Polymorphous low-grade adenocarcinoma of minor salivary gland. A comparative histologic and immunohistochemical study.

Sixteen polymorphous low-grade adenocarcinomas were reviewed and compared with 17 adenoid cystic carcinomas and with 21 other histologically similar minor salivary gland neoplasms. The polymorphous low-grade adenocarcinomas were for the most part distinctive in their microscopic appearance. Typically they exhibited infiltrative growth by small uniform cells in single-layered ducts. A syncytium of tumor cells was also characteristic, although solid and cribriform patterns were seen, making definitive diagnosis difficult with some tumors. Immunohistochemical staining for S-100 protein, glial fibrillary acidic protein, actin, vimentin, and keratins resulted in relatively distinctive antigenic profiles for the tumors studied. Of significance was strong S-100 protein and weak actin staining of polymorphous low-grade adenocarcinomas, moderate actin staining of adenoid cystic carcinomas, moderate glial fibrillary acidic protein staining of monomorphic adenomas and pleomorphic adenomas, and nonreactivity of monomorphic adenomas for vimentin. It is believed that the immunoprofiles could be useful in the microscopic diagnosis of salivary gland tumors. The identification of antigens found normally in myoepithelial and epithelial cells supports the concept that these tumors are derived from pluripotential reserve cells.

Immunoreactivity of granular cell lesions of skin, mucosa, and jaw.

Granular cell lesions from many different sites share similar light and electron microscopic features. Immunologically, however, these lesions do not appear to be a homogenous group. This study determines the extent of immunologic heterogeneity of granular cell lesions from a wide variety of sites in skin, mucosa, and jaw. Thirty-one granular cell lesions (26 granular cell tumors [GCT] and five other granular cell lesions) from 18 different sites were evaluated immunohistochemically for keratins, vimentin, desmin, muscle actin, ACT, HLA-DR, and S-100 protein. Paraffin-embedded sections were utilized with an avidin-biotin complex immunoperoxidase technique. Except for ameloblastomas, all lesions were negative for keratin and positive for vimentin. All lesions were negative for desmin and actin. Positive ACT reactivity was found in one of seven GCT of tongue, a colonic lesion, a nose lesion, and a granular cell ameloblastic fibroma. All lesions were positive for HLA-DR except a few in which fixation appeared inadequate. S-100 immunoreactivity was found in all lesions except the congenital epulis, a GCT of the skin of the nose, a colonic lesion, and the odontogenic tumors. The antigenic profile of GCT of skin and mucosa is consistent with Schwann cell origin. However, some GCT and other granular cell lesions appear to be derived from macrophages, epithelial cells, or other cells. The expression of HLA-DR by granular cells is believed to be unrelated to cellular origin but rather to some common immunologic function.

Osteosarcomas and chondrosarcomas of the jaws: immunohistochemical correlations.

Clinical, microscopic, and immunohistochemical characteristics of 17 jaw sarcomas are reported. Histologic subtypes included chondroblastic (five), fibroblastic (five), osteoblastic (three), telangiectatic (one), parosteal (two), and chondrosarcoma (one). Reactivity for all antigenic markers in decalcified tissue was judged to be comparable to nondecalcified tissue. All neoplasms were nonreactive for muramidase and leukocyte common antigen. alpha-1 Antichymotrypsin and HLA-DR immunoreactivity was found focally. Positive S-100 staining was found predominantly in chondrocytes. All tumors were positive for vimentin. Cells in focal zones of cartilage were positive for keratin. No distinctive pattern emerged relative to clinical recurrence and histologic subtype or immunotype. Leukocyte common antigen determinations were useful because they distinguished between neoplastic and inflammatory cells. S-100 protein stains helped in the subclassification of chondroblastic osteosarcoma, and vimentin stains confirmed mesenchymal origin. Cross-reactive staining of cartilage with keratin antibodies was regarded as a possible diagnostic pitfall.

Immunoprofile of benign and malignant fibrohistiocytic tumors.

Formalin-fixed, paraffin-embedded tissue sections from 26 malignant fibrous histiocytomas (MFH) and 61 benign fibrohistiocytic proliferations (BFHP) were evaluated immunohistochemically. An avidinbiotin-peroxidase technique was used to determine immunoreactivity for alpha-1 antichymotrypsin, muramidase, HLA-DR, leucocyte common antigen, S-100 protein, vimentin, desmin, and keratin. MFHs were consistently positive for ACT and vimentin and inconsistently reactive for the other antigens. MFHs were negative for LCA suggesting a mesenchymal origin for these lesions. In the MFH histologic subtypes, antigen expression was not significantly different to be useful in their classification. Also no distinctive pattern emerged relative to immunoreactivity and tumor location. The benign lesions, giant cell tumor of tendon sheath, dermatofibroma, and oral benign fibrous histiocytoma differed from the MFHs in that they were often LCA positive, suggesting origin from hematopoetic mononuclear-macrophages. The immunoprofiles of peripheral fibromas and "giant cell" fibromas were felt to be consistent with origin from mesenchymal cells. Several of the antigens studied could be used to differentiate the benign lesions studied from other benign neoplasms. The antigens were, however, of little value in separation of benign and malignant lesions.

An approach to the diagnosis and management of oral mucosal abnormalities. I. Introduction.

