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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists
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   2014| September  | Volume 18 | Issue 4  
    Online since September 20, 2014

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Oral candidiasis: An overview
Arun Singh, Renuka Verma, Aditi Murari, Ashutosh Agrawal
September 2014, 18(4):81-85
DOI:10.4103/0973-029X.141325  PMID:25364186
Candida is the shortened name used to describe a class of fungi that includes more than 150 species of yeast. In healthy individuals, Candida exists harmlessly in mucus membranes such as your ears, eyes, gastrointestinal tract, mouth, nose, reproductive organs, sinuses, skin, stool and vagina, etc. It is known as your "beneficial flora" and has a useful purpose in the body. When an imbalance in the normal flora occurs, it causes an overgrowth of Candida albicans. The term is Candidiasis or Thrush. This is a fungal infection (Mycosis) of any of the Candida species, of which Candida albicans is the most common. When this happens, it can create a widespread havoc to our overall health and well-being of our body.
  11,943 1,547 -
Oral mucocele: A clinical and histopathological study
Chandramani B More, Khushbu Bhavsar, Saurabh Varma, Mansi Tailor
September 2014, 18(4):72-77
DOI:10.4103/0973-029X.141370  PMID:25364184
Background: Oral mucocele is the most common benign minor (accessory) salivary gland lesion, caused due to mechanical trauma to the excretory duct of the gland. Clinically they are characterized by single or multiple, soft, fluctuant nodule, ranging from the normal color of the oral mucosa to deep blue. It affects at any age and is equally present in both sexes with highest incidence in second decade of life. They are classified as extravasation or retention type. Objectives: To analyze the data between 2010 and 2011 of, clinically and histopathologically diagnosed 58 oral mucoceles for age, gender, type, site, color, cause, symptoms and dimension. Results: Oral mucoceles were highly prevalent in the age group of 15-24 years, were seen in 51.72% of males and 48.28% of females, with a ratio of 1.07:1. The extravasation type (84.48%) was more common than the retention type (15.52%). The most common affected site was lower lip (36.20%) followed by ventral surface of the tongue (25.86%). The lowest frequency was observed in floor of mouth, upper lip and palate. The maximum numbers of mucoceles were asymptomatic (58.62%), and the color of the overlying mucosa had color of adjacent normal mucosa (48.28%). It was also observed that most of the mucoceles had diameter ranging from 5 to 14 mm. The causative factors of the lesion were lip biting (22.41%), trauma (5.18%) and numerous lesions (72.41%). Conclusion: Oral Mucoceles are frequently seen in an oral medicine service, mainly affecting young people and lower lip, measuring around 5 to 14 mm and the extravasation type being the most common.
  9,271 793 -
Artefacts in histopathology
Shailja Chatterjee
September 2014, 18(4):111-116
DOI:10.4103/0973-029X.141346  PMID:25364159
Histopathology is the science of slide analysis for the diagnostic and research purposes. However, sometimes the presence of certain artefacts in a microscopic section can result in misinterpretations leading to diagnostic pitfalls that can result in increased patient morbidity. This article reviews the common artefacts encountered during slide examination alongside the remedial measures which can be undertaken to differentiate between an artefact and tissue constituent.
  7,377 1,313 -
Oral potentially malignant disorders: A proposal for terminology and definition with review of literature
Sachin C Sarode, Gargi S Sarode, Jagdish V Tupkari
September 2014, 18(4):77-80
DOI:10.4103/0973-029X.141322  PMID:25364185
Several attempts to produce internationally accepted terminologies and definitions of 'oral precancer' have appeared in the literature. World Health Organizations (WHO) in 1972 subdivided 'precancer' into 'lesions' and 'conditions' with their definitions. Recent working group of WHO is not in favor of such subdivision and recommended the use of the term 'oral potentially malignant disorder (OPMD)'. This is mainly attributed to the recent advancement in molecular and genetic aspects of 'oral precancer'. But efforts to define OPMDs are few in the literature. 'Oral precancer' is ultimately colligated to oral squamous cell carcinoma (OSCC). With this semantics in mind, different OPMD and related terminologies in the literature used till date with their lexicographic analysis have been reviewed in the present paper. Attempt has also been made to propose desirable terminology and definition which suits to the current concept of OPMD. The proposed terminology and definition is based on the authors' opinions with a hope for further suggestions from readers.
  6,392 1,468 -
Salivary duct cyst on lower lip: A rare entity and literature review
Ankita Tandon, Keya Sircar, Aman Chowdhry, Deepika Bablani
September 2014, 18(4):151-156
DOI:10.4103/0973-029X.141375  PMID:25364168
Mucocele forms because of salivary gland mucous extravasation or retention and is usually related to trauma in the area of the lower lips. Salivary duct cyst, however, is a type of mucous retention cyst which is almost never located on the lower lip. The aim of this paper is to report this extremely rare salivary duct cyst present on the lower lip and to critically review the literature to build important concepts that would help clinicians in the diagnosis and treatment of this pathology.
