AAOMP case challenge: diffuse lip swelling.
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Adult↗
Biomedical subjects
Carl M Allen
Publications and source records attributed to Carl M Allen.
Sclerosing polycystic adenosis of minor salivary glands: report of three cases and review of the literature.
Sclerosing polycystic adenosis (SPCA) of the salivary gland is a rarely encountered lesion of uncertain pathogenesis that shares histologic features with sclerosing adenosis and fibrocystic disease of the mammary gland. To date, fewer than 40 cases of SPCA have been reported in the literature; all but one have arisen in the major salivary glands. We report 3 cases of SPCA involving minor salivary glands and discuss the characteristic histopathologic features of SPCA , which include a combination of fibrosis, tubuloacinar proliferation, and cystic change with retention of a somewhat lobular architecture. We also provide a review of contemporary relevant literature. Given that SPCA has been mistaken for malignant salivary gland neoplasia, a familiarity with the entity is critical. Three new cases of SPCA involving minor glands are added to 1 existing case in the literature to raise awareness of the lesion and to reduce the likelihood of misdiagnosis.
Aged↗
Molecular and clinical spectrum of type I plasminogen deficiency: A series of 50 patients.
Severe type I plasminogen (PLG) deficiency has been causally linked to a rare chronic inflammatory disease of the mucous membranes that may be life threatening. Here we report clinical manifestations, PLG plasma levels, and molecular genetic status of the PLG gene of 50 patients. The most common clinical manifestations among these patients were ligneous conjunctivitis (80%) and ligneous gingivitis (34%), followed by less common manifestations such as ligneous vaginitis (8%), and involvement of the respiratory tract (16%), the ears (14%), or the gastrointestinal tract (2%). Four patients showed congenital occlusive hydrocephalus, 2 with Dandy-Walker malformation of cerebellum. Venous thrombosis was not observed. In all patients, plasma PLG levels were markedly reduced. In 38 patients, distinct mutations in the PLG gene were identified. The most common genetic alteration was a K19E mutation found in 34% of patients. Transient in vitro expression of PLG mutants R134K, delK212, R216H, P285T, P285A, T319_N320insN, and R776H in transfected COS-7 cells revealed significantly impaired secretion and increased degradation of PLG. These results demonstrate impaired secretion of mutant PLG proteins as a common molecular pathomechanism in type I PLG deficiency.
Animals↗
AAOMP case challenge: an expansile mass of the right posterior mandible.
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Aged↗
Oral and maxillofacial pathology case of the month. Erosion secondary to bulimia nervosa.
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Adolescent↗
Gnathic osteoblastoma: clinicopathologic review of seven cases with long-term follow-up.
The clinical, radiographic and histopathologic features of seven cases of osteoblastoma of the jaw bones were analyzed. The mandible was involved in six cases and a periosteal presentation of the tumor was noted in three cases. Six tumors were symptomatic with pain being the common presentation. The radiographic appearance of the intraosseous tumors varied from well-defined radiolucencies to poorly-defined mixed lesions. A small periosteal tumor was undetectable radiographically. Histopathologically, the tumors exhibited variation in woven bone formation, osteoblastic rimming, lesional maturation as well as interaction of the tumor with surrounding host tissue. Intraosseous tumors were managed with aggressive surgical curettage and periosteal tumors were resected and the underlying bone was curetted down to normal host bone. Follow-up of cases ranged from 2 years to 18 years with no recorded recurrences. Gnathic osteoblastomas offer a unique diagnostic challenge as they resemble other tumors of the jaws including the cementoblastoma, cemento-ossifying fibroma, cemento-osseous dysplasia and most importantly the gnathic osteosarcoma. We stress on the need to correlate the histopathologic findings with clinical and radiographic features to reach an accurate diagnosis.
Adolescent↗
MSG-1 expression in benign and malignant melanocytic lesions of cutaneous and mucosal epithelium.
