Detection and Comparision of Cytopathological Changes in Smokers and Non-Smokers: A Comparative Study

Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers & smokers. Material & Methods: Smears sample were collected according to site (buccal mucosa, tongue & palate) from 100 subjects among smokers & non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.

Cytomorphometry in Oral Lesions - An Objective Approach to Cytological Diagnosis.

Objectives: The present study focusses on cytomorphological evaluation of the scrapings and cytological appearance of a spectrum of lesions of the oral cavity, Morphometric nuclear and cytoplasmic parameters were used to distinguish between benign, premalignant and malignant lesions. Material and Methods: The samples were obtained by scraping the lesion firmly till tiny pin point bleeding points were seen to ensure adequate sampling. Adequate sampling was defined as 50 cells consisting of transepithelial cytology specimen (superficial, intermediate and basal cells). Results: A total of 80 patients were evaluated with predominance in males and mean age of presentation was 45.05± 12.8 years. Cytomorphomteric analysis revealed an increasing trend in nuclear parameters as the spectrum of oral lesion moved from benign to malignant category while a decline was observed in cellular parameters. A significant p value of <0.0001 was found between cytomorphometrical parameters and histopathological subtypes. Sensitivity and specificity of conventional exfoliative cytology in conjunction with cytomorphometry was 100% and 94.74% respectively. Negative predictive value and positive predictive value of cytology for malignant lesions was 100% and 93.75% respectively. Diagnostic accuracy of cytology in predicting malignancy taking histopathology as gold standard was 97.0. Conclusion: Grading and scoring of oral cytosmears according to morphology showed a positive correlation with histopathological diagnosis. In addition, cytomorphometry increases the diagnostic accuracy of oral conventional exfoliative cytology and hence is seen to have an impact on early detection of cellular alterations and prompt treatment. Therefore, it is a sensitive and useful adjunct to monitor the cellular transformation.

Clinicopathological evaluation of the lesions of oral cavity, oropharynx, larynx and hypopharynx

Background: Early detection of malignancy substantially improves the survival in most head and neck cancers. A simpler and reliable screening method is something that is sought after by every clinician. Hence a clinicopathological study was carried out in the local population to study the pattern of various factors associated with the clinically suspicious lesions of the oral cavity, oropharynx, larynx and the hypopharynx. The role of exfoliative cytology was also evaluated.Methods: Our study, comprised of a total of 50 cases clinically suspicious of being either premalignant or malignant lesions of the oral cavity, oropharynx, larynx and the hypopharynx. All the patients were examined thoroughly and diagnosed clinically. Thereafter they were subjected to both exfoliative cytology and histopathology.Results: A malignant laryngeal lesion was the commonest. clinical diagnosis seen in 68% of the cases. On exfoliative cytology, the commonest finding was squamous cell carcinoma, seen in 34 (68%) cases. On histopathological examination, squamous cell carcinoma was found to be the commonest with 39 (78%) cases. The sensitivity and specificity of exfoliative cytology were observed as 84.6% and 90.90% respectively. The methods of diagnosis applied and their results were found to be significantly associated with a p value of 0.0119 which was <0.05.Conclusions: The commonest cause for the suspicious lesions of the oral cavity, oropharynx, larynx and hypopharynx was squamous cell carcinoma seen in 78% of the cases. Rapid assessment tools like exfoliative cytology can aid in early detection of malignant lesions.

Application of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of locally advanced gastric cancer / 中华胃肠外科杂志

