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7MEDICAL SCIENCES
CLEAR CELL CARCINOMA OF THE ORAL CAVITY - PRIMARY OR METASTATIC?
Ivanov A.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of General and Clinical Pathology, UMHA T "Saint George " - Plovdiv, Bulgaria
Ivanov G.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of General and Clinical Pathology, UMHA T "Saint George " - Plovdiv, Bulgaria
Bivolarski I.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Popivanova M., Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of General and Clinical Pathology, UMHAT "Saint George" - Plovdiv, Bulgaria
Tomova M.
Department of General and Clinical Pathology, UMHAT "Saint George" - Plovdiv, Bulgaria
ABSTRACT
Clear cell carcinomas of the oral cavity can be either primary or metastatic. The latter include the renal cell carcinoma, whose metastases most often affect the paranasal sinuses, gingiva and salivary glands. Our case describes a rather unusual metastatic location. It is a case of a 65-yeal-old man with a tumour formation on his left buccal mucosa, which in the space of 2-3 months grew fast and was excised. The biopsy result is clear cell carcinoma. The immunohistochemical examination shows positive CD10 and Vimetin. The additional clinical data of a preceding nephrectomy due to renal cell carcinoma help when defining he histogenesis of the tumour.
Keywords: clear cell carcinoma, renal cell carcinoma, metastases in oral cavity.
Introduction
Clear cell carcinoma of the oral cavity is a rare entity. The differential diagnoses include mucoepider-moid carcinoma, clear cell subtype of squamous and odontogenic carcinomas, as well as metastatic tumours [7]. Metastatic lesions are 1-3% of oral tumours [1]. The clear cell renal cell carcinoma most often metastasises to the lungs, bones, contralateral kidney, liver, brain and lymph nodes. A renal cell carcinoma giving metastases to the oral mucosa is rarely seen. The most common localisations are the paranasal sinuses, the gingiva, the tongue and major salivary glands [8].
Case report
A 65-year-old man was admitted in the Maxillofacial clinic in UMHAT "Sv. Georgi" - Plovdiv for a surgical removal of a tumour formation inside the oral cavity, arising from the mucosa of the left buccal surface. During the past 2-3 months it had grown in size at a quick rate. The physical examination revealed a pedun-culated exophytic formation in the area of the left parotid channel. It was lobulated, whitish, firm and painless. The fragmented biopsy sample showed salivary gland tissue and 3 nodule-like areas infiltrating it. They
had a different colour and a firm consistency, measuring from 1,5 to 3cm.
After a thorough background check and a consultation with a urologist, it was discovered that 10 years prior to the current problem the patient received a nephrectomy, due to kidney carcinoma.
Material and metods
The histologic specimens from the borders of the sample and the lesions were prepared with fixative of 10% neutral formalin and embedded in paraffin. The cut sections were 4 ^m thick and stained with hematoxylin and eosin (HE). An additional immunohistochemical examination was carried out with CD10 and Vi-mentin in order to further specify the histogenesis of the tumour.
Results
The biopsy examination revealed the presence of a salivary gland with an interstitial purulent inflammatory infiltrate. A fragment of multi-layered squamous epithelium of buccal mucosa was found - upper left corner (fig. 1). What was also found were well defined nests of tumour cells with a bright cytoplasm, separated by fine fibro-vascular stroma that underlines the nested appearance (fig. 1, 2).
Fig. 1. Buccal mucosa and nests of clear cell carcinoma, H-E staining, magn. x 40,
Fig.2. Tumour nests of clear cell carcinoma, H-E staining, magn.x400
Fig.3. Clear cell carcinoma, CD10 (+) in the membranes of the tumour cells. x 400.
Fig.4. Clear cells carcinoma, Vimentin (+) in the membranes and cytoplasm of the tumour cells, magn. x 400.
Discussion
Renal cell carcinoma very rarely gives metastases in the head and neck region, but sometimes they are diagnosed before the primary tumour [3]. The most common location are the paranasal sinuses, followed by the oral cavity, where most often the major salivary glands are affected [4, 5]. The location in the case we describe is exceptionally rare. The additional clinical data for the presence of a primary tumour aid to determine the tumour histogenesis, which in turn is essential for the therapy [6]. Although the clear cell differentiation is evident with H-E, the immunohistochemical test helps to
distinguish between a metastatic carcinoma from a primary one of the salivary glands. For this purpose CD10, Vimentin, CK7, PAX2 and PAX8 are used. Mucoepi-dermoid carcinoma, acinic cell carcinoma, epithelial-myoepithelial carcinoma, sebaceous carcinoma are on-cocytoma should be considered as differential diagnoses [2].
