Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

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Dr Saumya Navit
Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2010 | Month : April | Volume : 4 | Issue : 2 | Page : 2226 - 2236 Full Version

Mast Cells in Odontogenic Cysts


Published: April 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.674
SHYLAJA S

Department of Oral & Maxillofacial Pathology SVS Institute of Dental Sciences Mahabubnagar,Andhra-Pradesh (INDIA).

Correspondence Address :
Dr. Sanjeevareddigari Shylaja
MIG-276, 4th road, KPHB Colony, Kukatpally, Hyderabad-500072(INDIA)
Phone No. - 09441023999
Email id: eshwardental@rediffmail.com

Abstract

Background: Cysts of the jaws are probably the most common destructive bone lesions in the human maxillofacial skeleton. Odontogenic cysts are derived from the epithelium which is associated with the development of the dental apparatus and can be either developmental or inflammatory in origin. The most common odontogenic cysts are radicular cysts, dentigerous cysts and odontogenic keratocysts. However, the cysts of developmental origin may show inflammatory changes secondary to infection. Mast cell degranulation plays an important role in the inflammatory response and it is speculated that alteration in their number and distribution could contribute to the pathogenesis of odontogenic cysts. So, an attempt was made to evaluate the significance and distribution of mast cells in radicular cyst, odontogenic keratocyst and dentigerous cyst using toluidine blue staining.
Materials and Methods: This retrospective study was undertaken by retrieving the records and the paraffin blocks of 40 confirmed cases of odontogenic cysts, out of which 19 were Radicular cysts, 12 were odontogenic keratocysts and 9 were dentigerous cysts.
Sections of 5µm thickness were prepared and stained with haematoxylin and eosin, as well as with toluidine blue. The toluidine blue stained mast cells were then counted under a high power microscopic field (40X) for each specimen in three different zones and the mean value obtained. The mean number of mast cells was then compared between different zones by using the Relative Deviate ‘Z’ test.
Results: In cases of radicular cyst, the highest mean number of mast cells per high power field was seen in the age group of 10-19 years. A statistically significant difference (p<0.05) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones. In cases of odontogenic keratocyst, the highest mean number of mast cells per high power field was seen in the age group of 20-29 years. A statistically significant difference (p<0.01) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones, as well as between the sub-epithelial and the intermediate zones. In cases of dentigerous cyst, the highest mean number of mast cells per high power field was seen in the age group of 10-19 years. A statistically significant difference (p<0.05) amongst the distribution of mast cells was noted between the sub-epithelial and the deep zones.
Conclusion: In the present study, the maximum number of mast cells were noted in the sub-epithelial zone as compared to other zones. The number of mast cells were seen to decrease with age and there was no gender predilection. However, further studies using immunohistochemical techniques may help in the better understanding of the pathogenesis of these cysts.

Keywords

Mast cells, Odontogenic cysts, Radicular Cyst, Odontogenic Keratocyst, Dentigerous cyst, Toluidine blue.

Introduction
Cysts of the jaws are probably the most common destructive bone lesions in the human maxillofacial skeleton. The head and neck region and the jaw in particular, collectively comprise one of the most common sites for the occurrence of cysts (1).
Odontogenic cysts are derived from the epithelium which is associated with the development of the dental apparatus. They are either of developmental origin or may result from inflammation. The most common odontogenic cysts are radicular cysts, odontogenic keratocysts and dentigerous cysts (2).
Cystic expansion is influenced by a number of factors like mural growth, hydrostatic enlargement and bone resorbing factor. The hydrostatic pressure of the luminal fluid is important in cyst enlargement and mast cell activity might contribute to this by increasing the osmotic pressure of the fluid (3).

Mast cells have been the object of investigation for almost a century, but still remains an enigma in terms of their function in situ. They have often puzzled investigators from the time that they were first identified and were named by Ehrlich in 1887 (4).

Mast cells are present in mucosal and connective tissue environments. They possess cytoplasmic granules that stain meta-chromatically under ordinary conditions (5). Degranulations of mast cells play an important role in the initiation of the inflammatory response. This action is significant in the pathogenesis of different lesions like lichen planus, early periodontal diseases, ulcerative colitis, pulmonary fibrosis, inflammatory bowel, systemic mastocytosis and odontogenic cysts (6).

