Zygomycosis of the Oral Cavity in a Main Referral Centre in Malaysia: A Case Series (1967-2021)

@#Zygomycosis is a rare opportunistic fungal infection caused by fungi in the phylum Mucoromycota, subphylum Mucoromycotina and order Mucorales. Immunocompromised patients may harbour the disease by inhalation of the spores from the environment into the paranasal sinuses. Rhino-orbital-cerebral is the most common form which extends into the oral cavity, especially to the palate. We present twelve cases of zygomycosis diagnosed in the Stomatology Unit, Institute for Medical Research (IMR), Malaysia. Most of the patients are immunocompromised and presented as the rhino-orbital-cerebral form. Routine haematoxylin and eosin (H&E) staining were used for all cases while selected cases required additional special staining. The characteristic histological features of broad, non-septate, branched, amphophilic fungal hyphae are seen. We aim to report this rare occurrence to contribute to the literature and raise awareness about this condition among clinicians. To date, this is the first compilation of oral zygomycosis cases known to be reported in Malaysia.

The Clinical Features and Expression of bcl-2, Cyclin D1, p53, and Proliferating Cell Nuclear Antigen in Syndromic and Nonsyndromic Keratocystic Odontogenic Tumor.

UNLABELLED: The aim of this study was to describe the clinical features and expression of bcl-2, cyclin D1, p53, and proliferating cell nuclear antigen (PCNA) antibodies in syndromic (nevoid basal cell carcinoma syndrome [NBCCS]) and nonsyndromic patients diagnosed with keratocystic odontogenic tumor (KCOT). METHODS: This descriptive study comprised 5 patients of KCOT associated with NBCCS and 8 patients of nonsyndromic type treated in the Department of Oral Maxillofacial Surgery, Universiti Kebangsaan Malaysia Medical Centre between years 1998 and 2011. The clinical features (site, size, treatment, and recurrence), demographic characteristics, and immunohistochemistry results using antibodies of bcl-2, cyclin D1, p53, and PCNA were examined. The association of the antibody expression and the type of KCOT was analyzed using Fisher exact test. RESULTS: Altogether there were 13 patients, 5 with syndromic KCOT (1 patient met 3 major criteria of NBCCS) and 8 with sporadic KCOT. The age range for syndromic KCT was 11 to 21 years (mean 16.00 years, SD 4.36) and 10 to 54 years (median 24.50 years, interquartile range 19.00) for the nonsyndromic KCOT. Tumor recurrence occurred in 3 patients (7.7%); 1 patient from the syndromic and 2 patients from the nonsyndromic. The most positive expression was observed in PCNA for both the syndromic and nonsyndromic samples and the least positive expression involved the p53. CONCLUSION: PCNA, bcl-2 protein, and cyclin D1 expressions could be useful in evaluating the proliferative activity of the tumor and the aggressiveness of the clinical presentation; however, the authors would propose for larger sample size research for more definitive results.

An observational study of trigeminal neuralgia patients taking carbamazepine during the fasting month of Ramadan

Introduction: Trigeminal neuralgia is an agonising orofacial pain affecting unilaterally the distribution of the trigeminal nerve and it usually occurs in the middle and older age groups. Carbamazepine which is an anti-neuralgic as well as an anti-convulsant medication is the first line drug for treatment of trigeminal neuralgia. It is commonly taken as one tablet (200 mg) three times a day. Materials and Methods: This is an observational study carried out from April to September 2014 to determine how Muslim patients on carbamazepine treatment for trigeminal neuralgia cope with their neuralgic pain. The pattern of how the medication was taken during the fasting month of Ramadan was also observed. Results: A total of 29 patients participated in this study and 27(93%) observed the fast. Ten of them adjusted the carbamazepine dose from three times pre-Ramadan to twice daily during the fasting month. Three patients continued fasting despite feeling the pain during the daytime while five patients had their pain under control with the newly adjusted dose. Conclusion: Medical professionals should advise trigeminal neuralgia patients on how to take and adjust their carbamazepine dose during the fasting month.

Congenital epulis: immunohistochemical findings of 12 cases

Congenital epulis is a fairly rare soft tissue tumour occurring exclusively on the alveolar ridge of newborns. The exact origin of congenital epulis is still debatable. The objective of the study is to determine the clinicopathological features and immunohistochemical findings of congenital epulis. A retrospective study was carried out to determine the clinicopathological features of congenital epulis, diagnosed histologically in the main oral histopathology laboratory in Malaysia from 1967 to 2014. Immunostaining using vimentin, muscle specific actin, smooth muscle antigen, desmin, S100, CD34, CD68 and CD1a was carried out. Twelve cases of congenital epulis were reviewed. All of the patients were females and the presentation age ranged from 2 to 90 days. The patients comprised of 6 Malays, 3 Chinese, 2 Indians and 1 Orang Asli. Most of the cases (n=7) involved the maxillary ridge and presented as pedunculated well-defined lumps (n=8). Excisional biopsy was performed in all cases. Via immunohistochemistry, vimentin expression was observed in all cases; but negative for CD34, muscle specific actin, smooth muscle antigen, and desmin. CD1a and S100 positivity was seen in five cases. The interstitial cells were highlighted by CD68. Although congenital epulis has been first described 130 years ago, the exact nature of its histogenesis remains a mystery.

Gingival myofibroma in children: report of 4 cases with immunohistochemical findings.

Oral myofibroma is a rare tumour which usually occurs in children and has been reported in the mandible, tongue, buccal mucosa with only a few cases reported from the gingiva. It appears alarming clinically due to its fast growth which may mimic a malignancy. However, it is completely benign and is usually treated by complete surgical excision with excellent prognosis. Clinically, myofibroma presents as a single swelling when it occurs on the gingiva, and more common lesions such as fibrous epulis, pyogenic granuloma and peripheral odontogenic fibroma, myofibroma are usually considered in the differential diagnosis. We present 4 additional cases of gingival myofibroma in children. Their ages ranged from 7 to 14 years. Three were girls and 1 patient was a boy. All presented with solitary gingival growths, ranging from 3 weeks to 2 months in duration, and raised the clinical diagnoses of peripheral giant cell granuloma, pyogenic granuloma and fibrous epulis. Histopathology of incisional biopsies revealed proliferation of streaming and whorled fascicles of spindle cells around slit-like vascular spaces. The spindle cells were cytologically bland and were immunopositive for vimentin and smooth muscle actin, but were negative for desmin and S-100 protein. All were treated by surgical excision.