- Email: [email protected]
COWDEN'S SYNDROME, A RARE CONDITION: CASE REPORT
Vol. 124 No. 2 August 2017
Abstracts of the 42nd Brazilian Congress of Oral Medicine and Oral Pathology (Manaus, Amazonas, Brazil, July 4-8, 2016)
OP e ORAL PRESENTATION OP01 - BROWN TUMOR OF THE JAW MIMICKING MALIGNANT NEOPLASM. PAULO DE CAMARGO MORAES, RUBENS GONÇALVESTEIXEIRA, LUIS ALEXANDRE THOMAZ, CLAUDIO ROBERTO PACHECO JODAS, VICTOR ANGELO MONTALLI, MARCELO SPERANDIO, AMY LOUISE BROWN. Brown tumors are an unusual manifestation of primary hyperparathyroidism, a disease characterized by excessive secretion of parathyroid hormone (PTH). With the exception of bone loss, skeletal manifestations are rare, occurring in less than 2% of patients. The presence of multiple lesions may imitate a malignant neoplasm, hence posing a real diagnostic challenge. We describe a 50-year-old wheelchair-bound Brazilian female patient presenting with multiple expansive lytic lesions. The clinical differential diagnosis included metastatic disease and multiple myeloma. Intra-oral examination revealed a large ulcerating proliferative brown mass on the left side of the mandible with significant bone destruction. Serum calcium, alkaline phosphatase, and PTH (was 7 times above the upper limit of normal). A combination of physical examination, radiologic, and histopathologic investigations were performed. A parathyroid nodule was detected and surgically excised. Two months later, the patient was no longer wheelchair-bound. In addition, after 15 months of follow-up, the brown tumor has significantly decreased.
OP02 - LEISHMANIOSE IN ORAL CAVITY: A CLINICAL CASE REPORT. CARLOS DEYVER DE SOUZA QUEIROZ, HELIO MASSAIOCHI TANIMOTO, RAPHAEL HAIKEL JUNIOR, EDMUNDO CARVALHO MAUAD, ANDRÉ LOPES CARVALHO, JOSÉ HUMBERTO FRAGNANI, ADHEMAR LONGATTO FILHO. Leishmaniasis is an infectious disease, non-contagious, caused by different species of Leishmania protozoa, which can affect the skin and/or mucous membranes. When it affects the oral mucosa, the disease becomes destructive and granulomatous. The purpose is to report a clinical case and the difficulty of performing diagnosis of leishmaniasis in remote regions. Patient NF, male, 61-year-old, leucoderma, coming from Porto dos Gauchos - MT, was referred to the Prevention Department in Mouth Cancer by teledermatology with ulcerovegetative injury and granulomatous in the hard and soft palate. For more than 1 year, he had undergone treatment without improvement. We performed incisional biopsy and the material was sent to pathology, where the result was compatible with leishmaniasis. The compulsory notification was made and sent to a medical reference treatment center. After 6 months of treatment, the patient returned for reassessment, where cure of the disease without lesions in the oral cavity was observed.
OP03 - RELAPSED MULTIPLE MYELOMA WITH PRIMARY MANIFESTATION IN THE MANDIBLE: A CASE REPORT. AMANDA LEAL ROCHA, TARCÍLIA APARECIDA SILVA, ROBERTA
OLIVEIRA DE PAULA E SILVA, RICARDO SANTIAGO GOMEZ, RICARDO ALVES MESQUITA. Multiple myeloma (MM) is a systemic disease characterized by multifocal proliferation of atypical plasma cells and production of monoclonal immunoglobulins. A 51-year-old white male presented to a referral center complaining of pain in the left mandible. During physical examination, an increased volume at the inferior vestibule fornix with painful and hard consistency at palpation was observed. Panoramic radiography showed a circular osteolytic lesion in the left mandible. Medical history revealed a previously diagnosis of MM, treated with autologous stem cell transplantation in 2014. An incisional biopsy was taken with previous puncture and aspiration. The histopathologic analysis revealed atypical plasma cells with large hyperchromatic nuclei and large cytoplasm. The diagnosis was malignant neoplasm of plasma cell. Based on all the reports and laboratory findings, a final diagnosis of relapsed MM was made. The patient was referred for medical treatment. (CNPq #309322/2015-4 FAPEMIG).
