Assessment of MUC5AC and MUC2 Immunoexpression in Glandular Odontogenic Cysts, Dentigerous Cysts, and Mucoepidermoid Carcinomas

Glandular odontogenic cysts (GOCs) and dentigerous cysts may show mucous metaplasia. Central mucoepidermoid carcinoma is very rare and mostly associated with dental cysts. It is hypothesized that odontogenic cysts showing mucus differentiation in their lining, have a propensity to transform into MEC. The present study is the first attempt to explore the relationship between odontogenic cysts [GOCs and dentigerous cysts with mucus metaplasia (DCMM)] and MEC by evaluating immunoexpression of MUC5AC and MUC2. Immunoexpression of MUC5AC and MUC2 was evaluated semiquantitatively in GOCs (20 cases), DCMMs (20 cases), and MECs (20 cases). The percentage of positive cells, intensity, and localization of immunoexpression were assessed for each marker in all cases. Of GOCs, DCMMs, and MECs cases, 85%, 70%, and 80%, respectively, were immunopositive for MUC5AC. Strong cytoplasmic immunoreactivity for MUC5AC was noted, particularly in mucous cells present diffusely within MECs. However, the immunoreactivity was limited to the epithelial lining of GOCs and DCMMs. Most of the MECs (60%) showed more than 25% positivity for MUC5AC, followed by GOCs, and the least in DMMCs. Mild cytoplasmic and nuclear positivity of MUC2 was noted only in epithelial lining cells of 70% GOCs and 45% DCMMs. Whereas, 55% of MECs displayed moderate to strong cytoplasmic and membranous immunopositivity for MUC2 exclusively within mucous cells. As MECs showed strong MUC5AC immunoreactivity in mucous cells, immunoexpression of MUC5AC in odontogenic cysts with mucus cells can possibly explain the pathogenesis of MEC from cysts. However, the variable expression of MUC2 did not give any strong evidence regarding its role as a marker.

Multispectral polarization microscopy of different stages of human oral tissue: A polarization study

Many optical techniques have been used in various diagnostics and biomedical applications since a decade and polarization imaging is one of the non-invasive and label free optical technique to investigate biological samples making it an important tool in diagnostics, biomedical applications. We report a multispectral polarization-based imaging of oral tissue by utilizing a polarization microscope system with a broadband-light source. Experiments were performed on oral tissue samples and multispectral Stokes mapping was done by recording a set of intensity images. Polarization-based parameters like degree of polarization, angle of fast axis, retardation and linear birefringence have been retrieved. The statistical moments of these polarization components have also been reported at multiples wavelengths. The polarimetric properties of oral tissue at different stages of cancer have been analyzed and significant changes from normal to pre-cancerous lesions to the cancerous are observed in linear birefringence quantification as (1.7 ± 0.1) × 10-3 , (2.5 ± 0.2) × 10-3 and (3.3 ± 0.2) × 10-3 respectively.

A multicentric case study of fibroblastic and myofibroblastic oral spindle cell lesions

Context

Spindle cell lesions comprise a vast plethora of benign and malignant lesions with similar clinical and radiographic features. Their overlapping histopathologic features ensure a diagnostic dilemma.

Aim

The current multicentric study aims to delineate fibroblastic and myofibroblastic oral spindle cell lesions based on cytomorphology and comprehensive immunohistochemical analysis.

Settings and Design

The experimental study was conducted at MS Ramaiah University of Applied Sciences, Bangalore, and All India Institute of Applied Sciences, Delhi.

Methods and Material

A comprehensive histological scoring criteria and panel of immunohistochemical makers (STAT6, CD31, CD34, S100, SMA, vimentin, pan-CK, HHF-35, Ki67, ALK, desmin, HMB-45, SATB2, ERG, EMA and CD99) were employed concurrently for the first time for fibroblastic and myofibroblastic oral spindle cell lesions. The data obtained was tabulated and studied.

Statistical Analysis Used

NA. Results: Using cytological scoring criteria and panel of immunohistochemical makers, the cases analysed and characterized were desmoplastic fibroma, fibrosarcoma, leiomyosarcoma, nodular fasciitis, neurofibroma and epithelioid inflammatory myofibroblastic sarcoma (EIMS).

Conclusions

The diagnostic strategies need to be upgraded for the diagnosis of spindle cell lesions. Emphasis must be placed on cytomorphology, an immunohistochemistry (IHC) panel of markers is imperative for the accurate diagnosis of fibroblastic and myofibroblastic oral spindle cell lesions.

Childhood Pemphigus Vulgaris: Report of Two Cases with Emphasis on Diagnostic Approach

Childhood pemphigus vulgaris (CPV) is a rare entity with clinical features and management primarily similar to those of adults; diagnosis may be difficult due to clinical similarity to other disorders such as herpetic gingivostomatitis which is more prevalent in this age group. We report two cases of CPV with emphasis on diagnostic approach. While treating such patients, it is imperative to diagnose CPV in the early stages to prevent serious morbidity and to adjust drug dosage to minimize side effects.

