Central Giant Cell Granuloma: A Potential Endodontic Misdiagnosis

Central Giant Cell Granulomas (CGCGs) may manifest as radiolucencies anywhere in the mandible or maxilla. In rare cases, it can appear as a localized periradicular area and mimic an endodontic lesion. This case report presents an uncommon location of CGCG which was not accurately diagnosed nor timely treated. Periodic follow ups of periapical radiolucencies after RCT are necessary. Dentists should include CGCG in differential diagnosis of lesions that are refractory to endodontic treatment. [Iranian Endodontic Journal 2009;4(4):158-60

Evaluation of Mast Cell and Blood Vessel Density in Inflammatory Periapical Lesions

Introduction: Radicular cystsand periapical granulomas are the most common periapical inflammatory lesions. However, the role of cellular immunity and microvessels in their pathogenesis remains unknown. The aim of this study was to evaluate the mast cell density (MCD), mircovessel density (MVD) and investigating the correlation between their densities with each other in the above mentioned lesions.Materials & Methods: In this descriptive cross-sectional study, 40 paraffin blocks of mentioned lesions were selected from achieves of School of Dentistry, Babol University of Medical Sciences. Three sections were prepared from each block and stained by hematoxylin-eosin, toluidine blue, and immunohistochemically for CD34 to determine the score of inflammation, presence of mast cells and degranulatedmast cells (DMCs), and MVD, respectively. The correlation between MCD and either inflammatory infiltrate or MVD was evaluated. Data analyzed by t student, Mann-Whitney and Spearman test.Results: Mast cells were present in all periapical inflammatory lesions; 15.4±14.8 for MCD, 7.2±6.1 for DMCs, and the ratio of DMCs to total number of MCs was 0.354±0.166 and 14.8+4.44 for blood vessel density in radicular cyst and 8.52±6.75, 2.91±2.1, 0.196±0.194 and 13±8.02 in periapical granulomas, respectively. There was a positive correlation between MCD and MVD in radicular cyst (P=0.03, r=0.341), but not in periapical granulomas (P=0.6, r=0.124). MCD and MVD increased with the score of inflammation in radicular cyst (P=0.001, r=0.7) and periapical granuloma (P=0.012, r=0.54).Conclusion: Mast cells and microvessels play a role in pathogenesis of periapical inflammatory lesions. In this study, the density of mast cells and DMCs in radicular cyst was higher than periapical granulomas, but no difference was observed regarding MVD in periapical inflammatory lesions. It seems that the relationship between MCD and MVD is different based on the clinical stage of periapical inflammatory lesions

Cementoblastoma of the Mandible: A Case Report and Review of Literature

Objectives Cementoblastoma is a rare benign odontogenic tumor which is linked to the root of a vital tooth. This tumor is usually accompanied by pain and swelling, and its most common site is the left mandibular first molar. General dentists’ inattention to oral lesions, especially tooth-related radiopacities, is problematic in some cases and results in delayed or missed diagnosis.Case Our patient was a 31-year-old woman who presented to our clinic complaining of dull pain in the left mandibular first molar. Root canal therapy was performed for the patient but the pain continued for the next 2 years. The patient was referred to a surgeon. Panoramic radiography revealed a radiopaque mass of approximately 2 x 1 cm in diameter attached to the root of the mandibular left first molar. The lesion together with the involved tooth was removed by excisional biopsy. Histopathological diagnosis was cementoblastoma.Conclusion Dentists’ knowledge of pulpal, periapical and periodontal lesions is usually satisfactory, but their inattention to oral lesions, especially tooth-related radiopaque lesions, is problematic in some cases. Pain from cementoblastoma may be mistaken for endodontic pain

Huge maxillary metastasis of an aggressive pancoast tumor –A case report

Background: Metastatic carcinomas to the upper jaw region are very rare and unfortunately occur in advanced stages of malignancies. Pancoast tumor is a challenging subset of lung carcinoma commonly followed by distant metastasis. Since the metastatic lesion of our patient was very huge and unusual, we decided to report the case. Case Presentation: Our patient was a middle-aged heavy smoker male with a history of unresectable pancoast tumor. He was referred to the dental clinic with an expanded maxillary metastasis involving the bone and sinus region as well as oral soft tissues. To confirm the primary site of his malignancy, immunohistochemical staining was performed. Conclusion: Distant metastases of a pancoast tumor are more frequent when the primary tumor is unoperable and bone involvement is one of the early manifestations of disease

Histomorphometric Characterization of Benign and Malignant Salivary Gland Tumors Using Methyl Green Pyronin Staining