  6,680 360 -
Update on the classification of hemangioma
Antony George, Varghese Mani, Ahammed Noufal
September 2014, 18(4):117-120
DOI:10.4103/0973-029X.141321  PMID:25364160
Despite the fact that a biological classification of congenital vascular tumors and malformations was first published in 1982 by Mulliken and Glowacki, significant confusion still prevails due to the indiscriminate and interchangeable use of the terms hemangioma and vascular malformation. Hemangiomas are true neoplasms of endothelial cells and should be differentiated from vascular malformations which are localized defects of vascular morphogenesis. On an analysis of various scientific articles and latest edition of medical text books an inappropriate use of various terms for vascular lesions was found, contributing further towards the confusion. The widely accepted International Society for the Study of Vascular Anomalies (ISSVA) classification differentiates lesions with proliferative endothelium from lesions with structural anomalies and has been very helpful in standardizing the terminologies. In addition to overcoming obstacles in communication when describing a vascular lesion, it is important that we adhere to the correct terminology, as the therapeutic guidelines, management and follow-up of these lesions differ.
  5,614 826 -
Ergonomics in an oral pathology laboratory: Back to basics in microscopy
Krishna Sireesha Sundaragiri, Shikha Shrivastava, Bharat Sankhla, Akshay Bhargava
September 2014, 18(4):103-110
DOI:10.4103/0973-029X.141341  PMID:25364157
Ergonomics is simply a science focused on "study of work" to reduce fatigue and discomfort through product design. A comprehensive ergonomics program for the pathology laboratory has become necessary to prevent the occurrence of work related musculoskeletal disorders (MSDs) and accidents. Most of the literature on ergonomics involve various web links or occasional studies on the effect of laboratory work and associated MSDs. A Google search was carried out corresponding to the terms "ergonomics", "pathology laboratory", "microscope". All the relevant literature from web sources was sorted out and categorized. In this review, we intend to identify basic anthropometric factors, biomechanical risk factors, laboratory design considerations and specific microscopy-related considerations. The ultimate aim of ergonomics is to provide a safe environment for laboratory personnel to conduct their work and to allow maximum flexibility for safe research use.
  5,059 469 -
Dentinogenesis imperfecta type I: A case report with literature review on nomenclature system
D Devaraju, BK Yashoda Devi, Vijeev Vasudevan, V Manjunath
September 2014, 18(4):131-134
DOI:10.4103/0973-029X.141363  PMID:25364163
Dentinogenesis imperfecta (DI) is an inherited disorder affecting dentin. Defective dentin formation results in discolored teeth that are prone to attrition and fracture. Mutation in dentin sialophosphoprotein (DSPP) has been found to cause the dentin disorders DI - I and II (shields II and III). Early diagnosis and treatment of DI is recommended as it may prevent or intercept deterioration of the teeth and occlusion and improve esthetics. Here, we report a case with characteristic clinical, radiological and histological features of DI-I. The etiology and classification followed in literature is confusing since dentinoenamel junction (DEJ) in DI seems to be structurally and functionally normal and DI is clearly a disorder distinct from osteogenesis imperfecta (OI), but we still relate etiology of DI to DEJ and follow Shields classification. Therefore, we have briefly reviewed etiology and nomenclature system of DI.
  4,890 398 -
Oral Crohn's disease
BN Padmavathi, Smriti Sharma, Madhusudan Astekar, Y Rajan, GV Sowmya
September 2014, 18(4):139-142
DOI:10.4103/0973-029X.141369  PMID:25364165
'Crohn's disease' is an inflammatory granulomatous disease of the gastrointestinal tract with extra-intestinal manifestations. Oral lesions may precede the intestinal disease and serve as a source for histological diagnosis. We present a case of orofacial Crohn's disease where orofacial symptoms were present for about 13 years and occasional constipation was present, since 6 months. Oral examination plays an important role in early diagnosis of Crohn's disease.
  4,488 312 -
Enigmatic Morpho Insight: Mitosis At A Glance
Radhika M Bavle
September 2014, 18(4):2-5
DOI:10.4103/0973-029X.141175  PMID:25364173
  3,831 741 -
Focal fibrous hyperplasia: A review of 193 cases
Thiago de Santana Santos, Paulo Ricardo Saquete Martins-Filho, Marta Rabello Piva, Emanuel Savio de Souza Andrade
September 2014, 18(4):86-89
DOI:10.4103/0973-029X.141328  PMID:25364187
Context: Focal fibrous hyperplasia, also known as irritation or traumatic fibroma, is a reactive, inflammatory hyperplastic lesion of the connective tissue. Aim: The aim of this study is to perform a retrospective study of a focal fibrous hyperplasia of 18 years. Materials and Methods: We retrospectively reviewed 193 cases of focal fibrous hyperplasia of the oral cavity from the medical and histological reports of the Department of Oral Pathology, Pernambuco University, Brazil, during the period between January 1992 and December 2009. Settings and Design: Data with regard to age, gender, location, size of the lesion (equal to or less than 1 cm, between 1 and 2 cm and greater than 2 cm), pain, history of trauma, treatment, length of follow-up (from diagnosis to release or last review) and recurrence, were collected. Results: The most commonly affected site was the buccal mucosa (n = 119, 61.7%). Almost two-thirds of the cases were concentrated from the second to the fifth decade of life. Females were more affected than men and a history of trauma was related by 90.7% of the patients. Two recurrences were notified (1.0%). Conclusion: Further studies are needed on the distribution of the lesion in different ethnic and geographical populations. The influence of sex hormones on the development of focal fibrous hyperplasia must be clarified.
