Oral fibrolipoma: A rare clinicopathological entity.

Fibrolipoma, a subtype of lipoma, is a painless, well-circumscribed, slow-growing, submucosal benign adipocyte tumour. It is uncommon in the oral cavity and oropharyngeal region. It accounts for 1.6% of all facial lipomas. Fibrolipomas mostly affect the buccal mucosa and buccal vestibule and cause functional and cosmetic disabilities. The diagnosis and differentiation of fibrolipoma with clinically similar lesions such as fibroma and pleomorphic adenoma are very essential for a correct treatment plan and complete follow-up. Here, we present fibrolipoma, a very rare subtype of lipoma involving the buccal mucosa of the left premolar region in a 44-year-old male patient.

Immunohistochemical evaluation of superficial and invasive front of oral squamous cell carcinoma using epithelial membrane antigen as a marker.

Background: Epithelial membrane antigen (EMA) has been used as a marker for the expression of tumour margins in various glandular neoplastic lesions. Histopathologically, oral squamous cell carcinoma (OSCC) may exhibit several features within the same tumour cells, portraying that these cells at the invasive margins commonly display certain features that differ from those of the superficial part of the tumour. Aim: To identify and study the invasive tumour front and also to recognise any micrometastases in an OSCC lesion. Materials and Method: A retrospective study of 30 OSCC cases with superficial and most invasive parts were sectioned at 4 µm. Routine H&E staining and immunohistochemical staining with mouse antihuman EMA were done. The OSCC cases were graded into well differentiated squamous cell carcinoma (WDSCC), moderately differentiated squamous cell carcinoma (MDSCC) and poorly differentiated squamous cell carcinoma (PDSCC). The EMA-stained slides were observed and analysed under higher magnification to identify the individual EMA-stained cells. Results: Analysis of Variance (ANOVA) analysis revealed that when comparing the superficial and invasive fronts of OSCC, it was evident that the P values were significant across the groups. In WDSCC, positive predictive value was 70.6% and sensitivity was 100% when the same slide was analysed for large and small islands to individual cells in an EMA-stained section, while MDSCC and PDSCC showed both sensitivity and positive predictive value to be 100%. Conclusion: EMA could be considered a useful prognostic marker for describing the nature of the neoplastic epithelium as well as recognising the typical anaplastic cells in cases of OSCC.

Clinical management and histopathological analysis of composite type of gingival Stillman's cleft.

Gingival Stillman's cleft is one of the least-studied mucogingival defects that may jeopardize the periodontal health and esthetic of the affected teeth. The etiology behind this lesion is believed to be multifactorial, and the histopathology remains unclear. In this report, we present a case of composite gingival Stillman's cleft in anterior maxillary teeth that was clinically treated with a laterally moved coronally advanced flap. The cleft tissue was removed during root coverage surgery and then was harvested for histopathological analysis using hematoxylin and eosin, Masson's trichrome, and van Gieson's stain. In the cleft site, microscopic examination revealed variable degrees of epithelial bifurcations with elongated forking of rete ridges into the stroma. Endothelial-lined blood vessels and inflammatory cells, primarily lymphocytes and fibroblasts, were seen in the stroma. The Masson trichrome (blue) and Van Gieson (pink) revealed colored gingival tissue with prominent collagen fiber distribution at the cleft site, which is suggestive of gingival fibrous hyperplasia brought on by repeated damage from tooth brushing.

Mucoepidermoid carcinoma of the lower lip: A case report and review of literature.

Mucoepidermoid carcinoma (MEC) is a rare salivary gland malignancy characterized by diverse cellular components. This case report presents a unique instance of low-grade MEC in a 28-year-old female, emphasizing the importance of accurate diagnosis and tailored management. The patient exhibited a painless, enlarging lower lip swelling over a year, with imaging suggestive of a fibrolipomatous lesion. Surgical excision was successfully performed, with subsequent histopathological analysis displaying mucinous cystic spaces, varied epithelial cell types and other characteristic features consistent with MEC. The case findings aligned with hallmark MEC features are seen in established literature, highlighting the significance of precise diagnosis and grading for appropriate management. This report contributes to the understanding of MEC's varied presentations and underscores the importance of thorough: histopathological examination, lower lip, mucoepidermoid carcinoma clinical evaluation, accurate histopathological analysis and interdisciplinary collaboration. The case highlights the value of considering MEC in younger patients, even with atypical presentations, and encourages ongoing exploration of diagnostic and therapeutic strategies to improve patient outcomes.