Mast cells are recognized in non-keratinizing and keratinizing odontogenic cysts. Alteration in their number and distribution could contribute to the pathogenesis of odontogenic cysts (3). The special stains used for mast cell staining are toluidine blue, azur A, bismark brown, thionin and alcian blue (7).

Mast cells might play a role in the pathogenesis of odontogenic cysts. So, an attempt was made to evaluate the significance and distribution of mast cells in radicular cysts, odontogenic keratocysts and dentigerous cysts by using toluidine blue staining.

Aims and Objectives
To study the presence and the number of mast cells in radicular cysts, odontogenic keratocysts and dentigerous cysts. To evaluate the distribution of mast cells in the subepithelial, intermediate and deep zones. To correlate the number of mast cells and their distribution with age, sex and the different zones which were considered.

Material and Methods

This retrospective study was undertaken by retrieving the records and the paraffin blocks of confirmed cases of odontogenic cysts. The paraffin blocks were sectioned and stained with haematoxylin and eosin and toluidine blue. A total of 40 cases were included in this study, out of which 19 were radicular cysts, 12 were odontogenic keratocysts and 9 were dentigerous cysts.

Mast cell count was done in sections which were stained with toluidine blue. Four areas were randomly selected under a high power field (40x) for each specimen. The area encompassed by one high power field (HPF) was taken as one microscopic field (MF). In each area, three zones were considered. The subepithelial zone was the area just below the epithelium and the next two consecutive microscopic fields were the intermediate and the deep zones.

Statistical Analysis
The number of mast cells per microscopic field for individual cyst was calculated at the three zones and the means (±S.D) for each type of cyst were taken. The mean number of mast cells were compared between the different zones by using the Relative Deviate ‘Z’ test.

Results

Results and Observations
Out of the total 40 cases, 30 were males and 10 were females.

Age
In radicular cysts, the age ranged from 7 to 48 years. The maximum number of cases were in the age group of 10 to 19 years (8 cases). In odontogenic keratocysts, the age ranged from 15 to 58 years. The maximum number of cases were in the age group of 20 to 29 years (10 cases). In dentigerous cysts, the age ranged from 11 to 45 years. The maximum number of cases were in the age group of 10 to 19 years (4 cases) (Table/Fig 1).

Sex
Out of 19 cases of radicular cysts, 12 (63.2%) were males and 7 (36.8%) were females, with a male to female ratio of 1.7:1. Out of 12 cases of odontogenic keratocysts, 10 (83.3%) were males and 2 (16.7%) were females, with a male to female ratio of 5:1. Out of 9 cases of dentigerous cysts, 8 (88.9%) were males and 1 (11.1%) was a female, with a male to female ratio of 8:1 (Table/Fig 1).

Mast Cell Distribution
Age Wise Distribution of Mast Cells

In radicular cysts, the mean number of mast cells per HPF was high in the age group of 10 to 19 years [Table / Fig 2] (Table 2). In odontogenic keratocysts, the mean number of mast cells per HPF was high in the age group of 20 to 29 years (Table/Fig 2) (Table 3). In dentigerous cysts, the mean number of mast cells per HPF was high in the age group of 10 to 19 years [Table / Fig 2] (Table 4).

Sex Wise Distribution of Mast Cells
In all the three cysts, statistically significant differences was not noted in the distribution of mast cells between males and females (Table/Fig 3) (Table 5), (Table 6), (Table 7).

Zone Wise Distribution of Mast Cells
In radicular cysts, the mean number of mast cells per HPF was high in the subepithelial zone as compared to the intermediate and deep zones. A statistically significant difference (P<0.05) was noted between the subepithelial and the intermediate zones (Table/Fig 4)(Table 8).

In odontogenic keratocysts, the mean number of mast cells per HPF was high in the subepithelial zone as compared to the intermediate and the deep zones. A statistically significant difference (P<0.01) was noted between the subepithelial and the intermediate zones and between the subepithelial and the deep zones (Table/Fig 4)(Table 9).

In dentigerous cysts, the mean number of mast cells per HPF was high in the subepithelial zone as compared to the intermediate and the deep zones. A statistically significant difference (P<0.05) was noted between the subepithelial and the deep zones (Table/Fig 4)(Table10).

Comparison of Mast Cells between Odontogenic Cysts
Statistically significant differences was not noted in the distribution of the mast cells between the cysts when the zones are compared (Table/Fig 4) (Table 11),(Table/Fig 5) (Fig12), (Fig13), (Fig 14), (Fig15), (Fig16), (Fig 17).

