A Comparison of Clinicopathological Differences in Oral Squamous Cell Carcinoma in Patients Below and Above 40 Years of Age.

INTRODUCTION: Recent times have revealed an increase in incidence of Oral Squamous Cell Carcinoma (OSCC) in young adults including those who lack association with typical risk factors such as tobacco. There are reported variations in clinical behaviour of tumours in young and older individuals. AIM: Present study evaluated differences in clinicopathological characteristics between two groups of OSCC, below and above 40 years of age. MATERIALS AND METHODS: An analytical study was performed on two groups of OSCC patients, below and above 40 years of age. Clinicopathological parameters of site distribution, type of habit, histological grade, nodal metastasis, margin status, mitotic index and Argyrophilic Nucleolar Organizing Regions (AgNOR) count were compared. Chi-square test and Students t- test were applied for statistical analysis. RESULTS: Present study revealed that mean AgNOR count was significantly higher in older group (6.38) than younger group (4.27). However, no significant differences were noted in site distribution, tobacco habit, histological grade, mitotic index, nodal metastasis and status of resected surgical margins between the two age groups. A trend for increased metastasis and poor histological differentiation was also observed in the older and younger age group respectively. Most common site was buccal mucosa followed by tongue in both groups. CONCLUSION: Reasons for documented variability in tumour characteristics between young and older patients are currently unclear. Difference in AgNOR count found in present study is suggestive of variability in proliferative and ploidy characteristics between different age groups and supports the hypothesis of genetic and epigenetic influences in development of oral cancer.

The post-analytical phase of histopathology practice: Storage, retention and use of human tissue specimens.

There are several aspects to a histopathology practice besides the acquisition of biopsy specimens and histopathological diagnosis. Pathology Departments are home to an abundant source of knowledge in the form of stored specimens and slides. We attempt to highlight the importance of regulation of storage, retention, and appropriate use of human tissue material in research and ownership rights to the same. We also discuss requirement and waiver of informed consent for scientific work involving the use of such tissues, which in the absence of defined laws come under the purview of Institution Review Boards. Pathology Departments, under the binding of the parent institution, are conceded the responsibility of maintenance and retention of pathology specimens. This communication highlights some of the important aspects in human tissue material handling and research, underscoring the necessity for established regulations regarding the same.

Nuclear Fractal Dimensions as a Tool for Prognostication of Oral Squamous Cell Carcinoma.

BACKGROUND: Carcinogenesis follows complex molecular alterations, which are triggered by subtle chromatin architectural changes that are imperceptible to the human eye. As the treatment decisions in Oral Squamous Cell Carcinoma (OSCC) are hindered by the imprecise clinical stage determination and inter-observer variability in histological grading, focus in recent years has shifted to discovering identifiers related to neoplastic cell morphology studied through computer-aided image analysis. One such approach is the assessment of fractal geometry, a technique first described by Mandelbrot, which aids in precise assessment of architecture of natural objects. Assessment and quantification of degree of complexity of these fractal objects (self-similarities in structural complexity at different magnifying scales) is described as fractal dimension (FD). AIM: To evaluate the nuclear fractal dimension (NFD) in OSCC using computer-aided image analysis. MATERIALS AND METHODS: Histological sections of 14 selected cases of Oral Squamous Cell Carcinoma (OSCC) and 6 samples of normal buccal mucosa (as control) were stained with Haematoxylin-Eosin and Feulgen stain for histopathological examination and evaluation of nuclear complexity respectively. Fifteen HPF at Invasive Tumour Front (ITF) and Tumour Proper (TP) of Feulgen-stained sections were selected and photographed in test and control samples. At ITF, TP and normal buccal mucosa 200 nuclei each were selected and analyzed using Image J software to quantify FD. The test and control groups were compared statistically using Independent sample t-test and One-way ANOVA. RESULTS: Nuclear FD increased progressively towards worst tumour staging as compared to normal buccal mucosa. CONCLUSION: Nuclear FD can be considered for quantification of nuclear architectural changes as a prognostic indicator in OSCC.

Driving the Mineral out Faster: Simple Modifications of the Decalcification Technique.

INTRODUCTION: Quicker decalcification is essential for faster diagnosis of hard tissue pathology. Heat and mechanical agitation are known to hasten decalcification. AIM: To compare the rate of decalcification, cellular and staining characteristics of decalcified specimens of bone and teeth by using the conventional method (10% formal formic acid), heating to 45(o)C and by physical agitation with magnetic stirrer. MATERIALS AND METHODS: Weight-matched samples of caprine-origin bone (n=15) and teeth (n=15) were decalcified using three methods namely: a) Gooding and Stewart's fluid; b) Gooding and Stewart's fluid heated to 45(o)C for 6 hours daily; and c) Gooding and Stewart's fluid agitated using a magnetic stirrer for 6 hours daily. Non-lesional skin tissue samples were placed along with each specimen. End point of decalcification (chemical test) was noted; 4 micron sections were taken and stained with H&E. STATISTICAL ANALYSIS: Differences in rate of decalcification and staining characteristics were assessed by Kruskal Wallis test and chi-square test respectively. RESULTS: Hard tissues decalcified faster with stirring and heating methods. The amount of osteocyte retraction noted in bone was significantly reduced in the stirring method. In tooth specimens, modified techniques resulted in poorer nuclear-cytoplasmic contrast of pulp cells. Heating affected the odontoblast layer. Soft tissues exhibited higher eosinophilia in stirring and conventional methods, whereas nuclear-cytoplasmic contrast and chromatin staining was poorest in heating and conventional methods. CONCLUSION: Physical agitation of decalcifying fluid may be recommended while maintaining satisfactory quality of tissue morphology and staining.

Post-radiation changes in oral tissues - An analysis of cancer irradiation cases.

INTRODUCTION: Radiation, commonly employed as neoadjuvant, primary, and adjuvant therapy for head and neck cancer causes numerous epithelial and stromal changes, prominent among which is fibrosis with its early and late consequences. Very little is known about the true nature of the fibrosed tissue and the type of fibers accumulated. Radiotherapy affects the supporting tumor stroma often resulting in a worsening grade of tumor post-radiation. AIM: To study epithelial, neoplastic, stromal, and glandular changes in oral cavity induced by radiation therapy for oral squamous cell carcinoma (OSCC) using special stains. MATERIALS AND METHODS: The study included 27 samples of recurrent OSCC following completion of radiotherapy (recurrence within an average span of 11 months), and 26 non-irradiated cases of OSCC. Patients with a history of combined radiotherapy and chemotherapy were not included in the study. The epithelial changes assessed included epithelial atrophy, apoptosis, necrosis, dysplasia, and neoplasia. The connective tissue was evaluated for amount of fibrosis, quality of fibers (using picrosirius red staining), fibrinous exudate, necrosis, pattern of invasion, vessel wall thickening, and salivary gland changes. The aforementioned changes were assessed using light and polarizing microscopy and tabulated. STATISTICAL ANALYSIS: Epithelial and connective tissue parameters were compared between the irradiated and non-irradiated cases using chi square and t-tests. RESULTS: Epithelial and connective tissue parameters were found to be increased in irradiated patients. Pattern of invasion by tumor cells varied from strands and  cords between the two groups studied. The effect of radiation was seen to reflect on the maturity of fibers and the regularity of their distribution.