Hyalinizing clear-cell carcinoma (HCCC) is a rare, low-grade salivary gland tumor with distinctive clear-cell morphology and pattern of hyalinization as well as focal mucinous differentiation. However, histological overlap exists with other salivary gland tumors, such as epithelial-myoepithelial carcinoma (EMCa), salivary myoepithelial carcinoma, and mucoepidermoid carcinoma (MEC). The potential relationship between HCCC and its morphological mimics has not been yet investigated at the genetic level. In this study, we conducted a molecular analysis for the presence of rearrangements in MAML2, commonly seen in MECs, and EWSR1, involved in "soft tissue myoepithelial tumors" (SMET) by fusion with POU5F1, PBX1, or ZNF444. Fluorescence in situ hybridization (FISH) was performed on 23 HCCC cases for abnormalities in MAML2, EWSR1, FUS, POU5F1, PBX1, and ZNF444. FISH for MAML2 was negative in all cases (0 of 14), including those with mucinous differentiation (0 of 7). An EWSR1 rearrangement was identified in 18 of 22 HCCCs (82%), while no break-apart signals were seen in FUS, POU5F1, PBX1, or ZNF444. 3'RACE on an EWSR1 rearranged HCCC identified an EWSR1-ATF1 fusion, which was confirmed by RT-PCR. ATF1 involvement was further confirmed by FISH analysis in 13 of 14 EWSR1-rearranged HCCC cases (93%). In contrast, all control cases tested, including among others 5 EMCa and 3 MEC with clear cells, were negative for EWSR1 and ATF1 rearrangements. The presence of EWSR1-ATF1 fusion in most HCCCs reliably separates these tumors from its histological mimics. The distinction from MEC is particularly important, as conventional MEC grading schemes overgrade these indolent HCCCs, potentially impacting on treatment.

Oncocytic lipoadenomas of salivary gland are extremely rare tumors with only two previously reported cases. In this paper, we describe an additional example of oncocytic lipoadenoma showing sebaceous differentiation, a hitherto unreported occurrence. The tumor was encapsulated and measured 3 x 2.5 x 2 cm. Microscopically, the tumor comprised a mixture of oncocytes with "light" and "dark" cells intimately associated with mature adipose tissue. The oncocytes were positive for low molecular keratin, epithelial membrane antigen (EMA), and keratin 7, with only a small subgroup of cells expressing high-molecular-weight keratin, keratin 5/6, keratin 19, and p63. Terminally differentiated sebaceous cells were positive for EMA and keratin 14 only. Calponin and actins were negative, indicating a lack of myoepithelial cells in the tumor. The keratin profile and p63 expression of this oncocytic lipoadenoma suggest the presence of a dual cell population somewhat similar to the dual cell population described in some ultrastructural studies of pure salivary gland oncocytomas and may represent partial basal-cell differentiation. The presence and nature of a dual cell population in oncocytic neoplasms of salivary glands merit further investigation to confirm these observations.

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Ki67, p53, and MMP-1 demonstrated significant staining trends. Although a properly oriented hematoxylin-eosin-stained section including normal marginal tissue is considered to be the gold standard for differentiation of OVH and OVC, this immunohistochemistry panel may serve as a useful diagnostic adjunct in difficult cases.

Lichen planus (LP) is a chronic autoimmune disease. Oral lesions may occur in isolation or in combination with other affected muco-cutaneous sites. Oral LP (OLP) may present as one of the various manifestations of LP or may present as a disease sui generis with a broad range of severity. Despite this disease targeting the oral mucosa, its great impact on quality of life is underrated. In this article, we provide an updated review of the pathophysiology and epidemiology of OLP and offer guidance for its diagnosis and management. We also propose an algorithmic approach to the clinical forms of OLP and a novel staging system to facilitate management decisions.

Ectomesenchymal chondromyxoid tumor is a rare neoplasm of uncertain histogenesis that typically occurs in the anterior dorsal tongue. Recent reports in the literature have described rare examples of gingival, palatal and tonsillar lesions. Histologically, ectomesenchymal chondromyxoid tumors are typically well-circumscribed, lacking overtly aggressive features. Herein we report a tumor arising in the right mandible that is morphologically and molecularly consistent with ectomesenchymal chondromyxoid tumor. This case furthers awareness of the extra-glossal distribution of this neoplasm; moreover, it suggests that a subset of these tumors have the potential for locally aggressive behaviour.

The dentist's role following the death of a patient in his/her practice has received little attention in the literature. This study determined the prevalence of death within a dental practice. It also investigated methods by which dentists supported grieving survivors, and how frequently dentists received formal bereavement education in dental school. A perceived need for training in death and dying was also investigated. A survey was mailed to 200 randomly selected general dental practitioners in Ontario, Canada. It was found that (1) the vast majority of respondents (86%) had experienced the death of a patient within the past 12 months; (2) support methods included sending sympathy cards (79.3%), sending flowers (34.5%), attending the funeral or wake (23%), or visiting/calling survivors (11.5%); (3) only 4% of respondents reported receiving formal bereavement education during dental school; and (4) 61% believed bereavement education should be included in the dental school curricula. While the majority of dentists in this study provided bereavement support and believed they could effectively comfort grieving persons, these dentists experienced significant stress when dealing with issues of death and bereavement. The stress may be explained by inadequate education and exposure to the issues of death and dying.

An 86-year female patient was referred to us for assessment of lip lesions and numerous cutaneous warty growths of 6-month duration. She had mild dysphagia but no systemic symptoms, including weight loss. Her only medication was risedronate for osteoporosis and she was otherwise healthy. Examination revealed confluent fine papillomatosis across the lip vermillion (Fig 1), which diffusely affected the mucosa of the oral cavity and oropharynx. There were several wartlike papules affecting the skin of her face, neck, and extremities (Fig 2). There was no cutaneous hyperpigmentation or velvety thickening.Histologic examination of cutaneous and mucosal lesions showed hyperkeratosis, acanthosis, and papillomatosis but no viral inclusion or vacuolar degeneration of keratinocytes. There was no evidence of human papillomavirus (HPV) by polymerase chain reaction. Results of complete blood count and serum chemistry were normal but tumor markers showed elevated carcinoembryonic antigen (19.3 ug/L; normal, 0 to 4 ug/L), which was suggestive of a gastrointestinal tract neoplasm. A computed tomography scan showed marked mural thickening of the gastric body and antrum and several enlarged, confluent upper abdominal lymph nodes. Upper gastrointestinal endoscopy revealed gastric mucosal friability and ulceration. Biopsies demonstrated a poorly differentiated carcinoma. Palliative measures were provided when the patient experienced a rapid deterioration in health, and she died after 3 months.The eruption of wart-like papules was suggestive of a viral genesis but, surprisingly, there was no evidence to support the presence of