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Background: Early diagnosis is the single most effective means of reducing the mortality rate of oral cancer. Aim: This study was undertaken to assess the expression of minichromosome maintenance protein 5 (MCM5) in oral epithelial dysplasias and oral squamous cell carcinomas (OSCCs) and to evaluate their possible role as a biomarker for early diagnosis and prognosis of OSCC. Design: A retrospective cross-sectional study. Materials and Methods: The study was conducted to assess the expression of MCM5 immunohistochemically in the tissue samples of oral epithelial dysplasias (n = 27) and OSCCs (n = 30) diagnosed between 2014 and 2019. Statistical Analysis: The difference in the mean nuclear labelling index (LI) between the groups and the subgroups was analysed statistically using the Kruskal–Wallis test and the post hoc test, and the Dunn–Bonferroni multiple comparison analysis was conducted for pairwise comparison between the four main groups and the subgroups. The association between mean MCM5 LI and clinicopathological parameters was analysed using Spearman's rank correlation coefficient. Results: A progressive increase in the nuclear expression of MCM5 protein (P-value <0.001) was noticed from normal oral mucosa through oral epithelial hyperplasia and oral epithelial dysplasia to OSCC. A significant correlation was also observed between the mean nuclear MCM5 LI of OSCC and TNM staging (R2 = 0.268, P = 0.029). Conclusion: Our findings suggest that MCM5 may be of great value in assessing the malignant potential of dysplastic lesions and may serve as biomarker of utility in the early diagnosis and prognosis of OSCC. [ABSTRACT FROM AUTHOR]

Immunotherapy is a promising approach in the management of human cancers and has been proven to provide a durable response in many cancers. It is helpful as an adjuvant therapy for cancers and at present is considered as a fourth pillar supporting surgery, chemotherapy and radiotherapy. In the treatment of oral cancer, immunotherapy is approved in late-stage diseases where surgical resection cannot be carried out or fails, leading to recurrences and metastasis. Evidences suggest that when given as a first-line treatment, it can elicit an immune response that shrinks tumours, which could provide long-term benefit for patients. But unlike the traditional approach which follows the uniform protocol for all oral cancer patients, effective immunotherapy requires a more site-specific personalized approach. The aim of this paper is to review the various immune evasive mechanisms adopted by tumour cells and their relevance as potential targets for immunotherapy in oral tongue squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Dirofilariasis is a rare zoonotic disease endemic in tropical and sub-tropic countries, including India. Caused by the nematode of the genus Dirofilaria, the disease usually affects canines which form the primary hosts. Humans rarely get infected through the bite of potential mosquito vectors. Manifestations in humans have been reported to affect the orbital region, and intra-oral involvement is rarely reported. Our case was a 5-year-old boy who presented with a slow-growing diffuse swelling on the buccal mucosa. Dirofilariasis was diagnosed when the excised specimen was subject for histopathologic evaluation, yielding the identification of the Dirofilaria worm with the typical morphologic characteristics in the tissue sections. An extremely rare occurrence intra-orally, dirofilariasis can manifest as subcutaneous nodules. Pathologists have an important role in the final diagnosis of the disease through identifying the adult worm in the tissue sections of the biopsy specimen. Dental practitioners must be aware of such an entity as rarely this can be encountered in routine dental practice. [ABSTRACT FROM AUTHOR]

