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rani HS, Hui M, Manasa PL, Uppin SG, Uppin MS, Paul TR, Sadashivudu G. Bone Marrow Metastasis of Solid Tumors: A Study of 174 Cases Over 2 Decades from a Single Institution in India. Indian J Hematol Blood Transfus 2022; 38:8-14. [PMID: 35125707 PMCID: PMC8804032 DOI: 10.1007/s12288-021-01418-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/24/2021] [Indexed: 01/03/2023] Open
Abstract
To analyze the pathological findings in patients with marrow metastasis from solid tumors and to compare the accuracy of the bone marrow aspirate, trephine imprint and trephine biopsy in detecting metastasis. A total number of 174 cases diagnosed on bone marrow aspiration and/or bone marrow biopsy from January 2000 to December 2018 were included in the study. In addition to clinical and demographic data, we evaluated peripheral blood findings, and pattern as well as morphology of the tumor cells in bone marrow aspirate, imprint cytology and biopsy. The changes in the bony trabeculae were classified according to the classification of carcinomatous osteodysplasia. The most common laboratory findings included cytopenias and leucoerythroblastic blood picture. Trephine biopsy was found to be the most sensitive technique for detection of marrow metastases with a sensitivity of 99.4%. Trephine imprint cytology (89.9%) showed a significantly better detection rate than bone marrow aspiration (58.5%). Metastatic adenocarcinomas and undifferentiated carcinomas were more common than non-epithelial tumors. Metastatic carcinomas with known primary were mostly from breast, prostate and lung. Ewings/PNET and neuroblastoma were the commonest among metastatic non-epithelial tumors. Fibrosis (53.4%) was the most frequent stromal change and abnormalities in bony trabeculae were noted in 61.2% cases. Trephine biopsy has the highest sensitivity in detection of marrow metastasis followed by trephine imprint cytology. Immunohistochemistry on trephine section will help in confirming and or suggesting the primary tumor in unknown cases.
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Affiliation(s)
- Hanumanthu Sudha rani
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Monalisa Hui
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - P. Lakshmi Manasa
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Shantveer G. Uppin
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Megha S. Uppin
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - Tara Roshni Paul
- grid.416345.10000 0004 1767 2356Department of Pathology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana 500082 India
| | - G. Sadashivudu
- grid.416345.10000 0004 1767 2356Department of Medical Oncology, Nizam’s Institute of Medical Sciences, Hyderabad, India
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Kawashima I, Fukasawa H, Kasai K, Kumagai T, Koshiishi M, Nakajima K, Kondo T, Hashi A, Hirata S, Kirito K. Bone Marrow Invasion of Small Cell Neuroendocrine Carcinoma of the Endometrium: A Diagnostic Pitfall Mimicking a Haematological Malignancy. Intern Med 2019; 58:2561-2568. [PMID: 31118384 PMCID: PMC6761356 DOI: 10.2169/internalmedicine.2533-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Metastasis of cancer cells to the bone marrow is relatively rare, despite being one of the most important causes of myelosuppression in patients with solid tumours. A bone marrow examination via a biopsy is the standard method of diagnosing cancer cell invasion into the bone marrow. However, it is sometimes challenging to distinguish neuroendocrine carcinoma cells from haematopoietic cells due to their small, round shape and chromosomal abnormalities resembling haematological malignancies. We herein report a case of bone marrow invasion of small cell neuroendocrine carcinoma of the endometrium mimicking therapy-related myeloid malignancy.
