Odontogenic Carcinosarcoma: Clinicopathologic and Molecular Features of Three Cases, a Literature Review and Nomenclature Proposal

BACKGROUND

Odontogenic carcinosarcoma (OCS) is a rare odontogenic malignancy with limited characterization and unexplored molecular features. We report clinicopathologic and molecular findings in 3 additional OCS and review the literature.

METHODS

3 OCS (5.1%) were identified among 59 malignant odontogenic tumors (in our archives from 1992 to 2022). Clinical, radiologic, histopathologic, immunophenotypic, and molecular findings were reviewed. Data from prior case reports and systematic or non-systematic reviews were extracted for analysis.

RESULTS

Three mandibular OCS (age range: 66 to 72 years; 1 male, 2 females) were identified. Case 1 had novel clear-cell morphology, multiple recurrences, and a lethal outcome 28 months after resection. EWSR1 rearrangements were negative, but the tumor showed focal nuclear β-catenin and strong LEF-1 immunoreactivity. Case 2 demonstrated ameloblastic and sclerosing features and encased the inferior alveolar nerve; the patient was disease-free 22 months after resection with adjuvant chemoradiation therapy. LEF-1 was again strongly positive, and next-generation sequencing demonstrated 9p region-(CDKN2A, CDKN2B) copy number loss, and 12q region-(MDM2, CDK4) copy number gain. Case 3 showed clear-cell and markedly sclerosing features; no follow-up information was available. Literature review along with the current cases yielded 20 cases. OCS showed a male predilection (1.5:1), mandibular predominance (80%, typically posterior), and a bimodal age distribution (modes: 27.7 years, 62.7 years). OCS presented as masses (100%), often with pain (55%), and paresthesia (45%). Tumors were typically radiolucent (88.9%), with bone destruction (61.1%), and/or tooth effacement (27.8%). Preoperative biopsy was sensitive for malignancy (85.7%). At least 45% show evidence for a precursor lesion. 3-year DSS and DFS were 58% and 35%, respectively. Regional and distant (usually lung) metastatic rates were 25% and 31.3%, respectively. Increased mitotic rates and presence of tumor necrosis trended toward worse DSS and DFS.

CONCLUSION

OCS is a rare but aggressive malignancy, often arising from precursor tumors and may represent a terminal phenotype rather than a distinct entity. We describe novel clear-cell and sclerosing morphologies. Wnt pathway alterations appear important. Mitotic rates and necrosis may be adverse prognosticators. In keeping with nomenclature trends in other sites, OCS may be more appropriately designated as "biphasic sarcomatoid odontogenic carcinomas."

Microsecretory Adenocarcinoma of Salivary Glands: An Expanded Series of 24 Cases

Microsecretory adenocarcinoma (MSA) is a recently described salivary gland tumor with a characteristic histologic and immunophenotypic profile and recurrent MEF2C-SS18 fusions. Because only six cases of MSA have been published, its complete clinicopathologic spectrum is unclear, and its biologic behavior has not been documented. Here, we present an updated and expanded experience of 24 MSA cases. All cases of MSA were obtained from the authors' files. Immunohistochemistry for S100, SOX10, p63, p40, SMA, calponin, and mammaglobin was performed. Molecular analysis was performed by targeted RNA sequencing, SS18 break apart fluorescence in situ hybridization, and/or reverse transcriptase polymerase chain reaction for MEF2C-SS18 fusion. Clinical follow-up was obtained from medical records. A total of 24 MSA cases were collected, from 13 women and 11 men, ranging from 17 to 83 years (mean 49.5 years). The vast majority (23 of 24) arose in the oral cavity, with the palate (n = 14) and buccal mucosa (n = 6) as the most frequent subsites. Tumors showed consistent histologic features including: (1) microcystic tubules, (2) flattened intercalated duct-like cells, (3) monotonous oval hyperchromatic nuclei, (4) abundant basophilic luminal secretions, (5) fibromyxoid stroma, and (6) circumscribed borders with subtle infiltration. The tumors were very consistently positive for S100 (24 of 24), p63 (24 of 24), and SOX10 (14 of 14) and negative for p40 (0 of 21), calponin (0 of 12) and mammaglobin (0 of 16), while SMA (4 of 20) was variable. MEF2C-SS18 fusion was demonstrated in 21 of 24 cases; in the remaining 3 cases with insufficient RNA, SS18 break apart FISH was positive. Treatment information was available in 17 cases, all of which were managed with surgery only. In 14 cases with follow-up (1-216 months, mean 30), no cases recurred or metastasized. MSA is a distinct salivary gland neoplasm with remarkably consistent clinical, histologic, immunophenotypic, and genetic features that generally behaves in an indolent manner following surgery alone. These observations solidify MSA as a unique, low-grade salivary gland carcinoma that warrants inclusion in the next version of the WHO classification of head and neck tumors.

