Journal of Oral and Maxillofacial Pathology最新文献

Background: Oral squamous cell carcinoma (OSCC) accounts for over 90% of oral cavity malignancies, with the high mortality and limited therapeutic success due to challenges in early diagnosis. Periostin, a matricellular protein, is implicated in cancer progression, making it a potential diagnostic and therapeutic target. This study examines periostin expression in normal tissues, potentially premalignant oral epithelial lesions (PPOEL), and OSCC.

Aim: To evaluate and compare periostin expression in normal tissues, PPOEL, and OSCC stage I/stage II and stage III/IV using quantitative Reverse Transcription Polymerase Chain Reaction (qRT-PCR).

Materials and methods: This ex vivo comparative study included 80 subjects divided into four groups (20 per group): healthy controls, PPOEL, OSCC Stage I/II, and OSCC Stage III/IV. Ethical clearance and informed consent were obtained. Peripheral blood samples were processed for RNA extraction, quantified using Nanodrop spectrophotometry, and analysed via qRT-PCR for periostin and GAPDH (housekeeping gene).

Statistical analysis: Data normalcy was tested using the Shapiro-Wilk test. Parametric (ANOVA, post-hoc Bonferroni) and non-parametric (Mann-Whitney, Wilcoxon) tests were applied depending on data distribution. SPSS version 21 was used for analysis.

Results: Periostin expression increased progressively from normal tissues to PPOEL, OSCC Stage I/II, and OSCC Stage III/IV. Significant differences in ΔΔCT and fold change values were observed between normal and OSCC stages, with advanced OSCC showing the highest periostin expression. However, differences between normal and PPOEL were not statistically significant.

Conclusion: Periostin expression correlates with OSCC progression, highlighting its potential as a biomarker for early diagnosis and as a therapeutic target. Further large-scale studies are required to validate these findings.

Background: Oral squamous cell carcinoma (OSCC) cells break through the basement membrane and enter the connective tissue, during that significant variations are seen in the matrix and matrix-degrading enzymes, among which Matrix Metalloproteinases (MMPs) are the most important. OSCCs may develop from precursor lesions, such as oral leukoplakia (OL), which are in direct contact with saliva.

Aim: To evaluate the salivary levels of MMP-12 in participants with OSCC, OL, and normal oral mucosa using enzyme-linked immunosorbent assay (ELISA).

Materials and methods: A cross-sectional study was conducted among 66 subjects, which included 22 OSCC patients, 22 OL patients, and 22 healthy subjects. Saliva was collected from all the study participants and stored at -80°C. ELISA was performed to analyse MMP-12, and the mean concentration in ng/mL was calculated for each group.

Results: OSCC and OL patients had significantly higher salivary levels of MMP-12 compared to healthy controls. The salivary MMP-12 levels were also found to be significantly higher in moderate dysplasia as compared to mild dysplasia.

Conclusion: MMP-12 levels in the saliva of the OSCC patients were considerably higher than in the OL and healthy controls. The salivary MMP-12 levels were higher in higher grades of epithelial dysplasia and OSCCs. Hence, salivary MMP-12 levels can be used as a non-invasive, early diagnostic and prognostic biomarker for OSCC.

Introduction: Documenting orientation of resection specimens in head and neck surgery can be challenging.

Purpose: The primary objective of this study was to investigate an enhanced documentation method for orientation of the resection specimen.

Methods: A feasibility study was conducted to explore the potential of using a 3D scanner to improve documentation of the orientation of the resection specimen. 3D scans of the resection specimen were registered on a CT-based 3D model of the patient's original anatomy, resulting in 3D models of the resection specimen in the correct anatomical position and orientation.

Results: The scanning, orientation, and verification processes are explained in detail.

Conclusion: This innovative approach for documenting the orientation of resection specimens can improve the understanding of precise anatomical locations of close or positive margins. This understanding is crucial for determining the necessity and precise location of adjuvant therapy, minimising adverse effects and lowering the risk of local recurrence.

Aims: In oral squamous cell carcinoma (OSCC), we investigated whether perineural invasion (PNI) and cell proliferation are associated with locoregional metastasis and recurrence.

Settings and design: Thirty-nine cases of OSCC were included in this retrospective study.

Materials and methods: Clinical-histopathological data were obtained from medical records. New slides were performed, and PNI status was assessed using hematoxylin and eosin-stained (H&E) and immunostaining for S100. PNI was described as tumour cells infiltrating >33% of the nerve circumference, complete nerve encirclement or intraneural infiltration. The status of proliferation was assessed by immunohistochemistry using Ki-67.

Statistical analysis used: PNI and cell proliferation were associated with OSCC outcomes by univariate and multivariate regression.