Classical presentation of Gardner's syndrome in an Indian patient: A case report

Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis, osteomas, and a multitude of soft-tissue tumors. Dental anomalies are present in estimated 30% of all affected individuals of Gardner's syndrome, so dental professionals play an important role in determining the early signs of the syndrome. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated thus, early diagnosis and regular surveillance are important. In this report, we describe classical presentation of Gardner's syndrome in a patient who presented with bilateral swellings on palate along with multiple impacted teeth.

A case of peripheral ameloblastoma of retromolar trigone: Histopathological and immunohistochemical profile

Peripheral ameloblastoma (PA) is a rare and unusual entity with histological characteristics similar to those of the common intraosseous ameloblastoma. In this paper, we present a case of PA in a 44-year-old male affecting the right retromolar trigone area along with its immunohistochemical profile using CK19 and Ber-EP4 markers.

Histopathological spectrum of polymorphous low-grade adenocarcinoma

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms, with an almost exclusive propensity to arise from the minor salivary glands. PLGA frequently manifests as an asymptomatic, slow-growing mass within the oral cavity, which must be separated from adenoid cystic carcinoma and benign mixed tumor for therapeutic and prognostic considerations. We report a case of a 67-year-old male, who presented with a long-standing mass in the palate. This lesion was diagnosed as PLGA based on histopathological findings, which was further confirmed by the immunohistochemical marker.

Pursuit of the renal mass. Is ultrasound enough?

The accuracy of ultrasonography in evaluating renal masses was assessed retrospectively in 260 renal lesions detected by intravenous urography in 242 patients. The ultrasonographic diagnosis was confirmed by cyst puncture, surgery, or autopsy. Of the lesions, 168 were benign cysts, and all were diagnosed correctly by ultrasonography. The remaining 92 lesions were renal carcinomas, and 90 were diagnosed correctly by ultrasonography. In retrospect, it was clear that the two missed cancers did not fulfill all the ultrasonographic criteria for a cyst. An algorithm is presented for the differential diagnosis of renal masses primarily by ultrasonography, and the arguments in favor of operative diagnosis of renal masses are rebutted. With the approach described, invasive studies such as cyst puncture and arteriography will be required for a definitive diagnosis in fewer than 10 percent of patients, and the morbidity and expense of the diagnostic approach will be minimized, with no decrease in accuracy.

Renal vascular complications associated with the percutaneous removal of renal calculi

Significant immediate and delayed vascular complications occurred in 4 of 140 patients (3 per cent) undergoing percutaneous removal of renal and ureteral calculi. An understanding of renovascular anatomy, use of a safety guide wire and intraoperative availability of an angiographic balloon catheter may help to prevent and to treat bleeding problems.

Percutaneous nephrolithotomy: extraction of renal and ureteral calculi from 100 patients

A percutaneous nephrostomy tract was used as a conduit to the kidney and ureter for extraction of 149 calculi in 100 patients. A variety of grasping and fragmentation techniques under fluoroscopic and endoscopic control were used to extract calculi in 88 per cent of the patients. With experience, operator efficiency and rate of stone extraction increased from 76 per cent early in the series to 91 per cent in the most recent patients, and the incidence of complications decreased from 17 to 5 per cent. Percutaneous removal of upper tract urinary calculi appears to be an appropriate alternative to an open operation in most patients with symptomatic urolithiasis.

Percutaneous intrarenal electrosurgery

A 16F nephroscope with a 5F cutting element was used for percutaneous removal of kidney stones in 10 patients in whom an open operation otherwise would have been necessary. Stone removal was accomplished via percutaneous incision of narrowed infundibula, caliceal diverticula and the ureteropelvic junction. A thorough knowledge of renal vasculature, meticulous care and fluoroscopic control are necessary for successful percutaneous intrarenal electrosurgery.

Percutaneous nephrolithotomy. An approach to branched and staghorn renal calculi

Using electrohydraulic lithotripsy, we removed branched or staghorn calculi from four patients via a percutaneous nephrostomy tract with local anesthesia. There were no serious complications, and the patients were able to resume their preadmission activities immediately after discharge from the hospital. Our experience suggests that, eventually, all upper urinary tract calculi may be treatable by a percutaneous approach.

Percutaneous nephrolithotomy with Mazzariello-Caprini forceps

Mazzariello-Caprini forceps were used percutaneously to remove a stone that was impacted distal to the ureteropelvic junction in a patient who had undergone several previous open pyelolithotomies. These forceps open by a rotational rather than a scissoring movement so the shaft size does not increase and they are well suited for operation through a narrow nephrostomy tract. The original design has been modified to allow passage over an angiographic guide wire, thereby placing the forceps precisely at the site of the stone. Also, with the angiographic guide wire to direct them the forceps can be used in a freshly established nephrostomy tract as well as in a mature tract. In our experience the Mazzariello-Caprini forceps have been most useful for nonoperative manipulation of renal and upper ureteral calculi.