Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region: a clinical study of 58 cases and review of the literature.

PURPOSE: Approximately one third of non-Hodgkin lymphomas (NHLs) arise in tissues other than the lymph nodes. The purposes of this study are to evaluate the clinical outcome of NHLs of the oral cavity and maxillofacial region in a group of 58 patients who were diagnosed in our clinic and to discuss the clinical, histologic, and immunohistochemical features of these malignant neoplasms, as well as the prognosis. MATERIALS AND METHODS: The study included 58 patients with extranodal NHLs of the oral cavity and maxillofacial region. There were 32 male and 26 female patients. The patients' ages ranged from 7 to 81 years. The most frequent sites of occurrence were the salivary glands (24 patients) and intraoral mucosa (21 patients). Other sites were the paranasal sinus (3 patients), Waldeyer ring (4 patients), bone of the jaws (3 patients), and orbit (3 patients). The histologic subtype was extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) in 21 patients, diffuse large B-cell lymphoma (DLBCL) in 19, chronic lymphocytic leukemia in 10, mantle cell lymphoma in 4, follicular lymphoma in 2, Burkitt lymphoma/leukemia in 1, and B-cell acute lymphocytic leukemia (B-ALL) in 1. Of the DLBCL cases, 13 were stage IIE and 6 were stage IE. All the MALT lymphomas were stage IE. RESULTS: The mean follow-up was 5 years after the initial diagnosis. A better prognosis was found in patients with MALT lymphomas (19 of 21 patients are alive) compared with those with DLBCLs (10 of 19 patients are alive). CONCLUSIONS: MALT lymphomas have a more favorable outcome (about 90%) in comparison with DLBCLs. Careful examination of the oral cavity and neck by the maxillofacial surgeon is essential for the diagnosis and staging of lymphomas.

Short-term results of autologous blood injection for treatment of habitual TMJ luxation.

Many surgical and nonsurgical methods for the treatment of temporomandibular joint (TMJ) hypermobility have been published. The purpose of this study was to evaluate the results after autologous blood injection in and around the TMJ for the treatment of habitual luxation. Twenty-five patients were diagnosed as having habitual TMJ luxation and treated with autologous blood injection into the upper joint space and around the joint capsule (group A). A control group of 15 patients with the same diagnosis were subjected to physiotherapy with muscular exercise (group B). Patients in group A were reevaluated 3 months after treatment and those in group B were reevaluated after 3 months of physiotherapy. A statistically significant reduction in maximal mouth opening and TMJ sounds was noted only in group A, whereas the reduction for group B was minimal. These measurements show that intraauricular and periauricular autologous blood injection results in remission of signs and symptoms of TMJ luxation in the short term.

Central giant cell granuloma of the jaws: a clinical study of 17 cases and a review of the literature.

OBJECTIVES: The aim of this prospective study was to evaluate the outcome of treatment of a group of 17 patients with central giant cell granuloma (CGCG) who were treated in our clinic. METHODS: A group of 17 patients with CGCG were treated in the Clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" hospital in Thessaloniki. The age range was from 7 to 60 years. Eight patients were male and 9 patients were female. Because most of our patients (11) were less than 30 years old, the aim of the treatment was to eradicate the lesions without functional problems. All of the patients were treated by excision via curettage without a continuity defect and peripheral osteotomy. For 2 patients, the treatment was continued (after the first recurrence) with salmon calcitonin. RESULTS: The follow-ups ranged from 1 to 15 years. All of the patients were free of the disease, without features of recurrence and without functional or aesthetic problems. CONCLUSIONS: Surgery has usually been considered to be the best method of treatment for CGCG. Most authors have proposed conservative surgical procedures (excision via curettage), especially for young patients. For aggressive lesions, supplementary treatment with calcitonin would provide good results.

Acinic cell carcinoma of minor salivary glands: a clinical and immunohistochemical study.

