Correlation of Pattern of Invasion, Stromal Inflammation and Lymphovascular Invasion With Histopathological Grading in Oral Squamous Cell Carcinoma: A Retrospective Study

INTRODUCTION

Despite the progress in diagnostics and treatment modalities, the survival rate of oral squamous cell carcinoma (OSCC) patients has remained unchanged. Early diagnosis of the disease helps in better treatment and prognosis. Identifying clinicopathological and histopathological parameters that help predict disease progression is crucial.

OBJECTIVES

To assess the significance of various clinical and histopathological factors in OSCC and to correlate the patterns of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion with the histopathological grading of OSCC.

MATERIALS AND METHODS

This study included 30 oral squamous cell carcinoma cases from 2015 to 2021. The surgically operated cases of OSCC were obtained from the archives of the Oral Pathology Department. The subjects were categorized according to the degree of differentiation of OSCC. The parameters like the pattern of invasion of tumour (POI), stromal inflammation, and lymphovascular invasion were assessed and correlated with the different histopathological grades of OSCC.

RESULTS

We observed a statistically significant correlation between the pattern of invasion and stromal inflammation with histopathological grades of OSCC. There was no significant association between lympho-vascular invasion and histopathological grades of OSCC.

CONCLUSION

We conclude that histopathological parameters like the pattern of invasion and stromal inflammation significantly impact different grades of OSCC. These parameters should be included in routine histo-pathological reports for predicting clinical outcomes and management of the disease.

Circulating Tumor Cells in Oral Cancer

Till now, oral squamous cell carcinoma (OSCC) is graded as well-differentiated, moderately-differentiated, poorly-differentiated, and undifferentiated. However, this grading does not have a prediction of the prognosis of the patient. Also, prognosis impacts lymph node metastases, surgical margins, and vascular invasions (neural invasion, muscular invasion, salivary gland invasion). The prognosis of lymph node metastases is significant, which affects the survival of the patients which is 50%. So, a dependable blood marker is needed for prognosis in OSCC patients with loco-regional and distant recurrence. Some factors can be assisted only after surgery and invasive techniques to check the prognosis of the disease. Despite the ease of examining the oral cavity, there is no practical approach for non-invasive screening and detecting cancer. As it is abrupt to use such invasive procedures from time to time, there is a need for nonsurgical and reliable techniques to assess the progression of tumors. Also, frozen sections are helpful during the intraoperative procedure to evaluate the lymph node metastases. An increase in the number of tumor cells through blood is a significant event in disease metastases toward the peripheral blood. Oral health impact assessment instruments could aid in determining the quality of life, and their usage in the initial stages of oral carcinoma could help physicians choose the best treatment option for enhancing the quality of life.

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.

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.

Assessing the Utility of Actual Proliferation Index Measured by Expression of ‘Agnor and Ki-67’ in Histopathologically Negative Surgical Margins of Oral Squamous Cell Carcinoma as a Modality for Prediction of Recurrence

Background: Oral squamous cell carcinoma is most common malignancy of head and neck which is the major cause of death. Recurrence is the major important prognostic factor in the survival of patients and tumor stage, degree of differentiation of neoplastic cells, pN stage resected margins, and lymphovascular invasion are the factors for recurrence. The rate of recurrence varies from 18 to76% for patients who underwent standard treatment. Histological assessment of surgical margins has a major role to predict the recurrence. But in spite of negative histological surgical margins recurrence rate is high, as there are genetic alterations in these margins which are not detected by routine histopathlogy. Even when surgical margins are free histopathologically the local recurrence rate is 10 to 30 percent. That’s why molecular evaluation of these margins should be done. Many immunohistochemical studies are done to assess surgical margins of OSCC but no study is carried out to assess the proliferative index in surgical margins. Therefore this study will help to improve management and predict the recurrence of OSCC. Objectives: In this study we aim to assess the utility of “actual proliferation index” measured by expression of “Agnor” and “Ki-67” in histopathologically negative “surgical margins” of “oral sqaumous cell carcinoma” as a modality for prediction of recurrence.  Methodology: The resected surgical margins of the oral squamous cell carcinoma cases which are operated in Sharad Pawar dental college will be selected as samples. The anterior, posterior, inferior and superior margin of resected specimens will be stained by H&E staining.  Immunohistochemical staining by ki-67 antibody will be done in the negative histopathological surgical margins. The same sections will be stained with  AgNOR staining. Both sections will be evaluated. Actual proliferative index will be calculated with the given formula Ki67 Labeling Index: Ki67 L1= “Number of Ki67 positive cells” x 100 Total number of tumor cells observed “Actual Proliferative Index (PI)” = “ Ki-67” or MIB-1 LI × AgNOR count ’ Recurrence of tumor will be observed during first two years period after surgical procedure. Expected Results: The “actual proliferative index” calculated by “Ki-67 labelling index” and “AgNOR count expression in histopathologically” negative surgical margins of OSCC will be more in recurrence patients as compared to patients who do not have recurrence. Conclusion: The API values measured by assessing the Agnor and Ki67 expression, in histopathological negative surgical margins of OSCC will be compared between with values of patient with recurrence.

