Ultrasonographic Diagnosis of Osteochondroma of the Mandible: A Case Report.

Aim of the study: The aim of the present paper is to determine the diagnostic features of the rare presentation of osteochondroma in the mandible. The unusual aspect in this case is that the diagnosis was not established with cone beam computer tomography, which is a commonly used radiographic technique in dentistry, but with the use of ultrasonography. Case description: Ultrasonography is very useful for initial examinations, avoiding patient exposure to additional radiation and setting the diagnosis in debatable soft tissue involvement of various lesions. In the presented case, even though the clinical presentation was indicative, the cone beam computer tomography evaluation could not confirm the diagnosis, so the final diagnosis was made by ultrasonography. Conclusions: With the latest advances in the applications of ultrasonography in the maxillofacial region, an examination of lesions on the floor of the mouth or in the neck area may set the diagnosis in cases where hard tissue imaging does not provide enough information.

Sialolithiasis of minor salivary gland: a challenging diagnostic dilemma.

Minor salivary gland sialolithiasis (MSGS) is a not uncommon oral mucosal disease. Its clinical appearance may mimic a mucocyst or other benign submucosal overgrowth. Stasis of saliva, which accompanies MSGS, usually results in minor salivary gland inflammation, with a chronic sialadenitis appearance. MSGS typically is a painless lesion but can become painful when the salivary gland parenchyma or excretory duct becomes infected, with or without pus. However, misdiagnosis of this condition is rather common, as the clinical appearance is asymptomatic. The most common location is the upper lip, and MSGS affects males and females, with a slight predilection for males. The sialolith causing MSGS may be obvious during surgical excision, as in the case reported. In other cases, sialolith may be absent or fragmented. Differential diagnosis includes mucocele, swelling due to local irritation like fibroma and diapneusia, chronic abscess of the oral mucosa, and neoplasms either benign (lymphangioma, pleiomorphic adenoma) or malignant. Histopathological examination is needed to establish clinical diagnosis.

Angioleiomyoma of the oral cavity: a case report and brief review of the literature.

This study presents a case of an oral angioleiomyoma along with its clinical diagnostic approach and laboratory confirmation. The differential diagnosis, especially from angioleiomyosarcoma, is also included. A 51-year-old patient presented with a tumor-like lesion on his upper labial mucosa. The clinical examination revealed a benign lesion that was surgically removed. Histopathological and immunohistochemical examinations confirmed the diagnosis of an oral angioleiomyoma. The post-surgical period was uneventful. No recurrence had occurred after a year of follow-up surveillance. Oral angioleiomyoma is a very rarely occurring oral lesion. Clinically, it may mimic some benign lesions, including fibroma, pyogenic granuloma or minor salivary gland tumor. Surgical excision is the treatment of choice. Histological and immunohistochemical examination can confirm the diagnosis. The differential diagnosis is crucial to rule out angioleiomyosarcoma.

Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study.

OBJECTIVE: Non-Hodgkin's lymphomas (NHL) are the third most common group of malignant lesions in the oral cavity and maxillofacial region. Most such lymphomas have been shown to be predominantly of B-lineage. The purpose of the present study is to analyze the clinical signs and symptoms and the clinical staging of B-cell NHL of this region. STUDY DESIGN: Eighteen adults, with B-cell NHL manifestations of the oral cavity and maxillofacial region, were available for this study. The clinical stage according to the Ann Arbor system was assessed by history, physical, and laboratory examination. Hematoxylin and eosin--stained slides and paraffin blocks were available for all cases. Histologic diagnosis was based on the WHO classification of tumors. RESULTS: The mean age of patients at the time of biopsy was 64 years. At the time of the disease presentation, according to the Ann Arbor system, 11 patients were in stage IE, 2 patients in stage IIE, 2 patients in stage IIIE, 1 patient in stage IVE, and 2 patients in stage IV. The typical clinical appearance was a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. Tonsillar NHL was the most frequent site occurring in 8 patients followed by NHL of the oral cavity, of the salivary glands, and of the mandible. Grading revealed that most cases were high grade (11 cases), followed by the cases of low grade (5 cases) and intermediate grade (2 cases). All the different histologic types may be observed, but the most frequently encountered is the diffuse large type. CONCLUSIONS: The B-cell NHL may involve both osseous and soft tissues of the oral cavity and maxillofacial region. The favored sites are tonsils, palatal mucosa and parotid glands. The typical clinical appearance is a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. According to the Ann Arbor system, the majority of the cases at the time of diagnosis are in stage I or II. Most patients have high grade disease. All the different histologic types may be observed, but the most frequently encountered is the diffuse large type.

Angiofibrolipoma of the oral cavity.

We describe an unusual and rare case of a lipoma variant known as angiofibrolipoma. A literature search revealed only a few cases of angiofibrolipoma which were located in different anatomical sites; no case of angiofibrolipoma in the oral cavity has been previously reported. We present and discuss the histopatholological-immunohistological findings and features. Angiofibrolipoma histologically consists of mature adipocytes, blood vessels, and bundles of collagenous connective tissue with low to moderate cellularity. It is not encapsulated, but is histologically distinct from surrounding tissue. Positive immunohistological staining with CD-34 presented a large number of blood vessels of different sizes located between collagen fibers and adipocytes. The treatment of choice for a patient with angiofibrolipoma is surgical excision, which is expected to be curative.

Hereditary angioedema: three cases report, members of the same family.

BACKGROUND: This current clinical case report highlights three cases of Hereditary angioedema (HAE) patients who are all members of the same family (father and his two daughters). The father has C1-INH deficiency, while his daughters have low C1-INH levels: the first possesses only 10% function and the second has low C1-INH level with 0% function. Of note, the second daughter was discovered to have HAE at the age of 2, thus making her the youngest known HAE case report in the English literature. METHODS: Assess the efficacy of administration of C1-INH before dental operation as regards the prevention of HAE episode, when total or partial C1-INH deficiency exist. RESULTS: Acute angioedema leading to laryngeal oedema is a possibly fatal complication for HAE patients undergoing dental procedures. Use of both short-term and long-term HAE prophylaxis prior to dental operations might be life saving for those patients. CONCLUSIONS: Prevention and early recognition of potential laryngeal oedema that can occur as a complication of dental procedures may be lifesaving for HAE patients.

Acute myeloid leukaemia diagnosed by intra-oral myeloid sarcoma. A case report.

Myeloid sarcoma (MS) is a rare extramedullary malignant tumor composed of immature myeloid cells. It is strongly associated with a well known or covert acute myeloid leukaemia, chronic myeloproliferative diseases or myelodysplastic syndromes. Intraoral MS scarcely occurs. An unusual case of acute myeloid leukaemia, which was diagnosed by mandibular MS that was developed in the alveolar socket after a dental extraction, is reported. The histological examination (including immunohistochemical analysis) of a subsequent biopsy showed infiltration of the oral mucosa by neoplastic cells. This lesion was therefore classified as acute myeloid leukaemia. The patient was referred to oncologists that confirmed the initial diagnosis. The patient underwent chemotherapy and the mandibular tumor disappeared. Forty days later, a relapse of the disease, which appeared as a great-ulcerated lesion, was developed in the hard palate. Thirty days after the second chemotherapy had finished, a new intraoral tumor was developed in the vestibular maxillary gingiva. Review of the literature shows no report of intraoral relapse and particularly multiple relapse of a MS that involves the oral cavity. Even though MS is encountered infrequently in the oral cavity, it should be considered in the differential diagnosis of conditions (especially tumors) with a similar clinical appearance.