New tumour entities in the 4th edition of the World Health Organization Classification of Head and Neck tumours: odontogenic and maxillofacial bone tumours

A Retrospective Analysis of 129 Ameloblastoma Cases: Clinical and Demographical Trends from a Single Institution

Ameloblastomas are benign neoplasms of the jaw, but frequently require extensive surgery. The aim of the study was to analyze the demographic and clinicopathological features of ameloblastoma cases at a single Oral and Maxillofacial Surgery group in the United States.

STUDY DESIGN

A retrospective chart review of patients evaluated for ameloblastoma between 2010 and 2020 at a single tertiary care center. Age, race, sex, tumor size, tumor location, and histological subtypes were recorded.

RESULTS

A total of 129 cases of ameloblastoma were recorded with a mean patient age of 42 ± 18.6 years (range 9-91 years old), male to female ratio 1.08:1. Ameloblastoma presenting in the mandible outnumbered maxilla in primary (118 to 8, respectively) and recurrent cases (8 to 1, respectively). There was a higher prevalence of ameloblastoma in Black patients (61.3%) with mean age of Black patients occurring at 40.5 years and the mean age of White patients occurring at 47.8 years and mean tumor size trended larger in the Black patients (15.7 cm2) compared to White patients (11.8 cm2).

CONCLUSION

Data suggests a strong influence of racial factors on the incidence of ameloblastoma, with regards to size, Black patients with ameloblastoma trended higher and more data is needed to clearly elucidate any relationship between the tumor size and race, as other factors may influence the size (such as time to discovery).

Granular cell ameloblastoma: A rare case report with public health implications

RATIONALE

Ameloblastomas are benign odontogenic tumors that exhibit local aggressiveness and a high potential for recurrence. Their histopathological diversity and potential to cause significant anatomical and functional complications often make diagnosis and treatment challenging. This case highlights the clinical, radiographic, and histopathological features of a rare granular cell ameloblastoma and underscores the importance of a radical surgical approach to management.

PATIENT CONCERNS

A 46-year-old female was referred to the Outpatient Department with a complaint of swelling on the right side of her face for 10 months. The swelling started as a small, asymptomatic enlargement of the lower jaw and gradually increased over the past several months.

DIAGNOSES

The clinical examination revealed noticeable facial asymmetry with a diffuse, firm to bony-hard swelling in the right mandibular region. Intraorally, a lobulated, bony-hard swelling with significant cortical expansion in the right lower jaw was observed. The mandibular occlusal radiograph showed a "soap bubble" appearance with multilocular radiolucency, cortical plate thinning, and disruption. The orthopantogram displayed a well-defined multilocular radiolucent lesion with root resorption, displaced teeth, and a "tooth floating in air" appearance. An incisional biopsy revealed tumor islands or follicles of odontogenic epithelium. Tall columnar ameloblast-like cells were arranged in a palisaded fashion at the periphery, and stellate reticulum-like cells were at the center. Large granular cells containing eosinophilic cytoplasmic granules confirmed the diagnosis of granular cell ameloblastoma. The patient was diagnosed with granular cell ameloblastoma.

INTERVENTIONS

A lower cheek flap was raised using a Roux lip split incision, followed by segmental mandibulectomy and resection of the tumor mass. The resected specimen's histopathological findings were consistent with the incisional biopsy.

OUTCOMES

The patient exhibited uneventful postoperative recovery with no signs of recurrence or metastasis during a 2-year follow-up period.

LESSONS

Granular cell ameloblastoma, although uncommon, demands careful differentiation from other odontogenic neoplasms due to its distinctive histological characteristics. An integrated approach, combining clinical, radiographic, and histopathological assessments, is essential for precise diagnosis and optimal treatment planning. Given the tumor's locally aggressive nature, radical surgical treatment is often necessary to prevent recurrence. Long-term follow-up is vital to monitor for potential recurrence and ensure complete disease control.

From pathogenesis to precision medicine: Transformative advances in research and treatment of ameloblastoma

Odontogenic neoplasms of the jaw are dominated by ameloblastoma (AM), a locally aggressive epithelial tumor with a significant propensity for recurrence. The World Health Organization's 2022 update to the AM classification system underscores recent progress in comprehending its underlying mechanisms and refining clinical approaches. Contemporary research has yielded significant insights into the genetic underpinnings of AM, paving the way for the development of precision-based treatment strategies. Advanced genetic profiling has revealed a significant frequency of BRAF (V-raf murine sarcoma viral oncogene homolog) V600E and SMO (Smoothened) gene alterations in AM. Importantly, therapeutic interventions specifically designed to target these genetic aberrations, including BRAF and MEK pathway blockers, have shown encouraging results in terms of both effectiveness and tolerability, as documented in individual case reports and small-scale clinical investigations. This comprehensive review summarizes the recent modifications to the World Health Organization's categorization of AMs, explores progress in elucidating their underlying molecular pathways, and evaluates emerging targeted treatment modalities. Our objective is to present a thorough synthesis of contemporary scientific discoveries and therapeutic interventions, potentially paving the way for more efficacious and individualized clinical management protocols for this complex neoplasm.

A Case of Juvenile Trabecular Ossifying Fibroma Arising from the Maxilla in a 2-Year-Old Child

An ossifying fibroma is a fibroosseous lesion from the maxilla and mandible. Its histopathological subtypes include juvenile trabecular ossifying fibroma (JTOF) and juvenile psammomatoid ossifying fibroma. It commonly affects young individuals and is invasive in nature. A 2-year-old girl with a 2-week history of swelling in the left infraorbital region and a reduced opening of the left eye was referred to our department. Clinical examination revealed a diffuse bone-like swelling extending from the left infraorbital region to the left buccal region. Computed tomography revealed a well-defined 2-cm lesion, and magnetic resonance imaging revealed moderate-to-high signal intensity on T2-weighted imaging. A definitive diagnosis could not be arrived at based solely on imaging findings. A biopsy was initially planned; however, the tumor was extracted because it was relatively easy to separate from the surrounding bone. Histological findings showed fascicular and spiral hyperplasia of the tumor cells containing spindle nuclei and cytoplasm. Fibroma-like stroma, immature chondrocytes, and mature trabecular osteogenesis are also observed. Osteoblast-like or partially chondrocytic sequences were observed at the margins of hard tissue. Thus, a definitive diagnosis of JTOF was established. Although the tumor was extracted only in the present case, JTOF has a high recurrence rate; thus, resection of the surrounding bone is recommended following a definitive diagnosis. In this case, the period from onset to surgery was short, and early treatment allowed the tumor to be removed before it invaded the surrounding bone; therefore, extraction alone prevented recurrence. It can be distinguished from fibrous dysplasia, which has similar pathological findings, based on the observation of osteoblast-like structures at the edge of the trabecular bone. Moreover, the negative guanine nucleotide-binding protein alpha-stimulating activity of polypeptide 1 further confirmed JTOF. No signs of recurrence were observed in this case at 11 years and 9 months postoperatively.

