Document 6422597
Transcription
Document 6422597
"OFFtCIAL DIAGNOSIS" EI.LlS PlSCHEL STATE CANCER HOSPITAL AND C/..>iCER RESEARCH CENTER ORAL PATHOLOGY SfJIIIIA.R Q63 O.P.S . 79-99 Fe bruary 2, 1979 CASE I 1 PLroMORPUIC ADESOKA (Contdbuted by P<ocl P. Handl<>r, M.D . , 1431 S.W. Blvd., Jeffe<aon (78-949) • Cil:y, ItO) Dr. Abraas from uc:tJ\ comnented "I vould call this ple.oGor -pbie adenoD.a. although I a:a conc:arncd about the cellular pleot10rph.isD at one end of t:he apec.i.Den, t do not believa ~c is sufficient to justif y cnlling the laaio~ a ~11gnant mixed tumor . Ple ase do not tell ma it had nu~taatos·i zed. " Both Drs .. Cor io and 'l'n:rpley from :Setheada., NIH called i t "bonigo. 11ixecl tumor." Dr. Fay frota Fort 8ll&s, Texas stated 11pl e.omorphic adenoma , f i v·e of our fou rte.e.n pathologists cc»UJidered this as a aal:ignant cu;..or . " Dr . Ord.ie Una; i:ocoepidcr110id earC:1noc;), vt-ll clifferentJ.ated v eraua ~:~!.xed t\CIIOr with squamous mecaplasia. Dr. Wc.atber~, Ac ting Chairman, Oept . of Orat Pathol ogy, Emory University School o£ Dentt&~ry s aid the follow-i ng: 11Ce.llulnr mixed_ cumor, ther e ia 11 great deal of squ JUIIOUS dt.fferenti.atlon and foci of mucous cella and e ven intermediate t)'-pe of cella. buc not enou.gh to call it $ tlllJCoeptdermoid. WO'Uld this have been ona carcino=a, expleoewrphie adenoea? " Dr. Rowe f-rom ~n Arbor, Michigan e.alled it- aueoep1derID01d cucinoma. T>r. Rosai from Minnesou and T>r. LeGal Er0111 StraoboU<g called i t "benign !Jltx-ed t umor of the parotid. CASE I 2 (578-1 3894-2) IIEl!ANCIO!!!IDOTI!ELICKA (Contributed by Dr. •~•• Bucher, Pathologist at Boone County Rospitsl, Columbia, ~!0) Dr. Kori from Elkina , West ViT&ini.a c a lled i t "heJUngioe.ndochelioma .. " '1\.lo ~ers of the pathology staff 1n Dr. Pay ' s laboratory felt ~bat this vas a "beGIOngtopcrieyt""-"• " Dr . Sh&fu from Ind lana called it ''bemana1oendothel1o"" of infancy." CASE Q 3 (2366 / 78) MESP..NCHYMAL CHONDROSARC~ (Cona ibuted by Dr. Yvon LeG.• I, lnstitut D*An.ato:Uc, Pacholoaique-, Faculte De Medeceine, 1 Place Do L'Bopitol, Sl:<a$bOurg {Bas-Rh1n) Fraru:.e) Dr. L.eGal c:QIII'ented •• follOV8: ''taesenc:hya.a.l chondrosarcOD3-. it has reeurred seveYa.l tlae.s since. 1n chengtn,a DOrpholosy. Now SOIII:C- tert:icorie.a are n~turing: i n os teoonr c oma. 11 Dr . Azar from Taopa etnted : "per iosteal (ju-xt4tcorc:ical '"! osteosarcoma)." Thi.• \las also the diag-noais o f Dr. Moyer from Jewish Hosp.Lta1 in St. Louis . Dr. Weale.y from the Univeretty of Detroit eal.led it "osteogenic: sarcoma." ''This waor has not change i t'• cbarac.ttrUtics; the diagnosis of osteOsarcocaa reeaina the. .cost appropr-iate duigna tion. 11 said Dr. AbTaas froca uct..A. Dr . B.osai from Mi.nneeoto wrote: "I still believe that this is osteosarc.o!DA. although t bl!re ·are foci of c:losely pecked poly&onal cells ~uggC\eting thnt this tU!llor may be of odontogenic:. origin snd p~rh.aps a variant of ameloblast!e 14norr.a." CASE 0 3 con tinued Osteosarcoma vaa also the. di3.gn.oa.1s of John Meyer fro;:s St. Louis and Dr. Wealey froo