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Preanalytical variables: Influence on laboratory results and patient care
Rateesh Sareen, Menka Kapil, GN Gupta
January-June 2017, 1(1):31-34
Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There have been tremendous work and established quality control criteria for analytical phase of testing but there is paucity of standards for pre analytical phase. Recommendations for sample collection, storage, processing and transport have been developed by national and international consensus. There is a dire need for all laboratories to formulate their own quality manual so that day to day pre analytical errors are curtailed. As the errors in pre analytical phase are not inevitable and should be avoided with diligent application of quality control, education dedicated to patient care. We illustrate the ability of laboratory data by case studies to reinforce the importance of vigilance in pre analytical phase of testing.
  2,017 292 -
Salivary glucose levels in Type 2 diabetes mellitus: A tool for monitoring glycemic control
B Kartheeki, Abhishek Singh Nayyar, A Ravikiran, Y Samatha, KV Chalapathi, M Prasanthi, K Srikanth
January-June 2017, 1(1):7-14
Background and Aim of the Study: Diabetes mellitus (DM) requires a frequent monitoring of sera glucose levels in the body. This requirement of multiple pricking at regular intervals for monitoring sera glucose levels in the body is physically and psychologically traumatic to the patient. This necessitates a noninvasive procedure like salivary glucose estimation. The aim of this study was to assess whether salivary glucose levels can be used as a means of regular monitoring of DM without the need for serial invasive procedure required for sera glucose level estimations. Subjects and Methods: The study group comprised 300 patients, divided into three sub-groups: Group 1 (healthy controls/nondiabetic patients; n = 50); Group 2 (controlled diabetic patients; n = 125); and Group 3 (uncontrolled diabetic patients; n = 125). After explaining the need for the study and obtaining consent, salivary sample collection was performed in the morning hours between 9.00 a.m. and 11.00 a.m. immediately after obtainment of the sera samples. Salivary and sera glucose levels were measured using glucose oxidase method. Statistical Analysis Performed: Statistical analysis was performed with the Statistical Package for the Social Sciences version 16 software. The difference between means and standard deviations (SDs) between the groups were assessed using ANOVA one-way test, whereas multiple comparisons between different groups were carried out using Tukey's honest significant difference test. The value of P < 0.05 was considered statistically significant and a value <0.01 was considered highly statistically significant. Results: In this study, salivary glucose levels increased with sera glucose levels with the correlation coefficient between sera and unstimulated salivary glucose levels in the controls being 0.517, in controlled diabetics being 0.470 and in uncontrolled diabetics being 0.498 (P < 0.05). Conclusion: It was concluded from this study that saliva can be used as a potential tool in the regular monitoring of DM.
  1,998 227 -
Solitary neurofibroma of the floor of the mouth
Srikanth Hanasoge Srivathsa
January-June 2017, 1(1):20-22
Solitary neurofibromas (SNFs) are rare benign peripheral nerve sheath tumors. Unlike neurofibromatosis, SNFs occurs as single entities. They are uncommon in the oral cavity, and it is even rarer in the floor of the mouth. When encountered in the oral cavity the differential diagnoses should consist of both benign and malignant tumors. A rare case of solitary benign neurofibroma occurring as an exophytic lesion in the floor of the mouth is being reported.
  1,790 92 -
Relevance of surgical gloves in minor surgical procedures in the present scenario: A randomized, double-blind, controlled trial
Pradipta Das, Abhishek Singh Nayyar, Omkar Haridas, K Lakshmi Sirisha, Abhishek Karan, K Pramod
January-June 2017, 1(1):1-6
Context: In developing countries, where money set aside for public health is <1% of the gross domestic product, routine use of surgical gloves for examining patients as well as for minor surgical procedures can be a drain on the resources. The present study was, therefore, planned to ascertain whether it is necessary to use surgical gloves in routine minor surgical procedures. Aim: The aim of the study was to ascertain whether it is necessary to use surgical gloves in routine minor surgical procedures. Materials and Methods: A comparative, prospective, randomized, double-blind study was carried out in 100 patients for various minor surgical procedures, performed aseptically. Microbiology specimens were taken from the glove's surfaces according to a standard protocol. An independent assessor, who was blinded for the procedure, examined the patients on the 7th postoperative day. Statistical Analysis Used: Statistical analysis was done using IBM SPSS Statistics 20 core system software. Paired t-test, unpaired t–test, and Karl Pearson's coefficient test were used to calculate the scientific data and association between variables. Results: A total of 100 patients who underwent minor surgical procedures were obtained at the end of the study. Paired t-test showed highly significant difference from pre- to post-operative colony-forming units at 1% level of significance (P < 0.01). Conclusions: The present study concluded that the use of surgical gloves does not offer a definite advantage in minimizing the rate of infections following various minor surgical procedures.
