Renal cell carcinoma metastasizing to salivary glands: Systematic review.

Distant metastasis to salivary glands is a very rare event. Renal cell carcinoma (RCC) has been known for its high propensity of metastasis to unusual locations and salivary glands are one among those sites. Approximately 0.1% of all salivary gland metastatic neoplasms originate from renal malignancies Literature has reported several studies analysing the metastatic tumors to the oral region. However, very little research work has been published to date to analyse solely the RCC metastasizing to the salivary glands. Thus, this review was conducted to examine the published cases of RCC metastasizing to salivary glands in the literature to date and to learn about their characteristics. An electronic search of the published literature was performed without publication year limitation in PubMed/ Medline, Scopus, Google Scholar, Web of Science, Science Direct, Embase, and Research Gate databases, using mesh keywords like ('Renal cancer', OR 'Renal carcinoma' OR 'Renal cell cancer' OR 'Renal cell carcinoma'), AND ('Metastasis' OR 'Metastases'), And ('Salivary glands' OR 'Parotid gland' OR 'Submandibular gland' OR 'Sublingual gland'). We also searched all related journals manually. The reference list of all articles was also checked. Our research revealed a total of 83 relevant papers (1965-2022) with 100 patients. Parotid was the most predominant gland affected. 8% of patients died with a mean survival time of 1.3 yr. From this research, it can be concluded that RCC metastasizing to salivary glands is a rare occurrence. Careful evaluation of these cases is needed in order to raise awareness of these lesions and gain a better understanding of their characteristics for clinical as well as global implications.

Lung cancer metastasis to oral soft tissues; Systematic review of 122 cases.

Background: Lung cancer metastasis to oral region is very rare. Studies have been published analysing the cases of metastatic tumours to the oral cavity by many researchers. But very few research work has been conducted till date to analyse only the oral soft tissue metastasis from Lung cancer as the primary source. The goal of this study was to examine published cases of oral soft tissue metastasis from lung cancer as the only primary source from 1st August 1977 to 31st December 2021. Material and Methods: An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like 'Lung cancer', OR/ AND 'Lung carcinoma' OR/ AND 'Oral cavity', OR/AND 'Metastasis', OR/AND 'Primary', OR/AND 'Source', OR/AND 'Initial', OR/AND 'Tongue', OR/AND 'Palate', OR/ AND 'Tonsil', OR/AND 'Lip', OR/AND 'Buccal mucosa', OR/AND 'Floor of mouth', OR/AND 'Salivary glands', OR/ AND 'Parotid', OR/ AND 'Submandibular', OR/ AND 'Sublingual' OR/ AND 'Mandible', OR/AND 'Maxilla. We also searched all related journals manually. Reference list of all articles was also checked. Results: Our research revealed total 122 patients. The most prevalent diagnosed metastatic lung cancer was adenocarcinoma. Gingiva, tongue and tonsils were the most common site of metastasis. 54% patients died of metastasis with a survival time of 1 week to 2.5 years. Conclusions: Oral soft tissue metastasis from lung cancer has a bad prognosis. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics. Key words:Lung cancer, metastasis, oral, primary, soft tissues.

Jaw bone metastasis from Lung cancer as sole primary source: A systematic review.

