Specificity of paediatric jawbone lesions: Tumours and pseudotumours

IntroductionCharacteristics and epidemiology of jaw tumours have been described mostly in adults. Compared with their adult counterparts, childhood jaw tumours show considerable differences. The aim of this study was to describe the different jaw tumours in children, define diagnostic tools to determine their specificity and describe optimal treatment.MethodsAll children patients with jaw lesions, excluding cysts, apical granuloma and osteitis were included in our study between 1999 and 2009. The medical records were analyzed for clinical, radiological, and pathological findings, treatments and recurrences.ResultsMean patient age was 10.9 years old, ranging from 2 months to 18 years old. Of the 63 lesions, 18 were odontogenic and 45 non-odontogenic lesions. 6% of all cases were malignant tumours; the mean age of presentation was 7.25 years old, [ranging from 0.2 to 18 years old]. Approximately 80% of the tumours developed after 6 years of age. Odontogenic tumours occurred more often after the age of 6.ConclusionCompared with their adult counterpart, childhood jaw tumours show considerable differences in their clinical behaviour and radiological and pathological characteristics. Clinical features of some tumours can be specific to children. Tumourigenesis is related to dental development and facial growth. Conservative treatment should be considered.     

Calcifying epithelial odontogenic tumour or Pindborg's tumour: features and behaviour in relation to a case

The calcifying epithelial odontogenic tumour (CEOT) or Pindborg's tumour is a rare benign odontogenic neoplasm composed of epithelioid cells, amorphous amyloid-like substance and calcifications. Its clinical and radiographical pictures are not characteristic depending upon the site, size and developmental stages in a range of its composition degeneration. A case of calcifying epithelial odontogenic tumour in the mandible is presented and the main aspects of the research about this tumour, such as the pathogenesis, histological features, developmental stages, malignancy, recurrence rate, differential diagnosis and therapeutic aspects are discussed.     

The adenomatoid odontogenic tumour: an update of selected issues

The aim of this update was to present the recent notable progress within remaining questions relating to the adenomatoid odontogenic tumour (AOT). Selected issues that were studied included the following: (i) AOT history and terminology, (ii) the so‐called peripheral AOT, (iii) AOT and the gubernaculum dentis and (iv) the so‐called adenomatoid odontogenic cyst (AOC). The earliest irrefutable European case of AOT was described in 1915 by Harbitz as ‘cystic adamantoma’. Recently, Ide et al. have traced two Japanese cases with irrefutable proof described by Nakayama in 1903. The so‐called peripheral (gingival) variant of AOT seems to cover a dual pathogenesis, both an ‘erupted intraosseous’ and an ‘extraosseous’ (gingival) one. In 1992, we theorized that the generally unnoticed gubernaculum dentis (cord and canal) seems to be involved in the development of AOT. Ide et al. have concluded that the dental lamina in the gubernacular cord seems to be an embryonic source of the vast majority of AOTs. The suggestion by Marx and Stern to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC) is critically discussed. The present authors agree on the background of the work of several groups of researchers and WHO/IARC classifications that the biology of the follicular variant of AOT is already fully explained and does not make room for any change in diagnostic terms. Further, there is no reason to change terminology in this case where improvements or conditions to better clinical management are not an issue.     

A recurrent case of odontogenic ghost cell tumour of the mandible

Odontogenic ghost cell tumour (OGCT), also referred to as dentinogenic ghost cell tumour, is an extremely rare tumour classified as a neoplastic variant of calcifying ondontogenic cyst (COC). To date, only 13 cases of OGCT arising in the maxilla or mandible have been reported. We describe an OGCT that recurred after segmental resection of the mandible in a 59-year-old man. Histopathological examination revealed tumour invasion of the surrounding cortical bone, areas containing numerous calcifying flaky cell nests, and dentinoid matrix near epithelial cell nests. No atypical mitosis was found. There has been no evidence of recurrence or metastasis in the 4 years after operation.     

Intraoral Minor Salivary Gland Tumours: A Retrospective Study from a Dental and Maxillofacial Surgery Centre in Salem,Tamil Nadu

Abstract

Minor salivary gland tumors (MSGTs) constitute a heterogeneous group of neoplasms with variation in histopathology. These are rare neoplasms usually occurring in the palate. Dental examination may provide an opportunity for early detection.

Aim

This study was undertaken to do an epidemiological survey of minor salivary gland tumours reporting to a single dental and maxillofacial surgery centre and to determine the correlation of the histopathologic characteristics with the clinical features.

Materials and Methods

A retrospective survey of the histopathological findings of 1,020 consecutive biopsy reports in a single dental and maxillofacial surgery centre was done to identify cases of MSGT. The results were tabulated based on various criteria.

Results

In our study, only 8 tumors were benign (26.67 %), and 22 tumors were malignant (73.33 %). Mucoepidermoid carcinoma (MEC) was the most common tumor (15 of 30). Pleomorphic adenoma was most common benign MSGT in our series (7 of 30). This was followed by adenoid cystic carcinoma (6 of 30). Palate was the most common site (13 of 30) followed by buccal mucosa (5 of 30) and lip (4 of 30).