  1,474 156 -
Gorlin cyst of the maxilla: A rare case report
Abhishek Singh Nayyar, M.V.R. Ratnam, G Upendra, B Kalivara Prasad, S.V.N. Sashikiran, Debasis Sahu
January-June 2017, 1(1):15-19
A cyst is defined as a pathological cavity which may or may not have an epithelial lining and which has a fluid, semi-fluid, or gaseous content and is not formed by the accumulation of pus. Calcifying odontogenic cyst, as Gorlin cyst was recognized earlier, was first reported by Gorlin et al. in 1962. At that time, it was classified as a cyst related to an odontogenic apparatus. It was later renamed as calcifying cystic odontogenic tumor (CCOT) in the World Health Organization classification devised in 2005 due to its histological complexity, morphological diversity, and aggressive proliferation. CCOT was later recognized by numerous names including Gorlin cyst, calcifying ghost cell odontogenic cyst, and dentogenic ghost cell tumor. The present case report presents a case of the same in a 21-year-old female which was diagnosed as Gorlin cyst during the diagnostic workup.
  1,480 145 -
Lactational adenoma: A diagnostic pitfall on fine needle aspiration cytology
Wu Bingcheng, Yeo Yen Ching, Tay Zhi En Amos, Yan Zhiyan, Mihir Gudi
July-December 2017, 1(2):47-49
Pregnancy induces hormone-related breast changes which pose diagnostic challenges in the evaluation of a breast lump. In particular, fine needle aspiration cytology of a lactating adenoma may mimic malignancy. The authors present a case of a woman with a right breast lump. Fine needle aspiration cytology demonstrated the presence of numerous single-occurring epithelial cells with large round nuclei, discrete nucleoli, and ample vacuolated cytoplasm. Taken in isolation, this finding would be suspicious for malignancy. However, the clinical history of recent pregnancy was duly noted as was the presence of a granular vacuolated background on cytology. An accompanying core biopsy confirmed the lesion to be a lactating adenoma. This case highlights lactating adenoma as a potential diagnostic pitfall on fine needle aspiration cytology.
  1,273 159 -
Epidermal growth factor receptor, vascular endothelial growth factor, mouse double minute 2 homolog, Ki 67, and p53 expression in glioblastoma: A survival analysis including the prognostic value of clinical, histopathological, and immunohistochemical parameters
Ishita Pant, Deepak Kumar Jha, Vinod Kumar Singh Gautam, Chandra Bhushan Tripathi, Sujata Chaturvedi
July-December 2017, 1(2):35-40
Objective: The objective of the study was to describe the clinical, histopathological, and immunohistochemical profile of glioblastoma in patients and to correlate these findings with patient survival. Materials and Methods: Thirty cases of histopathologically diagnosed glioblastomas were included in this study. These cases were analyzed in detail for certain clinical and histopathological parameters. Immunohistochemical staining for p53, epidermal growth factor receptor, vascular endothelial growth factor, mouse double minute 2 homolog (MDM2), and Ki67 was done, and scores were calculated. Results of these findings were correlated with patient survival. Results: A retrospective analysis of the histopathology records and clinical case files was done in thirty cases of glioblastoma (World Health Organization Grade IV). The mean age of presentation was 50.6 years with a male predilection. The most common involved site was the frontal lobe. Among the clinical parameters, age of the patient and extent of surgical resection showed a significant correlation with the patient survival. Histopathological parameters showed no significant correlation with the patient survival, while among the immunohistochemical parameters, expression of MDM2 showed a significant correlation with the patient survival. Conclusion: In this study incorporating clinical, histopathological, and basic panel of immunohistochemistry, age of the patient, extent of the surgical resection, and expression of MDM2 showed a significant correlation with the patient survival.
