Clinico-pathological factors affecting lymph node yield in Indian patients with locally advanced squamous cell carcinoma of mandibular Gingivo-Buccal sulcus.

AIM: Lymph node yield (LNY) is a valid marker of prognosis in oral cancer. Precise estimation of LNY in Indian patients with T3/T4 gingivobuccal sulcus squamous cell carcinoma (GBS-SCC) has not been well documented. Hence, the primary objective of the study was to determine the LNY in patients with T3/T4 SCC of mandibular GBS, and the secondary objective was to study the association of LNY with clinicopathological factors such as tumor thickness, histological differentiation, number of positive nodes, and extracapsular spread (ECS). MATERIALS AND METHODS: Study patients comprised biopsy proven T3/T4 SCC of mandibular GBS that underwent unilateral surgery (composite or bite composite resection with level I to level V-neck dissection and pectoralis major flap reconstruction) at our center between January 2012 and October 2014. Grossing of surgical specimens was done as per the guidelines established by the Royal College of Pathologists (December 2009). The data were analyzed using SPSS software (22nd version) and Chi-square test. RESULTS: The surgical specimens of 106 patients yielded 2329 lymph nodes with the mean LNY of 21.97 ± 5.57. Higher mean LNY of over 21 was significantly associated with ECS, number of positive nodes, delay in surgery over 15 days, skin involvement by the tumor, and presence of oral potentially malignant disorders. CONCLUSION: With the single surgeon, pathologist and same surgical procedure, the mean LNY in Indian patients with T3/T4 SCC of mandibular GBS is 21.97 ± 5.57. Although clinicopathological factors affect the estimation of LNY, further studies are needed to validate the findings of this study.

Immunoexpression of tenascin as a predictor of the malignancy potential of oral leukoplakia associated with a tobacco habit.

Oral leukoplakia is a morphological alteration of tissue that is an early indicator for malignancy. Tenascin (TN) is a large hexameric extracellular matrix (ECM) protein with anti-adhesive properties that fosters cell migration during development, wound healing and tissue remodeling; it is present in small amounts in adult tissues. Overexpression of TN in a pathological condition may be either a cause or a consequence of the disease. We evaluated the efficacy of TN for early prediction of tobacco-associated oral cancers. We studied retrospectively 95 cases of oral leukoplakia, including mild, moderate and severe cases, using immunohistochemistry for TN. We evaluated the intensity, area and pattern of TN expression. Greater intensity and area of TN expression was observed in mild and severe dysplasia than in moderate dysplasia. Most cases showed a reticular pattern of expression, especially in mild and moderate dysplasia; a fibrillar pattern was more evident in severe dysplasia. We also observed homogeneous expression pattern in some cases. TN is a marker for dysplastic changes in epithelium and its expression may be helpful for predicting the malignancy potential of tobacco-associated oral leukoplakia.

Stromal characterization and comparison of odontogenic cysts and odontogenic tumors using picrosirius red stain and polarizing microscopy: A retrospective and histochemical study.

INTRODUCTION: Odontogenic lesions represent a range of conditions, the features of which probably depend on the stage of induction towards tooth formation reached prior to neoplastic or hamartomatous proliferation. It has been also suggested that inductive changes may allow progression from one type of odontogenic tumor to another. The epithelium also plays an important role in the pathogenesis of these lesions; even stroma is likely to play an equally important role in the pathogenesis and biological behavior. So, this study was performed to investigate, compare, and correlate different types of collagen fibers in odontogenic cysts and odontogenic tumors. MATERIALS AND METHODS: Thirty each pre-diagnosed odontogenic cysts and tumors were histochemically analyzed using a special stain (Picrosirius red stain) and polarizing microscopy. RESULTS: Seven cases (99%) of inflammatory cysts exhibited predominantly greenish-yellow birefringence indicating procollagen, intermediate, or pathologic collagen fibers suggestive of loosely packed collagen fibers. Predominant yellowish-orange birefringence exhibited by 21 cases (99%) of developmental cysts was comparable to the yellowish-orange and orangish-red to red birefringence exhibited by odontogenic tumors suggesting tightly packed fibers. CONCLUSIONS: The Picrosirius red stain in conjunction with polarizing microscopy serves as a specific and sensitive tool in characterizing collagen fibers in odontogenic cysts and odontogenic tumor.

Detection of metastases in oral squamous cell carcinoma: still a diagnostic impasse.

