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Granulocytic sarcoma of the submandibular gland preceding acute myeloid leukemia: Report of a case
Poster I I / T u m o r Surgery/Tumor Biology
151
of the marginal branch of the facial nerve, which subsided in 3 months. All patients recovered well. Benign neoplasms of the submandibular and sublingual gland are rare, compared to malignancies of these salivary glands, as opposed to parotid tumours. Careful preoperative evaluation is necessary, with computerized tomography scan and possibly fine needle aspiration or trucar biopsy of the lesion.
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JUVENILE ACTIVE OSSIFYING FIBROMA OF THE MANDIBLE: CASE REPORT
K. Yamaguchi, M. Numata, H. Kawamura. Division of Maxillofacial
Surgery, Graduate School of Dentistry, Tohoku University, Japan Maxillofacial fibro-osseous lesions are often difficult to diagnose from both a clinical and a histopathologic point of view. The World Health Organization divided the fibro-osseous lesions into two main groups: osteogenic fibro-osseous lesions and non-neoplastic osseous lesions. Juvenile active ossifying fibroma belongs to the second group. A lesion with aggressive growth in patients under the age of 15 is known as juvenile active ossifying fibroma. The purpose of this study was to report a case of juvenile active ossifying fibroma of mandiblar ramus. Patient was a 12-year-old boy. The clinical diagnosis was ameloblastoma. Complete enucleation of the tumor mass was performed under general anesthesia. The pathologic diagnosis was a juvenile active ossifying fibroma. The lesion was firm. Borders were distinct. Covering mucosa was healthy. The left mandibular ramus region was swelling, and face was asymmetry. No pain was elicited on palpation. The satellite lymph node was clinically healthy. Orthopantographic scan revealed the presence of a lesion in the mandibular ramus. The second and third molars were burred under the lesion. The lesion was enucleated. The size of the extracted tumor was 4 x 5 x 2 . 5 c m . The lateral and lingual cortex was thinned, but not perforated by the tumor. The inferior alveolar nerve was displaced inferiorly. Microscopically, the excised specimen consisted of a highly cellular fibrous tissue containing numerous spindle-shaped cells and multinuclear giant cells. The histology of specimens was typical for a juvenile active ossifying fibroma. Recurrence isn't seen six months after surgery. We report a case of juvenile active ossifying fibroma. Long-term observation is required, because it's recurrence rate is high.
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GRANULOCYTIC SARCOMA OF THE SUBMANDIBULAR GLAND PRECEDING ACUTE MYELOID LEUKEMIA: REPORT OF A CASE
H. Ihara 1,2, T. Ono 1,2, M. Nasu 1,2 . 1Department of Ora/and Maxi//ofacia/
Surgery, Tokyo Medical and Dental University, Tokyo, Japan; 2Dental and Oral Surgery and Clinical Laboratory of Pathology, International Medical Center of Japan, Tokyo, Japan Garanulocytic sarcoma is an uncommon extramedullary tumor composed of dense aggregates of immature myeloid precursor cells, which is usually associated with acute or chronic myeloid leukemia. Also known as Chloroma because of the green color of the gross tumor. The tumor may also be a predecessor to acute myeloid leukemia (AML). It may be found in any part of the body. The scull and the bony orbits are the most common sites in the head and neck region. This report describes a case of submandibular gland that developed prior to AML in a 55 year old female. The patient who had a 6 month history of submandibular enlargement, was diagnosed as submandibular abscess or lymphadenitis by CT and MR imaging. Initial morphologic examination favored lymphoblastic lymphoma/leukemia. Conventional cytochemical and immunohistochemical stains were negative for lymphoid markers. Subsequent immunohistochemical stains for T-cell and B-cell marker were negative. CD43(MT-1 )were positive. In additionrare cells were positive for myeloperoxidase (MPO) and Leder stains. This report describes a rare case of granulocytic sarcoma of submandubular gland and lymph nodes. We had the diagnostic dilemma that it imposes on the treating surgeon. References [1] American Journal of Otolaryngology, Vol 22, No 1 (January-February), 2001: pp 80-83.
