PMC4206926_01
Enlargement of gingival area associated with unerupted right mandibular second molar.
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Clinical examination showed enlargement of the gingival region of unerupted right mandibular second molar (Figure 1).
Radiographic aspect of the unerupted teeth. (a) Sectioned panoramic radiography: radiolucent well-defined area surrounding the crown of tooth 47, extending to apical region in the anterior area. (b) Periapical radiography: delicate sclerotic border, normal enamel and radicular formation, and absence of visible calcifications in pericoronal space.
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The radicular and enamel formation of the tooth were normal (Figure 2).
(a) Incisional biopsy of the lesion. (b) Fresh fragment of gingival and follicular tissues after removal.
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The pericoronal follicle was submitted to the Laboratory of Pathology of Bauru School of Dentistry, University of Sao Paulo, for histopathological analysis (Figure 3).
Histological aspect of the follicle: (a) pericoronal dental tissue with dense connective tissue; (b) multinucleated giant cells (arrows); (c) islands of odontogenic epithelium (large arrow) and calcified focus (small arrow) (H&E; (a) = 50x, (b) = 400x, and (c) = 200x).
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Microscopic examination revealed noninflamed fibrous connective tissue with dense collagen, fusiform cells, and giant multinuclear cells (Figures 4(a) and 4(b)). Odontogenic epithelial islands were scattered randomly and surrounded by calcification focus (Figure 4(c)).
Microscopic immunohistochemical features: (a) the giant multinucleated cells showed negative reactivity for antibody anti-CD-68 (arrow) indicating no monocyte origin; (b) the blood vessels were positive for anti-HHF-35 but the giant multinucleated cells were negative for this antibody (arrow); (c) strong vimentin immunopositivity of the giant multinucleated cells was observed indicating mesenchymal origin (arrow) ((a) = 400x, (b) = 400x, and (c) = 400x).
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The blood vessels were positive for HHF-35 and the collagen fibers for vimentin (Figure 5).
PMC4206926_02