Hybrid odontogenic tumor masquerading as a salivary gland lesion: A diagnostic predicament.

Hybrid odontogenic tumors are sporadic, where the distinctive areas of more than one odontogenic tumor tissue type have been reported. The occurrence of adenomatoid odontogenic tumor (AOT) with calcifying epithelial odontogenic tumor (CEOT) like areas histologically simulating salivary gland pathology is an unusual finding that has not been previously reported in the literature. We report the case of a 32-year-old female presenting with slow-growing firm swelling, radiographically as a pear-shaped radiolucent lesion in the interdental region of maxillary incisors. Histologically, the tissue showed nests and anastomosing strands of the bland cuboidal to squamoid epithelial cells showing nuclear pleomorphism, hyperchromatism, and abundant cytoplasm with prominent intercellular bridges focally. Multiple basophilic calcifications, amyloid-like material, duct-like formation, and mucinous spillage are seen. Tumor cells showed immunopositivity for CK 7, CK 19, CK 8/18 and low Ki67, p63, and immunonegativity for S100 suggesting of a hybrid lesion of CEOT with AOT.

"Migratory Kerato osteomyelitis" - A refractory lesion of the mandible: A pathologist's and surgeon's dilemma!!

A 62 year old female patient presented with a chief complaint of non healing extraction socket in the lower left back teeth region. She underwent extraction of 37 at a private clinic following which an ulceroinfiltrative lesion developed at operated side. Multiple biopsies from the lesion were inconclusive. Computed tomography revealed an osteolytic lesion radiologically simulating carcinoma or a chondrosarcoma. Because of persistent debilitating symptoms the patient underwent Wide local excision (WLE) with left segmental mandibulectomy. Frozen sections were negative for malignancy. All margins were free from malignancy. Lymph nodes dissected showed reactive morphology. Ziehl-Neelsen, Periodic acid-Schiff and Gram stain were all negative. The lesion continued to spread even after successful surgical intervention with adequate surgical margin. The patient was eventually lost because of severe cardiac arrest during her last surgical intervention for mandibular arch reconstruction. As the lesion migrated from one side of the mandible to the other, kept showing clinical features of inflammation of the bone and bone marrow simulating features of osteomyelitis and the continued presence of keratin histologically, we contemplated whether we could give a nomenclature to the lesion as that of "Migratory Kerato osteomyelitis of the oral cavity." This could be one of case of a lifetime where multiple consultations with oral and general pathologists failed to reach a conclusive diagnosis!

Oral amyloidosis: A case report and diagnostic algorithm.

Background: Amyloidosis is a distressing and infrequent condition caused by accumulation of abnormally folded proteins as aggregates in the extracellular tissue spaces of the body, leading to destruction of organ structure and function. Presentation of Oral Amyloidosis is generally a rare phenomenon, tongue being the most common site to manifest the disease process. Accurate recognition of the amyloid protein and its sub typing is absolutely critical for clinical management and to assess prognosis such as to avoid misdiagnosis and unwanted, potentially harmful treatment. Case Report: We report a case of 84 year old male patient with an enlarged tongue, who presented with burning sensation and a facial violaceous papules with no other known systemic findings. Incisional biopsy revealed amorphous deposits confirmed for amyloid by congo red stain and Immunohistochemistry. Conclusion: The suspicion of Amyloidosis should always be kept in mind whenever a solitary enlargement of the tongue is noticed. Close follow-up and an entire panel of investigations is mandatory, both to manage recurrences and to monitor the possible advancement of the disease into a full blown systemic form.

An oral pathologist's tryst with COVID 19: A chronicle of understanding, experience and despair.

Ever since the COVID 19 pandemic struck our nation and started to cripple our health care infrastructure around the world, a considerable number of research was directed toward the development of the COVID Vaccine. However, when it finally came into our medical infrastructure, people were skeptical about taking the vaccine because of the considerable confusion on its efficacy and adverse effects. An attempt has been made through this communication to narrate my personal experience; My journey from First Infection to Vaccination finally culminating with COVID Reinfection, lessons learnt!!

Intraosseous adenoid cystic carcinoma of the mandible: A rare presentation.

Central adenoid cystic carcinoma (ACC) of the mandible is a rare entity arising from minor salivary glands. Their clinical and radiographic features may be similar to any odontogenic/nonodontogenic pathology, thus making their precise diagnosis wearisome. ACC is well documented for its protracted clinical course, perineural invasion, multiple recurrence rates and its propensity for distant metastases. The aim of this study is to report a rare case of primary central ACC of the mandible with an unusual presentation in terms of location, however, demonstrating the classical features of ACC in histopathology and positivity in immunohistochemistry to S100, calponin and CD117. A thorough clinical, radiographic, CT evaluation and meticulous metastatic workup along with long-term follow-up is advised in such cases. Although central ACC is extremely rare, especially in the anterior mandible, it should be included in the differentials for lesions of the mandible.

Comparative efficacy of cedarwood oil and xylene in hematoxylin and eosin staining procedures: An experimental study.

BACKGROUND: Xylene is used as a clearing agent in hematoxylin and eosin (H and E) staining of tissue sections in routine histopathology based diagnosis. However, the hazards associated with exposure to xylene are of concern. Numerous solutions mainly essential oils have been evaluated in the past as clearing agents, which can possibly be substituted for xylene during the routine tissue processing. AIM: The aim of this study is to compare the efficacy of essential oil (cedarwood oil), as a possible replacement for xylene in H and E staining procedures. MATERIALS AND METHODS: The study was carried out in the Department of Oral Pathology and Microbiology. Thirty paraffin blocks of the routine biopsy specimen were retrieved from the department archives. The cedarwood oil was procured from organic and essential oil dealer in the local market. Two to three paraffin sections of four micron thickness were cut from each of the 30 paraffin blocks of processed tissue specimens, were subjected to different clearing agents: Essential oil (8% cedarwood oil) or xylene and stained with H and E stain. The stained sections were scored based on nuclear and cytoplasmic details, clarity and uniformity of staining. RESULTS: Significant correlation was observed between cedarwood oil and xylene in terms of the three staining quality parameters assessed. CONCLUSIONS: We conclude that cedarwood oil can be an effective, eco-friendly and safe alternative to xylene as a clearing agent in the histopathological laboratory.

Comparison and correlation of candidal colonization in diabetic patients and normal individuals.

BACKGROUND: Diabetes mellitus is a common universal endocrine disorder with decreased host immunity towards infections. In these people the most common opportunistic infection is oral candidiasis. Oral candidiasis is most commonly caused by yeast like fungus Candida albicans. In healthy individuals these microorganisms are believed to be commensals but in diabetic patients, it forms severe colonization, even in the absence of any clinically evident oral candidiasis. This type of subclinical colonization can make them more prone to develop deeper mucosal colonization with further dissemination via blood. The aim of this study is to compare the frequency and severity of oral candidal colonization in diabetic patients with normal individuals through cytological method. METHODS: 30 cases of diabetic patients and 30 cases of normal healthy individuals were examined to determine the oral candidal colonization through oral exfoliative cytological methods. Statistical analysis was done using the Chi - square test. RESULTS: A statistically significant increase in the candidal colonization was observed in diabetic patients as compared to normal individuals. CONCLUSIONS: Oral exfoliative cytological method is an easy and effective chair side technique to assess the oral candidal colonization in the diabetic group.