Plasmablastic lymphoma exclusively involving bones mimicking osteosarcoma in an immunocompetent patient: A case report

BACKGROUND

It has been known that plasmablastic lymphoma (PBL) is a neoplasm of immunocompromised patients occurring in soft tissue of oral cavity or in the vicinity whereas bone is an unlikely site to harbor PBL. However, its occurrence is increasingly being reported in immunocompetent individuals in either osseous or extra-oral sites. To our best knowledge, F-18 FDG PET/CT findings of PBL involving bones in an immunocompetent patient have not been reported, yet .

CASE SUMMARY

We report a case of PBL involving multiple bones in an immunocompetent patient. Features of different imaging modalities including F-18 Fluoro-deoxy glucose (FDG) positron emission tomography/computed tomography (PET/CT) were correlated well as findings of osteosarcoma in mandible with metastatic lesions. However, the histopathology and immunohistochemistry (IHC) of bone tissues from 2 separate biopsy sites revealed features of PBL.

CONCLUSION

awareness to F-18 FDG PET/CT findings of PBL involving bones in an immunocompetent patient may prevent misdiagnosis.

Combined treatment of odontogenic keratocysts: initial marsupialization and successive enucleation with peripheral ostectomy plus Carnoy's solution application. A five-year follow-up experience

AIM

The odontogenic keratocyst (KCOT) is a locally aggressive, cystic jaw lesion with a high growth potential and a propensity for recurrence. Considering its neoplastic features, treatments of keratocysts are required and they are generally classified as conservative or aggressive. However, although in literature there are several studies, the choice of treatment strategies remains controversial. We report a two-stage protocol based on initial marsupialization and successive enucleation.

METHODS

Three cases of large KCOTs have been treated by initial marsupialization and, after a mean period of six months, successive enucleation with peripheral ostectomy and application of Carnoy's solution was performed.

RESULTS

All patients were instructed in daily irrigation using chlorhexidine 0.2% during the period of marsupialization. After enucleation, good healing was obtained in all cases and from two up to five years of follow-up, there is no evidence of recurrence.

CONCLUSION

Two-stage surgical treatment protocol of keratocyst leads to complete healing, preservation of important anatomical structures and absence of recurrence.

[Oral metastasis of a renal cell carcinoma. A case report concerning the first manifestation of a renal cell carcinoma as bone metastasis in the mandible]

Tumorous lesions of the oral cavity are mostly of dental or local pathological origin. On occasion, they may have a distant origin outside the field of dentistry. Under certain circumstances, this can lead to serious consequences. Renal cell carcinomas are known for their frequent metastasis to the lungs, liver, bones, and brain. Metastases to the oral cavity are rare.

CASE REPORT

A 68-year-old woman with previously unknown renal cell carcinoma is presented. By biopsy of a suspicious lesion, an intraoral clear cell carcinoma was diagnosed. In the following tumor staging, a metastasizing clear cell renal cell carcinoma was identified as the focus and a systemic therapy was initiated.

SUMMARY

This case report exemplarily shows the importance of timely histological verification of each new intraoral lesion. Under certain circumstances, a diagnosis of a surprising and potentially life-threatening condition may be made in time to initiate adequate treatment.

Antitumor effect of novel HSP90 inhibitor NVP-AUY922 against oral squamous cell carcinoma

Heat-shock protein 90 (HSP90) is a major cellular chaperone protein. HSP90 supports the correct conformation, stabilization, activation, and localization of 'client' oncoproteins, many of which are involved in tumor progression. Therefore, the use of HSP90 inhibitors has become a new strategy in antitumor therapy. However, the effects of an HSP90 inhibitor on oral squamous cell carcinoma are still unclear. NVP-AUY922 (Novartis) is a novel 4,5-diaryloxazole adenosine triphosphate-binding site HSP90 inhibitor. In this study, we investigated the antitumor effect of novel HSP90 inhibitor NVP-AUY922 against oral squamous cell carcinoma. NVP-AUY922 inhibited the proliferation of oral squamous cell carcinoma cells in vitro. NVP-AUY922 caused degradation of client protein inducing ErbB2, p-Akt, p-S6, hypoxia-inducible factor 1-α (HIF1-α) and vascular endothelial growth factor (VEGF) and up-regulation of HSP70 in HSC-2 oral squamous cell carcinoma. NVP-AUY922 increased the expression of cleaved caspase-3 and induced apoptosis in HSC-2 cells. Treatment of NVP-AUY922 induced a robust antitumor response and suppressed p-Akt and VEGF expression in an HSC-2 xenograft model. In summary, NVP-AUY922 exhibits in vitro and in vivo efficiency against oral squamous cell carcinoma, representing a promising therapeutic approach for oral squamous cell carcinoma.

