Usha Hegde

Lipoid Proteinosis: A Rare Encounter in Dental Office

Lipoid proteinosis is a sporadic congenital metabolic disorder which is characterized by deposition of hyaline material in dermis, submucosal connective tissue, and various internal organs. It has an extremely low prevalence rate with less than 300 cases reported so far. This progressive disease has a vast spectrum of manifestations ranging from asymptomatic lesions to fatal seizures and respiratory obstruction making timely diagnosis of this rare disorder an imperative task for oral health care practitioners. We report a case of characteristic oral manifestations of lipoid proteinosis in a 28-year-old male patient along with a review of relevant prevailing literature.

Verruciform xanthoma: A view on the concepts of its etiopathogenesis

Verruciform xanthoma is a very uncommon papillary growth seen chiefly in the oral mucosa. The presence of foam cells in the connective tissue papillae between the epithelial rete ridges forms the hallmark in its diagnosis. There has been wide speculation and various hypotheses put forth in explaining the etiopathogenesis of verruciform xanthoma and the origin of foam cells. This article aims to update the different hypotheses in understanding the pathogenesis of the lesion.

Pseudolymphoma versus lymphoma: An important diagnostic decision

Small innocuous growths on the face usually do not pose difficulty in diagnosis on histopathology. However, some benign inflammatory lesions might mimic malignancy and hence need further investigations for final diagnosis. The distinction between a benign/inflammatory/malignant lesion needs no emphasis as the treatment plan, prognosis and the patients well-being depends on it. Lymphocytoma cutis, or Spiegler-Fendt Sarcoid, is classed as one of the pseudolymphomas, referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resembles, clinically and histopathologically, cutaneous lymphomas. To obtain an accurate diagnosis, careful clinical evaluation, as well as histopathological and immunohistochemical examination is needed. One such case of an otherwise unassuming growth mimicking malignancy is being presented.

Comparison of microwave versus conventional decalcification of teeth using three different decalcifying solutions

Background: In routine histopathology, decalcification of teeth is an essential and important step during tissue processing. The present study was attempted to decalcify teeth using microwave method and to compare it with conventional decalcification method. Aim: To compare microwave decalcification with conventional decalcification method with respect to the speed of decalcification, preservation of tissue structure, and efficacy of staining. Materials and Methods: A total of 72 single-rooted premolars were used for both conventional and microwave decalcification methods. Three different types of decalcifying agents at 5% and 7% were used. Decalcifying agents included nitric acid, formic acid, and trichloroacetic acid, each at 5% and 7%. About 6 teeth were included in each category and were decalcified by both conventional and microwave method. After decalcification, all the teeth were examined macroscopically and microscopically. Cramer′s V-test was used to determine the statistical significance. Results: The results have shown that microwave method using 5% and 7% nitric acid were the fastest. Structural details and good staining characteristics were better in teeth decalcified by 5% nitric acid and 5% trichloroacetic acid by both the methods. Conclusions: 5% nitric acid by microwave method proved to be the best decalcifying agent as it was fast and gave good structural details and staining characteristics.

Oral Granular Cell Tumor: Histogenesis - An Immuno-Histochemical Profile

A granular cell tumor (GCT) is an uncommon benign neoplasm affecting any part of the body, with a great percentage of lesions being reported to occur intraorally. One such case of GCT on the lateral margin of the tongue in a 17 year old girl is being reported. The histopathological diagnosis of GCT was confirmed by immunohistochemistry findings. The tumor was positive for S-100, NSE, Vimentin, CD-68 and negative for SMA and Desmin which helped us not only in arriving at the final diagnosis of GCT but also helped us to identify the origin of the tumor. Surgical resection of the tumor with wide margin was done and regular follow up of the patient for 2 years has not shown any evidence of recurrence and metastasis. INTRODUCTION: Granular cell tumor (GCT) was first described by Abrikossoff in 1926 as a tumor of myogenic origin. Hence, GCT was termed as myoblastoma, or as tumor of Abrikossoff.1 Later it was thought to be of neurogenic origin and was also called as granular cell neurofibroma or granular cell schwannoma.2 Various authors have proposed different cells in the histogenesis of GCT. It is thought to arise from myoblasts, histiocytes, fibroblasts, undifferentiated mesenchymal cells and schwann cells.2 Although GCT is benign in nature, few cases have been reported with recurrence or metastasis to regional lymph nodes. The malignancy rate is estimated to be less than 2% of all reported GCTs.3 GCTs are reported to occur most frequently between 4th-6th decade of life and is rare below that age group.1.2 An interesting case of intraoral GCT that is very rarely reported in adolescent population is being reported. It’s clinical and histopathological findings are discussed. The IHC markers that helped us in the final diagnosis and evaluation of the cell of origin of this tumor is elaborated. CASE REPORT A 17-year-old girl presented with a painless swelling since 8 months in the left lateral margin of the tongue. On clinical examination, a single, firm nodular mass about 1cm in dimension was seen on the left lateral border of the tongue. The swelling appeared normal in color, without any secondary changes. There was no regression in the size of the swelling since the past 8months. It was not tender on palpation. Excisional biopsy was performed under local anaesthesia and specimen sent for histopathological analysis. Fixation of the specimen was performed in 10% buffered formalin and embedded in the paraffin wax. 4-μ thickness of tissue sections were obtained from the paraffin-embedded block and stained with haematoxylin-eosin. Microscopically, the surface of the lesion was covered by stratified squamous epithelium, which exhibited pseudoepitheliomatous hyperplasia (Fig.1). Numerous foci of granular cells in the connective tissue, which were separated by fibrous septae was seen. The granular cells were large, polygonal to oval in shape with abundant pale, fine granular, eosinophilic cytoplasm and a small, vesicular, eccentrically placed nucleus. The cell membrane was distinct and well defined (Fig.2). The granular cells were seen invading the underlying muscle. There was no evidence of areas of necrosis. These findings were consistent with the diagnosis of granular cell tumor. The histopathological differential diagnosis of other granular cell tumors, such as granular cell leiomyoma, non-neural granular cell tumor, congenital epulis and alveolar soft part sarcoma were considered and hence an immunohistostaining for S-100, SMA, Neuron-specific enolase(NSE), Desmin, CD-68 and Vimentin was taken up for definitive diagnosis. The IHC staining showed positive immunoreactivity for S-100 (Fig.3), CD-68 (Fig.4), Vimentin (Fig.5) , NSE (Fig.6) and negative immunoreactivity for Desmin (Fig.7) and SMA (Fig.8), which helped us in arriving at a conclusive diagnosis of GCT. Post-operatively the patient showed good healing and a regular follow up for 2 years since the diagnosis and treatment has been uneventful without any evidence of recurrence and metastasis. DISCUSSION: GCT is a relatively uncommon benign neoplasm that occurs in almost any part of the body such as skin, nervous system, gastrointestinal tract, urinary bladder, female reproductive tract and bronchus.2 The head and neck region is involved in about 45 to 65% of the patients with this tumor and 70% account for intra oral lesions.2 The tongue, buccal mucosa, and hard palate are commonly affected.3 However, tumors of the lip, gingiva, uvula and parotid gland have also been reported.2 The tumor most frequently occurs in the fourth to sixth decades of life and is rare in children. Females are twice commonly affected than males.1,2 Cases of multiple lesions of GCT have also been reported.6 Generally, it presents as a solitary asymptomatic nodule on the subcutaneous or submucosal tissues. It shows slow growth1, usually not extending more than 3 cm in size. The mass appears pink in color but occasionally has a yellowish surface coloration and is firm in consistency. The overlying epithelium is usually intact. Sometimes the large lesions may show surface ulcerations, which

