Proliferative Verrucous Leukoplakia of the Gingiva: An Early Lesion Refractory to Surgical Excision

This report describes a case of proliferative verrucous leukoplakia (PVL) of the gingiva with no discernible aetiology, which presented in a 36-year-old female. The initial nonscrapable gingival lesion was treated with CO2 laser ablation, and the histopathological evaluation was carried out. The presence of koilocytic cells in the superficial epithelium led to immunohistochemical investigations with p16 antibody, which showed strong nuclear positivity and slight cytoplasmic positivity in >50% of the cells with >25% confluency. However, it was not possible to confirm the presence of HPV infection with further investigations due to logistic reasons. The lesion recurred twice within a short time despite the surgical resection following the first recurrence. Thus, this paper presents a case of proliferative verrucous leukoplakia, which demonstrated a significant resistance to routine treatment protocols recommended in the management of such lesions

A Peripheral Dentinogenic Ghost Cell Tumor With Immunohistochemical Investigations and a Literature Review-Based Clinicopathological Comparison Between Peripheral and Central Variants

The aim of the study was to present a peripheral dentinogenic ghost cell tumor (DGCT) and to describe clinicopathological differences between peripheral and central variants of the tumor using a selected literature review. The case report is based on a swelling present on the alveolar ridge of a 74-year-old edentulous denture wearer. The lesion was diagnosed as a peripheral DGCT after excluding the presence of a central lesion. Immunohistochemical investigations revealed similar cytokeratin expression pattern, with CK14 and MNF116 positivity in both the tumor and the surrounding surface epithelium. However, in contrast, CK19 expression was restricted to less than 5% of the tumor cells. A clinicopathological comparison was compiled using 30 cases of peripheral DGCTs (including the present lesion) and 16 cases of central DGCTs published over a period of 40 years. Accordingly, peripheral lesions were more often found in elderly denture wearers, in relation to mandibular gingiva and alveolar mucosa. None of the lesions had recurred after excision. In contrast, majority of the central lesions were common in younger individuals and showed a striking male predilection. It occurred equally on both jaws, while approximately 50% of the lesions gave rise to recurrences. In conclusion, similar cytokeratin expression in both the tumor and surface epithelium can be used to support oral surface epithelial origin, while CK14 positivity confirms the odontogenic derivation of the peripheral DGCT described in the report. In contrast to central DGCT, the peripheral DGCT is a distinct lesion with characteristic clinicopathological profile and nonaggressive behavior

A Retrospective Clinico-Pathological Analysis with Review of Literature of Oral and Cervical Lympho-Epithelial Cysts from a Pathological Perspective

Oral and cervical lympho-epthelial cysts (LECs) are uncommon lesions with histopathological similarities. The aim of the study is to present clinico-pathological characteristics of oral and cervical LECs with a review of literature in order to create awareness on this uncommon entity. Eighteen new cases of oral and cervical LECs obtained from the archives of the University of Peradeniya and University of Geneva were used for the clinico-pathological analysis. The average age at diagnosis of 7 oral and 11 cervical LECs were 40 and 36 years, respectively. Both showed a female predilection (male:female ratio at 3:4 and 4:7, respectively). The only difference was found in the size of the lesions with oral LECs being significantly smaller than cervical LECs (0.9 cm vs. 4.6 cm). LECs may clinically resemble neoplasms (4/18), including malignancies (1/11 in the present series). None of the 18 LECs recurred following surgical removal. The literature-review-based analysis of 514 oral LECs confirms that the lesions are observed predominantly in adults in 4th–5th decades of life and are relatively small lesions of less than 2 cm in diameter. Oral LECs were found to occur predominantly in the tongue and floor of the mouth, similar to 88% of lesions in literature. In conclusion, oral and cervical LECs are two histologically similar cysts that occur in two distinct sites. The literature review supports the information observed in our study with respect to age of occurrence, site predilections, and size. Cervical LECs, particularly the ones that occur in the parotid region, may require further investigations to exclude BLEL of parotid gland, which occur in HIV infected patients

A literature review on oral basaloid squamous cell carcinomas, with special emphasis on etiology

