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    Table of Contents - Current issue
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September-December 2020
Volume 24 | Issue 3
Page Nos. 409-593

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EDITORS DESK  

From the Editor's Desk Highly accessed article p. 409
T Smitha
DOI:10.4103/jomfp.jomfp_482_20  
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GUEST EDITORIAL Top

Oral pathology and the problem of plenty that isn't! Highly accessed article p. 411
Mandana Donoghue
DOI:10.4103/jomfp.jomfp_445_20  
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INVITED REVIEW Top

“Central giant cell granuloma” – An update Highly accessed article p. 413
V Ramesh
DOI:10.4103/jomfp.jomfp_487_20  
There are multiple lesions in the jawbones with a common histological character of the presence of osteoclast-like giant cells under one category – giant cell lesions. The central giant cell granuloma (CGCG) is the most common of all and is found to be more prevalent in the Indian population. The pathogenicity still remains an enigma and needs to be differentiated from other look-alike lesions in order to have proper treatment planning. Furthermore, CGCG specifically needs to be differentiated from central giant cell tumor to avoid mutilating surgeries. This article is an attempt to give an outline of the CGCG with updating of the latest information on the perception of this lesion.
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LIVING LEGEND Top

Dr. S. Bhattacharyya – A living legend p. 416
Alka Kale
DOI:10.4103/0973-029X.306677  
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ENIGMATIC MORPHO INSIGHT Top

Tingible body macrophages p. 418
Suhasini Palakshappa Gotur, Vijay Wadhwan
DOI:10.4103/jomfp.JOMFP_314_2  
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EMERGING HOT TOPICS - REVIEW ARTICLE Top

Innovative diagnostic approach and investigation trends in COVID19-A systematic review p. 421
J Beryl Rachel, N Gururaj, T Smitha, T Divyna Daniel, BS Harishini, Adlin Saroja Rosaian
DOI:10.4103/jomfp.jomfp_395_20  
A highly contagious viral infection emerged in Wuhan city; China had increased mortality with uncertain pathogenesis spreads throughout the world to become a pandemic. It is reported to be caused by a member of β coronaviruses and named it as COVID-19 by the World Health Organization (WHO). The disease is caused by a mutant strain of coronavirus SARS-COV-2 that affects the respiratory tract causing mild to severe respiratory tract illness. The clinical manifestation ranges from mild, moderate, severe and very severe signs and symptoms result in death due to severe hypoxia or multi-organ dysfunction. Also, the affected persons were capable of infecting others through various modes of transmission through respiratory droplets (aerosol spread). A definite investigation protocol has followed to diagnose COVID 19 disease but mainly confirmed with reverse transcription polymerase chain reaction. Computerized tomography scan plays a significant role in the diagnosis and prognosis of affected individuals. The major problem with COVID-19 is due to its novelty and lack of vaccination or treatment. This review focuses on the mutation, pathogenesis, various diagnostic tests adopted and autopsy findings in patients affected with COVID-19.
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EMERGING HOT TOPICS - ORIGINAL ARTICLE Top

Assessment of knowledge of oral pathologists and postgraduate students on safe laboratory practices during the COVID.19 pandemic Highly accessed article p. 437
Roquaiya Nishat, Narayanasamy Aravindha Babu, ST Srinivas Murthy, V Deepak, Shirsha Mukherjee, Shyam Sundar Behura
DOI:10.4103/jomfp.jomfp_442_20  
Background: Oral pathologists are involved in laboratory diagnosis and receive specimens of biopsy, oral cytologic smears and samples for hematology, biochemistry and microbiology and thus are at a risk for laboratory-acquired infections, which may occur inadvertently and can be considered as an occupational hazard. Aim and Objectives: This study was conducted during the coronavirus disease (COVID-19) pandemic to assess the knowledge of oral pathologists and oral pathology postgraduate students regarding the safe laboratory practices, procedures and guidelines. Materials and Methods: The study was a cross-sectional online questionnaire-based study. Questions were framed to evaluate the knowledge on specimen/sample collection, its handling, disposal and protective measures for laboratory personnel. The study population comprised oral pathologists and oral pathology postgraduate students of various dental colleges in India. A Google Doc format was used to create an effective computerized questionnaire system, and the link was forwarded to around 500 participants. The survey was fielded online between August 29, 2020, and September 5, 2020. Three hundred and twelve responses were received, which were downloaded as spreadsheets for subsequent data analysis. Results: Mean value of right answers for the oral pathologists was 8.11 ± 2.02 and for postgraduate students was 7.38 ± 1.75. When the knowledge score between the two groups was compared, a statistically significant difference was found. Conclusion: This article compares and highlights the knowledge lacunae among the oral pathologists and oral pathologists postgraduate students in relation to guidelines to be followed for safety in the laboratory. Adhering to these biosafety regulations reduces occupational health hazards and enhances a safe working environment in the laboratory.
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EMERGING HOT TOPICS - SHORT COMMUNICATION Top

Effect of COVID19 on oral research in Indian scenario: An observation p. 446
Krishna Sireesha Sundaragiri, Abikshyeet Panda
DOI:10.4103/jomfp.jomfp_480_20  
COVID-19 pandemic is an event to remember; it has unequivocally affected every part of our lives both ways. It has opened up numerous research areas with abundant funding opportunities and avenues; oral research is just a small part of this research world. In this review, we look into oral research in the COVID-19 era and India's position in COVID-19 research. The salient features of the National Guidelines for Ethics Committee Reviewing Biomedical and Health Research during the COVID-19 pandemic have been described. Some possible research topics in dentistry during COVID-19 and the need for the impetus to the dental community for oral research have been discussed.
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LETTER TO EDITOR Top

Need for innovative course module for teaching tooth morphology in India p. 451
Aman Chowdhry, Keya Sircar
DOI:10.4103/jomfp.jomfp_371_20  
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ORIGINAL ARTICLES Top

