Oral Mucosa and Soft Tissue Alterations Associated with Osteonecrosis of the Jaw
Simpal Gill, Nicole Hinchy, Vijay Jayaprakash, Maureen Sullivan, Mihai Merzianu. State University of New York at Buffalo, Buffalo, NY; Roswell Park Cancer Institute, Buffalo, NY
Background: Osteonecrosis of the jaw (ONJ) is a complication of radiation (RON) and bisphosphonate (BON) therapy for head and neck cancer, plasma cell neoplasms (PCN) or bone metastases. We noted epithelial and plasma cells alterations mimicking the underlying disorder and aim to assess their frequency and better describe these morphologic findings.
Design: Patients with an ONJ diagnosis were identified in our database. Charts and histologic slides were reviewed. Mucosal changes, including pseudoepitheliomatous hyperplasia (PEH), cytologic atypia, epithelial islands within the bone marrow space (bone pseudoinvasion-BPI) were recorded. Presence of acute, chronic lymphoplasmacytic infiltrate (LPI) and dense plasma cell infiltrate (PCI) were recorded, the latter when PCs >50% of total LPI. PC features such as hyperchromasia, binucleation, anisocytosis, exocytosis and Russell bodies were also recorded.
Results: There were 36 samples from 32 patients with ONJ, 21 men and 11 women, mean age 59 (range 38-83), 23 had RON and 9 BON. The mandible was involved in 30 (23 RON and 7 BON) and maxilla in 7 (3 RON and 4 BON) patients. Mucosa was seen in 30/36 and bone fragments in 21/36 samples. Underlying disease was head and neck squamous cell carcinoma (HNSCC) in 20, PCN in 5 and other diseases in 7 patients. PEH was present in 24 of 30 cases (80%), 12 from HNSCC patients. Reactive epithelial atypia was seen in 22/30 cases and considered severe in 15 (68%), the latter was associated with erosion and re-epithelialization; severe dysplasia suspected in 2. Residual SCC was present in 2 samples. BPI was present in 11 of 21 (47%) samples, 4 from HNSCC patients. Acute inflammation was seen in 84% and LPI in 94% of cases; of these, 17 (54%) had dense PCI, seen in all samples from PCN patients. Atypical PCs were seen in 23 cases, 6 from PCN patients; in 2, further workup was negative. Hyperchromatic, large PCs with binucleation and Russell budies were frequent but no Dutcher bodies, prominent nucleoli or mitotic figures were present. Actinomyces-like organisms were more common in the bone fragments from BON patients (100%, 8/8 samples) when compared to RON patients (54%, 7/13 samples), (p-value: 0.04).
Conclusions: PEH and bone pseudoinvasion are common neoplastic mimickers of mucosa in ONJ samples, the latter change heretofore not described. Atypical plasma cells are also common in ONJ but histologic examination allows separation from PCN in most cases. Rare cases require additional workup for definitive diagnosis.
Category: Head & Neck
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 206, Wednesday Morning