Expression of Ki-67, p53, α-SMA and COX-2 in lichen planus and related lesions: A pilot study.

BACKGROUND: Researchers have struggled to understand the natural history of lesions presenting with both lichenoid features and epithelial dysplasia. Thus the present study was designed to differentiate between OLP, OLP with dysplasia, epithelial dysplasia and epithelial dysplasia with lichenoid features based on the expressions of ki-67, p53, COX-2, and α-SMA. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded archival specimens of OLP, OLP with dysplasia, epithelial dysplasia and epithelial dysplasia with lichenoid features were subjected to immunohistochemical staining with ki-67, p53, COX-2, and α-SMA. RESULTS: Ki-67 exhibited strong positivity in 100% (6/6) of epithelial dysplasia cases, 71.4% (5/7) of lichenoid dysplasia cases, 57.1% (4/7) of OLP cases and 60% (3/5) of OLP with dysplasia cases. Strong p53 staining was evident in more cases of lichenoid dysplasia [42.8% (3/7)], while moderate staining was more frequent in OLP cases [42.8% (3/7)] and OLP with dysplasia cases [42.8% (3/7)] and mild intensity was more frequent in epithelial dysplasia cases [50% (3/6)] followed by lichenoid dysplasia cases [42.8% (3/7)], OLP cases [28.5 (2/7)] and OLP with dysplasia cases [40% (2/5)]. COX-2 strong positivity was more frequent in cases of epithelial dysplasia cases [57.1% (4/7)] and OLP [50% (3/6)]. Strong α- SMA staining was noted more frequently in lichenoid dysplasia cases [71.4 (5/7)], followed by OLP cases [42.8% (3/7)] and OLP with dysplasia cases [60% (3/5)]. CONCLUSIONS: Ki-67, p53, α-SMA and COX-2 expression do not differentiate between OLP, LP with dysplasia and epithelial dysplasia with lichenoid features.

Oral Candidal Carriage in Subjects with Pure Vegetarian and Mixed Dietary Habits.

INTRODUCTION: Candida albicans being a part of the normal oral microbial flora is one of the most commonly isolated species from the oral cavity. Recent studies have shown a steady rise in the number of non C. albicans species, which are relatively resistant to common antifungal agents and are being recognized as potential pathogens. It is vital to ascertain the predisposing factors leading to such a shift in the oral candidal flora. AIM: To estimate the prevalence of candidal species among vegetarians and non-vegetarians. MATERIALS AND METHODS: Clinical data including age, gender, and diet preference of 238 participants were noted. Participants with a history of systemic disorders, oral prosthesis, salivary gland disorders and habits such as smoking, alcoholism, and tobacco usage were excluded from the study. The participants were asked to gargle a 10 ml solution of phosphate buffered saline for one minute before depositing the same in a sterile container. The samples were cultured using Hicrome agar media. Data analysis was carried out using Statistical Package for Social Sciences (SPSS software) version 10.5 and differences between individual groups were tested by Chi-square test. RESULTS: Among 238 samples, 127 (53.3%) samples were positive for Candida. The candidal prevalence in vegetarians (68.5%) was higher than non-vegetarians (40.7%). C. albicans was the most common species to be isolated in both vegetarians (35.1%) and non-vegetarians (39.2%). Candida glabrata and Candida tropicalis showed a higher prevalence in vegetarians (30.5% and 10.1%, respectively) in comparison to non-vegetarians (8.4% and 2.3%, respectively). Candida krusei was isolated only from vegetarians (4.6%). CONCLUSION: Results indicate that diet plays a major role in oral candidal prevalence and species specificity which in turn may predispose the vegetarians toward these pathogenic organisms.

Exophytic oral verrucous hyperplasia: a new entity.

OBJECTIVE: Exophytic oral verrucous hyperplasia (OVH) is a new entity described by an expert working group from South Asia. First reported in Taiwan, there are no reports so far from an Indian population. The aim was to use the microscopic features described by the expert group to differentiate OVH from other oral verruco-papillary lesions in an Indian archive. MATERIALS AND METHODS: In a retrospective multicentre study, using pathology archives, 188 verruco-papillary lesions were retrieved from pathology archives. A proforma listing histopathological criteria for OVH based on published guidelines (Annals of Dentistry, University of Malaya, 2013) was used. Patients' demographic and clinical data were transcribed from patient charts. The Pearson chi-square test was used to determine associations between clinical and histopathological features. RESULTS: Of 188 oral verruco-papillary lesions that were evaluated, based on microscopic features the cases were reclassified as OVH (57), verrucous carcinoma (VC) (84), oral squamous cell carcinoma (16), and other verruco-papillary lesions (31). Both OVH (70%) and VC (60%) showed male predominance and commonly affected buccal mucosa (OVH 74% and VC 57%). Absence of downward growth of the hyperplastic epithelium into lamina propria when compared with the level of the basement membrane of the adjacent normal epithelium was a distinct feature in OVH. Keratin plugging, epithelial dysplasia and subepithelial lymphocytic infiltration were found to be significantly different (P < 0.05) in OVH versus VC. The sample size of other verruco-papillary lesions was insufficient for statistical comparison. CONCLUSION: Apart from the absence of an endophytic growth pattern in OVH, we noted the presence of dysplasia in OVH. This significant observation does institute a debate as to whether this enigmatic lesion could possibly be a precedent of oral squamous or verrucous carcinoma. We propose OVH is a distinct entity in our Indian population and should be considered in the classification of oral potentially malignant disorders.

