Chronic Irritation Research Articles

Recommendations for Research to Develop a Patient‐Centered Clinical Follow‐Up Protocol for Oral Epithelial Dysplasia

ABSTRACTOral epithelial dysplasia (OED) is the primary histological marker for assessing the progression of oral potentially malignant disorders (OPMDs) to cancer. Despite challenges in grading and low inter‐pathologist reproducibility, OED severity remains the key predictor of malignant transformation. However, globally accepted guidelines for OED monitoring are lacking, despite calls for individualized management based on host and lesion characteristics. The proposed research protocol involves acquiring high‐quality intraoral images, assessing oral hygiene and periodontal status, eliminating chronic mechanical irritation and Candida infections, and applying adjunctive diagnostic methods like toluidine blue staining, optical evaluation, and brush cytology. Tailored follow‐up regimens based on individual risk assessments are emphasized, with frequent monitoring for high‐grade dysplasia or patients at higher risk of progression. Therefore, effective OED management should consider the patient's immune status, dietary habits, and oral microbiota, aiming to develop personalized treatment strategies that optimize patient‐centered care.

Chronic Injury of Sagittal Band by Metacarpal Head Osteoma: A Case Report

Injury of the sagittal band, a crucial component of the extensor hood, can occur in various situations, including spontaneous events, trauma, and rheumatic diseases. This case presents a rupture of the sagittal band resulting from chronic irritation caused by a metacarpal head osteoma. A 22-year-old female presented with ulnar subluxation of the extensor tendon at the left third metacarpophalangeal joint, without any history of trauma or pain. Ultrasonography and computed tomography revealed a 1.7 mm-sized bony lesion on the radial side of the metacarpal head, accompanied by a partial tear of the radial sagittal band. Our hypothesis that chronic irritation of the sagittal band by the adjacent bony lesion led to the partial tear was confirmed by intraoperative findings. The lesion was excised, and the radial sagittal band was reconstructed. Histopathological examination confirmed a diagnosis of osteoma. To our knowledge, this is the first reported case of sagittal band rupture caused by an osteoma of the metacarpal head. This case underscores the importance of considering an underlying metacarpal head osteoma in patients with non-rheumatoid joints presenting, in the absence of a traumatic history, with a sagittal band rupture due to chronic irritation.

A case of esophageal squamous cell carcinoma with epidermization showing a unique morphology.

An 80-year-old woman with a history of endoscopic balloon dilation for esophageal stricture caused by accidental ingestion of caustic soda during infancy presented with dysphagia. Upper gastrointestinal endoscopy revealed a 10-cm-long, highly white, elevated lesion with a feathered appearance. This lesion was determined to be the cause of dysphagia and was completely resected via endoscopic submucosal dissection. Histopathological examination revealed a thick keratin layer on the surface of the stratified squamous epithelium, with a prominent granular layer underneath and some areas showing nuclear atypia. The lesion was diagnosed as a well-differentiated squamous cell carcinoma, pT1a-LPM, derived from epidermoid metaplasia. Cancer genome analysis revealed mutations in TP53 as well as amplification of MYC, FGFR1, chromosome 7, and chromosome 20q. This case suggests that epidermoid metaplasia caused by chronic irritation from an esophageal stricture may have been exacerbated by the dilation procedure.

Military doctor, teacher, researcher (essay on M.S. Schwartz)

The purpose of the study is to provide brief information about the professional career of associate professor Major of the medical service Moisei Solomonovich Schwartz, who made a significant contribution to experimental dentistry and periodontology with his research. Material and methods. The article is prepared on the basis of information provided in the Russian literature on dentistry and maxillofacial surgery, as well as taking into account the memories of dentists who personally knew M.S. Schwartz, namely Colonel of the medical service V.P. Zabelin and associate professor Colonel of the medical service V.V. Fiolkovsky. Results. The paper notes that the major of the medical service, associate professor M.S. Schwartz, conducted a series of studies devoted to the study of the functional properties of the vessels of the jaws, mainly the lower jaw. He was the first in dentistry to apply the Kravkov-Pisemsky technique, which allowed him to study the effect of biogenic amines on the vessels of an isolated jaw. A comparative study using this technique of the vessels of the ear and jaw of the dog allowed to establish the increased sensitivity of the latter to acetylcholine, histamine and adrenaline, and in 1936 he experimentally reproduced periodontal disease (alveolar pyorrhea) with the help of chronic irritation (ligation) of the inferior alveolar nerve in a dog. The participation of M.S. Schwartz in the Soviet-Finnish (winter) War of 1939-1940, as well as the Great Patriotic War of 1941-1945, was noted. Conclusions. M.S. Schwartz was a great scientist, a good doctor with sound manual skills, including providing surgical assistance to the maxillofacial wounded. He was a thoughtful researcher and a demanding teacher. His contribution to the development of experimental dentistry and periodontology is difficult to overestimate.

