Malignant Melanoma of the Oral Cavity: An Aggressive and Rare Entity.

It is exceptionally unusual to see oral malignant melanoma, which is highly aggressive with dismal prognosis. A 61-year-old female patient presented with hyperpigmented and hemorrhagic areas in the anterior mandible. Microscopically, positive Immunohistochemistry staining with monoclonal antibody Human Melanoma Black (HMB45) and S100 protein, confirmed the diagnosis as malignant melanoma.

A Quantitative Assessment of Apoptotic Index with Varying Histological Degree of Dysplasia and Squamous Cell Carcinoma of Oral Cavity - A Light Microscopic Study.

AIM AND OBJECTIVE: The aim of the present study was to quantitatively assess the apoptotic index at a light microscopic level in hyperkeratosis with varying histological degrees of dysplasia and different grades of oral squamous cell carcinoma (OSCC) and its correlation with prognostic significance. STUDY DESIGN: The study included the histo-pathologically diagnosed cases of hyperkeratosis with varying degrees of dysplasia and different grades of OSCC, which were retrieved from the archives of the department, and clinical details were retrieved from the case records of the patients. The sample size consisted of 80 biopsied cases, divided into seven groups of 10 experimental cases and one group of 10 cases of normal mucosa as a control group. RESULTS: The age range of 50-59 shows maximum patients of hyperkeratosis with varying degrees of dysplasia and OSCC. Maximum apoptotic bodies were seen in cases of severe dysplasia and well-differentiated cases of OSCC. There was an observational difference noticed in apoptotic bodies between the patients who had less than 1-year disease-free survival rate. CONCLUSIONS: The apoptotic cells are being seen using routine light microscopy techniques with hematoxylin and eosin staining. In different grades of squamous cell carcinoma, a decrease in the apoptotic count was noticed from well-differentiated squamous cell carcinoma toward poorly differentiated squamous cell carcinoma cases. Increased mean apoptotic bodies were observed in patients showing less than 1 year of survival.

An Unusual Case of Symptomatic Isolated Lingual Cysticercosis: Clinical Suspicion Helped Prevent Disseminated Disease.

Intraorally, cysticercosis is regarded as uncommon and a diagnostic challenge. Here, we report a diagnostic conundrum of an unusual case of innocuous appearing lesion on the tongue presenting as moderately tender swelling finally diagnosed as lingual cysticercosis, based on USG (Ultrasound), CT (Computed Tomography) findings and characteristic histopathologic features.

Cleidocranial dysplasia associated with dentigerous cyst-review of literature and case report of two siblings.

ABSTRACT: Cleidocranial dysplasia (CCD) is a developmental anomaly of the skeleton and teeth which may be inherited, be transmitted as dominant characteristics in either male or female or even appear spontaneously. A case was reported in the department of oral medicine and radiology of two sisters age 17 and 19 years old with a chief complaint of milk teeth not falling since childhood. They presented specific physical and oral findings in common which suggested the idea of an undiagnosed syndrome. The sisters showed CCD characteristics including short stature (4 feet) and frontal bone resorption indicating delayed closure of fontanels. The stature is moderately shortened with the neck appearing long and narrow and the shoulders markedly dropped. Dental abnormalities such as retention of primary dentition, multiple supernumerary teeth, and delayed eruption of permanent dentition. OPG showed the presence of multiple impacted permanent and supernumerary teeth with radiolucency involving the crowns of impacted teeth revealing a cystic lesion. Lateral cephalogram also revealed the presence of multiple impacted teeth. The provisional diagnosis of CCD with dentigerous cyst was given. The enucleation of cyst was done and submitted for histopathological examination. Histopathologically, the soft tissue section suggested the features of dentigerous cyst. The final diagnosis of CCD associated with dentigerous cyst was confirmed.

Glycogenic acanthosis of the tongue.

