Journal of Oral and Maxillofacial Pathology最新文献

Background: In the world, oral squamous cell carcinoma is a leading cause of mortality and morbidity. Numerous factors are known to influence the tumour microenvironment, promoting the development of neoplasms. Among them, hypoxia plays a crucial role in neo-angiogenesis by stimulating factors that are proangiogenic in order to thrive with an adequate supply of blood, thereby increasing tumour aggressiveness and worsening the prognosis in neoplasms. Oral cancer is most often preceded by OPMDs with a histological connotation of epithelial dysplasia.

Aim and objective: The aim is to assess the expression of HIF-1α and HIF-2α in various grades of epithelial dysplasia and normal buccal mucosa, which will aid in comprehending the mechanism of malignant conversion of OPMD.

Methodology: Assessment of HIF-1α and HIF-2α expression was done in 90 samples of epithelial dysplasia, which were categorised histologically into 30 samples each of mild, moderate and severe dysplasia immunohistochemically.

Results: A statistically significant difference was noted between expression of HIF-1 alpha and HIF-2 alpha in each mild (0.133 ± 0.098 and 0.014 ± 0.008, respectively), moderate (2.050 ± 0.530 and 1.200 ± 0.406, respectively) and severe grades of dysplasia (6.350 ± 0.939 and 2.400 ± 0.674, respectively). (P = 0.001, P = 0.002, P = 0.001, respectively).

Conclusion: Hypoxia is a crucial factor that triggers the switch of angiogenesis and other inflammatory mediators, facilitating tumorigenesis. This is essential for anticipating the malignant conversion of epithelial dysplasia and, in turn, also predicts the prognosis.

Background: Inflammasomes are multiprotein complexes that play a crucial role in cancer pathogenesis, including in head and neck squamous cell carcinoma (HNSCC), by regulating inflammation, immune responses, and tumour progression. This systematic review aimed to synthesize current evidence on the immunohistochemical (IHC) expression of inflammasome-related proteins in human HNSCC tissues.

Methodology: A comprehensive search of PubMed, Scopus, Web of Science, LILACS, and Google Scholar was conducted up to 31 May 2025, following PRISMA 2020 guidelines and after prior registration in PROSPERO. Studies were included if they evaluated inflammasome-related proteins, such as NLRP3, ASC, caspase-1, and IL-1β, using IHC in human HNSCC tissues.

Results: Sixteen studies were eligible, with sample sizes ranging from 7 to 176. Risk of bias was assessed using a modified QUIN tool, which revealed some methodological limitations, particularly with scoring consistency, blinding, and antibody validation. NLRP3 was the most consistently overexpressed marker, frequently associated with advanced tumour stage, poor prognosis, and therapy resistance. Other proteins, including IL-1β, ASC, and caspase-1, also demonstrated elevated expression and were linked to inflammation and metastatic features. Gasdermin E was associated with favourable clinical outcomes and improved chemotherapy response. Certainty of evidence, assessed using the GRADE approach, was moderate for NLRP3 but low for other markers. Significant heterogeneity in IHC protocols and a lack of standardized scoring limited cross-study comparability.

Conclusion: Overall, inflammasome-related proteins, especially NLRP3, appear to be key contributors to HNSCC progression and may hold potential as prognostic biomarkers or therapeutic targets.

Systematic review registration: PROSPERO CRD42023453852.

Background: Hematoxylin and eosin (H&E) remains the cornerstone of diagnostic pathology, but the potential harmful effects, high cost, and environmental pollution have necessitated the exploration of eco-friendly and economical alternatives.

Aims: This study evaluated and compared the overall staining efficacy, durability, and economic feasibility of H&E, hematoxylin and Allium cepa (H&AC), and hematoxylin and Bixa Orellana (H&BO).

Settings and design: The comparative study was conducted in the Department of Oral Pathology and Microbiology, Faculty of Dental Science, Dharmsinh Desai University, Nadiad, Gujarat, over 18 months.

Materials and methods: A total of 225 slides, including epithelium, collagen fibers, adipose tissue, salivary gland, and bone, were stained with H&E, H&AC, and H&BO. The overall efficacy evaluation was performed on the basis of staining intensity, clarity, and uniformity.

Statistical analysis used: Staining parameters were graded and statistically analyzed using Chi-square and post hoc Dunn and Bonferroni tests (P < 0.05).

Results: H&E demonstrated superior staining quality across all parameters, with 98.67% excellent intensity, 100% clarity, and 97.33% uniformity (P < 0.001). H&BO emerged as a viable alternative with consistent performance and high efficacy, particularly in collagen and salivary gland tissues. H&AC, while the most cost-effective and eco-friendly, showed variability and reduced staining precision.

