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    Table of Contents - Current issue
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January-April 2020
Volume 24 | Issue 1
Page Nos. 1-190

Online since Friday, May 8, 2020

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EDITORS DESK  

From the editor's desk Highly accessed article p. 1
T Smitha
DOI:10.4103/jomfp.JOMFP_119_20  
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FROM THE IAOMP OFFICE BEARERS Top

President's message p. 2
Susmita Saxena
DOI:10.4103/jomfp.JOMFP_148_20  
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GUEST EDITORIAL Top

Current trends and future perspectives of Oral Pathology: Indian Scenario p. 3
Yeshwant B Rawal
DOI:10.4103/jomfp.JOMFP_44_20  
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LETTER TO EDITOR Top

Coronavirus disease-2019: A brief compilation of facts Highly accessed article p. 5
Susmita Saxena
DOI:10.4103/jomfp.JOMFP_137_20  
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EMERGING HOT TOPICS Top

COVID - 19 fact sheet for the dental professional Highly accessed article p. 8
Kannan Ranganathan, T Smitha
DOI:10.4103/jomfp.JOMFP_149_20  
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INVITED REVIEW Top

Regenerative medicine - A new horizon for an oral pathologist p. 11
PM Sunil
DOI:10.4103/jomfp.JOMFP_16_20  
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LIVING LEGEND Top

Dr. R. M. Mathur p. 13
Shaleen Chandra
DOI:10.4103/jomfp.JOMFP_108_20  
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CANCER NEOTERICS Top

Can B- cell based immunotherapy be our new perspective to exit cancer? p. 15
Anela Thomas, T Smitha
DOI:10.4103/jomfp.JOMFP_121_20  
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ENIGMATIC MORPHO INSIGHT Top

The enigma of signet ring cells p. 18
Gitika Sharma, Mala Kamboj
DOI:10.4103/jomfp.JOMFP_77_20  
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ORIGINAL ARTICLES Top