Objective@#To explore the clinical significance of laparoscopic exploration combined with abdominal exfoliative cytology in the diagnosis and treatment of patients with locally advanced gastric cancer.@*Methods@#Inclusion criteria: (1) cancer confirmed by gastroscopy and pathology without preoperative anti-tumor treatment; (2) no distant metastases found in preoperative imaging examinations; (3) patients without surgical contraindications and being tolerant to surgery; (4) patients were willing to undergo laparoscopic exploration and abdominal exfoliative cytology examination, and signed informed consent. A retrospective cohort study method was used to collect and analyze the clinicopathological data of 225 patients with advanced gastric cancer based on the above inclusion criteria from a prospective, multicenter, open, randomized controlled phase III clinical trial (registration No. NCT01516944) conducted between February 2012 and December 2018 in The Fourth Hospital of Hebei Medical University, including 162 males and 63 females with age ranged from 23 to 78 years old. Forty-five patients (20.0%) were classified as Borrmann type I to II, and 180 (80.0%) were classified as type III to IV. All the patients underwent laparoscopy and peritoneal lavage cytology under general anesthesia. Laparoscopic exploration sequence: left and right diaphragm→liver and spleen→parietal peritoneum→pelvic cavity→greater omentum, small intestine, mesentery→transverse colon mesentery →stomach. Contents of exploration: (1) with or without ascites; (2) whether metastatic lesions existed in the peritoneum, mesentery, omentum and Douglas pouch; (3) whether metastasis existed on the liver surface; (4) whether the gastric lymph nodes were swollen; (5) whether infiltration occurred on the gastric serosa surface; (6) whether gastric wall was stiff. The left and right subphrenic, the abdominal and pelvic peritoneum, and the mesentery were rinsed with 500 ml of sterilized normal saline. Position of the reverse Trendelenburg was used in the Douglas pouch. The peritoneal lavage fluid under the liver and spleen fossa was collected. Cytological examination was carried out for exfoliative tumor cells. Evaluation criteria: (1) peritoneal metastasis (P): P0 meant no peritoneal metastasis, P1 meant peritoneal metastasis; (2) free peritoneal cancer cells (CY): CY0 meant no cancer cells in peritoneal lavage fluid cytology, CY1 meant cancer cells in peritoneal lavage fluid cytology. The results of patients undergoing laparoscopic exploration combined with abdominal exfoliative cytology, treatment options and prognosis were analyzed. Kaplan-Meier method was used to calculate the survival rate and a survival curve was drawn. Log-rank test was used for survival analysis.@*Results@#After laparoscopic exploration in 225 patients, clinical staging was corrected in 68 (30.2%) patients, of whom 7 (3.1%) downstaged and 61 (27.1%) increased in staging. Of 164 patients evaluated as P0CY0 after the first laparoscopy and peritoneal cytology examination, 126 underwent radical D2 surgery, and the other 38 patients were found to have later local lesions or extensive fusion of local lymph nodes, so then received neoadjuvant chemotherapy. Twenty-nine patients evaluated as P1CY0 or P1CY1 and 32 patients as P0CY1 underwent intraperitoneal hyperthermic chemotherapy+conversion therapy, and then a second laparoscopic exploration was performed to determine the treatment plan. In total, the original treatment regimens were changed after laparoscopic exploration in 99(44.0%) cases. The follow-up period ended in January 2019. The overall 2-year survival rate of 225 patients was 64.0%. As for those who were evaluated as P0CY0, P0CY1 and P1CY0-1 after the first laparoscopic exploration, the 2-year overall survival rate was 70.7%, 65.6% and 24.1%, respectively (P=0.002). The stratified analysis showed that among 180 patients with stage III tumor, after laparoscopic exploration combined with abdominal exfoliative cytology, 125 patients were found to be P0CY0, 28 were P0CY1, and 27 were P1CY0-1, whose 2-year overall survival rates were 70.4%, 64.3%, and 29.6% respectively, and the difference among these 3 groups was statistically significant (P=0.009).@*Conclusion@#Laparoscopic exploration combined with abdominal exfoliative cytology in patients with locally advanced gastric cancer has important clinical guiding significance in improving accurate staging, treatment options and prognosis evaluation, and can avoid non-therapeutic open-close abdominal surgery.

Cytomorphologic Analysis of Wet and Spray Fixation Methods in Oral Exfoliative Cytology

@#For a long time, oral exfoliative cytology (OEC) has been implemented as an effective preliminary diagnostic tool for pathological lesions and various methods for fixation of the cytology specimens have been studied. The present study was undertaken to compare the efficacy between the wet and spray type of fixation methods for Papanicolaou (PAP) stained oral cytosmears. The study comprised of 45 healthy subjects in the age group of 20-25 yrs. For each subject, two smears were collected from the buccal mucosa and subjected to wet and spray fixation methods respectively. Both the smears were stained using a commercial Rapid Pap Kit. Smears were observed microscopically and evaluated for cytomorphological features involving uniformity of staining, cellular morphology, nuclear morphology, cellular staining, nuclear staining and presence of impurities. Comparisons were made between the two methods of fixation and statistically analysed using McNemar non-parametric test. Cells were evenly distributed in wet-fixed smears (n=38, 95%) compared to spray fixed smears (n=19, 47.5%). Wet-fixed smears showed lesser impurities (n=13, 32.5%) than spray fixed smears (n=27, 67.5%). However, other parameters such as cytological and nuclear morphology, staining of cytoplasm and nucleus were found to be not significant when compared between the two methods of fixation (p<0.05). The study shows that wet-fixed smears have better cellular distribution and relatively fewer impurities when compared to the spray fixed smears. The method of wet-fixed smears may be used as an alternative to spray fixed smears. A larger sample size may be required for further validation.

