Dentinogenic Ghost Cell Tumor associated with Odontoma: A unique Histopathological Entity and its Surgical Management.

We report a rare case of dentinogenic ghost cell tumor (DGCT) associated with complex composite odontoma in a 17 years male affecting the posterior segment of the mandible. On radiographic examination, there was a well-defined multilocular radiolucency surrounding the radio opaque mass with respect to 44, 45 and 46. Histopathologically it showed ameloblastomatous proliferation with dentin like areas and ghost cells. It was associated with tooth like structures consisting of dentin, cementum and pulp like areas. DGCT with odontoma is extremely rare with only two cases being reported in literature till date. The management with its rare occurrence is discussed here.

Unusual clinical presentation, microscopy and immunohistochemistry of oral pyogenic granuloma in a paediatric patient.

An unusual clinical presentation of any pathology prompts a diagnostic dilemma, which further brings challenges in treatment planning. Pyogenic granuloma (microscopically lobular capillary haemangioma) is a benign vascular tumour that commonly involves the skin and mucous membranes and usually manifests as a solitary papule with a friable pedunculated base. Rapid exophytic growth and an ulcerated surface with bleeding on provocation are characteristic, with a gingival predominance for the site. This case report aims to elaborate on an unusual clinical presentation of oral pyogenic granuloma in a middle-childhood female patient. The clinical and radiographic characteristics of the lesion were unremarkable to the diagnosis but rather mimicked other intraoral lesions. It is histopathology that could solve the puzzle with the microscopic and immunohistochemical findings that rendered the final diagnosis of lobular capillary haemangioma.

Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas.

Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.

Telangiectatic osteosarcoma of maxilla in a young child.

Telangiectatic osteosarcoma (TO) is an uncommon variant of osteosarcoma that primarily afflicts young adults. In this case report, we describe a unique instance of TO occurring in a young child's maxilla. Under microscopic examination, it reveals abundant blood-filled spaces, extensive hemorrhagic regions, alongside atypical pleomorphic tumor cells and osteoid. It is crucial to conduct a meticulous histopathological examination to distinguish TO from other lesions, such as aneurysmal bone cysts and Ewing sarcoma.

Multimodal fluorescence imaging and spectroscopic techniques for oral cancer screening: a real-time approach.

The survival rate of oral squamous cell carcinoma (OSCC) patients is very poor, but it can be improved using highly sensitive, specific, and accurate techniques. Autofluorescence and fluorescence techniques are very sensitive and helpful in cancer screening; being directly linked with the molecular levels of human tissue, they can be used as a quantitative tool for cancer detection. Here, we report the development of multi-modal autofluorescence and fluorescence imaging and spectroscopic (MAF-IS) smartphone-based systems for fast and real-time oral cancer screening. MAF-IS system is indigenously developed and offers the advantages of being a low-cost, handy, non-contact, non-invasive, and easily operable device that can be employed in hospitals, including low-resource settings. In this study, we report the results of 43 individuals with 28 OSCC and 15 oral potentially malignant disorders (OPMDs), i.e., epithelial dysplasia and oral submucous fibrosis, using the developed devices. We observed a red shift in fluorescence emission spectrain vivo. We found red-shift of 7.72 ± 6 nm, 3 ± 4.36 nm, and 1.33 ± 0.47 nm in the case of OSCC, epithelial dysplasia, and oral submucous fibrosis, respectively, compared to normal. The results were compared with histopathology and found to be consistent. Further, the MAF-IS system provides results in real-time with higher accuracy and sensitivity compared to devices using a single modality. Our system can achieve an accuracy of 97% with sensitivity and specificity of 100% and 94.7%, respectively, even with a smaller number of patients (28 patients of OSCC). The proposed MAF-IS device has great potential for fast screening and diagnosis of oral cancer in the future.

A multicentric case study of fibroblastic and myofibroblastic oral spindle cell lesions.

Context: Spindle cell lesions comprise a vast plethora of benign and malignant lesions with similar clinical and radiographic features. Their overlapping histopathologic features ensure a diagnostic dilemma. Aim: The current multicentric study aims to delineate fibroblastic and myofibroblastic oral spindle cell lesions based on cytomorphology and comprehensive immunohistochemical analysis. Settings and Design: The experimental study was conducted at MS Ramaiah University of Applied Sciences, Bangalore, and All India Institute of Applied Sciences, Delhi. Methods and Material: A comprehensive histological scoring criteria and panel of immunohistochemical makers (STAT6, CD31, CD34, S100, SMA, vimentin, pan-CK, HHF-35, Ki67, ALK, desmin, HMB-45, SATB2, ERG, EMA and CD99) were employed concurrently for the first time for fibroblastic and myofibroblastic oral spindle cell lesions. The data obtained was tabulated and studied. Statistical Analysis Used: NA. Results: Using cytological scoring criteria and panel of immunohistochemical makers, the cases analysed and characterized were desmoplastic fibroma, fibrosarcoma, leiomyosarcoma, nodular fasciitis, neurofibroma and epithelioid inflammatory myofibroblastic sarcoma (EIMS). Conclusions: The diagnostic strategies need to be upgraded for the diagnosis of spindle cell lesions. Emphasis must be placed on cytomorphology, an immunohistochemistry (IHC) panel of markers is imperative for the accurate diagnosis of fibroblastic and myofibroblastic oral spindle cell lesions.

Anatomical and Histological Characteristics of Prematurely Erupted Teeth in Newborns.

