[Soft palate chronic lymphocytic leukemia]

INTRODUCTION

Forty percent of non-Hodgkin lymphoma (NHL) are located in extranodal sites. The palatal location of chronic lymphocytic leukemia (CLL) is usually observed at a late stage of the disease.

CASE

We report the case of a 62-year-old male patient managed for 8 years for CLL, having presented with a soft palatal tumor in the last 2 years. The diagnosis of CLL was made by immunohistochemistry. The patient was given 6 courses of chemotherapy combining fludarabine, cyclophosphamide, and rituximab.

DISCUSSION

The diagnosis of CLL requires immunohistochemistry. Chemotherapy is the first line treatment. The complication may be an aggressive lymphoma (Richter).

[Invasive aspergillosis of the maxillary sinus in an immunocompetent patient]

INTRODUCTION

Invasive aspergillosis of the maxillary sinus is a severe infection most commonly observed in immunocompromised patients. We report a pseudo-tumoral presentation of invasive aspergillosis of the maxillary sinus, in immunocompetent adult.

CASE REPORT

A 70-year-old female patient consulted for chronic rhino-sinusitis resistant to medical treatment. Computed tomography scan revealed a hyperdense mass filling the left maxillary antrum, with erosion of sinus walls. The ethmoidal and right frontal sinuses were involved. The histological and mycological examination of the surgical resection confirmed the diagnosis of invasive aspergillosis. The patient was given voriconazole as first line treatment. The outcome was good at 18 months.

DISCUSSION

Invasive aspergillosis of the maxillary sinus is a rare disease, usually observed in immunodepressed patients. It is very rarely observed in immunocompetent patients.

[Maxillary T/NK lymphoma. Case report]

INTRODUCTION

Primary nasal T/NK cell lymphoma is a very rare pathological clinical entity; it was defined by the WHO in 2001, thanks to immunohistochemistry. The treatment combines radiotherapy and chemotherapy. We report a case.

CASE REPORT

A 20-year-old male patient was admitted for ulceration of the vestibular mucosa from tooth 20 to 26, in June 2008. The lesion had appeared four months before, with a painful ulceration close to tooth 25. The lesion evolved progressively, it eroded the alveolar bone, exposing the roots of teeth 24, 25, and 26. CT scan revealed lysis of the external maxillary sinus wall. The diagnosis of T/NK cell lymphoma was obtained by immunohistochemistry of the biopsy. The tumor was staged IeA according to the Ann Arbor classification. After four courses of CHOP chemotherapy and two years of follow-up there was no recurrence.

DISCUSSION

Maxillary T/NK cell lymphoma is extremely rare. The diagnosis is based on immunohistochemistry. The treatment associates chemotherapy and radiotherapy. Recent studies suggest that radiotherapy at an early stage could improve the prognosis. But there is no consensus on therapeutic protocols.

[Leiomyosarcoma of the parotid gland]

INTRODUCTION

Primary leiomyosarcoma of the parotid gland is an extremely rare neoplasm, develops from smooth muscle cells. Its primary origin in the face and especially in the salivary glands is even more rare.

CASE REPORT

A 15-year-old boy, with no prior history was hospitalized for swelling in the left parotid area having appeared 5 months before. The mass was painless and there was no facial paralysis. CT scan showed a tumoral process of mixed density in the left parotid gland. Thoracoabdominal CT scan was normal. Conservative parotidectomy was performed. The histological diagnosis was primary leiomyosarcoma of the parotid gland.

DISCUSSION

Five per cent of salivary gland primitive tumors are of mesenchymatous origin, of which 0.3 to 1.5% are sarcoma. The diagnosis of leiomyosarcoma of the parotid gland is confirmed by histological and immunohistochemical assessment. Surgery sometimes combined to radiochemotherapy seems to be the treatment of choice.

[Plantar forefoot lipoma: an uncommon case report]

The plantar tumors of soft tissues are rare and are characterized by their slow and asymptomatic evolution, which delays their diagnosis. The authors report an exceptional case of plantar foot lipoma. The diagnosis was suspected by magnetic resonance imagery, which represents the technique of choice for the investigation of soft tissue tumors of the foot. The surgical treatment made the histological diagnosis and restored a normal and painless plantar support. The lipoma, in spite of its exceptional localization at the plantar level, will have to be evoked like differential diagnosis of the benign tumors of the foot.

