Seamus S. Napier

Strawberry gums: a clinicopathological manifestation diagnostic of Wegener's granulomatosis?

AIMS--To highlight an uncommon but characteristic gingival lesion associated with Wegeners granulomatosis, emphasising the presence of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells; and the paucity of the currently accepted histopathological criteria of Wegeners granulomatosis--namely necrosis, vasculitis, and granulomata. METHODS--The histopathological features of a gingival biopsy specimen from a case of Wegeners granulomatosis limited to the upper aerodigestive tract in a 36 year old woman were compared with those of 14 similar reported cases. RESULTS--Pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells were recorded as present in almost all cases of gingival Wegeners granulomatosis. Necrosis, vasculitis, and granuloma formation were present in only a few cases. CONCLUSIONS--The combination of pseudoepitheliomatous hyperplasia, microabscesses, and multinucleate giant cells in a gingival biopsy specimen from erythematous, swollen gums, clinically resembling over-ripe strawberries, in a patient with a severe systemic upset, is so typical of Wegeners granulomatosis as to be virtually diagnostic. Recognition of this characteristic lesion may aid early diagnosis and treatment in cases where other diagnostic variables are absent.

'Strawberry gums' - a case of Wegener's granulomatosis

We report a case of Wegeners granulomatosis (WG), localised to the upper aerodigestive tract, which presented as an unusual form of hyperplastic gingivitis in a 36-year-old female. The clinical, serological and histopathological findings are described. The resemblance of the affected gums to over-ripe strawberries is emphasised, in order to draw attention to this characteristic oral manifestation of a rare and potentially life-threatening condition. The response to co-trimoxazole as sole therapy is noted

Concordance between digital pathology and light microscopy in general surgical pathology: A pilot study of 100 cases

Aim (1) A pilot study to determine the accuracy of interpretation of whole slide digital images in a broad range of general histopathology cases of graded complexity. (2) To survey the participating histopathologists with regard to acceptability of digital pathology. Materials and methods Glass slides of 100 biopsies and minor resections were digitally scanned in their entirety, producing digital slides. These cases had been diagnosed by light microscopy at least 1 year previously and were subsequently reassessed by the original reporting pathologist (who was blinded to their original diagnosis) using digital pathology. The digital pathology-based diagnosis was compared with the original glass slide diagnosis and classified as concordant, slightly discordant (without clinical consequence) or discordant. The participants were surveyed at the end of the study. Results There was concordance between the original light microscopy diagnosis and digital pathology-based diagnosis in 95 of the 100 cases while the remaining 5 cases showed only slight discordance (with no clinical consequence). None of the cases were categorised as discordant. Participants had mixed experiences using digital pathology technology. Conclusions In the broad range of cases we examined, digital pathology is a safe and viable method of making a primary histopathological diagnosis.

p53, Cyclin D1, p21 (WAF1) and Ki-67 (MIB1) Expression at Invasive Tumour Fronts of Oral Squamous Cell Carcinomas and Development of Local Recurrence

BACKGROUND Expression of p53, cyclin D1, p21 (WAF1) and Ki-67 (MIB1) was evaluated in oral squamous cell carcinoma (OSCC) to test whether levels of these markers at invasive tumour fronts (ITFs) could predict the development of local recurrence. MATERIALS AND METHODS Archived paraffin-embedded specimens from 51 patients with T1/T2 tumours were stained immunohistochemically and analysed quantitatively. Local recurrence-free survival was tested with Kaplan-Meier survival plots (log-rank test) using median values to define low and high expression groups and with a Coxs proportional hazards model in which the expression scores were entered as continuous variables. RESULTS The assessment of expression of all markers was highly reliable, univariate analysis showing that patients with clear surgical margins, with low cyclin D1 and high p21 expression at the ITF had the best local recurrence-free survival. Multivariate analysis showed that these three parameters were independent prognostic factors but that neither p53 nor MIB1 expression were of prognostic value. CONCLUSIONS Assessment of p53, cyclin D1, p21 (WAF1), and Ki-67 (MIB1) at the ITF could help to predict local recurrence in early stage oral squamous cell carcinoma cases.

