Oral soft-tissue myxoma.

Oral soft-tissue myxomas of the oral cavity have been sparsely cited in the medical literature worldwide. This could be due to other clinically and/or histologically similar lesions requiring accurate differential diagnosis by experienced physicians and pathologists. Although myxomas are benign and do not metastasise, they have higher rates of recurrence and deserve proper attention and to be reported as well. Soft-tissue myxomas of the oral cavity are extremely rare and very few cases have been reported in the literature. The article describes a soft-tissue myxoma in a male patient in his 40s and review of published cases.

A rare histopathological variant of Schwannoma with rosette-like arrangements and epithelioid cells: a case report from a histopathologist's perspective.

Schwannomas exhibit histopathological variation that leads to diagnostic dilemmas, although less frequent in the oral cavity. We describe a case with unique histopathology and no relevant clinical history that adds to the breadth of literature on the diversity presented by Schwannoma. A 60-year-old female patient presented with a small dome-shaped, asymptomatic swelling on the alveolar ridge 6 years in duration. Histopathologically, it showed rich cellular pathology with a unique arrangement of tumor cells forming irregular rosettes. Each rosette presented with a central core of fibrincollagenous material and the tumor cells were arranged on the periphery, exhibiting epithelioid change with evidence of mild cellular and nuclear pleomorphism. On immunohistochemical evaluation, the cells were strongly and diffusely positive for S-100 and negative for Ki-67. A diagnosis of benign Schwannoma with a rosette-like arrangement with epithelioid change was made. The case report emphasizes the risk of misdiagnosis and the importance of awareness regarding rare histopathological variants of Schwannoma.

Publishing your research work: Updated concepts and nuances of few metrics used to assess journal quality.

Authors have a multitude of options for journals for publishing their research. However, their choice is mostly based on academic credits required for promotion, cost of publication, timeliness of process, etc., The purpose of this narrative review is to enlighten the authors about some other journal metrics used to assess journal ranking and quality in international scenario. The main concepts discussed in this paper are the impact factor and cite score. The paper includes an explanation of terms like web of science, journal citation reports, and how they are related to impact factor. This will help the authors to make the right decision about choosing the right journal for publishing their research. Along with the historic concepts we have included the latest updates about changes being made to the journal citation report and impact factor released in 2023 June. Hopefully with the review paper, we will be able to encourage the inclusion of such concepts and curriculum of post-graduation courses considering publishing a paper and choosing a journal are an integral aspect of a researcher's work life.

An unconventional career path for an oral pathologist: Sharing personal insights from experience as a part of medical publishing industry.

Oral pathologists or dentists in general opting for alternate career paths are very common nowadays. Financial security, lesser availability of jobs and work satisfaction are the most commonly observed reasons for this openness to switch career. While there is a multitude of alternate career options available such as medical writing and pharmacovigilance in this review, we aim to give an insight specifically on opportunities available in the medical journals aspect of the publishing industry. Oral pathologists can opt to take this field as a full-time engagement and attain a constant growth in terms of finances, knowledge and personal development. One of the authors has opted for this career path and has provided personal opinions about the scope, opportunities and perks of working in this industry.

A crude method of DNA extraction and identification from exfoliated human buccal mucosa cells.

BACKGROUND: DNA analysis has a key role in forensic dentistry. However, techniques of DNA extraction and analysis are far from the reach of majority of medical professionals owing to its expensive set up. AIM: The present study was aimed at formulating a crude method of extracting DNA from human buccal mucosa cells using materials commonly available in the laboratory so that the medical professionals could get more exposure to molecular biology techniques. The objectives were to identify the DNA and to assess its purity. METHODS: Buccal mucosa cells from 10 healthy volunteers were taken for DNA extraction following the protocol of cell lysis, purification, and precipitation. DNA was identified using standardized techniques like Diphenylamine test and its purity was assessed using a spectrophotometer. A gel electrophoresis apparatus was also constructed using readily available materials. RESULTS: DNA was extracted from human buccal mucosa cells using a crude method. The standardized tests confirmed the presence of DNA contaminated with proteins. The locally made Gel electrophoresis model exhibited a faint halo around the wells instead of DNA bands. CONCLUSION: DNA extraction from human buccal mucosa cells was made possible using locally available materials and a crude method, but it was not of high purity.

