Targeted therapies in ameloblastomas and amelobastic carcinoma-A systematic review

Targeted therapy has the potential to be used in the neoadjuvant setting for odontogenic tumors, reducing the morbidities associated with major surgery. In this regard, the aim of this study was to summarize the current evidence on the different forms of targeted therapy, effectiveness, and drawbacks of this course of treatment. Four databases were searched electronically without regard to publication date or language. Grey literature searches and manual searches were also undertaken. Publications with sufficient clinical data on targeted therapy for odontogenic tumors were required to meet the criteria for eligibility. The analysis of the data was descriptive. A total of 15 papers comprising 17 cases (15 ameloblastomas and 2 ameloblastic carcinomas) were included. Numerous mutations were found, with BRAF V600E being most common. Dabrafenib was the most utilized drug in targeted therapy. Except for one case, the treatment reduced the size of the lesion (16/17 cases), showing promise. Most of the adverse events recorded were mild, such as skin issues, voice changes, abnormal hair texture, dry eyes, and systemic symptoms (e.g., fatigue, joint pain, and nausea). It is possible to reach the conclusion that targeted therapy for ameloblastoma and ameloblastic carcinoma may be a useful treatment strategy, based on the findings of the included studies.

Calibration improves the agreement in grading oral epithelial dysplasia-Findings from a National Workshop in Malaysia

INTRODUCTION

A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems.

METHODS

A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems.

RESULTS

A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; Kw 0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise.

CONCLUSION

This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.

Controversies in verruco papillary lesions of the oral cavity-A systematic review

INTRODUCTION

Verruco papillary lesions (VPL) in the oral cavity encompass a spectrum of lesions starting from benign, potentially malignant to entirely malignant tumors. Much of the controversies in these entities occur due to lack of consensus on the disease characteristics and the management. This systematic review was conducted to identify and describe different lesions categorized as VPL in the oral cavity and their association with malignancy.

METHODS

An electronic literature search was conducted in MEDLINE (via PubMed), Scopus, LILAC, IMSEAR, and CENTRAL databases, which retrieved a total of 1020 abstracts. These abstracts were managed through Rayyan and Mendeley software, and only 28 studies with high quality were included in the systematic review.

RESULTS

Studies were published from 1992 to 2021. From the extracted data, nine different entities under the umbrella term VPL were identified associated with malignancy. We describe the clinical and histopathological characteristics of these and propose a uniform framework for nomenclature.

CONCLUSIONS

Lack of well-planned research with adequate follow-up duration and inadequate quality standards are major barriers for the lack of evidence. The use of uniform nomenclature, as proposed in this study, and research at the molecular level will greatly reduce the controversies in understanding oral VPL associated with malignancy.

Odontogenic Carcinosarcoma: An Updated Literature Review and Report of a Case

BACKGROUND

Odontogenic carcinosarcoma (OCS) is an exceptionally rare malignant mixed odontogenic neoplasm, which mostly arises from recurrent benign odontogenic tumour that undergoes malignant transformation.

METHODS

A literature review was conducted using the keyword of "Odontogenic carcinosarcoma" and all relevant articles were screened. The data collected include demographic profile (age, gender), clinical information (symptoms, location, size), radiologic features, histopathological examination, management, recurrence, metastases, and survival status.

RESULTS

A total of 17 OCS cases including a new case from our hospital. The incidence of OCS was highest in the third decades of life with predilection for male and posterior region of mandible. Clinically, patients may present with swelling and neurological symptoms. Radiographic examination often showed radiolucency with ill-defined border. This tumour demonstrates an aggressive behaviour with reported cases of distant metastases to the lung, lymph nodes, rib, and pelvis. Here, we report an interesting case of OCS in a 38-year-old man with a previous diagnosis of ameloblastoma. The patient was diagnosed with ameloblastoma but refused surgical intervention and returned after 10 years with rapidly enlarging mass on the right side of mandible. Microscopically, the lesion appears as biphasic odontogenic tumour with malignant cytological features seen in both epithelium and mesenchymal components. The spindle to round mesenchymal tumour cells were only positive for vimentin. Ki67 proliferation index was high in both epithelium and mesenchymal components.

CONCLUSION

This case showed the tendency of untreated ameloblastoma to undergo malignant changes in the long term.

EBV-Associated Smooth Muscle Tumor in the Malar Area of an HIV-Positive Patient: A Case Report

BACKGROUND

EBV-associated smooth muscle tumors (EBV-SMTs) are rare and typically develop in individuals with a compromised immune system, particularly those who have acquired immunodeficiency syndrome (AIDS) or who have undergone organ transplants.

METHODS

We document a case of EBV-SMT in an HIV-positive 25-year-old man. The lesion was incised and assessed histologically and a panel of immune markers were performed. EBV association was demonstrated by in situ hybridization for EBV-encoded RNA (EBER-ISH).

RESULTS

Microscopically, the tumor composed of mildly pleomorphic, ovoid to spindled cells with numerous slit-like vascular channels. The tumor cells exhibited diffuse and strong immunoreactivity for smooth muscle actin (SMA) and focal positivity for h-caldesmon. EBER-ISH of the tumor cells revealed strong positive nuclear signals.

CONCLUSION

The histopathological features of EBV-SMT do not conform to either benign or malignant SMTs and it has a peculiar predilection to develop at sites unusual for leiomyoma or leiomyosarcoma. The key diagnostic features of EBV-SMT include history of immunosuppression, histologic evidence of primitive and mildly pleomorphic cells maintaining blunt nuclear features in most areas, and positivity for EBER-ISH.

Image collection and annotation platforms to establish a multi-source database of oral lesions

OBJECTIVE

To describe the development of a platform for image collection and annotation that resulted in a multi-sourced international image dataset of oral lesions to facilitate the development of automated lesion classification algorithms.

MATERIALS AND METHODS

We developed a web-interface, hosted on a web server to collect oral lesions images from international partners. Further, we developed a customised annotation tool, also a web-interface for systematic annotation of images to build a rich clinically labelled dataset. We evaluated the sensitivities comparing referral decisions through the annotation process with the clinical diagnosis of the lesions.

