The role of MMP-2 and MMP-9 as prognostic markers in the early stages of tongue squamous cell carcinoma.

BACKGROUND: Tongue cancer is the most common intra-oral malignancy with a high rate of morbidity and mortality owing to its increased propensity for tumor invasion and metastasis. These processes require a controlled degradation of the extracellular matrix. Matrix Metalloproteinase-2 (MMP-2) and Matrix Metalloproteinase-9 (MMP-9) are known to be important regulators of matrix lysis and play a significant role in the metastasis of malignancies. AIM AND OBJECTIVES: To study the expression of MMP-2 and MMP-9 in the early stages of tongue squamous cell carcinoma and find the association between their expression and local recurrence, metastasis, and survival rates of the subjects. MATERIALS AND METHODS: Fifty-nine tumor biopsy samples of tongue squamous cell carcinoma in T1 N0 M0 and T2 N0 M0 stages were immunostained with MMP-2 and MMP-9 antibodies. The immunohistochemical expression was compared with the patient characteristics and outcome. RESULTS: Cytoplasmic expression of MMP-2 correlated with that of MMP-9 (r = 0.716, P < 0.001). Greater expression of MMP-2 and MMP-9 was observed in patients who subsequently developed local recurrence (P = 0.044 and P < 0.001, respectively), regional and/or distant metastasis (P < 0.001 and P = 0.001, respectively) of the tumor. Further, a higher expression of these biomarkers was associated with shorter survival. MMP-9 was found to have better specificity for local recurrence, metastasis and survival. CONCLUSION: Our results showed that these biomarkers may serve as indicators of a patient's risk potential for poor prognosis and presage the need for more aggressive treatment measures.

Primary synovial sarcoma of the maxilla.

An innocuously appearing gingival mass in the maxilla revealed extensive osteolysis on radiographic examination. A rare clinical presentation of synovial sarcoma, appropriate diagnostic strategies and suitable treatment protocol in a 21-year-old male is reported herewith. It is only the third case of primary monophasic synovial sarcoma of the maxilla to be reported to the best of our knowledge and the first to have occurred in a male patient. The importance of considering synovial sarcoma in the differential diagnosis of any mass in the oral cavity is highlighted.

A clinical report demonstrating the significance of distinguishing a nasopalatine duct cyst from a radicular cyst.

Endodontic diagnosis is challenging and depends on the organisation of information from the patient history, clinical examination and analysis of the pulp, radiographic and histopathological assessment. A 35-year-old man was endodontically treated for radiolucency in relation to the roots of maxillary central incisors as it was a provisionally diagnosed case of radicular cyst. Since the palatal swelling persisted, the lesion was re-evaluated using relevant diagnostic aids and a diagnosis of nasopalatine duct cyst (NPDC) was made, which was missed during the initial assessment. An erroneous interpretation of cystic radiolucency in relation to maxillary central incisors can often lead to inappropriate treatment planning. This case highlights the relevant aspects in the diagnosis of NPDC when it is mistaken for a radicular cyst and emphasises the need for thorough clinical examination and relevant investigations for periapical radiolucencies of questionable origin before initiating endodontic therapy.

Calcifying odontogenic cyst: a rare report of a nonneoplastic variant associated with cholesterol granuloma.

AIM: To report a case of a non-neoplastic variant of calcifying odontogenic cyst (COC) with the lining epithelium showing ameloblastomatous proliferation and capsule exhibiting features of a cholesterol granuloma. The importance of delineating this histologic variant from unicystic ameloblastoma and the formation of cholesterol granuloma in this variant is discussed. BACKGROUND: Calcifying odontogenic cyst is a developmental jaw cyst, which presents itself as both the neoplastic and the non-neoplastic forms. The ameloblastomatous variant of COC is often mistaken for unicystic ameloblastoma and treated aggressively. CASE REPORT: A 68-year-old female who presented with a cystic enlargement of the posterior mandible on the right side was suggestive of unicystic ameloblastoma based on radiography and initial biopsy report. Microscopic examination of the excision specimen, however, was fitting in favor of calcifying odontogenic cyst with ameloblastomatous proliferation. CONCLUSION: Identifying the non-neoplastic ameloblastomatous variant of COC from a cystic ameloblastoma is crucial as the treatment of the two lesions vary considerably. CLINICAL SIGNIFICANCE: This case emphasizes the need for thorough examination of the entire surgical specimen before arriving at an appropriate diagnosis.