ABSTRACT: Glycogenic acanthosis (GA) is a benign lesion characterized by elevated, small, white plaques commonly detected in the esophageal mucosa. To date, only 6 cases have been reported in the English literature documenting its involvement in the oral cavity. Herein we report a case of large GA on the ventrolateral aspect of the tongue in a 42-year-old male (third case reported on the tongue). Histologically, the lesion was characterized by acanthotic squamous epithelium with glycogen-rich, clear cells located in the upper layers of the epithelium. Since the oral presentation of GA is very rare, it is necessary to document more cases to clarify the clinical features, biological behavior, and management of GA in the future.

Sirka: An alternative to the formalin fixative.

Formalin fixation is the most essential step of routine histopathology practice. During the last few years, various fixatives have been developed for use in histopathology practice as an alternative to formalin, to overcome its side effects on health. Here we have demonstrated an interesting and novel idea of using sirka or sugar cane vinegar as an alternative to the formalin with the adequate result.

Clear cell oral squamous cell carcinoma as a diagnostic conundrum: report of 2 rare cases.

The occurrence of clear cell histologic sub-type of oral squamous cell carcinoma in the oral cavity is a distinct and exceedingly rare entity exhibiting aggressive behavior. To date, only 10 cases have been published in the literature. We describe 2 extremely rare cases, both presenting with swelling and ulcerated nodule-like proliferative growth in the mandible. Microscopically, sheets and lobules of neoplastic squamous epithelial cells showing clear cell differentiation were appreciated in both patients. Periodic acid-Schiff and mucicarmine revealed negative staining. Immunohistochemical (IHC) analysis for antibody for renal cell tumor marker CD 10 was immune-negative. The malignant clear cells in both cases showed intense positive reactions with IHC markers pan-cytokeratin and epithelial membrane antigen, confirming the diagnosis as a clear cell variant of oral squamous cell carcinoma (CCOSCC). The first patient was unwilling for treatment and eventually died within 2 months of the diagnosis. In the second patient, right hemi-mandibulectomy with level 1A and 1B lymph nodes was performed. Adjuvant chemotherapy with low-dose methotrexate was initiated. Follow-up after 2 months of surgery was uneventful. Current rare reports emphasize the significance of prompt and extensive diagnostic work-up of clear cell neoplasms, as the CCOSCC may be fatal.

Antimicrobial effect of Juglans regia bark with commonly used antibiotics against initial colonizers of Plaque and Caries: A comparative study.

Introduction: There is a progressive increase in the patients of dental caries and periodontitis in the recent years. The main emphasis is laid on avoiding the accumulation and inducing the elimination/suppression of caries-causing microbes in the oral cavity. A variety of antimicrobial agents are incorporated into oral hygiene products but these products come up with their own disadvantages. Natural products prove to be biocompatible with medicinal properties. Aims and Objectives: The objective of the study is to access the antimicrobial activities of Juglans regia bark against dental caries and plaque. Also, antibacterial activity of Juglans bark is compared with oral rinses and systemic antibiotics. Material and Methods: The study sample consisted of 50 subjects and was divided into two groups. Group 1 consisted of 25 samples without caries and Group 2 also included 25 samples with caries. Both samples were in the age group 18-22 years. Plant samples of Juglans regia bark from Kashmir and Himachal were collected. Extracts containing both varieties were prepared and antibacterial activities of both groups were determined. Comparison of Juglans regia bark with antibiotics and mouthwashes was also done. Results and Conclusion: J. regia bark of both the varieties showed zone of inhibitions. Ethanol variety showed larger zone of inhibition than distilled water variety of both plaque and caries groups. Chlorhexidine showed satisfactory antimicrobial activity while Betadine showed none. Amoxicilline was effective but Metronidazole showed no activity against both groups. Bark of J. regia proved to be very beneficial against both plaque and caries bacteria without any side effects as both mouthwashes and antibiotics are harmful and cannot be used daily.

Appraisal of elementary knowledge and awareness of oral cancer among dental and medical undergraduates.

