Sabato 27 ottobre 2012 - Pacini Editore

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Fig. 3. Microscopic appearance of ameloblastic carcinoma. tumor
islands with focal features of ameloblastoma (a) and areas with
obvious malignant aspects as spindle cells, pleomorphism and hyperchromatism,
increased mitotic ratio (B, C, d)..
We present a case of a 15-year old man who was diagnosed, by
occasional OPT, with a large expansive mass at right maxilla.
CT scan demonstrated a mass measuring 48x37x55 mm, which
occupied the entire right maxillary sinus, expanding to the orbit
and the nasal pits. Inferiorly, the tumor eroded the upper alveolar
arch, and was in contact with the masseter muscle (Fig. 1).
The patient underwent surgical asportation and avulsion of the
third upper right molar.
At macroscopic examination, we found a non-ulcerated cystic
mass with adherent thin bony plates within an impacted tooth
and numerous vegetations adherent to the inner surface (Fig. 2).
Histologically our case showed features of odontogenic cyst with
associated areas of stellate reticulum with peripheral palisading
as follicular or plexiform ameloblastoma and tumor islands with
marked cellular atypia, hyperchromatism, nuclear pleomorphism,
showing loss of peripheral palisading or nuclear polarity, increased
mitotic index with 5 mitoses/10HPF (Fig. 3).
Therefore our diagnosis was ameloblastic carcinoma arising from
an odontogenic cyst.
The patient has been followed for 12 months with CT scan of
head and neck, chest radiograph, neck and abdominal ultrasonography,
transnasal fibroendoscopy and CT-PET without evidence
of local recurrences or metastatic localizations.
references
1 Lucca M, D’Innocenzo R, Kraus JA, et al. Ameloblastic carcinoma of
the maxilla: a report of 2 cases. J Oral Maxillofac Surg 2010;68:2564-
9.
2 Yoon HJ, Hong SP, Lee JI, et al. Ameloblastic carcinoma: an analysis
of 6 cases with review of the literature. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2009;108:904-13.
3 Routray S, Majumdar S. Ameloblastic carcinoma: sometimes a challenge.
J Oral Maxillofac Pathol 2012;16:156-8.
A feasibility evaluation on the dentist’s role for
early diagnosis of oral cancer using a cost/effective
innovative first level test with micro-biopsy
R. Navone, S. Gandolfo1 , M. Pentenero1 , G. Tempia Valenta1 1 Dipartimento di Scienze Biomediche ed Oncologia Umana, Università
di Torino; 1 Dipartimento di Scienze Cliniche e Biologiche, Sezione di
Medicina ed Oncologia Orale, Università di Torino
Background. Oral squamous carcinoma (OSCC) and pharyngeal
cancer are amongst the most frequent malignant neoplasia (in 6th
place for cancer-related death). Unfortunately, the last 30 years
have not witnessed any significant improvement in survival rate,
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
most likely due to this type of tumour often being diagnosed at
an advanced stage. Moreover, the therapy required to deal with
advanced stages leads to a highly compromised quality of life
for the patient. Conversely, an early diagnosis has shown a high
5-year survival rate (96.9%) (Pentenero et al., 2011). Noteworthy
is the fact that numerous OSCC often arise on the site of precursor
tumoural lesions (dysplasias) and their identification could
well prevent their malignant transformation. The main obstacle
facing an early diagnosis of OSCC is that this serious tumoural
form and its precursors are easily confused with “clinically apparently
innocent lesions” of inflammatory, traumatic or prosthetic
origin, routine findings in the dentists’ every-day practise. When
symptoms involving the oral mucosa appear the individual usually
refers to his/her G.P., who, in turn, refers the patient to a
dentist. That is why the dentist and G.P. are potentially able to
carry out an effective prevention programme for an early OSCC
diagnosis, as long as they have the necessary “know-how” to do
so, including which tests to perform first and who to refer the patient
to for a definitive diagnosis. The first of such tests available
is the objective examination, which, although is surely necessary
and efficacious, does not suffice, as it is not able to allow for a
distinction between oral potentially malignant lesions (OPML)
from lesions that will never evolve into cancer (Lingen et al.,
2008). Therefore, the use of only an objective examination leads
to the risk of underestimating OPML and/or early-stage cancer
or, on the contrary, overestimating clinically apparently innocent
lesions. First level tests have been proposed to diagnose the intraepithelial
pre-invasive OPML that require scalpel (surgical)
biopsy, but also, and above all, to identify those cases that do not,
which are the majority. The requisites of a first level test include
it not only being reliable and repeatable, but also user-friendly,
even in non-expert hands, as well as it having a high sensitivity
and specificity. To date, the dentist has had only one first level
test at disposal i.e. oral cytology (Navone et al., 2007, 2011),
which is not always easy to perform, has a low sensitivity and
leads to a number of inadequate samples. There is, therefore, an
evident need for a test with enhanced characteristics. The scalpel
biopsy, today’s gold standard, is not a good first level test for the
diagnosis of these lesions (Pentenero et al, 2003) as it is invasive
and has sampling limits: it can be carried out only in restricted
areas and on a limited number of sites and the identification of
the most suitable sampling site is of no easy feat in non-expert
hands. In fact, it may lead to false-negative results, even in the
most expert of hands (Pentenero et al., 2003).
A new sampling technique, called “micro-biopsy”, was developed
by our team and data published (Navone et al., 2008). The
technique involves scraping with a dermatological curette to
obtain microhistological samples, rather than cytological ones. It
is minimally invasive and has a high sensitivity (97.65%), a high
negative predictive value (97.33%) and provides a high percentage
of adequate samples. Although we proposed it be used as a
first level test, before the data on this research project reported
herein, we had no information as to the probability a dentist, nonexpert
in oral mucosal pathology, has in obtaining samples of the
same level. Therefore, this research was aimed at obtaining data
on the capacity a dentist, who is not versed in the field, may have
in the correct use of the micro-biopsy technique with the curette
and to compare these data with those obtained by more expert
hands. The research project was carried out in collaboration with
free-lance dentists, with the aim of evaluating the adequacy of
their sampling of the oral cavity mucosa lesions they came across
in the course of their routine practise.
Materials and methods. We carried out a prospective study
financed by the Piedmont Region (Ricerca Sanitaria Finalizzata
2008) in collaboration with A.N.D.I. (the National Italian Association
of Dentists). A total of 75 free-lance dentists, working
in the Torino area, were enrolled for a pre-training session on a
voluntary basis, the only inclusion criteria was that they were