Nerve sheath myxoma of the oral cavity: a distinct entity.

Nerve sheath myxomas (NSM) are uncommon benign tumours of nerve sheath origin. These tumours are most often located in the dermis and subcutaneous tissue of the head and neck region, but less frequently can also involve extracutaneous sites but they are rarely seen in the oral cavity. Many authors consider nerve sheath myxoma and neurothekeoma to be variants of the same tumour, though currently it has been demonstrated that both the lesions are distinct entities with different origins and unique morphological features. Herein we report a case of Nerve Sheath Myxoma on the palatal gingiva.

Evaluation of CYP1B1, oxidative stress and phase II detoxification enzyme status in oral cancer progression model.

Background: Tobacco is one of the main etiological factors for oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD). CYP1B1 is an enzyme which plays a major role in the phase I detoxification of tobacco, the byproducts of which are subsequently detoxified by phase II enzymes Glutathione S Transferase (GST). We attempted to evaluate the L432V polymorphism and tissue expression of CYP1B1, along with the oxidant-antioxidant status in OSCC progression model. Method: ology: Tissue biopsies and blood samples were collected from the subjects; L432V polymorphism was evaluated by TaqMan RT-PCR, immunohistochemistry was performed on the tissue sample using CYP1B1 polyclonal primary antibody and Allred quick scoring system was used to evaluate the stained slides. Malonaldehyde (MDA) and GST activity were measured spectrophotometrically to assess oxidative-antioxidative status. Results: When the L432V polymorphism was analyzed, it was observed that in oral epithelial dysplasia (OED) and OSCC, CG was more common than GG genotype. Highest mean Allred score was observed in tobacco users (6.27), highest GST activity was seen in oral epithelial dysplasia (5.006 U/ml) and highest MDA activity was observed in OSCC (1553.94 nm/ml). Conclusion: Tobacco users with CG and GG genotypes are at equal risk of developing oral epithelial dysplasia or OSCC and L432V polymorphism does not appear to increase the risk of malignant transformation in oral epithelial dysplasia. Moreover, tobacco users with GG genotype and tissue expression of CYP1B1 may be at a greater risk of oxidative damage.

Clear cell variant of oral squamous cell carcinoma: case report and review.

The clear cell variant of Oral Squamous Cell Carcinoma (OSCC) is an uncommon histological variant. Kuo first discovered it in the skin, and Frazier et al. found it in the oral cavity. We know of only nine cases of clear cell variant of OSCC reported in the literature till now. The present case is in a 60-year-old male patient with an ulcer on the left posterolateral border of the tongue. The patient had a history of chewing tobacco for 22 years. Clinical examination showed features of malignant ulcer associated with pain and discomfort. Histopathological examination revealed sheets and islands of atypical epithelial cells with clear cytoplasm, nuclear and cellular pleomorphism, and few keratin pearls in the connective tissue suggesting OSCC. Various special stains were performed to identify clear cells. Periodic Acid Schiff-Diastase (PAS-D) and Mucicarmine stains showed positive and negative reactions in clear cells, respectively. Immunohistochemical (IHC) analysis for cytokeratin (AE1/AE3) showed diffuse positivity in clear cells and other epithelial cells. Based on special stains and IHC markers, we confirmed the diagnosis as a clear cell variant of OSCC. This variant is rare and presents diagnostic challenges. It is said to be aggressive in nature. More such cases should be reported to understand its biological behavior and prognosis.

Utility of serum homocysteine in oral squamous cell carcinoma patients as a potential biomarker.