Giant Lobular Fibrous Epulis- A Case Report

The Fibrous epulis, is a tumour like lesion arising from the gingiva, periosteum or periodontal ligament and is commonly involving the interdental papilla. Its etiology is attributed to a reactive mechanism in response to chronic irritation or tissue injury which stimulates excessive tissue response. They are usually asymptomatic and have a very slow rate of growth. The recurrence rate is high and they are commonly treated by a combination of surgical excision, thorough curettage and oral prophylaxis. We report a case of a Giant lobular fibrous epulis in a 62 year old female which was located in the left maxillary canine, first premolar region since 6 months. It was asymptomatic and was pale pink in colour and pedunculated and lobular with no involvement of the underlying bone. It was surgically excised along with thorough curettage and oral prophylaxis. The histopathology report was suggestive of fibrous epulis.

Neck Reflex Points: A New Clinical Test? Prevalence in Two Cohorts and Its Covariates.

Background: Neck reflex points (NRPs) are 2 × 6 potentially tender areas of the neck, denominated NRP-C0 to NRP-C7. They are different from muscular trigger points and become tender in response to chronic trigeminal irritation. NRP examination has a high inter-rater reproducibility. We investigated the prevalence of NRPs in two populations to investigate their usefulness as a clinical test for trigeminal irritation. Methods: In total, 165 patients with chronic pain and 431 students were examined for NRP tenderness using a three-level pain scale: absent pain (PI = 0), mild tenderness (PI = 1), or marked tenderness (PI = 2). Results: In patients, we found more tender NRPs than in the student group (p < 0.001), and on the left side, more tender NRPs were found in NRP-C0-C4. Left and right NRPs appeared independently (kappa 0.1-0.4), except for NRP-C7 (kappa 0.55). Females had more tender NRPs (p < 0.001). Tenderness was independent of age, BMI, and pre-existing diseases. Conclusions: NRP tenderness occurs more frequently in patients than in students, independent from potential covariates. Our results, together with previous findings, support the use of NRP examination as a clinical test for chronic silent inflammation of the trigeminal region. These data provide a base for further studies investigating correlations of NRPs with clinical findings.

Oral Cavity Cancer Secondary to Dental Trauma: A Scoping Review.

(1) Background: Oral cavity cancer represents the most common site of origin of head and neck mucosal malignancies. A few limited studies have suggested that chronic irritation, particularly in non-healing ulcers, and fibrotic tissue from poor dentition or ill-fitting dentures had a role in developing mouth cancer. This scoping review aims to evaluate the existing evidence concerning Oral Cavicty Cancer (OCC) in non-smokers/non-drinkers and the relationship with dental trauma. (2) Methods: A scoping review of the PubMed, Embase, and Web of Science databases was completed in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. (3) Results: Of the 33 articles that met inclusion, in 6 of them authors discussed the role of topography in dental trauma, in 11 articles authors discussed the carcinogenesis mechanism involved in chronic mucosal trauma, in 17 articles data on ill-fitting dentures was included, 4 studies dealt with the effect of broken/sharp teeth on mucosal damage, and in 7 studies the role of oral hygiene was covered. Less frequently discussed topics included gender, risk of neck nodes, and the role of potentially malignant oral disorders. (4) Conclusions: The available literature suggests a potential connection between chronic dental trauma and the development of OCC. Studies have highlighted factors such as denture use and ill-fitting dental appliances as contributors to an increased risk of oral cancer. Interestingly, we still miss data to support the hypothesis that women, particularly those without toxic habits like smoking or alcohol consumption, appear to be disproportionately affected by oral cancer related to chronic dental trauma.

