The intriguing role of IL33/ST2 axis signaling in oral diseases - A systematic review

PURPOSE

Oral diseases act as a silent epidemic, and the pathogenetic role of interleukin-33/ suppression of tumorigenicity-2 axis (IL-33/ST2) remains unclear due to a lack of literature. This review has attempted to highlight the importance of this axis in oral diseases, which may be helpful in developing therapeutic modalities required to halt disease progression.

MATERIALS AND METHODS

A thorough search was conducted using various databases. Original research articles that assessed both IL-33 and ST2 levels in oral diseases using different techniques were included in the review. The risk of bias for each study was analyzed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and Review Manager 5.4 was used to output the results.

RESULTS

In the qualitative data synthesis we included 13 published articles. The most commonly used method was serum estimation, while methods with optimistic results were saliva, real-time quantitative polymerase chain reaction and immunohistochemistry. The predominant mechanism of action was nuclear factor kappa B signaling and type 2 immune response. However, salivary gland epithelial cell activation, activation of mast cells, type 1 immune response, and upregulated angiogenesis are crucial in mediating IL-33/ST2 signaling in oral diseases.

CONCLUSIONS

Accumulating evidence demonstrates that the IL-33/ST2 axis is a fundamental pathogenetic mechanism of oral diseases of inflammatory, autoimmune, or neoplastic origin.

Comparative manual and digital analysis of gonial angle in lateral cephalograms for gender determination

Human skull has always been used for victim identification in forensic odontology. The gender-dimorphic bone of the skull is the mandible. The gonial angle has frequently been investigated for gender estimation with variable results and requires further exploration. We aim to compare the efficacy of gonial angle estimation by ancient methods of lateral cephalometric tracing compared with more recent digital analysis methods for gender estimation in the Indian population. Lateral cephalograms of 191 (96 M and 95F) cases above the age of 17 years were retrieved. Cephalometric analysis of gonial angle on radiographs was done using both manual cephalometric tracing method and digitally using Adobe Photoshop software. The results were subjected to statistical analysis for evaluation. The mean gonial angle was higher in females (125.05; 123.77 and 125.28) than in males (122.583; 121.715 and 122.008) using both manual and digital methods. On applying the logistical regression analysis (LRA), the digital method showed the highest gender estimation accuracy of 60.7% followed by Burstone's analysis (57.1%) and manual conventional analysis (56.5%). Burstone's analysis (57.9%) correctly identified increased females, whereas digital analysis (62.5%) and manual conventional analysis (59.4%) accurately recognised increased males. The present study showed a higher gender estimation accuracy using digital methods as compared to manual methods, but it still lacks the credibility to be used as a sole factor for predicting the gender of an individual. Hence, a cumulative factor must be taken into consideration for gender identification which would provide more promising results.

Immunohistochemical Comparison of Ki-67 and MCM-3 in Odontogenic Cysts: An Observational Study

Odontogenic cysts are a diverse group of pathologic entities with different proliferation potential, leading to variations in their biological behavior. One of the most cited proliferation markers used in diagnostic histopathology is Ki-67. Another group of proteins recently investigated is minichromosome maintenance (MCM-3) and its expression has been evaluated in several odontogenic lesions but the results were controversial. Thus, the present study endeavored to compare the expression of MCM-3 and Ki-67 in odontogenic cysts. Furthermore, a pioneer attempt was made to evaluate the sensitivity of these markers to inflammation. A total of 101 cases (37 dentigerous cysts, 37 odontogenic keratocysts, and 27 radicular cysts) were included. Immunohistochemical expression of Ki-67 and MCM-3 were investigated using a labeling index (LI). In addition, they were scored for inflammation, followed by correlation with both markers. The data obtained were subjected to statistical analysis ( P <0.05). Overall, a higher LI of MCM-3 than Ki-67 was obtained in all study groups along with a positive correlation of Ki-67 LI with inflammation. Thus, MCM-3 proteins proved to be a more accurate means to determine the proliferation potential and were not sensitive to external stimuli like inflammation than conventional markers, such as Ki-67.

Diagnostic Utility of Expression Pattern of S100/Mammaglobin/SOX10/DOG 1 Immunohistochemistry in Differentiation of Secretory and Acinic Cell Carcinoma: A Systematic Review and Meta-Analysis

Secretory carcinoma (SC) is a relatively new disease entity, separate from acinic cell carcinoma (AciCC), which frequently displays ETV6-NTRK3 gene fusion. However, the differences between SC and AciCC remain ambiguous. Genetic diversity makes its diagnosis complicated. In this regard combined expression of immunohistochemistry markers S100/Mammaglobin/SOX10 and DOG1 is need of the hour as alternative methodology. The current systematic review was to investigate the diagnostic utility of combined immunohistochemical expression of S100/Mammaglobin/SOX10/DOG1 in distinction of SC from AciCC histologically. An electronic search of databases was carried out using MEDLINE by PubMed, Google scholar, Scopus and Web of science. Articles inclusive of SC and AciCC were assessed with S100/Mammaglobin/SOX10/DOG1 immunohistochemistry and their predominant expression pattern, predictive values, sensitivity and specificity were gathered. Fourteen eligible articles were analysed, which revealed predominant immunostaining pattern of S100 + /Mammaglobin + /SOX10 + /DOG1- by nearly all ETV6::NTRK3 fusion prevalent SCs alongside with other gene fusions like RET, MET and MAML3 with 98.4% sensitivity as well as 86.1% specificity. The evidence supports that S100/Mammaglobin/SOX10/DOG1 combined immunostaining can serve as a reliable diagnostic method to differentiate secretory from acinic cell carcinoma.

Dental professional's perspective regarding knowledge, awareness, and attitude towards the importance of charting dental anomalies: a cross-sectional study

OBJECTIVES

The presence of dental anomalies could play a significant role in the identification of individuals by comparing antemortem and postmortem data. This cross-sectional study aimed to assess the level of knowledge, attitude, and awareness among dental professionals regarding the importance of charting dental anomalies and maintaining dental records.

METHODOLOGY

A self-structured questionnaire was e-mailed to dental professionals practicing in India. The responses were recorded, data tabulated, and one-way ANOVA and post hoc tests were applied for analysis. The criterion for significance was p < .05.

RESULTS

A total of 406 dental professionals responded to the survey. A significant difference was observed in the mean attitude score of participants towards the importance of charting dental anomalies and maintaining dental records with regard to place of work (p=.001), gender (p=.044) and educational qualification (p=.039). In addition, a statistically significant difference was observed in the mean awareness score of participants with respect to place of work (p=.033) and gender (p=.001). The major barriers in maintaining dental records were lack of time, adequate knowledge, infrastructure, and financial constraints.

CONCLUSION

81.3% and 69.26% study participants had very good awareness and attitude, whereas 71.2% had good knowledge regarding the importance of charting dental anomalies and maintenance of dental records; however, their inaccurate responses in anomaly identification hinted towards the need for proper dental charting and their maintenance to be taught en masse and made part of the BDS curriculum.

