Masquerading Spitz naevi on the upper lip: A case report with a brief review of the literature.

In a scenario where there is an increased incidence of oral squamous cell carcinoma (OSCC) in younger age groups, the diagnosis of pseudo-malignant lesions that mimic the histopathology of a moderate or even high-grade carcinoma becomes imperative for oral pathologists. Though paediatric malignancies such as melanomas and thyroid carcinomas and even OSCCs have been reported in young children, they are rare in the pre-pubertal age group. Melanocytic naevi such as Spitz naevi (SNs) or atypical SNs is, however, more common in this age group and could create some difficulty in diagnosis due to its histological variations that could mimic a malignancy. Hence, the need for a cautious correlation between clinical and histopathological features becomes manifold. Adjunct tools that use diagnostic and molecular techniques such as immunohistochemistry (IHC) and comparative genomic hybridisation (CGH) help in diagnosis and in differentiating certain types of SNs from Spitzoid melanomas or melanomas. A case that histopathologically resembled a moderately differentiated squamous cell carcinoma without any evidence of melanocytic content proved to be a melanocytic naevus after clinical correlation of both age and immunohistochemical analysis. This case report with review brings to light the importance of being aware of such pseudo-malignant lesions in our daily practice.

Peripheral Dentinogenic Ghost Cell Tumor- Diagnostic Challenge in a Gingival Epulis: Report of a Case with Update of all Dentinogenic Ghost Cell Cases Reported in English Literature.

Dentinogenic ghost cell tumor (DGCT), a variant of the calcifying odontogenic cyst, is considered to be a benign epithelial and mesenchymal neoplasm containing aberrant epithelial keratinization, ghost cells, and spherical calcifications. While there can be peripheral and central variants of this entity, the extraosseous type is rarer and usually innocuous in its clinical presentation. The aim of this article is to report a case of peripheral DGCT on the maxillary anterior region in a 14-year-old female evolving for 5 years and to emphasize the importance of histopathologic examination of gingival growths to avoid diagnostic pitfalls. A compilation of all reported cases in the English literature till date with details on the site, size, age sex, symptoms radiographic features, treatment follow-up, and recurrences has been attempted for better understanding of the biologic nature of this rare neoplasm.

Francis Robert Lloyd and the celebrated traveller: a British Raj murder mystery.

In 1854 the Schlagintweit brothers, scientist-explorers from Vienna were invited by the East India company to make a geological survey of the northern parts of the sub-continent. Adolphe Schlagintweit had wanted to cross into Central Asia from India. He had proceeded as far as Kashgar when he was allegedly murdered by a chief of one of the wandering tribes. His decapitated head became a source of intrigue. The paper describes the incident and the subsequent role of Dr F R Lloyd, a dentist from India, in the police investigation that followed. This is the first documented case from India of a legal case making use of forensic odontology.

Bilateral hilar sialoliths in a child: A rare occurrence.

Salivary sialolithiasis is a well-known cause for obstructive disease of the submandibular and parotid glands. However, the condition frequently occurs unilaterally, and it is uncommon to find a patient reporting with stones in both submandibular or parotid glands. Children below the age of 16 years rarely suffer from salivary stones. Thus, bilateral sialoliths in a child are extremely rare, with only four previous cases been reported in the literature. This is an additional case report of bilateral submandibular sialolithiasis occurring in the hilar area in a 13-year-old boy.

Understanding the mechanism of commonly occurring COVID-19-associated oral lesions.

Covid-19 pandemic is a novel disease with gradual emergence of its signs and symptoms. Oral healthcare providers had a setback in their dental practices due to the high rate of infectivity and the risk of contracting the disease through the patients carrying the virus. Once the dental practice resumed to its normalcy the dental surgeons came across a variety of oral manifestations in patients with a history of Covid and post recovery. An attempt is made to recognise the Covid-19 oral manifestations with plausible explanation of the mechanism of development of such oral signs.

