Investigation of foreign materials in gingival lesions: a clinicopathologic, energy-dispersive microanalysis of the lesions and in vitro confirmation of pro-inflammatory effects of the foreign materials

OBJECTIVES

This study aimed to evaluate the clinical and histopathologic features of gingival lesions containing foreign material (GLFMs). In parallel, the composition of the foreign material and its effects in primary human gingival fibroblasts (HGFs) were investigated.

STUDY DESIGN

Eighty-six GLFMs were retrieved from an oral pathology biopsy service. Clinical and microscopic data were analyzed, and the composition of the particles was identified by using energy-dispersive X-ray spectroscopy (EDX). Furthermore, HGFs were stimulated with silica (SiO₂) microparticles to investigate the production of collagen type 1 (COL-1), matrix metalloproteinase 2 (MMP2), and inflammatory cytokines.

RESULTS

GLFMs were most commonly found in women (60.5%) and most frequently described as white plaques. Histopathologic examination identified verrucous hyperplasia in 59% and epithelial dysplasia in 28% of the cases. EDX microanalysis revealed that Si (94%) was the most frequently detected foreign element. SiO₂ microparticles induced higher COL-1 expression; higher levels of proinflammatory cytokines, such as interleukin-6 (IL-6), IL-8, and transforming growth factor-β, and increased MMP-2 activity in HGFs.

CONCLUSIONS

There was a strong association between the presence of foreign material in the gingiva and white verrucous clinical lesions. In addition, the most common element in the foreign material was Si, and our in vitro findings demonstrate the importance of silica-mediated effects on gingival fibroblasts.

Investigation of immune cell markers in feline oral squamous cell carcinoma

Squamous cell carcinoma is the most common oral cancer in the cat and presents as a locally aggressive lesion for which an effective therapeutic protocol remains elusive. Feline oral squamous cell carcinoma (OSCC) shares many clinical characteristics with human head and neck squamous cell carcinoma (HNSCC). Accordingly, present studies were conducted to determine similarities for immune markers shared by feline OSCC and human HNSCC. Biopsies harvested from a feline patient cohort-1 (n = 12) were analyzed for lymphoid cell infiltrates by immunohistochemistry (IHC). Results revealed unique patterns of T cell infiltration involving both neoplastic epithelium and stroma that were detected in most patient tumor biopsies (92%) examined by IHC staining for CD3. Intratumoral B cell infiltrates were detected within tumor stroma only, based on IHC staining for CD79a and CD20 for all patients within the same cohort-1. Infiltration of tumors by a regulatory CD4 T cell subset (Tregs) defined by expression of the forkhead transcription factor FoxP3, was also detected in biopsies from 57% of patients and involved infiltration of neoplastic epithelium and stroma. Patient biopsies were also examined for expression of immunomodulator cyclooxygenase (COX)-2 and revealed positive but weak staining of neoplastic epithelium in a significant proportion of cases (75%). Interestingly, COX-2 expression was detected in both neoplastic epithelium and stroma. Blood collected from a second cohort of feline OSCC patients (n = 9) revealed an increased frequency of circulating CD4+FoxP3+ T cells when compared to healthy adult controls (n = 7) (P = 0.045), although frequencies of CD4+CD25+FoxP3+ T cells were comparable between patients and healthy pet cat controls. Lastly, biopsies from feline OSCC patients were characterized for histologic subtype using a classification scheme previously described for human HNSCC. This analysis revealed the conventional subtype as the predominant variant (75%) with conventional subtypes split evenly between well differentiated and moderately differentiated carcinomas. Two cases were classified as papillary and one case as basaloid subtypes. Correlations between subtype, immune marker scores or circulating Treg frequencies and clinical characteristics or outcome were not detected, most likely due to small patient numbers within patient cohorts. However, findings from these studies provide a preliminary step in the characterization of immune and histologic markers that will be critical to defining prognostic immune markers for feline OSCC and potential targets for testing of immunotherapeutics also relevant to human HNSCC in future studies.