Background: Currently, oral cancer in India ranks among the top three types of cancer affecting mainly the elderly population. However, recent years have witnessed a marked increase in the younger people less than 45 years of age being affected by oral squamous cell carcinoma (OSCC). Thus, its early detection and treatment are of utmost importance and this responsibility lies with the healthcare providers. Therefore, we planned this study to assess the knowledge, attitude and practices of oral cancer among undergraduate dental and medical students. The objective was to suggest strategies to improve awareness on oral cancer. Methods: A pretested questionnaire comprising nineteen questions were distributed among 193 undergraduate dental and 218 undergraduate medical students of our university. Fundamental questions were included in the clinical examination, risk factors and need for information lectures on oral cancer. Chi-square and ANOVA tests were used to analyse the data. Results: The response rate of the study was good with 91.7% (177/193) of the dental and 88% (191/218) of the medical undergraduates participating in the survey. Though dental students had sufficient knowledge regarding the prevention and detection of oral cancer, however, medical students were less aware of the investigative methods of oral cancer. Conclusion: Though the mean knowledge of the dental students was good, they were not confident of diagnosing the early clinical symptoms of oral cancer. Practices on detection of oral cancer have to be reinforced among medical students so that they can contribute to its prevention.

Prognostic implications of malignancy grading of invasive fronts of oral squamous cell carcinoma.

OBJECTIVE: Invasive front malignancy grading system in oral squamous cell carcinoma (OSCC) introduced by Bryne et al. is reported to be of prognostic significance in a number of studies conducted in Western countries. The aim of this study was to evaluate the prognostic significance of the modified Bryne's malignancy grading system and to compare it with the World Health Organization (WHO) grading system in the Indian population. METHODS: The records of 50 patients diagnosed with primary OSCC were evaluated. Only large surgically resected specimens that had deep invasive fronts in the cut sections were selected. All hematoxylin and eosin-stained slides were analyzed by two grading systems: the WHO grading system and the Bryne's malignancy grading of the deep invasive fronts of OSCCs. RESULTS: Histopathologic grading in the invasive sites had highly significant prognostic value and had significant correlation with overall survival rate. The Kaplan-Meier survival curves showed that five years following therapy, the proportion of cases surviving with Bryne's scores lower or equal to 12 was 60.6% compared to only 17.6% for those with scores greater than 12. The drop in the survival curve of the patients with Bryne's scores greater than 12 was much steeper toward the end of the two years (nearly 16 months). In WHO Grades I and II, the survival rate was 48.9% and in Grade III, it was Nil. CONCLUSION: The histologically invasive areas may be the only prognostic indicator for the clinical behavior of OSCC and can be used to predict overall survival in patients.

Oral metastatic clear-cell tumours: To and fro: Unusual case reports.

We report two extremely rare cases of metastatic clear-cell carcinomas, which metastasized from and to the oral cavity and both presented clinically in the oral cavity. First case was a primary lesion in the oral cavity, which showed distant metastatic deposits in liver, kidney, bone and brain. Histopathologically, lobules of pleomorphic clear cells were evident descending from the overlying mucosa, raising the suspicion of renal cell carcinoma. Immunohistochemical staining for CD10 was negative and the case was diagnosed as clear-cell type of oral squamous cell carcinoma which had disseminated to distant organs. In the second case, dysplastic clear granular cells were seen invading the bone. Immunohistochemical staining for CD10 showed focal mild positivity, confirming the diagnosis as clear-cell renal carcinoma which had metastasized to the oral cavity. Metastatic tumours must be considered in the differential diagnosis of rapidly growing ulcero proliferative lesions in the oral cavity.

Orthokeratinized versus parakeratinized odontogenic keratocyst: Our institutional experience.

