The light microscopic features of the dentine in three teeth from two cases of osteogenesis imperfecta (OJ) are presented. Results show that teeth in OJ distinctively have a more uniform and tubular mantle dentine, and a characteristic laminated circumpulpal dentine formed by distorted incremental bands alternating with parallel rows of interglobular dentine and interrupted by comet-shaped vascular canals. The study indicated that in the absence of overt OJ features, the changes in dentine alone are sufficiently characteristic to establish such a diagnosis.
Chemiluminescence was evaluated as a diagnostic aid in the detection of oral cancer and potentially malignant epithelial lesions (PMELs) by comparing it against 1% tolonium chloride mouth rinse. Forty-six clinically identified lesions [14 primary squamous cell carcinoma (SCC), 26 PMELs and 6 benign lesions] and five cases of normal oral mucosa from 40 subjects (inclusive of 10 previously treated SCC cases) were examined with a commercial chemiluminescent kit (Vizilite) and tolonium chloride. Biopsy and histological verification of 31 lesions disclosed 14 SCC (45.2%), 10 epithelial dysplasias (32.3%), 5 lichen planus (16.1%) and 2 benign lesions (6.4%). For the remaining 15 lesions, a biopsy was not performed owing to patient's lack of consent or ill-health. The five cases of normal oral mucosa which tested negative for both tools were also not biopsied for ethical reasons. Sensitivity for Vizilite and tolonium chloride was 100% and 70.3%, respectively; and specificity was 14.2% for Vizilite and 25% for tolonium chloride. Their accuracy was 80.6% and 64.5%, respectively. Current findings suggest that chemiluminescence is a more reliable diagnostic tool than tolonium chloride in the detection of oral cancer and PMELs, and for follow-up of patients treated for the same.
The turnaround time (TAT) for oral biopsies received for histological examination by the Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, for the years 1978, 1988 and 1998 was evaluated. For the three years studied, TATs for 61, 233 and 463 specimens were retrospectively analysed. Testing intervals, that is, from the dates the surgeons procured the specimens, the laboratories accessioned them and until the pathologists signed off the diagnoses, were used to calculate TAT. The performance level of the respective pathologists, the growth of tissue diagnostic services and the possible variables that influence TAT were also evaluated. As prompt diagnosis means prompt treatment, which in turn has a bearing on prognosis, the TAT pertinent to oral malignant tumors was emphasized. The mean TAT, its mode and median fell significantly in 1998 compared with the previous 2 years; it was lower for soft tissue than for hard tissue specimens, and lower for malignant, than for non-malignant specimens. The progression of tissue diagnostic services is up to a satisfactory level, as 88.89 % of biopsies could render diagnoses within a fair period of time in 1998.
Analysis of case records of 46 patients with peripheral odontogenic fibroma (1967-95) diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, disclosed a relatively young age of onset (mean, 32.2 years; range 5 months-64 years; peak incidence second decade of life), a slight female preponderance (M:F ratio 1:1.3), no racial predilection, a slight bias towards location in the mandible (52%) and a wide histomorphological range. All cases were treated by simple excision. Follow-up records were generally not available, so we do not know what the recurrence rate is.
Calcifying odontogenic cysts (COCs) represent a group of lesions that may be broadly classified into two main entities: cysts and neoplasms. In the present study 30 non-neoplastic cystic COCs were examined by a quantitative histological method in an attempt to calibrate the relative distribution of the type of epithelial lining, intensity of ghost cell formation and the amount of dentinoid present. The results showed that there are two main types of cystic COC: an odontoma-producing type and a non-odontoma-producing variant. Morphologically, tooth-like structures were a valid distinguishing feature, while morphometrically the odontoma-producing variant showed a greater amount of luminal and mural dentinoid as well as luminal ghost cells. Demographic analysis also revealed that the odontoma-producing COC occurred in younger patients and showed an even sex distribution, whereas the non-odontoma-producing type was seen in older patients and showed a predilection for females. Both subtypes were more prevalent in the Chinese population and occurred preferentially in the maxilla.