An exfoliative cytological study of qualitative changes in buccal mucosa cells of type 2 diabetes patients in south gujarat region

Background: Diabetes mellitus is a metabolic disease and affects many organs of the body including oralmucosa. Exfoliative cytology can be used to detect the effects of diabetes on buccal mucosa cells.Aim: The present study will evaluate the qualitative changes (cytomorphology) of buccal mucosal cells in type 2diabetic patients and compare that with the non-diabetic individuals of South Gujarat region.Materials and Method: Present study was done on 50 type 2 diabetic patients (case) and 50 healthy individuals(control) selected as per exclusion and inclusion criteria. Procedure was explained to the participants andinformed written consent was taken. Buccal mucosa smears were taken and stained with Pap’s stain. 100 cellsof each Pap stained smear was examined under a research microscope for various cytomorphological changes.Smears were examined for cell morphology like binucleation, pyknosis, perinuclear halo, cytoplasmic granules,karyolysis, karyorrhexis, cytoplsmic vacuoles and micronuclei. All data were noted and subjected to statisticalanalysis.Results: Mean values of binucleated cells, pyknotic cells, perinuclear halo, cytoplasmic granules, karyolyticcells, karyorrhectic cells, cytoplasmic vacuoles and micronuclei were noted in controls and cases. Significantdifferences in between non-diabetic control and diabetic cases for mean values of binucleation (p<0.001),pyknosis (p<0.001), perinuclear halo (p<0.001), cytoplasmic granules (p<0.001), karyolysis (p=0.026) andkaryorrhexis (p<0.001) was observed. But no significant differences in the mean cells for cytoplasmic vacuoles(p=0.109) and micronuclei (p=0.176) were found between diabetics cases and non-diabetics control.Conclusion: The results of present study showed that buccal mucosa of diabetic case group is associated withsignificant differences in the mean values of qualitative changes like binucleation, pyknosis, perinuclear halo,cytoplasmic granules, karyolysis and karyorrhexis when compare to non-diabetic control group. Diabetesproduces significant qualitative (cytomorphologic) changes in the buccal mucosa cells that can be documentedby exfoliative cytology.

Cytological Grading Of Oral Submucous Fibrosis

Oral submucous fibrosis (OSMF) is a condition that was first described in the 1950s. It is caused as a result of addiction to harmful areca nut products with or without tobacco. The rationale of using exfoliative cytology in our study lies in the epithelial physiology where continuous exfoliation of epithelial cells is a part of physiological turnover. Deeper cells, which are strongly adhered in normal conditions, become loose in the case of malignancy and exfoliate along with superficial cells. Our aim in this study was to compare the cellular changes such as formation of micronuclei within the cell and cytomorphometric analysis of the buccal mucosal cells of OSMF patients with that of normal controls. We identified thirty three such cases of OSMF on the basis of oral inspection and examination. We used exfoliative cytology and liquid based cytogy to obtain buccal cells. The smear thus prepared was stained with feulgan fast green, acridine orange and papanicolou. Micronuclei were identified and cytomorphometric analysis was done using Adelta software. There was a change in the hue of Papanicolou from pink to purplish indicating the degree of keratinization from normal cells to cells affected by OSMF. Acridine orange gave a green emission at wavelength 480-490 to normal cells, while it gave a bright red fluorescence in cells undergoing apoptosis. Mean cellular diameter decreased from normalcells affected oral lesions. Mean nuclear cytoplasmic ratio increased from normal-cells to those affected by oral lesions. Frequency of micronuclei increased from normal to the cells affected by oral lesions. Buccal cell mutations in premalignant and malignant lesions can serve as a useful tool for the bio-monitoring of oral lesions. Exfoliative Cytology being minimally invasive and cost effective can help in mass screening programmes

Pattern of Smokeless Tobacco Use in Various Age Groups and Its Association withthe Frequency of Micronuclei in Exfoliated Buccal Cells