The Oral Effects of Inhalation Corticosteroid Therapy: An Update

Inhaled corticosteroids (IC) are commonly used for the treatment of respiratory diseases. Although these medications are generally considered safer when compared to oral systemic corticosteroids, there is evidence for potential systemic and local adverse effects with their use. Therefore, dentists should be aware of these adverse effects, especially the commonest local effects that can involve the oral mucosa. This article reviews the literature on the complications of IC therapy with emphasis on its potential oral effects.

Metastatic epithelioid angiosarcoma to the mandible: report of a case and review of the literature

Angiosarcoma and its epithelioid variant are vascular malignancies that rarely affect the facial skeleton. Epithelioid angiosarcoma resembles carcinoma and can be difficult to diagnose. A case is presented of metastatic epithelioid angiosarcoma to the mandible from an angiosarcomatoid portion of renal carcinoma. The diagnostic challenge is outlined and the literature is reviewed.

MALT lymphoma in labial salivary gland biopsy from Sjögren syndrome: importance of follow-up in early detection

Mucosa-associated lymphoid tissue (MALT) lymphomas are known to occur in Sjögren syndrome (SS) patients, but reported cases in labial salivary glands (LSG) are rare. We report a case of 60-year-old female patient with SS who developed MALT lymphoma in the labial salivary glands during a 2-year time interval when she was participating in the Sjögren's International Clinical Collaborative Alliance, an ongoing longitudinal multisite observational study funded by the National Institutes of Health of the United States. At follow-up exam, LSG biopsy showed atypical diffuse infiltration by mononuclear cells of variable size and atypical nuclei affecting the whole specimen with destruction of glandular architecture, leading to a diagnosis of B-cell MALT lymphoma. Computerized tomography and bone marrow biopsy failed to show additional evidence of disease. Clinical, serologic, ocular, histologic and immunohistochemical findings are presented. A "watch and wait" policy was adopted with regular examinations.

Rare diagnosis of IgG4-related systemic disease by lip biopsy in an international Sjögren syndrome registry

IgG4-related disease has been recently defined as a distinct clinic-pathologic entity, characterized by dense IgG-4 plasmacytic infiltration of diverse organs, fibrosis, and tumefactive lesions. Salivary and lacrimal glands are a target of this disease and, when affected, may clinically resemble Küttner tumor, Mikulicz disease, or orbital inflammatory pseudotumor. In some patients, the disease is systemic, with metachronous involvement of multiple organs, including the pancreas, aorta, kidneys, and biliary tract. We report a 66-year-old man who presented with salivary gland enlargement and severe salivary hypofunction and was diagnosed with IgG4-related disease on the basis of a labial salivary gland biopsy. Additional features of his illness included a marked peripheral eosinophilia, obstructive pulmonary disease, and lymphoplasmacytic aortitis. He was evaluated in the context of a research registry for Sjögren syndrome and was the only 1 of 2594 registrants with minor salivary gland histopathologic findings supportive of this diagnosis.

Pseudotumor of the mandible as first presentation of hemophilia in a 2-year-old male: a case report and review of jaw pseudotumors of hemophilia

Pseudotumor of hemophilia (PTH) is a rare complication seen in approximately 1-2% of cases of hemophilia. Although much more common in long bones, the pelvis, and small bones of the hands and feet than in the jaws, occasionally hemorrhage in the jaws occurs with this result. We present a case in a two-year-old male with a one-month swelling of the right mandible without significant medical history or diagnosis of hemophilia who was subsequently diagnosed as having Factor IX deficiency, or hemophilia B. A review of the literature revealed only 15 reported cases of PTH of the jaws and salient features of PTH in the jaws are discussed. The differential diagnosis of masses occurring in the jaws of children is limited and PTH should be considered when a mass presents with rapid growth and the histopathologic features are not diagnostic for a neoplastic process, even in the absence of a prior diagnosis of hemophilia as PTH may be the initial manifestation of this disease.

Solitary fibrous tumor of the head and neck

OBJECTIVE

The aim of this study was to review the reported cases of solitary fibrous tumor (SFT) in the head and neck and to evaluate this tumor regarding histologic features, treatment, and recurrence. SFT has been described in many extrapleural sites, including the head and neck. Uniform overexpression of CD34 differentiates SFT from other spindle cell neoplasms. SFT is a slow-growing neoplasm that can be successfully treated by complete excision. A rare malignant counterpart has also been described.

