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Al-Sammak A, Rezki O, Pennington M, Manosca F, Cuevas-Nunez M, Qaisi M, Greenbaum E, Murphy J. Treatment challenges of persistent ghost cell odontogenic carcinoma: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e123-e132. [PMID: 37330392 DOI: 10.1016/j.oooo.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
The aim of this case report is to review and compare the clinical, radiologic, histopathologic, and immunohistochemical features, along with the treatment of a case of ghost cell odontogenic carcinoma. In addition, a report of the existing published literature with an emphasis on treatment will be described to provide information on this rare but aggressive tumor. The family of odontogenic ghost cell tumors comprises a spectrum of lesions characterized by odontogenic epithelium with ghost cell keratinization and calcifications. It appears that early detection is vital in proper treatment due to the high possibility of malignant transformation.
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Affiliation(s)
- Ali Al-Sammak
- Department of Oral and Maxillofacial Surgery, John H Stroger Jr Hospital, Chicago, IL, USA
| | - Othman Rezki
- Department of Oral and Maxillofacial Surgery, John H Stroger Jr Hospital, Chicago, IL, USA
| | - Michael Pennington
- College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - Frances Manosca
- Department of Pathology, John H Stroger Jr Hospital, Chicago, IL, USA
| | - Maria Cuevas-Nunez
- College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - Mohammed Qaisi
- Department of Oral and Maxillofacial Surgery, John H Stroger Jr Hospital, Chicago, IL, USA
| | - Even Greenbaum
- Department of Otolaryngology, Northwestern Medicine, Chicago, IL, USA; Department of Otolaryngology, John H Stroger Jr Hospital, Chicago, IL, USA
| | - James Murphy
- Department of Oral and Maxillofacial Surgery, John H Stroger Jr Hospital, Chicago, IL, USA; Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA.
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Harada H, Sato MP, Otsuki N, Kawamura M, Kurose A, Satou T. A novel parotid carcinoma with a prominent ghost cell population: a masquerading tumor or "salivary ghost cell carcinoma"? Med Mol Morphol 2021; 55:76-83. [PMID: 34392428 DOI: 10.1007/s00795-021-00302-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
Ghost cell is one of several unique cellular morphologies associated with aberrant keratinization. We encountered a novel parotid tumor containing numerous ghost cells and herein describe its histological features and discuss diagnostic problems. The patient was a 90-year-old Japanese male, who complained of swelling of the left parotid area for four months. Positron emission tomography indicated no cervical lymph node metastasis or distant metastasis. The tumor was successfully resected with no signs of recurrence or metastasis for six months after surgery. Histologically, the tumor was mainly composed of squamous cells forming irregularly shaped nests with a mixture of pleomorphic giant or multinucleated cells and bland basaloid cell. Keratinized areas were occupied by a prominent ghost cell population. Immunohistochemically, CK5/6 and CK19 were widely positive as well as AE1/AE3, p40 and p63. Nuclear expression of β-catenin was also observed. The present case can be regarded as a particular form of squamous cell carcinoma and is believed to contain a large number of ghost cells resulting from an unclear mechanism. However, it seems difficult to consider such tumors as a clinicopathologically independent entity at present. Applying a term such as "salivary ghost cell carcinoma" would be premature.
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Affiliation(s)
- Hiroshi Harada
- Department of Diagnostic Pathology, Kindai University Hospital, 377-2 Ohnohigashi, Osaka-Sayama, 589-8511, Japan. .,Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Mitsuo P Sato
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoki Otsuki
- Department of Otorhinolaryngology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Mao Kawamura
- Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Akira Kurose
- Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takao Satou
- Department of Diagnostic Pathology, Kindai University Hospital, 377-2 Ohnohigashi, Osaka-Sayama, 589-8511, Japan
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Vijayakumar G, Kamboj M, Narwal A, Devi A. Ghost cell odontogenic carcinoma of anterior mandible: A rare case report with review of literature. J Oral Maxillofac Pathol 2021; 25:S99-S108. [PMID: 34083982 PMCID: PMC8123258 DOI: 10.4103/jomfp.jomfp_195_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/29/2021] [Indexed: 12/18/2022] Open
Abstract
A 24-year-old male reported to the outpatient department with a complaint of swelling of the anterior lower jaw region for 9 months with history of traumatic injury and extraction of teeth from the same region, a month before the onset of swelling. Swelling was obvious extra- and intraorally which on examination presented as a soft to firm non-tender and non-fluctuant mass with an approximate size of 4 cm × 3 cm, extending from 34 to 43 region with obliteration of labial vestibule. Panoramic radiograph and cone-beam computed tomography showed a well-defined radiolucency in the mandibular anterior region crossing the midline with erosion of labial bony plates and root of 42 along with a tooth-like radiopaque mass within the lesion. Provisional diagnoses of odontogenic keratocyst, ameloblastomas, central giant cell granuloma and calcifying epithelial odontogenic tumor were listed. The histopathological and immunohistochemical examination of lesion followed by the biopsy confirmed the diagnosis of Ghost cell odontogenic carcinoma.
