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Harvey Kessler

Texas A&M Health Science Center, Diagnostic Sciences, Faculty Member

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Papers by Harvey Kessler

Localized juvenile spongiotic gingival hyperplasia

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2008

We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyper... more We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyperplasia in young patients. Clinically, the average age of patients in this study was 11.8 years, with a 2.3:1 female predominance. Caucasians comprised 77% of the cases, and nearly all of the lesions were located on the anterior gingiva, with 81% affecting maxillary gingiva. The most classic clinical presentation was a papillary, often pedunculated, red and easily bleeding gingival overgrowth in young patients. Histopathologically, the lesions exhibited a subtle papillary epithelial hyperplasia with prominent intercellular edema and neutrophilic exocytosis of the hyperplastic surface squamous epithelium. Based on the characteristic clinical and histologic features, we conclude that this lesion is a distinct subtype of gingival hyperplasia. Although previously described as juvenile spongiotic gingivitis, we propose the term localized juvenile spongiotic gingival hyperplasia as a more accurate designation.

Assessment of Hemostatic Efficacy and Osseous Wound Healing Using HemCon Dental Dressing

Journal of Endodontics, 2011

IntroductionObtaining hemostasis in the surgical crypt during periradicular surgery is essential.... more IntroductionObtaining hemostasis in the surgical crypt during periradicular surgery is essential. It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material. Although current materials may not be moisture sensitive during setting, hemostasis is important for proper placement of root-end filling materials during apical surgery. A new hemostatic agent, HemCon dental

Inter-Examiner Evaluation of Fluorescence in Oral Lesions

by Harvey Kessler and Terry Rees

Objective: To determine if three expert clinicians could categorize lichen planus (LP) and dyspla... more Objective: To determine if three expert clinicians could categorize lichen planus (LP) and dysplastic oral lesions by examining their color appearance on standard and fluorescence photographs. Methods: 59 lesions in 22 patients were evaluated from 8x10 photographs. Each lesion had standard clinical and fluorescent photographs (produced by a VELscope), taken within seconds of each other using a tripod mounted digital camera at the same angle, distance and magnification. Lesions without patient identity and diagnosis were identified with an overlay. Examiners scored the most prominent color as dark black, light black, brown, light green, dark green, other. Results: Clinician ratings were recoded from 6-pronged rating values into 3-pronged rating values of Dark, Medium, and Light, to accommodate each contingency table cell for reliability analysis. Kappa coefficients indicated modest but statistically significant inter-rater reliability between all combinations of clinicians, with κ= ....

A comparison of the periodontal status in patients with mucous membrane pemphigoid: a 5-year follow-up

Journal of Periodontology

Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of u... more Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of unknown etiology. Intraoral manifestations of MMP feature the formation of vesiculobullous lesions that eventually rupture, leading to pseudomembrane-covered, irregularly-shaped ulcerations. The presence of these often painful oral lesions may hinder oral hygiene efforts resulting in increased plaque accumulation and may increase the risk of developing periodontal disease. The purpose of this study was to evaluate the changes in periodontal status in patients with MMP after a period of 5 years. Twenty patients, 10 diagnosed with MMP and 10 controls matched for age, gender, and smoking history, were chosen to participate in a study evaluating their periodontal status. Parameters evaluated included the plaque index, gingival index, bleeding index, probing depths, recession, clinical attachment level, mobility, furcation involvement, number of missing teeth, and periodontitis. Data from the ...

Sarcoidosis and Sjögren’s syndrome: A comparison of salivary electrophoretic profiles

Oral and maxillofacial pathology case of the month. Regional odontodysplasia (ghost teeth)

by Harvey Kessler and Pavithra Pugalagiri

Texas dental journal

Foreign Bodies Associated With Peri-Implantitis Human Biopsies

Journal of Periodontology, 2015

Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this desc... more Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.

