An unusual presentation of an odontogenic tumor: A diagnostic quandary.

Squamous odontogenic tumor (SOT) is a rare benign neoplasm and may be located to multiple sites in the oral cavity mouth. As per the literature, there have been <50 reported cases. The tumor is often asymptomatic, although it can present with symptoms of pain and tooth mobility. Peripheral odontogenic tumor is a rare entity derived from either epithelial or mesenchymal portions of the tooth-forming apparatus. Lesions are common to gingiva and alveolar mucosa. Peripheral granular cell ameloblastoma (GCA) is considered to be even rarer. The purpose of the study is to report a case of SOT with a synchronous association with peripheral GCA of cystic nature in the mandible. The occurrence of SOT with ameloblastoma has not been reported as per the literature search.

Immunohistochemical expression of cyclooxygenase-2 in oral squamous cell carcinoma.

BACKGROUND AND AIM: Oral cancer is a major health problem in South East Asia. The immunohistochemical (IHC) overexpression of COX-2 in squamous cell carcinoma is well documented. This IHC study was undertaken to understand the COX-2 expression in different grades of oral squamous cell carcinoma (OSCC) and to compare the COX-2 expression in OSCC and normal mucosa. MATERIAL AND METHODS: A total of 30 cases of OSCC and 10 cases of normal mucosa and positive control colon cancer were studied for IHC expression of COX-2. Of the 30 cases studied 10 cases each of well, moderately and poorly differentiated carcinoma were studied. COX-2 staining was evaluated on the basis of presence or absence of the positive tumor cells and percentage of positive tumor cells. STATISTICAL ANALYSIS: The various statistical tests used in this study were t-test and Chi-square test which was carried out using SPSS for Windows 22.0.0 and Minitab version 17.1.0 software package. RESULTS: There was significant increase in COX-2 staining intensity from well to poorly differentiated OSCC. Significant difference was observed in staining intensity between moderately and poorly differentiated SCC. The percentage of positive tumor cells were high in poorly differentiated SCC compared to well and moderately differentiated OSCC. No significant expression of COX-2 was noted in normal mucosa. INTERPRETATION AND CONCLUSION: Our results revealed that the COX-2 enzymes were expressed, suggesting that they play complementary roles during oral carcinogenesis. In near future researches on administration of chemoradiation therapy combined with COX-2 should be evaluated to improve therapy response.

Immunohistochemical Expression of Cyclin B1 in Epithelial Hyperplasia, Dysplasia and Oral Squamous Cell Carcinomas - A Comparative Study.

INTRODUCTION: Cyclin B1 is important in the cell cycle progression from G2 to M phase. Cyclin B1 binds to CDC2, which then becomes dephosphorylated and gets relocated to the nucleus, ensuring the transition toward mitosis. AIM: Over expression of Cyclin B1, has been reported more recently in breast, colon, prostate, oral and esophageal carcinomas. Thus, the aim of the present study was to examine the expression of Cyclin B1 in hyperplasia, dysplasia and Oral Squamous Cell Carcinomas (OSCC). MATERIALS AND METHODS: A total of 64 histopathologically diagnosed cases of epithelial hyperplasias, dysplastic oral epithelium and OSCC were included in the study. Immunohistochemical procedure was carried out using the monoclonal mouse Cyclin B1 antibody (Clone V-152). The Cyclin B1 positive tumor cells counted were expressed as percentage of positive tumor cells. Nuclear and cytoplasmic labeling index (n&cLI) were calculated. The results were tabulated and statistically analyzed by Kruskal Wallis test- One Way ANOVA and Mann Whitney U- test. RESULTS: Combined n&cLI was considered only in 28.57% of epithelial hyperplasias, 40.7% of oral epithelial dysplasias and 72% of OSCC showed over expression of Cyclin B1 with p value being 0.029. Cyclin B1 expression was not significantly different between the grades of dysplasia, between the grades of OSCC and between the marginal groups. CONCLUSION: The present study demonstrates more than 50% of the study group showing less than 20% of nuclear staining. The importance of such variations within a type of lesion requires further investigation, since Cyclin B1 has proved useful in many studies from esophageal and laryngeal squamous cell carcinoma as a prognostic indicator, an indicator of recurrence and as an indicator for tumor sensitivity to radiotherapy. Further studies are to be extended towards evaluating the role of Cyclin B1 as a prognostic indicator.

