Histomorphometric and molecular characterization of stromal and mineralized components in fibro-osseous lesions

BACKGROUND

Indistinct and analogous histopathological features of various fibro-osseous lesions make establishing a definitive diagnosis a challenge. There is a need for additional molecular and histochemical tools to support and differentiate these lesions in order to establish a concrete diagnosis.

MATERIALS AND METHODS

A retrospective analysis of biopsied lesions in formalin-fixed paraffin-embedded sections (10 cases each of fibrous dysplasia, ossifying fibroma, and cement-osseous dysplasia) retrieved from the archives was studied for immunoexpression of osteocalcin (quantitative analysis in osteocytes), collagen characterization using Azan, Picrosirus, and Toluidine blue stain for evaluating intensity and localization of collagen fibers, and morphometric analysis of vasculature (for evaluating mean vessel density as square microns).

RESULTS

Positive immunostaining of osteocalcin suggested mutations of the GNAS-1 gene found in fibrous dysplasia indirectly, as it is a negative regulator of bone formation. Osteocalcin immunopositivity was quantitatively measured in the fibro-osseous lesions, with fibrous dysplasia measuring 14.47 ± 3.628 as compared to ossifying fibroma measuring 5.23 ± 1.33, followed by cemento-osseous dysplasia measuring 2.30 ± 1.409. Toluidine blue suggests the presence of oxytalan fibers (resistant to acid hydrolysis) in ossifying fibroma and cemento-osseous dysplasia, pointing toward the pathogenesis of the lesion. Azan stain and Picrosirus (under a polarizing microscope) helped in distinguishing hard tissue characteristics (70% of cases of fibrous dysplasia showed only a magenta component followed by intermixed magenta with a blue component in 20% of cases and only 10% of cases showed magenta with blue borders whereas for ossifying fibroma, 40% of cases depicted magenta with blue borders along with the other 40% with intermixed magenta with blue component). The mean vessel density was also highest in fibrous dysplasia measuring 7.90 ± 1.079 (in Sq. micron area), followed by ossifying fibroma and cemento-osseous dysplasia.

CONCLUSION

The diagnosis of fibro-osseous lesions by hematoxylin and eosin alone is confusing and thus should be supported by relatively simple histomorphometric analysis for better treatment outcomes. At the diagnostic stage of fibro-osseous lesions, evaluation of intralesional vessel size, reliable molecular marker, and histochemical nature can aid in differentiating fibrous dysplasia from central ossifying fibroma and cemento-osseous dysplasia alongside, other clinical, radiographic and pathological criteria. These parameters help in the diagnostic decision-making of fibro-osseous lesions.

Immunolocalization of epithelial cell adhesion molecule and matrix metalloproteinase-9 in oral epithelial dysplasia and oral squamous cell carcinoma

INTRODUCTION

Cancers are complex tissues composed of multiple distinct cell types that participate in heterotypic interactions with one another. Physiologically cell-to-cell contacts formed by dense populations of normal cells operate to suppress further cell proliferation.

OBJECTIVES

The objective of the study is to evaluate and compare the immunoexpression of matrix metalloproteinase-9 (MMP-9) and epithelial cell adhesion molecule (EpCAM) in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) and to hypothesize their role in the progression in varying grades of these lesions.

MATERIALS AND METHODS

A total of 60 samples comprising of 30 cases each of OED and OSCC. Three micrometers thin sections were taken and subjected for hematoxylin and eosin stain and immunohistochemical procedure. The sections were incubated with monoclonal anti-EpCAM anti-MMP-9 antibody. The data were analyzed using SPSS software version 19.

RESULTS

The results of the study show EpCAM immunoexpression decreased in OSCC when compared to OED. MMP-9 immunoexpression increased in OSCC when compared to OED (statistically significant, P ≤ 0.05).

CONCLUSION

Correlation between EpCAM and MMP-9 may help to unravel the signaling cascades involved in the carcinomatous changes, tumor cell invasion, and progression of OSCCs.

Serum and Saliva LDH Levels in Patients with Habit, Oral Potentially Malignant Disorders (OPMDs), and Oral Squamous Cell Carcinoma (OSCC): A Spectrophotometry Study

Background

Oral potentially malignant disorders (OPMDs) are chronic lesions or conditions characterized by a potential for malignant transformation. One of the hallmarks of cancer is aerobic glycolysis which confers immortality to cancer cells, correlates with the belligerent behavior of various malignancies, and shows an increase in the expression of lactate dehydrogenase (LDH). The present study was conducted to measure and compare serum and salivary LDH levels in patients with habit, OPMDs and oral squamous cell carcinoma (OSCC) patients, and to evaluate if LDH levels can be used as a biomarker in the progression into potentially malignant disorders (PMDs), the prognosis of OSCC, and to assess if saliva is a better biomarker.

Materials and Methods

Thirty patients of both genders were divided into three groups. Group I had patients with habits, group II had OPMDs, and group III had OSCC with 10 subjects from each group. Saliva and serum of patients were collected according to the standard protocol and measured for LDH using spectrophotometry of 340 nm.

Results

Group I had patients with habits, group II had OPMDs, and group III had OSCC. Group I had 6 males and 4 females, group II had 8 males and 2 females, and group III had 7 males and 3 females. The mean serum LDH level in group I was 265.50, in group II was 194.10, and in group III was 224.22. The difference was non-significant (P > 0.05). The mean salivary LDH level in group I was 345.68, in group II was 532.72, and in group III was 1.105. The difference was significant (P < 0.05).

Conclusion

Salivary LDH is a non-invasive, cost-effective technique, which can be used as an effective modality for the diagnosis and prognosis of oral cancer as well as for monitoring tobacco users and OPMDs.

Diagnostic utility of special stains in defining the spectrum of maxillofacial pathologies

Background

The Fine needle aspiration cytology (FNAC) is considered as a valuable and distinguished diagnostic test in the initial assessment of the patients presenting with a mass in the head and neck region or when a recurrence is suspected after previous treatment.

Aims

This study was therefore designed to elucidate the efficacy of FNAC as an alternate diagnostic tool to histopathology in head and neck swellings and evaluation of staining efficacy of PAP and MGG stain over Haematoxylin and eosin (H and E) in routine cytopathological smears.

Settings and Design

The study was conducted in the Department of Oral and Maxillofacial Pathology, where FNAC samples were collected from 150 patients with head and neck swellings.

Materials and Methods

All the slides were stained with H and E, Papanicolaou (PAP), and May Grunewald Giemsa (MGG) stains. The cytopathological diagnosis was compared with histopathological diagnosis based on H and E stained sections obtained from paraffin-embedded formalin-fixed biopsy specimen of benign and malignant neoplasms.

Statistical Analysis Used

The resulting data were analyzed using SPSS software version 19. Differences between the variables were analyzed using Pearson Chi-square test and Kruskal-Wallis test wherever applicable.

Results

The FNAC as a diagnostic tool has sensitivity of 84.8%, 72.72%, and 78.78%, specificity of 62.5%, 75%, and 75%, and accuracy of 80.48%, 73.14%, and 78.04% in H and E, MGG, and PAP stain, respectively. PAP stain was the most efficient stain when all qualitative parameters are taken into consideration with maximum sensitivity and specificity for achieving definitive cytodiagnosis.

Conclusions

The FNAC is an inexpensive and minimally invasive technique to diagnose different types of head and neck swellings and complement histopathological diagnosis.

