Estimation of cortisol levels in patients with premalignant disorders and oral squamous cell carcinoma.

INTRODUCTION: Oral cancer has been a scourge on the human population that drastically affects the quality of life-causing chronic anxiety and depression leading to disturbance in hypothalamus pituitary axis reflected by cortisol hormone dysregulation. Stress hormones affect tumor progression at different levels such as initiation, tumor growth and metastasis. Cortisol dysregulation has been reported in other malignancies; however, a thorough review of English literature revealed only anecdotal studies investigating it in patients with oral squamous cell carcinoma (OSCC). OBJECTIVES: The objective of this study is to evaluate morning plasma and salivary cortisol levels in patients with OSCC, premalignant disorders (PMD's) and smokers and/or drinkers without any lesion (risk group) and control group and its correlation with Hospital Anxiety And Depression Scale (HADS-subjective) and Hamilton Rating Scale for Anxiety and Depression (HRSA, HRSD-objective). MATERIALS AND METHODS: This cross-sectional study was carried out on 25 patients each of OSCC, PMD's, risk and control group. Self-administered HADS and clinician-rated HRSD, HRSA were applied to each patient. Morning unstimulated saliva and venous blood sample were collected between 08:00 and 11:00 h to avoid diurnal variations. Morning salivary and plasma cortisol levels were analyzed using enzyme-linked immunosorbent assay method. RESULTS: Both morning plasma and salivary cortisol levels were significantly higher in patients in OSCC group as compared to other three groups in the study which were further supported by higher scores obtained from HADS, HRSA and HRSD scales. CONCLUSION: The study observed that there was marked dysregulation of both morning plasma and salivary cortisol levels along with higher scores of anxiety and depression in OSCC.

Comparative evaluation of different histoprocessing methods.

OBJECTIVES: Tissue processing for years is carried out by the conventional method, which is a time-consuming technique resulting in 1-day delay in diagnosis. However, in this area of modernization and managed care, rapid diagnosis is increasingly desirable to fulfill the needs of clinicians. The objective of the present study was to compare and determine the positive impact on turnaround times of different tissue processing methods by comparing the color intensity, cytoplasmic details, and nuclear details of the tissues processed by three methods. METHODS: A total of sixty biopsied tissues were grossed and cut into three equal parts. One part was processed by conventional method, second by rapid manual, and third by microwave-assisted method. The slides obtained after processing were circulated among four observers for evaluation. Sections processed by the three techniques were subjected to statistical analysis by Kruskal-Wallis test. Cronbach's alpha reliability test was applied to assess the reliability among observers. One-way analysis of variance (ANOVA) was used for comparing mean shrinkage before and after processing. RESULTS: All observers were assumed to be reliable as the Cronbach's reliability test was statistically significant. The results were statistically non-significant as observed by Kruskal-Wallis test. One-way ANOVA revealed a significant value on comparison of the tissue shrinkage processed by the three techniques. The histological evaluation of the tissues revealed that the nuclear-cytoplasmic contrast was good in tissues processed by microwave, followed by conventional and rapid manual processing techniques. The color intensity of the tissues processed by microwave was crisper, and there was a good contrast between the hematoxylin and eosin-stained areas as compared to manual methods. CONCLUSION: The overall quality of tissues from all the three methods was similar. It was not feasible to distinguish between the three techniques by observing the tissue sections. Microwave-assisted tissue processing has reduced the time from sample reception to diagnosis, thus enabling the same-day processing and diagnosis.

Expression of CK14 and vimentin in adenomatoid odontogenic tumor and dentigerous cyst.

