Harvey P. Kessler

β-Catenin is expressed aberrantly in tumors expressing shadow cells: Pilomatricoma, craniopharyngioma, and calcifying odontogenic cyst

We studied the beta-catenin immunohistochemical profile in tumors expressing shadow cells: pilomatricoma, 10 cases; calcifying odontogenic cyst, 6 cases; and craniopharyngioma, 9 cases. There was strong membranous, cytoplasmic, and nuclear staining of the immature basaloid cells in all of these tumors. Shadow cells were negative in all tumors. It has been documented that rising levels of free beta-catenin drive the formation of complexes with T-cell factor/lymphoid enhancer factor (TCF-Lef) and up-regulate the wingless-Wnt cell-cell signals. The end result is an abnormality of beta-catenin degradation and, thus, a buildup of free beta-catenin in the cytoplasm and/or nucleus, resulting in the stimulation of cellular proliferation and/or inhibition of cell death. beta-Catenin seems to have an important role in the oncogenesis of these tumors. The similar pattern of keratinization in these tumors and the similar pattern of beta-catenin immunoreactivity in the cytoplasm and the nucleus are important findings. It seems that the activation of a common cellular pathway, namely Wnt-beta-catenin-TCF-Lef, has a role in the pathogenesis of these tumors. The latter could be related to their shared method of keratinization or shared dysfunction of the cellular adhesion complex leading to tumorigenesis.

The effects of bisphosphonates on osteoblasts in vitro

OBJECTIVE The purpose of this study was to test the effects of bisphosphonates on osteoblast viability and function. STUDY DESIGN Primary rat osteoblasts were cultured in normal media or media containing increasing concentrations of 2 bisphosphonates, alendronate and zoledronate. Enzyme-linked immunoabsorbent assays (ELISAs) were used to measure interleukin (IL)-6, transforming growth factor (TGF) beta1, and receptor activator of nuclear factor kappaB ligand (RANKL) expression in supernatants after 24, 48, and 72 h. Live and necrotic cell numbers were assessed with trypan blue assays. RESULTS As drug concentrations increased, cell viability decreased significantly. The ELISAs revealed significant increases in TGF-beta1 in treatment groups, but no significant change in RANKL or IL-6. CONCLUSIONS High concentrations of alendronate and zoledronate were cytotoxic, decreasing cell viability at 72 h. Transforming growth factor beta1 increased even as viability decreased, suggesting a mechanism for bisphosphonate action. These data suggest that lower concentrations of bisphosphonates may have therapeutic benefits without the cytotoxic effects which may result in osteonecrosis.

Foreign bodies associated with peri-implantitis human biopsies.

BACKGROUND Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. METHODS Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. RESULTS At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. CONCLUSIONS At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.

Localized juvenile spongiotic gingival hyperplasia

We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyperplasia in young patients. Clinically, the average age of patients in this study was 11.8 years, with a 2.3:1 female predominance. Caucasians comprised 77% of the cases, and nearly all of the lesions were located on the anterior gingiva, with 81% affecting maxillary gingiva. The most classic clinical presentation was a papillary, often pedunculated, red and easily bleeding gingival overgrowth in young patients. Histopathologically, the lesions exhibited a subtle papillary epithelial hyperplasia with prominent intercellular edema and neutrophilic exocytosis of the hyperplastic surface squamous epithelium. Based on the characteristic clinical and histologic features, we conclude that this lesion is a distinct subtype of gingival hyperplasia. Although previously described as juvenile spongiotic gingivitis, we propose the term localized juvenile spongiotic gingival hyperplasia as a more accurate designation.

A Comparison of the Periodontal Status in Patients With Mucous Membrane Pemphigoid: A 5-Year Follow-Up

BACKGROUND Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of unknown etiology. Intraoral manifestations of MMP feature the formation of vesiculobullous lesions that eventually rupture, leading to pseudomembrane-covered, irregularly-shaped ulcerations. The presence of these often painful oral lesions may hinder oral hygiene efforts resulting in increased plaque accumulation and may increase the risk of developing periodontal disease. The purpose of this study was to evaluate the changes in periodontal status in patients with MMP after a period of 5 years. METHODS Twenty patients, 10 diagnosed with MMP and 10 controls matched for age, gender, and smoking history, were chosen to participate in a study evaluating their periodontal status. Parameters evaluated included the plaque index, gingival index, bleeding index, probing depths, recession, clinical attachment level, mobility, furcation involvement, number of missing teeth, and periodontitis. Data from the same MMP and control patients were available for comparison from an identical baseline evaluation performed 5 years earlier. RESULTS Patients with MMP exhibited a statistically significant higher gingival index and amount of lingual gingival recession at both time periods compared to controls. Both groups exhibited statistically significant increases in attachment loss and facial/lingual recession, but the difference in change between groups was not statistically significant. CONCLUSIONS The results of this study suggest that patients diagnosed with MMP appear to be no more at risk than controls matched for age, gender, and smoking history in developing or having an increased progression of periodontal disease.

