|SLIDE SEMINAR BSOMP 2012
Panel: Professor JM Wright (TAMHSC, Baylor College of Dentistry, Dallas, Texas), Professor PR Morgan (KCL), Dr KD Hunter (Sheffield), Dr BI Conn (Edinburgh)
Case 1 (Leicester):
Panel diagnosis: no consensus, suggested within spectrum of CEOT
Local Diagnosis: Peripheral odontogenic fibroma
Tumour does not fit into any current conventional category. Notable nuclear inclusions. No clinical recurrence at time of meeting (case from 2008)
Case 11 (North Manchester):
Panel and local diagnosis: epithelium-rich odontogenic fibroma.
Treated with curettage
Case 2 (Groningen):
Panel and local diagnosis: ameloblastic carcinoma (same as local diagnosis)
Treated by hemimaxillectomy – original histology showed plexiform ameloblastoma. Did tumour develop from benign plexiform ameloblastoma? Patient well after 18 months
Note: Cytokeratin 18, MMP-2, MMP-9 and Ki-67 may be useful markers for differentiating ameloblastic carcinoma from ameloblastoma. See Yoon HJ, Jo BC, et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011: 112(6): 767-776.
Case 7 (Belfast):
The panel preferred odontogenic carcinoma. The local diagnosis was clear cell odontogenic carcinoma and the possibility of sclerosing odontogenic carcinoma was raised. Professor Wright did not regard the features in case 7 as consistent with descriptions of this entity.
Patient had loose tooth removed by dentist 18 months prior to presentation. Mandibulectomy with clinically 20mm clear margin – lesion was present along full length of marrow cavity up to the bone margin. Further 15mm taken to midline – bone margin also involved. Further specimen from beyond midline clear. Neck dissection negative.
Case 9 (Inverness):
Panel and local diagnosis: ameloblastoma
Sections form the original 1969 tumour show a unicystic ameloblastoma with mural invasion; the 2009 tumour is a conventional ameloblastoma. 1969 case diagnosed as inflammatory cyst at the time
Case 12 (Northwick Park):
Panel diagnosis: ameloblastic carcinoma (by W.H.O. classification) or odontogenic carcinoma.
7 years previously the patient developed swelling of anterior mandible with perforation of lingual plate and extension to floor of mouth. Biopsy showed ameloblastoma. Anterior mandibulectomy showed ameloblastoma with follicular and plexiform patterns. 1 year prior to current surgical episode: Lesion on right chin: Biopsy suggested a skin adnexal tumour with clear cell features. Subsequent CT showed recurrence in mandible: Resected specimen showed odontogenic carcinoma
Panel diagnosis: Follicle with active components of enamel organ. Not neoplastic.
Local diagnosis: odontome, possibly compound. Malformed dental tissue was also included in other blocks
Case 4 (Manchester):
Panel and local diagnosis: ameloblastic fibrodentinosarcoma.
Imaging showed lesion not overtly malignant - well defined and in dentigerous relationship with grossly displaced unerupted 8. Possible erosion of distal root of 7, possible irregular hard tissue in ramus region.
Case 8 (Turku):
Panel differential: Ameloblastic fibro-odontoma/ameloblastic fibroodontosarcoma or intermediate stage between benign and malignant. Zones of cellularity and atypia in stroma suspicious for malignancy but how much atypia is acceptable in mixed odontogenic tumour stroma?
Local diagnosis: Ameloblastic fibro-odontoma
Patient treated with extended hemimaxillectomy. No recurrence in 20+ years. Surgery was only modality.
Case 5 (Newcastle):
Panel diagnosis: calcifying epithelial odontogenic tumour, possibly malignant on the basis of the tumour’s clinical behaviour.
Case 6 (Amsterdam):
Panel Diagnosis: odontogenic cyst NOS – possibly dentigerous;
Local diagnosis was unicystic ameloblastoma, luminal variant.
Case 10 (East Grinstead):
Panel diagnosis: odontogenic carcinoma;
Local diagnosis was clear cell odontogenic carcinoma. Cytokeratin 19 expression focal. Frequent apoptoses.