Lymphangioma-like Kaposi sarcoma of the oral mucosa

Oral surgery, oral medicine, oral pathology and oral radiology, 2013

With the epidemic of acquired immunodeficiency syndrome, the clinical and histopathological featu... more With the epidemic of acquired immunodeficiency syndrome, the clinical and histopathological features of Kaposi sarcoma (KS) became routine for most practicing surgical pathologists. The histological spectrum of KS broadened significantly over time and today a wide variety of rare histological variants are reported, but not widely recognized. Lymphangioma-like KS (LLKS) is a rare histological variant of KS occurring in skin, with banal histological features that can lead to misdiagnosis and inappropriate therapy. We report a series of intra-oral cases of LLKS and review the literature regarding this lesion.

Oral and maxillofacial pathology case of the month. Bilateral supbontic osseous hyperplasia

Texas dental journal, 2006

Oral and maxillofacial pathology. Case of the month. Calcifying epithelial odontogenic tumor (Pindborg tumor)

Texas dental journal, 2012

Salivary gland malignancy with divergent differentiation: is it a teratocarcinosarcoma?

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007

Four poorly differentiated malignant lesions occurred in a 60-year-old Chinese male in the nasal ... more Four poorly differentiated malignant lesions occurred in a 60-year-old Chinese male in the nasal cavity, submandibular gland, a lymph node in the neck, and the mandible. These malignant lesions developed within an 8year period and each showed distinctive histological features. Among these malignant lesions, the neoplasm in the submandibular gland presented variegated histological and immunohistochemical (IHC) features and posed a diagnostic challenge in interpretation. Based on microscopic and IHC findings, we believe the diagnosis of teratocarcinosarcoma is justified for the submandibular neoplasm and the metastasis in the lymph node. The pathological features and diagnoses of these malignant lesions are discussed.

The effects of bisphosphonates on osteoblasts in vitro

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2008

Objective. The purpose of this study was to test the effects of bisphosphonates on osteoblast via... more Objective. The purpose of this study was to test the effects of bisphosphonates on osteoblast viability and function. Study design. Primary rat osteoblasts were cultured in normal media or media containing increasing concentrations of 2 bisphosphonates, alendronate and zoledronate. Enzyme-linked immunoabsorbent assays (ELISAs) were used to measure interleukin (IL)-6, transforming growth factor (TGF) ␤1, and receptor activator of nuclear factor B ligand (RANKL) expression in supernatants after 24, 48, and 72 h. Live and necrotic cell numbers were assessed with trypan blue assays. Results. As drug concentrations increased, cell viability decreased significantly. The ELISAs revealed significant increases in TGF-␤1 in treatment groups, but no significant change in RANKL or IL-6. Conclusions. High concentrations of alendronate and zoledronate were cytotoxic, decreasing cell viability at 72 h. Transforming growth factor ␤1 increased even as viability decreased, suggesting a mechanism for bisphosphonate action. These data suggest that lower concentrations of bisphosphonates may have therapeutic benefits without the cytotoxic effects which may result in osteonecrosis.

Localized juvenile spongiotic gingival hyperplasia

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2008

We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyper... more We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyperplasia in young patients. Clinically, the average age of patients in this study was 11.8 years, with a 2.3:1 female predominance. Caucasians comprised 77% of the cases, and nearly all of the lesions were located on the anterior gingiva, with 81% affecting maxillary gingiva. The most classic clinical presentation was a papillary, often pedunculated, red and easily bleeding gingival overgrowth in young patients. Histopathologically, the lesions exhibited a subtle papillary epithelial hyperplasia with prominent intercellular edema and neutrophilic exocytosis of the hyperplastic surface squamous epithelium. Based on the characteristic clinical and histologic features, we conclude that this lesion is a distinct subtype of gingival hyperplasia. Although previously described as juvenile spongiotic gingivitis, we propose the term localized juvenile spongiotic gingival hyperplasia as a more accurate designation.

Gingival swelling in a 13-year-old girl with multiple recurrences

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007

Calcifying odontogenic cyst with ameloblastic fibro-odontome: one lesion or two?

Journal of Oral Pathology and Medicine, 1978

Although it is a rare event, odontogenic tumors such as ameloblastoma, ameloblastic fibroma (AF),... more Although it is a rare event, odontogenic tumors such as ameloblastoma, ameloblastic fibroma (AF), ameloblastic fibro-odontoma, and odontoma have been reported associated with calcifying odontogenic cyst (COC). There are only four cases of COC with AF cited in the English literature. However, three of these four cases were either included in a review of a series of cases or reported as an abstract, and limited clinical and histological information was provided. We present three additional cases of COC with AF and discuss the management for this combined lesion. Because COC is known for its histologic diversity and variable clinical behavior, and the clinical significance of an association of COC with AF is still unknown, we think it is valuable to report COC with AF with detailed clinical and pathological documentation.

