S-100 Negative Granular Cell Tumor of the Oral Cavity.

Classic granular cell tumor is a mesenchymal neoplasm that commonly occurs on the skin, but is not infrequently found in the oral cavity, primarily on the dorsal tongue. Diagnosis is usually straightforward with hematoxylin and eosin stained slides. Immunohistochemical studies on classic granular cell tumor shows positive immunostaining for S-100 and vimentin, while CD68 is variably positive. We report a case of otherwise unremarkable oral granular cell tumor that was immunohistochemically negative for S-100, and positive for vimentin and CD68, and discuss the differential diagnosis. The results of the immunohistochemical studies in our case are compared with those of classic S-100 positive oral granular cell tumors, as well as cutaneous and oral S-100 negative granular cell tumors. Classic S-100 positive granular cell tumors and S-100 negative granular cell tumors of the oral cavity can only be distinguished by immunohistochemical studies; however, the necessity of this distinction is unclear, as both are benign lesions in which recurrence is unlikely.

Management of the anxious dental patient.

The anxious patient in the dental office reacts with panic and inability to cooperate with necessary treatment. It is the dentist's responsibility to recognize and assuage the patient's anxiety on both psychological and medical levels. The diagnosis, etiology and treatment of anxiety will be investigated and presented as any other disease entity. It is an illness that contributes to dental neglect and subsequent pain, disease and dysfunction. The purpose of this paper is to discuss the recognition and etiology of patient anxiety and to offer treatment solutions and behavior modification techniques. The discussion will include psychological insight as well as the use of anxiolytics and nitrous oxide-oxygen (N2O-O2) sedation to ameliorate the symptoms. Finally, a presentation will be made of the modern application of philosophic dicta of Plato and Aristotle in which the doctor is considered a philosopher who values the concept of self-healing based on the doctor-patient relationship. These techniques and concepts of totality in diagnosis and treatment are applicable today just as they were 17 centuries ago.

Ghost cell odontogenic tumor associated with odontoma--report of two rare cases.

The ghost cell odontogenic tumor (GCOT) is a neoplastic/cystic lesion with a diverse histopathological and clinical behavior It was formerly known as calcified odontogenic cyst, but in 2005 the World Health Organization categorized this lesion as an odontogenic, benign tumor rather than a cyst; nominating this neoplasm as calcifying cystic odontogenic tumor. A later comprehensive classification named it ghost cell odontogenic tumor because the most remarkable histopathologic characteristic is the presence of a mass of ghost cells embedded in the epithelium. We report two cases of a rare variant of a ghost cell odontogenic tumor associated with odontoma; to our knowledge, one is the youngest patient (four month old) reported in the English literature.

Submandibular gland MALT lymphoma associated with Sjögren's syndrome: case report.

Lymphoma is a common disease of the head and neck. Mucosal-associated lymphoid tissue (MALT) lymphoma constitutes a rare type of extranodal lymphoma. The Waldeyer's ring is one of the most common sites of occurrence, but MALT lymphoma may also arise in salivary glands, lung, stomach, or lacrimal glands. In the oral cavity, it may be confused with swellings from dental infection or sinus inflammation. Often, the patient will seek a dentist because of mobile teeth or because a denture no longer fits. We report a case of a female patient with salivary gland dysfunction and pain of several years' duration, who, after numerous tests and hospitalizations, was diagnosed with Sjögren's syndrome. She later developed mucosal-associated lymphoid tissue lymphoma. We discuss the diagnosis, treatment, and prognosis of this entity. MALT lymphoma is rare in salivary glands. In primary-Sjögren's syndrome, predisposition of the patient for development of malignant non-Hodgkin's lymphoma (4% to 10%) is well established. In this case, long-standing sialadenitis and Sjögren's syndrome seem to be the etiological factors. In cases of chronic infection of salivary glands and the presence of autoimmune syndromes, MALT lymphoma should be considered in the differential diagnosis. Consults should be called to ophthalmology, rheumatology, and head and neck oncologists for proper workup, staging, and treatment.