Evaluation and comparison of the efficacy of coconut oil as a clearing agent with xylene.

Background: Xylene is a routinely used clearing agent in histopathology. It is potentially toxic and flammable in nature. Histotechnicians are routinely exposed to this hazardous chemical. Because xylene is used so pervasively in histopathology, it has always been a concern for pathologists and laboratory workers, as its regular and prolonged exposure have serious health effects. Considering its toxicity, different biocompatible xylene substitutes have been evaluated. Aim and Objectives: This study was conducted to evaluate the efficacy of coconut oil as a clearing agent and compare with xylene. Materials and Methods: Two equal halves of 45 soft-tissue specimens were processed simultaneously in xylene and coconut oil as clearing agents. The xylene-treated specimens and coconut oil-treated specimens were checked for gross and histological features, and a comparison was done between the two groups. Results: Significant shrinkage was noted in xylene-treated specimens compared to that in coconut oil-treated specimens. No difference was found in either of the sections when checked for staining quality, overall morphological features and cellular details. Conclusion: It may be substituted for xylene without loss of information.

Malignant melanoma of gingiva: Case report and review of the literature.

Mucosal malignant melanoma arising from the head and neck region is a rare entity, and it is more aggressive than cutaneous melanoma. Furthermore, the complexity of the oral cavity makes surgical excision more difficult. Oral malignant melanoma is a rare tumour of melanocytic origin, accounting for 20-30% of malignant melanomas at the mucosal surface and 16% intra-orally. Hard palate and maxillary gingiva are the most common involved sites. The age of reported patients ranges from 20 years to 80 years. Hence, we do hereby present a case of malignant melanoma of mandibular gingiva with review of the literature in a 42-year-old female patient.

The Second Free Tissue Transfer After the First Free Flap Loss for a Complex Scalp Reconstruction: Our Strategy to Success With a Staged Approach.

ABSTRACT: Scalp reconstruction for a critical neurosurgical patient, as lifesaving efforts continued, can be challenging and a free tissue transfer is often needed to achieve reliable soft tissue coverage. However, the patient's labile perioperative condition may compromise successful reconstruction and perioperative hypotension is one of the major known factors for the failure of free tissue transfer. In this report, the authors encountered such an instance, and present our strategy in overcoming this hurdle toward obtaining successful scalp reconstruction with second free tissue transfer after the first free flap loss. After optimizing the patient's medical condition, the second free tissue transfer was performed in 2 stages with recipient vessel dissection during the first stage and the flap harvest and microvascular anastomoses during the second stage. Our staged approach is warranted to ensure the patient can tolerate the stressor of general anesthesia and to precondition the patient for ultimate successful second free tissue transfer.

Isolation and identification of oral Candida species in potentially malignant disorder and oral squamous cell carcinoma.

