Puneet Ahuja

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.

Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer

Tumor angiogenesis occurs by recruitment of endothelial cell precursors or by sprouting of existing capillaries, which differ from the normal vasculature by having an altered morphology that can be exploited for diagnosis and as a prognostic indicator. Improved technologies have propelled diagnosis into a new era. These technologies have to be used with great precision. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Accurate judgment of the proper site for biopsy is essential for reaching a correct diagnosis. The aim of this report is to analyze the vascular patterns with the help of direct oral microscopy and the technique of stereo-optical microscopy in the oral cavity to select biopsy sites, and compare the outcome of a directed biopsy with that of biopsy specimens obtained from sites selected solely on the basis of clinical criteria. The study sample comprised 50 oral mucosal lesions. A statistically significant difference was noted between samples judged to be microscopically representative sites. We conclude that this method would aid in early and better diagnosis and treatment planning of oral premalignant and malignant lesions by assessing the various vascular patterns in the mucosa.

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.

Primary intraosseous mucoepidermoid carcinoma of maxilla.

Primary intraosseous mucoepidermoid carcinoma (PIOC) of the jaw bones is an extremely rare malignant salivary gland tumor, comprising 2–3% of all mucoepidermoid carcinomas reported. It is commonly seen in the posterior part of the mandible; its occurrence in the maxilla is rare. They have been reported in patients of all ages, ranging from 1 to 78 years, with the overwhelming majority occurring in the 4th and 5th decades of life. They are histologically low-grade cancers and radiographically seen as uniocular or multiocular lesions. We report a rare case of PIOC in posterior palatal region in 18-year-old male.

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.