Metastatic sarcomas of the oral cavity: A systematic review.

Oral metastatic sarcomas (OMSs) occur only occasionally, and information about their characteristics is based on the restricted number of cases reported in the literature. This study aims to systematically review the English literature to recognize the clinicopathologic characteristics of OMSs. An electronic search was performed in PubMed Central and Scopus databases. The search included all the published articles (human case reports and case series) up till April 2023, with no time restrictions. OMSs were slightly more prevalent in males in their fifth to seventh decades of life. However, a high percentage of OMSs has been reported in the second decade of life. Lower extremities, breasts and uterus are the most common primary origin of metastatic sarcoma. Gingiva and mandible were common locations in the oral cavity for metastatic deposits. Generally, they demonstrated widespread affliction. The mean time interval between primary tumor detection and diagnosis of the oral metastasis was about 33.54 ± 36.19 months. Death was reported in 83 patients (67.48 %) with a mean survival rate of 7.98 ± 10.30 months. The most common microscopic tumor types were leiomyosarcoma (n = 21, 17 %), followed by angiosarcoma (n = 20, 16.26 %) and osteosarcoma (n = 18, 14.63 %). In conclusion, while oral metastases of sarcomas are not common, those should be considered in the differential diagnosis of the oral lesions. Although OMSs show a high occurrence in the 7th decade of the life, the average age of patients with oral involvement is lower than the overall metastatic lesions. OMSs may present as widespread disease with poor prognosis.

Histopathologic Evaluation of Periapical Radiolucencies Clinico-Radiographically Diagnosed as Endodontic Lesions: A Retrospective Analysis.

Statement of the Problem: Periapical cyst and granuloma are inflammatory endodontic lesions. Periapical granuloma usually heals spontaneously after endodontic treatment; however, periapical cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of periapical lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration. Purpose: The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of periapical cysts and granulomas in a major center of oral pathology service in Iran. Materials and Method: In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a periapical cyst/granuloma were extracted. Results:  In the present study, 474 cases were diagnosed with a periapical cyst/granuloma clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as periapical cyst/granuloma in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%). Conclusion:  A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

Oral Granular Cell Tumor: A Case Report with Emphasis on Pseudoepitheliomatous Hyperplasia in Oral Lesions.

A granular cell tumor (GCT) is an unusual benign mesenchymal neoplasm with Schwann cells origin. The most common site is the dorsum of the tongue. It has a striking tendency to occur in females and is more frequent in adult patients. GCT typically shows an asymptomatic, slow-growing, single nodule. Histopathologically, it reveals a proliferation of polygonal cells with granular cytoplasm penetrating the adjacent muscles. In some cases, the overlying epithelium demonstrates pseudoepitheliomatous hyperplasia (PEH), which can complicate its precise diagnosis and may mimic squamous cell carcinoma (SCC). This paper presents a 58-year-old woman with a chief complaint of painless mass on the dorsal of the tongue for two years. The lesion was pink and circumscribed with firm consistency measuring 1×1cm. The surface of the lesion was intact. Microscopic examination demonstrated unencapsulated sheets of large, polygonal cells with abundant eosinophilic, granular cytoplasm, and vesicular nuclei. The overlying epithelium showed florid PEH and keratin pearl formation. S100 protein was positive diffusely. The diagnosis of oral GCT was made. Though GCT is a non-aggressive lesion, it may be confused with SCC due to florid PEH and keratin pearl formation. Although PEH is a neglected topic among oral pathologists, it is of great importance in the field of research. Diagnosis can sometimes be problematic because they mimic other lesions. The pathogenesis of PEH is still uncertain. Therefore, familiarity with these characteristics and determining the cause of the PEH leads to correct treatment. This article intends to raise the insight of oral pathologists about PEH in oral lesions.

Metastatic Adenocarcinoma of Mandible with Unknown Primary Origin (CUP Syndrome): a Rare Case Report.

Metastatic lesions of the jaws are a diagnostic challenge because of their scarcity and uncharacteristic clinical-radiographic features. Carcinoma of unknown primary origin (CUP) is characterized by the existence of metastatic disease with no recognized primary neoplasm after a comprehensive work-up. CUP shows a poor prognosis with limited treatment choices. This paper presents a 64-year-old male with a chief complaint of paresthesia of the chin and lower lip. Panoramic radiography showed an ill-defined radiolucency in the left mandibular molar area and the residue of the first molar root. Microscopic examination demonstrated features of mucin-producing adenocarcinoma and was not similar to common neoplasms of the jaw. The whole-body scan revealed multiple osseous uptakes. CDX2 was diffusely positive. However, in the end, the origin of the primary tumor was not determined. Considering the aforementioned data, the diagnosis of metastatic adenocarcinoma with unknown primary origin was made. CUP of the oral cavity is an extremely rare event. The possibility of metastasis should be raised in a patient who complains of paresthesia. Awareness of the clinical and histopathologic features of these malignancies is crucial for clinicians and pathologists to have a proper diagnosis.

