Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

This study presents a series of six cases involving patients who underwent previous cancer treatments and utilized bisphosphonates, monoclonal antibodies, and high-dose corticosteroids, subsequently experiencing osteonecrosis in the oral cavity. The associated challenges included pain, recurrent infections, diminished quality of life—especially in terms of food intake—and social discomfort due to characteristic lesion odor. Medication-associated osteonecrosis (OAM) is identified as an injury leading to the temporary or permanent loss of blood supply to bones, with diverse causal factors. Patients underwent thorough anamnesis, substantiating medication use via medical prescriptions, clinical examinations by qualified Dental Surgeons, and imaging assessments including panoramic radiography, periapical radiographs during follow-up, and, in specific cases, computed tomography. The treatment involved weekly monitoring, adjusting consultation frequencies as the condition stabilized, and implementing Sonodynamic Therapy (SDT). SDT, an innovative approach, utilizes low-frequency, high-intensity ultrasound to stimulate sonosensitizers, inducing the formation of reactive oxygen species (ROS). A non-invasive treatment, SDT offers site-specific cytotoxicity by generating ROS in response to sonic/ultrasonic sources, potentially treating bacterial infections. All six patients treated with SDT experienced improved quality of life, as documented through visual evidence. The adaptability of SDT to equipment emitting sonic/ultrasonic waves envisions broader applications, particularly in resource-limited regions, rendering it a potentially accessible method for both professionals and patients. This research underscores the promising outcomes of SDT in managing medication-associated osteonecrosis, paving the way for further exploration and potential integration into broader clinical practices.

Introduction

Mesenchymal chondrosarcoma is a high grade biphasic primitive tumor with foci of hyaline cartilage. The tumors may occur in bone or soft tissue and are common in the craniofacial region. Microscopically this neoplasm can be difficult to diagnosis. Identification of the Hey1::NCOA2 fusion confirms the diagnosis. Two cases involving the jaws and one of the skull are reported.

Case Findings

Case 1: A 44-year-old male with right jaw pain and facial asymmetry presented for evaluation. Imaging revealed a 7 cm destructive intraosseous mixed radiolucent-radiopaque lesion. Case 2: An 11-year-old male presented with swelling of left temporal region of two weeks duration. Imaging revealed a 5 cm destructive lesion with a mixed radiographic appearance. Case 3: An 11-year-old male presented with a 2 month post-traumatic unresolved reddish-blue soft tissue swelling of upper anterior labial mucosa. Imaging revealed minimal bony surface destruction of the anterior maxilla.

Results

Microscopic variability characterized the three cases. Case 1 exhibited classic histopathological presentation of nodules of cartilage surrounded by spindle cells. Case 2 predominately exhibited spindle cells with a pericytomatous vascular growth pattern without a cartilage component. Osseous components were identified; it was unclear whether the bone was native or neoplastic. Case 3 exhibited a monotonous spindle cell lesion suggestive of monophasic synovial sarcoma, but minute osteochondroid foci led to molecular interrogation. Molecular analysis in all three cases identified a Hey1::NCOA2, confirming the mesenchymal chondrosarcoma diagnoses.

Conclusion

Aggressive clinical behavior characterized all three cases. Histologically, the biphasic presentation was best represented in Case 1. Case 2 and 3 showed the characteristic primitive cells with minimal to no atypia; a minimal cartilaginous component was noted on extensive sampling of case 3. Mesenchymal chondrosarcoma was confirmed in each case by identifying the Hey1::NCOA2 fusion.

Objective

The objective of this study was to evaluate the association between oral lichen planus (OLP)/oral lichenoid lesions (OLL) and other comorbidities, especially thyroid gland diseases and in addition, the risk of oral squamous cell carcinoma (OSCC).

Material and methods

We performed a retrospective case-control study by using medical data of 301 OLP/OLL patients and 301 age- and sex-matched controls who had visited Kuopio University Hospital (KUH), Finland between years 1996 and 2017. The medical history, the use of regular medications, allergies, presence of LP elsewhere in the body and clinical features of OLP/OLL lesions were registered. In addition, we studied how many of OLP/OLL patients developed a OSCC after at least a 6-year follow up time.

