CD44 Expression in Oral Lichen Planus and Related Lesions-An Immunohistochemical Study.

Background: Cluster of differentiation 44 (CD44) is a cell surface adhesion protein involved in the progression and metastasis of oral squamous cell carcinoma. The current study aims to evaluate the expression of CD44 in oral lichen planus and related lesions and thereby assess the relative risk of malignant transformation of these lesions. Materials and Methods: Formalin-fixed paraffin-embedded tissue blocks of 10 oral lichen planus (Group 1), 10 oral lichenoid lesions (Group 2), 8 with oral lichen planus with dysplasia (Group 3), and 5 with lichenoid dysplasia (Group 4) were included in the study. Immunostaining was done for the tissue sections using CD44 mouse monoclonal antibody. Staining density, staining intensity, and immunoreactive scores of CD44 were evaluated in all four groups. Statistical analysis was done by Statistical Package for the Social Sciences® software and the Kruskal-Wallis test was used. Results: CD44 staining pattern of lichenoid dysplasia and lichen planus with dysplasia changed from membranous to cytoplasmic. The membranous CD44 immunoreactivity was mild with a score of 2.25 for Group 3 and 1.6 for Group 4 whereas moderate for other groups with a P-value of 0.009. The cytoplasmic immunoreactivity was significantly high in Group 3 (5.3 ± 2.6) followed by Group 4 (3.2 ± 1.2), Group 2 (1 ± 1.8), and Group 1 (0.7 ± 1.3) with a P-value of 0.001. Conclusion: The CD44 membranous immunoreactivity scores were low while the cytoplasmic immunoreactivity was high in oral lichen planus with dysplasia and oral lichenoid dysplasia when compared to oral lichen planus and oral lichenoid lesions. CD44 immunostaining pattern can help in assessing the malignant transformation of oral lichen planus or lichenoid lesions.

Oral malignant melanoma - Clinical presentation with immunohistochemical analysis.

ABSTRACT: Oral melanoma is a rare malignancy with poor prognosis because of its invasive and metastasizing tendencies. It is derived from the melanocytes and is clinically asymptomatic initially but in later stages may show ulceration, pain, bleeding, tooth mobility, and parasthesia. Because of its silent progression, diagnosis is often delayed leading to poor survival rate. This article presents the clinical, histopathological, and immunohistochemical findings of a rare case of melanoma involving the maxilla and also highlights the importance of dental professionals in maintaining a high degree of surveillance for all oral pigmented lesions.

Intraoral neurofibroma: A case report with emphasis on immunohistochemical markers.

ABSTRACT: A neurofibroma is a benign peripheral nerve sheath tumor. They occur in combination with neurofibromatosis or as a solitary mass. Intraoral neurofibromas pose diagnostic difficulties, suggesting the appropriate use of diagnostic markers and clinical knowledge. Here, we report a case of intraoral neurofibroma in a 57-year-old female who reported with the complaint of painless growth in the lower left back tooth region for the past three years. Based on the clinical features, provisional diagnosis of traumatic fibroma was made. However, histopathology proved it to be a benign spindle cell lesion; upon further investigation by immunohistochemistry, it was diagnosed to be a case of neurofibroma.

Quantitative Proteomic Analysis of Non-Tobacco Associated Oral Squamous Cell Carcinoma Reveals Deregulation of Cytoskeletal and Apoptotic Proteins.