Introduction: The odontogenic keratocyst (OKC) is quite unique among odontogenic cysts in its specific histological features and in clinical characteristics. The OKC has two variants orthokeratinized odontogenic cyst (OOC) and parakeratinized odontogenic cyst (POC), and POC is considered to be more aggressive and has a high recurrence rate. Therefore, OKC has generated considerable controversy with regard to its true nature. Aim: The purpose of this study was to determine the differences between POC and OOC variants of odontogenic cysts on the basis of clinical as well as radiological features. Materials and Methods: A total of 85 cases were included in the present study. There was a marked difference in the age of occurrence, sex, location and radiological presentation of both these entities. Results: Our institutional experience suggests that POC is more common than OOC and both the variants were commonly found in males. Most of the cases of POC were found in the third decade of life and most of the cases of OOC were frequently seen in the second, fourth and fifth decades. Mandibular posterior area was frequently occurring in both variants. Left side involvement was seen in maxilla and right side in mandible in both variants. Most of the cases were clinically diagnosed as OKC. Conclusion: The treatment and prognosis varies in both the variants of OKC, hence such epidemiological studies are helpful to ensure proper treatment for these distinct entities.

Dentinogenic ghost cell tumor: Case report of a rare central variant and literature review.

The dentinogenic ghost cell tumor (DGCT), a solid variant of the calcifying odontogenic cysts, is an uncommon odontogenic neoplasm which is aggressive and has a propensity for recurrence. It accounts for <0.5% of all odontogenic tumors which can exhibit intraosseous (central) or extraosseous (peripheral) localization. Till today, only 39 cases of central DGCT have been reported in English literature according to WHO 2017 Classification. Therapeutic intervention of central variant should be aggressive, local resection with adequate safety margins and monitoring the patient for recurrence as the lesions show recurrence rate up to 71%. The purpose of this paper is to describe a rare case report of central DGCT in a 57-year-old female patient with a brief review of literature which provides an update on the epidemiology, diagnostic and clinicopathological characteristics of the published cases.

Prevalence of oral manifestations in COVID-19: A systematic review.

Coronavirus disease 2019 (COVID-19) is a novel disease caused by a newly identified virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing diverse systemic manifestations. The oral cavity too is not spared and the symptoms appear either independently, concurrently, or sequentially. In view of the rising documented cases of oral lesions of COVID-19, this systematic review aims to assess the prevalence of oral manifestations in COVID-19 confirmed individuals. An extensive literature search was conducted in databases like Scopus, Pubmed/Medline, Livivo, Lilacs and Google Scholar and varied oral signs and symptoms were reported as per the PRISMA guidelines. Studies published in English language literature only were included and were subjected to the risk of bias using the Joana Briggs Institute Appraisal tools for prevalence studies, case series and case reports. In a two-phase selection, 34 studies were included: 21 observational, 3 case-series and 10 case reports. These observational studies included approximately 14,003 patients from 10 countries. In this review, we explored the most commonly encountered oral and dental manifestations in COVID-19 and identified that loss of taste acuity, xerostomia and anosmia were frequently reported. Elevated incidence of opportunistic infections like mucormycosis and aspergillosis were reported during the treatment due to prolonged intake of steroids. Immunosuppression and poor oral hygiene led to secondary manifestations like enanthematous lesions. However, it is not clear that oral signs and symptoms are due to COVID-19 infection itself or are the result of extensive treatment regimen followed [PROSPERO CRD42021258264].

Determination of gender from dental pulp by identification of Barr bodies: A comparative study.

Introduction: The determination of gender by dental pulp Barr bodies seems to be efficient tool especially in case of natural calamities where bodies are mutilated, charred, and unidentified. Different techniques are used for Barr bodies two of which are histopathological and cytological methods. Aims and Objectives: The objective of the study is to check the reliability of human dental pulp for identification of gender using Barr bodies. Material and Methods: The study sample consisted of 60 extracted teeth from 20 male and 40 female patients aged 12-25 years. Inclusion criteria included non-carious freshly extracted teeth, Teeth were extracted and the pulp was obtained using a carborundum disc at 30,000 revolutions per minute (RPM). The teeth were categorized into two groups. Group 1 and Group II include 20 females and 10 males each. In group I, rapid manual tissue processing technique was done and in Group II pulp tissue slides were prepared by cytopathological technique. The slides obtained were stained with H&E and Barr bodies were visualized. Statistical Analysis: On comparison of Barr bodies on males and females in dental pulp, the mean number of Barr body count in females was more than males. Accuracy and count were much more appreciated in histopathological technique than cytological procedure. Conclusion: The mean Barr body count was more in females than in male samples. In histopathological technique Barr bodies were more analyzed and appreciated than in cytopathological technique on checking the efficacy and evaluating its diagnostic significance of dental pulp for identification of gender.

