Innocuous Lesions Research Articles

Expression of survivin and p53 in oral lichen planus, lichenoid reaction and lichenoid dysplasia: An immunohistochemical study.

Context:The malignant transformation potential of oral lichen planus (OLP) and related lesions is a subject of great controversy.Aim:The aim of this study was to compare the expression of proteins related to apoptosis and tumour suppressor gene processes in OLP, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD).Materials and MethodsThe immunohistochemical study was carried out to investigate the expressions of survivin and p53 in a total of 30 lesional biopsy specimens - 10 cases each of OLP, OLR and OLD. The expression rates were further compared with 10 control specimens of normal oral mucosa (NORM).Results:Immunoreactivity for p53 was seen in 7 cases (70%) of OLD, 4 cases (40%) of OLP and 2 cases (20%) of OLR and none of NORM. We obtained a significant difference (P = 0.01) in mean p53 expression between the different entities. The positive staining rate of survivin was found to be significantly different between OLD (50%), OLP (10%), OLR (0%), and normal mucosa (0%) (P = 0.004). There was a positive correlation between p53 and survivin expression in OLP and OLD using Pearson's correlation coefficient.Conclusion:Lichenoid dysplasia has shown p53 and survivin expression in the range of not OLP, but leukoplakia. On the other hand, OLR seems to be an innocuous lesion. The study results with OLP are inconclusive but points toward a small but important malignant potential in OLP. This kind of comparative study highlights the importance of biopsying OLP and related lesions for proper diagnosis and appropriate management.

Cysticercosis presenting as Neck Swelling: A Rare Case diagnosed on Ultrasound Report

ABSTRACTIntroductionCysticercosis is a condition that occurs when humans are infested by the larvae ofTaenia solium, acting as an intermediate host instead of definitive occurrence in neural and extra-neural forms. The latter commonly involves subcutaneous tissue, skeletal muscles, and eyes.Aims and objectivesOral cysticercosis is a rare event, and it represents great difficulty for clinical diagnosis. In present report we report a case of cysticercosis in the right submandibular region where it presented as a large, soft cystic swelling and tried to explain the clinical sign & symptom of oral cysticercosis. We emphasize on the importance of ultrasonographic and routine microscopic examinations for the diagnosis of even apparently innocuous lesions in submandibular regions.ResultsThis is a very rare case of oral cysticercosis showing neck swelling extended from the lower border of the mandible to the thyroid cartilage. The diagnosis was made by sonography and confirmed by gross and microscopic examination of cysticercosis cellulosae. In ultrasonography, there was well-defined cystic lesion with hyperechoic eccentric tiny nodules.How to cite this articleChandak RM, Chandak MG, Rawlani SM. Cysticercosis presenting as Neck Swelling: A Rare Case diagnosed on Ultrasound Report. J Contemp Dent 2017;7(2):122-124.

An Innocuous Appearing Thumb Lesion Leading to High Grade Shock and Multiorgan Failure

An Innocuous Appearing Thumb Lesion Leading to High Grade Shock and Multiorgan Failure

Maxillary Ewing′s sarcoma: A report of innocuous lesion with nocuous pathology

Ewing's sarcoma represents a highly lethal and a rare malignancy, which predominately prevails in the long bones and skeleton. Its occurrence in the oral cavity has been estimated to be 1-2% of the overall reported cases. The common presentation of this malignancy overlaps with that of other malignant lesions affecting the jaws. Early diagnosis and treatment initiation improves the overall prognosis, even though the estimated survival rate is 5 years in approximately 4-7% of the patients following therapy. Treatment in concordance to other bone malignancies such as osteosarcoma and chondrosarcoma has been tried and is known to improve and prolong the survival rate. Here, we report a case of this rare malignancy occurring in the jaws with an unusual presentation as a common dental problem of an unhealed and infected extraction socket.

