Mycobacterial disease of the parotid gland.

Mycobacterial disease is an unusual but important condition that should be considered in the differential diagnosis of a discrete parotid gland swelling or mass. The management of this condition involves exclusion of neoplastic disease and combined medical and surgical therapy. We present 5 cases of mycobacterial involvement of the parotid gland and discuss issues surrounding the diagnosis and treatment options.

Oncocytic adenomas and oncocytic hyperplasia of salivary glands: a clinicopathological study of 26 cases.

Twenty-six benign oncocytic lesions of the salivary glands, excluding Warthin's tumours, have been reviewed and criteria for their classification as oncocytoma, multifocal nodular oncocytic hyperplasia, diffuse oncocytosis, pleomorphic adenoma with oncocytic change or oncocytic monomorphic adenoma have been proposed. The histological and clinical features of this heterogeneous group of lesions are discussed. This analysis suggests that the majority of lesions initially categorized as oncocytomas were, in fact, either non-neoplastic or, alternatively, oncocytic change in other types of adenoma.

The problem of the taxonomy of the fusiform bacillus of acute necrotizing ulcerative gingivitis (Vincent's gingivitis).

The characteristic microscopic appearance of the fusospirochaetal complex in smears from patients with acute necrotizing ulcerative gingivitis has long been regarded as virtually pathognomonic of the disease. Unfortunately there is considerable confusion surrounding the taxonomy of the fusiform organism in the fusospirochaetal complex. The conflicting views appear to be irreconcilable and a re-evaluation of the taxonomy of oral fusiforms is urgently required.

Infarcted ('infected') adenolymphomas. A clinicopathological study of 20 cases.

From a total of 323 adenolymphomas in the files of the British Salivary Gland Tumour Panel there were 20 cases (6.2%) which showed extensive necrosis, fibrosis and inflammation. The clinical and microscopical features of this distinctive subtype are described and it is suggested that infarction rather than infection is the more probable aetiological factor. In 40% of these infarcted adenolymphomas there was granuloma formation which mimicked tuberculosis or sarcoidosis and this possibility should be borne in mind when examining lesions in the parotid region.

Nevus unius lateris and intraoral verrucous nevi.

A case of nevus unius lateris and two cases with similar intraoral lesions but no evidence of cutaneous involvement are described. The terminology of papillary intraoral epithelial nevi is discussed, and it is suggested that lesions of this type, confined solely to the mouth, should be called verrucous nevi.

Malignant myoepithelial carcinoma (myoepithelioma) arising in a pleomorphic adenoma of the parotid gland. An immunohistochemical study and review of the literature.

A 66-year-old woman presented with a giant tumor of the parotid gland, which under a light microscope had a sarcomatous appearance with spindle-shaped myoepithelial cells (malignant myoepithelioma). Histochemical examination showed longitudinal fibrils in the cytoplasm of the myoepithelial cells. Immunohistochemical studies showed positive staining for S-100 protein, vimentin, and actin in the myoepithelial cells. Cytokeratin was seen in the ductular epithelial cells and in the periductular myoepithelial cells, but it was absent from malignant myoepithelial cells. Ultrastructurally, these cells contained several longitudinally oriented slender structures resembling myofilaments without dense bodies. A review of the literature confirms the rarity of malignant myoepithelial carcinoma (myoepithelioma) arising in the parotid gland, and we therefore add another case.

Lymphomas of salivary glands.

Primary lymphomas arising in salivary glands are very uncommon. The histologic classification of 40 cases of lymphomas in salivary gland tissue submitted to the British Salivary Gland Tumour Panel is reported, and, for 30 of the patients for whom adequate information was available, the clinical presentation, management, and outcome have been analyzed. Lymphomas in salivary glands represented 1.7% of all reported salivary neoplasms. The majority developed in the parotid glands of patients aged between 50 and 70 years. Only four cases gave a premorbid history compatible with sicca syndrome. In this series, non-Hodgkin's lymphomas predominated; 23 were Grade I, and 13 were Grade II. Treatment regimens were not uniform, but are outlined. Survival ranged from 5 to 111 months. Median survival for the group was 49 months. Prognosis was not influenced by the clinical stage of disease at presentation. Four cases of lymphoma arising in benign lymphoepithelial lesions are included. None had clinical symptoms of sicca complex. Prognosis for this group was found to be as favorable as the others.

Acquired immune deficiency syndrome: review.

PIP: Acquired immunodeficiency syndrome (AIDS) is reviewed for dental practitioners, with an emphasis on oral findings; the clinical course, diagnosis, reporting, treatment, prognosis, transmission, and epidemiology are also covered. HIV infection has an incubation period that may be associated with glandular fever, a prodrome called AIDS-Related Complex (ARC) characterized by lymphadenopathy, low fever, weight loss, night sweats, diarrhea, oral candidosis, nonproductive cough and recurrent infections. AIDS is characterized by opportunistic infections. Over 50% present with pneumocystis carinii pneumonia, 21% with Kaposi's sarcoma, and 6% have both. The AIDS virus causes direct neurological symptoms in some cases. Oral candidosis (thrush) in a young male without a local cause such as xerostomia or immune suppression is strongly suggestive of AIDS. Other oral manifestations are severe herpes simplex, varicella-zoster, Epstein-Barr virus, cytomegalovirus, venereal warts, aphthous ulceration, mycobacterial oral ulcers, oral histoplasmosis, sinusitis and osteomyelitis of the jaw. Hairy leukoplakia, usually seen on the lateral border of the tongue, is probably caused by Epstein-Barr virus. Kaposi's sarcoma, an endothelial cell tumor, is characteristic of AIDS, and in 50% of patients is oral or perioral. Cervical lymph node enlargement will be seen in those with ARC as well as AIDS. No guidelines have been issued by the Department of Health and Social Security for dental surgeons in the UK for reporting AIDS cases. Although HIV virions have been isolated from saliva, there are no known incidents of transmission via saliva. HIV is less likely to be transmitted by needle stick injuries than, for example hepatitis B (25% risk), especially if the blood is from a carrier rather than a full blown AIDS case.^ieng