Background:Impaction of mandibular second molars is uncommon, particularly when associated with severe root dilaceration and intimate proximity to the inferior alveolar canal. Such cases present considerable diagnostic and therapeutic challenges because surgical extraction may result in neurosensory injury. This case report describes the successful interdisciplinary management of a deeply impacted mandibular second molar using controlled orthodontic traction supported by skeletal anchorage. Case Presentation:An 18-year-old female presented seeking orthodontic treatment because of dissatisfaction with her smile esthetics. Clinical examination demonstrated a skeletal Class I relationship with increased vertical facial proportions, mild mandibular deviation, posterior crossbite, and reduced overjet and overbite. Panoramic radiography and cone-beam computed tomography (CBCT) revealed a deeply impacted mandibular left second molar with severe root dilaceration, intimate proximity to the inferior alveolar canal, and a pericoronal radiolucency suggestive of a dentigerous cyst.Following interdisciplinary consultation with oral and maxillofacial surgeons, orthodontic traction was selected as a conservative alternative to surgical extraction. Initial treatment included maxillary expansion, alignment, and space creation, followed by surgical exposure, marsupialization of the pericoronal lesion, and attachment of a gold chain. Controlled orthodontic traction was subsequently performed using fixed orthodontic appliances, temporary anchorage devices (TADs), and a customized auxiliary levering arm. Results:After 30 months of active treatment, the impacted mandibular second molar erupted successfully into functional occlusion while maintaining pulp vitality and without clinical evidence of inferior alveolar nerve injury. A stable occlusion was maintained throughout the 6-month follow-up period. Conclusion:This case demonstrates that carefully planned interdisciplinary management combined with controlled skeletal anchorage-supported orthodontic traction can provide a safe and effective alternative to surgical extraction in selected patients with deeply impacted mandibular second molars presenting with severe root dilaceration and close proximity to the inferior alveolar canal.
Management of multiple impacted teeth in nonsyndromic adolescents can be challenging, particularly when impactions involve several quadrants. This case report describes two adolescent patients with extensive impactions affecting both permanent and supernumerary teeth, with an emphasis on the clinical reasoning that guided treatment decisions. A quadrant-by-quadrant approach was used to determine when teeth were extracted, surgically exposed, or retained based on eruption potential, root development, and surgical access. Although the anatomical complexity of the cases was similar, treatment strategies differed according to individualized risk-benefit considerations. These cases highlight the value of structured clinical judgment in managing complex impactions without relying on rigid treatment algorithms.
Bar-retained maxillary overdentures supported by four implants have shown favorable survival and consistently positive patient-reported outcomes, particularly when careful prosthetic planning and high primary stability are achieved. The case presented here illustrates the clinical application of this treatment approach as part of a full mouth rehabilitation. A 64-year-old male presented with poor esthetics and function due to multiple missing teeth in both arches and nonrestorable maxillary teeth and mandibular molars. Although the mandibular arch could be restored with a combination of fixed crowns and a removable partial denture, the remaining maxillary teeth were all deemed to have a poor prognosis. In shared decision making, the patient opted for removal of these maxillary teeth and replacement with an implant-supported bar overdenture. Following minimally traumatic extraction and partial grafting of sockets using a xenogeneic bone substitute, four bone-level implants were placed immediately in the canine-premolar positions (13, 15, 23, and 25) according to a prosthetically driven three-dimensional plan, achieving insertion torques of 40-45 Ncm. After a 5-month uneventful osseointegration period and minimally invasive uncovering surgery, straight multiunit abutments and an Ackermann-type bar (a prosthetic bar design unrelated to the Eckermann implant system) were used to support a bar-retained maxillary overdenture with bilateral balanced occlusion. At the 4- and 7-month follow-up visits, peri-implant tissues were healthy, the implants and bar remained stable, and no biological complications were detected. The patient reported improved comfort, chewing ability, and esthetics. These findings illustrate the short-term clinical feasibility of this treatment approach in this individual patient.