It is customary in traditional textbooks on oral pathology to classify and discuss diseases according to etiology. While this is a convenient and logical method to present basic material it does not always lend itself to the clinical situation. When a patient is examined, the clinician is most concerned with appearances, i.e. colour, shape, and size. These are some of the parameters which become a part of the thought process that is utilised in the diagnosis of lesions. In this approach oral diseases are to be classified according to their clinical appearance rather than by cause. Each grouping of lesions listed under a particular heading can be looked at then, as forming a basis for a differential diagnosis. It is important to remember that some redundancy exists in this type of approach, since there are lesions which characteristically have different clinical appearances. Squamous cell carcinoma is an excellent example of such a condition. The lesion may be red or white, exophytic or flat and ulcerated or non-ulcerated, which necessitates its consideration in a number of clinical categories.

An approach to the diagnosis and management of oral mucosal abnormalities. II. Evaluation of oral lesions with an intact surface.

Lesions of the oral mucosa which have an intact surface configuration are often without symptoms and rarely cause patient concern. This is especially true of lesions which have a relatively flat surface. The number of conditions which present in this fashion, of course, are great so only a few of these will be discussed in any detail. The importance of this type of lesion should not be underestimated, as they often represent an early stage of a condition which could cause problems if permitted to progress. These lesions can be conveniently separated into groups by the color variations noted during clinical examinations. White, red, blue, and brown lesions will be discussed.

An approach to the diagnosis and management of oral mucosal abnormalities. III. Evaluation of oral lesions with an ulcerated surface.

Ulcerated lesions of the oral cavity are extremely common. It is with these lesions that a systematized approach to evaluation be taken. As with previous group of lesions with an intact surface layer, ulcers are caused by a wide variety of agents. Since there are often painful symptoms with ulcerated lesions, patients usually seek treatment. Vesiculo-bullous lesions usually appear clinically as ulcers so they will be included with the more typical lesions. A notable difference with the vesiculo-bullous diseases, however, is a history of a blister or fluid filled sac prior to the appearance of the ulcer.

The pathology of head and neck tumors: cysts of the jaws, part 12.

The jaws are unique bones of the skeleton because of their intimate involvement with tooth and facial development. Abnormal sequelae of these developmental processes may give rise to cystic lesions later in life. This paper reviews the pathogenesis, clinical features, and behavior of these odontogenic and nonodontogenic cysts. Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification. Emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.

Granular cell tumors of the head and neck.

Forth-two granular cell tumors of the head and neck were collected and studied with light and electron microscopy. Granular cells were found in four odontogenic tumors, two congenital epulides of newborn infants, and 36 myoblastoma lesions of the skin and mucous membranes. Support is presented for the hypothesis that granular cells represent an unusual nonspecific degenerative process and that nonodontogenic granular cell tumors develop from undifferentiated mesenchymal cells that subsequently undergo autophagocytosis.

Odontogenic tumors: analysis of 706 cases.

From a total of 54,534 oral biopsy specimens, 706 (1.3%) odontogenic tumors were retrieved and reviewed. Odontomas comprised more than 65% of the odontogenic tumors, ameloblastomas about 10%, and the remaining six categories of odontogenic tumors accounted for approximately 25% of the lesions. The distribution by age, sex, and location of these tumors generally supported the data from other previously reported cases. A possible variant of the calcifying epithelial odontogenic tumor was described, and instances of two granular cell ameloblastic fibromas were reported. The myxomas as a group were characterized histologically more by residual bony trabeculae than by the presence of odontogenic rests. Because the clinical, histological, and behavioral features of the ameloblastic fibroma and ameloblastic fibro-odontoma were similar, these lesions were considered to be essentially the same. From limited follow-up information, the ameloblastoma was the only lesion that recurred. With the exception of one ameloblastoma found in the lung, no malignant odontogenic tumors were encountered.

Dental management of patients irradiated for oral cancer.

Management of patients irradiated for oral cancer should include consideration of their oral health prior to, and after, radiation therapy. Data from 130 patients, followed for a period of 1 to 10 years, are presented and evaluated. The philosophy of retention and maintenance of as many teeth as possible is supported by this data. Extraction of teeth with severe periodontal disease after irradiation also proves to be a relatively safe operation. Osteoradionecrosis tends to be limited in extent and is generally well tolerated by the patient when treated conservatively. A treatment regimen is presented that significantly reduces the morbidity from therapeutic irradiation of the jaws. A comprehensive dental evaluation and follow-up plan coupled with patient cooperation are instrumental to the success of this program.

Fibrous lesions of the skin and mucous membranes which contain stellate and multinucleated cells.

Various fibrous lesions of the skin and mucous membranes share the common histologic feature of stellate and multinucleated fibroblasts. These cells are conspicuous under the light microscope because they contain a well-developed, rough endoplasmic reticulum which, because of its high RNA content, stains basophilic. These characteristic cells are a nearly constant feature of the retrocuspid papilla. They are apparent in about half of the fibrous papules of the nose and abundant in about 1 per cent of irritation fibromas. These lesions most likely represent a nonspecific proliferation of the lamina propria or papillary dermis to various stimuli.

Keratinization in odontogenic tumors.

The potential of odontogenic epithelium to keratinize in the form of ghost cells is demonstrated in the histologic variants of a number of odontongic tumors. Although the cells lack keratohyaline granules, they do contain abundant tonofilaments and probably represent an altered form of keratin. The presence of this material in odontogenic tumors does not appear to alter clinical occurence or clinical behavior.

The odontogenic adenomatoid tumor. A comprehensive study of twenty new cases.

Twenty new cases of odontogenic adenomatoid tumor are added to the literature, bringing the total number of reported cases to 152. The clinical, radiographic, and microscopic findings in these cases support the previously reported data for this lesion. The odontogenic adenomatoid tumor is a benign lesion which arises from residual odontogenic epithelium. It should be treated conservatively, as there is no indication that this lesion will recur. The histogenesis of this lesion, as well as the origin of the esinophilic droplet material, is discussed.