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Affiliation(s)
- Gopikrishnan Vijayakumar
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Post Graduate Institute of Dental Sciences, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Mala Kamboj
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Post Graduate Institute of Dental Sciences, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Anjali Narwal
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Post Graduate Institute of Dental Sciences, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Anju Devi
- Department of Oral and Maxillofacial Pathology and Oral Microbiology, Post Graduate Institute of Dental Sciences, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, India
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Jia MQ, Jia J, Wang L, Zou HX. Ghost cell odontogenic carcinoma of the jaws: Report of two cases and a literature review. World J Clin Cases 2019; 7:357-365. [PMID: 30746377 PMCID: PMC6369398 DOI: 10.12998/wjcc.v7.i3.357] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/27/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic epithelial tumor with features of benign calcifying odontogenic cysts. Herein, we report two new cases of GCOC and systematically review the previous literature.
CASE SUMMARY In case 1, a 46-year-old man complained of painless swelling of the right maxilla for 3 years, with a 1-mo history of hemorrhinia in the right nasal cavity. In case 2, a 72-year-old man was referred to our hospital with a chief complaint of painful swelling of the right mandible. Initially, the preliminary diagnoses were ameloblastomas. Thus, the two patients underwent resection of the tumor under general anesthesia. Finally, immunohistochemical examination confirmed the diagnosis of GCOC. The patient in case 1 was followed for 2 years, with no evidence of recurrence. However, the patient in case 2 was lost to follow-up.
CONCLUSION GCOC is a rare malignant odontogenic epithelial tumor with high recurrence. Local extensive resection is necessary for the definitive treatment of GCOC.
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Affiliation(s)
- Meng-Qi Jia
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Jun Jia
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Li Wang
- Department of Pathology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
| | - Hai-Xiao Zou
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, Hubei Province, China
- Department of Stomatology, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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Qin Y, Lu Y, Zheng L, Liu H. Ghost cell odontogenic carcinoma with suspected cholesterol granuloma of the maxillary sinus in a patient treated with combined modality therapy: A case report and the review of literature. Medicine (Baltimore) 2018; 97:e9816. [PMID: 29443742 PMCID: PMC5839843 DOI: 10.1097/md.0000000000009816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Ghost cell odontogenic carcinoma (GCOC) is a rare malignant odontogenic tumor with aggressive growth characteristics. PATIENT CONCERNS A 41-year-old Chinese male visited our hospital in 2013, with a 4-month history of bloody purulent rhinorrhea with a peculiar smell in the right nasal cavity. DIAGNOSES The patient suffered from recurrent GCOC with suspected cholesterol granuloma of the maxillary sinus. The patient was incorrectly diagnosed with a calcifying epithelial odontogenic tumor at his first recurrence. Physical examination, radiological examination, and histopathology were used to identify GCOC. INTERVENTIONS Considering the recurrence of GCOC and poor effects of single surgery, postoperative adjuvant chemotherapy and concurrent chemoradiotherapy were performed after radical surgical excision. OUTCOMES So far, no significant evidence has suggested recurrence or metastasis after a long-term follow-up. LESSONS We advocate wide surgery with clean margins at the first accurate diagnosis. Combined modality therapy could be taken for the recurrent GCOC. We expect to provide a new treatment strategy to prevent the growth of this neoplasm.
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Affiliation(s)
| | | | | | - Hong Liu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Namana M, Majumdar S, Uppala D, Avv A, Rao AK. Ghost Cell Odontogenic Carcinoma Arising Denovo with Distant Metastasis: A Case Report and Review of Literature. J Clin Diagn Res 2017; 11:ZD01-ZD03. [PMID: 28969291 DOI: 10.7860/jcdr/2017/28143.10445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/25/2017] [Indexed: 11/24/2022]
Abstract
Ghost Cell Odontogenic Carcinoma (GCOC) is a rare malignant odontogenic tumour of epithelial origin accounting about 0.37% to 2.1% of all odontogenic tumours. They are characterized by the presence of ameloblastic islands along with ghost cells representing aberrant keratinization. The aim of this case report is to present a rare case that was diagnosed in a 37-year-old male patient and to describe the behavior of the tumour.