BACKGROUND: Origin of adenomatoid odontogenic tumor (AOT) has long been a controversy, and the issue of it being a neoplasm or hamartoma was a subject of debate for a long time. Earlier it was grouped under a mixed group of odontogenic tumors considering the varying degrees of inductive changes. Recently, the WHO classification states that the presence of hard tissue within AOT was not due to induction but was rather a metaplastically produced mineralization and hence the tumor was reclassified under a group of tumors arising from odontogenic epithelium. This study is an attempt to identify if both epithelial (cytokeratin 14 [CK14]) and mesenchymal (vimentin) markers are expressed in the follicular and extrafollicular variants of AOT and to compare the expression with dentigerous cyst (DC) as this cyst is known to arise from reduced enamel epithelium which expressed CK14. This is done to possibly relate the origin of AOT with reduced enamel epithelium. AIMS AND OBJECTIVES: To study, analyze and correlate the expression of CK14 and vimentin in AOT and DC. MATERIALS AND METHODS: Retrospective study on paraffin embedded tissues. Sixteen cases of AOT and 15 cases of DC were retrieved from the departmental archives and subjected to CK14 and vimentin immunostaining. STATISTICAL METHODS: Measures of central tendency was used to analyze the results. RESULTS AND OBSERVATIONS: Ninety percent of cases of follicular AOT (FAOT) and 100% cases of extra-follicular AOTs (EAOTs) showed positivity for CK14 and all cases of DC showed positivity for CK14. Vimentin was positive in 44% and negative in 56% cases of both FAOT and EAOT taken together. CONCLUSION: The CK14 expression profile in AOT and DC supports its odontogenic epithelial specific nature. The possible role of reduced enamel epithelium and dental lamina in histogenesis of AOT and DC is strongly evident by their CK14 expression pattern.

Detection of cervical lymph node micrometastasis and isolated tumor cells in oral squamous cell carcinoma using immunohistochemistry and serial sectioning.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) comprises one of the largest subsets of cancers with a tendency for regional metastasis. Nodal status is a key prognostic indicator in patients with OSCC, particularly with N0 neck. Occult metastasis in the form of micrometastasis (MM) and isolated tumor cells (ITCs), often goes undetected by routine hematoxylin and eosin (H&E) examination using 1-2 sections for analysis. This limitation could be overcome by combining serial sectioning (SS) with immunohistochemistry (IHC) for the detection of MM and ITC. Pan-cytokeratin (pan-CK) (AE1/AE3) is particularly a useful marker to detect these deposits as their presence has resulted in varied interpretations and different applications of the tumor-node-metastasis system. OBJECTIVES: The objective of the study was to identify a suitable method for detecting MM and ITC in lymph nodes (LNs) of OSCC by combining SS and IHC and to compare it with conventional H&E staining. MATERIALS AND METHODS: This laboratory-based, prospective study was conducted on 133 LNs harnessed from ten patients treated with radical neck dissection for primary OSCC. The LNs were subjected to SS at 100 µm intervals. The sections were stained with routine H&E staining, pan-CK and analyzed for MM and ITC according to criteria laid by Hermanek et al. STATISTICAL ANALYSIS: The obtained data were subjected to statistical analysis using Chi-square test. RESULTS: The application of combination of SS and IHC using pan-CK (AE1/AE3) in our study revealed the presence of MM and ITC in 2.25% of the LNs diagnosed as negative on routine H&E examination. The detection of these occult metastatic deposits resulted in upstaging of 33.33% of the patients. CONCLUSION: In the view of crucial role of occult LN metastasis in prognosis and survival of OSCC patients with N0 neck, diagnostic tools such as IHC staining, particularly with pan-CK (AE1/AE3), combined with SS should be preferred over conventional methods as they result in upstaging, thus sparing the low-risk patients the morbidity of unnecessary treatment.

Focal cemento-osseous dysplasia masquerading as a residual cyst.

Focal cemento-osseous dysplasia (FCOD) is a benign fibroosseous condition that can be seen in dentulous and edentulous patients. It is an asymptomatic lesion and needs no treatment; however, follow-up is essential due to the possibility that it can progress to a condition called florid cemento-osseous dysplasia. We report a case of FCOD of mandible in a 25-year-old female. Clinically, the lesion resembled periapical pathosis of odontogenic origin. An attempt has been made to discuss the clinical and histopathologic features along with differential diagnosis of cemento-osseous dysplasia.