1
|
Dias MM, Barrett AW. Comparison of histopathological turnaround times for mandibulectomies, glossectomies, and incisional biopsies of the tongue. Br J Oral Maxillofac Surg 2023; 61:131-135. [PMID: 36806395 DOI: 10.1016/j.bjoms.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 10/10/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Diagnostic histopathology plays a key role in the management of oral cancer and timely reports are essential. The aim of this study was to retrospectively compare the time interval between receipt of the specimen and issue of the histopathology report (the 'turnaround time', TT) of two types of oral cancer resections (mandibulectomies and glossectomies) and incisional biopsies from the tongue (n = 100 of each). The information documented included the number of days from receipt of the specimen until the sample was ready for reporting, and the number of subsequent days until the report was authorised by the pathologist. The number of days mandibulectomies required decalcification, the number of blocks processed per sample, and pathological TNM stage were also recorded. Results showed that mandibulectomies had statistically significantly longer TT than glossectomies. Incisional biopsies had the shortest TT with 87% reported in seven days and 95% in ten. There were also statistically significantly longer TT for pT3/pT4 than for pT1/pT2 glossectomies, and between the number of blocks processed for the three main groups. Decalcification and the interval whilst the slides awaited the pathologists' attention were identified as 'bottlenecks'. Dentate mandibulectomies had the longest TT of all; extraction of teeth at operation and detachment of the lower border of the mandible at macroscopic sampling are thus potential means by which the decalcification delay might be reduced. Expectations of the multidisciplinary team managing the patient should be realistic when scheduling postoperative discussion.
Collapse
Affiliation(s)
- Márcia M Dias
- Department of Histopathology, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom
| | - Andrew W Barrett
- Department of Histopathology, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, United Kingdom.
| |
Collapse
|
2
|
Barrett AW, Bisase BS. Malignant melanoma in situ of the palate: Radical treatment or "watch and wait"? An update reporting an adverse outcome. Oral Oncol 2022; 131:105969. [PMID: 35717724 DOI: 10.1016/j.oraloncology.2022.105969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew W Barrett
- Department of Histopathology, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| | - Brian S Bisase
- Maxillofacial Surgery Unit, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| |
Collapse
|
3
|
Barrett AW, Garg M, Armstrong D, Bisase BS, Newman L, Norris PM, Shelley M, Tighe JV, Hyde NC, Chaston NJ, Gulati A. CYSTIC SQUAMOUS CELL CARCINOMAS OF THE JAWS: TWELVE CASES HIGHLIGHTING HISTOPATHOLOGIC PITFALLS. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Bowe CM, Bean T, Loke R, Gallagher N, Rooney J, Surwald C, Dhanda J, Moody A, Bisase B, Norris P, Barrett AW, Lachanas V, Doumas S. Merkel cell carcinoma of the head and neck in the south-east of England. Br J Oral Maxillofac Surg 2021; 59:1280-1286. [PMID: 34465487 DOI: 10.1016/j.bjoms.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. Its incidence is increasing with half of cases involving the head and neck. To the best of our knowledge, few large studies have been published in the UK, and to date this is the largest reported series of head and neck MCC. We retrospectively reviewed the outcomes of patients with MCC in three hospitals in the south-east of England over a 12-year period (2008-2019). Diagnosis was based on histological data following biopsy. Overall survival and disease-specific survival were calculated using Kaplan-Meier and log-rank tests. Fifty-eight patients met the inclusion criteria (24 stage I, 22 stage II, 9 stage III, and 3 unclassified). Median disease-free survival was 36 months (95% CI 0 to 77.2) and median overall survival 50 months (95% CI 29.9 to 70). Overall five-year survival was 34.4% (95% CI 17% to 52%) with two-year survival at 62% (95% CI 48% to 76%). Five-year disease-free survival was 26.7% (95% CI 17 to 52%) with two-year disease-free survival at 54% (95% CI 40% to 68%). To date, this is the largest UK based study reporting overall and disease-free survival associated with MCC of the head and neck. Half the patients presented late, and surgery was the mainstay of treatment, augmented by adjuvant radiotherapy. There is a need to better stratify patients at risk of developing metastatic disease, with the use of sentinel lymph node biopsy and positron-emission tomography-computed tomography (PET-CT), as immunotherapy and targeted agents are now available to treat advanced disease.
Collapse
Affiliation(s)
- C M Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead.
| | - T Bean
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - R Loke
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - N Gallagher
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - J Rooney
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - C Surwald
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - J Dhanda
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead; Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - A Moody
- Department of Oral & Maxillofacial Surgery, Eastbourne General Hospital
| | - B Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - P Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - A W Barrett
- Department of Pathology Queen Victoria Hospital Foundation Trust, East Grinstead
| | - V Lachanas
- Department of Ear Nose Throat, University Hospital of Larissa, Greece
| | - S Doumas
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| |
Collapse
|
5
|
Al-Dabbagh R, Al-Hazmi N, Alhazzazi TY, Barrett AW, Speight PM. Human papillomavirus and head and neck squamous cell carcinoma in a UK population: Is there an association? Indian J Cancer 2021; 59:65-72. [PMID: 33753602 DOI: 10.4103/ijc.ijc_599_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Human papillomavirus (HPV) is an evolving important risk factor for head and neck cancer (HNC), especially for individuals who do not smoke and drink alcohol. The aim of this study was to establish the prevalence of HPV infection and elucidate its association with head and neck squamous cell carcinoma (HNSCC) patients in UK population. Methods The presence and association of HPV was investigated in HNSCC patients in this retrospective clinical study. Samples were obtained from archived biopsies and resections. HPV screening was performed by the use of polymerase chain reaction (PCR) using the GP5+/GP6+ and the SPF1/2 consensus as primers and by immunohistochemistry (IHC). Samples of viral warts that were IHC positive for HPV and fibroepethelial polyps (FEP) were used, as positive and negative controls, respectively. Results The cohort included 124 patients with HNSCC with an age range of 27-97 years (median, 60 years) and a male to female ratio of 2:1. Among the 124 HNSCC, 43/124 (34.7%) were from the tongue, 74/124 (60%) presented with advanced stage III or IV disease, 112/124 (90%) had a conventional phenotype, 84/124 (68%) were moderately differentiated, and 89/124 (72%) had bands or cords at the invasive front. Of the 124 patients with HNSCC, 84/124 (68%) demonstrated the presence of HPV, 0/124 (0%) was for oral squamous cell carcinomas (OSCC). HPV16 was the associated virus type in all positive samples. However, no significant association was observed between HPV positivity and other clinico-pathological variables including age and gender of the patients, stage, and malignancy differentiation. Conclusion The results we provide suggest that HPV infection is low in HNSCC, in general, and absent in OSCC, specifically, in this UK population during this time period. This implies that HPV infection may not play an important role in HNSCC carcinogenesis compared to other risk factors in UK population. This information can aid in more effective treatment approaches for treating UK cases of HNSCC.
Collapse
Affiliation(s)
- Raghad Al-Dabbagh
- Department of Oral and Maxillofacial Prosthodontics, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia; Eastman Dental Institute, University College London, Oral Pathology Department, London, United Kingdom, Saudi Arabia
| | - Nadia Al-Hazmi
- Department of Oral Biology, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Turki Y Alhazzazi
- Department of Oral Biology, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - A W Barrett
- Eastman Dental Institute, University College London, Oral Pathology Department, London, United Kingdom
| | - Paul M Speight
- Eastman Dental Institute, University College London, Oral Pathology Department, London, United Kingdom
| |
Collapse
|
6
|
Barrett AW, Pratt MK, Sassoon I, Bisase BS, Newman L, Tighe JV, Norris PM, Dhanda J, Gulati A. Perineural and lymphovascular invasion in squamous cell carcinoma of the tongue. J Oral Pathol Med 2020; 50:32-38. [PMID: 32815232 DOI: 10.1111/jop.13104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perineural invasion (PNI) and lymphovascular invasion (LVI) may be adverse prognostic indicators in squamous cell carcinoma (SCC) of the tongue. METHODS The percentages of histological PNI and LVI were determined in 335 patients with tongue SCC. Sixty tumours originally reported as negative for these features were tested to determine how many more were positive with "immunohistochemical enhancement." RESULTS PNI was found in 141 (42.1%) and LVI in 51 (15.2%) patients. 79.4% of the 141 patients who had PNI and 72.6% of the 51 with LVI had a T3 or T4 tumour. Lymph node metastasis was identified in 145 (51.2%) of the 280 patients who had undergone neck dissection; 58.2% of the 141 patients with PNI and 80.4% of the 51 patients with LVI had lymph node metastasis. There was a highly statistically significant correlation between PNI with increasing pT (P < .00001) and pN (P < .0001) stage, and a statistically significant correlation between LVI and pT stage (P < .001), the association of LVI with pN status could not be reliably tested statistically. Immunohistochemistry for S100 identified five further cases of PNI, but review of the original H&E showed the feature was present in four and had been missed at original reporting. CD31 identified three further possible cases of LVI and D2-40 none. The endothelium of some vascular channels was positive for both CD31 and D2-40 and cross-reactivity with other cells compromised interpretation. CONCLUSIONS Histological identification of PNI and LVI per se remains of uncertain prognostic significance. "Immunohistochemical enhancement" offered little benefit.
