Neoplastic melanocytic pleural effusion in a Portuguese water dog

A 9-year-old castrated male Portuguese water dog was presented following incomplete excision of a malignant melanoma at the left lip commissure by the referring veterinarian. Physical examination was otherwise unremarkable. The patient was staged using thoracic radiographs, abdominal ultrasound, and fine-needle aspirates of the mandibular lymph nodes and spleen. Given the absence of any definitive evidence of metastasis, the malignant melanoma was surgically completely removed. The dog then received four melanoma vaccine doses as an adjuvant therapy and remained clinically healthy for more than 3 months after the last immunization. However, 232 days after the initial discovery of the lip mass, the dog was euthanized due to deterioration and a poor prognosis based on the presence of lung metastases and neoplastic melanocytic pleural effusion. The latter has been rarely reported in dogs, despite the high prevalence of oral malignant melanomas and the tendency of these tumors to metastasize to the lungs.

Radiotherapy in Fibrodysplasia Ossificans Progressiva: A Case Report and Systematic Review of the Literature

Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant disease, characterized by the formation of heterotopic ossification (HO) in muscles, ligaments, and tendons. Flare-ups, an inflammatory process that often precedes the formation of HO, can occur spontaneously, but trauma is also a common trigger. It is not known whether radiotherapy, especially in higher doses, might cause sufficient trauma or inflammation to trigger a flare-up and subsequent HO in FOP patients. We report the case of a patient undergoing radiotherapy for the treatment of a 1-cm-wide basal cell carcinoma (BCC) of the lower lip. In addition, we present a systematic review of the available literature. Our patient received 54 Gy in 18 fractions with orthovoltage therapy, resulting in a clinical complete response of the tumor. Six months after treatment, there were no signs of HO either clinically or on [¹⁸F]NaF PET/CT. The systematic review identified 11 publications describing either radiation treatment in FOP or radiation therapy as a cause of HO in non-FOP patients. Six case reports described the use of radiation in FOP patients for various reasons, including one with a high-dose treatment of a lip BCC using superficial X-ray therapy. The remaining five studies described the use of low-dose radiotherapy to prevent or treat either an FOP flare-up or HO formation. None of these cases showed worsening of disease that could be attributed to the use of radiation therapy. Radiation induced HO in non-FOP patients was rare and occurred in five studies. The largest of these studies suggested that HO was induced after treatment with high doses, resulting in more widespread evidence of tissue damage, potentially being the end result of this damage. In conclusion, available reports suggest no contraindication to radiotherapy in FOP patients; although the number of cases was small, systematic toxicity reports often were not available, and none of the reports described high-dose, high-energy radiation treatment at locations such as muscle and joint regions.

[A Patient with Lower Lip Verrucous Carcinoma Treated with a Tongue Flap for Functional and Esthetic Reconstruction]

Surgery is generally indicated for the treatment of lower lip carcinoma. However, surgery can lead to esthetic as well as functional issues, with disturbances in eating and articulation. If the defect involves less than one-third of the width of the lower lip, primary closure is possible. If the defect is wider, reconstructive local flaps may be necessary for both esthetic and functional recovery. This report describes a case of lower lip verrucous carcinoma in which a tongue flap was used to treat a defect involving more than half the width of the lower lip following resection. The patient was a 91-year-old woman who complained of lower lip discomfort. A biopsy revealed verrucous carcinoma, and we performed resection. After a 3-week waiting period, we performed secondary tongue flap reconstruction. Satisfactory function and cosmetic results were achieved.

Oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip: second case report

This communication reports the second known case of oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip. The patient, an 82-year-old black woman, a former smoker (for more than 30 years), suffering from an ulcerous vegetative lesion in the middle third of the lower lip for approximately 12 months. The result of the histopathological analysis indicated carcinoma, with well-differentiated keratinized squamous cells and the presence of septate mycelial filaments. In the direct mycological examination, thick and dematiaceous septate mycelial filaments were observed. After the resection surgery, the patient did not need to use an antifungal drug to treat the phaeohyphomycosis, and no follow-up radiotherapy was needed to treat the squamocellular carcinoma. We stress that the presence of the squamocellular lesion of the lip was a possible contributing factor to the infection.