Background and purpose: Salivary gland neoplasms are heterogeneous and have low prevalence. Hematoxylin- eosin staining is used for their diagnosis, however, sometimes diagnosis may not be made by this method, so other methods are necessary. The aim of this study was to determine whether morphometry is an appropriate method in differentiating benign and malignant salivary tumors or not. Materials and methods: A cross-sectional study was done (in Babol Dental School, 2015) in which 60 paraffin embedded blocks of pleomorphic adenoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma were used. Two 5-micron sections were cut for hematoxylin-eosin and methyl green-pyronin staining. Images of stained slides of tumoral components were acquired at 100x magnification on an Olympus BX41, Japan Optical, in three microscopic thin-sections using lgvc camera, Tokyo, Japan which was connected to a computer. An average of 100 nuclei were examined in three microscopic fields. Morphometric and qualitative evaluation of the nucleoli (single- nucleolus and multi-nucleolar) were performed and data analysis was done applying Kruskal-Wallis and Mann-Whitney tests. Results: The maximum area of nucleus was detected in pleomorphic adenoma and the maximum area of cytoplasm was seen in mucoepidermoid carcinoma. The highest ratio of nuclear to cytoplasmic area and the highest ratio of large to small nuclear diameter were observed in adenoid cystic carcinoma and pleomorphic adenoma, respectively. There were significant differences between three lesions in terms of morphometric characteristics mentioned (P< 0.001). Conclusion: The results indicated that histomorphometry using methyl green pyronin staining is not useful in differentiating the benign and malignant salivary gland tumors

Immunohistochemical expression of progesterone receptors in pleomorphic adenoma and adenoid cystic carcinoma

Background: The importance of hormone receptor status in diagnosis, prognosis and response to hormone therapy of breast cancer has already been proven. Aim: Morphologic mimicry and similarity between salivary gland tumors and breast tumors led us to undertake an immunohistochemical evaluation on the expression of progesterone receptors (PRs) in pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) of salivary glands. Study and Design: We researched the role of PRs in tumorigenesis and hormone therapy of PA and ACC with immunohistochemistry and their expression in normal salivary glands was studied. Association of progesterone expression with grade 2 and 3 ACC was researched. Methods: In a descriptive, analytical, cross-sectional study, 29 paraffin blocks (14 samples of PA and 15 samples of ACC) were prepared for immunohistochemical staining with progesterone antibody. t-Test and Mann-Whitney test were used for the statistical analysis of the results. Results: PR staining was negative in 15 ACC and 13 PA cases. Slight to moderate staining was seen around the tumor in 12 normal cases. Little or no PR staining was observed among endothelial cells, fibroblasts and inflammatory cells. No progesterone expression in grade 2 and 3 ACC in the salivary glands was observed. Conclusion: Although progesterone seems to be essential for normal function of the salivary glands, it does not have a role in tumorigenesis and hormone therapy in PA and ACC. No association was found between progesterone expression and differentiation grade in ACC

Immunohistochemical expression of progesterone receptors in pleomorphic adenoma and adenoid cystic carcinoma

Background: The importance of hormone receptor status in diagnosis, prognosis and response to hormone therapy of breast cancer has already been proven. Aim: Morphologic mimicry and similarity between salivary gland tumors and breast tumors led us to undertake an immunohistochemical evaluation on the expression of progesterone receptors (PRs) in pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC) of salivary glands. Study and Design: We researched the role of PRs in tumorigenesis and hormone therapy of PA and ACC with immunohistochemistry and their expression in normal salivary glands was studied. Association of progesterone expression with grade 2 and 3 ACC was researched. Methods: In a descriptive, analytical, cross-sectional study, 29 paraffin blocks (14 samples of PA and 15 samples of ACC) were prepared for immunohistochemical staining with progesterone antibody. t-Test and Mann-Whitney test were used for the statistical analysis of the results. Results: PR staining was negative in 15 ACC and 13 PA cases. Slight to moderate staining was seen around the tumor in 12 normal cases. Little or no PR staining was observed among endothelial cells, fibroblasts and inflammatory cells. No progesterone expression in grade 2 and 3 ACC in the salivary glands was observed. Conclusion: Although progesterone seems to be essential for normal function of the salivary glands, it does not have a role in tumorigenesis and hormone therapy in PA and ACC. No association was found between progesterone expression and differentiation grade in ACC

Evaluation of Cytological Alterations of Oral Mucosa in Smokers and Waterpipe Users