Odontogenic and Developmental Oral Lesions in Pediatric Patients

This article reviews odontogenic and developmental oral lesions encountered in the gnathic region of pediatric patients. The process of odontogenesis is discussed as it is essential to understanding the pathogenesis of odontogenic tumors. The clinical presentation, microscopic features, and prognosis are addressed for odontogenic lesions in the neonate (dental lamina cysts/gingival cysts of the newborn, congenital (granular cell) epulis of the newborn, melanotic neuroectodermal tumor, choristoma/heterotopia, cysts of foregut origin), lesions associated with unerupted/erupting teeth (hyperplastic dental follicle, eruption cyst, dentigerous cyst, odontogenic keratocyst/keratocystic odonogenic tumor, buccal bifurcation cyst/inflammatory collateral cyst) and pediatric odontogenic hamartomas and tumors (odontoma, ameloblastic fibroma, ameloblastoma, adenomatoid odontogenic tumor, primordial odontogenic tumor). Pediatric odontogenic and developmental oral lesions range from common to rare, but familiarity with these entities is essential due to the varying management implications of these diagnoses.

Proliferative Verrucous Leukoplakia: An Expert Consensus Guideline for Standardized Assessment and Reporting

The many diverse terms used to describe the wide spectrum of changes seen in proliferative verrucous leukoplakia (PVL) have resulted in disparate clinical management. The objective of this study was to produce an expert consensus guideline for standardized assessment and reporting by pathologists diagnosing PVL related lesions. 299 biopsies from 84 PVL patients from six institutions were selected from patients who had multifocal oral leukoplakic lesions identified over several years (a minimum follow-up period of 36 months). The lesions demonstrated the spectrum of histologic features described in PVL, and in some cases, patients developed oral cavity squamous cell carcinoma (SCC). An expert working group of oral and maxillofacial and head and neck pathologists reviewed microscopic features in a rigorous fashion, in combination with review of clinical photographs when available. The working group then selected 43 single slide biopsy cases for whole slide digital imaging (WSI) review by members of the consensus conference. The digital images were then reviewed in two surveys separated by a washout period of at least 90 days. Five non-PVL histologic mimics were included as controls. Cases were re-evaluated during a consensus conference with 19 members reporting on the cases. The best inter-observer diagnostic agreement relative to PVL lesions were classified as "corrugated ortho(para)hyperkeratotic lesion, not reactive" and "SCC" (chi-square p = 0.015). There was less than moderate agreement (kappa < 0.60) for lesions in the "Bulky hyperkeratotic epithelial proliferation, not reactive" category. There was ≥ moderate agreement (> 0.41 kappa) for 35 of 48 cases. This expert consensus guideline has been developed with support and endorsement from the leadership of the American Academy of Oral and Maxillofacial Pathology and the North American Society of Head and Neck Pathologists to recommend the use of standardized histopathologic criteria and descriptive terminology to indicate three categories of lesions within PVL: (1) "corrugated ortho(para)hyperkeratotic lesion, not reactive;" (2) "bulky hyperkeratotic epithelial proliferation, not reactive;" and (3) "suspicious for," or "squamous cell carcinoma." Classification of PVL lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research and potentially guide clinical management.

Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm

Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including, but not limited to, infections, medications, autoimmune disease, and other systemic disease. This review discusses the pathogenesis, clinical presentation, diagnosis, and management of the common causes of recurrent oral ulceration. The following types/etiologies of recurrent oral ulceration are covered: traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease. A diagnostic algorithm for recurrent oral ulceration is also presented.

