Pijnlijke submandibulaire zwelling blijkt zeldzame odontogene tumor

Een 15-jarig meisje werd door haar huisarts verwezen naar een mondziekten-, kaak- en aangezichtschirurg vanwege een sinds 4 tot 5 maanden bestaande, pijnlijke submandibulaire zwelling. Na chirurgische behandeling en histopathologisch onderzoek bleek het om een relatief zeldzame adenomatoïde odontogene tumor te gaan. Van alle odontogene tumoren is 4% een adenomatoïde odontogene tumor. Deze tumor presenteert zich voornamelijk tussen het tiende en dertigste levensjaar. De tumor is door middel van chirurgische verwijdering goed te behandelen en heeft een gunstige prognose. De laatste beschrijving van een patiënt met adenomatoïde odontogene tumor in de Nederlandse literatuur dateert van 1975

Steelman

To determine the diagnostic test characteristics and inter-observer variation of pathology features for identifying high microsatellite instability (MSI-H) colorectal cancer (CRC). Six pathologists blindly evaluated 177 CRC for the presence of MSI-H associated pathology features. Inter-observer agreement was determined by using Kappa-statistics. In the first random 88/177 cases, mucinous carcinoma, tumor-infiltrating lymphocytes (TIL) and Crohns-like infiltrate (CLI) were the best discriminators between MSI-H and microsatellite stable CRC [OR 5.6 (95 % CI 1.7-19), 5.4 (1.8-17) and 3.5 (1.1-11), respectively], with high specificity (89-91 %). The sensitivities for MSI-H, however, were low (31-41 %). In addition, inter-observer agreement was moderate for TIL and CLI (kappa 0.38 and 0.48, respectively), but very good for mucinous carcinoma (kappa 0.86). Interpretation of overall histopathology as suggestive for MSI-H performed better than any individual feature; OR 15 (5.2-44), and area under the curve 0.79. However, inter-observer agreement was moderate (kappa 0.53). In the second set, TIL and CLI were scored according to updated scoring systems. Although both remained the best individual discriminators, test characteristics and inter-observer agreement did not improve. MSI-H pathology features have moderate accuracy for identifying MSI-H CRC, and are identified with moderate inter-observer agreement. These findings highlight the limitations of clinical strategies, such as the revised Bethesda guidelines, which incorporate the MSI-H associated pathology features in their strategy to identify persons with lynch syndrome