Ameloblastoma Case Study

Ameloblastoma Case Study Introduction: Ameloblastoma is the most common odontogenic epithelial tumor of the jaw bones. [REF] It was first described by Churchill in 1881 and defined by Robinson as a tumor that is usually â€Å"unicentric, nonfunctional, intermittent in growth, anatomically benign, and clinically persistent†.[M] Although most ameloblastomas are histologically benign and lack cytological atypia, they are generally considered to be locally aggressive and destructive, exhibiting various rates of recurrence. [K] WHO describes four variants of ameloblastoma, i.e. solid multicystic- follicular, plexiform, desmoplastic and unicystic. [Ref] However, many unusual histological variants have been reported in the past that mimic the conventional ameloblastomas but present with a widely variable histological presentation. Only few cases of such histological variants though have been reported in the literature which has made it difficult to predict the clinical course and biological behaviour of these variants. He re, we report a case of verrucopapillary ameloblastoma which is a very uncommon histopathological variant of ameloblastoma. Case report: An 18 year old male patient reported with a chief complaint of swelling in the right side of the lower jaw near the body of the mandible since 3 months which was visible on extraorally. The swelling was hard in consistency and was not associated with pain, paresthesia or discharge. The loco-regional lymph nodes were not palpable. On intraoral examination, the overlying mucosa showed swelling in the right buccal vestibular region without any signs of ulceration or paresthesia. The teeth in the region showed positive response to stimulus on vitality testing. The panoramic radiograph showed a lytic lesion with well defined margins in the premolar–molar region extending distal to the mandibular right second molar. The orthopantomograph of the patient showed a radiolucent multilocular osteolytic lesion extending from the distal periradicular area of 43 till right posterior body angle region corresponding to mesial crown outline of 48 antero-posteriorly and from the alveolar crest t ill the inferior mandibular cortex supero-inferiorly. The 3D cone beam computed tomography reconstruction showed a lesion measuring 5.9cm x 3.2cm x 2.7cm in size with fine curved and linear bony septae in the centre of the osteolytic area. The lesion was expansile with perforation of the buccal and lingual cortical plates and thinning of the inferior border of the mandible. The histopathological examination of the submitted specimen showed an unencapsulated lesion with mature fibrocellular stroma with proliferating odontogenic islands. The periphery of the tumour showed cystic cavity lined by hyperkeratinizing stratified squamous epithelium of varying thickeness. The lining epithelium was thrown into multiple sharp or blunt and rounded verrucopapillary projections into the cystic lumen plugged by keratin. These projections were supported by thin connective tissue cores. Keratin was seen deposited on the surface in the form of parallel lamella and keratin flakes were also present. An unusual finding seen in our case was the presence of acantholytic cells with areas of focal necrosis on the surfa. The lining epithelium shows basal layer with columnar cells with hyperchromatic nuclei and peripheral palisading with surface keratinization and cellular vacuolization indicative of KCOT like areas. Multiple odontogenic islands with peripheral columnar odontogenic cells with hyperchromatic nuclei were present in the connectice tissue stroma. The suppoting connective tissue stroma showed epithelial islands with acanthomatous changes and microcystic degeneration. Interconnecting strands of odontogenic epithelium resembling the plexiform variant were also present. The connective tissue was densely fibrocellular with numerous dilated and engorged blood vessels. Immunohistochemical staining with Ki-67 antibody showed intense positivity in the basal and supra-basal cells with infrequent positivity in the superficial cells indicative of high proliferative potential of the les ion. Immunohistichemical staining with anti-p53 antibody showed basal and suprabasal positivity of the lining epithelium suggestive of mutation in the tumour suppressor gene. Based on the histopathologic evaluation, a diagnosis of papilliferous keratoameloblastoma was given. The lesion was removed completely with wide excision and the patient has not reported back with any recurrence two after the surgery. Discussion: Ameloblastomas are common odontogenic tumour that show diverse, yet pathognomic histopathological features. However, wide variation has been reported in the past regarding the histopathological presentation of ameloblastoma. Squamous metaplasia has been reported commonly in the acanthomatous variant of ameloblastoma where the central stellate reticulum like areas are replaced by squamoid cells. This keratinization is well documented in some lesions such as