Dentinogenic ghost cell tumor: Case report of a rare central variant and literature review.

The dentinogenic ghost cell tumor (DGCT), a solid variant of the calcifying odontogenic cysts, is an uncommon odontogenic neoplasm which is aggressive and has a propensity for recurrence. It accounts for <0.5% of all odontogenic tumors which can exhibit intraosseous (central) or extraosseous (peripheral) localization. Till today, only 39 cases of central DGCT have been reported in English literature according to WHO 2017 Classification. Therapeutic intervention of central variant should be aggressive, local resection with adequate safety margins and monitoring the patient for recurrence as the lesions show recurrence rate up to 71%. The purpose of this paper is to describe a rare case report of central DGCT in a 57-year-old female patient with a brief review of literature which provides an update on the epidemiology, diagnostic and clinicopathological characteristics of the published cases.

Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study.

AIM AND OBJECTIVE: To evaluate the efficacy of root canal instrumentation and fracture strength assessment in primary molars after preparing different shapes of access cavity design. MATERIALS AND METHODS: Sixty extracted primary mandibular molars with at least 2/3rd roots were randomly, equally divided into two groups based on shapes of the access cavities; Group I: Traditional access cavity (TAC), Group II: Conservative access cavity (CAC). Each group was further subdivided into two subgroups with 15 samples each. After, root canal debridement, samples in subgroup 1 were sectioned for histological evaluation of root canal instrumentation efficacy, while subgroup 2 were assessed for fracture strength using a Universal Testing Machine. The data were analyzed statistically using Mann-Whitney and post hoc Tukey tests, with a p value <0.05. RESULTS: Traditional access cavity showed statistically significant root canal debridement efficacy (p < 0.05) compared with CAC. Statistically significant differences were obtained between fracture strength values among the two groups (p < 0.05), with considerably higher fracture strength in the CAC group than TAC. CONCLUSION: Traditional access cavity design resulted in complete root canal debridement but caused weakening of tooth structure due to low fracture strength, necessitating the use of full coverage restoration postendodontic therapy. HOW TO CITE THIS ARTICLE: Singhal Y, Srivastava N, Rana V, et al. Efficacy of Root Canal Instrumentation and Fracture Strength Assessment in Primary Molars after Preparing Two Different Shapes of Access Cavity: An Ex Vivo Histological Study. Int J Clin Pediatr Dent 2021;14(4):518-524.

Clinicopathological Profile of 80 Cases of Unicystic Ameloblastoma Aided by a Histopathological Comparison Using Modified Philipsen-Reichart Classification and Marx-Stern Classification.

Unicystic ameloblastoma (UA) is an uncommon variant of ameloblastoma and behaves totally different from the solid multicystic variant of ameloblastoma (SMA); furthermore the histological subgroups of UA also show varied behavior regarding proliferation. The present multi-centric study was designed to present the clinicopathological features of unicystic ameloblastoma (UA) and to compare the two popular histological classifications systems. 80 satisfactory cases of UA were retrieved and evaluated for clinicopathological parameters from four teaching dental schools of North India. The cases were classified using modified Reichart and Philipsen system and Marx and Stern system followed by comparison of inter-observer variability. The results were analyzed using SPSS software. The mean age of occurrence was 30.79 ± 16.49 years. Males outnumbered females (M:F::1.67:1). The majority of cases occurred in the third decade irrespective of the gender. Most cases were found in body-angle-ramus region of the mandible. The modified Reichart and Philipsen classification yielded better interobserver agreement (kappa value 0.845). The modified Reichart and Philipsen classification yields better inter-rater agreement and is easy to reproduce amongst oral pathologists. Being simpler it may easily be understood by the operating surgeon for better treatment outcome.

Primary intraosseous adenoid cystic carcinoma of the mandible: A rare clinical entity.

Central intraosseous adenoid cystic carcinoma (ACC) of the mandible, formerly known as cylindroma, is a rare neoplasm with only 47 cases reported in the literature. We present a case of central ACC involving the mandible of a 55-year-old male patient.

