Jerald L. Jensen

Malignant neoplasms metastatic to gingivae

Malignant neoplasms metastatic to the gingivae are rare. Our review of the literature revealed only eight acceptable examples. We are reporting two additional cases. One patient was a 58-year-old man with an adenocarcinoma of the lung which metastasized bilaterally to the maxillary gingiva. The second patient was a 27-year-old man with a synovial sarcoma which metastasized to multiple sites in the maxillary and mandibular gingiva. Clinically, gingival metastatic lesions are most often confused with hemangioma, pyogenic granuloma, giant-cell granuloma, and pepripheral fibroma. They usually occur late in the course of the disease and are associated with metastatic deposits in many other organs and tissues. Death usually occurs in a few weeks or months after discovery of the gingival metastasis.

Minor salivary gland calculi. A clinicopathologic study of forty-seven new cases.

An analysis of forty-seven previously unreported cases of minor salivary gland calculi revealed that they were usually solitary, firm, freely movable, small masses. Also, we noted that these calculi exhibited a striking predilection for the upper lip and buccal mucosa of adults. The organic matrix of all calculi was similar; however, the amount of mineralized material was variable. A variety of types of epithelial metaplasia was noted in the pericalcular ducts, with the most common type being squamous-cell metaplasia. Chronic periductal and lobular inflammation in addition to duct ectasia were common findings. The cause of minor salivary gland calculi is not known; however, local factors, such as duct morphology or biochemical alterations, or both, may be involved.

Lipomas of the parotid gland

Abstract Parotid gland lipomas are slowly growing, asymptomatic, nontender masses. They are rare lesions and exhibit no unique clinical features. There is no reliable method of establishing a preoperative diagnosis; therefore, treatment must conform to established principles of parotid gland surgery.

Metastatic tumors of the mandibular condyle: Review of the literature and report of a case

A metastatic tumor involving the mandibular condyle presented symptoms of temporomandibular joint (TMJ) dysfunction. Positive identification of the primary malignant lesion as prostatic adenocarcinoma was accomplished through the use of immunohistochemical stains for prostate-specific antigen and subsequent prostate biopsy. A review of the literature revealed fifteen additional cases of metastatic lesions of the mandibular condyle, seven of which also demonstrated TMJ-related symptoms as the initial manifestation of malignant disease. Such cases represent a diagnostic challenge, both clinically and microscopically. Symptoms of TMJ dysfunction coupled with radiographic evidence of a destructive lesion or pathologic fracture should suggest a possible malignant process indicating the need for biopsy. Subsequent examination of routine sections in combination with the use of selected stains, including immunohistochemistry may be helpful in identification of the primary tumor site.

Cutaneous keratocysts of nevoid basal cell carcinoma syndrome

Four cysts were removed from two unrelated patients with nevoid basal cell carcinoma syndrome. Multiple sections from each cyst were studied. Two cysts showed histologic features similar to keratocysts that occur in the jaws of patients with this syndrome. The cysts were lined by a festooned epithelium consisting of two to five layers of squamous cells that formed keratin without the presence of a granular cell layer. One cyst contained some lanugo hair and a small bud of follicular epithelium. This cyst was therefore similar to cutaneous steatocysts but did not have an identifiable sebaceous component. The second cyst was devoid of hair and adnexal structures and was indistinguishable from a jaw keratocyst. Two other cysts were typical epidermoid (infundibular) cysts. Although speculative, it is likely that some cutaneous cysts in patients with nevoid basal cell carcinoma syndrome are identical to jaw keratocysts and may be another cutaneous marker for this disease complex.

Sialadenoma papilliferum of the oral cavity

Abstract Sialadenoma papilliferum is a rare, recently reported, salivary gland tumor with distinctive morphologic and clinical features. Morphologically, these lesions exhibit a prominent exophytic and papillary growth pattern and appear to arise from extralobular salivary gland ducts. Clinically, they are asymptomatic and slow growing and must be differentiated from other papillary lesions, including squamous-cell papilloma, verrucous carcinoma, and warty dyskeratoma.

Focal osteoporotic bone marrow defects of the jaws: An analysis of 197 new cases

Abstract Osteoporotic bone marrow defects will usually present as asymptomatic radiolucencies which are located predominantly in the mandibular molar regions of middleaged women. Histologically, they are composed of either hematopoietic or, less commonly, fatty marrow. The majority of defects offer no ready explanation as to their pathogenesis; however, altered healing reactions or marrow hyperplasia may be the cause in a small number of cases. The defects often are radiographically similar to more ominous lesions, which must be ruled out.

Basal cell carcinoma of the buccal mucosa.

True basal cell carcinoma (BCC) involving the oral mucous membranes is extraordinarily rare. Most of those described as occurring in the oral cavity usually involve the gingiva and are not true BCCs but peripheral ameloblastomas. A true BCC, which arose on the buccal mucosa of a 69-year old man, is reported. It presented as a 1.3 cm ulcerated plaque without gingival connection. Histologically, the lesion exhibited classic features of BCC with palisading and retraction spaces, and focally communicated with the overlying squamous epithelium. Although it is possible that this lesion also arose from a heterotopic odontogenic rest, the anatomical location, focal squamous (metatypical) features, and positive staining for Ber-EP4 support an origin from the basal cell layer of stratified squamous mucosa.

Nevus cell aggregates in submandibular lymph nodes

Nevus cell aggregates are occasionally found in the capsules and trabeculae of lymph nodes. These aggregates are similar histologically to those in typical cutaneous nevi and should be differentiated from metastatic tumor.

Epithelial islands associated with mandibular nerves: Report of two cases in the walls of mandibular cysts

Epithelial islands in association with nerve fibers in the jaw bones have been reported previously. We describe two such cases and present evidence that the epithelial structures as observed in this study are odontogenic rests and not neuroepithelial organs. Regardless of origin, it should be recognized that these epithelial islands do not represent neural invasion by carcinoma.