Tatsumi Sugata

Invasive Aspergillus Stomatitis in Patients with Acute Leukemia: Report of 12 Cases

An 8-year retrospective analysis of invasive Aspergillus stomatitis in neutropenic patients with acute leukemia was performed to characterize the epidemiology and clinical features of the infection. Twelve cases of invasive Aspergillus stomatitis were identified with both clinicohistological and microbiological evidence, and the majority of cases were caused by Aspergillus flavus (10 [83%] of 12 patients). The infection was strongly suspected when a neutropenic patient developed persistent fever without a known source, symptoms of gingival pain and facial swelling, and a solitary ulcerating lesion of mucogingiva covered with a gray necrotic pseudomembrane. Aspergillus stomatitis was diagnosed a median 23 days after admission. In all 12 patients, the diagnosis was made during the period of neutropenia. Ten patients (83%) were treated with amphotericin B and surgery and survived with recovery of neutrophils. Two patients died, and disseminated aspergillosis was identified in 1 patient.

Pathologic features of invasive oral aspergillosis in patients with hematologic malignancies

PURPOSE Little is known about the characteristic macroscopic and microscopic changes that take place during the progression of oral invasive aspergillosis in immunocompromised patients. The aim of this study was to determine the relationship between the oral and histopathologic findings in these patients. Such a study would aid in understanding the early development of subsequent progression of the disease. PATIENTS AND METHODS Twelve patients with hematologic malignancies who developed invasive oral aspergillosis were studied. The condition was divided into three stages according to the oral findings at the time biopsy procedures were performed. Tissue sections from biopsy specimens were stained with hematoxylin and eosin for histopathologic study and the findings were evaluated in relation to the oral findings. Fungal cultures of biopsy specimens were also performed to confirm the causative organisms. RESULTS The diagnosis of oral aspergillosis was established in terms of both histologic and microbiologic evidence in all 12 patients. In the early stage (three patients), isolated areas of violaceous marginal gingiva consisted of degenerated epithelium and connective tissue infiltrated by fungal hyphae. In the advanced stage (four patients), the violaceous marginal gingiva had become transformed into gray necrotic lesions that extended to the attached gingiva. The necrotic lesions showed ulceration and were covered by a pseudomembrane containing fungal hyphae. At the base of the ulcers, connective tissue was occupied by proliferating fungal hyphae, with vascular invasion being observed. In the late stage (five patients), the ulcerated lesions had progressed, showing destruction of the alveolar bone and surrounding facial muscles, with infiltration of fungal hyphae unto the tissues. No inflammatory cellular reaction was observed until the hematologic status of the patients improved. CONCLUSION These findings indicate that invasive oral aspergillosis has three distinctive clinicopathological stages. Recognition of the different stages of invasive Aspergillus infections is helpful for correct diagnosis of the disease.

Invasive oral aspergillosis in immunocompromised patients with leukemia

The clinicopathologic characteristics of invasive oral aspergillosis in 16 immunocompromised patients who developed this infection during antileukemic chemotherapy are described. The primary site of the infection was the marginal gingiva, there was severe spontaneous pain, and the patients developed spiking fever and granulocytopenia. Necrotic ulceration of the gingiva rapidly extended to the contiguous mucosa, muscle, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transverse septa and dichotomous branching. The invasive organisms were not responsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who showed improvement of hematologic status, oral aspergillosis was controlled by the combination of antifungal chemotherapy and debridement of necrotic tissues.

Chondrosarcoma of the jaw: Report of two cases

Les 2 malades ont ete suivies pendant 7 ans. On discute les possibilites de la radiotherapie et de la chimiotherapie comme adjuvants de la chirurgie

Total upper lip reconstruction using a free radial forearm flap incorporating the brachioradialis muscle: Report of a case

One-stage reconstruction of the upper lip using a free radial forearm flap was successfully performed with excellent functional and cosmetic results. The free radial forearm flap, including the vascularized and innervated brachioradialis muscle, has a very wide potential for reconstruction of the lip defects due to carcinoma.

Identification of Aspergillus Species in Oral Tissue Samples of Patients With Hematologic Malignancies by In Situ Hybridization: A Preliminary Report

PURPOSE A definitive diagnosis of invasive oral aspergillosis can be difficult because the culturing of tissue samples frequently fails to isolate Aspergillus species. In addition, the mycelial elements of Aspergillus species seen in tissue sections are histopathologically indistinguishable from those of non-Aspergillus species. We analyzed the usefulness of a DNA probe directed against the alkaline proteinase (ALP) gene of Aspergillus fumigatus for the identification of Aspergillus species by the in situ hybridization (ISH) technique in patients with oral mycosis. PATIENTS AND METHODS The ALP probe was tested on tissue specimens from 16 patients with hematologic malignancies who had invasive, orofacial fungal infections and a positive culture for one of the following organisms: Aspergillus species in 13 patients (A. flavus in 10, A. terreus in 2, and A. fumigatus in 1), and Exophiala dermatitis, Trichoderma longibrachiatum, and Candida albicans in 1 patient each. In situ hybridization with the ALP probe was performed using formalin-fixed, paraffin-embedded tissue samples. RESULTS The ALP probe showed a strong reaction with specimens from all 13 patients who had culture-proven aspergillosis specimens attributable to A. flavus, A. terreus, and A. fumigatus. On the other hand, the ALP probe showed no cross-reactivity with other fungi (Exophiala dermatitis, Trichoderma longibrachiatum, and Candida albicans). CONCLUSION These findings indicate that ISH using an ALP probe may increase the accuracy of diagnosing invasive oral aspergillosis in immunocompromised patients, and facilitate the provision of adequate antifungal treatment.

Acromegaly identified in a patient with a complaint of malocclusion

Acromegaly in a female patient was first diagnosed after a dental examination at which time the patient complained of the inability to incise properly. An elevated serum growth hormone level and enlarged sella turcica confirmed the diagnosis of acromegaly. Based on examination of her plaster study models, it was apparent the patient had been developing a change in her dentition for years.

Unilateral Cheek Swelling in an Infant: Case Report of an Unusual Presentation of Internal Bleeding Caused by Vitamin K Deficiency

h h s 1 p t nilateral acute swelling of the cheek with no history f trauma or infection may present a diagnostic chalenge, especially in infants. We report an infant ith internal bleeding caused by vitamin K deficiency n a very uncommon location, the unilateral cheek. To ate, most cases of vitamin K deficiency bleeding VKDB) have been reported to manifest intracranial emorrhage, gastrointestinal bleeding, and thymus leeding. In particular, intracranial hemorrhage is the ost common presentation and accounts for approxmately 50% of cases. In Japan, oral administration f vitamin K prophylaxis at birth, on the sixth day, nd 1 month after birth has been recommended since 981. Although the incidence of VKDB has dramatially decreased by virtue of this prophylactic adminstration of vitamin K, it still occurs even in infants eceiving vitamin K prophylaxis. Typically, the brain is the primary site of involveent of VKDB. Extracerebral manifestations may ocur but can be difficult to diagnose. The purpose of his study was to encourage oral surgeons to consider KDB as a possible cause of unilateral acute swelling f the cheek, especially in infants.

Infection due to non-Aspergillus fungi in immunocompromised patients receiving itraconazole.

Correspondence Table 1. In vitro activity of itraconazole and amphotericin B against fungal isolates recovered from patients with invasive orofacial infections.

Transoral approach for large pituitary adenoma using Le Fort I osteotomy with mandibulotomy. A case report.

A patient is presented with a large pituitary adenoma that was successfully treated with a Le Fort I osteotomy in combination with mandibulotomy.