Oral focal mucinosis in adolesence: a sparingly diagnosed clinicopathologic entity.

OBJECTIVE: Oral focal mucinosis an oral counterpart of cutaneous focal mucinosis, is a rare disease of unknown etiology. Its pathogenesis may be due to the overproduction of hyaluronic acid by a fibroblast, at the expense of collagen production, resulting in focal myxoid degeneration of the connective tissue, primarily affecting the mucosa overlying the bone. Oral focal mucinosis occurs predonderantly in adults during the fourth and fifth decade of life, although it has been reported sparingly in children and adolescents. It has no distinctive clinical features, as the diagnosis is solely based on the histopathological features and treatment involves complete surgical excision. Recurrence is unreported. This case report put forward the clinical and histological presentation and consequent management of Oral focal mucinosis in an adolescent female patient.

Candidal carriage in diabetic patients: a microbiological study.

OBJECTIVE: Candida yeast species are widespread opportunistic microbes and incidence of its carriage in diabetic patients compared with non-diabetic controls is not clearly defined. The present study was carried out to isolate and identify the candida species in type I, type II diabetes mellitus patients and in controls. Study comprised of 60 subjects in the age range of 20 to 65 years, consisting of two groups of diabetes patients with controlled diabetic status (20 subjects each with type I and type II) and 20 age and sex matched controls. Saliva samples were collected from all groups and inoculated on Sabouraud's Dextrose Agar (SDA) to check for the fungus growth. The confirmed candidal colonies were further inoculated on CHROMagar for different colour differentiation. Out of 60 samples, 40 (66.67%) showed a positive fungal prevalence. Out of 40 positive fungal prevalence 82.50% were representative of candida. The positive fungal prevalence for candida I was 48.48%, in group II was 30.30%, in group III was 21.21 %. Further speciation in CHROMagar revealed different species of candida predominantly of candida albicans 20% and few mixed culture of candida albicans with candida krusei 5% and candida albicans with candida tropicalis 5% in group I. In group II, candida albicans was 35% and mixed culture of candida albicans with candida glabrata was 5%. In group III, candida albicans was 25% and candida tropicalis was 5%. The findings confirm that diabetic patients harbor yeast in their oral cavity and are more susceptible to oral candidiasis and also that CHROMagar medium is a satisfactory isolation medium for oral cavity specimens, allowing rapid and accurate identification of yeast colonies with easy recognition of mixed culture and is easy to use.

The role of novel prognostic markers PROX1 and FOXC2 in carcinogenesis of oral squamous cell carcinoma.

OBJECTIVE: Oral squamous cell carcinoma is the most common malignant tumor of the head and neck regions and accounts for more than 90% of cancers in the oral cavity. The angiogenesis, lymphangiogenesis and epithelial mesenchymal transition are known to be pivotal for tumor progression and metastasis. In the last decade, much data has been generated concerning the molecular mechanisms of angiogenesis, lymphangiogenesis and its significance in pathological conditions. The main angiogenic and lymphangiogenic factors have been identified as vascular endothelial growth factor A (VEGF-A), vascular endothelial growth factor receptor 2 (VEGFR-2), forkhead box (FOX) C2 while vascular endothelial growth factor C/D (VEGF-C/D), vascular endothelial growth factor receptor 3 (VEGFR-3), Prospero homeobox 1 (PROX1), LYVE-1, podoplanin, Tie/Angioprotein (Ang) 2 and EphrinB2 respectively. PROX1 is a mammalian homologue of Drosophilia homeobox protein, prospero and important for the embryonic development of many mammalian tissues. It has been suggested that it plays various tissue dependent functional roles, which reflects both oncogenic potential and a tumor suppressive role. The exact role in OSCC remains controversial. FOXC2 is a transcription factor belongs to large family of protein, forkhead box. It has been shown to be involved in cancer angiogenesis, proliferation and metastasis through its induction of epithelial-to-mesenchymal transition while its significance in OSCC remains unknown. Based on these data, this article reviews the role of novel prognostic factors PROX1 and FOXC2 in carcinogenesis of OSCC so that they might be considered as an attractive therapeutic target for both tumor associated blood vessels, lymphatic vessels and tumor cells.

Prevalence of oral squamous cell carcinoma in Bareilly Region: A seven year institutional study.

BACKGROUND: Oral squamous cell carcinoma is a major contributor to disability and death caused by malignant tumors. Variations in social, cultural, and geographic factors affect the tumor behavior and response to treatment. In this study, we undertake a seven years institutional review and analysis of Oral squamous cell carcinoma cases in Bareilly. MATERIALS AND METHODS: A total of 1938 histologically diagnosed cases during the period of seven years i.e. from 2010 to 2016 were extracted from the archives of Department of Oral & Maxillofacial Pathology, Institute of Dental Sciences, Bareilly and evaluated to know the prevalence of Oral squamous cell carcinoma. The details like age, sex, habits and anatomical site were also recorded from the archived patient's case sheets. RESULTS: Out of the total 1938 cases, 318 were found to be Oral squamous cell carcinoma of which 232 were males and 86 were females. Incidence was highest in 40-49 year age group. The most common site was buccal mucosa (190 cases), followed by tongue (68 cases). Most lesions were well differentiated Oral squamous cell carcinoma (230 cases). Patients with poorly differentiated lesions had a comparatively lower mean age than their counterparts with other histological varieties. CONCLUSION: The pattern of Oral squamous cell carcinoma differs from that of previous studies in relation to incidence and age correlation with the grade of carcinoma. The majority of the lesions were well differentiated. There is a need for intensive oral health awareness to encourage early presentation to cancer center as early detection will further enhance prognosis.

Leiomyosarcoma of maxilla: a case report with review of literature.

OBJECTIVE: One challenging feature of head and neck pathology is that a dizzying array of spindle cell lesions occurs here which ranges all the way from reactive, very aggressive forms to malignant lesions. Leiomyosarcoma is one such malignant tumour of mesenchymal origin exhibiting smooth muscle differentiation; presenting generally nonspecific signs and symptoms. Here we present a case of leiomyosarcoma in a 21 year old female patient associated with single reddish pink swelling present in the posterior right maxillary tuberosity region with moderate facial asymmetry. On histopathological analysis, all the classic features were noted and diagnosis of a spindle cell neoplasm was made without any obscurity. There are many lesions like rhabdomyosarcoma, fibrosarcoma, liposarcoma, multiple peripheral nerve sheath tumour, angiosarcomas, melanomas, kaposi sarcoma, solitary fibrous tumors, etc., which mimic leiomyosarcoma clinically and histopathologically and therefore immunohistochemical staining with specific markers plays a vital role in arriving at a conclusive diagnosis.

Diffuse large B cell lymphoma of hard palate: a case report with literature review.

OBJECTIVE: Lymphomas are diverse group of neoplasm affecting the lymphoreticular system. Diffuse large B cell lymphoma is the most frequently diagnosed type of non-Hodgkin lymphoma and is the fifth most frequent malignancy, accounting for about 40% of cases reported. In the present case report a 40 year old female patient complains of swelling on right side of face since 45 days and gradually increased to present size. Intra-orally an ulcero-proliferative growth was present on the right side of hard palate. Incisional biopsy was suggestive of Lymphoproliferative disorder. Panel of immunohistochemical antibodies were used; which showed positivity for CD45, PAX5, Bcl2, Ki67, CD138 and negativity for CD3, CD10, CD20 and CD30. Therefore through routine standard hematoxylin and eosin staining a clear cut diagnosis of specific lymphoma was difficult to obtain and thus immunohistochemistry plays an important role in confirming the pinpoint diagnosis.

Osteosarcoma: A Diagnostic Dilemma.

OBJECTIVE: Osteosarcoma is a primeval disease which is still partly understood. It is a malignancy of mesenchymal cells that have the capacity to generate osteoid or immature bone. There have been an abundance of debate and controversies about the nature, aggressiveness, behavior, and various treatment modalities of this entity. Different histologic variation has been common in osteosarcoma; hence multiple diagnostic approaches are vital in all cases. Detection of precise anatomic and histologic variants is of prime importance in view of better outcome. The purpose behind writing this case report was to highlight the importance of various investigation techniques for an affirmative diagnosis.

