Oral Cancer Discrimination and Novel Oral Epithelial Dysplasia Stratification Using FTIR Imaging and Machine Learning.

The Fourier transform infrared (FTIR) imaging technique was used in a transmission model for the evaluation of twelve oral hyperkeratosis (HK), eleven oral epithelial dysplasia (OED), and eleven oral squamous cell carcinoma (OSCC) biopsy samples in the fingerprint region of 1800-950 cm-1. A series of 100 µm × 100 µm FTIR imaging areas were defined in each sample section in reference to the hematoxylin and eosin staining image of an adjacent section of the same sample. After outlier removal, signal preprocessing, and cluster analysis, a representative spectrum was generated for only the epithelial tissue in each area. Two representative spectra were selected from each sample to reflect intra-sample heterogeneity, which resulted in a total of 68 representative spectra from 34 samples for further analysis. Exploratory analyses using Principal component analysis and hierarchical cluster analysis showed good separation between the HK and OSCC spectra and overlaps of OED spectra with either HK or OSCC spectra. Three machine learning discriminant models based on partial least squares discriminant analysis (PLSDA), support vector machines discriminant analysis (SVMDA), and extreme gradient boosting discriminant analysis (XGBDA) were trained using 46 representative spectra from 12 HK and 11 OSCC samples. The PLSDA model achieved 100% sensitivity and 100% specificity, while both SVM and XGBDA models generated 95% sensitivity and 96% specificity, respectively. The PLSDA discriminant model was further used to classify the 11 OED samples into HK-grade (6), OSCC-grade (4), or borderline case (1) based on their FTIR spectral similarity to either HK or OSCC cases, providing a potential risk stratification strategy for the precancerous OED samples. The results of the current study support the application of the FTIR-machine learning technique in early oral cancer detection.

Towards better understanding of giant cell granulomas of the oral cavity.

Giant cell granulomas are enigmatic lesions of the oral cavity characterised by a peculiar combined proliferation of mononuclear and multinucleated giant cells in a mesenchymal stromal background. Central and peripheral giant cell granulomas may have similar pathogenesis and histology but differ in their location and biological behaviour. It is important to differentiate them from other giant cell lesions that can occur in the oral cavity, such as giant cell tumour of the bone, aneurysmal bone cyst, brown tumour of hyperparathyroidism, and giant cell lesions of Ramon syndrome, Noonan syndrome, neurofibromatosis and Jaffe-Campanacci syndrome. A recent insight into their molecular genetics and pathogenesis, with identification of KRAS, FGFR1 and TRPV4 mutations, allows for better diagnostic differentiation and opens the door to the use of pathway inhibitors in the treatment of recurrent or dysmorphic lesions. In this review, we provide an updated summary of the clinical and pathological features of oral cavity giant cell granulomas that help with their precise diagnosis and management.

Adenomatoid odontogenic tumor with peripheral cemento-osseous reactive proliferation: report of 2 cases and review of the literature.

Two cases of a rare variant of adenomatoid odontogenic tumor encompassed by a prominent reactive cemento-osseous proliferation are reported. This unique variant of adenomatoid odontogenic tumor has only been seen twice in the authors' collective experience. Literature documenting the histopathologic patterns of adenomatoid odontogenic tumor and the occurrence of other combined lesions other is reviewed and discussed.

Effectiveness of a novel topical powder on the treatment of traumatic oral ulcers in orthodontic patients: A randomized controlled trial.

OBJECTIVE: To determine if 2-DeNT Oral Topical Powder is an effective treatment for traumatic oral ulcers. MATERIALS AND METHODS: Of the 46 patients who were randomly allocated, 20 patients from the experimental group and 17 from the placebo control group completed the study. The patients, operators, and evaluators were all blinded. Patients applied the powder twice a day and completed a diary twice a day for 10 days. The diary was used to monitor the size of the lesions and pain levels (using a 10-cm visual analog scale). RESULTS: By day 5, the ulcers in the experimental group had reduced in size by approximately 70%; and ulcers in the control group had reduced in size by 56%. The experimental-group ulcers were significantly (P < .05) smaller than the control-group ulcers from day 5 through day 9. Ulcers in the experimental group were completely resolved by day 8, whereas control-group ulcers were still present on day 10. Patients experienced a significant amount of stimulated pain until the night of day 2 in the experimental group and until the night of day 5 in the control group, but group differences in pain were not statistically significant. CONCLUSIONS: The 2DeNT Oral Topical powder was more effective than the placebo powder at accelerating the healing of oral traumatic ulcers.