odontogenic keratocyst, acanthomatous ameloblastoma, calcifying odontogenic cyst, squamous odontogenic tumor, and squamous odontogenic carcinoma. [G] Keratin formation has also been reported in another variant of ameloblastoma termed keratoameloblastoma, which was first described by Pindborg in 1970. Another variant of keratoameloblastoma, with verrucopapillary projections into the lumen has been reported under the name papilliferous ameloblastoma. Till date, 15 cases have reported in English literature with papilliferous histologi c components in ameloblastoma. [F] The distinction between acanthomatous ameloblastoma with keratin production and keratoameloblastoma is not clear. WHO in 2005 described keratin with pearl formation in ameloblastoma under the histologic variant of acanthomatous ameloblastoma. In 1992 classification of odontogenic tumours by WHO, it was defined as ameloblastoma with extensive keratinization. [G] However, Morgan et al have described ameloblastoma with unequivocal keratinization occurring in the centre of the epithelial follicles at the expense of the stellate reticulum-like areas as a keratoameloblastoma. Norval et al suggested that keratoameloblastoma should be considered a variant of acanthomatous ameloblastoma.[F] However, one criteria to distinguish acanthomatous ameloblastoma form keratoameloblastoma is the presence of keratin in the connective tissue stroma as compared to acanthomatous ameloblastoma which has keratin only in the areas showing sqauamous metaplasia in the centre of odontogenic islands and follicle. [H, cross ref 7] The present case in a male patient in the right mandibular body region is similar in presentation as compared to previously reported cases except the age of the patient which is comparatively younger (second decade) as compared to mean age of presentation of KA with papilliferous proliferation which occur at a relatively older age (mean age of occurrence in sixth decade). The right side of the mandible is commonly involved as compared to the left (2:1) with most cases reported in the posterior body-ramus region. [H] Our case differs from the previous cases in showing multiple papilliferous projections with acantholytic cells with necrotic and hemorrhagic material in the lumen and dilated, congested blood vessels. The lesion also showed multiple solid islands of odontogenic epithelium with hyperchromatic nuclei in the connective tissue stroma.[H] Whitt et al have described 4 variants of ameloblastoma showing keratin formation (Table 1). Corio et al.20 have described a keratinizing ameloblastic carcinoma showing the typical histologic features of malignancy in their series of ameloblastic carcinomas, which included pleomorphism, increased nuclear/cytoplastic ratio, nuclear hyperchromatism, increased numbers of mitotic figures, abnormal mitotic figures, and necrosis. Our case fulfils the criteria of papilliferous type of KA. The present case exhibited an elevated level of mitotic activity, altered p53 profile and proliferation index (Ki-67). It can be inferred that the lesion is comparatively more aggressive locally as compared to conventional ameloblastoma, and should be excised extensively to avoid local recurrence. [F] However, it is still unclear how the production of keratin in histopathologic variants of ameloblastoma affects the biological behaviour and prognosis of such lesions. The probable reason could be attributed to less number of reported cases with follow up of such variant to comment definitively on its behaviour. [G] Conclusion: Papilliferous keratoameloblastomas refers to a variant of ameloblastoma that is rarely reported and its biological behaviour is poorly understood. The present case shows higher proliferative activity in the basal and suprabasal cells of the tumour providing an indication of its local aggressiveness as compared to the conventional ameloblastomas. Presently, such lesions are treated in a manner similar to conventional ameloblastomas, though it lacks any authoritative evidence. Report of more such cases with longer follow up duration and molecular profiling is required in the future to completely understand the spectrum of clinical and histological features, biological behaviour and prognosis of such cases. Table 1 : Types Of Keratoameloblastoma Based On Histopathological Features(Whitt et al) Histological type Features Papilliferous histology Odontogenic epithelium is in papillary projections into the cystic spaces Simple histology Epithelial follicles filled with parakeratin or orthokeratin and lined by ameloblast like cells with reversal of polarity Simple histology with odontogenic keratocyst (OKC)-like features Features of conventional odontogenic keratocyst in addition to simple type Complex histology Epithelial follicles packed with parakeratin or orthokeratin, extrusion of keratin masses into connective tissue stroma in the form of pacinian like stacks with or without foreign body reaction; also there may be hard tissue formation resembling cementum and woven bone