  3,351 496 -
A comparative study of oral candidal species carriage in patients with type1 and type2 diabetes mellitus
Mangesh P Shenoy, Rudrayya S Puranik, Shrinivas S Vanaki, Surekha R Puranik, Pushparaja Shetty, Radhika Shenoy
September 2014, 18(4):60-65
DOI:10.4103/0973-029X.141361  PMID:25364182
Context: Diabetes mellitus can have profound effects upon the oral tissues especially in patients with poor glycemic control being prone to severe and/or recurrent infections particularly candidiasis. The main aim was to study the association between Type 1 and Type 2 diabetes mellitus and candidal carriage. Materials and Methods: The study design comprised of previously diagnosed 30 patients each with type 1 diabetes mellitus (Group A) and type 2 diabetes mellitus (Group B) and 30 age-, sex- and dental status-matched healthy non-diabetic individuals as controls (Group C). The saliva samples were collected and inoculated onto Sabouraud dextrose agar (SDA) and chromogenic agar culture medium. Candidal colony forming units per ml (CFU/ml) values were determined. Statistical Analysis: Data were analyzed by χ2 test, Mann-Whitney U-test, Spearman's rank correlation and Karl Pearson's correlation coefficient. Results: Data analysis showed statistically significant higher positive candidal growth in Group A and Group B when compared to Group C. The CFU/ml values were significantly higher in Groups A and B as compared with Group C. Significant positive correlation of CFU/ml with fasting blood sugar level and HbA1c% in both Groups A and B was seen. Oral signs and symptoms observed in diabetics were dry mouth, burning sensation, fissuring and atrophic changes of tongue and erythematous areas, which positively correlated with candidal load. Conclusion: The glycemic control status of the diabetic patients may directly influence candidal colonization. The quantitative and biochemical characterization allows better insight into the study of association of diabetes mellitus and candida.
  3,373 402 -
Comparing the efficacy of coconut oil and xylene as a clearing agent in the histopathology laboratory
Wajid Sermadi, Sudeendra Prabhu, Swetha Acharya, SB Javali
September 2014, 18(4):49-53
DOI:10.4103/0973-029X.141348  PMID:25364179
Background: The commonly used clearing agent, xylene is supposed to be highly toxic and carcinogenic. As previous research studies have shown the effectiveness of different vegetable oils as clearants, this study was designed to evaluate the efficacy of coconut oil. Materials and Methods: Two equal halves of 60 soft tissue specimens were processed simultaneously in xylene and coconut oil as clearing agents. The Xylene-treated specimens (XY-S) and Coconut oil-treated specimens (CO-S) were checked for gross and histological features and comparison was done between the two groups. Results: Significant shrinkage was noted in XY-S compared to that in CO-S. No difference was found in either of the sections when checked for cellular details and staining quality. Morphometrically, there was significant reduction in the mean cell area in XY-S compared to that in CO-S. Conclusion: Coconut oil may be substituted for the highly hazardous xylene as a clearing agent without compromising the quality of histological details.
  3,332 400 -
Ameloblastic carcinoma of the mandible: Report of a case and review
Shreenivas Kallianpur, Sanjay Jadwani, Biswajit Misra, US Sudheendra
September 2014, 18(4):96-102
DOI:10.4103/0973-029X.141336  PMID:25364189
Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that can arise either as a de novo lesion or from pre-existing ameloblastoma. Histopathologically, the tumor retains an ameloblastomatous differentiation pattern but shows cytological features of malignancy. Owing to variable biologic behavior and paucity of long-term follow-up cases, there has been no clear consensus on treatment protocol. The present case of ameloblastic carcinoma arose in the mandible of a 24-year-old male. Surgical treatment involved resection of the mandible along with regional lymph nodes. The patient has been on follow up for the past one year without any recurrence or metastases. An update on ameloblastic carcinoma encompassing the histogenesis, immunohistochemical features and treatment aspects are included.
  3,311 404 -
Dens invaginatus (dilated odontome) in mandibular canine
Sangamesh S Halawar, GVV Satyakiran, PS Krishnanand, R Prashanth
September 2014, 18(4):157-162
DOI:10.4103/0973-029X.141379  PMID:25364169
Dens invaginatus is a developmental malformation of teeth related to shape of the teeth. Affected teeth show a deep infolding of enamel and dentin starting from the tip of the cusps and may extend deep into the root. It results from the invagination of the enamel organ into the dental papilla before calcification has occurred. Teeth most affected are maxillary lateral incisors. The presence of dens invaginatus in mandibular canine is extremely rare. The tooth was symptomatic in that it was mobile and was oriented horizontally. This article presents a case of symptomatic dens invaginatus in mandibular canine.
