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Cystadenocarcinoma is an uncommon salivary gland tumor that predominantly occurs in the major salivary glands rather than minor glands. We report a case of cystadenocarcinoma arising in the anterior mandibular gingiva. A 70-year-old man visited a certain hospital because of an intraoral painless tumor. The tumor was initially suspected to be an epulis and was excised with the patient under local anesthesia. The histopathological diagnosis was a cystadenocarcinoma. Eighteen months after the excision, the patient visited our hospital because of lymph node metastasis. Left radical neck dissection was performed. Metastases were histopathologically found in eight lymph nodes, one of which showed extracapsular spread.Moreover, 4 months later, right submandibular lymph node metastasis was detected, and the patient underwent right functional neck dissection.Unfortunately, the tumor recurred in the left side of the neck 29 months after the initial excision, and the patient was given regional radiotherapy.

We report a case of neurothekeoma occurring in the gingiva of the anterior part of the mandible. A 48-year-old man visited our clinic on November 13, 2002 because of a gradually enlarging mass in the gingiva of the anterior part of the mandible. Oral examination revealed a pedunculated mass measuring 13×30×15mm. The histological diagnosis of a biopsy specimen was epulis fibrosa. After admission to our hospital, mass excision with extraction from the right canine to the left premolar was performed under general anesthesia on January 21, 2003. The surgical specimen was histologically diagnosed as neurothekeoma. On immunohistochemical examination, the tumor cells were positive for vimentin, NSE, and S-100 protein. There was no local recurrence after surgery.

Peripheral ameloblastoma(PA)is a rare extraosseous odontogenic tumor with histologic characteristics similar to those of commonly occurring intraosseous ameloblastoma. However, PA is rarely associated with invasive or aggressive intraosseous lesions. PA originates from one of two sources: extraosseous remnants of the dental lamina, or the basal cell layer of the oral epithelium. We describe a patient with a PA and report the results of immunohistochemical studies of Ki-67 antigen using MIB-1 antibody.A 48-year-old man was referred to us because of a painless mass of 1 years' duration on the buccal gingival region of the lower left premolar. The mass, 1.0cm in diameter, was hemispherical, sessile, firm, and nontender. Radiographic examination showed no resorption of bone. The mass was clinically diagnosed to be an epulis and was excised under local anesthesia. The surface of the denuded bone was removed owing to the presence of a small depression with granulation tissue. Routine pathological examination demonstrated ameloblastoma of follicular type. Immunohistochemical examination showed that 21.5 % of the tumor cells were Ki-67 antigen positive. The results suggested that the tumor cells may have high growth potential. There has been no sign of recurrence for 2 years 6 months.

We report a rare case of congenital epulis with tooth-like hard tissue. The epulis was found on the palatal gingiva of a 1-year 5-month-old boy. It was a smooth, round mass with a pedicle that may have been connected to tooth-like hard tissue. The tumor was excised with the patient under general anesthesia. It consisted of fibrous connective tissue with rich vascularity. The histopathological diagnosis was fibrous epulis.

Kaposi's sarcoma is one of the most common diseases in patients with AIDS, but it is rare in Japan. We describe a case of oral Kaposi's sarcoma diagnosed as epulis on the basis of clinical and pathological findings. Chang (1994) reported that Kaposi's sarcoma is associated with human herpesvirus 8 (HHV-8). We confirmed the presence of HHV-8 in this case by the nested PCR method. Moreover, the oral Kaposi's sarcoma indicated that this patient had AIDS.

Eight tumors metastasizing to the oral cavity were clinically investigated. The frequency of metastatic oral tumors was 2.6% among all oral malignant tumors (307 cases) treated at our department from 1977 to 1998. Of the 8 patients, 2 were male and 6 were female. At presentation 3 patients had a medical history of treatment for cancer arising in other organs. Four patients had metastasis to the mandible, 3 had gingival metastasis, and 1 had metastasis to the tip of the tongue. Common symptoms of bone metastasis were swelling of the gingiva and alveolar mucosa and pain of the mandible. Gingival and lingual metastasis was associated with a nodular formation resembling epulis. Panoramic radiographs showed infiltrative bony destruction with ill-defined margins or a moth-eaten appearance in 4 cases of mandibular metastasis, and irregular destruction of the alveolar process was observed in 3 cases of gingival metastasis. Three cases were clinically diagnosed as oral cancer, 3 as metastatic tumor, 1 as epulis, and 1 as mandibular osteomyelitis or trigeminal neuralgia. The pathological diagnosis of biopsy specimens or removed tissues was adenocarcinoma in 3 cases, renal cell carcinoma in 1, hepatocellular carcinoma in 1, acinic cell carcinoma in 1, adeno-squamous cell carcinoma in 1, and adenocarcinoma or small cell carcinoma in 1. On the basis of pathological findings and systemic examinations, the primary site was the stomach in 3 cases, the lung in 2, the kidney in 2, and the liver in 1. Surgical removal was performed in 3 cases with gingival or lingual nodular formation, radiotherapy in 3 with mandibular metastasis, and chemotherapy in 1 with mandibular metastasis. One case was not treated after biopsy because the patient and his family refused. The outcome of the patients was very poor, with a mean survival time of 6 months. When treating metastatic oral tumors, the patient's quality of the life must be adequately considered.

