Angiomyoma of the mandible: a case report

A rare case of intrabony angiomyoma affecting the mandible is presented. The patient was 25 years old male who complained of swelling and pain in the posterior segment of his lower jaw. Histopathologically diagnosed angiomyoma is discussed with emphasis on the pathogenesis in the present case. Literature concerning the lesion is reviewed. In the present paper we report a case of angiomyoma affecting the mandible. Angiomyomas are also known as vascular leiomyomas which commonly occur in the wrist and ankle region. They are painful tumours as was also evident in our case. These tumours are characterized histopathologically by convuluted thick walled vessels associated with bundles of well differentiated smooth muscle elements. They rarely affect the oral cavity. Therefore our case is one of the few cases affecting the oral cavity as reported earlier. Tumours of the smooth muscle cells which form involuntary muscle are known as leiomyomas. These commonly affect the alimentary tract. They are rarely found to affect the oral cavity.     

Recurrent oral angioleiomyoma

Angioleiomyomas are vascular variant of leiomyomas which are benign tumors of smooth muscle. They are exceedingly rare in the oral cavity. Malignant transformation of these tumors has also been reported occasionally which warrants knowledge of this soft tissue tumor. A 57 year old male patient reported with a 15 day history of an asymptomatic growth that had started insidiously in his lower left back tooth region. Clinical examination revealed a solitary, oval, sessile growth in the mandibular left retro molar region. Excisional biopsy was suggestive of Angioleiomyoma. A recurrence of the same was noted two months later which was also histopathologically reported as Angioleiomyoma. The same was confirmed using special stains. This case reports an unusual presentation of Angioleiomyoma with regards to both recurrence as well as rapid growth. It is important to be well aware of this uncommon entity as these tumors often can mimic or transform into malignancy. Precise clinicopathological examinations are therefore invaluable in establishing an accurate diagnosis and delivering suitable treatment.     

Diagnostic implications of oral intravascular papillary endothelial hyperplasia

This study examined the clinical, histological, and immunohistochemical features as well as the differential diagnoses of oral intravascular papillary endothelial hyperplasia (IPEH) to aid clinicians and pathologists in its diagnosis. Clinical features of five oral IPEH cases were obtained from medical records, and all histopathological diagnoses were reviewed. Immunohistochemical reactions, including anti-CD-34, laminin, vimentin, estrogen receptor alpha, and Ki-67, were assessed. Microscopically, a reactive proliferation of vascular cells composed of small papillary structures with hypocellular and hyalinized cores arising in an organized thrombus was seen. CD-34, vimentin, and laminin staining were strongly positive, while estrogen receptor alpha was negative in all cases. A low percentage of cells were positive for Ki-67 in four of five lesions, but one case was strongly positive. A diagnosis of angiosarcoma was investigated and rejected. IPEH presents specific microscopic characteristics that along with clinical data lead to an accurate diagnosis. The general dentist, the first to participate in the diagnostic process, must share the responsibility for diagnosis with the pathologist, and they must work together to determine the correct diagnosis and management. Oral lesions of IPEH are uncommon. Their main significance is that they show a microscopic resemblance to angiosarcoma. Thus, clinicians should have more information regarding this benign entity. Finally, we suggest that in recurrent cases exhibiting strong immunolabeling of proliferative markers the possibility of angiosarcoma should be investigated.     