[Non-Hodgkin lymphoma of the mandible--a case report with differential diagnostic considerations]

Approximately 5% of all malignant lesions are diagnosed as malignant lymphomas, of which 2-3% are localized in the head and neck region. After the squamous cell carcinoma and neoplasms of the salivary glands, malignant lymphomas represent the third most frequent malignant lesion in that region. Malignant lymphomas can be grouped into Hodgkin- and non- Hodgkin lymphomas (NHL) and subdivided into nodal (lymph nodes) and extranodal lymphomas. We present the case of an extranodal non-Hodgkin lymphoma in the left mandible of a 47-year-old woman, who was referred to our department with an unclear swelling, which was supposed to be infectious. After clinical and radiological examination, a biopsy was taken and a CD20 and BCL-6 protein positive non-Hodgkin lymphoma of the large B-cell type (DLBCL) was diagnosed. The patient was treated primarily with immunochemotherapy (R-CHOP protocol) and refused to undergo a subsequent radiotherapy. The 18 months follow-up showed a complete remission of the lymphoma. In this paper, the NHL in the oral and maxillofacial region is presented as a cause of unclear swelling. Important differential diagnostic conditions are discussed.

Primary diffuse large B-cell lymphoma of the mandible. A case report

Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma and is characterized by the appearance of rapidly developing tumor lesions in the lymph nodes, spleen, liver, bone marrow or other organs. Primary extranodal presentations of this entity in bone are rare (5% of all extranodal lymphomas) and their initial manifestation is usually in the form of a single bone lesion. This paper addresses a case of a 62-year-old male diagnosed with diffuse large B-cell lymphoma in the mandible. The patient had left mandibular swelling with intermittent paresthesia of the left lower lip and chin, without apparent neck adenopathies. No other locations were identified in the several exams performed, and the final diagnosis was an asymptomatic diffuse extranodal large B-cell lymphoma (IE-A) in the body of the left mandible. Four cycles of chemotherapy were given according to the R-CHOP protocol (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) plus external radiotherapy targeted to the involved site, resulting in complete remission of the tumor. Such lesions are fairly uncommon in daily clinical practice. However, considering their severity and the importance of an early diagnosis, such conditions should be included in the differential diagnosis of bone lesions in the orofacial region.

[Combination chemotherapy of S-1, docetaxel and CDDP produces a remarkable response in a patient with metastases of supraclavicular lymph nodes and gingival carcinoma of the mandible]

We report a 53-year-old female patient with an unresectable metastasis to the supraclavicular lymph node from a primary gingival carcinoma of the mandible. The patient had a history of tongue carcinoma and had undergone a radical neck dissection for the treatment of gingival carcinoma. She underwent combined chemotherapy consisting of S-1 (80 mg on days 1-14, followed by a 7-day rest), docetaxel (35mg/m2 by intravenous infusion on days 1 and 8), and CDDP (10mg/m2 by intravenous infusion on days 1 and 8) every 3 weeks. After three courses of the above chemotherapy regimen, a computerized tomography examination revealed a complete response. The patient did not experience any severe side effects during the course of chemotherapy. Combined S-1, docetaxel, and CDDP chemotherapy can thus be effective for unresectable recurrences of oral cancer in lymph nodes.

