Neuroectodermal influence in odontogenic cyst and tumor: evidence through CD56 immunoexpression.

BACKGROUND AND OBJECTIVES: CD56, associated with neuroectodermal differentiation of the embryonal cells, is often considered a marker of neural lineage. Odontogenic keratocysts (OKCs) are of particular interest because of their characteristic histopathologic features, high recurrence rate, and aggressive behavior. CD56 immunoreactivity in these lesions has been reported with very high frequency. The present study analyzes the immunoexpression of CD56 in ameloblastoma (AM) and OKC to infer neuroectodermal influence in the pathogenesis of odontogenic lesions and its correlation with clinicopathologic parameters. MATERIALS AND METHODS: Fifty histopathologically confirmed cases of OKC and AM, 25 from tooth-bearing (TB) and molar-ramus (MR) regions each, and 5 dental follicular tissues as control were collected from the department archives and immunohistochemical analysis with CD56 was carried out. RESULTS: CD56 immunopositivity was seen in 64% AM and 36% OKC cases. The majority of AM cases showed cytoplasmic expression in the peripheral cells of odontogenic islands; similarly, OKC cases showed continuous and uniform cytoplasmic expression in the basal and parabasal cells of the cystic lining. CD56 immunopositivity was found in more AM cases as compared to OKC cases in both the TB and MR regions. INTERPRETATION AND CONCLUSIONS: The assessment of CD56 immunoexpression in odontogenic cyst and tumor (AM) may aid in understanding the role of neuroectodermal influence in the etiopathogenetic pathways and a possible influence of CD56 on the clinical behavior and aggressiveness of the odontogenic lesions. A correlation of CD56 expression with the clinical outcome of the disease (site, perforation, root resorption, and tooth displacement) can help envisage possible prognostic assessment for these lesions.

Mitochondrial DNA content as a biomarker for oral carcinogenesis: correlation with clinicopathologic parameters.

BACKGROUND: Mitochondrial genome (mtDNA) exhibits greater vulnerability to mutations and/or copy number variations than nuclear counterpart (nDNA) in both normal and cancer cells due to oxidative stress generated by inflammation, viral infections, physical, mechanical, and chemical load. The study was designed to evaluate the mtDNA content in oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC). Various parameters were analyzed including its variation with human papillomavirus (HPV) during oral carcinogenesis. METHODS: The present cross-sectional study comprised of two hundred patients (100 OPMDs and 100 OSCCs) and 100 healthy controls. PCR amplifications were done for mtDNA content and HPV in OPMDs and OSCC using real-time and conventional PCR respectively. RESULTS: The relative mtDNA content was assessed quantitatively and it was observed that mtDNA was greater in OSCC (7.60±0.94) followed by OPMDs (5.93±0.92) and controls (5.37±0.95). It showed a positive linear correlation with habits and increasing histopathological grades. Total HPV-positive study groups showed higher mtDNA content (7.06±1.64) than HPV-negative counterparts (6.21±1.29). CONCLUSIONS: An elevated mutant mtDNA may be attributed to increased free radicals and selective cell clonal proliferation in test groups. Moreover, sustained HPV infection enhances tumorigenesis through mitochondria mediated apoptosis. Since, mtDNA content is directly linked to oxidative DNA damage, these quantifications might serve as a surrogate measure for invasiveness in dysplastic lesions and typify their malignant potential.

HIF - 1α as a marker of risk assessment for malignant transformation in oral submucous fibrosis: An immunohistochemical study.

Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with habit of chewing betel quid containing arecanut. Morphological features of OSMF especially fibrosis suggests a possibility of the hypoxic environment in diseased tissues. The adaptation of cells to hypoxia appears to be mediated via hypoxia inducible factor-1α (HIF-1α) which is also said to be associated with malignant transformation of epithelial cells in various other carcinomas like prostate and cervical carcinoma. Therefore, the main objective of this study was to investigate the role of HIF-1α in progression and malignant transformation of OSMF. Materials and Methods: The study group consisted of histo-pathologically diagnosed 30 cases of oral submucous fibrosis and 10 cases of OSCC were taken as control. The immunohistochemistry was carried out on neutral buffered formalin-fixed paraffin-embedded tissue sections by using the monoclonal antibody of HIF-1α. Statistical analysis was done using SPSS software version 2.0. Results: A gradual and significant rise in the expression of HIF-1α was observed in various grades of OSMF and OSCC cases. HIF 1α expression was increased in cases showing hylanization and constricted blood vessels. A cut off value of 39.6% of HIF-1α positive cells was determined statistically to categorize the cases into high risk and low risk group for malignant transformation. Conclusion: Overexpression of HIF-1α may contribute to the progression and malignant transformation of OSMF. Cases expressing more than 40% of HIF-1α positive cells are at a greater risk for malignant transformation.

