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Guimarães LM, Bastos VC, Souza MRF, de Castro WH, Gomes CC, Gomez RS. Tenosynovial giant cell tumor: Case report and molecular investigation. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00057-9. [PMID: 38760286 DOI: 10.1016/j.oooo.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 05/19/2024]
Abstract
Tenosynovial giant cell tumor is a benign neoplasm arising from the synovium of joints, including the temporomandibular joint (TMJ). Despite its benign nature, these tumors may exhibit aggressive behavior. A 57-year-old woman with a swollen, hardened area in the left TMJ was referred to the university´s clinic. The diagnosis of tenosynovial giant cell tumor was made based on the presence of hyperplastic synovial lining containing mononuclear and giant cells, hemorrhagic areas, hemosiderin deposits, and calcification foci in the biopsy. A low condylectomy was performed, and histopathologic analysis of the surgical piece upheld the diagnosis. Due to histopathologic resemblance with other giant cell-rich lesions (giant cell granuloma of the jaws, brown tumor of hyperparathyroidism, and non-ossifying fibroma) for which signature mutations are known, mutational analysis of KRAS, FGFR1, and TRPV4 genes was conducted. The results revealed wild-type sequences for all the mutations tested, thereby supporting the diagnosis of tenosynovial giant cell tumor.
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Victor Coutinho Bastos
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marina Rocha Fonseca Souza
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Wagner Henriques de Castro
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carolina Cavaliéri Gomes
- Department of Pathology, Biological Science Institute, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Medical School, Faculdade Ciências Médicas de Minas Gerais, Brazil.
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2
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Guimarães LM, Baumhoer D, Andrei V, Friedel D, Koelsche C, Gomez RS, von Deimling A, Gomes CC. DNA methylation profile discriminates sporadic giant cell granulomas of the jaws and cherubism from their giant cell-rich histological mimics. J Pathol Clin Res 2023; 9:464-474. [PMID: 37555357 PMCID: PMC10556276 DOI: 10.1002/cjp2.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023]
Abstract
Sporadic giant cell granulomas (GCGs) of the jaws and cherubism-associated giant cell lesions share histopathological features and microscopic diagnosis alone can be challenging. Additionally, GCG can morphologically closely resemble other giant cell-rich lesions, including non-ossifying fibroma (NOF), aneurysmal bone cyst (ABC), giant cell tumour of bone (GCTB), and chondroblastoma. The epigenetic basis of these giant cell-rich tumours is unclear and DNA methylation profiling has been shown to be clinically useful for the diagnosis of other tumour types. Therefore, we aimed to assess the DNA methylation profile of central and peripheral sporadic GCG and cherubism to test whether DNA methylation patterns can help to distinguish them. Additionally, we compared the DNA methylation profile of these lesions with those of other giant cell-rich mimics to investigate if the microscopic similarities extend to the epigenetic level. DNA methylation analysis was performed for central (n = 10) and peripheral (n = 10) GCG, cherubism (n = 6), NOF (n = 10), ABC (n = 16), GCTB (n = 9), and chondroblastoma (n = 10) using the Infinium Human Methylation EPIC Chip. Central and peripheral sporadic GCG and cherubism share a related DNA methylation pattern, with those of peripheral GCG and cherubism appearing slightly distinct, while central GCG shows overlap with both of the former. NOF, ABC, GCTB, and chondroblastoma, on the other hand, have distinct methylation patterns. The global and enhancer-associated CpG DNA methylation values showed a similar distribution pattern among central and peripheral GCG and cherubism, with cherubism showing the lowest and peripheral GCG having the highest median values. By contrast, promoter regions showed a different methylation distribution pattern, with cherubism showing the highest median values. In conclusion, DNA methylation profiling is currently not capable of clearly distinguishing sporadic and cherubism-associated giant cell lesions. Conversely, it could discriminate sporadic GCG of the jaws from their giant cell-rich mimics (NOF, ABC, GCTB, and chondroblastoma).
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Affiliation(s)
- Letícia Martins Guimarães
- Department of Pathology, Biological Science InstituteUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteMinas GeraisBrazil
| | - Daniel Baumhoer
- Bone Tumor Reference Centre, Institute of PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Vanghelita Andrei
- Bone Tumor Reference Centre, Institute of PathologyUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Dennis Friedel
- Department of Neuropathology, Institute of PathologyHeidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ)German Consortium for Translational Cancer Research (DKTK)HeidelbergGermany
| | - Christian Koelsche
- Department of Neuropathology, Institute of PathologyHeidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ)German Consortium for Translational Cancer Research (DKTK)HeidelbergGermany
- Department of General Pathology, Institute of PathologyHeidelberg University HospitalHeidelbergGermany
- Institute of Pathology, Faculty of MedicineLMU MunichMunichGermany
| | - Ricardo Santiago Gomez
- Department of Oral Surgery and Pathology, School of DentistryUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteMinas GeraisBrazil
| | - Andreas von Deimling
- Department of Neuropathology, Institute of PathologyHeidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ)German Consortium for Translational Cancer Research (DKTK)HeidelbergGermany
| | - Carolina Cavalieri Gomes
- Department of Pathology, Biological Science InstituteUniversidade Federal de Minas Gerais (UFMG)Belo HorizonteMinas GeraisBrazil
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Liu Y, Housley Smith M, Patel PB, Bilodeau EA. Pediatric Gnathic Bony and Mesenchymal Tumors. Pediatr Dev Pathol 2023; 26:621-641. [PMID: 37232383 DOI: 10.1177/10935266231170744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Evaluation of bone pathology within the head and neck region, particularly the gnathic bonesis is complex, demonstrating unique pathologic processes. In part, this variation is due to odontogenesis and the embryological cells that may be involved, which can contribute to disease development and histologic variability. As with any boney pathosis, the key is to have clinical correlation, particularly with radiographic imaging prior to establishing a definitive diagnosis. This review will cover those entities that have a predilection for the pediatric population, and while it is not all inclusive, it should serve as a foundation for the pathologist who is evaluating bony lesions involving the craniofacial skeleton.