Ectomesenchymal Chondromyxoid Tumor: A Neoplasm Characterized by Recurrent RREB1-MKL2 Fusions

Ectomesenchymal chondromyxoid tumor is a rare and benign neoplasm with a predilection for the anterior dorsal tongue. Despite morphologic heterogeneity, most cases are characterized by a proliferation of bland spindle cells with a distinctive reticular growth pattern and myxoid stroma. The immunophenotype of these neoplasms is likewise variable; most cases express glial fibrillary acid protein and S100 protein, with inconsistent reports of keratin and myoid marker expression. The molecular pathogenesis is poorly understood; however, a subset of cases has been reported to harbor EWSR1 gene rearrangement. Following identification of an RREB1-MKL2 fusion gene by RNA Sequencing in an index patient, a retrospective review of additional cases of ectomesenchymal chondromyxoid tumors was performed to better characterize the clinical, immunohistochemical, and molecular attributes of this neoplasm. A total of 21 cases were included in this series. A marked predisposition for the dorsal tongue was confirmed. Most cases conformed to prior morphologic descriptions; however, hypercellularity, hyalinized stroma, and necrosis were rare attributes not previously emphasized. The neoplastic cells frequently coexpressed glial fibrillary acid protein, S100 protein, keratin, smooth muscle actin, and/or desmin; a single case was found to contain significant myogenin expression. An RREB1-MKL2 fusion product was identified in 19 tumors (90%), a single tumor (5%) had an EWSR1-CREM fusion product, and the remaining case lacked any known fusion gene by RNA Sequencing. The latter 2 cases subtly differed morphologically from many in the cohort. This series illustrates that recurrent RREB1-MKL2 fusions occur in most, perhaps all, cases of ectomesenchymal chondromyxoid tumor.

Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study

The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons' responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.

Reappraising localized juvenile spongiotic gingival hyperplasia

BACKGROUND

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion of unknown cause. The purpose of this study is to present a series of LJSGH cases and compare the findings with the literature.

METHODS

After obtaining institutional review board approval, cases of biopsy-proven LJSGH from 2008 through 2018 were retrieved from the University of Pittsburgh Oral Pathology Biopsy Service archives and reviewed. In addition, a comprehensive review of the literature was performed.

RESULTS

Twenty-eight cases were identified. No significant sex predilection was noted (male-female ratio, 1.25:1). The age range was from 3 through 64 years (median, 14.5 years). Twenty-six cases (92.9%) affected the anterior facial gingiva, and 27 cases (96.4%) occurred in the maxilla. The most common clinical impression was pyogenic granuloma (55.6%). All cases presented with the same histopathology regardless of patient age. Cytokeratin 19 immunohistochemistry was used to confirm the diagnosis in cases that occurred in patients outside the typically affected demographic.

CONCLUSIONS

Our results are in concordance with the literature, with most cases localized to the anterior maxillary gingiva of children and young adults. However, 5 of our cases occurred in adults. Cytokeratin 19 is of diagnostic utility in these cases.

PRACTICAL IMPLICATIONS

Although LJSGH is most commonly seen in children and young adults, we present cases occurring in adults. Our series and the literature found that LJSGH is not restricted to juveniles and that it can be multifocal. Dentists should be aware of this when formulating a differential diagnosis. Therefore, the nomenclature may not represent the disease spectrum of these gingival lesions.

Relevance of smoking interventions for dental clinic patients with smoking-related disease

OBJECTIVES

Despite a decline in cigarette smoking in the United States, high rates persist among the socioeconomically underserved who consequently are at risk for smoking-related disease (SRD). Since academically affiliated dental clinics are more likely to encounter underserved patients, smoking interventions could address both the oral and systemic risks of continued smoking. To determine the relevance of providing smoking counseling in the context of SRD, this study examined the prevalence of smoking and its associations with socioeconomic status (SES), SRD and its sequela, and medication use.

METHODS

Socioeconomic and smoking status was determined from 1,797 electronic health records of a sample of patients at a Pennsylvania dental clinic in 2010. Low SES included patients who were covered by a Medicaid program (MA) or "self-payers." High SES encompassed those with an employment-based commercial dental insurance (COM). Self-reported smoking rates were compared with patients' SES, SRDs or sequela, and medications being used for the management of their SRDs.

