Alicia Keszler

Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjogren's syndrome among 1,726 registry participants.

OBJECTIVE To examine associations between labial salivary gland (LSG) histopathology and other phenotypic features of Sjögrens syndrome (SS). METHODS The database of the Sjögrens International Collaborative Clinical Alliance (SICCA), a registry of patients with symptoms of possible SS as well as those with obvious disease, was used for the present study. LSG biopsy specimens from SICCA participants were subjected to protocol-directed histopathologic assessments. Among the 1,726 LSG specimens exhibiting any pattern of sialadenitis, we compared biopsy diagnoses against concurrent salivary, ocular, and serologic features. RESULTS LSG specimens included 61% with focal lymphocytic sialadenitis (FLS; 69% of which had focus scores of ≥1 per 4 mm²) and 37% with nonspecific or sclerosing chronic sialadenitis (NS/SCS). Focus scores of ≥1 were strongly associated with serum anti-SSA/SSB positivity, rheumatoid factor, and the ocular component of SS, but not with symptoms of dry mouth or dry eyes. Those with positive anti-SSA/SSB were 9 times (95% confidence interval [95% CI] 7.4-11.9) more likely to have a focus score of ≥1 than were those without anti-SSA/SSB, and those with an unstimulated whole salivary flow rate of <0.1 ml/minute were 2 times (95% CI 1.7-2.8) more likely to have a focus score of ≥1 than were those with a higher flow rate, after controlling for other phenotypic features of SS. CONCLUSION Distinguishing FLS from NS/SCS is essential in assessing LSG biopsies, before determining focus score. A diagnosis of FLS with a focus score of ≥1 per 4 mm², as compared to FLS with a focus score of <1 or NS/SCS, is strongly associated with the ocular and serologic components of SS and reflects SS autoimmunity.

Myxoma in childhood : an analysis of 10 cases

PURPOSE The object of this study was to present a series of myxoma in children and to evaluate possible differences between young and adults patients. MATERIALS AND METHODS All tumors of patients under 16 years of age (10 cases), were separated from the 80 myxomas found in the Oral Pathology Laboratory, Faculty of Odontology, Buenos Aires University, and were analyzed in terms of clinical data, radiographic image, histopathology, treatment, and evolution. RESULTS Myxoma in childhood represented 12.5% of the 80 cases in our series. The mean age was 11.6 years. Six patients were boys and four were girls. Both jaws were affected equally, predominantly in the premolar-molar region. Eighty percent of the tumors were larger than 2 cm. Only one case was clinically diagnosed as myxoma. Radiologically the most frequent image was unilocular with cortical expansion and tooth displacement. Histologically seven cases were diagnosed as myxoma and three as fibromyxoma. Treatment involved surgical resection in most cases. Two patients showed recurrence within the first year after surgery. CONCLUSIONS The frequency of myxoma in childhood may be higher than that of other aggressive odontogenic tumors, although some literature refers to this tumor as very uncommon in children. Clinically this tumor may not always be taken into account in the differential diagnosis of intraosseous radiolucencies in young patients. The histologic appearance is similar in young and adult patients, but myxoma in children may be larger. It was not possible to correlate the histologic type of myxoma and the age of the patients.

Osteosarcoma of the jaw: an analysis of a series of 74 cases

To analyse a series of cases of osteosarcoma of the jaw.

Calcifying odontogenic cyst associated with odontoma: Report of two cases

The calcifying odontogenic cyst (COC) is a nonneoplastic lesion whose possible association with other odontogenic lesions such as odontoma has been considered improbable by some authors. This paper reports two cases of true odontoma found concurrently with the COC.