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Affiliation(s)
- Yingci Liu
- Rutgers School of Dental Medicine, Newark, NJ, USA
| | | | - Paras B Patel
- Center for Oral Pathology, Dallas, TX, USA
- Oral and Maxillofacial Pathology ProPath, Dallas, TX, USA
| | - Elizabeth Ann Bilodeau
- Oral & Maxillofacial Pathology, Director, UDHS Oral Pathology Laboratory, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
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4
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Gupta S, Sharma D, Hooda A, Sharma VK, Kamboj M. Unravelling the role of immunohistochemistry in giant cell lesions of jaws: A systematic review. J Oral Maxillofac Pathol 2023; 27:181-194. [PMID: 37234327 PMCID: PMC10207225 DOI: 10.4103/jomfp.jomfp_18_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/28/2022] [Accepted: 06/03/2022] [Indexed: 05/27/2023] Open
Abstract
Controversies exist in literature regarding nature, pathogenesis, and behaviour of giant cell lesions (GCLs) of jaws. Studies were attempted to solve these mysteries with immunohistochemical analysis, using various biological markers. Thus, the aim of this review is to appraise the role of immunohistochemistry (IHC) in evaluating the pathogenesis, cellular phenotype, nature, and behaviour of GCLs of jaws. PubMed, PubMed Central, and Clinical Key (Medline) databases were searched electronically irrespective of date of publication with assortment of several independent terms. Fifty-five articles that fulfilled the eligibility criteria were included in the review. Out of 55 included articles, 49 were associated with nature, pathogenesis, and behaviour and six articles were associated with treatment and outcome prediction. Although IHC solved some of the controversies associated with GCLs of jaws such as the osteoclastic phenotype of multinucleated giant cells, immunoexpression of proliferative markers does not distinct non-aggressive from aggressive central GCL but the nature, histogenesis, pathogenesis, and exact behaviour still remain debatable. With regard to formulation of treatment plan, immunohistochemical analysis revealed that expression of glucocorticoid and calcitonin receptors could act as a tool to decide the therapeutic strategy and aid in therapeutic adjustments according to evolution of the lesion.
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Affiliation(s)
- Shruti Gupta
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Deepti Sharma
- Department of Oral and Maxillofacial Pathology, Christian Dental College, Ludhiana, Punjab, India
| | - Anita Hooda
- Department of Oral Anatomy, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | - Vishal Kumar Sharma
- Department of Orthodontics, Desh Bhagat Dental College, Mandi Gobindgarh, Punjab, India
| | - Mala Kamboj
- Department of Oral Pathology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
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5
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Pediatric Maxillary Giant Cell Tumors: Surgical Management by Transoral and Endoscopic Transnasal Enucleation and Curettage. J Craniofac Surg 2022; 33:e747-e750. [DOI: 10.1097/scs.0000000000008689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022] Open
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Ghosh A, Lakshmanan M, Manchanda S, Bhalla AS, Kumar P, Bhutia O, Mridha AR. Contrast-enhanced multidetector computed tomography features and histogram analysis can differentiate ameloblastomas from central giant cell granulomas. World J Radiol 2022; 14:329-341. [PMID: 36186516 PMCID: PMC9521432 DOI: 10.4329/wjr.v14.i9.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 07/05/2022] [Accepted: 09/02/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND No qualitative or quantitative analysis of contrast-enhanced computed tomography (CT) images has been reported for the differentiation between ameloblastomas and central giant cell granulomas (CGCGs).
AIM To describe differentiating multidetector CT (MDCT) features in CGCGs and ameloblastomas and to compare differences in enhancement of these lesions qualitatively and using histogram analysis.
METHODS MDCT of CGCGs and ameloblastomas was retrospectively reviewed to evaluate qualitative imaging descriptors. Histogram analysis was used to compare the extent of enhancement of the soft tissue. Fisher’s exact tests and Mann–Whitney U test were used for statistical analysis (P < 0.05).
RESULTS Twelve CGCGs and 33 ameloblastomas were reviewed. Ameloblastomas had a predilection for the posterior mandible with none of the CGCGs involving the angle. CGCGs were multilocular (58.3%), with a mixed lytic sclerotic appearance (75%). Soft tissue component was present in 91% of CGCGs, which showed hyperenhancement (compared to surrounding muscles) in 50% of cases, while the remaining showed isoenhancement. Matrix mineralization was present in 83.3% of cases. Ameloblastomas presented as a unilocular (66.7%), lytic (60.6%) masses with solid components present in 81.8% of cases. However, the solid component showed isoenhancement in 63%. No matrix mineralization was present in 69.7% of cases. Quantitatively, the enhancement of soft tissue in CGCG was significantly higher than in ameloblastoma on histogram analysis (P < 0.05), with a minimum enhancement of > 49.05 HU in the tumour providing 100% sensitivity and 85% specificity in identifying a CGCG.
CONCLUSION A multilocular, lytic sclerotic lesion with significant hyperenhancement in soft tissue, which spares the angle of the mandible and has matrix mineralization, should indicate prospective diagnosis of CGCG.
