Pseudomelanocytic nests mimicking atypical melanocytic proliferations: first reported cases in the oral cavity.

The concept of pseudomelanocytic nests has been recently described in the dermatology literature. To our knowledge, this entity has yet to be published in the oral pathology literature. We report 2 cases with features of pseudomelanocytic nests. In both instances, nests of cells suspicious for melanocytes were observed. Interpretation of melan-A was negative. Both cases showed strong and diffuse immunoreactivity of the nested cells to CD68. This immunohistochemical staining pattern is most consistent with a melanophage identity. Pseudomelanocytic nests are a recently described entity that represents a potential diagnostic pitfall. Distinguishing pseudomelanocytic nests from an authentic atypical melanocytic proliferation can be challenging and is important for appropriate patient management. Clinicopathologic correlation with cautious interpretation of immunohistochemistry may be necessary to arrive at the correct diagnosis. These cases represent the first reports of pseudomelanocytic nests in the oral pathology literature.

Malignant epithelioid hemangioendothelioma of the lip: a case report and comprehensive literature review.

Malignant epithelioid hemangioendothelioma (MEH), also known as high-risk epithelioid hemangioendothelioma, is a low- to intermediate-grade vascular malignancy originally described as a vascular neoplasm of endothelial origin. This very rare vascular neoplasm has been described mainly in soft tissue, but also in various organs and locations, including the liver, lung, brain, colon, lymph nodes, peritoneum, spleen, bone, skin, heart, soft tissues, and vascular system. Several cases have been described in the head and neck, including the submandibular gland, parotid gland, nasal cavity, parapharyngeal space, maxilla, maxillary sinus, occipital bone, oral cavity, thyroid gland, neck, scalp, larynx, and mandible. This case report is the first description of MEH presenting as an exophytic lower-lip lesion.

Bowman birk inhibitor concentrate and oral leukoplakia: a randomized phase IIb trial.

Oral premalignancy serves as an ideal model for study of chemopreventive agents. Although 13-cis-retinoic acid showed reversal of oral premalignancy, toxicity, and reversal of clinical response after cessation of therapy obviated its widespread use. A search for nontoxic agents with cancer preventive activity led us to evaluate Bowman Birk Inhibitor (BBI) formulated as BBI Concentrate (BBIC). We previously reported encouraging results in a phase IIa trial of BBIC in patients with oral leukoplakia with measurable clinical responses and favorable biomarker changes. On the basis of these results, we undertook a randomized, placebo controlled phase IIb trial with patients receiving BBIC or placebo for 6 months, with assessment of clinical response and change in lesion area as primary end point and an intent-to-treat analysis. One hundred and thirty two subjects were randomized; and 89 subjects completed six months on study drug or placebo. Both placebo and BBIC showed a statistically significant decrease in mean lesion area of 17.1% and 20.6%, respectively, and partial or greater clinical responses of 30% and 28% respectively. No significant difference between placebo and study drug arms was observed. Histologic review, review of photographs of lesions, and comparison of serum neu protein and oral mucosal cell protease activity also did not show significant differences between study arms. Probable reasons for these negative results were considered, are discussed, and include a placebo with non-BBIC clinical activity and reduced pharmacokinetic availability of the second batch of BBIC. This experience should be a strong cautionary note to those considering "Green" chemoprevention.

Failure to diagnose pathology: an avoidable complication in oral and maxillofacial surgery.

The routine submission of abnormal tissue for histopathologic diagnosis is a vital link in the appropriate management of patients. Receipt of a biopsy report brings the usual case to its full conclusion. Patients are best served when clinical impressions are verified by histopathologic examination, and this in turn will reduce the likelihood of successful malpractice litigation for failure or delay in diagnosis.

Estrogen and progesterone receptor and p53 gene expression in adenoid cystic cancer.

OBJECTIVES: The current study examined the role of estrogen receptors (ER), progesterone receptors (PR) and p53 expression in adenoid cystic carcinoma (ACC) to determine if simple expression or possible overexpression of these products might influence the development and natural course of this cancer. STUDY DESIGN: ER and PR status and p53 overexpression were retrospectively evaluated utilizing immunohistochemical evaluation of 47 ACC specimens. METHODS: Formalin-fixed paraffin-embedded tissues from 47 ACC specimens and 47 samples of normal salivary gland tissue were evaluated histochemically for the presence of ER, PR and p53. Immunoreactivity was scored using a 0 to +3 scale in which staining was either (0) negative, (+1) spotty, (+2) weakly positive, or (+3) strongly positive. RESULTS: ER was expressed in 8 of 47 tumors while PR was expressed in 4 of 47 tumors. p53 aberrations were demonstrated in 26 of 47 tumors. Tumors showed varying degrees of immunopositivity ranging from 0 to +3. CONCLUSIONS: These studies suggest that p53 aberrations may be involved in ACC tumor progression and that ER and PR may play a role in ACC development.

The use of biopsy in dental practice. The position of the American Academy of Oral and Maxillofacial Pathology.

Biopsy is the gold standard of diagnostic procedures. The American Academy of Oral and Maxillofacial Pathology has stated its position concerning biopsy use in dental practice, believing that using the procedure more frequently will enhance diagnosis and contribute substantially to the quest for more evidence-based practice. Biopsy is a technique within the scope of practice of general dentists. It is vital to understand that biopsy is a tool for the diagnosis of myriad benign and malignant oral conditions. More frequent use of biopsy in dental practice will likely reduce the number of successful lawsuits brought for delay or failure to diagnose. This article offers 10 guidelines to dentists to help assure the success of the procedure.