Aadithya B Urs

Mineralized components and their interpretation in the histogenesis of peripheral ossifying fibroma

BACKGROUND Peripheral ossifying fibroma (POF) is a lesion of gingival tissue that predominantly affects women and is usually located in maxilla, anterior to molars. The definitive diagnosis is established by histopathological examination, which reveals the presence of cellular connective tissue with focal calcifications. OBJECTIVE This study hypothesizes the histogenesis of POF by analyzing the diverse spectrum of mineralized components with a polarizing microscope. MATERIALS AND METHODS A retrospective study was undertaken which involved a detailed review of clinical, radiographic and histopathological features of 22 cases of POF, retrieved from departmental archives. These cases were subsequently stained with a histochemical stain (van Gieson) and observed under a polarizing microscope. RESULTS The study revealed that the most common age of occurrence was in second and third decades with a strong female predilection (73%), Interdental papilla of the maxillary anterior region was the most commonly afflicted site. About 90% cases showed no radiographic features.Histopathological examination showed that 73% cases consisted of a fibrocellular connective tissue stroma surrounding the mineralized masses. 50% mineralized masses comprised of woven bone, 18% showed combination of lamellar bone and cellular cementum, 18% showed only cementum (cellular and acellular), and remaining 13.6% exhibited a mixture of woven and lamellar bone under polarizing microscope. CONCLUSION The study supports the theory that POF develops from cells of periodontal ligament (PDL)/periosteum as undifferentiated mesenchymal cells having an inherent proliferative potential to form bone or cementum, whose nature can be confirmed by polarizing microscope.

Case series on vascular malformation and their review with regard to terminology and categorization.

Malformations of vascular nature originate as anomalies caused due to errors in vasculogenesis. These tumors are generally broadly classified into vascular tumors (hemangiomas) and vascular malformations (venous malformations, arteriovenous malformations, lymphatic malformations). These descriptive tumors and malformations have been categorized based on the architectural assembly of vessels. Lymphangiomas are further subclassified microscopically into capillary, cavernous, cystic and lymphangioendothelioma, depending upon their histopathological features. Lymphatic malformations or lymphangiomas are uncommon congenital malformations of the lymphatic system, usually occurring in the head and neck region, characterized by collections of ectatic lymph vessels that form endothelial lined cystic spaces. Advancements in the knowledge of pathogenesis of such vascular malformations are continuously changing their treatment protocols. Early recognition is of utmost importance for initiation of proper treatment and avoiding serious complications. Hemangiolymphangioma is a variant of lymphangioma showing vascular component. Herewith, we present a case of vascular malformation diagnosed as hemangiolymphangioma histopathologically in a 9-year-old girl, along with a review of literature regarding its categorization.

Cementoblastoma Solely Involving Maxillary Primary Teeth--A Rare Presentation.

Cementoblastoma is a rare benign neoplasm of odontogenic ectomesenchyme origin, involving the roots of any tooth, which occurs predominantly in second and third decade of life. Very few cases of cementoblastoma associated with a primary tooth or having a maxillary presentation have been reported in the past. Here, a rare case of a ten year old boy who presented to the department with a swelling in maxillary posterior region since one month is being discussed. The radiographic presentation was mimicking an odontoma. The final diagnosis was cementoblastoma. We have advocated the use of polarized microscopy to support the histopathological diagnosis with respect to its cemental origin. Cementoblastoma should be considered in the differential diagnosis of radio-opaque lesions in the transitional dentition.

