Nodular fasciitis and solitary fibrous tumor of the oral region: tumors of fibroblast heterogeneity.

OBJECTIVE: Fibroblastic proliferations of the oral cavity are extremely varied, yet they share certain features-spindle cell morphology, collagen synthesis, and fasciculation. Nodular fasciitis is a cellular fibroblastic lesion, uncommonly located in the oral submucosa, that shows smooth muscle actin (SMA) immunoreactivity. Solitary fibrous tumor expresses a CD34 fibroblast phenotype. The aim of this study is to report instances of nodular fasciitis and solitary fibrous tumor in the orofacial region and investigate immunohistochemical markers to compare and contrast fibroblastic phenotypic heterogeneity in these tumors. STUDY DESIGN: Seven benign cellular fibrogenic tumors initially diagnosed as nodular fasciitis over a 10-year period were examined. Immunohistochemical markers, including S-100 protein, SMA, CD68, CD34, and vimentin, were used to further characterize these lesions. RESULTS: All tumors occurred in adults, and the buccal mucosa was found to be the favored site. The spindle cells in these tumors showed phenotypic heterogeneity both within and between tumors. All were vimentin-reactive and harbored small populations of CD68-positive macrophage/dendrocytes. Five tumors were SMA-positive and CD34-negative; the tumor in one case was SMA-negative and CD34-positive, and that in another was SMA-positive and CD34-positive. CONCLUSION: Although rare, nodular fasciitis and solitary fibrous tumor arise in oral submucosa, usually in the cheek. The histopathologic features and immunomarkers indicative of myofibroblastic differentiation are seen in nodular fasciitis, whereas solitary fibrous tumor is CD34-positive; however, one instance was found to be positive for both markers. All of these cases harbored subpopulations of CD68-positive cells. Immunomarkers are a valuable adjunct in differentiating nodular fasciitis from solitary fibrous tumor, yet some tumors may harbor heterogeneous fibroblast phenotypes.

Absence of radiometric differentiation between periapical cysts and granulomas.

A recent study reported that the mean density of periapical cysts was greater than that of periapical granulomas. This study, which used a larger sample size and a robust method for standardization of density and contrast between images, found no difference between the radiographic density of cysts and granulomas classified by microscopic evaluation. Cysts tend to be larger than granulomas, but there was wide variation in size of both types of lesions. There was no significant correlation between the density of a lesion and its size.

The effects of human immunodeficiency virus infection on macrophage phagocytosis of Candida.

The effects of infection by human immunodeficiency virus (HIV) on phagocytic function towards Candida pseudotropicalis were tested using monocytotropic and nonmonocytotropic HIV strains on peripheral blood monocytes. There were no differences in either quantitative phagocytic activity or efficacy between the two infected and control mock-infected monocytes. Immunofluorescence for cytoplasmic p24 antigen and in situ hybridization for detection of HIV-specific RNA sequences revealed that very few cells (10(-4)) exhibit productive infection. Occasional cells with active infection as defined by microscopically detectable fluorescence labelling contained phagocytized yeasts.

c-myc oncoprotein expression in oral precancerous and early cancerous lesions.

Squamous cell carcinoma of the oral cavity is often preceded by clinically evident precancerous lesions. These lesions exhibit progressive cytomorphologic changes connoting cellular transformation to malignant neoplasia. Molecular events underlie the microscopically identifiable cytological changes that herald transformation. Various proto-oncogenes are activated, overexpressed or mutated in the process of transformation. This investigation was designed to determine whether the nuclear binding c-myc oncoprotein, an activator of cell division, parallels or precedes cytomorphological changes at various histologically defined stages in oral precancerous lesions. Employing immunohistological methods, it was determined that c-myc nuclear labelling paralleled the progressive histological changes among various stages of transformation. It was also noted that some, yet not all, instances of benign keratoses which lacked any cytologic evidence of atypia harboured c-myc oncoprotein positive nuclei. It is concluded that c-myc expression is correlated with progressive cell transformation in oral cancerous lesions.

