Herald J Sherlin

Glandular Odontogenic Cyst: Report of Two Cases and Review of Literature

Glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin described in 1987 by Gardner et al. It is a cyst having an unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency to recur with only 111 cases having been reported thus far. The first case occurred in a 42-year-old female and presented as a localized swelling extending from 19 to 29 regions. There was a history of traumatic injury at the site. There was evidence of bicortical expansion and radiographs revealed a multilocular radiolucency. The second case occurred in a 21-year-old male, as a large swelling in the mandible and radiograph revealed radiolucency in the region. On histopathological examination, these lesions were diagnosed as GOC. It was concluded that, two cases submitted by us correlate with the existing literature that GOC’s affect more commonly in the middle age group, having predilection for mandible and that trauma could be a precipitating factor for its occurrence. The increased recurrence rates can be due to its intrinsic biological behavior, multilocularity of the cyst, and incomplete removal of the lining following conservative treatment.

Metastasizing Ameloblastoma – A perennial pathological enigma? Report of a case and review of literature

The Ameloblastoma is a slow growing locally invasive odontogenic epithelial neoplasm with a high recurrence rate and a low tendency to metastasize. Metastasis in Ameloblastoma was first described by Simmons and Emura in the 1920s. Slootweg and Muller proposed the term Malignant Ameloblastoma to describe a well-differentiated ameloblastoma that metastasizes but maintains the characteristic cytologic features of the original tumour and the term Ameloblastic Carcinoma to an ameloblastoma with malignant cytological features. About 2% of ameloblastomas undergo metastasis. So far there have only been two cases of Metastasizing Ameloblastoma reported from the Indian Subcontinent. We present the case of a 22-year-old male Indian patient, who presented with a diffuse swelling in the left posterior mandible. Radiographs revealed a multilocular radiolucency in the left mandible. On histopathological examination, the lesion was diagnosed as follicular ameloblastoma. Four years later the patient presented with a swelling in the left submandibular region. Histological examination revealed metastatic ameloblastoma within the cervical lymph node.

Promoter hypermethylation patterns of P16, DAPK and MGMT in Oral Squamous Cell Carcinoma: A systematic review and meta-analysis

BACKGROUND Oral squamous cell carcinoma (OSCC) is a common cancer world-wide that is highly lethal due to its recurrence and metastasis. Methylation is a common epigenetic mechanism that leads to gene silencing in tumors and could be a useful biomarker in OSCC. The prevalence of P16, death-associated protein kinase (DAPK) and O6-methylguanine-DNA-methyltransferase (MGMT) promoter hypermethylation in OSCC has been evaluated for several years while the results remain controversial. OBJECTIVE The aim of this systematic review is to critically analyze and perform a meta-analysis on the various studies in the literature that have reported the promoter hypermethylation of P16, DAPK and MGMT genes in OSCC. SEARCH STRATEGY Articles were searched and selected through PubMed. Hand search from the relevant journals was also performed. Articles were reviewed and analyzed. RESULTS The estimated prevalence of P16 methylation was 43%, DAPK methylation was 39.7% and MGMT methylation was 39.8%. Heterogeneity in methylation prevalences and correlations with the clinical outcomes of the disease prevailed in various studies. CONCLUSION We can conclude from our systematic review that a higher prevalence of methylation of P16, DAPK and MGMT occur in OSCC. Further studies are required to substantiate the role of methylation of P16, DAPK and MGMT as a marker in OSCC.

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.

Lichen sclerosus of the oral cavity. Case report and review of literature.

BACKGROUND Lichen sclerosus is a chronic muco-cutaneous inflammatory disorder of uncertain etiology. The prevalence of lichen sclerosus affecting only the oral mucosa is extremely rare and only 26 cases with histologically verified oral lichen sclerosus have been reported. MAIN OBSERVATIONS A 60-year-old man was referred to our hospital for complaints of white lesions in the oral cavity, which was otherwise asymptomatic and did not have any cutaneous or anogenital lesions. Clinical examination revealed white patches with reddish areas on the buccal mucosa bilaterally and on the maxillary posterior gingiva. Microscopic analysis of the lesion showed atrophied epithelium with basal cell degeneration, hyalinized connective tissue stroma with minimal chronic inflammatory cell infiltrate. Verhoeffs staining revealed scantiness of elastic fibers in the connective tissue stroma. On the basis of these histological findings, the final diagnosis was given as Lichen Sclerosus. LS is rare in the oral cavity, particularly in the absence of simultaneous cutaneous and anogenital lesions. CONCLUSIONS Only 7 cases of oral LS have been reported involving the gingiva. To our knowledge, this is the eigth case to be reported with gingival involvement and the first case to be reported with bilateral involvement of buccal mucosa and gingiva.

Intraosseous myofibroma of mandible: A rarity of jaws: With clinical, radiological, histopathological and immunohistochemical features.