Background:Type 3 von Willebrand disease (VWD) is the most severe and rare form of this inherited bleeding disorder, characterized by near-complete absence of von Willebrand factor (VWF) and markedly reduced Factor VIII activity. These patients are at high risk of excessive bleeding during invasive procedures, including dental treatment. Case Presentation:A 4-year-old boy with a confirmed diagnosis of Type 3 VWD presented with intermittent pain in the maxillary left lateral incisor, without clinical or radiographic signs of an abscess. Comprehensive dental rehabilitation was performed under general anesthesia. Treatment consisted of pulpotomy and placement of stainless-steel crowns for primary molars, as well as pulpectomy and resin composite restorations for primary incisors. Hemostatic management included preoperative and postoperative pdVWF/F VIII concentrate administration in consultation with a hematologist. Conclusion:With meticulous multidisciplinary planning, appropriate perioperative factor replacement, and careful intra- and postoperative management, safe and effective dental rehabilitation can be achieved in pediatric patients with Type 3 VWD.
Anterior open bite is a prevalent malocclusion that can cause occlusal dysfunction and markedly reduce masticatory efficiency. This case report describes the successful management of a 37-year-old female with an anterior open bite secondary to excessive vertical development in the molar region and clockwise mandibular rotation. The treatment combined clear aligners with implant anchorage for molar intrusion, alongside S-shaped double-arm root control attachments to facilitate the uprighting of severely tilted teeth. Following the placement of four implants in the maxillary posterior region, the therapy was systematically carried out in four distinct phases: molar intrusion, premolar intrusion, correction of mandibular anterior tooth axial inclination, and final occlusal refinement. After 30 months, both the occlusal relationship and facial profile were significantly improved, with complete resolution of the anterior open bite and establishment of normal overbite and overjet. Cephalometric analysis confirmed favorable outcomes, including counterclockwise rotation of the mandible. This case highlights the efficacy of an implant-assisted clear aligner protocol augmented by specialized attachments for managing complex anterior open bite, thereby expanding the scope of clear aligner therapy.
Unlike conventional water-soluble luting cements, which gradually dissolve in oral fluids and partially self-correct over time, polymerized resin cement is insoluble and will not be displaced from the restoration margin without active mechanical intervention. This case report describes the qualitative analysis of the cementation line of three metal-ceramic crowns 1 year after placement using scanning electron microscopy (SEM) and the replica technique, and the subsequent clinical management. A 45-year-old female patient presented with crowns on Teeth 11, 21, and 22 cemented with a self-adhesive dual-cure resin cement (RelyX U200, 3 M ESPE). Despite presenting with clinical signs of localized gingivitis, the patient reported no pain or discomfort and was entirely unaware of the presence of residual cement. SEM analysis revealed cement excess of 200-500+ μm, 10-23 times the manufacturer-specified film thickness of 22 μm, in cervical, interproximal, and subgingival regions. Following mechanical cement removal, resolution of bleeding on probing and reduction in probing depths were observed at all affected sites, providing direct clinical evidence of a causal relationship between residual resin cement and local gingival inflammation. These findings highlight the limitations of symptom-based monitoring and underscore that postcementation polishing is a definitive clinical requirement, not a discretionary step.
Background:Rehabilitation of the posterior maxilla is challenging due to sinus pneumatization, limited vertical bone height, and thin peri-implant soft tissues. Minimally invasive, biologically guided approaches aim to reduce morbidity while ensuring predictable outcomes. This report presents a staged protocol integrating hard- and soft-tissue augmentation to optimize implant site development. Case Presentation:A 48-year-old female presented with a missing maxillary left first molar (#26) and impaired mastication. The left premolars (#24 and #25) were buccopalatally malaligned and exhibited a poor periodontal prognosis. Radiographic examination revealed poor-prognosis premolars, advanced ridge atrophy, and sinus pneumatization, with a residual bone height < 6 mm. Initial alveolar ridge preservation was performed, but vertical bone gain remained insufficient after 6 months. Intervention:Following extraction of the premolars, socket preservation with bone grafting and a barrier membrane was performed. Implant placement was performed using a minimally invasive crestal sinus floor elevation with simultaneous grafting, achieving vertical bone augmentation and primary stability. Standard OSSTEM implants (4.5/11 and 4.5/10 mm) were used. After osseointegration, staged peri-implant soft-tissue augmentation increased keratinized mucosa width and mucosal thickness to improve tissue stability. The implants were restored with delayed-loading, screw-retained metal-ceramic single crowns following complete soft-tissue maturation. Results:The staged protocol achieved stable vertical bone gain, healthy peri-implant soft tissues, and successful functional and esthetic rehabilitation. These outcomes were maintained at the 2-year follow-up after crown delivery, with no biological or prosthetic complications, stable marginal bone levels, a favorable emergence profile, and high patient satisfaction. Conclusion:Sequential alveolar ridge preservation, minimally invasive crestal sinus elevation, and delayed soft-tissue augmentation provide a safe, predictable approach for atrophic posterior maxillary sites. This strategy minimizes surgical morbidity while enhancing implant stability, peri-implant tissue health, and long-term clinical outcomes.
