Central xanthoma of the jaws: a clinicopathologic entity?

OBJECTIVE: To investigate central lesions of the jaws dominated by foamy macrophages (foam cells), which are interpreted to be "central xanthomas of the jaws" and to differentiate this condition from reported cases of jaw nonossifying fibroma/fibrous cortical defect and benign fibrous histiocytoma of bone. STUDY DESIGN: The study is a literature review and a retrospective analysis of clinical, radiographic, microscopic, and immunohistochemical features of five new cases of this condition. RESULTS: The lesion has a predilection for the mandible in adults of variable ages, with the potential to become very large and destructive; however, it has a very low recurrence rate, if any, following surgical curettage. CONCLUSION: We suggest that the "central xanthoma of the jaws" be considered a unique, although rare, clinicopathologic entity. It is unclear whether this lesion is a benign neoplastic process or a persistent reactive process.

Odontoblasts in odontogenic tumors.

Odontoblasts are secretory cells displaying epithelial and mesenchymal features, which exist in a monolayer at the interface between the dentin and pulp of a tooth. During embryogenesis, these cells form a dentin shell and throughout life continue to produce dentin while, also acting as sensor cells helping to mediate tooth sensitivity. In this process, odontoblasts are forced to migrate inwards, resulting in an ongoing loss of pulp volume. Correspondingly, there is also a decrease in the surface area of the dentin which supports the odontoblast cell layer. As these events transpire, odontoblasts maintain a tightly controlled monolayer relationship to each other as well as to their dentin substrate. Stability is maintained laterally by epithelial attachment structures and transversely by complex cytoplasmic extensions into the supporting dentin. As a result, it is not possible for the layer to buckle to relieve the mechanical stresses, which develop during the inward migration. A theoretical consequence of this distinctive self-generated niche is the development of long term compressive stresses within the odontoblast population. We present a mechanobiology model, which causally relates the increase in cellular compressive stresses to contact inhibition of proliferation. We link this hypothesis to the observation that there are no reports of pulpal odontoblasts showing neoplasia or acquisition of changes suggestive of a pre-neoplastic phenotype.

Kallikrein-related peptidase 10 expression in salivary gland tissues and tumours.

OBJECTIVES: Kallikrein-related peptidase 10 (KLK10) has been implicated in the development of several types of cancer. The purpose of this study was to analyze the expression of KLK10 in 3 types of salivary gland tumour and normal salivary glands. MATERIALS AND METHODS: A standard immunoperoxidase staining technique was used to assess the immunoexpression profile of KLK10 in normal salivary glands and 3 types of salivary gland tumour: pleomorphic adenoma, adenoid cystic carcinoma and mucoepidermoid carcinoma. RESULTS: Pleomorphic adenomas showed significantly lower KLK10 levels than control tissues. Neither of the malignant tumours (adenoid cystic carcinoma and mucoepidermoid carcinoma) showed a significant alteration in the immunoreactive scores of KLK10 in comparison with the normal salivary gland tissues. KLK10 immunoreactive scores were comparable in adenoid cystic carcinoma and mucoepidermoid carcinoma. Pleomorphic adenoma had significantly lower levels of KLK10 than mucoepidermoid carcinoma. CONCLUSIONS: The finding of lower KLK10 levels in pleomorphic adenoma suggests aberrant expression in a tumour that develops primarily from myoepithelial cells. A kallikrein cascade may play a role in the development and/or outcome of some salivary gland tumours.

Oral lesions associated with injected hydroxyapatite cosmetic filler.

OBJECTIVE: The purpose of the study was to present the clinical and microscopic features of oral foreign body granulomas associated with the injectable dermal filler Radiesse, and to increase awareness of this potential complication as the use of dermal fillers by the aging Baby Boom generation increases. STUDY DESIGN: Demographic and clinical data of 8 patients with foreign body granulomas containing the characteristic microscopic appearance of hydroxyapatite microspheres were studied. Analysis of the microspheres of 1 case was carried out by energy dispersive x-ray microanalysis to confirm the calcium and phosphorus content. RESULTS: The clinical and microscopic appearance of Radiesse-induced foreign body granulomas is illustrated and discussed. CONCLUSIONS: Foreign body granulomas containing hydroxyapatite microspheres in patients receiving treatment with the cosmetic filler Radiesse have a characteristic microscopic appearance. Oral Radiesse-induced nodules occur more often in older women, most commonly in the lips and the mandibular labial vestibule.

Metastases to the mouth and jaws: a contemporary Canadian experience.

