{"title":"Information for Readers","authors":"","doi":"10.1016/S2212-4403(25)01056-9","DOIUrl":"10.1016/S2212-4403(25)01056-9","url":null,"abstract":"","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Page A6"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Madhu Shrestha , Saja Alramadan , Victoria Woo , John Wright
{"title":"Clinical Pathologic Conference Case 6: An ulcerated lesion on the gingiva of an adolescent female","authors":"Madhu Shrestha , Saja Alramadan , Victoria Woo , John Wright","doi":"10.1016/j.oooo.2025.03.012","DOIUrl":"10.1016/j.oooo.2025.03.012","url":null,"abstract":"<div><div><strong>Clinical Presentation</strong></div><div>A 12-year-old female patient presented with a chief complaint of a non-healing ulcer in the anterior maxilla. The lesion had been present for 3 months, and there was a history of a slowly growing mass. Clinical examination revealed an approximately 1.5 × 1 cm ulcerated mass involving the left maxillary canine-lateral incisor area (Figure 1). The surface appeared to be ulcerated, with an overall erythroleukoplakic appearance. The patient experienced variable sensitivity, and the medical history was unremarkable. Further palpation revealed a firm, ulcerated mass with rolled borders. An incisional biopsy was performed, and the tissue was sent for histopathological examination.</div><div><strong>Differential Diagnosis</strong></div><div>The clinical differential diagnosis for a gingival lesion in an adolescent is broad, encompassing a range of possibilities from reactive and benign to malignant lesions. The patient's age makes a malignant lesion unlikely. However, the clinical presentation of a speckled and granular erythro-leukoplakic appearance, along with visible dilated blood vessels (telangiectasias), raises suspicion for a malignancy. Despite the patient's age, the primary considerations include malignant entities such as squamous cell carcinoma and rhabdomyosarcoma, intermediate conditions like Langerhans cell histiocytosis, and benign conditions such as myofibroma, although the latter is less likely.</div><div>Squamous cell carcinoma (SCC) is highly suspected in this case, despite the patient's age. The clinical presentation of an exophytic lesion with a granular and erythro-leukoplakic appearance telangiectasias is concerning. The presentation of erythro-leukoplakia suggests an epithelial neoplastic origin. SCC is the most common malignancy of the oral cavity.<sup>1</sup> It typically exhibits a peak incidence in the elderly and is strongly associated with smoking and alcohol abuse.<sup>1</sup> Whereas oral SCC (OSCC) is rare in individuals under 50, recent global epidemiological studies have shown a rising incidence, particularly among young adults.<sup>1-3</sup> The etiopathogenesis of OSCC in younger patients remains unclear, and traditional risk factors like tobacco and alcohol use are thought to play a minimal role in these cases, since the duration of exposure to these factors is believed to be shorter in young individuals.<sup>1,4</sup></div><div>The gingival-alveolar ridge is a common site for OSCC in children without known genetic predisposition to cancer.<sup>4</sup> However, the possibility of a genetic predisposition should be considered in such cases. Rare hereditary syndromes, such as Fanconi anemia, xeroderma pigmentosum, Bloom syndrome, Li-Fraumeni syndrome, and dyskeratosis congenita, have all been associated with an increased risk of developing OSCC, particularly in the tongue, as well as other head and neck neoplasms.<sup>4</sup></div><div>Rhabdomyosarcoma (RMS) wa","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Pages e55-e57"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ivan José Correia-Neto DDS, MSc , Gabriela Anaya-Saavedra DDS, PhD , Paulo Afonso de Oliveira Junior DDS, MSc , Edgard Graner DDS, PhD , Alan Roger Santos-Silva DDS, PhD , Pablo Agustin Vargas DDS, PhD , Marcio Ajudarte Lopes DDS, PhD
{"title":"Clinical Pathologic Conference Case 1: A reddish nodule on the midline hard palate","authors":"Ivan José Correia-Neto DDS, MSc , Gabriela Anaya-Saavedra DDS, PhD , Paulo Afonso de Oliveira Junior DDS, MSc , Edgard Graner DDS, PhD , Alan Roger Santos-Silva DDS, PhD , Pablo Agustin Vargas DDS, PhD , Marcio Ajudarte Lopes DDS, PhD","doi":"10.1016/j.oooo.2025.03.008","DOIUrl":"10.1016/j.oooo.2025.03.008","url":null,"abstract":"<div><div><strong>Clinical Presentation</strong></div><div>A 13-year-old boy was referred for evaluation of an asymptomatic lesion on the midline hard palate with a 3-month history of evolution. The patient denied any history of trauma or injury to the area. Intraoral examination revealed a reddish sessile nodule, with well-defined borders, fibroelastic consistency, and measuring approximately 5 mm. Telangiectasia was also noticed on the surface (Figure 1A). Panoramic radiography showed complete permanent dentition and no bone alterations were observed in the area corresponding to the lesion (Figure 1B).