Uncommon inflammatory swelling of the lips: orofacial granulomatosis.

Orofacial granulomatosis (OFG) is an unusual condition associated with permanent or recurrent swelling of orofacial tissues together with oral mucosal ulceration and a variety of orofacial characteristics. The chronic inflammation inherent to OFG often displays granulomas in the subepithelial stroma. We present a case of OFG and its management. The patient responded to intralesional injections of corticosteroids.

Intraoral salivary duct carcinoma: A case report and a brief review.

Salivary duct carcinoma (SDC) is a rare, extremely aggressive malignancy arising in the ductal epithelium of the salivary glands. SDC occurs almost exclusively in the major salivary glands with parotid gland predominantly affected. Only isolated cases involving minor salivary glands have been reported in the literature. We report an unusual case of extensive SDC occupying the right cheek and the maxillary sinus, possibly arising from the minor glands of the buccal mucosa or from the mixed glands of the maxillary sinus in a 71-year-old man. The case was subjected to a panel of immunohistochemical markers like pan cytokeratin, low molecular weight cytokeratin (LMW CK), high molecular weight cytokeratin (HMW CK), CK 7, CK 20, CD 117, carcinoembryonic antigen (CEA), S-100, p63, Gross cystic disease fluid protein (GCDFP-15) and estrogen receptor (ER) to arrive at a definitive diagnosis.

Immunohistochemical expression of calretinin in ameloblastoma, adenomatoid odontogenic tumor, and keratocystic odontogenic tumor: a comparative study.

Calretinin is expressed primarily in the central and peripheral nervous system and extensively studied in colon adenocarcinoma and mesotheliomas. Calretinin is known to be expressed in the odontogenic epithelium and odontogenic tumors. However, the role of calretinin in the pathogenesis of odontogenic tumors is yet to be confirmed. Hence, the aim of the present study was to evaluate the expression and role of calretinin in selected odontogenic tumors. The study included 30 ameloblastomas, 30 adenomatoid odontogenic tumors, and 30 keratocystic odontogenic tumors. Staining intensity, pattern, and localization of the immunopositive cells were determined. Statistical analysis was performed using Mann-Whitney U test and Kruskal-Wallis analysis of variance test. P-values <0.05 were considered to be statistically significant. Results showed that 90% ameloblastomas and 80% keratocystic odontogenic tumors were immunopositive to calretinin, whereas none of the adenomatoid odontogenic tumors showed reactivity. Intensity was higher in the ameloblastomas compared with the keratocystic odontogenic tumors. Statistically significant differences were observed when the expression of calretinin was compared, except between the ameloblastoma and keratocystic odontogenic tumor. However, the intensity of calretinin was significantly higher in the ameloblastoma when compared with the keratocystic odontogenic tumor. On the basis of these results, it is suggested that calretinin might be used as a specific immunohistochemical marker for the ameloblastomas and could play an important role in the differentiation of aggressiveness of different odontogenic tumors. Depending on the cell regulatory processes, we suggest a possible role of calretinin in the pathogenesis of ameloblastomas and have to be further studied along with other proliferative cell cycle and apoptotic markers with larger sample size.

Prion diseases in humans: oral and dental implications.

Prion diseases are a group of neurodegenerative disorders characterized by accumulation of abnormal prion proteins in the central nervous system. The prions resist conventional sterilization procedures especially when infected tissue becomes dried onto metal or glass surfaces. This article, a review of literature collected using Pubmed as search engine, describes the oral manifestations of prion diseases in addition to studying the possibility of cross contamination in the dental office. The article emphasizes the importance for dentists to be aware of these diseases, to identify the high-risk patients by obtaining adequate medical history and to know the appropriate deactivation procedures to be followed.

Facts in artifacts.

Examination of microscopic sections of animal tissues reveals facts which are not always related to its normal histology or pathology. Processing of tissue specimens consists of lengthy procedures from the stage of surgical removal to the stained and mounted microscopic sections. Defects are common in tissue sections as a result of faulty procedures. These defects are referred to as artifacts. They lead to misinterpretation of histopathological diagnosis but at times they throw limelight into diagnosis. This paper attempts to put together all the facts regarding the various artifacts that are encountered in histopathology.

Etiopathogenesis of orofacial clefting revisited.

