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    Table of Contents - Current issue
September-December 2017
Volume 21 | Issue 3
Page Nos. 325-464

Online since Friday, December 15, 2017

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From the Editor's Desk Highly accessed article p. 325
T Smitha
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Oral potentially malignant disorders: Revisited Highly accessed article p. 326
Jay Gopal Ray
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Dr. H. M. Dholakia p. 328
Rajiv S Desai
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Oral submucous fibrosis: An update Highly accessed article p. 330
Jay Gopal Ray, T Smitha
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Natural killer cell: An immuno-oncology novel target for cancer therapy? p. 332
HR Shwetha, T Smitha
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Correlation of salivary glucose level with blood glucose level in diabetes mellitus p. 334
Shreya Gupta, Meghanand T Nayak, JD Sunitha, Geetanshu Dawar, Nidhi Sinha, Neelakshi Singh Rallan
Background: Saliva is a unique fluid, which is important for normal functioning of the oral cavity. Diabetes mellitus (DM) is a disease of absolute or relative insulin deficiency characterized by insufficient secretion of insulin by pancreatic beta-cells. The diagnosis of diabetes through blood is difficult in children, older adults, debilitated and chronically ill patients, so diagnosis by analysis of saliva can be potentially valuable as collection of saliva is noninvasive, easier and technically insensitive, unlike blood. The aim of the study was to correlate blood glucose level (BGL) and salivary glucose level (SGL) in DM patients. Methodology: A cross-sectional study was conducted in 120 patients, who were categorized as 40 controlled diabetics, 40 uncontrolled diabetics and 40 healthy, age- and sex-matched individuals constituted the controls. The blood and unstimulated saliva samples were collected from the patients at the different intervals for fasting, random and postprandial levels. These samples were then subjected for analysis of glucose in blood and saliva using glucose oxidase/peroxidase reagent in HITACHI 902(R) Automatic analyzer, and the results were recorded. Results: The mean SGLs were higher in uncontrolled and controlled diabetic groups than in nondiabetic group. A highly statistically significant correlation was found between fasting saliva glucose and fasting blood glucose in all the groups. Conclusion: With increase in BGL, increase in SGL was observed in patients with diabetes suggesting that SGL can be used for monitoring glycemic level in DM.
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Curcuma longa extract – Haldi: A safe, eco-friendly natural cytoplasmic stain p. 340
Hema Suryawanshi, Rupali Naik, Pramod Kumar, Rolly Gupta
Background: Eosin is most widely used synthetic dye belonging to the xanthene group. These dyes are efficient but are hazardous to human and animal health. With the increasing awareness of a green earth, it is advisable to use more of eco-friendly and biodegradable material which can be effectively achieved by the use of natural dyes obtained from plants and other natural sources. Turmeric, available as Curcuma longa (domestic), has long been in use in the subcontinent as a spice and flavoring agent in most food preparations. Its health benefit as a natural antibiotic and anti-inflammatory has been successfully established by several researchers. The intense yellow color imparted by turmeric inspired us to explore its efficacy as a potential alternative for eosin in routine histopathological procedures. Aim: The aim of this was to explore the efficacy of turmeric extract as a stand-alone counterstain for hematoxylin and its comparative assessment with routine H and E staining. Materials and Methods: The rhizomes of C. longa were cut into small pieces, dried and milled. This powder was dissolved into alcohol and centrifuged using a centrifugal machine. The supernatant was then collected with the help of micropipette. This supernatant was used as a counterstain for hematoxylin. Results: The data were analyzed using Mann–Whitney U test with Statistical Package for the Social Sciences version 15.0 (SPSS Inc.,). The P value obtained was statistically insignificant (P > 0.05). Conclusion: Although eosin is the most efficient counterstain for hematoxylin, turmeric can also be used as an alternative for eosin.
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The effect of fluorosis on human teeth under light microscopy: A cross-sectional study p. 345
Maya Ramesh, Malathi Narasimhan, Ramesh Krishnan, Rita Mary Aruna, Sarah Kuruvilla
Background: Fluoride is needed for the normal development of bone and teeth; in high levels, it affects developing teeth and bone. Dental fluorosis (DF) is caused by ingestion of excess fluoride mainly through drinking water. Aim: The present study aims to observe and understand the histological changes of fluorosed teeth under light microscope (LM). Materials and Methods: Teeth which were indicated for extractions for orthodontic or periodontal problems were selected. Thirty extracted teeth were selected with varying degrees of DF based on modified Dean's fluorosis index. Ground sections of these teeth were prepared and the sections were studied under binocular LM. Photomicrographs were taken under high power objective using 15 megapixels Nikon camera. Results and Conclusion: Qualitative histologic changes in different grades of fluorosed teeth were evaluated in enamel, dentin, cementum and between their junctions. Fluoride interacts with enamel in both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin, increased interglobular dentin, increased secondary curvatures and changes in cementum such as diffuse cementodentinal junction and increased thickness of Tomes' granular layer. Changes in the structure of the teeth with Dean's index below 2 and teeth with Dean's index of 2 and above were compared using Chi-square test. P value was found to be highly significant being 0.00047. Many of the features of dental fluorosis seen in the present study under light microscope are comparable to those results studied under specialized microscopes.
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Oral candidiasis: A retrospective study of 276 Brazilian patients p. 351
Henrique Cortes Meira, Bruna Mascarenhas De Oliveira, Igor Figueiredo Pereira, Marcelo Drumond Naves, Ricardo Alves Mesquita, Vagner Rodrigues Santos
Background: Although oral candidiasis (OC) is a very common fungal infection of oral cavity, clinical features of affected patients and their demographic profile are not well documented. Objective: The objective of the study was to assess the demographic profile of patients diagnosed with OC and its clinical features in an import Brazilian center of oral and maxillofacial pathology. Materials and Methods: A retrospective study consisted of 276 patients diagnosed with OC by cytopathology Periodic Acid-Schiff (PAS) staining, during the period of 20 years. The variables related to patients were gender, age and skin color. Regarding infection, the data collected were location, color, symptoms, early manifestation, or recurrent and associated factors. Results: Male and female were equally affected, and the median age was 43 years. The majority of lesions were of primitive origin, asymptomatic and affecting only one site of oral cavity. The most affected site was the palate followed by tongue. More than a half of the patients (56.2%) had red lesions. The main associated factors related were the use of removable prostheses, bone marrow transplantation and AIDS. Conclusions: OC affects predominantly adults and elderly, without difference between sex and skin color. Although clinical findings are crucial, cytopathology tests are important complementary examinations to reach a definitive diagnosis. PAS staining seems to be more used in cases of erythematous candidiasis since white lesions are easier to diagnose clinically.