Ethics of Online Air Ticket Reservations Systems Essay

Ethical issue is the belief in right or wrong with a particular area or system. In any organization ethical issue should be followed for the achievement of business objectives. Precision air reservation system, ethical issues are being considered for the achievement of company goal. The following are ethical issues relating to airline reservation system Security; Information’s which are being provided by users should be secure. The system will ensure the safety of customers. All transaction activities will be secured. Nobody will be able to gain access to see bank accounts and other relevant information’s. Privacy issue; Personal information should not be sold to third parties (other people apart from administrator and end-user) for their benefit. All booking information collected in the booking form, payment form should be kept confidential according to how privacy policy of the system claims. Equality of Access in the system; All people are allowed to use the system anytime they want for booking purpose only. Security; by providing the best and stable system to make customer’s information secure from unauthorized people to gain it. Through creation of administrator account who will be the only person who has access to view this kind of information in the system. This will make system secure especially for transaction. Privacy policy; through providing privacy policy page in the system, Customers will be aware of how their information are being used in an organization. And make sure that customer’s information is not released to other organization without customers consent. Equality of accessing system and performing regular functions such as book for flight, viewing schedule etc. anybody can be able to view the system and make book for flight. Equality will be for only unregistered members. Registered member will be given priority and offers.

Parenting Skills Essay

Review Questions 1. What are the differences between being a biological parent, an adoptive parent, and a foster parent? A biological parent are your real blood parents, an adoptive parent is your parent till you’re 18, and a foster home basically is somewhere to stay and home family till you get adopted not really a permanent situation. 2. What financial needs are parents obligated to provide and which are optional? Up to the age of 18 (unless they move out before) Then clothes, school, food, place to live ,utility bills etc, some kids have activities which would be provided by giving pocket money, educational toys and books, toiletries. Christmas presents are optional but cover fun toys etc after 18 I would hope she will have a job and can contribute towards bills etc. 3. What other needs might a child have that a parent is expected to provide? Toys for them to play with, love, support, food and a safe place to grow up in. 4. What are the qualities of a nurturing parent? A nurturing parent w ould never give up on their child and go throw everything with them. Would do anything for them even in the worst situation. Critical Thinking Questions 1. What qualities make a person a good parent? A bad parent? A good parent would be there for their child and do whats best for them. A bad parent wouldn’t show any love or care. 2. Which parental responsibilities do you think would be the most challenging? Why? I think letting go over your child and letting them go off on their own, because you will think they’re not safe or okay without you. 3. Which parental responsibilities do you think would be the most interesting to you? Why? I guess getting them their first pet. I love animals and when I do have kids one day I would love to teach them how to take care of the pet. 4. What are some things that people can do to prepare for parenthood? Nothing, because you wont know what to expect until it happens.

