Sarcoma is rare malignant tumors that develop from mesenchymal cells. Metastasis to the oral cavity is a rare occurrence. Undifferentiated Pleomorphic sarcoma(UPS), formerly known as Malignant fibrous histiocytoma(MFH), is rare spindle cell neoplasm that can have poorly prognosis with metastasis and local recurrence. This report describes a case of a 77-year-old man who was diagnosed with Undifferentiated Pleomorphic Sarcoma of the chest wall and underwent adjuvant radiation therapy after surgical resection. Although there was success of wide excision, two years later, he presented with metastasis to the several organs including tongue. We retrospectively analyzed results of Next Generation Sequencing(NGS), and we figured out RB1 gene mutation. Until now targeted therapy of RB1 gene mutation is not established. Surgeon needs to consider metastatic tumors through identifying patients’ chief complaints and past medical & dental history. We need to research through NGS, and take a step closer to find targeted therapy for tumors.

Oral adenosquamous carcinoma (ASC) is a rare and aggressive type of squamous cell carcinoma (SCC). It is characterized by a squamous component originating at the mucosa and a deep glandular component. ASC may be misdiagnosed as SCC by superficial incisional biopsy including only the squamous component. ASC has a worse prognosis than general variants of SCC, so accurate diagnosis is essential for patient survival. We present a case report of a large ASC arising in the buccal mucosa, first mistaken as general SCC.

Cervical neck dissection is a frequent technique during treatment for oral squamous cell carcinoma (SCC). Occasionally, specimens harvested as cervical lymph nodes reveal thyroid tissue and need differentiation with metastatic thyroid cancer and ectopic thyroid tissue. Here, we report a case of an ectopic thyroid tissue with lymphocytic thyroiditis mimicking thyroid cancer metastasis at the cervical lymph node.

Oral examination in a patient with a history of acute lymphoblastic leukemia (ALL) and allogeneic hematopoietic cell transplantation (HCT) needs considerations of leukemia relapse and graft-versus-host disease (GVHD). Oral manifestations may contribute to early detection of relapse or systemic complications making accurate oral examination and diagnosis significant. We report a case of a large tumor like mass arising in a patient with a history of ALL and HCT. The patient had been diagnosed with ALL relapse and was being treated with chemotherapy, and furthermore was suspected of GVHD development.

Ameloblastic fibrosarcoma (AFS) is an extremely rare malignant odontogenic tumor characterized with benign ameloblastic cells islands and malignant mesenchymal component. While two-thirds of AFS seem to arise de novo, but one-third develops from recurrent ameloblastic fibroma (AF) or ameloblastic fibro-odontomas (AFO). Pathological distinction of malignant transformation is essential for appropriate treatment. The patient was a 28 years old man. Since the primary tumor was excised, the mass recurred 2 years later. The recurrent tumor was diagnosed as AFS. Chief complaint was pain in the right mandible. Computer tomography finding revealed multilocular intrabony lesion with radiopaque substance in the primary lesion. In the recurrent lesion cortical bone destruction was found. Microscopically, both the primary and recurrent lesions showed benign ameloblastic follicles with myxoid or highly cellular mesenchymal proliferation. The histological difference between primary and recurrent lesions were that foci of dental hard tissue composed of enamel and dentin were found only in the primary lesion, whereas nuclear pleomorphism was aggrevated in the recurrent lesion. The histological criteria determining malignancy were discussed.

Osteonecrosis is defined as non-vital bone tissue as a result of abnormal process of osseous healing, and is caused by several reasons such as infection, radiation, and medication. Osteomyelitis, osteoradionecrosis, and medication related osteonecrosis of the jaws (MRONJ) which have necrotic bone in common are confused clinically due to similar symptoms and radiographic findings, and are difficult to diagnose definitively. Because each disease represents a separate clinical progress and requires a different treatment approach, it is very important to distinguish each disease. The aim of this study was to analyze the histopathologic features of osteomyelitis, osteoradionecrosis, MRONJ and to understand their different pathogenesis.

Epidermoid cyst of the oral and maxillofacial region is a soft tissue cyst lined with keratinized stratified squamous epithelium and most commonly arises in the superficial area of the mouth floor. Uncommonly, the epidermoid cyst may arise deeply in the submandibular region and should be differentially diagnosed with cystic salivary gland tumors, developmental cysts and other cystic lesions. We report a rare case of an epidermoid cyst near the submandibular gland, clinically and radiographically mistaken as a salivary gland tumor.

