Significance of HIF-1α and CD105 in establishing oral squamous cell carcinoma associated with oral submucous fibrosis a distinct clinicopathological entity.

Context: Oral squamous cell carcinoma associated with oral submucous fibrosis (OSCC with OSMF) is clinicopathologically a distinct entity. However, scientific proof in view of assessment of biomarkers of hypoxia and neoangiogenesis to differentiate them are lacking. The expression of hypoxia-inducible factor 1-α (HIF-1α) and CD105 in OSCC with and without OSMF possibly will be explicated along these lines. Aim: This study aims to evaluate the molecular basis of hypoxia and neoangiogenesis in terms of immunohistochemical expression of HIF-1α and CD105 in OSCC with and without OSMF cases. Settings and Design: A retrospective cohort. Subjects and Methods: The study comprise of 203 histopathologically diagnosed surgically operated cases of OSCC retrieved from the departmental archives. The OSCC cases were subgrouped into two, OSCC with OSMF (Group I) and OSCC without OSMF (Group II). The evaluation of hypoxia and angiogenesis was carried out by immunohistochemical markers, HIF-1α and CD105. MVD is the parameter of angiogenesis expressed by CD105. Statistical Analysis Used: Differences in CD105, and HIF-1α immunoreactivity between study groups were done using descriptive statistics using "Kruskal-Wallis test," "Mann-Whitney test." Statistical significance was set at P < 0.05. Results: On comparison of MVD in Group I and II, statistically significant difference was found in MVD (8.88 ± 3.41, 16.13 ± 5.86, P = 0.0001). The HIF1-α expression was less in Group I (6.85 ± 2.62) as compare to Group II (7.22 ± 3.08) but the difference was statistically nonsignificant (P = 0.35). Conclusions: The OSCC with OSMF is not only clinicopathologically distinct entity of OSCC but also diverse in its molecular pathogenesis as explicited by distinct expression of HIF-1 α and CD105.

Quantification of mast cells in nonreactive and reactive lesions of gingiva: A comparative study using toluidine blue and immunohistochemical marker mast cell tryptase.

Background: Mast cells (MCs) are immune cells derived from a multipotent CD34 precursor. The most significant identifying feature of MCs is the presence of metachromatic granules. MCs are increased in oral reactive lesions and are possibly involved in pathogenesis of these lesions. Objectives: 1. To compare the number of MCs between reactive and nonreactive lesions of gingiva using toluidine blue (TB) and mast cell tryptase (MCT) as a specific marker for MCs 2. To compare the staining specificity/efficacy of TB and MCT. Methodology: The study sample comprised 90 tissues which were divided into three groups: Group A comprised 30 cases of pyogenic granuloma (PG), Group B consisted of 30 cases of gingival hyperplasia (GH) and Group C comprised 30 cases of pericoronitis. Staining was done between 1% TB and immunohistochemistry (IHC) marker MCT. Results: A significant increase in number of MCs was observed in PG as compared to GH and pericoronitis. IHC marker MCT proved to be a more specific marker for MCs compared to TB. Conclusion: IHC marker MCT is a specific marker compared to TB. The position of MCs changed from juxtaepithelial in GH to deeper connective tissue in PG which was in correlation with the proliferating tissue that is epithelium in GH and blood vessel in PG.

Butyrylcholinesterase: An economical marker of disease activity in oral squamous cell carcinoma before and after therapy.