The cleft anomaly may be more ancient than the man himself. It is one of the most common developmental malformations reported in the literature. There are number of intriguing theories regarding its etiopathogenesis, each of which has some evidence in its favor. This review highlights all the genetic and environmental etiologic factors and focuses on its pathogenesis.

Cystic variant of calcifying epithelial odontogenic tumor.

The calcifying epithelial odontogenic tumor is a rare benign odontogenic neoplasm of the jaw. Clinically, calcifying epithelial odontogenic tumor manifests as an intraosseous lesion (central type) in the majority of cases (95%). Extraosseous or peripheral lesions account for less than 5% of cases. Calcifying epithelial odontogenic tumor can be associated with an impacted tooth and give a radiographic simulation of dentigerous cyst. Most calcifying epithelial odontogenic tumors are solid in nature, histopathologically, and might have few cyst-like spaces within them. However, a true cystic calcifying epithelial odontogenic tumor is a rare possibility. We describe a case of a true cystic variant of calcifying epithelial odontogenic tumor in a 30-year-old male, which to our knowledge, is only the second reported case.

Evaluation of PTEN immunoexpression in oral submucous fibrosis: role in pathogenesis and malignant transformation.

Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a premalignant condition of the oral cavity characterized by generalized submucosal fibrosis. Despite its precancerous nature, the molecular biology regarding its malignant potential has not been extensively studied. PTEN, a known tumor suppressor gene is mutated in a majority of human cancers and has also been implicated in several fibrotic disorders. The present study aims to evaluate the expression of PTEN in OSMF and oral squamous cell carcinoma (OSCC) and correlate it with the pathogenesis and malignant transformation of OSMF. 60 cases total of OSMF (30) and OSCC (30) were subjected to immunohistochemistry using PTEN antibody. Ten normal oral mucosa (NOM) specimens were also stained as controls. There was progressive loss of PTEN expression from normal mucosa to OSMF and OSCC (p ≤ 0.001). Significant differences were observed for PTEN expression between NOM and OSMF, OSMF and OSCC as well as NOM and OSCC. Though a progressive loss of PTEN was noticed between early OSMF and advanced OSMF, the variation did not reach statistical significance (p ≥ 0.001). Data suggest that there is a significant loss of PTEN expression in OSMF as compared to normal oral mucosa and that this trend increased from OSMF to OSCC. Thus, alteration of PTEN is likely an important molecular event in OSMF pathogenesis and oral carcinogenesis.

Oral pyogenic granuloma--a review of 215 cases in a South Indian Teaching Hospital, Karnataka, over a period of 20 years.

INTRODUCTION: Pyogenic granuloma (PG) is a solitary, benign vascular growth. The precise cause for the development of pyogenic granuloma is unknown. It is believed, however, to be an exuberant tissue response to local irritation or trauma. Up to date, few studies have been carried out among Asians, particularly on the Indian subcontinent. MATERIALS AND METHODS: Biopsy services were researched from 1989 to 2009. Two hundred-fifteen histologically confirmed PGs were retrieved and retrospectively analyzed for incidence, age, gender, site distribution, clinical presentation and histopathology. These cases were also evaluated for recurrence. RESULTS AND DISCUSSION: Pyogenic granuloma accounted for 50.35% among reactive lesions in this study with a mean age of 34.27 years and a peak incidence in the third decade of life. PG was more common in females with a greater predilection for the maxillary gingivae (50.23%). Eighteen cases occurred in pregnant women. Clinically, PG occurred more frequently as pedunculated lesions (103). Gingival irritation and inflammation due to poor oral hygiene were the major precipitating factors. Histologically, PG presented a greater number of vascular channels of varied sizes, lined with plump endothelial cells, capillary budding, and chronic inflammatory cells, namely lymphocytes and plasma cells. Recurrence was seen in 14.88% of patients, predominantly in females, especially in the maxillary anterior region. CONCLUSION: Among the reactive lesions, PG had the highest incidence. The frequency of pyogenic granuloma in the southern part of India was much higher compared to other studies. Additional epidemiological research is required to understand the frequency.

Diverse growth patterns in an intraosseous ameloblastoma: a case report.

