Oral mucosal hyperpigmentation secondary to antimalarial drug therapy.

A case of oral mucosal hyperpigmentation resulting from antimalarial drug therapy is presented. The patient reported a history of long-term quinacrine therapy and exhibited diffuse blue-gray pigmentation of the nail beds and the skin of the nasal ala. Microscopic examination of the involved mucosa showed macrophages, containing both melanin and ferric iron, scattered within the connective tissue adjacent to the epithelium. The clinical, historical, and microscopic features of antimalarial-induced pigmentation are discussed. Other causes of diffuse or multifocal oral pigmentation are also addressed.

Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa.

We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple-red papule and, in the other, as a blue submucosal swelling. Both lesions were non-painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit-like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII-related antigen was positive only within endothelial cells lining well-formed vascular channels. Both lesions were treated by excision; short-term follow-up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.

Palatal canalicular adenoma: report of 12 cases and review of the literature.

Canalicular adenoma is the second most common type of adenoma of the oral region and arises almost exclusively in the upper lip. Other locations include the buccal mucosa, the palate, and the parotid gland. We report 12 cases of canalicular adenoma that arose in the palates of nine women and three men between the ages of 42 and 76 years. The tumor presented as a nonulcerated (eight patients) or ulcerated (four patients) lesion, usually at the junction of the hard and soft palates. Two tumors were misdiagnosed: one as adenoid cystic carcinoma and the other as low-grade adenocarcinoma. Both patients had had partial maxillectomy; the patient diagnosed with adenoid cystic carcinoma also received radiotherapy. One patient reported having had an adenoma removed from the palate 10 years previous to presentation; thus, the tumor was classified as a recurrence. Evidence of tumor metastasis was absent in all cases during the follow-up period, which ranged from 1 to 25 years. Eleven patients are alive and disease free; one died of other causes. Canalicular adenoma does not commonly occur in the palate. This tumor has an excellent prognosis after conservative surgical treatment in all locations. Pathologists should be aware of the occurrence of this neoplasm in the palatal region and of its histopathology so they can distinguish it from malignant tumors of the salivary gland.

Caliber-persistent labial artery. A common vascular anomaly.

Sixteen cases of caliber-persistent labial artery of the lips have been reported to date in the English literature. Six of these were clinically misdiagnosed as squamous cell carcinoma and treated with wedge resection. To date, we have seen 187 cases clinically and an additional 23 cases through our surgical oral pathology services. Careful clinical observation usually reveals a soft linear or papular bluish elevation above the labial mucosal surface. The unique feature is pulsation--not simply pulsation toward and away from the observer, which can be caused by an underlying artery, but lateral pulsation, which only an artery can exhibit. All but 2 of our 187 clinical cases were asymptomatic. To the best of our knowledge, this is the first report of caliber-persistent labial artery of the upper lip. The upper:lower lip ratio for the clinical cases was almost 2:1. Three times as many lower lip as upper lip lesions were biopsied. Males and females were almost equally affected (clinical cases, 76:86; histopathologic cases, 9:13). Although a vascular term (artery, hemangioma, phlebolith, varix, vascular malformation) was used on the biopsy form in one half of the clinical differential diagnoses, none of the clinical histories mentioned pulsation. In contrast to the cases of Miko et al. in 1980 and 1983, none of our cases manifested itself as an ulcer, nor was carcinoma ever mentioned in the clinical differential diagnosis. The purpose of this article is to familiarize clinicians and pathologists with the clinical and histopathologic features of this seldom reported but common vascular anomaly. Clinicians should carefully look for lateral pulsation in lip mucosal papules so as to avoid unnecessary surgery and intraoperative arterial bleeding. Pathologists should recognize that a relatively large-caliber superficial artery in a lip biopsy may not be an incidental finding but rather the clinical lesion that was biopsied.

Adenomatoid dentinoma. Report of four cases of an unusual odontogenic lesion.

Four cases of a rare odontogenic lesion are reported. In each of the 4 examples, the lesion manifested itself as a well-circumscribed unilocular radiolucency in the mandibular third molar region in an adult. The histopathologic features consisted of an encapsulated proliferation of odontogenic hard and soft tissues. The hard tissue component consisted of dentin deposited in a peripheral ringlike configuration that enclosed odontogenic epithelium resembling adenomatoid odontogenic tumor. Whether this process represents a neoplasm or an odontogenic hamartoma is an unresolved question. Treatment in each case consisted of curettage, and no recurrences were observed.

Chondromyxoid fibroma of the jaws. Case report and review of the literature.

Chondromyxoid fibroma is a benign tumor of bone that is characterized by chondroid and myxoid differentiation and by ultrastructural and immunohistochemical evidence of chondral origin. It is rare in the jaws and skull bones, where only about 2% of all cases have been reported. A review of the 20 acceptable gnathic cases in the literature and of the current case revealed both a higher incidence in the mandible (76%) than in the maxilla (24%) and an equal sex distribution. The sites of occurrence in both jaws are compatible with origin from developmental cartilaginous remnants. The controversies regarding malignant transformation and therapeutic approach are addressed.

