Indian Journal of Pathology and Microbiology

: 2010  |  Volume : 53  |  Issue : 4  |  Page : 846--847

Rushton bodies or hyaline bodies in radicular cysts: A morphologic curiosity

Sunitha Jacob 
 Department of Pathology, Christian Medical College & Hospital, Ludhiana, Punjab, India

Correspondence Address:
Sunitha Jacob
Department of Pathology, Christian Medical College & Hospital, Ludhiana - 141 008, Punjab

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Jacob S. Rushton bodies or hyaline bodies in radicular cysts: A morphologic curiosity.Indian J Pathol Microbiol 2010;53:846-847

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Jacob S. Rushton bodies or hyaline bodies in radicular cysts: A morphologic curiosity. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Dec 9 ];53:846-847
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Rushton bodies (RB) or hyaline bodies in odontogenic cysts feature as eosinophilic, straight or curved, irregular or rounded structures within the epithelial lining of odontogenic cysts. [1] Data from published studies suggest an overall incidence of about 8%. [2] The origin and nature of RB have been hotly debated.

Two out of 50 cases of odontogenic cysts examined showed the presence of RB. Both were radicular cysts occurring in females aged 40 and 42 years. The anterior maxillary region was involved in both with radiological findings of unilocular radiolucent cysts affecting the apical region of non-vital tooth. The cysts' sizes were 3.5 and 1.5 cm, respectively. They were enucleated.

Histopathologic examination showed the cysts to be lined by stratified squamous epithelium which was variably thickened or attenuated and focally ulcerated. Dense lymphoplasmacytic infiltrate was present in the subepithelial tissues. Tucked within the epithelium were groups of acellular, variable-sized eosinophilic structures (RB) of different shapes from straight linear, curvilinear, to irregular circular forms [Figure 1] and [Figure 2]. Occasional ones had concentric laminations. Some RB were refractile but not birifringent. These bodies were periodic acid-Schiffnegative but strongly positive with Masson's Trichrome and orcein stains [Figure 3]. RB were numerous in one case and few in the other.{Figure 1}{Figure 2}{Figure 3}

Hyaline bodies within the epithelium of odontogenic cysts were first described in detail by Rushton [1] and hence are often referred to as Rushton bodies. RB occur almost exclusively within odontogenic cysts. They have not been identified within nasopalatine or fissural cysts, both of which are not of odontogenic origin. [3],[4] There has been only a single case of RB occurring in lesions other than jaw cysts, which was reported within a plexiform ameloblastoma. [5]

RB may show up in examination of the gross specimen as small, white, dome-shaped swellings measuring up to 0.1 mm on the epithelial surface and protruding into the cyst cavity. [6] In microscopic sections, they appear as eosinophilic, linear, straight or curved or hairpin shaped, circular or polycyclic forms, often with a granular core and sometimes concentrically laminated. [2],[6] RB are found almost always within the epithelial lining and only rarely in the fibrous capsule. [6] They stain strongly with orcein, Mallory aldehyde fuschin, Papanicolaou and Gomori. RB within a particular cyst are rarely all of the same shape or type. No association between the cyst type and any specific shape of the RB has been noted. [2] Electron microscopic studies show the lamellar variant to be composed of alternating electron dense and electron lucent layers, whereas the granular form consists of amorphous material. [6],[7]

The origin and nature of RB have been rather elusive, thus leading to numerous studies investigating the histologic, histochemical, enzyme histochemical, transmission and scanning electron microscopic, microprobe, micro-radiographic and immunocytochemical properties. [3],[4] Rushton [1] suggested that RB represented a cuticular or keratin like product of odontogenic epithelium. Alternatively, they have been considered to be of keratinous or of hematogenous origin, which was however disproved by ultrastructural and immunohistochemical studies. [3],[7],[8],[9] Other postulations regarding the origin were that it was formed due to elastotic degeneration or that it was the product of a cellular reaction to extravasated serum. [9] Because of their sole occurrence in odontogenic cysts, the odontogenic epithelium has been strongly implicated in the genesis of RB. It has been concluded after various exhaustive studies that RB are a secretory product of odontogenic epithelium deposited on the surface of particulate matter like cell debris or cholesterol crystals. [2],[3] The focal distribution within the epithelial lining together with the low overall incidence suggests that relatively uncommon local events are responsible. [2]

Thus, the origin of RB seems to have come full circle with the published data available today supporting the view first expressed by Rushton [1] that RB are odontogenic epithelial cell products formed in response to contact with particulate matter in a manner analogous to the formation of dental cuticle.


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