Evaluation of role of cytodiagnostic techniques in detection of oral premalignant and malignant lesions: Study of 50 cases

Aims and Objectives: In this study, we studied cytomorphological features and determined the sensitivity and specificity of cytology specimens obtained with simple instruments like toothbrush (modified brush biopsy), wooden spatula and analyzed without computer-assisted analysis. Settings and Design: Fifty patients attending outpatient clinics who exhibited oral lesions suspicious of premalignancy or malignancy were enrolled. All patients underwent scrapping by wooden ice cream stick and an oral brush biopsy using a baby toothbrush. The specimens were analyzed manually in a double-blinded fashion. Histopathological confirmation by a scalpel biopsy was obtained whenever possible. Chi square test and Fischer exact 't' test was used for statistical analysis. Results: In our study, brush cytology was better (P < 0.05) than scrape cytology in the criteria of cellularity, abnormal cell group adequacy and detection of higher grade of dysplasia. Also, we found that increased N: C ratio, nuclear pleomorphism, nucleoli and presence of micronuclei were the parameters statistically significant in oral carcinoma as compared to high grade dysplasia. Sensitivity of detecting malignancy by cytodiagnosis was 76.47% and false negative rate of 23.53% was present in our study. Conclusions: Modified brush biopsy is relatively easy, non invasive, OPD procedure, particularly an effective tool for screening small innocuous lesions for dysplasia/ malignancy as each of their evaluation by cumbersome and painful scalpel biopsy procedure is often impractical. Early diagnosis of dysplasia/ malignancy helps patient to aim for curative treatment. Though cytomorphological difference between high grade dysplasia and carcinoma is not very distinct, certain features like high grade nuclear pleomorphism, presence of high frequency of micronuclei, tumor diathesis and bizarre shaped cells like tadpole, spindle shape etc. are the features which are more significantly associated with malignancy.

Genotyping of High Risk Human Papillomavirus (HPV) among cervical precancer and cancer patients

Introduction: Human papillomavirus (HPV) is a DNA virus which has tropism for epithelial cells, is the major etiological factor for development of cervical precancerous and cancerous lesions. Nearly 100 diff erent types of HPV have been characterized and thereare a large number of other types. HPV infection is one of the most common causes of sexually transmitted disease in both men and women worldwide. It is associated with a variety of clinical conditions that range from innocuous lesions to cancer. Genital HPV types are divided into high and low-risk types, according to the oncogenic potential. Molecular and epidemiologic studies have solidifi ed the association between high risk HPV types (especially HPV-16 and HPV-18) and cervical squamous cell carcinoma. HPV infection is often transient and self-limiting but infection may persists and progress to high grade lesions and cancer. In addition to persistent high-risk HPV infection, other viral factors such as high viral loads, HPV variants, infections with multiple high-risk HPV types and genetic predisposition contribute to the development of cervical cancer. Th e aim of the present study was to detect HPV DNA and identify high risk HPV genotype among women having cervical intraepithelial neoplasia and carcinoma and to evaluate potential effi cacy of prophylactic HPV vaccine. Methods: Cervical swab from histopathologically diagnosed CIN (n=51) and carcinoma (n=39) patients were taken and high risk HPV DNA was detected by HC II assay. Polymerase Chain Reaction was used to identify high risk HPV genotype. Result: HPV DNA was detected in 41 (45.56%) patients by HC II assay. HPV type 16 was detected in 27 (81.82%) followed by type 18 in 3 (9.09%) and type 45 in 2 (6.06%) cases of cervical carcinoma. Among precancerous cases, only type 16 was detected. Conclusion: Knowledge based on HPV prevalence and genotype could be used to predict the effi cacy of cost eff ective prophylactic vaccine, introduction of newer generation vaccine and management of cervical carcinoma.

Pancreaticobiliary tract cytology: Journey toward "Bethesda" style guidelines from the Papanicolaou Society of Cytopathology.

