Gingival enlargements are frequently encountered in dental practice. There are different types of gingival enlargements and they vary according to the etiologic factors and pathologic processes that produce them. The exact diagnosis of the enlargement is important as some gingival enlargements can cause extensive morbidity or even mortality. Oral cancers especially squamous cell carcinomas present with variations in clinical presentation and the sites affected. A detailed medical history, clinical examination and radiographic evaluation will help identify the lesion. A biopsy will help provide a definitive diagnosis. An early diagnosis and treatment of squamous cell carcinomas is important as these tumours have a propensity for invasion of adjacent tissues and distant lymphatic metastasis which leads to a worsened prognosis. In this case report, the diagnosis and management of squamous cell carcinoma masquerading as a gingival overgrowth in the mandibular anterior region in a renal patient is reported. Dentists need to be aware and alert of the possibility of squamous cell carcinoma presenting on sites such as gingiva thereby preventing extensive morbidity and even mortality in these patients.

Introduction: Adenomatoid odontogenic tumor (AOT) is an uncommon benign odontogenic lesion with varied clinical and histological presentation. It has slow growth potential and a low recurrence rate. The tumor is mainly seen in females in the second decade of life, predominantly affecting the maxilla and associated most often with unerupted canine teeth, earning the epithet "two-thirds tumor". There are three variants: intrafollicular, extrafollicular, and peripheral. The peripheral or extra osseous type is a rare form that arises in gingival tissue. Case Presentation: This article describes a case of AOT in a 10-year-old girl who presented with gingival enlargement in relation to the maxillary left central incisor. Interestingly, intraoral periapical radiography did not show any significant findings. However, cone-beam computed tomography of the site revealed significant bone loss in the area. A surgical excision was done. Histopathological examination revealed features of AOT. Based on clinical, radiographic, and histological evidence, a diagnosis of peripheral AOT (PAOT) was made. Conclusion: PAOT is a rare disease entity in children that mimics gingival swelling, and may often be misdiagnosed by dentists. With literature still ambiguous on the origin of the tumor and biological course, it becomes imperative to examine any gingival swelling in children with a proper clinical examination, periapical radiography, and if necessary conebeam computed tomography. Excision and histopathological evaluation will help in confirming the exact disease condition.

Background. Ligneous periodontitis or destructive membranous periodontal disease is a rare condition involving gingival tissues, which is due to plasminogen deficiency and fibrin deposition. Plasminogen deficiency is an ultrarare autosomal recessive disease. The disease is characterized by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. A defect in fibrinolysis and abnormal wound healing are the main pathogenesis of this condition. It is caused by mutations in PLG, the gene coding for plasminogen, which results in decreased levels and functional activity. Case Presentation. In this case report, clinical and histopathological findings of a 26-year-old male patient who presented with generalized membranous gingival enlargement are presented. He was the third child of consanguineous parents and had multicystic congenital hydrocephalus at birth. Besides the gingival enlargement, he also presented ligneous conjunctivitis since childhood. The intraoral examination revealed generalized periodontal breakdown. Radiographs showed alveolar bone loss present in every quadrant. All blood investigations were normal except for plasminogen deficiency. A biopsy sample was excised from affected gingiva and a series of histopathological evaluation was performed. Based on clinical and histopathological evidence, a diagnosis of destructive membranous periodontal disease or ligneous periodontitis was made. A clinical exome assay for the PLG gene was also done. It was confirmed as Type 1 plasminogen deficiency. Conclusion. Ligneous periodontitis has been rarely reported in India. The reasons could be because of the rarity of the disease or missed diagnosis. The need to take a proper history and perform a proper clinical examination and histopathologic evaluation has to be stressed when diagnosing and treating gingival enlargements. If a genetic condition is suspected, genetic screening is also needed. All these will help the clinician in correctly diagnosing the disease and formulating a proper treatment plan for managing the condition.

