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This study evaluates the impact of depth of invasion (DOI) on local recurrence (LR) in node-negative oral tongue squamous cell carcinoma (SCC).Fifty-one patients were retrospectively reviewed from an institutional database. Patients were evaluated for local control (LC). Cox-proportional hazards modeling was used to calculate hazard ratios.There were 84.3% T1/2 and 15.7% T3/4 classification tumors. The 3-year overall survival rate was 97.9%. Local failure rate was 5.7% with a 3-year LC of 93.6%. On Univariate analysis, increased hazard of LR was noted with each unit increase in DOI (HR 1.40, 95% CI 1.07-1.83, p = 0.014). Age, sex, T classification, margins ≥5 mm, lymphovascular invasion (LVI) and perineural invasion (PNI), and adjuvant treatment were not associated with LR. On Multivariate analysis, adjusting for age and adjuvant treatment, results for DOI remained significant (aHR 1.46, 95% CI 1.08-1.98, p = 0.013).On evaluation of our institutional dataset increasing DOI was associated with increased hazard of local recurrence with oral tongue SCC.

Objective We report the first 4 cases of intraoral nonnecrotizing granulomatous foreign body reactions to diatoms, plausibly as a result of exogenous material introduced following iatrogenic or traumatic injury. Study Design Clinical and histopathologic findings of 4 intraoral cases of nonnecrotizing granulomatous foreign body reaction to diatoms, single-celled algae belonging to the taxonomic phylum Bacillariophyta, are reported. Results The lesions presented either in the jaws or in the soft tissue overlying the alveolar bone, in some instances mimicking an inflammatory lesion of odontogenic etiology. Microscopically, the lesions presented as nonnecrotizing granulomatous inflammation associated with either spherical and radially symmetric or rectangular and bilaterally symmetric diatomaceous foreign material. Conclusion The diagnosis of a diatom-associated foreign body reaction necessitates familiarization with the histopathologic features of these organisms to accurately characterize the nature of such lesions.

Meningiomas are common benign neoplasms developing within the central nervous system and arise from the meningothelial cells. Extracranial (ectopic) meningiomas are rare and may represent an extracranial extension of an intracranial meningioma or distant metastasis from a primary intracranial meningioma, or they may originate from arachnoid cells in the sheaths of the cranial nerves that are exiting the skull through the foramina or sutures. Ectopic meningiomas can also arise as true primary extracranial meningiomas originating from ectopic arachnoid lining cells or multipotential mesenchymal cells. Primary extracranial meningiomas occurring in the jaws are extremely rare, with only 11 reported cases (2 cases in the maxilla and 9 cases in the mandible) in the literature. The infrequent occurrence of this entity presenting in this unusual location of the jaws often poses a diagnostic challenge to the oral pathologist, resulting in misdiagnosis. We present the 10th mandibular case of extracranial meningioma involving the right side of the mandible in a 56-year-old female patient. The clinical and radiographic presentation, histopathologic features, and histopathologic differential and immunohistochemical findings of this case are presented. The proposed pathogenesis, treatment options, and prognosis are also discussed along with a review of the literature.

We report 7 cases of hitherto undescribed keratotic papillary plaques of uncertain etiology involving the gingiva. All 7 cases presented on the anterior maxillary attached gingiva of patients in the second decade. The lesions were asymptomatic and 86% (6 of 7 cases) presented in a bilateral symmetric distribution. Microscopically, the lesions exhibited parakeratosis and papillary acanthosis with parakeratin-filled crypts. No specific etiology such as a factitial habit or a common exogenous agent has been identified. The possibility of a developmental etiology such as an oral epithelial nevus cannot be entirely excluded. We propose the descriptive term idiopathic gingival papillokeratosis with crypt formation (IGPC) for this condition.

Perineural invasion (PNI) is a tropism of tumor cells for nerve bundles located in the surrounding stroma. It is a pathological feature observed in certain tumors, referred to as neurotropic malignancies, that severely limits the ability to establish local control of disease and results in pain, recurrent growth, and distant metastases. Despite the importance of PNI as a prognostic indicator, its biological mechanisms are poorly understood. The semaphorins and their receptors, the plexins, compose a family of proteins originally shown to be important in nerve cell adhesion, axon migration, and proper central nervous system development. Emerging evidence has demonstrated that these factors are expressed in tissues outside of the nervous system and represent a widespread signal transduction system that is involved in the regulation of motility and adhesion in different cell types. We believe that the plexins and semaphorins, which are strongly expressed in both axons and many carcinomas, play a role in PNI. In this study, we show that plexin-B1 is overexpressed in tissues and cell lines from neurotropic malignancies and is attracted to nerves that express its ligand, semaphorin 4D, in a Rho/Rho kinase-dependent manner. We also demonstrate that nerves are attracted to tumors through this same system of proteins, suggesting that both plexin-B1 and semaphorin 4D are important in the promotion of PNI.

Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm that has been associated with oncogenic osteomalacia. This tumor secretes fibroblast growth factor-23 (FGF-23). Although other mesenchymal tumors can cause oncogenic osteomalacia, PMT is the most common mesenchymal neoplasm associated with oncogenic osteomalacia and accounts for 80% of such cases. Most patients are adults and the tumor can affect both men and women. The most common location for the tumor is the lower extremities followed by the head and neck area. Patients typically present with diffuse bone pain, bone fractures, and progressive muscle weakness. The laboratory studies usually reveal increased levels of FGF-23, hyperphosphaturia, increased alkaline phosphatase, normal serum calcium and parathyroid hormone levels, normal to low levels of 1,25-dihydroxyvitamin D and hypophosphatemia. The four common phosphaturic mesenchymal tumor microscopic subtypes are: phosphaturic mesenchymal tumor mixed connective tissue variant (PMTMCT), osteoblastoma-like variant, ossifying fibroma-like variant, and non-ossifying fibroma-like variant. The small size of this slow growing tumor and the non-specific clinical presentation may present a diagnostic challenge to clinicians. We present a case of a 48-year-old Haitian male who was diagnosed with PMT in the right angle of the mandible. Fewer than 15 cases of PMT presenting in the oral cavity have been reported in the literature. The clinical presentation, the laboratory findings, imaging characteristics, and the histopathologic features for this case are discussed along with the molecular genetic aspects, treatment and prognosis for this rare neoplasm.

Perineural invasion (PNI) is a tropism of tumor cells for nerve bundles located in the surrounding stroma. It is a pathological feature observed in certain tumors, referred to as neurotropic malignancies, that severely limits the ability to establish local control of disease and results in pain, recurrent growth, and distant metastases. Despite the importance of PNI as a prognostic indicator, its biological mechanisms are poorly understood. The semaphorins and their receptors, the plexins, compose a family of proteins originally shown to be important in nerve cell adhesion, axon migration, and proper central nervous system development. Emerging evidence has demonstrated that these factors are expressed in tissues outside of the nervous system and represent a widespread signal transduction system that is involved in the regulation of motility and adhesion in different cell types. We believe that the plexins and semaphorins, which are strongly expressed in both axons and many carcinomas, play a role in PNI. In this study, we show that plexin-B1 is overexpressed in tissues and cell lines from neurotropic malignancies and is attracted to nerves that express its ligand, semaphorin 4D, in a Rho/Rho kinase-dependent manner. We also demonstrate that nerves are attracted to tumors through this same system of proteins, suggesting that both plexin-B1 and semaphorin 4D are important in the promotion of PNI.

Sialolithiasis is one of the most common pathologies of the submandibular gland; sialoliths account for about 80 percent of all salivary duct calculi. This report presents the unusual case of a large asymptomatic sialolith of the submandibular duct, initially diagnosed as a possible tumor. The giant sialolith was removed via an intraoral approach under local anesthesia. The etiology, pathogenesis, and management of such giant sialoliths are discussed.