In the recent years, basaloid squamous cell carcinomas (BSCCs) have gained attention because of (1) observation of a relative increase in the number of tumors arising particularly in head and neck sites, (2) identification of human papillomavirus (HPV) in BSCCs arising predominantly in the oropharynx, and (3) controversies that exist regarding the biological aggressiveness of the tumor. The objective of the present review was to address the issues mentioned above by focusing primarily on oral BSCCs, using literature that has been published in the English language up to 2013. According to the literature review, oral BSCCs were found to be relatively more common in elderly patients with a mean age of 64 years. A male predominance with a male/female ratio of 3:1 was observed. The predominant site was the tongue, with almost half of the reported cases occurring at this site, followed by the floor of the mouth and palate. With reference to habit history, majority were found to be tobacco and alcohol users. However, only 3 studies revealed data on HPV status of purely oral BSCC, and according to the results of these studies, of the 17 tumors tested, 4 had harbored high-risk HPV. Furthermore, most oral BSCCs were in an advanced clinical stage, namely, stage III or IV with T3 or T4 lesions and cervical lymph node metastasis at initial presentation, whereas 41% of patients had presented with local recurrences and 45% had died of the disease. In conclusion, although, the present literature review found enough evidence to consider tobacco and alcohol as risk factors for the development of oral BSCC, steps should be taken to fill the gap in our knowledge that exist with reference to contribution of oncoviruses, particularly HPV in the etiology of oral BSCC

A histopathologic comparison between synchronous and single primary oral squamous cell carcinomas

Objective: This study compares synchronous oral squamous cell carcinomas (OSCCs) with single primary OSCCs to assess the histopathologic parameters with a known prognostic significance. Study design: Twenty-eight cases of synchronous OSCCs and a control group of single primary OSCCs were compared for 15 histologic prognostic variables. Results: Results showed significantly less amount of abnormal mitoses (synchronous-1: P = .002; synchronous-2: P = .006) and tumor-induced stroma (synchronous-1: P = .011; synchronous-2: P = .001) in synchronous OSCCs than in single primary OSCCs. Depth of invasion was considerably lower in synchronous OSCCs than in single primary OSCCs (synchronous-1: P = .007; synchronous-2: P = .002). Lymph node metastasis (synchronous-1: P = .051; synchronous-2: P = .051) was found to be rare in synchronous OSCCs compared with single primary OSCCs. Conclusion: Synchronous OSCCs show less aggressive histopathologic features than single primary OSCCs. © 2010 Mosby, Inc. All rights reserved.Link_to_subscribed_fulltex

Descriptive study of 896 Oral squamous cell carcinomas from the only University based Oral Pathology Diagnostic Service in Sri Lanka

The study sample comprised of eight hundred and ninety six biopsies diagnosed as OSCC. The clinical and histopathological features were analyzed using the Chi-square test

Diagnostic Approach to Synovial Sarcoma of the Head and Neck Illustrated by Two Cases Arising in the Face and Oral Cavity

In the head and neck region, synovial sarcomas (SS) are rare tumours. We describe the diagnostic approach to SS based on two cases which developed in a 26-year-old male in the face and in a 53-year-old female on the alveolar mucosa of the upper jaw. The demographic profile of the patients was compatible with the literature. Histopathologically, both tumours presented as unencapsulated spindle cell tumours arranged into short fascicles. Although the chromosomal translocation of t(X;18)(p11.2;q11.2), transducin-like enhancer of split 1 (TLE-1) and SMARCB1 antibodies derived from gene expression studies are considered as the most sensitive makers to diagnose SS, these facilities were not available. Therefore, our cases were diagnosed as monophasic fibrous SS, utilizing a panel of immunohistochemical markers, including cytokeratins, EMA, Bcl-2, and CD99 as positive indicators and CD34, SMA, MYO-D, and S-100 as negative indicators. PAS staining was used to identify glycogen and to exclude spindle cell carcinomas and leiomyosarcoma, while Alcian blue was used to identify myxoid ground substance and to exclude nodular fasciitis. In conclusion, SS, although rare, should be included in the differential diagnosis of spindle cell tumours of the face and oral mucosa

Benign Fibrous Histiocytomas of the Oral Mucosa: Report on Three Cases and Review of the Literature

Benign fibrous histiocytomas (BFH) of the skin are common lesions, although they only rarely involve the oral mucosa. This article presents 3 additional cases of BFH of the oral mucosa, with a review of previously published cases. Although a malignant variant of BFH also exists, the present review focuses only on benign lesions. The clinical presentation, diagnosis, histopathological and immunohistochemical features of BFH are discussed. According to the present analysis, the majority of oral mucosal BFH have occurred in middle-aged and elderly patients, with a slight female predilection. Within the oral cavity, BHF may occur at any mucosal site, including the lips, tongue, buccal mucosa, mandibular and maxillary gingiva as well as the palate. Histopathology is essential to diagnose the lesion, while immunohistochemical investigations may be utilized to exclude the histopathological differential diagnoses such as juvenile xanthogranulomas and nevi. This review also revealed total excision as the treatment of choice for BFH, with a very good prognosis and an extremely low rate of relapse