Dettoi.t. Dr. Rove froo Michi gan ealled it "chondrosarcoma." Drs .. Kin3 and Che tr1.ck from SIU, as well aa Dr . Shafer from Indiana called it "chondroblas tic ost eosarcoma. " CASE I ~ (H-78-186) SIJ!CORNFAL PUSI'IIUR DERMAWSIS (Contdbuted by Dr. Will:iitl!l H. ~.lliwell, DVM, Ph.D • • D.irector of Pathology- Toxicology, Elars Bio- .. Teseardh L3boratorie~, Inc., Port Collins, Colorado) Dr. Roeat from M.Lnnesota co&c!ented : "If the. pacio.nt were e. human I would suggest impatigo, si.ne:e the patient is a dog , I have no idea Wac to suitgeat." ora. Cor io and tarpl&y from Bethesda e tated : "eub~rnea1 vesiculation comparable wi"th i;opetigo in hUlllana . 11 "An obvious good exa~ple. of Collie's nose." comentOO Dr. Shafer fro·m I ndiana . CASE I 5 (78-872) FtliROMA (Contributed by Dr. OOorles Dunlap, Dept. of Oral Patholoay, Univcrsicy ~!NTO-OSS!FYTh"C of Masouri-Kansas City, School of Oentie,try, ICansas City. MO) Dr. Wesley fr-om 1Jetro1t called i.t "fibt"o-oaseous lesion compatible with juvenile Thio was .Uso the diagnosis of Dr. Kclng alld Dr. Che.rrt.c:k, SIU, Or . Rosa1 fr-oo Minnesota, Dr. Meyer hom St. Lou.i.s., and Dr. Kori from West VirglnLa. Dr. Weathers f ro~ Flllory stated: "Desmoplastic f.ibr~'l is as close ~S I eon pigeon-hole th1s one.'' Dt:' . Le.('~ for Strasbours celled lt uoss:ifying fibroma." Or. Abram. from UClA stated: 11It ae.e.ms to be a beni.8n neoplaaa producing bone. nterefore, 1 would call it ossifying fibrcoa. tf rou aggressive ossUying fibroma . " believe the mincrali2ed is cementUQ then 1 suppoee a diaanosis of c~aentifylng f1b~om6 woul d be aecepta,le . Apparently ther e are no clinical or prognostlc differ~nc es between ce.mentifyi:n& fib roma and oaeifying fibroJW-. 11 'the col'!l!!lentnries of Dr. Sba.fet' Croa Indiana: ''this is a atrange ease. It has features o£ an odotttoge.ni.c fibroaa, of [.ent Johnson' s juvenile active oseifying f1bl>Ol!4, and slso of the lesion that we htlva: been calling a pt"eo&tcoblastomo." nOdontogenic fi.brom.1 with foreign body -reaction" was the dia&ttosis of Drs. Corio and Tar-1>l ~y fr-o• Bethesda at Nm. Drs. Dunlap and Barker comaented: "Ce:!::ento-t"sslfying fibroma, hovevcr, i t doea not: h•ve t.he typical whorled pattern .and bone trabeculae. Oseobltt.ats aTe e l so not prominent. Due to the PtruJence. of g-iant eeL l clusters, hemosidarin and widely scattered spars~ bone fnr~tion non-ossifylng fibroma is not: supposed to be p-rese:nt in J)e_&;X)pla.stic Fibromas." CASE I 6 (78-4500) JUVENILE .IBROMATOSIS (Contributed by Dr. and C:ha:rl~s Jhm1ap, by Dr. Caffrey, t:ndepc.odence, MO) 11 sub~ tted 0ssifying f i.broma" 9 88 the dia&nosis o f Or. Handler for Jeffers.on Azar frog Tampa. Or. Meyer frora St . U>uia. and Dr .. Kin& from SIU. froo Detroit c.alls it "fibrosarcoaa ~ feat urea of au aaaressive Dr . Abrams froiD UCLA st.atcd, "Ag&rcssive or juvenile. fibrmaat.osis. i.t is n locally destructive._ lesion without meta&t.ntic po tanti.al. '' City , Dr. Or . Wealey !ibromtosis. u f believe 1'his was also • CASt: II 6 coot.inuod the din,aosis of Dr . Weat hers from