Soluble forms of Toll-like receptor 4 are present in human saliva and modulate tumour necrosis factor-alpha secretion by macrophage-like cells.

In health, mucosal inflammation is prevented by tightly regulated responses via Toll-like receptors (TLR) that interact with specific microbe associated molecular patterns. Currently, 13 TLRs have been identified. Based on the specificity of ligand recognition, TLR-2 and TLR-4 can recognize most oral commensal microorganisms. Recent identification of some soluble TLRs (sTLRs) suggests additional regulatory roles for these receptors. We report here the presence of sTLR-4 polypeptides in adult human saliva. Functionally, the salivary sTLR-4 suppressed cytokine secretion by activated macrophages. The sTLR-4 levels were elevated significantly in oral lichen planus (OLP), a chronic inflammatory condition of the oral mucosa characterized by clinical persistence. In contrast, the epithelial cells in the saliva of OLP subjects expressed significantly reduced TLR-2 and TLR-4 mRNA that correlated with fewer bacteria/salivary epithelial cells. Investigating the soluble and cellular components of saliva is useful in identifying potential biomarkers for oral mucosal lesions.

Ameloblastic carcinoma: a clinicopathologic study and assessment of eight cases.

The term ameloblastic carcinoma is differentiated from the term malignant ameloblastoma and is defined as an ameloblastoma in which there is histologic evidence of malignancy in the primary tumor or the recurrent tumor (or metastasis), regardless of whether it has metastasized. Eight cases of ameloblastic carcinoma from the Armed Forces Institute of Pathology (AFIP) are reported. The mean age of patients was 30.1 years, with no sex predilection noted. Seven cases involved the mandible and one involved the maxilla, with the posterior regions favored. The most common sign was swelling, although pain, rapid growth, trismus, and dysphonia also occurred. Lesions characteristically were evident as ill-defined destructive radiolucencies, with occasional radiopacities noted. Histologic features generally resembled those of conventional ameloblastoma but with cytologic features of epithelial malignant disease. The clinical course was uniformly aggressive with extensive local destruction and spread, frequent recurrences, and one case of neck node metastasis. The nomenclature and classification of odontogenic carcinomas are discussed, as well as entities that should be included in the differential diagnosis. Further reporting of ameloblastic carcinoma is encouraged.

Salivary gland tumors of the tongue. Analysis of 55 new cases and review of the literature.

Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.

Psoriasis. Palatal manifestations and physiologic considerations.

The histologic and clinical criteria for psoriasis involving the palate are discussed. A review of the literature shows the present case to be the fifth well-documented one in the literature. A possible explanation for the rarity of clinical manifestations in the oral cavity is presented.

Clouston syndrome: an ultrastructural study.

A previously undescribed French-Canadian family affected with Clouston Syndrome (Hypohidrotic Ectodermal Dysplasia) is described. Ultrastructural study of the hair shows disorganization of the hair fibrils with loss of the cuticular cortex. The SEM findings are consistent with the model, suggesting a biochemical defect in the keratin of the integumentary system.

Squamous odontogenic tumor. Report of five cases and review of the literature.

Five previously unreported cases of squamous odontogenic tumor are reported and the literature is reviewed. This lesion appears to be a benign odontogenic neoplasm arising from rests of Malassez; it occurs over a wide range and has a predilection for the anterior maxilla and the posterior mandible. Maxillary lesions are more aggressive than mandibular ones. The most common sign is mobility of teeth in the area. Radiographically, the most characteristic picture is that of a well-circumscribed semicircular radiolucency bounded by a sclerotic border and emanating from the area of the alveolus adjacent to the roots of teeth. The histologic features are sufficiently characteristic to differentiate it from ameloblastoma and epidermoid carcinoma; however, evaluation of the entire clinicopathologic picture is necessary to exclude the diagnosis of squamous odontogenic tumorlike proliferations in an odontogenic cyst.

A clinical, genetic, and ultrastructural study of snow-capped teeth: amelogenesis imperfecta, hypomaturation type.

Snow-capped teeth (SCT) is a rare form of amelogenesis imperfecta, hypomaturation type. It has been alluded to on numerous occasions but, to our knowledge, no pedigree or clinical-histopathologic data have been published. In this report, two families are described. Scanning electron microscopic (SEM) studies of unetched teeth from affected persons revealed numerous defects of the enamel surface. After etching with 10 percent hydrochloric acid for 21/2 minutes to remove the outer prismless layer of enamel, SEM features of the enamel prism were essentially identical to those of normal teeth. These findings suggest that the structural defect in SCT is confined to the outer prismless enamel layer and that the bulk of the enamel is normal. The genetic analysis supports the concept that SCT is inherited in an X-linked recessive fashion and not as an autosomal dominant trait, as previously reported.

Paraoral cartilage analogue of fibromatosis.

A case of cartilage analogue of fibromatosis (CAF) adjacent and inferior to the mandible of a 48-year-old man is reported. CAF is a term currently used by some authors to replace the term juvenile aponeurotic fibroma. Histologically, this apparent variant of fibromatosis is made up of a richly cellular fibroblastic stroma with foci of fibrocartilage or benign chondroid differentiation. Although the CAF may be locally aggressive, malignant behavior has not been reported, and these neoplasms may be adequately managed by conservative surgery. This case appears to be the first case of CAF from paraoral region; however, care examination of previous reports and cases of fibromatosis may indicate that this entity may be more common that the literature suggests.

Focal odontoblastic dysplasia: dentin dysplasia type III?

A new, nonsyndromic dentin defect, focal odontoblastic dysplasia, is described on the basis of clinical, radiographic, histologic, and scanning electron microscopic criteria. A provisional classification is proposed for this disease entity according to the nosology of Shields and associates. Four additional cases in the literature which possibly represent this new entity are presented, and a possible genetic etiology is discussed.

Dentin dysplasia, type II: a rare autosomal dominant disorder.

Dentin dysplasia, Type II, is a rare autosomal dominant disorder. The primary teeth are amber and translucent and the pulp chambers are obliterated. The permanent teeth have a normal to brown-gray coloration and a thistle-tube pulp configuration with multiple true denticles. To date, only five families with this disorder have been reported. This article presents two additional families. Light and scanning electron microscopy of an affected primary incisor showed the dentin, including the mantle layer, to be highly disorganized throughout. Possible pathogenic events associated with the phenotype are discussed.

Central leiomyoma of the mandible.

A case of central leiomyoma of the mandible is reported, along with ultrastructural confirmation of the diagnosis. The pertinent literature is reviewed. It is probable that this lesion arose from the smooth muscle in the walls of blood vessels. To the best of our knowledge, this is only the second report of a leiomyoma central in bone.

Ultrastructural study of an odontogenic myxoma.

Ultrastructural study of an odontogenic myxoma has revealed two basic types of tumor cells: secretory and nonsecretory. The secretory cell type is the principal tumor cell and resembles the fibroblast in many respects. Although the ultrastructural findings indicate an abortive attempt at collagen fibrillogenesis, there is at the same time prominent secretory activity within the tumor cells, resulting in excessive production of acid mucopolysaccharide ground substance. There may also be phagocytosis by tumor cells of residual collagen in the area compatible with an odontogenic origin, they are not incompatible with an origin from primitive nonodonotogenic mesenchymal rests.