OP4 - MINERAL AND OSSEOUS DISORDERS RELATED TO CHRONIC KIDNEY DISEASE: A CASE REPORT WITH ORAL HEALTH IMPACT. FERNANDA TENÓRIO LOPES BARBOSA, ALEXANDRE BELLOTTI, ENEIDA FRANCO VÊNCIO, REJANE FARIA RIBEIRO-ROTTA. Jaw enlargement is an uncommon complication of chronic kidney disease related to mineral and bone disorders. A 24-yearold male patient was referred to an oral medicine center presenting with a large asymptomatic anterior mandible growing for 2 months’ duration. Medical history included chronic kidney disease and high blood pressure for 6 years. Laboratory examinations revealed high levels of parathormone and an endocrinologist diagnosed him as a secondary hyperparathyroidism patient. Histopathologic examination of incisional biopsy from the mandible lesion reported a cluster of spindle cells with numerous giant multinucleated cells and peripheral osteoid formation compatible with brown tumor of hyperparathyroidism. Phosphorus levels controlled through diet, chelating agents, and the use of vitamin D analogues were therapeutic approaches that have failed because of lack of adherence to treatment. Parathyroidectomy was considered, but the patient died before the intervention because of pulmonary embolism. Multidisciplinary professional integration was crucial to ensure the patient’s quality of life during treatment.
OP5 - COWDEN’S SYNDROME, A RARE CONDITION: CASE REPORT. ARTHUR WILSON FLORENCIO DA COSTA, MARÍLIA OLIVEIRA MORAIS, ALLISSON FILIPE LOPES MARTINS, INARA CARNEIRO COSTA REGE, ELISMAURO FRANCISCO DE MENDONÇA. Cowden’s syndrome (CS) is a rare genodermatosis that affects the white female gender. The skin is the most affected organ, and these cutaneous manifestations usually precede the
e47
ORAL AND MAXILLOFACIAL PATHOLOGY e48 Abstracts development of cancer, serving as important clinical signs identifying patients at high risk of developing malignancies. Our goal is to present the case of a female patient, 53 years old, with a main complaint of “infection in the mouth and burning sensation in the tongue.” Medical history showed a thyroidectomy, removal of inear hamartoma, and liver nodule. On extraoral examination a sessile nodule was seen in the ear and on intraoral examination it was noted multiple coloring papules similar to the mucosa. Incisional biopsy was performed and histopathologic examination proved compatible with inflammatory fibrous hyperplasia. The final diagnosis was CS associated with oral candidiasis. The patient was treated with nystatin to control the infection and has been under observation for 2 years without complaints or deteriorations in the frame.
OP6 - POLYMORPHOUS LOW-GRADE ADENOCARCINOMA OF THE LOWER LIP. TIAGO NOVAES PINHEIRO, CLAUDIA ANDREA GARCIA CORRÊA SIMÕES, ANTONIO JORGE ARAÚJO VASCONCELOS II, MARCO TÚLLIO BRAZÃO-SILVA. Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm that frequently occurs in the minor salivary glands of palate and oral cavity. We present a case of lower lip swelling with ulceroproliferative growth in a 48-year-old male with more than 20 years’ history of development. Fine needle aspiration cytology smears suggested salivary gland neoplasia. A wide incisional biopsy was performed and histopathologic examination diagnosed PLGA. The patient was referred to an oncology center and has been under follow-up for the last 6 months. The differential diagnosis of PLGA with pleomorphic adenoma, adenoid cystic carcinoma, mammary analogue secretory carcinoma, mucoepidermoid carcinoma, epithelial myoepithelial carcinoma, and papillary cystadenocarcinoma is discussed, as well as the significance of different histochemical techniques for microscopic diagnosis.