Early diagnosis of lip cancer preceded by a persistent actinic lesion in a kidney transplant patient: a case report

Lip cancer is 65 times more likely to occur in kidney transplant patients than in members of the general population. Immunosuppression drugs taken by the transplant patients have been associated with this increased occurrence. This case report shows the progression from actinic cheilosis to squamous cell carcinoma (SCC) in the lower lip of a 58-year-old man receiving immunosuppressive therapy 9 years after undergoing a kidney transplant. Earlier incisional biopsies had resulted in a histological diagnosis of actinic cheilosis. However, the last incisional biopsy showed histological results compatible with SCC, and oncological surgery was performed. Eight months post-surgery, the patient was free of cancer and metastasis. Frequent dental follow-up visits allowed for the early diagnosis, proper treatment, and an improved prognosis for this patient.

Median cleft of the upper lip associated with a mass: a rare case

Median cleft lip is a midline vertical cleft through the upper lip. This is a very rare anomaly described in the literature. Median cleft lip is caused by the failure of fusion of the medial nasal prominences. In this case report, a 4-month-old boy with a median cleft associated with a mass of the upper lip is presented. The patient has no other anomalies of the nose or alveolus. The patient has normotelorism. A Z-plasty technique was used on the skin of the base of the columella. A vertical excision of the cleft with muscle approximation was performed on the white roll and the wet-dry border of either side of the defect of the upper lip. Postoperatively, the patient had a satisfactory result. The incisive scars were not visible. Cupid's bow was appropriately aligned, and the height of the upper lip was equal on both sides.

Acantholytic squamous cell carcinoma: pathological study of nine cases with review of literature

Squamous cell carcinoma (SCC) is classified in many subtypes or forms; one of them is the acantholytic squamous cell carcinoma, also called pseudoglandular, adenoid, epithelioma dyskeratoticum segregans, or adenoacanthoma. Researching and analyzing nine cases of acantholytic squamous cell carcinoma, we intend to verify if the data provided by the cases studied can be validated by the scientific literature. All the cases presented lesions found on the head and neck skin, with two exceptions - one on the larynx and the other one on the tonsil, all of them ulcerated lesions. In two cases, the tumors developed on the skin, in preneoplasic lesions (actinic keratosis). The tumors had dimensions between 4/3/4 mm and 100/90/36 mm. During one year, two of the cases studied presented multiple recurrences. We also found two cases of metatypical carcinoma accompanied the acantholytic variant of squamous cell carcinoma. None of the analyzed cases presented distant metastasis. The histopathological criteria for selection were: keratinised squamous tumor cell type, adenoid structures with round spaces with a defined wall of at least one cell width, spaces with isolated or grouped dyskeratotic acantholytic cells.

Keratoacanthoma in the inferior lip of an immunosuppressed patient. A case report

Keratoacanthoma is a lesion typical crater, symmetrical, rounded, rapid growth with high potential for self-involution. The lesions may be multiple, disseminated and associated with some syndromes. The etiology of keratoacanthoma is not known, but it is often observed in patients chronically exposed to sun. Histopathological features of keratoacanthoma may resemble those of a well differentiated squamous cell carcinoma. The hallmark of the disease is spontaneous resolution after an intermediary stationary stage. The majority of the cases is treated by surgical excision. For this reason, very few cases have been documented until resolution, which constitutes the gold standard for this clinic diagnosis. The aim of this article is to report a case of keratoacanthoma in the inferior lip of an immunosuppressed patient.

One-stage operation for noma-induced bilateral ankylosis accompanied with mouth verrucous carcinoma - a case report and review of literature

A rare case of a male patient who suffered from noma with sequelae of ankylosis in bilateral temporomandibular joints for 52 years and a neoplasm in the right commissure of the lips for 1 year, was operated on to resolve the ankylosis, remove the neoplasm and reconstruct the soft tissue defect with a forearm flap through a one-stage operation. The neoplasm pathology was verrucous carcinoma.

Erythematous indurated swelling on nose and upper lip. Cutaneous T cell lymphoma

A 40-year-old man presented for diagnosis with nodules and plaques of the nose and upper lip, progessive over 1(1/2) years.

Actinic cheilitis adjacent to squamous carcinoma of the lips as an indicator of prognosis

Many studies have shown an association between actinic cheilitis and squamous carcinoma of the lips.

AIM

The aim of the study was to observe the relation between actinic cheilitis and the prognosis of squamous carcinoma of the lips. MATERIALS AND METHODS This is a retrospective cross-sectional cohort study of squamous carcinoma of the lips. Histological sections of squamous carcinoma tumors done at the the Department of Pathology of the Sao Paulo Federal University between 1993 and 2000 were reviewed for evidence of actinic cheilitis in the lip vermillion adjacent to the tumor. Patient reports were reviewed to find information about exposure to sun, metastases and relapses. The occurrence or absence of relapses and metastases was correlated with the presence or absence of actinic cheilitis in the lip vermillion. Data was analyzed by Fisher's Exact test.

