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Intraosseous mucoepidermoid carcinoma (IMEC) and Glandular odontogenic cyst (GOC) are those two pathological entities causing diagnostic dilemma due to the histopathological similarity. An accurate distinction between the two entities is difficult as both presents with a common radiological and histological similarities. The aim of our systematic review was to establish the diagnostic reliability of CRTC1/3::MAML2 gene fusion for the distinction between IMEC and GOC.A complete electronic literature search was made in MEDLINE by PubMed, Google Scholar, and EMBASE databases. Articles with keywords using molecular genetic findings of CRTC1/3::MAML2 gene fusion transcripts, IMEC and GOC were assessed and included for the systematic review.Twelve subgroups having both qualitative and quantitative analysis revealed CRTC1/3::MAML2 sensitivity of 100% and specificity of 70.59% in differentiating GOC and IMEC. Fixed-effects model confirmed translocation-negative cases to have a decreased risk of association with IMEC (combined odds ratio 8.770, 95% confidence interval - 2.45 to 31.45, p 0.002).The current evidence supports that in all cases with positive gene fusion transcript of the CRTC1/3::MAML2 was specific for IMEC and was significantly differentiating it from GOC. Whereas cases of IMEC with negative gene fusion transcript pose diagnostic difficulty in differentiating from a GOC which is negative for CRTC1/3::MAML2 expression.

To compare the efficacy of platelet-rich plasma (PRP) injection vs dry needling (DN) for management of trigger points in the masseter muscle in myofascial pain syndrome (MPS) patients.This randomized controlled trial included 30 clinically confirmed cases of myofascial trigger points (MTrPs) in the masseter muscle who were randomly and equally (1:1) assigned to the test (PRP) and control (DN) groups. Both groups were evaluated for pain (visual analog scale [VAS]), range of functional movements, need for pain medication, patient satisfaction (Likert scale), and sleep (VAS) at baseline and 2-week, 1-month, and 3-month follow-ups. VAS pain and Likert score were also obtained at 6-month intervals.The use of PRP solution in MTrPs in MPS patients had a better effect on pain and patient satisfaction compared to DN.PRP appears to be a more effective treatment modality compared to DN in the management of MTrPs in MPS patients.

Objective Salivary gland tumors are a heterogeneous group of neoplasms with complex clinicopathologic behavior. These tumors often show an extremely diverse morphology and significant histologic patterns, making diagnosis a difficult task. Owing to the considerable differences in prognosis, treatment, and follow-up, accurately distinguishing these histologic mimickers is imperative. The aim of the present systematic review was to establish the diagnostic utility of p63/p40 immunostaining in histologic differentiation of salivary gland tumors. Study Design An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Trip, Cochrane Library, and EMBASE databases. Articles in which both p63 and p40 immunohistochemical expressions were assessed were included for systematic review and their sensitivity and specificity were calculated. Risk of bias was analyzed for each study using the Quality Assessment of Diagnostic Accuracy Studies tool. Results Ten eligible articles were included in the quantitative synthesis, which revealed a concordant positivity of p63 and p40 by nearly all cases of adenoid cystic carcinoma, pleomorphic adenoma, and mucoepidermoid carcinoma and most polymorphous adenocarcinomas showed discordant immunohistochemical expression (p63+/p40−). Conclusions The current evidence supports that integrated immunostaining of p63/p40 is a valuable adjunct for discerning enigmatic salivary gland tumors with true myoepithelial and/or squamous differentiation.

