Background: The distinction between radicular cysts and apical GRANULOMAs is important in treatment decision.Objectives: The current study aimed to differentiate these two lesions based on radiography images.Patients and Methods: The material consisted of 138 radiographs obtained using Kodak E -speed, in patients aged 29 to 47, divided into two groups: 109 GRANULOMAs and 29 radicular cysts. Size of radiography images was measured; the tooth then was extracted and examined in pathologist lab. The results were analyzed by SPSS.15 andROCcurve was created to find cut-off point to differentiate PERIAPICAL GRANULOMA and radicular cysts.Results: Average size of radiography in PERIAPICAL GRANULOMA was 7.4mmand for a radicular cyst was 11.1 mm. Cut-off point was 8.2 mmand the area under curve (AUC) was 0.63. Also, the tests were 83% sensitive and 79% specific.Conclusions: Based on 8.2mmcut-off point could differentiate 83% PERIAPICAL GRANULOMAs and 79% radicular cysts from radiography images.

Background: PERIAPICAL lesions are induced in response to injuries to PERIAPICAL tissues, which are generally the result of infections within the root canal. Mast cells actively participate to the inflammatory infiltration of PERIAPICAL GRANULOMAs and cysts.Objectives: The aim of this study was to detect and compare the presence of mast cells in inflammatory PERIAPICAL lesions, including cysts and GRANULOMAs.Materials and Methods: In this cross-sectional study, 26 samples of inflammatory PERIAPICAL lesions (17 cysts and nine GRANULOMAs) were stained with an immunohistochemical technique using CD117 (C-KIT) antibody to detect mast cells. Then, mast cell count (the number of mast cells in 0.2 mm2) and the intensity of mast cell staining were determined by two board certified pathologists. Fisher exact test and t-test were used for statistical analysis, with P<0.05 for statistical significance.Results: Although mast cells were observed in all samples, there were more numerous in PERIAPICAL GRANULOMAs compared to PERIAPICAL cysts, with no statistically significant difference (P=0.076). The results also demonstrated that the staining in PERIAPICAL cysts and GRANULOMAs were of strong and moderate intensity, respectively, without any significant difference (P=0.411).Conclusions: According to the results of this study, it appears that mast cells are present in all the investigated inflammatory PERIAPICAL lesions and might play a role in the pathogenesis of these lesions.

Objective: PERIAPICAL GRANULOMAs (PGs) and Radicular Cysts (RCs), as the most common odontogenic lesions have yet unclear pathogenesis. This study was aimed to compare PCNA and Ki-67 expression in PGs and RCs and evaluate their possible relationship with two lesions.Methods: In this cross-sectional descriptive study, twenty PGs and twenty RCs were evaluated immunohistochemically using an anti-PCNA and anti-Ki-67 polyclonal antibodies. PCNA+ and Ki-67+ cells were counted in connective tissue wall and epithelial lining (in RCs). Statistical analysis was performed by using Mann-Whitney U test and Spearman’s rank correlation coefficient.Results: In PGs, percentage of PCNA and Ki-67 expression were found 70% and 30%, respectively; In RCs, PCNA and Ki-67 expression were observed 90% and 55%, respectively. Additionally, in RCS, Immunoexpression of PCNA (85%) and Ki-67 (60%) were detected at epithelial lining area. The positive immunoexpression of PCNA in RCs was greater than PGs (p<0.05).Conclusion Immunoexpression of PCNA and Ki-67 were detected in both lesions which may be mentioned as valuable markers for the prediction of biologic behavior of PGs and RCs.

Fish tank or swimming GRANULOMA caused by Mycobacterium marinum is an opportunist pathogen commonly found in aquatic environments. We present a 16 year-old boy with frequent exposure to aquarium water who had several nodules (sprotrichoid forms) on his right hand.Pervious studies showed that fish tank GRANULOMA is a rare skin infection (0.27 per 100,000 population in one year). However, taking proper history and considering the patient’s signs and symptoms could be helpful in diagnosis and treatment.

Introduction: PERIAPICAL diseases are the final outcome of untreated pulpitis or failure of root canal treatment, collectively referred to as PERIAPICAL lesions. Pulpitis is the final consequence of advanced dental caries or severe dental trauma, affecting the pulp. Spread of odontogenic infections into adjacent oral tissues and distinct structures by blood and lymph vessels can lead to more serious complications. Therefore, early and correct diagnosis and treatment of these lesions is necessary to prevent their potential complications. Considering the importance and high prevalence of PERIAPICAL lesions, this study was undertaken to evaluate the PERIAPICAL inflammatory lesions and spread of odontogenic infections.Review Report: In this study, studies performed from 2000 to 2013 about clinical, radiographic, and histopathologic features and treatment of PERIAPICAL lesions, and also spread of odontogenic infections were evaluated by running a search in PubMed, EBSCO, ISC and Google Scholar databases.Results: PERIAPICAL periodontitis is one of the most common odontogenic diseases; the chronic type of it or PERIAPICAL GRANULOMA is more prevalent than its acute type or PERIAPICAL abscess. Radicular cyst, the most common odontogenic cyst, is a sequela of PERIAPICAL GRANULOMA. Inflammatory lesions with an odontogenic origin can spread to the bone marrow, causing osteomyelitis. In addition, these lesions give rise to acute and serious diseases such as soft tissue abscesses and cellulitis if they are not managed on time.Early diagnosis of PERIAPICAL lesions leads to easier management, more successful treatment and better prognosis.

