Spindle cell carcinoma in the trail of radiotherapy for oral squamous cell carcinoma: A quest for rationale.

Spindle cell carcinoma (SpCC) is a rare variant of oral squamous cell carcinoma (SCC) with unique clinicopathological characteristics, a high recurrence rate, and metastatic potential. It will be truly devastating when it occurs as a second wave in a cancer survivor. Despite the multidisciplinary approach in the management of oral SCC, the incidence of second malignancies or multiple carcinomas has been constantly reporting in the literature. Although radiotherapy has saved the lives of countless cancer patients, its several serious late effects are well-documented in the literature, making it a double-edged sword. Radiation epidemiology studies revealed an increased risk of developing radiogenic second cancers after 5 or more years. The purpose of this article is to document a case of SpCC arising in a patient after a span of 5 years who was previously diagnosed and treated with radiotherapy for well-differentiated SCC.

Comparative Analysis of Cluster of Differentiation 57 and Proliferating Cell Nuclear Antigen Expression in Different Grades of Oral Squamous Cell Carcinoma: An Immunohistochemical Study.

BACKGROUND:  The immune defense against tumor cells is mainly mediated by the natural killer (NK) cells. Cluster of differentiation 57 (CD57) is a 110-kd glycoprotein, typically expressed by the NK cells, attacks the cancer cells and inhibits tumor development. Proliferating cell nuclear antigen (PCNA) is a 36-kd auxiliary protein for DNA polymerase delta that correlates with cell proliferation and DNA synthesis. It is an essential component of DNA replication, DNA recombination, and DNA repair. The uncoordinated proliferation of PCNA protein characterizes the biological behavior of malignant lesions. AIM:  The aim of the present study is to compare and correlate the expression of CD57 and PCNA in different grades of oral squamous cell carcinoma (OSCC) by immunohistochemistry. MATERIALS AND METHODS:  This retrospective analysis comprises 30 samples of various grades of OSCCs and 10 samples of healthy mucosa. Sections of 4-5 µm thickness were done and stained with monoclonal anti-PCNA and anti-CD57 antibodies. The statistical package for social science (SPSS) version 16.0 software (IBM Corp., Armonk, NY) was used to analyze the data in this study. The expression of CD57 and PCNA was compared and correlated between the groups using analysis of variance (ANOVA) post hoc, Dunnet t-test, and Pearson's correlation coefficient test. For statistical significance, a p-value of 0.05 or less was used. RESULTS: A significant decrease in CD57 labeling index was seen from well-differentiated squamous cell carcinoma (16.63 ± 2.33) to poorly differentiated squamous cell carcinoma (5.53 ± 1.20) whereas the significant increase in PCNA labeling index was noted from well-differentiated squamous cell carcinoma (45.88 ± 2.20), followed by moderately differentiated and poorly differentiated squamous cell carcinoma (72.77 ± 4.35). CONCLUSION:  The combination of CD57 and PCNA biomarkers appears to be good indicators of the immune status of the patient and the aggressiveness of the lesion.

An atypical case report of extensive mucormycotic osteomyelitis of maxilla as a consequence of post-COVID complication.

Saprophytic molds such as Mucor, Rhizopus, and Absidia cause mucormycosis, a fungal infection. These saprophytic fungi are common in the environment and have a strong proclivity for invading major blood arteries, causing tissue ischemia, necrosis, and infarction. They have been linked to immunocompromised individuals with a history of diabetic ketoacidosis, corticosteroid medication, HIV infection, malignant lymphomas, and patients currently receiving and recovering from COVID-19 treatment. The foregoing is the case of a 78-year-old COVID-19 recovered male who presented with a primary complaint of upper tooth movement for 1 month and maxillary segmental mobility. The maxillary alveolar process was resected, and histopathological reports revealed mucormycosis, which was treated with antifungal medication and nasolabial flap surgery. For the past 6 months, he has been disease-free. Early detection and treatment may offer a higher chance of successfully minimizing this debilitating condition.

Aggressive oral carcinoma cuniculatum: A rare entity.