Single-nucleotide polymorphisms of methylenetetrahydrofolate reductase gene in a South Indian cohort with nonsyndromic cleft lip with or without palate p. 453
Riaz Abdulla, Jagadish Kudkuli, Saketh Kapoor, Vishnudas Prabhu, Pushparaja Shetty, Niloufa Z Aziz
DOI:10.4103/jomfp.JOMFP_329_19  
Objective: Clefts of the lip, with or without cleft palate and cleft palate only, collectively called as orofacial clefts (OFCs) are one of the most common congenital malformations with varying degrees of penetrance and phenotype expressions. The aim of this study was to investigate the association between methylenetetrahydrofolate reductase (MTHFR) cytosine-to-thymine (c. 677 C>T), adenine-to-cytosine (c.1298 A>C) single- nucleotide polymorphisms (SNPs) and South Indian patients with the nonsyndromic cleft lip with or without palate (NSCL ± P). Methods: A cohort consisting of 25 cases of NSCL ± P and 18 controls from a South Indian cohort were included in this case–control study. Genetic analysis of c.677C>T and c.1298A C polymorphisms in the MTHFR gene was carried out using Sanger sequencing and analyzed from chromatogram profiles. Data interpretation was done using statistical software MedCalc Statistical Software version 16.2 and the Statistical Package for the Social Sciences (SPSS version 22.0). Results: DNA sequence analysis of the MTHFR gene revealed c. 677C>T and c. 1298A>C polymorphisms in 16% and 76% of NSCL ± P cases, respectively. Heterozygous variant in MTHFR c. 1298A>C polymorphism was found to be a significant risk factor (P = 0.0164) for NSCL ± P in South Indian ethnic population. c.677C>T polymorphism, in particular, was apparently dormant overall in the study population. These results offer certain novelty in terms of the distinctive pattern in SNPs of genotypes observed in the study. Conclusion: NSCL ± P is one of the most common and challenging congenital malformations with complex etiological basis. Common risk factors such as MTHFR SNPs, namely c.677C>T and c.1298A>C, are subjected to variations in terms of ethnic group, geographic region and micro/macro-environmental factors. Overall, our study has explored part of South Indian ethnic population and revealed a different and unique distribution of mutations in this sample population.
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Stereomicroscope as an aid in grossing and histopathological diagnosis: A prospective study p. 459
K Carmel Shobhita, N D V N Shyam, G Kiran Kumar, Vaishali Narayen, Mudududla Priyanka, Renukuntla Shravani
DOI:10.4103/jomfp.JOMFP_312_19  
Background: Routinely, naked eye and a magnified glass are used to observe the specimens during grossing procedure. Stereomicroscope is a significant adjuvant to examine a variety of specimens and it enables us to examine the surface details of the specimen efficiently. Aims and Objectives: To assess the role of stereomicroscope in macroscopic examination and its effectiveness in the study of surface details of the specimen, thereby evaluating its role as an effective tool in grossing and histopathological diagnosis. Materials and Methods: The study sample consisted of routine specimens received by the Department of Oral and Maxillofacial Pathology, Government Dental College and Hospital, Hyderabad, between July 15, 2018, and September 15, 2018. All the specimens were photographed under direct daylight ad later examined under stereomicroscope. The images were compared and grossing was carried out. The grossed specimen were processed using standard procedure and histopathological diagnosis was made. Results: Compared to naked eye, the stereomicroscopic observation of specimens showed better details which helped in proper orientation of the specimen. Conclusion: Stereomicroscope aids as an adjuvant for proper orientation of the specimen which helps in arriving at an accurate final diagnosis.
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Immunohistochemical analysis of Nuclear Factor-kappa B (NF-κ B) between follicular and plexiform ameloblastomas: A pilot study p. 466
Muniapillai Sivakumar, Thuckanaickenpalayam Ragunathan Yoithapprabhunath, Ramadas Madhavan Nirmal, Veeran Veeravarmal, Janardhanam Dineshshankar, Ramamoorthy Amsaveni
DOI:10.4103/jomfp.JOMFP_150_20  
Background: Ameloblastoma among benign tumors holds a unique position by its locally destructive and invasive nature. Tumors that originate from the odontogenic apparatus or its remnants in the jaws show diverse clinical presentations, behavior and histologic patterns. The differed biological behavior behind follicular and plexiform ameloblastomas has never attained completeness because of the lack of rhythmic correlation regarding the exact mechanism. Nuclear factor-kappa B (NF-κB) pathways play a crucial role in survival, death and differentiation during physiologic and pathologic conditions. With this background, the study has been aimed to investigate the expression of NF-κB in follicular and plexiform ameloblastomas. Objective: The objective of this study was to analyze the immunohistochemical expression pattern of NF-κB in ameloblastoma and to compare the immunohistochemical expression pattern of NF-κB among the histological types of ameloblastoma, follicular and plexiform patterns. Methodology: Total 20 ameloblastomas (10 follicular, 10 plexiform) were immunostained with antihuman NF-κB p65 mouse IgG monoclonal antibody, and the pattern of staining is statistically analyzed using Chi-square test with the level of significance (P < 0.05). Results: Twelve (3 follicular, 9 plexiform) out of 20 ameloblastomas showed immunoreactivity to NF-κB p65. In ameloblastoma, only the peripheral preameloblast-like tall columnar cells showed reactivity, whereas the stellate reticulum-like cells are immunonegative. The staining pattern was membranous in the immunoreactive cells. The results were studied with the associated and inducing pathways from the literature, and a possible mechanism has been proposed. Conclusion: The expression pattern of NF-κB was found to be higher in plexiform ameloblastoma than follicular ameloblastoma.
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Comparison of cytokeratin expressions among orthokeratinized odontogenic cysts, epidermoid cysts and odontogenic keratocysts: An immunohistochemical study p. 472
VM Padmapriya, B Kavitha, B Sivapathasundharam, J Nagaraj
DOI:10.4103/jomfp.JOMFP_243_19  
Background: Orthokeratinized odontogenic cysts are keratinizing jaw cysts and due their association with impacted teeth and keratinaceous content, they resemble odontogenic keratocysts but differ in regards to biological behaviour, being less aggressive. To unravel the nature of OOCs, as they resemble epidermoid cysts histologically and due to their developmental resemblances to OKCs, this study was conducted. Aim and Objective: To compare the cytokeratin expressions of CK 10 and CK 19 among orthokeratinized odontogenic keratocysts, epidermoid cysts and odontogenic keratocysts by immunohistochemical study. Materials and Methods: 30 cases of all three cysts were collected, 10 cases in each of these cysts (OOCs, EDCs and OKCs) were incubated with CK 10 and CK 19 markers respectively. IHC staining was performed and assessed all layers of epithelium. All the data were analyzed using SPSS software, P values were obtained by the Chi-square test and Fisher's test. Results: The expression pattern of CK10 showed 100% positive in both OOCs and EDCs with significant difference in OKCs. CK19 expression, between EDCs and OKCs was significant but between OOCs & EDCs and OOCs & OKCs was found to be statistically insignificant. Conclusion: CK 10 expressions in both OOCs and EDCs were near identical both in terms of expression and patterns of expression in surface and spinous layers. OOCs may not be distinguished from EDCs both histologically and with CK 10 expression. CK19 expression between OOCs & EDCs and OOCs & OKCs was statistically insignificant. Thus, based upon CK 19 expression, no significant differences were found between OOCs & EDCs and OOCs & OKCs, implying that OOCs resemble both EDCs and OKCs.
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Effect of chewing Azadirachta indica (neem) and Ocimum sanctum (tulsi) leaves on salivary acidogenicity: A comparative study p. 479
Gargi S Murthy, S Srinivasa Murthy, M Kavitha
DOI:10.4103/jomfp.JOMFP_345_19  
Background: Dental caries is an infectious disease affecting majority of children in the modern world. An acidogenic diet brings down plaque pH, leading to dental caries. However, certain foods bring about rapid reversal of plaque pH after an acidogenic challenge. Azadirachta indica and Ocimum sanctum leaves which are anticariogenic show promise in this regard. Aim: The aim of this study was to evaluate the salivary pH reversal phenomenon by chewing A. indica and O. sanctum leaves after an acidogenic challenge. Materials and Methods: Forty caries-free children were selected and randomly divided into two groups. The resting salivary pH and salivary pH after eating chocolate was measured using a pH meter at time intervals of 5, 30 and 60 min. The children were then instructed to chew A. indica and O. sanctum leaves after chocolate consumption, and salivary pH was again measured at 5, 30 and 60 min. The change in salivary pH was assessed. Statistical Analysis: The data obtained were analyzed using Student's t-test (two tailed, dependent) to find the significance of the study parameters. The level of significance was set at P < 0.05. Results: Chewing A. indica and O. sanctum leaves after chocolate consumption increased salivary pH to statistically significant values at 5, 30 and 60 min. Conclusion: The observations of the study show that chewing of A. indica and O. sanctum leaves reversed the drop in salivary pH levels after an acidogenic challenge.
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Correlative study of tumor budding, mode of invasion and lymphocytic host response with known clinicopathological prognostic factors in oral squamous cell carcinoma p. 484
B Chaitra, Manasa Burela, Laxmi Kasula, Renuka Venkata Inuganti, Tejeswini Vaddatti
DOI:10.4103/jomfp.JOMFP_178_20  
Background: Oral squamous cell carcinoma (OSCC) is a significant public health problem in India, accounting to 30% of all cancers with a worrying rise in incidence and related mortality. Invasive tumor front (ITF) of OSCC has been an area of histopathologic research interest, where parameters like tumor budding (TB), mode of invasion (MOI) and lymphocytic host response (LHR) are being evaluated extensively. Objectives: The aim is to study and evaluate the possible association of ITF histological parameters such as TB, LHR and MOI with known clinicopathological prognostic factors in cases of OSCC. Subjects and Methods: We reviewed and analyzed 69 cases of OSCC for routine clinicopathological parameters, TB, MOI and LHR for any significant correlation (P < 0.05 by Chi-square test) with each other and with outcome in cases where follow-up was available. Results: TB correlated significantly with histological grade, worst pattern of invasion (WPOI), Lymphnodal involvement (LNI), Lymphovascular invasion (LVI), Perineural invasion (PNI) and age; MOI correlated with WPOI, LNI, LVI and PNI; and LHR significantly correlated with WPOI, PNI, Tumor size (pT) and outcome. TB showed a strong correlation with MOI (P < 0.001) and LHR; and no significant association was noted between LHR and MOI. Among all the clinicopathological parameters, depth of invasion, pT, WPOI, PNI and LHR showed significant correlation with outcome. Conclusion: TB, MOI and LHR showed good correlation with established parameters and as they are easy and helps in prognostication, they should be included in routine histopathological reporting guidelines.
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Awareness about oral cancer among nonhealth professional students – A cross-sectional study in Bengaluru city p. 492
Padma K Bhat, SG Sushma, MY Jayachandra, CN Aruna, Mamatha Murthy
DOI:10.4103/jomfp.JOMFP_304_20  
Background and Aim: Oral cancer is one of the most life-threatening conditions, early diagnosis of which greatly increases the probability of cure and survival rates. Knowledge regarding risk factors and early signs among the nonhealth professionals which help in early detection prevention and of the disease. Therefore, the aim of this study is to assess the awareness about tobacco use among nonhealth professional students in Bangalore city. Methodology: A cross-sectional descriptive questionnaire study was conducted to assess the knowledge and awareness about oral cancer among 800 nonhealth professional students in Bengaluru city. A self-administered questionnaire containing 26 questions pertaining to awareness, signs, symptoms and risk factors of tobacco use was administered to the students. Results: The results revealed that the majority of the students (55.5%) were aware about oral cancer but have less knowledge in terms of its signs and symptoms of oral cancer. The main source for information pertaining to oral cancer was obtained from mass media, i.e., TV, radio and social media (21.5%). Conclusion: The study reveals that there is a need for education and raise awareness about oral cancer among nonhealth professional students.
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“Analysis of immunohistochemical expression of epidermal growth factor receptor in oral squamous cell carcinoma using tissue microarray technology and whole sections:” A comparative study p. 499
