OBJECTIVES:To analyze 106 nasopalatine duct (NPD) cysts to identify characteristics that may indicate radiographic follow-up as a first line option. STUDY DESIGN:Biopsy specimens were reviewed for gender, ethnicity, age, clinical presentation, treatment, size, and size vs symptoms. Ten cases (nine NPD cysts and one normal anatomical variant) with suitable documented radiographic imaging were selected to describe imaging features. Descriptive statistics were used to analyze gender, ethnicity, age, clinical presentation, size, size vs symptoms, gender vs symptoms, and size vs gender in symptomatic cases. RESULTS:Most occurred in Caucasian males, most at ages 42-76. Gross specimen size was available for 102 cases with most measuring ≤15 mm (<10 mm = 21.6%; 10 mm = 26.5%; 11-15 mm = 28%; > 15 mm = 23.5%). Symptoms were reported rarely, 91% with symptoms measured ≥10 mm grossly. Most with symptoms occurred after age 45 and 43.5% occurred in females. Symptomatic NPD cysts were larger in males than females. Cases with imaging, width ranged from 7.8 to 12 mm on imaging and 78% occurred in males. CONCLUSIONS:The data of this study validates existing literature reporting NPD cysts as non-aggressive and slow growing and suggests that there is a population of NPD cysts that are suitable for periodic follow-up. Combining size with symptoms and gender may help guide treatment decisions when radiographic findings are equivocal.

Introduction: The incidence of obesity has dramatically increased worldwide. Obesity has been shown to exacerbate the progression of periodontal disease. Studies suggest a sex difference in periodontitis, whereby males are more sensitive to periodontal inflammation compared to females. Aim: In the current study, it was hypothesized that obesity drives periodontal inflammation and bone loss in both sexes. Methodology: Utilizing leptin receptor mutant (SSLepR mutant) rats as a genetic model of obesity, 11–12-week-old male and female lean Dahl salt-sensitive (SS) rats and obese SSLepR mutant rats were used to investigate sex differences in obesity-induced periodontal inflammation. Results: Body weight, insulin, hemoglobin A1c and cholesterol levels were significantly elevated in the obese SSLepR mutant strain vs. the lean SS strain within the same sex. Sex differences in body weight and plasma hemoglobin A1c were only observed in obese SSLepR mutant rats, with males having significantly greater body weight and hemoglobin A1c vs. females. Plasma thiobarbituric acid reactive substances (TBARs) and monocyte chemoattractant protein-1 (MCP-1), markers of systemic oxidative stress and inflammation, respectively, were significantly elevated in obese SSLepR mutant rats vs. lean SS rats, with no sex differences in these parameters in either rat strains. Although micro-CT analyses of the maxillary first molar alveolar bone from obese SSLepR mutant rats revealed no evidence of bone loss and/or sex differences, immuno-histochemical analysis revealed significant elevations in periodontal IL-6 and decreases in IL-10 in obese SSLepR mutant rats vs. lean SS rats, with no apparent sex differences in these parameters. Conclusions: Obesity increases systemic and periodontal inflammation, without evidence of bone loss or apparent sex differences in SSLepR mutant rats.