F.mory. D't. Ros.:1i from Mi nneso t a .s t ated : 1 believe this 1a a not.her b c.nign fibro-osae.oua l esion, eitber fibrous dyapla..si.a or ossifying fibrou .. u The. aajoricy of the group of Dr . Fay fro• Be.aumonc ALDY Medical Center call it a 1'f1brou.s hls tiocyto~:~" , except 0-r,;. Lundy a nd Ortiz who cal l it 11 o~Jsi fyin& f ibroma. " !he fol l owing cOl!Wientar ie.a: o f f' i br o-oss cous l u i on Yas s ent by Dr a . Bar keT' a nd Dunlap f rom Uoivt rsity of Htssouri-Kansas City, School of Dentis t ry , Kaneas Cit y, MO. OSSIFY1 NC FIB.._OHA We believe an osa1f yi.ng f i b'foma is 3 f ibro-oaeaous l es i on whi eh has a well demarco t &d or s horply ciretwseribed border on r a iogrnphs. As described by Waldron and Giat\8anti~ Oral 8urg. , Ma:r c h 19 73, a nd Schmama.n, Smith and Ackctt~an in Cancer , August 1970 , d\ia eoodition is cO:Iposed of whorling. C'ell ular fibrous connec t i ve cissue which q y foro e.it her mature and ii!Datu-re bon• of ceo_ shoving osteoblas t i c rtmUng of trabeculae '-'hi c h may as sume a " rete fo raau pact:ern . Osteoclasts are of t en present and s ometimes numerous . We believn that thia is a separate enticy not A·v ariant o f f i brous d ysplasi a. 11 NON-OSSIF'fiiiG F18ROMA Usually aeen be fore age 25. Dahl in, ln the t hir d- edition of Bone Tumors , r~por cs no case s i n t he j aws . Radiogra phically he d es c ribes tt to have a n ~nner bor d er o f either a t hin or promine nt s calloped line of scleroe t a . Tile les~on often s hovH trabe e ulae ttaMvtrsing cha les ion &i ving i.t a aultiloculated appeara nce. It usually produces aooe. e ortical expaneion. ln the 1on.g bones both D.abU.n and thto AFIP Fa.scicl e agt"ee tha t this les ion has a d-1a t 1nctiva radiographic a ppearance . Microoeopically NOF containe.s a cellular f ibrous tissuQ which i.a of t e n whorled. Of ten it has benign cultinuc l eaced c ells which frequently l eads to a diagnosis of giant cell tlJI!W)T o r graouloaa.. 'There ean be ! oci of osseov.,. metaplasia , oecasional ~to ses , and t he l e$ion MOY contain lipopbagas and hemosiderin p~ entation . DESMOPLASTIC FIBROMA Bas a wide age range bu t alaost: 90% below ago. 30. Pain or a ehiQ.A is a co~:~:~on complaint. of the patien t.!~~: . Cases have been reported i n the j aws . Radio&raphtca11y i.t is us ~ l ly v ell demarcated, but sometime-s has an irregular bo-rder: producing a trabeculated a ppearance. llistologically it is a bypocellular f ibrous connective tissue wit h small s pindle s haped fibroblasts with mitose s being r are. According t G sevara~ a uthor&, bone £oraation is not seen thus di •tingu~ehins the l teion f r oa fi brous dyaplasi3. There is alsoa laek o f giant cells vhich can help d i s t inguish this fro~ a non-os sif ying fibroma. A fibrosarcoma would b~ ~uch aore cellul&r . JUVE!IlL£ i'LBR<MATOSIS this appears t o be a c ontrovers i a l area. The lesion lr~8 f irst described by Stout in Cance~ . Sept . 