</div><div><strong>Differential Diagnosis</strong></div><div>Lesions on the hard palate in pediatric patients may represent a complex diagnostic challenge, encompassing a range of benign and malignant possibilities. Given the clinical and radiographic characteristics, several entities can be included in the differential diagnoses, such as cysts, benign mesenchymal neoplasms, salivary gland tumors, inflammatory processes of the salivary glands, and developmental entities such as choristomas, hamartomas, and vascular lesions.</div><div>Reactive and inflammatory processes represent a group of lesions that can be frequently observed in pediatric patients, such as pyogenic granuloma, follicular lymphoid hyperplasia, subacute sialadenitis, and atypical histiocytic granuloma. Pyogenic granuloma (PG) is a common benign lesion characterized by an overgrowth of granulation tissue that typically develops in response to chronic irritation or trauma.<sup>1</sup> PG occurs more frequently in the gingiva and tongue. On the other hand, it is unusual on the hard palate, particularly in the middle region.<sup>1</sup> Follicular lymphoid hyperplasia (FLH) is a non-neoplastic lymphoproliferative disease (also known as a nodular lymphoid lesion and pseudolymphoma) associated with persistent local irritation that commonly affects the hard palate. Notably, a third of palatal FLH cases are linked to denture wear, predominantly affecting elderly patients. The typical presentation is a painless, slowly growing, non-ulcerated nodule, measuring less than 3 cm, with a color ranging from normal mucosa to purple-reddish and a texture varying from soft to firm.<sup>2,3</sup> Subacute sialadenitis (SAS) is a rare inflammatory condition affecting minor salivary glands. It is an uncommon and self-limiting necrotizing condition that often affects the minor salivary glands of the palate.<sup>4</sup> This condition typically occurs in men over 45 years of age but can also appear in teenagers and young adults. The most common clinical appearance is an ulcerative lesion, usually 1 to 3 cm in size, which can mimic a malignant growth. On the other hand, in some cases, the mucosal surface remains undamaged.<sup>4</sup> However, because of the absence of salivary glands in the midline of the hard palate, this diagnosis is unlikely. Atypical histiocytic granuloma is rarely reported in the pa","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Pages e41-e43"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilfredo Alejandro González-Arriagada DDS, PhD , Anne C. McLean DMD, MS
{"title":"Clinical Pathologic Conference Case 4: An adult male patient with a sellar mass","authors":"Wilfredo Alejandro González-Arriagada DDS, PhD , Anne C. McLean DMD, MS","doi":"10.1016/j.oooo.2025.03.010","DOIUrl":"10.1016/j.oooo.2025.03.010","url":null,"abstract":"<div><div><strong>Clinical Presentation</strong></div><div>A 62-year-old Black male patient presented to the emergency department in August of 2021 with muscle weakness and macroglossia. The patient's medical history included hypertension, osteoporosis, femoral and pubic bone fractures, muscle wasting, and generalized pain. He reported an unintentional loss of 100 pounds within the preceding 6-month period. Upon further questioning, the patient revealed that his muscle weakness began several years prior, in 2015. He also stated that a prior evaluation by a neurologist at an outside facility had been done, and that there was no concern for a neuropathic process. A physical examination and laboratory work-up were undertaken in the emergency department.</div><div>The patient demonstrated vocal changes including hoarseness and dysphagia, and examination revealed unilateral macroglossia with immobility (Fig. 1), and fullness of the base of tongue area. He exhibited extreme muscle weakness and spasmodic episodes and was unable to lift his legs off of the hospital bed. The patient had hypophosphatemia and hyperparathyroidism, indicative of electrolyte and endocrine derangement. Otolaryngology was consulted, and initial imaging studies were performed.</div><div>A computed tomography (CT) scan of the brain completed upon admission showed a 6.5-cm mass centered in the sellar region, which was eroding the left mastoid, clivus, and bilateral sphenoid sinuses (Fig. 2A, 2B). A mass effect was noted upon the posterior left orbit and medial rectus muscle. Magnetic resonance imaging (MRI) with and without contrast was then performed the next day, and this redemonstrated the heterogeneously enhancing mass extending anteriorly to the ethmoid sinus, abutting the bilateral optic nerves, and indenting the frontal lobes of the brain superiorly (Fig. 3A, 3B, 3C). The mass also encroached upon the posterior nasal cavity and nasopharynx. It was seen to displace the pituitary gland superiorly. The cavernous sinus was invaded by the mass, and the bilateral internal carotid artery cavernous segments were encased.