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Squamous-cell carcinoma of the jaw arising in a simple cyst
Squamous-cell carcinoma of the jaw arising in a simple cyst Report
of a case
K. I. II. Whitbock, :II.D.S., P.I).S.R.~‘.S.(E,I~~.), aad ,I. H. ,Jom, N.D., ;Ii.(‘.l’trth.. I..D.P.K.(‘.R.( Relfa.st. Northern lr(~lmd
C
I~‘.P’.D.R.(‘.S./.,* l&g.),**
USWiIt~
arcinoniatous involvcnwiit of the jaws is tho wsult of direct (lxOccasionally, tumors in distant sit.es ( I’OI tension from adjacent struvhlws. example. the hrcast: t,hyroid, kidney, lung, or prostatth) metastasize to the ,jaws. Primary carcinomas arising wit.hin thta jaws from cnc*Iavcd epit.lielinm or from the lining of odontogenic cysts arc unwmmon. Alth~~~~gh thwc arc n1a11>- W~OI?S oE malignant change in cyst, linings. in only a few of these is adt?(luat(~ cvidcnw pwscntcd to show bayond wasonahlc doubt. t,hat thv rwlignancy has originatccl in a c,vst. TIOWVC~, smc u~cll-tlocl7mrntrd rant reports’-:’ leave little tlonht that llldigllilIlt c*hangSeWI1 occ’lll’ in ttlc linings of dl3ltill c*ysts,tllltl th 0t)jWt. Of this i1ltiClP is to p*escnt iln ittlditi0ll;lt CilSf? in wliic*h th(l1v is cvidcnrc of il. similar o~:c’iirlww.
Volume 24 Sunlbor 4
532
Whitlock
aud Jones
OS., OX. & 02. ortohT,
1967
their nuclei were often large and hpperchroulatic (Figs. 1 and 2). in a few places the basal layer was uneven, and fingerlike processes formed 1-1~dysplastic epithelium penetrated the underlying tissue (Fig. 3). A diagnoriu of squamous-cell carcinoma arising in II cyst. was made. The patient was referred for further investigation and treatment. He hall had no prerious illnesses of note, and general examination showed him to be well nourished amI fit. So enlnrgemcnt of the sul)~l~al)tli~)~~laror cervical lymph ~~orles rvw fourlll, autl thcrca WR’:
3. Cyst wall. Fingerlikc processes formctl l)p dysplastic tissues. ( JT~~niatoyvlin and closin stain. Jingnific~ation~ xl1 0. j
Fig.
cpitl~c~linm pcnetrat~~ ~~IWIIUS
Pig. 6. Mandilde. t Inch scale.)
8pecimen
has lwrn
dccalcififd
and hiswt.c~d, and t.umor is clearly
visible.
0rtl1 mucosa was repaired, and the bony fragments t ion SOthat the gap between them was maintained.
were
immol)ilizetl
1)~ external
pin lisa-
The whole specimen removed at this operation was decalcilied anIl then divitle(l (Fig. f;j. An oval defect (approximately 1 cm. in diameter) was found in the lmne underlying the small sinus (Fig. i). This defect eontained vascular granulation tissue in which therr were ac*utc* anti chronic inflammatory cells ttntl occasional foreign-ho(ly giant. cc4l~;. Small rpttc~x lird with apparently innocent stratiliotl syuamons epilhelium were also present. in the granulation tissue (Fig. ~4). Except at its lower limit, thr l)on,v wall of thra Ilefcvt u‘:~s :llld tlleW Was SO1116? I1civ I)Olle fOrnl;rtiOrl . A grayibli white t11mnr n1:15* vstc.ulltvl W~llllil,
Pig. 7. Giant s&ion of mandible. Cirrular defect, lirs immedi:rtttly bencath manililk Tumor tdcds from itH lower limit. to lowrr I)ord(~r of rnandil~lv.
upper
1~171~ of
O.R.,
0.11. L 0.1’. oc~tolM~i-. 1Nii
~hang:c was in a prc-existing cyt. The malignant change had apparcttt 1). WIIImcnced in the lower part of I he cyst wall, and its infiltra.tion of bonca was Itlost cstensivc at this point. The pre-existing cyst. was prtyuttnahly a tGdtt;tl c*yxt of dctttal origin, but this diagttosis is speculat.ivc. The foregoing case is presented as further evidcnrc that oc*c.asiottally malipnattt change may occw in dental cyt.s, although it. is our cxprricttcc~ that I his rc~ott for is i111 cstretttcl~ uncotnmon occurrctice. Sf7x:rthclcss, it. is a fitrtlicr tltc complete removal of aI1 jaw cysts. The diaptosis of malignant (!ltittta(s is made by the recogttitiott of clpithrlial tlyspla.sia in a cyst, lining. This mllst IJ(~ differctttiatcd from the t!pithelial hypq&Gt whkh is so oftrn found in clctttitl cyst.s but in which t.he irrcgnlarity of ~11 sisc and ~turlear staining tlosc*rilJc~(l here? is not found. A careful csamittatiott of wvwal scc+otts itt series will usu;~ll~ Show lhat apparent invasion in simple cysts is an artifact CatisCcl by tllca tblilll(L of
sod ion.