1954, however , no bone lesions in e hildren u p to aaQ 15 whose f i brous l e a.ion W38 no t \lell d o.fi ned by oth er catasor ies t~uch as dOit"liiOpLast.ic: f-ibra::!a, e.cc. !nzi_qge:r de.aer ibed a a imilar l esion a s :!J;Rf'essivc tnfancfle. fibro:utosis~ However, soae l e siou d esc.ribed by Enzt.nser io""Ould fi-t Stout·,. _ dif f erentiacecl fibr osarcoma diag.nos is. I t appears that you can not j udge cll.ni.cal behavior on histology and t he f inal pt~ oo f of o f ibrosarcotoo would be ~tilt~tnsis . Tnese lesions aris-e in soft tissue or peri osteum and cu.y invade bone thu. diffed"'~ froa deamoplast ic fibroaas ~hich a rise ce ntra l l y iu bone and expand cortice5 bu~ l ea ving them gener ally i ntact . Hi s t ologically, the f ibroblastic proliferntion may ax t cnsivel y infi ltrate bone , fat, and musc le. Tho s pindle cells are usu31ly uni foT"ID in siz.e, well-di!!crc.:otiated and devoi d of lllito&c s . There i s UAunlly considerable collagen a nd ret iculin format ion~ Dahlin notes that the deP.IIopla-st1c fibro34 ~s a sepaxate entity vhile Rosai saya i C =ay r epr ese nt the bone counterpart of th~ soft t i saue desmoid . Stout and Enzinger both suggest s possible CASE # 6 continued de.s1gt'l3tion o f destDOtd fibroutosis , • desooid t umor for the. less eell ular lesions. Conl ey (Amcr J. of Surge~y. 112:609, 1966) ~ep o rted 40 cases with abodt 50% recurrence ~ate . · Saveral recent ~rtielas, some wit h jaw lesions are: Peede, Ora~ Snrg. 43:651 May 1977 Larsson, J. Oral Path 5:29- 51 1976 l!onefer, J . Oral Surg . 96: Dec . 19 78 J\JVENILE ACTIV3 01\ AGGRESSIVE OSSIFYING FillROMA th.is entity a ppear• in the litera ture but is poorly desct'i.be:d or documented as tQ what it actually looks like histolosica1ly . Lent Johnson ' s naoa is often associated with this lesion b~t we know of no tal~~cnce. It b~havo& as an aggressive fibro-osseous. lcsion vhieh maY kill by local extension. What t hen Are theae lesions? Using tha above inforcation, we believe Batsakis best sums it up in ·rumors of the: Read and Neck. He notes that: fibrous lesions often show a mixtu-re of f eatures making e xact elassiiication d.iff icul t . CASE t 7 (CMrt I 47930) HllCOI!PlDBR.'IOlD CA!\CIN<HA (Cont:r:ibuted by Dr. Don Krautz~r, 78-2519 tla.rrison, Arkans-3-c;) Dr . Lundy from Be.n.w:.ont A'r"Y H.Mical Center called it "ne.croti.zins s1 alcmet- aplasia." Dr. Ros.a1 fmc KJ.nne:sota stated_. ''this -te: a tu.or pf a.ioor salivary gland origin ari#ing i n che palate and characteri~ed by very pr~n4nt squamous I believe. i t is either benign_ or of A ver y low d~~ee. of tbink i t com~ closer to the leaton than people have designated as sialadeno:ta. papilliicr1.11 than a.ay other salivo.ry gland tumor I know.'' Dr. Azar from Taapa cU.led ~t "11ucoepideraoid t-uoor"wbich vaa also the diagnosis meJ:a pla aia. caligr~ney. of DY. ~ in& I from StU . Drs. Kori fro~ Wes~ Virslna, Jones f~om B~aumon~ Army Medi.cal Center , a nd Rowe fron1 Mi.chi&an call i t " SquamouR cell corclnoma." Or. Shafer from Ind.ia.oa called it 11hig.h grade mucoepidermoid c.arclnoll4. Dr. Weathersfro::n Emory coEDeote.d; ''iiish grade mucoepiaeraotd careinoo.'l. . Did t:his -arisll in a previoualy ben.ign taixed t.umort" (