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This report concerns a case of multiple cemento-ossifying fibroma involving the maxilla and mandible of a 55-year-old Japanese male. The clinical, radiographic and histopathological findings are presented and discussed.
There is a lack of well-documented evidence in the literature concerning the relative radioresponsiveness or radioresistance of ameloblastomas, although they are generally considered radioresistant. Most of the previous papers referring to this subject lack acceptable histopathologic proof of the diagnosis, adequate radiotherapeutic data, and/or follow-up information; many predate the use of megavoltage irradiation. The present article reports 5 cases of ameloblastoma that were treated by radiotherapy, 3 by megavoltage irradiation. All have been confirmed histologically by an oral pathologist, all have adequate radiotherapeutic data and, with one exception, adequate follow-up information. In addition, the reasons for our present lack of knowledge of this subject are discussed; objective criteria are presented for evaluating the results of radiotherapy on ameloblastomas; the only other series of ameloblastomas treated by megavoltage irradiation is analyzed. Although radiotherapy can reduce the size of an ameloblastoma, primarily that part of the tumor which has expanded the jaw or broken into the soft tissues, it does not appear to be an appropriate treatment for an operable ameloblastoma. Its main use is in inoperable cases, primarily in the posterior maxilla.
The aim of this study was to assess the cell proliferation in ameloblastomas and to correlate this with clinical features and histology. Immunohistochemistry with Ki-67 monoclonal antibody was performed on fresh tissue from 54 ameloblastomas. A labelling index (LI) was calculated by expressing the percentage of Ki-67 positive cells. There was no significant correlation between LI and clinical features: age, sex or tumour size. Follicular ameloblastomas had significantly higher LI (5.0 +/- 0.5; mean +/- SEM) than plexiform tumours (3.2 +/- 0.6; P < 0.05). Plexiform ameloblastomas from the anterior mandible had a significantly lower LI (1.8 +/- 0.5) than those from the posterior (3.9 +/- 0.8; P < 0.05). LI was higher in squamous arcades (6.4 +/- 3.1%) than in epithelial cords and cysts (1.4 +/- 1.3%; P < 0.001). These results suggest that LI correlates most closely with the histological pattern of the epithelium of ameloblastoma, both within and between different tumours.
To evaluate the incidence and treatment results of osteosarcoma of the jaw (OSJ) in the Netherlands, data from 48 patients with a histologically proven diagnosis of osteogenic sarcoma of the maxilla or mandible were retrospectively analysed. Patient files, covering the period from 1964 to 1992, were obtained from all university hospitals in the Netherlands and the Netherlands Cancer Institute. The incidence of OSJ in the Netherlands is estimated to be at least 0.14 per 1,000,000. The overall 10-year survival was 59%. Distant metastasis occurred in 21% and local recurrences in 31% of the cases. Survival was significantly better in case of radical surgery and small tumours. Long-term survival after treatment of OSJ was good if complete surgical excision was achieved. Radiotherapy should only be considered to prevent local recurrence if surgery is not complete. The possible benefit of current chemotherapy in preventing metastatic disease is still questionable. Since other malignant neoplasms associated with OSJ occurred in 17% of the cases, lifelong follow up is mandatory for the detection of these second primary malignancies.
Thirty cases of osteosarcoma of the jaws were reviewed (20 men and 10 women, mean age 34 years). Seventeen lesions occurred in the mandible and 13 in the maxilla. Swelling without pain was the most common presenting symptom. Thirteen lesions were initially misdiagnosed as odontogenic infections. Numbness as a presenting symptom was statistically associated with poor prognosis. Treatment included all combinations of surgery, chemotherapy and radiotherapy. Patients receiving chemotherapy with four or more agents showed a trend toward better survival with 71% alive and disease-free at the time of review. Patients' increasing age was statistically associated with decreased survival. The average age of survivors was 27 years and nonsurvivors, 40 years. Older patients suffered more local recurrences which, in all but one case, resulted in mortality. Expectedly, clear surgical margins correlated statistically with improved survival. With margins of less than 5 mm, 27% of patients were alive and disease-free as compared to 62% with surgical margins greater than 5 mm. The importance of early diagnosis, definitive surgical treatment and aggressive adjuvant chemotherapy is demonstrated. The Proportional Hazards Regression model was employed to evaluate the statistical significance of a variety of factors on disease-free and overall survival.
