Ivan J. Stojanov

Human papillomavirus and Epstein-Barr virus associated conditions of the oral mucosa.

Human papillomavirus (HPV) and Epstein-Barr virus (EBV) infections of the oral mucosa may present as both benign and malignant conditions. Squamous papilloma, verruca vulgaris, and condyloma acuminatum are benign, HPV-associated growths treated with simple excision while multifocal epithelial hyperplasia (Heck disease) usually occurs in children and adolescents and resolves over time. HPV-associated oral dysplasia is uncommon and HPV-carcinoma comprises 6% of oral squamous cell carcinomas. EBV is responsible for oral hairy leukoplakia, a benign condition seen in immunocompromised patients, while the EBV-associated mucocutaneous ulcer is a recently-described, indolent condition associated with an atypical lymphoid proliferation seen immunocompromised patients as well as older adults, the latter likely because of immunosenescence. Awareness of these conditions is important for the practicing pathologist because some of these conditions may represent the first sign of underlying immunocompromise.

Oral lichen planus pemphigoides: a series of four cases

OBJECTIVE Lichen planus pemphigoides (LPP), which is a rare autoimmune blistering mucocutaneous disease of the pemphigoid family of diseases, is characterized by the development of vesiculobullous lesions on or adjacent to the areas of lichen planus (LP). LPP primarily affects the skin, and oral involvement alone is rare. The objective of this case series was to report four new cases of oral LPP. STUDY DESIGN We present four cases with clinical, histologic, and direct immunofluorescence (DIF) features characteristic of LPP, with three cases having oral involvement only. RESULTS The four patients (including two males) were aged 49, 50, 51, and 61 years; only one patient had skin lesions. All patients had typical reticular, erythematous, or ulcerative oral LP involving the gingiva and the buccal mucosa. Mucosal biopsies showed features consistent with LP, mucous membrane pemphigoid (MMP), or a combination of both, and DIF studies in all 4 cases showed linear deposition of immunoglobulin G (IgG) and C3 at the interface. CONCLUSIONS Correlation of clinical findings, routine histopathology, and DIF studies is essential for the diagnosis.

Intraoral Salivary Duct Cyst: Clinical and Histopathologic Features of 177 Cases.

The salivary duct cyst (SDC) is a reactive ductal ectasia most frequently seen in major salivary glands, and likely caused by obstruction. The aim of this study is to define the clinical and histopathologic spectrum of intraoral SDCs. Cases were retrieved from the archives of Harvard School of Dental Medicine/StrataDx, Inc. from January 2012 to August 2014. There were 177 cases of which 103 (58.2%) occurred in females, with a median age of 56 (range 2–95). Approximately half of cases (45.8%) presented in the area of the buccal mucosa, lower lip mucosa, or mandibular vestibule, and 23.2% presented in the floor of mouth. SDCs were lined at least focally by 1–2 layers of cuboidal/columnar epithelium in 85.3% of cases and showed varying degrees of metaplasia (oncocytic, mucous cell, squamous, ciliated, apocrine-like) in 68.4% of cases. Intraluminal mucous stasis was present in 41.8% of SDCs, incipient calcification was present within 4.5% of SDCs, and chronic obstructive sialadenitis was seen in 90.2% of cases. No cysts showed adenomatous ductal proliferations or true papillary structures with fibrovascular cores, although 41.2% exhibited reactive undulation of cyst lining. Thirty-nine ‘papillary oncocytic cystadenoma-like’ SDCs (22.0%) demonstrated complete oncocytic metaplasia and marked undulation. An additional seven such cysts (4.0%) had a ‘Warthin tumor-like’ lymphoplasmacytic infiltrate. Intraoral SDCs occur most commonly in the sixth decade of life in locations distinct from extravasation mucoceles, likely secondary to intraluminal obstruction. SDCs show diverse histopathology and certain phenotypic variants may be mistaken for papillary oncocytic cystadenoma or Warthin tumor.

Predominance of oral mucosal melanoma in areas of high mechanical stress

cream on AFXL-pretreated skin. Since concentration of anesthetics was comparable for both formulations (AHES 4% vs lidocaine/prilocaine 5%), we proposed that a liquid solution may penetrate more easily into the AFXL ablation channels. Therefore, in the present study we aimed to compare AHES with a cream formulation containing a much higher concentration of anesthetics (AHES 4% vs LTC 14%), whichmay still not have sufficiently compensated for the possibly inferior vehicle. Despite the lack of comparability of the pharmacologic properties of both anesthetics (different anesthetics, presence of the potent vasoconstrictor epinephrine in AHES, which could enhance the sustained effect of the anesthetic), our finding that AHES still rendered more effective anesthesia than LTC might be considered as another indication for the superiority of a liquid vehicle. In conclusion, both AHES and LTC give effective anesthesia when applied on AFXL-pretreated skin for

Lipomas of the Oral Cavity: Utility of MDM2 and CDK4 in Avoiding Overdiagnosis as Atypical Lipomatous Tumor

5 minutes. Maximum anesthesia is already achieved after 15 minutes for AHES. Despite the much lower concentration of anesthetic, AHES is superior to LTC in this setting. Additional research comparing different formulations containing the same anesthetic at a fixed concentration is needed to assess the exact role of the drug vehicle in AFXL-assisted topical anesthesia and drug delivery in general.

Candidal carriage predicts candidiasis during topical immunosuppressive therapy: a preliminary retrospective cohort study

Traumatized lipomas with degenerative change may demonstrate histopathologic features that mimic atypical lipomatous tumor (ALT). Previously reported series of ALT involving the oral cavity preceded routine use of MDM2 and CDK4 immunohistochemistry. Our aim is to evaluate MDM2 and CDK4 immunohistochemical expression in adipocytic tumors arising in this site, in conjunction with the histiocytic marker PU.1, to determine whether MDM2 and CDK4 impacts classification. 17 cases originally diagnosed as ALT were retrieved and immunohistochemical studies for MDM2, CDK4 and PU.1 were performed. FISH analysis for MDM2 amplification was performed in select cases. For this study group, the male:female ratio was 9:8 and the median age was 62 (range 41–88). All 17 cases presented as well- or predominantly well-circumscribed proliferations of variably sized, mature adipocytes exhibiting uni- or multi-vacuolation with occasional scalloped nuclei and mild nuclear atypia. Variable amounts of fibrous stroma with focal myxoid change and bland spindle cells were identified in 14/17 cases. Lipoblasts or atypical hyperchromatic stromal cells were not identified in any cases. 14 of 17 cases were negative for MDM2 and CDK4 in tumor cells and 11 of these 14 showed weak nuclear positivity for MDM2 in histiocytes. 3 of 17 cases showed weak, multifocal immunohistochemical expression of MDM2 and CDK4. PU.1 highlighted histiocytes in all 17 cases. FISH analysis for MDM2 amplification was negative in all 3 cases with weak MDM2/CDK4 expression. All cases were reclassified as lipoma with degenerative changes. ALT, in all likelihood, is less common than previously thought in this anatomic location and best diagnosed with ancillary studies. MDM2 expression in histiocytes is best interpreted in conjunction with CDK4 immunohistochemistry and confirmatory FISH for MDM2 amplification.