A Non-Classical Presentation of Oral Pyogenic Granuloma with Actinomycosis

Introduction: Pyogenic granuloma is a rather confusing reactive lesion of the oral mucosa, considering it is neither a bacterial infection nor does it produce any pus. In fact, even histologically, there is no formation of granulomas to substantiate the name. Intraoral actinomycosis is another interesting lesion due to its unique ability to masquerade itself as a swelling, abscess, or even a neoplasm. The occurrence of the two lesions separately is common in the oral cavity, however, their co-existence is extremely rare. Case Presentation: A 65-year-old female patient was referred from a private dental clinic with the chief complaint of a growth on her left posterior region of mouth, at the occlusal level of 15, 18 tooth regions for past 1 month. Conclusion: Clinicians should be aware about the occurrence of such rare combination of intraoral lesions, in order to make an accurate diagnosis and in turn, tailor a correct treatment protocol for these patients.

An erupted odontoma associated with pigmentation: A histogenetic and histological perspective.

Odontomas are hamartomatous malformations of odontogenic origin composed of all the structures that form the tooth. Pigmentation associated with odontomas is rare, with only two cases reported in the literature. The genesis of this composite malformation is attributable to the organizational failure of the developing odontogenic apparatus leading to abnormal morphodifferentiation. Although some odontomas erupt into the oral cavity, it defies the existing views of normal physiologic tooth movement thus raising questions over the use of this term. Here, we review a case of large odontoma in a 23-year-old male surfacing into the oral cavity from its intraosseous location. The unusual occurrence of melanotic pigmentation in the odontogenic epithelial rests was demonstrated by Mason Fontana special stain. The histogenesis of this unusual entity and explanation to its possible occurrence is discussed.

Evaluation of mast cells, eosinophils, blood capillaries in oral lichen planus and oral lichenoid mucositis.

Introduction: Mast cells are granule containing secretory cells present in oral mucosal and connective tissue environment. Oral lichen planus and oral lichenoid lesions are commonly occurring oral diseases and have some similarity clinically and histologically. Both are characterized by an extensive sub epithelial infiltrate of T cells, together with mast cells, eosinophils and blood capillaries. In this study mast cell and eosinophil densities along with number of blood capillaries were studied to find out if they could aid in histopathological distinction between oral lichen planus and lichenoid mucositis. Aims: To enumerate mast cells and compare the status of Mast Cells (Intact or Degranulated) in Lichen planus, Lichenoid mucositis and normal buccal mucosa in tissue sections stained with Toluidine Blue, and also to enumerate Eosinophils and blood capillaries in tissue sections stained with H and E. Materials and Methods: The study group included 30 cases each of oral lichen planus and oral lichenoid mucositis. 10 cases of clinically normal oral buccal mucosa formed the control group. All the sections were stained with Toluidine blue and H and E separately. Histopathological analysis was done using binocular light microscope equipped with square ocular grid to standardize the field of evaluation. Results: The result of the study showed. •Significant increase in number of mast cells in oral lichen planus and oral lichenoid mucositis compared to normal buccal mucosa. •Significant increase of intact mast cells suepithelially within the inflammatory cell infiltrate in oral lichen planus compared to oral lichenoid mucositis. •Significant increase of degranulated mast cells in oral lichenoid mucositis to oral lichen planus, and increase in number of eosinophil densities in oral lichenoid mucositis compared to oral lichen planus. •Significant increase in number of capillaries in oral lichenoid mucositis compared to oral lichen planus. Conclusion: The findings of increased number of intact mast cells sub epithelially in oral lichen planus to oral lichenoid mucositis and increase in number of degranulated mast cells as well as capillaries subepithelially in oral lichenoid mucositis to oral lichen planus can be used as reliable criteria for histologic distinction between these two lesions. The increase of eosinophils in oral lichenoid mucositis to oral lichen planus could be used as adjunct histologic criterion in the diagnosis of oral lichenoid mucositis.

Comparative study of Candida by conventional and CHROMagar method in non-denture and denture wearers by oral rinse technique.