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Prevalence of nasal carriers of methicillin-resistant Staphylococcus aureus among dental students: An in vivo study p. 356
N Hema, N Sunil Raj, ED Chaithanya, Rashmi Chincholi, M Iswariya, KN Hema
Aim: The aim of this study is to evaluate the prevalence of nasal carriage of coagulase positive methicillin-resistant Staphylococcus aureus (MRSA) among dental students. Materials and Methods: Four hundred dental students, divided into two groups – undergraduates (200) and postgraduates (200), were screened using sterile cotton swabs for carriage of MRSA in anterior nares. The samples were inoculated on HiCrome MeReSa Agar Base-with cefoxitin supplement. Further confirmatory tests were done by Gram-staining, Tube coagulase and Cefoxitin disc diffusion test on Mueller–Hinton agar. Results: MRSA was positive among 25 (12.50%) undergraduates and 49 (24.50%) postgraduates students. Further confirmatory test also showed the same results. MRSA colonization was significantly more in postgraduate students, who are exposed to more number of patients and have put in more clinical hours as compared to undergraduate students who have just entered clinics and have limited clinical exposure. Conclusion: The present study concluded that rate of MRSA colonization was 18.5% in the dental school population. The colonization rate was significantly (P = 0.002%) higher in postgraduate students as compared to undergraduate students emphasizing the need to follow infection control protocols stringently. Clinical Significance: Awareness about MRSA among dental doctors is mandatory so as to prevent transmission of MRSA in dental settings.
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Quantitative and qualitative assessment of argyrophilic nucleolar organizer regions in normal, premalignant and malignant oral lesions p. 360
Buddhdev P Khushbu, Monali Chalishazar, Hemant Kale, Malay Baranwal, Tapan Modi
Aim: The aim of the study was to assess the cell proliferation and biologic aggressiveness of the lesions by evaluating the significance of number and dispersal pattern of Argyrophillic Nucleolar organizing Regions (AgNORs) using silver colloid technique in normal mucosa, premalignant and malignant lesions. Settings and Design: In-vitro study, lab setting Methods and Material: The study sample consisted of five groups each with a sample size of 10 and a control group. Group I (Control), Group II (Oral Submucous Fibrosis - Mild dysplasia), Group III (Oral Submucous Fibrosis - Moderate dysplasia), Group IV (Leukoplakia - Mild dysplasia), Group V (Leukoplakia - Moderate dysplasia) and Group VI (Squamous cell carcinoma). Two sections were cut, of which one was stained with H/E stain for histopathological analysis and the second one with Silver nitrate for AgNOR counting and grading. The data obtained were analyzed both qualitatively and qualititavely. Statistical Analysis Used: Student's Unpaired T test and One- way ANOVA Results: The Mean AgNOR count increased in the following ascending order: i.e OSMF with mild dysplasia, leukoplakia with mild dysplasia, OSMF with moderate dysplasia, leukoplakia with moderate dysplasia and squamous cell carcinoma. Qualititatively, Type II AgNOR pattern was found to be the predominant one in all the samples. Type III AgNOR pattern was found to be increasing with the increase in the grade of dysplasia. Conclusions: AgNOR quantity is proportional to the proliferative activity of the cell and does not necessarily always indicate malignancy. It is the qualitative characteristics of AgNOR that help to differentiate the premalignant and malignant lesions.
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Kerosene: Contributing agent to xylene as a clearing agent in tissue processing p. 367
Amisha Ashokkumar Shah, Dinraj Kulkarni, Yashwant Ingale, Ajit V Koshy, Sanjay Bhagalia, Nikhil Bomble
Background: Research methodology in oral and maxillofacial pathology has illimitable potential. The tissue processing involves many steps of which one of the most important step is “Clearing,” which is a process of replacing dehydrant with a substance which is miscible with embedding medium or paraffin wax. Xylene is one of the common clearing agents used in laboratory, but it is also hazardous. The main aim of this study is to substitute conventionally used xylene by a mixture of kerosene and xylene in clearing steps without altering the morphology and staining characteristics of tissue sections. This will also minimize the toxic effects and tend to be more economical. Materials and Methods: One hundred and twenty bits of tissue samples were collected, each randomly separated into 4 groups (A, B, C and D) and kept for routine tissue processing till the step of clearing; during the step of clearing instead of conventional xylene, we used mixture of xylene and kerosene in 4 ratios ([A-K:X – 50:50]; [B-K:X – 70:30]; [C – Ab. Kerosene]; [D – Ab. Xylene – as control]) and observed for the light microscopic study adopting H and E staining, IHC (D2-40), Special stains (periodic acid–Schiff and congo red) procedure. The result was subjected to statistical analysis by using Fisher's exact test. Results: The results obtained from the present study were compared with control group, i.e., D and it was observed that Groups A and B were absolutely cleared without altering the morphology of tissue and cellular details; optimum embedding characteristics and better staining characteristics were also noted, whereas Group C presents poor staining characteristics with reduced cellular details. Embedded tissues in Group C presented with rough, irregular surface and also appeared shrunken. Conclusion: Combined mixture of xylene and kerosene as a clearing agent in different ratio, i.e., Group A (K:X – 50:50) and B (K:X – 70:30) can be used without posing any health risk or compromising the cellular integrity.
