The Significance of Surface Ulceration as a Sign of Malignancy in Exophytic Oral Mucosal Lesions: Myth or Fact?

Allon, Irit; Allon, Dror M.; Anavi, Yakir; Kaplan, Ilana

doi:10.1007/s12105-012-0413-0

Cited by 10 publications

(13 citation statements)

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“…The study included only diagnostic biopsies which were microscopically diagnosed as benign tumors, while those lacking information on clinical presentation were excluded. The pre-biopsy clinical differential diagnoses with which the biopsies were submitted were classified into reactive/ developmental lesions, benign tumors or malignancy, as previously described ( 27 ). In cases that included more than a single provisional diagnosis, the analysis included the classification which was the most severe possibility.…”

Section: Methodsmentioning

confidence: 99%

The clinical characteristics of benign oral mucosal tumors

Allon¹,

Kaplan²,

Gal³

et al. 2014

Med Oral

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Objectives: To investigate the clinical characteristics and pre-biopsy provisional diagnoses of benign oral mucosal tumors. Material and Methods: A 10- year retrospective analysis of all benign tumors of the oral mucosa, from a university- affiliated oral and maxillofacial surgery department. Results: 146 benign tumors were included. The mean age was 49.6 years, with an approximately equal gender distribution. The most prevalent tumor types were lipomatous tumors (27.4%), vascular (23.3%), and salivary gland tumors (16.5%). Tongue, labial and buccal mucosa were the most frequently involved sites. The vast majority (98.6%) presented as non-ulcerated masses. Only 2 (1.4%) presented as ulcerated masses. The clinical provisional diagnosis correctly classified lesions as non-malignant in 93.3%. In only 9 (6.7%) suspicion of malignancy was included in the provisional diagnosis. However, benign neoplasia was unsuspected in 42.1% of tumors. These cases were clinically classified as reactive. Conclusions: Benign tumors were most likely to be clinically correctly classified as non-malignant, but even in the setting of experienced oral surgeons, neoplasia was unsuspected in more than 40% of cases. This data strongly supports the need to biopsy every oral mucosal mass, since inaccurate clinical evaluation of the lesion’s biological nature was a frequent event. Key words:Malignant, benign, reactive, ulcerated mass, non-ulcerated mass, clinical diagnosis.

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Section: Methodsmentioning

confidence: 99%

The clinical characteristics of benign oral mucosal tumors

Allon¹,

Kaplan²,

Gal³

et al. 2014

Med Oral

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“…11 As irritation fibromas can grow in various sites in the oral cavity, they may interfere with functional movements such as mastication and speech and may also become ulcerated due to trauma inflicted by these masticatory forces or other sources of irritation. 12 Based upon surface changes visualized microscopically, these types of irritation fibromas may be given a diagnosis of ulcerated irritation fibroma. Regardless of this designation, ulcerated irritation fibromas demonstrate similar clinical and prognostic features to nonulcerated irritation fibromas.…”

Section: Chapter 4: Discussionmentioning

confidence: 99%

“…30 Allon et al reported that surface ulceration was clinically recorded in 9.4% of exophytic oral lesions in their study and this was confirmed by microscopic evidence in 100% of the cases. 12 However, 3.5% of the clinically non-ulcerated lesions demonstrated microscopic ulceration. 12 Houston et al evaluated 464 giant cell fibromas and histologically described the lesions as bosselated nodules composed of loosely arranged fibrous connective tissue.…”

Section: Soft Tissue Lesionsmentioning

confidence: 99%

“…12 However, 3.5% of the clinically non-ulcerated lesions demonstrated microscopic ulceration. 12 Houston et al evaluated 464 giant cell fibromas and histologically described the lesions as bosselated nodules composed of loosely arranged fibrous connective tissue. 31 The authors found that the consistent diagnostic feature of these lesions was the presence of large stellate and multinucleated giant cells.…”

Section: Soft Tissue Lesionsmentioning

confidence: 99%

“…The authors speculated that the presence of surface ulcerations may be sizerelated and site-relatedas reactive lesions grow in various sites, they may interfere with functional movements such as mastication and speech. 12 Regardless of the designation as ulcerated, ulcerated irritation fibromas are treated with simple surgical excision and have almost no propensity for recurrence, similar to non-ulcerated irritation fibromas.…”

Section: Soft Tissue Lesionsmentioning

confidence: 99%

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Retrospective histopathologic evaluation of fibroblastic versus myofibroblastic entities of the oral mucosa

Desai¹

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The objective of this study is to use immunohistochemistry to determine whether myofibroblastic proliferations (MFPs) are a distinct entity or a variation of other fibroblastic entities. Staining patterns of vimentin, SMA and CD34 are evaluated in irritation fibromas, ulcerated fibromas, giant cell fibromas, inflammatory fibrous hyperplasias, focal keratosis and chronic mucositis, used in this study as a control group, and MFPs. This study assesses whether MFPs demonstrate similar staining patterns of vimentin, SMA and CD34 to the aforementioned lesions and if these stains are adequate in differentiating the entities. Upon IRB approval, 46 cases of irritation fibroma, 45 cases of ulcerated irritation fibroma, 44 cases of giant cell fibroma, 47 cases of focal keratosis and chronic mucositis, and 23 cases of MFPs were collected. Hematoxylin and eosin-stained slides were reviewed and immunohistochemistry of vimentin, SMA and CD34 was performed. Staining patterns were graded as 0, 1 and 2 (≤25%; ≤25-50%; and ≥50% respectively). Differences were analyzed by the Kruskal-Wallis exact test and Dunn's test for pairwise comparisons. Vimentin demonstrated grade 2 positivity in all groups with 6.5% and 4.4% of irritation fibromas and MFPs demonstrating grade 1 positivity, respectively. Smooth muscle actin was strongly positive in MFPs (78.3%, grade 2, p < 0.05) but also demonstrated positivity in focal keratosis and chronic mucositis (2.1% grade 1), giant cell fibromas (4.6% grade 1, 4.6% grade 2), inflammatory fibrous hyperplasias (13.6% grade 1, 13.6% grade 2) and ulcerated irritation fibromas (6.7% grade 2, 8.9% grade 1) though this was not statistically significant. CD34 demonstrated statistically significant positivity in irritation fibromas (87% grade 2, 2.2% grade 1), ulcerated irritation fibromas (73.3%

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Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework

Babahaji,

Ganeshan,

Nguyen

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveCritical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies.Study DesignA consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations.SettingAn online questionnaire was distributed in July 2023.MethodsThe questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W‐NASs) to represent the perceived importance of each feature, scaled from 0 to 1.ResultsGeneral concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W‐NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W‐NAS, 0.67). Similar analyses were performed for features in each case.ConclusionThe implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision‐making during nasal endoscopy.

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The Significance of Surface Ulceration as a Sign of Malignancy in Exophytic Oral Mucosal Lesions: Myth or Fact?

Cited by 10 publications

References 10 publications

The clinical characteristics of benign oral mucosal tumors

The clinical characteristics of benign oral mucosal tumors

Retrospective histopathologic evaluation of fibroblastic versus myofibroblastic entities of the oral mucosa

Features of Importance in Nasal Endoscopy: Deriving a Meaningful Framework

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