Salivary malondialdehyde in oral submucous fibrosis - A marker for oxidative damage.

BACKGROUND: Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa and its malignant transformation rate accounts to about 7%-13%. Oxidative damage and lipid peroxidation plays an important role in OSMF. Lipid peroxidation has not been widely investigated in OSMF patients with respect to clinical staging and histopathological grading. As human saliva is a diagnostic fluid which can be obtained in a noninvasive procedure as compared to the blood for serum analysis, the present study was aimed at evaluating the salivary malondialdehyde (MDA) levels in OSMF and comparison with respect to clinical staging and histopathological grading. AIM: This study aims to evaluate salivary MDA levels in OSMF and compare the levels with respect to clinical and histopathological grading systems. MATERIALS AND METHODS: Forty cases of clinically diagnosed and histopathologically proven cases of OSMF were included for the purpose of this study. As controls 40 age-matched individuals without any systemic disease were selected. Unstimulated whole saliva was collected from each individual, centrifuged and frozen at - 20°C until analysis. Lipid peroxidation products MDA were analyzed by thiobarbituric acid reaction. RESULTS: Salivary MDA levels were significantly increased in OSMF patients compared to controls. The progressively increased salivary MDA levels showed a positive correlation with the clinical stages and histopathological grades of OSMF and the results were statistically significant. CONCLUSION: The increased salivary MDA levels in OSMF patients compared to the control group suggests an increased oxidative stress levels in the potentially malignant disorders such as OSMF. The mean salivary MDA levels were increased significantly as the clinical stage and histopathological grade of OSMF advances, suggesting MDA to be used as a reliable biochemical marker and also a prognostic marker to assess the extent of oxidative damage in OSMF.

Stathmin! An immunohistochemical analysis of the novel marker in Oral Squamous Cell Carcinoma and Oral Leukoplakia.

BACKGROUND: Stathmin is an intracellular phosphoprotein that controls the microtubule dynamics by further regulating proper attachment and alignment of chromosomes in a dividing cell. Thus, any mutation or aberrantly expressed protein that reduces the fidelity of spindle assembly will enhance chromosomal instability contributing to aneuploidy. Oral Squamous Cell Carcinoma is an extensively studied malignancy that occurs due to accumulated genetic changes due to carcinogens. The current study is done to evaluate the stathmin role and its expression in OSCC and Oral epithelial dysplasia (OED). OBJECTIVE: The aim of the present study is to evaluate the role of stathmin in OSCC and Oral dysplasia and also to correlate the expression of Stathmin with respect to the different histopathological grades of OED and OSCC. MATERIALS AND METHODS: 30 neutral buffered formalin fixed, paraffin embedded (FFPE) tissues of Oral Leukoplakia/OED and 30 FFPE tissues of OSCC were subjected to immunohistochemistry with stathmin antibody. Five fields of each case with 300 cells were examined and a mean percentage of positive-stained slides were determined. The percentages were recorded accordingly with their respective histological grades. The results were analysed statistically. RESULTS: The results of the present study demonstrated higher mean values of stathmin in tissues with OSCC (2.50) compared to leukoplakia (2.11) and normal tissues (0.00) with a high level of statistical significance (0.0001). There is also an increase in the percentage levels of stathmin with increase in the histological grade of differentiation in OSCC as well as leukoplakia. CONCLUSION: The present study found a statistical correlation between increased grades of the disease with expression levels of stathmin. This confirms that stathmin expression can contribute to disease progression and that stathmin might have a potential role as an early diagnostic biomarker and can be a therapeutic target for OSCC. 
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Estimation of serum pyruvic acid levels in oral squamous cell carcinoma.

INTRODUCTION: Cancer cells generally exhibit increased glycolysis for adenosine triphosphate generation (the Warburg effect) due to mitochondrial respiration injury and hypoxia, which are frequently associated with resistance to therapeutic agents. Pyruvic acid is produced as an end product of glycolysis along with lactic acid. At room temperature, lactic acid converts into pyruvic acid as it is chemically unstable. AIM: To evaluate the serum pyruvic acid levels in patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Thirty clinically and histopathologically confirmed cases of OSCC were included in the study. The cases were staged clinically (tumor-node-metastasis staging) and graded histopathologically (modified Broder's classification). A control group of 30 age-matched individuals with no systemic diseases were selected and the serum levels of pyruvic acid were measured and the absorbance was read using a spectrophotometer at a wavelength of 540 nm. The results were evaluated statistically and discussed. RESULTS: Pair-wise comparison of clinical stages and histological grades of OSCC was done using Tukey's multiple post hoc procedure. The increase in mean serum pyruvic acid levels between any two groups and grades was found to be statistically significant respectively (P<0.05). CONCLUSION: Serum pyruvic acid levels gradually increased from individuals without OSCC to individuals with OSCC. Higher levels of serum pyruvic acid were seen with increasing clinical stage and the mean serum pyruvic acid levels were also found to be significantly increasing with advancing histopathological grades of OSCC.