RESULTS

Overall, 41.7 percent of these patients were smoking. Smoking was related to SES with the highest rate (52.7 percent) among MA patients compared with 31.5 percent in patients with COM. In addition, 37 percent of patients with SRD or sequela and 33 percent who were taking medications for their management were smoking.

CONCLUSIONS

Academically affiliated dental clinics are more likely to encounter underserved patients who smoke and have SRD. For greater patient impact and receptivity, it is essential that tobacco cessation interventions emphasize the risks of smoking on systemic as well as oral health.

Analytic survey of 57 cases of oral metastases

BACKGROUND

Oral lesions have been reported among the first signs of an undiagnosed metastatic disease. Accurate diagnosis of an occult metastasis remains critical in determining the treatment course. Previous studies regarding oral metastatic tumors present varied data regarding the most frequent metastases to the oral cavity. These discrepancies echo the changes in incidence rates for certain malignancies over time and demonstrate the need for periodic updates in oral metastasis studies.

METHODS

Using Text Information Extraction System, a de-identified pathology database, we compiled 57 cases over a period of 19 years using key terms to search for oral metastases.

RESULTS

For both males and females, the most common primary sites were lung (21.1%), liver (12.3%), breast (10.5%), kidney (10.5%), and colorectal (8.8%). We found an equal number of lung and breast metastases in females and metastases from the liver to be the most prevalent for males. In most of our cases (54.9%), the patient had no history of the primary malignancy and the oral lesion preceded awareness of the widespread cancer.

CONCLUSIONS

As a departure from many previous case series, we found lung and breast metastases to be equally numerous in women and liver as the most common oral metastasis in men. Also, we identified a tendency for the patient to present with a previous history in certain malignancies, such as breast cancer, whereas in other malignancies, such as renal cell carcinoma, our data demonstrated a propensity to present in the oral cavity without history of a primary tumor.

Intraoral Pseudo-Onion Bulb Intraneural Proliferations in a Patient with Hemimandibular Hyperplasia: A Case Report and Review of the Literature

This report and review of the literature describes a case of benign intraoral lesions of perineurial origin in a patient with symptomatic hemimandibular hyperplasia causing partial denture soreness. Perineuriomas are a benign peripheral nerve sheath tumor composed of perineurial cells. Intraoral perineuriomas are an extremely rare entity. Two main types of perineuriomas have been described: intraneural and extraneural perineuriomas. A third, similar entity, called an intraneural pseudoperineuriomatous proliferation, has recently been proposed in the literature as a separate and distinctive diagnosis. This report describes the histologic and clinical presentation of intraneural pseudoperineuriomatous proliferations in a patient with hemimandibular hyperplasia.

Cervicofacial subcutaneous emphysema: a clinical case and review of the literature

Cervicofacial subcutaneous emphysema is a known, rare complication of both dental and surgical procedures. Cervicofacial subcutaneous emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. This report presents a case of cervicofacial subcutaneous emphysema in a patient who had undergone surgical extraction of the mandibular right first molar. The dentist in this case used a compressed air-driven handpiece to section the tooth. This forced air, under high pressure, into the subcutaneous tissue spaces. The patient presented with severe hemifacial swelling and crepitus on palpation. Computed tomographic examination revealed air subcutaneously, and a diagnosis of cervicofacial subcutaneous emphysema was made.

An in vivo model to assess magnesium alloys and their biological effect on human bone marrow stromal cells

Magnesium (Mg) alloys have many unique qualities which make them ideal candidates for bone fixation devices, including biocompatibility and degradation in vivo. Despite a rise in Mg alloy production and research, there remains no standardized system to assess their degradation or biological effect on human stem cells in vivo. In this study, we developed a novel in vivo model to assess Mg alloys for craniofacial and orthopedic applications. Our model consists of a collagen sponge seeded with human bone marrow stromal cells (hBMSCs) around a central Mg alloy rod. These scaffolds were implanted subcutaneously in mice and analyzed after eight weeks. Alloy degradation and biological effect were determined by microcomputed tomography (microCT), histological staining, and immunohistochemistry (IHC). MicroCT showed greater volume loss for pure Mg compared to AZ31 after eight weeks in vivo. Histological analysis showed that hBMSCs were retained around the Mg implants after 8 weeks. Furthermore, immunohistochemistry showed the expression of dentin matrix protein 1 and osteopontin around both pure Mg and AZ31 with implanted hBMSCs. In addition, histological sections showed a thin mineral layer around all degrading alloys at the alloy-tissue interface. In conclusion, our data show that degrading pure Mg and AZ31 implants are cytocompatible and do not inhibit the osteogenic property of hBMSCs in vivo. These results demonstrate that this model can be used to efficiently assess the biological effect of corroding Mg alloys in vivo. Importantly, this model may be modified to accommodate additional cell types and clinical applications.