Oral squamous cell carcinoma (OSCC) being the most common malignancy of the oral cavity poses a significant public health problem due its impact on the speech, mastication, taste, swallowing and esthetics. Moreover, the presence of metastasis either regional or distant worsens the prognosis and reduces the survival rate in these patients. This makes it imperative to diagnose metastasis at an early stage to facilitate appropriate therapeutic management to reduce the morbidity and mortality associated with this disease. There have been several modalities that have been developed and in wide-use for recognition of metastasis with their inherent advantages and disadvantages making it a perplexing dilemma to the clinician and surgeon alike. This paper aims to give an insight into the diagnostic workup available for the evaluation of metastasis in patients with OSCC and reinforces the need for further research to develop more accurate methods.

Comparison of tetrachromic VOF stain to other histochemical staining techniques for characterizing stromal soft and hard tissue components.

The components of hard tissues including dentin, enamel, cementum, bone and other calcified deposits, and mature and immature collagen pose problems for identification in routine hematoxylin and eosin (H & E) stained sections. Use of combinations of stains can demonstrate the components of hard tissues and soft tissues distinctly. We assessed the efficacy of the Verde Luz-orange G-acid fuchsin (VOF) stain for differentiating hard and soft connective tissues and compared results with other histochemical staining techniques. Eighty tissue sections comprising developing tooth (30), ossifying fibroma (30) and miscellaneous pathologies (20) expected to contain varying types of calcified tissues were stained with H & E, VOF, and Masson's trichrome (MT). In developing tooth, VOF demonstrated better differentiation of hard tissues, while it was comparable to MT for ossifying fibroma and miscellaneous pathologies. The intensity of staining was greater with VOF than with the other stains studied. VOF stains hard tissue components distinctly and gives good contrast with the surrounding connective tissue. VOF is comparable to MT, but has added advantages including single step staining, rapid and easy procedures, and it distinguishes the maturity of the tissues.

Cementum made more visual.

Dental cementum is a specialized calcified structure covering the root of a tooth. This study aims to investigate cementum using various stains which can be exceedingly useful in investigation, observation and diagnosis. 4µm sections of 25 extracted normal teeth, 25 cases of various cemental pathologies and 25 ground sections were stained using cresyl violet, H/E, toluidine blue and periodic acid Schiff and were observed under light and florescence microscopes. Cresyl violet showed best contrast amongst all stains in decalcified and ground sections under light and florescence microscopy. Under the fluorescence microscope, cementum floresced more distinctly than dentin and enamel. Among the cemental pathologies examined, osteoid and cementoid exhibited florescence but cementum and bone did not fluoresce. Incremental lines were prominently visualised with cresyl violet under fluorescent microscopy, which may aid in forensic determination of age. The present results demonstrate that cementum in normal decalcified teeth and cemento-osseous lesions, could be observed best using cresyl violet stain under florescence microscopy.

Efficacy of "Dimodent" sex predictive equation assessed in an Indian population.

Teeth are considered as a useful adjunct for sex assessment and may play an important role in constructing a post-mortem profile. The Dimodent method is based on the high degree of sex discrimination obtained with the mandibular canine and the high correlation coefficients between mandibular canine and lateral incisor mesiodistal (MD) and buccolingual (BL) dimensions. This has been evaluated in the French and Lebanese, but no study exists on its efficacy in Indians. Here, we have applied the 'Dimodent' equation on an Indian sample (100 males, 100 females; age range of 19-27yrs). Additionally, a population-specific Dimodent equation was derived using logistic regression analysis and applied to our sample. Also, the sex determination potential of MD and BL measurements of mandibular lateral incisors and canines, individually, was assessed. We found a poor sex assessment accuracy using the Dimodent equation of Fronty (34.5%) in our Indian sample, but the populationspecific Dimodent equation gave a better accuracy (72%).Thus, it appears that sexual dimorphism in teeth is population-specific; consequently the Dimodent equation has to be derived individually in different populations for use in sex assessment. The mesiodistal measurement of the mandibular canine alone gave a marginally higher accuracy (72.5%); therefore, we suggest the use of mandibular canines alone rather than the Dimodent method.

Lesch-Nyhan syndrome: a case report.

Lesch-Nyhan syndrome, a rare inborn error of metabolism, is characterized by mental retardation and self-destructive behavior resulting in self-mutilation through biting and scratching. It is a rare anomaly consisting of deficiency in the production of hypoxanthine phosphoribosyltransferase that leads to the overproduction of purine and accumulation of uric acid. No medical treatment exists to alleviate the symptoms of self-mutilation where direct dental intervention is the only way these behavior can be affected. A unique case of this type affecting a 6-year-old male child is reported.