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Stevenson MD, Dunlap CA, Shin M, Oza S, Lai GS. Invasive Oral Squamous Cell Carcinoma Mimicking a Dentoalveolar Abscess: Report of a Case in a 14-Year-Old Patient. J Endod 2024:S0099-2399(24)00335-2. [PMID: 38815856 DOI: 10.1016/j.joen.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION A diagnosis of oral squamous cell carcinoma in adolescent patients is extremely rare. When an oral squamous cell carcinoma lesion arises near the teeth and/or periodontium, it can be easily misdiagnosed as an inflammatory condition of endodontic or periodontal origin. METHODS This is a case report of an otherwise healthy 14-year-old patient who was referred for endodontic evaluation and treatment of a soft-tissue swelling in the anterior maxilla. RESULTS The unexpected definitive diagnosis of invasive oral squamous cell carcinoma underscores the importance of proper diagnostic testing. CONCLUSIONS Accurate interpretation of pulp testing results, periapical and cone beam computed tomography imaging, timely biopsy, and prompt definitive treatment are critical when a lesion of nonodontogenic origin is suspected.
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Affiliation(s)
- Mark D Stevenson
- Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California
| | - Craig A Dunlap
- Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California.
| | - Michelle Shin
- Resident, University of California, San Francisco, Ravenswood Family Health Center, East Palo Alto, California
| | | | - Gordon S Lai
- Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California
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Krongbaramee T, Wongpattaraworakul W, Lanzel EA, Hellstein JW, Teixeira FB. Retrospective Evaluation of Periradicular Biopsies: An 18-Year Study. J Endod 2023; 49:1457-1463. [PMID: 37543187 DOI: 10.1016/j.joen.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Radiographic findings in periradicular areas are repeatedly associated with infected root canal systems. Although non-odontogenic lesions in teeth are reported to be low, they often mimic periapical pathoses, and consequently, histopathologic examinations after surgical revisions are nurtured. METHODS Biopsies submitted to the College of Dentistry between 2003 and 2021 were reviewed. Clinicopathologic characteristics were collected, including age, sex, medical history, location, sensibility tests, and clinic impressions from each specimen. Histopathologic diagnosis and gross description were also part of our database. RESULTS A total of 72,055 pathology reports were reviewed, of which 10,031 lesions (13.9%) met the criterion of being intraosseous lesions at the periradicular area. Among those 10,031 lesions, 7.94% (n = 796) were of non-endodontic origin, 7153 were documented as non-vital, and 2.36% (n = 169) of these non-vital teeth were diagnosed with a non-endodontic origin. A total of 5707 lesions were obtained from surgeries within the periapical tissues, primarily performed by endodontists (94.02%). Non-endodontic lesions were reported in 1.09% of the cases. Odontogenic keratocyst was the most common non-endodontic diagnosis, followed by nasopalatine duct cyst and benign fibro-osseous lesion, respectively. CONCLUSIONS Pathologic findings of the periradicular tissues are not always from endodontic origin. The probability of encountering non-endodontic lesions is almost 8%. Even in clinically reported teeth with pulp necrosis, 1%-3% of biopsies were confirmed as non-endodontic lesions.
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Affiliation(s)
- Tadkamol Krongbaramee
- Division of Endodontics, Department of Restorative Dentistry & Periodontology, Chiang Mai University, Chiang Mai, Thailand; Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Wattawan Wongpattaraworakul
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Emily A Lanzel
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - John W Hellstein
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Fabricio B Teixeira
- Department of Endodontics, College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa.
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Johnstone M, Evans M. Clinical and medico-legal considerations in endodontics. Aust Dent J 2023; 68 Suppl 1:S153-S164. [PMID: 37805420 DOI: 10.1111/adj.12984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Abstract
Endodontic treatment can be challenging for a number of reasons, including the microscopic nature of the clinical environment, reliance on tactile sensation and lack of direct visualization of the work being performed. Commonly, endodontic patients present with pain and distress, which can exacerbate an already difficult clinical situation. Complications may might arise prior to, or during treatment, despite practising with the utmost care and skill. Preventing and managing these complications can take considerable time and energy, and oftentimes assistance from or referral to more experienced colleagues is required. The aim of this review is to discuss medico-legal considerations in endodontics, with clinical correlations and a focus on the Australian legal landscape. [Correction added on 18 October 2023, after first online publication: The abstract was amended from a structured to an unstructured abstract.].
