Oral pathology: towards the 21st century.
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Biomedical subjects
Publications and source records attributed to B G Radden.
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Oncocytomas are extremely uncommon in the intra-oral minor salivary glands, they are rarely reported in the literature and the histopathology and clinical details are inadequately documented. This has led to uncertainty with regard to the behaviour and prognosis of this type of lesion. A case of benign solid oncocytoma arising from intra-oral minor salivary glands is reported here with a brief review of the pertinent literature.
The findings of a retrospective study of 98 minor salivary neoplasms are reported. The patient's ages ranged from 13-79 years and there was an equal sex distribution. Sixty-one of the lesions were benign, 53 being pleomorphic adenomas and 8 monomorphic adenomas. Of the malignant tumors, 19 were muco-epidermoid tumors, 12 adenoid cystic carcinomas, 4 adenocarcinomas, 1 carcinoma ex-pleomorphic adenoma and 1 epidermoid carcinoma. One striking finding was the difference in age at the time of presentation for patients with muco-epidermoid tumors compared with those with adenoid cystic carcinomas. Seventy-four percent of the patients with muco-epidermoid tumors were under 50 years of age, but 75% of those with adenoid cystic carcinomas were over 50 years.
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A case of a metastatic lesion to the mandible from a Fallopian tube carcinoma is reported. The presenting symptoms were altered lip sensation and an intraoral mass. A previous history of pelvic infection was reported, but later a diagnosis of adenocarcinoma of the left Fallopian tube was made. Metastatic spread also involved other bones and the liver. No previous case of a metastatic lesion to the oral cavity from the Fallopian tubes has been reported.
One hundred and eighteen patients with oral squamous cell carcinoma were staged according to the TNM and STNMP systems. Although both staging systems separated patients into those with a good prognosis and those with a poorer prognosis the more sophisticated system (STNMP) did not provide any additional information. A possible explanation for this anomaly lies in the weighting used in the STNMP system.
Seven cases of dentinal dysplasia Type I and a case of dentinal dysplasia Type II have been presented, and the literature concerning these rare disorders has been reviewed. Attention has been drawn to the important clinical and histological features of these dental abnormalities.
A case of unilateral cherubism is presented in which only one side of the mandible was affected. The associated diagnostic features are discussed.
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In an attempt to extend and update information relating to oral cancer in Australia and to provide a basis for international comparison a group of 244 patients suffering from oral cancer have been studied in detail. These patients were all diagnosed in one Oral Pathology Biopsy Service used almost exclusively by oral surgeons and dentists, and although this introduced bias into the sample it had the advantage of standardising documentation. The male: female ratio (1.3 : 1) of patients with oral cancer was lower than that previously reported in Australia, but the average age of patients (60 years) was comparable with many previous reports. The floor of the mouth was the most common site of cancer. There was a significant over-representation of tobacco and alcohol consumers amongst the patients, but a group of elderly females who had never used tobacco or alcohol, yet developed oral cancer, was identified. It was of particular interest that these elderly females had significantly lower haemoglobin and serum iron levels than a sex- and age-matched control group.
Warty dyskeratoma (WD) is a benign solitary lesion of unknown aetiology affecting the skin and oral mucosa. The profound dyskeratotic changes may mimic invasive squamous cell carcinoma. Two cases of oral WD, which were originally diagnosed as early squamous cell carcinoma, are presented. The clinical features, histopathology and aetiology are reviewed together with other reports in the literature. These 2 cases have been followed for 14 and 6 years respectively and they are the longest follow-up periods reported in the literature in English. The lesions have not recurred.
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This study was designed to provide a perspective of intraoral cancer, as it occurs in Victoria, by reference to the Central Cancer Registry of Victoria. Intraoral cancer was found to be a disease of males in the 50 to 69 years' age group. There was a low survival rate which appeared to be related to the aggressive nature of the disease and to the delays which often occurred before treatment was commenced. Therefore, a strong recommendation is made that clinicians, both medical and dental, increase their level of suspicion with regard to lesions of the oral mucous membrane in order to detect oral cancer at an early stage, and thereby to avoid the certain distress to patients which accompanies the management of advanced carcinoma of the oral mucous membrane.
The first case report of an oral infection due to Torulopsis glabrata is presented. This microorganism is a yeast-like fungus grouped in a similar family to the Candida species. It has been isolated with increasing frequency from the oral cavity but, surprisingly, has not been reported as a pathogen in this site. In other anatomical sites, including the urinary tract, lung and gastrointestinal tract, Torulopsis glabrata has been reported as a pathogen, at times resulting in a fatal outcome. However, there has usually been some modifying factor, e.g. malignancy, cytotoxic drug therapy, diabetes or broad spectrum antibiotics, which caused this marginal pathogen to assume a pathogenic role. No such modifying factors could be elicited in this case. The history of the case including the management is presented. A brief outline of the microbiologic grouping of Torulopsis glabrata is given, as well as the diagnostic test used in its identification. The histopathology is described and the necessity for combining special tests in establishing a positive diagnosis is exemplified, as the histology alone is not pathognomonic of the infection.
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