Introduction: Lip prints and palatal rugae are highly individualistic and stable structure, resist changes to disease and trauma and stays permanent throughout life. Correlation of lip print, rugae pattern and blood group can contribute to more precise personal identication apart from other conventional methods. Aim: To correlate lip prints and rugae pattern to blood group among dental students from Haryana. Methodology: Total 100 dental students were included in the study and divided into two groups of 50 males and 50 females. Lip prints were recorded using lipstick and cellophane tape, analyzed according to Suzuki and Tsuchiashi's classication. Rugae pattern were recorded using alginate and analyzed on the cast according to Kapali et al classication. Blood group of the same individuals were recorded and correlated. Obtained data was statistically analyzed using SPSS software v 21.0, IBM. Results: Statistically non-signicant difference was found between both male and female in upper lip pattern (p= 0.751) whereas for lower lip statistically signicant difference was found in males (p=0.004) with predominance of type III pattern whereas in females type I, II patterns predominated. For rugae, statistically non-signicant difference was found (p=0.196), in both the groups with predominance of wavy pattern and no difference in the frequencies of each type of blood group in both genders were seen. Conclusion: Rugae pattern was found to be signicantly correlated with blood group, with higher frequency of wavy pattern among dental students from Haryana

Unicystic ameloblastoma (UA) is an uncommon odontogenic tumor derived from odontogenic apparatus and comprises 6% of all ameloblastomas. We report a case of a forty-nine-year-old male presented with a chief complaint of bleeding from gums, pain, and difficulty in eating of one-year duration. The lesion was excised and diagnosed as unicystic ameloblastoma (type 1.2.3) with extensive granular cell change in all components. Granular cell variant of unicystic ameloblastoma appears to be a rare variant of unicystic ameloblastoma with only five satisfactory cases reported till date. As reported, this variant may show late recurrence as solid ameloblastoma hence a strict close follow-up is warranted.

A 24-year-old male reported to the outpatient department with a complaint of swelling of the anterior lower jaw region for 9 months with history of traumatic injury and extraction of teeth from the same region, a month before the onset of swelling. Swelling was obvious extra- and intraorally which on examination presented as a soft to firm non-tender and non-fluctuant mass with an approximate size of 4 cm × 3 cm, extending from 34 to 43 region with obliteration of labial vestibule. Panoramic radiograph and cone-beam computed tomography showed a well-defined radiolucency in the mandibular anterior region crossing the midline with erosion of labial bony plates and root of 42 along with a tooth-like radiopaque mass within the lesion. Provisional diagnoses of odontogenic keratocyst, ameloblastomas, central giant cell granuloma and calcifying epithelial odontogenic tumor were listed. The histopathological and immunohistochemical examination of lesion followed by the biopsy confirmed the diagnosis of Ghost cell odontogenic carcinoma.

Background: Cellular cannibalism is dened as cellular engulfment with death of the internalised cell. The probable etiology for this phenomenon might be nutritional depletion of a tumor microenvironment, tumor homeostasis or immune evasion. It is a well established indicator of aggressiveness. With this view in background, the aim of the present study to deciphering the occurrence of CC in schwannoma and to ascertain its biological behaviour. Furthermore to postulate the plausible pathogenesis behind it. Material and methods: Hematoxylin and Eosin stained sections of four schwannoma were retrieved from departmental archives and scanned for cannibalistic cells. In addition predominance of Antoni pattern (A/B) and degenerative changes (such as hemorrhage and hyalinized blood vessels) in schwannoma were also observed. While Results: observing cellular cannibalism in schwannoma, with increased in frequency of cellular cannibalism there is corresponding increase in Antoni A pattern and degenerative changes. These phenomena are depicted in schwannoma and Conclusion: could represent the change in biological behavior of tumor. The plausible pathogenesis underlying cannibalism in schwannoma are vascular insufciency provoked by the interrelated effect of hyper cellularity and degenerative changes like hyalinized blood vessels.