RESULTS

Of the 31 selected patients, most were caucasian, males and with lower lip involvement. Statistical analysis demonstrated independence between the occurrence of metastases and relapse and gender, skin color and site (lower or upper lips). There was dependence between actinic cheilitis and solar elastosis, and between the absence of actinic cheilitis and the occurrence of metastases. There was no dependence between the absence of actinic cheilitis and the occurrence of relapses.

CONCLUSION

It may be concluded that tumors originating from actinic cheilitis have a better prognosis.

A novel mutation of PTEN gene in a patient with Cowden syndrome with excessive papillomatosis of the lips, discrete cutaneous lesions, and gastrointestinal polyposis

Cowden syndrome is an inherited disease characterized by mucocutaneous lesions, gastrointestinal hamartomatous polyposis and an increased risk of breast, thyroid and endometrial carcinomas. Despite well described phenotypic expression of this disease, it is not easy to determine correct clinical diagnosis. In this case report we present a clinical history of a patient with Cowden syndrome. When he was 22 years old, he was found to have polyposis of gastrointestinal tract. The diagnosis of Peutz-Jeghers syndrome was established. Owing to intensive belly spasms, as a 36-year-old he was sent to another gastroenterological department where the thorough gastrointestinal tract examination was performed. We found glycogenic acanthosis of the esophagus; diffuse polyposis with large polyps within the stomach, and polyposis with small polyps in duodenum, colon, and rectum. We also noted the presence of excessive mucocutaneous papillomatosis of the lips and subtle skin lesions. Possible Cowden syndrome diagnosis was suggested. The same year he underwent plastic operation of the lips. During surgery, diffuse nodularity of the trachea was also noted. After plastic operation and assessment of Cowden syndrome as a possible diagnosis, he was recommended for a genetic examination. Diagnosis of Cowden syndrome was confirmed by sequencing analysis of the PTEN gene (phosphatase and tensin homolog deleted on chromosome 10). We found 'c.825_840delAAATACATTCTTCATA' deletion. This case affirmed that, for establishment of a correct diagnosis, especially for rare clinically overlapping syndromes, molecular testing is usually the only reliable method.

[A rare cause of dyspnea on exertion. A 76-year-old retired woman]

Es wird eine 76-jährige Nichtraucherin mit Gesichtshämangiomen und Anstrengungsdyspnoe vorgestellt. Krankheitsbild, Diagnose und Behandlung der pulmonalen AV-Malformation werden diskutiert und ein kurzer Überblick über den Morbus Osler vermittelt.

Malignant peripheral nerve sheath tumors of the head and neck: two cases and a review of the literature

Malignant peripheral nerve sheath tumors are uncommon lesions that occasionally affect the head and neck. We describe 2 new cases of head and neck pathology. One tumor involved the parotid gland and resulted in erosion of the temporal bone, and the other affected the lower lip. A rapid diagnosis has significant implications for management because of the tumor's potential for aggressive behavior and its high rate of recurrence. To the best of our knowledge, lip involvement is rare and temporal bone involvement has not been previously described.

Functional lower lip reconstruction with a forearm flap combined with a free gracilis muscle transfer

We applied a forearm flap combined with a gracilis muscle flap for total reconstruction of the lower lip. The motor nerve of the gracilis muscle was repaired to the buccal branch in the cheek. The patient obtained good sphincter function for eating and speaking, and he could inflate a balloon without air leakage.

Oral bowenoid papulosis in an HIV-positive male

Bowenoid papulosis (BP) is a condition triggered by human papillomavirus infection and characterized by the development of 1 or more warty lesions, usually in the anogenital region. Although the oral cavity has been known to host several types of warts, thus far only 4 cases of BP have been reported in this anatomic site. We describe a 42-year-old male with AIDS who presented with numerous papillary lesions of the labial mucosa and vermilion. Biopsy yielded a diagnosis of BP. Treatment of the condition consisted of intralesional and subcutaneous injections of interferon-alpha followed by topical application of imiquimod 5% cream. Neither regimen resulted in resolution of the lesions. To our knowledge, this represents the first case of BP arising in the oral mucosa of an HIV-infected individual.