Squamous Metaplasia in Pleomorphic Adenoma: A Diagnostic and Prognostic Enigma.

Pleomorphic adenoma (PA) is the most common benign salivary gland tumor. Histologically, squamous metaplasia has been reported in PA, but has rarely been documented as being extensive enough to cause significant misdiagnosis. Here, we present an unusual case of PA in a 50-year-old female patient presenting with swelling on the postero-lateral aspect of the palate for a week. Histopathologically, the tumor exhibited the features of conventional PA with extensive squamous metaplasia and giant keratotic lamellae in cyst-like areas. Such exuberant squamous metaplasia and keratin can be a diagnostic and prognostic pitfall and lead to overtreatment of the patient.

Evaluation and Immunolocalization of BMP4 and FGF8 in Odontogenic Cyst and Tumors.

Growth factors like bone morphogenetic protein 4 (BMP4) and fibroblast growth factor 8 (FGF8) play a major role in organogenesis and specifically in odontogenesis. They are also believed to have a role in oncogenesis. Thus, any discrepancies in their standard behavior and activity would lead to serious abnormalities including odontogenic cyst and tumors. The present research work investigated the expression of BMP4 and FGF8 in odontogenic tumors (OT) and cyst as well as developing tooth germs to elucidate their roles. Dental organs of various odontogenic stages and 30 OTs including solid multicystic ameloblastomas (SMA, 10 cases), ameloblastic fibroma (AF, 10 cases), odontogenic myxoma (OM, 10 cases), and odontogenic cysts: odontogenic keratocyst (OKC, 10 cases) were evaluated in both epithelial and mesenchymal components for the expression of BMP4 and FGF8 using immunohistochemistry. The epithelial nuclear expression of BMP4 was highest in OKC (9 cases) while FGF8 was highest in SMA (10 cases). The mesenchymal nuclear expression of both BMP4 (8 cases) (p = 0.001) and FGF8 (9 cases) (p = 0.045) were significantly high in OMs among all OTs. Both growth factors were actively expressed in different stages of tooth development. The expression of BMP4 and FGF8 corelates well with the proliferative component of the pathologies, indicating a possible role in the pathogenesis and progression.

Unicystic Ameloblastoma of Mandible with an Unusual Diverse Histopathology: A Rare Case Report.

Ameloblastomas of jaws are benign odontogenic tumours with four clinical variants being solid multicystic type, unicystic type, extra osseous type and desmoplastic type. Unicystic ameloblastoma accounts for only 13% of all the known cases in the scientific literature. Follicular and plexiform patterns are the commonly seen histopathological patterns in unicystic ameloblastoma. Though rare in itself, presence of granular cells along with acanthomatous changes occurring in unicystic ameloblastoma is a rare phenomenon. We present a rare case report of unicystic ameloblastoma of right mandible with an unusual histopathology. It exhibited both luminal and mural types as well as both acanthomatous and granular cell changes found together. As occurrence of unicystic ameloblastoma of jaws with such varied histopathology is rare, their course, clinical outcome, prognosis and recurrence rate are not clear. Documentation of more such cases in literature may make pathogenesis and nature of these lesions more insightful.

Osseous choristoma of submental region: A rare occurrence.

Osseous choristoma is a rare, benign lesion of the oral cavity. This report presents a case of osseous choristoma in the submental region of a 30-year-old female subject. Her chief complaint was a painless swelling in the submental region. Panoramic radiography showed a well-defined, round, radiopaque lesion near the inferior border of the left mental region. The lesion was diagnosed as an osseous choristoma based on the histopathological examination of the surgical specimen. This paper is an attempt to bring forward a unique occurrence of osseous choristoma, which would further help the medical fraternity in improvising their knowledge, diagnosis, and treatment of this entity.

