Vulvovaginal-gingival Lichen Planus: Association with Lichen Planopilaris and Stratified Epithelium-specific Antinuclear Antibodies.

Vulvovaginal-gingival lichen planus (VVG-LP) consists of a triad of symptoms: vulval, vaginal and gingival lichen planus lesions. The aim of this study was to analyse the prevalence of lesions in various anatomical locations in patients with VVG-LP. The study included 126 consecutive patients with lichen planus. Sixteen (12.7%) patients fulfilled the criteria of VVG-LP. In 12/16 (75%) patients with VVG-LP scalp lesions were also observed. Stratified epithelium-specific antinuclear antibodies (SES-ANA) and anti-ΔNp.3α antibodies were detected in 10/16 (75%) patients with VVG-LP and in 15/110 (13.6%) patients with other forms of lichen planus (p < 0.05). In conclusion, VVG-LP is frequently associated with lichen planopilaris. The new entity may be termed "vulvovaginal-gingival-pilar lichen planus" and our study indicates that SES-ANA is a marker of this type of lichen planus with extensive, severe and refractory-to-therapy involvement of the mucous membranes, skin and scalp.

Sensitivity of direct tissue fluorescence visualization in screening for oral premalignant lesions in general practice.

Various specialty clinics and research centers have conducted studies of direct tissue fluorescence visualization as a screening technique for oral premalignant lesions and early oral squamous cell carcinoma (OSCC). The effectiveness of the VELscope in a private practice setting is unknown. This pilot study is the first report to assess the VELscope system as a screening adjunct among lower-risk populations seen by a primary care clinician in a general practice setting. This study involved a retrospective comparison of two oral cancer screening examination protocols conducted on a presumably low-risk patient population seen in a private general dentistry practice. For one year, all patients age 12 or older received oral examinations, according to a standard oral cancer screening protocol. The following year, the same population was examined according to the same protocol with the addition of direct tissue fluorescence visualization using the VELscope. Screening with incandescent light examination yielded a prevalence of mucosal abnormalities of 0.83%, none of wich were premalignant. Screening with incandescent light examination combined with direct tissue fluorescence visualization yielded a 1.3% prevalence of mucosal abnormalities; based on surgical biopsy and histopathologic examination, 83% of these were potentially premalignant epithelial dysplasia.

A clinico-pathologic correlation: primary Ewing's sarcoma of the mandibular body-ramus.

A 15-year-old Asian male was referred to the department of oral and maxillofacial surgery at Tufts University School of Dental Medicine (TUSDM) for evaluation of a radiolucent lesion on the posterior left mandible. The patient was initially evaluated by his primary dentist for pain of two months' duration associated with teeth #17 and 18. Radiographic examination was performed and the panoramic radiograph revealed a radiolucent lesion involving the left mandibular body and ascending ramus, along with resorption of the roots of the predetermined teeth. Considering odontogenic infection, the patient was placed on antibiotics and referred to TUSDM for further evaluation and treatment.

The prevalence and significance of anatomic variance in the mandibular symphysis: a retrospective study.

As computerized tomography (CT) becomes more widespread in implant treatment planning, dentists are bound to encounter more uncharacteristic anatomical conditions in the jaws. This retrospective study examined the prevalence of one such anatomic variance on 78 CT scans of human mandibles. Irregular heterogeneous circular radiopacities with internal radiolucencies were present in a majority (97.4%) of the CT scans examined; however, the phenomenon only appeared pronounced in 28.9% of this group. Bone radiodensity was higher in the regions with the phenomenon as compared with adjacent bone without the phenomenon, which suggested no adverse indications for implant placement.

A diagnostic challenge: anterior variant of mandibular lingual bone depression.

Mandibular lingual bone depressions are considered to be developmental anomalies and most clinicians are familiar with the posterior variant (known as Stafne's bone cavity) that occurs in lingual mandibular molar regions, adjacent to the submandibular gland and below the mandibular canal. The anterior variant of the mandibular lingual bone depression is an asymptomatic bone cavity that occurs adjacent to the sublingual gland in the anterior mandible. Radiographically, it appears as a well-corticated radiolucency that retains a normal trabecular pattern internally. CT imaging is diagnostic and avoids surgical and sialographic procedures. This article reviews radiographic and CT features of a case involving the anterior variant of mandibular lingual bone depression.

Recurrent recalcitrant gingival hyperplasia and plasminogen deficiency: a case report.

BACKGROUND: Recurrent gingival hyperplasia due to plasminogen deficiency is a rare condition due to fibrin deposition in the connective tissue. Only eight cases have previously been reported in the English literature, and all cases were diagnosed before the age of 35 years. This paper presents an older patient with recurrent gingival hyperplasia due to plasminogen deficiency (hypoplasminogenemia). METHODS: A 59-year-old woman presented with recurrent gingival swelling of 6 years' duration. Multiple biopsies performed at various time periods were histologically reported to be gingival hyperplasia with chronic inflammation. Routine hematoxylin and eosin (H & E) staining and direct immunofluorescence were performed. RESULTS: H & E-stained sections showed subepithelial, eosinophilic, amorphous, acellular deposits. Direct immunofluorescence showed positive staining for fibrin, immunoglobulin (Ig) G, IgA, and IgM. Functional plasminogen and plasminogen activator inhibitor-1 assays were done and found to be deficient. A diagnosis of gingival hyperplasia due to plasminogen deficiency (hypoplasminogenemia) was rendered. CONCLUSIONS: Recurrent gingival hyperplasia due to plasminogen deficiency (hypoplasminogenemia) is a newly recognized and rare condition. H & E staining, direct immunofluorescence, and assessment of functional plasminogen levels are essential to differentiate this condition from other conditions in which subepithelial, eosinophilic, amorphous materials are deposited.