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Immunohistochemical evaluation of inducible nitric oxide synthase in the epithelial lining of odontogenic cysts: A qualitative and quantitative analysis p. 375
BK Akshatha, Karpagaselvi Karuppiah, GS Manjunath, Jayalakshmi Kumarswamy, Lokesh Papaiah, Jyothi Rao
Introduction: The three common odontogenic cysts include radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs). Among these 3 cysts, OKC is recently been classified as benign keratocystic odontogenic tumor attributing to its aggressive behavior, recurrence rate, and malignant potential. The present study involved qualitative and quantitative analysis of inducible nitric oxide synthase (iNOS) expression in epithelial lining of RCs, DCs, and OKCs, compare iNOS expression in epithelial linings of all the 3 cysts and determined overexpression of iNOS in OKCs which might contribute to its aggressive behavior and malignant potential. Aims: The present study is to investigate the role of iNOS in the pathogenesis of OKCs, DCs, and RCs by evaluating the iNOS expression in the epithelial lining of these cysts. Subjects and Methods: Analysis of iNOS expression in epithelial lining cells of 20 RCs, 20 DCs, and 20 OKCs using immunohistochemistry done. Statistical Analysis Used: The percentage of positive cells and intensity of stain was assessed and compared among all the 3 cysts using contingency coefficient. Kappa statistics for the two observers were computed for finding interobserver agreement. Results: The percentage of iNOS-positive cells was found to be remarkably high in OKCs (12/20) –57.1% as compared to RCs (6/20) – 28.6% and DCs (3/20) – 14.3%. The interobserver agreement for iNOS-positive percentage cells was arrived with kappa values with OKCs → Statistically significant (P > 0.000), RCs → statistically significant (P > 0.001) with no significant values for DCs. No statistical difference exists among 3 study samples in regard to the intensity of staining with iNOS. Conclusions: Increased iNOS expression in OKCs may contribute to bone resorption and accumulation of wild-type p53, hence, making OKCs more aggressive.
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Osteopontin expression and clinicopathologic correlation of oral hyperplastic reactive lesions: An institutional 6-year retrospective study p. 382
Anjali Narwal, Shashi Bala
Background and Objective: Reactive proliferations of oral cavity comprise pyogenic granuloma (PG), fibrous hyperplasia (FH), peripheral ossifying fibroma (POF), and peripheral giant-cell granuloma (PGCG). They often pose diagnostic challenges due to their overlapping clinical and histopathological features. This study was conducted to determine the frequency and clinicopathological correlation of reactive hyperplastic lesions in the oral cavity reported in our institute and compared it with other previous studies. Further evaluation of osteopontin (OPN) expression in normal gingival tissue and different types of focal reactive lesions was also done. Materials and Methods: Data of all reactive hyperplasias were retrieved, reviewed, and analyzed for age, gender, clinical presentation, and site of location. Presence and distribution of OPN were assessed using immunohistochemistry in these reactive lesions. Results: Two hundred and forty-eight reactive lesions were comprised of FH (38%), PG (23%), POF (13%), and PGCG (7%). FH was more common in males (55%) whereas other reactive lesions were more in females (68%–73%). The most frequently involved site was gingiva (59%), and most common clinical presentation was sessile growth on gingiva. OPN expression was minimal in normal gingiva. Few cases of FH, PG, and all cases of POF showed positivity for OPN in inflammatory cells, stromal cells, extracellular matrix, and in calcifications. Conclusion: Reactive hyperplastic lesions of oral cavity are mucosal responses to chronic low-grade irritation caused by plaque, calculus, and any other irritant. It is helpful to know their frequency and presentation as their early identification enables accurate patient evaluation and management.
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Evaluation of oxidative stress markers in oral lichen planus p. 387
VR Rekha, S Sunil, R Rathy
Background: Lichen planus (LP) is a chronic, inflammatory disease that affects the skin, mucous membrane, scalp and nails that frequently involves the oral mucosa. Oxidative stress reflects an imbalance between the production of reactive oxygen species and the biological system's ability to readily detoxify the reactive intermediates or repair the resulting damage. It has been suggested that oxidative stress may play a role in the pathogenesis of LP. Aim and Objectives: To evaluate the role of oxidative parameters in the pathogenesis of oral LP, estimate the levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPx) and uric acid (UA) in saliva of oral LP patients and to compare the levels of SOD, MDA, GP and UA in oral LP patients with healthy controls. Methodology: In this cross-sectional study, 1.5 ml of fasting saliva sample was collected using passive drool method from the study group (30 patients diagnosed as having oral LP) and the control group (30 age-matched healthy volunteers). The unstimulated saliva was collected were analyzed by spectrophotometry. Statistical analysis was done to evaluate and compare the values between groups. Results: The mean values of SOD and MDA in saliva in the study group showed a significant increase in amount when compared with the control group whereas GPx showed a significant decrease in the study group. UA value showed an insignificant difference in the same comparison. Interpretation and Conclusion: Oxidative stress markers as MDA and SOD are elevated, and GPx is decreased in the saliva of oral LP patients.
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Comparative analysis of the oxidative stress and antioxidant status in type II diabetics and nondiabetics: A biochemical study p. 394
Archana Nair, Bindu J Nair
Background: Diabetes mellitus is a metabolic disorder characterized by hyperglycemia along with biochemical alterations of glucose and lipid peroxidation. It produces free radicals that induce lipid peroxidation which acts as an indicator for oxidative stress in the body. The widely used assay for lipid peroxidation involves measurement of malondialdehyde (MDA). Defensive system in the body consists of antioxidant enzymes which help in scavenging free radicals. Two such antioxidant enzymes are reduced glutathione (GSH) and superoxide dismutase (SOD). In this study MDA, GSH and SOD are assessed in serum and saliva of age- and sex-matched 33 diabetics and nondiabetics. Objective: (1) To estimate the levels of MDA, GSH and SOD in saliva and serum of both diabetics and nondiabetics. (2) To correlate the levels of MDA, GSH and SOD in saliva and serum of both diabetics and nondiabetics. (3) To find if serum levels of MDA, GSH and SOD can be predicted from values of the same in saliva, in both groups. Materials and Methods: Whole unstimulated saliva and venous blood samples obtained after 12 h of overnight fast were transported to the designated laboratory chosen for the study. Supernatants of the centrifuged samples were used for the assays of MDA, GSH and SOD. Results: A significant correlation was obtained between serum and saliva values of MDA and GSH, hence the prediction of serum MDA and GSH was possible from their subsequent saliva values. Although the levels of serum and salivary SOD showed a weak positive correlation, prediction of SOD was not possible. Conclusion: Saliva can be used as a diagnostic tool for the estimation of MDA, GSH and SOD.
