Document 2805

O.P.S . 79-99
Fe bruary 2, 1979
(Contdbuted by P<ocl P. Handl<>r,
M.D . , 1431 S.W. Blvd., Jeffe<aon
Cil:y, ItO)
Dr. Abraas from uc:tJ\ comnented "I vould call this ple.oGor -pbie adenoD.a. although
I a:a conc:arncd about the cellular pleot10rph.isD at one end of t:he apec.i.Den, t do
not believa ~c is sufficient to justif y cnlling the laaio~ a ~11gnant mixed
tumor . Ple ase do not tell ma it had nu~taatos·i zed. " Both Drs .. Cor io and 'l'n:rpley
from :Setheada., NIH called i t "bonigo. 11ixecl tumor." Dr. Fay frota Fort 8ll&s,
Texas stated 11pl e.omorphic adenoma , f i v·e of our fou rte.e.n pathologists cc»UJidered
this as a aal:ignant cu;..or . " Dr . Una; i:ocoepidcr110id earC:1noc;), vt-ll
clifferentJ.ated v eraua ~:~!.xed t\CIIOr with squamous mecaplasia. Dr. Wc.atber~,
Ac ting Chairman, Oept . of Orat Pathol ogy, Emory University School o£ Dentt&~ry
s aid the follow-i ng: 11Ce.llulnr mixed_ cumor, ther e ia 11 great deal of squ JUIIOUS
dt.fferenti.atlon and foci of mucous cella and e ven intermediate t)'-pe of cella. buc
not to call it $ tlllJCoeptdermoid. WO'Uld this have been ona carcino=a,
expleoewrphie adenoea? " Dr. Rowe f-rom ~n Arbor, Michigan e.alled it- aueoep1derID01d cucinoma. T>r. Rosai from Minnesou and T>r. LeGal Er0111 StraoboU<g called i t
"benign !Jltx-ed t umor of the parotid.
(578-1 3894-2)
(Contributed by Dr.
Pathologist at Boone County Rospitsl,
Dr. Kori from Elkina , West ViT&ini.a c a lled i t "heJUngioe.ndochelioma .. " '1\.lo
~ers of the pathology staff 1n Dr. Pay ' s laboratory felt ~bat this vas a
"beGIOngtopcrieyt""-"• " Dr . Sh&fu from Ind lana called it ''bemana1oendothel1o"" of
(2366 / 78)
(Cona ibuted by Dr. Yvon LeG.• I,
lnstitut D*An.ato:Uc, Pacholoaique-,
Faculte De Medeceine, 1 Place Do
L'Bopitol, Sl:<a$bOurg {Bas-Rh1n)
Dr. L.eGal c:QIII'ented •• follOV8: ''taesenc:hya.a.l chondrosarcOD3-. it has reeurred
seveYa.l tlae.s since. 1n chengtn,a DOrpholosy. Now SOIII:C- tert:icorie.a are n~turing:
i n os teoonr c oma. 11 Dr . Azar from Taopa etnted : "per iosteal (ju-xt4tcorc:ical
osteosarcoma)." Thi.• \las also the diag-noais o f Dr. Moyer from Jewish Hosp.Lta1
in St. Louis . Dr. Weale.y from the Univeretty of Detroit eal.led it "osteogenic:
sarcoma." ''This waor has not change i t'• cbarac.ttrUtics; the diagnosis of
osteOsarcocaa reeaina the. .cost appropr-iate duigna tion. 11 said Dr. AbTaas froca uct..A.
Dr . B.osai from Mi.nneeoto wrote: "I still believe that this is osteosarc.o!DA.
although t bl!re ·are foci of c:losely pecked poly&onal cells ~uggC\eting thnt this
tU!llor may be of odontogenic:. origin snd p~rh.aps a variant of ameloblast!e 14norr.a."
CASE 0 3 con tinued
Osteosarcoma vaa also the. of John Meyer fro;:s St. Louis and Dr. Wealey
froo Dettoi.t. Dr. Rove froo Michi gan ealled it "chondrosarcoma." Drs .. Kin3
and Che from SIU, as well aa Dr . Shafer from Indiana called it
"chondroblas tic ost eosarcoma. "
(Contdbuted by Dr. Will:iitl!l H.
~.lliwell, DVM, Ph.D • • D.irector of
Pathology- Toxicology, Elars Bio- ..
Inc., Port
Collins, Colorado)
Dr. Roeat from M.Lnnesota co&c!ented : "If the. pacio.nt were e. human I would suggest
impatigo, the patient is a dog , I have no idea Wac to suitgeat." ora.
Cor io and tarpl&y from Bethesda e tated : "eub~rnea1 vesiculation comparable
wi"th i;opetigo in hUlllana . 11 "An obvious good exa~ple. of Collie's nose." comentOO
Dr. Shafer fro·m I ndiana .
(Contributed by Dr. OOorles Dunlap,
Dept. of Oral Patholoay, Univcrsicy
of Masouri-Kansas City, School of
Oentie,try, ICansas City. MO)
Dr. Wesley fr-om 1Jetro1t called i.t "fibt"o-oaseous lesion compatible with juvenile
Thio was .Uso the diagnosis of Dr. Kclng alld Dr.
