Sarah G Fitzpatrick

University of Florida | UF · Department of Oral and Maxillofacial Diagnostic Sciences

Mucinous Adenocarcinoma

Juvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion (BFOL) of the maxillofacial bones with a locally aggressive nature and a high recurrence rate. Murine Double Minute 2 (MDM2) is an oncogene located at chromosome 12 (12q13-15) that inhibits the tumor suppressor gene TP53. The presence of MDM2 gene locus amplification is a u...

Objectives: Autoimmune activation by COVID-19 infection/vaccination has been postulated to be responsible for initiating or reactivating multiple types of oral mucosal immune disorders. These include: oral lichen planus; oral pemphigoid; either bullous pemphigoid or mucous membrane pemphigoid with oral involvement; pemphigus vulgaris with oral inv...

White lesions in the oral cavity may be diverse in etiology and may present with significant clinical and sometimes histologic overlap between categories, making accurate diagnosis difficult at times. Although white lesions of immune and infectious etiology are covered in another article, this article discusses the differential diagnosis between de...

Background: Oral squamous cell carcinoma (OSCC) is a disease typically seen in the elderly, with an established relationship with tobacco and/or alcohol abuse. However, the incidence of OSCC among young adults (defined in this study as ≤ 30 years old) is on the rise. Materials and Methods: With IRB approval, a retrospective search was performed at...

Background Oral melanoacanthoma (OM) is a rare, reactive, and benign proliferation of two cell types: keratinocytes and melanocytes. Biopsy is mandatory to not only confirm the diagnosis but also, rule out other entities, as clinical correlation simply, is not definitive. Aim of the study We present a large series of OM with analysis of demographi...

Introduction Gingival growths are mostly reactive and seldom exhibit significant true neoplastic potential. The typical etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguished and categorized into diagnoses such as pyogenic granuloma, peripheral ossi- fying fib...

Introduction Secretory carcinomas (SC) of minor and major salivary gland (SG) are rare neoplasms that demonstrate microscopic overlap with acinic cell carcinomas (ACC), adenocarcinoma NOS (AdNOS), and mucoepidermoid carcinomas (MEC) respectively. Recently alternative translocations of ETV6-RET gene locus have been recognized in a small group of SC....

Introduction HPV-related benign papillary epithelial neoplasms are common lesions affecting any region of the oral cavity. This study evaluated the trends in frequency, location, and demographics of these lesions over 20 years. Materials and Methods Following IRB approval, the archives of UF Oral Pathology Biopsy Service between 19952015 were quer...

Background Verrucous gingival lesions are common within the spectrum of proliferative verrucous leukoplakia (PVL), and the gingiva is not an unusual location for oral carcinoma. However, non-PVL associated dysplastic gingival lesions appear to be less common and may not progress directly to malignancy. In addition, it appears HPV likely plays a lim...

Introduction Vesiculobullous disorders encompass several rare conditions with varying pathology and morbidity, but similar signs and symptoms. Materials and Methods With IRB approval, the record systems of the UF Oral Medicine and UF Dermatology Clinics were searched for cases diagnosed between 2011 and 2020 of the following disorders: pemphigus v...

Introduction Carcinomatous transformation in odontogenic cysts is rare, with few cases described in the literature. Squamous cell carcinoma (SCC) is the most common form of malignant transformation in odontogenic cysts. Radicular and dentigerous cysts are the most common odontogenic cysts to undergo malignant transformation. We present three cases...

Objective We present a case series of adenomatoid odontogenic tumor (AOT), a benign odontogenic tumor from a large biopsy service. AOT has a limited growth potential and is often seen in children and young adults, between the ages of 10-19 years. AOT has uncertain pathogenesis and studies suggest enamel organ, reduced enamel epithelium, and rests o...

Oral contact stomatitis (OCS) may be caused by oral hygiene products, common foods, and topical agents. OCS is of- ten a diagnostic challenge to health care providers. The purpose of this report is to present a rare case of reversible OCS related to components of electronic cigarettes (EC) not previously reported in the literature. A 55-year-old fe...

Introduction Oral cavity sarcomas are rare and account for 1% of all malignancies in this site. This study aims to evaluate the prevalence, variety and distribution of soft tissue and gnathic sarcoma in the oral cavity. Methods An IRB approved retrospective review encompassing years 2010-2020 of the University of Florida Oral Pathology Biopsy Serv...

Introduction Ameloblastic carcinoma (AC) is a rare malignant primary epithelial odontogenic tumor demonstrat- ing histologic features of ameloblastoma with signs of overt malignancy. In this case series, we describe the clinical, radiographic and histologic features of 3 cases of AC. Methods Three cases of AC were identified from the University of...

