Hari Ram

Oral cancer: risk factors and molecular pathogenesis.

IntroductionOral cancer is one of the most common cancers and it constitutes a major health problem particularly in developing countries. It is one of the leading causes of death. Tobacco and alcohol consumption appears to be the major determinants of oral cancer.Materials and methodsThe literature search was carried out in NCBI Pubmed database using keywords “oral cancer”, “risk factor”, “epidemiology” and “patho*”. Some basic information was also obtained from textbook and medical university websites.ResultsSeveral risk factors have been well characterized to be associated with oral cancer with substantial evidences. The development of oral cancer is a multistep process involving the accumulation of genetic and epigenetic alterations in key regulatory genes. Experimental pathological studies of oral cancer in animal models and direct molecular genetic analysis of oral cancer subjects in recent times have revealed a substantial amount of knowledge on specific gene alterations or other genetic mechanisms involved in initiation and subsequent progression.ConclusionConsidering known risk factors, oral cancer appears to be to a certain extent, a preventable disease. Recent development of molecular picture of pathoprogression and molecular genetic tools opens the avenue for easier diagnosis, better prognostication and efficient therapeutic management.

Bilateral cavernous sinus thrombosis and facial palsy as complications of dental abscess.

Septic cavernous sinus thrombosis (CST) related to dental infection is a rare clinical event. The septic CST is a disease of high morbidity and mortality. The prompt diagnosis and timely treatment of septic CST is cornerstone of successful outcome. The dental infection should be given due attention, as to prevent CST. In this case report of immunocompetent female, we highlighted the role of dental abscess in producing bilateral CST and facial palsy. The close collaboration between dentist and neurologist and early institution of antibiotics led to complete recovery at follow-up after 3 months. The dental infection should never be neglected as it is the interface of serious intracranial complication like CST.

Overexpression of COX-2 in oral squamous cell carcinoma patients undergoing chemoradiotherapy.

Aims and Objectives: To evaluate the prognostic significance of cyclooxygenase-2 (COX-2) overexpression in oral squamous cell carcinoma (OSCC) patients undergoing chemoradiation therapy. Purpose of the study was to determine whether COX-2 could be used as a diagnostic and prognostic index in OSCC. Materials and Methods: Forty-four patients of SCC were included in the present study and immunohistochemical examination was done for COX-2 expression. Negative and <5% COX-2 positivity were taken as negative expression and ≥5% COX-2 positivity as positive expression group. ≥30% COX-2 positivity was taken as overexpressed group and <30% COX-2 positivity was taken as underexpressed group. All the data were analyzed statistically. Results: COX-2 overexpression in OSCC was found in 15.90% cases. The proportion of COX-2 overexpression was higher in patients with large tumor size than in those with small tumor size. The proportions of COX-2 positive expression cases were higher with cervical lymph node metastasis. Negative COX-2 expression was higher in well-differentiated OSCC and positive expression was higher in moderately differentiated tumors. COX-2 underexpressed cases had better response to chemoradiation therapy as compared to cases with overexpressed COX-2. Conclusion: COX-2 expression in OSCC can be used as a prognostic marker. Studies with large sample size and long-term follow-up are required to find out the exact role and prognostic significance of COX-2 expression in OSCC.

Oral metastases from carcinoma of cervix

Metastatic tumours of the oral cavity are uncommon, they may occur in soft tissue as well as in bone in the oropharyngeal region. Owing to its rarity, metastatic tumours of the oral regions are a challenge to diagnose. We report a case of metastasis of the oral cavity, arising from uterine cervix mimicking as mucoepidermoid carcinoma. The metastatic lesions were noticed in the soft tissue of the lower buccal and gingival side of a oral cavity, in a 40-year-old woman with history of an adenosquamous carcinoma of uterine cervix treated by panhysterectomy.

Tubercular Ulcer: Mimicking Squamous Cell Carcinoma of Buccal Mucosa

Tuberculosis is a chronic granulomatous disease that rarely affects oral cavity. Tuberculous lesions of the oral cavity are frequently overlooked in the differential diagnosis of oral lesions. The oral clinical presentation of tuberculosis may take many forms as ulcers, nodules, tubercular fissure, tubercular papilloma and tuberculomas. Diagnosis is confirmed by histopathology.

A case of extensive left-sided facial atrophy of Romberg

Progressive facial atrophy or Parry-Romberg syndrome is characterized by slowly progressive facial atrophy involving skin, subcutaneous tissue, cartilage and bony structures. Apart from facial atrophy, it can be associated with diverse clinical manifestations including headache, partial seizures, trigeminal neuralgia, cerebral hemiatrophy and ocular abnormalities. The exact etiology is unknown although sympathetic system dysfunction, autoimmune disorders, focal scleroderma, trauma and genetic factors have been postulated. We hereby report a patient having marked left-sided facial atrophy and wasting of the tongue. Such an extensive wasting is not previously reported in the literature.

Congenital large maxillary teratoma

Teratoma of the maxilla is a rare entity. Congenital intraoral teratoma occurs in 1:4000 births. It is a benign tumor, although malignancy has been described in adults. A 10-year-old male child with this condition is described in this report. This case illustrates a huge mass on the right side of the maxilla. The mass was excised under general anesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly fibrous tissue. Postoperative result was uneventful and no recurrence was detected after 2 years.

Inflammatory dentigerous cyst in a ten-year-old child.

Dentigerous cyst may be developmental or inflammatory in origin. The latter is found only in mixed dentition with a low frequency. Treatment of inflammatory type of dentigerous cyst in children should be done with the aim of saving developing permanent teeth which should not be sacrificed as far as possible. This is a case report of a large inflammatory dentigerous cyst in a 10-year-old female patient treated conservatively by marsupialization method saving all teeth (mandibular permanent left canine, first and second premolars) in relation to the cyst.

Huge Mesenchymal Chondrosarcoma of Mandible

Mesenchymal Chondrosarcomas [MCS] are rare subtype of chondrosarcoma. They are distinct tumors arising in unicentric or multicentric locations. It usually appears in second to third decade of life. The neoplasm affects female more frequently than in males. They reveals unusual clinical behavior, characteristic male histopathological features, and poor prognosis with late recurrences. We report a rare case of MC arising in a 19 year male patient.

Metastatic malignant melanoma of palate: A review of literature and report of an unusual case.

Oral malignant melanoma is a rare tumor, accounting 0.8to 1.8 % of all oral malignancies. It occurs most commonly in Japanese and Negros. Radical surgery is mainstay of the treatment. Prognosis is very poor with 5 years survival rate. We present a case of malignant melanoma in a 55 years female, metastatizing to liver spleen and vertebrae.