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Affiliation(s)
- Madhurya Namana
- Postgraduate Student, Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Sumit Majumdar
- Head, Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Divya Uppala
- Reader, Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Aditya Avv
- Postgraduate Student, Department of Oral Pathology, GITAM Dental College and Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Ayyagari Kameswara Rao
- Dental Assistant Surgeon, Community Health Center, APVVP, Vizianagaram, Andhra Pradesh, India
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Ahmed SK, Watanabe M, deMello DE, Daniels TB. Pediatric Metastatic Odontogenic Ghost Cell Carcinoma: A Multimodal Treatment Approach. Rare Tumors 2015; 7:5855. [PMID: 26266014 PMCID: PMC4508645 DOI: 10.4081/rt.2015.5855] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/16/2015] [Indexed: 12/02/2022] Open
Abstract
Odontogenic ghost cell carcinoma (OGCC) is a rare and aggressive tumor wherein optimal treatment remains uncertain. We report the first pediatric metastatic OGCC case treated with multimodal therapy: surgery, adjuvant chemoradiation, and adjuvant immunotherapy. Adjuvant therapy was utilized due to locally advanced disease with pathologic features indicative of high recurrence risk. This multimodal approach was modeled after management of primary head and neck cancer, where adjuvant chemoradiation and immunotherapy are associated with improved outcomes. Our patient is alive and disease free at 14 months indicating a potentially positive role for multimodal therapy in the management of OGCC.
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Affiliation(s)
- Safia K Ahmed
- Department of Radiation Oncology, Mayo Clinic , Rochester, MN
| | - Masayo Watanabe
- Department of Cancer and Blood Disorders, Phoenix Children's Hospital , AZ
| | - Daphne E deMello
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital , AZ
| | - Thomas B Daniels
- Department of Radiation Oncology, Mayo Clinic , Phoenix, AZ, USA
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Martos-Fernández M, Alberola-Ferranti M, Hueto-Madrid JA, Bescós-Atín C. Ghost cell odontogenic carcinoma: A rare case report and review of literature. J Clin Exp Dent 2014; 6:e602-6. [PMID: 25674335 PMCID: PMC4312695 DOI: 10.4317/jced.51809] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 08/12/2014] [Indexed: 12/20/2022] Open
Abstract
Objectives: Ghost cell odontogenic carcinoma is a rare condition characterized by ameloblastic-like islands of epithelial cells with aberrant keratinitation in the form of Ghost cell with varying amounts of dysplastic dentina.
Material and Methods: We report a case of a 70 year-old woman with a rapid onset of painful swelling right maxillary tumor. Magnetic resonance showed a huge tumor dependent on the right half of the right hard palate with invasion of the pterygoid process and focally to the second branch of the trigeminal. Radiological stage was T4N0. The patient underwent a right subtotal maxillectomy with clear margins. Adjuvant radiotherapy was given. The patient was free of residual or recurrent disease 12 months after surgery.
Results: The tumor was 3,9cm in diameter. It was spongy and whitish gray. Microscopically the tumor was arranged in nets and trabeculae, occasionally forming palisade. Tumoral cells had clear cytoplasm with vesicular nuclei. There was atipia and mitosi with vascular and perineural invasion. The excised tumor was diagnosed as a GCOC.
Conclusions: Ghost cell carcinoma is a rare odontogenic carcinoma. Its course is unpredictable, ranging from locally invasive tumors of slow growth to highly aggressive and infiltrative ones. Wide surgical excision with clean margins is the treatment of choice although its combination with postoperative radiation therapy, with or without chemotherapy, remains controversial.
Key words:Ameloblastic carcinoma, calcifying odontogenic cyst, Ghost cell carcinoma, keratinizing epithelial odontogenic cyst, maxillary tumor, odontogenic carcinoma.
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Affiliation(s)
- Míriam Martos-Fernández
- MD. Resident, Oral and Maxillofacial Surgery Department, Vall d'Hebrón Hospital. Barcelona, Spain
| | | | - Juan Antonio Hueto-Madrid
- MD, DDS. Assistant Surgeon, Oral and Maxillofacial Surgery Department, Vall d'Hebrón Hospital, Barcelona, Spain. Researcher of the VHIR group
| | - Coro Bescós-Atín
- PhD MD, DDS. Head of Oral and Maxillofacial Surgery Department, Vall d'Hebrón Hospital. Barcelona, Spain. Researcher of the VHIR group
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Ki-67 and p53 expression in ghost cell odontogenic carcinoma: a case report and literature review. Oral Maxillofac Surg 2014; 19:85-9. [PMID: 25216652 DOI: 10.1007/s10006-014-0465-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/02/2014] [Indexed: 02/05/2023]
Abstract
Ghost cell odontogenic carcinomas are rare neoplasms that arise in the maxillary bones either from a calcifying odontogenic cyst or de novo. They are aggressive locally and can metastasize. We report herein a case of a ghost cell odontogenic carcinoma arising in the mandible of a Caucasian male 86 years of age. We have described the clinical and radiographic features, histological characteristics, immunohistochemistry findings, and surgical treatment. We especially focused on how Ki-67 expression guides the treatment choice. Finally, we reviewed 32 cases described in the literature and compared them with the cases described up until 2014 to help clinicians identify the diagnostic characteristics of and select appropriate treatment modalities for ghost cell odontogenic carcinomas.