Results

The prevalence of autoimmune hypothyroidism (HT) was 12.2% in OLP group, 18.8.% in OLL group and 9% (n=27) in the control group; the estimated odds ratios being 1.425 [95% CI 0.793 to 2.562] for OLP and 2.292 [95%CI 1.175 to 4.47] for OLL. Patients with HT had more often erosive mucosal lesions compared to patients without HT. Allergies were seen in 32.9% (n=99) of OLP/OLL cases and in 22.9% (69) of controls; the estimated odd ratio being 1.726 (1.184 to 2.516) for OLP/OLL. 6 of 205 OLP patients (3%) and 5 of 96 OLL patients (5.2%) developed OSCC. Most of the OSCCs (4/6) were located in the tongue in OLP group and in OLL group the cancers were randomly distributed.

Conclusions

This study confirms the previously seen association of OLP/OLL and thyroid diseases, especially hypothyroidism. In this study OLL was more strongly associated with HT than OLP. In addition, an association was seen between OLP/OLL and allergies. OLP and especially OLL increase the risk of OSCC.

This study investigates the patterns of patient quantity to diagnostic trends within a private practice oral pathology setting over a three-month period. A comprehensive data collection approach involved the extraction and analysis of relevant statistics, including the distinction of new versus established patients, the distribution of different diagnoses among these groups, and the overall number of patients who underwent procedures. By examining the interventions, and recommendations provided to patients following diagnosis, the research aims to enhance our understanding of the longitudinal care strategies employed by oral pathologists. The study utilizes a retrospective observational design, utilizing electronic health records and patient databases to ensure accurate and completeness of the dataset. Over three months, 1,542 patients were clinically examined, with an average of 33 patients per day, or 132 patients per week. Of these, 82% presented with lichenoid mucositis, 63% with leukoplakia, 22% with candidiasis, 15% with no evidence of recurrent disease following treatment, and 11% with burning mouth syndrome. There were an additional 60 diagnoses examined in this time period in smaller increments. Patients were placed into multiple diagnostic categories as they presented with multiple different lesions. Of the 1,542 patients examined, 351 had a biopsy procedure performed. The findings of this research contribute valuable information for what one can expect to see within a busy clinical oral pathology practice in a major metropolitan area. Understanding variations in the diagnostic landscape can inform personalized patient treatment plans and resource allocation. Additionally, insights into biopsy frequency enhances the understanding of the diagnostic process and may guide improvements in patient care, practice efficiency, and long-term oral health outcomes.

Introduction

Acute Myeloid Leukemia (AML), a malignant neoplasm characterized by the rapid proliferation of abnormal cells in the bone marrow, often manifests oral signs such as gingival bleeding and purple-colored gum hyperplasia. This clinical case underscores the pivotal role of dentists in diagnosing AML, shedding light on the nuanced presentation of hematological diseases in the oral cavity.

Case Report

A 57-year-old Caucasian female with a history of fibromyalgia and current use of Fluoxetine and Amitriptyline presented with a chief complaint of gum pain and bleeding persisting for 60 days. Clinical examination revealed distinctive purple hemorrhagic gingival hyperplasia, prompting a comprehensive evaluation. Initial investigations, including a full blood count, clotting profile, and HIV serology (suspected Kaposi's sarcoma), returned within normal parameters. Recognizing the potential severity of the oral manifestation, the patient was promptly referred for oncology-hematology assessment. Given the suspicion of an underlying hematologic condition, an incisional biopsy was performed, revealing a diagnosis of Acute Myeloid Leukemia. This diagnosis, unexpected in the absence of abnormal laboratory findings, underscores the imperative role of dental professionals in early detection and referral.

Conclusion

This case serves as a compelling example highlighting the significance of dental professionals in identifying potentially life-threatening oral lesions, even when routine laboratory tests appear normal. The timely and astute recognition of aberrant oral presentations can expedite referral to specialized medical care, significantly influencing patient outcomes. In essence, the presented case reinforces the critical collaboration between dentists and oncology-hematology specialists, emphasizing the need for a comprehensive understanding of oral manifestations of systemic diseases. This interdisciplinary approach contributes not only to the prompt diagnosis of potentially severe conditions like AML but also to the overall well-being of the patient.

