Nadim M. Islam

Common oral manifestations of systemic disease.

Oral manifestations of systemic diseases are potential indicators of an array of conditions. Truly the oral cavity is a mirror that reflects and unravels many of the human bodys internal secrets. Some of these manifestations are disease specific and help raise a high degree of suspicion for the alert clinician. Because oral manifestations may accompany many systemic diseases, it is essential that these are appropriately recognized to provide correct diagnosis and referral for treatment and patient care. Multiple entities involving the various areas of the oral cavity like the soft palate, hard palate, tongue, gingiva, oral mucosa, the dentition, periodontium, and the salivary gland tissue have been enlisted. Although this article is not all-inclusive, the authors highlight lesions or conditions that are directly related to or are caused by some of the more common systemic diseases, and hope to provide ample insight for physicians, dentists, and clinicians in otolaryngologic practice.

Post-transplant lymphoproliferative disorders of oral cavity

Post-transplant lymphoproliferative disorders (PTLD) are long-term complications of immunosuppression after solid organ/bone marrow transplantation. In most cases, PTLD arises as a result of primary or reactivated Epstein-Barr virus infection in a host with impaired cellular immunity. PTLD is most often seen in the gastrointestinal tract, although it has also been reported in other organ systems, including the central nervous system and, rarely, in the head and neck. It is characterized histologically by abnormal lymphoid cell proliferation. Although many forms of PTLD do not meet all of the histologic criteria of lymphoma, they often behave clinically in a malignant fashion if left untreated. We present 3 rare cases of PTLD manifesting in the oral cavity as mucosal masses after solid organ transplantation. There are only 8 published reports of PTLD in the literature presenting as oral lesions. The clinical, pathologic, and therapeutic spectra of PTLD are discussed.

Labial salivary gland biopsies in Sjögren's syndrome: still the gold standard?

OBJECTIVES The accuracy and diagnostic benefits of the labial salivary gland (LSG) biopsy for Sjögrens syndrome (SS) have received mixed reviews. This study was conducted to assess (1) the inter-rater agreement among 5 pathologists, and (2) the relationship between biopsy findings and clinical disease parameters. STUDY DESIGN Three oral pathologists (OP) and two surgical pathologists (SP) provided independent diagnoses, focus scores, and plasma cell characterizations for 37 LSG biopsies. Inter-rater reliability was assessed using percentage of overall agreement and intraclass correlation coefficients. Relationships between diagnoses and clinical parameters were assessed by nonparametric correlations. RESULTS Overall agreement among the pathologists was poor, although the intra-specialty agreement was good. The ratings of OP were most highly correlated with serological measures, while those of SP were correlated with salivary flow rate and disease damage. CONCLUSION Since the LSG biopsy can be the determining factor in SS diagnoses, these demonstrated inconsistencies merit further consideration.

Report of Two Cases of Combined Odontogenic Tumors: Ameloblastoma with Odontogenic Keratocyst and Ameloblastic Fibroma with Calcifying Odontogenic Cyst.

Combined odontogenic neoplasms have rarely been documented. Such tumors have also been described by other researchers as “hybrid” lesions. The histologic features are often identical to other individually well-established odontogenic neoplasms such as ameloblastoma, adenomatoid odontogenic tumor, ameloblastic fibroma (AF), and ameloblastic fibro-odontoma. Their clinical presentation is variable, ranging from cysts to neoplasms showing varying degrees of aggressive behavior. Most combined tumors contain features of one of the odontogenic tumors in combination with either a calcifying odontogenic cyst (COC) or a calcifying epithelial odontogenic tumor. We present two new cases of combined odontogenic tumors: an ameloblastoma with an odontogenic keratocyst and an AF with COC. Predicting clinical outcome is challenging when a combination tumor is encountered due to the paucity of such lesions. One must understand salient features of these entities and differentiate them from the more common conventional neoplasms to expand classification and provide prognostic criteria.

Colloid milium of the oral cavity: a rare presentation

Colloid milium (CM) is a rare condition characterized by the presence of multiple dome-shaped amber- or flesh-colored papules developing on sun-exposed skin. It is a degenerative condition linked to excessive sun exposure and possibly exposure to petroleum products and hydroquinone. The origin of the colloid deposition in the dermis is uncertain, although it is thought to be due to degeneration of elastic fibers. The condition is rare, with only 100 case reports documented in the world literature. The most commonly involved sites are the face, periorbital region, backs of the hands, back and sides of the neck, and ears. Involvement of the oral cavity is extremely rare. The purpose of this article is to report an extremely rare first case of CM of the oral cavity and to discuss the clinical, pathologic and therapeutic spectra of CM.

