A study to estimate the serum IgA and salivary IgA levels in patients with oral leukoplakia and oral squamous cell carcinoma.

Context: The increasing death rate because of oral cancer is mainly due to its late diagnosis. Tumour markers are often detected in abnormal amounts in blood, urine or saliva of patients with certain types of cancer. Diagnosing cancer through human saliva has advantages such as low invasiveness, minimum cost and easy sample collection. We have used serum immunoglobulin A (IgA) and salivary IgA for our present study. Aims: The aim of present study was to estimate serum and salivary IgA levels in oral leukoplakia and oral squamous cell carcinoma (OSCC) patients. Settings and Design: The study included 40 patients; 10 in the control group, 15 cases with oral leukoplakia and 15 cases with OSCC. Methods and Material: The blood samples and saliva were taken from clinically diagnosed oral leukoplakia and OSCC patients and were tested for IgA levels. Statistical analysis used: The data were analysed using SPSS 16.0. The mean values were compared between the groups by using analysis of variance (ANOVA) followed by post-hoc test for group-wise comparison. P value ≤ 0.05 was considered significant. Results: It was observed that the comparison of levels of serum IgA in control and leukoplakia group; control and OSCC group; leukoplakia and OSCC group were found to be statistically significant. Also, comparison between the levels of salivary IgA in control and OSCC group was found to be statistically significant. Conclusion: It is suggested that the serum and salivary IgA levels could be a better adjuvant diagnostic marker along with routine markers in patients with premalignant and malignant lesions.

A retrospective study to find out the correlation between NAFLD, diabetes, and obesity in Indian patients.

Background: Nonalcoholic fatty liver disease (NAFLD) is present in the body with metabolic disorders such as Type 2 diabetes mellitus (T2DM), obesity, and cardiovascular disease. However, no significant evidence has been found till date exhibiting their association epidemiologically in Indian patients. Objective: To assess the association among NAFLD, T2DM, and obesity, and to validate the scoring system with grades of fatty liver (severity of liver disease) estimated by ultrasound vs. NAFLD fibrosis score, BARD score, and aspartate aminotransferase to platelet ratio index (APRI) score. Methodology: A retrospective, observational study was conducted out in patients with NAFLD (n = 316) where diagnosis and grades of fatty liver were established via ultrasound reports. The patients were divided into two groups, Group A (n = 114, NAFLD with T2DM) and Group B (n = 202, NAFLD without T2DM). R 4.0.0 was used for statistical analysis. Results: The mean age (in years) of the patients was 54.08 ± 10.78 in Group A and 48.10 ± 15.36 in Group B. The mean BMI in Group A was found to be slightly higher as compared to Group B, 27.49 ± 4.94 and 26.56 ± 4.68, respectively, and the difference was found to be statistically significant (p-value <0.05). The overall predictive ability of the NAFLD scoring system matched that to ultrasonography liver grading fibrosis report for approximately 53% of patients. The BARD scoring system was found to be matched with ultrasonography reported Grade 1 fatty liver (198/316). In the case of the APRI scoring system, the association was not observed with ultrasonography reports in any grades of fatty liver. Conclusion: Body mass index might be an independent risk factor for NAFLD. NAFLD fibrosis score appears to be a reliable non-invasive tool to determine the severity of liver fibrosis in NAFLD patients. BARD score may predict Grade 1 liver fibrosis. However, APRI scores do not correlate with imaging evidence of fibrosis like NAFLD and BARD scores.

Primary Intra-Osseous Basaloid Squamous Cell Carcinoma of Mandible: Report of Rare Case with Proposed Diagnostic Criteria.

Basaloid squamous cell carcinoma (BSCC) is a distinctive variant of squamous cell carcinoma (SCC) characterised by nests of basaloid cells. BSCC is an aggressive and rare tumor of head and neck region; and is relatively rare in oral cavity in comparison to SCC. Although, infrequent, but primary intra-osseous SCC (PIOSCC) has been reported in the jaws. There are separate diagnostic criteria for this lesion and a classification for primary intra-osseous carcinoma has been described. No evidence was found in the published literature about primary intra-osseous BSCC (PIOBSCC). We, herein, present a case of giant osteodestructive lesion of the posterior mandible which was diagnosed as PIOBSCC with a correlation of histopathological and immunohistochemical features. As per the best of our knowledge, this is the first case of PIOBSCC of the jaw. There is no diagnostic criterion of PIOBSCC in the literature owing to the extreme rarity of this tumor. A diagnostic criterion is proposed here to make the diagnosis of this tumor easier.

Central Giant Cell Granuloma with Aneurysmal Bone Cyst in a 28-Year Male Patient: A Rare Concurrence.

