Enhancing access to the parapharyngeal space.
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Biomedical subjects
Publications and source records attributed to Elliot Abemayor.
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Irradiation-induced sarcomas are well-known potential late sequelae of radiation therapy. These tumors are very aggressive and often elude early detection and timely intervention, rapidly leading to early demise of afflicted patients. Long-term patient follow-up and a high index of suspicion are crucial for timely intervention. In this report, we present a case of irradiation-induced osteosarcoma involving the mandible. Diagnostic and therapeutic considerations are subsequently discussed.
Kuttner tumor (KT), known descriptively as chronic sclerosing sialadenitis, is a chronic inflammatory disease of the salivary gland. Clinically, it produces a firm swelling of the glands and may be difficult to distinguish from neoplasia. The diagnosis can only be made histologically and should not be difficult if the pathologist is aware of the condition's existence. Errors in diagnosis arise because KT is underrecognized and few cases have been reported in the English literature. We present a case of KT initially diagnosed as a primary salivary gland neoplasm that intraoperative frozen section revealed to be chronic sclerosing sialadenitis. Excision of the mass, usually carried out diagnostically, is adequate treatment.
Ameloblastoma is a benign odontogenic neoplasm of the mandible and maxilla that rarely exhibits malignant behavior. We report the case of an aggressive malignant ameloblastoma of the mandible that presented with an unusual multiphasic, histologic pattern. Initial fine needle aspiration and radiographic findings showed features consistent with a benign, fibro-osseous lesion. However, aggressive growth and the association of enlarged submandibular lymph nodes suggested a more malignant potential. Treatment consisted of an angle-to-angle composite mandibular resection, right modified neck dissection, left functional supraomohyoid neck dissection, and anterior chin skin resection with iliac crest osteocutaneous free flap reconstruction. Microscopic evaluation showed primarily malignant ameloblastoma without cellular atypia and extensive fields of fibro-osseous tissue with smaller fields of clear cell odontogenic tumor. This multiphasic, histologic arrangement may explain the perplexing preoperative microscopic diagnosis, suggesting a benign fibro-osseous lesion. Of the lymph nodes analyzed, one from the right submandibular triangle exhibited metastatic, benign-appearing ameloblastoma without fibro-osseous or clear cell features. The absence of cellular features of malignancy in the tumor mass and lymph node metastasis suggest that the lesion should be classified as malignant ameloblastoma rather than ameloblastic carcinoma or odontogenic carcinoma. A malignant ameloblastoma with all 3 of the aforementioned microscopic features has not been previously reported. We review the classification of epithelial odontogenic malignancies. Lesions showing multiphasic patterns can create diagnostic dilemmas and may require extensive surgical sampling and/or removal to establish an accurate diagnosis.