Clinico-pathologic correlations of myofibroblastic tumors of the oral cavity. II. Myofibroma and myofibromatosis of the oral soft tissues

BACKGROUND: Myofibroma is a solitary benign tumor of myofibroblasts. Myofibromatosis describes multiple, simultaneous myofibromas at different sites in various organs. The clinico-pathologic correlations of myofibroma/myofibromatosis confined only to oral soft tissues were analyzed. METHODS: In the English language literature, 41 myofibroma and 12 myofibromatosis cases involving the oral soft tissues were found. From our files, three new myofibroma cases were added. RESULTS: Age at time of diagnosis of oral mucosa myofibroma ranged from birth to 70 years (mean 21.7 years), considerably higher than myofibroma in other parts of the body. Lesions occurred during the first decade (44%) and in the first year of life (17%). Male:female ratio was 1:1.6, contrary to the male predominance in other parts of the body. Common sites were the tongue (32%) and buccal mucosa (18%). Treatment was local excision, either complete (n = 13) or partial (n = 3), wide excision (n = 4), surgery, and chemotherapy (n = 1). Myofibromatosis involving oral soft tissues was diagnosed at birth in nine (75%) patients, within the first year in two, and as a young adult in one. Male:female ratio was 2:1. The tongue was the most common site (50%). Half the patients died of disseminated disease within a few days from birth, three were cured by partial or complete excision, and three experienced spontaneous regression. Histologically, oral mucosa myofibroma/myofibromatosis appearance agreed with findings in the literature. CONCLUSIONS: Myofibroma should be included in the clinical differential diagnosis of masses of the oral soft tissues, especially in the tongue and buccal mucosa of children and adolescents. Histological differential diagnosis includes benign and malignant spindle-shaped lesions. Treatment of choice is local excision.     

口腔颌面部结节性筋膜炎临床病理分析（附3例报告）

目的：分析口腔颌面部结节性筋膜炎的临床病理特点,方法：对3例结节性筋膜炎性HE及免疫组化SP法染色和组织学观察,结果：3例结节性膜断断续续的为病史短,生长快,中年女性多见,发病部位为颊、舌、磨牙后区,肿物呈结节性,无包膜,直径在3cm以内,质偏硬,组织学特点为纤维母细胞增生活跃,核分裂象易见,“S”形结构,组织裂隙,外渗红细胞,粘液背是,Vim( ),SMA( ),Des(-).结论：结节性筋膜炎的本质是纤维母细胞和肌纤维母细胞增生,其组织学构型有诊断价值,需注意与肉瘤的鉴别诊断。     

Primary tuberculosis of the oral cavity

Tuberculosis is one of the major causes of ill health and death worldwide. Nevertheless, tuberculous lesions of the oral cavity are rare and can be a diagnostic challenge, particularly in young immunocompetent patients. Most of the cases are secondary to pulmonary disease and the primary form is uncommon. In this paper, we present a case of primary oral tuberculosis, affecting the floor of mouth in a 13-year-old Brazilian male patient.     

Cysticercosis of the oral cavity: report of seven cases

Cysticercosis is a condition in which a human acts as the intermediate host of the pork tapeworm Taenia solium. Although cysticercosis is a common disease in some regions of the world and can occur in any body site, oral lesions are rare. This paper reviews the natural history of the disease and reports on seven cases of oral cysticercosis.     

Magnetic resonance imaging findings of nodular fasciitis in the mental region

Nodular fasciitis (NF) is a benign reactive lesion of the soft tissues related to the fascia and characterized by fibroblastic proliferation. The most common site is the upper extremities (46%), followed by the head and neck region (20%). In the orofacial region, the lesion typically develops within the subcutaneous structures overlying the angle and inferior border of the mandible and the zygoma. Magnetic resonance imaging (MRI) findings of NF in the orofacial region are almost unreported in the literature. In the present case report, we describe MRI findings of mental NF in a 19-year-old woman. MRI revealed a well-defined, round soft-tissue mass lying on the mentum. On T1-weighted MRI, the lesion was isointense to skeletal muscle; it was hyperintense to skeletal muscle on T2-weighted MRI, and was enhanced by Gd-diethylenetriamine pentaacetic acid (DTPA). Histologic examination revealed abundant myxoid degeneration dispersed in the lesion. The T2-weighted higher heterogeneous signal intensity was likely due to abundant myxoid degeneration or the cellular component of the lesion. A strong bright signal intensity belt appeared in the periphery of the lesion on Gd-DTPA enhancement. This rim enhancement appearred to represent small arterioles and venules that were visible in the peripheral area on histologic examination.     

