Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

Introduction

Oral squamous cell carcinoma (OSCC) is the most common neoplasm in the oral and maxillofacial region and is commonly preceded by tissue alterations in the form of oral epithelial dysplasia (OED). OEDs are clinically and histologically heterogeneous, with unique cellular, stromal, and signaling components. The dysplasia immune microenvironment (DIME) and the study of this complex interplay of its various cellular and non-cellular components remain a knowledge gap in the field of OSCC immune-oncology. In our study, we propose a high-throughput multi-dimensional analysis to visualize the complex interactions of the tumor microenvironment in progressing and non-progressing oral epithelial dysplasia. This study highlights the vast potential of multiplex single-cell technology to quantify and understand spatial interactions within the microenvironment as a tool to understand dysplasia progression and oral cancer behaviour.

Materials and Methods

In this retrospective study, we used cytometry time-of-flight (CyTOF) imaging mass cytometry (IMC) to simultaneously examine the expression of 21 protein markers in the DIME including cellular and non-cellular components. We analyzed 11 progressing oral epithelial dysplasia, 11 non-progressing oral epithelial dysplasia, and 9 inflamed mucosa and 2 non-inflamed mucosa controls, resulting in 693 high-dimensional pathology images. Deconvolution, t-SNE, UMAP, cytometry analyses were performed using FlowJo, HistoCat, and ImaCyte.

Results

Qualitative, quantitative, and spatial interactions were characterized in both progressing and non-progressing oral epithelial dysplasias. We found that within progressing and carcinoma groups, there is a reduction in the cytotoxic immune response, and upregulation of inflammatory phenotypes, and stromal markers that promote a favorable microenvironment for cell growth and proliferation.

Conclusion

Our study highlights that spatially resolved, single-cell analysis can characterize pre-malignant and malignant OSCC heterogeneity in cellular architecture and cellular composition, which provides a basis for future studies on how better understanding of the microenvironment can influence disease outcomes.

Introduction

Ameloblastomas, a type of odontogenic tumor, exhibit the BRAF V600E mutation in more than 65% of cases. This study aims to explore the potential correlation between the BRAF V600E mutation, the biological behavior of conventional ameloblastomas, and Disease-Free Survival in patients.

Materials and Methods

This retrospective cohort study, following STROBE recommendations, involved individuals treated for conventional ameloblastomas. Clinical, imaging, histomorphological, immunohistochemical (Ki67 and CD138/syndecan-1), and molecular BRAF V600E mutation analyses were conducted. Bivariate statistical analysis employed chi-square and Fisher's exact tests. Kaplan-Meier analysis with log-rank test and Cox proportional hazards regression identified disease-free survival predictors at a 5% significance level.

The study included 41 individuals, with a male-to-female ratio of 1.15:1. The BRAF V600E mutation was present in 75.6% of tumors. No significant associations were found between BRAF mutational status and other clinical, imaging, histomorphological, and immunohistochemical variables. Univariate (p = 0.008) and multivariate (p = 0.030) analyses revealed that the initial treatment modality significantly influenced prognosis, favoring radical treatment with a Hazard Ratio of 9.60 (95%IC = 1.24 – 73.89).

Conclusions

BRAF V600E mutation emerges as a prevalent molecular aberration in ameloblastomas. Nevertheless, it does not seem to significantly affect the tumor proliferative activity, CD138/syndecan-1-mediated cell adhesion, and disease-free survival outcomes.

Introduction

Local recurrence of squamous cell carcinoma (SCC) occurs despite the report of negative histologic margins. P53 immunohistochemistry (IHC) has been recently shown to be able identify high-risk dysplasia that otherwise displays low-grade morphology. This study seeks to apply p53 IHC in evaluating a cohort of resected oral SCC and evaluate its utility in assessing margin status.

Materials and Methods

Cases of SCC, resected at our institution, with known p53 mutations were identified between 2015-2020. Data from the chart and pathology reports were reviewed. Blocks were pulled if available and additional H&E and p53 IHC was performed on the main tumor and margins. Slides were assessed for the presence of dysplasia and p53 staining pattern.

Results

At time of abstract submission, 5 patient cases were identified meeting inclusion criteria and had available tissue. P53 status will be reported. Issues with laser and frozen section artifact were identified. Further analysis is ongoing.

Conclusions

We report the results of a study applying p53 IHC in evaluating the margins of resected SCC. These findings will provide the basis for initiating a larger study investigating the reliability and prognostic implications of p53 staining patterns in SCC.

