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Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, Biasotto M. Oral lesions and lymphoproliferative disorders. JOURNAL OF ONCOLOGY 2010; 2010:202305. [PMID: 20871659 PMCID: PMC2939410 DOI: 10.1155/2010/202305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/26/2010] [Indexed: 11/17/2022]
Abstract
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.
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Affiliation(s)
- P. Castellarin
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - G. Pozzato
- Department of Haematology, University of Trieste, 34142 Trieste, Italy
| | - G. Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Trieste, 34127 Trieste, Italy
| | - R. Di Lenarda
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - M. Biasotto
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
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Elad S, Meyerowitz C, Shapira MY, Glick M, Bitan M, Amir G. Oral posttransplantation lymphoproliferative disorder: an uncommon site for an uncommon disorder. ACTA ACUST UNITED AC 2008; 105:59-64. [DOI: 10.1016/j.tripleo.2007.06.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/23/2007] [Indexed: 11/30/2022]
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Abstract
Plasmablastic lymphoma (PBL) is an uncommon, recently described B-cell-derived lymphoma that displays distinctive affinity for extranodal presentation in the oral cavity. Plasmablastic lymphoma is strongly associated with human immunodeficiency virus (HIV) infection, but has been reported in HIV-negative individuals. Plasmablastic lymphoma may be poorly recognized by pathologists, which is partly attributable to its relatively rare occurrence and unusual immunophenotype. Five cases of oral cavity lymphomas conforming to the current World Health Organization morphological criteria for PBL were retrieved from the consultation files at the Armed Forces Institute of Pathology. An immunohistochemical panel consisting of CD3, CD20, CD30, CD38, CD45RB, CD79a, CD138, Bcl-2, Bcl-6, Alk-1, Ki-67, EBV-LMP-1, and HHV8 was performed. All 5 cases were immunoreactive for CD38 and/or CD138, confirming plasma cell differentiation of the tumor cells. CD20 was immunoreactive in 1 case, and CD79a was positive in 2 cases. HHV8 and EBV-LMP-1 were nonreactive in all cases. Follow-up revealed only 1 patient alive with no evidence of disease. Our cases show that PBL is an aggressive type of B-cell lymphoma predominantly found in the oral cavity. Plasmablastic lymphoma is often associated with HIV infection.
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Affiliation(s)
- Gretchen S Folk
- Department of Oral and Maxillofacial Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
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4
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Epstein JB, Cabay RJ, Glick M. Oral malignancies in HIV disease: Changes in disease presentation, increasing understanding of molecular pathogenesis, and current management. ACTA ACUST UNITED AC 2005; 100:571-8. [PMID: 16243242 DOI: 10.1016/j.tripleo.2005.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2004] [Accepted: 01/10/2005] [Indexed: 11/19/2022]
Abstract
Infection with human immunodeficiency virus (HIV) and progression to acquired immune deficiency syndrome (AIDS) are associated with a vide variety of morbidities. Local and systemic diseases can develop in association with HIV infection and may manifest themselves as malignancies of the oropharynx. Advances in HIV management, fueled by increasing understanding of molecular pathogenesis, have resulted in marked changes in the prevalence of oral malignant disease. This paper discusses recent trends in the presentation and treatment of malignancies related to HIV and AIDS with an emphasis on malignancies seen in the oral cavity.
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MESH Headings
- Animals
- Antiretroviral Therapy, Highly Active
- Carcinoma, Squamous Cell/complications
- Carcinoma, Squamous Cell/epidemiology
- Carcinoma, Squamous Cell/therapy
- Carcinoma, Squamous Cell/virology
- DNA, Viral/analysis
- Developed Countries
- HIV Infections/complications
- HIV Infections/drug therapy
- Herpesvirus 4, Human/isolation & purification
- Humans
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/epidemiology
- Lymphoma, AIDS-Related/therapy
- Mouth Neoplasms/complications
- Mouth Neoplasms/epidemiology
- Prevalence
- Sarcoma, Kaposi/complications
- Sarcoma, Kaposi/epidemiology
- Sarcoma, Kaposi/therapy
- United States/epidemiology
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Affiliation(s)
- Joel B Epstein
- Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, Chicago Cancer Center, University of Illinois at Chicago, IL 60612USA.
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Tüzün Y, Kalayciyan A, Engin B, Tüzün B. Life-threatening disorders of mucous membranes. Clin Dermatol 2005; 23:267-75. [PMID: 15896542 DOI: 10.1016/j.clindermatol.2004.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Oral mucosa is one of the first barriers to the outside world which encounters various antigens, microorganisms and physical agents. Numerous oral pathologies challenge the dermatologists. Some may be the first sign of an underlying immunosuppression, while others are the inevitable serious outcomes of long-lasting mucosal disease. The differential diagnosis is crucial in terms of prompt and effective treatment.
