Efficacy of anti-desmoglein 1 and anti-desmoglein 3 levels by enzyme-linked immunosorbent assay compared to biopsy of chronic oral ulcerative diseases with positive Nikolsky's sign to diagnose oral pemphigus vulgaris with or without skin involvement: a retrospective institutional observational pilot study.

OBJECTIVE: We assessed the efficacy of anti-desmoglein 1 (anti-DSG1) and anti-DSG3 levels by enzyme-linked immunosorbent assay (ELISA) as a preliminary diagnostic test in the diagnosis of oral pemphigus vulgaris (OPV) with or without skin involvement compared to biopsy. STUDY DESIGN: We retrospectively analyzed data collected from 23 patients (mean age 45.13 years) who had presented with chronic oral ulcerations, desquamative gingivitis, and a positive Nikolsky's sign. We performed ELISA, histopathologic examination, and direct immunofluorescence (DIF) and then calculated the sensitivity and specificity of the results of ELISA, histopathology, DIF, and the presence of a positive Nikolsky's sign in diagnosis. RESULTS: The ELISA results showed that 18 patients had elevated anti-DSG3 levels, of whom 8 also had elevated anti-DSG1 levels. The histopathology results indicated that 18 patients had OPV, of whom 4 had oral lichen planus, and 1 had sub-epithelial blistering disease confirmed to be mucous membrane pemphigoid MMP by DIF. ELISA, histopathology, and DIF had a 100% sensitivity and specificity, and the presence of a positive Nikolsky's sign had a sensitivity and specificity of 100% and 78.26%, respectively. CONCLUSIONS: Measurement of anti-DSG1 and anti-DSG3 levels by ELISA warrants consideration as a first-line diagnostic test for early detection of OPV with or without skin involvement over biopsy.

Persistent Buccopharyngeal Membrane - A Systematic Review of Case Reports and Case Series.

OBJECTIVE: Persistent buccopharyngeal membrane (PBM) is a rare anomaly associated with failure of ecto-endodermal resorption of the buccopharyngeal membrane on the 26th day of intrauterine life. The current literature has insufficient information about PBM. DESIGN: Systematic Review. PATIENTS, PARTICIPANTS: Online electronic databases such as PubMed-MEDLINE, Embase, and Scopus were searched using appropriate keywords from the earliest available data until 30th August 2022, with no language restriction. Additional sources such as Google Scholar, major journals, gray literature, conference proceedings, and cross-referencing were also explored. MAIN OUTCOME MEASURES: The present systematic review evaluated and analysed the data available on PBM along with its treatment options and clinicopathological findings, prevalence, and prognosis of the patient. RESULTS: Thirty-four publications with 37 reported cases were included in this systematic review. The majority of patients had dyspnea (n = 18), followed by dysphagia (n = 10). Approximately 16 patients suffering from PBM reported orofacial abnormalities. Seventeen patients reported complete PBM, and 18 patients had partial PBM. The treatment modality followed by most patients (n = 15) was surgical excision of the membrane, along with stent placement in four patients. Oropharyngeal reconstruction was performed in four cases. The overall prognosis and survival rate of this rare condition is good. CONCLUSION: This review suggests that PBM is poorly understood, and the diagnosis of partial PBM is confirmed only when the patient complains of difficulty in breathing or eating. In-depth analysis and follow-up of the reported cases should be performed to diagnose the disease early so that clinicians can provide adequate treatment to the patients.

Schaumann bodies: The basophilic inclusion body.

Schaumann bodies are the inclusion bodies usually seen in sarcoidosis, but can also be found in other conditions like tuberculosis, chronic beryllium diseases and Crohn's diseases. Histopathologically, these bodies appear as round to oval shell-like basophilic calcifications usually considered to be as a residuum of lysosomal organelles activity.

Evaluation for noncompliance of recall in patients reporting to oral pathology department: Longitudinal study of 5 years.

BACKGROUND: Regardless of the form of treatment, long-term follow-up of the patient is an absolute necessity. This study aimed to follow surgically treated patients visiting our department of oral pathology over 5 years (January 2011-December 2015) to monitor recurrence of the condition, patient compliance and reasons for noncompliance. MATERIALS AND METHODS: We conducted half-yearly recall for patients visiting our department from January 2011 to December 2015. Patients were recalled through the use of letters, telephonic reminders and e-mails. RESULTS: The study included 171 recalled patients of whom, 42 (24.56%) reported for follow-up, while the remaining 129 (75.43%) did not report for follow-up. Of the 42 reporting patients, 26 (61.90%) reported once, 10 (23.81%) twice and 6 (14.28%) three times. Recurrence of the condition was reported in two cases. The reasons for noncompliance included: financial constraints (22.48%), casual attitude (37.20%), reported to nearby hospitals (5.42%) and lack of time (11.62%). Some patients could not be sent reminder letters due to incomplete address (7.75%), the wrong pin code (6.97%), change of address (4.65%), locked house (3.10%) and death of the patient (0.77%). CONCLUSION: This study highlights patient recall appointment noncompliance, ascribing various reasons to the patient's attrition rate for recall appointments. Probable solutions for increasing the compliance for recall need to be addressed, and further research should be conducted to evaluate these solutions.

Exophytic verrucous hyperplasia in oral submucous fibrosis: A single-center study.

