J. Michael McCoy

Pulse granuloma of the alveolar ridge.

Six examples of pulse granulomas of the alveolar ridge are presented. The lesion consists of a foreign-body granuloma containing identifiable particles of leguminous foods. The vegetable matter is introduced through an alveolar defect, usually a postextraction socket. Simple curettage is apparently adequate treatment to effect cure.

Intraoral ancient neurilemoma (ancient schwannoma): Report of a case with histologic and electron microscopic studies

A case of ancient neurilemoma arising in the oral soft tissues is presented. Histologic and electron microscopic studies indicate that this tumor is, indeed, a variant of the neurilemoma and that the Schwann cell is the cell of origin. At the ultrastructural level, the bulk of the lesion is composed of numerous reduplications of basal lamina accompanying thin cytoplasmic processes and thus resembles a confluence of Verocay bodies as described in previous studies of classic neurilemomas. Heretofore unreported submicroscopic calcified spherules were observed scattered through the basal lamina material.

The Use of Multiple Time Point Dynamic Positron Emission Tomography/Computed Tomography in Patients With Oral/Head and Neck Cancer Does Not Predictably Identify Metastatic Cervical Lymph Nodes

PURPOSE To determine whether the time course of 18-fluorine fluorodeoxyglucose (18F-FDG) activity in multiple consecutively obtained 18F-FDG positron emission tomography (PET)/computed tomography (CT) scans predictably identifies metastatic cervical adenopathy in patients with oral/head and neck cancer. It is hypothesized that the activity will increase significantly over time only in those lymph nodes harboring metastatic cancer. PATIENTS AND METHODS A prospective cohort study was performed whereby patients with oral/head and neck cancer underwent consecutive imaging at 9 time points with PET/CT from 60 to 115 minutes after injection with (18)F-FDG. The primary predictor variable was the status of the lymph nodes based on dynamic PET/CT imaging. Metastatic lymph nodes were defined as those that showed an increase greater than or equal to 10% over the baseline standard uptake values. The primary outcome variable was the pathologic status of the lymph node. RESULTS A total of 2,237 lymph nodes were evaluated histopathologically in the 83 neck dissections that were performed in 74 patients. A total of 119 lymph nodes were noted to have hypermetabolic activity on the 90-minute (static) portion of the study and were able to be assessed by time points. When we compared the PET/CT time point (dynamic) data with the histopathologic analysis of the lymph nodes, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 60.3%, 70.5%, 66.0%, 65.2%, and 65.5%, respectively. CONCLUSIONS The use of dynamic PET/CT imaging does not permit the ablative surgeon to depend only on the results of the PET/CT study to determine which patients will benefit from neck dissection. As such, we maintain that surgeons should continue to rely on clinical judgment and maintain a low threshold for executing neck dissection in patients with oral/head and neck cancer, including those patients with N0 neck designations.