Benign cementoblastoma--cementum analogue of benign osteoblastoma?

We believe that the current case is a good example of a "borderline lesion" that shows the histologic features of benign osteoblastoma but with some clinical features suggestive of a cementoblastoma, such as attachment to the roots. We suggest, however, that the involvement of the roots should not rule out the diagnosis of benign osteoblastoma. The fact that a benign osteoblastoma may envelop the roots in a way characteristic of a benign cementoblastoma, however, is suggestive of a close relationship between the two tumors.     

Morphometric study of epithelial neoplasms of the parotid gland

The histological diagnosis of parotid gland tumoral pathology is difficult in some cases. Morphometry provides a possibility to quantify the histopathology minimizing the risk of a misdiagnosis. On this basis, a morphometric study of the normal parotid tissue and 13 types of parotid tumors is carried out and nuclear Area, D. Circle, Form. PE, and Form. AR are calculated. Statistical analysis the results is made using the Student's "t-test" and significant differences between benign and malignant tumors and between each tumor and the remainder are obtained. Contribution of the results to the histopathological diagnosis is discussed.     

Benign parotid lymphoepithelial cysts associated with HIV infection

HIV infections are often related with lymphoepithelial benign cysts of the parotid gland; these lesions are uncommon and other salivary glands are rarely involved. The diagnosis, often difficult, is based on imaging techniques, like computed tomography, and pathologic techniques, like fine needle aspiration biopsy. The therapeutic approach can be performed by simple aspiration, surgical resection, pharmacotherapy, or radiotherapy. Three cases of HIV-related lymphoepithelial benign cysts of the parotid gland observed at the Department of Maxillofacial Surgery of the "Federico II" University of Naples and at the Department of Oral and Maxillofacial Surgery of "La Paz" Hospital of the Universitad Autonoma of Madrid are described.     

Recurring gnathodiaphyseal dysplasia in two Russian brothers

Two Russian brothers presented with recurring benign facial bone tumors and progressive limb bowing. The association of fibro-osseous jawbone lesions and long-bone bowing with cortical thickening suggested the diagnosis of gnathodiaphyseal dysplasia, in the absence of arguments in favor of fibrous dysplasia. Gnathodiaphyseal dysplasia is a rare autonomic dominant syndrome due to a mutation of the TMEM16E gene. The extreme and recurring phenotype of these two patients illustrates the variable expressivity of this disease. Differential diagnosis with other benign facial bone tumors is discussed.     

Pilomatricoma: A dermal analog of calcifying odontogenic cyst

Pilomatricoma, also known as "Calcifying Epithelioma of Malherbe" is an uncommon, benign, cutaneous tumor originating from the hair matrix. Most often, its precise preoperative diagnosis is not possible. Rarity of this lesion and its histological resemblance to the calcifying odontogenic cyst (the Gorlin's cyst) make it relevant, both to the maxillofacial surgeons and the pathologists. Here, we describe a case of pilomatricoma of the periorbital region in a young Indian female patient. We believe that its inclusion is essential in the differential diagnosis of hard masses of the maxillofacial and paraoral regions.     

Benign lymphoid hyperplasia of the tongue masquerading as carcinoma: case report and literature review

Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. A case of benign lymphoid hyperplasia (BLH) of the tongue is reported. Clinically this lesion presented as a painless ulcer, which mimicked carcinoma of the tongue. Microscopy showed typical histologic features of multiple germinal centers with a rim of small mature lymphocytes together with a mixed, mainly mononuclear infiltrate which clinched the diagnosis of benign lymphoid hyperplasia. This diagnosis averted extensive investigations and major surgery. The etiology of these lesions is unknown. Their distinction from carcinoma and lymphoma is discussed.     

Histopathologic examination to confirm diagnosis of periapical lesions: a review

Most periapical lesions are represented by inflammatory cysts, granulomas, abscesses or fibrous scars. These inflammatory conditions are often termed "endodontic lesions" because pulpal necrosis is the initiating event in their pathogenesis. Although rare, other clinically confusing periapical lesions have been extensively documented in numerous case reports and short case series. These lesions represent a wide range of pathosis, including various developmental cysts, infections, benign but locally aggressive lesions, and malignancies. The literature describing these lesions and the value of a histopathologic examination in diagnosis is reviewed.     