Acral necrotizing mycosis fungoides

A 65-year-old male with long-standing acral "eczema" and patches of mycosis fungoides suddenly developed a transformed, necrotizing ulcerative cutaneous T-cell lymphoma manifesting as necrotic lesions of the toe and lip. The tumor had brown and/or black eschars on the surface and grew multiple opportunistic organisms. Markers CD3, Epstein-Barr virus-encoded small RNA, and T-cell receptor g gene rearrangement were positive, with CD4, 8, 30, 56, and TIA-1 negative. In spite of initial response to radiation, the patient succumbed to infection within 3 months.

Cheilitis glandularis: A clinical marker for both malignancy and/or severe inflammatory disease of the oral cavity

We report the case of an 84-year-old white male who underwent vermilionectomy for removal of a tumor, which proved to be squamous cell carcinoma. Chelitis glandularis related to marked actinic damage was noted at a subsequent visit. The presence of chelitis glandularis should be investigated for the presence of neoplasia, immunosuppression, or inflammatory diseases related to extremely poor oral hygiene.

Low grade multiple myeloma that presented as a labial swelling — A case report

Myeloma is a disease of the bone marrow in which there is malignant proliferation of plasma cells. Myeloma is usually associated with the accumulation of a monoclonal immunoglobulin or light chains in plasma and subsequently an increase in light chains in the urine (Bence-Jones proteins). Renal failure can occur and bone destruction in the axial skeleton may ensue with pain and fractures. Amyloidosis associated with multiple myeloma is a relatively common finding. The most frequently reported oral sign of amyloidosis is macroglossia. There are numerous cases in the literature of amyloid deposition in tongues related to multiple myeloma. However, none of these cases describe amyloid deposition surrounding arteries in the oral cavity. We therefore report a case of an innocuous lower labial swelling, which subsequently led to the diagnosis of amyloid deposition surrounding an artery, the cause of which was later shown to be multiple myeloma.

[The rare occurence of fibrolipomas]

INTRODUCTION

The article describes rarely occurring fibrolipomas, which belong to the group of bening tumors. They are more frequent in males than in females, built mostly of fibrous connective tissue. Their surface is shiny, pink and plain. They are well separated from the surrounding tissues. The treatment of fibrolipomas is only surgical. Because there are few cases found in reference material, it seems right to present this problem here.

MATERIAL AND METHODS

6 patients were treated in the Oral Surgery Department of Medical University, between 1995-2004, because of the fibrolipomas. One of the six tumors was located on the upper lip, the remaining ones on the right or left buccal mucosa. All tumors occured in males, 60 years of age or above. The interwiev revealed that the tumor had begun growing 5-8 years before and their growth was painless. Medical history was irrelevant. Intra-oral examination revealed oval tumors of different size, on a wide base, ranging from a walnut to a mandarin. One of the six tumors (7,5 x 6,5 x 6 cm) protryded even when the mouth was shut. The surface of the tumors was plain, shiny and pink. They were easily movable against the seat, soft and painless. Performed morphology tests were normal. Because of clinical suspicion of fibrolipomas, there was no earlier histopathological verification, and the patients were qualified for surgical treatment. In local anaesthesia with 2% Lignocaine, the tumors were excised with the margin of surrounding tissue. Postoperative wounds were sutured in layers. The material was then sent to histopathological examination.

RESULTS

Received results of histological examination confirmed the preliminary diagnosis of fibrolipoma. In the course of treatment attention was paid on the symptoms of pain, oedema of the operated region and the healing of postoperative wounds. In the group of six patients, only in one case (where the tumor was located on the upper lip), oedema and pain complaints of the operated region were observed up to 2 days after the surgery. In the other patients the postoperative course was uneventful. The follow-up examination performed after 5 months and 4 years did not reveal any recurrences.

CONCLUSIONS

Fibrolipomas occur usually in adults and are extremely rare in children. The asymptomatic course, allows them to grow for many years. In most cases, it is the cosmetic background that prompt the patients to seek dental assistance. Longterm interview and the clinical assessment of the tumor are the basis for the preliminary diagnosis. Nevertheless the final diagnosis must always be confirmed by histological examination.

Congenital double lip associated to hemangiomas: report of a case

Double lip is a developmental abnormality which may occur either isolated or as a component of Aschers syndrome. A case of congenital double lip associated to hemangiomas and enlargement of the thyroid is reported. The oral and facial hemangiomas were excised under local anesthesia. Surgical reconstruction of the upper lip was done in order to reduce the interference with speech and mastication. The recognition and treatment of these abnormalities are discussed.