Bilateral Nonsyndromic Cystic Lesions Involving Impacted Teeth: Nomenclature and Diagnostic Protocol.

AIM: To present a brief overview of etiopathogenesis, nomenclature, and treatment modality for a case of nonsyndromic bilateral cysts in the mandible. BACKGROUND: Odontogenic cysts, though comprise a distinct group of lesions have on and off posed challenges in etiopathogenesis and nomenclature. The prima facia role of development/inflammation in the buildup of fluid between the reduced enamel epithelium attached at the cementoenamel junction and the enamel in the pathogenesis of dentigerous cysts has long been discussed. Along with this, the spread of inflammatory exudate from an overlying primary tooth could also be the source of an inflammatory dentigerous cyst. CASE DESCRIPTION: Bilateral swellings in a 12-year-old patient presented with a chief complaint of pain in the lower jaw for 4 months. The radiographic picture exhibited unilocular, well-circumscribed radiolucent areas extending from 34 to 37 on the left side and from 44 to 47 on the right side of the mandible and involving retained mandibular second premolars on both sides. CONCLUSION: Mere expansion of a follicle due to inflammation from an overlying infected/necrosed/treated primary tooth in which the reduced enamel epithelium does not appear to be attached at the cementoenamel junction should be aptly referred to as an "inflammatory follicular cyst". CLINICAL SIGNIFICANCE: The present article attempts to illuminate the notable differences between dentigerous cysts and inflammatory follicular cysts of jaws which requires an adequate distinction in pediatric cases for diagnostic and management considerations. HOW TO CITE THIS ARTICLE: Sethi A, Shetty DC, Tandon A, et al. Bilateral Nonsyndromic Cystic Lesions Involving Impacted Teeth: Nomenclature and Diagnostic Protocol. Int J Clin Pediatr Dent 2020;13(4):429-432.

Quantitative assessment of CD15 positive tissue eosinophils in Oral Squamous Cell Carcinoma: effects on mast cells and tumor angiogenesis.

BACKGROUND: The present study determines to correlate eosinophil, mast cell and microvessel densities with the histopathological grades and clinical staging of Oral Squamous Cell Carcinoma (OSCC) cases, as the potential role of inflammatory mediators within tumor stroma remains debatable. METHODS: The study sample comprised 60 cases consisting of 40 cases of Well to moderately differentiated OSCC (group 1) and 20 cases of poorly differentiated OSCC (group 2). Immunohistochemistry with anti-CD15 antibody and antifactor VIII antibody; and toluidine blue special stain were employed for the detection of eosinophils, microvessels, and mast cells, respectively. RESULTS: The mean numbers of eosinophils, mast cells, and microvessels per high power field in group 1 and group 2 were 15.37±11.86 and 12.62±14.30, 6.00±4.84 and 4.51±4.51, 13.96±6.25 and 6.62±2.05, respectively. Eosinophil density had a positive correlation with both mast cell and microvessel density. Also, the correlation of primary tumor size (T status) with microvessel density was found to be statistically significant (P≤0.05). CONCLUSIONS: The cohesive interpretation of the aforementioned mediators in OSCC suggested that while these variables correlate well with the differentiation of tumor, the quantification did not correlate with the clinical staging of the disease.

Superoxide Dismutase response: physiological plasticity in tobacco users.

BACKGROUND: Free radicals (FRs) are active chemical substances having unpaired electron(s) which participate in the causation of precancerous lesions or cancer in tobacco habituates. Alterations in the antioxidant levels are reflected throughout the antioxidant enzyme activities in blood, wherein erythrocytes are considered highly sensitive to those enzymes. Our study was therefore aimed to assess the effects of tobacco consumption on erythrocyte antioxidant enzyme- Superoxide dismutase (E-SOD) and evaluate its defensive action. METHODS: E-SOD was estimated in 32 participants categorized in 2 groups (tobacco users and controls). 3 mL venous blood was withdrawn and antioxidant levels were assessed using RANSOD kit (Randox, Catalogue No.-125) as per the manufacturer's instructions. The E-SOD activity was then determined using spectrophotometry and the data was statistically evaluated. RESULTS: The Two-tailed Paired t-test was applied in smokers-SOD intergroup (mean=-124.45, P<0.0001) and chewers-SOD intergroup (mean=-66.70, P=0.1017). The mean SOD values (139.72±36.94) in cases were found to be significantly lower as compared to controls (212.75±37.04). The lowest SOD level was seen with chewers compared to other groups. CONCLUSIONS: E-SOD was found to be lowest among tobacco chewers probably due to the fact of excessive enzyme activity against prolonged release of carcinogens. The variability in the enzyme activity envisaged its potential as a biomarker in establishing the oral potentially malignant disorders (OPMDs) much before the lesions arises or detect the progression of existing lesion to malignancy.