Leiomyosarcoma (LMS) is a soft tissue sarcoma arising from the embryonic mesoderm of smooth muscle lineage. LMS of the oral cavity is exceedingly rare, accounting for less than 1% of smooth muscle malignancies. We describe a 60-year-old female who presented for evaluation of a rapidly expanding mass in her lower left mandibular quadrant of three weeks duration. The patient reported a one-year history of sporadic pain in the area. The patient's medical history was significant for a lesion involving the same quadrant three months prior that was diagnosed as a myofibroma. Clinical examination revealed a large, exophytic, fleshy, erythematous mass extruding from the left posterior mandible. Cone beam computed tomography demonstrated a multilobulated hypodensity involving the left mandibular body and ramus. The lesion had perforated the buccal and lingual cortices, displaced tooth #19 in an anterior-buccal direction, and inverted its vertical orientation. A left hemimandibulectomy was performed, and histopathologic examination of the resection specimen showed an infiltrative hypercellular proliferation of atypical spindle cells with distinctly eosinophilic cytoplasm, cigar-shaped nuclei, and a fascicular growth pattern. The spindle cells demonstrated immunoreactivity to desmin and caldesmon, supporting a diagnosis of LMS. Immunohistochemical staining was also positive for ER, PR, and patchy WT1, suggesting the possibility of a gynecological origin. A uterine primary was discovered on subsequent medical evaluation. The patient is currently undergoing chemotherapy for the management of metastatic uterine LMS. Less than twenty cases of metastatic LMS have been reported in the literature to date. Knowledge of the morphological and immunohistochemical hallmarks of this malignancy can aid in directing the diagnostic workup, thereby facilitating timely management. Furthermore, this challenging case highlights the importance of effective interdisciplinary communication in reconciling discrepancies that arise between the histologic diagnosis and clinical behavior of a lesion.

Introduction

Sinonasal neuroendocrine malignancies are subclassified into small cell and large cell neuroendocrine carcinoma and olfactory neuroblastoma (ONB). Recently, neoplasms that display histomorphologic similarities to ONB but additionally reveal overt epithelial features have been designated as olfactory carcinoma (OCA). Herein, we report the clinicopathologic characteristics of two cases of OCA.

Material and methods

The archives of the OSU Department of Pathology were searched for tumors diagnosed as or displaying features suggestive of OCA. Information regarding patient age and gender, location, radiographic, histopathologic and immunohistochemical features of the lesion, treatment and follow-up was retrieved.

Results

Two cases, arising in 48 and 55-year-old males, met the diagnostic criteria for OCA. Both presented as destructive, midline, sinonasal tumors (4.3 and 7.0cm) that caused erosion of the cribriform plate and nasal septum, extending into the ethmoid, sphenoid and maxillary sinuses, with intracranial and, in one case, orbital involvement. Histopathologically, the tumors exhibited solid or ribbon-like areas with prominent rosette formation, or organoid and trabecular arrangements lacking identifiable neural-type rosettes. Neoplastic cells were small with rounded, ovoid and/or angulated, hyperchromatic nuclei, coarse nucleoplasm, nuclear molding, and minimal cytoplasm with indistinct cell borders. Geographic necrosis, apoptosis and mitoses were plentiful. Immunohistochemically, lesional cells featured focal-to-diffuse reactivity for pancytokeratin, CAM 5.2, EMA and p40, in addition to variable positivity for synaptophysin, chromogranin, CD56 and INSM1. S100 focally highlighted sustentacular cells, while SMARCB1 expression was retained. Both tumors were classified as Stage IVb and treated with surgery and chemoradiation therapy. Patients remained disease-free after 7 and 60 months of follow-up.

Conclusions

OCAs are exceedingly rare sinonasal malignancies with aggressive biologic behavior and overt neuroepithelial attributes. Such diagnosis, however, may be challenging due to lack of well-established criteria and occasional absence of glandular or rosette-like structures. Therefore, proper diagnosis relies heavily on immunohistochemical recognition of the combined neuroepithelial differentiation.

Adenoid cystic carcinoma (AdCC) is an uncommon malignant tumor of the head and neck region, typically arising from the major salivary glands with occasional origin from other organ sites. The most common metastatic sites are reported to be lung (75%) and bone (5%), whereas kidney involvement by AdCC is extremely rare with less than 40 reported single cases in literature. It is reported that kidney metastasis by AdCC is usually a late event, is typically unilateral, and is usually composed of one to three foci, and thus has clinical features which mimic a primary renal tumor. This case reviews the current literature on metastatic AdCC and describes a 66-year-old female with original diagnosis of adenoid cystic carcinoma of the right lacrimal gland with metastasis to the right kidney 6 years later.