  1,101 188 -
Osteolytic lesion of the mandible in a 42-year-old female
Jeffrey Allan Elo, Ho-Hyun Brian Sun, Chan M Park
July-December 2017, 1(2):54-60
A case of metastatic breast cancer with medication-related osteonecrosis of the jaws is described in a 42-year-old Hispanic female who was previously unaware of a preexisting breast carcinoma. Radiographic examination demonstrated the absence of visible lamina dura and periodontal ligament on teeth in the affected area; while clinical examination demonstrated a moderately diffuse swelling of the right mandible and vestibule without distinct masses. Microscopy revealed disordered lesional cells with moderate variations in nuclear size, shape, and chromaticity, with a low mitotic index. Also noted were segments of necrotic remodeled resorbed lamellar bone showing enlarged empty osteocytic lacunae, a serrated external surface, adherent granular basophilic bacteria, and a fibrinous exudate with neutrophils.
  1,074 146 -
Laboratory disease: Case of pseudothrombocytopenia
Rateesh Sareen, Menka Kapil, GN Gupta
January-June 2017, 1(1):23-25
We report a case of EDTA induced pseudothrombocytopenia (EDTA-PTCP) in a patient who was treated with platelet transfusion and with refractory thrombocytopenia was referred to us. The Automated blood analyzer and peripheral blood smear examination revealed numerous platelet aggregates, leading to falsely low platelet count on automated hematology analyzer. The case emphasizes careful examination of peripheral blood smear to rule out this form of in vitro phenomenon which can save the patient from unnecessary transfusions and invasive diagnostic procedures.
  1,070 123 -
Alkaline phosphatase and lactate dehydrogenase enzyme activity in gingival crevicular fluid during orthodontic tooth movements
N Yannawar Vijay, RM Dharma, MR Dinesh, Kalpesh Sharma, Sunny Gupta, Garima Chitakara, Abhishek Singh Nayyar
July-December 2017, 1(2):41-46
Background: Bone remodeling is a biologic process involving an acute inflammatory response in periodontal tissues during orthodontic tooth movement. The early response of periodontal tissues to mechanical stress involves metabolic changes that allow tooth movement. Aim of the Study: The aim of the present study was to evaluate the changes in alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) enzyme activity in gingival crevicular fluid (GCF) when forces are applied during initial alignment (P1) and retraction (P2). Settings and Design: The study was performed in a hospital-based population with an experimental design. Materials and Methods: Seventeen participants (11–21 years) included in the study, all requiring 1st premolar extractions were undergoing fixed orthodontic treatment. Maxillary canine and mandibular 2nd molar were used as test tooth (TT) and control tooth (CT) in each patient, respectively. On 14th day after start of each phase, 2 μL of GCF was collected from mesial side of both TT and CT for ALP and LDH activity determination using spectrophotometer. Statistical Analysis: Statistical analysis was performed with SPSS (version 13, SPSS Inc., Chicago, USA) package. The significance of differences in both phases at test or, at control site for LDH and ALP enzyme activity was evaluated by performing student's paired t-test. The significance of differences in between test and control sites in each phase separately was evaluated by performing student's unpaired t-test. Results: There was a variation in enzyme activity during orthodontic tooth movement. At TT, there was statistically significant increase in ALP and LDH activity in P2 as compared to P1 with P = 0.005 and P ≤ 0.001, respectively. At CT, there was no statistically significant difference in ALP and LDH activity in P1 and P2 with P = 0.054 and P = 0.061, respectively. Conclusion: This study concluded that ALP and LDH activity could be successfully estimated in the GCF and ALP and LDH activity in GCF reflects the biologic activity in the periodontium during orthodontic tooth movements.
  1,000 163 -
A usual tumor at an unusual site: Report of two cases of schwannoma at nonindigenous sites
Nigi Ross Philip, K Sajitha, Shubha Bhat, Chandrika Rao
July-December 2017, 1(2):50-53
Schwannoma is a benign, slow-growing encapsulated tumor arising from schwann cells of the nerve sheath and believed to originate from the embryonic neural crest cells. They are common tumors of the head-and-neck region and extremities arising from the nerve sheaths of cranial and spinal nerves. We present two cases of schwannoma occurring at uncommon sites. The first case is a solitary intra-cranial schwannoma presenting in the frontal region which was radiologically diagnosed as meningioma. And, the second case presented as a polypoidal lesion in the right nasal cavity.
