A 31 years old female had been suffered from a bony swelling in right premolar region of the mandible for 12 years, recently grown rapidly. A fistula tract developed on the right anterior mandibular border, but the lesion was relatively asymptomatic. In the radiological examination, the tumor mass was irregularly mixed with radiolucent and radiopaque areas, forming multiple cystic spaces. Under the diagnosis of calcifying odontogenic cyst, the mandibular mass was resected and examined pathologically. After decalcification, the dissected tumor mass showed multiple small cystic spaces and calcifying fibrous tissue, mimicking calcifying odontogenic cyst or ameloblastoma. Histological observation showed many calcifying cementoid materials and ossifying trabeculae. The cystic spaces were turned out to be dilated vascular channels lined by endothelial cells, containing plasma fluid. However, the main lesion was diagnosed as cemento-ossifying fibroma (COF), and the atypical vascular channels were greatly dilated and gradually expanded the whole tumor mass. The present COF was examined through immunohistochemical (IHC) array, and investigated for tumor cell characteristics, exhibiting abnormal ossification and aneurysmal cystic changes. IHC array disclosed that the tumor cells grew progressively in the lack of apoptosis, and that they showed lower expression of RUNX2 than BMP-2, RANKL, and OPG, and increases of protein expression in HIF-1α, VEGF-A, and CMG2. These data suggested that the reduced expression of RUNX2, osteoblast differentiation factor, be relevant to abnormal ossification of COF, and that the consistent expressions of angiogenesis factors be relevant to de novo angiogenesis in COF, subsequently resulted in aneurysmal cystic changes.

Metastatic tumors in oral cavity are rare, where their prognoses are considered to be extremely poor. Unless recognizing its primary origin, pathologic diagnoses for metastatic cancer have been troublesome for oral pathologists. This retrograde analysis was aimed at providing practical suggestion for the diagnoses of metastatic cancers to oral and maxillofacial region. We reviewed 20 patients diagnosed as metastatic cancers to oral cavity from 1991 to 2007. The patients were classified according to their clinical and histologic findings. We also reviewed 19 patients of mucoepidermoid carcinoma and 16 patients of adenoid cystic carcinoma to compare with those of metastatic cancers. Immunohistochemical staining for CK 5/6, CK 17, TTF-1, CEA was performed for differential diagnosis. Histologically, 20 cases compromised 11 cases of adenocarcinoma, 5 cases of undifferentiated carcinoma, 3 cases of squamous cell carcinoma, and one papillary carcinoma. The lung was the most common site for primary site (5/20), followed by the breast (2/20). In metastatic adenocarcinoma, TTF-1 positive cases were one lung cancer and a rectal cancer, and carcinomas from breast and rectum showed CK5/6 positive reaction. CEA was expressed in gastric and rectal carcinomas. In 19 cases of mucoepidermoid carcinoma, 13 cases (68.4%) are CK5/6 (+). In 16 cases of adenoid cystic carcinoma, 11 cases (68.8%) showed the positive reaction for CK5/6. TTF-1 is an antibody to show high sensitivity and specificity for lung adenocarcinoma, therefore, TTF-1 is helpful to make a diagnosis of metastatic adenocarcinomas from lung. Adenocarcinomas originated from salivary glands show high CK5/6 expression, but metastatic adenocarcinomas, except of those from breast and rectum, show no CK5/6 expression, lending support that CK5/6 may be useful to differentiate metastatic adenocarcinomas from carcinomas of salivary gland origin.

The purpose of this study was to evaluate the role of EGF(Epidermal Growth Factor), EGFR(Epidermal Growth Factor Receptor), aFGF(acidic Fibroblast Growth Factor, FGF-1), bFGF(basic Fibroblast Growth Factor, FGF-2), FGFR(Fibroblast Growth Factor Receptor) in the development of radicular cyst. For this study 37 subjects, diagnosed as radicular cysts. referred to the Dept. of Oral Path. College of Dentistry, Kyung Hee University, were used as experimental group. And for control group, 2 subjects of normal oral epithelium without any inflammatory changes were used. All the tissues; experimental and control group were neutral formation fixed and paraffin embedded. serial tissue section were made at 5㎛ and processed in the standard way for immunohistochemical method, using primary antibodies against, EGF(Antirabbit Ig G at 1:100 dilution), EGFR(Antimouse Ig G at 1:100 dilution), aFGF(Antirabbit Ig G, rabbit kit at 1:100 dilution), bFGF(Antirabbit Ig G, mouse kit at 1:100 dilution), FGFR(Antimouse Ig G mouse kit at 1:100 dilution), all BioGenex U.S.A. made except EGFR(Chemicon U.S.A.) followed by the Streptavidin - Horse Radish Peroxidase (InnoGenex Human-avidin kit) application, counter stained with Meyer's hematoxylin stain method. And examined under microscope, graded 0(no epithelial stain), +(weak or focal epithelial stain), ++(moderate or focal intensive epithelial stain), +++(intense generalized epithelial staining) for the epithelium, and connective tissue of cyst wall. 1. EGF, EGFR, aFGF, bFGF, FGFR showed more intense staining on radicular cysts compare to that on the normal mucosa. 2. EGF, EGFR, aFGF, bFGF, FGFR stained in mucosa, submucosa of the control group and also stained on the lining epithelium, connective tissues of cyst wall in the experimental group. EGF, EGFR, aFGF, bFGF, FGFR take a part in the development of the radicular cyst.