Neutrophils defending the defenders.

Neutrophils are the most abundant granulocytes which are involved in defense mechanism. As innate immune cells, they are first-line defenders and can perform different functions in the human body to maintain equilibrium. Neutrophils are the main leukocyte and their role in healthy oral cavity is to face pathological changes within oral environment. With regard to these, it has been observed that neutrophils are highly heterogeneous in their behavior. The aim of this review is to give an overview of the role of neutrophils in context of various physiological and pathological conditions.

Analysis of erythrocytes in oral submucous fibrosis - A morphometric study.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic progressive scarring oral disease caused due to areca quid chewing. The constituents of areca nut can enter into the circulation by swallowing the liquid mixture of areca quid which evokes oxidative stress on RBC membrane integrity. AIMS: To study the morphometric characteristics of erythrocytes under light microscopy and to assess the role of areca quid constituents on the morphology of circulating erythrocytes. MATERIALS AND METHODS: Peripheral blood smears prepared from blood samples of 50 patients selected according to Lai's classification. Group I: Normal individuals (10 cases); Group II: Mouth opening > 35 mm (10 cases); Group III: Mouth opening 30-35 mm (10 cases); Group IV: Mouth opening 20-30 mm (10 cases) and Group V: Mouth opening < 20 mm (10 cases). The slides were stained with Leishman's stain and assessed by light microscopy. A total of 100 randomly selected RBCs from 5 different fields in each smear were selected and the RBC circumference was measured and tabulated. STATISTICAL ANALYSIS AND RESULTS: Data was analyzed using GraphPad Prism 5.03 software. Tukey's multiple comparison test showed statistically significant difference (p < 0.05) between groups I and IV; I and V; II and IV; II and V; III and IV; III and V. CONCLUSION: These results suggest the possibility of cytotoxic effect of areca quid constituents on circulating erythrocytes in advanced cases of OSMF, which might result in microcytic anaemia.

Clinicopathological Profile of 80 Cases of Unicystic Ameloblastoma Aided by a Histopathological Comparison Using Modified Philipsen-Reichart Classification and Marx-Stern Classification.

Unicystic ameloblastoma (UA) is an uncommon variant of ameloblastoma and behaves totally different from the solid multicystic variant of ameloblastoma (SMA); furthermore the histological subgroups of UA also show varied behavior regarding proliferation. The present multi-centric study was designed to present the clinicopathological features of unicystic ameloblastoma (UA) and to compare the two popular histological classifications systems. 80 satisfactory cases of UA were retrieved and evaluated for clinicopathological parameters from four teaching dental schools of North India. The cases were classified using modified Reichart and Philipsen system and Marx and Stern system followed by comparison of inter-observer variability. The results were analyzed using SPSS software. The mean age of occurrence was 30.79 ± 16.49 years. Males outnumbered females (M:F::1.67:1). The majority of cases occurred in the third decade irrespective of the gender. Most cases were found in body-angle-ramus region of the mandible. The modified Reichart and Philipsen classification yielded better interobserver agreement (kappa value 0.845). The modified Reichart and Philipsen classification yields better inter-rater agreement and is easy to reproduce amongst oral pathologists. Being simpler it may easily be understood by the operating surgeon for better treatment outcome.

Basal cell carcinoma: Histopathological gamut.

INTRODUCTION: Basal cell carcinoma is the most common cutaneous malignancy which is exclusively observed on sun exposed and hair bearing areas of the face. DIAGNOSIS: We report two rare cases of basal cell carcinoma, which presented as a diagnostic challenge because of rare histopathology. FINDINGS: Both cases showed pigmentation, while one case resembled adenoid cystic carcinoma because of the glandular and ductal pattern of basaloid cells. RESULT: We present these cases because of rare histopathologic presentation.