STATEMENT OF SIGNIFICANCE

Magnesium (Mg) alloys have been investigated as ideal candidates for bone fixation devices due to high biocompatibility and degradation in vivo, and there is a growing need of establishing an efficient in vivo material screening system. In this study, we assessed degradation rate and biological effect of Mg alloys by transplanting Mg alloy rod with human bone marrow stromal cells seeded on collagen sponge subcutaneously in mice. After 8 weeks, samples were analyzed by microcomputed tomography and histological staining. Our data show that degrading Mg alloys are cytocompatible and do not inhibit the osteogenic property of hBMSCs in vivo. These results demonstrate that this model can be used to efficiently assess the biological effect of corroding Mg alloys in vivo.

Mixed radiopaque and radiolucent lesion of the maxillary sinus: a radiographic challenge

This article describes 3 patients, each of whom presented with an asymptomatic mixed radiopaque and radiolucent lesion of the maxillary sinus associated with a nonvital tooth. Based on the radiographic findings, a diagnosis of a collapsed (ruptured) radicular cyst was rendered in each case. A tissue biopsy was performed in 1 case, and the results supported the diagnosis. The radiographic and histopathological features, etiology, pathophysiology, and radiographic differential diagnosis of this condition are discussed.

Seven Cases of Proliferative Verrucous Leukoplakia: The Need for a High Clinical Suspicion Among Dental Practitioners

Proliferative verrucous leukoplakia is a distinct precancerous condition with a high rate of recurrence and malignant transformation over time. Proliferative verrucous leukoplakia has no specific histopathologic presentation; therefore, emphases must be on clinical presentation and history to make a diagnosis giving the need for a high clinical suspicion. This condition is very important for the general dentist to recognize. Here we describe the clinical and microscopic features of seven cases of proliferative verrucous leukoplakia, with two cases which demonstrated malignant transformation (hybrid carcinoma and squamous cell carcinoma).

Ameloblastic carcinoma of the mandible manifesting as an infected odontogenic cyst

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor. Although most ACs appear to originate de novo, some cases originate from a pre-existing ameloblastoma. This article presents the case of a 69-year-old man with an AC in the left body of the mandible. Radiographically, the lesion resembled an odontogenic cyst surrounding an impacted tooth. While ACs tend to have aggressive features that distinguish them from their benign counterparts, some are more subtle in their presentation. Therefore, it is important that dentists rule out malignancy in lesions that do not display obvious radiographic features.

Molecular and genetic aspects of odontogenic lesions

In this article we outline the molecular findings of select odontogenic tumors. In each section, we briefly review selected the clinicoradiographic, histologic, immunologic features, focusing on the molecular findings and their applications in practice. The understanding of molecular pathobiology at various other organ sites has developed quite rapidly in recent years, however much remains unknown about the genetic profile of odontogenic tumors. Improved understanding of mutations in odontogenic tumors may clarify classification schema and elucidate targets for novel therapies. Molecular testing will no doubt improve our understanding of odontogenic tumor pathogenesis and will likely be, someday, an important component of routine clinical practice and its role will only increase in the coming years.

Ectomesenchymal Chondromyxoid Tumor: A Series of Seven Cases and Review of the Literature

Ectomesenchymal chondromyxoid tumors (ECT) are rare, benign, intraoral mesenchymal soft tissue tumors that can be diagnostically challenging. In this study the demographic, clinical, histopathologic, and immunohistochemical features of seven ECTs are examined. The differential diagnosis of this rare neoplasm is discussed and the literature is reviewed.