Acinic cell carcinoma usually arises in the parotid gland and rarely occurs in the gingiva. We report a curious case of acinic cell carcinoma presenting as a caulescent lump in the left retromolar region of a 64-year-old woman, resulting in a clinically difficult diagnosis. The first clinicodiagnostic impression was epulis fibrosa or fibromatosa. After surgical excision of this lump, the histologic diagnosis was an acinic cell carcinoma. The clinical details of this case are discussed with related problems on the basis of the literature.

As we experienced a rare case of large epulis fibrosa osteoplastica which arose from the upper jaw of a 35 year-old male, we studied biologically and morphologically using this epulis.The tumor, 30×20×20 mm in size, located in the muco-gingival region of the bridge (765) and connected with a stalk to alveolar gingiva under the dummy of the bridge.Radiograph revealed radiopaque spots which indicated the existence of calcified substances.The tumor was surgically removed and investigated both morphologically and biochemically.The histopathological findings showed that there were immature woven bones surrounded by osteoblasts and prominant proliferation of fibrous connective tissue between epithelium and woven bones.Biochemical studies demonstrated that acid soluble calcium and phosphorus contents were relatively high corresponding with the region of bone formation. At this region alkaline phosphatase activity and inorganic phosphorus ion were also increased.These results suggest that the woven bones in epulis are calcified, and that both the increases of alkaline phosphatase activities and inorganic phosphorus ion contents may contribute to the onset of calcification.

Pyogenic granuloma occurs in the skin and the mucous membranes. The most characteristic features of the lesion are endothelial proliferation and formation of numerous vascular spaces. However criteria to differenciate the lesion from capillary hemangioma or epulis hemangiomatosa has never been established.We examined the histopathological, histochemical and immunohistochemical features in 5 cases of pyogenic granuloma, 6 cases of epulis hemangiomatosa and 2 cases of capillary hemangioma.1) Histopathological study by hematoxylin-eosin staining: In every cases of pyogenic granuoma and 2 out of 6 cases of epulis hemangiomatosa, ulcer formation and superficial inflammation were seen. Every cases of pyogenic granuloma and epulis hemangiomatosa revealed small lobules of proliferated endothelial cells with many vascular spaces in deeper portion of the tumor. These lobules were quite simillar to that of ordinary capillary hemangioma.2) Histochemical study by Ulex europaeus agglutinin I (UEA-I) lectin: UEA-I lectin has been known as the marker for endothelial cell of blood vessel. Endothelial cells in small lobules showed specific and strongly positive reaction to UEA-I lectin.3) Immunohistochemical study by Factor Via related antigen (F VI-RAG): Endothelial cells of lobules revealed no specific reaction to F Via-RAG.In conclusion, it is suggested that pyogenic granuloma and epulis hemangiomatosa are capillary hemangioma with granulation tissue induced by irritations such as repeated trauma or infection.

Epulis is generally classified histopathologically into several subtypes, e. g. epulis fibrosa, epulis granulomatosa, epulis fibromatosa, etc. among them epulis fibrosa and epulis granulomatosa are common in Japan, while epulis with a formation of hard tissue is relatively rare. A case of epulis fibro-osteomatosa cementoplastica is reported.The patient was a 32-year-old female who had noticed a small lump on the gingiva in the left mandibular molar region. Clinical examination revealed a mass of the thumb tip in size in the region between teeth numbered 35 and 37. Radiographic examination showed i cloudy irregular radioopacity in the mass region. The lesion was diagnosed clinically as epulis osteoplastica, and surgical operation was carried out under local anesthesia. On gross examination, the mass was mesured 19 × 13 × 11.5 mm and the/cross section showed a firm milky white mass with scattered areas of hard bony tissue. Histopathological examination was performed and the lesion was diagnosed as epulis fibro-osteomatosa cementoplastica.The postoperative course was uneventful and there is no evidence of recurrence after 6 years.