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.

T-cell lymphoma of oral cavity: A rare entity

Lymphomas are heterogeneous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkin's lymphoma (HL) and non-HL (NHL). NHL can originate from B, T or natural killer lymphocytes. Extranodal presentation of T-cell NHL is extremely rare and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in a 13-year-old patient. The patient was diagnosed to have T-cell lymphoma on the basis of biopsy and immunohistochemistry and was referred to the oral surgery department for definite treatment.

Oral Manifestations in Diabetic and Nondiabetic Chronic Renal Failure Patients receiving Hemodialysis

Aim: To assess the prevalence of oral findings in diabetic and nondiabetic chronic renal failure (CRF) patients receiving hemodialysis (HD). Materials and methods: This study was conducted on 144 CRF patients undergoing HD therapy. They were further classified into diabetic and nondiabetic groups and also according to the duration of CRF. An oral examination was performed, searching for CRF-associated oral findings, along with due considerations to duration of CRF. Results: The oral manifestations were found to be higher in diabetic CRF patients (97.14%) relative to nondiabetic CRF patients (89.18%). The diabetic group exhibited a significantly higher number of patients with poor oral hygiene index (p = 000), uremic fetor (p = 0.005), unpleasant taste (p = 0.009), dry-fissured lips (p = 0.002), and pale mucosa (p = 0.019) than the nondiabetic group. The oral manifestations were significantly higher in CRF patients of more than 24 months' duration. Conclusion: The CRF HD patients with diabetes mellitus exhibited a higher risk of oral uremic manifestations including uremic fetor, unpleasant taste, pale mucosa, and dry-fissured lips than nondiabetics. The oral health status of CRF HD patients becomes worse with the increase in the duration of CRF. Clinical significance: Oral health status is often a neglected aspect in CRF patients. It should be given prime importance for CRF patients receiving HD to improve the quality of life. Keywords: Chronic renal failure, Diabetes, Hemodialysis, Oral manifestations.

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.

Documentation of postmortem changes in salivary gland architecture and staining characteristics

CONTEXT

Estimation of time passed since death continues to be a major problem for the forensic pathologist and its determination plays an important and vital role in medico-legal cases. The histological studies on various tissues after death have been mostly confined to single organ or tissue by individual workers at different atmospheric conditions.

AIMS

The aim of this study is to determine the best rehydrating solution for dehydrated tissues in postmortem examination.

SETTINGS AND DESIGN

This study was specific to salivary gland tissues and certain pattern of changes were determined during postmortem time intervals using hematoxylin and eosin stain and special stains like mucicarmine and alcian blue.

MATERIALS AND METHODS

The study was divided into two groups. (1) Group A: Normal tissue samples (twenty normal salivary gland tissue samples left without fixation for varying periods of time). (2) Group B: Control group (twenty normal salivary gland tissue samples immediately fixed in formalin). The three different rehydrating agents used in this study were glycerol, normal saline and modified Ruffer solution.

STATISTICAL ANALYSIS USED

Not required.

RESULTS

Modified Ruffer solution is the best when compared to glycerol and normal saline for rehydration of dehydrated tissues.

CONCLUSIONS

Thus in our study we conclude that the tissue which had been dehydrated at the crime scene for a fairly long period showed better rehydration with modified Ruffer solution and yield good cellular and nuclear details.

Analysis of various risk factors affecting potentially malignant disorders and oral cancer patients of Central India

CONTEXT

The use of tobacco/betel quid can alone lead to death. India is the fourth largest consumer of tobacco/betel quid in the world and the third-largest producer of tobacco/betel quid after China and Brazil.

AIMS

A case-control study was carried out to assess the prevalence and various risk factors among potentially malignant disorders (PMD) and oral cancer patients of central India.

SETTINGS AND DESIGN

A total of 100 clinically and histopathologically diagnosed PMD and oral cancer patients were selected for the study.

MATERIALS AND METHODS

A histopathologically confirmed 100 patients who were suffering from PMD and oral cancers were selected and an equal number 100 healthy controls who were age- and sex-matched at par with the cases were also examined and interviewed. Chi-square (χ(2)) test and adjusted odds ratio (ORs) with 95% confidence interval (CI) were calculated to estimate the suspected risk factors for PMD and oral cancers by using multivariate logistic regression analysis. Significance level was set at P < 0.05.

