Robert Kelsch

Polymorphous low-grade adenocarcinoma: Flow cytometric, p53, and PCNA analysis

Polymorphous low-grade adenocarcinoma of minor salivary glands (terminal duct carcinoma, lobular carcinoma) was first defined more than a decade ago. A 17% recurrence rate and a 9% metastasis rate have been reported. Fifteen formalin-fixed, paraffin-embedded archival cases were analyzed. Ploidy and proliferative activity were evaluated with flow cytometric analysis. Demonstration of an abnormal p53 gene product and proliferative cell nuclear antigen analyses were also performed with routine immunohistochemical procedures. The purpose of this investigation was to evaluate these parameters and determine if a correlation existed. Flow cytometry was performed on 10 cases; 3 showed an aneuploid cell line (mean, S-phase diploid tumor cells 5.9%; S-phase aneuploid 26.7%). Products of a mutation of the p53 tumor suppressor gene have been noted to accumulate in salivary gland tumors, both benign and malignant. Qualitative assessment revealed p53 positive staining in 4 of 15 tumors; positive cells comprised 5% to 10% of the tumor. The percentage of tumor cells positive for proliferative cell nuclear antigen staining ranged from 0.5% to 70%. There was no correlation between proliferative activity as determined by proliferative cell nuclear antigen when compared with results of flow cytometric analysis except for one case that exhibited p53 staining, a 26% proliferative cell nuclear antigen fraction, and a distinct aneuploid cell line.

Gingival squamous cell carcinoma in adolescence

Squamous cell carcinoma (SCC) is a rare finding in the adolescent population, with most cases occurring in patients with underlying heritable diseases or immunologic conditions. Moreover, the incidence of oral SCC in this age group is extremely low. While isolated cases of adolescent oral SCC have been documented, most have been primary tongue or lip lesions. We report 4 cases of gingival SCC occurring in otherwise healthy adolescent patients. The preliminary clinical impressions ranged from factitial injury to inflammatory tissue. Microscopic similarities, including overlap with pseudoepitheliomatous hyperplasia and keratoacanthoma, were seen. Review of the literature indicates that adolescent gingival SCC is extremely rare and a challenging diagnosis for the clinician and pathologist alike. Diagnostic pitfalls, possible etiologic factors, and the prognostic outlook of this condition are discussed.

Desmoplastic fibroma of the anterior maxillary alveolus.

A 44-year-old woman was referred to the oral and maxillofacial surgery division at Montefiore Medical Center by a referring dentist for consultation regarding implants in the anterior maxilla. The patient had previously been seen at our institution approximately 10 years earlier and had the upper right lateral incisor to the upper left lateral incisor extracted and a biopsy specimen taken that had been reported as a radicular cyst with associated necrotic teeth. The specimen from that biopsy was reviewed and confirmed. The patient had a history of type 2 diabetes and depression, both of which had been treated with daily medication. She had no known drug allergies. The intraoral examination showed a diffuse palatal swelling posterior to the edentulous ridge of the anterior maxilla, anterior to tooth 11. The swelling measured approximately 2 2.5 cm, was firm to the touch, and had normal-appearing mucosa overlying it. The patient did not have any pain, paresthesia, or lymphadenopathy. An i-Cat (Imaging Sciences International, Hatfield, PA) cone-beam computed tomography scan showed a destructive radiolucent lesion of the anterior maxillary alveolus that did not involve the nasal cavity or maxillary sinus (Figs 1, 2). With the patient under intravenous sedation, a fullthickness mucoperiosteal flap was elevated in the buccal vestibule. A firm, rubbery, tan mass was identified. Tissue samples were taken and sent in 10% formalin for

Malignant Ameloblastoma: A Case Report of a Recent Onset of Neck Swelling in a Patient With a Previously Treated Ameloblastoma

A 41-year-old black man presented to the Montefiore edical Center in 1990 with a chief complaint of a “bump n my gums.” The patient reported the lesion to be of everal months in duration and denied any paresthesia or ain. His medical history was significant for tuberculosis, or which he stated that he was treated with appropriate ntibiotic therapy. Upon examination, an indurated expanion was noted lingual to the mandibular central incisors ith intact overlying mucosa, and a periapical radiolucency as present. The radiolucency was enucleated via a stanard intraoral approach, and the tissue submitted for histoathology was consistent with a radicular cyst. He was ubsequently lost to follow-up. Six years later, in March 1996, the patient returned to the ffice with a recurrent gingival swelling. Clinical evaluation evealed a 5-mm bony dehiscence lingual to the lower right ateral incisor and canine with an associated bluish soft issue swelling. The anterior mandibular teeth had Class I obility with no signs of infection. The panoramic radioraph demonstrated a well-defined multilocular radioluency that extended from the lower left canine to the right econd premolar. An incisional biopsy was performed and