Pathogenetic model of survivin-dependent molecular signalling pathways in tumorigenesis of oral cancer and precursor lesions

Background

p53 tumour suppressor gene limits unchecked cellular growth in response to DNA damage, by causing G1 arrest and the activation of apoptosis. Inhibitors of apoptosis include survivin which acts by inhibition of caspases. Survivin has a significant role as a cell cycle modulator and is only minimally present in mature tissues. Aberrant expression of p53 and survivin has been evaluated in various carcinomas. Thus, the objective of this research was to elucidate the co-expression of p53 and survivin in tissue samples of Oral Potentially Malignant Disorders (OPMDs) and Oral Squamous Cell Carcinoma (OSCCs).

Method

Thirty tissue samples of OPMDs and 30 tissue samples of OSCCs taken from department archives were used in the study. Expression of p53 and survivin was analyzed in the study groups by the help of immunohistochemistry. Also, co-expression of both the markers was evaluated.

Results

The expression of p53 and survivin in the oral epithelium of patients with OSCCs was significantly higher than that in patients with OPMDs (P value ≤0.05).

Conclusion

Our results provide insights into the altered survivin and p53 co-expression with significant immunoexpression within the study groups. Therefore, survivin and p53 could be better markers for identifying cell proliferation and apoptotic pathway. Also, malignant transformation rate of OPMD increases with increased expression of these markers.

Evaluation of EGFR in prognostic characterization in histopathological variants of oral squamous cell carcinoma

AIM OF THE STUDY

Epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor of the Erb B family contributing to proliferation, invasion, and metastasis. EGFR overexpression is frequently associated with poor clinical outcome in malignant neoplasms.• To evaluate and compare immunoexpression of EGFR in histopathological variants of oral squamous cell carcinoma (OSCC).• To hypothesize the role of EGFR in determining biological behavior and prognostic course of histopathological variants of OSCC.

MATERIALS AND METHODS

The study comprised a total of 40 cases including 10 cases each of Squamous cell carcinoma, Verrucous carcinoma, Adenosquamous cell carcinoma, and Adenoid squamous cell carcinoma. EGFR immunoexpression was observed qualitatively as low (1), moderate (2) and strong (3) and quantitatively as score 1 for <10%, 2 for 10%-50%, and 3 for >50% positive cells. The resulting data were analyzed using SPSS software version 19. Data have been expressed as mean and standard deviation. Differences between the different variables were analyzed using ANOVA, and Pearson's Chi-square. (p ≤ 0.05).

RESULT

The study results revealed that the EFGR immunoexpression was highest in adenosquamous cell carcinoma followed by adenoid squamous cell carcinoma then conventional squamous cell carcinoma followed by lowest immunoexpression in verrucous carcinoma. The results were statistically significant. (p ≤ 0.05).

CONCLUSION

Expression of EGFR could be established as a valuable biomarker with significant association in predicting aggressive potential and treatment response in various histopathological variants of OSCC. Further studies where EGFR could be linked to predictive indicators and tumor prognosis could be undertaken.

Emerging insights of NK cells immunosurveillance in histomorphologic prognostic indicators of oral squamous cell carcinoma

Background

IFN-gamma and natural killer (NK) cells have been considered the most effective cells in the combat of cancer, contributing to better prognosis and longer survival. The aim of the study was to analyze and correlate the CD 57 immunopositive NK cell-mediated Interferon-γ pathway in regulating immune mechanisms in Oral Squamous Cell Carcinoma.

Materials and Methodology

The study sample was composed of a total of 40 cases of histopathologically confirmed cases of Oral Squamous cell carcinoma (OSCC). Clinical data such as age, gender, habit history, signs and symptoms, and TNM staging were obtained for each case. The biopsy specimens of the cases obtained were fixed with 10% neutral buffered formalin and processed and embedded in paraffin wax. 3-4 μ thick sections were taken for hematoxylin and eosin staining and immunohistochemistry procedure. A saliva sample was collected from each patient and stored at 20 degree Celsius for estimation of salivary interferon-gamma levels using the sandwich ELISA technique.

Results

CD 57 NK cells quantitative assessment was significantly associated with tumor budding, cell nest size, the pattern of invasion, lymphocytic host response, NK cell morphology, Depth of invasion, and Tumor thickness. The ratio of CD 57 immunopositive NK cells to salivary IFN-γ levels showed a significant association with histopathological grades, tumor size, and lymph node status.

Conclusion

Adoptive cellular transfer therapy with NK cells has been advocated in both experimental models and clinical trials in treating hematopoietic malignancies. The strategy is based on reviving the patient innate immune surveillance and control of tumor invasion by the infusion of activated NK cells. The IFN-gamma and NK cell infiltration in oral squamous cell carcinoma might show a distinctive tumor microenvironment with a favorable local cytotoxic immune response against neoplastic cells.

Histopathological prognosticators and their clinicopathological correlation in oral squamous cell carcinomas of the tongue

Background

Tongue carcinomas account for 25%-40% of intraoral squamous cell carcinomas (OSCCs). Although TNM staging systems is an international standard for cancer reporting, prognosis evaluation, and treatment planning, multiple histopathological risk assessment predictors such as tumor thickness (TT), tumor shape, tumor growth pattern, and invasive malignancy grading scoring systems have been studied and should form a basis for prediction and prognostication of such aggressive carcinomas.

Aim

To evaluate and characterize the histomorphological prognostic indicators in OSCCs of tongue and compare it with OSCCs of other anatomic sites within the oral cavity. Furthermore, to elucidate the significance of histopathological indicators in predicting prognosis of tongue squamous cell carcinomas (SCCs).

Materials and Methods

Forty SCC cases with 20 each of tongue and 20 from other intraoral sites were retrieved from department archives. Clinical data and staging were obtained for each case. Histomorphological parameters including pattern of invasion (POI), tumor budding (TB), depth of invasion (DOI), TT, lymphocytic host response, tumor-associated tissue eosinophilia (TATE), vascular invasion, perineural invasion (PNI), and muscular invasion were assessed. The results were statistically evaluated.

Results

TB, DOI, and sarcolemmal spread were significant histologic predictors in tongue SCC. Upon correlation of histomorphological parameters with clinical staging, TT, POI, and TATE were observed to be significantly correlated (P ≤ 0.05).

Conclusion

The histomorphological risk assessment model may serve as important addition to the existing prognosticators and may be used as a prognostic index to help plan and individualize treatment protocol in cases with aggressive high-risk disease for whom the use of multimodality treatment seems beneficial.

Embryological Basis of Cystic Hygroma: A Case Report

Aim

We intend to present a cystic hygroma (CH) case in a 2-year-old baby in the anterior cervical triangle, which is a rare site, as the most common site for the occurrence of CH is the supraclavicular fossa of the posterior cervical triangle.

Background

Among developmental abnormalities in the lymphoid system, CH are usually seen in the posterior neck. Lymphatic malformations are generally exhibited either at birth or before the age of 2 years. Lymphatic channels are attenuated endothelium-lined spaces devoid of any cells and smooth muscle layer. Also, morphologically distinguishing normal lymphatic channels from venules or capillaries is a challenge.

Case description

A 2-year-old female patient reported having a chief complaint of swelling in the left submandibular region for 4 days. The patient underwent surgery for CH 18 days after birth. Swelling was rubbery in texture and firm in consistency.

Conclusion

A D2-40 immunoexpression was an identifying clue for normal lymphatics in comparison to morphology. Henceforth, this can be concluded that such tumors depict at least partial differentiation of endothelial cells lining lymphatic spaces.

