Restor Dent Endod.  2022 Feb;47(1):e12. 10.5395/rde.2022.47.e12.

Interplay of collagen and mast cells in periapical granulomas and periapical cysts: a comparative polarizing microscopic and immunohistochemical study

• Bansal D
• Kamboj M
• Narwal A
• Devi A
• Marwah N

• KMID: 2548107
• DOI: http://doi.org/10.5395/rde.2022.47.e12

Abstract

Objectives
This pilot study aimed to establish the interrelationship between collagen and mast cells in periapical granulomas and periapical cysts.
Materials and Methods
An observational cross-sectional study was conducted on the paraffin-embedded tissue sections of 68 specimens (34 periapical granulomas and 34 periapical cysts). The specimens were stained with picrosirius to observe collagen fiber birefringence and anti-tryptase antibody to evaluate the mast cell count immunohistochemically. The mean number and birefringence of collagen fibers, as well as the mean number of mast cells (total, granulated, and degranulated), and the mean inflammatory cell density were calculated. The data obtained were analyzed using the Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test (p < 0.05).
Results
The mean number of thick collagen fibers was higher in periapical cysts, while that of thin fibers was higher in granulomas (p = 0.00). Cysts emitted orange-yellow to red birefringence, whereas periapical granulomas had predominantly green fibers (p = 0.00). The mean inflammatory cell density was comparable in all groups (p = 0.129). The number of total, degranulated, and granulated mast cells exhibited significant results (p = 0.00) in both groups. Thick cyst fibers showed significant inverse correlations with inflammation and degranulated mast cells (p = 0.041, 0.04 respectively).
Conclusions
Mast cells and inflammatory cells influenced the nature of collagen fiber formation and its birefringence. This finding may assist in the prediction of the nature, pathogenesis, and biological behavior of periapical lesions.

Keyword

Collagen birefringence; Mast cells; Periapical cyst; Periapical granuloma; Tryptase

Figure

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  Figure 1 (A, B) A selected periapical granuloma; a periapical radiograph shows a well-defined radiolucency located over the root apex of the right maxillary central incisor (red arrow), and histological sections reveal fibro-cellular connective tissue stroma infiltrated by inflammatory cells and abundant foamy macrophages (H&E ×40). (C, D) A selected periapical cyst; a periapical radiograph shows a well-defined radiolucency, located over the root apex of the right maxillary lateral incisor (red arrow), and histological sections reveal stratified squamous, nonkeratinized epithelial lining with an arcading pattern and underlying fibro-collagenous connective tissue capsule with inflammatory cell infiltrate (H&E ×40).H&E, hematoxylin and eosin.

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  Figure 2 Photomicrographs of 3 cases showing predominant green birefringence of collagen fibers in periapical granulomas (A-C); case 1A shows predominantly green birefringence, case 2B depicts immature and thin fibers, and case 3C depicts greenish-yellow birefringence and immature fibers of a periapical granuloma. Predominantly red birefringence of collagen fibers in periapical cysts (D-F). Case 1D shows the ‘basket weave’ pattern associated with a periapical cyst, case 2E shows predominant orangish-red birefringence, and case 3F depicts the mature pattern formation associated with a periapical cyst. The sections were stained with picrosirius-red stain and analyzed under polarized light (×400).

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  Figure 3 Photomicrographs of 3 cases of periapical granulomas (A-C); case 1A shows immunoexpression of tryptase positive mast cells (×40), case 2B depicts hot spots for the evaluation of mast cells (×100), and case 3C shows granulated (green arrow) and degranulated (red arrow) mast cells in fibro-cellular connective tissue stroma (×400). Photomicrographs (D-F) depicting 3 cases of periapical cysts; case 1D reveals immunoexpression of tryptase-positive mast cells (×40), case 2E shows hot spots for the evaluation of mast cells (×100), and case 3F depicts granulated (green arrow) and degranulated (red arrow) mast cells in fibro-cellular connective tissue stroma (×400).

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