Nasopalatine Duct Cyst Associated with Non-Vital Teeth: Report of a Rare Case.

Nasopalatine duct cyst, which is also known as incisive canal cyst, is the most common developmental cyst of the maxilla. It arises from the proliferation of the remnants of the nasopalatine duct stimulated by trauma or infection. In this article, the authors report a rare case of an extensive nasopalatine duct cyst in a 57-year-old Male associated with non-vital tooth. Clinical examination revealed facial asymmetry associated with swelling that is painful and tender. Correlating clinical and radiological findings, a diagnosis of nasopalatine duct cyst was formed, and the histopathological examination confirmed the diagnosis of nasopalatine duct cyst. This case highlights the importance of knowing that nasopalatine duct cyst can be associated with non-vital teeth, challenging the assumption that they are exclusively associated with vital teeth. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04513-1.

Non-familial paediatric oral myofibroma - A masquerade. Case report with a brief literature review.

Myofibromas are fibrous tumours that could be of familial or non-familial origin, belonging to the fibroblastic and myofibroblastic subset with a wide spectrum of clinical behaviour. Oral myofibromas present with a broad range of differential diagnoses, including benign and malignant lesions. Histopathologically, these lesions may imitate many other soft tissue tumours of the oral cavity, such as spindle cell tumours of nerve, smooth muscle cell origin, and other myofibroblastic lesions, thus leading to misdiagnosis and mistreatment. In the present paper, we report a soft tissue lesion, which presented as a growth on the gingivobuccal sulcus in a 7-year-old child. We also emphasise the various differential diagnoses that need to be eliminated and the importance of immunohistochemistry to know the nature of tumour cells in establishing the accurate diagnosis.

"Giant cell fibroma of buccal mucosa -an unusual lesion of unusual size": A case report.

Giant cell fibroma is a benign oral fibrous tumour. The clinical appearance of majority of non-neoplastic fibrous growths is similar, but unique histopathological features of giant cell fibroma aid in its final diagnosis. It usually manifests as an asymptomatic, sessile or pedunculated mass usually less than 1 cm in diameter. In this case report, we highlight a case of giant cell fibroma in a 58-year-old male patient, which had an unusual size with associated pain. Although giant cell fibromas are benign lesions, it is important for dentists to be aware of this lesion based on its frequency of occurrence and need for its accurate diagnosis.

Concurrent autoimmune orofacial lesions: A rare occurrence!

Autoimmune disorders occur either as a solitary lesion or in pairs, but it is unusual to find two autoimmune disease lesions in the oral cavity in a single patient, who has been previously treated for psoriasis. We present the case of a 30-year-old male who presented with complaints of severe burning in the oral cavity. Examination revealed the presence of co-occurrence of vitiligo with oral lichen planus with a history of psoriasis and was managed conservatively with good response to treatment.

Could mouth rinses be an adjuvant in the treatment of SARS-CoV-2 patients? An appraisal with a systematic review.

OBJECTIVE: A wide variety of mouth rinses are available to combat micro-organisms in the oral cavity. At the present global pandemic, the need of the hour is to control the viral infection due to the novel corona virus SARS-COV-2, as its port of entry is through the receptors located in the oral and pharyngeal mucosa. This systematic literature review focuses on the in vivo studies [randomized control trials (RCTs)] done on the efficacy of existing mouth rinses which have been used in reducing the viral loads. METHODS: The electronic database which includes PubMed-MEDLINE, Google scholar, Scopus, Web of Science, EMBASE, ProQuest and CINAHL was searched from December 2019 to June 2021 with appropriate Medical Subject Headings (MeSH) terms and Boolean operators. Two reviewers independently reviewed the abstracts. RESULTS: Of the 2438 retrieved titles, 905 remained after removing duplicates. Twelve articles were eligible to be included in this review of which seven were randomized with adequate sample size. CONCLUSIONS: Mouth washes containing povidone iodine and chlorhexidine decrease the viral load transiently. Large amount of in vivo studies are of paramount importance, especially RCTs, to prove the efficacy of these mouth rinses.

Expression of Fascin and SALL4 in odontogenic cysts and tumors: an immunohistochemical appraisal.