  3,341 248 -
A study of salivary lactate dehydrogenase isoenzyme levels in patients with oral leukoplakia and squamous cell carcinoma by gel electrophoresis method
Priya Shirish Joshi, Someshwar Golgire
September 2014, 18(4):39-44
DOI:10.4103/0973-029X.141342  PMID:25364177
Context: The enzyme lactate dehydrogenase (LDH), which is found in almost all the cells of body tissues, can be separated into five fractions and the isoenzyme pattern is believed to vary according to the metabolic requirement of each tissue. LDH concentration in saliva, as an expression of cellular necrosis, could be considered to be a specific indicator for oral lesions that affect the integrity of the oral mucosa. Aim: The present study was designed to evaluate salivary LDH isoenzyme pattern in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) and to correlate between LDH isoenzyme levels and histopathologic grading in selected cases of OL and OSCC. Materials and Methods: Clinically diagnosed 30 cases each of OL and OSCC were selected for the study and 30 healthy individuals of comparable age served as control. Unstimulated whole saliva was aseptically collected and was processed immediately for LDH isoenzymes measurement by agarose gel electrophoresis. Biopsy specimen obtained was processed and stained by hematoxylin and eosin. Sections of OL and OSCC cases were scrutinized histopathologically and appropriately graded for epithelial dysplasia and differentiation of carcinoma respectively. Statistical Analysis Used: Two sample t test for testing the significance of difference between two group means was used. Results and Conclusion: The present salivary analysis for LDH isoenzyme reveals an overall increased salivary LDH isoenzyme level in OL and OSCC cases and a significant correlation between levels of salivary LDH isoenzymes and histopathologic grades of dysplasia in OL and OSCC. Salivary analysis of LDH will definitely provide the clinician and/or the patient himself with an efficient, non invasive and friendly new tool for diagnosis and monitoring of oral precancer and cancer.
  2,990 373 -
Telangiectatic osteosarcoma affecting the mandible
LR Kumaraswamy Naik, Pushparaja Shetty, S Teerthanath, H Makannavar Jagadeesh
September 2014, 18(4):143-146
DOI:10.4103/0973-029X.141371  PMID:25364166
Osteosarcomas are relatively rare in jaws and maxillomandibular lesions in children are distinctly uncommon. Telengiactic osteosarcomas in jaws are still a very rare variant and till now just 3 cases are reported in English literature. Herein, we report the first case of telangiectatic osteosarcoma occurring in mandible in pediatric patient. Patient was treated by hemimandibulectomy and is free of disease since seven years with regular follow-up.
  3,085 216 -
Mesenchymal chondrosarcoma of mandible: A rare case report and review
Priyanka Singh, Anil Singh, Sujata Saxena, Sanjay Singh
September 2014, 18(4):167-170
DOI:10.4103/0973-029X.141376  PMID:25364172
Mesenchymal Chondrosarcomas (MCs) are rare malignant connective tissue neoplasms representing approximately 1% of all chondrosarcomas (CSs) that can arise from both soft and hard tissues. They are distinct tumors arising in unicentric or multicentric locations. The tumor is most unusual as it has been described as a particularly aggressive neoplasm with a high tendency for late recurrence and delayed metastasis. It is a biphasic tumor with areas comprising of spindle cell mesenchyme having areas of chondroid differentiation. Here we report a case of 60-year-old male with mesenchymal CS of the mandible.
  2,798 268 -
Acantholytic squamous cell carcinoma of the oral cavity: A rare entity
Kavita Mardi, Narbir Singh
September 2014, 18(4):128-130
DOI:10.4103/0973-029X.141359  PMID:25364162
Acantholytic squamous cell carcinoma (ASCC) is an uncommon but well-recognized variant of squamous cell carcinoma that was first described by Lever in 1947. ASCC has been reported to originate in the sun-exposed skin of the head and neck and in other sites. However ASCC located in the oral cavity is extremely rare. The patient was a 50-year-old man who presented with an ulcer on the right maxillary alveolar mucosa. The biopsy was diagnosed as ASCC. Tumor resection was therefore performed. Histologically, acantholytic pattern was seen throughout the tumor.
  2,730 304 -
Follicular lymphoma of the submandibular salivary gland
R Shashidara, Priyanka R Prasad, Jaishankar , Thomas Joseph
September 2014, 18(4):163-166
DOI:10.4103/0973-029X.141382  PMID:25364171
Lymphomas are neoplastic diseases of lymph nodes. Lymphoma of the salivary gland is rare accounting for less than 5% of lymphomas overall. Furthermore, lymphomas arising in the submandibular gland are reported to comprise 916% of all salivary gland lymphomas. Among lymphomas originating from salivary glands, the ratio of follicular lymphoma is very low. They can also be seen in the lymph nodes of the salivary glands which is an uncommon presentation. Here, we present a case follicular lymphoma which presented as a salivary gland tumour.
