Radiosensitive hemangiopericytoma in the soft palate

Imaging Findings in AIDS-related Oral Kaposi's Sarcoma

Kaposi's sarcoma (KS) is one of the most common diseases in patients with acquired immunodeficiency syndrome, but is rarely encountered in dental practice in Japan. We encountered a case of oral KS (OKS) presenting in the hard palate, gingiva, and tongue in a 41-year-old man. We report the results of imaging, including computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT in this case. The process leading to an imaging diagnosis of OKS is discussed, emphasizing the importance of collating clinical, laboratory, pathological, and radiological findings. The present results suggest that mapping of accurate tumors is very important in cases of OKS, and that multiple or bilateral manifestations, ill-defined margins, osteolysis, and swollen lymph nodes, in particular, need to be taken into account.

A case of hemangiopericytoma of the soft palate with articulate disorder and dysphagia

We report a case of hemangiopericytoma of the soft palate of 60-year-old patient, who noticed a mass of the soft palate and experienced difficulty in speaking. We found a pediculate, hard, elastic mass measuring 38 mm (cross-sectional diameter). Computed tomography (CT) scans and dynamic magnetic resonance imaging (MRI) confirmed irregularly shaped mass and revealed a heterogeneous internal composition, consistent with vascular tumors. We excised the tumor under general anesthesia. Histopathological diagnosis was based on positive immunoreactivity of CD99 and vimentin and weak, positive staining of CD34. Three and half years following tumor excision, there is no recurrence or metastasis.

Solitary fibrous tumor with atypical histological features occurring in the palatine tonsil: an uncommon neoplasm in an uncommon site

Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm that usually arises in the pleura. Although this tumor has been described in other sites, including the head and neck area, in the oropharynx it is extremely rare. We report the first case of a SFT arising from the palatine tonsil of a 62-year-old man. The tumor consisted of spindle-shaped cells distributed in a haphazard pattern and presented atypical histological features such as hypercellular areas and high mitotic count. Immunohistochemical studies showed strong positivity for CD34 and bcl-2, and weak positivity for desmin. Smooth muscle actin, S-100 protein and cytokeratines were negative. The patient was well without disease 1 year after surgery.

A case of haemangiopericytoma-associated hypoglycaemia: Beneficial effect of treatment with radiotherapy

A 72-year-old lady presented with recurrent hypoglycaemia and a large pelvic mass. Hypoglycaemia was accompanied by undetectable serum insulin and c-peptide and high insulin-like growth factor II (IGFII) to IGFI ratio. She had undergone successful resection of a large bladder haemangiopericytoma 7 years earlier. A core biopsy was performed, and histology confirmed the recurrence of the haemangiopericytoma. Local palliative radiotherapy resulted in the reduction of IGFII level and IGFII to IGFI ratio and increased insulin, c-peptide and growth hormone (GH) level with long-term amelioration of hypoglycaemic episodes. Clinically and biochemically, radiotherapy was more effective than GH therapy.

Hämangioperizytom (extrapleuraler solitärer fibröser Tumor)

BACKGROUND

Hemangiopericytoma was first mentioned in 1942. It is a very uncommon potentially malignant vascular tumour which can occur at every site of the body. According to the WHO, most of the tumours formerly diagnosed as hemangiopericytomas are considered to be extrapleural solitary fibrous tumours. The diagnosis of "hemangiopericytoma" is now only determined if a constant histological picture of hemangiopericytoma is present. The tumour can lead to lymphogenous or hematogenous metastasis. The major location of occurrence is the cutis and subcutis. It originates from the pericytes of the vascular wall. This is reflected in its vascular character and therefore the hemangiopericytoma might clinically be mistaken for a hemangioma.

CASE REPORTS

Patient 1: 60 years, female; diagnosis: malignant suboccipital hemangiopericytoma; size: 4.9 x 4.5 x 4.2 cm; pT1bNXMX L0 V0 Pn0; stage IA; grading G1; R0.Patient 2: 38 years, male; diagnosis: benign hemangiopericytoma infraorbital left; size 1.5 x 1.5 x 1.5 cm.

DISCUSSION

Most often the hemangiopericytoma becomes clinically conspicuous as a slowly growing, painless swelling. The consistency ranges from soft to dense, and the color is greyish-blue. The slow and painless growth carries the danger of a clinically wrong diagnosis and thus delayed therapy. The histological diagnosis of hemangiopericytoma is determined by biopsy. Besides histology, MRI and angiography are methods that can be employed to diagnose hemangiopericytoma. The therapy of choice is the complete tumour-resection with a safety margin of 1 cm. In the case of an aggressive growth pattern, adjuvant postoperative radiotherapy is recommended. Until now there has been no documented specific therapy concept for managing incomplete resection and the occurrence of metastasis. There are reports about chemo- and radiotherapy either on their own or combined which evidence differing degrees of success. Lifelong monitoring is necessary because recrudescences and metastases can occur even decades later.

Haemangiopericytoma of the maxillary gingiva: report of a case

AIM

Haemangiopericytoma (HPC) represents approximately 3% of all tumours in the head and neck. This tumour is a soft tissue tumour derived from mesenchymal cells with pericytic differentiation. We present the clinicopathological findings of a case.

MATERIALS AND METHODS

A 69-year-old man was referred to our Department for a mass located on the right pre-molar maxillary gingiva; this mass caused problems during chewing, but was otherwise asymptomatic.

RESULTS

Clinical examination revealed a nodular, pink lesion, 3.5 cm in diameter, which was lined with normal mucosa. The lesion was mobile in relation to the deep and superficial tissues. Microscopic analysis of the neoplasm showed a vascular rich pattern, constituted by vessels covered with flat endothelium and surrounded by abundant spindly cells. On the basis of these histological and immunohistochemical findings, the final diagnosis was HPC.

CONCLUSIONS

HPC is an uncommon vascular tumour for which the biological behaviour is difficult to predict. In our patient, no recurrences or distant metastases were present at a 4 years follow-up.