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    Table of Contents - Current issue
May-August 2018
Volume 22 | Issue 2
Page Nos. 151-288

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Editorial desk Highly accessed article p. 151
T Smitha
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Future of oral pathology in India: Onus is on us Highly accessed article p. 152
Rajiv S Desai
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Dr. Vinay Hazarey p. 153
Alka D Kale
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Loss of heterozygosity as a marker to predict progression of oral epithelial dysplasia to oral squamous cell carcinoma p. 155
Umadevi Krishna Mohan Rao, Rooban Thavarajah, Elizabeth Joshua, Kannan Ranganathan
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Splendore–Hoeppli phenomenon p. 161
Divya Gopinath
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Immunohistochemical study of salivary gland tumors in a tertiary institution in South-South Region of Nigeria p. 163
Olufemi Gbenga Omitola, Cornelius Azekanabo Iyogun
Aim: The aim of this study was to see the usefulness of immunohistochemistry in diagnosing salivary gland tumors found in a tertiary health institution. Materials and Methods: Twenty-six formalin-fixed paraffin embedded salivary gland tumors were accessioned, and 2 μm were sectioned and processed using Streptavidin-Biotin immunoperoxidase method. Results: Adenoid cystic carcinoma (ADCC) was positive to alpha-smooth muscle actin (α-SMA) while mucoepidermoid carcinoma (MEC), polymorphous low-grade adenocarcinoma (PLGA), squamous cell carcinoma (SCC) and oncocytic carcinoma (OCC) were all negative to it. MEC, PLGA, ADCC and the only pleomorphic adenoma (PA) were positive to Ki-67 while both SCC and OCC were negative to it. All the tumors except PA were positive to p63. Conclusion: It appears that α-SMA may be used to distinguish ADCC from MEC and PLGA, but Ki-67 cannot be used for this purpose. Furthermore, p63 cannot help in the diagnosis of ADCC, MEC or PLGA. It was concluded that immunochemistry can be used as adjunct to routine H and E stain in the diagnosis of the various salivary gland tumors.
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The postoperative fall in platelet count in cancer: Mirroring the catastrophe? p. 168
Shubhangi Durgakumar Mishra, Jyoti D Bhavthankar, Suresh R Barpande, Mandakini S Mandale, Jayanti Humbe
Introduction: Progression of cancer requires the growth and invasion of the tumor at its parent site as well as metastasis. Recent studies have shown that tumor cells can aggregate platelets in vitro (a process termed tumor-cell-induced platelet aggregation [TCIPA]), and this aggregation correlates with the metastatic potential of cancer cells in vivo. Platelet depletion or even an inhibition of TCIPA reliably diminishes metastasis. Furthermore, tumor cells bind platelet adhesion receptors of circulating platelets to metastasize more effectively. Studies say that malignant tumors to interact with platelets in the above fashion secrete platelet activating factors which raise the platelet count in malignancy. The study undertaken aims at comparing the preoperative and postoperative platelet levels in patients with benign and malignant neoplasms. Materials and Methods: With an appropriate sample size of patients with benign or malignant neoplasms as per the inclusion and exclusion criteria, a platelet count presurgically and the 7th day postsurgically was advised. Results: In case of patients with benign neoplasms, the postoperative platelet count showed a significant rise attributed to a normal healing response, while in patients with malignant neoplasms, the platelet count appeared to fall down significantly due to the effect of tumor removal and therefore a diminished production of thrombopoietic cytokines. The results obtained were thus consistent with the theories of tumor cell-platelet interactions proposed in the recent literature so far. Conclusion: Postoperatively, the platelet count rises in the patients with the benign tumor as a result of a normal healing response while those in patients with malignant neoplasm apparently appears to fall down due to the effect of tumor removal thus diminishing the production of platelet activating factors.
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Clinicopathological profile of central giant cell granulomas: An institutional experience and study of immunohistochemistry expression of p63 in central giant cell granuloma p. 173
Mahadevi B Hosur, Rudrayya S Puranik, Shreenivas S Vanaki, Surekha R Puranik, Pramod S Ingaleshwar
Background: The central giant cell granuloma(CGCG) of bone constitutes about 10% of benign jawbone lesions. It affects females more often than males, mandible than maxilla. Biological behavior of CGCG ranges from a slow growing asymptomatic swelling to an aggressive process. True giant cell tumor (GCT) should be distinguished from CGCG. The histological distinction between these lesions depends on quite subtle differences. Expression of p63 has been demonstrated in GCT of bone conversely, has not been detected in CGCG. Therefore this short study attempts to study the expression of p63 in CGCG in conjunction with clinicopathological profile of the cases reported in the institute. Aims and objectives:
  1. To review all the cases of CGCGs of the jaws reported in the institute from 1998 to 2015 and study their clinicopathological profile.
