Madhusudan Astekar

Expression of vascular endothelial growth factor and microvessel density in oral tumorigenesis

Context: Significant increase in vascularity occurs during the transition from normal oral mucosa, through differing degrees of dysplasia, to invasive squamous cell carcinoma (SCC). Aims: To evaluate microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression in oral tumorigenesis and correlate it with the clinicopathological characteristics. Settings and Design: VEGF expression and MVD were quantified immunohistochemically using anti-VEGF and anti-CD34 antibody. Materials and Methods: For this study we used a total of 60 archival specimens, including 10 normal oral mucosa (NOM), 7 mild epithelial dysplasia (Mild ED), 8 moderate epithelial dysplasia (Mod ED), 5 severe epithelial dysplasia (SED), 14 well-differentiated SCC, 11 moderately-differentiated SCC, and 5 poorly-differentiated SCC. VEGF expression was assessed in relation to the localization, intensity, and area of the immunohistochemically stained cells. MVD was evaluated using the Image-Pro® Plus software. Statistical Analysis: One-way ANOVA (F test) was carried out for comparing the parameters for multiple groups such as different histopathological grades of dysplasia and carcinoma. Comparison between groups was carried out using the Students ‘t’ test. Correlations between VEGF score and MVD were estimated using the Karl Pearson coefficient of correlation. Results: VEGF and MVD appeared to increase with disease progression and were statistically higher in oral SCC than in epithelial dysplasia and normal buccal mucosa. There was significant correlation between VEGF expression and MVD. Conclusions: These findings indicate that VEGF expression is upregulated during head and neck tumorigenesis.

Cyclin D1 Expression and Its Correlation with Histopathological Differentiation in Oral Squamous Cell Carcinoma

Background. Cyclin D1 regulates the G1 to S transition of cell cycle. Its deregulation or overexpression may lead to disturbance in the normal cell cycle control and tumour formation. Overexpression of cyclin D1 has been reported in various tumors of diverse histogenesis. This case control retrospective study was carried out to study the immunohistochemical reactivity and expression of cyclin D1 and its association with site, clinical staging, and histopathological differentiation of oral squamous cell carcinoma (OSCC). Methods. Forty formalin-fixed paraffin-embedded tissue blocks of biopsy specimens of oral squamous cell carcinoma were immunohistochemically evaluated for expression of cyclin D1. Results. Cyclin D1 expression was seen in 45% cases of OSCC. It did not correlate with site and clinical staging. Highest expression was seen in well-differentiated, followed by moderately differentiated, and poorly differentiated squamous cell carcinomas, with a statistically significant correlation. Conclusion. Cyclin D1 expression significantly increases with increase in differentiation.

Role of viruses in oral squamous cell carcinoma

The etiology of oral squamous cell carcinoma (OSCC) is complex and involves many factors. The most clearly defined risk factors are smoking and alcohol, which substantially increase the risk of oral SCC. However, despite this clear association, a substantial proportion of patients develop OSCC without exposure to them, emphasizing the role of other risk factors such as genetic susceptibility and oncogenic viruses. Some viruses are strongly associated with OSCC while the association of others is less frequent and may depend on co-factors for their carcinogenic effects. Therefore, the exact role of viruses must be evaluated with care in order to improve the diagnosis and treatment of OSCC.

Maintaining dental records: Are we ready for forensic needs?

