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ABSTRACT: A cystic swelling in the parotid gland should lead to a differential diagnosis that includes benign cystic lesion of the gland, benign tumors that are frequently associated with cystic degeneration or entirely cystic de novo, or even a malignant neoplasm. The case presented is that of a cystic parotid swelling of 2 years' duration in a 52-year-old female patient. The clinical differentials in the present case were reviewed and were entirely different from the final histological diagnosis of low-grade mucoepidermoid carcinoma. The uniqueness of this case is the very rare unicystic presentation of the lesion. The authors also discuss why the clinical and radiological investigations were not suggestive of the final diagnosis.
International Journal of Surgical Pathology 07/2012; · 1.00 Impact Factor
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ABSTRACT: Salivary gland tumors (SGTs) of epithelial origin are relatively rare, and worldwide reports show considerable variations in their epidemiology. The aim of this study was to examine, for the first time, the records of SGTs from two very distant geographical locations, Finland (two medical centers) and Israel (one medical center) between 1999 and 2008, based exclusively on the 2005 WHO classification of head and neck tumors, and to compare those data to the other available (single-center) studies that used the same classification. A total of 2,218 benign and malignant tumors diagnosed in the three centers were analyzed. Differences in classification of the tumors were found between the two geographical locations as well as between the two centers from Finland. There was a higher ratio of benign-to-malignant SGTs in the Finnish centers (5.4:1 and 7:1) compared to the Israeli center (2:1), a higher frequency of tumors of minor salivary glands in the Israeli center (34%) than in the Finnish centers (4 and 11%), and a higher frequency of malignant SGTs in the minor salivary glands in Israel (64.5%) than in Finland (10.9 and 27%). The diversity of these multicenter data are compatible with reports from different parts of the world. We conclude that conducting epidemiologic surveys based on the latest WHO classification provides clinicopathologic correlations on SGTs that seem to be characteristic even in small geographical regions.
Head and Neck Pathology 01/2012; 6(2):224-31.
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ABSTRACT: Peripheral dentinogenic ghost cell tumor is a rare tumor with only 24 cases previously described in the English literature. The majority of cases have been reported to occur in the anterior part of the jaws. A case occurring in posterior (molar region) of the mandible in a 75-year-old edentulous woman is reported. The patient presented with a nodular swelling in the left mandible that showed erosion (saucerization) of the underlying bone radiographically. On microscopy, the tumor showed mainly solid epithelial islands resembling ameloblastoma in fibrous connective tissue. The islands were associated with ghost cells and dysplastic dentin. This report includes the clinical, radiographic, and microscopic features of the patient, in addition to the review of the English literature on the tumor.
International Journal of Surgical Pathology 11/2011; 20(5):494-9. · 1.00 Impact Factor
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ABSTRACT: Mobile tongue squamous cell carcinoma (MTSCC) is known for its strong propensity for regional metastasis and poor patient survival despite aggressive treatment, thus calling for new and reliable markers for predicting prognosis and guiding therapeutic management. Towards this end, three classes of markers were investigated: cancer-associated fibroblasts (CAFs; α-SMA positivity) as a representative of the tumor microenvironment, maspin (mammary serine protease inhibitor) as a tumor marker likely to be modulated by factors within the tumor microenvironment, and DNA content and Ki-67 labeling index as inbuilt tumor markers in 128 cases of MTSCC using immunohistochemistry and image cytometry. Of these markers, only CAF density was independently and relatively strongly associated with elevated mortality from MTSCC. The hazard ratio in the CAF-rich type of tumor microenvironment was 4.85 (95% CI 1.41-16.6, versus the CAF-poor) when adjusted by proportional hazards modeling for the center where the patient was managed, gender, tumor stage, presence of neck metastasis and age at diagnosis. CAF density was unrelated to non-MTSSC mortality. Given the strong association between increased CAF density and higher mortality in MTSCC, routine assessment of CAF density for disease course prognosis and inclusion as an integral part of treatment protocols are recommended.
Oral Oncology 01/2011; 47(1):33-8. · 2.86 Impact Factor
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ABSTRACT: Claudins (CLDNs) are a family of membrane proteins important for permeability of tight junctions. They have also been implicated in carcinogenesis and tumor progression. We analyzed patterns of distribution and intensity of expression of CLDNs 1, 3, 4, and 7 in mucoepidermoid carcinoma (MEC) of salivary gland in 39 patients. Correlations between the expression of CLDNs, tumor grade, and survival were explored. In immunohistochemical analysis, high expression of CLDN 1 was seen in low-grade MEC, and it appeared to be a suitable auxiliary marker of good prognosis. It classified MEC similarly to histological grading in 89.7% of cases (p = 0.001). High CLDN 3 expression was seen in intermediate- and high-grade MEC, while it was low in low-grade MEC. CLDN 3 intensity correctly categorized tumors into grades in 71.8% of cases (p = 0.017). However, in multivariate analysis CLDN 1 and CLDN 3 did not achieve significance over tumor grade in predicting patient behavior. We conclude that analysis of staining intensities of CLDN 1 and 3 is useful as an auxiliary diagnostic and prognostic tool in patients with salivary gland MEC.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 12/2010; 458(3):341-8. · 2.49 Impact Factor
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ABSTRACT: Squamous cell carcinoma of the oral (mobile) tongue (OTSCC) is increasingly regarded as a biologically different entity compared to cancer affecting other oral sites. It is more aggressive and generally associated with a higher rate of metastasis. This is the concluding part of our two-part article that examines the methods by which the behavior and prognosis of OTSCC has been studied, the prognostics markers, and the relevance and future direction of prognostic studies. In this part, we continue our discussion of the histopathologic and molecular prognostic factors, and serum and salivary biomarkers in of OTSCC, and emphasize the need to regard OTSCC as a high risk variant of oral cancer. We conclude with future direction of prognostic studies of OTSCC.
