Jaw actinomycosis-An opportunistic infection: Case series.

Jaw actinomycosis is a quite rare invasive facultative bacterial infection caused by Actinomyces, Gram-positive filamentous bacilli found in human commensal. A break in continuity of epithelium due to surgery, trauma or previous infection can lead to deeper invasion of bacteria causing infection. The risk factors for actinomycosis are trauma, caries, debilitation, and poorly controlled diabetes mellitus. Clinical presentation can mimic other pathologies, such as fungal infection tuberculosis, granulomatous diseases, so the diagnosis of actinomycosis is delayed or misdiagnosed. For the definitive diagnosis of jaw actinomycosis, medical history, dental history histopathological examinations and microbiological culture are important parameters. Actinomycotic bacteria are sensitive to antibacterial agents hence chemotherapeutic agents are used for treatment. This report presents case series of jaw actinomycosis involving mandible and maxilla. The final diagnosis was supported by histopathology.

Histochemical characterization of bone and cementum using modified gallego's iron fuschin stain and van gieson stain and its application in fibro-osseous lesions.

OBJECTIVES: Fibro-osseous lesions (FOLs) of the jaws exhibit an overlapping histomorphologic spectrum with respect to nature of calcifications. Sometimes these calcifications may be difficult to characterize as bone and cementum on routine Hematoxylin and Eosin (H&E) staining. This causes difficulty in assessing the origin and diagnosis of these lesions. Thus the study aimed to characterize bone, cementum, and hard tissue components in FOLs using special stains. METHOD: The study included a histochemical evaluation of 20 samples of bone and cementum and 12 cases each of fibrous dysplasia (FD) and ossifying fibroma (OF). Three consecutive sections of each tissue were stained with H and E, modified Gallego's iron fuschin stain and Van Gieson stain. H and E and modified Gallego's iron fuschin stained sections were analyzed under light microscope whereas Van Gieson stained section was analyzed under polarizing microscope. RESULTS: It was found that cementum stained red and bone stained greenish-yellow in color. The calcifications seen in fibrous dysplasia stained greenish-yellow in color. Three cases of OF showed greenish-yellow calcifications and nine cases showed reddish calcifications. Polarization study of bone showed lamellar pattern and tooth cementum showed quilt pattern. Four cases of FD showed lamellar pattern and eight cases showed haphazard pattern. In OF, three cases showed lamellar pattern and nine cases quilt pattern. CONCLUSION: Calcifications having lamellar pattern and greenish-yellow color suggest their osteogenic origin thus having aggressive nature and requiring aggressive treatment. Calcifications having quilt pattern and reddish color suggest periodontal ligament origin thus having less aggressive behavior and less extensive treatment.

Clear cell odontogenic carcinoma: Case report of a deceptive pathology.

Clear cells are associated with numerous physiological and pathological conditions. Odontogenic cysts and tumors can arise from physiological clear cells like rests of dental lamina. One such clear cell neoplasm is clear cell odontogenic carcinoma (CCOC) that is associated with aggressive clinical behavior, metastasis and low survival rate. With <80 cases reported so far, it is a rare entity. Initially described as a clear cell odontogenic tumor considering it as a benign but invasive neoplasm, it was later termed as CCOC owing to its infiltrative nature with a marked tendency for local recurrence, regional nodal spread and possible distant, mainly pulmonary, metastasis. Reported here is a case of CCOC affecting mandible of a 55-year-old female along with its immunohistochemical workup.

Bilateral submandibular swelling diagnosed as tuberculous lymphadenitis in an asymptomatic patient: A rare case report.

In India, tuberculosis (TB) is a prevalent systemic disease and number of people who die with TB is increasing year by year. TB can be life-threatening, and there is a high mortality rate of systemic infection with TB. Although extrapulmonary TB (EPTB) is a rare form of TB, its prevalence is increasing day-by-day. Reported here is a case of a 28-year-old female patient with a painless swelling bilaterally in the submandibular region. She was diagnosed with bilateral submandibular tuberculous lymphadenitis. Tuberculous lymphadenitis, when occurring in the cervical region, continues to be a common cause of EPTB. Thorough knowledge of this condition is important as it can help in early diagnosis leading to prompt treatment of the patient and prevent further complications.

The postoperative fall in platelet count in cancer: Mirroring the catastrophe?