The current series of articles related to the Papanicolaou Society of Cytopathology (PSC) guidelines for pancreaticobiliary cytology are the product of significant efforts by many experts working on different PSC guidelines committees.[1] The PSC guidelines for cytologic interpretation and reporting of variety of body site specimens have been described previously.[2,3,4,5,6] These are comparable to the guidelines from the National Cancer Institute for cervical cytology[7] and fine needle aspiration cytology of breast and thyroid.[8,9] Most of these systems are designed to stratify the risk of malignancy with diagnostic categories for guiding appropriate management algorithms. The current guidelines[10,11,12,13,14] follow the strategies comparable to the Bethesda System for Reporting Thyroid Cytopathology. The guidelines not only consider diagnostic categories and criteria, but also attempt to provide details on other aspects including techniques for obtaining specimens, which patient would benefit most from cytologic evaluation, information on ancillary testing, and patient follow-up/management. The scheme addresses the wide spectrum of approaches to acquire diagnostic material for cytopathologic evaluation from a variety of pancreaticobiliary lesions. A six-tiered system is recommended for the standardized nomenclature in pancreaticobiliary cytology. The categories proposed are: Non-diagnostic, negative, atypical, neoplastic (benign or other), suspicious, and positive.[12] “Atypical” and “suspicious” categories have relatively well reported malignancy risks.[15,16] Potentially, the most challenging and controversial category is “neoplastic (benign and other)” with the widest range of interpretations. The entities included in this category range from innocuous lesions such as benign cystic neoplasms (serous cystadenoma) to others like pre-malignant mucinous cysts (cystic mucinous neoplasm and intraductal papillary mucinous neoplasm), low-grade well-differentiated neuroendocrine tumors (NETs), and solid-pseudopapillary neoplasms. The premalignant mucinous cysts without unequivocal features of malignancy would fall in this category with very wide management options.[17] The NETs similarly have many challenges with controversies related to their categorical assignment. Due to their malignant potential, some favor these neoplasms be categorized as “malignant.” European Neuroendocrine Tumor Society (ENETS) and World Health Organization categorize low and intermediate grades of these as “tumor” or “neoplasm” in the absence of high-grade criteria (>50 mitoses per 50 high power field for NETs of pancreas and >20 mitoses per 10 high power field or Ki-67 index >20% for NETs of other sites).[18,19] Undoubtedly, the lesions with unequivocal cytological features of either small cell carcinoma or large cell undifferentiated carcinoma belong to the “malignant” category. An increasing trend with incidental NETs in surgically unfit older patients, favors a conservative approach for small NETs as an alternative management strategy. The categories proposed in the current guidelines permit practical flexibility by surgeons in order to assure that conservative strategies may be a better option than the surgery. This would be more confusing if these cases of low grade neoplasms automatically fell in a “malignant” category! Utilization of ancillary testing including molecular testing in cystic lesions is also addressed in appropriate areas.[13] With input from the guidelines by the National Cancer Center Network (www.nccn.org) and by the multidisciplinary international groups in the field of pancreatology, post cytologic evaluation and management are also covered.[14] A “triple test” approach similar to that applied for FNA of breast lesions is recommended. Patient management should be determined by correlating the clinical findings in concert with endoscopic, imaging, and cytologic findings. Effective application of such guidelines is heavily dependent on the collaborative, multidisciplinary interactions between endoscopists, pancreaticobiliary surgeons, radiologists, and cytopathologists. The current CytoJournal supplement issue with individual articles[10,11,12,13,14] covering various areas highlighted above would be a great resource under Open access platform[20,21] for all involved in the management of pancreaticobiliary lesions. These PSC guideline articles published under Open Access charter may be disseminated by multiple journals/platforms[22,23,24,25,26] including e-CytoJournal issue http://www.cytojournal.com/browse.asp?sabs=n.[27]

Experimental nonalcoholic steatohepatitis compromises ureagenesis, an essential hepatic metabolic function.

Nonalcoholic steatohepatitis (NASH) is increasing in prevalence, yet its consequences for liver function are unknown. We studied ureagenesis, an essential metabolic liver function of importance for whole body nitrogen homeostasis, in a rodent model of diet-induced NASH. Rats were fed a high-fat, high-cholesterol diet for 4 and 16 wk, resulting in early and advanced experimental NASH, respectively. We examined the urea cycle enzyme mRNAs in liver tissue, the hepatocyte urea cycle enzyme proteins, and the in vivo capacity of urea-nitrogen synthesis (CUNS). Early NASH decreased all of the urea cycle mRNAs to an average of 60% and the ornithine transcarbamylase protein to 10%, whereas the CUNS remained unchanged. Advanced NASH further decreased the carbamoyl phosphate synthetase protein to 63% and, in addition, decreased the CUNS by 20% [from 5.65 ± 0.23 to 4.58 ± 0.30 μmol × (min × 100 g)(-1); P = 0.01]. Early NASH compromised the genes and enzyme proteins involved in ureagenesis, whereas advanced NASH resulted in a functional reduction in the capacity for ureagenesis. The pattern of urea cycle perturbations suggests a prevailing mitochondrial impairment by NASH. The decrease in CUNS has consequences for the ability of the body to adjust to changes in the requirements for nitrogen homeostasis e.g., at stressful events. NASH, thus, in terms of metabolic consequences, is not an innocuous lesion, and the manifestations of the damage seem to be a continuum with increasing disease severity.

