Prognostic Role of Tumor Budding and Worst Pattern of Invasion in Lymph Node Metastasis and Disease-Free Survival in Oral Squamous Cell Cancer Patients: Result from Central India's Regional Cancer Centre.

Aim: To study the role of pattern of invasion, tumor budding and other clinicopathological parameters in determining the risk of nodal metastases and disease-free survival in oral squamous cell cancer patients. Method: The data of 90 patients with oral squamous cell carcinoma who underwent surgery as their primary modality of treatment were retrospectively analysed. Predictive significance of clinicopathological parameters was assessed with Univariate analysis with Fisher exact test and unpaired t-test. The factors which were significant on Univariate analysis were then analysed with multivariate analysis using logistic regression model to find independent predictors. P value < 0.05 was considered significant. Disease free survival analysis was performed using Kaplan-Meier method and comparison done using the log-rank test for each group. Result: The age of the patients ranged from 22yrs to 72 years with male predominance (81.1%). The most common site of involvement was buccal mucosa. Significant factors predicting nodal metastases on univariate analysis were site (p = 0.031), grade (p = 0.012), T stage (p = < 0.001), Depth of invasion (p = < 0.001), perineural invasion (p = < 0.001), lymphovascular emboli (p = 0.018), tumor budding (p = < 0.001), pattern of invasion (p = < 0.001) and stroma (p = 0.037). On multivariate analysis tumor budding (p = 0.016), depth of invasion (p = 0.016) and perineural invasion (p = 0.044) were predictive of nodal metastasis. A statistically significant difference in 3year disease free survival was seen in infiltrative pattern of invasion and tumor budding which showed a p-value of 0.0372 and 0.0489 respectively. Conclusion: Based on the findings of the present study and review of previous articles tumor budding, worst pattern of invasion, host lymphocyte response should also be included in routine histopathology reporting of OSCC.

Kocuria kristinae - An unusual opportunistic pathogen in head and neck malignancy: Case series from central India's regional cancer care centre.

Introduction: Kocuria kristinae is a commensal organism, sometimes considered as a lab contaminant, but its repeated isolation from clinical samples in immunocompromised patients should raise red flags. Materials and Methods: We confirmed the infection with re-isolation of the organism from the same site before starting treatment. For the identification of Kocuria kristinae we used IDGP cards on VITEK 2 compact system. Antibiotic susceptibility test was done manually following CLSI guidelines 2018 for Coagulase-negative staphylococci. Results: A total of 510 major head neck oncosurgeries were performed during the period of two years. Out of which 120 patients had skin and soft tissue infections. Out of these infected patients, 90 were culture positive and of these Kocuria kristinae were isolated in 12 patients. Resistance to penicillin and oxacillin is seen in all isolates. Conclusion: Kocuria kristinae should not be ignored as a commensal flora or lab contaminant in immunocompromised hosts. Its Increase in resistance pattern is a matter of concern. It is an ignored opportunistic pathogen whose detailed sensitivity test should be developed to treat patients timely and effectively.

Leuconostoc, a masquerading pathogen in oral cancer patient: A rare case report.

Osteoradionecrosis is the most common cause of mandibular osteomyelitis. Here we are reporting a case of osteomyelitis of the mandible caused by Leuconostoc mesenteroides spp cremoris. The frequency of Leuconostoc infections are under reported mainly due to its difficult identification. Non pathogenic organism like leuconostoc can cause infection in the immunocompromised and should warrant proper microbial identification and adequate targeted treatment to manage the patients.

Micronuclei in Exfoliated Oral Epithelial Cells in Tobacco Users and Controls with Various Oral Lesions: A Study from Gujarat, India.

To assess and compare cytogenic damage in the form of micronuclei in various oral lesions according to duration and frequency of tobacco use. The present cross sectional study was carried out from October 2015 to October 2016. We included total 420 cases with 60 cases in each of the following subgroups, no tobacco habit with no obvious oral lesion (control) and tobacco habit with no obvious oral lesion, oral sub mucous fibrosis, leukoplakia, melanoplakia, erythroplakia, oral squamous cell carcinoma. Oral mucosal cells were collected from both sides of cheek; slides were prepared and examined for cells with micronuclei. The mean micronuclei index distribution in control group, potentially malignant group, and malignancy group was 1.14, 2.63, and 4.88 respectively and was statistically significant. The mean micronuclei index in control group, smoking tobacco and smokeless tobacco group was 1.14, 2.64, and 2.76 and was statistically significant. The mean micronuclei index was significantly higher in those using tobacco, for longer duration and with frequent tobacco use. The mean micronuclei index can be used as a potential screening tool of genotoxic damage and biomarker for epithelial carcinogenesis. The method has practical utility for warning tobacco users that higher than range has a danger of malignant event and therefore this in future can be used as reinforcement to advice of avoiding tobacco before malignancy develops.