A model-adjusted space-time scan statistic with an application to syndromic surveillance.

The space-time scan statistic is often used to identify incident disease clusters. We introduce a method to adjust for naturally occurring temporal trends or geographical patterns in illness. The space-time scan statistic was applied to reports of lower respiratory complaints in a large group practice. We compared its performance with unadjusted populations from: (1) the census, (2) group-practice membership counts, and on adjustments incorporating (3) day of week, month, and holidays; and (4) additionally, local history of illness. Using a nominal false detection rate of 5%, incident clusters during 1 year were identified on 26, 22, 4 and 2% of days for the four populations respectively. We show that it is important to account for naturally occurring temporal and geographic trends when using the space-time scan statistic for surveillance. The large number of days with clusters renders the census and membership approaches impractical for public health surveillance. The proposed adjustment allows practical surveillance.

Central odontogenic fibroma: clinicopathologic features of 19 cases and review of the literature.

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.

Segmental odontomaxillary dysplasia. Report of eight cases and comparison with hemimaxillofacial dysplasia.

We report an analysis of eight cases with features as described for hemimaxillofacial dysplasia and compare our cases with those of that original report by Miles and associates. Patients were young and had bone and/or gingival enlargement, dental abnormalities, and unique radiographic and histologic features. Osseous and dental abnormalities were confined to the maxillary alveolus extending from the canine region to the tuberosity. Ipsilateral facial hypertrichosis was not observed. The condition seems to remain stable without significant progression and is hypothesized to be a developmental abnormality. We propose the term segmental odontomaxillary dysplasia (SOD) as a more precise descriptor for the constellation of features observed.

Solid adenoid cystic carcinoma of the maxilla.

Seven cases of solid variant of adenoid cystic carcinoma of the maxilla are reported. Clinical and radiographic characteristics suggest origin within the maxillary alveolar bone. Swelling was minimal and disproportionate to the extensive, diffuse bone destruction universally present. Histologic features were typical of this neoplasm occurring in other sites and consisted of diffusely infiltrating islands of small, closely packed monomorphous cells with sparse cytoplasm, indistinct borders, and small hyperchromatic nuclei. Four of five patients with follow-up data died of their disease. This confirms the lethality of the solid variant. Rationale is presented for considering these malignancies to be of primary intraosseous origin.

CEA immunoreactivity in odontogenic tumors and keratocysts.

Forty-five oral tumors and cysts were stained immunohistochemically for the presence of carcinoembryonic antigen (CEA). CEA, or a CEA-like antigen that is not nonspecific cross-reacting antigen (NCA), was demonstrated in the majority of aggressive or malignant tumors showing squamous differentiation, including cases of ameloblastoma, odontogenic carcinoma, and squamous carcinoma. CEA immunoreactivity was also found in cases of odontogenic keratocyst and focally in squamous odontogenic tumors but was not found in any of the ameloblastic fibromas, myxofibromas, odontogenic adenomatoid tumors, malignant melanomas, or apical cysts.

Oral hairy leukoplakia: a light microscopic and immunohistochemical study.

We compared the light microscopic features and immunoperoxidase staining for human papillomavirus antigen of oral hairy leukoplakia (OHL) and flat condylomatous lesions of the cervix. Our findings support the conclusion that OHL and flat condylomatous lesions of the cervix are not similar morphologically or etiologically. Therefore the term koilocyte seems inappropriate to describe the swollen epithelial cells in OHL. The various diagnostic criteria for a diagnosis of OHL were reviewed. On the basis of the review of our cases of OHL and our review of the literature, we conclude that a definitive diagnosis of OHL requires either the biochemical evidence of Epstein-Barr virus or the ultrastructural demonstration of herpesviruses in suspected lesions.

Oral hairy leukoplakia: ultrastructural observations.

On the basis of the clinical appearance and the light microscopic findings, we determined 16 biopsy specimens to be possible examples of oral hairy leukoplakia. All 16 specimens were studied by means of electron microscopy. Ten of these specimens contained typical herpes-type viral particles in the epithelial cells of the upper stratum spinosum. None of the specimens contained ultrastructural evidence of human papillomaviruses.

Extranodal oral lymphoma. Part II. Relationships between clinical features and the Lukes-Collins classification of 34 cases.