Elucidating the role of excision repair cross-complement group 1 in oral epithelial dysplasia and early invasive squamous cell carcinoma: An immunohistochemical study p. 20
Spoorti Kulkarni, Monica Solomon, Deepthi Pankaj, Sunitha Carnelio, Chetana Chandrashekar, Nisha Shetty
DOI:10.4103/jomfp.JOMFP_60_19  
Objectives: Oral epithelial dysplasia (OED) is characterized by cellular alterations which have the proclivity of progressing to squamous cell carcinoma. Excision repair cross-complement group 1 (ERCC1) is one of the key proteins involved in nucleotide excision repair (NER) pathway. The expression of ERCC1 has been studied in colorectal, esophageal, ovarian and oral squamous cell carcinoma; but, very few studies have been done to apprehend the expression of ERCC1 in OED and early invasive squamous cell carcinoma (EISCC). The goal of this study is to evaluate the role of ERCC1 in OED and EISCC. Materials and Methods: Histopathologically diagnosed cases of moderate dysplasia (n = 10), severe dysplasia (n = 10) and EISCC (n = 10) were retrieved. 4 μ thick sections were cut from the formalin-fixed paraffin-embedded tissue blocks. The sections were immunohistochemically stained for ERCC1 following standard protocols. The expression of ERCC1 was evaluated semiquantitatively. Statistical analysis was carried out using Fischer's exact t-test. Results: The expression of ERCC1 was found to be strong (+3) in EISCC, moderate (+2) in severe dysplasia and mild (+1) in moderate dysplasia. Thus, the results were statistically significant between the three groups (P < 0.001). Conclusion: Disruption in the mechanisms that regulate cell cycle checkpoints and DNA repair mechanism results in genomic instability; these alterations might contribute to carcinoma. ERCC1 is essential to repair the DNA damage induced by various carcinogens. The present study shows significant difference in the expression of ERCC1 between EISCC and OED, which suggests ERCC1 could be used as one of the predictive markers.
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Clinicomicrobiological evaluation of the efficacy of local delivery of moxifloxacin and ibuprofen gel as an adjunct to scaling and root planing in chronic periodontitis patients p. 26
Ramyasri Kadadasu, Abhinav Atchuta, Rajababu Palaparthy, S Harinath Reddy, Vidyasagar Sisinty, Mounika Beeravolu
DOI:10.4103/jomfp.JOMFP_253_19  
Aims: To evaluate the clinical and microbiological effects of local drug delivery of moxifloxacin and ibuprofen gel as an adjunct to conventional periodontal therapy in chronic periodontitis patients. Subjects and Methods: Twenty patients with moderate-to-severe chronic generalized periodontitis with probing pocket depth (PPD) of ≥5 mm and <8 mm were randomly assigned to one of the following two treatment modalities: scaling and root planing (SRP) group and moxifloxacin and ibuprofen combination gel as an adjunct to SRP group. Clinical parameters include plaque index (PI), gingival index (GI), probing depths and clinical attachment level (CAL) that were recorded at baseline and 1 and 3 months after the treatment, and microbiologic assessment was done using dark-field microscopy. Results: A statistically significant difference in mean PI and GI scores and reduction in PPD and gain in CAL were observed at different study intervals with greater difference in the test group. On microbiological examination, the percentage of cocci increased, while a statistically significant decrease in the mean percentage of bacilli and spirochetes was observed in both groups at given intervals. In-vitro dissolution showed controlled release of both the drugs. Conclusions: Among the two treatment modalities, treatment with moxifloxacin and ibuprofen local delivery as an adjunct to SRP gave superior results in clinical and microbiological parameters compared to SRP group.
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Study of Hypoxia-inducible factor-2α expression in the malignant transformation of Oral submucous fibrosis p. 33
Immanuel Joseph, Joshua Elizabeth, Umadevi K Rao, Kannan Ranganathan
DOI:10.4103/jomfp.JOMFP_42_19  
Context: Hypoxia-inducible factor (HIF)-2α is overexpressed in primary and metastatic human cancers, whose expression is correlated with tumor angiogenesis and patient mortality. HIF plays a role in the progression of fibrosis in oral submucous fibrosis (OSF). Aim and Objective: The aim is to study and compare the expression of HIF-2α in OSF (a), oral squamous cell carcinoma (OSCC) with areca nut usage (b), OSCC without areca nut usage (c) and normal mucosa (d) by immunohistochemistry. Subjects and Methods: Immunohistochemical detection of HIF-2α was done on 51 samples, which included 11 cases (a), 15 cases (b), 15 cases (c) and the expression was compared with that of (d). Statistical Analysis Used: Data were analyzed using the SPSS™ software (ver. 21.0). Chi-square test and kappa analysis were performed to compare the intensity of staining between the groups and for inter-observer agreement, respectively. Value of P ≤ 0.05 was considered statistically significant. The mean labeling index between the groups was studied by the Kruskal–Wallis test. Results: All the cases of (d), (a), (b) and (c) showed HIF-2α expression (P = 0.329). About 13% cases of (c) showed intense expression (P = 0.406) and 27% of (a) cases showed expression only in the connective tissue (P = 0.023). The number of positively stained nuclei in both (b and c) cases reduced as the tumor progression was from well to poorly differentiated. Conclusion: Areca nut initiates fibrosis and subsequent hypoxia in OSF which triggers HIF-2α expression in the epithelium. HIF-2α could be a surrogate marker for cancer initiation and progression.
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Syringic acid induces apoptosis in human oral squamous carcinoma cells through mitochondrial pathway p. 40
Bhaskhar Abijeth, Devaraj Ezhilarasan
DOI:10.4103/jomfp.JOMFP_178_19  
Background: Syringic acid (SA) has long been used as traditional medicine and is known to have antioxidant, hepatoprotective, neuroprotective and anticancer effects. Studies regarding the anticancer effect of SA against squamous carcinoma cell (SCC)-25, human oral SCC (OSCC) line has not been studied. Aim: This study was aimed to evaluate the cytotoxic potentials of SA in SCC-25 cells. Materials and Methods: Cytotoxic effect of SA was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenylte trazolium bromide assay, using concentrations of 25 and 50 μM/mL for 24 h. At the end of the treatment period, apoptotic markers such as caspase 3 and 9, bcl-2, bax and cytochrome c were evaluated by semiquantitative reverse transcription-polymerase chain reaction. SA-induced morphological changes were investigated by acridine orange/ethidium bromide dual staining. Results: SA inhibited the proliferation and induced cytotoxicity in SCC-25 cells in a concentration-dependent manner. SA treatment caused apoptosis-related morphological changes as evidenced by the dual staining and the modulation of apoptotic marker gene expressions. SA treatments modulated bcl-2/bax homeostasis and increased the expressions of cytochrome c and caspases 3 and 9. Conclusion: SA specifically induces cell death and inhibits the proliferation in OSCC cells through intrinsic/mitochondrial apoptosis pathway, suggesting that SA may be an effective agent for the treatment of human OSCC.
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Serum C-reactive protein in oral submucous fibrosis and oral squamous cell carcinoma: A cross-sectional study p. 46
Suchitra Rajesh Gosavi, Amruta Appasaheb Torkadi
DOI:10.4103/jomfp.JOMFP_317_19  
Context: Early detection of oral squamous cell carcinoma (OSCC) and oral submucous fibrosis (OSMF) transforming into malignancy can drastically improve the treatment outcomes and prognosis. Carcinoma development is an intricate complex mechanism and the multifactorial causation makes it more difficult to find specific prognostic and therapeutic biomarkers. Thus, the development of newer diagnostic and predictive approaches that are less invasive, economical and amenable to repeated sampling is imperative. Serum C-reactive protein (CRP) serves a useful marker for prognosis and monitoring of oral potentially malignant disorders (OPMDs) including OSMF as well as OSCC. Secreted by hepatocyte as an acute inflammatory marker, various studies have shown association between serum CRP and presence of OPMDs, as well as with presence and prognosis of OSCC. Aims: The aim of this study was to measure and compare serum CRP levels in patients with OSMF and OSCC as compared to healthy individuals and to establish baseline data for serum CRP levels in patients with OSMF and OSCC. Settings and Design: Cross-sectional observational prospective study. Materials and Methodology: The study includes 150 individuals, with 50 healthy, 50 OSMF and 50 OSCC individuals. Spinreact CRP-turbilatex Kit (SPINREACT) and Prietest-EXP semi-automatic biochemical analyzer were used for quantitative determination of serum CRP. Statistical Analysis Used: Data were analyzed by SPSS 16© (Statistical Package for the Social Sciences) software. Results: The mean value of serum CRP in Group I was 2.20 mg/L with standard deviation of 1.74; in Group II, it was 5.40 mg/L with standard deviation of 4.79 mg/L and in Group III, it was 12.17 mg/L with standard deviation of 11.38. Conclusions: Serum CRP levels in patients with OSMF were raised, but not statistically significant as compared to the control group. Values of serum CRP were significantly higher in patients with OSCC as compared to the control group, and it was statistically significant; these values also showed positive association with primary tumor size.
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Establishing the accuracy of a new and cheaper sample collection tool: Oral cytology versus oral histopathology p. 52
Anubhuti Sood, Deepika Mishra, Rahul Yadav, Krushna Bhatt, Harsh Priya, Harpreet Kaur
DOI:10.4103/jomfp.JOMFP_273_19  
Objective: High cost of tools used for the collection of oral cytology sample; deters their use as mass screening tool in the developing countries. Hence, this study aims to assess the diagnostic accuracy of a new, cheaper sample collection tool in the field of oral exfoliative cytology through comparison with histopathology. Materials and Methods: Fifty-seven patients out of 394 cases were selected for the study in whom the cytological examination was performed using the wooden end of a sterile cotton swab followed by biopsy. The cytological smear classified in accordance with the Pap classification was compared with the histopathological diagnosis. Results: The study recruited 11 cases of oral potentially malignant disorders, 33 cases of oral carcinomas, and 13 cases of other lesions. The sensitivity and specificity of the cytology test using the wooden end of a sterile cotton swab was 75.0% and 61.5%, respectively. The Spearman's correlation coefficient was 0.618, with the P < 0.01. Conclusion: Our study proves that the use of wooden end of a sterile cotton swab stick offers a low cost and fairly effective solution which is not only easily available but can be potentially applied as a mass screening tool at primary health-care centers.
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Characterization of perineural invasion in different histological grades and variants of oral squamous cell carcinoma p. 57
G Deepthi, N D V N Shyam, G Kiran Kumar, Vaishali Narayen, K Paremala, P Preethi
DOI:10.4103/jomfp.JOMFP_162_19  