OP7 - EIGHT-YEAR FOLLOW-UP OF CENTRAL GIANT CELL LESION TREATED WITH CORTICOSTEROID: CASE REPORT. JULIANA BORGES, TILA FORTUNA COSTA, SILVIA REIS, ANTÔNIO MÁRCIO TEIXEIRA MARCHIONNI, BRIANA MONTEIRO, ALENA PEIXOTO MEDRADO. Herein we report on a case of a pediatric patient with central giant-cell granuloma of the jaw that was successfully treated with intralesional corticosteroid injections as the sole therapy. We also discuss if there is an ideal waiting period between nonoperative treatment and the need of surgical intervention. An 8-year-old boy with a central giant cell lesion on the right side of the mandible was treated with intralesional corticosteroids injections. After an 8-year follow-up, the patient’s bone architecture was near normal. Panoramic radiography showed areas of new bone formation, without recurrence or side effects of the medication. Is there an ideal waiting period between nonoperative treatment and the need for surgical intervention? It is estimated that a monitoring period of 6 to 8 years is necessary to determine the success of such treatment.
OP8 - SURGICAL CILIATED CYST: A CASE REPORT. JOSÉ ALCIDES ALMEIDA DE ARRUDA, SAULO QUEIROZ DE ARAUJO, THIAGO COELHO GOMES DA SILVA, BELMIRO CAVALCANTI DO EGITO VASCONCELOS, MARCIA MARIA FONSECA DA SILVEIRA, ANA PAULA VERAS SOBRAL.
OOOO August 2017 Surgical ciliated cyst is often described as a postoperative maxillary cyst or paranasal cyst. Characterized by an aggressive injury, it is commonly described in patients who underwent radical surgery on the maxillary sinus region, such as orthognathic or Caldwell-Luc procedures. Herein we report a case of a 47-year-old patient complaining of spontaneous pain and swelling in the anterior maxilla, presenting a history of a 9-month-old surgery in the posterior maxilla intended to remove an odontogenic cystic lesion. CT scan showed a low-density lesion in the left maxillary sinus region. Biopsy and histopathologic examination established the diagnosis of surgical ciliated cyst. The patient is under a 2-year non-symptomatic follow-up.
OP9 - A NEW HETEROZYGOUS MUTATION IN FGFR2 GENE CAUSING PFEIFFER SYNDROME. RENATO ASSIS MACHADO, SHIRLENE BARBOSA PIMENTEL FERREIRA, MARCOS JOSÉ BURLE AGUIAR, DANIELLA REIS B. MARTELLI, RICARDO DELLA COLETTA, HERCÍLIO MARTELLIJÚNIOR. Pfeiffer syndrome (PS) (MIM: #101600) is a rare autosomal dominant disorder classically characterized by coronal craniosynostosis, brachycephaly, midfacial hypoplasia, broad and deviated thumbs, and big toes and fingers. PS occurs in approximately 1:100,000 live births. Clinical manifestations and molecular genetic are used to confirm the diagnosis of the disease. Heterozygous mutations in the fibroblast growth factor receptor types 1 and 2 gene (FGFR1 and FGFR2) can cause PS. Herein we report on a female patient and her mother, both affected with PS of similar severity, carrying a previously undescribed heterozygous missense mutation characterized by c.868T>G, encoding Trp289Gly, in the FGFR2 gene. Classical phenotypes related to PS were exhibited by both PS patients. Intraoral examination revealed malocclusion, dental midline deviation, high arched palate, and excessive interdental spacing. Thus, our approach led to the identification of a new target mutation in FGFR2 gene that contributes to the pathophysiology of PS.
OP10 - ORAL METASTATIC BREAST ADENOCARCINOMA IN A MALE PATIENT. NATHALIA DE ALMEIDA FREIRE, NATHALIE HENRIQUES DA SILVA CANEDO, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MÁRIO JOSÉ ROMAÑACH. Oral metastatic tumors are uncommon, with the breast, prostate, lung, and kidney being the most common primary sites. Less than 1% of all breast cancers occur in male patients, and to date only 4 cases of metastatic breast adenocarcinoma to the oral cavity have been reported in the literature. An 88-year-old male patient with previous history of a successfully treated primary breast adenocarcinoma 12 years earlier was referred for evaluation of an oral swelling of unknown evolution. Intraoral examination revealed a 2-cm reddish pedunculated nodule covered by smooth surface in the left retromolar region. The patient was submitted to incisional biopsy and microscopic evaluation revealed invasive tumor islands compounded by malignant epithelial cells, sometimes exhibiting ductal arrangement, which were positive for estrogen receptor and GCDFP-15. The final diagnosis was oral metastatic breast adenocarcinoma. Clinicians should be aware of aggressive behavior and oral metastasis of breast adenocarcinomas in male patients.