STUDY DESIGN

In this case series and review of published cases from English-language journals in the National Library of Medicine, we reviewed 142 cases of SFT reported in English-language literature and add 11 new cases. We compared the features reported in the previous publications of SFT from the head and neck with our series, including cases described as malignant or atypical SFT.

RESULTS

Four out of 9 cases with positive margins recurred, whereas only 1 out of 10 cases with atypical or malignant features recurred.

CONCLUSIONS

An important finding in SFT of the head and neck is that recurrence appears more related to incomplete excision than to microscopic grade.

Abstract 351: Mutations of genes in the c-Kit receptor tyrosine kinase signaling pathway are inactive in adenoid cystic carcinoma of the salivary glands: Implications for c-Kit targeted therapy

Adenoid cystic carcinoma (ACC) is a malignant salivary gland tumor well-known for spreading in wide local area and invasion of vital structures of the head and neck. Unfortunately, conventional therapies have not improved longer-term survival, resulting in significant morbidity and a very low overall survival rate. Improved systemic therapies are clearly needed for this population. ACC tumors overexpress the receptor tyrosine kinase c-Kit, which is thought to be a therapeutic target. However, the role of c-Kit in the pathogenesis of ACC is not currently understood. We addressed this question through a functional genomic study with 17 sporadic ACC tumor specimens. We found heterogeneous missense mutations in three genes in the c-Kit signaling pathway, although mutations were identified at a low frequency. Two ACC tumors had distinct missense mutations in the gene KIT, resulting in G664R and R796G amino acid substitutions in the c-Kit kinase domain. Furthermore, two ACC tumors without KIT mutations had missense mutations in either KRAS or BRAF, causing S17N K-Ras and V590I B-Raf mutants. KRAS and BRAF are downstream effectors of c-Kit. We explored the functional consequences of these amino acid substitutions and found that all of c-Kit, K-Ras and B-Raf mutations in our ACC samples were inactive. These observations suggest that the c-Kit signaling pathway must be dispensable for maintaining established ACC. As a result, we believe that selective c-Kit inhibition is not a suitable treatment for the patients.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 351.

Nerve growth factor and tyrosine kinase A receptor in oral squamous cell carcinoma: is there an association with perineural invasion?

PURPOSE

Perineural invasion (PNI) in oral squamous cell carcinoma (SCC) is recognized as a significant predictor of outcome. PNI is associated with locoregional recurrence and decreased survival of patients with head and neck SCC. Nerve growth factor (NGF) has been shown to be involved in PNI in several malignancies, including breast, prostate, and pancreatic cancers. We investigated the hypothesis that NGF and its high-affinity receptor tyrosine kinase A (TrkA) are highly expressed in cases of oral SCC that have histologic evidence of PNI.

MATERIALS AND METHODS

We performed immunohistochemistry on archived oral tongue SCC specimens from the established oral and general pathology databases at the University of California, San Francisco. The following groups were evaluated: 1) 21 T1/T2 oral tongue SCC cases with PNI and 2) 21 T1/T2 oral tongue SCC cases without histologic evidence of PNI.

RESULTS

Strong homogeneous cytoplasmic staining for NGF and TrkA was detected in the malignant cells in the PNI-positive group of tumors. In group II (PNI negative) NGF and TrkA were detected in the stroma cells or were very weakly expressed by the malignant cells. We were able to show the presence of NGF and TrkA in the cytoplasm of malignant squamous cells in tumors with histologic evidence of PNI. Immunostaining for NGF (P = .0001) and TrkA (P = .039) was significantly higher in the PNI-positive oral SCC group than in the PNI-negative oral SCC group.

CONCLUSION

This study shows that oral SCC with evidence of PNI shows increased expression of NGF and TrkA and suggests that NGF and TrkA are involved with the mechanism leading to PNI. Further investigations are warranted to determine the potential for use of NGF and TrkA as candidate biomarkers to predict progression and outcome.

