CHARACTERISTIC OF AMELOBLASTOMA IN ORAL AND MAXILLOFACIAL SURGERY AT HASAN SADIKIN HOSPITAL : 2 YEARS RETROSPECTIVE STUDY

ABSTRACTBackground: Ameloblastoma is the most common odontogenic tumor. Ameloblastoma is a borderline tumor because it is a benign but locally aggressive tumor with a high recurrence rate if the excision is not complete. The principle of treatment for ameloblastoma is excision all the tumor. This article aimed to conduct a retrospective study to analyze the characteristics of ameloblastoma in patients at Oral and Maxillofacial Surgery Hasan Sadikin Hospital Oral Surgery between the period of January 2018-December 2019Method: This is a retrospective study with 37 patients diagnosed with ameloblastoma during 2018-2019. We took data from each patient such as gender, age, radiological features, histopathological diagnosis of the location of ameloblastoma, management, defects, reconstruction. Result: A total of 22 patients were diagnosed with plexiform ameloblastoma, 12 cases of follicular ameloblastoma, 3 cases of mixed plexiform and follicular ameloblastoma. 31 patients were treated radically, while 6 patients were treated conservatively. Radical treatment is more often used to reduce recurrence rates, whereas conservative measures are indicated in children and adolescents, as well as adult patients with unilocular ameloblastoma types. Conclusion: The most characteristic of ameloblastoma is plexiform ameloblastoma in the mandible. Ameloblastoma is usually performed radically and reconstructed with an AO plate.

Serous borderline tumour of the peritoneum- A rare entity

Serous borderline tumor is a rare entity of peritoneum which can lead to diagnostic dilemma due to its resemblance with reactive lesions of peritoneum and ovarian borderline and malignant neoplasms. Complete clinical details, histopathological evaluation and immunohistochemistry aid in arriving at correct diagnosis. Recognizing this entity is important as it carries good prognosis.

Paraneoplastic encephalomyeloradiculits with multiple autoantibodies against ITPR-1, GFAP and MOG: case report and literature review

Background Recently, antibodies against the alpha isoform of the glial-fibrillary-acidic-protein (GFAPα) were identified in a small series of patients with encephalomyelitis. Coexisting autoantibodies (NMDA receptor, GAD65 antibodies) have been described in a few of these patients. We describe a patient with rapidly progressive encephalomyeloradiculitis and a combination of anti-ITPR1, anti-GFAP and anti-MOG antibodies. Case presentation and literature review A 44-year old caucasian woman with a flu-like prodrome presented with meningism, progressive cerebellar signs and autonomic symptoms, areflexia, quadriplegia and respiratory insufficiency. MRI showed diffuse bilateral T2w-hyperintense brain lesions in the cortex, white matter, the corpus callosum as well as a longitudinal lesion of the medulla oblongata and the entire spinal cord. Anti-ITPR1, anti-GFAP and anti-MOG antibodies were detected in cerebrospinal fluid along with lymphocytic pleocytosis. Borderline tumor of the ovary was diagnosed. Thus, the disease of the patient was deemed to be paraneoplastic. The patient was treated by surgical removal of tumor, steroids, immunoglobulins, plasma exchange and rituximab. Four months after presentation, the patient was still tetraplegic, reacted with mimic expressions to pain or touch and could phonate solitary vowels. An extensive literature research was performed. Conclusion Our case and the literature review illustrate that multiple glial and neuronal autoantibodies can co-occur, that points to a paraneoplastic etiology, above all ovarian teratoma or thymoma. Clinical manifestation can be a mixture of typically associated syndromes, e.g. ataxia associated with anti-ITPR1 antibodies, encephalomyelitis with anti-GFAPα antibodies and longitudinal extensive myelitis with anti-MOG antibodies.

Borderline Serous Papillary Tumor Arising in a Paraovarian Cyst: A Case Report and an Extensive Review of the Literature

Background: Paraovarian cysts are benign cysts that develop near the ovaries and fallopian tubes in the pelvic region. They can cause mass effects requiring excision. In rare cases, tumors may develop inside these cysts. These tumors may be benign, malignant, or borderline. Case Report: A 26-year-old lady presented for excision of a paraovarian cyst. Pre-operative imaging showed the presence of few undulating folds at the periphery of the cyst. The patient underwent laparoscopic pelvic cystectomy without intra-operative drainage. Pathological examination of the specimen revealed a borderline serous papillary tumor protruding from the cyst wall. Conclusion: The occurrence of a borderline tumor, also known as a tumor of low malignant potential, in a pre-existing paraovarian cyst is very rare and has only been reported few times in the literature. A thorough review of these cases showed that the most common imaging finding that raises suspicion for a borderline tumor within a paraovarian cyst is the presence of small intracystic projections within the unilocular adnexal cyst. However, since evaluating the presence of an intracystic tumor is not always possible, performing a fertility-preserving laparoscopic cystectomy without cyst content spillage, is recommended. If properly excised, the prognosis of this tumor is good, and recurrence is rare.