Background: Lung cancer is one of the leading causes of death worldwide. Lung cancer metastasis to oral region is very rare. Very few research work has been conducted till date to analyse the jaw bone metastasis from Lung cancer as the primary source. The goal of this research was to examine published cases of jaw bone metastasis from lung cancer as the sole primary source from 1st December 1961 to 31st December 2021 and to learn about their characteristics. Material and Methods: An electronic search of the published English literature was performed in PubMed/ Medline, Scopus, Google Scholar, and Research gate databases, using keywords like 'Lung cancer', OR/AND 'Lung carcinoma', OR/AND 'Metastasis', OR/AND 'Primary', OR/AND 'Source', OR/AND 'Oral cavity' OR/AND 'Jaw', OR/ AND 'Mandible', OR/AND 'Maxilla', OR/ AND 'Temporomandibular joint', OR/ AND 'Condyle', OR/ AND 'Ramus', OR/ AND 'Maxillary sinus', AND Initial', OR/ AND 'Treatment', OR/AND 'Prognosis', OR/ AND 'Follow-up', OR/AND 'Recurrence', OR/ AND 'Survival rate'. We also searched all related journals manually. Reference list of all articles was also checked. Data extracted were tabulated and summarized. Results: In total, we found 60 relevant publications with 66 patients in our research. The prognosis was poor, with a survival time of 1 week to 1.5 years. The most prevalent diagnosed metastatic lung cancer to jaw bones was adenocarcinoma and mandible was the predominant site. Conclusions: Jaw bone metastasis from lung cancer is rare and has a bad prognosis. Because of their resemblance to other jaw problems and late clinical signs, these lesions go unnoticed the majority of the time, making detection difficult. More cases need to be published in order to raise awareness of these lesions and gain a better understanding of their characteristics. Key words:Jaw bone, lung cancer, metastasis, primary, prognosis.

Unusual Cystic Variant of Calcifying Epithelial Odontogenic Tumor.

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, which is exclusively epithelial in its tissue of origin. Many cases of CEOTs are associated with impacted tooth and simulate dentigerous cyst radiographically. The histologic features of CEOT are unique; however, among its various histologic subtypes, the cystic variant is a rare and less well-understood entity. Our report elucidates a cystic variant of CEOT in the maxilla of a 16-year-old male that presents clinical and radiologic findings conscientious to dentigerous cyst; but histopathological diagnosis came out to be a gold standard in identifying this rare tumor. This case report describes the clinicopathologic features of this rare entity, highlighting the histomorphological findings along with reviewing other reported cases.

Stature estimation from regression analysis of facial anthropometry in Indian population.

BACKGROUND: Stature or body height is one of the most important and useful anthropometric parameters which determines the physical identity of an individual. As craniofacial structures have the advantage of being composed largely of hard tissue which is relatively indestructible, the careful study of these can enable reliable determination of stature of the person in life. Studies pertaining to stature estimation from facial measurements are limited in an Indian population. The present investigation attempts to estimate stature from anthropometric dimensions of face. MATERIALS AND METHODS: The material for the present study comprises 361 Indian students (151 males and 210 females) in the age range of 21-45 years. Stature and six facial measurements were taken on each participant following standard methods and techniques. Karl Pearson's correlation coefficient and linear regression were done to estimate stature. RESULTS: The results indicate that facial measurements are strongly and positively correlated (P < 0.001) with stature. The accuracy of the computed equations was further tested on 50 randomly selected study participants of each group, which shows close approximation of actual and estimated stature. CONCLUSION: Within the limits of this study, we conclude that facial dimensions can be used as a supplementary approach for the estimation of stature but with caution, as these are population-specific approach.

Potential immmunohistochemical markers to characterize epithelial-mesenchymal transition in pleomorphic adenoma.

BACKGOUND: The histogenesis process of pleomorphic adenoma (PA) of salivary gland continues to remain a controversial subject. In this neoplasm, transition occurs from an epithelial or myoepithelial cell to a stromal element and is called an epithelial-mesenchymal transition (EMT) resulting in heterogeneity. The present research was aimed to study the morphological characteristics of varied components and epithelial-mesenchymal transitions in PA using histopathological and immunohistochemical (IHC) analysis. MATERIALS & METHODS: For this purpose 15 PAs cases were selected from the archives and from each case of PA and 5 cases of normal salivary gland, five additional sections were cut from each for immunohistochemical analysis using E- cadherin, vimentin and a-actin. The numbers of immunoreactive cells were semi- quantitatively measured and also determined the intensity of the immunostaining reaction. RESULT: Immunohistochemically, as the cells transitioned from the lumial cells to descrete/detached cells of ductal structures, the percentage of positive cells tends to decrease for E- cadherin and increases for vimentin and actin. Additionally, neoplastic cells towards the periphery of ducal-cystic structures or completely detached cells in the stroma showed intense to moderate positivity for vimentin and alpha smooth muscle actin (a-SMA). Chondroid/ hyalinized or myxoid stroma showed variable staining with these markers. CONCLUSION: Our study provides the evidence that epithelial-mesenchymal transition process represent the basic principle of the tisuse heterogeneity in pleomorphic adenomas.