  2. To study the immunohistochemical (IHC) expression of p63 in CGCG cases
Methods and materials: The retrospective study reviewed records for clinically and histopathologically diagnosed cases of CGCG from the archives of department of Oral pathology. Data was recorded and analyzed. These cases were subjected for IHC analysis for expression of p63, also RANK, RANKL in selected cases to study the nature of giant cells. Results and Conclusion: This paper is an institutional experience of clinicopathological profile of diagnosed cases of CGCG. Clinicopathological findings were in concurrent with previous literature. Total number of cases was ten. Six occurred in females and four in males. Most of them occurred in the second decade, more commonly involving mandible. Three cases showed recurrence. Histologically most showed classical features. Expression of p63 showed negativity in all the cases in accordance with the previous studies. RANK and RANKL showed strong and diffuse immunoexpression in both mononuclear and giant cells. Thus study supports the finding that p63 expression can be used to differentiate between CGCG and GCT. However, more number of studies with larger sample size are required to confirm reliability of using p63 as a distinguishing marker between GCT and CGCG.
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Clinicopathological analysis of oral squamous cell carcinoma among the younger age group in coastal Karnataka, India: A retrospective study p. 180
Riaz Abdulla, Soniya Adyanthaya, Prajna Kini, Varshasnata Mohanty, Neevan D'Souza, Yashwanth Subbannayya
Aims: Oral squamous cell carcinoma (OSCC) primarily occurs in older age group. However, in the recent years, incidence of oral cancer in young people has been on rise worldwide. Towards this end, we sought to analyze the clinical and histopathological characteristics of OSCC in patients less than 45 years of age. Materials and Methods: The clinical and histological features of patients diagnosed with squamous cell carcinoma of the oral cavity at two hospitals in the coastal Karnataka region of South India between 1996-2012 were reviewed. The tabulation and descriptive statistics of the study were carried out. Results: A total of 420 patients were treated for OSCC in the 17-year period (1996-2012), of which 86 (20.5 %) patients were under 45 years of age. The most common site of involvement among the young was tongue (29.07%) and buccal mucosa (27.9%) respectively. A total of 47 (54.65%) patients were either habitual chewers, smokers, or alcoholics. Pathological grading of cases classified tumors into well differentiated (34.88%), moderately differentiated (46.51%) and poorly differentiated (4.65%). Conclusions: The data from this study reveals that a significant proportion of the OSCC cases are observed in patients of 45 years or younger. Additionally, our study also indicated an increase in the usage of tobacco and pan chewing in young adults in comparison to older individuals in the two hospitals of South India. The data obtained from this analysis emphasizes the need for screening programs that are tailor-made for individuals at high risk of developing oral cancer and warrants tobacco awareness programs in the community.
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Immunohistochemical study of alpha-smooth muscle actin in odontogenic cysts and tumors p. 188
Vidya Mallipattana Annegowda, HS Uma Devi, Kavita Rao, T Smitha, HS Sheethal, A Smitha
Context: Myofibroblasts (MFs) are fibroblasts with smooth muscle-like features characterized by the presence of a contractile apparatus. Alpha-smooth muscle actin (α-SMA) is the actin isoform that predominates within vascular smooth muscle cells and plays an important role in fibrogenesis. MFs are metabolically and morphologically distinctive fibroblasts expressing α-SMA, and their activation plays a key role in development of the fibrotic response. Aims and Objectives: The aim of this study is to demonstrate the frequency, distribution and expression of α-SMA-positive MFs in odontogenic keratocyst (OKC), dentigerous cyst (DC) and ameloblastoma and correlate it to their aggressive biological behavior. Settings and Design: A retrospective study of 45 diagnosed cases, which includes 15 cases of OKC, 15 cases of DC and 15 cases of ameloblastoma, was undertaken to demonstrate expression of α-SMA retrieved from archives of our department. Materials and Methods: α-SMA mouse anti-human antibody and horseradish peroxidase detection system were used in this study. Statistical Analysis: Descriptive statistical analysis and ANOVA test were used for statistical analysis. Results: The difference in mean α-SMA count was found to be statistically significant between ameloblastoma and DC group (P < 0.001) as well as OKC and DC group (P < 0.001). No significant difference is observed between ameloblastoma and OKC group (P > 0.05). Results showed that mean number of stromal MFs in OKC and ameloblastoma were significantly higher than DC. Conclusion: The present study has shown that the mean number of MFs was higher in OKC and ameloblastoma, while the mean number of MFs in DC was quite low and significantly different from that of ameloblastoma and OKC.
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Cytodiagnosis of tuberculosis using modified bleach method on lymph node aspirates p. 193
Sarah Khan, Hemalata Mahantappa, Anagha A Joshi
Background: The conventional Ziehl–Neelsen (ZN) staining method for demonstration of acid-fast bacilli (AFB) by direct microscopy plays a key role in the diagnosis of tuberculosis. Its major disadvantage is low sensitivity. Aims: The present study was undertaken to emphasize the role of bleach concentration method over conventional ZN smear for detection of AFB in fine-needle aspiration (FNA) material of clinically suspected tuberculous lymphadenitis. Settings and Design: Tertiary care teaching hospital, cross-sectional design. Materials and Methods: FNAs were done on 150 patients with clinical suspicion of tuberculosis presenting with lymphadenopathy. Smears from the aspirates were processed for routine cytology and the conventional ZN method. The remaining material in the needle hub and/or the syringe was used for the bleach method. The significance of the bleach method over the conventional ZN method and cytology was analyzed. Results: Among the 150 aspirates, 57% (85/150) were indicative of tuberculosis on cytology, 37% (55/150) were positive for AFB on conventional ZN method, and the smear positivity for AFB increased to 41% (62/150) on bleach method. Conclusion: The bleach method is simple, safe and inexpensive. It improves the microscopic detection of AFB and can be a useful contribution to routine cytology.
