Oral synovial sarcoma: a report of 2 cases and a review of the literature

The head and neck region constitutes the second most common site of involvement for synovial sarcoma, accounting for up to 10% of all cases. Intraoral synovial sarcoma is rare; in fact, only 29 cases have been reported. We describe 2 additional cases occurring in the floor of the mouth and the retromolar area. In addition, we have reviewed the clinicopathologic features of the previously reported cases. Our findings indicate that intraoral lesions differ from lesions occurring in other sites only in that intraoral cases show a greater male predilection and a generally painless initial presentation. In the oral cavity, the possible earlier detection, easy accessibility, and small size render these tumors more likely to be amenable to surgical excision, but their biologic behavior remains aggressive, with a poor long-term prognosis. Awareness of the potential for the occurrence of this neoplasm in the oral cavity is important for effective histopathologic diagnosis of intraoral spindle cell malignancies.     

Perineural infiltration of the inferior alveolar nerve in mandibular ameloblastomas

Our aim was to evaluate the histological association of mandibular solid and multicystic ameloblastoma with the inferior alveolar nerve, both in situ and in segments of the nerve that had been removed separately, to assess the feasibility of preserving the nerve during resection of mandibular ameloblastomas. In this prospective histological examination of 13 resected hemimandibulectomy specimens, we studied the proximity of tumour cells to the inferior alveolar nerve. In group 1 (n = 8) this association was examined with the nerve still within the mandibular segment after resection, while in group 2 (n = 5) the nerve was removed from the resected tumour and examined separately. Perineural and intraneural involvement of the ameloblastoma with the nerve was confirmed in 5 cases in group 1 and 2 cases in group 2. Tumour cells abutted the nerve directly in group 1. In group 2 tumour was removed with, and found within, the nerve. On this evidence we cannot recommend preservation of the inferior alveolar nerve during operation for large, advanced, mandibular ameloblastomas.     

Evaluation of Fecal Myeloperoxidase as a Biomarker of Disease Activity and Severity in Ulcerative Colitis

Background  

Subclinical inflammation in ulcerative colitis (UC) can predispose to relapses and biomarkers can detect mucosal inflammation.     

HIV-Specific T Cells Generated from Naive T Cells Suppress HIV In Vitro and Recognize Wide Epitope Breadths

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Hepatic Adenomatosis: A Rare but Important Liver Disease With Severe Clinical Implications

A 56-year-old white female presented to the emergency room (ER) with acute onset of right upper quadrant abdominal pain, nausea, and vomiting, and she was found to have a sudden drop in hemoglobin. Abdominal computed tomography (CT) with and without intravenous contrast revealed multiple bilobar focal hepatic hypervascular lesions, one of them demonstrating spontaneous rupture with active intraperitoneal bleeding. A moderate hemoperitoneum was present. The patient underwent exploratory laparotomy for right hepatic posterior segmentectomy (right posterior sectionectomy) and peritoneal lavage. The histopathology evaluation revealed multiple liver adenomas. Hepatic adenomatosis is a clinical entity characterized by 10 or more hepatic adenomas. It must be distinguished from isolated hepatic adenoma as it bears a much higher risk of complications, such as spontaneous rupture, hemorrhage and malignant transformation. Here we discuss the radiologic and histopathologic findings of the current case along with a review of the English language medical literature.Key words: Liver, Computed Tomography, Adenomatosis, Hemoperitoneum, Hemorrhage, MassIsolated hepatic adenomas are benign neoplasms that commonly occur in young women with a history of oral contraceptive pills or anabolic steroids use and type I glycogen storage disease. Most patients are asymptomatic with a normal liver function test.¹Hepatic adenomatosis (HA) was first described as a separate entity in 1985 by Flejou et al.² He defined this disease as when at least 10 adenomas were present in a background of normal looking hepatic parenchyma. Contrarily to isolated hepatic adenomas, HA shows no relation with oral contraceptive use; an increase of serum alkaline phosphatase and gamma-glutamyl transpeptidase is a common biochemical finding in HA.² Although HA is considered a benign disease, some patients may develop potential fatal complications, i.e., hypovolemic shock due to rupture of the liver lesions with intraperitoneal hemorrhage. The overall spontaneous bleeding and hemorrhagic complication rate reaches 62.5%.² Malignant transformation to hepatocellular carcinoma occurs in less than 10% of cases.^3,4 We review the English language literature and discuss the radiologic and pathologic findings of this case in comparison with the previously reported cases.