Evaluation of copper salivary level in oral squamous cell carcinoma, occupationally copper exposed, and its normal population and its association with cytomorphologic changes of oral mucosa.

Background: Oral squamous cell carcinoma (SCC) is one of the most common malignancies in oral cavity. Hence, presenting methods for early diagnosis and find the etiologic factors of oral SCC are important. Saliva analysis can be used to discover various conditions because of its noninvasive methods. Copper as a useful metal has been used by men since ancient times. The level of copper increases when the cancerous changes occur in addition to biopsy, an alternative method for examining oral lesions is exfoliative cytology. The primary objective of this study was to determine the salivary copper level and cytomorphologic changes of oral mucosa among three study groups. Materials and Methods: This cross-sectional study included 15 individuals with oral SCC, 15 workers exposed to copper, and 15 healthy individuals. Saliva samples were collected and analyzed by atomic absorption spectrophotometer. The exfoliative smears were prepared by brush biopsy and stained by Papanicolaou and argyrophilic nucleolar organizer region (AgNOR) staining methods. Data analysis using one-way ANOVA and Kruskal-Wallis test. P < 0.05 was considered significant. Results: There was a significant difference in mean salivary copper (P = 0.008), cytomorphology of oral mucosa, and AgNOR among the three groups (P < 0.001). Conclusion: The results suggested that occupational exposure to copper increases the salivary levels of this element and causes changes in mucosal cells. Since this increase was very high and evidence of nuclear activity was seen in this group and in oral SCC patients, exposure to copper should be considered an important risk factor for oral mucosal changes.

Estrogen receptor α expression in different stages of salivary gland mucoepidermoid carcinoma.

Background: Since salivary and breast glands are both considered as a tubulo-acinar, exocrine glands, and they have a common neoplastic morphology, it is not surprising if they share a similar molecular mechanism responsible for their neoplastic transformation. From the first description of estrogen receptor-α (ER-α) in salivary tumors, tremendous attentions have been attracted to this receptor for evaluating its impact in mucoepidermoid carcinoma (MEC). Materials and Methods: In this descriptive analytics, 28 samples of MEC (14 high grade and 14 low grade) were collected from the Oral and Maxillofacial Pathology Department of Isfahan Dental School and Isfahan Alzahra Hospital. All of these samples were stained with immunohistochemical technique with ER-α marker. The expression of the receptor was evaluated by two oral and maxillofacial pathologists. Statistical data were saved at SPSS and had been analyzed by Mann-Whitney U- and independent t-tests (significance level: P ≤ 0.05). Results: The high-grade MEC was more common in patients with a higher average age (55.9); on the other hand, low-grade MEC was mostly observed in those with a mean age of 39.2 years. Moreover, high-grade MEC was more prevalent in men rather than in women. The staining intensity distribution average in high-grade MEC and low-grade MEC was 2.4 and 0.8, respectively (P = 0.48). Conclusion: The expression of ER-α in high-grade MEC was significantly more than low-grade MEC, indicating that targeting this receptor alongside surgery could bring more advantages for patients.

Evaluation of oral pathologic lesions in elderly patients in Isfahan, Iran, 1989-2018 years / Avaliação de lesões patológicas orais em pacientes idosos em Isfahan, Irã, entre 1989 e 2018

Objective: One of the most important alterations in elderly is the destruction and loss of teeth and oral mucosal lesions. The aim of this study was to determine the frequency of biopsed pathologic lesions in elderly registered in the pathology department of Isfahan University of Medical Sciences during 1989 to 2018 years. Material and Methods: This cross-sectional descriptive-analytic study was performed on pathologic lesions in elderly archived in Faculty of Dentistry, Isfahan University of Medical Sciences. In this study, all archived information of elderly over 65 years including gender, age, location of lesion, clinical diagnosis, pathology diagnosis, and diagnosis year were evaluated in last three decades, and were analyzed statistically. Results: The age range of elderly patients was 65 to 90 years with a mean of 72.8 ± 4.9. The highest frequency for location of lesions was related to mandibular vestibule (21.1%). The most clinical diagnosed lesions were squamous cell carcinoma (24.5%) and Epulis Fissuratum (13.4%). The highest pathologic diagnosed lesions were related to reactive lesions group (35.6%). The squamous cell carcinoma malignancies and other malignancies were increased significantly in elderly patients with high age. Conclusion: According to the considerable frequency of oral lesions in elderly and increased frequency of squamous cell carcinoma and other malignancies, attention to oral lesions in elderly and periodic examinations are important to early diagnosis and treatment. (AU)