Evaluation of efficacy of peri-operative administration of hydrocortisone and dexamethasone in prevention of post-operative complications in oral and maxillofacial surgeries / Evaluación de la eficacia de la administración peri-operatoria de hidrocortisona y dexametasona para prevenir las complicaciones postoperatorias de la cirugía oral y maxilofacial

Objective: To evaluate the role of intra-operative hydrocortisone and post-operative dexamethasone on reducing post-operative complications following major surgeries involving oral cavity as in oral and maxillofacial surgeries performed under general anesthesia. Methodology: The post-surgical stress induces changes in metabolic and endocrinal pathways and also results in activation of inflammatory pathways. Post-operative administration of steroids helps in blocking all the stages of inflammatory process. This study was conducted on a group of 20 patients undergoing major surgical procedures. These patients were administered a combination of intra-operative hydrocortisone and post-operative dexamethasone therapy. Efficacy of these drugs in reducing post-operative complications was evaluated, using parameters like post-operative pain, number of analgesic injections, edema, sore throat, nausea and vomiting. Results: A 70% mean reduction in pain was seen on 2nd post-operative day and a drastic 97% pain reduction was noted on 4 th post-operative day. An overall 12 mm reduction in swelling was noted over the span of 4 days of hospital stay. Post-operative administration of dexamethasone helped in reduction of sore throat up to 95% on 2nd post-operative day. A remarkable finding noted was, that, none of the patients developed nausea and vomiting post-operatively. Conclusion: Surgeries done in and around the oral cavity are mostly prone to contamination as presence of saliva, bacteria, contaminants from stomach flora through acid reflux and post-operative events like vomiting, pollute the surgical site. A single intra-operative dose of hydrocortisone followed by post-operative tapered administration of dexamethasone helps in combating almost all of the post-operative complications after major oral and maxillofacial surgical procedures and hence hastens healing of surgical site

Objetivo: Evaluar el papel de la administración intraoperatoria de hidrocortisona, y postoperatoria de dexametasona, para reducir las complicaciones postoperatorias tras las cirugías mayores de la cavidad oral y la cirugía oral y maxilofacial realizadas bajo anestesia general. Metodología: El estrés postquirúrgico induce cambios en las vías metabólica y endocrina, y origina también la activación de las vías inflamatorias. La administración postoperatoria de esteroides ayuda a bloquear todas las etapas del proceso inflamatorio. Este estudio se realizó en un grupo de 20 pacientes sometidos a intervenciones quirúrgicas mayores. A dichos pacientes se les administró una combinación de hidrocortisona intra-operatoria y dexametasona postoperatoria. Se evaluó la eficacia de dichos fármacos para reducir las complicaciones postoperatorias, utilizando parámetros tales como dolor postoperatorio, número de inyecciones analgésicas, edema, dolor de garganta, náuseas y vómitos. Resultados: Se observó un 70% de reducción media del dolor al segundo día postoperatorio y un 97% de reducción drástica del dolor al cuarto día postoperatorio. Se observó una reducción general de 12 mm del edema durante el transcurso de la estancia hospitalaria de 4 días. La administración postoperatoria de dexametasona ayudó a reducir el dolor de garganta en un 95% durante el segundo día postoperatorio. Un hallazgo destacable fue que ninguno de los pacientes desarrolló náuseas ni vómitos a nivel postoperatorio. Conclusión: Las cirugías practicadas en y alrededor de la cavidad oral son más propensas a la contaminación, ya que la presencia de saliva, bacterias, contaminantes de la flora estomacal a través del reflujo ácido, y los acontecimientos post-operatorios tales como vómitos, contaminan el sitio quirúrgico. La administración de una única dosis intra-operatoria de hidrocortisona y postoperatoria de dexametasona ajustada ayuda a combatir la mayoría de las complicaciones postoperatorias tras las intervenciones quirúrgicas mayores orales y maxilofaciales y, por tanto, contribuye a la curación del sitio quirúrgico

Diagnostic Efficacy of Deeper Sections in Routine Oral Histopathology Practice: a Retrospective Study.