Collapse
Affiliation(s)
- Andrew W Barrett
- Department of Histopathology, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Murray K Pratt
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Isabel Sassoon
- Department of Computer Science, Brunel University London, Uxbridge, UK
| | - Brian S Bisase
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Laurence Newman
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - John V Tighe
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Paul M Norris
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Jag Dhanda
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| | - Aakshay Gulati
- Maxillofacial Unit, Queen Victoria Hospital NHSF Trust, East Grinstead, UK
| |
Collapse
|
7
|
Bowe CM, Shastri M, Gulati A, Norris P, Corrigan A, Barrett AW, Bisase B. Challenges and outcomes in establishing a sentinel lymph node biopsy service for oral squamous cell carcinoma in a regional district specialist hospital. Br J Oral Maxillofac Surg 2020; 59:217-221. [PMID: 33131801 DOI: 10.1016/j.bjoms.2020.08.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/11/2020] [Indexed: 01/19/2023]
Abstract
UK national guidelines in 2016 recommended that sentinel lymph node biopsy (SLNB) should be offered to patients with early oral squamous cell carcinoma (OSCC). We review the establishment of an OSCC SLNB service with specific consideration to resources, service implications and patient outcomes. A review of processes was performed to identify key stages in establishing the service, and subsequently a retrospective cohort study consisting of 46 consecutive patients with T1/T2 N0 OSCC was undertaken. The key stages identified were: coordinating a nuclear medicine pathway and reliable cost-appropriate pathology service, constructing a Trust business case, and gaining approval of a new interventional service policy. A median (range) of 3.3 (1-8) sentinel nodes (SLN) were removed, with 17 patients having a positive SLN. The negative predictive value of SLNB was 100%, with 12 having a SLN outside the field if elective neck dissection (END) was planned. There was a significantly increased risk of a positive SLN with increasing depth of invasion (DOI) (p=0.007) and increased diameter (p=0.036). We also identified a longer-than-ideal time to completion neck dissection and inadequate ultrasound follow up of negative SLNB patients. Establishment of a service requires careful planning. Our results were in keeping with those reported in the literature, and showed that SLNB for OSCC has a high negative predictive value and can identify at-risk SLN outside the traditional END levels, even in well-lateralised tumours. Our findings show that DOI and size of SLN were significantly associated with a positive SLN, and also identified areas requiring improvement.
Collapse
Affiliation(s)
- C M Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead.
| | - M Shastri
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - A Gulati
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - P Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - A Corrigan
- Department of Nuclear Medicine, Maidstone and Tunbridge Wells NHS FT
| | - A W Barrett
- Department of Pathology, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| | - B Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead
| |
Collapse
|
8
|
Patel S, Boyapati RP, Gulati A, Barrett AW. Patients undergoing primary surgery for oral and oropharyngeal cancer: how many are referred on the two-week wait pathway and by whom? Ann R Coll Surg Engl 2020; 102:532-535. [PMID: 32538126 DOI: 10.1308/rcsann.2020.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Available data suggest that the two-week wait referral pathway is ineffective at expediting diagnosis of cancer due to large numbers of inappropriate referrals. This study aimed to compare the referral pathway of 125 patients who had undergone primary surgery for oral and oropharyngeal cancer with 100 who had been two-week wait referrals. MATERIALS AND METHODS This was a case note review. RESULTS Of the 125 patients who underwent surgery; 47 (38%) were referred via the 2WW pathway. GPs had referred 25 (53%) of the 47 patients and general dental practitioners 22 (47%). The tumour stage was similar regardless of referral pathway (two-week wait or routine). GPs recognised that the two-week wait pathway was needed in 49% of the patients they had referred, whereas the equivalent figure for GDPs was 40%. Of the 100 2WW patients, 52 were biopsied. Of these, nine (9%) were diagnosed with a malignancy. GPs referred 61% of the 100 two-week wait patients and accurately diagnosed five of the cancers (although two were basal cell carcinomas), general dental practitioners the remainder (including one basal cell carcinoma). Overall, 41% of the patients referred on the two-week wait pathway by GPs needed a biopsy, compared with 69% of those referred by general dental practitioners. CONCLUSIONS While the criteria for referral on the two-week wait pathway lack discrimination and the majority of referrals proved benign, nearly 40% of surgically treated patients were referred via this pathway, suggesting that it does serve a useful purpose. More patients with cancer were referred by GPs, but more two-week wait referrals by general dental practitioners warranted biopsy.
Collapse
Affiliation(s)
- S Patel
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - R P Boyapati
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - A Gulati
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| | - A W Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK
| |
Collapse
|
9
|
Shastri M, Paterson T, Bisase BS, Barrett AW. Malignant melanoma in situ of the palate: Radical treatment or "watch and wait"? Oral Oncol 2020; 110:104805. [PMID: 32446892 DOI: 10.1016/j.oraloncology.2020.104805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Mayank Shastri
- Maxillofacial Surgery Unit, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Tom Paterson
- Maxillofacial Surgery Unit, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Brian S Bisase
- Maxillofacial Surgery Unit, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK
| | - Andrew W Barrett
- Department of Histopathology, Queen Victoria Hospital NHSF Trust, Holtye Road, East Grinstead RH19 3DZ, UK.
| |
Collapse
|
10
|
Barrett AW, Garg M, Armstrong D, Bisase BS, Newman L, Norris PM, Shelley M, Tighe JV, Hyde NC, Chaston NJ, Gulati A. Cystic Squamous Cell Carcinomas of the Jaws: Twelve Cases Highlighting Histopathological Pitfalls. Int J Surg Pathol 2020; 28:624-630. [PMID: 32046560 DOI: 10.1177/1066896920903388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cystic squamous cell carcinomas (SCCs) of the jaws, including carcinoma cuniculatum, are rare, slow growing, and relentlessly invasive. The aim of this article is to present 12 cases, 4 of which were designated as carcinoma cuniculatum on the basis of deeply endophytic, anastomosing channels of cystic stratified squamous epithelium and keratin microabscesses. The other 8 were also cystic, but more heterogeneous morphologically and were diagnosed as well differentiated SCCs. Six patients were female, 6 were male (mean age = 74.0 years, range = 50-94 years). Six tumors affected the mandible, 6 the maxillary alveolus with or without extension into the hard palate. All patients underwent primary resection with neck dissection and were staged as T4a N0 M0. In 4 patients, diagnosis was delayed as a result of superficial biopsies and/or confusing histopathology. Cystic SCCs of the jaws can be difficult to diagnose and clinicoradiological correlation is essential. Long-term follow-up is mandatory.
Collapse
Affiliation(s)
- Andrew W Barrett
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Montey Garg
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Daniel Armstrong
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Brian S Bisase
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Lawrence Newman
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Paul M Norris
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Michael Shelley
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - John V Tighe
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | | | | | - Aakshay Gulati
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| |
Collapse
|
11
|
Barrett AW, Boyapati RP, Bisase BS, Norris PM, Shelley MJ, Collyer J, Sneddon KJ, Gulati A. Verruciform Xanthoma of the Oral Mucosa: A Series of Eight Typical and Three Anomalous Cases. Int J Surg Pathol 2019; 27:492-498. [PMID: 30727785 DOI: 10.1177/1066896919827374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this series, there are 8 typical verruciform xanthomas of the oral mucosa and 3 anomalies, 1 polypoid, 1 florid, and 1 carcinomatous. All were characterized by infiltrates of CD68-positive xanthomatous histiocytes in the lamina propria. The 11 patients comprised 6 men and 5 women (mean age = 54.5 years, range = 40-69). Both keratinized and nonkeratinized sites were affected. A history of lichenoid inflammation was recorded in 5 patients. The polypoid xanthoma presented in a woman aged 54 years as a polyp of the labial commissure. The florid lesion affected the dorsum of the tongue of a man aged 54 years and at 20 mm was the largest of the 11 lesions, but the only one with candidal infection. The squamous cell carcinoma manifested as a papilloverrucous hyperkeratosis of the palatal gingiva in a man aged 69 years. The latter 2 (and 1 "typical" verruciform xanthoma) required re-excision, but none has since recurred.
