ChSE U

CASE 12

CASE f3

CASF. ~ 4

f'LLIS FISC!iFL STATE C.I>.NCEK <.:l<<n'l:lt<

ORAL I'A'I'ROLOGY SEMINAR 183 O.P.S. NO. 84-15 MIIRC!l 1. 1984

CASE HISTORIES

(S8J-l2862) Contributed by Noel Weidner, M.D., Pathologist, The University of Iowa, Iowa City, Iowa.

The case corresponds to a 2 em, riqht cheek mass of two weeks duration taken from an 18 year old black, athletic male. The mass was situated such that an intra-oral approach was chosen.

(S83-l473lE) Contributed by Noel Weidner, M.D., Patholoqist , The University of Iowa, Iowa City, Iowa.

This case represents maxillary and mandibular tissue sampled from an ll year old female. She presents with multiple maxillary and mandibular, radiolucent , eystic lesions (35 mm X-ray photos x 21. She has no skin lesions, bifid ribs, or palmar pitting. The patient's father has basal cell nevus syndrome.

(172/83) Contributed by Risto-Pekka Happonen, D.D.S., Oral Pathologist, Institute of Dentistry, tTniversity of Turku, Finland.

A hard exostosis-like tumor measuring 3.0 x 2.0 x 1.5 em was excised from the left edentnlous maxillary alveolar crest of a healthy 54 year old woman {x-ray included). The lesion had been present more than one year causing difficulties i n wearing denture.

(114/83) Contributed by Risto-Pekka Happonen, D.D.S, Oral Pathologist, Institute of Dentistry, University of Turku, Finland.

!I 36 year old man complained about pain in the left mandibular molar region. Radiologically a sclerotic expansive tumor with sun-ray appearance was fou.a. Diagnosis of osteosarcoma was made from a biopsy specimen taken from the lesion. The mandible was resected. The enclosed slide is a transversal section from the resection specimen.

•

I

\ • .r O.PJS 84-15 CASE HISTORIES CONTINUED:

CASE 5.

CASE 16.

CASE t7.

CASE ~8 ..

CASE ~9.

(D~lA) COntributed by Char l es l'laldron, o.o.s., Washington Univ. School o ·f Dental Medicin~, St. Louis, He.

A wh.ite firl, age 8, had a mandi bular swelling of uncertain duration. Radiographs showed a large, lytic lesion of the left body and asce~ding ramus of the mandible. A biopsy was performed and based on t he pathology report, the tumor was ~emoved by enucleation and curettage. Rapid recurrence followed with pathol<>"gic fracture and development of a large perimandibular mass. A mandibular resection was then performed. The slides are from t his resection specimen. 1

(10523-83) COntributed by James J. Sciubba, DMD, PhD, Long Island Jew~sh Hillsi de Nedical €enter , Byde Park, New York 58 year o ld white male who presented with a mass in the superior portion of t:he nasal cavity. Tb.fs mass produced a deformity of the bridge of the nose and was noted to involve t he frontal e ,thyqiDid sinuses in addition to the nasal septum.

(8069-83) Contr ibuted by Dr. Virgilio Cardona Lopez, Departamento de pathologia, Esc:;ula de He9.icina, TegucigaLpa, Honduras, Central America L.~.P~ , 16 year dld female developed a painful mass in t~e hard P.alate o~ two monthS duration without involvement of the mucosa. On palpation it was hard and fixed. A biopsy was obtained.

(.UMKSC4-02.0) Contributed by Charles Dunlap &-Bruce Barker, DDS, Dept. of Oral Path ., Univ. of Me-Kansas City School of Den.tistry

Two slides submitted. In Hay of 1983, this 10 year old boy was hit in the j aw with a baseball bat. Ln August ,P.ainless swelli~ was noted -in the area. ~adiographs showed a 5.0 em sharply, circumscribed lesion o f the entire r j.qht ramus. It was radio­lucent wi t h multiple small dense bodies.

tJMKC 84-079) Cont~ibuted by Charles Dunlap & Bruce Barker, n.D.S. Dep t . of_ Or<!l I' a~,, !jniv. of Mo.-Kansas- City,;-.?chool-o.f. Dentistry

A 14 year old fel)lale had a 1.5 em radiolucent lesion ad,jacent to the apex of tooth t.7. There was s.welling and pain and· res­orption of t he tooth root. CliniCal impression was abscess.