A polarizing microscopic analysis of the calcified masses based on their collagen fibre orientation in peripheral ossifying fibroma

correspondence: Devi c Shetty Department of Oral and Maxillofacial Pathology and Microbiology, I.T.S-cDSr, Muradnagar, ghaziabad-201206, Uttar Pradesh, India Tel +91 9873525076 email shettydivya76@rediffmail.com Abstract: Peripheral ossifying fibroma (POF) is a reactive gingival lesion exhibiting a diverse spectrum of histopathology, accounting for 9.6% of gingival lesions. This study encompasses a detailed clinical, radiographic, and histopathological analysis of 15 cases of POF, retrieved from departmental archives. The following cases were subsequently stained with a histochemical stain (van Gieson) and observed under a polarizing microscope. This study is an effort to analyze the diverse spectrum of mineralized components and their surrounding tissues. Clinically, the study revealed a female predilection (73%) with the second and third decade commonly affected. The most common site was interdental papilla of anterior region, presenting itself as pink and sessile nodular mass. Radiographic examination revealed 93% of the cases showing no manifestation on the radiograph. Histopathological analysis showed 73% of the cases exhibited a fibrocellular connective tissue stroma with plump fibroblasts around the mineralized areas. The collagen was predominantly mature. Polarizing microscopy of the mineralized tissue revealed that 53% of the cases showed only woven bone, 20% showed combination of lamellar bone and cellular cementum, 13.3% showed only cementum (cellular and acellular) with another 13.3% showing mixture of woven and lamellar bone. Thus, the concept/theory that POF develops from cells of PDL/periosteum is emphasized. The undifferentiated mesenchymal cells have an inherent proliferative potential and can form bone or cementum, whose nature can be confirmed by polarizing microscope. This origin from periodontal ligament can also account for the high recurrence rate seen in POF.

Classifying odontogenic keratocysts as benign cystic neoplasms: a molecular insight into its aggressiveness

ObjectiveThe present study was conducted with the aim to evaluate the expression of p53 in Odontogenic Keratocyst (OKC) and Ameloblastoma to correlate with the aggressiveness of these lesions.Material and methodsImmunohistochemical (IHC) staining was performed using anti-p53 antibody in eighteen cases each of OKC and ameloblastoma.Resultsp53 positivity was seen in all the cases of OKCs and ameloblastomas. p53 positive cells were seen predominantly in the suprabasal cell layer of OKC and in the peripheral pre-ameloblast like cells in ameloblastoma. Total p53 count was significantly higher in ameloblastoma as compared to OKC. But the intensely stained p53 cell count showed no statistically significant difference between the two lesions.ConclusionThe high p53 expression in OKC when compared with ameloblastoma, acknowledges OKC as an aggressive lesion and hence a more aggressive treatment modality is recommended.

Association of Macrophages With Angiogenesis in Oral Epithelial Dysplasia, Oral Verrucous Carcinoma, and Oral Squamous Cell Carcinoma: An Immunohistochemical Study.

The present study aimed to elucidate the role of tumor-associated macrophages (TAMs) and angiogenesis in tumor progression by assessing their immunohistochemical expression in oral epithelial dysplasia (OED), oral verrucous carcinoma (OVC), and oral squamous cell carcinoma (OSCC). About 20 histopathologically confirmed cases of OED, OVC, and OSCC each and 10 cases of normal oral mucosa taken as controls were stained immunohistochemically using CD68 and CD31 antibodies. The average TAM count and the microvessel density (MVD) were calculated for each group and expressed as mean±SD and compared using the Mann-Whitney U Test. Pearson correlation was applied to assess the correlation between TAM and MVD in different groups. The CD68 count was found to be significantly higher in all the groups as compared with controls, with the highest counts in OSCC, followed by OED and OVC. MVD was significantly higher in all the test groups as compared with controls. The increase in MVD was highly significant in OSCC as compared with OVC, and in OVC as compared with OED. No association could be determined between TAM and MVD. There does not seem to be any direct influence of macrophages on angiogenesis in the microenvironment of OED, OVC, and OSCC.

