Ilana Kaplan

Solid Keratocystic Odontogenic Tumor—Report of a Nonaggressive Case

Odontogenic keratocyst (OKC), which was originally described by Philipsen 1 in 1956, has distinctive clinical and histologic characteristics. The histologic features of OKC include a thin epithelial lining of uniform thickness, with palisading of basal cells and a thin corrugated layer of parakeratin. OKCs have a high recurrence rate, which can be attributed both to the high proliferative activity of the epithelial lining and to the extension along the bony cancellous spaces, which makes complete enucleation difficult. 2,3 In a recent report that reviewed hundreds of published cases, the recurrence rates ranged from 0% to 100%, with those undergoing with enucleation having the worst recurrence rates (0% to 56%), in contrast to those undergoing resection, with a recurrence rate of 0% in all reviewed series. The investigators explained this discrepancy by the differences in the length of the postoperative follow-up periods, operative techniques used, differences in cyst location, the presence or absence of infection, associated teeth, involvement of mucosa, lesion size, or inclusion of cases with Nevoid basal cell carcinoma syndrome. 4 In the 2005 edition of the World Health Organization Classification of the Head and Neck Tumors, the odontogenic keratocyst was reclassified from a cystic to a neoplastic lesion, and the term “keratocystic odontogenic tumor” (KCOT) was coined. 5 In very rare cases, KCOT has been described as a solid, rather than a cystic, lesion. Only 3 cases of solid KCOT have been previously reported; thus, information on its characteristics is minimal. However, it has been suggested in 2 of these reports that these solid variants might be clinically more aggressive than the more common cystic variant of KCOT. 6,7 Keratoameloblastoma is another rare odontogenic tumor, with microscopic features of both ameloblastoma and KCOT, 8 which bears significant overlap with features of solid KCOT, and should be considered in the differential diagnosis. The purpose of the present report is to present a case of solid KCOT that did not present with unusually aggressive behavior and to discuss in detail the histologic differential diagnosis with keratoameloblastoma.

Primary Oral Malignancy Imitating Peri-Implantitis

PURPOSEnTo describe new cases of primary malignancy arising around dental implants.nnnMATERIALS AND METHODSnThree patients presented with asymptomatic lesions around longstanding dental implants that resembled peri-implantitis. One case was primary large B-cell lymphoma and the remaining cases were primary squamous cell carcinoma in patients with oral lichen planus. The literature was reviewed for cases mimicking peri-implantitis.nnnRESULTSnOf 42 implant-associated malignancies reported from 2000 through 2014, 85.7% were squamous cell carcinoma (69% primary and 9.4% metastatic). Most patients presented with pre-existing risk factors for oral cancer. Lymphoma was not associated with dental implants.nnnCONCLUSIONSnPrimary and metastatic malignancies can occur in peri-implant mucosa, often with clinical and radiographic features resembling peri-implantitis. Clinicians should have a high index of suspicion for changes in peri-implant mucosa in patients with existing risk factors; however, rare cases such as lymphoma might present outside this risk population. Histopathologic analysis should be included in the management of selected peri-implant lesions to avoid delayed diagnosis of malignancy.

Can Differences in Vascularity Serve as a Diagnostic Aid in Fibro-Osseous Lesions of the Jaws?

PURPOSEnDifferent lesions in the fibro-osseous group share microscopic features; thus, establishing a definitive diagnosis based on microscopic features alone can be a challenge. There is a need for additional microscopic tools to aid in differentiating these lesions. This study compared parameters related to vascularity among 3 lesions in the fibro-osseous group: fibrous dysplasia (FD), central ossifying fibroma (COF), and cemento-osseous dysplasia (COD).nnnMATERIALS AND METHODSnThis study was a cross-sectional analysis of biopsied lesions retrieved from 3 medical centers over a 14-year period. The primary predictor variables were the vascularity parameters (number,xa0perimeter, and area). The outcome variables were diagnoses of FD, COF, and COD. Diagnosis was based on clinical, microscopic, and radiologic correlations. From each histopathologic slide, 5 representative fields were captured with a computerized digital camera. The number of blood vessels was counted, and the surface area and vascular perimeter were measured by tracing the perimeter of each vessel. Data were statistically analyzed using analysis of variance with logarithmic transformation and a Tukey adjustment.nnnRESULTSnSixty-six cases were included in the study (26 in FD group, 26 in COF group, and 14 in COD group). The mean number of vessels showed only a tendency to be larger in the FD group compared with the COF and COD groups (5.4 ± 2.6, 3.7 ± 2.3, and 3.6 ± 1.7, respectively), but the results did not reach the threshold for significance. The mean vascular perimeter was 1,385.8 ± 859.2 pixels in the FD group and 742.6 ± 661.8 in COF group after logarithmic transformation (Pxa0= .012). The perimeter in the COD group was smaller (941.1 ± 502) compared with that in the FD group, but the difference did not reach the threshold for significance. The mean area was 25,061 ± 24,875.6 in the FD group and 11,773.8 ± 21,734.4 in the COF group after logarithmic transformation (Pxa0= .004). The perimeter in the COD group was smaller (13,011.1 ± 8,338.3) compared with the FD group, but the difference did not reach the threshold for significance.nnnCONCLUSIONnThe vascular content of the FD group was markedly higher than of the COF group. These vascular changes can aid in differentiating these lesions microscopically.

Epiglottitis as the Presenting Sign of Mucous Membranous Pemphigoid: A Case Report

Mucous membranous pemphigoid (MMP) is an autoimmune disease of the mucous membranes characterized by formation of subepithelial blisters. MMP commonly involves the ocular and oral mucosa. Laryngeal MMP is very rare, estimated as occurring in 1 of 10 million persons in the general population. It mostly affects the supraglottis, but may also involve other laryngeal sites as well as extralaryngeal areas. This report describes the clinical picture, workup to diagnosis, and differential diagnosis of an isolated epiglottic process in an elderly female who presented with isolated, long-standing, nonresolving epiglottitis, later diagnosed as MMP with epiglottal and oral involvement.

The Spectrum of Oral Lesions Presenting Clinically With Papillary-Verrucous Features

PURPOSEnWe sought to study the spectrum of oral pathologies presenting clinically with papillary-verrucous features.nnnMATERIALS AND METHODSnA 10-year (2007 to 2016) retrospective study of oral papillary lesions was undertaken. All biopsy reports that included a clinical description of papillary or verrucous architecture were retrieved. The data collected included clinical features, size, color, location, histopathologic diagnosis, age, and gender.nnnRESULTSnThe study included 137 patients, with a total of 150 lesions. The ages ranged from 10xa0weeks to 84xa0years (mean, 49xa0years).xa0Histopathologically, 60% of cases were human papillomavirus (HPV) related, 19% showed hyperplasia, 11% had hyperplastic candidiasis, 7% were dysplastic or malignant, and 3% were benign of unknown etiology. Among the 7% of lesions diagnosed with dysplasia or malignancy, only 60% were suspected to have malignancy at the time of biopsy. HPV-related lesions and hyperplasia were most frequently found on the tongue (38% and 41%, respectively) and soft palate (21% and 14%, respectively). Hyperplastic candidiasis was most frequently found on the buccal mucosa and tongue (35% and 24%, respectively). Squamous cell carcinoma was found in 1.3% of total lesions and verrucous carcinoma in 1.3%. Of the verrucous or papillary malignant lesions, 50% were found on the gingiva. Most malignant lesions occurred in the 40- to 60-year age group.nnnCONCLUSIONSnThe results of this study suggest that, because of the wide spectrum of entities presenting clinically with a papillary-verrucous architecture, biopsy is necessary for diagnosis. The clinical presentation allowed for overall accurate diagnosis in only 47% of cases and 60% accuracy in dysplastic or malignant cases. It is of considerable importance to correctly identify those lesions that are HPV related but at the same time to rule out those lesions that are unrelated to HPV to help alleviate a patients anxiety.xa0Most important, biopsy is mandatory for the recognition of malignant lesions with a papillary-verrucous architecture, which may mimic other benign entities in the group of papillary-verrucous lesions.

Clinical-pathological conference: case 1.

A healthy 37-year-old female noticed a loose 2nd maxillary molar, which became progressively worse over several weeks. A course of antibiotics was prescribed by her dentist without improvement. She then visited an oral surgeon, and a decision to extract the tooth was taken, since all supporting bone seemed to have been lost. A panoramic radiograph showed partial opacification of the sinus floor which was interpreted as a possible sign for sinus mucocele (Fig. 1a). Immediately following extraction, an oro-antral communication was observed, with a mass of pale, soft, gelatinous tissue protruding through. A sample of the tissue was submitted for histopathological examination and CT scans were ordered. Coronal CT scans exhibited a mass occupying the right maxillary and ethmoidal sinuses, and protruding into the right nasal space and pterygomaxillary fossa. Destruction of the bony walls and septa were evident at the level of the maxillary and ethmoidal sinuses, as well as thinning of the orbital floor and erosion of the pterygoid plates (Fig. 1b).