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Wongpattaraworakul W, Krongbaramee T, Lanzel EA, Hellstein JW, Teixeira FB. Hematolymphoid neoplasm mimicking endodontic lesions: case series and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00406-1. [PMID: 39179451 DOI: 10.1016/j.oooo.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/16/2024] [Accepted: 07/20/2024] [Indexed: 08/26/2024]
Abstract
Hematolymphoid neoplasms originating in the periapical region of a tooth are rare occurrences. Their signs, symptoms, and radiographic findings can also mimic lesions of endodontic origin. History-taking and clinical examination provide clues to determine the possibility of a non-endodontic lesion, although the definitive diagnosis can only be rendered based on histologic examination. In our case series, we present four cases of hematolymphoid neoplasms that radiographically mimicked endodontic lesions. All the cases initially underwent endodontic treatment, but the lesions failed to resolve. In one case, the clinician suspected a diagnosis of lymphoma based on the patient's history. In the other cases, the clinicians' impression was that the lesions originated from endodontic issues. We present two cases of diffuse large B-cell lymphoma, a case of a plasma cell neoplasm, and a case of Langerhans cell histiocytosis, along with a literature review of three entities when found in the oral cavity as well as review of hematolymphoid neoplasm mimicking endodontic lesion previously reported in literature.
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Affiliation(s)
- Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA; Division of Oral Diagnostic Sciences, Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
| | - Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, IA, USA.
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Palma L, Marcucci M, Serrano R, Campos L. Langerhans cell histiocytosis simulating endodontic periapical lesion: Are we prepared to diagnose and manage it? A case report. Natl J Maxillofac Surg 2022; 13:294-297. [PMID: 36051796 PMCID: PMC9426689 DOI: 10.4103/njms.njms_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/02/2022] [Accepted: 04/02/2022] [Indexed: 11/05/2022] Open
Abstract
Many aggressive non-endodontic radiolucent lesions show very similar clinical and radiographical features to periapical lesions of endodontic origin. Since the treatments of endodontic and non-endodontic lesions differ markedly, a precise diagnosis is imperative. Thus, the present study aimed at presenting a clinical case on the diagnosis and management of a Langerhans cell histiocytosis (LCH) lesion mimicking a periapical lesion of endodontic origin. A 51-year-old male patient was referred to a private dental office due to slight pain from the region of tooth 36. Although no sign of prosthetic or endodontic failure was noted, radiographical examination revealed a radiolucent image with poorly defined borders associated with the periapical region of the tooth. Apicoectomy and bone curettage were then performed and, given the clinical and laboratory features, the definitive diagnosis of solitary eosinophilic granuloma was made. The surgical treatment was sufficient for the remission of the symptoms, and recurrence was not observed. Given the current case, dentists should be aware of LCH lesions as they may mimic endodontic periapical pathoses, leading to misdiagnosis and therapeutic complications. Moreover, alveolar bone lesions may be the first or only sign of LCH in many cases.
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Cardoso CL, Damante JH, da Silva Santos PS, de Assis Taveira LA, da Silva Ramos Fernandes LMP, Pigatti FM, Soares CT, Coelho RF. Rosai-Dorfman Disease With Widespread Oral-Maxillofacial Manifestations: A Case Report. J Oral Maxillofac Surg 2012; 70:2600-4. [DOI: 10.1016/j.joms.2011.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 12/02/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022]
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Santos LC, Ramos EAG, Gurgel CAS, de Santana EJB, Dos Santos JN. Immunohistochemical detection of Langerhans cells in dental granulomas and radicular cysts. J Mol Histol 2007; 38:201-5. [PMID: 17427037 DOI: 10.1007/s10735-007-9088-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 03/22/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Dental granulomas (DGs) and radicular cysts (RCs) are chronic periapical lesions frequently involving the jaws. Langerhans cells (LCs) are dendritic cells responsible for the presentation of antigens to T lymphocytes. This study examined the expression of LCs in DG and RCs by immunohistochemical staining. STUDY DESIGN Eighteen cases of DGs and 26 cases of RCs were analyzed using anti-CD1a marker. RESULTS CD1a-labeled LCs were observed in 11.1% of DGs and in 69.2% of RCs, showing a significant correlation (P < 0.0001; Fisher's test). In DGs, LCs were only observed in granulation tissue, showing discrete immunostaining density. In RCs, LCs exhibited both a round and a dendritic shape in all epithelial layers. Although a correlation was observed between immunostaining density and epithelial thickness, as well as between immunostaining and inflammatory intensity, the differences were not significant in radicular cysts. CONCLUSION Langerhans cells provide important insight into the immunopathogenesis of chronic periapical lesions.
