Cervical tularaemia in a non-endemic area

Tularemia is a zoonotic disease caused by Francisella tularensis. The microorganism is transmitted to humans by contact with, or ingestion of, infected animal tissues, by insect bites, consumption of contaminated food or water, or from inhalation of aerolized bacteria. In this report we describe a case of tularemia presenting with multiple cervical lymphadenitis in Asturias (Spain). Final diagnosis was established based on a serological test. The patient was successfully managed with surgery and streptomycin for 2 weeks. The ulceroglandular form of tularemia should be considered in the differential diagnosis of cervical lymphadenitis, particularly in those not responding to penicillin treatment. To our knowledge, this is the first case described in Asturias, a north coast county of Spain

Lemierre’s Syndrome: a serious complication of an odontogenic infection

Necrobacillosis, postanginal septicaemia or Lemierre’s Syndrome is characterised by suppurative thrombophlebitis of the internal jugular vein with embolization to several sites, including the lungs. We report the case of a 38-year-old man who was initially hospitalized because of odontogenic cellulitis. Given the deterioration of his clinical state (septic shock and multiple organ failure), neck computed tomography was performed, revealing both cervical and parotid abscesses, and thrombosis of the right internal jugular vein. Streptococcus salivarius was isolated. The patient was treated with intravenous antibiotics, and surgical drainage and after 6 weeks of treatment, recovered completely. Lemierre’s Syndrome is an uncommon, but potentially lethal complication of an odontogenic infection. The case reported here is interesting since the pathogen and the site of primary infection are unusual. Fusobacterium necrophorum is the most common pathogen in Lemierre’s Syndrome, and to the best of our knowledge there are no similar case reports with Streptococcus salivarius as the causative bacteria. Early recognition and high-dose antibiotics are critical elements in reducing mortalit

Odontoma intraóseo erupcionado: una infrecuente patología

Objetivos: Los odontomas que afectan a los tejidos blandos son muy infrecuentes, pudiendo presentarse bajo dos formas clinicas: odontoma periférico y odontoma erupcionado. Se documenta un caso de odontoma erupcionado con el objetivo de discutir entre ambas formas de presentación clínica de esta patología. Diseño del estudio: Estudio de caso. Resultados: Se presenta el caso de un varón con una masa dura localizada en la región posterior del reborde alveolar izquierdo del maxilar superior, de un año de evolución y lento crecimiento. La ortopantomografía mostró la presencia de una tumoración radiodensa en la región posterior del maxilar izquierdo. El estudio histológico de la pieza operatoria fue de odontoma complejo. Conclusiones: Hasta el momento se han documentado 11 casos de odontoma erupcionado en la literatura. A diferencia del odontoma periférico, el odontoma erupcionado suele ser del tipo complejo, afectando a pacientes de mayor edad.Objectives: Odontoma arising in the extraosseous soft tissue is extremely uncommon. Two forms of odontoma are presently recognized: peripheral odontoma and erupted odontoma. We report an erupted odontoma arising in the posterior maxilla, and discuss the main differences between both forms of clinical presentation. Study design: Case study. Results: A 23-year-old man presented with a firm gingival mass on the left posterior maxilla, that had gradually enlarged over one year. Orthopantomography showed a dense radiopaque mass occupying the posterior portion of the left maxilla. The pathology was reported as complex odontoma. Conclusions: This is the eleventh reported case of erupted odontoma. Unlike peripheral odontoma, erupted odontoma is generally a complex odontoma, and affects older patients

Immunohistochemical comparative study of the odontogenic keratocysts and other odontogenic lesions

Objectives: The present study was undertaken to compare the pattern of expression of EGFR, cyclin D1, Ki-67, p-53 and carcinoembryonic antigen (CEA) in the epithelial lining of odontogenic keratocysts, dentigerous cysts, radicular cysts and ameloblastomas. Methods: four micrometers, formalin-fixed, paraffin-embedded tissue sections from 11 odontogenic keratocysts, 10 dentigerous cysts, 10 radicular cysts and 10 ameloblastomas were immunohistochemically studied. Results: There were statistically significant differences between cyclin D1 expression in odontogenic keratocysts and radicular cysts (p= 0.001) and ameloblastomas (p= 0.04). The differences in CEA expression between the four studied lesions were statistically significant (p< 0.0005). Proliferating cells were significantly more prevalent in odontogenic keratocysts (p< 0.0005) with a mean percentage of Ki-67 positively stained nuclei of 40%. In dentigerous cysts this mean was of 17%, of 15.5% in RC and of 7.8 in ameloblastomas. Conclusion: Some of these findings could support the theory that odontogenic keratocysts are neoplastic in origin, but other results clearly support that these lesions are developmental cysts with some neoplastic properties because of the high intrinsic growth potential