Benign conditions of the temporomandibular joint: a diagnostic dilemma

The diagnosis of certain benign conditions affecting the condyle in the temporomandibular joint can be difficult. A spectrum of osteomas, condylar hyperplasia and synovial chondromatosis can all present the same clinical and radiological picture, while the histological appearance may be difficult to interpret and are often misleading. Trauma, local infection or surgery may play a part in the development of these pathologies. A case is reported which clearly illustrates the difficulties of diagnosis of these benign conditions.     

Myxoma of the mandible with unusual radiographic appearance

Myxoma of the jaws is a fairly frequent bone tumor classified as a benign odontogenic neoplasm. The radiographic picture varies according to its evolution and, it many cases, diagnosis is not easy. A new case with an unusual radiographic appearance is reported. On occlusal radiographic examination the tumor showed multiple spicules of bone with a classic "sun-ray" effect. Only two similar cases were found in the literature. Oral and maxillofacial surgeons should be aware of this unusual presentation so that a misdiagnosis of malignant bone tumor is not made.     

Recurrent aphthous stomatitis: etiology,diagnosis, and treatment

Recurrent aphthous stomatitis is a very common condition seen frequently by dentists in practice. Although the majority of cases are benign and resolve in less than two weeks, these ulcerations may be indicative of underlying systemic diseases ranging from vitamin deficiency to autoimmunity. Awareness of these correlations can help the dentist make or aid the diagnosis of potentially serious conditions. There are treatments of which the practitioner should be aware that may ameliorate the pain of the ulcerations or shorten their duration. The diagnosis and management of this important condition is reviewed in this article.     

Efficacy of Colour Doppler Ultrasound in Diagnosis of Cervical Lymphadenopathy

Objectives

The purpose of the study was to evaluate the efficacy of colour doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy.

Materials and Methods

The study group consisted of 30 patients with clinical evidence of cervical lymphadenopathy (19 patients with clinically suspected reactive/benign cervical lymphadenopathy and 11 patients with clinically suspected malignant/metastatic cervical lymphadenopathy). CDUS examinations were carried out for one lymph node (LN) in each patient and fine needle aspiration cytology of the same LN was obtained. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological features of enlarged cervical LNs were then done.

Results

Clinical examination evaluated 54 cervical LNs. CDUS evaluation discovered an additional 55 LNs (54 + 55 = 109). Accuracy of the CDUS examination was higher than clinical evaluation. Patterns of colour doppler flow signals when correlated with cytological diagnosis showed central flow for benign nodes and peripheral flow for malignant nodes. The mean pulsatility index (PI) was 1.977 ± 0.669 in LNs involved with metastases and 0.839 ± 0.135in LNs affected by benign processes. LNs involved with metastases showed a characteristic high resistive index (RI) and a high pulsatility index than the lymph nodes affected by benign processes. The RI and PI were significantly different between LNs affected by benign versus malignant disease.

Conclusion

Nodal vascularity of the LNs can be used to differentiate benign from malignant lymphadenopathy. CDUS can be trusted upon as a reliable marker for the diagnosis of cervical lymphadenopathy.     

Oral capillary hemangioma: A clinical protocol of diagnosis and treatment in adults

Purpose

Hemangiomas are benign vascular anomalies characterized by benign proliferation of blood vessels. There are no well-defined criteria for the diagnosis and treatment of oral capillary hemangioma (OCH). The objective of this study is to report a safe, effective, and low-cost protocol for diagnosis and treatment of OCH.

Materials and methods

Eight patients were diagnosed with OCH, through two physical examination maneuvers—the diascopy and head lowering maneuver with abdominal compression (HLMAC). The treatment performed was sclerotherapy with ethanolamine oleate, weekly, until the disappearance of the lesion. No local anesthetics were administered prior to the sclerosing agent injection.

