A comparative study for qualitative and quantitative analysis of light and fluorescence microscopy stains in oral premalignant and malignant lesions.

OBJECTIVES: The present study highlights the use and benefit of fluorescence microscopy stains in easy diagnosis of oral premalignant and malignant lesions. This study was carried out to evaluate the efficiency of light microscopy using Papanicolaou stain (PAP) and May Grunwald Giemsa (MGG) stains and fluorescence microscopy using acridine orange (AO) and 4',6-diamidino-2-phenyl indole (DAPI) stains. All smears have been qualitatively and quantitatively analyzed in premalignant and malignant lesions using cytology and cytomorphometry. MATERIALS AND METHODS: The subjects included in this study were selected from patients suffering from premalignant and clinically suspicious malignant lesions. Specimens were collected from the most representative site in study groups and normal buccal mucosa in the control group. The smears were evaluated under fluorescence microscopy for AO and DAPI and under light microscopy for conventional PAP and MGG. We studied 5 HPF to compare the number of normal cells to dysplastic cells. These were then subjected for cytomorphometric and statistical analysis. RESULTS: Assessment of quality using quality index revealed that PAP has better diagnostic efficiency as compared to MGG because the quality index of PAP was 0.87 and that of MGG was 0.74, the quality index of AO was 0.9, and that of DAPI was found to be 0.82, hence proving AO to be better in comparison with DAPI. CONCLUSION: We found that among all the four stains used AO is reliable, has greater efficacy, and can be easily performed with less cost. Despite the difficulties mentioned in this study, the progress in the field of fluorescence microscopy is expected to be rapid in the following years.

In vivo autofluorescence of oral squamous cell carcinoma correlated to cell proliferation rate.

CONTEXT: Loss of cell differentiation and increased cellular proliferative activity during malignant transformation leads to alteration of biochemical content of cells. This is reflected in the fluorescence profile of tissues. AIMS: (1) To evaluate the efficacy of autofluorescence in clinical detection of oral cancer. (2) To correlate it with the rate of cell proliferation by analyzing argyrophilic nucleolar organizer regions (AgNORs). SUBJECTS AND METHODS: Autofluorescence status was studied by devising a visual enhancement system using ultraviolet light, followed by an incisional biopsy. Tissue was sent for fluorescence spectroscopy and analyzed by routine histopathology and AgNORs staining. The obtained results were statistically analyzed using Chi-square test (P < 0.05) and one-way analysis of variance. RESULTS: A statistically significant correlation was seen between autofluorescence (AF) and clinical diagnosis as well as autofluorescence and histopathological diagnosis. The importance of autofluorescence as a screening tool was further supported by a statistically significant correlation between autofluorescence status and cell proliferative rate. CONCLUSION: A preliminary effort was attempted at delving into this relatively unexplored arena of optical biopsy systems through this study. They can be used to monitor treatment and potential complications, surgical margins, detection of nodal metastasis, etc. They can provide a diagnosis noninvasively, in situ, and in real time.

Peripheral Odontogenic Fibroma: A Rare Tumor mimicking a Gingival Reactive Lesion.

Gingival growths are one of the most frequently encountered lesions in the oral cavity. A plethora of lesions can be seen having similar clinical presentation, making diagnosis a dilemma. Peripheral odontogenic tumors are rare neoplasms to occur on gingiva, the most common among them being the peripheral odontogenic fibroma (POdF). The POdF is a benign, slow-growing, exophytic lesion. Although considered to have a recurrence potential after excision, the actual recurrence rate is not known due to paucity of reported cases. Presented here is a case of a rare neoplasm mimicking an inflammatory gingival lesion with review of the available literature. HOW TO CITE THIS ARTICLE: Khot K, Deshmane S, Bagri-Manjrekar K, Khot P. Peripheral Odontogenic Fibroma: A Rare Tumor mimicking a Gingival Reactive Lesion. Int J Clin Pediatr Dent 2017;10(1):103-106.

Human Papilloma Virus in Oral Squamous Cell Carcinoma - The Enigma Unravelled.

