A family case report of parathyroid carcinoma associated with CDC73 mutation in hyperparathyroidism-jaw tumor syndrome

Background

Hereditary primary hyperparathyroidism (PHPT) accounts for 5-10% of all PHPT cases, necessitating genetic testing for diagnosis and management. Among these, hyperparathyroidism-jaw tumor syndrome (HPT-JT) is an autosomal dominant disorder caused by CDC73 mutations with variable clinical presentations and incomplete symptoms.

Case summary

The proband, diagnosed with PHPT, underwent parathyroidectomy at the age of 41 with pathological examination of parathyroid carcinoma (PC). Hereditary PHPT was initially suspected due to the early-onset PHPT and family history. Genetic testing identified a heterozygous CDC73 mutation, NM_024529.4: c. 687_688delAG (p. Arg229Serfs*37). Even in the absence of jaw tumors, the diagnosis of HPT-JT was confirmed based on the discovery of renal cysts. A secondary thyroidectomy was performed to reduce the risk of recurrence.

Conclusion

Genetic testing is strongly recommended in cases of early-onset PHPT, family history, jaw tumors, renal and uterine involvement, atypical parathyroid tumors, and PC. This testing provides valuable information for personalized management, and counseling is available for affected families.

Phenotypic Profiling and Molecular Mechanisms in Hyperparathyroidism-jaw Tumor Syndrome

CONTEXT

Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a heritable form of primary hyperparathyroidism caused by germline inactivating mutations in CDC73 encoding parafibromin and is associated with an increased risk of parathyroid cancer. There is little evidence to guide the management of patients with the disease.

OBJECTIVE

(1) Characterize the natural history of HPT-JT, (2) correlate genotype and histology of parathyroid tumors with parafibromin immunostaining, (3) understand molecular changes downstream to CDC73 loss.

DESIGN

Retrospective study of patients with HPT-JT syndrome (genetically confirmed or affected first-degree relatives). Independent review of uterine tumor from 2 patients and staining for parafibromin on parathyroid tumors from 19 patients (13 adenomas, 6 carcinomas) was performed. RNA-sequencing was performed in 21 parathyroid samples (8 HPT-JT-related adenomas, 6 HPT-JT-related carcinomas, and 7 sporadic carcinomas with wild-type CDC73).

RESULTS

We identified 68 patients from 29 kindreds with HPT-JT with median age at last follow-up of 39 [interquartile range, 29-53] years. A total of 55/68 (81%) developed primary hyperparathyroidism; 17/55 (31%) had parathyroid carcinoma. Twelve of 32 (38%) females developed uterine tumors. Of the 11 patients who had surgical resection for uterine tumors, 12/24 (50%) tumors were rare mixed epithelial mesenchymal polypoid lesions. Four of 68 patients (6%) developed solid kidney tumors; 3/4 had a CDC73 variant at p.M1 residue. Parafibromin staining of parathyroid tumors did not correlate with tumor histology or genotype. RNA-sequencing showed a significant association of HPT-JT-related parathyroid tumors with transmembrane receptor protein tyrosine kinase signaling pathway, mesodermal commitment pathway, and cell-cell adhesion.

CONCLUSIONS

Multiple, recurrent atypical adenomyomatous uterine polyps appear to be enriched in women with HPT-JT and appear characteristic of the disease. Patients with CDC73 variants at p.M1 residue appear predisposed to kidney tumors.

CLINICAL TRIAL NUMBER

NCT04969926.

Fibula osteal flap with proximal peroneal perforator skin paddle for composite oromandibular reconstruction: A case report

RATIONALE

Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel.

PATIENT CONCERNS

A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us.

DIAGNOSIS

Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma.

INTERVENTIONS

The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle.

OUTCOMES

The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up.

LESSONS

The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.

Pulmonary Malignant Ameloblastoma without Local Recurrence 31 Years after Primary Resection: A Case Report and Literature Review

A 78-year-old man with a history of surgical resection for ameloblastoma 31 years earlier visited our hospital for prolonged cough. Chest computed tomography showed multiple nodules in both lungs. Although there was no local recurrence in the mandible, the specimen taken from a transbronchoscopic bronchial biopsy showed recurrent ameloblastoma. Despite receiving no treatment, the disease in our patient remained clinically stable for 8.4 years. Chest physicians should be aware that pulmonary malignant ameloblastoma can first relapse several decades after curative surgery. In addition, pulmonary malignant ameloblastoma without local recurrence may be associated with a good prognosis.

Benign polypoid adenomyomatous endometrium associated with hpt-JT syndrome: a case report

Hyperparathyroidism-jaw tumor (HPT-JT) is an autosomal dominant disorder responsible for benign and/or malignant tumors. Affected women often present life-threatening menorrhagia that leads to the identification of uterine tumors, and experience miscarriages and infertility. Overall though, fewer data concerning gynecological pathologies related to HPT-JT syndrome are available. We report the case of a 32-year-old woman with HPT-JT syndrome, referred for recurrent vaginal bleeding, with a history of repeated endometrial polyps and infertility. We also review the literature that explores medical options for these women.

Management of familial hyperparathyroidism syndromes: MEN1, MEN2, MEN4, HPT-Jaw tumour, Familial isolated hyperparathyroidism, FHH, and neonatal severe hyperparathyroidism

While primary hyperparathyroidism (PHPT) generally represents a common endocrine disorder, being the more frequent cause of hypercalcemia in outpatients, familial forms of PHPT (FPHPT) account for no more than 2-5% of the overall PHPT. In the last decades, many technical progresses in both molecular and biochemical-radiological evaluation have been made, and substantial advancements in understanding these disorders have been reached. Differences both in the pathogenesis and clinical presentation exist among the various hyperparathyroid syndromic forms, and, since FPHPT is frequently associated to other endocrine, proliferative and/or functional disorders, as also non-endocrine tumours, with varying clinical spectrum of occurrence in each syndrome, its early clinically detection for appropriately preventing complications (i.e. kidney and bone disorders) is strictly advised. In this review, the clinical-biochemical features and diagnostic procedures of each FPHPT form will be summarized and a general overview on surgical and pharmacological approaches to FPHPT has been also considered.

