Inflammatory Myofibroblastic Tumor of the Oral Cavity. A Great Mimicker.

Inflammatory myofibroblastic tumor (IMT) is a seldom-described tumor of indefinite etiology and pathogenesis. It occurs primarily in the lungs, but has occurred in other extra-pulmonary sites. Histologically, these lesions appear as an inflammatory infiltrate within a variably myofibrotic background. Current evidence shows that inflammatory myofibroblastic tumors are neoplastic processes resulting from chromosomal translocations that frequently cause an overexpression of ALK kinase, often assessed using immunohistochemical studies. Currently, the biological behavior of oral IMT is still uncertain. This article illustrates the clinical, histological and operative features of a case of IMT of the oral cavity.

Genotoxic and cytotoxic effects of X-ray on buccal epithelial cells following panoramic radiography: A pediatric study.

BACKGROUND: Ionizing radiation is a potent mutagenic agent capable of inducing both mutation and chromosomal aberrations. Non-lethal doses of ionizing radiation may induce genomic instability favoring carcinogenesis. In spite of their mutagenic potential, this kind of radiation is an important tool for diagnosis of the disease and is used in medical and dental practice. It has been believed that the number of micronucleus and increased frequency of other nuclear alterations, including karyorrhexis, condensed chromatin and pyknosis, are related to the increasing effects of carcinogens. Many approaches and techniques have been developed for the monitoring of human populations exposed to various mutagens, but the analysis of micronuclei (MN) has become a standard approach for the assessment of chromosomal damage in human populations. AIM: To assess the effects of radiation exposure from panoramic radiography on the buccal epithelial cells (BECs) of pediatric patients. MATERIALS AND METHODS: The study included 20 pediatric patients who had to undergo panoramic radiography for further dental treatment. Exfoliated BECs were obtained and examined immediately before and 10 days after radiation exposure. The cells were stained using rapid Papanicolaou (PAP) kit. Evaluation for MN and nuclear alterations was carried out by an oral pathologist and data were statistically analyzed using the "t" test. RESULTS: The mean number of MN in the BECs before exposure of pediatric patients to panoramic radiography was 4.25 and after exposure was 4.40. This difference was not found to be statistically significant (P < 0.0001). However, the mean nuclear alterations of 8.70 and 15.75 before and after exposure were statistically significant (P < 0.0001). CONCLUSION: Panoramic radiographs can induce cytotoxicity but not genotoxic effects in buccal mucosal cells. Hence, dental radiographs should be prescribed only when deemed indispensable.

Value of immunohistochemistry in diagnosing a rare case of maxillofacial plasma cell granuloma masquerading as a gingival epulis.

BACKGROUND: Plasma cell granuloma is a non-neoplastic lesion rather uncommonly seen in the maxillofacial region. Its etiology, biological behavior, ideal treatment and prognosis are still unclear and rather controversial. STUDY: A detailed histopathological examination and immunohistochemical study of the excised specimen was carried out, both for making a confirmatory diagnosis as well as to determine the etiopathology, biological behavior and prognosis of the lesion. RESULTS: Light microscopy revealed a hyperplastic stratified squamous epithelial lining, overlying a densely fibrocellular granulation tissue containing a rich proliferation of mononuclear inflammatory cells, among which there was a predominance of plasma cells with their typical eccentric, cartwheel shaped, "clock-faced" nuclei. Strong immunohistochemical positivity was observed for CD-138 by numerous cells of the connective tissue of the lesion, thus confirming them to indeed be plasma cells. Further, immunohistochemistry (IH) analysis also demonstrated the expression of both, the lambda and kappa light chain immunoglobulins by the plasma cell population, thus confirming them to be polyclonal and of an inflammatory, non-neoplastic origin. SUMMARY AND CONCLUSION: As a plasma cell granuloma is rarely encountered in the oral and maxillofacial region, its diagnosis could have been very easily missed, had it not been for the detection of the large numbers of plasma cells by light microscopy, which was further confirmed by IH. IH also helped in establishing the likely etiopathology of the lesion and confirmed it to be of a non-neoplastic reactive/inflammatory origin.