Ameloblastoma, a benign but locally aggressive odontogenic tumor, often demonstrates metastasis despite benign histological features and this variant is termed as metastasizing ameloblastoma (METAM). It was classified under the malignant category in the 2005 WHO but has been re-classified under benign epithelial odontogenic tumors in the latest 2017 WHO classification. The present review aimed at gathering the available data on METAM to update the current cognizance about the pathology. Comprehensive search of the databases (viz., PubMed, Medline, SCOPUS, Web of Science, EMBASE and Google Scholar) was done for published articles on METAM following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 42 cases were extracted. The mean age of occurrence was 42.71 ± 15.87 years. A slight male predilection was noted. Mandibular cases showed more metastasis than maxillary cases. Follicular ameloblastoma was most frequently encountered at secondary site followed by plexiform type. Lungs were the most commonly affected secondary sites. METAM is a rare odontogenic tumor and the diagnosis is usually made in retrospect. Inadequate treatment may result in multiple recurrences and metastasis in rare instances. Metastasis in ameloblastoma appears to be multi-factorial in nature and needs further investigation in untapped territory like exploration of quantum effects at cellular and molecular levels.

Primordial odontogenic tumor (POT) is a recently designated benign mixed epithelial and mesenchymal odontogenic tumor and only sixteen cases have been reported worldwide till now. Here we report an another case of POT in a 14–year old boy who presented with an asymptomatic buccal enlargement in the right maxillary region for past 4–5 months. A well-defined, unilocular, radiolucent lesion with impacted teeth was observed radiographically. A detailed account of clinico-radiographical and histolological differential diagnoses along with an updated literature review has been presented.

Odontogenic myxoma is a benign, locally aggressive neoplasm of mesenchymal origin. Histologically, the tumor exhibits spindle or stellate cells embedded in loose myxoid extracellular matrix and sometimes sparsely scattered residual bone and dystrophic mineralization in tumor stroma. Although, lesion sometimes presents with residual bony trabeculae but the formation of osteocementum-like calcifications is an extremely rare phenomenon. The present paper highlights two cases of odontogenic myxoma with osteocementum-like calcifications with emphasis on additional differential diagnosis that arose because of them and their effect on behavior of the lesion.

The study was conceived with an aim to correlate mast cell expression and angiogenesis in oral lichen planus (OLP) and inflamed oral mucosa.An observational study was performed on fifty tissue blocks of OLP and inflamed oral mucosa which were stained immunohistochemically using mast cell tryptase, CD34 and CD105. The data was analysed using Mann Whitney U-test and Spearman's rank correlation coefficient test (p 0.05).OLP showed significantly higher mast cell density for total and degranulated mast cells and higher microvessel density (CD105) compared to inflamed oral mucosa (p = 0.006, 0.000). Microvessel density, total and mean vascular area (CD34) were higher in inflamed oral mucosa with a non significant difference (p = 0.985, 0.977, 0.720). Mild negative association was observed between mast cells and angiogenesis in OLP (p = 0.879). A significant positive correlation was seen between degranulated mast cells and microvessel density (CD34) in inflamed oral mucosa (p = 0.009).Mast cells execute different roles in OLP depending upon stage of the disease. We found that although degranulation of mast cells is not the predominant pathway for angiogenesis in OLP, yet is one of the important precursor phenomena in inflamed tissues.

This study aimed to compare the levels of high-sensitivity C-reactive protein (hsCRP) and complete hemogram (CH) parameters before and after root canal treatment in patients with apical periodontitis (AP) and healthy controls.Twenty-five patients with asymptomatic AP in a single permanent tooth were recruited along with age- and sex-matched healthy controls. Baseline serum hsCRP and CH parameters were recorded in both groups. Root canal treatment was performed in teeth with AP, and biochemical parameters were re-evaluated at the 6-month follow-up. Mann-Whitney and chi-square tests were used to analyze data quantitatively and qualitatively, respectively. Spearman correlation was applied to explore the relation between hsCRP with AP and periapical healing. Multivariate linear regression tests were used to assess the effect of independent variables such as age, sex, body mass index, and periapical index score on levels of hsCRP.A baseline comparison between patients with AP (3.37 ± 2.69 mg/L) and controls (1.69 ± 2.2 mg/L) revealed a significant difference in hsCRP levels. However, all CH parameters were within the reference range. A total of 22 patients in the AP group completed follow-up, and based on the periapical index score and clinical presentations, 72.2% of patients were classified as healed. At follow-up, hsCRP significantly reduced to 1.79 ± 1.65 mg/L in the AP group. A significant correlation between AP and hsCRP was observed.Patients with AP had a significantly higher inflammatory burden than healthy controls, which significantly reduced after root canal treatment. No significant change was detected in CH indices.