Burkitt's lymphoma in a young Brazilian boy

Burkitt's lymphoma is not an uncommon malignancy in the paediatric population. It is a high-grade non-Hodgkin B-cell lymphoma which may present as endemic, sporadic and human immunodeficiency-associated subtypes. The African, or endemic, variant usually involves the maxilla and other facial bones while head and neck manifestations in sporadic Burkitt's lymphoma are rare. We described a case of oral Burkitt's lymphoma involving the right jaw in a 4-year-old boy. The patient presented with a rapidly-enlarging swelling of one month duration, toothache-like pain and radiographical appearance of 'floating teeth' in the right mandible. Incisional biopsy revealed small round tumour cells with scarce cytoplasm and multiple small nuclei interspersed by phagocytic macrophages. The tumour cells were immunopositivity for CD20 and CD10, expressed weak positivity for CD3, negative for CD5 and showed > 90% positivity for Ki-67. Tumour remission was achieved with six cycles of chemotherapy with the CHOP regime.

Desmoplastic small round cell tumor of the mandible in a child with unusual plantar metastasis

Desmoplastic small round-cell tumor (DSRCT) is a rare and aggressive tumor that usually affects young males. Abdominal or pelvic disease is generally present in patients with DSRCT. Despite multimodality treatment, it still remains highly aggressive and has poor prognosis. We report a 16-year-old male with DSRCT in the mandible, an unusual site of the disease, treated with chemo-radiotherapy but recurred in an unexpected site 5 months after the completion of treatment.

Diffuse large B-cell lymphoma of mandible: a case report

Non-Hodgkin's lymphomas are a group of neoplasms that originate from the cells of the lymphoreticular system. Forty percent of non-Hodgkin's lymphomas arise from extra nodal sites. Non-Hodgkin's lymphomas detected primarily in the bone are quite rare, but among jaw lesions, they are more frequently present in the maxilla than in the mandible. There are no classical characteristic clinical features of lymphomas involving the jaw bones. Swelling, ulcer or discomfort may be present in the region of the lymphoma, or it may mimic a periapical pathology or a benign condition. Though non-Hodgkin's lymphomas have been reported in all age groups, they generally affect the elderly, particularly males. Primary non-Hodgkin's lymphomas of the bone can be effectively managed by chemotherapy, with or without radiotherapy. We report a case of a large B-cell lymphoma of the mandible, in which the patient presented with a diffuse swelling on the right body of the mandible. A subsequent biopsy and immunohistochemistry were instrumental in this diagnosis. After finding no metastasis to other sites, the patient was treated with chemotherapy. The swelling regressed completely following the chemotherapy regimen, with no sign of recurrence observed over the last eighteen months.

Primary Diffuse Large Cell Lymphoma of the Mandible

Primary diffuse large cell lymphoma of the mandible is a rare form of extranodal non-Hodgkin's lymphoma (NHL). Herein we present 4 cases treated at our institution over a 5-year period and review 40 cases previously reported in the English-literature. The median age at presentation is 51 years with equal distribution between males and females. At presentation the lymphoma is usually limited to the jaw (stage IE) and the most common presenting symptoms include swelling of the jaw (58%), pain (53%), and mental dysesthesia or numbness (20%). Despite symptoms of numb chin syndrome, central nervous system (CNS) involvement at presentation has not been reported. The reported therapy of this rare diffuse large cell lymphoma presentation is very heterogeneous, however majority of patients were treated with combination of chemotherapy and radiotherapy with estimated 5-year overall survival of only 60%. Multi-center prospective clinical trials are needed to determine the optimal therapeutic approach to this rare diffuse large cell lymphoma presentation.

Central giant cell lesion of mandible managed by intralesional triamcinolone injections. A report of two cases and literature review

Central giant cell lesion (CGCL) is a benign lesion which has unpredictable biologic behaviour and is amenable to a plethora of treatment alternatives. We describe our experience in managing this lesion by intralesional triamcinolone. The mainstay of treatment of CGCL in our centre until now has been surgical curettage or resection. We chose two patients for this pilot endeavour at our hands. Case I is a 10 year old girl having CGCL of left side mandible. Case II is a 20 yr old man with CGCL affecting the left side posterior mandible. Both patients responded well to intralesional administration of triamcinolone acetonide (Kenacort-10) with no obvious recurrences to date. Successful application of this conservative drug therapy for managing CGCL can not only save the patient from a mutilating procedure but also has significant financial implications. The amount of triamcinolone injected ranged from 85 mg to 180 mg by 5-6 injections at weekly intervals.