Treatment of oral Kaposi's sarcoma with a sclerosing agent in AIDS patients. A preliminary study.

Presently oral Kaposi's sarcoma is primarily treated with systemic and intralesional chemotherapy, immunotherapy, radiation, and occasionally lasers. Each of these modalities achieves varying degrees of success. In patients with acquired immunodeficiency syndrome, the traditional treatments are frequently accompanied by local and generalized side effects that are detrimental to an already compromised immune system. Experience using sclerosing agents to treat other oral vascular lesions in healthy patients is known to produce excellent results. To evaluate the use of this treatment method in patients with acquired immunodeficiency syndrome, 15 oral lesions in 12 patients were injected with 3% sodium tetradecyl sulfate (Sotradecol). Thirteen lesions were located on hard palate; nine were nodular, three papular, and three macular. One week after treatment, some degree of ulceration occurred in all lesions with healing beginning by the middle of the second week. Six lesions required a second treatment to completely resolve. In one patient, healing was delayed, and the patient encountered a period of discomfort as a result of superficial bone sequestration. All other lesions healed uneventfully without the major side effects encountered with the other commonly used methods. Patients were followed for recurrence until they died or moved away. No recurrences were noted, with many followed for 18 months or longer. It is suggested that for lesions 2.6 cm or less in size, a sclerosing agent may be a better treatment modality than those now commonly used for oral Kaposi's sarcoma.

Self-healing traumatic bone cysts.

The etiology and pathogenesis of traumatic bone cyst are still far from being conclusively established with multiple theories, names, and forms of management being proposed and used. The rarity of these lesions in the older age groups suggests that self-healing can occur. This article presents two well-documented cases of what clinically and radiographically were consistent with so-called "traumatic bone cyst" of the mandible, which have appeared to heal without surgical intervention, thus providing additional information to our understanding of the biologic nature of this entity. Case 1 involved a 14-year-old boy with a lesion of the anterior left mandible that was monitored for 7 years and 5 months. Case 2 involved a 19-year-old female patient with a lesion of the right mandible that was monitored for 2 years and 9 months. In both cases, intraosseous biopsy or other surgical procedures were not undertaken. By the time both patients approached age 22, their lesions had resolved and the trabecular bone pattern radiographically approached normal.

Surgical suction damage: a common tissue artifact.

The vacuum effect of a surgical suction tip can induce significant artifactual alterations in the connective tissue of specimens removed for diagnostic or therapeutic purposes. The alterations described in this article consist of a surgical suction artifact characterized by the formation of numerous, pleomorphic vacuoles that, on casual microscopic examination, resemble the morphology of traumatized adipose tissue. This artifact occurs when a vacuum draws air into connective tissue and mobilizes connective tissue mucins (acid mucopolysaccharides) that localize within the vacuoles that are formed.

Effect of tar condensate from smoking tobacco and water-extract of snuff on the oral mucosa of mice with latent herpes simplex virus.

Upper lips were inoculated with virus to establish a latent infection in the trigeminal ganglia. During the latent period, tobacco smoke tar condensate or water-extract of snuff were topically applied to the primary inoculation site for two or three consecutive months. Tar condensate induced re-activation of latent HSV in the ganglia of 10 to 20 per cent of animals but snuff extract did not. Infectious virus was also detected in lips after the chronic application of tar condensate in 10 per cent of animals. Three months' exposure to tobacco produced epithelial dysplasia and other changes in a significant number of latent HSV-infected mice, whereas tobacco alone did not induce dysplasia in the labial epithelium of uninfected mice.

Oral cancer induced in hamsters with herpes simplex infection and simulated snuff dipping.