INTRODUCTION: Biomarkers which can predict disease progression and serve as prognostic indicators are necessary for better management of oral cancer. Studies have shown that Cholinesterase plays an important role in cellular proliferation, differentiation and may have a possible involvement in tumor growth. AIM AND OBJECTIVE: The present study is aimed to determine the utility of serum Butyrylcholinesterase (BChe) levels as a marker for progression of oral squamous cell carcinoma (OSCC) in relation to the grade of the tumor and to determine if any variation occurred in the levels of BChe before and after therapy. MATERIALS AND METHODS: A total of 120 patients were included in the study and divided into two groups as Group A-30 patients (healthy individuals) and Group B-90 cases of histopathologically diagnosed OSCC. The blood sample was collected before surgery, re-collected after the completion of radiotherapy (i.e., 3 and 6 months postsurgery) and analyzed biochemically for the concentration of BCh. STATISTICAL ANALYSIS: Paired t-test, ANOVA, and post hoc test (Bonferroni) were used for determining the statistical significance. RESULTS: BChe levels were lower in OSCC (2940.32-1405.50 u/l when compared with controls (11149.60-11243.07 unit/l) and this difference was statistically significant. Postoperatively at 3 months, the serum BChe levels of OSCC patients increased almost two-fold compared to the preoperative values, and this difference was also statistically significant (P = 0.000) After 6 months, these levels further increased but did not reach those of controls. CONCLUSION: BChe can be used as an inexpensive, easy to use, noninvasive biomarker for the evaluation of disease-free survival in OSCC patients.

Evaluation of efficacy of 1% Crystal Violet & Nuclear Fast Red stain compared to Haematoxyline & Eosin stain for assessing mitotic figures in oral premalignant and malignant lesions.

Various chromosomal arrangements in cells undergoing division are referred to as Mitotic figure (MF). The abnormal excess of mitotic figures is commonly seen in oral epithelial dysplasia (ED) and oral squamous cell carcinoma (OSCC). In present study, we compared the number of mitotic figures in normal oral mucosa, epithelial dysplasia & OSCC sections with haematoxyline & eosine (H&E) and 1%Crystal Violet & Nuclear Fast Red (CV&NFR) stain, also the efficacy of the CV&NFR stain as compared to H & E stain. We investigated the correlation between the number of mitotic figures & grades of OSCC. Study sample comprised of two serial sections of archival blocks of normal oral mucosa & diagnosed cases of epithelial dysplasia & OSCC. One slide stained with H& E & the other one with 1% CV & NFR. Mitotic figures were counted with the grid eyepiece. There was significant increase in number of MFs in oral ED and OSCC in comparison with normal oral mucosa. There was a highly significant increase in number of MFs in CV&NFR stained tissue sections when compared with H & E stain. Metaphase is the most commonly observed phase of mitosis. In summary, our study proposes the use of Crystal violet & Nuclear fast red stain as a selective stain for better contrast & easy identification MFs.

Peripheral odontogenic fibroma: a rare gingival neoplasm with clinico-pathological differential diagnosis.

The peripheral odontogenic fibroma (POdF) is a rare gingival neoplasm, characterised by relatively mature collagenous fibrous tissue and varying amounts of odontogenic epithelium. It can be described as a slow growing, firmly attached, solid and smooth gingival mass which may be present asymptomatically for years, which may cause displacement of adjacent teeth. The purpose of this article is to discuss a case of POdF, occurring in the maxillary anterior region, with detailed clinico-pathological differential diagnosis to clarify characteristic features of various gingival overgrowths to enhance easy identification.

Assessment of postoperative pain of oral mucosal biopsy: A health initiative prospective study.

OBJECTIVES: The aim of the present study was to evaluate post-biopsy pain using a questionnaire supported by a visual analog scale (VAS), and the role of pharmacological agents in pain relief. METHOD AND MATERIALS: Three hundred patients undergoing oral biopsy were included in the study and divided into three groups. Group A: Patients received no analgesic post biopsy, except when required (SOS). Group B: Patients received anesthetic mouthwash along with oral analgesic post biopsy. Group C: Patients received anesthetic mouthwash alone. The statistical analysis was done using statistical analysis software SPSS version 11.0. ANOVA was used to compare the VAS scores and hygiene status of the three groups, while Pearson's chi-square test was used for determining association between age, sex, educational status, and association of pain with biopsy site. RESULTS: A highly significant difference was found between the VAS scores of patients in Groups A, B, and C, and significant correlation was observed between hygiene status and degree of pain. CONCLUSION: Oral biopsy is definitely associated with pain, if proper medications are not deployed. Anesthetic mouthwash alone is sufficient to relieve the pain produced by oral biopsy. Direct correlation exists between hygiene status and the level of discomfort, thereby indicating that pain control is essential for good oral hygiene maintenance.

