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P.133 Histopathologic and histomorphometricanalysis of irradiation injury of bone and the surrounding soft tissues of the jaws
Diagqwsis. Radiotherapy. Combined treatments, Alternative and future treatments
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Histopathologic and histomorphometric analysis of irradiation injury of bone and the surrounding soft tissues of the jaws
M.M. Curl, M.O. dos Santos, O. Feller, G. Landman. :Servicio de Oncologta, Hospttat Santa Catarma, Sffo Pauto, Brazd, :Centro de Tratamento e Pesqutsa Hospital do Cancer, Sffo PauIo, Brazil Introduetion: Management of irradiated head and neck cancer patients remains a difficult and challenging problem. Radiotherapy leads to damage of tissue cells and vasculature. Surgery m such compronnsed tissue has an mcreased comphcatlon rate because of the development of hypovascular-hypocellularhypoxic tissue. These histomorphological changes in irradiated bone are of major concern to oral and maxillofacial surgeons, who must consider how to manage palaents after therapeutic radiation, hfformation on whether or when tile patient may recover from such changes as also important for tile schedule of treatment and proper protection of the patient. Materials and Methods: Fifty-five human tnandabular bone and the surronndmg soft tissues specimens obtained from surgical procedures for the treatment of osteoradionecrosis of the jaws or during head and neck salvage surgery after radiotherapy were used m this study. All specimens were stained with hematoxyhn and eosm for hlstologlc and hlstomorpholnetrlC evaluations. The study analysed also the expression of CD34 in all specnnens by mmmnohastologlcal techmque using parafthaembedded lassue and specific anti-human CD34 monoclonal antibody. Each tnstologac specimen was assessed as a function of tune since treatment with radiation to develop a relative time course of radiation tissue injury. Normal hulnan mandibular bone and the surrounding soft tissues were used as control specmaens. Results: Hastopathologlc exarmaatlon found seven processes m order of appearance: hypereima, endarterltlS, thronlbosas, cellular loss, hypovascularlty, increase of fat in bone-marrow cavity, and fibrosis. Hastomorphometrac analysis revealed a slgmficant loss of Imcrovascular content, increase of fibrosis and hypocellularaty m Irradiated specnnens compared to control specmaen (p <0.001: p <0.001; and p 0.007, respectively). Conelusion: Our results concluded that irradiation injuries affects bothj tile bone and the surrounding soft tissues. These radiation effects were observed on tile bone cells, on tile counectlve tissue and on the fine vasculature m these tissues. All irradiated tissues showed reduced spontaneous capacity of recovering with tune. Radiation tissue injury seems to be time progressive.
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Effects of radiation therapy on cytologic specimens of oral cancer
R M . Viler1, K. Vahtsevanos, E. Aslamdou, A. Ntomouchtsls, Z. Teleloudls, M. Charalalnbldou, Ch. Destounl, K. Antomadls.
Cytology and Moxdlofac~aI Surgery Department, Anttcancer Hospital "Theagemon'; Thessalontla, Greece Introduetion: Surgery and radiation therapy are the cornerstones m the treatment of head and neck cancers. Oral mucosal changes occur because of radiation therapy as part of the therapeutic regimen ill thlS area. Serial cytologic scrapmgs can differentiate well these radiation-induced changes and help ill the follow-up of these patients. To evaluate the cytologic abnormahtles m cells collected by serial scrape smears from oral cancer patients on fractlonated radiotherapy. Materials and Methods: Fifty five oral cancer patients given radiotherapy after surgery form the study population. Serial scrape smears using a brush were taken before, during and
187
after delivery o f radiation fractions from their tumor mad adjacent areas. The cytologic material was processed using both conventional and Thin-layer cytology (ThinPrep technique). Results: Our results re~-ealed that early cytologic changes (durmg and tmmediately after radiotherapy) include hyperkerato sis, cytoplasnnc vacuollZatlon, mild nuclear atypia axtd wrinkling o f the surface of the nucleus, wt~le the late ones (few months to two years) are more that of fibrosis. A small number of these patients presented with a recurrent tumor. Conclusion: 1) Serial cytologic smears help in the follow up of oral cancer patients especially for persistent or recurrent lesions. 2) Tile new ThmPrep method offers a better smear quality, increased cellularity and the easier application of new techniques. Therefore, it is the method of choice especially for head and neck tumors
~ A
