Albert M. Abrams

Necrotizing sialometaplasia. A disease simulating malignancy

Results of a clinicopathologic study of seven cases of a previously unreported disease of minor salivary gland are presented. Necrotizing sialometaplasia is a disease of adults with four of seven patients being in the sixth decade of life. In every case, this benign inflammatory process involved only the tissues covering the hard palate, and, in six instances, it was characterized by ulceration. Lobular necrosis and marked squamous metaplasia of salivary gland are consistent features. Microscopically, necrotizing sialometaplasia shows marked similarity to mucoepidermoid carcinoma, and criteria are presented to aid in distinguishing these two conditions. There have been no recurrences following local surgical excision. Etiologic factors remain obscure.

Florid osseous dysplasia. A clinical-pathologic study of thirty-four cases.

Thirty-four patients with florid osseous dysplasia were studied. The majority were asymptomatic Negro women: Seventeen biopsy-proven simple bone cysts were found in affected quadrants of fourteen patients. Radiographs displayed a spectrum of sclerotic and ground-glass opacities limited to alveolar processes but not to root apices. Biopsy material was studied in all cases, and biochemical analyses of serum and cyst fluid were performed on some patients. Test results and skeletal radiographs indicate that the disease is limited to the jaws. Patients have remained asymptomatic with little alteration of radiographic patterns. Three cysts failed to heal following treatment, others filled with radiographically abnormal tissue. Chronic osteomyelitis may infrequently complicate the disease. These cases appear to represent the most exuberant manifestation of this reactive fibro-osseous jaw disease.

Intraosseous benign neural sheath neoplasms of the jaws: Report of seven new cases and review of the literature

Benign neural sheath neoplasms occurring centrally within the jaws are most uncommon. Our search of the English-language literature revealed twenty-eight previously reported cases. Seven additional cases--five neurofibromas and two neurilemmomas--are newly described here. Most cases have not been associated with multiple neurofibromatosis. These tumors occur predominantly in females, in patients under 45 years of age, and in the posterior mandible. The tumors generally present as asymptomatic radiolucencies, but some are associated with pain and/or swelling. Neurofibromas tend to recur more often than neurilemmomas when treated by conservative local excision.

Central odontogenic fibroma : clinicopathologic features of 19 cases and review of the literature

The odontogenic fibroma is a benign neoplasm infrequently reported in the literature (20 cases). Nineteen additional examples are reported. This lesion occurs most frequently in the maxilla anterior to the molars and displays a striking female predilection. On occasion, it may be associated with an unerupted mandibular third molar. Histomorphologically, it is not encapsulated. A spectrum of fibrous connective tissue stroma is present: from myxoid to densely hyalinized and from relatively acellular to cellular. Calcification may or may not be present. It is distinguished by the presence of sparse cords and islands of inactive odontogenic epithelium. Enucleation or surgical curettage is appropriate therapy and recurrence is low. As there appears to be no correlation of histologic pattern with clinical behavior, it seems unnecessary to try to separate the tumor into two variants.

Lobular (polymorphous low-grade) carcinoma of minor salivary glands: A clinicopathologic study of twenty cases

Twenty cases of a recently described adenocarcinoma of minor salivary gland--lobular carcinoma--are reviewed. This distinctive lesion occurs most frequently on the palate of patients in their sixth and seventh decades and displays no apparent sex or race predilection. Histomorphologically, the tumor is characterized by cytologic uniformity, bland nuclear chromatin, and low mitotic rate. Its lobular configuration and marked infiltrative tendency, often by single-filed tumor cells, are reminiscent of lobular carcinoma of the breast. Follow-up data indicate a favorable prognosis and are in accord with findings of previous investigators. The possible relationship of this lesion to adenoid cystic carcinoma is discussed.

