Sarcomatoid Carcinoma: A Clinicopathological Dichotomy.

Spindle cell carcinoma (SpCC) or sarcomatoid carcinoma is an uncommon biphasic malignant neoplasm occurring mainly in the upper aerodigestive tract. It has spindled or pleomorphic tumor cells simulating a true sarcoma with epithelial origin. WHO recognized this tumor as an aggressive variant of squamous cell carcinoma and further designated it as spindle cell carcinoma. This neoplasm is known for its propensity of recurrence and metastasis reinforcing the importance of its proper diagnosis. In our case report, we talk about sarcomatoid carcinoma involving the oral cavity having a high metastasizing rate according to histopathological and immunohistochemical features.

Metastatic mucinous adenocarcinoma from breast mimicking a pyogenic granuloma in the gingiva: a case report.

Mucin-producing adenocarcinomas (MAC) are an extremely rare, indistinct group of neoplasm having either a salivary gland origin or with prominent glandular component. The diagnosis is chiefly based on the histological aspect conjoined with immunohistochemical evaluation as clinico-radiographical features are non-specific. It can arise as a primary metastasis to soft tissues, most commonly from either lung, breast, kidney, or colon. This paper reports a 51-year-old woman with buccolingual gingival swelling having a final diagnosis of metastatic mucinous adenocarcinoma from the breast. A tissue biopsy was performed followed by immunohistochemistry that confirmed the diagnosis. They are extremely rare, making the diagnosis challenging as it may mimic a benign neoplasm. It accounts for approximately 1% of all oral malignant neoplasms having gingival propensity. The clinician should therefore take into account every diagnostic aspect while encountering such oral lesions to achieve proper patient welfare.

Decoding the Rarity: A Unique Case of Clear-Cell Variant of Oral Squamous Cell Carcinoma.

The clear-cell variant of oral squamous cell carcinoma is an extremely rare histological variant and an incompletely understood entity. Clear cell appearance in squamous cell carcinoma may be attributed to hydropic degeneration of neoplastic cells. We report a case of a 32-year-old male patient who presented with an ulceroproliferative growth in the left maxillary posterior region on the hard palate and gingiva, obliterating the buccal vestibule. Histopathologic examination revealed thick anastomosing strands of round to ovoid neoplastic cells with predominantly clear cytoplasm and marked cellular and nuclear pleomorphism infiltrating into the fibro-cellular connective tissue stroma. Special staining and immunohistochemistry (IHC) were performed to rule out the differentials of clear-cell variants of different sites such as salivary gland, odontogenic origin, and metastatic tumors. The clear cells were negative for periodic acid Schiff (PAS) and mucicarmine. The malignant clear cells showed positive reactions with IHC markers pan-cytokeratin and P63 and yielded negative results for S100 and CD10, confirming the diagnosis as a clear-cell variant of oral squamous cell carcinoma. We emphasize the importance of prompt and comprehensive diagnostic work-up to identify this rare, aggressive, and possibly fatal neoplasm.

Myxomatous Mysteries: Decoding the Oral Focal Mucinosis.

Oral focal mucinosis (OFM) is a unique benign lesion of the oral cavity with uncertain etiology which is analogous to cutaneous focal mucinosis. It mainly affects women in their fourth and fifth decades of life. The diagnosis of this condition is based on histopathological examination, as it lacks characteristic clinical and radiographic features. Its pathophysiology is associated with fibroblasts producing excessive amounts of hyaluronic acid, which causes localized myxomatous changes. Here, we describe the occurrence of this rare entity in a 54-year-old female patient involving attached gingiva of the left posterior mandibular region along with emphasis on its histopathological and histochemical findings to differentiate it from clinically and microscopically look-alike lesions.

Anti-Mullerian Hormone as a Marker of Ovarian Reserve and Function.

BACKGROUND: Ovarian reserve tests are required to screen women with a diminished ovarian reserve so that women who are more likely to exhibit poor response to ovarian stimulation and a lower likelihood of becoming pregnant with treatment can be identified. AIM AND OBJECTIVES: This study aimed to determine whether serum anti-Mullerian hormone (AMH) level is a better predictor of ovarian reserve and function than other biochemical tests for ovarian reserve. The primary objective of this study was to find out the correlations of day 3 serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, inhibin B, AMH, ovarian volume, and antral follicle count (AFC) with advancing age; and a secondary objective was to find out the correlations between day 3 serum AMH, LH, FSH, estradiol, and inhibin B levels with AFC. METHODS: This was a prospective, single-center, observational study. A total of 100 infertile women who attended the Gynecology outpatient department over a period of two years and met the inclusion criteria were included in the study. History, clinical examination, routine investigations, hysterosalpingography for tubal patency, estimation of day 3 serum AMH, LH, FSH, estradiol and inhibin B, measurement of ovarian volume, and AFC were done. Correlations of different parameters with advancing age and with AFC were found using Spearman's rho correlations. p-value < 0.05 was considered significant. RESULTS: The maximum infertile women were in the age group of 21-30 years (58 of 100). Serum AMH showed the strongest negative correlation (r=-0.931) with age, followed by AFC (r=-0.884), ovarian volume (r=-0.876), and inhibin B (r=-0.878), whereas serum LH, FSH, and estradiol showed a positive correlation (r=0.589, 0.408, and 0.638 respectively). Serum AMH also showed a strong positive correlation (r=0.972) with AFC followed by ovarian volume (r=0.919) and inhibin B (r=0.769), whereas serum LH, FSH, and estradiol showed a negative correlation (r=-0.504, -0.663, and -0.543 respectively) with AFC.  Conclusion: Among all the different tests of ovarian reserve, serum AMH was the most reliable indicator of reproductive aging and decline in the ovarian pool as well as very closely related to AFC, which is one of the best predictors of ovarian reserve.