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Introduction: Thoracic SMARCA4-deficient Undifferentiated Tumors (SMARCA4-UT) are rare and aggressive malignancies. This case is unique as it describes the first gingival metastasis from thoracic SMARCA4-UT, emphasizing the diagnostic role of dental professionals. Observation : A 71-year-old man, heavy smoker (50 pack-years), presented with chest pain, dyspnea, weight loss, and a gingival lesion. Oral examination revealed poor oral health with severe periodontitis, trismus, halitosis, pain on palpation, and a 3 cm friable gingival tumor in sector 2. Premolars showed grade 3 mobility and loss of vitality. 3D imaging confirmed tumor extension. CT, PET-CT, revealed thoracic, adrenal masses and multiple metastases. Histopathology confirmed SMARCA4-UT with gingival metastasis. Outcome : The patient's condition deteriorated rapidly, and he died before treatment could be initiated. Conclusion : Dental professionals play a key role in suspecting systemic disease from oral manifestations. This case underscores the importance of considering metastasis in atypical oral tumors.

Alterations in Plasma Vitamin E Distribution in Type 2 Diabetic Patients With Elevated Plasma Phospholipid Transfer Protein Activity Martina Schneider 1 , Bruno Vergès 2 , Alexis Klein 1 , Elizabeth R. Miller 3 , Valérie Deckert 1 , Catherine Desrumaux 1 , David Masson 1 , Philippe Gambert 1 , Jean-Marcel Brun 2 , Jamila Fruchart-Najib 4 , Denis Blache 1 , Joseph L. Witztum 3 and Laurent Lagrost 1 1 Institut National de la Santé et de la Recherche Médicale (INSERM) U498, Dijon, France 2 Department of Endocrinology and Diabetes, Bocage Hospital, Dijon, France 3 Department of Medicine, University of California, San Diego, La Jolla, California 4 INSERM U545, Pasteur Institute, Lille, France Address correspondence and reprint requests to Laurent Lagrost, INSERM U498, Laboratoire de Biochimie des Lipoprotéines, Faculté de Médecine, BP 87900, 21079 Dijon Cedex, France. E-mail: laurent.lagrost{at}u-bourgogne.fr Abstract Mouse studies indicated that plasma phospholipid transfer protein (PLTP) determines the plasma distribution of vitamin E, a potent lipophilic antioxidant. Vitamin E distribution, antioxidant status, and titer of anti–oxidized LDLs (oxLDL) autoantibodies were evaluated in plasma from control subjects ( n = 31) and type 2 diabetic patients ( n = 31) with elevated plasma PLTP concentration. Unlike diabetic and control HDLs, which displayed similar vitamin E contents, diabetic VLDLs and diabetic LDLs contained fewer vitamin E molecules than normal counterparts. Plasma PLTP concentration in diabetic plasmas correlated negatively with vitamin E in VLDL+LDL, but positively with vitamin E in HDL, with an even stronger correlation with the VLDL+LDL–to–HDL vitamin E ratio. Circulating levels of oxLDL were significantly higher in diabetic plasmas than in control plasmas. Whereas the titer of IgG autoantibodies to modified LDL did not differ significantly between diabetic patients and control subjects, diabetic plasmas showed significantly lower levels of potentially protective IgM autoantibodies. The present observations support a pathophysiological role of PLTP in decreasing the vitamin E content of apolipoprotein B–containing lipoproteins, but not of HDL in plasma of type 2 diabetic patients, contributing to a greater potential for LDL oxidation. apo, apolipoprotein ELISA, enzyme-linked immunosorbent assay MDA-LDL, malondialdehyde-modified LDL oxLDL, oxidized LDL PLTP, phospholipid transfer protein Footnotes Accepted July 9, 2004. Received May 5, 2004. DIABETES