Long-Term Outcomes of Surgical Decompression in Treating Calcifying Odontogenic Cyst Associated With Compound Odontoma: A 9-Year Follow-Up Case Report and Literature Review

A calcifying odontogenic cyst (COC) is a cystic lesion originating from odontogenic epithelium, exhibiting ameloblastomatous features and containing focal accumulations of ghost cells. The standard treatment for COC typically involves enucleation followed by surgical curettage. However, if the cyst is large or closely associated with anatomical structures, decompression may be considered as a preliminary step before enucleation. A 12-year-old male patient presented with swelling in the anterior mandibular region. Radiological assessment revealed an extensive radiolucent area crossing the mandibular midline, accompanied by radiopaque areas within the lesion. The diagnosis of COC associated with compound odontoma was confirmed. The treatment plan involved decompression, followed by enucleation. After over 9 years of follow-up, the patient showed satisfactory and effective outcomes, with no signs of recurrence. This therapeutic approach minimizes the morbidity and cost associated with extensive and invasive reconstructive surgeries.

Exploring the Rarity: Clinical insights and histopathological diversity of hybrid desmoplastic-plexiform ameloblastoma

Ameloblastoma represents a rare and locally aggressive odontogenic neoplasm, notable for its histopathological diversity. Among its subtypes, the desmoplastic and plexiform variants are relatively rare, with the hybrid form, encompassing both architectural patterns, representing an even more exceptional entity. This article delineates the clinical, radiological, and histopathological profile of a 45-year-old male presenting with pain persisting over the past month in the right posterior maxillary region. Radiographic imaging displayed a mixed radiolucent-radiopaque lesion with poorly demarcated margins, indicative of an aggressive pathology. Histopathological examination revealed a hybrid ameloblastoma, juxtaposing desmoplastic zones with densely fibrotic stroma and classic plexiform sections with epithelial strands in a reticular configuration. This unique hybrid variant underscores the complexity of ameloblastomas and necessitates comprehensive histopathological assessment, as radiological interpretations may prove insufficient for accurate diagnosis. Such detailed analysis contributes to understanding the biological behavior of this rare form, underscoring the need for heightened clinical awareness and continued investigative focus.

The Prevalence and Diagnostic Patterns of Oral and Maxillofacial Lesions: A Seven-Year, Retrospective, Single-Center Cone Beam Computed Tomography and Histopathology Study in Saudi Arabia

Objective: To determine the prevalence of oral and maxillofacial lesions among patients at King Abdulaziz University from January 2016 to December 2022. Methods: This cross-sectional observational study included patients diagnosed with oral and maxillofacial intra-bony lesions based on radiological findings and confirmed by histopathological examination. The lesions were classified according to the fourth edition of the World Health Organization Classification of Head and Neck Tumors. Results: This study included 237 patients with a mean age of 31.53 ± 14.97 years, of which 45.1% were female. Most patients (46.7%) had mandibular lesions, followed by maxillary lesions (35.9%). Only 2.95% of the tumors were malignant. Odontogenic cysts were the most prevalent (65.40%), with radicular cysts and keratocytes being the most common types. The most prevalent tumor types were odontoma and ameloblastoma. The most malignant lesion was multiple myeloma. Conclusions: Our findings reveal that mandibular cystic lesions predominated, and emphasize the low incidence of malignancy in the study population. They provide valuable insights into the oral and maxillofacial lesion landscape at a high-volume tertiary care center.

Cone-beam computed tomography imaging of benign odontogenic lesions in the maxilla: A report of 2 cases

Odontogenic tumors are slow-growing and generally nonaggressive; however, aggressive characteristics appear to exist in particular tumors. The author reports two cases of benign odontogenic lesions at the anterior maxilla. A 44-year-old woman came to an oral-maxillofacial surgeon with a complaint of asymptomatic swelling of the left anterior region of the maxilla 15 years ago, which started gently but gradually increased over time. The patient experienced a physical injury 15 years ago, resulting in the loss of the upper left front teeth. In the other case, a 50-year-old woman complained for 5 years about a little swelling in her left anterior maxilla that became larger over time without causing any discomfort or pain. The Cone-beam computed tomography (CBCT) exam revealed a partially multilocular radiopaque mixed radiolucent lesion in the anterior maxilla, with margins that are both well-defined and ill-defined. Both display features of infiltrative, expansive, and moderately aggressive growths, leading to the erosion and perforation of the cortical plates in the buccal and palatal regions. Based on the biopsy results, both samples showed similar findings, specifically a benign odontogenic lesion, likely desmoplastic ameloblastoma, and squamous odontogenic tumor without any atypic cells or malignancy. This study aims to further our understanding of the clinical and radiological features of these patients and emphasize the importance of investigating specific lesions as potential diagnoses.

Odontogenic carcinosarcoma of the mandible: A case report

Key Clinical Message

Odontogenic carcinosarcoma, a rare and challenging diagnosis, was identified in a 60-year-old male through histopathology, revealing a biphasic neoplasm with malignant epithelial and mesenchymal components. Surgical resection is crucial for management, highlighting the importance of vigilant postoperative follow-up to ensure early detection of any recurrence.

Abstract

One rare mixed malignant odontogenic tumor is odontogenic carcinosarcoma, which comprises malignant epithelial and mesenchymal components. Diagnosing odontogenic carcinosarcoma is challenging due to its rarity and atypical clinical presentation. This study reports a 60-year-old male patient who presented with a painless swelling on the right side of his face and experienced facial asymmetry for 6 months, ultimately diagnosed with odontogenic carcinosarcoma. A biphasic neoplasm with malignant alterations in both epithelial and mesenchymal components was identified upon histopathological examination. MRI imaging showed an expansile multilobulated lytic lesion with cortical erosion and extraosseous extension in the posterior region of the right mandibular body and ramus. Following contrast administration, homogeneous lesion enhancement was observed, with a few small non-enhancing necrotic areas in central parts. The patient subsequently underwent a right hemi-mandibulectomy with resection of adjacent soft tissues and neck dissection due to lymph node involvement. The resulting defect was reconstructed using a pectoralis major flap. No recurrence or metastasis was reported during the 6-month follow-up, reinforcing the positive results. This case highlights the importance of recognizing odontogenic carcinosarcoma and underscores the challenges in diagnosing and managing this rare tumor. Early identification and aggressive treatment can lead to positive outcomes, as evidenced by the absence of recurrence or metastasis in this patient during the follow-up period.

Periapical cemento-osseous dysplasia masquerading as asymptomatic chronic apical periodontitis in a Chinese woman: A case report

Key Clinical Message

Cemento-osseous dysplasia (COD) belongs to a group of fibrous osseous disorders that can masquerade as periapical inflammatory conditions in the jawbones. We present a rare case of COD occurring in a patient who also had periapical periodontitis concurrently. When faced with a patient exhibiting no symptoms, diagnosis may be challenging.

Abstract

COD is a fibrous osseous disorder similar to periapical chronic inflammatory conditions and other cysts in the jaw bones on the radiograph. There is a rare case of COD occurring in a 49-year-old Chinese woman who also had chronic periapical periodontitis concurrently. The lesions were incidentally discovered in the mandibular anterior tooth region during the patient's imaging examination. The patient exhibited no symptoms, and diagnosing the conditions may be challenging due to the confusingly similar radiological features that present as a radiolucent lesion in the periapical region. The final diagnosis was made through pulp vitality tests, cone beam computed tomography (CBCT), and clinical examinations. The COD was recommended for annual follow-up. Root canal therapy has been performed for chronic apical periodontitis. According to the diagnostic process of COD, a thorough history check, multiple clinical examinations, and imaging studies should be emphasized to prevent misdiagnosis and avoid unnecessary or inappropriate therapies. The patient was followed up for 6 years. The recovery of chronic apical periodontitis in tooth #31 and the transformation of osteolytic and osteogenesis of COD had been observed in CBCT.