Mangala Sajjanar, Parappa Sajjan, Rudrayya S Puranik, Shreenivas Vanaki, V Jayanth, Pooja Naik
DOI:10.4103/jomfp.JOMFP_154_19  
Background: Oral squamous cell carcinoma (OSCC) accounts for more than 90% of all oral cancers. Epidermal growth factor receptor (EGFR) dysregulation is associated with essentially all of the key features of cancer. Tissue microarrays (TMAs) allow the simultaneous analysis of many tumours using small-diameter cores sampled from larger blocks of tissue. Hence present study was taken up to validate TMA technology. Aims and Objectives: To analyse and compare the immunohistochemical (IHC) expression of EGFR in OSCC using TMA technology and in whole tissue sections. Materials and Methods: Study included 34 cases of OSCC.Three tissue cores, each 1 mm in diameter were placed into a recipient paraffin block using a precision microarray instrument finally containing 102 spots. EGFR expression was analysed. Agreement between whole sections and TMA scores was analysed using Cohen's weighted Kappa. Results: EGFR expression was seen in 61.8% of whole section cases. In TMA out of 102 cores 75.50 % of the disks were confirmed to represent an adequate amount of tumor tissue. In TMA 48.5% cases showed EGFR expression.The EGFR expression of whole. Conclusion: Some OSCC express high EGFR and this expression may be an independent Wfactor of certain clinico-pathological variables. TMA may be used as an adjunct with conventional method of evaluation of OSCC especially in larger sample sized studies keeping in mind its limitations.
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How genetic variation was analyzed in phenytoin-induced gingival enlargement using single-nucleotide polymorphism of candidate gene CYP2C9? p. 505
Premalatha Balakrishnan, V Ramesh, PD Balamurali, S P K Kennedy Babu, Karthiksree V Prasad, D Gandhimadhi
DOI:10.4103/jomfp.JOMFP_273_18  
Background: Phenytoin-induced gingival overgrowth is an adverse drug reaction affecting few individuals, on phenytoin therapy for its antiepileptic effect. Analysis of genetic variation of CYP2C9*2 gene was done to identify the action of metabolic enzyme cytochrome P 450 on this drug. The main background of this publication is a quick review about one of the molecular techniques used to identify the single-nucleotide polymorphism (SNP) using polymerase chain reaction coupled with restriction fragment length polymorphism (PCR-RFLP). Materials and Methods: Deoxyribonucleic acid (DNA) was extracted from 5 ml of venous blood withdrawn from the individual, who had gingival overgrowth following phenytoin therapy. DNA was isolated, using the phenol-chloroform method. Isolated DNA was used for SNP analysis of CYP2C9*2 presentation. The basic procedure used for SNP analysis in our case was PCR-RFLP. Results: Genetic variation of CYP2C9*2 in our case was homomutant. Conclusion: The etiology of phenytoin-induced gingival overgrowth is always an enigma, but it is now becoming clearer that a multifactorial role may be involved in the cause. One of the factors analyzed was polymorphism of CYP2C9*2 gene and it was found to be homomutant in our case. Adverse drug reaction can be minimized, by either reducing the drug dosage or drug substitution. However, larger scale genome-wide study has to be carried out to confirm one of the etiopathogenesis as mutation of the CYP2C9 gene, in phenytoin-induced gingival overgrowth.
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Gender determination analysis using anthropometrical dimensions of 2D:4D, foot index and mandibular canine index p. 510
N Sivakumar, Deepty Bansal, Anjali Narwal, Mala Kamboj, Anju Devi
DOI:10.4103/jomfp.JOMFP_285_19  
Introduction: Sex determination is a challenge for forensic experts during mass disasters. Teeth are an excellent source in both living and nonliving population, where bodies are mutilated beyond recognition. Mandibular canines can be employed for gender determination in such situations. Similarly, second-to-fourth digit ratio (2D:4D) and foot index (FI) are sexually dimorphic and differ in males and females. Mandibular canine index (MCI), 2D:4D and FI are considered quick, easy and reproducible methods for determining the sex of an individual. Aim: This study aimed to determine the combined role of MCI, 2D:4D and FI in denoting gender identity and establish their correlation. Materials and Methods: The present study comprised of 100 dental students (50 males and 50 females) of our institution, aged 19–25 years, with specific inclusion and exclusion criteria. The measurements were done using a Vernier caliper, a divider and a ruler, and MCI, 2D:4D and FI were calculated using their specific formulae. The calculated values of FI, MCI and 2D:4D were subjected to statistical analysis. Results: There was a statistically significant difference observed between left MCI (P < 0.05), right and left 2D:4D and FI (P < 0.05). The results revealed that 2D:4D was less, whereas MCI and FI were higher in males than in females. The observed MCI was compared with standard MCI, and left MCI revealed higher sexual dimorphic characteristics (15.2%). Although the overall correlation between 2D:4D, FI and MCI was insignificant, the measurements were comparable. Conclusion: This study indicated that the anthropometric dimensions of 2D:4D, FI and MCI can be used for sex determination independently with accurate results.
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Evaluation of antifungal activity of mint, pomegranate and coriander on fluconazole-resistant Candida glabrata p. 517
Lekshmy Jayan, N Priyadharsini, R Ramya, K Rajkumar
DOI:10.4103/jomfp.JOMFP_355_19  
Introduction: Antifungal resistance shown by different species of Candida has affected the management of candidiasis drastically. This has led to the need for newer safer therapeutic alternatives for their management. Phytochemical agents have been long known to possess numerous medicinal activities. Aim: The aim of this study was to evaluate the efficacy and resistance of fluconazole and to compare the antifungal effects of Coriandrum sativum, Mentha piperita and Punica granatum in Candida glabrata. Materials and Methods: The organism was inoculated into a specific medium, and extracts are added at serial dilutions and incubated to evaluate the zone of inhibition. Results: All the three extracts showed statistically significant and superior antifungal activity to fluconazole in fluconazole-resistant C. glabrata. Conclusion: Although the extracts showed superior antifungal activity in resistant C. glabrata strains, further studies are needed to evaluate these extracts in patients to see if their efficacy is impeded by any systemic or local factors in the body.
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Expression of CK 19 as a biomarker in early detection of oral squamous cell carcinoma p. 523
Parvathy Rajeswari, Mahija Janardhanan, Rakesh Suresh, Vindhya Savithri, Thara Aravind, Greeshma C Raveendran
DOI:10.4103/jomfp.JOMFP_302_19  
Background: Increased mortality in oral squamous cell carcinoma (OSCC) had been attributed to delay in diagnosis. Lack of a specific marker to assess the malignant potential of premalignant lesions is thought to be one of the reasons for late detection. Expression of Cytokeratin 19, which is widely used as an odontogenic epithelial marker had been reported in OSCC. Downregulation of CK 19 expression plays an important role in terminal differentiation of superficial squamous cell and increased expression in various epithelial malignancies has been suggested to be an indicator of malignant change. Aims and Objectives: To assess the role of CK19 as a potential marker in predicting malignant transformation in oral precancerous lesions and as a prognostic marker in OSCC. Materials and Methods: Study population consisted of ten samples each of normal oral mucosa, epithelial hyperplasia, varying grades of both oral epithelial dysplasias and OSCC. The tissue sections were subjected to immunohistochemical staining for the marker cytokeratin 19. Results: An increased expression of CK19 was noted in oral epithelial hyperplasia, severe dysplasia and in superficial epithelium at the invading front in OSCC. In mild and moderate dysplasias, CK19 expression was lower than the normal mucosa. In oral squamous cell carcinoma, the expression of CK19 was restricted to either a few islands or a few cells within the islands, resulting in a lesser expression than the normal epithelium. The malignant epithelial islands in the superficial connective tissue stroma were showing greater expression than the deeper islands. The epithelial cells associated with formation of keratin pearls were found to be showing more expression than those with infrequent keratin pearls. Conclusion: The study suggests that malignant transformation of epithelium can be predicted based on the increased expression of CK19. But it should be done with caution as a similar increased expression may also be noticed in presence of inflammation.
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Extracellular matrix metalloproteinase inducer expression in histological grades of oral squamous cell carcinoma – An immunohistochemical study p. 530
Sabiha Mohiddin Khan, Nilima Prakash, GL Pradeep, Aarti Mahajan, Rizwan Raiskhan Mokashi, Rekha Patil
DOI:10.4103/jomfp.JOMFP_26_20  
Background: Oral squamous cell carcinoma (OSCC) is the most common type of head-and-neck cancer. It is a complex and relentless malignancy prone to local invasion and dissemination. An insight into the molecular alterations associated with metastasis will provide critical insights into the fundamental mechanisms underlying its progression and further contribute to improvements in the clinical management of H and N cancer patients. Hence, identifying specific biomarkers would pave the way for early detection and prognosis of OSCC. Extracellular matrix metalloproteinase inducer (EMMPRIN) is a membrane-bound glycoprotein found on the surface of tumor cells. It plays a central role in the promotion of tumor invasion, progression and metastasis as it upregulates matrix metalloproteinases secreted from adjacent fibroblasts. There is a paucity of studies on the expression of EMMPRIN in OSCC. Objectives: The aim is to assess the immunohistochemical expression of EMMPRIN in OSCC and to compare it with the clinicopathological parameters and histological grades of OSCC. Materials and Methods: Thirty histopathologically diagnosed cases of OSCC were included in the study. The slides were immunohistochemically analyzed for EMMPRIN expression and correlated with the clinicopathological parameters and histological grades of OSCC. Results: EMMPRIN expression was noted in all 30 cases of OSCC. Strong EMMPRIN expression was noted in the advanced clinical stages of OSCC. Higher histological grades of OSCC exhibited strong EMMPRIN expression. Conclusion: EMMPRIN overexpression indicates that this protein could be used as an important biological prognostic marker to identify high-risk OSCC patients.
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Immunohistochemical detection of 8-hydroxydeoxyguanosine: A biomarker of oxidative DNA damage in oral submucous fibrosis p. 536
Chandramohan Kulasekaran, M Devi, K Dhivya, D Vijayalakshmi, M Sathishkumar, A Madhanmohan
DOI:10.4103/jomfp.JOMFP_42_20  
Background: Oral submucous fibrosis (OSMF) is one of the common potentially malignant disorders prevailing in India. The primary etiological factors include tobacco and arecanut, which contain numerous reactive oxygen species (ROS). ROS attack guanine bases in DNA and form 8-hydroxydeoxyguanosine (8-OHdG), which can be detected in patients who have diseases associated with oxidative stress. The oxidative DNA damage produced by oxidative stress may induce malignant transformation. Aim: The aim of the present study is to detect the expression of 8-OHdG in OSMF patients and compare the expression within different grades of OSMF and also normal buccal mucosa. Materials and Methods: A total of 30 samples were examined for the immunohistochemical expression of 8-OHdG. The control group included 10 formalin-fixed paraffin-embedded tissue blocks of the normal buccal mucosa. The study group includes 20 cases of formalin-fixed paraffin-embedded tissue blocks of OSMF (5 cases in each grade of very early, early, moderately advanced and advanced cases of OSMF). Three-micron thick tissue sections were made from each sample and stained with 8-OHdG antibody. The results were statistically analyzed using Kruskal–Wallis and Mann–Whitney U test Results: Statistically significant difference exists in the intensity of 8-OHdG expression between the study groups. The P-value obtained was <0.001, which was highly statistically significant. Conclusion: The present study is the first attempt to evaluate the expression of 8-OHdG in tissue samples of OSMF that revealed the role of free radicals and oxidative DNA damage in these patients. Further research with larger sample size, clinicopathologic correlation and long-term follow-up will shed more light on the pathogenesis of OSMF. It will also be useful for the development of new therapeutic strategies targeting treatment modalities for OSMF.
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CASE REPORTS Top

