Now of course, nowhere does the report say it’s not cancer.
Let me see what sense I can make of it.
The radiologists and the pathologists were concerned about the way the tumour had grown.
For the radiologist, it was the tumour’s proliferative activity, the buccal and lingual expansion and the perforation of the lingual cortex and the focal buccal perforation. That, I think, just means the way the cheek and tongue had expanded and the way the tumour had penetrated their outer layers.
The pathologists were concerned about the way the tumour’s cells looked: somewhat basaloid appearance, apoptotic cells and scattered mitoses. From what I took in speaking to Dr P this morning, this means the way the tumour had infiltrated surrounding tissue.
The two properties that separate cancer from your garden variety benign tumour are metastasis and invasiveness. Metastasis is the ability of the tumour to spread from one organ to another and to start the growth of a secondary tumour. This is the aspect of cancer that really scared me. Invasiveness is the ability to infiltrate and destroy surrounding tissue. Benign tumours are more visually defined than malignant tumours.
We already knew my tumour is aggressive and destructive. It has eaten away at my jaw bone (mandible) until paper thin in sections and it has eaten into the surrounding tissue.
It seems the degree of invasiveness was an ‘unusual finding in a straightforward benign ameloblastoma’. But it lacks ‘frank malignant features’.
So yes, they will have to remove a great deal of my jaw. Yes, they will have to take a large margin around it to be sure they get all the cells from the tumour that have invaded the surrounding tissue. But this aggressive resection will mean it is really unlikely that the tumour will grow back in my jaw. Possible, but very unlikely. And because it is not malignant, a related tumour is not going to pop up elsewhere unannounced.
Back to The Plan – Part 2. Never did I think I would be so thankful.
If you haven’t had your fill of big medical words, feel free to read on…
1. ‘Left lateral mandible’. The specimen consists of portion of grey soft tissue 11mm in maximum dimension.
2. ‘Periosteum left mandible’. The specimen consists of a portion of cream soft tissue 14mm in maximum dimension.
3. ‘Deep mandible’. The specimen consists of a portion of firm cream soft tissue 10mm in maximum dimension.
I’ll spare you this bit.
The histologic appearances in all of the three biopsies predominantly reflect organising fibrosis and granulation tissue with occasional strips of reactive bone all of which could reflect a reaction to prior biopsy. In specimens 1 and 2, rare islands of odontogenic epithelial cells persist and although a suggestion of basal palisading certainly prompts consideration of a residuum of an ameloblastomatous process.
I have taken this case in conjunction with the imaging to the Royal Prince Alfred bone and soft tissue tumour meeting which is attended by Professor H who reported the original biopsy. He has sent the initial material to Dr C in the USA in consultation as he had some concerns regarding its proliferative activity.
Professor H kindly brought recuts of the histology to the meeting, The images were reviewed in which the presence of a destructive radiolucent lesion of the left posterior mandible with perforation of the lingual cortex and focal buccal perforation. The lesion had focally multiloculated appearance and it extended into the ramus of the mandible. On MRI it had a heterogenous appearance with soft tissue extension on the buccal and lingual aspect. Overall the radiology had a somewhat aggressive appearance which could fit for a large ameloblastoma.
I have reviewed the sections originally reported by him in which the presence of an ameloblastoma with a partly cystic and partly solid infiltrative appearance is confirmed. As noted by Dr H, much of the ameloblastomatous component has a somewhat basaloid appearance, apoptotic cells are seen and scattered mitoses are noted, an unusual finding in a straightforward benign ameloblastoma. While these findings are of some concern, frank malignant features are not seen.
Professor H did inform me that he had done progesterone receptor on the tissue and found it to be strongly positive, raising the possibility of some degree of hormonal effect on this tumour. Within the current material as receive by me. scattered islands of residual epithelium consistent with residual ameloblastoma are noted in speciment 1 and 2. Residual tumour is not seen in specimen 3.