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Affiliation(s)
- Ichiro Kawashima
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | | | - Takuma Kumagai
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Megumi Koshiishi
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Kei Nakajima
- Department of Hematology and Oncology, University of Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Japan
| | - Akihiko Hashi
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Japan
| | - Keita Kirito
- Department of Hematology and Oncology, University of Yamanashi, Japan
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Wang D, Luo Y, Shen D, Yang L, Liu HY, Che YQ. Clinical features and treatment of patients with lung adenocarcinoma with bone marrow metastasis. TUMORI JOURNAL 2019; 105:388-393. [PMID: 30931812 DOI: 10.1177/0300891619839864] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bone marrow metastasis occurs in lung adenocarcinoma patients with a poor prognosis due to the late course and lack of definitive treatments, although reports on this are limited. This study analyzed the clinical manifestation, laboratory examination, treatment, and prognosis of patients with lung adenocarcinoma with bone marrow metastasis. METHODS All patients were confirmed to have bone marrow infiltration by bone marrow aspiration. The clinical data of 12 patients with lung adenocarcinoma with bone marrow metastasis were analyzed retrospectively. The prognostic factors were analyzed by Kaplan-Meier statistics. RESULTS The common biomarker abnormalities in 12 patients were elevated carcinoembryonic antigen in 12 cases (100%), elevated lactate dehydrogenase in 9 cases (75%), increased alkaline phosphatase and anemia in 8 cases each (66.7%), and thrombocytopenia in 4 cases (33.3%). After diagnosis of bone marrow metastasis, 5 patients were treated with platinum-based chemotherapy, 3 patients received chemotherapy and targeted drug tyrosine kinase inhibitor (TKI) therapy, 2 patients received simple TKI therapy, and 2 patients received only best supportive care (BSC) therapy. The median duration of survival after the diagnosis of bone marrow involvement was 422 days. The survival time of patients receiving TKI therapy after bone marrow metastasis was significantly better than that of patients receiving only BSC and chemotherapy (χ2=4.636, P=0.031). CONCLUSIONS The survival period of patients with lung adenocarcinoma with bone marrow metastasis is short, and targeted drug TKI treatment can prolong the survival time for patients with EGFR mutation-carrying lung adenocarcinoma with bone marrow metastasis.
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Affiliation(s)
- Di Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Luo
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Shen
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui-Ying Liu
- Department of Clinical Laboratory, Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing, China
| | - Yi-Qun Che
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Massenkeil G, Gropp C, Kreipe H, Hussein K. [Analysis of therapy-relevant receptors in bone marrow carcinosis : Comparison of pathological and clinical parameters]. DER PATHOLOGE 2017; 38:317-323. [PMID: 28577052 DOI: 10.1007/s00292-017-0300-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bone marrow carcinosis is a sign of advanced tumor stage with nonspecific clinical and hematological symptoms. Diagnosis is based on bone marrow biopsy and histopathology, but biopsies are not part of the standard work-up in oncological diseases and data on the correlation between clinical presentation and pathological findings are sparse. MATERIAL AND METHODS In a retrospective single-center study, data from 20 tumor patients with bone marrow carcinosis were analyzed. Bone marrow biopsies were re-evaluated regarding quantity of tumor cells, fibrosis/necrosis, and bone changes. Immunohistochemistry of potential therapy-relevant receptors and PD-L1 was performed. RESULTS The median age in these 20 patients (13 women, 7 men) was 65 years. The most frequent diagnoses were breast (n = 8) and lung cancer (n = 5). Anemia (94% of patients), thrombocytopenia (72%), and elevated LDH (83%) were frequent findings. The degree of bone marrow infiltration was highly variable and accounted for between 1 and 95% of biopsy space. Significant bone remodeling was present in 14/20 biopsies. No correlation could be found between histological and radiological findings. Treated patients showed some clinical and biochemical improvement, but the overall survival was poor (median 4.5 months, range < 0.5 to 21.5 months). DISCUSSION Anemia and thrombocytopenia are frequently associated with bone marrow carcinosis, but are nonspecific. The extent of tumor cell infiltration and osteolytic/osteoblastic changes did not correlate with radiological findings. Therapy-relevant target factors should be evaluated, but therapeutic options are often limited and the prognosis is bad.
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Affiliation(s)
- G Massenkeil
- Klinik für Innere Medizin, Klinikum Gütersloh, Reckenberger Straße 19, 33332, Gütersloh, Deutschland.
| | - C Gropp
- Onkologische Gemeinschaftspraxis, Gütersloh, Deutschland
| | - H Kreipe
- Institut für Pathologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - K Hussein
- Institut für Pathologie, Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
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Occult Breast Lobular Carcinoma with Numerous Circulating Tumor Cells in Peripheral Blood. Case Rep Pathol 2015. [PMID: 26199779 PMCID: PMC4496473 DOI: 10.1155/2015/135684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We experienced a very rare case of occult breast lobular carcinoma with numerous circulating tumor cells in peripheral blood. The diagnosis was very difficult because there were no symptoms of breast cancer and the preceding chief complaints such as general fatigue and weight loss or abnormality of peripheral blood findings were suggestive of a hematological disease. We could make a correct diagnosis of this case by checking the findings of complete blood count and bone marrow biopsy at the same time using immunohistochemistry.