Clinical significance

The present article helps in illuminating the role of D2-40 in the diagnosis of lymphatic malformations, such as CH, and also highlights the embryological basis of the pathogenetic mechanism of this rare disease, which potentiates the role of various treatment modalities in pediatric cases for management considerations.

How to cite this article

Yadav S, Gulati N, Shetty DC, et al. Embryological Basis of Cystic Hygroma: A Case Report. Int J Clin Pediatr Dent 2022;15(6):774-778.

Osseous Microanatomy and Histochemical Characterization in Species, Gender Determination and Age Estimation

Background: Bone is a tissue of particular interest, because the hard tissue of the skeleton is normally well preserved and details of microscopic structure can be seen in specimens many centuries old. The microscopic structure of bone can be utilized for identification of unknown bone samples in forensic odontology. Physical anthropologists may encounter complete or fragmentary specimens of bone in which standard anthropometric methods provide inconclusive or questionable information. If the histological structure of such material could reveal, with reasonable accuracy, details of species, age, and gender, it would be a useful and valuable laboratory tool. Materials and Methods: A cross-sectional analysis of formalin fixed paraffin embedded sections from biopsied lesions (5 cases each of goat bone, 5 cases of chicken bone specimen, 5 cases of human male bone specimen, 5 cases of human female bone specimen) was done. The variation of the trabeculae by measuring the average width of trabeculae, the average marrow space, and the ratio of the above two through morphometric analysis was assessed. The observational percentage variation amongst the species by number of osteons, osteocytes shape i.e., -spindle, elliptical and round, presence of inflammation was noted. The stroma and hard tissue for Collagen characterization (Special stains)Type, orientation and maturity using Picrosirus stain, Sub intimal fibrosis surrounding the bone using Van Gieson, Percentage of mature and immature bone pattern using Azan stain was analyzed. Result: Chicken bone shows absence of osteons in comparison to human bone with increased number of osteocytes. Goat bone shows plexiform pattern with scattered haversian canals more comparable to human bone architecture. Average human Haversian canal diameter was greater than non-human mammalian species. Azan staining helped in differentiation of mature from immature bone. Picrosirus staining helped in establishing collagen type, orientation and thickness. Sub intimal fibrosis surrounding the bone was checked using Van Gieson staining. Discussion: The complexities of bone tissue and its growth processes are such that misinterpretations of a critical nature can be made if the observer is not well informed on the multitude of basic details dealing with Osteogenesis, remodelling, and comparative histology. Conclusion: Bone histomorphological assessment is an effective method for species identification, gender determination and age estimation by fragmentary osseous remains.

To analyse the mitotic and keratinisation correlation with bcl-2 expression in varying grades of oral epithelial dysplasia and squamous cell carcinoma

Context

The bcl-2 proto-oncogene was discovered at the chromosomal breakpoint of t (14;18) found in follicular lymphoma. Histological changes in dysplasia are considered the earliest signs preceding the progression into squamous cell carcinoma. Serving as critical regulators of apoptotic pathways, bcl-2 prohibits programmed cell death and subsequently assists in uncontrolled neoplastic growth.

Settings and Design

This study included 48 cases, eight each of epithelial dysplasia and squamous cell carcinoma. Immunohistochemical staining using bcl-2 antibody was performed and different histological parameters were correlated with bcl-2 positive cells in all the cases.

Materials and Methods

All 3 μm thick sections were stained with bcl-2 antibody. After identifying four representative fields at 40x, their images were obtained for assessment of bcl-2 labelled cells and their intensity along with different histological parameters in all the cases.

Statistical Analysis

The differences between different histological parameters were analysed using the Anova test, post hoc test and Bonferroni test. Pearson's Chi-square test was carried out to determine the level of correlation between the bcl-2 positive cells in both epithelial dysplasia and oral squamous cell carcinoma cases.

Conclusion

Sequential increase in the bcl-2 expression was observed in increasing grades of epithelial dysplasia, whereas bcl-2 expression was significantly decreased in ascending stages of squamous cell carcinoma thus, suggesting a possible role of bcl-2 in disease progression from premalignancy to malignancy.

El papel emergente de la inteligencia artificial en la oncología oral

Artificial Intelligence (AI) and its application is providing new horizons in research and applied science. The goal of this study was to determine the level of awareness, attitudes, and future perspectives about AI among dental students and professionals and its application in digital pathology. A questionnaire survey was conducted among Undergraduate and Postgraduate dental students and Faculty/Clinicians through Google Forms. It was categorised into sections with the objective of determining knowledge, attitudes, and future perspectives of AI and its potential applications in pathology. The responders' identities were kept anonymous. A total of 200 people responded to the poll, with 136 females and 64 males with an average of 24 years. The study included 125 Undergraduates, 44 Post graduate students, and 31 Faculty/Clinicians. 73.5 % were aware that AI might be utilised in medicine. According to 87.5 %, it should be incorporated in the curriculum. 79 % feel it will play an important role in diagnostic and treatment planning in the future. Although the participants have a limited understanding of AI, they are eager to learn more about it. Participants expressed optimism, believing that AI will have a beneficial influence on medical practise in future. Artificial Intelligence approaches and development trends will focus on machine learning based on data acquired from the most recent diagnostic modalities, such as multi-omics (e.g., genomics, metabolomics) and imaging technologies, especially in areas where objective detection methods are missing. Finally, developing global and national standards and laws is required to accelerate the use and spread of AI in health and medicine. It will be useful in forecasting the prognosis, recurrence, and survival rate of oral cancer patients and also to predict the malignant transformation of pre-malignant lesion in high-risk patients.

MCM3 proliferative index is worthier over Ki-67 in the characterization of salivary gland tumors

Background

Salivary gland tumors bear uncanny characteristics of being different based on their morphological aspects rather than the presence of clear demarcation. This ambiguity in the spectrum from benign to malignant salivary gland neoplasms while categorizing the neoplasm is having inherent pitfalls. The present study was, therefore, designed to characterize benign and malignant salivary gland tumors based on their proliferative indices.

Materials and Method

Study samples comprised of 97 cases of histopathologically confirmed benign and malignant salivary gland tumors. The cases were immunohistochemically assessed for MCM3 and Ki-67 expressions and the molecular characterization was performed based on the findings.

Results

The majority of benign and malignant salivary gland tumors were from the parotid gland, (51.2%) and (42.4%), respectively. Overall mean labeling index of MCM3 was higher i.e., (5.60 ± 3.99) in comparison to Ki-67 i.e., (2.82 ± 3.14) with P = 0.05 using paired t-test. Besides, malignant salivary gland neoplasms represented a higher mean score of MCM3 and Ki-67 than benign neoplasms.

Conclusion

The requirement of a novel marker has led to the use of MCM3 which has a characteristic role in the entire spectrum of the cell cycle. The present study highlighted the extrapolation of MCM3 over Ki-67 for diagnosis and for true characterization of biologic behavior of salivary gland pathologies which may, in turn, influence the treatment modality employed for such lesions.

Occult prostate carcinoma with metastasis to the mandible presenting as numb chin syndrome

Prostate cancer is one of the leading causes of death due to malignancy in men. Occult malignancy presenting with no primary symptoms could be a challenge to the diagnostician. Metastasis of prostate carcinoma to the mandible is rare and usually presents with non-specific symptoms. Only 1% of oral cancers account for lesions which present as metastasis of other primary malignancies. We report a rare case of prostate carcinoma being diagnosed as metastasis to the mandible with the patient presenting with numb chin syndrome.