Context: Dental remains are usually the last to get destroyed among body parts after death. They may be useful for personal identification in cases of mass disasters and decomposed unidentified bodies. Dental records may help in the identification of suspects in criminal investigations and in medicolegal cases. Maintenance of dental records is legally mandatory in most of the European and American countries. Unfortunately, the law is not very clear in India, and the awareness is very poor. Aims: To assess the awareness regarding the dental record maintenance among dentists in Rajasthan, to deduce the quality of average dental records kept by them and to evaluate the potential use of their maintained records, in any of forensic or medicolegal cases. Settings and Design: A cross-sectional survey was conducted among 100 dental practitioners of different cities in Rajasthan, India. Materials and Methods: Data were collected through a structured questionnaire, which was responded by the study population in the course of a telephonic interview. The questionnaire addressed on the mode of maintaining dental records in their regular practice. Statistical Analysis Used: The data so gathered were subjected for descriptive analysis. Results: As for knowledge or awareness about maintaining dental records, surprisingly a very low percentile (about 38%) of surveyed dentists maintained records. Sixty-two percent of the dentists were maintaining no records at all. Conclusion: Nonmaintenance or poor quality of records maintained indicates that the dentists in Rajasthan are not prepared for any kind of forensic and medicolegal need if it arises.

Total sialic acid, total protein and total sugar levels in serum and saliva of oral squamous cell carcinoma patients: A case control study.

Background: Detection of cancer at an early stage is of utmost importance to decrease the morbidity and mortality of the disease. Apart from the conventional biopsy, non-invasive methods like analysis of serum and saliva may provide cost-effective approach for screening a large population. Tumor markers are a major part of secondary prevention and thus, the detection of malignancies. The aim of this study was to evaluate total sialic acid (TSA), total protein and total sugar (TS) in serum and saliva of oral squamous cell carcinoma (OSCC) and controls to assess their role as a diagnostic marker. Materials and Methods: Unstimulated whole saliva and sera were collected from 40 squamous cell carcinoma patients and 20 controls. Serum and salivary TSA, total protein and TS estimation was carried out. This was correlated with clinical stages and histopathological grades of OSCC. The data obtained was analyzed statistically using Chi-square test, ANOVA and Students t-test with SPSS statistical software. Results: A highly significant rise in the salivary sialic acid, serum sialic acid and serum protein was noted in OSCC subjects compared to controls. Salivary protein, serum and salivary sugar did not show any significance. Furthermore, serum and salivary sialic acid levels were found to be significantly increased with increasing level of histopathological grading. Conclusion: The present study showed a significant increase in serum sialic acid, salivary sialic acid and serum protein from control to OSCC and suggests that these markers may be reliable in diagnosis and predicting prognosis.

Hidden keys in stroma: Unlocking the tumor progression.

Malignancy is considered as a pathological imbalance of tissue-cell societies, a state that emerges from tumor-host microenvironment in which host participates in induction, selection and expansion of the neoplastic cells. Invasion of these malignancies can be viewed as a derangement in the proper sorting of cell populations, causing a violation of normal tissue boundaries. This violation is carried out by certain stromal cells like carcinoma associated fibroblasts (CAFs), tumor associated macrophage (TAMs), endothelial cells (ECs) leucocytes, bone marrow derived cells, etc. Tumor cells may alter the surrounding stroma and in turn, stromal cells may promote cancer progression and invasion. Thus, this review compares the role of CAFs, TAMs and ECs in tumor microenvironment towards tumor progression. This compilation aims to collate existing literature on stromal cell with particular emphasis on their role in tumor invasiveness and summarize experimental studies, trials and literature of last 10 years collected from pubmed central indexed journals.

Estimation of age based on tooth cementum annulations: A comparative study using light, polarized, and phase contrast microscopy

Context: The identification of living or deceased persons using unique traits and characteristics of the teeth and jaws is a cornerstone of forensic science. Teeth have been used to estimate age both in the young and old, as well as in the living and dead. Gradual structural changes in teeth throughout life are the basis for age estimation. Tooth cementum annulation (TCA) is a microscopic method for the determination of an individuals age based on the analysis of incremental lines of cementum. Aim: To compare ages estimated using incremental lines of cementum as visualized by bright field microscopy, polarized microscopy, and phase contrast microscopy with the actual age of subject and to determine accuracy and feasibility of the method used. Materials and Methods: Cementum annulations of 60 permanent teeth were analyzed after longitudinal ground sections were made in the mesiodistal plane. The incremental lines were counted manually using a light, polarized and phase contrast microscopy. Ages were estimated and then compared with the actual age of individual. Statistical Analysis: Analysis of variance (ANOVA), Students t-test, the Pearson product-moment corre (PPMCC) and regression analysis were performed. Results: PPMCC value r = 0.347, 0.542 and 0.989 were obtained using light, polarized and phase contrast microscopy methods respectively. Conclusion: It was concluded that incremental lines of cementum were most clearly visible under a phase contrast microscope, followed by a polarized microscope, and then a light microscope when used for age estimation.