The Morbidity of Oral Mucosal Lesions in an Adult Swedish Population

Objectives: To study the severity of symptoms and estimate the prevalence of oral mucosal lesions in a non-referral adult Swedish population, as registered by general dental practitioners. This study also aims to evaluate the possibi-lity of dental practitioners collecting large quantities of reliable and accurate clinical data on oral mucosal lesions. Study Design: Data from 6,448 adult Swedish patients were collected by general dental practitioners using a standardized registration method. A correlation analysis between a group with oral mucosal lesions and a control group, with no oral mucosal lesions, was performed for various parameters such as symptoms from the oral mucosa, systemic diseases, medication, allergy history, tobacco habits and the patient’s own assessment of their general health. In addition, clinical photos were taken of all oral mucosal lesions in order to determine the degree of agreement between the diagnoses made by general dental practitioners and those made by oral medicine specialists. Results: A total of 950 patients (14.7%) presented with some type of oral mucosal lesion and of these, 141 patients (14.8%) reported subjective symptoms. On a visual analogue scale, 43 patients (4.5%) scored their symptoms <30, 65 patients (6.8%) scored their symptoms ?30, and 28 patients (2.6%) scored their symptoms ?60. The most debilitating condition was aphthous stomatitis and the most common oral mucosal lesion was snuff dipper’s lesion (4.8%), followed by lichenoid lesions (2.4%) and geographic tongue (2.2%). There was agreement between the oral medicine specialists and the general practitioners over the diagnosis of oral mucosal lesions on the basis of a clinical photograph in 85% of the cases (n=803). Conclusions: Nearly 15% of the patients with oral mucosal lesions reported symptoms. General practitioners could contribute significantly to the collection of large quantities of reliable and accurate clinical data, although there is a risk that the prevalence of oral mucosal lesions may be underestimated. Key words:Epidemiology, oral mucosal lesions, oral medicine, examiner reliability.     

Oral spindle cell neoplasms: a review of 307 cases

The infrequent exposure of pathologists to soft tissue spindle cell neoplasms coupled with overlapping histologic patterns can often make diagnosis challenging. We reviewed all nonodontogenic spindle cell neoplasms seen between 1982 and 2002 (86,162 total accessions). Diagnoses were reclassified according to current standards supplemented with immunohistochemistry. Of the 307 neoplasms reviewed (0.36% of total accessions), neural tumors were the most common benign entities, accounting for 21% of total cases. Kaposi's sarcoma was the most common malignancy, accounting for 67% of all cases. Diagnoses were revised for 57 cases. Schwannoma and neurofibroma were most commonly revised to palisaded encapsulated neuroma. There were 8 myofibromas and 1 inflammatory myofibroblastic tumor. There were no oral leiomyomas; that is, all 4 originally reported cases were reclassified as myofibroma, palisaded encapsulated neuroma, and solitary fibrous tumor. With the exception of Kaposi's sarcoma, oral soft tissue sarcomas were rare; most benign lesions were neural in origin. The relatively high prevalence of some tumors, such as myofibroma, likely reflects the use of immunohistochemistry in the diagnosis of spindle cell tumors.     

Adult and infantile myofibromatosis: a report of three cases affecting the oral cavity

Myofibromatosis is a rare but well recognized entity which was originally thought to affect only neonates and infants. It is now apparent however that adults may also be affected. Solitary cases affecting the oral cavity appear to be rare and only two cases of solitary lesions in adults appear in the literature. This report documents three solitary cases; two typical lesions in infants and a lesion from the tongue of an adult. The lesions were composed of small polygonal cells and large elongated cells in a scant fibrous stroma. The elongated spindle cells were identified as myofibroblasts by immunocytochemistry and electron microscopy. The lesions showed characteristic features which enabled them to be distinguished from other fibrous lesions and from benign or malignant smooth muscle tumors with which they have frequently been confused.     

Oral leiomyomas. Review of the literature and report of a case of palatal angioleiomyoma

A rare case of angioleiomyoma of the palate is reported. A review of the literature shows that of a total of 116 previously reported cases of oral leiomyomas, only 19 were palatal angioleiomyomas.     

Oral HIV lesions and oral health behaviour of HIV-positive patients attending the Queen Elizabeth II Hospital, Maseru, Lesotho.