Pediatric intraosseous schwannoma in maxillary sinus: A case report with review of literature p. 542
Sumit Majumdar, A Kameshwar, K Sreekanth, B Alekhya
DOI:10.4103/jomfp.JOMFP_32_20  
Neurilemmoma has been defined as a benign, encapsulated neoplasm that arises in the nerve fiber. It originates from the proliferation of Schwann cells in the perineurium causing displacement and compression of the adjacent nerve. This neoplasm is composed primarily of Schwann cells in a poorly collagenized stroma. It can occur in any age group. Neurilemmoma occurs all over the body including the head and neck region. In the head and neck region, 25%–40% of schwannoma cases have been reported. Occurrences of intraoral schwannomas are rare with reported prevalence being 1%. In the present article, we report a case of a 19-month-old baby complaining of pain and swelling. On clinical, radiological and histopathological features it was diagnosed as pediatric intraosseous schwannoma of the maxillary sinus.
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Cementoblastoma of a primary molar: A rare pediatric occurrence p. 548
Gotur Palakshappa Suhasini, Vijay Wadhwan, Nitin Garg
DOI:10.4103/jomfp.JOMFP_307_19  
Cementoblastoma is a relatively uncommon, benign odontogenic mesenchymal tumor that is associated with and attached to the roots of teeth. It is considered to be the only true neoplasm of cemental origin. Its prevalence has been reported to vary from 0.69% to 8% of all odontogenic tumors. The tumor is frequently seen in the second and third decades of life and affects the molar and premolar regions of the mandible predominantly. We herein describe a case of cementoblastoma occurring in association with primary teeth in a 5-year-old male patient with a brief review of literature. Only 20 cases of cementoblastoma involving primary teeth were found after the English literature search, the current case being the 21st. Moreover, the deciduous teeth-associated cementoblastomas (14 out of 20) show a distinct predilection for the right side of the face. The current case is the seventh one to involve the left side.
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Rare and unusual occurrence of ectopic hidradenoma papilliferum in maxillofacial region p. 554
Himanshu Chauhan, Parul Tandon, Ipshita Potlia, Ekta Jain
DOI:10.4103/jomfp.JOMFP_126_20  
Hidradenoma Papilliferum (HP) is a rare, benign, cutaneous adnexal tumor of middle-aged females arising mainly in the apocrine sweat glands of perianal and genital region. Initially, HP was considered to be an apocrine sweat gland tumor however recent research showed that it descends from the anogenital mammary-like glands, HP can be regarded theoretically as the cutaneous complement of mammary intraductal papilloma. Nongenital HP is an infrequent manifestation, ectopic forms of this entity have been defined with bulk of them occurring on the head and neck region (60%) and 85% of cases being 1.5 cm in the greatest diameter or lesser. Average age of patients with ectopic HP is 1–2 decades older than the age range of onset in patients with anogenital HP. Here, we present a 15-year-old adolescent female with an unusually large, ectopic occurrence of nodular HP on right cheek since 2 years.
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Rhinomaxillary mucormycosis presenting as palatal ulcer: A case report with comprehensive pathophysiology p. 558
Meenal Verma, Rakhee Sharma, Nikhil Verma, Kavita Verma
DOI:10.4103/jomfp.JOMFP_145_20  
Mucormycosis is an emerging fungal infection which has exceptionally high mortality rates in immunocompromised patients and remains a life-threatening infection in uncontrolled diabetics. The reported cases in literature may be less in number due to its frequent misdiagnosis. Imaging techniques in the early stages are usually nondiagnostic and cytological smears are not very reliable, thus, the gold standard for definitive diagnosis remains with the histopathological examination. A thorough understanding of the pathogenesis and host fungus interaction aids in the histopathological evaluation and clinical management. Despite of surgical and medical management, the overall mortality rate remains high in persistently immunocompromised individuals. We present a case report of a 58-year-old female patient with rhinomaxillary mucormycosis with a history of uncontrolled diabetes.
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Rare histologic presentation of pleomorphic adenoma: A diagnostic dilemma p. 563
T Radhika, S Uma Maheswari, K Senthil Kumar, Nadeem Jeddy
DOI:10.4103/jomfp.JOMFP_62_20  
Pleomorphic adenoma is the most common benign salivary gland tumor deriving its name from varied morphological patterns in histopathology. The presence of chondromyxoid stroma in histopathology is characteristic of pleomorphic adenoma. Cellular variants without characteristic chondromyxoid stroma are rare and often pose a diagnostic challenge. We report a case of pleomorphic adenoma involving minor salivary glands of the palate presenting with a predominantly cellular histopathology. Immunohistochemical workup was pivotal in the diagnosis of this challenging case.
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FORENSIC CORNER Top

