Epithelial-myoepithelial carcinoma of retro-molar trigone: Unveiling the mystery of rare diagnosis.

Epithelial-myoepithelial carcinoma (EMC), a low-grade malignant neoplasm of glandular origin, most commonly involves major and occasionally minor salivary glands. It is rare in minor salivary glands such as hard and soft palate, buccal mucosa, tongue, and so on, frequently affecting geriatric females. EMC comprises diverse histo-pathologic features of an epithelial, myoepithelial de-lineating biphasic pattern along with clear cells, sometimes oncocytic differentiation. Aberrant histo-pathologic features in EMC need judicious discrimination from alike entities, which facilitates appropriate surgical management. Here, we present an unusual case report of EMC in the left retro-molar trigone region in a 60-year-old male patient, the complete diagnosis of which was based on clinical, radiological, histo-pathological, and immuno-histo-chemical features.

Validation of a Point-of-Care Optical Coherence Tomography Device with Machine Learning Algorithm for Detection of Oral Potentially Malignant and Malignant Lesions.

Non-invasive strategies that can identify oral malignant and dysplastic oral potentially-malignant lesions (OPML) are necessary in cancer screening and long-term surveillance. Optical coherence tomography (OCT) can be a rapid, real time and non-invasive imaging method for frequent patient surveillance. Here, we report the validation of a portable, robust OCT device in 232 patients (lesions: 347) in different clinical settings. The device deployed with algorithm-based automated diagnosis, showed efficacy in delineation of oral benign and normal (n = 151), OPML (n = 121), and malignant lesions (n = 75) in community and tertiary care settings. This study showed that OCT images analyzed by automated image processing algorithm could distinguish the dysplastic-OPML and malignant lesions with a sensitivity of 95% and 93%, respectively. Furthermore, we explored the ability of multiple (n = 14) artificial neural network (ANN) based feature extraction techniques for delineation high grade-OPML (moderate/severe dysplasia). The support vector machine (SVM) model built over ANN, delineated high-grade dysplasia with sensitivity of 83%, which in turn, can be employed to triage patients for tertiary care. The study provides evidence towards the utility of the robust and low-cost OCT instrument as a point-of-care device in resource-constrained settings and the potential clinical application of device in screening and surveillance of oral cancer.

Lichenoid dysplasia- report of 2 cases and review of literature.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) have an annual malignant transformation rate of 0.5-2.1%. Lichenoid dysplasia (LD) appears clinically similar to OLP, OLL but histologically harbors atypical cells for which it has a greater potential for malignant transformation. The case reports of two female patients are reported here, which were clinically diagnosed as OLP, later as LD following histopathological confirmation. Both had positive tobacco history and extensive intra-oral lesions. Habit cessation was supplemented by non-steroidal therapeutics with periodic follow-up. There was reduction in the burning sensation, lesion size, and the degree of inflammation of the lesions. Clinical lichenoid like features warrants a biopsy to rule out OLP, OLL from LD. Except for palliation, lesion oriented proper therapeutic treatment should be instituted only after histopathological confirmation.

Inter- and Intra-Observer Variability in Diagnosis of Oral Dysplasia

Background: Oral potentially malignant disorders (OPMDs) are lesions from which malignancy is more likely to develop that from other tissues. The potential for malignant transformation of OPMDs is estimated by determining the degree of dysplastic changes in the epithelium. Dysplasia grading has been criticized for lack of reproducibility and poor predictive value but is still considered the gold standard for diagnosing OPMDs. Since grading of dysplasia is based on architectural and cytological changes, there can be considerable inter- and intra-observer variability due to subjective impressions. This aim in this study was to assess the degree of agreement between two pathologists grading dysplasia in the same patients and review the existing grading system. Materials and Methods: In this hospital-based cross-sectional study, 100 patients with clinically diagnosed OPMDs were subjected to biopsy followed by histopathological examination. The slides were examined by two pathologists using WHO and binary systems of classification and both were blinded to the clinical and each other's histological diagnosis. For statistical analysis the Chi square test was applied. Results: Statistical analysis showed poor inter-observer variability with P values of 0.8 using the WHO classification and 0.3 using the binary classification. Conclusion: Our study provides evidence that the existing systems for grading dysplasia are not competent to rule out subjectivity. There is a need for a classification system that can overcome this drawback.