Acantholytic oral squamous cell carcinoma with clear cell change - a rare amalgamated variant

ABSTRACT Background Acantholytic squamous cell carcinoma (ASCC) is an uncommon histological variation of oral squamous cell carcinoma (OSCC), accounting for fewer than 4% of all occurrences. The tumor shows a slight masculine predisposition, with the lower lip being the most commonly affected location. ASCC is reported to have a diverse biologic behavior, which explains its ability to metastasize to distant places and, thus, its poor prognosis. Similarly, clear cell change in OSCC is a rare occurrence with an unknown etiology that suggests its aggressive nature. Method and Results Histopathology reveals central acantholytic cells with numerous duct-like features. The presence of distinct cytological atypia contributes to the diagnosis of SCC. Special stains and IHC aid in distinguishing tumor from other histopathologically similar entities. Conclusion The case of a 29-year-old male presented here with an updated literature review highlights the need for histological study of the unique and seldom seen oral ASCC with clear cell change, which can be ignored because of similarities with other entities. Because recurrence rates are so high for ASCC, amalgamated clear cell change makes it critical for proper treatment initiation with a definite diagnosis. To the best of our knowledge, this is the first documented occurrence. Our experience with the present case suspected a more aggressive behavior due to a high Ki-67 index, anticipating a poorer prognosis in the oral cavity considering the patient's young age.

Knowing the unknown in oral squamous cell carcinoma: An observational study

Introduction: Conventional oral squamous cell carcinoma (OSCC) is relatively easy to diagnose on histopathology, as it comprises dysplastic epithelial cells with variable degrees of squamous differentiation. Different grading systems have been employed in grading OSCC based on its dysplastic features and host response. Some unusual features such as clear cell change, epithelial–mesenchymal transition (EMT), stromal hyalinization, stromal desmoplasia, perineural invasion, vascular invasion, tissue eosinophilia, giant cells, and tertiary lymphoid follicle formation are evident in OSCC histologically but have not yet been accounted in any grading systems of OSCC except perineural and vascular invasion. Aim: The aim of the present study was to identify these uncommon features and to correlate them with different grades of OSCC. Materials and Methods:This study was conducted on 100 histopathologically confirmed OSCC cases retrieved from the archives of our department. They were graded on the basis of Broder's grading system and were reviewed for the features mentioned above. Data collected were subjected to statistical analysis. Results: Clear cell change, EMT, foreign body giant cells, and tumor giant cells were observed in 13%, 20%, 1%, and 3% of cases, respectively. We found stromal desmoplasia in 15% and stromal hyalinization in 9% of cases. Tissue eosinophilia, tertiary lymphoid follicle formation, and perineural invasion were observed in 12%, 3%, and 2% of cases, respectively. Vascular invasion was not evident in any of the cases examined. Conclusion: The incidence of the unusual features was 7.8% in our study.

Dentinal Tubules of Attrited, Abraded and Eroded Teeth- A Comparative Evaluation of Scanning Electron and Light Microscope.

Aim: The aim was to study the ultrastructure of dentin exposed by attrition, abrasion and erosion separately and in combination and to visualize the lesions using scanning electron microscope and thereby establish a superior basis for evaluating dentinal changes at the ultra-structural level and to correlate the findings with changes seen at the light microscopic level. Study Design: Tooth wear is often multifactorial. Loss and excessive wear of hard dental tissues is a permanent problem of the dentition, especially in present era, encompassing almost all age groups. In this study 40 extracted teeth were used. Four groups were made and comparison was made between light microscope and scanning electron microscopic findings. Place and Duration of Study: Department of oral and maxillofacial pathology, career post graduate institute of dental sciences, lucknow, (U.P.), India. Methodology: Forty extracted permanent teeth (10 attrited, 10 abraded, 10 eroded and 10 normal premolars and molars) were sampled divided into four groups. After debridement and fixation in 10% formalin for 24-48 hours, the teeth were fractured along their longitudinal axes. Two halves of the teeth were studied under scanning electron and light microscope. The dentinal changes secondary to attrition, abrasion and erosion such as dead tracts, dentinal sclerosis and reparative dentin formation seen under light microscopy, were correlated with the ultra-structural findings. The data so obtained were tabulated and statistically analyzed. Results: The light microscopic finding of 4 randomly selected teeth, showed frequency of tertiary dentin significantly more than dead tracts and dentinal sclerosis was absent, from each group. 10 samples scanned with electron microscope showed the tubular surface/margins smooth, tubular surface/margins rough and presence of crystals was highly significant (p<0.001) whereas peritubular dentin and intertubular dentin, was not significant (p>0.05) in each group. Similarly, mean density of dentinal tubules of normal group was the highest followed by abraded, attrited and eroded the least. The percentage of affected dentinal tubules was most in eroded & least in attrited teeth. Conclusion: The scanning electron microscope is a powerful magnification tool which offers extremely high resolution. In the present study, scanning electron microscopic image complements the information available from the light microscope about the dentinal changes in abraded, attrited and eroded teeth.