Background: Increased mortality in oral squamous cell carcinoma (OSCC) had been attributed to delay in diagnosis. Lack of a specific marker to assess the malignant potential of premalignant lesions is thought to be one of the reasons for late detection. Expression of Cytokeratin 19, which is widely used as an odontogenic epithelial marker had been reported in OSCC. Downregulation of CK 19 expression plays an important role in terminal differentiation of superficial squamous cell and increased expression in various epithelial malignancies has been suggested to be an indicator of malignant change. Aims and Objectives: To assess the role of CK19 as a potential marker in predicting malignant transformation in oral precancerous lesions and as a prognostic marker in OSCC. Materials and Methods: Study population consisted of ten samples each of normal oral mucosa, epithelial hyperplasia, varying grades of both oral epithelial dysplasias and OSCC. The tissue sections were subjected to immunohistochemical staining for the marker cytokeratin 19. Results: An increased expression of CK19 was noted in oral epithelial hyperplasia, severe dysplasia and in superficial epithelium at the invading front in OSCC. In mild and moderate dysplasias, CK19 expression was lower than the normal mucosa. In oral squamous cell carcinoma, the expression of CK19 was restricted to either a few islands or a few cells within the islands, resulting in a lesser expression than the normal epithelium. The malignant epithelial islands in the superficial connective tissue stroma were showing greater expression than the deeper islands. The epithelial cells associated with formation of keratin pearls were found to be showing more expression than those with infrequent keratin pearls. Conclusion: The study suggests that malignant transformation of epithelium can be predicted based on the increased expression of CK19. But it should be done with caution as a similar increased expression may also be noticed in presence of inflammation. [ABSTRACT FROM AUTHOR]

Osteoblastoma, often referred to as "Benign Osteoblastoma" (BO) is a rare bone forming neoplasm which comprises only about 1% of all bone tumors. It occurs with a greater frequency in the long bones of the appendicular skeleton and the vertebrae. The occurrence of osteoblastoma in the bones of the skull and the jaw bones is rare. A predilection for occurrence in the mandible has been reported when it affects the jaw bones. It is usually seen in the second to fourth decade of life with a definite male predilection. Because of its clinical and histopathologic similarities with other bone-forming lesions of the jaw, BO can pose a diagnostic challenge. Here, we report a rare case of BO in the anterior maxilla of a 16-year-old female patient, and its route to diagnosis, along with a brief review of the literature. [ABSTRACT FROM AUTHOR]

Introduction: Ever since its initial use as tissue fixative in the 19th century, formalin has been the choice fixative in histopathology, providing efficient and economic tissue fixation. In recent years, there has been a search for suitable alternatives to this "golden fixative," following the reported harmful effects of formalin on humans. Honey has been quoted as having excellent fixative property, posing no hazard, being naturally occurring. Others like sugar and jaggery with composition similar to honey are also being explored of late, as substitutes to formalin. Aim: To analyze the fixative properties of honey, jaggery, and sugar and compare the same with that of formalin, to assess the best fixative among them to seek the possibility of an ecofriendly substitute for formalin in routine histopathology. Materials and methods: Bits of human gingival tissue were placed in four containers with 20% solutions of honey, jaggery, and sugar and 10% formalin. After 24hour fixation followed by conventional processing and staining, the sections were analyzed under light microscopy for details, such as cell outline, nuclear and cytoplasmic staining, and uniformity of staining. Each criterion was assessed by two independent observers on a scale from 0 to 3; 0 for poor and 3 for excellent. The results obtained were analyzed using Kruskal--Wallis analysis of variance test. Results and conclusion: Our study, aimed at assessing the fixation abilities of three ecofriendly substances, has yielded positive and promising results. The naturally occurring and highly economical substances like honey and jaggery were found to give better results than formalin, indicating a more prominent role for them in histopathology in the near future, thereby keeping alive the possibility of being used as substitutes to formalin in laboratories in the years to come. [ABSTRACT FROM AUTHOR]

Background: Early detection of oral squamous cell carcinoma (OSCC) remains one of the most efficient ways to ensure patient survival and improved quality of life. Although specific biomarkers related to OSCC have been investigated, a useful biomarker that assesses the transition potential of potentially malignant lesion to OSCC remains to be found. Osteopontin (OPN) has been recognized as an important factor in tumorigenesis and their expression in OSCC have been investigated earlier. In the present study, evaluation of OPN expression in premalignant and malignant lesions has been carried out to assess their possible role as a biomarker in the early diagnosis and prognosis of OSCC. Objectives: The objective of this study is to evaluate the role of OPN as a biomarker in the diagnosis and prognosis of OSCC. Materials and Methods: The study group consisted of archival paraffin-embedded blocks of ten cases each of varying grades of OSCC, oral epithelial dysplasias and epithelial hyperplasias. Sections were subjected to immunohistochemical staining for the biomarker OPN. Results: A positive OPN expression was noticed in epithelial dysplasias and SCC arising from the oral epithelium. A progressive increase in the intensity of staining was seen with increasing grades of dysplasias and a decrease in OPN expression with an increase in grades was observed in OSCC. Conclusion: The expression of OPN in full thickness of epithelium in severe dysplasias, carcinoma in situ, and in the superficial epithelium of OSCC suggest the possibility of considering OPN expression in full epithelial thickness in dysplasias as an indicator for malignant transformation. [ABSTRACT FROM AUTHOR]

