Giant Parotid Pleomorphic Adenoma with Atypical Histological Presentation and Long-Term Recurrence-Free Follow-Up after Surgery: A Case Report and Review of the Literature.

Salivary gland tumors (SGT) comprise 3% of all head and neck tumors, are mostly benign, and arise frequently in the parotid gland. Pleomorphic adenoma (PA) is the commonest SGT, representing 60-70% of all benign parotid tumors. Clinically, parotid PA presents as irregular, lobulated, asymptomatic, slow-growing preauricular mass, involving both superficial and deep lobes, and could grow to gigantic proportions. Histologically, PA has epithelial and mesenchymal elements in chondromyxoid matrix and is managed surgically. Based on a review of 43 cases reported in English literature since 1995, giant parotid PA is reported as large as 35 cm (diameter) and 7.3 kg (resected weight). Although rare, 10 cases of malignant transformation were reported in the review. Surgical management included extracapsular dissection (ECD), superficial parotidectomy, and total parotidectomy for benign tumors, and adjuvant radiation or chemotherapy for malignant tumors. We further present the case of a 36-year-old healthy male with slow-growing and asymptomatic giant parotid PA, of 4-year duration. The patient presented with firm, lobulated preauricular swelling, provisionally diagnosed as PA based on radiographic and cytological findings. The tumor was resected through ECD, and the patient had uneventful postoperative recovery and a 7-year recurrence-free follow-up period. Histological examination revealed epimyoepithelial proliferation punctuated by chondromyxoid areas, with extensive squamous metaplasia and keratin cysts. To the best of knowledge from indexed literature, giant parotid PA is rarely reported in Saudi Arabia. In addition to its rarity, this case is reported for its benign nature despite atypical histological presentation, successful surgical management without complications, and long-term recurrence-free follow-up. Based on this report, clinicians must be aware of atypical histological presentations associated with PA and plan suitable surgical management and follow-up to avoid morbidity. Nevertheless, attempts must be made to diagnose and manage these lesions at an early stage and before they reach gigantic proportions.

Evaluation of concordance between clinical and histopathological diagnoses in periapical lesions of endodontic origin.

Background/purpose: Periapical lesions of endodontic origin are often diagnosed based on the clinical and radiological presentations that may be different from the histological diagnoses. The purpose of this study was to assess the concordance between the clinical diagnosis of these lesions and the histopathological diagnoses and to analyze their clinical and pathological features. MATERIALS AND METHODS: Biopsies of periapical lesions of endodontic origin diagnosed in the histopathology laboratory between 2006 and 2017 were retrieved from the database and used to conduct this retrospective review. Clinical data were obtained, and tissue samples were re-evaluated. The overall agreement between the clinical and histological diagnoses was tested utilizing the Cohen kappa (k). RESULTS: A total of 317 periapical biopsy specimens were included in this study which consisted of 137 periapical granulomas, 174 periapical cysts, and six periapical scars. Generally there was weak overall agreement between the clinical and histological diagnoses of periapical granuloma and periapical cysts (Cohen kappa, k = 0.059). CONCLUSION: The findings of this study indicate that clinical/radiographic examinations are not able to preoperatively determine whether a periapical lesion is a cyst or a granuloma and highlights the importance of developing a reliable nonsurgical diagnostic method to differentiate periapical lesions.

Diagnostic challenges of an unusually large schwannoma of the mandible: Report of a case.

Schwannomas are slow-growing, benign neoplasms arising from the Schwann cells and are commonly reported as peripheral tumors in the head and neck region. Central intramandibular schwannomas are extremely rare lesions. We report a case of intramandibular schwannoma in a 70 year old male patient. Panoramic radiography revealed a large, multilocular radiolucent lesion with distinct borders involving the right mandibular body and ramus. A complete excision was achieved by removing the tumor followed by reconstruction of the mandible. The clinical, radiological, and histopathological features are discussed within the context of this case.

Oral Kaposi Sarcoma in HIV-seronegative Saudi patient: Literature review and case report.

Kaposi Sarcoma (KS) is an intermediate neoplasm affecting the endothelial cells of mucous membranes and skin. It arises most commonly among HIV-infected individuals. We present an intra-oral KS in an 80-year-old Saudi male patient, who is HIV-seronegative, non-immunosuppressed, and with no history of organ transplantation. The patient was treated with fractionated radiation therapy, and had no recurrence in the 48 months of follow-up. The clinical disease, histologic features, and treatment modality used, as well as the relative literature are presented in this paper.

Odontogenic tumors: analysis of 188 cases from Saudi Arabia.

BACKGROUND AND OBJECTIVES: Odontogenic tumors (OTs) represent an uncommon group of lesions that arise from the tooth-forming apparatus. They pose a significant diagnostic and management challenge. There is a lack of data among the Saudi population. The aim of the study was to establish the relative frequency of the various histological types of OTs. DESIGN AND SETTINGS: A retrospective study of 188 cases of OTs using the histopathology archives of the College of Dentistry, King Saud University. METHODS: The histopathology archives of the College of Dentistry, King Saud University were reviewed from January 1984 to December 2010 for OTs. The age and gender of the patients, tumor site, and histopathologic typing were analyzed. RESULTS: A total of 188 (4.3%) patients met the criteria for being classified as an OT. Odontogenic keratocystic tumor (36.7%) was the most commonly diagnosed, followed by ameloblastoma (25.0%), odontoma (14.9%), and odontogenic myxoma (6.4%). Two cases of malignant OTs (1.1%) are found. The male-to-female ratio was 1.4:1. The most frequently affected area was the posterior mandible (48.9%), followed by the anterior maxilla (22.9%). CONCLUSION: This is a relatively large series of OTs revealing aspects of similarities and differences with those of previous studies of populations in Africa, Asia, and the Americas. The findings of the present study may be useful as a guide for clinicians who need to make clinical judgments prior to biopsy about the most probable diagnosis.

Epithelioid Osteosarcoma of the Maxilla: A Case Report and Review of the Literature.

Epithelioid osteosarcoma is an uncommon variant; only 4 cases have been reported in the jaw area, 2 of which were in the maxilla. A 22-year-old woman, in the eighth month of pregnancy, presented to the oral surgery clinic with a mass in the right maxilla that had rapidly expanded over the past 3 months. Computed tomography scans showed an ill-defined sclerotic destructive lesion that formed bone matrix in its soft tissue extension. Microscopic examination of the lesion revealed malignant epithelioid cells with osteoid deposits. The tumor cells were shown to have pale cytoplasm, vesicular nuclei, and prominent nucleoli and to undergo frequent mitosis. In addition, the tumor was positive for epithelial membrane antigen and vimentin and negative for AE1/AE3, Melan-A, CD30, synaptophysin, NSE, CD45, CD99, desmin, and myogenin. The final diagnosis was epithelioid osteosarcoma, which is a rare aggressive variant of osteosarcoma. Few cases of epithelioid osteosarcoma have been reported in the literature, and more studies are required to determine the clinical behavior of this tumor.