Development of cancer as a complication of clinical transplantation.
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Three cases of tricholemmal keratosis and two of tricholemmal carcinoma are reported. All patients were female and the age range was from 71 to 83 years. These rare tumors occur on the face and are obviously the result of long-standing actinic skin damage. Clinically, verrucous hyperkeratosis or cornu cutaneum (keratosis) are observed and in the case of tricholemmal carcinomas, ulcerated tumor nodules. Histologically pale, glycogen-rich polygonal cells with signs of tricholemmal keratinization without the presence of a granular cell layer are characteristic features. Tricholemmal keratoses exhibit no atypia or only a mild form; however, carcinoma in situ may occasionally develop. In contrast, tricholemmal carcinomas are characterized by increased pleomorphia, an increase in the rate of mitosis, and an invasive growth pattern. The prognosis is favourable.
Pigmented lesions of the oral cavity are of multiple origin. They can be subdivided as follows: non tumoral pigmentations, non melanin pigmented tumors or tumor-like lesions, benign melanin pigmented tumors and malignant melanomas. Among non tumoral pigmented lesions, some of them show melanin deposits: they can be associated with a systemic disease (Peutz Jeghers syndrome, Addison's disease) or have a medicamentous origin, or belong to a lichen migricans. Non tumoral and non melanin pigmentations are principally due to a heavy metal accumulation or an accidental tatoo arising after tooth treatment. Peripheral giant cell granuloma, so-called giant cell epulis is the major non pigmented non melanin pseudotumoral lesion; pigmentation is due to hemosiderin deposits. In the oral cavity nevi are principally of the intramucosal type. Blue nevus, the second type in frequency, is usually located on the hard palate. Primary malignant melanomas are rare in the oral cavity, but it is--because its very bad prognosis--the most important lesion. In order to improve the survival it is necessary to do the diagnosis as early as possible.
The author presents 14 patients with the gradations "neurofibroma--neurofibromatosis-neurofibrosarcoma". The great variability of forms of this disease ist emphasized. Apart from pure soft-tissue tumours, primary and secondary osseous changes were demonstrated in 4 patients. Intra-oral neurofibromas were seen in 5 cases. In 3 of these, the tongue was involved. Suggestions are given for the treatment of this clinical picture.
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