Discussion

Mast cells are the normal members of the cell population in fibrillar connective tissue. For three quarters of a century, mast cells were biological curiosities. Few people knew anything about them, their contents and functions, though occasionally, few investigators made some studies without any conclusive results. In recent years, mast cells have received increasing attention and a number of investigations and reviews have appeared in the literature. With the advent of new techniques, various attempts have been made to study the response of these cells in physiological and different pathological conditions (8).

The mast cells in Hand E stained sections showed predominantly abundant basophilic granules and with toluidine blue, the mast cells stained red-purple (metachromatic staining) and the rest of the section stained blue. Mast cells can be confused with basophils. The functional and the biochemical characteristics of both the cells are much identical. A distinction between mast cells and basophils can be made upon morphology, natural history, and by the expression of cell surface structures. Other cells that have been confused with mast cells include immature eosinophils or eosinophilic melanocytes and macrophages (14).

Mast cells might play a role in the pathogenesis of odontogenic cysts (9). They contribute to cyst enlargement by increasing the osmotic pressure of the fluid at least in three ways 1) by direct release of heparin into the luminal fluid, 2) by release of hydrolytic enzymes which could degrade capsular extracellular matrix components, thereby facilitating their passage into the fluid and by the action of histamine on smooth muscle contraction and vascular permeability, thus encouraging the transudation of serum proteins (10). Degranulation of mast cells has been implicated in the generation of prostaglandins, which would promote bone resorption and remodeling to accommodate the growing cyst (11). Because of their possible importance in the pathogenesis of odontogenic cysts, an attempt was made to evaluate the presence and distribution of mast cells in the connective tissue and to correlate this data with age, sex, and the different zones considered.

When the age groups were compared in all the three cysts, the mean number of mast cells per HPF showed progressive decrease with age.

Although there are no studies mentioning the correlation between mast cell count and age in odontogenic cysts, in general, it was noted that mast cell count decreases in the connective tissue with age, as noted by some authors. Matsson L (1993) (12) and Sjolin K.E (1946) (13) showed that in man, there was a decrease in the number of dermal mast cells with increasing age from childhood to adults. Wolf J.E et al. (1973) (14) noted a decrease in the number of mast cells with age in germfree rats in the connective tissue of mandibular alveolar mucosa and bone marrow. This decrease in the number of mast cells with age could be due to increasing degranulation which is noted in older age (14). Abdel et al. (1976) (15) reported an increase in the human dermal mast cells from 5 to 15 years of age, followed by a gradual decrease.

Matsson L. (1993) (12) noted a decrease in the number of mast cells from juvenile to adult rats in the tongue, buccal mucosa and gingival mucosa. The high number of mast cells in various oral sites of juvenile rats suggested that the oral mucosa of growing animals have a higher readiness for reaction, where mast cells take an active part than that of adults.

It is a pure conjecture, whether the reduced number of mast cells with increasing age in all the three odontogenic cysts is a result of the normal aging process or whether it is related to the pathogenesis of these cysts. So, further studies have to be carried out to know whether it is related to age or whether some other factors are responsible. Mast cell count varies between species. Therefore, studies of possible age variation in the mast cell population in the oral mucosa of man are needed.

In the present study, no statistically significant difference was noted in the mast cell count between the sexes in all the three odontogenic cysts. Coleman E.J (1974) (16) noted no statistical difference in the mast cell count between males and females in hamster gingiva.

In the present study, the number of mast cells was more in the subepithelial zone as compared to the intermediate and deep zones in all the three odontogenic cysts. The difference in the distribution of mast cells between the subepithelial and deep zones was statistically significant (P<0.05) in all the three odontogenic cysts. In odontogenic keratocysts, a statistically significant difference (P<0.01) was noted in the subepithelial and the intermediate zones. This is compatible with that the reports of Smith G. et al.(1989) (9) who also noted a statistically significant difference (P< 0.05) between the subepithelial and the deep zones of all the three odontogenic cysts and also between the subepithelial and the intermediate zones in case of odontogenic keratocysts.

The subepithelial collection of mast cells in odontogenic cysts could be attributed to the chemotactic stimulus to mast cells, attracting them to the epithelial lining or luminal fluid contents. The nature of such stimulus is unclear, but the secretory matrix proteins of the normal odontogenic epithelium have been reported to be chemotactic to mast cells. Although odontogenic cysts are not known to secrete enamel matrix proteins, the epithelial lining stains positively for keratins and has been shown to share common antigenic determinants with enamel matrix proteins (9).

