Elite Lab - Dr. Osama Elkashty Oral & Maxillofacial Pathology lab

30/08/2024

السلام عليكم و رحمه الله
اعتذر عن استقبال حالات تحليل الانسجة لظرف السفر لخارج البلاد

Send a message to learn more

02/07/2024

My recent international publication in " BMC Oral Health" Q1 journal in Scopus and WOS with my dear respectable colleague Prof. Hala H Hazzaa
Hope you enjoy it

Objective Oral lichen planus carries a risk for malignancy. The pathogenesis of the disease is mediated by various inflammatory mediators. Several mediators could be responsible for the oncogenic behavior in certain cases. Hypoxia-inducible factor-1a (HIF-1), and its possible correlation to Galactin...

27/04/2024

An interesting case of 𝐏𝐚𝐥𝐚𝐭𝐚𝐥 𝐌𝐞𝐭𝐚𝐬𝐭𝐚𝐭𝐢𝐜 𝐑𝐞𝐧𝐚𝐥 𝐂𝐞𝐥𝐥 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚.

A 42 male patient complains of a large, rapidly growing mass at the left side of the hard palate. Medical history is insignificant except for renal dialysis for over 10 years.

Clinical examination revealed a firm mass with normal color mucosa and the related teeth were vital. The CBCT showed a large soft tissue mass with minimal bone invasion.

Complete surgical excision was done by the talented Dr. Ahmed Talat and sent to our lab for histopathological examination. The H&E examination revealed a glandular structure with papillary and oncocytic features and a moderate degree of atypia. The margin of the specimen was focally infiltrated by the tumor tissue. The specimen was diagnosed as 𝐌𝐨𝐝𝐞𝐫𝐚𝐭𝐞 𝐃𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐢𝐚𝐭𝐞𝐝 𝐀𝐝𝐞𝐧𝐨𝐜𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚 and an immunohistochemical panel was suggested to specify the tumor.

IHC panel revealed the tumor to be PAX8 diffuse positive (Ovarian and Renal cancers), CD10 diffuse positive (Lymphoma), and CK7 focal positive. The tumor was negative for Hep par (hepatic cancer), TTF1(lung and thyroid cancer), and CK20 (intestinal carcinoma).

The tumor was diagnosed as 𝐑𝐞𝐧𝐚𝐥 𝐂𝐞𝐥𝐥 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚 𝐦𝐨𝐬𝐭𝐥𝐲 𝐂𝐡𝐫𝐨𝐦𝐨𝐩𝐡𝐨𝐛𝐞 𝐫𝐞𝐧𝐚𝐥 𝐜𝐞𝐥𝐥 𝐜𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚. The patient was referred to the oncology center for abdominal CT and a second surgical intervention with frozen sectioning to remove the rest of the metastatic lesion.

Surgical work by Dr. Ahmed Talaat.

23/04/2024

A case of P𝐨𝐨𝐫𝐥𝐲/𝐌𝐨𝐝𝐞𝐫𝐚𝐭𝐞 𝐃𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐢𝐚𝐭𝐞𝐝 𝐒𝐪𝐮𝐚𝐦𝐨𝐮𝐬 𝐂𝐞𝐥𝐥 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚 arose in a 64-year-old female patient.
The patient presented with an exophytic mass at the buccal gingiva related to the lower right molars. The swelling shows speckled leuko and erythroplakia with a papillary surface. The lower wisdom had grade 3 mobility and needed extraction during the biopsy. An incisional biopsy was taken and examined histologically.

Histological examination revealed dysplastic malignant epithelial cells arranged in sheets and cell nests. Check the obvious nuclear and cellular pleomorphism, increase normal and abnormal mitosis, and prominent nucleoli.

The healing of the extraction site was filled with the lesions as observed in the next visit (the visit when we informed the patient of the condition and received the pathology report)

The case was diagnosed as Poorly/Moderate-differentiated Squamous Cell Carcinoma and referred to the oncology center for further treatment.