Localization of beta catenin across the domain of odontogenic lesions: A systematic review

BACKGROUND

CTNNB1 gene encodes beta catenin, a transcriptional activator of Wnt pathway involved in the pathogenesis of odontogenic lesions. Though located intramembranously, its translocation into cytoplasm and nucleus could trigger cell proliferation, inhibition of apoptosis, invasion and migration of the tumour cell.

MATERIALS AND METHODS

Five electronic databases including MEDLINE by PubMed, Google scholar, Scopus, Trip, Cochrane library and EMBASE until 1 January 2023 without period restriction were thoroughly searched. Those articles that identified CTNNB1 mutation and beta catenin in odontogenic lesions were included for review. Risk of bias was analysed for each study using QUADAS 2 tool and Review Manager 5.3 was used to output its result.

RESULTS

Thirty four published articles were included for data synthesis. A total of 1092 cases of odontogenic lesions were assessed for both CTNNB1 mutation and beta catenin expression. CTNNB1 mutation was observed in ameloblastoma, calcifying odontogenic cyst, calcifying cystic odontogenic tumour and all malignant odontogenic tumours. The beta catenin expression (nuclear and cytoplasmic) was maximum in odontogenic keratocyst and calcifying odontogenic cyst. The expression was variable in ameloblastomas, membranous in odontomas, calcifying cystic odontogenic tumour and nuclear in all malignant tumours.

DISCUSSION AND CONCLUSION

High recurrence of odontogenic keratocyst and aggressiveness of solid ameloblastoma and malignant odontogenic tumours could be associated with the nuclear translocation of beta catenin. Disparity between CTNNB1 mutation and beta catenin expression within odontogenic lesions suggests alternate routes of beta catenin activation. The review results support the unique localisation of beta catenin as a helpful diagnostic factor in the pathogenesis of odontogenic lesions.

Acantholytic oral squamous cell carcinoma with clear cell change - a rare amalgamated variant

Background

Acantholytic squamous cell carcinoma (ASCC) is an uncommon histological variation of oral squamous cell carcinoma (OSCC), accounting for fewer than 4% of all occurrences. The tumor shows a slight masculine predisposition, with the lower lip being the most commonly affected location. ASCC is reported to have a diverse biologic behavior, which explains its ability to metastasize to distant places and, thus, its poor prognosis. Similarly, clear cell change in OSCC is a rare occurrence with an unknown etiology that suggests its aggressive nature.

Method and Results

Histopathology reveals central acantholytic cells with numerous duct-like features. The presence of distinct cytological atypia contributes to the diagnosis of SCC. Special stains and IHC aid in distinguishing tumor from other histopathologically similar entities.

Conclusion

The case of a 29-year-old male presented here with an updated literature review highlights the need for histological study of the unique and seldom seen oral ASCC with clear cell change, which can be ignored because of similarities with other entities. Because recurrence rates are so high for ASCC, amalgamated clear cell change makes it critical for proper treatment initiation with a definite diagnosis. To the best of our knowledge, this is the first documented occurrence. Our experience with the present case suspected a more aggressive behavior due to a high Ki-67 index, anticipating a poorer prognosis in the oral cavity considering the patient's young age.

An exotic pathogenetic mechanism of angiogenesis in oral lichen planus-A systematic review

OBJECTIVE

Angiogenesis plays a vital role at the molecular level in various inflammatory lesions, that lead to their chronicity. Oral lichen planus is an immune-mediated chronic inflammatory disorder. The angiogenetic role and exact mechanisms in oral lichen planus are still unclear due to a dearth of studies. Its clinical significance with angiogenesis also requires further elucidation necessitating a thorough review of the studies that have been conducted so far. The present review was designed to identify the dependence of oral lichen planus progression on angiogenesis which could aid in devising metronomic treatments required to halt the progression of this disease.

MATERIALS AND METHODS

A thorough search was made using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original research articles, that immunohistochemically evaluated angiogenesis in oral lichen planus were included for review. Risk of bias was analysed for each study using Modified Newcastle-Ottawa scale and Review Manager 5.4 was used to output its result.

RESULTS

Twenty-nine published articles were included for data synthesis. The most commonly employed antibody was CD34, however, upregulated VEGF expression was the principal while ICAM-1, VCAM-1, and PECAM-1 were critical angiogenic factors to mediate angiogenesis in oral lichen planus.

CONCLUSION

The current evidence supports that angiogenesis, a fundamental pathogenetic mechanism of oral lichen planus, leads to its persistence and chronicity. However, studies with a larger sample size, standard evaluation criteria, different subtypes, and adequate follow-up are warranted.

Demystifying Histologic Conundrum of Adenoid Ameloblastoma: Case Report with Literature Review

Introduction: Odontogenic tumors encompass a heterogeneous group of lesions that range from hamartomatous lesions to malignancy. Considerable variation in histologic presentation can mislead their accurate diagnosis and categorization. Ameloblastoma is generally well understood and is easy to diagnose but there has been a constant change in the classification systems ever since Broca classified odontogenic tumors in the year 1867. Over the years, it has been modified by the World Health Organization with many additions and omissions. This dynamic change is based on the result and conclusions of molecular and genetic studies with the last modification in 2017. Case Report: We present two cases of females aged 32 and 60 years who reported with facial swellings, revealed the presence of distinct histopathological findings and were diagnosed as ameloblastoma with dentinoid or adenoid ameloblastoma. Literature search revealed dearth of distinct forms of ameloblastoma that show the formation of duct like structures and dentinoid. Conclusion: It is interesting to highlight such cases as the biological behavior is still unexplored due to paucity of relevant studies and follow up of patients. Understanding the pathogenesis and the histopathological characteristics of the newer entities will enable the prompt diagnosis, treatment plan and expanding the spectrum of the lesions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03534-6.

Immunohistochemical evaluation of cyclooxygenase-2 and mast cell density in periapical lesions

AIM

Periapical granuloma (PG) and cyst (PC) are formed as a protective response consequent to pulpal infection leaching through the apical foramen and lateral canals. Various inflammatory mediators like mast cells and cyclooxygenase (COX)-2 are involved in this intricate process. This pilot study aimed to evaluate and compare the immunoexpression of tryptase and COX-2 in periapical granuloma and periapical cyst, and also correlate them with intensity of inflammatory infiltrate and thickness of cystic epithelial lining.

METHODOLOGY

An observational and cross-sectional study was conducted on paraffin-embedded tissue sections of 50 PGs and 50 PCs submitted for morphological and immunohistochemical analysis using anti-tryptase and anti-COX-2 antibodies. The mean number of mast cells (total, granulated & degranulated), mean COX-2 expression and inflammatory score was calculated. The data obtained were analyzed using Mann Whitney U, Student's T, Chi-square and Spearman correlation test (P < 0.05).

RESULTS

The inflammatory score, total mast cells and COX-2 expression were similar in PGs and PCs (P= 0.352, 0.339 and 0.352) however, the degranulated mast cells were highly significant in PC while granulated mast cells were highly significant in PG respectively (P<0.001 in both). Although a non-significant correlation existed between COX-2 and total mast cells in both groups but, total mast cells were significantly correlated with epithelial thickness in PC (P= 0.029).

CONCLUSIONS

Mast cells and cyclooxygenase-2 proved to be independent inflammatory markers in periapical lesions. Further studies should be planned on mast cell and COX-2 inhibitors as treatment modalities of periapical lesions.

