Page 53 - AAOMP Meeting 2019

POSTER ABSTRACTS - TUESDAY, JUNE 11, 2019

#57 MARJOLIN’S ULCER INVOLVING THE UPPER LIP: A CASE REPORT
Dr. Devaki Sundararajan (Boston University), Dr. Vikki Noonan (Boston University), Dr. Steven
Caldroney (Boston University School of Dental Medicine), Dr. Andrew Salama (Boston University)
Marjolin’s ulcers are uncommon and represent malignant transformation of scar tissue. Such ulcers tend to
develop mainly in burn scars but have also been reported at other traumatized tissue sites such as vaccination
scars, amputation stumps, and chronically traumatized wounds. A majority of Marjolin’s ulcers represent
squamous cell carcinoma at biopsy and less commonly basal cell carcinoma. Rarely, Marjolin’s ulcers can
represent a melanoma or sarcoma. The most common location for squamous cell carcinoma arising from a
burn scar is the extremities followed by the head and neck area. Although most patients are adults at the time
of diagnosis, Marjolin’s ulcers can develop in any age group. Burn injury that is left to heal by secondary
intention without skin graft, incompletely- healed burn wounds, or repeated trauma to a burn scar resulting in
ulceration are considered to be some of the risk factors for development of a Marjolin’s ulcer. We present a
case of a Marjolin’s ulcer involving the left upper lip in a 49 year-old male with a history of burn at that site
and with a histopathologic diagnosis of poorly differentiated squamous cell carcinoma. The etiopathologic
factors, clinical presentation, treatment, and prognosis of this uncommon lesion are discussed.

#58 PALE (CLEAR) CELL ACANTHOMA OF THE PALATE
Mr. Dan Ho (University of Minnesota School of Dentistry), Dr. Prokopios Argyris (University of
Minnesota School of Dentistry), Dr.
Andrew Nelson (University of Minnesota School of Medicine), Dr. Ioannis Koutlas (University of
Minnesota)
Objective:Clear Cell Acanthoma (CCA), also known as pale cell acanthoma, represents a rare benign
epidermal tumor with strong predilection for the lower extremities of middle-aged and elderly individuals
(50-70 years of age), and no frank gender preference. The etiology of CCA is poorly understood, although
recent clinical and immuno- histochemical evidence favors a localized psoriasiform reaction. Well-
documented intraoral CCAs are scarce with only one previously reported example, affecting the vermillion
mucosa of the lower lip. Herein, we report the clinicopathologic and immunohistochemical features, and
HPV status of an ostensible example of oral CCA. Findings: A 58-year-old female presented with a well-
circumscribed, asymptomatic, exophytic, pedunculated and erythematous nodule of the right hard palate,
measuring 0.7 cm in greatest dimension. The clinical differential diagnosis included papilloma and verruca
vulgaris. Microscopically, the lesion featured parakeratosis and acanthosis with neutrophilic microabscesses
and broad elongated rete pegs. In areas, epithelial cells within the spinous cell layer exhibited pale or clear
cytoplasm without nuclear pleomorphism, mitoses or cytologic atypia. The supporting connective tissue
revealed mild chronic inflammation with few scattered neutrophils. P.A.S histochemical stain with and
without diastase disclosed the presence of cytoplasmic glycogen in the pale cells. Additionally, glycogen-
rich epithelial cells stained strongly for EMA and were negative for podoplanin (D2-40). Ki-67
immunostaining was confined to the basal cell layer of the epithelium. A diagnosis of CCA was rendered.
The lesion was negative for human papillomavirus (HPV) infection, as assessed by HPV-DNA PCR using the
MY09/11 primers for the L1 conserved region.
Conclusions: CCA is an uncommon probably reactive cutaneous lesion with distinctive histopathologic
features. Intraoral involvement is rare, although the possibility of underdiagnosis seems plausible.
Transcriptionally active HPV infection does not appear to contribute to the pathogenesis of oral CCA.