'

UNIVERSITY OF MINNESOTA 1VIINCnt£S

Or. Ca rlos Perez-Nasa El l is Fi schel Sta te Cancer Hospi tal Department of Pathology Columbia, MO 65201

Dear Carlos:

Divlsoon ol Sur!;icll PothoiO!IY ~ ot l.abo<IIOIY 1.-ne 8lld Palhd~ Sox 76. Mayo lltmOna! Bu<cing

''""'""'"'"· ,.. """ .... 5!>455 (6>2) 373-8760

February 13, 1984

These are my diagnostic impressions in the cases for the Oral P~thology Seminar 183, to be held on March l, 1984.

Case 1.- Beautiful case of nodular fasclltls. I have seen several examples of this entity within the oral cavity. In addition, I have lately seen three cases of typical nodular fa.sciltis located within a major salivary gland.

Case 2.- This is a primordial cyst (keratocyst) of the jaw. In view of the histology and history , I suppose that this could represent a form frus t re of the basal cel l nevus syndrome.

Case 3.- I pass.

Case 4.· I think that t hi s is an osteosarcoma. The al ternat ive is an aggressive osteoblastoma, but I t hink that there is too much atypicality for the l atter.

Case 5.- This is a sarcoma, but 1 am not sure about the kind. It is not a particularly good preparation from a technical standpoint.

Case 6.· It looks like an adenocarcinoma, perhaps with neuroendocrine features, but the section is so poorly stained that it is Impossible to evaluate the cell details.

Cas! 7.- My differential diagnosis is between osteoblastoma and osteo· sarcoma. I favor the fonner, but the biopsy is too small and fragmented to make a definitive diagnosis.

Case 8.· Compound odontoma.

Or. Carlos Perez-Mesa - 2 -February 13, 1984

Case 9.- I don't know, but it looks benign, epithelial , and probably odontogenic. I also considered the possibility of this representing the juxtaoral organ of Chievitz, but I th ink there Is too much of It for thi s structure.

I looked at these cases in a rush. Please don ' t quote me in the proceedings, If I am too far off in my impressions. See you in San Francisco.

JR/dmp

Best Rersonal regards,

Juan Rosa\, M.D. Professor, Laboratory Medicine

and Pathology Di rector of Anatomic Pathology

CASE 5o

CASE 6o

"OFFICIAL" DIAGNOSES, OPS 84-15 , MARCH 1, 1984

Coa.t.ia.ued:

Santa Cruz froa Washington Uoiversicy, Kina from SIU. Waldron fyoa Waabingcou Ua.iveraity, Dunlap and Barker fro• Oolveraity of Hiasouri-Kansas City, Toto froa Loyola preferr~d osteosarcoma. Sc..iubba fro. Stoney Brook c a.ae.nted: ''Oateosat'C:OIU. Note: there are eleaenu re:a11liacent of an oateobla.storaa here. One caay choose to consider Ule rare e:u..ple o! oateosarco:ma arising v i thin a previoutly Ulat:log osteoblaatoma.. " Abrams from USC also prefer~ed osteosarc:oaa while Tarpley •nd Corio froa NIH preferred osteoblastic chondroaareoaa. Weidner frOID the Medical School, Un.iver•ity ot lova: "osteoblaato.t.a (.a;o c alled be.ntan cementoblastoma). u -The latter di.a&nosia, benign cmeatoblaatomm vas preferred by Sprague froca Nebraska. Hansen f-co11 San Francisco comme.nte.d: "The problem appear s t o be osteoblastom.o vs. osteosarcoma. I favor the fonaer . " Osteoblaat.oma vas also preferred by Lu.etman f rom Fluah:tng. Nev Yorlt, Hori from Elkins, Weat Virginia. Lilly, Fiok~lsteiD. Vincent , N.elson and HIIIQ:ond: "Osteoblastou-cementoblast:oma vaa the diagnosis of 2, os te.osareom.a vas thot dia.gnoais of 3 others." Rove from Michigan also pre!erzed oateoblaatoaa. Hyaaa and Heffner from dne AFIP st•ted: ·~~ bad to eettle for an osteoaarcoaa althouah v e con.e:idered also \lhat: baa; bee.o called aggressive osteoblastoa..a .'" LeC&l. fr011 Strasbourg preferred 11Au-reas1ve oat.eobleatoaa" Asareaaive osteoblasto.a vas also the 41agnoaia of Cardona Lopez from Hoaduraa. !u.ae.bi f r oo Bologna called it nosteoblastocaa_. u vhtch vas also the d,.tagoosis of llutbero f r""' Doory 0

Spjut froe Baylor cc:mment.ed: "This is not cooviociog for os:teosarc 011a. The presence of cartilage virtually excl1.1<lee osuoblaetoma. This is possibly reactive.,.