Primary maxillofacial large B-cell lymphoma in immunocompetent patients: report of 5 cases.

Lymphomas of the oral cavity represent 5% of all lymphomas. They usually occur in immunocompromised patients. Lymphoma arising within a single bone, without visceral or lymph node involvement, is known as primary intraosseous lymphoma. It is a rare condition and constitutes 3.1% of malignant bone tumors and 5% of extranodal lymphomas. Primary lymphoma of the jaw is seldom seen and it is often misdiagnosed. Clinically, the manifestations are usually similar to an odontogenic tumor, cyst, or infection. Radiographically it appears as a radiolucent area that may mimic endodontic lesion, periodontal pathology, or odontogenic cyst or tumor. The initial presentation is commonly followed by multiple unnecessary extractions and/or root canal treatments. We present five cases of rare primary lymphoma of the maxillofacial complex, four of them intraosseous.

Brown tumor as a result of hyperparathyroidism in an end-stage renal disease patient.

A 49-year-old male with known history of end-stage renal disease (ESRD) presents with an intraoral exophytic mass of the right mandible. This lesion was given a histologic diagnosis of a Brown tumor. Purpose. To allow physicians to include this lesion in a differential diagnosis when evaluating patients with primary, secondary, or tertiary hyperparathyroidism.

Clinical variant of ablepharon macrostomia syndrome.

Ablepharon syndrome is an extremely rare genetic problem that causes severe craniofacial deformities and numerous other abnormalities of the face, genitalia, and skin. The literature regarding this condition is scarce. We present a case of this syndrome with dental manifestations, not reported before, and discuss its characteristics in order to increase the knowledge of this condition among the dental profession.

A holistic approach to a rare pathology.

A case of cystic hygroma (CH), a congenital lymph-filled multicystic hamartoma of the neck, with a holistic approach to patient management is presented. The stigma of the CH imposed by attending physicians, dentists, parents, teachers and peers affected the psychological development of this patient since her diagnosis in childhood. Although surgery relieves the threat of airway obstruction and may improve the esthetic appearance of the CH, the patient may be isolated and traumatized by the ignorance and superstitions of the individuals she encounters on a daily basis.

Pigmentary demarcation lines (Futcher lines): an orofacial case.

Pigmentary demarcation lines are rare physiologic pigmentations shaped as lines of deeper discoloration with abrupt transition from less pigmented areas. These lines are known and seen by dermatologists in the skin of African, Indian, and Japanese patients, usually females. No report of intraoral pigmentary demarcation lines was found in the literature. This article presents a rare case of pigmentary demarcation lines of the skin of the face and oral mucosa, which should be of interest to the general dentist.

Cryopreserved amniotic membrane for modulation of periodontal soft tissue healing: a pilot study.

BACKGROUND: The purpose of this randomized study is to evaluate cryopreserved amniotic membrane (CAM) for helping cicatrization and wound healing after dental implant surgery. Epithelialization, pain, infection, inflammation, and scarring were studied. METHODS: CAM was placed in surgical wounds related to implant surgery. The extent of healing was evaluated by a masked investigator for lesion size, epithelialization, pain, infection, inflammation, and scarring. A clinical evaluation occurred at baseline, 72 and 144 hours, 2 weeks, and 1, 1.5, and 3 months. The results were compared to conventionally managed, similar lesions that were treated the same day in the same patient allowing each patient to serve as their own control. RESULTS: This prospective randomized study showed statistically significant differences between experimental and control groups regarding cicatrization, wound healing, and pain. The effects of the membrane were statistically significant during the first 3 weeks of the study, and thereafter, the effects of the membrane for the two groups were equivalent. CONCLUSIONS: CAM was effective in helping cicatrization and wound healing. CAM supported the growth of the epithelium and, thus, facilitated migration and reinforced adhesion. It also decreased the pain of subjects. Regarding dental implants, the use of CAM is not cost effective. New studies evaluating other oral conditions are encouraged.