Conclusions: While H&E remains the benchmark in diagnostic histopathology, H&BO presents a promising eco-conscious alternative. H&AC, despite its affordability, requires refinement for consistent diagnostic use. This study highlights the potential for balancing diagnostic excellence with environmental responsibility in routine staining protocols.

Background: Salivary glands, as exocrine glands, play a crucial role in saliva production, vital for maintaining oral cavity health and moisture. Histochemical analysis of saliva identifies mucins as its primary component. Variations in mucin characteristics could potentially indicate early neoplastic changes. Utilizing special stains such as PAS and mucicarmine is essential for accurately diagnosing salivary gland neoplasms (SGNs). This study focuses on the histochemical analysis of pleomorphic adenoma (PA) and mucoepidermoid carcinoma (MEC) to evaluate mucin expression using periodic acid-Schiff (PAS) and mucicarmine stains.

Aim: To access, analyse and compare the mucin expression in cases of PA and MEC.

Materials and methods: The study group comprised 41 SGNs, which included 21 cases of MEC and 20 cases of PA, and 15 cases of normal oral mucosa containing minor salivary gland tissues were included in the control group. Histopathologically diagnosed cases, both PA and MEC, were selected, and tissue sections were stained with PAS and Mucicarmine to assess and analyse the mucin expression. Pearson's Chi-squared test was applied for the statistical analysis.

Results and conclusion: MEC stained with mucicarmine and PAS showed strong mucin expression in low-grade cases, moderate expression in intermediate-grade cases and weak mucin expression in high-grade cases, showing a statistically significant difference (P < 0.05). PA cases were similarly stained with mucicarmine and PAS, and it was found to have strong mucin expression in the cellular variant, moderate expression in the mixed variant and weak mucin expression was observed in the myxoid variant, giving us a statistically significant result (P < 0.05). Therefore, it was concluded that mucin expression decreased with increasing grades of MEC, but mucin expression increased proportionally with the cellularity of PA.

Background and objectives: Among the various biofluids, 8-isoprostane is a relatively underexplored yet stable oxidative stress biomarker that can be detected in measurable quantities. It is a unique by-product of arachidonic acid lipid peroxidation, and in recent years, its expression has been investigated in various diseases, particularly in malignancies. Our study was performed to evaluate the level of 8-isoprostane and compare its expression in plasma and saliva samples of oral leukoplakia (OL), oral submucous fibrosis (OSMF) patients and healthy controls (HC).

Methodology: Plasma and saliva samples were collected from clinically and histopathologically confirmed cases of OL, OSMF and HC, with 12 participants in each group. The 8-isoprostane levels in all samples were analysed using the enzyme-linked immunosorbent assay (ELISA) technique.

Results: The expression of 8-isoprostane level was statistically significant (P < 0.05) in both plasma and saliva, denoting a steady elevation of 8-isoprostane level in oral potentially malignant disorder (OPMD) (OSMF and OL), when compared to HC. However, when compared to saliva, plasma 8-isoprostane levels were higher in the OL group, whereas the reverse trend was observed in the OSMF group, where salivary levels were higher.

Conclusion: The study reveals a significant plasma and salivary 8-isoprostane level, where the concentration was higher in OPMD groups implying that saliva could be used as the diagnostic sample of choice for evaluating this oxidative stress marker.

Oral submucous fibrosis (OSF) is a progressive potentially malignant disorder. Matrix metalloproteinase-3 (MMP3) regulates extracellular matrix remodelling, and promoter polymorphisms may influence OSF susceptibility. This systematic review and meta-analysis evaluated the association between MMP3 expression, promoter polymorphism, and OSF risk. Electronic databases (PubMed, Cochrane, Google Scholar, ScienceDirect) were searched for studies published between 2000 and 2023, assessing MMP3 expression or promoter polymorphism in OSF. Four eligible studies were analysed using RevMan 5.4. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using I² statistics, and publication bias using funnel plot asymmetry and Egger's test. No significant association was observed between OSF risk and the homozygous 5A/5A genotype (OR = 2.34, 95% CI 0.63-8.71, P = 0.21, I² = 0%) or homozygous 6A/6A genotype (OR = 1.23, 95% CI 0.20-7.56, P = 0.83, I² = 89%). The heterozygous 5A/6A genotype showed a significant association with increased OSF susceptibility (OR = 2.75, 95% CI 1.63-4.64, P = 0.0002, I² = 0%). Egger's test indicated no publication bias. All studies demonstrated acceptable methodological quality. The MMP3 -1171 5A/6A promoter polymorphism is significantly associated with nearly three-fold increased OSF risk, whereas homozygous genotypes show no significant association. These findings suggest a role of MMP3 promoter variation in OSF pathogenesis. Larger, well-designed studies are required to validate these results and assess their diagnostic and preventive value.

