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Patients (299) with various types of headaches (migraines, cluster headaches, and so-called idiopathic headaches) were operated on between 1973 and 1991. Septal correction, resection of the middle concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (235; 78.5%) were totally asymptomatic postoperatively; 34 (11.5%) had a sensation of pressure in the head on rare occasions but no further migraines, and 30 (11%) continued to experience headaches that occurred only rarely and were mild and of short duration.

Malignant tumours of the appendix are rare. They are usually carcinoid tumours that must be distinguished from extremely rare adenocarcinomas. Metastatic mucinous adenocarcinomas of the appendix are only reported as case histories. In clinical terms, the tumours usually manifest themselves as acute appendicitis, as ruptured appendicitis, as a tumour in the right lower abdominal quadrant or as a pelvic tumour, which are generally mistaken for an ovarian tumour with the same sonographic image. Advanced primary adenocarcinomas of the appendix with ovarian metastases cannot be distinguished intraoperatively from a FIGO III ovarian carcinoma. The pathologist makes the definitive diagnosis. These characteristics also apply to the case presented here. Surgical therapy of the isolated primary appendiceal carcinoma consists of a hemicolectomy--an appendectomy in favourable cases--and, in the case of a metastasised carcinoma, according to the guidelines for an advanced ovarian or colon carcinoma. The effect of chemotherapy is insufficiently documented.

Intraoral malignant melanotic schwannoma is an extremely rare tumor. Two cases are presented, one occurring in the mandible of a 62-year-old man, the other in the maxilla of a 79-year-old man. The clinical presentation, light microscopic findings and immunohisto-pathological features are described. The difficulty of diagnosing this special tumor at initial presentation correctly, is discussed.

We report on two patients with actinomycosis. The first case was a 45-year-old cachectic man with extensive bilateral pulmonary infiltrates. The lesions remained unclear for 18 months and only open lung biopsy with microscopic and cultural evaluation led to the diagnosis of actinomycosis. In the second case, classic cervico-facial actinomycosis in a 69-year-old farmer is described. Diagnosis was established on the basis of microscopic findings of "sulphur granules" eroding the mandible. Furthermore, the clinical presentation, with an indurated swelling of the jaw and intraoral fistula formation, was typical. The patient had a severe combined aortic valve lesion and died after ventricular fibrillation during hospitalization. Diagnosis could not be confirmed by culture, probably due to antibiotic prophylaxis against endocarditis during tooth extraction on the first day of admission. Diagnostic difficulties and microbiologic aspects are discussed, with special focus on the rare species of Actinomyces meyeri which was cultured from biopsy specimens from the lung of the first patient. So far this species has been described in only 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The ameloblastic fibro-odontoma is a rare nonagressive mixed odontogenic tumor. Most of these lesions occur in patients under 20 years. There is no sex predilection. They are located more often in the mandible, usually in the posterior segment. Painless swelling in the most common clinical sign. Radiologically, ameloblastic fibro-odontomas show a circumscribed radiolucency which contains radiopaque foci of various sizes and shapes. Histological examination reveals fibrous soft tissue and islands of odontogenic epithelium. The tumor produces enamel or enamel matrix, dentin and cementum. Treatment of ameloblastic fibro-odontomas usually consists of enucleation or surgical curettage. Eight cases of ameloblastic fibro-odontoma are reported and the clinical features, radiographic and histo-pathologic findings will be discussed along with the 67 cases found in the literature.

18 cases of metastases to the jaws in the last 10 years obtained from the Clinic of Maxillofacial Surgery and the Department of Pathology, University Hospital Zürich, are described. They were seen in patients with carcinoma of the breast, lung, prostate gland, uterus and seminoma of the testis. In 16 cases the metastases were situated in the mandible, in 2 cases in the maxilla. The average age of these patients was 61.6 years with no sex predilection. The initial symptoms were pain swelling. In 4 cases a pathologic fracture was diagnosed. The majority of the metastatic lesions are osteolytic in nature. The metastases were diagnosed, in average 3.3 years after diagnoses of the preliminary tumor. In 2 cases the metastases were diagnosed before the occult primary tumor. Death usually ensues 1 year after diagnoses.