Introduction Sjogren syndrome (SS) is a chronic autoimmune rheumatic disease characterized by lymphocytic infiltration of exocrine glands and other organs. The spectrum of clinical manifestations suggests that SS clinical phenotype in children is more heterogeneous than that in adults. The objective of this study was to perform histopathological an...

Introduction Odontogenic keratocyst (OKC) represents approximately 11% of all odontogenic cysts and may be an early sign of Nevoid Basal Cell Carcinoma syndrome (NBCCS). We aim to identify histologic variations in syndromic OKC in patients under 30 years of age that correlate with the protein patched homolog-1 (PTCH-1) immunohistochemical (IHC) sta...

Introduction p53 overexpression is well documented in premalignant lesions of the oral cavity. However, recent studies have shown increased expression of podoplanin (D2-40) in oral dysplasia. This study aims to evaluate the efficacy of both markers in predicting malignant transformation in cases of proliferative verrucous leukoplakia (PVL), a recal...

The calcifying epithelial odontogenic tumor (CEOT), also known as the Pindborg tumor, is a rare benign neoplasm which makes up less than 1% of all odontogenic tumors. The purpose of this study is to describe a series of cases of CEOT spanning 25 years. METHODS: With IRB approval, all cases diagnosed as CEOT between 1994 and 2019 were retrieved from...

Background Oral Melanoacanthoma (OM) is an unusual, likely reactive heavily pigmented, benign epithelial proliferation. OM often grows rapidly mimicking melanoma and leading to anxiety for both the patient and the clinician. We present a large series of OM including demographics, description of clinical appearance and characteristics, histology, an...

Background Burning mouth syndrome (BMS) is a relatively common condition defined as a relentless, idiopathic burning sensation of the oral mucosa after exclusion of other underlying causes of burning. Currently effective treatment is limited mostly to pharmacologic interventions. The use of non-pharmacologic therapy, specifically the use of protect...

Introduction Oral squamous cell carcinoma (OSCC) is typically associated with older adults often with established relationship to tobacco and/or alcohol abuse. OSCC is rare in children and young adults without traditional risk factors. This case series encompasses an archival review of OSCC affecting patients under 30 years of age with analyses of...

Human papillomavirus (HPV)-related benign papillary epithelial neoplasms are common lesions affecting any region of the oral cavity. This study evaluated the trends in frequency, location, and demographics of these lesions over 20 years in a large biopsy service. Following IRB approval, the archives of UF Oral Pathology Biopsy Service between 1995...

Oral lesions may be the initial or only manifestation of leukemia and can be the key to early diagnosis. The varied nature of presenting signs and dentists' general lack of familiarity with oral presentations makes diagnosis challenging. This retrospective review reports a series of cases of leukemia to familiarize dentists with the oral manifestat...

Introduction: Buccal bifurcation cyst is an inflammatory odontogenic cyst and constitutes up to 5% of all odontogenic cysts. The aim of this study was to report a series of cases, review the recent literature, and facilitate recognition and proper treatment of this entity. Methods: With institutional review board approval, the authors retrieved...

Objective: Adenomatoid odontogenic tumor (AOT) is a benign odontogenic tumor with an excellent prognosis, often seen in children and young adults. The aim was to examine the spectrum of clinical, radiographic, and histologic attributes of AOT and assess clinician recognition of this entity. In addition, diagnostic considerations and treatment moda...

Secretory carcinoma (SC) is an uncommon salivary gland neoplasm of the oral cavity that microscopically may mimic acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC). This study describes a series of SC in minor glands with a literature review. We performed a retrospective search for oral SC, within the archives of the University of Flor...

Gingival growths, barring a few are mostly reactive and seldom exhibit significant true neoplastic potential. The common etiology is local irritation from dental plaque/calculus, trauma as well as medication-related overgrowth. Such lesions are easily distinguishable and categorized into diagnoses such as pyogenic granuloma, peripheral ossifying fi...

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...

Objectives: The role of Human papillomavirus (HPV) in the oral squamous cell carcinoma (OSCC) has not been completely elucidated. The purpose of the present study was to investigate the prevalence and localization of HPV-16 virus in OSCC and to correlate HPV-16 positivity and p16INK4A expression with the clinical and pathological features of OSCC....

Objectives Studies have indicated that cases of HPV-associated squamous cell carcinoma (SCC) in the oropharynx and the oral cavity are on the rise. However, the distribution of human papilloma virus (HPV) in different sites of the oral cavity affected by oral SCC (OSSC) has not been well characterized. The present study was designed to investigate...

Objective Idiopathic pulmonary fibrosis (IPF) patients commonly present with sicca symptoms. This study aims to assess labial minor salivary glands (LMSG) in those patients to rule out Sjögren's syndrome (SS), in which sicca symptoms are the clinical hallmark. Study Design Cases of IPF patients with sicca symptoms referred to the Oral Medicine Cli...

