Peripheral Odontogenic Fibroma: A Report of a Rare Case and Review of Literature

Peripheral odontogenic fibroma (POF) is described as a relatively rare, benign, extraosseous odontogenic tumor derived from odontogenic ectomesenchyme. It is characterized by a mature fibrous stroma with embedded inactive resting islands of odontogenic epithelium. In the category of peripheral/extraosseous neoplasms, odontogenic fibroma (OF) is one of the most prevalent tumors. The radiographic examination shows minimum bone loss in the alveolar crest area. It poses a diagnostic challenge for clinicians and pathologists because its clinical and radiological aspects are similar to other peripheral odontogenic as well as non-odontogenic tumors, and the differential diagnosis is predicated on histological assessment. Histopathological examination is the key to a final confirmed diagnosis. This article presents a case report of a 53-year-old male who reported a painless, pale pink mass in the maxillary anterior region. We emphasize the clinicopathological, radiographical, and histopathological aspects of the rare entity of POF.

Cherubism Unmasked: A Case Report of Clinical and Histopathological Presentation

Cherubism, an uncommon genetic disorder, manifests as painless swelling in both jaws. A 20-year-old male presented with symmetrical swelling in both the mandible and maxilla. The jaws exhibited bilateral expansion, typical of this condition. Dentofacial abnormalities associated with cherubism stem from mutations in the SH3BP2 gene, which plays a crucial role in regulating osteoblasts and osteoclasts. In summary, cherubism is a genetic disorder characterized by non-cancerous jaw bone lesions. Surgical intervention may be necessary for functional or aesthetic concerns.

A Case Series and Literature Review of Craniofacial Fibrous Dysplasia

Craniofacial fibro-osseous lesions (CFOLs) are a diverse group of relatively rare entities whose etiology ranges from reactive to dysplastic with a potential for malignant transformation. It is distinguished by the replacement of bone with fibrous tissue, that subsequently develops different degrees of calcification. Fibrous dysplasia (FD) is a component of the fibro-osseous lesion spectrum. The clinical spectrum of FD is wide, ranging from minor monostotic lesions affecting a single bone to devastating polyostotic disease involving the entire skeleton. FD produces asymmetry, which impairs face aesthetics. FD leads to bone differentiation, disintegration, and disorganization. It depicts a cellular collagenous stroma lacking mitotic figures and pleomorphism. Blood capillaries are evenly distributed, as are elongated trabeculae of woven or lamellar bone with uneven curves (often referred to as the Chinese letters pattern). Three types of FD patterns can be identified by computed tomography (CT) imaging: a cystic pattern, a homogeneously dense pattern, and a ground-glass pattern. The cornerstone of treatment is surgery, although the method varies depending on the location, size, and symptoms of the lesion. As an alternative to surgery, the use of bisphosphonates to reduce osteoclastic activity is under consideration. In this case series, we present three cases of FD involving the maxilla and mandible. We aim to correlate the clinical presentation, histological features, and radiographic findings, to promote early diagnosis, treatment, and better prognosis of the patient.

Spindle Cell Carcinoma of Buccal Mucosa: An Unusual Presentation of Squamous Cell Carcinoma

Oral squamous cell carcinoma (OSCC) is the most common carcinoma in the H&N (head and neck) region, in which squamous cells show variability in differentiation like basaloid, glandular, and spindle cells. Spindle cell carcinoma (SpCC) is an unusual variant of SCC that is aggressive in nature and has the ability to recur and metastasize. The presence of malignant mesenchymal and squamous epithelial cells gives it a biphasic nature. So, we present a case of SpCC of buccal mucosa in a 45-year-old male who had an ulcerated growth on his left buccal mucosa that had been present for two years.

Case Report: Basaloid Squamous Cell Carcinoma of the Tongue: A Case Report

The upper aerodigestive tract is where basaloid squamous cell carcinoma (BSCC), a rare variation of conventional SCC, is most frequently found. The hypopharynx, tonsil, supraglottic larynx, tongue (base), and head-neck regions are particularly susceptible to BSCC. Clinically, the presentation of BSCC is similar to that of conventional SCC, but it has a poorer prognosis than conventional SCC. BSCC is distinguished histopathologically by a dimorphic pattern, a distinctive basal cell component paired with a squamous component, and a squamous component. However, its similar features to conventional SCC make it difficult to diagnose. Therefore, histopathology and immunohistochemistry play a crucial role in diagnosing such tumors. Here we present the case of a 70-year-old male diagnosed with BSCC involving the tongue.

Role of proliferative markers in assessing recurrences in surgical margins of oral squamous cell carcinoma: A systematic review

The primary goal of this systematic analysis is to determine the predictive significance of proliferative markers in surgical margins of patients with oral squamous cell carcinoma (OSCC). A thorough literature search was done on databases like MEDLINE/Pub-Med, Cochrane and Scopus libraries for similar studies until December 2022. All the relevant original research studies (retrospective and prospective) published in the literature assessing the predictive value of proliferative markers in surgical margins in OSCC were included. Seventeen studies with 1159 patients were included. The research included here used p53, p44/p42, proliferating cell nuclear antigen (PCNA), epidermal growth factor receptor (EGFR), Ki-67, Bcl2, Nibrin, AgNORs, Cyclin B1, Cornulin, ISG 15antibodies, MCM3 in OSCC. Four studies were done on oral premalignant lesions and OSCC. Among these studies, Ki-67 was the most accurate, followed by p53 (75%) and AgNORs, while PCNA had the least accuracy. To minimize the risk of bias panel of antibodies was suggested in most studies. For interobserver variability, analysis of variance and Chi-square test were used in most studies. The chance of recurrence rate was calculated using a log-rank test and a Kaplan-Meier curve. The significance of proliferative markers in surgical margins of OSCC has been emphasized in the present review. Future research should focus on selecting antibodies, preferably a panel, with a large sample size and extended follow-up.

Epithelial-myoepithelial carcinoma with multiple recurrences: An unusual presentation

Epithelial-myoepithelial carcinoma (EMC) is a type of malignant salivary gland tumors that is extremely rare. EMC primarily affects major salivary glands, particularly the parotid gland, but minorsalivary glands are also affected. It contributes less than 0.5-1% of all salivary gland neoplasms. Multiple recurrences are relatively rare with EMC. There have been very few reports of multiplerecurrences in the literature. Biphasic tubular structures composed of externalclear cells and inner ductal cells are the distinguishing histopathological feature. However, histological variation is prevalent, making a precise diagnosis challenging. We present a case of EMC that had multiple recurrences during a six-year period.

Granular Cell Ameloblastoma: A Rare Case Report and Literature Review

Ameloblastomas are rare, benign, aggressive neoplasms of odontogenic epithelial origin. Among the various types of ameloblastomas, granular cell ameloblastoma is rare and accounts for less than 5% of the total. Granular cells are epithelial in origin. The distinct histopathological characteristics of granular cells are associated with high lysosomal content in tumour cells cytoplasm. A 43-yearold female patient presented with a painful swelling on the left-side of the jaw. The diagnosis was based on clinical, radiological and histopathological examination. A complete surgical resection was done. Histopathology showed features of granular cell ameloblastoma. The operative procedure was uneventful. Granular cell ameloblastoma has a high tendency for recurrence. Around 33.3% recurrence is reported, according to various studies. This rate is much higher than other subtypes of ameloblastoma, which are more common. Hence, it is essential to provide appropriate surgical treatment on time to prevent tumour recurrence and metastasis.This case report aims to highlight the unique features of granular cell ameloblastoma, distinguishing it from other subtypes and discussing the pathogenesis and treatment modalities.

Ki-67, CD105, and α-smooth muscle actin expression in oral squamous cell carcinoma corresponds with different forms of tobacco consumption habits

Background

Association with variety of etiological agents is one of the characteristic features of oral squamous cell carcinoma (OSCC). We hypothesized the existence of tobacco consumption habit-based heterogeneity in the immunohistochemical expression of carcinogenesis relevant molecular markers in OSCC. Hence, the present study was conducted to investigate the carcinogenesis relevant three commonly expressed markers (Ki-67, CD105, and α-smooth muscle acting [SMA]) in various forms of tobacco consumption habits in OSCC patients.

Materials and Methods

A total of 217 patients of OSCC were included in the study, and based on the habit, they were broadly categorized into tobacco lime (TL), TL and areca nut (TLAN), and areca nut (AN). Further, categorization was done on the basis of absence or presence of additional habit of smoking. Immunohistochemistry (IHC) was performed using Ki-67, CD105, and α-SMA markers on formalin-fixed paraffin-embedded tissues.