CONTEXT: Oral cancer is one of the ten most common cancers in the world. More than 95% of the carcinomas of the oral cavity are of squamous cell type in nature. Oral Candida is a "yeast-like opportunistic pathogen." The Candida genus is comprised of over 150 species of asporogenous "yeast-like" fungi. AIM AND OBJECTIVES: The aim of study is to correlate the association of oral fungal infection in progression of oral squamous cell carcinoma (OSCC) and potentially malignant disorders. The current study was undertaken to probe the isolation and identification of oral Candida species in potentially malignant disorder and OSCC versus normal oral mucosa. MATERIALS AND METHODS: Twenty patients for each abovementioned three lesions were randomly selected by using swabs. These swabs were subsequently inoculated in agar medium. Candida grows as white, convex colonies. Samples growing 1-3 colony-forming units (CFUs) were considered normal flora of the oral cavity. The specimens showing moderate to heavy growth were subjected to tests for identification of species of Candida. The chromogenic medium, HiMedia CHROMagar, has chromogenic substances which helps in the quick detection of Candida species, based on the reactions between the extract enzymes of the dissimilar species and the chromogenic substances. STATISTICAL ANALYSIS: Chi-square test, one-way analysis of variance test, and post hoc Tukey's test were utilized. RESULTS: According to our study, Candida albicans, Candida krusei, Candida tropicalis, and Candida parapsilosis in the culture were found to be in increasing incidence from healthy, OSCC, and oral potentially malignant disorders (OPMDs). These results clearly indicated that Candida species are increasing in the CFUs (P < 0.0001). CONCLUSION: Our study showed a higher intensity of Candida in OPMD and squamous cell carcinoma patients with results. The increasing CFU level and hyphae of Candida species in individual biopsy tissue with oral potentially malignant lesions to OSCC suggest that this pathogen plays a role in disease development and could aid in identifying the pathogenic commensal.

Quantitative analysis of tumor-associated tissue eosinophils and tumor-associated blood eosinophils in oral squamous cell carcinoma.

BACKGROUND: Stromal response to cancer is usually characterized by intense lymphoplasmacytic infiltrate. However, recently, the attention has shifted to tumor-associated tissue eosinophils (TATE). Tumor-associated blood eosinophils (TABE) are rare in solid cancers; however, carcinoma of the head and neck shows its prevalence. AIM: The aim of the study was to investigate the prevalence and relationship of tissue and blood eosinophils in various grades of oral cancer. The purpose of the article is to emphasize the possible clinical and biological significance of eosinophils in patients of oral squamous cell carcinoma (OSCC) so that appropriate therapeutic strategies can be devised accordingly. STUDY DESIGN: Thirty histologically confirmed cases of oral squamous cell carcinoma were divided into well, moderate and poorly differentiated carcinoma. Eosinophilic infiltration in the tissue was graded as low, moderate and massive TATE. The number of eosinophils per 100 WBCs was taken as the differential eosinophil count. Blood eosinophilia (BE) >6% was considered to be TABE. MATERIALS AND METHODS: Hematoxylin and eosin-stained tissue sections at 5 µ were evaluated. Prolonged staining in dilute 0.05% aqueous eosin demonstrated eosinophils selectively. Blood smears were stained by Leishman stain. STATISTICAL ANALYSIS: Student's t-test, Chi-square test, ANOVA, Newman-Keuls Multiple Comparison Test and Karl Pearson correlation coefficient® method were used. RESULTS: The mean TATE value was highest in poorly differentiated carcinoma. TABE was seen only in a few cases and was associated mostly with poorly differentiated OSCC. CONCLUSION: There was a statistically significant correlation between TATE and histological grades of OSCC. Eosinophilia of the peripheral blood is an adverse sign in patients with carcinoma.

A quantitative and qualitative comparative analysis of collagen fibers to determine the role of connective tissue stroma in oral squamous cell carcinoma using special stains and polarized microscopy.

BACKGROUND: Solid tumors such as oral squamous cell carcinoma (OSCC) are composed of malignant epithelial cells and the stroma in which these cells are dispersed. As the tumor progresses, the extracellular matrix undergoes dramatic morphological and architectural changes. Special stains make analysis easy and less erroneous by highlighting the area of interest and can be used to study these changes. AIM: The aim of the study was to analyze morphological changes in collagen fibers in various histological grades of OSCC using Masson's trichrome (MT) and Picrosirius red (PSR). STUDY DESIGN: The study comprised 74 tissue samples, divided into two groups: Group I consisted of 63 cases of histologically proven OSCC (39 cases of well-differentiated squamous cell carcinoma [WDSCC], 17 moderately differentiated squamous cell carcinoma [MDSCC] and 7 poorly differentiated squamous cell carcinoma [PDSCC]) and Group II consisted of 11 cases of normal mucosa as controls. MATERIALS AND METHODS: Sections were stained with hematoxylin and eosin, MT and PSR and observed under light and polarizing microscope, respectively. STATISTICAL ANALYSIS: ANOVA, Tukey's honestly significant difference post hoc multiple comparison test, Chi-square test and paired t-test were used for the statistical analysis. RESULTS: As the grade of OSCC progressed, collagen fibers became thin, loosely packed and haphazard. The mean area fraction also decreased. They exhibited orange-red hue and strong birefringence in WDSCC, yellowish-orange hue and strong birefringence in MDSCC and greenish-yellow hue and weak birefringence in PDSCC. CONCLUSION: Initially, there is a reorganization of the collagen fibers in an attempt to prevent the invasion of tumor cells, but as cancer progresses, the stromal change enhances movement of the tumor cells within it, leading to metastasis.

