Minal Chaudhary

Oral squamous cell carcinoma in the background of oral submucous fibrosis is a distinct clinico‐pathological entity with better prognosis

BACKGROUND The aim of this study was to compare the clinicopathological features of oral squamous cell carcinoma in the background of oral submucous fibrosis (OSCC-OSMF) and oral squamous cell carcinoma (OSCC). METHODS A total of 217 cases of OSCC were retrieved from achieves for the analysis. OSCC-OSMF cases were segregated on the basis of history and clinicopathological parameters. RESULTS The study included 217 patients of which 112 had OSCC and 105 OSCC-OSMF. OSCC-OSMFs were younger compared with OSCC. Overall oral cancer was noted predominantly in males compared to females. The number of OSCC-OSMF was more in clinical TNM stage I and stage II as compared to OSCC, whereas the number of OSCC was more in stage III and stage IV compared to OSCC-OSMF. Histological presentation of well-differentiated squamous cell carcinoma was significantly more in OSCC-OSMF compared to OSCC, whereas moderately differentiated squamous cell carcinoma was significantly more in OSCC compared to OSCC-OSMF. Regional lymph node metastasis was significantly higher in OSCC compared to OSCC-OSMF. Three-year disease-free survival rate was significantly higher in OSCC-OSMF compared to OSCC. CONCLUSION The OSCC-OSMF was found to be a clinicopathologically distinct entity with a better grade of tumor differentiation, less incidence of nodal metastases, and early detection (early clinical TNM stage) compared to OSCC. All these factors probably contribute to a better prognosis and increased 3-year disease-free survival in OSCC-OSMF patients.

Xeroderma Pigmentosum: A Case Report of Two Siblings

Xeroderma Pigmentosum: A Case Report of Two Siblings Xeroderma Pigmentosum (literally means dry pigmented skin) is defined by extreme sensitivity to sunlight, resulting in sunburn, pigment changes in the skin and greatly elevated incidence of skin cancers (Alan R Lehman et al.). Herba and Kaposi first described Xeroderma Pigmentosum in 1974. Kramer et al. found an equal sex predilection and significant parental consanguinity, confirming an autosomal recessive inheritance pattern. The incidence of XP seems to vary across the globe. The incidence reported in US and Europe is 1:250000 and in Japan and other countries at a higher frequency 1:40000. Its incidence is not that significant in context to the other part of the world. The basic defect underlying the clinical manifestations is a nucleotide excision repair (NER) defect leading to a defective repair of DNA damaged by ultra violet (UV) radiation. Historically, the disease was classifies as classical XP with only skin abnormalities and the De-Sanctis-Cacchione syndrome with skin abnormalities and extreme neurological degeneration was evident.

The domino effect: Role of hypoxia in malignant transformation of oral submucous fibrosis

Introduction: Oral submucous fibrosis (OSMF) is a precancerous condition predominantly seen in people of Asian descent. About 7–12% OSMF patients develop oral squamous cell carcinoma (OSCC). Morphological features of OSMF especially fibrosis suggests a possibility of the hypoxic environment in diseased tissues. Oral cancer usually develops from hyperplasia through dysplasia to carcinoma. Neovascularization and increased glycolysis, represent adaptations to a hypoxic microenvironment that are correlated with tumor invasion and metastasis. The adaptation of cells to hypoxia appears to be mediated via hypoxia inducible factor-1α (HIF-1α). HIF-1α is said to be associated with malignant transformation of epithelium in other sites. It appears that HIF-1α plays a significant role in both prostate and cervical carcinogenesis at early stages. We hypothesize that progression of OSMF and malignant transformation in the background of fibrosis mediates via HIF-1α either by up- or down-regulation of various such molecules. Therefore, the main objective of this study was to investigate the relationship between the expression of HIF-1α in OSMF, OSCC and OSCC with OSMF. Aim: To investigate the relationship between the expression of HIF-1α in OSMF, OSCC and OSCC with OSMF. Materials and Methods: The study group consists of histopathologically diagnosed 20 cases of OSCC, oral submucous fibrosis and OSCC with OSMF each. The immunohistochemistry was carried out on neutral buffered formalin-fixed paraffin-embedded tissue sections by using the monoclonal antibody of HIF-1α. Results: A rise in the expression of HIF-1α from OSMF to OSCC to OSCC with OSMF is observed.