A case of gigantic epulis of the mandible with pillar-shaped bone formation is reported. The patient was a 37-years-old man. He complained of a slowly growing, painless, tumor protruding from the right molar region of the mandible to the maxilla. The color of the lesion was normal. On palpation, the lesion was elastic hard with an irregular surface, but had a bony hard base. There was bone resorption of the maxilla at regions in direct contact with the tumorous mass. Radiographically, pillar-shaped bone formation was observed in the lesion. The clinical diagnosis was epulis. The epulis was excised with the patient under NLA anesthesia. The excised specimen measured 30×45×40mm. The bone in the lesion was shaped like a pillar and adhered to the mandible. The histopathologic diagnosis was epulis osteoplastica.

We report a case of peripheral odontogenic fibroma arising in the mandible.A 26-year-old Japanese woman visited our hospital because of gingival swelling in the right premolar region of the mandible.The diagnosis was epulis, and the lesion was extracted. The pathological diagnosis was peripheral odontogenic fibroma. This may be the llth case reported in Japan.

Ameloblastoma, especially peripheral ameloblastoma, which arises in oral soft tissue and usually develops extraosseously, is a very rare odontogenic tumor. We describe a case of ameloblastoma that originated in the anterior mandible and persisted for 15 years. The case was in a 61-year-old man, who presented with a 22× 18× 10 mm tumor on the lingual surface of the anterior mandible. Radiographic examination revealed no intraosseous destruction of the mandible. The preoperative clinical diagnosis was an epulis, and the tumor was resected under local anesthesia. The resected tumor was histologically diagnosed to be a peripheral ameloblastoma. Histologically, cord-like or meshwork-like nests of tumor cells were observed below the epithelium. Distinct continuity was noted between the epithelium and the nests. Histologically, the tumor basically showed a plexiform pattern, but an acanthomatous pattern was also noted frequently. There have been no signs of relapse as of two years after operation.

We present a case of a relatively large epulis osteoplastica (epulis osteomatosa), suspected of being a malignant tumor on initial examination, in the mandibular molar region.The patient was a 26-year-old man with a painless mass in his left mandibular gingiva. He had first noticed the mass more than 10 years previously. On initial examination, an eggsized mass was found in the left lower molar region, and x-ray examination revealed calcification in the form of a radiopaque shadow. Various examinations, including biopsy, revealed no evidence of malignancy, and the mass was resected under general anesthesia. The lesion measured 65×50×45mm. Histopathologic examination revealed fairly calcified, chondroid tissue and irregular bone tissue in the mass, and lamination was found at its base. On the basis of these three findings, a diagnosis of epulis osteoplastica (epulis osteomatosa) was made.

The hard laser is now widely used in the oral and maxillofacial region because itshemostatic ability and imploved visualization of the operative field facilitate a presice op-eration. Another important advantage of the hard laser is that some operations can be donewithout anesthesia. In this paper, six cases of epulis excised by the hard laser without anes-thesiaare presented.A CO2 laser (one type of hard laser) was used with a continuous wave, power setting of 2 to 4 watts. All lesions could be excised completely, and no patients felt pain during laserirradiation. The operation was successful without using surgical packs, and there was nopostoperative discomfort. There has been no evidence of recurrence after operation.

An extremely enlarged epulis is reported. The patient was a 37-year old female. She complained of a slowly growing painless tumor on the left side of the upper jaw. This tumor was excised under general anesthesia and measured 80×85×45mm. The histopathologic features indicated epulis fibrosa.

A pathological analysis of 18 cases with pregnancy epulis were performed. Most of the tumors appeared at latter half of pregnant period, and gradually increased in size before delivery. It was thought that pregnancy epulis had a tendency to reverse its growth after delivery, but a few cases did not show size regression. The tumor arose most frequently in the anterior region of the maxilla.Histologically, vascular component predominated in 11 cases, fibrous component predominated in 5 cases, and granulation tissue predominated in 2 cases. Of these, the cases which were excised at latter half of pregnant period were chiefly composed of vascular component. The cases which were excised after delivery showed an increase in the fibrous component.In the epulis of nonpregnant women and men in the same generation, the most frequent cases were histologically prominent fibrous components.

