proliferation in a pseudo–onion bulb pattern (A: H-E ⫻50; B: H-E ⫻200). C, Tumor cells
are reactive for epithelial membrane antigen (⫻100). D, S-100 protein is nonreactive for tumor cells, but some residual Schwann
cells at the center of perineurial whorls are stained (⫻100).
OOOOE
e40 Siponen et al. July 2007
5. perineurioma, whereas the specimen from suprazygomatic
area contained normal tissue structure with no evidence of
intraneural perineurioma.
DISCUSSION
Etiology
Intraneural perineurioma was previously considered
to be a reactive process, referred to as localized hyper-
trophic neuropathy or hypertrophic mononeuropathy.2,5
Both intraneural and extraneural perineuriomas are now
recognized as benign nerve sheath tumors composed of
perineurial cells, with evidence of the neoplastic nature
of the tumor presented recently in several reports de-
scribing clonal cytogenetic aberrations of chromosome
22.12,16,17
Most recently, rearrangements and/or dele-
tions in chromosome 10q have been found in the scle-
rosing variant of perineurioma.18
Abnormalities of
chromosome 22 are found also in a variety of other
neural tumors and meningiomas.17
It has been found
that the long arm of chromosome 22 contains a tumor
suppressor gene, possibly the NF-2 gene, involved in
the pathogenesis of nerve sheath tumors.16
Clinical features
Intraneural perineuriomas are most often found in
young individuals, equally in both genders. They typi-
cally affect peripheral nerves of the extremities, caus-
ing muscle weakness and sometimes sensory deficits.1,2
Extraneural perineuriomas are seen in adults of all
ages, with a female predilection.2
They occur in a wide
anatomic distribution, but usually in the superficial soft
tissues of the extremities, and cause most often a symp-
tomless mass.3
Both intraneural and extraneural peri-
neuriomas may rarely arise intraosseously.7,10,12
Histopathologic and ultrastructural features
Normally, the epineurium surrounds peripheral
nerves, which are composed of a bundle of nerve fas-
cicles. These individual nerve fascicles are in turn
surrounded by 1 or more layers of perineurial cells,
forming the perineurium. Inside the nerve fascicles
the endoneurial stroma ensheaths axon–Schwann cell
complexes.19
In intraneural perineuriomas the affected nerve is
enlarged symmetrically forming a fusiform expansion
of the nerve.5
Most lesions are less than 10 cm in
length.2
Extraneural perineurioma is typically unassociated
with nerve and measures 0.3-20 cm (mean 4.1 cm).3
Perineuriomas are typically well circumscribed, often
having a fibrous pseudocapsule. However, they may
have poorly defined infiltrative margins, such as the
gingival soft tissue perineurioma described by Graadt
van Roggen et al.8
Cytologically, the cells in both intraneural and ex-
traneural perineuriomas share similar features: the neo-
plastic cells are spindle-shaped, have elongated cell
processes and elongated often wavy, tapered nuclei and
inconspicuous nucleoli.2,17
Occasionally atypical cells
are seen but mitotic activity is rare.2
Histologically, intraneural perineuriomas are com-
posed of perineurial cells proliferating in concentric
layers around nerve fibers; in transverse sections they
form a pseudo-onion bulb pattern.2
In the center of
these proliferating “onion bulbs” a degenerating axon
and some Schwann cells are seen.
