Periapical central giant cell granuloma misdiagnosed as odontogenic cyst.

AIM: To present the clinicopathological features of a series of four periapically located central giant cell granulomas (CGCGs) that were misdiagnosed and treated as being of endodontic origin. SUMMARY: Four cases of periapical CGCGs were submitted with a clinical diagnosis of either radicular or residual cyst. In two cases, root canal treatment had been performed previously. The patients were two women and two men whose age ranged from 31 to 85 years. Two cases were located in the mandibular premolar-molar region, and two in the anterolateral region of the maxilla. Two lesions were submitted for histological examination with a diagnosis of radicular cyst whereas the remaining two were submitted with a diagnosis of residual cyst. KEY LEARNING POINTS: Periapical giant cell lesions may be unilocular and therefore misdiagnosed as an endodontic lesion because of their radiographic similarity to an inflammatory periradicular lesion, especially if the teeth have been root filled or if the vitality is negative or doubtful. It is important to follow up the healing process of a periapical radiolucency related to a root filled tooth and, in case of persistence, to perform surgery and to submit the specimen for histological examination.

Focal cemento-osseous dysplasia involving a mandibular lateral incisor.

AIM: To report a case of focal cemento-osseous dysplasia (FCOD) affecting a single tooth misdiagnosed as an inflammatory periapical lesion. SUMMARY: The patient, a black 47-year-old woman complained of pain affecting the right side of the mandible. Routine X-ray examination discovered a periapical radiolucency on the mandibular left lateral incisor (tooth 32), which was otherwise normal and not carious. As the response of this tooth to a vitality test was doubtful, the lesion was diagnosed as a periapical granuloma or cyst secondary to pulpal necrosis. Endodontic treatment and curettage of the periapical lesion were performed, and histological examination of the curettage material revealed a localized osseous dysplasia. KEY LEARNING POINTS: FCOD may rarely affect only one tooth, resembling a periapical granuloma or cyst. Careful diagnosis is of paramount importance in cases of questionable periapical lesions affecting normal-looking teeth, before beginning treatment. FCOD generally requires no treatment. Biopsy is warranted in case of doubt.

Reticulocyte hemoglobin content in the evaluation of iron status of hemodialysis patients.

The assessment of iron status for hemodialysis patients has been hindered by the inaccuracy of commonly used diagnostic tests. A novel assay, the reticulocyte hemoglobin content (CHr), has recently been found to sensitively detect functional iron deficiency among nonuremic patients treated with recombinant erythropoietin (rHuEPO). The purpose of this study was to evaluate the CHr for the assessment of iron status in hemodialysis patients. One hundred sixty-four stable hemodialysis patients had a mean CHr of 27.5 +/- 2.8 pg with a normal distribution of values. The mean CH (mature red cell hemoglobin content) was 26.4 +/- 2.4 pg. There was a close correlation between CHr and CH (r = 0.86, P < 0.0001). A significant subgroup of patients (12.2%) had CHr values < CH. These patients had recent increases in rHuEPO dose, and a lower mean transferrin saturation and hematocrit, suggesting the recent onset of functional iron deficiency due to the increase in rHuEPO dose. In the second phase of the study, 32 patients were randomly selected to receive treatment with a single dose infusion of 1,000 mg of intravenous iron dextran (IVFe). Patients were classified as iron deficient (N = 7) if they responded with a significant reticulocytosis (sustained 1 basis point increase in corrected reticulocyte index within 2 weeks). All other patients were classified as iron replete (N = 25). A CHr < 26 pg at baseline predicted iron deficiency with a sensitivity of 100%, specificity of 80%. The serum ferritin, transferrin saturation and percentage of hypochromic red blood cells all were less accurate. The time to correction of iron deficiency at the level of the reticulocyte was found to be within 48 hours as measured by correction of the mean CHr to > 26 pg, and by the shift of the vast majority of the reticulocyte population to CHr > 26 pg within this time span. We conclude that CHr < 26 pg is an accurate measure of iron status in hemodialysis patients, that a CHr value < CH indicates the acute onset of iron deficiency, and that a single dose infusion of intravenous iron results in correction of iron deficiency at the level of the reticulocyte within 48 hours.