Localized juvenile spongiotic gingival hyperplasia possibly originates from the junctional gingival epithelium-an immunohistochemical study.

AIMS: To immunohistochemically evaluate the cytokeratin (CK) pattern of expression in localized juvenile spongiotic gingival hyperplasia (LJSGH) as compared with the gingival epithelium (GE). METHODS AND RESULTS: Ten cases of LJSGH were semiquantitatively evaluated for the immunohistochemical pattern of CK1/10, CK4, CK8/18, and CK19. GE controls were taken from 10 cases of reactive gingival fibroepithelial hyperplasia. GEs showed mean positivity rates of 80% for both CK1/10 and CK4, and 5% for both CK8/18 and CK19. LJSGHs showed mean positivity rates of 65% for CK19, 60% for CK8/18, 30% for CK4, and 5% for CK1/10. The differences between LJSGHs and GEs were statistically significant (P < 0.01). CONCLUSIONS: The LJSGH pattern of CK expression is reminiscent of the profile described in the literature for the junctional epithelium (JE). Possibly, JE exteriorized from the gingival sulcus would be more prone to irritation from a variety of sources, resulting in inflammation and hyperplasia, with the subsequent development of LJSGH.

Management of central giant cell granuloma with subcutaneous denosumab therapy.

PURPOSE: In recent years, the treatment of central giant cell granuloma (CGCG) has become focused on the inhibition of osteoclast differentiation and proliferation. Medications that were developed for the treatment of giant cell tumor of bone and bone resorption from metastatic skeletal disease have shown some success in the treatment of CGCG. The present report describes 2 cases of CGCG of the mandible that were treated effectively with subcutaneous denosumab. MATERIALS AND METHODS: Two cases of histologically diagnosed CGCG of the mandible were treated with monthly subcutaneous injections of denosumab 120 mg primarily or after intralesional corticosteroid therapy. Clinical and radiographic follow-ups were recorded over a period of 24 months (case 1) and 15 months (case 2). RESULTS: In the 2 cases, progressive radiodensity and osseous regeneration were noted 4 to 6 months after denosumab therapy was initiated. A decrease in lesion size and improvement in bone contour and facial symmetry were seen in the 2 cases. CONCLUSION: The major radiographic, clinical, and histologic responses seen in these 2 cases suggest that denosumab may represent a viable alternative or adjunctive procedure to eliminate or decrease the extent of surgical intervention and morbidity in the treatment of CGCG. Future prospective studies with a larger sample would provide more comprehensive information about the long-term effects and possible adverse side effects of treating CGCG of the jaws with denosumab.

Epstein-Barr virus-positive oral ulceration simulating Hodgkin lymphoma in a patient treated with methotrexate: case report and review of the literature.

Immunosuppressive therapy for patients diagnosed with rheumatoid arthritis has long been implicated in the development of various neoplastic processes, including leukemia and lymphoma. Methotrexate is a commonly administered antimetabolic medication thought to improve the symptoms of rheumatoid arthritis through its anti-inflammatory effects. Longterm methotrexate therapy and concurrent rheumatoid arthritis have both been independently suggested as risk factors for developing lymphoma. The mechanism has been theorized to be severe immunosuppression and an increased frequency of latent infection with pro-oncogenic viruses, such as the Epstein-Barr virus (EBV). Spontaneous remission of these malignancies has been seen after discontinuation of the methotrexate therapy. In the present study, we report the case of a patient diagnosed with rheumatoid arthritis and treated with methotrexate and prednisone. She developed intraoral ulcerations that histopathologically resembled Hodgkin's lymphoma.

Local application of zoledronate for maximum anchorage during space closure.