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Association of oral manifestations in ulcerative colitis: A pilot study p. 199
KP Mohan Kumar, N Nachiammai, GS Madhushankari
Background: Ulcerative colitis (UC) is a chronic tissue destructive inflammatory bowel disease (IBD) of autoimmune origin characterized by predominant bowel symptoms such as abdominal pain, diarrhea and relapsing and remitting rectal bleeding, leading to loss of weight. Extraintestinal manifestations, including involvement of the oral cavity, may also occur. Oral involvement during IBD includes aphthous ulcers, pyostomatitis vegetans (PV) and lichen planus (LP). Objectives: The purpose of this study was to document the oral manifestations in UC patients and also to evaluate whether oral manifestation can predict relapse and remission of UC. Materials and Methods: Fifteen patients (8 men and 7 women) diagnosed for UC, in clinics of gastroenterology (with disease duration 5–15 years), with equal age- and sex-matched healthy controls were included in the study. All study participants were subjected to intraoral examination to evaluate for oral manifestation. The same patients were also asked a series of questions in the form of questionnaire to evaluate possible association between occurrence of oral manifestations and relapse of UC episode. Results: PV, minor aphthous ulcer, LP, halitosis, dysgeusia, dry mouth, tongue coating, gingivitis and periodontitis were documented as oral manifestations in UC. PV, minor aphthous ulcer and LP exhibited relapse and remission with the severity of UC. Conclusion: Our study revealed numerous and varied intraoral manifestations among the patients with UC. The previous episodes of oral manifestations were also similar and reported exacerbation of oral manifestations during relapses. Thus, oral manifestations can be used as an indicator of relapse in UC.
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Effects of salivary thiocyanate levels on oral mucosa in young adult smokers: A biochemical and cytological study p. 204
BV Prakruthi, DB Nandini, Mandana Donoghue, S Basandi Praveen, KP Mohan Kumar, R Ashwini
Background and Objectives: Cigarette smoking is one of the major global health issues. Accurate measurement of smoking is essential for accepting patterns of adolescent smoking behavior and for the evaluation of health education programs aimed at reducing or preventing the habit. The aim of the present study was to estimate and compare the salivary thiocyanate levels in young adult smokers and nonsmokers and also to evaluate and correlate the cellular and nuclear changes in cytological smears with salivary thiocyanate levels. Materials and Methods: The study included a total of 70 individuals in the age range of 18–25 years comprising of 35 smokers and 35 nonsmokers. A volume of 2 ml unstimulated whole saliva samples were collected by spitting method and were carried in a vaccine carrier with ice pack to the laboratory to avoid biochemical changes. Each sample was analyzed on the same day of collection by spectrophotometric method. In addition, cytosmears were prepared using Cytobrush® plus and stained with rapid Papanicolaou stain for cytological evaluation. Results: Salivary thiocyanate levels were significantly higher in smokers than nonsmokers. When these levels were compared with pack-years, there was a progressive significant increase in salivary thiocyanate levels as the pack-years increased. Duration of habit showed no statistically significant effect on salivary thiocyanate levels. Cytological evaluation revealed increase in nuclear-cytoplasmic area ratio and number of micronuclei in smokers than nonsmokers. The correlation between salivary thiocyanate levels and cytological changes showed insignificant result. Conclusion: Salivary thiocyanate levels were significantly higher in smokers than controls and showed significant correlation with the number of pack years. Although the present study failed to reveal any significant correlation between salivary thiocyanate level and cytological alterations, few early alterations in the oral mucosa even in the absence of clinical manifestations were detected by exfoliative cytology. Salivary thiocyanate determination is a safe, inexpensive, noninvasive method to differentiate early smokers from nonsmokers.
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Expression of mucin-1 in oral squamous cell carcinoma and normal oral mucosa: An immunohistochemical study Highly accessed article p. 210
Arush Thakur, Jagdish V Tupkari, Tabita Joy, Prajwalit Prakash Kende, Pooja Siwach, Manisha S Ahire
Background: Mucins are high-molecular-weight glycoproteins with a high O-linked carbohydrate content, which are synthesized by many secretory epithelial cells as membrane-bound and/or secreted products. Mucin-1 (MUC1) is a transmembrane mucin that protects and lubricates the mucous membranes of the human body and involves itself in various cellular functions such as growth, differentiation and signaling. An aberrant expression of MUC1 has been demonstrated in various human cancers. Many studies on MUC1 expression have been conducted on a variety of neoplastic lesions other than head-and-neck region. In this study, an attempt has been made to evaluate the MUC1 immunoexpression in oral squamous cell carcinoma (OSCC) and normal oral mucosa (NOM). Aims: This study aims to compare and correlate the immunoexpression of MUC1 in NOM and OSCC using immunohistochemical technique. Settings and Design: Thirty patients of OSCC formed the study group and thirty patients were included in the control group (NOM). Formalin-fixed paraffin wax blocks were prepared from the tissue samples obtained. Materials and Methods: Immunohistochemistry (IHC) for MUC1 was performed, and the overall percentage of positive cells along with distribution and localization of immunoexpression was studied. Statistical Analysis: Pearson's Chi-square test was used. P <0.05 was considered to be statistically significant. Results: In OSCC study group, MUC1-positive immunoreaction was observed in 21 (70%) cases out of 30. All the samples in control group were negative for MUC1 immunoexpression. The immunohistochemical expression of MUC1 in OSCC group was statistically significant when compared with normal control group, as P < 0.05 (Pearson's Chi-square). Conclusions: MUC1 is a reliable biomarker for the diagnosis of OSCC, but further studies are required to prove its role in prognosis.
