The management of a large hemangioma of the oral cavity with cryotherapy.
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Histological examination of the gingivovestibular lesion in the first case with known kidney cancer, confirmed the metastatic nature of the buccal tumor and its origin. The second case raised the problem of the diagnosis of a labial swelling occurring during widespread metastases from breast cancer. The third case was more complex as the palatine lesion was seen initially, and metastatic seeding extremely rapid. This led to the hypothesis only, that bronchial cancer was the primary lesion.
The authors report a case of necrotic metaplasia of the salivary glands and review the principal clinical, histological, and evolutional characteristics of this rare affection of unknown etiology. The lesion occurs in adults, is located exclusively in the palate and appears as a small usually greatly ulcerated swelling which is sometimes preceded by pain. Histological examination, which requires a relatively deep and fairly large sample, demonstrates a group of modifications essential for diagnosis: ulceration on a inflammatory base with hyperplasic epithelial borders, plus deeper accessory salivary lobules with necrotic plaques and a great deal of malpighian metaplasia, and conservation of normal gland structure. This affection, which is sometimes wrongly diagnosted as a tumor, heals spontaneously within several weeks, which contra-indicates any strong therapeutic measures.
An adult rhabdomyoma was light and electron microscopically studied. The lesional cells presented well-known structural details, such as abundance of mitochondria and glycogen, myofilaments and myofibrils, hypertrophied Z-bands and masses of Z-band material. Triads were randomly scattered in the cytoplasm and also related to the individual sarcomeres. In sarcomeres the triads were regularly placed near to the A-I-junctions. This peculiarity of mammalian skeletal muscle fibers may yield a criterion to distinguish between cardiac and extracardiac rhabdomyomas. Circumscribed surface areas of the tumor cells were provided with elaborate infoldings of plasma membrane and basal lamina. These areas were interpreted as imitating myotendinous junctions. Satellite cells were regularly found.
In addition to the classical type of Kaposi's sarcoma, a new, aggressive and prognostically ominous variant occurs since 1980: the AIDS-associated Kaposi's sarcoma. This aggressive variant is associated with viral infection by the lymphotropic retrovirus HTLV-III, identical to LAV. In the U.S.A. and in Europe, this virus is transmitted mainly by homosexual contact, whereas in Central Africa the characteristic mode of transmission is heterosexual promiscuity. The authors present for the benefit of the ENT-specialist, case-reports of an American/European and of an African AIDS-associated Kaposi's sarcoma of the palate illustrating the major symptoms of generalized lymphadenopathy, opportunistic infections, and the relevant immunological and serological features.
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