Field cancerization: concept and clinical implications in head and neck squamous cell carcinoma.

Cancer begins with multiple cumulative epigenetic and genetic alterations that sequentially transform a cell or a group of cells in a particular organ. The early genetic events might lead to clonal expansion of pre-neoplastic daughter cells in a particular tumor field. Subsequent genomic changes in some of these cells drive them towards the malignant phenotype. These transformed cells are diagnosed histopathologically as cancers owing to changes in cell morphology. Conceivably, a population of daughter cells with early genetic changes (without histopathology) remains in the organ, demonstrating the concept of field cancerization. The concept of "field cancerization" was first introduced by Slaughter et al in 1953 when studying the presence of histologically abnormal tissue surrounding oral squamous cell carcinoma. It was proposed to explain the development of multiple primary tumors and locally recurrent cancer. With present technological advancement and carefully designed studies using appropriate control tissue will enable identification of important molecular signatures in these genetically transformed but histologically normal cells. Such tumor-specific biomarkers should have excellent clinical utility. This review examines the concept of field cancerization in head and neck cancer and its possible utility in early detection, tumor progression and clinical significance.

Congenital granular cell lesion: A rare tumor of new born.

Congenital granular cell tumor (CGCT), or congenital epulis, is an uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates and may cause respiratory and feeding problems. The histogenesis and clinical history of the lesion remains obscure. Treatment involves surgical excision and recurrences are rare. The present report describes a case of congenital granular cell lesion (CGCL) in the anterior segment of maxillary alveolar ridge of a 2-month-old female. This lesion was causing feeding problem and was excised under local anesthesia, with no recurrence even after 3 years.

Correlation of serum levels of vascular endothelial growth factor with TNM staging, histopathologic grading, and surgical therapy for oral squamous cell carcinoma.

OBJECTIVE: This study aimed to assess the serum levels of vascular endothelial growth factor in oral squamous cell carcinoma patients before and after surgical therapy, to compare these values with those of healthy individuals using ELISA, and to evaluate if any correlation existed between vascular endothelial growth factor levels and TNM stage or histolopathologic grade of the tumor. METHOD AND MATERIALS: The study included three groups: group A1 consisted of 31 oral squamous cell carcinoma patients who had not received any prior treatment; group A2 consisted of the same 31 oral squamous cell carcinoma patients who had undergone radical surgical excision 1 month prior but no adjuvant therapy; and group B (control group) consisted of 16 healthy individuals. The serum vascular endothelial growth factor levels were assessed using the ELISA kit. RESULTS: The vascular endothelial growth factor levels of preoperative oral squamous cell carcinoma patients were found to be three times higher than those of controls, and this difference was found to be statistically significant. The postoperative vascular endothelial growth factor levels had decreased 1 month after surgery but did not decrease to baseline levels. The vascular endothelial growth factor levels increased progressively with the TNM stage and histologic grade of tumor, but no definite correlation between the two could be found. CONCLUSION: Vascular endothelial growth factor is an important marker of angiogenesis, as the vascular endothelial growth factor levels of the oral squamous cell carcinoma groups remained significantly elevated compared to that of controls. Though no significant difference was found between the pre- and postoperative oral squamous cell carcinoma groups, it can be suggested that successful treatment may reduce serum vascular endothelial growth factor levels if the time period of postoperative sample collection is increased. Only then can the utility of vascular endothelial growth factor as marker for assessing the effectiveness of surgical therapy or as a prognostic indicator be commented upon.