Collapse
Affiliation(s)
- A W Barrett
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - R P Boyapati
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - B S Bisase
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - P M Norris
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - M J Shelley
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - J Collyer
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - K J Sneddon
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - A Gulati
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| |
Collapse
|
12
|
Linnard H, Newman L, Barrett AW. Dermoid cyst of the submandibular gland: case report. Br J Oral Maxillofac Surg 2017; 55:983-984. [PMID: 28919075 DOI: 10.1016/j.bjoms.2017.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/28/2017] [Indexed: 11/16/2022]
Affiliation(s)
- H Linnard
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, West Sussex, UK.
| | - L Newman
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, West Sussex, UK
| | - A W Barrett
- Department of Histopathology, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead RH19 3DZ, West Sussex, UK
| |
Collapse
|
13
|
Barrett AW. Will the 8th editions of the UICC & AJCC staging manuals improve the pathological diagnosis of extranodal extension from cervical lymph nodes? Oral Oncol 2017; 72:197. [DOI: 10.1016/j.oraloncology.2017.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/13/2022]
|
14
|
Gray DG, Franklin JL, Nicholls MK, Eaton KA, Barrett AW. Compliance of referral and hospital documentation with National Institute of Health and Care Excellence guidelines for the extraction of third molars: a comparative analysis of two NHS Trusts. Br J Oral Maxillofac Surg 2017; 55:575-579. [PMID: 28372881 DOI: 10.1016/j.bjoms.2017.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/28/2017] [Indexed: 10/19/2022]
Abstract
To find out whether documentation for the extraction of wisdom teeth complies with National Institute of Health and Care Excellence (NICE) guidelines, we reviewed the referral letters and hospital notes of patients treated at the maxillofacial unit of two NHS Trusts (A: 314 records and B: 280) over 12 months (1 September 2012 to 31 August 2013). Compliance was assessed as unsatisfactory ("indication for extraction not mentioned", "incorrect indication", "indication unclear") or satisfactory ("correct indication implied", "correct indication explicit"). The grade of the clinician who examined the patient was also recorded. A total of 194/314 (62%) referral letters in Trust A and 126/280 (45%) in Trust B were unsatisfactory (p<0.001). Hospital notes were unsatisfactory in 168/323 (52%) and 87/297 (29%) of cases, respectively (p<0.001). In Trust A, middle grades saw 23% (75/323) of the patients, as compared with 53% (157/297) in Trust B. In both, junior staff produced the highest percentage of satisfactory documentation, but in Trust A they were also responsible for most of the unsatisfactory examples. However, senior house officers saw 60% (195/323) of the patients in Trust A, and only 28% (83/297) in Trust B. Consultants were responsible for significantly more unsatisfactory documentation (p<0.001). One referral letter (0.2%) and seven hospital records (1%) explicitly and accurately complied with the guidelines. We conclude that compliance of documentation with the current NICE guidelines is poor and inconsistent.
Collapse
Affiliation(s)
- D G Gray
- Department of Oral & Maxillofacial Surgery, Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE; Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG
| | - J L Franklin
- Maxillofacial Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ; Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG
| | - M K Nicholls
- Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG
| | - K A Eaton
- Health Education England, Kent, Surrey, Sussex Deanery, and University of Kent, Centre for Professional Practice, Compass Centre South, Chatham Maritime, Kent ME4 4YG
| | - A W Barrett
- Department of Histopathology, Queen Victoria Hospital, Holtye Road, East Grinstead, RH19 3DZ.
| |
Collapse
|
15
|
Barrett AW, Sneddon KJ, Tighe JV, Gulati A, Newman L, Collyer J, Norris PM, Coombes DM, Shelley MJ, Bisase BS, Liebmann RD. Dentigerous Cyst and Ameloblastoma of the Jaws. Int J Surg Pathol 2016; 25:141-147. [PMID: 27621276 DOI: 10.1177/1066896916666319] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine how many ameloblastomas were misdiagnosed as dentigerous cysts (DCs) by correlating the radiological and histopathological features of a series of both entities. METHODS AND RESULTS Histopathology reports and radiological imaging of 135 DCs and 43 ameloblastomas were reviewed. Any clinical or radiological feature that suggested that the diagnosis of DC was wrong-for example, absence of an unerupted tooth-prompted review of the original histology. A total of 34 cases coded as DC at diagnosis were excluded; in the remaining 101 patients, the clinicoradiological and histopathological features were consistent with DC in 96 (95.0%). Review of the histology revealed that 4 patients had actually had odontogenic keratocysts (OKCs) and one a luminal/simple unicystic ameloblastoma (UA). One other OKC and 3 other ameloblastomas (1 luminal UA, 2 solid/multicystic) had originally been diagnosed as DC; these had been identified prior to the study. Of the 9 misdiagnosed patients, 6 were ≤20 years old. Clinically, DC had been the only, or one of the differential, diagnoses in 7 patients; in the other 2, the clinical diagnosis was radicular cyst. In none of the 4 misdiagnosed ameloblastomas was the radiology compatible with a diagnosis of DC. Incorrect terminology had been used on the histopathology request form in 5 of the 34 excluded cases where the clinical diagnosis was DC, despite the cyst being periapical to an erupted carious or root-filled tooth. CONCLUSIONS The entire clinical team must ensure that a histopathological diagnosis of DC is consistent with the clinicoradiological scenario, particularly in younger patients.
Collapse
Affiliation(s)
- Andrew W Barrett
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Kenneth J Sneddon
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - John V Tighe
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Aakshay Gulati
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Laurence Newman
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Jeremy Collyer
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Paul M Norris
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Darryl M Coombes
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Michael J Shelley
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | - Brian S Bisase
- 1 Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | | |
Collapse
|
16
|
Abstract
Recent evidence indicates that political coverage in newspapers varies from outlet to outlet in correlation with the political atmosphere of those papers.Visual images from photographs of political candidates published in these newspapers are no exception. Although previous works have examined the importance of visual images on observer evaluations, little work has been done to assess whether differing newspaper photographs of a political candidate can actually shape how potential voters view that candidate. We address this gap in the extant literature through an experiment designed to assess the potential influence of candidate photographs on voter perceptions when partisanship is not available as a heuristic device.The results of our study indicate that newspaper photographs can shape how voters evaluate a candidate's personal traits, their general impression of that candidate,and their decision whether to vote for that candidate.We also found thatwomen and men are affected differently by photographs, with the former influenced more by a positive picture and the latter triggered by a negative one.
Collapse
Affiliation(s)
- Andrew W. Barrett
- Department of Political Science, Marquette University, Wehr Physics Building, Room 468A, P.O. Box 1881, Milwaukee, WI 53201-1881; phone: 414-288-3321; fax: 414-288-3360
| | - Lowell W. Barrington
- Department of Political Science, Marquette University, Wehr Physics Building, Room 468A, P.O. Box 1881, Milwaukee, WI 53201-1881; phone: 414-288-5983; fax: 414-288-3360
| |
Collapse
|
17
|
Kichenaradjou A, Barrett AW, Norris P, Rowell N, Newman L. Inflammatory pseudotumour of the maxilla. Oral Maxillofac Surg 2016; 20:309-312. [PMID: 27052813 DOI: 10.1007/s10006-016-0553-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
Inflammatory pseudotumour (IP), also known as inflammatory myofibroblastic tumour (IMT), is a rare lesion of the maxillofacial skeleton and a diagnosis by exclusion. We describe three cases which affected the maxilla, two women and one man of ages 67, 56 and 70 years at presentation. All showed the typical, rather non-specific histopathological features. IgG4-positive plasma cells varied greatly in prominence, and none of the three lesions expressed ALK-1. Both women responded to steroids and radiotherapy, though one also required azathioprine. Despite maxillectomy, radiotherapy, steroids and cyclophosphamide, the man suffered intracranial spread and succumbed to persistent disease. The cases described here demonstrate the clinicopathological difficulties presented by this entity and its aggressive, unpredictable behaviour.
Collapse
Affiliation(s)
- A Kichenaradjou
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK.
