|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 1 | Page : 121-122
Enigmatic Morpho-Insight: Toto bodies
Mamatha GS Reddy, Supriya Kheur
Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil University, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||8-Jan-2015|
Mamatha GS Reddy
Department of Oral Pathology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil University, Pimpri, Pune - 18, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Reddy MG, Kheur S. Enigmatic Morpho-Insight: Toto bodies. Med J DY Patil Univ 2015;8:121-2
Toto described the eosinophilic bodies as homogenous masses conforming in size and shape to the superficial prickle cells and referred them as "Mucopolysaccharide Keratin Dystrophy". Various authors gave different names to these eosinophilic bodies as "Keratin pooling", "Keratin like material".  These eosinophilic bodies are commonly found in various oral inflammatory lesions like Epulis fissuratum, irritation fibromas, pyogenic granuloma, peripheral giant cell granuloma, and inflammatory hyperplastic gingivitis.  According to the study by Buchner et al, the percent of cases with eosinophilic bodies was found highest in pyogenic granuloma followed by inflammatory hyperplastic gingivitis, peripheral giant cell granuloma, Epulis fissuratum, and irritation fibromas.  [Figure 1] and [Figure 2].
|Figure 1: Homogenous eosinophilic bodies of varying size and shapes in the superficial epithelium [arrows and labeled as A] (Hand E, x100).|
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|Figure 2: Eosinophilic bodies surrounded by compressed cells with pyknotic nuclei [labeled as A] (Hand E, x400).|
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Toto used various strains to study the nature of the eosinophilic bodies and were positive for periodic acid-Schiff (PAS), alcian blue and other metachromatic stains which then labeled as mucopolysaccharides. He concluded that these bodies are homogeneous dystrophic complexes of acid and neutral mucopolysaccharides with keratin,  hence he labeled it as mucopolysaccharide keratin dystrophy.
Buchner et al., postulated two possibilities of origin of these bodies i.e., keratin like material or blood plasma infiltrate. As the changes increases with intensity of inflammatory reaction, they might represent a filtrate from the blood vessels similar to inflammatory exudates. Histochemically, the presence of -SH and -SS groups suggests similarity to keratin.  Therefore, he suggested the term keratin like material for these epithelial masses. 
Chen proved ultrastructurally that these eosinophilic bodies were located extracellularly in the dilated intercellular spaces. The superficial cells of inflamed oral mucosa were weakened by degenerative changes and they become compressible. Besides this cytoplasmic degeneration, the plasma membranes of superficial cells were thickened, and which become less permeable to macromolecules. Thus, there is no outpouring of keratin like material (tonofilaments or keratohyalin granules) into extracellular space.  Based on his study observations, he suggested that the eosinophilic bodies are probably the combination of glycoprotein and mucopolysaccharides of normal intercellular substance and exudates of plasma fluid which are accumulated in the dilated intercellular spaces of superficial degenerating cells. 
As disease progresses, various changes occur in the body which are biochemical in nature which further lead to cellular changes. One of these cellular changes is the ones visible in the epithelium as eosinophilic- Toto bodies, indicating underlying inflammatory process.
| References|| |
Chen SY. Ultrastructure of eosinophilic bodies in the degenerative surface epithelium of chronic hyperplastic oral lesions. Oral Surg Oral Med Oral Pathol 1977;43:256-66.
Buchner A, Mlineck A, Calderon S. Eosinophilic bodies in the epithelium of oral inflammatory hyperplastic lesions. Oral Surg Oral Med Oral Pathol 1976;41:378-84.
Toto PD. Mucopolysaccharide keratin dystrophy of the oral epithelium. Oral Surg Oral Med Oral Pathol 1966;22:47-8.
[Figure 1], [Figure 2]