Tumor-associated tissue eosinophilia versus tumor associated blood eosinophilia: A ratio of diagnostic importance in oral squamous cell carcinoma

Introduction

Eosinophils are multifunctional granulocytes, which play a pivotal role in health and disease. Tumor Associated Tissue Eosinophilia (TATE) has long been evaluated in the diagnosis and progression of oral squamous cell carcinomas (OSCCs). However, their association with Tumor Associated Blood Eosinophilia (TABE) in OSCCs is still far fetched. We, therefore, attempted to evaluate their individual roles and to achieve a ratio between TATE and TABE in order to signify its usage in objectifying the diagnosis.

Materials and Methods

TATE was evaluated using H and E stain per 10 high power fields in 33 previously diagnosed cases of OSCC which were retrieved from department archives. TABE values were achieved from complete blood hemogram reports of patients. TATE/TABE ratio was calculated. All the parameters were clinicopathologically correlated and statistically evaluated using SPSS.

Results

TATE represented higher values in well-differentiated squamous cell carcinoma (WDSCC) and poorly differentiated squamous cell carcinoma (PDSCC) and was least in moderately differentiated squamous cell carcinoma (MDSCC), whereas TABE linearly increased from WDSCC to PDSCC. TNM Stage II cases revealed the highest TATE and lowest TABE. TATE/TABE ratio was the highest in WDSCC.

Conclusion

Due to the dual nature of eosinophils in early and late carcinogenesis events, evaluation of only TATE might not be conclusive in determining tumor grade. Hence, in a first of its kind attempt, the TATE/TABE ratio may be suitable to achieve a criterion for the determination of tumor grade and may also help to unfold the underlying biologic events.

Immunohistochemical expression of p53 and murine double minute 2 protein in odontogenic keratocyst versus variants of ameloblastoma

Introduction

Oncogenes and tumor suppressor genes play a major role in cancer formation, growth, and progression. One of the important findings in this area is that murine double minute 2 (MDM2) oncogene is a negative regulator of wild-type p53. In tumors, expressing wild-type p53, inhibition of MDM2 expression will stabilize p53 and allow it to perform its proapoptotic function, while simultaneously preventing MDM2 from exerting its p53-independent oncogenic effects. The intracellular levels of p53 are tightly regulated by MDM2, as it is a key player in autoregulatory feedback loop under nonstressed conditions. The p53-MDM2 relationship is vital not only for essential functions of the cell, but it also appears to be an integrated part of the complex cellular network which supports the importance of this affair and is a hallmark for its coexistence.

Subjects and Methods

This study was designed to identify immunohistochemically the expression of p53 and MDM2 gene using monoclonal antibody in 60 cases of formalin-fixed paraffin-embedded tissue blocks, of which 20 cases were of solid multicystic ameloblastoma (SMA), 20 cases were of odontogenic keratocyst (OKC), and 20 cases were of unicystic ameloblastoma (UA).

Results

Immunoexpression of p53 and MDM2 was highest in OKC followed by SMA and was minimum in UA. Further results showed positive correlation between both the molecules.

Conclusion

The studied showed that the relationship has a significant role in cancer etiology and progression and therefore is an important topic for future research which should help in the development of new therapeutic agent against cancer.

Biochemical analysis of cytokeratin fragment 21-1 concentration and expression of cytokeratin 19 in oral potentially malignant disorders

Introduction

Cytokeratin fragment 21-1 (CYFRA21-1), a constituent of the intermediate filament protein is known to be elevated in cancer. In vitro cleavage of cytokeratin 19 (CK19) protein results in the release of it's fragments into the supernatants of premalignant cell lines. This study was designed with the aim to investigate the concentrations of CYFRA21-1 in serum and saliva of oral potentially malignant disorders (OPMD), to evaluate CK19 expression in tissues of the same patients and to correlate the levels of CYFRA21-1 concentration in serum and saliva with CK19 expression in OPMDs, and to compare it with oral squamous cell carcinoma (OSCC), which was taken as positive control.

Materials and Methods

Concentration of CYFRA21-1 was measured in saliva and serum of 30 OPMD cases with five patients having OSCC using ELISA technique and analysis of CK19 protein expression in the tissue of same patients using immunohistochemical technique was done.

Results

Concentration of CYFRA21-1 in saliva and serum with regard to CK19 protein expression in tissues was significantly higher in control group than in study groups.

Conclusion

CYFRA21-1 can be used as a promising diagnostic molecule and as an adjunctive marker for early detection, disease staging, and monitoring.

Evaluation and comparison of the antimicrobial activity of royal jelly - A holistic healer against periodontopathic bacteria: An in vitro study

Context:

RJ is a natural bee product and is known to have remarkable health benefits. The objective was to evaluate its antimicrobial potential against periodontopathic bacteria and compare the same with chlorhexidine.

Aims:

The aim was to evaluate and compare the antimicrobial activity of royal jelly (RJ) with chlorhexidine against the periodontopathic bacteria (aerobic and anaerobic) in subgingival plaque.

Materials and Methods:

Subgingival plaque samples of 15 chronic periodontitis patients were taken, and clinical parameters were evaluated. Inhibitory effect of RJ and chlorhexidine was investigated “in vitro” on the growth of aerobic and anaerobic bacteria by colony count, minimum inhibitory concentration, and minimum bactericidal concentration (MBC) by the method of serial broth dilution.

Statistical Analysis Used:

ANOVA statistical analysis was used in this study.

Results:

Subgingival anaerobic bacteria predominate (colony-forming unit). Chlorhexidine is more sensitive in inhibiting aerobic and anaerobic bacteria (at concentration 50 μg/100 μl). A higher concentration of RJ is required to have an inhibitory effect. MBC of chlorhexidine shows no growth on blood agar plates, whereas minimum bacterial growth is seen around the RJ.

Conclusions:

Chlorhexidine (gold standard) has a higher inhibitory effect in the case of chronic periodontitis; however, RJ can also be used as an alternative but at higher concentration and lesser dilution. Evaluation of the quality, quantity and the biological activity of RJ is a necessity and must be done before its “in vivo” application.

Staining efficacy assessment of a differential routine and special stains for pathological stromal calcifications in maxillofacial lesions

Head and neck connective tissue lesions may have diverse calcifications within the fibrous connective tissue stroma. The perplexity involved in the identification and determination of the nature or degree of calcification through routine hematoxylin and eosin (H&E) stains necessitates the usage of a specific, simple, and cost- and time-effective differential staining techniques. The aim of the present study was to develop criteria to distinguish bone formation from bone resorption using methylene blue-acid fuchsin (MB/AF) stain and the role of collagen fibers in the identification of stromal calcifications using polarizing microscopy with picrosirius red stain. Twenty cases with pathological diagnoses for various stromal calcifications in maxillofacial lesions were retrieved from the departmental archives. Decalcified formalin fixed paraffin embedded tissue sections were stained with hematoxylin and eosin, Masson's trichrome (MT), methylene blue-acid fuchsin (MB/AF), and picrosirius red. The stained sections were assessed to identify the calcifications found in the surrounding connective tissue stroma. It was observed that most cases showed maximum staining intensity with MB/AF stain as compared to the other staining methods. Moreover, the results suggested that contrast between calcification and stromal soft tissue was best distinguished with the MB/AF stain except in the case of dystrophic calcifications. Along with this, polarizing microscopy with picrosirius red enables better characterization of stromal components. Although the H&E stain and a connective tissue stain i.e. Masson's trichrome, are employed routinely in histopathology; the use of special stains such as MB-AF and picrosirius red facilitates the identification of calcifications from the stromal tissues.