Estimation of postmortem death interval from autopsied tongue tissue: A cross-sectional study p. 568
S Rajkumari, R Mensudar, N Naveen, B Thayumanavan, Smitha Thammaiah
DOI:10.4103/jomfp.jomfp_479_20  
Context: Estimation of time since death is the preliminary step in any postmortem examination. Although there are various physiological methods to conclude the postmortem, interval histological changes can be applied to obtain precision. However, the utility of oral tissues for such an event is still evolving. Aims: The present study was conducted to assess the efficacy of postmortem histological changes that occur in tongue to conclude the postmortem interval (PMI). Materials and Methods: After obtaining institutional human ethical committee, tongue tissue was collected for during routine autopsy procedure. The study comprised twelve autopsied tongue tissues. The tissue specimens were subjected to routine laboratory tissue processing procedure and the histological changes were evaluated. Conclusion: This is the first study of this kind in the scientific literature to explore the tongue tissue to estimate the PMI. There were definite changes in the epithelium and the connective tissue of the tongue, and these features were highly remarkable at various postmortem time intervals.
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KNOW THE FIELD Top

Rushton bodies p. 572

DOI:10.4103/jomfp.jomfp_427_20  
Rushton bodies (RBs) are hyaline bodies found in epithelial lining of the odontogenic cysts that appear as peculiar, eosinophilic, straight or curved, irregular or rounded, polycyclic glassy structures occurring with variable frequency in the epithelial lining of odontogenic cysts. This article depicts the various shapes and amusing staining properties of RBs along with a brief cognizance about their much-debated origin.
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ONLINE ONLY ARTICLES - ORIGINAL ARTICLES Top