The lining epithelium of 15 cases of odontogenic keratocyst (OKC) was evaluated immunohistochemically. The peroxidase-antiperoxidase technique was applied to study the distribution of polyclonal keratin and S-100 protein while the indirect method was used to examine monoclonal vimentin and desmin reactivity. Consistent positive keratin staining was revealed in the lining epithelium of all 15 OKCs with additional intense staining in the stratum corneum. None of the cases showed vimentin or desmin reactivity within the lining epithelium elements. One of the 15 cysts studied showed positive S-100 protein staining in the nuclei of the lining epithelial cells. The pertinent literature on the immunophenotyping of the lining epithelium of OKC is reviewed.
We reviewed biopsy records for 37 cases of oral histoplasmosis for patient characteristics, clinical features, and histopathologic findings. These represented cases diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur between July 1967 and October 1994. All were male patients who ranged in age from 11 to 79 years (mean age, 56.7 years). There were 40.6% Malays, 37.8% Chinese, 18.9% Indians, and 2.7% other races. Five patients with mouth lesions as the initial presenting lesions were proven to be cases of disseminated histoplasmosis. In the remaining cases apart from the biopsy-proven oral histoplasmosis lesions, the extent of the disease elsewhere was unknown. The majority of these lesions involved the gingiva, tongue, and palate in decreasing order of frequency. The most frequent presenting symptom was oral mucosal ulceration. Squamous cell carcinoma and tuberculosis were the two most common clinical differential diagnoses. Our present findings compare favorably with published reports from other regions.
Seventeen cases are reported of desmoplastic variant of ameloblastoma of the jaws observed during the years 1967-1991. There were 12 females and 5 males, and these consisted of 7 Chinese, 6 Malays, 2 Indians, 1 Sikh and 1 Kadazan. Their ages at diagnosis ranged from 21-60 years with a mean of 36.6 years. There were 10 mandibular and 7 maxillary tumours. Of these, 14 cases involved the anterior segment with extension to the premolar region in 5 cases. 60% of cases were radiologically suggestive of fibro-osseous lesions. The main mode of treatment was resection and 1 case presented with recurrence. The findings of this study were compared with those of previous reports.
Four cases of either combined occurrence of ameloblastoma and odontogenic keratocyst or a rare keratinising variant of ameloblastoma are presented. The cardinal histomorphologic characteristics are simultaneous occurrence of ameloblastomatous epithelial islands with central keratinisation and multiple keratinising cysts. Immunohistochemically the tumour elements were keratin positive and occasionally S-100 protein and desmin positive. Major differential diagnosis of these neoplasms are discussed.
Granular cell ameloblastoma (GCA) is a well recognized variant of follicular ameloblastoma with extensive granular cell change. In contrast, plexiform granular cell odontogenic tumor (PGCOT) is a rare and recently described lesion characterized histologically by a monophasic plexiform pattern of granular cells. In this paper, two cases of an unusual granular cell odontogenic tumor exhibiting combined features of these two entities are described along with their immunohistochemical characteristics. The granular cells of both the GCA and PGCOT areas showed similar patterns of expression for keratin and S-100, which differed from those of typical ameloblastoma. No reactivity for desmin or vimentin was noted. The histomorphologic and immunohistochemical features of these hybrid tumors suggest that the granular cells present have a common origin, most probably the odontogenic epithelium.
Seventeen cases of desmoplastic ameloblastoma were examined immunohistochemically. Immunoperoxidase techniques were applied for detection of keratin, desmin, vimentin and S-100 protein expression in these tumors. The tumor epithelium of desmoplastic ameloblastoma exhibited weak, focal, inconstant keratin staining, weak, variable expression of S-100 protein, desmin immunoreactivity of mild to moderate intensity and vimentin non-reactivity. The pertinent literature on the immunohistochemistry of ameloblastomas is briefly reviewed.
The clinical and histological features of the peripheral odontogenic fibroma are briefly outlined. A case arising from the attached lingual gingiva between the mandibular right permanent first molar and the second molar in a 67 year old Indian female is reported here. The unusual occurrence of marked clear cell differentiation within the odontogenic epithelial component, and histogenetic link to the clear cell rests of the dental lamina and surface epithelium are discussed.
