Neutrophil: Lymphocyte ratio and oral squamous cell carcinoma: A preliminary study.

INTRODUCTION/BACKGROUND: It is well-established that host response plays a vital role in the determination of biological behavior of tumors. Inflammatory response against tumors has been a focus of research in recent years. There has been extensive research regarding inflammatory reaction in oral squamous cell carcinoma (OSCC) in tissue specimens. However, there is no much data regarding systemic inflammatory response in OSCC. It was recently reported that an elevated neutrophil:lymphocyte ratio (NLR) may correlate with aggressive biological behavior in various malignancies including head-and-neck tumors. Thus, the study was undertaken with the aim of evaluation of NLR in peripheral blood of patients suffering from OSCC. MATERIALS AND METHODS: The research was a prospective, case-control study. Hundred patients suffering from OSCC and 100 healthy individuals were included in the study, after obtaining informed consent. NLR was determined from the differential leukocyte count obtained from complete blood count in each case. Comparison of NLR was made among two groups. RESULTS: The mean value of absolute neutrophil count was found to be significantly higher in OSCC cases than in controls (P < 0.01). The mean value of NLR in OSCC was found to be 2.84, and in controls, it was 1.95. This difference was found to be statistically significant (P < 0.001). CONCLUSION: NLR and other hematological parameters may serve as surrogate marker for potential aggressive behavior of OSCC and may help in prognostic prediction of these cases.

Evaluation of relationship between serum homocysteine and Vitamin B12 levels in oral submucous fibrosis patients using chemiluminescence immunoassay.

BACKGROUND: Serum homocysteine (Hcy), a nonessential amino acid, is considered as a helpful indicator of vitamin status for its strong correlation with Vitamin B12. Although Hcy levels in oral submucous fibrosis (OSMF) have been studied, the relationship between Hcy and Vitamin B12 has not been studied yet. This study is the first one to compare and correlate the levels of serum Hcy and Vitamin B12 in OSMF patients. MATERIALS AND METHODS: The study group comprised 60 patients. Serum Hcy and Vitamin B12 estimation were done by chemiluminescence immunoassay. These levels in OSMF patients were compared and correlated with corresponding levels in healthy controls. RESULTS: Hcy levels were elevated in OSMF and were found to be statistically significant (P = 0.014) as compared to healthy controls. On the contrary, although Vitamin B12 levels were found to be higher in healthy controls, the difference was statistically nonsignificant (P = 0.657). A significant correlation was found (P = 0.01) between Hcy and Vitamin B12 in both groups, i.e., decreased Vitamin B12 levels led to elevated Hcy levels but vice versa was not found. No correlation was found between levels of Hcy and the severity of OSMF (P = 0.806). CONCLUSION: Chronic inflammation in OSMF leads to hyperhomocysteinemia, which may also be seen in cases of Vitamin B12 deficiency and certain systemic disorders. Thus, while serum Hcy could be used as biomarker for OSMF, Vitamin B12 deficiency and certain systemic disorders should be ruled out.

Quantitative assessment of tumor-associated tissue eosinophilia and mast cells in tumor proper and lymph nodes of oral squamous cell carcinoma.

Background: Oral squamous cell carcinoma (OSCC) is the most common cancer of the oral cavity. Tumor stage, thickness, lymph node metastasis (LNM), extranodal spread, perineural invasion, tumor differentiation, mutations, human papillomavirus infection and tumor microenvironment are independent prognostic indicators of OSCC. However, clinically, among all factors, LNM is considered an important prognostic factor in OSCC as it not only determines the stage of disease but also the strongest independent factor which predicts recurrence of disease. Further research proves that there are several biologically important factors in tumor tissue and LNs which promote or defend LNM. While it is proposed that tumor-associated tissue eosinophils (TATE) and mast cells (MCs) have "immuno-protective" effect, this remains unproven and various researchers have conflicting opinion. Aim: The aim is to determine the presence of TATE and MCs in OSCC and to evaluate if any association exists between them and LNM. Study Design: It is a comparative retrospective study between two groups including 35 OSCC cases positive and 35 negative for LNM. Materials and Methodology: Quantification of cells was done by counting total number of cells in 10 high-power fields under ×40 objective lens using "zigzag" method and dividing it by total number of fields. Eosinophils stained bright red with carbol chromotrope and MCs purple-violet with toluidine blue. Statistics: Independent t-test and Pearson's correlation were done using STATA IC 0.2 software. The level of significance was at 5%. Comparison of eosinophil and MC infiltration was done based on gender, metastatic, nonmetastatic LN and in tumor proper. Results and Conclusion: Our study showed weak positive correlation between mean eosinophils count in tumor and LNs which implies a definite association between the microenvironment of tumor, its progression and LNM. There was a significant association between MC density and decreased LNM also. We conclude that an increased number of immunological cells (TATE and MCs) are a favorable prognostic indicator in OSCC. There is evidence of reduction in LNM with increasing density of these immunological cells. Recognition of TATE and MCs as integral to tumor biology opens an avenue for novel approaches to cancer therapies.