Introduction

Hematolymphoid neoplasms originating in the periapical region of a tooth are a rare occurrence. Signs, symptoms, and radiographic findings can mimic lesions of endodontic origin. History-taking and clinical examination might provide some clues to define the possibility of a non-endodontic lesion, although the definitive diagnosis can only be rendered based on histologic examination.

Description

We present four cases of hematolymphoid neoplasms that radiographically mimic endodontic lesions. All of the cases initially underwent endodontic treatment, but the lesions failed to resolve. In one case, the clinician suspected a diagnosis of lymphoma based on the patient's history. In the other cases, the clinicians' impression was that the lesions originated from endodontic issues. We present two cases of diffuse B-cell lymphoma, a case of plasma cell neoplasm, and a case of Langerhans cell histiocytosis, along with a literature review of all three entities when found in the oral cavity.

Conclusion

Hematolymphoid neoplasms can manifest in the periapical region of teeth. The definitive diagnosis can only be established through histopathologic examination, making an accurate diagnosis crucial. Consequently, the patient will undergo further appropriate investigation and management.

Introduction

A 65-year-old male presented with a 6-month history of right facial swelling and paresthesia of the lower jaw. CBCT revealed an expansile, ill-defined, mixed radiolucent-radiopaque lesion with lingual cortical bony expansion and spiculated appearance. Although not pathognomonic, the spiculated periosteal reaction is most commonly reported with primary bone tumors such as osteosarcoma.

Materials and Methods

Case report and literature review

Results

An incisional biopsy was performed, revealing sheets and irregular islands of pleomorphic malignant blue cells infiltrating bony trabeculae. Immunohistochemical staining was performed. Based on the histologic and immunohistochemical findings, a diagnosis of high-grade prostate adenocarcinoma was rendered.

Utilizing PubMed, Ovid, Scopus, and Google Scholar Databases, the authors conducted a search of all full-text case reports, case series, and literature reviews in the English language published from 2000-2020 and report on the incidence of a “sunburst” and "spiculated" periosteal reaction in association with metastatic prostate adenocarcinoma to the mandible.

Conclusions

Metastatic prostate adenocarcinoma to the mandible can produce a spiculated periosteal proliferation of bone resembling that of a primary bone tumor.

Introduction

Odontogenic carcinoma with dentinoid (OCD) is a rare entity found in the head and neck region particularly involving the jaws. Histopathology is remarkable for its well-circumscribed lesion composed of epithelioid tumor cells with eosinophilic to clear cytoplasm admixed with a diffuse dentinoid matrix. Conventionally, focal dentinoid histomorphology is nonspecific and can be found in many benign odontogenic tumors such as odontoma, adenomatoid odontogenic tumor, and calcifying odontogenic cyst. However, diffuse dentinoid phenotype in OCD is one of the key diagnostic features. This overlapping morphology has often led to a misdiagnosis. OCD has shown pathogenic mutations in CTNNB1 and APC genes in the Wnt-pathway which is also found in other odontogenic tumors such as dentinogenic ghost cell tumor, dentinogenic ghost cell carcinoma, and adenoid ameloblastoma. Hence, further studies are needed to observe if harboring the same mutations demonstrate any similarities in disease behavior and prognosis.

Material and methods

A case of a 19-year-old male with a left nasal mass filling the entire maxillary sinus diagnosed as odontogenic carcinoma with dentinoid is presented. In addition, a search of the English-language literature retrieved additional cases of odontogenic carcinoma with dentinoid.

Results

Approximately 11 additional cases were found in the MEDLINE/PubMed literature search. Disease characteristics including epidemiological factors, clinical presentations, and histology are reviewed and data recorded.

Conclusion

Odontogenic carcinoma with dentinoid should be considered as a differential when a biopsy of a nodular lesion in the jaws shows dentinoid features. Clinical and radiologic correlation along with consideration for rebiopsy is recommended when suspicion arises.

Introduction

This study explores an innovative therapeutic strategy by integrating photodynamic therapy (PDT) and hyperbaric chamber treatment for effective osteonecrosis management.

Case Report

A 65-year-old male with metastatic prostate cancer, receiving Zometa® treatment, presented bilateral mandibular exposed bone, causing pain. A multidisciplinary approach was employed, using topical antiseptics, PDT sessions, and hyperbaric therapy to address the complex condition.

Conclusions

During follow-up, the patient underwent sequestrectomy due to bone sequestration. Subsequent tissue repair occurred smoothly, and the patient remained asymptomatic for three years post-treatment. This integrated approach shows promise in managing osteonecrosis, addressing microbial burden, and enhancing tissue repair. PDT and hyperbaric therapy offer a comprehensive solution for osteonecrosis. Further investigations are essential to validate and refine this approach, potentially establishing it as a standard protocol in oral medicine.