Pulp Cavity Calcification in SLE Patient Associated with Long-term Use of Glucocorticoids: A Case Study with Endodontic Approaches

Background Calcification in the tooth pulp cavity occurs in response to various factors, including dental trauma and chronic irritation. Systemic lupus erythematosus (SLE) is the most common type of lupus, causing widespread inflammation and tissue damage in the affected organs. The SLE condition is generally managed by long-term use of drugs, including glucocorticoids (GCs). Objective This study aimed to assess the association of pulp cavity calcification in SLE patients with long-term use of GCs and to present endodontic perspectives on the issue. Case Presentation A female SLE patient with a history of long-term use of GCs visited our hospital for an oral surgery examination due to an accident. The crown of tooth 11 was visibly fractured. The tooth was sensitive to cold stimulus, while tooth 21 was mobile. Various examinations (including electric pulp test and panoramic radiography) pointed to the diagnosis of chronic pulpitis in the affected teeth (11 and 21), and cone beam computed tomography (CBCT) revealed that the pulp cavities in all teeth were almost completely calcified. Thus, the root canal treatment (RCT) was attempted and followed by crown restoration for the affected teeth. The involvement of GCs in the pulp cavity calcification was assessed. Conclusion According to this case and a series of related studies, long-term use of glucocorticoids is associated with the incidence of pulp cavity obliteration (PCO). More frequent dental examinations and appropriate adjustments in medication use (dose and duration) should be considered and implemented.

The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management.

Floppy Eyelid Syndrome (FES) is an underdiagnosed ocular condition characterized by the abnormal laxity of the upper eyelids, often leading to chronic eye irritation and redness. This review provides an in-depth examination of FES, covering its pathophysiology, clinical presentation, and diagnostic and therapeutic approaches. We discuss the potential etiological factors, including genetic predispositions and associations with ocular and systemic conditions such as obesity, obstructive sleep apnea, keratoconus, and glaucoma. Diagnostic strategies are outlined, emphasizing the importance of thorough clinical examinations and specific tests for an efficacious grading and assessment of FES. Management of FES ranges from conservative medical treatments to surgical interventions for more severe cases and should be driven by a comprehensive and multidisciplinary approach. Herein, we illustrate the practical aspects of diagnosing and managing this condition. This comprehensive review aims to enhance the recognition and treatment of FES, ultimately improving the quality of life for affected patients.

A synovial cyst-induced vertebral artery dissection in bow hunter's stroke: illustrative case.

Bow hunter's stroke (BHS) is a rare condition characterized by occlusion of the vertebral artery (VA) due to a head rotation. BHS typically results from neck hyperrotation, often due to anatomical factors. The authors present a case of BHS in a young male patient exacerbated by os odontoideum (OD), resulting in atlantoaxial dislocation, which ultimately led to VA dissection. A man in his 20s presented with persistent dizziness and nausea and initially received a diagnosis of a brain infarction. However, imaging revealed VA dissection caused by an OD with an associated synovial cyst. Surgical intervention, specifically atlantoaxial posterior fixation, resolved the instability and allowed for natural regression of the synovial cysts, preventing further vascular events. In this case, the OD with atlantoaxial dislocation was identified as the causative factor for BHS. The coexistence of a synovial cyst was a unique finding, likely triggered by chronic irritation caused by the OD. This case emphasizes the importance of thorough cervical spinal evaluation in young patients presenting with posterior circulation stroke. https://thejns.org/doi/10.3171/CASE2487.