(DHA) RIJABDOHYOSARCOMA, ALVEOLAR PATTERN Contributed by Charles Waldron, Washin~too Uaivetaity, St. Louis, Ho.

The diagnosis of alveolar rhabdomyosarcoma was the moet popula~ and ~t vas offerad by an almos t overwhel ming majority. A fev because of variation in the tiototial quality of sose of the cectiona offered oth~r possibilities includi.Dg rh.abdDI!tyoaarc0111& , t!mbryun 11 t-ype. lipoaarc.ou. Ewing • s an.g1.osarc:a.a and aalianant mesenchym~l tumor. Dr. Waldron c01111tented: "I am. sorry about th• atainin& quality of the aatttrial ." Thia c,a•e dated back to 1949 and the block• vere taken from ~e gros5 spec~en vbic:h 8&t around i.n fomalin until l9S7. Ve tried a.t1 hard as ve could v i tb tbe •tainin& and it's n,ot very satisfactory. Tbie represents the ODly intra-o••eoua RMS I have ever seen ...

(10523-83) BASALOID ADF.NOCARCINOMA III1'!1 COH!DO CAJ.CINDHA 1"1lA11l'R£S Contrtbut,ed by J..,eo J o Sciubba, Lo~s bland Jev loh llill•i4e M<'4i~al Center, Hyde Park, Hew York.

(

There va:re acxae technical difficulties bec.auae: of the cJeca lcification pr~e.es of the. spe.cimeu for which the contributor offers hi1 aea culpa ~ Nevertbe.less, there were 801110 diagnosis which were suggested that 1 could oot reGist but t·o record " t hate t'o conplain but I at'l having a bad time with the slide, ? parasitic. leaioo; '~rhinosporidiosis~· frotia hidratado. trnposible hecer diagnostico; byd rophic brain tissue; fore ign material."

' "OFFICIAL" DIAGNOSIS, OPS 84-15, MRCH 1, 1984

AS£ 7. (8069-83) OSTlOSABCOHA

PACE 4

Contributed by Virgilio Cardona Lopez, te&ueigalpa, Hoodu~as.

Dr. Cardona Lopez .seot the: paraffin blocks which v•re e-ut in our laboratory. lhe preparations vere inadequate for vbicb ve apologize. l:lyuas and Heffne..r from the A:PIP coramented: "We have no idea what this luioo represented e:xcept to feel it -was a malignant histology."

there \lere asny who felt the lesion vas 8.11 oateocarcoaa. Weidner fra. Iova co..ente.d: "The overall aark.e.t' atypia &ad osteoid foruttoo le.ad M to the di•a.noais of oateosarco.a." Shafer from. Indiana: "oateoblastic oateosarc0111a; e011plete ag-ree•ent." John Hcyers from Jewish a~cpital, St. Louis, Moo interpreted it as osteosarcoaa. Sant.a Ctu% fr• Vasbington Uoiveraity: "osteosarc:oaa - very uaus\.L(ll cyc.ology, physa1lipher oua calls!" Kin~ fra. StU c~t~: '"Malig;naat fibroua hi•tioqtoca vs. oateo&areoaa. You got to be kiddiag." Waldron fr0111 Washington University co1111entcd: " 1 believe v e are dealing with a booe-forail:ag aeoplas• and 1 suspect it's an osteoaar·cou. I u a bit heaitant co aalte a apecific d.iagn.oeia on theae s:aall tiaaue ft'ap~rtnt.a and it aigbt be 'lf/ery ''active" os.teoblaatoaa. 1 favor oeteo•arca.a, hC'Wever ... Sciubba fro. Stooey ~rook called tt osteoaarc:oma. Spjut from 'Baylor commented: "Posaibly osteosarcoma." Weathers fro. E&ory: "I also bad trouble vitb die one and I ae re.a-ly havin& trou.ble te.llic& wh.etber the l .ar&e vacuolated ce.ll.e are ye.ally bistiocytea contaiai_og perhaps organiams or vhethcr thi• eoulG aven repreeent an oataoaarcoaa a tnc:e it looks like it might be fomiog bone." Abrams froa USC c.01111ented: 11Again, scanty tissue aakea the d1a&noaia difficult. I &uJOpect oateoblastoaa but reserve the right to c.han.ge ay di.agnoai.& if 110re tiaeue beeoaea .wail•ble." Tarpley and Corio from NUl: '"Malignaat mese.acbyul tu.ar, ehoodrosarC-011& va osteosarcoma."