Effect of essential oils incorporated edible film on quality and storage stability of chicken patties at refrigeration temperature (4 ± 1 °C).

A blend of oregano and thyme essential oils (EOs) incorporated edible film was evaluated to improve the storage quality of chicken meat patties. Several preliminary trials were carried out to optimize the levels of bio-polymer to obtained desired edible film as a carrier and blend of EOs as bio preservatives. Preliminary studies indicated that 1.5% (w/v) solution of carrageenan as bio-polymer and 0.10% (v/v) oregano with 0.15% (v/v) thyme EOs in blend form as antimicrobial were suitable. Chicken meat patties wrapped with edible film incorporated with aforementioned EOs, packaged aerobically were stored at refrigeration temperature (4 ± 1 °C) for further studies. Results of refrigeration storage, showed that control samples had significantly higher pH and thiobarbituric acid reacting substances value than EOs treated products. There were significantly lower microbial counts observed in treatment samples (with EOs) and found well within permissible limit as compared to control. All the treatment samples showed lower or comparable flavour score in regard with control. It was found that shelf-life of chicken meat patties increased significantly (P < 0.05) during refrigerated storage and showed acceptable quality up to storage period of 30 days.

Immunohistochemical evaluation of tumor angiogenesis and the role of mast cells in oral squamous cell carcinoma.

BACKGROUND: Increased angiogenesis has been associated with neoplastic progression, metastasis and outcome in several studies and in a number of malignancies. Among the various host immune cells, mast cells have been implicated in tumor progression by promoting angiogenesis. The aim of this study is to examine the relationship between angiogenesis, mast cells with that of the normal oral mucosa (NOM) and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: The study was conducted using routine haematoxylin and eosin staining procedure and included immunohistochemical staining for microvessels and toluidine blue staining for mast cells. RESULTS: The microvessel density (MVD) and mast cell density (MCD) of two groups (NOM and OSCC). The MVD and MCD in OSCC ranged from 59.18 to 263.31 microvessel/mm 2 and 41.65 to 193.28 cells/mm 2 respectively with mean (±standard deviation) 161.73 ± 48.27 microvessel/mm 2 and 83.59 ± 40.67 cells/mm 2. In both NOM and OSCC, the mean MCD was comparatively lower as compared to respective MVD (MCD < MVD) and comparatively lower in NOM as compared to OSCC (normal < OSCC). CONCLUSION: A significant correlation is present between MCD and MVD in OSCC and also that both these entities are significantly increased in the disease process when compared to that of the NOM.

Keratinizing pleomorphic adenoma: An unusual case report.

Pleomorphic adenoma (PA) is the most common benign tumor of major or minor salivary glands. PA exhibits a great histological diversity, such as differentiation into oncocytic, sebaceous, mucinous, squamous, chondroid, osseous or adipose cells. Squamous metaplasia rarely results in the formation of extensive keratin-filled cyst lined by squamous epithelium. Extensive squamous metaplasia can be mistaken for malignancy, including mucoepidermoid carcinoma and squamous cell carcinoma. Here, we report a case of slowly enlarging PA with extensive squamous metaplasia and keratin cyst formations in a minor salivary gland in hard palate and discuss its microscopic features.

The Omental Free Flap-A Review of Usage and Physiology.