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Affiliation(s)
- M Johnstone
- Private Practice, Maribyrnong, Victoria, Australia
| | - M Evans
- The University of Melbourne, Melbourne, Victoria, Australia
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Evangelista K, de Faria Vasconcelos K, Teodoro AB, Cavalcanti MGP, de Mendonça EF, Watanabe S, Silva MAG. Malignant tumours mimicking periapical lesions: A report of three cases and literature review. AUST ENDOD J 2022; 48:515-521. [PMID: 34939718 DOI: 10.1111/aej.12597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/12/2021] [Accepted: 12/05/2021] [Indexed: 12/14/2022]
Abstract
Apical periodontitis shows radiographic signs such as widening of the periodontal ligament and periapical radiolucency, which differ in extent depending on the stage of the lesion. However, other lesions can be associated with or coincidental to the apical region, representing developmental lesions and benign or malignant tumours. This article describes three cases of malignant tumours, a central mucoepidermoid carcinoma (CMEC), a chondroblast osteosarcoma and an osteosarcoma of the jaw (OSJ) that presented as periapical lesions. Endodontists must be aware of unsuccessful treatment, persistent pain, signs of paraesthesia, a rapid growth rate and delayed response to therapy associated with atypical features. Complementary examinations, such as biopsy and computed tomography, can allow the early diagnosis of malignant tumours, leading to a better prognosis and thus increased survival rates and improvement in quality of life.
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Affiliation(s)
- Karine Evangelista
- Division of Orthodontics, Dental School, Federal University of Goiás, Goiás, Brazil
| | - Karla de Faria Vasconcelos
- Department of Imaging and Pathology & Department of Oral Health Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ana Beatriz Teodoro
- Department of Stomatology, Dental School, Federal University of Goiás, Goiás, Brazil
| | | | | | - Satiro Watanabe
- Department of Oral and Maxillofacial Surgery, Dental School, Federal University of Goiás, Goiás, Brazil
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Rudman J, He J, Jalali P, Khalighinejad N, Woo V. Prevalence of Nonendodontic Diagnoses in Periapical Biopsies: A 6-year Institutional Experience. J Endod 2022; 48:1257-1262. [PMID: 35843357 DOI: 10.1016/j.joen.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The purpose of this study was to identify non-endodontic periapical lesions (NPLs) mimicking endodontic pathosis most frequently encountered by clinicians. METHODS A retrospective study was conducted on biopsies obtained from 2015-2020 at Texas A&M College of Dentistry oral pathology laboratory. The online database was screened for cases submitted as suspected endodontic pathology using specific keywords. Histological diagnoses were collected to determine prevalence of NPLs that were originally thought to be of endodontic origin. The frequency and percentage of endodontic pathology and NPLs were documented. RESULTS Among 6,704 biopsies clinically diagnosed as endodontic lesions, 190 (2.8%) were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocyst (n=70, 36.8%), cemento-osseous dysplasia (n=27; 14.2%), and dentigerous cyst (n=22; 11.6%). Of all NPLs, 3.7% were malignant neoplasms, with the most common diagnosis being squamous cell carcinoma. Of 6,514 endodontic histological diagnoses, the prevalence of periapical granulomas and cysts was 60.2% (n=3,924) and 39.1% (n=2,549), respectively. CONCLUSIONS While most endodontic submissions are likely to be histologically diagnosed as periapical granuloma or cyst, the clinician should be aware that a small portion of these lesions may be non-endodontic in origin and possibly neoplastic in nature. Histopathological evaluation of biopsied specimens is critical to achieve a proper diagnosis to ensure appropriate management of patients.
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Affiliation(s)
- Jessica Rudman
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas
| | - Jianing He
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas.
| | - Poorya Jalali
- Department of Endodontics, Texas A&M University College of Dentistry, Dallas Texas
| | | | - Victoria Woo
- Department of Diagnostic Sciences, Texas A&M University College of Dentistry, Dallas Texas
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Shan S, Liu S, Yang ZY, Wang TM, Lin ZT, Feng YL, Pakezhati S, Huang XF, Zhang L, Sun GW. Oral and maxillofacial pain as the first sign of metastasis of an occult primary tumour: A fifteen-year retrospective study. World J Clin Cases 2022; 10:4436-4445. [PMID: 35663053 PMCID: PMC9125288 DOI: 10.12998/wjcc.v10.i14.4436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/05/2022] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Metastatic adenocarcinoma of the jaw (MAJ) is a rare disease that accounts for 1%-3% of all oral and maxillofacial malignant tumours. Oral and maxillofacial pain may be the first symptom of metastatic spread of an occult primary tumour. Therefore, early identification of oral and maxillofacial pain by dental professionals is critical.