Small cell osteosarcoma of bone, which was first described in 1979, is an unusual variant of osteosarcoma. Osteoid production by tumor cells is frequently focal or minimal, making the differential diagnosis with other small round cell tumors of bone difficult. Here, we present a rare case of small cell osteosarcoma of the mandible appearing as bony bulging mass in 31-year-old male who has neither tenderness nor paresthesia. Histologically, the tumor contains hypercellular cartilage and abnormal osteoid associated with small round to ovoid malignant cells. Awareness of small cell osteosarcoma should be emphasized because it has worse prognosis than both other small round cell tumor and conventional osteosarcoma.

Whereas calcium deposition in soft tissues is not uncommon, highly-structured, identified as mature cancellous bone within soft tissues is not frequent. Here, we report an usual case of mature cancellous bone in cheek subcutaneous tissue in 15-year-old Korean male. Microscopically the cancellous bone was encompassed by epithelial cells, which was confirmed by immunohistochemical staining with cytokeratin AE1/3. The present mature cancellous bone in subcutaneous tissue could be originated from oral epithelium.

Malignant tumor of the paranasal sinus is a rare, occurring most frequently in the maxillary sinus. Carcinomas of the maxillary sinus are usually diagnosed at the advanced stage because most tumors have no symptom or nonspecific symptoms such as pain, nasal obstruction, rhinorrhea, and epistaxis. In addition to these features, it is difficult to distinguish carcinoma from inflammatory or cystic lesion on imaging study until the carcinoma destroys the surrounding structures. Therefore, the diagnosis is prone to be delayed. Here, we report a case of an 83‐year‐old male with nonkeratinizing carcinoma on the maxillary sinus, which was initially misdiagnosed as a cystic lesion. The aim of this study is to emphasize the effort for early diagnosis in order to improve prognosis and avoid inadequate treatment

Nodular fasciitis is defined by the World Health Organization as a benign proliferative fibroblastic lesion. It was first described in 1955 by Konwaler et al. and also known as “nodular pseudosarcomatous fasciitis” and “infiltrative fasciitis”, which reflect the lesion’s rapid growth, dense cellularity, alarming mitotoic activity and lack of circumscription. Here, we report a case of nodular fasciitis, which appeared as subcutaneous mass of right perizygoma area in 40-year-old Korean female. She had no history of trauma or cosmetic surgery related with the lesion. She disclosed that the mass grew rapidly for last 2 months. Computed tomography showed relatively well-defined spherical mass with 1.2 cm in diameter. Under local anesthesia the mass was resected by intraoral approach. The histological examination revealed a relatively poor-dermacated mass with high cellularity, which was composed with infiltrative spindle-shaped cells without accompanying inflammatory reactions. The tumor cells were partially positive for α-smooth muscle actin and β-catenin, but negative for cytokeratin AE1/3, S-100, desmin, and CD34. Therefore, the lesion was pathologically diagnosed as nodular fasciitis. Although nodular fasciitis is known to pseudosarcomatous benign reactive lesion, the clinician need to follow up the patient periodically. The reasons are as follows; Nodular fasciitis may accompany nuclear accumulation of β-catenin, which imply neoplastic process rather than reactive process of the lesion. Moreover, it has many histological similarities with inflammatory myofibroblastic tumor which have malignant transformation tendency. Further research for mesenchymal tumor could help our understanding for the disease entity of nodular fasciitis

The osteoblastic activity of carcinoma is restricted in osteoblastic metastasis, common in the patients with prostate cancer, whereas its mechanism and the factors involved are unknown. Here, we present a case of central adenocarcinoma showing the osteoblastic activity in the mandible of the 80-year-old Korean male who had suffered from the paresthesia of lower lip during four mouths. Clinically the overlying oral epithelium was intact, but the radiologic images revealed the ill-defined radiolucent intraosseous lesions in left ascending ramus. Microscopically, the mandibular lesion was composed with carcinoma of ductal or glandular differentiation but lack typical features of any epithelial salivary gland malignancies. Intriguingly abundant new bone formation was found in the stroma, but the tumor cells expressed no reactivity for prostate-specific antigen(PSA). The patient had low ionized calcium level, normal serum alkaline phosphatase and PSA level. Positron emission tomography-computed tomopraphy scan revealed the benign prostatic hyperplasia, but failed to trace the primary site of tumor other than mandible. Therefore, pathologically diagnosis for the lesion was informed as adenocarcinoma, not otherwise specified(NOS). Because occult primary tumor associated with osteoblastic metastasis cannot be completely ruled out, periodic and careful check-ups for the patient should be performed.