Objetivo: Uma das alterações mais importantes no idoso é a destruição e perda de dentes; e lesões da mucosa oral. O objetivo deste estudo foi determinar a frequência de lesões patológicas biopsiadas em idosos registrados no departamento de patologia da Universidade de Ciências Médicas de Isfahan durante os anos de 1989 a 2018. Material e métodos: Este estudo transversal descritivo-analítico foi realizado em lesões patológicas em idosos arquivadas na Faculdade de Odontologia da Universidade de Ciências Médicas de Isfahan. Neste estudo, todas as informações arquivadas de idosos com mais de 65 anos, incluindo sexo, idade, localização da lesão, diagnóstico clínico, diagnóstico patológico e ano do diagnóstico foram avaliadas nas últimas três décadas e foram analisadas estatisticamente. Resultados: A faixa etária dos pacientes idosos foi de 65 a 90 anos, com média de 72,8 ± 4,9. A maior frequência de localização das lesões foi relacionada a região vestibular da mandíbula (21,1%). As lesões mais diagnosticadas clinicamente foram carcinoma espinocelular (24,5%) e Epulis Fissuratum (13,4%). As maiores lesões patológicas diagnosticadas foram relacionadas ao grupo de lesões reativas (35,6%). As neoplasias do carcinoma de células escamosas e outras neoplasias aumentaram significativamente em pacientes idosos com alta idade. Conclusão: Devido à considerável frequência de lesões orais em idosos e ao aumento da frequência de carcinoma espinocelular e outras neoplasias, a atenção às lesões orais em idosos e os exames periódicos são importantes para o diagnóstico e tratamento precoces. (AU)

Analysis of artifacts in oral and maxillofacial histopathologic sections and related reasons.

BACKGROUND: Artifacts, artificial structures at microscopic section, may lead to incorrect diagnosis and wrong treatment of a pathological entity. The aim of this study was to evaluate the frequency of various artifacts found in oral and maxillofacial histopathologic sections. MATERIALS AND METHODS: In this cross-sectional study, the specimens included the histopathologic sections along with their diagnosis that were collected from the archive of Isfahan Oral and Maxillofacial Pathology Department using systematic sampling method over a 10-year period. These histopathologic sections were studied by two oral pathologists and an expert laboratory technician for the presence or absence of various artifacts, and the specimens from inside and outside the university were compared. The data were analyzed by SPSS software using independent t-test at significance level α = 0.05. RESULTS: From among 237 specimens studied, 235 specimens (99.15%) had artifacts and two specimens had no artifacts. From among 21 different types of artifacts, folding (n = 158) and throughout cleft (n = 149) artifacts had the highest frequency. There was no significant difference between the specimens of inside and outside the university (P = 0.125). CONCLUSION: The results of this study showed a high number of artifacts in the histopathologic sections, the most frequent artifact being reported for the folding artifact. It seems adequate control of specimens and preventing technical errors can reduce the number of artifacts.

Central unilocular mucoepidermoid carcinoma of the mandible: A case report and literature review.

Mucoepidermoid carcinoma (MEC) is the most common salivary gland malignancy. Central MEC (CMEC) is a rare tumor which affects women more than men and is more common in the mandible. Most cases are histologically classified as low-grade tumor and radiographically appear as well-defined unilocular or multilocular radiolucent lesion, although this tumor causes destruction and metastasis to other organs. In this article, we present a rare case of CMEC in a 47-year-old woman with unilocular radiolucent lesion of the mandible. Early and accurate diagnostic approach in all lesions with clinical/radiographical bland appearance is important, and all possibilities such as a malignant lesion should be considered.