[Desmoplastic ameloblastoma in a 7 year old child]

Desmoplastic ameloblastoma is a benign, locally aggressive neoplasm of proliferating odontogenic epithelial origin. It is seen among old patients from 17 to 72 years with an average age 42 years and without predilection of sex. We report the case of a 7 year old child, having presented since the 5 years age, a gingival tumefaction on the left higher incisivo-canin group which increased volume gradually. The stomatologic examination showed a gingival tumefaction covered with a healthy mucous membrane, ovoid form and measuring 3 cm on its horizontal axis. The tomodensitometry of the jawbone showed in front of the 21st and the 22nd tooth, the presence of an osseous lesion associating of the hearths of osteolysis and osteocondensation with rupture of cortical and invasion of the soft tissue. A curetting of the lesion was carried out and the anatomopathologic examination retained the diagnosis of desmoplastic ameloblastoma. The characteristic of our observation is the youth of the patient. In addition, the desmoplastic ameloblastoma is relatively rare, is characterized by an anatomical distribution, a radiological appearance and a morphological aspect differents from the traditional ameloblastoma. A radical surgical treatment is suggested for this tumour to avoid recurrency.

Métastase maxillaire révélatrice d'un cancer de prostate

CASE

A 57 year-old-man presented with a maxillary tumor which proved to be an adenocarcinoma. The prostate was hard and PSA were high. Biopsy confirmed the diagnosis of metastatic prostatic adenocarcinoma. Evolution was fatal despite a medico-surgical treatment.

DISCUSSION

Facial bone metastases are rare comparatively to the high metastatic incidence in the rest of the skeleton.

Expansion cutanée dans les alopécies cicatricielles du cuir chevelu: 18 cas

INTRODUCTION

Skin expansion technique used to increase the hair surface available at the scalp level was a major breakthrough in the surgical treatment of important cicatricial alopecia. This article had for aim to define the importance and limits of this technique in the treatment of alopecia and to highlight its relevance compared to other methods.

PATIENTS AND METHODS

Between November 1998 and April 2006, 18 patients (7 women and 11 men) presenting with one or many cicatricial alopecia areas were treated by skin expansion. The age of patients ranged between 14 and 68 years, with an average of 33 years. The indications were related to burn sequels in 44% of all cases. The average area of alopecia was 167 cm2. This technique combines two operating phases. In the first phase, the expansion balloon is inserted and then gradually filled. In the second phase, it is removed and the alopecic area is covered by the expanded flaps.

RESULTS

Thirty-nine expansion prostheses were used, with an average volume of 292 cc. Their number varied between 1 and 6 (two on average) for each patient. The average duration of expansion was 77 days. The tissue gained with this technique allowed the use of 38 flaps. The transposition flaps was the most frequently used (39.4%). The rate of major complications leading to total failure of the process reached 5.5%. The final result was considered good in 90% of the cases.

DISCUSSION

The results demonstrate that skin expansion technique is a simple, reliable, and efficient method in the healing of important cicatricial alopecia of scalp. It enables a wider use of the classical local flap technique, by expanding the surface and vascularization allowing for a direct suturing of the donor site. Skin expansion holds an important place in the treatment of significant skin cicatricial alopecia, since it represents the only surgical solution when the alopecia area exceeds 50 cm2.

[Ganglioneuroma of the zygoma]

INTRODUCTION

Ganglioneuroma is an uncommon benign tumor that arises from the sympathetic nervous system accounting for less than 1% of all soft-tissue neoplasms.

CASE REPORT

We report the case of a 22 year-old man who presented a ganglioneuroma localized in the zygoma.

DISCUSSION

Ganglioneuroma generally develop in the abdomen or thorax soft tissue. The occurrence of ganglioneuroma in the bone is exceptional. To date less than ten cases have been reported, six of which involved the mandible. We discuss the possible causes of tumor development at this site.

[Natal teeth: apropos of five cases]

INTRODUCTION

The normal eruption of primary teeth begins with mandibular incisors about the age of 6 months. There are several qualifiers used to describe prematurely erupted teeth. Massler and Savara defined "natal teeth" as teeth present at birth and "neonatal teeth" as teeth erupted within the first month of life. The aim of this study, based on 5 cases, is to present clinical and structural characteristics, etiology, management techniques, complications and a review of the literature for natal teeth.

MATERIAL AND METHODS

Our study is a retrospective study of 17,000 infants who were examined in the Neonatal Department of Children Hospital between 1984 and 2001. The material consisted of 5 infants with natal teeth, identified by the pediatrician. We analyzed the family history, the pregnancy history, the gender, the etiology, the complete examination of the infant, the clinical, the structural characteristics, the complications and the management of the teeth.

