PMC5917518_01
Clinical and radiographic images. (a) Preoperative clinical image (before tooth extraction). (b) Preoperative clinical image (after tooth extraction). (c) Preoperative radiographic image. (d) Postoperative clinical image. (e) Postoperative radiographic image
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F1
Though pulpectomy was initiated considering poor prognosis of the tooth, extraction was planned eventually [Figure 1b]. Periapical radiograph showed no intrabony involvement [Figure 1c]. Two days postexcision, excised site was asymptomatic with signs of healing [Figure 1d]. Nine months postexcision, follow-up reveals no recurrence or symptoms clinically and radiographically [Figure 1e].
Composite photomicrographs. (a) Lesion with superficial epithelium and connective tissue stroma with numerous amelobastic follicles (x4 OM*). (b) Follicle showing ameloblast-like cells, stellate reticulum and dentinoid tissue (x10 OM*). (c) Numerous ameloblastic follicles seen with interspersed dentinoid-like material (x10 OM*). (d) Dentinoid secreted by odontoblast (x40 OM*). *Original magnification
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F2
The hematoxylin and eosin-stained section showed surface hyperplastic parakeratinized stratified squamous epithelium with underlying fibrovascular connective tissue stroma [Figure 2a]. The connective tissue stroma showed numerous ameloblastic follicles [Figure 2a]. The follicles were lined by tall columnar ameloblast-like cells at the periphery with apically placed nucleus [Figure 2b]. Stellate reticulum-like cells were also seen adjoining ameloblastic cells at the center of the follicle [Figure 2b]. Abundant eosinophillic calcified areas resembling dentinoid were seen in between the follicles [Figure 2c and d].
Composite photomicrograph of immunohistochemistry with cytokeratin 19. (a) Scanner view. (b) Positivity of cytokeratin 19 in epithelial islands (x10 OM*). (c) Cytokeratin 19-positive follicles (x40 OM*). (d) Dentinoid not marked by cytokeratin 19 (x40 OM*). *Original magnification
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F3
The tissue section was tested for cytokeratin 19 (CK19) (319M-1 Sigma-Aldrich ) [Figure 3a], following the standard immunohistochemical protocol for confirmation of the odontogenic origin. CK19 was found to be expressed in all the odontogenic epithelial areas [Figure 3b] and especially among those associated with the dysplastic dentinoid matrix [Figure 3c]. The dysplastic dentinoid matrix was not marked by CK19 [Figure 3d].