口腔髓细胞肉瘤报告1例

髓细胞肉瘤是一种由原始粒细胞或不成熟粒细胞形成的孤立性恶性肿瘤,发病于口腔较为少见且较难诊断。本文报告1例原发灶位于牙龈处的髓细胞肉瘤,并对其临床表现、组织形态特征,免疫组化结果进行报告,并回顾相关性文献进行讨论。     

口腔粒细胞肉瘤2例

口腔粒细胞肉瘤是一种少见的生长于髓外、由未成熟的髓样细胞构成的孤立性肿瘤。本文对2例口腔粒细胞肉瘤患者的临床、病理及治疗进行报道,并结合文献对口腔粒细胞肉瘤进行讨论。     

Helicobacter pylori in the oral cavity is associated with gastroesophageal disease

Background:  In Mexico, more than 80% of the population is infected with Helicobacter pylori . The frequency of H. pylori detection in the oral cavity is unknown, as its relationship with gastroesophageal pathology.
Aim:  To detect the presence of H. pylori in the oral cavity in Mexican population by PCR and to determine its association with gastroesophageal disease.
Methods:  Patients were divided into two groups with different clinic conditions from whom gastric biopsy, dental plaque, and saliva samples were taken and analyzed. The first group comprised of hospitalized patients, the majority of whom were diagnosed with gastroesophageal disease, while the second group was selected from a dental clinic (ambulatory population) the majority of whom appeared to be healthy subjects.
Results:  H. pylori was detected in gastric biopsy, dental plaque and saliva samples by PCR using a set of specific primers for the signal sequence of the vacuolating cytotoxin gene; detection of H. pylori in general was higher in gastric biopsy and dental plaque samples than in saliva samples. Detection of H. pylori in the oral cavity is significantly ( P  = 0.0001) associated with patients presenting gastroesophageal disease, while healthy subjects and those with other non-gastric disease do not present with H. pylori in their oral cavity.
Conclusions:  H. pylori detection in the oral cavity is associated to gastroesophageal disease. In addition, it is suggested that all patients presenting gastric symptoms and H. pylori detection in the oral cavity would begin bacterial treatment immediately.     

Epithelioid hemangioendothelioma of the oral cavity

OBJECTIVE: To investigate the clinicopathological characteristics and biologic behaviour of epithelioid hemangioendothelioma in the oral cavity. MATERIALS AND METHODS: The clinical features and pathological findings of nine cases with intraoral epithelioid hemangioendothelioma were reviewed, including immunohistochemistry study. RESULTS: This series comprised seven males and two females aged 6-53 years (mean 28 years). The sites of the tumour included the tongue (n = 4), lip (n = 1), the gingiva and alveoli of the maxilla (n = 1), the gingiva and alveoli of the mandible (n = 1), buccal mucosa (n = 1), and the floor of the mouth (n = 1). A painless solitary mass was the most common presentation and was found in eight cases. On pathology, the tumour grew in short strands, cords or nests of polygonal to slightly spindled epithelioid cells in fibro-myxoid stroma, with formation of intracytoplasmic lumina. Tumour cells were immunoreactive to CD34, FVIIIRAg, and vimentin. Focal-positive cytokeration were observed in three cases. Immunoreactivity for S-100 protein, epithelial membrane antigen (EMA) and human herpesvirus (HHV)-8 was negative in all cases. Two cases recurred after surgical excision, but no patient developed local or distant metastasis. CONCLUSIONS: Wide local excision with long-term follow-up seems to be the treatment of choice for intraoral epithelioid hemangioendothelioma because of their unpredictable biological behaviour and recurrence potential.     