Estimating the frequency of Candida in oral squamous cell carcinoma using Calcofluor White fluorescent stain.

OBJECTIVE: To determine the frequency of Candida in oral squamous cell carcinoma (OSCC) using Calcofluor White (CFW) fluorescent stain and to evaluate the association of the same in different grades of OSCC. METHODS: One hundred archival formalin fixed paraffin embedded tissues of diagnosed cases of OSCC were retrieved. The samples comprised of 81, 18 and 1 case of well, moderately, and poorly differentiated squamous cell carcinomas (WSCC, MSCC, PSCC) respectively. Each section was subjected to staining with CFW fluorescent stain for the detection of frequency of candidal hyphae. A chi square test was used to compare the proportion of occurrence of candidal hyphae between different grades of OSCC. RESULTS: Ten of the 100 cases of OSCCs stained positive for Candida with CFW. Positive staining for Candida was seen in six out of 81 and four out of 18 cases of WSCCs and MSCCs respectively. The chi square test used for comparison of the proportion of occurrence of candidal hyphae between WSCC and MSCC (P = 0.059) and all grades of OSCC (P = 0.157) did not yield any statistically significant value. CONCLUSION: The presence of Candida in OSCC solely does not justify its role in carcinogenesis. Further appraisal to evaluate a direct causal role of the micro-organism in potentially malignant disorders and OSCC is required.

Lichenoid dysplasia revisited - evidence from a review of Indian archives.

AIM AND OBJECTIVES: To report on the prevalence of 'lichenoid dysplasia' (LD) in oral mucosal biopsies previously reported as oral lichen planus (OLP), oral lichenoid lesion (OLL) and oral epithelial dysplasia (OED). Based on this case series, to postulate whether features of dysplasia are present in biopsies with a diagnosis of OLP or OLL and vice versa that warrant a separate diagnostic entity of 'lichenoid dysplasia'. MATERIAL AND METHODS: This retrospective, multicentre study was carried out by retrieving archival slides of cases diagnosed with OLP, OLL and OED. Diagnostic criteria for the study were based on published guidelines from seminal papers. A total of 165 cases, 70 OLP and OLL and 95 epithelial dysplasia cases, were re-examined. The diagnosis of OLPs and OLLs was first reconfirmed according to published diagnostic criteria. They were then verified for microscopic features of epithelial dysplasia. Among cases of leukoplakia diagnosed with epithelial dysplasia, we further verified for the presence of lichenoid features. RESULTS: A total of 70 cases of OLP and OLL were microscopically evaluated (OLP-54; OLL-16). Epithelial dysplasia was noted in 11 cases (OLP - 8 of 54; OLL - 3 of 16). Nineteen cases of OLP (19 of 54) were found to bear features of OLLs as per published diagnostic criteria. Among the OED group, 22 of the 95 cases showed lichenoid features. CONCLUSION: The study confirms lichenoid features may be found in OEDs and epithelial dysplasia may be found in OLP/OLL. We reconfirm that these microscopic features may coexist. Our findings require further discussion by a panel of experts to redefine the entity known as 'lichenoid dysplasia'. Future studies should address the concept of lichenoid dysplasia that may assist to resolve any controversies with regard to the malignant potential of OLP.

Analysis of human papilloma virus in oral squamous cell carcinoma using p16: An immunohistochemical study.

AIMS: The aim of this study is to evaluate the expression of human papilloma virus (HPV) in oral squamous cell carcinoma (OSCC) and to correlate the association of HPV in histological grades of OSCC using p16 (p16INK4a) immunohistochemistry (IHC). SUBJECTS AND METHODS: This study consists of 30 histological diagnosed cases of OSCC (10-well-differentiated oral squamous cell carcinoma [WDOSCC], 10-moderately differentiated oral squamous cell carcinoma [MDOSCC] and 10-poorly differentiated oral squamous cell carcinoma [PDOSCC]). The sections were subjected to IHC procedure using p16. Two parameters in immunohistochemical p16 expression were evaluated by 3 observers based on the criteria by Galgano M. Tetal (2010) (a) percentage of p16 positive cases (b) pattern of p16 staining in various grades of OSCC. STATISTICAL ANALYSIS USED: Kappa test. RESULTS: Totally, 30 samples of 0SCC, p16 positivity was noted in 26/30 (86.66%). Of 26 positive cases, p16 staining was positive in 7/10 (70%) of WDOSCC, 9/10 (90%) in MDOSCC and, 10/10 (100%) PDOSCC. Incidentally, we also found single dispersed cell staining in WDOSCC, patchy staining in MDOSCC and more diffuse staining pattern predominant in PDOSCC. CONCLUSIONS: Our study revealed an association between HPV and OSCC. Diffuse staining pattern was noted in PDOSCC, which in turn depicts the increase viral overload, which might have an influence on its aggressive behavior.

Microbial flora in oral diseases.

The oral cavity being the hub of gamut of microbes, promotes the establishment of distinct microbial communities, such as on the mucosa and teeth. Metabolism of these organisms facilitates the attachment and growth of the subsequent colonisers. A delicate balance is maintained in the microbial ecosystem, with these organisms contributing to normal development and defences. However, any change or disruption in the microbial profile due to either intrinsic or extrinsic factors can result in an unfavorable shift toward pathogenic organisms triggering various diseases like dental caries or periodontitis. Furthermore, recent findings also state that these microorganisms may lead to systemic diseases like diabetes or atherosclerosis. This article is an attempt to give an overview of the altered flora in diseased states.