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Morphology and prevalence of middle canals in the mandibular molars: A systematic review p. 216
Rashmi Bansal, Sapna Hegde, Madhusudan Astekar
Objectives: The purpose of this paper is to systematically review the various studies and case reports on the morphology and prevalence of middle canals in the mandibular molars. Methodology: Electronic databases such as MEDLINE, PubMed, EBSCOhost, ScienceDirect and various journals were screened to identify published literature till March 2017 and earlier for articles related to middle canals in the human permanent mandibular molars. Obtained articles were categorized as original researches, case reports and review articles. Well-defined review questions were developed using the patient population, intervention, comparison and outcome framework to summarize the objectives: “Does middle canal vary in morphology and anatomic location? What is the prevalence of middle canals in mandibular molars? Does ethnicity affect the prevalence of middle canals in mandibular molars?” Morphology was studied and prevalence rates were determined from the evaluation of data extracted from the articles. Results: The search strategy resulted in 87 articles, of which 36 were original research papers and 51 were case reports. The prevalence of middle canals in the various populations ranged from 0.26% to 53.8%. Middle canals were reported in Europeans, Asians, Africans and South and North American populations. The prevalence of middle mesial canal and middle distal canal in various races was reported as up to 53.8% and 10%, respectively. The orifice of middle canal exists below a dentinal projection in the groove between the two main canals. They were observed in fin, confluent and independent configuration. Out of these, confluent configuration was more prevalent. Conclusion: Middle canal varies in morphology and anatomic location. Ethnicity affects the prevalence of middle canals in the mandibular molars.
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Quantitative assessment of tumor-associated tissue eosinophilia and mast cells in tumor proper and lymph nodes of oral squamous cell carcinoma p. 227

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Oral bacterial flora and oral cancer: The possible link? p. 234
Pratyusha Prakash Gaonkar, Sangeeta R Patankar, Nidhi Tripathi, Gokul Sridharan
Oral cancer exhibits multifactorial etiology with tobacco and alcohol long been implicated as the primary risk factors. In addition, betel nut, dietary factors and poor oral hygiene have also been found to have a role in the etiology of oral cancer. Past research has uncovered a great deal of information regarding the association of exogenous bacteria with cancer. However, our definitive knowledge of the oral commensal bacteria and oral cancer link remains inadequate. In the present article, we hypothesize a causal role for oral bacterial flora in oral cancer although an indirect one. We propose that the normal bacterial flora in conjunction with the already established risk factors such as alcohol consumption may play a role in cancer development. The continued exploration of this topic may aid in better understanding of the pathogenesis of oral cancer thereby helping in appropriate treatment and better prognosis.
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Host defense peptides: An insight into the antimicrobial world p. 239
Shiva Gupta, Gouri Bhatia, Anamika Sharma, Sameer Saxena
A serious challenge to antimicrobial therapies has emerged due to rapid increase in drug-resistant infections creating an urge for the development of alternative therapeutics. Antimicrobial peptides (AMPs) have gained importance because of their broad-spectrum antimicrobial activities and mediator-like functions linking innate and adaptive immune responses. The multidimensional properties of these peptides hold promising potentials as prophylactic and antimicrobial agents. This review discusses various AMPs and their role in combating microorganisms and infections along with its clinical implication.
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Clear cell myoepithelial carcinoma involving vestibule and alveolus: A rare case report with review of literature p. 245
Anish A Gupta, Pooja Khare, Megha Jain, Hina Handa
Myoepithelial carcinomas (MCs) are difficult to distinguish from their benign counterpart due to diverse morphology. This neoplasm was introduced by Stromeyer et al. in 1975. They comprise of <2% of all salivary gland carcinomas involving most commonly major salivary glands and are characterized by differentiation of tumor cells into myoepithelial cells. The cells may present as epithelioid, plasmacytoid, spindle, clear, stellate and mixed type predominantly. Literature search revealed very few cases reported as clear cell variant of MC. Here, we report a case of clear cell MC involving buccal vestibule extending up to alveolus. The diagnosis was confirmed, and the patient was surgically treated.
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Peripheral keratoameloblastoma: A novel case report p. 249
Neelampari Parikh, C Nandini, Shikha Jain, Anuj V Mansata
Keratoameloblastoma is an exceptionally rare subtype of ameloblastoma that has been reported <20 times previously in the literature. All present as intraosseous lesions. We report an unusual case of keratoameloblastoma localized in the palate without involving palatal bone, thus presenting as a peripheral lesion. To the best knowledge of the authors, no case of peripheral keratoameloblastoma has been reported in the English literature till now, probably rendering this case to be the first one. Therefore, the purpose of this article is to present a rare and the first case of peripheral keratoameloblastoma with histopathological features of this tumor.