Osteogenic sarcoma is primary malignant bone tumor. It can arise de novo or from the benign precursors lesions, like Paget’s disease, giant cell tumor, chronic osteomyelitis, osteoblastoma, and fibrous dysplasia. Here, we present a case of osteogenic sarcoma arising from florid osseous dysplasia appearing as a rapidly growing bony bulging mass in 44‐year‐old Korean female who had at first been non‐symptomatic, but later suffered from the numbness of chin and lower lip. The radiologic images revealed the mixed radiopaque‐ radiolucent intraosseous lesions throughout the mandible, which were diagnosed as florid osseous dysplasia pathologically. But only after 6 months, the lesions were substituted by the radiological ill‐defined diffuse bony sclerotic lesion with bone destruction, accompanying the interrupted periosteal bone formation, which were pathologically diagnosed as osteogenic sarcomas. These serial clinicopathologic changes imply the malignant progression of florid osseous dysplasia rather than the collision of benign condition, florid osseous dysplasia and malignant tumor, osteogenic sarcoma. The possibility for fibro‐osseous lesion of the jaw as premalignant lesion should not be overlooked; therefore, periodic check‐ups for the lesions are necessary. Proper evaluation and interpretation for clinical neural symptom and radiologic change of bone density may lead to the correct differential diagnosis and therapeutic intervention.

Epithelioid hemangioma is an unusual, which was at first described as angiolymphoid hyperplasia with eosinophilia (ALHE) in 1969 and misinterpreted as the same disease with Kimura’s disease. But now it represents a distinctive vascular tumor, a different entity with those inflammatory conditions. Here, we present a case of epithelioid hemangioma appearing as a diffuse gingival nodular mass in 33‐year‐old male who had suffered from the idiopathic sharp pain of left mandible area previously and later extended to left maxillary region, therefore the gingival lesion was clinically estimated as malignancy associated with neural invasion. CT images revealed the soft tissue mass restricted to left maxillary gingiva without infiltration to underlying maxillary alveolar bone. Histologically, the circumscribed soft tissue mass consist of solid sheets of epithelioid to spindled cells, expressing reactivity for neither cytokeratin AE1/3 nor HMB‐45, but for CD31, endothelial cell marker. Therefore, the lesion was pathologically diagnosed as epithelioid hemangioma. Diagnostic evaluation for the neurologic symptoms of the patient revealed the trigeminal neuralgia, accompanying with the present epithelioid hemangioma incidentally. Awareness of epithelioid hemangioma should be emphasized not to be misdiagnosed as malignant disease like an invasive squamous cell carcinoma, malignant melanoma, or angiosarcoma. Proper evaluation and interpretation for neural symptom may lead to the correct differential diagnosis and therapeutic intervention

Facial numbness restricted to the distribution of the mental nerve(mental neuropathy) is called "numb chin syndrome". The clinical importance of this syndrome is associated with first recognition of involvement of malignant diseases. The malignant neoplasm with numb chin syndrome show rapid progression and high mortality. We present a 43-year-old female who had been treated by radiotherapy for precursor T-cell leukemia/lymphoma involving the central nervous system( CNS) previously and later developed mental nerve invasion without central nervous system recurrence. MRI images revealed the CNS tumor mass remitted, and there was no identified peripheral nervous system(PNS) involvement including the mental nerve invasion, nevertheless the patient complained of consistent numbness and pain on right mandibular area. This is the first case of precursor T-cell leukemia/lymphoma accompanying mental nerve invasion without recurrence for central nervous system. Proper interpretation for mental neuropathy may lead to the prompt diagnosis and therapeutic intervention.