Background: Various stemness markers (SOX2, OCT4, and NANOG) have been studied in odontogenic cysts and tumors. However, studies on SALL4 having similar properties of stemness has not been documented. Additionally, insight into fascin as a migratory molecule is less explored. In this study, the expression of SALL4 and fascin were evaluated in ameloblastoma, adenomatoid odontogenic tumor (AOT), odontogenic keratocyst (OKC), dentigerous cyst (DC), radicular cyst (RC), and calcifying odontogenic cyst (COC). Methods: Semi-quantitative analysis of fascin and SALL4 immuno-positive cells was done in a total of 40 cases of ameloblastoma (11 plexiform, 12 follicular, 12 unicystic, and 5 desmoplastic) variants, 6 cases of AOT, 15 each of OKC, DC, RC and 5 of COC. Chi-square test was applied to evaluate the association between SALL4 and fascin expression in odontogenic cysts and tumors. Results: Fascin immunopositivity was observed in peripheral ameloblast-like cells, and weak or absent in stellate reticulum-like cells. A moderate to weak immune-reactivity to SALL4 was observed in the cytoplasm of ameloblastoma, epithelial cells of dentigerous and radicular cysts, having a marked inflammatory infiltrate, which is an interesting observation. COC and AOT had negative to weak expressions. No recurrence has been reported. Conclusions: Expression of fascin in ameloblastomas elucidate their role in motility and localized invasion. Its expression in less aggressive lesions like DC, COC, AOT will incite to explore the other functional properties of fascin. SALL4 expression in the cytoplasm of odontogenic cysts and tumors may represent inactive or mutant forms which requires further validation.

Primary cervical lymph nodal leishmaniasis.

Leishmaniasis, an endemic disease in several parts of India, is a parasitic disease caused by protozoa and transmitted by the sandfly. Although cutaneous and visceral varieties are common, isolated lymph nodal involvement is extremely rare, and the diagnosis is often delayed owing to its uncommon presentation and lack of awareness of this possibility. We present a 72-year-old woman with asymptomatic right facial lymphadenopathy which on biopsy revealed leishmaniasis and responded well to drug therapy.

Elucidating the role of excision repair cross-complement group 1 in oral epithelial dysplasia and early invasive squamous cell carcinoma: An immunohistochemical study.

OBJECTIVES: Oral epithelial dysplasia (OED) is characterized by cellular alterations which have the proclivity of progressing to squamous cell carcinoma. Excision repair cross-complement group 1 (ERCC1) is one of the key proteins involved in nucleotide excision repair (NER) pathway. The expression of ERCC1 has been studied in colorectal, esophageal, ovarian and oral squamous cell carcinoma; but, very few studies have been done to apprehend the expression of ERCC1 in OED and early invasive squamous cell carcinoma (EISCC). The goal of this study is to evaluate the role of ERCC1 in OED and EISCC. MATERIALS AND METHODS: Histopathologically diagnosed cases of moderate dysplasia (n = 10), severe dysplasia (n = 10) and EISCC (n = 10) were retrieved. 4 µ thick sections were cut from the formalin-fixed paraffin-embedded tissue blocks. The sections were immunohistochemically stained for ERCC1 following standard protocols. The expression of ERCC1 was evaluated semiquantitatively. Statistical analysis was carried out using Fischer's exact t-test. RESULTS: The expression of ERCC1 was found to be strong (+3) in EISCC, moderate (+2) in severe dysplasia and mild (+1) in moderate dysplasia. Thus, the results were statistically significant between the three groups (P < 0.001). CONCLUSION: Disruption in the mechanisms that regulate cell cycle checkpoints and DNA repair mechanism results in genomic instability; these alterations might contribute to carcinoma. ERCC1 is essential to repair the DNA damage induced by various carcinogens. The present study shows significant difference in the expression of ERCC1 between EISCC and OED, which suggests ERCC1 could be used as one of the predictive markers.

Spalt-like transcription factor 4 expression in oral epithelial dysplasia and oral squamous cell carcinoma: An immunohistochemical appraisal.

BACKGROUND: Spalt-like transcription factor 4 (SALL4) is a stem cell marker that plays a critical role in maintaining the pluripotency and self-renewal of embryonic and hematopoietic stem cells. Only a few studies have been done to apprehend the expression of SALL4 in the potentially malignant oral lesion (leukoplakia with dysplasia) and oral squamous cell carcinoma (OSCC). AIM: The aim of this study is to evaluate the expression of SALL4 in leukoplakia with dysplasia and OSCC and to correlate the expression of the marker (SALL4) with the various clinicopathological parameters and patient outcome. MATERIALS AND METHODS: Immunohistochemistry for SALL4 protein was performed on 140 cases: those histopathologically confirmed cases of leukoplakia with dysplasia (n = 30) and OSCC (n = 110). Ten cases of nonepithelial neoplasm (fibroepithelial hyperplasia and excised tissue surrounding impacted third molars) were taken as control. Statistical analyses were applied to evaluate correlations between SALL4 overexpression and clinicopathological features of leukoplakia and OSCC. Survival rates were analyzed using Kaplan-Meier method. RESULTS: SALL4 positivity was observed to be higher (P = 0.001) in the tumor cells of OSCC with Immuno Reactive Score (IRS) ranging from 0 to 9. Poorly differentiated squamous cell carcinoma (SCC) had paramount higher expression with a median IRS of 6. Similar IRS and above (IRS, 6-9) was observed in Stage I (five cases), which recurred and well-differentiated cases with metastasis (four cases) while in leukoplakia with dysplasia the SALL4 expression was weak with a range of 2-4. CONCLUSIONS: SALL4 being one of the cancer stem cell molecules plays an important role in the progression of oral cancer, which was evident in this study. This could also account for aggressive clinical behavior. Follow-up of these patients would relate this molecule could be responsible for cancer relapse. Patients diagnosed to have oral epithelial dysplasia had a low expression of SALL4, are under follow-up, although seven cases did transform to SCC. Thus, we conclude, SALL4 may be of prognostic relevance, but in oral epithelial dysplasia, it requires further investigations.