Squamous cell carcinoma of the head and neck (HNSCC) has long been regarded as a disease entity having a remarkable incidence worldwide and a fairly onerous prognosis; thus encouraging further research on factors that might modify disease outcome. Squamous cell carcinomas encompass at least 90% of all oral malignancies. Several factors like tobacco and tobacco-related products, alcohol, genetic predisposition and hormonal factors are suspected as possible causative factors. Human papilloma virus (HPV), the causal agent of cervical cancer also appears to be involved in the aetiology of oral and oropharyngeal cancer. HPVpositive squamous cell carcinoma (SCC) seems to differ from HPV-negative SCC. Many questions about the natural history of oral HPV infection remain under investigation. The aim of this review is to highlight the current understanding of HPV-associated oral cancer with an emphasis on its prognosis, detection and management.

A cytomorphometric analysis of oral mucosal changes in tobacco users.

AIM: Tobacco use is the major cause of oral cancer, which is the sixth most common form of malignancy globally. Even in the absence of clinical manifestations, early changes in the oral mucosa can be detected microscopically by exfoliative cytology. The present study aimed to study and compare the cellular changes in the oral mucosa of tobacco users using cytomorphometry. MATERIALS AND METHODS: A total of 80 subjects were included: 20 without any tobacco use habits, 20 tobacco chewers, 20 smokers, and 20 mishri users. Smears were collected from each subject, fixed, and stained using Papanicolaou stain. All slides were evaluated for nuclear and cytoplasmic changes using image analysis software. RESULTS: Statistically significant decrease in cytoplasmic area and an increase in nuclear area and nuclear-cytoplasmic ratio were observed in tobacco users. CONCLUSION: Tobacco in any form causes significant cellular changes, which could be the earliest indicators of developing malignant pathology. Exfoliative cytology can be used to detect such changes.

Pleomorphism of argyrophilic nucleolar organizer regions in oral submucous fibrosis and oral squamous cell carcinoma.

BACKGROUND: Argyrophilic nucleolar organizer regions (AgNORs) is demonstrated to be useful in diagnostic pathology, mainly to distinguish benign lesions from their malignant counterparts. We aimed to correlate AgNORs pleomorphism with the severity of lesion in oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) using a retrospective study on 45 archival tissues. MATERIALS AND METHODS: Silver nitrate staining was performed on archival tissues consisting of 20 OSMF and 20 OSCC. Five biopsies from normal oral mucosa acted as a control. One hundred cells per slide were observed for AgNORs dots, which were classified as typical (spherical) and atypical (large, kidney-shaped and clustered). RESULTS: A positive and significant correlation was found between increased atypical shapes and increasing grades of OSMF and OSCC. CONCLUSIONS: AgNORs pleomorphism can be a reliable criterion to assess disease severity and progression in OSMF and OSCC.

Comparative analysis of the immunohistochemical expression of vascular endothelial growth factor and matrix metalloproteinase-9 in keratocystic odontogenic tumor, dentigerous cyst and radicular cyst.

BACKGROUND: Vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) have been implicated in the pathogenesis of cysts. Both these factors seem to be interrelated to each other. The importance of the MMPs in the induction of the angiogenic process has recently been described. MMPs, which are produced by microvascular endothelial cells, break down the extracellular matrix. This is one of the earliest and sustained events in the process of new capillary formation. Thus, we studied the expression of VEGF and MMP-9 in Keratocystic odontogenic tumors (KCOTs), dentigerous cysts (DCs) and radicular cysts (RCs). MATERIALS AND METHODS: Ten cases each of KCOTs, DCs and RCs and were included in the study and immunohistochemistry was performed using anti-VEGF and anti-MMP-9 antibody using standard protocol. RESULT: When the data of positive cells in the epithelium of KCOTs was compared with DCs and RCs, it showed highly significant results (P<0.05). Furthermore, the expression of VEGF and MMP-9 in the stroma of KCOTs showed a significant result when compared to DCs and RCs. The expression of VEGF in inflammatory cells was more in RCs when compared to DCs. Also, the expression of MMP-9 was more in RCs and DCs as compared to KCOTs. CONCLUSION: Higher expression of VEGF and MMP-9 in KCOTs could be responsible for the aggressive behavior of this cyst that is currently considered a cystic tumor rather than a developmental cyst.