Sarah G. Fitzpatrick

The association between periodontal disease and cancer: A review of the literature

OBJECTIVES Periodontal disease has long been linked to many systemic diseases, and recently a link between periodontal disease and cancer has been established. The purpose of this paper is to review the literature to explore the evidence to date of a relationship between periodontal disease and cancer. In addition, the main hypotheses for the association are discussed along with challenges in evaluating the evidence. DATA/SOURCES/STUDY SELECTION In this review, English-language papers studying the relationship between periodontal disease or tooth loss in humans and increased risk of several types of cancers along with overall cancer risk between 1990 and April 2009 were reviewed. CONCLUSIONS The most consistent increased risk was noted in studies of oral and esophageal cancers and periodontal disease. Gastric and pancreatic cancers had an association in most but not all studies. Lung, prostate, hematologic and other cancers were less consistently associated or did not have sufficient studies to determine a predictable pattern. Studies to date indicate a positive correlation between several forms of cancer and periodontal disease.

The clinical and histologic presentation of gingival squamous cell carcinoma: a study of 519 cases

OBJECTIVES Gingival squamous cell carcinoma (SCCA) often presents with benign features, which may lead to delay in treatment. This study describes the clinical and histologic characteristics of a series of gingival SCCA cases. STUDY DESIGN A retrospective consecutive case review was performed using the University of Florida College of Dentistry Biopsy services database, which yielded clinical and histologic information on 519 cases of gingival SCCA. RESULTS The average age of affected patients was 72.3 years. The most common site was the mandibular posterior gingiva. Approximately 72% of lesions were present for >2 months at biopsy. The majority of clinicians considered a malignancy in their differential diagnosis (64%), although 15% considered only reactive lesions. Most of the carcinomas presented as exophytic masses and, histologically, were moderately differentiated. CONCLUSIONS Gingival SCCA may present with varied clinical and histologic appearances and should be considered in the differential diagnosis of benign appearing lesions of the gingiva.

Histologic Lichenoid Features in Oral Dysplasia and Squamous Cell Carcinoma

OBJECTIVE This study describes the occurrence of histopathologic characteristics of oral lichenoid mucositis in epithelial dysplasia and squamous cell carcinoma. STUDY DESIGN This retrospective review examined 352 histologic specimens of group 1 (mild to moderate dysplasia), group 2 (severe dysplasia or carcinoma in situ), and group 3 (squamous cell carcinoma) for correlation between 5 histologic characteristics frequently found in oral lichen planus and grade, age, gender, and oral subsite. RESULTS In this sample, 29% of all cases exhibited 3 or more lichenoid features. Lichenoid features were significantly more frequent in group 1 over group 2 lesions for cases meeting a minimum lichenoid threshold (P = .001). No statistically significant patterns were noted for age or gender. The buccal mucosa was significantly overrepresented (P = .039) and the floor of the mouth was significantly underrepresented (P = .049) in regard to lichenoid feature frequency. CONCLUSIONS This study confirms the frequent correlation of lichenoid characteristics in oral premalignant and malignant lesions.

Nasal Sinus Leiomyosarcoma in a Patient with History of Non-Hereditary Unilateral Treated Retinoblastoma

Hereditary patients with a history of treated retinoblastoma (RB) have a greatly increased risk of a broad spectrum of secondary malignancies appearing many years later, with a high incidence in the head and neck region. Leiomyosarcomas (LMS) account for up to 58% of these tumors. LMS in the sinonasal region generally are uncommon and are associated with a locally aggressive course and have a poor prognosis. RB may occur in two forms. The hereditary form is generally bilateral but can present unilaterally with a positive family history and typically exhibits a germline mutation in the RB1 gene on chromosome 13. The non-hereditary form is usually unilateral but can show the same germline mutation in up to 10% of cases. Patients with hereditary RB have been shown to have a significantly higher cumulative risk of developing secondary malignancies than those with the non-hereditary form (28 vs. 1.44% respectively). Most reported cases of sinonasal LMS are in patients with a history of the bilateral hereditary form of treated RB. We report a case of LMS of the nasal sinus area in a 35-year-old African American male with a history of non-hereditary unilateral RB and radiation therapy. To the best of our knowledge, this is the first reported case of sinonasal LMS arising in a patient with a history of non-hereditary unilateral RB. The clinical history, radiology, and pathology are presented along with a brief discussion of the literature.