Background: In India, Oral cancer is one of the most common cancers. Despite advances in treatments, prognosis for oral cancer has remained poor with a five-year survival rate of 40-50%. Therefore, it is necessary to develop effective diagnostic methods for early diagnosis and better prognosis. Homocysteine (Hcy) has been reported as a 'tumour marker' in various cancers such as breast cancer, colorectal cancer, lung cancer, cervical cancer. Aim: To study the levels of serum Hcy in oral squamous cell carcinoma (OSCC) patients. Objectives: To assess the clinical utility of serum Hcy as a potential tumour marker for OSCC cases. Methodology: Serum Hcy levels were studied and compared between patients with OSCC and healthy individuals. Results: Serum Hcy levels were higher in patients having OSCC. Conclusion: Serum Hcy levels could be utilized as a biological marker in the diagnosis and the prognosis of OSCC patients.

Detection of Helicobacter pylori in oral squamous cell carcinoma using modified Giemsa stain: A new diagnostic approach.

Context: Oral squamous cell carcinoma (OSCC) is the sixth most common cancer worldwide. It is mainly known to be caused by tobacco in various forms and also due to viral, fungal infection and poor oral hygiene, etc. Poor oral hygiene leads to colonization of pathogenic bacteria including Helicobacter pylori. It seems that the presence of H. pylori might be a risk factor for developing oral cancer. The successful attempt was made to detect H. pylori in diagnosed specimens of OSCC using Warthin-starry and Giemsa stains in our department. The modified Giemsa stain is the method of choice because it is sensitive, cheap, easy to perform, faster, and reproducible. Aim: The aim of this study is to detect H. pylori in various grades of OSCC using modified Giemsa stain. Subjects and Methods: Thirty cases of various grades of OSCC were selected from the archives of the department. Five-micrometer-thick paraffin-embedded tissue sections of these cases were taken and stained with modified Giemsa and were studied under ×100 magnification. Results: All the tissue sections studied were positive for H. pylori bacteria. Conclusions: Our study showed a significant presence of H. pylori in histological sections of OSCC, and it seems likely that the presence of H. pylori might be a risk factor for the developing oral lesions such as oral cancer. Early detection and eradication of H. pylori in the oral cavity, especially in high-risk patients, might prevent its harmful consequences.

Deciphering the "Collagen code" in tumor progression.

Invasion and metastasis are the fundamental properties of tumor biology and the root causes of cancer death. With the elucidation of genetic and epigenetic mechanisms, it has been postulated that cancer is a disease of imbalance. It is not merely a disease of tumor cells but also the body's mismanagement of those tumor cells. Tumor microenvironment plays an important role in tumor progression via the co-evolution of tumor cells and tumor stroma. Hence, exploring the complex mechanisms of tumor progression from perspectives of tumor stroma has become a new frontier. The major component of tumor stroma, the extracellular matrix (ECM), acts as a key regulator of cell and tissue function. Conventionally, the role of ECM was considered primarily as a physical scaffold that binds cells and tissues together. However, recent studies revealed the biochemical and biophysical signaling properties of the ECM as well that affect cell adhesion and migration, tissue morphogenesis and repair, and angiogenesis and cancer. The most abundant constituent of ECM, collagen, accounts for the major function of ECM, which can be associated with increased malignancy. The present review summarizes the dynamic interplay between collagen and tumor cells. It focuses on changes in physicochemical-biological properties of collagen. A new paradigm has been formulated that collagen can no more be considered playing a passive role over which tumor progression and metastasis takes place. Rather, its active role in the promotion of tumor progression and metastasis should be explored.

Assessment of apoptotic index in various grades of oral epithelial dysplasia: A cross-sectional study.

