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Identify- histopathology section of swelling lower jaw What is this image

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Leisegang rings seen in birefringence - Pindborg tumour Calcifying epithelial odontogenic tumour

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Calcifying Epithelial Odontogenic Tumour Pindborg tumour

The calcifying epithelial odontogenic tumor was first described in 1956 by the late Dr Jens J Pindborg. The Pindborg tumor is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin.Pindborg tumor are reminiscent of the cells in the stratum intermedium layer of the enamel organ in tooth development. This tumor occurs most frequently in middle-age.There is a predilection for occurrence of the tumor in the mandible over the maxilla by a ratio of 2 : 1.Most patients with this lesion are asymptomatic and are aware only of a painless swelling. Nearly 52% patients report with impacted or u erupted teeth. An extraosseous calcifying epithelial odontogenic tumor is also known to occur but is quite rare. Till date only 8 cases havr been reported. The tumor may show considerable radiographic variation. In some cases, the lesion appears as either a diffuse or a well-circumscribed unilocular radiolucent area, while in other cases there may appear to be a combined pattern of radiolucency and radiopacity with many small, irregular bony trabeculae traversing the radiolucent area in many directions, producing a multilocular or honeycomb pattern. Scattered flecks of calcification throughout the radiolucency have given rise to the descriptive term of a ‘driven snow’ appearance. On CT examination, calcifying epithelial odontogenic tumor in the mandible demonstrates expansion and thinning of buccal and lingual cortical bony plates by a well-defined mass containing scattered radiopaque areas of varying size and signal intensity. Histopathological features The calcifying epithelial odontogenic tumor is composed of polyhedral epithelial cells, sometimes closely packed in large sheets but other times consisting chiefly of scattered small islands of cells in a bland fibrous connective tissue stroma. Occasionally, the cells are arranged in cords or rows, mimicking adenocarcinoma. The tumor cells have a well-outlined cell border with a finely granular eosinophilic cytoplasm, and intercellular bridges are often prominent. The nuclei are frequently pleomorphic, with giant nuclei and multinucleation being quite common but mitotic figures rare. The tumor cells in some lesions are characterized by extreme morphologic variation with severe cellular abnormalities, mimicking those often seen in some highly malignant neoplasms, while other cases of the calcifying epithelial odontogenic tumor are composed of very monomorphic, innocuous-appearing tumor cells. Commonly called the frog's eggs. One of the characteristic microscopic features of this tumor is the presence of a homogeneous, eosinophilic substance which has been variously interpreted as amyloid, comparable glycoprotein, basal lamina, keratin or enamel matrix. In at least some instances, this appears to form intracellularly and then is extruded into the extracellular compartment as a result of cell secretion or degeneration. This homogeneous eosinophilic material may be present in large or very limited quantities. In most cases, it stains metachromatically with crystal violet, positively with Congo red, and fluoresces under ultraviolet light with thioflavin T, all in a fashion similar to amyloid. Ultrastructural studies have shown that this amyloid-like material is composed of at least three different types of fibrils, but that they have a smaller size than the fibers of ‘conventional’ amyloid, although this term is a rapidly expanding one. Reference Shafer's textbook of oral pathology 7th ed. Chapter 5 Odontogenic cysts and tumors.

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Leisegang rings seen in birefringence - Pindborg tumour Calcifying epithelial odontogenic tumour

Leisegang rings seen in birefringence - Pindborg tumour

Calcifying Epithelial Odontogenic Tumor.So its the amyloid which gets calcified in a concentric fashion....
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Nice to learn Sir. Not seen such a rare case. Thanks for sharing..

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pindborg tumor.

Cacified odontogenic tumour.D/d juvenile ossifying fibromas.

Possibly, Multiple impacted supernumerary teeth in lower jaw.

No it is a tumour
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Thanku Sir Nice to Learn

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