An oral lesion as the primary clinical manifestation of sarcoidosis.

An oral lesion as the first clinical presentation of sarcoidosis is extremely rare. We present the case of a 39-year-old woman who was referred to the oral and maxillofacial surgery department with a persistent asymptomatic nodular lesion in the hard palate. This was located adjacent to a grossly carious upper first molar and a provisional diagnosis of chronic periapical granuloma was made. An incisional biopsy of the lesion was carried out, which unexpectedly revealed the presence of a non-caseating granulomatous inflammatory reaction. A referral was sent to the respiratory medicine team and a diagnosis was later confirmed of stage II sarcoidosis. This case report highlights the need for clinicians to be aware of all possible causes of oral lesions, including rare manifestations of underlying systemic disease.

Granular cell tumor of the palate: a case report.

Granular cell tumor (GCT) is an infrequent benign neoplasm, which Abrikosoff accurately described in 1926. GCT probably has a neural crest cell origin. We present the clinical and imaging findings in a 45-year-old woman with a GCT involving the palate. CT and MR imaging revealed perineural tumor spread along the greater and lesser palatine nerves. We emphasize the peculiarity of the palatine location and the perineural spread of GCTs.

Regional behavioral variations of epidermoid carcinoma of the head and neck: a study in an animal model.

Regional behavioral differences have been observed clinically in epidermoid carcinoma of the head and neck. An animal model was developed for study, using homograft, transplanted epidermoid carcinoma in Fisher rats. Histopathologic review of tumors of the palate, base of tongue and larynx shows cartilage, arterial wall, surface epithelium and dense connective tissue containing elastic fibers to be relatively resistant to tumor invasion. Muscle, bone, vein and loose connective tissues were easily invaded. This correlates well with the known biochemical and immunological events in tumor invasion and host-tumor interactions. Regional metastasis occurred in two animals with base of tongue tumors. No distant metastases were found.

[A palate tumor revealed by pain]. / Une tumeur du palais révélée par des douleurs.

A 41-year-old female presented in April 1996 with a tumor of the hard palate revealed by increasing left palate pain. Adenoid cystic carcinoma was suspected on clinical and imaging data. Two limited surgical procedures showed a tumor histologically made of small lobules of granular cells, PAS positive and expressing S100 protein, infiltrating some medullary spaces of the palatine bone, consistent with a granular-cell tumour. Pain recurred in the territory of the maxillary branch of the left trigeminal nerve (V2). Imaging showed a tumor of the origin of V2-extending through the foramen rotondum. Two radical interventions in September and in October 2000 showed an infiltrating tumor of the V2 and palatine mucosa, with the same histology. There was no immuno-staining for p53, and less than 5% of nuclei expressed Ki67. Malignant Abrikossof tumors are exceptional, morphologically difficult to differentiate from benign ones, only metastasis proving malignancy. Tumor size above 5 cm, recurrence and infiltrative character are considered pejorative. The value of p53 and Ki67 expression remains controversial. We discuss our observation according to these criteria.

Effect of oral contraceptive on early DMBA carcinogenesis of the rat palatal mucosa.

Experiments were undertaken to find out whether administration of oral contraceptive (OC) per nasogastric tube could accelerate or inhibit early carcinogenesis of the rat palatal mucosa induced by painting 0.5% solution of 7,12-Dimethyl benz (a) anthracene (DMBA) in liquid paraffin. Forty female Sprague-Dawley rats were divided into 8 groups consisting of 5 animals per group. Group I--DMBA; Group II--DMBA + Oral Contraceptive I (13.0gm% Norethindrone + 8.7mg% ethyl estradiol); Group III--DMBA + Oral Contraceptive II (6.5mg% Norethindrone + 4.3% ethyl estradiol). Group IV--Oral Contraceptive I, Group V--Oral Contraceptive II, Group VI--liquid paraffin, Group VII--Corn oil and Group VIII--untreated control. Each animal was sacrificed at 18 weeks, the palatal mucosa degloved, fixed in 10% formal saline, sectioned in paraffin at 5u, stained with Hematoxylin and Eosin and evaluated histologically for features of epithelial dysplasia. Morphometric analysis was performed on epithelial and keratin thickness. Results indicate higher mean grade of epithelial dysplasia for group II when compared to group I (P less than 0.01) thereby suggesting a cocarcinogenic action for the Oral Contraceptive I. Lower dose Oral Contraceptive II was, however, unable to produce any significant mean grade of dysplasia in group III, suggesting further that the cocarcinogenic action of the Oral Contraceptive used was dose dependent. Morphometric analysis shows a decrease (P less than 0.01) in Keratin and palatal epithelium in DMBA treated animals and further decrease (P less than .001) in those two structures when Oral Contraceptive was used in combination with DMBA, suggesting that the cocarcinogenic action of Oral Contraceptive could result from the induced atrophy of keratin/epithelium and subsequent improved access of the DMBA to target cells in the basal layer of the epithelium. It is suggested that Oral Contraceptive accelerated the induction of early DMBA carcinogenesis of the rat palatal mucosa in this study.

Behavior of in vitro grown normal human mucosal epithelial cells and tumorigenic rat cells inoculated into nude mice.

The present study describes the behavior of in vitro grown normal human oral mucosal epithelial cells and that of a tumorigenic epithelial cell line following subcutaneous inoculation into nude mice. A successful recovery of viable human epithelial cell inocula was seen in 25-90% of mice and there was no improvement in recovery rates after addition of fibroblasts. These inocula resulted in cyst formation lined by a 2-6 cell layer unkeratinized squamous epithelium without rete ridges. There was no increase in recovery rate or size of cysts when coinoculated with fibroblasts. The tumorigenic cell inocula were successfully recovered in all cases. Tumors established from these inocula had a low grade of differentiation and were without signs of metastasis. Inocula of tumorigenic cells showed an increased size after addition of fibroblasts to the inocula. The model may be useful in studies of interactions between inoculations of heterologous normal and pathologic cells as well as in studies of differentiation of carcinogen-treated epithelial cells.

True malignant mixed tumors (carcinosarcoma) of salivary glands.

True malignant mixed tumors (carcinosarcomas) of salivary glands are of a high grade of malignancy and are distinguishable from the more frequently occurring carcinomas ex pleomorphic adenoma. Having a putative origin from a benign pleomorphic adenoma, the true malignant mixed tumor is an aggressive, often rapidly lethal neoplasm in which the sarcomatous element is most often a chondrosarcoma and the epithelial element is most often a ductal carcinoma. The twelve cases in this report represent the largest recorded series to date.