Michael W. Finkelstein

Clinical and therapeutic features of polymorphous low-grade adenocarcinoma

Polymorphous low-grade adenocarcinoma, also known as terminal duct or lobular carcinoma, was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms including pleomorphic adenomas, variants of monomorphic adenomas, or salivary malignant conditions including malignant pleomorphic adenomas, adenoid cystic carcinomas, and adenocarcinoma not otherwise stated. This neoplasm with few exceptions originates in minor salivary gland tissue of the posterior hard and soft palates or buccal mucosa. It is characteristically slow to enlarge; clinical reports show the neoplasm present for many years before diagnosis. We have evaluated the clinical and microscopic features of 15 cases from the archives of The University of Iowa Surgical Oral Pathology Laboratory and added these to published case reports. A total of 204 cases were evaluated with a female/male ratio of almost 2/1. Forty-nine percent originated in palatal mucosa. Polymorphous low-grade adenocarcinomas arising from pleomorphic adenomas or de novo have been reported within major salivary glands and outside the oral cavity. A 17% recurrence rate was found with a regional metastasis rate of 9%. Five cases had multiple recurrences, and 13 recurrences were at or beyond 5 years after the initial diagnosis. Regional node metastases were identified at the time of initial treatment or at the time of recurrence in 9% of cases in which follow-up data were specified.

Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa

We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple–red papule and, in the other, as a blue submucosal swelling. Both lesions were non‐painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit‐like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII‐related antigen was positive only within endothelial cells lining well‐formed vascular channels. Both lesions were treated by excision; short‐term follow‐up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.

Keratocystic odontogenic tumor: A retrospective analysis of genetic, immunohistochemical and therapeutic features. Proposal of a multicenter clinical survey tool

OBJECTIVE In 2005, the World Health Organization reclassified the parakeratinizing odontogenic keratocyst as a neoplasm. This article reviews the research leading to this reclassification, and validates a new survey tool that can be easily used to pool surgical and recurrence data from multiple offices. STUDY DESIGN All odontogenic lesions accessioned in the Iowa Surgical Oral Pathology Laboratory between 1949 and 2010 were identified from the database. A survey tool to assess treatment and follow-up was created. A total of 46 surgeons agreed to participate. RESULTS A total of 70 keratocystic odontogenic tumors (KOTs) had documented recurrences at follow-up intervals ranging from 6 months to 5 years. Primary tumors that recurred ranged in size as measured by greatest radiographic diameter from 0.7 to 6 cm. CONCLUSIONS This survey tool is recommended as standard allowing treatment of cases by multiple practitioners to be compared retrospectively or prospectively.

Delayed mandibular reconstruction following removal of a mesenchymal chondrosarcoma: Report of a case

An unusual case of mesenchymal chondrosarcoma is presented. Initially seen when the patient was 8 years old, the lesion was repeatedly biopsied and curetted with a diagnosis of odontogenic fibroma. In 1971 a diagnosis of osteosarcoma of the chondroblastic type was made. At that time, the patient underwent a partial mandibulectomy with immediate graft. The patient did well until 1981, when a recurrence of the lesion was noted. The microscopic diagnosis at this time was mesenchymal chondrosarcoma. The treatment of this lesion as a staged procedure with initial resection of the mandible and placement of a silicone rubber mandibular prosthesis is discussed. The second stage of the procedure was definitive mandibular reconstruction, with an allogeneic mandible as a crib for autologous particulate cancellous bone from the iliac crest. Although the prognosis of mesenchymal chondrosarcoma is usually grave, this case is unusual because of its long history of multiple procedures performed prior to the definitive treatment of the lesion 14 years after its discovery. Two-year follow-up since the definitive mandibular reconstruction shows adequate range of motion, excellent healing, and no recurrence.

Hyalinosis cutis et mucosae

Hyalinosis cutis et mucosae is an uncommon genetic disease characterized by accumulation of glycoproteinaceous material not only at mucocutaneous sites but also in salivary glands, central and peripheral nervous systems, eyes, nd other organs and tissues. The course of the disease is protracted, and it is not likely to regress, either spontaneously or with therapy. Although it does not usually result in decreased longevity, the disorder may produce considerable disfigurement and functional impairment. This article documents the case of a 5-year-old girl who presented with vocal weakness, misarticulations, and hoarseness; hypopigmented scarring of the arms and pubis; fibrotic thickenings of the oral and laryngeal mucosa; and serous otitis media. A tongue biopsy revealed diffuse hyaline deposits throughout the connective tissue and in a lamellar pattern about blood vessels. A diagnosis of hyalinosis cutis et mucosae was made.