The role of myofibroblasts in the progression of oral submucous fibrosis: A systematic review.

Oral Submucous Fibrosis (OSMF) is a chronic progressive scarring oral disease predominantly affecting people of South Asian origin. It is characterized by juxtaepithelial inflammatory cell infiltration followed by fibrosis in the lamina propria and submucosa of the oral mucosa. The pathogenesis of the disease is not well established and a number of mechanisms have been proposed regarding the pathogenesis. A renewed interest has been shown in myofibrobasts which have been implicated to play a significant role in the pathogenesis of OSMF. The myofibroblast were initially identified by means of electron microscopy in granulation tissue of healing wounds as a modulated fibroblast exhibiting features of smooth muscle cells, with prominent bundles of microfilaments, dense bodies scattered in between, and gap junctions. The presence of myofibroblasts has successively been described in practically all fibrotic situations characterized by tissue retraction and remodeling. This review paper is an attempt to identify all the studies involving myofibroblasts and explaining the pathogenesis in a simplified manner.

Impact of stromal CD45RO+ immune cells on proliferation and dedifferentiation in node-negative squamous cell carcinomas of cheek mucosa.

BACKGROUND: The most fundamental trait of cancer cells involves their ability to sustain chronic proliferation. Tumors have a complex cellular ecology that establishes the malignant potential of the tumor. In these ecosystems, innate immune cells are highly represented. Many contradictory reports have been published regarding the impact of tumor-infiltrating immune cells on proliferation of the tumors. AIM: This study aims to assess the impact of CD45RO+ve immune cells on proliferation and dedifferentiation of node-negative squamous cell carcinomas of cheek mucosa (SCC-CM). MATERIALS AND METHODS: Thirty formalin-fixed paraffin-embedded tissue blocks of previously diagnosed node-negative SCC-CM subclassified as Grade I SCC - 10 cases; Grade II SCC - 10 cases; and Grade III SCC - 10 cases (Broders' classification - 1927). Immunohistochemistry performed on each selected tissue section using anti-p53 and anti-CD45RO as primary antibodies. Semi-quantitative analyses performed for all the tissue sections to assess the p53 and CD45RO expression. p53:CD45RO expression ratio calculated. The data were statistically analyzed using GraphPad Prism 5 for Windows. RESULTS: Our results showed statistically significant increase (P = 0.0006) in p53 expression and decrease (P = 0.0044) in CD45RO+ immune cell response with the decrease in differentiation of SCC-CMs using Fisher's exact test and statistically significant increase (P < 0.001) in p53:CD45RO expression ratio with decrease in differentiation using one-way ANOVA. CONCLUSION: Based on all these findings from the present study, we perceive the following findings. In node-negative SCC-CMs, CD45RO+ immune cells play a possible role in controlling the dedifferentiation of the tumor and in limiting the proliferative potential of the tumor cells which are tumor antagonistic in nature.

Correlation and estimation of stature from cephalofacial measurements: A study on Western Uttar Pradesh population.

BACKGROUND: Identification of an individual from fragmented remains is still a very challenging task for forensic experts in spite of the many studies which have been carried out till date, across the globe. Stature, one of the criteria of personal identification, has a definite and proportional biological relationship with every part of the human body which includes the cephalofacial (CF) region. At instances, where only CF remains are available, it becomes difficult for the forensic scientist to identify the deceased since there is a paucity of studies pertaining to the estimation of stature from CF dimensions. Results from such a study can be used as database for forensic investigations and other anthropometric studies. AIM: To estimate stature of an individual using data derived from CF measurements. MATERIALS AND METHODS: The study was conducted on 540 representative candidates (270 males and 270 females) in the age group of 20-25 years. Stature (S) and CF measurements (maximum head length [MHL], maximum head breadth [MHB], horizontal circumference of head [HHC], bigonial diameter [BGD], and morphological facial length [MFL]) of each candidate were recorded and tabulated. The statistical analysis was performed using SPSS Statistics v. 19.0 (IBM, Armonk, NY, USA) for the CF dimensions obtained. Comparisons were made between the CF measurements recorded with respect to the gender using statistical mean, standard deviation, range, and Pearson's correlation coefficient, and linear regression equation of height to the parameters recorded was derived. RESULTS: Findings suggest that all the CF measurements are significantly correlated with stature (P < 0.01). MHL, MHB, and HHC show higher correlation coefficients (r value) when compared to MFL and BGD. The CF measurements arranged in descending order based on their r value is HHC > MHL > MHB > MFL > BGD. In general, head measurements show lower values of standard error of estimate (SEE) compared to facial measurements. Among both sexes, HHC shows the least and BGD shows the highest SEE value when compared to all the other CF measurements. CONCLUSION: It can be concluded that the recommended anthropometric measurements provided serve as a template and confirm that there are geographical and sexual dimorphism in anthropometric parameters; therefore, these should be considered in forensic or criminal investigations.