Background: PERIAPICAL lesions develop in response to chronic stimulation of an infected root canal in the PERIAPICAL tissue. Two of the most common PERIAPICAL inflammatory lesions are PERIAPICAL cysts and GRANULOMAs. A mast cell is a round to elliptical immune cell that originates from bone marrow stem cells and enters peripheral blood, secreting histamine, heparin, cytokines, and chemokines under the influence of triggers. The present study aimed to evaluate mast cell density in PERIAPICAL cysts and GRANULOMAs. Materials and Methods: This descriptive cross-sectional study was performed on 60 samples of PERIAPICAL inflammatory lesions, including radicular cysts and PERIAPICAL GRANULOMAs. Sections were stained with Giemsa and then the number of mast cells were counted in five random areas of the cyst and GRANULOMA walls. The results were analyzed in SPSS software (version 23) using the Mann-Whitney test. P-value<0. 05 was considered statistically significant. Results: The mean number of mast cells in the radicular cyst (6. 073±4/6) was higher than PERIAPICAL GRANULOMA (4. 627±5. 4),nonetheless, no significant correlation was found (P =0. 174). Conclusion: The presence of mast cells suggests the major role of these cells in the inflammatory mechanism of PERIAPICAL lesions. Based on the critical role of these cells in the development and spread of PERIAPICAL lesions, incorporating therapeutic and pharmaceutical approachs to alter the function of mast cell degranulation may be helpful in arresting inflammation in the early stages or preventing the spread of lesions.

Central Giant Cell GRANULOMAs (CGCGs) may manifest as radiolucencies anywhere in the mandible or maxilla. In rare cases, it can appear as a localized periradicular area and mimic an endodontic lesion. This case report presents an uncommon location of CGCG which was not accurately diagnosed nor timely treated. Periodic follow ups of PERIAPICAL radiolucencies after RCT are necessary. Dentists should include CGCG in differential diagnosis of lesions that are refractory to endodontic treatment.

Statement of the Problem: PERIAPICAL cyst and GRANULOMA are inflammatory endodontic lesions. PERIAPICAL GRANULOMA usually heals spontaneously after endodontic treatment; however, PERIAPICAL cyst mostly needs to be removed via surgical approaches. Although some clinicians believe that microscopic examination of PERIAPICAL lesions is unnecessary, it is proved that some of them has non-endodontic nature that need critical consideration. Purpose: The purpose of this study was to assess the disagreement between clinico-radiographic and microscopic diagnosis of PERIAPICAL cysts and GRANULOMAs in a major center of oral pathology service in Iran.Materials and Method: In this retrospective, descriptive cross-sectional study, the archives of the oral and maxillofacial pathology department of Shahid Beheshti University of Medical Sciences served as the source of the material during an 18-year-period for this retrospective, descriptive cross-sectional study. The reports of all patients whose initial clinical diagnosis was a PERIAPICAL cyst/GRANULOMA were extracted.Results: In the present study, 474 cases were diagnosed with a PERIAPICAL cyst/GRANULOMA clinico-radiographically, of which 61 cases (12.86%) received a microscopic diagnosis of a non-endodontic pathology. The most frequent lesion was odontogenic keratocyst (n= 12, 19.67%) followed by infected odontogenic cyst (n= 12, 19.67%). About 21.31% of diagnoses were non-cystic lesions and 4.9% were malignancies. The most odontogenic tumors that were diagnosed as PERIAPICAL cyst/GRANULOMA in clinico-radiography were the ameloblastoma variants (n= 4, 6.55%).Conclusion: A wide variety of microscopic diagnoses, including aggressive lesions such as ameloblastoma, as well as other malignant lesions was noted in this study. These misdiagnoses can lead to an inappropriate treatment plan. It is important to microscopically examine all lesions removed from the jaw.

Introduction: Radiolucent lesions are common bony lesions and can be seen in the forms of PERIAPICAL, pericoronal, interradicular and lesions not necessarily related to teeth. The purpose of this study was to determine the epidemiology of radiolucent lesions in patients who were referred to radiology department of Mashhad Dental School. Materials & Methods: In this prevalence descriptive study, panoramic radiographs of 256 patients referred to the radiology department were evaluated for one year and the frequency of their lesions were determined according to age, sex, number of lesions, site of occurrence, shape, border and effects on surrounding structures. The data were statistically analyzed using chi-square test. Results: From 51 radiolucent lesions, the PERIAPICAL GRANULOMA was the most common lesion (45.1%) followed by periodontal disease (19.6%), radicular cyst (13.7%) dentigerous cyst (3.9%), cherubism, traumatic bone cyst, squamous cell carcinoma and central giant cell GRANULOMA (2%). These lesions occurred predominantly at the second decade of life and most frequently in men. Conclusion: Three common radiolucent lesions were PERIAPICAL GRANULOMA, periodontal disease and radicular cyst. PERIAPICAL GRANULOMA occurs predominantly in mandible while periodontal disease and radicular cyst occur in maxilla more frequently.