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Marti K, Skouteris CA, Mylonas AI, Angelopoulos AP, Morgan TA. Large preauricular swelling in a 75-year-old woman. J Oral Maxillofac Surg 2004; 62:730-5. [PMID: 15170287 DOI: 10.1016/j.joms.2003.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kiki Marti
- Department of Oral and Maxillofacial Surgery, Evangelismos General Hospital of Athens, Greece
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Suzuki T, Kumamoto H, Ooya K, Motegi K. Immunohistochemical analysis of CD1a-labeled Langerhans cells in human dental periapical inflammatory lesions--correlation with inflammatory cells and epithelial cells. Oral Dis 2001; 7:336-43. [PMID: 11834096 DOI: 10.1034/j.1601-0825.2001.00722.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Distribution and density of CD1a-labeled Langerhans cells (LCs) were examined in human dental periapical inflammatory lesions, and compared with inflammatory cell infiltration or epithelial cell proliferation. MATERIALS AND METHODS Eighty three periapical lesions (26 apical granulomas (AGs), 8 epitheliated granulomas (EGs), 34 radicular cysts (RCs), 15 residual radicular cysts (RRCs)) were collected. As control, specimens of periodontal ligaments including Malassez epithelial rests were curetted from 21 teeth. LC densities were measured and various degrees of inflammatory cell infiltration were examined immunohistochemically. Labeling indices for the cellular proliferation markers Ki-67 antigen and DNA topoisomerase II alpha were calculated in the epithelial components. RESULTS LCs were found in all periapical lesions but not in Malassez epithelial rests. LCs were more abundant in epithelial components than in subepithelial layers. Intraepithelial LCs were more frequent in RCs than in RRCs, whereas subepithelial LCs were less frequent in RRCs than in AGs and EGs. T lymphocytes consistently outnumbered macrophages, plasma cells and B lymphocytes. The range of the CD4/CD8-positive cell ratio differed according to the lesions. Increased LC density was associated with the severity of CD3-positive cell infiltration. Ki-67- and Topo II-LI showed various degrees of epithelial immunoreactivity. There was a significant correlation between LC density and proliferative potential of the epithelium in periapical lesions. CONCLUSION These findings suggested that LCs appeared to be associated with T lymphocyte infiltration and proliferative potential of the epithelial tissue in periapical lesions.
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Affiliation(s)
- T Suzuki
- Division of Maxillofacial and Plastic Surgery, Department of Oro-Maxillofacial Surgical Science, Tohoku University Graduate School of Dentistry, Sendai, Japan.
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Milián MA, Bagán JV, Jiménez Y, Pérez A, Scully C, Antoniades D. Langerhans' cell histiocytosis restricted to the oral mucosa. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2001; 91:76-9. [PMID: 11174575 DOI: 10.1067/moe.2001.110031] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Langerhans' cell histiocytosis comprises a group of disorders with Langerhans' cell proliferation as a common feature. The clinical presentation might be highly varied. Typically, there is bone involvement and, less frequently, lesions might be found in other organs, particularly the lungs, liver, lymph nodes, skin, and mucosae. Lesions limited to the oral mucosa are rare. We describe two patients with unifocal eosinophilic granuloma exclusively limited to the oral mucosa. Triamcinolone acetonide infiltration of a palatal lesion yielded a good result in one patient. Six months later, a similar lesion developed in the mandibular gingival mucosa, but it responded to the same treatment. The lesion in the other patient responded to local radiotherapy.
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Affiliation(s)
- C B Fowler
- Oral & Maxillofacial Pathology Services, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Texas, USA
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Holzhauer AM, Abdelsayed RA, Sutley SH. Eosinophilic granuloma: a case report with pathologic fracture. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:756-9. [PMID: 10397673 DOI: 10.1016/s1079-2104(99)70176-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 10% to 20% of all cases of eosinophilic granuloma occur in the jaws. A palpable mass with or without pain is the most frequent presenting clinical feature. Less common clinical signs include gingivitis, loose teeth, and oral ulceration with poor healing. We report a case of monostotic mandibular eosinophilic granuloma in a 38-year-old woman that initially manifested mandibular body fracture, an unusual and poorly documented clinical sign for this disease. The clinical and radiographic features, differential diagnosis, and treatment plan of the case are presented.
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Affiliation(s)
- A M Holzhauer
- Oral Biology and Maxillofacial Pathology Department, School of Dentistry, Medical College of Georgia, Augusta 30912-1001, USA
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Unlü F, Gürses N, Seçkin T, Unal T. Multifocal eosinophilic granuloma with sequential periodontitis-like lesions. J Clin Periodontol 1997; 24:384-7. [PMID: 9205916 DOI: 10.1111/j.1600-051x.1997.tb00201.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Eosinophilic granuloma (EG) is the localized and mildest form of the triad commonly known as Langerhans cell histiocytosis. This report describes a case manifesting itself as a periodontal problem with the localized osseous lesions in jawbones which was first diagnosed as early-onset periodontitis. Later on, the diagnosis of EG was established, relying on histopathological and immunohistochemical evaluations. Immunohistochemical findings confirm that a minor component of cell aggregates is phenotypically related to Langerhans cells among the sheet-like accumulations of histiocytes and eosinophils. The aetiology of the disease remains largely unknown. Although surgical curettage of lesions is usually effective in treatment of EG of bone, corticosteroids might be used as an adjunctive. This multifocal case of EG stresses the importance of clinical follow-up examinations, since the sequential lesions appear with irregular intervals, and this may cause diagnostic problems as well as a delay in starting the treatment regimen.
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Affiliation(s)
- F Unlü
- Department of Periodontology, School of Dentistry, Ege University, Turkey
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Uckan S, Gurol M, Durmus E. Recurrent multifocal Langerhans cell eosinophilic granuloma of the jaws: report of a case. J Oral Maxillofac Surg 1996; 54:906-9. [PMID: 8676239 DOI: 10.1016/s0278-2391(96)90546-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- S Uckan
- Department of Oral and Maxillofacial Surgery, Selcuk University, Konya, Turkey
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12
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Vincent SD, Tucker DF, Lilly GE, di Stefano J. Pathologic discontinuity of the mandible. J Oral Maxillofac Surg 1994; 52:967-71. [PMID: 8064462 DOI: 10.1016/s0278-2391(10)80082-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S D Vincent
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City
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