Che.rrt.c:k, SIU, Or . Rosa1 fr-oo Minnesota, Dr. Meyer hom St. Lou.i.s., and Dr. Kori
from West VirglnLa. Dr. Weathers f ro~ Flllory stated: "Desmoplastic f.ibr~'l is
as close ~S I eon pigeon-hole th1s one.'' Dt:' . Le.('~ for Strasbours celled lt
uoss:ifying fibroma." Or. Abram. from UClA stated: 11It to be a beni.8n
neoplaaa producing bone. nterefore, 1 would call it ossifying fibrcoa. tf rou
aggressive ossUying fibroma . "
believe the mincrali2ed is cementUQ then 1 suppoee a diaanosis of c~aentifylng
f1b~om6 woul d be aecepta,le .
Apparently ther e are no clinical or prognostlc
differ~nc es
between ce.mentifyi:n& fib roma and oaeifying fibroJW-. 11 'the col'!l!!lentnries
of Dr. Sba.fet' Croa Indiana: ''this is a atrange ease. It has features o£ an fibroaa, of [.ent Johnson' s juvenile active oseifying f1bl>Ol!4, and slso
of the lesion that we htlva: been calling a pt"eo&tcoblastomo." nOdontogenic
fi.brom.1 with foreign body -reaction" was the dia&ttosis of Drs. Corio and Tar-1>l ~y
fr-o• Bethesda at Nm. Drs. Dunlap and Barker comaented: "Ce:!::ento-t"sslfying
fibroma, hovevcr, i t doea not: h•ve t.he typical whorled pattern .and bone trabeculae.
Oseobltt.ats aTe e l so not prominent. Due to the PtruJence. of g-iant eeL l clusters,
hemosidarin and widely scattered spars~ bone fnr~tion non-ossifylng fibroma is
not: supposed to be p-rese:nt in J)e_&;X)pla.stic Fibromas."
(Contributed by Dr.
by Dr. Caffrey,
t:ndepc.odence, MO)
sub~ tted
0ssifying f i.broma" 9 88 the dia&nosis o f Or. Handler for Jeffers.on
Azar frog Tampa. Or. Meyer frora St . U>uia. and Dr .. Kin& from SIU.
froo Detroit c.alls it "fibrosarcoaa ~ feat urea of au aaaressive
Dr . Abrams froiD UCLA st.atcd, "Ag&rcssive or juvenile. fibrmaat.osis.
i.t is n locally destructive._ lesion without meta&t.ntic po ''
City , Dr.
Or . Wealey
!ibromtosis. u
f believe
1'his was also
CASt: II 6 coot.inuod
the din,aosis of Dr . Weat hers from F.mory. D't. Ros.:1i from Mi nneso t a .s t ated :
1 believe this 1a a not.her b c.nign fibro-osae.oua l esion, eitber fibrous
or ossifying fibrou .. u The. aajoricy of the group of Dr . Fay fro• Be.aumonc ALDY
Medical Center call it a 1'f1brou.s hls tiocyto~:~" , except 0-r,;. Lundy a nd Ortiz who
cal l it 11 o~Jsi fyin& f ibroma. "
!he fol l owing cOl!Wientar ie.a: o f f' i br o-oss cous l u i on Yas s ent by Dr a . Bar keT' a nd
Dunlap f rom Uoivt rsity of Htssouri-Kansas City, School of Dentis t ry , Kaneas Cit y, MO.
We believe an osa1f f i b'foma is 3 f ibro-oaeaous l es i on whi eh has a well
demarco t &d or s horply ciretwseribed border on r a iogrnphs. As described by
Waldron and Giat\8anti~ Oral 8urg. , Ma:r c h 19 73, a nd Schmama.n, Smith and Ackctt~an
in Cancer , August 1970 , d\ia eoodition is cO:Iposed of whorling. C'ell ular fibrous
connec t i ve cissue which q y foro her mature and ii!Datu-re bon• of ceo_ shoving
osteoblas t i c rtmUng of trabeculae '-'hi c h may as sume a " rete fo raau pact:ern .
Osteoclasts are of t en present and s ometimes numerous . We believn that thia is a
separate enticy not A·v ariant o f f i brous d ysplasi a.
Usually aeen be fore age 25.
Dahl in, ln the t hir d- edition of Bone Tumors , r~por cs
no case s i n t he j aws . Radiogra phically he d es c ribes tt to have a n ~nner bor d er
o f either a t hin or promine nt s calloped line of scleroe t a . Tile les~on often s hovH
trabe e ulae ttaMvtrsing cha les ion &i ving i.t a aultiloculated appeara nce. It
usually produces aooe. e ortical expaneion. ln the 1on.g bones both D.abU.n and thto
AFIP Fa.scicl e agt"ee tha t this les ion has a d-1a t 1nctiva radiographic a ppearance .
Microoeopically NOF containe.s a cellular f ibrous tissuQ which i.a of t e n whorled.
