Late Presentation of Oral Chronic Graft Versus Host Disease Manifesting As Hyperkeratotic Plaque: A Case Report.

Hematopoietic stem cell transplantation is the only curative intervention for myelodysplastic syndrome, with graft-versus-host disease (GVHD) being a frequently encountered consequence. GVHD is classified as acute (aGVHD) or chronic (cGVHD). The oral cavity is the most impacted by chronic. Oral manifestations of cGVHD are variable and include plaque, Wickham striae, and lichenoid patches. In order to prevent malignant misdiagnosis, the 2014 NIH consensus report decided to exclude white plaque as a diagnostic indicator for oral cGVHD. Nevertheless, it is still possible to classify a white plaque lesion as cGVHD through histological confirmation. The performance of a biopsy should be undertaken following meticulous consideration and a thorough evaluation of the associated risks and benefits. The in-depth review of oral cancer risk assessment is crucial, necessitating a careful review of multiple factors to accurately estimate the likelihood of malignant transformation in individuals with oral cGVHD. This report describes a case of oral cGVHD manifesting as hyperkeratotic plaque lesions confirmed by histopathology in a 62-year-old man who received an allogeneic hematopoietic stem cell transplant over a decade ago.

Clinicohistological Characteristics of Patients with Oral Lichenoid Mucositis: A Retrospective Study for Dental Hospital Records.

Oral lichenoid mucositis (OLM) of the oral mucosa is a histological diagnosis mainly characterised by a band of inflammatory infiltrate in lamina propria and basal cell degeneration. These features describe oral lichen planus or oral lichenoid reaction. However, it could be seen in oral dysplasia. The study aimed to assess the demographics and clinicohistological characteristics of patients with OLM and their relevance to dysplastic changes in the oral mucosa. This was a cross-sectional and retrospective study of archived and electronic records of individuals with histological confirmation of OLM at King Saud University Medical City, Saudi Arabia. The descriptive and correlation assessments were used to describe the demographics and clinicohistological characteristics and their associations, respectively [p < 0.05]. The analysis included 140 records of patients with histological confirmation of OLM with a mean age of 47 (±13), and 57% (n = 81) were females. Notably, 40% of patients had at least one medical condition, mainly diabetes mellitus, 74% were asymptomatic, and 52% had lesions in the buccal mucosa. Dysplasia was seen in 18 (12%) of the 140 reviewed records. Regarding the associations between study variables, dysplastic changes were associated with the male gender [p = 0.024] and were of no significance with increased age [p = 0.594]. Moreover, having oral symptoms was associated with older age [p < 0.001], medical history of diabetes [p = 0.0132] and hypertension [p < 0.001]. The present study findings could help indicate the individuals with histologically confirmed OLM who suffer the most from the clinical disease and have an increased risk of dysplastic changes. Therefore, symptomatic management and long-term follow-up can be planned accordingly.

Proliferative verrucous/multifocal leukoplakia: Updates and literature review "case report".

RATIONALE: Proliferative verrucous leukoplakia (PVL) is a multifocal, slowly evolving lesion that resists all types of treatment and has a high propensity for malignant transformation into oral squamous cell carcinoma. Lack of awareness and acquaintance with white lesions of the oral cavity makes it difficult to diagnose. Besides being rare, PVL significantly aggressive, so clinicians need to be aware of it carefully. Therefore, it is recommended to have the earliest possible diagnosis and total excision of this lesion. We report this case to present typical clinical and histologic features of PVL so a For the purpose of sensitizing clinician. PATIENT CONCERN: A 61-year-old female came to the clinic concerning of recurring painless, white patch on the tongue 2 months ago, associated with oropharyngeal dryness. DIAGNOSES: This case satisfies these major and minor criteria to diagnosed PVL. INTERVENTION: An excisional biopsy of the lesion was done to check for the presence of dysplasia, as lesions were persisting. Hemostasis was achieved with single interrupted sutures. OUTCOME: no recurrence has been observed since excisional 1 year follow-up. LESSON: The key feature is early detection, precisely in cases of PVL it is critical for better treatment outcomes, lifesaving, quality-of-life enhancement. To detect and treat any potential pathologies, clinicians should meticulously examine the oral cavity and patients have to be aware and informed of the importance of regular screenings. This lesion is resistant to the presently available treatment modalities; therefore, total excision with free surgical margins is critical combined with a lifelong follow-up.

Habitual khat chewing and oral melanoacanthoma: A case report.

BACKGROUND: Habitual khat (Catha edulis) chewing has been proven to cause numerous oral tissue changes. However, oral melanoacanthoma triggered by chronic khat chewing is rare. Oral melanoacanthoma is an uncommon, sudden, asymptomatic, benign pigmentation of the oral cavity. Under the microscope, the epithelial layer of the oral mucosa showed dendritic melanocyte proliferation and acanthosis. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma. CASE SUMMARY: In the current study, we report a case of a 26-year-old male patient with a rare presentation of oral melanoacanthoma triggered by regular khat chewing. Many intrinsic and extrinsic factors can cause oral pigmentation. Chewing khat is an extrinsic factor that can cause several diseases, including oral pigmentation. In this case, the definitive diagnosis was oral melanoacanthoma. This diagnosis was made based on the patient's history, clinical lesion presentation, and microscopic biopsy results. CONCLUSION: Habitual khat (Catha edulis) chewing causes many oral tissue changes including oral melanoacanthoma. The study aimed to highlight chronic khat chewing as a trigger for oral melanoacanthoma.