Squamous cell carcinomas in situ arising in seborrheic keratoses: an association with concomitant immunosuppression?

Seborrheic keratoses (SK) are the most common cutaneous neoplasm in humans. Given their numbers, a squamous cell carcinoma in situ (SCCIS) arising from an SK would not be unexpected, although this occurrence has not been widely reported. This study compares the immune status of patients with a SCCIS arising contiguously from SK (SK/SCCIS) and the number of daily medications taken by these patients. The biopsy tissue was evaluated for the presence of human papillomavirus DNA. Over a 5-year period at our institution, 13 cases of SK/SCCIS were diagnosed. For each case, age- and sex-matched control patients with a histologically diagnosed unremarkable SK were randomly selected. The number of patients taking immunosuppressing medications was determined from each group and compared statistically. In addition, polymerase chain reaction analysis of the 13 SK/SCCIS biopsies was performed. Five of the 13 study patients took immunosuppressive medications compared to none of the 39 control patients (P=0.0005). None of the biopsies demonstrated the presence of human papillomavirus DNA by polymerase chain reaction. Immunocompromised patients with SKs appear to carry a greater risk of these otherwise innocuous lesions developing an SCCIS, although given the small number of patients evaluated, further research into this possible association is warranted.

Proliferative Verrucous Leukoplakia: An elusive disorder

Proliferative Verrucous Leukoplakia (PVL) is a multifocal form of progressive leukoplakia with a high rate of malignant transformation that requires early recognition by oral health care providers for proper management. Background and PurposePVL will frequently appear as an innocuous white lesion or lesions that can easily be overlooked or considered clinically insignificant, yet it has a high rate of malignant transformation. There is limited in-depth knowledge about the pathobiology of PVL. Oral health care providers lack familiarity with this lesion; consequently the intent of this article is to increase awareness of the clinical aspects of PVL. MethodsCase reports, case series and review articles provide a profile of PVL. ConclusionIt is essential that health care providers performing intraoral examinations are aware that PVL is a distinct and rare form of multifocal oral leukoplakia. PVL commonly affects females above the age of 62. Currently, little is known about its etiopathogenesis. Additionally, no specific treatment modality has proven to be effective in aborting its progression. Because of its high recurrence potential and relentless progression to squamous cell carcinoma, all recurrent and multifocal white lesions of the oral cavity should be viewed with suspicion.

Aggressive meningioma presents as innocuous forehead lesion: a case report

Cutaneous meningiomas are very rare neoplasms. In this case report we document a type III (anaplastic meningioma) presenting as a subcutaneous forehead mass. Anaplastic meningiomas arise from the neuraxis. They are biologically aggressive neoplasms that extend into the dermis or subcutaneous tissue via direct extension through the bone.

A case of rib fungal osteomyelitis

Candida Osteomyelitis is uncommon.(1,2) It is associated with surgery, broad spectrum antibiotic use, central venous catheter insertion and immunosuppression.(2) We present a rare case of candidal rib osteomyelitis presenting initially with an innocuous skin lesion managed by extensive excision and reconstruction with minimal duration of post-operative antimicrobial therapy.

Fluid Within Striae – An Unusual Phenomenon

Striae distensae are common innocuous skin lesions. We report a patient of nephrotic syndrome with corticosteroid-induced large striae, which suddenly developed bulging and fluid accumulation. There were no associated cutaneous or systemic symptoms. Analysis of aspirated fluid showed it was a transudate and culture was sterile. It was concluded that edema fluid, as part of anasarca, had preferentially accumulated within the striae, probably due to their altered dermal mechanical properties. Recognizing this entity is important to avoid unnecessary alarm or irrational use of antibiotics.

