Publications by authors named "Elizabeth A Bilodeau"

37 Publications

Microsecretory Adenocarcinoma of Salivary Glands: An Expanded Series of 24 Cases.

Head Neck Pathol 2021 May 12. Epub 2021 May 12.

Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.

Microsecretory adenocarcinoma (MSA) is a recently described salivary gland tumor with a characteristic histologic and immunophenotypic profile and recurrent MEF2C-SS18 fusions. Because only six cases of MSA have been published, its complete clinicopathologic spectrum is unclear, and its biologic behavior has not been documented. Here, we present an updated and expanded experience of 24 MSA cases. All cases of MSA were obtained from the authors' files. Immunohistochemistry for S100, SOX10, p63, p40, SMA, calponin, and mammaglobin was performed. Molecular analysis was performed by targeted RNA sequencing, SS18 break apart fluorescence in situ hybridization, and/or reverse transcriptase polymerase chain reaction for MEF2C-SS18 fusion. Clinical follow-up was obtained from medical records. A total of 24 MSA cases were collected, from 13 women and 11 men, ranging from 17 to 83 years (mean 49.5 years). The vast majority (23 of 24) arose in the oral cavity, with the palate (n = 14) and buccal mucosa (n = 6) as the most frequent subsites. Tumors showed consistent histologic features including: (1) microcystic tubules, (2) flattened intercalated duct-like cells, (3) monotonous oval hyperchromatic nuclei, (4) abundant basophilic luminal secretions, (5) fibromyxoid stroma, and (6) circumscribed borders with subtle infiltration. The tumors were very consistently positive for S100 (24 of 24), p63 (24 of 24), and SOX10 (14 of 14) and negative for p40 (0 of 21), calponin (0 of 12) and mammaglobin (0 of 16), while SMA (4 of 20) was variable. MEF2C-SS18 fusion was demonstrated in 21 of 24 cases; in the remaining 3 cases with insufficient RNA, SS18 break apart FISH was positive. Treatment information was available in 17 cases, all of which were managed with surgery only. In 14 cases with follow-up (1-216 months, mean 30), no cases recurred or metastasized. MSA is a distinct salivary gland neoplasm with remarkably consistent clinical, histologic, immunophenotypic, and genetic features that generally behaves in an indolent manner following surgery alone. These observations solidify MSA as a unique, low-grade salivary gland carcinoma that warrants inclusion in the next version of the WHO classification of head and neck tumors.
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http://dx.doi.org/10.1007/s12105-021-01331-7DOI Listing
May 2021

Odontogenic and Developmental Oral Lesions in Pediatric Patients.

Head Neck Pathol 2021 Mar 15;15(1):71-84. Epub 2021 Mar 15.

Academic Unit of Oral and Maxillofacial Medicine and Pathology, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.

This article reviews odontogenic and developmental oral lesions encountered in the gnathic region of pediatric patients. The process of odontogenesis is discussed as it is essential to understanding the pathogenesis of odontogenic tumors. The clinical presentation, microscopic features, and prognosis are addressed for odontogenic lesions in the neonate (dental lamina cysts/gingival cysts of the newborn, congenital (granular cell) epulis of the newborn, melanotic neuroectodermal tumor, choristoma/heterotopia, cysts of foregut origin), lesions associated with unerupted/erupting teeth (hyperplastic dental follicle, eruption cyst, dentigerous cyst, odontogenic keratocyst/keratocystic odonogenic tumor, buccal bifurcation cyst/inflammatory collateral cyst) and pediatric odontogenic hamartomas and tumors (odontoma, ameloblastic fibroma, ameloblastoma, adenomatoid odontogenic tumor, primordial odontogenic tumor). Pediatric odontogenic and developmental oral lesions range from common to rare, but familiarity with these entities is essential due to the varying management implications of these diagnoses.
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http://dx.doi.org/10.1007/s12105-020-01284-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010029PMC
March 2021

Proliferative Verrucous Leukoplakia: An Expert Consensus Guideline for Standardized Assessment and Reporting.