Neck dissections: emerging role of oral pathologists.

BACKGROUND: Surgical resection has been the principle treatment approach for early lesions as well as advanced stage carcinomas of upper aero digestive tract. Neck dissection is the primary treatment given to nodal metastasis of oral carcinomas. Choice of irradiation and chemotherapy post surgery relies heavily on the histopathological assessment of surgical margins of resected tumor, dissected lymph nodes and accessory tissues. METHODS: A total of ten cases of head and neck carcinomas reported in two years period were analyzed. The tissues were assessed histopathologically for tumor grade, margin status, nodal metastasis and vascular invasion. RESULTS: Out of the total 10 neck dissection specimens, eight cases were of Well Differentiated Squamous Cell Carcinoma, one each of ameloblastic carcinoma and occult cancer with metastasis in cervical lymph nodes. In case of marginal clearance, two cases were negative, one case was of occult primary and seven cases had positive involvement at the margin, of which five cases demonstrated tumor component at <5mm from the surgical cut margin and two cases at >5mm. Concerning the nodal involvement, four cases were positive, five were negative, while in one case no lymph node was available for assessment. Among the accessory tissues received, submandibular gland and perinodal tissue involvement was seen in one case each whereas skin and muscle involvement was negative for tumor cells in all the cases. CONCLUSION: The emphasis is on the role of oral pathologists in assessment of such neck dissection specimens. The information provided would maximize treatment outcome and minimize recurrence.

Dentigerous cyst associated with ectopically impacted maxillary second premolar.

Dentigerous cysts are benign odontogenic cysts that are accompanying with the crown of permanent teeth. They are typically single in incidence and are situated in the mandible. They are usually associated with impacted mandibular third molar and maxillary canines. Here we report a very rare presentation of dentigerous cyst in anterior maxilla accompanying with ectopically impacted maxillary second premolar. The cyst was enucleated along with extraction of premolar.

Immunohistochemical expression of paxillin in ameloblastoma and odontogenic keratocyst: An observational study.

Background: Cell adhesion molecules (CAMs) are found on the surface of all cells, where they allow dynamic processes to take place. These include cadherins, integrins, selectins and Immunoglobulin superfamily. Directly associated with ß-integrin tails is a multidomain protein known as paxillin. However, CAMs participate in cell-cell and extracellular matrix-cell interactions during histomorphogenesis in the various phases of odontogenesis. Some tumours or cysts like ameloblastoma (AB) or odontogenic keratocyst (OKC) having odontogenic origin show disturbance in the interaction of these CAMs. Hence, the assessment of paxillin expression in AB and OKC was carried out. Materials and Methods: The present observational study comprised 30 clinically and histologically confirmed cases of AB and OKC. All the slides were stained immunohistochemically using a paxillin antibody. Results: Upon comparison of staining intensity of paxillin among AB and OKC showed statistically significant result, whereas quantitative staining and final summation showed non-significant result. Gender-wise comparison of paxillin staining intensity, quantitative staining and final summation among OKC showed significant result; however, in AB, staining intensity showed non-significant result, whereas quantitative staining and final summation showed significant result. Conclusion: Paxillin has the greatest influence on tissue morphogenesis and development. The regulation of cell mobility is aided by the multiple roles that paxillin plays in a range of cells and tissues. However, further studies using a large sample size, along with other molecular analytical methods, may be essential to draw a definite conclusion about the association of paxillin and its exact function in OKC and AB.

Development of Automated Risk Stratification for Sporadic Odontogenic Keratocyst Whole Slide Images with an Attention-Based Image Sequence Analyzer.

