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Case
8:
A diffuse nodular swelling 2x1cm left upper
buccogingival fold (upper fornix). The mucosa over the swelling is normal. The
surrounding borders are not well defined. No associated focus of infection.
For photomicrographs of this case contact:
info@teleoralpathology.com
Diagnostic
Interpretations of this case by Members:
Mgk
The cells look like histiocytes. Is it fibrous
histiocytoma?
Fábio Pires
Leishmaniasis??
Sivapatha Sundharam B
Appears richly vascular with numerous vessels of
different sizes and shape. Cells exhibit pleomrphism hyperchromatism. Could be Hemangioendithelioma.
Elias Romero
Histoplasmosis
Dr. CSBR. Prasad
Solitary fibrous tumor.
Dr. Vinay Hazare
It looks aggresive fibrous lesion. but without
age/sex and duration its difficult to comment.
Dr Jaya Joshi
My microscopical acumen more likely goes in
favor of a Hemangiopericytoma
Samadara samadaraspdn.ac.lk
Looks toxoplasmosis
Our
Histopathological Interpretations of the case:
Hemangiopericytoma.
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Case
9:
A male patient aged 23 years reported with a
swelling on the right side of the mandible. Radiographically it showed a
unilocular radiolucency extending from right first premolar to second molar with
lingual cortical expansion from first premolar to third molar on the same side.
Clinical diagnosis given was Odontogenic keratocyst. It was completely
enucleated and sent for histopathological examination. The cystic lesion showed
two different histological appearances at two different sites.
For photomicrographs of this case contact:
info@teleoralpathology.com
Diagnostic
Interpretations of this case by Members:
Rafik Abdelsayed
Dx: Odontogenic Keratocyst with chronic inflammation and cholesterol granuloma
Siva
Intra osseus muco – epi
Fábio Pires
From these images I suppose the lesion is compatible with glandular odontogenic
cyst (specially based on the last figure) secondarily inflamed
Dr.CSBR.Prasad
Radicular cyst.
Please give more images which are of good quality.
C.D. Daniel Quezada Rivera
In the first slide just I can see an cyst epithelium and his capsule of
connective tissue. But in the other slide I am lost. If you can put another
images. With this evidence my Dx. is: Cyst
Lakshmanan Suresh
Central Mucoepidermoid carcinoma
Mahija Janardhanan
Glandular odontogenic cyst/sialo odontogenic cyst
Charu Miglani
Infected odontogenic keratocyst
Yong Lu
OKC with infection
Our
Histopathological Interpretations of the case:
Odontogenic Keratocyst with Keratogranuloma
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Case
10:
Dr. Pramod Mathews seeks your
opinion on histopathology of the following case.
A 26 year old male patient presented with a swelling in the right mandibular buccal fold of size 2x2 cm.
For photomicrographs of this case contact:
info@teleoralpathology.com
Diagnostic
Interpretations of this case by Members:
Paul Freedman
Cellular lobular capillary hemangiom
Yeshwant B. Rawal
Lobulated Capillary hemangioma (also known as pyogenic granuloma).
Pyogenic granuloma
Kaposi's sarcoma versus hemangioendotheliom
Suresh
Lobular capillary hemangioma
Paulo
Salivary gland neoplasia
Fábio Pires
It looks like an angiomatous lesion
(haemangioendothelioma?, cellular hemangioma?)
Pramod BJ
Based on the clinical history, and histopathological findings,
the impression may be of "PYOGENIC GRANULOMA", as numerous chronic
inflammatory cell infiltrate dispersed all over with numerous
proliferating endothelial lined blood vessels are seen in the connective
tissue stroma which is suggestive of "pyogenic granuloma".
Charu Miglani
The histilogical picture is suggestive of hemangiopericytoma.
Bouquot
Looks like hemangioendothelioma, with some suspiciously large nuclei (epitheliod
cells?). Cannot rule out hemangiopericytoma or Kaposi's.
Elias Romero
Capillary hemangioma
Govindrajkumar
Granulomatous reaction, further clinical history is needed.
Geetha
Epithelioid hemangioma
Rakesh
Hemangioendothelioma
Samadara
Myoepithelioma (One area looks pleomorphic adenoma)
Mahija Janrdhanan
Looks like a benign vascular lesion probably capillary hemangioma
(cellular variant)
Madhu
Lobular haemangioma
Jaya Joshi
Highly vascular lesion - likely a Hemangioendothelioma
Girish H C
Haemangioendothelioma
Fabian Ocampo
Pyogenic granuloma vs. Kaposi's sarcoma
Our
Histopathological Interpretations of the case:
Haemangioendothelioma
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Case 11:
A 48 year old female patient
reported with an ulcer in relation to lingual gingiva of lower right
second molar of 3 months duration. Slight granularity was noticed. Non
healing ulcer. Radiograph does not suggest any obvious abnormalities.
