A retrospective study of 51,781 adult oral and maxillofacial biopsies.

BACKGROUND: Few studies have compared patient and anatomic characteristics across the broad scope of oral and maxillofacial disease seen in dental clinics. The authors conducted a study to make these comparisons by surveying a large sample of histologically diagnosed oral and maxillofacial lesions in a US adult population. METHODS: A total of 51,781 specimens biopsied from 51,781 adult patients were received by an oral pathology service over 13 years (2001-2015) and analyzed. A description of patients' sex and age at diagnosis, as well as the anatomic site of biopsy was given for diagnoses of 10 oral disease types, including malignant neoplasm, benign neoplasm, infectious, reactive, potentially malignant, developmental, healthy tissue, immune dysfunction, physical trauma, and other. RESULTS: The authors reported reactive lesions were the most prevalent disease type found in the sample (74.9%). Malignant diagnoses comprised 1.97% of all biopsies. The 3 most prevalent diagnoses in this study included benign keratosis, chronic apical periodontitis, and radicular cyst. Different anatomic sites, patient age groups, and sexes show different distributions of disease. CONCLUSIONS: Certain disease types and diagnoses were found to have a higher prevalence by sex, among particular age groups, and in certain anatomic sites. PRACTICAL IMPLICATIONS: This information provides clinicians with a detailed and broad scope of the variety of oral and maxillofacial lesions processed at an oral pathology service and may assist practitioners in forming clinical impressions and differential diagnoses.

Pediatric Oral Pathology: A Retrospective Survey of 4,554 Biopsies.

PURPOSE: The purposes of this study were to: (1) report patient age, gender, and anatomical information on a large number of pediatric oral biopsies in the United States; and (2) highlight differences in recent pediatric oral lesions compared to past pediatric studies and an adult population. METHODS: A total of 4,554 pediatric biopsies received over the past 13 years (2001-2015) were surveyed. Patient's age, gender, anatomical site of biopsy, and diagnosis were described under 10 diagnostic categories: (1) malignant neoplasm; (2) benign neoplasm; (3) infectious; (4) reactive; (5) precancerous; (6) developmental; (7) healthy tissue; (8) immune dysfunction; (9) physical trauma; and (10) other. RESULTS: A gradual increase in the number of biopsies with age was noted. The most common diagnosis observed was mucocele, consisting of 28 percent of all biopsies. Biopsies across pathological categories were most commonly obtained from the mandible. CONCLUSIONS: Biopsies received from a pediatric population are largely reactive in nature. Compared to an adult population, the pediatric population has a significantly lower rate of malignant and precancerous lesions but a higher rate of developmental diagnosis. A diverse array of pathoses was seen in the gingiva and mandible, whereas palatal mucosa and the floor of the mouth exhibited more variation.

Odontogenic fibroma, including amyloid and ossifying variants.

Sixty-five cases of odontogenic fibroma (OdonF) are herein presented having been segregated into peripheral, extra bony tumors (n = 40) and tumors arising in bone or centrally (n = 25). All cases were characterized microscopically by a fibrous proliferation that varied within and between cases in cellularity and collagen fibril diameter, with intermixed odontogenic epithelial islands and cords. All central lesions presented as well demarcated radiolucencies and resorption of contiguous tooth roots was a common finding. These intraosseous lesions were of the WHO type; the so-called nonWHO type was excluded as all lesions with this diagnosis were devoid of an epithelial component and could be reclassified as other soft tissue fibrogenic tumors. Neither the central tumors nor the peripheral lesions recurred following enucleation/curettage, with a mean follow-up of 4 and 3.4 years respectively. Three distinct microscopic variations were encountered in this series: (1) two cases of OdonF with giant cell reaction, (2) two instances of OdonF with ossifying fibroma; and (3) four instances of OdonF with odontogenic ameloblast-associated protein (ODAM), an amyloid-like protein found deposited adjacent to epithelial cords plus CD1a+/S-100+ Langerhans dendritic cells entwined around the epithelial element. A single instance of the odontogenic fibroma-like hamartoma/enamel hypoplasia syndrome has been included in this series.

Cellular angiofibroma of oral mucosa: report of two cases.

Cellular angiofibroma is a benign vascular neoplasm that typically arises in the vulva, perineal, and paratesticular region. Microscopically the lesions exhibit multiple small, non-dilated capillary channels, many of which contain erythrocytes. The endothelial lining cells are prominent, with monomorphic oval nuclei. Interposed among the vessels are both delicate and mature collagen fibers with fibroblastic hypercellularity that is variable in older lesions where sclerosis is prominent. The lesions usually do not recur following simple excision. Recent evidence indicates that cellular angiofibromas may be cytogenetically related to spindle cell lipoma. This represents the first reported instances of cellular angiofibroma in the oral cavity.

The central granular cell odontogenic tumor: report of 5 new cases.

This article reports 5 previously unreported cases of central granular cell odontogenic tumor and compares them with 25 cases from the literature. This lesion appears to be an uncommon benign odontogenic neoplasm of uncertain histogenesis; it occurs over a wide age range with a predilection for the mandibular premolar-molar region. Radiographically, it typically manifests as a well-defined unicystic or multilocular radiolucency, although it can be a mixed-density lesion as well. In our series, there was a narrow spectrum of histologic features consisting of fibrous tissue of altering density and cellularity with plentiful numbers of large eosinophilic granular cells, variable amounts of "inactive-appearing" odontogenic epithelium, and the variable presence of calcified tissue resembling cementum or dystrophic calcifications. The ultrastructural and immunohistochemical findings in this study support a mesenchymal origin for the granular cells. One recurrence was documented in the current series in contrast to no recurrences in the literature.