A Comparative In Vitro Analysis of Antimicrobial Effectiveness and Compressive Resilience in Chirata and Terminalia arjuna Modified Glass Ionomer Cement

BACKGROUND

Glass ionomer cements are commonly utilized in dental restorations due to their biocompatibility, strong chemical bond with dental tissues, and ability to resist tooth decay. However, their effectiveness can be compromised by the presence of persistent cavity-causing microorganisms. Therefore, it is essential to consider incorporating antibacterial agents into these restorative materials. Swertia chirayita (S. chirayita) and Terminalia arjuna (T. arjuna) are well-known for their rich composition of phytochemicals that can potentially inhibit the growth of bacteria. Hence, the current research is focused on modifying glass ionomer cement with Chirayita and T. arjuna extracts to enhance its antibacterial properties.

AIM

This research aims to determine the antimicrobial efficacy and compressive strength of glass ionomer cement modified with Chirayita and T. arjuna extracts.

METHODOLOGY

Plant extracts were prepared from both Chirayita and T. arjuna. The powder and liquid components of conventional glass ionomer cement (GIC) were mixed, followed by adding these extracts at three different concentrations. To assess antimicrobial properties, typical strains of Streptococcus mutans and Lactobacillus were employed to test both the modified GIC and unmodified GIC (used as a control). For Chirayita and T. arjuna-modified GIC, minimum inhibitory concentration (MIC) assays were conducted at three different concentrations. MIC was assessed at various time intervals ranging from 1 to 4 hours for modified and unmodified groups. Moreover, compressive strength was measured using cylindrical molds. The highest force exerted at the point of specimen fracture was recorded to calculate the compressive strength values in megapascal (MPa).

RESULTS

The antimicrobial efficiency of Chirata and T. arjuna-modified GIC was evaluated using a MIC assay, indicating a statistically significant enhancement in antimicrobial potency against S. mutans and Lactobacillus within the modified groups in contrast to the control group (p<0.05). However, there were no notable changes in compressive strength when comparing the control group to the modified groups (p>0.05).

CONCLUSION

The antimicrobial effectiveness against S. mutans was observed to be greater in both T. arjuna and Chirayita-modified GIC. In the case of Lactobacillus, Chirayita-modified GIC exhibited more pronounced antimicrobial properties compared to T. arjuna. Importantly, both extracts did not alter the compressive strength of Conventional (unmodified) GIC. Hence, Chirayita-modified GIC appears to be a promising restorative material for combatting recurrent caries. Additional investigation is required to assess the material's stability over an extended period.

Rare Case of Epitheloid Angiosarcoma Posing a Diagnostic Challenge in Duodenal Biopsy

Introduction/Objective

Angiosarcoma (AS) is an aggressive tumor usually arising in the skin and soft tissue. We report a unique case of AS presenting as multiple nodules in duodenum with epithelioid histomorphology without prior diagnosis.

Methods/Case Report

An 80-year-old man presented with dyspnea on exertion, fatigue and severe anemia. Initial work up showed bilateral pleural effusions; a wedge biopsy of the left lung was done, but results were inconclusive. The patient required repeated blood transfusions over the next three months due to persistent anemia, and gastroenterology was consulted to further investigate the cause of anemia. Occult blood was found on rectal examination. Endoscopy revealed multiple mucosal nodules and polyps in the duodenum. Biopsy showed sheets of markedly atypical, lamina propria infiltrating large epithelioid cells with vesicular nuclei, prominent nucleoli, and eosinophilic cytoplasm undermining an adenoma. The atypical cells showed strong positivity for vimentin, CD31 and ERG, patchy positivity for MNF 116; and negative for HHV-8, S-100, CK20, and various other markers. Ki-67 index was approximately 30%. The diagnosis of duodenal angiosarcoma was made and referred for expert consultation, who concurred with the diagnosis. The patient’s previous lung wedge biopsy was reviewed, and determined to represent small foci of metastatic epithelioid angiosarcoma. The patient received radiotherapy but remained dependent on frequent transfusions, and died 7 weeks after the duodenal biopsy.

Results (if a Case Study enter NA)

NA.

