A Retrospective Case Review of Soft Tissue Oral Malignancies & Associated Clinicopathologic Features (1991-2016)

Intraoral soft tissue masses can clinically present as benign, premalignant, or malignant lesions. Variability in presentation of soft tissue masses bear the possibility of misdiagnosis not only by general dentists but also by specialists. After a differential diagnosis is formulated, histopathologic evaluation is essential for establishing a definitive diagnosis. Neoplastic oral lesions in their early stages are subtle, which can make diagnosis challenging. Dentists play a vital role in the prevention of oral malignancy by early detection, and a thorough understanding of the diagnostic features. However, as most intraoral pathology is benign, clinicians frequently do not include malignancy in their differential diagnosis for soft tissue masses.1 The aim of this study is to emphasize the need of for histologic diagnosis of seemingly benign soft oral lesions as the clinical impression may not be accurate.2-6 It is hypothesized that there will be a large number (~5%) of false negative diagnoses. Cases in which the clinical diagnosis is a benign entity (e.g. fibroma or pyogenic granuloma) but, upon histologic confirmation the pathologic diagnosis of a malignant soft tissue mass. We will also identify which clinical features (i.e. size, color, or clinical differential diagnoses) were most commonly diagnostic pitfalls. The purpose of the study is to elucidate the features most commonly associated with malignancy

Molecular and Genetic Aspects of Odontogenic Lesions

In this article we outline the molecular findings of select odontogenic tumors. In each section, we briefly review selected the clinicoradiographic, histologic, immunologic features, focusing on the molecular findings and their applications in practice. The understanding of molecular pathobiology at various other organ sites has developed quite rapidly in recent years, however much remains unknown about the genetic profile of odontogenic tumors. Improved understanding of mutations in odontogenic tumors may clarify classification schema and elucidate targets for novel therapies. Molecular testing will no doubt improve our understanding of odontogenic tumor pathogenesis and will likely be, someday, an important component of routine clinical practice and its role will only increase in the coming years

Evaluation of a Technique to Trap Lemmings Under the Snow

We attempted to live trap lemmings under the snow in their preferred winter habitat at two sites in the Canadian Arctic using chimney-like boxes. Lemmings used the boxes during winter, but we had very low trapping success in April and May. During spring trapping, in contrast to most of the winter, subnivean temperatures became colder than ambient air temperatures. We hypothesize that our low success in spring resulted from lemmings’ leaving the deeper snow areas where our boxes were located and moving to shallower snow or exposed tundra. We suggest that the trapping boxes could be successful if trapping occurred earlier during winter.Nous avons tenté de capturer des lemmings sous la neige dans leur habitat hivernal préféré en utilisant des boîtes en forme de cheminée à deux sites situés dans l’Arctique canadien. Les boîtes ont été utilisées par les lemmings durant l’hiver mais nous avons eu un très faible succès de capture en avril et mai. Contrairement à la majorité de l’hiver, les températures sous-nivales étaient plus froides que les températures de l’air pendant que nous avons trappé au printemps. Nous émettons l’hypothèse que notre faible succès au printemps est dû au déplacement des lemmings des sites de fort enneigement, où nos boîtes étaient installées, vers ceux de faible enneigement ou vers la toundra exposée. Nous suggérons que les boîtes de trappage pourraient être plus utiles si le trappage se faisait plus tôt au courant de l’hiver

Balancing the Cost of Leaving with the Cost of Living: Drivers of Long-Term Retention of Health Workers: An Explorative Study in Three Rural Districts in Eastern Uganda

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits

A Case of Recurrent Multifocal Central Giant Cell Granulomas

One case of recurrent multifocal central giant cell granulomas (CGCG) is presented. Initially, the lesions presented concurrently in the maxilla and mandible with subsequent recurrence in the mandible. Now, two recurrences are seen in the maxillary sinus and ethmoid region. The literature regarding multifocal CGCG is reviewed

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma: Report of a case in the oral cavity

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (DLBCL/BL) is a new category of B-cell lymphoma according to the 4 th edition of the World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues (2008). The following report presents a case of this rare, newly described entity on the palate of a 59 year-old male

Evaluation of SOX2 as a potential marker for ameloblastic carcinoma

ObjectiveAmeloblastic carcinoma often poses diagnostic challenges in its separation from benign ameloblastoma with atypical cytologic features or an unusual clinical course. This study aimed to determine whether SOX2 (sex determining region-Y-related high mobility group box 2), a protein expressed in the epithelial basal proliferative zone in dentigerous cysts, is a marker for ameloblastic carcinoma as well as for high-grade transformation in ameloblastic neoplasms.Study DesignImmunoperoxidase stains were performed according to a standard protocol. Immunostains were interpreted independently by 3 pathologists, and scores were recorded based on the percentage of staining and intensity of staining in the cells of interest.ResultsThe diffuse strong nuclear staining pattern has 86.4% specificity (19 of 22) to indicate the presence of high-grade features and has 76.9% sensitivity (10 of 13) in comparison with benign counterparts (P = .0021). Although previously shown as a marker for ameloblastic neoplasms, calretinin is weakly positive in a few cells in 50% (5 of 10) of ameloblastic carcinoma and 43% (3 of 7) of benign ameloblastic neoplasms, with little value in highlighting the high-grade change (P = .36).ConclusionsThe diffuse nuclear staining pattern of SOX2 is suggestive of a high-grade process in ameloblastic neoplasms. Numerous aggregates of cells harboring dense nuclear stain should raise concern for a malignancy