Altered expression of HSP70 in oral lichen planus

Background: Oral lichen planus (OLP), a well-known mucocutaneous lesion has been the center of debate regarding its obscure etiopathogenesis. Recent highlight has been placed on the role of autoimmunity and a sect of constitutional molecules, the native chaperones HSP70, proposed to be important in the onset and progress of disease. Aim: To substantiate a potential role of HSP70 in the pathogenesis of oral lichen planus. Settings and Design: The study involved immunohistochemical (IHC) analyses in a laboratory under monitored conditions. It was a retrospective study on clinically and histopathologically confirmed specimens. Materials and Methods: 30 samples of confirmed cases of OLP were selected and grouped on the basis of the thickness of the epithelial layer into atrophic, normal (classical) and acanthotic. An immunohistochemical analysis of the expression of HSP70 protein was done, followed by a quantitative and qualitative analysis of the stained layers. Statistical Analyses: A Z test was performed to estimate the difference observed between two sample proportions. The statistics was given at 1% level of significance i.e. P<0.01. Results: An increased expression of HSP70 was noted in the basal and suprabasal cells of the epithelium of OLP. A higher count and intensity of HSP70 expression was seen in the basal layer of the epithelium. Greater expression was noted in the epithelium of the atrophic group. Conclusion: The expression pattern of HSP70 positively implicates it in the pathogenesis of OLP.

Aggressive fibromatosis of anterior maxilla

Aggressive fibromatosis is a comparitively rare tumor with unpredictable growth and varying local recurrence rates. It does not develop distant metastases but locally it shows an aggressive and infiltrative behavior. Clinically, aggressive fibromatosis manifests as a painless, firm, often rapidly enlarging mass, fixed to underlying bone or soft tissue. It is never encapsulated. Histologically, it is rich in collagen and fibroblastic cells that are devoid of hyperchromatic or atypical nuclei, but with more variable cellularity in different tumor sections.

Calcifying ghost cell odontogenic tumor (CGCOT) with predominance of clear cells: a case report with important diagnostic considerations.

An 18-year-old female reported painful swelling in the left maxillary region 4 months after the extraction of tooth #15. Because incisional biopsy suggested ameloblastoma with clear-cell changes, segmental resection was performed. The microscopic examination of the excised tissue revealed histomorphologic diversity, with features of typical calcifying ghost cell odontogenic tumor (CGCOT) and a significant clear-cell component constituting more than 50% of the tumor mass without any features of malignancy. Clear cells were periodic acid-Schiff (PAS) positive and mucicarmine negative. CK19 was strongly positive in the solid tumor islands and variably positive in clear cells. A definitive diagnosis of CGCOT with predominance of clear cells was confirmed. Because both squamous metaplasia and clear-cell components were present in the ameloblastic follicles independent of each other, the presence of abundant calcifications favored the diagnosis of CGCOT with a clear-cell component over that of an ameloblastoma with clear-cell changes. The importance of identifying the histomorphologic features of the 2 entities, ameloblastoma and CGCOT, is highlighted. This appears to be the second case reported in the literature, to the best of our knowledge.

Fungal osteomyelitis of maxillofacial bones: Rare presentation

Osteomyelitis is defined as inflammation of the medullary cavities, haversian system and adjacent cortex of bone. Osteomyelitis involving maxilla is quite rare when compared to that of mandible. Fungal osteomyelitis is very rarely seen and documented in the maxillofacial area. It is devastating to patients if it is invasive in nature. A prospective study was undertaken from December 2011 to December 2013. Biopsied hard tissue bits were decalcified and sections were stained with H&E, periodic acid Schiff and Grocott methenamine silver. Culture sensitivity was carried out in all cases. Surgical intervention followed by antifungal therapy was advocated to treat the patients. The current series showed five cases of fungal osteomyelitis which included candidal osteomyelitis, aspergillosis and mucormycosis with slight predominance of maxilla over mandible. Osteomyelitis of facial bones needs to be investigated thoroughly as there is no difference in clinical presentation between bacterial and fungal osteomyelitis. The diagnostic workup with biopsy and culture sensitivity helps to identify the pathogen at the earliest. Appropriate antifungal treatment needs to be advocated for successful treatment.