Amos Buchner

Pigmented nevi of the oral mucosa: A clinicopathologic study of 36 new cases and review of 155 cases from the literature

Review and analysis of data on 191 cases of oral pigmented nevi from the literature and from two studies at the University of California, San Francisco, revealed that nevi of the intramucosal type are the most common, followed by the common blue nevus. Compound and junctional nevi are rare, and combined nevi are the rarest. The data on location, presence of clinical pigmentation, configuration, size, and duration of the nevi, as well as on the patients age, sex, and race, are analyzed. Blue nevi were found mostly on the hard palate, whereas intramucosal nevi occurred on the buccal mucosa, on the gingiva, and on the lips as well as on the palate. Nonpigmented nevi were especially common (22%) in the intramucosal group. Most oral nevi are raised, which can be of help in the differential diagnosis. Oral nevi are small, most being between 0.1 and 0.6 cm at the largest dimension. Because the malignant potential of oral nevi is still uncertain and because preexisting macular pigmentation is present in about one third of all patients with oral melanoma, it is advisable to accurately diagnose all oral pigmented lesions, many of which will require microscopic examination.

Amalgam pigmentation (amalgam tattoo) of the oral mucosa. A clinicopathologic study of 268 cases.

Abstract A series of 268 cases of amalgam tattoo is analyzed both clinically and histologically. The most common location was the gingiva and alveolar mucosa, followed by the buccal mucosa. Histologically, the amalgam was present in the tissues as discrete, fine, dark granules and as irregular solid fragments. The dark granules were arranged mainly along collagen bundles and around blood vessels. They were also associated with the walls of blood vessels, nerve sheaths, elastic fibers, basement membranes of mucosal epithelium, striated muscle fibers, and acini of minor salivary glands. Dark granules were also present intracellularly within macrophages, multinucleated giant cells, endothelial cells, and fibroblasts. Although in 45 percent of the cases there was no tissue reaction to the amalgam, in 17 percent there was a macrophagic reaction and in 38 percent there was a chronic inflammatory response, usually in the form of a foreign body granuloma, with multinucleated giant cells of the foreign body and Langhans types. Asteroid bodies were also found in some of the foreign body giant cells.

The histomorphologic spectrum of peripheral ossifying fibroma

A series of 207 cases of peripheral ossifying fibroma was analyzed both clinically and histologically. Almost 60% of the lesions occurred in the maxilla, and in both jaws more than 50% occurred in the incisor-cuspid region. The lesion was most common in the second decade. Females were affected more frequently than males; the ratio was 1.7:1. The recurrence rate--16%--was relatively high. Histologically, in 66% of the cases the surface epithelium was ulcerated and in the remainder it was intact. The ulcerated lesions were composed of highly cellular fibroblastic connective tissue, whereas in the nonulcerated lesions part of the tissue was more collagenized. Both types contained mineralized products in the form of bone, cementum-like material, and/or a dystrophic type of calcification. The dystrophic calcification was most prevalent in the ulcerated lesions. The mean duration at time of excision for the ulcerated lesions was 5.6 months and for the nonulcerated lesions was 24 months. It is proposed that the ulcerated and nonulcerated lesions represent a spectrum of one lesion with different stages of maturation.

Melanotic macule of the oral mucosa. A clinicopathologic study of 105 cases.

A series of 105 cases of melanotic macule of the oral mucosa is analyzed, both clinically and histologically. In most patients the melanotic macule was a solitary lesion, and the most common location was the vermilion border, followed by the gingiva. Histologically, the melanotic macule is characterized by increased pigmentation in either the basal-cell layer, the lamina propria (mainly within melanophages), or in both locations. It is suggested that the term melanotic macule be reserved for lesions in which there is a definite clinicopathologic correlation between a clinically pigmented macule and the aforementioned histologic features and that the term focal melanosis be used only as a histologic designation when these features appear in clinically nonpigmented pathologic conditions.