STATEMENT OF THE PROBLEM: Histopathology is a gold standard diagnostic tool for oral lesions. Nonspecific and overlapping microscopic features often pose diagnostic challenges in routine practice. In such conditions, deeper sections have utility to enhance the sensitivity and accuracy of the diagnosis. PURPOSE: To analyze the percentage of deeper sections requested and to evaluate the diagnostic efficacy of these deeper sections in routine oral histopathology practice. Additionally, the utility of deeper sections in specific oral lesions have also been evaluated. MATERIALS AND METHOD: A total of 850 cases from the archives of Department of Oral Pathology and Microbiology, were analyzed, and 106 cases with deeper sections were selected. Out of 106, 82 cases were accepted for our analysis and 24 were rejected as deeper sections were done due to staining errors or folding of tissue. The present retrospective study involves comparison of initial histological findings with those seen in deeper sections of same specimen. RESULTS: Deeper sections improved the diagnosis of 48 cases (58.54%). Remaining 31 cases (38%) showed the same histological features, whereas in 3 cases (3.66%), initial sections were good as compared to deeper sections. Out of 22 cases of provisional hyperkeratotic/ dysplastic lesion, 16 (72.72%) showed change in diagnosis, i.e. from mild to severe dysplasia or from dysplasia to carcinoma. A total 12 out of 17 (70.59%) cases of odontogenic lesions were non- diagnostic or showed minimal characteristic features on initial sections, but their deeper sections revealed clearly identifiable features and some of them also showed cystic lesion turning into tumor pathology. CONCLUSION: This study highlights the diagnostic efficacy of deeper sections and their contribution towards providing accurate and more descriptive features.

Agenesis of permanent canines: Rare case report.

Agenesis of permanent canines is a rare condition, and that of both maxillary and mandibular permanent canines is extremely rare. It may occur either isolated or in association with other dental anomalies. Reports of such cases are very scarce in the literature. Need for early diagnosis of such conditions should be emphasized because of functional, esthetic, and psychological problems which should be evaluated and treated appropriately. The present paper presents a report of bilaterally missing permanent maxillary and mandibular canines. This case might contribute in the future studies of incidence of agenesis of permanent canines.

Report of a rare cyst at a rare site: Heterotopic gastrointestinal cyst partially lined with dermoid cyst epithelium.

Heterotopic gastrointestinal cysts (HGCs) of the oral cavity are rare benign lesions mimicking benign or malignant pathologies. These cysts are usually discovered during infancy but may not appear until well into adulthood. The epithelial lining of these cysts shows variable presentation with the presence of an enteric lining as an essential component. The histogenesis is related to entrapment of undifferentiated, noncommitted endoderm within the oral cavity during the 3rd - 4th week of fetal life. We report a rare case of oral HGC located at a very rare site, i.e., infratemporal fossa with histopathologic features that included portions resembling dermoid cyst also. Histopathology and etiopathogenesis of the lesion are discussed. Origin from misplacement of embryonic remnants, i.e., undifferentiated endodermal cells is suggested.

Classical Cases of Lymphangioma - As Multiple Vesicular Eruptions.

Lymphangiomas are uncommon congenital hamartomas of the lymphatic system, usually diagnosed in infancy and early childhood. They are rarely situated in oral cavity and most commonly identified on the anterior two-thirds of the tongue. Though rarely seen in the oral cavity, lymphangiomas are the entities which should be taken into consideration by the clinician while examining vesicular lesions of the oral cavity. Early recognition is of utmost importance for the initiation of proper treatment and to avoid serious complications. We hereby report two classical cases of lymphangioma of the buccal mucosa with multiple vesicular eruptions, a rare site.

An Odontometric Approach for Estimation of Stature in Indians: Cross- Sectional Analysis.

