Expression of epithelial glycoprotein (EGP40) in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC).

AIM: To study the expression of Epithelial Glycoprotein (EGP40) in various grades of Oral Epithelial Dysplasia namely mild, moderate and severe epithelial dysplasia and in various grades of Oral Squamous Cell Carcinoma (OSCC) namely well, moderate & in poorly differentiated squamous cell carcinoma. MATERIAL AND METHODS: This laboratory study comprised of 47 samples in which 27 samples were of three different grades of OSCC, Well (n=10), Moderate (n=10) and Poorly differentiated (n=7) and remaining 20 samples were of three different grades of dysplasia [Mild (n=7), Moderate (n=8), Severe dysplasia (n=5)]. All the 47 cases were subjected to immunohistochemical staining to evaluate the expression of EGP40. Chi square was used to analyze the significance of differences in different grades of oral epithelial dysplasia & in different grades of OSCC. RESULTS: The percentage of EGP40 immuno positivity was increased from mild to severe dysplasia and the percentage of EGP40 immuno positivity was increased from well to poorly differentiated carcinoma No statistical significance was observed in the immunoreactivity and in the intensity of expression between various grades of oral epithelial dysplasia and oral squamous cell carcinoma. CONCLUSION: The epithelial cell adhesion molecule can be considered as an early marker for predicting malignant transformation of dysplastic epithelial lesions and used as a marker in predicting the OSCC prognosis.

Inverted Sinonasal Papilloma Masquerading as a Malignancy - Report of an Unusual Case.

Inverted sinonasal papilloma (ISP) is a benign epithelial neoplasm arising from the Schneiderian membrane. We report a case of ISP in a 50-year-old male that clinically presented as a polypoid mass in the nasal cavity. Imaging studies revealed it to be an aggressive lesion showing intracranial extension. On histopathological examination of the excised specimen, a diagnosis of ISP was arrived at. However, an extensive sampling of the tissue revealed no evidence of any malignant transformation. Taking into account the suggested viral aetiology for such lesions and the aggressiveness observed in this case, human papillomavirus (HPV) profiling was done but it turned out to be negative. Only one other case of inverted sinonasal papilloma arising from the nasal cavity and involving the brain has been reported in the literature to date. Considering the alarming clinical course in spite of its benign nature, it is important for the pathologist and surgeon to be well informed about this lesion.

Acinic cell carcinoma of minor salivary gland showing features of high-grade transformation.

INTRODUCTION: Acinic cell carcinoma (AciCC) of salivary gland is a relatively infrequent tumor. Though known for its low-grade behavior, its unpredictable element of recurrence and malignancy should never be ignored. CASE REPORT: A male patient with complaints of pain and swelling in the left jaw region since a year was operated based on the computed tomography (CT) and incisional biopsy report. Histopathology (routine staining, special staining, immunostaining and electron microscopy) of the excised specimen revealed it to be a variant of AciCC from minor salivary gland. DISCUSSION: To the best of our knowledge, this is the first case of AciCC showing propensity for high-grade transformation (HGT), arising from minor salivary gland, being reported. The rarity of such variants and the importance of various investigative techniques in the diagnosis of such cases are discussed.

Identifying sexual dimorphism in a paediatric South Indian population using stepwise discriminant function analysis.