Histopathological spectrum of primordial odontogenic tumor with co-existing dentigerous cyst: 1st reported case of the world with a proposed 'updated diagnostic criteria'

BACKGROUND

POT is a relatively newly described benign odontogenic tumor with very few cases registered to date. We present the 1st case of Primordial odontogenic tumor (POT) from Sub-Saharan Africa with unique clinicopathological features; also, this is the first case to report POT's existence as a Hybrid Odontogenic lesion (HOL), with a pertinent review of the literature.

CASE PRESENTATION

This was a 17-year-old patient who presented with slow-growing, painless posterior mandibular swelling. The imaging revealed a well-defined, unilocular, expansile, lytic lesion with internal calcific foci surrounding an impacted #36, indicating a calcifying odontogenic cyst. The incisional biopsy revealed the presence of POT. The tumor was excised along with the involved tooth.

CONCLUSION

POT is predominantly a non-aggressive and mostly affects the pediatric population. Hence, clinicians must be updated on all the aspects of this tumor to diagnose it appropriately and avoid any undue over-or under-treatment.

Odontoma - Basic Third Dimensional Histopathology Model Using 3D Animation Software and Clay Model

Background

Oral lesions of the jaw has been well explained in the literature through high-quality 2D clinical, radiographic, and histopathological images. But the clinicians and most of the times students too, don't understand the histopathological aspect through the description of text and existing 2D images. This article is preliminary attempt to explain the key events of histopathological aspects of odontoma in third dimension and clay models in a life-like manner which author herself has designed, for better understanding not only by oral and general pathologists, and students but also by patients, which is the unique feature of this short manuscript.

Aim

To create 3D animation video and images of odontoma using various 3D animation softwares and clay models.

Methodology

Preliminary 3D images and videos on histopathological aspect of odontoma were designed by using 3Dmax (Autodesk Media and Entertainment) and Adobe premiere pro 5.5 software which is a video editing software (Adobe Systems). Additionally models were prepared using kids' colourful clay material.

Observation

The clay model and 3D animation videos gave life like picture of a disease.

Conclusion

3D animation and clay models to explain histopathology has promising future for histology and histopathology.

PD-L1 immunohistochemical expression considering HPV status in oropharyngeal squamous cell carcinoma

This systematic review aims to determine whether the presence of human papillomavirus (HPV) influences the immunohistochemical expression of programmed cell death-1 ligand (PD-L1) in oropharyngeal squamous cell carcinoma (OPSCC). PD-L1 immunohistochemical expression varies in OPSCC, and the presence of HPV is a plausible explanation for this variability. Comprehending these findings is crucial, as high PD-L1 expression in the tumor microenvironment of OPSCC can help identify patient subgroups that could be suitable for immunotherapy. Therefore, a systematic review was conducted following PRISMA guidelines (CRD42023437800). An electronic literature search was performed without time or language restrictions. The search included PubMed/MEDLINE, Embase, Scopus, Web of Science, https://clinictrials.gov, and relevant journals. A meta-analysis was performed using RStudio. Fourteen studies involving 1,629 participants were included. The sample consisted predominantly of males (81.26%) with a mean age of 58.3 years. Concerning clinical and pathological characteristics, the most frequently described anatomical location was the tonsils (68.54%), and most participants were either current or former smokers (78%) and alcohol users (79%). Advanced TNM IV was the most common stage. Regarding histopathological characteristics, HPV 16 was the only type mentioned, and half of the cases were detected through immunohistochemistry. The SP142 clone (35.7%) and the pattern of membrane immunostaining in tumor cells (71%) were the most commonly employed methods. The most prevalent findings were positive expression of PD-L1 (64.28%) and negative HPV status (57.14%). The association between PD-L1 positivity and HPV positivity (78.57%) was confirmed by meta-analysis. The conclusion was that HPV-positive status has an impact on immunohistochemical expression of PD-L1 in OPSCC.

Giant Cell Lesions of the Jaws: A Work on Current Concepts and Making Through a Working Classification

INTRODUCTION

Giant cell-rich lesions are a diverse group of lesions that usually occur in bone and contain varying numbers of reactive osteoclastic-type multinucleate giant cells. These lesions present a challenge in pathologic diagnosis, often requiring a combination of clinical, radiographic, and histopathological assessments. The present retrospective observational study aims to provide a concise diagnostic criterion by combining all these parameters, which will aid in effective diagnosis and targeted treatment planning in the future.

MATERIAL AND METHOD

Previously diagnosed cases of these lesions were taken from the archives and categorized as Central Giant Cell Granuloma (CGCG), CGCG with secondary Aneurysmal Bone Cyst (ABC), primary ABC, and Brown's Tumour. Their demographic characteristics along with clinical, radiological, and histological data were retrieved and compiled into the table. The data was then analyzed and classified into aggressive and non-aggressive CGCG according to the criteria set in the study.

RESULT

10 reported cases were of isolated CGCG, 5 were CGCG with secondary ABC, 5 of Brown's tumor and 3 were that of conventional ABC. Out of these, the lesions showing extensive size along with an increased number of giant cells were categorized under aggressive CGCG, whereas those with less aggressive characteristics were categorized under non-aggressive CGCG. The aggressive category comprised 5 cases of isolated CGCG, 2 cases of CGCG with secondary ABC, 3 cases of primary ABC, and 5 of brown tumor, whilst the rest of the cases were categorized under non-aggressive CGCG.

CONCLUSION

Since all these share overlapping features, thereby this type of concise categorization is the dire need so that the lesions can have a precise diagnosis with treatment and follow-up intervals for aggressive lesions.

Florid cemento-osseous dysplasia: A case report and review of literature

Florid cemento-osseous dysplasia (FCOD) is a benign slowly growing fibro-osseous disorder, usually diagnosed accidentally through routine radiographic examination. The lesions are generally asymptomatic, but, in the most severe cases, focal enlargement and pain may occur due to infection. Here, we report the rare case of a Caucasian middle-aged woman showing, at orthopantomography performed during routine dental check-up, the presence of multiple symmetrical, dense and lobulated radiopaque bone lesions in several areas of the jaws, surrounded by a radiolucent border. The lesions were asymptomatic. Histologically, the replacement of healthy bone by metaplastic bone and fibrous tissue, typical of FCOD, was observed. The lesion remained painless, clinically and radiologically stable over two years follow-up. In asymptomatic cases, no treatment is required, but active clinical and radiographic follow-up are recommended at long-term, to reduce the risk of dental infections and oral surgery involving the area of the lesion. The avascular nature of FCOD contributes to susceptibility to severe infection, bone sequestration and osteomyelitis, limiting the in-site penetration of the antibiotics. Therefore, a careful clinical and radiographic monitoring of the lesions is recommended together with periodical dental check-up.