Molecular Analysis as a Guide to Determining the Extent and Pathophysiology of Perilesional Tissues in Oral Epithelial Dysplasias

Introduction

Clinically and histologically normal appearing perilesional mucosa of epithelial dysplasia may harbor early genetic changes. Hence, the present study is designed to determine the early molecular changes in the form of p16 and EGFR immunoexpressions in perilesional tissues.

Objectives

To analyze immunohistochemical expressions of p16 and EGFR individually and percentage change of immunoexpressions in oral dysplastic lesions and their perilesional tissues.

Materials and Methods

Forty formalin-fixed paraffin-embedded tissues of oral epithelial dysplasia with perilesional tissue marked by India ink were included in this study. Immunohistochemical staining was performed using anti-p16 and anti-EGFR monoclonal antibodies (BioGenex) using squamous cell carcinoma of uterine cervix and breast carcinoma as the positive controls, respectively.

Results

p16 and EGFR expressions were assessed based on the presence, intensity, extent and immunolocalization of positive cells. Out of 40 cases, p16 immunoexpression was positive in 82.5% cases of lesional tissues and in 62.5% cases of perilesional tissues (p ≤ 0.05); however, EGFR immunoexpression was positive in 90% cases of both lesional and perilesional tissues (p > 0.05).

Conclusion

The disease status and progression based on p16 and EGFR expressions and co-expressions can be used as an effective guide to evaluating the progression of normal epithelium to dysplastic epithelium in otherwise clinically normal mucosa.

Immunoexpression of alpha smooth muscle actin correlates with serum transforming growth factor-β1 levels in oral submucous fibrosis

AIM

The aim of the present study was to correlate the immunoexpression of alpha-smooth muscle actin (α-SMA) for myofibroblasts with the serum levels of transforming growth factor-β1 (TGF-β1) in oral submucous fibrosis (OSMF).

METHODS

A total of 100 cases of histopathologically confirmed OSMF were assessed for α-SMA expression. Clinical data, such as age, sex, mouth opening, and habit history, were obtained for each case. Serum TGF-β1 levels were recorded in 73 patients with the help of enzymelinked immunosorbent assay technique.

RESULTS

The staining index of α-SMA increased concomitantly with higher myofibroblast count in the increasing histopathological grades of OSMF (P ≤ .05). Serum TGF-β1 levels were highest in the intermediate grades of OSMF. Clinical parameters, such as mouth opening, cheek flexibility, and tongue protrusion, showed a direct correlation with increasing clinical grades of OSMF.

CONCLUSIONS

The progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF. Additionally, as myofibroblasts are responsible for producing a variety of factors that are involved in the fibrotic processes; they could be the key link in the pathogenesis of OSMF. Interruption of their development, recruitment, or activation could provide a unique therapeutic target for future treatment options in patients with OSMF.

Tetrachromic VOF/Masson's trichrome/H and E stains: Unmasking their usability in differential stromal hard tissue staining

Background

Identification and differentiation of stromal hard tissue components is a challenging task. Numerous methods of demonstrating these components have been worked upon in the past. Although some of the methods have been successful, there are many drawbacks of employing them. The need of the hour, therefore is to develop and use a simple, rapid and cost-effective method of identifying stromal hard tissues as they may signify an important change in the diagnosis of the pathology. Our aim is therefore to observe the usability of tetrachromic VOF stain over Hematoxylin and Eosin and Masson's Trichrome in routinely encountered head and neck pathologies.

Materials and Method

Routine cases such as Central and peripheral ossifying fibromas, osteomas, giant cell granulomas, osteomyelitis and malignancies like osteosarcomas were retrieved from the department archives and 3 sections from each block were prepared to stain with H and E, Masson's trichrome and modified tetrachromic VOF stains respectively using standard staining protocol.

Results

Tetrachromic VOF takes an upper hand in stromal hard tissue differentiation irrespective of the pathology.

Conclusion

Modified tetrachromic VOF is simple, cost-effective method and can be employed for diagnosis of cases with hard tissue differentiation within the stroma on routine basis.

Utility of DNA-Specific Stains in Micronuclei Assay as a Marker of Genotoxicity in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma

Background:

The term oral potentially malignant disorder (OPMD) was recommended to refer to precancer as it conveys that not all disorders described under this term may transform into cancer. Oral squamous cell carcinoma (OSCC) arises through an accumulation of genetic alterations, deoxy ribonucleic acid (DNA) changes, and epigenetic alterations. Thus, a simple yet a sensitive and specific test for early diagnosis is the need of an hour. The micronuclei (MN) assay in exfoliated epithelial cells is potentially an excellent biomarker to detect chromosome loss or malfunction of mitotic spindle.

Aim of the Study:

To compare the frequency of MN in exfoliated cells from oral mucosa exposed to genotoxic agents using different staining procedures and to observe the incidence of micronucleus in potentially malignant and malignant lesions.

Materials and Methods:

The study was undertaken to observe the cytogenetic damage in the exfoliated buccal cells of 75 cases of tobacco-related PMDs, OSCC and control subjects (25 cases from each group) and were evaluated with nonspecific May-Grünwald Giemsa stain and DNA-specific Feulgen stain. The results were statistically determined using SPSS version 17.0.

Results:

Correlation analyses in the present study depicted that MN frequency was significantly more in oral squamous cell carcinoma than OPMDs and normal group (P < 0.05). Giemsa-stained slides correlated significantly with karyorrhexis, karyolysis, condensed chromatin, and binucleates, whereas no such correlations were found with DNA-specific stains.

Conclusion:

Malignant transformation is accompanied by loss of cell capacity to evolve to death in situations of DNA damage. These findings indicate that nuclear anomalies may be misinterpreted as MN with nonspecific DNA stains and lead to false-positive results in studies with cells of epithelial origin.

Redefining epithelial characterization in oral submucous fibrosis using morphometric analysis

Background:

Oral submucous fibrosis (OSMF) is a chronic oral mucosal disease characterized by progressive deposition of collagen in subepithelial connective tissue and epithelial atrophy. The present study was conducted to evaluate the changes in epithelial thickness and cellular and nuclear morphometric characteristics of parabasal and spinous compartments of the epithelium in various stages of OSMF in comparison to normal epithelium.

Materials and Methods:

Sample included 30 cases of OSMF of various stages and five cases of normal buccal mucosa. Measurements for epithelial thickness and cellular morphology using morphometric analysis were performed on captured digital images using image analysis software.

Statistical Analysis:

The ANOVA analysis of epithelial thickness and correlation of epithelial thickness with cell contour and cell roundness was done using Karl Pearson's coefficient of correlation.

Results:

There was a statistically significant decrease in epithelial thickness with increase in severity/stage of OSMF. It was also observed that there is a highly statistically significant correlation (P = 0.000) between the thickness of epithelium and cell morphology in varying stages of OSMF.

Conclusion:

The morphometric parameters and the use of quantitative histological methods in determining the squamous epithelial structures thus made it possible to evaluate that there is reduction in thickness of epithelium or “atrophy” with increasing stages of OSMF which may be due to actual change in cell morphology of the individual cells of specific compartment or all compartments in the epithelium.

E-cadherin-mediated impairment increases anti-apoptotic mechanism through upregulation of Bcl-2: An immunohistochemical study in various patterns of invasion of oral squamous cell carcinoma

BACKGROUND

Bcl-2 and E-cadherin proteins are known to be involved in the control of apoptotic cell death and invasive potential, respectively, which is an important hallmark of tumor regulation that influences their biologic behavior.

AIM

This study investigates the relationship of Bcl-2 and E-cadherin immunoexpression in various Bryne's patterns of invasion.