INTRODUCTION: Progression of cancer requires the growth and invasion of the tumor at its parent site as well as metastasis. Recent studies have shown that tumor cells can aggregate platelets in vitro (a process termed tumor-cell-induced platelet aggregation [TCIPA]), and this aggregation correlates with the metastatic potential of cancer cells in vivo. Platelet depletion or even an inhibition of TCIPA reliably diminishes metastasis. Furthermore, tumor cells bind platelet adhesion receptors of circulating platelets to metastasize more effectively. Studies say that malignant tumors to interact with platelets in the above fashion secrete platelet activating factors which raise the platelet count in malignancy. The study undertaken aims at comparing the preoperative and postoperative platelet levels in patients with benign and malignant neoplasms. MATERIALS AND METHODS: With an appropriate sample size of patients with benign or malignant neoplasms as per the inclusion and exclusion criteria, a platelet count presurgically and the 7th day postsurgically was advised. RESULTS: In case of patients with benign neoplasms, the postoperative platelet count showed a significant rise attributed to a normal healing response, while in patients with malignant neoplasms, the platelet count appeared to fall down significantly due to the effect of tumor removal and therefore a diminished production of thrombopoietic cytokines. The results obtained were thus consistent with the theories of tumor cell-platelet interactions proposed in the recent literature so far. CONCLUSION: Postoperatively, the platelet count rises in the patients with the benign tumor as a result of a normal healing response while those in patients with malignant neoplasm apparently appears to fall down due to the effect of tumor removal thus diminishing the production of platelet activating factors.

Adenoid cystic carcinoma of palate: Report of a solid variant.

Adenoid cystic carcinomas (ADCCs) are uncommon tumors, comprising < 1% of all head-and-neck cancers and 20%-25% of all salivary cancers. The most common presenting symptom of the lesion is a slowly growing mass followed by pain due to the propensity of these tumors for perineural invasion. The tumor is most often clinically deceptive by its small size and slow growth, which actually overlies its extensive subclinical invasion and marked ability for early metastasis making the prognosis questionable, aptly referred as "wolf in sheep's clothing." Cribriform, tubular and solid are the three recognized histopathological patterns. In ADCC, one of the important prognostic factors is the histological grade determined by the percentage of solid component in the tumor, which in the present study comprise more than 30% of the entire lesion rendering it an unfavorable prognosis.

Serum Cyfra 21-1 levels in oral squamous cell carcinoma patients and its clinicopathologic correlation.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the oral and maxillofacial region. The diagnosis in most cases is made at advanced stages with lymph node metastases and thus has a poor prognosis. Evidence suggests that detection of molecular abnormalities might be useful in screening for early malignancy. Cytokeratins (CKs) are part of the epithelial cytoskeleton. In malignancy, some CK filament fragments might be released in the serum. CK19 fragment Cyfra 21-1 is useful tumor marker for squamous cell carcinoma, but its clinical value in OSCC has not been confirmed. Hence, the aim was to investigate the diagnostic value of serum Cyfra 21-1 in OSCC patients. MATERIALS AND METHODS: The preoperative serum Cyfra 21-1 concentration of forty OSCC patients and forty healthy controls was detected by enzyme-linked immunosorbent assay (ELISA) using a commercial Cyfra 21-1 ELISA kit Xema Co., Ltd., Moscow, Russia. All statistical analyses were performed on STATISTICA statistical software (Windows version 6.0). RESULTS: There was a statistically significant difference (P P P = 0.459). CONCLUSION: It could thus be conjectured from the present study that increased serum Cyfra 21-1 level can be used as an adjunctive serological marker for the OSCC disease staging.

Evaluation of sexual dimorphism in arch depth and palatal depth in 500 young adults of Marathwada region, India.