Background: Oral squamous cell carcinoma (OSCC) accounts for 3% of all malignant neoplasms and is the fifth most frequent cancer in the world. They usually spread by hematogenous or lymphatic spread, and perineural invasion (PNI) is considered an alternate method of tumor spread where it is described as the tumor affinity toward a neural tissue. Aim and Objectives: The present study aims to evaluate the biological behavior of OSCC with respect to PNI and to evaluate the importance of PNI with respect to different histopathological grades and variants, tumor stage and lymph node status of OSCC. PNI was also assessed with respect to its frequency, patterns, types and number in various grades of OSCC. Materials and Methods: This retrospective, double-blind study was conducted on 148 histopathologically proven cases of different histopathological grades and variants of OSCC. The tissue sections were examined for PNI and its patterns and were further compared with habit history, site of the lesion, tumor staging, grading and lymph node status. Results: A Chi-square test was performed. A percentage positivity of 45.27% (67 cases) among 148 cases was found. PNI positivity of 63.6% and 50% was observed in T4 and T3 tumor stages, respectively, with high significance. Seventy percent of cases belonging to poorly differentiated squamous cell carcinoma showed positivity for PNI, which was statistically significant. PNI positivity with respect to lymph node status is nonsignificant. Conclusion: The present study showed that there is a direct proportionality between PNI and different grades and stages of OSCC. Given this context, a histopathologist ought to examine for PNI and make it mandatory to report the same to the clinician for better treatment and follow-up of the patient.
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Can coffee combat caries? An in vitro study p. 64
Divyasri Godavarthy, Rashmi Naik, Praveen Kumar Gali, BR Ahmed Mujib, Venkata Ramana Reddy Baddam
DOI:10.4103/jomfp.JOMFP_172_19  
Background: Dental caries is a multifactorial disease caused by oral microflora, diet and oral environment. Oral microflora is crucial in initiation and progression of caries. An important strategy in the prevention of dental caries is to inhibit Streptococcus mutans, a caries causing bacteria. Use of natural products in the disease prevention has been increasing recently. One among such products is coffee which has anticariogenic properties against S. mutans. The aim of the present study is to evaluate the anticariogenic efficacy of coffee against S. mutans. Materials and Methods: The study is carried out using saliva samples collected from 120 healthy individuals of 18–25 years' age group divided into two groups (carious and noncarious). S. mutans is isolated from the saliva samples, cultured on mitis salivarius–bacitracin agar plates and used for checking the inhibitory activity of coffee in different formulations on these bacteria. Results: Our study results showed that coffee, when used alone, has highest antibacterial activity against S. mutans and its anticaries activity reduces when it is mixed with milk and sugar (P < 0.01). Conclusion: Our study proved that coffee has anticariogenic activity against S. mutans.
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Isolation, culture and characterization of primary cell lines of human buccal mucosal fibroblasts: A combination of explant enzamytic technique p. 68
Ritiha Patil, Alka D Kale, Deepa R Mane, Dhanashree Patil
DOI:10.4103/jomfp.JOMFP_282_19  
Background: The cell culture technique has become a routine and a popular method for its wide applications in the field of cell biology and biotechnology and in medical research. Isolation of primary cells over the cancer cells is an essential component of cell culture technology as they are the reliable source to understand normal physiological, morphological and molecular process of human cells. As fibroblasts are the prominent cells of the connective tissue of oral mucosa, many disease entities and histogenesis are linked to fibroblasts. Culture of oral fibroblast cells helps the oral biologists and researchers to study the morphological and molecular process in the oral diseases. Aim: The aim of our experiment is to isolate and culture the human buccal mucosal fibroblast cells from healthy individuals using a combination of explant–enzymatic method and characterization of the cells by short tandem repeat (STR) profiling. Materials and Methods: The tissue samples were collected from healthy individuals undergoing routine impacted third molar extraction. A combination of explant–enzymatic technique was used for the isolation from the tissue samples. The cells were further subcultured, maintained and stored as per the standard protocols. Thus, to confirm the oral fibroblasts of human origin and its uniqueness, they were characterized using STR profiling. Results and Conclusion: Using the combination technique, we were successful in isolating the cells at a faster rate by detachment of cells on day 3 and confluency on day 10. The morphological assessment and STR profiling further confirmed that the isolated cell lines resemble human fibroblast cells.
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Relative frequency of oral focal reactive overgrowths: An institutional retrospective study p. 76
Bhagirathi D Lakkam, Madhusudan Astekar, Shakir Alam, Gaurav Sapra, Ashutosh Agarwal, Aditi Murari Agarwal
DOI:10.4103/jomfp.JOMFP_350_19  
Context: Focal fibrous hyperplasia, peripheral ossifying fibroma, pyogenic granuloma, peripheral giant cell granuloma, giant cell fibroma and focal reactive overgrowth (FROGs) are one of the foremost numerous benign soft-tissue growths in the oral cavity. Chronic irritation or trauma is with identified as the causative aspect. It may develop up to few centimeters in diameter, pedunculated or sessile and may arise on the gingiva or buccal mucosa. Treatment involves surgical excision, and recurrences are infrequent. Aims: The aim of this study was to assess the prevalence of FROGs of oral mucosa in an institutional setup. Subjects and Methods: All the histopathologically diagnosed cases of FROGs within a period of 10 years (January 2008–December 2017) were retrieved from the archives of the Department of Oral Pathology. The information such as age, sex, site, anatomical side and its prevalence were recorded on customized case history performa. Statistical Analysis Used: The significance of difference was assessed using the Chi-square test and Fisher's exact test. Results: A total of 2849 cases were identified, of which 449 (15%) were FROGs. The most prevalent lesion amid them were focal fibrous hyperplasia (277, 62%), followed by pyogenic granuloma (92, 20%), whereas the least common was giant cell fibroma with 2 (0.5%) cases. All the FROGs were distributed among 21–40 years of age showing female predominance. The commonly affected site was the right buccal mucosa. Conclusions: Nevertheless, information of the frequency and distribution of these lesions is favorable when establishing a diagnosis and treatment plan in clinical practice.
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Comparative evaluation of staining efficacy of calcofluor white and acridine orange for detection of Candida species using fluorescence microscopy – A prospective microbiological study p. 81
Vishal Punjabi, Shilpa Patel, Jigna Pathak, Niharika Swain
DOI:10.4103/jomfp.JOMFP_315_18  
Context: Candida is a yeast-like fungus, and it causes candidiasis. Since it is commonly encountered in many cases, the need of the hour is for rapid and reliable method for identification of these fungi in tissue sections. Aim: The aim of this study was to evaluate and compare the staining efficacy of calcofluor white (CFW) and acridine orange (AO) for the detection of Candida species in formalin-fixed paraffin-embedded tissue samples of oral squamous cell carcinoma (OSCC) using fluorescence microscopy. Settings and Design: Sample size comprised forty cases of OSCC. Materials and Methods: Before tissue sampling, a swab of the area was taken, it was immediately inoculated on Sabouraud's dextrose agar media and germ tube test was performed for positive cultures for species identification. Tissue sections were obtained from cases of OSCC from the formalin-fixed paraffin-embedded tissue blocks of the same cases in which microbiological assessment was done at the time of tissue sampling, were stained with CFW and AO stain, respectively, and were examined using a fluorescent microscope. Statistical Analysis Used: Descriptive statistics were expressed in numbers and percentage. Independent t-test (unpaired t-test) and Chi-square test were used. P ≤0.05 was taken to be statistically significant. Results: The mean number of microorganisms per high-power field stained by CFW and AO was 6.35 and 2.57, respectively, and a statistically significant difference (P ≤ 0.001) was observed. CFW compared to swab culture gave P = 0.018, which showed a statistically significant association. Conclusions: CFW is a better fluorescent stain when compared to AO to detect Candida species in tissue sections of OSCC cases.
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Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study p. 87
Shruti Singh, Jaya Singh, Shaleen Chandra, Fahad Mansoor Samadi
DOI:10.4103/jomfp.JOMFP_347_19  
Background: Despite our sincere and serious efforts, oral cancer (particularly oral squamous cell carcinoma [OSCC]) is the major cause of morbidity and mortality in the Indian population. Oral precancerous lesions show quite high malignant transformation rate. Epidemiological data of oral epithelial dysplasia (OED) and OSCC could help in early diagnosis and thus may improve the prognosis. The current study aims to retrospectively analyze the epidemiological profile of patients with different grades of OED and OSCCs. Materials and Methods: The current study is a retrospective analysis of OED and OSCC reported in 5 years in our institution from 2014 to 2018. Data for the analysis were attained from the case sheets from the patients diagnosed with OED and OSCC. Results: The mean prevalence of OED and OSCC was 5.71% and 9.85%, respectively. Among the dysplastic lesions, severe dysplasia was more common, while well-differentiated squamous cell carcinoma was more common among the carcinomatous lesions. The peak age prevalence of both the lesions was third to fifth decade. Males were more frequently affected than females, with buccal mucosa being the most common site. Conclusion: The data attained from this study highlight the need for community-based screening and awareness programs for general population and thus obtain a healthier society.
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Effect of Ocimum sanctum extract on leukemic cell lines:A preliminary in-vitro study p. 93
M Harsha, KP Mohan Kumar, Santosh Kagathur, Vikram S Amberkar
DOI:10.4103/jomfp.JOMFP_181_19  
Background: Surge of cancer incidence, effects of chemotherapeutic agents and their cost and reduced survival and responsiveness to treatment have led to shift of attention of researchers toward herbal remedies to look for newer dimension in cancer therapy. Ocimum sanctum, Holy Basil or Tulsi, holiest herb well used in the Indian household, has drawn much attention toward its various health benefits, especially anti-cancer property. The present study was carried out to evaluate the cytotoxic effect of O. sanctum on leukemic cell lines K562. Materials and Methods: Dry and aqueous extracts of two types of Tulsi leaves (Rama Tulsi and Krishna Tulsi) were evaluated for a dose-dependent cytotoxicity and anti-proliferative against K562 cell lines, leukoerythroid progenitor leukemic cell lines by 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay. Half-maximal inhibitory concentration was evaluated for each of the extracts. Results: Both dry and aqueous extracts of both types of Tulsi leaves demonstrated a significant amount of cytotoxicity against the studied cell lines. Conclusion: This being preliminary study, we propose the initial finding of cytotoxic abilities of the herb against the leukemic cell lines and recommend a more detailed evaluation of the herb and its components.