MATERIAL AND METHODS

Immunohistochemical analyses for Bcl-2 and E-cadherin were performed on paraffin-embedded tissue sections on 40 cases (32 cases of Oral squamous cell carcinoma and eight cases of controls) and were scored using qualitative and quantitative (percentage positive) analysis.

STATISTICAL ANALYSIS

The resulting data were analyzed using SPSS software version 19. Correlation between patterns of invasion and qualitative scores of Bcl-2 and E-cadherin was calculated using Spearman rho correlation. Difference of mean percentage of positive cells of Bcl-2 and E-cadherin in different patterns of invasion was tested by ANOVA followed by Tukey HSD test.

RESULTS

Bcl-2 and E-cadherin immunoreactivity was positively correlated with Bryne's pattern of invasion (P value<.05). An inverse relation was found between Bcl-2 and E-cadherin expression with Bryne's patterns 1-5 of invasion.

CONCLUSIONS

The results pointed to the antagonistic role of E-cadherin and Bcl-2 and thus provide the opportunity for cell survival along with increased invasive potential.

Papilliferous Keratoameloblastoma: A Rare Case Report

Ameloblastoma is true odontogenic tumor of epithelial origin, which is described as locally aggressive with varying chances of recurrence. It is believed to derive from enamel organ, remnants of dental lamina, lining of odontogenic cysts, or basal cells of oral epithelium. Radiologically, it may present as unilocular or multilocular radiolucency commonly. Although conventional ameloblastoma presents typical histological features as described by Vickers and Gorlin, few unusual variants have been reported with different histological patterns. However, the clinical and biological behavior of these lesser known variants has not been established yet due to the scarcity of cases reported. Here, we report an extremely rare case of papilliferous ameloblastoma in a young male patient with 2-year follow-up and presenting with unusual histological presentation than conventional ameloblastoma.

Orthokeratinized odontogenic cyst masquerading as dentigerous cyst

The orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst that has been considered as a variant of the keratocystic odontogenic tumor until Wright (1981) defined it as a different entity. Recognition of OOC as a unique entity has long been due, yet its inexplicable clinical, radiographic presentation resembling dentigerous cyst due to its association to an impacted tooth, and its histological features makes it rather perplexing. This is the report of a case of OOC in relation to an impacted maxillary canine and its immunohistochemical analysis with Ki-67.

Molecular Characterization of Clear Cell Lesions of Head and Neck

The salivary glands, oral mucosa and jaws constitute a group of lesions which are heterogeneous in nature and are odontogenic, salivary or metastatic in origin. This group of tumours is termed as Clear Cell Tumours. Fixation artifacts are one of the most important reasons for the cell to appear clear but clearing of cells may also result from cytoplasmic accumulation of water, presence of glycogen within the cell, intermediate filaments, immature zymogen granules, or a paucity of cellular organelles. Clear cell Odontogenic neoplasms predominantly include odontogenic carcinoma, ameloblastoma and calcifying epithelial odontogenic tumour. Clear cell tumours of salivary gland origin are almost invariably malignant in nature but they do include two benign lesions. Very frequently, surgical pathologist encounters clear cells in many malignant neoplasms, the nature and sources of which are undetermined on the basis of conventional histopathology. This review will selectively discuss the clinicopathological features of neoplasms which at times may pose a diagnostic challenge and dilemma due to clear cell changes.

Oral exfoliative cytology as a screening tool for iron overload in β-thalassemia patients

BACKGROUND

Increased iron overload is frequent problem in thalassemia patients, and this is monitored by serum ferritin levels or chemical assessment of the iron levels in liver tissue. However, repeated monitoring of serum ferritin levels to assess the iron overload is an invasive procedure associated with practical problems.

AIMS

To use Perl's Prussian blue reaction to evaluate the iron overload in beta-thalassemia patients by staining the oral cytosmears.

MATERIALS AND METHODS

The study comprised 35 patients diagnosed with beta-thalassemia. Cytosmears were prepared from exfoliated oral epithelial cells, fixed in 70% ethanol and stained with Perl's Prussian blue stain for detection of blue colored granules in the cytoplasm.

RESULTS

29/35 (82.9%) cases showed a positive reaction for Perl's Prussian blue reaction while 6/35 (17%) cases did not show the presence of blue colored granules in the oral cytosmears. The presence of iron detected by Perl's Prussian blue reaction correlated with serum ferritin level (P < 0.05).

CONCLUSION

Perl's Prussian blue reaction can be used to evaluate the iron overload in beta-thalassemia patients by staining the oral cytosmears. It is a simple and noninvasive method for assessment of iron overload in such patients.

To analyze the concomitant expression of human papillomavirus-16 in the pathogenetic model of p53-dependant pathway in oral squamous cell carcinoma

Background:

Oral squamous cell carcinoma (OSCC) accounts for 90% of all primary oral malignancies. Association between human papillomavirus (HPV) as a risk factor of cervical cancer is well known; there is a need to widen the knowledge for its role in oral cancer development. The viral E6 protein of HPV binds to p53 making it nonfunctional.

Aims and Objective:

To study mutated/wild type p53 expression using immunohistochemistry and detect HPV-16 presence using polymerase chain reaction (PCR), in OSCC and correlating their expression.

Materials and Methods:

Immunohistochemical staining for p53 molecule in 24 sections of OSCC followed by DNA extraction of the cases using qiagen extraction kit and subsequent HPV-16 detection using PCR technique.

Statistical Analysis:

The data were analysed using SPSS software version 19.

Results:

Out of 24 cases of OSCC, twenty cases were positive for P 53 expression and four cases were negative for P 53 expression. Out of the four negative cases, one case was detected positive for HPV-16.

Conclusion:

HPV infection along with p53 expression helps in understanding its exact pathogenesis which further helps in expanding our spectrum of therapeutic modalities

Exfoliative cytology: A possible tool in age estimation in forensic odontology

Introduction:

Age determination of unknown human bodies is important in the setting of a crime investigation or a mass disaster because the age at death, birth date, and year of death as well as gender can guide investigators to the correct identity among a large number of possible matches.

Objective:

The study was undertaken with an aim to estimate the age of an individual from their buccal smears by comparing the average cell size using image analysis morphometric software.

Materials and Methods:

Buccal smears were collected from 100 apparently healthy individuals. After fixation in 95% alcohol, the smears were stained using standard Papanicolaou laboratory procedure. The average cell size was measured using Dewinter's image analysis software version 4.3. Statistical analysis of the data was done using one-way ANOVA, Bonferroni procedures.

Results:

The results showed significant decrease in average cell size of individual with increase in age. The difference was highly significant in age group of above 60 years.

Conclusion:

Age-related alterations are observed in buccal smears.

A call for a new speciality: Forensic odontology as a subject

Background:

Forensic science is defined as a discipline concerned with the application of science and technology to the detection and investigation of crime and administration of justice, requiring the coordinated efforts of a multidisciplinary team. Dental identification remains one of the most reliable and frequently applied methods of identification. Hence, it can be defined as the science that deals with evidence from the dental and oral structures and is a specialty in itself.

Objectives:

To analyze the level of awareness of Forensic Odontology amongst the individuals from the field of dentistry with the help of a survey.

Materials and Methods:

A questionnaire was prepared and a survey was conducted with a sample size of 200 divided in four groups.

Results:

Revealed inadequate knowledge, poor attitude, and lack of practice of forensic odontology prevailing among the dentists.

Conclusion:

Our study reflects the current situation of our country in the field of forensic odontology, which could be improved by introducing forensic odontology as a subject in the dental curriculum at both the undergraduate and the post-graduate levels.