Sensory processing sensitivity (SPS) is a personality trait that has been linked to various mental health outcomes among highly sensitive children. To investigate the SPS trait and its relationship with emotional and behavioral problems among Egyptian children. A cross-sectional study was conducted targeting parents of Egyptian children aged 4–17 years. Participants (n = 391) were recruited via different online platforms. Besides a questionnaire on sociodemographic data, parents completed the Arabic version of Strengths and Difficulties Questionnaire (SDQ), and the Highly Sensitive Person Scale (HSPS) for children. Sampled children’s mean age was 9 ± 3.75 years, and 57.5
Erosive tooth wear (ETW) is increasingly prevalent, particularly among younger populations, and is often associated with dietary habits, including frequent soft-drink consumption. Patients with advanced tooth wear may report hypersensitivity, impaired mastication, and dissatisfaction with their smile, all of which can negatively affect daily function and quality of life. This case report describes the full-mouth rehabilitation of a young patient with severe ETW using a minimally invasive approach. Treatment combined digital planning, diagnostic digital wax-ups, and 3D-printed preparation guides to support precision and tissue preservation. Lithium disilicate was selected because of its favorable mechanical and optical properties. Its reduced thickness allowed conservative tooth preparation, and the restorations were adhesively cemented according to a carefully planned protocol. Re-establishing an appropriate vertical dimension of occlusion (VDO) addressed the patient's functional and esthetic concerns while preserving healthy tooth structure. At the 1-year follow-up, the restorations remained stable, supporting the effectiveness of a minimally invasive protocol based on contemporary adhesive techniques and durable ceramic materials.
Objective:We are aimed at describing the clinical and psychosocial benefits of resin infiltration as a minimally invasive treatment option for hypomature amelogenesis imperfecta in a child. Hypomature amelogenesis imperfecta is a rare hereditary enamel defect that significantly compromises dental esthetics, function, and psychosocial well-being. Conventional management often involves invasive restorative approaches such as composites, veneers, or crowns, which may require removal of sound tooth tissue and pose challenges in pediatric patients. Clinical Considerations:An 11-year-old girl presenting with hypomature amelogenesis imperfecta and severe esthetic concerns associated with impaired oral health-related quality of life was treated using an erosion infiltration technique with resin (Icon, DMG). Following enamel surface conditioning, a low-viscosity resin infiltrant was applied to penetrate and mask hypomature enamel opacities. The procedure led to immediate and significant esthetic improvement, with enhanced enamel translucency and high patient satisfaction. Esthetic outcomes remained stable over a 3-year follow-up period, including during orthodontic treatment, and were associated with a marked improvement in oral health-related quality of life. Conclusions:This case highlights the potential of resin infiltration to offer a conservative alternative to conventional restorative methods in hypomature amelogenesis imperfecta, with meaningful improvement in dental esthetics and oral health-related quality of life. Nevertheless, further clinical studies and long-term follow-up are required to validate its durability and to establish standardized treatment protocols.
