Clear cell odontogenic carcinoma

中國醫藥大學附設醫院 口腔顎面外科 報告者—簡杏宜

指導者—陳百立醫師 薛水上醫師

下顎骨齒源性透明細胞癌

Clear Cell Odontogenic Carcinoma

of Mandible

Basic Data

Name : 葉賴XX

Gender : female

Age : 70 y/o

初診日期 : 2009.06.19

Chief complaint

 Referred from another hospital for evaluation

of the mandible lesion.

Systemic disease

: HTN

under medical control

Present Illness

 2002 Received enucleation surgery for the left mandible lesion at another hospital.

Pathologic report: Ameloblastoma  Clear cell odontogenic carcinoma

Without regular follow up

Physical

Examination

2009/07/02

 Treatment Plan

 Segmental mandibulectomy

(from left angle to right angle area)

 L’t Neck dissection (SOHND)

 Reconstruction with ALT flap and reconstruction plate.

Clinical impression:

Surgical Procedure

Left neck supraomohyoid dissection

Composite resection of the main tumor with neck lymph adipose tissue in one piece.

Surgical Pathology

 Main tumor:

 _{Clear cell odontogenic carcinoma (CCOC)}

 _{No definite lymphovascular permeation nor}

perineural invasion

 Surgical margin:

1.soft tissue, peri-mandibular, left, wide excision,

invaded by clear cell odontogenic carcinoma. 2.Mandible bone, bilateral, wide excision, free of

Surgical Pathology

 Neck lymph node:

 _{Level I – negative for malignancy (0/5).}  _{Level II – negative for malignancy (0/14).}  _{Level III– negative for malignancy (0/2).}

_{Major salivary gland, submandibular, left, free of}

Treatment

Course

Started adjuvant radiotherapy

6 MV X-ray with IMRT technique ( TD:5940 cGy/33 fr)

2009/07/27

2009/09/11

2009/09/11 Post-op 2 months

2010/03/05

DISCUSSION 1

Characteristics

No. of patients (%)

Sex ratio 3:1 (Female)

Mean age 57.8

Site of lesion

Mandible 36/43 (84) Maxilla 7/43 (16) Erosion of bone 40/40 (100) Soft tissue involvement 15/25 (60)

Clinical Characteristics

Pathologic

Pattern

Eugenio Maiorano Am J Clin Pathol 2001;116:107-114

Composed of irregular sheets of neoplastic epithelial islands immersed in a richly cellular, collagenous stroma

CK 8

HE

Findings Cellular types

involved classification WHO of CCOC

Our Case

Cytokeratin CK8: clear cells

CK 14: eosinophilic cells

EMA Clear, eosinophilic, duct-like structures

S-100 Dendritic cells

Vimentin Stromal components

Mucin Salivary gland tumors

PAS Intracytoplasmic glycogen

Modified from: Werle et al. Clear-Cell Odontogenic Carcinoma. J Oral Maxillofac Surg 2009 ; Calo et al. CCOC:case report with immunohistochemical findings OSurgOMedO PathORadiolEndod 2008

DISCUSSION 2

Metastasis No. of patients (%)

Overall 10/40 (25)

Distant 6/40 (15)

Outcomes

Alive with no disease 26/36 (72) Alive with disease 2/36 (6) Dead of disease 6/36 (17)

Recurrent disease 21/38 (55)

Local only 12/38 (32)

Local and LNM 7/38 (18)

LNM 2/38 (5)

Treatment strategies

Charles S. Ebert HEAD & NECK June 2005

%

Initial treatment

Recurrence Rate

Curettage/enucleation alone 8/10 (80) Resection alone 11/23 (43) Resection with LND 0/2 (0) Resection with XRT 1/3 (33) Resection, LND, and XRT 0/1 (0) Chemotherapy alone ____

Treatment strategies

1. Surgical control of CCOC with

an en bloc

resection

of bone and any soft tissue

involvement decreases the risk of recurrence

-- The importance of free surgical margin

2. A

regional lymph node dissection

can be

performed for staging and treatment of regional

disease

3. With

adjuvant radiation therapy

4. Long term surveillance

Charles S. Ebert