Treatment of submandibular fibromatosis with chemotherapy and surgery. A case report

Fibromatoses are a broad group of fibrous tissue proliferation that arise from the musculoaponeurotic structures. Because of the locally aggressive behaviour and the high recurrence rate of these tumors, various treatment options are suggested but there is still no optimal therapy for these diseases. This paper describes a case of infantile fibromatosis of the submandibular region, which was successfully treated with an interdisciplinary approach using chemotherapy and surgery. A three-year-old girl with a growing submandibular mass over a period of six months is described. The tumor was clinically aggressive, causing bone erosion and invading adjacent soft tissue structures. The diagnosis of infantile fibromatosis was established on histological and immunohistochemical findings. With a combined treatment based on ''low-dose'' chemotherapy including vinblastine and methotrexate and surgery; complete remission was achieved in 30 months. Management of head and neck fibromatoses in child-hood needs a specific approach. Combined treatment by chemotherapy and nonmutilating surgery seems to offer the best potential for cure.

Adjuvant Antiangiogenic Therapy for Giant Cell Tumors of the Jaws

PURPOSE

To further evaluate a novel treatment protocol for the management of aggressive giant cell lesions (GCLs) consisting of enucleation followed by adjuvant subcutaneous interferon alpha therapy.

PATIENTS AND METHODS

Using a retrospective case series study design, a sample of patients with aggressive GCLs was enrolled between April 1995 and June 2006. Lesions were enucleated with preservation of vital structures. Postoperatively, the patients received daily subcutaneous interferon alpha (3 million units/m2 of body surface area). Interferon treatment continued with regular clinical and radiographic follow-up until the surgical defects filled in with bone, as demonstrated by panoramic radiographs and confirmed by computed tomography. Side effects, such as fever, fatigue, weight loss, decreased white blood cell count, decreased platelet count and elevated liver enzymes, were monitored. After completion of interferon therapy, patients followed for 2 years without evidence of recurrence were considered cured of disease.

RESULTS

The study sample was comprised of 26 subjects (65% female) with a mean age of 18.5 years. At the time of this writing, 16 of the subjects have completed the protocol and are cured of disease, 6 are in remission, and 4 are in active treatment. Four subjects experienced significant side effects from the interferon, requiring modification of treatment.

CONCLUSIONS

Enucleation of aggressive GCLs with preservation of vital structures and adjuvant interferon is an excellent strategy for managing aggressive GCLs. Approximately 15% of subjects developed significant side effects limiting interferon administration and necessitating alternative therapies.

Rare oral cavity presentation of a B-cell lymphoblastic lymphoma. A case report and review of the literature

Lymphoblastic lymphoma is an uncommon malignancy, with most cases showing a T-cell phenotype and presenting as a mediastinal mass. By contrast, B-cell lymphoblastic lymphoma/leukemia is a rare high-grade malignancy that comprises approximately 10% of all lymphoblastic lymphomas. Lymphomas of the oral cavity are rare and typically present as intraosseous lesions that are most commonly diffuse large B-cell type. Here we present what we believe is the first B-cell lymphoblastic lymphoma initially presenting in the oral cavity. The case involves a 46-year-old white woman who presented with a mass in the right mandible. This report discusses this rare malignancy, including clinical presentation, histopathologic features, immunologic profile, treatment, and prognosis. This case emphasizes the importance of recognizing rare entities that may present in the oral cavity and the impact of the disease and its management.

Male breast cancer with mandibular metastasis. A case report

Female breast cancer is one of the major causes of death among women while male breast cancer is relatively uncommon and accounts for about 1% of all breast cancers in both sexes. Influencing factors are: gynecomasty, familiarity for male breast cancer, Jewish and African-American male population. From the histological point of view, it is not different from the female breast cancer, except for the infiltrant ductal carcinoma, but with a much severe prognosis. Breast cancer metastases to the jaws are rare, only 1%; the most common sites of metastases are: lungs(59-69%), liver (58-65%), bone (44-71%), pleura (23-37%), brain (9-22%) and kidney (4-17%). At present, based on a literature research (May 2006), there have been just two other case reports of male breast cancer metastasis to the maxillofacial region, both to the mandible. The case of a 69-year-old white man who in 2001 underwent a radical mastectomy due to ductal breast cancer is reported. In 2005 the patient was referred to our department by his oncologist for multiple oral fistula. A mandibular TC revealed osteolytic lesions and the patient underwent mandibular surgery to remove the lesions and clean up the area. The histological examination was consistent with that of a metastatic deposit of adenocarcinoma of the breast. In June 2006 the patient died due to worsening of the general clinical conditions, in particular due to ascites and hepatic insufficiency.