Introduction: Exfoliated buccal epithelial cells serve as an ideal site for an assessment of genotoxic events. Exfoliative cytology is economical and minimally invasive, its specificity and sensitivity of over 95% makes it an ideal diagnostic tool for mass screening purposes. An assessment of micronuclei in buccal epithelial cells gives a fair idea about the genotoxic events occurring in the oral cavity. Subjects and Methods: A case controlled study was performed on 300 participants. The participants were divided into four broad categories according to their pattern of consumption of smokeless tobacco. Thereafter they were subdivided in to various age groups. The distribution was done equally with 60 participants in each broad category. Results: The results in our study show that young adults consume the packaged form of smokeless tobacco while adults above 50 consumed tobacco leaves. Oral lesions were more common in young adults. Cellular alterations in the form of micronuclei were observed to have progressively increased from the control group to tobacco to gutkha users and the frequency of micronuclei was found to be highest in the oral lesions group. Conclusion: Certain lifestyle factors, such as consumption of smokeless tobacco are one of the major factors causing oral lesions. Frequency of micronuclei was assessed in exfoliated buccal epithelial cells. Maximum number of micronuclei was found in the oral lesion group. The age group with maximum cellular alterations was between 30-40 years. Hence we conclude that an assessment of micronuclei can be used as a biomarker for mass screening purposes since it is economical and a non- invasive procedure.

Effects of diabetes and hypertension on oral mucosa and tgfß1 salivary levels

Abstract The aim of this study was to investigate salivary levels of TGFβ1 and proliferation/ maturation of epithelial mucosa cells in diabetic and hypertensive patients. Design: in this cross-sectional study, whole stimulated saliva and oral mucosa exfoliative cytology specimens were collected from 39 patients that were healthy (control, n=10) or presented history of arterial hypertension (HAS, n=9), diabetes mellitus (DM, n=10) or both (DM+HAS, n=10). Salivary flow rate (SFR), TGFβ1 level in saliva, AgNORs and the epithelial maturation were evaluated. Non-parametric Kruskal-Wallis test, followed by Dunn's multiple comparison post-test and the Spearman test correlation analysis were used. SFR showed a significant decreased in DM and DM+HAS (0.47±0.11 and 0.64±0.43 mL/min) when compared to control (1.4±0.38 mL/min). DM+HAS presented the highest value of TGFβ1 concentration (24.72±5.89 pg/mL). It was observed a positive correlation between TGFβ1 and glycaemia (R=0.6371; p<0.001) and a negative correlation between TGFβ1 and saliva (R=-0.6162; p<0.001) and glycaemia and SFR (R=-0.5654; P=0.001). AgNORs number and status of maturation of mucosa cells were similar for all conditions. DM and DM+HAS presented the lowest SFR, which correlated with increased TGFβ1 levels. Despite the higher TGFβ1 secretion it was not observed changes in the morphology or proliferation of epithelial cells when diabetes or hypertension was present.

Resumo O objetivo deste estudo foi investigar os níveis de TGFβ1 na saliva e a proliferação/maturação das células epiteliais da mucosa em paciente diabéticos e hipertensos. Neste estudo transversal, saliva estimulada e amostras de citologia exfoliativa de mucosa oral foram coletadas de um total de 39 pacientes que se apresentavam saudáveis (controle, n=10) ou com história de hipertensão arterial (HAS, n=9), diabetes mellitus (DM, n=10) ou ambos (DM+HAS, n=10). Taxa de fluxo salivar (SFR), níveis de TGFβ1 na saliva, AgNORs e maturação epitelial foram avaliados. Teste não-paramétrico de Kruskal-Wallis, seguido de comparação múltipla de Dunn e correlação de Spearman foram utilizados para as análises. SFR diminuiu significantemente em DM e DM+HAS (0,47±0,11 e 0,64±0,43 mL/min) quando comparado ao controle (1,4±0,38 mL/min). DM+HAS apresentou os maiores valores de concentração de TGFβ1 (24,72±5,89 pg/mL). Foi observada uma correlação positiva entre TGFβ1 e glicemia (R=0,6371; p<0,001) e uma correlação negativa entre TGFβ1 e saliva (R=-0,6162; p<0,001) e glicemia e SFR (R=-0,5654; p=0,001). Número de AgNORs e o padrão da maturação das células epiteliais foram similares entre os todos grupos. DM e DM+HAS apresentaram os menores valores de SFR, os quais foram correlacionados com o aumento nos níveis de TGFβ1. Apesar da maior secreção de TGFβ1, não foram observadas mudanças na morfologia ou proliferação das células epiteliais quando o paciente apresentava diabetes ou hipertensão.