(1) Background: The categorization of recurrent and non-recurrent odontogenic keratocyst is complex and challenging for both clinicians and pathologists. What sets this cyst apart is its aggressive nature and high likelihood of recurrence. Despite identifying various predictive clinical/radiological/histopathological parameters, clinicians still face difficulties in therapeutic management due to its inherent aggressive nature. This research aims to build a pipeline system that accurately detects recurring and non-recurring OKC. (2) Objective: To automate the risk stratification of OKCs as recurring or non-recurring based on whole slide images (WSIs) using an attention-based image sequence analyzer (ABISA). (3) Materials and methods: The presented architecture combines transformer-based self-attention mechanisms with sequential modeling using LSTM (long short-term memory) to predict the class label. This architecture leverages self-attention to capture spatial dependencies in image patches and LSTM to capture sequential dependencies across patches or frames, making it suitable for this image analysis. These two powerful combinations were integrated and applied on a custom dataset of 48 labeled WSIs (508 tiled images) generated from the highest zoom level WSI. (4) Results: The proposed ABISA algorithm attained 0.98, 1.0, and 0.98 testing accuracy, recall, and area under the curve, respectively, whereas VGG16, VGG19, and Inception V3, standard vision transformer attained testing accuracies of 0.80, 0.73, 0.82, 0.91, respectively. ABISA used 58% fewer trainable parameters than the standard vision transformer. (5) Conclusions: The proposed novel ABISA algorithm was integrated into a risk stratification pipeline to automate the detection of recurring OKC significantly faster, thus allowing the pathologist to define risk stratification faster.

Building Automation Pipeline for Diagnostic Classification of Sporadic Odontogenic Keratocysts and Non-Keratocysts Using Whole-Slide Images.

The microscopic diagnostic differentiation of odontogenic cysts from other cysts is intricate and may cause perplexity for both clinicians and pathologists. Of particular interest is the odontogenic keratocyst (OKC), a developmental cyst with unique histopathological and clinical characteristics. Nevertheless, what distinguishes this cyst is its aggressive nature and high tendency for recurrence. Clinicians encounter challenges in dealing with this frequently encountered jaw lesion, as there is no consensus on surgical treatment. Therefore, the accurate and early diagnosis of such cysts will benefit clinicians in terms of treatment management and spare subjects from the mental agony of suffering from aggressive OKCs, which impact their quality of life. The objective of this research is to develop an automated OKC diagnostic system that can function as a decision support tool for pathologists, whether they are working locally or remotely. This system will provide them with additional data and insights to enhance their decision-making abilities. This research aims to provide an automation pipeline to classify whole-slide images of OKCs and non-keratocysts (non-KCs: dentigerous and radicular cysts). OKC diagnosis and prognosis using the histopathological analysis of tissues using whole-slide images (WSIs) with a deep-learning approach is an emerging research area. WSIs have the unique advantage of magnifying tissues with high resolution without losing information. The contribution of this research is a novel, deep-learning-based, and efficient algorithm that reduces the trainable parameters and, in turn, the memory footprint. This is achieved using principal component analysis (PCA) and the ReliefF feature selection algorithm (ReliefF) in a convolutional neural network (CNN) named P-C-ReliefF. The proposed model reduces the trainable parameters compared to standard CNN, achieving 97% classification accuracy.

Cyclin d1 expression and its correlation with histopathological differentiation in oral squamous cell carcinoma.

BACKGROUND: Cyclin D1 regulates the G1 to S transition of cell cycle. Its deregulation or overexpression may lead to disturbance in the normal cell cycle control and tumour formation. Overexpression of cyclin D1 has been reported in various tumors of diverse histogenesis. This case control retrospective study was carried out to study the immunohistochemical reactivity and expression of cyclin D1 and its association with site, clinical staging, and histopathological differentiation of oral squamous cell carcinoma (OSCC). METHODS: Forty formalin-fixed paraffin-embedded tissue blocks of biopsy specimens of oral squamous cell carcinoma were immunohistochemically evaluated for expression of cyclin D1. RESULTS: Cyclin D1 expression was seen in 45% cases of OSCC. It did not correlate with site and clinical staging. Highest expression was seen in well-differentiated, followed by moderately differentiated, and poorly differentiated squamous cell carcinomas, with a statistically significant correlation. CONCLUSION: Cyclin D1 expression significantly increases with increase in differentiation.