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New diagnostic markers in basal cell carcinoma p. 99
Sadaf Anghaei, Kambiz Kamyab-Hesari, Shahriar Haddadi, Maryam Jolehar
DOI:10.4103/jomfp.JOMFP_199_19  
Background: The clinical significance of plasma lipoprotein levels in the diagnosis and prognosis of certain diseases is known fact. Some studies have reported different and contradictory levels of blood lipoproteins in cancer patients. Therefore, we decided to compare lipid profiles in patients with basal cell carcinoma (BCC) and healthy individuals. Materials and Methods: In this case-control study, lipid biomarkers in blood plasma of 64 patients with BCC compared with biomarkers in 64 healthy subjects. According to including criteria's both group selected. 5 cc blood samples taken after 8–12 h of fasting. Ultimately, the diagnosis of biopsy samples confirmed by the dermatopathologist. The information data entered into the PASS II software and then characterized by a descriptive and analytical statistics of the lipid profile. The role of the related factors was assessed by two sample t-test power analysis. Results: In this research, mean age of patient group and the healthy one was 67.13 ± 11.33 and 64.31 ± 6.98, respectively. The average amount of triglyceride, cholesterol, high density lipoprotein (HDL) and low density lipoprotein in the BCC patients were 147.97 ± 87.11 mg/dl, 188.25 ± 38.90 mg/dl, 61.98 ± 18.61 mg/dl and 95.98 ± 31.69 mg/dl, respectively, whereas these amounts in the control group were 137.34 ± 61.41 mg/dl, 173.22 ± 38.79 mg/dl, 42.34 ± 7.83 mg/dl and 106.44 ± 35.17 mg/dl, respectively. There were statistically significant differences between cholesterol and HDL in patients with BCC and healthy controls, respectively (P = 0.030) (P < 0.001). Conclusion: It seems that changes in lipid profile can help as a diagnostic marker for detecting cancer like BCC. Although this change could be different in lipid markers and also among different types of cancer.
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Qualitative expression of hypoxia-inducible factor-1α in malignant transformation of oral submucous fibrosis: An immunohistochemical study p. 106
Treville Pereira, Ridima Surve, Subraj Shetty, Swati Gotmare
DOI:10.4103/jomfp.JOMFP_234_19  
Background: Oral submucous fibrosis (OSF) is a precancerous condition predominantly seen in people of Asian descent. About 7%–12% of OSF patients develop oral squamous cell carcinoma. Morphological features of OSF, especially fibrosis, suggest a possibility of hypoxic environment in diseased tissues. Neovascularization and increased glycolysis, represent adaptations to a hypoxic microenvironment that are correlated with tumor invasion and metastasis. The adaptation of cells to hypoxia appears to be mediated through hypoxia-inducible factor-1α (HIF-1α). HIF-1α is said to be associated with malignant transformation of epithelium in other sites. Aim: The aim of this study was to investigate the relationship between the expression of HIF-1α in OSMF and its role in malignant transformation. Materials and Methods: A retrospective study which included 20 histopathologically diagnosed cases of OSF was conducted. A qualitative evaluation of HIF-1α was performed. Statistical analysis was carried out using the IBM Statistical Package for Social Sciences 20.0 version (IBM Corporation, Armonk, NY, USA). Results: Results showed an increased expression of HIF-1α in OSF. Conclusion: HIF-1α appears to play a role in malignant transformation of OSF.
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Evaluation for noncompliance of recall in patients reporting to oral pathology department: Longitudinal study of 5 years p. 113
Anuradha Sinha, Shivani Bansal, Pankaj M Shirsat, Pooja Prasad, Rajiv S Desai
DOI:10.4103/jomfp.JOMFP_170_19  
Background: Regardless of the form of treatment, long-term follow-up of the patient is an absolute necessity. This study aimed to follow surgically treated patients visiting our department of oral pathology over 5 years (January 2011–December 2015) to monitor recurrence of the condition, patient compliance and reasons for noncompliance. Materials and Methods: We conducted half-yearly recall for patients visiting our department from January 2011 to December 2015. Patients were recalled through the use of letters, telephonic reminders and e-mails. Results: The study included 171 recalled patients of whom, 42 (24.56%) reported for follow-up, while the remaining 129 (75.43%) did not report for follow-up. Of the 42 reporting patients, 26 (61.90%) reported once, 10 (23.81%) twice and 6 (14.28%) three times. Recurrence of the condition was reported in two cases. The reasons for noncompliance included: financial constraints (22.48%), casual attitude (37.20%), reported to nearby hospitals (5.42%) and lack of time (11.62%). Some patients could not be sent reminder letters due to incomplete address (7.75%), the wrong pin code (6.97%), change of address (4.65%), locked house (3.10%) and death of the patient (0.77%). Conclusion: This study highlights patient recall appointment noncompliance, ascribing various reasons to the patient's attrition rate for recall appointments. Probable solutions for increasing the compliance for recall need to be addressed, and further research should be conducted to evaluate these solutions.
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Oral microbial profile in oral cancer patients before and after radiation therapy in a cancer care center –A prospective study p. 117
K Anjali, AB Arun, TS Bastian, R Parthiban, M Selvamani, H Adarsh
DOI:10.4103/jomfp.JOMFP_213_19  
Background: Head and neck cancer is the sixth most common cancer reported worldwide. In many cases, the level of aggressiveness of therapy adopted in cancer patients may cause the alteration in oral microbiota; the emergence of potential pathogens may cause opportunistic infections in already immune-compromised individuals leading to increases in morbidity and mortality. Hence, this study was conducted to assess the oral microbial profile in oral cancer patients before and after radiotherapy. Materials and Methods: A total of 145 oral swabs were collected before radiotherapy (n = 96), 3 months postradiotherapy (n = 25), 6 months postradiotherapy (n = 12) and controls (n = 12). The samples were inoculated into brain–heart infusion broth and later in different media for bacterial isolation. The isolates were subjected to phenotypic characterization by automatic identification system. Results: Among the 96 samples studied from the preradiotherapy patient samples, Streptococcus species (n = 28) were the predominant isolate, followed by Staphylococcus species (n = 16), Enterobacter species (n = 6) and Enterococcus species (n = 6). Of the 25 samples studied 3 months after radiotherapy, Klebsiella pneumoniae (n = 4) was isolated and 12 samples studied after 6 months of radiotherapy Candida species (n = 4) and Pediococcus species (n = 3) were isolated. Among the control group (n = 12) screened, Streptococcus acidominimus (n = 3) is the predominant bacteria isolated. Conclusion: High prevalence of Streptococcus sp. was found in patients of oral cancer before radiotherapy, while Candida albicans and Klebsiella species and Pediococcus species are the significant pathogens isolated in postradiotherapy cancer patients.
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Immunohistochemical detection of Tyrosine Kinase receptor (TrK) in follicular and plexiform ameloblastoma – A novel study p. 125
George Babu Jisha, Vadivel Ilayaraja, Thuckanickenpalayam Ragunathan Yoithapprabhunath, Nalliappan Ganapathy, Janardhanam Dineshshankar, Ramadas Madhavan Nirmal
DOI:10.4103/jomfp.JOMFP_220_19  
Objectives: The objective is to analyze the immunohistochemical expression pattern of tyrosine kinase receptor (TrK) in ameloblastoma and to compare the immunohistochemical expression pattern of TrK among the histological types of ameloblastoma, follicular and plexiform patterns. Materials and Methods: Forty ameloblastomas (20 follicular and 20 plexiform) were immunostained with anti-human TrK mouse IgG monoclonal antibody, and the pattern of staining is statistically analyzed. Results: Total 20 (4 follicular and 16 plexiform) out of 40 ameloblastomas showed immunoreactivity to TrK. Only the peripheral preameloblast like tall columnar cells showed reactivity, whereas the stellate reticulum like cells is immunonegative. The staining pattern was membranous in the immunoreactive cells. The Chi-square value for the immunoexpression between follicular and plexiform ameloblastoma was statistically significant with a P < 0.005. The results were studied with the downstream pathways from the literature, and a possible mechanism has been proposed. Conclusion: The expression pattern of TrK is found to be more in plexiform ameloblastoma than follicular ameloblastoma.
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Quantitative analysis of tumor-associated tissue eosinophils and tumor-associated blood eosinophils in oral squamous cell carcinoma p. 131
Safia Siddiqui, Rohit Jaiswal, Ghulam Sarwar Hashmi
DOI:10.4103/jomfp.JOMFP_70_18  
Background: Stromal response to cancer is usually characterized by intense lymphoplasmacytic infiltrate. However, recently, the attention has shifted to tumor-associated tissue eosinophils (TATE). Tumor-associated blood eosinophils (TABE) are rare in solid cancers; however, carcinoma of the head and neck shows its prevalence. Aim: The aim of the study was to investigate the prevalence and relationship of tissue and blood eosinophils in various grades of oral cancer. The purpose of the article is to emphasize the possible clinical and biological significance of eosinophils in patients of oral squamous cell carcinoma (OSCC) so that appropriate therapeutic strategies can be devised accordingly. Study Design: Thirty histologically confirmed cases of oral squamous cell carcinoma were divided into well, moderate and poorly differentiated carcinoma. Eosinophilic infiltration in the tissue was graded as low, moderate and massive TATE. The number of eosinophils per 100 WBCs was taken as the differential eosinophil count. Blood eosinophilia (BE) >6% was considered to be TABE. Materials and Methods: Hematoxylin and eosin-stained tissue sections at 5 μ were evaluated. Prolonged staining in dilute 0.05% aqueous eosin demonstrated eosinophils selectively. Blood smears were stained by Leishman stain. Statistical Analysis: Student's t-test, Chi-square test, ANOVA, Newman–Keuls Multiple Comparison Test and Karl Pearson correlation coefficient® method were used. Results: The mean TATE value was highest in poorly differentiated carcinoma. TABE was seen only in a few cases and was associated mostly with poorly differentiated OSCC. Conclusion: There was a statistically significant correlation between TATE and histological grades of OSCC. Eosinophilia of the peripheral blood is an adverse sign in patients with carcinoma.
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FORENSIC CORNER Top