Conclusion

Angiosarcoma occurring in the GI tract is rare and has a poor prognosis. In our case, the patient presented with an occult GI bleed and was found to have metastatic disease on presentation. AS presenting with epithelioid morphology in the GI tract can cause significant diagnostic challenges; therefore, pathologist should be aware and may benefit from including vascular immunohistochemical markers in work up to rule out this clinically aggressive vascular malignancy.

Rare Case of Distant Cutaneous Metastasis of Urothelial Carcinoma

Introduction/Objective

Cutaneous metastasis of urothelial carcinoma is extremely rare with poor prognosis. Many cutaneous metastases present in locoregional areas such as abdomen, groin, genitalia or thigh. Only very few cases present with distant cutaneous metastases. We report a rare case of urothelial carcinoma presenting with a cutaneous metastasis to the right neck.

Methods/Case Report

A 71-year-old male with a history of prostate cancer in 2009 presented with hematuria with clots, urinary retention and dysuria. The patient was also noted to have right submandibular ulcerative mass measuring 2.6 cm. Cystoscopy revealed a nodular tumor in the right lateral trigone area and transurethral resections of bladder tumor revealed high-grade papillary urothelial carcinoma, invasive into muscularis propria with lymphovascular invasion. Skin punch biopsy of the right submandibular mass was obtained revealing an infiltrative nodular proliferation of sheets of atypical epithelioid cells with readily identifiable mitoses in at least the dermis without an epidermal connection. Immunostains show the lesional cells are positive for CK5/6, EMA, Ber-EP4 (weak), p40, and GATA3 with variable positivity for p16, consistent with metastatic urothelial carcinoma. The patient received 4 cycles of cisplatin-gemcitabine chemotherapy with good partial response, continued with avelumab for maintenance therapy and is alive up to 6 months.

Results (if a Case Study enter NA)

NA.

Conclusion

Most cutaneous metastases of urothelial carcinoma occur in the local region and have poor prognosis with patients dying within several weeks without treatment. It is important for pathologists to be aware of cutaneous metastatic urothelial carcinoma in more distant sites.

Planar-Type Gastrointestinal Stromal Tumor in the Sigmoid Colon Presenting as Perforation and Peritonitis

Introduction/Objective

Gastrointestinal Stromal Tumor (GIST) is the most common mesenchymal neoplasm of the stomach, and it also can involve the small bowel, rectum, and esophagus. It can be incidentally found on imaging or can present with nonspecific GI symptoms and/or bleeding. Non-rectal colonic GISTs are extremely rare. A few cases of small bowel/colonic GISTs presenting as a non-discrete mass and forming a diverticulum with/without perforation have been documented in the literature and referred to as interstitial cells of Cajal hyperplasia/planar-type GIST. We report another case of non-rectal colonic planar-type GIST presenting as a diverticular perforation and peritonitis and the frequency of such presentation at our institution.

Methods/Case Report

A 43-year-old female presented with fever and abdominal pain. CT scan showed pneumoperitoneum and the patient was taken for surgery which revealed a sigmoid colon perforation. Gross examination of the sigmoidectomy specimen revealed a perforated diverticulum (2.5 cm). Sectioning of the diverticular pouch did not reveal a grossly obvious mass. Histologic examination revealed a band-like proliferation of bland spindle cells along the entire length of the diverticulum partially replacing the muscularis propria. No mitoses were identified. On immunohistochemistry, the cells were diffusely positive for DOG-1, CD34, and negative for MNF116, S100, and desmin; thus, a diagnosis of a planar-type GIST was made. In our institution, a total of 143 GISTs were resected between Jan 2000 and May 2022. The most common site was the stomach (73%), and the most common presentation was anemia and/or GI bleeding (27%). The index case is the only non-rectal colonic GIST (0.7%) in our cohort that also presented with perforation (0.7%).

Results (if a Case Study enter NA)

NA.

Conclusion

Non-rectal colonic GISTs are extremely rare (0.7% in our cohort) and may not present as a grossly apparent mass. Therefore, pathologists should be cognizant of planar-type GIST while evaluating colonic diverticular perforations.