Gelfoam sponge biopsy in the diagnosis of oral carcinoma

GELFOAM

SPONGE

BIOPSY IN THE CARCINOMA

DIAGNOSIS

OF ORAL

lixw

of tougue

Soft pal:kte .-tlvwlar ridge, chwk, 110&!s Base of tongue,

8 ‘I

10 II

s

t onsillar fossa liwcnl giugivxe Fistulous trnct I Laterrtl l)ordcr of tongue s Floor of mouth, tongue’, sul,maxillnry r2re:i I Cheek, gum, soft pa1atc, tongur Gingivar: I TorIpe, base of, x Aoft pi11atr

s s s s I s

s x s

Results ‘I’hr clinical diagnosis ant1 the histologic findings frOJn the surgical hiopsj 01’ these lesions have heen car-related with the detailed histopathologic findings ohtninrd from Gelfoam sponge biopsy in Tables 11 and TTT. In clach of the elc\:ell (*iIses, positive diagnosis for carcinonla was made without difficulty by surgkwl biopsy of the lesions. It1 only t,hree of these proved cases of carcinoma was the Gelfoam sponge biopsy specimen considered

Syn:m~ous cell car~inorru Squ:tmous cell cpithelioma of soft palate Squ:unous ~11 epithelioma of left alveolar ritlgc nrez S(4u:unous cell epitheliom:, of tongue, moderately differentiated Squamous cell epithelioma of right huccnl mucosa

i i

CASE NUMBER 1 2

11

3

III.

TABLE

li

11

15

10

14

13

n 6 i s

4

2 12 3 16

GELFOAM BIOPSY NUMBER 1

DETAILED

FINDINGS

~PECI~IEKS

BIOPSY SECTIONS

SPONGE BIOPSY MALIGNANCY

FROM GELFOAM

FROM GELFOAM OF PROVED INTRAORAL

Ordain-ED

CASES

HISTOPATHOLOGIC

F'Isu~scis

'l'.\k-m

F~oar

So cells. .\ few cells, mostl\- leukocytes, a few squamous cells. No definite cancer cells:. Several moderate-sized pieces of stratified squamous epithclium. Seutrophils and lymphocytes. Rare epithelial elements. Predominantly neutrophils, an occasional cluster of m-ell-diflerentiated squamous epithelial cells! and bacterial colonies. A few cells \vith dark pyknotic nuclei that Some eplthelial cells singly aud in clumps. Surnorous neutrophils and lymphocytes. occupy two-thirds of the cell volume. Masses of bacteria. occasional squamous cells and leukocytes. (‘ellular debris; Srutrophils, lymphocytes, bacterial colonies, a few squamous epithelial cells. squamous cells. One small cluster of lymphocytes and polys; six well-differentiated Lymphoc\-tes, some neutrophlls, occasional squamous cells-none abnormal. Shreds of fibrin heavily infiltrated with neutrophils and an occasional well-differentiated A few cells in one area whose squamous epithelial cell with small pyknotic nucleus. One giant nuch~un with and hare prominent nucleoli. nuvlri are enlarged, vesicular, voarsc chromatrn. cytoplasm. large I n~casional cluster of atypical polygonal epithelial ceil P with eosinophilic hyperchromatic pleomorphic nuclei with condensed chromatin and prominent nucleoli. .4n oval laminated cpithelial pearl. .\‘l,ruerous fragments of well-difFerentiated, stratified scluamous epithelial cells, neutrophils, h few small clusters of atypical epithelial cells with amphoand bacterial colonies. philic cytoplasm and enlarged. opaque, plromorphic. polygonal nuclei with I)rominent nucleoli. (‘lusters of atypical cpithclial cells with large plcoruorphic polygonal vesicular nuclei with Moderate numeosinoahilie cvtonlasm. condensed chromatin, and prominent nucleoli. lkers o? nentrdphfis, lymphocytes, and collagen fiber;. Predominantly partially hemolyzed red cells, neutrophils,, lymphocytes, and atypical epitheenlarged resrcular polygonal nuclei with prom lial cells with amphophilic cytoplasm, Latter cells are arranged in small clumps. inent nucleoli,, and condensed rhromatin. Uoclerate number of fusiform well-differentiated stratified squamous epithelial cell clusoccasional bacterial colonies, occasional atypical individual ters ; some neutrophils. cells. and 1 to 3 cell clusters whose nuclei are larger, vesicular, polygonal, and with condensed rhromat,in and prominent nucleoli. colonies. on+ kerato.I few n-ell-diff’erentiated squamous epithelial cells, sotnc bacterial hy$ine mass. No tumor cells.

~TIsToI~.\TII~~I.I~~;I('

\

x

x

1

I

7

1'OSITIVE FOR CANCER .~

ELEVES

Y x x B

Y

~ NEGATIVE FOR ; / ClNCER x x s x x

CSSELECTED

Summary OI\P 01’ more C:el f’oi\m S~OII~C hioI)sy slwcim(~ns \v(‘w tirkcn ill cblt~~eltVO~Iscccntivc (~HSCS of carcillotna (13wvetl positive hy surgicdal hiolwy) of the oral cayit;-. Once each of these (:cli’oam hio])sies was performed, processed, and st,ndictl specimens were rrccortlitlg to the technique of Glaclstone, while additional In our hands, fixed, mounted, and stuck? l,- ;I slightly nlodifiecl techniqut. st.aine(? sections of fhcw Gclfoan~ l)iolq spccimcns were negative for ca,ncw in eight of the eleven eases. The authors express their appreciation to l)Ts. Thomas G. Petrick, Joseph Halleron, \\‘. 1% Stewart., and Philip 8. Vassar for their cooperation in aiding in the evaluation of thr surgical and the Gelfoam biopsy specimens and to Miss .-\lice Harnrtt for her assistance in coordinating t,hese studies.

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