BACKGROUND: A more recently characterized melanocyte-specific gene, MSG-1, has been suggested as having a role in embryogenesis, melanogenesis and melanoma progression. Studies involving MSG-1 have involved cutaneous melanocytic lesions, which are different than non-cutaneous melanocytic lesions in certain pathogenetic aspects. The purpose of this study was to evaluate MSG-1 protein expression in cutaneous and mucosal melanocytic lesions, with the aim to explore its association with pigment production, malignant potential and UV light exposure. MATERIAL/METHODS: Benign and malignant melanocytic lesions of cutaneous and mucosal epithelium were selected from our pathology registry (n=48). Immunohistochemistry was performed using polyclonal anti-MSG-1 antibody and standard streptavidin-biotin immunoperoxidase techniques. The staining pattern of MSG-1 was evaluated by three pathologists independently. RESULTS: MSG-1 protein demonstrated immunoreactivity in only one mucosal melanoma (1/20, 5%), arising in the lower lip, and showing histopathologic evidence of sun-induced tissue damage. MSG-1 also showed positivity in five cutaneous melanomas (5/14, 36%), one of which was a metastatic lesion. All mucosal and cutaneous nevi failed to express MSG-1. Melanin pigmentation, seen in 18/34 melanoma and 13/14 nevi, did not correlate with MSG-1 expression. All cases but one showing MSG-1 immunoreactivity were located in sun-exposed sites. CONCLUSIONS: The finding of MSG-1 expression in some cases of malignant melanoma, and its absence in all benign nevi, may indicate an association with melanoma progression, particularly UV-induced lesions. Its infrequent expression in melanocytic lesions limits its diagnostic value as an immunohistochemical marker in routine pathology practice.
Adult↗
AAOMP case challenge: expansile mass of the left maxilla.
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Adult↗
Palatal perforation associated with intranasal prescription narcotic abuse.
BACKGROUND: Palatal perforation resulting from insufflation of cocaine has been well documented. In comparison, reports of destructive orofacial lesions resulting from intranasal abuse of prescription narcotics are rare. We present the clinical and histologic findings in a case of palatal perforation arising in a patient abusing a prescription opioid drug. The patient denied any history of cocaine use but admitted to habitually crushing and snorting a hydrocodone/acetaminophen preparation. Study design The patient presented to our clinic seeking resolution of speech difficulties associated with an oroantral fistula. Surgical repair of the defect had been attempted unsuccessfully in the past. In addition to blood and chemistry panels, endoscopic examination was conducted, with removal of several biopsy specimens for histologic evaluation and flow cytometry. Biopsy specimens included both lesional and perilesional tissue from within the oral and nasopharyngeal cavities. Culture and cytology for fungal organisms were also performed. RESULTS: Histopathologic examination revealed normal mucosa with diffuse and focal inflammatory changes and no evidence of malignancy. Polarizable foreign material was noted in the specimens. The absence of lymphoid neoplasia was confirmed by flow cytometric analysis. The toxicology panel was positive for the presence of opiates in the blood. Culture and cytology were positive for candidal organisms. A palatal obturator was fabricated for the patient, producing significant improvement in the quality of speech. CONCLUSIONS: This may represent a case of palatal perforation resulting from abuse of a drug other than cocaine. The potential for drugs other than cocaine to produce destructive orofacial lesions should be considered.
Administration, Intranasal↗
Solitary central myofibroma presenting in the gnathic region.
Solitary myofibroma of adults is an uncommon neoplasm that typically arises in soft tissue and subcutaneous sites in the head and neck, but rarely within bone. When encountered in the jaws, the lesions exhibit clinical and radiographic features suggestive of an odontogenic tumor or cyst as well as several other neoplastic conditions. Tooth mobility, displacement of teeth, and dramatic jaw expansion may be observed. Analogous to other sites of involvement, gnathic myofibromas are biologically indolent and show little or no recurrence following excision. In rare instances, however, the ability to obtain adequate surgical margins by conservative measures may be limited; thus, issues of local control may supercede the importance of biologic potential. We present the radiologic and histopathologic findings in a case of central myofibroma presenting as a large lytic lesion of the mandible. Myofibroma involving the jaw bones represents a unique diagnostic and therapeutic challenge, and accurate diagnosis and management is predicated on careful correlation of radiographic and pathologic findings.