Hereditary gingival fibromatosis: A report of two cases in the same family

Overgrowth of keratinized gingival tissues is a common condition and is described under variety of names. Causes of such enlargement can be medications, hereditary, and/or local irritating factors. Mutation in SOS1, son-of-sevenless gene, is thought to be responsible for hereditary gingival fibromatosis. This report shows a case of 19-year-old male and his 15-year-old sister, with a chief complaint of overgrowth of gingival and irregularly placed teeth. A similar overgrowth was also found in other members of the same family, without any drug history or syndromic conditions. An occurrence of the disease has been found in two generations of this family and therefore, it may be following autosomal dominant trait of inheritance. Since it is idiopathic and has a genetic cause for its occurrence, it cannot be prevented. Both cases underwent a surgical intervention to rectify the abnormality and were followed from 6 months to 1 year, during which there was no recurrence.

Knowledge, attitude, and practices of hepatitis B infection among dental students -

Background: Hepatitis B virus (HBV) infection is a major worldwide public health problem. Nearly 45% of the world’s population lives in areas of high endemicity, with India being a country of intermediate endemicity. Objective: To assess the knowledge, attitude, and practices of dental students about HBV infection at a private dental institution in Mysore, Karnataka, India. Materials and Methods: A cross-sectional survey was conducted using a pretested, structured, and validated questionnaire containing 16 questions on awareness, transmission, prevention, diagnosis, treatment, vaccination status, and postexposure prophylaxis of HBV infection. Descriptive statistics were carried out along with chi-square test and contingency coefficient. Result: The response rate was 100% (n = 486). A total of 88.7% of the students knew about the transmission of HBV infection. Only 64% students were immunized against HBV. Majority of the students (91.1%) agreed for vaccination against HBV infection. Only 28.4% students knew about the postexposure treatment against HBV infection. About 58.8% students knew about the preventive measures against HBV infection. Conclusion: The overall awareness regarding HBV disease was found to be lacking among the dental students.

Mucocele: A Case Report with Etiopathogenesis, Clinical Features and Various Treatment Options

A mucocele is a benign, mucous-containing cystic lesion of the minor salivary glands presenting as a distinct, fluctuant, painless swelling of the mucosa. Mucocele is a clinical term used that includes mucous extravasation phenomenon and mucus retention cyst. Because each has a distinctive pathogenesis and microscopy, they are considered separately. Extravasation mucocele is the most common type of the two and the most common reason for mucocele is traumatic injury to the minor salivary ducts. They can appear at any site where minor salivary gland is present. The most common site is lower lip followed by the tongue, floor of mouth and buccal mucosa. There are various modalities for the treatment of mucocele. This paper reviews a case of extravasation type of mucocele; its etiopathogenesis, clinical features and various treatment options.

Case Report and Review of Glandular Odontogenic Cyst in Anterior Maxilla- A Histopathologic Perspective

Glandular odontogenic cyst is a rare odontogenic jaw cyst which exhibits a locally aggressive behaviour with high recurrence rate. It is a relatively new entity that was first described in 1987. Because of the paucity of reported cases, there is no consensus or established protocols about many aspects of management of this lesion. In this article, we present a case of glandular odontogenic cyst in maxilla in a 48 year old male patient and focus on the review of clinicopathologic features and differential diagnosis, which can be often challenging.

Peripheral ossifying fibroma with an underlying exophytic bony mass

The peripheral ossifying fibroma (POF) is a benign reactive gingival overgrowth occurring mainly in the anterior maxilla in young adults, predominantly among females. The definitive diagnosis is established by histological examination. Surgery is the treatment of choice, though the recurrence rate can reach up to 20%. The purpose of this article is to present a case of POF in a 50-year-old female with an abnormal size and an exophytic bony mass associated with it.