Myofibroma is an uncommon benign mesenchymal neoplasm composed of myofibroblasts, but it can be confused with more aggressive spindle cell tumors. Solitary myofibroma is common in soft tissues of head and neck, but rare in the jaw bones with only 38 cases of central myofibroma of mandible reported in English medical literature. When encountered in the jaws, lesions exhibit clinical and radiographic features suggestive of odontogenic cysts/tumors or other neoplastic conditions. We hereby present the 39th case of intraosseous myofibroma of the mandible which had been reported to our institution. A 16-year-old male reported with a chief complaint of swelling in the right side of face. Intraorally there was a firm, nontender swelling in the right buccal aspect of the mandible. Radiologically the lesion was osteolytic, destroying the buccal cortical plate. Histologically, characteristic biphasic pattern of myofibroma was noticed. Immunoreactivity was positive for vimentin and αSMA but negative for desmin, thus confirming our diagnosis. The patient was treated by local-wide surgical excision of the lesion. A 3-year follow-up revealed no signs of recurrence. Occurrence of myofibroma involving the jaw bones is common in the younger age groups and represents a unique diagnostic and therapeutic challenge. Differentiating this lesion from other benign and malignant neoplasms is crucial in deciding between a radical and a conservative treatment approach.

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.

Immunohistochemical evaluation of oral epithelial dysplasia using cyclin-D1, p27 and p63 expression as predictors of malignant transformation.

Objective: To evaluate the degree of expression of cyclin-D1, p27 and p63 in mild, moderate and severe dysplasia using immunohistochemical evaluation in order to illustrate their prognostic value and attempt to propose a molecular grading system for oral epithelial dysplasia. Materials and Methods: The analysis included thirty cases of mild, moderate and severe dysplasia from Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Chennai after a critical review of the Hematoxylin and Eosin (H and E) stained sections. They were subjected to immunohistochemical evaluation using the markers cyclin-D1, p27 and p63. The assessment of the expression based on staining intensity and distribution of immunohistochemical staining of the various markers was analyzed followed by statistical analysis. Results: A highly significant increase in the expression of cyclin-D1 (P < 0.000) and p63 (P < 0.001) and a moderately significant decrease in the expression of p27 (P < 0.012) with the increasing severity of dysplasia was observed in our study. Conclusions: The result of our research affirms the fact that the increase in the expression of markers of cell cycle regulators such as cyclin D1, decrease in the expression of cell cycle inhibitors like p27 and increased expression of p63 in parallel with the increasing severity of dysplasia, emphasizes the use of immunohistochemical markers cyclin D1, p27 and p63 as prognostic markers for better understanding the behaviour of these potentially malignant disorders aiming towards proposing a molecular grading system for oral epithelial dysplasia to enable timely management prior to their possible malignant transformation.

Expression of CD 68, CD 45 and human leukocyte antigen-DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study.

BACKGROUND Multinucleated giant cells (MNCs) form an integral part of numerous bone and soft tissue tumors, tumor-like lesions and are often associated with granulomas of immunological and nonimmunological origin. The presence of various types of giant cells depends on the lesions in which they are present which are difficult to be diagnosed under routine histological techniques. Immunohistochemistry can be used for a better diagnosis and understanding of the origin of various giant cells using various markers of immune response like human leukocyte antigen-DR (HLA-DR) and those expressed on monocytes and macrophages like CD 68 and leukocyte common antigen (LCA). MATERIALS AND METHODS The study group consisted of 10 cases of giant cell tumor (GCT) of long bones, tuberculous granuloma, and giant cell granuloma to evaluate and analyze the expression pattern of LCA, CD 68, and HLA-DR in various giant cell lesions. RESULTS Strong expression of CD 68 was observed in 80% of the lesions, strong and moderate expression of CD 45 observed in 70% of the lesions among and within the groups. In contrast, HLA-DR demonstrated negative expression in 80% of cases except for tuberculous granuloma where all the 10 cases showed moderate to strong immunoreactivity. CONCLUSION CD 68 and CD 45 expression was found in central giant cell granuloma, peripheral giant cell granuloma and GCT, suggesting the origin from mononuclear phagocyte system and considering their clinical behavior of osteoclast type. High expressivity of HLA-DR in tuberculous granulomas which is an essential factor for presentation of the microbial antigen to CD 4 helper cells thus reassuring the fact that they are up-regulated in response to infection.

Immunohistochemical profiling of Ameloblastomas using cytokeratin, vimentin, smooth muscle actin, CD34 and S100

Background: Ameloblastoma is characterized as a slow growing, non-metastatic and a locally invasive tumor with a high risk of recurrence. Immunohistochemical evaluation of ameloblastomas using epithelial and connective tissue specific markers help in studying the histogenesis and assessing the biological behavior. The aim of the study was to study the expression patterns of cytokeratin, vimentin, smooth muscle actin (SMA), S100 and CD34 in ameloblastomas. Materials and Methods: The material for the study consisted of 24 cases of ameloblastomas. The excised specimens were grossed and bits were taken from different areas of the specimen. Based on the histopathology, the cases were classified into different types and stained for immunohistochemistry. Results: The cases showed strong positivity to cytokeratin, vimentin, moderate positivity for SMA and S100. Five cases were also moderately positive for CD34 in blood vessels. Conclusion: The results and hypothesis achieved from the study, proved to be consistent, not only augmenting the already existing hypothesis but also imparting new concepts of hypothesis.