Introduction:Plasma cell gingivitis is an uncommon benign inflammatory condition of the gingiva which is considered to arise as a hypersensitivity reaction to certain allergens. The distinguishing feature of this condition is massive infiltration of plasma cells into the subepithelial connective tissue. This case report discusses a case of plasma cell gingivitis which produced a diagnostic dilemma due to its unusual histopathologic appearance.Case Presentation: A 13-year-old female patient presented with diffuse gingival enlargement in relationship to upper anterior teeth. The case was managed successfully by gingivectomy following phase I therapy. Histopathological examination showed presence of epithelioid granulomas and foreign body giant cells along with plasma cells which is an uncommon finding in plasma cell gingivitis. Further tests conducted excluded granulomatous disease and the diagnosis was confirmed as plasma cell gingivitis. Conclusion:Plasma cell gingivitis can present a diagnostic dilemma and should be included in the differential diagnosis of patients presenting with non-specific gingival enlargements.

Diffuse idiopathic skeletal hyperostosis is a non inflammatory systemic disease affecting axial skeleton which results in ossification and calcification of spinal ligaments and entheses. The pathophysiology of the disease is poorly understood. The closest differential diagnosis for DISH remains ankylosing spondylitis. Further research is necessary to treat the disease and to improve the prognosis and quality of life of patients affected with DISH. This article reports a patient with DISH and its management in a tertiary care hospital.

Highlights Lateral periodontal cyst [LPC] is a rare developmental odontogenic cyst. It is difficult to differentiate a LPC from a cyst of endodontic origin by clinical and radiographic methods. Histopathological evaluation is the only method to confirm diagnosis. Usually seen in association of a vital tooth, but in this case it was seen in a non-vital tooth. LPC is usually seen within bone, but in this case besides Intrabony component there was a gingival presentation as a swelling.

Background. Metastatic cancers in the oral cavity are usually very rare and are usually an indication of widespread malignancy. In some cases, oral metastasis was found to be the first presentation of distant site tumours. Even though oral metastatic lesions may be found anywhere in the oral cavity, they commonly present in the posterior areas of the jaw bones. Among the soft tissues, the gingiva is the most common site. The presence of inflammation in the gingiva and the role of periodontal microbiota are suggested to play a role in the attraction of metastatic cells. The purpose of this case report is to present a rare case of metastatic breast carcinoma presenting as a gingival enlargement in the maxillary anterior region. Case Presentation. A 37-year-old female patient who underwent modified radical mastectomy for invasive ductal breast carcinoma reported to the dental clinic with a gingival enlargement in the anterior maxillary region. Clinical and radiographic examination showed a rapidly enlarging gingival lesion with destruction of the underlying bone. A wide excision of the entire lesion was done. Histopathological and immunohistochemical (IHC) evaluations were suggestive of infiltrating poorly differentiated adenocarcinoma. Conclusion. This case report presents a metastatic oral lesion in the maxillary anterior region of the primary breast cancer site. The young age of patient and an uncommon site of metastatic lesion are the striking features of this case. We would like to highlight the importance of a thorough clinical, radiological, and histological evaluation of any gingival swelling as it could be a metastatic lesion. IHC staining helps in the diagnosis of the primary site of metastatic carcinomas. An early diagnosis and intervention could reduce the morbidity of the lesion and improve the survival rate.

BACKGROUNDCranial neuropathies are frequently seen by neurologist. The causes are many and evaluation presents a unique challenge for the diagnostician. The differential diagnosis is broad and includes infections, inflammatory conditions, cavernous sinus lesions, and many life-threatening processes like neoplastic meningitis A knowledge of the anatomy of the cranial nerves and their involvement in pathologic processes is therefore one of the corner stones of neurologic diagnosis. Just as with any other neurologic presentation, the first step in the evaluation requires correct localization. Processes affecting multiple cranial nerves may involve intramedullary structures of the brainstem as well as their extramedullary course. The majority of the literature regarding aetiologies of multiple cranial neuropathies consists of case reports or small case series with very few reported large series. The largest reported series to date of multiple cranial neuropathies was that of Keane.