Evaluation of Hematological profile in Oral Submucous Fibrosis: A Cross-sectional Study p. 575
Deepa Jatti Patil, Manjiri Joshi
DOI:10.4103/jomfp.JOMFP_65_20  
Aims: The purpose of this study was to estimate hemoglobin (Hb) level, red cell indices (RCIs), serum iron level and Vitamin B12 level in patients with oral submucous fibrosis (OSMF) and to analyze the association of these parameters in different stages of OSMF. Setting and Design: This case–control study comprised of 65 individuals, with 40 OSMF patients and 25 controls. The OSMF patients were graded clinically according to the classification by Arakeri et al. Fasting blood samples were collected from both groups for hematological evaluation. Statistical Analysis Used: The mean values and standard deviations were calculated by Chi-square test. Normality of various parameters was evaluated by Kolmogorov–Smirnov test. The independent t-test was used to compare more than two means simultaneously. Correlation analysis was done by Karl Pearson's correlation coefficient method. Results: The OSMF patients were in the age range of 21–67 years, with a mean age of 39.85 ± 10.42 years. The mean value of Hb of the control group was 14.24 ± 1.03 g/dL, whereas that of OSMF group was 11.18 ± 2.06 g/dL (P < 0.001). The mean value of the serum iron level of the control group was 119.67 ± 42.42 μg/dL, whereas that of the OSMF group was 45.04 ± 10.41 μg/dL (P < 0.001). The mean value of serum Vitamin B12 levels of the control group was 422.98 ± 112.57 μg/dL, whereas that of the OSMF group was 211.78 ± 45.17 μg/dL (P < 0.001). The RCIs including packed cell volume, mean corpuscular volume, mean corpuscular Hb (MCH) and MCH concentration were significantly reduced in OSMF cases. Iron deficiency was present in 38 patients among the study group and Vitamin B12 deficiency was present in 22 patients of the study group. Conclusion: OSMF causes depletion of minerals and trace elements, and its replenishment is required for the healing of tissues and performing daily routine activities.
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Log odds of positive lymph nodes as an independent predictor of overall survival in oral squamous cell carcinoma p. 576
Varuni Iyer, Kiran Kumar, Kaveri Hallikeri, Anil Kumar Desai, Niranjan Kumar, Srikant Natarajan
DOI:10.4103/jomfp.JOMFP_110_20  
Context: Log odds of positive lymph nodes (LODDS) have been recently demonstrated as a very promising staging model and have outperformed AJCC pN, lymph node ratio (LNR) category in major cancers. Literature is scarce concerning the prognostic ability of LODDS in oral squamous cell carcinoma (OSCC) patients. Aims: The present study was aimed to evaluate the importance of LODDS in predicting locoregional recurrence and overall survival (OS) in patients with OSCC compared to LNR. Settings and Design: The retrospective study was carried out on 194 patients with OSCC cases treated by surgery ± adjuvant therapy from 2008 to 2014 at our institution. Subjects and Methods: Demographical and clinicopathological details of study cases were recorded. LNR and LODDS were calculated and expressed as a percentage and mean ± standard deviation. Statistical Analysis Used: The OS analysis was done by the Kaplan–Meier curve followed by log-rank (mantel-cox) test. Univariate and multivariate survival analysis was done to analyze the prognostic ability of LNR% and LODDS after adjusting the clinicopathological parameters by the Cox proportional hazards model. Results: Patients with cut off values of LODDS >-1.2 and LNR% >4 had significantly lower mean OS (P = 0.001). Multivariate analysis indicated that only mean LODDS >-1.2 was significantly associated with poor OS. Although there was a correlation with locoregional recurrence, LODDS and LNR failed to be the independent predictors of locoregional recurrence. Conclusions: LODDS was an independent reliable prognostic indicator for patients with OSCCs than conventional staging systems and LNR.
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Cemento-osseous dysplasia: Clinicopathological spectrum of 10 cases analyzed in a tertiary dental institute p. 576
Aadithya B Urs, Jeyaseelan Augustine, Sunita Gupta
DOI:10.4103/jomfp.JOMFP_139_20  
Background: Cemento-osseous dysplasia (COD) is a distinct entity, which is confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Aims: This study analyzes the demographic, clinical, radiographic and histopathological features of COD. Materials and Methods: Archival data from 2013 to 2017 present in the Department of Oral Pathology were retrieved. Clinicopathological and radiological features of all the cases which had been previously diagnosed as COD were analyzed in detail. Results: In the present study, 10 cases of COD were analyzed (1 periapical, 6 florid and 3 focal). Equal sex predilection was observed. The mean age in females and males was 42.6 years (22–64 years) and 28.6 years (17–36 years), respectively. Bony expansion was seen frequently, but pain was not a common feature. Mandible was affected almost twice as frequently as maxilla and posterior region was affected more than anterior region. Most cases showed mixed radiopaque and radiolucent lesion (5/10) and peripheral radiolucent rim (9/10) on radiographic examination. Histopathological features included the presence of curvilinear trabeculae (4/10), sheets of compact bone (3/10) or both (3/10). Foci of mineralization in form of ossicles or cementicles were noted in 5 out of 10 cases. Conclusion: COD is a nonneoplastic process usually confined to the tooth-bearing areas of the jaws or edentulous alveolar processes. Depending on the location and extent, it can be either focal/periapical/florid variant. Histopathological features of COD can overlap with other fibro-osseous lesions. Hence, the correlation of clinical, radiological and histopathological features is of paramount importance in the accurate diagnosis of COD.
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Evaluation of density of tumor-associated macrophages using CD163 in histological grades of oral squamous cell carcinoma, an immunohistochemical study p. 577
Nayana Chaudhari, Nilima Prakash, GL Pradeep, Aarti Mahajan, Snehal Lunawat, Vaibhavi Salunkhe
DOI:10.4103/jomfp.JOMFP_109_20  
Background: Macrophages account for 30%–50% of the total inflammatory cell population of ''tumor microenvironment'' that plays an important role in cancer metastasis. M2 macrophages are designated as tumor-associated macrophages (TAMs). They are known to orchestrate all the stages of tumor progression. CD163 is TAMs–M2-specific marker. Aims: The aim of the study was to evaluate the role of TAMs using CD163 in different histological grades of oral squamous cell carcinoma (OSCC). Setting and Design: Expression of CD 163 was investigated in 30 histopthologically diagnosed cases of OSCC. Materials and Methods: Two sections of 4-μ thickness were stained with hematoxylin and eosin, CD163 (Cell Marque, USA). The expression of TAMs with CD163-positive cells was done by counting the number of macrophages in three high-power fields (×400), and the mean number of macrophages per HPF was evaluated. Statistical Analysis: The statistical analysis was performed using Statistical Software SPSS version 20.0. Results: CD163 TAMs score increasing in higher tumor, node, metastasis stages with significant positive correlation. Conclusion: With higher histological grades, CD163 TAMs score increased. Thus, TAMs may be considered as an independent factor for determining the progression of the tumor. The immunotherapeutic approaches to control M2 TAM numbers could protect against progression to malignancy.
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Evaluation of glucose transporter-1 expression in oral epithelial dysplasia and oral squamous cell carcinoma: An immunohistochemical study p. 578
Preethi Patlolla, N D V N Shyam, G Kiran Kumar, Vaishali Narayen, Paremala Konda, Priyanka Mudududla
DOI:10.4103/jomfp.JOMFP_314_19  
Introduction: Oral squamous cell carcinoma (OSCC) is the most common malignancy of oral cavity and is commonly preceded by oral potentially malignant disorders. Glucose transporter-1 (GLUT-1) protein expression is upregulated in malignant cells that show increased glucose uptake. Alterations in GLUT-1 expression have been reported in several potentially malignant and malignant lesions. Aims and Objectives: The aims and objectives of this study were to analyze and assess the role of GLUT-1 immunomarker in oral epithelial dysplasia (OED) and OSCC, to demonstrate and analyze the presence, location and intensity of GLUT-1 immunomarker in low-risk and high-risk OEDs and in different grades of OSCC and to correlate the expression of GLUT-1 immunomarker between normal oral mucosa (NOM), OED and different grades of OSCC. Materials and Methodology: A total of ninety paraffin-embedded tissue blocks, 15 each of NOM; low-risk and high-risk OED and well, moderately and poorly differentiated OSCC were stained with the immunomarker GLUT-1. Results and Observation: GLUT-1 immunoexpression was statistically significant in terms of number of positive cells, staining intensity, IRS score and level of staining within the epithelium and also within the cell between NOM, OED and OSCC. Conclusion: Increased GLUT-1 expression has a consistent role in the malignant transformation of OED and aggressiveness of OSCC.
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Immunohistochemical expression of podoplanin as a myoepithelial cell marker in pleomorphic adenoma p. 579
Aanchal Adwani, Supriya Kheur, Mohit Kheur, Pratiksha Mahajan
DOI:10.4103/jomfp.JOMFP_337_19  
Purpose: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor with salivary gland excision as the treatment of choice; however, recurrences after parotidectomy have been reported. The current study is aimed at evaluating podoplanin expression in PA as a myoepithelial (ME) cell marker and its role in estimating the prognosis and outcome of the tumors by correlating it with various clinical and histological parameters. Materials and Methods: A total of 10 paraffin-embedded specimens of histologically diagnosed PA with clinical records of the patients were retrieved and the slides were then stained using hematoxylin and eosin staining and were then immunohistochemically stained with podoplanin. Results: The study revealed the specificity of podoplanin as a differential marker for ME cells. Conclusion: Although the study revealed the specificity of podoplanin as a differential marker for ME cells, additional markers to overcome the limitations of podoplanin which will predict the biologic behavior (biologic behavior of the tumor) the tumor with respect to parameters such as age, gender and site of the tumor are required. Furthermore, a larger sample size is required to validate the findings in our data.
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Morphometric analysis of basal cells of oral epithelium in predicting malignant transformation of oral potentially malignant disorders in patients with tobacco chewing habit p. 579
Chatraspalli Krishna Santoshi, Jogishetty Vijay Kumar, Pacha Venkat Bhagirath, B Hari Vinay, Y John Prakash
DOI:10.4103/jomfp.JOMFP_55_20  
Background: Oral potentially malignant disorders (OPMDs) are a heterogenous group of disorders which precede the development of oral cancer. These are characterized by increased risk of malignant transformation to Oral cancer. Aims & Objectives: In this study, an attempt has been made to assess the morphological alterations of the nuclei of the basal cells in OPMDs and oral squamous cell carcinoma (OSCC). Our objective was to compare the alterations and to assess the predictive factor of such alterations of basal cells in malignant transformation of OPMDs to OSCC. Materials and Methods: This was a retrospective study conducted on tissue sections of 150 formalin fixed, paraffin embedded blocks obtained from the archives. The specimens were grouped into OSCC group (n= 50) and OPMDs (n= 100). Nuclear features were evaluated using computer- assisted microscopic image analysis. One- way ANOVA analysis was done to verify the difference between the groups for all variables. Results: Our results showed statistically significant difference for all parameters between the groups. Among OPMDs, leukoplakia showed significant increase in nuclear area, nuclear perimeter, Nuclear/Cytoplasm (N/C) ratio, density and loss of polarity, while OSF showed significance with only perimeter, density and loss of polarity. Conclusion: Based on findings of present study, it is concluded that measurements using computer- aided morphometric analysis may provide an objective means for predicting the malignant transformation OPMDs to OSCC. Among OPMDs, Leukoplakia has a higher chance of malignant transformation than OSF
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Immunohistochemical expression of kallikrein 7 in oral squamous cell carcinoma p. 580
Dodda Venkatesh Kumar, Y Sivaranjani, Guttikonda Venkateswara Rao
DOI:10.4103/jomfp.JOMFP_244_19  
Background and Objectives: The kallikrein (KLK) family of genes consists of 15 members, many of which are highly expressed in number of cancers compared to their normal parent tissues. KLK7 was initially characterized as an enzyme implicated in the degradation of intercellular cohesive structures in the stratum corneum of stratified squamous epithelia, preceding desquamation in the skin. It catalyzes the degradation of desmosomes in the outermost layer of skin and permits cell shedding to take place at the skin surface. Overexpression of KLK7 in tumor cells has been reported to significantly enhance the invasive potential in intracranial malignancies and ovarian cancer cells. Thus, KLK7 could contribute to the degradation of extracellular matrices in oral squamous cell carcinoma (OSCC) tissues, promoting invasion of neoplastic cells locally and facilitating metastasis to regional lymph nodes. The objectives of the present study were to compare the expression of KLK 7 in normal subjects and patients with OSCC, to correlate the expression of KLK 7 with respect to the clinical staging of OSCC and to evaluate the expression of KLK 7with respect to different histopathological grades of OSCC. Materials and Methods: Thirty cases of OSCC were staged clinically and graded histopathologically. The immunohistochemical method was used to detect the expression of KLK 7 in OSCC. The scores obtained were documented and compared statistically. Results: KLK 7 immunoreactivity was noticed in all cases of OSCC. A statistically significant difference was observed in immunoreactivity of KLK 7 between the normal and OSCC (P = 0.0001*) and in different histopathological grades (P = 0.0001*) and in different clinical stages (P = 0.0127*) of OSCC using Kruskal–Wallis analysis of variance test. Conclusion: The KLK 7 immunoexpression histopathologically increased from low grade to high grade and clinically from Stage 1 to Stage 4 in OSCC. Hence, increased expression of KLK 7 may be related to poor prognosis in patients with OSCC.