[-P-'~-'~ MANAGEMENT OF THE RELAPSING PLEOMORPHIC A D E N O M A OF THE PAROTID GLAND R. Pujol, J. Acero, C. Navarro Cuellar, A. del Amo, T. Bucci, C. Navarro Vila. Gregorio Marahon University Hospital, Madrid, Spain Pleomorphic adenoma is the most frequent tumor affecting the parotid gland. Although pleomorphic adenoma treatment guidelines are well established, relapse is not infrequent in these cases. In this paper we discuss our experience in the treatment of the relapsing pleomorphic adenoma. We review a series of 240 patients affected by parotid gland tumors treated from 1992 to 2002, 121 cases out of them were pleomorphic adenoma. 16 cases (13%) of relapsing pleomorphic adenoma were registered. Incorrect primary treatment leaded to relapse in most cases. After secondary treatment of relapsing pleomorphic adenoma, further relapse was registred in 37.5% of cases. We discuss the management of this complication. Pleomorphic adenoma of the parotid gland constitutes a therapeutical challenge. Secondary relapse is frequent after treatment of relapsing cases. [-P-~-'~ FDG-PET TO PREDICT RESPONSE TO INTRAARTERIAL CHEMORADIOTHERAPY AND PROGNOSIS IN ORAL SQUAMOUS CELL CARCINOMA Y. Kitagawa 1 , K. Sano 2, M. Nakamura 2, T. Ogasawara 2, H. Okazawa 3, Y. Fujibayashi 3, "~ Yonekura 3 . iOta~ Diagnosis and Medicine, Graduate
School of Dental Medicine, Hokkaido University, Sapporo, Japan; 2Division of Dentistry and Oral Surgery, University of Fukui, Japan; 3Biomedical Imaging Research Center, University of Fukui, Japan In patients with oral cancer accurate evaluation of therapeutic effect is essential to determine further operation after the chemoradiotherapy in consideration of the patient's prognosis and quality of life. The aim of this study was to evaluate the usefulness of positron emission tomography with 18F labeled fluorodeoxyglucose (FDG-PET) for predicting response to intraarterial chemoradiotherapy and prognosis in oral carcinomas. Thirty-five patients with oral SCC were included in the study. Each patient underwent 2 FDG-PET studies, one prior to and one after the chemoradiotherapy. The pre- and post-treatment PET images were compared with clinical and histopathological evaluations of the treatment effect. For the quantitative evaluation of regional radioactivity, standardized uptake values (SUVs) were used. The chemoradiotherapy demonstrated good response (CR rate 71%, p-CR rate 83%). All neoplastic lesions showed high SUVs (mean, 10.00mg/ml) prior to the treatment, which values significantly decreased after the therapy (3.74). Lesions with higher preSUVs (> 7 ) showed residual viable tumor cells after the treatment in 6 out of 25 patients, and 3-year survival rate of 79%. whereas those with lower SUVs (<7, 10 patients) were successfully treated, and showed significantly higher 3-year survival (100%). Six out of 13 tumors with post-SUVs > 4 had viable tumor cells, whereas all (22/22) tumors with post-SUVs <4 showed no viable cells. Based on PET results, 10 patients avoided operation altogether. Each patient showed no local recurrence within 5-year follow-up. Pretreatment FDG-PET is useful in predicting the response to treatment and prognosis. Posttreatment FDG-PET can evaluate residual viable cells. Organ preservation may be feasible based on PET evaluation. Hence FDG-PET is a valuable tool in the treatment of oral cancer. References [1] Kitagawa Y. Nishizawa S. et al: Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med 44: 198-206, 2003. [2] Kitagawa Y. Sano K. et al: FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 30: 63-71, 2003. [-P-~'-~ ANALYSIS OF S100A7 PROMOTER ON THE REGULATORY MECHANISM OF GENE EXPRESSION IN ORAL SQUAMOUS CELL CARCINOMA H. Fukuzawa, K. Hashimoto, S. Ozeki. Section of Ora/ Surgery, Department of Oral & Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan $100A7 is a small calcium-binding protein of $100 family, and was first described as one of the specific proteins in the psoriatic lesion. Up-
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of the marginal branch of the facial nerve, which subsided in 3 months. All patients recovered well. Benign neoplasms of the submandibular and sublingual gland are rare, compared to malignancies of these salivary glands, as opposed to parotid tumours. Careful preoperative evaluation is necessary, with computerized tomography scan and possibly fine needle aspiration or trucar biopsy of the lesion.