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Affiliation(s)
- Adarsh Ghosh
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Meyyappan Lakshmanan
- Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Prem Kumar
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ongkila Bhutia
- Department of Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Asit Ranjan Mridha
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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7
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Dong X, Png NCY, Fortier MV, Lim JY, Wong KPL, Choo JTL, Tan EC, Jamuar SS. Fibrous dysplasia in cardio-facio-cutaneous syndrome: A case report and review of literature. Am J Med Genet A 2022; 188:2732-2737. [PMID: 35801299 DOI: 10.1002/ajmg.a.62879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 01/25/2023]
Abstract
Cardio-facio-cutaneous (CFC) syndrome (OMIM #:115150, 615278, 615279, 615280) is a rare genetic condition caused by variants in the RAS/mitogen-activated protein kinase (MAPK) signal transduction pathway. Up to 75% of cases are caused by mutations in the BRAF gene, whereas KRAS gene mutation has only been reported in <2% of cases. CFC syndrome is characterized by cardiac abnormalities, distinctive craniofacial dysmorphism, and various cutaneous abnormalities. Musculoskeletal and orthopedic manifestations are also prevalent in patients with CFC syndrome, among which the most common are skeletal deformities and joint laxities. Dysplastic bone disorders, on the other hand, have not been reported in CFC syndrome before. We report on a case of symmetrical polyostotic fibrous dysplasia (FD) in a patient with CFC syndrome with the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe variant. The FDs were incidentally picked up, and patient was conservatively managed and remained asymptomatic on follow-up. The same variant was reported previously in a patient with Oculoectodermal Syndrome (OES), who developed polyostotic non-ossifying fibroma (NOF). This case explores FD as a possible new clinical feature of CFC syndrome, and when linked to the historical case of OES, explores whether the KRAS(NM_004985.5):c.57G>C; p.Leu19Phe mutation may potentially contribute to the development of dysplastic bone lesions in patients with this particular mutation.
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Affiliation(s)
- Xiaoao Dong
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Nicholas C Y Png
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
| | - Jiin Ying Lim
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,SingHealth Duke-NUS Genomic Medicine Centre, Singapore
| | - Kenneth P L Wong
- Department of Paediatric Orthopaedics, KK Women's and Children's Hospital, Singapore
| | - Jonathan T L Choo
- Department of Cardiology, KK Women's and Children's Hospital, Singapore
| | - Ene Choo Tan
- KK Research Centre, KK Women's and Children's Hospital, Singapore
| | - Saumya Shekhar Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore.,Department of Diagnostic and Interventional Radiology, KK Women's and Children's Hospital, Singapore
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Abstract
The term giant cell-rich tumors of bone refers to a shared morphologic pattern in a group of different osseous lesions, that is, the abundance of osteoclastlike giant cells. Fitting with a broad spectrum of clinical presentations and biological behavior, the recent detection of characteristic molecular alterations in giant cell tumor of bone (H3-3), nonossifying fibroma (KRAS, FGFR1), giant cell granuloma of the jaws (KRAS, FGFR1, TRPV4), and aneurysmal bone cyst (USP6) have contributed significantly to the biological understanding of these morphologically related but clinically distinct lesions and their systematic classification, highlighting differences and pathogenic relationships.
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Affiliation(s)
- Wolfgang Hartmann
- Division of Translational Pathology, Gerhard-Domagk-Institut of Pathology, University Hospital Münster, Albert-Schweitzer-Campus 1, Münster 48149, Germany
| | - Dorothee Harder
- Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, Basel 4031, Switzerland
| | - Daniel Baumhoer
- Bone Tumor Reference Center, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Schoenbeinstrasse 40, Basel 4031, Switzerland.
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9
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Acquired Facial, Maxillofacial, and Oral Asymmetries—A Review Highlighting Diagnosis and Management. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Facial asymmetry refers to the absence of, or the deviation from the regular mirror image of facial structures, relative to a referenced midline axis. It can be attributed to a wide spectrum of deformities, including congenital, developmental, or acquired conditions, which can originate either prenatally or postnatally. Though highly prevalent, asymmetry commonly goes undiagnosed due to its subtle or relative nature. Among the spectrum of conditions, acquired cases are triggered postnatally, in previously normal individuals, thus subjecting them to sudden, eventful psychological and psychosocial disharmony. When detected early, timely management may help intervene progressive growth of these conditions. This, therefore, emphasizes the need for a thorough diagnostic workup including medical/dental history, clinical examinations, study models, photographic and radiographic records for a case-by-case basis to prevent severe functional and aesthetic complications. Recently, advanced diagnostic procedures, such as stereophotogrammetry, 3D stereolithographic models, skeletal scintigraphy (radionucleotide scans), 3D computed tomographic scans, cone-beam computed tomography, and magnetic resonance imaging, have provided innovative diagnostic instruments for numerous craniofacial defects. This descriptive review aims at focusing on the factors leading to frequently encountered conditions of acquired facial asymmetry and highlights their clinical evaluation, conservative and surgical interventions by a multi-disciplinary team of clinicians.
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10
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Ruddocks LA, Nascimento AF, Bhattacharyya I, Islam MN, Cohen DM. Central odontogenic fibroma in association with brown tumor of hyperparathyroidism in a patient with neurofibromatosis type 1. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:e26-e32. [PMID: 34511348 DOI: 10.1016/j.oooo.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/04/2021] [Indexed: 11/24/2022]
Abstract
We present a patient with bone abnormalities and a myriad of lesions secondary to his redeveloping renal failure and neurofibromatosis type 1 (NF1). A 21-year-old male renal transplant recipient with NF1 presented with painless masses and large, irregular radiolucent lesions in the maxilla and mandible. After histologic examination, the lesion was diagnosed as a central odontogenic fibroma (COdF) in association with a central giant cell lesion, most consistent with brown tumor of hyperparathyroidism. The bone changes were interpreted to be highly suggestive of renal osteodystrophy. Around 30 cases of hybrid central giant cell granuloma-like lesion in association with central odontogenic fibroma have been reported. This, to our knowledge, is the first reported case of brown tumor in association with COdF. Our case provides further evidence of the giant cell component as the initiating entity in these hybrid lesions.