  2,720 174 -
A phase contrast cytomorphometric study of squames of normal oral mucosa and oral leukoplakia: Original study
Afreen Nadaf, Radhika M Bavle, Lalita J Thambiah, K Paremala, M Sudhakara, M Soumya
September 2014, 18(4):32-38
DOI:10.4103/0973-029X.141339  PMID:25364176
Oral leukoplakia represents the most common potentially malignant oral disorder, representing 85% of such lesions. The worldwide prevalence of leukoplakia is 1.5- 4.3%. Leukoplakia is often associated with carcinogenic exposures, such as from use of tobacco, alcohol or betel nut. The level of risk for malignant transformation of leukoplakia is associated with lesion histology. The overall malignant transformation rates for dysplastic lesions range from 11% to 36%, depending on the length of follow-up. Exfoliative cytology is a simple and minimally invasive method. Phase contrast microscope, an essential tool in the field of biology and medical research provides improved discrimination of cellular details. Aims: To study and compare the cytomorphological and cytomorphometric features of squames obtained from the mucosa of normal individuals, tobacco habituates with and without clinically evident leukoplakia. To assess the role of phase contrast microscopy as an alternative and easy method of cytological evaluation of wet and unstained smears. Materials and Methods: Fifty cases from each group were taken. Fixed, unstained smears were viewed under phase contrast microscope and were evaluated morphologically and morphometrically for nuclear and cellular diameters. Results: The study showed a significant increase in the mean nuclear diameter and decrease in the mean cellular diameter. Conclusion: Cytomorphometric changes could be the earliest indicators of cellular alterations. This indicates that there could be a cause-effect relationship between tobacco and quantitative alterations.
  2,274 419 -
Evaluating the efficacy of osteopontin expression as a prognostic marker in oral squamous cell carcinoma in the Indian subpopulation
Yashwant Ingale, Samapika Routray, Supriya M Kheur, Mohit Kheur, Neeta Mohanty
September 2014, 18(4):11-15
DOI:10.4103/0973-029X.141327  PMID:25364158
Aim: This study aimed to correlate the prognostic value of osteopontin (OPN) expression using both tissue and plasma samples from patients with clinically and histologically confirmed oral squamous cell carcinoma (OSCC). Methods and Materials: The study group comprised of sixty patients (n = 60), which were clinically and histologically diagnosed for oral squamous cell carcinoma (OSCC) . The Control group comprised of ten (n = 10) healthy volunteers. Plasma OPN levels were assayed using a quantitative enzyme-linked immunosorbent assay (OPN ELISA). Expression of OPN was also identified and evaluated by immunohistochemistry in tissue sections. These OPN expressions were then correlated with different parameters like age, sex, site, clinical presentation, tumor node metastasis (TNM) staging, histopathological grading and lymph node metastasis. Statistical Analysis: One-way analysis of variance (ANOVA) was used to evaluate the difference in tissue intensity and plasma OPN levels between the OSCC and the normal control groups. Results: The distribution of the plasma OPN levels and tissue OPN intensity in OSCC cohorts were compared to histopathological grades and analyzed. When evaluated OPN expression in tissue had higher intensity observed in OSCC (95% +ve) cases. And the mean plasma OPN concentration in OSCC cohort was more in comparison to the normal cohort. The results clearly showed that the plasma OPN levels and intensity grading in tissue correlated with tumor grades. Conclusion: The study highlights OPN as a biomarker for prognosis in OSCC in both plasma and tissue samples. We would like to emphasize on the evaluation of plasma OPN as a protocol of blood examination for all cancer patient, as it may serve as an indicator for tumor progression and potential risk of metastasis.
  2,407 272 -
Intraoral salivary duct carcinoma: A case report and a brief review
Swetha Acharya, S Padmini, Anila Koneru, Rekha Krishnapillai
September 2014, 18(4):121-127
DOI:10.4103/0973-029X.141353  PMID:25364161
Salivary duct carcinoma (SDC) is a rare, extremely aggressive malignancy arising in the ductal epithelium of the salivary glands. SDC occurs almost exclusively in the major salivary glands with parotid gland predominantly affected. Only isolated cases involving minor salivary glands have been reported in the literature. We report an unusual case of extensive SDC occupying the right cheek and the maxillary sinus, possibly arising from the minor glands of the buccal mucosa or from the mixed glands of the maxillary sinus in a 71-year-old man. The case was subjected to a panel of immunohistochemical markers like pan cytokeratin, low molecular weight cytokeratin (LMW CK), high molecular weight cytokeratin (HMW CK), CK 7, CK 20, CD 117, carcinoembryonic antigen (CEA), S-100, p63, Gross cystic disease fluid protein (GCDFP-15) and estrogen receptor (ER) to arrive at a definitive diagnosis.