A rare case of congenital epulis with natal tooth in a 6-month-old girl is presented. The lesion was excised under general anesthesia. Histological examination revealed that the tooth had scanty root formation and was directly connected to the soft tissue without periodontal membrane. The epulis consisted of fibrous connective tissue covered by layers of stratified squamous epithelium. According to these findings, it was considered that the epulis was formed by the response to irritation of the natal tooth as a result of the upward transposition of germs.

Peripheral giant cell granuloma, also called giant cell epulis, is a disease characterized by the appearance of many giant cells exclusively in the oral soft tissues. This lesion has been the subject of frequent research by many authors. So far, however, the origin of giant cells has not been elucidated.A case of peripheral giant cell granuloma is reported. The patient was a 69-year-old woman who complained of tumor formation at gingiva of maxilla under a clinical diagnosis of epulis. The tumor was resected with alveolar bone under local anesthesia.By light microscopic findings, the surface of the tumor was covered with mucous menbrance and many giant cells were seen in the central area of the tumor reguly.With the electron microscope the giant cell had many mitochondoria and r-ER in cytoplasm. The mononuclear cells have high electron dense granules in cytoplasm and these cells resemble macropharges.

Lipoma is a benign tumor derived from nonepithelial origin and may occur almost anywhere on the body. In the oral cavity, however, lipoma is a relatively rare tumor.In this report, 30 cases of lipomas treated in our department during past 24 years are reviewed.1) The incidence of lipoma in our department is 4.1% of all benign tumor. Salivary gland tumors and epulis are excluded in this report.2) 16 patients were male and 14 female.3) Age ranged from 47-day-old baby to an 82-year-old man; mean age was 47.9 years.4) 11 cases were in the buccal mucosa, 4 in the mucogingival junction, 3 in the retromolar pad, 3 in the tongue, etc.5) Tumor size ranged fron 5×5mm to 50×50×40mm in the oral cavity, and from 25×25mm to 80×50mm out of the oral cavity.6) 24 tumors were histologically diagnosed as lipoma, 5 as fibrolipoma, and 1 as angiomyolipoma.

A 51-year-old female noted the tumor, arising from the 167 region of alveolar ridge around November 1982.The tumor gradually increased in size, and the patient was referred to our department in November 1983. Two epulises bad elastic hard, smooth, surfaces.In the orall cavity, two large tumors, pyorrhoer alveolaire, dental calculus were found.Radiographic examination revealed a horizontally absorption over the alveolus dentalis. Tomographic examination revealed lower radiolucency in the left maxillary sinus than in the right.Under local anethsethia, these epulises were extirpated and extracted3/2-8 8543/8.Pathologically, the surface of the epulis is covered by squamous epithelium with frequent and irregular elongation of rete ridges. Subepithelial tissue is loosely or densely fibrous and rich in vasculatures.Postoperative, inflammation in the maxillary sinus disappeared.

Statistical analysis was made on 1, 341 biopsy specimens from patients treated in our department during the last five years. Seven hundred and eleven patients were males and 630 were females. Mean age of the series was 42.1 years. Cystic lesions were most frequently seen in this series and 388 out of 526 cystic lesions were odontogenic origin. Inflammatory lesions were seen in 281 patients. Of the 285 cases of tumors, 142 were malignant, 61 were odontogenic and 82 were benign tumors of non-odontogenic origin. Other lesions found in this series were leukoplakia (58 cases), epulis (60 cases), polyp (86 cases), ulcer (10 cases), etc.

This study is based on an analysis of biopsy specimens that were diagnosed histopathologically in the Department of Oral Pathology, Tokushima University School of Dentistry from 1979 to 1983. This paper is presented with special reference to the oral mucosal lesions and other lesions except tumorous and cystic lesions in this series.1. The total number of cases related to oral mucosal lesions during these five years were 160, that is, 12.8% of all cases.2. The most common lesion of the oral mucosa was epithelial dysplasia (47 cases), followed by fibrous polyp (43 cases) and denture fibrosis (14 cases).3. The epithelial dysplasia was found in the older age group and most frequent site was the gingiva, followed by the tongue and buccal mucosa.4. The most common lesion except tumorous, cystic and mucosal lesions was radicular granuloma (43 cases) followed by epulis (38 cases).5. Radicular granuloma was found in anyage and the most common site was the gingiva of maxilla. Microscopically, cases of 30.2 per cent contained epithelium within the granuloma.6. The epulis was observed in anyage and more frequent in the maxilla. Microscopically, cases of 60.5 per cent were epulis granulomatosa and fibrosa.