Adult↗
Post-irradiation leiomyosarcoma of the maxilla: report of a case in a patient with prior radiation treatment for retinoblastoma.
Post-irradiation sarcoma is a well-defined complication of radiation therapy, yet few reports document such lesions in the head and neck. A 30-year-old man presented for evaluation of an expansile lesion of the left posterior maxilla. His medical history was significant for a childhood ocular malignancy - unilateral retinoblastoma - which was treated with a combination of surgical enucleation of the eye and external beam radiation therapy. Biopsy of his maxillary lesion revealed a spindle cell malignancy that was morphologically and immunohistochemically consistent with a diagnosis of leiomyosarcoma. Further investigation into the case revealed that the patient had three children, every one of whom developed unilateral retinoblastoma in infancy. Compared to the more frequent presentation of bilateral tumors in hereditary cases of retinoblastoma, such cases of heritable unilateral retinoblastoma are exceptional. Importantly, heritable forms of retinoblastoma confer a significant risk for development of second primary cancers, necessitating long-term clinical follow-up in these patients.
Adult↗
Oral graft-versus-host disease and programmed cell death: pathogenetic and clinical correlates.
Graft-versus-host disease (GVHD) is an untoward complication of bone marrow transplantation. It is characterized by an immune-mediated attack by donor immune cells against various host cells and tissues, a process which may be associated with significant morbidity in affected patients. Oral lesions are a common sequelae and can serve as a highly predictive index to the presence of systemic GVHD. The oral lesions of GVHD are clinically and histologically lichenoid in nature and can be a challenge in terms of management. Ulcerated and painful mucosal lesions may represent a significant impediment to normal eating habits and nutritional intake, necessitating appropriate diagnosis and treatment. Importantly, recent evidence has indicated that programmed cell death, or apoptosis, is the major constituent in the pathogenesis of GVHD. Apoptosis not only plays a major role in normal growth and ontogeny, but has been shown to contribute to a wide spectrum of both inflammatory and neoplastic disorders. Since knowledge of apoptotic molecular pathways is requisite for understanding GVHD, the purpose of this paper is to provide a fundamental overview of the predominant apoptotic mechanisms implicated in the pathogenesis of GVHD and to relate these findings to the oral complications of the disease. Finally, we will discuss management strategies for diagnosing and treating the oral lesions of GVHD. By explicating the molecular events in the apoptotic pathway, unique therapeutic and pharmacologic strategies for regulating apoptosis may be developed in the future, reducing the morbidity associated with conditions like GVHD.
Apoptosis↗
Undifferentiated malignant neoplasm involving the interdental gingiva: a case report.
BACKGROUND: Metastases to the gingiva are uncommon. They can be a diagnostic challenge clinically because of their rarity and tendency to mimic benign lesions. In this report, we present a case of an undifferentiated malignant neoplasm of unknown origin presenting as benign inflammatory gingival lesions and we review the literature on metastases to the gingiva. METHODS: A 44-year-old female patient was referred by a local periodontist for evaluation of multiple painless gingival lesions that clinically resembled pyogenic granulomas or periodontal abscesses, but with an uncharacteristic multifocal presentation in the background of good oral hygiene. Her medical history was unremarkable except for recent weight loss. Periapical radiographs were obtained, as well as two incisional biopsies, one placed in formalin for routine histology and immunohistochemistry, the other in phosphate buffered saline for flow cytometry. RESULTS: Radiographic findings were non-contributory for hard tissue pathoses. Histopathological findings were consistent with a poorly differentiated malignancy, suggestive of metastatic disease. Immunohistochemical studies and flow cytometry were unsupportive in delineating any tumor differentiation. The patient subsequently developed multiple tumors throughout the body with similar histopathological findings, yet no primary tumor was identified and a definitive diagnosis could not be rendered. She was discharged one month later in poor condition with the principal diagnosis of hemorrhage/ pancytopenia, and a secondary diagnosis of metastatic head and neck cancer. CONCLUSION: This case of malignant metastatic tumor of unknown origin presenting as benign gingival lesions illustrates the importance of thorough patient evaluation, which should include a biopsy when necessary for definitive diagnosis.
