William M. Carpenter

Adenomatoid hyperplasia of minor salivary glands

Adenomatoid hyperplasia of minor salivary glands is an uncommon clinicopathologic entity. It comprises clinical swelling resembling a neoplasm with a histologic picture of aggregates of normal-appearing salivary gland tissue in excess of that anticipated for the anatomic site. The significance of this lesion is derived from its clinical resemblance to a neoplasm of salivary gland origin. This study adds 40 new cases to the literature and analyzes their clinical and histologic features. Most of the lesions were located on the hard and soft palates. The exact nature of the minor salivary gland hyperplasia is not clear. Some of the cases may represent a hamartoma or a reactive hyperplasia, but in most cases the nature of the hyperplasia is idiopathic.

Treatment of HIV-related hairy leukoplakia with podophyllum resin 25% solution

Ten HIV-infected patients who had bilateral hairy leukoplakia on the tongue were treated with topical podophyllum resin 25% solution. Only one side of the bilateral lesion was treated and the other side served as the control and was not treated. The lesions on both the treatment and control sides were evaluated at day 2, 7, and 30 by an investigator who had not been involved in the initial treatment and had no knowledge of which side had been treated. Therefore the treatment side is compared with the control side in a single-subject design, single-blind control setting. The lesions were judged by the degree of resolution and assigned a number of 0 to 4 with 4 indicating the highest degree of resolution and 0 indicating no resolution or worsening of the condition. The results were analyzed by Students t test. Significant resolution of hairy leukoplakia was noted on the treatment side compared with the control side at the 2-, 7-, and 30-day levels; the 2-day results were the most significant. Furthermore, the patients reported minimal side effects, which included burning sensation, bad or altered taste, and pain, that were of mild intensity and short duration. The side effects were reported to occur immediately after the topical application. Patient tolerance and acceptance were found to be very favorable. No systemic side effect was reported. We conclude that single topical application of podophyllum resin 25% solution is efficacious in producing significant short-term resolution of HIV-related oral hairy leukoplakia. We also conclude that it is a safe topical regimen with minimal side effects.

Anterior lingual mandibular salivary gland defect. Evaluation of twenty-four cases.

Lingual mandibular salivary gland defects in the posterior part of the mandible are not uncommon. Analogous defects in the anterior region, however, are rare, and the four new cases presented in this report bring the total number of reported cases up to 24. The purpose of the present study was to review and analyze the clinical, radiographic, and histologic features of the previously reported cases together with those of the present study. The majority of these defects were located in the cuspid and/or premolar area and were diagnosed in men in their fifth and sixth decades of life. Almost all defects contained normal salivary gland tissue. The differential diagnosis, treatment, and pathogenesis of these defects are discussed.

Central (intraosseous) calcifying odontogenic cyst

The central calcifying odontogenic cyst (CCOC) is an uncommon lesion. The present study reports 17 new cases of CCOC and analyses their clinical and histomorphologic features. The data revealed that CCOC were usually diagnosed in the second decade of life with an almost equal distribution between the maxilla and the mandible. Six of the 17 cases (35%) were associated with odontomas and 6 lesions (35%) were associated with unerupted teeth. Histologically, most of the lesions were unilocular cysts but at least one was multilocular and one was a mixed lesion - partially cystic and partially solid. Excision with long-term follow-up (up to 10 years) is the treatment of choice.

Classic neurothekeoma (nerve sheath myxoma) and cellular neurothekeoma of the oral mucosa: immunohistochemical profiles

BACKGROUND Classic neurothekeoma (nerve sheath myxoma) is regarded as being a true benign cutaneous tumor of nerve sheath origin. Cellular neurothekeoma was separated from the classic type by histogenesis, morphology and immunophenotype. Whether cellular neurothekeoma represents a continuum within the spectrum of classic neurothekeoma or is an independent entity is controversial. Only a small number of classic neurothekeomas of the oral mucosa have been reported and there are even fewer publications on cellular neurothekeoma. We analyzed a series of oral neurothekeomas (classic and cellular) with a panel of neural and other mesenchymal markers to enhance their diagnosis and classification. METHODS One cellular and three classic neurothekeomas were submitted to a panel of immunohistochemical stains with antibodies against S100, S100A6, NSE, NKI/C3, PGP9.5, α-SMA, HHF-35, CD68 and vimentin. Two cases of neurofibroma (plexiform type), representing a true lesion of neural origin, served as control. RESULTS The cellular neurothekeoma yielded a positive immunoreaction for S100A6 and NKI/C3 and a negative immunoreaction for S-100. The classic neurothekeomas demonstrated a positive reaction for S-100 and S100A6, but a negative one for NKI/C3. Other markers were non-contributory to distinguishing between these types of lesions. CONCLUSIONS The small number of reported oral neurothekeomas (classic and cellular) could be due, in part, to the lack of recognition of their particular morphologic and immunohistochemical features. Our results indicate that testing for NKI/C3 immunoreactivity may be of value in distinguishing between cellular and classic neurothekeoma.

Histopathologic effects of kinetic cavity preparation for the removal of enamel and dentin

Recent developments in technology, direct placement restorative materials, and cavity preparation design have renewed interest in kinetic cavity preparation, a term to describe the use of air-abrasion for removal of tooth structure. This study compared the pulpal response of 120 teeth in mixed-breed dogs treated with four kinetic cavity preparation combinations of pressure (80 psi and 160 psi) and aluminum oxide particle sizes (27 microns and 50 microns) to those treated with high-speed rotary burs. Class V buccal preparations were made and restored with an interim material. Teeth were collected 72 hours after surgery, decalcified, sectioned, stained with hematoxylin and eosin, and blindly evaluated by two examiners at the minimal dentin thickness. Samples were graded for extent of displacement, disruption, inflammation, and necrosis of pulpal structures. Differences between groups were analyzed with the use of Bonferroni-adjusted multiple Mann-Whitney-Wilcoxon tests with p < 0.05 being significant. Higher pressures and smaller particles yielded significantly fewer pulpal effects than the high-speed treated teeth whereas lower pressures and larger particles were not significantly different for most effects evaluated. No adverse soft tissue effects were noted when kinetic cavity preparation was directed at attached gingiva.

Reactivity of monoclonal antibodies 17.13 and 63.12 with oral epithelial dysplasia and hyperkeratosis

Monoclonal antibodies (MAbs) 17.13 and 63.12 exhibit characteristic reactivity patterns in normal stratified squamous epithelium, as well as highly sensitive and specific altered reactivity patterns in squamous cell carcinoma. The purpose of this study was to critically evaluate the patterns of reactivity of MAbs 17.13 and 63.12 in 43 biopsies of clinical oral leukoplakia or erythroleukoplakia with microscopic diagnoses of hyperkeratosis or epithelial dysplasia. Altered carcinoma-like reactivity patterns were seen in 72% of hyperkeratoses and in all cases of epithelial dysplasia, but varied in the level of epithelial strata exhibiting altered reactivity. Increased frequency of altered reactivity within the epithelial strata was associated with the presence, but not the grade of, epithelial dysplasia, as well as with the presence, intensity; and pattern of submucosal inflammation. The results of this study suggest that altered reactivity patterns of MAb 17.13 are associated with epithelial dysplasia and may be of assistance in detecting precancerous changes in hyperkeratoses before morphologically identifiable epithelial dysplasia. The association of submucosal inflammation with altered MAbs 17.13 and 63.12 reactivity may indicate either a decrease in specificity of these antibodies for precancerous change or an increased significance of inflammation in precancerous lesions.