Results

TLAN (62.21%) was the most common habit noted in OSCC patient followed by TL (20.73%) and AN (15.20%). The additional habit of smoking was observed in 31.11% and 25.92% of TL and TLAN habits of OSCC patients, respectively. All the three markers (Ki-67, CD105, and α-SMA) showed statistically significant differences in the habit group such as TL, TLAN, and AN (P < 0.001). Although the expression of all the three markers was increased in TL as compared with TLAN, differences were not statistically significant. When these markers were compared in with and without smoking category, only TLAN with smoking and TLAN without smoking showed statistically significant differences in the expression of all three markers.

Conclusions

Ki-67 CD105 and α-SMA immunohistochemical expression in OSCC corresponds with different forms of tobacco consumption habits. Habit-related unique carcinogenesis events are reflected at IHC level thus providing proof of concept for future studies.

Hematological and Biochemical Responses of Newly Formulated Primary Root Canal Obturating Material: An In Vivo Study

Background and objective Any drug or medicinal agent, when implanted into the body, gets biotransformed by various organ systems and the toxic byproducts of this process alter the normal physiological process. In this experimental study, we aimed to quantify the safety of newly formulated primary root canal obturating material by investigating the hematological and biochemical parameters related to liver function. Methodology Forty-eight Wistar rats (weighing 250-350 grams) were classified into three groups (n=16) through random allocation. Preoperative blood samples were collected by puncturing the orbital venous plexus, the values of which were used as control. Zinc oxide eugenol (ZOE), calcium hydroxide iodoform paste (Metapex), and newly formulated triple antibiotic obturating paste (TAOP) were implanted (100 µg) into dorsal connective tissues. Blood samples on the seventh, 15th, and 30th postoperative days were evaluated respectively by analyzing hematological, hepatic, and, renal function tests for acute and chronic inflammatory responses. Results  The intra-group and inter-group comparisons among all the test materials after seven days exhibited high significance in terms of hemoglobin (Hb), mean corpuscular volume (MCV), neutrophils, and serum glutamic-oxaloacetic transaminase (SGOT) (p<0.001), while others showed mixed responses (p<0.05 to p>0.05). After 15 days, the comparisons showed high significance with respect to packed cell volume (PCV), mean cell volume (MCV), and serum creatinine (p<0.001), while others showed significant to nonsignificant differences (p<0.05 to p>0.05). At the end of 30 days, all the parameters showed mixed responses (p<0.001 to p>0.05). Conclusion The newly formulated obturating material TAOP showed lower adverse hematological, hepatic, and renal effects in experimental animals compared to other test materials, with most parameters reverting to normal after 30 days.

Immunoexpression of Podoplanin in Leukoplakia and Oral Squamous Cell Carcinoma and its Correlation with Survival: A Research Protocol

Introduction: Podoplanin (PDPN) is a well-conserved mucintype transmembrane glycoprotein. According to various studies, podoplanin expression is seen in various human cancers and it also encourages the progression of the tumour. A high PDPN expression, specifically in oral cancers, shows a significant relation to the metastasis of lymph nodes and poor patient survival, suggesting its substantial role in identifying the malignant transformation of a lesion by its expression in initial oral tumourigenesis. Only few studies have mentioned the use of podoplanin marker in detection of malignant transformation of Oral Potentially Malignant Disorders (OPMDs). Most malignant transformations are seen in cases of oral leukoplakia. This study will help in early diagnosis of malignant transformation of leukoplakia by showing an increased expression of podoplanin thereby resulting in better treatment and prognosis of the disease. Aim: To evaluate immunoexpression of podoplanin in leukoplakia and oral squamous cell carcinoma and also to correlate it with the clinicopathological characteristics of leukoplakia and Oral Squamous Cell Carcinoma (OSCC) and the survival of OSCC patients. Materials and Methods: This retrospective study will be conducted in the Oral Pathology Department at Sharad Pawar Dental College, Wardha, Maharashtra, India. Surgically operated OSCC cases from year 2005-2019 in this Institute will be retrieved from the archival of the department. Ninety samples in total will be taken for the study which will be further divided into three groups, consisting of 30 samples in each group as follows: leukoplakia, OSCC and normal oral mucosa (control). Immunohistochemical staining will be carried out, and podoplanin (PDPN) immunoexpression with different clinical characteristics of leukoplakia and oral squamous cell carcinoma will be assessed. Broder's grading system will be used for histopathological grading of all cases of OSCC. The Chi-square test, Kaplan-Meier method, and the log-rank test will be used to statistically analyse the data.

