Page 29 - AAOMP Meeting 2019

POSTER ABSTRACTS - TUESDAY, JUNE 11, 2019

#9 COMPARISON OF SPINDLE CELL LESIONS OF ORAL MUCOSA AND JAWBONES-A
RETROSPECTIVE PATHOLOGICAL ANALYSIS
Dr. Letizia Mamber (Tel- Aviv University), Prof. Marilena Vered (Tel- Aviv University), Prof. Abraham
Hirshberg (Tel- Aviv University), Prof. Ilana Kaplan (Tel- Aviv University)
Introduction: Lesions composed microscopically of spindle cells can be reactive, benign or malignant
tumors, derived from a variety of origins. There is sparse specific literature regarding oral lesions.
Objectives:To investigate the spectrum of spindle cell lesions with comparison between oral soft tissue
and jaw- bones.
Materials & Methods: Retrospective analyses, archives of oral pathology, 1996-2018.
Results:18,897 biopsies were searched. 877 (4.6%), cases were included, 70% in soft tissues, 30% in jaws.
Over 90% of these were benign, with 9 (1%) malignant in soft tissues and 15 (7%) malignant in jawbones.
In soft tissues the most prevalent lesions were peripheral ossifying fibroma 271 (44%), peripheral giant cell
granu- loma 234 (39%), benign nerve sheath tumor 22 (3%),peripheral odontogenic fibroma 20 (3%), oral
focal mucinosis
14 (2%) and nodular fasciitis 8 (1%). 86% of soft tissue lesions were reactive, 14% were neoplastic.
9(1%) cases of malignant soft tissue tumors included 3 melanomas, 3 Kaposi’s sarcoma and 1 each
spindle cell carcinoma, metastatic rhabdomyosarcoma and malignant histiocytoma.
In the jaws lesions included central giant cell granuloma 79 (30%), fibro-osseous lesions 64 (26%), central
ossifying fibroma 38 (15%), central odontogenic fibroma 33(13%), cemento-osseous dysplasia 18 (7%),
odontogenic myxoma
7 (2%) and desmoplastic fibroma 3 (1%). Malignant jaw lesions 19 (7%) were all sarcomas.
86% of soft tissue lesions were of odontogenic or periodontal ligament origin and only 33% of central
lesions were of odontogenic origin.
Conclusions: Over 90% of all cases were benign, with a higher prevalence of spindle cell malignancies
in the jawbones. The majority (86%) of the soft tissue lesions were reactive. In the jaws, 33% were
clearly neoplastic, whereas the remainder were of undetermined nature. Odontogenic/periodontal
ligament origin was significantly more prevalent in soft tissue lesions than in jaw lesions.

#10 EBV-POSITIVE ATYPICAL LYMPHOCYTIC PROLIFERATION IN AN IMMUNOSUPPRESSED
PATIENT WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A DIAGNOSTIC DILEMMA
Dr. Stephen Roth (Long Island Jewish Medical Center at Hofstra/Northwell Zucker School of
Medicine), Dr. John Fantasia (Long Island Jewish Medical Center at Hofstra/Northwell Zucker
School of Medicine)
Objectives: Immunosuppressed patients, such as those having an autoimmune disease, transplant
recipients, acquired immunodeficiencies, and elderly patients exhibiting immunosenescence, are at risk of
both lymphoma and infection. Ulcerated lesions in these patient populations with an atypical lymphocytic
proliferation and Epstein-Barr virus (EBV) positivity are problematic; the differential diagnosis includes
EBV-related lymphomas and EBV-related mucocutaneous ulcers. Often, EBV-related mucocutaneous ulcers
resolve with the withdrawal of immunosuppressive agents or restored immunocompetence. However, many
patients require the causative immunosuppressive therapy, thus discontinuance of such therapy can be
problematic. Stopping immunosuppression to allow confirmation of the suspected diagnosis of EBV-related
mucocutaneous ulcer and ruling out a lymphoma is challenging. We hope to highlight the difficulty in
differentiating these entities and in counselling these patients to pursue appropriate care, presenting one
such case in a patient with systemic lupus erythematosus.
Patients and methods: We describe a case of a palatal ulcer in a 27-year-old female with systemic lupus
erythematosus. The histologic exam of the ulcer revealed an atypical and large B cell population that was
EBER positive in both perivascular and nested patterns admixed with extensive necrosis. The differential
diagnosis includes an EBV-positive diffuse large B-cell lymphoma vs. an EBV-related mucocutaneous
ulcer resembling a diffuse large B-cell lymphoma.
Conclusion: Differentiating between an EBV-related lymphoma and an EBV-related mucocutaneous ulcer
is difficult from a histologic and molecular standpoint. The WHO describes EBV-related mucocutaneous
ulcers that mimic diffuse large B-cell lymphomas, polymorphic post-transplant lymphopoliferative disorders,
and Hodgkin-like morphology. Clinical considerations and course must be weighed before advising the
best route of care for a patient presenting with an ulcerative lesion and the described histologic and
molecular features. Consideration must be given to the patient’s underlying conditions that require
immunosuppression in planning the best course of action.