Extensively ossifying oral leiomyoma: a rare histologic finding.

AbstractOral leiomyoma are rare neoplasms of the oral cavity. Ossification within leiomyoma is not unusual but is mostly reported in leiomyoma of the deep soft tissue. Ossifying leiomyoma is extremely rare in the head and neck. We identified a total of three cases of extensively ossified leiomyoma in the head and neck in the literature including lesions in the lateral pterygoid muscle and orbit. To the best of our knowledge, only one case of extensively calcified leiomyoma has been reported in the oral cavity. We present two such rare cases of oral leiomyoma with extensive intratumoral calcifications and ossification. Ossified leiomyoma should be considered in the differential diagnosis of calcified or hard/firm soft tissue masses in the oral cavity.

Clinico-Pathologic Conference: Case 3

Clinical PresentationA 52-year old, HIV? homosexual male presented to adental specialist’s office with a 3 week history of painful‘‘gum sores’’ and a white lesion of the right lateral tongue,which appeared 2 weeks after a vacation to the southernUnited States. General physical exam was unremarkablewith vital signs as follows: temperature, 37.1 C; bloodpressure, 116/74 mm Hg; pulse rate, 88 beats/min; andrespiratory rate, 12 breaths/min. Appropriate medical care,including highly active antiretroviral therapy, had beenadministered since his diagnosis with HIV 10 years pre-viously. His current regimen included abacavir/lamivudine,ritonavir and atazanavir. During this period, annual rapidplasma reagin (RPR) titers were non-reactive, including thelatest testing 8 months prior to lesion onset. The patientindicated that he had been diagnosed and treated forsyphilis in 1975, 33 years previously. Recent laboratoryreports indicated an undetectable viral load with a CD4count of 624 cells/mm

Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome

BACKGROUND Radiculomegaly, or root gigantism, is a rare dental abnormality with important clinical implications. It is highly specific for oculo-facio-cardio-dental (OFCD) syndrome, which places dentists at the forefront of diagnosis of this syndrome. Only 1 case of nonsyndromic radiculomegaly has been reported in the literature since the description of OFCD syndrome in 1996. We present the second confirmed, nonsyndromic/nonfamilial case and review the literature for dental treatments in patients with this dental finding. STUDY DESIGN A review of the English language literature was performed in PubMed for patients with radiculomegaly or OFCD syndrome. Teeth affected by radiculomegaly, gender, orodental findings, presence of OFCD syndrome, and dental treatment methods were recorded. RESULTS Sixty-seven cases of radiculomegaly and 92 cases of OFCD syndrome were found in the literature. Only 1 confirmed case of nonsyndromic/nonfamilial radiculomegaly had been reported previously. Ten reports described dental treatment or treatment plan details, and even fewer included specific methods. CONCLUSIONS Because dental anomalies, especially radiculomegaly, are a primary feature of OFCD syndrome, dentists should be aware of the clinical and radiographic features. Radiculomegaly poses a distinct challenge to dentists, and reports of dental therapy provided to these patients are sparse. Early diagnosis of the syndrome may prevent dental challenges and improve prognosis.

STAT6 Reliably Distinguishes Solitary Fibrous Tumors from Myofibromas

Solitary fibrous tumors (SFT) and myofibromas (MF) historically have belonged to the same morphologic spectrum and have been lumped together under the nonspecific umbrella term, “hemangiopericytoma” along with other pericytic/myoid tumors. While current evidence shows clear distinction between the two entities, they frequently remain in the same histopathologic differential diagnosis. This diagnostic dilemma especially is common for smaller incisional biopsies from the oral cavity. STAT6 immunohistochemistry (IHC) recently was established as a reliable method to detect solitary fibrous tumor; however, the literature is sparse regarding STAT6 reactivity in MFs. The authors report ten new cases of oral solitary fibrous tumor, discuss histopathologic similarities and differences between the two tumors, and list respective STAT6 IHC expressivity. After IRB approval, 10 cases diagnosed as SFT and 24 cases of MF were collected from the University of Florida Oral and Maxillofacial Pathology Biopsy Service between the years 1994 and 2016. The original hematoxylin and eosin slides and related IHC were reviewed. IHC with STAT6 antibody was performed on all 34 samples, and the findings were analyzed. All cases were from the oral cavity or perioral regions. 10/10 SFTs expressed STAT6 nuclear reactivity, while no cases of MF showed nuclear expression of STAT6. STAT6 is a dependable marker to differentiate SFTs from MFs.