Immunohistochemical and clinical significance of matrix metalloproteinase-2 and its inhibitor in oral lichen planus.

BACKGROUND: Matrix metalloproteinases (MMP) are being considered important mediators in cancer invasion, and plenty of research is in progress. Our objective was to evaluate the presence of MMP-2 and tissue inhibitor of metalloproteinase (TIMP-2) in oral lichen planus (OLP) and to assess its role in the pathogenesis of OLP and as an indicator of malignant transformation. MATERIALS AND METHODS: Immunohistochemical analysis for MMP-2 and TIMP-2 was performed in thirty histopathologically confirmed, formalin-fixed, paraffin-embedded specimens of OLP (24 cases of reticular and 6 cases of erosive LP). A semi-quantitative analysis was done to assess the expression and distribution of this marker in these lesions. RESULTS: In all cases of OLP, MMP-2 expression was seen mainly in areas of lymphocytic inflammatory infiltrate (100%) in the lamina propria within the overlying epithelium. TIMP-2 expression was seen more than 50% in the fibroblasts and basal and parabasal cells. CONCLUSION: The expression of MMP-2 and TIMP-2 was observed in all cases of OLP. However, a clinical 5-year follow-up of the lesion revealed no progression of the disease except for chronic exacerbation and regression of these lesions. Although our study considers MMP-2 and TIMP-2 as mediators in the pathogenesis of OLP, it still remains debatable whether they have a direct role to play in the disease process or whether they are suitable biomarkers to assess the disease progression.

Parotid Lymphoepithelial Cyst in a HIV-Negative Individual: A Case Report.

Benign lymphoepithelial cysts of the parotid are common in retropositive patients, but extremely rare in HIV-negative individuals. We present a 28-year-old man who presented with a painless, gradually increasing swelling in the left parotid region and was clinically diagnosed to have a pleomorphic adenoma of the left parotid gland. Preoperative blood investigations revealed that the patient was seronegative. He underwent a left superficial parotidectomy and the histopathology report indicated a benign lymphoepithelial cyst. The rarity of this lesion in a seronegative patient is the main reason for reporting this case.

A linguoverted impacted tooth with orocutaneous fistula - a rare case report.

The orocutaneous fistulous tract of odontogenic origin is often a diagnostic challenge, due to its rare manifestation and absence of dental signs and symptoms. The odontogenic cutaneous fistula is often misdiagnosed as a superficial skin lesion of non-odontogenic origin delaying the treatment. The diagnosis and treatment must be precise and swift to improve the clinical outcome and minimize the complications. This article presents a rare case of odontogenic keratocyst involving a linguoverted impacted third molar presenting as orocutaneous fistula. The patient was initially treated with empirical antibiotic therapy with no resolution of the cutaneous fistula and thickening of the skin around the sinus opening resulting in cosmetic deformity. Once the fistula was attributed to the underlying odontogenic cyst, treatment was done by cyst enucleation along with the extraction of tooth and fistula excision. The purpose of the paper is to emphasize the importance of early and accurate diagnosis and prompt management of the orocutaneous fistula due to the odontogenic origin.

The prognostic implication of the expression of EGFR, p53, cyclin D1, Bcl-2 and p16 in primary locally advanced oral squamous cell carcinoma cases: a tissue microarray study.

Oral squamous cell carcinomas comprise a heterogeneous tumor cell population with varied molecular characteristics, which makes prognostication of these tumors a complex and challenging issue. Thus, molecular profiling of these tumors is advantageous for an accurate prognostication and treatment planning. This is a retrospective study on a cohort of primary locally advanced oral squamous cell carcinomas (n = 178) of an Indian rural population. The expression of EGFR, p53, cyclin D1, Bcl-2 and p16 in a cohort of primary locally advanced oral squamous cell carcinomas was evaluated. A potential biomarker that can predict the tumor response to treatment was identified. Formalin-fixed paraffin-embedded tumor blocks of (n = 178) of histopathologically diagnosed cases of locally advanced oral squamous cell carcinomas were selected. Tissue microarray blocks were constructed with 2 cores of 2 mm diameter from each tumor block. Four-micron-thick sections were cut from these tissue microarray blocks. These tissue microarray sections were immunohistochemically stained for EGFR, p53, Bcl-2, cyclin D1 and p16. In this cohort, EGFR was the most frequently expressed 150/178 (84%) biomarker of the cases. Kaplan-Meier analysis showed a significant association (p = 0.038) between expression of p53 and a poor prognosis. A Poisson regression analysis showed that tumors that expressed p53 had a two times greater chance of recurrence (unadjusted IRR-95% CI 2.08 (1.03, 4.5), adjusted IRR-2.29 (1.08, 4.8) compared with the tumors that did not express this biomarker. Molecular profiling of oral squamous cell carcinomas will enable us to categorize our patients into more realistic risk groups. With biologically guided tumor characterization, personalized treatment protocols can be designed for individual patients, which will improve the quality of life of these patients.

