Revisiting Vickers and Gorlin criteria in histopathological subtypes of ameloblastoma.

Background: Ameloblastoma is a benign tumour of odontogenic epithelial origin arising from enamel organ tissue that has not undergone differentiation to the point of hard tissue formation. Aims: This study was conducted with an aim to provide a baseline data to analyse whether various histopathological variants of ameloblastoma satisfies all the characteristic histopathological features of Vickers and Gorlin criteria. Settings and Design: A retrospective study of 25 cases of intraosseous ameloblastoma was carried out in the Department of Oral Pathology and Microbiology in accordance with the Institutional Ethics Committee. Methods and Materials: Histopathological slides of ameloblastoma subtypes were analysed microscopically to assess Vickers and Gorlin criteria. Statistical Analysis Used: Statistical analysis was done using the Chi-square test. A P- value of < 0.05 was set for statistical significance. Results: Presence of hyperchromatic nuclei was seen in all the variants (100%), except for the desmoplastic variant which showed only 60% positivity. Basal cell palisading, reverse polarity and subnuclear vacuolization were seen predominantly only in acanthomatous (100%), and follicular variants (83%). Conclusions: Vickers and Gorlin criteria have become an integral part of diagnosis of histopathological subtypes of ameloblastoma and should be applied vigilantly in the diagnosis as these may not always fulfill all the gold standard criteria when individual subtypes are assessed.

Understanding the approach to interpretation and challenges in measurement of pathological depth of invasion in oral squamous cell carcinoma: A cross-sectional survey of oral and maxillofacial pathologists in India.

Objectives: To understand the approach to interpretation along with challenges encountered in assessing pathological depth of invasion (pDOI) in oral squamous cell carcinoma (OSCC) as per 8th Edition of TNM-AJCC staging among oral and maxillofacial pathologists in India. Method and Materials: A cross-sectional web-based survey was conducted (May 2021-October 2021) with a pre-validated 21-item questionnaire. Responses were stored in a Microsoft Excel worksheet and analysed by descriptive statistics using SPSS v 25.0. Results: About 69.7% of the 267 respondents correctly defined pDOI while 13.1% measured the same from tumour surface. Among those not reporting pDOI, one-third of respondents (36.6%) lacked requisite awareness about 8th edition staging while more than half of them (55.4%) lacked proper tools to measure. The vst majority of the oral pathologists found pDOI measurement practically challenging (85.8%), mostly with difficulty in obtaining adjacent normal mucosa (77.9%). Selection of reference points of adjacent normal mucosa was divided between deepest point of rete ridge (43.1%), the closest rete ridge (28.8%) and the tip of highest submucosal papilla (15%). Conclusion: Underreporting of pDOI was observed owing to inherent challenges in measurement, thus ostensibly substituted with tumour thickness. Elaboration on reference points of adjacent normal mucosa is awaited.

Expression of CD 20 B-Lymphocyte in oral epithelial dysplasia and oral squamous cell carcinoma: A comparative immunohistochemistry study.

Background: As the progressive trends in the field of immunotherapy, it is very favourable to reconsider the role played by B lymphocytes in the tumor microenvironment. Both the protumorogenic and antitumorogenic responses have to be evaluated to formulate an effective immunotherapeutic protocol. Aim and objective: The study was primarily conducted to assess the qualitative expression of B lymphocytes in pretumorogenic (oral epithelial dysplasia) and tumorogenic environment (oral squamous cell carcinoma). The differential immunohistochemical staining of CD 20 immune marker was assessed in about 60 cases that included 30 cases of oral epithelial dysplasia and 30 cases of oral squamous cell carcinoma. Results: The study found significant correlation between CD 20 IHC immune expression and histopathological diagnosis along with significant correlation between the subject's age group and histopathological diagnosis. Conclusion: Modulating the immune response in a precancerous state can be highly beneficial in implementing better immunotherapeutic strategies to treat or prevent malignancy at an early stage.

Vasculogenic mimicry.

