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Background/PurposeOral giant cell fibromas (GCFs) are found predominantly in Caucasians and rarely in other races. This retrospective study evaluated the clinicopathological features of 24 GCFs in Taiwanese patients.MethodsTwenty-four consecutive cases of oral GCF were investigated from 1987 to 2008. Clinical data and microscopic features were reviewed and analyzed.ResultsThe mean age of patients at the time of diagnosis was 29 years. Oral GCF occurred more commonly in patients between 11 and 40 years of age. There were 12 male and 12 female patients. The lesions were found more frequently on the tongue (8 cases) and gingiva (7 cases). The mean size of the lesion was 5.5 mm (range, 2–10 mm) in greatest dimension. GCF is misdiagnosed frequently as fibroma (19 cases) or papilloma (5 cases). All tumors were treated by total surgical excision and no recurrence was found after treatment. Microscopically, the GCF was a sessile or pedunculated mass covered with a thin layer of parakeratinized or orthokeratinized stratified squamous epithelium. The tumor was composed mainly of loose or dense fibrous connective tissue with well-formed capillaries and no inflammation. The consistent and diagnostic feature was the presence of large stellate giant cells, usually with one or two nuclei. Multinucleated giant cells were seen occasionally. These giant cells were most numerous in the connective tissue just beneath the epithelium.ConclusionOral GCFs show no significant sex predilection and occur in patients in the second to fourth decades of life. Usually, the lesions are < 1 cm in diameter and are found more frequently on the tongue and gingiva. GCF resembles fibroma or papilloma and is difficult to diagnose correctly at the first glance. All GCFs can be treated by conservative surgical excision without subsequent recurrence.

Background/Purpose: Odontogenic keratocysts (OKCs) are more aggressive and more osteolytic lesions than dentigerous cysts (DCs) and radicular cysts (RCs). Osteopontin (OPN) is related to cancer metastasis and bone destruction. Binding of OPN to its cell membrane receptors integrin α(subscript v) and CD44v6 can enhance tumor cell motility, migration, invasion and spread. This study assessed the possible contribution of OPN, integrin α(subscript v) and CD44v6 to the local aggressive behavior and osteolytic ability of OKCs. Methods: We used an immunohistochemical method to examine the expression of OPN, integrin α(subscript v) and CD44v6 in tissue sections of 20 OKCs, eight DCs and 10 RCs. Results: We found strong cytoplasmic OPN immunostaining in lining epithelial cells of 8 of 20 OKCs but not in any DCs and RCs. Positive OPN staining was also noted in the subepithelial connective tissue of four OKCs with intraepithelial expression of OPN. Diffuse and strong membranous integrin α(subscript v) staining was discovered in osteoclasts in all our tissue sections and in nearly all lining epithelial cells of DCs and RCs, but not in OKCs. In addition, diffuse and strong membranous CD44v6 staining was also observed in nearly all lining epithelial cells of OKCs, DCs and RCs. Conclusion: Binding of OPN to osteoclast cell membrane receptor integrin α(subscript v) can activate the osteoclasts and increase their osteolytic activity. In addition, binding of OPN to OKC lining epithelial cell membrane receptor CD44v6 can enhance the motility, migration, invasion and spread of lining epithelial cells into the surrounding cancellous bone. Therefore, we suggest that the local aggressive behavior and high osteolytic ability of OKCs in the jawbone can be explained at least partially by high expression of OPN and CD44v6 in lining epithelial cells of OKCs and high expression of integrin α(subscript v) in osteoclasts.

Background/Purpose Central ossifying fibroma (COF) is the most common benign fibro-osseous lesion of the jaw. This retrospective study evaluated the clinical and histopathologic features of 28 COFs in Taiwanese patients. Methods Twenty-eight consecutive cases of COF were collected from 1988 to 2006. The clinical data and microscopic features of these cases were reviewed and analyzed. Results The mean age of patients at the time of diagnosis was 34 years. There were six male and 22 female patients. Twenty-six (93%) cases were found in the mandible and two (7%) in the maxilla. The most common sites for COFs were the molar region (17 cases, 61%), followed by the premolar (8 cases, 28%), and incisor/canine (3 cases, 11%) regions. Bone swelling or expansion (96%, 26/27) was the most frequent clinical presentation. Six (21%) COFs presented as a radiolucent lesion, 17 (61%) as a mixed lesion, and five (18%) as a radio-opaque lesion. No recurrence of the lesion was found after surgical excision in this series. Microscopically, COFs showed trabeculae of woven bone (25 cases) and/or lamellar bone (5 cases) and/or spherules of cementoid (19 cases) in a cellular fibrous connective tissue stroma. The stromal component was highly cellular in 21 cases, moderately cellular in seven cases, prominently vascular in 11, and collagenous in six. Conclusion COFs occur more frequently in female patients and in those in the second to fourth decades of life. The most commonly affected site is the mandible, especially the molar region. The majority of COF lesions present as a well-defined, mixed lesion radiographically. Most COFs can be treated by conservative surgical excision without subsequent recurrence.