Oral Metastatic Undifferentiated Pleomorphic Sarcoma: A Case Report.

Introduction: Oral metastases are rare; nevertheless, they must be considered in the differential diagnosis of lesions in patients with a previous history of malignancy or older adults. The clinical signs of oral metastasis typically comprise pain, dysphagia, ulceration, bleeding, and paresthesia. Soft tissue sarcomas tend to affect the extremities and retroperitoneum. The most common metastases in the oral cavity are carcinomas, and sarcomas rarely metastasize to this area. Undifferentiated pleomorphic sarcoma (UPS) is a mesenchymal malignancy that infrequently affects the head and neck site. It shows a male predilection and occurs in all age groups. The lung is the most common area of distant metastasis in undifferentiated pleomorphic sarcoma. Case Report: This report presents a 61-year-old female patient with a painful bluish-purple mass of the posterior right mandibular alveolar mucosa. She had a history of thigh UPS about four years ago. An incisional biopsy was performed, and the specimen was stained with hematoxylin and eosin. Immunohistochemical antibodies for CK, S100, desmin, myogenin, MDM2, SOX10, and caldesmon were negative and focally positive for CD68. Ki-67 index was about 70%. Conclusions: This report aimed to increase awareness of a rare lesion by describing the clinical, histopathologic, and immunohistochemical findings of metastatic undifferentiated pleomorphic sarcoma of the oral cavity.

Peri-implant squamous cell carcinoma mimicking peri-implantitis: a case report.

Peri-implant oral lesions, benign or malignant, may be misdiagnosed as peri-implantitis. Squamous cell carcinoma is the most common cancer reported around dental implants. Malignant peri-implant lesions are life-threatening, and their resemblance to peri-implantitis, especially in their early stage, necessitates a precise differential diagnosis. This report presents a case of a 55-year-old woman with a peri-implant squamous cell carcinoma mimicking peri-implantitis.

Lactobacillus fermentum and Lactobacillus crispatus Do Not Have Cytotoxic Effects on HN5 Oral Squamous Cell Carcinoma Cell Line.

BACKGROUND: The oral environment has a very complex normal flora and a wide variety of bacteria including lactobacilli. Studies have shown oral microbial flora has important influence in the development of oral cancer. Squamous cell carcinomas account for more than 90% of cancers in oral cavity. Lactobacilli are known as one of the newest methods for the prevention and treatment of cancers. Previous studies on the effects of probiotics on oral cancer cells are very limited, and only two species of Lactobacillus which are not present in the normal oral microflora have been studied. Due to the unknown effects of lactobacilli on oral cancer, this study aimed to investigate the effect of two species of lactobacilli of oral cavity on oral cancer cells. METHODS AND MATERIALS: The effects of the supernatant of two lactobacilli, namely, fermentum and crispatus were studied on HN5-cancer cells. The MTT method was used to study the effects of lactobacilli on inhibition of cancer cell growth. RESULTS: The results showed that these lactobacilli do not prevent the progression of oral cancer cells. Moreover, the results showed that the acidic medium had the most effect on reducing the growth of oral cancer cells. CONCLUSION: Due to the different effects of lactobacilli on various cancer types, the effects of two Lactobacillus crispatus and Lactobacillus fermentum on other oral cancer cell lines may be different from what has been reported in this study.

Clinicoradiographic Features and Histopathologic Variations of Intraosseous Lipoma: Report of a Case and Review of the Literature.

Intraosseous lipoma is a very rare lesion, and the jaw is its least common bone location. Fibrolipoma is a microscopic variant of lipoma which is characterized by a significant fibrous component intermixed with lobules of fat cells. Intraosseous fibrolipoma of the jaw is a rare lesion, and to the best of our knowledge, only two cases have been reported from 1948 in English literature. This paper presents a 39-year-old man with a chief complaint of tooth displacement in the anterior region of the mandible. Radiographic evaluation revealed a unilocular radiolucent lesion with sclerotic borders located between the left lateral incisor and canine. Histopathologic evaluation after an excisional biopsy confirmed the diagnosis of intraosseous fibrolipoma. We also reviewed the literature on this rare lesion.

Verruciform Xanthoma of the Ventral Surface of the Tongue: A Rare Case Report and Literature Review.