Stature and gender determination and their correlation using odontometry and skull anthropometry

BACKGROUND

When the body has been mutilated, it is common to have the extremities or head amputated from the trunk. In concern with forensic odontology, an estimate must have been made based on the correlation of osteometry along with odontometry in determining sex, race and stature.

OBJECTIVE

The objective of this study is to investigate and correlate height and gender from odontometry and anthropometric data of the skull.

MATERIALS AND METHODS

The study was conducted in the Department of Oral and Maxillofacial Pathology and Microbiology, I.T.S Center for Dental studies and Research, Muradnagar, Ghaziabad (UP) with the representative study subjects of 60 patients as 30 males and 30 females in the age group of 15-25 years. The selected parameters were measured and then correlated to investigate stature and gender from odontometry and anthropometric data of the skull.

RESULTS

On linear regression analysis, the selected parameters were found to be statistically significant predictor of height. It was also established by Karl Pearson's coefficient correlation that the left mandibular canine index for female was statistically significant to show sexual dimorphism.

CONCLUSION

In the emerging field of forensic odontology, skull anthropometry, odontometry exhibits stature determination and strong sexual dimorphism.

Dentinoameloblastoma with ghost cells: A rare case report with emphasis on its biological behavior

Ameloblastomas are regarded as a homogeneous group of neoplasms with locally invasive character. They generally do not show induction of dental hard tissue formation except in few cases. Biological behavior and histogenesis of these tumors is still unexplored as there is lack of relevant studies and long follow-up of these patients. So, we aimed to report this rare case of dentinoameloblastoma with unique presence of ghost cells in middle-aged female involving maxilla with emphasis on its biological behavior. We conclude that although histogenesis of this tumor is not clear but biological potential is similar to conventional ameloblastoma requiring wider excision.

A quantitative and qualitative comparative analysis of collagen fibers to determine the role of connective tissue stroma on biological behavior of odontogenic cysts: A histochemical study

Background:

Intricate relationship between epithelium and connective tissue is believed to play a significant role in pathogenesis of odontogenic lesions. Role of epithelium in its pathogenesis is well established and at the same time role of mesenchyme cannot be underestimated.

Aim:

To investigate, compare and correlate different types and pattern of collagen fibers in odontogenic cysts using picrosiriusred stain under polarizing microscopy in order to delineate its exact role in biological behavior of these lesions.

Materials and Methods:

The color and orientation of collagen fibers in the wall of 15 odontogenickeratocysts, 15 dentigerous cysts and 15 radicular cysts and 5 progressive stages of odontogenesis was studied histochemically by staining sections with picrosirius red and examining under polarizing microscope. Results were statistically analyzed using SPSS software.

Results:

In OKC, DC and progressive stages of odontogenesis the predominant color of thin collagen fibers birefringence was found to be greenish yellow and in radicular cyst it was orange red whereas thick fibers in OKC showed yellow orange color whereas DC and RC showed orange red color. OKC showed principally parallel orientation of collagen fibers in loosely packed stroma in contrast to dentigerous and radicular cyst.

Conclusion:

Quality, organization and packing of collagen fibers is different in 3 cystic lesions which accounts for difference in biological behavior of these lesions and it justifies that neoplastic growth requires a functional stroma and the ability of neoplastic cells to induce the formation of such a stroma is of great importance.

Analysis of the changes in the basal cell region of oral lichen planus: An ultrastructural study

Context:

Oral lichen planus (OLP) affects 0.5-1% of the total world's population. The histological features of oral lichen planus were first described by Dubreuill in 1906. Despite the advent of various techniques, the etiology of lichen planus remains obscure, although many theories for the etiology have been proposed.

Aims:

By studying OLP electron microscopically, we shall be emphasizing on the cells and its interactions in specific/altered surroundings which would help us in hypothesizing the effects of its specific cell-to-cell interactions.

Materials and Methods:

A total of 20 cases of oral lichen planus were selected and categorized into erosive and nonerosive forms based upon clinical pattern and confirmed as lichen planus by histopathological analysis. Tissue specimens thus obtained were cut into two halves and fixed in appropriate fixatives, i.e., neutral buffered formalin for paraffin-embedded hematoxylin and eosin stained sections and 2.5% glutaraldehyde and 2% paraformaldehyde for electron microscopic purpose respectively.

Results:

Ultrastructural comparison among the two forms showed significant differences between them. The basal layer showed cytoplasmic processes, intercellular spaces, desmosomes, nuclei, and signs of degeneration. The erosive form showed elongated, narrow or irregular cytoplasmic projections whereas the nonerosive showed short and broad based projections.

Conclusions:

The present study confirms the ultrastructural findings of basal cells in OLP with previous authors findings. Besides this, the categorization of the ultrastructural differences between erosive and nonerosive has raised the question of difference in the probable cellular and molecular mechanism between erosive and nonerosive forms.

Synchronous oral squamous cell carcinomas with unusual histopathological feature

Patients with head and neck carcinomas have high incidence (2–3% per year) of second primary lesions. Although “field cancerization” was first described in oral squamous cell carcinomas (OSCCs), only few studies have been concentrated on multifocal primary squamous cell carcinomas in the oral cavity. Synchronous carcinomas are defined as second neoplasms at the same time or within 6 months period of primary lesions. After this period, they are considered as metachronous neoplasms. Tumors composed exclusively or in large part of clear cells are rare in salivary glands, jaws and oral mucosa. OSCCs composed of clear cells or clear cell variant are not documented in the English literature. We present an unusual case of synchronous OSCCs composed predominantly of clear cells.

Amelogenin: A novel protein with diverse applications in genetic and molecular profiling

Tooth enamel is a unique entity among all mineralized tissues because of the presence of high mineral content. It is non collagenous and does not undergo resorption and remodelling. Its formation occurs through a transient collaborating network of enamel matrix proteins which controls hydroxyapatite crystal growth and orientation. Amelogenins constitute about 90% of the total enamel matrix proteins and play a major role in enamel bio mineralization. Amelogenin isoforms coalesce into nanospheres thus dictating the width and thickness of apatite crystals. The X and Y copies of amelogenins do not undergo homologous recombination, thus preferring it for sex determination in modern forensics. Recently, it was discovered that application of amelogenin to diseased periodontal tissue surfaces enhanced the regeneration of all the periodontal tissues. Additionally, low molecular mass amelogenin polypeptides have also been thought to possess osteogenic potential. Recent data regarding usage of immunohistochemical markers for mesenchymal stem cells suggested that amelogenin has the capacity to induce the recruitment of mesenchymal stem cells directly or indirectly during regeneration of the supporting periodontal tissues. Thus, our current concepts of dental enamel formation should be reviewed thoroughly so that this information could be applied to clinical circumstances where this understanding may be particularly relevant.

Oral hygiene status of individuals with cardiovascular diseases and associated risk factors

Dentist and oral health screening may be the latest weapon in identifying persons at risk of cardiovascular disease. Oral infections, specifically periodontitis, may confer independent risks for different systemic conditions. The risk factors associated with cardiovascular diseases also suggest that the relationship between periodontal disease and diabetes works in both ways. The aim of this study was to support and strengthen the association and relationship between oral hygiene status of individuals with cardiovascular diseases and its associated risk factors. A simple random sampling was carried out in 200 inhabitants of Western Utter Pradesh, India. An oral health visit and examination was made for an equal number of males and females of different age groups with cardiovascular diseases. Evaluation of the oral status was made by means of an oral hygiene index, community periodontal index of treatment needs and loss of attachment. Evaluation of oral status in patients with cardiovascular diseases and in the control group has shown a statistically significant low level of oral health in patients with cardiovascular diseases as compared to control. Prevalence of systemic diseases in different age groups significantly correlated with the prevalence of severe periodontal diseases. Treating gum disease may reduce the risk of heart disease and improve health outcomes for patients with periodontal disease and vascular heart problems.

