Metastatic mucinous adenocarcinoma from breast mimicking a pyogenic granuloma in the gingiva: a case report.

Mucin-producing adenocarcinomas (MAC) are an extremely rare, indistinct group of neoplasm having either a salivary gland origin or with prominent glandular component. The diagnosis is chiefly based on the histological aspect conjoined with immunohistochemical evaluation as clinico-radiographical features are non-specific. It can arise as a primary metastasis to soft tissues, most commonly from either lung, breast, kidney, or colon. This paper reports a 51-year-old woman with buccolingual gingival swelling having a final diagnosis of metastatic mucinous adenocarcinoma from the breast. A tissue biopsy was performed followed by immunohistochemistry that confirmed the diagnosis. They are extremely rare, making the diagnosis challenging as it may mimic a benign neoplasm. It accounts for approximately 1% of all oral malignant neoplasms having gingival propensity. The clinician should therefore take into account every diagnostic aspect while encountering such oral lesions to achieve proper patient welfare.

Sarcomatoid Carcinoma: A Clinicopathological Dichotomy.

Spindle cell carcinoma (SpCC) or sarcomatoid carcinoma is an uncommon biphasic malignant neoplasm occurring mainly in the upper aerodigestive tract. It has spindled or pleomorphic tumor cells simulating a true sarcoma with epithelial origin. WHO recognized this tumor as an aggressive variant of squamous cell carcinoma and further designated it as spindle cell carcinoma. This neoplasm is known for its propensity of recurrence and metastasis reinforcing the importance of its proper diagnosis. In our case report, we talk about sarcomatoid carcinoma involving the oral cavity having a high metastasizing rate according to histopathological and immunohistochemical features.

B-Cell Lymphoma of Mandible: A Unique Case Report with Diagnostic Perplexity.

Lymphoma in the jaw bone is a rare malignant neoplasm with heterogeneous nature diagnosis of which requires utmost knowledge of cellular morphology and tissue architecture. The lineage of the neoplastic lymphocytes, whether it is B- or T-cell or mixed in nature, is designated by cluster of differentiation numbers. Broad classification of malignant lymphoma includes Hodgkin's and non-Hodgkin's lymphoma which have various subtypes. An unusual case of a B-cell lymphoma in the mandible in a middle-aged male patient is presented herewith clinicopathological and immunohistochemical features.

Primary amelanotic malignant melanoma of parotid and submandibular salivary gland: A rare case report.

Primary amelanotic malignant melanomas (AMMs) of the parotid and submandibular salivary glands are extremely rare with only a few reported cases due to its low incidence and misdiagnosis. Malignant melanoma (MM) has a high predilection for the head-and-neck region and majority of the cases in the parotid gland reported as association with metastasis in and around the gland from a cutaneous primary tumor. Immunohistochemistry is solely needed for confirmation of diagnosis and MMs give positive reactivity for melan-A, HMB-45, and S-100. Prognosis for AMM in the mucosal or salivary gland regions is much poorer than cutaneous regions because of anatomic considerations and its delayed diagnosis. The treatment of choice is radical surgery and parotidectomy along with radiotherapy and chemotherapy.

Atypical Presentation of Granular Cell Tumor Involving Tongue: A Rare Case Report.

Granular cell tumor (GCT) is a rare benign tumor chiefly affecting the orofacial region, especially tongue. The origin of this neoplasia, after remaining a controversy for years, was finally identified to be from Schwann cell or neuroendocrine cell. They usually present as asymptomatic, firm, sessile, submucosal, solitary, or multiple nodule/papule like lesions. Histopathologically, the presence of sheets, cords or nests of large cells having abundant, eosinophilic granular cytoplasm, and pseudoepitheliomatous hyperplasia are the characteristic features of this neoplasm. Immunohistochemical stains such as S100, Cluster of differentiation 68, neuron-specific enolase, and laminin also aid in the proper diagnosis of granular cells. We hereby present a case of GCT in a 50-year-old male, which had a unique exophytic appearance, probably being only the second to be reported till date.

Oral sarcoidosis aiding in diagnosis of underlying systemic disease.

Sarcoidosis is a chronic, multisystemic, granulomatous disease of unknown aetiology characterised by the formation of non-caseating granuloma. It shows slight female predominance and has a bimodal age distribution. Lungs, skin, eye and liver are commonly affected. The oral lesion, though uncommon, may present as submucosal nodule, papule or superficial ulceration. Occasionally, oral lesion may be the first manifestation of underlying systemic disease. This case is interesting because it emphasises that dental practitioners may play a key role in early recognition of the clinical presentation of this multifaceted disease, and thereby aid in the diagnosis of the systemic condition. The present report deals with a case of sarcoidosis affecting the buccal mucosa in a 48-year-old woman. The patient was treated with oral prednisolone and within 4 months of corticosteroid therapy, the oral lesion regressed with no recurrence or new lesion noted over a period of 1 year.