Of ten it has benign cultinuc l eaced c ells which frequently l eads to a diagnosis of
giant cell tlJI!W)T o r graouloaa.. 'There ean be ! oci of osseov.,. metaplasia , oecasional
~to ses , and t he l e$ion MOY contain lipopbagas and hemosiderin p~ entation .
Bas a wide age range bu t alaost: 90% below ago. 30. Pain or a ehiQ.A is a co~:~:~on
complaint. of the patien t.!~~: . Cases have been reported i n the j aws . Radio&raphtca11y
i.t is us ~ l ly v ell demarcated, but sometime-s has an irregular bo-rder: producing a
trabeculated a ppearance. llistologically it is a bypocellular f ibrous connective
tissue wit h small s pindle s haped fibroblasts with mitose s being r are. According
t G sevara~ a uthor&, bone £oraation is not seen thus di •tingu~ehins the l teion
f r oa fi brous dyaplasi3. There is alsoa laek o f giant cells vhich can help
d i s t inguish this fro~ a non-os sif ying fibroma. A fibrosarcoma would b~ ~uch aore
cellul&r .
this appears t o be a c ontrovers i a l area. The lesion lr~8 f irst described by
Stout in Cance~ . Sept . 1954, however , no bone lesions in e hildren u p to aaQ 15
whose f i brous l e a.ion W38 no t \lell d ned by oth er catasor ies t~uch as dOit"liiOpLast.ic: f-ibra::!a, !nzi_qge:r de.aer ibed a a imilar l esion a s :!J;Rf'essivc tnfancfle.
However, soae l e siou d esc.ribed by Enzt.nser io""Ould fi-t Stout·,. _
dif f erentiacecl fibr osarcoma diag.nos is. I t appears that you can not j udge
behavior on histology and t he f inal pt~ oo f of o f ibrosarcotoo would be ~tilt~tnsis .
Tnese lesions aris-e in soft tissue or peri osteum and cu.y invade bone thu. diffed"'~
froa deamoplast ic fibroaas ~hich a rise ce ntra l l y iu bone and expand cortice5 bu~
l ea ving them gener ally i ntact . Hi s t ologically, the f ibroblastic proliferntion
may ax t cnsivel y infi ltrate bone , fat, and musc le. Tho s pindle cells are usu31ly
uni foT"ID in siz.e, well-di!!crc.:otiated and devoi d of lllito&c s . There i s UAunlly
considerable collagen a nd ret iculin format ion~ Dahlin notes that the deP.IIopla-st1c
fibro34 ~s a sepaxate entity vhile Rosai saya i C =ay r epr ese nt the bone counterpart of th~ soft t i saue desmoid . Stout and Enzinger both suggest s possible
CASE # 6 continued
de.s1gt'l3tion o f destDOtd fibroutosis , • desooid t umor for the. less eell ular
Conl ey (Amcr J. of Surge~y. 112:609, 1966) ~ep o rted 40 cases with abodt 50%
recurrence ~ate . · Saveral recent ~rtielas, some wit h jaw lesions are:
Peede, Ora~ Snrg. 43:651 May 1977
Larsson, J. Oral Path 5:29- 51 1976
l!onefer, J . Oral Surg . 96:
Dec . 19 78
J\JVENILE ACTIV3 01\ AGGRESSIVE OSSIFYING FillROMA entity a ppear• in the litera ture but is poorly desct' or documented as
tQ what it actually looks like histolosica1ly .
Lent Johnson ' s naoa is often
associated with this lesion b~t we know of no tal~~cnce. It b~havo& as an
aggressive fibro-osseous. lcsion vhieh maY kill by local extension.
What t hen Are theae lesions? Using tha above inforcation, we believe Batsakis
best sums it up in ·rumors of the: Read and Neck. He notes that: fibrous lesions
often show a mixtu-re of f eatures making e xact elassiiication d.iff icul t .
CASE t 7
(CMrt I 47930)
(Cont:r:ibuted by Dr. Don Krautz~r,
tla.rrison, Arkans-3-c;)
Dr . Lundy from Be.n.w:.ont A'r"Y H.Mical Center called it "ne.croti.zins s1 alcmet-
aplasia." Dr. Ros.a1 fmc KJ.nne:sota stated_. ''this -te: a tu.or pf a.ioor salivary
gland origin ari#ing i n che palate and characteri~ed by very pr~n4nt squamous
I believe. i t is either benign_ or of A ver y low d~~ee. of
tbink i t com~ closer to the leaton than people have designated
as sialadeno:ta. papilliicr1.11 than a.ay other salivo.ry gland tumor I know.'' Dr.
Azar from Taapa cU.led ~t "11ucoepideraoid t-uoor"wbich vaa also the diagnosis
meJ:a pla aia.
of DY.
~ in&
from StU .
Drs. Kori
fro~ Wes~
Virslna, Jones
f~om B~aumon~
Army Center , a nd Rowe fron1 Mi.chi&an call i t " SquamouR cell corclnoma."
Shafer from Ind.ia.oa called it 11hig.h grade mucoepidermoid c.arclnoll4. Dr. Weathersfro::n Emory coEDeote.d; ''iiish grade mucoepiaeraotd careinoo.'l. . Did t:his -arisll in a
previoualy ben.ign taixed t.umort"