Between July 1st, 1984, and December 12th, 1988, a total of 135 patients underwent surgery for carcinomas of the oral cavity at the Maxillofacial Surgery Department and the Institute for Pathology of the University Hospital of Zürich. In 121 cases the malignancies involved the mandibular area including the floor of the mouth and the tongue, in 14 cases the maxillary area without the sinuses. 18 patients (13.3) had distant metastases and 8 patients (5.9%) had second carcinomas; 2 patients had both second carcinomas and metastases of their oral cavity carcinomas. The average age of the patients with distant metastases was 57.8 years, that of patients with second carcinomas 52.2 years. Diagnosis, treatment and the course of the disease are discussed.

Biologic behavior of glomus temporale tumors in relation to cranial nerve infiltration remains unclear. An analysis of cranial nerve involvement in relation to tumor staging was undertaken in a series of 102 glomus temporale tumors. Frequent neural infiltration was noted to occur in large glomus tumors, and a grading system of infiltration with both pathologic and surgical relevance introduced.

Tissue polypeptide antigen (TPA) has been increasingly used as an immunological marker for tumors derived from the lining epithelia of body cavities, including those of the gastrointestinal tract and genitourinary and bronchopulmonary systems. Here, we present evidence that this antigen is consistently and strongly expressed by a nonepithelial lesion — the chordoma. Irrespective of their sites, all seven chordomas, including one chondroid lesion, were heavily stained. In contrast, five chondro-sarcomas were unstained or showed only focal slight positivity. TPA staining was also found to be strongly expressed by notochordal rests within the intervertebral disks of one newborn and five fetuses (15th to 32nd week of gestation), adding further evidence that these rests are the histogenetic origin of the chordoma.

We describe the case of a 64-year-old man who presented with a rare salivary gland tumour, an epithelial-myoepithelial carcinoma. This was removed but recurred and required further surgery and radiotherapy. At the time of the patient's 2nd admission, a further primary tumour was detected. This proved to be a primary mixed adeno and squamous carcinoma of lung: a thoracotomy was performed and a lobectomy. The patient died suddenly 11 months later because of cor pulmonale. We describe the histology of epithelial-myoepithelial carcinoma and the immunohistochemical appearances of the tumour on staining for S-100, vimentin and keratin. The literature on this lesion is reviewed and radical surgery with post-operative radiotherapy are recommended as the best therapeutic approach. The literature on coincident second primary tumours in patients with salivary gland neoplasia is also reviewed. This is only the second case in which this phenomenon has been observed with epithelial-myoepithelial carcinoma.

The literature pertinent to calcifying odontogenic cysts is reviewed, and an additional case is described. Relevant clinical, radiological and histological features, as well as methods of treatment are considered, and an unusual method of treatment with good results is described in detail.

In 39 denture-wearing patients in whom anterior maxillary flabby ridge tissue (prosthesis fibroma) was excised, 15.4% contained cartilaginous nodules within this tissue. The chondrometaplasia may arise due to mechanical irritation activating pluripotential mesenchymal cells; but the possibility that the cartilaginous nodules represent remnant embryologic tissue cannot be excluded.

We report two new cases of rare idiopathic nodular calcinosis of the scrotum, which is characterized by intracutaneous chalky deposits restricted to the scrotum in otherwise healthy young men. Diagnosis has to be made histologically. Therapy consists of local excision.

Five cases of intramural venous leiomyosarcomas are described. Only one was localized in the inferior vena cava, the classic site; the other four cases were situated in smaller veins, namely, the short and long saphenous veins, the external jugular vein, and a superficial vein at the back of the hand. Light and, in two cases, electron microscopy, as well as immunohistochemical examinations for factor VIII, helped to establish the diagnosis. The fate of these cases indicates that size and localization are the main determining factors of outcome, whereas the level of mitotic activity is informative only if it is high. Small tumors in superficial veins that are detected early may have an excellent prognosis, even after limited removal of the tumor.

The clinical features, macroscopic and radiologic findings and typical histologic alterations in three cases of fibrous dysplasia of ribs are described. In one case the lesion presented as a tumor-like growth of a size unprecedented in previously reported cases. In differentiating this condition from ossifying fibroma, the pattern of distribution of newly formed bone to fibrous connective tissue is shown to be a valuable criterion. In fibrous dysplasia this ratio is constant for any given area, but varies considerably in ossifying fibroma.