Conclusions

Unlike many previous studies, malignant salivary gland tumours were predominant. MEC was the most common malignant tumour in our study similar to many other studies. The palate was the most common site for minor salivary gland neoplasms.     

Highly aggressive brown tumour of the maxilla as first manifestation of primary hyperparathyroidism

A case is presented of a 62-year-old man with a right maxillary swelling for the previous three months. The lesion was expansive and osteolytic, with invasion of the adjacent maxillary sinus, nasal and pterygomaxillary fossae and floor of the orbit. Histology revealed the presence of an intrabony giant cell lesion. Blood tests demonstrated elevations in calcium (16.2 mg/dl) and parathyroid hormone (PTH) concentrations (841 pg/ml). This suggested the diagnosis of hyperparathyroidism initially manifesting as a brown tumour of the maxilla. Posterior explorations confirmed the existence of an underlying ectopic parathyroid adenoma as the cause of the condition.     

Eccrine spiradenoma of the ear: case report

A case of eccrine spiradenoma of the left pinna is described. To the best of our knowledge, this is the first report regarding this site. The treatment was a surgical excision in safe margins. This rare benign tumour should be considered for the differential diagnosis of solitary or multiple soft tissue lesions of the head and neck.     

Rare case of bizarre parosteal osteochondromatous proliferation presenting in the zygoma

Bizarre parosteal osteochondromatous proliferation is a rare benign lesion that tends to occur within the bones of the hands and feet. To our knowledge this is the third published case of its occurrence in the head region. We report the case of a 31-year-old man with an eight-month history of an asymptomatic, slowly enlarging lump on the right zygomatic area diagnosed as bizarre parosteal osteochondromatous proliferation. Diagnosis depends on specific radiological and histopathological features. Treatment is by complete excision, and recurrence has been reported in up to 50% of cases. Awareness of the condition will expedite its correct diagnosis and management.     

Adenomatoid odontogenic tumour: A case report

Adenomatoid odontogenic tumour (AOT) is a rare benign odontogenic tumour characterized by a progressively slow growing pattern and symptomless behavior. The differential diagnosis between AOT and other odontogenic tumours, such as ameloblastoma, should be well conducted in order to avoid extensive ablative surgery. This report presents an unusual case of an 11-year-old male patient who referred to the oral surgeon due to a significant painless gingival swelling in the anterior mandible. A panoramic X-ray revealed a round radiolucid image of an intraosseous lesion with well defined boards and related to the left lateral incisor and left canine. The Computerized Tomography was performed and the sagittal sections revealed a tooth image in contact with the inferior board of the tumour. Additionally, the coronal sections showed the presence of a tooth inside the lesion. Several calcifying nodules could be distinguished within the cystic area. The clinical diagnostic hypothesis was of calcifying epithelium odontogenic tumour but the histological sections were consistent with AOT. The tumour was enucleated under local anesthesia. After one year follow-up there were no signs of reoccurrence. With respect to the distinguishing tumour enlargement and localization in the lower jaw, the reported case is an uncommon example of AOT.     

Primitive neuroectodermal tumour in the oral cavity. Case report

Primitive neuroectodermal tumour is regarded as a rarely seen lesion as it occurs mainly within the central nervous system. However, this neoplasm does occasionally occur elsewhere in the body. One such case which occurred in the posterior part of the palate in a child is reported. Following a combined therapeutic approach comprising surgery, radiotherapy and chemotherapy, the patient has been well for nine years since treatment.     

Circulating tumour cells in head and neck cancers: Biological insights

Tumour metastasis is one of the leading cause of cancer-related mortality. Circulating tumour cells (CTCs) have been implicated in loco-regional and distant metastasis and its role is being extensively studied in various malignancies, including those from the head and neck region. The main challenge in understanding their significance lies in the rarity of these cells in the blood. However, newer technologies have attempted to overcome these pitfalls. This review explores the evolution of CTC research and other related areas, including its biological significance, sustainability within the circulating vascular environment and possible clinical implications.     

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目的探讨舌肌内巨大颗粒细胞瘤的临床特点。方法对中国医科大学口腔医学院口腔颌面外科2003—2004年收治的2例舌肌内颗粒细胞瘤患者的临床资料进行回顾性分析,结合文献探讨其临床特征、组织病理学特点、诊断及治疗。结果2例患者均为年轻女性,肿物均位于舌肌内,直径约5cm,为无痛性,病程为渐进性。组织学特点为无明显被膜,瘤细胞体积较大,呈圆形,胞浆丰富,可见较多嗜伊红均质细颗粒,过碘酸-希夫(PAS)染色阳性,瘤细胞呈巢状或腺泡状生长。手术切除后均无复发。结论舌肌内颗粒细胞瘤为良性病变,切除后不易复发。     

