AAOMP case challenge: hemorrhagic gingival mass

This 24-year old black female presented with a chief complaint of this gingival mass. She states she first noticed the lesion about three months ago and it has gotten progressively larger. What is your diagnosis?

Adenomatoid dentinoma. Report of four cases of an unusual odontogenic lesion

Four cases of a rare odontogenic lesion are reported. In each of the 4 examples, the lesion manifested itself as a well-circumscribed unilocular radiolucency in the mandibular third molar region in an adult. The histopathologic features consisted of an encapsulated proliferation of odontogenic hard and soft tissues. The hard tissue component consisted of dentin deposited in a peripheral ringlike configuration that enclosed odontogenic epithelium resembling adenomatoid odontogenic tumor. Whether this process represents a neoplasm or an odontogenic hamartoma is an unresolved question. Treatment in each case consisted of curettage, and no recurrences were observed.

Odontogenic keratocysts of the midline maxillary region

PURPOSE

This article compares the demographic features of the anterior midline maxillary odontogenic keratocyst with those in other regions.

MATERIALS AND METHODS

The data on 18 cases of anterior midline maxillary odontogenic keratocyst were reviewed.

RESULTS

Thirteen of the cases were in men (72.2%), and 16 of the patients (88.9%) were past the age of 60 years. The mean age of the patients was 69.9 years, which is much higher than for odontogenic keratocysts in other locations. The most common clinical diagnoses were periapical cyst and nasopalatine duct cyst.

CONCLUSION

It is important to include odontogenic keratocyst in the differential diagnosis of anterior midline maxillary radiolucencies, especially when they occur in older individuals.

Macrognathia of renal osteodystrophy in dialysis patients

A multiinstitutional study of macrognathia secondary to renal osteodystrophy in dialysis patients is presented. The nine cases reviewed reveal a variety of radiographic and histopathologic features, some of which resemble fibrous dysplasia and others suggestive of Paget's disease of bone. This article contains diagnostic criteria for differentiating renal osteodystrophy from similar fibro-osseous proliferations along with a discussion of the underlying cause and appropriate therapeutic interventions.

Squamous cell carcinoma of the gingiva with an atypical appearance

An atypical presentation of squamous cell carcinoma of the mandibular gingiva is presented. This case, along with previously reported cases in the literature, demonstrate the need for thorough intraoral examination and investigation of any unexplained, persistent lesions. Emphasis is placed upon histopathologic examination of such lesions in order to arrive at a definitive diagnosis.

Guided tissue regeneration using a biodegradable barrier membrane for new attachment: a clinical, histologic, and histometric study in dogs

Although nonbiodegradable barrier membranes have proven partially successful in achieving regeneration of lost periodontium through the principles of guided tissue regeneration, their use requires a second surgical procedure for their removal. The results of a study, in which a biodegradable collagen membrane was used to treat dehiscence defects in dogs, are presented. The membrane was an effective barrier to the downgrowth of gingival epithelium during the early stages of healing and tended to increase the regeneration of new cementum and connective tissue attachment. It was also biocompatible and biodegradable.

Calcium channel blocker-induced gingival hyperplasia: case report and review of this iatrogenic disease

Gingival hyperplasia is a common disorder associated with phenytoin and cyclosporine therapy. However, induction of this condition by calcium channel blockers is less well known. Inflammation of the gingival tissue from bacterial plaque and the subsequent development of gingival crevicular fluid may allow sequestration of the calcium channel blocker, thus predisposing the tissue to a localized toxic effect and the development of gingival hyperplasia. Calcium channel blockers have cellular effects similar to those of phenytoin and cyclosporine, including the production of a localized folic acid deficiency. All of the available calcium channel blockers have been reported to cause gingival hyperplasia. Treatment options include meticulous plaque control, and in severe cases, gingivectomy. Gingival hyperplasia can be prevented with meticulous plaque control or avoidance of the offending medication.

Investigation into the histogenesis of congenital epulis of the newborn

Five previously unreported cases of congenital epulis of the newborn are presented. All five cases were on the anterior maxillary alveolar ridge. Four were removed at 2 days of age and one at 7 weeks. Light microscopy demonstrated large eosinophilic granular cells within vascular fibrous connective tissue. Immunohistochemical studies revealed a positivity for vimentin and neuron specific enolase. Cytogenetic evaluation performed on one case was normal. Estrogen and progesterone receptors were absent in the one case so studied. Electron microscopy demonstrated tumor cells that were filled with autophagosomes. Cellular organelles were significantly reduced and inversely related to the number of cytoplasmic autophagosomes. Many of the autophagosomes contained collagen precursors. Poorly formed junctional complexes were seen. Occasional tumor cells demonstrated long processes that contained contractile microfilaments, pinocytosis, and areas of exocytosis. These studies suggest the tumor cells represent early mesodermal cells that express pericytic and myofibroblastic features that undergo cytoplasmic autophagocytosis.

Oral neurofibrosarcoma associated with neurofibromatosis type I

One of the most feared complications of neurofibromatosis type I (NF-I) is development of cancer, which is estimated to occur in about 5% of cases. The most common associated malignancy is the neurofibrosarcoma (NFS). HOwever, oral NFS in association with NF-I has rarely been reported. We report two cases of oral NFS arising in patients with NF-I. Both patients died of their tumors. Oral NFS arising in association with NF-I appears to have an extremely poor prognosis, as do these tumors at other sites of the body.

Myospherulosis. Report of a case

A case of myospherulosis, a condition first reported in 1969, is reported following the extraction of mandibular third molars and subsequent placement of Terra-Cortril and Gelfoam into the extraction sites. The lesions were discovered during a periodontal surgical procedure and to the best of our knowledge this is the first such report in the periodontal literature.