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Immunofluorescence in oral lesions p. 402
SJ Nithya, R Sankarnarayanan, VT Hemalatha, T Sarumathi
Immunofluorescence is an immunohistochemical method used to demonstrate the presence of antigen and antibodies in the tissues or serum. It is an auxiliary diagnostic tool for the autoimmune bullous and inflammatory disorders. It detects the in situ and circulating immune deposits that are involved in the pathogenesis of immunobullous diseases.
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Nanotechnology in oral cancer: A comprehensive review p. 407
Monika Poonia, Karthikeyan Ramalingam, Sandeep Goyal, Supreet Kaur Sidhu
Oral health could be maintained by application of this technology in prevention, diagnosis and treatment. Oral cancer is a debilitating disease, and numerous research activities are being pursued worldwide to combat this deleterious process. Nanotechnology is very diverse field that has revolutionized the industry and is setting new trends in the management of oral cancer. Hence, we performed a PubMed search on nanotechnology in oral cancer and found 211 articles related to this search. We have reviewed the reported literature to the best of our abilities and summarized the various aspects of nanotechnology, its role in diagnosis - nanodiagnostics and treatment of oral cancer - nanotherapeutics in this article.
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Hemangioendothelioma of palate: A case report with review of literature p. 415
R Heera, Latha Mary Cherian, Rupali Lav, V Ravikumar
Hemangioendothelioma commonly occurs in the superficial or deep soft tissue of the extremities, lungs, liver, bone and lymph nodes, with oral cavity being a rare location. It is usually benign but can show variable grades of malignancy. According to the histological presentation, hemangioendothelioma has been classified as epithelioid, Kaposiform, hobnail (Dabska-Retiform), epithelioid sarcoma like and composite. We present a case of ulcerated swelling of palate clinically diagnosed as pyogenic granuloma which presented a diagnostically challenging histological picture. We discuss the differential diagnoses obtained from various oral pathologists and general pathologists and substantiate the diagnosis of hemangioendothelioma based on its clinical behavior, histological features and immunohistochemical findings. In addition, we attempt to highlight the diagnostic dilemma that such cases can pose to the attending pathologists.
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Early diagnosis of an isolated primary peripheral T-cell lymphoma masquerading as massive gingival enlargement in a pediatric patient p. 421
Sravani Ghattamaneni, Venkateswara Rao Guttikonda, Sivaranjani Yeluri, Rajani Kolipara
Lymphomas are malignant neoplasm of the lymphocyte cell lines, classified as either Hodgkin's or non-Hodgkin's lymphoma (NHL). NHL comprises a heterogeneous group of lymphoid neoplasm arising from B-cell, T-cell or natural killer cell with a spectrum of behavior ranging from relatively indolent to highly aggressive and potentially fatal. Peripheral T-cell lymphoma, a variant of NHL, is a disease characterized by the presence of diffuse lymphadenopathy, extranodal involvement, classical B symptoms such as fever (>100.4°F) for 3 consecutive days, weight loss exceeding 10% of body weight in 6 months and drenching night sweats with a tendency for recurrence. Among NHLs, extranodal presentations are relatively common. Extranodal presentation particularly in the oral cavity is very rare and may misinterpret the diagnosis. Lesions of this type should be cautiously dealt especially in pediatric patients and young adolescents. The present case report is about an atypical presentation of disease process in a 15-year-old male patient, which was diagnosed early with the help of a combination of histopathology and immunohistochemistry techniques.
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Clear-cell variant of squamous cell carcinoma in maxilla as primary lesion: A rare case p. 425
Anju Devi, Mala Kamboj, Virender Singh, Sunita Singh
Oral squamous cell carcinoma with prominent clear-cell differentiation is a rare occurrence with incompletely understood etiology. We report a case of a 55-year-old male working in a steel factory presented with an ulcerated swelling on maxillary alveolar ridge, a rare site. Histopathology showed sheets of squamous cells with clear cell differentiation and features of malignancy. Periodic acid–Schiff and mucicarmine stains showed negative reaction. Immunohistochemical study using antibody for cytokeratin and epithelial membrane antigen revealed diffuse and intense positivity. The neoplastic cells showed complete negative reaction with antibodies for S-100 and vimentin.
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Giant-cell fibroma: Understanding the nature of the melanin-laden cells p. 429
Spoorti Kulkarni, Chetana Chandrashekar, Ranjani Kudva, Raghu Radhakrishnan
Giant-cell fibroma is a localized, benign fibrous mucosal mass, which clinically mimics any other fibroepithelial growth, and its distinction from other lesions is on the basis of its peculiar histopathology. A case of giant-cell fibroma with stroma strewn with brown pigment-laden cells is presented herewith. Immunohistochemical staining aided with histochemical reaction to understand the origin of these cells was carried out. Various mechanisms that explain the presence of melanin granules in reactive lesions of giant-cell fibroma is discussed in the present report.
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Xanthomatous sialadenitis: Autoimmune- or treatment-induced lesions? p. 434
Adriana Handra-Luca
Xanthomatous sialadenitis (XS) is rarely reported. Here we report XS in a case of HLA-B27-positive ankylosing spondylitis showing also anti-MAG-positive polyneuropathy with IgM-kappa dysimmunoglobulinemia/paraproteinemia, lung small cell carcinoma and buccal squamous cell carcinoma (SCC). The lesions were identified in submandibular and labial minor salivary glands of a neck dissection specimen (made during a buccal 1.7 cm large SCC resection procedure). The oral SCC was resected at 8 months after the diagnosis of the lung small cell carcinoma (with skull dome metastases, revealed by a superior cava syndrome) and at 2 months after radiotherapy. The microscopic XS-lesions consisted in multifocal accumulations of CD68-positive macrophages. Plasmocyte-abundant foci (CD138-positive) were extra-xanthomatous (atrophic parenchyma, zones of adipose involution). CD138 was also expressed in ductal cells and in acini (focally). In conclusion, we report XS of submandibular and labial minor salivary glands, occurring in the context of a HLA-B27-positive ankylosing spondylitis, polyneuropathy with IgM-kappa dysimmunoglobulinemia and anti-MAG antibodies in a case of small cell lung carcinoma (treated by radio-chemotherapy) and oral SCC.