Anthropological research relies on skeletal and dental remains for the identification of species. Sexual dimorphism is the systematic difference in form between males and females of the same species. This study is designed to compute a new formula for sex determination using discriminant function analysis in the deciduous crown dimensions of a paediatric population of South Indian origin and to check its accuracy. The sample consisted of 93 females and 90 males of South Indian origin aged between 5 and 13 years. Alginate impressions of the upper dental arch were made and casts were poured immediately. A digital vernier calliper was used to obtain measurements. Teeth considered for measurement were deciduous maxillary canines and molars. Our study is a maiden attempt in considering diagonal measurements along with mesiodistal (MD) and buccolingual (BL) dimensions as predictor variables for sex determination. Statistical analysis was performed using the Statistical Package for the Social Science version 17.0 software. By using the Student t-test, the different predictor variables of teeth selected between male and females were found to be significant (p < 0.05). Highly significant sexual dimorphism was found in the mean MD dimension of maxillary right canine and right and left first molar, BL dimension of right first molar, distobuccal-mesiolingual of right and left first molar and right second molar and mesiobuccal-distolingual of right second molar. The percentage of sexual dimorphism in MD dimensions revealed that the right upper first molar was the most dimorphic tooth and the upper first molar of the left side was the least dimorphic of the six teeth studied. The present study found the level of sexual dimorphism in the deciduous crown dimensions of a selected group of South Indian population, which is sufficiently large to determine sex with an accuracy of 87.2-88% by discriminant function analysis. Hence the formula derived from the present study could be of some value in sex determination of paediatric populations of South Indian origin.

Intraosseous myofibroma of mandible: A rarity of jaws: With clinical, radiological, histopathological and immunohistochemical features.

Myofibroma is an uncommon benign mesenchymal neoplasm composed of myofibroblasts, but it can be confused with more aggressive spindle cell tumors. Solitary myofibroma is common in soft tissues of head and neck, but rare in the jaw bones with only 38 cases of central myofibroma of mandible reported in English medical literature. When encountered in the jaws, lesions exhibit clinical and radiographic features suggestive of odontogenic cysts/tumors or other neoplastic conditions. We hereby present the 39(th) case of intraosseous myofibroma of the mandible which had been reported to our institution. A 16-year-old male reported with a chief complaint of swelling in the right side of face. Intraorally there was a firm, nontender swelling in the right buccal aspect of the mandible. Radiologically the lesion was osteolytic, destroying the buccal cortical plate. Histologically, characteristic biphasic pattern of myofibroma was noticed. Immunoreactivity was positive for vimentin and αSMA but negative for desmin, thus confirming our diagnosis. The patient was treated by local-wide surgical excision of the lesion. A 3-year follow-up revealed no signs of recurrence. Occurrence of myofibroma involving the jaw bones is common in the younger age groups and represents a unique diagnostic and therapeutic challenge. Differentiating this lesion from other benign and malignant neoplasms is crucial in deciding between a radical and a conservative treatment approach.

Genetic alterations in syndromes with oral manifestations.

Ever since Gregor Johan Mendel proposed the law of inheritance, genetics has transcended the field of health and has entered all walks of life in its application. Thus, the gene is the pivoting factor for all happenings revolving around it. Knowledge of gene mapping in various diseases would be a valuable tool in prenatally diagnosing the condition and averting the future disability and stigma for the posterity. This article includes an array of genetically determined conditions in patients seen at our college out-patient department with complete manifestation, partial manifestation and array of manifestations not fitting into a particular syndrome.

Palatal rugae in population differentiation between South and North Indians: A discriminant function analysis.

AIM: The present study is aimed at delineation of different types of rugae in two different populations and developing a discriminant function for the same. MATERIALS AND METHODS: A total of 940 subjects were included in the present study. The sample consisted of 466 subjects from South Indian population and 474 from North Indian population in the age group of 18-23 years. Neo colloid Easy flow((™)) alginate impressions of maxillary arch were made and casts were immediately poured with Type IV dental stone. A sharp graphite pencil was used to delineate the rugae and patterns were recorded according to the classification given by Kapali et al. The association between different population and different sexes was analyzed with chi-square test and a stepwise discriminant function analysis was also performed to develop a discriminant formula. RESULTS: Wavy, curved and straight rugae were the most common forms in both groups. Chi-square analysis for association between rugae shape and population groups showed significant differences among all the rugae patterns at the P < 5%. Chi-square analysis for assessing sex differences in the rugae shapes showed significant difference in straight, unification and circular type. Five rugae shapes - curved, wavy, nonspecific, unification and circular - were selected for discriminant function. CONCLUSION: The discriminant function equation obtained from the different rugae shapes in the present study was highly accurate enough to distinguish the Southern and Northern Indian population with the classification accuracy of 87.8%. Thus to identify a specific population, separate discriminant function formulae have to be developed. Hence, the study of palatal rugae is one of the simple and reliable tools for population identification in forensic science.