Pulpal effects of enamel ablation with a microsecond pulsed lambda = 9.3-microm CO2 laser

BACKGROUND AND OBJECTIVES

In vitro studies have shown that CO2 lasers operating at the highly absorbed 9.3 and 9.6-microm wavelengths with a pulse duration in the range of 10-20-microsecond are well suited for the efficient ablation of enamel and dentin with minimal peripheral thermal damage. Even though these CO2 lasers are highly promising, they have yet to receive FDA approval. Clinical studies are necessary to determine if excessive heat deposition in the tooth may have any detrimental pulpal effects, particularly at higher ablative fluencies. The purpose of this study was to evaluate the pulpal safety of laser irradiation of tooth occlusal surfaces under the conditions required for small conservative preparations confined to enamel.

STUDY DESIGN/MATERIALS AND METHODS

Test subjects requiring removal of third molar teeth were recruited and teeth scheduled for extraction were irradiated using a pulsed CO2 laser at a wavelength of 9.3 microm operating at 25 or 50 Hz using a incident fluence of 20 J/cm(2) for a total of 3,000 laser pulses (36 J) for both rates with water cooling. Two control groups were used, one with no treatment and one with a small cut made with a conventional high-speed hand-piece. No anesthetic was used for any of the procedures and tooth vitality was evaluated prior to treatment by heat, cold and electrical testing. Short term effects were observed on teeth extracted within 72 hours after treatment and long term effects were observed on teeth extracted 90 days after treatment. The pulps of the teeth were fixed with formalin immediately after extraction and subjected to histological examination. Additionally, micro-thermocouple measurements were used to estimate the potential temperature rise in the pulp chamber of extracted teeth employing the same irradiation conditions used in vivo.

RESULTS

Pulpal thermocouple measurements showed the internal temperature rise in the tooth was within safe limits, 3.3+/-1.4 degrees C without water cooling versus 1.7+/-1.6 degrees C with water-cooling, n = 25, P<0.05. None of the control or treatment groups showed any deleterious effects on pulpal tissues and none of the 29 test-subjects felt pain or discomfort after the procedure. Only two test-subjects felt discomfort from "cold sensitivity" during the procedure caused by the water-spray.

CONCLUSION

It appears that this CO2 laser can ablate enamel safely without harming the pulp under the rate of energy deposition employed in this study.

Leukocyte adhesion deficiency type 1: an important consideration in the clinical differential diagnosis of prepubertal periodontitis. A case report and review of the literature

Leukocyte adhesion deficiency type 1 (LAD-1) is a rare, inherited immunodeficiency that affects 1 in 1 million people yearly and usually presents with recurrent, indolent bacterial infections of the skin, mouth, and respiratory tract and impaired pus formation and wound healing. Features of this disease result from mutations in the region of the CD18 gene, which is encoded on chromosome 21q22.3. This gene codes for the common subunit of the leukocyte integrins LFA-1, Mac 1, and p150,95. Failure to produce a functional subunit results in the defective expression of all 3 leukocyte integrins, and the leukocytes of LAD have subnormal adhesion properties. We present a case of the moderate-to-severe form of LAD in a 3-year-old girl who initially presented with generalized swelling and erythema of the gingiva, with slight tooth mobility and a nonhealing labial ulceration. Her medical history was significant for recurrent urinary tract infections. Periodontal pathogens, including Capnocytophaga, Eikenella corrodens, and Candida albicans, were cultured. The patient had a significantly elevated white blood cell count and absolute neutrophil count. The diagnosis of LAD was confirmed with flow cytometry, which revealed significantly decreased subunits. Twenty-four months after the diagnosis was made and after a series of granulocyte transfusions and bone marrow transplantations, she expired as the result of respiratory failure.

Rare oral cavity presentation of a B-cell lymphoblastic lymphoma. A case report and review of the literature

Lymphoblastic lymphoma is an uncommon malignancy, with most cases showing a T-cell phenotype and presenting as a mediastinal mass. By contrast, B-cell lymphoblastic lymphoma/leukemia is a rare high-grade malignancy that comprises approximately 10% of all lymphoblastic lymphomas. Lymphomas of the oral cavity are rare and typically present as intraosseous lesions that are most commonly diffuse large B-cell type. Here we present what we believe is the first B-cell lymphoblastic lymphoma initially presenting in the oral cavity. The case involves a 46-year-old white woman who presented with a mass in the right mandible. This report discusses this rare malignancy, including clinical presentation, histopathologic features, immunologic profile, treatment, and prognosis. This case emphasizes the importance of recognizing rare entities that may present in the oral cavity and the impact of the disease and its management.