Oral Oncology 09/2010; 46(9):636-43. · 2.86 Impact Factor
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ABSTRACT: Oral (mobile) tongue squamous cell carcinoma (OTSCC) is the most common cancer diagnosed within the oral cavity. Due to the inherent disadvantages of the mobile tongue OTSCC behaves aggressively and is generally associated with higher rates of occult metastasis and neck nodal metastasis than any other cancer of the oral cavity. The prognosis remains relatively poor and is still heavily reliant on TNM (tumor, node, metastasis) staging of the tumor despite a vast array of literature on possible prognostic indicators. This is a two-part article which examines the methods by which the behavior and prognosis of OTSCC has been studied, the prognostics markers, and the relevance and future direction of prognostic studies. In this first part, we discuss the relative merits of the methods used in prognostic studies and the clinicopathologic prognostic factors.
Oral Oncology 09/2010; 46(9):630-5. · 2.86 Impact Factor
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ABSTRACT: We examined cancer-associated fibroblasts (CAFs) and a panel of immunohistochemical markers of epithelial-mesenchymal transition (EMT) in 19 pair-matched oral tongue squamous cell carcinoma (SCC) and metastatic tumors to regional lymph nodes (RLNs). alpha-Smooth muscle actin (alpha-SMA) was studied to identify CAFs. EMT was studied with syndecan-1, Cadherin-11, fibroblast-specific protein (FSP)-1, secreted protein acidic and rich in cysteine (SPARC) and Twist. Triple immunostaining in RLNs was used to highlight the carcinoma cells (E-cadherin and Ki-67) and their relationship to the CAFs (alpha-SMA). We found that metastatic RLNs hosted CAFs similarly as in pair-matched primary tumors. Expression of EMT markers is common in both primary and metastatic tumors. We demonstrate that metastatic carcinoma cells (Ki-67 positive) downregulate E-cadherin expression at the periphery of cancer islands, where they are in direct contact with CAFs. The supporting connective tissue microenvironment also commonly expresses syndecan-1, Cadherin-11, FSP-1, and SPARC. In conclusion, CAFs are common to both primary and metastatic SCC. We hypothesize that CAFs not only promote tumor invasion but also facilitate metastases, either by cometastasizing and/or being recruited to lymph nodes. Evidence of EMT is common within primary tumors and metastatic SCC and may be further modulated by CAFs.
International Journal of Cancer 03/2010; 127(6):1356-62. · 5.44 Impact Factor
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ABSTRACT: Claudins and occludin are tight junctional proteins known to play a role in normal tissues and epithelial tumors. We analyzed the distribution patterns of claudins 1, 4, 5, and 7 and occludin in the superficial and invasive front of squamous cell carcinoma of the tongue of 97 patients and their relationship to cause-specific (squamous cell carcinoma of the tongue) patient survival (median follow-up period of 33.5 months; range, 1-234 months). Claudins 1 and 7 were strongly expressed, claudin 4 had moderate expression, whereas claudin 5 was least expressed. Occludin staining was mostly negative or very weak. Western blot analysis of tongue carcinoma (HSC-3) cells showed that all these proteins are also expressed in vitro. In cause-specific survival analysis, strong and low immunoreactivity of claudin 7 tended to be associated with decreased survival compared with medium immunoreactivity. We suggest that analyzing the immunohistologic staining levels of claudin 7 could be used for the prognostic purposes in patients with tongue squamous cell carcinoma.
Human pathology 07/2008; 39(8):1212-20. · 3.03 Impact Factor
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ABSTRACT: To analyze the distribution pattern of claudins 1, 4, 5, 7 and occludin in benign and malignant ameloblastomas and developing human teeth.
Paraffin-embedded tissue specimens of 25 benign and four malignant ameloblastomas and two developing human teeth were examined immunohistochemically using antibodies against claudins 1, 4, 5, 7 and occludin.
In ameloblastomas strongest expression was seen for claudins 1 and 7 while claudin 4 was expressed less frequently. Claudin 5 and occludin were seen only in a minority of cases. There were no evident differences in the expression of claudins or occludin neither between different histologic subtypes of ameloblastomas nor between benign or malignant cases. The strongest expression for claudins was present in the central stellatum reticulum-like cells surrounding the microcysts and in the areas with squamous differentiation of the ameloblastomas. In developing teeth both claudin 1 and 7 stained strongly in the enamel epithelium, ameloblasts, and enamel matrix, but staining for claudin 4 was relatively weak. Claudin 5 was preferentially expressed only in vessels, and occludin staining ranged from negative to weak in ameloblastomas and teeth germs.
There were no clear differences in the expression levels between benign and malignant ameloblastic tumors. The overexpression of claudins in the areas with microcyst formation may indicate their attempt to maintain the interepithelial cohesion of the cells. The strong immunoreactivity of ameloblasts and newly synthesized enamel matrix for claudins 1 and 7 indicates that they may be involved in cell signaling influencing enamel formation.
Journal of Oral Pathology and Medicine 02/2007; 36(1):48-54. · 1.63 Impact Factor