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Histological assessment of budding and depth of invasion (BD) model in biopsies of oral squamous cell carcinoma p. 581
Swetha Acharya, Monica Raj, Kaveri Hallikeri, Anil Desai
DOI:10.4103/jomfp.JOMFP_236_19  
Objectives: Recognizing precise prognosticators from preoperative biopsies that aids in treatment is of immense clinical importance. Thus, the aim of this study was to assess and compare the tumor budding (B), depth of invasion (D) and combined scores (BD) model in the preoperative biopsies and subsequent postoperative specimens of oral squamous cell carcinoma (OSCC). Material and Methods: B and D were assessed in the pre- and postoperative specimens of 65 OSCC cases treated in the institution. Relationship between pre- and postoperative assessments was subjected to McNemar's, Chi-square, Fisher's exact, sensitivity and specificity statistics. Results: There was an agreement between the pre- and postoperative B scores in 54 cases with accuracy of 83% (95% confidence interval 71.73%–91.24%). The preoperative scores showed a good sensitivity of 67.86% and a high specificity of 94.59% in predicting the postoperative score of the same. The difference in assessing intensity B as low and high between preoperative and postoperative biopsies was not statistically different. There was an agreement between the pre- and postoperative scores of the BD model in 72%. The difference in BD scoring as low intermediate and high between preoperative and postoperative biopsies were significantly different statistically. Postoperative BD scoring showed a significant association with stage and lymph node metastasis. Conclusions: The findings validate the prognostic value of BD model in the postoperative specimens. Its value in preoperative biopsies is questionable. A judicious representative biopsy may increase the accuracy and reliability in the assessment of preoperative B and precision in BD model evaluation.
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Expression of p53 at invasive front of oral squamous cell carcinoma and negative histopathological surgical margins to establish correlation at 3-year survival p. 582
Madhuri Gawande, Minal Chaudhary, Preethi Sharma, Alka Hande, Swati Patil, Archana Sonone
DOI:10.4103/jomfp.JOMFP_106_20  
Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity. The histologic features of OSCC differ from area to area within same tumor, and most prognostic information can be revealed from the invasive front of tumor. The most accepted line of treatment is radical neck dissection. The boundaries of a resected specimen are the surgical margins (SMs), which are excised by the surgeon. The survival outcome is based on the status of these resected SMs. To avoid local recurrence and improve overall survival, it is necessary to attain negative SM. Apart from routine histopathology, the molecular assessment of resected margins has recently gained value which has a promising role for margin surveillance. The value of the use of molecular markers in the routine examination of resection specimens of OSCC has not yet established. It is crucial to identify the percentage of altered cells in SMs which go undetectable in the routine histopathology. It is essential to assess their role in recurrence and survival. Materials and Methods: The study was divided into two groups, i.e., Group I (control group): ten cases of normal oral mucosa and Group II consisted of thirty cases, in which biopsy samples of invasive tumor front and histopathologically negative SM of OSCC were included. Both the groups were subjected to p53 immunohistochemical staining Results: There was overexpression of p53 at the deep tumor invasive front of OSCC associated with different histologic grades of malignancy. Conclusion: The overexpression of p53 at the invading tumor front with clear SMs is associated with poor survival. p53 expression at the tumor front can be a prognostic marker for OSCC.
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Analysis of the results obtained by national research groups with the Russian state cancer program for the screening of diseases of the oral mucosa and the vermillion border p. 582
Lyudmila Nikolaevna Maksimovskaya, Marina Yakovlevna Abramova, Aleksey Aloisovich Erk
DOI:10.4103/jomfp.JOMFP_289_20  
Aims and Objectives: The purpose of the article is to analyze the results obtained by the national research groups with the Russian State Cancer Program for the screening of diseases of the oral mucosa and the vermillion border. This article analyzes the results obtained by national research groups in the implementation of the Russian State Cancer Program. Background: Based on the Department of Therapeutic Dentistry of A.I. Yevdokimov Moscow State University of Medicine and Dentistry, national research groups were created to implement the state program draft for the screening of oncological and precancerous diseases of the oral mucosa and the vermillion border – a grant of the “A” format to support applied research on a competitive basis in the form of subsidies of the federal target program. Materials and methods: From 2015 to the first half of 2019, the national clinical groups studied the epidemiology (prevalence rate and structure) of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18-92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of active pathology detection during targeted examination of the population (screening) and appealability in the preclinical period, early, timely and late detection. Results: the results of the research confirm low cancer alertness of practicing dentists. An individual patient registration card has been developed to systematize data and create a diagnostic register for the screening of cancer and precancerous diseases of the oral mucosa and the vermillion border. Conclusion: A project has been developed to implement the Russian State Cancer Program for oncological and precancerous diseases of the oral mucosa among the population of the Russian Federation.
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Immunohistochemical analysis and correlation of cyclooxygenase-2 expression status with clinicopathological parameters in head and neck squamous cell carcinomas: An Indian perspective p. 583
Prerna Chadha, Richa Ranjan, Nikhilesh Kumar, Rig Vardhan, Prashant Sengupta, Rakhi Negi
DOI:10.4103/jomfp.JOMFP_128_20  
Context: Head and neck squamous cell carcinoma (HNSCC) poses a major health problem and despite the advancements in its diagnosis and management the overall survival has not improved significantly. A search for newer diagnostic and prognostic markers along with fresh molecular targets is required for its prevention and cure. Aims: The study aims to study the expression of cyclooxygenase-2 (COX-2) in HNSCCs and investigate its correlation with the clinicopathological profile of these cases. This study was performed to determine the significance of COX-2 expression in the Indian context. Settings and Design: This study incorporated 90 cases of HNSCCs; both prospectively and retrospectively in a tertiary care center. Materials and Methods: Expression of COX-2 on immunohistochemistry (IHC) was evaluated in correlation with the histological grade, maximum tumor size, tumor depth, nodal status and lymphovascular/perineural invasion (lvi/pni). The study received a waiver from the institutional ethics committee. Statistical Analysis Used: Statistical analysis of the data was done using SPSS software. Results: COX-2 expression was found in 97.8% of the cases. A statistically significant correlation of COX-2 immunopositivity was found with the histological grade, clinical staging (tumor size and nodal status), maximum tumor depth and lvi/pni in our study (P < 0.05). Conclusions: COX-2 is expressed by most of the cases in this study. Its expression is related to tumor growth, differentiation and aggressiveness and therefore can be used as a good independent prognostic marker in HNSCCs. There is also possible scope of using it for targeted therapy in HNSCCs.
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Evaluation of salivary gamma-glutamyl transpeptidase as a biomarker in oral squamous cell carcinoma and precancerous lesions p. 584
Salim Javeed Mujawar, G Suchitra, Kiran A Kosandal, Sameer Choudhari, Nurul Ameen Inamdar, K Basheer Ahmed
DOI:10.4103/jomfp.JOMFP_73_20  
Background: Oral cancer is such a common malignancy, but its manifestations are usually asymptomatic, and by the time the lesion is diagnosed its invasion is deep. This makes the survival rate poor and also the treatment rendered during such stages is extensive and debilitating. In this regard, a novel approach has been advocated in the estimation of biomarkers in the body fluids. Gamma-glutamyl transpeptidase (GGT)/gamma-glutamyl transferase is an enzyme that is essential for the absorption of amino acids, especially in the degradation of glutathione. Its activity is increased in oral cancer and precancerous lesions. Aims and Objectives: The purpose of this study was to assess the activity and concentration of GGT in precancerous and cancerous patients in comparison with normal patients and also to assess its efficacy as an effective tumor marker. Materials and Methods: The study population comprised a total of 75 patients who were categorized into three groups as normal patients (25 cases in Group A), patients with precancerous lesions (25 patients in Group B) and patients with oral squamous cell carcinoma (25 cases in Group C). 5 ml of whole unstimulated saliva collection was done, it was centrifuged at 3000 rpm for 15 min and the supernatant thus obtained was used for the estimation of GGT levels. The detection was done by photometric method reading the absorbance at 405 nm. Results: Group A patients had values of GGT ranging from 4 to 30U/L with a mean of 16.7 ± 1.94U/L. Group B had activity of GGT ranging from 39 to 65 U/L with a mean of 50.4 ± 1.67U/L. In group C, the evaluated GGT activity was between 53 and 86 U/L and the mean was 70 ± 2.37 U/L. Statistical analysis using Chi-square test was conducted. Correlations between Group A and Group B and between Groups A and C showed a statistically significant relation (P < 0.005). Conclusion: Salivary gamma-glutamyl transferase activity can be used effectively as a tumor marker, and further studies with a larger sample size can be done to correlate this finding.
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Prevalence of odontogenic cysts and its associated factors in South Indian population p. 585
Vindhya Savithri, Rakesh Suresh, Mahija Janardhanan, Thara Aravind, Mridula Mohan
DOI:10.4103/jomfp.JOMFP_171_20  
Background: Odontogenic cysts (OCs) constitute a major part of oral pathological lesions, but little is known about their distribution patterns in various populations. Aims: The aim was to determine the prevalence and factors associated with the cases of histopathologically diagnosed OCs that report to our institution and to analyze the factors associated with the presence of OCs and to study the biologic behavior of different types of cysts. Materials and Methods: A cross-sectional study was performed on 596 oral and maxillofacial specimens during 2013–2017. Out of these, the cases which were histopathologically proven as OCs were separated and data were collected and analyzed regarding the age, gender, primary symptom, site, radiographic feature, histopathologic diagnosis, treatment given, recurrences and associated conditions if any. Results: Of the 596 cases included in the study, 67 (11.2%) had a histopathological diagnosis of OCs. 41 cases were inflammatory cysts and 26 developmental cysts. 28 cases (41.8%) were reported as periapical cysts, 10 cases (14.9%) were odontogenic keratocysts (OKCs), 9 cases (13.4%) were dentigerous cysts, 8 cases (11.9%) were inflamed cyst wall, 5 cases (7.5%) each of residual cyst and developmental OCs and one case (1.5%) each of orthokeratinized OC and calcifying OC. Conclusion: This study showed that the prevalence of OCs was similar to other reported studies. Periapical cysts were the most common cysts reported, followed by OKCs showing that the latter were more frequent than dentigerous cysts.
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Estimation of serum pyruvic acid levels in oral squamous cell carcinoma p. 585
Priyanka Guduguntla, Venkateswara Rao Guttikonda
DOI:10.4103/jomfp.JOMFP_246_19  
Introduction: Cancer cells generally exhibit increased glycolysis for adenosine triphosphate generation (the Warburg effect) due to mitochondrial respiration injury and hypoxia, which are frequently associated with resistance to therapeutic agents. Pyruvic acid is produced as an end product of glycolysis along with lactic acid. At room temperature, lactic acid converts into pyruvic acid as it is chemically unstable. Aim: To evaluate the serum pyruvic acid levels in patients with oral squamous cell carcinoma (OSCC). Materials and Methods: Thirty clinically and histopathologically confirmed cases of OSCC were included in the study. The cases were staged clinically (tumor–node–metastasis staging) and graded histopathologically (modified Broder's classification). A control group of 30 age-matched individuals with no systemic diseases were selected and the serum levels of pyruvic acid were measured and the absorbance was read using a spectrophotometer at a wavelength of 540 nm. The results were evaluated statistically and discussed. Results: Pair-wise comparison of clinical stages and histological grades of OSCC was done using Tukey's multiple post hoc procedure. The increase in mean serum pyruvic acid levels between any two groups and grades was found to be statistically significant respectively (P<0.05). Conclusion: Serum pyruvic acid levels gradually increased from individuals without OSCC to individuals with OSCC. Higher levels of serum pyruvic acid were seen with increasing clinical stage and the mean serum pyruvic acid levels were also found to be significantly increasing with advancing histopathological grades of OSCC.
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Comparison of staining adequacy between tissues stored in formalin and paraffin embedded blocks for prolonged duration p. 586
Hariyabbe Rangaswamy Likhithaswamy, GS Madhushankari, Manickam Selvamani, Ganganna Kokila, KP Mohan Kumar, Krishna Chethana
DOI:10.4103/jomfp.JOMFP_49_20  