Parathyroid carcinoma

Parathyroid carcinoma (PC) is a rare disease with an indolent behavior due to the low malignant potential. The etiology is unknown. Somatic mutations of CDC73 gene, the same gene involved in the hyperparathyroidism-jaw tumor syndrome, can be identified in up to 70% of patients with PC and in one-third of cases the mutations are germline. Therefore, in patients who carry germline CDC73 gene mutations, its finding permits to identify the carriers among relatives and sometimes to early detect a parathyroid lesion in such subjects. The diagnosis of PC is commonly made after surgery, however there are some clinical/biochemical features that should raise the suspicion of PC, namely markedly elevated serum calcium and PTH levels, a large parathyroid lesion with suspected ultrasonographic features of malignancy, the damages of kidney and bones. The best chance of cure is the complete surgical resection with the en-bloc excision at the first operation, however several recurrences are often observed during the follow-up. Since PC is an indolent tumor with long-lasting survival and the death is due to complications of untreatable hypercalcemia, multiple surgical interventions with debulking of tumoral tissues along with medical treatment for reducing hypercalcemia are often needed. Patients with PC should be followed up along their lifetime.

Familial Gigantiform Cementoma: Case Report of an Unusual Clinical Manifestation and Possible Mechanism Related To "Calcium Steal Disorder"

Familial gigantiform cementoma is an exceedingly rare but distinct subtype of cemento-osseous-fibrous lesion. Undocumented radiographic changes and related bone metabolism disorder are herein hypothesized and discussed. We present an adolescent case with recurrent familial gigantiform cementoma who received surgical intervention in our hospital. Apart from typical multiquadrant and expansile abnormalies involving both jaws, he also suffered from several times of fractures in lower extremity. Furthermore, radiographic examinations of calvaria, pelvis, femoris, tibia, and fibula all revealed radiolucent areas signifying diffuse osteopenic bone losses. Some of his consanguineous relatives bore the same burden of fractures during pubertal period.Considering these polyostotic conditions, a correlation of congenital bone metabolism disorder in cases with familial gigantiform cementoma, named "calcium steal disorder," was thus proposed. Familial gigantiform cementoma is closely associated with "calcium steal disorder." Whole-body dual-energy absorptiometry should be considered as a routine examination for fracture-related risk prediction.

[Support at home for a patient with cancer of the jaw]

Home care presents specific difficulties. The support of Ms. C, suffering from a malignant tumour of the lower jaw illustrates a difficult care context due to a painful and poorly-healing wound, low self-esteem and communication difficulties. Maintaining the right distance and providing professional support are therefore essential in order to give high quality care to this patient.

Secondary jaw aneurysmal bone cyst (JABC)--a possible misnomer? A review of literature on secondary JABCs, their pathogenesis and oncogenesis

CONTEXT

Aneurysmal bone cysts are rare pseudocysts, commonly seen in long bones and vertebral column. Although a well described and reported lesion, many misconceptions still prevail regarding their etiopathogenesis. Many of the reported cases of jaw aneurysmal bone cysts (JABC) present with another bone pathology.

AIMS

The purpose of this review was to evaluate the incidence of neoplastic lesions occurring simultaneously with a JABC (in contrast to primary JABCs). Any pathogenetic and oncogenetic association between primary and secondary jaw ABCs has been reviewed and discussed.

SETTINGS AND DESIGN

A methodical narrative review of literature was performed, given the incidence of mostly case reports on this topic.

METHODS AND MATERIAL

A methodical electronic search of Pubmed, Pubmed Central, Medline and Cochrane databases was performed for reported cases of JABC. These articles were analysed and segregated into primary and secondary ABC and, if secondary, the lesion it concurrently occurred with. Another search was conducted to yield articles discussing the cytopathogenetic and oncogenetic origins of ABCs.

RESULTS AND CONCLUSIONS

About 15% of the ABCs reported were of secondary nature. Amongst the associated lesions, cement-ossifying fibroma and ossifying fibroma were the most common, followed by fibrous dysplasia and central giant cell granuloma. No ABCs were associated with metastatic changes. The search for histopathogenesis pointed to a specific cytogenetic abnormality as the origin of primary ABCs, with USP6 as its main oncogene and spindle cell as the neoplastic cell, unlike with secondary ABCs, suggesting that they are distinct pathological processes.

Ameloblastoma: a neglected criterion for nevoid basal cell carcinoma (Gorlin) syndrome

Ameloblastomas are considered to be aggressive and locally invasive neoplasms derived from odontogenic epithelium with a tendency for recurrence and bone destruction. Although the relationship between nevoid basal cell carcinoma syndrome (NBCCS) and ameloblastoma is less frequent, it might constitute a peculiar stigmata of this hereditary disorder. The objective of the current study was to evaluate whether a combined clinical and biomolecular approach could be useful for the identification of NBCCS among patients with a diagnosis of ameloblastoma. The authors collected ameloblastoma tumors recorded in the databases of the Pathology Departments of the University of Modena during the period 1991-2011. Family trees were drawn for all 41 patients affected by these specific odontogenic tumors. Two patients with ameloblastoma were also affected by multiple basal cell carcinomas and odontogenic keratocysts tumors (OKCTs) achieving the requested clinical criteria for the diagnosis of NBCCS. The clinical diagnoses were confirmed by the identification of two different novel PTCH1 germline mutations (c.2186A > T [p.K729 M]; c.931insA) in those unrelated patients. Clinical ameloblastoma findings can be used as screening for the identification of families at risk of NBCCS. Ameloblastomas diagnosis warrants the search for associated cutaneous basal cell carcinomas and other benign and malignant tumors related to NBCCS. Thus, we propose the inclusion of ameloblasoma as criterion for the identification of NBCCS.

Retrospective study of 25 cases of keratocystic odontogenic tumor: epidemiology and treatment

AIM

Keratocystic odontogenic tumor (KOT) is a benign odontogenic neoplasm with locally aggressive behavior and high recurrence rates. It is associated with nevoid basal cell carcinoma syndrome which usually has a more rapid growth. The aim of the study is to report the experience of our service on diagnosis and treatment of KOT.

MATERIALS AND METHODS

Twenty-five cases of KOT were diagnosed between the years of 1989 and 2006. Demographic data was collected as well as diagnose and treatment.

RESULTS

Fifty-six percent were female with a mean age of 33 years old. Seventy percent occurred in mandibula and all received surgical treatment, associate or not with adjuvant therapy, such as cryotherapy and Carnoy's solution. Recidive was observed in 48% of cases with a mean period of time of 18 months.