Solitary plasmacytoma of mandible: A rare entity.

Plasmacytoma is a discrete, unifocal, monoclonal neoplastic proliferation of the plasma cells. It may present as one of the three distinct clinical entities: multiple myeloma (MM), solitary plasmacytoma of bone and extramedullary plasmacytoma. Solitary bone plasmacytoma accounts for 3% of all plasma cell neoplasms with approximately 50% of the cases transforming into MM. It is frequently seen in vertebrae and secondarily in long bones. Its presence in jaws is extremely rare and when it is seen, retromolar area, angle and ramus of the mandible are most common sites of occurrence. A comprehensive clinical, radiological, histological and immunohistochemical features of solitary plasmacytoma of the mandible in a 46-year-old female patient is reported.

Sclerosing Polycystic Adenosis of Hard Palate: A Rare Entity in Salivary Glands.

Sclerosing polycystic adenosis (SPA) is a rare neoplasm of salivary glands, with a striking resemblance to the benign fibrocystic disease of the breast. The most common site of occurrence is the parotid gland. However, submandibular gland, minor salivary glands, and buccal mucosa may also be affected. It shows a slight female predilection and occurs over a wide age range. The exact nature of the disease is unknown but is postulated to be a neoplasm recently. The treatment is effective by localized surgical excision, and recurrence is rare. To the best of our knowledge, there is only one case report of SPA involving palate. Here, we describe an additional case report of SPA occurring in the palatal region of a 49-year-old male patient.

Natural substitutes for formalin: A boon to histopathology!!

INTRODUCTION: In routine tissue processing, formalin has been proved as efficient as fixative since inception and hazards associated with it are of major safety and health concern. AIM: The aim of this study is to compare the efficacy of natural fixatives such as jaggery and Khandsari over formalin. MATERIALS AND METHODS: Ninety normal tissue specimen collected during minor oral surgical procedures were included in this study. Thirty specimen each were fixed in 30% jaggery (Group-A), 30% Khandsari (Group-B) and 10% formalin (Group-C). The slides obtained after tissue processing were analyzed for the quality of fixation. The tissue sections were assessed for cellular outline, cytoplasmic details, nuclear details, staining quality and overall morphology. Each criterion was rated on a scale of 1-4. (one for poor and four for excellent). The study was double-blinded and subjected to the Kruskal-Wallis ANOVA and Chi-square test. RESULTS: The cellular outline is excellent in 90% (Group-C) followed by 36.67% (Group-B) of specimens. With respect to cytoplasmic staining 83.33% (Group-C) of tissues showed excellent results followed by 60% (Group-B), 33.33% (Group-A). Nuclear details are excellent in 86.67% (Group-C) followed by 83.33% (Group-B), 36.67% (Group-A) of specimens. With respect to staining quality 93.33% (Group-C) followed by 50% (Group-B), 26.67% (Group-A). Overall morphology is excellent in 90% (Group-C) followed by 46.67% (Group-B). CONCLUSION: In the present study, Khandsari was on par with formalin and our effort of using Khandsari and jaggery for tissue fixation in human oral tissues yielded good results.

Ameloblastoma arising in the wall of dentigerous cyst: Report of a rare entity.

Dentigerous cyst (DC) is a developmental odontogenic cyst that encloses the crown of an unerupted tooth by expansion of its follicle with accumulation of fluid between the reduced enamel epithelium and the tooth crown and is attached to the neck of the tooth. The lining of DCs shows a potential for neoplastic transformation to ameloblastoma, squamous cell carcinoma, and mucoepidermoid carcinoma. Here, we report a rare case of an ameloblastoma arising in the wall of a DC.

Polymorphous adenocarcinoma of the oral cavity: A skeptical case mimicking lobular carcinoma of breast and gastric carcinoma.

Polymorphous adenocarcinoma (PAC) is a distinctive salivary gland neoplasm that predominantly occurs in the minor salivary glands. The tumor is characterized by cytological uniformity, morphological diversity, an infiltrative growth pattern and low metastatic potential. It presents as an asymptomatic, slow- growing mass within the oral cavity. This salivary gland tumor is difficult to diagnose both clinically and histopathologically due to its indolent presentation and diverse architectural pattern which includes various microscopic patterns namely- solid, ductal-tubular, cribriform, trabecular and single-file growth. Hence, Immunohistochemistry plays a very important role in diagnosing this tumor. We hereby report a rare case of PAC occurring in a 50yr old female patient presenting with a lesion in right upper posterior part of alveolus extending to the hard palate.