Although there were otbers vbo considered tbe lesion as an osteoblaatoma, soee vere c.autiou. 1o their ioterpretatiou. Rosa1 ftv11 Mionesots: ,,.,. d iagnoaia U b•tveeo ostf:oblaatoaa and osteoaarc:oaa .. 1 favor the to~er but the biopsy is too saall and f r as-eoted to .ake a definite diagnosis. 11

Uanaen froa Sao 1ranc1aco: 'Ve eonaider thla a aali&D&ot neoplasm, probably an oateosareoaa until proven othervise. l.eco-ae-D4 a r·e-biopsy." White fro• Kentuek:y: "Osteoblastcc.a is our fi_rst choice, bu.t attll concet11ed with the activity of the cells."

A follov-up will be obtained.

lAS£ 18. (IJI!KC84-0420) AMELOILASTIC l'tBRO~D.:JliTOK.\ Contributed by Drs. Dunlap & Barker. University of Miaaou:ri-Kao.aaa City.

Tbe official diagnosis 18 ameloblAstic fibro-odontoma, which oleo was the op~oion of the majority of the consultants. During the presentation of the ease by Dr . Dunlap, there vere several coaaentaries aad question•. I vtll eeleet only the one froa Chuelt llddron! "Fibr o-smeloblastic odontoma vo a ''Mnunos " or srovios odoot,... ·which still boa a signi ficant soft tissue coeponent. I believe the latter is ~robably the b~at ansver that I have great difficulty aaking a distinction betveeo theae tvo "entities, u if they are entities and fibro-aeeloblut.i.c odootoaa.s teo.d to Mr&* into odoot.oau." Dr. Dunlap se.nt the following note: "A fev post-.....eet1ag cocaenta regaTdia& the am.eloblastic: fibre-odontoma that we sub11itted for the last Oral Patholos.y Seminar. Dr. Waldron .. ked if cfie ameloblaetic fibro-odontoea ic in fact an

•

"OF'PIClAL" DlAGNOSlS, OPS 84-15 , MARCH 1, 1984 Page 5.

CASE I 8 , Continued:

an t.nature odenton.&. Or stated another vay, vill an omeloblo.stie fibro­odoatoma if left along, "grov-up" to bee..ooe an odontoma? At the ttme, I indicated that the answer woo not known but I thought that the literature indicated otbervise; e.ach tumor bas itl own degrt• of ditfc.re.otiit1oo. and in the 111ixed odonto&eaic tuaora, the-re 1a no "gr~g-up" or tra.Nltion from a less differentiated to a more diffeceotiated f oro."

"Appa.rentl y I vas vrang. ln an at'ticle on t.he subject, An ~alyais of the lnter-Relstionah~p of the Mixed Odootoseoic Tumorc - ~elobla&tic Fibroca, Amelol)}a•tic Pibro-odontou and t .he Odontcdas, Slootveg, P .. J., Oral Surgery, Volume 51 1 pase 266, March 19$1~ the evidence cited indicet~ that the $Celob-l.asti c fibTo-o<lontO!Ila ie probably an i.maaatut'e c:011plex o-dontOIIla; they do "arow~p." Thia i.8 not true of the least diffe:re.nt1ated of the. mixed odontogenic tumors. tbe ;m.eloblastic fibrOCl&. Apparently, oace aa ame. loblutic. fibl"'';la, alwaya ao uelobl-aatJ:c ..fibtoru. They <lo not go on to be.c:OSLe an a:aeloblaat.ic fibro-odontocu."

