Rare and Extensive Malignant Melanoma of the Oral Cavity: Report of Two Cases.

Primary oral melanomas are uncommon malignant neoplasm of melanocytes origin. The most common site of oral melanoma is maxillary gingiva and hard palate. Oral mucosal melanoma exhibit a pathobiological behavior and clinical features different from cutaneous melanomas. Oral melanomas are often clinically silent which may consequently result in delayed diagnosis; thus, making the prognosis extremely poor. This case report presents clinical, histopathological and immunohistochemical features of two cases of advanced oral melanoma, one pigmented or melanotic melanoma in a 46-year-old female and another amelanotic melanoma in a 59-year-old male patient, with chief complaint of swelling in oral mucosa. Most oral melanomas are usually asymptomatic lesions with quick growing. Thus, the most cases are detected in late stage of diagnosis. Early diagnosis with careful examination by dentists, and early biopsy of pigmented and suspicious non-pigmented lesions would have an imperative role in more survival rate and better prognosis.

Prevalence of Geographic tongue and Related Predisposing Factors in 7-18 Year-Old Students in Kermanshah, Iran 2014.

Geographic tongue is a benign lesion at the dorsum and margins of the tongue that sometimes causes pain and burning sensation. This lesion is characterized by an erythematous area with white or yellow folded edges. The predisposing factors of this lesion include heredity, allergies, psoriasis, stress, fissured tongue and consumption of some foods. The present study was conducted to investigate the prevalence of geographic tongue and its related factors among the 7-18 year-old students in Kermanshah, Iran. This descriptive cross-sectional study was carried out in three schools in Kermanshah using multi-stage random cluster sampling method. A total number of 3600 students were examined (1800 girls and 1800 boys). Demographic data and the results of examinations were recorded in a questionnaire. The factors affecting the incidence of geographic tongue were analyzed by the SPSS-20 software and the Chi-square test.The prevalence of geographic tongue was 7.86% (283 individuals). The incidence of this lesion was significantly higher in males than in females (p<0.01). There was no relationship between geographic tongue and psoriasis or fissured tongue.  Pain and discomfort during eating was more prevalent in those with geographic tounge compared to those without this condition (p<0.02). The prevalence of geographic tongue among the studied population was 7.86%, and the prevalence of geographic tongue in male students was higher than in female students.

Oral focal epithelial hyperplasia: report of three cases.

Focal epithelial hyperplasia or Heck's disease is an infrequent asymptomatic condition caused by human papillomavirus types 13 or 32 affecting the mucous membrane of the mouth and is commonly seen in young individuals. Firstly, it was described in Indians and Eskimos, but it exists in various populations. We present three cases of Heck's disease in an Afghan immigrant family group living in Iran that seem to have familial predominance. The disease was identified as oral focal epithelial hyperplasia on the basis of histopathologic and clinical findings. The lesions were reduced significantly after 4 months of good oral hygiene. Dentists should be familiar with the clinical manifestations of these types of lesions that affect the oral cavity. In fact, histopathologic assessment and clinical observation are necessary to establish the diagnosis.

Ewing's sarcoma in mandibular similar to dental abscess.

Ewing's sarcoma is a rare malignant neoplasm that comprises approximately 4-6% of primary bone tumors. In most cases, femur and pelvis are affected, and less commonly the head and neck areas (in the jaws, usually the mandible). These tumors have been reported more frequently in males, mostly aged 5-20 years old. Systemic symptoms and signs such as fever, weight loss, anemia, leukocytosis, and elevated erythrocyte sedimentation rate (ESR) may be the first signs in oral Ewing's sarcoma. Such signs and symptoms are also seen in odontogenic infections and abscess. In one case, the patient went to a dentist with pain, swelling, and abscess similar to odontogenic infection and patient's tooth was pulled due to misdiagnosis. This tumor has an aggressive clinical behavior and is identified with rapid growth and high probability of metastasis at diagnosis. Thus, it is necessary to differentiate it from a dental abscess. As for the treatment of Ewing's sarcoma, first the tumor must undergo chemotherapy to reduce its size and, eventually, it undergoes extensive surgery. This case report deals with a 16-year-old patient wrongly diagnosed with odontogenic infection and abscess, and hospitalized. As the symptoms did not remit, biopsy was carried out and the patient was operated on with Ewing's sarcoma diagnosis.

Study of apoptosis in oral pemphigus vulgaris using immunohistochemical marker Bax and TUNEL technique.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune mucocutaneous disease presenting clinically with blisters or erosions of the skin and mucous membrane. The main histopathologic characteristic of this disease is suprabasal vesicles due to loss of cell-cell adhesion between keratinocytes named acantholysis. Studies have shown that apoptosis is increased in PV. The purpose of this study is to investigate the role of apoptosis in blister formation in PV. METHODS: This cross-sectional study was conducted on 25 specimens of oral PV. The presence of apoptosis was evaluated using the TUNEL technique in the normal perilesional region, vesicle area, and acantholytic cells. Also, the expression of Bax pro-apoptotic marker was assessed by the biotin-streptavidin immunohistochemical method. SPSS software was used for Wilcoxon test analysis. P values <0.05 were considered significant. RESULTS: The percentage and intensity staining of TUNEL-positive cells were noteworthy. There were statistically significant differences between basal and parabasal (P = 0.05), tombstone with vesicle roof (P = 0.038) and basal with tombstone (P = 0.038). However, the expression and staining intensity of pro-apoptotic marker Bax were weak, and no statistically significant differences were observed between the various areas. CONCLUSION: The results obtained in the present study suggest that the process of apoptosis occurs early in PV because it was observed in the perilesional normal appearing tissue. Also, the process of apoptosis may cause exacerbation or speeding of the bulla formation. In other words, inhibition of apoptosis in the patients could reduce the severity of the lesions.

The role of VEGF in melanoma progression.

BACKGROUND: Melanoma is the most serious skin cancer. There is an established correlation between thickness and aggressiveness of the tumor. Nevertheless, the potential value of vascular endothelial growth factor (VEGF) in correlation with tumor progression remains unresolved. MATERIALS AND METHODS: Thirty seven paraffin blocks of cutaneous melanoma were obtained from Pathology department of Al-zahra hospital between 2005 and 2010. The sections were stained with monoclonal mouse antibodies (mAbs) against vascular endothelial growth factor A and evaluated by distribution of expression of VEGF in tumor cells as 0, 0%; 1, 1%--25%; 2, 25%--50%; 3, >50% and the staining intensity from 0 (negative) to 3 (strong). The sum of intensity score and distribution score was then calculated as the VEGF index. The relationship between VEGF expression (distribution, intensity, and index) and tumor progression (vertical and radial growth, Clark's level, and Breslow's depth) was studied. SPSS software was used to analyze the data by ANOVA, and chi-square tests. RESULTS: 51.4% of the patients showed vertical growth pattern. Mean Breslow's depth was 1.84 ± 1.79 mm. There was a significant association between growth pattern and VEGF distribution, intensity and index (P = 0.006, P = 0.005, and P = 0.001 respectively). VEGF distribution, intensity, and index all had correlation with Breslow's depth as well (ANOVA test: P = 0.003, P < 0.001, and P < 0.001 respectively) VEGF index had also correlation with Clark's level, but this was not seen for VEGF distribution and intensity. CONCLUSION: VEGF expression (both VEGF distribution and intensity) is associated with progression of malignant melanoma. VEGF index can explain this association better.