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Arashiyama T, Kodama Y, Kobayashi T, Hoshina H, Takagi R, Hayashi T, Cheng J, Saku T. Ghost cell odontogenic carcinoma arising in the background of a benign calcifying cystic odontogenic tumor of the mandible. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:e35-40. [PMID: 22862988 DOI: 10.1016/j.oooo.2012.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 01/11/2012] [Accepted: 01/18/2012] [Indexed: 12/31/2022]
Abstract
Ghost cell odontogenic carcinoma (GCOC) is a rare malignant variant of odontogenic tumor with ghost cells; only 29 cases are documented. Our patient was a 68-year-old man with a painless, well-defined, radiolucent swelling of the mandibular gingiva in the right incisor-to-molar region. It was diagnosed as a benign calcifying cystic odontogenic tumor (CCOT) on fenestration biopsy. Eighteen years later, he returned with swelling in the same area. The lesion was excised, diagnosed as GCOC, and considered a secondary malignant manifestation of the benign CCOT. No adjuvant chemotherapy or radiotherapy was administered, and his postoperative course was uneventful for 48 months, with no recurrence or distant metastasis. Among the 30 reported cases of GCOC, the mean age at diagnosis was 40.3 years, 22 (73%) involved the maxilla. Twelve (40%) were secondary malignant manifestations of benign CCOTs or dentinogenic ghost cell tumors. Five patients died of recurrence or distant metastasis.
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Affiliation(s)
- Takaroni Arashiyama
- Division of Oral and Maxillofacial Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Motosugi U, Ogawa I, Yoda T, Abe T, Sugasawa M, Murata SI, Yasuda M, Sakurai T, Shimizu Y, Shimizu M. Ghost cell odontogenic carcinoma arising in calcifying odontogenic cyst. Ann Diagn Pathol 2009; 13:394-7. [PMID: 19917476 DOI: 10.1016/j.anndiagpath.2009.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 02/27/2009] [Indexed: 12/27/2022]
Abstract
A case of exceptionally rare odontogenic malignant tumor, called ghost cell odontogenic carcinoma, is described. The tumor was considered to be derived from calcifying odontogenic cyst, which had been resected 5 years before. In the present resected specimen, cellular atypia, mitotic activity, Ki-67 labeling index, and p53 positivity were all increased in comparison with the initially resected specimen. This is a valuable case in which malignant transformation from calcifying odontogenic cyst to ghost cell odontogenic carcinoma was proven by the histopathologic and immunohistochemical findings. Pathologists should be aware of this rare entity.
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Affiliation(s)
- Utaroh Motosugi
- Department of Pathology, Saitama Medical University International Medical Center, Saitama 350-1298, Japan.
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12
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Li BB, Gao Y. Ghost cell odontogenic carcinoma transformed from a dentinogenic ghost cell tumor of maxilla after multiple recurrences. ACTA ACUST UNITED AC 2009; 107:691-5. [PMID: 19272810 DOI: 10.1016/j.tripleo.2009.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 01/05/2009] [Accepted: 01/05/2009] [Indexed: 10/21/2022]
Abstract
Dentinogenic ghost cell tumor (DGCT), also referred to as odontogenic ghost cell tumor, is a rare tumor classified as a neoplastic variant of calcifying odontogenic cyst (COC). Ghost cell odontogenic carcinoma (GCOC) is the especially rare malignant counterpart of DGCT and COC. The case of a middle-aged male with a maxillary DGCT which transformed to GCOC after 5 recurrences during a 21-year period is presented. When the diagnosis of GCOC (first identified as malignant after 17-year recurrence) was made, the tumor cells showed more obvious atypia, necrosis, and numerous mitoses, and interestingly the ghost cell was hard to find and even disappeared. The significances in pathologic diagnosis and clinical treatment are discussed.
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Affiliation(s)
- Bin-Bin Li
- Department of Oral Pathology, Peking University School, Hospital of Stomatology, Beijing, China
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13
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Roh GS, Jeon BT, Park BW, Kim DR, Hah YS, Kim JH, Byun JH. Ghost cell odontogenic carcinoma of the mandible: a case report demonstrating expression of tartrate-resistant acid phosphatase (TRAP) and vitronectin receptor. J Craniomaxillofac Surg 2008; 36:419-23. [PMID: 18674923 DOI: 10.1016/j.jcms.2008.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 06/10/2008] [Accepted: 06/17/2008] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Ghost cell odontogenic carcinoma is a rare neoplastic variant of calcifying odontogenic cyst, with aggressive growth characteristics. A painful swelling in the jaws with local paraesthesia is the most common symptom. Although it often causes irregular destruction of the adjacent bone, immunohistochemical expression of tartrate-resistant acid phosphatase (TRAP) and vitronectin receptor has not previously been described in this carcinoma. CASE REPORT This article describes a ghost cell odontogenic carcinoma affecting the mandible of a 55-year-old man. The patient was treated by segmental mandibulectomy and there was no evidence of recurrence or metastasis for 1.8 years. Cytological features including the immunohistochemical expression of TRAP and vitronectin receptor were studied. CONCLUSION Specimens revealed varying sized islands of anucleate cell clusters with homogenous, pale eosinophilic cytoplasm, so called ghost cells, admixed with sheets of tumour. TRAP and vitronectin receptor were detected in the ghost cells, but they were not expressed in the tumour cells. Our findings suggest that some of the cytokines produced by ghost cells may play important roles in causing extensive bone resorption in the ghost cell odontogenic carcinoma.
