INTERESTING CASE REVIEWS

INTERESTING CASE REVIEWS

“FIRST OF ITS KIND IN THE NATION”

Dedicated Exclusively to Diagnostic and Consultative
Pathology of the Oral Cavity, Head and Neck

CLINICAL INFORMATION:

52 year old female with asymptomatic osteolytic lesion in the mandibular symphysis. Negative medical and dental history.

MATERIALS RECEIVED:

One H and E-stained slide and its corresponding paraffin block. One panoramic image.
CONTRIBUTOR’S DIAGNOSIS:
Clear Cell Odontogenic Carcinoma.
MICROSCOPIC FINDINGS:
The lesion reveals haphazardly arranged pleomorphic malignant cells with focal clear cytoplasm and foci of undifferentiated small cells with hyperchromatic nuclei displaying “pseudo-molding”. Of note is a hypercellular stroma with smooth muscle features, stromal hyalinization and areas of necrosis (tumor and stroma).
DISCUSSION:
The histomorphology of the lesion was not characteristic of any known/reported malignant primary tumor of odontogenic origin. The possibility of a metastatic epithelial process was entertained although some radiologic findings (root divergence, no obvious root destruction) suggested a long-standing lesion/primary tumor/slow growth.
Additional information was obtained: The patient denied smoking, cough, gross hematuria, flank pain, abdominal fullness, weight loss and pain or discomfort of any nature. Aside from the bone lesion, the oral cavity was free of pathology.
A panel of immunohistochemical special stains confirmed the epithelial nature of the cells and did not support the possibilities of lung, renal, ovarian, breast and other glandular malignancies. The stroma showed diffuse strong reactivity with smooth muscle markers.
FINAL DIAGNOSIS: HIGH GRADE CARCINOMA WITH FOCAL CLEAR CELL COMPONENT.
Comment: It is likely that the tumor is primary, but further clinical/radiologic work-up is indicated for confirmation.
A special thank you to Dr. Rigo Cornejo for the opportunity of studying this very challenging
case and for his longtime trust and support.

Rosa H. Robison, MD. DDS. FCAP.

Rosa H. Robison, MD. DDS. FCAP.

  • Diplomate of the American Board of Medical
    Pathology.

  • Diplomate of the American Board of Oral and
    Maxillofacial Pathology.

  • Fellowship Training: Soft Tissue Neoplasia and
    Immunohistochemistry.
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