; clear2cell odontogenic tumor ( immunohistochemical and electron
Learning Center
Plans & pricing Sign in
Sign Out
Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

clear2cell odontogenic tumor ( immunohistochemical and electron


clear2cell odontogenic tumor ( immunohistochemical and electron

More Info
  • pg 1
									¡¡60 ¡¡ ¡¡ ¡⁄¡¡ ¡⁄

¡¡ ˙»¢ˆ˝¿˘ ¡¡ ¿

2004 ˜Œ ¡¡

14 ¡¡

1 ˘ ¡¡


( 1. ¡¡ Department of Oral and Maxillofacial Surgery , School of Dentistry , Oregon Healt h and Science University. 2. ¡¡ Department of Oral and Maxillofacial Surgery , Department of Pat hology and Radiology. 3. ¡¡ Department of Pat hology and Radiology. 4. ¡¡ Pat hology , Laboratory Medicine and Research Services , Portland Veterans Administration Medical Center)

¡¡¡¡ ¡¡ “ “ ·»‡†·

߇˚⁄‚·¯¯`—”˝»•·…«ˇ˜”¸ˇ¸˘ˇ‚ß ¡£

·¶˚˛˜ˇ–¤·—˝‚ˆˇ‚ß`˚˙»‰¨—` ¡£˚˚ı” ‡˘·¸`˛“·—˝‚ˆˇ‚ß' ¡£«˚˙†—”¶†¡›‡⁄˘¸•ˆ ( ˝‡` “˘ ¡£˚˚ı”¸•ˆ ) ˜†¡ ,˚˚ı˙·

‡ˆ‰ ¡£˘ˇ˛¢¸ø…ß ¡¡¡¡ …·˚ „

˜ˆ⁄†`˜——˛“ ¡£¯ß¿Ø`˙—‡

¡¡¡¡ —˝…•”¯

epit helial t umor of putative odontogenic origin first

described by Hansen et al. The t umor arises cent rally

larly in respect to it s malignant behavior , is still un2 is limited. We report t he CCO T wit h benign biologic mical and ult rast ruct ural feat ures wit h a discussion of t he current classification of t his disease. In addition , we describe reasonable parameters of t reat ment for t his t umor based on t he findings presented Odontogenic t umors wit h prominent clear cell component s are rare neoplasms. Thirty five cases re2
: ¡¡ 2003 - 10 - 28 …‰Ø : ¡¡ Thomas Allert , Professor.

cause of t he rarity of t he t umor , it s nat ure , particu2

certain and information about it s fine st ruct ural details behavior including it s microscopic , immunohistoche2

in t he jaws and is known to be locally aggressive. Be2

¡¡¡¡ Clear2cell odontogenic t umor ( CCO T) is a rare

Clear2cell Odontogenic Tumor ( Immunohistochemical and Electron Microscope Study)
·—˝‚ˆˇ‚ß` ¡“““ ¡¡ ˆØ»fl…—¿ : ¡¡ ·—˝‚ˆˇ‚ß`˝¤‡£‡˘·—˝‚ˆˇ‚ß' ,˚˙»…«…ߘ` ¡£Øfl§ˇ ,ˇ‚߇˚˝†—˛»¶–—˛ ,—•Æ‚»˝‚ˆ»›`”ˇ‚߉‹”˝»—¡˜˘«——˜ ,¨˜”¸ ¡£¯…¶ß`‡†˜–ˇ‚ ,—‚·•¢˙ªˇ ;‡£—˙ł…¶·ƒ“˘ ¡£·¸ ,—¸•ˆ‡⁄· ,˚ı”˛‚·•¢ 13a ,˚˚ı˚–‰…߆¿¯˝”˝†¿†˘⁄˚„˙·'¿ ¡£˚ı˙…˚ı”ˆ»—˙ł”˝¶·ƒ 5a ¡£—'‰Æ„߸˘‚˚†¡ƒ˚`…—`•¶‡º ¡£`˚˙•æ—·`…—‰¶æ—˜“–„ ,ˆØ»fl…ˇ˛¢…†Ø‰Æ„ß ;ˆØ»fl ; ,˚ı—–ø¶‡˙—˘‹…†Ø–Œ– ,†»˜º˜˙—'—¶æ———˛“˜`˙ł– ¡£·¸ ,˘»æˆ˛`†—`˜⁄ ¡£ : ¡¡ ·—˝‚ˆˇ‚ß` : ¡¡ R739. 8 ; ¡¡¡¡¡¡ ˛˜ˇ–Œ˚¶´º : ¡¡ A ¡¡¡¡¡¡ ˛˜´–”¯

Thomas Albert 1 , ¡¡ Wei2Xiong Ye2 , Monica B Zieper3 , Charles K Meshul4
English language literat ure. adipose and tendon sheat h
: ¡¡ 100524979 ( 2004) 0120060203