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Jia S, Li B. Osteosarcoma of the jaws: case report on synchronous multicentric osteosarcomas. J Clin Diagn Res 2014; 8:ZD01-3. [PMID: 25121065 DOI: 10.7860/jcdr/2014/6833.4412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 01/27/2014] [Indexed: 11/24/2022]
Abstract
Research has shown that osteosarcomas display high potential for metastasis to the lungs, pleurae and bones. Mandible, on the other hand, is an uncommon site for metastatic tumour cell colonization. Nevertheless, a metastatic tumour to mandible might be the first indication of an undiscovered malignancy at a distant site. This case report presents a case of a 61-year-old female patient. An osteosarcoma metastasized to her mandible shortly after the curettage of her jaw cyst. Both the metastatic osteosarcoma and the jaw cyst were confirmed by pathology. Initially, bilateral well-defined radiolucent lesions were shown in her panoramic X-ray image. Also, the diagnosis of a dentigerous cyst was made, based on histology. Two months later, a mixed radiolucent-radio opaque mass, which was confirmed as an osteosarcoma by pathology later, occupied the site of the previously enucleated dentigerous cyst, in her right mandible. Then, an identical osteosarcoma was found in the left pelvis on further doing overall radiological and pathological examinations. The pathologic hypotheses, treatment modality and follow-up of this case have also been presented.
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Affiliation(s)
- Shengnan Jia
- DDS, Department of Oral Pathology, Peking University School and Hospital of Stomatology , Beijing, P.R.China
| | - Binbin Li
- Associated Professor, Department of Oral Pathology, Peking University School and Hospital of Stomatology , Beijing, P.R.China
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Tanaka Y, Nobusawa S, Ikota H, Yokoo H, Hirato J, Ito H, Saito T, Ogura H, Nakazato Y. Leukemia-like onset of bone marrow metastasis from anaplastic oligodendroglioma after 17 years of dormancy: an autopsy case report. Brain Tumor Pathol 2013; 31:131-6. [PMID: 23900511 DOI: 10.1007/s10014-013-0156-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/11/2013] [Indexed: 01/11/2023]
Abstract
Extraneural metastases from primary brain tumors are extremely rare. We present an autopsy case that displayed a very late and unique pattern of metastasis from an anaplastic oligodendroglioma. The patient was a 74-year-old woman who was disease free for 17 years after resection of the primary oligodendroglioma. She was subsequently admitted to a hospital for heart failure where her bone marrow was found to be completely infiltrated with tumor cells, eventually resulting in disseminated intravascular coagulation. The onset was like leukemia, but the "blast-like" cells were different from leukemic cells, and the diagnosis was difficult until autopsy. After her death, a review of her past medical history and comprehensive analysis of her primary brain tumor and aspiration biopsy/autopsy bone marrow samples with glial immunohistochemical markers, fluorescence in situ hybridization examination, and immunohistochemical/sequencing analyses of mutant IDH1 revealed the accurate diagnosis. The metastatic tumor in her bone marrow was finally diagnosed as bone metastasis from the primary anaplastic oligodendroglioma. Although metastatic oligodendroglioma is very rare, it should be noted that this condition displays a propensity for bone and bone marrow and can present with features similar to those of leukemia after a long latency period.
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Affiliation(s)
- Yuko Tanaka
- Department of Human Pathology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan,
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Garbay D, Durrieu F, Bui B, Italiano A. Bone Marrow Metastases in a Patient with Primary Mediastinal Non-Seminomatous Germ Cell Tumor – an Unusual Pattern of Relapse. ACTA ACUST UNITED AC 2012; 35:40-2. [DOI: 10.1159/000335881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Riley RS, Williams D, Ross M, Zhao S, Chesney A, Clark BD, Ben-Ezra JM. Bone marrow aspirate and biopsy: a pathologist's perspective. II. interpretation of the bone marrow aspirate and biopsy. J Clin Lab Anal 2010; 23:259-307. [PMID: 19774631 DOI: 10.1002/jcla.20305] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Bone marrow examination has become increasingly important for the diagnosis and treatment of hematologic and other illnesses. Morphologic evaluation of the bone marrow aspirate and biopsy has recently been supplemented by increasingly sophisticated ancillary assays, including immunocytochemistry, cytogenetic analysis, flow cytometry, and molecular assays. With our rapidly expanding knowledge of the clinical and biologic diversity of leukemia and other hematologic neoplasms, and an increasing variety of therapeutic options, the bone marrow examination has became more critical for therapeutic monitoring and planning optimal therapy. Sensitive molecular techniques, in vitro drug sensitivity testing, and a number of other special assays are available to provide valuable data to assist these endeavors. Fortunately, improvements in bone marrow aspirate and needle technology has made the procurement of adequate specimens more reliable and efficient, while the use of conscious sedation has improved patient comfort. The procurement of bone marrow specimens was reviewed in the first part of this series. This paper specifically addresses the diagnostic interpretation of bone marrow specimens and the use of ancillary techniques.
