Anuja N

Characterization of different tissue changes in normal, betel chewers, potentially malignant lesions, conditions and oral squamous cell carcinoma using reflectance confocal microscopy: Correlation with routine histopathology

The goal of this study was to characterize the features of normal mucosa, mucosa in betel chewers and smokers, potentially malignant lesions and squamous cell carcinoma of oral mucosa using reflectance confocal microscopy. Oral cavity biopsies were acquired from 25 patients from College of Dental Surgery, Saveetha University who underwent screening for suspected lesions of Oral precancer and Oral cancer along with normal patients who underwent impaction. Biopsies were acquired from the clinically suspicious area and immediately placed in Dulbecco modified eagles growth medium (DMEM). Reflectance confocal images were obtained at multiple image plane depths from biopsies within 6h of excision. After imaging, biopsies were fixed in 10% formalin and submitted for routine histopathological examination by an experienced oral and maxillofacial pathologist. Reflectance confocal images were compared with histological images from the same sample to determine the tissue features which contribute to early cellular changes, image contrast and early diagnosis. The confocal images were obtained to a depth of up to 150 microns on intact biopsy specimens and subsequent 3-dimensional images, keratin thickness measurements, cell measurements, cell density analysis and graphical representations were performed using Leica image analysis software. In normal mucosa keratin deposition were seen as alternating dark and bright stacks and in different cell layers the nuclei were seen as disks of varying intensities. In pre-cancerous lesions the keratin thickness and cell nuclear density were found to be increased when compared to normal controls. In OSMF cases confocal images of fibrosis show scattering from individual fibres as hyperdense areas. Oral squamous cell carcinoma cases demonstrated extensive variations in cell size, nuclear size and nuclear morphology. At cellular level, dysplastic features like increased nuclear density, increased nuclear cytoplasmic ratio, nuclear and cellular pleomorphism with loss of cohesiveness were identified in all five cases. Our results support the potential of reflectance confocal microscopy to play a significant role in clinical evaluations of oral lesions, early diagnosis of potentially malignant and malignant oral lesions and real time identification of tumour margins.

Unilocular cystic sebaceous lymphadenoma: a rare tumour.

A unique variant of the sebaceous lymphadenoma, so-called unilocular cystic sebaceous lymphadenoma, occurred in a 28-year-old male with a painless swelling in the left parotid region. The recognition of key histological features will readily allow differentiation of this unique neoplasm from its benign and malignant mimics. To our knowledge, out of 21 cases of sebaceous lymphadenoma reported, only 3 unilocular cystic variants have been recorded.

Pleomorphic Adenoma in the Infra-temporal Space: The First Case Report

The infratemporal fossa is a deep retromaxillary space corresponding to the inferior aspect of the middle cranial fossa. Tumours in the infratemporal fossa are very rare; therefore experience in their diagnosis and therapeutic management is very limited. Tumors that are reported commonly in the infratemporal region are nasopharyngeal carcinomas, juvenile angiofibromas and adenoid cystic carcinomas. To the best of our knowledge, this is the first report in the English language literature of a pleomorphic adenoma presenting in the infratemporal space and probably arising from an ectopic minor salivary gland, along with a brief description of the surgical technique.

Feasibility of Squash Cytology as a Diagnostic Technique in oral Squamous Cell Carcinoma -A Pilot Study

Background: Intra-operative cytology is an important diagnostic tool. The study was done to assess the feasibility of squash cytology as standalone diagnostic test in setting where frozen section facility is not available. Objective: To asses the value of squash cytology as intra-operative diagnostic technique. Material and Methods :this is the pilot study done on five cases of oral squamous cell carcinoma and 5 normal tissues.

Impregnation and embedding using bees wax and paraffin wax in oral tissue samples: A comparative study

Aim: The aim of this study is to compare paraffin wax that is used as routine embedding media and beeswax in impregnation and embedding of oral tissues. Materials and Methods: Ten biopsy specimens were impregnated and embedded in paraffin wax, ten biopsy specimens were impregnated and embedded in beeswax. After manual processing, all sections were stained with Hematoxylin and Eosin to compare the effect of beeswax and paraffin wax based on the features of the integrity of the section, uniformity of the stain, staining which includes nuclear details, cytoplasmic details, and background staining. Results: Beeswax showed well impregnation and embedding of the tissues as well as the preservation of the nuclear details, good cytoplasmic appearance, good tissue architecture and no bad effect on staining characteristics of the tissue. In addition, beeswax reduced the time needed for wax cooling. Conclusion: Beeswax can be used as an alternative to paraffin wax. Thus, we recommended using beeswax in our laboratories as they are widely available.

Cytomegalovirus and Mucoepidermoid carcinoma: A possible causal relationship? A pilot study.

Background: Human cytomegalovirus (CMV) infection has tropism for salivary gland ductal epithelium and establishes a persistent and lifelong infection. Mucoepidermoid carcinoma (MEC) is the most common salivary gland tumor. Recent studies have established that mouse CMV-induced tumorigenesis displays histologic and molecular characteristics similar to human MEC. We wished to explore further down the lane by analyzing the expression of pp65 and the key oncogenic signaling pathway in cases of MEC and their etiological relevance in the Indian scenario as a pilot study. Materials and Methods: Histopathologically confirmed cases of MEC (n = 4) and normal salivary gland tissue (n = 4) were subjected to immunohistochemical analysis using the markers pp65 and epidermal growth factor receptor (EGFR). Results: The pp65 antigen expression was found to be negative in all the studied cases and one case of high-grade MEC showed EGFR expression. Conclusion: The purpose of the study was to explore the role of CMV in the development of MEC, as it might help to exploit this etiological agent as a therapeutic target. Similar to human papillomavirus (HPV), these might identify a subset of neoplasms with a varied biological behavior and alternative therapies. However, this vision is obscured by contradicting evidence in the literature. As of today, surgery remains the only best possible management for these patients unless proven otherwise.

Detection of alcohol in saliva for blood alcohol concentration using alcohol saliva strip test: A forensic aid

Context: Alcohol is a factor in many categories of injury. Alcohol intoxication is frequently associated with injuries from falls, fires, drowning, overdoses, physical and sexual abusements, occupational accidents, traffic accidents and domestic violence. In many instances, for forensic purpose, it may be necessary to establish whether the patients/subjects have consumed alcohol that would have been the reason for the injury/accidents. Combining rapidity and reliability, alcohol saliva strip test (AST) has been put forward for the detection of alcohol in saliva for blood alcohol concentration (BAC). In the present study, we have determined BAC by using AST. Aims and Objectives: The main objective of this study was to detect alcohol in saliva for BAC in alcoholics by using AST. Materials and Methods: Two socio-economic groups were selected for the present study where Group A consisted of 40 subjects from the local bar and Group B consisted of 40 subjects from an organized party. The subjects were selected randomly at the local bar and at the organized party who have consumed different forms of alcohol. ALCO-SCREEN 02 plastic strip with a reactive pad was used for the detection of presence of alcohol in saliva. Results: In the present study, 85% of subjects from Group A, i.e., at the local bar, demonstrated positive results of variable intensity with AST when compared to the subjects from Group B in the organized party which was only about 25%. Conclusion: The present study showed that AST, performed by using ALCO-SCREEN 02 plastic strip with a reactive pad, can detect the presence of 0.02% BAC or more that can be helpful for various purposes such as forensic, workplace, medical and research settings. The study also showed that amount, time period, concentration and quality of the alcohol intake can influence the BAC, which can be a contributory factor for many accidents, injuries and medical conditions.