  2,235 239 -
Ameloblastoma in the Northeast region of Brazil: A review of 112 cases
Thiago de Santana Santos, Marta Rabello Piva, Emanuel Sávio de Souza Andrade, André Vajgel, Ricardo José de Holanda Vasconcelos, Paulo Ricardo Saquete Martins-Filho
September 2014, 18(4):66-71
DOI:10.4103/0973-029X.141368  PMID:25364183
Context: Ameloblastomas are benign tumors of the jaws with locally invasive capacity. Aim: The aim of this study was to review 112 cases of ameloblastoma seen over an 18-year period (1992-2009) at the Pernambuco Dental School, University of Pernambuco and at Federal University of Sergipe, in the northeast region of Brazil. Materials and Methods: The following data were selected for analysis: age, gender, race, site distribution, radiographic appearance, association with an impacted tooth, size, presence of symptoms, clinicopathologic subtypes and recurrence. Settings and Design: In this retrospective study, Pearson's χ2 test and t-test were employed. The critical level of significance was set at P < 0.05. Results: The mean age of the patients at presentation was 35.1 ± 16.8 years with a slight female preference. The peak prevalence was in the 11- to 20-year age group and declined with increasing age. Total 75 patients were black and 37 were white, for a 2:1 black: white ratio. The location of the ameloblastomas showed a marked predominance in the mandible (84.8%) and 69% of the cases presented with a multilocular radiographic appearance. The tumor was associated with an embedded tooth in 14 cases (12.7%): nine unilocular and five multilocular ameloblastomas. The maximum radiological extension of the lesions on panoramic radiographs was 0.5-20 cm (mean ± SD: 5.2 ± 3.3 cm) and most cases were symptom-free (75.9%). Solid/multicystic ameloblastoma was the most common clinicopathologic subtype. There was an association between the clinicopathologic subtypes and radiographic appearance (P < 0.001). Recurrence was observed in 13.3% of cases. Conclusion: We propose that racial factors may have strong influence on the incidence of ameloblastomas in the northeast region of Brazil, since most people have African descent. Data related to gender, location, radiographic appearance, size, symptoms, clinicopathologic subtypes and recurrence were similar to previous studies conducted in various parts of the world.
  2,129 265 -
Ki-67 and p53 expression in solitary sporadic, syndrome associated and recurrent keratocystic odontogenic tumor
Jyoti Alur, TV Narayan, Leeky Mohanty, Sadhana Shenoy, Saleha Jamadar, Shobith Shetty
September 2014, 18(4):21-25
DOI:10.4103/0973-029X.141330  PMID:25364174
Background: Ki-67 and p53 are markers expressed in actively proliferating cells, particularly in neoplasms. Objectives: (1) To study the proliferative potential of epithelia in Solitary Sporadic, Syndrome-associated and Recurrent Keratocystic odontogenic tumors (KCOTs) using Ki67 and p53 labeling indices (LI). (2) To derive a relationship if any between the expression of these proteins and the biologic behavior of Solitary Sporadic and Syndrome associated KCOTs. Study Design: Thirteen paraffin embedded blocks of KCOTs (Solitary Sporadic, n = 03; Recurrent, n = 03; Syndrome associated, n = 07) were stained immunohistochemically for Ki-67 and p53 and labeling indices were calculated. Statistical Analysis: Z test with predetermined alpha set at 0.05 was used for the comparison of Ki-67 positivity between the three groups and p53 positivity between the three groups. Results: Ki-67 labeling indices were: 30% in solitary sporadic; 26% in recurrent; and 32% in syndrome associated KCOTs. p53 labeling indices were: 19% in solitary sporadic; 23% in recurrent; and 21% in syndrome-associated KCOTs. There was no difference seen in the rate of proliferation in the epithelial linings between the three groups. However, in our cases where Ki-67 positivity was seen there was expression of p53. Though not statistically significant a trend was seen, reflecting the loss of balance between the proliferative potential and apoptotic activity. Conclusion: On the basis of proliferative index alone it is not possible to comment on biological behavior of KCOTs associated with syndrome versus those of solitary and recurrent. There is probably a mesenchymal role which needs to be researched.
  2,130 231 -
A rare incident of Paget's disease of bone in early adult life
Harishchandra Rai, Shaila M Pai, Anitha Dayakar, Vivek Javagal
September 2014, 18(4):147-150
DOI:10.4103/0973-029X.141373  PMID:25364167
Paget's disease of bone (PDB) is characterized by a focal alteration of bone remodeling, which leads to bone with anomalous structure and altered mechanical properties associated with pain and complications. It is more common in Western Europe where as rare in Africa and Asia. The disease is more common in men of older adults and mean age of occurrence is 59 ± 14 years. But it is rarely encountered in patients younger than 40 years of age.