Extraneural perineuriomas are in contrast morpho-
logically heterogeneous, showing spindle or epithelioid
cytological features.3,15
The cells are arranged in
whorls, in storiform or in fascicular patterns.3
Stroma
may be collagenous, myxomatous or markedly hyalin-
ized.3
Several variants of extraneural perineurioma
have been described, sclerosing perineurioma being
probably the most common.5
Other variants include
reticular/retiform8,14
and plexiform.14
It has been sug-
gested that identification of unusual variants of peri-
neurioma requires ultrastructural confirmation.5
Ultrastructural features of perineurial cells include
long thin cytoplasmic processes with large numbers of
pinocytotic vesicles, abundant collagenous stroma, in-
continuous basement membrane and rudimentary inter-
cellular junctions.2,3
Diagnosis and differential diagnosis
Although ultrastructural identification of perineurial
cell differentiation has long been and still is regarded
by some investigators as the “gold standard” of diag-
nosis of perineurioma,17
many now consider light mi-
croscopic features combined with immunohistochemi-
cal findings of EMA positivity and S-100 negativity of
the neoplastic cells sufficient for the diagnosis.15,18
The staining pattern of EMA is membranous, and in
intraneural perineurioma some residual axons and
Schwann cells in the center of the “onion bulbs” show
positivity with GFAP and S-100, respectively.2
How-
ever, in the series of 81 soft tissue (extraneural) peri-
neuriomas by Hornick and Fletcher,3
4 (5%) showed
focal perineurial cytoplasmic and nuclear staining for
S-100. In some cases, the intensity of EMA staining
may be weak or focal.8,15
Perineurial cells are also
positive for vimentin and show membranous laminin
and collagen IV positivity, although this is not a spe-
cific finding.1,3
Glut-1, again not specific for perineurial
cells, has been suggested recently as a useful marker for
detecting or confirming perineurial differentiation.18
Also focal Claudin-1 (tight junction–associated pro-
tein), cytokeratin, SMA, and CD34 positivity may be
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Volume 104, Number 1 Siponen et al. e41
6. found.3,8,15
The proliferative activity of perineuriomas
using MIB-1 ranges from 3.7% to 17%.2,16
The differential diagnosis of intraneural perineu-
rioma includes other spindle cell lesions that may pro-
duce an onion bulb–like histologic pattern. Palisaded
encapsulated neuromas, neurofibromas and traumatic
neuromas may have a histologic growth pattern that
superficially resembles that of intraneural perineu-
rioma.11,16
In hereditary hypertrophic neuropathies of
Charcot-Marie-Tooth disease and of Dejerine-Sottas
disease, there are periaxonal lamellar proliferations of
Schwann cells of the affected nerves producing an
onion bulb–like pattern.11,16
However, immunohisto-
logic evaluation with S-100 and EMA enables the dis-
tinction to be made easily, with the majority of the
lesional cells reacting with S-100 in these lesions in
contrast to mostly EMA-positive cells in intraneural
perineurioma.
In the case of extraneural (soft tissue) perineurioma,
a considerably wider range of spindle and epithelioid
cell lesions have to be considered in the differential
diagnosis. Generally, the immunohistochemical detec-
tion of EMA and Claudin-1 positivity and S-100 neg-
ativity is sufficient to make the diagnosis of extraneural
perineurioma. Benign lesions that may mimic extran-
eural perineurioma histologically include, for example,
fibromatosis, nodular fasciitis, neurofibroma, nerve
sheath myxoma, and the rare soft tissue meningioma.15
Some neurofibromas are rich in perineurial-like cells,
and may be therefore difficult to distinguish from peri-
neuriomas.13
Rare examples of hybrid tumors showing
a combination of perineurioma and schwannoma or
neurofibroma have recently been reported.20
Of malig-
nant tumors, for example, low-grade fibromyxoid sar-
coma may closely resemble extraneural perineurioma
but lacks EMA or Claudin-1 positivity.15
Malignant
peripheral nerve sheath tumors (MPNST) may show
perineurial differentiation and therefore cause difficul-
ties in the differential diagnosis.21
Treatment
Therapy for intraneural perineurioma remains con-
troversial. The progression of the tumor may justify
surgical excision and nerve grafting even before symp-
toms; however, this approach often results in the loss of
nerve function.11
Many authors prefer no treatment
after biopsy or neurolysis, because of the benign nature
of the process and in order to retain neurologic function
as long as possible.2,11,16
For extraneural perineurio-
mas, a conservative excision is advocated.2,9
Prognosis
Perineuriomas are benign peripheral nerve sheath
tumors composed exclusively of perineurial cells with
no tendency for recurrence.2
In a series of 81 extran-
eural (soft tissue) perineuriomas, only 2 recurred, one
with atypical histologic features.3
Atypical cellular fea-
tures such as pleomorphic or multinucleated cells, hy-
percellular areas, or infiltrative margins are not uncom-
mon in perineuriomas, and many investigators believe
these cellular features to be a degenerative change and
therefore to have no clinical or prognostic signifi-
cance.3,7,21
Metastases from perineuriomas have not
been reported.