Association of HPV infections with second primary tumors in early-staged oral cavity cancer

Oral Diseases (2012) 18 , 809–815 Objective: The infection of human papilloma virus (HPV) has been reported in head and neck cancer; however, the clinical significance of HPV infection on the pathogenesis of oral cavity squamous cell carcinoma (OSCC) is still uncertain. Materials and Methods: The study recruited 103 patients with pathological early‐stage OSCC between March 1997 and December 2003 from Chang Gung Memorial Hospital, Taiwan. Tumor specimens were HPV‐genotyped by the EasychipVR HPV Blot method. Clinical association study was performed by using chi‐square, Kaplan–Meier, and logrank tests. Results: Thirty‐one patients (30.1%) were positive for HPV infection. The most frequent HPV types were types 16 (16 patients, 51.6%) and 18 (seven patients, 22.6%). HPV infection was not associated with tumor aggressiveness (pathological tumor stage or differentiation status), risk exposure (alcohol, cigarette, or areca quid chewing habit), or the treatment outcome (disease‐free survival or overall survival). However, infection with HPV‐18 was associated with the occurrence of a second primary cancers (P = 0.033), indicating the infection of HPV in OSCC enhances the susceptibility of developing secondary malignancy. Conclusions: There are 30% of the patients with OSCC infected with HPV, with most high‐risk types. HPV‐18 infection may enhance the susceptibility of second primary tumors. Large scale of validation study will be needed to confirm this result.     

Leukocytoclastic vasculitis (anaphylactoid purpura): a unique occurrence in the oral cavity.

Leukocytoclastic vasculitis, immune complex disorder (type III), is a skin disease with both an acute form characterized by bullae, vesicles and ulcerations, and a chronic form characterized by petechiae, macules and ulcerations. The disease presents certain systemic features including diffuse or focal glomerulonephritis and renal failure. The histopathologic characteristics of leukocytoclastic vasculitis in the skin appear primarily in small blood vessels and consist of an infiltration of inflammatory cells, leukoclasis, swelling of endothelial cells, occlusion of blood vessels, accumulation of fibrin and fibrinoid degeneration, as well as the presence of immune complexes in and around blood vessel walls. Although leukocytoclastic vasculitis is described as several diseases which can spread systemically, including the gastrointestinal tract and the kidneys, the manifestations of the disease in the oral cavity have not yet been reported. The present paper reports unique oral lesions in a 38-yr-old woman, diagnosed as leukocytoclastic vasculitis, without any accompanying skin or systemic lesions.     

Juvenile xanthogranuloma occurring in the oral cavity: case report and histopathological findings

Juvenile xanthogranuloma is commonly seen in the dermis, and only very rarely develops in the oral mucosa. Here we report a case that occurred in the anterior palate of a 9-year-old boy. The lesion appeared as a dark red and well-defined nodule measuring 12×14 mm. Histologically, it consisted of a proliferation of histiocytes and fibroblastic stroma intermingled with foamy cells. Many lipid droplets without limiting membrane were observed in the cytoplasm under electron microscopy, but no Langerhans' cell granules were observed. The proliferative histiocytes were positive for lysozyme and macrophage HAM56 under immunohistochemical observation, but not for S-100 protein. From these findings, the lesion was diagnosed as juvenile xanthogranuloma. The post-operative course, now amounting to 7 years, has been uneventful.     

口腔颌面部结节性筋膜炎6例报道

目的:总结口腔颌面部结节性筋膜炎的临床病理特点及鉴别诊断要点。方法:对1995-2003年收治的6例口腔颌面部结节性筋膜炎患者的临床资料进行回顾分析,探讨其临床特征、组织病理学特点、鉴别诊断、治疗及预后等。结果:6例结节性筋膜炎均为病程短、生长快的肿瘤中年女性多见。肿块呈结节形,直径为1.5～3.5cm。组织学特点为纤维母细胞增生活跃,核分裂像易见“,S”形结构、组织裂隙、外渗红细胞、黏液背景;免疫组化染色显示Vim( )、SMA( )、Des(-)。手术切除后,随访1～9a,无1例复发。结论:结节性筋膜炎的本质是纤维母细胞和肌纤维母细胞增生,属良性病变,切除后不易复发,预后良好。     