Large B-cell lymphoma of the base of the tongue and oral cavity: a practical approach to identifying prognostically important subtypes

OBJECTIVE

The aim of this study is to illustrate a practical approach to the identification of prognostically important subtypes of large B-cell lymphomas.

STUDY DESIGN

Twenty-six cases of large B-cell lymphoma in the base of the tongue and oral cavity were retrieved from 2003 through 2012. All cases were classified based on the 2008 World Health Organization criteria. Hematoxylin-eosin-stained sections, immunohistochemical stains, flow cytometric immunophenotypic data, and fluorescence in situ hybridization studies were performed and evaluated.

RESULTS

Four different subtypes of large B-cell lymphoma were identified: pleomorphic variant mantle cell lymphoma, Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly, diffuse large B-cell lymphoma not otherwise specified, and B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma, including a case of double-hit lymphoma.

CONCLUSIONS

Diverse subtypes of large B-cell lymphoma were identified in the base of tongue and oral cavity, and illustrate a practical approach to recognizing prognostically important lymphoma subtypes.

Orofacial dermal fillers: foreign body reactions, histopathologic features, and spectrometric studies

OBJECTIVE

The aim of this study is to assess the different histopathologic presentations of dermal filler materials-induced foreign body reactions by spectrometric analyses.

STUDY DESIGN

Sixteen cases of dermal filler foreign body reactions in the orofacial region were retrieved from the 2006-2013 period. The histologic features were evaluated and categorized into 5 groups (I to V). Unstained deparaffinized sections of representative tissue from one case in each of groups I to IV were sent for spectrometric analysis, along with samples of 2 popular dermal fillers (Juvéderm and Radiesse).

RESULTS

With the help of spectrometric analysis, we were able to correlate the histopathologic presentations with the specific type of dermal filler used.

Osseous dysplasia (cemento-osseous dysplasia) of the jaw bones in western Pennsylvania patients: analysis of 35 cases

OBJECTIVES

The purpose of this study is to analyze the demographic, clinical, and radiographic presentations of osseous dysplasia of the jaws in western Pennsylvania patients and its associated complications.

MATERIALS AND METHODS

The clinical records and radiographs of patients diagnosed with osseous (cement-osseous) dysplasia were retrieved from the electronic health record of the University of Pittsburgh, School of Dental Medicine from 2007 to 2012. All cases were reviewed; the WHO criteria and classification for osseous dysplasia was used. Clinical and demographic data, radiographic findings, and final diagnoses were collected and analyzed.

RESULTS

35 cases of osseous dysplasia were retrieved over the six-year period.The majority (33) were females [94.3%], with ages ranging from 26 to 89 years, with a mean age of 53.9 years +/- standard deviation of 15.6 years, 32 [91.4%] were African Americans and 3 [8.6%] were Caucasians. 17 [48.6%] were florid osseous dysplasia, 13 [37.1%] periapical osseous dysplasia and 5 [14.3%] focal osseous dysplasia. Of the 35 patients only 8 [22.9%] patients were symptomatic. All florid osseous dysplasia patients were African American females, with 7 of the patients being symptomatic and the commonest symptom being pain. Also, all periapical osseous dysplasia patients were African Americans (12 females and 1 male), with 1 of the patients presenting with widening of the diastema. Of the focal osseous dysplasia patients, 3 were Caucasians and 2 African American (4 females and 1 male).

CONCLUSION

The cases occurred mostly in African American females with a peak incidence in the fifth and sixth decades of life; most cases occurred in the mandible. The commonest form of osseous dysplasias was the florid osseous dysplasia which is most likely to present with symptoms.

Clear cell carcinoma and clear cell odontogenic carcinoma: a comparative clinicopathologic and immunohistochemical study

Clear cell carcinoma or hyalinizing clear cell carcinoma (CCC) and clear cell odontogenic carcinoma (CCOC) are rare, low-grade and typically indolent malignancies that can be diagnostically challenging. In this study the clinicopathologic, histologic, and immunohistochemical features of 17 CCCs and 12 CCOCs are examined. The differential diagnosis of clear cell malignancies in the head and neck is discussed. The relationship of CCCs and CCOCs to other clear cell tumors on the basis of their immunohistochemical staining patterns is postulated.