Conclusion
Previous reported cases of perineuriomas of the oral
and maxillofacial area are summarized in Table I. Most
Table I. Reported cases of perineuriomas of the oral and maxillofacial regions
Authors Age/gender Location Variant
Kusama et al., 19817
31/F Mandible Extraneural (reticular)*
Giannini et al., 199717
59/F Maxillary sinus Extraneural
Graadt van Roggen et al., 20018
42/F Gingiva Extraneural (reticular)
Senghore et al., 200122
70/F Facial skin Extraneural
Barrett et al., 200210
53/M Mandible Extraneural
Meer et al., 20039
46/F Nasolabial area Extraneural
Damm et al., 200311
26/F Tongue Intraneural
Huguet et al., 200412
64/M Mandible Intraneural
Ide et al., 200413
59/F Gingiva Extraneural
Mentzel and Kutzner, 200514
60/F Lower lip Extraneural (plexiform)
Hornick and Flecther, 20053
15/F Tongue Extraneural
44/M Upper lip Extraneural
10/F Nostril Extraneural
70/M Retrotonsillar Extraneural
37/F Temple Extraneural
Present case 19/F Buccal mucosa and infraorbital area Intraneural/intraneural
*Kusama et al. thought the case should be classified as a variant of neurilemmoma.
OOOOE
e42 Siponen et al. July 2007
7. of these have been extraneural (soft tissue) variants of
perineurioma. To the best of our knowledge, only 3
cases of intraneural perineuriomas (including the
present one) have been published so far in this location.
Damm et al.11
described an intraneural perineurioma in
a small unnamed nerve of the tongue in a 26-year-old
woman, and Huguet et al.12
reported an intraneural
perineurioma related to inferior alveolar nerve in the
mandible in a 64-year-old man. Intraneural perineurio-
mas almost exclusively affect major nerves, causing
symptoms such as motor and sensory deficits. The
present case is thought to have arisen from branches of
the facial nerve, in the buccal mucosa and in the in-
fraorbital area. The tumors have not caused any motor
or sensory symptoms so far and excision of tumors has
not been attempted after incisional biopsies.
The patient presented in this report has hemifacial
hyperplasia and multiple orofacial intraneural perineu-
riomas. Hemifacial hyperplasia is a sporadic congenital
condition which classically presents as a unilateral
overgrowth of the orofacial soft tissues, bones, and
teeth.23
The condition is also called hemifacial hyper-
trophy, but actually the number of cells is increased
rather than the size of cells. Hemifacial hyperplasia is a
segmental form of congenital hemihyperplasia. Other
forms of congenital hemihyperplasia include simple
(limited to a single digit) and complex (so called hemi-
body hyperplasia). Although usually unilateral, limited
bilateral crossover may occur in hemihyperplasia.24
Other possible findings in patients with hemihyperplasia
include Wilms’ tumor, nevus, pigmentation and telangi-
ectasia of the skin, unilateral enlargement of the cerebral
hemisphere, seizures, mental retardation, and conductive
hearing loss.23,24
A tumor surveillance protocol with ab-
dominal ultrasound examinations is recommended for
children with congenital hemihyperplasia.25
Hemihyperplasia may also be a feature in other syn-
dromes. It is sometimes seen in association with Pro-
teus syndrome, Beckwith-Wiedemann syndrome, or
Schimmelpenning (epidermal nevus) syndrome. It is
possible that there may be overlap of clinical manifes-
tations between hemihyperplasia and these syndromes.
