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Bone scintigraphy of the facial skeleton with 99Tcm-diphosphonate using gamma-camera was performed in 10 cases without, and in 4 cases with pathologic processes. A. p. and lateral projections were used and a converging collimator. The normal distribution of the isotope in the bones of the face seemed to be uniform with minor variations. Increased uptake varying in intensity was evident in the region of the lesion.
Melanomas diagnosed in 29 cats over an 11 year period included 19 ocular (16 intraocular, three palpebral), five oral, and five dermal melanomas. Intraocular melanomas involved the ciliary body and iris in 12; the whole eye was involved in four. The average age of cats with intraocular melanomas was 11 years; the female : male ratio was 9 : 7. Histologically, eight intraocular tumors were mixed, six were epithelioid, and two were spindle cell. Ten of 16 cats (62.5%) with intraocular melanomas were killed because of the tumor at a mean of 156 days; four are living with no evidence of disease (average, 255 days). The mean time of death in cats with palpebral melanoma was 409 days. Metastasis occurred in 63% of cats with intraocular melanoma and all cats with palpebral melanoma. Four cats with oral melanoma were killed at a mean of 61 days; all had metastasis. Of five cats with cutaneous melanoma, one was killed with metastasis at 90 days; three cats were alive without evidence of recurrence or metastasis greater than 365 days after surgery. Results of this study indicate that in the cat, ocular melanomas are more common than oral and dermal melanomas, and ocular and oral melanomas are more malignant than dermal melanomas, with higher rates of mortality and metastasis.
Three young, female dogs were operated for compound odontoma. All tumors were considered stage III with treatment consisting of partial mandibulectomy or maxillectomy. Microscopic examination of the resected tissue confirmed the diagnosis. Relatively aggressive, resective surgery resulted in prolonged tumor-free intervals.
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PURPOSE: To evaluate the possible value of chemotherapy in the treatment of craniofacial osteosarcoma (CFOS). DESIGN: In a systematic review, data of 201 patients (age, 36.6 +/- 19.0 years [mean +/- SD]) from 20 uncontrolled series on CFOS indexed in Medline and Excerpta Medica between 1974 and 1994 were pooled; 180 patients had undergone surgery. Various chemotherapy regimens had been given to 71 patients. Radiotherapy was used in 69 patients. All patients had data for overall survival, and 182 had data for disease-free survival analysis. Cumulative survival distributions were estimated by the product-limit method, and a multiple regression analysis was performed. RESULTS: Patients' overall and disease-free survival rates were significantly improved by treatment with chemotherapy. This was confirmed for patients with complete surgical removal, as well as for those with incomplete removal of tumor. In a proportional hazards model, complete surgical removal and chemotherapy were independent significant factors for overall and disease-free survival. The effect of radiotherapy was insignificant. No prognostic factors could be identified among age groups, sex, and subsites. CONCLUSION: Evidence exists that chemotherapy improves survival in CFOS. We advocate the adoption of the chemotherapy protocols used for OS of the long bones for CFOS.
The radiographic findings in eight cases of Ewing's sarcoma of the jaws are analysed in detail. Similar findings to those in peripheral skeletal involvement were demonstrated including: (a) permeative bone destruction, (b) periosteal reaction, and (c) extraosseous soft tissue mass. Specific to the jaws is the occurrence of dental displacement without destruction. The differential diagnosis of Ewing's sarcoma of the jaws is discussed in detail and illustrated.
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It is generally accepted that conventional imaging techniques have limitations in their ability to differentiate benign and malignant disease processes resulting in bone destruction. Although computed tomography (CT) has proved helpful in the diagnosis of such lesions in the paranasal sinuses, the underlying radiological criteria are unclear and the value of contrast enhancement appears limited. Conventional radiographs and CT scans, with dynamic contrast infusion, from five patients in whom a provisional diagnosis of antral carcinoma had been made were reviewed in the light of a subsequent histopathological diagnosis of benign inflammatory disease. In four of these patients, a band of enhancement was demonstrated to parallel the antral walls which, in three cases, remained intact despite underlying bony defects. Their finding is significant in that it demonstrates mucosal integrity, thus making the radiological diagnosis of antral carcinoma less attractive and allowing assessment of the extent of inflammatory soft tissue changes. Thus the use of contrast-enhanced CT is recommended in the assessment of patients in whom sinus disease with bone destruction has been identified on conventional radiographic examination.