  875 133 -
Multiple keratocystic odontogenic tumors: Insight to a rare syndrome?
Aravinda Konidena, Samridhi Shekhar, Avani Dixit, Deepa Jatti Patil
January-June 2017, 1(1):26-30
Nevoid basal cell carcinoma (BCC) syndrome is a rare syndrome caused by mutations in PTCH1 gene and characterized by several developmental anomalies and neoplasms affecting multiple organ systems. Conventionally, the syndrome was described as a triad of multiple BCCs, keratocystic odontogenic tumors (KCOTs), and bifid ribs. However, recently, we encountered a 25-year-old male patient who presented incidentally with multiple KCOTs, bifid ribs, and other characteristic findings, but not BCCs. This case along with appropriate literature review is being presented herewith.
  730 77 -
Primary mucosal melanoma of maxillary gingiva with metastasis: A rare case report with brief review of literature
Jimsha Vannathan Kumaran, Mariappan Jonathan Daniel, Mithunjith Krishnan, Divakar Seetharaman
July-December 2017, 1(2):61-65
Primary malignant melanoma of the oral cavity is a rare neoplasm. Over 90% of melanoma occurs in skin, but they may also arise from the mucosal surfaces or other sites where neural crest migrates. Intraorally, the most common sites are the palate and gingiva followed by mandibular gingiva and lip mucosa. Oral melanoma is initially asymptomatic. It may develop as a slowly growing mass and be present for months or years before being noticed. Mucosal melanoma of the head and neck has poor prognosis, with the survival of a patient with mucosal melanoma being less when compared with cutaneous melanoma, so early diagnosis is important.
  668 60 -
Bilateral oral leukoplakia: A case report and review on its potential for malignant transformation
K Tupakula Pavan, Ankita Kar, S Reddy Sujatha, BK Devi Yashodha, Nagaraju Rakesh, V Shwetha
July-December 2018, 2(2):27-30
Oral leukoplakia (OL) is considered as a most common potentially malignant disorder (PMD) affecting the mucosa of the oral cavity. With the passage of time, the definitions of OL kept evolving. Leukoplakia usually presents after the fourth decade of life and is one of the most common oral PMDs affecting the oral cavity. Based on the macroscopic features of OL, it can be classified into two subtypes: homogeneous and nonhomogeneous.
  476 76 -
Laboratory disease: Case of pseudothrombocytopenia
Sohil Nakra, Ashmeet Kaur, Rateesh Sareen, Menka Kapil
July-December 2017, 1(2):66-67
  471 65 -
Correlation between total serum bilirubin and clinico-laboratory parameters of babies admitted for neonatal jaundice in a resource-limited setting
Uchenna Ekwochi, Chidiebere D.I Osuorah, Ikenna Kingsley Ndu
July-December 2018, 2(2):21-26
Background: Neonatal jaundice (NNJ) is one of the most frequent reasons newborn babies in low- to middle-income countries visit the hospital during the neonatal period. If not promptly managed, it could lead to serious neurological sequela and mortality. The level and type of bilirubin in serum are an important determinant of the management option in NNJ. Unfortunately, this simple but fundamental investigation is not readily available in many hospitals in low- to middle-income countries, and where available, needs to be done serially, an expenditure most clients cannot afford. Methodology: This study enrolled 83 newborns admitted and managed for NNJ at the Enugu State University Teaching Hospital during an 18-month period. We report correlation between total serum bilirubin (TSB) and selected newborn clinical and laboratory parameters. Results: A total of 83 newborns were admitted for NNJ during the study. The mean TSB (mTSB) was 307 ± 145.2 μmol/L. Preterm infants (T = 0.462, P = 0.500), neonates with birth weight <2.5 kg (T = 0.219, P = 0.804), female neonate (T = 0.314, P = 0.578), and those that presented with skin level at the lower body region (T = 28.52, P = 0.001) had a higher mTSB at presentation to the special care baby unit. Similarly, mTSB at presentation was higher in neonates with PCV <40% (T = 0.005, P = 0.942), negative malaria parasite film (T = 0.01, P = 0.933), and those that were Glucose-6-Phosphate dehydrogenase deficient (T = 1.59, P = 0.221). Only skin level of jaundice at presentation was significantly correlated to the TSB (R = 0.818 P = 0.001) while gestational age (R = 0.096, P = 0.500), age at presentation (R = 0.197, P = 0.157), and birth weight (R = −0.107, P = 0.459) were not. Linear regression analysis showed that for every regional rise in skin level of jaundice (X), the TSB (Y) in μmol/L increases by a factor of 89.74 expressed in a regression equation as, Y = −10.66 + 89.74 X. Conclusions: The skin level of jaundice can be used as a rough guide in the estimation of total bilirubin in newborns with jaundice. This is especially useful in resource-limited setting where facilities for testing bilirubin level are lacking.