Recombinant viruses were constructed to have an Escherichia coli replicon containing a mutagenesis marker, the supF gene, integrated within the thymidine kinase locus ( tk ) of herpes simplex virus type 1. These viruses expressed either wild-type or mutant DNA polymerase (Pol) and were tested in a mutagenesis assay for the fidelity of their replication of the supF gene. A mutation frequency of approximately 10 −4 was observed for wild-type strain KOS-derived recombinants in their replication of the supF gene. However, recombinants derived from the PAA r 5 Pol mutant, which has been demonstrated to have an antimutator phenotype in replicating the tk gene, had three- to fourfold increases in supF mutation frequency ( P < 0.01), a result similar to that exhibited when the supF gene was induced to replicate as episomal DNA (Y. T. Hwang, B.-Y. Liu, C.-Y. Hong, E. J. Shillitoe, and C. B. C. Hwang, J. Virol. 73:5326-5332, 1999). Thus, the PAA r 5 Pol mutant had an antimutator function in replicating the tk gene and was less accurate in replicating the supF gene than was the wild-type strain. The spectra of mutations and distributions of substituted bases within the supF genes that replicated as genomic DNA were different from those in the genes that replicated as episomal DNA. Therefore, the differences in sequence contents between the two target genes influenced the accuracy of the Pol during viral replication. Furthermore, the replication mode of the target gene also affected the mutational spectrum.

Estrogens modulate the catabolic effects of PTH on bone in vivo and in vitro. PTH-stimulated cAMP accumulation in osteoblasts is thought to be linked to increased osteoclastic activity, but the precise mechanism is still unknown. In cocultures of clonal marrow stromal cells (MS1) and normal mouse spleen cells, both 1,25-dihydroxyvitamin D3 and rat PTH (rPTH)-(1-34) can induce the formation of tartrate-resistant acid phosphatase- and calcitonin receptor-positive multinucleated osteoclast-like cells, which can attach to dentine slices and produce resorption pits. In this system, osteoclastogenesis stimulated by PTH, but not by 1,25-dihydroxyvitamin D3, was suppressed by 17beta-E2 (10(-10)-10(-8) M), whereas 17alpha-E2 (10(-8) M) had no effect. Exposure to 10(-8) M 17beta-E2, but not 17alpha-E2, also significantly decreased the PTH-induced attachment of osteoclast-like cells to dentine slices. 17beta-E2 inhibited osteoclast-like cell formation induced by 8-bromo-cAMP (10(-4) M), 12-O-tetradecanoylphorbol 13-acetate (10(-8) M), or rat PTH-(1-34) (10(-7) M) in combination with either rp-adenosine-3',5'-cyclic monophosphorothioate (10(-4) M) or 1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride (10(-5) M). 17beta-E2 suppressed the partial stimulation of tartrate-resistant acid phosphatase-positive multinucleated osteoclast-like cell formation induced by [Arg(2)]human (h) PTH-(1-34) (10(-7) M) or hPTH-(3-34) (10(-7) M), but not that caused by 10(-7) M hPTH-(53-84). We conclude that estrogens suppress PTH-stimulated osteoclast-like cell formation by blocking both the cAMP-dependent PKA pathway and the PLC-coupled calcium/PKC pathway. In addition to inhibiting formation of osteoclasts and promoting their apoptosis, estrogen may regulate bone resorption by blocking attachment of osteoclasts to bone.

