Dwight R. Weathers

Unusual multilocular cysts of the jaws (botryoid odontogenic cysts).

Abstract Two cases of an unusual multilocular cyst of the jaws are described, both clinically and histologically. Although the etiology is unknown, the lesion is probably of odontogenic origin. This appears to be a distinct entity which has not been previously reported.

Giant-cell fibroma☆

Abstract A previously undescribed benign fibrous tumor of the oral cavity is reported. Its clinical and histopathologic features are discussed. It is found most commonly on the gingiva in young people and is characterized histologically by stellate, mononuclear, and multinuclear giant cells. Evidence is presented suggesting that these characteristic cells are large atypical fibroblasts.

Psoriasiform lesions of the oral mucosa (with emphasis on “ectopic geographic tongue”)

Abstract The psoriasiform lesions, including psoriasis, Reiters syndrome, and geographic tongue, are discussed. The entity of “ectopic geographic tongue” is given special attention, and eight new cases are presented. Two examples of oral psoriasis and two examples of oral lesions of Reiters syndrome are also reported. The similarities, differences, and possible relationship of these diseases are discussed.

The oral melanotic macule.

A clinical and histologic study of eighty oral melanotic lesions which do not readily fit into recognized categories of melanotic lesions was conducted. These lesions tend to occur in the fifth decade of life and are most frequently seen on the gingiva, with the buccal mucosa and palate the next most frequent sites. The lesions are usually single, smaller than 1 cm., but they may also occur as multiple lesions. There is no sex bias, and there seems to be a number of etiologic factors. In a few cases long-term follow-up was possible. There is no indication of a tendency toward recurrence or development of malignant lesions. Histologically, none of the lesions shows atypia. Melanin pigmentation tends to be present in significant amounts in the basal-cell layer and less often in the lamina propria. There are no outstanding histologic differences among the eighty specimens. It is suggested that the term oral melanotic macule be used for these lesions, unless a specific cause can be confirmed by clinical data. Although these lesions should not be considered premalignant, it would be prudent to remove them for histologic confirmation of clinical impressions.

The labial melanotic macule

Fifty-five cases of a melanotic lesion of the lips which is well known, but not well described, are reported. The lesions characteristically occur on the lower lips of young adults. Males and females are equally affected. These lesions may be ephelides, postinflammatory melanoses, or unique lesions for which there is no exact cutaneous counterpart. We suggest the term labial melanotic macule as a descriptive one which would encompass the three different constituent entities. On the basis of follow-up information obtained and the histopathologic character of the lesions, this entity is benign and does not, in our opinion, have any malignant potential.

Ultrastructure of the giant-cell fibroma of the oral mucosa

Abstract The ultrastructural features of the giant-cell fibroma of the oral mucosa are described. These features suggest that the characteristic cells are atypical fibroblasts containing numerous intracellular microfibrils. The multinucleated giant cells appear to occur by fusion of the mononuclear cells. A viral origin for the tumor is postulated.

Desquamative gingivitis: a form of cicatricial pemphigoid?

Desquamative gingivitis, a sub‐epithelial vesiculo‐bullous disease involving the gingiva, has been shown to have positive direct immunofluorescent findings similar to those of cicatricial pemphigoid. However, the lack of severe scarring, limitation of lesions to the anterior portion of the mouth and the tendency toward limitation of lesions to the oral mucosa over long periods of time in desquamative gingivitis, suggest that desquamative gingivitis and cicatricial pemphigoid are distinct and separate entities.

Necrosis in benign salivary gland neoplasms. Not necessarily a sign of malignant transformation.

Necrosis that occurs in a salivary gland neoplasm is usually considered to be an ominous sign, suggesting malignant transformation, particularly in lesions that have had no prior manipulation such as fine-needle aspiration. We describe five pleomorphic adenomas and two canalicular adenomas of salivary gland origin that exhibited necrosis, yet were otherwise benign. All lesions displayed a distinctive histopathologic pattern characterized by a narrow rim of viable tumor tissue at the periphery of the neoplasm combined with a diffuse central region that demonstrated apparent ischemic necrosis. No invasion of adjacent normal tissue was identified, and no recurrence or metastasis has been seen with these lesions. Caution should be exercised in the evaluation of salivary gland neoplasms with central necrosis to avoid misdiagnosis of all such lesions as malignant.

Merkel cell carcinoma of the labial mucosa: An immunohistochemical and ultrastructural study with a review of the literature on oral Merkel cell carcinomas

Merkel cell carcinoma is a rare cutaneous neuroendocrine tumor that occurs predominantly in the head and neck region of older patients. An 88-year-old white man had an erythematous, umbilicated tumor on his lower lip, which on histopathologic examination showed solid sheets of infiltrating basaloid round cells with a high mitotic index. Globular, paranuclear immunostaining for low-molecular-weight cytokeratins (Nos. 8, 18, and 19) and neurofilament was observed. On ultrastructural examination, the tumor cells demonstrated paranuclear whorls of intermediate filament aggregates and occasional electron-dense granules. This unique cytokeratin- and neurofilament-staining pattern with coexpression enabled the Merkel cell carcinoma to be differentiated from other small cell malignant tumors that included metastatic neuroendocrine carcinomas from other regions. The follow-up 1 year after surgery and radiation showed that the patient remained disease free. Review of the literature revealed 11 cases of oral Merkel cell carcinomas with a predilection for the labial mucosa of older men. The mode of treatment and the clinical course of these cases are also presented, with an update on therapeutic management of Merkel cell carcinomas.

Aggressive fibromatosis involving the paramandibular soft tissues: A study with the aid of electron microscopy

The distinction at the level of light microscopy between aggressive fibromatosis and low-grade malignancies with fibroblastic features may be difficult. An electron microscopic study of four cases of aggressive fibromatosis of the mandibular soft tissue was undertaken to determine whether any ultrastructural characteristics could be identified that would aid in a more uniform distinction between these lesions. The pertinent findings include the identification of cells of fibroblastic derivation showing a range of organelle-poor to organelle-rich features, cytoplasmic microfibrils, and dilated rough endoplasmic reticulum profiles. These features are discussed in the light of previously published findings of other forms of aggressive fibromatosis and closely related lesions. The study reaffirms that although electron microscopy may be useful in confirming the cell of origin in these lesions, the accurate diagnosis of fibrous tumors still rests with the proper correlation of clinical and light microscopic features. Clinical follow-up of the cases supports both the diagnosis of aggressive fibromatosis and the recommended treatment of adequate local excision.