Conclusion
Besides the immunohistochemical examination, in order to determine the histogenesis of metastatic clear cell carcinoma of the oral cavity, it is important to obtain precise clinical and anamnestic data.
References
1. Azam F, Abubakerr M, Gollins S: Tongue metastasis as an initial presentation of renal cell carcinoma: a case report and literature review. J Med Case Reports. 2008, 2: 249-10.1186/1752-1947-2-249,
2. Corsi A., Guerra F., Grippaudo G., Bosman C., Oral metastasis of renal cell carcinoma. Report of case and critical evaluation of morphologic features for differential diagnosis, Pathologica, 01 Dec 1994, 86(6):665-669.
3. Dietlind L., Wahner-Roedler, Sebo Thomas, Renal Cell Carcinoma: Diagnosis Based on Metastatic Manifestations, Mayo Clinic Proceedings, Volume 72, Issue 10, October 1997, Pages 935-941.
4. Milner P., Janas A., Grzesiak-Janas G., Clear cell renal carcinoma metastasis in the oral cavity - case report, Journal of Pre-Clinical and Clinical Research, 2014, Vol 8, No 2, 127-129.
5. Nisi M., Izzetti R., Graziani F and all., Renal Cell Carcinoma Metastases to the Oral Cavity, Journal of Oral and Maxillofacial Surgery, Volume 78, Issue 9, September 2020, Pages 1557-1571.
6. Patel Sh., Barros J., Nwizu N., Ogbureke K., Metastatic renal cell carcinoma to the oral cavity as first sign of disease: A case report, Clinical Case Reports, 14 July 2020, https://doi.org/10.1002/ccr3.2923.
7. Pires R., Azevedo R., Ficarra G. and all. Metastatic renal cell carcinoma to the oral cavity and clear cell mucoepidermoid carcinoma: comparative clinicopathologic and immunohistochemical study, Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology, Volume 109. Issue 4, April 2010, Pages e22-e27.
8. Tomas A. Will, Neena Agarwal and Guy J. Petruzzell, Oral cavity metastasis of renal cell carcinoma: Journal of Medical Case Reports, volume 2, 313 (2008).
HISTOLOGICAL TRANSFORMATION IN RECURRENT AMELOBLASTOMA
Ivanov A.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of Clinical Pathology, UMHA T "Sveti Georgi" - Plovdiv, Bulgaria
Ivanov G.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of Clinical Pathology, UMHA T "Sveti Georgi" - Plovdiv, Bulgaria
Bivolarski I.,
Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Popivanova M., Department of General and Clinical Pathology, Medical University of Plovdiv, Bulgaria Department of Clinical Pathology, UMHA T "Sveti Georgi" - Plovdiv, Bulgaria
Tomova M.
Department of Clinical Pathology, UMHA T "Sveti Georgi" - Plovdiv, Bulgaria
ABSTRACT
Ameloblastoma is a benign tumour with a slow, locally aggressive growth and high recurrence rate. Macro-scopically it is a unicystic or multicystic tumour formation. The histological variants of ameloblastoma are - fol-licular, plexiform, basal cell, acanthomatous, granular and desmoplastic, the latter being the most commonly diagnosed recurring type. We present a case of a 79-year-old woman, who, in the year 2000, was operated, due to a tumour formation, 6cm in diameter, of the mandible, that limited her mouth movement. In 2014 another operation was performed, due to the tumour reappearing and the defect was substituted with a metal plate. Contrary to the usual histological transformation diagnosed, the tumour from the first operation was defined as desmoplastic and from the second one - plexiform. We are discussing the differences between the two variants and the reasons for the histological transformation observed.
Keywords: plexiform ameloblastoma, desmoplastic ameloblastoma, recurrent ameloblastoma.
Introduction
Ameloblastoma is a benign tumour arising from the odontogenic epithelium. It has a relatively slow growth, but it's aggressive, destroying the adjacent bones and sometimes leading to facial deformities. What is characteristic about it is that even after surgical
removal it has the tendency to reappear [2]. It represents 1% of tumours in the oral cavity and around 10% of odontogenic ones. It occurs most often between the 3rd and 5th decades of life. Macroscopically it is a unicystic or multicystic tumour formation. The histologi-