Mucormycosis infection associated with global COVID-19 pandemic - an institutional histopathological study

BACKGROUND

Coronavirus disease 2019 (COVID-19) in the recent times have instilled signs of immunosuppression globally which has further precipitated increasing range of opportunistic infections. Mucormycosis is a distressing opportunistic fungal infection with a high incidence and is the third commonest acute invasive infection following candidiasis and aspergillosis. The aim of the present observational study is to delineate the enigmatic histopathological profile between mucormycosis cases seen prior to pandemic (PPM) and pandemic associated mucormycosis (PAM).

MATERIAL AND METHODS

Tissue archives of 105 histopathologically diagnosed cases of mucormycosis were included and analysed for demographical details and histopathological parameters like fungal load and localization, granuloma formation, necrosis, inflammatory infiltrate and tissue invasion.

RESULTS

0ut of 105 included cases, 11/105 (10.48%) were reported PPM and 94/105 (89.52%) PAM. Among 94 cases of PAM, 51/94 (54%) cases also showed COVID-19 positivity, while 43/94 (46%) did not. Of all the histological variables, increased fungal load and necrosis were observed in PAM relative to PPM cases.

CONCLUSIONS

The histopathological variables like fungal load, necrosis, granuloma formation and tissue invasion, could help the clinician in assessing the clinical status at the time of tissue diagnosis and improve the treatment accordingly.

Diagnostic Reliability of CRTC1/3::MAML2 Gene Fusion Transcripts in Discriminating Histologically Similar Intraosseous Mucoepidermoid Carcinoma from Glandular Odontogenic Cyst: A Systematic Review and Meta-analysis

BACKGROUND

Intraosseous mucoepidermoid carcinoma (IMEC) and Glandular odontogenic cyst (GOC) are those two pathological entities causing diagnostic dilemma due to the histopathological similarity. An accurate distinction between the two entities is difficult as both presents with a common radiological and histological similarities. The aim of our systematic review was to establish the diagnostic reliability of CRTC1/3::MAML2 gene fusion for the distinction between IMEC and GOC.

METHODS

A complete electronic literature search was made in MEDLINE by PubMed, Google Scholar, and EMBASE databases. Articles with keywords using molecular genetic findings of CRTC1/3::MAML2 gene fusion transcripts, IMEC and GOC were assessed and included for the systematic review.

RESULTS

Twelve subgroups having both qualitative and quantitative analysis revealed CRTC1/3::MAML2 sensitivity of 100% and specificity of 70.59% in differentiating GOC and IMEC. Fixed-effects model confirmed translocation-negative cases to have a decreased risk of association with IMEC (combined odds ratio 8.770, 95% confidence interval - 2.45 to 31.45, p < 0.002).

CONCLUSIONS

The current evidence supports that in all cases with positive gene fusion transcript of the CRTC1/3::MAML2 was specific for IMEC and was significantly differentiating it from GOC. Whereas cases of IMEC with negative gene fusion transcript pose diagnostic difficulty in differentiating from a GOC which is negative for CRTC1/3::MAML2 expression.

Qualitative assessment of Aloe vera as natural tissue fixative: An institutional study

Objectives

The art of microscopy is only appreciable in well-fixed tissues. We conducted this study to determine the effectiveness of Aloe vera as a tissue fixative and compare its results with the natural fixatives already studied in the literature.

Materials and Methods

A pilot study was tried out using commercially available fresh chicken and fish with Aloe vera, and then after getting the promising results similar study protocol was carried out using 10-autopsied human tissue. Four natural fixatives-30% jaggery solution, 20% honey solution, 20% sugar solution, 20% Aloe vera solution and 10% formalin were used for fixation in the study. Fixation of tissues was carried out at room temperature for 24 h. All pre- and postfixation measurements were recorded using stereomicroscope and its software. The difference between pre-and postfixation was calculated and later, all pieces were kept for routine tissue processing followed by routine staining. The tissue sections were assessed for quality, and the whole procedure was blinded among three oral pathologists who scored them.

Results

The mean percentage of shrinkage in each bit with different reagents was calculated. The shrinkage seen with 10% formalin and 20% Aloe vera were more likely similar. Among all the natural fixatives, qualitatively also Aloe vera excelled and its results were comparable to that of formalin.

Conclusion

The use of Aloe vera in the present study as fixative is the first of its kind, as exhaustive search of the literature shows only its use as transport media in dentistry.

Cytotoxic Role of Chlorogenic Acid on Oral Squamous Cell Carcinoma Cell Line

The aim of the present study was to determine the cytotoxic, anticancerous and antiproliferative activity of CGA on oral squamous cell carcinoma (OSCC) cell line (KB) and to evaluate expression level of p21 and p53 in these CGA treated OSCC cell line. Different concentrations of CGA varying from 500 to 2500 µM were tested on OSCC cell line. Trypan blue and MTT assay were performed to establish IC50. DNA fragmentation and expression level of p21 and p53 were evaluated with the help of RT-PCR. CGA exerted antiproliferative and cytotoxic effect on OSCC (KB) cell line. Statistically significant results were found regarding effect of different CGA concentrations on KB cell line with IC50 at 1800 µM. No DNA fragmentation was observed. p21 and p53 expression were down regulated after CGA treatment. CGA revealed neither apoptosis nor damage to the nucleus after DNA fragmentation. Antiproliferative role of CGA was hinted by down regulation of p53 and p21 probably through cell cycle arrest at G1-S phase. It was reaffirmed that CGA a natural chemo preventive agent could enhance the treatment modalities with minimal side effects.

Primary Oral Histoplasmosis in Immunocompetent Host: Case Series with Review of Literature

Histoplasmosis, a systemic mycosis caused by Histoplasma capsulatum manifests clinically in immunocompromised subjects as acute or chronic pulmonary infection or as a progressive disseminated disease. In oral region it clinically presents as multiple, granular and painful ulcers or verrucous growth. It is rare to find primary oral lesion of histoplasmosis in immunocompetent patient free from systemic disease. In presence of any unusual oral lesion possibility of Histoplasmosis should be considered and prompt diagnosis be attained with exclusion of false negative results as non-specific manifestation of disease may lead to gruesome misdiagnosis of lesion and inadequate treatment. In the present paper two cases of oral histoplasmosis in immunocompetent host have been discussed along with updated review of literature.

Low Grade Intraductal Carcinoma of Palate: An Extremely Rare Entity with Review of Literature

Low-grade intraductal carcinoma (LG-IDC) is the new World Health Organization designation for tumors previously called "low-grade cribriform cystadenocarcinoma" and "low-grade salivary duct carcinoma". LG-IDC is a rare low grade malignant salivary gland neoplasm. A 56-year old woman presented with a painless swelling on the right posterior part of palate of 2 months duration. Radiographic examination revealed heterogenously enhancing soft tissue mass on right side of palate. A provisional diagnosis of pleomorphic adenoma was executed and local excision was done. The tumor had a typical feature of intraductal growth pattern composed of low grade ductal epithelial cells with cribriform and micropapillary patterns forming true "Roman bridges". Immunohistochemically myoepithelial cells displayed p63 around all tumor islands. The case was diagnosed as LG-IDC. LG-IDC is an extremely rare entity and awareness of this entity is important to avoid erroneous diagnosis and inappropriate treatment.