Successful treatment of mandibular squamous cell carcinoma in a Malayan sun bear (Helarctos malayanus)

An adult, female Malayan sun bear (Helarctos malayanus) was diagnosed with squamous cell carcinoma of the rostral mandible. Initial treatment included bilateral mandibulectomy rostral to the lingual frenulum followed by intra- and perilesional cisplatin injections. Recovery after the procedure was uneventful and the Malayan sun bear adapted well to a shortened mandible. Histopathology indicated incomplete surgical excision of the tumor; therefore, radiation therapy was instituted weekly for four treatments at 2 Gy in parallel opposed fields (total 4 Gy each treatment) with one additional cisplatin treatment. Two years after initial presentation, the animal showed no recurrence of neoplasia.

Analysis of complications after reconstruction of bone defects involving complete mandibular resection using finite element modelling

BACKGROUND

In a retrospective study, risk factors for complications after the bridging of mandibular defects using reconstruction plates were reviewed. Especially the loosening of the plate-screw-mandible complex should be analyzed with a finite element model in order to reduce plate complications in future.

PATIENTS AND METHODS

We examined 60 patients who underwent a treatment with reconstruction plates after tumor resection during a period of 10 years. The problem of screw loosening was additionally reviewed by means of a finite element study, and a model for the loosening process was developed.

RESULTS

Our postoperative examination showed that 26 patients suffered from complications that required an early removal of the plate. These complications were oral or extraoral plate exposures, the looseness of screws with or without plate displacement, and plate fractures. Thereby, we noticed that maxillary and mandibular areas of opposing teeth, the size of the mandible defect, and the crossing of the orofacial midline are all risk factors for plate complications. On the basis of the finite element model, a modified arrangement of the screws was derived. Hence, a new type of resection plate was established.

CONCLUSIONS

By repositioning the screw holes along the long axis of the plate, the transition from tensile force to torque force of the screws in the screw-plate-bone complex can be minimized. Thereby, the complication of screw loosening will be considerably reduced.

[Mandibular chloroma]

CASE REPORT

A 23 year-old girl was admitted for a facial tumefaction, fixed to the mandible. The X-rays showed a fuzzy osteolytic lesion of the mandibular angle. The CT-scan confirmed the rupture of the cortical bone and the extension to the soft tissue. Biopsy provided the diagnosis of granulocytic monoblastic sarcoma (chloroma). Chemotherapy was efficient.

DISCUSSION

Mandibular localizations of chloroma are rare. Granulocytic monoblastic sarcoma is a localized tumor made of extramedullar immature granulocytes, in general associated (or more rarely preceded by) with leukemia. Early diagnosis is important because high dose chemotherapy induction may completely cure leukemia.

Imaging findings of Ewing's sarcoma in the mandible

First described by James Ewing in 1921, Ewing's sarcoma (ES) or Ewing's tumor is one of the most aggressive bone tumors known. ES is an uncommon intra-osseous malignant tumor of questionable pathogenesis that occurs in children and young adults. Reports indicate that only 2 to 7% of cases involve the maxillofacial region, usually the mandible ramus, and few reported cases have involved the maxilla. In the present report of a case of ES of the mandible, we describe the results of imaging and evaluation after therapeutic treatment. This report provides a rare opportunity to observe radiologic features of ES in the mandible.

Chondrosarcoma involving the periodontum: clinicopathological and immunohistochemical features of a case study

Chondrosarcoma is a rare flat bone neoplasm. Herein, we present the clinicopathological and immunohistochemical findings of a case affecting the periodontum. A 16-year-old girl presented a painless reddish mass in the lower anterior gingiva. Radiographs showed bone affected by vertical and horizontal loss and enlargement of periodontal space. The histopathological features showed atypical cartilage arranged in lobules compatible with chondrosarcoma. Immunohistochemistry showed that tumor cells were immunoreactive for the anti-vimentin and S-100 antibodies. Moreover, no tumor cells had been immunostained by anti-p53. Treatment consisted of chemotherapy, followed by radical surgery and postsurgery treatment with an association of radio and chemotherapy. After one year, no signs of recurrence have been observed.