Central Giant Cell Granuloma (CGCG) is a benign tumor of jaw. As compared to males, females are more commonly affected. Mandible is the common site of occurrence. Aneurysmal bone cysts (ABCs) are cystic lesions which are expansile osteolytic blood-filled lesions. These are commonly seen in the mandible, and they also show gender-predilection towards females. Concurrence of both the lesions is rarely reported. The treatment of both CGCG and ABC depends upon the extent of the lesions as well as on their nature. Due to aggressive nature of the lesions, these usually cause disfigurement of the patients' face. Wide excision is the treatment modality for aggressive lesions to avoid recurrence. We present a case of 28-year male who showed CGCG along with ABC in the same lesion, a rare concurrence.

Central Acinic Cell Carcinoma of the Mandible Simulating as Benign Odontogenic Lesion: A Case Report.

Centrally occurring salivary gland tumors are rare. Because of a considerable overlap between the clinical and histopathological features, this group of tumors often produces a diagnostic difficulty to the clinicians and oral pathologists. Acinic cell carcinoma (ACC) is an unusual, low-grade, malignant salivary gland tumor that represents approximately 2% of the salivary gland tumors with almost 90% arising in the parotid gland. The rest involve the submandibular and the minor salivary gland. ACC of the jaw is extremely rare and, to our knowledge, only 8 cases have been reported in the English literature. Herein, a case of primary intraosseous ACC of the mandible in a 31-year-old woman is presented. The present case is unique, as the central ACC has never been reported in a patient in the third decade of life. The complete surgical removal of the tumor was carried out under general anesthesia along with the extraction of teeth #31, #32, #41, and #42. The follow-up period of 1-year was uneventful.

Basal Cell Adenoma of Hard Palate Involving Maxillary Alveolus.

Minor salivary glands are relatively rare location for these tumors. Microscopically, they are composed of isomorphic cells, similar to basaloid cells with palisading arrangement and distinctive basement membrane like material. Herein, we report a case of BCApresenting as a soft tissue growth of left hard palate involving maxillary alveolus of a 41-year male.

Ortho Keratinized Odontogenic Cyst with Dentinoid Formation.

Orthokeratinized odontogenic keratocyst (OOC) was first identified as orthokeratinized variant of odontogenic keratocyst in 1981 by Wright, due to its different histology and relatively low recurrence rate. Parakeratinized odontogenic cyst is now considered as keratocystic odontogenic tumor (KCOT) owing to its neoplastic nature. Although rare, calcification in the form of dystrophic calcification, dentinoid and cartilage has been reported in KCOT, but calcification in OOC is extremely rare and no case in English literature has been reported so far. Here, we report the first case of OOC with calcification located in the mandible of a 40-year female.

Prognostic Potential of N-Cadherin in Oral Squamous Cell Carcinoma via Immunohistochemical Methods.

OBJECTIVE: To assess the prognostic potential for N-cadherin in oral squamous cell carcinoma and oral epithelial dysplasia. STUDY DESIGN: Across-sectional study, analytical study. PLACE AND DURATION OF STUDY: Maharishi Markandeshwar College of Dental Science Research (MMCDSR), Ambala, India, from 2011 to 2014. METHODOLOGY: Immunohistochemistry was used to observe the N-cadherin expression in 100 cases having epithelium with normal oral mucosa, oral epithelial dysplastic lesions and oral squamous cell carcinoma (OSCC). For statistical significance, SPSS 13.0 was used to calculate the data by Mann-Whitney and Kruskal-Wallis tests. RESULTS: In OSCC, N-cadherin expression was more evident than in oral epithelial dysplasia followed by the normal oral epithelium that did not show any dysplastic changes (p=0.001). Conversely, N-cadherin expression was not significant among the histological grade of OSCC. CONCLUSION: N-cadherin can be used as a potential biomarker for early diagnosis of OSCC. However, the N-cadherin expression did not show any correlation with the histological grade of OSCC.

Angiomyxolipoma of Tongue.

Angiomyxolipoma is a rare histological variant of lipoma, characterized by proliferation of adipose tissue associated with a variable amount of myxoid stroma with numerous thick- and thin-walled blood vessels. An exhaustive literature review could reveal only 12 cases of angiomyxolipoma affecting subcutaneous tissue, subungual area and spermatic cord. In oral cavity, only 2 cases of angiomyxolipoma have been reported to date, one case in the buccal mucosa and one case in the floor of the mouth. Hence, this is only the third case of angiomyxolipoma affecting oral cavity and the first case of angiomyxolipoma of the tongue. We report a case of a 51-year male presenting with a swelling on the right lateral border of the tongue. The lesion was excised and microscopical examination confirmed the diagnosis of angiomyxolipoma.

Psammomatoid Juvenile Ossifying Fibroma of Mandible in a 41-Year Male Patient.

Juvenile ossifying fibroma (JOF) is a rare fibro-osseous neoplasm that develops among the craniofacial bones at an early age; and in majority of patients, it is diagnosed in the first or second decade of life. We present a case in 41-year male patient having it in the left anterior mandibular region. Peripheral eosinophilic areas resembling psammomatoid bodies along with other features impelled the diagnosis of psammomatoid ossifying fibroma. However, the term juvenile seems to be losing impact with the patients showing such features in old age.

Glandular Odontogenic Cyst.

