Studies have shown that there is a close association between obesity and obstructive sleep apnea (OSA). We report a case of a 47-year-old Caucasian male who presented with a chief complaint of “extensive erosion of the teeth.” Patient had a history of OSA and stated that he occasionally used CPAP. He denied any other medical conditions, besides weight issues (250 lb). It was very difficulty for this patient to stay awake throughout the initial dental examination and he needed to walk around every few minutes in order to forcefully stay awake. Upon intra-oral examination, it was determined that the patient had a distinct, generalized pattern of dental erosion. His posterior teeth were more severely eroded than his anterior teeth, including the lingual and the facial aspects of these teeth. While the patient denied any medical conditions or heartburn or bulimia, it was determined that the underlying cause should be determined before a full mouth reconstruction could be undertaken. Based on a literature review of dental erosion, the patient was recommended to take an OTC proton pump inhibitor. Two weeks later, at his follow up appointment, the patient reported that he had been taking Prilosec and noticed that he was able to stay awake for 16 hours straight and then sleep through the night. Studies have reported that there is a correlation between OSA and GERD; however, the exact mechanism for this causal relationship is not known.

Smartphone telemedicine can be an efficient and effective way for remote Oral Pathology consultation. There are no reports to date, on the impact of smartphone telemedicine on the interaction of Oral Pathologists with multidisciplinary clinicians. A primary care physician has about 10 minutes to provide a clinical examination and formulate a treatment plan. In the past, under the presence of a suspicious oral lesion, the patient would be initially medicated with antifungal, antibiotics and antivirals; a few weeks later, when lesion did not resolve, the patient would be referred to a specialist for further evaluation. Today, a primary care physician can take a photograph of an oral lesion with a smartphone and sent it to the oral pathologist with a description of signs and symptoms and medical history; the oral pathologist makes an assessment of the information and guides the clinician accordingly. Use of smartphone telemedicine in developing an accurate preliminary diagnosis is a great tool that can save a patient's life. To illustrate this process we present cases, such as that of a 34 year old patient with lesion of the buccal mucosa which was photographed by the primary care physician, assessed by the oral pathologist and within a couple of weeks patient underwent resection of a T2N1M0 squamous cell carcinoma by the oral and maxillofacial surgeon. Without the use of smartphone telemedicine, the diagnosis and treatment would have been greatly delayed. To function effectively, it is crucial for smartphone telemedicine to include the participation of a multidisciplinary network. It is also very important for the oral pathologist to interact directly with primary care physicians.

Chondrosarcoma to the head and neck region is an uncommon event, representing 1% to 12% of all chondrosarcoma cases. When present, a vast majority of chondrosarcomas manifest in the bony skeleton (59.7%). The laryngotracheal cartilage (23.4%); soft tissue of the head and neck (11.2%); and separate anatomic locations such as the oral cavity, pharynx, tongue, and orbit (5.8%) make up the remaining distribution. With regard to oral cavity tumors, patients may present with complaints of swelling, pain, tooth mobility or occlusal discrepancy. If the temporomandibular joint (TMJ) is affected, additional symptoms may include trismus or hearing loss. Although rare, the surgeon and specialist must be aware of this phenomenon and be prepared to understand the potential therapeutic challenges associated with management. This paper describes a case of chondrosarcoma to the TMJ in a 53-year-old female veteran who presented with left facial swelling. Computed tomography demonstrated an expansile and destructive lesion of the left TMJ and condylar head. An open biopsy revealed a grade III/III chondrosarcoma of the left TMJ. She was treated primarily with composite resection of the right mandibular condyle and temporal bone along with superficial parotidectomy with facial nerve preservation and delayed reconstruction to improve tumor surveillance. Adjuvant intensity-modulated radiation therapy (IMRT) of 6000 cGy was administered following her resection. She is remains disease free at 18 months postoperatively. Chondrosarcoma to the TMJ presents a complex problem to the surgeon and clinician. A combined, multi- disciplinary approach may be necessary to effectively treat and monitory the disease as well as restore form and function to the patient.

Gene expression profiles of human ameloblastoma microdissected cells were characterized with the purpose of identifying genes and their protein products that could be targeted as diagnostic and prognostic markers as well as for potential therapeutic interventions. Five formalin-fixed, decalcified, paraffin-embedded samples of ameloblastoma were subjected to laser capture microdissection, linear mRNA amplification, and hybridization to oligonucleotide human 41,000 RNA arrays and compared with universal human reference RNA, to determine the gene expression signature. Assessment of the data by Significance Analysis of Microarrays (SAM) and cluster analysis showed that 38 genes were highly expressed (two-fold increase) in all samples, while 41 genes were underexpressed (two-fold reduction). Elements of the sonic hedgehog pathway and Wingless type MMTV integration site family were validated by immunohistochemistry. We have identified the expression of multiple genes and protein products that could serve as potential diagnostic, prognostic, and therapeutic targets.