Giant Peripheral Ossifying Fibroma of the Posterior Mandible-A Rare Case Report.

Large, atypical peripheral ossifying fibromas are known as giant peripheral ossifying fibromas. These lesions have often been associated with heterogeneous clinical and radiographic characteristics subsequently leading to their misdiagnosis. Biopsies have been the gold standard for the diagnosis of such lesions. This study reports on an acute presentation of giant peripheral ossifying fibroma, clinically mimicking a malignant lesion due to its atypical presentation along with its characteristic histological features, which led to the establishment of the diagnosis.

A benign salivary gland tumor of minor salivary gland mimicking an epithelial malignancy.

Pleomorphic adenoma (PA) is the most common benign tumor of major or minor salivary glands. Microscopically, PA exhibits a great diversity of morphological aspects. Here, we present an unusual case of PA with extensive squamous metaplasia and keratin-filled cysts in the left retromolar region of a 50-year-old edentulous person whose microscopic finding may represent a diagnostic dilemma for pathologists.

Oncocytoma of minor salivary gland involving the retromolar region: A rare entity.

Oncocytic neoplasms comprise a group of rare tumors of salivary glands. Histologically, World Health Organization (WHO) (1991) classified them into three distinct types: Oncocytosis, oncocytoma and oncocytic carcinoma. Oncocytoma is also known by the more descriptive and less confusing terms of oxyphilic adenoma and oxyphilic granular cell adenoma. Oncocytoma is a rare benign salivary gland neoplasm composed of large epithelial cells with characteristic bright eosinophilic granular cytoplasm (oncocytic cells). It accounts for approximately 0.4-1% of all salivary gland neoplasms, occurring primarily in parotid glands, with only a small percentage occurring in minor salivary glands of palate, tonsillar fossi, larynx, nasal cavity, maxillary sinus and the lacrimal gland. It occurs primarily in persons older than 50 years of age. According to some authors, the biologic behavior of oncocytomas arising from minor salivary glands is that of an aggressive nature and should be considered as low-grade malignancies. Only 17 cases of histologically verified oncocytoma of an intraoral minor salivary gland are reported in literature, the current case being the 18th. Owing to the lack of large series, assiduous study of the cases reported in the literature may lead to better understanding of this rare entity. We herein describe a rare and probably the first case of minor salivary gland oncocytoma involving retromolar area in a 32-year-old female patient with a brief review of literature.

Mast cell count in oral reactive lesions: A histochemical study.

BACKGROUND: The aim of this study was to quantify the number of mast cells in focal reactive hyperplastic lesions of the oral cavity and to compare these two number of mast cells in normal gingival tissues and to correlate their presence with the state of connective tissue changes in reactive lesions and probably suggest a role for mast cells in these lesions. MATERIALS AND METHODS: Patient records were retrieved during a 10 year period from 2001 to 2010. Data of all reactive hyperplasias namely focal fibrous hyperplasia, pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell granuloma (PGCG) were reviewed and 10 cases seen in the gingiva were selected for each category and stained with 1% toluidine blue for mast cells. Statistical analysis was applied to see the significant differences between the groups and with the normal gingival tissue. One-way ANOVA-F and unpaired t-test was applied and significant differences were seen between the groups at 5% level of significance. RESULTS: In this study, mast cell count was maximum in POF and fibrous hyperplasia (FH) followed by cases of PG and PGCG. CONCLUSION: The number of mast cells was more numerous in POF and FH suggesting that mast cell activation is a characteristic feature of chronic inflammation, a condition that may lead to fibrosis as a result of increased collagen synthesis by fibroblasts.