We hereby report an unusual case which presented as a routinely encountered reactive lesion on the palate, whilst the radiological examination revealed a radiolucent cystic lesion underneath. After the investigations from radiography to histopathology, it was finally diagnosed as a peripheral ossifying fibroma coexisting with a nasopalatine duct cyst.

Objective: Oral cancer usually has an early precancerous stage before its actual malignant transformation. Although there are various approaches to diagnose early stages of cancer, yet there is one less explored, cost effective and simple technique known as crystallization test. The aim of the study was to reaffirm the effectiveness of Pfeiffer’s crystallization test in screening oral leukoplakia and squamous cell carcinoma. Methods: Fifty oral leukoplakia, sixty five oral squamous cell carcinoma and sixty healthy individuals participated in crystallization test. Single blood drop was used to perform the test and obtained crystal patterns were analysed. Cross tabulation and Chi-Square test was performed to find the frequency and association between the groups. Kruskal-Wallis H test and Mann Whitney U test was applied comparing mean transverse form. Results: Sensitivity of crystallization test was 80% and 93.84% in oral leukoplakia and squamous cell carcinoma. Chi-Square analysis revealed highly significant transverse form between the study groups (p < 0.000). Conclusion: Crystallization test proves to be simple, reliable and minimal invasive diagnostic approach under strictly maintained physical conditions.

The cancer stem cells deliver uncontrolled proliferative capacity within the tumor imparting to increasing size while epithelial mesenchymal transition adds to the invasive potential. Studies using specific markers elucidating the role of these phenomena may bring advancement in the targeted therapy of tumor. SOX2 and OCT4 are two among few stem cell markers indicative of proliferative potential and WNT5A is an epithelial mesenchymal transition marker indicative of invasive potential. We aimed to determine the association between expression of SOX2, OCT4 and WNT5A in oral epithelial dysplasia, oral squamous cell carcinoma and normal oral mucosa. 20 cases of oral squamous cell carcinoma, 20 cases of oral epithelial dysplasia (leukoplakia with dysplasia) and 25 normal oral mucosa tissues specimens were immunohistochemically stained to assess SOX2, OCT4 and WNT5A expression. SOX2 expression was higher in oral squamous cell carcinoma than in oral epithelial dysplasia and very low in normal oral mucosa. OCT4 was very low in oral squamous cell carcinoma and oral epithelial dysplasia when compared to SOX2, while negative in normal tissues. Co-expression of SOX2 and OCT4 showed statistically non-significant difference for tumor proliferation. WNT5A expression was found to be increasing from normal oral mucosa to oral epithelial dysplasia and oral squamous cell carcinoma. In conformity with present study, SOX2 itself can act as a potential marker for proliferation in tumor cells while OCT4 has non-significant role in regulation of tumor behavior in oral squamous cell carcinoma as well as in oral epithelial dysplasia. WNT5A can be a putative marker in studying invasive potential of oral squamous cell carcinoma.

Background Human papilloma virus (HPV) has a well-established carcinogenic role in certain head and neck cancers. These HPV associated cancers possess unique clinicopathological behavior and exhibits better prognosis than their negative counterparts. Detection through polymerase chain reaction (PCR) has been considered as the "gold standard" but imposes burden in low resource settings. Therefore, in the present study, we assessed the validity of cytomorphological features for the detection of HPV in oral leukoplakia (OL), oral squamous cell carcinoma (OSCC), and oropharyngeal squamous cell carcinoma (OPSCC). Methodology This study included 63 subjects comprising of 25 OL, 26 OSCC, and 12 OPSCC cases. Exfoliated cells were collected and processed for PCR followed by Papanicolaou staining and subsequent grading. Additionally the non-classical signs were evaluated and statistical analysis included Chi-square and Spearman's test. Result 23/63 (36.5%) cases showed PCR positivity for HPV16. Most of the cytomorphological features showed significant correlation for the presence of HPV. A greater sensitivity and specificity was observed in the Bethesda system for reporting cervical cytology (TBS) than the Papanicolaou grading system. Conclusion We conclude that the non-classic cytological features could be employed in the detection of HPV in low resource settings with improved sensitivity. Liquid based cytology graded using TBS could be suitable for oral cytology in the detection of early atypical changes.