The Lesson by Toni Cade Bambara Essay - 1319 Words

Toni Cade Bambara addresses how knowledge is the means by which one can escape out of poverty in her story The Lesson. In her story she identifies with race, economic inequality, and literary epiphany during the early 1970’s. In this story children of African American progeny come face to face with their own poverty and reality. This realism of society’s social standard was made known to them on a sunny afternoon field trip to a toy store on Fifth Avenue. Through the use of an African American protagonist Miss Moore and antagonist Sylvia who later becomes the sub protagonist and White society the antagonist â€Å"the lesson† was ironically taught. Sylvia belong to a lower economic class, which affects her views of herself within highlights the†¦show more content†¦Also, the people who have influence on color people, that they are not qualify for higher education and good salary. As Martin Luther King Jr. said â€Å"Make a career of humanity. Commit your self to the noble struggle for equal rights. You will make a better person of yourself, a greater nation of your country, and a finer world to live in† ( ). Sylvia struggle in the communities makes her to be better person with the understand classism and the race. Also, makes her to fight for what she deserve. Also, to have high income and equal right she have to have higher education. Then she might will be able to change the view of classism and race in the communities. The economic issues in American society have major effect on young on young children basic needs. Young children do not understand the economic issues their families facing in today’s society. In the short story â€Å"The Lesson† the author addresses the reader regarding social and economic inequality in America. In America lower family are suffering the most because of their monthly income and cannot afford things their children’s wants. Therefore, lower family cannot afford the expens ive materials for their children because they have to think about their daily life styles. Also these lower families had difficult times affording clothing, food, house rents and other essentials. According to the article, â€Å"Children are especially vulnerable economicallyShow MoreRelatedThe Lesson By Toni Cade Bambara992 Words   |  4 PagesThe Lesson: Summary/Response In the story The Lesson, author Toni Cade Bambara shows us a view of life from a black girl who lives in a poverty-stricken community just outside of New York City. In the story, there is a teacher whom takes the responsibility of teaching Sylvia and her friend group important lessons not only for a better education but to better understand life in its entirety. I believe the story is used as a tool to teach others about the lack of education in our nation in the seventiesRead MoreThe Lesson By Toni Cade Bambara1552 Words   |  7 PagesThroughout the years knowledge and culture has been passed down within generations. Elders within the community often teach life lessons to the young adults growing up in the neighborhood. This idea still holds true today, especially in low-income communities. People from different socioeconomic backgrounds live different lifestyles they also have different opportunities made available to them. Because of this idea, people with a higher social stand ing have an advantage over those in lower classRead Morethe Lesson by Toni Cade Bambara1428 Words   |  6 Pagesâ€Å"The Lesson† From The Mentor Whenever there is a civil rights movement going on, there are always 3 parties involved. One the Oppressor, second the Oppressed and lastly the Activist or the Mentor. The Activists usually always emerges from the Oppressed. That is when the Oppressed intellectuals feel that it’s time to standup to defend the identity of their people and make them strong enough to make a name of their own. This is what happened during the early 20th century within the African AmericanRead MoreThe Lesson By Toni Cade Bambara968 Words   |  4 PagesThere is a lesson in every situation no matter if you choose to accept it or not. A lesson can sometime guide you in the right path that is needed in your life or maybe it can just be for a certain situation. In the short story â€Å"The Lesson† by Toni Cade Bambara, she relates teaching a life changing lesson to the character Sylvia. Sylvia is a very strong willed young lady who is challenged with poverty in her neighborhood. The story begins with Miss Moore, an educated black woman who moves in theRead MoreThe Lesson By Toni Cade Bambara1429 Words   |  6 PagesUpon reading The Lesson, by Toni Cade Bambara, the reader cannot help but feel empathy towards the narrator Sylvia and her friends, as they are introduced to the realization of unfairness distribution of wealth in society, the diverse democracy. The lesson is taught by a lady named, Miss Moore, who moves into Sylvia’s neighborhood block. Miss Moore is a college educated women who shows the reality of the economic inequality to Sylvia and her friends by taking them on a field trip to a fancy toy storeRead MoreThe Lesson By Toni Cade Bambara850 Words   |  4 Pagesideas into the readers’ minds. Readers often begin reading a work with a biased opinion of the contents of the story. The superficial theme of a story is obvious, but the less obvious theme can have the most powerful message. In Toni Cade Bambara’s short story, â€Å"The Lesson,† the apparent t heme is poverty and wealth, but the true theme is the misapprehension of everything not being as it seems. The first physical description of Miss Moore gives the reader the impression that she is a woman of littleRead MoreThe Lesson by Toni Cade Bambara638 Words   |  3 Pagesthe hardest because the kids just want to play, goof around and don’t listen. Elementary teachers have hard time teaching young uneducated students just like Miss Moore with her uneducated children from the neighborhood, in the story â€Å"The Lesson† by Toni Cade Bambara. Miss Moore teaches the students how to take the first step toward a better education just like elementary teachers, her teaching method were to show how the upper class lived in comparison to the children but she could have though themRead MoreThe Lesson, By Toni Cade Bambara881 Words   |  4 Pagesthe story ‘The Lesson’, Sylvia and her friends’ receives a chance to take a look at the upper side of town and compare how the two communities differ from each other. The author uses social conflict to explain the r acial and social divide between the white and black community. In the story, the reader sees how social classes effect how adults and even children see the world. The author, Toni Cade Bambara, compares how blacks and whites live these times. In the story, â€Å"The Lesson†, a woman by theRead MoreThe Lesson By Toni Cade Bambara1346 Words   |  6 Pagesâ€Å"The Lesson† by Toni Cade Bambara is not just about a sassy, defiant, ungrateful poor girl that is out of place in an overpriced expensive toy store. â€Å"The Lesson† is a short story about a young black girl who is struggling with her increasing awareness of class inequality. When Sylvia’s new neighbor, Miss. Moore, a smart college educated woman introduces the reality of social inequality to Sylvia and her group of friends, they become cynical. Sylvia has always known in the back of her mind that sheRead MoreThe Lesson by Toni Cade Bambara1830 Words   |  8 PagesThe Lesson by Toni Cade Bambara is a short story set in the inner part of New York City that gives the reader an opportunity to briefly see into the lives of children living devoid of wealth and education. It takes place in the early seventies, following the civil rights move ment and during a time when the imbalance of wealth in terms of race was immense. Bamabara, through the use of narrative point of tone, symbols, setting and characterization, brings out and develops what I believe to be the