Malignant calcifying epithelial odontogenic tumor of the mandible: report of a case with pulmonary metastasis showing remarkable response to platinum derivatives

We describe a case of CEOT of the mandible, which underwent malignant transformation and developed metastatic tumors of the lung after repeated local recurrence. The primary tumor revealed typical histological features of benign CEOT showing sheets of polyhedral epithelial cells associated with abundant eosinophilic amyloid-like materials. On the other hand, the locally recurrent tumors had malignant features, such as increased nuclear pleomorphism with frequent mitotic figures and vascular invasion of tumor cells, as well as increased proliferative activity assessed by immunostaining for Ki-67. Chemotherapy was carried out against the pulmonary metastatic lesions, which showed a drastic response after 3 courses of intravenous administration of cisplatin (CDDP). To date, a total of 6 courses of CDDP and 6 courses of nedaplatin (CDGP) have been done, and the remaining pulmonary tumors have been dormant. This suggests that platinum derivatives could be a chemotherapeutic agent of choice against this rare tumor.

Salivary duct carcinoma in the mandible: a case report

Salivary duct carcinoma (SDC) is a distinctive and aggressive neoplasm. The most frequent site of origin is the parotid gland, followed by the submandibular gland. SDC originating in the minor salivary glands, particularly in the ectopic glands within the mandible, is extremely rare. We describe a 62-year-old man with SDC in the mandible, who presented with a painless lump in the right submandibular region (later identified as lymph node metastasis) and ipsilateral mental nerve palsy. Histologic examination after ablative surgery revealed SDC originating in the mandible and cervical nodal metastases spreading to levels I-III. The patient remains alive 59 months after presentation as a result of postoperative full-dose irradiation and regular intensive chemotherapy using TXT, 5-FU, and CDDP. However, the patient has local recurrence and distant metastases to the lung and brain. In this report, we also discuss the specific diagnostic criteria and developmental theories of intraosseous salivary gland tumors.

Ewings’ sarcoma of the mandible

Ewings’ sarcoma involving the facial bones is rare although it is the second most frequent bone malignancy. For the diagnosis a biopsy is needed. Currently the treatment is the combination of chemotherapy and radiotherapy with surgery indicated in only a few instances. We report a case of Ewing’s sarcoma of the mandible and describe its clinicopathologic features and the treatment of this disease.

Burkitt's lymphoma: an unusual cause of lip numbness

A 38-year-old man was referred by his dental surgeon with a painful swelling in the right mandibular sulcus and an ipsilateral numb lip. Dental infection secondary to caries was initially diagnosed but biopsy revealed this to be a Burkitt's lymphoma. After intense chemotherapy, the patient is still in remission three years later. This case is a reminder that malignancy should always be high on a clinician's list of differential diagnoses of jaw swelling associated with neurological abnormalities and prompt referral is essential.

Sporadic Burkitt's lymphoma of the jaws: the essentials of prompt life-saving referral and management

Burkitt's lymphoma is an undifferentiated non-Hodgkin's B-cell lymphoma. Three clinical subtypes are recognized: African (endemic), American (sporadic) and HIV associated. Sporadic Burkitt's lymphoma is a rare malignancy among western populations. This report describes a case of sporadic Burkitt's lymphoma of the jaws with an alarmingly rapid spread associated with acute renal failure. This type of rapid progression bespeaks the need for prompt recognition and life-saving referral by the dental practitioner. The clinical features of Burkitt's lymphoma involving the jaws include severely hypermobile, ectopically displaced and supra-erupted teeth. The purpose of this case report and review of the literature is to illustrate the clinical and histopathologic features of Burkitt's lymphoma to help clinicians recognize such cases readily and facilitate prompt and potentially life-saving referral.

Bilateral intraosseous adenoid cystic carcinoma of the mandible: report of a case with lung metastases at first clinical presentation

OBJECTIVE

Malignant epithelial tumours arising in the jaws are very rare. Adenoid cystic carcinoma (ACC) represents approximately 7.5% of all carcinomas and only a few cases of intraosseous (central) ACC have been reported in the literature.