Malocclusion: An adjunctive aid in individual identification p. 138
N Goutham, RJ Shishira, AM Shailaja, HK Vedavathi, KS Sowmya, S Neeharika
DOI:10.4103/jomfp.JOMFP_340_19  
Introduction: Cheiloscopy and dactyloscopy have long been the most commonly used methods for forensic investigations. Orthodontists perform numerous diagnostic procedures, which include radiographs, photographs and impressions of the teeth and palate for the evaluation of malocclusion. The data recorded by them provide immense information about a patient. Fingerprints, lip prints and palatal rugae have been considered the most stable, reliable, imitable, convenient, cost-effective and time-friendly modes of investigating crime and other purposes. Aim: The main aim of this study is to correlate cheiloscopy, fingerprint pattern and palatoscopy to skeletal Class I sagittal jaw relationship and to include cheiloscopy, fingerprint pattern assessment and palatoscopy in routine orthodontic investigation procedures as an adjunct procedure in individual identification. Methods: Fingerprints, lip prints, palatal rugae pattern and lateral cephalograms of 37 skeletal Class I patients were obtained using standardized procedures. Results: In Class I skeletal malocclusion, the maximum number of patients exhibited ulnar loop dermal pattern, Type 1 and Type 2 lip patterns and a wavy rugae pattern (Kapali et al. primary classification). Conclusion: Orthodontists prepare various antemortem records for diagnostic purposes, i.e., photographs, the impression of the teeth and palate, lateral cephalograms, orthopantomograms and hand-wrist radiographs. If orthodontists recorded additional data of finger and lip prints, the archives of an orthodontist would be of tremendous profit to forensic sciences in individual identification.
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REVIEW ARTICLE Top