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Affiliation(s)
- Lauren A Ruddocks
- Resident, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
| | - Alessandra F Nascimento
- Unit Director, Bone & Soft Tissue Pathology, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Division Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Program Director, Oral & Maxillofacial Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department Chair, Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
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11
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Friedrich RE, Zustin J, Luebke AM, Rosenbaum T, Gosau M, Hagel C, Kohlrusch FK, Wieland I, Zenker M. Neurofibromatosis Type 1 With Cherubism-like Phenotype, Multiple Osteolytic Bone Lesions of Lower Extremities, and Alagille-syndrome: Case Report With Literature Survey. In Vivo 2021; 35:1711-1736. [PMID: 33910856 DOI: 10.21873/invivo.12431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND/AIM Neurofibromatosis type 1 (NF) is an autosomal dominant hereditary disease. The cardinal clinical findings include characteristic skeletal alterations. Difficulties in diagnosis and therapy can arise if an individual has further illnesses. CASE REPORT This is a case report of a 16-year-old patient affected by NF1. She also suffered from Alagille syndrome and the consequences of fetal alcohol exposure. The patient's facial phenotype showed findings that could be assigned to one or more of the known diseases. The patient was referred for treating a cherubism-like recurrent central giant cell granuloma (CGCG) of the jaw. The patient developed bilateral, multilocular non-ossifying fibromas (NOF) of the long bones of the lower extremity. Treatment of the skeletal lesions consisted of local curettage. While NOF regressed after surgery, the CGCG of the jaw remained largely unchanged. Extensive genetic tests confirmed a previously unknown germline mutation in the JAG1 gene, the germline mutation of the NF1 gene, and the somatic mutation in the NF1 gene in the diffuse plexiform neurofibroma, but not in the CGCG. CONCLUSION Assigning facial findings to a defined syndrome is ambiguous in many cases and especially difficult in patients who have multiple diseases that can affect the facial phenotype. Surgical therapy should be adapted to the individual findings.
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Affiliation(s)
- Reinhard E Friedrich
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany;
| | - Jozef Zustin
- Institute of Osteology and Biomechanics, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany.,Institute of Pathology, Gemeinschaftspraxis Pathologie-Regensburg, Regensburg, Germany
| | - Andreas M Luebke
- Institute of Pathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | | | - Martin Gosau
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Felix K Kohlrusch
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
| | - Ilse Wieland
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Zenker
- Institute of Human Genetics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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12
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Tobón-Arroyave SI, Isaza-Guzmán DM, Flórez-Moreno GA. Immunohistochemical Comparative Study of Aggressive and Non-aggressive Central Giant Cell Lesions of the Jaws Based on the Tenascin-C Expression Profile. J Histochem Cytochem 2021; 69:475-484. [PMID: 34120502 DOI: 10.1369/00221554211025479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to compare the immunohistochemical expression of tenascin-C (Tn-C) regarding clinicopathological variables and its association with the clinical behavior of central giant cell lesions (CGCLs). Forty-eight paraffin-embedded samples of CGCLs were selected. Based on clinical and radiographic features, the lesions were classified as aggressive (A-CGCLs) and non-aggressive (NA-CGCLs) subtypes. Histological assessment included the microvessel count (MVC), multinucleated giant cell (MGC) count, and the proportion of tissue area involved by mononuclear stromal cells/interstitial fibrosis. Immunoreactivity, immunolocalization, and distribution patterns of Tn-C were studied immunohistochemically. The association between Tn-C expression and clinicopathological characteristics was analyzed separately and adjusted for confounders using logistic regression models. A significantly greater proportion of cases with moderate-to-intense, intracellular, and diffuse staining of Tn-C was observed in A-CGCLs. CGCLs with a size ≥3.3 cm, fast growth, cortical disruption, high MVC/MGC counts, and low interstitial fibrosis showed a significantly greater frequency of moderate-to-intense, intracellular, and diffuse staining. Logistic regression analysis indicated a strong/independent association of these three immunohistochemical parameters with the aggressiveness of lesions. These data appear to suggest a possible role for Tn-C in the etiopathogenesis of CGCLs of the jaws, where its upregulation might favor the destructive behavior of A-CGCLs.
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Affiliation(s)
- Sergio Iván Tobón-Arroyave
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Diana María Isaza-Guzmán
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
| | - Gloria Amparo Flórez-Moreno
- Laboratory of Oral Pathology and Bioanalysis, Faculty of Dentistry, University of Antioquia, Medellín, Colombia
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Santana LADM, Felix FA, de Arruda JAA, da Silva LP, Brito ÉDAC, Takeshita WM, Trento CL. A rare case of a metastatic giant cell-rich osteosarcoma of the mandible: Update and differential diagnostic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:e163-e169. [PMID: 33187945 DOI: 10.1016/j.oooo.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 01/02/2023]
Abstract
A metastatic giant cell-rich osteosarcoma (GCRO) to the jaws is an exceedingly rare neoplasm. To date, fewer than 10 cases have been reported in the English language literature. In this article, we describe an additional case of a metastatic GCRO that presented the diagnostic challenge of a painless mass in the posterior mandible of a 19-year-old girl who exhibited rapid and aggressive local growth. The lesion was confirmed radiologically as an ill-defined expansive osteolytic mass showing cortical perforation. Microscopically, the presence of osteoclast-like giant cells permeated with atypical oval and rounded mesenchymal cells in a fibrovascular stroma, cellular atypia, and scarce osteoid formation were observed. Immunohistochemistry revealed the Ki-67 proliferative index in 50% of positive cells, positivity for vimentin and CD68, as well as scarce positivity for CDK4. The patient's medical history involved a GCRO in the proximal ulna. This report highlights the aggressive behavior of GCRO and its high capacity for metastasis to different parts of the body. Clinicians, pathologists, and surgeons should be aware of the giant cell-rich variant of osteosarcoma of the jaws, an imminent "wolf in a sheep's skin", because its indolent but unrelenting growth and dissemination, with radiographic and histologic characteristics that may represent a diagnostic pitfall regarding aggressive central giant cell lesions of the jaws.