INTRODUCTION: Verruciform xanthoma (VX) is an uncommon benign lesion with the subepithelial accumulation of foamy histiocytes and superficial papillary proliferations with a bright orange hue. This lesion exhibits an oral region predilection. Its clinical differential diagnosis includes verrucous leukoplakia, verrucous carcinoma, squamous papilloma, verruca vulgaris, condyloma accuminatum, squamous cell carcinoma, and fibroepithelial polyp. CASE REPORT: This report presents a case of VX of the ventral surface of the tongue afflicting a 33-year-old otherwise healthy male. CONCLUSION: This case report can be valuable as a consequence of VX rarity and the similarity of its clinical features to papillary lesions. A biopsy is required for its definite diagnosis particularly when it occurs at sites with a high-risk of squamous cell carcinoma development, such as the lateral border and ventral surface of the tongue.

Genetic factors in the pathogenesis of ameloblastoma, dentigerous cyst and odontogenic keratocyst.

Ameloblastoma (AB), dentigerous cyst (DC) and Odontogenic keratocyst (OKC) are odontogenic lesions with propensity to malignant transformation or local invasion. The molecular mechanisms of development of these lesions are not fully understood. However, some researches have reported dysregulation of tumor suppressor genes or oncogenes in these lesions. Down-regulation of P53 gene has been reported in AB, DC and OKC. Moreover, several long non-coding RNAs such as ENST00000512916 and KIAA0125 have been dysregulated in AB tissues. Single nucleotide polymorphisms within a variety of genes have been associated with certain types of odontogenic lesions. In the current review, we summarize the current data about the expression pattern of genes in these lesions and the observed association between genetic polymorphisms and development of these lesions.

Effects of raw vegan diet on periodontal and dental parameters.

OBJECTIVES: Macronutrients and micronutrients present in different types of diet could influence different aspects of both inflammatory and immune responses; thereby, diets could influence oral health and the periodontal condition. The raw vegan diet is a subset of vegetarianism in which only uncooked plant-derived foods are consumed. The present study's aim was to evaluate the effect of the raw vegan diet on periodontal and dental health parameters. MATERIALS AND METHODS: A total of 118 participants (59 raw vegans and 59 controls) were interviewed about their level of education and oral health habits. Samples of unstimulated whole saliva were collected for pH analysis, and dental and periodontal parameters were examined. Then, statistical analysis was performed. RESULTS: Raw vegans had better oral hygiene (P = 0.001). The decayed-missing-filling indices were relatively equal in both groups. The probing depth, bleeding on probing (BOP), and simplified oral hygiene index were significantly lower in raw vegans (P = 0.047, P = 0.017, and P = 0.001, respectively). Multiple regression analyses disclosed that probing depth and BOP were significantly related to debris index. CONCLUSION: Based on this study's results, it can be presumed that the better periodontal condition in raw vegans is a result of their better oral care and lifestyle.

Oral rehabilitation of Papillon-Lefèvre syndrome patients by dental implants: a systematic review.

OBJECTIVES: Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder. These patients lose their teeth at a young age and are in need of prosthetic rehabilitation. The aim of this systematic review was to assess the success of dental implant placement in these patients. MATERIALS AND METHODS: An electronic search was performed in PubMed Central, Scopus, and Web of Science using the keyword "Papillon-Lefèvre syndrome" AND "dental implant" OR "prosthodontics". Articles reporting implant placement in patients with PLS until July 2019 were included. RESULTS: Assessment of the included 11 articles reporting 15 cases showed 136 implant placements in these patients. Implant failure occurred in 3 patients (20 implants). The peri-implantitis and failure rate was higher in the maxilla. Meta-analysis showed the probability of failure to be 7% (95% confidence interval [CI] 0%-31%) for maxillary implants and 2% (95% CI 0%-9%) for mandibular implants. The follow-up time ranged between 1 and 20 years. Healing after bone graft and implant placement in these patients was uneventful. CONCLUSION: Dental implants may be a viable treatment option for PLS patients. Implantation can help preserve alveolar bone if the patients' immunological and growing conditions are well-considered and proper oral hygiene and compliance with the maintenance program are continued.

Mandibular Metastasis of Silent Papillary Thyroid Carcinoma: A Rare Case Report with Review of the Literature.

Metastasis to the jaws is a rare event; however, it has great importance because it may be the only symptom of an undiagnosed underlying malignancy. Papillary thyroid carcinoma, the commonest histopathologic variant of thyroid cancer, has minimal potential for distant metastasis, and most reported metastatic thyroid carcinomas of the oral cavity have been follicular thyroid carcinoma. The aim of this article is to present a rare case of metastatic papillary thyroid carcinoma, which presented itself as a painless expansion in the anterior region of the mandible in a 56-year-old female, and to review previously published cases of this type of cancer. Reporting rare cases such as this one, together with reviewing previous reports of related rare diseases, will expand the body of knowledge about these uncommon lesions.

