ORAL CAVITY

Malacoplakia of the tongue: a case report and clinicopathologic review of 6 cases.

Diapera MJ, Lozon CL, Thompson LD.

Am J Otolaryngol. 2009 Mar-Apr;30(2):101-5. Epub 2008 Jul 22.

BACKGROUND: Extra-urogenital tract malacoplakia is uncommon, with tongue malacoplakia being exceptionally rare. The nonspecific clinical presentation and variable histologic patterns can make recognition of this lesion and separation from other lesions challenging. There are only a few reported cases in the English literature.

MATERIALS AND METHODS: Five case reports of tongue malacoplakia were compiled from the literature (MedLine 1960-2008) and integrated with this case report.

RESULTS: The patients included 4 males and 2 females, ranging in age from 9 to 98 years (mean, 64 years). Patients presented with difficulty swallowing, foreign body sensation, a mass lesion, or referred pain (neck or ear). Symptoms were present from a few days up to 18 months. The base of the tongue was the most frequent site, although midline tongue and half of the tongue were also affected. Radiographic studies demonstrated a mass, with a single lesion showing positron emission tomography positivity. Two patients had previous cancers (prostate and colorectal; larynx). This case report was a farm hand for horses, with gram-negative rods, suggestive of Rhodococcus equi identified. The lesions were 1 to 2 cm in greatest dimension. Histologically, there is pseudoepitheliomatous hyperplasia or ulceration with a heavy acute and chronic inflammatory infiltrate. The subepithelial spaces are completely filled with eosinophilic histiocytes, most of which contain granular material in their cytoplasm. Well-formed, blue, calcific bodies are noted, a few showing a "targetoid appearance" and concentric lamination. These Michaelis-Gutmann bodies are positive with von Kossa, iron, and periodic acid-Schiff stains. These findings support a diagnosis of malacoplakia. The differential diagnosis includes granular cell tumor, poorly differentiated carcinoma, and Langerhans histiocytosis. Patients are managed with antibiotic therapy and excision.

CONCLUSIONS: Tongue malacoplakia is rare, often presenting as a mass lesion. Histologic recognition of this abnormal phagocytic disorder will prevent potentially disfiguring surgery.

PMID: 19239951

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Management of melanotic neuroectodermal tumor of infancy.

Gaiger de Oliveira M, Thompson LD, Chaves AC, Rados PV, da Silva Lauxen I, Filho MS.

Ann Diagn Pathol. 2004 Aug;8(4):207-12.

Melanotic neuroectodermal tumor of infancy is a rare congenital neoplasm involving the head and neck in young patients. The clinical assessment, histologic diagnosis, and management is reviewed, with an emphasis on different treatment alternatives in two new case reports.

PMID: 15290671

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Ameloblastoma.

Thompson LD

Ear Nose Throat J. 2003 Jan;82(1):19.

FIRST PARAGRAPH: Ameloblastomas are locally aggressive gnathic tumors that have a high propensity for recurrence. They are believed to arise from remnants of the odontogenic epithelium or the developing enamel organ. They occur in patients over a wide spectrum of ages and equally among the sexes, as a slow-growing, often asymptomatic, locally invasive tumor. Radiographic images usually demonstrate a multilocular, expansile radiolucency of bone, usually of the posterior mandible.

PMID: 12610896

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Fibrous dysplasia of bone.

Nelson BL, Thompson LD

Ear Nose Throat J. 2003 Apr;82(4):259.

FIRST PARAGRAPH: Fibrous dysplasia (fibro-osseous metaplasia) is one of a diverse group of diseases that are characterized by alterations in bone growth. It is a developmental, tumor-like process of unknown etiology. Its initial clinical sign is usually a painless enlargement of the affected bone. It occurs in equal proportions in males and females, most often during the first two decades of life.

PMID: 12735156

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Compound Odontoma.

Nelson BL, Thompson LD.

Head Neck Pathol. 2010 Jun 9

A case of compound odontomas of the anterior maxilla is discussed. Multiple tooth like structures were discovered upon surgical excision.

PMID: 20533004

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Oral cicatricial pemphigoid.

Nelson BL, Thompson LD.

Ear Nose Throat J. 2004 Jan;83(1):22.

FIRST PARAGRAPH: Cicatricial pemphigoid is a vesiculobullous disease of the skin that may be found in the oral cavity. Previously designated 'benign mucous membrane pemphigoid,' cicatricial pemphigoid is a chronic, blistering, autoimmune disease that affects mucous membranes. Tissue-bound autoantibodies are directed against one or more components of the basement membrane in an affected individual. Cicatricial pemphigoid initially occurs in the fifth to seventh decades of life, and it is observed more frequently in women. Patients usually describe oral pain and/or ulceration, often of many years’ duration. Clinically, the disease is characterized by the formation of bullae, which can be found anywhere in the oral cavity. The bullae rupture and produce ulceration, which may cause a scar (cicatrix) upon healing.

PMID: 14986753

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Median rhomboid glossitis.

Nelson BL, Thompson L

Ear Nose Throat J. 2007 Oct;86(10):600-1.

FIRST PARAGRAPH: Median rhomboid glossitis -- also known as central papillary atrophy and posterior midline atrophic candidiasis -- is a type of erythematous candidiasis unique to the midline posterior tongue. It occurs in as many as 1% of adults.

PMID: 17990677

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Ossifying fibroma of the jaw.

Gannon FH, Thompson L.

Ear Nose Throat J.  2004 Jul;83(7):458.

FIRST PARAGRAPH: Ossifying fibroma of the jaw is a benign, fibro-osseous lesion that is part of a larger family of fibro-osseous lesions that includes juvenile active ossifying fibroma, psammomatous ossifying fibroma, and extragnathic ossifying fibroma of the skull. Ossifying fibromas of the jaw are well-circumscribed, slowly growing lesions. They are often mentioned in the same differential diagnosis as fibrous dysplasia, but it is important to make the distinction because the former lends itself to ready enucleation, while the latter can be admixed with surrounding tissues, making surgery more complicated.

PMID: 15372914

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Melanotic neuroectodermal tumor of infancy.

Nelson BL, Thompson LD.

Ear Nose Throat J. 2006 Jun;85(6):365.

FIRST PARAGRAPH: Melanotic neuroectodermal tumor of infancy is a rare, neural-crest-derived neoplasm that is believed to be congenital. The tumor has a marked predilection for the head and neck -- particularly the maxilla, where approximately 70% of these tumors are located. The anterior maxilla is most commonly affected. There is no predilection for either sex. Nearly all patients present with an enlarging mass, usually within a few years of birth. Intraoral lesions may appear 'blue,' suggesting the presence of pigment. Radiographic images will often show a destructive lesion with tooth displacement, but they are nonspecific. Laboratory studies show high urinary levels of vanillylmandelic acid.

PMID: 16866106

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