Altered expression of HSP70 in oral lichen planus

Background:

Oral lichen planus (OLP), a well-known mucocutaneous lesion has been the center of debate regarding its obscure etiopathogenesis. Recent highlight has been placed on the role of autoimmunity and a sect of constitutional molecules, the native chaperones HSP70, proposed to be important in the onset and progress of disease.

Aim:

To substantiate a potential role of HSP70 in the pathogenesis of oral lichen planus.

Settings and Design:

The study involved immunohistochemical (IHC) analyses in a laboratory under monitored conditions. It was a retrospective study on clinically and histopathologically confirmed specimens.

Materials and Methods:

30 samples of confirmed cases of OLP were selected and grouped on the basis of the thickness of the epithelial layer into atrophic, normal (classical) and acanthotic. An immunohistochemical analysis of the expression of HSP70 protein was done, followed by a quantitative and qualitative analysis of the stained layers.

Statistical Analyses:

A Z test was performed to estimate the difference observed between two sample proportions. The statistics was given at 1% level of significance i.e. P<0.01.

Results:

An increased expression of HSP70 was noted in the basal and suprabasal cells of the epithelium of OLP. A higher count and intensity of HSP70 expression was seen in the basal layer of the epithelium. Greater expression was noted in the epithelium of the atrophic group.

Conclusion:

The expression pattern of HSP70 positively implicates it in the pathogenesis of OLP.

Rare occurrence of intraosseous schwannoma in a young child, its review and its pathogenesis

Schwannoma is a benign, encapsulated, perineural tumor that arises from the Schwann cells. Approximately 25% of the reported cases originate from the head and neck region. Of these, approximately 1–12% occurs intraorally. The intrabony lesion accounts for less than 1% of the central neoplasms. We report a rare case of intraosseous schwannoma in an 8-year-old male patient characteristically originating from the mental nerve. Radiographic examination followed by histopathological evaluation was further confirmed by immunohistochemical markers, S-100 protein, and GFAP that stained intensely positive for the tumor. Thus, confirming the diagnosis of intraosseous schwannoma.

Multiple supernumerary teeth and odontoma in the maxilla: A case report

Most supernumerary impacted teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. The detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the diagnostic problems associated with multiple supernumerary impacted teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity.

Biopsy and Tissue Processing Artifacts in Oral Mucosal Tissues

Artifact refers to an artificial structure or tissue alteration on a prepared microscopic slide—the result of an extraneous factor. It can result in alteration of normal morphologic and cytologic features that may occur as a result of the way the tissue has been handled, right from the time the biopsy, which is surgically obtained till the entire histopathological procedures of fixation, processing, embedding, sectioning and staining are performed on it. The procedures themselves subject to human and material errors resulting in an artifact may interfere with an adequate diagnosis or render the tissue to be undiagnosable. The present review provides in depth knowledge on the mismanagement of tissue during different biopsy sampling techniques and various processing procedures leading to the appearance of artifacts. Such familiarization in turn will contribute to knowledge of the material and instruments required for correct biopsy performance in dentistry, as well as of the material required for correct sample storage, transport and processing thereby necessitating stringent precision in technique at every step to enable an accurate diagnosis.

How to cite this article

Kumar K, Shetty DC, Dua M. Biopsy and Tissue Processing Artifacts in Oral Mucosal Tissues. Int J Head Neck Surg 2012;3(2):92-98.

Case series on vascular malformation and their review with regard to terminology and categorization

Malformations of vascular nature originate as anomalies caused due to errors in vasculogenesis. These tumors are generally broadly classified into vascular tumors (hemangiomas) and vascular malformations (venous malformations, arteriovenous malformations, lymphatic malformations). These descriptive tumors and malformations have been categorized based on the architectural assembly of vessels. Lymphangiomas are further subclassified microscopically into capillary, cavernous, cystic and lymphangioendothelioma, depending upon their histopathological features. Lymphatic malformations or lymphangiomas are uncommon congenital malformations of the lymphatic system, usually occurring in the head and neck region, characterized by collections of ectatic lymph vessels that form endothelial lined cystic spaces. Advancements in the knowledge of pathogenesis of such vascular malformations are continuously changing their treatment protocols. Early recognition is of utmost importance for initiation of proper treatment and avoiding serious complications. Hemangiolymphangioma is a variant of lymphangioma showing vascular component. Herewith, we present a case of vascular malformation diagnosed as hemangiolymphangioma histopathologically in a 9-year-old girl, along with a review of literature regarding its categorization.

A color contrast aided density imaging technique to differentiate between dental hard tissues and its relevance

AIM

Radiographic interpretation of a disease requires knowledge about normal structures. The calcifying jaw diseases can range from radiolucent areas to varying degrees of calcification. Therefore, it is vital to differentiate radiographically between various hard tissues.

MATERIALS AND METHODS

We have illustrated the use of computed tomography scan to quantify the calcified structures as dentin and enamel in a case of ameloblastic fibro-odontoma.

RESULTS

The enamel, dentin and cementum showed different values.

CONCLUSION

The "Dentascan" can be used to distinguish the hard tissues in a variety of calcifying diseases of jaws.

Relevance of tumor angiogenesis patterns as a diagnostic value and prognostic indicator in oral precancer and cancer

Tumor angiogenesis occurs by recruitment of endothelial cell precursors or by sprouting of existing capillaries, which differ from the normal vasculature by having an altered morphology that can be exploited for diagnosis and as a prognostic indicator. Improved technologies have propelled diagnosis into a new era. These technologies have to be used with great precision. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Accurate judgment of the proper site for biopsy is essential for reaching a correct diagnosis. The aim of this report is to analyze the vascular patterns with the help of direct oral microscopy and the technique of stereo-optical microscopy in the oral cavity to select biopsy sites, and compare the outcome of a directed biopsy with that of biopsy specimens obtained from sites selected solely on the basis of clinical criteria. The study sample comprised 50 oral mucosal lesions. A statistically significant difference was noted between samples judged to be microscopically representative sites. We conclude that this method would aid in early and better diagnosis and treatment planning of oral premalignant and malignant lesions by assessing the various vascular patterns in the mucosa.

Classifying odontogenic keratocysts as benign cystic neoplasms: a molecular insight into its aggressiveness

OBJECTIVE

The present study was conducted with the aim to evaluate the expression of p53 in Odontogenic Keratocyst (OKC) and Ameloblastoma to correlate with the aggressiveness of these lesions.

MATERIAL AND METHODS

Immunohistochemical (IHC) staining was performed using anti-p53 antibody in eighteen cases each of OKC and ameloblastoma.

RESULTS

p53 positivity was seen in all the cases of OKCs and ameloblastomas. p53 positive cells were seen predominantly in the suprabasal cell layer of OKC and in the peripheral pre-ameloblast like cells in ameloblastoma. Total p53 count was significantly higher in ameloblastoma as compared to OKC. But the intensely stained p53 cell count showed no statistically significant difference between the two lesions.

CONCLUSION

The high p53 expression in OKC when compared with ameloblastoma, acknowledges OKC as an aggressive lesion and hence a more aggressive treatment modality is recommended.