Head Neck Pathol 2021 Jun 7;15(2):572-587. Epub 2021 Jan 7.

Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.

The many diverse terms used to describe the wide spectrum of changes seen in proliferative verrucous leukoplakia (PVL) have resulted in disparate clinical management. The objective of this study was to produce an expert consensus guideline for standardized assessment and reporting by pathologists diagnosing PVL related lesions. 299 biopsies from 84 PVL patients from six institutions were selected from patients who had multifocal oral leukoplakic lesions identified over several years (a minimum follow-up period of 36 months). The lesions demonstrated the spectrum of histologic features described in PVL, and in some cases, patients developed oral cavity squamous cell carcinoma (SCC). An expert working group of oral and maxillofacial and head and neck pathologists reviewed microscopic features in a rigorous fashion, in combination with review of clinical photographs when available. The working group then selected 43 single slide biopsy cases for whole slide digital imaging (WSI) review by members of the consensus conference. The digital images were then reviewed in two surveys separated by a washout period of at least 90 days. Five non-PVL histologic mimics were included as controls. Cases were re-evaluated during a consensus conference with 19 members reporting on the cases. The best inter-observer diagnostic agreement relative to PVL lesions were classified as "corrugated ortho(para)hyperkeratotic lesion, not reactive" and "SCC" (chi-square p = 0.015). There was less than moderate agreement (kappa < 0.60) for lesions in the "Bulky hyperkeratotic epithelial proliferation, not reactive" category. There was ≥ moderate agreement (> 0.41 kappa) for 35 of 48 cases. This expert consensus guideline has been developed with support and endorsement from the leadership of the American Academy of Oral and Maxillofacial Pathology and the North American Society of Head and Neck Pathologists to recommend the use of standardized histopathologic criteria and descriptive terminology to indicate three categories of lesions within PVL: (1) "corrugated ortho(para)hyperkeratotic lesion, not reactive;" (2) "bulky hyperkeratotic epithelial proliferation, not reactive;" and (3) "suspicious for," or "squamous cell carcinoma." Classification of PVL lesions based on a combination of clinical findings and these histologic descriptive categories is encouraged in order to standardize reporting, aid in future research and potentially guide clinical management.
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http://dx.doi.org/10.1007/s12105-020-01262-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8134585PMC
June 2021

Multiple oral soft tissue nodules in a Caucasian septuagenarian.

Int J Dermatol 2021 Apr 5;60(4):e122-e124. Epub 2020 Jun 5.

Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1111/ijd.14968DOI Listing
April 2021

Recurrent oral ulceration: Etiology, classification, management, and diagnostic algorithm.

Periodontol 2000 2019 06;80(1):49-60

Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.

Recurrent oral ulcerations are manifestations of a heterogeneous set of both general and more-or-less specific oral diseases due to numerous potential etiologies, including, but not limited to, infections, medications, autoimmune disease, and other systemic disease. This review discusses the pathogenesis, clinical presentation, diagnosis, and management of the common causes of recurrent oral ulceration. The following types/etiologies of recurrent oral ulceration are covered: traumatic ulceration, chemical ulceration, recurrent aphthous stomatitis, medication-related ulceration, infectious ulceration, mucocutaneous disease, and autoimmune/systemic disease. A diagnostic algorithm for recurrent oral ulceration is also presented.
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http://dx.doi.org/10.1111/prd.12262DOI Listing
June 2019

Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study.

Head Neck Pathol 2020 Mar 10;14(1):156-165. Epub 2019 Apr 10.

Southern California Permanente Medical Group, Woodland Hills Medical Center, Woodland Hills, CA, USA.

The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss' kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons' responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.
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http://dx.doi.org/10.1007/s12105-019-01035-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021885PMC
March 2020

Reappraising localized juvenile spongiotic gingival hyperplasia.

J Am Dent Assoc 2019 02 7;150(2):147-153.e2. Epub 2018 Dec 7.

Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion of unknown cause. The purpose of this study is to present a series of LJSGH cases and compare the findings with the literature.

Methods: After obtaining institutional review board approval, cases of biopsy-proven LJSGH from 2008 through 2018 were retrieved from the University of Pittsburgh Oral Pathology Biopsy Service archives and reviewed. In addition, a comprehensive review of the literature was performed.

Results: Twenty-eight cases were identified. No significant sex predilection was noted (male-female ratio, 1.25:1). The age range was from 3 through 64 years (median, 14.5 years). Twenty-six cases (92.9%) affected the anterior facial gingiva, and 27 cases (96.4%) occurred in the maxilla. The most common clinical impression was pyogenic granuloma (55.6%). All cases presented with the same histopathology regardless of patient age. Cytokeratin 19 immunohistochemistry was used to confirm the diagnosis in cases that occurred in patients outside the typically affected demographic.

Conclusions: Our results are in concordance with the literature, with most cases localized to the anterior maxillary gingiva of children and young adults. However, 5 of our cases occurred in adults. Cytokeratin 19 is of diagnostic utility in these cases.

Practical Implications: Although LJSGH is most commonly seen in children and young adults, we present cases occurring in adults. Our series and the literature found that LJSGH is not restricted to juveniles and that it can be multifocal. Dentists should be aware of this when formulating a differential diagnosis. Therefore, the nomenclature may not represent the disease spectrum of these gingival lesions.
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http://dx.doi.org/10.1016/j.adaj.2018.10.001DOI Listing
February 2019

Ectomesenchymal Chondromyxoid Tumor: A Neoplasm Characterized by Recurrent RREB1-MKL2 Fusions.

Am J Surg Pathol 2018 10;42(10):1297-1305

Department of Pathology, UT Southwestern Medical Center, Dallas, TX.

Ectomesenchymal chondromyxoid tumor is a rare and benign neoplasm with a predilection for the anterior dorsal tongue. Despite morphologic heterogeneity, most cases are characterized by a proliferation of bland spindle cells with a distinctive reticular growth pattern and myxoid stroma. The immunophenotype of these neoplasms is likewise variable; most cases express glial fibrillary acid protein and S100 protein, with inconsistent reports of keratin and myoid marker expression. The molecular pathogenesis is poorly understood; however, a subset of cases has been reported to harbor EWSR1 gene rearrangement. Following identification of an RREB1-MKL2 fusion gene by RNA Sequencing in an index patient, a retrospective review of additional cases of ectomesenchymal chondromyxoid tumors was performed to better characterize the clinical, immunohistochemical, and molecular attributes of this neoplasm. A total of 21 cases were included in this series. A marked predisposition for the dorsal tongue was confirmed. Most cases conformed to prior morphologic descriptions; however, hypercellularity, hyalinized stroma, and necrosis were rare attributes not previously emphasized. The neoplastic cells frequently coexpressed glial fibrillary acid protein, S100 protein, keratin, smooth muscle actin, and/or desmin; a single case was found to contain significant myogenin expression. An RREB1-MKL2 fusion product was identified in 19 tumors (90%), a single tumor (5%) had an EWSR1-CREM fusion product, and the remaining case lacked any known fusion gene by RNA Sequencing. The latter 2 cases subtly differed morphologically from many in the cohort. This series illustrates that recurrent RREB1-MKL2 fusions occur in most, perhaps all, cases of ectomesenchymal chondromyxoid tumor.
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http://dx.doi.org/10.1097/PAS.0000000000001096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133728PMC
October 2018

Analytic survey of 57 cases of oral metastases.

J Oral Pathol Med 2018 Mar 30;47(3):275-280. Epub 2018 Jan 30.

University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.

Background: Oral lesions have been reported among the first signs of an undiagnosed metastatic disease. Accurate diagnosis of an occult metastasis remains critical in determining the treatment course. Previous studies regarding oral metastatic tumors present varied data regarding the most frequent metastases to the oral cavity. These discrepancies echo the changes in incidence rates for certain malignancies over time and demonstrate the need for periodic updates in oral metastasis studies.