BACKGROUND: The exact etiology of non-tobacco associated oral squamous cell carcinoma (NT-OSCC) is still unknown. The lack of established biomarkers for oral NT-OSCC has resulted in less effective management and poor prognosis. Here, we report for the first time a panel of potential markers identified from the quantitative proteomic analysis of NT-OSCC using two-dimensional gel-electrophoresis (2D-GE) using matrix-assisted laser desorption/ionization - time of flight (MALDI-TOF) coupled with mass spectrometry (MS) and further analysis using protein analysis through evolutionary relationships (PANTHER) database. OBJECTIVE: To quantitatively analyze the proteomic profile of non-tobacco associated oral squamous cell carcinoma. METHODS: Twenty fresh tissue samples were collected from healthy controls and NT-OSCC, ten each, and were subjected to proteomic analysis. Sample quantification for the presence of protein was done using Bradford assay and bovine serum albumin was used as a standard protein to obtain the standard graph. Fractionation of protein was done using sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE) and they were separated based on their molecular weight. MS analysis was done and the purified peptides were analysed using MALDI-TOF. PANTHER database for functional classification and pathway analysis was done for identification of protein expression. RESULTS: Our approach of combining 2D-GE with MS identified four candidate proteins including keratin, alpha-1-antitrypsin (AAT), S100 and serpin B5 with significant differential expression in NT-OSCC as compared with healthy controls. The results showed that the levels of these proteins were significantly upregulated in NT-OSCC when compared to the healthy controls that suggests that these proteins can be used as candidate targets for NT-OSCC therapeutics. CONCLUSION: The differentially expressed proteins are found to be involved in apoptotic signalling pathways, cytoskeletal dynamics and are known to play a critical role in oral tumorigenesis. Put together, the results provide available baseline information for understanding the development and progression of NT-OSCC. These identified proteins on further validation may be used as potential biomarkers in future for early detection and predicting therapeutic outcome of patients with NT-OSCC.

Anti-fibrotic activity of licorice extract in comparison with colchicine on areca nut-induced fibroblasts: An in vitro study.

Objective: Oral submucous fibrosis (OSMF) is a debilitating chronic disease of the oral cavity with a high potential for malignant transformation. The main etiological agent attributed to the development of OSMF is the use of smokeless tobacco products like areca nut. There is no known cure for the disease. Current modalities of treatment do not provide a complete cure and often prove invasive for the patient. Herbal preparations using natural compounds and medicinal plant extracts have long since been used in India, as an acceptable, noninvasive and cost-effective method in the treatment of various diseases. Hence, the present study aims to assess the anti-fibrotic effect of licorice in comparison with colchicine on areca nut-induced fibroblasts. Materials and Methods: Extracts of areca nut, licorice and colchicine were prepared in accordance with established protocols. Human fibroblast cell lines were procured from ATCC®(PSC-201-018). Fibroblast cultures were established, and upon reaching confluence the cells were subjected to the 25 µg/ml areca nut extract for 24 h to induce fibrosis, with CCl4 used as control fibrosing agent. The areca nut and CCl4 induced cells were then subjected to varying concentration of the test antifibrotic agent, licorice extract for the periods of 24 and 48 h, with colchicine used as positive control. Total collagen quantification was done using spectrophotometry. Results: Collagen accumulation decreased with increase in the concentration of licorice extract with maximum reduction seen at 200 µg/ml. Kruskal-Wallis test was done to analyze the difference in collagen accumulation. Analysis revealed that the P < 0.05 for both periods in both the areca and CCl4 induced cell lines following the addition of licorice extract. The data were found to be statistically significant. Conclusion: The current study proves the antifibrotic efficacy of licorice in areca nut induced cell lines and hence, this agent can be used for the therapeutic management of OSMF.

Diagnosing oral lesions in immunocompromised individuals: A case report with a review of literature.

Oral lesions are often the first tell-tale sign for human immunodeficiency virus infections (HIV). Numerous oral lesions have been associated with HIV infections, some lesions such as candidiasis being more common than others. Regular oral screening can aid in identifying such lesions allowing for the early diagnosis of HIV and help in monitoring the progression of HIV in such individuals. We report a case of a family who manifested with oral lesions consistent with HIV. A review of literature on diagnosing immunocompromised individuals in clinical practice has also been summarized.

Alpha-L-fucosidase levels in patients with oral submucous fibrosis and controls: A comparative study.