RESULTS

The image repository hosts 2474 images of oral lesions consisting of oral cancer, oral potentially malignant disorders and other oral lesions that were collected through MeMoSA^® UPLOAD. Eight-hundred images were annotated by seven oral medicine specialists on MeMoSA^® ANNOTATE, to mark the lesion and to collect clinical labels. The sensitivity in referral decision for all lesions that required a referral for cancer management/surveillance was moderate to high depending on the type of lesion (64.3%-100%).

CONCLUSION

This is the first description of a database with clinically labelled oral lesions. This database could accelerate the improvement of AI algorithms that can promote the early detection of high-risk oral lesions.

Association of clinicopathological factors and treatment modalities in the recurrence of ameloblastoma: Analysis of 624 cases

BACKGROUND

Ameloblastoma is an odontogenic tumour exhibiting locally invasive behaviour and high recurrence rate after treatment. Conventional ameloblastoma is reportedly been more aggressive showing infiltrative growth patterns and a tendency for recurrence. This is a retrospective study performed to analyse the relationship between clinicopathological characteristics and treatment modalities in the recurrence of ameloblastoma.

METHODS

624 cases of ameloblastoma comprising of 519 non-recurrent ameloblastoma and 105 recurrent ameloblastoma from two main diagnostic centres in Malaysia and Sri Lanka were included. The demographic data, clinical characteristics, histopathological data, treatment modality and episodes of recurrence were extracted and analysed.

RESULTS

The mean age for recurrent ameloblastoma was 37.23 with a peak occurrence in the third decade of life. Recurrent ameloblastoma was marginally female predominant with male to female ratio of 1:1.3. Mandible was the commonest site for the recurrence with a predilection for more than two segments of left mandible followed by left posterior mandible. Follicular (58.1%) histopathological variant was the most reported type to recur followed by plexiform (17.1%). 49.5% of recurrent cases were treated with conservative approach. 65.7% of recurrent cases demonstrated a single episode of recurrence. Mixed (follicular and plexiform) histopathological variants showed the longest average years (11.5 years) for the single episode of recurrence. Plexiform ameloblastoma treated with conservative approach recurred in the shortest follow-up period. The recurrence of ameloblastoma was significantly associated with age group, sub-site of occurrence and histopathological variants (p<0.05).

CONCLUSION

This study showed that age, sub-site of occurrence and histopathological variants are significant factors responsible for the recurrence of ameloblastoma.

Critical appraisal of different triggering pathways for the pathobiology of pemphigus vulgaris-A review

Pemphigus vulgaris is an autoimmune blistering disease with an increased potential for mortality. The epithelium is key in understanding the pathobiology as it is specialized to perform functions like mechanical protection, immunological defense, and proprioception. In order to perform these array of functions, epithelial integrity is important. This integrity is maintained by a host of molecules which orchestrate the ability of the keratinocytes to function as a single unit. Desmoglein 3 antibodies formed in genetically susceptible individuals are known to cause the disruption of the intact oral mucosa leading to the formation of blisters in pemphigus vulgaris patients. However, there are underlying complex triggering pathways leading to the clinical disease. The aim of the review is to congregate and critically appraise the various triggering pathways which contribute toward the pathobiology of pemphigus vulgaris. Articles relevant to the pathobiology of pemphigus vulgaris were identified from various search databases till the year 2020. The pathogenesis of pemphigus vulgaris is complex, and it involves an in-depth understanding of the various predisposing factors, provoking factors, and progression mechanisms. Congregation of the various triggering pathways will open our minds to understand pemphigus vulgaris better and in turn develop a reliable treatment in the near future.

A Sociological Analysis and Exploration of Factors Associated with Commercial Preparations of Smokeless Tobacco Use in Sri Lanka

Background:

Use and addiction to commercial preparation of Smokeless Tobacco (CPSLT) is creating new socio-cultural issues and health challenges in Sri Lanka. The objective of this sociological study is to investigate and analyse the socio-cultural factors that influence CPSLT use Sri Lanka to enable development of effective interventions.

Methods:

This is a qualitative study for which data was collected through in-depth interviews in selected groups that use CPSLT. Thirty-five interviews were carried out in seven of the 24 districts in the country representing urban, rural, plantation communities and different livelihood and ethnic, gender and age groups in the year 2016. Purposive and snowball sampling techniques were used for selecting interviewees. The data was analysed by using qualitative data analysis techniques and sociological perspectives.

Results:

This study reveals that the CPSLT use has integrated with the culture of several sociological and livelihood groups. Products such Thool (tobacco powder) and Maawa (dried areca-nut with flaked tobacco and some flavoured chemicals) were identified as the most popular forms of CPSLT. Use of CPSLT has developed as a silent sub-culture specific to several social and livelihood groups. The informal CPSLT industry operating in the urban and sub-urban areas is influencing the school children and youth engaged in sports. Different groups of users express different reasons and justifications for its use.

Conclusion:

Use of CPSLT is closely integrated with the day to-day lifestyle and values of people of specific groups. and is an unseen part of life. Therefore, interventions will be urgently required to control the use of CPSLT to prevent its significant health impacts, considering the different contexts, symbolisms and justifications of its among the different groups.

Evaluation of Successfulness of Capacity Building Programmes on Smokeless Tobacco and Areca Nut Cessation

Background:

Prevalence of smoking in Sri Lanka has shown a gradual reduction whilst the use of smokeless tobacco and areca nut exhibits an increasing trend. At present, only a few well-structured smokeless tobacco (SLT)/areca nut (AN) cessation programs have been conducted in Sri Lanka, which is a gross underachievement as betel chewing-related oral squamous cell carcinoma is the most common cancer in Sri Lankan males. As General Dental Practitioners (GDP) do not contribute significantly to SLT/AN cessation activities at present, capacity building programs on SLT/AN control were carried out. The study evaluated the knowledge, attitude and practices imparted on SLT/AN control among dental surgeons.

Methods:

Following a single day capacity building program on smokeless tobacco / areca nut control, two self-administered questionnaires were used to assess the improvement of knowledge and change of attitudes among 663 GDPs.

Results:

Majority had a good knowledge on harmful effects of SLT but not on areca nut. Knowledge of the current legislation on SLT control in Sri Lanka and carcinogenicity of areca nut was not satisfactory. Almost all agreed that proper counseling leads to patient quitting the habit, a formal training is necessary to conduct tobacco control activities and it should be a part of the regular treatment modalities. More than 80% of the participants support strict legislation. Most important factors leading to poor involvement in tobacco cessation activities were lack of expertise and inadequate educational material and not breach of patient privacy and lack of financial incentives. 20.1% dental surgeons had consumed smokeless tobacco / areca nut products in the past and only a few were current users of tobacco and/or areca nut.