Papillary synovial metaplasia-like change in oral mucoceles: A retrospective institutional study of 105 cases

Background

Mucoceles are mucus-filled cavities and are broadly of two types: mucus retention cysts and mucus extravasation phenomenon. A wide variety of histological features have been documented in the literature. The present study was an attempt to study these histological features: papillary synovial metaplasia-like changes (PSM-like changes) in particular.

Materials and Methods

One hundred and five tissue samples of mucoceles were retrieved and evaluated for age, gender, type, site, color, etiology, symptoms, dimension of the lesion and presence or absence of PSM-like changes. The results were documented on Microsoft Excel spreadsheet and analyzed by using SPSS.

Results

All 105 cases were of mucus extravasation phenomenon with a definitive male preponderance. The mean age of occurrence was 25.82 ± 11.65 years and a predilection for the lower lip. PSM-like changes were seen in 31 cases (Group II), and the remaining 74 cases did not show a definite presence of these features (Group I). The cases in Group II were statistically larger in dimension than Group I cases. No difference was noted in age, gender and laterality.

Conclusion

PSM-like changes appear to be an underrecognized histological alteration seen in oral mucoceles and must be recognized to differentiate from other salivary gland entities showing papillary architecture.

Interplay of collagen and mast cells in periapical granulomas and periapical cysts: a comparative polarizing microscopic and immunohistochemical study

Objectives

This pilot study aimed to establish the interrelationship between collagen and mast cells in periapical granulomas and periapical cysts.

Materials and Methods

An observational cross-sectional study was conducted on the paraffin-embedded tissue sections of 68 specimens (34 periapical granulomas and 34 periapical cysts). The specimens were stained with picrosirius to observe collagen fiber birefringence and anti-tryptase antibody to evaluate the mast cell count immunohistochemically. The mean number and birefringence of collagen fibers, as well as the mean number of mast cells (total, granulated, and degranulated), and the mean inflammatory cell density were calculated. The data obtained were analyzed using the Kruskal Wallis test, Mann Whitney U test, and Spearman correlation test (p < 0.05).

Results

The mean number of thick collagen fibers was higher in periapical cysts, while that of thin fibers was higher in granulomas (p = 0.00). Cysts emitted orange-yellow to red birefringence, whereas periapical granulomas had predominantly green fibers (p = 0.00). The mean inflammatory cell density was comparable in all groups (p = 0.129). The number of total, degranulated, and granulated mast cells exhibited significant results (p = 0.00) in both groups. Thick cyst fibers showed significant inverse correlations with inflammation and degranulated mast cells (p = 0.041, 0.04 respectively).

Conclusions

Mast cells and inflammatory cells influenced the nature of collagen fiber formation and its birefringence. This finding may assist in the prediction of the nature, pathogenesis, and biological behavior of periapical lesions.

Association of childhood vaccination with pediatric lichen planus: A systematic review

Lichen planus (LP) is a chronic T-cell-mediated mucocutaneous inflammatory disease, largely recognized in adults. It is uncommon in children, and the literature present still lacks comprehensive understanding mainly due to underreporting of such cases. LP shows atypical clinical features, when seen in children, mainly affecting the flexor aspect of the wrists, legs, and the oral and genital mucosae. It is largely considered an autoimmune response of the body with various etiologic factors. Its association with vaccination is still an interesting field for research. The focus of the present systematic review was to discover the link of vaccine in the pathogenesis of juvenile LP. An electronic search was carried out using MEDLINE by PubMed, Google Scholar, and Web of Science databases. Articles that reported LP in children with prior records for vaccination were selected for the present systematic review. Twenty-three published articles in the English language were included for the quantitative and qualitative syntheses. The demographic data, specific vaccine history, and clinical details of the lesions were recorded. The existing evidence supports that vaccines could play an important role in etiopathogenesis of pediatric LP.

Diagnostic utility of p63/p40 in the histologic differentiation of salivary gland tumors: A systematic review

OBJECTIVE

Salivary gland tumors are a heterogeneous group of neoplasms with complex clinicopathologic behavior. These tumors often show an extremely diverse morphology and significant histologic patterns, making diagnosis a difficult task. Owing to the considerable differences in prognosis, treatment, and follow-up, accurately distinguishing these histologic mimickers is imperative. The aim of the present systematic review was to establish the diagnostic utility of p63/p40 immunostaining in histologic differentiation of salivary gland tumors.

STUDY DESIGN

An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Trip, Cochrane Library, and EMBASE databases. Articles in which both p63 and p40 immunohistochemical expressions were assessed were included for systematic review and their sensitivity and specificity were calculated. Risk of bias was analyzed for each study using the Quality Assessment of Diagnostic Accuracy Studies tool.

RESULTS

Ten eligible articles were included in the quantitative synthesis, which revealed a concordant positivity of p63 and p40 by nearly all cases of adenoid cystic carcinoma, pleomorphic adenoma, and mucoepidermoid carcinoma and most polymorphous adenocarcinomas showed discordant immunohistochemical expression (p63+/p40-).

CONCLUSIONS

The current evidence supports that integrated immunostaining of p63/p40 is a valuable adjunct for discerning enigmatic salivary gland tumors with true myoepithelial and/or squamous differentiation.

Application of the Bethesda system of reporting for cervical cytology to evaluate human papilloma virus induced changes in oral leukoplakia, oral squamous cell carcinoma, and oropharyngeal squamous cell carcinoma: A cytomorphological and genetic study

BACKGROUND

Human papilloma virus (HPV) has a well-established carcinogenic role in certain head and neck cancers. These HPV associated cancers possess unique clinicopathological behavior and exhibits better prognosis than their negative counterparts. Detection through polymerase chain reaction (PCR) has been considered as the "gold standard" but imposes burden in low resource settings. Therefore, in the present study, we assessed the validity of cytomorphological features for the detection of HPV in oral leukoplakia (OL), oral squamous cell carcinoma (OSCC), and oropharyngeal squamous cell carcinoma (OPSCC).

METHODOLOGY

This study included 63 subjects comprising of 25 OL, 26 OSCC, and 12 OPSCC cases. Exfoliated cells were collected and processed for PCR followed by Papanicolaou staining and subsequent grading. Additionally the non-classical signs were evaluated and statistical analysis included Chi-square and Spearman's test.

RESULT

23/63 (36.5%) cases showed PCR positivity for HPV16. Most of the cytomorphological features showed significant correlation for the presence of HPV. A greater sensitivity and specificity was observed in the Bethesda system for reporting cervical cytology (TBS) than the Papanicolaou grading system.

CONCLUSION

We conclude that the non-classic cytological features could be employed in the detection of HPV in low resource settings with improved sensitivity. Liquid based cytology graded using TBS could be suitable for oral cytology in the detection of early atypical changes.

Does COVID 19 generate a milieu for propagation of mucormycosis?

