Cemental tear: An overlooked finding associated with rapid periodontal destruction. A case series.

Cemental tear is defined as cementum fragment completely or partially detached from the root surface, and it has been associated with localized rapid periodontal breakdown. Although history of trauma and/or attrition may be risk factors, the etiopathology of cemental tear remains unknown. This case series aims to discuss the clinical, radiographic and histopathologic features of cemental tears to aid clinicians in making differential diagnosis. Three teeth from three patients presenting a periradicular lesion underwent an exploratory surgery to determine the cause and provide treatment. Soft and hard tissue biopsies were obtained from each lesion and forwarded for histopathologic evaluation. Two patients received a guided tissue regeneration (GTR) procedure, which allowed the tooth to be retained. One patient received an extraction with simultaneous guided bone regeneration (GBR) due to a hopeless prognosis of the tooth. The results after histopathologic evaluation yielded a final diagnosis of cemental tear for all three patients. Cemental tears may be overlooked, and therefore, they should be included in the differential diagnosis of periapical periodontitis, endodontic-periodontal lesion and vertical root fracture (VRF).

Spindle cell hemangioma (hemangioendothelioma) of the head and neck: case report of an unusual (or underdiagnosed) tumor.

Spindle cell hemangioma (SCH), also known as spindle cell hemangioendothelioma, is a unique vascular tumor with combined microscopic features of both a cavernous hemangioma and Kaposi sarcoma. It almost exclusively affects the dermis and subcutis of the distal extremities. A review of the literature disclosed only 5 cases of SCH reported in detail in the soft tissues of the head and neck. An additional case of SCH manifesting as a submucosal nodule in the upper lip of a 29-year-old woman is presented. Because this is the second case reported from the same institution, it is suggested that SCH is an underdiagnosed lesion.

Canine heparan sulfate sulfamidase and the molecular pathology underlying Sanfilippo syndrome type A in Dachshunds.

Heparan sulfate sulfamidase (HSS) is a lysosomal exohydrolase that, when deficient, results in intralysosomal accumulation of heparan sulfate and the clinical phenotype of Sanfilippo syndrome type A. The first animal disease homolog of human Sanfilippo syndrome type A has been recently indentified in Dachshund littermates. To identify the molecular defect, the nucleotide sequences of the normal canine HSS gene and cDNA were determined using PCR-based approaches. The coding region showed 87% nucleotide homology, and 89% amino acid sequence homology, with human HSS. All exon-intron borders were conserved. Sequence analysis of the entire coding region with exon-intron boundaries was performed in the propositus, a healthy littermate, and six unrelated normal dogs. Comparison revealed a 3-bp deletion, 737-739delCCA, resulting in the loss of threonine at position 246 in both alleles of the propositus and in one allele of a healthy littermate. Prediction of the three-dimensional structure of canine HSS, based on homology with human arylsulfatases A and B, suggested the pathogenic effect of this deletion. Six other sequence variations in exons, and 10 in introns, appear to be benign polymorphisms. This study supports the potential development of a canine model of Sanfilippo syndrome type A to evaluate gene therapy for this disorder.

Solitary fibrous tumor of the oral cavity: an uncommon location for a ubiquitous neoplasm.

Solitary fibrous tumor is an uncommon soft tissue tumor initially reported in the pleura but recently described in other sites of the body. To date, only 5 examples of oral solitary fibrous tumor have been reported. Here, we describe 2 additional cases of this tumor in the oral cavity. The tumors were composed of small to medium-sized spindle cells with bland cytologic features; these cells were haphazardly arranged in highly cellular sheets or ill-formed fascicles as well as in hypocellular areas with hyalinized blood vessels. Both tumors contained blood vessels with a hemangiopericytomalike appearance and expressed vimentin, CD34, and CD99. One case was also strongly positive for bcl-2. The diagnosis of solitary fibrous tumor may be difficult inasmuch as it shares a number of histologic features with other soft tissue tumors. Awareness of its occurrence in the oral cavity is important so that confusion with other spindle cell neoplasms can be avoided.

Multiple schwannomas, multiple nevi, and multiple vaginal leiomyomas: a new dominant syndrome.

We report on a family of seven affected with a new syndrome of multiple deep schwannomas, multiple nevi (both intradermal and compound types), and multiple leiomyomas of the vagina. Inheritance is dominant, whether autosomal or X-linked cannot be determined at this time. The nevi, which are congenital, appear to be a marker for the syndrome. Both the schwannomas and leiomyomas do not manifest until adulthood.

Labeling of calcitonin gene-related peptide and substance P increases in subnucleus caudalis of rabbit during maxillary sinusitis.

Calcitonin gene-related peptide-like immunoreactivity (CGRP-LI) and substance P-like immunoreactivity (SP-LI) were evaluated in subnucleus caudalis following induction of sinusitis. Three days after induction, intensity of labeling for CGRP-LI and SP-LI increased in ipsilateral subnucleus caudalis. Labeling for CGRP-LI and SP-LI appeared normal at later time points (20 and 28 days). Early changes in these neuropeptides may contribute to the inflammatory process and painful symptoms accompanying sinusitis.