Conclusions:

Well planned workshops are efficient in improving knowledge, practices and attitudes of dental surgeons towards SLT/AN cessation.

Sclerosing odontogenic carcinoma - review of all published cases: is it a justifiable addition as a malignancy?

INTRODUCTION

Sclerosing odontogenic carcinoma was a new addition to the list of head and neck tumors by World Health Organization in 2017. This lesion has scarcely been reported and a lack of pathognomonic markers for diagnosis exists.

OBJECTIVE

The aim of the study was to summarize findings from the available literature to provide up-to-date information on sclerosing odontogenic carcinoma and to analyse clinical, radiological, and histopathological features to obtain information for and against as an odontogenic malignancy.

METHODS

We conducted a comprehensive review of literature by searching Pubmed, EBSCO and Web of Science databases, according to PRISMA guidelines. All the cases reported as sclerosing odontogenic carcinoma in English were included. Data retrieved from the articles were gender, age, clinical features, site, relevant medical history, radiographical findings, histopathological findings, immunohistochemical findings, treatments provided and prognosis.

RESULTS

Mean age at diagnosis of sclerosing odontogenic carcinoma was 54.4 years with a very slight female predilection. Sclerosing odontogenic carcinoma was commonly reported in the mandible as an expansile swelling which can be asymptomatic or associated with pain or paraesthesia. They appeared radiolucent with cortical resorption in radiograph evaluation. Histologically, sclerosing odontogenic carcinoma was composed of epithelioid cells in dense, fibrous, or sclerotic stroma with equivocal perineural invasion. Mild cellular atypia and inconspicuous mitotic activity were observed. There is no specific immunohistochemical marker for sclerosing odontogenic carcinoma. AE1/AE3, CK 5/6, CK 14, CK19, p63 and E-cadherin were the widely expressed markers for sclerosing odontogenic carcinoma. Surgical resection was the main treatment provided with no recurrence in most cases. No cases of metastasis were reported.

CONCLUSION

From the literature available, sclerosing odontogenic carcinoma is justifiable as a malignant tumor with no or unknown metastatic potential which can be adequately treated with surgical resection. However, there is insufficient evidence for histological grading or degree of malignancy of this tumor.

Knowledge and Attitudes of Nursing Students Towards Smokeless Tobacco and Areca Nut Control in Central Province of Sri Lanka

Background: Use of smokeless tobacco (SLT) and areca nut (AN) is widespread in Sri Lanka. Several workshops to train healthcare workers on SLT/ AN cessation programmes (SLT/AN-CP) were carried out. Objective of the study was to evaluate the enhancement of knowledge and attitudes related to SLT/AN-CP among nursing students following a workshop. Methods: A cross sectional study was conducted with the use of two questionnaires. A total of 212 nursing students were assessed and the study group included 184 females (86.8%). Results: Results were analyzed according to the 3 main areas of the assessment, i.e knowledge related to Oral cancer, knowledge related to SLT, its effects and cessation practices and attitudes regarding SLT cessation counselling. Out of the eight questions to assess the knowledge related to oral cancer, five questions demonstrated a statistically significant difference (P<0.05) following the workshop when compared to the pre workshop knowledge. Even though, majority had a good knowledge on harmful effects of SLT and AN, it was interesting to note that 14.15 % of the participants were unaware about the fact that the oral cancer is the commonest cancer among Sri Lankan males. 96.7% agreed that proper counseling would lead patient to quit the habit. Conclusions: This preliminary study showed that the knowledge and attitude towards SLT/AN-CP among nursing students were satisfactory and effective workshops can be used to improve their knowledge and attitudes towards SLT/AN-CP especially in low economical settings

Clinical and demographic characteristics of adenomatoid odontogenic tumors: analysis of 116 new cases from a single center

Introduction

The adenomatoid odontogenic tumor is a relatively uncommon odontogenic neoplasm representing about 4.7% of all odontogenic tumors.

Objective

The aim of this study was to determine the demographic and clinical profile of the adenomatoid odontogenic tumors in a Sri Lankan population.

Methods

Data gathered from the cases received for a period of 38 years from the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya. Request forms, biopsy reports and electronic data base of the department were used to obtain relevant information. Demographic data including age, gender and location of the tumor were included in the analysis.

Results

Out of 116 cases of adenomatoid odontogenic tumor, the mean age was 21.02 ± 11.24. It occurs more fre quently in the second decade of life, more prevalent in females, most often associated with the maxilla, predominantly affecting anterior jaw bones and presenting mostly in the right side of the jaw bone. The results from the present study showed the statistically significant relationship with site of occurrence (maxilla/mandible) and age (p < 0.005). Further, depending on whether it occurs in anterior/mid/posterior site also showed a significant relationship with age (p ≤ 0.001). However, side of occurrence, left or right or site of occurrence, showed no statistically significance with age (p > 0.05).

Conclusion

Adenomatoid odontogenic tumor occurs more frequently in the second decade of life with a significant female predominance and the commonest site is anterior maxilla. This study revealed few differences on demographic and clinical presentations of adenomatoid odontogenic tumor from some regions of the world.

Malignant transformation of a long-standing submental dermoid cyst to a carcinosarcoma: a case report

Background

Submental dermoid cysts are uncommon midline cysts which occur due to entrapment of ectoderm between the second and third branchial arches during embryogenesis. Most dermoid cysts of the head and neck are benign, but rarely malignant transformation may occur. To the best of our knowledge, this is the first report of a carcinosarcoma arising in a submental dermoid cyst.

Case presentation

A 42-year-old Sri Lankan Tamil man presented with a large cystic swelling in his submental region which was diagnosed as an extensive submental dermoid cyst. The cyst had been asymptomatic for 11 years but there was sudden enlargement and pain during the past 2 months. On surgical removal, a primary carcinosarcoma arising from part of the cyst wall was identified. After completion of radiotherapy, the disease was well controlled and he was disease free at 18 months.

Conclusions

Although extremely rare, a dermoid cyst of the submental region can undergo malignant transformation. It can be successfully treated with surgical excision and radiotherapy.