Prior studies have established the carcinogenic role of HPV16 and also demonstrated its unique biological behavior in cervical and oropharyngeal squamous cell carcinoma (OPSCC) but its role in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) is not well explored. Therefore, in the present study, we assessed HPV16 prevalence using PCR and Anti-HPV16 antibodies for the first time and correlated its biological behavior using p16(INK4a) and Ki67 proliferation index (PI) in OL, OSCC, and OPSCC. This study included 63 subjects comprising of 25 OL, 26 OSCC, and 12 OPSCC cases. Exfoliated cells were collected and processed for PCR followed by immunohistochemistry with primary antibodies p16(INK4a), Anti-HPV16, and Ki67. The expressions were evaluated and statistical analysis included Chi-square and Spearman’s test. Cumulatively 37% (OL—7%, OSCC—14% & OPSCC—16%) of cases showed positive PCR expression. PCR positivity was observed to be significantly higher (p 0.00) in OPSCC (9/12) than OSCC (9/26) and OL (5/25) cases. Overall immunohistochemical expression of p16(INK4a), Anti-HPV16, and Ki67 were significantly (p 0.02) higher in HPV16 (PCR) positive cases. HPV16 + OSCC cases showed higher grades of p16(INK4a) and Ki67 expression. We have demonstrated a prevalence of HPV16 in OL, OSCC, and OPSCC through PCR, which may be concluded as a gold standard for the detection of HPV16 DNA.

Unicystic ameloblastoma (UA) is an uncommon variant of ameloblastoma and behaves totally different from the solid multicystic variant of ameloblastoma (SMA); furthermore the histological subgroups of UA also show varied behavior regarding proliferation. The present multi-centric study was designed to present the clinicopathological features of unicystic ameloblastoma (UA) and to compare the two popular histological classifications systems. 80 satisfactory cases of UA were retrieved and evaluated for clinicopathological parameters from four teaching dental schools of North India. The cases were classified using modified Reichart and Philipsen system and Marx and Stern system followed by comparison of inter-observer variability. The results were analyzed using SPSS software. The mean age of occurrence was 30.79 ± 16.49 years. Males outnumbered females (M:F::1.67:1). The majority of cases occurred in the third decade irrespective of the gender. Most cases were found in body–angle–ramus region of the mandible. The modified Reichart and Philipsen classification yielded better interobserver agreement (kappa value 0.845). The modified Reichart and Philipsen classification yields better inter-rater agreement and is easy to reproduce amongst oral pathologists. Being simpler it may easily be understood by the operating surgeon for better treatment outcome.

MUC1 and MUC4 are two transmembranous proteins, which have been seen to express aberrantly in various human neoplasms and advocated as independent prognostic markers. Till now no extensive studies have been carried out on combined expression of MUC1 and MUC4 in oral leukoplakia and Oral squamous cell carcinoma. This study is an endeavour to evaluate Immunohistochemical coexpression of MUC1 and MUC4 in Oral Leukoplakia and Oral squamous cell carcinoma and furthr establish them as prognostic markers. Immunohistochemical analysis of MUC1 and MUC4 was done on 24 cases of Oral squamous cell carcinoma, 24 cases of leukoplakia and 12 normal oral mucosal tissues. Chi square test and one way ANOVA test were employed for statistical analysis. Normal oral mucosa and leukoplakia group showed higher frequency of negative immunoexpression compared to oral squamous cell carcinoma group. Furthur in Oral squamous cell carcinoma group, higher frequency of double positive coexpression in well and moderately differentiated oral squamous cell carcinoma and single positive coexpression in poorly differentiated oral squamous cell carcinoma was obtained. A definite rise of immunoexpression of MUC1 and MUC4 was observed from normal oral mucosa to leukoplakia to oral squamous cell carcinoma indicative of their contribution as diagnostic and prognostic markers.