  2,129 225 -
Second malignancies in Hodgkin's disease: A review of the literature and report of a case with a secondary Lennert's lymphoma
Ernst JG Norval, Erich J Raubenheimer
September 2014, 18(4):90-95
DOI:10.4103/0973-029X.141332  PMID:25364188
A small percentage of patients treated for Hodgkin's disease are at risk of developing a second malignancy. The appearance of secondary malignancies such as leukemia, carcinoma or non-Hodgkin's lymphomas may be attributed to the mutagenic effects of chemotherapy and/or radiotherapy. Most secondary non-Hodgkin's lymphomas are of the B-cell type, but isolated cases were reportedly of a T-cell lineage. A review of the literature pertaining to the development of secondary peripheral T-cell lymphomas is presented along with the description of an additional case. The latter developed in the tonsil and was diagnosed as a Lennert's lymphoma (lymphoepithelioid T cell lymphoma)on histological and immunological grounds. This report also reviews the development of a of peripheral T-cell lymphoma described in patients following chemotherapy and/or radiotherapy for Hodgkin's disease
  2,109 204 -
DNA damage in peripheral blood leukocytes in tobacco users
Venkateswara Rao Guttikonda, Rekha Patil, GS Kumar
September 2014, 18(4):16-20
DOI:10.4103/0973-029X.141329  PMID:25364170
Aim : To Quantify the DNA single-stranded breaks in the peripheral blood leukocytes (PBLs) of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma. Objectives: To evaluate DNA damage levels in PBLs of tobacco-habituated individuals with clinically normal mucosa and patients with oral carcinoma and compare with a control group of healthy volunteers. To evaluate the extent of DNA damage in PBLs using Single Cell Gel Electrophoresis (SCGE) in the above groups. Materials and Methods : Patients who were attending the outpatient department were enrolled in this study. A control group of 30 healthy volunteers included in Group I were selected from various age groups who are not tobacco users in any form. Thirty patients with tobacco habituation but with clinically normal mucosa were included in Group II, while 30 tobacco-habituated patients with oral squamous carcinoma were included in Group III. A biopsy was taken from the representative area and confirmed histologically. Intravenous blood samples were collected from all the groups for evaluation of the extent of DNA damage using ethidium bromide-stained slides under fluorescent microscope. The DNA tail length was calculated by subtracting the diameter from the total length. Twenty-five randomly selected cells per slide were analyzed and mean calculated. Results : The mean DNA damage levels in patients with tobacco habits were compared with that of the control group and the results were found to be statistically significant. The mean DNA damage level in PBLs between tobacco-habituated patients with normal mucosa and oral cancer patients was found to be statistically significant. The DNA damage in cancer patients was compared with the control group and the results were found to be statistically significant. Conclusion : DNA damage evaluation in PBLs by SCGE technique is a sensitive and reliable indicator of tobacco insult.
  1,879 340 -
Analysis of silver stained nucleolar organizing regions in odontogenic cysts and tumors
MD Prasanna, CR Charan, Kranti Kiran Reddy Ealla, V Surekha, Ganesh Kulkarni, Sandhya Gokavarapu
September 2014, 18(4):45-48
DOI:10.4103/0973-029X.141345  PMID:25364178
Objective: The present study aimed to investigate the probable differences in cell proliferation index of odontogenic cysts and tumors by means of a comparative silver stained nucleolar organizing region (AgNOR) quantification. Study Design: This descriptive cross-sectional study was done on archival paraffin blocks (n = 62), consisting of 10 odontogenic keratocysts, 10 dentigerous cysts, 10 radicular cysts, 10 conventional ameloblastomas, 10 adenomatoid odontogenic tumors, 10 calcifying epithelial odontogenic tumors and 2 ameloblasic carcinomas. Results: The mean AgNOR count of odontogenic cysts was 1.709 and the benign odontogenic tumors was 1.862. Highest AgNOR count was recorded in odontogenic keratocyst and lowest was seen in radicular cyst. Statistically significant difference in AgNOR counts of ameloblastoma and adenomatoid odontogenic tumor, amelobalastoma and calcifying epithelial odontogenic tumor, benign odontogenic tumors and ameloblastic carcinoma were seen. AgNORs in ameloblastic carcinoma were more in number and more widely spread. Conclusion: AgNOR technique may be considered a good indicator of cell proliferation in odontogenic cysts and tumors.
  1,833 312 -
Esthesioneuroblastoma presenting as tooth pain
Parvathi Devi, Radhika Bhavle, Avanti Aggarwal, Cherry Walia
September 2014, 18(4):135-138
DOI:10.4103/0973-029X.141367  PMID:25364164
Esthesioneuroblastoma, also called olfactory neuroblastoma, is a rare malignant tumor originating in the olfactory epithelium in the upper nasal cavity with intracranial extension and may also be associated with secondary sinus diseases. Esthesioneuroblastoma has been observed to cause death by distant metastasis or by invasion through the cribriform plate and secondary meningitis. It usually produces nasal obstruction, epistaxis and less commonly anosmia, headache and pain. We report a case of esthesioneuroblastoma in a 50-year-old female who reported with tooth pain as a presenting symptom.