Oral carcinoma cuniculatum (OCC) is a rare and distinct clinicopathological variant of oral squamous cell carcinoma (OSCC). The term cuniculatum was derived from a Latin word "cuniculus" meaning burrow, because of the "rabbit burrow" appearance. As it invades the underlying tissue, it forms crypts filled with keratin that are essential in distinguishing this neoplasm from other variants of squamous cell carcinoma (SCC). It is a common lesion of the plantar region of the foot but rare in the oral cavity. The first case of OCC was reported in 1977 by Flieger and Owenski in the jaw, with fewer than 50 cases reported in the English literature till date. Tumor cell cannibalism has been reported in various carcinomas such as lung, gallbladder, hepatobiliary, pancreatic, and SCC. Cell cannibalism when it refers to a cancer cell, either within a tumor mass or cell culture, is "a cell that is contained within another bigger cell with a crescent-shaped nucleus." This report aims to present a rare case of aggressive OCC of the maxillary gingiva with cellular cannibalism and its diverse immunohistochemical expression of E-cadherin, Ki-67, and p53.

Immunohistochemical expression of putative cancer stem cell markers aldehyde dehydrogenase 1, SOX2, CD44 and OCT4 in different grades of oral epithelial dysplasia.

Objectives: The hypothesized existence of cancer stem cells (CSC) and its markers aldehyde dehydrogenase 1 (ALDH1), CD44, SOX2 and OCT4 in oral dysplastic tissues provides the potential for a more reliable assessment of malignant transformation of oral epithelial dysplasia (OED). Thus, the present study is intended to evaluate the immunohistochemical expression of four different CSC markers ALDH1, CD44, SOX2 and OCT4 in different grades of OED and to investigate the co-expression of these putative stem cell markers in OED. Subjects and Methods: A total of 35 samples of varying grades of OED which included 7 mild, 11 moderate and 17 severe dysplasia samples and 10 samples of normal oral mucosa without dysplasia were used. Four sections each from all 45 samples were stained with ALDH1, CD44, SOX2 and OCT4, respectively, by immunohistochemistry. The acquired data were analyzed and evaluated using the Chi-square test and unpaired t-test and the P < 0.05 was taken significant. Results: ALDH1 and SOX2 expression percentages showed statistically significant differences among study groups (P < 0.05). Statistical comparison of percentage expression of CD44 and OCT4 between OED and normal was nonsignificant (P > 0.05). Co-expression of all four markers was found in 15 cases of OED with none of the normal cases showing co-expression. Conclusion: The expression of CSC markers in OED and normal mucosa differs significantly with co-expression of all four markers located only in dysplastic tissues. Until now, no single protein marker has been able to unequivocally identify the CSCs. Thus, a panel of putative CSC markers will help in identifying the patients with high risk for malignant transformation in OED.

Accuracy of Demirjian's and Indian-specific formulae in age estimation using eight-teeth method in Kanyakumari population.

BACKGROUND: Most of the scientific formulae for age estimation in forensic odontology were tested among western population and hence cannot be applied to the Indian population consistently. Therefore, it was in this context that Dr. Ashith B. Acharya had carried out a study using the modified Demirjian's method in Indian population and found out that the study gave inferior results for age estimation. So he developed Indian-specific regression analysis and worked out a formula. AIM: This study was done to validate age using Demirjian's eight-teeth method and to compare the effectiveness of Demirjian's formula and Indian-specific formula in Kanyakumari population. MATERIAL AND METHODS: Digital orthopantomographs of 150 patients fulfilling the inclusion and exclusion criteria in the age group of 8-24 years were used in the study. The third quadrant in the radiograph was assessed visually from mandibular central incisor to the third molar using Demirjian's modified criteria chart. Calculation of the dental age was done using Demirjian's formula and Ashith B. Acharya's Indian-specific formula. The difference between chronological age and dental age was calculated, and the mean absolute error (MAE) was obtained. RESULTS: The MAE was 0.20 years for the whole of Kanyakumari population, and for males it was 0.10 years and for females 0.29 years with Indian-specific formula, whereas the MAE was 2.66, 1.86, and 3.51 years, respectively, for the whole of Kanyakumari population, males, and females using Demirjian's formula. CONCLUSION: The observations from this study suggest that the MAE was less between chronological age and estimated dental age which was calculated using Indian-specific formula, compared with the values obtained using Demirjian's formula. Thereby we conclude that Indian-specific formula is more reliable in age estimation of Kanyakumari population.