Expression of metallothionein in oral squamous cell carcinoma: A systematic review p. 143
Palati Sinduja, Pratibha Ramani, S Gheena, Abilasha Ramasubramanian
DOI:10.4103/jomfp.JOMFP_137_19  
Free radicals are chemical particles containing one or more unpaired electrons, which may be part of the molecule making them highly reactive species. The free radicals are also known to play a dual role in biological systems, as they can be either beneficial or harmful. It has been proven that there are numerous mechanisms participating in the protection of a cell against free radicals. In this systematic review, we have reviewed metallothioneins (MTs) which are a small, cysteinerich and heavy metalbinding protein, that participates in an array of protective stress responses. The aim of this study was to systematically evaluate the role of MT in oral squamous cell carcinoma (OSCC). In this systematic review, we have found that in 9 studies involving 1340 cases and 542 controls concluded that MT was found to be present in the cytoplasm as well as the nucleus of the tumor tissue in 66.6% of the articles using immunohistochemistry and 11.1% of the articles reported the mosaic pattern of expression of MT in OSCC.
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KNOW THE FIELD Top

Pink bodies with halo p. 148
Sushruth Nayak, Asha Karadwal, Amit Aggarwal, Prachi Nayak
DOI:10.4103/jomfp.JOMFP_102_20  
The presence of eosinophilic Toto bodies in oral lesions could be found in a variety of situations and sometime may present a challenge to the pathologist. We present three case reports where the oral biopsy was taken from the gingival region of a 30-year-old female, a 32-year-old male patient and another from the buccal mucosa of a 67-year-old male patient. Histopathologically, the three cases were finally diagnosed as pyogenic granuloma and moderately differentiated squamous cell carcinoma with the presence of clusters of Toto bodies in the upper spinous layer of stratified squamous epithelium.
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SHORT COMMUNICATION Top

Role of artificial intelligence in diagnostic oral pathology-A modern approach p. 152
Ayinampudi Bhargavi Krishna, Azra Tanveer, Pancha Venkat Bhagirath, Ashalata Gannepalli
DOI:10.4103/jomfp.JOMFP_215_19  
Over the decades, new equipment was emerged in medical field, and we have witnessed the importance of medical imaging such as computed tomography, magnetic resonance imaging, ultrasound, mammography and X-ray and their contribution in successful diagnosis and treatment of various diseases. Now, we are in era of artificial intelligence (AI), where machines were modeled after human brain's ability to take inputs and produce outputs from given data. AI has a wide range of uses and applications in health services industry. Factors such as increase in workload, complexity of work and potential fatigue of doctors may compromise diagnostic ability and outcome. AI components in imaging machines would reduce this workload and drive greater efficiency. They also have access to a greater wealth of data than human counterparts and can detect cancer with more accuracy than humans. This study presented an overview of AI, its recent advances in pathology and future prospects.
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CASE REPORTS Top