Comparison of blood parameters between periodontitis patients and healthy participants: A cross-sectional hematological study.

Background: Bacteria and their products involved in periodontitis evoke an immunoinflammatory response in the host tissue. Inflammatory diseases, such as periodontitis, are often not just a local event, but may have systemic ramifications, including elevations in the numbers of circulating leukocytes, acute-phase proteins and oxidative stress markers. It is now emerging that also erythrocytes are affected by chronic inflammatory diseases. This phenomenon, named "anemia of inflammation," is not caused by marrow deficiencies or other diseases. The present study aimed to assess whether there was any relation between chronic periodontitis and hematological parameters. Materials and Methods: A total of 80 patients were included in the study and were divided into the healthy and periodontitis groups. Blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes, platelets, red blood cell (RBC) distribution width (RDW), mean corpuscular volume (MCV), platelet count and neutrophil-leukocyte ratio (NLR). Further, the values were gathered and subjected to statistical analysis. Unpaired t-test was performed to assess the statistical significance between the groups and P < 0.05 and < 0.001 were considered to be statistically significant. Results: Results show statistically significant difference seen in leukocytes, lymphocytes, RDW, MCV, platelet count and NLR which was higher in patients with periodontitis, all other parameters are nonsignificant. Conclusion: Thus, within limitations, it can be concluded that increased levels of leukocytes, lymphocytes, RDW, MCV, platelet count and NLR depict the inflammatory state and destructive nature of periodontitis.

Immunohistochemical expression of paxillin in potentially malignant disorders and squamous cell carcinoma patients.

Background: Cell adhesion molecules are essential to maintain the integrity of stratified squamous epithelium but their expression has to be dynamic to aid the mobility and turnover of cells. Paxillin is one such multi-domain protein which integrates numerous signals from cell surface receptors, integrins and growth factors. It thus functions as a regulator of various physiological and pathological processes including tissue remodeling, cell motility, gene expression, matrix organization, cell proliferation, metastasis and survival. Hence, the assessment of paxillin expression in normal control, potentially malignant disorders and oral squamous cell carcinoma patients was carried out. Material and Methods: The present retrospective study comprised of 20 each clinically and histologically confirmed case of normal control, potentially malignant disorders, and oral squamous cell carcinomas. All the slides were stained immunohistochemically using Paxillin antibody. Results: The localization, staining intensity and percentage of positivity for paxillin expression was statistically significant among normal control and potentially malignant disorders, whereas oral squamous cell carcinoma showed a non-significant difference. Upon comparison of histopathological grading of potentially malignant disorders, mild versus severe and moderate versus severe epithelial dysplasia showed a statistical significant difference among all the parameters of paxillin expression. However, WDSCC & MDSCC a statistically significant difference among localization and staining intensity of paxillin. Conclusion: Paxillin may play an important role in pathogenesis of oral squamous cell carcinoma by altering the adhesive properties of the tumor cells interacting with the extracellular matrix which in turn affects their invasive behavior and histologic differentiation.

Traumatic ulcerative granuloma with stromal eosinophilia: A puzzle.

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative condition of the oral mucosa amid a chronic course and delayed healing. It is a reactive lesion that usually affects the tongue. TUGSE is a rare mucosal lesion to aid as an ulcer or an indurated submucosal mass and might cause diagnostic problems as it mimics a traumatic or neoplastic ulcer. However, chronic irritation from traumatic agents is well thought out to be a major initiating aspect. Histopathologically, it is categorized by an eosinophilic inflammatory infiltrate penetrating into the underlying muscle. It is significant to make out this mucosal lesion as it mimics malignant ulcers; the condition tends to resolve on its own. Thus, attentiveness of this entity is imperative to emphasize the accurate diagnosis of indurated ulcerated lesions and convey suitable and effective treatment. The present case highlights the clinical aspects, etiopathogenesis and histopathology of this unusual lesion.

Anti candidal efficacy of commercially available triphala, neem, denture cleanser and natural aloevera leaf on heat polymerized acrylic resin.