A mutagenesis system was developed for the in vivo study of the fidelity of DNA replication mediated by wild-type herpes simplex virus type 1 (HSV-1) strain KOS and its polymerase (Pol) mutant derivatives PAA r 5, Y7, and YD12. The pHOS1 shuttle plasmid, which contained the SupF mutagenesis marker gene and the HSV ori s sequence, was used for analysis of the mutation frequency and the mutation spectrum. All three Pol mutants induced significant increases in the mutation frequencies of the target gene, despite the fact that PAA r 5 was previously shown to have an antimutator phenotype by the thymidine kinase mutagenesis assay (J. D. Hall, D. M. Coen, B. L. Fisher, M. Weisslitz, S. Randall, R. E. Almy, P. Gelep, and P. A. Schaffer, Virology 132:26–37, 1984; C. B. C. Hwang and J.-H. Chen, Gene 152:191–193, 1995). Altered spectra of mutated target genes induced by these three mutants were also observed. The relative frequencies of both deletion and complex mutations found in mutants induced by exonuclease-proficient Pols were significantly higher than those induced by exonuclease-deficient Pols. On the other hand, the exonuclease-deficient Pols induced significant increases in the frequency of base substitutions, which comprised predominantly G · C-to-T · A transversions, as well as mutations at additional hot spots. These results suggest that the HSV-1 DNA Pol can incorporate purine-purine or pyrimidine-pyrimidine mispaired bases which may be preferentially proofread by its intrinsic exonuclease activity. Furthermore, the effects of the sequence context of the target gene and the assay method should also be considered carefully in any analysis of replication fidelity.

Background/purpose Oral verruciform xanthoma (VX) is an uncommon oral mucosal lesion. This retrospective study evaluated the clinical and histopathologic features of 15 oral VXs occurring in Taiwanese patients. Methods Fifteen consecutive cases of oral VX were collected from January 1988 to December 2005. Clinical data and microscopic features of these cases were reviewed and analyzed. Results The mean age of patients was 45 years (range, 18-79 years). There were eight male and seven female patients. Seven (46.6%) cases occurred on the gingiva, four (26.7%) on the tongue, and four (26.7%) on the buccal or vestibular mucosa. The greatest mean dimension of the lesions was 0.8 cm (range, 0.3-2.0 cm). Three patients had concomitant other oral mucosal lesions such as oral submucous fibrosis, squamous cell carcinoma, and erosive oral lichen planus. Microscopically, all specimens showed varying degrees of surface parakeratosis and the accumulation of numerous foam cells in the connective tissue papillae among uniformly elongated epithelial ridges. Individuals or aggregates of foam cells were also found underneath the epithelial ridges in nine (60%) cases. When the oral VX lesions were further classified into three types according to the microscopic surface architecture, seven (47%) lesions were of the verrucous type, three (20%) the papillary type, and five (33%) the flat type. All patients received surgical excision of the lesions and no recurrence was noted during follow-up of up to 18 years. Conclusion Oral VXs occur more frequently in the fifth decade of life. The more commonly affected site is the gingiva. The treatment of choice for oral VXs is surgical excision. The prognosis is excellent and recurrence was not seen in this study. [ J Formos Med Assoc 2007;106(2):141-147]

Odontoma is the most common odontogenic tumor. It includes 2 types, the compound and complex odontomas. There has not been a series study of the clinical and histologic features of odontomas from Taiwan. This study evaluated the clinicopathologic features of odontoma in Taiwanese.Cases of odontoma treated from 1998 to 2002 identified from medical records were included. The microscopic features, radiographic features, and clinical history of the patients were reviewed and analyzed.A total of 81 odontomas in 81 patients (36 males and 45 females) were included. There were 62 compound and 19 complex odontomas. The mean age of the patients was 18 years with the majority of odontomas occurring in the first (32%) and second decade (38%) of life. Odontomas had a marked predilection for the maxilla (70%) and for the anterior region of the jaw (83%), particularly for the anterior maxilla (62%). Sixty four (79%) of the 81 odontomas were associated with 80 impacted teeth, including 71 permanent teeth, 2 deciduous teeth, and 7 supernumerary teeth. Of the 71 impacted permanent teeth, the maxillary central incisor (27%) was most commonly affected, followed by the maxillary canine (26%) and mandibular canine (24%). Histologic examination revealed enamel matrix in 90%, dentin in 100%, cementum in 88%, pulp tissue in 96%, fibrous capsule in 93%, ghost cells in 83%, reduced enamel epithelium in 86%, and nests of odontogenic epithelium in 58% of odontomas. Dentigerous cyst was associated with 9% of odontomas.In this series, odontomas occurred most often in the first and second decade of life. Although complex odontomas are usually found in the posterior jaw, in this Taiwanese series they were most commonly found in the anterior maxilla. Odontoma is frequently associated with an impacted tooth and occasionally with a dentigerous cyst. No recurrence of odontomas was found after surgical excision with follow-up of 1 to 15 years.

