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.

Characterization of verruciform xanthoma by in situ hybridization and immunohistochemistry.

Verruciform xanthoma (VX) is a rare, benign lesion, mainly found in the oral mucosa. Histologically and ultrastructurally, the lesion is characteristic and well defined. However, the etiology of the lesion remains unclear. The purpose of the present study was to elaborate upon the pathogenesis of VX by evaluation of an additional series of oral examples for human papillomaviruses (HPV), using immunohistochemistry and in situ hybridization, and to further characterize the cellular components of VX immunohistochemically. Twelve specimens diagnosed as VX were retrospectively collected. One of the twelve specimens was positive for HPV types 6/11 by in situ hybridization. None of the twelve specimens demonstrated the presence of HPV antigen by immunohistochemistry. By immunohistochemical studies, the predominant cells in the inflammatory infiltrate were T cells. The foam cells were of monocyte/macrophage lineage. S-100-positive (Langerhans) cells were occasionally found in the suprabasal layer of the epithelium. HLA-DR-positive keratinocytes were noted at the intense inflammatory sites. Taken together, these findings suggest that an immune response may play a role, at least in part, in VX pathogenesis.

Identification of an attractant for the caneborerSesamia grisescens walker (Lepidoptera: Noctuidae).

The composition of the sex pheromone ofSesamia grisescens was investigated using gas chromatography, electroantennograms, and field trapping. (Z)-11-Hexadecenyl acetate and (Z)-11-hexadecenol were identified in field tests as the major attractants. Trapping trials identified a 3:2 blend of these compounds as the most effective bait. Gas chromatography indicated the presence of hexadecyl acetate. (Z)-9-hexadecenyl acetate, (Z)-9-hexadecenol, and (E)-11-hexadecenyl acetate in the pheromone gland, but these compounds had no significant effect on trap catches when added to the major components. Traps baited with the major components in a 1:1 ratio caught more male moths than traps baited with virgin females.

Compounds modifying male responsiveness to main female sex pheromone component of the currant borer,Synanthedon tipuliformis clerk (Lepidoptera: Sesiidae) under field conditions.

Various blends of (E,Z)-2,13-octadecadien-1-ol acetate (E,Z2,13-18: OAc), (Z)-13-octadecen-1-ol acetate (ZOAc) (two previously identified pheromone components of the currant borer,Synanthedon tipuliformis females), (E,Z)-, (Z,Z)-3,13-octadecadien-1-ol acetates (E,Z- andZ,Z3,13-18:OAc), andZ,Z-3,13-octadecadien-1-ol (Z,Z3,13-18:OH) were evaluated in field traps in three geographic regions. MaleS. tipuliformis were attracted toE,Z2,13-18:OAc in Tasmania, New Zealand, and Hungary. Captures were not influenced by the addition ofZ13-18: OAc, tested in Tasmania and Hungary. In Hungary and New Zealand, the addition ofE,Z3,13-18: OAc toE,Z2,13-18:OAc in a ratio of 100:3 was strongly synergistic; however, in Tasmania captures were reduced. The addition ofZ,Z3,13-18: OAc toE,Z2,13-18:OAc in a ratio of 10∶1 resulted in strong inhibition of trap captures in Hungary. WhenZ,Z3,13-18: OAc was added in different ratios to a 100:3 binary mixture ofE,Z2,13-18:OAc/E,Z3,13-18:OAc in Hungary, it strongly reduced captures at, or above a ratio of 100∶3∶3 but no decrease was recorded at a ratio of 100∶3∶1. In New Zealand and Tasmania it reduced captures at a ratio of 100∶3∶1. Observations of behavioral responses of maleS. tipuliformis in Hungary to synthetic baits in the field showed thatE,Z2,13-18:OAcby itself evoked close-range approaches to the source from only 20% of males, whereas the addition ofE,Z3,13-18:OAc in a ratio of 100∶3 raised that value to 65 %. Landing on the source was significant only at sources with a 100∶3∶0.1∶3∶10 blend ofE,Z2,13-18:OAc/E,Z3,13-18: OAc/Z,Z3,13-18: OAc/Z,Z3,13-18: OH/Z13-18: OAc. A 100∶3 binary mixture ofE,Z2,13-18:OAc/E,Z3,13-18:OAc in a dose range of 10-1000 µg can be recommended for more effective field monitoring ofS. tipuliformis populations in Hungary and in New Zealand. In Tasmania, at present,E,Z2,13-18: OAc by itself is the most potent sex attractant of the species.

The Noonan syndrome/cherubism association.

Noonan syndrome is characterized by short stature, unusual facies, congenital heart disease, chest deformity, mild mental retardation, and cryptorchidism in males. It may be sporadic or inherited as an autosomal dominant trait and occurs between 1 in 1000 and 1 in 2500 live births. Cherubism is a giant cell lesion of the jaws thought to be transmitted as an autosomal dominant trait. It is usually recognized by age 7 years, follows a variable course, and is not known to be related to other genetic disorders. We herein report on four patients with Noonan syndrome, all of whom had cherubism. Two other probable cases are cited in the literature for a total of six known cases.