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Odontoameloblastoma: A report of a rare case p. 254
Karpagaselvi Sanjai, Bhavna Pandey, Divya Shivalingaiah, Harish Muniswamy Kumar
Odontoameloblastoma (OA) is an uncommon mixed odontogenic tumor that contains an ameloblastomatous component and odontoma-like elements, usually seen to occur in the mandible of younger patients. Radiographically, the tumor shows central destruction of bone with extension of cortical plates and calcified structures which have the radiopacity of tooth structure. These may resemble miniature teeth similar to a compound odontoma or occur as large masses of calcified material similar to a complex odontoma. We report a case of a 17-year-old male with a hard solitary, diffuse swelling over the right lower third of the face for 8 months. Histopathological sections of tumor mass showed diverse and characteristic features of ameloblastoma along with odontogenic epithelium proliferation in unrestrained manner so as to resemble developing tooth bud in stages of morphodifferentiation, apposition and calcification. A diagnosis of OA was made. Hemimandibulectomy was performed on the patient and he remains disease free till today.
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Aggressive histologic features do not predict biologic behavior in melanotic neuroectodermal tumor of infancy p. 260
Jeffrey S Marschall, George M Kushner, Brian S Shumway
While generally benign, occasional aggressive histologic features in the melanotic neuroectodermal tumor of infancy (MNTI) have been used to justify a diagnosis of malignancy; this could lead to overtreatment. We report a case with presumed aggressive histologic features that did not recur following conservative treatment. This adds evidence that histologic features are not predictive of clinical behavior in MNTI.
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Sclerosing polycystic adenosis of lower lip: A new and rare salivary gland entity p. 263
Rudrayya Shivanand Puranik, VG Bhagya Shree, Surekha R Puranik, Praveen S Anigol
Sclerosing polycystic adenosis (SPA) was first described in 1996 by Smith et al. and was characterized by resemblance to epithelial proliferative lesions of the breast such as fibrocystic disease and sclerosing adenosis. Etiopathogenetically, it is generally believed to represent a nonneoplastic sclerosing and inflammatory process. The age range is broad (typically fourth decade), with a slight female predilection. The vast majority are parotid lesions, with very few in minor salivary glands. As of 2017, not more than 60 cases have been reported worldwide. Microscopically, it is characterized by a well-circumscribed to partially circumscribed tubulocystic proliferation of a gland within a sclerotic-fibrous stroma. Ductal epithelium showing variations such as foamy, mucous and apocrine are seen. We report a case of SPA of lower lip in a 70-year-old male.
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Panoramic radiograph as a forensic aid in age and gender estimation: Preliminary retrospective study p. 266
Ruchi Bhuyan, Sandeep Mohanty, Sanat Kumar Bhuyan, Abhisekh Pati, Smita Priyadarshini, Pinali Das
Background: The temporomandibular joint is a hinge joint which is formed by the mandible with articulation of the jaw with the cranium. The morphology of the mandible is evaluated by measuring the gonial angle ramus height and bigonial width. Aim: The aim of this study to investigate the impact of age and gender on ramus height, gonial angle and bigonial width in the dentulous odisha population using digital panaromic radiographs. Materials and Methods: A total of 50 dentulous participants (25 males and 25 females) aged between 10 and 80 years were included in this study. The data were collected after comprehensive examination by 1 principal and two coinvestigators. Statistical Analysis: The mean difference between gender and different age groups was calculated using SPSS version 20.0. Unpaired t-test and one-way ANOVA were used for comparison studied parameters according to gender, side and different age groups followed by Tukey's post hoc test. Results: A statistically significant gender difference was seen for gonial angle, ramus height and bigonial width. All the parameters increased with increase in age. This difference was statistically significant on the right side for gonial angle and ramus height. Conclusion: This study is useful as for age and sex determination using mandible as primary object in forensic odontology.
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Palatoscopy and odontometrics for sex identification and hereditary pattern analysis in a Navi Mumbai population: A cross-sectional study p. 271
Treville Pereira, Subraj Shetty, Ridima Surve, Swati Gotmare, Pooja Kamath, Sourab Kumar
Background: Identification of an individual is a challenging task in the field of forensic odontology. Sometimes, the identity of individuals by fingerprints is difficult; hence, the examination of palatal rugae and the human dentition is a viable option. Aims and Objectives: The objective of the present study was to determine the sex of an individual and the hereditary pattern using three parameters are as follows: palatine rugae, dimensions of maxillary molar and maxillary canine. Materials and Methods: A cross-sectional study involved a total of 200 participants which included 60 males, 60 females and 20 families with four members each. Maxillary impressions were made with elastomeric impression material, and dental stone was used to make the models. The parameters used were as follows: palatine rugae classified by Thomas and Kotze (1983), which included the shape, size, direction and unification pattern, mesiodistal (MD) width of canines and intercanine width and MD and buccolingual width of maxillary molars. Statistical Analysis: Unpaired t-test and the median test were used to assess the sex differences in the number and unification pattern for the palatal rugae and to compare dimensions measured for males and females for the odontometric data. The data collected was statistically analyzed using the Statistical Package for Social Sciences 17.0 statistical program for windows. The statistical significance was fixed at 0.05. Results: Males showed more number of converging rugae and females showed more number of diverging patterns of rugae. The number of primary and forward rugae was more in both the genders and females showed more wavy rugae while males showed more number of straight and curved rugae. The maxillary canine and maxillary molar dimensions both were more in males than the females and also none of these parameters showed a hereditary pattern. Conclusion: Rugae pattern and the human dentition are both highly individualistic and can be used for personal identification and sex determination.