Methods: Using Text Information Extraction System, a de-identified pathology database, we compiled 57 cases over a period of 19 years using key terms to search for oral metastases.

Results: For both males and females, the most common primary sites were lung (21.1%), liver (12.3%), breast (10.5%), kidney (10.5%), and colorectal (8.8%). We found an equal number of lung and breast metastases in females and metastases from the liver to be the most prevalent for males. In most of our cases (54.9%), the patient had no history of the primary malignancy and the oral lesion preceded awareness of the widespread cancer.

Conclusions: As a departure from many previous case series, we found lung and breast metastases to be equally numerous in women and liver as the most common oral metastasis in men. Also, we identified a tendency for the patient to present with a previous history in certain malignancies, such as breast cancer, whereas in other malignancies, such as renal cell carcinoma, our data demonstrated a propensity to present in the oral cavity without history of a primary tumor.
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http://dx.doi.org/10.1111/jop.12672DOI Listing
March 2018

Relevance of smoking interventions for dental clinic patients with smoking-related disease.

J Public Health Dent 2018 03 27;78(2):154-158. Epub 2017 Oct 27.

Department of Diagnostic Sciences, University of Pittsburgh, School of Dental Medicine, Pittsburgh, PA, USA.

Objectives: Despite a decline in cigarette smoking in the United States, high rates persist among the socioeconomically underserved who consequently are at risk for smoking-related disease (SRD). Since academically affiliated dental clinics are more likely to encounter underserved patients, smoking interventions could address both the oral and systemic risks of continued smoking. To determine the relevance of providing smoking counseling in the context of SRD, this study examined the prevalence of smoking and its associations with socioeconomic status (SES), SRD and its sequela, and medication use.

Methods: Socioeconomic and smoking status was determined from 1,797 electronic health records of a sample of patients at a Pennsylvania dental clinic in 2010. Low SES included patients who were covered by a Medicaid program (MA) or "self-payers." High SES encompassed those with an employment-based commercial dental insurance (COM). Self-reported smoking rates were compared with patients' SES, SRDs or sequela, and medications being used for the management of their SRDs.

Results: Overall, 41.7 percent of these patients were smoking. Smoking was related to SES with the highest rate (52.7 percent) among MA patients compared with 31.5 percent in patients with COM. In addition, 37 percent of patients with SRD or sequela and 33 percent who were taking medications for their management were smoking.

Conclusions: Academically affiliated dental clinics are more likely to encounter underserved patients who smoke and have SRD. For greater patient impact and receptivity, it is essential that tobacco cessation interventions emphasize the risks of smoking on systemic as well as oral health.
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http://dx.doi.org/10.1111/jphd.12255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5924571PMC
March 2018

Intraoral Pseudo-Onion Bulb Intraneural Proliferations in a Patient with Hemimandibular Hyperplasia: A Case Report and Review of the Literature.

Head Neck Pathol 2016 Dec 2;10(4):475-480. Epub 2016 May 2.

Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, 15261, USA.

This report and review of the literature describes a case of benign intraoral lesions of perineurial origin in a patient with symptomatic hemimandibular hyperplasia causing partial denture soreness. Perineuriomas are a benign peripheral nerve sheath tumor composed of perineurial cells. Intraoral perineuriomas are an extremely rare entity. Two main types of perineuriomas have been described: intraneural and extraneural perineuriomas. A third, similar entity, called an intraneural pseudoperineuriomatous proliferation, has recently been proposed in the literature as a separate and distinctive diagnosis. This report describes the histologic and clinical presentation of intraneural pseudoperineuriomatous proliferations in a patient with hemimandibular hyperplasia.
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http://dx.doi.org/10.1007/s12105-016-0725-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082049PMC
December 2016

Cervicofacial subcutaneous emphysema: a clinical case and review of the literature.