Microbiome dysbiosis in gallbladder cancer: A systemic review

Gallbladder cancer (GBC) starts in the epithelial tissue (lining of the bile duct and gallbladder). It is a type of aggressive cancer called adenocarcinoma that can spread to other tissues. Among all cases of biliary tract cancer, 50% is from GBC. It is a deadly cancer with a survival rate of 17.6% between 2007 and 2013. GBC is rarely found in the Western world, but it is commonly found in South Asia. In Southeast Asian countries, GBC plays a significant role in cancer-related morbidity and mortality. GBC incidence exhibits marked regional variability, a rare condition in the western population but having a higher frequency in India, especially the Indo-Gangetic belt and some northeast districts excluding Nagaland. This might be attributed to the differences in environmental factors and genetic predisposition modulating carcinogenesis. In GBC, only 10% of cases are identified in the early stages. The low rate of early detection is due to the lack of screening techniques and the aggressive characteristics of the tumor. Various risk factors are associated with GBC, for example, chronic cholecystitis with or without gallstones, obesity, exposure to heavy metals such as lead and arsenic, bacterial infection, congenital biliary cysts, and abnormal pancreaticobiliary duct junction. The risk factors can cause chronic gallbladder mucosa irritation, leading to dysplasia and neoplasia. GBC can form metaplasia to dysplasia in a time span of 5–15 years, then to carcinoma in situ, and finally to invasive cancer. Dysbiosis is responsible for various diseases, including cancer. Multiple triggers can cause dysbiosis, for example, environmental changes, inflammation, infection, medications, dietary changes, or genetic predisposition. Various researches show that Helicobacter pylori, human papillomavirus, Hepatitis B virus, and Hepatitis C virus microbial species can cause cancer. They are the major species responsible for 90% of infection-associated cancers. Various studies demonstrate that the strains of Salmonella and Helicobacter colonize are linked to developing GBC. While the mechanisms linking gut microbiota to GBC are not fully understood, several studies have suggested a potential association. According to a study, certain gut microbiomes, such as Fusobacterium nucleatum, found glut in GBC tissues, compared to adjacent normal tissues. By evaluating gut microbiome dysbiosis, we can see the potential link between gut microbiome dysbiosis and GBC; it may provide valuable insights into the development and progression of GBC. It could lead to the identification of new diagnostic markers and the development of novel therapeutic strategies. In GBC, the evaluation of gut microbiome dysbiosis (involving evaluating the composition, diversity, and functional capacity of the gut microbiome in patients) has emerged as a promising method for understanding the molecular mechanisms and identifying biomarkers for early prevention and detection of GBC and also investigating the possibility of any link between the gut microbiome and host immune response. In conclusion, evaluating gut microbiome dysbiosis in GBC is a promising direction for identifying potential early detection and prevention biomarkers. Additional investigation is therefore needed to determine the role of gut microbiome dysbiosis in the development and progression of GBC and to identify reliable biomarkers for clinical use.

Reliability and validity of the German version of the Glasgow Edinburgh Throat Scale

Many patients who consult the ENT doctor suffer from globus sensation, as a term for a multifactorial symptom description. It is particularly important during initial consultation to take the often-sensitive patients seriously and to offer a structured diagnostic clarification. Today, there is a lack of a screening tool in everyday clinical practice that can be used to differentiate the globus sensations more closely and assess their severity OBJECTIVES: The reliability and validity of the German version of the Glasgow Edinburgh Throat Scale (GETS) were examined. The original GETS questionnaire was translated into German (GETS-G) and completed by 60 patients with globus sensation (>3 months) in a prospective observational study. All patients received a clinical examination a sonography of the neck. In patients without an identifiable organic cause, a pH monitoring was carried out. A local organic cause for the globus sensation was found in 30 patients (50%). In addition, reflux was detected in 24 patients (40%) using pH monitoring. No cause could be determined in only 6 patients (10%). According to the overall score (Q1-Q12), there was no significant difference between these three groups. The Cronbach's alpha for assessing reliability was 0.88 in the 12-item analysis. Principal component analysis yielded a globus scale, dysphagia scale and a chronic pharyngeal irritation scale. The GETS-G showed high reliability and validity, which justifies its use in patients with globus sensation in German-speaking countries and may lead to a better assessment of the severity of this symptom.

The Role of 20% Ethanol in Enhancing Pterygium Surgery Outcomes: A Clinical Study.

Introduction Pterygium is an ocular surface disorder characterized by a hyperplastic growth of conjunctiva encroaching over the cornea. It causes redness, watering, and foreign body sensation. Surgical excision is the preferred mode of treatment when there is encroachment over the visual axis, chronic irritation, restricted ocular motility, and cosmetic concerns. Various surgical methods have been adopted for the treatment and to prevent recurrences. This study assessed the effectiveness and safety of 20% ethanol as an adjuvant in pterygium excision with conjunctival autograft implantation, evaluating surgical outcomes. Methods A prospective hospital-based interventional study was conducted among 30 patients with pterygium from August 2022 to December 2023. Patients were evaluated preoperatively for anterior segment, posterior segment, visual acuity, and corneal astigmatism. Pterygium was excised using 20% ethanol as an adjuvant, and conjunctival autograft was placed over the bare sclera without sutures. Patients were evaluated on postoperative days 1, 8, 30, and 90 for graft condition, visual acuity, corneal astigmatism, and associated complications. Results After three months of follow-up, the mean visual acuity improved to LogMAR 0.46±0.35 (p=0.001), which was statistically significant, and the average corneal astigmatism decreased from 3.36±2.87 to 0.87±0.57 (p=0.0001). No recurrence was noted among the participants. Conclusion This study has shown that using 20% ethanol as an adjuvant for pterygium excision facilitated clean dissection of a pterygium from the underlying cornea and the pterygium-induced corneal astigmatism has significantly decreased, which led to progress in vision.