Metastatic retinoblastoma of the jaws is very rare. We present a 4-year-old boy with metastatic retinoblastoma that involved both the maxilla and mandible simultaneously. Enhanced CT indicated bone-destructive masses with partially non-enhanced area and enhanced margin in the right maxilla and left mandible. MRI showed well-delineated masses that were isointense on T(1) weighted images and hyperintense on T(2) weighted images. Four weeks after chemotherapy and bone marrow transplantation, the size of lesions remarkably decreased. The patient died 19 months later with extensive tumour metastases despite additional chemotherapy. In this case, the dental crypt of a permanent tooth was considered the potential target through which retinoblastoma metastasized to the jaws.
OBJECTIVES: To analyse systematically the clinical and radiological features of odontogenic ghost cell carcinoma (OGCC). METHODS: Clinical and radiological features of 22 OGCCs (4 new and 18 from the literature) were analysed. RESULTS: There were 17 (77%) males and 5 (23%) females (male-to-female ratio of 3.4:1). Ages ranged from 13 years to 72 years (mean 36.7) with a peak in the fourth (40.9%) and fifth (27.3%) decades. The maxilla was involved in 68% and the mandible in 32%. Our study confirmed that OGCC is more prevalent in Asians (12/18) than in other racial groups. The mixed radiolucent and radiopaque lesion pattern was the most frequent (14/19) compared with radiolucent lesions (5/19). 89% (17/19) showed poorly defined borders and 11% (2/19) showed well defined borders. Root resorption was reported in 31% (6/19) of patients and tooth displacements in 21%. CONCLUSIONS: OGCC demonstrates clinical and radiographic features of a malignant tumour with high recurrence.
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The purpose of this paper is to present the precursors and complications of multiple myeloma as manifested in Otolaryngology. The modern Otolaryngologist is well aware that systemic disease may manifest itself in our specialty. Multiple myeloma is a distinctive form of plasma cell dyscrasia which often manifests itself in Otolaryngology. For example, patients may present with epistaxis, hoarseness, asymmetry of the face, swelling of the palate, nasal obstruction and a multiplicity of other symptoms. Therefore, the practicing Otolaryngologist must maintain a high index of suspicion that a seemingly simple sign or symptom may represent one small facet of a generalized condition. The paper emphasizes that in many instances a slight extension of our history taking may provide us with information leading to the diagnosis of this systemic disease. Cases seen by the author are reviewed and the relevant clinical features are presented.
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Clinical and histological manifestations of von Recklinghausen disease are reviewed. The oral findings in a patient with a solitary maxillary plexiform neurofibroma are described.
BACKGROUND: The desmoplastic ameloblastoma exhibits important differences in anatomical distribution, histologic appearance and radiographic findings compared with the classic type of ameloblastoma. The purpose of this article is to assist the dental community in better understanding this variation in odontogenic tumor. CASE DESCRIPTIONS: The authors present two cases of desmoplastic variant of ameloblastoma localized in the anterior portion of the jaw. The tumors were expansile, destructive and painless. The radiographic findings showed diffuse, mixed (radiopaque/radiolucent) lesions with cortical bone destruction. Block excision was performed in both cases. Follow-up examination one and two years later disclosed no recurrence of tumor. CLINICAL IMPLICATIONS: The desmoplastic variant of ameloblastoma tends to infiltrate between bone trabeculae. Curettage leaves islands of tumor within bone, which later manifest as recurrences. Therefore, block excision is the most widely used treatment to avoid recurrence.
Six cases of cemento-osseous dysplasia (COD) of the jaw bone in Jamaicans are reviewed. Five were documented over a 15-year period (1980-1995). These include a case of florid cemento-osseous dysplasia (previously called gigantiform cementoma). Three of the initial cases were histologically diagnosed as gigantiform cementoma. There was no indication in the patient's case file whether these were familial or non-familial. The other two cases were diagnosed histologically as periapical cemento-osseous dysplasia and cementoblastoma respectively. Based on the current understanding of the nature of florid-cemento-osseous dysplasia (FLCOD), a new case was diagnosed as such solely on radiological findings. This single case of FLCOD is reported and discussed against the background of other cemento-osseous lesions. Special emphasis is placed on the radiology of COD in this paper. The confirmative role of radiology without the need for histophathology and treatment for asymptomatic FLCOD is emphasized.