Background: Oral submucous fibrosis (OSMF) in recent times has been recognized as a potentially malignant disorder (PMD) with an increased risk of developing oral squamous cell carcinoma with malignant transformation rates that vary from 0.6% to 36%. Alpha-L-fucosidase (AFU) is a lysosomal enzyme that is involved in maintaining the homeostasis of fucose metabolism. In benign and malignant tumors, the cells modulate their surface by increasing fucosylation leading to uncontrolled growth. Aims and objectives: This study was designed to estimate the levels of salivary and serum AFU in patients with OSMF and healthy controls and also to evaluate the clinical utility of salivary AFU levels over serum. Materials and Methods: Saliva and blood samples were collected from twenty participants in both the groups (OSMF and healthy controls). Serum and salivary alpha-L-fucosidase levels were measured by enzyme-linked immunosorbent assay. The data were subjected to appropriate statistical analysis. Results: We found a significant increase in alpha-L-fucosidase level in OSMF compared with healthy subjects. Pearson's correlation showed salivary alpha-L-fucosidase level to have superior sensitivity in detecting OSMF compared with serum alpha-L-fucosidase. Conclusion: The outcome of this study suggests that salivary alpha-L-fucosidase can be utilized as a biomarker in early detection of oral precancer and cancer.

Evaluation of recurrent GNPTAB, GNPTG, and NAGPA variants associated with stuttering.

Stuttering is a childhood-onset fluency disorder, intertwined with physiological, emotional, and anxiety factors. The present study was designed to evaluate the recurrence of the reported mutations among three previously implicated (GNPTAB, GNPTG, NAGPA) candidate genes, in persons with stuttering from south India. Mutation screening was performed among 64 probands on 12 specific exons, by Sanger sequencing. A total of 12 variants were identified, which included five nonsynonymous, five synonymous, and two noncoding variants. Three unrelated probands harbored heterozygous missense variants at conserved coding positions across species (p. Glu1200Lys in GNPTAB, p. Ile268Leu in GNPTG and p. Arg44Pro in NAGPA). Of these, only one variant (p. Glu1200Lys in GNPTAB) cosegregated with the affected status while p. Ile268Leu in GNPTG gene was found to be a rare de novo variant. Although this study identified some previously reported variants that have been claimed to have a role in stuttering, we confirmed only one of these to be a likely causal de novo variant (p.Ile268Leu) in the GNPTG gene at an allele frequency of 0.8% (1/128) in the families with stuttering.

Mural unicystic ameloblastoma with multifarious histopathological patterns: An exquisite case report.

Ameloblastoma is a true benign neoplasm of odontogenic epithelial origin mostly seen in the mandible. After odontoma, it is the second most commonly seen odontogenic neoplasm. Ameloblastoma comprises of several clinical, radiological and histological varieties, making it the most significant odontogenic neoplasm. Among these, the unicystic type is the least explored due to the fewer numbers of reported cases. Clinically and radiographically, it represents a cyst, but displays classic ameloblastomatous epithelial lining part of the cyst cavity, with or without intraluminal and/or mural tumor growth. We present an unusual case of unicystic ameloblastoma showing mural proliferation with mixed histological pattern [Plexiform, Follicular and Acanthomatous] of the mandible in a 32-year-old male.

Oral pemphigus vulgaris: A case report with direct immunofluorescence study.

Pemphigus vulgaris (PV) is a chronic, autoimmune, intraepidermal blistering disease of the skin and mucous membranes. The initial clinical manifestation is frequently the development of intraoral lesions, and later, the lesions involve the other mucous membranes and skin. The etiology of this disease still remains obscure although the presence of autoantibodies is consistent with an autoimmune disease. These antibodies are targeted against the adhesion proteins of keratinocytes, leading to acantholysis (disruption of spinous layer, leading to intraepidermal clefting) and blister formation. Because only oral lesions are present initially, the chances of misdiagnosing the disease as another condition are increased, leading to inappropriate therapy. In this article, we report a case of PV with only oral manifestations in a 36-year-old male.