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Affiliation(s)
| | - Fernanda Aragão Felix
- Postgraduate Program in Oral Pathology, School of Dentistry, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | | | | | - Cleverson Luciano Trento
- Department of Dentistry, School of Dentistry, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Khavanin N, White MJ, Walsh JM, Steinberg JP. Mandibular Reconstruction Following Central Giant Cell Granuloma Resection in Primary Dentition: A Case for the Use of a Costochondral Graft. Cleft Palate Craniofac J 2020; 58:260-268. [PMID: 32757776 DOI: 10.1177/1055665620946985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Central giant cell granuloma is a benign, intraosseous lesion that may affect the pediatric craniofacial skeleton, particularly the mandible. When surgery is indicated, the role of the craniofacial surgeon is to ameliorate the sequelae of ablative surgery by restoring facial symmetry, ensuring appropriate postoperative occlusion, and allowing for adequate interincisal opening, all in the setting of a growing craniofacial skeleton. Herein, we report the case of a 3-year-old female presenting for reconstruction after resection of the right hemimandible proximal to the unerupted first permanent molar. We highlight the various reconstructive challenges associated with mandibular reconstruction during primary dentition and make a case for the use of a costochondral graft, with a successful outcome demonstrated at 2 years of follow-up.
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Affiliation(s)
- Nima Khavanin
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marissa J White
- Department of Pathology, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan M Walsh
- Department of Otolaryngology-Head and Neck Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jordan P Steinberg
- Department of Plastic and Reconstructive Surgery, 1500The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Sharma T, Cotney J, Singh V, Sanjay A, Reichenberger EJ, Ueki Y, Maye P. Investigating global gene expression changes in a murine model of cherubism. Bone 2020; 135:115315. [PMID: 32165349 PMCID: PMC7305689 DOI: 10.1016/j.bone.2020.115315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 03/08/2020] [Indexed: 11/22/2022]
Abstract
Cherubism is a rare genetic disorder caused primarily by mutations in SH3BP2 resulting in excessive bone resorption and fibrous tissue overgrowth in the lower portions of the face. Bone marrow derived cell cultures derived from a murine model of cherubism display poor osteogenesis and spontaneous osteoclast formation. To develop a deeper understanding for the potential underlying mechanisms contributing to these phenotypes in mice, we compared global gene expression changes in hematopoietic and mesenchymal cell populations between cherubism and wild type mice. In the hematopoietic population, not surprisingly, upregulated genes were significantly enriched for functions related to osteoclastogenesis. However, these upregulated genes were also significantly enriched for functions associated with inflammation including arachidonic acid/prostaglandin signaling, regulators of coagulation and autoinflammation, extracellular matrix remodeling, and chemokine expression. In the mesenchymal population, we observed down regulation of osteoblast and adventitial reticular cell marker genes. Regulators of BMP and Wnt pathway associated genes showed numerous changes in gene expression, likely implicating the down regulation of BMP signaling and possibly the activation of certain Wnt pathways. Analyses of the cherubism derived mesenchymal population also revealed interesting changes in gene expression related to inflammation including the expression of distinct granzymes, chemokines, and sulfotransferases. These studies reveal complex changes in gene expression elicited from a cherubic mutation in Sh3bp2 that are informative to the mechanisms responding to inflammatory stimuli and repressing osteogenesis. The outcomes of this work are likely to have relevance not only to cherubism, but other inflammatory conditions impacting the skeleton.
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Affiliation(s)
- Tulika Sharma
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health, United States of America
| | - Justin Cotney
- Department of Genetics and Genome Sciences, University of Connecticut Health, United States of America
| | - Vijender Singh
- Computational Biology Core, Institute for Systems Genomics, University of Connecticut, United States of America
| | - Archana Sanjay
- Department of Orthopedic Surgery, University of Connecticut Health, United States of America
| | - Ernst J Reichenberger
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health, United States of America
| | - Yasuyoshi Ueki
- Department of Biomedical Sciences and Comprehensive Care, Indiana University, United States of America
| | - Peter Maye
- Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health, United States of America.
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16
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Melo-Muniz VRV, Nunes FD, Cangussu MCT, Cury PR, Xavier FCA, de Azevedo RA, Leitão ÁCGH, de Faro Valverde L, Carneiro Júnior B, Dos Santos JN. Central giant cell granuloma: A clinicopathological and immunohistochemical study of macrophages, blood vessels, lymphatic vessels and regulatory proteins. Ann Diagn Pathol 2020; 46:151526. [PMID: 32339965 DOI: 10.1016/j.anndiagpath.2020.151526] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE This study seeks to investigate immunohistochemical parameters that could distinguish non-aggressive Central giant cell granuloma (CGCG) from aggressive CGCG, two groups of lesions which differ in their clinical and radiographic features and prognosis. MATERIAL AND METHODS 12 cases of non-aggressive CGCG and 11 cases of aggressive CGCG were investigated and associated the immunohistochemical expression of macrophages (CD68 and CD163), blood vessels (CD34 and CD105), lymphatic vessels (D2-40) and regulator proteins (p63 and Ki-67). Clinical and radiographic features were also studied. RESULTS Associations between all proteins in non-aggressive and aggressive CGCG were not significant (p > 0.05). With respect to non-aggressive CGCG, there were no significant correlations, while in aggressive CGCG there was a significant positive correlation between CD68 and CD163 (p = 0.031), between CD34 and D2-40 proteins (p = 0.04), whereas a significant negative correlation was observed between CD105 and CD68 (p = 0.040). However, regardless of aggressiveness of CGCG, there was a significant positive correlation between CD68 and CD163 (p = 0,04). Among the clinical and immunohistochemical aspects, only the symptomatology was a significant risk factor for the occurrence of aggressive CGCG (OR = 12.00/p = 0.016). CONCLUSION Macrophages and angiogenesis contribute to their maintenance and development of CGCG. In addition, immunohistochemistry used here was not able to differentiate their aggressiveness. However, symptomatology was proved to be a risk factor for the occurrence of aggressive CGCG. It is possible that clinical features, particularly symptomatology, represent the most appropriate parameter to attempt to distinguish GCCG.