Cognitive disengagement syndrome (CDS) is an emerging cognitive-attentional construct characterized by excessive daydreaming, mental slowness, drowsiness, and reduced engagement with external demands. Although CDS symptoms are substantially associated with attention-deficit/hyperactivity disorder (ADHD) symptoms, accumulating psychometric and external-validity evidence supports their conceptualization as related yet distinguishable symptom dimensions. However, large-scale evidence regarding the distribution and demographic correlates of elevated CDS symptoms, as well as their differentiation from ADHD symptoms, remains limited, particularly in non-Western contexts. In this large-scale cross-sectional study, 8,075 Iranian participants aged 15–55 years, recruited through convenience and snowball sampling, completed the Persian Adult Concentration Inventory as a self-report measure of CDS symptoms. A subsample of 2,012 participants also completed the Adult ADHD Self-Report Scale. The study examined the distribution and demographic correlates of elevated CDS symptoms and the extent to which CDS and ADHD symptom dimensions showed overlap and differentiation. Sample-based percentile thresholds were used to identify elevated symptom levels. Analyses included descriptive statistics, logistic regression, correlation and overlap analyses, discriminant function analysis, and leave-one-out cross-validation. Using the sample-based 95th-percentile threshold, 5.8
Abstract Background Substance use and co-occurring mental health conditions are common among adolescents and young adults and represent an important clinical and public health concern in North America. Trauma exposure, psychiatric symptoms, and social adversity frequently co-occur with substance-related problems in this population. This systematic review aimed to synthesize evidence on prevalence patterns, associated clinical and psychosocial factors, and care-related implications described in the literature on adolescents and young adults with substance use and co-occurring mental health conditions. Methods This systematic review followed PRISMA guidelines and was preregistered in PROSPERO (CRD42024581685). A systematic search was conducted in MEDLINE (Ovid), Embase, PsycINFO, and Google Scholar. Eligible studies examined adolescents and young adults (≤ 25 years) in North America. A combination of subject headings, keywords, and synonyms for the concepts “adolescents,” “young adults,” “substance use disorders,” and “co-occurring mental health conditions” was used. Of 1,882 records identified, 29 studies met the inclusion criteria. Given the heterogeneity of the literature, findings were synthesized narratively. Results The included studies showed heterogeneity in population, setting, denominator, and ascertainment method. Across the literature, depressive, anxiety-related, trauma-related, and externalizing mental health presentations were frequently reported alongside substance-related problems in adolescents and young adults. Trauma exposure, adverse childhood experiences, and broader social adversity were also commonly reported in association with substance-related problems across studies. Care-related implications were more limited and were largely derived as future directions mentioned across studies rather than direct evaluations of youth-specific service models. Conclusion Co-occurring mental health and substance-related problems were frequently reported among adolescents and young adults in high-risk and service-engaged populations in North America. Trauma and social adversity were prominent across the reviewed literature, while direct evidence for evaluated, integrated, youth-specific care models remains limited. These findings support the relevance of developmentally appropriate, integrated, and trauma-informed approaches to care and highlight the need for further research directly evaluating improved service delivery models for this population. Clinical trial number Not applicable.
Systemic inflammatory and nutritional indices derived from hematological parameters have emerged as accessible markers of immune imbalance. Although these indices have been investigated across various medical disciplines, their roles in psychiatric patients with positive urinary drug metabolites have not yet been reported. This study aimed to compare hematological inflammation and nutritional indices between psychiatric patients with positive urinary drug metabolites and healthy controls, to evaluate the Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), and Prognostic Nutritional Index (PNI), explore their variations across substance types and usage patterns, and determine their association with immune–nutritional dysregulation. This retrospective study included 760 psychiatric inpatients with positive urinary drug metabolites, 171 psychiatric patients without positive metabolites, and 151 healthy controls treated at X City Hospital between 2022 and 2024. SIRI, SII, and PNI were calculated from hematological and/or biochemical parameters. Patients with infectious, autoimmune, or malignant diseases or incomplete data were excluded. Group comparisons, age- and sex-adjusted regression analyses, multiple-comparison corrections, and ROC analyses were performed. Patients had higher SIRI [1.24 (0.79–1.97) vs. 0.98 (0.74–1.27)] and lower PNI (56.0 ± 6.12 vs. 58.8 ± 3.87) than controls (both p < 0.001), whereas SII did not differ significantly between the groups (p = 0.108). SIRI was positively associated with disease presence (OR = 1.847, 95
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and interaction, along with restricted, repetitive patterns of behavior. It is often accompanied by gastrointestinal dysfunction and gut microbiota dysbiosis. Fecal Microbiota Transplantation (FMT) and the Ketogenic Diet (KD) are interventions targeting the gut microbiota for ASD. 30 participants were diagnosed with ASD according to DSM-5 and ADOS-2. ASD core symptoms were evaluated with CARS and ABC. Gut microbiota composition was analyzed by shotgun metagenomic sequencing. Both groups demonstrated significant improvements in core symptoms. In the FMT group, the mean CARS score significantly decreased from 34.87 to 33.53 (p < 0.01); in the KD group, it declined from 35.13 to 33 (p < 0.01). The mean ABC score reduced from 79.93 to 69.33 (p = 0.064) in the FMT group and from 63.07 to 42.73 (p < 0.01) in the KD group. Following the intervention, no statistically significant changes were observed in α-diversity or β-diversity within either group. LEfSe analysis revealed distinct post-intervention microbial signatures: FMT significantly enriched butyrate-producing taxa (Wujia chipingensis, Eubacterium sp. MSJ-33, and Butyrivibrio crossotus), while KD elevated Blautia massiliensis and decreased propionate metabolism -associated taxa (Veillonella sp. S12025-13 and Veillonella nakazawae). KEGG enrichment analysis revealed that KD enriched propionate metabolism (Fold enrichment = 3.747, q = 0.010) and aromatic compound degradation (Fold enrichment = 3.591, q = 0.010). Both interventions significantly improved clinical symptoms among children with ASD, potentially through distinct patterns of gut microbiota modulation. NCT06348433 (03/21/2024).