Factors and management techniques in odontogenic keratocysts: a systematic review

OBJECTIVES

Odontogenic keratocysts exhibit frequent recurrence, distinctive histopathological traits, a tendency towards aggressive clinical behavior, and a potential linkage to the nevoid basal cell carcinoma syndrome. The aim of this systematic review is to compile insights concerning the control of this condition and assess the effectiveness of various treatment approaches in reducing the likelihood of recurrence.

MATERIALS AND METHODS

The following systematic review adhered to the PRISMA guidelines. The systematic revision was registered on PROSPERO and  structured around the questions related to the population, intervention, control, outcome and study design (PICOS).

RESULTS

After conducting a search on the PubMed database, we initially identified 944 records. After using end-note software to remove duplicate entries, results totally with 462 distinct records. A thorough review of the titles and abstracts of these articles led to the selection of 50 papers for in-depth examination. Ultimately, following the application of our eligibility criteria, we incorporated 11 articles into our primary outcome analysis.

CONCLUSION

Among the studies examined, the most common location for these lesions was found to be in the area of the mandibular ramus and the posterior region of the mandible. In cases where the exact location wasn't specified, the mandible emerged as the predominant site. When we considered the characteristics of these lesions in studies that mentioned locularity, most were described as unilocular in two studies, while in two other studies, the prevalence of multilocular lesions was observed. Risk factors associated with keratocyst recurrence include younger patient age, the presence of multilocular lesions, larger lesion size, and a longer anteroposterior dimension. Certain treatment methods have demonstrated a lack of relapses. These include the use of 5-fluorouracil, marsupialization, enucleation with peripheral ostectomy or resection, enucleation and curettage, as well as resection without creating continuity defects. However, it is important to note that further research is essential. Prospective studies and randomized trials are needed to collect more comprehensive evidence regarding the effectiveness of various treatment approaches and follow-up protocols for managing odontogenic keratocysts.

CLINICAL RELEVANCE

Odontogenic keratocysts still enter into differential diagnoses with other lesions that affect the jaw bones such as ameloblastama and other tumor forms, furthermore it is not free from recurrence, therefore the therapeutic approach to the lesion aimed at its elimination can influence both the possible recurrence and complications, knowledge of the surgical methods that offer the most predictable and clinically relevant result for the management of follow-up and recurrences.

Challenging pitfalls in frozen section pathology: a case of mandible ghost cell odontogenic carcinoma and the literature review

BACKGROUND

Ghost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation.

CASE PRESENTATION

A 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for β-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30-40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC.

CONCLUSION

We have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates.

Expression Profiling of EMT Transcriptional Regulators ZEB1 and ZEB2 in Different Histopathological Grades of Oral Squamous Cell Carcinoma Patients

Background

Pakistan has a high burden of oral cancers, with a prevalence rate of around 9%. Oral Squamous Cell Carcinoma (OSCC) accounts for about 90% of oral cancer cases. Epithelial to Mesenchymal Transition (EMT) gets highly stimulated in tumor cells by adopting subsequent malignant features of highly invasive cancer populations. Zinc Finger E-Box binding factors, ZEB1 and ZEB2, are regulatory proteins that promote EMT by suppressing the adherent ability of cells transforming into highly motile cancerous cells. The present study aimed to analyze the expression of EMT regulators, ZEB1 and ZEB2, and their association with the clinicopathological features in different grades of OSCC patients.

Methods

Tissue samples were collected for both case and control groups from the recruited study participants. Cancer tissues (cases) were collected from the confirmed OSCC patients, and healthy tissues (controls) were collected from third-molar dental extraction patients. The study participants were recruited with informed consent and brief demographic and clinical characteristics. The case group was further segregated with respect to the histological cancer grading system into well-differentiated (WD), moderately differentiated (MD), and poorly differentiated (PD) squamous cell carcinoma (SCC) groups. RNA was extracted from the tissue samples for expression profiling of ZEB1 and ZEB2 genes through quantitative real-time PCR (qRT-PCR).

Results

All of the recruited participants had a mean age of 46.55 ± 11.7 (years), with most of them belonging to Urdu speaking ethnic group and were married. The BMI (kg/m2) of the healthy participants was in the normal range (18-22 kg/m2). However, BMI was found to be reduced with the proliferation in the pathological state of cancer. The oral hygiene of patients was better than the healthy participants, possibly due to the strict oral hygiene practice concerns of consultants. Every recruited OSCC patient had one or multiple addiction habits for more than a year. Patients reported health frailty (46.6%), unhealed mouth sores (40%), swallowing difficulties and white/reddish marks (80%), and restricted mouth opening (64.4%). Furthermore, 82.2% of the recruited patients observed symptoms within 1-12 months, and buccal mucosa was the most exposed tumor site among 55.6% of the patients. Expression profiling of EMT regulators showed gradual over-expressions of ZEB1 (8, 20, and 42 folds) and ZEB2 (4, 10, and 18 folds) in respective histological cancer grades.

Conclusion

High expressions of ZEBs have been significantly associated with cancer progression and poor health. However, no association was found between OSCC with other clinicopathological features when compared to healthy controls.

Imaging of Fibro-osseous Lesions and Other Bone Conditions of the Jaws

This review directs the focus on the imaging features of various fibro-osseous lesions and other bone lesions that can be of similar presentation. Broad diagnosis of "fibrous osseous lesion" may culminate in improper treatment and management. Radiographic discriminating factors between these entities are highlighted and summarized to improve the diagnostic process when encountering these lesions.

Unicystic ameloblastoma: A retrospective study on recurrent factors from a single institute database

OBJECTIVE

Unicystic ameloblastomas are a variant of ameloblastoma with a definite recurrence rate because of the biological behaviours of the tumour. The risk factors associated with disease recurrence were analysed in this retrospective study.

METHODS

A total of 132 patients with primary unicystic ameloblastoma reported in a tertiary hospital from 2005 to 2015 were analysed to identify the clinic-pathological and radiological factors associated with recurrence using univariate and multivariate Cox regression analyses.

RESULTS

The mean volume was 30.54cm3 ± 12.55 cm3, and this value differed significantly according to recurrence (p < 0.001). Root resorption and bone cortex/soft tissue invasion were also significantly associated with recurrence among unicystic ameloblastoma patients (p = 0.017 vs. p < 0.001, respectively). A new stage classification system was developed to predict disease recurrence of patients. The multivariate Cox regression analysis revealed that the new stage classification system was the only predictor of disease recurrence in unicystic ameloblastoma patients (p < 0.001), regardless of root resorption, position and site characteristics.

CONCLUSIONS

Volume, root resorption and bone cortex/soft tissue invasion were risk factors for disease recurrence among unicystic ameloblastoma patients. The new stage classification was an independent predictor of disease recurrence in patients with unicystic ameloblastoma.