The histomorphologic spectrum of the gingival cyst in the adult

Gingival cysts with clinical manifestations are relatively uncommon lesions. The present study adds thirty-three new cases to the literature and analyzes their clinical and histologic features. The mandibular cuspid and first premolar region was found to be the most common location. The epithelial lining of the cysts was of several types. The most common type was a thin, flattened lining with or without localized thickenings (buds). Other types included nonkeratinized stratified squamous epithelium, keratinized stratified squamous epithelium, and parakeratinized epithelium with palisading basal cells. Gingival cysts should be distinguished from lateral periodontal cysts on the basis of their origin in the gingiva rather than in bone. It appears that most gingival cysts with clinical manifestations are of odontogenic origin.

Angiolymphoid hyperplasia with eosinophilia (Kimura's disease)

Angiolymphoid hyperplasia with eosinophilia (Kimuras disease) primarily affects the skin of the head and neck and the oral mucosa. While the clinical picture is nonspecific, the variable microscopic tissue pattern often is diagnostic. The etiology is unknown, and treatment is unpredictable. A case is presented in which Kumuras disease was not suspected clinically prior to the biopsy. The patient responded to topical fluocinonide, and there was no evidence of an immunologic defect.

Peripheral odontogenic fibroma

Peripheral odontogenic fibroma (WHO type) is an uncommon lesion of the gingiva; 18 well-documented cases have been published. It is considered to be the extraosseous counterpart of the central odontogenic fibroma. Because of the paucity of reported cases, the full histomorphologic spectrum of this lesion has not yet been established. This article presents nine cases of peripheral odontogenic fibroma that illustrate the variety of its histopathologic findings. The connective tissue ranged from loose (almost myxomatous) to markedly cellular to relatively acellular and well-collagenized. Islands and/or strands of odontogenic epithelium were present in all lesions. Matrix of mineralized material was present in three cases, and juxtaepithelial hyalinization was seen in one case. To avoid the introduction of additional diagnostic terms, we suggest that all these lesions be considered a spectrum of the peripheral odontogenic fibroma (WHO type). We also suggest that the term WHO type be used to distinguish peripheral odontogenic fibromas from the peripheral ossifying fibroma with which they have often been confused.

Pigmented nevi of the oral mucosa: a clinicopathologic study of 32 new cases and review of 75 cases from the literature. Part I. A clinicopathologic study of 32 new cases.

Pigmented nevi are much less common in the oral cavity than they are in the skin. The present study adds thirty-two new cases to the literature. The most common type of nevus was found to be the intramucosal, followed in decreasing order by the common blue nevus, compound nevus, and junctional nevus. The clinical and histologic features of the nevi are analyzed and discussed.

Pigmented nevi of the oral mucosa: a clinicopathologic study of 36 new cases and review of 155 cases from the literature. Part I: A clinicopathologic study of 36 new cases.

Pigmented nevi are uncommon oral lesions. This study adds data on 36 new cases. The most common type of nevus was the intramucosal type (20 cases), followed by the common blue nevus (11 cases). Only three cases were of the compound type and only two were of the junctional type. The hard palate was the most frequent location for the blue nevus, whereas the buccal mucosa was the most frequent site for the intramucosal nevus. One nevus (intramucosal type) was located on the tongue, and to our knowledge, this is the first reported example of pigmented nevus at this site. The individual data on the 36 cases are presented and compared with a previous study on oral nevi from the University of California at San Francisco. The previously unpublished clinical details on the 32 nevi from the previous study are also presented.

Histopathologic spectrum of oral erythema multiforme

The histopathologic tissue patterns found in twenty-five patients with oral erythema multiforme were as variable as the clinical appearances. The biopsies served an important role in ruling out malignancy, dysplasia, and other classified diseases. While all of the specimens were designated as showing nonspecific inflammatory reactions, in many biopsy specimens there were sufficient characteristic connective tissue and epithelial changes to suggest a tissue diagnosis consistent with the clinical diagnosis of erythema multiforme.