1
|
Venkat S, Islam MN, Bhattacharyya I, Cohen DM, Kratochvil FJ, Woods TR, Ganatra S, Alramadhan SA. Xanthoma of the Jaw Bones: Cases Series and Review of Literature. Head Neck Pathol 2024; 18:19. [PMID: 38502367 PMCID: PMC10951172 DOI: 10.1007/s12105-024-01615-8] [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] [Received: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Intraosseous xanthomas are rare benign lesions sometimes associated with excess lipid production. Xanthoma of the jaw bones (XJB) was first reported in 1964, and fewer than 50 cases have been reported in the English literature to date. The etiopathogenesis of XJB is highly suggestive of a reactive process or a metabolic condition. METHOD Seven cases of XJBs were retrieved from the archives of 4 oral and maxillofacial pathology services. Clinical, radiographic and histopathologic features of all these cases were retrospectively analyzed. Immunohistochemical (IHC) stains for S100 and CD68 were performed. RESULTS All seven cases involved the mandible. Patients' age ranged between 13 and 69 years with an evenly distributed female to male ratio. One patient had a medical history of hyperlipidemia, but the medical and dental histories of the others were unremarkable. For most cases, XJB was an incidental finding discovered during routine radiographic examination. Swelling and cortical expansion were noted in a few cases. Radiographically, cases typically presented as either well-defined multilocular or unilocular lesions, which were either radiolucent or mixed radiolucent/radiopaque. All the lesions were treated with surgical curettage and no recurrence was observed during subsequent follow-ups. Each of the seven cases exhibited sheets of foamy macrophages. The diagnosis is established by exclusion of entities with overlapping microscopic features and involved correlation with the clinical, histological, radiographic and IHC profiles. Immunohistochemically, all the cases expressed diffuse positivity for CD68 and were negative for S100. CONCLUSION XJB is a rare lesion of unknown etiology, which may mimic other benign or reactive jaw lesions. Due to its rarity and the potential diagnostic challenges it presents, clinicians must remain vigilant and consider CXJ in their differential when assessing radiolucent jaw anomalies.
Collapse
Affiliation(s)
- Shankar Venkat
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Mohammed N Islam
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Indraneel Bhattacharyya
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Donald M Cohen
- Department of Oral and Maxillofacial Pathology, University of Florida College of Dentistry, Gainesville, FL, USA
| | - F James Kratochvil
- Department of Pathology and Radiology, Oregon Health and Science University School of Dentistry, Portland, OR, USA
| | - Tina R Woods
- The Medical University of South Carolina, Charleston, SC, USA
| | - Seema Ganatra
- University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Saja A Alramadhan
- University of Mississippi Medical Center, 2500 N. State St, Jackson, MS, 39216-4505, USA.
| |
Collapse
|
2
|
Mewar P, Foss RD. Benign fibrohistiocytic jaw lesions: a 48-year clinicopathologic analysis and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00428-5. [PMID: 37277279 DOI: 10.1016/j.oooo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/23/2023] [Accepted: 04/02/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Intra-osseous fibrohistiocytic lesions have long been reported in the literature; evidence suggests they represent a heterogeneous group of reactive and neoplastic processes. This study evaluated a series of gnathic fibrohistiocytic lesions to identify and categorize their clinical, radiographic and morphologic spectrum. STUDY DESIGN A retrospective case search over 48 years was conducted for maxillary and mandibular intra-bony fibrohistiocytic lesions. Diagnoses were confirmed and demographic, radiographic, clinical and follow-up data was analyzed. RESULTS Fifty cases met the inclusion criteria. Most cases (80%) were found in the second through fourth decades (mean, 29 years). The most common location (86%) was the posterior mandible. Radiographic presentations varied, but a few patterns emerged, including a distinctive mottled, honeycomb type with punctate lucencies. All cases demonstrated fibrous components admixed with variable histiocytes. Eight cases (16%) were histiocyte-rich with dominant sheets of xanthoma cells. Immunohistochemical staining revealed strong CD68 and CD163 expression, along with variable smooth muscle actin staining. The vast majority (92%) of cases were treated conservatively. Available follow-up showed lesional stability in 17 cases (average, 85 months) with 2 recurrences (24 months each) and no evidence of malignant transformation. CONCLUSIONS This study is the largest to date of fibrohistiocytic gnathic lesions, revealing distinctive radiographic and histologic findings and characteristic clinical and immunophenotypic features. Available evidence suggests that most of these are indolent, slow-growing lesions amenable to conservative therapy.