Evaluation and Assessment of the Expression of DNA Damage Response – Related Molecules in Oral Submucous Fibrosis (OSF) and Oral Squamous Cell Carcinoma (OSCC) with OSF

Background: Oral submucous fibrosis (OSF) is the most common chronic, progressive and irreversible potentially malignant disorder with high probability of malignant transformation (MT). From a clinical as well as the histological point of view, establishing and understanding the molecular nature of malignant transformation mechanism in OSF is almost important. The majority of genetic alteration caused by exogenous and endogenous mutagens is restored by the cell’s ability by DNA Damage Response (DDR). DDR mechanism dysfunction is one of the leading causes of MT. In OSF, this investigation remains scare. Objectives: To determine the DDR molecules expression (γΗ2ΑΧ, 53BP1, pChk2 and p53) in subjects with habit of arecanut and tobacco without OSF, OSF and oral squamous cell carcinoma (OSCC) with OSF and compare and quantify the expression among them. Methodology: Material and Methods: 90 subjects with 30 individuals in one of the three groups would be included in the given study. Group A: Subjects with habit of arecanut and tobacco without OSF. Group B: Patients with OSF. Group C: Patients having OSCC with OSF. DDR molecule (γΗ2ΑΧ, 53BP1, pChk2 and p53) expression will bequantified by RT-PCR. The expression levels will be analyzed using SPSS software version 17 using one-way ANOVA, followed by post hoc comparisons using Tukey’s HSD and Categorial data will be analysed using the chi-squared test. Expected Results: The OSF lesion prone for development of OSCC, DDR markers (γΗ2ΑΧ, 53BP1, pChk2 and p53) will accumulate before the development of p53 mutation resulting in OSCC Conclusion: Thus, the present study assess and quantify DDR-related molecules (γΗ2ΑΧ, 53BP1, pChk2 and p53)in OSF patients suggesting the potential benefit in the prevention of OSCC due to early therapeutic exploitation of DDR.

“Prognostic significance of PD-L1 Immunoexpression in Oral Potentially Malignant Disorder and Oral Squamous Cell Carcinoma”: A Study Protocol

Background: “Oral squamous cell carcinoma” (OSCC) is a most common type of invasive disease. It involvs damage to the oral epithelium. It gives a bad prognosis. There are alterations in cells of the oral mucosa called “oral epithelial dysplasia” (OED) and are categarised as “Oral Potentially Malignant Disorders” (OPMD). As a result, prior alteration in premalignant lesions would encourage prior cancer treatment and could essentially diminish morbidity and mortality.  “Programmed death ligand 1” (PD-L1) is functionally imputed ligand of the “co-inhibitory programmed death receptor 1 (PD-1)”. “(PD-L1)” is over-expressed on different cells including lymphocytes, tumor cells and different tissues in numerous malignancies. In this study, we will make effort to evaluate a new role of PD-L1 by correlating the immunoexpression of PD-L1 and clinicopathological characteristics and its prognostic significance in OSCC. We will evaluate and compare immunoexpression of PD-L1 in normal mucosa, OPMD and OSCC. Methodology: Total 93 samples will be included in this study and they are divided into three groups, 31 in each group of the following: OPMD, OSCC and normal oral mucosa (control).Immunohistochemical staining will be performed and the integration of PD-L1 expression with various clinical features of OPMD and OSCC will be performed. Expected Result: The present study will find immunohistochemical expression of “PD-L1” in OPMD and OSCC and its correlation with clinicopathological characteristics of OPMD and OSCC and 3 years disease-specific survivalof OSCC patients. Conclusion: There is natable positive correlation of “PD-L1” appearance with OSCC. In case of OPMD, the progression of disease in terms of prognosis could be monitored. The unpredictable “PD-L1” appearance may be the main focus of integration therapy in OSCC. To provide personal immunotherapy to a variety of patients, the condition of PD-L1 should be considered.

Correlation of p53 Immunoexpression with Depth of Tumor in Microinvasive Oral Squamous Cell Carcinoma