Quantitative assessment of tumor-associated tissue eosinophilia and mast cells in tumor proper and lymph nodes of oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most common cancer of oral cavity. Tumor stage, thickness, lymph node metastasis (LNM), extranodal spread, perineural invasion, tumor differentiation, mutations, human papillomavirus infection, and tumor microenvironment are independent prognostic indicators of OSCC. However, clinically, among all factors, LNM is considered an important prognostic factor in OSCC as it not only determines the stage of disease but also the strongest independent factor which predicts recurrence of disease. Further research proves that there are several biologically important factors in tumor tissue and LNs which promote or defend LNM. While it is proposed that tumor-associated tissue eosinophils (TATE) and mast cells (MCs) have "immuno-protective" effect, this remains unproven and various researchers have conflicting opinion. AIM: The aim is to determine the presence of TATE and MCs in OSCC and to evaluate if any association exists between them and LNM. STUDY DESIGN: It is a comparative-retrospective study between 2 groups including 35 OSCC cases positive and 35 negative for LNM. MATERIALS AND METHODOLOGY: Quantification of cells was done by counting total number of cells in 10 high-power fields under ×40 objective lens using "zigzag" method and dividing it by total number of fields. Eosinophils stained bright red with carbol chromotrope and MCs purple-violet with toluidine blue. STATISTICS: Independent t-test and Pearson's correlation were done using STATA IC 0.2 software. Level of significance was at 5%. Comparison of eosinophil and MC infiltration was done based on gender, metastatic, nonmetastatic LN, and in tumor proper. RESULTS AND CONCLUSION: This study showed weak positive correlation between mean eosinophils count in tumor and LNs. Recognition of TATE and MCs as integral to tumor biology opens an avenue for novel approaches to cancer therapies. We conclude that an increased number of immunological cells are a favorable prognostic indicator in OSCC.

Cutaneous horn: A mask to underlying malignancy.

Cutaneous horns (cornu cutaneum) are uncommon lesions consisting of keratotic material resembling that of an animal horn. It is a conical- or cylindrical-shaped excessive hyperkeratosis of variable size ranging from few millimeters to several centimeters with a variable in size and shape, such as cylindrical, conical, pointed, transversely or longitudinally corrugated, or curved like a ram's horn. The lesions typically occur in sun-exposed areas, particularly the face, ear, nose, forearms and dorsum of hands. Even though 60% of the cutaneous horns are benign in nature, the possibility of skin cancer should always be kept in mind. The clinical diagnosis includes various benign and malignant lesions at its base. Lesions associated with cutaneous horn are keratosis, sebaceous molluscum, verruca, trichilemmal, Bowen's disease, epidermoid carcinoma, malignant melanoma and basal cell carcinoma. Herewith, we report a case of cutaneous horn on the upper lip vermillion masking the underlying malignancy at its base.

Comparative assessment of maxillary canine index and maxillary first molar dimensions for sex determination in forensic odontology.

BACKGROUND: Sexual identification of immature skeletal remains is still a difficult problem to solve in forensic anthropology. In such situations, the odontometric features of the teeth can be of immense help. Teeth, being the hardest and chemically the most stable tissue in the body, are an excellent material in living and nonliving populations for anthropological, genetic, odontologic, and forensic investigations. Using tooth size standards, whenever it is possible to predict the sex, identification is made easier because then only missing persons of one sex need to be considered. AIM: To determine sex from the odontometric data using maxillary canine index and maxillary first molar dimensions and to determine which index gives higher accuracy rate for sex determination using only maxillary cast. MATERIALS AND METHODS: In a sample size of 200 population (100 male and 100 female), alginate impression was taken of maxillary arch and poured with dental stone. Using Vernier caliper, the dimension of maxillary first molar (buccolingual [BL] and mesiodistal [MD]), canine (MD), and intercanine distance was measured on the cast. The obtained data were analyzed using discriminant statistical analysis. RESULT AND CONCLUSION: This study concludes that BL dimension of maxillary first molar is a more reliable indicator for gender determination than other molar and canine dimensions in maxilla.

Evaluation of occlusal groove patterns of mandibular first and second molars in an Indian population: A forensic anthropological study.