Oral melanoma: case reports and review of the literature.

Oral melanomas occur most often on the palate and gingiva with the maxillary arch affected 80% of the time. Melanosis may exist many years before a definitive biopsy. Long-standing lesions may ulcerate but lack rolled borders or induration, features commonly associated with squamous cell carcinoma. Melanoma that involves oral mucosa is rare with an extremely poor prognosis. Surgical management remains the preferred treatment in combination with chemotherapy. Irradiation therapy is used occasionally as a primary modality in the elderly and medically compromised patients. Lymph node dissection is not routinely practiced. The poor prognosis of oral melanomas requires that pigmented lesions of undetermined origin be routinely biopsied.

Clinical and therapeutic features of polymorphous low-grade adenocarcinoma.

Polymorphous low-grade adenocarcinoma, also known as terminal duct or lobular carcinoma, was first described in two clinical case series in 1983. Before that time most of these neoplasms were diagnosed as benign salivary gland neoplasms including pleomorphic adenomas, variants of monomorphic adenomas, or salivary malignant conditions including malignant pleomorphic adenomas, adenoid cystic carcinomas, and adenocarcinoma not otherwise stated. This neoplasm with few exceptions originates in minor salivary gland tissue of the posterior hard and soft palates or buccal mucosa. It is characteristically slow to enlarge; clinical reports show the neoplasm present for many years before diagnosis. We have evaluated the clinical and microscopic features of 15 cases from the archives of The University of Iowa Surgical Oral Pathology Laboratory and added these to published case reports. A total of 204 cases were evaluated with a female/male ratio of almost 2/1. Forty-nine percent originated in palatal mucosa. Polymorphous low-grade adenocarcinomas arising from pleomorphic adenomas or de novo have been reported within major salivary glands and outside the oral cavity. A 17% recurrence rate was found with a regional metastasis rate of 9%. Five cases had multiple recurrences, and 13 recurrences were at or beyond 5 years after the initial diagnosis. Regional node metastases were identified at the time of initial treatment or at the time of recurrence in 9% of cases in which follow-up data were specified.

Central odontogenic fibroma, WHO type. A report of three cases with an unusual associated giant cell reaction.

Three cases of central odontogenic fibroma, WHO type, that exhibited a prominent giant cell granuloma-like histopathologic component are described in this report. All three lesions occurred in women, and all were located in the mandibular premolar-molar region. One lesion recurred after conservative excision, and the recurrence displayed the two histologically distinct tissues of the original lesion. The authors think that this pathologic process does not represent a "collision lesion" but, instead, is a unique presentation of a central odontogenic fibroma, WHO type.

The immunoperoxidase method for the rapid diagnosis of intraoral herpes simplex virus infection in patients receiving bone marrow transplants.

Bone marrow transplant patients (N = 12) with oral lesions consistent with herpes simplex virus (HSV) infection were studied to compare the sensitivity of two rapid cytodiagnostic methods with viral cultures. Routine viral cultures and exfoliative cytology smears were prepared for microscopic evaluation using the Papanicolaou method and an immunoperoxidase staining technique for detection of HSV type 1. Patients with a positive viral culture (N = 10) showed positive staining for HSV, using the immunoperoxidase technique. Multinucleated giant epithelial cells were observed in only seven of the ten positive specimens, using the Papanicolaou method. The results from this preliminary study suggest that the immunoperoxidase method may provide the dentist with a reliable and rapid approach for the diagnosis of intraoral HSV.

Central granular cell odontogenic fibroma.

First described in 1962, the so-called granular cell ameloblastic fibroma has been a rarely reported benign odontogenic tumor. On reviewing the literature, we have identified eight previously reported cases. All cases involved well-circumscribed radiolucencies in women who ranged in age from 53 to 65 years. Seven lesions occurred in the posterior body of the mandible, and one occurred in the premolar region of the maxilla. All lesions were treated with surgical excision, and no recurrences were identified during follow-up periods of 6 to 144 months. Two additional cases also appear to represent instances of this neoplasm, which bring the total number identified to ten. We describe the clinical, radiographic, and histopathologic features of two additional cases and suggest reasons the tumor should be referred to as central odontogenic fibroma, granular cell variant.

Nodular hidradenoma: an eccrine sweat gland analog of pleomorphic adenomas of salivary gland origin.

A tumor of eccrine sweat gland origin is described that bears a striking resemblance to pleomorphic adenomas of salivary gland. Upon closer examination, the tumor contained areas of apocrine decapitation secretory activity, primitive hair follicles, and melanin pigmentation, indicating cutaneous rather than mucosal origin. Six-month follow-up examination has revealed no evidence of recurrence.