Oral Crohn's disease

’Crohns 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 Crohns 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 Crohns disease.

Comparison of hard tissue interrelationships at the cervical region of teeth based on tooth type and gender difference

Context: Cementoenamel junction (CEJ) represents the anatomic limit between the crown and root surface. With advancing age and continuous eruption, this area becomes exposed in the oral media. Consequently, CEJ will be subjected to the action of various physical and chemical factors that might alter its morphology, with the cementum being affected in most cases. Aim: To identify the frequency of hard tissue interrelationships present at the CEJ in relation to different genders, positions and aspects of tooth using a light microscope. Materials and Methods: The cervical regions of 80 permanent teeth (40 male and 40 female), extracted for orthodontic or periodontal reasons, were analyzed after longitudinal ground sections were made in the mesio-distal plane. The CEJ of the prepared sections was then studied and their frequencies were categorized as: cementum overlapping enamel, enamel overlapping cementum, edge-to-edge relationship and the presence of gap junctions. Statistical Analysis: Chi-square test performed using SPSS 15 software. Results: Edge-to-edge contact of the cementum and enamel was most frequent, followed by gap junction and cementum overlapping the enamel, respectively. Chi-square test revealed no statistically significant differences with respect to the gender and tooth aspect, whereas the result was significant when the position of the tooth was studied. Conclusion: The observations of the study indicate a considerable morphological diversity in the anatomical pattern of CEJ. It can be concluded that the region should be protected against dentinal sensitivity, erosion, abrasion, abfraction and resorption, as it is more prone to cervical pathologies.

The study of inheritance analysis and evaluation of lip prints in individuals

Context: Identification of an individual is a pre-requisite for certification of death and for personal, social, and legal reasons. The study of lip prints (cheiloscopy) was thought as a method for identification of a person. It is safe to assume that cheiloscopy, in its present stage of development, has become a means of criminalistic identification dealing with lip prints. Aim: The first aim of the study was to evaluate the visible lip patterns in Rajasthan population in relation to the gender and to ascertain the existence of hereditary pattern followed among parents and offsprings. The second aim was to compare visible and latent lip print patterns on non-biological materials like tracing paper, microscopic glass slides and stainless steel tumblers. Materials and Methods: The lip prints of 300 subjects including 25 families were obtained using lipstick. Out of these 300 individuals, 60 were selected for latent lip prints. In order to prevent any intra- and inter-observer variability single observer carried out all the observations. The lip prints were analyzed using magnifying lens and were classified using the criteria given by Suzuki and Tsuchihashi. The determination of the pattern in each segment of the lip was based on the numerical superiority of properties of the lines on the fragment. Statistical Analysis Used: After recording all the values for various parameters, data obtained were statistically analyzed with the help of the Statistical Package for Social Sciences software version-13 using independent t-test. For all the tests, a P value of 0.05 or less was considered. Results: In the present study, most predominant pattern in the entire study population among upper and lower lips considering both males and females was type III lip pattern. Hereditary resemblance was observed between parents and offsprings in 37.66%. The latent lip prints were better visualized on microscopic glass slide when compared to stainless steel tumblers. Conclusion: Lip prints have a good potential for use in criminal investigations. They have been used only occasionally despite their frequent occurrence at crime scenes. A place for cheiloscopy is recommended within the scope of forensic odontology, along with other means of forensic identification.