Evaluation of Hearing Efficiency in Patients with Oral Sub mucous Fibrosis

Objective: To evaluate hearing deficit in patients with Oral Submucous Fibrosis. Study background: A Cross Sectional study. Settings: The present work was carried out in the Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India. Subjects and methods: 20 patients clinically diagnosed as having OSMF were evaluated by audiometry. Results: On comparing hearing loss in patients with grade I OSMF, there was a slight variation observed in values between Rt and Lt sides. Patients with grade II OSMF demonstrated hearing loss which was bilateral in 5 of the 9 patients with Conductive Hearing Loss (CHL). 4/9 patients had mild CHL on either Rt or Lt. sides. 5 cases in group II had normal hearing threshold on both sides. Patient with grade III OSMF had bilateral mild CHL. Conclusion: Significant correlation was observed between the degree of fibrosis of the palatal muscles and hearing deficit.

Evaluation of natural killer cell (CD57) as a prognostic marker in oral squamous cell carcinoma: An immunohistochemistry study

Objectives: Natural killer (NK) cells are important effector lymphocytes. NK cells are considered to represent innate immune system. NK cells target and kill aberrant cells such as virally infected and tumorigenic cells. The purpose of this study was to assess the expression of CD57 in oral squamous cell carcinoma (OSCC) and to correlate the expression of CD57 with 3 years survival in patients with OSCC. Materials and Methods: About 100 histopathologically diagnosed cases of OSCC of various grades were divided into two groups, i.e., Group I (dead patients) and Group II (live patients) from the archives of Department of Oral Pathology and Microbiology. CD57 was detected in these tissues by immunohistochemistry. Result: The results were analyzed using Spearmans correlation coefficient and students unpaired t-test. The mean CD57 labeling index in Group II was significantly higher than that found in Group I (P = 0.000). There was a significant correlation (P = 0.00) in the mean CD57 levels between Groups I and II and prognosis of patient. Conclusion: CD57 could be a good prognostic marker for OSCC patients.

KAI-1 and p53 expression in oral squamous cell carcinomas: Markers of significance in future diagnostics and possibly therapeutics

Context: KAI-1/CD82 is a tumor suppressor gene with decreased gene expression being associated with increased invasive ability of oral squamous cell carcinomas (OSCCs). p53 protein functions in the G1-S phase of the cell cycle to allow repair of damaged DNA. In the present study, p53 and KAI-1 expression was investigated using monoclonal antibodies in OSCC. Aims: The aim of this study was to detect KAI-1 and p53 expression in OSCCs and to assess the relation between both in OSCCs. Materials and Methods: The present study included histopathologically diagnosed thirty cases of well- and moderately differentiated OSCCs to study the expression of KAI-1 and p53 antibodies. Statistical Analysis: The results obtained were tabulated and statistically analyzed using descriptive statistical analysis; one-way ANOVA; least square difference method and independent t-test. Results: OSCCs exhibited 41.62% positivity for KAI-1 while p53 positive cells were recorded to an extent of 60.82%. A significant positive correlation was observed between KAI-1 and p53 expression in OSCCs. Conclusions: Although a significant amount of work is still required to uncover the mechanisms of action and regulation of KAI-1 and p53 expression, control of the complex metastatic processes would be of interest in controlling the tumor biology in OSCCs as well as other types of malignancies to enhance prognosis in the affected patients and to help protect against future metastasis in the going to be treated and treated patients.

Histopathological evaluation of tissue undergoing thermal insult

Context: Thermal insult is the major cause of thermal injury or death and in case of death due to thermal injury the body often has to be recovered from the site. Histologically, one can predict whether the victim was alive or dead when the fire was on going. However, determination of probable cause of thermal insult to which victim subjected to be difficult when the victims body is found somewhere else from the crime scene or accident site or found alone. Hence, histopathological evaluation of the tissue which has undergone thermal insult in such conditions could help to place evidence in front of law officials, regarding probable condition, or scenario at time of burn of victim. Aims: Keeping this as a criteria in this study we aim to evaluate burnt tissue histopathologically, that undergone various degree of thermal insult, which simulates various real life scenario for mortality in burn cases. Settings and Design: We evaluate the changes in hematoxylin and eosin staining pattern of tissue which has undergone thermal insult compared to normal tissue and also the progressive changes in staining pattern, architectural, and cellular details. Methods and Material: Samples were taken from the patients, in various surgical procedures. Each sample was cut into five parts with close margins so that each burnt tissue is evaluated for same field or region. The tissue that obtained was immediately subjected to varying degree of temperature over a specific period so as to simulate the various real-life condition. Then the tissues were fixed, processed, and stained with routine H and E staining. The processed slides of tissue were examined under the microscope, and the staining, and architectural changes were evaluated and described. Results: Results show that there was a progressive changes in the architectural pattern of the epithelium and connective tissue showing cleft formation and vacuolization, staining pattern also shows mixing of stains progressively as the severity of thermal insult increases.