Abstracts of the 42nd Brazilian Congress of Oral Medicine and Oral Pathology (Manaus, Amazonas, Brazil, July 4-8, 2016)
OP e ORAL PRESENTATION OP01 - BROWN TUMOR OF THE JAW MIMICKING MALIGNANT NEOPLASM. PAULO DE CAMARGO MORAES, RUBENS GONÇALVESTEIXEIRA, LUIS ALEXANDRE THOMAZ, CLAUDIO ROBERTO PACHECO JODAS, VICTOR ANGELO MONTALLI, MARCELO SPERANDIO, AMY LOUISE BROWN. Brown tumors are an unusual manifestation of primary hyperparathyroidism, a disease characterized by excessive secretion of parathyroid hormone (PTH). With the exception of bone loss, skeletal manifestations are rare, occurring in less than 2% of patients. The presence of multiple lesions may imitate a malignant neoplasm, hence posing a real diagnostic challenge. We describe a 50-year-old wheelchair-bound Brazilian female patient presenting with multiple expansive lytic lesions. The clinical differential diagnosis included metastatic disease and multiple myeloma. Intra-oral examination revealed a large ulcerating proliferative brown mass on the left side of the mandible with significant bone destruction. Serum calcium, alkaline phosphatase, and PTH (was 7 times above the upper limit of normal). A combination of physical examination, radiologic, and histopathologic investigations were performed. A parathyroid nodule was detected and surgically excised. Two months later, the patient was no longer wheelchair-bound. In addition, after 15 months of follow-up, the brown tumor has significantly decreased.
OP02 - LEISHMANIOSE IN ORAL CAVITY: A CLINICAL CASE REPORT. CARLOS DEYVER DE SOUZA QUEIROZ, HELIO MASSAIOCHI TANIMOTO, RAPHAEL HAIKEL JUNIOR, EDMUNDO CARVALHO MAUAD, ANDRÉ LOPES CARVALHO, JOSÉ HUMBERTO FRAGNANI, ADHEMAR LONGATTO FILHO. Leishmaniasis is an infectious disease, non-contagious, caused by different species of Leishmania protozoa, which can affect the skin and/or mucous membranes. When it affects the oral mucosa, the disease becomes destructive and granulomatous. The purpose is to report a clinical case and the difficulty of performing diagnosis of leishmaniasis in remote regions. Patient NF, male, 61-year-old, leucoderma, coming from Porto dos Gauchos - MT, was referred to the Prevention Department in Mouth Cancer by teledermatology with ulcerovegetative injury and granulomatous in the hard and soft palate. For more than 1 year, he had undergone treatment without improvement. We performed incisional biopsy and the material was sent to pathology, where the result was compatible with leishmaniasis. The compulsory notification was made and sent to a medical reference treatment center. After 6 months of treatment, the patient returned for reassessment, where cure of the disease without lesions in the oral cavity was observed.
OP03 - RELAPSED MULTIPLE MYELOMA WITH PRIMARY MANIFESTATION IN THE MANDIBLE: A CASE REPORT. AMANDA LEAL ROCHA, TARCÍLIA APARECIDA SILVA, ROBERTA
OLIVEIRA DE PAULA E SILVA, RICARDO SANTIAGO GOMEZ, RICARDO ALVES MESQUITA. Multiple myeloma (MM) is a systemic disease characterized by multifocal proliferation of atypical plasma cells and production of monoclonal immunoglobulins. A 51-year-old white male presented to a referral center complaining of pain in the left mandible. During physical examination, an increased volume at the inferior vestibule fornix with painful and hard consistency at palpation was observed. Panoramic radiography showed a circular osteolytic lesion in the left mandible. Medical history revealed a previously diagnosis of MM, treated with autologous stem cell transplantation in 2014. An incisional biopsy was taken with previous puncture and aspiration. The histopathologic analysis revealed atypical plasma cells with large hyperchromatic nuclei and large cytoplasm. The diagnosis was malignant neoplasm of plasma cell. Based on all the reports and laboratory findings, a final diagnosis of relapsed MM was made. The patient was referred for medical treatment. (CNPq #309322/2015-4 FAPEMIG).
