Vijay Wadhwan

Evaluation of chemiluminescence, toluidine blue and histopathology for detection of high risk oral precancerous lesions: A cross-sectional study

BackgroundEarly detection holds the key to an effective control of cancers in general and of oral cancers in particular. However, screening procedures for oral cancer are not straightforward due to procedural requirements as well as feasibility issues, especially in resource-limited countries.MethodsWe conducted a cross-sectional study to compare the performance of chemiluminescence, toluidine blue and histopathology for detection of high-risk precancerous oral lesions. We evaluated 99 lesions from 55 patients who underwent chemiluminescence and toluidine blue tests along with biopsy and histopathological examination. We studied inter-as well as intra-rater agreement in the histopathological evaluation and then using latent class modeling, we estimated the operating characteristics of these tests in the absence of a reference standard test.ResultsThere was a weak inter-rater agreement (kappa < 0.15) as well as a weak intra-rater reproducibility (Pearsons r = 0.28, intra-class correlation rho = 0.03) in the histopathological evaluation of potentially high-risk precancerous lesions. When compared to histopathology, chemiluminescence and toluidine blue retention had a sensitivity of 1.00 and 0.59, respectively and a specificity of 0.01 and 0.79, respectively. However, latent class analysis indicated a low sensitivity (0.37) and high specificity (0.90) of histopathological evaluation. Toluidine blue had a near perfect high sensitivity and specificity for detection of high-risk lesions.ConclusionIn our study, there was variability in the histopathological evaluation of oral precancerous lesions. Our results indicate that toluidine blue retention test may be better suited than chemiluminescence to detect high-risk oral precancerous lesions in a high-prevalence and low-resource setting like India.

Fibrosarcoma of the oral cavity

Fibrosarcoma has been defined as a malignant tumor of the fibroblasts that shows no other evidence of cellular differentiation and is capable of recurrence and metastasis. Fibrosarcomas are rare but may occur anywhere in the body, most commonly in the retroperitoneum, thigh, knee and distal extremities. Fibrosarcoma is uncommon in the head and neck region and constitutes about 1% of all the malignancies affecting the human race. Of all the fibrosarcomas occurring in humans, only 0.05% occurs in the head and neck region. Of this, almost 23% is seen in the oral cavity. Fibosarcomas generally have a poor prognosis and the overall survival rate is 20-35% over a period of 5 years.

A quantitative and qualitative comparative analysis of collagen fibers to determine the role of connective tissue stroma on biological behavior of odontogenic cysts: A histochemical study.

Background: Intricate relationship between epithelium and connective tissue is believed to play a significant role in pathogenesis of odontogenic lesions. Role of epithelium in its pathogenesis is well established and at the same time role of mesenchyme cannot be underestimated. Aim: To investigate, compare and correlate different types and pattern of collagen fibers in odontogenic cysts using picrosiriusred stain under polarizing microscopy in order to delineate its exact role in biological behavior of these lesions. Materials and Methods: The color and orientation of collagen fibers in the wall of 15 odontogenickeratocysts, 15 dentigerous cysts and 15 radicular cysts and 5 progressive stages of odontogenesis was studied histochemically by staining sections with picrosirius red and examining under polarizing microscope. Results were statistically analyzed using SPSS software. Results: In OKC, DC and progressive stages of odontogenesis the predominant color of thin collagen fibers birefringence was found to be greenish yellow and in radicular cyst it was orange red whereas thick fibers in OKC showed yellow orange color whereas DC and RC showed orange red color. OKC showed principally parallel orientation of collagen fibers in loosely packed stroma in contrast to dentigerous and radicular cyst. Conclusion: Quality, organization and packing of collagen fibers is different in 3 cystic lesions which accounts for difference in biological behavior of these lesions and it justifies that neoplastic growth requires a functional stroma and the ability of neoplastic cells to induce the formation of such a stroma is of great importance.

Primary intraosseous squamous cell carcinoma in odontogenic keratocyst: A rare entity.

Squamous cell carcinoma (SCC) arising from the wall of an odontogenic cyst (also known as primary intraosseous carcinoma) is a rare tumor which occurs only in jaw bones. This tumor was first described by Loos in 1913 as a central epidermoid carcinoma of the jaw. Primary intraosseous carcinomas (PIOC) may theoretically arise from the lining of an odontogenic cyst or de novo from presumed odontogenic cell rests. According to the new histological classification of tumors of the World Health Organization, odontogenic keratocyst is nowadays considered a specific odontogenic tumor and the PIOC derived from it is considered as a specific entity which is different from other PIOCs derived from the odontogenic cysts. The following report describes a case of such extremely rare entity that is primary intraosseous SCC of the mandible derived from an OKC in a 60-year-old male patient with brief review of literature.

Biphasic synovial sarcoma in mandibular region

The term synovioma was coined by Smith in 1927, and later in 1936 Knox suggested the name synovial sarcoma. It occurs primarily in the paraarticular regions, usually in close association with tendon sheaths, bursae, and joint capsules. On rare occasions it may be seen in areas without any apparent relationship to synovial structures as in parapharyngeal region or the abdominal cavity. The first description of synovial sarcoma in the head and neck region was by Pack and Ariel in 1950. The majority of these tumors seem to take origin from paravertebral connective tissue spaces and manifest as solitary retropharyngeal or parapharyngeal masses near the carotid bifurcation. Synovial sarcoma has been reported in soft palate, tongue, maxillofacial region, angle of mandible, sternoclavicular region, scapular region, and the esophagus. We report a case of 28-year-old male patient with synovial sarcoma in mandibular region with biphasic pattern.