PURPOSE: Acinic cell carcinoma is a rare malignant tumor of salivary glands. The purpose of this study is to evaluate the clinical outcome of acinic cell carcinoma in a group of 11 patients, who were treated in our clinic, and to discuss the management as well as the immunohistochemical features and prognosis of this carcinoma. MATERIALS AND METHODS: The study included 11 patients with acinic cell carcinoma of the minor salivary glands who were treated in our clinic. The patients were 7 women and 4 men. The patients' age ranged from 46 to 83 years. The distribution of the primary sites was buccal mucosa (4) maxilla/maxillary sinus, etc, (2), hard palate (1), junction of soft/hard palate (1), lower lip (1), labio marginal sulcus (1), and vestibular sulcus and mandible (1). All patients were treated with surgery. Adjuvant radiotherapy was used in 3 patients. Immunohistochemical assay of expression of Ki-67, p53, EGFR, and c-erbB-2/neu markers was performed on specimens of all tumors. RESULTS: The mean follow-up range was 2 to 15 years. Of the 11 patients, 7 were alive (2, 3, 4, 5, and 15 years after the initial therapy). Two patients died of another cause free of the disease 9 and 10 years after the initial treatment, and 2 patients died of the disease (local recurrence, distant metastases 2 and 3 years later). Overexpression of immunohistochemical markers was evident for tumors with widespread metastases. CONCLUSIONS: Acinic cell carcinoma is a rare malignant tumor of the salivary glands, characterized by an indolent clinical course with the potential for both local recurrence and distant metastases. The immunohistochemical analysis of proliferation markers provides additional prognostic information for this tumor.

Epithelioid angiosarcoma of the maxillary sinus and the maxilla: a case report and review of the literature.

Epithelioid angiosarcoma is a rare malignant tumor that arises from the endothelium of the blood vessels. In the head and neck area, most of these lesions affect the scalp and facial soft tissues, and the maxillary sinus and the maxilla are among the rarest locations involved. In this paper, we present a case of angiosarcoma of the left maxillary sinus, with extension into the left maxilla. We review the literature and discuss the differential diagnosis of endothelial neoplasms and the management and the prognosis of this tumor.

Ossifying fibroma of the jaws: a clinical study of 14 cases and review of the literature.

OBJECTIVE: The purpose of this study was to evaluate the clinical outcomes of ossifying fibroma (OF) in a group of 14 patients treated in our clinic and discuss the management and the prognosis of this tumor. STUDY DESIGN: The study included 14 consecutive patients with OF of the jaws with ages ranging from 7 to 55 years. Primary site distribution was maxilla (1), maxilla, maxillary sinus (1), and mandible (12). All of the patients treated by surgery (curettage, enucleation, or radical surgery). RESULTS: The mean follow-up range was 2-18 years. All of the patients were alive and disease free. CONCLUSIONS: OF is a benign slow-growing tumor of the jaws. Early tumors that are small or well demarcated are treated by curettage or enucleation. For aggressive tumors that show rapid enlargement, radical resection (maxillectomy or segmental mandibulectomy) is used. By either method of treatment, the recurrence rate is extremely low.

Variable histopathological features of 6 cases of aneurysmal bone cysts developed in the jaws: review of the literature.

OBJECTIVES: The aim of this study was to evaluate the results of treatment of 6 patients with ABC who were treated in our clinic. MATERIAL AND METHODS: A group of 6 patients with ABC were treated in the clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" hospital in Thessaloniki. The age of the patients ranged from 7 to 35 years. Four patients were female and 2 patients were male. Three lesions located in the maxilla-maxillary sinus and 3 lesions in the mandible. All the patients were treated by surgery (excision via curettage or radical resection). The final histopathologic diagnosis for one lesion was "solid" type of ABC and for another one it was ABC in association with an ossifying fibroma. RESULTS: The mean follow-up range was 2-17 years. All the patients were free of the disease without functional problems. CONCLUSIONS: ABC is a rare bony lesion characterized by variable clinical and radiographic features. The incisional biopsy preoperatively is important for the diagnosis before the surgical treatment. The histopathological examination of the whole lesion is determinative for the existence of associated pathological lesions. Regular follow-up is important to detect any recurrence of the lesion.