C&SI 9. (Ul!XC 8.4..079) ODO!ITQGENIC !'lBIIOMA Contributed by Drs. Dunlap end Barker, University of Hlasouri~aas City. lhe majority of tht consultants agreed vith the "official'' diagnosis. A fw caaaentarie.s at ra..adoo: Shafer from Indiana: 11The majority felt that this vas an atypical GEOT (Piodborg) tuaor. A oinority thought it represented an odontogenic. fibrOSDa., centrlll (WHO Type). One other .sugge.atioa: rule out central JSUeoe.piderraoid cat"ctnoma (do a PAS and uweicar-ime). ' ' Hanaon frcn:r. San Fraoci.~co: "OdontO&e.o.iC fibrcaa. One ~ber of our &roup vould call this a aquamO\J,S odontogenic tumor. 11

_

LwM.r..:a. from Flushing: 11Epithelial odontogenic tu11o·r, not otherwise claeatfied." This vas the di agnoais of Spjut fr~ BayloT. Yyaas and Reffner (rom the APIP: "This one also p-coved a pl'obl~ to us. We queaU.cm the diegooais of aqu.uoue odootogeni.c tuaor." Wesley, Carpenter, Jon~• and Pay froa the lOth Medical Laboratory, Landstbul. Cenoany: ' 'A dlffic:u~t case. 1t looks epithelial oud odoutoaeuic oo I vould call it epithelial odontogenic tucor va hyperpla.stic odontogt:nJ.c. reste." Odoo.togenic:: -fibrolla wa& also the diagnosis of Santa Cru~ fr011 Vaahia.Stton University. Waldron (rom Washington University coaiUlott:d: "1 •av this caae in con.eu.ltatioo. a fev veeke ago. It's a aost unusual periapical l~sion. 1 have never aeea anything qu.i.ta like. it and vUl be interested to be.ar the op1ni.ona. It is eitb&r a WUO type of odontogaaic fibromn vtch 3 aore proainent than uaual epitbell&l c.c.ponet\t or an uuc.la..ssifted epithe.lial odontogenic: epithelial reat tumor. t don't think it 11ask.es a aood e~ccple of the ao-c.alled squamous odontogenic tumor. Hovever, I really doo't know . 1 suspect soce aay consider this an at.ypic.al fiDdborg lUIIOT but tbis stretche-s tty concept of the Pindborg tumor too f•T. Cerclon.a Lopu froa Honduras c.allecl 1~: "Fibroma odonto&enico. " Sprague (ros:a Nebraska: "Ameloblaetic fibrosa vs. early squeous oc.fontogea.ic tuaor. 11

tu.aebi f roa Bologna c.alled it: .. Odoo.togeaic fibroaa." sc.tubba preferred: ''Atypical odontogenic. epithelial ne:oplase vs odootogen.ic. tibroa:e." Weathe-rs CcCIU,oted: "1 think that 1 would place. this in the odontoge nic fibroma WHO type. although so111e people aaigbc. pr,efer to c&Ul this uoc.leasif ied odontogeaJ.c. t•or or eve_n a.o atypical Piodbors. 11

Abrtu:Ds from USC: "Although t.he quantity of epithelium. o.ight be consi dered to be ucesaive. I thi.ok this i• a variant of odontogenic f ibro.a." White from Kentucky: '--rUIIIor of dental lmioa vith clear cell c~pone.nt. We see

no aayloid to sugg.:,st Pindborg t.uaor. n

.. ntll"inued - -

Page 6. "OI'nCAL" DIAGNOSIS, OPS 84-lS, MARCH 1, 1984

CAS£ # 9 Coo<tnued:

Uog froa USC offered: "I suppose Charlie would call it odoo<og..,ic ·ft.broaa or atypical Pindborg tUDor, but it is not. It ie a "laaioCiala" or eet"ruoaa."

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USE f l

ELLIS FISCHEL STATE CANC!Il C.!IITI!R

OltAL PAYIIOLOG'f SI!IIIIWt #83 (OPS84-15)

MARCil 1, 1984 "OFFICIAL" DIAGNOSES"

(583-12862) NODULAR PASCIITlS

Cootributecl by Noel Wetdo.e.r, K.D., Uoiveruty of Iova He.dical School, Deptartunt of Pathology. Slightly over half of the coneultants int-e rpreted the lesion as oodula't' faac.Utia.