Oral mucosal cytomegalovirus as a manifestation of the acquired immune deficiency syndrome

Cytomegalovirus (CMV) infection presenting as a painful palatal gingival ulcer was one of the initial clinical manifestations of the acquired immune deficiency syndrome (AIDS) in a male homosexual patient. The diagnosis of oral CMV infection was established when large intranuclear and smaller cytoplasmic CMV inclusions were observed in endothelial cells at the base of the mucosal ulcer. The identification of intranuclear and intracytoplasmic herpes-type viral particles in the infected cells was confirmed by electron microscopy. Cytoplasmic viral particles coexisted with paranuclear dense bodies resembling lysosomes. These features are characteristic of CMV-infected cells. A review of the English-language literature disclosed only three previously reported cases of CMV infection involving the oral mucous membranes. A vasculitis associated with the CMV-infected endothelial cells appears to be the underlying mechanism responsible for development of the oral ulcer. CMV should be considered a possible causative agent when oral ulcers are detected in immunocompromised patients. Likewise, the finding of CMV in oral ulcers should alert one to the possibility of an immunocompromised state.

Adenoameloblastoma. A clinical pathologic study of ten new cases

Ten new cases of adenoameloblastoma were studied. Three were entirely extraosseous. Females predominated; age ranged from 9 to 16 years and the lesions were most often associated with an unerupted permanent maxillary anterior tooth. Painless swelling or missing teeth were the most frequent presenting symptoms for intraosseous lesions while peripheral lesions presented as painless gingival swellings. A well‐demarcated radiolucency containing faint radiopacities characteristically surrounded the crown and portions of the root. Simple enucleation was curative. Encapsulation, duct‐like structures containing eosinophilic hyaline material, spindled epithelium, cribriform pattern, microcyst formation, intraluminal calcification and dystrophic calcification of degenerated connective tissue were common histologic features. Results of special stains suggested possible connective tissue origin for the hyaline material. There were no clinical or microscopic similarities noted between the adenoameloblastoma and the simple ameloblastoma. “Odontogenic Adenomatoid Tumor” is suggested as a more acceptable designation.

Sialadenoma papilliferum. A previously unreported salivary gland tumor.

This report presents the clinical and morphological features of a previously unreported distinctive neoplasm of salivary gland origin. It appears to be quite similar morphologically to the syringadenoma papilliferum of sweat gland origin which tends to support the close relationship that exists between neoplasms of salivary and sweat gland origin. We propose the name sialadenoma papilliferum for this distinct tumor.

The calcifying odontogenic cyst: Report of four cases

Abstract 1. 1. Four cases of calcifying odontogenic cysts are reported. All lesions were associated with the upper jaw, and one was entirely extraosseous. Three patients were 21 years of age or younger. 2. 2. Clinical and roentgenographic features were not specific. A radiolucency containing faint opacities might suggest this condition, but other calcifying or ossifying lesions must be considered. 3. 3. “Odontogenic” epithelial lining, “ghost cells,” calcification, and keratin foreign-body reaction are consistent features. One case featured heavy melanin pigmentation, a rare but previously reported finding in this lesion. 4. 4. Although the term calcifying odontogenic cyst may not be entirely accurate on a histomorphologic basis, the apparent limited growth potential and strictly benign behavior of the lesion makes this designation reasonable on a clinical basis.

Extranodal oral lymphoma. Part II. Relationships between clinical features and the Lukes-Collins classification of 34 cases

Thirty-four cases of extranodal oral lymphoma were classified according to the Lukes-Collins system on the basis of morphology and immunoperoxidase staining, and these findings were correlated with the clinical features of each case. Vestibule and gingiva, mandible, palatal soft tissue, and maxilla were, respectively, the most common locations for all the tumors, and the most frequently stated signs and symptoms were swelling, pain, paresthesia, anesthesia, ulceration, and discoloration. Eighty percent of the lymphomas were composed of transformed follicular center cells or postfollicular cells. Patients with lymphomas composed of nontransformed follicular center cells had a greater mean age than those with tumors of transformed follicular center cells or postfollicular cells, and a trend of decreasing age with increasing B cell transformation of the tumor type was seen. Within each Lukes-Collins category, the percentage of tumors that presented with bone involvement increased as the tumor category advanced in B cell transformation. Follow-up information indicated that the prognosis was poorest with postfollicular lymphomas, intermediate with transformed follicular center cell lymphomas, and best with nontransformed follicular center cell lymphomas.