Results

All cases showed a complete remission of the lesions after sclerotherapy. There were no visible scars or compromise esthetics or normal function, and there was no evidence of recurrence. Only one patient had superficial ulceration, which remained asymptomatic and healed without specific treatment.

Conclusions

This protocol was effective in the diagnosis of OCH through two physical examination maneuvers with low-cost and easy implementation, the diascopy and the HLMAC. The low concentration associated with a reduced amount of the sclerosing agent was responsible for the excellent results in the cases treated.     

Riesenzellgranulom und Osteitis fibrosa cystica bei Hyperparathyreoidismus

Background

Giant cell lesions of the bone present similar histological features. The differential diagnosis comprises central giant cell granuloma, giant cell tumor of bone, and osteitis fibrosa cystica (brown tumor) in combination with hyperparathyroidism. Since these lesions may mimic metastatic bone disease in patients with a history of cancer, a malignant process has to be considered. Since the treatment and prognosis of these entities—benign versus malignant osteolytic bone processes—differ greatly, definitive differential diagnosis is of utmost importance.

Case report

Two patients presenting with osteolytic lesions of the maxilla are reported here. In both cases a history of cancer (breast and prostate) suggested bone spreading of these malignant tumors. The clinical and histological findings were similar in both patients. One lesion was diagnosed as central giant cell granuloma, the other was found to be brown tumour in osteitis fibrosa cystica as an initial manifestation of hyperparathyroidism.

Discussion

The presented cases demonstrate the difficulties in establishing the correct diagnosis of patients found to have osteolytic lesions of the jawbones which is critical for the appropriate management of these patients. The article discusses the different entities of osteolytic lesions of the jawbones and the necessary diagnostic and therapeutic approach.     

Is ultrasound alone sufficient for imaging superficial lobe benign parotid tumours before surgery?

Ultrasound (US) is a valuable technique for the assessment of salivary gland disease and regional nodes. When used in combination with fine needle aspiration cytology (FNAC) or core biopsy it has a high sensitivity and specificity in the diagnosis of tumours. The role of additional cross-sectional imaging (computed tomography (CT) or magnetic resonance (MR)) to help with the diagnosis of benign parotid tumours is questionable except when there is deep lobe extension or the suggestion of malignancy. We investigated 37 FNAC-confirmed benign parotid tumours in patients who had undergone both US and CT or MRI investigations, to find out whether cross-sectional imaging had provided any further useful diagnostic information before operation. Three patients had bilateral Warthin tumours. Tumours ranged in size from 11 to 45 mm (mean 22). Of the 37 patients 35 (95%) had a clearly delineated mass in the superficial lobe of the parotid on US and no further information was gained from additional CT or MRI. On US 34 patients (92%) had features suggestive of a benign tumour, and three had features suggestive of malignancy but these were found to be benign on FNAC and after operation. CT or MRI confirmed these suspicious findings. In two different patients the deep margin was not visible on US (suggestive of deep lobe extension) and this was confirmed on MRI. The mean time delay between US and CT or MRI was four weeks (range 1-44). These results suggest that additional imaging is not required in most patients with a sonographically and FNAC confirmed benign lesion confined to the superficial lobe of the parotid and confirmed by FNAC or biopsy examination.     

Capillary hemangioma or pyogenic granuloma: A diagnostic dilemma

Pyogenic granulomas and hemangiomas of oral cavity are well-known benign lesions. Although pyogenic granuloma is known to show a striking predilection for the gingiva and capillary hemangioma for lips, check, and tongue, palatal occurrence of these lesions is extremely rare. The clinical diagnosis of such an uncommon occurrence can be quite challenging as they sometimes may mimic more serious lesions such as malignancies. The purpose of this article is to report an unusual case of benign tumor occurring on hard palate which was clinically diagnosed as pyogenic granuloma and histopathologically as capillary hemangioma.     

Benign lip lesions. A 10-year retrospective study

Objectives

This paper aims to present a retrospective analysis of a cohort of patients with benign lip lesions managed over the last decade at the Department of Maxillofacial Surgical Oncology of Theagenio Cancer Hospital of Thessaloniki. It aims to highlight the substantial clinical and histological diversity of the lesions, as well as to present an epidemiological analysis for the specific cohort/population.