</div><div>Based on these findings, the patient was taken to the operative room for bilateral nasal endoscopy and biopsy. At surgery, the mass was noted to be at least partially encapsulated. Several biopsies were taken, and intraoperative consultation was performed.</div><div><strong>Differential Diagnosis</strong></div><div>Considering the clinical presentation and the patient's medical history, a bone neoplasm associated with a systemic condition is postulated; furthermore, the differential diagnosis should include other sinonasal tumors, such as benign tumors of the base of the skull (pituitary adenoma or craniopharyngioma), or endocrine lesions involving bones (hyperparathyroidism-related bone tumor). In this particular case, the initial discussion also includes a quite broad number of lesions such as suprasellar teratoma, Rathke cleft cyst, multiple myeloma wit","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Pages e46-e52"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Pathologic Conference Case 3: A WELL-DEFINED OSTEOLYTIC LESION IN THE BODY OF THE MANDIBLE WITH SPECIAL EMPHASIS ON DIAGNOSTIC ALGORITHM USING IMMUNOHISTOCHEMICAL AND HORMONAL PROFILING","authors":"N. Sivakumar MDS , Katya Pulido-Díaz DDS, MSc, PhD , Kiran Jot MDS , Sandeep R. Mathur MD , Ongkila Bhutia MDS , Varun Surya MDS , Ajay Gogia MD, DM , Deepika Mishra MDS","doi":"10.1016/j.oooo.2025.03.009","DOIUrl":"10.1016/j.oooo.2025.03.009","url":null,"abstract":"<div><div><strong>Case Presentation</strong></div><div>A 56-year-old North Indian woman presented with heaviness in her right lower back teeth region for 3 months. On intraoral examination, root stumps were present in #18 and #25 regions (FDI numbering system). No visible soft tissue lesions were found in the oral cavity, but an orthopantomogram revealed an ill-defined unilocular osteolytic radiolucency in the right body of the mandible, corresponding to the periapical regions of #43, #44, and #45, with blunting of root apices (Fig. 1). The patient had a history of fine-needle aspiration biopsy from the left breast, which was suggestive of invasive breast carcinoma of no special type. The hormonal profile of the tumor was as follows: estrogen receptor (ER)–positive (Allred score = 8/8), progesterone receptor (PR)–positive (Allred score = 7/8), and Her2Neu–negative (0/8). The tumor cells retained E-cadherin expression, with a Ki67 labeling index of 10% in proliferating areas. Following histopathological diagnosis, the patient underwent neoadjuvant chemotherapy (6 cycles of doxorubicin at 84 mg, cyclophosphamide at 840 mg, and G-CSF at 300 mg) and radiotherapy (15 cycles of 2.67 gray whole breast irradiation). A follow-up positron emission tomography (PET) scan revealed metabolically active soft tissue enhancement in the upper outer quadrant of the left breast. Thus, a mastectomy was performed to excise the residual tumor, which showed similar histopathological and immunohistochemical features as the incisional biopsy, with ypT3ypN3ayMx staging; Miller Payne grade 3, residual cancer burden (RCB) score of 4.536, and RCB class III.</div><div><strong>Differential Diagnosis</strong></div><div>The clinical presentation of the lesion favored a range from a benign cystic lesion to a malignant neoplasm. The differential diagnosis included central giant cell granuloma, odontogenic keratocyst, odontogenic fibroma, unicystic ameloblastoma, osteosarcoma, solitary plasmacytoma, non-Hodgkin's lymphoma, Langerhans cell histiocytosis (LCH), intraosseous mucoepidermoid carcinoma, and metastatic disease.<sup>1</sup></div><div>Central giant cell granulomas are more common in the anterior portions of the jaw that frequently cross the midline and, radiographically, may appear as a unilocular radiolucency with well-delineated borders. In the case of an odontogenic keratocyst, the lesion shows anteroposterior growth within the medullary cavity without causing expansion of the medullary cavity.<sup>1</sup> Odontogenic fibromas are rare lesions, and more than half of the tumors are located posterior to the first molar of the mandible. Solitary plasmacytoma of bone shows a preponderance in males and is most common in the spine, with the least occurrence in the mandible. It may also produce a well-delineated radiolucency.<sup>2</sup> LCH most commonly occurs in children younger than 15 years old as multiple or solitary, sharply punched-out radiolucencies, with a characterist","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Pages e44-e46"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical Pathologic Conference Case 5: Sinonasal mass in an HIV-positive patient","authors":"Liam Robinson , Vivian Petersen Wagner","doi":"10.1016/j.oooo.2025.03.011","DOIUrl":"10.1016/j.oooo.2025.03.011","url":null,"abstract":"<div><div><strong>Clinical presentation</strong></div><div>A 52-year-old male patient, HIV-positive on treatment with an unknown CD4 count and viral load, presented with a 6-month history of a left sinonasal mass with intermittent epistaxis. Computer tomography (CT) imaging showed a mass in the paranasal and nasal cavity with local bone destruction and extension to the skull base (Figure 1A and 1B). Multiple incisional biopsies were performed and submitted for histopathologic assessment.