INTRODUCTION: Height/stature is one of the useful anthropometric parameter for individual identification. Correlation of stature to long bones, even fragmentary bones is frequently reported among various populations. As teeth have the advantage of being composed largely of hard tissue which is relatively indestructible, the careful study of these can enable reliable determination of stature of the person in life. AIM: The present study was designed to elucidate the anthropometric correlation of tooth dimensions with stature and also devises regression formulae. MATERIALS AND METHODS: This study was carried out on 361 Indian students (151 males and 210 females) in the age range of 21- 45 years to estimate stature using odontometry. Stature and tooth measurements were taken on each partcipant following standard methods and techniques. Karl Pearson's correlation co-efficient and linear regression was used to estimate stature. RESULTS: Regression analysis showed that the canine width can aid in estimation of stature as an adjunct when only teeth are available for identification. CONCLUSION: Tooth dimensions can be used only as a supplementary approach for the estimation of stature but with caution.

Anaplastic lymphoma kinase negative anaplastic large cell lymphoma of hard palate as first clinical manifestation of acquired immune deficiency syndrome.

Anaplastic large cell lymphoma (ALCL) is an uncommon disease, accounting for <5% of all cases of non-Hodgkin's lymphoma. We report a case of 48-year-old male who presented a clinically benign swelling in the right anterior palatal region since last 2 months. Radiographic evaluation showed no bone loss in palatal area. Histological and radiological examination was in favor of a peripheral reactive lesion like pyogenic granuloma or a benign salivary gland tumor. Immunohistochemistry confirmed the diagnosis of anaplastic lymphoma kinase-negative (ALK(-)) ALCL. Further laboratory tests ELISA for human immunodeficiency virus (HIV) and CD4 cell count was done which showed positivity for HIV. To the best of our knowledge, it is the first case of ALK(-) ALCL in the hard palate presenting as the first clinical manifestation of acquired immune deficiency syndrome.

Correlation of Beta Angle with Antero-Posterior Dysplasia Indicators and FMA: An Institution Based Cephalometric Study.

INTRODUCTION: Beta angle utilizes three skeletal landmarks - point A, point B, and point C (the apparent axis of the condyle). It is formed between A-B line and point A perpendicular to C-B line. Further this angle indicates the severity and the type of skeletal dysplasia in the sagittal dimension and it changes with the growth pattern of the patient. Hence, it is important to study the dependence of beta angle on the growth pattern. AIM: The present study was designed to evaluate the correlation of Beta angle with point A-Nasion-point B (ANB) angle, points A and B to palatal plane (App-Bpp), Wit's appraisal and Maxillary-Mandibular plane angle Bisector (MMB) and Frankfort-Mandibular plane Angle (FMA) in Skeletal Class I, Class II and Class III malocclusion groups. MATERIALS AND METHODS: Pre-treatment lateral head cephalo-grams of 120 subjects in age group of 15-25 years were obtained. Three skeletal Class I, Class II and Class III malocclusion groups (40 each) were assorted on the basis of ANB, MMB, App-Bpp, Wit's appraisal and FMA. Analysis of variance (ANOVA) and mean differences were calculated to compare the study groups. Bivariate correlations among different parameters of these groups were obtained. RESULTS: Normal values of beta angle in skeletal Class I group, skeletal Class II group and skeletal Class III group was 31.33±3.25, 25.28±4.28 and 40.93±4.55 respectively. Overall beta angle showed a strong correlation with all parameters of anterio-posterior dysplasia indicators except FMA. CONCLUSION: Beta angle shows weak correlation with FMA and is not affected by growth pattern/jaw rotation. The normal values are in same range irrespective of the differences in craniofacial morphology.

Sex assessment efficacy of permanent maxillary first molar cusp dimensions in Indians.

