Oral malignant melanoma of the lower jaw-a case report with immunohistochemical investigations.

Oral mucosal melanoma is a type of pigment-producing cell malignancy that primarily affects the skin and oral mucosa, but can also affect the ears, eyes, gastrointestinal tract and vaginal mucosa. Oral mucosal melanoma has several different clinical manifestations. Even though it frequently manifests as a black-brown patch, macule, or nodular lesion with varying tones of red, purple or depigmented tissue, the clinical characteristics and pathobiological behaviour of oral mucosal melanomas differ from those of cutaneous melanomas. The prognosis for oral melanomas is exceedingly bad because they frequently exhibit no symptoms, which may delay diagnosis. The case of a 65-year-old male patient with a primary complaint of blackened gums in the right lower back region of the jaw is presented here.

Preliminary Report on Histopathology of Odontogenic Keratocyst in Third Dimension: Three-Dimensional Video and Images.

Introduction: Odontogenic keratocyst (OKC) is a developmental odontogenic cyst of the jaws that causes extensive destruction even before the clinical manifestations are evident. It is a well-known entity among private practitioners as it has a high recurrence rate and requires meticulous treatment planning. Unfortunately, clinicians have less understood its basic histopathology. Objective: This article highlights the preliminary attempt of an author in designing third dimension of histopathological aspect of OKC so that it is easily understood by oral pathologists, general pathologists, nonpathologists, students, and even patients too. Methodology: Preliminary three-dimensional (3D) images and videos on histopathological aspect of OKC were designed by the author using 3DMax (Autodesk Media and Entertainment) and Adobe Premiere Pro 5.5 software which is a video editing software (Adobe Systems) based on two-dimensional descriptions mentioned in the literature. Results: Internal cellular architecture of OKC was created in a lifelike manner through 3D animation video and images. Conclusion: Histopathological aspect of all oral lesions should be explained in third dimension too.

Multiple myeloma with presentation in the oral cavity.

Plasma cell neoplasms may present in the bone as monoclonal gammopathy of undetermined significance, solitary plasmacytoma of bone, multifocal plasma cell neoplasm of bones known as multiple myeloma (MM) and in soft tissues as extramedullary plasmacytoma. MM is a malignant disease of atypical plasma cells characterized by their multifocal proliferation and production of monoclonal immunoglobulins. Often, the initial clinical feature of this disease is subtle and requires trained primary health-care providers to identify this illness and put together a suitable treatment plan. This case report describes a patient with a swelling in the buccal vestibule which on clinical and pathologic investigation turned out to be MM.

Histology of Tooth Development in 3D Animation Video and Images - A Preliminary Report.

The process of tooth development is both, fascinating and well-described aspect of embryology. Although a big deal of the dental literature is being focused to the understanding of early stages of tooth development, still huge gap exist in our knowledge on how the dental hard tissues are formed, based on available images and descriptions. Tooth development process takes place in 3D form, inside our body. Therefore, histology should also be additionally explained with the help of additional 3D images and a video, which have not been reported so far. Methodology: Therefore, this brief article is a technical note and preliminary attempt to showcase 3D animation images and video of stages of tooth development which have been designed by the author herself using various the 3D animation softwares such as 3D max (Autodesk Media and Entertainment, San Rafael, California) and Adobe Premiere Pro 5.5 software which is a video-editing software (Adobe Systems, San Rafael, California).

Correlation of p53 Expression with Histopathological and Immunohistochemical Features of Human Papillomavirus in Oral Leukoplakia.

BACKGROUND: Oral cancer is strongly associated with the habit of tobacco chewing, alcohol, and betel quid consumption in India. However, sometimes, majority of the population develop oral cancer without exposure to these risk factors and are sometimes cautious about their fitness, suggesting that additional causes such as genetic predisposition, diet, and viral agents may be associated which need to explored. AIMS AND OBJECTIVES: The aim of this study was to establish a possible correlation between clinical types of leukoplakia with their histopathological features of high-risk human papillomavirus (HPV) infection and the presence or absence of HPV and expression of p53through immunohistochemistry (IHC). MATERIALS AND METHODS: Sample comprised of 40 cases of leukoplakia and 10 cases as control group. Three sections were prepared from each biopsy and subjected to IHC and hematoxylin and eosin (H and E) stain, respectively. IHC-stained slides were used to evaluate the expression of p53 and HPV and then correlated with the features of HPV infection using H and E staining. Chi-square test with a statistical analysis software package (SPSS software Version 20.0) was used. OBSERVATION AND RESULTS: The P value for p53 against HPV (IHC) was 0.012, which indicates a significant difference between positivity proportion of P53 and HPV (IHC), whereas the P value for koilocyte and HPV (IHC) is 0.311, which is nonsignificant and indicates no significance of difference between proportion of positivity between koilocyte and HPV (IHC). CONCLUSION: The expression of p53 was proportionally significant to the expression of positivity of HPV, but there was no significant association between koilocyte and p53 expression.

