Epithelial-mesenchymal transition in osteogenic sarcoma of the neck following oral squamous cell carcinoma

Hyun Sil Kim; Nam Hee Kim; eon Hui Han; In Ho Cha; Dong Jun Seo; Wonse Park; Jong In Yook; Hyung Jun Kim

doi:10.5125/jkaoms.2010.36.3.172

Journal List > J Korean Assoc Oral Maxillofac Surg > v.36(3) > 1032383

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Kim, Kim, Han, Cha, Seo, Park, Yook, and Kim: Epithelial-mesenchymal transition in osteogenic sarcoma of the neck following oral squamous cell carcinoma

Original Article

J Korean Assoc Oral Maxillofac Surg 2010;36(3):172-176.

Published online: 10 January 2010

DOI: https://doi.org/10.5125/jkaoms.2010.36.3.172

Epithelial-mesenchymal transition in osteogenic sarcoma of the neck following oral squamous cell carcinoma

Hyun Sil Kim¹, Nam Hee Kim¹, eon Hui Han¹, In Ho Cha², Dong Jun Seo², Wonse Park³, Jong In Yook¹, Hyung Jun Kim²

¹Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University, Seoul, Korea

²Department of Oral and Maxillofacial Surgery, Yonsei University, Seoul, Korea

³Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea

Hyung Jun Kim Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea TEL: +82-2-2228-3132 FAX: +82-2-364-0992 E-mail: kimoms@yuhs.ac

Received 18 March 2010 Revised 25 April 2010 Accepted 20 May 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Postirradiation extraosseous osteogenic sarcomas are uncommon in the head and neck, despite the extensive use of high-dose radiation. It has been described as de novo radiation-induced neoplasm. We present a 73-year-old male who had been treated by radiotherapy for gingival cancer 7 years earlier and later developed extraosseous osteogenic sarcomas (EOSs) of the neck. Microscopically, the neck mass was composed with mesenchymal malignant cells with cartilaginous and osteogenic differentiation. Immunohistochemical stain demonstrated strong positivity of tumor cells for Snail, the one of major epithelial-mesenchymal transition (EMT) inducer. The E-cadherin expression was scarce, showing inverse relationship to Snail expression. Compared with previous squamous cell carcinoma (SCC) of the gingiva, the present EOS sample revealed the remained epithelial cells on cytokeratin immunohistochemistry, suggesting the tumor arise from the cells of epithelial origin. We have also reviewed the previous 6 cases of head and neck EOSs carefully. The clinicopathologic features of the unusual lesion suggest that it is an incomplete EMT of precedent epithelial malignancy rather than de novo pathology.

Keywords: Squamous cell carcinoma (SCC), Extraosseous osteogenic sarcoma (EOS), Epithelial-mesenchymal transition (EMT), Snail, E-cadherin, Mouth neoplasms

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Fig. 1.

A. Microscopically, primary gingiva lesion showed cords and nests of epithelial cells exhibiting aberrant accumulation of keratin.(arrow) B. Second primary tumor of buccal mucosa showed severe cellular abnormalities of hyperchromatism and pleomorphism. Scant production of keratin is notified. C-D. Microscopic feature revealed that lesion of the neck was composed of sarcomatous spindle cells with hypercellular cartilage and irregular osteoid.(D, aster-isk)(H&E staining, original magnification A, B, and D: x200, C: x100) (SCC: squamous cell carcinoma, EOS: extraosseous osteogenic sarcoma)

Fig. 2.

Axial CT scan reveals a neck mass (asterisk) of approximately 3.0×3.0 cm in left level III. (CT: computed tomography)

Fig. 3.

A. Immunohistochemical stain for previous SCC showed intense cytoplasmic staining for cytokeratin AE1/3, whole epithelial cell marker. B. Snail was detected in the nucleus of peripheral carcinoma cells. C. The cytoplasmic membranous expression of E-cadherin was occasional. D. The expression of N-cadherin could not be identified. E. The present EOS revealed the minimum positivity for cytokeratin Immunohistochemical staining. F. Sarcoma cells surrounding and whinin abnormal cartilage (asterisk) showed definitely strong Snail expression. G. E-cadherin disappeared through whole tumor samples. H. The scarce cytoplasmic membranous expression of N-cadherin was detected among the mesenchymal tumor cells. (Immunohistochemical stain, A and E: cytokeratin AE1/3, B and F: Snail, C and G: E-cadherin, D and H: N-cadherin, original magnification x200) (SCC: squamous cell carcinoma, EOS: extraosseous osteogenic sarcoma)

Table 1.

Clinicopathologic data of EOS in the head and neck

Case	Author, year	Gender, age	Location	History of RTx	Treatment	Recur/Mets	Status	Follow-up
1	Parsons, 1944	M, 53	Lip	No	Excision	Local recur, Mandible mets¹	Die 24 hrs after operation	No
2	Juassawalla, 1964	M, 48	Submental	No	Excision	Probable cerebral mets	Dead	9 mos
3	Shanoff, 1967	M, 48	Chin	Yes	Excision	Skull mets	Dead	2 1/2 yr
4	Das Gupta, 1968	M, 41	Rt. Zygoma	No	Excision	No	Alive	12 1/2 y
5	Sordillo, ?²	No info	Face	No	−²	−²	−²	−²
6	Manning, 1986	M, 73	Rt. Parotid gland	No	Parotidectomy	Unknown	Alive	−²
7	Present case	M, 66	Neck	Yes	Excision	No	Alive	5 mos

¹ The first lip lesion was SCC, but the recurred tongue was osteogenic sarcoma.(more than 3 years) The metastatic mandibular lesion (within months) was diagnosed radiologically, and necropsy was not permitted.

² There is no related information. (SCC: Squamous cell carcinoma, EOS: extraosseous osteogenic sarcoma)

Table 2.

EOS associated with radiotherapy in the head and neck

Case	Site and reason for RTx	Previous treatment	Amount of radiation	Interval to development of EOS	Site of EOS Remarks
3	Head and neck, chest and arm for multiple skin cancer (SCC) and precancer	Excision, electrodesiccation, and irradiation	unkown	14 yrs	Chin History of benign lesion¹
7	Gingiva and neck for SCC of gingiva	Segmental mandibulectomy and cervical neck node dissection	9,900 cGy	7 yrs and 9 mos	Neck Present case

¹ The previous three biopsies showed myositis ossificans. (SCC: Squamous cell carcinoma, EOS: extraosseous osteogenic sarcoma)

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