•
JUVENILE ACTIVE OSSIFYING FIBROMA OF THE MANDIBLE: CASE REPORT
K. Yamaguchi, M. Numata, H. Kawamura. Division of Maxillofacial
Surgery, Graduate School of Dentistry, Tohoku University, Japan Maxillofacial fibro-osseous lesions are often difficult to diagnose from both a clinical and a histopathologic point of view. The World Health Organization divided the fibro-osseous lesions into two main groups: osteogenic fibro-osseous lesions and non-neoplastic osseous lesions. Juvenile active ossifying fibroma belongs to the second group. A lesion with aggressive growth in patients under the age of 15 is known as juvenile active ossifying fibroma. The purpose of this study was to report a case of juvenile active ossifying fibroma of mandiblar ramus. Patient was a 12-year-old boy. The clinical diagnosis was ameloblastoma. Complete enucleation of the tumor mass was performed under general anesthesia. The pathologic diagnosis was a juvenile active ossifying fibroma. The lesion was firm. Borders were distinct. Covering mucosa was healthy. The left mandibular ramus region was swelling, and face was asymmetry. No pain was elicited on palpation. The satellite lymph node was clinically healthy. Orthopantographic scan revealed the presence of a lesion in the mandibular ramus. The second and third molars were burred under the lesion. The lesion was enucleated. The size of the extracted tumor was 4 x 5 x 2 . 5 c m . The lateral and lingual cortex was thinned, but not perforated by the tumor. The inferior alveolar nerve was displaced inferiorly. Microscopically, the excised specimen consisted of a highly cellular fibrous tissue containing numerous spindle-shaped cells and multinuclear giant cells. The histology of specimens was typical for a juvenile active ossifying fibroma. Recurrence isn't seen six months after surgery. We report a case of juvenile active ossifying fibroma. Long-term observation is required, because it's recurrence rate is high.
r
P
•
l
-
]
GRANULOCYTIC SARCOMA OF THE SUBMANDIBULAR GLAND PRECEDING ACUTE MYELOID LEUKEMIA: REPORT OF A CASE
H. Ihara 1,2, T. Ono 1,2, M. Nasu 1,2 . 1Department of Ora/and Maxi//ofacia/
Surgery, Tokyo Medical and Dental University, Tokyo, Japan; 2Dental and Oral Surgery and Clinical Laboratory of Pathology, International Medical Center of Japan, Tokyo, Japan Garanulocytic sarcoma is an uncommon extramedullary tumor composed of dense aggregates of immature myeloid precursor cells, which is usually associated with acute or chronic myeloid leukemia. Also known as Chloroma because of the green color of the gross tumor. The tumor may also be a predecessor to acute myeloid leukemia (AML). It may be found in any part of the body. The scull and the bony orbits are the most common sites in the head and neck region. This report describes a case of submandibular gland that developed prior to AML in a 55 year old female. The patient who had a 6 month history of submandibular enlargement, was diagnosed as submandibular abscess or lymphadenitis by CT and MR imaging. Initial morphologic examination favored lymphoblastic lymphoma/leukemia. Conventional cytochemical and immunohistochemical stains were negative for lymphoid markers. Subsequent immunohistochemical stains for T-cell and B-cell marker were negative. CD43(MT-1 )were positive. In additionrare cells were positive for myeloperoxidase (MPO) and Leder stains. This report describes a rare case of granulocytic sarcoma of submandubular gland and lymph nodes. We had the diagnostic dilemma that it imposes on the treating surgeon. References [1] American Journal of Otolaryngology, Vol 22, No 1 (January-February), 2001: pp 80-83.