A case is described of ameloblastoma of the mandible presenting with multiple recurrences and subsequent extension to the maxilla with resultant transformation into an aggressive (malignant?) epithelial odontogenic ghost cell tumour. The latter is a rare, biologically virulent entity that affects mainly males, exhibits a preference for the maxilla and is histologically characterized by atypical malignant odontogenic epithelium associated with areas of ghost cell formation and varying amounts of dentinoid.
The cemento-ossifying fibroma is classified as an osteogenic neoplasm of the jaws. It commonly presents as a progressively growing lesion that can attain an enormous size with resultant deformity if left untreated. A case of a large cemento-ossifying fibroma involving the left mandible is described in a 15 year old male patient. The clinical, radiographic and histological features as well as surgical findings are presented. The treatment of choice of this lesion is also emphasized. Two years after surgery, there was no evidence of recurrence and the transosseous wire used to immobilize the fracture was found to be completely buried in the jaw bone.
Florid cemento-osseous dysplasia refers to a group of fibro-osseous lesions which are exuberant, multiquadrant and arise from the tooth-bearing area of the jaws. It is classically described as a condition occurring almost exclusively in middle-aged black women. A case of florid cemento-osseous dysplasia occurring in a young Chinese male is reported which was rare in regard to race and sex. This 20 year old Chinese man presented with huge symmetrical bony lesions in all four quadrants of the jaws. Clinical presentation, radiological findings and histological features of the excised specimens are described. Treatment of the lesions was unusual. Curettage was first done with minimal benefit and it was followed by mandibular recontouring to improve facial appearance. The outcome of these procedures will be discussed.
This report reviews the clinicopathologic characteristics of 104 cases of odontomas diagnosed in the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, over a 29-year period (1967-1995). The results showed no real predilection in terms of sex (M:F ratio, 1:1), race (45.2% Malays, 40.4% Chinese, 10.6% Indians and 3.8% other races) or site (maxilla:mandible ratio, 1: 1.04) distribution. The mean age at presentation was 24.8 years and the age range was 3-74 years. There were 102 intraosseous and 2 extraosseous odontomas. Swelling was the most common presenting complaint. The majority of cases (81.9%) were clinically diagnosed as odontomas. The treatment of choice was surgical enucleation. Compound (43.3%) and complex (35.5%) odontomas were the two most common histological types encountered. The present findings correlate favorably with reported studies from other geographic areas.
We reviewed the clinicopathological characteristics of 13 cases of calcifying epithelial odontogenic tumour (CEOT) (Pindborg tumour) diagnosed in the Division on Stomatology, Institute for Medical Research, Kuala Lumpur, over a 29-year period. There were eight female and five male patients. These consisted of eight (61.5 per cent) Malays, three (23.1 per cent) Chinese, one (7.7 per cent) Indian and one (7.7 per cent) Melanau. Their ages at presentation ranged from 19-61 years (mean age, 31.8 years). There were 12 central and one peripheral CEOT. Of these, 76.9 per cent of cases were located in the maxilla, the remaining in the mandible. The commonest clinical diagnosis was a dentigerous cyst (66.7 per cent). Enucleation was the main mode of treatment. Histologically, sheets and strands of polyhedral epithelial cells containing eosinophilic, homogeneous globules with Liesegang rings were observed. One case also showed extensive calcification and clear cell differentiation. Immunohistochemistry revealed a variable keratin staining of the CEOT epithelium, confirming its heterogeneity.
Twelve pleomorphic adenomas of minor salivary gland origin were examined for the distribution of S-100 protein, detected using the peroxidase-antiperoxidase (PAP) method. Strong S-100 protein immunoreactivity was noted in areas containing plasmacytoid cells, stellate and spindle cells against a myxochondroid or hyalinous stroma, and solid epithelial areas. Tubular and duct-like structures showed variable stainability. Stromal tissue and normal salivary glands were generally negative for S-100 protein. These findings were compared with those reported elsewhere.
The records of the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, Malaysia, were reviewed for the incidence of odontogenic keratocysts of the orthokeratinised variety, during the 20-year-period, 1967 to 1986. Nine cases were found. The clinical, histological and radiological features of these cases are reported. Many features were similar to previous reports of this entity but a peak incidence in the second decade of life, an almost even distribution in the maxilla and mandible, and a distinct predilection for the Chinese were observed. It is suggested that these features may be peculiar to Malaysians.