Chronic ulcerative stomatitis: clinical, histopathologic, and immunopathologic findings.

Chronic ulcerative stomatitis (CUS) is a mucocutaneous disease primarily involving mucosal surfaces, but occasionally may involve the skin. Clinically, CUS patients exhibit erosive or ulcerative lesions of the oral mucosa that resemble erosive oral lichen planus. Direct immunofluorescence (DIF) studies of mucosal or skin biopsies reveal a unique pattern of IgG immunoglobulin bound to nuclei of keratinocytes of the basal and lower one third cell layers, the stratified epithelial specific (SES) antinuclear antibody (ANA) pattern. Patient sera also exhibit circulating SES-ANA reactions on indirect immunofluorescence (IIF) using an esophagus substrate. We report the clinical and immunopathologic findings of 3 cases of CUS and demonstrate autoantibody recognition of the CUS antigen on Western blot. An important reason to distinguish CUS from other oral ulcerative conditions is that it may be refractory to standard treatments with topical corticosteroids, and favorable clinical responses may be achieved with hydroxychloroquine pharmacotherapy.

Localized juvenile spongiotic gingival hyperplasia: a report of 3 cases.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a recently described benign condition that affects the gingiva of children and young adults. Clinically distinctive, LJSGH presents as a localized area of erythema on the attached gingiva, with a subtly papillary surface architecture. The lesions are generally biopsied because of the lack of resolution with conservative oral hygiene therapeutic measures and esthetic concerns. The histopathology has a characteristic appearance of subtle papillary epithelial hyperplasia, acute inflammation, and numerous engorged capillary vascular spaces in the lamina propria, although clinical correlation is necessary to make the diagnosis. The purposes of this paper were to: introduce localized juvenile spongiotic gingival hyperplasia to the pediatric dental community; document its clinical and histologic features and treatment and the follow-up of three cases; and discuss the most common clinical differential diagnoses.

Chronic ulcerative stomatitis: evidence of autoimmune pathogenesis.

OBJECTIVES: Chronic ulcerative stomatitis is a condition characterized by chronic, painful oral ulcers, whose pathogenesis is unknown. Patients demonstrate specific IgG autoantibodies against ΔNp63α, an epithelial nuclear transcription factor. The aim of this study was to investigate the role of patient autoantibodies in the disease pathogenesis. METHODS: Three-dimensional in vitro tissues consisting of a fully differentiated, multilayer epithelium that mimics its in vivo counterpart were incubated with serum from patients with chronic ulcerative stomatitis. RESULTS: Our results show a subepithelial detachment of the epithelium at the basement membrane interface, mimicking the oral ulcerations that are seen clinically. Expression of basement membrane proteins Type IV collagen and laminin-5 was unaltered, whereas the expression of α6ß4 integrins, hemidesmosome components that attach basal keratinocytes to the basement membrane, was reduced, as determined by immunohistochemistry. CONCLUSION: These results give evidence that patient autoantibodies are pathogenic; and support an autoimmune pathogenesis in chronic ulcerative stomatitis.

Ewing sarcoma of the mandibular condyle: multidisciplinary management optimizes outcome.

BACKGROUND: Ewing sarcoma (ES) is a rare, primary malignancy of bone that occurs in childhood and early adolescence. Improved methods of diagnosis and treatment have dramatically increased survival over the last 20 years. Treatment mainstays are chemotherapy and surgical tumor resection. ES usually occurs in long bones of the axial skeleton; however, it may rarely arise in facial structures, particularly the mandible. In these cases, resection presents a challenging postsurgical reconstruction. METHODS AND RESULTS: We present the clinical findings and management of a case of ES that developed in the left mandibular condyle of a 15-year-old female. Chemotherapy and segmental mandibulectomy were used to achieve local control. An innovative temporomandibular joint reconstruction was successfully accomplished using a microvascular fibular free flap and conchal cartilage graft. CONCLUSION: Multidisciplinary management in diagnosis, treatment, and restoration of function produced an optimal result that eliminated disease and preserved aesthetics and quality of life.

Necrotizing sialometaplasia associated with bulimia: case report and literature review.

Necrotizing sialometaplasia (NSM) is a self-limiting disorder affecting mainly the minor salivary glands. The significance of NSM resides in its clinical and histopathological resemblance to carcinoma. Few cases of NSM associated with eating disorders have been reported to date. We present here the clinical features and histomorphology of an additional case of bulimia-associated NSM closely mimicking an invasive carcinoma. A high index of suspicion and good communication between clinician and pathologist are essential in recognizing this entity and preventing unnecessary surgical therapy.

Clinical and immunopathologic findings in oral lichen planus pemphigoides.

Lichen planus pemphigoides (LPP) is a rare, acquired, immunobullous disorder of skin that occasionally involves oral mucous membranes. Clinical, histologic, and immunopathologic findings of the oral manifestations of LPP are described. Clinical features are lichenoid striae, erosions, and ulcerations involving gingiva and buccal mucosae. Histopathologic features are similar to those of ora lichen planus. Direct immunofluorescence demonstrates linear deposits of immunoglobulin G and complement component C3 along the basement membrane with fibrillar deposits of fibrin at the epithelial/lamina propria junction. Fluorescence overlay antigen mapping and laser scanning confocal microscopy of the biopsy specimen exhibits colocalization of in situ antibodies with beta4 integrin, a marker of the keratinocyte basal plasma membrane and upper lamina lucida, consistent with the location of the bullous pemphigoid antigens. This case report describes a case of LPP that presented exclusively as an oral condition. Lichen planus pemphigoides should be considered in the clinical differential diagnosis of vesiculoerosive oral mucosal diseases.