case of highly aggresive clear cell odontogenic tumor M. Karas. Department of Maxdlo-Fac~al Surgery, AI Qasstml Hospital, Shauah, Umted Arab Emtrates Introduction: Clear cell odontogemc ttmaor had been first reported m 1985, and only a handful have been diagnosed since. In most cases these are "border-hne", low mall~lancy tumors, slowly growing, with tendency for late recurrence, ususally seen m elderly patients. Materials and Methods: My patient is a 48 years old male Indian, who had been referred to me for the cyst o f the (R) body o f tile mandible. During tile surgery, following the enucleatlon o f the cyst, small m size soft tissue mass had been found an the distal part of the bone defect, not connected with the cyst' wall, and removed. After obtaining HP results, wider excision of the soft tissue has been done, to be found non-radical m the next pathological examination. Extremly fast growth of the tumorous mass and bone destruction could be seen an radiograms and C T Tile patient underwent henmnandibulectomy with radical neck dissection. Metastases have been found m majority of the lymph nodes, some of the lymph nodes had capsules ruptured. Radiation therapy with a full dose for the facial and cervical fields followed. The patient was free from tumor for 8 months, when a mass started to be palpable an tile (R) mfratemporal region. CT clearly indicated tile presence of recurrence, hence chemotherapy had been started. Results: The patient remains free from tuninr since the completion of the chemotherapy (April 2004), and the reconstruction o f the iuandible is planned in March/April 2005. Conclusion: The case is slgmficantly different than majority o f previously reported younger age of the patient, extremely fast progress, early cervical metastases and very quack recurrence.
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Carcinoma of the buccal mucosa treated in a tertiary care hospital - epidemiology, pattern of care and survival S. Ghoshal, I. Malllck, N. Panda, S.C. Sharma. Postgraduate bzstmtte of Me&oil Educatwn and Research, tndta Introduction: Carcinoma of the buccal mucosa is a common mahgnancy m our region but very little data as available regarding epldeimology and outcome of therapy. Therefore, the present study was conducted to analyse the epidemiological factors and results o f treatment m these patlents.py and paste your text here Materials and Methods: Records o f 100 consecutive cases o f buccal mucosa treated m our institute between January 2000 and Decenlber 2003 were analysed for epldermologlcal factors, common clinical presentations and outcome o f
[P•
Histopathologic and histomorphometric analysis of irradiation injury of bone and the surrounding soft tissues of the jaws
M.M. Curl, M.O. dos Santos, O. Feller, G. Landman. :Servicio de Oncologta, Hospttat Santa Catarma, Sffo Pauto, Brazd, :Centro de Tratamento e Pesqutsa Hospital do Cancer, Sffo PauIo, Brazil Introduetion: Management of irradiated head and neck cancer patients remains a difficult and challenging problem. Radiotherapy leads to damage of tissue cells and vasculature. Surgery m such compronnsed tissue has an mcreased comphcatlon rate because of the development of hypovascular-hypocellularhypoxic tissue. These histomorphological changes in irradiated bone are of major concern to oral and maxillofacial surgeons, who must consider how to manage palaents after therapeutic radiation, hfformation on whether or when tile patient may recover from such changes as also important for tile schedule of treatment and proper protection of the patient. Materials and Methods: Fifty-five human tnandabular bone and the surronndmg soft tissues specimens obtained from surgical procedures for the treatment of osteoradionecrosis of the jaws or during head and neck salvage surgery after radiotherapy were used m this study. All specimens were stained with hematoxyhn and eosm for hlstologlc and hlstomorpholnetrlC evaluations. The study analysed also the expression of CD34 in all specnnens by mmmnohastologlcal techmque using parafthaembedded lassue and specific anti-human CD34 monoclonal antibody. Each tnstologac specimen was assessed as a function of tune since treatment with radiation to develop a relative time course of radiation tissue injury. Normal hulnan mandibular bone and the surrounding soft tissues were used as control specmaens. Results: Hastopathologlc exarmaatlon found seven processes m order of appearance: hypereima, endarterltlS, thronlbosas, cellular loss, hypovascularlty, increase of fat in bone-marrow cavity, and fibrosis. Hastomorphometrac analysis revealed a slgmficant loss of Imcrovascular content, increase of fibrosis and hypocellularaty m Irradiated specnnens compared to control specmaen (p <0.001: p <0.001; and p 0.007, respectively). Conelusion: Our results concluded that irradiation injuries affects bothj tile bone and the surrounding soft tissues. These radiation effects were observed on tile bone cells, on tile counectlve tissue and on the fine vasculature m these tissues. All irradiated tissues showed reduced spontaneous capacity of recovering with tune. Radiation tissue injury seems to be time progressive.