In Proteus syndrome, the patients are said to have
asymmetry of the limbs, overgrowth of hands and/or
feet, lipomas, connective tissue nevi, and vascular and
lymphatic malformations.26
In Beckwith-Wiedemann
syndrome, the patients usually have increased birth
weight, postnatal gigantism, macroglossia, omphalo-
cele, and distinctive ear lobe grooves.26
In Schim-
melpenning syndrome (epidermal nevus syndrome), the
patients have epidermal nevi, of which sebaceous nevi
is said to be the hallmark of the syndrome. Also com-
mon features of Schimmelpenning syndrome are sei-
zures, developmental delay, hemangiomas, kyphosis/
scoliosis, and extention of nevus to the lid.26
Although
the epidermal nevus extended to the lower lid of the left
eye in our patient, the other features common in Schim-
melpenning syndrome were not present.
The management of this patient’s condition was
greatly influenced by the results of the surgical biopsy.
The patient was assumed to have hemifacial hyperpla-
sia, but the possibility of neurofibromatosis was enter-
tained. The knowledge that the patient’s biopsy showed
the intraoral protuberance of the buccal mucosa to be a
perineurioma, which might have arisen from the facial
nerve, allowed the surgical team to counsel the patient
to limit their surgical treatment to bony recontouring,
rather than risking morbid facial nerve–related compli-
cations associated with soft tissue resection procedures.
Perineuriomas are almost exclusively solitary lesions
affecting a single nerve. There is only 1 report of an
intraneural perineurioma affecting 2 nerve roots; no
association with phakomatosis was noted.16
Recently,
Chen et al.27
described a patient with Beckwith-Wiede-
mann syndrome and an intraneural perineurioma of the
wrist. This seems to be the only previously reported
association of perineurioma to a syndrome. We report a
rare, previously undescribed, case of multiple orofacial
intraneural perineuriomas in a young woman with
hemifacial hyperplasia. Whether this represents a coin-
cidental finding or a previously unknown syndrome
remains unclear. However, it seems possible that the
multiple intraneural perineuriomas are related to the pa-
tient’s underlying condition of hemifacial hyperplasia.6
The authors thank Dr. Birkan Ozkan for collecting
some of the reference material and Dr. Jukka Rosberg
for help in analyzing the radiologic images in this
case report.
REFERENCES
1. Weiss SW, Goldblum JR. Enzinger and Weiss’s soft tissue
tumors. 4th ed. St. Louis: Mosby: 2001. p. 1173-8.
2. Kleihues P, Cavenee WK, editors. WHO classification of tu-
mours. Tumours of the nervous system. Lyon: IARC Press; 2000.
p. 169-71.
3. Hornick JL, Fletcher CDM. Soft tissue perineurioma. Clinico-
pathological analysis of 81 cases including those with atypical
histologic features. Am J Surg Pathol 2005;29:845-58.
4. Lazarus SS, Trombetta LD. Ultrastructural identification of a
benign perineurial cell tumor. Cancer 1978;41:1823-9.
5. Miettinen M. Diagnostic soft tissue pathology. Philadelphia:
Churchill Livingstone; 2003. p. 363-5.
6. Ironside JW, Moss TH, Louis DN, Lowe JS, Weller RO. Diag-
nostic pathology of nervous system tumours. London: Churchill
Livingstone; 2002. p. 444-8.
7. Kusama K, Iwamoto A, Mikuni M, Komagamine M, Suzuki T,
Yamamura J, Kimura T. A case of central perineurioma (Lazarus
and Trombetta) of the mandible. J Nihon Univ Sch Dent 1981;
23:10-7.
8. Graadt van Roggen JF, McMenamin ME, Belchis DA, Rosen-
berg AE, Fletcher CDM. Reticular perineurioma. A distinct
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Volume 104, Number 1 Siponen et al. e43
8. variant of soft tissue perineurioma. Am J Surg Pathol 2001;
25:485-93.
9. Meer S, Coleman H, Altini M. Intraoral perineurioma: report of
a case with a review of the literature. Oral Dis 2003;9:99-103.
10. Barrett AW, Hopper C, Landon G. Intra-osseous soft tissue
perineurioma of the inferior alveolar nerve. Oral Oncol 2002;
38:793-6.
11. Damm DD, White DK, Merrell JD. Intraneural perineurioma—
not restricted to major nerves. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2003;96:192-6.