OP4 - MINERAL AND OSSEOUS DISORDERS RELATED TO CHRONIC KIDNEY DISEASE: A CASE REPORT WITH ORAL HEALTH IMPACT. FERNANDA TENÓRIO LOPES BARBOSA, ALEXANDRE BELLOTTI, ENEIDA FRANCO VÊNCIO, REJANE FARIA RIBEIRO-ROTTA. Jaw enlargement is an uncommon complication of chronic kidney disease related to mineral and bone disorders. A 24-yearold male patient was referred to an oral medicine center presenting with a large asymptomatic anterior mandible growing for 2 months’ duration. Medical history included chronic kidney disease and high blood pressure for 6 years. Laboratory examinations revealed high levels of parathormone and an endocrinologist diagnosed him as a secondary hyperparathyroidism patient. Histopathologic examination of incisional biopsy from the mandible lesion reported a cluster of spindle cells with numerous giant multinucleated cells and peripheral osteoid formation compatible with brown tumor of hyperparathyroidism. Phosphorus levels controlled through diet, chelating agents, and the use of vitamin D analogues were therapeutic approaches that have failed because of lack of adherence to treatment. Parathyroidectomy was considered, but the patient died before the intervention because of pulmonary embolism. Multidisciplinary professional integration was crucial to ensure the patient’s quality of life during treatment.
OP5 - COWDEN’S SYNDROME, A RARE CONDITION: CASE REPORT. ARTHUR WILSON FLORENCIO DA COSTA, MARÍLIA OLIVEIRA MORAIS, ALLISSON FILIPE LOPES MARTINS, INARA CARNEIRO COSTA REGE, ELISMAURO FRANCISCO DE MENDONÇA. Cowden’s syndrome (CS) is a rare genodermatosis that affects the white female gender. The skin is the most affected organ, and these cutaneous manifestations usually precede the
e47
ORAL AND MAXILLOFACIAL PATHOLOGY e48 Abstracts development of cancer, serving as important clinical signs identifying patients at high risk of developing malignancies. Our goal is to present the case of a female patient, 53 years old, with a main complaint of “infection in the mouth and burning sensation in the tongue.” Medical history showed a thyroidectomy, removal of inear hamartoma, and liver nodule. On extraoral examination a sessile nodule was seen in the ear and on intraoral examination it was noted multiple coloring papules similar to the mucosa. Incisional biopsy was performed and histopathologic examination proved compatible with inflammatory fibrous hyperplasia. The final diagnosis was CS associated with oral candidiasis. The patient was treated with nystatin to control the infection and has been under observation for 2 years without complaints or deteriorations in the frame.
OP6 - POLYMORPHOUS LOW-GRADE ADENOCARCINOMA OF THE LOWER LIP. TIAGO NOVAES PINHEIRO, CLAUDIA ANDREA GARCIA CORRÊA SIMÕES, ANTONIO JORGE ARAÚJO VASCONCELOS II, MARCO TÚLLIO BRAZÃO-SILVA. Polymorphous low-grade adenocarcinoma (PLGA) is a malignant neoplasm that frequently occurs in the minor salivary glands of palate and oral cavity. We present a case of lower lip swelling with ulceroproliferative growth in a 48-year-old male with more than 20 years’ history of development. Fine needle aspiration cytology smears suggested salivary gland neoplasia. A wide incisional biopsy was performed and histopathologic examination diagnosed PLGA. The patient was referred to an oncology center and has been under follow-up for the last 6 months. The differential diagnosis of PLGA with pleomorphic adenoma, adenoid cystic carcinoma, mammary analogue secretory carcinoma, mucoepidermoid carcinoma, epithelial myoepithelial carcinoma, and papillary cystadenocarcinoma is discussed, as well as the significance of different histochemical techniques for microscopic diagnosis.