RESULTS

Statistically significant difference was observed in the age group, socioeconomic status (SES), duration, frequency, exposure time and synergistic effect of tobacco/betel quid chewing, smoking, and alcohol drinking in our study population.

CONCLUSIONS

Chewing tobacco/betel quid is a strong risk factor in the development of PMD and oral cancer. Also age, gender, SES, education, and occupation influence the development of PMD and oral cancer.

Chondrosarcoma of maxilla

Chondrosarcoma (CHS) is a rare malignant neoplasm of the jaws. Based on the morphologic features alone, a correct diagnosis of CHS may be difficult. Therefore, correlation of radiological and clinicopathological features are mandatory for the diagnosis of CHS. A case of CHS of the maxilla is reported. A brief discussion on the etiopathogenesis, radiologic and histologic presentation of the tumor and the treatment modalities of this unusual tumor is discussed.

XIAP and Ki-67: A Correlation Between Antiapoptotic and Proliferative Marker Expression in Benign and Malignant Tumours of Salivary Gland: An Immunohistochemical Study

BACKGROUND

Impaired balance between cell proliferation and apoptosis is crucial to the development of malignant neoplasm. The purpose of this study was to evaluate and compare the expression of X-Linked inhibitor of apoptotic protein (XIAP) (antiapoptotic marker) and Ki-67 (proliferative marker) expression in benign and malignant salivary gland (SG) tumours.

MATERIALS AND METHODS

The study consisted of 40 cases of benign SG tumours and 50 cases of malignant SG tumours. The immunohistochemistry was carried out by using Ki-67 antibody (clone MIB-1) and XIAP antibody in all the groups.

RESULTS

XIAP expression was significantly higher in malignant SG tumours than benign SG tumours (p = 0.016). Ki-67 LI was significantly higher in malignant SG tumours than benign SG tumours (p = 0.0002). Statistically significant positive correlation between Ki-67 count and XIAP expression was noted in benign and malignant SG tumours (p = 0.000).

CONCLUSION

As the expression of an antiapoptotic marker (XIAP) increases, the expression of a proliferative marker (Ki-67) also increases from benign to malignant SG tumours. Thus, targeted therapy of XIAP may play a future role in the management of SG malignancy.

Detection of micrometastasis in lymph nodes of oral squamous cell carcinoma: A comparative study

Background:

The annual mortality rate from head and neck squamous cell carcinoma (HNSCC) is over 11,000 worldwide. Squamous cell carcinoma of the head and neck (SCCHN) frequently metastasizes to the regional lymph nodes which are the first site of arrest of tumor cells that have invaded the peritumoral lymphatics, hence the strongest predictor of disease prognosis and outcome.

Aim:

The present study aims to compare the efficacy of frozen sections (cryosection), step-serial sectioning conventional H and E staining, immunohistochemistry (IHC) and RT-PCR analysis in detection of lymph node micrometastasis.

Materials and Methods:

A prospective series of 30 patients who were diagnosed with primary squamous cell carcinoma of the oral cavity and underwent surgical treatment including unilateral or bilateral selective neck dissection were considered for the study.

Result:

Metastatic carcinomatous cells were observed in H and E staining of frozen section in 18 lymph nodes (54%) and in 19 lymph nodes (57%) in step-serial sectioned H and E-stained sections of the 78 lymph nodes from 30 patients. Carcinomatous cells were immunolabeled with pancytokeratin in 18 lymphnodes (54%). CK19 mRNA was detected in 33 lymph nodes of 16 patients. RT-PCR gave positive signals for 24% and 23% of lymph nodes positive by histopathology and immunohistochemistry.

Conclusion:

Our study demonstrated that RT-PCR is far more sensitive in detection of micrometastasis than any other technique used in routine procedures and immunohistochemistry. Fifty-three percent patients with micrometastasis detected by RT-PCR had large T3/T4 tumors. Prognosis was poor for patients who were positive for micrometastasis detected only by RT-PCR, among which two patients died within a period of 6 months.