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A review of artifacts in histopathology p. 279
Syed Ahmed Taqi, Syed Abdus Sami, Lateef Begum Sami, Syed Ahmed Zaki
Histopathological examination is considered as gold standard procedure for arriving at a final diagnosis of various lesions of the human body. However, it is limited by a number of alterations of normal morphologic and cytological features that occur as a result of presence of artifacts. These artifacts may occur during surgical removal, fixation, tissue processing, embedding and microtomy and staining and mounting procedures. They can even lead to complete uselessness of the tissue. It is therefore essential to identify the commonly occurring artifacts during histopathological interpretations of tissue sections. This article reviews the common artifacts encountered during slide examination alongside the remedial measures which can be undertaken to differentiate between an artifact and tissue constituent.
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Immunohistochemical expression of extracellular matrix metalloproteinase inducer (EMMPRIN) in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma p. 279
Manika Arora, Deepa R Mane
Background: In oral squamous cell carcinoma (OSCC), extracellular matrix metalloproteinase inducer (EMMPRIN) expression has been noted in the cell membrane throughout the epithelium of the lesion, suggesting its increased expression. Objectives: The present study was conducted to evaluate and compare the expression of EMMPRIN in the normal oral mucosa (NOM), different histological grades of oral epithelial dysplasia (OED) and OSCC. Materials and Methods: A total of 100 formalin-fixed paraffin-embedded tissue blocks of NOM (n = 10), 20 cases each of mild, moderate and severe (OED) (n = 60), and 10 cases each of well differentiated, moderately differentiated and poorly differentiated carcinomas (n = 30) were included in the study. The tissues sections were immunohistochemically stained and were evaluated for intensity and area of expression in different groups. Results: Out of 60 cases of OED, 29 (48%) cases showed intense dark brown staining in the epithelium. The stroma in 38 (63%) cases showed positive immunoexpression. The expression of EMMPRIN in OSCC revealed intense dark brown staining in 9 (90%) cases of well differentiated, and a decent thereon in 8 (80%) cases of moderately differentiated and 4 (40%) cases of poorly differentiated carcinomas. Conclusion: The role of EMMPRIN in precarcinogenesis and early carcinogenesis needs to be studied on considerable sample size. This can enable oncologists to detect cancer at an early stage before it progresses to malignancy.
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Primary sinonasal lymphoma in immunocompetent patients: A 10 years retrospective clinicopathological study p. 280
Nadia Shirazi, Sampan Singh Bist, Neeti Puri, Meena Harsh, Sohaib Ahmad
Introduction: Sinonasal tumors occur in the nasal cavity or paranasal sinuses (PNS). These tumors are rare and lymphomas are even rarer. Lymphoma of the nose and PNS may mimic benign processes and may manifest either in an isolated fashion or in conjunction with systemic diseases. B-cell lymphomas, a more favorable diagnosis, account for the majority of cases, whereas T-cell and extranodal natural killer lymphoma are associated with rapid disease progression and death. Materials and Methods: All patients with sinonasal lymphomas who were nonreactive for HIV and were operated and treated in our hospital from 2006 to 2016 were included in the study. Histopathological diagnosis and immunohistochemistry using a panel of antibodies (CK, CD99, CD 15, CD30, CD45, Bcl 2, anaplastic lymphoma kinase-1, CD 16, CD 57 and ki-67) were reviewed and recorded. Results: Out of 153 malignant sinonasal tumors, 18 were diagnosed with lymphoma. Non-Hodgkins lymphoma constituted 88.8% of cases with the most common subtype being diffuse large B-cell lymphoma (n = 12, 66.6%). Maxillary sinus was the most frequently involved site (62%). The average age of presentation was 52 years with a slight male predominance. Computed tomography and magnetic resonance imaging scans were done in virtually all cases to assess the extent of the tumor as well as bony destruction. Average 5-year survival was 50%. Local recurrence was the most frequent cause of treatment failure. Conclusion: Malignant lymphomas constituted 11.7% of all malignancies of PNS. The association of diffuse large B-cell tumors with obstructive nasal mass and T-cell tumors with septal perforation, orbital extension and ophthalmological symptoms were more commonly seen.