Thirty-four cases of extranodal oral lymphoma were classified according to the Lukes-Collins system on the basis of morphology and immunoperoxidase staining, and these findings were correlated with the clinical features of each case. Vestibule and gingiva, mandible, palatal soft tissue, and maxilla were, respectively, the most common locations for all the tumors, and the most frequently stated signs and symptoms were swelling, pain, paresthesia, anesthesia, ulceration, and discoloration. Eighty percent of the lymphomas were composed of transformed follicular center cells or postfollicular cells. Patients with lymphomas composed of nontransformed follicular center cells had a greater mean age than those with tumors of transformed follicular center cells or postfollicular cells, and a trend of decreasing age with increasing B cell transformation of the tumor type was seen. Within each Lukes-Collins category, the percentage of tumors that presented with bone involvement increased as the tumor category advanced in B cell transformation. Follow-up information indicated that the prognosis was poorest with postfollicular lymphomas, intermediate with transformed follicular center cell lymphomas, and best with nontransformed follicular center cell lymphomas.

Oral mucosal cytomegalovirus as a manifestation of the acquired immune deficiency syndrome.

Cytomegalovirus (CMV) infection presenting as a painful palatal gingival ulcer was one of the initial clinical manifestations of the acquired immune deficiency syndrome (AIDS) in a male homosexual patient. The diagnosis of oral CMV infection was established when large intranuclear and smaller cytoplasmic CMV inclusions were observed in endothelial cells at the base of the mucosal ulcer. The identification of intranuclear and intracytoplasmic herpes-type viral particles in the infected cells was confirmed by electron microscopy. Cytoplasmic viral particles coexisted with paranuclear dense bodies resembling lysosomes. These features are characteristic of CMV-infected cells. A review of the English-language literature disclosed only three previously reported cases of CMV infection involving the oral mucous membranes. A vasculitis associated with the CMV-infected endothelial cells appears to be the underlying mechanism responsible for development of the oral ulcer. CMV should be considered a possible causative agent when oral ulcers are detected in immunocompromised patients. Likewise, the finding of CMV in oral ulcers should alert one to the possibility of an immunocompromised state.

Extranodal oral lymphoma. Part I. A morphologic and immunoperoxidase study of 34 cases.

Thirty-four cases of oral lymphoma were classified by the Lukes-Collins system on the basis of morphology and immunoperoxidase staining. Ninety-seven percent of these were morphologically identified as B-cell neoplasms: 6% SCFCC, 9% LCFCC, 26% SNCFCC, 24% LNCFCC, 12% IBS, and 18% malignant plasma cell proliferations. Monoclonal immunoperoxidase staining for cytoplasmic immunoglobulin was positive in 41% of the cases overall, but 100% of the cases of immunoblastic sarcoma and malignant plasma cell lesions stained positively.

Squamous cell carcinoma of the lip developing in discoid lupus erythematosus.

Since the substitution of steroids and antimalarials for irradiation in the treatment of discoid lupus erythematosus, squamous cell carcinoma arising in discoid lupus erythematosus is thought by some to be an uncommon occurrence. A review of the recent literature (subsequent to 1945) revealed fifteen cases, of which seven occurred in the lips. In one of twelve of the cases a history of irradiation was documented. In three other cases, there was no evidence of its use. We report an additional case of squamous cell carcinoma occurring in the lower lip of a 24-year-old black woman in the absence of radiation therapy. A review of the literature and a discussion of possible predisposing factors are presented.

Lobular (polymorphous low-grade) carcinoma of minor salivary glands. A clinicopathologic study of twenty cases.

Twenty cases of a recently described adenocarcinoma of minor salivary gland--lobular carcinoma--are reviewed. This distinctive lesion occurs most frequently on the palate of patients in their sixth and seventh decades and displays no apparent sex or race predilection. Histomorphologically, the tumor is characterized by cytologic uniformity, bland nuclear chromatin, and low mitotic rate. Its lobular configuration and marked infiltrative tendency, often by single-filed tumor cells, are reminiscent of lobular carcinoma of the breast. Follow-up data indicate a favorable prognosis and are in accord with findings of previous investigators. The possible relationship of this lesion to adenoid cystic carcinoma is discussed.