of a case
K. I. II. Whitbock, :II.D.S., P.I).S.R.~‘.S.(E,I~~.), aad ,I. H. ,Jom, N.D., ;Ii.(‘.l’trth.. I..D.P.K.(‘.R.( Relfa.st. Northern lr(~lmd
C
I~‘.P’.D.R.(‘.S./.,* l&g.),**
USWiIt~
arcinoniatous involvcnwiit of the jaws is tho wsult of direct (lxOccasionally, tumors in distant sit.es ( I’OI tension from adjacent struvhlws. example. the hrcast: t,hyroid, kidney, lung, or prostatth) metastasize to the ,jaws. Primary carcinomas arising wit.hin thta jaws from cnc*Iavcd epit.lielinm or from the lining of odontogenic cysts arc unwmmon. Alth~~~~gh thwc arc n1a11>- W~OI?S oE malignant change in cyst, linings. in only a few of these is adt?(luat(~ cvidcnw pwscntcd to show bayond wasonahlc doubt. t,hat thv rwlignancy has originatccl in a c,vst. TIOWVC~, smc u~cll-tlocl7mrntrd rant reports’-:’ leave little tlonht that llldigllilIlt c*hangSeWI1 occ’lll’ in ttlc linings of dl3ltill c*ysts,tllltl th 0t)jWt. Of this i1ltiClP is to p*escnt iln ittlditi0ll;lt CilSf? in wliic*h th(l1v is cvidcnrc of il. similar o~:c’iirlww.
Volume 24 Sunlbor 4
532
Whitlock
aud Jones
OS., OX. & 02. ortohT,
1967
their nuclei were often large and hpperchroulatic (Figs. 1 and 2). in a few places the basal layer was uneven, and fingerlike processes formed 1-1~dysplastic epithelium penetrated the underlying tissue (Fig. 3). A diagnoriu of squamous-cell carcinoma arising in II cyst. was made. The patient was referred for further investigation and treatment. He hall had no prerious illnesses of note, and general examination showed him to be well nourished amI fit. So enlnrgemcnt of the sul)~l~al)tli~)~~laror cervical lymph ~~orles rvw fourlll, autl thcrca WR’:
3. Cyst wall. Fingerlikc processes formctl l)p dysplastic tissues. ( JT~~niatoyvlin and closin stain. Jingnific~ation~ xl1 0. j
Fig.
cpitl~c~linm pcnetrat~~ ~~IWIIUS
Pig. 6. Mandilde. t Inch scale.)
8pecimen
has lwrn
dccalcififd
and hiswt.c~d, and t.umor is clearly
visible.
0rtl1 mucosa was repaired, and the bony fragments t ion SOthat the gap between them was maintained.
were
immol)ilizetl
1)~ external
pin lisa-
The whole specimen removed at this operation was decalcilied anIl then divitle(l (Fig. f;j. An oval defect (approximately 1 cm. in diameter) was found in the lmne underlying the small sinus (Fig. i). This defect eontained vascular granulation tissue in which therr were ac*utc* anti chronic inflammatory cells ttntl occasional foreign-ho(ly giant. cc4l~;. Small rpttc~x lird with apparently innocent stratiliotl syuamons epilhelium were also present. in the granulation tissue (Fig. ~4). Except at its lower limit, thr l)on,v wall of thra Ilefcvt u‘:~s :llld tlleW Was SO1116? I1civ I)Olle fOrnl;rtiOrl . A grayibli white t11mnr n1:15* vstc.ulltvl W~llllil,
Pig. 7. Giant s&ion of mandible. Cirrular defect, lirs immedi:rtttly bencath manililk Tumor tdcds from itH lower limit. to lowrr I)ord(~r of rnandil~lv.
upper
1~171~ of
O.R.,
0.11. L 0.1’. oc~tolM~i-. 1Nii
~hang:c was in a prc-existing cyt. The malignant change had apparcttt 1). WIIImcnced in the lower part of I he cyst wall, and its infiltra.tion of bonca was Itlost cstensivc at this point. The pre-existing cyst. was prtyuttnahly a tGdtt;tl c*yxt of dctttal origin, but this diagttosis is speculat.ivc. The foregoing case is presented as further evidcnrc that oc*c.asiottally malipnattt change may occw in dental cyt.s, although it. is our cxprricttcc~ that I his rc~ott for is i111 cstretttcl~ uncotnmon occurrctice. Sf7x:rthclcss, it. is a fitrtlicr tltc complete removal of aI1 jaw cysts. The diaptosis of malignant (!ltittta(s is made by the recogttitiott of clpithrlial tlyspla.sia in a cyst, lining. This mllst IJ(~ differctttiatcd from the t!pithelial hypq&Gt whkh is so oftrn found in clctttitl cyst.s but in which t.he irrcgnlarity of ~11 sisc and ~turlear staining tlosc*rilJc~(l here? is not found. A careful csamittatiott of wvwal scc+otts itt series will usu;~ll~ Show lhat apparent invasion in simple cysts is an artifact CatisCcl by tllca tblilll(L of
sod ion.