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Affiliation(s)
- Gu Seob Roh
- Department of Anatomy, Gyeongsang National University School of Medicine, Jinju, South Korea
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Iezzi G, Rubini C, Fioroni M, Piattelli A. Peripheral dentinogenic ghost cell tumor of the gingiva. J Periodontol 2008; 78:1635-8. [PMID: 17668984 DOI: 10.1902/jop.2007.060464] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A dentinogenic ghost cell tumor is a locally invasive neoplasm that is characterized by ameloblastoma-like islands of epithelial cells in a mature connective tissue stroma. METHODS A 43-year-old male patient presented a well-circumscribed sessile, exophytic mass of the gingiva with a diameter of 2 cm located in the canine area of the right maxilla. The lesion was enucleated. RESULTS The lesion showed odontogenic epithelium, ghost cells, dentinoid material, and giant cells. The final microscopic diagnosis was a dentinogenic ghost cell tumor. CONCLUSIONS A dentinogenic ghost cell tumor is an extremely rare tumor, and only a few cases have been reported in the English literature. The peripheral, extraosseous lesion can be easily confused with other gingival lesions such as reactive or inflammatory lesions or other peripheral odontogenic tumors. The clinical appearance of all of these lesions is similar; therefore, the definitive diagnosis depends on histology, and a biopsy with a microscopic examination is mandatory.
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Affiliation(s)
- Giovanna Iezzi
- Department of Odontostomatologic Science, Dental School, University of Chieti-Pescara, Chieti, Italy
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15
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Sun ZJ, Zhao YF, Zhang L, Li ZB, Chen XM, Zhang WF. Odontogenic ghost cell carcinoma in the maxilla: a case report and literature review. J Oral Maxillofac Surg 2007; 65:1820-4. [PMID: 17719405 DOI: 10.1016/j.joms.2006.06.289] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 12/13/2005] [Accepted: 06/14/2006] [Indexed: 12/20/2022]
Affiliation(s)
- Zhi-Jun Sun
- Department of Oral and Maxillofacial Surgery, Key Laboratory for Oral Biomedical Engineering, Ministry of Education, Wuhan University, Wuhan, People's Republic of China
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16
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Cheng Y, Long X, Li X, Bian Z, Chen X, Yang X. Clinical and radiological features of odontogenic ghost cell carcinoma: review of the literature and report of four new cases. Dentomaxillofac Radiol 2004; 33:152-7. [PMID: 15371314 DOI: 10.1259/dmfr/67909783] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyse systematically the clinical and radiological features of odontogenic ghost cell carcinoma (OGCC). METHODS Clinical and radiological features of 22 OGCCs (4 new and 18 from the literature) were analysed. RESULTS There were 17 (77%) males and 5 (23%) females (male-to-female ratio of 3.4:1). Ages ranged from 13 years to 72 years (mean 36.7) with a peak in the fourth (40.9%) and fifth (27.3%) decades. The maxilla was involved in 68% and the mandible in 32%. Our study confirmed that OGCC is more prevalent in Asians (12/18) than in other racial groups. The mixed radiolucent and radiopaque lesion pattern was the most frequent (14/19) compared with radiolucent lesions (5/19). 89% (17/19) showed poorly defined borders and 11% (2/19) showed well defined borders. Root resorption was reported in 31% (6/19) of patients and tooth displacements in 21%. CONCLUSIONS OGCC demonstrates clinical and radiographic features of a malignant tumour with high recurrence.
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Affiliation(s)
- Y Cheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Wuhan University, Wuhan, Hubei, PR China 430079
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Abstract
BACKGROUND Odontogenic ghost cell carcinoma (OGCC), a malignant counterpart of the calcifying odontogenic cyst (COC), is exceedingly rare. Previous descriptions of this tumor were based on identification of malignant histologic characteristics such as infiltration, cellular pleomorphism, numerous mitoses, and necrosis concurrent with classical benign COC or its solid benign variant, the odontogenic ghost cell tumor. METHODS We present a case of a young Asian man who underwent multiple local excisions of a recurring maxillary COC. After one such excision, a rapid onset of painful swelling ensued, and the patient was referred to our institution for definitive surgery. RESULTS The patient underwent a right subtotal maxillectomy. Intraoperatively, a 5-cm tumor was found to be extending into the right maxillary sinus and nasal cavity. The excised tumor was diagnosed as an OGCC. The tumor was excised with clear margins, and no adjunctive radiotherapy was given. The patient was free of residual or recurrent disease 18 months after surgery. CONCLUSION On the basis of this case and prior cases found in the literature, OGCCs show a spectrum of growth from slow growing locally invasive tumors to highly aggressive, rapidly growing, infiltrative tumors. Wide local excision with histologically clean margins is the recommended mode of treatment. We recommend close long-term surveillance of recurrent or long-standing benign COCs and OGCC.