Melanotic Neuroectodermal Tumor of Infancy, a Rapidly Growing Maxillary Alveolar Mass: A Case Report.

Melanotic neuroectodermal tumor of infancy is a rare, rapidly growing, painless, pigmented neoplasm with neural crest derivation. It usually occurs during the first year of life and there is a prominent predilection for the maxilla. The purpose of the present report is to describe additional case of melanotic neuroectodermal tumor of infancy of maxilla in a 6-month-old infant male. The treatment included surgical excision with safe margins. No attempt was made for immediate grafting of the surgery site due to high proliferation rate of tissues and self-renewal during infancy. The facial growth was normal and the surgical cleft was tightly closed. Due to the rarity of tumor, essential knowledge on characteristics of this lesion would contribute to a proper diagnosis and benefit treatment planning.

Oral cyst-like nodule caused by a long standing unusual embedded foreign object: Report of a case.

Traumatic implantation of foreign material in the oral mucosa is unusual and may occur. In this article, we report the presence of an unusual foreign object associated with a cyst-like inflammatory response in a 50-year-old male. The patient presented with a painless recurrent soft tissue swelling in the anterior vestibule of maxilla of at least 2-year duration. The lesion was surgically excised and a retained shrapnel-like object within a cyst-like and thick-walled structure was obtained. Histopathologically, the cyst-like structure exhibited a lymphohistiocytic infiltrate in the wall and a luminal synovial metaplasia-like change, predominantly composed of histiocytes. Immunohistochemical stain of CD163 highlighted the histiocytes. The patient stated a history of traumatic implantation of shrapnel fragments in the area that occurred 30 years ago due to an explosion in the Iran-Iraq war.

Relative frequency of dentigerous cyst in Iranian population: A 20-year retrospective study.

PURPOSE: Dentigerous cyst (DC) is the most common type of developmental odontogenic cysts which apparently develops via accumulation of fluid between the reduced enamel epithelium and crown of the tooth. The aim of this study is to analyze the frequency of DC in Iranian population. MATERIALS AND METHODS: The files of oral pathology, Shahid Beheshti University of Medical Sciences, served as the source of the materials from 1992 to 2012 for this study. All lesions diagnosed as DCs were subjected to microscopic reevaluation. Patient's age, sex, location, and microscopic characteristics were recorded. Based on these data, a descriptive statistical analysis was performed using SPSS 19 software (IBM SPSS Statistics 19, New York, United States) and the results with P < 0.05 were considered as significant. RESULTS: DC accounted for 34.37% of all odontogenic cysts of the jaws during the 20-year period. The mean age of patients was 24.72 years and most cases are diagnosed in the second and third decades of life. The male-to-female ratio was 1.52. About 73.89% of all lesions had occurred in the mandible and 26.11% in maxilla. DCs showed Vickers and Gorlin (ameloblastomatous) changes in 2.36% of cases. The mean age was significantly lower in the premolar area (P = 0.00). CONCLUSION: Age, sex, and location of DCs in Iranian population are similar to previous studies. In addition, the age of occurrence for this lesion in the premolar region was relatively lower than at other sites. Although the risk of ameloblastic change is low, it should be considered as an important issue.

Mandibular Mural Ameloblastoma with Unusual Histopathologic Features: a Rare Challenging Case.

Ameloblastomas demonstrate various clinical and microscopic patterns. They typically have been described as possessing three biologic variants including solid, cystic (unicystic) and peripheral, of which about 13% to 21% of all cases are unicystic. Granular cell subtype is a rare variant especially when both the inner and peripheral layers of tumoral islands composed exclusively of eosinophilic granular cells. The purpose of this case report is to present a unique case of cystic ameloblastoma with an unusual radiographic and microscopic pattern affecting a 25-year-old female. Awareness of these rare histopathologic features for oral pathologist is essential to help correct diagnosis.

Granular Cell Odontogenic Tumor, an Extremely Rare Case Report.

The granular cell odontogenic tumor is an extremely rare odontogenic neoplasm which about 38 cases has been reported with sufficient documentation in the literature. It has a prominent predilection to occur in the posterior of mandible of middle-aged women. Here, we report a case of mandibular granular cell odontogenic tumor in a 57-year-old female with chief complaint of swelling and tooth mobility. As rarity of these lesions, their clinical behavior and prognosis are not clear; hence, reporting more such cases may be beneficial to correct diagnosis and prevent unnecessary treatment.