Clinical photos and surgical procedure curtsy to Dr. Ayman Elkashty

05/03/2024

An interesting case of mild inflamed 𝐆𝐥𝐚𝐧𝐝𝐮𝐥𝐚𝐫 𝐎𝐝𝐨𝐧𝐭𝐨𝐠𝐞𝐧𝐢𝐜 𝐂𝐲𝐬𝐭 𝐰𝐢𝐭𝐡 𝐜𝐡𝐨𝐥𝐞𝐬𝐭𝐞𝐫𝐨𝐥 𝐜𝐥𝐞𝐟𝐭𝐬.
The patient is a 40 Y Female who complained of pain and discomfort in the mandibular right side after endodontic treatment for 6 months. The CBCT showed a multilocular radiolucent lesion with buccal and lingual perforation.
An incisional biopsy was done as the lesion was large and near the inferior border of the mandible. Histopathological examination revealed multiple cystic spaces lined by glandular epithelium with multiple 𝐜𝐫𝐢𝐭𝐞𝐫𝐢𝐚 𝐟𝐫𝐨𝐦 𝐭𝐡𝐞 𝐠𝐥𝐚𝐧𝐝𝐮𝐥𝐚𝐫 𝐨𝐝𝐨𝐧𝐭𝐨𝐠𝐞𝐧𝐢𝐜 𝐜𝐲𝐬𝐭 𝟏𝟏 𝐜𝐫𝐢𝐭𝐞𝐫𝐢𝐚.
1) Intraepithelial microcysts, crypts, or duct-like spaces
2) Epithelial spheres or plaque-like thickenings
3) Multiple cyst compartments
4) Variable thickness of the cyst lining
5) Papillary projections or "tufting" of the epithelium into the cyst lumen
6) Clear or vacuolated cells
7) Surface eosinophilic cuboidal cells (hobnail cells)
8 ) Apocrine snouting of hobnail cells
9) Mucous goblet cells
10) Ciliated cells
11) Solid islands of odontogenic epithelium in the connective tissue wall that may show cyst formation too

Cholesterol clefts were found too (red arrow) which is a very rare instance.

GOC treatment ranges of enucleation, curettage, +/- peripheral ostectomy, marsupialization segmental mandibulectomy, marginal mandibulectomy
More aggressive initial surgery may reduce the rate of recurrence, although no definitive studies
Treatment is influenced by the size of the lesion, involvement of teeth, bone compromise present, cortical bone perforation, history of recurrence, proximity to vital anatomic structures, patient desires, and other patient-related variables

10/02/2024

09/02/2024

A case of 𝐖𝐞𝐥𝐥/𝐌𝐨𝐝𝐞𝐫𝐚𝐭𝐞 𝐃𝐢𝐟𝐟𝐞𝐫𝐞𝐧𝐭𝐢𝐚𝐭𝐞𝐝 𝐒𝐪𝐮𝐚𝐦𝐨𝐮𝐬 𝐂𝐞𝐥𝐥 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚 arose in a 60-year-old male patient.
The patient had presented with a non-healing cheek ulcer and swelling for 3 weeks. The swelling shows speckled leuko and erythroplakia. An incisional biopsy was taken and examined histologically.
Histological examination revealed dysplastic malignant epithelial cell nests and epithelial pearls. Check the obvious nuclear and cellular pleomorphism, increase normal and abnormal mitosis, and prominent nucleoli.
The case was diagnosed as Well/Moderate-differentiated Squamous Cell Carcinoma and referred to the oncology center for further treatment.

Clinical work and photos curtsy to Dr. Rabab Hamed
https://www.facebook.com/dr.rababhamed

25/01/2024

Another case of 𝐂𝐋𝐄𝐀𝐑 𝐂𝐄𝐋𝐋 𝐌𝐔𝐂𝐎𝐄𝐏𝐈𝐃𝐄𝐑𝐌𝐎𝐈𝐃 𝐂𝐀𝐑𝐂𝐈𝐍𝐎𝐌𝐀
(MEC) arose in a 32 year old female patient.
The patient had presented with a palatal swelling that was present for several months with recent pain. Bone erosion with nasal floor perforation was detected by CBCT.

Histological examination revealed nests of mucous and epidermoid cells with few intermediate cells. Most of the mucous cells showed clear cell differentiation.

The case was diagnosed as Clear Cell Mucoepidermoid Carcinoma.

Treatment for MEC is complete surgical resection with a conservative approach for stage I and stage II tumors or wide excision with a wide margin for high-grade tumors or tumors with positive margins. Neck lymph node dissection (depends on nodal status and histologic grade). Adjuvant radiotherapy and chemotherapy might be considered for higher-grade tumors.