Immunohistochemically Detection of Angiogenesis in Oral Pre-Cancerous Lesions Compared with Oral Invasive Carcinomas

Background: Angiogenic activity is an important event in oral carcinogenesis. During transition of normal oral mucosa to different grades of dysplasia and to invasive carcinoma, significant increase of vascularity occurs. Angiogenesis can be determined by immunohistochemical assessment of several endothelial cell markers like Endogelin (CD 105), expressed in activated endothelial cells and associated with neovasculature, and the vascular endothelial growth factor (VEGF). This study was conducted to evaluate angiogenic activity in oral precancerous lesions compared with oral invasive carcinomas by immunohistochemical staining of VEGF and CD 105 proteins. Methods: In the present cross-sectional study, 20 normal, 20 pre-cancerous mucosa and 20 oral invasive carcinoma samples were immunohistochemically stained. Positive cells were counted in each section and micro vessel density (MVD) was determined. The data were statistically analyzed by Mann-Whitney and Kruskal-Wallis tests, with a P-value ≤0.05 considered significant. Results: The mean expression value for VEGF was 24.6 in oral invasive carcinoma, 16.4 in precancerous mucosa and 15.5 in normal mucosa, with no significant differences between the latter two. Endoglin was negative in all normal mucosa samples, but had scores of 7.58 for precancerous mucosa and 19.4 in oral invasive carcinoma specimens. MVD was significantly higher in SCC than in dysplastic mucosa. Conclusion: Oral invasive carcinoma has more angiogenic activity in comparison with pre-cancerous lesions and normal mucosa. Given the high expression of CD105 positive vessels in malignant lesions, we can argue that determination of mean vessel density (MVD) by application of the CD105 marker could be a useful parameter to differentiate cancerous from pre-cancerous lesions.

A Comparative Study of the Perspectives of General and Oral and Maxillofacial Pathologists about the Rate and Value of Second Referral in Assessment of Oral and Maxillofacial Pathologic Lesions.

The main purpose in the practice of pathology is to provide an accurate diagnosis. Second referral and reassessment by a second pathologist significantly cause diagnostic errors, help to make an accurate diagnosis, and improve patient management. This study was aimed to assess the general perspectives of general and oral and maxillofacial pathologists in Iran on second referrals. In this cross-sectional, descriptive-analytical study, a 20-item questionnaire on second referrals was used to assess the general and oral and maxillofacial pathologists' perspective in Iran. The obtained data were analyzed by chi-square and Mann-Whitney tests (α = 0.05). A total of 64 questionnaires from general and 45 questionnaires from oral and maxillofacial pathologists were collected. The findings showed 70.9% of pathologists were in favor of seeking a second opinion when faced with diagnostic challenges. Significant differences were found between the oral and general pathologists in terms of the most challenging oral and maxillofacial lesions (p value < 0.001). In total, 74.8% of pathologists suggested second opinion to be useful and productive. Both groups of pathologists approved of the second referral. However, this pattern is still different, and it is possible to improve the referral rate among both groups and to enhance the knowledge of general pathologists about second referral to oral and maxillofacial pathologists.

Epidemiological Evaluation of Head and Neck Sarcomas in Iran (the Study of 105 Cases Over 13 Years).

BACKGROUND: Head and neck sarcomas are exceedingly rare and they include 4% - 10% of all sarcomas and less than 1% of all neoplasm of head and neck. OBJECTIVES: The aim of this study is to evaluate the epidemiological characteristics of head and neck sarcomas of patients in Isfahan, Iran. PATIENTS AND METHODS: In this retrospective study, from the 16000 patients whose files were evaluated, the total number of 105 head and neck sarcomas were collected. They were evaluated with due attention to age, gender of the patients and the most common location of the lesion. RESULTS: From the total number of 105 (0.6%) patients with sarcomas, 56 were men (53.33%) and 49 women (46.66%). The most common head and neck sarcomas among this population were Osteosarcoma (32 cases, 30.47%), Chondrosarcoma (14 cases, 13.33%), and Ewing sarcoma (11 cases, 10.47%).The most common soft tissue sarcoma was Rabdomiosarcoma. Mandible was the most common location for these lesions. CONCLUSIONS: In this study, the hard tissue sarcomas were more prevalent than soft tissue ones. Hence, special attention should be paid to the patients when being diagnosed.

