Condyloma acuminatum and condyloma-like lesions of the oral cavity: a study of 11 cases with an intraductal component.

AIMS: We studied the clinicopathological features of 11 condyloma and condyloma-like lesions of the oral cavity with an unusual mixed pattern of exophytic and intraductal growth. The latter manifest as involvement of minor salivary gland ducts by the proliferative squamous lesions. This pattern of ductal involvement has not been previously described in oral condyloma. METHODS AND RESULTS: The clinical history was available for nine patients ranging in age from 17 to 73 years. Two were female and seven male. The buccal mucosa (five cases) was the most common site of occurrence, followed by the floor of mouth (two cases), lingual frenum (two cases), and hard palate (one case). All lesions exhibited exophytic and intraductal growth. The latter manifested itself as extension of the lesions into the excretory ducts of minor salivary glands. Underlying minor salivary glands, present in many of the excisional biopsy specimens, typically showed changes of obstructive atrophy. The exophytic components of all cases exhibited some degree of parakeratosis, and cryptic invaginations of parakeratin were typically present. Koilocytes were present in seven lesions and were equivocal in four. Mucous cells were present in the intraductal component of all cases and the intraductal component was never keratinized, but often papillary. A mild stromal-based, lymphocytic host response was present in three. A variably prominent neutrophilic infiltrate was present in the exophytic component of eight. Dysplasia was not present in any case. Five of 11 cases were positive with anti-human papillomavirus (HPV) and two of 11 cases were positive for in-situ hybridization probes directed against HPV 6/11. All cases were negative for HPV 16/18 and 13/33/35. CONCLUSIONS: Oral condyloma acuminatum may involve the excretory ducts of minor salivary glands. The diagnosis of oral condyloma acuminatum is difficult, as these lesions share considerable histological overlap with squamous papilloma. Finally, the relationship between these two lesions is incompletely understood.

Early soft tissue pathosis associated with impacted third molars without pericoronal radiolucency.

OBJECTIVES: This study was performed to histologically evaluate soft tissue pathosis in pericoronal tissues of impacted third molars that did not exhibit pathologic pericoronal radiolucency. STUDY DESIGN: One hundred impacted third molars without evidence of abnormal pericoronal radiolucency (follicular space <2.0 mm) were removed for reasons other than participation in this study, and the pericoronal tissues were submitted for histopathologic examination. Specimens were fixed and processed routinely and were stained with hematoxylin and eosin before independent evaluation by each of 2 oral pathologists. A subset of both diseased and healthy tissues underwent additional evaluation for the presence of proliferating cell nuclear antigen (PCNA) for assessment of cellular activity. RESULTS: Of the specimens submitted, 34% showed squamous metaplasia suggestive of cystic change equivalent to that found in dentigerous cysts. Soft tissue pathosis was significantly higher in patients over 21 years of age (P =.001). Five of 8 diseased specimens demonstrated PCNA uptake, whereas none of 10 healthy specimens were PCNA positive. CONCLUSIONS: These findings suggest that radiographic appearance may not be a reliable indicator of the absence of disease within a dental follicle. We conclude that the incidence of soft tissue pathologic conditions is higher than generally assumed from radiographic examination alone.

Benign mixed odontogenic tumors.

As a group, the mixed odontogenic tumors histologically resemble various stages of tooth formation (odontogenesis). Because of this, confusion arises in diagnosis and nomenclature unless one is familiar with normal tooth development and its subsequent resemblance to the neoplasms and hamartomas which arise from the tooth-forming tissues of the jaws. This article reviews odontogenesis and relates it to the formation of the mixed odontogenic tumors-the ameloblastic fibroma, ameloblastic fibro-odontoma, and the odontomas. Correlation of clinical and radiographic features with the histologic features will generally result in correct diagnosis and proper treatment.

Linear IgA disease histopathologically and clinically masquerading as lichen planus.

In each of 2 cases reported, the patient presented with features of erosive lichen planus or lichenoid drug eruptions and an incisional biopsy taken from the patient was diagnosed histologically as lichen planus. Subsequent recurrences or exacerbations were associated with vesiculobullous lesions. Simultaneous or subsequent direct immunofluorescence studies--from the same tissue sample in one case and from a similar site in the other case--demonstrated classic features of linear IgA disease. Both patients were originally treated for lichen planus with systemic and/or topical corticosteroids with limited success. One patient was treated with sulfapyridine with minimal improvement. Both patients were subsequently treated with dapsone and demonstrated significant clinical improvement. We propose that linear IgA disease may be more common than reported in the oral cavity, inasmuch as many cases of recalcitrant lichen planus, erosive lichen planus, and lichenoid drug eruptions, especially those with a vesiculobullous component, may in reality represent linear IgA disease. We recommend that direct immunofluorescence be done in any case in which bullous lichen planus is suspected.

Intraosseous fibrous lesions of the jaws: a manifestation of tuberous sclerosis.