Spontaneous fracture of the mandibular genial tubercles : a case report

Fracture of the mandibular genial tubercles is an uncommon pathology affecting edentulous patients with severe maxillary atrophy. Usually occurs spontaneously which complicates the diagnosis. Their importance lies in the functional alterations, which occur as a consequence of the disinsertion of the genihyoid and genioglossus muscles. The treatment of fracture of the genial tubercles is controversial, including no surgical intervention, excision of the avulsed bone fragments, and muscular repositioning. There have been only 11 cases reported in the literature of this fracture, most of them spontaneous. We present a difficult diagnosis situation of spontaneous fracture of the genial tubercles in an 86-year-old edentulous female with a painful sublingual and submental hematoma and anterior cervical echimosis. Computerized Tomography should be made to confirm the diagnosis. Surgical treatment was not necessary, and follow-up at 6 months revealed complete symptomatic recovery, and full return of function

Papillary cystadenoma and cystadenocarcinoma of salivary glands : two unusual entities

Cystadenoma and cystadenocarcinoma are rare salivary gland tumours histologically characterized by prominent cystic and frequently papillary growth. We present two cases of cystadenoma of a minor salivary gland (upper lip) and parotid cystadenocarcinoma respectively, captured between 834 salivary gland tumors studied in our hospital from 1980 to 2004. The authors review the clinical, histological, and biological features of these two unusual tumours, and differential diagnosis with other salivary glands neoplasms. Both entities usually reveal papillary proliferation of the epithelial lining and are composed of cells that possess bland cytomorphologic features. Differentiation of tumour types depends largely on the identification of actual infiltration of salivary gland parenchyma or surrounding connective tissue by either cystic or solid epithelium in cystadenocarcinomas. Step sections of a borderline tumour may yield unequivocal evidence of invasion. The authors discuss the problematic diagnosis between these rare neoplasms and with other tumours and compare histological findings of these two entities

Adenoma sebáceo de la glándula parótida

Los tumores de las glándulas salivales constituyen un área importante de la patología oral y maxilofacial. La mayor parte de las neoplasias glandulares salivales son benignas, representando las malignas entre el 15 y el 32% del total. La localización más común de estas entidades es la glándula parótida, en la que asientan hasta el 80% de todos los casos. En este artículo se presenta un caso de adenoma sebáceo salival, de localización parotídea. El tumor, formado por células epiteliales que tapizan conductos, exhibe amplias áreas de diferenciación sebácea y zonas con metaplasia oncocítica. El patrón histológico es predominantemente quístico, observándose cavidades rellenas con material sebáceo. Si bien la presencia de glándulas sebáceas en las glándulas salivales es frecuente, las neoplasias exclusivamente formadas por las mismas son muy infrecuentes. Dada su rareza, este tumor plantea problemas diagnósticos diferenciales con otras entidades benignas y malignas. Su tratamiento implica la extirpación de la lesión, lo que generalmente involucra la eliminación de la glándula en la que ha surgido. El presente caso constituye el séptimo publicado de esta entidad.Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven

Chondrosarcoma of the temporomandibular joint : a case report and review of the literature

Chondrosarcoma is a malignant tumor characterized by the formation of cartilage, but not bone, by tumor cells. Only 5% to 10% of chondrosarcomas occur in the head and neck, representing 0.1% of all head and neck neoplasms, with the larynx and the maxillo-nasal region being the most common sites. This report describes an unusual case of chondrosarcoma in a 54-year-old man who presented with pain and swelling in the left preauricular area. Computed tomography demonstrated a soft tissue mass in the left temporomandibular joint without causing erosion of the adjacent bony structures. The tumor was treated by excision in a single block with perilesional tissues, preserving the facial nerve. Histopathologic examination revealed chondrocytes with irregular nuclei with S-100 immunocytochemical staining positive in 30% of the tumor. The diagnosis was a grade I chondrosarcoma. There was no evidence of disease at the 16-month follow-up. The occurrence of chondrosarcoma in the temporomandibular joint (TMJ) is an exceptional event, with only 16 cases described. We report a case of this unusual entity and review the literature