Evaluation of Prognostic Significance of Immunological Cells (Tissue Eosinophil and Mast Cell) Infiltration in Oral Squamous Cell Carcinoma

Background: In oral carcinoma much effort has been made to predict the prognosis of patients but a sound understanding of underlying cell biology is likely to need progress. Recently, attention has been directed towards tumour associated tissue eosinophils and mast cells and their role in the biologic behavior of tumours. Aim: The retrospective study was used to evaluate the influence of tumour associated tissue eosinophils and mast cells on prognosis of oral squamous cell carcinoma (OSCC). Material and methods: The follow-up, of histopathologically diagnosed thirty cases of OSCC, was carried out for minimum period of 3 years. Special stains are wonderful they allow us to see which we can not see clear with routine H&E stain.Tissue sections were stained with special stains, Carbol Chromotrope for tissue eosinophil and Toluidine blue for tissue mast cell staining. Result: The results of the present study shows that increase infiltration of tissue eosinophils and mast cells in OSCC, associated with favourable prognosis. Conclusion: We concludes that infiltration of tissue eosinophils and mast cells are indicators of favourable prognosis in OSCC. Thus quantitative assessment of eosinophils and mast cells are the most important aspects of the microscopic evaluation of OSCC.

Assessment of age of majority by measurement of open apices of the third molars using Cameriere's third molar maturity index

Aims and Objectives: Evaluation of biological age of a living subject around the legal cutoff age for adulthood has become a grave concern for forensic experts in India, mainly due to the consequences of criminal obligations in judicial proceedings. Thus, this study was planned to examine the open apices of third molars in discriminating between individuals who are aged 18 years or older and who are not 18 years or older and to assign a cutoff for estimation of the age of 18 years. Materials and Methods: Orthopantomographs of 1062 individuals (14 and 23 years) were assessed, to verify Camerieres third molar maturity index (I3M). The apical ends of the roots of the left mandibular third molar were analyzed. If the apical ends of the roots are completely closed, then I3Mis zero; otherwise, it is calculated as the sum of the distances between the inner sides of the two open apices divided by the tooth length. Results and Conclusion: The sensitivity of the test for 0.08 value was 74.7% for males and 66% for females. Specificity was 83.6% for males and 79.6% for females. The probability that an Indian individual with an I3M<0.08 in 18 years or older is 78% for males and 70.3% for females. I3Mis efficacious to determine age in Indian population.

Intraosseous verrucous carcinoma arising from an orthokeratinized odontogenic keratocyst: A report of a rarest entity.

Intraosseous verrucous carcinomas (VCs) arising from odontogenic cysts are a rare entity. An unusual case of a VC arising from the orthokeratinized odontogenic cyst is described for the first time. The microscopic features of the lesion are presented.

Stature and gender determination and their correlation using odontometry and skull anthropometry.

Background: When the body has been mutilated, it is common to have the extremities or head amputated from the trunk. In concern with forensic odontology, an estimate must have been made based on the correlation of osteometry along with odontometry in determining sex, race and stature. Objective: The objective of this study is to investigate and correlate height and gender from odontometry and anthropometric data of the skull. Materials and Methods: The study was conducted in the Department of Oral and Maxillofacial Pathology and Microbiology, I.T.S Center for Dental studies and Research, Muradnagar, Ghaziabad (UP) with the representative study subjects of 60 patients as 30 males and 30 females in the age group of 15-25 years. The selected parameters were measured and then correlated to investigate stature and gender from odontometry and anthropometric data of the skull. Results: On linear regression analysis, the selected parameters were found to be statistically significant predictor of height. It was also established by Karl Pearsons coefficient correlation that the left mandibular canine index for female was statistically significant to show sexual dimorphism. Conclusion: In the emerging field of forensic odontology, skull anthropometry, odontometry exhibits stature determination and strong sexual dimorphism.

A call for a new speciality: Forensic odontology as a subject

Background: Forensic science is defined as a discipline concerned with the application of science and technology to the detection and investigation of crime and administration of justice, requiring the coordinated efforts of a multidisciplinary team. Dental identification remains one of the most reliable and frequently applied methods of identification. Hence, it can be defined as the science that deals with evidence from the dental and oral structures and is a specialty in itself. Objectives: To analyze the level of awareness of Forensic Odontology amongst the individuals from the field of dentistry with the help of a survey. Materials and Methods: A questionnaire was prepared and a survey was conducted with a sample size of 200 divided in four groups. Results: Revealed inadequate knowledge, poor attitude, and lack of practice of forensic odontology prevailing among the dentists. Conclusion: Our study reflects the current situation of our country in the field of forensic odontology, which could be improved by introducing forensic odontology as a subject in the dental curriculum at both the undergraduate and the post-graduate levels.