Pulp canal obliteration (PCO), commonly following dental trauma, is characterized by progressive canal calcification and may be associated with pulp necrosis and apical periodontitis (AP). Conventional root canal treatment (RCT) may be technically unfeasible or associated with a high risk of iatrogenic complications. In the case reports, we explored endodontic microsurgery (EMS) as a primary treatment strategy for managing PCO with AP. Three patients (aged 30-46 years) presented with a history of dental trauma, severe canal calcification, and radiographic evidence of apical radiolucency, with or without associated bone loss. All cases were diagnosed using cone beam computed tomography (CBCT) and managed with EMS as the primary treatment approach, combined with iRoot BP Plus for apical sealing. Clinical symptoms, including gingival abscesses, resolved following treatment, and radiographic follow-up (up to 3 years) demonstrated resolution of periapical radiolucency and evidence of bone healing in all cases. Within the limitations of these case reports, primary EMS may represent a feasible alternative for selected cases of PCO with AP, allowing effective management of periapical pathology while avoiding the risks associated with attempting RCT in severely calcified canals.
Sialolithiasis of the minor salivary glands is a rare clinical entity that is seldom detected through preoperative imaging. Due to its nonspecific clinical presentation, it is frequently misdiagnosed as mucocele, fibroma, or minor salivary gland tumor; consequently, most cases are identified only through postoperative histopathological examination. We report a rare case of sialolithiasis in a minor salivary gland of the upper lip in a 73-year-old male patient. Despite the lesion's small size, a history of suppuration prompted radiographic investigation. A standard dental radiograph identified a 0.5-mm radio-opaque entity, enabling an accurate preoperative diagnosis. This case underscores that dental radiography remains a simple, cost-effective, and highly efficient screening tool for differentiating sialolithiasis from other soft-tissue lesions in the lip.
Cognitive distortions are central to the maintenance of depression, as they bias information processing and negatively impact adaptive emotion regulation. As one manifestation of cognitive distortions, usage of absolutist words (e.g., always, never, must, completely) in written texts has been found to be indicative of underlying depression. Since absolutist word usage may allow important insights into maladaptive thinking patterns, it could be a relevant target for both monitoring and treating depressive symptoms. Therefore, we tested the relationships between absolutist word usage in spoken language with depression diagnosis, depressive symptom severity and current depressed mood. We recruited 144 age- and gender-matched participants with clinical depression (n = 48), subclinical depression (n = 48), and no history of depression (n = 48). By conducting smartphone-based ecological momentary assessments (EMA) three times daily for two weeks, participants provided ratings of depressed mood and speech samples, which included mood descriptions and mood-regulating statements. The Hamilton Rating Scale for Depression (HRSD) was administered at the end of the 2-week period to assess depressive symptom severity retrospectively. Group differences were calculated with ANOVAs, associations between depressed mood and absolutist word usage were evaluated with multilevel models, and the relationship between depressive symptom severity and absolutist word usage was calculated with regression models. Results showed more frequent absolutist word usage over the EMA phase in individuals with clinical depression compared to individuals with no history of depression. Furthermore, absolutist word usage was negatively associated with momentary depressed mood among individuals with elevated depressive symptoms. Additional analyses testing the temporal relationship showed that greater absolutist word usage was associated with higher levels of depressed mood after 12–24 h. Accordingly, absolutist word usage was positively associated with depressive symptom severity assessed after the 2-week period. Our results have several implications: First, absolutist word usage in spoken language appears to be an indicator of depression, which may be relevant for the optimization of depression assessment and monitoring approaches. Second, the finding that absolutist word usage was associated with lower depressed mood in the short-term, but higher depressed mood in the long-term provides important insights into the mechanisms of depression, and may help identify relevant treatment targets for clinicians. German Clinical Trial Registration DRKS00023670 on 19/01/2021 ( https://drks.de/search/en/trial/DRKS00023670 ).