- , 6 Smeeds Close, East Grinstead, West Sussex, RH19 3AL, UK.
| | - A W Barrett
- Department of Histopathology, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
| | - P Norris
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
| | - N Rowell
- Kent Oncology Centre, Maidstone Hospital, Maidstone, ME16 9QQ, UK
| | - L Newman
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, RH19 3DZ, UK
| |
Collapse
|
18
|
Starkey LA, Barrett AW, Beall MJ, Chandrashekar R, Thatcher B, Tyrrell P, Little SE. Persistent Ehrlichia ewingii infection in dogs after natural tick infestation. J Vet Intern Med 2015; 29:552-5. [PMID: 25776536 PMCID: PMC4895497 DOI: 10.1111/jvim.12567] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/26/2014] [Accepted: 01/28/2015] [Indexed: 12/03/2022] Open
Abstract
Background Ehrlichia ewingii, which causes disease in dogs and people, is the most common Ehrlichia spp. infecting dogs in the United States, but little is known about how long E. ewingii infection persists in dogs. Hypothesis/Objectives To evaluate the persistence of natural infection with E. ewingii in dogs. Animals Four Class A Beagles; no previous exposure to ticks or tick‐borne infectious agents. Methods Dogs were exposed to ticks by weekly walks through tick habitat in north central Oklahoma; dogs positive for infection with Ehrlichia spp. by sequence‐confirmed PCR and peptide‐specific serology were evaluated for 733 days (D). Whole blood was collected once weekly for PCR, and serum was collected once monthly for detection of antibodies to Ehrlichia canis (peptide p16), Ehrlichia chaffeensis (indirect fluorescence antibody [IFA] and variable‐length PCR target [VLPT]), and E. ewingii (peptide p28). Results All dogs (4/4) became infected with Ehrlichia spp. as evidenced by seroconversion on IFA to E. chaffeensis (4/4); PCR detection of E. ewingii (4/4) and E. chaffeensis (2/4) DNA using both nested and real‐time assays; and presence of specific antibodies to E. ewingii (4/4) and E. chaffeensis (2/4). Infection with E. chaffeensis was not detected after D55. Intermittent E. ewingii rickettsemia persisted in 3 of 4 dogs for as long as 733 days. Conclusions and Clinical Importance Our data demonstrate that dogs infected with E. ewingii from tick feeding are capable of maintaining infection with this pathogen long‐term, and may serve as a reservoir host for the maintenance of E. ewingii in nature.
Collapse
Affiliation(s)
- L A Starkey
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK
| | | | | | | | | | | | | |
Collapse
|
19
|
Doumas S, Paterson JC, Norris PM, Tighe JV, Newman L, Bisase BS, Kolokotronis AE, Barrett AW. Fractalkine (CX3CL1) and fractalkine receptor (CX3CR1) in squamous cell carcinoma of the tongue: markers of nerve invasion? Oral Maxillofac Surg 2014; 19:61-4. [PMID: 25008036 DOI: 10.1007/s10006-014-0455-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/29/2014] [Indexed: 01/16/2023]
Abstract
PURPOSE Perineural invasion (PNI) in oral squamous cell carcinoma (SCC) is an independent predictor of poor prognosis. As PNI is not always identified with routine histology, a surrogate marker of PNI would improve detection and better inform treatment planning. The chemokines fractalkine (CX3CL1) and its receptor (CX3CR1) have shown such potential in other cancers, but have yet to be investigated with respect to PNI in oral SCC. METHODS Thirty SCCs of the tongue in which PNI was identified histologically, and 30 in which it was not, were stained for fractalkine and fractalkine receptor using polyclonal antibodies and an immunoperoxidase technique. Tumours were assessed as either positive or negative; no attempt was made to subjectively assess staining intensity or extent. RESULTS Both markers labelled myofibroblasts in the stroma surrounding the tumour, various neural components, leucocytes, endothelium and salivary myoepithelial cells. Fractalkine also labelled salivary ductal epithelium, vascular smooth muscle and 12/30 SCC which showed PNI. Eight of 30 positive SCCs in which PNI was not identified were also positive for this marker. There was no statistically significant association between fractalkine staining and PNI (p = 0.273). No SCC was positive for fractalkine receptor, but immune dendritic cells within tumour islands were strongly positive, as was striated muscle. CONCLUSIONS Neither fractalkine nor fractalkine receptor is a reliable surrogate marker of PNI in lingual SCC.
Collapse
Affiliation(s)
- S Doumas
- Queen Victoria Hospital NHSF Trust, East Grinstead, West Sussex, UK
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Villarroel Dorrego M, Papp Y, Shelley MJ, Barrett AW. Chondroid lipoma of the tongue: a report of two cases. Oral Maxillofac Surg 2014; 18:219-222. [PMID: 23900485 DOI: 10.1007/s10006-013-0426-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 07/09/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Chondroid lipoma affecting the oral cavity is rare and usually presents as a polyp of benign clinical appearance which is easily excised. However, the histopathological features of chondroid lipoma resemble liposarcoma due to the presence of lipoblasts and lack of mature cartilage. CASE REPORTS The clinicopathological features of two cases of chondroid lipoma of the dorsum of the tongue, one in a 66-year-old woman and the other in a 43-year-old man, are described. CONCLUSION Once the diagnosis had been established, no treatment other than surgical excision was necessary and in neither case has there been recurrence in two years of follow-up.
Collapse
|
21
|
Doumas S, Kolokotronis A, Zormpa M, Barrett AW. Essential mixed cryoglobulinemia manifesting as recurrent perioral edema: report of a case. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:e57-60. [PMID: 24332336 DOI: 10.1016/j.oooo.2013.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022]
Abstract
Cryoglobulins are immunoglobulins that precipitate in vitro at temperatures <37°C but that redissolve if heated; they are broadly divided into 3 classes. Cryoglobulinemia has a plethora of clinical manifestations, but it typically presents a vasculitic syndrome, most notably a triad of purpura, arthralgia, and weakness secondary to cryoglobulin deposition in small or medium-sized blood vessels. The highly variable clinical presentation and inconsistent laboratory isolation of cryoglobulins mean that the diagnosis may be one of exclusion or of retrospective review. We describe a case of a 67-year-old woman whose principal symptom was recurrent perioral edema, which was characteristically induced by cold. Raised cryoglobulins combined with a positive autoantibody screen suggested mixed cryoglobulinemia secondary to Sjögren syndrome. However, in the subsequent 6 years, she has remained generally well, having developed no autoimmune, neoplastic, or other disease, suggesting the diagnosis is one of "essential" mixed cryoglobulinemia. No treatment other than symptomatic analgesia has been required.
Collapse
Affiliation(s)
- Stergios Doumas
- Maxillofacial Unit, Queen Victoria Hospital NHS Foundation Trust, West Sussex, United Kingdom.
| | - Alexandros Kolokotronis
- Professor of Oral Medicine & Maxillofacial Pathology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matina Zormpa
- Postgraduate in Oral Medicine & Maxillofacial Pathology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A W Barrett
- Consultant Oral Pathologist, Queen Victoria Hospital NHS Foundation Trust, West Sussex, United Kingdom
| |
Collapse
|
22
|
Abstract
OBJECTIVES The aim of this study was to determine the expression of PLUNC proteins in benign and malignant salivary gland tumours and thus their potential use as diagnostic and / or prognostic tools. MATERIALS AND METHODS A tissue microarray was assembled from 64 salivary gland tumours including adenoid cystic carcinoma, carcinoma ex-pleomorphic adenoma, mucoepidermoid carcinoma, polymorphous low-grade adenocarcinoma, pleomorphic adenoma, acinic cell carcinoma, myoepithelial carcinoma and papillary cystadenocarcinoma. Clinicopathological data were collected retrospectively and immunohistochemical analysis of three PLUNC proteins (SPLUNC1, SPLUNC2 and LPLUNC1) was performed. Immunoreactivity was assessed as positive or negative. RESULTS PLUNC expression was only found in mucoepidermoid carcinomas and papillary cystadenocarcinoma; all other tumours studied were negative. Mucin plugs, mucous and intermediate cells of mucoepidermoid carcinomas were positive for LPLUNC1 and SPLUNC2, but areas composed of epidermoid and clear cells were negative for all PLUNCs. Papillary cystadenocarcinoma was positive for all PLUNCs. No correlation was found with tumour grade or outcome. CONCLUSIONS Intense expression of two PLUNC proteins in mucous cells and mucin plugs of mucoepidermoid carcinoma and papillary cystadenocarcinoma indicate that they could be used as additional diagnostic tools in some equivocal cases, but further studies are needed to understand the biological processes involved in PLUNC expression.
