Andréia Aparecida da Silva

Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Is It Locally Aggressive?

Our biopsy service (Oral Pathology, Piracicaba DentalSchool-UNICAMP, Sao Paulo, Brazil) received a specimenfrom a 65-year-old male of a painless swelling located be-tween the mandibular right lateral incisor and canine thathad been growing slowly for about 3 years. The clinicalinformation sent by the private dentist was of a fibrous,firm, sessile, and painless lesion covered by a smooth andregular mucosal surface in the anterior mandibular gingivabetween the right lateral incisor and canine, which mea-sured nearly 1.5 cm in its maximum dimension. Theperiapical radiograph showed a well-defined unilocularradiolucent lesion with radiopacities dispersed through-out the lesion. In addition, there was resorption of thebone crest between the right mandibular lateral incisorand canine; however, the roots of the adjacent teethwere not displaced, and there was no sign of the rootresorption (Fig 1). The lesion was removed by completesurgical excision.Hematoxylin and eosin-stained sections showed multiplemucosal fragments represented by a dense connective tis-sue that was replaced by irregular strands, cords, and nestsof epithelial cells. The polyhedral epithelial cells dis-closed an abundant and eosinophilic cytoplasm; round-to-oval relatively large nuclei with dense chromatin, andevident intercellular bridges. These cells showed mildpleomorphic and hyperchromatic nuclei. In significant por-tions, the epithelial cells had a clear, foamy, vacuolatedcytoplasm (Figs 2-4). The calcifications areas and Lieseg-ang’s rings were observed, and amyloid-like deposits werenot visualized. However, these amyloid-like deposits couldbe observed in Congo red staining under polarized light (Fig5). The periodic acid Schiff (PAS) showed numerous glob-ules of positive material, which was removed by prior

Medication-related osteonecrosis of the jaw, osteoradionecrosis, and osteomyelitis: A comparative histopathological study

It is largely known that some oral diseases can be diagnosed based upon their clinical manifestation combined with the patients medical history and generally not depending on examination. This is the case of some bone diseases such as osteoradionecrosis of the jaw (ORNJ), osteomyelitis of the jaw (OMJ), and medication-related osteonecrosis of the jaw (MRONJ). The present study aimed to analyze the histopathological features of these specific bone diseases in order to evaluate similarities and differences. Forty-four bone specimens resected from each bone disease (22 cases of ORNJ, 6 cases of OMJ, and 16 cases of MRONJ) were analyzed by two experienced oral pathologists without prior knowledge of the diagnosis, considering bone tissue condition, inflammation, vascularization, and the presence of microorganisms. In addition, the examiners formulated a diagnostic hypothesis for each specimen. Many histopathological similarities were found among the diseases, especially considering the presence of necrotic bone, inflammation, and microorganisms. Statistically significant differences were detected in empty bone lacunae, which was decreased in ORN (p = 0.042), and considering neutrophil count, which was low in the MRONJ group (p ≤ 0.001). The Kappa coefficient was calculated and agreement was detected based on the histopathological parameters, but not for diagnostic suggestion (p=0.23). In conclusion, histopathological aspects of ORNJ, OMJ, and MRONJ do not permit a conclusive diagnosis, emphasizing the necessity of a detailed clinical report.