Epstein-Barr virus-positive oral ulceration simulating Hodgkin lymphoma in a patient treated with methotrexate: case report and review of the literature.

Immunosuppressive therapy for patients diagnosed with rheumatoid arthritis has long been implicated in the development of various neoplastic processes, including leukemia and lymphoma. Methotrexate is a commonly administered antimetabolic medication thought to improve the symptoms of rheumatoid arthritis through its anti-inflammatory effects. Longterm methotrexate therapy and concurrent rheumatoid arthritis have both been independently suggested as risk factors for developing lymphoma. The mechanism has been theorized to be severe immunosuppression and an increased frequency of latent infection with pro-oncogenic viruses, such as the Epstein-Barr virus (EBV). Spontaneous remission of these malignancies has been seen after discontinuation of the methotrexate therapy. In the present study, we report the case of a patient diagnosed with rheumatoid arthritis and treated with methotrexate and prednisone. She developed intraoral ulcerations that histopathologically resembled Hodgkin's lymphoma.

Sarcoidosis and Sjögren's syndrome: clinical and salivary evaluation.

BACKGROUND: Sarcoidosis and Sjögren's syndrome are two different diseases; however, when affecting the salivary glands, both diseases exhibit similar clinical signs and symptoms, which often complicates the diagnosis. The purpose of this study was to investigate the possibility of using salivary electrophoresis to differentiate between the two diseases. METHODS: Saliva was collected from patients with sarcoidosis and patients with Sjögren's syndrome. Salivary flow rate, total protein, and electrophoretic profiles were examined. RESULTS: Mean salivary flow rate was 0.41 ± 0.07 ml/min/gland vs. 0.43 ± 0.07 ml/min/gland; total salivary protein was 130.0 ± 29.2 mg% vs. 104.0 ± 8.8 mg% for sarcoidosis vs. Sjögren's syndrome, respectively. No differences were observed in salivary flow rate, total salivary protein, or electrophoretic profile between patients with sarcoidosis and patients with Sjögren's syndrome (P = 0.768, 0.718, and 1.000, respectively). CONCLUSIONS: Salivary protein electrophoresis does not appear to be useful to differentiate between sarcoidosis and Sjögren's syndrome.

Spindle-cell variant of ameloblastic carcinoma: a report of 3 cases and demonstration of epithelial-mesenchymal transition in tumor progression.

Ameloblastic carcinoma is a rare odontogenic neoplasm that demonstrates the histologic characteristics of ameloblastoma, accompanied by the cytologic features of malignancy. The spindle-cell variant of ameloblastic carcinoma (SCAC) is exceptionally rare, with a total of 10 cases having been reported in the literature to date. Histologically, a prominent sarcomatoid cell population appears to originate from the epithelial (ameloblastic) component. Like conventional ameloblastic carcinoma, most cases of SCAC occur in individuals older than 40 years of age. Here, 3 additional cases of SCAC are reported, 2 of which occurred in young individuals. Diagnostic criteria to aid in the identification of SCAC are proposed. Finally, histologic and immunohistochemical evidence supporting the occurrence of epithelial-mesenchymal transition in SCAC is presented.

Masson trichrome stain helps differentiate myofibroma from smooth muscle lesions in the head and neck region.

BACKGROUND/PURPOSE: Myofibromas are well described in the head and neck region, but differentiating them from smooth muscle lesions is still difficult using smooth muscle immunohistochemical stains. This study evaluated the usefulness of the Masson trichrome stain in differentiating myofibromas from smooth muscle lesions in the head and neck region. METHODS: Samples of 11 oral myofibromas, two leiomyomas, one angioleiomyoma, and one smooth muscle hamartoma were retrieved from our archives. Immunohistochemistry and Masson trichrome stains were performed on tissue sections of these lesions. RESULTS: All 11 oral myofibromas, seven from male patients and four from female patients, were solitary myofibromas. The patients' mean age at diagnosis was 32.8 years. Oral myofibromas occurred most commonly on the gingiva (four cases) and in the mandible (three cases). With the Masson trichrome stain, the smooth muscle cell cytoplasm was stained red, while the collagenous fibrous tissue was stained blue. Myofibromas and smooth muscle lesions demonstrated different characteristic patterns with the Masson trichrome stain. Myofibromas were composed of a much more collagenous stroma intermixed with the spindle cells. Thick fibrous bundles with random, irregularly intersecting angles were prominent in myofibromas. Smooth muscle lesions showed only minimal delicate fibrous tissue surrounding the smooth muscle cells and in the septa between the smooth muscle masses. On low-power view, red masses of smooth muscle tumor surrounded by blue fibrous tissue were observed. CONCLUSION: The Masson trichrome stain can be a useful tool to differentiate myofibromas from smooth muscle lesions, but immunohistochemical methods to rule out other spindle cell lesions are still needed.