Determining dental sex dimorphism in South Indians using discriminant function analysis.

Dental forensics forms a vital branch of forensic science which deals with proper handling, examination and evaluation of dental evidences for identification of victims of crime, accidents or calamities. Therefore skull and teeth often provide the identification material. The aim of the study was to investigate the accuracy of odontometric methods in sex determination of permanent teeth and to compute new formula to differentiate male and female teeth using discriminant function analysis for South Indian population. A total of 100 subjects were selected for the study from a parent population of 4800 students by simple random sampling method. Alginate impressions of the upper dental arch were made and casts were poured immediately. A digital vernier calliper was used for the measurement of all upper anteriors. Twelve different tooth measurements were recorded and from those two indexes have been computed. Statistical analysis was performed using the SPSS version 17.0 software. All the predictor variables were subjected to stepwise discriminant function analysis which optimally separates the genders and a best discriminant function was generated. In all the observed mean dimensions, male values exceed the female values. Student's 't' test for the different predictor variables of all teeth selected between male and females were found significant (p < 0.05). Very high significance was found in mean MD of 11, 12 and 13 and |c| of 23. The variables exhibiting best discriminant powers were mesiodistal width of both upper central incisors, DB-ML of 13 and canine crown module of 13. Sexual dimorphism in the size of permanent teeth differs from one population to the other and hence the standards set for one population could not be applied for another population. Hence this technique would be a simple, quick, cost effective, reliable and accurate for sex determination.

Characterization of different tissue changes in normal, betel chewers, potentially malignant lesions, conditions and oral squamous cell carcinoma using reflectance confocal microscopy: correlation with routine histopathology.

The goal of this study was to characterize the features of normal mucosa, mucosa in betel chewers and smokers, potentially malignant lesions and squamous cell carcinoma of oral mucosa using reflectance confocal microscopy. Oral cavity biopsies were acquired from 25 patients from College of Dental Surgery, Saveetha University who underwent screening for suspected lesions of Oral precancer and Oral cancer along with normal patients who underwent impaction. Biopsies were acquired from the clinically suspicious area and immediately placed in Dulbecco modified eagles growth medium (DMEM). Reflectance confocal images were obtained at multiple image plane depths from biopsies within 6h of excision. After imaging, biopsies were fixed in 10% formalin and submitted for routine histopathological examination by an experienced oral and maxillofacial pathologist. Reflectance confocal images were compared with histological images from the same sample to determine the tissue features which contribute to early cellular changes, image contrast and early diagnosis. The confocal images were obtained to a depth of up to 150 microns on intact biopsy specimens and subsequent 3-dimensional images, keratin thickness measurements, cell measurements, cell density analysis and graphical representations were performed using Leica image analysis software. In normal mucosa keratin deposition were seen as alternating dark and bright stacks and in different cell layers the nuclei were seen as disks of varying intensities. In pre-cancerous lesions the keratin thickness and cell nuclear density were found to be increased when compared to normal controls. In OSMF cases confocal images of fibrosis show scattering from individual fibres as hyperdense areas. Oral squamous cell carcinoma cases demonstrated extensive variations in cell size, nuclear size and nuclear morphology. At cellular level, dysplastic features like increased nuclear density, increased nuclear cytoplasmic ratio, nuclear and cellular pleomorphism with loss of cohesiveness were identified in all five cases. Our results support the potential of reflectance confocal microscopy to play a significant role in clinical evaluations of oral lesions, early diagnosis of potentially malignant and malignant oral lesions and real time identification of tumour margins.