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Affiliation(s)
- Yalçin Tüzün
- Department of Dermatology, Cerrahpasa Medical Faculty, Istanbul University, Aksaray, Turkey.
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Abstract
BACKGROUND B-cell lymphomas are rare neoplasms in the oral cavity. They are significant to dentists because the oral complications associated with treatment mean that dentists can play an important role in their detection. CASE DESCRIPTION The authors describe the case of a 55-year-old man with nonhealing ulcers, swelling and pain six months after maxillary left canine extraction. As it occurred in the infraorbital region after canine tooth extraction, the authors suspected B-cell lymphoma. Clinical examination revealed infraorbital edema with regional submandibular lymphadenopathy. Intraoral examination revealed a nonhealing ulceration with ill-defined borders in the surrounding mucosa. It was 5- x 5-centimeters in diameter and gray-white. The histopathologic examination showed diffuse, atypical, lymphoid cell infiltration and immuno-histochemically positive staining. After the histopathologic examination, the authors referred the patient to a medical center for treatment. CLINICAL IMPLICATIONS Dentists should look for signs of B-cell lymphoma when a patient has extended pain and swelling after an extraction.
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Affiliation(s)
- Rüştü Gedik
- Cumhuriyet University, Faculty of Dentistry, Oral Diagnosis and Radiology Department, Sivas, Turkey.
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Iamaroon A, Pongsiriwet S, Mahanupab P, Kitikamthon R, Pintong J. Oral non-Hodgkin lymphomas: studies of EBV and p53 expression. Oral Dis 2003; 9:14-8. [PMID: 12617252 DOI: 10.1034/j.1601-0825.2003.01808.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aims of the study were to assess sociodemographic and clinicopathologic characteristics of patients with oral non-Hodgkin lymphomas (NHLs) and the expression of Epstein-Barr virus (EBV) and p53. MATERIALS AND METHODS The clinical and pathologic features of 11 patients with oral NHLs were studied. The expression of EBV mRNA and p53 protein were studied by means of in situ hybridization and immunohistochemical methods in 11 formalin-fixed, paraffin-embedded specimens from these patients. RESULTS The patients' age ranged from 13 to 70 years with the mean of 42 years. Human immuno-deficiency virus (HIV) status was documented in five of the 11 patients and three were known to be HIV-positive. The most common locations were gingiva and alveolar mucosa. Pain and tenderness were major symptoms of the patients. The most common histologic subtype was diffuse large-cell, intermediate-grade NHL. Eight of 11 cases (72.7%) showed positive expression of p53 protein. Four of 10 cases (40%) expressed EBV-encoded RNA (EBER) transcripts. All known HIV-positive cases were EBV-positive. CONCLUSIONS The findings suggest that appropriately expressed p53 protein may play a role in tumorigenesis of oral NHLs. In addition, EBV may be involved with the pathogenesis of oral NHLs particularly in patients with HIV infection.
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MESH Headings
- Adolescent
- Adult
- Aged
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoenzyme Techniques
- In Situ Hybridization
- Lymphoma, AIDS-Related/genetics
- Lymphoma, AIDS-Related/metabolism
- Lymphoma, AIDS-Related/virology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/virology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/virology
- Middle Aged
- Mouth Neoplasms/genetics
- Mouth Neoplasms/metabolism
- Mouth Neoplasms/virology
- RNA, Viral/analysis
- Tumor Suppressor Protein p53/biosynthesis
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Affiliation(s)
- A Iamaroon
- Department of Odontology and Oral Pathology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
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Abdelsayed RA, Sangueza O. Refractory localized "periodontitis". ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 2002; 93:394-8. [PMID: 12029277 DOI: 10.1067/moe.2002.121434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Rafik A Abdelsayed
- Oral and Maxillofacial Pathology Department, School of Dentistry, Medical College of Georgia, Augusta 30912-1110, USA.
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Funk GF, Karnell LH, Robinson RA, Zhen WK, Trask DK, Hoffman HT. Presentation, treatment, and outcome of oral cavity cancer: a National Cancer Data Base report. Head Neck 2002; 24:165-80. [PMID: 11891947 DOI: 10.1002/hed.10004] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Oral cancer has been identified as a significant public health threat. Systematic evaluation of the impact of this disease on the US population is of great importance to health care providers and policy makers. METHODS This study used the National Cancer Data Base (NCDB) to evaluate associations between demographic and disease characteristics, treatment, and survival for patients with oral cavity cancer in the United States. Of patients diagnosed between 1985 and 1996, 58,976 were extracted from the NCDB. ANOVAs were performed on selected cross-tabulations, and relative survival was used to calculate outcome. RESULTS Median age of patients was 64.0 years. Men made up 60.2% of patients. Pathologic diagnosis was squamous cell carcinoma (SCC) in 86.3% of cases. Younger patients had a much higher frequency of non-SCC, and this was related to survival in these patients. African-Americans (independent of income), lower income patients, and patients with higher grade disease were seen more frequently with advanced-stage SCC. Five-year relative survival for SCC cases was lower for older patients, men, and African-Americans. CONCLUSIONS This study addressed many issues related to oral cancer that have been previously discussed in the literature. The demographic, site, stage, histologic, and survival data available for this large number of cases in the NCDB allowed an accurate characterization of the contemporary status of oral cancer in the United States.