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Screening of oral potentially malignant disorders: Need of the hour p. 437
Nadeem Jeddy, Shivani Ravi, T Radhika
Oral potentially malignant disorders (OPMDs) include a variety of lesions and conditions which display an increased risk for malignant transformation to oral cancer. As the incidence and prevalence of OPMD are highly increasing in India, its early detection and prevention is the need of the hour. Early diagnosis of such disorders is necessary to prevent the malignant transformation. Many advanced diagnostic techniques are used to predict their progression and to assess the risk of malignant transformation. Management of symptoms of OPMDs is necessary for the overall well-being of the patient. This short communication provides an overview and the importance of early diagnosis and prevention of OPMDs.
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Post extraction foreign body reaction in mandibular third molar region: An uncommon presentation p. 439
TT Sivakumar, Anna P Joseph, BR Varun, Vinod Mony
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A comparative study of three commonly used two-dimensional overlay generation methods in bite mark analysis p. 442
Nilufer Gev Pajnigara, Apeksha S Balpande, Mukta B Motwani, Anuraag Choudhary, Samantha Thakur, Natasha G Pajnigara
Aim: The present study attempts to compare the bite mark overlays generated by three different methods. The objectives of the study were to compare the three commonly used techniques for overlay generation and to evaluate the interobserver reliability in assessing bite marks by these methods. Materials and Methods: Overlays were produced from the biting surfaces of six upper and six lower anterior teeth of 30 dental study models using the following three methods: (a) Hand tracing from wax impressions, (b) radiopaque impression method and (c) computer-based method. Results: The computer-based method was found to be the most accurate method. Of the two hand tracing methods, radiopaque wax impression method was better than the wax impression method for overlay generation. Conclusions: It is recommended that forensic odontologists use computerized method, but the use of hand tracing overlays in bite mark comparison cases using radiopaque wax impression method can also be done where sophisticated software and trained persons in forensic odontology are not available.
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Assessment of the most reliable sites in mandibular bone for the best deoxyribonucleic acid yield for expeditive human identification in forensics p. 447
Shruti Singh, Radhika Manoj Bavle, Paremala Konda, Reshma Venugopal, Shiny Bopaiah, Sameer Kumar
Background: In recent years, the techniques used to identify human remains post accidents, trauma or in case of criminal investigation have been expanded, improved and rendered more complex by the emergence of technologies based on deoxyribonucleic acid (DNA) analysis. In the head and neck area, tooth has been proven to be the best quantitative source for DNA but in certain cases where the mandible specimen is edentulous or the tooth is extensively destroyed with caries, large dental restorations, mobile, or if they show any perimortem or postmortem fractures, sampling of such tooth specimen is usually avoided. In such situations, bone is considered the next best site for DNA analysis. Mandible being the largest, strongest and dense cortical bone is the most prominent facial bone that can be easily disarticulated. It can be analyzed for the best short tandem repeat (STR) segment qualitative amplification using polymerase chain reaction (PCR) technique for forensic analysis which can be used for gender and age determination. Aim: The aim of this study is to determine the best site for optimum quantitative and qualitative yield of DNA for amplification using specific and standard STR segment by conventional PCR technique. Methodology: Fifteen mandibular samples exposed to different environmental conditions were collected. Bone pieces of 1 cm × 1 cm were cut from each mandible from three sites, i.e., the ramus, angle and body, wherein the genomic DNA was isolated and was subjected to PCR using restricted number of 25 cycles. Results: The STR segment D3S1358 from clone RP11-438F9 used for the study showed very good amplification in restricted number of PCR cycles in the ramus region with number of repeats in every 15th genomic region. Conclusion: This study highlights the use of mandibular bone for the expeditive human identification. As per the study, the ramus of the mandible gave high quantitative and qualitative yield of DNA with thick amplification band of the STR segment as compared to the body and angle of the mandible. Thus ramus of the mandible can be preferred over other sites for molecular forensic investigations.
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Estimation of silver nucleolar organizer regions in oral lichen planus, oral lichenoid reactions and oral lichenoid dysplasia p. 454
J Chandrakala, M Vidya, S Hemavathy, Sahana Srinath, T Suresh, T Satish Yadav
Aims and Objective: (1) To study the clinical and histological features of oral lichen planus, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD). (2) To estimate and compare the silver nucleolar organizer regions in OLR and OLD. Materials and Methods: A total of 40 biopsies were studied; sections were divided as study group, which consists of OLP, OLR and OLD each of 10 cases and 10 biopsies of normal oral mucosa as control group. Sections were stained by silver staining technique and total number of silver stained nucleolar organizer regions (AgNORs ) were counted in nucleoli of 100 cells in each section under x100 objective (oil immersion). Results: Our study revealed that the difference between the (AgNOR) count of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) is not statistically significant (P = 0.81). The mean AgNOR count of OLD (2.388 ± 0.043) compared to that of OLP (2.272 ± 0.09) and OLR (2.27 ± 0.073) showed an increase and it is statistically highly significant (P = 0.002 and P = 0.003, respectively). Conclusion: AgNOR count is an objective test, which has stronger biological basis for diagnosing epithelial dysplasia. It is easy to perform, inexpensive and is performed on biopsied specimen. However, this technique cannot differentiate OLP and OLR, as there is no much difference in the proliferative activity of cells in these two lesions. It is reasonable to suggest that all biopsy tissues from lichenoid lesions where dysplastic features are observed in routine histopathological sections should be additionally stained by silver technique to ascertain dysplastic status of the lesion. Clinical Significance: This is an improved diagnostic parameter, which will help pathologists to formulate more definitive final histopathological diagnosis and will in turn facilitate the formulation of patient treatment and follow-up care by clinicians.