Toxic epidermal necrolysis. A case report.

We present an extreme case of Toxic Epidermal Necrolysis, which corresponds to a severe form of Stevens Johnson Syndrome. This is a potentially fatal immune reaction that affects skin and mucosa, producing blisters and sloughing of the epithelium. Severe sequelae, including blindness, hearing loss, tooth malformation and esophageal destruction are seen in this case.

Conservative treatment of a pathologic fracture in a patient with Gorham-Stout disease.

Gorham-Stout disease, or massive osteolysis, is an extremely rare idiopathic condition characterized by spontaneous, localized relentless resorption of one or several contiguous bones. There is no known successful treatment. Autologous bone graft also resorbs. It is a condition with difficult diagnosis, treatment, and prognosis. We report an extreme case of massive osteolysis of the maxillofacial complex. Unique to this case is that the patient presented with a mandibular fracture, and was taking alendronate (Fosamax), one of the treatment options for patients with Gorham-Stout disease. We discuss our treatment and add to the growing list of patients who have presented with this devastating disease.

Hereditary osteodystrophy with multiple hormone resistance--a case report.

Hereditary Osteodystrophy, also called pseudohypoparathyroidism, Type 1A (PHP), is a very rare condition composed of a heterogeneous group of autosomal dominant disorders with the common feature of organ resistance to multiple hormones. These patients produce the right amount of hormones but there is resistance to its effect. PHP is difficult to diagnose and the lack of diagnosis may have serious implications for the patient. We report a case of PHP, diagnosed by the dentist, due to the dental and jaw manifestations.

Odontogenic carcinoma differentiation into rhabdomyosarcoma: report of a rare case.

To the authors' knowledge, this is the first reported case of an odontogenic carcinoma with documented skeletal muscle differentiation (rhabdomyosarcoma). The histology and clinical features of this aggressive odontogenic neoplasm are described. Within the English-language literature, only 2 cases are reported of an odontogenic tumor with muscle differentiation: a benign odontogenic tumor (ameloblastoma) with differentiation into a rhabdomyosarcoma and an odontogenic sarcoma with smooth-muscle differentiation. The general practitioner should be aware that odontogenic lesions may be malignant, even though this is extremely rare, and all tissue removed from the oral cavity should be submitted for biopsy.

Central mucoepidermoid carcinoma with an atypical radiographic appearance.

Central mucoepidermoid carcinoma (CMC) is a rare osseous neoplasm occurring most often in the fourth to seventh decades of life. Its usual presentation is one of a locally destructive radiolucent lesion found primarily in the mandible, in the premolar region. No reported case to date has shown a mixed radiolucent-radiopaque expression of this tumor. The objective of this article is to report such a case: a CMC that presented an atypical radiographic appearance of a mixed lesion.

Osteoid osteoma of the zygoma: report of an unusual case.

BACKGROUND: Osteoid osteoma is a benign tumor of bone characterized by pain, usually occurring at night, that shows a dramatic response to aspirin. The literature contains reports of only a few cases in the head and neck region. CASE DESCRIPTION: The authors present an unusual case of an osteoid osteoma of the craniofacial bones. The patient sought an evaluation of pain in the area of the right zygoma. One of the authors, an oral and maxillofacial surgeon, noted a small area of swelling. The patient underwent radiographic, computed tomographic and nuclear medicine studies. On the basis of the images and the biopsy report, the authors made a diagnosis of osteoid osteoma. In this article, they describe the treatment of and new modalities of therapy for this condition. CLINICAL IMPLICATIONS: The general dentist should be aware of any lesion that is not common. If the generalist has any doubt about the nature or management of an unusual oral lesion, referral to appropriate specialists is mandatory.