Expression of epithelial cell adhesion molecule (EpCAM) in oral squamous cell carcinoma.

AIMS: To study the expression of epithelial cell adhesion molecule (EpCAM) in oral squamous cell carcinoma (OSCC) by immunohistochemistry and investigate its association with various clinicopathological parameters, including patient survival. METHODS AND RESULTS: This cross-sectional study was carried out on 60 histologically confirmed cases of OSCC. EpCAM expression was evaluated by the indirect streptavidin-biotin method and was then assessed semiquantitatively in terms of staining proportion, staining intensity and total staining. The immunoprofile of EpCAM was correlated with clinicopathological parameters such as gender, habit, tumour size, site, regional lymph node and distant metastasis, clinical stage, histological grade, local tumour recurrence and patient survival. EpCAM expression was found to be absent in normal oral mucosa. However, positive staining was seen in 51 of 60 OSCC cases and EpCAM overexpression in 11 specimens. Overexpression of EpCAM was associated significantly with tumour size, histological grade, local recurrence of tumour and patient survival. CONCLUSIONS: EpCAM serves as a potential biomarker of prognostic significance that could be used to identify patients at high risk and to predict patient survival. Moreover, EpCAM antigen represents an attractive target for immunotherapeutic approaches in a subgroup of patients with EpCAM-positive OSCC.

The Diagnostic Dilemma of a Granulomatous Gingival Enlargement.

INTRODUCTION: The oral cavity is considered an easily accessible window to the body. The mouth is frequently involved in conditions that affect multiple organs. In many instances, oral involvement precedes the appearance of many other symptoms or lesions. A complete examination of the oral cavity provides a gateway for an accurate diagnosis and precise management of many systemic conditions. Gingival enlargement is one of the varied manifestations of many systemic diseases. Here, a case report of a gingival enlargement is presented that provided information for the diagnosis of post-primary pulmonary tuberculosis. CASE PRESENTATION: A 62-year-old female presented with a persistent gingival enlargement of 6-month duration, which was non-responsive to periodontal therapy. A complete general examination with the help of additional diagnostic aids provided the diagnosis of post-primary pulmonary tuberculosis. CONCLUSION: Clinicians should be aware of the unusual forms of common diseases, which will aid in early diagnosis and proper patient management.

Clear cell variant of calcifying epithelial odontogenic tumor without calcification: a rarity.

Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor that affects the jaws. Although there are numerous reports on the variants of CEOT, occurrence of clear cells with complete absence of calcification has been a rarity. Histochemical analysis of tumor cells revealed glycogen granules with PAS staining, with absence of CD 1a staining in clear cells, while the amyloid-like deposit associated with clear cells showed green birefringence with Congo red. We report an unusual variant of CEOT occurring in a 27 years old male patient.

Role of immunomarkers in the clinicopathological analysis of unicystic ameloblastoma.

PURPOSE: The clinical behavior of unicystic ameloblastoma varies according to its subtype. The assessment of its proliferative capacity, neovascularization, and invasiveness using relevant immunomarkers may aid in appropriate surgical therapeutic protocol. METHODS: 18 cases of clinically and histologically confirmed unicystic ameloblastoma, categorized as luminal, intraluminal, or mural subtypes, were analyzed retrospectively. Immunomarkers such as Ki-67, CD34, MMP-2, and MMP-9 were studied to evaluate their behavior. RESULTS: Labeling index of Ki-67 was 4.25% in the intraluminal subtype, compared with 2.14% in the luminal and 4.04% in the mural variant (P = 0.3). CD34 immunostaining was significantly higher in the mural variant (43 per high power field) than the other two subtypes (P = 0.04). MMP-2 and MMP-9 were strongly expressed in mural, moderately in intraluminal, and weakly to absent in luminal variant. CONCLUSIONS: High proliferative index, angiogenesis, and protease activity in the mural ameloblastoma, ascertained by the expression of these markers, confirm its aggressive phenotype. The intraluminal and luminal subtype exhibiting decreased expression are compatible with their indolent clinical behavior.