Peripheral adenomatoid odontogenic tumor of mandible - A synchronous presentation or a subtype?!

Adenomatoid odontogenic tumor (AOT) with its unique and varied presentations histologically and clinically has always been an enigma. AOTs are multifaceted in their appearance with reports pointing out to its occurrence as a synchronous tumor, a purely cystic variant or with multiple foci; however, the three commonly encountered forms are Follicular/Coronal, Extra Follicular/Extra Coronal and Peripheral variants. Here, we present a subtype of the Peripheral AOT (PAOT) seen synchronous with an intraosseous cystic variant of AOT in a 16-year-old female in the anterior mandible. This case is unique in that a PAOT occurring adjacent to a focally aggressive intraosseous cystic AOT (not associated with impacted tooth) could either be synchronous with no connection to the intraosseous component or could actually be an erupted intraosseous cystic variant with peripheral manifestation. Features of cortical expansion, perforation and displacement of teeth without resorption were seen. Histologically, all the classical features of AOT along with abundant eosinophilic amorphous fibrinous deposits, cellular vacuolization, clearing of cells, dystrophic and reactive bone formation and a cystic lining were seen. Thus, this case of PAOT would add to the myriad presentation of AOT making it one of the most often discussed odontogenic tumor.

Effect of trans retinoic acid on patients with oral submucous fibrosis-randomized single-blind monocentric study.

Various treatment modalities have been practiced for the suppression of premalignant conditions such as oral submucous fibrosis (OSMF) to prevent their differentiation into malignant lesions. Conventional treatment includes steroids, enzymes like hyaluronidase, trypsin, chymotrypsin and placental extracts which are advocated intralesionally and oral drugs like carotenoids, alpha lipoic acid, lycopene, vitamins, microelements and tea pigments have also been advocated.In this study, a total number of 30 patients with OSMF were taken and randomly divided into two groups with 15 patients each according to Khanna and Andrade group of classification 1995. Group 1 (test group) received the test drug Tretiome 20 mg, whereas Group 2 (control group) received an antioxidant lycopene 20 mg/day for a period of 1 month and the effect of the therapy with the changes in the symptoms was recorded every 1 week, 15 days and 30 days of follow-up. The result of this study showed an improvement in the mouth opening of the patients of test Group with a significant decrease in the burning sensation as compared to the control group (P < 0.05). Xerostomia and headache were the two most commonly seen side effects which were reported in the patients of the test group, of which headache was associated with the withdrawal symptom of habit cessation and xerostomia was taken care by increase in hydration.

Swelling of the submandibular gland region: Cystic or neoplastic entity?

A 43-year-old male patient reported with a swelling in the left submandibular region of 3-4 months' duration. The soft fluctuant swelling was painless and cystic on palpation. The excised submandibular gland was submitted for histopathological examination, which showed the presence of a bluish, thin-walled cystic cavity containing gelatinous straw-colored fluid. H and E-stained sections showed thin cystic lining with papillary projections of salivary glandular cells and multiple cystic spaces. Immunohistochemistry was recommended to differentiate between acinic cell carcinoma of papillary-cystic variant and low-grade mucoepidermoid carcinoma.

Incremental lines in root cementum of human teeth: an approach to their role in age estimation using polarizing microscopy.

Age estimation is an important factor in the identification of an individual in forensic science. The hard tissues of the human dentition are able to resist decay and degradation long after other tissues are lost. This resistance has made teeth useful indicators for age calculation. Recent research indicates that tooth cementum annulations (TCA) may be used more reliably than any other morphological or histological traits of the adult skeleton for age estimation. The purpose of this study was to examine the correlation between age and the number of incremental lines in human dental cementum and to ascertain the best method of studying cementum with respect to different forms of microscopy. Thirty nonrestorable teeth were extracted from 20 people, and longitudinal ground section of each tooth was prepared. Photomicrographs of the area at the junction of apical and middle third of the root under light and polarized microscope were taken. The cementum was composed of multiple light and dark bands that were counted on the photomicrograph with the help of image analysis software and added to the average eruption time of individual tooth. The predicted age of the individual was thus obtained. Results showed a significant correlation between the predicted age and actual chronological age of the individual. These data indicate that quantitation of cementum annuli is a moderately reliable means for age estimation in humans and polarizing microscopy is a better means of visualizing incremental lines of cementum compared to light microscopy.