CONTEXT: : Oral cancer is a major health problem worldwide. In cancer, the equilibrium between cell proliferation and apoptosis is disturbed. The defect in the apoptotic pathway allows cells to proliferate with genetic abnormalities. Thus, the apoptotic index (AI) can be used to assess the significance of apoptosis as a proliferative marker in oral epithelial dysplasia. AIMS: To assess the apoptotic index in various grades of epithelial dysplasia. OBJECTIVES: 1) To calculate the apoptotic index in various grades of oral epithelial dysplasia, 2) To compare the apoptotic index between various grades of oral epithelial dysplasia, 3) To predict the biologic behavior of oral epithelial dysplasia based on an apoptotic index. SETTINGS AND DESIGN: Cross-sectional tissue analyzing study. METHODS AND MATERIALS: This study constituted 30 cases, previously diagnosed with various grades of oral epithelial dysplasia (OED). AI was calculated as the number of apoptotic bodies/cells expressed as a percentage of the total number of cells counted in each case. STATISTICAL ANALYSIS USED: Statistical analysis was carried out using ANOVA test. RESULTS: A statistically significant difference was observed between mild dysplasia and severe dysplasia where P = 0.002. The mean AI was increased progressively with increasing grades of OED. CONCLUSIONS: This study demonstrated the clinical significance of apoptosis in assessing disease progression in Oral Potentially Malignant Disorder (OPMD) which may be used as a prognostic indicator in OED. This would, in turn, help in knowing the prognosis of the disease and to develop targeted drug therapy.

Adenomatoid odontogenic tumor - hamartoma or true neoplasm: a case report.

Adenomatoid odontogenic tumor (AOT) is an uncommon tumor of odontogenic origin with a relative frequency of 2.2 - 7.1%. As the histogenesis of AOT is still uncertain, it is sometimes categorized as a hamartomatous lesion rather than a true neoplasm. We report a case of AOT in the right maxillary anterior region in a 20-year-old woman. The tumor showed some unusual and aggressive features that suggested it was a true neoplasm.

Fibrolipoma on a Child's Lip: A Rare Clinical Finding.

Lipoma is very common benign tumor of adipose tissue, but its presence in the oral cavity is rare. Fibrolipoma is a histological variant of lipoma that affects the buccal mucosa and nasal septum in the orofacial region and causes functional and cosmetic issues. However, this lesion has not been reported on the upper lip and may be confused with other soft tissue lesions of children. Hence, accurate histopathological examination of lipomas is important for a correct treatment plan. The purpose of this report is to describe the case of an 11-year-old boy with fibrolipoma of the upper lip.

Wheatgrass: Green Blood can Help to Fight Cancer.

INTRODUCTION: Oral squamous cell carcinoma is the sixth most common cancer worldwide and is one of the leading causes of death especially in developing countries like India. It is usually managed with the help of chemotherapeutic agents that are toxic not only to the tumor cells but also to normal cells in many ways. Whereas the traditional herbal medicines which are used from ancient days in India are generally known to be free of toxic effects and are effective. Wheatgrass is the young grass of the wheat plant 'Tritcumaestivum Linn', family Poaceae (Gramineae). It contains a number of vitamins, mineral, amino acids and vital enzymes, these play an important role in the anticancer approach of this herbal product. It is also called as 'green blood' because of its high content of chlorophyll, which bears a structural similarity to haemoglobin and this result in high oxygen supply to all the body tissues. AIM: To analyse the effect of the aqueous wheat grass extract on Oral Squamous Cell Carcinoma (OSCC) cell line by MTT assay. MATERIALS AND METHODS: 'KB cell line' (Mouth Epidermal Carcinoma Cells) was used for the present study. Aqueous extract of wheat grass was prepared in the institution. The aim of the study was to assess the effect of the aqueous wheat grass extract on KB cell line(OSCC) by MTT assay. RESULTS: A 41.4% of OSCC cell inhibition was observed at 1000 µg/ml dilution of aqueous wheatgrass extract in 24 hours. CONCLUSION: The aqueous extract of wheatgrass has an inhibitory effect on the oral cancer cell line proliferation.