Epithelioid leiomyoma of the oral mucosa.

Oral leiomyomas are rare because of the paucity of smooth muscle in the mouth. The solid and vascular types are the most frequent variants. The purpose of this article is to present the pathologic features and differential diagnosis of an example of epithelioid leiomyoma. A 50-year-old woman presented with a small raised nonpainful polypoid lesion of unknown duration on the right buccal mucosa. The tumor was well demarcated and consisted of large epithelioid cells with distinct cytoplasmic borders, round to oval nuclei, and prominent nucleoli. A few mitoses (4 in 20 high power fields) were present. Scattered spindle cells were also seen. The cytoplasm was eosinophilic to amphophilic and showed frequent clearing and retraction. Small capillaries were identified and surrounded by neoplastic cells that gave the lesion an angiomyomatous appearance. Masson trichrome stain highlighted focally smooth muscle cells. Immunohistochemical evaluation revealed staining for vimentin, desmin, and muscle-specific actim.

Respiratory scleroma: a clinicopathologic and ultrastructural study.

Respiratory scleroma (rhinoscleroma) is a chronic granulomatous infection produced by Klebsiella rhinoscleromatis, a gram-negative aerobic coccobacillus. This disease is endemic to Africa, Central and South America, South Central and Eastern Europe, the Middle East, and China. Sporadic cases have been reported in the United States, especially in persons who migrated from the aforementioned areas. The majority of cases affect the nose, but extension to the soft and hard palate, upper lip, and maxillary sinuses also is frequent. This study comprises 11 patients (6 females and 5 males) with respiratory scleroma identified over a 6-year period in Guatemala. Their ages ranged from 16 to 60 years. Light microscopy showed a dense plasmacytic infiltrate, Mikulicz histiocytes, and Russell bodies within the plasma cells. Ultrastructural study revealed Mikulicz histiocytes, cytoplasmic vacuoles containing bacilli, and so-called A and B granules. We favor the term respiratory scleroma for this lesion because it affects not only the nose but also the upper and lower respiratory tracts as well as the mouth.

Spindle-cell hemangioendothelioma of the oral cavity. A case report.

We describe a vascular tumor classified as SCH by histological criteria that was found in the mandibular-buccal fold of a 12-year-old girl. Microscopically, the lesion consisted of thin-walled cavernous spaces containing thrombi and phleboliths, and cellular areas composed of spindle-shaped, epithelioid and vacuolated cells. Immunohistochemically, the endothelial vascular lining was highly reactive with HAM56 antibody, while variable reactivity was observed for factor VIII-associated antigen. All cell types were positive for vimentin and anti-PCNA stained less than 3% of the tumor cells. This is the first report of SCH in the oral cavity.

Intravascular papillary endothelial hyperplasia of the oral soft tissues: report of 18 cases and review of the literature.

PURPOSE: Intravascular papillary endothelial hyperplasia (IPEH) is a benign, nonneoplastic, vascular lesion, that is characterized histologically by papillary fronds lined by proliferating endothelium: it is thought to represent an unusual form of organizing thrombus. It may develop in a distended vessel or in association with other vascular lesions. The main significance of IPEH is its microscopic resemblance to angiosarcoma and possible misinterpretation as such. METHODS: We report the clinicopathologic features of 18 examples of IPEH of the oral soft tissues and lips, and review such features of 55 previously reported oral cases. RESULTS: The lips and tongue were most frequently involved and a female predilection was evident. Histologically, the pure form of IPEH was more commonly encountered. CONCLUSION: The differential diagnosis and possible histogenesis of the lesion are discussed.

Arteriovenous hemangioma: a clinicopathological and immunohistochemical study.

The clinicopathological and immunohistochemical properties of 6 examples of arteriovenous hemangioma, including 2 intraoral lesions, were reviewed. This distinct benign, acquired vascular lesion, infrequently encountered in the literature, is characterized by multiple thick- and thin-walled vascular spaces resembling arteries and veins, respectively. In our study, we performed elastic stains that revealed a prominent venular component, whereas the arterial aspect was inconspicuous to absent. Our aim was also to elucidate the possible histogenesis of this lesion. Previous reports suggest as pathogenetic mechanisms hamartomatous proliferation either of the subpapillary vascular plexus or of the Suquet-Hoyer canal of the true glomus. Our immunohistochemical studies failed to identify typical glomus cells. In addition, we investigated the mast cell count in all lesions and it was found increased. These findings, as well as recent evidence directly implicating mast cells in angiogenesis, can support the theory of hamartomatous proliferation of the subpapillary plexus. One should also not exclude the possibility of a reactive process resulting in the characteristic features of arteriovenous hemangioma.

Oral sebaceous retention phenomenon.

An unusual lesion associated with obstruction of ectopic sebaceous glands of the retromolar mucosa is presented. Histologically, this was associated with mucus-producing and respiratory metaplasia of the sebaceous ducts that also demonstrated microcyst formation. Sebaceous glands were hyperplastic. A review of the literature did not reveal a similar published example.