Expression of the Laminin-5γ2 Chain Is Associated With Acquisition of Malignant Traits in Ovarian Serous and Mucinous Tumors.

BackgroundOvarian tumors are predominantly of epithelial origin and are currently divided into three groups: Adenoma, borderline tumor, and adenocarcinoma by the presence or absence of invasion and cellular atypia. However, it is difficult to assess invasion, so a more objective biomarker would be desirable. Laminin-5 (Lam5) is a protein that constitutes the extracellular matrix of the basement membrane, and it is composed of three short-chain subunits. One of them, the Lam5γ2 chain (Lam5γ2), has been reported to be expressed in some malignant tumors and is suggested to be related to tumor cell invasion. Against this background, we investigated immunohistologically whether the Lam5γ2 would be useful as a marker to predict invasion in ovarian serous and mucinous tumors.MethodsImmunohistochemistry for Lam5γ2 was performed on a total of 80 cases of serous and mucinous tumor adenomas, borderline tumors, and adenocarcinomas, and the differences in the localization of Lam5γ2 expression were observed.ResultsThe basement membrane expression of Lam5γ2 tended to be preserved or had disappeared in half of the adenomas and borderline serous tumors. In all cases of adenocarcinoma, the expression on the basement membrane had disappeared. The frequency of expression in tumor cells increased in the order of adenoma, borderline tumor, adenocarcinoma. In particular, in most adenocarcinoma cases a cytoplasmic expression was observed. The same tendency was noted in mucinous tumors, and the basement membrane expression tended to disappear in the order of adenoma, borderline tumor and adenocarcinoma. Many cases of adenocarcinoma were observed among the tumor cells. In adenocarcinoma cases of both types of tumor, many tumor cells showed prominent cytoplasmic expression particularly in the microinvasive foci and in the invasive front.ConclusionsThe disappearance of Lam5γ2 from the basement membrane and its aberrant expression in serous and mucinous tumor cells may serve as a phenotype for invasiveness.

Cystectomy of Ovarian Borderline and Malignant Tumors for Fertility Sparing: Outcome of Seventeen Cases

Background: Here we present a retrospective study of 17 cases in which the ovary on the affected side was spared in fertility-sparing surgery (FSS) during treatment for ovarian borderline malignant or malignant tumor. We determine that cystectomy is a suitable treatment for ovarian borderline tumors. Methods: A retrospective observation study was conducted at Saiseikai Fukuoka General Hospital in Japan between April 2009 and September 2020. Our hospital experienced 89 cases of FSS during treatment for ovarian borderline or malignant tumor. Of those, there were 17 cases in which the ovary on the affected side was spared. We examined recurrent and pregnant cases by stage, preoperative diagnosis, intraoperative pathological diagnosis, postoperative pathological diagnosis, and adjuvant therapy. Result: Of the 17, 12 cases were borderline malignant tumor, 4 were immature teratoma grade 1 (G1), and 1 case was endometrioid adenocarcinoma G1. Rapid intraoperative pathological diagnosis was conducted in 9 of the cases, and there were 6 in which surgical method was chosen based on the aforementioned results. Laparoscopic surgery was performed in 2 cases in which tumors were deemed benign via preoperative diagnosis, 2 cases of mature teratoma, and 2 in which borderline ovarian tumor was suspected. One (1) case of paraovarian cystecomy in a patient with history of multiple cesarean sections turned out to be serous borderline tumor. Postoperative treatment took place in only 1 case: endometrioid adenocarcinoma. There were 2 cases of recurrence, and 4 cases were eventually able to become pregnant naturally post-surgery. These pregnant cases included 1 in which serous borderline tumor recurred and we performed both cystectomy and lymphadenectomy, and one in which chemotherapy was performed after cyst enucleation for endometrioid adenocarcinoma G1. Conclusion: At present, there is no clear policy for FSS in cases such as stage Ib in which there are bilateral tumors. Accordingly, in the current study a radiologist was consulted for preoperative diagnosis, and surgical method was chosen with a view towards possible borderline malignancy or malignancy. In cases where fertility preservation of the affected ovary is a high priority, it is crucial to clearly explain the possibility of recurrence to the patient. We also stress the importance of detailed consultation among the surgical team during rapid intraoperal frozen section pathological examination for making the appropriate decision to ensure fertility preservation mid-surgery.