Unicystic ameloblastoma in conjunction with peripheral ameloblastoma: A unique case report presenting with diverse histological patterns.

Ameloblastomas are benign epithelial odontogenic neoplasms which are locally aggressive with an insidious growth pattern. Based on the clinical, radiographic, histopathology and behavioral and prognostic aspects, four variants of ameloblastoma are distinguished. They include solid/multicystic ameloblastoma, unicystic ameloblastoma (UA), peripheral ameloblastoma (PA) and desmoplastic ameloblastoma. UA and PA are two variants that have no clinical or radiological resemblance to each other. A case of simultaneous occurrence of these two lesions displaying an array of different histopathological entities together, with a note on pathological insight, has been reported in a 59-year-old adult male patient.

Modified ultrafast Papanicolaou staining technique: A comparative study.

INTRODUCTION: Ultrafast Papanicolaou stain (UFP) was introduced as a hybrid of Romanowsky and Papanicolaou (PAP) stain. It enhances the quality and reduces the time. In the present study, a modified staining technique was adapted where Gill's Hematoxylin was replaced by Harris Hematoxylin. AIMS: The aim of the study was to assess the use of the modified ultrafast Papanicolaou (MUFP) stain for fine needle aspiration cytology (FNAC) of head and neck swellings in comparison with the routine PAP stain, hematoxylin and eosin (H and E), and Giemsa. MATERIALS AND METHODS: Forty FNACs of head and neck swellings were collected. FNAC procedure was performed by standard method; two smears were fixed in 95% propanol and stained with PAP and H and E. Two smears were air dried, 1 was stained with Giemsa, and 1 was rehydrated with normal saline, fixed in alcoholic formalin, and stained with MUFP. Four parameters were considered and scored background, cell morphology, nuclear staining, and overall staining pattern). RESULTS: The quality of MUFP smears were better when compared to routine PAP, H and E, and Giemsa, and was statistically significant by Wilcoxon matched pair test. CONCLUSIONS: MUFP stain in comparison to routine PAP, H and E, and Giemsa provides an excellent and suitable alterative in cytological staining for the study of various organs.

Estimation of hemoglobin, serum iron, total iron-binding capacity and serum ferritin levels in oral submucous fibrosis: A clinicopathological study.

INTRODUCTION: Oral submucous fibrosis (OSMF) is also considered as an Asian version of sideropenic dysphagia, wherein chronic iron deficiency leads to mucosal susceptibility to irritants, such as chillies and areca nut products. Hemoglobin (Hb) levels, in particular, serum iron levels, are considered as biochemical indicators for nutritional assessment. Serum iron content can thus be a predictor for the progression of the condition, and there appears to be an association between serum iron content and oral carcinogenesis. Therefore, biochemical assessment of oral precancerous conditions may help in early diagnosis and prognosis. Hence, the present study was aimed to evaluate Hb, serum iron, total iron-binding capacity (TIBC) and serum ferritin in OSMF patients. MATERIALS AND METHODS: Forty cases of OSMF were staged clinically and graded histopathologically to assess the levels of Hb, serum iron, TIBC and serum ferritin and compared with normal subjects. The results were compared using t-test, ANOVA, and Tukeys multiple post hoc procedures. RESULTS: It was observed that the levels of Hb, serum iron and serum ferritin levels gradually reduced in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05. It was observed that the levels of TIBC gradually increased in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05. CONCLUSION: The Hb, serum iron and serum ferritin levels in OSMF patients were reduced and TIBC increased as compared with controls and as the clinical stage and histological grade of OSMF advances indicating their role as a reliable biochemical indicator.

Inflammatory myofibroblastic tumor of mandible: A rare case report and review of literature.

Inflammatory pseudotumor is a term given to different neoplastic and nonneoplastic entities that have a common histological appearance, which comprises spindle cell proliferation with a prominent chronic inflammatory cell infiltrate. Inflammatory myofibroblastic tumor (IMT) is an uncommon lesion with distinctive clinical, pathological and molecular features and is considered to be pseudotumor for the past two decades due to its appearance. IMT is an intermediate soft tissue tumor which was first observed in lungs. It was named as IMT because it mimics a malignant neoplasm clinically, radiologically and histopathologically. The most common sites are lungs, liver and gastrointestinal tract. IMT in head and neck region is exceptionally rare and the sites reported include gingiva, tongue, hard palate, mandible, buccal mucosa and submandibular salivary gland. Till now, 8 cases of intramandibular IMT were reported. Here, we report an additional case of intramandibular IMT in a 20-year-old male patient.

Non Calcifying Type of Calcifying Epithelial Odontogenic Tumor: An Unusual Case Report with Special Emphasis on Histogenesis of Calcifications.

Calcifying epithelial odontogenic tumour also known as Pindborg tumour, is a rare benign odontogenic neoplasm of locally aggressive behavior. It is thought to arise from the epithelial element of the enamel origin which are reminiscent of the cells in the stratum intermedium layer of enamel organ in tooth development. The tumour is characterized histologically by the presence of polygonal epithelial cells, calcifications and eosinophilic deposits resembling amyloid. Non-calcifying epithelial odontogenic tumours are very rare and unusual. Only five cases have been reported in the English literature till date. Here, we present an additional case of non calcifying type along with a review of previously reported cases. It has a much lower recurrence and malignant transformation rate.

Age estimation using exfoliative cytology and radiovisiography: A comparative study.

INTRODUCTION: Age estimation is one of the essential factors in establishing the identity of an individual. Among various methods, exfoliative cytology (EC) is a unique, noninvasive technique, involving simple, and pain-free collection of intact cells from the oral cavity for microscopic examination. OBJECTIVE: The study was undertaken with an aim to estimate the age of an individual from the average cell size of their buccal smears calculated using image analysis morphometric software and the pulp-tooth area ratio in mandibular canine of the same individual using radiovisiography (RVG). MATERIALS AND METHODS: Buccal smears were collected from 100 apparently healthy individuals. After fixation in 95% alcohol, the smears were stained using Papanicolaou stain. The average cell size was measured using image analysis software (Image-Pro Insight 8.0). The RVG images of mandibular canines were obtained, pulp and tooth areas were traced using AutoCAD 2010 software, and area ratio was calculated. The estimated age was then calculated using regression analysis. RESULTS: The paired t-test between chronological age and estimated age by cell size and pulp-tooth area ratio was statistically nonsignificant (P > 0.05). CONCLUSION: In the present study, age estimated by pulp-tooth area ratio and EC yielded good results.

Early diagnosis of an isolated primary peripheral T-cell lymphoma masquerading as massive gingival enlargement in a pediatric patient.

Lymphomas are malignant neoplasm of the lymphocyte cell lines, classified as either Hodgkin's or non-Hodgkin's lymphoma (NHL). NHL comprises a heterogeneous group of lymphoid neoplasm arising from B-cell, T-cell or natural killer cell with a spectrum of behavior ranging from relatively indolent to highly aggressive and potentially fatal. Peripheral T-cell lymphoma, a variant of NHL, is a disease characterized by the presence of diffuse lymphadenopathy, extranodal involvement, classical B symptoms such as fever (>100.4°F) for 3 consecutive days, weight loss exceeding 10% of body weight in 6 months and drenching night sweats with a tendency for recurrence. Among NHLs, extranodal presentations are relatively common. Extranodal presentation particularly in the oral cavity is very rare and may misinterpret the diagnosis. Lesions of this type should be cautiously dealt especially in pediatric patients and young adolescents. The present case report is about an atypical presentation of disease process in a 15-year-old male patient, which was diagnosed early with the help of a combination of histopathology and immunohistochemistry techniques.

Mesiodistal odontometrics as a distinguishing trait: A comparative preliminary study.

INTRODUCTION: Sex determination is a vital step in reconstructing an individual profile from unidentified skeletal remnants. Variations in tooth size are influenced by genetic and environmental factors. Tooth size variations have been reported among different populations. AIM: To identify the sex by determining the mesiodistal (MD) dimensions of maxillary canines. OBJECTIVES: (1) To compare the MD diameter of all maxillary canines - (a) in the entire urban and tribal population, (b) in urban male and urban female populations, (c) in tribal male and tribal female populations, and (d) in the entire male and female populations and (2) To estimate the percentage of sexual dimorphism individually in urban and tribal populations. MATERIALS AND METHODS: Fifty subjects each from urban and tribal populations in equal gender ratio were selected in Khammam district, Telangana, for the purpose of this study. After obtaining informed consent, maxillary study models of the selected subjects were made. MD diameters of left and right maxillary canines were measured on casts using vernier calipers. The obtained data were subjected to statistical analysis. RESULTS: (1) The total tribal population showed a greater MD diameter of maxillary canines than the total urban population, (2) Urban males showed a greater MD diameter of maxillary canines than urban females, (3) Tribal males showed a greater MD diameter of maxillary canines than tribal females, (4) The entire male population showed a greater MD diameter of maxillary canines than the entire female population, and (5) The percentage of dimorphism between males and females in individual groups was found to be significant. CONCLUSION: The study showed maxillary canines exhibiting significant sexual dimorphism and can be used as a distinguishing trait for sex determination along with other procedures.