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Affiliation(s)
- Gerry F Funk
- Department of Otolaryngology-Head and Neck Surgery, 212 PFP, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, Iowa 52242
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Flaitz CM, Nichols CM, Walling DM, Hicks MJ. Plasmablastic lymphoma: an HIV-associated entity with primary oral manifestations. Oral Oncol 2002; 38:96-102. [PMID: 11755827 DOI: 10.1016/s1368-8375(01)00018-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Plasmablastic lymphoma is a relatively new entity that is considered to be a diffuse large B-cell lymphoma with an unique immunophenotype and a predilection for the oral cavity. We present a 50 year-old HIV-positive, bisexual, white male with a CD4 count 300/mm(3) and a viral HIV-RNA polymerase chain reaction (PCR) load of 237 copies/ml, who developed a painful, purple-red mass in the edentulous area of the maxillary right first molar. Erythematous gingival enlargements of the interdental papillae were seen in three of the dental quadrants. In addition, the patient was being managed with antiretroviral therapy and liposomal doxorubicin for recurrent cutaneous Kaposi's sarcoma (KS). Although oral KS was suspected, the gingival lesions were biopsied because they were refractory to chemotherapy and a lymphoma could not be excluded. Histopathologic examination revealed a lymphoid malignant neoplasm, consistent with a plasmablastic lymphoma. Immunoreactivity with vs38c, CD79a, kappa light chain, and IgG was readily identified in tumor cells; while only focal cells expressed CD20 and LCA (CD45RB). CD56, CD3, lambda light chain, and EMA were non-reactive. EBV was detected in the tumor by Southern hybridization, PCR amplification, in situ hybridization for EBER-1 DNA, and immunohistochemistry for latent membrane protein-1. The same tumor was negative for HHV-8 by PCR. Recognition of plasmablastic lymphoma is important, because it represents an HIV-associated malignancy that predominantly involves the oral cavity, may mimic KS and has a poor prognosis.
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Affiliation(s)
- C M Flaitz
- Department of Stomatology, University of Texas-Houston Health Science Center, Dental Branch, 6516 John Freeman Avenue, Houston, TX 77030, USA.
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Abstract
Oral lesions are important in the clinical spectrum of HIV/AIDS, arousing suspicion of acute seroconversion illness (aphthous ulceration and candidiasis), suggesting HIV infection in the undiagnosed individual (candidiasis, hairy leukoplakia, Kaposi's sarcoma, necrotizing ulcerative gingivitis), indicating clinical disease progression and predicting development of AIDS (candidiasis, hairy leukoplakia), and marking immune suppression in HIV-infected individuals (candidiasis, hairy leukoplakia, necrotizing periodontal disease, Kaposi's sarcoma, long-standing herpes infection, major aphthous ulcers). In addition, oral lesions are included in staging systems for HIV disease progression and as entry criteria or endpoints in clinical trials of antiretroviral drugs. Recognition and management of these oral conditions is important for the health and quality of life of the individual with HIV/AIDS. In keeping with this, the U.S. Department of Health Services Clinical Practice Guideline for Evaluation and Management of Early HIV Infection includes recommendations that an oral examination, emphasizing oral mucosal surfaces, be conducted by the primary care provider at each visit, a dental examination by a dentist should be done at least two times a year, and patients should be informed of the importance of oral care and educated about common HIV-related oral lesions and associated symptoms.
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Affiliation(s)
- L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, USA.
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Porter SR, Diz Dios P, Kumar N, Stock C, Barrett AW, Scully C. Oral plasmablastic lymphoma in previously undiagnosed HIV disease. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1999; 87:730-4. [PMID: 10397667 DOI: 10.1016/s1079-2104(99)70170-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-Hodgkin's lymphoma is the second most common HIV-associated malignancy. This report details a case of the recently described entity plasmablastic lymphoma of the mouth in a patient who was later found to have severe HIV disease. The tumor manifested as a large ulcerated mass of the left maxillary alveolus, causing bony destruction and tooth mobility. Histologic examination of lesional tissue revealed a lymphoid tumor with a high proliferation rate containing lymphoplasmacytoid cells that were reactive to the plasma cell marker VS38c but not to CD20 or CD79a; these are features of the recently reported non-Hodgkin's lymphoma termed plasmablastic lymphoma. This is only the second report of an unusual tumor that has a predilection for the orofacial tissues.
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Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, United Kingdom
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