Four patients previously diagnosed with tuberous sclerosis are reported with intraosseous fibrous lesions of the jaws. Review of the literature revealed comparable pathosis occurring in extragnathic bones and several previous reports of similar lesions within the jaws. Therefore, these intraosseous fibrous proliferations are thought to represent an intraoral manifestation of tuberous sclerosis and not coincidental findings. In all 4 cases, the tumors demonstrated significant collagenization with numerous interspersed plump fibroblasts. Although histopathologically similar, the features of the lesions are not specific and also can be found in desmoplastic fibromas and simple odontogenic fibromas. The definitive diagnosis requires appropriate clinicopathologic correlation.

Desmoplastic variant of ameloblastoma in an 83-year-ald Asian female: report of a case with literature review.

The desmoplastic ameloblastoma is a rare histologic variant of ameloblastoma. This presentation outlines the successful treatment of an 83-year-old Asian female with this type of tumour by surgical resection and peripheral ostectomy with preservation of the interior border of the mandible. Clinical, radiographic, histopathologic and surgical aspects of this tumour were reviewed.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Focal cemento-osseous dysplasia: a clinicopathologic study of 221 cases.

Classification of cemento-osseous lesions of the jaws has long been a dilemma for pathologists. A group of 221 cemento-osseous lesions exhibited sufficiently distinctive clinicopathologic features to be separated into a specific category: focal cemento-osseous dysplasia. This entity presents as an asymptomatic, focal, mixed radiolucent/radiopaque lesion with ill-defined borders in the tooth-bearing areas. It was found to occur with greater frequency in women (88%) and in the posterior mandible (77%). The average age at presentation was 37 years and a relative predilection for black patients was observed. At surgery these lesions were noted to be hemorrhagic, gritty, and adherent to the surrounding bone. The gross appearance of multiple hemorrhagic fragments is of diagnostic significance. Histologic features include a cellular connective tissue stroma punctuated by irregular osseous and/or cementum-like calcifications. Focal cemento-osseous dysplasia is thought to be of periodontal ligament origin and to be non-neoplastic in nature. Further surgical intervention is not necessary, but periodic follow-up is recommended, because occasional cases were observed to progress into florid osseous dysplasia. Care must be taken to differentiate focal cemento-osseous dysplasia from central cementifying and/or ossifying fibromas, which are true neoplasms and require surgical treatment.

Oral hairy leukoplakia.

Oral hairy leukoplakia, usually observed on the lateral border of the tongue, may herald the development of symptomatic human immunodeficiency virus infection. This paper reviews the pertinent clinical features and differential diagnosis, histology, methods of establishing a definitive diagnosis, and management of the patient with this Epstein-Barr virus-associated lesion.

Oral focal acantholytic dyskeratosis.

Focal acantholytic dyskeratosis (FAD) is an uncommon lesion of the oral mucosa with only 22 cases reported in the medical/dental literature. Fifteen additional cases of solitary oral FAD are presented. Of these cases, 4 occurred clinically as leukoplakia. Leukoplakia-associated lesions may be an addition to the current classification of solitary FAD.

Melanoacanthosis (melanoacanthoma) of the oral mucosa.

A pigmented lesion of the oral mucosa that bears histologic resemblance to the cutaneous melanoacanthoma is discussed. A study of 22 cases, including 4 in the current series, shows that the intraoral lesion occurs most commonly in adult black women on the buccal mucosa and lip. The lesion is known to regress. The term melanoacanthosis is suggested for this condition.

Erythema migrans--a psoriasiform lesion of the oral mucosa.

Psoriasiform lesions are unusual occurrences on oral mucosa. Nineteen cases of erythema migrans are presented with a discussion of the literature. Fifty-eight percent of these cases presented with tenderness, pain, or roughness. One case was associated with geographic tongue and two cases with cutaneous psoriasis.

Oral condyloma acuminatum.

Fifty-one cases of oral condyloma acuminatum are reported, bringing the total number in the English medical/dental literature to approximately 156 cases. Ninety-five percent of the 59 new cases were in males. Eight-one percent occurred in the age range of 21-40 years. The most common locations were upper lip, lingual frenum, dorsum of the tongue, and lower lip. Thirty-four percent presented with multiple lesions.

A histopathologic study of oral mucosal lupus erythematosus.

Specimens representing 17 cases of each of oral mucosal lupus erythematosus (LE) and lichen planus were examined under the light microscope to establish a set of histopathologic criteria that would distinguish between the two. Statistical analysis showed that significant differences in histopathology exist between the two diseases. A classic case of LE was found to exhibit the following characteristics: vacuolization of keratinocytes, patchy PAS-positive deposits subepithelially, edema in the lamina propria, PAS-positive thickening of blood vessel walls, and the presence of a severe or perivascular inflammatory cell infiltrate. A number of other less significant alterations were also identified. It is concluded from this study that oral LE in most cases is characteristic enough to provide a definitive diagnosis at the light microscopic level.

Embryonal rhabdomyosarcoma arising in the masseter muscle as a second malignant neoplasm.

A case is reported about a patient who was originally treated for bilateral retinoblastoma and subsequently developed an embryonal rhabdomyosarcoma in the masseter. Such patients have a genetic predisposition to a second malignancy that statistically far exceeds the rate for the general population. In addition, current treatment methods also increase the patient's susceptibility to another malignancy. This case emphasizes the necessity of maintaining a high degree of clinical suspicion in the evaluation of any lesion that may appear subsequent to the treatment of cancer in children, particularly bilateral retinoblastoma.