For photomicrographs of this case contact:
info@teleoralpathology.com
Diagnostic
Interpretations of this case by Members:
Yeshwant B. Rawal
Peripheral Ameloblastoma
Manisha Sardar
Salivary gland tumor-Monomorphicadenoma
Lia Piperi
Peripheral Ameloblastoma
Rafik Abdelsayed
Peripheral ameloblastoma. I wish we had a higher magnification to examine
cellular details. However, the morphologic features and growth patterns are
suggestive pf peripheral ameloblastoma.
Ted Zislis
I think it looks like a benign proliferation of odontogenic epithelium, what we
used to call odontogenic epithelial hamartoma, whatever that was.
Rivera Helen
Peripheral Ameloblastoma or Extraosseous ameloblastoma
Willie van Heerden
Peripheral Ameloblastoma
Elias Romero
Peripheral Ameloblastoma
Devilliers
Peripheral Ameloblastoma
Dr.N.Govindrajkumar
CEOT
Mabokesone
Peripheral Ameloblastoma
T.R.Gururaja Rao
Connective tissue lesion shows histiocytes with endothelial
proliferation. Has granular cytoplasm. Histiocytic Endothelioma
Dr.Santosh.H
The picture shows severe atypia with hyper pigmented nuclei ,presence of mitosis
suggesting of Squamous cell carcinoma
Dr. B. Sivapathasundharam
(peripheral) Cell have basaloid appearance in nests and cords.
Diagnosis could be
1. Basal cell ameloblastoma (peripheral)
2. Basal cell/Canalicular adenoma (Heterotopic salivary gland tissue)
3. Metastatic lesion
Rajeshwar Chawla
1. Basi-squamous carcinoma of gingiva
2. Basal cell adenocarcinoma of gingival
Einstein T. Bertin
Cords, islands and gland like lobules of basaloid cells are seen in the
connective tissue. One section shows a keratin pearl like structure. Suggestive
of basaloid squamous cell carcinoma
Mario Nava
In the second image appear that epithelium neoplastic origin from superficial
epithelium, the image remember me a periferic ameloblastoma.
D/D 2: Periferic Odontogenic Fibroma
Dareen
Poorly differentiated squamous cell carcinoma
Dr Girish H C
Basaloid Squamous Cell Carcinoma
Raana hirad
Pleomorphic Adenoma
Fares
Mucoepidermoid carcinoma
Kumaraswamy
Tumor cells appears to be originating from the basal cells. They are having tall
columnar with hyperchromatic nucleus, mimics basal cell carcinoma, but
considering the site of origin, it seems to be "basal cell ameloblastoma"
Fabian Ocampo Acosta
Basaloid squamous carcinoma vs basal cell carcinoma
Dr Priya N S
Basaloid Squamous Cell Carcinoma
Our
Histopathological Interpretations of the case
Peripheral Ameloblastoma ( Basal Cell )
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Case 12:
Van der
Woude Syndrome
Only four
members had responded, and all of them had diagnosed the case correctly as
Van der Woude Syndrome.
For photomicrographs of this case contact:
info@teleoralpathology.com
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Case
13:
A 13 year old female patient residing in North Karnataka, India,
reported with a complaint of enlarged upper anterior gingivae since 1
year, which started as a smaller swelling that increased to present size
in 1 year. The patient is from low-socioeconomic strata; both the parents
are daily wageworkers. No family history of similar condition in the
family was evident.
The patient attained menarche 16 months back, and her
menstrual history was non-contributory. The patient’s oral hygiene regimen
consisted of cleaning her teeth with charcoal and finger since the age of
2 years. Her built was below average and there were signs of
malnourishment. She had no history of any systemic illness or any
hospitalization.
On local examination, there was a diffuse gingival
enlargement of anterior gingiva covering up to or beyond the middle third
of the upper anterior teeth crowns associated with minimal local deposits
corresponding to the lesion. The colour of the gingiva was reddish;
surface was pebbled with no ulcerations and no tendency for bleeding. On
palpation, it was fibrous associated with pseudopockets of 6-8 mm depth.
Lower arch gingiva showed minimal enlargement.
Radiograpically, there was minimal crestal bone loss in upper
anterior region.
The blood cell count and smears showed normal blood
chemistry. Serum electrolytes were within the normal range.
Incisional Biopsy was done which showed multiple non-caseating
granulomas (hard Tubercle) in the connective tissue with langerhans type
of giant cells.
Giemsa stain, PAS stain and GMS stain was done on the
specimen to rule out any bacterial or fungal etiology; the results were
negative.
Montoux test was done along with chest radiograph to find any
primary focus of tuberculosis elsewhere in the body, which was in
conclusive.
We arrived at the diagnosis of primary tuberculosis
associated gingival enlargement but we find it difficult in correlating
the lack of clinical systemic manifestations in the patient.
For photomicrographs of this case contact:
info@teleoralpathology.com
Diagnostic
Interpretations of this case by Members:
Nasser Said-Al-Naief
Orofacial granulomatosis, must rule our focal allergy, Sarcoid, Crohn's
and Melkersson-Rosenthal syndrome, monosymptomatic form.