Diagnostic value of exfoliative cytology for chronic oral ulcers / 临床与实验病理学杂志

Purpose To evaluate the effectiveness of exfoliative cytology in chronic oral ulcers diagnosis.Methods To examined 107 cases of chronic oral ulcers which were difficult to determine the nature of the ulcer in exfoliaticve cytology,and compared postoperative histopathological results or clinical results,and made the final diagnosis with cytology.Results The qualitative diagnostic accuracy of cytology was 95.3％.The sensitivity and specificity for benign and malignant lesions was 94.6％ and 100％,respectively.False positive rate was 0,and false negative rate was 5.4％,and the coincidence rate of cytological examination with the final pathology was 67.0％.Conclusion Exfoliative cytology has important reference value in chronic oral ulcer diagnosis.It is characterized by simple,rapid procedure and less trauma.Doctors can develop next treatment plan based on the results of exfoliative cytology.

Levels of salivary thiocyanate and its relation with occurrence of micronuclei using exfoliative cytology in smokers and nonsmokers.

Aims: To evaluate the levels of salivary thiocyanate and its relation with the occurrence of micronuclei (MN) using exfoliative cytology in smokers and nonsmokers. Materials and Methods: One hundred and twenty patients were divided into 3 groups: nonsmoker group 1 (control), smokers group 2, and smokers group 3. Their saliva was collected and analyzed for thiocyanate levels, and exfoliative cytology was evaluated for the presence of MN. Statistical Analysis Used: Fisher’s exact test and ANOVA test were used. Results: It was seen that as the grade of smoking increased, the levels of salivary thiocyanate and occurrence of MN increased. Conclusions: Detection and quantification of “biomarkers” such as salivary thiocyanate and MN in noninvasive and painless procedures such as oral exfoliative cytology can be an upcoming research domain in the field of cancer prevention and therapeutics.

Assessment Of Cytotoxicity Of Chlorhexidine Containing Mouthrinses By Micronucleus Test In Exfoliated Buccal Epithelial Cells.

Background & Objective: Chlorhexidine mouth rinses are utilized worldwide on regular basis in oral hygiene practice for plaque control. Studies have shown that chlorhexidine has toxic effects on a variety of eukaryotic cells. Micronuclei count in exfoliative cells is an economical and non invasive diagnostic method for evaluation of cytotoxic effects of many carcinogens/ co-carcinogens. The present study was conducted in order to evaluate frequency of micronuclei in buccal epithelial cells of patients using chlorhexidine containing mouthrinses. Methodology: Study included 50 subjects, of whom 30 having clinically suspected mild gingivitis, rinsed with chlorhexidine; 20 control subjects, rinsed with saline. Buccal epithelial cells were collected with a brush before and after one week of usage of chlorhexidine by patients and physiologic saline by controls. Cells subjected to Fuelgen reaction and analysed by two independent observers for micronuclei counts. Results: Considerable increase in micronuclei count was noted in patients using chlorhexidine compared to controls. Conclusion: Present study suggests that chlorhexidine has cytotoxic effects and further studies involving the therapeutic use of different mouthrinses for a longer duration may provide justification for their usage in clinical practice.

A new approach to exfoliative cytology: A comparative cytomorphometric study.

CONTEXT: Early detection of oral premalignancy and malignancy using simple screening aids play a promising role in curbing the disease. AIM: The primary aim of this study is to evaluate and the secondary aim of this study is to compare the cytomorphometry and cellular atypia in keratinocytes obtained from oral rinse and conventional exfoliative cytology in normal oral mucosa and clinically diagnosed oral leukoplakia. MATERIALS AND METHODS: The study comprised of 55 clinically diagnosed cases of leukoplakia and 55 age and sex matched normal controls. Smears were prepared using oral rinse technique followed by the conventional exfoliative cytology. Papanicoloau stained smears were evaluated for atypia and subjected to image analysis. Based on the presence of atypia they were further divided into three groups (Group 1‑cases with atypia, Group 2‑without atypia and Group 3‑normal controls) and analyzed. Statistical analysis used one‑way analysis of variance followed by Tukey Honestly Significant Difference test for intergroup analysis and unpaired students t‑test to compare the two methods. RESULTS: Smears prepared with both methods demonstrated atypia in 18 cases. The cellular diameter and cellular area (CA) were progressively increased from Group 1 through Groups 2 and 3 in both the smears. Nuclear diameter and nuclear area and nuclear cytoplasmic ratio progressively decreased from Group 1 through Groups 2 and 3. Both the methods showed no significant differences among the cellular parameters except in normal controls. CONCLUSION: Cytomorphometric analysis of keratinocytes obtained with oral rinse method and wooden spatula can serve as a useful screening aid to detect oral leukoplakia. Oral rinse method being more convenient results in smears of better quality.