Collapse
Affiliation(s)
- P A Vargas
- Department of Oral Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | | | | | | |
Collapse
|
23
|
Shah N, Tighe JV, Barrett AW, Kumar S, Allen JP. Bilateral intraparotid and extraparotid Warthin's tumours. Br J Oral Maxillofac Surg 2007; 45:238-9. [PMID: 16207506 DOI: 10.1016/j.bjoms.2005.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 08/12/2005] [Indexed: 11/29/2022]
Abstract
Warthin's tumour is a benign adenoma in the parotid gland, but extraparotid and synchronous bilateral Warthin's tumours may occur. In this report, we describe a patient with simultaneous bilateral involvement of the parotid glands and neck by multiple Warthin's tumours, an occurrence not previously described.
Collapse
Affiliation(s)
- N Shah
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK.
| | | | | | | | | |
Collapse
|
24
|
Chakravarthy KM, Lavery KM, Barrett AW. Recurrent cutaneous metaplastic synovial cyst. ACTA ACUST UNITED AC 2007; 103:e42-4. [PMID: 17395059 DOI: 10.1016/j.tripleo.2006.02.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 02/06/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
Abstract
Reported here is the first case of a recurrent cutaneous metaplastic synovial cyst (CMSC). The CMSC is a recently described lesion that is histologically characterized by a cystic cavity lined by cells resembling metaplastic synovium overlying villous connective tissue cores. The lesion clinically appears as a tender subcutaneous nodule and may often be misdiagnosed as a suture granuloma. Although the actual cause is unclear, a history of trauma usually precedes its onset. Here we present a case of CMSC in a 34-year-old white male, which recurred at the same site following excision of an epidermoid cyst. CMSCs are unique lesions that should be included in the differential diagnosis of tender subcutaneous swellings following surgical trauma.
Collapse
Affiliation(s)
- Kalyan M Chakravarthy
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, West Sussex, England.
| | | | | |
Collapse
|
25
|
Abstract
We report a case of benign fibrous histiocytoma (BFH) of the medial canthus that mimicked keratoacanthoma in clinical appearance and growth. Excisional biopsy confirmed the diagnosis of the cellular subtype of benign fibrous histiocytoma. These types of BFH are typically more aggressive in growth, with a high recurrence rate and a tendency to undergo autonomous growth at other sites. The diagnosis of BFH should also be considered among those that appear typical of keratoacanthoma. Similar to other rapidly enlarging eyelid tumors, prompt excisional biopsy is recommended.
Collapse
Affiliation(s)
- Sharon R Morris
- Corneoplastic Unit, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex, United Kingdom
| | | | | | | |
Collapse
|
26
|
Abstract
This report describes the 12th documented case of histiocytoid, diffuse or signet-ring cell eccrine sweat gland carcinoma of the eyelid, a rare neoplasm that characteristically affects older men and mimics distant metastasis. Clinically, the patient was thought to have a colonic metastasis. Histologically, the neoplasm comprised sheets and cords of polygonal, eosinophilic cells, with dispersed larger, rounded single cells resembling histiocytes, and cells with cytoplasmic lumina or a signet-ring appearance. Occasional duct formation was also seen. The features were reminiscent of both the histiocytoid and lobular variants of breast carcinoma. Ultrastructurally, the presence of nonintestinal type microvilli with a length : width ratio in excess of 16 were consistent with an eccrine origin, but also raised the possibility of metastatic mesothelioma. However, a metastatic lesion was excluded by clinical and imaging investigations. There has been no recurrence 3 years after primary excision.
Collapse
Affiliation(s)
- B Swinson
- Oral and Maxillofacial Pathology Unit, Eastman Dental Institute for Oral Healthcare Sciences, University College London, University of London, London, UK
| | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Villarroel Dorrego M, Whawell SA, Speight PM, Barrett AW. Transfection and ligation of CD40 in human oral keratinocytes affect proliferation, adhesion and migration but not apoptosis in vitro. Clin Exp Dermatol 2006; 31:266-71. [PMID: 16487107 DOI: 10.1111/j.1365-2230.2005.02018.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS CD40 expression is restricted to Keratinocytes of normal epidermis or stratified squamous epithelium of oral mucosa. Ligation of CD40 inhibits keratinocyte proliferation and apoptosis. The aim of this study was to investigate the functional significance of CD40 in the proliferation, apoptosis, adhesion and migration of human oral keratinocytes in vitro. METHODS The CD40-negative oral keratinocyte line OSC19, its CD40-positive transfected derivative (OSC19T-CD40) and null transfectants (OSC19T-control), with and without stimulation by soluble protein CD40 ligand (sCD40L) or anti-CD40 antibodies were used. RESULTS OSC19T-CD40 showed significantly (P < 0.001) slower growth than the null transfectants and parent cells. OSC19T-CD40 proliferation was inhibited by ligation with sCD40L and blocking by two anti-CD40 antibodies, but stimulated by a third. Binding of CD40 with ligand or antibody had no effect on keratinocyte apoptosis in any cell line. The capacity of OSC19T-CD40 cells to adhere to CD40L-coated wells was significantly greater (P < 0.001) than that of parent OSC19 and OSC19T-control cells, and the migration rate of OSC19T-CD40 cells was significantly higher than parent OSC19 (P = 0.038 on fibronectin, P = 0.004 on Matrigel) or OSC19T-control (P =0.017 on fibronectin, P = 0.013 on Matrigel) cells. CONCLUSIONS CD40 is an important molecule in keratinocyte homeostasis, and has more than one ligand. The ligand that is bound may be critical in oral epithelial homeostasis, the development of malignancy and the behaviour of the subsequent tumour.
Collapse
Affiliation(s)
- M Villarroel Dorrego
- Oral and Maxillofacial Pathology Unit, Eastman Dental Institute for Oral Healthcare Sciences, University College London, London, UK
| | | | | | | |
Collapse
|
29
|
Villarroel Dorrego M, Whawell SA, Speight PM, Barrett AW. Transfection of CD40 in a human oral squamous cell carcinoma keratinocyte line upregulates immune potency and costimulatory molecules. Br J Dermatol 2006; 154:231-8. [PMID: 16433790 DOI: 10.1111/j.1365-2133.2005.07006.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is upregulation of class II molecules of the major histocompatibility complex (MHC) by keratinocytes in oral squamous cell carcinoma (OSCC) and inflammatory diseases such as lichen planus. The significance of this expression, or whether it is accompanied by upregulation of membrane-bound costimulatory molecules, is unknown. OBJECTIVES To compare the expression of CD40, CD80, CD86, MHC class II and intercellular adhesion molecule-1 (ICAM-1), and the ability to induce allogeneic T-lymphocyte proliferation in vitro, of a CD40- OSCC cell line, its CD40+ transfected derivative and null transfectants. METHODS OSCC cell lines and purified T lymphocytes were cocultured and T cell proliferation recorded. Phenotypes were analysed by flow cytometry. RESULTS After T lymphocyte proliferation, which all OSCC cell lines were able to induce, there was upregulation of MHC class II and ICAM-1. However, the CD40+ transfectants were the most immunologically potent and were the only cells to show increased expression of CD86 (as well as further upregulation of CD40 and a statistically insignificant rise in CD80). The effects of blocking antibodies on T-cell proliferation were only statistically significant with the CD40+ transfectants. CONCLUSIONS While not essential, expression of CD40 by OSCC cells is necessary for optimal induction of allogeneic T lymphocytes, possibly because of concurrent upregulation of other membrane-bound costimulatory molecules.
Collapse
Affiliation(s)
- M Villarroel Dorrego
- Department of Oral Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield S10 2TA, UK
| | | | | | | |
Collapse
|
30
|
Kingsmill VJ, Berkovitz BKB, Barrett AW. An immunohistochemical analysis of human Merkel cell density in gingival epithelium from dentate and edentulous subjects. Arch Oral Biol 2005; 50:883-7. [PMID: 16137497 DOI: 10.1016/j.archoralbio.2005.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2004] [Accepted: 02/06/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether there is a difference in the density of Merkel cells between the gingiva of dentate and edentate subjects. METHODS One hundred and two blocks of human mandibular (n=55) and maxillary (n=47) gingiva from 69 white skinned individuals (44 males, 25 females, mean age 70.1 years, range 42--92 years) were analysed. Twenty-six individuals had teeth remaining in at least one jaw (mean age of dentate 64.5 years, edentate 72.1 years), of which 15 were dentate in both jaws. Overall, 24/55 mandibles and 17/47 maxillae were dentate. Five micrometer sections were stained with a monoclonal antibody to cytokeratin 20 (CK 20) using standard immunoperoxidase or immunoalkaline phosphatase methods. Positive cells were counted in 20 consecutive high power fields using the x 40 objective in three sections from each biopsy, and the results analysed for differences related to age, sex, site and presence of teeth. RESULTS CK 20-positive Merkel cells were present either singly or in clusters in the basal epithelial layers, particularly at the tips of rete ridges. Numbers of gingival Merkel cells were significantly higher (p<0.005, Mann-Whitney) in edentate (cells per field mean, median, standard deviation, respectively: 1.39, 0.64, and 1.85) when compared to dentate (0.67, 0.20, and 1.21) specimens. The differences were not statistically significant for any other variable. CONCLUSION The data raise the possibility that reduced perception following loss of teeth may be compensated for by an increase in the local Merkel cell population.