Introduction

Odontogenic myxoma is considered to originate from the odontogenic ectomesenchyme. The tumor can involve any age group, but is predominantly seen in young adults. Here we present a patient with odontogenic myxoma with a history of multiple endocrine neoplasia type 2A (MEN2A). To the best of our knowledge, odontogenic myxoma has not been previously reported in a patient with a MEN2A history.

Case presentation

A 14-year-old female with a known history of MEN2A, presented with a painless bony expansion and radiolucency with fine residual bone trabeculae arranged at right angles to one another between teeth #4 and #5. Upon biopsy a diagnosis of odontogenic myxoma was rendered. MEN2A is an autosomal dominant syndrome characterized by clinically aggressive medullary thyroid carcinoma (MTC), pheochromocytoma, parathyroid hyperplasia, or adenoma. Therefore, as the standard of care for the MTC includes prophylactic total thyroidectomy, it was undertaken in this patient at an early age. For the odontogenic myxoma, the patient was treated with enucleation and curettage. At 2 years post-resection follow-up, the patient was disease-free.

Conclusion

It is unclear if the odontogenic myxoma in this patient was associated with previously diagnosed MEN2A syndrome or incidental, but the possibility of associated mesenchymal tissue tumors should be considered in patients with history of syndromic conditions. Although odontogenic myxoma is a benign lesion, because of its high recurrence rate and locally aggressive clinical behavior, periodic follow-up is necessary for at least 5 years post-treatment. Despite the high recurrence rate of 25% as reported in the literature, the prognosis largely remains good.

Introduction

Nodular hidradenomas are benign adnexal neoplasms presenting as solitary asymptomatic intradermal nodules, often on facial skin. Tumors are covered by normal skin, but superficial ulcers may occur. Hidradenomas often exhibit cuboidal cells with pink cytoplasm, but clear cell, squamoid, plasmacytoid, and mucinous variants have been described. Malignant counterpart of hidradenoma exists. There is morphologic and molecular overlap between cutaneous adnexal tumors and salivary gland tumors, for example, hidradenoma and mucoepidermoid carcinoma (MEC).

Case Findings

A 64-year-old male patient presented with a submental subcutaneous mass for six months. A fine needle aspiration (FNA) was performed, based on the clinical suspicion for a granulomatous process and to rule out malignancy. FNA cytology was interpreted as positive for malignant cells, suspicious for squamous cell carcinoma (SCC). Constituent cells were p40 positive and negative for p16, androgen receptor (AR), and CD163. AFB staining negative for acid fast bacilli. Excision of the lesion was performed.

Results

Microscopic examination reveals a fragmented epithelioid tumor with squamoid, clear cell, glandular, and papillary features favoring a benign adnexal skin tumor. The proliferative index was < 5%. Included in the differential diagnosis was MEC. Positive MAML2 gene rearrangement was identified on fluorescent in-situ hybridization (FISH). Upon consultation with dermatopathology, a diagnosis of benign nodular hidradenoma was rendered.

Conclusions

Clinical presentation, discussed with the surgeon, excluded association with salivary glands, emphasizing the subcutaneous location. Although there is morphologic and molecular overlap between nodular hidradenoma and MEC, clinical location supports the final diagnosis of a benign adnexal tumor, specifically benign nodular hidradenoma. In addition, MAML2 interrogation can help distinguish hidradenoma from other sweat gland neoplasms.

Introduction

The cellular spindled histiocytic pseudotumor is a rare, benign, and reactive mass-producing lesion that clinically and histopathologically mimics spindle cell neoplasms. There is only one previous report of twenty cases, all arising in the breast in association with fat necrosis. This is the first description of oral involvement.

Materials and Method

A 70-year-old male presented with a few month history of a painful swelling of the anterior maxilla. Teeth 8 and 9 were extracted approximately three years ago. A CBCT showed a mass partially covered by a thin rim of bone. Clinical suspicion for a neoplastic process was high and an incisional biopsy was submitted for histopathological evaluation.