Smith G. et al. (1988) (3), in their histochemical studies on glycosaminoglycans of odontogenic cysts, observed a subepithelial band of alcian blue staining and this appeared to be due to the presence of heparin, which could have been released by the degranulation of mast cells beneath the epithelium to produce this staining pattern.

In the present study, a statistically significant difference was not noted between other zones like the subepithelial and the intermediate zones, and between the intermediate and the deep zones, except for odontogenic keratocysts which showed a statistically significant difference (P<0.01) between the subepithelial and the intermediate zones. This is in contrast to the reports by Smith G. et al. (1989) (9) who noted a significant difference (P<0.05) between the above mentioned zones.

Smith G. et al. (1989) (9) also noted a statistically significant difference (P<0.03) in the subepithelial zones of radicular cysts and odontogenic keratocysts, which was not observed in the present study.

These differences could be attributed to the specificity of the avidian-peroxidase staining as compared to the toluidine blue staining. They found that the avidin peroxidase stain was specific for mast cells and the differentiation of the mast cells from other tissue elements was good, because there was no staining on other cells of the inflammatory infiltrate or the connective extracellular matrix. Toluidine blue was not found to be effective due to poor metachromasia, probably arising from acid decalcification of the tissue.

Several reasons may account for the difficulty to compare the data of different studies, like size of the sample, type of tissue examined, the method of fixation, the type of staining used, the morphological criteria of the mast cells considered by the investigator, the method used for counting the cells, the number of cells examined per biopsy, or maybe the investigated tissue area was too small to reduce the possible error caused by the inhomogeneity of cellular distribution (17), (18).

Schwartz J. and Dibble M. (1975) (19) and Teronen O. et al. (1996) (20) observed that toluidine blue, the routinely used special stain for mast cells, does not stain degranulated mast cells (phantom cells). This might lead to variations in the number of mast cells observed in the different zones.

Degranulated mast cells can be detected by immunohistochemical staining by using monoclonal antihuman tryptase antibodies and Western blotting by using specific antihuman mast cell tryptase antiserum (20).

Teronen O (1996) (20) noted that the density of intact mast cells decreased outwards from the cyst lumen. Degranulated mast cells were highest at the periphery of the cysts, at their border with bones, indicating higher activity of mast cells in this area. This was observed using immunohistochemical staining of mast cell tryptase.

Bischoff S.C.et al. (1996) (17) observed a difference in the number of mast cells in toluidine blue stained sections and by the immunohistochemical staining of mast cells by using monoclonal antibodies against the human mast cell proteases, tryptase and chymase. They found a decreased number of mast cells in toulidine blue stained sections. The obvious reason for this discrepancy is that only a few of the activated mast cells are detectable in toluidine blue stained sections. Maximal degranulated and resting mast cells can be stained immunohistochemically.

Joseph S. et al. (2003) in their study comparing toluidine blue and thionin noted that toluidine blue showed more intact mast cells as compared to thionine. Hence, Carnoy’s fixative toluidine blue is a better stain as compared to thionin (21).

Before any definitive conclusion can be reached, additional research must be conducted at histochemical levels. Such research should make use of specific histochemical labeling techniques so that the products of expelled granules may be identified in the connective tissue and so that the decrease in the mast cell counts may be correlated to the increased concentration of the degranulation products.

Standardization of the conventional methods, strict requirement for mast cell identification, immunohistochemical staining of mast cells using antibodies raised against granule proteases, and Western blotting with specific antihuman mast cell tryptase on jaw cyst extract samples may throw more light on the role of mast cells in the pathogenesis of cysts.

Mast cell plays a contributory role in the pathogenesis of odontogenic cysts which are often treated by surgical enucleation. In extreme cases where surgical intervention is not possible, one might speculate the role of the inhibitors of mast cells or that of mast cell tryptase. In future, studies which examine the influence of mast cell antagonists on cyst pathogenesis may completely unravel the role of mast cells.

Conclusion

In the present study, more number of mast cells was noted in the subepithelial zone as compared to the intermediate and the deep zones. The number of mast cells decreased with age. No gender dependence on mast cell count was noted.

Further studies using immunohistochemical techniques of mast cells and the influence of mast cell antagonists on cyst pathogenesis may help unravel the role of mast cells in the pathogenesis of odontogenic cysts.

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