Context: Myofibroblasts are fibroblasts with smooth muscle-like features characterized by the presence of a contractile apparatus and found in the connective tissue stroma of normal tissues such as blood vessels and lymph nodes. They are now thought to play a role in the synthesis and reorganization of extracellular matrix, which could contribute to the aggressive biologic behavior of the lesions. Aims: To compare the mean number of stromal myofibroblasts in dentigerous cysts (DCs), keratocystic odontogenic tumor (KCOT) and ameloblastoma; and to derive a correlation between the stromal myofibroblasts and the known biologic behavior of the lesions. Settings and Design: A cross-sectional immunohistochemical analysis of cases of DC, KCOT and ameloblastoma. Materials and Methods: Twenty paraffin-embedded tissue blocks each of DC, KCOT and multicystic ameloblastoma were selected for the study and diagnosis confirmed through hematoxylin and eosin staining. Tissue sections were analyzed for the number of myofibroblasts using alpha smooth muscle actin (α-SMA) immunostaining. Statistical Analysis: Differences in the mean number of α-SMA positive cells in each group were analyzed using one-way ANOVA test. Intergroup comparisons of mean values of a-SMA positive cells were performed using Mann-Whitney U-test. Results: Ameloblastoma showed the highest number of myofibroblasts, whereas DC showed the lowest. Among the groups, there were significant differences between the myofibroblast counts among DC and KCOT and between DC and ameloblastoma, whereas the difference in counts was not statistically significant between KCOT and ameloblastoma. A positive correlation was observed between the myofibroblast count and the known biologic behavior of the lesions. Conclusion: Myofibroblasts may act in close association with the epithelial cells to bring about changes in stromal microenvironment, favorable to the growth and progression of the lesion. They may be of great value in predicting the biologic behavior and growth potential of such lesions. [ABSTRACT FROM AUTHOR]

Unicystic ameloblastoma (UA) is a variant of the solid or multicystic ameloblastoma. Radiographically, though the unilocular appearance is common, it can produce multilocular lesions also. Histologically, the minimum criterion for diagnosing a lesion as UA is the demonstration of a single cystic sac lined by ameloblastomatous epithelium often only in focal areas with or without areas of intraluminal or intramural proliferation or both. The clinical and radiologic presentation of UA can give a confusing picture of odontogenic cysts especially when it is seen in the inter-radicular or periapical area. Also, tooth associated UA may show features similar to dentigerous cyst. Hence histopathologic examination is essential to diagnose such cases. Here we present such a lesion which was initially diagnosed as an odontogenic cyst. [ABSTRACT FROM AUTHOR]

Mast cells are regarded as one of the important cells of the immune system. They are generally believed to have different roles in human health and disease. Present study aimed to evaluate the total mast cell count, the distribution of degranulated mast cells and the possible role played by them in Oral Leukoplakia (OLK). Total mast cell count and the count of degranulated mast cells were analyzed separately in 40 histopathologically confirmed cases of OLK after staining the sections with 1% Toluidine blue. These values were compared with sections taken from clinically healthy papillary gingival in 10 normal subjects. The count of degranulated mast cells was also separately evaluated in the three zones viz. Sub-epithelial, Intermediate and Deeper zones of the connective tissue in all the OLK cases. There was significant increase in the total mast cell count and the count of degranulated mast cells in Oral Leukoplakia as compared to normal oral mucosa (p < 0.001). The count of degranulated cells was found to be the highest in the Deep zone in all the OLK cases studied. The resent study revealed that the total count of mast cells and the count of degranulated mast cells were significantly increased in oral leukoplakia. This may be attributed to their pro-inflammatory and pro-angiogenic role in oral leukoplakia and may actually play a significant role in its progression to invasive carcinoma. [ABSTRACT FROM AUTHOR]