INTRODUCTION: The present study analyzed the occurrence of exophytic verrucous hyperplasia (EVH) in the background of oral submucous fibrosis (OSF), which presents clinically as a solitary verrucopapillary lesion (VPL) mimicking malignancy. We also aimed to obtain additional information on VELscope appearance and histopathological features of EVH. MATERIALS AND METHODS: The prevalence of EVH in OSF background was assessed from January 2014 to December 2018 using VELscope and histopathological examination. RESULTS: Six hundred and sixty-two OSF patients were examined. Thirteen patients presented with solitary VPL in OSF background. A VELscope examination found ten cases with increased autofluorescence (fluorescence visualization increase, FVI), two cases with autofluorescence loss (fluorescence visualization loss, FVL), whereas one case exhibited dual autofluorescence (focal areas of FVL within FVI regions). Histopathologic examination revealed two FVL cases as oral verrucous carcinoma (OVC) and oral squamous cell carcinoma (OSCC) and one dual autofluorescence case as OVC, while six FVI cases showed nondysplastic epithelium having verrucopapillary pattern without connective tissue invasion, consistent with the clinicopathological diagnosis of EVH. CONCLUSION: The present study demonstrated the evidence of EVH in OSF background, which on histopathological examination revealed nondysplastic epithelium exhibiting the verrucopapillary pattern. A VELscope examination of these lesions showed increased autofluorescence, suggesting its nonneoplastic nature of clinically malignant-looking exophytic VPLs in OSF background. Present study suggests newer perspective for using the term oral verrucous hyperplasia (OVH) and EVH with justification and also proposes to introduce new terminology such as oral verrucous dysplasia and exophytic verrucous dysplasia.

Low frequency of BRAF V600E immunoexpression in mandibular ameloblastomas: An institutional study.

BACKGROUND: Ameloblastoma is an uncommon, benign neoplasm of odontogenic epithelium commonly affecting the posterior mandible (almost 80%) particularly in the molar/ramus region, with occasional tumors involving the maxilla. Recently, there has been much interest generated after the reports of BRAF V600E mutations in ameloblastomas with a frequency of 46%-80% using both molecular as well as immunohistochemical (IHC) techniques. We sought to assess the presence of BRAF V600E expression in ameloblastomas in Indian patients and correlate the same with clinical behavior and histological variants by performing IHC analysis with anti-BRAF V600E antibody. MATERIALS AND METHODS: Thirty formalin-fixed paraffin-embedded tissues of mandibular ameloblastomas were examined by anti-BRAF V600E antibody and correlated with clinicopathologic and histological parameters. Cytoplasmic staining of neoplastic epithelium was considered positive for BRAF V600E expression. STATISTICAL ANALYSIS: Data analysis was performed using Chi-square test and Student's t-test with statistical software IBM SPSS statistics 20.0. RESULTS: BRAF V600E antibody showed positive expression only in 33.3% (10/30) cases. About 66.7% (4/6) recurrent cases and 63.6% (7/11) plexiform cases showed statistically significant association of P = 0.05 and P = 0.021, respectively, among cases with positive BRAF V600E immunoexpression. CONCLUSION: We report the lowest frequency (33.3%) of BRAF V600E immunoexpression in mandibular ameloblastomas in Indian population. However, a significant association of BRAF V600E-positive immunoexpression with recurrence and plexiform pattern could underline its role as a therapeutic marker for ameloblastoma.

Evaluation of the diagnostic efficacy and spectrum of autofluorescence of benign, dysplastic and malignant lesions of the oral cavity using VELscope.

OBJECTIVES: Conventional oral examination and biopsy are the only reliable methods for the early detection of oral cancer at present. Autofluorescence examination of oral tissues using the VELscope has been suggested as an adjunctive tool for cancer detection and diagnosis. The aim of our study was to evaluate the efficacy of the VELscope in recognizing dysplastic and/or neoplastic changes in oral mucosal lesions that were identified on conventional oral examination. MATERIALS AND METHODS: Two hundred patients with oral mucosal lesions were subjected to conventional oral examination followed by VELscope examination and their autofluorescence characteristics were compared with the histopathological diagnosis. The sensitivity, specificity, positive and negative predictive values of the VELscope examination was calculated. RESULTS: The VELscope examination showed sensitivity and specificity values of 76% (95% CI: 54.87-90.64%) and 66.29% (95% CI: 58.76-73.24%) respectively while the positive and negative predictive values were 24.36% (95% CI: 19.22-30.36%) and 95.08% (95% CI: 90.52-97.51%) respectively. CONCLUSION: The VELscope examination alone cannot provide a definitive diagnosis as to the presence of dysplastic tissue change. In spite of having a reasonable sensitivity, the high number of false-positive results limits its efficiency as an adjunct. However, a high negative predictive value can serve to alleviate patient anxiety regarding suspicious mucosal lesions in a general practice setting.

Tubulopapillary Hidradenoma-like Tumour of the Mandible: A Case Report and Literature Review.

Tubulopapillary hidradenoma is an uncommon benign sweat gland tumour which appears as a well-defined superficially located dermal nodule, most commonly occurring in the head or of the extremities. Its occurrence is extremely rare in the mandible, as there are only two cases of tubulopapillary hidradenoma-like tumour of the mandiblereported in the literature. Microscopically, the lesion appears as a well circumscribed but unencapsulated neoplasm composed of numerous irregularly shaped tubular structures that have a double to several layered epithelial lining. The outer layer consists of flat to cuboidal myoepithelial cells and inner layer contains cuboidal to columnar cells that demonstrate decapitation secretions. We report an unusual case of tubulopapillary hidradenoma-like tumour presented as a nodular growth in the right retromolar region of the mandible in a 67-year-old man. The light microscopic features along with immunohistochemical findings of this unusual neoplasm are discussed.