Adult↗
The histologic differentiation of oral condyloma acuminatum from its mimics.
OBJECTIVE: The purpose of this study was to determine which histologic features could enable one to distinguish oral condyloma, as defined by the detection of human papillomavirus (HPV) DNA through in situ hybridization, from its mimics. STUDY DESIGN: Thirty-two paraffin-embedded specimens from 28 patients that were clinically suggestive of oral condyloma were analyzed histologically and through in situ hybridization with a consensus HPV probe. RESULTS: HPV DNA was detected in 17/32 (53%) of the lesions; no additional positive cases were detected after polymerase chain reaction amplification. Only 5 of the 17 virus-positive cases were considered to be histopathologically unequivocal for condyloma. The histologic features significantly associated with HPV detection were nonuniform perinuclear halos, often in association with epithelial crevices (P =.02), and papillomatosis (P =.02). Each of the 17 patients who were HPV-positive had either HPV-6 or HPV-11, a finding that is similar to those for condyloma involving the penis and vulva/vagina. CONCLUSION: Differentiation between oral condyloma and its mimics is best accomplished by using a combination of histologic, clinical, and in situ viral studies.
Adult↗
Pagetoid reticulosis: a case report and review of the literature.
The histologic finding of a pagetoid epidermotropic growth pattern is associated with a variety of conditions that range from reactive to neoplastic in nature. Included among these conditions is the uncommon skin disorder pagetoid reticulosis. Pagetoid reticulosis may present clinically as a solitary, indolent plaque-like lesion. Conversely, it may manifest as a more generalized clinically aggressive disease. The generalized form may develop into systemic lymphoma, leading to severe morbidity and death. We present a case of pagetoid reticulosis of the perioral region, a rare anatomic site for this condition. Histopathologic and immunohistochemical findings were consistent with a diagnosis of isolated pagetoid reticulosis. This review discusses the nature of pagetoid reticulosis and addresses past and current concepts regarding the condition.
Aged↗
Human papillomavirus, type 40-associated papilloma, and concurrent Kaposi's sarcoma involving the anterior hard palate of an HIV-positive man.
A number of oral lesions have been reported in association with HIV, including lesions caused by other viruses such as the epitheliotropic human papillomavirus (HPV). More than 90 types of HPV have been identified, with the less commonly encountered strains of HPV tending to show association with immunodeficiency states. In addition, HIV-infected patients may have Kaposi's sarcoma develop, a malignancy thought to be caused by human herpes virus, type 8. Recent evidence suggests a sexual mode of transmission for this virus. We report an HIV-positive man with a large, HPV type 40-associated papilloma of the anterior palate and a previously undiagnosed focus of Kaposi's sarcoma.
AIDS-Related Opportunistic Infections↗
White plaque of the lateral tongue.
A healthy 48-year old white woman presented with a chief complaint of an 'irritated' sensation involving her tongue. The problem seemed to be limited to her left lateral tongue and had been noticed for at least six months by the patient. She also indicated the condition varied in severity.
Candidiasis, Oral↗
Essential role of the Candida albicans transglutaminase substrate, hyphal wall protein 1, in lethal oroesophageal candidiasis in immunodeficient mice.
Oroesophageal candidiasis is caused by the combined action of fungal virulence factors and host inflammatory responses when protective immunity is absent. Hyphal wall protein 1 (Hwp1) on germ tubes and true hyphae of Candida albicans forms covalent cross-links to buccal epithelial cells in vitro by functioning as a substrate for mammalian transglutaminases. In this study, beige-athymic (bg/bg-nu/nu) or transgenic epsilon 26 mice that have combined natural killer and T cell defects did not succumb to candidiasis after oral administration of C. albicans strains with inactivated HWP1 genes, whereas mice given isogenic strains of C. albicans that had a single copy of HWP1 survived only 2-3 weeks. Illness correlated with extensive alterations of the lingual and esophageal mucosa that were absent in mice given the hwp1/hwp1 mutant. HWP1 is a promising target for development of antifungal drugs for treatment of oroesophageal candidiasis.
Animals↗