A number of epidemiologic studies indicate that snuff dipping is associated with an increased incidence of oral cancer in human beings. Since inactivated herpes simplex virus (HSV) has been shown to induce malignant changes in vitro and in vivo and is partially inactivated by snuff water extract, we examined the histopathologic changes of hamster buccal pouches after exposure to repeated HSV inoculation combined with long-term simulated snuff dipping. One hundred twenty-five Syrian hamsters were divided into seven groups, and the buccal pouches were inoculated with HSV-1, HSV-2, or culture medium. The mock and HSV inoculations were done once a month for 6 consecutive months. In an effort to determine the effect of snuff on the mock- or HSV-inoculated buccal pouches, a consistent amount of a commercially available snuff was placed into both the right and left pouches twice a day in half of the animals. At the end of the 6 months of simulated snuff dipping (4 weeks after the final mock or viral inoculation), the hamsters were killed and the buccal pouches were removed for the histopathologic evaluation. Neither simulated snuff dipping nor HSV infection alone induced neoplastic changes in hamster buccal pouches. However, HSV infection in combination with simulated snuff dipping resulted in epithelial dysplasia and invasive squamous cell carcinoma in more than 50% of the animals.

Oral mucosal antigen reactivity during exacerbation and remission phases of recurrent aphthous ulceration.

Pooled serum from subjects with active recurrent aphthous ulceration (RAU) and from control subjects was tested against indigenous surface mucosal material from subjects with active RAU, remission RAU subjects, and normal subjects. IgM antibody reactivity in both sera was significantly higher to material from remission RAU subject mucosa than to material from control subjects or subjects with active RAU. IgG antibody activity in both sera was significantly lower to material from active RAU subject mucosa than to material from control subjects or subjects whose RAU was in remission. These results suggest that the character and amount of antigen on mucosa may differ during the pathogenesis of RAU.

Serum antibody responses to indigenous oral mucosal antigens and selected laboratory-maintained bacteria in recurrent aphthous ulceration.

Sera from subjects with recurrent aphthous ulceration (RAU) and control subjects were tested for relative levels of IgM, IgG, and IgA antibodies against eight selected laboratory-maintained bacteria, including Streptococcus sanguis which has been implicated in the etiopathogenesis of RAU. There were no differences in relative serum antibody levels for any isotype against any bacteria between control and RAU groups. RAU subjects with active lesions were then paired with control subjects, and each serum was tested against sedimentable material derived from the oral mucosa of each pair member. The analysis of data indicated that RAU and control subjects had similar levels of serum antibodies to indigenous mucosal antigens, but RAU subjects had significantly less antigenic material than control subjects.

The distribution and morphologic variation of hyaline deposits in odontogenic lesions.

The deposits of homogeneous hyaline substances present in epithelium-containing odontogenic lesions were evaluated in 201 tumors. The material was evaluated to establish the types of odontogenic lesions capable of producing the substance, its frequency of occurrence, its microscopic variation, and the different morphologic relationships of the substance to the odontogenic epithelium present in the lesions. The deposits were found in 40.3 percent of the 201 odontogenic tumors and frequently in several other nonneoplastic odontogenic lesions. It was most consistent in odontomas but was found to some extent in all types of epithelium-containing odontogenic tumors. It was present either in a basement membrane location or as a diffuse deposit in the connective tissue. In the latter location, the deposits commonly contained enclaved islands of odontogenic epithelium and had a distinct tendency to calcify. The study also suggests that since some odontogenic tumors may contain large amounts of the hyaline deposits, multiple sections through different parts of the tumor may be required to find the epithelial elements necessary for the correct diagnosis.

Osteomyelitis of the mandible as a complicating factor in Paget's disease of bone.

A case of osteomyelitis of the mandible in a patient with extensive Paget's disease of bone is presented. The changes in the bone with Paget's disease makes the diagnosis, clinical assessment and management of the osteomyelitis in such patients a difficult task.

Extracondylar osteochondromas of the jaws.

A review of the literature and the addition of two new cases have revealed that according to a histologic criterion there are presently twenty reported cases of osteochondroma of the jaws located outside the condyles. Although most of the extracondylar lesions have occurred on the coronoid process, cases are now reported on the maxilla and the body of the mandible. The clinical features of these lesions are compared with those located in the condyle, and the radiographic and surgical approaches of the extracondylar lesions are discussed.