Adenomatoid odontogenic tumor with peripheral cemento-osseous reactive proliferation: report of 2 cases and review of the literature.

Two cases of a rare variant of adenomatoid odontogenic tumor encompassed by a prominent reactive cemento-osseous proliferation are reported. This unique variant of adenomatoid odontogenic tumor has only been seen twice in the authors' collective experience. Literature documenting the histopathologic patterns of adenomatoid odontogenic tumor and the occurrence of other combined lesions other is reviewed and discussed.

Oral melanocytic nevi: a clinicopathologic study of 100 cases.

OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of oral melanocytic nevi (OMN). STUDY DESIGN: One hundred cases of OMN were retrieved from the files of two oral pathology services, and the data were analyzed with regard to histologic type and clinical features. RESULTS: Intramucosal nevus was the most common type (61%), followed by common blue nevus (23%), compound nevus (7%), and junctional nevus (3%). Combined nevus and cellular blue nevus were rare (2% each). The hard palate was the most commonly affected site (33%), followed by the buccal mucosa (18%), vermilion border of the lip (18%), and gingiva (15%). An interesting case of intramucosal nevus with lipomatosus-like changes and neurotization and two cases of oral dysplastic nevus are also reported. CONCLUSIONS: Intramucosal and common blue nevi are the most common types of OMN. Dysplastic nevus, which is recognized as a marker for melanoma in the skin, can rarely involve the oral cavity. Accordingly, dentists, especially oral and maxillofacial pathologists, should become familiar with the clinical and histopathologic features of this entity.

beta-Catenin is expressed aberrantly in tumors expressing shadow cells. Pilomatricoma, craniopharyngioma, and calcifying odontogenic cyst.

We studied the beta-catenin immunohistochemical profile in tumors expressing shadow cells: pilomatricoma, 10 cases; calcifying odontogenic cyst, 6 cases; and craniopharyngioma, 9 cases. There was strong membranous, cytoplasmic, and nuclear staining of the immature basaloid cells in all of these tumors. Shadow cells were negative in all tumors. It has been documented that rising levels of free beta-catenin drive the formation of complexes with T-cell factor/lymphoid enhancer factor (TCF-Lef) and up-regulate the wingless-Wnt cell-cell signals. The end result is an abnormality of beta-catenin degradation and, thus, a buildup of free beta-catenin in the cytoplasm and/or nucleus, resulting in the stimulation of cellular proliferation and/or inhibition of cell death. beta-Catenin seems to have an important role in the oncogenesis of these tumors. The similar pattern of keratinization in these tumors and the similar pattern of beta-catenin immunoreactivity in the cytoplasm and the nucleus are important findings. It seems that the activation of a common cellular pathway, namely Wnt-beta-catenin-TCF-Lef, has a role in the pathogenesis of these tumors. The latter could be related to their shared method of keratinization or shared dysfunction of the cellular adhesion complex leading to tumorigenesis.

Respiratory epithelial adenomatoid hamartoma of the maxillary sinus presenting as a periapical radiolucency: a case report and review of the literature.

We report a case of respiratory epithelial adenomatoid hamartoma of the left maxillary sinus that initially presented as a periapical radiolucency involving the left maxillary first molar. Respiratory epithelial adenomatoid hamartoma is a rare lesion that occurs in the nasal cavity, paranasal sinuses, and nasopharynx. Most cases are found in the nasal cavity associated with the posterior nasal septum. Involvement of the maxillary sinus is very unusual, and only one other report of a respiratory epithelial adenomatoid hamartoma involving the maxillary antrum was found in a search of the literature. The current case is additionally unique as it was initially detected in the course of a dental examination. Awareness of this lesion is important because inverted schneiderian papilloma and adenocarcinoma may be included in the histopathological differential diagnosis. Conservative surgical removal is curative and recurrence has not been reported.

Calcifying odontogenic cyst with ameloblastic fibroma: report of three cases.

Although it is a rare event, odontogenic tumors such as ameloblastoma, ameloblastic fibroma (AF), ameloblastic fibro-odontoma, and odontoma have been reported associated with calcifying odontogenic cyst (COC). There are only four cases of COC with AF cited in the English literature. However, three of these four cases were either included in a review of a series of cases or reported as an abstract, and limited clinical and histological information was provided. We present three additional cases of COC with AF and discuss the management for this combined lesion. Because COC is known for its histologic diversity and variable clinical behavior, and the clinical significance of an association of COC with AF is still unknown, we think it is valuable to report COC with AF with detailed clinical and pathological documentation.

Recurrent left mandibular enlargement.

A 35-year old African-American female presented with a painful enlargement of the left face in the area of the posterior mandible and ramus extending to the submandibular area. She also complained of some difficulty swallowing along with mobility and supereruption of the mandibular left first molar tooth. See if you can make the diagnosis.