Gen Dent 2016 May-Jun;64(3):68-71

Cervicofacial subcutaneous emphysema is a known, rare complication of both dental and surgical procedures. Cervicofacial subcutaneous emphysema arises when air is forced beneath the tissues, leading to swelling, crepitus on palpation, and the potential of the air to spread along the fascial planes. This report presents a case of cervicofacial subcutaneous emphysema in a patient who had undergone surgical extraction of the mandibular right first molar. The dentist in this case used a compressed air-driven handpiece to section the tooth. This forced air, under high pressure, into the subcutaneous tissue spaces. The patient presented with severe hemifacial swelling and crepitus on palpation. Computed tomographic examination revealed air subcutaneously, and a diagnosis of cervicofacial subcutaneous emphysema was made.
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September 2017

A subset of ectomesenchymal chondromyxoid tumours of the tongue show EWSR1 rearrangements and are genetically linked to soft tissue myoepithelial neoplasms: a study of 11 cases.

Histopathology 2016 Oct 6;69(4):607-13. Epub 2016 May 6.

Division of Oral and Maxillofacial Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.

Aims: Ectomesenchymal chondromyxoid tumour (ECT) is a rare, benign intraoral neoplasm showing a predilection for the anterior dorsum of the tongue. The World Health Organization includes ECT in the pathological spectrum of soft tissue myoepithelioma. EWS RNA-binding protein 1 gene (EWSR1) rearrangement is found in 45% of cutaneous, soft tissue and bone myoepithelial neoplasms, and pleomorphic adenoma gene 1 (PLAG1) aberrations are found in 37% of EWSR1-negative soft tissue myoepitheliomas. The aim of this study was to evaluate the presence of EWSR1 and PLAG1 rearrangements in ECTs.

Methods And Results: Eleven formalin-fixed, paraffin-embedded ECTs were evaluated with fluorescence in-situ hybridization probes for EWSR1 (22q12) and PLAG1 (8q12). Among the 11 ECTs tested, three (27.3%) showed EWSR1 rearrangement in >15% of tumour cells, whereas eight (72.7%) cases did not show EWSR1 rearrangement. Eight of nine (89%) ECTs showed gain of EWSR1, probably representing gain of all or part of chromosome 22, in a varying proportion of neoplastic cells ranging between 1.4% and 27.9%. PLAG1 rearrangement was not detected in the successfully hybridized tissue sections (7/11). No correlation was observed between the molecular and histopathological findings, such as morphology of the neoplastic cells, the presence of atypia, and matrical type.

Conclusions: We identified EWSR1 rearrangement in >25% of ECTs. These results suggest that some ECTs are at least genetically related to myoepithelioma of the soft parts. Finally, PLAG1 aberrations do not appear to be critical in the pathogenesis of ECT of the tongue.
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http://dx.doi.org/10.1111/his.12973DOI Listing
October 2016

Mixed radiopaque and radiolucent lesion of the maxillary sinus: a radiographic challenge.

Gen Dent 2015 Sep-Oct;63(5):74-7

This article describes 3 patients, each of whom presented with an asymptomatic mixed radiopaque and radiolucent lesion of the maxillary sinus associated with a nonvital tooth. Based on the radiographic findings, a diagnosis of a collapsed (ruptured) radicular cyst was rendered in each case. A tissue biopsy was performed in 1 case, and the results supported the diagnosis. The radiographic and histopathological features, etiology, pathophysiology, and radiographic differential diagnosis of this condition are discussed.
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April 2016

An in vivo model to assess magnesium alloys and their biological effect on human bone marrow stromal cells.

Acta Biomater 2015 Dec 28;28:234-239. Epub 2015 Aug 28.