Corona Virus Disease 2019 (COVID 2019), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a dreadful infectious disease which has emerged as one of the most significant medical emergency affecting everyone directly or indirectly. COVID 2019 is a multisystem disease and causes severe immunosuppression. Initially thought to affect mainly the respiratory system, it strikes all vital organ systems and cause defects in cardio-circulatory, respiratory system and gastrointestinal systems to name a few leading to copious biochemical alterations. Reports show there is thromoembolism, raised ferritin levels, lymphocytopenia, thrombocytopenia, lactic acidosis, acute diabetes like state and cytokine storm. Data regarding levels of neutrophils is equivocal. Further there is increased incidence regarding high incidents of mucormycosis in COVID 2019 positive subjects. In the present paper, we identified and correlated the virus mediated biochemical alterations as the potential ideal environment for propagation of mucorales; and thus concentrate on early diagnosis and treatment of mucormycosis in COVID 2019 cases.

Broder versus Bryne's histologic grading parameters on incision biopsy specimens: A comparative study with P53 and KI67 expression

Objective:

Various histological grading of oral squamous cell carcinoma has been contributed to the literature at different periods, but the reliability of such grading systems is controversial. This study attempted to measure the efficacy of Bryne's parameters on the full thickness of incisional biopsies which are representative of the original lesion with the proven molecular malignancy markers P53 and Ki67.

Materials and Methods:

One hundred incisional biopsy specimens of oral squamous cell carcinoma were obtained and histologically graded according to Broder's grading system. The same was graded using Bryne's parameters on full thickness of obtained incision sample. Immunohistochemistry was carried out for both p53 and Ki67.

Results:

We found a high discrepancy in the grading of lesions with Broader as well as Bryne grading parameters within the same lesion. When compared with the molecular expression percentages of p53 and Ki67, highly significant correlation was found in Bryne's parameters (Pearson Chi-square, P value 0.000) in incisional biopsies than Broder's.

Conclusion:

The use of parameters by Bryne on invasive front of excision biopsies can provide significant grading on incisional biopsies which are more comparable to the molecular behavior of tumor given by the p53 and Ki67 expression.

Ghost cell odontogenic carcinoma of anterior mandible: A rare case report with review of literature

A 24-year-old male reported to the outpatient department with a complaint of swelling of the anterior lower jaw region for 9 months with history of traumatic injury and extraction of teeth from the same region, a month before the onset of swelling. Swelling was obvious extra- and intraorally which on examination presented as a soft to firm non-tender and non-fluctuant mass with an approximate size of 4 cm × 3 cm, extending from 34 to 43 region with obliteration of labial vestibule. Panoramic radiograph and cone-beam computed tomography showed a well-defined radiolucency in the mandibular anterior region crossing the midline with erosion of labial bony plates and root of 42 along with a tooth-like radiopaque mass within the lesion. Provisional diagnoses of odontogenic keratocyst, ameloblastomas, central giant cell granuloma and calcifying epithelial odontogenic tumor were listed. The histopathological and immunohistochemical examination of lesion followed by the biopsy confirmed the diagnosis of Ghost cell odontogenic carcinoma.

Molecular and Immunohistochemical Cognizance of HPV16 in Oral Leukoplakia, Oral Squamous Cell Carcinoma and Oropharyngeal Squamous Cell Carcinoma

Prior studies have established the carcinogenic role of HPV16 and also demonstrated its unique biological behavior in cervical and oropharyngeal squamous cell carcinoma (OPSCC) but its role in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) is not well explored. Therefore, in the present study, we assessed HPV16 prevalence using PCR and Anti-HPV16 antibodies for the first time and correlated its biological behavior using p16^INK4a and Ki67 proliferation index (PI) in OL, OSCC, and OPSCC. This study included 63 subjects comprising of 25 OL, 26 OSCC, and 12 OPSCC cases. Exfoliated cells were collected and processed for PCR followed by immunohistochemistry with primary antibodies p16^INK4a, Anti-HPV16, and Ki67. The expressions were evaluated and statistical analysis included Chi-square and Spearman's test. Cumulatively 37% (OL-7%, OSCC-14% & OPSCC-16%) of cases showed positive PCR expression. PCR positivity was observed to be significantly higher (p 0.00) in OPSCC (9/12) than OSCC (9/26) and OL (5/25) cases. Overall immunohistochemical expression of p16^INK4a, Anti-HPV16, and Ki67 were significantly (p 0.02) higher in HPV16 (PCR) positive cases. HPV16 + OSCC cases showed higher grades of p16^INK4a and Ki67 expression. We have demonstrated a prevalence of HPV16 in OL, OSCC, and OPSCC through PCR, which may be concluded as a gold standard for the detection of HPV16 DNA.

Immunohistochemical Coexpression of MUC1 and MUC4 in Oral Leukoplakia and Oral Squamous Cell Carcinoma

MUC1 and MUC4 are two transmembranous proteins, which have been seen to express aberrantly in various human neoplasms and advocated as independent prognostic markers. Till now no extensive studies have been carried out on combined expression of MUC1 and MUC4 in oral leukoplakia and Oral squamous cell carcinoma. This study is an endeavour to evaluate Immunohistochemical coexpression of MUC1 and MUC4 in Oral Leukoplakia and Oral squamous cell carcinoma and furthr establish them as prognostic markers. Immunohistochemical analysis of MUC1 and MUC4 was done on 24 cases of Oral squamous cell carcinoma, 24 cases of leukoplakia and 12 normal oral mucosal tissues. Chi square test and one way ANOVA test were employed for statistical analysis. Normal oral mucosa and leukoplakia group showed higher frequency of negative immunoexpression compared to oral squamous cell carcinoma group. Furthur in Oral squamous cell carcinoma group, higher frequency of double positive coexpression in well and moderately differentiated oral squamous cell carcinoma and single positive coexpression in poorly differentiated oral squamous cell carcinoma was obtained. A definite rise of immunoexpression of MUC1 and MUC4 was observed from normal oral mucosa to leukoplakia to oral squamous cell carcinoma indicative of their contribution as diagnostic and prognostic markers.

Gender determination analysis using anthropometrical dimensions of 2D:4D, foot index and mandibular canine index

Introduction

Sex determination is a challenge for forensic experts during mass disasters. Teeth are an excellent source in both living and nonliving population, where bodies are mutilated beyond recognition. Mandibular canines can be employed for gender determination in such situations. Similarly, second-to-fourth digit ratio (2D:4D) and foot index (FI) are sexually dimorphic and differ in males and females. Mandibular canine index (MCI), 2D:4D and FI are considered quick, easy and reproducible methods for determining the sex of an individual.

Aim

This study aimed to determine the combined role of MCI, 2D:4D and FI in denoting gender identity and establish their correlation.

Materials and Methods

The present study comprised of 100 dental students (50 males and 50 females) of our institution, aged 19-25 years, with specific inclusion and exclusion criteria. The measurements were done using a Vernier caliper, a divider and a ruler, and MCI, 2D:4D and FI were calculated using their specific formulae. The calculated values of FI, MCI and 2D:4D were subjected to statistical analysis.

Results

There was a statistically significant difference observed between left MCI (P < 0.05), right and left 2D:4D and FI (P < 0.05). The results revealed that 2D:4D was less, whereas MCI and FI were higher in males than in females. The observed MCI was compared with standard MCI, and left MCI revealed higher sexual dimorphic characteristics (15.2%). Although the overall correlation between 2D:4D, FI and MCI was insignificant, the measurements were comparable.

Conclusion

This study indicated that the anthropometric dimensions of 2D:4D, FI and MCI can be used for sex determination independently with accurate results.

Metastasizing Ameloblastoma: A 10 Year Clinicopathological Review with an Insight Into Pathogenesis

Ameloblastoma, a benign but locally aggressive odontogenic tumor, often demonstrates metastasis despite benign histological features and this variant is termed as metastasizing ameloblastoma (METAM). It was classified under the malignant category in the 2005 WHO but has been re-classified under benign epithelial odontogenic tumors in the latest 2017 WHO classification. The present review aimed at gathering the available data on METAM to update the current cognizance about the pathology. Comprehensive search of the databases (viz., PubMed, Medline, SCOPUS, Web of Science, EMBASE and Google Scholar) was done for published articles on METAM following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 42 cases were extracted. The mean age of occurrence was 42.71 ± 15.87 years. A slight male predilection was noted. Mandibular cases showed more metastasis than maxillary cases. Follicular ameloblastoma was most frequently encountered at secondary site followed by plexiform type. Lungs were the most commonly affected secondary sites. METAM is a rare odontogenic tumor and the diagnosis is usually made in retrospect. Inadequate treatment may result in multiple recurrences and metastasis in rare instances. Metastasis in ameloblastoma appears to be multi-factorial in nature and needs further investigation in untapped territory like exploration of quantum effects at cellular and molecular levels.

Primordial Odontogenic Tumor of Anterior Maxilla in a Young Male: A Case Report and an Updated Review of Literature

Primordial odontogenic tumor (POT) is a recently designated benign mixed epithelial and mesenchymal odontogenic tumor and only sixteen cases have been reported worldwide till now. Here we report an another case of POT in a 14-year old boy who presented with an asymptomatic buccal enlargement in the right maxillary region for past 4-5 months. A well-defined, unilocular, radiolucent lesion with impacted teeth was observed radiographically. A detailed account of clinico-radiographical and histolological differential diagnoses along with an updated literature review has been presented.

Determination of Sexual Dimorphism by Odontometric Study of Permanent Maxillary Incisors and Canines: A Cross-sectional Study from Population of Haryana

Introduction: Sex determination is one of the prime factors employed to assist with the identification of an individual. As extensively mutilated bodies are difficult to identify, teeth can be used as they can withstand bacterial decomposition and fire. Odontometric parameters can be used for gender determination in a specific population. Variations have been documented in different regions in determining sex of an individual using tooth size and accuracy of odontometric sex prediction which prompted us to draw population specific data. Aim: To evaluate permanent maxillary incisors and canines for sexual dimorphism and to estimate the level of accuracy with which they could be used for sex determination in the age group of 18-24 years in Haryana. Materials and Methods: This cross-sectional study comprised of 300 subjects (150 males and150 females) in the age group of 18-24 years, from population of Haryana during January 2017 to May 2017. Maximum mesiodistal (MD) diameter of permanent maxillary incisors and canines were measured using digital vernier calliper. The mean, range, and standard deviation were calculated for the size of the teeth. A two-sample t-test was used to test for statistical difference between means. Results: The present study comprised of 300 individuals (150 males with mean age of 20.81 years and 150 females with mean age 20.54 years) between the age group of 18-24 years. Mean mesiodistal dimension for each tooth was found to be greater in males as compared to females with statistically significant difference for right canine (p-value=0.003), left canine (p-value=0.001) and right lateral incisor (p-value=0.019). Left maxillary canine showed highest percentage (3.164%) of sexual dimorphism. The level of accuracy of sex determination when all the teeth under study were taken into consideration was 62.7% of females and 58% of males. Conclusion: Sexual dimorphism of teeth is population specific and was well evident in population of Haryana, hence the mesiodistal dimensions in maxillary left permanent canine can aid in sex determination.

Knowing the unknown in oral squamous cell carcinoma: An observational study

Introduction

Conventional oral squamous cell carcinoma (OSCC) is relatively easy to diagnose on histopathology, as it comprises dysplastic epithelial cells with variable degrees of squamous differentiation. Different grading systems have been employed in grading OSCC based on its dysplastic features and host response. Some unusual features such as clear cell change, epithelial-mesenchymal transition (EMT), stromal hyalinization, stromal desmoplasia, perineural invasion, vascular invasion, tissue eosinophilia, giant cells, and tertiary lymphoid follicle formation are evident in OSCC histologically but have not yet been accounted in any grading systems of OSCC except perineural and vascular invasion.

Aim

The aim of the present study was to identify these uncommon features and to correlate them with different grades of OSCC.Materials and Methods:This study was conducted on 100 histopathologically confirmed OSCC cases retrieved from the archives of our department. They were graded on the basis of Broder's grading system and were reviewed for the features mentioned above. Data collected were subjected to statistical analysis.

Results

Clear cell change, EMT, foreign body giant cells, and tumor giant cells were observed in 13%, 20%, 1%, and 3% of cases, respectively. We found stromal desmoplasia in 15% and stromal hyalinization in 9% of cases. Tissue eosinophilia, tertiary lymphoid follicle formation, and perineural invasion were observed in 12%, 3%, and 2% of cases, respectively. Vascular invasion was not evident in any of the cases examined.

Conclusion

The incidence of the unusual features was 7.8% in our study.

Odontogenic myxoma: ambiguous pathology of anterior maxilla

Swellings in the anterior maxilla are uncommon and if present can be deemed as paradoxical conundrums presenting diagnostic and therapeutic dilemmas. Odontogenic myxoma is a rare, locally aggressive lesion that is primarily seen affecting the mandibular posterior region in association with an impacted tooth. It is found to be associated with odontogenesis. Treatment is usually surgical, with extent varying from curettage to resection. This report describes a rare case of odontogenic myxoma of the anterior maxilla in a 14-year-old boy, with an emphasis on its epidemiology, clinical presentation, histopathology, diagnosis and treatment planning.

Unusual Cystic Variant of Calcifying Epithelial Odontogenic Tumor

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, which is exclusively epithelial in its tissue of origin. Many cases of CEOTs are associated with impacted tooth and simulate dentigerous cyst radiographically. The histologic features of CEOT are unique; however, among its various histologic subtypes, the cystic variant is a rare and less well-understood entity. Our report elucidates a cystic variant of CEOT in the maxilla of a 16-year-old male that presents clinical and radiologic findings conscientious to dentigerous cyst; but histopathological diagnosis came out to be a gold standard in identifying this rare tumor. This case report describes the clinicopathologic features of this rare entity, highlighting the histomorphological findings along with reviewing other reported cases.

Detection of Apoptosis in Leukoplakia and Oral Squamous Cell Carcinoma using Methyl Green Pyronin and Hematoxylin and Eosin

Background & Objective:

Cell population and turnover are controlled by a balance between cell proliferation and apoptosis. Detection of apoptosis in oral cancer contributes to its better prognosis and improved management. This study aimed to quantify apoptotic cells in leukoplakia and oral squamous cell carcinoma (OSCC) using methyl green-pyronin (MGP) and hematoxylin and eosin (H & E) staining.