RESULTS

We found 4 boys and 1 girl, 2 of the newborns were premature, all of them observed to have natal teeth. The incidence was 1: 3,400 births. There were 14 natal teeth, 10 incisors (70%) and 4 canines (30%), no molar was found. Nine of the teeth (6 incisors and 3 canines) were maxillary (65%) and 5 (4 incisors and 1 canine) were mandibular (35%). No morphological syndrome was discovered. Most of the teeth were mobile in all directions and were extracted because of the possibility of aspiration, the difficulty in feeding and the ulceration of the ventral surface of the tongue.

DISCUSSION

According to the literature, this phenomenon is rare and the incisors are the teeth most commonly involved. Natal teeth are more common than neonatal teeth and nearly 90% of these teeth are the normal primary teeth. The presence of natal teeth is due to several factors related to an unknown cause of disturbed biological chronology. There is no conclusive evidence of a correlation between early eruption and systemic disorders, but some investigators suggest that natal teeth may be associated with certain syndromes. We must keep in mind that radiographic examination is essential for the differential diagnosis between supernumerary and normal primary teeth. The supernumerary teeth should always be extracted but the decision to extract a normal mature natal tooth should be done according to scientific knowledge, mobility of the tooth, local or general complications and parental opinion.

[Orbito-temporal plexiform neurofibroma: 6 cases]

INTRODUCTION

Orbito-temporal plexiform neurofibroma is characteristic of Von Recklinghausen neurofibromatosis. We report 6 cases of orbito-temporal plexiform neurofibromas and review different aspects of diagnosis, course and treatment.

PATIENTS AND METHODS

Six patients, 4 males and 2 females, with orbito-temporal plexiform neurofibromas were treated between 1986 and 2003. Patient age varied between 10 and 29 years (age average=19). Computed tomography and magnetic resonance imaging were performed in all 6 patients. Surgical resection of the neurofibroma was performed in all patients.

RESULTS

The tumor was located on the left in 5 cases and on the right in one. Spheno-orbital dysplasia was found in all patients and was associated with fronto-temporal meningoencephalocele and pulsate exophthalmia. Surgical resection enabled reduction of the neurofibroma. Exenteration was performed in all patients because of a nonfunctional eye. Two patients underwent cure of fronto-temporal meningoencephalocelus with reconstruction of the large wing of the sphenoid using an iliac bone graft and a titanium plate.

DISCUSSION

Surgery is essential for orbito-temporal plexiform neurofibroma but is usually difficult, particularly when the tumor has developed increasing the risk of hemorrhage. Bony reconstruction is difficult considering the risk of progressive osseous dysplasia. The cosmetic results achieved in this patient were considered good.

[Non-Hodgkin's malignant lymhoma of mental soft tissue: a case report]

Non-Hodgkin's malignant lymphoma is rarely located in the soft tissue of the chin making diagnosis difficult. Clinical signs are non-specific: progressive weight loss, asthenia, fever, an inflammatory tumefaction unresponsive to medical treatment. Imaging shows a homogeneous tumefaction of the soft tissues. Pathology and immunohistochemistry establish the diagnosis.

[Ameloblastoma of the mandible]

Ameloblastoma is a benign tumor of the jaws. The mandible is affected more often than the maxilla. Conservative treatment or radical resection may be indicated. We reviewed our experience with 16 cases of ameloblastoma. We concluded that radical resection is more appropriate despite the sequelae.

[Nodular fasciitis or pseudosarcoma]

Nodular fasciitis is a benign neoplastic and reactive proliferation of fibroblasts of soft tissues, which is often mistaken for a sarcoma because of its rapid growth, rich cellularity and mitotic activity. A case is reported that provides the opportunity to discuss the specific clinical and pathological features of nodular fasciitis.

[A very unusual complication of the extraction of a wisdom tooth]

We report here a case of a 42-year-old man who presented a major complication during wisdom tooth extraction. Secondarily after an extraction attempt to tooth migrated into the temporal fossa which required hemi-coronal surgical removal. We present a description of the surgical technique.

[Iatrogenic cervicofacial hydatid cysts. Apropos of a case]

The writers give an account of a cervicofacial hydatid dissemination case, provoked by iterative ponctions of hydatid cyst initially isolated in the left maxillary sinus. They state diagnostic and therapeutic difficulties sometimes found and they insist on the role that must be played by immunologic tests in diagnostic approach and treatment monitoring of this disease which is unfortunately current and serious.