Lung metastasis, an incidental finding in maxilla - A case report.

The aim of this article was to present an asymptomatic lesion with insignificant clinical findings which turned out to be metastatic lesion in the jaws with primary in lung. The most common site of lung metastasis in the orofacial region is the mandible, but in our case it was seen in the maxilla. Metastases to the jaw bones occur in later stages. Hence, a careful examination of patients with jaw bone lesions is strongly suggested. Metastasis to the jaw should be considered while doing oral examination as observed in the current case because such lesions usually develop at terminal stage of cancer.

Evaluation of Ki-67 Expression in Oral Submucous Fibrosis and Its Correlation with Clinical and Histopathological Features.

OBJECTIVES: Oral submucous fibrosis (OSMF) is a potentially malignant disorder. Although it shows atrophic epithelium, it has a high proliferative capacity. Therefore, this study correlates the Ki-67. (The name "ki" is derived from the city of origin [Kiel, Germany] expression with functional grading and epithelial thickness in OSMF). METHODS: The study group comprised of thirty patients of OSMF, divided randomly into Group A, Group B, Group C, and Group D as per mouth opening (functional staging). Five participants without OSMF formed the negative control group. The positive control group comprised of five patients of diagnosed cases of squamous cell carcinoma. All the sections of biopsy were subjected for hematoxylin and eosin and immunohistochemistry staining and observed for expression of Ki-67. Epithelial thickness was evaluated using image analysis software of Leica research microscope. Images were analyzed by three independent observers who were blindfolded. All the findings were tabulated and statistically analyzed. RESULTS: In the present study, as the functional staging increased, the Ki-67 expression also increased. Ki-67 expression was highest in severe functional staging/severely decreased mouth opening (100.78) and is least in mild functional staging/mild decreased mouth opening (10.39). However, there was no significant correlation between epithelial thickness and functional staging/mouth opening (P > 0.05). CONCLUSION: A decrease in functional staging (mouth opening) showed a greater expression of Ki-67, and there was no significant correlation between functional staging and epithelial thickness.

Histopathology of Oral Submucous Fibrosis in Third Dimension with an Additional note on Hypothesis of Epithelial Atrophy.

Oral submucous fibrosis (OSMF) is a potentially malignant disorder, characterized by progressive fibrosis of the lamina propria and underlying connective tissue. It has high chances of malignant transformation. It is caused by betel nut which is very common habit among Indians. Thus, regular monitoring of histopathological changes is mandatory by physicians, private practitioners, and oral pathologists. Therefore, histopathological changes should be understood by everyone who is into health care. This article is a preliminary report on three-dimensional (3D) images and 3D-animation video of histopathological aspect of OSMF designed by author herself, for better understanding of histopathological aspect, which has never been reported so far. Additional hypothesis on epithelial atrophy have also been proposed.

Glandular odontogenic cyst: a case report in an asymptomatic patient.

OBJECTIVE: Glandular odontogenic cyst is an extremely rare lesion of the jaw. Its aggressive behavior and high recurrence rate makes it important while excising. Both clinical and radiographic features were nonspecific due to the similarities with other lesions therefore it can be misdiagnosed very easily. This article presents another case of Glandular odontogenic cyst in 17 year of male patient who was unaware of the lesion which was detected on routine examination.

Third dimension on histopathological aspect of oral lichen planus: An innovation in teaching oral pathology.

Oral lichen planus is a chronic mucocutaneous disorder. There are plethora of 2D histopathological images, but 3D images and 3D animation video of the same have not been published so far. Therefore, this article is a preliminary attempt to present the same which the author has designed herself.

Comparison of Hematoxylin and Eosin Stain with Modified Gallego's Stain for Differentiating Mineralized Components in Ossifying Fibroma, Cemento-ossifying Fibroma, and Cementifying Fibroma.