INTRODUCTION: Orthodontists have used various compliance-dependent physical means such as headgears and intraoral appliances to prevent anchorage loss. The aim of this study was to determine whether 1 local application of the bisphosphonate zoledronate could be used to prevent anchorage loss during extraction space closure in rats. METHODS: Thirty rats had their maxillary left first molars extracted and their maxillary left second molars protracted into the extraction space with a 10-g nickel-titanium closing coil for 21 days. Fifteen control rats received a local injection of phosphate-buffered saline solution, and 15 experimental rats received 16 µg of the bisphosphonate zoledronate. Bisphosphonate was also delivered directly into the extraction site and left undisturbed for 5 minutes. Cephalograms and incremental thickness gauges were used to measure tooth movements. Tissues were analyzed by microcomputed tomography and histology. RESULTS: The control group demonstrated significant (P <0.05) tooth movements throughout the 21-day period. They showed significantly greater tooth movements than the experimental group beginning in the second week. The experimental group showed no significant tooth movement after the first week. The microcomputed tomography and histologic observations showed significant bone loss in the extraction sites and around the second molars of the controls. In contrast, the experimental group had bone preservation and bone fill. There was no evidence of bisphosphonate-associated osteonecrosis in any sample. CONCLUSIONS: A single small, locally applied dose of zoledronate provided maximum anchorage and prevented significant bone loss.

The role of the human papillomavirus in oropharyngeal cancer.

In recent years there has been an overall decrease in cancers of the oral cavity, and a concurrent increase in cancers in specific sites of the posterior oral cavity and oropharynx in the United States. There is increasing evidence that the human papillomavirus may play a role in the development of oropharyngeal squamous cell carcinoma. In this article we review the biology and risk factors associated with HPV and oropharyngeal carcinoma, and recent data suggesting that this type of cancer may be unique in its response to treatment and prognosis.

The role of the human papillomavirus in oropharyngeal cancer.

In recent years there has been an overall decrease in cancers of the oral cavity, and a concurrent increase in cancers in specific sites of the posterior oral cavity and oropharynx in the United States. There is increasing evidence that the human papillomavirus (HPV) may play a role in the development of oropharyngeal squamous cell carcinoma. In this article we review the biology and risk factors associated with HPV and oropharyngeal carcinoma, and recent data suggesting that this type of cancer may be unique in its response to treatment and prognosis.

Clinical pathologic conference case 3: nodular fasciitis.

Intraoral nodular nodular fasciitis is a rare entity that is important to recognize because it may simulate a malignancy clinically and histologically. The rapid growth and high mitotic index seen in nodular fasciitis may suggest a malignant neoplastic process, but it is generally considered to be a benign reactive proliferation. Recognizing the unique histologic features of nodular fasciitis is important to avoid a possible misdiagnosis as a malignancy, leading to unnecessary further treatment.

Focal hypercementosis affecting a mandibular molar: a case report.

Hypercementosis is an abnormal thickening of the cementum. Although the etiology of this condition is uncertain, it occasionally is related to disorders of bone metabolism, including Paget disease and hyperthyroidism. The case presented here illustrates localized idiopathic deposition of excess cementum at the apex of the distal root of a mandibular first molar.

CD56 (NCAM) expression in ameloblastomas and other odontogenic lesions.

AIMS: Ameloblastomas recapitulate certain elements of tooth formation. CD56 is expressed by a variety of cells and is used in tumour diagnosis, but is also expressed in the enamel organ during tooth development. The aim of this study was to describe the expression of CD56 in odontogenic lesions with particular reference to the differential diagnosis of ameloblastoma and odontogenic keratocyst. METHODS: Cases were selected from the pathology archives at Glasgow Royal Infirmary, Glasgow, Royal Victoria Infirmary, Newcastle and Department of Diagnostic Sciences, Texas A&M Health Science Center Baylor College of Dentistry, Dallas. The study population included 38 ameloblastomas, 19 odontogenic keratocysts and a number of other odontogenic lesions, including nine compound odontomes. All sections were examined for CD56 immunoreactivity and the extent of staining was recorded. RESULTS: Thirty-seven of 38 (97%) ameloblastomas expressed CD56 on the cell membrane of peripheral cells in tumour nests (16 extensively, 21 focally). Immunoreactivity was lost in areas of inflammation, acanthomatous differentiation, in areas of cystic change and upon fusion with overlying surface epithelium. One odontogenic keratocyst expressed CD56 (5%, P < 0.0001). CD56 was expressed very focally in two odontomes, exclusively in stratum intermedium-like cells. CONCLUSIONS: CD56 expression in odontogenic epithelium is highly suggestive of ameloblastoma and can help in differentiating this from odontogenic keratocyst.