</div><div><strong>Differential diagnosis</strong></div><div>Given the lesion's aggressive appearance on the CT scan, the primary consideration was a malignant neoplasm arising in the nasal cavity and extending to the paranasal sinuses. Opportunistic infections due to the patient's systemic condition were also considered as a less probable possibility.</div><div>Considering the systemic condition of the patient, malignant neoplasm associated with HIV was included as the primary diagnostic hypothesis. Kaposi's sarcoma (KS) is a soft tissue tumor associated with HHV-8 infection. It has 4 clinical types, one of which is the HIV-related form. In HIV patients with CD4 counts less than 200 cells/mm³, KS is the second most common tumor and is considered an acquired immunodeficiency syndrome (AIDS)-defining illness.<sup>1</sup> Although KS is more common in the oral cavity and tends to be less destructive than in the present case, aggressive lesions in the nasal cavity have been reported.<sup>2</sup> Plasmablastic lymphoma (PBL) is another hypothesis of HIV-linked malignancy. This is a highly aggressive B-cell non-Hodgkin lymphoma commonly associated with AIDS. It often involves extranodal sites, with the oral cavity being a frequent location.<sup>3</sup> Nasal cavity involvement is rare but possible.<sup>4</sup> Given the patient's systemic condition and the lesion's destructive behavior, PBL was considered as a strong hypothesis.</div><div>Other primary nasal cavity cancers, not associated with HIV, were also considered. Aggressive forms of keratinizing or non-keratinizing squamous cell carcinomas are possibilities; however, these lesions tend to have a less destructive behavior.<sup>5</sup> Sinonasal undifferentiated carcinoma (SNUC) is rare and highly aggressive, typically presenting as a rapidly enlarging tumor over weeks or a few months. The local invasive growth of the present case is compatible with SNUC.<sup>6</sup> However, the reported duration of 6 months is less typical for this malignancy. Another hypothesis is human papilloma virus (HPV)-related multiphenotypic sinonasal carcinoma, which most commonly originates in the nasal cavity. Although usually less aggressive and often confined to the nasal cavity, extension to the ethmoid and sphenoid sinus, as seen in the present case, can occur.<sup>7</sup></div><div>Opportunistic infections in systemically compromised patients can in some instances mimic malignancies. Invasive fungal sinusitis conditions, like muc","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 2","pages":"Pages e52-e55"},"PeriodicalIF":2.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Information for Readers","authors":"","doi":"10.1016/S2212-4403(25)00860-0","DOIUrl":"10.1016/S2212-4403(25)00860-0","url":null,"abstract":"","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":"140 1","pages":"Page A6"},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143946550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Justin Bubola, Grace Bradley, Iona Leong, Deepika Chugh, Marco Magalhaes
{"title":"Oral angioleiomyomas: a case series and review of the literature.","authors":"Justin Bubola, Grace Bradley, Iona Leong, Deepika Chugh, Marco Magalhaes","doi":"10.1016/j.oooo.2025.04.097","DOIUrl":"https://doi.org/10.1016/j.oooo.2025.04.097","url":null,"abstract":"<p><strong>Objectives: </strong>To characterize the clinical and microscopic features of oral angioleiomyomas (ALMs).</p><p><strong>Study design: </strong>A retrospective search of our diagnostic oral pathology biopsy service archives was performed for ALMs diagnosed between 1989 and 2024. Additionally, a review of the literature was performed using PubMed.</p><p><strong>Results: </strong>There were 38 tumors in 29 males and 9 females, with a mean age of 56.8 years. The most common site of involvement was the lips, followed by the palate and buccal mucosa. While the majority of tumors were blue or purple, the color of 8 tumors was pink or normal; therefore, they were not clinically suspected to represent vascular lesions. The most common clinical impression was of a salivary gland lesion. Histologically, the venous subtype was the most frequent, followed by the solid and cavernous subtypes. Adipocytic differentiation was noted in 55.3% of tumors.</p><p><strong>Conclusions: </strong>To the best of our knowledge, this is the largest series of oral ALMs reported in the literature. We found that oral ALMs commonly exhibit adipocytic differentiation. It is important for pathologists to be aware of this phenomenon in order to avoid erroneous classification as angiomyolipoma. Unlike angiomyolipoma, ALMs are not known to be associated with tuberous sclerosis.</p>","PeriodicalId":49010,"journal":{"name":"Oral Surgery Oral Medicine Oral Pathology Oral Radiology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}