5a ,ı`ˆ–£˚˛`˘


ported wit h a variety of designators , including 23 cas2 es of CCOC , 5 cases of CCO T , and 7 cases of clear cell ameloblastoma ( CCA) have been published in t he The common clinical manifestations of t he CCO T include painless swelling of t he jaw wit h expansion of bone. The mean patient age at diagnosis was 48. 8 years wit h most cases occurring in t he 4 th t hrough 7 th mors , bot h benign and malignant , may be derived f rom a diverse group of epit helial cell types including adnexa , salivary glands , odontogenic epit helium , melanocytes and even mesenchymally derived cells of . renal epit helium , keratinizing epit helium , cutaneous The clear cell in CCO T are epit helial because immunohistochemical

decades. Females were affected more often t han males

cent of cases occurred in t he mandible. Clear2cell t u2

wit h a female¡ˆmale ratio of 16 ¡ˆ1. Seventy2six per2

¡¡ ˙»¢ˆ˝¿˘ ¡¡ ¿

2004 ˜Œ ¡¡

14 ¡¡

1 ˘ ¡¡

¡⁄ ¡¡61 ¡⁄ ¡¡¡¡

tokeratin and epit helial membrane antigen , but are myosin. Ult rast ruct ural findings also confirm t hat

t hese clear cells are epit helial.

ot her areas showed solid nest s or cord of clear cell ep2 it helial component s wit hout glandular differentiation. are positive for acid p hosp hatase , nonspecific esterase and HADH diap horase. They are negative for alkaline p hosp hatase. Eversole et al proposed t hat t he clear cells are derived f rom presecretory and secretory ameloblast s and are different f rom cells of t he st rat um it helium because t he latter are alkaline p hosp hatase positive. However , Odukoya and Arole demonst rated t hat clear cells were present in t he cent ral areas of t he CCO T are different f rom t hose of calcifying epit helial follicular ameloblastoma. In addition , clear cells in odontogenic t umor which also demonst rates alkaline p hosp hatase positivity. f rom t he rest s of dental lamina. Wysocki et al stated t hat t here are two distinct types of dental lamina rest s. Most commonly t hey appear as small islands of Clear2cell nest s may arise pear as single or multiple islands of polyhedral or variably eosinop hilic cytoplasm. cuboidal cells wit h t he vesicular nuclei and a clear or Whet her t hese t umors represent a new entity or a clear2cell variation of ameloblastoma is debatable.

lands showing varying numbers of clear cell wit h ec2 cent rically placed pyknotic nuclei ; ot her islands con2 eral cells of t he islands often appeared columnar or ment membrane , t hereby resembling ameloblast s. intermedium , stellate reticulum and outer enamal ep2 cuboidal wit h nuclei polarized away f rom t he base2 Ot her unique feat ures of t hese t umors are a variable bling follicular ameloblastoma , alt hough t he stellate reticulum2like st ruct ure was not predominant . Still squamous epit helium. Less commonly , t hese rest s ap2 microscopic growt h pattern wit h some areas resem2 sist of eosinop hilic polygonal epit helial cells. Perip h2

staining of t hese cells shows positive reactions for cy2 negative for S2100 , vimentin , muscle actin and Histologically , t hese t umors are composed of a

Brinck et al used cytogenetic analysis to distinguish genetic analysis of four previously reported cases of CCOC f rom ameloblastoma. The aut hors cited cyto2 detected in t heir recurrent CCOC were losses of 6 and stated t hat such apparent cytogenetic differences may delineate ameloblastoma f rom CCOC. recur locally after surgery and may metastasize bot h regionally and distantly. Thus , Eversole et al and neoplasm. Bang et al stated t hat all odontogenic t u2 The question is how extensive a clear cell popula2 Ng et al reported a case of perip heral Whet her t hose neoplasms represent a benign t u2

ameloblastoma t hat demonst rated monosony 22 in two

of t hem. The patterns of chromosomal abnormality

bip hasic cellular population wit h some epit helial is2

9 and additions of 14q , 19 and 20. Thus , t he aut hors

Wit h enzyme histochemical stains , t hese clear cells

or wit hout metastasis. Benton and Eisenberg reported each recurrent episode , t he t umor tissue lost more of clear2cell component . adult.

ot hers preferred to name t his t umor as CCOC. Ever2 mation reported in t he literat ure. They reported four patient s died f rom t he disease , one patient was alive

certain. CCO T was defined by t he World Healt h Or2 ganization in 1922 as a benign but locally invasive garded as malignant . de Aguiar et al proposed t hat lateral periodontal cyst , and gingival cyst of t he ameloblastoma wit h clear cell differentiation. ameloblastoma may represent a sign of dedifferentia2 tion and indicate t he possibility of malignancy , wit h a case of CCOC which had several recurrences. In t he ameloblastic2like p henotype and increased t he nent as a sign of being benign. However , a review of t hat t hese t umors are aggressive wit h a tendency to havior for t his t umor. A clear2cell component can also tion is necessary to predict a clinically malignant be2 appear in benigh odontogenic t umors or t umor2like le2 sions such as calcifying odontogenic epit helial t umor , 17 cases of t hese t umors by Eversole et al revealed sole et al also reviewed 13 cases wit h follow2up infor2 mors wit h extensive clear cell growt h should be re2 t he presence of a clear cell component in an