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Affiliation(s)
- Vinicius Rio Verde Melo-Muniz
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Fábio Daumas Nunes
- Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Patrícia Ramos Cury
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Flávia Caló Aquino Xavier
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Roberto Almeida de Azevedo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Águida Cristina Gomes Henriques Leitão
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Bráulio Carneiro Júnior
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Southwest University of Bahia, Jequié, Bahia, Brazil
| | - Jean Nunes Dos Santos
- Dentistry and Health Postgraduate Program, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil; Laboratory of Oral and Maxillofacial Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil.
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17
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Lee JC, Huang HY. Soft Tissue Special Issue: Giant Cell-Rich Lesions of the Head and Neck Region. Head Neck Pathol 2020; 14:97-108. [PMID: 31950466 PMCID: PMC7021864 DOI: 10.1007/s12105-019-01086-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
Giant cell-rich lesions represent a heterogeneous group of tumors and non-neoplastic lesions, usually arising in bone, which harbor varying number of reactive osteoclastic-type multinucleate giant cells as a common feature. Among these entities, some are confined to the head and neck region (e.g., central giant cell granuloma and mimicking lesions, i.e., peripheral giant cell granuloma and cherubism) or show a relative predilection for this region (e.g., aneurysmal bone cyst and brown tumor of hyperparathyroidism), while others are rare but associated with distinct underlying disease (e.g., giant cell tumor of bone) or histology (e.g., tenosynovial giant cell tumor of the temporomandibular joint and phosphaturic mesenchymal tumor of the jaws) when occurring in the head and neck. Collectively, these lesions pose great challenge in the pathologic diagnosis, which often requires combinatory assessment from the clinical, histopathologic, and/or molecular aspects. This review provides a summary of pertinent clinical and pathologic features and an update of recent molecular and genetic findings of these entities. The considerations in differential diagnosis as well as the effects of the emerging therapeutic RANKL-antagonizing antibody denosumab will also be addressed.
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Affiliation(s)
- Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsuan-Ying Huang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung District, Kaohsiung, 833 Taiwan
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18
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Gomes CC, Diniz MG, Bastos VC, Bernardes VF, Gomez RS. Making sense of giant cell lesions of the jaws (GCLJ): lessons learned from next-generation sequencing. J Pathol 2019; 250:126-133. [PMID: 31705763 DOI: 10.1002/path.5365] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 01/09/2023]
Abstract
Next-generation sequencing has revealed mutations in several bone-related lesions and was recently used to uncover the genetic basis of giant cell lesions of the jaws (GCLJ). Consistent with their benign nature, GCLJ show a low tumor mutation burden. They also harbor somatic, heterozygous, mutually exclusive mutations in TRPV4, KRAS, or FGFR1. These signature mutations occur only in a subset of lesional cells, suggesting the existence of a 'landscaping effect', with mutant cells inducing abnormal accumulation of non-mutant cells that form the tumor mass. Osteoclast-rich lesions with histological similarities to GCLJ can occur in the jaws sporadically or in association with genetically inherited syndromes. Based on recent results, the pathogenesis of a subgroup of sporadic GCLJ seems closely related to non-ossifying fibroma of long bones, with both lesions sharing MAPK pathway-activating mutations. In this review, we extrapolate from these recent findings to contextualize GCLJ genetics and we highlight the therapeutic implications of this new information. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Carolina C Gomes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marina G Diniz
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Victor C Bastos
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vanessa F Bernardes
- Department of Pathology, Biological Sciences Institute, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ricardo S Gomez
- Department of Oral Surgery and Pathology, Faculty of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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19
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Melo Muniz VRV, Nunes FD, Xavier FCDA, Cangussu MCT, Almeida Freitas R, Cury PR, Gurgel CA, Santos JN. Potential role of Hedgehog signaling pathway and myofibroblastic differentiation in central giant cell granuloma—A preliminary study. J Oral Pathol Med 2019; 48:855-860. [DOI: 10.1111/jop.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Fábio Daumas Nunes
- Laboratory of Oral and Maxillofacial Pathology School of Dentistry University of São Paulo São Paulo SP Brazil
| | - Flávia Caló de Aquino Xavier
- Dentistry and Health Postgraduation Program School of Dentistry Federal University of Bahia Salvador BA Brazil
- Laboratory of Oral and Maxillofacial Pathology School of Dentistry Federal University of Bahia Salvador BA Brazil
| | | | - Roseana Almeida Freitas
- Laboratory of Oral and Maxillofacial Pathology School of Dentistry Federal University of Rio Grande do Norte Natal RN Brazil
| | - Patrícia Ramos Cury
- Dentistry and Health Postgraduation Program School of Dentistry Federal University of Bahia Salvador BA Brazil
| | - Clarissa Araújo Gurgel
- Dentistry and Health Postgraduation Program School of Dentistry Federal University of Bahia Salvador BA Brazil
| | - Jean Nunes Santos