AIM: The aim of the study was to determine the prevalence of oral mucosal lesions strongly associated with HIV infection and to assess the oral health behaviour among patients attending Queen Elizabeth II Hospital in Maseru. The objectives were: (i) to determine the prevalence of group 1 lesions in HIV-positive patients according to the ECC/WHO classification; (ii) assess the oral hygiene practices of these patients; and (iii) make recommendations based on the findings. METHODOLOGY: A questionnaire was administered by an interviewer to a sample of 270 patients with a serological diagnosis of HIV infection to assess their oral health behaviour; they were then examined for oral manifestations. The assessment of oral health behaviour involved determining the regularity and frequency of oral hygiene practices, and use of mouth wash, interdental and other adjunct cleaning aids. The presumptive criteria as defined by the ECC/WHO classification were used for diagnosis of the oral mucosal lesions. Results were entered and analysed using Epi info-6 statistical software RESULTS: The prevalence of specific oral mucosal lesions in order of occurrence was pseudomembranous candidiasis 27%, erythematous candidiasis 26%, angular cheilitis 14%, hairy leukoplakia 12%, ulcerations 12%, necrotising gingivitis 5%, linear gingival erythema 3%, and non-Hodgkin's lymphoma and Kaposi's sarcoma less than 1%. This pattern reflects the findings in other regional studies where pseudomembranous candidiasis is often the most common lesion found. Nearly all patients reported cleaning their mouths; 82% did it every day. Mouth wash and interdental cleaning aids were not often used. CONCLUSIONS: A high prevalence (73%) of oral mucosal lesions was found. Oral candidiasis was the most common group of lesions (54%). The oral hygiene practices reported by the patients were considered acceptable.     

Oral leiomyosarcoma. Report of a case and review of the literature pertaining to smooth-muscle tumors of the oral cavity.

Primary malignant smooth-muscle tumors of the mouth have rarely been reported. A review of the literature has yielded only eleven cases; to these, a new case is added. The age, sex, and site distribution of oral leiomyosarcomas are compared with those of oral leiomyomas.     

Clinicopathologic characterization of oral angioleiomyomas

OBJECTIVE: The purpose of this study was to better define the clinicopathologic features of oral angioleiomyomas. STUDY DESIGN: A retrospective search was performed for angioleiomyomas among all smooth muscle tumors accessioned from 1963 to 2001 in an oral pathology service. Twelve lesions met histopathologic criteria for inclusion in the study and were combined with 97 additional cases identified from the English language literature, yielding 109 cases for evaluation. RESULTS: The mean age of the patients with oral angioleiomyomas was 45.0 years, with a 1.43:1 male to female predilection. The most frequently reported site was the lip, in 48.6% of patients, followed by the palate (21.1%), buccal mucosa and tongue (each 9.2%), mandible (8.3%), and buccal sulcus, labial sulcus, floor of mouth, and gingiva (each 0.9%). Most mucosal lesions varied in size from a few millimeters to 2 cm, with most central lesions of the mandible measuring greater than 2 cm. Although angioleiomyomas are vascular lesions, only 55.9% of cases appeared red, blue, or purple; the remainder were gray, white, or the color of normal mucosa. Tumors were typically described as painless and manifested a low growth rate. All lesions were well circumscribed and composed of numerous vascular spaces surrounded by thick smooth muscle walls. CONCLUSION: Oral angioleiomyomas are benign smooth muscle tumors with a limited degree of morbidity. Careful histologic inspection is necessary to distinguish these lesions from their malignant counterpart, the leiomyosarcoma. Surgical excision is the treatment of choice, and recurrence is rarely encountered.     

A survey of localized lesions of oral tissues: a clinicopathological study

OBJECTIVE: The purpose of this study was to establish the relative prevalence of the different histopathological aspects of biopsied localized soft tissue oral lesions in a university-based dental school biopsy service. STUDY DESIGN: A retrospective analysis of patients' records with localized lesions treated in the Department of Oral Medicine and Oral Surgery between 2001 and 2004 was conducted. The lesions were classified into either fibrous lesions or soft hemorrhagic lesions. Clinical data regarding age, gender, location, and treatment of the lesions were obtained for each case. RESULTS: The majority of the lesions were located in the gingiva. There were a total of 294 cases of which 182 (61.9%) were fibrous lesions and 112 (38.1%) were soft hemorrhagic lesions. All cases were treated by excisional biopsy and elimination of the chronic irritant. CONCLUSION: Although this data might be used as a guide for forming clinical impressions about oral lesions, the clinician must always be aware of the possible occurrence of more rare lesions. This study indicates there are some differences in age and gender distribution as well as in location between the different lesions.     

A study of the clinical characteristics and treatment of oral carcinoma in situ

Twelve patients with oral carcinoma in situ were examined to clarify the clinical features and the most suitable therapy for this lesion. Seven cases were classified clinically as the erythroplakic type, two as the leukoplakic type, and three as the mixed type. The cumulative survival rate of ten cases, excluding two cases with lesions of the soft palate, was 100% in 10 years. Of 12 lesions of oral carcinoma in situ 50% progressed into invasive carcinoma. Erythroplakic lesions of oral carcinoma in situ were more aggressive than the other two types. The most suitable therapy for this lesion is prompt surgical treatment.     

Oral discoid lupus erythematosus. III. A histopathologic study of sixty-six patients

A detailed histopathologic study was conducted blindly on biopsy specimens from 66 patients with oral discoid lesions (oral DLE) mixed in random order with biopsy specimens from control groups of 25 cases of oral lichen planus (LP), 25 cases of oral leukoplakia, 13 cases with an uncertain diagnosis termed DLE? LP? and 7 cases of galvanic lesions related to amalgam fillings. Fifty-two histopathologic variables were examined, and a ranking was calculated for the variables that provided the best discrimination between the subgroups of clinically typical oral DLE and LP and between typical DLE and leukoplakia, respectively. Histopathologic variables not previously described in oral DLE but characteristic of this disease were identified: multinucleated epithelial cells containing three or more nuclei and the presence of epithelial islands in the connective tissue. Patients with systemic lupus erythematosus (SLE) in addition to oral DLE showed generally the same histopathologic features as those without SLE. The inflammatory infiltrates were slighter and more diffuse among the SLE patients as compared to the non-SLE patients. The simplest possible combination of histopathologic variables diagnostic for oral DLE consisted of the following five: (1) hyperkeratosis with keratotic plugs, (2) atrophy of the rete processes, (3) deep inflammatory infiltrate, (4) edema in the lamina propria, and (5) thick patchy or continuous PAS-positive juxtaepithelial deposits. This combination is suggested as new histopathologic criteria for oral DLE. These criteria were tested among clinically atypical cases of DLE and the other groups of mucosal lesions, with a sensitivity of 92% and a specificity of 96% against both LP and leukoplakia for the presence of two or more of the five criteria.     

Improving detection of precancerous and cancerous oral lesions. Computer-assisted analysis of the oral brush biopsy. U.S. Collaborative OralCDx Study Group

BACKGROUND: A study group composed of researchers from across the United States undertook a study to evaluate the sensitivity and specificity of OralCDx (OralScan Laboratories Inc.), a computer-assisted method of analysis of the oral brush biopsy, in the detection of precancerous and cancerous lesions of the oral mucosa. METHODS: The study group conducted a multicenter double-blind study comparing results of OralCDx analysis with those of scalpel biopsy of suspicious oral lesions, as well as using OralCDx on oral lesions that appeared benign clinically. RESULTS: In 945 patients, OralCDx independently detected every case of histologically confirmed oral dysplasia and carcinoma (sensitivity = 100 percent, false-negative rate = 0 percent). Every OralCDx "positive" result was subsequently confirmed by histology as dysplasia or carcinoma. The specificity for the OralCDx "positive" result was 100 percent, while the specificity for the OralCDx "atypical" results was 92.9 percent. In 4.5 percent of clinically benign-appearing lesions that would not have received additional testing or attention other than clinical follow-up, OralCDx uncovered dysplasia or carcinoma (statistical sensitivity > 96 percent, P < .05, n = 131; statistical specificity for the OralCDx "positive" result > 97 percent and for the "atypical" result > 90 percent, P < .05, n = 196). CONCLUSIONS: The authors propose that this multicenter trial demonstrates that OralCDx is a highly accurate method of detecting oral precancerous and cancerous lesions. OralCDx can aid in confirming the nature of apparently benign oral lesions and, more significantly, revealing those that are precancerous and cancerous when they are not clinically suspected of being so. All OralCDx "atypical" and "positive" results should be referred for scalpel biopsy and histology to completely characterize the lesion. CLINICAL IMPLICATIONS: Given the difficulty in clinically differentiating premalignant and malignant lesions from benign lesions with a similar appearance, OralCDx appears to determine the significance of an oral lesion definitively and detect innocuous-appearing oral cancers at early, curable stages.     

Oral Kaposi's sarcoma: a 10-year retrospective histopathologic study

Microscopic diagnosis of early Kaposi's sarcoma continues to be a challenge to the pathologist, as does the identification of bacillary angiomatosis (BA) which may have a similar appearance. 120 oral Kaposi's sarcoma (KS) biopsies submitted to the UCSF-'oral pathology service from 1981–1991 were reviewed in order to describe the clinical-pathologic spectrum of these lesions and to search for unrecognized cases of BA. Also, histopathologic features of oral KS were compared to 30 oral pyogenic granulomas. and immunohistochemical stains for endothelium-associated CD34 antigen were done. The diagnosis of KS was confirmed in all biopsies and no cases of BA were found. Histologically, the KS specimens exhibited numerous features that separated them from pyogenic granulomas, and could themselves be divided into two clinical-pathologic subtypes: small, well-delineated macular lesions (31), which were characterized by inconspicuous patches of spindle cells containing ill-defined vascular spaces; and larger, infiltrative nodular lesions (89), which were characterized by spindle cells lining vascular slits and bizarre-shaped vessels, Extravasated RBCs were evident in almost all KS lesions; hemosiderin deposits and hyaline globules were seen in half of each of the small and large lesions. Nuclear atypia was minimal and mitotic activity was slight. Lymphocytes in small lesions added to the difficulty of microscopic interpretation of these incipient lesions. CD34 was expressed on all spindle cells lining vascular spaces in larger lesions and on spindle cells of small, subtle lesions. We conclude that within the spectrum of lesions that are diagnosed as oral KS. two clinical-pathologic types can be identified: macular small spindle-cell lesions and nodular infiltrative vascular lesions. KS expression of CD34 antigen is a characteristic that may be useful in the diagnosis of small, well-delineated oral lesions that lack classic KS features.     

Oral tuberculosis: a clinical evaluation of 42 cases

OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy. MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients' serum (ELISA). RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions. CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing.     

Oral bowenoid lesions: differential diagnosis and pathogenetic insights

OBJECTIVE: To determine if oral lesions exhibiting bowenoid features reflect the diverse microscopic appearance and biologic behaviour of Bowen's disease and bowenoid papulosis of the skin and genitalia. STUDY DESIGN: Seven cases of oral bowenoid lesions (6 with follow-up data) were assessed for differences in histologic features, human papillomavirus (HPV) viral status, and selected immunohistochemically detectable cell cycling proteins (p53, WAF-1, Cyclin D1, Bcl-2) and were correlated with available follow-up data. RESULTS: Two histologic subsets were identified. One, which was believed to correspond to Bowen's disease, exhibited large numbers of transepithelial apoptotic bodies, dyskeratotic cells and mitoses (bowenoid elements), poor differentiation of background epithelial cells, and consistent HPV-16/18 positivity. The other, believed to correspond to bowenoid papulosis, exhibited few bowenoid elements, good background differentiation, and inconsistent HPV-16/18 positivity. One of the aggressive cases exhibited repeated recurrences despite apparent total clinical excision, whereas none of the other group recurred. CONCLUSION: Although a small number of cases are in this study, results suggest that oral bowenoid lesions may exhibit histopathologic and behavioral variations ranging from oral Bowen's disease to oral bowenoid papulosis. Studies on more cases are needed to confirm this initial impression.     

Nonendodontic Lesions Misdiagnosed as Apical Periodontitis Lesions: Series of Case Reports and Review of Literature

Introduction

This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source.

Methods

A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain.

Results

The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings.

Conclusions

Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.     

Prevalence of oral soft and hard tissue lesions related to mechanical toothcleansing procedures

The prevalence of oral soft and hard tissue lesions related to mechanical oral hygiene procedures was recorded and correlated to toothbrushing habits and oral hygiene status in two selected samples. Fifty-one percent of 533 persons examined exhibited gingival retractions and 45% had wedge-shaped defects in the cervical area of one or several teeth. Both types of lesions were often seen in the same area, indicating a common etiologic factor. The subjects with a good oral hygiene status, as well as those who brushed more than twice daily, showed a high frequency of lesions. The various toothbrushing techniques did not, however, seem to influence the development of such lesions in the present material. Subjective symptoms were reported in a few cases only.