Vasculogenic mimicry (VM) refers to the ability of malignant cells to form microvascular channels, having nature of blood vessels but are not endothelium lined. These channels contain blood cells & plasma and provide sufficient nutrient supply to the cancerous cells to meet their metabolic demands. VM can be seen in various tumors and is associated with their malignant phenotype, high tumor grade, invasion, metastasis and poor clinical outcome. In this paper, we made an attempt to explain the mechanism, visualisation and prognostic significance of vasculogenic mimicry.

Is diabetes a real susceptibility for SARS-CoV-2 oral manifestation?

Background: Furin, a polybasic cleavage enzyme, is increasingly recognized in the pathogenesis of metabolic syndromes like diabetes. Its cleavage action is an essential activation step for the SARS-CoV-2 attachment site at the junction of S1 and S2, the two subunits of the spike. This allows effective cleavage by furin and has a role in determining viral infectivity and host range. The increased expression of the furin enzyme in the saliva is remarkable enough to be noted as a susceptibility factor for diabetic patients. Aim of the Study: The present study focuses on the qualitative assessment of the furin enzyme through an immunological ELISA test. Materials and Methods Used: The study consisted of three groups, each of whom was a COVID-19 recovered patient (n = 20), a diabetic patient (n = 20), and a healthy patient (n = 20). Result: The study assessed significantly increased levels of the furin enzyme generally in diabetic patients and COVID-19 recovered patients as compared to the healthy control group. Conclusion: The estimation of furin in saliva still holds the possibility of being a prognostic marker in many COVID-19 infected patients. Further evidence-based studies are required to establish the same.

Assessment of condyle-coronoid angle and gonial angle for gender determination: A digital panoramic study in Bagalkot population.

Background: The determination of gender is of utmost importance for forensic science and medico-legal purposes. The mandibular bone may play a vital role in gender determination as it is the most dimorphic bone of the skull that is often recovered intact. In this respect, orthopantomograms are of great value in accurate age and sex estimation. The mandibular angles, especially the gonial angle is an important parameter of the craniofacial complex giving an indication about the vertical parameters and symmetry of the facial skeleton. The purpose of the current study was to evaluate the usefulness of mandibular gonial and coronoid-condyle angle measurements on digital panoramic images as an indicator for gender determination in the Bagalkot population. Materials and Methods: A total of 200 panoramic images (100 males and 100 females) of Bagalkot district patients aged (18-58) yrs old were selected. Two mandibular parameters 1) gonial angle and 2) condyle-coronoid angle were analyzed using trophy DICOM 6.1.2.0, masterview 4.2.0. Two-way analysis of variance (ANOVA) test and Tukey's multiple post hoc procedures were used to compare the gender and two sides (left and right) with respect to gonial angle and condyle-coronoid angle. Results: The analysis of the present study confirmed a statistically significant difference between the right and left sides of the gonial angle and condyle-coronoid angle in both genders. The mean comparison also shows a variation between males and females, based on gonial angle and condyle-coronoid values; females have statistically significant higher mean values than males. Based on the analysis, the present study concludes that this difference between males and females from both sides suggests that the gonial angle and condyle-coronoid angle help in gender determination. Conclusion: The results of the study show that greater mandibular angle aids in gender dimorphism and proves to be beneficial in gender estimation. Gonial angle and condyle-coronoid angle can be used to differentiate gender with high accuracy.

Assessment of epidermal growth factor receptor in histological, clinical and pathological staging of oral squamous cell carcinoma.