Study design

During the period 1995–2004 a total of 420 patients were managed for lip lesions. Of these, 280 were malignant and 116 benign. A total of 24 cases of actinic keratosis were added in the latter group.

Results

Of the benign lesions, the commonest were haemangiomas (19.28%), actinic keratosis (17.14%), intradermal naevus (14.28%), fibroma (9.28%), papilloma (7.85%), mild and moderate dysplasia (7.85%) and mucocele (7.14%). The group included 17 different histological types of benign lesions. The most frequent site of presentation was the lower lip (56.42%). Post-operative follow-up ranged from 6 months to 2 years (average 15.5 months). There was a single case of recurrence during follow-up.

Conclusions

Benign lip lesions do not usually pose a problem for the clinician and their surgical management is straightforward. Accurate auditing and detailed statistical analysis aid in disease prevention and help avoid errors in diagnosis and management.     

Proteomics pattern associated with gingival oral squamous cell carcinoma and epulis: A case analysis

Objectives

Oral squamous cell carcinoma (OSCC) is the most common epithelial malignant neoplasm affecting the oral cavity. OSCC can mimic oral lesions of inflammatory origin with benign features, often leading to delay in diagnosis and treatment. Early detection is important to greatly increase the chances of a successful treatment. The present study reports a proteomic analysis of a gingival oral squamous cell carcinoma (G-OSCC) and an epulis.

Papillary cystadenoma of the lower lip exhibiting ciliated pseudostratified columnar epithelium: report of a bizarre case and review of the literature

Background

Salivary gland tumors are uncommon and constitute 2–6.5 % of all head and neck neoplasms. Tumors of minor salivary gland origin account for less than 25 % of all salivary gland neoplasms. Papillary cystadenoma of salivary glands is a rare benign epithelial neoplasm characterized by multicystic growth in which the epithelium exhibits adenomatous proliferation. Papillary cystadenoma of minor salivary glands most frequently involves the lip, buccal mucosa, and palate. This tumor typically presents as a slow-growing, painless mass, usually with diameter of less than 1 cm and clinical resemblance to a mucocele. Although most papillary cystadenomas are predominantly of one cell type, a regional variability may be present.

Case Report

We present a case of papillary cystadenoma of the minor salivary glands in a 58-year-old patient exhibiting an upper respiratory tract epithelium, a profoundly atypical benign tumor.

Discussion

This type of minor salivary gland tumor epithelium in the lower lip may be the result of a metaplastic process or simply another neoplastic manifestation of papillary cystadenoma. As far as the differential diagnosis of this entity is concerned, it is important to distinguish it from papillary cystadenoma lymphomatosum (Warthin's tumor), low-grade mucoepidermoid carcinoma, the papillary-cystic variant of acinic cell carcinoma, and cystadenocarcinoma Recognition of this lesion is important for the clinician since the differential diagnosis includes lesions with similar clinical appearance and infiltrative behavior.     

Schwannoma of the Cheek: Clinical Case and Literature Review

Introduction

Schwannoma is a relatively uncommon benign tumor that apparently originates from Schwann cells of peripheral nerves. The most common intraoral site is the tongue followed by the palate, floor of mouth, buccal mucosa, lips and the jaws. The preoperative diagnosis is often difficult, and in the majority of cases, the diagnosis can only be made during surgery and by histological study. The immunohistochemistry reveals that the schwannoma cells test positive for S-100 protein.

Case Report

The authors report here a case of an intraoral schwannoma situated in the cheek, treated by complete surgical excision. In the present case the schwannoma presented as a slow growing, circumscribed swelling without any particular features to distinguish it from other benign soft-tissue lesions. The final diagnosis was established based on the clinical, histopathologic and immunohistochemical findings.

Conclusion

The presence of schwannoma calls for the careful search for nerve tumors in other parts of the body, although in most cases none may be found. The differentiation of schwannoma from neurofibroma is essential, because an apparently solitary neurofibroma may be a manifestation of neurofibromatosis.