Schwannoma of the upper lip: a case report

Schwannomas are neurogenic tumors that arise from the Schwann cells of the nerve sheath. They are benign, usually solitary, and encapsulated neoplasms. In this report, a 29-year-old woman with a complaint of painless swelling in the upper lip is presented. Computed tomography showed a well-circumscribed solid mass. The lesion was excised and histopathologic diagnosis was made as schwannoma. The postoperative course was uneventful. No recurrence was observed during a follow-up period of 12 months.

Microcystic adnexal carcinoma: an unusual cause of swelling and paraesthesia of the lower lip

Microcystic adnexal carcinoma (MAC) is an uncommon, recently described, cutaneous adnexal malignant neoplasm, associated with significant morbidity as a consequence of its propensity for perineural invasion. The present report details the clinical and histological features of MAC in a young female presenting with lower labial swelling and paraesthesia.

[Etiology of lip defects]

Lips repair cannot be considered until the characteristics of the loss of substance which are given by its aetiology, has been carefully determined. Traumatic aetiologies remain dominated by accidents on the public roads associated more often with adjacent damage. Dog bites remain the burden of children and always raise the problem of their septicity. For burns there is a need to wait for the organism to delimit its own viable tissues. Ballistic traumatisms will lead to major damage where functional repair to the lips can often be very difficult. Tumours of the lips, essentially malignant, lead to wide exeresis, where the margins are dictated by histological findings. They, of course, pose the problem of eventual neck node dissection and are dominated by squamous cell carcinomas.

Basal cell carcinoma arising in a cleft lip repair scar

BACKGROUND

A case of basal cell carcinoma (BCC) developing in the repair scar of a cleft lip is presented.

OBJECTIVE

Primary BCCs arising in surgical scars are very rare and no known reported cases exist of a BCC developing in a surgically repaired cleft lip scar.

METHODS

A 69-year-old white man presented with a 5 mm primary BCC on his upper lip at the site of his cleft lip repair scar. The diagnosis was made by a tangential biopsy that showed an ulcerated BCC.

RESULTS

Review of the medical literature indicates that a scar may be an independent risk factor for developing BCC.

CONCLUSION

BCC may rarely arise in a cleft lip repair scar.

Large granular lymphocyte leukemia and its association with oral neutropenic ulcerations: a case report

Large granular lymphocyte leukemia is a rare chronic indolent disorder commonly associated with severe neutropenia. The pathogenesis of the neutropenia is unclear. A case is presented of a 74-year-old man who had recurrent oral ulcerations for over a year before a diagnosis was made. These recurrent oral ulcers cleared with treatment and have not returned. The differential diagnosis of persistent oral ulcerations includes trauma; viral, fungal, and bacterial infections; systemic disease; or various malignant conditions. The oral ulcers in this man were likely infectious in nature and related to the severe chronic neutropenia. This case serves to illustrate the potentially complex nature of oral ulcers.

p53 intronic point mutation, aberrant splicing and telomeric associations in a case of B-chronic lymphocytic leukaemia

We report a case of chronic lymphocytic leukaemia (CLL) with telomeric associations and a p53 intronic point mutation. Karyotypic analysis revealed clonal and non-clonal telomeric associations, accompanied by clonal cytogenetic abnormalities and also in isolation. The p53 mutation, which occurred at the invariant base pair -2 of the splice acceptor site in intron 7 resulted in the abolition of correct splicing of exon 7 to exon 8. Multiple aberrant splice products were characterized, all of which differed from wildtype in the DNA binding domain. Fluorescence in situ hybridization demonstrated that the clone retained two copies of the p53 gene and wild-type p53 transcript was detected on cloning of reverse transcriptase polymerase chain reaction (RT-PCR) product, indicating that one wild-type allele remained. However, a plasmid clone with correct splicing at the exon 7/8 boundary, but with a 21 bp deletion in exon 8, was also found at low frequency. This finding indicates clonal evolution, resulting in complete loss of wild-type p53. The intronic point mutation was not present in DNA extracted from cervical tissue indicating that it was a leukaemic phenomenon. This is the first case of an intronic point mutation to be reported in CLL. This mutation led to chaotic p53 expression and, interestingly, occurred in a case showing telomeric associations, a rare phenomenon in B-CLL.

[Carcinoma of the lips developing in discoid lupus erythematosus]

OBJECTIVE

This clinical study was designed to learn the diagnosis and treatment of lip carcinoma developing in discoid lupus erythematosus.

METHODS

One hundred and eighty-one of squamous cell carcinoma of the lips treated in our department from 1980 to 1995 were retrospectively studied.