Developing Odontoma in the Mandible of an Eight-Year-Old Boy

Benign mixed odontogenic tumors have been repeatedly classified and reclassified over the past few decades. Odontoma is considered a hamartoma due to its slow growth and non-aggressive nature. We present an interesting case of developing odontoma in an eight-year-old boy. His complaint was a slow-growing swelling in the lower right back tooth region. Clinical examination revealed a carious deciduous second molar. The orthopantomogram revealed a well-defined radiolucency around the unerupted mandibular first premolar and impacted mandibular second premolar. Histopathology revealed an odontogenic epithelial lining overlying myxofibrous stroma with inflammatory cells and calcified structures with few odontogenic rests. Special staining methods including Van Gieson and modified Gallego stains led to the final diagnosis of a developing odontoma.

Odontogenic Keratocyst With Moderate Epithelial Dysplasia: A Rare Entity

We present a rare case of odontogenic keratocyst (OKC) with moderate epithelial dysplasia in a 47-year-old male patient. He presented with a history of pain and swelling on the right side of his face for the past three months. The radiograph revealed multi-locular radiolucency involving the ramus, coronoid process, and condylar process of the right mandible. We have discussed the cytology, incisional biopsy, radiological investigations, surgical management, reconstruction, excisional biopsy report, and follow-up of this rare entity.

High-grade osteosarcoma arising in DCIA flap reconstruction after a prior resection of maxillar cemento-ossifying fibroma: A case report

Cemento-ossifying fibroma is a rare benign odontogenic tumour of the tooth-bearing jaws. Its concomitant occurrence with osteosarcoma, a malignant maxillofacial bone tumour, has never been described before. We present an uncommon case of a 43-year-old woman in whom a cemento-ossifying fibroma in the right maxilla was treated by resection and reconstruction using a deep circumflex iliac artery flap. During surgical prosthetic rehabilitation one-year post-operative, an osteosarcoma extending from the contralateral maxilla was coincidentally discovered in the deep circumflex iliac artery flap. The aim of this case report is to raise awareness on the extremely rare but possible simultaneous and independent occurrence of a cemento-ossifying fibroma and an osteosarcoma.

Collision Tumour Comprising Desmoplastic Ameloblastoma and Squamous Odontogenic Tumour in the Anterior Maxilla: A Case Report

Collision tumours, characterized by the simultaneous occurrence of two distinct neoplasms within the same anatomical site, are exceedingly rare in oral pathology. This case report presents an uncommon collision tumour involving desmoplastic ameloblastoma and squamous odontogenic tumour in the anterior maxilla of a 52-year-old male from the Indian population. Desmoplastic ameloblastoma is a variant of ameloblastoma known for its unique histopathological features, while squamous odontogenic tumour is a benign epithelial odontogenic tumour with distinctive clinical behaviour. The rarity of this occurrence emphasizes the need for accurate diagnosis and effective treatment strategies. This report discusses the clinical presentation, radiographic findings, and histopathological characteristics of this collision tumour. Through the presentation of this case, we aim to contribute to the understanding of these rare entities and their management considerations.

Sclerosing odontogenic carcinoma misnomering previously as central odontogenic fibroma-A case report with review of literature

Sclerosing odontogenic carcinoma (SOC) was first described by Koutlas et al. in 2008. Despite its inclusion in the World Health Organization (WHO) as a distinct entity, it is a tumour that remains poorly defined in the literature, with only 10 reported cases to date. The mandibular premolar and molar region is more commonly affected compared to the maxilla. In the maxilla, the anterior and the molar regions are most commonly affected. This article describes a case report of a Sclerosing Odontogenic Carcinoma in a 50 year old male patient in the mandibular region. The radiograph showed a well-defined radiolucency extending from the left ramus of the mandible to the right lower molar region. SOC is low grade with mild atypia and frequent mitosis and diffused infiltrative and perineural spread.

Ameloblastoma of the Mandible in a 16-Year-Old Female-Case Report

Ameloblastoma is a benign epithelial tumor that has aggressive, destructive and unlimited growth potential, having the capacity for recurrence and malignant transformation. Regarding the symptoms and clinical signs, the presentation of ameloblastoma is poor. In children and young people, ameloblastoma can be difficult to diagnose, because it mimics other benign lesions. Its diagnosis requires a combination of imaging data, histopathological analysis and molecular tests. The methods of treatment consist of radical surgery (segmental resection) and conservative treatments (enucleation with bone curettage). The particularity of the presented case is represented by the late request for medical consultation, a direct consequence of the measures implemented to prevent and control the spread of COVID-19.

A retrospective study of the malignant change of odontogenic keratocyst

The odontogenic keratocyst (OKC) is a common cystic lesion of the maxilla and mandible. Squamous cell carcinoma (SCC) arising from OKC or dysplasia occurring in OKC is rare. This study aimed to explore the incidence and clinical features of the dysplasia and malignant transformation of OKC. In this study, 544 patients diagnosed with OKC were collected. Among them, 3 patients were diagnosed as SCC arising from OKC, and 12 patients were diagnosed as OKC with dysplasia. The incidence was calculated. Clinical features were analyzed by chi-square test. In addition, a representative case reconstructing mandible with vascularized fibula flap under general anesthesia was reported. And cases reported before were reviewed. The incidence of the dysplasia and malignant transformation of OKC, which are highly associated with the clinical features of swelling and chronic inflammation, is about 2.76%. But the relevance between the dysplasia and malignant transformation and age, gender together with pain is not statistically high. All in all, the clinical features of swelling and chronic inflammation can be considered as characteristics of the dysplasia and malignant transformation of OKC. Although the pain isn't statistically relevant, it may be a dangerous clew. Also, combined with earlier literatures, the dysplasia and malignant transformation of OKC shows unique features of radiographs and histopathology.

Cemento-ossifying fibroma resection combined with heterotopic canine autotransplantation: a case report

Cemento-ossifying fibroma (COF) is a mesenchymal benign odontogenic tumor, which may lead to impacted or ectopic permanent teeth. Autotransplantation of teeth is a surgical process, in which a tooth is transplanted from one position to another in the same individual. This method can effectively restore the patient's mastication and aesthetics and is feasible in replacing missing teeth. This study reports a case of simultaneous COF resection combined with heterotopic canine autotransplantation to repair dentition defect, which effectively promotes the restoration of bone continuity and stability and achieves immediate and long-term aesthetic function requirements.

MXene-Integrated Silk Fibroin-Based Self-Assembly-Driven 3D-Printed Theragenerative Scaffolds for Remotely Photothermal Anti-Osteosarcoma Ablation and Bone Regeneration

Aiming to address the bone regeneration and cancer therapy functionalities in one single material, in this study, we developed a dual-functional theragenerative three-dimensional (3D) aerogel-based composite scaffold from hybridization of photo-cross-linked silk fibroin (SF) biopolymer with MXene (Ti3C2) two-dimensional (2D) nanosheets. To fabricate the scaffold, we first develop a dual-cross-linked SF-based aerogel scaffold through 3D printing and photo-cross-linking of the self-assembly-driven methacrylate-modified SF (SF-MA) gel with controlled pore size, macroscopic geometry, and mechanical stability. In the next step, to endow a remotely controlled photothermal antiosteosarcoma ablation function to fabricated aerogel scaffold, MXene 2D nanosheets with strong near-infrared (NIR) photon absorption properties were integrated into the 3D-printed scaffolds. While 3D-printed MXene-modified dual-cross-linked SF composite scaffolds can mediate the in vitro growth and proliferation of preosteoblastic cell lines, they also endow a strong photothermal effect upon remote irradiation with NIR laser but also significantly stimulate bone mineral deposition on the scaffold surface. Additionally, besides the local release of the anticancer model drug, the generated heat (45-53 °C) mediated the photothermal ablation of cancer cells. The developed aerogel-based composites and chosen therapeutic techniques are thought to render a significant breakthrough in biomaterials' future clinical applications.

