The Clinical Misdiagnosis of Lichen Planus and its Potential for Untoward Outcome

The diagnosis of lichen planus may be incorrectly applied to a solitary white lesion and to lesions with ulceration, referred pain and lack of response to corticosteroid therapy. In two patients, the diagnosis of lichen planus lead to the delayed recognition of squamous cell carcinoma requiring extensive surgery.https://digitalcommons.unmc.edu/cod_pres/1002/thumbnail.jp

USP6 Translocation in Giant Cell Granulomas of the Jaws

Central giant cell granulomas (CGCG) account for 7% of all benign tumors of the jaw while peripheral giant cell granulomas (PGCG) occur on the gingiva (Table 1). The underlying pathophysiology of CGCG and PGCG is not known. Therefore there are studies attempting to identify biomarkers to increase understanding the pathogenesis of CGCG and PGCG. Some authors consider CGCG in jaw bones similar to giant cell tumors of long bones while others believe them to be reactive or non-neoplastic lesions. Recurrence of these lesions following conservative treatment is attributed to matrix metalloproteinases, namely MMP9. Recent studies have shown an increase in levels of MMP9 in central and peripheral giant cell granulomas as in aneurysmal bone cysts (ABC). De-ubiquitinating enzymes play an important role in cellular processes, though their precise role in normal physiology is not fully understood. USP6 is the first de-ubiquitinating enzyme recognized as an oncogene. Recently studies have described the USP6 translocation in CGCG as transforming this lesion to a neoplasm. This retrospective study analyzed two cases of CGCG and one PGCG for the USP6 translocation.https://digitalcommons.unmc.edu/cod_pres/1001/thumbnail.jp

Misdiagnosis of Lateral Periodontal Cysts: A Retrospective Study

A total of 239 cases were retrieved from the files of the UNMC College of Dentistry oral biopsy service which had lateral periodontal cyst (LPC) as a clinical or a histological diagnosis. Of these, 178 were submitted with a clinical differential diagnosis that included LPC. Upon histological examination only 26 (11%) of those were in fact LPC. Only 21(9%) of the 51 cases diagnosed histologically met the criteria for LPC. Within those 239 cases, 120(50%) cases were inflammatory cysts, 31(13%) of the samples were determined to be keratocystic odontogenic tumors (odontogenic keratocysts). Conclusion: The LPC is frequently misdiagnosed due to its radiographic similarity to other lateral radiolucencies.https://digitalcommons.unmc.edu/cod_pres/1000/thumbnail.jp

Desmosomal Component Expression in Normal, Dysplastic, and Oral Squamous Cell Carcinoma

Squamous cell carcinoma (oral SCC) is the most common oral cancer in the U.S., affecting nearly 30,000 Americans each year. Despite recent advances in detection and treatment, there has been little improvement in the five-year survival rate for this devastating disease. Oral cancer may be preceded by premalignant disease that appears histologically as dysplasia. Identification of molecular markers for cellular change would assist in determining the risk of dysplasia progressing to oral squamous cell carcinoma. The goal of this study was to determine if any correlation exists between histological diagnosed dysplasia and OSCC lesions and altered expression of desmosomal cell-cell adhesion molecules in the oral epithelium. Our data showed that oral SCC tissue samples showed decreased immunoreactivity of both desmoplakin and plakophilin-1 proteins compared to normal oral epithelium. Furthermore, significant decrease in desmoplakin immunoreactivity was observed in dysplastic tissue compared to normal oral epithelium. In contrast, the level of desmoglein-1 staining was unchanged between samples however desmoglein-1 was found localized to cell borders in oral SCC samples. These data suggest that changes in expression of desmoplakin and plakophilin-1 may prove to be a useful marker for changes in tissue morphology and provide a tool for identifying pre-neoplastic lesions of the oral cavity

A Guide to Medications Inducing Salivary Gland Dysfunction, Xerostomia, and Subjective Sialorrhea: A Systematic Review Sponsored by the World Workshop on Oral Medicine VI

Background: Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist. Objective: Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. Data Sources Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. Limitations While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search. Conclusions: We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications

Ameloblastic fibro-odontoma of the anterior mandible in a 22-month-old boy

We report an ameloblastic fibro-odontoma (AFO) presenting in the anterior mandible as a "bump on his gums" in a 22-month-old boy. An occlusal radiograph revealed a well-circumscribed radiolucency with scattered radiopaque foci. The tumor was enucleated under general anesthesia. The histologic findings were characteristic of an AFO, a mixed odontogenic tumor most common in the posterior jaws, primarily affecting individuals with an average age of 10 years. The clinical presentation, microscopic findings, differential diagnoses, and treatment are discussed