OBJECTIVE: The nature of calcifications in fibro-osseous lesions is difficult to differentiate under hematoxylin and eosin (H and E) stain and could be misleading. Special stains could be used. Modified Gallego's stain is a differential stain for hard tissues, which has been discussed recently in the literature. METHODS: Retrospective study was done from June to December 2015 to differentiate various types of mineralized tissues in ossifying fibroma (OF), cemento-OF (COF), and cementifying fibroma (CF), using modified Gallego's stain and its correlation with H and E stain. Control group comprised of decalcified section of bone, tooth, and odontoma, stained with modified Gallego's stain. Study group comprised of 30 lesions (10 OF, 10 COF, and 10 CF) stained with both modified Gallego's stain and H&E stain. This study did not have any numerical data; therefore, no appropriate statistical test could be performed. Hence, cross tabulation of the categorical data was used followed by descriptive statistical analyses. Results were presented on continuous measurements using mean ± standard deviation, and results on categorical measurements were presented in number (%). RESULTS: Modified Gallego's staining showed that, out of 10 cases of OF, 9 cases were interpreted as OF; one case of juvenile psammomatoid OF was interpreted as juvenile psammomatoid COF. Out of 10 cases of COF, 4 cases were interpreted as OF. Out of 10 cases of CF, 2 cases were interpreted as COF and 3 cases as OF. CONCLUSIONS: Fibro-osseous lesions are difficult to diagnose using H and E staining alone. Modified Gallego's stain could be a best adjunct.

Immunohistochemical Expression of Myofibroblasts Using Alpha-smooth Muscle Actin (SMA) to Assess the Aggressive Potential of Various Clinical Subtypes of Ameloblastoma.

OBJECTIVE: Ameloblastoma is a rare odontogenic neoplasm with high recurrence rates if improperly treated. If left untreated (or is treated inadequately), it can cause substantial morbidity, disfigurement, and even death. Hence, there is a need to explore the stromal cells too, which might play an important role in assessing its aggressive behavior and may help to predict the recurrence of different clinical variants of ameloblastoma. Myofibroblasts (MFs) are such cells which have been studied in various lesions. MATERIALS AND METHODS: This retrospective study involved archival tissues of ameloblastoma. Among a total of 40 cases, 12 cases of SMA (solid multicystic ameloblastoma), 10 cases of unicystic ameloblastoma (UA), 8 cases of desmoplastic ameloblastoma, and 10 cases of oral squamous cell carcinoma were selected as control. Immunohistochemical staining with anti-alpha-smooth muscle actin antibody was done. Interpretation of ten examined fields was counted by three observers. RESULTS: Significant difference in the number of MFs in SMA and UA and desmoplastic ameloblastoma and UA (P < 0.05) was found. However, there was no statistically significant difference in MFs of SMA and desmoplastic ameloblastomas (P > 0.05). In addition, there was no statistically significant difference in the staining intensity between the three variants (P > 0.05). CONCLUSION: A significant correlation was obtained between the number of MF in all the three clinical variants, i.e., SMA, UA, and desmoplastic ameloblastoma (P = 0.02), which is the unique feature of the study.

Quantitative and Qualitative Analysis of Mast Cells in Oral Lichen Planus and Its Effect on Basement Membrane Using Special Stains.

BACKGROUND: Oral lichen planus (OLP) is characterized histologically by epithelial basal cell destruction and a dense subepithelial lymphocytic infiltrate. Mast cells (MCs) play a role in the pathogenesis and progression of the disease causing changes in the basement membrane (BM). BM is seen as continuous or fragmented, distinct or indistinct, and afibrillar or fibrillar extensions. AIMS AND OBJECTIVES: This study was done to demonstrate the BM using acriflavine stain in addition to hematoxylin and eosin (H-E) stain. An attempt was also made to study MC using Azure A stain and assess the degree of changes in the thickness of BM associated with degranulated MC in patients with OLP. MATERIALS AND METHODS: A total of 66 paraffin-embedded tissue sections which included 30 inflamed gingival mucosa (IGM) and 36 OLP were stained with H-E stain, Azure A, and fluorescent periodic acid-acriflavine stain. RESULTS: MC density was higher in OLP when compared with MC in IGM. Degranulated MCs were found in abundance in OLP. Thickness of BM was significantly less in OLP when compared with IGM. Significant fragmentation was seen in OLP when compared with BM of IGM. CONCLUSION: Degranulated MC in OLP may or may not alter the quality of BM but definitely seems to influence the thickness of the BM both directly and indirectly.

Writing oral pathology biopsy report: a guide for beginners.