Sarcoidosis and Sjögren's syndrome: clinical and salivary evaluation

Journal of Oral Pathology & Medicine, 2013

Polymorphous low grade adenocarcinoma

by Harvey Kessler and Lester Thompson

Cancer, 1999

Polymorphous low-grade adenocarcinomas are minor salivary gland neoplasms with a predilection for... more Polymorphous low-grade adenocarcinomas are minor salivary gland neoplasms with a predilection for intraoral sites. Women are affected twice as frequently as men, and generally present in the fifth to sixth decade of life with a painless ihaoral mass. The palatal mass is, on average, about 2 cm in greatest dimension. The tumors are submucosal, identified below an intact mucosa as a well-circumscribed although unencapsulated mass. The tumor is characterized by a polymorphous growth pattern, with individual tumors demonstrating multiple patterns, including solid, ductal-tubular, cribriform, trabecular, and single-file growth. Neurotropism is common, frequently forming a central nidus around which a "targetoid" pattern is formed. The neoplastic cells are isomorphic, containing round to oval vesicular nuclei with small nucleoli. Mitotic activity and necrosis are inconspicuous. There is frequently a slate gray-blue stroma separating the tumor cells. Immunohistochemical analysis demonstrates reactivity with cytokeratin, vimentin, S-100 protein, CD117, glial fibrillary acidic protein, and actin. Bcl-2 is overexpressed and there is generally a low proliferation index as determined by Ki-67 reactions. The tumor must be separated from pleomorphic adenoma (benign mixed tumor) and adenoid cystic carcinoma. Complete surgical excision will yield a more than 95% 10-year survival, although persistence or recurrence can emerge often in about 10% of patients more than 10 years later.

Localized juvenile spongiotic gingival hyperplasia

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2008

We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyper... more We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyperplasia in young patients. Clinically, the average age of patients in this study was 11.8 years, with a 2.3:1 female predominance. Caucasians comprised 77% of the cases, and nearly all of the lesions were located on the anterior gingiva, with 81% affecting maxillary gingiva. The most classic clinical presentation was a papillary, often pedunculated, red and easily bleeding gingival overgrowth in young patients. Histopathologically, the lesions exhibited a subtle papillary epithelial hyperplasia with prominent intercellular edema and neutrophilic exocytosis of the hyperplastic surface squamous epithelium. Based on the characteristic clinical and histologic features, we conclude that this lesion is a distinct subtype of gingival hyperplasia. Although previously described as juvenile spongiotic gingivitis, we propose the term localized juvenile spongiotic gingival hyperplasia as a more accurate designation.

Assessment of Hemostatic Efficacy and Osseous Wound Healing Using HemCon Dental Dressing

Journal of Endodontics, 2011

IntroductionObtaining hemostasis in the surgical crypt during periradicular surgery is essential.... more IntroductionObtaining hemostasis in the surgical crypt during periradicular surgery is essential. It allows for improved visibility and contributes to a dry environment suitable for the placement of moisture-sensitive root-end filling material. Although current materials may not be moisture sensitive during setting, hemostasis is important for proper placement of root-end filling materials during apical surgery. A new hemostatic agent, HemCon dental

Inter-Examiner Evaluation of Fluorescence in Oral Lesions

by Harvey Kessler and Terry Rees

Objective: To determine if three expert clinicians could categorize lichen planus (LP) and dyspla... more Objective: To determine if three expert clinicians could categorize lichen planus (LP) and dysplastic oral lesions by examining their color appearance on standard and fluorescence photographs. Methods: 59 lesions in 22 patients were evaluated from 8x10 photographs. Each lesion had standard clinical and fluorescent photographs (produced by a VELscope), taken within seconds of each other using a tripod mounted digital camera at the same angle, distance and magnification. Lesions without patient identity and diagnosis were identified with an overlay. Examiners scored the most prominent color as dark black, light black, brown, light green, dark green, other. Results: Clinician ratings were recoded from 6-pronged rating values into 3-pronged rating values of Dark, Medium, and Light, to accommodate each contingency table cell for reliability analysis. Kappa coefficients indicated modest but statistically significant inter-rater reliability between all combinations of clinicians, with κ= ....