11/01/2024

Today's case is a palatal 𝐌𝐮𝐜𝐨𝐞𝐩𝐢𝐝𝐞𝐫𝐦𝐨𝐢𝐝 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚 in the minor salivary glands.
The patient (41-year-old female) is diabetic and has no other significant medical history. She complained of palatal swelling for 8 months. The mucosa was lifted and the lesion was biopsied immediately. As shown in the histopathologic pictures there were nests of malignant epidermoid cells mixed with a few mucous-secreting cells. The case was diagnosed as moderate/poorly-differentiated mucoepidermoid carcinoma and the lesion will be removed surgically in the oncology center.

21/12/2023

𝐓𝐡𝐞 𝐟𝐢𝐫𝐬𝐭 𝐜𝐚𝐬𝐞 𝐢𝐬 𝐚 𝐭𝐢𝐩 𝐨𝐟 𝐭𝐡𝐞 𝐭𝐨𝐧𝐠𝐮𝐞 𝐒𝐪𝐮𝐚𝐦𝐨𝐮𝐬 𝐂𝐞𝐥𝐥 𝐂𝐚𝐫𝐜𝐢𝐧𝐨𝐦𝐚.
The patient (51 Y male) is a smoker and diabetic. He complained of a non-healing, etching red patch for 8 months. The patch was biopsied immediately and as shown in the histopathologic pictures there were nests of dysplastic epithelium invading the submucosa with moderate keratin formation. The case was diagnosed as moderate/well-differentiated squamous cell carcinoma and the lesion was removed surgically along with selective neck lymphnodes dissection.

𝐓𝐡𝐞 𝐬𝐞𝐜𝐨𝐧𝐝 𝐜𝐚𝐬𝐞 𝐢𝐬 𝗴𝗶𝗻𝗴𝗶𝘃𝗮𝗹 𝗵𝗲𝗺𝗮𝗻𝗴𝗶𝗹𝗶𝗽𝗼𝗺𝗮.
The patient (24 Y male) has no significant medical history. The chief complaint was a soft swelling at the lower right area adjacent to the second molar. The lesion was completely excised and examined microscopically. As shown in the histopathologic photos the lesion was formed of lobules of well-formed, fat cells with a signet ring appearance (black arrow) alternating with large, congested blood vessels (red arrow). No signs of dysplasia or malignancy can be detected. The case was diagnosed as Hemangiolipoma. Follow-up is all we needed in this case.

14/11/2023

A case of 𝑨𝒅𝒆𝒏𝒐𝒊𝒅 𝑪𝒚𝒔𝒕𝒊𝒄 𝑪𝒂𝒓𝒄𝒊𝒏𝒐𝒎𝒂 in the palate.

The histopathological photos show clearly the infiltrative nature of the malignant tumor.
𝐏𝐞𝐫𝐢𝐧𝐞𝐮𝐫𝐚𝐥 𝐢𝐧𝐯𝐚𝐬𝐢𝐨𝐧
𝐏𝐞𝐫𝐢𝐯𝐚𝐬𝐜𝐮𝐥𝐚𝐫 𝐢𝐧𝐯𝐚𝐬𝐢𝐨𝐧
𝐈𝐧𝐭𝐫𝐚𝐦𝐮𝐬𝐜𝐮𝐥𝐚𝐫 𝐢𝐧𝐯𝐚𝐬𝐢𝐨𝐧

03/11/2023

Today's case is a typical presentation of 𝐋𝐢𝐜𝐡𝐞𝐧 𝐏𝐥𝐚𝐧𝐮𝐬

The patient (male 42Y) came to our center complaining of a burning sensation and multiple ulcerations in the bilateral checks.

The clinical examination revealed atrophic red patches (red arrow), radiating white stria (black arrow) (Wickham's striae), and minor ulceration.

A biopsy was taken and the histopathological examination revealed parakeratinized stratified squamous epithelium with variable thickness, alternating thickening and loss of basement membrane (blue arrow), and Civatte bodies (red arrow). The underlying connective tissue is fibrous with a dense subepithelial lymphocytic band (black arrow).

Lichen Planus is an ongoing (chronic) inflammatory condition that affects mucous membranes inside your mouth. Oral lichen planus may appear as white, lacy patches; red, swollen tissues; or open sores. These lesions may cause burning, pain, or other discomfort.

Treatment is topical corticosteroids in remission times accompanied by systemic corticosteroids in exacerbation times.