Objective: Oral mucosal epithelia of smokers and waterpipe users are more susceptible to malignant alterations. The aim of this study was morphometric evaluation of the effects of using waterpipe on normal oral mucosa.Materials and Methods: In a cross sectional study, cytologic smear samples from the following three different areas: buccal mucosa, lateral surface of the tongue, and floor of the mouth (right) were taken from 40 smokers, 40 waterpipe users, and 40 normal individuals. They were then stained using Papanicolaou staining technique. Quantitative cytologic alterations such as nuclear and cytoplasmic size, nuclear-cytoplasmic (N/C) ratio, Feret ratio (FR), percent of karriorhexis, vacuolization of cytoplasm, two or multilobed nuclei, inflammation, and candida were evaluated. Quantitative evaluation was performed using MoticPlus 2 software, and 50 cells in each slide were studied. Practitioners were matched with age and sex in three groups.Results: An increase in nuclear size, the N/C ratio, and F.R, while a decrease in cytoplasm size were observed in lateral surface of the tongue, buccal mucosa and floor of the mouth of smokers, waterpipe users and normal individuals, respectively(p≤0.001). No statistically significant differences were observed in percent of karriorhexis, vacuolization of cytoplasm, and two or multilobed nuclei in oral mucosa of smokers, waterpipe users (p=0.8), and normal individuals (p=0.9) in buccal mucosa,tongue, and mouth floor areas. However, the percentage of inflammation and candida in smokers (p<0.001) and waterpipe users (p=0.002) were higher than normal.individualsConclusion: Smoking and using waterpipe are effective in creating some quantitative cytometric alterations in oral mucosa; however, smoking shows greater effect in the cytometric alterations than using waterpipe. Role of cytology in screening and detection of oral mucosa malignancies in smokers and waterpipe users needs further studies

Comparison of TNF-α and TGF-β1 level in radicular cyst and odontogenic keratocyst fluid and its association with histopathological findings

Background: TNF-α is a multifunctional proinflammatory cytokine and TGF-β1 is a secretory protein controlling epithelial proliferation and differentiation. Keratocyst presents an aggressive behavior and a growth mechanism different from that of radicular cyst. Aim: In this line, the present study aimed at evaluating TNF-α and TGF-β1 level and its association with histopathological findings in the two odontogenic lesions of different origins. Materials and Methods: In this case-control study, aspirated fluid of 15 cases of radicular cyst and 15 cases of keratocyst were investigated using ELISA method. The grade of inflammation and the mean number of blood vessels in three microscopic fields were provided with a magnification of 40 times on microscope slides. T-test, x2, Mann Whitney, and Pearson correlation tests were used for the comparison of TNF-α and TGF-β1 levels in the mentioned lesions and the association between cytokine levels and grade of inflammation and angiogenesis.Results: TNF-α and TGF-β1 were observed in aspirated fluid of all radicular cysts and keratocysts. Levels of TNF-α and TGF-β1 were found to be 6.72 ± 2.985 and 5.882 ± 2.985 respectively in radicular cyst fluid and 24.759 ± 94.849 and 63.38 ± 30.069 in keratocyst fluid however, no statistically significant difference was observed in terms of TNF-α (P=0.450) increasing trend in TNF-α level in radicular cyst and keratocyst was accompanied by increased inflammation and angiogenesis (P<0.001 and P=0.001). Conclusion: TNF-α and TGF-β1 are involved in the pathogenesis of radicular cyst and keratocyst. TGF-β1 level was higher in radicular cyst when compared with keratocyst however, TNF-α level was similar in the two lesions. A positive correlation was found between TNF-α level and grade of inflammation and angiogenesis

Immunohistochemical Expression of CD56 and ALDH1 in Common Salivary Gland Tumors

Introduction: Natural killer (NK) cells, of which CD56 is a specific marker, play an important role in host defense against tumors. Cancer stem cells, of which aldehyde dehydrogenase isoform 1 (ALDH1) is an immunohistochemical marker, are a group of tumorigenic cells which are involved in migration and tumor recurrences. We aimed to evaluate the expression of ALDH1 and CD56 in common salivary gland tumors, as well as their relationship with each other and with a number of clinicopathologic factors.   Materials and Methods: Forty-five paraffin blocks of salivary gland tumors (pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma, 15 samples each) were selected. Malignant tumors were classified into two groups: low-grade (including mucoepidermoid carcinoma grade I) and high-grade (including mucoepidermoid carcinoma grade III and adenoid cystic carcinoma). Immunohistochemical staining for ALDH1 and CD56 markers was performed. Data were analyzed using SPSS (20) and the Chi-square test.   Results: CD56 expression was significantly higher in benign and high-grade malignant tumors (P=0.01). ALDH1 overexpressed in all three salivary tumors, but not to statistically significant degree (P=0.54). There was no statistically significant correlation between ALDH1 and CD56 expression with demographic factors (age, gender, or location of tumor; P>0.05).   Conclusion: It appears that the number of NK cells and their function change in different types of salivary gland tumors (benign/malignant) and stroma. NK cells are important components of the anti-tumor system; therefore immune dysfunction is associated with tumor progression in tumors of the salivary gland. ALDH1 overexpression suggests its role in tumorogenesis, but ALDH1 is not involved in the morphogenesis of salivary gland tumors