Molar incisor hypomineralization (MIH) is a qualitative enamel defect characterized by reduced mineralization, increased porosity, and compromised mechanical properties, making affected teeth highly susceptible to posteruptive breakdown, hypersensitivity, and restorative failure. Conventional direct restorations often exhibit limited longevity in severely affected molars due to weak enamel bonding and structural fragility. Consequently, indirect restorations with cuspal coverage have been increasingly recommended as a more durable and protective treatment option. This clinical case reports the restorative management of MIH-affected maxillary first molars in a 24-year-old patient using lithium disilicate ceramic overlays. Following the removal of defective amalgam restorations, a minimally invasive tooth preparation with a butt-joint design was performed, combined with immediate dentin sealing to enhance adhesion. Impressions were taken using polyvinylsiloxane materials, and overlays were fabricated via CAD/CAM technology. Adhesive cementation was carried out under strict isolation, including surface treatment of both the restoration and dental tissues. The use of lithium disilicate overlays provided a conservative yet effective approach, ensuring reinforcement of weakened tooth structure while preserving remaining sound tissues. The literature supports the high survival rates of such restorations in MIH cases, with reduced hypersensitivity and satisfactory functional and aesthetic outcomes. In conclusion, lithium disilicate overlays represent a reliable and minimally invasive solution for the rehabilitation of compromised MIH molars. Careful case selection, proper adhesive protocols, and regular follow-up are essential to ensure long-term success, particularly given the inherent fragility of MIH-affected enamel.
Angina bullosa hemorrhagica (ABH) is an abruptly developing oral blood blister that most often affects the soft palate. Ventral-tongue presentations are uncommon and can mimic traumatic, vascular, hematologic, or immune-mediated disease. A 78-year-old Saudi man with hypertension and Type 2 diabetes presented with a 3-day history of tongue discomfort and a solitary hemorrhagic bulla measuring 1.5 × 1.0 cm on the right ventral tongue. No other oral lesions, cutaneous involvement, or airway symptoms were present, and he reported a previous similar palatal lesion. Based on the characteristic clinical appearance, oral-only distribution, and prior recurrence, a clinical diagnosis of ABH was made. The lesion was managed conservatively. Four days later, it had ruptured. At 2-month follow-up, the lesion had completely healed without scarring. This case highlights an uncommon ventral-tongue presentation of ABH and emphasizes that ABH should be considered in the differential diagnosis of solitary hemorrhagic bullae and postbullous erosions of the tongue. Recognition of its characteristic clinical course may prevent misdiagnosis and unnecessary intervention while ensuring appropriate hematologic evaluation and, when indicated, investigation for immune-mediated disease.
Oral hobnail hemangioma is an exceptionally rare benign vascular lesion of the oral cavity. A 57-year-old edentulous woman presented for evaluation of discomfort associated with her existing prosthesis, and intraoral examination revealed a bluish-purple, smooth-surfaced, asymptomatic nodular lesion located in the anterior maxillary labial mucosa. Clinically, vascular malformation and hemangioma were considered in the differential diagnosis. Histopathological examination revealed dilated superficial vascular channels within the lamina propria, some of which contained erythrocytes, together with characteristic hobnail endothelial cell morphology in the superficial aspect of the lesion. Immunohistochemical analysis demonstrated CD34 positivity and HHV-8 negativity. Based on the clinical, histopathological, and immunohistochemical findings, a diagnosis of oral hobnail hemangioma was established. Accurate recognition of this rare entity is important because of its clinical and histopathological overlap with other benign, intermediate-grade, and malignant vascular proliferations, particularly Kaposi sarcoma and hemangioendothelioma variants.