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Evaluation of role of trace elements in oral submucous fibrosis patients: A study on Gujarati population p. 455
Yesha Vijaykumar Jani, Anjani Ramchandra Chaudhary, Bhavin Bipinchandra Dudhia, Parul Vijay Bhatia, Naresh Chandulal Soni, Purv Shashank Patel
Introduction: Oral submucous fibrosis (OSMF), a precancerous condition, is highly prevalent in the Indian subcontinent. Among many trace elements, copper and iron are required for the functioning of numerous enzymes. The biochemical alterations of these trace elements in the serum of patients with premalignant conditions can help in determining the staging of the disease, its appropriate treatment and as an indicator for prognosis. Aims and Objectives: The objective of the study was to evaluate the role of iron and copper as well as to identify the better predictor of the two in the diagnosis and progression of OSMF. Materials and Methods: The study sample consisted of 150 patients, out of which the cases group consisting of 100 OSMF patients and control group consisting of 50 individuals. All the cases were confirmed of having OSMF by histopathological examination. The blood sample was obtained from all 150 patients and evaluated by digital autoanalyzer photometer for serum level of copper and iron by the colorimetric method. The results obtained for cases and controls were compared by statistical analysis. Results: The mean serum copper level increases while the mean serum iron level decreases with the advancement in the severity of clinical and histological stages of OSMF. Conclusion: Biopsy is the gold standard to diagnose OSMF, but it is an invasive and time-consuming technique. However, nowadays, many recent advances are used to diagnose OSMF at an early stage and reduce its progression into late and reversible stages. The trace elements serve as potential prognostic and diagnostic markers for OSMF patients.
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Influence of risk factors on patients suffering from potentially malignant disorders and oral cancer: A case–control study p. 455
Vidya Kadashetti, KM Shivakumar, Minal Chaudhary, Swati Patil, Madhuri Gawande, Alka Hande
Background: Tobacco use can alone lead to death worldwide, especially in developing and underdeveloped countries. China and Brazil are the world's largest producer of tobacco. India holds the third place in producing, and it is the fourth largest consumer of tobacco and its products in the world. Objectives: A case–control study was carried out to assess the influence of risk factors on patients with potentially malignant disorders (PMD) and oral cancer. Materials and Methods: Fifty cases diagnosed with PMD and oral cancer patients were selected for the study. An equal number 50 healthy controls who were also selected after age and gender matching. Multivariate logistic regression analysis was used to estimate the suspected risk factors for PMD and oral cancers. Chi-square test, Adjusted odd's ratios with 95% confidence interval were also used for the statistical analysis. Results: There is a statistically significant difference between the different age group, duration, frequency, exposure time, and synergistic effect of tobacco chewing, smoking and alcohol drinking. Conclusions: Chewing tobacco is one of the major risk factors in the initiation of PMD which can lead to oral cancer.
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Expression of survivin and p53 in oral lichen planus, lichenoid reaction and lichenoid dysplasia: An immunohistochemical study p. 456
Shaini Basheer, PM Shameena, S Sudha, Sujatha Varma, S Vidyanath, Aniruddha Varekar
Context: The malignant transformation potential of oral lichen planus (OLP) and related lesions is a subject of great controversy. Aim: The aim of this study was to compare the expression of proteins related to apoptosis and tumour suppressor gene processes in OLP, oral lichenoid reaction (OLR) and oral lichenoid dysplasia (OLD). Materials and Methods: The immunohistochemical study was carried out to investigate the expressions of survivin and p53 in a total of 30 lesional biopsy specimens - 10 cases each of OLP, OLR and OLD. The expression rates were further compared with 10 control specimens of normal oral mucosa (NORM). Results: Immunoreactivity for p53 was seen in 7 cases (70%) of OLD, 4 cases (40%) of OLP and 2 cases (20%) of OLR and none of NORM. We obtained a significant difference (P = 0.01) in mean p53 expression between the different entities. The positive staining rate of survivin was found to be significantly different between OLD (50%), OLP (10%), OLR (0%), and normal mucosa (0%) (P = 0.004). There was a positive correlation between p53 and survivin expression in OLP and OLD using Pearson's correlation coefficient. Conclusion: Lichenoid dysplasia has shown p53 and survivin expression in the range of not OLP, but leukoplakia. On the other hand, OLR seems to be an innocuous lesion. The study results with OLP are inconclusive but points toward a small but important malignant potential in OLP. This kind of comparative study highlights the importance of biopsying OLP and related lesions for proper diagnosis and appropriate management.
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Odontogenic tumors: Review of 127 cases in Marathwada region of Maharashtra p. 457
Atul Bhagwat, SR Barpande, JD Bhavthankar, MS Mandale, Jayanti Humbe, Preeti Singh
Introduction: Odontogenic tumors (OTs) are a group of heterogeneous lesions derived from epithelial or ectomesenchymal tissues or both, which are part of the tooth-forming apparatus. They range from hamartomatous or nonneoplastic tissue proliferations to malignant neoplasms with metastatic capacity. OTs are comparatively rare, comprising about 4.79% of all oral and maxillofacial biopsy specimens diagnosed. Several retrospective studies carried out in Africa, Asia, Europe and America, show that differences exist in the relative frequency of the various histologic types. Very few studies are reported among Asians, especially from the Indian subcontinent. Hence, the present study is designed to determine the frequency of the OTs and compare them with reports of various other part of the world. Study Design: A retrospective study was carried out with the ethical clearance and permission from the authority. The histopathology records from the Department of Oral Pathology and Microbiology, within the period from January 1992 to June 2012 were obtained. A total number of OTs were analyzed for age, gender, site of the tumor and histopathological type. The odontogenic keratocyst now considered as kerato cysticodontogenic tumor (KCOT) was also included in the present study. Statistical analysis was carried out to find out the incidence of OTs according to their histopathological type, and also to find male: female ratio in various OTs. Results: Totally, 2652 tissue specimens were received for histopathologic examination out of which 127 were OTs. All these reported cases were benign except two cases of malignancy. Among these male: female ratio of 1.04:1 with an overall mandible: maxilla ratio of 1.01:1. The most common benign odontogenic tumor was KCOT (44.9%). Ameloblastomas were the second most common benign tumors (35.43%), followed by odontome (7.08%) and adenomatoid odontogenic tumor (4.72%). Age distribution showed a peak occurrence of the odontogenic tumor in the fourth decade (31.49%). Conclusion: OTs are rare lesions in the studied population and are represented mainly by the KCOT, ameloblastoma and odontoma. Data from the reviewed cases have shown a possible geographic variation of OTs. With the introduction of the KCOT in the 2005 WHO classification, this neoplasm is now one of the most prevalent OT types.