Ameloblastic carcinoma with features of ghost cell odontogenic carcinoma in a patient with suspected Gardner syndrome

Ameloblastic carcinoma and ghost cell odontogenic carcinoma are rare malignancies arising in odontogenic epithelium within the jaws. Gardner syndrome is a multifaceted autosomal dominant condition, which results in multiple dentofacial anomalies along with premalignant colon polyp formation and tumor formation in the skin and other organs. We report a case of ameloblastic carcinoma with features of ghost cell odontogenic carcinoma and extensive clear cell change and melanin pigmentation in a patient with clinical features of Gardner syndrome. To the best of our knowledge, odontogenic carcinoma arising in a patient with features of Gardner syndrome has not been reported previously. The clinical, radiographic, and histologic features of the case are discussed along with a review of the relevant literature.

Autoimmune Disease Manifestations in the Oral Cavity

Immune-related disorders of the oral cavity may occur as primary disease process, secondary to systemic disease or neoplasm, or as a reaction to medications and other agents. The entities represented within this group may vary significantly by severity, clinical presentation, microscopic presentation, and special testing results. The selected immune-related conditions of the oral cavity in this article are categorized and presented by their prototypical tissue reaction patterns: vesiculobullous, including acantholytic and subepithelial separation; psoriasiform; spongiotic; and lichenoid reaction patterns.

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.

Benign Non-neoplastic Lesions of the Head and Neck

This chapter continues the previous chapter’s discussion of the DAMIEN mnemonic concept for formulating a differential diagnosis of pathology of the head and neck. The categories to be discussed are Developmental, Allergy or immunologic, Metabolic or systemic, Infectious, and Environmental. Neoplastic benign conditions were discussed in the prior chapter, and malignant neoplastic conditions are discussed elsewhere in this book. In each category, pathologic entities or conditions common to multiple sites in the head and neck are discussed, followed by discussion of examples of pathology characteristic to several different locations in the head and neck.

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.

Clear cell changes in salivary gland neoplasms: a 20-year retrospective study

Background Clear cells are observed histopathologically in both benign and malignant neoplasms but their presence in salivary gland tumors has not been extensively documented. Material and Methods With IRB approval, the archive of the University of Florida College of Dentistry oral pathology biopsy service was retrospectively searched from 1994-2014 for all benign and malignant salivary tumors. Epidemiological data, tumor location and duration, and type of tumor were recorded. A four reviewer panel examined the original slides. Reviewers scaled each case as 0 (no clear cells present), 1 (few to focal clear cells), 2 (less than 50% clear cells), and 3 (greater than 50% clear cells). Results A total of 535 cases were included of which 48% of tumors displayed 0 clear cells (257/535), 31.4% (168/535) scored 1, 13.6% (73/535) scored 2, and 7% (37/535) scored 3. Of the 251 (47%) malignant neoplasms, 64% (160/251) demonstrated 0-1 clear cell change, while 36% (91/251) showed a score of 2-3. For the total 284 (53%) benign tumors, 93% (265/535) scored 0-1 and 7% (19/535) scored a 2-3 range. No statistical difference was noted for gender, age, or duration of time present in regards to presence or absence of clear cells. Statistically significant differences in clear cell presence were found between location groups, between benign and malignant diagnosis, and between specific diagnostic groups. Conclusions This study demonstrates the frequent presence of increased numbers of clear cells in oral salivary malignancies and highlights salivary gland differential diagnoses when presented with clear cell changes. Key words:Clear cell change, salivary tumors, benign tumors, malignant tumors.