Enumeration of Salivary Streptococci and Lactobacilli in Children with Differing Caries Experiences in a Rural Indian Population

Objectives. Compare the total salivary Streptococci and Lactobacilli counts in cleft and noncleft children with differing caries experiences, correlate the bacterial counts with dmft/DMFT status and identify the different biotypes of Mutans Streptococci (MS). Patients. Group I included thirty subjects with dental caries (DC) and cleft lip and palate (CL/P); Group II had thirty subjects with DC but without CL/P. Group III comprised a control of thirty subjects with neither DC nor CL/P. Methodology. Enumeration of total salivary Streptococci and Lactobacilli was done by the plate count method and correlation of counts with dmft/ DMFT status examined. Differences in biochemical reactions were used to identify the biotypes. Results. Streptococci colonies in CL/P children with caries (64.30 ± 24.52) was significantly higher than in children with no CL/P or caries (45.57 ± 16.73). No significant differences in the Lactobacilli count were observed. dmft/DMFT status and Streptococci counts showed a strong positive correlation whereas Lactobacilli counts showed a moderate correlation. S. mutans was the predominant biotype. Conclusions. Higher total salivary Streptococci and Lactobacilli counts exist in cleft subjects with caries than in the non-cleft subjects. Positive correlation between dmft/DMFT scores and salivary Streptococci reinforces its role in DC. S. mutans and S. sobrinus are the biotypes more frequently associated with dental caries in children.

Correlation of serum levels of vascular endothelial growth factor with TNM staging, histopathologic grading, and surgical therapy for oral squamous cell carcinoma

OBJECTIVE

This study aimed to assess the serum levels of vascular endothelial growth factor in oral squamous cell carcinoma patients before and after surgical therapy, to compare these values with those of healthy individuals using ELISA, and to evaluate if any correlation existed between vascular endothelial growth factor levels and TNM stage or histolopathologic grade of the tumor.

METHOD AND MATERIALS

The study included three groups: group A1 consisted of 31 oral squamous cell carcinoma patients who had not received any prior treatment; group A2 consisted of the same 31 oral squamous cell carcinoma patients who had undergone radical surgical excision 1 month prior but no adjuvant therapy; and group B (control group) consisted of 16 healthy individuals. The serum vascular endothelial growth factor levels were assessed using the ELISA kit.

RESULTS

The vascular endothelial growth factor levels of preoperative oral squamous cell carcinoma patients were found to be three times higher than those of controls, and this difference was found to be statistically significant. The postoperative vascular endothelial growth factor levels had decreased 1 month after surgery but did not decrease to baseline levels. The vascular endothelial growth factor levels increased progressively with the TNM stage and histologic grade of tumor, but no definite correlation between the two could be found.

CONCLUSION

Vascular endothelial growth factor is an important marker of angiogenesis, as the vascular endothelial growth factor levels of the oral squamous cell carcinoma groups remained significantly elevated compared to that of controls. Though no significant difference was found between the pre- and postoperative oral squamous cell carcinoma groups, it can be suggested that successful treatment may reduce serum vascular endothelial growth factor levels if the time period of postoperative sample collection is increased. Only then can the utility of vascular endothelial growth factor as marker for assessing the effectiveness of surgical therapy or as a prognostic indicator be commented upon.

A Rare Case of Chorea Gravidarum

Chorea Gravidarum is the term given to chorea occurring during pregnancy. It is not an etiologically or pathologically distinct morbid entity but generic term for chorea of any etiology. We report a case of Chorea Gravidarum, who had past history of Rheumatic fever and Sydenham's Chorea in childhood. Factors associated with recurrence of chorea; those aggravating chorea during pregnancy and its management have been discussed.

Actual Proliferating Index and p53 protein expression as prognostic marker in odontogenic cysts

BACKGROUND

The purpose of this study was to evaluate the biological aggressiveness of odontogenic keratocyst/keratocystic odontogenic tumour (KCOT), radicular cyst (RC) and dentigerous cyst (DC) by observing the actual proliferative activity of epithelium, and p53 protein expression.

METHODS

The actual proliferative activity was measured by Ki-67 Labelling Index and argyrophilic nucleolar organizing regions (AgNOR) count per nucleus. The p53 protein expression was also evaluated.

RESULTS

Ki-67 positive cells were observed higher in suprabasal cell layers of KCOT with uniform distribution, a few of them were predominantly observed in basal cell layer in RC and DC. The AgNOR count was significantly higher in suprabasal cell layers of KCOT. The actual proliferative activity was noted to be higher in suprabasal cell layers of KCOT. The p53 immunolabelling was dense and scattered in basal and suprabasal cell layers in KCOT. The weakly stained p53 positive cells were observed diffusely distributed in KCOT, whereas they were mainly seen in basal cell layer of RC and DC.

CONCLUSION

The quantitative and qualitative differences of the proliferative activity and the p53 protein expression in sporadic KCOT may be associated with intrinsic growth potential that could play a role in its development and explain locally aggressive biological behaviour. AgNOR count and p53 protein detection in odontogenic lesions can be of great consequence to predict the biological behaviour and prognosis.