Objective The calcifying epithelial odontogenic tumor (CEOT) is a rare benign neoplasm that makes up less than 1% of all odontogenic tumors. This study aims to describe a case series of CEOT spanning 25 years and to review, and compare our results with, the existing literature. Study design With IRB approval, all CEOT archival cases from the UF Or...

Oral squamous cell carcinoma (OSCC) is an extremely rare occurrence during pregnancy. OSCC accounts for less than 2% of all malignancies in pregnant women, with an average mortality rate of 36%. Understanding the features of this tumor during pregnancy is important; however, the paucity of reports in the literature makes this challenging. Case pres...

Odontogenic myxoma (OM) is an uncommon benign odontogenic tumor arising in the jaw. Though it has slight histologic overlap with other entities, definitive diagnosis is imperative considering the tumor’s aggressive nature, high recurrence rate, and necessity of radical surgical intervention in large-sized lesions. With IRB approval, a retrospective...

Salivary gland neoplasms of the buccal mucosa are relatively rare and often present with an unusual histopathologic profile when compared with other intraoral locations. We present a series of minor salivary gland neoplasms of the buccal mucosa and discuss demographics, clinical presentation, and histologic findings. An IRB approved retrospective s...

Verruciform xanthoma (VX) of the oral cavity is an uncommon, reactive lesion of unknown etiology. In this study, we present a large series of VX with analysis of demographics, clinical appearance, histologic presentation and extensive review of literature. To the best of our knowledge, this is the largest series of oral VX reported to date. Followi...

Background: Potentially malignant lesions of the gingiva may frequently present as well-demarcated white lesions confined to the marginal gingiva. These lesions often become thick and verrucoid and spread along the marginal gingiva to encircle the tooth. Some cases of marginal gingival leukoplakia, over time, progress to extensively involve the gi...

Fibrous dysplasia (FD) is a rare condition commonly involving the jaws. While FD has a typical clinical and histological presentation, considerable variation exists. Moreover, overlap of features with other disorders is possible. This study serves to characterize the features of a large case series of FD of the jaws. With IRB approval, the Universi...

Introduction: p53 overexpression is well documented in premalignant lesions of the oral cavity. However, recent studies have shown increased expression of podoplanin (D2-40) in oral dysplasia. This study aims to evaluate the efficacy of both markers in predicting malignant transformation in cases of proliferative verrucous leukoplakia (PVL), a reca...

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 termi...

Verrucous hyperkeratosis (VH), verrucous carcinoma (VC) and the relentless, truly pre-malignant variant proliferative verrucous leukoplakia often exhibit lichenoid histologic features that may create a diagnostic dilemma for pathologists. This study aims to evaluate and categorize the frequency and the histopathologic patterns of lichenoid features...

Introduction: p16INK4a is a tumor suppressor protein that retards cell cycle progression from G1 to S phase. Prior studies have evaluated p16INK4a expression in odontogenic keratocyst and ameloblastoma, but data regarding other odontogenic cysts and tumors have been sparse. Methods: With IRB approval, cases from the following entities were ident...

Chronic ulcerative stomatitis (CUS) is a poorly understood disease with clinical and histologic overlap with lichen planus (LP). Unlike classic LP, direct immunofluorescence (DIF) studies in cases of CUS exhibit a granular pattern of IgG in nuclei of basal and parabasal cells. This study assesses the demographic, clinical, histologic, and DIF featu...

Background Enhancer of zeste homolog-2 (EZH2) is a member of the polycomb group PcG of proteins; the genes that are involved in transcriptional repression. Cell cycle regulation and cell proliferation is associated with EZH2 expression and EZH2 overexpression stimulates cell proliferation and invasiveness. Conversely, inhibition of EZH2 precludes c...

Objective The use of diverse terminology may lead to inconsistency in the diagnosis and subsequent treatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objective of this study was to determine inter-observer variability between pathologists in the diagnosis of PVL spectrum lesions. Methods Digitally scanned slide...

Objectives Chronic ulcerative stomatitis (CUS) is a rare disease of unknown etiology. The histopathologic features are similar to lichen planus, but direct immunofluorescence (DIF) studies show characteristic presence of IgG in basal and parabasal epithelial nuclei.This study will review a case series of CUS and assess if the entity is more similar...

Objectives MAML2 expression has been demonstrated in the majority of mucoepidermoid carcinomas (MEC) arising in the salivary glands. MEC may also arise intraosseously in the jawbone (IMEC). Glandular odontogenic cyst (GOC) is an odontogenic cyst with some histologic overlap with IMEC. MAML2 expression has not been extensively studied in IMEC or in...