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Comparitive efficacies of a natural fixative with a conventional fixative p. 458
Nidhi Sinha, Meghanand T Nayak, JD Sunitha, Geetanshu Dawar, Neelakshi Rallan, Shreya Gupta
Introduction: The quest for formalin substitutes has long been going on due to its health hazards. Honey has been recognized as a safe substitute for formalin. However, we explored jaggery as a natural substitute for formalin. The aim of this study was to compare the tissue fixation abilities of jaggery syrup (30%) with that of 10% neutral-buffered formalin (NBF) and to determine the best fixative among both. Materials and Methods: A study was conducted with 65 pathological tissues. Each specimen was divided into two equal parts. One part was fixed in 30% jaggery solution (Group A), while the other half was fixed in 10% NBF solution (Group B). 24 h tissue fixation was attained at room temperature followed by evaluation of pre- and post-fixation, tissue shrinkage, weight difference and ease of sectioning, followed by evaluation of conventional processing and staining. The histomorphological assessment for each slide was made based on evaluation of cellular outline, cytoplasmic details, nuclear details, staining quality and overall morphology under light microscopy. Each criterion was rated on a scale of 1–4. Nominal categorical data between the groups were compared using Chi-squared test. Results: The preservation of tissue specimen by jaggery syrup was comparable to that of formalin and surprisingly overall nuclear detail of the tissue was better than conventional formalin fixative. Conclusion: Jaggery can be successfully adopted in routine histopathology laboratories in place of formalin.
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A comparative study of odontogenic keratocyst and orthokeratinized odontogenic cyst using Ki67 and α smooth muscle actin p. 458
Vinay Kumar Dandena, Satish Yadava Thimmaiah, Mohammad Asif Kiresur, Prahlad Hunsigi, Swathi Roy, M Rashmi
Aim: This study aimed to demonstrate and evaluate the expression of stromal myofibroblasts (MFs) and epithelial cell proliferation using α-smooth muscle actin (α-SMA) and Ki67 markers, respectively, in odontogenic keratocyst (OKC) and orthokeratinized odontogenic cyst (OOC) to correlate their aggressive behavior. Materials and Methods: Twenty cases of OKC and twenty cases of OOC were stained with α-SMA and Ki67 markers for demonstration of stromal MFs and epithelial cell proliferation, respectively, and ten cases of well-differentiated squamous cell carcinoma were used as positive control. Assessment of the number of α-SMA-positive stromal cells and Ki67-positive epithelial cells determined by MFs and proliferative epithelial cell frequency in 10 high-power fields (×400) was presented as the mean number of positive cells per field. Statistical Analysis: Kruskal–Wallis and Mann–Whitney test were used to analyze the difference in the mean number of α-SMA- and Ki67-positive cells per field between OKC and OOC. Results: The mean number of positively stained cells for α-SMA and Ki67 is significantly higher in OKC compared to OOC. Conclusion: Impression is that, the different behaviors of these two entities are compatible with their immunohistochemical view. The high value of stromal MFs and proliferative epithelial cells in OKC in comparison to OOC indicates its aggressiveness and potential for recurrence.
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A study on Evaluation of efficacy of bethanechol in the management of chemoradiation-induced xerostomia in oral cancer patients p. 459
M Kavitha, K Mubeen, KR Vijayalakshmi
Objectives: Squamous cell carcinoma is the most common oral cancer. Radiotherapy with concomitant chemotherapy is an ideal treatment modality largely used for oral cancers, which precipitates many side effects, of which the most challenging and debilitating side effect is xerostomia. This study aimed to evaluate the efficacy of bethanechol in patients with xerostomia following chemoradiation therapy for oral cancer. Materials and Methods: Fifty patients with xerostomia postchemoradiation therapy, aged between 30 and 65 years, were selected based on selection criteria. Thirty patients in the study group were administered 25 mg bethanechol three times daily (TDS) and 20 patients in the control group with placebo capsules. The subjective symptoms of oral dryness were periodically evaluated at baseline, at the end of 1st, 2nd and 3rd weeks using a self-reported questionnaire. Salivary analysis such as whole resting saliva and whole stimulated saliva (WSS) volumes, amylase, pH and sodium potassium ratio were evaluated before and 3 weeks after bethanechol and placebo therapy. Results: Twenty-four (80%) patients in bethanechol group and only 2 (10%) patients in control group showed subjective improvement in oral dryness at the end of 3rd week. A significant difference was found between two groups in whole resting and stimulated saliva volume, pH and amylase. However, there was no statistically significant difference in sodium potassium ratio with insignificant adverse effects after 3 weeks of bethanechol therapy. Conclusions: 25 mg bethanechol (TDS) has shown subjective improvement in oral dryness in 24 (80%) patients with significant improvement in whole resting and WSS volumes, pH and salivary amylase with insignificant adverse effects.
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Quantitative assessment of silver-stained nucleolar organizer region in odontogenic cysts to correlate the growth and malignant potentiality p. 460
Sailendra Nath Biswas, RR Paul, Jay Gopal Ray, Sumit Majumdar, Divya Uppala
Context: The most common and important odontogenic cyst involving jaws is the odontogenic keratocyst (OKC) or primordial cyst, the dentigerous cyst and the radicular cyst. These cysts all though do not show similar behavior, they all have the potentiality to recur. Silver nitrate staining of the nucleolar organizer regions (AgNORs) of the benign and malignant lesions is becoming very useful as a diagnostic indicator. Thus, the aim of this study is to assess the diagnostic potential of AgNORs in the cystic epithelium of common odontogenic cysts. Materials and Methods: Archived specimens of odontogenic cysts were stained with hematoxylin and eosin stain and AgNOR stain. Results: The comparative evaluation of the AgNOR counts was done among the three varieties of odontogenic cysts, i.e., radicular cysts, dentigerous cysts and OKC and were observed that the mean for OKC was significantly higher than that of radicular cyst. Conclusion: Therefore, AgNor could be used as an efficient tool for comparative evaluation of microscopic features such as epithelial thickness, surface keratinization and mural proliferation in dentigerous cyst to that of the AgNOR count.