Oral submucous fibrosis: review on mechanisms of malignant transformation

Research studies focusing on various aspects of carcinogenesis in the background of fibrosis have advanced significantly in the recent past, allowing us to understand the mechanisms involved in malignant transformation of oral submucous fibrosis (OSF), the most prevalent potentially malignant oral disorder in South Asia. The role of areca nut as a carcinogen has been proven beyond doubt, with a large number of animal studies demonstrating its carcinogenicity, mutagenicity, and genotoxicity. Studies on the molecules implicated in cell cycle regulation, hypoxia, processes leading to DNA double-strand breaks, senescence, and many other pathways related to carcinogenesis have shown ample evidence for the malignant transformation in OSF induced by areca nut. More importantly, the understanding of the mechanisms of malignant transformation may lead to early diagnosis of oral squamous cell carcinoma arising in the background of OSF, which is now considered to constitute a clinicopathologically distinct disease, and the differences are believed to arise from the differential mechanisms of areca nut carcinogenesis. Therefore, the objective of this study is to review the literature on the various mechanisms leading to the malignant transformation of OSF.

Comparison of spatula and cytobrush cytological techniques in early detection of oral malignant and premalignant lesions: a prospective and blinded study

BACKGROUND

The use of oral cytology to diagnose malignant and premalignant lesions at an early stage is considered crucial. The aim of this study was to evaluate the diagnoses of the spatula and the cytobrush techniques compared with the gold standard histopathological findings, analysed according to different diagnostic criteria.

METHODS

Cytological smears were obtained from 76 suspicious oral malignant lesions and 116 oral leukoplakia lesions using two techniques: cytobrush plus cell collector and metal spatula. Subsequently, a surgical biopsy was performed on each lesion to achieve a histopathological diagnosis. Evaluation was conducted with respect to three different diagnostic criteria.

RESULTS

The sensitivity for diagnosing carcinoma in clinically malignant cases was 89.58% and 60.42% for cytobrush and spatula techniques, respectively. Inclusion of severe dysplastic cases for 'high-risk' lesions increased the sensitivity up to 96.36% and 78.18% for two techniques, respectively. In leukoplakia lesions, malignant and severely dysplastic cells were diagnosed at a sensitivity of 88.89% in the cytobrush and 55.56% in the spatula techniques. Extending the criteria by defining malignant or any dysplastic findings as positive, sensitivity was increased to 98.02% and 89.11% for the spatula and the cytobrush techniques, respectively. Specificity for both techniques increased to 100%. The difference between the diagnoses of histopathology and the spatula cytology was statistically significant (P < 0.01), while no such difference was found with the cytobrush technique (P > 0.1).

CONCLUSION

The cytobrush, unlike the spatula, is a useful screening instrument for early diagnosis of suspicious oral lesions and could therefore contribute to improved oral cancer prognosis.

Predictive model of oral cancer metastasis for different cancer sites and age groups

AIM

The high incidence rates for oral cancer (excluding lip) are especially found in the South and South-East Asia. Therefore, the aim of the present study was to investigate the relationship between sex, age, site, and metastasis of a large sample with oral squamous cell carcinoma (OSCC).

METHODS

A total of 989 OSCC treated with neck dissection were selected. All the relevant data were recorded from biopsy request forms. The patients were divided into seven groups, and there were nine different oral sites.

RESULTS

The male-to-female ratio of the sample was 4:1. Most of the patients were aged between 30 and 60 years. Of the 989 patients, approximately 40% patients had metastasis. Age <30 years showed a higher probability of metastasis compared to higher age groups, but it was not statistically significant. Palate cancers had more than 14 times higher chance of metastasis, followed by maxilla (4.6 times) and tongue (2.8 times).

CONCLUSION

The present study provides important information on the metastatic potential of OSCC in different oral sites, and identifies high-risk age groups for metastasis. This will be helpful in planning neck treatment for OSCC.

Dysregulation of the suppressor of cytokine signalling 3-signal transducer and activator of transcription-3 pathway in the aetiopathogenesis of Sjögren's syndrome

The suppressor of cytokine signalling 3 (SOCS3) negatively regulates the Janus kinase (JAK)/signal transducer and activator of transcription-3 (STAT-3)/interleukin (IL)-17 pathway. The proinflammatory cytokine IL-17 is over-expressed in Sjögren's syndrome (SS) and is a key factor in its pathogenesis. We hypothesized that IL-17 over-expression in SS results from ineffective regulation by SOCS3. The expression of SOCS3 was analysed in peripheral blood mononuclear cells (PBMC) from SS cases, sicca controls (SC) and healthy controls (HC) and tissue samples from SS, SC and healthy salivary glands (HSG). PBMC and salivary gland tissue from SS and controls were dual-immunostained for SOCS3 and IL-17. IL-6-stimulated PBMC from SS and controls were evaluated for time-dependent STAT-3 activation and SOCS3 induction, and for IL-17 expression. Immunoblotting revealed greater levels of SOCS3 in PBMC from SS than SC (P = 0·017) or HC (P < 0·001). Similarly, the proportion of salivary-gland tissue cells staining for SOCS3 was significantly higher in SS than SC (P = 0·029) or HSG (P = 0·021). The cells in PBMC/salivary gland samples from controls predominantly expressed either SOCS3 or IL-17. However, there was a high frequency of SOCS3/IL-17 co-expression within cells of SS samples. IL-6-stimulation of PBMC from SS cases revealed prolonged activation of STAT-3 with reduced negative regulation by SOCS3, and enhanced expression of IL-17. This study showed that SOCS3 expression is up-regulated in SS. However, the absence in SS of the normal inverse relationship between SOCS3 and pSTAT-3/IL-17 indicates a functional disturbance in this signalling cascade. Consequently, a reduction in function, rather than a reduction in expression of SOCS3 accounts for the unregulated expression of IL-17 in SS, and may play a crucial role in aetiopathogenesis.

Diagnostic dilemma of unicystic ameloblastoma: novel parameters to differentiate unicystic ameloblastoma from common odontogenic cysts

AIM

Diagnostic criteria that have been specified for unicystic ameloblastomas (UAs) are not always helpful to differentiate these cystic tumors from common odontogenic cysts. The aim of this study therefore was to identify additional histopathological features (other than the features considered for the diagnosis of UA at present) that would be helpful to differentiate UA from odontogenic cysts.