•
Effects of radiation therapy on cytologic specimens of oral cancer
R M . Viler1, K. Vahtsevanos, E. Aslamdou, A. Ntomouchtsls, Z. Teleloudls, M. Charalalnbldou, Ch. Destounl, K. Antomadls.
Cytology and Moxdlofac~aI Surgery Department, Anttcancer Hospital "Theagemon'; Thessalontla, Greece Introduetion: Surgery and radiation therapy are the cornerstones m the treatment of head and neck cancers. Oral mucosal changes occur because of radiation therapy as part of the therapeutic regimen ill thlS area. Serial cytologic scrapmgs can differentiate well these radiation-induced changes and help ill the follow-up of these patients. To evaluate the cytologic abnormahtles m cells collected by serial scrape smears from oral cancer patients on fractlonated radiotherapy. Materials and Methods: Fifty five oral cancer patients given radiotherapy after surgery form the study population. Serial scrape smears using a brush were taken before, during and
187
after delivery o f radiation fractions from their tumor mad adjacent areas. The cytologic material was processed using both conventional and Thin-layer cytology (ThinPrep technique). Results: Our results re~-ealed that early cytologic changes (durmg and tmmediately after radiotherapy) include hyperkerato sis, cytoplasnnc vacuollZatlon, mild nuclear atypia axtd wrinkling o f the surface of the nucleus, wt~le the late ones (few months to two years) are more that of fibrosis. A small number of these patients presented with a recurrent tumor. Conclusion: 1) Serial cytologic smears help in the follow up of oral cancer patients especially for persistent or recurrent lesions. 2) Tile new ThmPrep method offers a better smear quality, increased cellularity and the easier application of new techniques. Therefore, it is the method of choice especially for head and neck tumors
~ A
case of highly aggresive clear cell odontogenic tumor M. Karas. Department of Maxdlo-Fac~al Surgery, AI Qasstml Hospital, Shauah, Umted Arab Emtrates Introduction: Clear cell odontogemc ttmaor had been first reported m 1985, and only a handful have been diagnosed since. In most cases these are "border-hne", low mall~lancy tumors, slowly growing, with tendency for late recurrence, ususally seen m elderly patients. Materials and Methods: My patient is a 48 years old male Indian, who had been referred to me for the cyst o f the (R) body o f tile mandible. During tile surgery, following the enucleatlon o f the cyst, small m size soft tissue mass had been found an the distal part of the bone defect, not connected with the cyst' wall, and removed. After obtaining HP results, wider excision of the soft tissue has been done, to be found non-radical m the next pathological examination. Extremly fast growth of the tumorous mass and bone destruction could be seen an radiograms and C T Tile patient underwent henmnandibulectomy with radical neck dissection. Metastases have been found m majority of the lymph nodes, some of the lymph nodes had capsules ruptured. Radiation therapy with a full dose for the facial and cervical fields followed. The patient was free from tumor for 8 months, when a mass started to be palpable an tile (R) mfratemporal region. CT clearly indicated tile presence of recurrence, hence chemotherapy had been started. Results: The patient remains free from tuninr since the completion of the chemotherapy (April 2004), and the reconstruction o f the iuandible is planned in March/April 2005. Conclusion: The case is slgmficantly different than majority o f previously reported younger age of the patient, extremely fast progress, early cervical metastases and very quack recurrence.
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Carcinoma of the buccal mucosa treated in a tertiary care hospital - epidemiology, pattern of care and survival S. Ghoshal, I. Malllck, N. Panda, S.C. Sharma. Postgraduate bzstmtte of Me&oil Educatwn and Research, tndta Introduction: Carcinoma of the buccal mucosa is a common mahgnancy m our region but very little data as available regarding epldeimology and outcome of therapy. Therefore, the present study was conducted to analyse the epidemiological factors and results o f treatment m these patlents.py and paste your text here Materials and Methods: Records o f 100 consecutive cases o f buccal mucosa treated m our institute between January 2000 and Decenlber 2003 were analysed for epldermologlcal factors, common clinical presentations and outcome o f