Results

The lesion consisted of cohesive and compact fascicles of spindle cells with scattered lymphocytes. One focus of necrotic bone and degenerating fat was seen. Two pieces of likely graft foreign material were embedded among lesional cells towards one margin of the submitted tissue. Lesional cells were seen infiltrating surrounding skeletal muscle fibers. Mitotic figures were not obvious. Lesional cells expressed CD68 and CD163 strongly but were negative to AE1/AE3, S100, SMA, desmin, CD34 and CD21. A working diagnosis of reactive proliferation with features like a cellular spindled histiocytic pseudotumor was given. Thorough curettage and follow-up were recommended. Following a thorough curettage, healing was uneventful with no recorded recurrence.

Conclusions

The cellular spindled histiocytic pseudotumor is an exaggerated reactive response to degenerating fat and foreign material. The clinical and histopathological presentation is worrisome for benign and malignant spindle cell tumors. Incisional biopsies may not show degenerating fat or other foreign material. This is the first report of oral involvement. Awareness of this entity will prevent misadventures in its diagnosis and management.

Introduction

Idiopathic gingival papillokeratosis with crypt formation (IGPCF) is an uncommon condition of unknown etiology, characterized by keratotic plaques in the upper labial attached gingiva of young patients. No treatment is required, although periodic follow-up is recommended as some lesions persist. Despite the limited number of published cases, the diagnosis of IGPCF is highly suggestive based on the distinctive clinical features, and biopsy is usually unnecessary. We aim to report seven additional patients with IGPCF from Brazil and the United States.

Material and Methods

Seven IGPCF cases were retrieved from the archives of the Oral Pathology Laboratories from the Federal University of Rio de Janeiro, Brazil, and Texas A&M University, USA, between 2017 and 2023.

Results

Six patients were male, and one patient was female, with an average age of 15.8 years (ranging from 12 to 21). All patients presented with asymptomatic bilateral papillary white plaques located exclusively in the attached anterior gingiva with a duration ranging from 4 to 12 months. Six cases presented in the maxillary labial gingiva, whereas a single case was located in the mandibular labial gingiva. Clinically, the lesions appeared as well-demarcated symmetric white plaques with an irregular surface, stopping abruptly at the mucogingival junction. Incisional biopsies were performed on six patients with exuberant lesions, while an exclusively clinical diagnosis was established in a single patient with discrete plaques. Microscopic analysis revealed gingival mucosa showing overlying parakeratosis with papillary architecture and multifocal epithelial crypt-like invaginations with parakeratin plugging. Mild pseudoepitheliomatous hyperplasia was noticed, with no signs of epithelial atypia.

Conclusion

Clinicians should be aware of IGPCF and differentiate it from other papillary keratotic oral lesions. Reporting additional cases may provide further characterization of this unusual entity and improve understanding as it relates to etiology and prognosis.

Introduction

Different markers, such as p53, CK13, CK17, and Ki67, have been used to assist in the histopathologic grading of oral epithelial dysplasia (OED). This study aims to evaluate the correlation between these markers and histopathologic grading.

Materials and Methods

This retrospective study included 65 OED cases: 15 with mild dysplasia, 31 with moderate dysplasia, and 19 with severe dysplasia. Patient age, gender, lesion location, histopathologic grading, and expression patterns of p53, CK13, CK17, and Ki67 immunohistochemical studies were reviewed and analyzed.

Results

In our cases, half of the mild dysplasia and all of the moderate and severe dysplasia cases showed a reverse CK13/CK17 staining pattern. An increased number of Ki67-positive cells, located upward, were frequently associated with moderate and severe dysplasia cases. However, mutated p53 staining patterns were correlated with severe dysplasia (16/19; 84.2%). All our mild dysplasia cases showed a wild-type p53 staining pattern, and fewer than one-third (7/31; 22.6%) of moderate dysplasia cases revealed a mutated p53 staining pattern. The staining patterns were not associated with patient age and gender. Lesions at the ventral and lateral border of the tongue and soft palate were mainly associated with a mutated p53 staining pattern (12/14; 85.7% and 3/3; 100%, respectively). Only 17.5% (7/40) of the lesions on the buccal mucosa were associated with mutated p53.

Conclusions

The alteration in the CK13/17 staining pattern can be used to detect differentiation changes in early OED. Mutation of p53 is most likely a later event and is associated with more advanced OED.