IntroductionEpithelial sodium channel (ENaC) is a major conduit for sodium transport across the cell membrane, and its activity is regulated by multiple factors/mechanisms, including the serum and glucocorticoid-regulated kinase-1 (SGK-1). Saliva production and secretion are complex processes, with ENaC regulation of the ionic composition of saliva being an essential event prior to the ultimate secretion of hypotonic saliva into the oral cavity. However, the status of salivary gland SGK-1, in the context of ENaC, remains to be determined. We tested the hypothesis that lower lip minor salivary gland expressions of SGK-1 and ENaC are affected in subjects reporting xerostomia.MethodsAccordingly, archived biopsy specimens of subjects with a diagnosis of mucocele (control; n = 7) and those of subjects complaining of dry mouth (experimental; n = 12) were subjected to histopathological and immunohistochemical assessments for SGK-1, its phosphorylated (active) form (pSGK-1), and the alpha subunit of ENaC (α-ENaC).ResultsControl specimens displayed extravasated mucus surrounded by a capsule of inflamed granulation tissue, while experimental specimens showed patchy periductal, predominantly lymphocytic, infiltrates. Control specimens showed variable degrees of SGK-1 and pSGK-1 immunolabeling of ductal epithelial cells. In contrast, experimental specimens displayed patchy and strong SGK-1 but variable degrees of pSGK-1 immunolabeling of ductal epithelial cells. While control specimens showed variable ductal α-ENaC immunolabeling, those of the experimental group displayed primarily diffuse cytoplasmic, with some membrane, immunolabeling in ductal cells. Semi-quantitative analyses, using ImageJ Fiji, showed increased normalized staining for α-ENaC and SGK-1, but not pSGK-1, for experimental compared to control cases.DiscussionCollectively, the data suggest a difference between the active form of the kinase and α-ENaC in minor salivary glands in xerostomia and that higher SGK-1 and α-ENaC may serve as diagnostic markers for this condition.

Background: Obesity is a major contributor to chronic kidney disease (CKD) through mechanisms involving inflammation and metabolic dysregulation. Premenopausal female rats are known to be protected from cardiovascular disorders vs. age matched male rats. The current study investigates if there are sex differences in obesity-induced renal inflammation in SS leptin receptor mutant (SSLepR mutant) rats as a model of metabolic syndrome. Method: Male and female lean and obese SSLepR mutant rats were used in the current study to assess changes in metabolic parameters and markers of renal inflammation. Results: Obese SSLepR rats showed significant increases in body weight, hemoglobin A1c (HbA1c), and cholesterol vs. lean control, although their blood glucose levels remained comparable to lean rats. Plasma leptin, insulin, and TNF-α converting enzyme (TACE) levels were significantly elevated in obese SSLepR rats vs. lean control rats, with no apparent sex differences. Obesity was associated with an elevation in renal injury since protein and albumin excretion levels were significantly elevated in obese SSLepR rats vs. lean control rats, with no apparent sex differences. The elevation in renal injury was associated with increased renal fibrosis as evidenced by increased collagen deposition and TGF-β expression in the kidney of obese SSLepR rats vs. lean control rats. Increased renal fibrosis also coincided with increased renal inflammation and apoptosis as evidenced by increased macrophage infiltration and IL-6 expression in the kidneys of obese SSLepR rats vs. lean control rats. Conclusion: These findings indicate that obesity triggers renal inflammation and fibrosis independent of hyperglycemia in SSLepR rats, and these changes may override sex-based protective effects seen in females in other experimental rodent models of cardiovascular diseases.

Granulomatous diseases include a diverse range of chronic inflammatory disorders with a wide variety of pathologies and clinical characteristics. In particular, the orofacial region can be affected by granulomatous conditions-whether as an isolated disease or as part of a systemic disorder. Regardless of the nature of the disease or its mechanism of development, precise diagnosis can be challenging, as etiopathogenesis may be driven by several causes. These include reactions to foreign bodies, infections, immune dysregulation, proliferative disorders,, medications, illicit drugs, and hereditary disorders. Granulomas can be identified using histopathological assessment but are not pathognomonic of a specific disease, and therefore require correlation between clinical, serological, radiographical, and histopathological findings. The purpose of this review is to provide a summary of the etiopathogenesis, clinical and histopathologic characteristics, and treatment of oral granulomatous disorders.

OBJECTIVES This article aims to expand the literature on myoepitheliomas by describing several cases with an emphasis on histological presentation, clinical appearance, and demographics. To the best of our knowledge, this article is the largest single-center case series of myoepitheliomas. METHODS A retrospective search for myoepithelioma salivary gland tumors in the oral and maxillofacial pathology archive at The Dental College of Georgia was performed. Patient demographics and the clinicopathologic features were collected and analyzed. Additionally, a comprehensive literature review of benign myoepithelioma of the salivary glands was conducted. The database PubMed was searched from (1/1/2008-to-9/1/2023) using the search terms: “salivary gland”, “myoepithelioma.” Demographic and clinicopathologic data were extracted and analyzed. Descriptive analysis was performed using SPSS Statistics Version 26 (IBM Corporation, NY). Categorical data was analyzed through the Fisher exact test. Results were considered statistically significant at (P < .05). RESULTS Institutional Case Series: The retrospective search revealed 13 cases of myoepithelial salivary gland tumors—9 benign myoepitheliomas & 4 malignant myoepithelial tumors (included for comparison). Tumor morphology was analyzed—epithelioid pattern, 6 cases (4 benign, 2 malignant); spindle cell pattern, 6 cases (4 benign, 2 malignant); plasmacytoid pattern, 7 cases (6 benign, 1 malignant). The characteristics of connective tissue trauma were also analyzed. The stroma was myxoid in 2 cases (1 benign, 1 malignant), fibrinous in 5 cases (4 benign, 1 malignant), and necrotic in 2 cases (2 malignant). The difference in reported clinicopathologic characteristics was not statistically significant, except for the presence of mitosis (p=.001). CONCLUSIONS Rare salivary gland tumors, especially those arising in atypical locations with ambiguous morphological patterns, present a unique diagnostic challenge. Due to myoepithelioma's ability to manifest in the various glandular structures of the head and neck, dental professionals and physicians who encounter head and neck pathology must recognize this entity as part of their differential diagnosis when clinically appropriate. IMPLICATIONS This project is targeted at clinicians and pathologists who encounter and manage head and neck pathology. Due to the rarity of this tumor class, there are many case reports, but no case series or reviews of this magnitude providing a clear profile of this neoplasm. The value of this article lies in the scope of our data set and the clinicopathologic overview it provides. It will contribute to improved differential diagnoses and, therefore, improved management of this condition.

A 38-year-old Caucasian male presented to a primary care provider for evaluation for recent onset of progressive vision loss and multiple oral nodules involving the lower lip, right buccal mucosa, gums, and palate. The patient's medical history included uncontrolled HIV, depression, gastroesophageal reflux disease, and hearing loss. Medications included omeprazole 20 mg once daily; and venlafaxine 150 mg once daily. Social history included occasional marijuana use. Review of systems revealed fatigue, lack of concentration, and a mild headache.

IntroductionHuman papillomavirus virus-related oropharyngeal squamous cell carcinoma (HPV-OPSCC) comprises a significant portion of head and neck cancers. Several glucocorticoid-inducible proteins play important roles in pathogenesis of some cancers but their status and roles in HPV-OPSCC remain elusive; these include the glucocorticoid-induced leucine zipper (GILZ), Annexin-A1 and serum glucocorticoid-regulated kinase-1 (SGK-1).MethodsWe determined expression profiles of these proteins, using immunohistochemistry, in archived biopsy samples of patients diagnosed with HPV-OPSCC; samples of non-cancer oral lesions (e.g., hyperkeratosis) were used as controls.ResultsGILZ staining was primarily confined to nuclei of all tissues but, in HPV-OPSCC specimens, neoplastic cells exhibiting mitosis displayed prominent cytoplasmic GILZ expression. On the other hand, nuclear, cytoplasmic and membranous Annexin-A1 staining was observed in suprabasal cell layers of control specimens. A noted feature of the HPV-OPSCC specimens was few clusters of matured and differentiated nonbasaloid cells that showed prominent nuclear and cytoplasmic Annexin-A1 staining while the remainder of the tumor mass was devoid of staining. Cytoplasmic and nuclear staining for SGK-1 was prominent for control than PV-OPSCC specimens while staining for phosphorylated SGK-1 (pSGK-1; active) was prominent for cell membrane and cytoplasm of control specimens but HPV-OPSCC specimens showed mild and patchy nuclear and cytoplasmic staining. Semi-quantitative analysis of GILZ immunostaining indicated increased staining area but similar normalized staining for HPV-OPSCC compared to control specimens. By contrast, staining area and normalized staining were reduced for other proteins in HPV-OPSCC than control specimens.DiscussionOur collective observations suggest differential cellular localization and expression of glucocorticoid-inducible proteins in HPV-OPSCC suggestive of different functional roles in pathogenesis of this condition.

INTRODUCTION:Plasma cell gingivitis (PCG) is a rare benign condition usually found on marginal and attached gingiva. This case details a generalized PCG, to include the management of the patient and clinicopathologic characteristics of the disorder.CASE PRESENTATION:The patient, a 24-year-old African American female, was referred to the periodontics clinic for severe generalized gingival erythema and edema. Past medical history review was remarkable for sickle cell anemia and systemic lupus erythematosus. The patient was initially prescribed dexamethasone oral rinse (0.5 mg/5 ml) pending biopsy and medical consult for potential causes of any hypersensitivity reaction. The patient also was instructed to discontinue her current type of oral mouthrinse and dentifrice. Biopsy results confirmed a diagnosis of PCG. Resolution of signs and symptoms started 1 month later, and approximately 2 years after initial diagnosis the patient was clinically stable.CONCLUSION:This report describes the management of a diffuse plasma cell gingivitis and reviews pertinent literature on the lesion. The etiology of PCG, although unclear, may be attributable to a hypersensitivity reaction. PCG may mimic other pathological entities, which underscores the importance of microscopic examination in establishing a definitive diagnosis before treatment initiation.

Objectives Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa with no approved treatment. This was the first and largest global randomized, double-blind, placebo-controlled efficacy and safety OLP trial of a novel mucoadhesive clobetasol propionate patch (Rivelin-CLO). Study Design One hundred and thirty-eight adults with symptomatic OLP and ≥1 measurable ulcer were randomized to 1, 5, 20 µg/patch doses or placebo in 1:1:1:1 ratio. Up to 6 patches were applied BID for 4 weeks. The primary endpoint was total ulcer area reduction. Secondary endpoints included patient- and clinician-reported outcome measures. Results One hundred and twenty-two patients completed the study. All 138 patients were included in the efficacy and safety analyses. The 20-μg/patch treatment resulted in significant reduction in total ulcer area (−45.0 mm2; P < .05), symptom severity score (−2.967; P < .001; 28-point scale), clinician's severity assessment (−4.453; P < .05; 106-point scale), and oral mucosal disease-specific quality of life (−9.022; P < .05; 104-point scale). One- and 5 ug/patch treatments showed a positive impact but did not broadly reach significance. Patches were universally reported as easy to apply and remove, well tolerated, and associated with high compliance. Most adverse events deemed to be related to treatment were mild and localized and did not result in study discontinuation. Conclusions Rivelin-CLO 20 μg/patch treatment for 4 weeks resulted in clinically significant improvement in OLP ulcer size, symptoms, and quality of life, with a favorable safety profile, demonstrating its potential to address a significant unmet need in OLP. (Funded by Afyx Therapeutics A/S; EudraCT 2017-002193-40; ClinicalTrials.gov NCT03592342.)

Numb chin syndrome (NCS) has been described in the context of known malignancy or as a signal of disease recurrence; however, it is unusual to be the initial presenting symptom of malignancy. We offer a case report of an otherwise healthy 14-year old female who presented with NCS of seven months duration. Radiographic imaging showed a ill-defined “moth eaten” appearance of the mandible and incisional biopsy showed diffuse lymphocyte infiltrates. Immunohistologic staining performed was consistent with T-cell acute lymphoblastic leukemia/lymphoma (T-ALL), which was later confirmed with bone marrow aspirate. While traditionally the diagnosis of lymphoma was reserved only for bulky lesions with minimal disease of the peripheral blood and bone marrow, current trends have shifted to group lymphoblastic leukemia and lymphoma as a single disease process spectrum. After a review of the literature, no reports were identified of NCS as the only presenting symptom of T-ALL in a previously healthy child. We therefore propose an algorithm to guide clinicians in an accurate and timely diagnosis of this common pediatric malignancy.

Background: Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic epithelial neoplasm of the jaws. It is composed of irregular nests of clear to faintly eosinophilic cells resembling clear cell rests of primitive dental lamina and an intermixed hyalinized fibrous stroma. Most cases occur in the 5th and 6th decades of life, with a female predominance. The mandible is affected more than the maxilla. Clinical features vary from asymptomatic to non-specific pain, ill-defined radiolucency, root resorption, and sometimes soft tissue extension. Histology varies from bland to high grade. CCOC demonstrated a significant tendency to recur. Metastasis typically involves regional lymph nodes, which haves been reported in 20–25% of cases. Pulmonary metastasis rarely occurs. Differential diagnoses are broad and include odontogenic, salivary, melanocytic, and metastatic neoplasia. CCOCs are positive for cytokeratins, mainly AE1/AE3 and CK19. Most cases show EWSR1 rearrangement and rarely, the BRAFV600E mutation. Design: Patient charts were reviewed at our institution. A total of three cases were found in electronic medical records, which were diagnosed as clear cell odontogenic carcinoma over a period of six years (2014–2019). Patient charts were reviewed for medical history and radiology data. The pathology slides were reviewed by one or more faculty members. Results: We present three cases of CCOC, ranging in age from 40 to 69 years (two women and one man). Two cases involved the maxilla and one involved the mandible. Two presented with painful swelling and one with mass recurrence. Radiography results show that two had poorly defined radiolucent lesions, and one was heterogeneous with a small nodule projecting into the maxillary sinus. Histological examination revealed an epithelial neoplasm composed of irregular sheets, cords, and nests of polygonal cells with central hyperchromatic, mildly pleomorphic nuclei surrounded by clear to pale eosinophilic cytoplasm, with occasional mitotic figures. The tumor had infiltrated the bone and soft tissues. Two cases were immunopositive for CK5/6 and one case was positive for p63 and CK19. Interestingly, the eosinophilic dentinoid matrix interspersed among tumor cells in one case was consistent with its odontogenic origin. Histochemical staining showed PAS-positive and diastase-labile intracytoplasmic material consistent with glycogen. Conclusion: Our study highlights the potential diagnostic significance of dentinoid (although reportedly seen in only 7% of cases), along with CK5/6 immunopositivity, in supporting the histologic diagnosis of CCOC among a variety of neoplasia in its differential diagnosis.

Adrenal glands are the major source of glucocorticoids, but recent studies indicate tissue-specific production of cortisol, including that in the oral mucosa. Both endogenous and exogenous glucocorticoids regulate the production of several proteins, including the glucocorticoid-induced leucine zipper (GILZ) and Annexin A1, which play important roles in the regulation of immune and inflammatory responses. Common inflammation-associated oral conditions include lichen planus and candidiasis, but the status of GILZ and Annexin A1 in these human conditions remains to be established. Accordingly, archived paraffin-embedded biopsy samples were subjected to immunohistochemistry to establish tissue localization and profile of GILZ and Annexin A1 coupled with the use of hematoxylin–eosin stain for histopathological assessment; for comparison, fibroma specimens served as controls. Histopathological examination confirmed the presence of spores and pseudohyphae for oral candidiasis (OC) specimens and marked inflammatory cell infiltrates for both OC and oral lichen planus (OLP) specimens compared to control specimens. All specimens displayed consistent and prominent nuclear staining for GILZ throughout the full thickness of the epithelium and, to varying extent, for inflammatory infiltrates and stromal cells. On the other hand, a heterogeneous pattern of nuclear, cytoplasmic, and cell membrane staining was observed for Annexin A1 for all specimens in the suprabasal layers of epithelium and, to varying extent, for inflammatory and stromal cells. Semi-quantitative analyses indicated generally similar fractional areas of staining for both GILZ and Annexin A1 among the groups, but normalized staining for GILZ, but not Annexin A1, was reduced for OC and OLP compared to the control specimens. Thus, while the cellular expression pattern of GILZ and Annexin A1 does not differentiate among these conditions, differential cellular profiles for GILZ vs. Annexin A1 are suggestive of their distinct physiological functions in the oral mucosa.

Osteosarcoma is the most common primary malignancy of the jaws and is treated by radical surgical resection. Early detection is crucial because removing the lesion with clean margins contributes most to the outcome. We present 3 cases of osteosarcoma occurring in the interradicular region of the mandible, 2 of which were thought to represent nonmalignant processes upon initial presentation. All 3 demonstrated early but significant clinical and radiographic features indicative of the malignant disease process. Radiographically, these cases had in common unilateral periodontal ligament (PDL) space widening, displacement of teeth, and growth of the crestal bone. Clinically, all 3 cases presented with a painless intraoral swelling. Case 1: a 20-year-old African American man presented with swelling and loose teeth with a duration of 1.5 months. Histopathologic diagnosis of osteoblastic osteosarcoma, high grade, was made. Case 2: a 75-year-old White man presented with a 2 × 2 cm expansile lesion with a duration of 2 months. Histopathologic diagnosis of chondroblastic osteosarcoma was made. Case 3: a 63-year-old White woman presented with a 5- to 6-mm lesion with a duration of at least 1 month. Histopathologic diagnosis of chondroblastic osteosarcoma was made. All 3 cases were treated with wide surgical resection.

Introduction: This study described the degenerative changes and infection patterns of the pulp tissue associated with symptomatic irreversible pulpitis. Methods: The material consisted of 32 extracted teeth with untreated deep caries that were clinically and histologically diagnosed with irreversible pulpitis and were part of the histopathologic collection of 1 of the authors. The controls consisted of intact teeth with normal uninflamed pulps and teeth with reversible pulpitis. Teeth were processed for histopathologic and histobacteriologic analyses. Results: All teeth with irreversible pulpitis showed areas of severe acute inflammation, necrosis, microabscesses, and bacterial infection in the pulp chamber. These areas were surrounded by a chronic inflammatory infiltrate, and, at the distance, the pulp tissue was often uninflamed. Bacteria were also observed in the areas surrounding the necrotic foci, both as scattered cells through the extravascular space and at varying numbers within the blood vessel lumen. The number of bacteria and the density of the intravascular bacterial aggregations varied considerably. In one third of the cases, bacteria occurred in the lumen of venules in areas at a considerable distance from the necrotic focus in the coronal third of the root. No intravascular bacteria were noted in the middle and apical segments of the canal. No bacteria were found in the pulps of any of the control specimens. Conclusions: Bacterial invasion and colonization of necrotic areas were observed in the pulp of all teeth with caries exposure and symptomatic irreversible pulpitis. Bacterial penetration of blood vessels occurred in all cases, suggesting that this may be an important mechanism of spread of bacterial infection through the pulp tissue in an endodontic infection.

Background Oral lichen planus (OLP) is a chronic inflammatory disorder of the oral mucosa. Currently there is no approved treatment for OLP. We report on the efficacy and safety of a novel mucoadhesive clobetasol patch (Rivelin(R)-CLO) for the treatment of OLP. Methods Patients with confirmed OLP and measurable symptomatic ulcer(s) participated in a randomized, double-blind, placebo-controlled, multicenter clinical trial testing a novel mucoadhesive clobetasol patch (Rivelin(R)-CLO) in OLP across Europe, Canada, and the United States. Patients were randomized to placebo (nonmedicated), 1, 5, 20 mu g Clobetasol/patch, twice daily, for 4 weeks. The primary endpoint was change in total ulcer area compared to baseline. Secondary endpoints included improvement from baseline in pain, disease activity, and quality of life. Results Data were analyzed and expressed as mean [SD]. One hundred thirty-eight patients were included in the study; 99 females and 39 males, mean age was 61.1 [11.6] years. Statistical analyses revealed that treatment with 20-mu g Rivelin(R)-CLO patches demonstrated significant improvement with ulcer area (p = 0.047), symptom severity (p = 0.001), disease activity (p = 0.022), pain (p = 0.012), and quality of life (p = 0.003) as compared with placebo. Improvement in OLP symptoms from beginning to the end of the study was reported as very much better (best rating) in the 20-mu g group (25/32) patients compared to the placebo group (11/30), (p = 0.012). Adverse events were mild/moderate. Candidiasis incidence was low (2%). Conclusions Rivelin(R)-CLO patches were superior to placebo demonstrating statistically significant, clinically relevant efficacy in objective and subjective improvement and, with a favorable safety profile.

BACKGROUNDWith this poster we add 2 new cases of intercrestal osteosarcoma to the 2 cases reported at the 2017 AAOMR annual meeting in the poster entitled, “Osteosarcoma: A Report of Two Cases With Similar Radiographic Features.” One of the present intercrestal cases was clinically thought to be a “gingival epulis.” These 2 additional cases serve to raise awareness of the importance of recognizing the radiographic features of osteosarcoma occurring in an intercrestal location. In addition, we present another case of osteosarcoma with the classical features of sunburst bone pattern, knife-edge root resorption, and periodontal ligament (PDL) widening. With these cases and the authors’ own experience it is certainly true that osteosarcoma is the most common primary malignant bone tumor of the jaws.1CASE REPORTIntercrestal case 1: A young male patient presented with clinical swelling in the area of teeth #26 and #27. A panoramic radiograph revealed unilateral PDL widening on teeth #26 and #27 and displacement of these teeth. There was growth of the intercrestal bone and a patchy sclerotic nature to the interradicular bone pattern. Intercrestal case 2: A 63-year-old white female patient presented with a gingival nodule of 2 months’ duration. Periapical and panoramic radiographs revealed PDL widening along tooth #21, displacement of teeth #20 and #21, growth of the intercrestal bone, and subtle radiolucent and radiopaque changes in the interradicular bone. Classical osteosarcoma case: A 53-year-old African American female patient presented with an expansile 2 × 2 cm firm, painful lesion associated with the mandibular left second molar. Panoramic and cone beam computed tomography images revealed a radiopaque bone pattern, PDL widening, tooth displacement, spiked root resorption, and sunburst bone pattern.DISCUSSION/CONCLUSIONSIntercrestal osteosarcoma may be a subtle relative of the expansion associated with the classic sunburst pattern. Meticulous attention to details is crucial during radiographic evaluation. With this poster we add 2 new cases of intercrestal osteosarcoma to the 2 cases reported at the 2017 AAOMR annual meeting in the poster entitled, “Osteosarcoma: A Report of Two Cases With Similar Radiographic Features.” One of the present intercrestal cases was clinically thought to be a “gingival epulis.” These 2 additional cases serve to raise awareness of the importance of recognizing the radiographic features of osteosarcoma occurring in an intercrestal location. In addition, we present another case of osteosarcoma with the classical features of sunburst bone pattern, knife-edge root resorption, and periodontal ligament (PDL) widening. With these cases and the authors’ own experience it is certainly true that osteosarcoma is the most common primary malignant bone tumor of the jaws.1 Intercrestal case 1: A young male patient presented with clinical swelling in the area of teeth #26 and #27. A panoramic radiograph revealed unilateral PDL widening on teeth #26 and #27 and displacement of these teeth. There was growth of the intercrestal bone and a patchy sclerotic nature to the interradicular bone pattern. Intercrestal case 2: A 63-year-old white female patient presented with a gingival nodule of 2 months’ duration. Periapical and panoramic radiographs revealed PDL widening along tooth #21, displacement of teeth #20 and #21, growth of the intercrestal bone, and subtle radiolucent and radiopaque changes in the interradicular bone. Classical osteosarcoma case: A 53-year-old African American female patient presented with an expansile 2 × 2 cm firm, painful lesion associated with the mandibular left second molar. Panoramic and cone beam computed tomography images revealed a radiopaque bone pattern, PDL widening, tooth displacement, spiked root resorption, and sunburst bone pattern. Intercrestal osteosarcoma may be a subtle relative of the expansion associated with the classic sunburst pattern. Meticulous attention to details is crucial during radiographic evaluation.