Collapse
Affiliation(s)
- Parth Mewar
- Head and Neck Pathology, The Joint Pathology Center, Silver Spring, MD; Oral and Maxillofacial Pathology, Madigan Army Medical Center, Joint Base Lewis-McChord, WA.
| | - Robert D Foss
- Head and Neck Pathology, The Joint Pathology Center, Silver Spring, MD
| |
Collapse
|
3
|
Primary intraosseous xanthoma of the mandible – A case report, novel approach to removal, and review of the literature. ORAL AND MAXILLOFACIAL SURGERY CASES 2022. [DOI: 10.1016/j.omsc.2022.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
4
|
Kim MJ, Kang MJ, Kang SH. Primary xanthoma inferior to the right mandibular third molar and intraoral vertical ramus osteotomy. Imaging Sci Dent 2022; 52:231-238. [PMID: 35799964 PMCID: PMC9226232 DOI: 10.5624/isd.20210303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/24/2022] [Accepted: 03/09/2022] [Indexed: 12/05/2022] Open
Abstract
Intraosseous xanthoma of the mandible is a rare benign disorder. A 17-year-old male patient presented with a suspected abscess in the right mandibular third molar, detected on a panoramic radiograph. The patient had no history of systemic or lipid-related metabolic diseases and complained of no specific symptoms or pain. A radiographic examination revealed a heterogeneous radiolucency extending from the apical to the distal aspect of the right mandibular third molar tooth germ. The lesion measured 9×16×24 mm (antero-posterior×mediolateral×supero-inferior) and showed a relatively well-defined, multilocular, foamy appearance with hyperostotic borders spreading to the inferior alveolar nerve canal. After excisional biopsy, a diagnosis of central xanthoma was made. The lesion recurred, and intraoral vertical ramus osteotomy was done near the lesion. For the treatment of xanthoma of the mandible, extensive and delicate surgical treatment under general anesthesia should be considered.
Collapse
Affiliation(s)
- Min-Ji Kim
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Min-Jun Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| |
Collapse
|
5
|
Wilkinson PE, Merkourea S, Gopalakrishnan R, Argyris PP. Primary Intraosseous Xanthomas of the Jaws: A Series of Six Cases Including an Example with Formation of Apoptosis-Related Hyaline Globules, So-Called "Thanatosomes". Head Neck Pathol 2020; 14:859-868. [PMID: 31916206 PMCID: PMC7669974 DOI: 10.1007/s12105-020-01126-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022]
Abstract
Primary intraosseous xanthomas of the jaws (PIXJ) are rare and predominantly affect the posterior mandible (86%) of normolipemic patients, with a mean age of 30 years and no gender predilection. Clinically, PIXJ exhibit indolent biologic behavior; curettage is considered treatment of choice. Only 36 PIXJ have been reported. Apoptosis-related hyaline globules (HGs), also known as "thanatosomes", have not been previously reported in PIXJ. Cases diagnosed as xanthoma of bone were retrieved. Six cases fulfilling currently accepted criteria were identified and their clinicopathologic and immunohistochemical properties are presented herein. Mean age for PIXJ was 21.8 years (range = 12-33) and F:M ratio = 2:1. All cases presented as well-demarcated, unilocular or multilocular radiolucencies. Microscopically, PIXJ featured sheets of lipid-laden macrophages with eosinophilic or foamy cytoplasm. A secondary fibroblastic population lacking storiform pattern was evident in two cases. Adipocytes (3/6), peripheral neurovascular bundles (1/6), bone fragments (3/6) and dystrophic calcifications (3/6) were observed enclosed by the xanthoma cells. Notably, one case exhibited numerous, spherical, eosinophilic HGs containing apoptotic nuclei. PIXJ were consistently CD68(+) and negative for CD1α and S100. CD45 decorated lymphocytes and the membrane of foamy histiocytes. Xanthoma cells stained for lysozyme and plasma proteins including alpha-1 antitrypsin (AAT), IgG and IgA in one probed case. HGs were lysozyme(+), AAT(+), IgG(+), IgA(+), PAS(+) and diastase-resistant, and fuchsinophilic with Masson's trichrome. PIXJ represent infrequent, solitary, mandibular lesions with a predilection for the second and third decade of life. Thanatosomes associated with cell injury and death can be present in PIXJ.
Collapse
Affiliation(s)
- Peter E. Wilkinson
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA
| | - Stavroula Merkourea
- grid.5216.00000 0001 2155 0800School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Rajaram Gopalakrishnan
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA
| | - Prokopios P. Argyris
- grid.17635.360000000419368657Division of Oral and Maxillofacial Pathology, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, 515 Delaware Street SE 16-206B, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Department of Biochemistry, Molecular Biology, and Biophysics, College of Biological Sciences, University of Minnesota, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455 USA ,grid.17635.360000000419368657Institute for Molecular Virology, University of Minnesota, Minneapolis, MN 55455 USA
| |
Collapse
|
6
|
de Arruda JAA, Almeida TFA, Abreu LG, do Amaral MBF, Anbinder AL, Flores RM, Agostini M, Romañach MJ, Silva TA, de Andrade BAB, Mesquita RA. Intraosseous xanthoma of the mandible: A multi‐institutional case series with a literature review. J Oral Pathol Med 2019; 48:935-942. [DOI: 10.1111/jop.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Lucas Guimarães Abreu
- Department of Paediatric Dentistry, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Ana Lia Anbinder
- Department of Biosciences and Oral Diagnosis, Institute of Science and Technology Universidade Estadual Paulista ‐ UNESP São José dos Campos Brazil
| | - René Martínez Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry Universidad Andrés Bello Viña del Mar Chile
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| | | | - Ricardo Alves Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
| |
Collapse
|