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Role of cell proliferation and vascularity in malignant transformation of potentially malignant disorders p. 281
Suchita Sheelam, Shyam Prasad Reddy, Pavan G Kulkarni, SRK Nandan, M Keerthi, G Shyam Raj
Background: Significant increase in cell proliferation and vascularity occurs during the transition from normal oral mucosa through differing degrees of dysplasia to oral squamous cell carcinoma (OSCC). Aims: To evaluate the cell proliferation and vascularity in potentially malignant disorders and OSCC. Settings and Design: Proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF) and CD34 were quantified immunohistochemically (IHC) using anti-PCNA, anti-VEGF and anti-CD34 antibody. Materials and Methods: A total of 60 archival specimens included 10 oral lichen planus, 10 oral leukoplakia, 10 oral submucous fibrosis and 30 OSCC (well differentiated, moderately differentiated and poorly differentiated), and also, 10 normal oral mucosa as control group were taken. PCNA, VEGF and CD34 expression was assessed in relation to the localization and area of IHC-stained cells. Statistical Analysis: One-way analysis of variance test and post hoc least significant difference test were assessed for statistical significance. Results: Cell proliferation and vascularity appeared to increase gradually with disease progression. Conclusion: Upregulation of cell proliferation and vascularity indicates their possible role in malignant transformation of potentially malignant disorders.
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CD4 cell counts and oral manifestations in HIV infected and AIDS patients p. 282
MVR Ratnam, Abhishek Singh Nayyar, D Santhosh Reddy, B Ruparani, KV Chalapathi, Sania Azmi Md
Context: Acquired immunodeficiency syndrome (AIDS) is an acronym for AIDS caused by a retrovirus known as human immunodeficiency virus (HIV) which breaks down the body's immune system leaving a patient vulnerable to a host of life-threatening opportunistic infections, neurological disorders or unusual malignancies. According to estimates by the World Health Organization and UNAIDS, 35 million people were living with HIV globally at the end of 2013. The first AIDS case in India was detected in 1986. Seldom studies have been conducted correlating these parameters with oral manifestations in the Indian population. Aim: The present study was carried out to evaluate the CD4 cell counts and oral manifestations in HIV-infected and AIDS patients and to correlate them with the seronegative controls. Methodology: This was a cross-sectional, hospital-based study on individuals who were divided into three groups, Group A consisting of 500 patients who were healthy controls without any systemic illness; Group B consisting of 500 patients who were diagnosed as HIV infected and Group C consisting of 500 patients diagnosed as AIDS patients depending on their CD4 cell counts. The permission from the Ethical Committee of the Institution as well as Superintendent of Government Hospital was obtained. Evaluation of CD4 cell counts in HIV-infected and AIDS patients was done using CyFlow Counter. Results: The results were found to be statistically significant with the P < 0.001 for the CD4 cell counts. Oral manifestations revealed varied results with different levels of significance. Conclusion: CD4 cell counts were significantly altered in HIV-infected and AIDS patients when compared with the controls while oral manifestations revealed varied results with different levels of significance.
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Evaluation of relationship between dental caries, diabetes mellitus and oral microbiota in diabetics p. 282
Bhagyashri Ramachandra Latti, Jitendra V Kalburge, Sanjeev Bhimashankar Birajdar, Ramachandra Girimallappa Latti
Background: Diabetes mellitus is a metabolic disease leading to abnormal fat, carbohydrate and protein metabolism. Reduced salivary flow rate caused by hyperglycemia is characteristic mainly for periods of poor metabolic control of diabetes, thereby facilitating the growth of aciduric bacteria and caries-lesion development. The objective of our study was to evaluate the effects of diabetes mellitus on dental caries micro-organisms responsible for caries. Materials and Methods: This study was carried out on 60 subjects consisting of 2 groups. The Group A (study group) consisted of 30 subjects with diabetes mellitus and dental caries, and the Group B (control group) consisted of 30 subjects with dental caries but no systemic disease. DFS/dfs index in all subjects was evaluated and compared. Unstimulated salivary flow was collected and levels of Streptococcus mutans were analyzed. Results: It was found that the fasting blood sugar in Group A subjects because of which there was increased streptococcus mutans count and hence high caries index as compared to that of Group B. Conclusion: From our study, we could conclude that with increased age, blood sugar levels, DMFT values, dental caries increases in diabetics than in normal (control) subjects and therefore relationship does exist between diabetis mellitus, oral microbiota and dental caries.
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Comparison of efficacy of local anesthetic solution, distilled water and normal saline as emergency fixatives p. 283
Sowmya Kasetty, Dhara Dwivedi, T Raju Ragavendra, Shreenivas Kallianpur, Sandeep Gupta, Nitin Prabhakar
Context: Adequate tissue fixation is fundamental to good quality histological sections. Owing to undesirable effects of 10% buffered formalin, its availability in clinics is questionable. Thus, the present study was conducted with a novel approach to fixation, together with the scope of finding fixative properties of more commonly used reagents available at the clinics. Aims: The present study was aimed to compare the efficacy of local anesthetic solution, normal saline (NS) and distilled water (DW) with that of 10% neutral-buffered formalin. Settings and Design: It is a single-blinded study where histological assessment of fixation was done to assert if the tissues procured were sufficient or insufficient for the clinical diagnosis with/without any problems. Subjects and Methods: Forty soft-tissue specimens obtained from 2 goat tongue were used. Tissues each were directly immersed in local anesthesia, DW, NS solution and formalin for 12 and 24 h each and labeled as Group I and Group II, respectively. The sections were evaluated for staining quality and were subjected to statistical analysis. Statistical Analysis Used: Kruskal–Wallis test was employed to assess the differences in histological quality scores. Comparison between the tissues of the two groups was estimated with Mann–Whitney U-test. Kappa Statistic was used to measure the interobserver variation. Results: There was a significant difference (P ≤ 0.05) in the efficacy of all the three emergency fixatives. Conclusions: On the basis of the results obtained, local anesthetic solution can be used as an emergency fixative.