Immunoexpression of Metallothionein in Oral Squamous Cell Carcinoma.

BACKGROUND AND OBJECTIVES: Metallothionein (MT) is a family of ubiquitous low molecular weight (7 kDa), intracellular (cytoplasmic/nuclear), cysteine rich proteins with high affinity for heavy metals, present in both normal cells and neoplastic cells. Increased expression of MT has been reported to be associated with poor prognosis in various tumours. The objectives of the present study were to compare the expression of MT in normal subjects and in patients with oral squamous cell carcinoma (OSCC), to correlate the expression of MT with respect to clinical staging of OSCC and to evaluate the expression of MT with respect to different histopathological grades of OSCC. METHODS: Thirty cases of OSCC were staged clinically and graded histopathologically. Immunohistochemical method was used to detect the expression of MT in OSCC. The scores obtained were documented and compared statistically. RESULTS: MT immunoreactivity was noticed in all cases of OSCC. A statistically significant difference was observed in immunoreactivity of MT between the normal and OSCC, and in different histopathological grades of OSCC (p = 0.00001*). However, no statistical significance was found in a number of immunopositive cells in different clinical stages of OSCC (p = 0.7573). CONCLUSION: The MT immunoexpression increased from low grade to high grade OSCC. Hence, increased expression of MT may be related to poor prognosis in patients with OSCC.

Lipomatous hemangiopericytoma in a child: A case report with immunohistochemical evaluation.

Lipomatous hemangiopericytomas are rare soft-tissue tumors that show areas of hemangiopericytoma like vascular pattern admixed with lipid containing cells. It is now considered a subtype of solitary fibrous tumor due to histopathological and immunohistochemical similarities. To date, only a few cases have been adequately reported in the medical literature. A case of lipomatous hemangiopericytoma in an 11-year-old female patient is presented and the clinical, histopathological and immunohistochemical features are discussed, along with a literature review. To the best of our knowledge, this is the first known case of a lipomatous hemangiopericytoma in a pediatric patient. Our case report further emphasizes that a number of studies should be evaluated to delineate hemangiopericytomas from solitary fibrous tumors.

Sex determination using maxillary sinus.

BACKGROUND: Individual identification is a subtle concept and often one of the most important priorities in mass disasters, road accidents, air crashes, fires, and even in the investigation of criminal cases. Matching specific features detected on the cadaver with data recorded during the life of an individual is an important aspect in forensics, and can be performed by fingerprint analysis, deoxyribonucleic acid matching, anthropological methods, radiological methods and other techniques which can facilitate age and sex identification. Sinus radiography is one such method that has been used for determination of the sex of an individual. Hence, an attempt is being made to use the different dimensions of the maxillary sinus in the determination of sex using coronal and axial sections of plain computed tomography (CT) scan. MATERIALS AND METHODS: A total of 30 patients including 17 male and 13 female, visiting the Outpatient Department of the Mamata General Hospital were included as the study subjects. The dimensions of right and left maxillary sinuses of 30 subjects from plain CT were measured using SYNGO software and statistical analysis was done. RESULTS: Sex determination using height, length, width, and volume of the maxillary sinus on both sides showed statistically significant results with a higher percentage of sexual dimorphism in the case of volume. CONCLUSION: Volume of the right maxillary sinus can be used as accurate diagnostic parameter for sex determination.

Maxillary plexiform ameloblastoma showing basaloid differentiation: Report of a rare case with review of literature.

Ameloblastoma is a benign, locally aggressive tumor originating from the odontogenic epithelium. It manifests as a slow growing swelling, causing expansion of the jaw bones. Radiologically, it presents as a unilocular or multilocular radiolucency exhibiting a characteristic soap bubble or honeycomb appearance. Ameloblastoma exhibits several histologic patterns of which basal cell variant is a rare entity. The present case report is that of a maxillary ameloblastoma exhibiting a basaloid differentiation that may put one in the mind of a basaloid squamous cell carcinoma or a basal cell carcinoma. Confirmation of such rare variants should be done not only based on histopathology but with the help of supplemental immunohistochemical analysis. The present case report helps in exposing a rare variant of ameloblastoma and emphasizes the role of advanced diagnostic aids such as immunohistochemistry in establishing the diagnosis.