METHODS

One hundred histopathologically confirmed unicystic ameloblastomas and 20 cases each of radicular, inflamed dentigerous and non-inflamed dentigerous cysts were selected. Histopathological features of the UAs that are not used as diagnostic criteria at present were identified.

RESULTS

Hyperplastic arcading epithelial proliferations with stellate-reticulum-like and vacuolated cells were always seen associated with inflammation in odontogenic cysts, while in UA plexiform-like areas were also seen without inflammation (P < 0.001). In addition, a spiky rete pattern was observed in non-inflamed UA while this pattern was observed only in inflamed odontogenic cysts. Furthermore, spiky retes together with subepithelial hyalinization were usually observed in UAs while only subepithelial hyalinization was observed in non-inflamed dentigerous cysts.

CONCLUSIONS

Combinations of histopathological features were identified to differentiate non-inflamed UA from common odontogenic cysts. However, presence of inflammatory changes in UA precludes the use of features identified in the present study for diagnostic purposes.

Pigmented mucoepidermoid carcinoma with spindle cell differentiation

Mucoepidermoid carcinoma is the most common malignant salivary gland tumor of children and adults, showing diverse histopathologic features. Mucoepidermoid carcinoma with both melanin pigmentation and spindle cell differentiation has not been previously reported. We report the first documented case of pigmented mucoepidermoid carcinoma with spindle cell differentiation in a 34-year-old woman who presented with a swelling of the floor of the mouth.

Clinical and histopathologic parameters in survival of oral squamous cell carcinoma

OBJECTIVE

The aim of this study was to assess the relevance of clinical and histopathologic parameters on survival of oral squamous cell carcinoma (OSCC) patients in Sri Lanka.

STUDY DESIGN

A cohort of 193 previously diagnosed OSCC patients were followed for up to 5 years. Clinical and histopathologic parameters were analyzed regarding local recurrence and 5-year survival after treatment.

RESULTS

Site, stage, local recurrence, degree of differentiation, degree of keratinization, pattern of invasion, and status of the excision margins showed a significant association with the 5-year survival (P < .05). Multivariate analysis identified stage, pattern of invasion, and status of the excision margins as true independent prognostic indicators of OSCC. Pattern of invasion was the best prognosticator of both local recurrence and overall survival in the Cox regression model (P < .001).

CONCLUSIONS

Stage, pattern of invasion, and status of the excision margins are superior prognostic indicators of OSCC compared with other parameters.

Melanotic neuroectodermal tumor of infancy: a histopathological and immunohistochemical study

Melanotic neuroectodermal tumor of infancy is an uncommon neoplasm that normally occurs in the anterior maxilla of children less than 1 year of age. This is a tumor with controversial origin, although neural crest origin is proposed. This case report presents an analysis of histopathological and immunohistochemical findings in this rare tumor.

Genetics/epigenetics of oral premalignancy: current status and future research

Squamous cell carcinoma (SCC) of the oral and oropharyngeal region is the sixth most common malignancy in the world today. Despite numerous advances in treatment, long-term survival from this disease remains poor. Early detection can decrease both morbidity and mortality associated with this neoplasm. However, screening for potentially malignant disease is typically confounded by difficulty in discriminating between reactive/inflammatory lesions vs those lesions that are premalignant in nature. Furthermore, the histologic diagnosis of dysplasia can be subjective and is thus prone to a considerable range of interpretation. Similarly, no definitive, validated criteria exist for predicting which dysplastic lesions are most likely to progress to cancer over time. Given this state of science, the presence of dysplasia can only be used to indicate that an oral lesion may have an increased risk of malignant transformation. Molecular biomarkers capable of identifying the subset of lesions likely to progress to cancer are required to eliminate this clinical diagnostic dilemma. The purpose of this review is to assess the current state of knowledge regarding genetic/epigenetic alterations observed in oral mucosal premalignancy. In addition, recommendations for future research studies directed at defining the predictive capacity of specific biomarkers in this modeling are presented.

Grading oral epithelial dysplasia: analysis of individual features

BACKGROUND

Assessing epithelial dysplasia to predict malignant transformation remains problematic in many tissues because grading systems are poorly structured and individual features poorly defined. Dysplasia grading is criticised for lack of reproducibility and poor predictive value. Grading systems for upper aerodigestive tract dysplasia have evolved over several decades and are not supported by good outcome experimental data.

METHODS

 This study analysed the individual features of dysplasia in 86 oral dysplastic lesions and determined the reproducibility of scoring for each, and correlated them with other features and clinical factors using complex clustering analyses.

RESULTS

A uniform pattern of dysplasia was found in 37 lesions, focal dysplasia in 36 and in 13 lesions dysplasia formed complex discontinuous patterns. There was wide variation in reproducibility of scoring of individual features and many, including thickness, some types of rete morphology, basaloid cell anisonucleosis, basal dyscohesion, and dyskeratosis as deep single cells correlated with sub-sites. Rete morphology, type of keratinisation, hyperchromatism of the basaloid compartment, prickle cell anisonucleosis and extension down salivary ducts correlated with smoking. Conventional grading and oral intraepithelial neoplasia (OIN) grading by 'thirds affected' showed strong correlation overall but scores obtained with the OIN system tended to a higher grade at all sites except soft palate/fauces. There was poor correlation between the systems for moderate dysplasia and also severe dysplasia at some sites. Individual features could not be shown to cluster to form distinct patterns of dysplasia.

CONCLUSIONS

These variations may account in part for the lack of reproducibility and poor predictive value of the grading systems in current use and could inform the design of future grading systems.

A clinico-pathological comparison between mandibular and maxillary ameloblastomas in Sri Lanka

BACKGROUND

The aim of this retrospective study was to analyse the relative prevalence and the clinico-pathological characteristics of mandibular and maxillary ameloblastomas in Sri Lanka.

METHODS

Clinico-pathological features of a total of 286 cases of ameloblastomas were analysed.