Introduction: “Oral squamous cell carcinoma (OSCC)” is a major health issue in India, the incidence of OSCC is 3-7 times more in developing countries than developed countries. OSCC is the ‘3rd most common cancer’ in India followed by “cervical and breast cancer”. One side  of OSCC that  has not much explore is the ‘microinvasive squamous cell carcinoma’ which is an early stage neoplasm  without infiltration in the deeper tissues. There is no particular definition of “microinvasive oral squamous cell carcinoma (MIOSCC)” There are no specific guideline are present to categories the “microinvasive squamous cell carcinoma (MIOSCC)”. Most of the time the infiltrating neoplastic cells are masked under the background of the inflammatory cell infiltrate present connective tissue stroma. So this study is humble attempt to recognized and measured depth of invasion of infiltrative neoplastic cells to categories MIOSCC and to find better management protocol for it Aim: This study aims to: Measure p53 immunoexpression  in “microinvasive oral squamous cell carcinoma, evaluate the depth of invasion in MIOSCC  in H & E stained section, and correlate the  p53 immunoexpression with  the depth of tumor in it. Methodology: The  25 cases of  “microinvasive oral squamous cell carcinoma” will be selected  and 10 cases of “normal oral mucosa (NOM)” will be   obtained from “gingiva and vestibular mucosa” as controls  after extraction of impacted teeth. “The depth of tumor”  will  be measured from the “basement membrane or in areas of basement membrane loss, from an imaginary line reconstructing the basement membrane from the adjacent epithelium to the deepest point of invasion in connective tissue” by  Leica DMLB2 research microscope with Leica Q-win standard software (Switzerland). Results: The results  show that   the depth of invasion in MIOSCC, will be  categorized the lesion and give the better guidelines for histological grading and treatment protocol for MIOSCC Conclusion: There are no definite guidelines for histological grading and final treatment protocol for MIOSCC. The assessments of depth of tumor through p53 immunoexpression may be one of the criteria for grading in MIOSCC. Thus the correlation of p53 immunoexpression with the depth of tumor in MIOSCC helps to determine the treatment modalities of MIOSCC.

Expression of p53 at invasive front of oral squamous cell carcinoma and negative histopathological surgical margins to establish correlation at 3-year survival

Background:

Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity. The histologic features of OSCC differ from area to area within same tumor, and most prognostic information can be revealed from the invasive front of tumor. The most accepted line of treatment is radical neck dissection. The boundaries of a resected specimen are the surgical margins (SMs), which are excised by the surgeon. The survival outcome is based on the status of these resected SMs. To avoid local recurrence and improve overall survival, it is necessary to attain negative SM. Apart from routine histopathology, the molecular assessment of resected margins has recently gained value which has a promising role for margin surveillance. The value of the use of molecular markers in the routine examination of resection specimens of OSCC has not yet established. It is crucial to identify the percentage of altered cells in SMs which go undetectable in the routine histopathology. It is essential to assess their role in recurrence and survival.

Materials and Methods:

The study was divided into two groups, i.e., Group I (control group): ten cases of normal oral mucosa and Group II consisted of thirty cases, in which biopsy samples of invasive tumor front and histopathologically negative SM of OSCC were included. Both the groups were subjected to p53 immunohistochemical staining

Results:

There was overexpression of p53 at the deep tumor invasive front of OSCC associated with different histologic grades of malignancy.

Conclusion:

The overexpression of p53 at the invading tumor front with clear SMs is associated with poor survival. p53 expression at the tumor front can be a prognostic marker for OSCC.

Ki67, CD105, and α-SMA Expression Supports Biological Distinctness of Oral Squamous Cell Carcinoma Arising in the Background of Oral Submucous Fibrosis

BACKGROUND

The clinicopathological distinctness of oral squamous cell carcinoma arising in the background of oral submucous fibrosis (OSCC-OSF) is well known; however, the molecular distinctness of this unique OSCC-OSF has not been investigated to date. With this in mind, we compared the expression of Ki67, CD105, and α-SMA between OSCC-OSF and oral squamous cell carcinoma (OSCC).

METHODS

Formalin-fixed paraffin-embedded tissues of 105 OSCC-OSF and 112 OSCC cases were subjected to immunohistochemistry for evaluation of Ki67, CD105, and α-SMA expression.

RESULTS

Ki67 (labeling index) LI, MVD and α-SMA expression were significantly higher in OSCC compared to OSCC-OSF. Ki67 LI and MVD was significantly higher in OSCC compared to OSCC-OSF in parameters such as well-differentiated, early TNM stage, non-metastatic, and more than 3-year survival. α-SMA expression was significantly higher in OSCC compared to OSCC-OSF in parameters such as moderate differentiation, metastatic lesions, and survival less than 3 years. Ki67 LI, MVD and α-SMA showed significant positive correlation with each other in OSCC and OSCC-OSF.

CONCLUSION

Proliferation, neoangiogenesis and myofibroblast differentiation were significantly higher in the OSCC group compared to the OSCC-OSF group. This suggests the biological distinctness of OSCC-OSF, which could help the future development of targeted therapies.

