Granular-cell myoblastoma of tongue. Report of a case.
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Granular-cell tumors in the oral cavity occur primarily on the tongue (myoblastoma) in adults and on the gum pads (congenital epulis) in infants. Because of the usual location and age, these histologically and histochemically similar tumors have been separate clinical entities. These case reports, however, report the concurrence of both clinical entities in the same patient. A 7-day-old female infant had a 1 cm. epulis on the right anterior maxilla and two 1.5 mm. masses on the anterior ventrum of the tongue. A 12-day-old girl had a 1 cm. epulis on the anterior mandible and two 1.5 mm. masses on the anterior tongue near the tip. In both cases, all lesions were histologically and histochemically similar and were granular-cell tumors. This suggests a relationship in the origin of these entities and tends to rule out an odontogenic origin for the epulis.
Although granular cell tumor (GCT) has been a distinct pathological entity since 1926, confusion and controversy have long existed regarding the nature and histogenesis of the tumor. Twenty-five cases of granular cell tumor involving the orbit and ocular adnexae previously reported in the ophthalmic literature, are reviewed and six additional cases are reported. The histopathological and immunohistochemical characteristics of granular cell tumors in this uncommon location are discussed and their probable origin from Schwann cells is also considered.
Intraoperative electron beam radiation therapy (IOEBRT) in the treatment of ovarian malignancies was investigated at the Clement O. Miniger Radiation Oncology Center (COMROC). Nine patients were operated in the COMROC IOEBRT operating amphitheater and five were found to have disease sufficiently limited to allow for IOEBRT. The patients' ages ranged from 13 to 80 (median 53) years. Five patients had serous cystadenocarcinoma, one papillary adenocarcinoma, one mixed germ cell tumor, one squamous cell carcinoma, and one granular cell tumor of the ovary. The median survival of the non-IOEBRT group was 13 (range 12-29) months, while the IOEBRT group's median survival was 14 (range 18-46) months. All of the patients tolerated IOEBRT well without addition to the surgical morbidity.
A case is reported about a patient who was originally treated for bilateral retinoblastoma and subsequently developed an embryonal rhabdomyosarcoma in the masseter. Such patients have a genetic predisposition to a second malignancy that statistically far exceeds the rate for the general population. In addition, current treatment methods also increase the patient's susceptibility to another malignancy. This case emphasizes the necessity of maintaining a high degree of clinical suspicion in the evaluation of any lesion that may appear subsequent to the treatment of cancer in children, particularly bilateral retinoblastoma.
From 1977 to 1987, 23 patients with isolated chest wall recurrence, excluding sternal metastasis, from breast cancer underwent full thickness chest wall resection. The 5-year survival rate after chest wall resection was 48% but the 5-year relapse-free survival rate was 26%. Mediastinal metastasis was proved histologically at the time of chest wall resection in 7 patients, and survival period with mediastinal involvement was significantly (P less than 0.01) shorter than that with no mediastinal involvement (n = 16). In 17 patients with a long disease-free interval (DFI greater than or equal to 24 months), survival was longer than in 6 patients with a short DFI (less than 24 months). For the selected patients without mediastinal involvement and long DFI, surgical treatment for chest wall recurrence of breast cancer should play a significant role in improving the quality of life, and even in prolonging the survival rate.
A 22-year-old white woman presented with a recurrent mass in her tongue that had originally been diagnosed as a fibrosarcoma. Review of the original specimen with new immunohistochemical staining showed that it was an inflammatory fibroblastic tumour.
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Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.
After the first 2 years of follow-up, the prognosis of testicular cancer confined to the testis is traditionally considered excellent. We report on a man who presented with a psoas mass, corresponding to a very late relapse of his left testicular cancer initially confined to the testis and confirmed by negative retroperitoneal lymph node dissection. Histologic analysis of the mass revealed malignant teratoma. The patient's history was remarkable because of the very long interval to relapse (32 years) associated with this malignant teratoma. This clinical case illustrates the possibility of late relapses throughout life, whatever the initial stage.
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