Genotoxic Effects of Silver Amalgam and Composite Restorations: Micronuclei-Based Cohort and Case-Control Study in Oral Exfoliated Cells.

CONTEXT: A huge number of people carry dental fillings which contain either mercury-based amalgam and/or the recently introduced methacrylate-based resins. It has been shown that both these materials are known to be leached into the oral cavity and induce genotoxic alterations in the buccal mucosal cells. Because of its low cost and ease of manipulation, dental amalgam is still widely used as a restorative material in developing countries. The health risks associated with the components of this restorative material has always been a matter of concern. The present study was designed to assess the frequency of micronuclei (MN) in oral mucosal cells as it is a promising tool for studying the genotoxic effect of clastogenic agents on them. AIMS: The aim of this study is to evaluate the genotoxic effects of silver amalgam and composite restorations by measuring the mean number of MN in oral exfoliated cells. MATERIALS AND METHODS: The present study was a prospective cohort study which includes a study group consisting of 110 participants. The study sample was equally divided into 55 participants requiring only amalgam restoration and 55 participants requiring only composite restoration in any permanent molar teeth. The same participants before the restoration formed the control group. Smears were obtained from each patient before and 10 days after restoration and were stained with DNA-specific Feulgen stain. The number of cells containing MN out of 500 cells were counted and recorded. After the evaluation of the slides, the results were compiled and subjected to statistical analysis. RESULTS: There was a statistically significant (P < 0.01) variation in the mean number of MN after the restoration in both amalgam (5.41 ± 1.25) and composite (2.83 ± 0.85) restorations when compared to before the restoration. However, the mean number of MN in composite restoration was significantly less when compared to amalgam restoration. There was also a statistically significant difference in the mean number of MN in subjects with single restoration when compared with multiple restorations in both amalgam and composite restorations. CONCLUSIONS: The observations from the present study showed the genotoxic effect of amalgam and composite restorations on the oral cavity. However, composite restorations were least cytotoxic when compared to amalgam restoration. Future research and technical advancements are needed for developing safer materials for use in humans.

Virtopsy: An integration of forensic science and imageology.

In an era where noninvasive and minimally invasive techniques are heralding medical innovations and health science technology, necrological analysis is not bereft of this wave. Virtopsy is virtual autopsy. It is a new-age complimentary documentation approach to identify and analyze the details of demise. Utilizing virtual autopsy for orofacial forensic examination is an emerging specialty which holds a plethora of potential for future trends in forensic science. Being a noninvasive technique, it is a rapid method which facilitates the medicolegal process and aids in the delivery of justice. The present article is an overview of this emerging methodology.

Linear IgA dermatosis adult variant with oral manifestation: A rare case report.

Linear immunoglobulin A (IgA) dermatosis (LAD) is a rare autoimmune disorder that presents as a vesiculo-bullous lesion with cutaneous manifestations, but rare oral mucosal involvement. Here we discuss a case of a vesiculobullous lesion with severe oral and ocular mucosal involvement mimicking pemphigoid with histopathological evidence of subepithelial blisters. Direct immunofluorescence (DIF) confirmed the lesion as LAD of adult variant, although with atypical clinical features.

Drug induced oral erythema multiforme: A rare and less recognized variant of erythema multiforme.

Oral erythema multiforme (EM) is considered as a third category of EM other than EM minor and major. Patients present with oral and lip ulcerations typical of EM but without any skin target lesions. It has been reported that primary attacks of oral EM is confined to the oral mucosa but the subsequent attacks can produce more severe forms of EM involving the skin. Hence, it is important to identify and distinguish them from other ulcerative disorders involving oral cavity for early management. This article reports two cases of oral EM that presented with oral and lip ulcerations typical of EM without any skin lesions and highlights the importance of early diagnosis and proper management.