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Affiliation(s)
- David Goldenberg
- Department of Otolaryngology--Head and Neck Surgery, The Johns Hopkins University School of Medicine, JHOC, 601 N. Caroline St., Baltimore, Maryland, USA
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18
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Fenton S, Slootweg PJ, Dunnebier EA, Mourits MP. Odontogenic myxoma in a 17-month-old child: a case report. J Oral Maxillofac Surg 2003; 61:734-6. [PMID: 12796890 DOI: 10.1053/joms.2003.50121] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sinead Fenton
- University Medical Centre, Utrecht, The Netherlands.
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19
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Li TJ, Yu SF. Clinicopathologic spectrum of the so-called calcifying odontogenic cysts: a study of 21 intraosseous cases with reconsideration of the terminology and classification. Am J Surg Pathol 2003; 27:372-84. [PMID: 12604894 DOI: 10.1097/00000478-200303000-00011] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The so-called calcifying odontogenic cyst (COC) represents a heterogeneous group of lesions that exhibit a variety of clinicopathologic and behavioral features. Because of this diversity, there has been confusion and disagreement on the terminology and classification of these lesions. We reviewed the clinicopathologic features of 21 intraosseous cases that were previously diagnosed as COC or under related diagnostic terms. Based on the biologic behavior, the lesions of the present series were divided into three subgroups: cyst, benign tumor, and malignant tumor. Sixteen cases (nine men and seven women) proved to be unicystic lesions with (five cases) or without associated odontoma. The lining epithelium of the cystic lesions fulfilled the histologic criteria for COC proposed by the World Health Organization, and their overall clinicopathologic features were consistent with that of developmental odontogenic cysts. The age of patients from the cyst group peaked at the second decade. The maxilla was affected more often (69%) than the mandible, with a predilection for the canine-premolar region (62.5%). Thirteen patients with follow-up information revealed no recurrence following enucleation. The four cases in the benign tumor group had variable clinicopathologic features. Two cases were solid tumors consisting of ameloblastoma-like sheets of odontogenic epithelium that contained ghost cells/calcification foci and juxtaepithelial dentinoid. Both patients experienced multiple recurrences following conservative surgeries. The other two lesions contained typical areas of COC and other types of odontogenic tumors (one ameloblastoma and one odontogenic myxofibroma). All four lesions occurred in the mandible and were relatively large. In the present series one case identified as malignant tumor arose from a previously benign COC. The tumor shared some features of COC (ghost cell foci and dystrophic calcification) but also had prominent mitotic activity, nuclear and cytoplasmic pleomorphism, areas of tumor necrosis, and infiltrative/destructive growth. Recognizing the extreme diversity in clinicopathologic features and biologic behavior among the so-called COCs, we suggest that the term COC should be used to specifically designate the unicystic lesions with or without an associated odontoma, i.e., lesions of the cyst group, and other related lesions identified as benign tumor and malignant tumor should be termed and classified separately. A tentative scheme with respect to the terminology and classification for this group of disparately behaving lesions was herein proposed to reflect the likely difference of their nature.
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Affiliation(s)
- Tie-Jun Li
- Department of Oral Pathology, School of Stomatology, Peking University, 22 South Zhongguancun Avenue, Haidian District, Beijing 100081, P. R. China.
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20
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Moleri AB, Moreira LC, Carvalho JJ. Comparative morphology of 7 new cases of calcifying odontogenic cysts. J Oral Maxillofac Surg 2002; 60:689-96. [PMID: 12022111 DOI: 10.1053/joms.2002.33123] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A B Moleri
- Department of Stomatology, Grande Rio University School of Dentistry, Rio de Janeiro, Brazil.
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21
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Kim HJ, Choi SK, Lee CJ, Suh CH. Aggressive epithelial odontogenic ghost cell tumor in the mandible: CT and MR imaging findings. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2001. [PMID: 11158905 DOI: 10.1002/0470846453.ch77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report a case of aggressive epithelial odontogenic ghost cell tumor arising from the mandible in a 32-year-old man. On CT and MR studies, the tumor was seen as a large, heterogeneous soft-tissue mass that caused marked destruction of the mandible and invaded the mouth floor and tongue base. The tumor displayed a variety of densities and signal intensities on CT and MR images, which correlated well with the degree of cellularity of epithelial islands, abundance of ghost cells and eosinophilic materials, calcification, and cystic areas on histologic sections. Owing to the unpredictable biological behavior of this type of tumor, careful, long-term follow-up is highly recommended.