CONCLUSION

Our data analysis showed the importance of previous diagnosis before enucleation procedure and long-term follow-up for recurrence early detection. Recurrence incidence is more frequent on first year after diagnosis.

CLINICAL SIGNIFICANCE

KOT is a benign tumor with local aggressive behavior and therefore its treatment must consider the high index of recidive. Reports of protocol treatment should raise new discussion to decrease recurrence rates.

Oro-facial manifestations of Burkitt's lymphoma: an analysis of 680 cases from Malawi

Burkitt's lymphoma (BL) is a highly aggressive, fast growing, mature B-cell non-Hodgkin's Lymphoma (NHL) and has one of the highest proliferation rates of any human tumour. There are three forms of BL: endemic or the African form (eBL), sporadic or non-endemic form (sBL) and the immunodeficiency-associated form in HIV-AIDS. The survival rate of a child with BL is dependent upon rapid diagnosis and treatment. The aim of the present study was to determine the oro-facial manifestations in children with BL in Malawi. It was carried out in two parts: the first, a retrospective record-based study (2005-2007) consisting of 661 cases of BL and the second, a prospective study (June 2008 -October 2009) documenting 19 cases of suspected and confirmed cases of BL. In the retrospective study, two thirds presented with BL at various sites of which the abdomen was the most common site. The 5-9 year age group predominated with an average peak incidence of 7 years and accounted for 60.0% of all the cases. There was a male preponderance with a ratio of male to female of 1.6:1. The maxilla was the most common site for oro-facial BL (13.7%) followed by the mandible (7.2%), cheeks (5.7%), maxilla and mandible (4.5%) and cervical lymph nodes (4.1%). Of the 397 with BL, 41.4% were tested for HIV and 37.97% were HIV-negative while 5% were HIV-positive. In the prospective study, females predominated with a male to female ratio of 1.1:1 and the mandible was the most common site accounting for 19.04%. The age group 5-9 years predominated with 68.4% relative frequency. Generally the trend of BL had decreased from 2005 to 2007 possibly due to better access to health services, increased use of bed-treated mosquito nets for malaria prevention and knowledgeable healthcare workers. All oral healthcare and other healthcare workers need to be educated on the oro-facial manifestations of BL for prompt referral and management. This would result in a better prognosis since BL is curable as it responds favourably to chemotherapy. Furthermore, communities need to be educated on the early signs and symptoms of BL and the importance of visiting a hospital as soon as possible.

Osseous (cemento-osseous) dysplasia of the jaws: clinical and radiographic analysis

OBJECTIVES

To explore the demographic characteristics and clinical features among patients with osseous (cemento-osseous) dysplasia (OD/COD) of the jaws and to determine the frequency of particular radiographic characteristics.

METHODS

The charts and radiographic reports of 118 patients with OD/COD, obtained from the archives of the University of Toronto discipline of oral and maxillofacial radiology, were reviewed. Demographic and clinical data, radiographic findings and final diagnoses were collected and analyzed to determine typical characteristics.

RESULTS

Of the 117 patients for whom age and sex were known, the majority (97 [82.9%]) were female; these female patients had a mean age (± standard deviation) of 44.3 ± 13.4 years. Eighty-three (72.2%) of the 115 patients for whom symptoms were known were clinically asymptomatic. Ninety-three patients (78.8%) had OD/COD at single sites (i.e., periapical OD/COD), and 25 (21.2%) had OD/COD at multiple sites (i.e., florid OD/COD). In addition, 15 (12.7%) of the cases were associated with one or more simple bone cysts, and 13 (11.0%) were associated with osteomyelitis. In most cases, the OD/COD was unilateral, with the lesion being located in the mandible, usually associated only with the posterior teeth. The lesions exhibited well-defined, sclerotic or corticated margins (108 patients [91.5%]) and were surrounded by a radiolucent border. Minimal effects on surrounding structures were observed. As well, 85 (72.0%) of the lesions were in the mixed radiolucent-radiopaque stage, with dense, cementum-like radiopacities.

CONCLUSIONS

The majority of cases of OD/COD occurred in women in the fifth decade of life, and most cases were asymptomatic. OD/COD was more likely to present as solitary lesions but also occurred in association with simple bone cysts or osteomyelitis.

Analysis of aberrantly spliced HRPT2 transcripts and the resulting proteins in HPT-JT syndrome

The risk for parathyroid carcinoma is high in those with the HPT-JT syndrome. Parafibromin is a protein derived from HRPT2 gene and its inactivation has been coupled to familial form of parathyroid malignancy. We previously identified altered transcripts resulting from splice site mutation of the HRPT2 gene in a family with this syndrome. In the present work, we investigated the stability of the altered HRPT2 transcripts and translation products produced in the HPT-JT syndrome. We quantified the differentially expressed HRPT2 mRNAs using real-time RT-PCR and developed a novel monoclonal parafibromin antibody to study the expression of parafibromin in the HPT-JT syndrome. The relative quantification ratios of the wild type HRPT2 mRNA, 23 bp deleted HRPT2 mRNA, and 70 bp deleted HRPT2 mRNA in the HPT-JT syndrome were 0.68, 0.17 and 0.15, respectively. But endogenous parafibromin expression was not detectable in the HPT-JT syndrome carcinoma. The altered HRPT2 mRNAs resulting from the splice site mutation in the HPT-JT syndrome were stable, but their parafibromin translation products from the HPT-JT syndrome carcinoma were probably degraded rapidly. Additional studies that aim to fully characterize the consequences of altered HRPT2 mRNAs in HPT-JT syndrome are required to explore these possibilities.