Department of Periodontics and Preventive Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address:

Unlabelled: Magnesium (Mg) alloys have many unique qualities which make them ideal candidates for bone fixation devices, including biocompatibility and degradation in vivo. Despite a rise in Mg alloy production and research, there remains no standardized system to assess their degradation or biological effect on human stem cells in vivo. In this study, we developed a novel in vivo model to assess Mg alloys for craniofacial and orthopedic applications. Our model consists of a collagen sponge seeded with human bone marrow stromal cells (hBMSCs) around a central Mg alloy rod. These scaffolds were implanted subcutaneously in mice and analyzed after eight weeks. Alloy degradation and biological effect were determined by microcomputed tomography (microCT), histological staining, and immunohistochemistry (IHC). MicroCT showed greater volume loss for pure Mg compared to AZ31 after eight weeks in vivo. Histological analysis showed that hBMSCs were retained around the Mg implants after 8 weeks. Furthermore, immunohistochemistry showed the expression of dentin matrix protein 1 and osteopontin around both pure Mg and AZ31 with implanted hBMSCs. In addition, histological sections showed a thin mineral layer around all degrading alloys at the alloy-tissue interface. In conclusion, our data show that degrading pure Mg and AZ31 implants are cytocompatible and do not inhibit the osteogenic property of hBMSCs in vivo. These results demonstrate that this model can be used to efficiently assess the biological effect of corroding Mg alloys in vivo. Importantly, this model may be modified to accommodate additional cell types and clinical applications.

Statement Of Significance: Magnesium (Mg) alloys have been investigated as ideal candidates for bone fixation devices due to high biocompatibility and degradation in vivo, and there is a growing need of establishing an efficient in vivo material screening system. In this study, we assessed degradation rate and biological effect of Mg alloys by transplanting Mg alloy rod with human bone marrow stromal cells seeded on collagen sponge subcutaneously in mice. After 8 weeks, samples were analyzed by microcomputed tomography and histological staining. Our data show that degrading Mg alloys are cytocompatible and do not inhibit the osteogenic property of hBMSCs in vivo. These results demonstrate that this model can be used to efficiently assess the biological effect of corroding Mg alloys in vivo.
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http://dx.doi.org/10.1016/j.actbio.2015.08.037DOI Listing
December 2015

Seven Cases of Proliferative Verrucous Leukoplakia: The Need for a High Clinical Suspicion Among Dental Practitioners.

J Mich Dent Assoc 2015 Jun;97(6):48-51, 95

Proliferative verrucous leukoplakia is a distinct precancerous condition with a high rate of recurrence and malignant transformation over time. Proliferative verrucous leukoplakia has no specific histopathologic presentation; therefore, emphases must be on clinical presentation and history to make a diagnosis giving the need for a high clinical suspicion. This condition is very important for the general dentist to recognize. Here we describe the clinical and microscopic features of seven cases of proliferative verrucous leukoplakia, with two cases which demonstrated malignant transformation (hybrid carcinoma and squamous cell carcinoma).
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June 2015

Medical conditions and medication use in a U.S. dental school clinic population.

Oral Surg Oral Med Oral Pathol Oral Radiol 2015 Apr 7;119(4):379-84. Epub 2015 Jan 7.

Bradford Dental Center, Bradford Regional Medical Center, Bradford, PA.

Objectives: The aim of the study was to characterize coexisting medical conditions and medication use in patients treated at a US dental school in 2010 and to assess their implications on providing dental care.

Study Design: Data on the types and prevalence of self-reported medical conditions and the use of medications were extracted from the electronic health records of 1797 adult patients and compared against their socioeconomic status (SES).

Results: Within this sample, 8.7% were classified as American Society of Anesthesiologists (ASA) physical status (PS) 1. The remainder were designated PS 2 to PS 4 for smoking, having one or more medical conditions that ranged from myasthenia gravis (<1%) to hypertension (24%), or both. Medications for hypertension were the most frequently reported (23%), followed by more than 40 other classes of drugs.

Conclusions: Dental practitioners must be prepared to treat larger numbers of older patients, whose life expectancies continue to increase as advances in pharmacotherapeutics and biomedical technologies improve the control of their chronic medical conditions.
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http://dx.doi.org/10.1016/j.oooo.2014.12.016DOI Listing
April 2015

Ameloblastic carcinoma of the mandible manifesting as an infected odontogenic cyst.