OBJECTIVE: Descriptive pathology in surgical biopsy reports is mainly about writing histopathology reports. However, it is almost always performed under the pressure of time and accuracy. Accuracy is critical because the patient is still alive and the clinician is going to act on the diagnosis quickly. Most reports are evaluated and generated by a single pathologist. Therefore, possibility of making mistakes in writing a biopsy report is usually existing. A clear concise unambiguous writing style is extremely important to meet the needs of the report. In some reports there is insufficient information and in others excess verbiage is included with no medical value. The lack of a professional standard has resulted in some of the inconsistency in biopsy reports. Although much has been studied and written about biopsy reports but no such compiled studies along with descriptive pathology mentioned in oral and maxillofacial pathology literature. Therefore, extensive literature search had been made and various articles have been retrieved from various databases such as PubMed, Medline, google science direct etc. Duration of studies or articles have not been decided as there are very few such descriptive articles in reputed journals. Articles in the form of PDF, word and even website articles have been included. This review article presents extensive review of various parameters to be considered in writing histopathology report of oral lesions.

Evaluation of Mitotic Figures and Cellular and Nuclear Morphometry of Various Histopathological Grades of Oral Squamous Cell Carcinoma: Comparative study using crystal violet and Feulgen stains.

OBJECTIVES: The objectives of this study were to quantitatively estimate the number of mitotic figures (MFs) and evaluate the cellular and nuclear features of various histological grades of oral squamous cell carcinoma (OSCC) using Feulgen and 1% crystal violet stains. METHODS: This case-control study took place at the Dr D. Y. Patil Dental College & Hospital in Mumbai, Maharashtra, India, between June and December 2016. A total of 51 samples were retrieved from the hospital archives. Of these, 15 well-differentiated, 15 moderately-differentiated and six poorly-differentiated OSCC samples formed the case group while 15 samples of normal gingival mucosa constituted the control group. Each sample was dyed using Feulgen and 1% crystal violet stains and the mitotic count, nuclear area (NA), cellular area (CA), nuclear perimeter (NP), cellular perimeter (CP) and nuclear-to-cytoplasmic (N/C) ratio was calculated using computer-aided morphometry techniques. RESULTS: The number of MFs visible per field was significantly higher in Feulgen-stained sections as compared to those stained with crystal violet (P = 0.050). In addition, the NA, NP, CA and CP values and N/C ratios of samples in the experimental group increased significantly in accordance with an increase in OSCC grade (P <0.001). CONCLUSION: The Feulgen stain is more reliable than 1% crystal violet in terms of the selective staining of MFs. Moreover, the findings of this study indicate that computer-based morphometric analysis is an effective tool for differentiating between various grades of OSCC.

Comparative analysis of oral rinse-based cytology and conventional exfoliative cytology: A pilot study.

BACKGROUND: Oral exfoliative cytology is a novel technique of using cells to detect dysplastic changes in the oral cavity in potentially malignant disorders and malignant oral lesions in resourced challenged areas. The aim of this study was to compare specimen adequacy and cellular clarity between oral rinse-based smears and conventional smears in normal controls, histologically confirmed and clinically diagnosed squamous cell carcinoma, and oral leukoplakia. For many years, oral rinse-based cytology has been used to detect candidal colonization in microbiology. Emphasis has been placed to detect changes in oral rinse-based cytology. From this research and development, oral rinse-based cytology has evolved as a method of preparing samples for examination in cytopathology. MATERIALS AND METHODS: Oral exfoliated cells from 10 cases of smears of potentially malignant disorders (oral leukoplakia), 10 cases of histologically confirmed and clinically diagnosed squamous cell carcinoma, and 10 controls with healthy mucosa were taken. Smears were stained with the Papanicolaou stain and were examined independently by two different oral pathologists. The results were compared to assess four parameters such as nuclear cytoplasmic ratio, sample adequacy, cellular distribution, and cellular clarity in both the smears. The results were then analyzed with SPSS (version 20) software using the descriptive statistics such as mean and standard deviation and inferential statistics such as t-test and one-way ANOVA. The level of significance was set at 5%. RESULTS: Oral rinse-based cytology was significantly more efficient than conventional exfoliative cytology in terms of cellular clarity (P < 0.001), cellular distribution (P < 0.001), and sample adequacy (P < 0.001). CONCLUSION: Oral rinse-based cytology shows overall improvement in cellular clarity, sample adequacy as compared to traditional exfoliative cytology.

Intraosseous neurofibroma in a 13-year-old male patient: A case report with review of literature.

