Ameloblastic Fibrosarcoma of the mandible evolving from a prior Ameloblastic Fibroma after two years: an unusual finding.

Transformation of an ameloblastic fibroma to an ameloblastic fibrosarcoma has been reported rarely in the literature. The present case report describes such evolution in a patient under long-term follow-up. The patient was first treated in 2008, and he developed the malignant counterpart of the disease 2 years later. The patient is currently under careful long-term follow-up and is free of disease. This article describes the clinical and radiographic features, histological characteristics, immunohistochemical findings, and surgical treatment of the tumor.

Tumor Infiltration Depth as Predictor of Nodal Metastasis in Early Tongue Squamous Cell Carcinoma.

PURPOSE: A retrospective longitudinal study was conducted to identify the cutoff value of infiltration depth for predicting the risk of lymph node metastasis of the neck in a well-defined population of surgically treated patients affected by stage T1 to T2 oral squamous cell carcinoma of the tongue. PATIENTS AND METHODS: Sixty-seven patients were enrolled in this study. Forty-four patients (65.5%) had pN0 status and 23 (34.5%) had pN(+) status. Thirty-five positive lymph nodes were analyzed. The median follow-up for these patients was 51.4 months. RESULTS: The mean infiltration depth of the N-negative group was 2.4 mm; this was substantially different from the mean value observed in the N-positive group at 5.5 mm. A meaningful cutoff was identified at an infiltration depth value of 4 mm. CONCLUSION: Infiltration depth was identified as an important predictor for neck nodal status. In this specific population, mortality was associated with increasing tumor infiltration depth.

Mandibular reconstructions using computer-aided design/computer-aided manufacturing: A systematic review of a defect-based reconstructive algorithm.

Modern planning techniques, including computer-aided design/computer-aided manufacturing (CAD-CAM) can be used to plan reconstructive surgery, optimising aesthetic outcomes and functional rehabilitation. However, although many such applications are available, no systematic protocol yet describes the entire reconstructive procedure, which must include virtual planning, custom manufacture, and a reconstructive algorithm. We reviewed current practices in this novel field, analysed case series described in the literature, and developed a new, defect-based reconstructive algorithm. We also evaluated methods of mandibular reconstruction featuring virtual planning, the use of surgical guides, and laser printing of custom titanium bony plates to support composite free flaps, and evaluated their utility.

DNA methylation analysis by bisulfite next-generation sequencing for early detection of oral squamous cell carcinoma and high-grade squamous intraepithelial lesion from oral brushing.

PURPOSE: Oral squamous cell carcinoma (OSCC) is commonly preceded by oral potentially malignant lesions (OPML). The aim of the present study was to assess, by bisulfite next-generation sequencing (NGS), the methylation status of a list of candidate genes obtained from oral brushings to early detect OPML and OSCC. MATERIAL AND METHODS: Oral brushing specimens from 11 OSCC, 11 high-grade squamous intraepithelial lesions (HG-SIL), 9 low-grade SIL (LG-SIL), 9 oral lichen planus (OLP), and 8 healthy donors were included in this study. We investigated, by means of bisulfite NGS, the promoter of GP1BB, ZAP70, KIF1A, p16[CDKN2A], CDH1, miR137, and miR375. Statistical significance between lesions and a pool of healthy donors were evaluated with the Mann-Whitney U test. RESULTS: ZAP70 was found to be hypermethylated in 100% of OSCC and HG-SIL and in 28.6% of LG-SIL. GP1BB hypomethylation was detected in 90.9% OSCC and HG-SIL and in 37.5% of LG-SIL. MiR137 was hypermethylated in 100% of OLP, 44.4% of OSCC, 40% HG-SIL, and 25% LG-SIL. KIF1A hypermethylation was found to be associated with TP53 mutations (p < 0.0001). CONCLUSION: In the present preliminary cohort of patients, DNA methylation analysis of GP1BB and ZAP70 seems to be a promising noninvasive tool for early detection of OSCC and HG SIL from oral brushing specimens.

Laser evaporation versus laser excision of oral leukoplakia: A retrospective study with long-term follow-up.

OBJECTIVES: The study makes a comparison between two surgical approaches for the treatment of oral leukoplakia (OL) in terms of recurrence in a well-defined cohort of patients with a long-term follow-up period. METHODS: The cohort consisted of 77 OL patients divided into 2 groups. Group 1: 47 patients treated with laser evaporation using a Nd:YAG laser. Group 2: 30 patients treated with a CO2 laser for excision. Clinical and histological examinations were performed for the diagnosis of OL before treatment. We included OLs with or without dysplasia. The mean follow-up period was 60 ± 32.49 months. RESULTS: Of the 77 patients, 22 (28.5%) showed recurrence during the follow-up period. No significant difference was found between the two treatments (χ(2) = 2.6; p = 0.2). However, CO2 laser excision resulted in better results than the Nd:YAG laser evaporation, considering the non-homogeneous OLs (χ(2) = 3.9; p = 0.04) and OLs with mild dysplasia (χ(2) = 4.6; p = 0.03). DISCUSSION: The study makes a comparison between our results and articles from the literature, and suggests when each of the two surgical approaches is most appropriate.

Aggressive Central Giant Cell Granuloma of the Mandible Treated With Conservative Surgical Enucleation and Interferon-α-2a: Complete Remission With Long-Term Follow-Up.

Central giant cell granuloma (CGCG) is a benign tumor of the jaws. Aggressive lesions present a strong tendency toward recurrence after surgical enucleation; thus, en bloc resection and microvascular bone free flap transfer are usually performed. However, in young patients, aggressive surgical treatment is a not always suitable solution. This report describes the case of a young female patient who developed an aggressive recurrence of CGCG after its diagnosis and enucleation from the mandible. Surgical enucleation with subcutaneous injection of interferon-α-2a was performed. The patient was evaluated every 6 weeks, and after 6 months radiographic evidence of complete bone regeneration was obtained. No sign of recurrence was seen after 8 years of follow-up. A review of the literature proved that interferon treatment is an effective strategy to avoid extensive surgery in patients with aggressive CGCG.

Jaw cysts diagnosed in an Italian population over a 20-year period.

BACKGROUND: Cysts of the jaws (JCs) are an important topic of oral pathology, but few epidemiological data are present in the literature, in particular about the potential of recurrence. The aim of this study was to describe a case series of JCs from a single institution, evaluating the frequency, the site, the age distribution, and the percentage of recurrence of all types of JCs. METHODS: All JCs present in the histological records of the Section of Anatomic Pathology of the University of Bologna at Bellaria Hospital from 1992 to 2012 were retrieved. RESULTS: A total of 1136 jaws cysts were obtained, of which 1117 (98.3%) were odontogenic and 19 (1.7%) were nonodontogenic. About odontogenic cysts (OCs), the most frequent was the radicular cyst (538 cases), followed by parakeratinized keratocystic odontogenic tumor (pKOT, 193 cases) and dentigerous cyst (120 cases). Among pKOT, 21 out of 193 cases (10.89%) showed a recurrence after a mean time of 4.5 years (range, 1-12 years). During follow-up (mean 11 years, range 1-19 years), all 3 cases of botrioid cysts, 12 out of 46 cases of unicystic ameloblastoma (26.09%), 2 out of 20 cases of calcifying OCs (10%) and 2 out of 538 cases of radicular cyst (0.37%) showed a recurrence. CONCLUSION: Our study confirms that the distribution pattern of JCs in Italy is relatively similar to other studies worldwide and emphasizes the importance of recognizing the different histological types of JCs for their potential local aggressive behavior.