Odontogenic sarcoma: First report after new who nomenclature with systematic review p. 157
Pratibha Ramani, Reshma Poothakulath Krishnan, Monika Karunagaran, MR Muthusekhar
DOI:10.4103/jomfp.JOMFP_14_20  
Ameloblastic fibrosarcoma (AFS) now designated as odontogenic sarcoma is a malignant odontogenic tumor characteristically composed of a benign epithelium and a malignant mesenchymal component. It can arise de novo without any preexisting lesion or it can result from the malignant transformation of ameloblastic fibroma (AF). Hereby, we report an extremely rare case of odontogenic sarcoma which was transformed from AF over a period of about 2 years. This is the first case to be reported after it has been reclassified as odontogenic sarcoma. A systematic review was also done to evaluate the studies that reported AFS arising de novo and AFS arising from AF. The objective of this study is to systematically review the studies that reported AFS arising de novo and AFS arising from AF. Articles that reported AFS arising de novo and AFS arising from AF were collected from PubMed, Medline, Embase, Cochrane, Google search and manual search. The results of the systematic review showed that six studies (46.1%) reported AFS arised de novo with no previous history of AF. Seven studies (53.84%) reported that amelobastic fibrosarcoma arised from AF. A rare case of odontogenic sarcoma transformed from AF is reported here. This is the first case report to be published on odontogenic sarcoma after the World Health Organization reclassification. AF once diagnosed should be treated immediately without any delay to avoid the chances of its malignant transformation into odontogenic sarcoma.
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Schwannoma of head-and-neck region: A clinical chameleon – Report of two cases occurring at rare sites with unusual clinical manifestations p. 164
Mayank Kumar, Meenakshi Rao, Poonam Elhence, Darwin Kaushal, Taruna Yadav
DOI:10.4103/jomfp.JOMFP_13_20  
Schwannomas are rare benign encapsulated neoplasms that usually do not arise in the nasal and oral cavities. Only about 25% of the schwannomas are located in the head-and-neck region. The preoperative diagnosis of schwannomas in the head-and-neck region is difficult, as they present with varied clinical manifestations and have nonspecific radiological findings, which can lead to a diagnostic dilemma. We report two cases of schwannomas, one in the nasal cavity and the other in the tongue, that were considered to be an infective lesion and malignant lesion respectively on clinical evaluation. The biopsy and subsequent histopathological examination led to the diagnosis of schwannoma. It is important to be aware of the unusual clinical manifestations of schwannomas and keep it in the differential diagnoses, even at relatively uncommon sites such as the nasal and oral cavities. Lesions that are suspected to be infectious lesions or malignant lesions on clinical and/or radiological evaluation can also be schwannomas. Unnecessary diagnostic evaluations and radical therapeutic measures can be avoided with early diagnosis.
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Bisphosphonate-related spindle cell carcinoma and osteonecrosis p. 168
Nazanin Mahdavi, Kheirandish Yasaman, A Garajei, Naeimeh Nikfarjam Nouri
DOI:10.4103/jomfp.JOMFP_346_19  
A 48-year-old female with a complaint of persistent pain referred to the Imam Khomeini (Tehran, Iran) in 2018. Based on the radiographic findings, radiolucent lesion found in the right mandible and she had alendronate administration approximately for 10 years. Since the past 6 months, the lesion detected in the right mandible. According to the computed tomography scan, a large lytic destructive lesion with a soft-tissue component was seen at the right mandibular ramus. Microscopic examinations revealed the proliferation of anaplastic spindle-shaped cells arranged in interlacing bundles and whorled patterns. Nuclear polymorphism, scattered cells with hyperchromatic nuclei and increased mitotic activity were notable. Immunohistochemistry findings for tissue section composed of spindle cell proliferation revealed Ki67 (20% positive in hotspots), scattered positive right side incisional biopsy was done. The observation revealed hyperplastic and disorganized squamous epithelial lesion, suggestive of spindle squamous cell carcinoma and osteonecrosis in this patient.
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Strawberry gingivitis – First sign of Wegener's granulomatosis p. 172
Chandulal D Dhalkari, Sayali Chandrakant Patil, Maya S Indurkar
DOI:10.4103/jomfp.JOMFP_3_19  
Wegener's Granulomatosis (WG) is an immunologically mediated rare multisystem disease characterized by necrotizing granulomatous inflammation affecting the upper and lower respiratory tracts, disseminated vasculitis and glomerulonephritis. WG oral lesions are reported to occur in 6%–13% of patients; they were an initial presenting feature in only 2% of cases. A case of strawberry gingivitis as the first sign of WG presented with erythematous and painful localized gingival enlargement affecting the maxillary anterior region of jaw in a 17-year-old boy is reported here. Correlation of histopathology with routine hematoxylin and eosin and special stains such as Grocott-Gomori's methenamine-silver nitrate and periodic acid–Schiff, peripheral blood smear, chest radiographs, Mantoux test and clinical presentation were established in diagnosing this rare entity. By the above-mentioned procedures, we arrived at the diagnosis of WG. The aim of reporting this case was to emphasize that, the dental surgeon often being the first person to examine the oral cavity, should be familiar with the typical appearance of gingiva as “strawberry gingivitis,” its clinical course, diagnostic parameters and adequate management of WG.
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Ten-cusped primary molar tooth: A rare entity with literature review p. 176
EJ Akhil Jose, Plato Palathingal, Mebin George Mathew, Md Muzammil Khan
DOI:10.4103/jomfp.JOMFP_131_19  
Teeth arise by complex and progressive interactions between the ectoderm, oral epithelium and underlying mesenchyme. However, it may show variations and changes in morphological structure. A 6-year-old female child patient came for the treatment of her carious tooth. Intraoral examination revealed supernumerary cusp on occlusal surface of the maxillary right second primary molar. Incidence of supernumerary cusp is a rare condition formed by abnormal proliferation and folding of inner enamel epithelium during morphodifferentiation stage of the tooth development. Conservative cavity preparation and restorative treatment protocol were carried out to treat this case. Early diagnosis, management and timely recall of these rare anomalies will help to avoid potential complications, resulting from faster carious progression in these teeth due to the presence of many fissures and early pulpal extensions into the cuspal area.
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Compact osteoma of the maxilla: A rare case report p. 179
Umesh Yadalam, Partha Pratim Roy, Aditi Bose, T Smitha
DOI:10.4103/jomfp.JOMFP_223_19  
Osteomas of the facial bones are a rare entity and very few cases have been reported in the literature.Osteoma is a benign osteogenic lesion with a very slow growth, characterized by proliferation of either cancellous or compact bone. This paper describes a case of a 27 year old male seeking treatment for a slowly enlarging lesion in the maxillary right anterior region. Surgical excision of the lesion was done and the histopathologic evaluation revealed dense compact bone with osteocytes in the lacunae suggestive of compact osteoma. One year followup showed no evidence of recurrence. To best of our knowledge this is the twelfth case of maxillary osteoma reported in English language literature.
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ONLINE ONLY ARTICLES - ORIGINAL ARTICLES Top