Pediatric Oral Pathology: Odontogenic Cysts

Cysts encountered in the head and neck typically arise from epithelium that would normally be programmed to form teeth or tooth-supporting structures (odontogenic epithelium). These cysts come with a confusing array of similar-sounding names and histopathologic features that are sometimes shared between conditions. Here we describe and contrast the relatively-common lesions: hyperplastic dental follicle, dentigerous cyst, radicular cyst, buccal bifurcation cyst, odontogenic keratocyst, glandular odontogenic cyst, and the less-common gingival cyst of the new-born and thyroglossal duct cyst. The goal of this review is to help clarify and simplify these lesions for the general pathologist, pediatric pathologist, and surgeon.

Clinico-pathological and prognostic overview of metastasizing ameloblastoma: An overview of the systematic reviews

Background

Metastasizing Ameloblastoma (MA) is an aggressive variant of ameloblastoma (AM) with the ability to metastasize without cytological malignant changes. Thus it aims to comprehensively review the clinico-pathological and prognostic aspects of MA through integration of current literature.

Methods

Electronic searches were conducted in PubMed-MEDLINE, Scopus, Web of Science and Google Scholar. Two independent reviewers screened abstracts and evaluated paper eligibility. AMSTAR2 checklist was used to assessed methodological quality of included systematic reviews (SRs).

Results

From 390 initial papers, 279 underwent eligibility screening, with five systematic reviews (SRs) meeting inclusion criteria. Six hundred sixty-one MA cases were found in five SRs that were included. MA predominantly affects men, exhibits mandible preference, and occurs in individuals in their fourth or fifth decade. Benign metastatic deposits commonly manifest in lungs and lymph nodes. Distant metastasis probability rises with multiple recurrences and incomplete surgical removal. Tumor recurrence and metastasis unfavorably impact clinical outcomes. Quality of evidence assessment was absent across SRs; four SRs were critically low in methodological quality.

Conclusions

AM's metastatic potential lacks predictability. Early/multiple recurrences post-treatment may signal poor prognosis, warranting vigilant follow-up. Methodical analysis of each AM case is imperative to comprehend the metastatic-benign histology relationship.

Pediatric Odontogenic Tumors

Odontogenic tumors are rare tumors of the jaws that arise from remnants of the tooth forming apparatus. Some odontogenic tumors demonstrate strong predilection for pediatric patients including the unicystic ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma, ameloblastic fibro-odontoma, odontoma, and primordial odontogenic tumor. In this review, we discuss the clinical, radiographic, histopathologic, and molecular characteristics of select odontogenic tumors that demonstrate pediatric predilection and review management.

Primordial Odontogenic Tumor; Archival Review of 19380 Cases in a 55-Year Retrospective Study

BACKGROUND AND OBJECTIVE

Primordial odontogenic tumor is a rare odontogenic tumor reported for the first time in 2014. It was included in the latest edition of World Health Organization classification of Head and Neck Tumors as a new benign mixed epithelial-mesenchymal neoplasm. To date, 26 cases has been reported in literature. The aim of this study was to determine the possible presence of primordial odontogenic tumor in the previously diagnosed cases with myxoid stroma.

MATERIALS AND METHODS

This study was a retrospective descriptive study that was concluded in Oral and Maxillofacial Pathology Department, School of Dentistry, Tehran University of Medical Sciences. We reviewed all 19,380 cases from 19,66 to find the lesions with myxoid stroma which were in differential diagnosis with primordial odontogenic tumor. These cases should be associated with an impacted or unerupted tooth and belong to the patients under 20 years old.

RESULTS

We find 503 pericoronal lesions with myxoid stroma. Three cases were isolated after recut and reevaluation for finding fulfill histologic features. After immunohistochemical analysis, we find a new case of developing primordial odontogenic tumor associated with odontoma.

DISCUSSION

Primordial odontogenic tumor a recently described odontogenic tumor has a well-defined clinicopathological and immunohistochemical profile and should be differentiated from the others pericoronal lesions. It is the first time that this archival review has been done to find probable cases of primordial odontogenic tumor.

A Current Review of Machine Learning and Deep Learning Models in Oral Cancer Diagnosis: Recent Technologies, Open Challenges, and Future Research Directions

Cancer is a problematic global health issue with an extremely high fatality rate throughout the world. The application of various machine learning techniques that have appeared in the field of cancer diagnosis in recent years has provided meaningful insights into efficient and precise treatment decision-making. Due to rapid advancements in sequencing technologies, the detection of cancer based on gene expression data has improved over the years. Different types of cancer affect different parts of the body in different ways. Cancer that affects the mouth, lip, and upper throat is known as oral cancer, which is the sixth most prevalent form of cancer worldwide. India, Bangladesh, China, the United States, and Pakistan are the top five countries with the highest rates of oral cavity disease and lip cancer. The major causes of oral cancer are excessive use of tobacco and cigarette smoking. Many people's lives can be saved if oral cancer (OC) can be detected early. Early identification and diagnosis could assist doctors in providing better patient care and effective treatment. OC screening may advance with the implementation of artificial intelligence (AI) techniques. AI can provide assistance to the oncology sector by accurately analyzing a large dataset from several imaging modalities. This review deals with the implementation of AI during the early stages of cancer for the proper detection and treatment of OC. Furthermore, performance evaluations of several DL and ML models have been carried out to show that the DL model can overcome the difficult challenges associated with early cancerous lesions in the mouth. For this review, we have followed the rules recommended for the extension of scoping reviews and meta-analyses (PRISMA-ScR). Examining the reference lists for the chosen articles helped us gather more details on the subject. Additionally, we discussed AI's drawbacks and its potential use in research on oral cancer. There are methods for reducing risk factors, such as reducing the use of tobacco and alcohol, as well as immunization against HPV infection to avoid oral cancer, or to lessen the burden of the disease. Additionally, officious methods for preventing oral diseases include training programs for doctors and patients as well as facilitating early diagnosis via screening high-risk populations for the disease.

Self-Assembly-Driven Bi2S3 Nanobelts Integrated a Silk-Fibroin-Based 3D-Printed Aerogel-Based Scaffold with a Dual-Network Structure for Photothermal Bone Cancer Therapy

Multifunctional all-in-one biomaterial combining the therapeutic and regeneration functionalities for successive tumor therapy and tissue regeneration is in high demand in interdisciplinary research. In this study, a three-dimensional (3D) aerogel-based composite scaffold with a dual-network structure generated through self-assembly and photo-cross-linking with combined properties of photothermally triggered controlled anticancer drug release and photothermal cancer cell ablation was successfully fabricated. The fabrication of composites consists of self-assembly of a silk fibroin methacrylate (SF-MA) biopolymer incorporated with hydrothermally driven bismuth sulfide (Bi₂S₃) methacrylate nanobelts, followed by a photo-cross-linking-assisted 3D-printing process. The developed scaffolds presented hierarchically organized porosity and excellent photothermal conversion thanks to the strong near-infrared (NIR) photon absorption of incorporated Bi₂S₃ nanobelts inside the scaffold matrix. The heat generated in the scaffold mediated by laser irradiation has not only triggered controlled and prolonged release of the anticancer drug but also significantly ablated the bone cancer cells adhered on the scaffold. In addition, the developed 3D composite scaffolds have demonstrated excellent biodegradability for organic and inorganic network constituents at different media, enabling them as potential implants to be replaced by de novo tissue. In combination of chemotherapy and photothermal therapy, the multifunctional 3D-printed composite aerogel scaffold is expected to be an excellent implantable material in bone tissue engineering (BTE) for successive cancer therapy and tissue regeneration.