Clear cell variant of oral squamous cell carcinoma: case report and review

Abstract The clear cell variant of Oral Squamous Cell Carcinoma (OSCC) is an uncommon histological variant. Kuo first discovered it in the skin, and Frazier et al. found it in the oral cavity. We know of only nine cases of clear cell variant of OSCC reported in the literature till now. The present case is in a 60-year-old male patient with an ulcer on the left posterolateral border of the tongue. The patient had a history of chewing tobacco for 22 years. Clinical examination showed features of malignant ulcer associated with pain and discomfort. Histopathological examination revealed sheets and islands of atypical epithelial cells with clear cytoplasm, nuclear and cellular pleomorphism, and few keratin pearls in the connective tissue suggesting OSCC. Various special stains were performed to identify clear cells. Periodic Acid Schiff-Diastase (PAS-D) and Mucicarmine stains showed positive and negative reactions in clear cells, respectively. Immunohistochemical (IHC) analysis for cytokeratin (AE1/AE3) showed diffuse positivity in clear cells and other epithelial cells. Based on special stains and IHC markers, we confirmed the diagnosis as a clear cell variant of OSCC. This variant is rare and presents diagnostic challenges. It is said to be aggressive in nature. More such cases should be reported to understand its biological behavior and prognosis.

Intraosseous Neurofibroma of the Mandible: A Case Report and Review of Literature.

Neurofibroma (NF) is a benign tumor of the peripheral nervous system. Head and neck NF are generally located in the soft tissue. The tumour is rarely seen intraosseously and most commonly such tumours are seen as solitary lesions, rather than part of neurofibromatosis. The following report describes a case of an intraosseous neurofibroma in a 45-year-old male located in the left posterior mandible. The diagnosis was made based on the clinical findings, radio graphical features, histopathology, and immunohistochemistry. A literature review has been done on intraosseuos neurofibromas located in the jaws, with a discussion on the possible differential diagnosis.

Histopathological study of apparently normal oral mucosa in lepromatous leprosy.

In lepromatous leprosy, it may be postulated that apparently normal areas of skin are the probable sites of future extension of the pathological process and the events taking place in these site might represent the earlier stages of such an extension. Thus the present study has been done to evaluate any such changes in the apparently normal oral mucous membrane of the lepromatous leprosy patients, since oral involvement is common in these patients. Twenty two cases of lepromatous leprosy were studied histologically to see changes in apparently normal oral mucosa. Out of the 22 patients, apparently normal skin biopsies were taken from 13 patients and 5 lesional biopsies were taken from the same patients. Apparently normal oral mucosal biopsies were done for all patients. Biopsies of 22 cases of apparently normal oral mucosa did not show granulation formation of acid-fast bacilli histologically. The only change present was mild inflammation.

Keratoameloblastoma a rare entity: a case report.

Ameloblastoma is the second most common odontogenic tumour of oral cavity; which has several different histological variants such as follicular, plexiform, acanthomatous, granular cell, desmoplastic, basal cell, clear cell, hemangiomatous, mucous cell differentiation and keratoameloblastoma. It is common in posterior mandible and has high male predilection in the ratio of 3:1. This report presents a case of keratoameloblastoma in 65-year-old female patient in the anterior mandible region with literature review on clinical features, histopathological findings, radiological appearance and treatment options.

Cd34 and Mast Cell Analysis in Normal Oral Mucosa and Different Grades of Oral Squamous Cell Carcinoma: A Comparative Study.

BACKGROUND: Oral Squamous Cell Carcinoma (OSCC) remains a serious health problem worldwide. Prognosis of OSCC is poor and long term survival rate still remains below 50%. Angiogenesis or neovascularisation plays an important role in tumour progression and metastasis. Mast cells have been implicated in promoting tumour angiogenesis, especially of digestive tract, little is known in OSCC. AIM & OBJECTIVE: To study the correlation between blood vessel density (BVD) and mast cell density (MCD) in different grades of OSCC. METHODS: Thirty eight paraffin blocks of different grades of OSCC were retrieved from the department and sections were stained with CD34 followed by counterstaining with toluidine blue. The slides were then analysed using Leica Software (Version 4.5). RESULTS: Mean BVD and MCD were found to be increased in OSCC as compared to normal mucosa. Increase in BVD with co-current increase in MCD was also observed in different grades of OSCC. CONCLUSION: From our study, it was concluded that, mast cells play a major role in promoting tumour angiogenesis. But, as the grade of the tumour increases, other angiogenic factors may play a more significant role than mast cells in tumour progression.