Collapse
Affiliation(s)
- V J Kingsmill
- Barts and The London, Queen Mary's School of Medicine and Dentistry, Turner Street, London E1 2AD, UK
| | | | | |
Collapse
|
31
|
Porter SR, Poate TWJ, Hodgson TA, Buchanan JAG, Moles DR, Scully C, Speight PM, Barrett AW. Re: Eisen, D & Frist, S--letter. Oral Oncol 2005; 41:861. [PMID: 15935727 DOI: 10.1016/j.oraloncology.2004.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Indexed: 11/18/2022]
|
32
|
Barrett AW, Morgan M, Nwaeze G, Kramer G, Berkovitz BKB. The differentiation profile of the epithelium of the human lip. Arch Oral Biol 2005; 50:431-8. [PMID: 15748696 DOI: 10.1016/j.archoralbio.2004.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Accepted: 09/08/2004] [Indexed: 10/26/2022]
Abstract
The aim of this study was to analyse the immunohistochemical differentiation profile of the stratified squamous epithelium of the adult human lip. Full-thickness lower lips taken from 31 cadavers were analysed. Sections were stained with haematoxylin and eosin, periodic acid-Schiff (PAS), cytokeratins (CK), loricrin, involucrin, profilaggrin and filaggrin. The stratified squamous epithelium covering the lip could be divided into: (i) appendage-bearing, orthokeratinised epidermis; (ii) orthokeratinised vermilion which had a more prominent rete pattern than the epidermis; (iii) parakeratinised, PAS-positive intermediate zone; and (iv) non- or parakeratinised labial mucosal epithelium. Epithelial thickness increased gradually from the skin to the mucosal aspect. The CK pattern changed across the intermediate zone, with gradual loss of CK 1 and 10 from the skin, and CK 4, 13 and 19 from the mucosal, aspect. CK 5 and 14 were consistently expressed basally, and variably expressed suprabasally. Apart from labelling Merkel cells, CK 8, 18 and 20 were negative. Involucrin, which was present at all sites, was restricted to the stratum granulosum in skin, but extended into the stratum spinosum, and gradually into parabasal keratinocytes, across the vermilion and mucosa. Loricrin, profilaggrin and filaggrin were present in the stratum granulosum of orthokeratinised sites, but expression was abruptly lost at the junction between the vermilion and the intermediate zone. In conclusion, the phenotype of the stratified squamous epithelium covering the lip changes at, or across, the intermediate zone of the adult vermilion. It is possible that changes in the composition of the stratified squamous epithelium affect the colour of the vermilion.
Collapse
Affiliation(s)
- A W Barrett
- Oral and Maxillofacial Pathology Unit, Eastman Dental Institute for Oral Healthcare Sciences, University College London, 256 Grays Inn Road, London WC1X 8LD, UK.
| | | | | | | | | |
Collapse
|
33
|
Poate TWJ, Buchanan JAG, Hodgson TA, Speight PM, Barrett AW, Moles DR, Scully C, Porter SR. An audit of the efficacy of the oral brush biopsy technique in a specialist Oral Medicine unit. Oral Oncol 2004; 40:829-34. [PMID: 15288839 DOI: 10.1016/j.oraloncology.2004.02.005] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 02/19/2004] [Indexed: 11/25/2022]
Abstract
The diagnosis of oral epithelial dysplasia has traditionally been based upon histopathological evaluation of a full thickness biopsy specimen from lesional tissue. It has recently been proposed that cytological examination of "brush biopsy" samples is a non-invasive method of determining the presence of cellular atypia, and hence the likelihood of oral epithelial dysplasia. The present audit determined, retrospectively the sensitivity, specificity and positive and negative predictive values of the oral brush biopsy technique in the diagnosis of potentially malignant disease in a group of 112 patients attending a specialist Oral Medicine unit. The sensitivity of detection of oral epithelial dysplasia or squamous cell carcinoma of the oral brush biopsy system was 71.4% while the specificity was 32%. The positive predictive value of an abnormal brush biopsy result (positive or atypical) was 44.1%, while the negative predictive value was 60%. It is concluded that not all potentially malignant disease is detected with this non-invasive investigative procedure.
Collapse
Affiliation(s)
- T W J Poate
- Oral Medicine, Division of Maxillofacial Diagnostic, Medical and Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
Synovial sarcoma is a rare soft tissue tumour of uncertain histogenesis and intraorally they occur mainly in young adults. We present a case of synovial sarcoma of the hard palate in a 68-year-old woman. To our knowledge, there is no previously reported instance of this tumour at this site.
Collapse
Affiliation(s)
- P J Ameerally
- Department of Oral and Maxillofacial Surgery, Queens Medical Centre, Nottingham, UK.
| | | | | | | |
Collapse
|
35
|
Kumar M, Stivaros N, Barrett AW, Thomas GJ, Bounds G, Newman L. Polymorphous low-grade adenocarcinoma—a rare and aggressive entity in adolescence. Br J Oral Maxillofac Surg 2004; 42:195-9. [PMID: 15121262 DOI: 10.1016/j.bjoms.2004.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2004] [Indexed: 11/19/2022]
Abstract
Polymorphous low-grade adenocarcinoma (PLGA) is an uncommon tumour that usually affects the minor salivary glands, particularly in the palate. It is rare in young patients, and here we report a case in a teenage girl. She presented at the age of 16, although the lesion had been noticed 2 years previously. The tumour showed histopathological features of PLGA, but recurred locally, behaved aggressively, and ultimately metastasised to cervical lymph nodes. This was accompanied by an altered histological picture, with a papillary cystic pattern and necrosis becoming progressively more prominent. PLGA is not always a low-grade lesion and some tumours, notably those with a papillary cystic growth pattern, may require more aggressive treatment.
Collapse
Affiliation(s)
- M Kumar
- Maxillofacial Unit, University College Hospital, London WC1E 6AU, UK.
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND Reported cases of syphilis in the United States, Europe and elsewhere are increasing in number. Clinical manifestations are protean, and oral biopsies may be taken where the diagnosis is unsuspected, but data on the histopathology of oral mucosal syphilis are sparse. METHODS The histopathology of five oral lesions in patients with serologically proven syphilis was reviewed. RESULTS There were two cases of primary syphilis, one secondary and two tertiary. Epithelial hyperplasia was present in three cases, and was pseudocarcinomatous in one case of primary syphilis, and psoriasiform in the secondary lesion, where heaped-up epithelium surrounded a defined crater covered by flatter epithelium. Plasma cell (primary and secondary disease) and granulomatous (tertiary) infiltrates were prominent. Other features observed were endarteritis (5/5), plasma cell neuritis (3/5) and spirochetes (4/5). CONCLUSIONS Although no single microscopic feature is specific, a diagnosis of syphilis should be considered where there is unusual epithelial hyperplasia, granulomatous or plasma cell-predominant chronic inflammation, endarteritis and neuritis.
Collapse
Affiliation(s)
- A W Barrett
- Oral and Maxillofacial Pathology, Eastman Dental Institute for Oral Healthcare Sciences, UCL, University of London, 256 Grays Inn Road, London, WC1X 8LD, UK.
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Pyostomatitis vegetans is a rare oral disorder often associated with gastrointestinal and/or cutaneous diseases and sometimes with other disorders. The association of pyostomatitis vegetans with inflammatory bowel disease, particularly ulcerative colitis, is well known and in most cases bowel disease precedes the onset of oral lesions by months or years. A peripheral eosinophilia has been observed in most reported cases. Pyostomatitis vegetans is characterized by erythematous, thickened oral mucosa with multiple pustules and superficial erosions. Histopathologically, it is characterized by intraepithelial and/or subepithelial abscesses containing large numbers of eosinophils. The pathogenesis is as yet unknown although immunological and microbial factors have been suggested as possible aetiological factors. Management of pyostomatitis vegetans consists mainly of immunosuppression using topical or systemic corticosteroids with medical and/or surgical treatment of any underlying inflammatory bowel disease.
