Giant Epignathus Teratoma Discovered at Birth: A Case Report and 7-Year Follow-Up

<div><p>Abstract Teratomas are tumors composed by tissues derived from the three germ cell layers, and they are relatively uncommon in head and neck. The term epignathus has been applied to teratomas from the oropharynx. This paper reports the case of a giant epignathus teratoma discovered at birth, which was successfully managed and followed up for 7 years. A newborn boy presented a polypoid tumor mass exteriorizing through the mouth over a length of 9 cm, with some surface areas resembling skin and others exhibiting hair. Computed tomography showed that the mass arose deep from the left hemiface. Alpha-fetoprotein (AFP) levels were high (316,000 ng/mL). Surgery was performed and microscopic analysis confirmed the diagnosis of mature teratoma. Because of residual tumor and high AFP levels, the patient was submitted to chemotherapy, resulting in complete regression of the lesion and normalization of AFP levels. Surgical repair of a cleft palate was performed at 5 years of age. At 7 years of age, the patient was in good general health and showed no clinical signs of recurrence. Although epignathus is a rare condition, it should be diagnosed in the fetus as early as possible. Prenatal care provides unquestionable benefits, providing the early diagnosis of anomalies that can jeopardize the life of the fetus and contributing to the indication of cases that require treatment before birth.</p></div

Effect of Atorvastatin treatment on alveolar bone loss associated with experimental periodontitis Disease (EPD) in rats.

<p>Values are expressed as means± SEM (###p<0.001, *p<0.05; determined with ANOVA and Tukey'stest).</p

Histological analysis of maxillae from rats presenting with periodontal disease, Natal, RN, 2013.

*<p>p<0.05.</p

Levels of IL-1β, Il-10, and TNF-α in normal control animals with no ligature (NL), animals with periodontal disease induced by a ligature and treated with saline (L), or animals with periodontal disease and treated with 1, 5, or 10 mg/kg of Atorvastatin (#; *<i>p</i><0.05; **<i>p</i><0.01; ***<i>p</i><0.001).

<p>Levels of IL-1β, Il-10, and TNF-α in normal control animals with no ligature (NL), animals with periodontal disease induced by a ligature and treated with saline (L), or animals with periodontal disease and treated with 1, 5, or 10 mg/kg of Atorvastatin (#; *<i>p</i><0.05; **<i>p</i><0.01; ***<i>p</i><0.001).</p

Microscopic analysis.

<p>(A) Normal periodontium and (B) periodontium from a rat presenting with periodontitis (treated with saline) showing alveolar bone and cementumresorption and inflammatory cell infiltration. (C) Reduced inflammation and alveolar bone loss in the periodontium of rats treated with Atorvastatin (10 mg/kg) for 10 days. Sections were stained with H&E. Microscopic original magnification at 40×. Scale bars = 100 µm. G = gingiva; PL = Periodontal ligament; D = dentin; AB = alveolar bone; C = Cementum; a = increased bone loss in AB; b = resorption of cementum; c = inflammatory process in PL and intense destruction of collagen fibers in the PL; e = decreased inflammation process in PL anddiscrete destruction ofcollagen fibers in PL; f = decreasedbone loss in AB.</p

Histological analyses of (A–C) MMP-2, (D-F) MMP-9, (G–I) COX-2, (J–L) RANK, (M–O) RANK-L, and (P–R) OPG in periodontal tissue of rats with periodontal disease.

<p>Rats subjected to saline are pictured in A, D, G, J, M, P; rats with periodontal disease are pictured in B, E, H, K, N, Q; rats with periodontal disease and treated with Atorvastatin (10 mg/kg) are pictured in C, F, I, L, O, R. 100× magnification, bar scale = 100 µm.</p

Levels of myeloperoxidase (MPO), malondialdehyde (MDA), and glutathione (GSH) in control animals with no ligature (NL), animals with periodontal disease induced by a ligature and treated with saline (L), or animals with periodontal disease and treated with 1, 5, or 10 mg/kg of Atorvastatin (#; * <i>p</i><0.05;).

<p>Levels of myeloperoxidase (MPO), malondialdehyde (MDA), and glutathione (GSH) in control animals with no ligature (NL), animals with periodontal disease induced by a ligature and treated with saline (L), or animals with periodontal disease and treated with 1, 5, or 10 mg/kg of Atorvastatin (#; * <i>p</i><0.05;).</p

IL-1β, IL-10, and TNF-α levels were measured in the NL, L and CARVE 1, 5, and 10 mg/kg groups.

<p><b>^#,*</b>p<0.05;</p

Histological analysis of maxillae from rats presenting with periodontal disease, Natal, RN, 2013.

*<p>p<0.05.</p

Immunoreactivity to MMP-2, MMP-9, COX-2, RANK, RANK-L, and OPG. Photomicrographs of periodontal tissues from rats presenting with EPD and treated with Carvedilol (10 mg/kg) (A, D, G, J, M, P).

<p>Rats treated with saline only (B, E, H, K, N, Q) and untreated rats presenting with EPD (C, F, I, L, O, R). Magnification 40X, bar scale = 100 µm. Pulp tissue (P), gingiva (G), periodontal ligament (PL), and dentina (D).</p