MATERIALS

The salient clinico-pathological features of a case of ACC, bilaterally occurring in the mandible of a young caucasian woman who also had lung metastases are reported to appropriately characterize such unusual lesions and discriminate them from other tumours that more commonly affect the mandible.

RESULTS

The patient presented with a painful swelling of the right retro-molar area and paraesthesia of the ipsilateral lower lip and radiological investigations disclosed bilateral radiolucent lesions of the mandible with unequivocal signs of malignancy but without intra-lesional calcifications or association with teeth roots or cystic component. Conventional histological examination disclosed typical ACC with solid and cribriform growth patterns and extensive infiltration of the adjacent tissues.

CONCLUSIONS

The diagnosis of intraosseous malignant salivary gland type neoplasms is very difficult in view of their rarity and lack of specific signs and mainly achieved after histological examination and complete clinico-radiological work up. As surgical treatment of the patient was not indicated, due to extensive neoplastic disease, the patient is being controlled with multimodal treatment, including chemo- and radiotherapy and is alive with persistent disease 3 years after the original diagnosis.

Suppression by incadronate of invasion and growth of A-375 human melanoma in mandible in nude mice

Frequent invasion of oral cancers into the neighboring jaw bones is a major cause of increased mortality. Moreover, majority of patients with these oral cancers suffer from functional inconveniences and esthetic disadvantages during clinical course and after surgical treatments. Understanding of the mechanisms underlying oral cancer invasion into jaw bones is, therefore, critical to the better management of oral cancer patients. To study the pathophysiology of mandibular invasion of oral cancers, we established an animal model by inoculating the A-375 human melanoma cells onto mandible through masseter muscle in nude mice. Histological study showed that A-375 tumor cells aggressively destroyed the mandibular cortical bones and invaded into the bone marrow cavities. Histochemical examination revealed that there were numerous tartrate-resistant acid phosphatase-positive osteoclasts on the residual bone surfaces facing A-375 tumors. To examine the role of osteoclasts in mandibular bone invasion of A-375 tumors, we next studied the effects of the bisphosphonate incadronate (INC), a potent inhibitor of osteoclastic bone resorption, using this model. Daily subcutaneous injections of INC (1 mg/kg) markedly decreased A-375-increased osteoclasts, increased numbers of apoptotic osteoclasts and inhibited mandibular cortical bone destruction. Furthermore, INC significantly suppressed the growth of A-375 tumors, increased numbers of apoptotic A-375 cells and decreased the tumor-associated blood vessel density. These results suggest that invasion and growth of oral cancers in mandibular bone is dependent on osteoclastic bone resorption and that INC can inhibit the aggressive behavior of oral cancer through inhibiting osteoclastic bone resorption.

Long-term effects of cancer therapy on dental development: a case report

As the prognosis of malignant conditions in children improve by cancer therapy, long-term side effects due to antineoplastic treatment may be encountered. This case report demonstrates the long-term alterations on dental development in patient who had been treated for malignant condition. Alterations were observed during radiographic control 8 years after the therapy and included short, blunted, tapered and V-shaped root malformations as well as delayed and ectopic eruptions.

Malignant lymphoma associated with rheumatoid arthritis, developing shortly after initiation of oral methotrexate

We report a patient with rheumatoid arthritis (RA) who developed malignant lymphoma of the diffuse large B-cell type in the right submandibular region shortly after initiation of oral methotrexate (MTX). Despite cessation of MTX, the lymphadenopathy did not regress, and only reached complete remission after 3 courses of CHOP therapy followed by irradiation. In this patient highly active RA itself was considered to be the main cause of malignant lymphoma, and MTX might have contributed to the development by modifying the immune system. When RA is highly active, MTX should be used carefully because of the possible development of malignant lymphoma as well as other serious complications.

High-grade maxillofacial osteosarcoma: evolving strategies for a curable cancer

Maxillofacial osteosarcoma is a rare tumour. Curative treatment strategies have evolved to include chemotherapy in addition to definitive surgical resection. To review and report our experience in eight patients with maxillofacial osteosarcomas, we retrospectively reviewed eight patients with high-grade maxillofacial osteosarcoma seen over the last decade at our institution. Our results suggest that a combined surgical and chemotherapy approach provides excellent local disease control and high cure rates.