Collapse
Affiliation(s)
- A M Hegarty
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK.
| | | | | |
Collapse
|
38
|
Abstract
Microcystic adnexal carcinoma (MAC) is an uncommon, recently described, cutaneous adnexal malignant neoplasm, associated with significant morbidity as a consequence of its propensity for perineural invasion. The present report details the clinical and histological features of MAC in a young female presenting with lower labial swelling and paraesthesia.
Collapse
Affiliation(s)
- T A Hodgson
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, UCL University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | | | | | | |
Collapse
|
39
|
Abstract
This report describes an intra-osseous perineurioma affecting the inferior alveolar nerve, the second at this site, of a 53-year-old man. It produced a well defined, partially corticated, round radiolucency associated with resorption of the root apices of 36 and 37. Histology showed a circumscribed, partially encapsulated cellular tumour composed of bland spindle cells with undulating nuclei and indistinct cell membranes arranged in interlacing fascicles. The tumour was strongly positive for epithelial membrane antigen, collagen IV and laminin, with only scattered S100-positive cells and lack of CD34 expression. Electron microscopy showed elongated cells with continuous external laminae of basement membrane-like material, subplasmalemmal densities, desmosome-like junctions, and variable numbers of micropinocytotic vesicles. The lesion was surgically excised and in 9 months there has been no recurrence.
Collapse
Affiliation(s)
- A W Barrett
- Oral and Maxillofacial Pathology Unit, Eastman Dental Institute for Oral Healthcare Sciences, University College London, 256 Grays Inn Road, London WC1X8LD, UK.
| | | | | |
Collapse
|
40
|
Abstract
Salivary gland tumours are a relatively rare and morphologically diverse group of lesions. Although most clinicians and pathologists will have encountered the more common benign neoplasms, few have experience of the full range of salivary cancers, which are best managed in specialist centres. This review considers some current areas of difficulty and controversy in the diagnosis and management of these neoplasms. The classification of these lesions is complex, encompassing nearly 40 different entities, but precise classification and terminology is essential for an accurate diagnosis and for the allocation of tumours to prognostic groups. For many salivary tumours diagnosis is straightforward but the wide range of morphological diversity between and within tumour types means that a diagnosis may not be possible on small incisional biopsies and careful consideration of the clinical and pathological features together is essential. Although tumour grading is important and helpful, it is not an independent prognostic indicator and must be considered in the context of stage. Large malignancies tend to have a poor prognosis regardless of grade and even high-grade neoplasms may do well when they are small. A helpful guide to management of salivary cancers is the '4 cm rule'.
Collapse
MESH Headings
- Adenocarcinoma/classification
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenoma, Pleomorphic/classification
- Adenoma, Pleomorphic/diagnosis
- Adenoma, Pleomorphic/pathology
- Carcinoma, Adenoid Cystic/classification
- Carcinoma, Adenoid Cystic/diagnosis
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Mucoepidermoid/classification
- Carcinoma, Mucoepidermoid/diagnosis
- Carcinoma, Mucoepidermoid/pathology
- Humans
- Immunohistochemistry
- Neoplasm Staging
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Prognosis
- Salivary Gland Neoplasms/classification
- Salivary Gland Neoplasms/diagnosis
- Salivary Gland Neoplasms/pathology
Collapse
Affiliation(s)
- P M Speight
- Department of Oral and Maxillofacial Pathology, Eastman Dental Institute for Oral Health Care Sciences, University College London, UK.
| | | |
Collapse
|
41
|
Barrett AW, Morgan M, Ramsay AD, Farthing PM, Newman L, Speight PM. A clinicopathologic and immunohistochemical analysis of melanotic neuroectodermal tumor of infancy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 93:688-98. [PMID: 12142876 DOI: 10.1067/moe.2002.124000] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The purpose of this study was to review the features of 8 cases of melanotic neuroectodermal tumor of infancy (MNTI) of the jaws with respect to the expression of NB84, CD99, PGP 9.5, specific cytokeratins, and Ki-67, markers not previously reported in this entity. STUDY DESIGN A clinicopathologic and immunohistochemical analysis of MNTIs in 8 children was undertaken. RESULTS Patients were aged 2(1/2) months to 14 months. Seven were males. Seven lesions affected the maxilla. Microscopically, collections of larger, melanocyte-like cells were admixed with smaller, neuroblast-like cells. All MNTIs contained melanin; although most showed cellular atypia, mitoses were infrequent (<2 per 10 high-power fields). However, in one lesion in which the melanocyte-like cells appeared less differentiated, 7 mitoses per 10 high-power fields were counted. The larger cells expressed cytokeratins 7 (4/8), 8 (8/8), 18 (6/8), and 19 (3/8); PGP 9.5; neuron-specific enolase (6/8); S100; HMB45; and chromogranin A (2/8). The small cells expressed CD56 (7/8), neuron-specific enolase (7/8), synaptophysin (3/8), PGP 9.5 (3/8), and chromogranin A (2/8). No MNTIs expressed NB84. The most mitotically active tumor was the only one to show membrane expression of CD99 (by both cell populations), have a detectable Ki-67-positive fraction (25% in both the large- and small-cell components), behave aggressively, and require bilateral maxillectomy. All other MNTIs responded to local excision, and none metastasized. CONCLUSIONS Most MNTIs are benign and respond to conservative excision. Histology is an unreliable means of predicting clinical behavior, but this study has identified some morphologic and phenotypic features that may indicate a more aggressive lesion.
Collapse
Affiliation(s)
- A W Barrett
- Oral and Maxillofacial Pathology Unit, Eastman Denatal Institute for Oral Healthcare Sciences, University College, London, United Kingdom.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
Previous studies have suggested a link between the presence of Candida albicans and the development of oral squamous cell carcinoma (OSCC). The aim of the present study was to assess the presence and level of colonisation of oral yeast in patients undergoing an incisional oral mucosal biopsy in order to assess whether the amount of oral yeast present correlated with the presence and degree of oral epithelial dysplastic or neoplastic change. Two hundred and twenty-three patients who were undergoing an incisional biopsy for the diagnosis of an oral mucosal lesion were enrolled in this study. Mouth swills were obtained from each patient for the presence and amount of oral yeast present. Some of the patients (44.6%) had a histopathological diagnosis of either oral epithelial dysplasia (OED) or OSCC and the frequency of oral yeast carriage was significantly greater (P<0.001) in these patients than those without histopathologically detected dysplastic or neoplastic oral lesions. Furthermore, significantly (P<0.001) more patients with OED or OSCC had a higher number of yeast (over 1000 cfu/ml) in their oral cavity than patients without any evidence of epithelial dysplasia or neoplasia histopathologically. The degree of epithelial dysplasia present in these patients also correlated with higher amounts of yeast in the oral cavity (P=0.017). The results of the present study reveal that there is an interaction between oral carriage of yeast and oral epithelial dysplasia, however it remains unclear how yeast infection influences the development and progression of dysplasia.
Collapse
Affiliation(s)
- M McCullough
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Medulloblastoma is an infratentorial primitive neuroectodermal tumour. It is the most commonly occurring brain tumour of childhood, accounting for 15-20% of all paediatric tumours. Extracranial metastasis is rare, but may involve the skeleton. Jaw lesions, however, have never been described. A case is reported of metastases of a medulloblastoma to the jaw including the dental pulp.
Collapse
Affiliation(s)
- S Ahmad
- Department of Paediatric Dentistry, Eastman Dental Hospital and Institute, University College, London
| | | | | | | | | |
Collapse
|
44
|
Fasanmade A, Barrett AW. Primary leiomyosarcoma of the oral cavity: A case report and review of the literature. Plast Surg (Oakv) 2002. [DOI: 10.4172/plastic-surgery.1000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
45
|
Abstract
Cellular neurothekeoma is an unusual benign neoplasm which, despite its name, is of uncertain origin. This report describes a cellular neurothekeoma of the cheek mucosa, the first at this site. The tumour presented in a 29-year-old man as a discrete mucosal thickening. Histology showed a generally well circumscribed, but unencapsulated, solid tumour which replaced the entire lamina propria and permeated between minor salivary glands and bundles of striated muscle in the submucosa. There was a sub-epithelial Grenz zone. The tumour was composed of nodules of pale, epithelioid cells separated by fascicles of spindle cells, with smaller strands and nests superficially. The nuclei were vesicular and, though mainly bland, occasionally atypical. The stroma was moderately infiltrated by mixed chronic inflammatory cells. Prominent nerves and blood vessels were seen at the periphery of the lesion, and neoplastic cells were noted within intact striated muscle fascicles. With immunohistochemistry, all the neoplastic cells strongly expressed NKI/C3, synaptophysin, neurone-specific enolase and vimentin, some expressed smooth muscle actin and PGP 9.5, but all were negative for S100, factor XIIIa, CD34, CD56, CD57, CD68, chromogranin A, desmin, epithelial membrane antigen and von Willebrand factor. The origin of the lesion is thus speculative. It was, however, completely excised and in 12 months there has been no recurrence.