  387 49 -
Clopidogrel-induced thrombotic thrombocytopenia after years of medication
Rateesh Sareen, Menka Kapil, Piyush Mathur, Madhulika Sharma
July-December 2018, 2(2):31-33
Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever, microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and capillaries without eliciting inflammatory response. The idiopathic cases of TTP are characterized by deficiency of ADAMTS-13 (a disintegrin and metalloprotease, with thrombospondin -1 like domains) metalloprotease activity. The use of antiplatelet drugs, the thienopyridine derivatives Clopidogrel & Ticlodipine, is associated with drug induced TTP. The literature studies indicate that most cases of thienopyridine associated TTP involve an antibody to ADAMTS-13 metalloprotease that cause thrombocytopenia and respond to therapeutic plasma exchange (TPE). We report a case of 59 year old male who was on Clopidogrel post coronary angioplasty since past five years. He presented to us with complaints of nose bleeding and renal insufficiency. The evaluation of this potentially fatal drug complication should be borne in mind by physicians for all patients receiving Clopidogrel treatment.
  310 43 -
Endometrial osteocartilaginous metaplasia: A case report and review of the literature
Yeo Yen Ching, Mihir Gudi, Josefa E.O Vella
July-December 2018, 2(2):34-36
Rare cases of osseous metaplasia and a single case of cartilaginous metaplasia have been reported previously but no previously reported cases of osteo-cartilagenous metaplasia were found on searching the literature. Osteo-cartilagenous metaplasia is a benign lesion which may be treated successfully with hysteroscopy. Awareness of this condition by histopathologists is important in order to avoid misdiagnosis of endometrial malignant mixed mullerian tumour. The authors report a patient with endometrial osteo-cartilagenous metaplasia, describe the clinical and histological features and review the literature on this condition.
  228 31 -
Analysis of molecular markers in glioblastoma and correlation with survival pattern
Ishita Pant, Sujata Chaturvedi, Vaishali Suri, Ajay Kumar Bansal, Deepak Kumar Jha, Vinod Kumar Singh Gautam
January-June 2018, 2(1):6-11
Objective: The objective of this study was to apply the newly recommended mandatory immunohistochemical (IHC) markers, isocitrate dehydrogenase (IDH) and ATRX, in addition to our previously applied panel of p53, epidermal growth factor receptor [EGFR], vascular endothelial growth factor [VEGF], MDM2, and Ki67 on histopathologically diagnosed thirty cases of glioblastoma. Their interrelationship and correlation with survival pattern were analyzed. Materials and Methods: A retrospective analysis of the histopathology records and clinical case files was done in thirty cases of glioblastoma (World Health Organization Grade IV). These cases were analyzed for certain defined clinical and histopathological parameters. IHC staining for IDH1-R132H and ATRX was done. IHC scores for p53, EGFR, VEGF, MDM2, and Ki67 were included from the previously published dataset. IHC labeling of all these markers was analyzed, and their interrelationship was studied and correlated with the survival pattern. Results: Cases were categorized as glioblastoma, IDH-wild type; glioblastoma, IDH-mutant; and glioblastoma, not otherwise specified (NOS). A total of 17 cases were categorized as glioblastoma, IDH-wild type and 10 cases were categorized as glioblastoma, IDH-mutant. Three cases in younger adults were categorized as glioblastoma, NOS. In glioblastoma, IDH-wild type, p53 expression was found in 7 cases, increased Ki67 expression was present in 12 cases, VEGF expression was found in 16 cases, MDM2 was expressed in 14 cases, while EGFR expression was present in 10 cases. In glioblastoma, IDH-mutant, p53 expression was found in 5 cases, increased Ki67 expression was present in 4 cases, VEGF expression was found in 9 cases, MDM2 was expressed in 5 cases, while EGFR expression was present in 3 cases. The mean overall survival in glioblastoma, IDH-wild type was 3.1 months and, in glioblastoma, IDH-mutant, the mean overall survival was 6.4 months. Conclusion: Survival pattern of glioblastoma, IDH-mutant, was better than glioblastoma, IDH-wild type.