A comparison of the periodontal status in patients with mucous membrane pemphigoid: a 5-year follow-up

Journal of Periodontology

Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of u... more Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of unknown etiology. Intraoral manifestations of MMP feature the formation of vesiculobullous lesions that eventually rupture, leading to pseudomembrane-covered, irregularly-shaped ulcerations. The presence of these often painful oral lesions may hinder oral hygiene efforts resulting in increased plaque accumulation and may increase the risk of developing periodontal disease. The purpose of this study was to evaluate the changes in periodontal status in patients with MMP after a period of 5 years. Twenty patients, 10 diagnosed with MMP and 10 controls matched for age, gender, and smoking history, were chosen to participate in a study evaluating their periodontal status. Parameters evaluated included the plaque index, gingival index, bleeding index, probing depths, recession, clinical attachment level, mobility, furcation involvement, number of missing teeth, and periodontitis. Data from the ...

Sarcoidosis and Sjögren’s syndrome: A comparison of salivary electrophoretic profiles

Oral and maxillofacial pathology case of the month. Regional odontodysplasia (ghost teeth)

by Harvey Kessler and Pavithra Pugalagiri

Texas dental journal

Foreign Bodies Associated With Peri-Implantitis Human Biopsies

Journal of Periodontology, 2015

Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this desc... more Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.

Lymphangioma-like Kaposi sarcoma of the oral mucosa

Oral surgery, oral medicine, oral pathology and oral radiology, 2013

With the epidemic of acquired immunodeficiency syndrome, the clinical and histopathological featu... more With the epidemic of acquired immunodeficiency syndrome, the clinical and histopathological features of Kaposi sarcoma (KS) became routine for most practicing surgical pathologists. The histological spectrum of KS broadened significantly over time and today a wide variety of rare histological variants are reported, but not widely recognized. Lymphangioma-like KS (LLKS) is a rare histological variant of KS occurring in skin, with banal histological features that can lead to misdiagnosis and inappropriate therapy. We report a series of intra-oral cases of LLKS and review the literature regarding this lesion.

Oral and maxillofacial pathology case of the month. Bilateral supbontic osseous hyperplasia

Texas dental journal, 2006

Oral and maxillofacial pathology. Case of the month. Calcifying epithelial odontogenic tumor (Pindborg tumor)

Texas dental journal, 2012

Salivary gland malignancy with divergent differentiation: is it a teratocarcinosarcoma?

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007

Four poorly differentiated malignant lesions occurred in a 60-year-old Chinese male in the nasal ... more Four poorly differentiated malignant lesions occurred in a 60-year-old Chinese male in the nasal cavity, submandibular gland, a lymph node in the neck, and the mandible. These malignant lesions developed within an 8year period and each showed distinctive histological features. Among these malignant lesions, the neoplasm in the submandibular gland presented variegated histological and immunohistochemical (IHC) features and posed a diagnostic challenge in interpretation. Based on microscopic and IHC findings, we believe the diagnosis of teratocarcinosarcoma is justified for the submandibular neoplasm and the metastasis in the lymph node. The pathological features and diagnoses of these malignant lesions are discussed.

The effects of bisphosphonates on osteoblasts in vitro

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2008

Objective. The purpose of this study was to test the effects of bisphosphonates on osteoblast via... more Objective. The purpose of this study was to test the effects of bisphosphonates on osteoblast viability and function. Study design. Primary rat osteoblasts were cultured in normal media or media containing increasing concentrations of 2 bisphosphonates, alendronate and zoledronate. Enzyme-linked immunoabsorbent assays (ELISAs) were used to measure interleukin (IL)-6, transforming growth factor (TGF) ␤1, and receptor activator of nuclear factor B ligand (RANKL) expression in supernatants after 24, 48, and 72 h. Live and necrotic cell numbers were assessed with trypan blue assays. Results. As drug concentrations increased, cell viability decreased significantly. The ELISAs revealed significant increases in TGF-␤1 in treatment groups, but no significant change in RANKL or IL-6. Conclusions. High concentrations of alendronate and zoledronate were cytotoxic, decreasing cell viability at 72 h. Transforming growth factor ␤1 increased even as viability decreased, suggesting a mechanism for bisphosphonate action. These data suggest that lower concentrations of bisphosphonates may have therapeutic benefits without the cytotoxic effects which may result in osteonecrosis.