Collapse
Affiliation(s)
- A W Barrett
- Department of Oral Pathology, Eastman Dental Institute for Oral Healthcare Sciences, University College London, 256 Grays Inn Road, London WC1X 8LD, UK.
| | | |
Collapse
|
46
|
Abstract
Retinoic acid is an important signalling molecule in embryological development and continues to be important in the adult animal because it modulates growth and differentiation in many epithelial tissues. The distribution of the enzyme retinaldehyde dehydrogenase-2 (RALDH 2), which is involved in the synthesis of retinoic acid, was studied using immunocytochemical techniques in: (1) the developing orodental region of rats aged between 15 days in utero and 6 months; and (2) in archival human autopsy material consisting of abdominal skin and mucosa from various regions of the mouth. In developing tooth germs, RALDH 2 was absent in the enamel organ and dental papilla, its presence only being noted at the periphery of the dental follicle adjacent to parts of the developing alveolar crypt. In adult teeth, the presence of RALDH 2 was limited to blood vessels in the periodontal ligament. In embryos, the connective tissue beneath the nasal epithelium and the meninges stained strongly positively for RALDH 2, as did the connective tissue beneath nasal epithelium in an adult rat. Both keratinized and non-keratinized human oral epithelia and abdominal skin stained positively for RALDH 2. Staining was present throughout the stratified epithelium, except in the keratinized layer and in the basal layer associated with the dorsal surface of the tongue. In addition, the adnexia as well as the ductal lining of mucous glands stained positively for RALDH 2.
Collapse
Affiliation(s)
- B K Berkovitz
- Department of Anatomy, Cell and Human Biology, GKT School of Biomedical Sciences, Henriette Raphael House, Guy's Campus, London Bridge, SE1 1UL, London, UK.
| | | | | | | |
Collapse
|
47
|
Abstract
OBJECTIVE Superficial arteriovenous hemangioma (AH) is a benign vascular lesion that often affects the head and neck, but only 3 histologically proven intraoral lesions have been previously reported. The aim of this study was to analyze the clinical and histologic features of 36 oral AHs from 35 patients. STUDY DESIGN All vascular lesions, other than pyogenic granulomas, accessioned between 1952 and 2000 were retrieved, and clinical details were gleaned from the request forms or, when available, from the case notes. Histologic sections stained with hematoxylin-eosin were reviewed, and all selected cases were stained for smooth muscle actin and elastin. RESULTS The age range was 12 to 90 (mean, 53 years; median, 59). Of all patients, 54% were female. All the lesions were solitary. The labial mucosa or vermilion was affected in 17 (49%) patients, the tongue in 5, the hard palate and cheek mucosa in 4 each, the gingiva or alveolar mucosa in 3, and the floor of the mouth in 1. Clinical presentation was most often a raised lesion smaller than 20 mm. Duration ranged from months to many years. Four lesions recurred. The consistent histopathologic feature was an unencapsulated mass of blood vessels located in the lamina propria, the submucosa, or both, but 3 patterns could be discerned. The most common (in 44% of cases) comprised a diffuse mixture of thick-walled and thin-walled vessels in variable proportions. The second pattern (42%) showed a lobular arrangement of smaller vessels of uniform wall thickness, sometimes associated with an arteriole. The remaining 14% showed a tortuous pattern of angular, branching, thick-walled vessels lacking inner elastic laminae; one lesion showed both this pattern and the first pattern, one showed both the lobular morphology and the third pattern. Of the patients with the lobular arrangement, 64% were female. Smooth muscle actin was a major component of the lesional vessel walls regardless of thickness, but although most contained some fibrillary elastin, none had inner elastic laminae as prominent as those seen in adjacent true arteries. All AHs contained plump endothelial cells, and mast cell numbers were increased. CONCLUSIONS The etiology of AH is uncertain; endocrine and inflammatory stimuli may activate an underlying vascular malformation. Some lesions, especially those in younger patients, may be true hamartomas.
Collapse
Affiliation(s)
- A W Barrett
- Department of Oral Pathology, Eastman Dental Institute for Oral Health Care Sciences, University College London
| | | |
Collapse
|
48
|
Abstract
Cytokeratin (CK) 20 is a low molecular-weight intermediate filament reportedly expressed only by benign and malignant gastrointestinal epithelium, urothelium and Merkel cells. The main aims here were to map its expression in normal oral mucosa of humans and other mammals, and to determine whether it was expressed by abnormal human oral epithelium. Salivary and odontogenic epithelium were also analysed. An immunoperoxidase method was used on wax-embedded and cryostat sections. In addition, double-labelling experiments were undertaken to determine the association between CK 20 expression and that of CK 8/18 or S100 protein. Normal human oral mucosa from four sites, together with abdominal skin, was studied in autopsy samples from 32 individuals. CK 20-positive, basally situated, round or angular cells, consistent with Merkel cells, were recorded in 24/32 (75.0%) samples of mandibular gingiva, 25/32 (78.1%) samples of hard palate, 7/32 (21.9%) samples of buccal mucosa, 0/32 samples of lateral border of tongue, and 2/32 (6.3%) samples of abdominal skin. Double-labelling showed that all CK 20-positive Merkel cells also expressed CK 8/18 and S100. The only other cells to express CK 20 were human taste buds. There was no expression by dysplastic or invasive oral epithelium from biopsy samples. Colonic mucosa showed luminal-cell positivity in man, marmoset, ferret, rabbit and guinea-pig, but oral mucosa was universally negative in non-human species. It is concluded that in oral mucosa CK 20 is a specific marker of Merkel cells and taste buds, that Merkel cells are more frequently present in keratinized than non-keratinized oral mucosa, that CK 20-positive Merkel cells are also S100-positive, that there may be interspecies variations in CK 20 polypeptide composition and that, by contrast to urothelium, CK 20 has no value in the diagnosis of oral epithelial dysplasia.
Collapse
Affiliation(s)
- A W Barrett
- Department of Oral Pathology, Eastman Dental Institute for Oral Healthcare Sciences, University College London, 256 Grays Inn Road, WC1X 8LD, London, UK.
| | | | | | | |
Collapse
|
49
|
Abstract
AIM To devise an optimal protocol and to analyse the leucocyte composition of periapical (PA) lesions by flow cytometry. METHODOLOGY PA lesions were mechanically agitated, with and without proteolysis. This was with either 0.2% collagenase alone, or in combination with 0.02% DNA-ase in serial incubations until all tissue was digested. The efficacy of each method was assessed by counting total cell yield and cell viability. Phenotype stability was gauged by the percentage of peripheral blood leucocytes (PBL) which expressed CD45RB, CD3, CD20, CD4 and CD8 before and after mechanical and collagenase treatment. RESULTS Disaggregation of PA lesions was superior if collagenase was present, but cell clumping was problematic unless the DNA-ase was also added, and serial digestion with this combination produced optimal cell yield and viability. Nevertheless, the total number of cells released rarely exceeded 105, though viability was in excess of 80%. Mechanical agitation and proteolysis adversely affected PBL phenotypes, but collagenase digestion limited to 10 min caused least damage. Flow cytometric analysis of disaggregated PA lesions failed to identify more than 7.9% (mean, range 6-10%) CD45RB + cells. CONCLUSIONS Because of the necessity for single cell suspensions, flow cytometry is not easily applied to the analysis of leucocytes in PA lesions, and further refinements in tissue disaggregation and cell preparation are required.
Collapse
Affiliation(s)
- K Fernando
- Department of Conservative Dentistry, Eastman Dental Institute for Oral Healthcare Sciences, University College London, UK
| | | | | |
Collapse
|
50
|
Porter SR, Diz Dios P, Kumar N, Stock C, Barrett AW, Scully C. Oral plasmablastic lymphoma in previously undiagnosed HIV disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- S R Porter
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University of London, United Kingdom
| | | | | | | | | | | |
Collapse
|