The SSB-positive/SSA-negative antibody profile is not associated with key phenotypic features of Sjögren's syndrome

Objective To determine whether the Sjögrens syndrome B (SSB)-positive/Sjögrens syndrome A (SSA)-negative antibody profile is associated with key phenotypic features of SS. Methods Among registrants in the Sjögrens International Collaborative Clinical Alliance (SICCA) with possible or established SS, we compared anti-SSA/anti-SSB reactivity profiles against concurrent phenotypic features. We fitted logistic regression models to explore the association between anti-SSA/anti-SSB reactivity profile and each key SS phenotypic feature, controlling for potential confounders. Results Among 3297 participants, 2061 (63%) had negative anti-SSA/anti-SSB, 1162 (35%) had anti-SSA with or without anti-SSB, and 74 (2%) anti-SSB alone. Key SS phenotypic features were more prevalent and had measures indicative of greater disease activity in those participants with anti-SSA, either alone or with anti-SSB, than in those with anti-SSB alone or negative SSA/SSB serology. These between-group differences were highly significant and not explained by confounding by age, race/ethnicity or gender. Participants with anti-SSB alone were comparable to those with negative SSA/SSB serology in their association with these key phenotypic features. Among SICCA participants classified with SS on the basis of the American-European Consensus Group or American College of Rheumatology criteria, only 2% required the anti-SSB-alone test result to meet these criteria. Conclusions The presence of anti-SSB, without anti-SSA antibodies, had no significant association with SS phenotypic features, relative to seronegative participants. The solitary presence of anti-SSB antibodies does not provide any more support than negative serology for the diagnosis of SS. This serological profile should thus be interpreted cautiously in clinical practice and potentially eliminated from future classification criteria.

Pericoronal Follicles of Asymptomatic Impacted Teeth: A Radiographic, Histomorphologic, and Immunohistochemical Study

Objective. To associate radiographic and histopathological features of pericoronal follicles (PFs) of asymptomatic impacted teeth and evaluate cell proliferation and apoptosis in the epithelium. Study Design. Epithelium and mesenchyme of radiographically normal (NPF ≤ 2.5 mm) and hyperplastic (HPF 2.6 to 5 mm) PF (n = 140) were studied histologically. Cell proliferation (PI) and epithelial apoptosis were evaluated by Ki-67 and bcl-2 expression in 14 NPFs and 10 dentigerous cysts (DCs). Results. Radiographically, 127 were NPFs and 13 were HPFs; 87.8% of total PFs exhibited epithelium on the surface. Reduced enamel epithelium was observed in 78 (61.4%) NPFs and 6 (46.2%) HPFs, squamous metaplasia in 17 (13.4%) NPFs and 4 (30.8%) HPFs, and cystic epithelium in 15 (11.8%) NPFs and 3 (23%) HPFs. Mean PI was 1.97 ± 1.25 and 7.97 ± 1.74 in the epithelial component of NPF and DC, respectively; bcl-2 positive expression was observed in 9 (64.3%) NPFs and 7 (70%) DCs. Conclusion. The scant epithelial remnant proliferation could imply low risk for development of odontogenic pathologies in the absence of an additional stimulus.

The formocresol technique in young permanent teeth. A histopathologic study.

Twenty-six extractions were performed at random among seventy-six young, permanent teeth, treated by the formocresol technique, between 5 and 20 months after treatment: twenty-one with penetrating caries (nine vital and twelve nonvital) and five healthy. As a control group, thirteen permanent teeth with penetrating caries were removed: seven vital and six nonvital. The histopathologic analysis compared pretreatment and posttreatment radiographic examinations. In the control cases, there was almost always inflammation and/or necrosis in the entire root canal. In the experimental cases, fibrosis and osteodentin predominated in the apical third, diminishing gradually near the cervical third. Inflammation and necrosis, very low in the apical third, increased similarly near the cervical third. This response seems to be a stage in a process of evolution in biologic scar healing. The complete cure must require a greater lapse of time than that of this experiment--around 10 to 12 months.

Usefulness of a direct immunofluorescence in the diagnosis of plaque type oral lichen planus

• Plaque-like oral lichen planus and leukoplakia may pose problems for differential diagnosis.