Diatoms: A novel cause of granulomatous inflammation of the head and neck.

OBJECTIVE: We report the first 4 cases of intraoral nonnecrotizing granulomatous foreign body reactions to diatoms, plausibly as a result of exogenous material introduced following iatrogenic or traumatic injury. STUDY DESIGN: Clinical and histopathologic findings of 4 intraoral cases of nonnecrotizing granulomatous foreign body reaction to diatoms, single-celled algae belonging to the taxonomic phylum Bacillariophyta, are reported. RESULTS: The lesions presented either in the jaws or in the soft tissue overlying the alveolar bone, in some instances mimicking an inflammatory lesion of odontogenic etiology. Microscopically, the lesions presented as nonnecrotizing granulomatous inflammation associated with either spherical and radially symmetric or rectangular and bilaterally symmetric diatomaceous foreign material. CONCLUSION: The diagnosis of a diatom-associated foreign body reaction necessitates familiarization with the histopathologic features of these organisms to accurately characterize the nature of such lesions.

Idiopathic gingival papillokeratosis with crypt formation, a report of 7 cases of a previously undescribed entity: possible unusual oral epithelial nevus?

We report 7 cases of hitherto undescribed keratotic papillary plaques of uncertain etiology involving the gingiva. All 7 cases presented on the anterior maxillary attached gingiva of patients in the second decade. The lesions were asymptomatic and 86% (6 of 7 cases) presented in a bilateral symmetric distribution. Microscopically, the lesions exhibited parakeratosis and papillary acanthosis with parakeratin-filled crypts. No specific etiology such as a factitial habit or a common exogenous agent has been identified. The possibility of a developmental etiology such as an oral epithelial nevus cannot be entirely excluded. We propose the descriptive term idiopathic gingival papillokeratosis with crypt formation (IGPC) for this condition.

Oral lichen planus pemphigoides: a series of four cases.

OBJECTIVE: Lichen planus pemphigoides (LPP), which is a rare autoimmune blistering mucocutaneous disease of the pemphigoid family of diseases, is characterized by the development of vesiculobullous lesions on or adjacent to the areas of lichen planus (LP). LPP primarily affects the skin, and oral involvement alone is rare. The objective of this case series was to report four new cases of oral LPP. STUDY DESIGN: We present four cases with clinical, histologic, and direct immunofluorescence (DIF) features characteristic of LPP, with three cases having oral involvement only. RESULTS: The four patients (including two males) were aged 49, 50, 51, and 61 years; only one patient had skin lesions. All patients had typical reticular, erythematous, or ulcerative oral LP involving the gingiva and the buccal mucosa. Mucosal biopsies showed features consistent with LP, mucous membrane pemphigoid (MMP), or a combination of both, and DIF studies in all 4 cases showed linear deposition of immunoglobulin G (IgG) and C3 at the interface. CONCLUSIONS: Correlation of clinical findings, routine histopathology, and DIF studies is essential for the diagnosis.

Granulomatous foreign body reaction to dermal cosmetic fillers with intraoral migration.

OBJECTIVE: We report intraoral granulomatous foreign body reactions in patients treated with calcium hydroxylapatite (CHA) or poly-l-lactic acid (PLA). STUDY DESIGN: Clinical and histopathologic data were obtained from 25 patients who developed orofacial nodules or swelling after dermal filler injections. RESULTS: All 25 patients were women aged 35 to 78 years (median, 55 years). All had a history of injection of CHA (n = 13) or PLA (n = 12) to the lips, nasolabial area, or mental area. Two patients developed cutaneous nodules at the sites of injections; all others presented with intraoral nodules (labial/buccal or vestibular mucosa) distant from the site of injections, suggestive of filler migration. Five of 21 cases presented with pain. Histopathologically, CHA presented as a diffuse mass of mauve-gray or beige, nonrefractile spherules, and PLA as rice- or spindle-shaped, geometric, refractile bodies within circumscribed nodules. CONCLUSIONS: Cutaneous injections of CHA and PLA fillers may induce granulomatous reactions presenting as intraoral nodules distant from the injection sites.

Mucosal pigmentation caused by imatinib: report of three cases.

Imatinib mesylate (STI-571, Gleevec(®)), a tyrosine kinase inhibitor, is a first-line medication for treating chronic myeloid leukemia (CML). Clinical studies revealed very good hematological responses without significant side effects. However, imatinib may lead to mucosal pigmentation. Three patients, two males aged 64 and 53 and one female aged 29 presented with a painless, diffuse, grey-blue pigmentation of the mucosa of the hard palate. Both male patients had a history of CML and had been on imatinib for 4 and 10 years, respectively. The female patient had been on imatinib for 4 years for pelvic fibromatosis. Histopathologically, deposition of fine, dark-brown, spherical granules was noted within the connective tissue. There was no inflammation or hemorrhage, and no melanosis or melanocytic hyperplasia in the epithelium. The granules stained positively for both Fontana-Masson and Prussian blue stains. Imatinib-induced pigmentation is similar to that caused by other medications such as minocycline and anti-malarial medications, namely the deposition of a drug metabolite containing melanin and iron.