Prevalence of Squamous Cell Carcinoma of The Tongue In Dr. Hasan Sadikin General Hospital During 2017 – 2022

Introduction: Squamous cell carcinoma is the most common malignant neoplasm in the oral cavity, accounting for 90% of all malignancies in the oral cavity. Exposure of the oral epithelium to carcinogenic substances can cause squamous cell carcinoma. This study was show the prevalence of squamous cell carcinoma of the tongue in West Java which is used as education for the prevention of squamous cell carcinoma of the tongue. Purpose: This research is a descriptive study and carried out using purposive sampling method. The sample in this study were patients with a diagnosis of squamous cell carcinoma of the tongue at Dr. Hasan Sadikin Hospital Bandung during January 2017 - January 2022 who had been confirmed by histopathological examination results. Data analysis will be carried out on secondary data from collected medical records and the results of the pathologist's interpretation, then the results of the data analysis will be arranged and presented in tabular and percentage form. Methods: The data obtained were 218 cases. Based on age, the most patients were in the age group above 48 years (58%). Based on gender criteria, it shows more women (57%). Based on domicile criteria, the highest domicile was in Bandung (38%). Based on family history criteria, there were 215 patients with no family history or 99%. Based on the predisposing factor criteria, it shows more patients with a history of chronic irritation (48%). Based on the mass size criteria, it shows more patients with mass size T4 (60%). Based on KGB criteria, it shows more patient showed N1 lymph nodes involvement (63%). Based on tumor metastasis criteria, it shows more patients with Mx tumor metastasis (50%). Based on the therapy status criteria, it shows more patients with combined therapy (32%). Results: Type the result of your research, including statistical analysis. Conclusion: Patients suffering from squamous cell carcinoma in the tongue are mostly patients over 48 years old with female gender who live in Bandung City, West Java, and have no family history but have predilection factors such as irritation and infection. The size of the tumor mass in patients with squamous cell carcinoma mostly has a mass size &gt; 3 cm, with lymph node involvement mostly on the ipsilateral with a size &lt; 3 cm and metastasis to other organs is difficult to assess due to lack of supporting modalities. The therapy received was mostly combined therapy (surgery and chemotherapy or radiotherapy) Keywords: Squamous cell carcinoma of the tongue, prevalence, patient characteristics

Cytomorphological Spectrum of Ocular Surface Squamous Neoplasia in Elderly Age Group and Its Clinicopathological Correlation

ABSTRACT Background: Ocular surface squamous neoplasia (OSSN) encompasses a range of dysplastic changes from mild dysplasia to invasive carcinoma. This research aims to elucidate the cytomorphological spectrum of OSSN in the elderly age group and correlate these findings with clinical and pathological features. Methods: A retrospective analysis was conducted on elderly patients (&gt;60 years) diagnosed with OSSN over a 5 year period. Cytological and histopathological findings were analyzed and correlated with clinical data. Results: The cytomorphological spectrum of OSSN in the elderly age group exhibited a broad range of cellular changes, from mild dysplasia to invasive squamous cell carcinoma. The predominant cytological features included increased nuclear–cytoplasmic ratio, pleomorphism, and abnormal mitotic figures. Clinically, OSSN presented most commonly as a unilateral conjunctival mass with a history of chronic irritation. Histopathologically, there was a significant correlation between the degree of dysplasia and the depth of invasion (P &lt; 0.05). Conclusion: This research highlights the diverse cytomorphological spectrum of OSSN in the elderly age groups and emphasizes the importance of comprehensive clinicopathological correlation for accurate diagnosis and management. The predominant cytological features observed, including increased nuclear–cytoplasmic ratio, pleomorphism, and abnormal mitotic figures, reflect the underlying dysplastic alterations and provide valuable insights into the diagnosis and the classification of OSSN. Further studies are warranted to explore the potential role of impression cytology in the diagnosis and management of OSSN and to evaluate the efficacy of different treatment modalities in the elderly age group.