Erratum: Orofacial overgrowth with peripheral nerve enlargement and perineuriomatous pseudo-onion bulb proliferations is part of the PIK3CA-related overgrowth spectrum.

[This corrects the article DOI: 10.1016/j.xhgg.2020.100009.].

Evaluation of concordance between clinical and histopathological diagnoses in periapical lesions of endodontic origin.

Background/purpose: Periapical lesions of endodontic origin are often diagnosed based on the clinical and radiological presentations that may be different from the histological diagnoses. The purpose of this study was to assess the concordance between the clinical diagnosis of these lesions and the histopathological diagnoses and to analyze their clinical and pathological features. MATERIALS AND METHODS: Biopsies of periapical lesions of endodontic origin diagnosed in the histopathology laboratory between 2006 and 2017 were retrieved from the database and used to conduct this retrospective review. Clinical data were obtained, and tissue samples were re-evaluated. The overall agreement between the clinical and histological diagnoses was tested utilizing the Cohen kappa (k). RESULTS: A total of 317 periapical biopsy specimens were included in this study which consisted of 137 periapical granulomas, 174 periapical cysts, and six periapical scars. Generally there was weak overall agreement between the clinical and histological diagnoses of periapical granuloma and periapical cysts (Cohen kappa, k = 0.059). CONCLUSION: The findings of this study indicate that clinical/radiographic examinations are not able to preoperatively determine whether a periapical lesion is a cyst or a granuloma and highlights the importance of developing a reliable nonsurgical diagnostic method to differentiate periapical lesions.

Ameloblastic fibrosarcoma: clinicopathological and molecular analysis of seven cases highlighting frequent BRAF and occasional NRAS mutations.

AIMS: Ameloblastic fibrosarcoma (AFS) is an aggressive odontogenic neoplasm featuring malignant mesenchymal stroma in addition to an ameloblastic epithelial component, and is hence considered to be the malignant counterpart of ameloblastic fibroma (AF). AFS is exceedingly rare, with <110 cases having been reported so far. Although BRAF mutations are recognised driver mutations in ameloblastoma, the molecular pathogenesis of AFS remains elusive. METHODS AND RESULTS: We herein describe seven AFSs that were analysed, for the first time, for mutations in the BRAF-NRAS pathway. The patients were four females and three males aged 23-57 years (median, 26 years). Three tumours developed after one or multiple recurrences of AF (4-20 years after initial diagnosis), two showed transition from AF-like bland areas, and two developed de novo. All patients were treated with surgery; adjuvant chemotherapy was given to one patient. At the last follow-up, five patients were alive and well (19-344 months). The remainder were lost to follow-up. Histological examination showed variable sarcomatous overgrowth with varying degrees of atypia and increased mitotic activity. The epithelial component varied greatly according to the degree of sarcomatous overgrowth. Molecular testing revealed BRAF V600E mutations in five cases and NRAS p.Gln61Lys mutation in one case. One tumour was wild-type. CONCLUSION: To our knowledge, this is the first study on BRAF/NRAS mutations in AFS. Given the activity of RAF and MEK inhibitors across different cancers harbouring V600E mutations, our data strongly suggest that all AFS cases should be genetically tested, and that targeted treatment approaches for this extremely rare sarcoma subtype should be clinically investigated.

Orofacial overgrowth with peripheral nerve enlargement and perineuriomatous pseudo-onion bulb proliferations is part of the PIK3CA-related overgrowth spectrum.

Individuals with orofacial asymmetry due to mucosal overgrowths, ipsilateral bone and dental aberrations with perineurial hyperplasia and/or perineuriomatous pseudo-onion bulb proliferations, comprise a recognizable clinical entity. In this article, we describe three individuals with this clinical entity and mosaic PIK3CA variants c.3140A>G (p. His1047Arg), c.328_330delGAA (p. Glu110del), and c.1353_1364del (p.Glu453_Leu456del). We conclude that the identification of these mosaic variants in individuals with orofacial asymmetry presenting histopathologically perineurial hyperplasia and/or intraneural pseudo-onion bulb perineurial cell proliferations supports the inclusion of this clinical entity in the PIK3CA-related overgrowth spectrum.

Cytokeratin 19 Immunostain Reduces Variability in Grading Epithelial Dysplasia of the Non-Keratinized Upper Aerodigestive Tract Mucosa.

