Toto bodies.

Toto described these as eosinophilic bodies of homogenous masses conforming in size and shape mostly confined to the superficial spinous layer of surface epithelium and referred them as “Mucopolysaccharide Keratin Dystrophy.”[12]

These bodies are commonly associated with inflammatory gingival and other mucosal lesions, for example, epulis fissuratum, irritational fibroma, pyogenic granuloma, peripheral giant cell granuloma, inflammatory hyperplastic gingivitis, etc.[3] In a study done by Buchner et al., they found that the highest percent of cases with eosinophilic bodies was in pyogenic granuloma followed by inflammatory hyperplastic gingivitis, peripheral giant cell granuloma, epulis fissuratum and irritation fibroma.[4]

Various authors have explained the diverse possibility of its origin.

Toto: These bodies were positive for periodic acid-Schiff, alcian blue and other metachromatic stains and hence, he labeled it as mucopolysaccharides. He concluded that these are homogeneous dystrophic complexes of acid and neutral mucopolysaccharides with keratin and labeled it as “Mucopolysaccharide Keratin Dystrophy”[2]

Buchner et al.: Postulated two possibilities of its origin, i.e., keratin-like material or blood plasma infiltrate. As the intensity of inflammatory reaction increases, 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[4]

Chen: Ultrastructurally observed that these bodies were located extracellularly in the dilated intercellular spaces. He explained that the superficial cells of inflamed oral mucosa were weakened by degenerative changes and they become compressible. Besides the cytoplasmic degeneration, the plasma membranes of superficial cells were thickened and become less permeable to macromolecules. Thus, there would be no outpouring of keratin-like material (tonofilaments or keratohyalin granules) into extracellular space. Therefore, he suggested that these bodies are probably formed by the combination of glycoprotein and mucopolysaccharides of normal intercellular substance and the exudates of plasma fluid which are accumulated in the dilated intercellular spaces of superficial degenerating cells.[5]

Identification of underlying pathology consists of detailed histopathological examination. Occasionally, presence of Toto bodies can be of diagnostic importance. These are mostly round to oval shaped homogenous eosinophilic bodies of variable size, combined to a superficial spinous layer of surface epithelium. These are mostly observed in the pathology associated with the reactive or inflammatory process.[12346] Its etiopathogenesis is varied and various histochemical and ultrastructural studies are still not a mandate to answer its possibility of origin.

A low power view of Toto bodies confined to the superficial spinous layer of stratified squamous epithelium is illustrated in Figure 1. Whereas, a high power photomicrograph of Toto bodies along with a hand-drawn illustration is presented in Figure 2.

Figure 1

Photomicrograph showing Toto bodies confined to the superficial spinous layer of surface epithelium (H&E stain, ×100)

Figure 2

Photomicrographs showing predominantly eosinophilic bodies of homogenous masses conforming in size and shape with a well-defined cell border (Toto bodies) [H&E stain, (a) x200, (b) x400, (c) x200, (d) x400]. The corresponding hand-drawn illustration is presented in (e-h)

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