Neurofibroma is a benign tumor of nerve tissue origin, derived from the cells that constitute the nerve sheath. It is commonly found in soft tissues, but the intraosseous occurrence of solitary neurofibroma in the head and neck is comparatively rare, with the most common site being mandible. This article presents a case report of neurofibroma on the posterior right side of the mandible of a 13-year-old boy who is the youngest patient in the series along with a review of literature.

Recurrent Psammomatoid Juvenile Ossifying Fibroma with Aneurysmal Bone Cyst: An Unusual Case Presentation.

Juvenile ossifying fibroma (JOF) is a rare, benign, locally aggressive entity of the extragnathic craniofacial bones with a high tendency towards recurrence. Two distinctive microscopic patterns of juvenile ossifying fibroma have been described: a trabecular juvenile ossifying fibroma (TrJOF) and a psammomatoid juvenile ossifying fibroma (PJOF). Psammomatoid variant is predominantly a craniofacial lesion and occurs rarely in the jaws. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Aneurysmal bone cyst exists as a secondary lesion arising from another osseous condition such as fibrous dysplasia, ossifying fibroma and giant cell granuloma. Very few cases of juvenile psammomatoid ossifying fibroma in association with the secondary aneurysmal bone cyst formation have been reported in the literature. Treatment consists of complete surgical removal; the incomplete excision has been associated with a high local recurrence rate. The authors report a case of recurrence of psammomatoid juvenile ossifying fibroma with aneurysmal bone cyst in an 8-year-old boy emphasizing the point that concomitant occurrence of these locally aggressive lesions requires adequate surgical removal and long-term follow-up.

Total Serum Protein Estimation and Its Correlation with Clinical and Histopathological Grading using Masson's Trichrome Stain in Patients of Oral Submucous Fibrosis.

OBJECTIVES: Oral submucous fibrosis (OSMF) caused by dense deposition of collagen fibers which is a protein. There is a plethora of research to evaluate degree of collagen deposition using various simple histochemical techniques, but its correlation with total serum protein (TSP) level has not been explored so far. MATERIALS AND METHODS: This case-control study comprised total forty samples with thirty cases of OSMF and ten cases were selected as control group, divided into four groups as per Lai et al. classification. Histological grading was also done according to the Rooban et al.'s classification. Blood sample was collected to evaluate TSP estimation. Findings were tabulated, and comparisons were made between clinical, histological, and TSP estimation. Discrete statistical data were analyzed by Chi-square test, ANOVA, and t-test with a statistical analysis package (SPSS version software 6.0). RESULTS: No significant correlation was obtained between clinical staging and histopathological grading. Definite correlation was obtained in TSP and globulin levels of OSMF patients and their grades of fibrosis histopathologically. CONCLUSION: In the present study, it was observed that biochemical investigations involving assessment of TSP can be used as a diagnostic tool in OSMF, along with histopathological examination.

Association of Candida sp. with the Degrees of Dysplasia and Oral Cancer: A Study by Calcofluor White under Fluorescent Microscopy.

BACKGROUND AND OBJECTIVE: Candida albicans (C. albicans) play a significant role in oral mucosal carcinogenesis. It can be identified using various techniques in cytological smears. But, very few studies have been conducted on histopathological sections using calcofluor white M2R under fluorescent microscopy. Additionally, detection and quantification of Candida colonies and its correlation with various grades of oral leukoplakia and oral carcinomas have not been explored much. METHODS: The current retrospective study included 80 samples from archives consisting of 60 samples in the study group (10 cases each of mild, moderate, and severe epithelial dysplasia (totally 30) and 30 cases of oral carcinoma). Sections were stained with calcofluor white (CFW) and 10% KOH for the observation under fluorescent microscopy and correlated with different grades of oral leukoplakia and oral carcinomas. Chi-square test was used in SSPS software to study the presence and absence of Candida sp. in different groups. RESULTS: The study groups of oral carcinoma and dysplasia showed a significant association with Candida sp. (P=0). When carcinoma was compared with each grade of dysplasia, except mild dysplasia (P=4.4E-05), both moderate (P=0.402195) and severe dysplasia (P=0.558746) showed an insignificant P-value. When the groups of mild (13.3%), moderate (30%), and severe (33.3%) dysplasia were considered independently, the incidence of Candida sp. increased as the grade of dysplasia increased. The number of colonies have been counted and the maximum number of colonies have been observed in carcinoma and the least have been observed in mild dysplasia. CONCLUSION: A significant association of Candida colonies with epithelial dysplasia and oral cancer was established. Further, CFW was found a promising candidate to identify Candida colonies in tissue sections using fluorescent microscopy.