BACKGROUND AND OBJECTIVE: The types of cancers that most frequently metastasize to the mouth and jaws reflect, for the most part, the relative incidence of cancers in a given population at a given time. We report a retrospective, but relatively contemporary study of 38 cases of metastatic oral tumours in a Canadian population to compare the Canadian experience with that of nearby and distant countries. METHODS: Thirty-eight cases of metastatic disease to the mouth and jaws in a Canadian population were analyzed. Data about patients' age, sex, site of metastatic deposits, clinical history, including the presence of a known primary cancer, and radiographic features were collected from the files (1992-2010) of the oral pathology diagnostic service at the University of Western Ontario, and the hospital archives (2002-2010) of the department of pathology, London Health Sciences Centre, London, Ontario. RESULTS: Most metastases were to the mandible, although oral soft tissues were also involved, most frequently, the gingiva and mucosa of the alveolar ridge. Prostate, lung and breast cancers were the most common primary sites, but a variety of cancer types were found. CONCLUSIONS: The relative frequency of types of metastatic cancer to the oral region is similar in Canada, the United States and Northern Europe, but differs significantly from those reported in South East Asia and Japan. The relative frequency of types of cancer that metastasize to the mouth and jaws reflects the relative incidence of cancers in the population.

Benign Triton tumor of the tongue.

A case of the extremely rare benign Triton tumor of the tongue is presented. This article presents new observations concerning associated hyperelastosis, the recognition of 2 distinct clinicopathological variants, and a new theory concerning pathogenesis that more closely fits current clinical and histopathological observations.

Juvenile spongiotic gingivitis.

BACKGROUND: This article recognizes the microscopic diagnosis of acute spongiotic mucositis as an analog to acute spongiotic dermatitis of the skin and defines a specific clinicopathological entity "juvenile spongiotic gingivitis" within this microscopic spectrum. METHODS: Twenty-four patients, usually juveniles, with patches of bright red, often slightly thickened, painless, and persistent lesions of the attached gingiva, which may or may not involve the marginal gingiva, were identified by clinical and microscopic features. Immunohistochemical studies for cytokeratins 5/6 and 19, estrogen receptors, and progesterone receptors were completed on 10 of these cases. A comparison to puberty gingivitis, which occurs in the same age group, was done. RESULTS: Microscopically, the epithelium exhibited hyperplasia, significant spongiosis, loss of keratinization, and a neutrophilic infiltrate, sometimes with microabscess formation, whereas the underlying connective tissue exhibited an acute on chronic inflammatory infiltrate. Full-thickness epithelial immunostaining for cytokeratins 5/6 and 19 was found, whereas no reactivity was seen for estrogen receptors or progesterone receptors in the specimens. CONCLUSIONS: Juvenile spongiotic gingivitis differs from puberty gingivitis by not needing to show continuity with plaque-related marginal gingivitis, by a lack of response to hygiene procedures, by an occasional occurrence at ages not related to puberty, and by the absence of sex hormone receptors investigated immunohistochemically in 10 of the cases. We propose juvenile spongiotic gingivitis as a distinct clinicopathological entity.

Oral manifestations of gastrointestinal diseases.

The present paper offers a detailed review of the oral manifestations of various gastrointestinal diseases or conditions, with suggestions on how they may be relevant to the practice of gastroenterology. The review includes Crohn's disease, ulcerative colitis, Gardner syndrome, Peutz-Jeghers syndrome, malabsorption conditions related to hematopoesis, gastrointestinal malignancy metastatic to the jaws, jaundice and gastric reflux diseases.

Oral pathology in the dental curriculum: a guide on what to teach.

There has been considerable disagreement among educators on the topics and details of topics that should be included in the teaching of oral pathology to dental students and graduate students in dental specialties. Various authorities have recommended core curricula that range from comprehensive teaching of eighteen categories, each with up to nine subheadings, covering hundreds of entities, to as few as approximately fifty of the most common lesions that affect the oral and maxillofacial region. This article offers a curriculum planning model designed to help faculty make decisions about course content and emphases. The model allows instructors to assess content relevance and priority based on three criteria: 1) commonness, 2) uniqueness, and 3) significance of diseases and conditions. The product of this decision-making process is a relevance score that can serve as a guideline for the choice and details of topics to be included in oral pathology courses.

Blistering mucocutaneous diseases of the oral mucosa--a review: part 2. Pemphigus vulgaris.

Oral mucous membranes may be affected by a variety of blistering mucocutaneous diseases. In this paper, we review the clinical manifestations, typical microscopic and immunofluorescence features, pathogenesis, biological behaviour and treatment of pemphigus vulgaris. Although pemphigus vulgaris is not a common disease of the oral cavity, its potential to cause severe or life-threatening disease is such that the general dentist must have an understanding of its pathophysiology, clinical presentation and management.