RESULTS

Out of the 286 cases, 87.8% (251/286) of ameloblastomas occurred in the mandible, while 10.8% (31/286) occurred in the maxilla indicating a ratio of 8:1. In the mandible, 54% (136/251), 40% (100/251) and 6% (15/251) of tumours and in the maxilla, 23% (7/31), 48% (15/31) and 29% (9/31) of tumours were solid/multicystic ameloblastomas (SMA), unicystic ameloblastomas (UA) and desmoplastic ameloblastomas (DA) respectively. No gender predilection was observed in mandibular or maxillary ameloblastomas. Most of the lesions were observed in 2nd to 5th decade of life (mean age 33.2 years). No differences between mandibular and maxillary ameloblastomas were observed with reference to overall cellularity and mitotic activity. Solid/multicystic and UAs showed a predilection to posterior region, while DAs were frequently found in the anterior region of both jaws. Twenty-one percentage (60/286) of ameloblastomas presented with recurrences, and 94% (34/36) of these recurrences were observed in cases treated conservatively.

CONCLUSION

In conclusion, mandibular ameloblastomas were more prevalent than maxillary ameloblastomas, while no differences were observed in age or gender distribution between the mandibular and maxillary ameloblastomas. However, higher proportion of DAs and UAs was observed in the maxilla compared with some of the other studies. SMA should be treated with resection to prevent recurrences.

Aberrant beta-catenin expression and adenomatous polyposis coli gene mutation in ameloblastoma and odontogenic carcinoma

The Wnt pathway is involved in carcinogenesis and three regulatory genes of the Wnt pathway, APC (adenomatous polyposis coli), beta-catenin and Axin are frequently mutated in some primary human cancers. This study was conducted to clarify the relation of beta-catenin accumulation and the mutation of the CTNNB1 (beta-catenin) gene with the mutation of APC gene in the process of development of odontogenic tumors including ameloblastoma and odontogenic carcinoma (OC). beta-Catenin accumulation was examined by immunohistochemistry in formalin-fixed, paraffin-embedded samples of six ameloblastomas and eight OCs. We also performed a mutation analysis of CTNNB1 and APC to examine the cause of beta-catenin accumulation. All ameloblastoma cases and six out of eight (75%) OC cases exhibited beta-catenin accumulation in the nucleus. CTNNB1 mutation was only found in one OC case, whereas three of six (50%) ameloblastoma cases and two out of eight (25%) OC cases had APC mutations within the mutational cluster region. Our findings suggest that aberrant beta-catenin expression and APC missense mutation may play an important role for the pathogenesis of epithelial odontogenic tumors.

Orofacial granulomatosis: review on aetiology and pathogenesis

Orofacial granulomatosis (OFG) is considered as an uncommon disease and nomenclature of the disease was subjected to debate for a long time. Although various aetiological agents such as food substances, food additives, dental materials and various microbiological agents have been implicated in the disease process its precise pathogenesis is yet to be elucidated. Delayed type of hypersensitivity reaction appears to play a significant role, although the exact antigen inducing the immunological reaction varies in individual patients. However, evidence for the role of genetic predisposition to the disease is sparse. The underlying immunological mechanism appears to show some similarities between OFG and Crohn's disease, emphasizing the need for more comparative studies of the two entities. Therefore, we propose the term idiopathic OFG as a better term for those cases restricted to oral region without any identifiable known granulomatous disease and the diagnosis should not be changed until the patient develops systemic manifestations of a specific granulomatous condition. This review attempts to discuss the role of different aetiological agents and certain aspects of pathogenesis of OFG.

Fingerprinting genomic instability in oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) is a high-risk pre-cancerous condition where 7-13% of these patients develop head and neck squamous cell carcinoma (HNSCC). To date there is no cancer predictive markers for OSF patients. Genomic instability hallmarks early genetic events during malignant transformation causing loss of heterozygosity (LOH) and chromosomal copy number abnormality. However, to date there is no study on genomic instability in OSF. Although this condition is known as a high-risk pre-cancerous condition, there is no data regarding the genomic status of this disease in terms of genetic susceptibility to malignant transformation.

METHODS

In this study, we investigated the existence of genetic signatures for carcinogenesis in OSF. We employed the high-resolution genome-wide Affymetrix Mapping single nucleotide polymorphism microarray technique to 'fingerprint' global genomic instability in the form of LOH in 15 patient-matched OSF-blood genomic DNA samples.

RESULTS

This rapid high-resolution mapping technique has revealed for the first time that a small number of discrete hot-spot LOH loci appeared in 47-53% of the OSF tissues studied. Many of these LOH loci were previously identified regions of genomic instability associated with carcinogenesis of the HNSCC.

CONCLUSION

To our knowledge, this is the first evidence that genomic instability in the form of LOH is present in OSF. We hypothesize that the genomic instability detected in OSF may play an important role in malignant transformation. Further functional association studies on these putative genes may reveal potential predictive oral cancer markers for OSF patients.

Upregulation of HIF-1alpha in malignant transformation of oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) is a precancerous condition showing extensive fibrosis of the submucosa and affects most parts of the oral cavity, including pharynx and upper third of the oesophagus. The molecules involved in the biological pathways of the fibrotic process appeared to be either down- or upregulated at different stages of the disease. Despite the precancerous nature, malignant transformation of the epithelium in the background of fibrosis has not been studied in detail. HIF-1alpha is a known transcription factor that is induced by hypoxia.

AIMS

To test the hypothesis that hypoxia plays a role in malignant transformation and progression of OSF.

MATERIALS AND METHODS

We used both formalin-fixed and frozen samples of OSF and normal mucosa to investigate the relationship between HIF-1alpha and epithelial dysplasia using immunohistochemistry and RT-PCR.

CONCLUSIONS

Our data indicate that HIF-1alpha is upregulated at both protein and mRNA levels in OSF and the correlation with epithelial dysplasia is statistically significant (P < 0.001). We propose that HIF-1alpha may play a role in malignant transformation of OSF. Further, over-expression of HIF-1alpha may contribute to the progression of fibrosis. It may be possible to use HIF-1alpha as a marker for malignant transformation of OSF.

Prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka

BACKGROUND

To screen for oral cancer or not is being debated, but for high-risk populations with minimal access to regular dental care systematic oral examinations could provide some benefit.

METHODS

We undertook oral mucosal examinations of labourers employed in tea estate plantations in Sri Lanka. In a two-stage screening procedure, first by estate medical officers and then by visiting specialists, we examined 12 716 persons at their workplaces achieving a coverage of one-sixth of the total workforce.