Pathological analysis of 50 cases of the epulis with hard tissue formation was performed. The results were as follows:1. Females were affected more frequently than males; the ratio was 2.3:1 (female: 35 cases; male: 15 cases).2. The lesion was more common in the third and sixth decades of age, and the mean age was 37.3 years.3. No predilection was found for the location of the epulis, compared with other nonhard-tissue forming types of the epulis which frequently developed in the front tooth area.4. Size of the lesion was most often between 1 and 2 cm in diameter.5. The cases were classified hard tissues into histologically 4 types by i. e. 35 cases of bonelike tissue, 10 cases of mixture of bone-and cementum-like tissues, 2 cases of cementum-like tissue, and 3 cases of dystrophic calcification alone.6. Hard tissue of all male cases showed bone-like structure. On the other hand, cementumlike tissue was found in female cases only.

A case of peripheral ossifying fibroma that occurred in 17-year-old girl is presented here along with the findings of a histopathological examination. Four tumors, consisting of two larger and two smaller masses, were detected in the maxillary and mandibular alveolar bones. The larger masses were diagnosed as ossifying fibromas and the smaller ones as fibromas with no apparent calcification. The presented case, having four tumors of two different histological types, hinted at the hypothesis that transformation could occur from fibroma to ossifying fibroma. Discussion was focused in this paper to the criteria for differential diagnosis between epulis osteoplastica, cemmentifying fibroma, monostotic fibrous dysplasia, and ossifying fibroma.

A case of epulis fibro-osteoplastica. Although epulis is a phyma of relatively high incidence in the oral mucosa, less reports an epulis with bone formation in fibrous tissues have been so far available. We recently experienced a case of epulis fibro-osteoplatica and the clinical couse is described in this paper. A 45 year old female noticed a swelling of the palate of the maxillary incisors around April, 1981. Under the diagnosis of palatal tumor, an incision was given, resulted in a temporal reduction in the tumor size. However, the tumor gradually increased in size on and after October and the patient was then referred to our department.The phyma was perdiculated having the base in the palate at 3|2 portion and the elastic hard, smooth surface without tenderness. The surrounding mucosa was normal. The tumor including its surrounding mucosa was removed and alveolar rearrangement was performed followed by a tentative suture and closure. The size of tumor thus extirpated was 25×15×12 mm, and the cut surface was grayish white, solid and elastic hard with many hard tissues.Pathologically, irregularly shaped bone formation was noted among many proliferated fibrous tissues suggestive epulis fibro-osteoplastica. The prognosis is evenful without any tendency of relapse as of 2 years lapsed after operation.

Case reports of giant cell epulis are rare in Japan. A case of this lesion is reported with clinical studies of epulis in our department.A 74 year old woman was admitted to our department because of a lesion in the right maxilla. The tumor was resected with alveolar bone under a clinical diagnosis of epulis.Microscopic findings: The surface of the tumor wa. covered with mucoustnembrane and connective tissue which separated the epithelium from the giant cell lesion. The central area of the tumor was occupied by short spindle cells and giant cells were seen regularly.From 1972 to 1981, 61 cases of epulis were examined histolgoically in our department. Granulomatous epulis appeard most frequently (39%) and there was 1 case (1.6%) of giant cell epulis.

Giant cellular lesions are characterized by the presence of multinuclear cells, and those known to develop in the intramaxillary regions include giant cytoma, giant cellular granuloma, brown tumor, Cherubism, etc.Modifiable giant cellular granuloma that were advanced by Jaffe (1953) have been treated as giant cellular epulis or giant cellular granuloma, which develops in a perimaxillary region, and central giant cellular granuloma which develops in an intramaxillary region.As we experienced suspected the central giant cellular modifiable granuloma in a 6.7-year old boy that developed in the bilateral mandibular molar regions, we report our pathological findings in addition to some discussions on the published literatures.The diagnosis in this patient was established as central giant cellular modifiable granuloma, although the symptoms initially suspected as Cherubism were neither clinically nor genetically confirmed.

The term “epulis” has been used as a clinical name for the benign circumscribed tumor originating in the gingiva. Recently, we experienced one case of relatively large epulis.A 15-year-old girl, who complained of a mass in the molar region of the right mandible, was referred to our clinic.Examination revealed a egg-sized pedunculated tumor in the lingual gingiva of the second molar of the right mandible. The mass was removed with a portion of the periosteum and the gingiva under local anesthesia. The histopathological diagnosis was epulis fibrosa. No evidence of recurrence has been observed until now.