Comparative evaluation of eosinophils in normal mucosa, dysplastic mucosa and oral squamous cell carcinoma with hematoxylin-eosin, Congo red, and EMR1 immunohistochemical staining techniques.

BACKGROUND: Oral squamous cell carcinoma is the most common malignant lesion of the oral cavity, and it involves various molecular mechanisms. The development of oral squamous cell carcinoma is influenced by the host immune cells, such as eosinophils. The present study was conducted to compare the presence of eosinophils in normal mucosa, dysplastic mucosa, and oral squamous cell carcinoma by -hematoxylin- eosin staining, Congo red staining, and epidermal growth factor-like (EGF-like) module containing a mucin-like hormone receptor1 (EMR1) immunohistochemical marker. METHODS: In this cross-sectional study, 60 paraffinized samples were selected, consisting of 20 normal mucosae, 20 dysplastic mucosae, and 20 squamous cell carcinoma samples. After confirmation of the diagnosis, the mean number of eosinophils was evaluated by hematoxylin-eosin, Congo red, and immunohystochemical staining techniques. The data were analyzed by SPSS-10 software using the Kruskal-Wallis and Friedman tests. RESULTS: The results showed that the number of eosinophils in dysplastic mucosa was significantly higher than the number in normal mucosa, and the number of eosinophils in squamous cell carcinoma was significantly higher than the number in dysplastic mucosa in all staining techniques (p<0.001). Moreover, the comparison of staining techniques showed a significantly higher number of eosinophils in EMR1immunohistochemicalmarker than were observed when Congo red and hematoxylin - eosin (H&E) staining techniques were used (p<0.001). CONCLUSION: It can be argued that eosinophil contributes to the identification of lesions that have a higher potential of malignant transformation. Moreover, eosinophil can be suggested as an indicator in the differentiation of oral lesions in cases with borderline diagnosis and in targeted molecular therapy.

Granulocytic sarcoma (chloroma) presenting as multiple sites in oral cavity: report of a case.

Granulocytic Sarcoma (GS), an unusual extramedullary tumor, is composed of immature granulocytic precursor cells. The intraoral occurrence of this tumor is extremely rare. Here, we report a case of GS with palatal swelling, gingival lesions in maxilla and mandible and aleukemic presentation in a 45- year- old male.

Epithelial dysplasia in oral cavity.

Among oral lesions, we encounter a series of malignant epithelial lesions that go through clinical and histopathologic processes in order to be diagnosed. Identifying these processes along with the etiology knowledge of these lesions is very important in prevention and early treatments. Dysplasia is the step preceding the formation of squamous cell carcinoma in lesions which have the potential to undergo dysplasia. Identification of etiological factors, clinical and histopathologic methods has been the topic of many articles. This article, reviews various articles presenting oral cavity dysplasia, new clinical methods of identifying lesions, and the immunohistochemical research which proposes various markers for providing more precise identification of such lesions. This article also briefly analyzes new treatment methods such as tissue engineering.

Mandibular intraosseous schwannoma in a child: Report of a rare case.

Intraosseous schwannomas is a very rare neoplasm, and less than 50 cases have been reported in the medical literature. In this article, the clinical, radiographic and histopathologic appearances of a rare case of intraosseous schwannomas are presented. The importance of this case is that other benign central lesions such as odontogenic tumors and cysts might be included in differential diagnosis. This case was recognized in a 9-year-old child, which is a very rare occurrence. The diagnosis was confirmed by immunohistochemical staining with S100 protein.