Purpose: To assess the characteristics of dental hard and soft tissue structures of prematurely erupted teeth in newborns. Methods: Extracted natal and neonatal teeth were assessed in ground sections for evaluation of enamel, dentin, dentino-enamel junction and cementoenamel junction. Soft tissue harvested was histologically analyzed for cellularity, vascularity and other characteristics of the dental pulp. Results: This study included 15 teeth from nine neonates, of which seven erupted at birth, eight erupted within the first month of birth. All erupted in the mandibular anterior region. The demineralized ground section revealed enamel cracks, a straight dentinoenamel junction, and S-shaped dentinal tubules along with the enamel lamellae, and enamel spindle. None of the samples showed enamel tuft or cementum. Histology of soft tissue revealed enhanced cellularity, vascularity without any fibrosis, calcification and inflammation when compared with the young healthy pulp in permanent teeth. Conclusion: The prematurely erupted teeth in newborns were almost exclusively rootless and exhibited the characteristic anatomical findings pertaining to enamel, dentin, dentinoenamel junction and cementoenamel junction. The histology of their dental pulp was characterized by increased cellularity and vascularity compared.

Rare case of spindle cell haemangioma of oral cavity.

Spindle cell haemangioma (SCH) is a slow growing, benign vascular lesion with a preference for the distal extremities. Its occurrence in the oral cavity is rare. Clinically, it presents as solitary or multiple subcutaneous nodules, therefore, it could be considered in the differential diagnosis of benign soft tissue tumours. Microscopically it mimics some malignant vascular tumours and it is necessary to differentiate it from other malignant vascular lesions. We report a case of SCH in anterior mandibular region of a young male in his 20s. Although it is a benign lesion, the reported case displayed extensive areas of muscle infiltration and necrosis. After studying the radiographic findings and considering the absence of cellular atypia, a final diagnosis of SCH was made. Literature survey suggests that this is the eleventh case of SCH reported in oral cavity.

Does Loss of Immunohistochemical Expression of Glypican 3 in Oral Squamous Cell Carcinoma Play a Role in the Wnt/ß-catenin Signaling Pathway?

Glypican 3 (GPC3) is a cell membrane protein and plays a dual role, as a tumor suppressor and oncogene, depending on its structure. It is known to regulate the Wnt/ß-catenin signaling pathway and affect cell growth and proliferation. ß-catenin plays a major oncogenic role in progression of oral squamous cell carcinoma (OSCC); thus, this study aimed to explore the relationship between ß-catenin and GPC3 in OSCC. Immunoexpression of GPC3 and ß-catenin was evaluated semiquantitatively in tumor tissue (n=80) and normal oral mucosa tissue (n=20). For GPC3, the percentage of stained cells and the staining intensity were assessed. For ß-catenin, the percentage of stained cells, localization, and intensity of staining were assessed at the tumor-invasive front. The Pearson correlation was used to determine the correlation between the GPC3 and ß-catenin immunoreactivity. Significantly decreased expression of GPC3 (P=0.008) and a highly significant difference in the case of localization of ß-catenin (P=0.0001) were observed in OSCC when compared with normal oral mucosa. Cytoplasmic expression with a shift of ß-catenin expression to the nucleus was seen in OSCC in comparison with primarily membranous and membranous and cytoplasmic staining in normal mucosa. A significant difference was observed with respect to localization of stain, with ß-catenin staining moving to the nuclear compartment with an increase in the tumor grade (P=0.011). No correlation was observed between ß-catenin and GPC3 expression in OSCC cases. It is concluded that loss of expression of GPC3 in OSCC compared with normal oral mucosa indicates that it plays the role of a tumor suppressor gene in OSCC and its expression is therefore silenced in OSCC.

Pathological Diversity in Schwannomas of the Orofacial Region.

Schwannoma is a slow-growing, encapsulated benign tumor of the neuroectodermal origin arising from the perineural Schwann cells. This study aims to elucidate the clinicoradiographical and histopathological features of orofacial schwannomas through a case series of seven cases. The patients' aged ranged from 13 to 45 years, with a male predilection in the ratio of 5:2. One intraosseous case presented as a radiolucent lesion. All the cases exhibited Antoni A and Antoni B type of microscopic patterns in varying amounts. One case of ancient schwannoma showed degenerative features. The tumor cells showed diffuse positive immunohistochemical reaction for S-100 protein. Our study suggests that intraosseous schwannoma should be considered in the differential diagnosis of the intraosseous jaw lesions. Histopathologically, it is important to recognize the findings of ancient schwannoma and to avoid misdiagnosing it as a malignant lesion.

Ghost cell characterization in calcifying odontogenic cysts and dentinogenic ghost cell tumors: An immunohistochemical study.

OBJECTIVES: The aim of our study was to ascertain the true nature of ghost cells (GCs) by immunolocalization of cytokeratin (CK) 6, CK19, and amelogenin in calcifying odontogenic cysts (COCs) and dentinogenic ghost cell tumors (DGCTs) in an attempt to determine the nature of this unique cell. METHODS: A total of thirteen cases (six COCs and seven DGCTs) were examined immunohistochemically, in order to compare immunoreactivity for CK6, CK19, and amelogenin in odontogenic GCs. RESULTS: Positive expression of amelogenin (92.3%) and CK6 (77%) was chiefly found in GCs. CK19 expression was observed in the cytoplasm of odontogenic epithelial cells of the lining epithelium. GCs were devoid of CK19 expression and were positive only on the cytoplasmic periphery. CONCLUSION: In the current study, GCs showed accumulation of amelogenin and hard keratins in their cytoplasm during pathological transformation.