AIM To explore the clinical and computerized tomography (CT) features of MAJ with oral and maxillofacial pain as the first symptom.
METHODS The medical records of all patients who were treated in our hospital between January 2006 and February 2020, and diagnosed with MAJ with oral and maxillofacial pain as the first symptom, were reviewed retrospectively. Clinical data were collected on age, sex, medical history, clinical manifestations, site of metastasis, and site of the primary lesion. CT features were analysed in detail, and a radiological classification scheme comprising five types: Osteolytic, osteoblastic, mixed, cystic, and alveolar bone resorption was proposed.
RESULTS The primary sites of MAJ were the lungs (n = 6), liver (n = 4), kidneys (n = 2), prostate (n = 1), and gastric cardia (n = 1). Five tumours were classified as the osteolytic type, all with a permeative margin (100%, P < 0.05), and three were classified as the mixed type, mostly with a moth-eaten margin (80%, P < 0.05). The cystic (n = 3) and alveolar bone resorption (n = 1) types had geographic margins, and the osteoblastic type (n = 1) had sclerotic margins. Moreover, nine tumours showed periosteal reaction and five showed a localised soft tissue mass, while the occurrence of jaw expansion was relatively rare.
CONCLUSION MAJ has complex clinical and CT features. Oral and maxillofacial pain may be the first sign of a primary tumour affecting other sites.
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Affiliation(s)
- Shan Shan
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Shu Liu
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Zhen-Yu Yang
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Tie-Mei Wang
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Zi-Tong Lin
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Ying-Lian Feng
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Seyiti Pakezhati
- Department of Dentomaxillofacial Radiology, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Xiao-Feng Huang
- Department of Oral Pathology,The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Lei Zhang
- Department of Oral Pathology,The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Guo-Wen Sun
- Department of Oral and Maxillofacial Surgery, The Affiliated Stomatology Hospital of Medical School, Nanjing University, Nanjing 210008, Jiangsu Province, China
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Primary Extra Nodal Diffuse Large B-Cell Lymphoma of the Maxillary Sinus with Symptoms of Acute Pulpitis. Case Rep Dent 2022; 2022:8875832. [PMID: 35433056 PMCID: PMC9010219 DOI: 10.1155/2022/8875832] [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: 07/03/2020] [Revised: 01/15/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS) is a subtype of large B-cell non-Hodgkin lymphoma with various clinical and pathological manifestations. DLBCL-NOS which primarily arises from maxillary sinus is rare and hard to diagnose due to unique anatomy. Here, we present a case of DLBCL-NOS that developed in the left maxillary sinus of a 72-year-old male, who presented with severe toothache that resembled acute pulpitis. The lesion was diagnosed and treated based on radiographs, histological, immunohistological examinations, and PET-CT analysis. Despite its rare incidence, DLBCL-NOS should still be included in differential diagnoses to rule out malignancy in cases of endodontic disease.
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Abstract
Background/purpose Periapical scar (PS) is an alternative healing process with the formation of scar tissue after appropriate endodontic treatments/retreatments with or without periapical surgeries. This retrospective study evaluated the clinical, radiographic, and histopathological features of 7 PSs. Materials and methods The clinical, radiographic, and histopathological data of 7 PSs were collected and analyzed. Results The 7 PSs were taken from the maxilla (3 cases) and mandible (4 cases) of 3 men and 4 women. The most frequently involved teeth were maxillary or mandibular incisors (4 cases) and first or second molars (3 cases). Of 7 PS patients, 6 had none of symptoms, 5 had previous nonsurgical endodontic treatments/retreatments, and 2 had previous endodontic treatments/retreatments plus periapical surgery. Radiographically, all 7 PS cases presented as a persistent and well-defined periapical radiolucent lesion for a long period of time. Microscopically, all 7 surgical specimens of PS showed dense fibrous collagenous tissues with one having amalgam particles in the scar tissue. Conclusion PSs do have their common clinical and radiographic features. When the periapical radiolucent lesion is well-defined, persistent without a significant change of its size, and free from symptoms and signs after a long-term follow-up; the involved tooth has no evidence of root fracture and healthy periodontium except the periapical radiolucency; and the previous endodontic treatment/retreatment or periapical surgery is well performed with an adequate root canal or retrograde filling, then the PS may be a possible diagnosis and a close follow-up may be a more conservative treatment strategy for this condition.
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