Introduction: Candidal species colonizes the oral cavities of healthy individuals without dentures and also of denture wearers. Soft liners and tissue conditioning materials have been found to support the growth of Candida albicans which may predispose to lesions. The most important and common candidal species are C. albicans, C. tropicalis, and C. glabrata. C albicans is usually isolated from both the fitting surface of the denture and the denture-bearing mucosa of the affected patients. The aim of this study was to isolate, quantify, and speciate candidal species in non-denture wearers (controls) and denture wearers (study group) by the oral rinse technique. Isolation was done using Sabouraud dextrose agar (SDA). Speciation was done using conventional methods like the germ tube test, carbohydrate fermentation test, urease test, as well as the CHROMagar method. Aims and Objective: 1) To assess the prevalence of Candida in non-denture wearers and in denture wearers by oral rinse technique, with isolation on SDA; 2) to speciate and quantify Candida in non-denture wearers and denture wearers by using conventional methods (germ tube test, carbohydrate fermentation test, urease test) and the CHROMagar method; 3) to assess the influence of smoking and diabetes on candidal species among the denture wearers; and 4) to assess the sensitivity and specificity of SDA and CHRO Magar Materials and Methods: Salivary samples for Candida evaluation were collected from the subjects in sterile sample containers, using the oral rinse technique. Results: C glabrata was the most commonly found species among denture wearers and non-denture wearers both by conventional and CHROMagar methods. In males, C. albicans was the predominant species, whereas C. glabrata was the predominant species in females. Candidal colonization was higher in denture wearers compared to non-denture wearers, especially among females. The CHROMagar method was more rapid compared to conventional methods. In the present study, CHROMagar Candida showed 100% specificity and 100% sensitivity when compared to SDA and conventional methods.

Plasma cell granuloma of lip.

Plasma cells are medium-sized round-to-oval cells with eccentrically placed nuclei, usually found in the red pulp of the spleen, tonsils, medulla of the lymph nodes, nasal mucosa, upper airway, lamina propria of the gastrointestinal tract, and sites of inflammation. Plasma cell granuloma is a rare reactive tumor-like proliferation composed chiefly of plasmacytic infiltrate. Here, we present a case of plasma cell granuloma of lip in a female patient.

Evaluation of oral submucous fibrosis using ultrasonographic technique: A new diagnostic tool.

Aim: The aim of this study is to evaluate oral submucous fibrosis (OSMF) by clinical and histopathological examination, and compare the results with those from ultrasonographic technique. Materials and Methods: 30 clinically diagnosed OSMF patients were subjected to both ultrasonographic and histopathological evaluation before treatment. Later, only ultrasonographical examination was done during 4 th and 8 th week of treatment. Prognosis of the lesion for the treatment was evaluated. Peak systolic velocity (PSV) of blood in the lesional area was statistically analyzed. 10 normal individuals without any mucosal lesions were considered as the control group. Results: In normal individuals, ultrasonography delineates normal mucosa with uniform fine mottled appearance with interspersed hypoechoic areas. Color Doppler and spectral Doppler depicts uniform distribution of blood vessels and normal peak systolic velocity of blood respectively. All OSMF patients were diagnosed upon clinical and histopathological examination. Clinical examination revealed 14 individuals with unilateral palpable fibrotic bands and 16 individuals with bilateral fibrotic bands whereas, ultrasonographic evaluation revealed 6 individuals with unilateral fibrotic bands and 24 individuals were with bilateral fibrotic bands, which was statistically significant. Ultrasonography demonstrated number, length and thickness of the fibrotic bands. Color Doppler and spectral Doppler showed decreased vascularity and PSV in lesional area. Prognosis evaluation revealed 25 cases of good prognosis and 5 cases were showed poor prognosis. Wilcoxon Signed Ranks Test revealed no significant difference of PSV was seen in poor prognosis patients. Conclusion: Ultrasonography is a non-invasive diagnostic tool for OSMF. It could be a better diagnostic tool compared to clinical and histopathological examination.

Immunohistochemical evaluation of mast cells and vascular endothelial proliferation in oral submucous fibrosis.

Introduction: Oral submucous fibrosis (OSMF) is a chronic, progressive, scarring disease that predominantly affects the people of south-east Asian origin. Aim: The present study is aimed at comparing and correlating the mast cell density (MCD) and micro vascular density (MVD) in normal mucosa and different grades of OSMF and to analyze their role in the disease progression. Materials and Methods: MCD was assessed immunohistochemically using anti mast cell tryptase and MVD was assessed using anti-factor VIII related von Willebrand factor. Results: The one way comparison of MVD and MCD in normal mucosa and among different grades of OSMF showed a significant increase in MCD and MVD among OSMF cases. Correlation analysis using Pearson correlation coefficient, showed positive correlation between MCD and MVD i.e. as MCD increases there is an exponential increase in MVD. Conclusion: The increase in MVD and MCD reveals their role in the pathogenesis of OSMF, a lesion characterized by progressive fibrosis in early stages and failure of degradation or remodeling in the advanced stages.

Role of genes in oro-dental diseases.