Sclerosing odontogenic carcinoma of maxilla: A case report

BACKGROUND

Sclerosing odontogenic carcinoma is a rare primary intraosseous neoplasm that was featured recently as a single entity in the World Health Organization classification of Head and Neck Tumors 2017, with only 14 cases published to date. The biological characteristics of sclerosing odontogenic carcinoma remain indistinct because of its rarity; however, it appears to be locally aggressive, with no regional or distant metastasis reported to date.

CASE SUMMARY

We reported a case of sclerosing odontogenic carcinoma of the maxilla in a 62-year-old woman, who presented with an indolent right palatal swelling, which progressively increased in size over 7 years. Right subtotal maxillectomy with surgical margins of approximately 1.5 cm was performed. The patient remained disease free for 4 years following the ablation surgery. Diagnostic workups, treatment, and therapeutic outcomes were discussed.

CONCLUSION

More cases are needed to further characterize this entity, understand its biological behavior, and justify the treatment protocols. Resection with wide margins of approximately 1.0 to 1.5 cm is proposed, while neck dissection, post-operative radiotherapy, or chemotherapy are deemed unnecessary.

Histopathological diagnosis in pediatric stomatology: A 43-year retrospective study of 1,480 cases from a Brazilian institution

OBJECTIVES

the aim of this study was to analyze the prevalence of histopathological diagnoses in oral biopsied tissues obtained from a Brazilian pediatric population.

METHODS

an analytical, cross-sectional retrospective study was performed with biopsy files of patients ≤14 years of age from a Brazilian oral pathology laboratory over a 43-year period. Data included sex, age, location, and diagnoses. The prevalence was calculated by means of relative frequency. Associations between sex, age groups and diagnoses were verified with Pearson's chi-square test.

RESULTS

from 19,456 oral biopsies, 1480 (7.6%) were obtained from patients aged ≤14 years. Most children were 10-14 years of age (60.1%) and females (55.1%), with an overall M:F of 1:1.2. Children aged 0-9 years and males had a higher frequency of lesions of the oral mucosa, whilst the 10-14 year age group showed a higher frequency of cysts, odontogenic tumors, and salivary gland lesions. The latter was also significantly higher in females. Samples consisted mostly of soft tissue lesions (53%) obtained from the lower lip (30.7%). Intraosseous lesions showed a slight predilection for the mandible (21.2%). Salivary gland lesions (28.8%) was the most common diagnostic category, followed by reactive lesions (18.8%), and cysts (16.1%). Mucocele (33.5%), dentigerous cyst (6.7%), and fibrous hyperplasia (5.9%) were the top three histopathological diagnoses. Malignant lesions affected only 0.9% of this population.

CONCLUSION

our results were similar to other retrospective studies. Due to the low frequency of oral biopsies in children, data on the prevalence of oral pathology in this population might aid in the clinical and histopathologic diagnoses.

Homeobox Genes in Odontogenic Lesions: A Scoping Review

BACKGROUND

Homeobox genes play crucial roles in tooth morphogenesis and development and thus mutations in homeobox genes cause developmental disorders such as odontogenic lesions. The aim of this scoping review is to identify and compile available data from the literatures on the topic of homeobox gene expression in odontogenic lesions.

METHOD

An electronic search to collate all the information on studies on homeobox gene expression in odontogenic lesions was carried out in four databases (PubMed, EBSCO host, Web of Science and Cochrane Library) with selected keywords. All papers which reported expression of homeobox genes in odontogenic lesions were considered.

RESULTS

A total of eleven (11) papers describing expression of homeobox genes in odontogenic lesions were identified. Methods of studies included next generation sequencing, microarray analysis, RT-PCR, Western blotting, in situ hybridization, and immunohistochemistry. The homeobox reported in odontogenic lesions includes LHX8 and DLX3 in odontoma; PITX2, MSX1, MSX2, DLX, DLX2, DLX3, DLX4, DLX5, DLX6, ISL1, OCT4 and HOX C in ameloblastoma; OCT4 in adenomatoid odontogenic tumour; PITX2 and MSX2 in primordial odontogenic tumour; PAX9 and BARX1 in odontogenic keratocyst; PITX2, ZEB1 and MEIS2 in ameloblastic carcinoma while there is absence of DLX2, DLX3 and MSX2 in clear cell odontogenic carcinoma.

CONCLUSIONS

This paper summarized and reviews the possible link between homeobox gene expression in odontogenic lesions. Based on the current available data, there are insufficient evidence to support any definite role of homeobox gene in odontogenic lesions.

Oral giant cell tumor or giant cell granuloma: How to know?

Introduction

The distinction between giant cell tumors and giant cell granulomas is challenging, as both entities have overlapping diagnostic criteria, especially in oral locations. The two entities have similar clinical and radiological presentations, but they differ in their prognoses.

Objective

The main objective of this study was to list the clinical, radiological, histological, and prognostic features of maxillomandibular giant cell tumors and giant cell granulomas cases n order to assess their value as a diagnostic referral factor that may allow the distinction between maxillo-mandibular giant cell granuloma and giant cell tumor.

Study design

Data of maxillomandibular giant cell granulomas and giant cell tumors were assessed through a scoping review and a pre-existing systematic review of literature. We have also realized a bicentric retrospective study.

Results

Various criteria facilitate the differential diagnosis like age, size, locularity and presence of necrosis zone but not the gender. The most discriminating factors was symptomatology (reported in 72% of GCTs while only 15% of GCGs) and the distribution pattern of giant cells in the stroma (homogeneously dispersed in 80% of GCTs versus grouped in clusters in 86.7% of GCGs). Recurrences were most described for giant cell tumors than giant cell granulomas. Malignant transformation and pulmonary metastasis were exclusively reported for giant cell tumors.

Conclusion

As clinical and radiological elements are not sufficient to distinguish between these two entities, immunohistochemistry and molecular genetics can be represent diagnostic biomarkers to distinguish giant cell granulomas and giant cell tumors in oral cavity. We have attempted to define the main criteria for the differentiation of giant cell tumor and giant cell granuloma and propose a decision tree for the management of single maxillomandibular giant cell lesions.