Management of patients with foreign body gingivitis: report of 2 cases with histologic findings.

Foreign body gingivitis is an inflammation of the gingiva, characterized by foci containing particles of foreign material in the connective tissue, which can have either a granulomatous or a lichenoid microscopic appearance. In clinical terms, it differs from other immune-mediated gingival disorders in its limited involvement of tissues other than the gingiva, as well as its relative resistance to treatment by topical corticosteroids. Two cases are presented, with a review of the clinical features, including characteristic desquamation and mottling of the marginal gingiva and symptoms of localized tenderness and pain; gingival recession was observed in both of the reported cases. Histologic examination revealed damaged epithelium and degeneration of the basal layer, as well as a mixed inflammatory cell infiltrate in the connective tissue with refractile or opaque particles of foreign material. Gingival inflammation and the severity of gingival erosions improved dramatically with careful debridement, improved home care and more frequent, diligent periodontal maintenance therapy. Free gingival grafts, together with excision of affected tissues, served to stabilize and reinforce the marginal tissues, as well as eliminating further clinical signs of the disease; excision alone was not as effective. Patients require careful dental and periodontal management as well as appropriate oral home care to avoid further mechanical damage to the gingiva; in addition, the use of dental abrasives and polishing agents should be restricted, particularly if gingival lesions are present. Home care recommendations include avoidance of dentifrices with certain chemical additives and rinses with a high alcohol content.

Intraoral chondroid lipoma: a case report and immunohistochemical investigation.

Lipomas are common neoplasms of fat in the oral cavity. However, the diagnosis may be difficult for lesions exhibiting unusual histological features. This paper documents the first intraoral report of a chondroid lipoma. The differential diagnosis is discussed. It is important for practicing oral pathologists to recognize rare variants to ensure accurate diagnosis and appropriate treatment for the patient.

Blistering mucocutaneous diseases of the oral mucosa--a review: part 1. Mucous membrane pemphigoid.

Oral mucous membranes may be affected by a variety of blistering mucocutaneous diseases. In this paper, we review the clinical manifestations, typical microscopic and immunofluorescence features, pathogenesis, biological behaviour and treatment of mucous membrane pemphigoid (MMP). As MMP is a relatively common condition, the general dentist must be able to diagnose, treat and monitor the progress of their affected patients or refer when appropriate.

The adhesion molecules NCAM, HCAM, PECAM-1 and ICAM-1 in normal salivary gland tissues and salivary gland malignancies.

BACKGROUND: Some malignant salivary gland tumors are known for their propensity to exhibit perineural invasion and vascular metastases. It was hypothesized that alterations in the expression of cell adhesion molecules are involved in these processes. METHODS: The expression and distribution of neural cell adhesion molecule (NCAM), HCAM (CD44), platelet-endothelial cell adhesion molecule-1 (PECAM-1), and intercellular cell adhesion molecule-1 (ICAM-1) in normal salivary gland tissues and selected salivary gland malignancies, especially adenoid cystic carcinoma (AdCyCa) and polymorphous low-grade adenocarcinoma (PMLG), were determined immunohistochemically, and their influence on histologically demonstrated perineural invasion, vascular invasion, and tumor recurrence/patient death were investigated. RESULTS: NCAM, HCAM, and ICAM-1 were often found to be expressed by neoplastic cells, but no correlation to perineural invasion, tumor behavior, or patient prognosis was found. PECAM-1 was rarely and only focally expressed in three tumors, all of which were related to tumor metastases and patient death. CONCLUSIONS: Immunohistochemical demonstration of NCAM, HCAM, and ICAM-1 is not related to perineural invasion or tumor behavior. PECAM-1 expression was related to vascular invasion and poor patient prognosis in three cases.

Nonsquamous cell malignant tumours of the oral cavity: an overview.

Many malignant tumours other than squamous cell carcinoma may present in the oral cavity. Melanomas of the oral cavity are usually pigmented, aggressive tumours associated with a poor prognosis. Neoplasms of the minor salivary glands have a greater tendency to be malignant than those of the major glands, and some exhibit a predilection for occurring in the mouth. Many types of connective tissue malignant tumours (sarcomas) may arise in the mouth, including soft-tissue cancers and lesions of hematologic cells such as lymphoma, whereas osteosarcoma is the most common malignancy of the hard tissues found in the mouth. Cancers from distant organs such as breast, lung and prostate may metastasize to the oral cavity. This paper presents a brief overview of nonsquamous cell oral cancers, with emphasis on those most likely to be encountered by the practising dentist.