Introduction: Tissues submitted for histopathological diagnoses are routinely fixed in formaldehyde fixative which facilitates tissue storage for the extended period of time for further investigation or research purpose. The literature has reliable data relating to immunohistochemistry and molecular studies done using tissue fixed in formalin for longer duration and in paraffin-embedded tissue blocks. We have attempted to evaluate staining adequacy of archival specimens using hematoxylin and eosin (H&E) and trichrome stains. Methodology: We compared staining adequacy in tissues stored in formalin for a minimum period of 5 years labeled as long term fixed tissues (LFT) and corresponding 5-year-old paraffin-embedded tissue blocks of same cases available in the archives designated as old tissue blocks (OTB), along with freshly fixed tissues (FFT) used as controls. Fifty-one tissue sections in each study group were stained with H&E, Mallory's trichrome and Van Giesons' and microscopic evaluation was carried out using Research Microscope B × 51. Results: Staining adequacy of the tissue sections was found to be superior in FFT, followed by OTB and LFT using all three stains. Staining for H&E, was found to be superior as compared to trichrome stains. Conclusion: Trichrome stains were poorly demonstrated in LFT indicating the possible alteration in protein structure and tissue architecture in LFT whereas H&E, stained LFT specimens showed relatively good staining character. Hence, OTB proved to be better as compared to LFT in terms of staining quality and hence archiving tissue in paraffin embedded tissue blocks serve as valuable bio-bank and source for prospective studies.
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Tumor budding – A promising prognostic histopathological parameter in oral squamous cell carcinoma – A comparative immunohistochemical study p. 587
Priya Joshi, Jaydeep Pol, Madhuri Chougule, Kiran Jadhav, Sangeeta Patil, Swapnita Patil
DOI:10.4103/jomfp.JOMFP_74_20  
Introduction: The majority of the head and neck squamous cell carcinomas (HNSCC) occur in the oral cavity. Even with advances in cancer therapy only minor improvements in the survival of HNSCC patients have taken place and approximately 350,000 patients die annually of HNSCC worldwide. Tumor budding (TB) is a novel and promising histo-morphological parameter that has been studied in many cancers. The presence of TB is associated with lymph node and distant metastasis as well as poor survival, independently of the applied scoring system. The depth of tumor invasion (D) measured from the surface of the tumor to the deepest point of invasion is also an important prognostic parameter for oral squamous cell carcinoma (OSCC) with a cutoff point of 4 mm. Both taken together constitute BD model and it has also been found to be an independent prognostic factor for patients with OSCC. Therefore, it would be highly beneficial to evaluate TB and BD model in routine histopathological reporting. Aims and Objectives: This study aims to compare the detection of TB in hematoxylin-eosin and pan-cytokeratin stained immune-histochemical sections of OSCC and also to evaluate whether BD score can serve as a reliable prognostic indicator for OSCC. Methodology: A total of 30 formalin-fixed, paraffin-embedded tissue blocks of clinically and histopathologically diagnosed cases of OSCC were retrieved. One section was stained with hematoxylin and eosin and the other was processed for pancytokeratin immunohistochemistry to evaluate tumor buds. Depth of invasion (D) was also evaluated to achieve the BD score. Results: Statistical significance (P < 0.001) was noted between TB score evaluated in hematoxylin and eosin (H&E) and pancytokeratin stained sections. There was no statistical significance between age, gender, site of lesion, clinical staging, survival and BD score. Conclusion: Immunohistochemical analysis of TB is superior to H&E staining in detection of tumor buds at the tumor invasive front.
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Dental caries prevalence among HIV adult population in India: A systematic review p. 588
Arunkumar Acharya, Shrikanth Muralidharan, Pramila Mallaiah, S Geetha
DOI:10.4103/jomfp.JOMFP_64_20  
Dental caries is a universal disease. Untreated dental caries adds to the existing burden of diseases. It is necessary to have national data on the same, especially in HIV cases, to understand the epidemiological aspects and formulate a treatment plan for the population. Hence, a systematic review was carried out to collectively report the dental caries prevalence among this population. A systematic search for articles was done in PubMed and Google Scholar using the keywords: Dental Caries, India, HIV, AIDS and adults from January 1990 to December 2019. All freely available full-text articles were evaluated based on the inclusion criteria. Only four articles fulfilled the criteria based on qualitative analysis. Decayed, Missing and Filled Teeth index was used to record dental caries. Risk factors related to the same were not specified by any of the authors. Studies were not from different regions of India. More epidemiological studies are needed to understand the prevalence rate and correlated to dental caries among HIV-positive population in India.
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Oral condyloma acuminatum with changes in excretory duct of minor salivary gland: An unusual case report and review of literature p. 588
Himani Tiwari Chaturvedi, Chandrashekher Chaturevedi
DOI:10.4103/jomfp.JOMFP_196_20  
Condyloma acuminatum (CA) is human papilloma virus-induced disease, rarely involving oral cavity, usually sexually transmitted and frequently occurs in anogenital areas. Oral lesions are being present predominantly on the tongue, lip mucosa, buccal mucosa, palate and floor of the mouth. The disease is more common in teenagers and appears as solitary or multiple, sessile or pedunculated masses. Here, we report the unique case of CA on the lower lip in a 45-year-old man, showing changes in the excretory duct of the minor salivary gland, which is relatively unusual.
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Osteosarcoma of jaws: Challenges in diagnosis p. 589
Sonalee Shah, Biswajit Mishra, Nidhi Tiwari, Anand Nikunj
DOI:10.4103/jomfp.JOMFP_142_20  
Osteosarcoma (OS) accounts for about 20% of all sarcomas with gnathic involvement seen in about 6%–10% of all OSs. The clinical presentation of OSs in the jaws is different from that of long bones as swelling is the most common complaint in patients with jaw OS followed by pain. The histopathologic variables seen are more favorable in OSs of jaws. Low-grade tumors are Stage I, high-grade tumors are Stage II and metastatic tumors (regardless of grade) are Stage III. A 17-year-old male patient reported with a complaint of the presence of an intra-oral growth gradually increasing in size in the right buccal mucosa region soft tissue enveloping the occlusal aspect of the right mandibular second molar. Extraorally swelling was present on the right side of the face for 4 months. Radiographically, there was a radiolucency from the distal aspect of right Mandibular second molar extending into the ramus region of the mandible with ill-defined borders. Hemi-mandibulectomy was done with the removal of the right mandible from the premolar region to condyle and coronoid processes. Microscopic evaluation of the sections after hematoxylin and eosin staining revealed interlacing fascicles of spindle-shaped cells arranged in a biphasic pattern and some areas of attempted bone formation evident in deeper sections. Tumor was an osteoblastic variety consisting of tumor osteoid surrounded by bizarrely arranged fibroblast-like cells. It showed positive staining with α-smooth muscle actin and Vimentin, suggesting a malignant tumor of mesenchymal cells with high myofibroblastic activity. Our case had small-cell histology; therefore, differential diagnosis was important.
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Mucosal keratocyst of buccal mucosa: A rare entity p. 589
Valappil Thannikunnath Beena, Dilshad Banu Meleveetil, Latha Mary Cheriyan, Kavitha Angamuthu
DOI:10.4103/jomfp.JOMFP_54_20  
The odontogenic keratocyst (OKC) is a developmental odontogenic cyst that is important due to its specific histopathologic features and clinical behavior. It is well known that the OKC arises from cell rests of the dental lamina. This cyst is important as it shows a different growth mechanism and biologic behavior from other common odontogenic cysts. In rare cases, OKCs occur in sites other than intraosseous sites. The most common location of peripheral OKC is the gingiva, but mucosal, epidermal and even intramuscular sites have also been described. The origin of peripheral OKCs is still under controversy. We, hereby, add a case of peripheral OKC located in the soft tissue of the buccal mucosa to the scarce literature consisting of only a few case reports and small case series of peripheral odontogenic cysts.
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Sclerosing polycystic adenosis of minor salivary glands: Report of a rare case with diagnostic approach and review of literature p. 590
Surya Narayan Das, Kirti Jyoti, Rachna Rath, Bodhiswata Pattnaik
DOI:10.4103/jomfp.JOMFP_186_20  
Sclerosing polycystic adenosis (SPA) is an uncommon entity occurring in the salivary glands, with majority of the cases reported in major salivary glands reminiscent of fibrocystic disease of the breast. SPA arising in minor salivary glands of the oral cavity constitutes an exceedingly rare phenomenon. Here, we report a case of SPA that presented as a solitary, submucosal mass on the left lower labial mucosa in a 19-year-old male. The pathology features and a clinicopathologic diagnostic approach highlighting key features are discussed here. Similar cases published in the English literature are reviewed.
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Clear cell odontogenic carcinoma in maxilla: A rare case report p. 590
Swapna Amod Patankar, Pratik Raut, Amod Pramod Patankar, Rajesh Ashok Kshirsagar
DOI:10.4103/jomfp.JOMFP_298_20  
A rare and aggressive form of tumor with a female predilection and more seen with mandible is the clear cell odontogenic carcinoma (CCOC). The World Health Organization categorized it as a malignant neoplasm in 2005. This type of tumor is characterized by local recurrences as well as distant metastasis apart from being highly aggressive in nature. Due to the presence of clear cells, it is a diagnostic challenge to the pathologist. Only about 84 cases of maxillary variant have been reported in the literature. Here, we present a case report of a 31-year-old male with CCOC in the maxilla from the pathological and diagnostic point of view.
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Gorlin syndrome: A rare case report p. 591
Sandhya Shrivastava, Sushruth Nayak, Prachi Nayak, Sourabh Sahu
DOI:10.4103/0973-029X.190048  
Gorlin syndrome is an autosomal dominant inherited condition that exhibits high penetrance and variable expressivity. The syndrome is caused by mutations in PTCH, a tumor suppressor gene that has been mapped to chromosome 9q22.3-q31. It is observed that most aggressive forms of keratocystic odontogenic tumor are the first signs of this syndrome which show a high recurrence rate due to its varied histopathological features. The other components are multiple basal cell carcinomas of the skin, intracranial calcifications and rib and vertebral anomalies. In addition, >100 minor criteria have been described with two major and one minor criteria or one major and three minor criteria necessary for confirmatory diagnosis. It is a rare syndrome having an estimated incidence of 1 in 50,000–150,000 in the general population with a 3:1 male/female gender predilection. Here, we report the case of a 14-year-old female patient diagnosed with Gorlin syndrome.
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An atypical case of cutaneous cysticercosis in buccal mucosa p. 591
G Manikandan, Vandana James, Charanya Chandrasekaran, Sunil Chandy Varghese
DOI:10.4103/jomfp.JOMFP_266_20  
Cysticercosis is a recognized fatal disease to the humans. Taenia solium, a larval stage of pork tapeworm that causes cysticercosis which is an important cause of morbidity in the world. This case report shows the clinical presentations of an atypical case of cutaneous cysticercosis on the right buccal mucosa and its management. It presents the importance of thorough knowledge, proper investigation, symptomatic management with improved treatment regimens and important role of minimally invasive surgery. Its outcome and the treatment options mainly depend on the number, location, size and stage of parasites, as well as on the immune response of the host.
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Pigmented lateral periodontal cyst: A case report and review of pigmented odontogenic cysts p. 592
Hardeep Kaur Chehal, Jasbir Deol Upadhyaya, Indraneel Bhattacharyya, Mohammed N Islam
DOI:10.4103/jomfp.JOMFP_179_20  
Pigmented odontogenic cysts are uncommon and to date, only 37 cases have been reported in the English literature. Here, we report a case of a pigmented lateral periodontal cyst (LPC) in the maxilla of a 48-year-old female. The patient presented with clinical swelling in the maxillary anterior region. Microscopic features of the biopsied specimen were consistent with a diagnosis of LPC. The epithelial cyst lining exhibited numerous coarse granules of melanin pigment, which was confirmed by S-100 immunohistochemistry and Fontana-Masson bleach histochemical method. Almost all documented cases of pigmented odontogenic cysts have occurred in Asians and African-Americans, with only three cases in white patients. Racial pigmentation may have a role in the pathogenesis of these lesions. Although the origin and pathologic significance of melanocytes in these pigmented intraosseous lesions cannot be explained, it may be something to consider for investigation in future.
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Castleman's disease p. 593
Himanshu Srivastava, Dulganti Santosh Reddy, Shreyas N Shah, Vandana Shah
DOI:10.4103/jomfp.JOMFP_283_20  
Castleman's disease, a type of lymph node hyperplasia, usually occurs in the mediastinum and rarely presents in the cervical region as an asymptomatic solitary mass. Clinically, they are of two types-solitary and multi-centric. Most of the solitary types are asymptomatic with no associated symptoms, whereas the multi-centric type is associated with systemic symptoms and has a poor prognosis. Histologically, they can be classified as–Hyaline vascular, plasma cell, transitional and stromal rich type. We report a case of Castleman's disease involving the submandibular lymph node in a 75-year-old male patient whose definitive diagnosis was made only on histological examination. Isolated Castleman's disease of the submandibular node is rare and a thorough clinical and histological examination is necessary to rule out the systemic form of the disease and other diseases with manifestations as a cervical lymph node enlargement.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007