EPEN-25. “CONCERNING EPENDYMOMAS, A FURTHER SUBDIVISION IS NEITHER MORPHOLOGICALLY NOR BIOLOGICALLY NECESSARY”: A NARRATIVE REVIEW OF RESEARCH ON EPENDYMOMAS BETWEEN 1865 AND 2024

Abstract BACKGROUND The history of research on ependymomas dates back to the nineteenth century. However, ependymomas have received much less attention than other neuro-oncological diseases. This narrative review investigates the history of ependymoma as a distinct tumour entity. METHODS A comprehensive literature search in German, English and French was carried out for publications from 1850 to 2024 in PubMed, the Internet Archive, and the library of Heidelberg University. Additionally, the evolution of the classification of ependymoma throughout the editions of the WHO classification of CNS tumours was analysed. RESULTS The first major systematic description of ependymal tumours was published in 1865 by Rudolf Virchow, who hypothesized that ependymomas originated from chronic irritations to the ependyma. In 1899, perivascular (pseudo-)rosettes were described for the first time. Subsequently, Percival Bailey and Harvey Cushing’s systematic classification efforts laid the groundwork for new advancements. Debates about the classification of ependymomas can already be found in publications by Percival Bailey or Gustave Roussy in 1924, with a major focus on the definition of ependymoblastoma as an independent entity, which was only resolved in 2016 with the introduction of the new diagnosis ETMR. Klaus Joachim Zülch’s important mid-20th-century work highlighted clinical variations within ependymomas but deemed no further stratification necessary. The WHO’s classifications in 1979, 1993, 2000 and 2007 relied on histopathology, with only minor details being adapted over the years. A new era began in 2016 with the recognition of C11orf95-RELA (ZFTA-RELA) as a defining hallmark of supratentorial ependymomas. The latest WHO classification in 2021 adopted a molecular-anatomical approach, incorporating new subgroups and abandoning histomorphological subtypes due to limited prognostic value. Tumor grading became mostly optional. CONCLUSIONS This review summarises the significant evolution in ependymoma research, particularly in the 2010s. Strikingly, many of the questions that Virchow, Bailey or Roussy investigated, remain unanswered in 2024.

Low Inter-Rater Reliability and Reproducibility of Neck Reflex/“Adler-Langer” Points in Neural Therapy Diagnostics but Increased Pressure Pain Threshold after Therapy: Results of a Randomized Controlled Observer-Blind Trial

Background: Neck reflex points or Adler-Langer points are commonly used in neural therapy to detect so-called interference fields. Chronic irritations or inflammations in the sinuses, teeth, tonsils, or ears are supposed to induce tension and tenderness of the soft tissues and short muscles in the upper cervical spine. The individual treatment strategy is based on the results of diagnostic Adler-Langer point palpation. This study investigated the inter- and intra-rater reliability and explored treatment effects. Methods: We performed a randomized controlled trial with 104 inpatients (80.8% female, 51.8 ± 12.74 years) of a German department for internal and integrative medicine. Patients were randomized to individual neural therapy according to the pathological findings (n = 48) or no treatment (n = 56). In each patient, three experienced raters (20–45 years of experience in neural therapy) and two novice raters (medical students) rated Adler-Langer points rigidity on a standardized rating scale (“strong,” “weak,” “none”). The patients independently evaluated the tenderness on palpation of the eight points using the same scale. Pressure pain thresholds were assessed at the eight Adler-Langer points. All patients were retested after 30 min. The five raters were blinded to treatment allocation and assessments of the other raters. Video recordings were obtained to assess the consistency of the areas tested by the different raters. Results: Agreement between patients and raters (Cohen’s kappa = 0.161–0.400) and inter-rater reliability were low (Fleiss kappa = 0.132–0.150). Moreover, the individual agreement (pre-post comparisons in untreated patients) was similarly low even in experienced raters (Cohen’s kappa = 0.099–0.173). Video documentation suggests that raters do not place their fingers in the correct segments (percentage of correct position: 42.0–60.6%). Pressure pain thresholds at five of the eight Adler-Langer points showed significant changes after treatment compared to none in the control group. Conclusion: Under this artificial experimental setting, this method of Adler-Langer point palpation has not proven to be a reliable diagnostic tool. But it could be shown that, as claimed by the method, the tenderness in five of eight Adler-Langer points decreased after neural therapy.