The glandular odontogenic cyst (GOC), though rare, has now become a well known entity. The frequency of GOC ranges from 0.012% to 1.3% of all jaw cysts and its worldwide prevalence is 0.17%. The GOC's microscopic features have been well documented, and are also included in the list of World Health Organization. We report a case of GOC presenting as a unilocular osteodestructive lesion of anterior mandible in a 28-year female. The diagnosis was made on the basis of characteristic histological findings.

Osteogenic Sarcoma of Mandible.

Osteosarcoma (OS) is a malignant neoplasm characterised by the formation of osteoid matrix by neoplastic cells. It is the most common primary malignant bone tumor accounting for 20% of all sarcomas, although its occurrence in the jaw is rare. It shows typical clinical behaviour but varied radiological and histopathological features. It presents various histological aspects. We report a case of 30-year male presented with a painful swelling of mandible, diagnosed as OS after histopathological evaluation.

Can Feulgen Stain be a Reliable Biomarker over PAP Stain for Estimation of Micronuclei Score?

INTRODUCTION: Malignant transformation of the Potentially Malignant Lesions (PML) in the oral cavity is associated with elevated mortality rate because of its aggressive and exceedingly invasive nature. Meticulous diagnosis and prompt therapy of PML may help prevent malignant conversion in oral lesions. Carcinogenic insult to oral cells results in chromosomal damage and formation of Micronuclei (Mn), before the development of clinical symptoms. AIM: To determine the genotoxic effect of smoking and chewing tobacco on target tissue using Mn assay and to evaluate the prevalence of other nuclear anomalies associated with it and to determine the reliability of feulgen stain for Mn assay over Papaincolau (PAP) stain. MATERIALS AND METHODS: PAP and feulgen staining was done to study Mn in individuals who were having tobacco habits (smoking and chewing) without lesion (n=30), individuals who were having tobacco habit (smoking and chewing) with PML (n=30) and apparently healthy subjects (n=30). Data was analysed for statistical significance using SPSS 17.0 by Kruskal - Wallis Test and Bonferronii test. RESULTS: Tobacco habits in the form of smoking and chewing have mutagenic effects on human chromosomes which is indicated by increased frequency of Mn in oral exfoliative cells. The mean Mn frequency using feulgen stain was found to be 12.27 with lesion, 10.23 with without lesion and 3.87 in controls. Whereas, metanucleated analysis revealed no significant correlation with the formation of Mn. Non-specific DNA stain (PAP) showed high numbers of Mn cells in all the groups compared to feulgen. Statistically significant difference (p<0.0001) was observed when both the stains were compared for Mn numbers. CONCLUSION: These findings indicate that the individuals having tobacco habits (smoking and chewing) with lesion have high number of Mn cells, thus supporting the assay to be used as a reliable biomarker to assess the genotoxic effect of tobacco in the oral mucosa. The reason for almost twice as high Mn in PAP stained smears is suggestive of cell injury which is collimated by formation of keratin bodies, resulting in its misinterpretation as Mn, leading to false positive results. Hence, it was concluded that PAP stain can be used to identify abnormal cytological changes resulting from mutagenic agent but not to interpret Mn.

The Oral Carriage of Candida in Oral Cancer Patients of Indian Origin Undergoing Radiotherapy and/or Chemotherapy.

INTRODUCTION: Oral cancer is a challenging disease in Indian subcontinent because of increased use of tobacco and associated products. Although surgery is the main treatment modality, radiotherapy (RT) and chemotherapy (CT) are employed in inaccessible cases. Both RT & CT will result in painful and debilitating adverse effects in oral cavity e.g., mucositis, ulceration, dysgeusia, xerostomia and opportunistic infections. One of the most common opportunistic infection is caused by fungus Candida. AIM: Our aim was to investigate the incidence of oral colonization of Candida species with differentiation between carrier and infective state of the organism. We also investigate the effect of treatment modality (RT and CT) on the incidence of Candida, in oral cancer patients, undergoing RT and/or CT, in order to prevent and treat the Candida infection in a better way. MATERIALS AND METHODS: It was a cross-sectional case-control study; done in Gujarat, India. Fifty patients of oral cancer undergoing RT, CT alone or combined were investigated and compared with the healthy controls. The samples were collected from mid-dorsum of tongue by using imprint culture technique. The samples were inoculated on Sabouraud's dextrose agar medium and the organisms were identified by wet mount, germ tube test, chlamydospore formation and sugar fermentation tests. RESULTS: There was significant increase in oral Candida colonization from 20% in healthy controls to 70% in oral cancer patients undergoing RT and/or CT (p = 0.001, < 0.05). A significant increase in infective state of Candida (71.4%) was noted (p = 0.001, < 0.05) with predominance of non-albicans species of Candida, chiefly C. tropicalis (42.8%). CONCLUSION: RT and CT leads to increased oral colonization and infection by Candida with a shift towards growth of non-albicans species. As the pattern of candidal species infection is changing, such studies are important for better diagnosis and treatment planning to gain good control over the disease.