Micronucleus Assay: An Early Diagnostic Tool to Assess Genotoxic Changes in Patients with Tobacco Use, Oral Leukoplakia and Oral Submucous Fibrosis.

INTRODUCTION: Micronuclei (MNi) are acentric chromatid or chromosome fragments produced via genetic damage through genotoxic agents contained in tobacco and betel nut. Evidently, the various Oral Potentially Malignant Disorders (OPMDs) like oral lichen Planus, oral leukoplakia and Oral Submucous Fibrosis (OSMF) demonstrate MNi, as a substantiation of genetic damage. As these changes can be easily appreciated in oral exfoliated cells, an exfoliated cell based MNi assay might be utilized as handy and non invasive biomonitoring tool for gauging the genetic damage and hence the propensity for malignant transformation in OPMDs. To this end, MNi are definitely easier to evaluate when compared to chromosome aberrations. AIM: To compare the MNi frequency in normal mucosa, in individuals using various tobacco forms without oral leukoplakia, individuals using various tobacco forms with oral leukoplakia, and areca nut chewers with OSMF, using three different stains. MATERIALS AND METHODS: Oral exfoliated cells from 50 cases of normal mucosa (Group I), 50 cases of tobacco chewing people without Oral Leukoplakia (Group II), 50 cases of people with Oral Leukoplakia (Group III) and 50 cases of areca nut chewers with OSMF (Group IV) were taken. MNi frequencies were compared in these groups using three different stains i.e., Papanicolaou (PAP) stain, May Grunwald Giemsa (MGG) stain and Feulgen stain. The data between cases (Group II, III and IV) and control groups (Group I) was analyzed by Kruskal-Wallis Test. The comparison between two independent groups was done by Mann-Whitney U test and interstain comparison between cases and control was done by Wilcoxon Signed Rank Test and the individual p-value was obtained. RESULTS: A significant increase in the count was observed during transition of normal mucosa to OPMDs. The best stain for detecting MNi was PAP stain followed by MGG stain and Feulgen stain. CONCLUSION: The higher mean MNi count for PAP stain and MGG stain could be attributed to nonspecific staining. Further study using a larger sample size on quantitative assessment of MNi count in various OPMDs is warranted.

Kaleidoscope of oral artifacts: A vivid picture through light and polarizing microscope.

BACKGROUND: This study is based on finding of an inexplicable artifact that was seen in the tissue received as periapical granuloma. AIM: To observe the histological appearance of different commonly implanted food particles and easily incorporated substances from a laboratory in the oral biopsy tissues. MATERIALS AND METHODS: Various food particles such as wheat chapatti, beans, peas, pulses, and coriander leaves and substances such as a suture, cotton, and paper that can easily gain entry during biopsy and histotechnical procedures were intentionally introduced in the tissue specimens of a uterus from outside. Both light and polarizing microscopes were utilized to view them. RESULTS: Different food particles and substances gave different appearances that could lead to misdiagnosis. Some of these also exhibited positive birefringence under the polarizing microscope. CONCLUSION: Knowledge and familiarity with probable foreign substances which can appear in tissues may help prevent misdiagnosis or erroneous diagnosis of biopsy specimens.

Stromal fibers in oral squamous cell carcinoma: A possible new prognostic indicator?