Myopericytoma of the thoracic spine: a case report

STUDY DESIGN

A case of myopericytoma of the thoracic spine is reported.

OBJECTIVE

To report a recently described and extremely rare soft tissue neoplasm in the previously unreported location of the thoracic spine.

SUMMARY OF BACKGROUND DATA

Myopericytoma is a recently described soft tissue neoplasm with perivascular myoid differentiation. All cases have been reported in the subcutaneous and superficial soft tissues of the extremities. This represents the first reported case of this unusual lesion in the spine.

METHODS

A patient with a 3-month history of progressive weakness of the arms and legs was found to have a lytic lesion of T3. The lesion was surgically treated by curettage followed by a course of radiation. Presenting symptoms, imaging studies, histologic findings, and related literature are reviewed in this study.

RESULTS

Histologic evaluation of sections of the surgically removed lesion revealed a concentric, periluminal proliferation of cells with prominent positive smooth muscle actin immunoreactivity. These findings are consistent with the diagnosis of a myopericytoma, a lesion not previously reported in the spine.

CONCLUSIONS

This study shows the presence of a lesion in the thoracic spine only previously described in the soft tissue of the extremities. The diagnosis of myopericytoma should be included, along with hemangiopericytoma, in the differential diagnosis of lytic lesions of the spine.

Ameloblastic carcinoma ex ameloblastoma of the mandible with malignancy-associated hypercalcemia

Ameloblastoma is a rare, locally destructive, benign neoplasm of the jawbones, which arises from epithelium derived from the epithelial components of the developing tooth. Ameloblastic carcinoma is the term used to designate any ameloblastoma in which there is histologic evidence of malignancy in the primary tumor, regardless of whether it has metastasized. Most ameloblastic carcinomas are presumed to have arisen de novo, with few cases of malignant transformation of ameloblastoma being apparent. Hypercalcemia is the most common metabolic complication of malignancy. Although malignancy-associated hypercalcemia is often reported in association with other malignancies, it is exceedingly unusual in association with ameloblastoma, malignant ameloblastoma, or ameloblastic carcinoma. We describe a patient with multiple recurrences of ameloblastoma, with subsequent malignant transformation presenting with malignancy-associated hypercalcemia.

The dexamethasone suppression test in agoraphobia

Patients diagnosed as having agoraphobia with panic attacks by DSM-III criteria were evaluated with the dexamethasone suppression test (DST). Depressive symptoms were assessed using the Beck Depression Inventory, the Depression Scale of the Minnesota Multiphasic Personality Inventory, and the Hamilton Rating Scale for Depression. Of 97 patients tested, 12.4% had a positive DST. These findings are consistent with earlier reports that found an incidence of abnormal DSTs between 11% and 15% in agoraphobic patients. Abnormal DSTs did not correlate with levels of depression on any of the depression measures.

Biological Process for Converting Naphthalene to cis -1,2-Dihydroxy-1,2-Dihydronaphthalene

A biological process for converting naphthalene to cis -1,2-dihydroxy-1,2-dihydronaphthalene (DHD) catalyzed by Pseudomonas putida strain 119 was optimized in flask experiments. These studies revealed the following: (i) P. putida 119 can propagate efficiently and produce DHD when supplied one of several carbon sources and naphthalene; (ii) maximum DHD production by P. putida 119 occurs in logarithmic-growth-phase cells and decreases at various rates in the stationary growth phase, depending upon the carbon source used; (iii) several analogs of salicylic acid can be used as effective inducers of naphthalene metabolism in P. putida cells growing on glucose; and (iv) the addition of chemical surfactants to naphthalene-cell ( P. putida 119) mixtures stimulates DHD production.