Expression of p63 in tooth germ, dentigerous cyst and ameloblastoma

Context:

To assess the role of p63, a p53 homolog, in the cytodifferentiation (odontogenesis) and oncogenesis of odontogenic epithelium.

Aim:

The present study aimed to compare the expression pattern of p63 in the epithelium of tooth germ, dentigerous cyst (DC) and ameloblastoma (AB).

Materials and Methods:

Tissue specimens of thirty tooth germs, thirty ABs and thirty DCs were examined by immunohistochemistry for the expression of p63. Results: p63 labeling index (LI) was observed in descending order in epithelial cells of ABs, tooth germs and DCs. p63 LI was statistically nonsignificant among all the three groups. ABs revealed the highest p63 expression, but, surprisingly, tooth germs showed higher expression than DCs.

Conclusion:

p63 plays a role in the cytodifferentiation and proliferation of odontogenic epithelial cells irrespective of the tissue (normal developing or lesional tissue). This implies that p63 cannot be used as a diagnostic marker. However, our results indicate p63 overexpression as a mark of increased proliferation. Thus, it can be stipulated that p63 can be used as a prognostic marker in odontogenic lesions with more aggressive and invasive phenotype. Our results also suggest the differential function of p63 in both developing and lesional odontogenic tissues, which, however, depends on p63 isoform predominantly being expressed. Therefore, identification of p63-predominant isoform in a particular lesion is more important than the presence or absence of p63. Consequently, we suggest the performance of polymerase chain reaction analysis along with immunohistochemical evaluation in further studies.

Ki67, CD105, and α-SMA expression supports the transformation relevant dysplastic features in the atrophic epithelium of oral submucous fibrosis

Background

The grading of oral epithelial dysplasia is not possible in the atrophic epithelium of oral submucous fibrosis (OSMF). Recently, we found that features such as increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, increased nuclear size, and hyperchromasia represent transformation-relevant dysplastic features in the atrophic epithelium of OSMF. The presence of these features can be considered a high-risk feature for patients. However, these findings have not been tested and authenticated using markers relevant to oral carcinogenesis.

Method

Paraffin-embedded tissues from 30 normal oral mucosa (NOM) and 50 OSMF were retrieved from 2008 to 2016 and subjected to immunohistochemical expression using Ki67, CD105 and α-SMA antibodies.

Results

Ki67 LI showed significant increases from NOM (12.47±2.34) to LRED (23.47±3.75) to HRED (34.31±7.31) (<0.0001). Similarly, MVD was increased significantly from NOM (3.53±5.17) to LRED (27.57±12.25) to HRED (46.18±12.55) (p<0.0001). The expression of α-SMA was significantly increased from LRED (0.21±0.41) to HRED (1.13±0.56) (<0.0001). The Ki67 LI and α-SMA; MVD and α-SMA; and Ki67Ki67 LI and MVD in NOM, LRED and HRED showed a statistically significant positive correlation (P<0.0001). The increase in Ki67 LI was directly proportional to MVD and α-SMA expression from NOM to LRED to HRED (P<0.0001). The connective tissue stroma of NOM lacks α-SMA expression. Mild myofibroblast expression was noted in 4 cases of LRED (14.28%) and in 18 cases of HRED (81.81%). Moderate expression was noted only in 4 cases of HRED (22.22%).

Conclusion

Ki67 LI, CD105, and α-SMA expression showed significant differences between normal, LRED and HRED. These findings further support that features such as increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, and hyperchromasia could be transformation-relevant dysplastic features.

Ki67, CD105, and α-SMA expressions better relate the binary oral epithelial dysplasia grading system of World Health Organization

BACKGROUND

The binary system of oral epithelial dysplasia (OED) has never been investigated with reference to the carcinogenesis-related biomarkers. Hence, Ki67, CD105, and α-SMA immune-expressions were studied in oral potentially malignant disorders (OPMDs) to assess their relationship with the binary OED grading system of World Health Organization.

METHODS

The study was carried out on paraffin-embedded tissues of 30 normal oral mucosa (NOM) and 140 OPMD cases. OPMD cases were classified into two groups "no/questionable/hyperkeratosis/mild"=low-risk epithelial dysplasia (LRED) and "moderate or severe"=high-risk epithelial dysplasia (HRED). The immunohistochemistry was carried out to evaluate the expression of Ki67, CD 105, and α-SMA antigen.