BACKGROUND: Many studies have been carried out to study the role of extracellular matrix proteins, growth factors and matrix metalloproteinases on tumor invasion. However, literature related to the analysis of connective tissue fibers in varying grades of oral squamous cell carcinoma (OSCC) is very limited. AIM: To analyze the changes in collagen and elastic fibers in varying grades of (OSCC). SETTINGS AND DESIGN: This retrospective study was carried out using a light and polarizing microscope. MATERIALS AND METHODS: Three sections each were cut from fifty samples of varying grades of OSCC and ten samples of control followed by staining with H and E, Picrosirius-Red and Verhoeff-Van Gieson. Qualitative and quantitative analysis of collagen and elastic fibers were accomplished using set criteria. STATISTICAL ANALYSIS: Data were entered into the Statistical Package for Social Sciences (SPSS) version 13.5 for analysis. RESULTS: A change in colors of collagen fibers was seen on progressing from well to poorly differentiated OSCC. Thin collagen fibers predominantly exhibited greenish yellow, but the thick fibers exhibited a variety of colors. As the grade of OSCC progressed, collagen fibers were loosely packed haphazardly arranged. Statistically insignificant results were obtained for quantitative analysis of collagen and qualitative analysis of elastic fibers. CONCLUSION: The collagen fibers undergo a change in color, orientation and packing in the stroma of varying grades of OSCC. The uniqueness of this study lies in the exploration of elastic fibers in OSCC which has not been done so far.

Bacterial Viability within Dental Calculus: An Untrodden, Inquisitive Clinico-Patho- Microbiological Research.

INTRODUCTION: Chronic inflammatory periodontal diseases i.e. gingivitis and periodontitis are one of the most common afflictions faced by human beings. Dental plaque, which is a pool of pathogenic microorganisms, remains to be current mainstay in etiopathogenesis. Dental calculus, which is a mineralized product of this plaque remains ignored and is considered merely as an ash heap of minor significance. However, the intriguing array in disease etiopathogenesis bulldozed researchers to suspect the role of calculus in disease chrysalis but still the viability of bacteria inside calculus and thus its pathogenicity remains an intricacy; the answer to which lies in the Pandora's Box. AIM: The present study was undertaken to investigate the viability of bacteria within dental calculus along with their identification. Also, to classify dental calculus on the basis of mineralization and to observe the variation of viable microflora found in dental calculus with the extent of mineralization and disease severity. MATERIALS AND METHODS: A total of 60 samples were obtained, by harvesting two samples of supragingival calculus from each patient having chronic inflammatory periodontal disease. These samples were divided into two groups (Group A and Group B). Samples of Group A were kept non-irradiated and samples of Group B were exposed to UV radiation. The samples were categorized into less, moderately and highly mineralized according to the force required for crushing them. All the crushed calculus samples were then divided into three parts. These were used for dark-field microscopy, gram staining and bacterial cultures. Bacterial identification of the cultures obtained was also carried out by performing various biochemical assays. RESULTS: The present study revealed the presence of motile spirochaetes within the samples under dark-field microscope. Gram staining revealed presence of numerous gram positive cocci and gram negative bacilli. Bacterial cultures showed growth of variety of aerobic and capnophilic microorganisms. CONCLUSION: The present study concludes the presence of viable aerobic and capnophilic bacteria inside dental calculus which may reside within the lacunae and channels in the calculus.

Estimation of time elapsed since the death from identification of morphological and histological time-related changes in dental pulp: An observational study from porcine teeth.

AIM: Putrefaction of the human body with its rate and stages of the various changes occurring in this entire process have been explored widely by the forensic medicine experts to estimate the time elapsed since death. However, experimental data reported in literature pertaining to rates of putrefaction of the dental pulp retrieved from jaws of the dead is scarce. This study makes an attempt to find out the series of various changes which occur during the process of putrefaction of the dental pulp in a coastal environment like that of Southern India. An attempt has also been made to estimate the time elapsed since the death by assessing the duration for which dental pulp remains microscopically intact. MATERIALS AND METHODS: Three different study setups at different times, followed one by other were created. In each setup, 10 specimens of porcine jaws with teeth were buried in surface soil and 10 specimens in subsurface soil. Dental pulp was retrieved at an interval of every 24 h to see for the various changes. All the environmental parameters including average daily rainfall precipitation, temperature, soil humidity, soil temperature, and soil pH were recorded. RESULTS: A specific series of morphological changes in terms of changes in size, color, consistency, and odor; and a sequence of histological changes were observed from both surface and subsurface samples. CONCLUSION: Dental pulp buried in a coastal environment goes through a specific series of morphological and histological changes which can be interpreted up to 144 h from burial, after which pulp ceases to exist.

