title: Atypical Lymphocytes and Cellular Cannibalism: A Phenomenon, First of its Kind to be Discovered in Chronic Periapical Lesions.
abstract: BACKGROUND
  Lymphocytes are often termed to be isomorphic, having a monotonous light microscopic appearance. Morphological aspects of lymphocytes in tissue sections thereby are not routinely taken notice of as their morphology seems to vary only in case of lymphoid malignancies, hematological malignancies apart from certain viral infections. Atypical lymphocytes are the lymphocytes with unusual shape, size or overall structure. These are more commonly known as reactive lymphocytes. The unusual histomorphological feature of these cells include larger size than normal lymphocytes; in some cells the size exceeds even 30 microns. The large size is the result of antigenic stimulation of the cell. Alongwith these, the other rare feature which is recently coming under light is "Cellular Cannibalism" which is defined as a large cell enclosing a slightly smaller one within its cytoplasm. Previously, this feature was noted only in cases of malignant tumors.
  
  
  OBJECTIVE
  The objectives of this study were to determine the proportion of atypical lymphocytes in chronic periapical granulomas and cysts; to determine the proportionate cellular cannibalism in these periapical lesions.
  
  
  METHODS
  This was a descriptive, observational study conducted in the Department of Oral Medicine and Radiology and Oral Pathology and Microbiology. Haematoxylin and eosin stained 30 slides of chronic periapical granulomas and 20 slides of cysts reported in the year 2014-15 and the clinical proformas of the patients were retrieved from the files of the Department of Oral Medicine and Radiology and Oral Pathology and Microbiology. These slides were evaluated by 3 experts from the specialization of Oral Pathology and Microbiology to determine the presence of atypical lymphocytes and cellular cannibalism under high power magnification (400X).
  
  
  RESULTS
  Out of the 30 slides of chronic periapical granulomas, about 12 slides (40%) revealed presence of atypical lymphocytes. In case of slides of chronic periapical cysts, however, only 4 out of the 20 slides (20%) examined histopathologically showed presence of atypical lymphocytes. An interesting feature of cellular cannibalism was noted in tissues with atypical cells. Cannibalistic cells were present in 12 out of the 30 slides of chronic periapical granulomas (40%). None of the cysts, however, revealed cannibalistic cells (0%).
  
  
  CONCLUSIONS
  In the present study, we have quoted our observations on the unique cellular composition that was seen in histopathological sections of chronic periapical lesions. As also it was noted that those cases in which atypical cells & cellular cannibalism was evident the lesion clinically showed size more than 5cm. The question arises that whether presence of atypical cells from the tissue sections in these lesions denotes an aggressive clinical behavior and should be given a due consideration in deciding the treatment protocols for such cases to provide an optimum patient care.
authors.affiliation: Senior Lecturer, Department of Oral and Maxillofacial Pathology and Microbiology, V.Y.W.S Dental College & Hospital , Amravati, Maharashtra, India .
authors.forename: Ketki P
authors.initials: KP
authors.lastname: Kalele
authors.affiliation: Consultant, Periodontics and Oral Implantology , Pune, Maharashtra, India .
authors.forename: Kaustubh P
authors.initials: KP
authors.lastname: Patil
authors.affiliation: Senior Lecturer, Department of Oral Medicine and Radiology, Saraswati-Dhanwantari Dental College & Hospital & Post-Graduate Research Institute , Parbhani, Maharashtra, India .
authors.forename: Abhishek Singh
authors.initials: AS
authors.lastname: Nayyar
authors.affiliation: Senior Lecturer, Department of Prosthodontics, Terna Dental College & Hospital , Nerul, Navi Mumbai, Maharashtra, India .
authors.forename: Rutuparna S
authors.initials: RS
authors.lastname: Sasane
keywords: B lymphocytes; Chronic periapical granuloma; Immune system; Owl-eye cells; Periapical cyst; Plasma cells