BACKGROUND: The omental flap has a rich history of use over the last century, and specifically as a free flap in the last four decades. It has a wide variety of applications in reconstructive surgery and has shown itself to be a reliable donor tissue. We seek to review the properties that make the omental free flap a valuable tool in reconstruction, as well as its many surgical applications in all anatomic regions of the body. METHODS: We conducted a narrative review of the literature on Medline and Google Scholar. We reviewed basic science articles discussing the intrinsic properties of omental tissue, along with clinical papers describing its applications. RESULTS: The omental free flap is anatomically suitable for harvest and wound coverage and has molecular properties that promote healing and improve function at recipient sites. It has demonstrated utility in a wide variety of reconstructive procedures spanning the head and neck, extremities, and viscera and for several purposes, including wound coverage, lymphedema treatment, and vascularization. It is also occasionally employed in the thoracic cavity and chest wall, though more often as a pedicled flap. More novel uses include its use for cerebrospinal fluid leaks. CONCLUSIONS: The omental free flap is a valuable option for reconstructive efforts in nearly all anatomic regions. This is a result of its inherent anatomy and vascularity, and its angiogenic, immunogenic, and lymphatic properties.

A rare case of oral melanoacanthoma.

Oral melanoacanthoma is a rare, pigmented lesion which brings suspicion of a malignancy with its sudden appearance and rapid growth. It is characterized clinically as a brown-black lesion and histologically it shows acanthosis of the superficial epithelium and proliferation of dendritic melanocytes. Due to their unusual clinical pattern, biopsy is mandatory to rule out malignancy.

Estimation of gender using cheiloscopy and dermatoglyphics.

BACKGROUND AND OBJECTIVE: Forensic dentistry plays a vital role in detection and resolution of crime, civil proceedings and personal identification. With ever-increasing demands placed upon law enforcement to provide sufficient physical evidence linking a perpetrator to a crime, it makes sense to utilize any type of physical characteristic to identify a suspect of an offense. The least invasive and cost-effective procedure among all methods of human identification is the study of lip prints and fingerprints. This study is done to determine the predominant pattern of fingerprint and lip print in males and females and to correlate it for gender identification. MATERIALS AND METHODS: The study sample comprised 100 individuals (50 males and 50 females) aged between 20 and 50 years; dark-colored lipstick was applied uniformly on the lips. The glued portion of cellophane tape was dabbed first in the center and then pressed uniformly over the corner of lips. Cellophane tape was then stuck to a white chart sheet for the purpose of permanent record. Lip print patterns were analyzed following the classification of Suzuki and Tsuchihashi. The imprint of left thumb was taken on a white chart sheet using a blue ink stamp pad and visualized using magnifying lens. Fingerprints were analyzed by following the classification given by Kücken. Correlation of lip print and fingerprint was analyzed using Chi-square test. RESULTS: The overall correlation of lip prints with fingerprints in males revealed branched lip pattern associated with whorl fingerprint and in females as vertical lip print pattern associated with loop fingerprint. CONCLUSION: We conclude that the study between lip print and fingerprint can aid in gender determination.

The role of less commonly used local muscle flaps for soft tissue coverage of complex lower extremity wounds.

INTRODUCTION: Lower extremity reconstructions may be pursued by adhering to established algorithms primarily based on the area of injury and the extent of missing tissue and wound. Certain flaps--either local or free--have been relied on as workhorse flaps for soft-tissue reconstruction of the lower extremity. However, when these flaps are unavailable or contraindicated, alternative options can be considered for reconstruction of relatively small wounds in the lower extremity. METHODS: We report 2 cases of complex lower extremity wounds that were the result of complications from orthopedic procedures after traumatic injuries. In case 1, an exposed Achilles tendon (7×3 cm) after wound infection and breakdown after orthopedic fixation was performed using a distally based peroneal brevis muscle flap with split thickness skin grafting. The same patient also had a previous free anterolateral thigh flap for the coverage of his medial tibial wound in the distal third of the leg with success. In case 2, a middle lateral leg wound (5×3 cm) with exposed tibia as a result of hematoma and wound breakdown after orthopedic debridement was reconstructed with a distally based tibialis anterior muscle flap with split thickness skin grafting. RESULTS: Full soft tissue coverage of the defects was achieved using these distally based local muscle flaps. There was complete healing of each complex wound in the lower extremity without complications, thus a microvascular free flap reconstruction for those patients was avoided. Aesthetic appearance of the reconstructions was closely matched to the native skin. Functional status was acceptable over long-term follow-up in both patients. CONCLUSIONS: For complex lower extremity wounds, less commonly used local muscle flaps that are distally based may successfully reconstruct certain relatively small defects in the lower extremity. Knowledge of these flaps and illustration of their success allow the reconstructive surgeon to confidently add them to the reconstructive armamentarium.

Treatment of elbow osteomyelitis with an interposition arthroplasty using a rectus abdominis free flap.

INTRODUCTION: Osteomyelitis of the elbow may be a complex clinical problem. Treatment goals include the eradication of infection and preservation of maximal joint function. Bony debridement may be necessary in addition to elbow joint arthroplasty. The use of synthetic material or allograft as the arthroplasty material may be contraindicated in the setting of infection. The use of free muscle transfer as an arthroplasty medium has not been well described. METHODS: A 22-year-old paraplegic man developed recurrent osteomyelitis of the right elbow, necessitating extensive bony debridement by the orthopedic surgery team. Reconstruction arthroplasty was performed using a free rectus abdominis muscle flap as the arthroplasty material to serve as a source of biologically active, well-vascularized arthroplasty medium in the presence of ongoing infection. RESULTS: A successful free muscle flap arthroplasty was performed. External fixation and physical therapy were implemented postoperatively. The patient had resolution of osteomyelitis and excellent functional use of the elbow for activities of daily living and wheelchair motion. CONCLUSIONS: Elbow arthroplasty in the setting of active infection may be accomplished by means of free tissue muscle transfer. Elimination of infection and acceptable joint function may be possible with this form of reconstruction.

Association of Ki-67 antigen and p53 protein at invasive tumor front of oral squamous cell carcinoma.

AIM: Studies reveal that invasive tumor front may be the best field for quantification of proliferative and apoptotic markers. The current study assessed the expression of Ki-67 antigen and p53 protein at invasive tumor front of oral squamous cell carcinoma (OSCC) and correlated the immunostaining with the histologic grades of malignancy. MATERIALS AND METHODS: A total of 80 slides sample was prepared for the study, one each from ten normal oral mucosa cases and two each from 30 OSCC cases. The OSCC patients were biopsied along invasive tumor front, and samples were immunohistochemically analyzed for the expression of both Ki-67 antigen and p53 protein. RESULTS: Of the total 30 OSCC cases, the expression of p53 was found positive in 20 cases (66.6%), while Ki-67 expression was found positive in 21 cases (70%). All the cases in the control group were negative. A higher p53 and Ki-67 expression were seen in OSCC group as compared to normal mucosa. On comparing the control group with various grades of OSCC a statistically significant result was obtained. CONCLUSION: Higher and statistically significant expression was noted for both p53 and Ki-67 antigen. The results emphasize the potential of Ki-67 and p53 as biomarkers of carcinogenesis in OSCC. Ki-67 expression was comparatively higher when compared with p53 except in poorly differentiated squamous cell carcinoma and signifies actively proliferating malignant cells at invasive tumor front.

Determination of sex by radiographic analysis of mental foramen in North Indian population.

AIM: Identification and determination of sex of unknown human skeletal remains has been one of the most challenging tasks for forensic dentistry. The purpose of this study was to determine the gender from the analysis of mental foramen on panoramic radiographs in a north Indian population. MATERIALS AND METHODS: One hundred radiographs were selected for the analysis of mental foramen. Tangents were drawn to the superior and inferior borders of the foramen and perpendiculars were drawn from the tangents to the lower border of the mandible (S-L and I-L). The data obtained were tabulated and subjected to statistical analysis. RESULTS: The average values of S-L and I-L were significantly higher in males than in females, while the distances for the right and left sides of an individual were almost similar in both the male and the females group, and the results were non-significant. CONCLUSION: The distances from the mental foramen to the lower border of the mandible exhibit sexual dimorphism in the north Indian population.