Brown tumors of the jaws associated with primary or secondary hyperparathyroidism. A clinical study and review of the literature.

PURPOSE: The aim of this article is to present the development of brown tumors in the jaws as a definite feature of hyperparathyroidism (HPT), whether primary or secondary. PATIENTS AND METHODS: The study included 2 cases of primary HPT and 3 cases of secondary HPT associated with brown tumors in the jaws. The patients presented in our clinic at the "G. Papanikolaou" Hospital in Thessaloniki for treatment of their disease. The patients were 4 women and 1 man, and patient's ages ranged from 21 to 76 years. Four cases of the brown tumors involved the mandible, and 1 case involved the maxilla and the maxillary sinus. The surgical excision of bone lesions and treatment of primary or secondary HPT were performed on the patients in our study. RESULTS: Patient 1 (primary HPT, caused by an adenoma of the right parathyroid glands) was treated with surgical removal of the maxillary lesion and excision of the adenoma. Three years later, the patient is free of the disease, with no recurrence of the brown tumor. Patient 2 (primary HPT, caused by an adenoma of the right parathyroid glands) was treated with excision of the adenoma. One year later, a second bone lesion developed in the mandible, and 3(1/2) of the fourth parathyroid (right) glands was removed. The patient is being observed. The other 3 patients with brown tumors associated with secondary HPT were treated with excision of the bone lesions; HPT was treated with hemodialysis (2 patients) and renal transplantation (1 patient). For the patients treated with hemodialysis, the disease is under control and there is no recurrence of the brown tumors. The patient who underwent transplantation is free of the disease 7 years later. CONCLUSIONS: Primary or secondary HPT may be recognized by the presence of an osteolytic lesion with giant cells, a condition referred as "brown tumor." The most useful therapy for patients with brown tumors is surgical excision of bone lesions and therapy (surgical or medical) for primary or secondary HPT.

Management of adenoid cystic carcinoma of minor salivary glands.

PURPOSE: Adenoid cystic carcinoma (ACC) is a rare malignant tumor originating from the salivary glands. The characteristic clinicopathologic features of this tumor are perineural spread, local recurrences, and distant metastases. Radical surgery combined with radiotherapy, as mentioned in the literature, is the best method of treatment. This clinical review article is intended to analyze the outcome of management of a group of 22 ACC patients, who were treated in our clinic. METHODS: Between 1985 and 2000, 22 patients with ACC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the "G. Papanikolaou" General Hospital, in Thessaloniki. The age range was 22 to 87 years. The distribution of the primary sites was buccal mucosa (3), floor of the mouth (1), hard palate (3), soft palate (2), junction of hard and soft palate (7), and hard or soft palate with spread in the paranasal sinus etc (6). All the patients were treated radically with surgery. The surgery was combined with radiotherapy in 17 patients. A total dose of 60 Gy in a 30- to 40-day period was given, using conventional 2 Gy fractions per day. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS: The mean follow-up range was 4 to 14 years. From the 22 patients, 15 (68.18%) were alive for more than 5 years and 6 (27.7%) had died from the disease. Eight patients were free of the disease for more than 5 years (ranging from 7 to 14), 4 patients were free of the disease for 5 years, and 3 patients were free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence was developed in 2 patients. One recurrence occurred within the first year after the treatment and the second local recurrence occurred 13 years after the initial treatment. Lymph node metastases occurred in 2 patients, 3 years and 7 years after completing the treatment. Distant metastases (lung) occurred in 2 patients, 2 years and 6 years after completing the treatment. The Mann-Whitney statistical analysis was used for comparing the Ki-67 values in correlation with prognosis and location of ACCs. The Ki-67 value was significantly higher in tumors from patients with treatment failure than in nonfailures (P < .001). The Ki-67 expression was also higher in large tumors characterized by wide topical spread (P < .005). CONCLUSIONS: The most proper method of treatment for ACC seems to be radical resection combined with radiotherapy. The treatment failure is associated with positive margins of the excised surgical specimen and named nerve involvement. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.