BACKGROUND: The study of dental morphological characteristics is important in anthropological research as it can provide information on the phylogenetic relationship between species, as well as variations and diversities within a population. AIMS AND OBJECTIVES: To determine the prevalence of six types of mandibular second molars in Gujarat state and the results can be used in both forensic anthropological researches and clinical aspects of dental sciences. MATERIALS AND METHODS: This descriptive investigation was undertaken among 1000 students (13-25 years old) in high schools and dental institutes of Gujarat state. The students were selected by cluster sampling method and screened for the number of cusps and groove patterns of mandibular first and second molars. Gender and religion of the students were recorded on prepared forms. STATISTICAL ANALYSIS: It was done with the help of STATAIC-13 software. Descriptive statistics were used to summarize the data and Pearson's Chi-square test was used to check association between variables. Throughout the discussion, level of significance was set at 5%. RESULTS AND CONCLUSION: The high percentage of "+-"shaped groove pattern and low percentage of primitive "y-"shaped pattern in our study shows a tremendous evolutionary trend persisting in this population. The analysis of dental morphological traits is crucial in anthropological research as it can provide data on the phylogenetic relationship between species, as well as variations and diversities within a population.

Denture labels: Various types and their abilities to resist different assaults.

INTRODUCTION: The use of denture labels for the purpose of identification has been well documented. A number of labels for marking the denture are documented till date demonstrating the ease of fabrication and its potential value in identification. Therefore, it becomes essential that these denture labels fulfill the requisites of an ideal denture label and thus should be able to sustain the various assaults to which they might be subjected simulating a crime scene. AIM: The aim of this study was to determine the ability of various denture labels to withstand different types of assaults thereby evaluating the performance of routinely used denture labels. MATERIALS AND METHODS: Four polymethylmethacrylate blocks were fabricated where the inclusion labels were incorporated on one side, and the surface labels were marked on the other side. Each of the blocks was then placed in different containers to be subjected to different assaults such as acid, alkali, water, and heat of increasing temperature. RESULTS: Inclusion labels performed better as compared to surface marking labels. Among the inclusion labels, the metallic labels performed the best. CONCLUSION: The metallic inclusion labels were able to withstand most assaults than any other inclusion labels or surface marking labels. Due to easy availability, cost-effectiveness, ease of incorporation and inertness, metallic labels are best suited as denture labels for personal identification.

Nuclear fractal dimension: A new objective approach for discriminating normal mucosa, dysplasia and carcinoma.

BACKGROUND: Various clinical and histological factors have helped in predicting the survival of patients with oral squamous cell carcinoma (OSCC). However, there has been a need for more specialized diagnostic and prognostic factors to avoid subjective variation among opinion. Thus, fractal dimension (FD) can be used as an index of the morphological changes that the epithelial cells undergo during their transformation into neoplastic cell. In oral cancer study, nuclear FD (NFD) can be used as a quantitative index to discriminate between normal, dysplastic and neoplastic oral mucosa. AIM: To use nuclear fractal geometry to compare the morphometric complexity in the normal, epithelial dysplasia and OSCC cases and to verify the difference among the various histological grades of dysplasia and OSCC. It was fulfilled by estimating the FDs of the nuclear surface. MATERIALS AND METHODS: Histopathologically diagnosed cases of epithelial dysplasia and OSCC were taken from the archives. Photomicrographs were captured with the help of Lawrence and Mayo research microscope. The images were then subjected to image analysis using the Image J software with FracLac plugin java 1.6 to obtain FDs. FD of ten selected nuclei was calculated using the box-counting algorithm. STATISTICAL ANALYSIS: was done using descriptive analysis, ANOVA and Tukey's honest significant difference post hoc tests with STATAIC-13 software. RESULTS AND CONCLUSION: NFD can provide valuable information to discriminate between normal mucosa, dysplasia and carcinoma objectively without subjective discrimination.

A Rare and Extensive Case of Oral Malignant Melanoma involving Mandibular Gingiva.

Oral malignant melanoma is an infrequent but an aggressive neoplasm of unknown etiology, seen most commonly in middle age male patients and is more frequently seen at the hard palate and gingiva. The tumor tends to metastasize or locally invade tissue more readily than other malignant tumors in the oral region. In this article, we report a rare case of extensive oral melanoma in a 55-year-old male patient, with a chief complaint of painless growth in mandibular anterior gingiva measuring about 2.6 X 1.7 X 0.8 cm and extending bilaterally till posterior mandibular gingiva and unilaterally to right buccal mucosa. The most common site being hard palate and maxillary gingiva, it is extremely rare in mandibular gingiva (less than 7%) and hence, this rare occurrence in mandibular gingiva is reported, the diagnosis of which was confirmed by histopathology and immunohistochemistry.