Squamous odontogenic tumour is a benign odontogenic tumour composed of a well-differentiated squamous epithelium immersed in a fibrous connective tissue stroma. It is a rare tumour and a recent literature review yielded only 36 cases. Two cases of squamous odontogenic tumour are presented, 1 located in the maxilla and the other in the mandible: 1 of these cases showed a periodontal involvement. The radiographic picture was fairly characteristic in 1 case, with a radiolucent lesion between the roots of the second mandibular premolar and the first molar, while, in the other case, it was possible to observe the presence of a lesion located at the apex of a molar. The tumours were enucleated, and no recurrences were observed after 5 years.
Ameloblastic fibro-odontoma is a rare odontogenic tumour. It affects young people and is usually located in the posterior jaws. Two cases of this tumour are presented: both lesions had produced an asymptomatic swelling. The histology showed the presence of an odontogenic epithelium immersed in a fibrous mesenchyme; dental hard tissues were also present. No recurrences were found after 12 and 4 years from the surgical enucleation of the tumour.
A case of atypical benign osteoblastomas occurring at multiple sites in the maxilla and mandible of a 38-year-old woman, in association with simple bone cysts, is described. The tumors produced hazy or ground-glass-like semiradiolucent lesions with well-defined or poorly-defined margins on conventional radiographs. Histologically, the lesions were characterized by a proliferation of plump osteoblast-like cells forming trabeculae of osteoid and immature bone in a well-vascularized stroma. In addition, simple bone cysts associated with a radiolucent-radiopaque lesion consisting of lamellar bone and loose connective tissue were found next to one of the tumours. Possible pathogenesis of the tumours and cysts is discussed.
The present investigation concerns 4 patients with juvenile ossifying fibroma (JOF) whose data are analyzed together with 30 cases from the literature. The tumour mainly occurs in juveniles, 79% of the patients being 15 years or younger. Radiologically as well as at surgery, the lesion is demarcated from its surroundings. Histologically, JOF is unique in showing a loose-fibroblastic stroma that contains garland-like strands of osteoid with entrapped osteoblasts, the latter feature not being observed in other fibro-osseous lesions. JOF responds very well to conservative treatment that provided permanent cure in all cases with adequate follow-up data.
134 cases of paediatric tumours of the jaws in Nigerian children are reviewed. Non-odontogenic tumours and tumours of mesenchymal origin were the commonest. Among malignant disease cases, Burkitt's lymphoma predominated. Late presentation for treatment and gross disfigurement were typical clinical findings. Most of the non-Burkitt malignant lesions had grown to inoperable proportions and the few that were amenable to aggressive surgery responded poorly to treatment.
A clinicopathological study of 5 cases of unusual ameloblastoma was performed. Three cases were characterized by marked stromal desmoplasia. The lesions occurred in the tooth-bearing areas of the anterior or premolar regions of the jaw. They were relatively small and showed a honeycomb appearance radiographically. Histologically, the islands of tumour cells were small and discrete in the widely extended desmoplastic stroma. They lacked obvious ameloblastic polarity in many parts. The other 2 cases were hybrid lesions of desmoplastic and conventional types. The former appeared in the alveolar part and the latter in the lower part of the mandible. It was concluded that the desmoplastic variant of ameloblastoma could be categorized as a new distinct type histologically, clinically and radiographically.
Two cases of malignant ameloblastoma with metastases to the lungs are reported. One originated in the mandible and the other in the maxilla. The doubling time of the metastatic lesions to the lungs were calculated according to Collins' method, and ranged from 129 to 201 days.