[-P-'~-'~ MANAGEMENT OF THE RELAPSING PLEOMORPHIC A D E N O M A OF THE PAROTID GLAND R. Pujol, J. Acero, C. Navarro Cuellar, A. del Amo, T. Bucci, C. Navarro Vila. Gregorio Marahon University Hospital, Madrid, Spain Pleomorphic adenoma is the most frequent tumor affecting the parotid gland. Although pleomorphic adenoma treatment guidelines are well established, relapse is not infrequent in these cases. In this paper we discuss our experience in the treatment of the relapsing pleomorphic adenoma. We review a series of 240 patients affected by parotid gland tumors treated from 1992 to 2002, 121 cases out of them were pleomorphic adenoma. 16 cases (13%) of relapsing pleomorphic adenoma were registered. Incorrect primary treatment leaded to relapse in most cases. After secondary treatment of relapsing pleomorphic adenoma, further relapse was registred in 37.5% of cases. We discuss the management of this complication. Pleomorphic adenoma of the parotid gland constitutes a therapeutical challenge. Secondary relapse is frequent after treatment of relapsing cases. [-P-~-'~ FDG-PET TO PREDICT RESPONSE TO INTRAARTERIAL CHEMORADIOTHERAPY AND PROGNOSIS IN ORAL SQUAMOUS CELL CARCINOMA Y. Kitagawa 1 , K. Sano 2, M. Nakamura 2, T. Ogasawara 2, H. Okazawa 3, Y. Fujibayashi 3, "~ Yonekura 3 . iOta~ Diagnosis and Medicine, Graduate
School of Dental Medicine, Hokkaido University, Sapporo, Japan; 2Division of Dentistry and Oral Surgery, University of Fukui, Japan; 3Biomedical Imaging Research Center, University of Fukui, Japan In patients with oral cancer accurate evaluation of therapeutic effect is essential to determine further operation after the chemoradiotherapy in consideration of the patient's prognosis and quality of life. The aim of this study was to evaluate the usefulness of positron emission tomography with 18F labeled fluorodeoxyglucose (FDG-PET) for predicting response to intraarterial chemoradiotherapy and prognosis in oral carcinomas. Thirty-five patients with oral SCC were included in the study. Each patient underwent 2 FDG-PET studies, one prior to and one after the chemoradiotherapy. The pre- and post-treatment PET images were compared with clinical and histopathological evaluations of the treatment effect. For the quantitative evaluation of regional radioactivity, standardized uptake values (SUVs) were used. The chemoradiotherapy demonstrated good response (CR rate 71%, p-CR rate 83%). All neoplastic lesions showed high SUVs (mean, 10.00mg/ml) prior to the treatment, which values significantly decreased after the therapy (3.74). Lesions with higher preSUVs (> 7 ) showed residual viable tumor cells after the treatment in 6 out of 25 patients, and 3-year survival rate of 79%. whereas those with lower SUVs (<7, 10 patients) were successfully treated, and showed significantly higher 3-year survival (100%). Six out of 13 tumors with post-SUVs > 4 had viable tumor cells, whereas all (22/22) tumors with post-SUVs <4 showed no viable cells. Based on PET results, 10 patients avoided operation altogether. Each patient showed no local recurrence within 5-year follow-up. Pretreatment FDG-PET is useful in predicting the response to treatment and prognosis. Posttreatment FDG-PET can evaluate residual viable cells. Organ preservation may be feasible based on PET evaluation. Hence FDG-PET is a valuable tool in the treatment of oral cancer. References [1] Kitagawa Y. Nishizawa S. et al: Prospective comparison of 18F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med 44: 198-206, 2003. [2] Kitagawa Y. Sano K. et al: FDG-PET for prediction of tumour aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 30: 63-71, 2003. [-P-~'-~ ANALYSIS OF S100A7 PROMOTER ON THE REGULATORY MECHANISM OF GENE EXPRESSION IN ORAL SQUAMOUS CELL CARCINOMA H. Fukuzawa, K. Hashimoto, S. Ozeki. Section of Ora/ Surgery, Department of Oral & Maxillofacial Surgery, Fukuoka Dental College, Fukuoka, Japan $100A7 is a small calcium-binding protein of $100 family, and was first described as one of the specific proteins in the psoriatic lesion. Up-