- Dentistry and Health Postgraduation Program School of Dentistry Federal University of Bahia Salvador BA Brazil
- Laboratory of Oral and Maxillofacial Pathology School of Dentistry Federal University of Bahia Salvador BA Brazil
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20
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Three Skulls Dating from the French Revolutionary Years Diagnosed with Tinea Capitis: A Paleopathologic Approach. J Craniofac Surg 2018; 29:1713-1716. [PMID: 30169450 DOI: 10.1097/scs.0000000000004728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The Musée Dupuytren was a Parisian pathology museum established in 1835. This museum hosted 3 skulls with severe craniofacial lesions initially tagged as aggressive forms of tinea capitis. The aim of this study was to investigate these specimens and discuss the initial diagnosis. Historical investigations were conducted based on the biographic data from the tags of the 3 skulls and entries on the catalog of the museum. Age was determined using dentition and the patency of cranial base synchondroses. The computed tomography scans were performed using standard medical devices. The 3 skulls were from the late 18th to early 19th century. Skull № 1 was a 5-year-old child and presented with microcephaly and extensive vault osteolysis compatible with an aggressive benign lesion, a malignant tumor, or a chronic infection. Skull № 2 was a 12- to 18-year-old teenager and presented with symmetrical porotic hyperostosis compatible with undernutrition and various hematologic conditions causing prolonged anemia, but also with chronic inflammation and/or infection. Skull № 3 was also from a 12- to 18-year-old teenager and presented with focal temporal osteolysis compatible with an aggressive benign or a low-grade malignant temporal soft-tissue lesion or with chronic infection. These skulls contribute to the understanding of the concept of tinea in the 19th century. They are furthermore windows on the sanitary and social conditions in Paris in the years following the French revolution and during the Napoleonian wars.
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21
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Primary aneurysmal bone cyst of the mandibular condyle with USP6-CDH11 fusion. Pathol Res Pract 2018; 215:607-610. [PMID: 30401581 DOI: 10.1016/j.prp.2018.10.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 01/09/2023]
Abstract
Primary aneurysmal bone cyst (ABC) is a cystic bone neoplasm characterized by disease-defining gene fusions involving the USP6/Tre2 gene. The literature describing gnathic ABC is limited. This case report describes a 27-year-old man presenting with a long-standing left-sided facial asymmetry. Multi-detector computed tomography imaging demonstrated a large expansile lesion positioned within the left condylar head. The lesion was biopsied and resected. The specimen showed a giant cell-rich cystic neoplasm, with fibrous tissue lined by multinucleated giant cells. Next-generation sequencing confirmed the presence of a USP6-CDH11 fusion gene, consistent with classification as a primary ABC, the first reported to be translocation-positive in the head of the mandibular condyle.
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22
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TRPV4 and KRAS and FGFR1 gain-of-function mutations drive giant cell lesions of the jaw. Nat Commun 2018; 9:4572. [PMID: 30385747 PMCID: PMC6212533 DOI: 10.1038/s41467-018-06690-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/18/2018] [Indexed: 01/09/2023] Open
Abstract
Giant cell lesions of the jaw (GCLJ) are debilitating tumors of unknown origin with limited available therapies. Here, we analyze 58 sporadic samples using next generation or targeted sequencing and report somatic, heterozygous, gain-of-function mutations in KRAS, FGFR1, and p.M713V/I-TRPV4 in 72% (42/58) of GCLJ. TRPV4 p.M713V/I mutations are exclusive to central GCLJ and occur at a critical position adjacent to the cation permeable pore of the channel. Expression of TRPV4 mutants in HEK293 cells leads to increased cell death, as well as increased constitutive and stimulated channel activity, both of which can be prevented using TRPV4 antagonists. Furthermore, these mutations induce sustained activation of ERK1/2, indicating that their effects converge with that of KRAS and FGFR1 mutations on the activation of the MAPK pathway in GCLJ. Our data extend the spectrum of TRPV4 channelopathies and provide rationale for the use of TRPV4 and RAS/MAPK antagonists at the bedside in GCLJ. Giant cell lesions of the jaw (GCLJ) are debilitating benign tumors of unclear origin. The authors identify driver recurrent somatic mutations in TRPV4, KRAS and FGFR1 and show they converge on aberrant activation of the MAPK pathway. Their findings extend the spectrum of TRPV4 channelopathies and provide rationale for targeted therapies at the bedside in GCLJ.
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23
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Fasciano D, Wei S, Li R, Siegal GP. Chondroblastoma-like tumor of the skull in a patient with cardio-facio-cutaneous syndrome. Pathol Res Pract 2018; 214:1510-1513. [DOI: 10.1016/j.prp.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/25/2018] [Accepted: 08/06/2018] [Indexed: 01/09/2023]
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24
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Flanagan AM, Lindsay D. A diagnostic approach to bone tumours. Pathology 2017; 49:675-687. [PMID: 29110879 DOI: 10.1016/j.pathol.2017.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
In this review we discuss an approach to diagnosing primary bone tumours, namely the cartilaginous, bone-forming, giant cell-rich, fibro-osseous and round cell neoplasms. Less common lesions including chordoma are also discussed. The value of integrating clinical, histopathological and relevant radiological features is emphasised with a view to providing the general histopathologist with a methodical approach to reaching an accurate diagnosis.
