Bullous Lichen Planus: Case Report and Review.

Lichen planus is a chronic inflammatory mucocutaneous disorder that is seen in skin and oral mucosa. Definitive etiology for oral lichen planus remains unknown. It may or may not be associated with skin lesions. Different clinical patterns such as reticular, plaque, erosive, bullous, and atrophic are seen in oral mucosa of which bullous lichen planus is a rare entity. We present a unique case of bullous lichen planus in a 20-year-old male without skin manifestations along with the review of literature comprising various case reports of bullous lichen planus.

Odontoameloblastoma: A report of a rare case.

Odontoameloblastoma (OA) is an uncommon mixed odontogenic tumor that contains an ameloblastomatous component and odontoma-like elements, usually seen to occur in the mandible of younger patients. Radiographically, the tumor shows central destruction of bone with extension of cortical plates and calcified structures which have the radiopacity of tooth structure. These may resemble miniature teeth similar to a compound odontoma or occur as large masses of calcified material similar to a complex odontoma. We report a case of a 17-year-old male with a hard solitary, diffuse swelling over the right lower third of the face for 8 months. Histopathological sections of tumor mass showed diverse and characteristic features of ameloblastoma along with odontogenic epithelium proliferation in unrestrained manner so as to resemble developing tooth bud in stages of morphodifferentiation, apposition and calcification. A diagnosis of OA was made. Hemimandibulectomy was performed on the patient and he remains disease free till today.

Modified Cajal's trichrome stain as a diagnostic aid in the study of epithelial pathology.

BACKGROUND: Diagnosis of initial epithelial pathology maybe difficult in Squamous Cell Carcinoma (SCC), Carcinoma In Situ and other atypical epithelial malignancies, under routine Haematoxylin and Eosin (H and E) stain. The detection of minor basement membrane alterations in doubtful cases is both time consuming and confusing. AIMS: To evaluate efficacy of Modified Cajal's Trichrome Stain (CTS) in relation to Haematoxylin and Eosin for study of epithelial dysplasia, carcinoma in situ, micro invasive SCC, frank SCC, and SCC in lymph nodes. MATERIALS AND METHODS: Formalin-fixed, paraffin-embedded tissue blocks of mild epithelial dysplasia (n = 2), moderate epithelial dysplasia (n = 2), severe epithelial dysplasia (n = 4), carcinoma in situ (n = 1), micro-invasive SCC (n = 4), verrucous carcinoma (n = 1), and frank OSCC (n = 5) were stained with CTS and H&E. The sections were compared based on set histopathological criteria. RESULTS AND CONCLUSION: In SCC cases stained with CTS, invasion into connective tissue and keratin pearls were strikingly evident. Depth of invasion could be more accurately determined. Tumour cells in lymph node were intensely contrasted and easily discernible. Thus, CTS is a good differential stain, clearly delineating the epithelial elements from the connective tissue elements visually. This helps in tracing the basement membrane very clearly. It is an economic, rapid and easy to use method which cannot replace Haematoxylin and Eosin stain in cancer diagnosis, but can definitely be used adjunctive to it. Prompt diagnosis is crucial to effective treatment, and this stain assists in early and rapid diagnosis of cancer.

Expression of human telomerase reverse transcriptase protein in oral epithelial dysplasia and oral squamous cell carcinoma: An immunohistochemical study.

BACKGROUND: Telomerase is an RNA-dependent DNA polymerase that synthesizes TTAGGG telomeric DNA sequences and almost universally provides the molecular basis for unlimited proliferative potential. The telomeres become shorter with each cycle of replication and reach a critical limit; most cells die or enter stage of replicative senescence. Telomere length maintenance by telomerase is required for all the cells that exhibit limitless replicative potential. It has been postulated that reactivation of telomerase expression is necessary for the continuous proliferation of neoplastic cells to attain immortality. Use of immunohistochemistry (IHC) is a useful, reliable method of localizing the human telomerase reverse transcriptase (hTERT) protein in tissue sections which permits cellular localization. Although there exists a lot of information on telomerase in oral cancer, little is known about their expression in oral epithelial dysplasia and their progression to oral squamous cell carcinoma (OSCC) compared to normal oral mucosa. This study addresses this lacuna. AIMS: To compare the expression of hTERT protein in oral epithelial dysplasia and OSCC with normal oral mucosa by Immunohistochemical method. SUBJECTS AND METHODS: In this preliminary study, IHC was used to detect the expression of hTERT protein in OSCC (n = 20), oral epithelial dysplasia (n = 21) and normal oral mucosa (n = 10). The tissue localization of immunostain, cellular localization of immunostain, nature of stain, intensity of stain, percentage of cells stained with hTERT protein were studied. A total number of 100 cells were counted in each slide. STATISTICAL ANALYSIS: All the data were analyzed using SPSS software version 16.0. The tissue localization, cellular localization of cytoplasmic/nuclear/both of hTERT stain, staining intensity was compared across the groups using Pearson's Chi-square test. The mean percentage of cells stained for oral epithelial dysplasia, OSCC and normal oral mucosa were compared using analysis of variance (ANOVA). A P < 0.05 was considered to be statistically significant. RESULTS: The mean hTERT positive cells in the study groups were as follows, 62.91% in normal oral mucosa samples, 77.06% in oral epithelial dysplasia cases, and 81.48% in OSCC. In 61.9% of oral epithelial dysplasia and 65% of OSCC in our study, staining was visualized within the nucleus predominantly in the dot like pattern. There was a statistically significant difference in the nature of nuclear stain between oral epithelial dysplasia and OSCC (P = 0.023). CONCLUSIONS: Our results suggests that the mean percentage of cells showing hTERT expression steadily increased from normal oral mucosa to oral epithelial dysplasia to OSCC. The steady trend of increase in the percentage of cells was evident in different grades of oral epithelial dysplasia group and OSCC. The nature of hTERT staining did show variations among the three groups and promise to be a potential surrogate marker for malignant transformation. Further studies using IHC on larger sample size and clinical follow-up of these patients will be ascertaining the full potential of hTERT as a surrogate marker of epithelial transformation.

Sclerosing Mucoepidermoid Carcinoma: A unique case.

Sclerosing mucoepidermoid carcinoma is an unusual type of mucoepidermoid carcinoma with special histological features which differ from those of the classic type of mucoepidermoid carcinoma. We report the case of a 32-year-old male, who reported to the Vydehi Institute of Dental Sciences, Bangalore, India, with an asymptomatic swelling over the right parotid region which had been present for the previous two and a half years. Histopathological sections of the tumour mass showed mucous and epidermoid cell nests in a dense, hyalinised, sclerotic stroma. A diagnosis of sclerosing mucoepidermoid carcinoma was made. A superficial parotidectomy was performed on the patient and he has remained disease free to date.

Mayer-Rokitansky-Küster-Hauser syndrome of Müllerian agenesis [corrected].

Müllerian agenesis, a congenital malformation of the genital tract is the second most common cause of primary amenorrhoea. Its etiology is poorly understood. It may be associated with renal, skeletal or other abnormalities. The diagnosis is often made radiologically or laparoscopically. Three-dimensional ultrasound is a useful diagnostic tool. The hormonal profile and karyotype in these patients are normal. The management varies, but the treatment of choice is non surgical aimed at creating a neovagina. These patients require psychological support due to the implications for reproduction. Here, we present the case of a 24-year-old married woman with primary amenorrhoea with this malformation.