A fe.v c eotartea: Rosai f rom the Un1verait} of Mino.eaota: •taeauti.ful c:.aae of oodu.lar f aae1.1t1.a.

l have eeen •everal exaaplea of thil entity vithio th~ oral cavity. In addition, l have lately a.e:ca three casea of t'Jpic.al a.odul.a.r faaciitia locat-ed in the .. jor a ali vary gl.and.

Shafer froa lAdiana: ''Moat felt thia vas nodular faaci1t18 although ea-e. als o conei dered f ibr oua hiatiocyt.ou. Tbere v u ooa vote for deraatofibroaarcaaa protuberans ."

Byeas and Haffner ftoa the AFIP: •" e pretty much agree that histology supported a di.agnosia of nodular fascUtis . "

Barker and Dunlap from. the Uuive:raity of Missouri. Kauu City School of Deot.i.atry toae.tber vith Toto frOll. Loyola in Chicago, Santa Crut. froa Wa1hington l1-civera1ty, Euaeb1 fToa tb.e Ontnnita Di Bolopa. Lua.erau fra FluabiD&. M. T-. Wbite fro. Ke.t.11tueky, Lilly , Pioblatein, Vincent, Nell on and Raaaoud froa I011a vere .. ong thoae vbo alao called i t nodular faseiitie.

Ca.aeatariea at raod~ froa other d.iverging opin1oDS. Pay, Wesl ey, Carpenter and Jones froe the. lOth Medical Laboratory, Landatuhl Army Medical Center, Cenaany, c.-oted: "B..UID iofl- tory leoiou- c/v DodYler faaeiitia, should alao con1 ider benign fibroua hiatioeytoaa. fibroxantha.a.n

Koraeco fro. lirkaville. Mleaouri; '~eniga granulating tiaeue . fibroblastic. fibrobistiocytoaa."

Cardona Lopes fro. Teguctsalpa, D.C. Rooduras: "Atypical f1broh1at1ocyt~l vra. fibroaatosia."

Spjut froa lay lor: "Reaction to injury e.g. faac11t.1e." We.atbera froa Eaory: "I thint t vould ca ll thi..e a paeudoaarecaatou.a fuciit.ia althouah a fibrous hi.stiocytQD.a vould be a etroug ca~ts1deratton. ,. Othen vere coo.ceroed about N.ligta_at eh&a,gu.

Hori froa Weat Virsio.ta ca.Ued it. ''lov grade -fib rot: arc--. (le:iof)" Toung fro. Oklaho.a cv.aented: "f.ibro.atoata (fibroearcoaa, sra.de one half ~~ fr'Oa Southern lllinoia School of Dentiatey; 11Sarco.a. fibroaa.rc.o ..

•• secoa.d choice leia.yoa arcoea (alao t keep th.iokins 1 ean U.oat ae.e atrtattoua . vouldn't rule out rhabdomyo•arcoma vithout special stains) . I doo't tbtnk it i e nodular fascUU.S.

Waldron f--ros Vaehinaton U'.:.iver·atty: "A,agreaaive fi.broaatoai.e (nodular fud.it:U) •• vell differentiated fibroaarcoaa . the short biatory aiabt favor a ~•active proceea but I • conee.zuad about. tbe a1tot..1c aetiYity and ao.e degTee of cellular pleo­aorphiaa. 1 will vote for fibroaarcoaa vitbout uy &Te&t. eoancti.Oo. &Ad t bna a sreat deal of difficulty aepar attnn theae tvo leaiObl.

Sprat~~e offered: •rucUt14 wa aali&OI!l~ flbroua bbtiocytou." LeGal fto. Straabouts preferred: " fibroaarca.a, low aaltsnancy." Sc~bba froa Univers ity of ~~ York at Stony Brook: '~ov srade fibroearcoaa.

There are so.e fe.atures of fibrou..s hiatioc:yto.a ber e .. veU." There vere other dtagnosi e vb.ich include vucular lei.oayoaa, hiaU.ocytoid

besansioca and epitbeloid beaaogioaa. Ve ..Ul try to obtain a follow--up of t his p.at.ient 1o. six aonth•.

CASE #2 .