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Multiple myeloma presenting as an unhealed extraction socket: Report of a case with brief review of literature p. 284
Suhasini Gotur Palakshappa, Vijay Wadhwan, Vishal Bansal, Nagaraju Kamarthi
Multiple myeloma (MM) is a relatively rare malignant hematological disease, which is characterized by a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions. Maxillofacial presentations in patients with MM are not uncommon, but because the symptoms are varied, it is very difficult to diagnose MM in this region especially in patients with initial oral involvement. Furthermore, maxillofacial manifestations as an initial sign or symptom are scarce. We report a case of a 40-year-old male patient who presented with an unhealed socket in lower left back tooth region for the past 2 months. The panoramic radiograph revealed a multilocular radiolucency. Histopathological examination of the biopsy specimen revealed a malignant hematopoietic neoplasm formed by plasmacytoid cells. Radiographic survey and immunoreactivity for CD 138 and lambda chain antibody further confirmed the diagnosis of MM.
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Oral rhabdomyosarcoma in an adult male: A rare case report p. 285
Tabita Joy, Jagdish Vishnu Tupkari, Amrut V Hanchate, Pooja Siwach
Rhabdomyosarcoma is a malignant neoplasm of mesenchymal cells, showing varying degrees of striated muscle cell differentiation. It predominantly occurs in children while rarely found in adults and involvement of the oral cavity accounts for only 10%–12% of all head-and-neck cases. Herewith, we present a rare case of spindle cell rhabdomyosarcoma in a 52-year old male, involving the mandibular gingiva, and describe the clinical, radiological, histopathological and immunohistochemical findings.
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Basaloid squamous cell carcinoma: Report of two rare cases and review of literature p. 285
Kalavani Peddapelli, Guttikonda Venkateswara Rao, Taneeru Sravya, Sravya Ravipati
Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of SCC in the head-and-neck region it occurs most commonly in older men with a history of heavy smoking and alcohol abuse and usually presents as a high stage disease with widespread metastases and hence poor prognosis. BSCC is believed to arise from a totipotential primitive cell in the basal layer of the surface epithelium or from the salivary duct lining epithelium. BSCC is an uncommon tumor with a predilection for the upper aerodigestive tract, is a distinct variant of squamous carcinoma, due to its unique histological features and ominous clinical behavior. In the oral cavity, BSCC has a predilection for the tongue, followed by the floor of the mouth, palate, buccal mucosa, retromolar trigone and gingiva. In the oral cavity, retromolar trigone/gingiva is very rare sites and only a few cases have been reported in the literature. This paper reports an additional two cases of BSCC, one reported in the retromolar region and other reported on the gingiva.
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Aggressive angiomyxoma of maxilla: A confounding clinical condition with rare occurrence! p. 286
Jigna S Shah, Sheetal Sharma, Mahalaxmi Panda
The angiomyxomas are rarely reported in the head and neck region; this paper entails a case of aggressive angiomyxoma presenting as a growth in the maxillary anterior alveolar mucosa and lip region for 1 year, which was accurately identified and treated successfully by surgical excision. An attempt has been made to highlight the clinical and pathologic stand out features of this tumor with intricate emphasis, alongside a literary review.
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True median palatal cyst; A rare case report p. 286
Shruthi Rangaswamy, Madhumati Singh, Ranjeeta Yumnum
Median palatal cyst is rare nonodontogenic lesion as it represents only 7.14% of all jaw cysts. Also called mid palatal cyst has raised controversy about pathogenesis of such fissural cysts. Specific diagnostic criteria have been described for true median palatal cyst after it has been excluded from WHO classification. The purpose of this paper is to report a rare case of true median palatal cyst satisfying these criteria and discuss current controversy about these cysts.
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Acquired arteriovenous malformation of lip occurring as an occupational hazard: A case report with review of literature p. 287
Manisha Nanasaheb Pandhare, D Bhavthankar Jyoti, Mandakini S Mandale, R Barpande Suresh
“Vascular malformations” comprise a group of lesions, formed by an anomalous proliferation of angiovascular or lymphovascular structures. Arteriovenous malformations (AVMs) are high-flow malformation, characterized by direct communication between arteries and veins, lacking normal capillary network. AVMs are usually congenital. Acquired AVMs are reported to occur due to trauma or hormonal changes. Acquired AVMs, though rare in oral cavity, when present are persistent and progressive in nature and can represent a lethal benign disease. They are often associated with extensive blood loss, and an incomplete resection frequently leads to regrowth of the lesion often larger than its original size. We present a rare case of an acquired AVM diagnosed on contrast-enhancing computed tomography angiography and histopathology in a 65-year-old professional trumpet blower.
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Erratum: Quantitative assessment of tumor - associated tissue eosinophilia and mast cells in tumor proper and lymph nodes of oral squamous cell carcinoma p. 288

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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007