Assessment of lactate dehydrogenase enzyme levels in saliva and serum of oral submucous fibrosis and leukoplakia patients p. 183
Abikshyeet Panda, Shyam Sundar Behura, Lipsa Bhuyan, Kailash Chandra Dash, Vijay Kumar, Shirsha Mukherjee
DOI:10.4103/jomfp.JOMFP_214_19  
Background: Pathology involving the oral epithelium may alter the level of salivary concentration of LDH. Thus its estimation can be used as a non invasive screening tool for the early detection of OPMDs and also to predict its malignant transformation especially in high risk population. Aims and Objectives: To evaluate the salivary and serum levels of lactate dehydrogenase (LDH) in patients having of oral submucous fibrosis (OSMF) and leukoplakia and compare it with healthy individuals. Materials and Methods: A total of 120 subjects were selected and divided into three groups comprising clinically diagnosed cases of OSMF and leukoplakia and healthy subjects as controls. Unstimulated whole saliva and blood samples were collected under aseptic conditions for biochemical estimation of LDH by Semiautomatic Analyzer using LDH kit utilizing enzymatic UV-Kinetic method. The values obtained were statistically analyzed using the SPSS software version 20.0. P-value < 0.05 was considered significant. Results: The mean salivary LDH level in Group I (OSMF) was 631.67 + 7.67, Group II (Leukoplakia) was 492.28 + 16.17 and Group III (Healthy Control) was 140.62 + 8.87. There was a statistically significant difference between the Serum and salivary LDH levels among the various groups of study population. A positive correlation between salivary LDH and serum LDH level was seen and the regression equation for OSMF and leukoplakia was computed. Conclusion: A significant difference was found between mean salivary LDH Levels and serum LDH levels in patients with leukoplakia, OSMF and health controls. A positive correlation was also established between salivary and serum LDH levels in patients with OSMF and leukoplakia patients making saliva a potent non invasive tool for early prediction and detection of PMOD and its malignant transformation.
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Odontogenic keratocyst: Analysis of recurrence by AgNOR, p53 and MDM2 profiling p. 184
Chetana Chandrashekar, Pratik Patel, Aatish Thennavan, Raghu Radhakrishnan
DOI:10.4103/jomfp.JOMFP_129_19  
Background: Odontogenic keratocyst (OKC) is a clinical entity with characteristic microscopic features, high growth potential and propensity to recur. Aggressive behavior and higher tendency for recurrence have been attributed to greater proliferative activity of epithelial lining. The incidence of recurrence in various reported series ranges from 2.5% to 62%. Objectives: The objective of the study was to investigate the clinical behavior of OKC by evaluating p53, MDM2 expression, AgNOR staining and to ascertain if the expression of these markers correlate with the clinical outcome and tendency for recurrence. Materials and Methods: All recurrent and nonrecurrent OKCs from the archives were included, and sections were subjected to AgNOR staining, p53 and MDM2 immunohistochemical staining. Results and Conclusion: There was a significant difference in the staining pattern of MDM2 and AgNOR in the recurrent group as compared to the nonrecurrent group. The higher expression of these markers in recurrent lesions may be important in order to consider additional surgical interventions to improve prognosis.
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Immunoexpression of p53 in histologically negative surgical margins adjacent to oral squamous cell carcinoma:A preliminary study p. 184
Mamata S Kamat, Bhagwan Das Rai, Rudrayya S Puranik, Uma V Datar
DOI:10.4103/jomfp.JOMFP_288_19  
The prognostic significance of genetic changes occurring in the histologically negative surgical margins (HNMs) has been focus of various studies recently. Since p53 is the most frequently observed genetic alteration found in oral squamous cell carcinoma (OSCC), we hypothesized that a similar variation might be evident in HNMs as well. Literature is scarce regarding comparison of expression of p53 in the tumor tissue and its adjacent HNMs; hence, the aim of the present study was to study p53 immunoexpression in OSCC and its HNMs. We included 12 paraffin-embedded tissue blocks of OSCC having tumor tissue and HNMs. The samples were subjected to immunohistochemical staining using primary mouse monoclonal antibody against p53, and the stained slides were evaluated for staining intensity and percentage of expression. Descriptive analysis and Chi-square test were applied. The expression of p53 was observed in 66% of HNMs and 91.6% of tumor tissue. The three cases which showed local recurrence demonstrated the expression of p53 in HNM. Hence, molecular analysis of p53 in surgical margins might potentially predict local recurrence of OSCC.
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Odontogenic tumors: A review of 93 cases in the Vidharba region of Maharashtra p. 185
Preethi Narendra Sharma, Rajul Kamalkishore Ranka, Minal Shashi Chaudhary, Madhuri Nitin Gaw, Alka Harish Hande, Prajakta Fande Zade
DOI:10.4103/jomfp.JOMFP_145_19  
Background: Tumors of the odontogenic origin (OTs) are rare tumors accounting for 1% of all the jaw tumors in the oral cavity. The behavior of these tumors ranges from hamartomatous proliferation to malignant neoplasm. Aim: The aim of this study was to determine the epidemiological data, clinical and histopathological picture with variants of the OTs diagnosed at our institute in the Vidarbha region. Settings and Design: A retrospective study was carried out with the permission from the institutional authorities. The archival records of the Department of Oral Pathology and Microbiology were reviewed. Materials and Methods: A total of 93 cases of OTs were reviewed retrospectively from the archival records of the Department of Oral Pathology and Microbiology from January 2008 to December 2018. Statistical analysis was carried out and the determination of the age, gender, jaw, site, diagnosis, variants and year-wise distribution of odontogenic lesions was taken out using the SPSS software. Results: Ninety-three cases of OTs were identified. The most common OT identified was ameloblastoma (n = 37/39.7%) followed by keratocystic OT (n = 8/8.6%), adenomatoid OT (n = 7/7.5%) and odontome (O) (n = 6/6.4%). The tumors were diagnosed in a wide age range from 1st to 3rd decennium of life. The mandibular posterior region was the most commonly affected anatomical site with the maxilla and mandible ratio of 1:6. Conclusion: OTs were found to be rare in the sample studied. The findings of the study were in concordance to those of Asian and African series. Variations were shown from the series of American reports, and further investigations are needed for this disparity.
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Galectin-1 expression in oral squamous cell carcinoma: An immunohistochemical study p. 186
Vaibhavi Salunkhe, Aarti Mahajan, Nilima Prakash, GL Pradeep, Rekha Patil, Sajda Khan Gajdhar
DOI:10.4103/jomfp.JOMFP_240_19  
Context: Oral squamous cell carcinoma (OSCC) of the head and neck are a heterogeneous group of neoplasms with an increasing rate of mortality and morbidity. OSCCs are characterized by a high degree of local invasiveness and metastasis to cervical lymph nodes but show a lower rate of distant metastasis. Galectin-1 (Gal-1), a β-galactoside-binding lectin, is known to regulate tumor cell growth, angiogenesis, mediate cell-cell or cell-extracellular matrix adhesion and promote cancer cell migration. Aims: This study aims to evaluate the Gal-1 expression in different clinical stages and histological grades of OSCC. Settings and Design: Forty histopathologically diagnosed cases of OSCC, including 16 cases of well-differentiated, 18 moderately differentiated and 6 poorly differentiated carcinomas, were included in the study group. Materials and Methods: The samples were subjected to staining using primary mouse monoclonal antibodies against Gal-1 and visualized using polymer-HRP detection system. Statistical Analysis: The nonparametric Mann–Whitney U-test and Kruskal–Wallis ANOVA test were used for the statistical analysis. Results: Gal-1 expression was higher in advanced stages of OSCC, and the results were statistically significant. Immunoexpression of Gal-1 increased with advancing histological grades of OSCC with statistically significant results. Conclusion: Gal-1 plays an important role in invasion, metastasis and as a prognostic marker.
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Microwave-assisted tissue processing, fixation and staining in tissues of different thicknesses: A comparative study p. 186
Mahesh Rao, Shaila M Pai, Sanjeev Balappa Khanagar, Salman Siddeeqh, Darshan Divakar Devang, Sachin Naik
DOI:10.4103/jomfp.JOMFP_290_19  
Aim and Objectives: The study aimed at assessment of microwave assisted tissue fixation, processing and staining and to determine if it can replace standard formalin fixed paraffin embedded processing in tissues of different thickness. Materials and Methods: Specimens from buccal mucosa and gingiva was used in the study and were divided into three different thickness and was fixed, processed and stained according to conventional method and with a use of kitchen microwave oven respectively. The present study is the first of its kind where oral tissues was fixed, processed and stained with a kitchen microwave in three different thickness. The results obtained was statistically analyzed using IBM SPSS Statistics version 21.0 software. Results: The new technique of fixation, tissue processing and staining using a microwave employed in the present study represented a major change from conventional method and achieved significant reduction in time taken. Conclusion: The ease of application and speed of this technique significantly reduced turnaround time in diagnostic labs.
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Salivary glucose levels in diabetes mellitus patients: A case–control study p. 187
Vineet Gupta, Amanpreet Kaur
DOI:10.4103/jomfp.JOMFP_15_20  
Aim: The aim of the present study was undertaken to correlate the glucose levels in saliva and blood of diabetic and healthy nondiabetic individuals and to determine the efficacy of saliva as a diagnostic tool. Setting and Design: This was a case–control study. Materials and Methods: Forty-five patients previously diagnosed with diabetes mellitus and 45 healthy controls were included in the study. The patients and controls were asked to come to the clinic in the morning, after 8–10 h fasting. At that time, 5 ml of venous blood and unstimulated saliva was collected from both the groups, and 2 h after meal, again, venous blood and unstimulated saliva were collected. The saliva and sera from blood samples were subjected to glucose estimation. Saliva was collected in sterilized vials, and blood was collected in test tubes. Glucose estimation was done by oxidase–peroxidase method. Statistical Analysis: Pearson's correlation coefficient, Student's t-test and paired t-test were used for statistical analysis. Results: Correlation coefficient values show that there is a significant positive correlation between fasting blood and fasting salivary glucose levels and postprandial blood and postprandial salivary glucose levels. Conclusion: Salivary glucose level estimation can be used as a potential indicator in screening, diagnosis and monitoring of diabetes mellitus. Furthermore, it is an easy and noninvasive method.
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Punica granatum as a salutiferous superfruit in the treatment of oral candidiasis – An in-vitro study p. 188
KS Prem Kumar, S Shiny Samlin, B Siva, R Sudharshan, A Vignesswary, K Divya
DOI:10.4103/jomfp.JOMFP_268_19  
Context: The rise in the incidence of clinical resistance to antifungal therapy and failure to respond in recent years underscores the need for a time-honored approach to treat the disease using natural drugs instead of synthetic drugs, which have lesser adverse effects and good patient response. Punica granatum (pomegranate) is a fruit that has admirable medicinal value. Aims: The study aimed to evaluate the in vitro antifungal efficacy of P. granatum peel extract against oral Candida compared with clotrimazole. Settings and Design: The study design involves an in-vitro study. Subjects and Methods: Saliva from candidiasis patients was inoculated and cultured on 60 separate Sabouraud dextrose agar plates and incubated at 37°C for 48 h from which Candida species were collected. Agar well-diffusion method was followed. Different concentrations of P. granatum peel extracts, ethanol solvent (control) and standard clotrimazole were added into the wells and allowed to diffuse at room temperature for 2 h. The plates were incubated at 37°C for 48 h. The antifungal potential of test compounds was determined based on the mean diameter of the zone of inhibition around the well in millimeters. Statistical Analysis Used: Statistical analysis was performed using IBM software SPSS version 20 at one-way ANOVA. Results: Antifungal efficacies of P. granatum peel extract and clotrimazole were statistically significant, and there was an increase in inhibitory efficacy with an increase in concentration. Minimum inhibitory concentration of P. granatum peel extract approximated with that of clotrimazole. Conclusions: The results of this study indicate that P. granatum peel extract can be used as an effective natural substitute for synthetic antifungal agents.
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Malignant potentiality assessment of oral submucous fibrosis through semi-quantitative approach p. 188
Mousumi Pal, Debaleena Nawn, Pooja Lahiri, Debnath Das, Ranjan Rashmi Paul, Debjani Chakraborty
DOI:10.4103/jomfp.JOMFP_297_19  
Background: In the context of early diagnosis and prevention of oral cancer, precise assessment of malignant potentiality of the oral potentially malignant disorders, particularly oral submucous fibrosis (OSF) is crucial. Till date, the assessment of malignant potentiality suffers from predictive ambiguity due to the lack of precision in the gold standard techniques. This can be addressed by integrating heuristic domain knowledge with quantitative analysis. Aim: The aim of this study is to propose an index for enhancing accuracy in malignant potentiality evaluation. Materials and Methods: The present study analyzes important histomorphometric attributes (epithelial thickness, basal cell nuclear size, nuclear-to-cytoplasmic area ratio of basal cells, chromaticity of basal cell nucleus, thickness of basement membrane, ratio of vasculature in juxta-epithelial connective tissue [i.e., area covered by blood vessels/total area], collagen density in the lamina propria) of oral mucosa in dysplastic and nondysplastic OSF in association with relevant oncopathological appreciations (weightage of different features as suggested by oral pathologists) toward proposing a “Malignant Potentiality Index” (MPI). Results: Analysis of variance and notch box plot analysis depict statistically significant differences (P < 0.0001) in the histopathological features among different study groups (normal oral mucosa, OSF without dysplasia, OSF with dysplasia). Histopathological observation of one OSF patient with calculated MPI is shown. Conclusion: This newly proposed diagnostic cum prognostic decision-making parameter, the “MPI” may bring a value addition to the conventional diagnostic gold standard.
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Epithelial–mesenchymal transition in oral squamous cell carcinoma: An insight into molecular mechanisms and clinical implications p. 189
P Jayanthi, BR Varun, J Selvaraj
DOI:10.4103/jomfp.JOMFP_334_19  
Epithelial–mesenchymal transition (EMT) is an important event in embryonic development, fibrosis and cancer invasion. During cancer progression, the activation of EMT permits cancer cells to acquire migratory, invasive and stem-like properties. Despite recent advances in treatment, there is no improvement in the 5-year overall survival rate of oral squamous cell carcinoma (OSCC). Local recurrence and lymph node metastasis are considered to be mainly responsible for the low survival rate in OSCC. EMT plays a major role in local recurrence and lymph node metastasis of oral cancer. This review article addresses the clinical implications of EMT in OSCC and explains the molecular mechanisms of EMT, highlighting the cadherin switching and signaling pathways involved.
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Cancer stem cells: A comprehensive review on identification and therapeutic implications p. 190
BR Varun, P Jayanthi, Pratibha Ramani
DOI:10.4103/jomfp.JOMFP_336_19  
Cancer stem cells (CSCs) are distinct subpopulations of tumor cells that possess the ability for perpetual self-renewal and proliferation. They produce downstream progenitor cells and cancer cells that drive tumor growth. Studies of many cancer types including oral squamous cell carcinoma (OSCC) have identified CSCs using specific markers, but it is still unclear as to where in the stem cell hierarchy these markers fall. This is compounded further by the presence of multiple CSC subtypes within OSCC, making investigation reliant on the use of multiple markers. This review paper focuses on the current knowledge in CSC markers including OCT4, SOX2, NANOG, aldehyde dehydrogenase 1, CD44, CD24, CD133 and Musashi-1, highlighting their use and validity in OSCC CSC research.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007