A rare case of plasma cell mucositis in a young patient.

Plasma cell mucositis (PCM) is a rare benign proliferative disorder affecting various mucosal surfaces usually seen in elderly patients. In the present case, a 13-year-old young boy reported with the complaint of swollen upper lip and enlarged gums in relation to upper front teeth. The diagnosis of plasma cell mucositis is complex and frequently requires histopathological examination and immunohistochemistry. Management included conventional gingivectomy and intralesional steroid. Regular follow-up of PCM is essential based on the possibility of recurrence, the potential involvement of other mucosal surfaces and unknown potential for malignant transformation.

Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study.

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.

Effect of copper-based fungicide (bordeaux mixture) spray on the total copper content of areca nut: Implications in increasing prevalence of oral submucous fibrosis.

BACKGROUND: Potentially malignant disorders like oral submucous fibrosis (OSMF) often precede oral squamous cell carcinoma (OSCC). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), and the high copper content in areca nut plays an important role in the pathogenesis of the disorder. Even though many studies estimated and confirmed increased copper levels in areca nuts, studies tracing the source of the increased copper content are scarce. Interestingly, on review of agricultural literature, it was found that most of the areca nut plantations in South India commonly use a copper-based fungicide, bordeaux mixture (BM). AIM: The aim of the study was to estimate and compare the copper content in areca nuts from plantations with and without copper-based fungicide usage. MATERIALS AND METHODS: Four areca nut plantations from Dakshina Kannada district, Karnataka (group A) and four plantations from Ernakulam district, Kerala (group B) were selected for the study. The plantations from Karnataka used copper-based fungicide regularly, whereas the latter were devoid of it. Areca nut samples of three different maturities (unripe, ripe, and exfoliated) obtained from all plantations were dehusked, ground, and subjected to atomic absorption spectrometry (AAS) for copper analysis. RESULTS: There was statistically significant difference in the copper content of areca nuts from both groups. The areca nuts from plantations treated with copper-based fungicide showed significantly higher copper levels in all maturity levels compared to their counterparts in the other group (P < 0.05). CONCLUSIONS: The high copper content in areca nut may be related to the copper-based fungicide treatment on the palms. These areca nuts with high copper content used in quid or commercial products may be responsible for the increasing prevalence of OSMF.

Evaluation and Comparison of the Biopathology of Collagen and Inflammation in the Extracellular Matrix of Oral Epithelial Dysplasias and Inflammatory Fibrous Hyperplasia Using Picrosirius Red Stain and Polarising Microscopy: A Preliminary Study.

BACKGROUND: The role of tumour inflammation and the dysplastic epithelial-stromal interactions on the nature of collagen fibres in the extracellular matrix of dysplastic epithelium is not fully understood. The present study was aimed to evaluate and compare the inflammation and pathological stromal collagen (loosely packed thin disorganized collagen) present in mild, moderate and severe epithelial dysplasias with that of inflammatory fibrous hyperplasias. The basement membrane intactness of epithelial dysplasias was also evaluated to determine if dysplastic epithelial mesenchymal interaction has any role in the integrity of stromal collagen in epithelial dysplasia. METHODS: Oral epithelial dysplasias, inflammatory fibrous hyperplasia and normal oral mucosal samples were used for the study. Packing, thickness and orientation of collagen fibres in mild, moderate and severe grades of oral epithelial dysplasias (n = 24), inflammatory fibrous hyperplasia (n = 8) and normal oral mucosal samples (n = 8) were analysed based on the polarisation of collagen fibres in picrosirius red polarising stain under polarising microscope. RESULTS: All the grades of epithelial dysplasias showed greenish yellow birefringence confirming the presence of loosely arranged pathological collagen in the presence of moderate inflammation. All the cases of inflammatory fibrous hyperplasia showed red polarisation hue and moderate inflammation. A statistically significant difference was found in the packing and orientation of collagen when epithelial dysplasias and inflammatory fibrous hyperplasia were compared (P < 0.01). When the intactness of basement membrane integrity was compared in all the groups of epithelial dysplasia, a statistically significant result was obtained (P < 0.05). CONCLUSIONS: Presence of significant amount of loosely packed thin disoriented collagen even in mild epithelial dysplasia suggests that tumourigenic factors are released to connective tissue stroma much earlier than expected. Hence we suggest considering the integrity of extracellular matrix collagen, intactness of basement membrane and inflammation associated with dysplasia along with the anaplasia of epithelial cells in the microscopic assessment of dysplastic epithelium.

Estimation and Comparison of Copper Content in Raw Areca Nuts and Commercial Areca Nut Products: Implications in Increasing Prevalence of Oral Submucous Fibrosis (OSMF).

BACKGROUND: Oral Squamous cell carcinoma (OSCC) is often preceded by potentially malignant disorders (PMDs) like oral submucous fibrosis (OSMF). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), a habit prevalent among the population groups in south-east Asia. Along with alkaloids, the high copper content in areca nut plays an important role in the pathogenesis of OSMF. The increased prevalence of OSMF in the last two decades or so corresponds with the increased processing and commercialization of areca nut products. AIM: The aim of the study was to estimate and compare the copper content of raw areca nuts in three different stages of maturity, and commercial areca nut products. MATERIALS AND METHODS: Raw areca nut samples of three different maturities were obtained from four plantations in Sullia, Karnataka, India and commercial areca nut products were obtained from local shops in Chidambaram, Tamil Nadu, India. The samples were grounded and subjected to Atomic Absorption Spectrometry (AAS) for copper analysis. RESULTS: There was statistically significant difference in copper content in raw areca nuts of all three maturities (p<0.05) and was highest in the exfoliated mature nuts. Importantly copper level was significantly higher in the commercial products compared to raw areca nuts of different degrees of maturity (p<0.05). CONCLUSIONS: The copper levels in commercial products are significantly higher than that of raw areca nuts in all three stages of maturity. The increase in copper content on processing and post commercialization can be related to the increasing prevalence of OSMF.

Expression of inducible nitric oxide synthase (iNOS) in oral precancer and oral squamous cell carcinoma: an immunohistochemical study.

AIMS: Prolonged production of the free radical, nitric oxide (NO) by the enzyme inducible nitric oxide synthase (iNOS) plays an important role in tumour progression by promoting angiogenesis, invasion and inducing mutation in tumour suppressor gene. The purpose of this study is to evaluate the expression and intensity of iNOS in normal oral mucosa, precancer and oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: An immunohistochemical study was performed using rabbit monoclonal antibody to iNOS on archival formalin fixed, paraffin embedded tissues of 5 normal oral mucosal samples, 10 Leukoplakia, 10 oral submucous fibrosis (OSMF) and 15 OSCC of different grades. RESULTS: A statistical significant difference was found between normal oral mucosa, precancer and OSCC in expression of iNOS (p value 0.0015). However, there was no statistically significant difference between the expressions of iNOS within premalignant groups (p value 0.5647) and histological sub-groups of OSCC (p value-0.5647). There was no statistically significant difference in the intensity of iNOS expression within the precancer group, OSCC sub-groups and between precancer and OSCC (p value-0.623). CONCLUSION: The orderly increase in the expression of iNOS from normal, through precancer, to OSCC suggests the essential role played by iNOS in epithelial transformation and tumour formation.