Immunohistochemical identification of alpha-1-antitrypsin, alpha-1-antichymotrypsin, and lysozyme in focal hyperplastic gingivitis.

Tissues from twenty-four patients with focal hyperplastic gingival lesions containing calcification were stained for lysozyme (muramidase), alpha-1-antitrypsin, and alpha-1-antichymotrypsin. In eighteen of the twenty-four cases the tissues stained positively for lysozyme, and in all instances the tissues stained positively for alpha-1-antitrypsin and alpha-1-antichymotrypsin. These data suggest that the fibrous components of these lesions are derived from tissue histiocytes.

Calcifying odontogenic cyst. Range, variations and neoplastic potential.

16 cases of calcifying odontogenic cysts (C.O.C.) were studied and reevaluated. It could be concluded, that the group contained two entities, a cyst and a neoplasm. The cyst occurs as three variants. 1. A simple unilocular cyst with moderate mural proliferations of epithelium and no, or sparse amounts of dentinoid (dysplastic dentin); it seems to occur during man's entire life span. 2. A unilocular cyst which produces compound or complex odontomas in its luminal part, more rarely it may instead produce an intramurally growing ameloblastic fibroma, which may call for more radical surgery. It occurs mainly in patients between 10 and 29 years of age. 3. A unilocular cyst with extensive luminal as well as mural ameloblastomalike proliferations of epithelium. The C.O.C. may be located outside or inside the bone according to the location of the source of odontogenic epithelium, from which it develops. The neoplasm shows an entirely different structure. It consists of ameloblastoma-like strands and islands of odontogenic epithelium growing infiltratively in a mature connective tissue. Varying amounts of ghost cells are seen in the epithelium and varying amounts of dentinoid is formed in contact with the odontogenic epithelium. The term "Dentinogenic ghost cell tumour" is suggested for this lesion. It is possible that it occurs predominantly in the later part of life. It occurs as an extraosseous as well as an intraosseous lesion. Recurrence has been observed following cystectomy.

Malignant melanotic neuroectodermal tumor of infancy: a clinical, pathologic, ultrastructural and tissue culture study.

The melanotic neuroectodermal tumor of infancy is an uncommon neoplasm typically of early childhood which has a predilection for the head and neck region, particularly the maxilla. Except for one previous example in the literature, this tumor has consistently behaved in a benign fashion. This study documents the clinical course and pathologic findings of a tumor which began in the maxilla of a 4-month-old boy, followed by a local recurrence, metastasis to a cervical lymph node and finally, widespread dissemination and death at 18 months, 24 months and 38 months, respectively. The tumor was initially composed of nests consisting of melanin-containing cells and small dark cells. An elevated vanillylmandelic acid level was recorded during the course of the disease. At autopsy, the tumor in lymph nodes, liver, bone and soft tissues had a monotonous pattern of small dark cells similar to a conventional neuroblastoma. Previous ultrastructural studies indicate that the melanotic neuroectodermal tumor of infancy is composed of melanocytes and neuroblast-like cells. Our case provided the unique opportunity to examine in sequence the ultrastructural and in vitro characteristics of a recurring and eventually metastasizing melanotic neuroectodermal tumor. Although the neuroblast-like cells were initially difficult to identify by electron microscopy, a melanin-producing cell line and a separate nonpigmented cell line were successfully isolated from various tumor explants. Various stages of melanosome development were identified in the pigmented cells from the local recurrences and in vitro. Dibutyryl cAMP accentuated the formation of pigment and dendritic development in the melanocytes and dendrites only in the small nonpigmented cells. Electron dense granules were observed in the cultured smaller cells and also in the lymph node and soft tissue metastases. Tyrosine hydroxylase activity was demonstrated in the neuroblast-like cells. In the final biopsy and autopsy material, only the neuroblast-like cells remained and the tumor resembled a conventional neuroblastoma.

Immunopathology of Sjögren-like disease in NZB/HZW mice.

In vitro responsiveness of spleen cells from NZP/NZW (B/W) female mice, aged 2 through 40 weeks, to the mitogens phytohemagglutinin (PHA), concanavalin-A (Con-A) and lipopolysaccharide (LPS) was determined. An age-related decline in proliferative response of splenic cells was found; this decline correlated with the age of onset and progression of lymphoid infiltration in lacrimal and salivary glands in the mice. The worsening with age of this lymphoid infiltrate, coupled with the decline in responsiveness to mitogens, suggests a complex immunopathologic process with destruction of glands terminating in a disease similar to the Sjögren syndrome in humans.

Multiple mucosal neuromas, pheochromocytoma, medullary carcinoma of the thyroid and marfanoid body build with muscle wasting: reexamination of a syndrome of neural crest malmigration.

Initially described in part by Wagenmann and by Froboese almost 50 years age, the syndrome of a) multiple mucosal neuromas, b) pheochromocytoma, c) medullary carcinoma of the thyroid and d) marafanoid build with muscle wasting of the limbs, was enlarged by Williams and Pollock, Gorlin et al, Schimke et al and Levy et al.