Calcifying odontogenic cyst (COC) is a rare type of odontogenic cyst. This retrospective study analyzed the clinical, radiographic, and histopathologic features of COC in Taiwanese.Ten cases of COC in 2 male and 8 female patients with a mean age of 29 years (range, 11 to 48 years) treated from January 1985 to December 2002 were included. Microscopic slides, clinical histories, and radiographic features of these 10 COC cases were reviewed and analyzed.COCs occurred in the maxilla in 3 cases and in the mandible in 7 cases. COCs were associated with impacted teeth in 6 cases and with odontomas in 3 cases. All COCs appeared as either unilocular (9 cases) or multilocular (1 case) radiolucencies. In 7 cases, spotty radiopaque materials were scattered throughout the radiolucency. Histologically, all of the lesions were at least partially lined by epithelium with cuboidal to columnar basal cells and stellate reticulum-like suprabasal cells. Variable numbers of ghost cells, some of which were calcified, were observed in the lining epithelium or in the fibrous connective tissue wall of all 10 cases. Juxta-epithelial dentinoid was also found in all cases. However, proliferation of ameloblastoma-like tumor nests was observed in only 1 case. Based on the above histologic findings, 6 COC lesions were classified as simple unicystic type, 3 as unicystic odontoma-producing type, and 1 as unicystic ameloblastomatous proliferating type.COC occurs frequently in the second and third decades and is commonly associated with an impacted tooth or an odontoma. It usually appears as a mixed radiolucent and radiopaque lesion radiographically. Simple unicystic type is the most common type of COC. No recurrences were found after conservative surgical removal in this series.

During skeletal development and bone remodeling, bone marrow stromal cells give rise to osteoblasts and provide a critical microenvironment to support osteoclast formation. Estrogen is important for the maintenance of bone balance in adult animals by either increasing bone mass or inhibiting osteoclastic bone resorption. This study sought to determine the role that estrogen plays in coordinating osteogenic differentiation of bone marrow stromal cells and the ability of these cells to support osteoclast formation.A conditionally immortalized mouse bone marrow stromal cell line, MS1, was used to examine the effects of estrogen on stromal cell differentiation and on stromal cell-supported osteoclast formation.On treatment of MS1 cells with 17 beta-estradiol (E2) (10(-12)-10(-8) M), alkaline phosphatase activity and bone nodule formation were increased in a dose-dependent manner, while the proliferation of MS1 cells was dose-dependently inhibited. 17 beta-E2 (10(-12)-10(-8) M) also caused a concentration-dependent inhibition of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cell (MNC) formation in parathyroid hormone (PTH)-stimulated MS1 and spleen cell cocultures. Furthermore, estrogen pretreatment of MS1 cells also decreased the number of TRAP-positive MNCs in cocultures. Culturing in PTH-treated conditioned media did not rescue the loss of activity supporting osteoclast-like cell formation in MS1 cells.These results indicate that 17 beta-E2-stimulated osteoblastic differentiation of mouse marrow stromal cells results in bone matrix mineralization and a decrease in activity of supporting PTH-induced osteoclast-like cell formation.

Type-1 PTH/PTH-related peptide receptors (PTH1Rs), which activate both adenylyl cyclase and phospholipase C (PLC), control endochondral bone development by regulating chondrocyte differentiation. To directly analyze PTH1R function in such cells, we isolated conditionally transformed clonal chondrocytic cell lines from tibial growth plates of neonatal mice heterozygous for PTH1R gene ablation. Among 104 cell lines isolated, messenger RNAs for PTH1R, collagen II, and collagen X were detected in 28%, 90%, and 29%, respectively. These cell lines were morphologically diverse. Some appeared large, rounded, and enveloped by abundant extracellular matrix; whereas others were smaller, flattened, and elongated. Two PTH1R-expressing clones showed similar PTH1R binding and cAMP responsiveness to PTH and PTH-related peptide but disparate morphologic features, characteristic of hypertrophic (hC1--5) or nonhypertrophic (nhC2--27) chondrocytes, respectively. hC1--5 cells expressed messenger RNAs for collagen II and X, alkaline phosphatase (ALP), and matrix GLA protein, whereas nhC2--27 cells expressed collagen II and Indian hedgehog but not collagen X or ALP. In hC1--5 cells, PTH and cAMP analog, but not phorbol ester, inhibited both ALP and mineralization. PTH1R-null hC1--5 subclones were isolated by in vitro selection and then reconstituted by stable transfection with wild-type PTH1Rs or mutant (DSEL) PTH1Rs defective in PLC activation. ALP and mineralization were inhibited similarly via both forms of the receptor. These results indicate that PLC activation is not required for PTH1R regulation of mineralization or ALP in hypertrophic chondrocytes and are consistent with a major role for cAMP in regulating differentiation of hypertrophic chondrocytes.