Aim: The aim of the study was to evaluate the anticandidal efficacy of Triphala, aloe vera, Neem, and denture cleanser on heat polymerized acrylic resin. Settings and Designs: In vitro - experimental study. Materials and Methods: In this study, forty denture wearer patients were selected and were divided into four groups consisting of ten patients, namely, Group I, Group II, Group III, and Group IV, in which dentures were cleansed with denture cleanser (tablets), Triphala (churna), aloe vera (leaf), and Neem (tablets), respectively, and stored in copper containers. Swabs were collected from the dentures before and after the use of Denture cleanser, Triphala, aloe vera, and Neem. Thereafter, the swabs were cultured on Sabouraud dextrose agar and the total Candida counts (CFU/4 cm2) were determined. Statistical Analysis Used: One way ANOVA and Tukeys HSD post hoc test were used. Results: The pre- to post-reduction in mean Candida count was found highest in Denture cleanser followed by Neem, Triphala, and aloe vera. Further, both Denture cleaner and Neem showed statistically significant reduction (P < 0.001) in the mean Candida count when compared to Triphala and aloe vera. However, reduction in the mean Candida count of both Denture cleanser and Neem was found statistically similar (P > 0.05). Conclusion: The anticandidal efficacy of denture cleanser was found to be the highest. The cost-effective Neem can be used as anticandidal modality in place of denture cleanser.

Oral mucocele in infant with an unusual presentation.

Mucocele is a benign lesion characterised by an extravasation or retention of mucous secretion in submucosal tissue from minor salivary glands. The occurrence of mucocele is common in the oral cavity, with more than 70% of cases on lower labial mucosa. The occurrence of mucocele on the tongue is considered rare and accounted for only 2.25% in the previous literature. Histopathological examination plays a great role in the confirmation of the clinical diagnosis. Management of mucocele is at times challenging. This paper highlights a rare case of mucocele in a 5-month-old infant who was successfully managed under day-care anaesthesia.

Evaluation of titanium-prepared platelet-rich fibrin and leucocyte platelet-rich fibrin in the treatment of intra-bony defects: A randomized clinical trial.

Background. Various treatment modalities, such as leucocyte platelet-rich fibrin (L-PRF), bone grafts, and membranes, have been used for the restoration of lost periodontal tissues. Titanium-prepared platelet-rich fibrin (T-PRF) has attracted attention for its proper haemocompatibility, thick fibrin meshwork, and long resorption time. The present study aimed to evaluate the effectiveness of T-PRF and L-PRF in the management of intra-bony defects based on clinical and radiographic criteria. Methods. Twenty-six subjects with 34 intra-bony 3- walled defects were divided into two groups (n=17) and treated with T-PRF or L-PRF. Clinical and radiographic measurements were recorded at baseline and 6- , 3- and 9- month intervals and tabulated on Microsoft Excel spreadsheets. For intra- and intergroup comparisons, paired and unpaired t-tests were performed. P<0.05 was set as statistically significant Results. Intra-group comparisons revealed statistically significant differences (P<0.05) from baseline in both groups regarding clinical measurements. On intergroup comparison, the T-PRF group exhibited a significantly higher defect fill compared to the L-PRF group (P<0.05). Conclusion. Within the limits of the present study, T-PRF seems to be a better alternative to L-PRF in the treatment of intra-bony defects.

Grub in the mouth: an unusual case with review of literature.

Oral myiasis is a rare disease, identified primarily in non-industrialised nations. It is caused fundamentally by the attack of larvae from Dipteran flies on the human tissues. Predisposing factors for oral myiasis are extraction wounds, destitute oral cleanliness, meagreness, mouth breathing amid rest, suppurative injuries, necrotic tissues, diabetes and perivascular infections primarily within the elderly, extreme halitosis, alcohol addiction, cerebral paralysis and components that favour prolonged mouth opening. Myiasis may have predilection to patients with mental challenges, cerebral palsy and hemiplegia due to unfortunate physical agility. The present case reports an oral myiasis in a 25-year-old woman who was mentally challenged. This condition was treated by topical application of turpentine oil with manual expulsion of hatchlings, taken after by surgical debridement and wide range antimicrobials.