Sara Gordon
She cleans her teeth with charcoal. Is there a possibility there are
small foreign bodies in these tissues? The resolution of web
electrophotomicrographs makes this difficult to assess but it could be
ruled out microscopically. The foreign bodies (often silicates) may be as
small as a micron in diameter and should be visible in the same inflamed
area in at least 2 sequential sections. It's worth a look. Other top
concerns in any case of orofacial granulomatosis are Crohn disease and
sarcoidosis.
Francis kassir
Possible foreign body granuloma associated with carbon particles?
Yeshwant B. Rawal
The clinical history gives away the cause. Use of charcoal to clean
teeth. The non caseating granulomas with langhan type giant cells are
consistent with foreign body granulomas and not tuberculosis. The fine
particulate matter seen histologically is most likely fragmented charcoal.
The fibrous enlargement is consistent with foreign body reaction and not a
inflammatory / infectious process. It would be worthwhile polarizing the
sections to check out if the foreign body is birefringent or refractile. A
gingivoplasty and avoidance of charcoal will result in normalization of
appearance. Hope this helps. Excellent pictures.
Paul Freedman
The patient may have Crohn's disease with this being the oral
manifestation. GI evaluation should be performed.
Fabian Ocampo
We should rule out orofacial granulomatosis, before thinking on
tuberculosis, based on the abscence of necrosis focuses. These are much
better slides, congratulations.
Dr Gita rezvani
There was no organisem therefor it may be sarcoidosis or foreign body
reactions.I think it is foreign body reactions;because of using charcoal
for oral hygiene by patiant.
Michael A Kozlowski, DDS
Do you have any radiographs of the area?
Elias Romero
Foreign Body Granulomas
Jim Burns
Granulomatous Gingivitis R/O foreing body (charcoal) vs. Chronic
Granulomatous Disease.
Gururaja.Rao
The lesion looks to be chronic granulomatous in nature .It shows
stratified squamous keratinied lining with dense chronic inflammatory
cells namely plasma cells , epitheloid cells and also giant cells with
multiple nuclei in their cytoplasm suggestive of chronic tuberculosis of
gingival
Gary Ellis
In addition to TB, you can consider an early stage of Crohn's disease,
sarcoid, granulomatosis, and leprosy
James Cade
Sarcoid is a possibility, 2 references below: Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 1997 Apr;83(4):458-61., Oral Surg Oral Med Oral
Pathol. 1978 Oct;46(4):540-54.
Susan Zunt
Hyperplastic gingivitis with chronic granulomatous inflammation. The
discrete granulomas are suggestive of sarcoid. Perhaps serum angiotension
converting enzyme level would be helpful.
Sook Woo
In the absence of foreign bodies (refractile or otherwise) and of
stainable organisms and systemic signs of infection, my diagnosis would be
oro-facial granulomatosis. It is unusual that it is presenting without lip
swelling but the firm gingiva would be consistent with that. The next part
is of course trying to find if there is a triggering factor causing this
Type 4 hypersensitivity reaction.
Dr. Santosh
I think the diagnosis is primary TB.IT IS ASSOCIATED WITH GINGIVA.I
SUGGEST TO GO FOR Ig test.it may help in diagnosis.
Dr Alpana Srivastava
You have not mentioned AFB stain,good staining tech and thorough
search is required to find AFB. It certainly looks like TB esp when fungal
stains are negative. In India I have seen quite a lot atypical cases of TB
and learnt it a hard way to always have TB as first differential in
granulomatous lesions even when necrosis is absent
P V PUROHIT
Fungal granuloma with fungal bodies.
Dr Susmita Saxena
Primary tuberculous lesion of gingiva possible but no caseation is
seen.can it be peripheral giant cell granuloma?
Dr.CSBR.Prasad
Shows non-caseating granulomatous lesions with giant cell of Langhan's
type and prominent plasma cell infiltration. No endarteritis. As the
fungal infections and TB are excluded, I would like to consider Crohn's
disease and Sarcoidosis in my differentials. Sometimes oral lesions may be
the first manifestation of Crohn's. I would like to do RPR to exclude
Syphilis too.
Allan Giovanini
I think about some protozoose, I suggest leishmaniose
Aruna Madan
Histoplasmosis
D Jeevan
Granulomatous lesion of Fungal etiology
Dr.M.Neelamani Murthy
It is a case of non caseating granulamatous inflammation with the
possibility of Crohn`s disease, or Melkerson Rosenthal syndrome.
Dr Devendra Palve
Tuberculous gingivitis
Dr Seema Gupta
Pyogenic granuloma
Dr Helen Rivera
Primary Oral Tuberculosis
Rafael Segura SAint-Gerons
I think it is Langans giants cells and not Langerhans because they are
dendritics cells. It would be interesting a Ziehl of the especimen but I
think in tuberculosis
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