OP116: “Optical biopsy” by narrow band imaging and autofluorescence of oral and oropharyngeal erythro-leukoplakias

Autofluorescence (AF) and narrow band imaging (NBI) assist the naked eye (NE) in achieving a reliable distinction between normal and preneoplastic/neoplastic mucosa of oral (OC) and oropharyngeal (OP) cavities, performing a so called “optical biopsy”. Aim of the study is to prospectively evaluate sensitivity (Se), specificity (Sp), positive (PPV), negative predictive values (NPV), and accuracy (Ac) of AF, and NBI in the evaluation of never biopsied before OC and OP erythro-leukoplakias. Between 2009 and 2012, 116 patients with OC (n = 100) and OP (n = 16) erythro-leukoplakias were evaluated. At NE, they were divided into Class I (suspicious) and Class II (innocuous) lesions according to the Sciubba’s classification. Subsequently, the lesions underwent AF and NBI examinations (categorized “positive” or “negative”), and excisional biopsy. True positive were those considered as “positive” at AF or NBI and with histopathologic diagnosis ranging from mild dysplasia to invasive carcinoma. Among 116 lesions, 70 were Class I and 46 Class II at NE. Excisional biopsies resulted: 32 benign lesions, 7 mild, 6 moderate, 13 high-grade dysplasias or carcinoma in situ, and 58 invasive carcinomas. For Class I lesions Se, Sp, PPV, NPV, and Ac for AF were 83%, 60%, 93%, 37%, 80%; for NBI, 95%, 80%, 96%, 73%, 93%, respectively. For Class II these values were 62%, 59%, 63%, 59%, 61% for AF, and 79%, 91%, 90%, 80%, 85% for NBI, respectively. NBI provided a “correct” diagnosis in 87% of the benign lesions, and in 93% of pre-neoplastic and neoplastic. AF gave us a “correct” diagnosis in 58% of benign lesions, and in 73% of pre-neoplastic and neoplastic lesions. NBI can be considered the more accurate diagnostic tool for “optical biopsy”, it can improve diagnostic insight into the nature of potentially malignant erythro-leukoplakias, especially when dealing with apparently innocuous lesions.

Squamous papilloma

S quamous papillomas are exophytic masses of the oral cavity which are most often benign and as- ymptomatic. They are innocuous lesions that are nei- ther transmissible nor threatening. As an oral lesion they raise concerns because of the clinical appearance, which may mimic an exophytic carcinoma. The patho- genesis is related to human papillomavirus but there is controversy regarding the viral origin. In this article two cases of squamous papilloma of the oral cavity are presented.

Multiple Peripheral Osteomas of Forehead: Report of a Rare Case

Osteoma is a benign slow growing osteogenic lesion, composed of well-differentiated mature bone tissue, characterized by the proliferation of compact or cancellous bone, almost exclusively found in the head and neck region. Central, peripheral and extra skeletal are the three variants of osteoma. Trauma, inflammation, developmental disorders and genetic defects are considered as the etiologic factors. Paranasal sinuses are the favourite locations of peripheral osteoma of the craniofacial region; frontal and ethmoidal sinuses being the common ones. Although, peripheral osteomas are usually benign, innocuous lesions, their size and prominent location on the visible parts of the face makes the surgical intervention necessary. We report case of multiple peripheral osteomas of forehead, without involvement of the frontal sinus, which is a rare variety.

Intraosseous carcinoma arising from an odontogenic cyst: a case report

Carcinomas from an odontogenic cyst are not common, yet when they occur, squamous cell carcinomas are the most often seen. Among these cysts, the malignancy of keratocysts or dentigerous cysts are most likely. In contrast, a malignant transformation of a radicular cyst to an intraosseous carcinoma is extremely rare. In this case report, an intraosseous carcinoma arising from an odontogenic cyst in a 26-year-old male patient is presented. This case report clearly demonstrates the importance of the clinician's awareness of the malignant potential of apparently innocuous cystic lesions.