Microbial conversion of ethylbenzene to 1-phenethanol and acetophenone by Nocardia tartaricans ATCC 31190

A culture of Nocardia tartaricans ATCC 31190 was capable of catalyzing the conversion of ethylbenzene to 1-phenethanol and acetophenone while growing in a shake flask culture with hexadecane as the source of carbon and energy. This subterminal oxidative reaction with ethylbenzene appears not to have been previously reported for Nocardia species. When N. tartaricans was grown on glucose as its source of carbon and energy and ethylbenzene was added, no subsequent production of 1-phenethanol or acetophenone was observed. The mechanisms of 1-phenethanol and acetophenone production from ethylbenzene are thought to involve a subterminal oxidation of the alpha-carbon of the alkyl group to 1-phenethanol followed by biological oxidation of the latter to acetophenone.

Flavonoid intermediates for the synthesis of mopanol trimethyl ether[trans-trans-7,7',8'-Trimethoxyisochromano(4',3':2,3)chroman-4-ol]

Preparation of a number of intermediates for the synthesis of (�)-mopanol trimethyl ether is described, together with exploratory reactions with model compounds, and especially with 7-methoxyflavanone-2'-carboxylic acid. 7-Methoxyflavan-4-ol, the initial product from reduction of 7-methoxyflavanone-2'-carboxylic acid with complex metal hydrides, was found to undergo facile dehydration to a novel intramolecular dibenzyl ether [the cyclic ether (19)*]. It was noted that the methoxymethyl group, which may be used as a protecting group for phenols, did not survive the conditions of methylation with dimethyl sulphate and potassium carbonate in acetone.

Factors affecting trimethylarsine and dimethylselenide formation byCandida humicola

Selenite, selenate, and tellurate inhibited the conversion of arsenate to trimethylarsine byCandida humicola. Trimethylarsine disappeared from the gas phase when incubated withC. humicola in the presence of selenium or tellurium salts. The fungus generated dimethyl-selenide from selenite and selenate and an unidentified gas from tellurate. Sulfate but not arsenate, tellurate, or phosphate inhibited the conversion of selenate to dimethylselenide. Arsenate-grown cells generated trimethylarsine from arsenate, and selenate-grown cells formed dimethylselenide from selenate with almost no lag phase. Cells grown in media with selenate or with no additions only formed the alkylarsine from arsenate after a lag phase, and those grown in solutions with arsenate or no additions produced dimethylselenide slowly from selenate.

Effect of phosphate and other anions on trimethylarsine formation by Candida humicola

Phosphate inhibited the formation of trimethylarsine from arsenite, arsenate, and monomethylarsonate, but not from dimethylarsinate, by growing cultures of Candida humicola. Phosphite suppressed trimethylarsine production by growing cultures from monomethylarsonate but not from arsenate and dimethylarsinate, and hypophosphite caused a temporary inhibition of both proliferation and the conversion of these three arsenic sources to trimethylarsine. Resting cells of C. humicola derived from cultures grown in arsenic-free media generated the volatile arsenical only after a lag phase. High antimonate concentrations reduced the rate of conversion of arsenate to trimethylarsine by resting cells, but nitrate was without effect.

Effect of different nutritional conditions on the synthesis of tricarboxylic acid cycle enzymes

The effect of various nutritional conditions on the levels of Krebs cycle enzymes in Bacillus subtilis, B. licheniformis, and Escherichia coli was determined. The addition of glutamate, alpha-ketoglutarate, or compounds capable of being catabolized to glutamate, to a minimal glucose medium resulted in complete repression of aconitase in B. subtilis and B. licheniformis. The synthesis of fumarase, succinic dehydrogenase, malic dehydrogenase, and isocitric dehydrogenase was not repressed by these compounds. It is postulated that glutamate or alpha-ketoglutarate is the true corepressor for the repression of aconitase. A rapidly catabolizable carbon source and alpha-ketoglutarate or glutamate must be simultaneously present for complete repression of the formation of aconitase. Conditions which repress the synthesis of aconitase in B. subtilis restrict the flow of carbon in the sequence of reactions leading to alpha-ketoglutarate but do not prevent glutamate oxidation in vivo. The data indicate that separate and independent mechanisms regulate the activity of the anabolic and catabolic reactions of the Krebs cycle in B. subtilis and B. licheniformis. The addition of glutamate to the minimal glucose medium results in the repression of aconitase, isocitric dehydrogenase, and fumarase, but not malic dehydrogenase in E. coli K-38.