Eccrine spiradenoma: report of a case

A case of eccrine spiradenoma of the lip is presented. This benign lesion of the eccrine sweat glands must be considered in the differential diagnosis of solitary or multiple soft tissue lesions of the head and neck. Final diagnosis is dependent on histologic examination. Carcinomatous transformation has been reported in eight cases, especially in those tumors of long duration.

Labial salivary gland tumors

A study was conducted on labial salivary gland tumors from four oral pathology laboratories. Of the 103 identified tumors, 87 (84.5%) were from the upper lip, whereas 16 (15.5%) were from the lower lip. Of the 87 upper lip tumors, 80 (92.0%) were benign. Forty-three of these were monomorphic adenomas and 37 were pleomorphic adenomas. Seven malignant tumors of the upper lip were as follows: four adenoid cystic carcinomas, two acinic cell carcinomas, and one adenocarcinoma. Of the 16 lower lip tumors, 15 (93.8%) were malignant. Thirteen of these were mucoepidermoid carcinomas and two were acinic cell carcinomas. The only benign lower lip tumor was an intraductal papilloma. These results confirm the findings of previous investigations, showing that minor salivary gland tumors are much more common in the upper lip than the lower lip, but that lower lip tumors are more likely to be malignant.

Dentinal candidiasis in cancer patients

Two examples of an unusual presentation of oropharyngeal candidiasis in cancer patients are offered. The light and scanning electron microscopic appearances of candidiasis involving the dentin of teeth are described. The potential significance of recognition of this form of candidiasis in cancer patients is discussed.

Histologic fate of dermal grafts following implantation for temporomandibular joint meniscal perforation: a preliminary study

A study was carried out to evaluate the histologic changes of meniscus perforation repair associated with dermal grafts to the temporomandibular joint of cynomolgus monkeys (Macaca fascicularis) following surgical perforation of the meniscus. Dermal grafts were studied histologically at 3-week, 6-week, 3-month, and 6-month intervals. Results showed early attachment of the dermal graft to the meniscus, followed by gradual incorporation of the graft into the meniscus and subsequent return of the meniscal-graft complex to a normal meniscal architecture.

The prevalence of benign fibro-osseous lesions of periodontal ligament origin in black women: a radiographic survey

A radiographic study was conducted to determine the prevalence of benign fibro-osseous lesions of periodontal ligament origin (BFOLPDLO) in black women. Of 491 black women with both a panoramic radiograph and a full or partial periapical series, thirty-eight or 7.7% (age-adjusted rate = 7.7%) exhibited BFOLPDLO. Of these thirty-eight patients, twenty-nine had what is clinically recognized as periapical cemental dysplasia, for a prevalence of 5.9% (age-adjusted rate = 5.5%). The combination of a panoramic radiograph and a full or partial periapical series appeared more sensitive in the detection of BFOLPDLO than a panoramic radiograph or full series alone.

Pyostomatitis vegetans

Pyostomatitis vegetans is a rare and unusual disorder of the oral cavity, characterized by erythema and edema of the mucosa and numerous small, superficial yellow pustules. Its significance lies in its association with inflammatory disease of the bowel, either ulcerative colitis or Crohn's disease. We report here a patient with pyostomatitis vegetans who, upon medical workup, was discovered to have asymptomatic Crohn's disease. The clinical features, histopathology, and treatment of pyostomatitis vegetans, and its purported relationship to pemphigus vegetans of Neumann are discussed.

The lateral periodontal cyst. A report of 37 cases

The lateral periodontal cyst is a developmental cyst of odontogenic origin which is located along the lateral aspect of a tooth root. Thirty-seven previously unreported lateral periodontal cysts ( LPCs ) are presented. Clinical, roentgenographic and histologic features of the LPC are reviewed. Further, the importance of distinguishing the developmental LPC from laterally positioned inflammatory cysts of pulpal or periodontal disease origin and laterally occurring odontogenic keratocysts is stressed.

The laterally positioned odontogenic keratocyst. A case report

An odontogenic keratocyst which was in a lateral periodontal location is reported. The histology of the odontogenic keratocyst is compared with that of the lateral periodontal cyst. The importance of correctly diagnosing the odontogenic keratocyst is stressed, especially in view of its high recurrence rate and its possible association with the basal cell nevus syndrome.

Oral melanoacanthoma. Review of the literature and report of ten cases

Melanoacanthoma is a simultaneous benign proliferation of two cell types--the keratinocyte and the melanocyte. It is a rare lesion; only twenty cases have been reported on skin and three cases intraorally. This article reports a series of ten cases of intraoral melanoacanthoma. Significant clinical differences exist between skin and mucosal lesions. Whereas the skin lesions occur almost exclusively in white persons and in an older population, the mucosal melanoacanthoma occurs in a much younger population, is seen almost exclusively among blacks, and is frequently associated with a history of trauma or irritation which precedes the rapid development of the lesion. Several cases have resolved with incomplete removal. It is conjectured that this lesion may represent a reactive phenomenon on oral mucosa rather than neoplasia.

Histologic study of a freeze-dried skin allograft in a human. A case report

HISTOLOGIC EXAMINATION at 6 weeks of a freeze-dried skin (FDS) allograft used to treat a mucogingival defect in the human revealed a striking prominence of elastic fibers within the graft, when compared to the adjacent gingiva and alveolar mucosa. This finding suggests that these fibers were retained from the donor material. The absence of a significant inflammatory infiltrate and the clinically normal healing that was observed indicates that FDS allografts are biocompatible with human oral tissue.