A 19-year-old African American female presented with facial asymmetry and prominent left facial swelling for 2 years. The patient reported loss in her sense of smell and blurred vision as well as 2 episodes of severe headaches shortly before presentation. She also indicated little to no improvement when she used medications for headaches. On physical examination, facial asymmetry with bulging left maxillary bone and left upward proptosis was noted. Extraocular muscle movement and cranial nerves II-XII were grossly intact and symmetrical. Rhinoscopy showed a markedly deviated nasal septum to the right without turbinate hypertrophy. Oropharyngeal examination showed good dentition, no palatopharyngeal mass, and fully mobile and symmetric tongue and palate. Computed tomography (CT) images showed an extradural mass, measuring 81.2 × 44 × 39 mm, involving the left nasal cavity and paranasal sinuses with mass effect on the left orbit and skull base. Magnetic resonance imaging was subsequently performed and revealed a lobulated, well-defined heterogeneously enhanced expansile lesion with calcified matrix and soft tissue component involving the left maxillary sinus with extension into the left nasal cavity, frontal and ethmoid sinuses, and medial wall of the left orbit (Figures 1A and 1B). The patient received debulking of the lesion via endoscopic surgery, and a tissue specimen was submitted for microscopic examination.

Glucocorticoid-induced leucine zipper and serum-glucocorticoid-regulated kinase-1 (SGK-1) are major glucocorticoid-inducible proteins. Recent studies indicate the local production of cortisol in oral mucosa, which can impact the tissue generation of glucocorticoid-induced leucine zipper (GILZ) and SGK-1. Furthermore, GILZ and SGK-1 play pathogenic roles in a variety of cancers, but their status in potentially malignant (e.g., epithelial dysplasia) or malignant oral lesions remains unknown. This study tested the hypothesis that expression profiles of GILZ and SGK-1, along with the phosphorylated (active) form of SGK-1 (pSGK-1), are different in epithelial dysplasia than squamous cell carcinoma. Accordingly, archived paraffin-embedded biopsy samples were subjected to immunohistochemistry to establish tissue localization and the profile of proteins of interest, while hematoxylin-eosin stained tissues were used for histopathological assessment. Based on histopathological examinations, tissue specimens were categorized as displaying mild-moderate or severe epithelial dysplasia and squamous cell carcinoma; benign keratosis specimens served as controls. All the tissue specimens showed staining for SGK-1 and pSGK-1; however, while SGK-1 staining was primarily cytoplasmic, pSGK-1 was mainly confined to the cell membrane. On the other hand, all the tissue specimens displayed primarily nuclear staining for GILZ. A semi-quantitative analysis of immunohistochemistry staining indicates increased GILZ expression in epithelial dysplasia but reversal in squamous cell carcinoma to a level seen for benign keratosis. On the other hand, the SGK-1 and pSGK-1 expressions decreased for squamous cell carcinoma specimens compared with benign keratosis or dysplastic specimens. Collectively, in this cross-sectional study, immunostaining patterns for proteins of interest do not seemingly differentiate epithelial dysplasia from squamous cell carcinoma. However, subcellular localization and expression profiles for GILZ, SGK-1, and pSGK-1 are suggestive of differential functional roles in dysplastic or malignant oral lesions compared with benign keratosis.