Challenging pitfalls in frozen section pathology: a case of mandible ghost cell odontogenic carcinoma and the literature review.

BACKGROUND: Ghost cell odontogenic carcinoma (GCOC) is a rare malignancy characterized by the presence of ghost cells, preferably in the maxilla. Only slightly more than 50 case reports of GCOC have been documented to date. Due to the rarity of this tumor and its nonspecific clinical criteria, there is a heightened risk of misdiagnosis in clinical examination, imaging findings, and pathology interpretation. CASE PRESENTATION: A 50-year-old male patient presented to the hospital due to experiencing pain in his lower front teeth while eating for the past 2 months. Upon examination, a red, hard, painless mass was found in his left lower jaw, measuring approximately 4.0 cm × 3.5 cm. Based on the malignant histological morphology of the tumor and the abundant red-stained keratinized material, the preoperative frozen section pathology misdiagnosed it as squamous cell carcinoma (SCC). The surgical resection specimen pathology via paraffin section revealed that the tumor was characterized by round-like epithelial islands within the fibrous interstitium, accompanied by a large number of ghost cells and some dysplastic dentin with infiltrative growth. The malignant components displayed marked heterogeneity and mitotic activity. Additionally, a calcified cystic tumor component of odontogenic origin was observed. Hemorrhage, necrosis, and calcifications were present, with a foreign body reaction around ghost cells. Immunoreactivity for ß-catenin showed strong nuclear positivity in tumor cells, while immunostaining was completely negative for p53. The Ki67 proliferation index was approximately 30-40%. The tumor cells exhibited diffuse CK5/6, p63, and p40 immunoreactivity, with varying immunopositivity for EMA. Furthermore, no BRAFV600E mutation was identified by ARMS-PCR. The final pathology confirmed that the tumor was a mandible GCOC. CONCLUSION: We have reported and summarized for the first time the specific manifestations of GCOC in frozen section pathology and possible pitfalls in misdiagnosis. We also reviewed and summarized the etiology, pathological features, molecular characteristics, differential diagnosis, imaging features, and current main treatment options for GCOC. Due to its rarity, the diagnosis and treatment of this disease still face certain challenges. A correct understanding of the pathological morphology of GCOC, distinguishing the ghost cells and the secondary stromal reaction around them, is crucial for reducing misdiagnosis rates.

[Source and distribution of organohalogens in atmosphere in Shanghai].

Neutron activation analysis (NAA) and gas chromatography (GC) were used to determine organohalogens in air particles and precipitation in Jiading District, Shanghai, collected between December 2004 and August 2005. Analysis of extractable organohalogens (EOX), extractable persistent organohalogens (EPOX), organochlorine pesticides (OCPs) and polychlorinated diphenyls (PCBs) in atmosphere were presented. Monthly average concentration of EOX in air particles (TSP, PM10) and precipitation were 1425.37 ng x m(-3), 552.78 ng x m(-3), and 815.7 ng x L(-1) respectively, EPOX were 21.18 ng x m(-3), 0.7 ng x m(-3) and ND, OCPs were 64.4 pg x m(-3), 31.00 pg x m(-3) and 7.08 pg x L(-1). Analytical results showed that 80% - 96% of EOX was EOC1, which indicated organochlorine was the major component of organohalogens in atmospheric environment. Most organohalogens were acid-liable and unknown compounds. Correlativity between different size particles and organohalogens concentration implied that fine air particles has the effect of preference for absorbance of organohalogens especially for organobromine and organoiodine. Distribution of PCBs congeners in air particles and precipitation was preliminarily studied, which suggested that air particles were major carrier of OCPs and PCBs absorbed predominantly penta-, hexa-, hepta-, octa-PCBs, DDT and its metabolites, however precipitation contained mainly tri-, tetra-, penta-PCBs and HCH.