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Affiliation(s)
- Adrienne M Flanagan
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom; UCL - Cancer Institute, London, United Kingdom.
| | - Daniel Lindsay
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, United Kingdom
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25
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Abstract
The jaws combine several unique properties that mainly result from their distinct embryonic development and their role in providing anchorage for the teeth and their supporting structures. As a consequence, several bone-related lesions almost exclusively develop in the jaws (eg, osseous dysplasias, ossifying fibromas), have distinct clinical features (eg, osteosarcoma), or hardly ever occur at this location (eg, osteochondroma, enchondroma). The specific characteristics of these tumors and tumorlike lesions are outlined in this article.
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Affiliation(s)
- Daniel Baumhoer
- Bone Tumour Reference Centre at the Institute of Pathology, University Hospital Basel, University of Basel, Schoenbeinstrasse 40, Basel 4031, Switzerland.
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26
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Recurrent multilocular mandibular giant cell granuloma in neurofibromatosis type 1: Evidence for second hit mutation of NF1 gene in the jaw lesion and treatment with curettage and bone substitute materials. J Craniomaxillofac Surg 2016; 44:1054-60. [PMID: 27316856 DOI: 10.1016/j.jcms.2016.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 04/07/2016] [Accepted: 05/09/2016] [Indexed: 12/16/2022] Open
Abstract
Giant cell granuloma (GCG) of the jaw is a rare, well-known feature of neurofibromatosis type 1 (NF1), an inborn multisystem disorder. Recently, the development of GCG in NF1 was attributed to second hit mutations in the NF1 gene. The treatment of GCG is pragmatic with a preference for local curettage of lytic osseous areas. This report describes the surgical therapy of an NF1-affected female with multilocular mandibular GCG and hypodontia who additionally suffered from a brain tumour and Hashimoto's thyroiditis. Although local recurrence of GCG was noted, augmentation of the curetted cavities with a bone substitute in successive interventions successfully restored the extensive periradicular local defects and stabilised the teeth. A meticulous in vitro study of the GCG specimen revealed a second hit mutation in the NF1 gene in the GCG spindle-cells. This study contributes to the increasing knowledge of the molecular basis for GCG in the jaw of NF1 patients, indicating that it is a neoplasm.
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27
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Raubenheimer EJ, Noffke CE, Boy SC. Osseous Dysplasia with Gross Jaw Expansion: A Review of 18 Lesions. Head Neck Pathol 2016; 10:437-443. [PMID: 27161103 PMCID: PMC5082044 DOI: 10.1007/s12105-016-0720-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/27/2016] [Indexed: 01/09/2023]
Abstract
Fourteen cases with 18 grossly expansive lesions diagnosed over a period of 15 years as either "familial gigantiform cementoma" or "osseous dysplasia with jaw expansion" in an African population sample were reviewed. Eight lesions occurred in the anterior mandible, the maxilla was affected by four, three patients presented with more than one lesion and the most common associated pathologies were tooth displacement, conventional non expanding florid osseous dysplasia and simple bone cyst. No history of similar lesions in relatives of the diseased were recorded. The radiolucent fibrous component contained globular bone deposits and cellular osteoid with trabecular differentiation which matured into radiodense mineralized masses. Resorption of the cellular bone created cavities which are proposed to represent the early stage of simple bone cyst formation. It is recommended that "expansive osseous dysplasia" replace the out-dated term "familial gigantiform cementoma". The differential diagnoses of expansive osseous dysplasias are discussed.
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Affiliation(s)
| | - Claudia E. Noffke
- Radiology, School of Oral Health Sciences, SMU, Pretoria, 0208 South Africa
| | - Sonja C. Boy
- Pathology, School of Oral Health Sciences, SMU, Pretoria, 0208 South Africa
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28
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Amary MF, Berisha F, Mozela R, Gibbons R, Guttridge A, O'Donnell P, Baumhoer D, Tirabosco R, Flanagan AM. The H3F3 K36M mutant antibody is a sensitive and specific marker for the diagnosis of chondroblastoma. Histopathology 2016; 69:121-7. [PMID: 26844533 DOI: 10.1111/his.12945] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/22/2016] [Accepted: 01/31/2016] [Indexed: 12/19/2022]
Abstract
AIMS We recently reported that 95% of chondroblastomas harbour a p.K36M mutation in either H3F3A (chromosome 1) or H3F3B (chromosome 17), with the majority involving H3F3B. The aim of this study was to assess the expression of the K36M-mutated protein by immunohistochemistry in a large group of tumours. METHODS AND RESULTS One thousand eight hundred and ninety-four tumours, including 85 chondroblastomas and 10 clear-cell chondrosarcomas, were studied; of these, 82 chondroblastomas and one clear-cell chondrosarcoma known to harbour the H3F3 p.K36M mutation expressed the mutated protein. Three chondroblastomas and nine clear-cell chondrosarcomas wild type for H3F3A/H3F3B were negative for p.K36M immunoexpression. The remaining 1799 cases tested, 545 of which were known to be wild type for the H3F3A and H3F3B p.K36M mutations, included 1047 primary bone tumours, and 507 soft tissue and joint tumours. Two hundred and forty-five other tumour types not expected to harbour the mutation were negative for p.K36M immunoexpression. CONCLUSIONS Our data demonstrate the specificity and sensitivity of this immunomarker, and will be a useful adjunct for reaching a diagnosis of chondroblastoma.
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Affiliation(s)
- M Fernanda Amary
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,UCL Cancer Institute, Huntley Street, London, UK
| | - Fitim Berisha
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Rafael Mozela
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,Department of Anatomical Pathology, A. C. Camargo Cancer Centre, Sao Paulo, Brazil
| | - Rebecca Gibbons
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Paul O'Donnell
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Daniel Baumhoer
- Bone Tumour Reference Centre at the Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Roberto Tirabosco
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Adrienne M Flanagan
- Department of Histopathology, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.,UCL Cancer Institute, Huntley Street, London, UK
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