RESULTS

Fourteen oral cancers and 848 subjects with oral pre-cancer (6.7%) were detected giving population prevalences of 46.1 per 1000 for leukoplakia and 16.4 per 1000 for oral submucous fibrosis. Among subjects with any oral mucosal disorder (n = 1159) proportions of current users of betel quid, smokers and alcohol use was recorded at 92%, 31% and 61% respectively. The synergistic effect of these three risk habits on the development of oral leukoplakia was evident in mixed habit groups.

CONCLUSIONS

The prevalence of oral pre-cancer in tea estate labourers was higher than estimates reported in previous studies. In the absence of state-sponsored preventive activities, it is necessary to improve the capacity of individual health practitioners and small medical centres to participate in oral health promotion and oral cancer/pre-cancer screening.

VEGF-C is associated with lymphatic status and invasion in oral cancer

BACKGROUND

Nodal metastasis is a major prognostic indicator for oral squamous cell carcinoma (OSCC) progression. Recently, it has been revealed that lymphangiogenic growth factor VEGF-C and its receptor Flt-4 play an important role for invasion and metastasis in cancer cells.

AIM

To examine VEGF-C expression and its correlation with lymphatic status, including the number of lymph vessels and lymphatic invasion, tumour invasion and metastasis in OSCC.

METHODS

Intratumoural and peritumoural lymphatic vessels were examined using D2-40 in 54 OSCC cases and correlated with VEGF-C expression and clinicopathological findings. The histological pattern of invasion and pathological findings were compared.

RESULTS

High expression of VEGF-C was frequently observed in OSCC and was associated with increased number of lymph vessels and lymphatic invasion. VEGF-C was well correlated with invasion pattern and metastasis.

CONCLUSIONS

Results suggest that VEGF-C may play an important role for lymphangiogenesis and invasion in the metastatic process and can be a strong predicting factor for metastasis of OSCC.

Analysis of histopathological and immunohistochemical differences of oral squamous cell carcinoma in young and old patients in Sri Lanka

BACKGROUND

Oral squamous cell carcinoma (OSCC) most commonly occurs in the middle-aged and older individuals. The purpose of the present study was to evaluate the histopathological and immunohistochemical differences of the younger (<40 years) and the older (more than 50 years) groups.

METHODS

The histopathological parameters of 112 patients (younger 56 and older 56) were compared according to three grading systems (Broder JAMA 1920; 74: 656, Anneroth et al. Scand J Dent Res 1987; 95: 229, Bryne et al. J Pathol 1992; 166: 375) and as individual histopathological parameters. Further, the expression of p53 and Proliferative Cell Nuclear Antigen (PCNA) index was also compared.

RESULTS

Although there was no significant difference between two groups regarding the three grading systems, a significantly higher number of nuclear aberrations was found in younger group (P<0.001). Interestingly, higher number of mitoses (P<0.05) and lymph node metastasis (P<0.05) were observed in the older group (P<0.05). Furthermore, significantly a higher PCNA index was found in the older group (P<0.005).

CONCLUSIONS

Although tumours of the young patients showed more nuclear aberrations, OSCC of the older patients is proliferative and showed higher metastatic rate.

Renal disease and the mouth

Oral manifestations of renal disease are common. They may present as unique signs of multi-system disease affecting the kidneys (such as vasculitis), or as common oral pathologies found at an increased prevalence in patients with end-stage renal disease. Despite more oral and dental disease in patients on renal replacement therapy, attendance at dental clinics is infrequent, and physician awareness of the problem is low. In our short review, aimed at renal, transplant, and general physicians, we discuss the link between clinical changes in the mouth and multi-systemic disease involving the kidney. We suggest a standardized approach to oral examination to increase diagnostic yield and discuss common oral complications in patients on dialysis or successfully transplanted. Finally, we suggest potential treatments for oral disease that nephrologists might safely institute.

Oral submucous fibrosis and oral yeast carriage - a case control study in Sri Lankan patients

Oral submucous fibrosis (OSMF) is a well-known precancerous condition. Epithelial atrophy is one of the key features in OSMF. Presence of Candida in the mouth together with epithelial changes may predispose to candidal infection. Candidal infection together with other co-factors may also induce epithelial atypia and dysplasia leading to malignant change. The purpose of this study was to determine the prevalence of oral yeast carriage in patients with OSMF and to compare the carriage with the normal individuals. Thirty patients with histologically proven OSMF and healthy subjects were used as the test and control respectively. Oral rinse samples were collected from all the subjects and cultured on Sabouraud's agar. Species were identified using API 32C AUX identification kits. Nineteen (63.6%) of the test group and 15 (50%) of the control group had yeast isolated from their mouth. The carriage of yeast in the OSMF group was not statistically significant compared with the control group. We isolated C. dubliniensis in Sri Lanka for the first time and interestingly from the oral cavities of both OSMF patients and healthy individuals.

Odontogenic Tumors in Sri Lanka: Analysis of 226 Cases

PURPOSE

The purpose of this study was to analyze the relative prevalence of odontogenic tumors in Sri Lanka and compare it with prevalences reported for other countries.

PATIENTS AND METHODS

A total of 226 cases of odontogenic tumors reported by the Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya between 1996 and 2002, were analyzed.

RESULTS

The most prevalent tumor was ameloblastoma (69.8%); odontoma was the fourth most prevalent (4.5%). No gender predilection was seen, but the tumors occurred most frequently in the second to fifth decades of life (77.4%) and most commonly in the mandible (79.6%).

CONCLUSIONS

The comparative data with statistically significant differences suggest a geographical difference in the relative prevalence of ameloblastoma among various continents. It is suggested that ameloblastoma most frequently occurs in the mandible (the posterior region) in all Asian, African, and South American countries.

Clinicopathological analysis of osteosarcoma of jaw bones

OBJECTIVES

To identify clinicopathological characteristics and prognosis of osteosarcoma of the jaw bones (JOS) and to compare the data with results of similar studies. To study the effectiveness of different treatment modalities currently available for this malignancy.

SUBJECTS AND METHODS

Nineteen cases of JOS diagnosed from 1993 to 2003 were retrieved from the departmental archives. These were categorized into histopathological subtypes and graded according to the severity of the malignancies and the data analyzed. Fourteen cases were followed up and the success rate with different treatment modalities assessed.