A survey of the Japanese literature revealed 28 well-documented cases of central carcinoma of the jaws. There was no sex predominance and the mandible was the site of involvement in 26 cases. The most common initial symptom was local swelling, which was followed in order of frequency by spontaneous pain, paraesthesia of the lower lip, discomfort, loosening of teeth and trismus. On clinical examination, local swelling which was often accompanied by variable symptoms was an almost constant finding. Radiographic appearance varied from unilocular to worm-eaten type radiolucencies which were often surrounded by indistinct margins on close examination. Radical surgery, combined with irradiation and/or chemotherapy was the principal treatment in most cases, but there were 4 cases in which the lesions were simply excised under a tentative diagnosis of cyst; local recurrence was noted in 5 cases. Regional lymph node metastasis and lung metastasis were observed in 8 and 2 cases, respectively. No definite conclusion was drawn with regard to the prognosis because of the short follow-up period. Histologically, epidermoid carcinoma was most frequently seen, but odontogenic cyst was confirmed to be the site of origin in 3 cases only.
Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.
Benign odontogenic tumors are characterized by imaging findings of expansile growth and well-defined margins with smooth borders, and their appearance is very similar to that of odontogenic and nonodontogenic cysts. From the viewpoint of diagnostic imaging of odontogenic tumors, teeth are designed differently according to their origin from the apex or crown. Therefore, for differential diagnosis, it is necessary to select diagnostic methods that make it possible to evaluate these findings in detail. Intraoral and panoramic radiography are highly effective in examining the relationship between teeth and lesions, especially the vertical relationship. When a lesion is suspected in the mandible or maxilla on CT, MR imaging, or nuclear medicine, these procedures must be performed as supplementary imaging techniques. CT demonstrates well the degree of bone resorption, osteosclerosis, cortical bone swelling, destruction, and calcification. MR imaging is effective in differentiating between tumors and cysts, evaluating the infiltration of malignant tumors in the jawbone and surrounding soft tissue, and detecting bone marrow changes of the jaw. Differentiation between tumors and cysts must be achieved by contrast-enhanced studies. Combining plain radiography with advanced imaging techniques, including CT and MR imaging, can improve the accuracy of diagnosing odontogenic tumors.
Fibro-osseous, osseous, cartilaginous, and giant cell lesions of the mandible, maxilla, and other craniofacial bones share overlapping clinical, radiologic, and pathologic features that may lead to diagnostic confusion and possible misdiagnosis. The value of combined clinical-radiologic-pathologic correlation in the diagnosis of these lesions is paramount to achieving the correct diagnosis with subsequent implementation of appropriate therapeutic intervention.
Malignant tumors of the mandible and maxilla are grouped into primary tumors that originate within the mandible and secondary lesions, predominantly oral cancers and metastatic lesions, that involve the mandible secondarily. The most common malignant tumors of the mandible represent SCCs of the oral cavity, notably carcinoma of the floor of the mouth and gingiva that invade the mandible secondarily. Metastatic disease, most commonly from the breast and lung, are not an uncommon malignant lesion in the mandible and may be the first manifestation of a malignant lesion outside the head and neck. The osteogenic sarcoma is the most common sarcomatous lesion in the mandible and is suggested when a bone-forming matrix with sclerosis is found within the tumor on CT images. Some benign lesions may mimic a malignant tumor on imaging studies. In such cases, a biopsy is indicated to establish the diagnosis by histopathologic means. CT is indicated for assessment of bone destruction in the mandible before surgery or radiation therapy. MR imaging is the optimal modality for the assessment of marrow involvement and evaluation of the extraosseous soft tissue component. Finally, conventional films, frequently a Panorex view, are the initial radiographic examinations in suspected lesions.
OBJECTIVES: Solitary myofibromas are well described in the head and neck, but oral examples are less well known, and jaw lesions are rare. We studied the clinicopathologic features of a series of such lesions. DESIGN: Nine cases of oral myofibromas were retrieved from archives and studied. RESULTS: Two cases involved the mandible (intraosseous), 3 involved the gingiva, 2 involved the tongue, and 2, the hard palate. There were 4 men and 5 women, aged 9 months to 50 years (mean, 24 years; median, 27 years). Deep lesions showed typical histology, with paucicellular lobules and intervening hemangiopericytoma-like zones. In ulcerated submucosal lesions, these features blended superficially with cellular fascicles. The tumors expressed smooth muscle actin but lacked desmin and S100 protein. None of the tumors recurred or metastasized. CONCLUSION: Myofibromas appear in osseous, intramuscular, and submucosal aspects of the oral cavity. Ulceration imparts a fascicular appearance that makes superficial biopsy specimens difficult to interpret.