29-year-old female with chronic renal failure and a history of hemodialysis during 10 years showed localized jaw enlargement in the anterior mandible. She also revealed increased serum PTH level, osteosclerosis in her skull base and facial bone, chronic pain in the both knee joint, and gastrointestinal disorder which are symptoms of renal osteodystrophy. The patient was diagnosed hyperparathyroidism associated with chronic renal failure. Parathyroidectomy was performed, however, serum PTH level increased again after the parathyroidectomy, the affected area of the mandible was enlarged as the serum PTH level increased. The enlarged area seemed like as peripheral lesion clinically. We reported a case of localized jaw enlargement as oral manifestation in renal osteodystrophy.

thus, resembles scar tissue. TGF-β1, MMP and TIMP play an essential role in remodeling extracellular matrix during scar formation. This study investigates the pathogenesis of IF with respect to the coordinated expression of factors involved in wound healing. Proliferative activity and expression of TGF-β1, MMP-1 and TIMP-1 were observed using immunohistochemistry in 88 cases of IF and 9 cases of normal oral mucosa(NOM). Proliferative activity and expression of TGF-β1 and TIMP-1 were increased in IF compared to NOM. MMP-1 expression was not significantly increased in IF. We propose that IF is caused by increased expression of TGF-β1 and an imbalance in expression of MMP-1 and TIMP-1.

Epithelial-mesenchymal transition (EMT) can play an important role in carcinogenesis of oral squamous cell carcinoma (OSCC). EMT is characterized by morphological and phenotypical change of epithelial cells into mesenchymal cells, and transcriptional repressor of E-cadherin, Snail is critical for EMT. In order to investigate the role of Snail and E-cadherin in OSCC, we analyzed the immunohistochemical pattern of Snail and E-cadherin in 18 OSCCs. The expression of Snail in the OSCC was increased whereas the expression of E-cadherin in the OSCC was decreased in comparison with those of normal oral mucosa, showing reverse correlation. Especially, the fibroblasts near the islands of OSCC showed the positivity of Snail, suggesting the reactive fibroblasts to the EMT of epithelial tumor cells. In metastatic squamous cell carcinoma in cervical lymph node, the positivity of Snail of tumor cells was higher than that of primary OSCC. We concluded that the increased Snail expression and the decreased E-cadherin expression were involved in the progression, invasion and metastasis of OSCC.

Wntsignaling is involved in the normal development and tumorigenesis via epithelial- mesenchymal transition (EMT). init iated by down-regul ation of E-cadherin by the transc ription factor Snail. Wnt signaling inhi bits Sna il phosph o rylation t hrough Axin2-dependent pathway that sustains nuclear accumul ation 0 1' Snail by driving CSK3ß nucleocytoplasmic export then consequently increases Snail protein levels and induces an EMT However. the roles of Wnt and Axin expression and their functional implication on Snail dependent EMT program a re not clear du ring the multistep carcinogenic process. We examined that canonical Wnt signaling engagingmul t istep carcinogenic process of uterine cervical cancer through Wnt-Axin2-Snail axis. In nonnal cervi cal mucosa, Wntl. Wnt3a. and Axin2 mRNA expression were locali zed in basal cell layer suggesting that canonical Wnt is required for maintenance of self-renewal program of cervica l epi theli al cells. With progression to cervical int r aepithelial neoplasia (CIN) and carcinoma. Wntl, Wnt3a‘ Axin2, and Snail expression were gradually increased in patient samples suggesting that canonical Wnt pathway is involved in earl y step of carcinogenesis in uterine cervix. LRP6 and Axin2 transfected cells showed the highly increased nuclear Snai l resul ted from dec reased level 0 1' nu clear GSK3ß , indicating that LRP6- Axin2 serves to stabili ze Sna il protein levels and susLains iLs nllclear acc llrnulation by driv ing GSK3ß . RNA interference of Axin2 and Snail on SiHa cells relieved E-cadherin proximal promotel‘ activity and block the in 띠 vo chorioalantoic membra ne ln VaSlOn These results suggest the canon ical Wnt signa ling regul ating Axin2-GSK3ß compartmentalization may important for stabi li zation of E- cad herin repressor Snail during the multistep carcinogen ic process of uteri ne cervix. It may lead to not only tracing the proper biomarker 0 [' ca ncer progression‘ but a lso the development oJ new targets for therapeutic intervention in cancer

Combined epithelial odontogenic tumors are very rare and represent hybrid lesion comprising adenomatoid odontogenic tumor intermixed with calcifying epithelial odontogenic tumor. The authors present 3 cases of combined epithelial odontogenic tumor which contained diagnostic areas for both adenomatoid odontogenic tumor and calcifying epithelial odontogenic tumor. Their behaviour and histogenesis were discussed.