RESULTS

According to the binary grading system of WHO, 69 (49.28%) cases were LRED, while 71 (50.71%) case showed HRED. There was significant increase in Ki67 labeling index (LI) from NOM to LRED to HRED (P=.000). Similarly, mean vascular density (MVD) also increased significantly from NOM to LRED to HRED (P=.000). The α-SMA expression was significantly higher in HERD compared to LRED and NOM (P=.000). A positive correlation was noted among Ki67 LI, MVD, and α-SMA expressions in NOM, LRED, and HRED (P=.000).

CONCLUSION

The expressions of ki67, CD105, and α-SMA markers compliment binary grading system of OED in OPMDS, thus justifying its use in clinical practice.

Oral squamous cell carcinoma in the background of oral submucous fibrosis is a distinct clinicopathological entity with better prognosis

BACKGROUND

The aim of this study was to compare the clinicopathological features of oral squamous cell carcinoma in the background of oral submucous fibrosis (OSCC-OSMF) and oral squamous cell carcinoma (OSCC).

METHODS

A total of 217 cases of OSCC were retrieved from achieves for the analysis. OSCC-OSMF cases were segregated on the basis of history and clinicopathological parameters.

RESULTS

The study included 217 patients of which 112 had OSCC and 105 OSCC-OSMF. OSCC-OSMFs were younger compared with OSCC. Overall oral cancer was noted predominantly in males compared to females. The number of OSCC-OSMF was more in clinical TNM stage I and stage II as compared to OSCC, whereas the number of OSCC was more in stage III and stage IV compared to OSCC-OSMF. Histological presentation of well-differentiated squamous cell carcinoma was significantly more in OSCC-OSMF compared to OSCC, whereas moderately differentiated squamous cell carcinoma was significantly more in OSCC compared to OSCC-OSMF. Regional lymph node metastasis was significantly higher in OSCC compared to OSCC-OSMF. Three-year disease-free survival rate was significantly higher in OSCC-OSMF compared to OSCC.

CONCLUSION

The OSCC-OSMF was found to be a clinicopathologically distinct entity with a better grade of tumor differentiation, less incidence of nodal metastases, and early detection (early clinical TNM stage) compared to OSCC. All these factors probably contribute to a better prognosis and increased 3-year disease-free survival in OSCC-OSMF patients.

Influence of risk factors on patients suffering from potentially malignant disorders and oral cancer: A case-control study

Background:

Tobacco use can alone lead to death worldwide, especially in developing and underdeveloped countries. China and Brazil are the world's largest producer of tobacco. India holds the third place in producing, and it is the fourth largest consumer of tobacco and its products in the world.

Objectives:

A case–control study was carried out to assess the influence of risk factors on patients with potentially malignant disorders (PMD) and oral cancer.

Materials and Methods:

Fifty cases diagnosed with PMD and oral cancer patients were selected for the study. An equal number 50 healthy controls who were also selected after age and gender matching. Multivariate logistic regression analysis was used to estimate the suspected risk factors for PMD and oral cancers. Chi-square test, Adjusted odd's ratios with 95% confidence interval were also used for the statistical analysis.

Results:

There is a statistically significant difference between the different age group, duration, frequency, exposure time, and synergistic effect of tobacco chewing, smoking and alcohol drinking.

Conclusions:

Chewing tobacco is one of the major risk factors in the initiation of PMD which can lead to oral cancer.

Histopathological evaluation of tissue undergoing thermal insult

Context:

Thermal insult is the major cause of thermal injury or death and in case of death due to thermal injury the body often has to be recovered from the site. Histologically, one can predict whether the victim was alive or dead when the fire was on going. However, determination of probable cause of thermal insult to which victim subjected to be difficult when the victim's body is found somewhere else from the crime scene or accident site or found alone. Hence, histopathological evaluation of the tissue which has undergone thermal insult in such conditions could help to place evidence in front of law officials, regarding probable condition, or scenario at time of burn of victim.

Aims:

Keeping this as a criteria in this study we aim to evaluate burnt tissue histopathologically, that undergone various degree of thermal insult, which simulates various real life scenario for mortality in burn cases.

Settings and Design:

We evaluate the changes in hematoxylin and eosin staining pattern of tissue which has undergone thermal insult compared to normal tissue and also the progressive changes in staining pattern, architectural, and cellular details.

Materials and Methods:

Samples were taken from the patients, in various surgical procedures. Each sample was cut into five parts with close margins so that each burnt tissue is evaluated for same field or region. The tissue that obtained was immediately subjected to varying degree of temperature over a specific period so as to simulate the various real-life condition. Then the tissues were fixed, processed, and stained with routine H and E staining. The processed slides of tissue were examined under the microscope, and the staining, and architectural changes were evaluated and described.