In oral cavity, the spectrum of diseases due to genetic alterations ranges from developmental disturbances of teeth to the pre-cancerous and cancerous lesions. Of late, significant progress has been made in the molecular analysis of tumors. With molecular genetic testing emerging as diagnostic, prognostic, and therapeutic approach, a review of genetic alterations ranging from the development of oro-facial structures to the tumors in the head and neck region are addressed in this article. The functional regulatory aspect of genes in relation to oro-facial structures are discussed separately, i.e., in relation to tooth genesis, tooth agenesis (non-syndromic, syndromic), tooth structural alterations, syndromic oro-facial defects, bone diseases, skin diseases (genodermatoses), and malignant tumors. In this literature, various genes involved in the development of the oro-facial structures and tooth in particular are discussed. The genetic basis of disorders in the tooth development (agenesis, hypodontia), tooth structural defects like amelogenesis imperfecta (AI), dentinogenesis imperfecta (DI), and oro-facial structural alterations (various syndromes) are explained.

Immunohistochemical evaluation of mast cells and angiogenesis in oral squamous cell carcinoma.

Objectives : Angiogenesis is a complex event mediated by angiogenic factors released from cancer cells and immune cells. It has been reported to be associated with progression, aggressiveness and metastases of various malignant tumors including oral squamous cell carcinoma (OSCC). Similarly, mast cells have also been reported to play a role in tumor progression and metastases by promoting angiogenesis. The present study aims at comparison of microvascular density (MVD) and mast cell density (MCD) in normal oral mucosa (NM) and among various grades of OSCC. Materials and Methods : MVD was assessed immunohistochemically using anti-Factor VIII related von Willebrand factor, and MCD using anti-mast cell tryptase in a study sample of 30 cases of OSCC and 10 cases of clinically normal oral mucosa. Results : The mast cells in normal oral mucosa and oral squamous cell carcinoma strongly expressed mast cell tryptase. The density of mast cells and micro vessels were significantly higher in OSCC compared to normal oral mucosa. The MCD and MVD were higher in moderately differentiated OSCC than in well differentiated OSCC ( P > 0.05) and normal oral mucosa ( P < 0.05). Pearson's correlation revealed a positive correlation between MCD and MVD ( r=0.33; P=0.077). Conclusion : These findings indicate that mast cells may play a role in up regulation of tumor angiogenesis in OSCC probably through mast cell tryptase.

A rare case of sarcoid-like reaction of lymph nodes associated with squamous cell carcinoma of alveolar mucosa.

Non-necrotizing granulomas are occasionally seen in patients with certain malignant disorders and are termed as "sarcoid-like reaction," which have many similarities with sarcoidosis. Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by organ involvement and interference of organ function by granuloma or fibrosis. Sarcoidosis is occasionally found in a variety of malignant diseases with an overall incidence of 4.4% in carcinoma patients. We present here a rare case of moderately differentiated squamous cell carcinoma of alveolar mucosa with regard to mandible associated with sarcoid-like reaction of cervical lymph nodes in a female patient in the absence of clinical evidence of systemic sarcoidosis. The relevant literature including pathogenesis is also discussed.

Rhinosporidiosis of parotid duct.

Rhinosporidiosis is a benign chronic granulomatous infection caused by Rhinosporidium seeberi. Rhinosporidiosis is endemic in south Asia, notably in southern India and Sri Lanka. Majority of the cases have been reported to occur in upper respiratory sites, notably anterior nares, nasal cavity, nasopharynx, larynx and soft palate. Only two rare cases of involvement of parotid duct, have been reported in literature. Hence, this case will probably be the third to be reported.

Cementum analysis in cleidocranial dysostosis.

OBJECTIVE: Cleidocranial dysostosis (CCD) is a skeletal disorder associated with dental anomalies such as failure or delayed eruption of permanent teeth and multiple impacted supernumerary or permanent teeth. Absence of cellular cementum at the root apex is presumed to be one of the factors for failure or delayed eruption. The aim of this study was to analyze the root cementum of supernumerary(S) and permanent teeth (P) of a CCD patient and to compare the findings with those of normal individuals with special emphasis on delayed eruption. MATERIALS AND METHODS: Ground sections of 12 extracted teeth (9S + 3P) of a CCD patient and 12 teeth of normal individuals (5S + 7P) were taken for the study. The sections were longitudinal and 50 microm thick. Root characteristics were recorded with the aid of a light microscope. RESULTS: The absence of apical cellular cementum, increased root resorption and increased percentage of the gap type of cemento-enamel (C-E) junctions were significant findings noted both in the supernumerary and permanent teeth of the CCD patient. CONCLUSION: The presumption of cellular cementum is essential for tooth eruption is not supported by the findings of the present study. Delayed exception could be attributed to various other factors like mechanical obstruction, reduced serum alkaline phosphatase levels etc. Also, the significance of the increased percentage of the gap type of C-E junctions and its role in tooth eruption has to be further evaluated.