Defective nucleolar localization and dominant interfering properties of a parafibromin L95P missense mutant causing the hyperparathyroidism-jaw tumor syndrome

The hyperparathyroidism-jaw tumor syndrome (HPT-JT) is a familial cancer syndrome that can result from germline inactivation of HRPT2/CDC73, a putative tumor suppressor gene that encodes parafibromin, a component of the transcriptional regulatory PAF1 complex with homology to the yeast protein Cdc73p. The vast majority of HRPT2/CDC73 germline mutations identified have been truncation or frameshift mutations, and loss of function due to missense mutation is rare. We report here a kindred with HPT-JT due to a germline L95P missense mutation in parafibromin. The mutant parafibromin was studied in vitro to understand the basis of its presumed loss-of-function. When transfected in cultured cells, the L95P mutant was expressed to a lower level than wild-type (wt) parafibromin, a difference that was not overcome by inhibition of the proteasomal degradation pathway. The L95P mutant parafibromin retained the ability to assemble with endogenous PAF1 complex components as evidenced by co-immunoprecipitation. Analysis of subcellular localization showed that the L95P mutant was markedly deficient in nucleolar localization compared to the wt, an impairment likely resulting from disruption of a putative nucleolar localization signal immediately upstream of the L95P mutation. Transfection of the L95P parafibromin mutant, but not the wt, enhanced cell cycle progression and increased cell survival in NIH-3T3 and HEK 293 cells, resulting apparently from dominant interference with endogenous parafibromin action. The simultaneous loss of nucleolar localization and acquisition of a growth stimulatory phenotype with the L95P mutation raise the possibility that parafibromin must interact with targets in the nucleolus to fully execute its tumor suppressor functions.

Osteosarcoma in a pregnant patient with McCune-Albright syndrome

Malignant transformation of fibrous dysplasia is very rare and has not been previously described in patients with McCune-Albright syndrome in the absence of radiation treatment during gestation. Here, we report a 38-year-old pregnant woman with McCune-Albright syndrome and acromegaly accompanied by osteosarcoma. The patient was in the 6th week of pregnancy, when she visited our hospital. She had multiple fibrous dysplasia, skin pigmentation, and acromegaly. The markedly high bone turnover rate during pregnancy tended to decrease after a normal delivery. Fibrous dysplasia of the lower jaw rapidly increased in the 37th week of pregnancy, and the tumor was surgically resected after delivery. Pathological examination of the resected tumor revealed fibrous dysplasia admixed with osteosarcoma containing chondroblastic and osteoblastic tissue. We firstly reported a case of osteosarcoma in a patient with McCune-Albright syndrome, which rapidly progressed during pregnancy.

The effect of disease-associated HRPT2 mutations on splicing

Mutations in the tumour suppressor HRPT2 occur in patients with parathyroid carcinoma, kidney tumours and Hyperparathyroidism-Jaw Tumour syndrome. Disruption of exonic splicing through mutation of donor/acceptor splice sites or exonic splice enhancer (ESE) sites leads to loss of function of a number of major tumour suppressors including BRCA1, APC and MLH1. Given that the effect of HRPT2 mutations on splicing has not been widely studied, we used an in vitro splicing assay to determine whether 17 HRPT2 mutations located in hot-spot and other exons predicted to disrupt ESE consensus sites led to aberrant splicing. Using two independent web-based prediction programs, the majority of these mutations were predicted to disrupt ESE consensus sites; however, aberrant splicing of HRPT2 transcripts was not observed. Canonical donor or acceptor splice site mutations were also investigated using this splicing assay and transcripts assessed from tumour tissue. Splice site mutations were shown to lead to either exon skipping or retention of intronic sequences through the use of cryptic splice sites comprised of non-classical splicing signals. Aberrant splicing caused by disruption of ESE sites does not appear to have a major role in HRPT2-associated disease; however, premature truncation of parafibromin as the result of canonical donor or acceptor splice site mutations is associated with pathogenicity. Functional splicing assays must be undertaken in order to confirm web-based software predictions of the modification of putative ESE sites by disease-associated mutations.

[Delayed wound healing post molar extraction]

One month post extraction of the second left maxillary molar the alveolar extraction site showed no signs of healing and was painful. The patient had been using an oral bisphosphonate during 3 years. Therefore, the lesion was diagnosed as bisphosphonate-induced maxillary osteonecrosis. Treatment was conservative. Since one month later the pain had increased and the wound healing had decreased, a biopsy was carried out. Histopathologic examination revealed a non-Hodgkin lymphoma.

Odontomas: a clinicopathologic study in a Portuguese population

OBJECTIVE

Odontoma is a tumorlike malformation (hamartoma) that contains odontogenic epithelium with odontogenicectomesenchyme. Frequency and distribution of odontogenic tumor among a Portuguese population were analyzed and compared with previous reports.

METHOD AND MATERIALS

A total of 65 odontogenic tumor cases were collected from the files of the Department of Pathology of Hospital Sao Joao,Porto,Portugal, and the Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), from January 1993 to December 2006. Of these cases, 48 were retrieved and analyzed. The final diagnosis of each case was based on the 2005 WHO histopathologic classification of odontogenictumors, and to the authors' best knowledge, the present series represents the first study on odontomas in a northern Portuguese population.

RESULTS

Of the 65 odontogenic tumors cases, 64 (98.5%) were benign and 1 (1.5%), an ameloblasticcarcinoma, was malignant. Odontoma was the most frequent odontogenic tumor (73.9%), followed by unicysticameloblastoma(7.7%) and calcifying cystic odontogenic tumor (7.7%). Of the 48 odontomas(26 males and 22 females), 34 (70.8%) were compound and 14 (29.2%) were complex. Most odontomas(72.9%) occurred in patients under the age of 30, with a peak incidence in the second decade of life. Twenty-eight (58.3%)odontomas were in the maxilla and 20 (41.7%) in the mandible (P<.05). Twenty-eight (58.3%) of the 48 odontomas were associated with 33 impacted teeth, including 31 permanent teeth, 1 primary tooth, and 1 supernumerary tooth. The maxillary central incisor (n= 6; 19.4%) and the maxillary canine (n= 6; 19.4%) were most commonly associated with odontoma, followed by the mandibular canine (n= 5; 16.0%) and maxillary third molar (n= 4; 12.9%).

CONCLUSION

This study provides clinical and pathological information on odotogenic tumors in a nothern Portuguese population

So-called hybrid central odontogenic fibroma/central giant cell lesion of the jaws. A report on seven additional cases, including an example in a patient with cherubism, and hypotheses on the pathogenesis

BACKGROUND

Central odontogenic fibroma (COF) is characterized by poor to cellular fibroblastic proliferation and a variable odontogenic epithelial (OE) component. Central giant cell lesions (CGCL) are osteolytic fibroblastic proliferations characterized by osteoclast-like multinucleated giant cells (MGC). Rare examples of hybrid COF/CGCL have been described. Two pathogenetic theories prevail based on clinicopathologic characteristics. One regards the CGCL component as reactive to the COF, while the other regards the CGCL as inductive of a COF-like proliferation. The possibility of colliding tumors seems unlikely.

METHODS AND MATERIALS

Seven patients with hCOF/CGCL, among them one with cherubism, were studied. Immunohistochemistry for cytokeratin 19 was applied to better appreciate the epithelial component.

RESULTS

Six patients were males and one female and their age ranged from 15 to 73 years old. All lesions occurred in the premolars and molars of the mandible and presented as radiolucencies with primarily well-delineated borders. All patients underwent surgical excision and recurrences have not been reported to this date in 6 out of 7 patients (mean follow-up 60.6+/-36.25 months). The COF component predominated in 3 cases and the CGCL component in 3. Zones of collagen fibers featuring a whorling pattern and containing multiple nests of OE were present. In four cases there were hyalinized deposits in OE, while some foci of MGC contained few OE.

CONCLUSIONS

Gender predilection in our series is in contrast with previously published reports. However, when all previously reported cases are reviewed there is still female predilection. The predominant site, as previously reported, is the tooth-bearing areas of the posterior mandible. This is the first report of hCOF/CGCL in cherubism. The pathogenesis of hCOF/CGCG remains obscure and molecular interactions would be of interest to be investigated.

International collaborative study on ghost cell odontogenic tumours: calcifying cystic odontogenic tumour, dentinogenic ghost cell tumour and ghost cell odontogenic carcinoma

BACKGROUND

Calcifying odontogenic cyst was described first by Gorlin et al. in 1962; since then several hundreds of cases had been reported. In 1981, Praetorius et al. proposed a widely used classification. Afterwards, several authors proposed different classifications and discussed its neoplastic potential. The 2005 WHO Classification of Odontogenic Tumours re-named this entity as calcifying cystic odontogenic tumour (CCOT) and defined the clinico-pathological features of the ghost cell odontogenic tumours, the CCOT, the dentinogenic ghost cell tumour (DGCT) and the ghost cell odontogenic carcinoma (GCOC).

METHODS

The aim of this paper was to review the clinical-pathological features of 122 CCOT, DGCT and GCOC cases retrieved from the files of the oral pathology laboratories from 14 institutions in Mexico, South Africa, Denmark, the USA, Brazil, Guatemala and Peru. It attempts to clarify and to group the clinico-pathological features of the analysed cases and to propose an objective, comprehensive and useful classification under the 2005 WHO classification guidelines.

RESULTS

CCOT cases were divided into four sub-types: (i) simple cystic; (ii) odontoma associated; (iii) ameloblastomatous proliferating; and (iv) CCOT associated with benign odontogenic tumours other than odontomas. DGCT was separated into a central aggressive DGCT and a peripheral non-aggressive counterpart. For GCOC, three variants were identified. The first reported cases of a recurrent peripheral CCOT and a multiple synchronous, CCOT are included.

CONCLUSIONS

Our results suggest that ghost cell odontogenic tumours comprise a heterogeneous group of neoplasms which need further studies to define more precisely their biological behaviour.

Adenomatoid odontogenic tumors: an analysis of 67 cases in a Thai population

OBJECTIVE

The aim of this study was to determine the biologic profile of the adenomatoid odontogenic tumor (AOT) in a Thai population.

STUDY DESIGN

Sixty-seven cases of AOT registered from January 1974 to May 2006 were studied retrospectively. Age, sex, variants of AOT, site and extent of tumors, associated impacted teeth, initial clinical diagnoses, clinical presentations, and duration of symptoms were analyzed.

RESULTS

All AOT cases were intraosseously located, of which 55.2% were follicular and 44.8% extrafollicular. The 2 variants together were found more frequently in the maxilla than in the mandible, with a ratio of 2:1. Females were affected more often than males, with a ratio of 1.8:1. The peak incidence (56.7%) was found in the second decade of life. The majority of AOT lesions (68.7%) was found in the anterior jaws. Adenomatoid odontogenic tumors were observed more often on the left side of jaws (50.7% vs. 38.8%). Canines were the most common teeth associated with follicular AOT (67.5%), and the maxillary canines alone accounted for 51.3% of all cases. The majority of our patients presented with a painless swelling and with duration of symptoms of 6 months and longer.

CONCLUSIONS

The distribution and characteristics of AOT in a Thai population are similar to the findings found in other populations. Interestingly, in this series we observed a case involving an impacted deciduous canine and a case associated with an impacted maxillary third molar.

Nonendodontic periapical lesions: a retrospective study in Chile

AIM

To determine the frequency with which the histopathological diagnosis of periapical lesions contributes to a change in the clinical diagnosis.

METHODOLOGY

Cases having a clinical diagnosis of disease resulting from dental pulp necrosis were selected from the database of the Oral Pathology Reference Institute between 1975 and 2005. Cases with different histopathological diagnoses were determined and information about age and gender of the patient, location of associated tooth, pulp status and the histopathological diagnosis were recorded. The percentage of nonendodontic periapical lesions was then determined.

RESULTS

In the 30-year period, 32,423 [corrected] biopsy specimens were received. Overall 4006 (9.13%) had a clinical diagnosis of pulpal necrosis with associated pathosis in the periradicular area. Within this group, 26 cases (0.65%) had a histopathological diagnosis of nonendodontic pathology. Keratocystic odontogenic tumour was the most frequent nonendodontic lesion (11 cases) in the periradicular region followed by central giant cell granuloma (three cases), chronic sinusitis (three cases) and one case each of the following lesions: nasopalatine duct cyst, lateral periodontal cyst, calcifying cystic odontogenic tumour, ameloblastic fibroma, squamous odontogenic tumour, cemental dysplasia, haemangioma, foreign body cell granuloma and amalgam tattoo.

CONCLUSIONS

The histopathological study of periapical pathosis can occasionally reveal nonendodontic lesions. Odontogenic tumours made up the largest group.

Central giant cell granuloma associated with central ossifying fibroma of the jaws: a clinicopathologic study

OBJECTIVE

To investigate the prevalence of clinical, radiographic, and histopathologic characteristics of combined central giant cell granuloma (CGCG) and central ossifying fibroma (COF).

STUDY DESIGN

Retrospective clinical and histomorphometric analysis of all cases diagnosed as CGCG or COF between 1994 and 2002.

RESULTS

A total of 51 cases were included in the study: CGCG (n = 23), COF (n = 25), and combined COF-CGCG (n = 3). All 3 lesions presented expansile, well-defined unilocular radiolucencies, with radiopacities (66%), root resorption (66%) and tooth displacement (33%). Microscopically, areas of classical CGCG and COF were separated by a transition zone of nonvascularized densely packed spindle cells. Surgical procedure resulted in recurrence within 1 year in 1 of 2 patients, calcitonin nasal spray treatment resulted in growth arrest in 1 case.

CONCLUSIONS

Because of the small number of the combined cases, the biologic behavior of the lesions is uncertain. The CGCG component may drive the clinical behavior toward a more aggressive behavior than classical COF; therefore, close follow-up is recommended.

[Mixed odontogenic tumors in children and adolescents]

Mixed odontogenic tumors in the jaws of children and adolescents usually cause dentition anomalies. The typical forms of these are ameloblastic fibroma, ameloblastic fibroodontoma, complex odontoma and compound odontoma. In the present study mixed odontogenic tumor cases are presented in patients under 20 years of age. All of them were associated with tooth eruption disturbances. Further aim of this study was to discuss the nature and interrelationships of this group of lesions. Ameloblastic fibromas (AFs) are true, mixed, soft tissue neoplasms, deriving from the proliferation of both odontogenic epithelium and mesenchyma. They have a potential to both recurrence and malignant transformation. Ameloblastic fibroodontomas (AFOs) may be regarded as hamartomas, which exhibit epithelial, mesenchymal and abundant hard tissue components of the developing teeth. Odontomas are calcifying benign hamartomas, and represent the most common type of odontogenic jaw tumors among patients less than 20y, having complex and compound variants. Complex odontomas (CXOs) are built up from amorphous hard tissue elements, and generally occur in the premolar or molar regions of the maxilla. Compound odontomas (CDOs) usually appear in the maxilla, in the region of the incisors and canines, and contain small, radio-opaque structures reminiscent of rudimentary teeth. Early diagnosis and treatment of mixed odontogenic jaw tumors in children may prevent the serious orthodontic complications and jaw deformations.

Loss of nuclear expression of parafibromin distinguishes parathyroid carcinomas and hyperparathyroidism-jaw tumor (HPT-JT) syndrome-related adenomas from sporadic parathyroid adenomas and hyperplasias

Parathyroid carcinoma is notoriously difficult to diagnose with confidence in borderline cases. Commonly there is a long lag time between diagnosis and clinical evidence of malignant behavior even in histopathologically straightforward lesions. There is therefore a need for a novel adjunctive marker to assist in the diagnosis of carcinoma. Parafibromin is the protein encoded by the putative tumor suppressor gene HRPT2. Mutations predicted to inactivate parafibromin were first detected in the germline of patients with hyperparathyroidism-jaw tumor (HPT-JT) syndrome. Subsequently, somatic mutations have been identified in the majority of sporadic carcinomas. We performed immunohistochemistry for parafibromin on 115 parathyroid tissues comprising 4 HPT-JT-related tumors (3 adenomas and 1 carcinoma), 11 sporadic parathyroid carcinomas, 79 sporadic adenomas, 3 multiple endocrine neoplasia 2A-related adenomas, 2 sporadic primary hyperplasias, 2 multiple endocrine neoplasia (MEN)-1-related hyperplasias, 6 secondary hyperplasias, 4 tertiary hyperplasias, and 4 normal parathyroid glands. There was complete absence of nuclear staining in 3 of 4 (75%) HPT-JT-related tumors and 8 of 11 (73%) sporadic parathyroid carcinomas and focal weak staining in 1 of 4 HPT-JT tumors and 2 of 11 sporadic parathyroid carcinomas. Only 1 parathyroid carcinoma exhibited diffuse strong nuclear expression of parafibromin. In contrast, 98 of 100 non-HPT-JT-related benign parathyroids showed diffuse strong nuclear positivity and 2 of 100 showed weak positive staining. We conclude that, in the correct clinical and pathologic context, complete absence of nuclear staining for parafibromin is diagnostic of parathyroid carcinoma or an HPT-JT-related tumor.

Compound odontoma causing airway obstruction of the newborn: a case report

A newborn presented with acute airway obstruction secondary to a compound odontoma of the hard palate/nasal floor. This is the first case recorded in the literature. We review the pathology of compound odontomas and discuss the management of this rare and interesting case.

Cytologic aspect of brown tumor of hyperparathyroidism. Report of a case affecting the hard palate

The cytologic and histologic findings of one brown tumor (BT) of hyperparathyroidism located in the hard palate, at first misdiagnosed as peripheral giant-cell granuloma, are described. Poor communication between cytopathologist and ear nose and throat specialist was responsible for the error. The overriding cytologic finding was the presence of numerous multinucleated giant cells (MGCs) of the osteoclastic type. MGC-rich aspirates pose the same diagnostic dilemmas as those of histologic sections of MGC-containing lesions of bone: these cells are not diagnostic by themselves and can be seen in several benign and malignant conditions. Clinical history, X-ray films and biochemical findings, particularly serum parathormone levels, are essential to diagnose a BT and to rule out other MGC-rich bone lesions.

Calcifying odontogenic cyst: Radiologic findings in 11 cases

OBJECTIVE

This retrospective study examines the relationship between histopathologically diagnosed cases of in calcifying odontogenic cysts (COCs) on the adjacent dentition.

STUDY DESIGN

The records including diagnostic radiograph images of 11 patients treated for COCs from 1991 to 2004 were analyzed and correlations made between radiologic and histopathologic features. Special attention was applied to the associations between COCs and adjacent teeth.

RESULTS

Radiologic and histopathologic features of the 11 lesions were variable, with some lesions being more solid and others more cystic. Calcifications varied from small flecks to solid calcified areas of frank odontoma. In 7 cases, the COC was associated with an impacted tooth and 5 of these cases involved COC-enveloping teeth. All cases excepting one in an edentulous jaw segment showed positional changes of adjacent teeth, including impaction.

CONCLUSIONS

The radiographical features of COCs are varied but there is a high frequency of changes in adjacent teeth, including dental impaction. The presence of impaction or displacement of teeth for COCs occurring in the posterior segments of the jaw, and absence of this finding for anteriorly placed lesions may be indicative of the timing of COC development.

Impaired tooth eruption: a review

Eruption is the continuous process of movement of a tooth from its developmental location inside the jaw to its functional location in the mouth. Impaired tooth eruption, where this process is disturbed, is common in dental practice. It may manifest either as delayed or complete absence of eruption. Although unerupted teeth are usually asymptomatic, they may cause cosmetic and pathologic complications. The purpose of this article is to provide a review on the pathogenesis and differential radiographic interpretation of impaired tooth eruption.

[Large ossifying fibroma of the jaws and hyperparathyroidism in a chronic hemodialyzed patient]

OBJECTIVE

Describe the exceptional and fortuitous character of the association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient.

CASE REPORT

A twenty-year-old man who had undergone dialysis for ten years as the result of an indeterminate nephropathy was admitted for a functional disability in the standing position and a serious dysmorphic syndrome with swelling of the jaws that hindered proper closure of the mouth.

RESULTS

Medical imagery revealed a polyostotic attack pleading in favor of renal osteodystrophy or a fibrous dysplasia. The surgical reduction of the tumor of the jaws shown, from the histological viewpoint, a large aggressive ossifying fibroma of the jaws.

CONCLUSION

The association of ossifying fibroma and hyperparathyroidism in a chronic hemodialyzed patient is exceptional and fortuitous. The difficult treatment points out the need for early rigorous prevention of hyperparathyroidism in a chronic hemodialyzed patient.

Calcifications in Untreated Burkitt’s Lymphoma of the Upper Jaw

BACKGROUND

Dystrophic calcifications are uncommon in lymphomas. They may occur after chemotherapy or radiotherapy, whereas calcifications in untreated non- Hodgkin's lymphomas are rarely reported in the literature.

CASE REPORT

We report the case of a 9-year-old boy who developed tumefaction of the right upper jaw. CT examination revealed a neoplastic lesion in the right upper jaw sinus with destruction of the maxilla and subcutaneous fat infiltration. Furthermore the tumor showed accentuated central calcifications. Histological examination revealed endemic type of Burkitt's lymphoma of the paranasal sinus.

CONCLUSION

Our experience showed that calcification can rarely occur also in untreated Burkitt's lymphoma.

HRPT2, a tumor suppressor gene for hyperparathyroidism-jaw tumor syndrome

Hyperparathyroidism-jaw tumor (HPT-JT) syndrome is a familial multi-tumor syndrome resulting from inactivating mutations in the HRPT2 tumor suppressor gene, which encodes a protein product named parafibromin. Here, we will review recent advances in genetic and protein studies on parafibromin, and examine its biological functions.

Familial gigantiform cementoma with brittle bone disease, pathologic fractures, and osteosarcoma: a possible explanation of an ancient mystery

We describe four individuals of an African-American family with a predominantly diaphyseal bone disease associated with familial gigantiform cementoma (FGC), a disorder typically seen in Caucasians. The mother and her children presented with deformities of the jaws, abnormalities of the long bones, and pre-pubertal pathologic fractures. The index patient carried the diagnosis of osteosarcoma (OS). In addition, we provide a possible explanation for the jaw abnormalities of King Tutankhamen's father in the 18th dynasty in Egypt around 1350 BC.

Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case

Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

Desmoplastic fibroma-like tumor of maxillofacial region associated with tuberous sclerosis

Desmoplastic fibroma is a rare primary tumor of bone that histologically and biologically mimics the extra-abdominal desmoid tumor of soft tissue. It usually presents in patients during the first three decades of life and often involves the mandible or long bones of the skeleton. Its clinical behavior is characterized by a locally aggressive, infiltrating, and destructing course, often with invasion of surrounding tissues but without metastasis. We present herein the clinicopathological features of a desmoplastic fibroma-like tumor involving the left maxillofacial region in a 14-year-old Hispanic boy with tuberous sclerosis.

Odontoma: a clinicopathologic study of 81 cases

BACKGROUND AND PURPOSE

Odontoma is the most common odontogenic tumor. It includes 2 types, the compound and complex odontomas. There has not been a series study of the clinical and histologic features of odontomas from Taiwan. This study evaluated the clinicopathologic features of odontoma in Taiwanese.

METHODS

Cases of odontoma treated from 1998 to 2002 identified from medical records were included. The microscopic features, radiographic features, and clinical history of the patients were reviewed and analyzed.

RESULTS

A total of 81 odontomas in 81 patients (36 males and 45 females) were included. There were 62 compound and 19 complex odontomas. The mean age of the patients was 18 years with the majority of odontomas occurring in the first (32%) and second decade (38%) of life. Odontomas had a marked predilection for the maxilla (70%) and for the anterior region of the jaw (83%), particularly for the anterior maxilla (62%). Sixty four (79%) of the 81 odontomas were associated with 80 impacted teeth, including 71 permanent teeth, 2 deciduous teeth, and 7 supernumerary teeth. Of the 71 impacted permanent teeth, the maxillary central incisor (27%) was most commonly affected, followed by the maxillary canine (26%) and mandibular canine (24%). Histologic examination revealed enamel matrix in 90%, dentin in 100%, cementum in 88%, pulp tissue in 96%, fibrous capsule in 93%, ghost cells in 83%, reduced enamel epithelium in 86%, and nests of odontogenic epithelium in 58% of odontomas. Dentigerous cyst was associated with 9% of odontomas.

CONCLUSIONS

In this series, odontomas occurred most often in the first and second decade of life. Although complex odontomas are usually found in the posterior jaw, in this Taiwanese series they were most commonly found in the anterior maxilla. Odontoma is frequently associated with an impacted tooth and occasionally with a dentigerous cyst. No recurrence of odontomas was found after surgical excision with follow-up of 1 to 15 years.

[Serious jaw osteolytic lesions]

Among oral and maxillofacial diseases, the maxillary osteolytic lesions constitute a rich and investigated field to define the more appropriate diagnosis and treatment. In the maxillary region, the same tumors of the other bones (osteogenic sarcoma, chondroma, etc.) cause found together with tumors and dysembryoplasias connected with the teeth development (ameloblastoma, odontoma, odontogenic myxoma, etc.). Moreover in the medullary spaces of the bones, there are reticular and hematopoietic cells that are connected with different diseases (leucemia, myeloma, lymphoma, etc.). What's more, due to the possible presence of pseudotumors (fibrous dysplasia, giant cell tumor, etc.) and metastases of tumors of other regions (breast, lung, prostate gland, etc.), the diagnosis of this disease could be difficult. In this paper the more important pictures of this disease, that due to its recurrence or malignity needs an accurate diagnosis by imaging like CT, CT-3D, MR, etc, are analyzed. The more suitable surgical approach is presented, according to the forms of the disease.

