Forum for Clinical and Surgical Oral Pathology

Case BBOPF 20-1

Dr. Audrey Boros (Oral Pathology Associates. Los Angeles California) would like to get your opinion on case BBOP 20-01. The case will be posted until May 15, 2020. A summary of the responses will ensue shortly after.

History

This is a 32 year old female who has had severe pain for months after a tooth extraction performed in Mexico. Palpation of soft tissues reveals slight tenderness. During biopsy, residual bone fragments were noted by the clinician.

Histology is attached showing granulomatous inflammation with foreign bodies. The challenging part is that they appear to stain with all three stains: GMS, PAS and AFB (photomics shown respectively). Controls are good. The material is not polarizable, there is no maltese cross observed. We are not sure if it is a foreign material or a microorgansim. Research has resulted in limited information on anything that stains with all three stains. Any input would be much appreciated from bbop members.

Images

Case prepared by Dr. Alfredo Aguirre (BBOP Manager) and Daniel Emmer (University at Buffalo School of Dental Medicine).