A Retrospective Analysis of the Clinicopathological Profile of Oral Squamous Cell Carcinoma in Tobacco and Non-tobacco Users: Highlighting the Significance of Chronic Mechanical Irritation

A Retrospective Analysis of the Clinicopathological Profile of Oral Squamous Cell Carcinoma in Tobacco and Non-tobacco Users: Highlighting the Significance of Chronic Mechanical Irritation

A giant peripheral ossifying fibroma of the maxilla with extreme difficulty in clinical differentiation from malignancy: a case report and review of the literature

BackgroundPeripheral ossifying fibroma is a nonneoplastic inflammatory hyperplasia that originates in the periodontal ligament or periosteum in response to chronic mechanical irritation. Peripheral ossifying fibroma develops more commonly in young females as a solitary, slow-growing, exophytic nodular mass of the gingiva, no more than 2 cm in diameter. While various synonyms have been used to refer to peripheral ossifying fibroma, very similar names have also been applied to neoplastic diseases that are pathologically distinct from peripheral ossifying fibroma, causing considerable nomenclatural confusion. Herein, we report our experience with an unusual giant peripheral ossifying fibroma with a differential diagnostic challenge in distinguishing it from a malignancy.Case presentationA 68-year-old Japanese male was referred to our department with a suspected gingival malignancy presenting with an elastic hard, pedunculated, exophytic mass 60 mm in diameter in the right maxillary gingiva. In addition to computed tomography showing extensive bone destruction in the right maxillary alveolus, positron emission tomography with computed tomography revealed fluorodeoxyglucose hyperaccumulation in the gingival lesion. Although these clinical findings were highly suggestive of malignancy, repeated preoperative biopsies showed no evidence of malignancy. Since even intraoperative frozen histological examination revealed no malignancy, surgical resection was performed in the form of partial maxillectomy for benign disease, followed by thorough curettage of the surrounding granulation tissue and alveolar bone. Histologically, the excised mass consisted primarily of a fibrous component with sparse proliferation of atypical fibroblast-like cells, partly comprising ossification, leading to a final diagnosis of peripheral ossifying fibroma. No relapse was observed at the 10-month follow-up.ConclusionsThe clinical presentation of giant peripheral ossifying fibromas can make the differential diagnosis from malignancy difficult. Proper diagnosis relies on recognition of the characteristic histopathology and identification of the underlying chronic mechanical stimuli, while successful treatment mandates complete excision of the lesion and optimization of oral hygiene. Complicated terminological issues associated with peripheral ossifying fibroma require appropriate interpretation and sufficient awareness of the disease names to avoid diagnostic confusion and provide optimal management.

E028 A differential diagnosis for treatment resistant psoriatic arthritis

Abstract Background/Aims This case involves a 45 year old gentleman with established psoriatic arthritis with axial and peripheral joint involvement. His disease was managed with subcutaneous methotrexate and etanercept. Despite improvement in axial symptoms and resolution of symptoms at other peripheral joints, he had ongoing severe monoarthritis of his right knee with significant pain and swelling. Methods In spite of several joint aspirations and intra-articular steroid injections [ten in total], escalation of dose of methotrexate, addition of sulfasalazine and switch of biologic to adalimumab, the patient’s right knee symptoms persisted. Further imaging was performed. An US scan showed chronic synovial hypertrophy with fatty metaplasia and an MRI scan showed frond like synovial thickening, suggestive of lipoma arborescens. Results The patient was referred to the orthopaedic surgeons and underwent excision synovectomy. The histopathology reported fibrofatty tissue with areas of chronic synovitis with presence of lymphoplasmacytic aggregates. The patient’s knee symptoms persisted for five years in total after clinical improvement at other joints; post-synovectomy, his right knee symptoms were improved. Lipoma arborescens is a benign progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium; it frequently affects the knee joint suprapatellar pouch. Villous proliferation of the synovium occurs, with subsequent replacement of synovial connective tissue by adipocytes. Conclusion Lipoma arborescens has been described occasionally in association with psoriatic arthritis. It is felt to occur as a reactive response to chronic synovial irritation; in this case from an inflammatory affront. Given the rarity of lipoma arborescens, coupled with the patient’s known underlying diagnosis of a seronegative arthritis, there was significant delay in his diagnosis. This case highlights the need to consider other causes of persistent joint pain and swelling when maximal therapeutic options have been unsuccessful. Disclosure A. Jacobs: None. M. Callan: None.