Architectural Analysis of Picrosirius Red Stained Collagen in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma using Polarization Microscopy.

INTRODUCTION: Collagen degradation is important both for carcinogenesis and in its progression. Research regarding the co-relation of collagen with Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) is less explored. AIM: To elucidate the nature of collagen in Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) using Picrosirius Red Stain (PSR) under polarizing microscopy. MATERIALS AND METHODS: The study consisted of a total 40 samples which were divided into three groups. Group I included buccal mucosa as negative and irritation fibroma as positive control, group II consisted of OED and group III consisted of Oral Squamous Cell Carcinoma (OSCC). A histochemical analysis was conducted using PSR-polarization method by two independent observers. RESULTS: The control group shows predominantly reddish-orange birefringence. In OED with the advancement of grades, the colour changed from yellowish-orange colour to yellow-greenish with progressive increase in greenish hue. As OSCC regresses from well to poorly differentiated, the colour changed from reddish-orange to yellowish orange to greenish-yellow suggesting a transition from mature to immature collagen. CONCLUSION: An observable gradual change in collagen of both OED and OSCC was noted as they were proceeding from benign to critical step. Thus, PSR is a useful tool for studying stromal changes as supporting collagen shows the transition in the form besides the alterations in epithelial cells.

Age estimation in Indian children and adolescents in the NCR region of Haryana: A comparative study.

INTRODUCTION: Age estimation is a preliminary step in the identification of an individual. It is a crucial and often most critical step for forensic experts. The assessment has been standardized utilizing common dental diagnostic x-rays, but most such age-estimating systems are European population-based and their applicability has not been determined in the context of the Indian population. AIMS AND OBJECTIVES: To assess the applicability and to compare the methods of dental age estimation by Demirjian's method and the same method as modified by Willems (i.e. the Willems method) in Indian children of the National Capital Region (NCR). Also, to find a correlation among skeletal maturity using the Cervical vertebrae maturation index (CVMI), dental maturity, and chronological age in the same population. MATERIALS AND METHODS: This cross-sectional study was conducted using dental radiographs of 70 orthodontic patients (37 males, 33 females) in the age range 9-16 years selected by simple random sampling. pantomogram were used to estimate dental age by Demirjian's method and the Willems method using their scoring tables. Lateral cephalograms were used to estimate skeletal maturity using CVMI. The latter was compared with Demirjian's stage for mandibular left second molar. RESULTS: Overestimation of age among males by 0.856 years and 0.496 years was found by Demirjian's and the Willems methods, respectively. Among females, both the methods underestimated the age by 0.31 years and 0.45 years, respectively. Demirjian's stage G corresponded to CVMI stage 3 in males and stage 2 in females. CONCLUSION: In our study, the Willems method has proved to be more accurate for age estimation among Indian males, and Demirjian's method for Indian females. A statistically significant association appeared between Demirjian's stages and CVMI among both males and females. Our study recommends the derivation of a regression formula by studying a larger section of the Indian population instead of applying the European system of age estimation directly to the Indian scenario.

Usage of betel quid, areca nut, tobacco, alcohol and level of awareness towards their adverse effects on health in a north Indian rural population.

AIM: To assess the overall prevalence of betel quid, areca nut, tobacco and alcohol use in the rural population of Muradnagar tehsil of Ghaziabad district and their awareness level towards adverse effects of these habits on general as well as oral health. METHODS: A total of 422 persons from 63 households of four (4) villages were enrolled for the participation in the study. A preformed, pretested questionnaire was used to collect the information on prevalence of risk behaviours of chewing tobacco, areca nut, betel quid, smoking and alcohol consumption. RESULTS: 72.5% of respondents reported indulgence in one or more habits of chewing areca nut, betel quid, tobacco, smoking and alcohol consumption. Smoking tobacco was the most common type of adverse habit in males while chewing tobacco in females. 26% of respondents believed that the community residents would quit the habit only if they personally experience any health problem due to the habit. CONCLUSION: In spite of being aware of risk of having multiple health problems, a major proportion of respondents were using betel quid, areca nut, tobacco and alcohol.