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Affiliation(s)
- H J Kim
- Department of Radiology, Inha University Hospital, Inchon, Korea
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22
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Kim J, Lee EH, Yook JI, Han JY, Yoon JH, Ellis GL. Odontogenic ghost cell carcinoma: a case report with reference to the relation between apoptosis and ghost cells. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2000; 90:630-5. [PMID: 11077388 DOI: 10.1067/moe.2000.109016] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The neoplastic variant of calcifying odontogenic cyst has various designations, and its malignant counterpart has been reported as aggressive epithelial odontogenic ghost cell tumor or odontogenic ghost cell carcinoma. We present a case of odontogenic ghost cell carcinoma with reference to the relation between the ghost cells and apoptosis. A 33-year-old man complained of a mandibular mass. The mass occupied the entire right side of the mandible with destruction of both buccal and lingual bone. The mass also infiltrated into submandibular and sublingual spaces. Histologically, the mass was composed of a solid proliferation of hyperchromatic and pleomorphic epithelial cells with abnormal mitoses. Islands of ghost cells were frequently admixed with nucleated cells, and there were foci of ameloblastic differentiation. Immunohistochemical stains for cytokeratins, involucrin, and apoptosis-related proteins such as Bcl-2, Bcl-X(L), and Bax were done. Terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) assay was also performed. The nucleated cells adjacent to the ghost cells expressed cytokeratins and involucrin, but the ghost cells had no reaction. Bcl-2 was negative. Both Bcl-X(L) and Bax were demonstrated in the nucleated cells adjacent to the ghost cells. The ghost cells exhibited Bax protein. Some nucleated cells adjacent to the ghost cells were positive with TUNEL assay. The above results indicate that ghost cells undergo abnormal terminal differentiation as an apoptotic process.
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Affiliation(s)
- J Kim
- Department of Oral Pathology, Yonsei University College of Dentistry, Seoul, Korea.
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23
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Kamijo R, Miyaoka K, Tachikawa T, Nagumo M. Odontogenic ghost cell carcinoma: report of a case. J Oral Maxillofac Surg 1999; 57:1266-70. [PMID: 10513878 DOI: 10.1016/s0278-2391(99)90502-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- R Kamijo
- Second Department of Oral and Maxillofacial Surgery, School of Dentistry, Showa University, Tokyo, Japan
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24
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Abstract
A 57-year-old man had an expanding cystic lesion of the anterior maxilla that demonstrated destruction and disruption of local structures. A cystic odontogenic neoplasm as well as various forms of odontogenic carcinoma was suspected. Incisional biopsy and microscopic examination revealed an aggressive epithelial odontogenic tumor with histologic features suggesting malignant transformation from an odontogenic cyst. The patient continues to refuse further treatment despite remaining tumor. This case further documents the malignant potential of a calcifying odontogenic cyst and the existence of at least an aggressive or possibly malignant form of epithelial odontogenic ghost cell tumor. To date, metastatic work-up has not been performed.
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Affiliation(s)
- J T Castle
- Oral & Maxillofacial Pathology, Armed Forces Institute of Pathology, Washington, DC, USA
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25
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Lu Y, Mock D, Takata T, Jordan RC. Odontogenic ghost cell carcinoma: report of four new cases and review of the literature. J Oral Pathol Med 1999; 28:323-9. [PMID: 10432199 DOI: 10.1111/j.1600-0714.1999.tb02048.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Only 12 odontogenic ghost cell carcinomas (OGCC) have been reported in the English language literature to date. This article reports four additional cases of this rare odontogenic tumour and examines them in relation to those previously described. Judging from the number of published cases, the OGCC is more prevalent in Asians than other racial groups, occurs more often in the maxilla than the mandible, and is slightly more common in males than females. Histologically, elements of a benign calcifying odontogenic cyst (COC) can be identified in all the malignant variants, either separated or admixed with the malignant epithelial component. The latter can consist of either small basaloid cells or large epithelial cells. Despite the differing histological presentations, the biological behavior of the tumour is unpredictable, with some cases characterized by relatively indolent growth and others by a locally aggressive and potentially fatal course. The tumour apparently arises most often from malignant transformation of a preexisting benign COC, although it may also develop from other odontogenic tumours.
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Affiliation(s)
- Y Lu
- University of Toronto and Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Ontario, Canada
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26
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Lombardi T, Küffer R, Di Felice R, Samson J. Epithelial odontogenic ghost cell tumour of the mandibular gingiva. Oral Oncol 1999; 35:439-42. [PMID: 10645413 DOI: 10.1016/s1368-8375(98)00128-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The epithelial odontogenic ghost cell tumour (EOGCT) is considered as a solid 'neoplastic' variant of the calcifying odontogenic cyst and is an uncommon lesion for which various names have been proposed over the years. We describe here an extraosseous case occurring on the edentulous mandibular gingiva in the right bicuspid area of a 70-year-old woman. The lesion was a painless nodule that appeared clinically as a hyperplastic mass, which was considered to be of reactive nature. Radiographic examination showed a localised resorption of the underlying mandibular bone. The tumour was excised; there was no recurrence at a 2-year follow-up examination.