Odontogenic tumors occur within the jaw bones and may be derived from odontogenic epithelium or ectomesenchyme or contain active components of both tissue types. We investigated the gene expression profile of enamel matrix proteins (EMPs), genes related to osteogenesis, and the mineralization process in odontogenic tumor cell populations focusing on an ameloblastoma (AB-1), a keratocystic odontogenic tumor (KCOT-1), and a calcifying epithelial odontogenic tumor (CEOT-1). All cell populations were shown to be epithelial in origin by CK14 expression. All tested EMPs were expressed by all odontogenic tumor cell types, with higher transcript levels seen in the AB-1 population especially for AMEL, AMBN, and ODAM. CEOT-1 cell populations showed a greater content of ALP-positive cells as well as higher ALP mRNA levels. Using qRT-PCR, we found a higher expression of 8 genes in the CEOT-1 compared to the AB-1 and KCOT-1. In this study we demonstrated the establishment of AB-1, KCOT-1 and CEOT-1 cell populations. The unique gene expression profiles of AB-1, KCOT-1, and CEOT-1 cells and their interactions with the surrounding microenvironment may support their unique tumor development, progression, and survival.

6027 Background: Polyomaviruses are frequently associated with malignancies in their hosts. Recently, a novel polyoma virus, named Merkel cell polyomavirus (MCV) was identified integrated to the genome of 6 of 10 fresh frozen samples of MCC. These findings suggest an involvement of MCV in the pathogenesis of MCC. Because MCC is a rare tumor, the most readily available tissue is archival formalin-fixed, paraffin-embedded (FFPE) material. In this study we evaluated the presence of MCV in FFPE tissue and correlated its presence with tumor progression. Methods: Representative FFPE specimens from 18 tumors belonging to 14 patients with a diagnosis of MCC were retrieved. Following DNA extraction, we performed PCR using 4 different primer pairs amplifying sequences within the T antigen and VP1 gene of MCV. The identity of the PCR products was confirmed by direct sequencing. For clinical outcome analysis we used our MCC database containing 40 patients from 1997 to 2008 with a median follow-up interval of 20 months (range 1–108 months). Results: We detected MCV amplicons in 8 of 18 analyzed tumors (44.4%) from 7 of 14 cases (50%). PCR products from the T antigen portion of MCV were found in 6 of 18 tumors (33.3%) and from the VP1 gene in 2 of 18 tumors (11.1%). For 3 patients, MCV detection was performed in both the primary and metastatic tumors. In one of these the virus was found in both lesions while in the other 2 only the primary tumor demonstrated the virus. Two- and 5-year survival rates for the MCCs containing the virus were 47.6% and 0% respectively while for the rest of the cases in our database 2- and 5-year survival rates were 61.6% and 40.8% respectively; the difference did not reach however, statistical significance (p = 0.3). Conclusions: We identified MCV sequences in half of the cases analyzed demonstrating the feasibility of this technique in FFPE tissue. We also found that the tumors harboring MCV exhibit a trend for more aggressive behavior compared to the rest of MCCs. These findings suggest that MCV might have an etiologic role in carcinogenesis or tumor progression in MCC. Further studies investigating the biological significance of MCV integration in the human genome and the presence of MCV in other neuroendocrine tumors are warranted. No significant financial relationships to disclose.

Microgenomics implies the precise molecular analysis of a very small pure cell population that has been microdissected from biopsies. Gene expression profile analysis using microarrays provides information to elucidate the signaling pathways that drive tumorigenesis and behavior of tumors. RNA was isolated and amplified from 5 samples of formalin-fixed paraffin-embedded, (FFPE) decalcified ameloblastoma tissue using the laser capture microdissection technique. To assess the quality and quantity of the RNA, samples were analyzed using the NanoDrop spectrophotometer, as well as the 2100 ribosomal RNA Bioanalyzer. The aminoallyl antisense RNA was hybridized to 40000-oligonucleotide expression microarray using human universal reference RNA. GeneSpring software was used to analyze the microarray data and the PathArt database was utilized to perform gene-signaling pathway enquiries. The results showed 38 upregulated genes, twofold, in 5 of the 5 samples, and 988 overexpressed genes, twofold, in 2 of 5 samples. Among the 38 genes, WNT and LGR4, part of the breast cancer pathway, were overexpressed, as well as tenascin from the melanoma pathway.