Nasal Cavities and Paranasal Sinuses

This chapter outlines the anatomy, clinical presentation, and relevant clinical investigations. Details of both non-neoplastic and neoplastic pathological conditions affecting this organ site are given. Clinical considerations in obtaining the diagnostic biopsy and therapeutic resection specimens are outlined, with details of their handling and dissection in the histopathology laboratory. This is correlated with relevant histopathology reports, giving summary core prognostic and patient management items. Current WHO and TNM classifications are referenced.

Case report: Getting it taped

Sir, a 16-year-old female, who was originally from East Timor, presented at the Oral Surgery Department of the Royal Victoria Hospital in Belfast, having moved to Northern Ireland when she was 7 years old. She had been referred by her general medical practitioner regarding a lump in her lower lip. This was painless, and had been present for approximately 9 years with no fluctuation in size noticed by the patient. She had no relevant past medical history. Examination revealed a well circumscribed submucosal swelling at the inner aspect of the left side of her lower lip, which was approximately 1 cm in diameter. The lump was firm in texture with normal overlying mucosa, and appeared blue in colour when pressed towards the mucosal surface of the lip. No other abnormalities were noted. The lesion was excised under local anaesthetic. Histopathological examination revealed a cysticercus cyst consistent with a cestode (tapeworm) parasitic infection, following the ingestion of tapeworm eggs (Fig. 1). The patient was referred to the infectious diseases department of the hospital, whereupon in light of the fact that she displayed no other manifestations of tapeworm infection she was discharged without further intervention but advised to recontact if further symptoms arose. Her lip healed well, and she was also discharged from the Oral Surgery Department. Cysticercosis is particularly prevalent in Latin America, sub-Saharan Africa, and Southeast Asia but the incidence in western countries is rising in line with increased international travel and immigration.1,2 The likelihood is that this patient contracted the condition before she moved to Northern Ireland. We can find no previous reports of cysticercosis affecting the oral cavity being diagnosed in this country. We would like to highlight the possibility of cysticercosis as a differential diagnosis when considering oral submucosal swellings, particularly in patients who have lived in areas of the world where the condition is prevalent. J. Smyth, V. Adams and S. Napier, Belfast

Maxilla, Mandible, and Teeth

This chapter outlines the anatomy, clinical presentation, and relevant clinical investigations. Details of both non-neoplastic and neoplastic pathological conditions affecting this organ site are given. Clinical considerations in obtaining the diagnostic biopsy and therapeutic resection specimens are outlined, with details of their handling and dissection in the histopathology laboratory. This is correlated with relevant histopathology reports, giving summary core prognostic and patient management items. Current WHO and TNM classifications are referenced.

Neck: Cysts, Tumors, and Dissections

This chapter outlines the anatomy, clinical presentation, and relevant clinical investigations. Details of both non-neoplastic and neoplastic pathological conditions affecting this organ site are given. Clinical considerations in obtaining the diagnostic biopsy and therapeutic resection specimens are outlined, with details of their handling and dissection in the histopathology laboratory. This is correlated with relevant histopathology reports, giving summary core prognostic and patient management items. Current WHO and TNM classifications are referenced.

Pharynx and Larynx

This chapter outlines the anatomy, clinical presentation, and relevant clinical investigations. Details of both non-neoplastic and neoplastic pathological conditions affecting this organ site are given. Clinical considerations in obtaining the diagnostic biopsy and therapeutic resection specimens are outlined, with details of their handling and dissection in the histopathology laboratory. This is correlated with relevant histopathology reports, giving summary core prognostic and patient management items. Current WHO and TNM classifications are referenced.

Lips, Mouth, and Tongue

This chapter outlines the anatomy, clinical presentation, and relevant clinical investigations. Details of both non-neoplastic and neoplastic pathological conditions affecting the lips, mouth and tongue are given. Clinical considerations in obtaining the diagnostic biopsy and therapeutic resection specimens are outlined, with details of their handling and dissection in the histopathology laboratory. This is correlated with relevant histopathology reports, giving summary core prognostic and patient management items. Current WHO and TNM classifications are referenced.