Low-grade intraductal carcinoma (LG-IDC) is the new World Health Organization designation for tumors previously called “low-grade cribriform cystadenocarcinoma” and “low-grade salivary duct carcinoma”. LG-IDC is a rare low grade malignant salivary gland neoplasm. A 56-year old woman presented with a painless swelling on the right posterior part of palate of 2 months duration. Radiographic examination revealed heterogenously enhancing soft tissue mass on right side of palate. A provisional diagnosis of pleomorphic adenoma was executed and local excision was done. The tumor had a typical feature of intraductal growth pattern composed of low grade ductal epithelial cells with cribriform and micropapillary patterns forming true “Roman bridges”. Immunohistochemically myoepithelial cells displayed p63 around all tumor islands. The case was diagnosed as LG-IDC. LG-IDC is an extremely rare entity and awareness of this entity is important to avoid erroneous diagnosis and inappropriate treatment.

Context: Anthropometry plays an important role in the assessment of ethnicity and identification of an individual. There is paucity of literature on various facial parameters in Haryanvi population. Thus, the present study was an initiation to collect this database in Haryanvi population. Aim: The aim of the present study was to create a database of craniofacial parameters of Haryanvi population. Materials and Methods: The study was conducted on 300 individuals of Haryanvi ethnicity. A digital vernier caliper was used for the measurement of facial parameters. Statistical Analysis: Chi-square test, t-test, and Pearson's correlation test were used for finding the difference between the measurements for various parameters. Results: In the present study, mesoprosopic was the predominant facial phenotype in both males and females. A significant sexual dimorphism was found between all the facial parameters measured in the study. However, upper facial height and facial index did not follow the same pattern in relation to gender determination. Conclusion: Based on the present study findings, we conclude that craniofacial parameters could be used as an important tool to assess the ethnicity and gender of an individual. In addition, our data could be used as a baseline for further studies in the identification of a Haryanvi individual.

Lipomas are common benign neoplasms of oral region which occur scarcely in the parapharyngeal space (PPS). The diversity observed in its histologic presentation classified it into many subtypes among which Spindle Cell Lipoma (SCL) is a rare entity. SCL is an uncommon benign tumor of adipose tissue usually located superficially in the neck, back and shoulder region but its presentation in oral and pharyngeal spaces is very rare. Exhaustive literature search for oral and pharyngeal space pleomorphic SCL till date revealed 45 cases of oral SCL with a mean age distribution of 55 years. Only one reported case of parapharyngeal occurrence of pleomorphic SCL was found. A rare case of pleomorphic variant of SCL in PPS extending into the buccal space is being presented. This case could be the first to report the multiple presentation and the youngest age of occurrence of SCL in PPS.

Spindle cell lesions of head and neck are very diverse entities. These may vary from benignity to malignancy. They exhibit a wide diversity ranging from benign fibroma to malignant peripheral nerve sheath tumor. These can be neural, myofibroblastic, fibroblastic, muscle, vascular, odontogenic, epithelial in origin. Such variable tissues involved provide a diagnostic challenge to the oral pathologists. Among these, neural tumors are very rare in oral cavity. A case of spindle cell tumor, which clinically mimicked pleomorphic adenoma, is presented. On histopathology it appeared like a spindle cell tumor. On further investigations like immunohistochemistry, it was diagnosed as neurofibroma. Neurofibromas may present as solitary or associated with neurofibromatosis. In our case, it is of solitary type. Till today only few cases of solitary neurofibromas of hard palate have been reported. Present case report is a rare presentation of solitary extraosseous neurofibroma on hard palate.