Gen Dent 2015 Jan-Feb;63(1):e1-4

Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor. Although most ACs appear to originate de novo, some cases originate from a pre-existing ameloblastoma. This article presents the case of a 69-year-old man with an AC in the left body of the mandible. Radiographically, the lesion resembled an odontogenic cyst surrounding an impacted tooth. While ACs tend to have aggressive features that distinguish them from their benign counterparts, some are more subtle in their presentation. Therefore, it is important that dentists rule out malignancy in lesions that do not display obvious radiographic features.
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November 2016

A comparative analysis of LEF-1 in odontogenic and salivary tumors.

Hum Pathol 2015 Feb 12;46(2):255-9. Epub 2014 Nov 12.

Department of Pathology and Laboratory Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15213.

LEF-1 is a nuclear transcription factor of the Wnt pathway that regulates multipotent skin stem cell differentiation. β-Catenin is considered a transcriptional coactivator that interacts with LEF-1.This study evaluates LEF-1 in a variety of odontogenic and salivary tumors and determines the prevalence of β-catenin coexpression. Ninety-eight salivary gland tumors and 51 odontogenic tumors were evaluated for LEF-1 and β-catenin immunohistochemical staining. Positivity was defined as at least 2+ intensity in more than 50% of tumor cells, which required a composite score of 6 or more. LEF-1 was positive in 64% (7/11) of calcifying cystic odontogenic tumors (CCOT). Nuclear β-catenin was present in 82% (9/11) of CCOT. Coexpression of LEF-1 and nuclear β-catenin was noted in all LEF-1-positive CCOT. Strong and diffuse LEF-1 expression was seen in 69% (11/16) of basal cell adenocarcinomas (BCAC) and 63% (5/8) of basal cell adenomas (BA). Nuclear β-catenin was present in 50% (4/8) of BA and 43% (6/14) of BCAC. For BA, 4 of 5 LEF-1-positive tumors showed coexpression of β-catenin, and for BCAC, 5 of 9 LEF-1-positive tumors showed coexpression. In conclusion, this study documents for the first time the presence of LEF-1 expression and nuclear β-catenin coexpression in select basaloid salivary gland tumors and various odontogenic tumors. We demonstrate LEF-1 expression in both BA and BCAC preferentially over other salivary gland tumors suggesting some utility as a diagnostic marker.
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http://dx.doi.org/10.1016/j.humpath.2014.10.018DOI Listing
February 2015

Molecular and genetic aspects of odontogenic lesions.

Head Neck Pathol 2014 Dec 20;8(4):400-10. Epub 2014 Nov 20.

Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, 15261, USA,

In this article we outline the molecular findings of select odontogenic tumors. In each section, we briefly review selected the clinicoradiographic, histologic, immunologic features, focusing on the molecular findings and their applications in practice. The understanding of molecular pathobiology at various other organ sites has developed quite rapidly in recent years, however much remains unknown about the genetic profile of odontogenic tumors. Improved understanding of mutations in odontogenic tumors may clarify classification schema and elucidate targets for novel therapies. Molecular testing will no doubt improve our understanding of odontogenic tumor pathogenesis and will likely be, someday, an important component of routine clinical practice and its role will only increase in the coming years.
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http://dx.doi.org/10.1007/s12105-014-0588-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245404PMC
December 2014

Ectomesenchymal Chondromyxoid Tumor: A Series of Seven Cases and Review of the Literature.

Head Neck Pathol 2015 Sep 18;9(3):315-22. Epub 2014 Nov 18.

Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA,

Ectomesenchymal chondromyxoid tumors (ECT) are rare, benign, intraoral mesenchymal soft tissue tumors that can be diagnostically challenging. In this study the demographic, clinical, histopathologic, and immunohistochemical features of seven ECTs are examined. The differential diagnosis of this rare neoplasm is discussed and the literature is reviewed.
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http://dx.doi.org/10.1007/s12105-014-0578-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542793PMC
September 2015

Hyalinizing clear cell carcinoma of the head and neck: Case series and update.