  150 23 -
Demographic profile and clinicopathologic concordance of leprosy in the North-West part of Rajasthan, India: A 2 years prospective study
Sanya Sharma, Naresh N Rai
January-June 2018, 2(1):1-5
Background: Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae principally affecting the skin and peripheral nerves. M. leprae is an obligate intracellular bacillus (0.3–1 μ wide and 1–8 μ long) that is acid-fast. Leprosy exhibits a spectrum of clinical characteristics that correlate with the histopathological changes and the immunological status of the individual. There is a range of varied clinicopathologic manifestations, and the diagnosis is made from adequate clinical information combined with histopathology. The aim of the study was to classify leprosy according to the Ridley–Jopling classification and perform the clinicopathological correlation. Materials and Methods: A prospective study was conducted on 184 cases of skin biopsies clinically diagnosed with leprosy, received in the Department of Pathology, Government Medical College, Kota from July 2015 to July 2017. Adequate clinical history was taken and biopsies were stained with hematoxylin and eosin and modified Fite Faraco stain. The Ridley and Jopling classification was followed in both clinical and histopathological diagnosis. Results: This study included 184 patients diagnosed clinically with leprosy. Skin biopsy revealed evidence of leprosy in 158 cases. A maximum number of patients clinically belonged to indeterminate leprosy which constituted 57 (30.9%) cases followed by borderline tuberculoid (BT) 41 cases (22.2%). On the contrary, histologically, although indeterminate leprosy was the most common with 51 cases (32.2%), the second most common was borderline lepromatous (BL) with 28 cases (17.7%) cases. Twenty-six cases of clinically diagnosed leprosy showed no features of leprosy histologically. The clinical and histopathological correlation was seen in 158 cases (85.3%the). The correlation was highest in BL (89.2%) followed by lepromatous and BT leprosy. Fite-Farraco stain was positive in 85 cases (53.7%). Conclusion: The classification of leprosy requires attention to the histopathological criteria and correlation with clinical information and bacteriological examination to facilitate accurate therapy.
  150 19 -
An unusual cause of osteomalacia – A case report of phosphaturic mesenchymal tumor of the right hip bone
Bingcheng Wu, Joel-Louis Zongwei Lim, Fredrik Petersson
January-June 2018, 2(1):12-14
Phosphaturic mesenchymal tumor (PMT), while a rare entity, is nevertheless an important cause of oncogenic malacia/tumor-induced osteomalacia (TIO). We present a case of PMT. Our 47-year-old patient presented with unexplained osteomalacia refractory to medical therapy, associated with left subtrochanteric stress fracture. Further workup revealed the presence of a tumor in the left anterior inferior iliac spine, which was subsequently excised. Histopathology of the tumor showed the characteristic features of PMT, including grungy calcifications, osteoclast-type multinucleated giant cells, and bland round-to-spindled tumor cells. Following excision of the PMT, the patient's osteomalacia swiftly resolved. PMT is an important differential diagnosis in the context of oncogenic osteomalacia/TIO. As highlighted by our case report, PMT has fairly characteristic clinical and histopathologic features. However, given its rarity, an awareness of this entity is required for correct diagnosis and treatment.
  123 18 -
Adenomatoid odontogenic tumor: An unusual presentation
Divakar Seetharaman, Mariappan Jonathan Daniel, Venkatapathy Ramesh, Saikat Chakraborty
January-June 2018, 2(1):15-19
Adenomatoid odontogenic tumor (AOT) is considered to be an uncommon odontogenic tumor which occurs most commonly in an unerupted maxillary canine. Some investigators consider it to be a benign neoplasm, while others consider it to be a hamartomatous malformation due to its limited size and to the lack of recurrence in most of the cases. The specific stimulus that triggers proliferation of progenitor cells of AOT is unknown, as in case of all odontogenic tumors. As it is exclusively associated with an unerupted or impacted tooth and the cytological resemblance to the dental lamina and enamel organ, it can be considered as odontogenic in origin. The present case highlights the unusual presentation of AOT which is not associated with an impacted or unerupted tooth.
  123 11 -