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The relationship between histological differentiation and disease recurrence of primary oral squamous cell carcinoma p. 461
Ramasamy Padma, Amitkumar Kalaivani, Sivapatham Sundaresan, Paulraj Sathish
Background: Although advance techniques were available for diagnosis and prognosis of oral cancer, histopathology was used as major method in clinical routine. Of all oral subsites, buccal mucosa squamous cell carcinoma is aggressive in nature with poor survival. Therefore, the aim of the present study was to evaluate the relation of tumor histopathological grade with disease recurrence of buccal squamous cell mucosa carcinoma. Materials and Methods: A retrospective study was carried out in regional cancer research institute, Tamil Nadu. Demographic, histopathological and participant's follow-up details were collected from medical records. Results: Of 198 participants, high frequently encountered with well-differentiated squamous cell carcinoma (n = 98, 49.5%). The clinical characteristics of lymphovascular invasion (P = 0.031), perineural invasion (P = 0.019), tumor stage (P = 0.004), tumor depth (P = 0.048), lymph node (P = 0.02) and metastasis (P = 0.043) had significant association with histopathological grade. In addition, the treatment strategies (P = 0.014) also showed significance at P < 0.05. Further, multivariate revealed cell differentiation (P = 0.048), tumor size (P = 0.037) and depth (P = 0.021) as independent hazard risk of the development of disease using recurrence-free survival of participants at P < 0.05. Of 198 participants, 24 (12.1%) recurrences reported during 34-month follow-up period and the overall estimated recurrence-free survival was 52%. The high frequency of recurrence, 12 (50%), was identified with moderately differentiated tumor cells. However, poorly differentiated tumor showed significantly lower survival (28%) than moderate (54%) and well differentiated (81%) by Kaplan–Meier analysis using log-rank test (P = 0.004, P < 0.05). Conclusions: The present study concludes high frequency of recurrence observed in moderately differentiated and also revealed lower survival in poorly differentiated tumor. Hence, further treatment plans should focus on moderate and poorly differentiated tumors to improve survival outcome.
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Immunoexpression of programmed cell death 4 protein in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma p. 462
Karishma M Desai, Alka D Kale
Background: Oral squamous cell carcinoma (OSCC) is the frequently reported cancer of the head and neck. Recent studies are being conducted to evaluate the role of potential markers for diagnosing the stages of development of OSCC from normal cells. Aim: The aim of this study is to evaluate and compare the immunoexpression of programmed cell death 4 (PDCD4) protein in normal oral mucosa, oral epithelial dysplasia (OED) and OSCC. Materials and Methods: Histologically diagnosed, formalin-fixed paraffin-embedded archived cases (n = 100) of normal mucosa (n = 10), OED (n = 60) and OSCC (n = 30) were analyzed immunohistochemically in the present retrospective study using monoclonal rabbit antihuman PDCD4. OED and squamous cell carcinoma were graded according to the World Health Organization and Broder's histological grading criteria, respectively. Clinical parameters and immunohistochemical results were analyzed by Fisher exact test using SPSS software. P <0.05 was indicative of significant differences. Results: PDCD4 expression was observed in the normal oral mucosa, OED and OSCC. The maximum expression was observed in the normal oral mucosa, which reduced significantly in OED and OSCC (P = 0.017). With the increase in the transformation from normal cells to cancer cells, a shift from nuclear to cytoplasmic staining was observed indicating predominant cytoplasmic localization of stain as a feature of altered cells. Conclusion: The present study delineates the molecular difference between the normal, dysplastic and carcinomatous cells; and points toward the role of PDCD4 localization in the proliferation of cells. This study thus highlights the need for further research with inclusion of long follow-up period and other pathological criteria such as inflammation and microenvironment, immune status of patient and tumor stage, which could aid in the development of prospective diagnostic options.
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Myofibroblasts: Master of disguise p. 462
Bhavana S Bagalad, KP Mohan Kumar, HK Puneeth
Myofibroblasts are the unique population of smooth muscle-like fibroblasts. These cells have a role in growth factors secretion, matrix deposition and degradation. Thereby, myofibroblast contributes in both human physiology and pathology. This review explains the myofibroblastic lesions, imperative role of myofibroblasts in organogenesis, repair, regeneration, inflammation and tumorigenesis.
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Cancer stem cells: An insight p. 463
Rohit Balwant Moharil, Alka Dive, Shubhangi Khandekar, Ashish Bodhade
Cancer stem cells (CSCs) have the ability to self-renew and are present in most tissues including breast, brain, lung, head and neck, prostates, testis, ovary, esophagus, colon and liver. Their origin is yet to be discovered though a series of hypotheses have been proposed in this regard. CSCs play a role in not only the creation of cancer but also its evolution, metastasis and recurrence. CSCs have an important role in cancer therapy and the resistance toward chemotherapeutic agents. This article reviews the characteristics of CSCs in terms of origin, methods of isolation and cancer therapy.
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Metastasis: To and fro p. 463
Prachi Baldawa, Pallavi Shirol, Jyoti Alur, Venkatesh V Kulkarni
Cancer is one of the most life threatening diseases afflicting mankind. Oral carcinogenesis is a multifactorial process involving numerous genetic events that alter normal functions of oncogenes and tumour suppressor genes. These changes lead to a cell phenotype with increased cell proliferation, with loss of cell cohesion, and infiltration of adjacent tissue thus causing distant metastasis. The fact that cancer patients might develop metastasis after years or even decades from diagnosis of the primary tumor makes the metastatic process even more complex and the disease more deadly. The promise of this article is to enhance the understanding on molecular mechanisms underlying metastasis and provide a better approach towards development of novel therapeutic treatment modalities.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007