Desmoplastic ameloblastoma (DA) is a benign but locally invasive variant of the solid/multicystic ameloblastoma (SMA). In the recent World Health Organization classification of odontogenic tumours, DA has been characterised as a variant, with specific clinical, radiographic and histopathological features. A possible 'transitional' form of DA, showing microscopic features of the desmoplastic variant together with areas typical of classic follicular or plexiform ameloblastoma, has been described as a 'hybrid' lesion of ameloblastoma (HLA). A unique case with synchronous emergence of desmoplastic and unicystic ameloblastoma (different growth patterns) in the mandible of a 50-year-old male is reported.

ß-Catenin expression in benign and malignant salivary gland tumors.

OBJECTIVE: To assess the expression of ß-catenin in benign and malignant salivary gland tumors and to investigate the possible role of ß-catenin in the behavior of salivary gland tumors. STUDY DESIGN: Paraffin embedded tissues from 45 salivary gland tumors were studied immunohistochemically for expression of ß-catenin. RESULT: Reduced/aberrant ß-catenin expression was seen in benign and malignant salivary gland tumors. Cytoplasmic localization and reduced membranous expression were comparatively observed more in malignant salivary gland tumors. Additionally, in pleomorphic adenomas (PAs), ß-catenin exhibited intense staining in cells arranged in the form of ducts/tubules, whereas cells in clusters and sheets showed weaker immunoreactivity. CONCLUSION: Reduced and cytoplasmic localization of ß-catenin could indicate lack of differentiation, invasive potential, and aggressive behavior in malignant salivary gland tumors. Furthermore, change in expression based on the arrangement of tumor cells may suggest that ß-catenin may have a role in morphological variations seen in PAs.

A clinical, radiographic, and histologic review of 73 cases of ameloblastoma in an Indian population.

OBJECTIVE: Ameloblastomas in Indians have rarely been studied. The present study was undertaken to retrospectively compare the clinical, radiologic, and histopathologic features of 73 cases of ameloblastoma in Indians. METHOD AND MATERIALS: Biopsy records of 73 histologically diagnosed cases of ameloblastoma over an 18-year period were retrieved and analyzed for age, sex, site distribution, clinical presentation, radiologic features, and histopathology. These cases were also evaluated for recurrence. RESULTS: Ameloblastoma accounted for 60.3% of all odontogenic tumors in this study, with a mean age of presentation of 30.2 years. A slight male predilection and predominant occurrence in the mandibular molar-ramus area were noted. Radiologically, ameloblastoma presented as either unilocular or multilocular radiolucency, with a significant age difference noted between unilocular and multilocular lesions. Interestingly, findings such as cortical plate expansion, perforation, and involvement of the temporomandibular joint were more frequent in females. The most common histologic type in contrast to other studies was unicystic ameloblastoma followed by follicular and acanthomatous ameloblastoma. Specific correlations between histologic type and age, sex, site, and radiologic features were also observed. Recurrence was seen in 13.3% of patients, predominantly in males, in the molar-ramus area, and the common histologic type was follicular ameloblastoma followed by unicystic ameloblastoma. CONCLUSION: The finding of unicystic ameloblastoma being the second most common recurrent variant of ameloblastoma, especially when associated with cyst wall invasion or intramural proliferation, may warrant a more aggressive treatment than traditional enucleation/curettage for this entity to prevent recurrence.

Cyclin D1 expression in oral squamous cell carcinoma and verrucous carcinoma: correlation with histological differentiation.

OBJECTIVE: To assess the expression of cyclin D1 in oral squamous cell carcinoma (OSCC) and verrucous carcinoma (VC), to compare its expression in both of these carcinomas, and to investigate the possible correlation of cyclin D1 expression in different histological grades of OSCC. STUDY DESIGN: Paraffin embedded tissues from 71 cases of OSCC and VC were studied immunohistochemically. Expression of protein was correlated between the 2 entities and in different grades of OSCC. RESULTS: Cyclin D1 overexpression was seen in 29 cases (70.7%) of OSCC and in 19 cases (63.3%) of verrucous carcinoma. Statistical significance at the 5% level was observed for cyclin D1 expression between all categories of squamous cell carcinoma (SCC), that is, between well-differentiated and moderately differentiated carcinomas, and between moderate and poorly differentiated carcinomas, and well and poorly differentiated squamous carcinomas. No statistical significance was observed in cyclin D1 expression between SCC and oral verrucous carcinoma; however, statistical significance was seen between oral VC and poorly differentiated squamous cell carcinoma. CONCLUSION: Increased expression of cyclin D1 significantly correlated with lack of differentiation in these malignant epithelial neoplasms.