Multiple radiolucent areas of the jaw.

A case of neurofibromatosis, or von Recklinghausen's disease, was presented. The skin manifestations include the development of numerous, variable sized, smooth-surfaced nodules (benign neural tumors) and asymmetric areas of hyperpigmentation called cafe-au-lait spots. Oral manifestations are not always apparent but, when they do occur, include multiple, discrete, nonulcerated mucosal nodules (typically benign neural tumors). Intraosseous tumors (usually neurofibromas) occasionally develop in the mandible as was reported in this patient. Clinicians should be aware of the characteristics of this hereditary disease, especially the possibility of malignant transformation of the neural tumors.

Multiple radiopaque masses in the jaws.

In this report, the less common oral findings occurring in Gardner's syndrome are described, which occurred concurrently with colorectal polyposis. In addition, what clinically appeared as small intestinal polyps, microscopically represented nodular lymphoid hyperplasia, as reported in the literature. Review of the literature showed the oral findings reported here are not common and that enzyme assays can help detect polyps at an early stage of this complex syndrome.

Exophytic mass of the floor of the mouth.

A tissue mass in the floor of the mouth was found to be an unusual, exophytic squamous cell carcinoma. The patient also had synchronous hepatic metastasis from an occult primary adenocarcinoma. The case is discussed from the standpoint of the differential diagnosis of lesions that may appear as masses of the floor of the mouth. Individuals with one primary cancer are at increased risk for developing second malignancies which may be in either the same anatomic area or in other organ systems. This case report emphasizes the need for the clinician to periodically follow-up any patient with a history of malignancy.

Facial asymmetry.

A case of monostotic, mandibular fibrous dysplasia has been described in a 22-year-old Amerasian male, who had facial asymmetry of approximately 5 years' duration. Foci of ill-defined sclerotic, pagetoid calcifications were seen on routine film. The CT scans demonstrated bone facial and slight lingual expansion of bone with thinning of the cortex. A three-dimensional, enhanced CT film showed that this lesion was greater than 4 cm. The clinical, radiologic, and microscopic features of fibrous dysplasia have been described.

Rapidly expanding pigmented lesion of the buccal mucosa.

A case of oral melanoacanthoma was presented. The differential diagnosis of pigmented lesions of the oral mucous membrane includes a wide variety of categories of disease including local and systemic manifestations of hereditary and developmental conditions, reactive and inflammatory lesions, neoplasms, and metabolic diseases. For some of these lesions the histopathological pattern is diagnostic; for others, the tissue structure and organization are nonspecific and intelligent evaluation requires clinicopathological correlation. This discussion of oral mucosal pigmented lesions emphasizes the importance of the clinical parameters in the differential diagnosis of this group of lesions.

White plaque of the dorsal tongue.

A case of oral lichen planus has been discussed. The causes, associated conditions, laboratory tests, and treatment were addressed. The use of cyanoacrylate "super glue" may have acted as a contactant and promoted the patient's localized lichenoid process. No additional treatment was provided other than confirmation of clinical suspicions. The most important factor was ruling out the possibility of a dysplastic or a malignant process. Should the patient become symptomatic, the treatment would probably start out with kaolin and pectin (Kaopectate) lidocaine/benadryl rinses. Should supportive therapy fail, alternative regimens including topical to systemic corticosteroids would be considered.

Mixed density lesion of the anterior maxilla.

A case of COC which developed as a mixed lucent-opaque lesion in the anterior maxilla of a young person is discussed from the standpoint of clinical and radiographic differential diagnosis. Current concepts of the pathology of the COC and EOGCT are discussed.

Aggressive (malignant) epithelial odontogenic ghost cell tumor.

A 57-year-old man had an expanding cystic lesion of the anterior maxilla that demonstrated destruction and disruption of local structures. A cystic odontogenic neoplasm as well as various forms of odontogenic carcinoma was suspected. Incisional biopsy and microscopic examination revealed an aggressive epithelial odontogenic tumor with histologic features suggesting malignant transformation from an odontogenic cyst. The patient continues to refuse further treatment despite remaining tumor. This case further documents the malignant potential of a calcifying odontogenic cyst and the existence of at least an aggressive or possibly malignant form of epithelial odontogenic ghost cell tumor. To date, metastatic work-up has not been performed.

Cylindrical cell papilloma. Report of a case with light and ultrastructural analysis.

The clinicopathologic features of an additional case of cylindrical cell papilloma are reported. This tumor is relatively rare, with approximately twenty cases recorded under that name in the literature. Surgical correction of papillomas in the nose and paranasal sinuses is discussed. Ultrastructural analyses suggest that cylindrical cell papilloma may possibly be an oncocytic lesion and thus different from the inverted and fungiform types.

Enzyme-linked immunosorbent assay for detection of antibodies to Staphylococcus aureus cell walls in experimental osteomyelitis.

An enzyme-linked immunosorbent assay was used to evaluate and compare the immunoglobulin G antibody response to Staphylococcus aureus cell walls of rabbits with either chronic staphylococcal osteomyelitis or subcutaneous abscesses. Osteomyelitis of the femur was produced by the intramedullary application of a sclerosing agent (3% sodium tetradecyl sulfate) and S. aureus. Radiographic evidence of osteomyelitis was observed in 10 of the 13 animals that survived the 10-week experimental period, and the diagnosis was confirmed by histopathology in 8 of the 10 instances. Abscess formation was initiated in a separate group of rabbits by the subcutaneous injection of S. aureus cells. All 10 of these rabbits subsequently developed abscesses, which usually resolved spontaneously within 3 to 5 weeks. Elevated levels of immunoglobulin G antibodies to the cell wall antigen were detected in 7 of 10 rabbits with osteomyelitis at 21 days postinfection, and these animals continued to display high antibody levels even at 59 days postinfection. In contrast, elevated levels of anti-cell-wall antibodies were only detected in 1 of 10 rabbits with subcutaneous abscesses. The enzyme-linked immunosorbent assay was found to be a rapid and sensitive serological technique for the detection of cell wall antibodies in this experimental osteomyelitis model and may be useful for the diagnosis of staphylococcal bone infections in humans.