Immunohistochemical analysis of a dentinogenic ghost cell tumour

A dentinogenic ghost cell tumour in an 80-year-old male patient is presented. It is an extremely rare tumour and only 10 cases have been reported in the English literature. The lesion showed odontogenic epithelium, ghost cells, dentinoid, giant cells. The immunohistochemical analysis for Mib-1 and bcl-2 showed a strong positivity of the cells of the odontogenic epithelium, while with p53 only a rare positivity was observed. Completely negative were the ghost cells, giant cells and dentinoid material. In this tumour the cells expressing Mib-1 and bcl-2 could be the cells that proliferate, and that could undergo malignant transformation.     

Surgical treatment for Zenker’s diverticulum: comparison between diverticulectomy and diverticulopexy

Background

The ideal surgical technique for symptomatic Zenker’s diverticulum has not been identified yet. Endoscopic treatment, although frequently performed, has not replaced the open cricopharyngeal myotomy, which is still deemed the standard therapy by many dedicated physicians. The management of the diverticular sac after myotomy is still a matter of debate. The aim of this study is to compare the results of diverticulectomy and diverticulopexy after cricopharyngeal myotomy, in homogeneous groups of patients.

Methods

Thirty-seven patients were treated for Zenker’s diverticulum at the same university medical school, but in two different units, with open cricopharyngeal myotomy, associated with diverticulectomy in 17 patients and with diverticulopexy in the remaining. No clinical criteria influenced the different choice of treatment of the diverticular pouch, but only the surgeon’s preference. Clinical data, diverticulum size, postoperative course, and complications were analyzed. Patients were followed up for median duration of 37 months (range 12–113 months) through contrast swallow study and clinical evaluation, aided by a specifically conceived questionnaire. Records were analyzed by Mann–Whitney–Wilcoxon test and Fisher’s exact test.

Results

Homogeneous comparative values for sex, age, diverticulum size, and symptoms were found in the two groups. Statistical analysis indicated that diverticulopexy, as compared with diverticulectomy, allowed reduced postoperative complications and slightly improved long-term swallowing.

Conclusions

Diverticulopexy is feasible also in large Zenker’s diverticula and can achieve equivalent or even better results than diverticulectomy with a smoother postoperative course.

     

Spindle cell lipoma of the floor of the mouth: report of a case

Spindle cell lipoma is a benign tumour composed by: (1) mature fat cells; (2) spindle cells; (3) a myxoid matrix separated by thick bands of birefringent collagen. Only 14 cases have been reported in the oral cavity. The authors present the second case located in the floor of the mouth. The treatment of the lesion consists of a local excision.     

Central granular cell odontogenic tumour: report of the first malignant case and review of the literature

Granular cell odontogenic tumours (GCOT) are rare neoplasms that usually manifest a benign clinical behaviour. We document the first case of GCOT exhibiting clinico-pathological features of malignancy that occurred in the maxilla of a 40-year-old male. The lesion appeared as an intra-oral polypoid mass and, at CT scan, as a poorly demarcated radiolucency eroding the cortical plate. Histologically, the tumour consisted of clusters of granular cells, exhibiting nuclear pleomorphism, prominent nucleoli and mitotic figures, and spindle cells in a collagenous stroma containing cementicles and strands of odontogenic epithelium. Morphologic transition from fibroblast-like to granular cells was frequently detected. The tumour cells extensively invaded the oral and respiratory mucosae and the adjacent soft tissues and exhibited vimentin and CD 68 immunoreactivity and high (21%) Ki 67 immunolabeling but not cytokeratins, E.M.A. actin, desmin, myosin or S-100 protein positivity. The patient experienced tumour recurrence 16 months after radical surgery. While the histogenesis of GCOT remains to be clarified, we document the existence of a malignant counterpart of this tumour and propose the name of malignant GCOT or granular cell odontogenic sarcoma for such entity.     

Warty carcinoma of the oral mucosa in an HIV+ patient

The authors present the case of a 36-year-old HIV+ male patient with a 1-cm diameter papillary exophytic lesion of the right cheek. Microscopic examination showed a papillary epithelial neoplasm with invasion of the stroma in the peripheral part. Cellular and nuclear atypia were present in the superficial and in the deep layers of the neoplasm. An in situ hybridization for human papillomavirus (HPV) 6, 11, 16, 18, 31, 35 and 51 was performed. A focal positivity only for HPV 16 and 18 was present in koilocytotic cells of the most peripheral portion of the lesion. The microscopic definitive diagnosis was warty carcinoma of the cheek. No recurrence was observed at a 3-year follow-up.     

Angiomyolipoma of the palate. Report of a case

Angiomyolipoma (AML) is a tumour or an hamartomatous growth that usually affects the kidney. Only rarely has AML been described in the oral cavity. The authors report a case of AML located in the palate in a 43-year-old patient. AML is composed of smooth muscle cells, blood vessels and mature fat cells. In 50% of cases, AML presents with symptoms of tuberous sclerosis. Renal AML are often invasive, may involve regional nodes and may recur, while, on the contrary, AML are most often well circumscribed and easily resected. AML seems to follow an entire benign course.