Hedgehog signaling is differentially regulated in squamous cell carcinomas of the skin and the head and neck. Sonic hedgehog expression may serve as a prognostic factor in patients with head and neck cancer.

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Leishmaniasis directly affects 1.5-2 million patients per year, and more than 350 million persons are at risk worldwide for contracting this disease.1 It is a vector-borne disease caused by Leishmania , obligate intramacrophage protozoa. Human infection occurs through the bite of female phlebotomine sand flies. Non-vector transmission is possible, but is rarely reported. Leishmaniasis is classified into cutaneous, mucocutaneuous, and visceral (kala-azar) forms and shows a wide spectrum of clinical manifestations.2 Oral involvement is unusual and typically appears as mucosal ulcerations, mainly in the nasopharyngeal region. 3A 49-year-old white man was admitted to the Medical University of Vienna Hospital for the evaluation of a painful ulcer in a grossly enlarged tongue ( Figure 1A and B). The ulcer was present for two months. He reported a burning sensation, accompanied by the development of a small vesicle, which resulted in the persistent ulcer. Because of difficulties in swallowing, the patient had substantial weight loss and fatigue.Clinical examination diagnosed an ulcer 1.5 cm in diameter on the left ventrolateral surface of the tongue. Mandibular lymph nodes on the left side were enlarged, non-tender, and relocatable. Clinical differential diagnosis included malignomas, eosinophilic granuloma, primary syphilis, infection with herpes zoster, and tuberculosis.Routine laboratory investigations show negative results for infection with human immunodeficiency virus and elevated levels of cholesterol (225 mg/dL), gamma-glutamyl transferase (102 U/L), aspartate aminotransferase (42 U/L), and alanine aminotransferase (105 U/L). Ultrasonic testing of the abdomen showed slight signs of steatosis hepatis. A computed tomography scan of the paranasal sinuses did not show any pathologic changes except for chronic inflammations in the area of four teeth. Fibrotic changes in the mediastinum, with a single enlarged pre-aortal lymph node and numerous minimally increased mediastinal lymph nodes were illustrated by a computed tomography scan of the lungs and mediastinum. T2-weighted magnetic resonance imaging of the mouth and tongue indicated residual hyperintensities of the tip of the tongue, which extended ventrally to the left side.Histopathologic analysis of a Giemsa-stained punch biopsy specimen of the tongue identified granulomatous changes ( Figure 2A ) and numerous Leishman-Donovan bodies within macrophages ( Figure 2B ). Results of parasitologic and serologictests presented borderline values ( Leishmania sp. indirect immu nofluorescence test titer = 1:40 and Leishmania sp. enzyme-linked immunosorbent assay optical density = 0.39). A subsequent polymerase chain reaction identified Leishmania donovani complex DNA ( Figure 2C ). A detailed travel history indicated that the patient had taken a trip to the island of Rab in Croatia four weeks before the onset of his symptoms.Treatment with parenteral application of liposomal amphotericin B (3 mg/kg/day) for 5 consecutive days was initiated. The medication was well tolerat...