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Affiliation(s)
- T Lombardi
- Laboratory of Oral Histopathology, Faculty of Medicine, University of Geneva, Switzerland.
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27
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Ide F, Shimoyama T, Horie N, Shimizu S. Intraosseous squamous cell carcinoma arising in association with a squamous odontogenic tumour of the mandible. Oral Oncol 1999; 35:431-4. [PMID: 10645411 DOI: 10.1016/s1368-8375(99)00010-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a rare occurrence of intraosseous squamous cell carcinoma (SCC) arising in association with a squamous odontogenic tumour (SOT), which had not previously been documented in the literature. A 53-year-old man had, for 5 years, a well-demarcated radiolucency attached to the impacted third molar of the mandible. The enucleated specimen had a characteristic pattern of SOT, but in which a few epithelial islands showed atypical features suggestive of SCC. Intense p53-, proliferating cell nuclear antigen- and Ki-67-positive cells were detected in carcinoma areas. Within 2 months, aggressive bone destruction showing typical findings of intraosseous SCC appeared. The present tumour is presumably a malignant variant of SOT.
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Affiliation(s)
- F Ide
- Department of Oral Surgery, Saitama Medical Center, Saitama Medical School, Japan
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28
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Affiliation(s)
- W R Walstad
- Oral and Maxillofacial Surgery, Baylor College of Dentistry, Dallas, TX 75266-0677, USA
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29
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Takata T, Lu Y, Ogawa I, Zhao M, Zhou ZY, Mock D, Nikai H. Proliferative activity of calcifying odontogenic cysts as evaluated by proliferating cell nuclear antigen labeling index. Pathol Int 1998; 48:877-81. [PMID: 9832056 DOI: 10.1111/j.1440-1827.1998.tb03854.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The calcifying odontogenic cyst (COC) presents with diverse histological features; thus, several subclassifications have been proposed. To evaluate the significance of the various histological features and subtypes of COC from the perspective of proliferative activity, the proliferating cell nuclear antigen (PCNA) labeling index (LI; the percentage of positive nuclei) was assessed immunohistochemically in 25 cases of COC (21 benign and four malignant). All of the benign cases were of the cystic variety and further subclassified into non-proliferative subtype (NPS; four cases); proliferative subtype (PS; eight cases); and COC associated with odontoma (COCaO, nine cases). The PCNA LI of the malignant COC (65.2+/-5.6) was significantly higher than that of the benign COC (11.6+/-9.0; P = 0.002). Non-proliferative subtype (6.8+/-2.8) showed the lowest PCNA LI and PS (17.2+/-11.2) the highest of among the three subtypes of benign cystic COC (P = 0.028). In nine cases of COCaO, six showed epithelial lining of the non-proliferative type as NPS and the other three had lining with proliferative features as PS. The PCNA LI of the latter COCaO group (14.3+/-6.6) was significantly higher than that of the former (6.1+/-4.3; P = 0.05), as seen between PS and NPS. These results demonstrate that PCNA LI is a possible parameter for differentiating malignant COC from benign COC and, whatever the subtypes, the proliferative features in the lining are the main factor influencing the proliferating activity of COC.
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Affiliation(s)
- T Takata
- Department of Oral Pathology, Hiroshima University School of Dentistry, Japan.
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Piattelli A, Fioroni M, Di Alberti L, Rubini C. Immunohistochemical analysis of a dentinogenic ghost cell tumour. Oral Oncol 1998; 34:502-7. [PMID: 9930362 DOI: 10.1016/s1368-8375(98)00034-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A dentinogenic ghost cell tumour in an 80-year-old male patient is presented. It is an extremely rare tumour and only 10 cases have been reported in the English literature. The lesion showed odontogenic epithelium, ghost cells, dentinoid, giant cells. The immunohistochemical analysis for Mib-1 and bel-2 showed a strong positivity of the cells of the odontogenic epithelium, while with p53 only a rare positivity was observed. Completely negative were the ghost cells, giant cells and dentinoid material. In this tumour the cells expressing Mib-1 and bcl-2 could be the cells that proliferate, and that could undergo malignant transformation.
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31
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Folpe AL, Tsue T, Rogerson L, Weymuller E, Oda D, True LD. Odontogenic ghost cell carcinoma: a case report with immunohistochemical and ultrastructural characterization. J Oral Pathol Med 1998; 27:185-9. [PMID: 9563575 DOI: 10.1111/j.1600-0714.1998.tb01938.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The odontogenic ghost cell tumor (OGCT) is the rare, neoplastic variant of the calcifying odontogenic cyst (COC). To date, there have been only four reports of malignant OGCTs, in five patients. We report an additional case of a malignant odontogenic ghost cell tumor that involved the right maxilla of a 20-year-old man. Our report includes its immunocytochemical and ultrastructural characterization.
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Affiliation(s)
- A L Folpe
- Department of Pathology, University of Washington, Seattle, USA
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