Odontogenic keratocyst in the mandibular condyle base region: A case report

Odontogenic keratocysts (OKCs) often occur in the molars in the mandibular ramus; they often progress asymptomatically and are discovered only after widespread development. Some cases of OKC progress to the mandibular condyle; however, very few cases exist only in the condyle. To the best of our knowledge, in all of the previously reported cases, OKCs occurred in the mandibular ramus, which underwent resection. The present study reports the case of a 31-year-old man in whom an OKC (13x12x6 mm) occurred discretely in the base of the condyle, in which the condylar head was successfully preserved. The tumor was removed under general anesthesia using the approach of shaving the anterior surface of the mandible. The extraction cavity was managed using the packed open technique and with an obturator. Approximately 20 months post-operation, the patient remained recurrence-free. This report presents a rare case of an OKC in the mandibular condyle base region. Resection was performed under general anesthesia and the condylar process was successfully preserved.

Surgical treatment of jaw inflammatory odontogenic cysts in primary teeth: a retrospective analysis

Relevance. Odontogenic cysts in children are the most common bone pathology. The study aimed to conduct a retrospective descriptive analysis of inflammatory odontogenic cysts cases associated with primary teeth in children.Material and methods. The study analysed the medical records of children diagnosed with "radicular cyst associated with a primary tooth" from 2015-2020. We studied the following characteristics, namely, sex, age, location of the process, condition of the teeth in question, surgical treatment techniques and outcome. The data obtained were processed by methods of variational statistics. The Student t-test assessed the significance of differences.Results. The study analysed 60 cases of inflammatory odontogenic cysts in children aged 6 to 13 years. Cysts were more often associated with the primary lower second molars previously treated with the resorcinol-formaldehyde resin therapy. The period from the tooth treatment to the cyst diagnosis was 3 to 5 years. The treatment of cysts applied methods of a gentle and traditional cystotomy. Fifty-one children (85.0%) had follow-up examinations. All children showed bone tissue restoration during the period of 4 to 12 months and spontaneous eruption of permanent teeth in 3-8 months. Only 4 cases (7.8%) required orthodontic correction of permanent teeth position.Conclusion. Primary lower molars, previously treated with resorcinol-formaldehyde resin, are the most common cause of jaw inflammatory odontogenic cysts in children. Low-traumatic surgical methods preserving the follicles of permanent teeth are highly effective (88.2%).

Evaluating histopathological factors of predicting the recurrence rate of odontogenic keratocyst

Background

Odontogenic keratocyst (OKC) is one of the most common jaw cysts with high recurrence rate. Some possible factors affecting recurrence that have not been evaluated in previous studies are examined in this study. This study aimed to predict the recurrence rate of OKC and more viable treatment of OKC.

Materials and Methods

In this descriptive, analytical, and cross-sectional study, 10 recurrent OKCs, which both slides before and after recurrence were accessible, were collected from oral and maxillofacial pathology department's archive. First, they were evaluated based on common histopathologic features. In the second phase, the frequency of these findings in 36 OKCs (24 samples with recurrence and 12 without recurrence after 5 years) was evaluated based on clinical, radiological, and histopathologic features. Data were analyzed by SPSS, Wilcoxon signed-rank test, McNamara, t-test, Chi-square, Mann-Whitney, Fisher's exact test, Cohen's kappa coefficient, and odds ratio (P < 0/05).

Results

According to this study, OKC in women, with multilocular radiolucency and mitosis in basal layer of epithelium as well as diffused inflammation, were statistically associated with probability of recurrence (P = 0.05, 0.035, 0.033, and 0.045, respectively). The corrugated surface, reverse polarity, hypercellularity in parabasal, and satellite cysts can affect the recurrence of OKC with odds ratios = 2.364, 2.364, 1.190, and 1.500, respectively).

Conclusion

Gender (women), multilocular radiolucency, diffused inflammation in stroma, and mitosis in basal layer of epithelial lining, can statically predict the possibility of recurrence rate. In addition, findings regarding the age (in younger patients), corrugated surface, reverse polarity, and sub-basal cleft can be helpful in predicting recurrence.

Transformation of Cemento-Ossifying Fibroma into Osteosarcoma after Radiotherapy and Nine Endoscopic Surgeries

Cemento-ossifying fibromas (COFs) are benign fibro-osseous tumors usually found in the mandible and maxilla that can show malignancy in rare situations. COFs usually grow slowly and asymptomatically until they produce local bulges, pain, headaches, and visual impairment, and have a Ki-67 index within 3%, even in aggressive and recurrent cases. Surgical resection can usually provide a satisfactory prognosis. However, no cases of COF transforming into osteosarcoma have been reported. We present a case of COF involving a 58-year-old woman whose initial symptom was hearing loss in the right ear accompanied by tinnitus. Enhanced magnetic resonance imaging revealed a 3.1 cm x 3.2 cm mass centered on the right pterygoid process of the sphenoid bone. Postoperative pathology revealed a COF with a high Ki-67 index (8%-10%). Over the next two years, the tumor relapsed repeatedly. The patient underwent nine endoscopic surgeries and radiotherapy. The sixth postoperative biopsy showed that the COF had transformed into an osteosarcoma. The patient subsequently experienced respiratory and cardiac arrests and was receiving treatment in the intensive care unit with a poor prognosis at the time of writing this manuscript. Thus, a high Ki-67 index may be a risk factor for malignant transformation for COFs.

Ameloblastomatous calcifying cystic odontogenic tumour involving the mandibular anterior region: An unusual case report

Ameloblastomatous calcifying odontogenic cyst (COC) is a very rare histopathological variant of COC, which is an odontogenic cyst of the jaw. The term "calcifying odontogenic cyst" is not covered in the World Health Organisation (WHO) Classification of Tumors 2005 and was re-named as calcifying cystic odontogenic tumour (CCOT). There are only a few reports containing details on CCOT being associated with ameloblastoma. This variant has been classified as ameloblastomatous CCOT (type 3) as per the WHO 2005 classification. In this article, we reported an exceptional case of ameloblastomatous CCOT in a 15-year-old boy involving the mandibular anterior region, which is a rare combination for age and site of the lesion, along with an impacted tooth which is again an uncommon association.

MR appearance of a rare ameloblastic fibroma with formation of dental hard tissues with histopathologic correlation: a case report

An ameloblastic fibroma with formation of dental hard tissues, which the classical name is ameloblastic fibro-odontoma (AFO), is a rare type of mixed odontogenic tumor. An 8-year-old boy was diagnosed with AFO, with an inhomogeneous high signal within the lesion shown by T2-weighted magnetic resonance imaging (MRI). Computed tomography (CT) imaging revealed a unilocular low CT value area of 24 × 19 × 26 mm with buccolingual bony expansion and cortical bone thinning on the left side of the mandible including the crown of the mandibular left second molar. In addition, multiple calcified bodies were detected within the lesion, one of which had a CT value of approximately 2200 HU, equivalent to that of enamel. MRI indicated the lesion to be sized 24 × 19 × 25 mm along with buccolingual bony expansion in the left side of the mandible. Additionally, the lesion showed an internal inhomogeneous high signal, while a portion had an especially high signal in T2-weighted images. That particularly high signal area coincided with the nodular growth area of mucus-rich mesenchymal components without the epithelial component in histopathology findings. The particularly high signal revealed by T2-weighted imaging could be attributed to the mucus-rich component. MRI was found useful for revealing differences in the internal histopathological properties of an AFO in our patient.