ANN ARBOR STAGING

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Stage I: Involvement of single lymph node/extra lymphatic site

Stage II: Involvement of 2 or more lymph node regions or an extra-lymphatic site & lymph node region on the same side of diaphragm.

Stage III: Involvement of lymph node region on both the sides or without extra-lymphatic involvement/involvement of spleen or both.

Stage IV: Diffuse involvement of one or more extra-lymphatic tissues e.g. liver or bone marrow.

References: Textbook of Pathology, Harsh Mohan

Dr. Mehnaz Memon🖊

BURKITT’S LYMPHOMA

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🌏 African Jaw Lymphoma

🌏 The endemic form is linked to malaria and to the Epstein-Barr virus (EBV), a common virus that also causes glandular fever.

🌏 A tumour peculiar to children of central Africa was reported by Denis Burkitt in 1950. It is a lymphoreticular cell malignancy.

▪️It is a high grade B-cell neoplasm & has 2 major forms:

🔷 Clinical Features:

1. Age – between 6 & 9 years

2. Sex – M:F – 2:1

3. Site: In African form (Endemic),

  • Maxilla > Mandible
  • Spreads to floor of orbit
  • Molar area
  • More than one quadrant is involved

American form (Non-endemic) – Oral: only 1 quadrant involved. Other: Mainly involves Abdomen.

4. Onset & progress – fast growth with tumor doubling time of <24 hours.

5. Symptoms –

  • Swelling of jaws, abdomen & paraplegia
  • Loosening of teeth
  • Abdominal tumors
  • Bowel obstruction

6. Sign – Lymphadenopathy (Non-tender)

🔷 Oral Manifestations:

  • Gingiva and mucosa – swollen, ulcerated, necrotic
  • Facial asymmetry
  • Teeth are pushed out of their sockets

🔷 Radiographic Features:

Moth-eaten appearance with loss of lamina dura around the teeth.

🔷 Histological Features:

1. Monoclonal proliferation of B-lymphocytes characterized by small non-cleaved cells.

2. Burkitt cells are homogenous in size & shape with –

  • round to oval nuclei
  • coarse chromatin
  • Multiple nucleoli
  • Basophilic vacuolated cytoplasm with neutral fat
3. Starry sky appearance – scattered macrophages with abundant clear cytoplasm, often containing phagocytic cellular debris👇🏻

🔷 Differential Diagnosis:

  • Non-hodgkins lymphoma
  • Cherubism
  • Osteosarcoma

🔷 Treatment: Intrathecal Chemotherapy

References: Shafer’sTextbook Of Oral Pathology

Dr. Mehnaz Memon🖊

Ann Arbor Staging System for Lymphoma: https://dentowesome.wordpress.com/2020/06/15/ann-arbor-staging/

GHOST CELLS (SHADOW CELLS)

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🔷 Introduction:

Ghost cells are altered epithelial cells characterized by the loss of Nuclei with presence of basic cell outline.

➡️ Lesions showing Ghost cells:-
  1. COC & dentinogenic ghost cell tumour
  2. Odontomas
  3. Ameloblastomas (Pituitary)
  4. Ameloblastic fibro-odontoma
  5. Ameloblastic Odontoma
▪️Characteristic Features:
  • Ghost cell change occurs due to coagulative Necrosis or a form of Normal/aberrant keratinization of odontogenic epithelium.
  • Masses of ghost cells may fuse to form large sheets of amorphous, acellular material.
  • Calcifications with them is common.
  • Appear as basophilic granules- ⬆️ in size & no. – form extensive masses of calcified material.
  • Areas of eosinophilic matrix material represent dysplastic dentin(dentinoid) present adjacent to epithelial component.
  • Ghost cell contain –
  1. Nuclear Remnants
  2. Remnants of cytoplasmic organelles
  3. Numerous tonofilaments
  • Ghost cell differ from normal keratotic squames – they are larger, vacuolated & remnants of nuclear membrane are more prominent.
  • This may be due to intracellular edema & presence of dilated degenerated membranous organelles.
  • Ghost cells are immuno-reactive for Amelogenin (enamel protein).

References: Shafer’sTextbook Of Oral Pathology

Dr. Mehnaz Memon🖊