Assessment of Hemostatic Efficacy and Osseous Wound Healing Using HemCon Dental Dressing

INTRODUCTION Obtaining hemostasis in the surgical crypt during periradicular surgery is essential. It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material. Although current materials may not be moisture sensitive during setting, hemostasis is important for proper placement of root-end filling materials during apical surgery. A new hemostatic agent, HemCon dental dressing (Patterson Dental, St Paul, MN), may improve upon the efficacy of wound healing and hemostasis both in extent and time. The aim of this study was to evaluate the hemostatic effect of HemCon in osseous wound sites and evaluate the wound healing potential and percentage of new bone formation in osseous crypts treated with HemCon. METHODS A split-mouth design was used with random allocation of sham and experimental sites in 12 rabbits. In experimental sites, either HemCon or 15.5% ferric sulfate was applied to osseous crypts created with a round bur. Hemostatic efficacy was evaluated using predetermined scores. Rabbits were sacrificed at 21 days, and tissues were harvested and prepared for histologic evaluation. A blinded pathologist scored samples relative to inflammation. The percentage of new bone deposition was calculated using NIS Elements software (Nikon Instruments Inc, Melville, NY). RESULTS There was no statistical significant difference in hemostatic efficacy or wound healing between HemCon and ferric sulfate (P > .05). The HemCon group showed a significantly higher percentage of new bone deposition compared with the controls (P < .01). CONCLUSIONS HemCon shows promise as an adjunct to the endodontic surgical armamentarium.

Oral melanocytic nevi: a clinicopathologic study of 100 cases.

OBJECTIVE The purpose of this study was to evaluate the clinical and histopathologic features of oral melanocytic nevi (OMN). STUDY DESIGN One hundred cases of OMN were retrieved from the files of two oral pathology services, and the data were analyzed with regard to histologic type and clinical features. RESULTS Intramucosal nevus was the most common type (61%), followed by common blue nevus (23%), compound nevus (7%), and junctional nevus (3%). Combined nevus and cellular blue nevus were rare (2% each). The hard palate was the most commonly affected site (33%), followed by the buccal mucosa (18%), vermilion border of the lip (18%), and gingiva (15%). An interesting case of intramucosal nevus with lipomatosus-like changes and neurotization and two cases of oral dysplastic nevus are also reported. CONCLUSIONS Intramucosal and common blue nevi are the most common types of OMN. Dysplastic nevus, which is recognized as a marker for melanoma in the skin, can rarely involve the oral cavity. Accordingly, dentists, especially oral and maxillofacial pathologists, should become familiar with the clinical and histopathologic features of this entity.

Epstein-Barr virus-positive oral ulceration simulating Hodgkin lymphoma in a patient treated with methotrexate: case report and review of the literature.

Immunosuppressive therapy for patients diagnosed with rheumatoid arthritis has long been implicated in the development of various neoplastic processes, including leukemia and lymphoma. Methotrexate is a commonly administered antimetabolic medication thought to improve the symptoms of rheumatoid arthritis through its anti-inflammatory effects. Longterm methotrexate therapy and concurrent rheumatoid arthritis have both been independently suggested as risk factors for developing lymphoma. The mechanism has been theorized to be severe immunosuppression and an increased frequency of latent infection with pro-oncogenic viruses, such as the Epstein-Barr virus (EBV). Spontaneous remission of these malignancies has been seen after discontinuation of the methotrexate therapy. In the present study, we report the case of a patient diagnosed with rheumatoid arthritis and treated with methotrexate and prednisone. She developed intraoral ulcerations that histopathologically resembled Hodgkins lymphoma.

The diagnostic challenges of separating chronic ulcerative stomatitis from oral lichen planus

OBJECTIVE To attempt to establish criteria to differentiate between chronic ulcerative stomatitis (CUS) and oral lichen planus (OLP) with hematoxylin and eosin (H&E) staining alone. STUDY DESIGN Ten confirmed cases of CUS were reviewed from the Stomatology Clinic at the Texas A&M University Baylor College of Dentistry. RESULTS The original diagnosis on H&E evaluation was OLP, chronic mucositis, or mucositis with lichenoid features, but subsequent direct immunofluorescence (DIF) revealed a positive speckled intranuclear deposition of immunoglobulin G (IgG) in the basal and parabasal layers of the epithelium, confirming a diagnosis of CUS. CONCLUSIONS No consistent histopathologic features were present that would allow recognition of CUS from H&E analysis alone. DIF remains the gold standard for diagnosis.

Lymphangioma-like Kaposi sarcoma of the oral mucosa

With the epidemic of acquired immunodeficiency syndrome, the clinical and histopathological features of Kaposi sarcoma (KS) became routine for most practicing surgical pathologists. The histological spectrum of KS broadened significantly over time and today a wide variety of rare histological variants are reported, but not widely recognized. Lymphangioma-like KS (LLKS) is a rare histological variant of KS occurring in skin, with banal histological features that can lead to misdiagnosis and inappropriate therapy. We report a series of intra-oral cases of LLKS and review the literature regarding this lesion.