Localized juvenile spongiotic gingival hyperplasia

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2008

We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyper... more We report 52 cases of a unique and pathologically distinctive form of inflammatory gingival hyperplasia in young patients. Clinically, the average age of patients in this study was 11.8 years, with a 2.3:1 female predominance. Caucasians comprised 77% of the cases, and nearly all of the lesions were located on the anterior gingiva, with 81% affecting maxillary gingiva. The most classic clinical presentation was a papillary, often pedunculated, red and easily bleeding gingival overgrowth in young patients. Histopathologically, the lesions exhibited a subtle papillary epithelial hyperplasia with prominent intercellular edema and neutrophilic exocytosis of the hyperplastic surface squamous epithelium. Based on the characteristic clinical and histologic features, we conclude that this lesion is a distinct subtype of gingival hyperplasia. Although previously described as juvenile spongiotic gingivitis, we propose the term localized juvenile spongiotic gingival hyperplasia as a more accurate designation.

Gingival swelling in a 13-year-old girl with multiple recurrences

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2007

Calcifying odontogenic cyst with ameloblastic fibro-odontome: one lesion or two?

Journal of Oral Pathology and Medicine, 1978

Although it is a rare event, odontogenic tumors such as ameloblastoma, ameloblastic fibroma (AF),... more Although it is a rare event, odontogenic tumors such as ameloblastoma, ameloblastic fibroma (AF), ameloblastic fibro-odontoma, and odontoma have been reported associated with calcifying odontogenic cyst (COC). There are only four cases of COC with AF cited in the English literature. However, three of these four cases were either included in a review of a series of cases or reported as an abstract, and limited clinical and histological information was provided. We present three additional cases of COC with AF and discuss the management for this combined lesion. Because COC is known for its histologic diversity and variable clinical behavior, and the clinical significance of an association of COC with AF is still unknown, we think it is valuable to report COC with AF with detailed clinical and pathological documentation.

Sarcoidosis and Sjögren's syndrome: clinical and salivary evaluation

Journal of Oral Pathology & Medicine, 2013

Polymorphous low grade adenocarcinoma

by Harvey Kessler and Lester Thompson

Cancer, 1999

Polymorphous low-grade adenocarcinomas are minor salivary gland neoplasms with a predilection for... more Polymorphous low-grade adenocarcinomas are minor salivary gland neoplasms with a predilection for intraoral sites. Women are affected twice as frequently as men, and generally present in the fifth to sixth decade of life with a painless ihaoral mass. The palatal mass is, on average, about 2 cm in greatest dimension. The tumors are submucosal, identified below an intact mucosa as a well-circumscribed although unencapsulated mass. The tumor is characterized by a polymorphous growth pattern, with individual tumors demonstrating multiple patterns, including solid, ductal-tubular, cribriform, trabecular, and single-file growth. Neurotropism is common, frequently forming a central nidus around which a "targetoid" pattern is formed. The neoplastic cells are isomorphic, containing round to oval vesicular nuclei with small nucleoli. Mitotic activity and necrosis are inconspicuous. There is frequently a slate gray-blue stroma separating the tumor cells. Immunohistochemical analysis demonstrates reactivity with cytokeratin, vimentin, S-100 protein, CD117, glial fibrillary acidic protein, and actin. Bcl-2 is overexpressed and there is generally a low proliferation index as determined by Ki-67 reactions. The tumor must be separated from pleomorphic adenoma (benign mixed tumor) and adenoid cystic carcinoma. Complete surgical excision will yield a more than 95% 10-year survival, although persistence or recurrence can emerge often in about 10% of patients more than 10 years later.