RESULTS

Ten cases of the 181 lip carcinoma (5.5%) had concomitant discoid lupus erythematosus (DLE) of the vermilion border of the lower lip.

CONCLUSION

Bleomycin or radiotherapy is the best treatment for the disease.

A young woman with xeroderma pigmentosum complementation group F and a morphoeic basal cell carcinoma

We report an 18-year-old Japanese woman who had mild photosensitivity and a facial tumour, which was shown to be a morphoeic basal cell carcinoma. Although a line of fibroblasts derived from the patient, Kps6 cells, were slightly more sensitive to UV irradiation than normal cells, their level of unscheduled DNA synthesis was about 20% that of normal cells, and recovery of RNA synthesis after UV irradiation was moderately depressed. Complementation tests, carried out by cell fusion or by microinjection of plasmids harbouring xeroderma pigmentosum (XP) genes, indicated that the patient had XP group F. To our knowledge, this is the youngest XP group F patient with a malignant tumour reported to date.

Squamous cell carcinoma complicating lichen planus: a clinico-pathological study of three cases

Squamous cell carcinoma complicating lichen planus is described in 3 patients. In 2, the cancers developed on the lower leg in chronic and hypertrophic lichen planus. In the other case, the cancer complicated lichen planus of the lip mucosa in a smoker. In the two cutaneous cases, the tumour and the adjacent skin showed features of lichen planus, including hypergranulosis, cytoid bodies and a lichenoid infiltrate. The association, though rare with cutaneous lichen planus when it tends to affect chronic hypertrophic lesions on the lower legs, is now well recognized with oral lichen planus. Patients with oral involvement warrant long-term follow-up, especially if they have other risk factors such as smoking or excessive ultraviolet exposure. Chronicity of lichen planus at other skin sites may also be a risk factor.

[Radiation complications in the combined treatment of cancer of the oropharyngeal area]

A follow-up of 236 patients exposed to combined radiotherapy, carried out at the Chelyabinsk oncologic center, has shown that 27 (11.4%) of these patients developed radiologic complications, 18 (7.6%) developed ulcers and 9 (3.8%) osteomyelitis. Radiation ulcers occurred in 6.7% of the patients with cancer of the oral cavity fundus mucosa, osteomyelitis in 9%. In the patients with lingual carcinoma the complications occurred in 4.6 and 10.8%, respectively, in those with cancer of the lower lip radiation ulcers developed in 3.5% of patients, whereas osteomyelitis did not occur. Radiation injuries developed mostly in the patients with large tumors located near osseous structures. The authors emphasize a careful follow-up of this patient population, particularly in the earliest period after the irradiation.

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

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

[Unusual manifestations of squamous carcinoma of the lip]

We present a case of squamous cell carcinoma of the lip with metástasis to the mandible and meningeal involvement causing multiple cranial nerve palsies. Biopsy proven metástasis to the mandible was demonstrated. Studies of CT scan of the head were negative. Extension through perineural space have been speculated.

[A case of a particularly destructive carcinoma of the lip]

We present a case of squamous-cells carcinoma of the inferior lip in a man at the age of 59 years, of particular interest either of the extension and infiltration of the neoplasia, of considerable longevity, since the patient had his first operation for the removal of the tumour. Fifteen years ago he had radiotherapy and it was found he had no visceral metastases. The outcome of the patient stage, had increased the neoplasia, which depended on the overall isolated condition in which he lived.

Focal dermal hypoplasia syndrome with incomplete transverse facial cleft and tumour of the lips

A case of Goltz's syndrome complicated with both incomplete transverse facial cleft and characteristic tumour of the upper and lower lips is presented. Tumour excision and repair of defect were successfully performed.

Thick lips, bumpy tongue, and slipped capital femoral epiphysis--a deadly combination

Multiple endocrine neoplasia type 2b (MEN 2b) is a rare genetic disorder. Affected individuals have malignant thyroid tumors, pheochromocytoma, and ganglioneuromatosis. The musculoskeletal manifestations of MEN 2b include a Marfanoid habitus, pes cavus, scoliosis, slipped capital femoral epiphysis, joint laxity, poor muscle development, and delayed maturation. The initial clinical presentation of MEN 2b frequently involves the musculoskeletal system. The characteristics ganglioneuromatosis of the lips and tongue, however, should alert the orthopedic surgeon to the underlying disorder. Effective treatment of the malignant neoplasms hinges on early diagnosis. The risk of perioperative hypertensive crisis is significant; it may be prevented by appropriate treatment of the pheochromocytoma.