[Primary non-Hodgkin lymphoma of the mandible: apropos of three cases]

BACKGROUND

Primary non-Hodgkin lymphoma is rarely located in bony tissue, observed in only 5% of primary bone tumors and 4-6% of extranodal non-Hodgkin lymphomas. The mandibular localization is exceptional (0.6%). Clinical and histological features may be misleading, raising the risk of late diagnosis. Chemotherapy and radiotherapy are required.

CASE REPORTS

We report three cases of primary non-Hodgkin lymphoma of the mandible diagnosed between 1993 and 2000. All patients were males, aged 9, 37, and 45 years. Mean delay to diagnosis was 8 months. The inaugural complaint was a painful mass of the mandible in all patients. The histomorphology study and immunohistochemistry established the diagnosis. Two patients had diffuse large B cell non-Hodgkin lymphoma, the third anaplastic non-Hodgkin lymphoma. All patients were staged IE and given chemotherapy, associated with radiotherapy in one case. All patients achieved complete remission and continued to be in good health during follow-up lasting from 1 to 9 years.

Ewing's sarcoma of the mandible: a combined approach to treatment

Ewing's Sarcoma (ES) is a malignant tumor, which arises primarily in children. Most commonly found in the long bones and pelvis, it rarely is found in the bones of the face. This is a report of ES of the mandible in a nine-year-old Caucasian female. Treatment for this malignancy included an incisional biopsy, chemotherapy and radiotherapy protocol to the involved area in accordance with St. Christopher's Hospital and the Children's Hospital of Philadelphia. The patient is currently disease-free and has been for approximately five years.

Biomedical technology revolution: opportunities and challenges for oral and maxillofacial surgeons

During this 45-minute presentation, I have tried to describe my vision of the exciting future that awaits us. I have tried to impart my enthusiasm for the opportunities provided to us as surgeons by the advances in molecular biology and genetics, imaging, surgical technology and bioinformatics. Most of all, I hope I have transmitted my optimism for the future to our younger members. I think the following statement or observation by the great educator Margaret Mead accurately summarizes our current situation regarding the application of all this new knowledge that will become available to us as surgeons: 'We are now at the point where we must educate people (surgeons) in what nobody knew yesterday, and prepare in our schools (training programs) for what no one knows yet but what some people must know tomorrow.'

Burkitt's lymphoma presenting as mandibular swelling--report of a case and review of publications

Burkitt's lymphoma in a 4-year-old Chinese boy presented with acute mandibular swelling but no associated systemic disturbance. A review of published reports shows that the diagnosis should be suspected in jaw lesions with no obvious cause.

Antiangiogenic therapy of a recurrent giant cell tumor of the mandible with interferon alfa-2a

We report a 5-year-old girl with a large rapidly growing giant cell tumor of the mandible that recurred 2 months after the first surgical excision and 3 months after a second resection. An angiogenic protein, (bFGF), was abnormally elevated in her urine. The patient was treated with interferon alfa-2a for 1 year because this agent inhibits angiogenesis by suppressing bFGF overexpression in infantile hemangiomas and in other human tumors. During this time the bone tumor regressed and disappeared, the urinary bFGF fell to normal levels, and the mandible regenerated. She has remained tumor-free and has been off therapy for 3 years at this writing. This first successful use of interferon alfa-2a to treat a mandibular tumor in a child demonstrates: 1) low grade tumors that overexpress bFGF may respond to interferon alfa-2a, in a manner similar to life-threatening infantile hemangiomas; 2) antiangiogenic therapy, given without interruption for 1 year, was safe and effective in this patient; and 3) treatment may be continued for 1 year without the development of drug resistance.

[Pathological fracture of the mandible: a report of a clinical case treated with clodronate]

Oral squamous cell carcinoma often invades the mandible. However, the incidence of pathological fractures of the maxillofacial bones is low and their treatment is rarely satisfactory. A patient, too weak to undergo surgery, affected by squamous cell carcinoma of the mandibular region with bone involvement and pathological fracture of the mandible, underwent chemotherapy with carboplatin associated with diphosphonate.