mor wit h aggressive behavior or a malignancy is un2

Some investigators regard t he clear2cell compo2

¡¡62 ¡¡ ¡¡ ¡⁄ ¡¡ ¡⁄

¡¡ ˙»¢ˆ˝¿˘ ¡¡ ¿

2004 ˜Œ ¡¡

14 ¡¡

1 ˘ ¡¡

wit h residual or recurrent disease. and eight patient s were alive and well at t he time of publication. Even plasms behaved as carcinomas. in t heir series , not all clear2cell odontogenic neo2 Waldron et al reported a case of a 50 year old male wit h a large mandibular CCA t hat was surgically marginal resection to t reat a CCA of t he mandible in a sion to t reat a CCA in t he mandible of a 152year2old male. There was no recurrence 5 years after t he Our case had a disease2duration of at least 13
44 ‡ ) ,¶œ»¢ ,„ªˇŒ ,¨ . ´¨¯˛¿ˆ‚¿˘¿“‚„ ˚˚ı”†¡¨¸ ¿ ˝· ` ·† — ¿ 531. J . — ´Ø , 2001 , 9 : . 3 . ––' : ,‡´†fi˙ . ˇ·œ´Ø§ ,2003. 2546. ,˙ˇ˛ ¨¸ˆæ˛œ‡ ,¶œ»¢ ,¨ . ´¨¯˛¿ ,´•¨”˝˙œ´¶ ˆ‚¿˘¿“‚„˚˚ı”»… ¿˝·˜–¨‰ˇ ¿˘§”§–¤ ,2001 ,23 :472. . —´–´Ø'˛˚ˆ˚†Æ M . ––' :˚´

A review of t he t reat ment of four patient s who died of t his disease in t he Eversole et al report showed t hat one t umor was enucleated ; one was t reated wit h curettage ; one had a partial maxillectomy , and one ries was caused by uncont rol primary lesion by had a marginal resection. One fatal case in Li et al se2 Furt her case st udies wit h lengt hy follow2up and possi2
( –…› : · ¡¡ • ) ‰§¿˘§‡ ,2001. 105. 10 9 ] ¡¡ Detlef ER , Morten A , Dietmar S. A comparison of pa2 p hine in patients undergoing lumber disk surgery J . Anest Analg , 1998 ,86 :1045. ¡¡ Devulder J , De2Laat M , Dumoulin K , et al. Nigtmares combined wit h antidepressants J . Acta Clin Bel g , 1996 ,51 :184. ( –…› : ) and hallucinations after long2term intake of tramadol tient2controlled analgesia wit h lotnoxicam versus mor2

out evidence of recurrence. Muller et al in 1986 used 142year2old boy. The patient was followed for 15 used enucleation to t reat a CCOC in t he manndible. There was no recurrence or metastasis 3 years after surgery. dence of regional or distant metastasis preoperatively nign category. st ruct ural feat ures of our case are indistinguishable
( ˇ‰ 5 ] ¡¡ „¤ª 6 ] ¡¡ fl—˜`… ,ł„œˆ 7 ] ¡¡ ¤¤ª „ 8 ] ¡¡ ‡˙– ¸

years wit h no evidence of recurrence. Yamamoto et al

years before surgery. During t hat time , t he lesion

f rom ot her cases t hat possessed malignant behavior. predict t he behavior of t he lesion.

or postoperatively. This case has had follow2up for 5

currence of metastasis. These feat ures would seem to

indicate t hat t his case should be classified in t he be2 Therefore , t hese characteristics cannot be used to
J . —„œ

ration of t he lingual cortical plate. There was no evi2 years since t he initial surgery wit h no evidence of re2 Microscopic , immunohistochemical and ult ra2

removed and was followed for six and half years wit h2 manifested wit h only local extension and focal perfo2

surgery. Could t he deat hs in t hese cases have been proach ? Alt hough several factors will influence t he prognosis of t he disease ¡“ t he size of t he lesion ,

surgery. Odukoya et al used complete surgical exci2

for microscopic examination during surgery in order to obtain a t umor2f ree margin. information



partially att ributed to a ¡ conservative¡– surgical ap2 excision of t he entire lesion including f rozen sections in our case is questionable. The reason for t his part of t he t reat ment was based upon t he Eversole et al f rom Eversoleπs

anatomic location , t he presence or absence of metas2 tasis before t reat ment and t he patientπs immune stat us tor which will effect t he prognosis. We prefer enbloc Ret rospectively , t he necessity of neck dissection ticle t hat included several cases wit h metastasis. The and ries demonst rate at least 50 % to 75 % of patient s are were even t reated wit h conservative surgery. The still alive and well after t reat ment . Some patient s resent a spect rum ranging f rom benign to malignant . ble use of cytogenic analysis are needed to clarify t his question is raised whet her t hese t umors , in fact , rep2 Yamamotoπs case review papers as well as Li et al se2 ¡“ t he modality of t reat ment is certainly a major fac2 ar2

To top