Clinico-pathological correlation of E-cadherin expression at the invasive tumor front of Indian oral squamous cell carcinomas: An immunohistochemical study.

BACKGROUND: Recent studies have indicated that although malignant cells at the invasive tumor front, bare morphological resemblance to the cells at central portion of the tumor, their molecular character differs significantly. E-cadherin is a cell-cell adhesion molecule that connects epithelial cells. This study attempts to correlate the E-cadherin expression at the invasive tumor front with tumor differentiation along with its clinico-pathological parameters. MATERIALS AND METHODS: Immunohistochemical staining with E-cadherin was carried out on archival cases of primary oral squamous cell carcinomas (n = 30). The E-cadherin expression at the invasive tumor front was analyzed and was linked to clinico-pathological parameters including patient prognosis. RESULTS: The downregulation of E-cadherin expression at the invasive tumor edge when compared with patient's prognosis yielded a significant correlation (P = 0.041) but its correlation with the degree of differentiation determined was not significant (P = 0.27). Also, its association with tumor size and lymph node status was negative. CONCLUSIONS: Loss of E-cadherin expression at the invasive tumor front is an important event in the progression of oral squamous cell carcinomas. Tumors with a loss of expression of E-cadherin are those which had a poor prognosis.

An unusual case report of basal cell adenoma: A Diagnostic Enchanter.

Oral lesions show a wide range of biologic behaviours. There are various lesions which may mimic others and present in such an unusual manner thus making them very difficult to diagnose clinico-pathologically. An accurate diagnosis is not only important for correct treatment planning but also for determination of prognosis. Thus, it is very important for a surgical pathologist to be aware of the various atypical presentations of the lesions. The present unusual case report of basal cell adenoma occurring on upper lip with frank areas of calcifications and abundant inspissated mucoid secretions is an example of one such case. BCA is an uncommon benign epithelial salivary gland neoplasm. It is one of the nine subcategories of salivary gland epithelial tumours according to WHO 2005 classification of salivary gland tumors. It is composed of basaloid cells organized with a prominent basal cell layer and distinct basement membrane-like structure and no myxochondroid stromal component as seen in pleomorphic adenomas. To our best knowledge, no case in English literature has been reported BCA with exuberant inspissated mucoid secretions and frank areas of calcifications to such a large extent and this is the first case to report the same. Key words: Basal cell adenoma, calcifications, diagnosis, inspissated mucoid secretions, surgical pathologist.

Cytological artifacts masquerading interpretation.

BACKGROUND: Cytological artifacts are important to learn because an error in routine laboratory practice can bring out an erroneous result. AIMS: The aim of this study was to analyze the effects of delayed fixation and morphological discrepancies created by deliberate addition of extraneous factors on the interpretation and/or diagnosis of an oral cytosmear. MATERIALS AND METHODS: A prospective study was carried out using papanicolaou and hematoxylin and eosin-stained oral smears, 6 each from 66 volunteer dental students with deliberate variation in fixation delay timings, with and without changes in temperature, undue pressure while smear making and intentional addition of contaminants. The fixation delay at room temperature was carried out at an interval of every 30 minutes, 1 day and 1 week and was continued till the end of 1 day, 1 week, and 1 month, respectively. The temperature variations included 60 to 70°C and 3 to 4°C. RESULTS: Light microscopically, the effect of delayed fixation at room temperature appeared first on cytoplasm followed by nucleus within the first 2 hours and on the 4(th) day, respectively, till complete cytoplasmic degeneration on the 23(rd) day. However, delayed fixation at variable temperature brought faster degenerative changes at higher temperature than lower temperature. Effect of extraneous factors revealed some interesting facts. CONCLUSIONS: In order to justify a cytosmear interpretation, a cytologist must be well acquainted with delayed fixation-induced cellular changes and microscopic appearances of common contaminants so as to implicate better prognosis and therapy.