Steven D. Budnick

Compound and complex odontomas

One hundred forty-nine cases of odontoma were reviewed: sixty-five cases were accepted from the literature, and eighty-four additional cases were included from the files of the Pathology Department of the Emory University School of Dentistry. The cases were combined and analyzed together. Odontomas are most often diagnosed in the second decade of life. Sixty-five per cent of all odontomas occur in the maxilla. Compound odontomas are more common in the anterior maxilla, whereas complex odontomas occur more frequently in the posterior jaws. A slight predominance in males was seen. The most common presenting symptom was an impacted tooth with retention of deciduous teeth.

Ameloblastic fibrosarcoma of the jaws. A clinicopathologic and DNA analysis of five cases and review of the literature with discussion of its relationship to ameloblastic fibroma.

Ameloblastic fibrosarcoma, the malignant counterpart of the ameloblastic fibroma, is a rare odontogenic tumor characterized by benign epithelium and a malignant fibrous stroma. We have compared nuclear DNA content of five ameloblastic fibrosarcomas and three ameloblastic fibromas by image analysis. The three ameloblastic fibromas were diploid, whereas 1 of 5 ameloblastic fibrosarcomas was aneuploid. There was no correlation with histologic grade and aneuploidy. These five new cases were also added to a review of the literature, bringing the total cases of reported ameloblastic fibrosarcomas to 51. The ameloblastic fibrosarcoma occurs at a later age (mean, 27.5 years) compared with reported ameloblastic fibromas (mean, 14.6 to 22 years), which supports a step-wise malignant transformation. There was histologic documentation that 44% of ameloblastic fibrosarcomas developed in ameloblastic fibromas. In view of this data and of the reported cumulative recurrence rate of 18.3% for ameloblastic fibroma, it is recommended that ameloblastic fibromas be treated with complete surgical excision and long-term follow up rather than simple curettage or enucleation.

Leiomyosarcoma of the maxilla: Report of a case and review of the literature☆

Abstract Primary malignant smooth-muscle tumors of bone have rarely been reported. A review of the literature has yielded only nineteen cases. The light microscopic features and ultrastructural findings of an additional case of leiomyosarcoma of the maxilla are added. The age, sex, and site distributions of primary leiomyosarcomas of bone are examined.

Intraoral molluscum contagiosum

Molluscum contagiosum (MC) presenting as a self-limiting disease of the skin is not uncommon. To date, however, documented cases of MC of the oral cavity have been rare. A case of MC of the palate of a 52-year-old man is reported. The clinical and histopathologic features of this uncommon oral lesion are discussed, and the literature is reviewed.

Expression patterns of epithelial differentiation Antigens and lectin-binding sites in ameloblastomas: A comparison with basal cell carcinomas

Whether the peripheral ameloblastoma (PA) and intraoral basal cell carcinoma (BCC) are two different clinical entities or essentially the same lesion still remains unresolved. The immunophenotypes of neoplastic cells of peripheral and intraosseous ameloblastomas, ameloblastic carcinomas, and BCCs were studied using a panel of monoclonal/polyclonal antibodies and lectins. The major cytokeratins (CKs) of neoplastic cells of ameloblastomas were CKs 5 and 14, whereas co-expression of CKs 8, 18, and 19 was observed in the cells of the stellate reticulum-like areas. Metaplastic squamous and keratinizing cells found in follicular and acanthomatous variants of ameloblastomas expressed CKs 1 and 10, involucrin, and binding sites for the lectins Ulex europeaus agglutinin I and Helix pomatia agglutinin. beta 2-Microglobulin was uniformly negative in all cases of ameloblastomas and ameloblastic carcinomas studied. Cutaneous BCCs also demonstrated similar reactive patterns with the above-mentioned antigens. The most striking feature is the presence of a peritumorous band-like peanut agglutinin staining found in both BCCs and PAs but not in intraosseous ameloblastomas. This unique peanut agglutinin staining pattern of PA may be diagnostically useful for its histopathologic distinction from an intraosseous ameloblastoma that has infiltrated the soft tissue. The neoplastic cells of ameloblastomas express markers of less-differentiated epithelial cells. Despite differences in epithelial origins, PAs are tumors analogous to cutaneous BCCs.

T-Cell Receptor Gene Rearrangement and CD30 Immunoreactivity in Traumatic Ulcerative Granuloma With Stromal Eosinophilia of the Oral Cavity

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative lesion of the oral mucosa with unknown pathogenesis. A few recent case reports have demonstrated molecular evidence of T-cell clonality in TUGSE and CD30 immunoreactivity in the large atypical mononuclear cells, raising the possibility that a TUGSE subset may represent the oral counterpart of primary cutaneous CD30+ T-cell lymphoproliferative disorders. We examined the immunoreactivity for CD30 and T-cell receptor (TCR) gamma gene rearrangement in 37 TUGSE cases. Clonal TCR gene rearrangements were demonstrated in 7 (24%) of 29 cases with amplifiable DNA, and the morphologic features and CD30 immunoreactivity of these cases did not differ from those with polyclonal TCR gene rearrangements. Clinical follow-up was available for 5 of 7 TUGSE cases with clonal TCR gene rearrangement for an average period of 1.75 years after the initial biopsy or excision, and there was no evidence of local recurrence or development of systemic T-cell lymphoproliferative disorder. Without morphologic and/or clinical evidence of lymphoma, T-cell clonality and/or CD30 positivity in these lesions is not indicative of malignancy and should be interpreted with caution.

Multiple cutaneous leiomyomas: Report of a case

Multiple cutaneous leiomyomas usually appear as painful nodules of the skin. Historically these have been treated by surgical excision, however, because they are often numerous, surgery may be an impractical approach. This article reports on a patient with multiple leiomyomas of the face treated by excision as well as a discussion of alternative treatments such as pharmacologic agents that may be used when surgical excision is not feasible.

The future of oral and maxillofacial pathology.

The future of oral and maxillofacial pathology* John M. Wright, DDS, MS, Steven D. Vincent, DDS, MS, Susan Muller, DMD, MS, Kenneth D. McClatchey, DDS, MD, Steven D. Budnick, DDS, and Valerie A. Murrah, DDS, MS, Dallas, Tex; Iowa City, Iowa; Atlanta, Ga; Maywood, Ill; and Chapel Hill, NC BAYLOR COLLEGE OF DENTISTRY, UNIVERSITY OF IOWA, EMORY UNIVERSITY, LOYOLA UNIVERSITY, AND UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL