Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite their high prevalence, etiopathogenesis remains unclear. This review article summarizes the clinical presentation, diagnostic criteria, and recent trends in the management of recurrent apthous stomatitis.

Cancer cachexia is a wasting syndrome characterized by weight loss, anorexia, asthenia and anemia. The pathogenicity of this syndrome is multifactorial, due to a complex interaction of tumor and host factors. The signs and symptoms of cachexia are considered as the prognostic parameters in cancer patients. This review gives an emphasis on the various mechanisms involved in cachexia and an insight into head and neck cancer cachexia.

Aim: To study the immunofluorescence pattern and to assess its reliability as a confirmatory diagnostic test in patients with pemphigus, pemphigoid, lichen planus, and lupus erythematosus and also to assess the disease activity by indirect immunofluorscence (IIF) in patients with pemphigus only. Materials and Methods: Twenty-six patients were included in the study group, out of which, 6 patients were clinically and histopathologically diagnosed as pemphigus, completely free of active lesions were subjected to IIF only to assess the disease activity and were grouped separately. Based on the clinical and provisional diagnosis, the remaining 20 patients who had active lesions were subjected to direct immunofluorscence (DIF) and IIF and were divided into four groups. Biopsy specimens were taken from the periphery of the lesions and were examined by both conventional light microscopic and DIF methods. Five milliliters of venous blood was collected from each patient and were subjected to IIF. Results: Histopathological diagnosis was consistent with direct immunofluorescence study in 15 cases (75%). The various immunofluorescence patterns observed in our study were consistent with those described by various authors in standard textbooks and articles. Conclusion: Histopathology remains gold standard for most of the diseases, it is recognized from this study that not all lesions are amenable to definitive histopathological diagnosis thus; DIF can provide a valuable additional criterion in diagnosis.

Recent attention has been directed toward the role of mast cells in the pathogenesis of oral lichen planus. Mast cells are responsible for trafficking inflammatory cells into the connective tissue that in turn helps in progression and maintenance of chronicity of oral lichen planus (OLP). OLP is a T-cell-mediated chronic inflammatory oral mucosal disease of unknown etiology, and lesions contain few B-cells or plasma cells and minimal deposits of immunoglobulin or complement. Hence, OLP is ideally positioned for the study of human T-cell-mediated inflammation and autoimmunity. This study was done to evaluate the mast cell count using toluidine blue stain in OLP and compares it with oral lichenoid reaction (OLR), and to propose the possible role of mast cells in the pathogenesis of OLP and OLR. Ten cases each of OLP and OLR and five cases of normal buccal mucosa were taken from the archives of Department of Oral Pathology. The samples were stained with toluidine blue using standard toluidine blue method by Wolman 1971. An increase in mast cell count was observed in OLP and OLR in comparison to normal oral mucosa. However, no significant differences in mast cell count were noted between OLP and OLR.

Aim: The biological mechanism(s) that guide the immunological effectors of lymphocytes to sites of inflammatory response, a feature consistently seen in oral submucous fibrosis (OSF) was evaluated. It is envisaged that endothelial/lymphocyte adhesion cascades involving VCAM-1/α4β1 integrins control the migration of lymphocytes across the vascular endothelium resulting in their homing in these locales. Materials and Methods: The study group comprised 28 OSF cases (M:F = 12:16, age range 18-65 years; mean 55.4 ± 8.5 SD) divided into early (n=17) and advanced (n=11) disease groups. Biopsy specimens of normal buccal mucosa (site compatible) were obtained from 10 healthy volunteers (age and sex matched) who served as control. All the samples were fixed in 10% neutral-buffered formalin and embedded in paraffin. Immunolocalization of b1 subunit associated with α4 integrin was performed by a mouse heterodimer (clone 4B7R, Ig G, R & D Systems Inc., dilution 1:100) using a peroxidase labeled streptavidin-biotin technique. The immunocompetent cell density was expressed as the number of positive cells per mm ² . The Mann-Whitney U-test and Fischer exact test were used to evaluate differences. P<0.05 was considered to be significant. Results: The median percentage of "T" lymphocytes with positive integrin α4β1 expression was 77.7 (an interquartile range of 73.3-83.4) for the test cases and for the controls, it was 28.2 (IQR 24.0-38.3). This difference was significant at 0.001 level. For the endothelial cells the positive expression was 82.8 (IQR 77-90.6) and 22.3 (IQR 18.3-29.2) respectively (P<0.001). When the intensity of integrin expression was considered 26/28 cases (96%) and 2/10 (20%) of controls showed intense expression of integrins a4b1 on T lymphocytes (P<0.001). Similarly, 27/28 cases (92.9%) and 2/10 (20%) of controls showed intense expression on endothelial cells (P<0.001). T lymphocyte-endothelial cell interactions were assessed by evaluating the overexpression of integrins on both the endothelial cells and lymphocytes together. The interaction was positive in 15/17 and 11/11 early and advanced OSF cases respectively (P=0.51). Conclusion: Following leukocyte activation, the interaction between leukocyte integrin heterodimers and endothelial superfamily adhesion ligands results in a firm adherence of leukocytes to endothelium, leading to leukocyte migration and homing to sites of mucosal inflammation consistently seen in OSF.

Sister chromatid exchange (SCE) test is a sensitive, biomarker of genotoxic substances. The frequency of SCE in lymphocytes of ten pan chewing patients, oral submucous fibrosis (OSF) patients and age matched healthy controls were investigated. The frequency of mean SCE/cell was found to be 10.428 ± 0.755 in OSF patients, 8.752 ± 0.383 in case of pan chewers as compared to 5.912 ± 0.310 in controls. These values show a significant increase in frequency of SCE/cell in OSF patients and pan chewers when compared with that of healthy controls. There is a positive correlation co-efficient of SCE/cell with frequency, quantity, duration, intensity and period of exposure of pan-parag to oral mucosa in pan chewers and OSF patients indicating genotoxic effect of pan. Thus SCE could be used as a biomarker in chewers also to assess the level of genomic damage and to advocate efficient control measures.

Background: Cyclin D1, a member of G1 cyclins, controls the cell-cycle transit from the G1 to S phase. The deregulation and overexpression of cyclin D1 has been revealed in many tumors of diverse histogenesis. Ameloblastoma is the most frequently encountered odontogenic tumor known for its local invasiveness and a high tendency to recur. The adenomatoid odontogenic tumor is a benign, nonaggressive tumor with a limited growth and no tendency to recur. Aim: The aim was to investigate whether the immunohistochemical expression of cyclin D1 as a proliferation marker in ameloblastoma and adenomatoid odontogenic tumor correlates with the known clinical behavior of these two benign neoplasms. Materials and Methods: Ameloblastoma cases consisted of follicular, plexiform, and unicystic subtypes. The positive staining was assessed based on intensity of staining, localization of staining, and in different cell types in both the tumors. Two cases of follicular ameloblastoma and one case of plexiform ameloblastoma showed intense staining, but the predominant staining intensity was overall mild in both ameloblastoma and adenomatoid odontogenic tumors. The immunoreactivity was found both in nucleus and cytoplasm in ameloblastoma and only nuclear in adenomatoid odontogenic tumors. The peripheral columnar and central stellate reticulum-like cells of ameloblastoma showed immunoreactivity with squamous and granular cells being negative. In adenomatoid odontogenic tumors, the whorls showed predominant localization of staining. Statistical comparison with a Mann-Whitney U-test showed no significant difference in staining intensities between different histologic subtypes of ameloblastomas and also between ameloblastoma and adenomatoid odontogenic tumors (P>0.005). Conclusion: The marked expression of cyclin D1 in these tumors suggested its participation in proliferation of both the tumors and its expression patterns were irrespective of their known biologic behavior.

Background : E-cadherin is known to be an invasion suppressor gene and cathepsin-D, a protease, which is an invasion promoter and plays a central role in solid tumors including oral cancer. Aims: To look for the expression pattern in normal buccal mucosa, dysplastic oral epithelium and oral squamous cell carcinoma (SCC) along with their correlation to individual atypical features, thereby providing an objective to the grading system in predicting the fate of affected epithelium. Materials and Methods: To elucidate the expression patterns of these markers, we examined immunohistochemically on formalin fixed, paraffin embedded sections 22 dysplastic epithelia, eight SCC and ten normal buccal mucosa. Results: In dysplastic epithelium slight loss of expression of E-cadherin was noted as grade of dysplasia increased. Two cases of carcinoma clearance showed only basal and suprabasal staining. The staining varied in SCC with patchy to complete absence of expression. With cathepsin-D fine to moderate granular cytoplasmic staining was noted in most of the dysplastic epithelium. Similar staining was noted in SCC. The atypical features which strongly correlated to loss of expression of E-cadherin and intense cathepsin-D expression are basilar hyperplasia, loss of cohesion, mitosis, loss of polarity and drop shaped rete ridges. Conclusions: The result of the study shows that the above atypical features should be given more weightage in addition to traditional grading system, in predicting the fate of affected epithelium. Additional studies with larger sample size and using monoclonal antibody against cathepsin-D may further strengthen our findings.

Calcifications or hard tissue deposits in the wall of keratocystic odontogenic tumor (KCOT) are rare and uncommon. Three types of calcifications have been reported in the literature: dystrophic, cartilagenous, dentinoid. A case of maxillary KCOT with calcification is reported with a review on prevalence and pathogenesis of these calcifications. The calcifications associated with the connective tissue of keratocystic odontogenic tumor were studied using special stains. These calcifications were positive for collagen stains, Van Gieson, Masson trichrome, and negative for congo red and mallory suggesting that these irregularly shaped, diffuse calcifications which form on a collagenous matrix are dysplastic dentin.

Juvenile ossifying fibroma is an uncommon benign but aggressive fibroosseous lesion that affects the craniofacial skeleton. Their distinct clinical and histopathological features warrant the lesion to be considered as a separate entity from other fibro-osseous group of lesions such as fibrous dysplasia and cemento ossifying fibroma. Concomitant development of secondary aneurysmal bone cyst may rarely occur, which makes the lesion more aggressive and difficult to treat. We report a case of a 6 year old girl who was diagnosed with aneurysmal bone cyst during her earlier presentation at a private hospital and was treated for the same. The lesion recurred within 6 months. The second incisional biopsy specimen revealed features of trabecular variant of juvenile ossifying fibroma along with areas of aneurysmal bone cyst.

Ameloblastic fibroma (AF) is an uncommon true mixed odontogenic tumor with a relative frequency between 1.5% and 4.5%. Recently, it has been proposed that two subtypes of AF exist: A neoplasm and a hamartomatous lesion. We report a case of AF in left mandibular posterior region in a 6-year-old male patient. The tumor showed unusual and aggressive features that suggested it was a true neoplasm.

A patient diagnosed with early squamous-cell carcinoma (SCC) with microinvasion was treated by surgical excision followed by histopathologic evaluation. During surgery, all the nodes appeared free of tumor other than a single level-3 node which looked suspicious and enlarged. Surprisingly, the node, instead of showing SCC showed features suggestive of "Metastatic papillary thyroid carcinoma." The characteristics of papillary thyroid carcinoma (PTC), their usual histopathologic features and treatment are discussed. The aim of this paper is to present the case of a patient with dual malignancy--oral SCC and PTC in an adult male, which was diagnosed accidently because the protocol of complete surgery and extensive sampling for pathologic examination was followed and thus emphasizes on the necessity for the same.

The mantle cell lymphoma (MCL) is a rare (3.7%) low-grade non-Hodgkin lymphoma originating from the B-cell precursor-subpopulation. The clinical appearance in the oral cavity is rare. Since 1980, nine cases have been reported. A 41-year-old patient showed a MCL presenting with a symmetric, painless palatal swelling without any other clinical symptoms. Histological sections revealed malignant monotonous lymphoid cells (CD20+, CD43+, Ki67+) and the typical cyclinD1 over-expression by the chromosomal translocation t(11;14)(q13;q32). The proliferating cells weekly expressed CD5, kappa-and lambda-light chains and no EMA, CD10, bcl-6, CD30, and CD23. The patient was treated according to the European MCL younger study, and the MCL is regressive. The high incidence of dento-alveolar abscesses, inflammations, or benign tumor-formations leads to associate any maxillary or palatal swelling with this clinical condition. Considering the serious consequences of a missed therapy a histological examination of any untypical "swelling" is demanded.

Hemangiomas occupy a grey zone between hamartomatous malformations and true neoplasms. They are frequently designated and regarded as neoplasms because of their usually localized nature and mass effect. Although clearly benign, they can become very large and unsightly, and can even be fatal if they affect vital structures. They almost never become malignant, although a few documented examples of this complication are on record. A high percentage occur in children, manifesting within the first month of life. One half of these cases are in the head and neck area. Hemangiomas have been classified according to their clinical appearance and the caliber of vessel involved, namely, capillary, cavernous and venous. Capillary hemangiomas are made up of small vessels of capillary caliber. One such capillary hemangioma, the juvenile hemangioma (JH), is usually present at birth or appears during the first month and enlarges rapidly during the first few months of life (infancy), only to stop growing when the child is approximately 6 years old. We present one such JH, seen in a 3 year old male child, which appeared when the child was 2 months old. Routine histopathological (H and E) and immunohistochemical analysis (CD 34, CD 31) was done on biopsy received.

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children under 15 years of age and rare among persons older than 45 years of age. It is considered to result from malignant transformation of primitive mesenchymal cells. Although it has a relative predominance for head and neck region, it is found less often in oral cavity. Here we report a case of RMS of mandible in an adult patient, which was initially diagnosed as carcinosarcoma. Clinical and pathologic findings are described, which were confirmed by histochemical and immunohistochemical stains.

Juvenile ossifying fibroma is an uncommon, benign, bone-forming neoplasm with aggressive local growth that is distinguished from other fibro-osseous lesions primarily by its age of onset, clinical presentation and aggressive behavior. Although a benign entity, juvenile ossifying fibroma is known to be locally aggressive and has a high tendency to recur. Two distinctive microscopic patterns have been described: A trabecular variant and a psammomatoid variant. This latter variant is predominantly a craniofacial lesion and occurs rarely in the jaws. We present herein two cases of psammomatoid juvenile ossifying fibroma involving the jaws. The first case was a mandibular lesion in a 31-year-old female whereas the second case presented with maxillary involvement in a 46-year-old female. In addition, the pathology of the lesion was analyzed with confocal laser scanning microscopy.

Small cell osteosarcoma, a rare histological subtype, has very infrequently been reported in the mandible. We present a case of a 28-year-old female who had classic signs, symptoms, and radiographic features of the lesion. The histology showed sheets of small round cells and osteoid. The absence of the latter would have made it difficult to distinguish from other small round cell tumors of bone, especially Ewing's sarcoma. We have reviewed the clinical and radiographic features, cytologic and histologic characteristics, as well as the immunohistochemistry and molecular genetics of small cell osteosarcoma.

Hyalinizing clear cell carcinoma (HCCC) is an uncommon malignant salivary gland tumor accounting for about 1% of all intra-oral salivary gland tumors. Microscopic diagnosis of clear cell carcinoma may be challenging because of the spectrum of features which frequently overlaps with the other salivary gland tumors that contain clear cells, and thus it may be a diagnosis of exclusion. Here we, report a case of HCCC in a 36 years old female with detailed histological, histochemical and immunohistochemical discussion.

Myiasis is a rare disease primarily caused by infestation of tissue by larvae of houseflies. Oral myiasis is still more "rare" and "unique" owing to the fact that oral cavity rarely provides the necessary habitat conducive for a larval lifecycle. Here we report a case of extensive gingival myiasis, in an 81-year-old female patient, diagnosed and treated successfully in our department. The case is discussed in relation to its clinical presentation, etiopathogenesis, management, and prognosis.

Inflammatory pseudotumor is a rare entity in the head and neck region. Clinically it behaves as an aggressive lesion with extensive destruction but considered to be a benign reactive process. Because of its extensive involvement and infiltrative nature, it is confused as a malignancy. Most of them respond very well to corticosteroid and surgical excision.

The incidence of ectopic teeth has increased. In many cases, the etiology of ectopic teeth cannot be identified. Ectopic tooth in deciduous dentition period is very rare and information is limited about its causes and characteristics. The conditions commonly associated with an increased prevalence of ectopic teeth include cleft lip and palate, cleidocranial dysplasia, and Gardner syndrome. The diagnosis is made by the clinical and radiological examinations. The indication for extraction in ectopic teeth cases is in general determined by the presence of symptomatology, or by the need for preventing future complications. We present a case of an ectopic maxillary tooth in a 4 year-old boy. In addition, this report also addresses a young patient with a tooth in the oropharynx with the objective of non traumatic etiology, and such a clinical presentation is extremely rare. The authors believe the case presented here is the first documented case of an ectopic supernumerary tooth seen in the oropharynx.

Treacher Collins syndrome (TCS) is a rare autosomal dominant disorder of craniofacial development. It is a congenital malformation of first and second branchial arch which may affect the size and shape of the ears, eyelids, cheek bones, and jaws. The extent of facial deformity varies from one affected individual to another. A case of 20-year-old boy having TCS is briefly described in this article.

The goal of periodontal therapy has always been regeneration of the lost tissues. However, conventional periodontal therapy has not always been successful in achieving regeneration, especially when it is part of a syndrome. This case report involves a 13-year old male patient with the chief complaint of mobile teeth for over 3 months. His dental history revealed early loss of primary dentition, around 3-4 years of age and that he noticed mobility of permanent incisors and molars at 9-10 years.Keratotic skin lesions on the palms and soles were present since the age of 3 years. Full mouth intra-oral periapical radiographs showed extensive bone loss upto apical thirds of the teeth and an orthopantamograph showed "floating in air" appearance. Further, a lateral cephalogram was taken to rule out any calcifications of the duramater. The case was provisionally diagnosed to be Papillon Lefιvre syndrome. A conventional polymerase chain reaction assay was also done to assess the virulence genes in aggressive periodontitis. Though the management of PLS involves the regular phases of periodontal therapy, namely, etiotropic, surgical, restorative and maintenance phases, the complete esthetic and functional rehabilitation also involves other specialities especially prosthodontic and dermatologic and later an implantologist. After appropriate periodontal and prosthodontic management, the patient has been followed up for over a year and is maintaining in a stable condition.

Benign cementoblastoma is a rare odontogenic tumor characterized by the formation of a mass of cementum or cementum-like tissue attached to the roots of a tooth. Cementoblastoma are distinctive but relatively uncommon tumors. The clinical, radiographic, and histopathologic features of a case of benign cementoblastoma are presented in this paper along with a brief review of the literature.

Oral leiomyoma is a benign smooth muscle tumor with a low incidence. Oral leiomyomas present as slow growing, asymptomatic sub mucosal masses, usually in the tongue, hard palate or buccal mucosa. They may be seen at any age and are usually discovered when they are 1 to 2 cm in diameter. The diagnosis is mainly determined by histological studies and special stains that confirm the smooth muscle origin. Surgical excision appears to be the best line of treatment and recurrence is unexpected. The purpose of this article is to present a case of a 32-year old male with a 1 month history of a leiomyoma on his right submandibular region.