Oral Squamous Cell Carcinoma (OSCC) constitutes one of the most common cancers with a wide geographic distribution. Its incidence in India is rated as one among the highest in the world. Though the use of tobacco in various forms is widely accepted to be the major etiologic factor in OSCC, Human Papilloma Viruses (HPVs) are now being increasingly associated with the cause of OSCC. Incidence of tongue carcinomas in patients below forty years, without any history of tobacco habits is also being attributed to HPV. Histological detection of HPV altered epithelial cells - Koilocytes - is considered pathognomonic of HPV infection. Here a brief review is done to highlight the association of HPV with OSCC and the methods for timely detection of HPV in such cases. [ABSTRACT FROM AUTHOR]

Oral lichen planus is a chronic mucosal disease of unknown etiology that appear clinically as a persistent red, white or a mixed lesion. Though the precise pathogenesis is unidentified, evidences available at present strongly suggest that cell mediated immunity plays a major role in the initiation and evolution of this disease. The mast cell, the major immuno effector cell of the connective tissue is thought to be mediating this synchronized cellular orchestra, the symphony of which results in the various clinical manifestations of oral lichen planus. Aim: This study is done to evaluate mast cell density in oral lichen planus and to compare it with mast cell density in normal mucosa. Materials & Methods: Sections from thirty cases of oral lichen planus and ten normal oral mucosa were studied for mast cells using toluidine blue stain. Two sample T test was used to compare the mean values of the density of cells in the lesional area to that of control. The mean of the type and distribution of mast cells were compared using F test-One way ANOVA. Result: An increase in mast cell density was noted in lichen planus when compared to normal buccal mucosa. Distribution of mast cells was significantly increased below the inflammatory band and mast cell degranulation was prominent here. Conclusion: The increased density of mast cells and their distribution suggest their definite role in different phases of evolution of Oral Lichen Planus. [ABSTRACT FROM AUTHOR]

Background: Oral leukoplakia (OL) is a potentially malignant disorder with increased risk for the development of oral squamous cell carcinoma (OSCC). Many cases of OSCC arise from the malignant transformation of preexisting OL. However, the risk of progression into OSCC and the possible prediction of malignant potential of OL remain inconclusive. Recent studies have shown that podoplanin, a mucin-like transmembrane glycoprotein specifically expressed in lymphatic endothelial cells, is expressed in various neoplasms including OSCC, indicating its possible biologic role in tumor cells. In this study, an evaluation of podoplanin expression in OL and OSCC has been carried out to assess its potential role as a biomarker to predict the possibility of malignant transformation in OL cases. Aims and Objectives: To assess the usefulness of podoplanin as a potential biomarker for predicting the risk of malignant transformation in OL, by comparing its immunohistochemical expression in OL and OSCC. Materials and Methods: Archival paraffin-embedded blocks of 25 OL cases with varying grades of dysplasia and 30 OSCC cases showing its varying grades were selected. Sections were subjected to immunohistochemical staining for podoplanin and compared with the control group for evaluation of results in the three groups. Results: A statistically significant increase in podoplanin expression was observed from normal mucosa through OL to OSCC. In the OL cases, the podoplanin staining score progressively increased from mild dysplasia to carcinoma in situ, whereas in OSCC, well-differentiated group showed the maximum expression of podoplanin. Conclusion: The progressive increase in podoplanin expression through the increasing grades of dysplasia in OL is suggestive of an increased risk for malignant transformation with increased expression of podoplanin in OL cases. A high podoplanin expression in the well-differentiated OSCC may indicate a vital role for podoplanin in the early stages of tumorigenesis. [ABSTRACT FROM AUTHOR]