Role of inflammation in developmental odontogenic pathosis.

Periapical infection in the primary tooth may lead to periapical abscess, granuloma, radicular cyst and even osteomyelitis. The infection in primary teeth can also affect the developing successor teeth leading to hypomineralization, hypoplasia, arrest of tooth development, regional odontodysplasia, delayed eruption etc. The purpose of this article is to report a case of malformed permanent tooth in relation to overlying infected deciduous teeth. The probable role of inflammation in pathogenesis of the present condition is also being discussed.

pH Gradient Reversal: An Emerging Hallmark of Cancers.

Several tumors exhibit pH gradient reversal, with acidification of extracellular pH (pHe) and alkalinization of intracellular pH (pHi). The pH gradient reversal is evident even during the preliminary stages of tumorigenesis and is crucial for survival and propagation of tumors, irrespective of their pathology, genetics and origins. Moreover, this hallmark seems to be present ubiquitously in all malignant tumors. Based on these facts, we propose a new emerging hallmark of cancer "pH gradient reversal". Normalizing pH gradient reversal through inhibition of various proton transporters such as Na(+)-H(+) exchanger (NHE), Vacuolar-type H(+)-ATPase (V-ATPase), H(+)/K(+)-ATPases and carbonic anhydrases (CAs) has demonstrated substantial therapeutic benefits. Indeed, inhibition of NHE1 is now being regarded as the latest concept in cancer treatment. A recent patent deals with the utilization of cis-Urocanic acid to acidify the pHi and induce apoptosis in tumors. Another patent reports therapeutic benefit by inhibiting Lactate Dehydrogenase - 5 (LDH-5) in various cancers. Several patents have been formulated by designing drugs activated through acidic pHe providing a cancer specific action. The purpose of this review is to analyze the available literature and help design selective therapies that could be a valuable adjunct to the conventional therapies or even replace them.

A review of histopathological and immunohistochemical parameters in diagnosis of metastatic renal cell carcinoma with a case of gingival metastasis.

The oral cavity constitutes a site of low prevalence for metastasis of malignant tumors. However, oral metastasis of a renal origin is relatively more common and represents 2% of all cancer deaths. Renal cancer may metastasize to any part of the body, with a 15% risk of metastasis to the head and neck regions, and pose one of the greatest diagnostic challenges in medical sciences. Approximately 25% of patients have a metastatic disease at initial assessment, which is often responsible for initiating the diagnosis in the first place. Here we present a review of literature of renal cell carcinoma along with a case of gingival metastasis.

Primary oral malignant melanoma: Clinicopathological series of four cases.

Melanoma of the oral cavity is a rare malignant disease. On account of the presence at relatively obscure areas in the oral cavity, most of oral malignant melanomas are diagnosed at a late stage. Early diagnosis is essential for successful treatment and perhaps is the key factor in improving the prognosis of oral malignant melanoma. However, no large clinical series exist, and in fact, clinical cases are the sole key source of information. We hereby present a series of four cases of primary oral malignant melanoma of South-East Asian ethnic origin, with long-term, regular follow-up. The age of the patients ranged between 40 and 70 years, with equal sex predilection, and the gingiva was found to be the most common site of its occurrence. Based on clinical and histological parameters, all the cases were diagnosed as primary malignant melanoma, which were further confirmed by using immunohistochemical markers.

Report of Two Siblings with Overlapping Features of Ellis-van Creveld and Weyers Acrodental Dysostosis.

Skeletal dysplasias are a heterogenous group of disorders combining abnormalities in the skull and other skeletal bones. Weyers acrofacial dysostosis also known as Weyers acrodental dysostosis was first described in 1952, by Weyers, as a postaxial polydactyly, which had features distinct from, yet some in common with the Ellis-van Creveld Syndrome (EvC). Both the syndromes have been mapped to the same chromosome, 4p16. The cases reported here highlight the overlapping features of both syndromes, which are dissimilar in mode of inheritance and phenotypic severity, emphasizing the need for genetic analysis, to categorize these conditions.

Aggressive fibromatosis of anterior maxilla.

Aggressive fibromatosis is a comparitively rare tumor with unpredictable growth and varying local recurrence rates. It does not develop distant metastases but locally it shows an aggressive and infiltrative behavior. Clinically, aggressive fibromatosis manifests as a painless, firm, often rapidly enlarging mass, fixed to underlying bone or soft tissue. It is never encapsulated. Histologically, it is rich in collagen and fibroblastic cells that are devoid of hyperchromatic or atypical nuclei, but with more variable cellularity in different tumor sections.