Detection of micro-metastasis using cytokeratins (AE1/AE3) in haematoxylin & eosin-stained N0 lymph nodes of oral squamous cell carcinoma.

Background & objectives: Oral squamous cell carcinoma (OSCC) is one of the most common malignancies affecting the head-and-neck region, regional lymph nodes being an important prognostication factor dictating the survival rate. Despite an array of modalities used, clinically, radiographically and routine histopathologically, the detection of micro-metastasis (2-3 mm tumour cell deposits) in the lymph nodes often escapes identification. The presence of few of these tumour epithelial cells in the lymph nodes drastically increases mortality and alters treatment plan. Hence, the identification of these cells is of major prognostic significance for a patient. Thus, the present study was aimed to evaluate and detect the efficacy of the immunohistochemical (IHC) marker [cytokeratin (CK) AE1/AE3] over routine Hematoxylin & eosin (H & E) staining in detecting micro-metastasis in the lymph nodes of OSCC cases. Methods: Hundred H & E-stained N0 lymph nodes of OSCC cases treated with radical neck dissection were subjected to IHC with marker AE1/AE3 antibody cocktail for detecting micro-metastasis. Results: The IHC marker CK cocktail (AE1/AE3) did not demonstrate any positive reactivity for the target antigen in all the 100 H & E stained lymph node sections evaluated in the present study. Interpretation & conclusions: This study was undertaken to check the efficacy of IHC (CK cocktail AE1/AE3) in the detection of micro-metastasis in lymph nodes that are found to be negative in routine H&E stained sections. The findings of this study suggest that the IHC marker AE1/AE3 did not prove to be useful to detect micro-metastasis in this study population.

Comparative Assessment of E-cadherin's Expression between the Metastatic and Non-metastatic Oral Squamous Cell Carcinoma: An Immunohistochemical Study

ABSTRACT Objective: To identify the clinicopathological correlation of E-cadherin expression in metastatic and non-metastatic oral squamous cell carcinoma (OSCC). Material and Methods: A total of 90 paraffin-embedded tissue sections of OSCC were retrieved from the registry. The total selected samples were 45 cases each from the primary lesions of metastatic and non-metastatic OSCC. One section was subjected to routine Hematoxylin and eosin stain and another to immunohistochemical analysis for E-cadherin expression. Results: A non-significant (p˃0.05) increased expression is seen in the non-metastatic group compared to the metastatic group, with predominantly membrane as the staining site in either group. However, the expression of E-cadherin did not reveal any statistically significant association with independent variables such as age, gender, and adverse habits of the patients (p>0.05). On the other hand, with respect to the histological differentiation of OSCC, a significant association (p<0.001) was observed with the well-differentiated type of metastatic OSCC. Conclusion: E-cadherin was useful to some extent in predicting regional metastasis. However, further studies using a panel of biomarkers with increased sample size may help us understand the process involved in metastasis.

Efficacy of centrifuged liquid-based cytology over conventional cytology: A comparative study.

BACKGROUND: Exfoliative cytology is the microscopic examination of a shed or desquamated cells from the epithelial surface. Centrifuged liquid-based cytology (CLBC) is a modified technique that is used in the current study. AIMS: To compare the efficacy of CLBC with conventional cytology in apparently normal mucosa and histologically proven cases of oral squamous cell carcinoma after staining with Papanicolaou stain. MATERIALS AND METHODS: The study sample was collected from fifty individuals with no habits and apparently normal oral mucosa (Group 1) and forty cases of histologically proven cases of oral squamous cell carcinoma (Group 2). One smear was taken and spread on the slide by a conventional technique. The second sample was flushed out in a suspending solution, centrifuged, and the cell pellet obtained was used to make the smear. The stained smears were compared for nine parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, cellular elongation, mucus, inflammatory blood, and microbial colonies. Chi-square test was used for statistical analysis and P ≤ 0.05 was considered statistically significant. RESULTS: There was a statistically significant result with parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, and cellular elongation in CLBC technique, in comparison with the conventional technique. The presence of mucus, microbial colonies, and inflammatory cells were also less in CLBC technique in comparison with the conventional technique. CONCLUSION: CLBC has better efficacy over conventional method in all the parameters analyzed.

Improvization of conventional cytology by centrifuged liquid-based cytology in oral exfoliative cytology specimen.

BACKGROUND: Exfoliative cytology is the microscopic examination of shed or desquamated cells from the epithelial surface. Centrifuged liquid-based cytology (CLBC) is a modified technique that was used in the current study. AIMS: To compare the efficacy of CLBC with conventional cytology in apparently normal mucosa after staining with Papanicolaou (PAP) stain. MATERIALS AND METHODS: Fifty cases of apparently normal mucosa from healthy subjects were selected for the study. The first sample was taken and spread on the slide by the conventional technique. The second sample was flushed out in a suspending solution, centrifuged, and the cell pellet obtained was used to make the smear. The stained smears were compared for seven parameters such as adequate cellularity, clear background, uniform distribution, cellular overlapping, cellular elongation, mucus, and inflammatory cells. Chi-square test was used for statistical analysis and P ≤ 0.05 was considered to be statistically significant. RESULTS: There was a statistically significant difference between CLBC and conventional cytology with parameters such as adequate cellularity (P = 0.001), clear background (P = 0.001), uniform distribution (0.005), cellular overlapping, and cellular elongation (P = 0). The presence of mucus and inflammatory cells was minimal as the samples were collected from healthy subjects. CONCLUSION: CLBC has better efficacy over the conventional method in all the parameters analyzed.

Apoptosis in oral epithelial dysplastic lesions and oral squamous cell carcinoma: A prognostic marker.

BACKGROUND: Apoptotic index (AI) using light microscopy as an indirect measure to assess the significance of apoptosis as a proliferative marker in dysplastic lesions and malignant epithelial lesions of the oral cavity. AIMS: (1) To quantify the apoptotic bodies/cells in oral epithelial dysplastic (OED) lesions and oral squamous cell carcinoma (OSCC). (2) To measure AI in OED and OSCC. (3) To compare AI in OED and OSCC. SETTINGS AND DESIGN: The proposed laboratory-based retrospective study involved the use of hematoxylin and eosin (H and E)-stained slides of previously diagnosed OED lesions and OSCC from institutional archives. MATERIALS AND METHODS: This study constituted 50 cases, each of H and E-stained slides of previously diagnosed cases of OED and OSCC. AI was calculated as the number of apoptotic bodies/cells expressed as a percentage of the total number of nonapoptotic tumor/dysplastic cells counted in each case. STATISTICAL ANALYSIS USED: Nonparametric tests such as Kruskal-Wallis test and Mann-Whitney test were used. RESULTS: There was a statistically significant increase in AI from OED to OSCC (P = 0.000). CONCLUSIONS: Further studies need to be undertaken to detect and understand the apoptotic mechanisms in the progression from OED to OSCC.

Micrometastasis Detection using Special Stains in Nodal Tissues of Oral Squamous Cell Carcinoma - A Histochemical Study.

INTRODUCTION: Micrometastasis to the lymph node is an important prognostic factor in survival and recurrence and even in making critical decisions regarding postoperative radiation treatment. Methods like Immunohistochemistry (IHC), serial sectioning and Polymerase Chain Reaction (PCR) are very sensitive; however, they are expensive and time consuming. Hence, there is a need for the detection of micrometastasis by method which is easily feasible and inexpensive. AIM: This study was undertaken to identify if special stains (Modified Papanicolaou stain and Ayoub Shklar stain) are valuable in detecting micrometastasis which are routinely missed in Haematoxylin and Eosin stain and also to compare their efficacy over Haematoxylin and Eosin stain in detection of metastatic tumour cells in non-metastatic lymph nodes. MATERIALS AND METHODS: This study constituted a total of 300 histopathologically proven non metastatic lymph node sections. Other than Haematoxylin and Eosin stain, Modified Papanicalaou and Ayoub Shklar stain were used for identification of micrometastatic deposit. RESULTS: Papanicolaou stain was the only stain useful in detecting micrometastasis which accounted to 7% of non metastatic lymph node sections used in our study. CONCLUSION: Papanicolaou stain has definitely proved valuable in detecting micrometastasis over routine Haematoxylin and Eosin and Ayoub Shklar stain with an added advantage of being economical, easily available and technique insensitive.

