Ameloblastic fibrosarcoma of the jaws. A clinicopathologic and DNA analysis of five cases and review of the literature with discussion of its relationship to ameloblastic fibroma.

Ameloblastic fibrosarcoma, the malignant counterpart of the ameloblastic fibroma, is a rare odontogenic tumor characterized by benign epithelium and a malignant fibrous stroma. We have compared nuclear DNA content of five ameloblastic fibrosarcomas and three ameloblastic fibromas by image analysis. The three ameloblastic fibromas were diploid, whereas 1 of 5 ameloblastic fibrosarcomas was aneuploid. There was no correlation with histologic grade and aneuploidy. These five new cases were also added to a review of the literature, bringing the total cases of reported ameloblastic fibrosarcomas to 51. The ameloblastic fibrosarcoma occurs at a later age (mean, 27.5 years) compared with reported ameloblastic fibromas (mean, 14.6 to 22 years), which supports a step-wise malignant transformation. There was histologic documentation that 44% of ameloblastic fibrosarcomas developed in ameloblastic fibromas. In view of this data and of the reported cumulative recurrence rate of 18.3% for ameloblastic fibroma, it is recommended that ameloblastic fibromas be treated with complete surgical excision and long-term follow up rather than simple curettage or enucleation.

Multiple cutaneous leiomyomas. Report of a case.

Multiple cutaneous leiomyomas usually appear as painful nodules of the skin. Historically these have been treated by surgical excision, however, because they are often numerous, surgery may be an impractical approach. This article reports on a patient with multiple leiomyomas of the face treated by excision as well as a discussion of alternative treatments such as pharmacologic agents that may be used when surgical excision is not feasible.

Giant cell lesions of the jaws: evaluation of nucleolar organizer regions in lesions of varying behavior.

To examine whether giant cell lesions of the jaws (GCL) of varying behavior could be separated histologically, a number of GCL were studied using the AgNOR staining technique for nucleolar organizer regions. The mean AgNOR count of mononuclear cells from recurrent lesions (1.73 +/- 0.15) was slightly higher than that of the aggressive lesions (1.54 +/- 0.21) and much higher than that of the non-aggressive/non-recurrent lesions (1.33 +/- 0.14). Similarly, the mean AgNOR count of the multinucleate giant cells of the recurrent lesions (1.52 +/- 0.14) was slightly higher than that of aggressive lesions (1.34 +/- 0.092) and much higher than that of non-aggressive/non-recurrent lesions (1.26 +/- 0.05). Statistical analysis showed a significant difference between the mean number of AgNORS of recurrent lesions and non-recurrent/non-aggressive ones in both the mononuclear and multinuclear population (p < 0.05).

Conservative management of interstitial pregnancy.

Earlier detection of ectopic pregnancies allows the patient and physician the option of conservative management. Conservative surgical management of ampullary ectopic pregnancies has been well described. Traditional management of interstitial or cornual gestation has been by salpingectomy with or without cornual resection or by hysterectomy. In this paper we present a case report of alternative, less radical surgical management and review the literature on conservative surgical and medical management of interstitial pregnancies.

Expression patterns of epithelial differentiation antigens and lectin-binding sites in ameloblastomas: a comparison with basal cell carcinomas.

Whether the peripheral ameloblastoma (PA) and intraoral basal cell carcinoma (BCC) are two different clinical entities or essentially the same lesion still remains unresolved. The immunophenotypes of neoplastic cells of peripheral and intraosseous ameloblastomas, ameloblastic carcinomas, and BCCs were studied using a panel of monoclonal/polyclonal antibodies and lectins. The major cytokeratins (CKs) of neoplastic cells of ameloblastomas were CKs 5 and 14, whereas co-expression of CKs 8, 18, and 19 was observed in the cells of the stellate reticulum-like areas. Metaplastic squamous and keratinizing cells found in follicular and acanthomatous variants of ameloblastomas expressed CKs 1 and 10, involucrin, and binding sites for the lectins Ulex europeaus agglutinin I and Helix pomatia agglutinin. beta 2-Microglobulin was uniformly negative in all cases of ameloblastomas and ameloblastic carcinomas studied. Cutaneous BCCs also demonstrated similar reactive patterns with the above-mentioned antigens. The most striking feature is the presence of a peritumorous band-like peanut agglutinin staining found in both BCCs and PAs but not in intraosseous ameloblastomas. This unique peanut agglutinin staining pattern of PA may be diagnostically useful for its histopathologic distinction from an intraosseous ameloblastoma that has infiltrated the soft tissue. The neoplastic cells of ameloblastomas express markers of less-differentiated epithelial cells. Despite differences in epithelial origins, PAs are tumors analogous to cutaneous BCCs.

Diagnosing and treating common oral pathologies.

When the physician is confronted with an oral pathologic condition in a child, the adage "common things happen commonly" should be applied. Congenital lesions such as palatal and alveolar cysts occur in almost 50% of newborns. Developmental conditions such as Fordyce granules and retrocuspid papillae are found in most children. Localized soft-tissue enlargements commonly seen in young children include the parulis, mucocele, papilloma, and inflammatory gingival tumors. In addition, soft-tissue pathologies and discomfort associated with herpesvirus infections or recurrent aphthous ulcerations often present as a chief complaint. The physician's knowledge and treatment recommendations for common oral pathologies should be an integral component to the overall medical management of infants, children, and adolescents.

Intraoral molluscum contagiosum.

Molluscum contagiosum (MC) presenting as a self-limiting disease of the skin is not uncommon. To date, however, documented cases of MC of the oral cavity have been rare. A case of MC of the palate of a 52-year-old man is reported. The clinical and histopathologic features of this uncommon oral lesion are discussed, and the literature is reviewed.

Compound and complex odontomas.

One hundred forty-nine cases of odontoma were reviewed: sixty-five cases were accepted from the literature, and eighty-four additional cases were included from the files of the Pathology Department of the Emory University School of Dentistry. The cases were combined and analyzed together. Odontomas are most often diagnosed in the second decade of life. Sixty-five per cent of all odontomas occur in the maxilla. Compound odontomas are more common in the anterior maxilla, whereas complex odontomas occur more frequently in the posterior jaws. A slight predominance in males was seen. The most common presenting symptom was an impacted tooth with retention of deciduous teeth.