Methods:

The sample included a total of 130 subjects (comprising 108 males and 22 females). Formalin fixed and paraffin embedded tissues were used and categorized into three groups of normal oral mucosa (n=10), leukoplakia with dysplasia (n=60), and OSCC (n=60). The number of apoptotic cells and apoptotic index (AI) were calculated after staining with MGP and routine H & E stained slides.

Results:

MGP stained the condensed chromatin of apoptotic cells. Statistically significant difference (P≤0.001) was observed among various study groups in terms of numbers of AI and apoptotic cells. Also, AI increased with increasing grades of dysplasia, and it was the highest in well differentiated OSCC. Results were statistically significant in both H & E and MGP stained sections (P≤0.001). A good correlation was found between MGP and H & E staining results.

Conclusion:

MGP is more specific and can lead to intense staining for chromatin in apoptotic cells. Accordingly, it can provide a good alternative to H&E in identifying apoptotic cells.

Potency of Pfeiffer's Crystallization to Analyze Oral Leukoplakia and Squamous Cell Carcinoma

OBJECTIVE

Oral cancer usually has an early precancerous stage before its actual malignant transformation. Although there are various approaches to diagnose early stages of cancer, yet there is one less explored, cost effective and simple technique known as crystallization test. The aim of the study was to reaffirm the effectiveness of Pfeiffer's crystallization test in screening oral leukoplakia and squamous cell carcinoma.

METHODS

Fifty oral leukoplakia, sixty five oral squamous cell carcinoma and sixty healthy individuals participated in crystallization test. Single blood drop was used to perform the test and obtained crystal patterns were analysed. Cross tabulation and Chi-Square test was performed to find the frequency and association between the groups. Kruskal-Wallis H test and Mann Whitney U test was applied comparing mean transverse form.

RESULTS

Sensitivity of crystallization test was 80% and 93.84% in oral leukoplakia and squamous cell carcinoma. Chi-Square analysis revealed highly significant transverse form between the study groups (p < 0.000).

CONCLUSION

Crystallization test proves to be simple, reliable and minimal invasive diagnostic approach under strictly maintained physical conditions.

Association of SOX2, OCT4 and WNT5A Expression in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma: An Immunohistochemical Study

The cancer stem cells deliver uncontrolled proliferative capacity within the tumor imparting to increasing size while epithelial mesenchymal transition adds to the invasive potential. Studies using specific markers elucidating the role of these phenomena may bring advancement in the targeted therapy of tumor. SOX2 and OCT4 are two among few stem cell markers indicative of proliferative potential and WNT5A is an epithelial mesenchymal transition marker indicative of invasive potential. We aimed to determine the association between expression of SOX2, OCT4 and WNT5A in oral epithelial dysplasia, oral squamous cell carcinoma and normal oral mucosa. 20 cases of oral squamous cell carcinoma, 20 cases of oral epithelial dysplasia (leukoplakia with dysplasia) and 25 normal oral mucosa tissues specimens were immunohistochemically stained to assess SOX2, OCT4 and WNT5A expression. SOX2 expression was higher in oral squamous cell carcinoma than in oral epithelial dysplasia and very low in normal oral mucosa. OCT4 was very low in oral squamous cell carcinoma and oral epithelial dysplasia when compared to SOX2, while negative in normal tissues. Co-expression of SOX2 and OCT4 showed statistically non-significant difference for tumor proliferation. WNT5A expression was found to be increasing from normal oral mucosa to oral epithelial dysplasia and oral squamous cell carcinoma. In conformity with present study, SOX2 itself can act as a potential marker for proliferation in tumor cells while OCT4 has non-significant role in regulation of tumor behavior in oral squamous cell carcinoma as well as in oral epithelial dysplasia. WNT5A can be a putative marker in studying invasive potential of oral squamous cell carcinoma.

Role of angiogenesis in oral submucous fibrosis using vascular endothelial growth factor and CD34: An immunohistochemical study

Background

Oral submucous fibrosis (OSF) is an insidious, chronic, disabling disease, in which there is lack of perfusion due to reduced level of the vasculature and this is said to be responsible for the epithelial atrophy seen in OSF. The degree of vasculature of the affected mucosa and its effects on the epithelial thickness remains controversial till date.

Aims

This study attempts to analyze the role of angiogenesis in OSF and its progression using vascular endothelial growth factor (VEGF) and CD34 markers.

Materials and Methods

The study samples for the present study comprised of 10 cases each of early OSF, moderately advanced, advanced OSF, and 10 cases of normal oral mucosa were used as controls. All the cases were subjected to immunohistochemical staining with VEGF and CD34 markers.

Results

Among the different grades of OSF, we did not find any noticeable difference in VEGF expression although we found a upregulation in microvessel density (CD34) in early and moderately advanced OSF followed by a downregulation in advanced OSF.

Conclusions

As the disease progresses, there is an increased production of the extracellular matrix component (collagen I and II and fibronectin) and results in fibrosis. Subsequently, it leads to the reduction in the level of corium vascularity and results in hypoxia which ultimately causes reduction and constriction of the vascular channels. This sequence of events alerts us to the relevance of early disease diagnosis and management in an irreversible pathology such as OSF.

Baseline data of facial parameters in the population of Haryana: An anthropometric study

Context:

Anthropometry plays an important role in the assessment of ethnicity and identification of an individual. There is paucity of literature on various facial parameters in Haryanvi population. Thus, the present study was an initiation to collect this database in Haryanvi population.

Aim:

The aim of the present study was to create a database of craniofacial parameters of Haryanvi population.

Materials and Methods:

The study was conducted on 300 individuals of Haryanvi ethnicity. A digital vernier caliper was used for the measurement of facial parameters.

Statistical Analysis:

Chi-square test, t-test, and Pearson's correlation test were used for finding the difference between the measurements for various parameters.

Results:

In the present study, mesoprosopic was the predominant facial phenotype in both males and females. A significant sexual dimorphism was found between all the facial parameters measured in the study. However, upper facial height and facial index did not follow the same pattern in relation to gender determination.

Conclusion:

Based on the present study findings, we conclude that craniofacial parameters could be used as an important tool to assess the ethnicity and gender of an individual. In addition, our data could be used as a baseline for further studies in the identification of a Haryanvi individual.

Myriad facades of keratocanthoma: Benignity VS malignancy

Keratoacanthoma (KA) is a self-limiting benign epithelial neoplasm. It occurs predominantly on sun-exposed areas of the body and is believed to arise from hair follicle. It shows a unique behavior in being clinically benign and microscopically malignant. Earlier it was considered as a pseudomalignant lesion but now it is believed to be pseudobenign in nature. The most common concern is related to its nosological position at the border of malignancy and benignity. We hereby report a rare case of keratoacanthomatous type of squamous cell carcinoma in an elderly female showing aggressive nature of the lesion. The various terminologies used for KA in the past have also been tabulated.

Giant Cell Granulomas of Jaws: a Clinicopathologic Study

Objectives

The purpose of present study was to investigate and correlate the histological findings in central giant cell granuloma and peripheral giant cell granuloma of jaws with clinical and radiographic interpretations of the lesion.