Infección por virus del papiloma humano en la cavidad bucal / Infection due to the human papillomavirus in the oral cavity

Se efectuó un estudio descriptivo y transversal de 75 parejas sexualmente activas, tratadas en la consulta estomatológica del Policlínico de Especialidades perteneciente al Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero del 2010 hasta igual periodo del 2014, con vistas a determinar la presencia del virus del papiloma humano en la cavidad bucal. Se realizó el examen clínico intrabucal, y como procedimiento diagnóstico corroborativo la colposcopia. Se halló que la totalidad de los integrantes de la serie padecían de esta infección, a pesar de encontrarse asintomáticos en una etapa subclínica donde se observaron pequeñas lesiones exofíticas, aumento de la vascularización y del epitelio blanco. Los resultados citológicos e histológicos obtenidos en la citología exfoliativa y la biopsia confirmaron la presencia de este agente viral dentro de la célula.

A descriptive and cross-sectional study of 75 sexually active couples was carried out, treated in the Stomatology Department from Specialties Polyclinic belonging to "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from January, 2010 to the same period of 2014, with the aim of determining the presence of the human papillomavirus in the oral cavity. The clinical intraoral exam was carried out, and the colposcopy was used as corroborative diagnostic procedure. It was found that all the members of the series suffered from this infection, in spite of being asymptomatic in a subclinical stage during which small exophytic injures were observed, increase of the vascularization and of white epithelium. The cytological and histological results obtained in the exfoliative cytology and the biopsy confirmed this viral agent's presence inside the cell.

Cytomorphometry as a Diagnostic Tool for Assessing the Altered Nature of Exfoliated Buccal Mucosal Cells in Diabetic and Hypertensive Patients.

Aim: To study the cytomorphometric analysis of cells in the cytologic smears from buccal mucosal cells of diabetic and hypertensive patients. Materials and Methods: Smears were collected from clinically normal mucosa of 30 diabetes and 30 hypertensive patients and 30 healthy controls. Smears were stained using papanicolauo method. Cell diameter, nuclear diameter, cell area, nuclear area and nuclear: cytoplasmic ratio was obtained for each patient.Results: Compared to normal it was found that there were significant changes in diameter of cells (P<0.01), nucleus diameter (P<0.01), cell area(P<0.01) and nuclear area (P<0.001) in diabetes patients but not in hypertensive patients (P>0.01). Conclusion: Diabetes produces definite cytomorphometric changes in buccal mucosal cells. This research area is worthy for further exploration for public health implications.

The Clinical Value of Combined Detection of Pleural Effusion Cytology and tumor markers / 国际检验医学杂志

Objective The paper discussed the clinical value of differential diagnosis of pleural effusion by combined examination of exfoliative cytology and tumor markers,such as Carcinoembryonic-antigen(CEA),Carbohydrate-antigen1 9-9 (CA1 9-9),Cytoker-antin-1 9-fragment 21-1 (CYFRA21-1)and carbohydrate antigen 125 (CA125).Methods A total of 21 6 patients with pleural effu-sion were divided into malignant group containing 1 96 patients and benign group consisting of remaining patients.Aside from the conventional exfoliative cytology examination,by electrochemical luminescence immunoassay technology,the contents of tumor markers of CEA,CA1 9-9,CYFRA21-1,CA125 in the pleural effusion were measured.Finally,the data were statistically analyzed. Results In malignant group,the positive rate of exfoliative cytologic examination was 82.7%,in which adenocarcinoma accounted for 87.7%.The tumor markers in malignant group was significantly higher than that of benign group.The difference was statisti-cally significant (P < 0.05 ).The sensitivity of CEA is 52.0%,CA1 9-9 48.5%,CA125 41.9%,and the four tumor markers is 74.5%,respectively.For the combined examination of exfoliative cytology and tumor marke,the sensitivity is 96.4%,and specifici-ty is 80%,accuracy is 96.8%.Conclusion The exfoliative cytologic examination is one of the best ways to diagnose malignant pleu-ral effusion.The tumor marker detection is a useful auxiliary method for correct diagnosis and treatment.The sensitivity and accura-cy of the diagnosis of benign and malignant pleural effusion can be improved by the exfoliative cytologic examination combined with tumor marker detection.