C,I.SE #3.

WE #4.

"OFPICI/>.L" DIAGNOSES, OPS 84- IS, 11/>.RCH 1 , 1984

583- 14731£) MULTIPLE ODONTOCENI C RERATOCYSTS

.rage '1. ,

Contributed by 'NoeL Weidner, Department of Pathology, University of Iowa Med~cal School, Iowa Ci~ 1 lava

Multiple odont ogenic keratocystsvas the overwhelming opinion. A fev commentaries at random:

Hansen frqm tbe University of California, San Ftanc~sco : 1~ltiple odontogenic keratocysts. The keratocysc·s are consistent vit.b the basal cell uevua syndrome. She aay or may not aevelop other stigmata of the syndrome at a later date .

liyam.s· and Heffner frou AFlP: "We both felt that there vaa histology tbet supflorted a k:eratoeya.t . but could not explain the areas that bad vbat looked like a -fibromyxO'IIlatous proliferation witli' :fnc;lusions of Odouto&enic~ e._pitbelium."

Waldron from Washington University: ·~ontogenic keratocyat, auliiple. In view of the history of this patient probably has a mild form of the syodroae. 1 have se~ several patients vho had multiple cysts for some years before any akin lea ions appeared. '1

weathers fro. Emory: "Odontogeoic kera.toeyet.. I t ce·rtainly m.akea you wonder -1.£ this i.s not a fome.frusr of tho ba.sal cell nevus syndrome, however, the typical budding and proliferation s een -in tbue: cysts of the BCNS' 1'8 not seen here."

Many: othe r COllSultants ,.ra also conCerned with · the basal cell o.evua ayndroce.

( 172/83) REACTIVE PIBROUS LESION WITH KET/>.PLASTIC BONE AND CHONDROID TISSUE (OSTEOcliOND&OH/>.)

Con.tributed by Ri sto-Pekka U.apponen·, D.D.S., University of Turltu, Finland.

The opinions of the dJ:ffere.nt. consultants were.. sharply di.vided between benign and malipant~ one third i.nterpret.ed i i as malig;aant.

Shafer f ront Indi-ana: "Nearly eve·eyone agreed that tbis Was osteosa-rcama and very likely paros.teal type.."

RCIIIIIDood , Lil~y. Finkelstein, Vincent and Nelson -fraua Jowa COliDented: "Parostea.l aaycom.a is. the diagnoaia, correctly made by 2; however, 3 others he·ld out for osteochondroma.

King h;om SlU: "I quesUon whether t here is tumor ost:eoi;d preae.ot or not. Sure does -look ~ike it ln some az:eas . ''

Waldron fr~ Vash~ngton University: Low gTade cbondrosarcoa~ ~ In spite . of the relative benign appe.erance, I worry abOllt ..any cartilag~fotlliing tumor of the javs and serio~ly question if there is such a thing as benign chondro~ iD the jaw bone. " ~

Sciubba from Stony Brook: ''Chondroblastic osteosarcaraa." We-athers frosn Emory cal led it.: "Chrondrogenic osteosarOOla. " Abrams frOC'I USC: "osteosarcoma. 11 ~ '

Tarpley and Corio from Nm called it: "chondrosarc.oma. n

(114/.83) OS'l'EOS/>.RCOH/>. (CHONDROBLASTIC UPE) Cont ·r-ibu,.ted by Risto-P:ekka Uapponea, D.D. S. , Oral Pathologist, lDstitute-.of Denti&try, Un~versity of turku, Finland.

'' r The oPinions among the va~ioua consultants vas -almost evenly distributed between oateoblaatoma and osteoaax:c::ooa. A fev commentaries on the u&arcou aide" Rosa.i. .from Minnesota: "1 think this is an oste'OS&l"C::OJ&a. The alternative. ia an aggressiYe osceoblas toma but I think tber~ is too ~ch atypicality for the latter. " Shafe~~ ftom Indiana: ·~oat agreed that it va.s osteocarcioma although there was one vote for uliguant osteoblastoma. " White from Kentucky: "osteogenic sat:co~r~a." Wesl ey Carpenter. JOnes and Fay from lOth Medical Laborat ory, Lapdstuhl Army K~ic.el Cencer , Cennany: "Osteogenic aarcot~~a."

•' cont:U:l.ued --