Toxoplasmosis submandibular lymphadenitis: Report of an unusual case with a brief review.

A 16-year-old male patient reported with swelling of the right submandibular region for 3 months. The patient was asymptomatic and gave a history of fever lasting for 2 days before observing the swelling. Fine-needle aspiration cytology revealed nonspecific lymphadenitis, and since there was no apparent cause detected in the oral cavity or any systemic condition noted, the enlarged lymph node was surgically excised and submitted for histopathologic examination. The inflammatory condition and large numbers of macrophages appeared nonspecific while granuloma formation was not seen. Specific antibody titer against Toxoplasma gondii was carried out and extremely high level of IgG for toxoplasma was detected confirming the diagnosis of toxoplasmosis leading to lymphadenitis.

Polarized microscope assisted study of collagen fibres in Oral Submucous Fibrosis and their clinicopathologic correlation: An in-vitro study.

BACKGROUND: The present study was aimed to evaluate and analyze orientation and birefringence pattern of collagen fibers histopathologically in different grades of OSMF using the special stain (Picrosirius red) under polarizing microscope and relate these factors with the severity of OSMF. MATERIALS AND METHOD: 45 confirmed cases of OSMF were taken from the archives. The selection of clinical cases was done according to classification by J.N Khanna and Andrade (1999). These cases were correlated histopathologically as per the criteria given by Pindborg J.J and Sirsat S.M (1966). The sections were stained with H & E and Picrosirius red stains and assessment was done accordingly. 10 cases of normal mucosa were taken as control. RESULTS: In clinical grade I, 60% of the cases showed histopathological grade II, while 53.4% cases in clinical grade II correlated with histopathological grade III and 33.4% of clinical grade III cases showed histopathological grade IV. Upon application of Fisher's exact test a significant P value <.01 was obtained suggesting no statistical significant correlation between these two parameters. However, the orientation pattern revealed a parallel orientation as OSMF advanced. Also as the severity of the disease increased, there was a gradual shift from green- greenish yellow colour of the fibres and a shift to orange red-red colour. CONCLUSION: Upon correlation of clinical grades with histopathological grades, no statistically significant difference was found. Birefringence pattern of collagen revealed similar findings as other studies in case of clinical grades but histopathological grades showed a contrast finding.

Saliva in forensic odontology: A comprehensive update.

In recent years, saliva has attracted much interest among researchers especially in the field of forensic sciences. This complex body fluid is gaining popularity due to its ease of collection, safety in handling and its close relationship with plasma. Analysis of saliva for serological testing and cellular content has proved to be of wide use in crime detection, drug and alcohol abuse, hormone identification, cases of poisoning and animal bites. There is a need for forensic laboratories to automate the settings specific for saliva as routinely done for blood or urine in order to consider saliva as the primary investigating tool in the absence of other body fluids. This update is aimed at highlighting the many uses of saliva in the practice of forensic odontology.

Tuberculosis of odontogenic cyst.

Tuberculous infection of the oral tissues is a rare finding. An interesting case of primary tuberculosis of mouth is described, presenting as persistent discharge of pus from the lower wisdom tooth region. Incisional biopsy revealed features of an infected dentigerous cyst while histopathological examination of the excised lesion showed keratinizing cyst with secondary infection. Non-healing of the bony defect prompted curettage of the area and the submitted sample microscopically showed granuloma with characteristic Langhans' giant cells, raising the suspicion of underlying systemic tuberculosis. The importance to the dental surgeon in the recognition, especially by use of pathological examination, is emphasized and also the value of diagnosis for the patients and the community.