Recurrent Oral Manifestations of Paracoccidioidomycosis without Pulmonary Involvement: Case Report and Review of Literature / Manifestación Oral Recurrente de Paracoccidioidomcosis sin Compromiso Pulmonar: Reporte de Caso y Revisión de la Literatura

This article describes a case of recurrence of chronic paracoccidioidomycosis (PCM) 11 years following the initial diagnosis. The patient was a 51-year-old white Brazilian female, which had been previously diagnosed with PCM. The physical examination revealed the presence of a single crusted lesion in the upper lip and an elevated lesion with fibrous scar appearance on right buccal mucosa. Although the diagnosis of PCM, the absence of pulmonary involvement led to the biopsy of the lesion localized on the buccal mucosa and the histopathological analysis in H&E and PAS stains revealed no morphological changes suggestive of any lesion. However, the exfoliative cytology stained with Grocott-Gomori showed the presence of Paracoccidioides brasiliensis and the infection caused by this fungus was proven. Of this way, we emphasize the importance of stomatologic evaluation to the diagnosis of diseases that usually manifestssystemically. So, the correct diagnosis of oral manifestations of PCM, is essential to ensure early and safe intervention.

En este artículo se describe un caso de paracoccidioidomicosis crónica (PCM) recurrente 11 años después del diagnóstico inicial. La paciente una mujer blanca de Brasil de 51 años de edad, que había sido diagnosticada previamente con PCM. El examen físico reveló la presencia de una lesión única en el labio superior y una lesión elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnóstico de PCM, la ausencia de compromiso pulmonar llevó a la biopsia de la lesión localizada en la mucosa bucal y el análisis histopatológico no demostró cambios morfológicos indicativos de cualquier lesión. Sin embargo, la citología exfoliativa teñida con Grocott-Gomori mostró la presencia de Paracoccidioides brasiliensis y la infección causada por este hongo fue probado. De esta manera, hacemos hincapié en la importancia de la evaluación odontológica para el diagnóstico de enfermedades que se manifiestan generalmente por vía sistémica. Por lo tanto, el diagnóstico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervención temprana y segura.

Cytomorphometrical Analysis of Exfoliated Buccal Mucosal Cells: Effect of Smoking.

Introduction: Exfoliative cytology is a non-aggressive, non-invasive procedure with higher patient compliance and is therefore, an attractive technique for the early diagnosis of oral lesions. Th e purpose of this study is to evaluate and compare cytological changes using morphometric analysis of the exfoliated buccal mucosal cells in smokers, with results obtained for non-smokers. Methods: Smears were collected from the clinically normal buccal mucosa of 120 individuals. Age range of subjects taken was 40-60 years. Smears were then stained with Papanicolaou stain. Results: Mean NA for smokers was signifi cantly elevated compared with the mean NA for non-smokers. Mean CA in smokers was decreased as compared to non-smokers but the diff erence was not signifi cant. Also, N/C ratio was signifi cantly elevated in smokers group. With increasing heavy exposure in duration of years, Cytomorphometric changes show signifi cant altered values for all three measured parameters (NA, CA and N/C ratio). Conclusion: Increase in NA and decreased CA as well as altered N/C ratio would appear to be due to smoking tobacco. Cytomorphometric analysis can be used regularly to detect these cell alterations. Th is method can also aid in motivating individuals to withdraw from adverse eff ects of tobacco smoking. Currently, use of exfoliative cytology has increased as an adjunct to screening of precancerous lesions and malignancies of the oral cavity.