Abstract 645: Differences in epidemiologic risk factors for colorectal adenomas and serrated polyps by anatomic site and lesion severity

Abstract Colorectal cancer (CRC) is a heterogeneous disease, and different subsets of CRC probably have different precursor lesions. Some colorectal polyps are considered precursors to CRC and are broadly classified into: 1) adenomas, including tubular, tubulovillous, and villous adenomas, and 2) serrated polyps, including hyperplasic polyps (HPs), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs). Adenomas are established CRC precursors, particularly for advanced lesions ≤ 10 mm, with villous components, or high-grade dysplasia. HPs were previously considered innocuous lesions, but new data suggests that a subset of these may progress to CRC via advanced serrated lesions, such as SSPs and TSAs. To gain insight into the factors associated with initiation and progression for divergent CRC pathways, we tested differences in risk factors for polyps according to histologic type, anatomic site, and severity. Participants, aged 20-79, were sampled from enrollees of Group Health, a large healthcare provider in Washington State, who underwent colonoscopy for any indication between 1998 and 2007. Participants completed a structured interview, and all lesions received a standardized pathology review. We evaluated 1,469 cases, including 628 with adenomas only, 594 with serrated polyps only, and 247 with both types of polyps, as well as 1,037 controls who were free of colorectal pathologies during colonoscopy. We focused on the following risk factors: age, sex, race, education, body mass index (BMI), NSAID use, family history of CRC, hormone use among women, endoscopy screening, smoking status, alcohol use, and physical activity. Multivariable polytomous logistic regression models were used to compare case groups to controls adjusted for all factors. Our study confirmed previously described risk factors for adenomas: age, male sex, obesity, never use of NSAIDs, no previous endoscopy, and physical inactivity. Risk factors for serrated polyps were smoking and never use of estrogen-only therapy. There were statistically significant differences in the association between several risk factors and polyp type. Male sex (P&amp;lt;0.001) and smoking (P&amp;lt;0.001) were stronger risk factors for adenomas than for serrated polyps. With respect to anatomic site, smoking (P=0.05) and never use of estrogen-only therapy (P=0.01) were stronger risk factors for distal/rectal than for proximal adenomas. Smoking (P&amp;lt;0.001) and BMI (P=0.01) were stronger risk factors for distal/rectal than for proximal serrated polyps. With respect to lesion severity, lack of prior endoscopy was a stronger risk factor for advanced adenomas (P&amp;lt;0.001) than for non-advanced adenomas, and higher education level was a stronger risk factor for SSP/TSAs than for HPs (P=0.02). These findings may suggest carcinogenic mechanisms that distinguish the adenoma-carcinoma pathway and the serrated pathway to CRC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 645. doi:1538-7445.AM2012-645

An asymptomatic tongue nodule

Cysticercosis is a major health concern in developing countries, as it is a major cause of seizures in these countries. The tissues commonly affected are the neural tissues, muscle, heart, lungs, liver, subcutaeneous layers and peritoneum, but oral manifestations are rare. Present case is of an asymptomatic tongue nodule which was diagnosed as cysticercosis on histologic examination. Thus, emphasizing the importance of routine microscopic examination and diagnosis of apparently innocuous lesions of the oral cavity.

Arias-Stella reaction of the cervix: The enduring diagnostic challenge

SummaryBackground:The Arias-Stella reaction is a hormone-related atypical endometrial change characterized by hypertrophy and vacuolization of glandular epithelial cells, associated with marked nuclear pleomorphism, enlargement, and hyperchromasia. When presenting in extra-uterine sites, the differentiation of Arias-Stella changes from other more ominous clear cell lesions may pose significant difficulties.Case Report:We report a case of an endocervical clear cell lesion incidentally discovered during a prenatal visit of a young pregnant woman. Interpretation of the pathological findings was complicated by the small size and fragmentation of the specimen.Conclusions:Recognition of Arias-Stella reaction in extra-uterine sites, especially in young women, is critical to avoid misdiagnosis of this innocuous lesion as clear cell adenocarcinoma. Attention to cellular and nuclear detail, as well as careful consideration of the clinical scenario, is crucial for establishment of the correct diagnosis.