BACKGROUND: The human first maxillary molar provides clues about evolution and is functionally important. It has four main cusps, and each cusp has an independent growth pattern and different evolutionary background. Though less explored, the analysis based on measurement of each cusp appears to be more meaningful biologically than conventional measurements of the whole crown. AIM: This study aimed to demonstrate the extent of sexual dimorphism in permanent maxillary first molar cusp diameters and their potential utility in sex prediction among Indians using logistic regression analysis (LRA). MATERIALS AND METHODS: The mesiodistal and buccolingual (BL) crown diameters along with cusp dimensions and cusp indices of right maxillary first molar were measured in an Indian sample (149 males, 151 females; age range of 18-30 years). The possible sex dimorphism in these parameters was evaluated, and LRA was performed to ascertain their usefulness in sex prediction. RESULTS: BL crown dimension and the hypocone (distolingual) cusp showed the highest sexual dimorphism. The combination of metacone and hypocone, i.e., distal cusp diameters among cusp parameters showed the highest accuracy (61.3%). While, on combining all the crown and cusp diameters together the overall accuracy was raised (64.3%). CONCLUSION: This study supports the ontogeny hypothesis suggesting that early-forming mesial cusps demonstrate less sexual variation as compared to subsequently formed distal cusps in the maxillary molar. Though the sex identification accuracy for cusp diameters of the permanent maxillary first molar in Indians is relatively moderate (≈61%), it can be used as an adjunct for sexing of adult Indians in forensic contexts.

Basal Cell Adenoma of Palate, a Rare Occurrence with Review of Literature.

Basal cell adenoma is an uncommon benign epithelial neoplasm of salivary gland which derives its name from the basaloid appearance of tumor cells and accounting for 1-2 % of all salivary gland epithelial tumors. This tumor usually arises in the major salivary glands, with the parotid being the most frequent site of occurrence, followed by the upper lip; while it is very rare in the minor salivary glands. Microscopically, it is composed of isomorphic cells similar to basal cells with nuclear palisading. We report a case of BCA presenting as an asymptomatic swelling over the right side of palate of 55-year-old female patient. A follow-up of 1 year revealed no recurrence. This report emphasizes the rare site of occurrence of this tumor and briefly reviews the literature.

A Contemporary Approach to Classify Ghost Cells Comprising Oral Lesions.

Ghost cells are swollen eosinophilic epithelial cells that have lost their nuclei but retain the cellular and nuclear outline. Pathologic ghost cell formation could be the process of aberrant keratinization or the result of coagulative necrosis. Ghost cells have been described in several odontogenic lesions, which include calcifying epithelial odontogenic cysts or tumours like odontomas, ameloblastic fibro-odontomas, and ameloblastomas. This article present a view on the formation of ghost cells with proposal/introduction of a classification for ghost cell lesions of the oral cavity in an attempt to organize these lesions for the better understanding and academic purpose.

Histological assessment of cellular changes in postmortem gingival specimens for estimation of time since death.

Estimating the time after death is an important aspect of the role of a forensic expert. After death, the body undergoes substantial changes in its chemical and physical composition which can prove useful in providing an indication of the post-mortem interval. The most accurate estimate of the time of death is best achieved early in the post-mortem interval before the many environmental variables are able to affect the result. Whilst dependence on macroscopic observations was the foundation of the past practice, the application of histological techniques is proving to be an increasingly valuable tool in forensic research. The present study was conducted to evaluate the histologic post-mortem changes that take place in human gingival tissues and to correlate these changes with the time interval after death. Thirty one samples of post-mortem human gingival tissues were obtained from a pool of decedents at varied post-mortem intervals (0-8 hrs, 8-16 hrs, 16-24 hrs). Ante-mortem samples of gingival tissues for comparison were obtained from patients undergoing crown lengthening procedure. Histological changes in the epithelium (cytoplasmic and nuclear) and connective tissue were assessed. The initial epithelial changes observed were homogenization and eosinophilia while cytoplasmic vacuolation and other alterations, including shredding of the epithelium, ballooning, loss of nuclei and suprabasilar split were noticed in late post-mortem interval (16-24 hrs). Nuclear changes such as vacuolation, karyorrhexis, pyknosis and karyolysis became increasingly apparent with lengthening post-mortem intervals. Homogenizations of collagen and fibroblast vacuolation were also observed. To conclude; the initiation of decomposition at cellular level appeared within 24 hours of death and other features of decomposition were observed subsequently. Against this background, histological changes in the gingival tissues may be useful in estimating the time of death in the early post-mortem period.