Teratoid cyst of the oral cavity: A rare entity.

The teratoid cyst is a rare variant of the dermoid cyst which seldom occurs in the oral cavity. If seen, they generally present as slow growing cysts of the floor of mouth, reported commonly in the 2(nd) and 3(rd) decade of life in males. Histopathologically, dermoid cyst is classified as epidermoid cyst, true dermoid cyst and teratoid cyst depending on the presence of adnexal structures and derivatives of all three germ layers. Herewith we report a rare case of teratoid cyst of the floor of the mouth, in a 2-year-old female child, which was present since birth.

Ewing's sarcoma of maxilla: A rare case report.

Ewing's sarcoma is uncommon malignancy of childhood, frequently involving the mandible. The occurrence in maxilla is rare. It is histopathologically characterized by sheets of round cells positive for CD99. Although the prognosis is poor but early diagnosis and long term follow up can improve the survival. This article presents a rare case of Ewing's sarcoma of maxilla in a 15 year old male patient showing excessive fibro-osseous response which is not a frequent presentation. A retrospective analysis of cases of Ewings sarcoma of maxilla published in the English litreture is reviewed. In our case, diagnosis was confirmed by immunohistochemistry where sheets of round tumor cells were positive for CD 99. Ewings sarcoma of maxilla is a rare and aggressive tumor. Hence early diagnosis, combined therapy and long term follow up is suggested in such cases.

Leimyosarcoma of the buccal mucosa and review of literature.

UNLABELLED: Leiomyosarcoma (LMS) is an uncommon malignant spindle cell tumor of the head and neck region. The occurrence is particularly rare in the buccal mucosa of the oral cavity. It is a rapidly growing tumor with aggressive behavior and poor prognosis. METHOD: This article presents a rare case of primary leimyosarcoma of the buccal mucosa in a 35 year old female and retrospective analysis of primary oral LMS published in the English literature since past 20 years is done. Diagnosis was confirmed by immunohistochemistry profile showing positivity for vimentin, smooth muscle actin (SMA), high proliferative index displayed by Ki-67, focal positivity for pan-CK and negativity for S-100. CONCLUSION: Based on the presence of malignant spindle cells showing positivity for vimentin and SMA, a diagnosis of leiomyosarcoma was made.

Rose Bengal staining - diagnostic aid for potentially malignant and malignant disorders: a pilot study.

BACKGROUND: The word "Cancer" itself is sufficient to cause a fear in the minds of people. Early detection of oral potentially malignant and malignant disorders is still a diagnostic challenge for most of the clinicians. In the present study, we have evaluated the efficacy of Rose Bengal staining in the detection of oral premalignant and malignant lesions. AIM: The aim of the study was to evaluate the efficacy of the Rose Bengal staining for the identification of dysplastic areas clinically, and then correlating the findings with the histological grading of dysplasia. METHODS AND MATERIALS: A total of 20 patients were selected for the study. Patients had been evaluated clinically and histopathologically along with the grading of dysplasia, and Rose Bengal stain was painted over the lesional mucosa with the patient's consent. Incisional biopsies were taken from the stained area of the Rose Bengal dye, and studied histopathologically. Grading of dysplasia and intensity of the Rose Bengal staining were found to be correlated. Chi square test was performed and a statistical significance of P<0.001 was observed. Statistical significance was defined as P<0.001. RESULTS AND CONCLUSION: Grading of dysplasia and the intensity of Rose Bengal staining were directly proportional to each other according to this study. P value was found to be significant. Thus Rose Bengal stain can be used as a diagnostic aid in the detection of oral potentially malignant and malignant disorders.