Introduction Chairside clinical oral pathology consultations are frequently provided in most dental schools; however, the outcome and efficacy of those consults remains largely unanalyzed. We designed a retrospective study to assess the utilization of consults by Oral and Maxillofacial Pathology (OMP) providers at the UF College of Dentistry (UFCOD...

Introduction Studies on inflammatory response to oral squamous cell carcinoma (OSCC) generally do not include verrucous carcinoma (VC), which typically carries a far better prognosis. While high CD8 expression is associated with favorable outcome in head and neck cancers, the role of CD4+ lymphocytes remains controversial. B cell involvement has be...

Background The jaws are an uncommon location for primary aneurysmal bone cysts (ABCs), and few gnathic cases have been tested for USP6 rearrangement. Rearrangements of CDH11 and/or USP6 are identified in approximately 70% of primary extragnathic ABCs. MATERIALS/METHODS Herein, this multi-institutional, IRB-approved study investigates the USP6 stat...

Premalignant and malignant lesions of the gingiva frequently present as a white ring or cuff initially involving the crevicular gingival margin of the tooth. This phenomenon is not well-recognized or documented in the literature. The objective of this study is to report a case series of premalignant and malignant peri-gingival leukoplakic cuffing -...

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic lung condition characterized by a progressive diminution in lung function. Certain forms of interstitial lung disease have been reported secondary to Sjögren syndrome (SS). However, IPF-related oral symptoms mimicking SS have not been reported. This study is the first retrospective case...

Introduction: Epithelioid hemangioendothelioma (EHE) is an unusual vascular neoplasm of indeterminate biologic behavior, classified as intermediate between benign and malignant. It may microscopically mimic other vascular and spindle cell lesions, and definitive diagnosis is paramount owing to its potential for local recurrence and infiltrative nat...

Intraoral neural neoplasms though unusual may be clinically significant. The aim of this study was to categorize and evaluate oral neural tumors in a large oral pathology biopsy service. With IRB approval, a retrospective search of all neural neoplasms of the oral cavity in the archives of the University of Florida Oral Pathology Biopsy Service spa...

Lichenoid granulomatous reaction can be subcategorized into lichenoid granulomatous dermatitis or lichenoid granulomatous stomatitis. It is described in the literature as demonstrating a band-like lichenoid infiltration with clusters of histiocytic or granuloma formation. In this study we presented a large case series of lichenoid granulomatous sto...

Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication c...

Objective: MAML2 expression is proven in the majority of mucoepidermoid carcinomas (MECs) arising in salivary glands. MEC can also occur intraosseously (IMEC). Glandular odontogenic cyst (GOC) is an odontogenic cyst with histologic overlap with IMEC. This study aimed to determine the reliability of MAML2 in distinguishing IMEC cases from GOC cases...

Skin lesions are often submitted to oral and maxillofacial pathology practices. The purpose of this study is to evaluate the frequency, distribution, variability, and composition of dermatologic lesions within a large oral and maxillofacial pathology biopsy service. An IRB-approved retrospective search of skin lesions diagnosed at University of Flo...

Proliferative verrucous leukoplakia (PVL) is defined as an aggressive, relentless and recalcitrant form of leukoplakia that has a high propensity for malignant transformation. The aim of this study was to evaluate the malignant potential of PVL and determine its possible association with high-risk human papillomavirus (HPV). Twenty cases with a cli...

When cells are injured, one of two patterns will generally result: reversible cell injury leading to adaptation of the cells and tissue, or irreversible cell injury leading to cell death and tissue damage. When cells adapt to injury, their adaptive changes can be atrophy, hypertrophy, hyperplasia, or metaplasia. Injured cells may also accumulate ma...

Burning mouth syndrome (BMS) is a complex condition that affects the oral cavity, and data regarding effective treatment are limited. The purpose of this study was to explore the demographic and clinical information along with treatment outcomes for patients with BMS treated in a large referral center. Clinical records of the Oral Medicine Clinic a...

Solitary fibrous tumors (SFT) and myofibromas (MF) historically have belonged to the same morphologic spectrum and have been lumped together under the nonspecific umbrella term, “hemangiopericytoma” along with other pericytic/myoid tumors. While current evidence shows clear distinction between the two entities, they frequently remain in the same hi...

Several medications have been reported as possible etiologic factors for oral lichen planus (OLP) and oral lichenoid lesions (OLLs). This study investigated the medication profile and medical history of patients with biopsy-proven OLP or OLLs, also classified by the clinically nonspecific term oral lichenoid mucositis (OLM), in a busy oral medicine...

Peripheral ameloblastoma (PA) is a rare odontogenic tumor, arising in the mucosa of tooth-bearing areas of the jaws, that typically shows no radiographic evidence of bone involvement. It bears close histologic resemblance to intraoral basal cell carcinoma (IOBCC), an extremely rare and often aggressive entity. In our experience from previous publis...