RESULTS

The mean age for JOS was 34.1 years. There were 11 mandibular lesions and eight maxillary lesions. Osteoblastic variant (53%) was the commonest histopathological subtype. High grade (grades III and IV) was more prevalent. All 14 followed up patients underwent surgical excision--five with adjuvant radiotherapy and six with adjuvant chemotherapy. Local recurrence was the commonest complication. Nine of the 14 were surviving with a survival rate of 64.2% for a median follow-up period of 5.25 years.

CONCLUSIONS

JOS is a distinct group of lesions with a better prognosis if diagnosed and treated early. It does not show any ethnic variability. Existing histopathological typing and grading may not indicate the prognosis of JOS. Adjuvant chemotherapy is a better treatment modality than adjuvant radiotherapy.

Periostin is frequently overexpressed and enhances invasion and angiogenesis in oral cancer

Oral squamous-cell carcinoma (OSCC) is one of the most common types of human cancer. Typically OSCC cells show persistent invasion that frequently leads to local recurrence and distant lymphatic metastasis. We previously identified Periostin as the gene demonstrating the highest fold change expression in the invasive clone by comparing the transcriptional profile of parent OSCC cell line and a highly invasive clone. Here, we demonstrated that Periostin overexpression enhanced invasiveness in oral cancer cell lines. To know the role of Periostin in invasion, angiogenesis and metastasis in OSCC cases, we first examined the expression of Periostin mRNA in 31 OSCC cases by RT-PCR and Periostin protein in 74 OSCC cases by immunohistochemistry. Then, we compared the Periostin expression with invasion pattern, metastasis and blood vessel density. Periostin mRNA and protein overexpression were frequently found in OSCC cases and Periostin expression was well correlated with the invasion pattern and metastasis. Moreover, blood vessel density of Periostin-positive cases was higher than those of Periostin-negative cases. Interestingly, recombinant Periostin enhanced capillary formation in vitro in a concentration-dependant manner. In summary, these findings suggest that Periostin may promote invasion and angiogenesis in OSCC, and that Periostin can be a strong marker for prediction of metastasis in oral cancer patients.

Oral submucous fibrosis: Review on aetiology and pathogenesis

Data from recent epidemiological studies provide overwhelming evidence that areca nut is the main aetiological factor for OSF. A clear dose-dependent relationship was observed for both frequency and duration of chewing areca nut (without tobacco) in the development of OSF. Commercially freeze dried products such as pan masala, Guthka and mawa (areca and lime) have high concentrates of areca nut per chew and appear to cause OSF more rapidly than by self prepared conventional betel quid that contain smaller amounts of areca nut. It is logical to hypothesise that the increased collagen synthesis or reduced collagen degradation as possible mechanisms in the development of the disease. There are numerous biological pathways involved in the above processes and, it is likely that the normal regulatory mechanisms are either down regulated or up regulated at different stages of the disease. Among the chemical constituents, alkaloids from areca nut are the most important biologically whilst tannin may have a synergistic role. These chemicals appear to interfere with the molecular processes of deposition and/or degradation of extracellular matrix molecules such as collagen. In vitro studies on human fibroblasts using areca extracts or chemically purified arecoline support the theory of fibroblastic proliferation and increased collagen formation that is also demonstrable histologically in human OSF tissues. The copper content of areca nut is high and the possible role of copper as a mediator of fibrosis is supported by the demonstration of up regulation of lysyl oxidase in OSF biopsies. It has been postulated that areca nut may also induce the development of the disease by increased levels of cytokines in the lamina propria. Increased and continuous deposition of extracellular matrix may take place as a result of disruption of the equilibrium between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMP). Current evidence implicates collagen-related genes in the susceptibility and pathogenesis of OSF. The individual mechanisms operating at various stages of the disease-initial, intermediate and advanced-need further study in order to propose appropriate therapeutic interventions.

An unusual presentation of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient: a case report and literature review

Zygomycosis is a rare fungal infection usually found in immunocompromised patients. It is a rapidly progressing infection with a high mortality rate. Our report describes an unusual case of rhinofacial zygomycosis due to Cunninghamella sp. in an immunocompetent patient, who presented with a slowly progressive swelling of the left cheek. An interrupted course of amphotericin B treatment caused regression of the lesion. Drug therapy was abandoned due to impairment of renal function. The patient was clinically and radiologically disease free for 2 years following cessation of therapy.

Demographic, aetiological and survival differences of oral squamous cell carcinoma in the young and the old in Sri Lanka

Oral squamous cell carcinoma (OSCC) is a major oncological problem in many regions of the world where tobacco habits are practiced in the form of chewing and/or smoking with or without alcohol intake. It accounts for 16.5% of all cancers in Sri Lankan patients with a male:female ratio of 4:1. In Sri Lanka nearly 5% of OSCC are diagnosed in young patients. This comparative study describes, demographic, aetiological and survival data from young and old patients with OSCC (n=56). Both younger and older groups showed a marked male predilection (male:female ratio was 4:1 and 3.7:1 in younger and older groups respectively). Tongue was the commonest site for younger group (41%, P<0.01) whilst buccal mucosa (37.5%, P<0.05) and alveolar mucosa (25%, P<0.01) were for older group. 39% of cancers in younger group were not associated with any identifiable risk factor (P<0.01) and 70% of SCC of the tongue has no associated habits (P<0.01). SCC of the tongue in the younger group shows poor prognosis than the older patients. Three-year survival rate for the total number showed no significant difference in two age groups. Survival appeared to be better in patients without associated habits in the older group.

Synovial sarcoma of the mandible

The term synovial sarcoma was first proposed for the histologically well defined entity by Knox in 1936. The name was proposed due to the fact that at least the cases reported in the early part showed some resemblance of the tumour to normal synovial tissue histologically. Thereafter, tumours have been diagnosed from areas without synovial tissue. The diagnosis of monophasic tumours can be difficult and immunostains appear to be a good diagnostic tool in those cases. The occurrence in the mandible is extremely rare. This is a case of synovial sarcoma arising in the condyle involving most of the ramus. The tumour was diagnosed as synovial sarcoma with predominant spindle cell component by correlation of histopathology with immunostains (cytokeratin, epithelial membrane antigen, actin and desmin). The patient has been treated with surgery and radiotherapy.