Quantification of AgNOR expression in exfoliated oral mucosal cells of tobacco chewers with and without lesion.

BACKGROUND: Nucleolar organizer regions (NOR) are associated with proliferative activity and represent a diagnostic and prognostic marker. MATERIALS AND METHODS: Smears were taken from smokers, tobacco chewers, oral squamous cell carcinoma patients, and normal subjects and evaluated by 2 silver-staining nucleolar organizer region (AgNOR) counting methods: (1) mean number of AgNORs per nucleus (mAgNOR); and (2) percentage of nuclei with >3 and >5 AgNORs (pAgNOR). RESULTS: A statistically significant difference was observed between normal subjects, smokers, tobacco chewers, and oral cancer patients and between tobacco chewers with and without lesion. No significant difference was observed between tobacco chewers and smokers except in the percentage of >5 criteria. CONCLUSIONS: AgNOR enumeration using noninvasive methods, such as the cytobrush appears to be useful technique in distinguishing between normal mucosa, mucosa with and without lesions exposed to carcinogens, such as tobacco and frank oral carcinoma.

Pediatric jaw tumors: Our experience.

BACKGROUND: Reports of series of central jaw tumours in children are rare hence predicting their biological behaviour as well as treatment, prognosis have not been documented from this part of the world. AIM: To study retrospectively, the paediatric central jaw tumours, reported to our institute with relation to site of occurrence, presentation and biological behaviour. MATERIALS AND METHODS: All consecutive patients (<18 years), between 2004-2010, histologically diagnosed as having an intraosseous tumour or tumour-like lesions formed the study population. Patients fulfilling the inclusion criteria were only considered for further study. The entire study material was analyzed and grouped into various categories for logical conclusions. The data accumulated were grouped, entered and analyzed. RESULTS: Sixty-one cases fulfilled the criteria. Gender distribution was equal, with mandible predominance (2.2:1) and a predominance of non-odontogenic lesions (2:1). There were 4 malignant and 57 benign conditions. Anterior jaw lesions were 23 while 38 were present in the posterior region of jaws (1:1:6). CONCLUSIONS: The pattern of central jaw tumours presentation in children from this part of India has been documented. In this study, paediatric jaw tumours are less common compared to those in adults with non-odontogenic tumours being common. The finding of the present study indicates that an impacted tooth, beyond the eruption time deserves more attention for the reason of associated pathologies in children.

Reactive hyperplastic lesions of the oral cavity: A ten year observational study on North Indian Population.

BACK GROUND: The aim of this study was to determine the frequency of focal reactive hyperplastic lesions of the oral cavity as reported in the Department of Oral Pathology and Microbiology, Subharti Dental College, Meerut and to compare these data with those of previously reported studies from other regions and countries. MATERIAL AND METHOD: Patient records of the Department of Oral Pathology were retrieved during a 10 year period from 2001 to 2010. Data of all reactive hyperplasias namely focal fibrous hyperplasia (FFH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell granuloma (PGCG) were reviewed and analyzed for age, gender, and site of location. RESULTS: There were 209 focal reactive hyperplastic lesions that comprised 12.8% of the 1634 accessed biopsies. FFH was the most common lesion constituting 57.4% of the cases, followed by PG (18.7%), POF (17.7%) and PGCG (6.22%). The mean age of patients at presentation was 31.56 years. The female to male ratio was 1.5:1. The most frequently involved site was the gingiva (81.8%); other sites were the buccal mucosa, lips, tongue, alveolar mucosa and palate. CONCLUSION: Oral lesions are often detected by Dental professionals and surgeons. Knowledge of the frequency and presentation of the most common oral lesions is beneficial in developing a clinical impression of such lesions encountered in practice and to minimize potential dentoalveolar complications. Key words:Focal reactive hyperplastic lesions, fibrous hyperplasia, pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell granuloma.