1 267例南京及周边地区口腔恶性肿瘤统计分析

目的 分析了解南京及周边地区口腔恶性肿瘤的发病情况和构成特点,为口腔恶性肿瘤的防治提供参考数据。方法 对南京市口腔医院2010—2013年4年间住院治疗的口腔恶性肿瘤患者1 267例,作一回顾性统计分析。结果 1 267例口腔恶性肿瘤患者平均年龄60.94岁,男性发病率高于女性,男女性别比为1.3∶1.0,具有吸烟与饮酒史者亦为男性高于女性, 60~69岁及70岁以上为高发年龄组,男性于60~69岁患病比例最高,女性于70岁以上患病比例最高,男女各年龄组统计学分析（P<0.05） 差异有统计学意义;口腔恶性肿瘤以口腔癌多见,口腔癌中又以鳞状上皮癌多见,共818例,占总数64.56%;发病部位分布在前6位的依次为舌、颊、牙龈、软硬腭、颌骨、涎腺,其中以舌部为多,占27.55%,口腔溃疡、口腔黏膜病和牙齿病变者932例,占73.56%。结论 在南京市口腔医院住院治疗的口腔恶性肿瘤患者中男性高于女性,高发年龄在60岁以上,以口腔上皮鳞癌为多见,提示应加强老年人的口腔保健工作。     

唾液中白细胞介素与口腔癌的关系

唾液用于疾病的诊断越来越受到重视,由于口腔癌（OCC）发生部位的特点,唾液中白细胞介素（IL）可作为OCC诊断的生物标志物,并与OCC的发生、发展、侵袭、转移密切相关。本文对唾液中IL的检测方法及其与OCC发生、发展的关系等方面的研究进展进行综述。     

口腔颌面部肌内型结节性筋膜炎3例报告及文献复习

目的 探讨结节性筋膜炎的病因和诊断方法。方法 报告3例肌内型结节性筋膜炎患者资料,并结合文献对结节性筋膜炎的病因、诊断方法进行回顾性分析。结果 结节性筋膜炎好发于20~40岁,临床检查为界限清晰或不清晰的结节;CT可见结节与肌筋膜关系密切,切除行组织病理学检查是诊断本病的最好方法。结论 结节性筋膜炎的发病机制尚不明确,临床表现复杂多样,临床医师应加强对结节性筋膜炎的认识,提高诊断的正确率。手术是治疗本病的最好方法。     

聚桂醇注射液治疗口腔颌面部脉管性病变的临床观察

目的:评价聚桂醇注射液治疗口腔颌面部脉管性病变的临床疗效。方法:对56例口腔颌面部脉管性病变进行次数不等,剂量不同的瘤腔内注射聚桂醇注射液,通过6～24个月的观察,判断其疗效。结果:56例中,显效33例,占58.9%,有效21例,占37.5%,无效2例,占3.6%,总有效率96.4%。结论:聚桂醇注射液治疗口腔颌面部脉管性病变起效快,安全性好,毒副作用小,疼痛发生率低,组织坏死罕见。     

Primary small cell carcinoma of the nasal cavity with an unusual oral manifestation

Small cell carcinoma (SCC) is a malignancy that mainly occurs in the lung, with primary lesions in the head and neck being very rare. This neoplasm has an aggressive growth pattern, high recurrence rate, and tendency to metastasize to other sites via the lymphatics and bloodstream. The prognosis of patients with SCC is poor, as the 5-year survival is only 13%. Treatment options include surgical excision, multiple-agent chemotherapy, and radiation therapy. We report a rare case of primary SCC of the nasal cavity presenting as a lesion of the hard palate and describe its clinical, histologic, and immunohistochemical features.     

A review of risk factors for oral cavity cancer: the importance of a standardized case definition

The aim of this work is to review the literature on risk factors of oral cavity cancer with a special attention to the definition of the cases, in order to highlight special features of these cancers and of their subsites. PubMed database was systematically searched to access relevant articles published between 1980 and 2010. Reference lists of selected papers were examined to identify further articles. One hundred and two studies met the inclusion criteria. Their results were difficult to compare because of the lack of uniformity in defining oral cavity. In addition, few studies examined risk factors other than alcohol and tobacco, and studies differentiating between subsites were rare. Despite these limitations, some characteristics of oral cavity cancers may be emphasized: smoked tobacco seems to be a stronger risk factor for oral cavity cancer than alcohol, and the floor of the mouth seems to be more sensitive to the harmful effects of alcohol and smoked tobacco. Studies limited strictly to oral cavity cancers and distinguishing between subsites are needed to better understand the aetiology of these cancers, and better define risk groups to target prevention efforts and screening.