Giuseppe Ficarra

Kaposi's sarcoma of the oral cavity: a study of 134 patients with a review of the pathogenesis, epidemiology, clinical aspects, and treatment.

Since our first description and profile of patients with Kaposis sarcoma (KS) in 1984, the relative rate of KS in patients with the acquired immunodeficiency syndrome has dropped from 34% to 20%. However, the absolute number is increasing. The pathogenesis of KS is still obscure, and its interaction with the human immunodeficiency virus infection remains unclear. Cause of death is usually opportunistic infections in both endemic and epidemic KS. The most common intraoral site is the palate, which is involved in 95% of our cases. The oral cavity may be the only or first site of KS, and therefore, becomes important in the diagnosis. More than 20% of our current patient population had the oral cavity as the initial site of manifestation. Because of functional impairment, bleeding, pain, or cosmetic reasons, treatment is frequently required. There are many modalities used, including chemotherapy, radiation, and laser resection. Radiation appears to be a most effective and practical control measure for oral KS.

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.

Granulocytic sarcoma (chloroma) of the oral cavity: A case with aleukemic presentation

A case of granulocytic sarcoma, or chloroma, of the palatal mucosa, which developed 15 months before the onset of acute myelogenous leukemia (AML), is reported. The diagnosis was suspected on the basis of the light microscopic findings and confirmed by histochemical studies. Granulocytic sarcomas are rare, may be observed in a variety of body locations, and are considered specific lesions of AML or of the onset of blast crisis in chronic myelogenous leukemia. Primary granulocytic sarcomas of the oral cavity without systemic manifestations of AML are extremely rare. Clinical diagnosis of these lesions in patients with normal peripheral blood and bone marrow may be very difficult.

Intraoral solitary glomus tumor (glomangioma): Case report and literature review

The glomus tumor, or glomangioma, is a benign neoplasm arising from the normal glomus. Glomus tumors of the oral cavity are rare, with only ten cases reported in the literature. We report the light and electron microscopic features of an additional case of glomus tumor of the lip which occurred as a solitary, painless, submucosal mass in a 51-year-old woman. Clinical, diagnostic, and histogenetic aspects are discussed.

Hyaline ring granuloma: A distinct oral entity

Hyaline ring granuloma (HRG) is a distinct oral entity. In this study, 64 cases from the literature are analyzed and two new cases are reported. The lesions could be classified by location as central hyaline ring granuloma (42%) and peripheral hyaline ring granuloma (53%). Radiographically, a radiolucent area irregularly outlined by well-formed trabeculae of bone was found in central HRG, and a poorly defined erosion at the crest of the alveolar ridge was often found in peripheral HRG. Occasionally, the lesion occurred in the connective tissue wall of cysts (5%). The etiology of this condition is controversial, but most lesions were in edentulous areas and most patients had a history of tooth extraction or other trauma. The majority of cases (83%) occurred in the mandible, usually posterior to the premolar. The mean age of patients at diagnosis was 43 years, and the male/female ratio was 1.9:1. Pain was not a symptom, although local discomfort, such as recurrent swelling and tenderness, was noted in many cases. Hyaline rings with giant cell inclusions are the significant features for histopathologic diagnosis. HRG is treated by curettage or surgical excision, care being taken to remove the entire lesion. The removal of a peripheral HRG in an edentulous jaw should be followed by careful smoothing of the bone surface, since the lesion tends to infiltrate and is not well demarcated. Recurrence, probably due to incomplete excision, is uncommon.

Combined nevi of the oral mucosa

Pigmented nevi are uncommon oral lesions. We report the clinical and microscopic features of three cases of combined nevus, characterized by the association of an intramucosal nevus and a common blue nevus. Two cases were clinically suspected to be melanoma. The lesions were located on the maxillary gingiva, the mandibular gingiva, and the mucosa of the left posterior portion of the hard palate. Combined nevi of the skin vary considerably in histologic appearance. The microscopic findings demonstrated by oral combined nevi also appear to exhibit substantial histologic variation. The oral combined nevus should be differentiated from malignant melanoma by histopathologic means for, as in the skin, it appears to be clinically benign.

Artefacts created during oral biopsy procedures

Biopsy specimens removed from the oral cavity are often small, and there is high potential for causing artefacts at several stages: during removal, fixation, embedding, or staining. This report describes several of the most common artefacts created by erroneous handling of oral tissue and lists recommendations for preventing them.

Peripheral ameloblastoma. A case report

The peripheral or extraosseous ameloblastoma is a rare tumour of the oral cavity. Only a few well-documented cases have been reported. One additional case of this infrequent tumour in a 70-year-old edentulous man is described. The tumour arose on the mucosa of the lower alveolar crest. It was asymptomatic tender, with a raised and red appearance. The tumour was excised and no evidence of recurrence was seen five years later. Peripheral ameloblastoma probably arises from oral mucosa or from cell rests. It is less invasive than its intraosseous counterpart, and surgical excision with adequate margins is the treatment of choice.