Case 6 -

Juxtaoral Organ Of Chievitz- A Diagnostic Pitfall Dr. Michal Michal Sikl's Department of Pathology Laboratore Spec. Diagnostiky Medical Faculty Hospital Alej Svobody 80, 304 60 PILSEN, Czech Republic

Case description: The lesion was excised from an 80 year old woman in perimandibular soft tissues because of staging for the salivary gland tumor. Histologically one can see small lobules of entirely benign nests of squamous cells in association with twigs of peripheral nerves. MIB1 antibody reacted entirely negatively. Case 6 - Figure 1 Click to view with ImageScope Click to view with a Web-Based Viewer Diagnosis: Juxtaoral organ of Chievitz Comment Juxtaoral organ of Chievitz is one of the most treacherous pitfalls in the surgical pathology of the head and neck tumors. It has remained an enigmatic structure since the time the lesion was originally described by a Dutch anatomist in 1885, while studying the development of salivary glands [3]. This enigmatic structure had been given various names such as orbital inclusions [8] buccopharyngeal tract [2], buccotemporal organ [10] and juxtaoral organ [4, 7]. Theories relating to its embryonic origin are as diverse as the suggested names fior this structure [6]. Juxtaoral organ of Chievitz may be quite a frequent finding in humans when meticulous exploration of the area at the angle of the mandible near the insertion of the pterigomandibular raphe is made [5]. Tschen and Fechner found the juxtaoral organ of Chievitz in 14 out of 25 consecutive autopsies in adults who did not have carcinoma or other lesion of the oral mucosa [9]. The squamous cell nests of the juxtaoral organ of Chievitz can form luminization of the epithelial nests [9]. The main surgical pathological significance lies in the fact that the squamous epithelial nests in the juxtaoral organ of Chievitz lie in the vicinity of a peripheral nerve and that pathologist unwary of these structures might mistakenly call them a squamous cell carcinoma with perineurial spread. This mistake is particularly threatening in the patients operated for the primary squamous cell carcinoma of the oral cavity. The lack of mitoses and especially the knowledge to existence of juxtaoral organ of Chievitz is the best way to avoid such mistake. References Allen RC, Zoghbi HY, Moseley AB, Rosenblatt HM, Belmont JW. Methylation of HpaII and HhaI sites near the polymorphic CAG repeat in the human androgen-receptor gene correlates with X chromosome inactivation. Am J Hum Genet 1992;5:1229-1239 Brachet A. Sur le tractus bucco-pharingien; organe de Chievitz "Orbotal inclusion". C R Hebd Soc Biol 1919;71:923-925 Chievitz JH. Beiträzur Entwicklungsgeschichte der Speicheldrusen. Arch. Anat. Physiol 1885;9:401-436. Leibl W, Pfluger H, Kerjaschki D. A case of nodular hyperplasia of the juxtaoral organ in man. Virchovs Arch A Pathol Anat Histol 1976;371:389-391. Lutman GB. Epithelial nests in the intraoral sensory nerve endings simulating perineural invasion in patients with oral carcinoma. Am J Clin Pathol 1974;61:275-284 Merida-Velasco JR, Rodriguez-Vazquez JF, de la Cuadra-Blanco C, Salmeron JI, Sanchez-Montesino I, Merida-Velasco JA. Morphogenezis of the juxtaoral organ in humans. J Anat 2005;206:155-163 Salzer GM, Stockinger L, Zenker W. Das Juxtaorale Organ. Verh Anat Ges 1965;115:479 Schulte HW. The development of the salivary glands in man. Contribution to the anatomy and development of the salivary glands in the mammalian. Studies Cancer Allied Subjects 1913;4:15-472. Tschen JA, Fechner RE. The juxtaoral organ of Chievitz. Am J Surg Pathol 1979;3:147-150 Zenker W, Hanzl L. Beitrag zur Entwicklung des Chievitzchen Organ beim Menschen. Z Anat Entw Gesch 1953;117:215-236