Prevalence of the posterior superior alveolar canal in cone beam computed tomography scans

OBJECTIVE This study was primarily aimed at determining the prevalence of the posterior superior alveolar (PSA) canal in cone beam computerized tomography (CBCT) scans in a North American population. MATERIALS AND METHODS Cone beam computed tomography scans were selected on the basis of predetermined eligibility criteria from a pool of 976 data sets. Two calibrated examiners assessed the presence of PSA canal on the postero-lateral wall of the maxillary sinus using coronal sections. One examiner also recorded the presence of images compatible with sinus disease. Associations between the presence of PSA canal and sinus disease were investigated for males and females separately using statistical methods. RESULTS A total of 254 CBCT scans were selected. The pooled prevalence of the PSA canal in CBCT scans was 94.4% and 91% on the right and left side, respectively. The ability to detect the presence of the canal was not significantly affected by the presence of intrasinusal disease. Males are more likely than females to present signs of maxillary sinus pathoses on the right (63.3% vs. 36.7%) and the left side (59.2% vs. 40.8%). CONCLUSIONS The prevalence of the PSA canal on CBCT images in the selected population is high. The PSA canal can be consistently visualized on CBCT scans with a high level of reproducibility regardless of the presence of radiographic signs of intrasinusal pathoses.

Adapting to changes in molecular biosciences and technologies

Dental education, like any other educational programme in a research-intensive university environment, must be research led or at least research informed. In this context, as the research and knowledge base of dentistry lies in the biological and physical sciences, dental education must be led by advances in research in both these areas. There is no doubt that biotechnology and nanotechnology have, over the past 25 years, led research in both these areas. It is therefore logical to assume that this has also impacted on dental education. The aim of this paper is twofold; on one hand to examine the effects of biotechnology and nanotechnology and their implications for dental education and on the other to make recommendations for future developments in dental education led by research in biotechnology and nanotechnology. It is now generally accepted that dental education should be socially and culturally relevant and directed to the community it serves. In other words, there can be no universal approach and each dental school or indeed curriculum must apply the outcomes in their own social, cultural and community settings.

A computer management system for patient simulations

A series of interactive videodisc patient simulations is being used to teach clinical problem-solving skills, including diagnosis and management, to dental students. This series is called Oral Disease Simulations for Diagnosis and Management (ODSDM). A computer management system has been developed in response to the following needs. First, the sequence in which students perform simulations is critical. Second, maintaining records of completed simulations and student performance on each simulation is a time-consuming task for faculty. Third, the simulations require ongoing evaluation to ensure high quality instruction. The primary objective of the management system is to ensure that each student masters diagnosis. Mastery must be obtained at a specific level before advancing to the next level. The management system does this by individualizing the sequence of the simulations to adapt to the needs of each student. The management system generates reports which provide information about students or the simulations. Student reports contain demographic and performance information. System reports include information about individual patient simulations and act as a quality control mechanism for the simulations.

Discoid lupus erythematosus of the lip and face

Lupus erythematosus (LE) includes a broadly defined group of related clinical illnesses that can affect the orofacial region. Discoid lupus erythematosus (DLE) is a generally benign mucocutaneous disease, whereas systemic lupus erythematosus (SLE) includes multisystem and organ involvement with significant mortality. Of intermediate severity, subacute LE (SCLE) often may share features found in both DLE and SLE.rm3 Although several different types of LE have been described, they all may have similar skin lesions. Ap proximately 20% to 30% of SLE patients and 15% to 20% of SCLE patients have discoid lesions sometime during their disease, most commonly involving the skin of the face and scalp. The discoid lesions appear as erythematous patches with scaling, telangiectasia, follicular plugging, atrophy, and scarring.4 Discoid lupus erythematosus also may include oral mucosal lesions in 3% to 20% of cases.’ Patients with DLE have minimal or absent systemic or serologic abnormalities, although it has been reported that 5% to 10% of patients eventually develop systemic manifestations.5 The following case report describes a patient with lip and facial lesions of DLE.