Interradicular dentin dysplasia associated with amelogenesis imperfecta with taurodontism or trichodentoosseous syndrome: a diagnostic dilemma.

Amelogenesis imperfecta is a hereditary disorder with diverse clinical presentation, where enamel is the tissue that is primarily affected either quantitatively or qualitatively. Hypomaturation/hypoplastic amelogenesis imperfecta with taurodontism is a rare variant of amelogenesis imperfecta which is often confused with trichodentoosseous syndrome. We report a rare case of hereditary enamel defect with taurodontism associated with interradicular dentin dysplasia.

Biometric Analysis - A Reliable Indicator for Diagnosing Taurodontism using Panoramic Radiographs.

BACKGROUND: Taurodontism is a clinical entity with a morpho-anatomical change in the shape of the tooth, which was thought to be absent in modern man. Taurodontism is mostly observed as an isolated trait or a component of a syndrome. Various techniques have been devised to diagnose taurodontism. AIM: The aim of this study was to analyze whether a biometric analysis was useful in diagnosing taurodontism, in radiographs which appeared to be normal on cursory observations. SETTING AND DESIGN: This study was carried out in our institution by using radiographs which were taken for routine procedures. MATERIAL AND METHODS: In this retrospective study, panoramic radiographs were obtained from dental records of children who were aged between 9-14 years, who did not have any abnormality on cursory observations. Biometric analyses were carried out on permanent mandibular first molar(s) by using a novel biometric method. The values were tabulated and analysed. STATISTICS: Fischer exact probability test, Chi square test and Chi-square test with Yates correction were used for statistical analysis of the data. RESULTS: Cursory observation did not yield us any case of taurodontism. In contrast, the biometric analysis yielded us a statistically significant number of cases of taurodontism. However, there was no statistically significant difference in the number of cases with taurodontism, which was obtained between the genders and the age group which was considered. CONCLUSION: Thus, taurodontism was diagnosed on a biometric analysis, which was otherwise missed on a cursory observation. It is therefore necessary from the clinical point of view, to diagnose even the mildest form of taurodontism by using metric analysis rather than just relying on a visual radiographic assessment, as its occurrence has many clinical implications and a diagnostic importance.

Antibacterial drug resistance and its impact on dentistry.

The continuing emergence of antimicrobial resistant bacteria is a global health problem. Multi-drug resistance is now widespread. Resistance rates differ noticeably on a worldwide, regional and even institutional basis. Because antibiotics are commonly used in dentistry, the dental community is not spared from this threat of microbial resistance to antibiotics. This article presents an overview of antimicrobial drug resistance, discusses how this large and expensive problem affects the dental community and what we can do to change the situation, both as concerned citizens and as dental practitioners.

Congenital hairy polyp associated with cleft palate-a rare entity.

Hairy polyps are common congenital benign lesions of oroand nasopharynx containing elements of both ectodermal and mesodermal origin. However, their occurrence in palate is quite rare. Here we present a case of hairy polyp associated with palatal cleft in an eight months old female infant. We discuss the clinicopathological features, etiology, proposed theories related to its formation and its significance.

A massive ameloblastic fibro-odontoma of the maxilla.

Ameloblastic fibro-odontoma is a rare, benign mixed odontogenic tumor. It occurs exclusively as an intraosseous lesion. It usually has a slow growth and is seen in children and young adults. A painless swelling is the most common clinical sign. Radiographically, ameloblastic fibro-odontoma appears as a circumscribed radiolucency which may contain radiopaque foci. Most cases of ameloblastic fibro-odontoma exhibit benign behavior, but cases of malignant transformation have been reported. The treatment modality in most cases involves conservative surgery, but cases with malignant transformation will require more radical treatment. A massive ameloblastic fibro-odontoma involving the maxilla has been described here with its clinical, radiological, and histopathological features.