Material and Methods

In present study, data from 14 cases of central giant cell granuloma (CGCG) and 9 cases of peripheral giant cell granuloma (PGCG) were analysed, focusing on demographic, clinical and radiographic features. For each patient, microscopic slides were assessed in terms of histologic features of giant cells i.e. number of giant cells, mean number of nuclei/giant cell, pattern of distribution, size and relative size index of giant cells, percentage fractional surface area (FSA) occupied by giant cells and stromal characteristics. Data collected was subjected to statistical analysis. Fisher-exact test, Pearson's correlation coefficient, one-way ANOVA test and Student's t-test were used for analysis.

Results

No significant difference was found between PGCG and CGCG in relation to all the traits that were evaluated. It was observed that mean number of giant cells and mean FSA was more in aggressive CGCG as compared to non-aggressive CGCG.

Conclusions

Further studies on large sample size are required to confirm the relationship between histomorphometric features of giant cells and behaviour of giant cell granulomas of jaws.

The Diagnostic Role of Methyl Green-Pyronin Y Staining in Oral Leukoplakia and Oral Squamous Cell Carcinoma: An Exfoliative Cytology-Based Cytomorphometric Analysis

BACKGROUND

Oral exfoliative cytology is a noninvasive and nonpainful technique for early diagnosis of oral potentially malignant disorders and oral cancer, and the use of cytomorphometry ameliorates its diagnostic reliability. The objective of the present study was to analyze methyl green-pyronin Y (MGP)-stained oral exfoliated cells (OECs) of oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) by cytomorphometry.

MATERIALS AND METHOD

An observational study was conducted on 150 individuals equally divided into three groups: normal mucosa, OL, and OSCC. Smears were prepared from OECs and stained with MGP. Cytomorphometry was done for 100 cells per subject, and various cell and nuclear parameters were measured and calculated.

RESULTS

The Kruskal-Wallis test with post hoc correlation showed significant differences in nucleus and cell diameter (ND, CD), nucleus and cell area (NA, CA), nucleus and cell perimeter (NP, CP), and nucleus to cytoplasmic (N:C) ratio for diameter, perimeter, and area. Spearman's ρ correlation of various N:C ratio methods showed good correlation between N:C perimeter and diameter ratio, N:C diameter and ellipse ratio, and N:C area and ellipse ratio. Additional morphological factors showed significant relations for both cell and nuclear regularity factor, shape factor, and nuclear contour index.

DISCUSSION

MGP-based cytomorphometry showed a significant decrease in CD, CA, and CP and increase in ND, NA, NP, and N:C ratio from normal mucosa to OL and OSCC. MGP proved its worth as an effective stain for OECs, despite its strict standardization.

Potential immmunohistochemical markers to characterize epithelial-mesenchymal transition in pleomorphic adenoma

BACKGOUND

The histogenesis process of pleomorphic adenoma (PA) of salivary gland continues to remain a controversial subject. In this neoplasm, transition occurs from an epithelial or myoepithelial cell to a stromal element and is called an epithelial-mesenchymal transition (EMT) resulting in heterogeneity. The present research was aimed to study the morphological characteristics of varied components and epithelial-mesenchymal transitions in PA using histopathological and immunohistochemical (IHC) analysis.

MATERIALS & METHODS

For this purpose 15 PAs cases were selected from the archives and from each case of PA and 5 cases of normal salivary gland, five additional sections were cut from each for immunohistochemical analysis using E- cadherin, vimentin and a-actin. The numbers of immunoreactive cells were semi- quantitatively measured and also determined the intensity of the immunostaining reaction.

RESULT

Immunohistochemically, as the cells transitioned from the lumial cells to descrete/detached cells of ductal structures, the percentage of positive cells tends to decrease for E- cadherin and increases for vimentin and actin. Additionally, neoplastic cells towards the periphery of ducal-cystic structures or completely detached cells in the stroma showed intense to moderate positivity for vimentin and alpha smooth muscle actin (a-SMA). Chondroid/ hyalinized or myxoid stroma showed variable staining with these markers.

CONCLUSION

Our study provides the evidence that epithelial-mesenchymal transition process represent the basic principle of the tisuse heterogeneity in pleomorphic adenomas.

Convolutions of dentigerous cyst: An institutional experience

OBJECTIVE

Statement of the Problem: Benign appearing dentigerous cyst (DC), also the most common developmental odontogenic cyst, shows various complications due to its pluripotent cell lining. The spectrum of diseases produced by conversion of its pluripotent cell varies from unicystic ameloblastoma, intraosseous epidermoid and central mucoepidermoid carcinoma. So, the need of the hour is to be acquainted with the etiopathogenesis of DC at molecular level and an attempt should be made to minimize its rate of tumor conversion.

PURPOSE

To analyze the potential complications, their demographic profile, disease characteristics which can arise from the dentigerous cyst, and to be geared up for such situations in future.

MATERIALS AND METHOD

Retrospective analysis was conducted and data was collected from the requisition forms during the time frame 2011- 2016 in the Department at Government Dental College, Haryana. Histopathologically diagnosed cases of dentigerous cyst were reviewed by three different observers and recorded, out of which DCs that showed potential complications were reviewed in detail.

RESULTS

Six cases of DC out of 26 showed transformation into central mucoepidermoid carcinoma, adenomatoid odontogenic tumor (two) and ameloblastoma (three) respectively.

CONCLUSION

The present research highlights the probable complications of DC encountered in our institute and conscientious vigilance should be exercised while histopathological examination of biopsied specimens. This study further unravels the enigma behind the emergence of neoplasms arising from DC.

A radiolucent lesion presenting calcification histopathologically: a classical case of CEOT

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm that accounts for approximately 1% of all odontogenic tumors. Histologically, it shows sheets of polyhedral epithelial cells with deep eosinophilic cytoplasm and prominent nuclei. Globules of amyloid like material among tumor cells which undergoes calcification are evident. We present a case of CEOT which presented classical histopathologic picture but clinico- radiological it presented variably. Its non association with impacted tooth, no calcifications in the incisional material and finally on excision giving its classical picture of prominent intercellular bridges, hyperchromatic polyhedral cells and amyloid with calcifications made it an interesting case to report.

A mismatch of tumor grade and biologic behaviour in a rare case of Sclerosing Mucoepidermoid Carcinoma of Parotid - with review of literature

Although mucoepidermoid carcinoma is the most common primary malignancy of the salivary glands, the sclerosing morphologic variant of this tumor is extremely rare and only 26 cases have been reported till date in the english literature. This report describes a case involving a 35-year-old female with an intermediate-grade sclerosing mucoepidermoid carcinoma of parotid gland and we review the litreture. Immunohitochemical markers, Her-2/neu and MIB-1 evaluated to help predict the clinical outcome and to determine whether an association exists between the histologic grade and immunohistochemical findings. A PAS stain revealed cytic spaces filled with basophilic material. We found MIB-1 labeling indices of >50% and strong positivity for Her-2/neu suggesting poor prognosis. Our case did not show any correlation between MIB-1 index and tumor grade as shown in other case reports. This unusual but distinctive variant of mucoepidermoid carcinoma can be difficult to recognize and is frequently misdiagnosed as a benign lesion.