Background: Oral squamous cell carcinoma (OSCC) remains a significant global health burden, with early detection being critical for improving outcomes. Aberrant DNA methylation of tumour suppressor genes has emerged as a promising biomarker for early oral carcinogenesis. This study investigates the methylation status of p16, DAPK, and MGMT genes in OSCC, leukoplakia, and adjacent normal tissues.

Methods: Tissue samples from 18 patients were collected from a single contiguous field, including clinically normal mucosa, leukoplakia, and OSCC lesions. DNA was extracted and subjected to bisulfite conversion followed by methylation-specific PCR (MS-PCR). Methylation patterns were analysed for frequency, statistical association (Chi-square), and diagnostic performance (sensitivity and specificity).

Results: DAPK showed progressive and statistically significant promoter methylation from normal to OSCC (P = 0.0021), with 100% sensitivity and 50% specificity. MGMT exhibited consistently high methylation across all stages but low specificity (16.67%), while p16 displayed highest methylation in leukoplakia, suggesting early involvement but limited diagnostic power. Only DAPK demonstrated a significant association with disease progression.

Conclusion: Among the three genes studied, DAPK emerged as a reliable biomarker for early OSCC detection. The findings support its integration into methylation-based screening panels, while MGMT and p16 may serve as complementary markers. Further large-scale studies are recommended to validate their clinical utility.

Context: Precise age assessment is essential in forensic identification. This study assessed the relationship between pulp-to-tooth area ratio (PTAR) and chronological age and developed population-specific regression models for individuals from Kerala, India.

Aim: To estimate the age by pulp-to-tooth area ratio in maxillary anterior teeth using Cameriere's method in the Kerala sample population.

Settings and design: A retrospective, cross-sectional study utilised digital intra-oral periapical radiographs to estimate age by Cameriere's approach in persons aged 21 to 70 years, focussing on maxillary anterior teeth.

Methods and material: A total of 561 digital radiographs from persons aged 21 to 70 years were analysed with GIMP software. Regression models were developed and tested using a control group (n = 170 per tooth). The accuracy was evaluated by mean absolute error (MAE) and root mean square error (RMSE) and compared with existing models.

Statistical analysis used: The Student t-test, Pearson's correlation, linear regression, MAE, and RMSE were used to evaluate model performance.

Results: The newly derived Indian regression equations demonstrated MAEs of 5.627 years for central incisors, 7.608 years for lateral incisors, and 5.890 years for canines. The canine showed the best accuracy, outperforming Cameriere's (MAE = 7.223, 6.699) and Jeevan's (MAE = 6.549) equations. All new models produced acceptable age estimates (MAE <10 years) across age groups.

Conclusions: PTAR-based regression models are effective for age estimation in the Kerala population, with the canine providing the most reliable estimates.

Aim: Haematoxylin and eosin (H&E) staining is routinely used for histopathological evaluation in oral pathology. However, eosin, a synthetic dye, may pose environmental and occupational safety concerns. Kumkum, a traditional herbal preparation, exhibits biocompatible properties and may serve as a potential natural counterstain. This study aimed to evaluate the staining efficacy of Kumkum in comparison with eosin in oral tissue sections.

Materials and methods: Forty formalin fixed, paraffin embedded oral tissue specimens were sectioned and stained using two protocols: Group A with standard H&E staining, and Group B with haematoxylin and Kumkum (H&K). Kumkum stain was prepared from commercially available organic powder using an ethanolic extraction method. Two blinded oral pathologists independently assessed cytoplasmic clarity, nuclear detail, and overall staining quality using semi quantitative scoring criteria. Statistical analysis was performed using the Chi square test with a significance level of P < 0.05.

Results: The H&K technique demonstrated improved cytoplasmic clarity (χ² = 5.46, P = 0.0195), nuclear clarity (χ² = 4.64, P = 0.0312), and overall staining quality (χ² = 16.87, P = 0.0002) compared to H&E. Higher grading scores and greater inter-observer agreement were observed in H&K-stained sections.

Conclusion: Kumkum exhibited effective counterstaining properties in oral histopathological sections and may serve as a natural, safe, and cost-effective alternative to eosin. Further studies evaluating long-term archival stability and protocol standardisation are recommended before routine implementation.