Tuberculosis of odontogenic cyst.

Tuberculous infection of the oral tissues is a rare finding. An interesting case of primary tuberculosis of mouth is described, presenting as persistent discharge of pus from the lower wisdom tooth region. Incisional biopsy revealed features of an infected dentigerous cyst while histopathological examination of the excised lesion showed keratinizing cyst with secondary infection. Non-healing of the bony defect prompted curettage of the area and the submitted sample microscopically showed granuloma with characteristic Langhans' giant cells, raising the suspicion of underlying systemic tuberculosis. The importance to the dental surgeon in the recognition, especially by use of pathological examination, is emphasized and also the value of diagnosis for the patients and the community.

Corneal sensitivity, blink rate, and corneal nerve density in progressive supranuclear palsy and Parkinson disease.

PURPOSE: Patients with progressive supranuclear palsy (PSP) and patients with Parkinson disease frequently manifest signs of dry eyes, yet many remain asymptomatic. In this study, we established the relationships between blink rate, corneal sensitivity, and corneal nerve density in patients with ocular surface disease associated with PSP and Parkinson disease. METHODS: Fourteen eyes of 7 patients with PSP, 8 eyes of 4 patients with Parkinson disease, and 10 eyes of 5 age-matched controls were examined for meibomian dysfunction, ocular surface staining, and blink rate. Corneal sensitivity was measured with a Cochet-Bonnet esthesiometer, and corneal subbasal nerve density was measured by using confocal microscopy in vivo. Comparisons between variables were assessed by using generalized estimating equation models to account for possible correlation between fellow eyes of the same subject. RESULTS: Abnormal ocular surface staining and meibomian disease were present in most subjects with PSP and Parkinson disease, but in none of the controls. Patients with PSP and Parkinson disease had lower blink rates (P < 0.001) and decreased corneal sensitivity (P < 0.001) compared with controls, whereas subbasal nerve density did not differ between groups. Blink rate was correlated with corneal sensitivity (r = 0.83, P < 0.001), but corneal sensitivity was not correlated with subbasal nerve density (r = -0.16, P = 0.78). CONCLUSIONS: Patients with ocular surface disease associated with PSP and Parkinson disease might be asymptomatic because of decreased corneal sensitivity. Decreased corneal sensitivity was not explained by loss of corneal nerves but was associated with decreased blink rate.

Reactive hyperplastic lesions of the oral cavity: A ten year observational study on North Indian Population.

BACK GROUND: The aim of this study was to determine the frequency of focal reactive hyperplastic lesions of the oral cavity as reported in the Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut and to compare these data with those of previously reported studies from other regions and countries. MATERIAL AND METHOD: Patient records of the Department of Oral Pathology were retrieved during a 10 year period from 2001 to 2010. Data of all reactive hyperplasias namely focal fibrous hyperplasia (FFH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell granuloma (PGCG) were reviewed and analyzed for age, gender, and site of location. RESULTS: There were 209 focal reactive hyperplastic lesions that comprised 12.8% of the 1634 accessed biopsies. FFH was the most common lesion constituting 57.4% of the cases, followed by PG (18.7%), POF (17.7%) and PGCG (6.22%). The mean age of patients at presentation was 31.56 years. The female to male ratio was 1.5:1. The most frequently involved site was the gingiva (81.8%); other sites were the buccal mucosa, lips, tongue, alveolar mucosa and palate. CONCLUSION: Oral lesions are often detected by Dental professionals and surgeons. Knowledge of the frequency and presentation of the most common oral lesions is beneficial in developing a clinical impression of such lesions encountered in practice and to minimize potential dentoalveolar complications. Key words:Focal reactive hyperplastic lesions, fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma.