Proceeding of the 20Th Annual Meeting of the Japanese Society of Oral Pathology

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Proceeding of the 20Th Annual Meeting of the Japanese Society of Oral Pathology Oral Med Pathol 14 (2009) 65 Proceeding of the 20th Annual Meeting of The Japanese Society of Oral Pathology Meeting Period: July 29-31, 2009 Meeting Venue: Royton Sapporo, Sapporo, Hokkaido, Japan Organizing Committee: Chairperson: Professor Tohru Kaku, Division of Clinical Oral Pathology, Department of Human Biology and Pathophysiology, School of Dentistry, Health Sciences University of Hokkaido, Ishikari-Tobetsu, Hokkaido, Japan Program Opening Address: T. Kaku (Health Sciences University of Hokkaido) Special Lecture: Speaker: T. Himi (Sapporo Medical University) Scientific Symposium: Symposium Ⅰ: Diagnostic Pitfall of Oral Pathology Organizer; I. Ogawa (Hiroshima University Hospital), H. Harada (Iwate Medical University) Symposium Ⅱ: Approaches to correct diagnosis of the Oral Lichen Planus - Concepts of clinical status and histopathology - Organizer; H. Maeda (Aichi-Gakuin university), K. Komiyama (Nihon University) Symposium Ⅲ: Surgical Conference Organizer; Y. Tanaka (Tokyo Dental College), G. Sekine (Shimane University) Case Discussion: 13 Titles Case Report: 21 Titles (poster) General Session: 32 Titles (poster) Slide Seminar: 1. Cytology: K. Kayo & T. Utsunomiya (Nihon University, School of Dentistry at Matsudo) 2. Autopsy: T. Yamada (Nihon University, School of Medicine) 3. Macroscopy: M. Toida (Gifu University, School of Medicine) Closing Address: T. Kaku (Health Sciences University of Hokkaido) Abstracts Symposium: Diagnostic Pitfall of Oral Pathology or synovial sarcoma. Herein a reference on diagnostic problems especially focused on double-layered ducts or SⅠ-1. Morphological characteristics of salivary biphasic morphology is made. gland tumors: a reference focused on double- layered ducts and biphasic differentiation SⅠ-2. Non-odontogenic lesions of the jaw bone: Harada H bone tumors and tumor-like lesions Department of Oral Pathology, School of Dentistry, Iwate Utsunomiya T Medical University Department of Oral Pathology, Nihon University School of The most striking histological feature of salivary gland Dentistry at Matsudo tumors is the participation of modified (neoplastic) There are various types of tumors and tumor-like lesions myoepithelial cells, which is typically reflected in double- in the jaws. For making the definitive diagnosis, it is so layered ducts commonly seen in pleomorphic adenoma, important to understand the characteristic features of tumor adenoid cystic carcinoma or epithelial-myoepithelial carci- cells and extra- (inter-) cellular matrices in these lesions. For noma. In these structures, myoepithelial cells are arranged in instance, osteosarcoma, one of the most major bone tumors, the outer layer and reveal cellular morphology equivalent to consists of proliferation of atypical mesenchymal cells with basaloid or clear cells in most instance. Although lacking osteoid and/or bone formation as the typical characteristics, ductal structures, myoepithelioma or myoepithelial carci- the tumor, however, often shows minimum cellular atypism, noma could show biphasic morphology, but does not directly marked cartilage and/or myxoid matrix formation, or impart dual directional differentiation, unlike carcinosarcoma unremarkable evidence of osteoid and bone formation. In 66 Proceeding of the 20th Annual Meeting of The Japanese Society of Oral Pathology such cases, it is so difficult to distinguish the osteosarcoma different etiologies with a common clinical and histological from the chondrosarcoma, fibrosarcoma and fibro-osseous appearance. Oral lichen planus (OLP), lichenoid contact lesions. The diagnostic problems of the tumors and tumor- reactions (LCR), lichenoid drug reactions (LDR) and graft like lesions in jaws are present and discussed herein, from versus host disease (GVHD) can affect the oral mucosa and viewpoints of morphology of these tumor cells and formation belong to the group of lichenoid reactions (LR). Thus, LR of the extra- (inter-) cellular matrices. does not represent one disease entity but should be considered as a pathological reaction pattern instigated by SⅠ-3. Histological diversity in ameloblastoma different etiological entities. Immunological mechanisms Nagatsuka H play an important role in the pathogenesis of all members of Department of Oral Pathology and Medicine, Graduate School the LR-group. OLP is a mucocutanous disease which of Medicine, Dentistry and Pharmaceutical Sciences, Okayama presumably involves autoreactive T-cells. LCR are seen in University oral mucosa in contact with dental materials, and is Ameloblastoma is the most common odontogenic tumor, considered to be a delayed hypersensitivity reaction against which is characterized by proliferation of odontogenic the filling material. Recently it has been suggested that epithelium. However, its diagnosis may sometimes be diffi- bacterial antigens may also induce LCR. LDR are elicited by cult or misguided by its histological diversity. We should pharmacological drugs which may act as haptens linked to note that the epithelial component which appears in self-proteins. GVHD is observed in patients treated with ameloblastoma is also observed in other odontogenic allogeneic stem cell transplantation. Immune cells from the tumors, and vice versa, the feature of other odontogenic donor recognize the recipient’s tissue as foreign causing a T tumors also may be appears in ameloblastoma. Also the cell dominated inflammatory cell infiltrate in the mucosa estimation of malignancy in ameloblastoma is problematic. underlying the oral epithelium. In the diagnosis of ameloblastoma, it is absolutely imperative The explanation behind the different clinical to inform the proper information to the clinicians, contem- manifestations of OLP is related to the magnitude of the plating its histology, invasiveness and clinical behavior. subepithelial inflammation. A mild degree of inflammation may provoke the epithelium to produce hyperkeratosis, SⅠ-4. Lymphoid lesions in the head and neck- MALT whereas more intense inflammation will lead to partial or lymphoma and related lesions- complete deterioration of the epithelium, histopathologically Izumo T perceived as atrophy, erosion or ulceration. This corroborates Department of Pathology, Saitama Cancer Center with the fact that most erythematous and ulcerative lesions In new WHO classification (2008) histopathological are surrounded by white reticular or papular structures. An examination plays only a part in determining the final inflammatory gradient may be formed where the central part diagnosis. In this symposium I comment on a diagnostic comprise an intense inflammatory process while the procedure about lymphoid lesions at present, mainly MALT periphery is less affected and the epithelial cells are able to lymphoma (MZBL). MZBL affects almost all extranodal respond with hyperkeratosis. sites, common site in head and neck are salivary glands, To differentiate between the four types of lichenoid thyroid gland, ocular adnexa, oral mucosa and tonsil. It was reactions, a histopathologic examination is of modest known that MZBL had a history of chronic inflammatory diagnostic value. The reason is that the four lesions display disorder, such as Sjögren’s syndrome, Mikulicz’s disease, the same histopathologic features. Undoubtedly, histopa- Hashimoto’s disease, but it was recently reported that MZBL thology is a valuable tool when lichenoid reactions are to be can also arise from IgG4-related sclerosing disease. MZBL discriminated from other mucosal lesions. The necessity of a consists of various cells, has varieties by organs and there is biopsy to arrive at an accurate diagnosis of olp has been no specific marker, so distinguishing morphologically discussed but explicit guidelines have not been universally between the early phase and chronic inflammatory lesions is approved. When the diagnosis is uncertain, biopsies should very difficult. In the future MZBL may be divided into always be taken. subtypes that can not be distinguished histopathologically. Since the etiology behind OLP is unknown, basic conditions are lacking for development of causal therapies. Symposium: Approaches to correct diagnosis of the Thus, all current treatment strategies are aiming at reducing Oral Lichen Planu - Concepts of clinical status and or eliminating symptoms. Several topical drugs have histopathology been suggested including steroids, calcineurin-inhibitors (ciclosporin and tacrolimus), retinoids, and UV-phototherapy. SⅡ-2. Clinical characteristics and treatment Among these, topical steroids are widely used and accepted strategies of oral lichenoid reactions with special as the primary treatment of choice. Some reports have reference to oral lichen planus advocated very potent steroids as clobetasol propionate in Jontell M favour of intermediate steroids as triamcinolone acetonide. Department of Oral Medicine and Pathology. Institute of However, no randomized clinical trials exist where different Odontology, Sahlgrenska Academy, University of Gothenburg, formulas, strengths and classes of topically applied steroids Sweden have been compared. Topical application of ciclosporin, Lichenoid reactions represent a family of lesions with tacrolimus and retinoids has been suggested as a second line Oral Med Pathol 14 (2009) 67 therapy for OLP. Ciclosprorin has been reported to be less expansive and infiltrative growth. Microscopically, the effective than clobetasol propionate and not significantly tumor mainly consisted of sheet-like arrangement of the better than 1% triamcinolone paste. In a comparison
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