Clinical and light and electron microscopic findings of one case of malignant melanotic schwannoma of the oral cavity are presented. The tumor recurred four times and developed submandibular metastasis. At autopsy, 24 months after manifestation of the initial symptoms, a hematogenous metastatic nodule was present in the liver. Peripheral melanotic schwannomas show a more malignant behavior than intraspinal examples. The Schwann's cell character of the individual tumor cells is demonstrated ultrastructurally by the presence of a prominent basal lamina, desmosomelike junctions between interdigitated elongated cell processes, and melanosomes in all stages of formation. These findings support the concept that neoplastic human Schwann's cells are capable of melanogenesis.

This paper describes the histopathological examination of an autopsy case featuring reconstruction of an edentulous maxilla by means of uncoated blade implants made of Titanaloy (TI6AL4V) inserted by the first author two years and seven months prior to the patient's death. The naturally induced reparative processes which encourage the success of this method and the optimal geometric flexibility allowed by the use of delicate blades are also examined. The significance of fibro-osseous tissue in blade implant support systems and the term "osseo-integration" often used in implantological literature will be discussed. The present study allows the following conclusions to be drawn: (1) Blade implants can be made in the maxilla. Provided sinus elevation is performed, blade implantation is feasible even when only minimal vertical quantities of bone are available in the distal regions. (2) Even if the opposing jaw bone (in this case the mandible) presents a complete natural dentition, blade implantation therapy remains feasible. (3) As the findings in this study show, the dynamic formation of calcified and non-calcified connective tissue around and within an endosseous implant is a totally natural reaction ensuring (a) fixation, (b) shock absorption, (c) the prevention of infection, and (d) the prevention of epithelial downgrowth. (4) Properly placed blade implants can be subjected to functional loading after six post-operative weeks and do not require a two-stage operative process, with a healing period of three to four months between the first and second surgical interventions. This often-cited three-to-four-month ossification period is thus unnecessary. (5) This case study clearly refutes the claims made by some authors (Tetsch, 1983; Strunz and Tetsch, 1985; Schramm-Scherrer and Tetsch, 1986) to the effect that (1) the maxilla cannot be implanted, and (2) blade implantology is doomed to failure, whether practiced in the maxilla or the mandible.

A case of eosinophilic granuloma of the mandibular condyle in a 38-year-old woman is reported. Clinically, the lesion presented as a malignant process with pathological fracture. The problems related to radiographic and histological diagnosis are discussed.

Eosinophilic gastroenteritis is a rare disease characterized by gastrointestinal symptoms, peripheral eosinophilia and massive infiltration of segments of the gastrointestinal tract by eosinophils. A case of this disease in a 25-year-old patient with symptoms of slight dysphagia and isolated esophageal involvement is described. Improvement of the symptoms, but not of the histological abnormalities, was obtained by steroids combined with withdrawal of the food components probably responsible for the symptoms.

A case of localized nodular synovitis of the temporomandibular joint is described and discussed. There are no cases previously reported in the literature. The distinction between synovitis of the villo-nodular type and that of the localized nodular type can be made, given the close collaboration of clinician and pathologist. The recognition of these to clinical entities of nearly similar histomorphological pattern is of great importance, as they differ in clinical course, treatment and prognosis.

In Great Britain and other countries there have been reports of an increased frequency of adenocarcinoma of the nose and paranasal sinuses, mimicking histologically mucinous colonic carcinoma, among workers exposed to wood dust and workers in the leather industry. No such cases have been reported so far in Switzerland. 31 patients with this type of adenocarcinoma of the nose and paranasal sinuses observed between 1953 and 1984 have been reviewed. In 13 of these patients there was occupational exposure to wood dust, and 4 were shoemakers. The study suggests an association of this type of nasal carcinoma with occupational exposure to wood dust and leatherwork. The nature of the postulated carcinogen is unknown. The authors propose further investigations to define the magnitude of the cancer risk associated with exposure to wood dust and leather.

A case of malacoplakia of the prostate in a 66-year old man is reported. This is the first time, that the diagnosis was established by needle biopsy. There are only eight previous reports of prostatic involvement. Three of these cases were initially misinterpreted as carcinoma. The present case is discussed in view of the pertinent clinical and pathological data in the literature.