Background: Oral squamous cell carcinoma is an invasive epithelial neoplasm with varying degrees of squamous differentiation that arises from the following anatomic sites: the oral cavity, particularly oral soft tissues including the gingival and alveolar mucosa, floor of the mouth, tongue, soft and hard palate, tonsils and oropharynx. In normal epithelium EGFR is localized to basal cell layer, while its expression beyond basal localization in cancerous tissue suggest that correlation of EGFR and tumor progression might exist. The present study aimed to assess epidermal growth factor receptor in histological, clinical and pathological staging of oral squamous cell carcinoma. Materials and Methods: The current study was performed on subject with confirmed histological diagnosis of oral squamous cell carcinoma of age group between 35 and 70 years reported to Kempe-Gowda Institute of Medical Science and Hospital, Department of Oral and Maxillofacial Surgery, Vokkaligara Sangha Dental College and Hospital Bangalore and KIDWAI Memorial Institute of Oncology, Bangalore between December 2019 and March 2021. Total of 30 subjects included in the study of age group between 35 and 70 years. In the selected subject for the study, tumor was resected and preserved in 10% formalin, which was sent to department of pathology for analysis and PTNM was recorded. Immunohistochemical evaluation of EGFR was done. Total score of EGFR of each subject was co-related with pathological prognostic factor. Results: Correlation of EGFR with adjuvant therapy and histological grading, P values were 0.001 and 0.005, respectively. The obtained results were tabulated statistically using Chi square test and significance was set at P < 0.05. Conclusion: A preventive approach and assessment of EGFR in early stage of SCC provide better results. Subjects with higher EGFR value have poor prognosis and have to undergo postsurgical adjuvant therapy for long term-survival.

Reliability of palatal rugae patterns in individual identification.

Background: Dental identification plays a major role in mass disaster identification of human remains. Palatal rugae can be used as a substitute for a comparative method of identification. Materials and Methods: The present cross-sectional study was done with 137 pre- and post-orthodontically treated casts of patients, which were divided into 50 cases each of extraction and nonextraction and 37 cases of palatal expansion involving both extraction and nonextraction. Hydrocolloid (alginate) impression of the upper jaw of the patient was taken and then cast in the dental plaster of Paris material. Palatal rugae pattern was classified according to Lysellm, and Thomas and Kotze classification. Two Observers recorded the data, mean of two were taken for analysis. Results: On the right side, there was no significant difference between the extraction and nonextraction groups; however, there was a rise in length in the nonextraction and palatal expansion groups. On the left side, there was little change between the nonextraction and palatal expansion groups, but the extraction group had a modest increase in length. Mean lengths compared within three groups revealed insignificant difference. Conclusion: Palatal rugae pattern can be used in establishing identity in forensic medicine provided antemortem data are available. Orthodontic treatment has an impact on stability of palatal rugae. Most reliable and stable points being third rugae, they could be used as reference points to evaluate tooth movements.

The Role of Salivary Lactate Levels in assessing the Severity of Septic Shock.

Background: Sepsis is a major worldwide cause of morbidity and mortality. Hence, rapid and reliable diagnosis is essential. Emergency departments use a standard measure of sepsis, based upon an elevated Lactate level in blood. Saliva is more readily available and easier to obtain than blood samples, and is increasingly being studied as a new source of diagnostic information. Aim: This study aimed to evaluate whether analysis of Lactate levels in saliva can substitute for that of Lactate levels in blood. Methods/Materials: We processed saliva samples and serum samples from septic shock and non-septic shock patients. We found out Lactate levels in both the group. We plotted the concentration of Lactate in non-septic and septic patients and compared lactate levels in saliva to its levels in blood.Statistical analysis: Results were statistically analyzed by independent sample t test and A Spearman rho correlation. Results: We found increased serum and salivary Lactate levels in all cases of sepsis compared to the control group. Notably, the increase in Lactate levels was higher in serum as compared to saliva in septic patients, suggesting saliva may not serve as a better indicator of sepsis compared to blood. Salivary lactate was more in septic shock patients compared to non-septic shock patients. Conclusions: To our knowledge, this is the first study to compare lactic acid levels in serum and saliva in cases of sepsis. The increase in serum lactate in patients with sepsis is evident when compared to increase in salivary lactate, so serum lactate level would be easier for physicians to differentiate septic patients from non-septic patients. Salivary lactate may not serve as better indicator in septic shock patients.