CONTEXT: In exhibiting gender dimorphism, the bony pelvis and skull give the most reliable results from morphometric analysis. Palatal dimensions were reported to exhibit racial difference and sexual dimorphism in several studies. AIM: The aim of the present study was to measure the maxillary arch depth and palatal depth in Indian population to assess their use as a tool for sexual dimorphism. MATERIALS AND METHODS: Two hundred and fifty males and 250 females in the age group of 17-25 years were enrolled in the study, and impressions of maxillary arch were made. Measurement of palatal depth and maxillary arch depth was carried out at specific reference points using Korkhaus compass and digital caliper, respectively. The comparison of maxillary arch depth and palatal depth values was done using independent t-test. P < 0.05 was considered statistically significant. Diagnostic performance of significantly different variable was quantified by plotting "receiver operating characteristic" (ROC) curve. RESULTS: Arch depth mean values were significantly higher in males than females. However, palatal depth mean values, though higher in males, were not significant. Area under the curve in ROC curve for maxillary arch depth was found to be 0.76, indicating sufficiency of discriminatory power of this variable. CONCLUSION: The present study showed that maxillary arch depth can be used as a tool for sex determination along with other morphometric methods. Mean value of both maxillary arch depth and palatal depth can be used as the baseline value for given population to be used as a reference for further studies.

Orofacial granulomatosis: A disease or a concealed warning.??

Granulomatosis is any condition characterized by the formation of multiple nodules or granulomas in the soft tissues. Differential diagnosis for orofacial region includes a wide spectrum of diseases, but most of these lesions present histopathologically as noncaseating granulomas, giving a nonspecific depiction and leading to a diagnostic impasse. In the absence of any diagnosable entity, the disease is labelled as "orofacial granulomatosis". A nine-year-old girl child reported with recurrent gingival enlargement and persistent macrochelia which histopathologically presented as noncaseating granulomas. The disease was progressive raising the suspicion of being oral manifestation of a systemic disorder such as Sarcoidosis or Crohn's disease. This paper throws some light on this rare entity and reports rarer features of this disease, like eye involvement and staphylococcal mucositis in the case report.

Clinical profile of 108 cases of oral lichen planus.

Oral lichen planus (OLP) is a T cell-mediated chronic inflammatory disease with a varied clinical presentation. The present clinical study was carried out to clarify the demographic and clinical profile of 108 patients with OLP. The patients were identified based on the diagnostic criteria proposed by van der Meij et al. (2003) modified from the WHO (1978) clinical and histopathologic definition of OLP. Information such as age, gender, clinical presentation and type of OLP, site of involvement, symptoms, extraoral involvement, history of systemic disease, familial occurrence and risk factors like chewing and smoking tobacco, chewing betel quid, alcohol consumption were obtained. Mean age of OLP patients was 45.4 years, and among the identified patients, 70.4% were females. The most frequent clinical type was the reticular form (80.6%). The OLP lesions were symptomatic in 77.8% of the patients. The buccal mucosa was the most affected site (87.9%) and multiple oral lesions were observed in 41.7% of the patients. Among the OLP patients, 36.1% and 4.7% reported chewing tobacco and smoking tobacco, respectively. Histopathologically, epithelial dysplasia was seen in two cases. The chronic nature of OLP warrants patient education, psychological support and long-term follow up. (J Oral Sci 58, 43-47, 2016).

Bilateral orthokeratinized odontogenic cyst: A rare case report and review.

Orthokeratinized odontogenic cyst (OOC) is a developmental cyst of jaw and was initially considered by the World Health Organization (1992) as the uncommon orthokeratinized variant of odontogenic keratocyst (OKC). However, studies have shown that OOC has peculiar clinicopathologic aspects when compared with other developmental odontogenic cysts, especially OKC. So orthokeratinized odontogenic cyst now stands out to be a distinct entity. Clinically, it occurs as a single cyst, shows a predilection for males and is most often found in the second to the fifth decade. Its bilateral occurrence is extremely rare. The purpose of the article is to present a rare case of bilateral OOC arising in the mandible and review the literature on bilateral occurrence of this lesion.

Oral tuberculosis in an asymptomatic pulmonary tuberculosis.

Tuberculosis (TB) has been a worldwide health problem for centuries. It most commonly affects the lungs, but rare oral manifestations of TB have been reported. The aim of this paper is to present a case of painful erythematous lesion of oral cavity in undiagnosed asymptomatic pulmonary tuberculosis. This case is unusual in that the appearance of the painful oral lesion caused the patient to seek professional care and was concurrent with quiescent pulmonary disease.

Dentinogenic ghost cell tumor.

Dentinogenic ghost cell tumor (DGCT) is a rare tumorous form of calcifying odontogenic cyst and only a small number of cases have been described. It is a locally invasive neoplasm that is characterized by ameloblastoma-like epithelial islands, ghost cells and dentinoid. The present report describes a case of a 21-year-old male with a tumor in the posterior region of the mandible, showing features of DGCT.