Ki67, CD105, and α-SMA expression supports the transformation relevant dysplastic features in the atrophic epithelium of oral submucous fibrosis

Background The grading of oral epithelial dysplasia is not possible in the atrophic epithelium of oral submucous fibrosis (OSMF). Recently, we found that features such as increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, increased nuclear size, and hyperchromasia represent transformation-relevant dysplastic features in the atrophic epithelium of OSMF. The presence of these features can be considered a high-risk feature for patients. However, these findings have not been tested and authenticated using markers relevant to oral carcinogenesis. Method Paraffin-embedded tissues from 30 normal oral mucosa (NOM) and 50 OSMF were retrieved from 2008 to 2016 and subjected to immunohistochemical expression using Ki67, CD105 and α-SMA antibodies. Results Ki67 LI showed significant increases from NOM (12.47±2.34) to LRED (23.47±3.75) to HRED (34.31±7.31) (<0.0001). Similarly, MVD was increased significantly from NOM (3.53±5.17) to LRED (27.57±12.25) to HRED (46.18±12.55) (p<0.0001). The expression of α-SMA was significantly increased from LRED (0.21±0.41) to HRED (1.13±0.56) (<0.0001). The Ki67 LI and α-SMA; MVD and α-SMA; and Ki67Ki67 LI and MVD in NOM, LRED and HRED showed a statistically significant positive correlation (P<0.0001). The increase in Ki67 LI was directly proportional to MVD and α-SMA expression from NOM to LRED to HRED (P<0.0001). The connective tissue stroma of NOM lacks α-SMA expression. Mild myofibroblast expression was noted in 4 cases of LRED (14.28%) and in 18 cases of HRED (81.81%). Moderate expression was noted only in 4 cases of HRED (22.22%). Conclusion Ki67 LI, CD105, and α-SMA expression showed significant differences between normal, LRED and HRED. These findings further support that features such as increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, and hyperchromasia could be transformation-relevant dysplastic features.

T-cell lymphoma of oral cavity: A rare entity

Lymphomas are heterogeneous malignancies of the lymphatic system characterized by lymphoid cell proliferation. They can broadly be divided into Hodgkins lymphoma (HL) and non-HL (NHL). NHL can originate from B, T or natural killer lymphocytes. Extranodal presentation of T-cell NHL is extremely rare and is often seen in immunocompromised individuals. Here, we report a rare case of T-cell lymphoma of the oral cavity in a 13-year-old patient. The patient was diagnosed to have T-cell lymphoma on the basis of biopsy and immunohistochemistry and was referred to the oral surgery department for definite treatment.

Prevalence of dental caries and gingivitis among pregnant and nonpregnant women

Objective: The aim of this study was to find the occurrence of dental caries and gingivitis among pregnant women and to compare it with those in nonpregnant women. Materials and Methods: A total of 303 pregnant and 238 nonpregnant women were recruited from the Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha. Dental caries and gingivitis were defined clinically according to the World Health Organization (WHO) diagnostic criteria. Results: Over 63.3% of pregnant women had caries, and 71.9% had gingivitis. A significant difference came out between pregnant women and nonpregnant women with regard to dental caries (P = 0.0001) and gingivitis (P = 0.0007). The pregnant women were 2.2 times more likely to suffer from dental caries and 1.94 times more from gingivitis compared to nonpregnant women. Dental caries was significantly seen in pregnant women above 25 years of age, illiterate, and homemakers. Poor oral hygiene, poor dental care knowledge, and poor attitude were all important risk factors for dental caries and gingivitis. Conclusion: Proper dental healthcare programs should be conducted to improve the dental health and to increase the awareness of hygienic practices in pregnant women.