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Affiliation(s)
- Roger S Riley
- Medical College of Virginia Hospitals of Virginia Commonwealth University, Richmond, Virginia, USA.
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Yun HK, Shin MG, Bo D, Kim DW, Cho D, Shin JH, Suh SP, Ryang DW. [Laboratory evaluation of bone marrow metastasis: single institute study]. Korean J Lab Med 2007; 27:96-101. [PMID: 18094558 DOI: 10.3343/kjlm.2007.27.2.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of bone marrow (BM) metastasis might be related with the occurrence of malignant tumors in ethnic groups. So, we investigated the type and the frequency of metastatic tumors of BM and analyzed the clinicopathologic variables of BM metastasis. METHODS This study included 932 cases of primary malignant tumor which were requested for BM study from January 1995 to June 2006 in Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Peripheral blood smears (PBS); aspirates, touch prints, and trephine biopsies of BM; and medical records including other laboratory test results were reviewed. RESULTS Overall frequency of BM metastasis was 11.9% (111/932). Primary tumors with BM involvement in children comprised neuroblastoma (74.1%), rhabdomyosarcoma (7.4%), and malignant lymphoma (7.4%). For adult patients, they consisted of malignant lymphoma (56.0%), gastrointestinal cancer (20.2%), and lung cancer (6.0%). In the case of malignant lymphoma, diffuse large cell lymphoma was the most frequent one. Laboratory findings of patients with BM metastasis commonly showed anemia and thrombocytopenia; in addition, serum LD, ALP, AST and ALT were elevated in 81.5% (75/92), 63.4% (59/93), 63.5% (61/96) and 33.3% (32/96), respectively. Leukoerythroblastosis was observed only in 19.8% (22/111) on PBS examination. CONCLUSIONS The most common non-hematopoietic metastatic tumor was neuroblastoma in children and gastrointestinal tumors in adults. Leukoerythroblastosis, anemia, and the elevation of serum LD, ALP, and AST were useful markers for the prediction of BM metastasis.
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Affiliation(s)
- Hyeong Kee Yun
- Department of Laboratory Medicine, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Korea
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Hirshberg A, Shnaiderman-Shapiro A, Kaplan I, Berger R. Metastatic tumours to the oral cavity - pathogenesis and analysis of 673 cases. Oral Oncol 2007; 44:743-52. [PMID: 18061527 DOI: 10.1016/j.oraloncology.2007.09.012] [Citation(s) in RCA: 286] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Revised: 09/19/2007] [Accepted: 09/19/2007] [Indexed: 02/07/2023]
Abstract
The oral region is an uncommon site for metastatic tumour cell colonization and is usually evidence of a wide spread disease. In 25% of cases, oral metastases were found to be the first sign of the metastatic spread and in 23% it was the first indication of an undiscovered malignancy at a distant site. The jawbones, particularly the mandible, were more frequently affected than the oral soft tissues (2:1). In the oral soft tissues, the attached gingiva was the most commonly affected site (54%). The major primary sites presenting oral metastases were the lung, kidney, liver, and prostate for men, breast, female genital organs (FGO), kidney, and colo-rectum for women. The primary site differs according to oral site colonization, in men the lung was the most common primary site affecting both the jawbones and oral mucosa (22% and 31.3%, respectively) followed by the prostate gland in the jawbones (11%) and kidney in the oral soft tissues (14%). In women, the breast was the most common primary tumour affecting the jawbones and soft tissues (41% and 24.3%, respectively), followed by the adrenal and female genital organs (FGO) in the jawbones (7.7%) and FGO in the soft tissues (14.8%). The clinical presentation of the metastatic lesions differ between the various sites in the oral region. In the jawbones most patients complain of swelling, pain and paresthesia which developed in a relative short period. Early manifestation of the gingival metastases resembled a hyperplastic or reactive lesion, such as pyogenic granuloma, peripheral giant cell granuloma, or fibrous epulis. Because of its rarity, the diagnosis of a metastatic lesion in the oral region is challenging, both to the clinician and to the pathologist, in recognizing that a lesion is metastatic and in determining the site of origin. The clinical presentation of a metastatic lesion in the oral cavity can be deceiving leading to a misdiagnosis of a benign process, therefore, in any case where the clinical presentation is unusual especially in patients with a known malignant disease a biopsy is mandatory.
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Affiliation(s)
- Abraham Hirshberg
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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