Head Neck 2016 Mar 18;38(3):426-33. Epub 2015 Jun 18.

Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Background: Hyalinizing clear cell carcinoma (HCCC) is a rare neoplasm of salivary gland origin which is low-grade in nature. In this series, we report on 9 cases of HCCC and update the literature.

Methods: A comprehensive literature search was performed. Our institutional database was queried for cases of HCCC. Pathology reports and slides were reviewed. Data was extracted, including demographics, staging, primary treatment, histopathologic findings, recurrence, and disease status. Statistical analysis was performed using a Pearson's chi-square test.

Results: One hundred thirty-six total cases were included for analysis. The overall recurrence rate was 19.8%. Necrosis was associated with risk of recurrence (p = .003). Positive margins and lymph node status were associated with risk of recurrence. Prognosis was good with only 3 of 82 patients reported dying with disease.

Conclusion: HCCC has an overall good prognosis with potential for aggressive behavior. The presence of necrosis, locoregional disease, or positive margins is associated with risk for recurrence.
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http://dx.doi.org/10.1002/hed.23902DOI Listing
March 2016

A white lesion of the buccal mucosa.

J Am Dent Assoc 2014 Sep;145(9):961-3

Dr. Bilodeau is an assistant professor, Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh.

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http://dx.doi.org/10.14219/jada.2014.62DOI Listing
September 2014

Large B-cell lymphoma of the base of the tongue and oral cavity: a practical approach to identifying prognostically important subtypes.

Oral Surg Oral Med Oral Pathol Oral Radiol 2014 Sep 14;118(3):338-47. Epub 2014 Jun 14.

Professor of Pathology, Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address:

Objective: The aim of this study is to illustrate a practical approach to the identification of prognostically important subtypes of large B-cell lymphomas.

Study Design: Twenty-six cases of large B-cell lymphoma in the base of the tongue and oral cavity were retrieved from 2003 through 2012. All cases were classified based on the 2008 World Health Organization criteria. Hematoxylin-eosin-stained sections, immunohistochemical stains, flow cytometric immunophenotypic data, and fluorescence in situ hybridization studies were performed and evaluated.

Results: Four different subtypes of large B-cell lymphoma were identified: pleomorphic variant mantle cell lymphoma, Epstein-Barr virus-positive diffuse large B-cell lymphoma of the elderly, diffuse large B-cell lymphoma not otherwise specified, and B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma, including a case of double-hit lymphoma.

Conclusions: Diverse subtypes of large B-cell lymphoma were identified in the base of tongue and oral cavity, and illustrate a practical approach to recognizing prognostically important lymphoma subtypes.
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http://dx.doi.org/10.1016/j.oooo.2014.06.002DOI Listing
September 2014

Orofacial dermal fillers: foreign body reactions, histopathologic features, and spectrometric studies.

Oral Surg Oral Med Oral Pathol Oral Radiol 2014 May 20;117(5):617-625. Epub 2014 Jan 20.

Associate Professor, Department of Diagnostic Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.

Objective: The aim of this study is to assess the different histopathologic presentations of dermal filler materials-induced foreign body reactions by spectrometric analyses.

Study Design: Sixteen cases of dermal filler foreign body reactions in the orofacial region were retrieved from the 2006-2013 period. The histologic features were evaluated and categorized into 5 groups (I to V). Unstained deparaffinized sections of representative tissue from one case in each of groups I to IV were sent for spectrometric analysis, along with samples of 2 popular dermal fillers (Juvéderm and Radiesse).

Results: With the help of spectrometric analysis, we were able to correlate the histopathologic presentations with the specific type of dermal filler used.
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http://dx.doi.org/10.1016/j.oooo.2014.01.018DOI Listing
May 2014