Regional odontodysplasia: morphological, ultrastructural, and immunohistochemical features of the affected teeth, connective tissue, and odontogenic remnants.

PURPOSE: Regional odontodysplasia (RO) is a rare developmental odontogenic defect. The affected teeth are described as "ghost teeth," due to malformation of dentin, enamel, and cementum. The purpose of this study was to describe the ultrastructural characteristics of the affected teeth as well as the immunohistochemical features of the soft tissue associated with 2 cases of regional odontodysplasia. METHODS: Two cases diagnosed as RO were included on the study. After diagnosis, affected teeth and associated soft tissue were surgically removed from both patients and processed for light and scanning electron microscopy (SEM) analysis. For light microscopy, the specimens were decalcified in 5% nitric acid for 10 to 16 days and stained with hematoxylin and eosin. For SEM studies, specimens were cleaned with diamond paste and, after polishing, treated with 37% phosphoric acid for 5 minutes and covered by a thin layer of metallic gold. Soft tissues covering and surrounding the extracted teeth were routinely processed, and submitted to immunohistochemical reactions against pan-cytokeratins, cytokeratin 19, vimentin, laminin and collagen IV. RESULTS: Both enamel and dentin showed gross alterations, including hypomineralization and discoloration, being more prominent on the coronal structures than the radicular structures. Ultrastructural features included alterations on the prismatic enamel surface, dentinal grooves, interglobular dentin, and hypoplastic and hypocalcified dental hard tissues. The soft gingival and alveolar tissue surrounding and covering the affected teeth showed calcifications and odontogenic remnants, positive for cytokeratin 19, laminin, and collagen IV. CONCLUSIONS: Enamel and dentin are grossly altered in regional odontodysplasia, while cementum is less affected, and soft-tissue calcifications are associated with odontogenic cytokeratin-positive epithelial remnants, in addition to mesenchymal components.

Odontogenic myxoma: clinico-pathological, immunohistochemical and ultrastructural findings of a multicentric series.

The aim of this study was to analyze the clinico-pathological and immunohistochemical features of 62 cases of odontogenic myxoma (OM) diagnosed in three Oral Pathology Diagnostic Services in Latin America, as well as to describe the ultrastructural features of three of these cases. OM showed a wide age range (9-71 years), with a mean of 27.97 yr (SD: 11.01) and a male to female ratio of 1:2.2. Mandible was affected in 37 cases (59.6%) and maxilla in 25 (40.4%), with 61.3% located in the posterior region. Thirty-nine cases (62.9%) were multilocular and 23 (37.1%) unilocular. Size ranged from 1 to 13 cm, (mean: 5.2 cm). Thirty-seven multilocular (54.8%) and 6 unilocular lesions (26%) were larger than 4 cm (p<0.05). Epithelial islands were identified in 5 cases (8%) on H&E stained sections, but AE1/AE3 and CK14 disclosed these structures in 15 cases each (24.2%); CK5 was positive in 8 (12.9%); CK7 in 2 (3.2%) and CK19 in only 3 cases (4.8%). All cases were negative for CKs 8 and 18, S-100 protein, NSE and CD68, and showed a low index of expression of Bcl2 and ki-67 proteins (<1%). Mast cell antibodies showed these cells in 45 cases (72.6%). Myofibroblastic differentiation evidenced by myofilaments and fibronexi was found in one case out of the three studied by TEM and 29 cases (46.7%) were positive by immunohistochemistry for alpha actin. In conclusion, only a minority of OM had epithelial islands, and only 3 cases expressed CK 19, indicating an odontogenic epithelium origin. Immunohistochemical and ultrastructural findings suggest that OM is a mesenchymal neoplasm in which several factors may contribute to its pathogenesis, including myofibroblastic differentiation and the participation of mast cell products. However, further investigations are needed to better understand the participation of these elements in this particular neoplasm.

Oral cysticercosis: a collaborative study of 16 cases.

Cysticercosis is a potentially fatal parasitic disease that rarely involves the oral region in humans. This study includes 21 lesions seen in 16 Latin American patients. There were 8 men and 8 women, with an age range from 6 to 67 years (mean 33.6 years). Most cases appeared as asymptomatic submucosal nodules that resembled mucous cysts or benign mesenchymal neoplasms. Most were found in the tongue (11 cases), followed by buccal mucosa and the lower lip (4 cases each) and upper lip (2 cases). These were well circumscribed, and ranged in size from 1 to 2.5 cm in diameter. Typical histologic features of viable cysticerci were observed in 15 cases, and the presence of colloid degeneration and granular mineralization were detected in only 1 case. In all cases, simple surgical excision was sufficient to ensure complete removal of the lesions without postoperative complications. It is important to carry out a detailed study in every case, in order to exclude the presence of the parasite in other sites.