  1,951 170 -
Immunohistochemical analysis of laminin expression in adenoid cystic carcinoma
S Anupriya, Pushpalatha Mahesh, P Sharada, Uma Swaminathan, BR Nagamalini, Sreelatha S Hosthor
September 2014, 18(4):26-31
DOI:10.4103/0973-029X.141334  PMID:25364175
Background and Objectives: This study aims at the observation of the immunohistochemical expression of laminin in adenoid cystic carcinoma (ACC) of salivary gland origin and to analyze the distribution of laminin in various components of the tumor and correlate the expression of laminin with the growth and differentiation of the tumor. Materials and Methods: Thirty cases of ACC were subjected to immunohistochemical study using polyclonal antihuman laminin primary antibody, distribution of laminin in each case of ACC was observed in the following areas: Intracellularly, inner borders of the pseudocystic spaces, within the lumen of the pseudocysts, around the tumor islands and in the intervening stroma. Results: Laminin positivity was observed in the inner aspect of the pseudocystic spaces in 15 cases, within the lumen of pseudocystic spaces in 22 cases, in the intervening stroma in 20 cases, bordering the tumor islands in 16 cases and intracellularly in 4 cases. Interpretation and Conclusion: Based on these observations, it can be assumed that laminin plays a major role in proliferation of the tumor cells and in pseudocyst formation. Thus, laminin might play a significant role in the growth and differentiation of ACC and also help in assessing the prognosis of the tumor.
  1,826 217 -
Computer assisted histomorphologic comparision and the expression of AgNORs in the central and peripheral giant cell lesions of the oral cavity and giant cell tumor of the long bone
Bina Kashyap, Sridhar P Reddy, Rajiv Desai, Rudrayya S Puranik, Srinivas S Vanaki
September 2014, 18(4):54-59
DOI:10.4103/0973-029X.141350  PMID:25364180
Objective: Computer-assisted image analysis was attempted to ascertain, if any of the previously described histologic features along with argyrophilic nucleolar organizer regions (AgNORs) could be used to determine the aggressiveness of the central giant cell granuloma of the jaws (CGCG), peripheral giant cell granuloma of the oral cavity (PGCG) and giant cell tumor of the long bones (GCT). Study Design: The study consisted of 20 cases of CGCG, 20 cases of PGCG and 5 cases of GCT. The histological features included were number of giant cells, number of nuclei in each giant cell, number of blood vessels, fractional surface area (FSA) and relative size index (RSI) of giant cells. The histologic parameters were measured using Motic image plus analyzer and AgNORs were evaluated using silver stain. Results: The statistical analysis showed significant differences among various histological parameters between CGCG, PGCG and GCT. A statistically significant difference was noted for the mean number of nuclei, FSA and RSI when GCT was compared with CGCG and PGCG. FSA of histologically aggressive central giant cell granuloma (HA-CGCG) was more compared to histologically non-aggressive central giant cell granuloma (HNA-CGCG). No statistical correlation was observed for AgNORs of multinucleated giant cells and mononuclear cells among CGCG, PGCG and GCT. Conclusion: Based on the present study findings, CGCG and GCT are distinct and separate entities and not a continuum of a single disease process. Histological parameters alone have a little implication on predicting clinical behavior of CGCG. AgNORs alone as a proliferative marker has a limited value in assessing the proliferation potential of giant cell lesions.
  1,836 197 -
Seasonality of Burkitt's lymphoma in Uganda
L Muwazi, CM Rwenyonyi, A Kutesa, A Kasangaki, A Kamulegeya
September 2014, 18(4):6-10
DOI:10.4103/0973-029X.141323  PMID:25364181
Background/Aims:Burkitt's lymphoma is the most common childhood oral maxillofacial tumor in Africa and some studies have reported seasonal variation. Materials and Methods:All Burkitt's cases diagnosed from 1969 to 2006, from all over Uganda, at the Makerere University's Department of Pathology, were analyzed, to determine seasonal variation. This was done by evaluation of monthly and rainy versus dry season prevalence. Statistical analysis: The Wilcoxon test was used in both cases, to assess the statistical significance of differences in the diagnostic rates of Burkitt's lymphoma, in comparison to nonspecific chronic inflammation, using the total as the denominator. Yearly variation in prevalence was examined by a Chi-square test for linear trend. Mann-Whitney tests were done to compare the climatic regions. Multivariate analysis of variance (MANOVA) was used to test for differences when gender, seasons and climatic regions were factored in. Results: Although monthly frequencies varied considerably over the period, none of the differences were statistically significant (Pearson's 15.199, degrees of freedom df = 11, P = 0.174). Likewise, there was no statistically significant difference in the total number of Burkitt's and nonspecific chronic inflammation biopsies handled at the Department during the rainy and dry seasons. Conclusion: Although the 38-year period gave us sufficient numbers to use the Edward's method for seasonality, it also meant that a lot of seasonal changes that occurred during the period were not taken into consideration. We hence feel that a review of this data with weather experts, so as to group the biopsies into accurate rainfall and dry patterns, would yield a more authoritative publication.
  1,843 182 -
From the Editor's desk
Radhika M Bavle
September 2014, 18(4):1-1
DOI:10.4103/0973-029X.141173  PMID:25364156
  1,369 210 -
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