OP7 - EIGHT-YEAR FOLLOW-UP OF CENTRAL GIANT CELL LESION TREATED WITH CORTICOSTEROID: CASE REPORT. JULIANA BORGES, TILA FORTUNA COSTA, SILVIA REIS, ANTÔNIO MÁRCIO TEIXEIRA MARCHIONNI, BRIANA MONTEIRO, ALENA PEIXOTO MEDRADO. Herein we report on a case of a pediatric patient with central giant-cell granuloma of the jaw that was successfully treated with intralesional corticosteroid injections as the sole therapy. We also discuss if there is an ideal waiting period between nonoperative treatment and the need of surgical intervention. An 8-year-old boy with a central giant cell lesion on the right side of the mandible was treated with intralesional corticosteroids injections. After an 8-year follow-up, the patient’s bone architecture was near normal. Panoramic radiography showed areas of new bone formation, without recurrence or side effects of the medication. Is there an ideal waiting period between nonoperative treatment and the need for surgical intervention? It is estimated that a monitoring period of 6 to 8 years is necessary to determine the success of such treatment.
OP8 - SURGICAL CILIATED CYST: A CASE REPORT. JOSÉ ALCIDES ALMEIDA DE ARRUDA, SAULO QUEIROZ DE ARAUJO, THIAGO COELHO GOMES DA SILVA, BELMIRO CAVALCANTI DO EGITO VASCONCELOS, MARCIA MARIA FONSECA DA SILVEIRA, ANA PAULA VERAS SOBRAL.
OOOO August 2017 Surgical ciliated cyst is often described as a postoperative maxillary cyst or paranasal cyst. Characterized by an aggressive injury, it is commonly described in patients who underwent radical surgery on the maxillary sinus region, such as orthognathic or Caldwell-Luc procedures. Herein we report a case of a 47-year-old patient complaining of spontaneous pain and swelling in the anterior maxilla, presenting a history of a 9-month-old surgery in the posterior maxilla intended to remove an odontogenic cystic lesion. CT scan showed a low-density lesion in the left maxillary sinus region. Biopsy and histopathologic examination established the diagnosis of surgical ciliated cyst. The patient is under a 2-year non-symptomatic follow-up.
OP9 - A NEW HETEROZYGOUS MUTATION IN FGFR2 GENE CAUSING PFEIFFER SYNDROME. RENATO ASSIS MACHADO, SHIRLENE BARBOSA PIMENTEL FERREIRA, MARCOS JOSÉ BURLE AGUIAR, DANIELLA REIS B. MARTELLI, RICARDO DELLA COLETTA, HERCÍLIO MARTELLIJÚNIOR. Pfeiffer syndrome (PS) (MIM: #101600) is a rare autosomal dominant disorder classically characterized by coronal craniosynostosis, brachycephaly, midfacial hypoplasia, broad and deviated thumbs, and big toes and fingers. PS occurs in approximately 1:100,000 live births. Clinical manifestations and molecular genetic are used to confirm the diagnosis of the disease. Heterozygous mutations in the fibroblast growth factor receptor types 1 and 2 gene (FGFR1 and FGFR2) can cause PS. Herein we report on a female patient and her mother, both affected with PS of similar severity, carrying a previously undescribed heterozygous missense mutation characterized by c.868T>G, encoding Trp289Gly, in the FGFR2 gene. Classical phenotypes related to PS were exhibited by both PS patients. Intraoral examination revealed malocclusion, dental midline deviation, high arched palate, and excessive interdental spacing. Thus, our approach led to the identification of a new target mutation in FGFR2 gene that contributes to the pathophysiology of PS.
OP10 - ORAL METASTATIC BREAST ADENOCARCINOMA IN A MALE PATIENT. NATHALIA DE ALMEIDA FREIRE, NATHALIE HENRIQUES DA SILVA CANEDO, MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MÁRIO JOSÉ ROMAÑACH. Oral metastatic tumors are uncommon, with the breast, prostate, lung, and kidney being the most common primary sites. Less than 1% of all breast cancers occur in male patients, and to date only 4 cases of metastatic breast adenocarcinoma to the oral cavity have been reported in the literature. An 88-year-old male patient with previous history of a successfully treated primary breast adenocarcinoma 12 years earlier was referred for evaluation of an oral swelling of unknown evolution. Intraoral examination revealed a 2-cm reddish pedunculated nodule covered by smooth surface in the left retromolar region. The patient was submitted to incisional biopsy and microscopic evaluation revealed invasive tumor islands compounded by malignant epithelial cells, sometimes exhibiting ductal arrangement, which were positive for estrogen receptor and GCDFP-15. The final diagnosis was oral metastatic breast adenocarcinoma. Clinicians should be aware of aggressive behavior and oral metastasis of breast adenocarcinomas in male patients.