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

A blastomicose sul americana, paracoccidiodomicose (Pb micose) ou doença de Lutz é uma infecção fúngica endêmica na América Latina. É causada pelo fungo dimórfico Paracoccidiodes brasiliensis, e pode causar lesões na mucosa oral. Nós avaliamos a incidência de lesões orais de Pb micose nos pacientes atendidos em um Centro Especializado em Diagnóstico Oral com foco principal nas diferentes formas clinicas das lesões, suas localidades, ocupação dos pacientes, hábitos deletérios e diagnóstico e metodologia, e foram detectados 31 casos (18 pacientes). Os resultados mostraram que 88,8% dos pacientes eram do sexo masculino com idade média de 50 anos de idade, e 39% trabalham, ou trabalhavam, com atividades relacionadas à agricultura. Observou-se que 88,9% eram fumantes e 72,2% ingeriam álcool. Citologia esfoliativa foi feita em 66,6%. Mucosa jugal foi acometida em 30%, gengiva, e lábios 16% (cada um) foram os locais mais comuns de lesões orais da Pb micose. Comparando o diagnóstico inicial com o definitivo feito pelos profissionais, a acurácia foi de 33%; o diagnóstico dos estudantes foi mais preciso demonstrando 72,5% do diagnóstico inicial correto com diferença estatística significante (p=0,25) através do teste ANOVA do SPSS WIN com nível de significância de 5%. Biópsia incisonal e citologia esfoliativa são eficientes para um diagnóstico precoce desta doença na boca; o treinamento dos estudantes em diagnóstico para reconhecer as patologias orais é urgente para melhorar a saúde pública.

Estudio citomorfométrico de pacientes con cáncer y desórdenes potencialmente malignos de la cavidad bucal / Citomorphometric study of patients with cancer and potentially malignant disorders of the oral cavity

La detección temprana de lesiones bucales promete aumentar sobrevivencia y reducir la morbilidad de los pacientes que sufren esta condición. Un método alternativo para el examen de lesiones en la cavidad bucal, es la citología. Objetivo: valorar las relaciones del tamaño núcleo/citoplasma de células de mucosa bucal sana, de lesiones bucales potencialmente malignas y de cáncer bucal, obtenidas con citología exfoliativa utilizando citomorfometría. Material y método: Se realizó citología a 22 pacientes, de ambos sexos, con edades entre 23 y 81 años utilizando cytobrush. Las muestras se dividieron en tres grupos: 1) citologías de pacientes con lesiones de cáncer bucal (n=7); 2) citologías de pacientes con desórdenes bucales potencialmente malignos (leucoplasia y líquen) (n=15); 3) citologías del lado sano de pacientes con lesiones de cáncer y desórdenes bucales potencialmente malignos (grupo control) (n=15). Se seleccionaron 30 células de cada paciente y se midió el área nuclear (AN), la citoplasmática (AC) y se calculó la relación AN/AN. Se utilizó el Test de Kruskal Wallis y el Sofware estadístico Infostat. Resultados: No se encontraron diferencias significativas entre los tres grupos estudiados al valorar la relación AN/AC. Teniendo en cuenta el género, se observó que en las mujeres se diferenciaron significativamente las células del grupo control de las de los grupos de lesiones. En el género masculino se observaron diferencias significativas entre los tres grupos celulares. No hubo diferencias significativas entre los diferentes grupos etarios .Discusión: A pesar de las diferencias significativas entre los géneros, no es posible hacer una buena separación de los tres grupos de estudio, utilizando solamente citología exfoliativa.

Early detection of bucal lesions promises to increase survival and to reduce morbidity in patients suffering from this condition. An alternative method for examining lesions in the bucal cavity is cytology. Objective: To assess by cytomorphometry the relationship of size nucleus / cytoplasm of superficial cells from healthy bucal mucosa, from potentially malignant bucal disordes lesions and bucal cancer using exfoliative cytology. Material and methods: PAP smear was performed in 22 patients of both gender, aged between 23 and 81. Cytobrush was used. The samples were divided into three study groups: 1) smears of patients with bucal cancer lesions (n = 7), 2) smears of patients with potentially malignant bucal disordes lesions (n = 15), lesions considered were leukoplakia and lichens ; 3) (control group) (n=15): smears of the healthy side of patients with cancer and potentially malignant bucal disordes lesions.Thirty cells were selected for each patient and the nuclear area (NA), cytoplasmic area (CA) were measured and the ratio NA / CA was calculated. We used Kruskal Wallis and Statistical Software InfoStat. Results: No significant differences were found between the three groups studied the relationship NA / CA was assesed . When comparing cells from each of the three groups considering the gender of the patients separately, we found that in women differ significantly from the control group cells and groups of injuries, we could not discriminate between cells obtained from potentially malignant bucal disordes lesions and cancer lesions . In the male gender differences were significant among the three cell groups. Discusion: Despite the significant gender differences, we could not difference the three study groups using only exfoliative cytology.