A case of multiple AOT-like jawbone lesions in a young patient--a new odontogenic entity?

We assessed the immunohistochemical profile of an unusual case of multiple similarly looking tumors in the jawbone of a young patient. Histologically, the tumors exhibited features of adenomatoid odontogenic tumor (AOT) and adenomatoid dentinoma but showed no resemblance to any other defined odontogenic tumor entities. They expressed high amounts of cytokeratin (CK) 8 and 14 together with some Vimentin. A small rim of peripheral cells showed CK 5, 17, and 19 reactivity. Also, these lesions expressed some bcl-2 as well as p53 and Ki67. Histologically and immunohistochemically, the unusual multiple lesions differed in details from a simultaneously examined group of 24 classical AOT cases, suggesting that they may represent a hitherto less well-defined odontogenic tumor entity.

Hyperparathyroidism in hereditary syndromes: special expressions and special managements

Hyperparathyroidism (HPT) in its hereditary variants assumes special forms, has special associations, and requires special managements. Familial hypocalciuric hypercalcemia (FHH or FBHH) and neonatal severe primary hyperparathyroidism (NSHPT) reflect heterozygous or homozygous mutations, respectively, in the calcium-sensing receptor. FHH and NSHPT represent the mildest and severest variants of HPT. Both cause hypercalcemia from birth and atypical HPT that always and uniquely persists after subtotal parathyroidectomy. Their HPT is likely polyclonal and nonneoplastic. In contrast, mono- or oligo-clonal parathyroid neoplasia underlays most other HPT variants: multiple endocrine neoplasia type 1 (MEN1), multiple endocrine neoplasia type 2A (MEN2A), and hyperparathyroidism-jaw tumor syndrome (HPT-JT). Familial-isolated HPT combines several diagnoses, including occult forms of the above syndromes. Each neoplastic variant has tumors in multiple parathyroids and a delayed, but still early age of onset for HPT (average age, 25-35 years). Each justifies special and similar approaches to parathyroidectomy: typically, identification of four glands, subtotal parathyroidectomy, rapid intraoperative parathyroid hormone (PTH) assays, and parathyroid cryopreservation. Outcomes of parathyroidectomy remain suboptimal in each. Each syndrome of parathyroid neoplasia associates with characteristic cancer(s): enteropancreatic neuroendocrine or foregut carcinoid tissues (MEN1), thyroidal C cells (MEN2A), or parathyroid (HPT-JT). HPT has promoted gene discovery more through its rare hereditary variants than through common adenoma; the main genes causing four of six hereditary variants are known. The RET mutation test became essential in management of MEN2A. The MEN1 test is less urgent, because it rarely guides a major patient benefit. The CASR test, perhaps least urgent, has largely been unavailable. Further progress in molecular genetics will enhance understandings, diagnosis, and therapy of HPT.

Pathologically significant pericoronal lesions in adults: Histopathologic evaluation

PURPOSE

Oral and maxillofacial surgeons devote a large portion of their practice to the removal of impacted teeth. Many of these teeth have associated soft tissue that is submitted along with or without the tooth for histopathologic examination. This study reports the histopathologic diagnoses of a large series of pericoronal lesions in adults submitted to an oral and maxillofacial pathology biopsy service.

MATERIALS AND METHODS

Two thousand six hundred forty-six pericoronal lesions received during a 6-year period were reviewed for location, age, and histopathologic diagnosis.

RESULTS

Retrospective evaluation showed that 67.1% of all submissions were nonpathologic follicular tissue. Pathologically significant lesions were diagnosed in 32.9% of cases. Among these lesions were 673 dentigerous cysts (28.4%), 79 dentigerous cysts with mucous cell prosoplasia, 71 odontogenic keratocysts (2.68%), 19 odontomas (0.7%), 13 ameloblastomas (0.5%), 6 carcinomas (0.23%), 6 calcifying odontogenic cysts (0.23%), 4 calcifying epithelial odontogenic tumors, and 1 odontogenic myxoma (0.04%). When stratified by age, the data showed pathologically significant lesions and age are related (chi(2), P <.0001).

CONCLUSIONS

Because of selection bias inherent in a study of this nature, population generalizations cannot be made. However, this study serves to show that the potential for the development of significant, even life-threatening, disease associated with impacted teeth is real and should be a factor in the decision-making process when oral surgeons and others are confronted with the dilemma of managing an impacted tooth.

Concomitant focal fibrocartilaginous dysplasia of the tibia and eosinophilic granuloma of the jaw in a child

This 2-year-old child presented with concomitant eosinophilic granuloma of the lower jaw and focal fibrocartilaginous dysplasia of the right tibia. Her eosinophilic granuloma was diagnosed on the basis of the clinical picture, imaging studies and the characteristic histologic appearance. Focal fibrocartilaginous dysplasia was revealed incidentally during the eosinophilic granuloma staging process. After chemotherapy, all signs of eosinophilic granuloma subsided, but focal fibrocartilaginous dysplasia remained without signs of clinical or radiographic progression. The importance of differentiating these two conditions is stressed in order to avoid ineffective and inappropriate treatment of focal fibrocartilaginous dysplasia.

[Nutritional status assessment of patients with oral maxillofacial cancers]

OBJECTIVE

The objective of the study is to evaluate the nutritional status of patients with oral maxillofacial cancer.

METHODS

The nutritional status was evaluated using seven easily determined variables and multi-factor nutritional index in 50 hospitalized patients with oral maxillofacial cancer from 1990 to 1992.

RESULTS

Fifty-six percent of patients had protein-energy malnutrition. The high incidence of protein-energy malnutrition was found in those patients without adequate dietary intake.

CONCLUSION

Patients with oral maxillofacial cancer usually have protein-energy malnutrition. The reason is that the patients always have an inadequate dietary intake.

Combined benign odontogenic tumors: CT and MR findings and histomorphologic evaluation

SUMMARY

Calcifying epithelial odontogenic tumors and calcifying odontogenic cysts are rare, benign odontogenic tumors. We report two cases of an exceptional combination of these tumors with either an ameloblastic fibroodontoma or an odontoma.