Epithelial dysplasia (ED) grading systems are criticized for low reliability. The effects of diagnostic tests or stains on reducing examiner variability in grading ED of the upper aerodigestive tract have not been investigated. The study aim was to examine the effectiveness of cytokeratin 19 (K19) immunostain on enhancing inter and intraexaminer reliability of ED grading and to reiterate the relation of K19 positivity with epithelial keratinization. The study sample consisted of 122 paraffin blocks that fulfilled the inclusion criteria. Each paraffin block had three sections cut: one immunostained for K19 and two for hematoxylin and eosin stain (H&E). Each examiner graded the study sample in six rounds; three using H&E stain only and three using paired K19-H&E stains. The study examiners were three American-Board certified practicing oral pathologists. The results were analyzed using Krippendorff's alpha, ROC curve, Chi square test and binary logistic regression. Upon the use of paired K19-H&E stains the results showed that the intraexaminer reliability coefficients of grading were improved from 0.70, 0.69, 0.78 to 0.73, 0.88, 0.91 for examiners 1, 2, and 3 respectively. Reliability coefficients for inter-examiners improved from 0.55 to 0.73 (Krippendorff alpha). The accuracy of identifying the diseased cases (high-grade dysplasia) increased from 0.82 to 0.94 (ROC curve). Binary logistic regression revealed that K19 positivity is negatively associated with hyperkeratinization of surface epithelium (P = 0.001). To conclude, for grading non-keratinized epithelial dysplastic lesions of the upper aerodigestive tract, paired K19-H&E stains proved to reduce inter and intra-examiner variability by highlighting the extension of dysplastic epithelial cells within epithelial thickness, thus identifying the involved epithelial third and assigning a more reliable and better reproducible grade.

Survival of Titanium-Zirconium and Titanium Dental Implants in Cigarette-smokers and Never-smokers: A 5-Year Follow-up.

OBJECTIVE: To compare the peri-implant clinical and radiographic status around bone-level narrow-diameter titanium-zirconium (TiZr) implants and titanium (Ti) implants placed in cigarette-smokers (CS) and never-smokers (NS). METHODS: Partially edentulous CS and NS rehabilitated with TiZr and Ti implants were included. Demographic data and information regarding smoking habits were collected. Participants were divided into four groups: group-1, CS with TiZr implants; group-2, NS with TiZr implants; group-3, CS with Ti implants; and group-4, NS with Ti implants. 36, 30, 31 and 33 implants were placed in 24, 23, 24 and 25 male individuals in groups 1, 2, 3 and 4, respectively. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) and mesial and distal crestal bone loss (CBL) were measured. All patients were enrolled in biannual routine oral prophylaxis care at least until the fifth year of follow-up and oral hygiene instructions were reinforced at each recall appointment. P < 0.05 was considered statistically significant. RESULTS: At the 3- and 5-year follow-ups, there was no statistically significant difference in the peri-implant PI, BOP, PD and CBL between individuals in all groups. In all groups, the implant success and survival rates were 100% and 100%, respectively, at the 5-year follow-up. CONCLUSION: The TiZr and Ti dental implants can remain clinically and radiographically stable in CS in a manner similar to NS. Routine oral hygiene maintenance plays an essential role in this regard.

Clinicopathologic significance of in vivo antinuclear autoantibodies in oral mucosal biopsies.

OBJECTIVE: Although antinuclear autoantibody (ANA) staining of oral biopsy specimens is indicative of chronic ulcerative stomatitis, it is not known whether this staining is characteristic of other autoimmune diseases. Our study was undertaken to characterize the various in vivo ANA patterns detected in the oral mucosa by direct immunofluorescence to describe the associated hematoxylin and eosin findings, and determine whether patients with these findings had a coexisting systemic connective tissue disease. STUDY DESIGN: This was a retrospective analysis of oral biopsy specimens submitted from 2013 to 2016. RESULTS: In vivo ANA staining was present in 72 of the 2019 cases examined. Immunoglobulin G was the most common immunoreactant (71 of 72 cases), and speckled nuclear staining was the most frequent in vivo ANA pattern (52 of 72). In most cases, hematoxylin and eosin staining of biopsy specimens showed mucositis (24 of 34). Detailed clinical information was available for 10 patients, and all of them had an autoimmune disease. CONCLUSIONS: We found similar prevalence of ANA staining with direct immunofluorescence in oral epithelial biopsy specimens as reported for those of skin. In vivo ANA in the oral epithelium may indicate the presence of an immune-mediated disease. Patients who show ANA deposits in oral mucosal biopsy specimens should be investigated for systemic connective tissue disease as well as for chronic ulcerative stomatitis.

Metastasizing Pleomorphic Adenoma Case Report and Review of the Literature.

Pleomorphic adenoma (PA) is by far the most common salivary gland tumor. It is well known that PA can undergo malignant transformation. However, in rare occasions it can metastasize preserving its benign phenotype. Metastasizing pleomorphic adenoma (MPA) constitutes an extremely rare tumor. Here we are reporting an unusual MPA affecting the mandible that was preceded by a submandibular gland pleomorphic adenoma.