Oral pathology in East Timor, the world's newest nation
Purpose: East Timor presents an interesting spectrum of surgical pathology, including oral. In spite of being located in a betel-nut chewing cultural area, the oral tumours received from Dili National Hospital so far have not been betel nut associated. We describe two oral tumours, the first reported from this country.
Methods: Surgical operations in East Timor are performed by local general surgeons and visiting subspecialist teams from the Royal College of Surgeons of Australasia. Histology is performed by volunteer pathologists around Australia. The present cases are:
1. A 35-year old Timorese male presented with a lesion of the left mandible thought clinically to be an ameloblastoma. The gross specimen consisted of grey/brown tissue 45x22x8 mm with a firm, grey cut surface.
2. A 16-year old Timorese girl presented with a tumour of the right mandible. The specimen consisted of 3 pieces of pale tan soft tissue measuring 5 to 10 mm each.
Results:
1. Microscopy showed a biphasic tumour comprising cords and ducts of flattened and cuboidal epithelium dispersed in a loose fibromyxoid stroma without atypia. The diagnosis was odontogenic fibroma.
2. Microscopy showed fibrous tissue lined by squamous epithelium featuring a plexiform pattern and peripheral palisading of basal cell nuclei. The features were those of a unicystic ameloblastoma, plexiform type.
Conclusion: Both these benign lesions have a low recurrence rate. Neither has a known environmental aetiology, and are not associated with alcohol, tobacco or betel nut. A possible reason we have not seen oral squamous cell carcinoma in an otherwise endemic part of the world (Southeast Asia and Melanesia), is the pre-selected nature of the material sent from East Timor for histology. Only tissue of unusual interest is sent, and the majority of surgical specimens where the diagnosis is known grossly is discarded. Much work remains to be done on the epidemiology of oral neoplasia in East Timor.