PMC9593120_01
Clinical aspect at presentation of the patient with signs of inflammation of the periodontium, with increases in gingival volume and color changes
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F1
During the intraoral clinical examination, generalized gingival volume increases were observed having color changes on bright red on the maxillary and purple on the mandible, with granular appearance at the free gingival margin level and firm consistency on probing (Figure 1).
Radiological aspect at presentation of the patient with generalized bone resorption
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F2
The radiological exam (Figure 2) revealed vertical resorptions located at the central interincisive septum level on the mandible and maxillary, and to the 2.4 tooth.
Clinical aspect after ablation of the prosthetic restoration, with an improvement in the clinical appearance of the periodontium but still with increases in gingival volume and color changes
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F3
After scaling, ablation of the prosthetic restorations and rinsing with mouthwash with 0.2% Chlorhexidine, twice daily for 14 days (Figure 3), the excisions of the overgrowth papillae from the frontal area 1.3, 1.2, 1.1 were performed with a 15C blade scalpel.
Histopathological aspect of the gingival mucosa: (A) Epithelial hyperplasia with marked acanthosis and papillomatosis; mild hyperplasia of the basal cells; abundant cytoplasm with focal clearings of the superficial spinous cells (glycogen); marked chronic inflammatory infiltrate within the lamina propria; focal vascular dilatation; (B) Control - gingival mucosa with mild acanthosis; apparent thickening of the epithelium due to tangential cut; very few lymphocytes within lamina propria (normal histological findings); no vascular dilatation; (C) Marked spongiosis with significant lymphocytic exocytosis within the epithelium; numerous lymphocytes and plasma cells present within the lamina propria; vascular dilatation; (D) Control - no spongiosis and no obvious lymphocytic exocytosis within the epithelium; few dilated blood vessels with several non-agglutinated red blood cells with normal cytoplasmic staining (no pathological significance); (E) Marked inflammatory infiltrate consisting in lymphocytes and very numerous plasma cells within the lamina propria; occasional hyaline globules within the plasma cells cytoplasm - Russell's bodies; collagen deposition in thick bundles with mild fibroblastic proliferation; (F) Control - lamina propria consisting of collagenous background with fibrocytes, few small, dilated capillaries and very few lymphocytes (normal histological findings); no plasma cells are present. Hematoxylin-Eosin (HE) staining: (A and B) x200; (C-F) x400
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F4
The patient presented marked epithelial hyperplasia, with acanthosis and papillomatosis; marked diffuse spongiosis was present within the epithelium; within the lamina propria, marked chronic inflammatory infiltrate was present, consisting of mononuclear cells (lymphocytes and monocytes and numerous plasma cells, some of them with intracytoplasmic hyaline globules - Russell's bodies), with mild focal lymphocytic exocytosis within the epithelium; no neutrophils or eosinophils were identified; thick collagen bundles with mild fibroblastic proliferation were present (Figure 4A,4B,4C,4D,4E,4F). Also, no B-cells, plasma cells or histiocytes are present within the epithelium (CD20-, CD79a-, CD68- within the epithelium; CD138 presented membranous epithelial positivity without revealing any non-epithelial positive cells interspersed between the epithelial cells) (Figures 4,5,6,7).
T-lymphocytes distribution within the gingival mucosa: (A) Numerous CD3+ T-lymphocytes within the inflammatory infiltrate; very few negative lymphocytes are present; blood vessels are negative; (B) Control - few CD3+ T-lymphocytes within the lamina propria (normal histological findings); (C) Numerous CD5+ T-lymphocytes within the inflammatory infiltrate; very few negative lymphocytes are identifiable; the density of the inflammatory infiltrate is lower than in Figure 5A, however the proportion of the CD5+ cells is similar; (D) Control - few CD5+ T-lymphocytes within the lamina propria; occasional T-cell intraepithelial exocytosis; no spongiosis is present (normal histological findings); (E) Numerous CD5+ T-lymphocytes within the inflammatory infiltrate, with occasional intraepithelial exocytosis; very few negative lymphocytes are present, with similar density of the inflammatory infiltrate and proportion of the CD5+ cells to Figure 5A; (F) Control - CD5+ T-lymphocytes within the squamous epithelium; no spongiosis is identifiable (normal histological findings). Anti-CD3 antibody immunomarking: (A and B) x400. Anti-CD5 antibody immunomarking: (C-F) x400. CD: Cluster of differentiation
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F5
T-lymphocytes (CD3+, CD5+) admixed with very few B-lymphocytes (CD20+, CD79a+) and very numerous CD138+ cells (plasma cells) and few CD68+ cells (histiocytes) within the lamina propria. The intraepithelial exocytosis of inflammatory cells consisted exclusively of T-cells (CD3+ and CD5+), no B-cells, plasma cells or histiocytes being present (CD20-, CD79a-, CD68- within the epithelium; CD138 presented membranous epithelial positivity without revealing any nonepithelial positive cells interspersed between the epithelial cells) (Figures 5,6,7).
No positivity for p53 in the epithelium in both studied case (A) and control (B) (normal histological findings in both studied case and control). Anti-p53 antibody immunomarking: (A and B) x400
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F8
No neutrophils or eosinophils were present within the inflammatory infiltrate. p53 was negative (Figure 8, A and B). As expected, p53 (oncogene product) was negative (Figure 8, A and B).