Results:

Results show that there was a progressive changes in the architectural pattern of the epithelium and connective tissue showing cleft formation and vacuolization, staining pattern also shows mixing of stains progressively as the severity of thermal insult increases.

The domino effect: Role of hypoxia in malignant transformation of oral submucous fibrosis

INTRODUCTION

Oral submucous fibrosis (OSMF) is a precancerous condition predominantly seen in people of Asian descent. About 7-12% OSMF patients develop oral squamous cell carcinoma (OSCC). Morphological features of OSMF especially fibrosis suggests a possibility of the hypoxic environment in diseased tissues. Oral cancer usually develops from hyperplasia through dysplasia to carcinoma. Neovascularization and increased glycolysis, represent adaptations to a hypoxic microenvironment that are correlated with tumor invasion and metastasis. The adaptation of cells to hypoxia appears to be mediated via hypoxia inducible factor-1α (HIF-1α). HIF-1α is said to be associated with malignant transformation of epithelium in other sites. It appears that HIF-1α plays a significant role in both prostate and cervical carcinogenesis at early stages. We hypothesize that progression of OSMF and malignant transformation in the background of fibrosis mediates via HIF-1α either by up- or down-regulation of various such molecules. Therefore, the main objective of this study was to investigate the relationship between the expression of HIF-1α in OSMF, OSCC and OSCC with OSMF.

AIM

To investigate the relationship between the expression of HIF-1α in OSMF, OSCC and OSCC with OSMF.

MATERIALS AND METHODS

The study group consists of histopathologically diagnosed 20 cases of OSCC, oral submucous fibrosis and OSCC with OSMF each. The immunohistochemistry was carried out on neutral buffered formalin-fixed paraffin-embedded tissue sections by using the monoclonal antibody of HIF-1α.

RESULTS

A rise in the expression of HIF-1α from OSMF to OSCC to OSCC with OSMF is observed.

How much do junior staff know about common legal situations in paediatrics?

BACKGROUND

Recent high-profile medico-legal cases such as the death of Victoria Climbie and the subsequent Laming report have highlighted widespread deficiencies in child protection practice. Junior doctors are the frontline staff regularly facing issues with potentially major legal implications, including child protection, Gillick competence, consent, and professional responsibility/accountability. It is therefore important for them to be aware and understand the Children Act, common medico-legal principles and practices, particularly in the current, increasingly litigious climate.

AIMS

(1) To determine junior medical staff's knowledge of legal issues involved in child protection and common basic legal situations, and (2) to assess whether experience and training improved this knowledge.

METHODS

A standardized structured interview was developed exploring common issues with important legal implications for paediatric practice. It focused on: legal issues in child protection, the Children Act, awareness of the General Medical Council (GMC), principles of professional responsibility/accountability, the Bolam principle for good medical practice and Gillick competence. Basic demographic data were recorded. We attempted to contact all 180 paediatric junior medical staff in Wales by telephone.

RESULTS

Interviews were conducted with 119/180 (66%) doctors: 46/56 specialist registrars (SpRs; 82%) and 73/124 senior house officers (SHOs; 59%). SpRs scored a median of 6.5 correct responses from a possible of 12 (range 3-11), compared with a median of 5 (range 1-11) by the SHOs (P < 0.0001; Mann-Whitney test). A third of SHOs and a fifth of SpRs were unaware that the GMC was the organization responsible for good medical practice in the UK. Similarly, a fifth of all juniors were ignorant of the legal age for consent. Approximately two-thirds of the SHOs and half of the SpRs were ignorant that the police and social services have the legal power to protect the child in child protection cases. Alarmingly, none of the SHOs and only 11% of the SpRs were aware of the Bolam principle. SpRs scored significantly higher on topics of Gillick competence, legal right to see medical notes, consent, Children Act, burden of proof in civil and criminal court, and on Bolam principle. They also had received training more frequently than SHOs, which, when combined with their greater experience, probably explains these statistically significant differences.

CONCLUSION

Few junior staff have adequate knowledge of the basic legal principles and practice as they relate to children. Widespread deficiencies concerning the understanding of the Children Act and child protection powers exist.

Arachnoid cyst within the fourth ventricle--a case report

We describe a case of congenital intra-fourth ventricular arachnoid cyst and review the literature. A one-and-half-year-old boy had presented with delayed milestones, intermittent raised intracranial pressure and ataxia. Excision of the arachnoid cyst has cured him.