微波治疗口腔良性肿瘤近期临床观察

目的观察微波治疗口腔肿瘤近期治疗效果。方法 应用微波治疗口腔良性肿瘤４４例，血管瘤２０例，粘液囊肿１５例，其他９例。治疗后者３～６月临床观察疗效。结果 ３月后复查，４４例中，痊愈４０例，有效４例。无效仿例。６例后复查，无一例瘤体复发。结论微波治疗口腔良性肿瘤临床效果满意。     

Incidence and grading of cranio-facial osteosarcomas

Osteosarcoma of the cranio-facial structures and skull is rare. In children, only 5.6% of cases are localized in these areas. It is claimed that the mean age at presentation is at least 10–15 years higher than for osteosarcomas in other parts of the body. However these reports are based on data from single institutions or compiled from several registries. It is further claimed that tumours in the mandible and maxilla are less malignant, as based on observations of a better prognosis and lower incidence of metastatic spread as compared with osteosarcomas arising elsewhere. We report all histologically proven cranio-facial osteosarcomas in The Netherlands occurring over a 20-year period, based on the national registration covering all Dutch pathology laboratories (PALGA). The age-corrected incidence of primary osteosarcoma ranged from 0.33 to 0.41 per million across the age ranges. The mandible was the most frequent site of involvement. Only 61% had a high malignant histological grading. Our data indicate that the age-corrected incidence of primary osteosarcomas is similar across all age ranges. In respect to histology, a lower grade of malignancy is more frequent. Maxillary lesions significantly more often have a lower histological grade of malignancy.     

下唇-颏唇沟-颌下径路在腭后部肿瘤切除术中的应用

目的探讨下唇-颏唇沟-颌下径路在腭后部肿瘤切除术中的应用价值。方法采用下唇-颏唇沟-颌下径路对6例腭后部肿瘤患者施行肿瘤扩大切除术,遗留缺损用游离前臂皮瓣移植修复。结果术野显露良好,随访3个月～3年,仅1例患者出现暂时性口角歪斜,3个月后恢复正常;无肿瘤复发,移植皮瓣全部成活,腭部形态和面部外形恢复良好,张口无受限。结论下唇-颏唇沟-颌下径路用于腭后部肿瘤扩大切除术,术野显露良好,符合肿瘤外科、美容外科和功能性外科原则。     

Haemangiopericytoma of the maxillary gingiva: report of a case

AIM: Haemangiopericytoma (HPC) represents approximately 3% of all tumours in the head and neck. This tumour is a soft tissue tumour derived from mesenchymal cells with pericytic differentiation. We present the clinicopathological findings of a case. MATERIALS AND METHODS: A 69-year-old man was referred to our Department for a mass located on the right pre-molar maxillary gingiva; this mass caused problems during chewing, but was otherwise asymptomatic. RESULTS: Clinical examination revealed a nodular, pink lesion, 3.5 cm in diameter, which was lined with normal mucosa. The lesion was mobile in relation to the deep and superficial tissues. Microscopic analysis of the neoplasm showed a vascular rich pattern, constituted by vessels covered with flat endothelium and surrounded by abundant spindly cells. On the basis of these histological and immunohistochemical findings, the final diagnosis was HPC. CONCLUSIONS: HPC is an uncommon vascular tumour for which the biological behaviour is difficult to predict. In our patient, no recurrences or distant metastases were present at a 4 years follow-up.     

Extraskeletal chondroma of the masseter muscle: a case report with review of the literature

The authors report a case of soft tissue chondroma of the masseter muscle in a 49- year-old man. The tumour was entirely composed of lobules of hyaline cartilage. The literature on head and neck soft tissue chondroma is also reviewed. To the authors’ knowledge, this is the first case of muscular soft tissue chondroma in the head and neck region.     

Intraosseous schwannoma mimicking a periapical lesion on the adjacent tooth: case report

AIM: To present an additional case of intraosseous schwannoma involving the apical area in the mandibular alveolar bone mimicking an inflammatory periapical lesion. SUMMARY: This article describes a case of schwannoma periapically located mimicking an inflammatory periapical lesion in the mandible of a 34-year-old female. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as being endodontic in origin. The diagnosis, radiograph, immunohistochemical aspects and treatment are also discussed. KEY LEARNING POINTS: Intraosseous schwannoma is a rare unilocular radiolucency that when located periapically could be misdiagnosed as an endodontic lesion and result in unnecessary root canal treatment. The vitality of the pulp is an important test to exclude lesions of inflammatory origin. Histological examination is important to establish the diagnosis of lesions in the periradicular region.     

Adenomatoid odontogenic tumour (adenoameloblastoma). Case report and review of the literature

An adenomatoid tumour was found in the anterior maxillary region of a 15 year old female patient. Two impacted teeth were found in the tumour. The lateral incisor found in the tumour was dilacerated, and the roots of the first premolar were resorbed. A review of the English literature indicated that 294 similar cases have been reported.