Langerhans Cell Histiocytosis in an Adult with Oral Cavity Involvement: Posing a Diagnostic Challenge.

Langerhans cell histiocytosis (LCH) is a rare hematological disorder characterized by local or generalized, uncontrolled proliferation and infiltration of Langerhans type of histiocytic cells. It represents a spectrum of clinicopathologic disorders, ranging from a highly aggressive and frequently fatal multisystem disease to an easily cured solitary lesion of bone. Involvement of children and the younger age group is more common than the adults. Oral cavity involvement occurs early in LCH, but the initial symptoms are generally nonspecific, often causing misdiagnosis. This report describes a rare case of chronic localized LCH in an adult patient, with involvement of oral cavity. A 34-year-old male patient presented with multiple nodulo-papular, ulcerated lesions in gingiva involving both the jaws (primarily mandible) and the left buccal mucosa, in addition to regional teeth mobility. The most striking feature was that even after extraction of mobile teeth, the lesions persisted. After recording proper history, performing clinical and radiological evaluation, an incisional biopsy was performed followed by histopathology and immunohistochemistry to reach a confirmatory diagnosis of LCH, thereby implementing early and appropriate initiation of treatment.

Oral condyloma acuminatum in a 75-year-old geriatric patient.

Condyloma acuminatum (CA) is a human papillomavirus-induced sexually transmitted disease which is characterised by epithelial proliferation in the genital region, perianal region, oral cavity and larynx. It was first reported by Knapp and Uohara in 1967. The disease is more common in children and teenagers and appears as solitary or multiple, pinkish, sessile papules or plaques with pebbled surface or as pedunculated papillary lesions. Oral lesions commonly affect the lips, floor of the mouth, lateral and ventral surfaces of tongue, buccal mucosa, soft palate and rarely gingiva. The present report deals with a case of CA affecting a 75-year-old male patient with emphasis on clinical presentation, histological features and importance of PCR for establishment of definitive diagnosis. This case is unique because CA is extremely rare in geriatric age group.

A unique case of clear cell variant of calcifying epithelial odontogenic tumor involving the maxilla.

Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, odontogenic tumor arising from the odontogenic epithelium and accounts for approximately 1% of all odontogenic tumors. Clear cell variant of CEOT is a distinct entity and has more aggressive biological behavior and higher chances of recurrence. Here, we present a unique case of clear cell variant of CEOT involving the left side of the maxillary alveolus in a 73-year-old female patient with thorough clinical, radiological, and histological details.

Solitary Myofibroma of the Mandible in a Six-Year Old-Child: Diagnosis of a Rare Lesion.

Myofibroma is a benign uncommon fibroblastic tumour originating from the soft tissue, bone and may affect both children and adults. Radiographically myofibroma presents as unilocular radiolucency. Histologically, typical biphasic cellular arrangement is noted. Immunohistochemical markers are useful for definitive diagnosis of this uncommon neoplasm. Here, a case of six-year-old male child with a localized swelling in the left body of mandible is presented. The clinical, radiological, histological and immunohistochemical findings were corroborative of Infantile Myofibroma.

Clinical enigma: A rare case of clear cell odontogenic carcinoma.

Clear cell odontogenic carcinoma is a rare, aggressive neoplasm of the jaw with only 74 reported cases. It occurs predominantly in the mandibular anterior region during fifth to seventh decades of life. Clinically it manifests as intra-bony swelling with a variable degree of pain. Microscopically, it reveals nests of cells with clear cytoplasm in connective tissue stroma arranged in different patterns. It is often misdiagnosed due to the rarity of lesion and confusing histopathology. Immunohistochemical staining plays an intricate role to uncertain the native of the clear cell to reach a confirmative diagnosis. The article aims to highlight the clinicopathologic features of clear cell odontogenic carcinoma in a middle-aged man with special emphasis on its differential diagnosis.

Cervicofacial Actinomycosis Mimicking Osseous Neoplasm: A Rare Case.

Actinomycosis is a rare chronic infectious disease caused primarily by Actinomyces israelli. Although they are normal inhabitants of the oral cavity, infection occurs when there is a breach in the mucosa allowing them access to the subcutaneous tissues. Poor oral hygiene, dental caries, recent dental extraction, oromaxillofacial trauma have been implicated as risk factors for actinomycosis. Cervicofacial actinomycosis is the most common form of this rare disease. Here, we are presenting a rare case of actinomycosis involving the parotid gland and coronoid process of mandible in a young child where diagnosis was made based on histopathological findings since the classical clinical manifestations of actinomycosis, were absent in the case.