12. Huguet P, De la Torre J, Pallarès J, Carrera M, Soler F, Espinet
B, Malet D. Intraosseous intraneural perineurioma: report of a
case with morphological, immunohistochemical and FISH study.
Med Oral 2004;9:64-8.
13. Ide F, Shimoyama T, Horie N, Kusama K. Comparative ultra-
structural and immunohistochemical study of perineurioma and
neurofibroma of the oral mucosa. Oral Oncol 2004;40:948-53.
14. Mentzel T, Kutzner H. Reticular and plexiform perineurioma:
clinicopathological and immunohistochemical analysis of two
cases and review of perineurial neoplasms of skin and soft
tissues. Virchows Arch 2005;447:677-82.
15. Rankine AJ, Filion PR, Platten MA, Spagnolo DV. Perineu-
rioma: a clinicopathological study of eight cases. Pathology
2004;36:309-15.
16. Emory TS, Scheithauer BW, Hirose T, Wood M, Onofrio BM,
Jenkins RB. Intraneural perineurioma. A clonal neoplasm asso-
ciated with abnormalities of chromosome 22. Am J Clin Pathol
1995;103:696-704.
17. Giannini C, Scheithauer BW, Jenkins RB, Erlandson RA, Perry
A, Borell TJ, et al. Soft-tissue perineurioma. Evidence for an
abnormality of chromosome 22, criteria for diagnosis, and re-
view of the literature. Am J Surg Pathol 1997;21:164-73.
18. Brock JE, Perez-Atayde AR, Kozakewich HPW, Richkind KE,
Fletcher JA, Vargas SO. Cytogenetic aberrations in perineurioma.
Variation with subtype. Am J Surg Pathol 2005;29:1164-9.
19. Midroni G, Bilbao JM. Normal anatomy of peripheral (sural)
nerve. In: Biopsy diagnosis of peripheral neuropathy. Newton
(MA): Butterworth-Heinemann; 1995. p. 14-9.
20. Kazakov DV, Pitha J, Sima R, Vanecek T, Shelekhova K,
Mukensnabl P, Michal M. Hybrid peripheral nerve sheath tu-
mors: schwannoma-perineurioma and neurofibroma-perineu-
rioma. A report of three cases in extradigital locations. Ann
Diagn Pathol 2005;9:16-23.
21. Hirose T, Scheithauer BW, Sano T. Perineurial malignant pe-
ripheral nerve sheath tumor (MPNST): a clinicopathological,
immunohistochemical, and ultrastructural study of seven cases.
Am J Surg Pathol 1998;22:1368-78.
22. Senghore N, Cunliffe D, Watt-Smith S, Hollowood K. Extran-
eural perineurioma of the face: an unusual cutaneous presenta-
tion of an uncommon tumour. Br J Oral Maxillofacial Surg
2001;39:315-9.
23. Regezi JA, Sciubba J. Oral pathology. Clinical-pathological cor-
relations. 2nd ed. Philadelphia: Saunders; 1993. p. 485-6.
24. Pollock RA, Newman MH, Burdi AR, Condit DP. Congenital
hemifacial hyperplasia: an embryologic hypothesis and case re-
port. Cleft Palate J 1985;22:173-84.
25. Hoyme HE, Laurie HS, Jones KL, Procopio F, Crooks W,
Feingold M. Isolated hemihyperplasia (hemihypertrophy): report
of prospective multicenter study of the incidence of neoplasia
and review. Am J Med Gen 1998;79:274-8.
26. Gorlin RJ, Cohen MM, Hennekam RCM. Syndromes of the head
and neck. 4th ed. New York: Oxford University Press; 2001.
27. Chen L, Li Y, Lin JH. Intraneural perineurioma in a child with
Beckwith-Wiedemann syndrome. J Pediatr Surg 2005;2;E12-4.
Reprint requests:
Maria Siponen
Department of Diagnostics and Oral Medicine
Institute of Dentistry
P.O. Box 5281
90014 University of Oulu
Oulu
Finland
maria.siponen@oulu.fi
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e44 Siponen et al. July 2007
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