Sebaceous adenoma of the parotid gland

Tumors of the salivary glands constitute an important field of oral and maxillofacial pathology. The majority of salivary gland neoplasms are benign, with malignant salivary tumors accounting for 15 to 32 percent. The most common site for salivary gland tumors is the parotid gland, accounting up to 80 percent of all cases. This article reports the pathologic picture in a case of sebaceous adenoma of the parotid gland. The tumor was composed of epithelial cells lining ducts and closely associated with broad areas of sebaceous differentiation. The growth pattern was predominantly cystic, with cavities filled with sebaceous material. Areas of oncocytic metaplasia were also seen. The presence of sebaceous glands in salivary neoplasms is frequent, however, and in spite of this, salivary neoplasms constituted partially or entirely of these cells are rarely observed. To the surgeon and pathologist, the major problem in dealing with sebaceous adenoma is the recognition of this rare entity, avoiding confusing with other more aggressive neoplasms. The treatment involves surgical excision. The addition of the current case to the previously published data brings the total number of parotid sebaceous adenoma to seven

Tratamiento de los carcinomas epidermoides orales y orofaringeos mediante láser de CO2

Introducción: El efecto de la amplia longitud de onda del láser de CO2 es la vaporización térmica de los tejidos, consiguiendo una máxima concentración de energía con una mínima penetración en los mismos. En el campo de la cirugía oral generalmente se emplea para el tratamiento de los pequeños tumores mucosos de la cavidad oral y la orofaringe, por la escasa morbilidad que produce y la ausencia de necesidad reconstructiva del defecto creado. Objetivo: Analizar la evolución postoperatoria, en los pacientes tratados por carcinomas epidermoides orales y orofaringeos, tras la resección mediante láser de CO2. Compararla con la de los pacientes tratados mediante métodos quirúrgicos convencionales realizando la reconstrucción a través de la sutura directa o el empleo de colgajos locales, regionales o a distancia. Diseño del estudio: Estudio de carácter prospectivo que incluye a 70 pacientes tratados por carcinomas epidermoides orales y orofaringeos. Treinta y cinco pacientes fueron tratados mediante láser de CO2, en 10 se realizó cierre directo de la lesión y en los restantes 25 algún colgajo local, regional o a distancia. Se analizó la presencia de sintomatología dolorosa durante el postoperatorio, el grado de retracción cicatricial y la presencia de alteraciones funcionales en la deglución y habla en función de la resección y reconstrucción realizada. Resultados: Obtuvimos un menor grado de dolor y de retracción cicatricial postoperatoria mediante el empleo de láser de CO2, minimizando así las secuelas funcionales de habla (mejor articulación de la palabra) y deglución (recuperación funcional más eficaz y precoz). Conclusión: La resección mediante láser de CO2 se ha convertido en el tratamiento de elección de los pequeños tumores mucosos orales y orofaringeos, por la ausencia de necesidad reconstructiva, menor retracción cicatricial y buena evolución postoperatoria.Introduction: The effect of the wide long-wave CO2 laser is the thermal vaporization of the tissues, getting a maximum energy concentration with a minimum of tissue penetration. In oral surgery, it is generally used for the treatment of oral and oropharyngeal small mucous tumors, due to the scarce morbidity that takes place and the absence of reconstructive necessity. Objective: To analyze the postoperative evolution, in the patients treated by oral and oropharyngeal epidermoid carcinomas, after CO2 laser resection. To compare it with that of the patients treated by means of conventional surgical methods, achieving the reconstruction through direct suture or the employment of local, regional or distance flaps. Methods: A prospective study was designed including 70 patients treated by oral and oropharyngeal epidermoid carcinomas. Thirty-five patients were treated by means of CO2 laser, in 10 cases direct wound-closure was realized, and in the remaining 25 patients some local, regional or distance flap were used. There were analysed the presence of postoperative pain, the degree of cicatricial retraction, and the speech and swallowing functional results. Results: We obtained a smaller painful degree and postoperative cicatricial retraction by the employment of CO2 laser. It permits minimizing the functional speech sequels (better words articulation) and swallowing (effective and precocious functional recovery). Conclusion: CO2 laser resection has become the elective treatment for small oral and oropharyngeal epidermoid carcinomas. The reasons are the absence of reconstructive surgery necessity, the scarce cicatricial retraction, and the excellent postoperative evolution