Results: PNI was positive in 17.9% H&E cases, increasing to 51.2% immunostaining (S100) analysis (0.004). All PNI-positive patients were ≤50 years. Intraneural invasion was the most common PNI-positive feature, followed by complete encirclement. All PNI-positive cases with locoregional recurrence showed intraneural invasion (0.001). PNI-positive tumours were most common in the soft palate and oropharyngeal subsites (66.7%), and smokers + alcoholics represented 80.0% of all PNI-positive cases. N0 and M0 tumours represented most PNI-positive cases. High cell proliferation represents an increased risk of PNI and is associated with lymph node metastasis in OSCC (0.001).

Conclusions: S100 immunohistochemistry is useful to improve the diagnostic accuracy of PNI in OSCC by reducing the alpha and beta errors. PNI is common in OSCC, and PNI S100 diagnosis correlates with locoregional OSCC recurrence. High cell proliferation (Ki-67) was useful in predicting lymph node metastasis.

Background: Oral lichen planus is a chronic inflammatory cell-mediated immunological disease. As it has a multifactorial aetiology, treatment is symptomatic. Corticosteroids are used as first-line treatment; however, it has various side effects, resulting in the search for new therapeutic options. Coconut has therapeutic, anti-inflammatory, antioxidant and immunomodulatory effects. Liquorice reduces the enzymatic activity of cyclooxygenase and lipoxygenase, limits the generation of oxygen free radicals and cell migration and inhibits arachidonic acid metabolism. Thus, it lessens the inflammatory response and pain. Purslane has wound healing, antibacterial, antiulcerogenic, anti-inflammatory and antioxidant qualities. Thus, all the above properties suggest the use of coconut-liquorice-purslane in the management of oral lichen planus (OLP).

Method: Following approval from the Institutional Ethical Committee, 40 participants who met the inclusion criteria and were seeking treatment at the research hospital were randomly assigned to two groups. 'Group A' received coconut-liquorice-purslane cream, while 'Group B' received topical 0.1% triamcinolone acetonide gel. Both groups were instructed to apply the ointment to the affected area thrice a day for 90 days and were to refrain from eating and drinking for 15 minutes after application. The intensity of pain was measured using a visual analogue scale at baseline before treatment and on days 14, 30, 60 and 90.

Results: Both groups showed statistically significant reduction in pain intensity, but the coconut-liquorice-purslane group showed better results when compared to the 0.1% Triamcinolone Acetonide group.

Conclusion: Coconut-Liquorice-Purslane cream can be safely used as an alternative treatment modality in the management of OLP for reducing pain intensity as compared to topical 0.1% triamcinolone acetonide gel with no systemic, as well as topical side effects.

Introduction: Areca nut, derived from the Areca catechu palm, is consumed by 10-20% of the global population and is linked to oral submucous fibrosis (OSMF), a potentially malignant oral disorder marked by increased fibroblast proliferation. The processing of areca nut involves husking, nut removal, drying, roasting, boiling, and fermentation.

Aim: This study aims to examine how various processing methods and storage conditions of areca nut affect L929 fibroblastic cell lines.

Materials and methods: Five areca nut varieties which underwent different processing methods and five commercial areca nut products (without tobacco) from Karnataka, Kerala, and Gujarat were collected and extracted using a triple solvent solution. Cytoproliferative activity was assessed using the methyl thiazolyl tetrazolium (MTT) and Trypan blue dye exclusion assays. Varieties with the highest proliferative activity were further analysed by Reverse transcription-Polymerase chain reaction (RT-PCR) and immunofluorescence, targeting collagen, fibronectin, and α-SMA expression.

Results: Certain areca nut extracts stimulated fibroblast proliferation. However, there were no significant differences across processing methods, storage conditions, or chemical treatments. Two areca nut varieties and one commercial product exhibited the highest expression of collagen, fibronectin, and α-SMA, confirmed by both RT-PCR and immunofluorescence.

Conclusion: The elevated expression of fibrosis-related proteins in two areca nut varieties with differing processing and storage suggests a potential role in fibrosis development. Only one of five commercial products showed similar activity, indicating variability in commercial preparations. These findings underscore the importance of further research into how processing and storage influence areca nut's role in OSMF.

Context: Elevated IgG levels signify immune activation during the transition from OSMF to OSCC. Integrating IgG profiling with molecular diagnostics enhances early detection, risk prediction, and personalized treatment.

Aims: The aim is to estimate and evaluate the serum immunoglobulin G (IgG) levels in OSMF and OSCC patients and compare them with the control group.

Settings and design: Sardar Patel Postgraduate Institute of Dental and Medical Sciences Cross-sectional, Observational, Quantitative Study.

Methods and materials: This study involved 36 participants aged 18 and older. After informed consent and oral examination, 2 mL blood samples were drawn, processed, and serum separated. Serum IgG levels were measured using Nephelometry (AGAPPE MISPA i2).

Statistical analysis used: Statistical analysis was performed using the Chi-square test and ANOVA.

Results: The mean serum IgG levels were highest in the OSCC group (1606.86 ± 500.44 mg/dL), followed by the OSMF group (1217.06 ± 136.95 mg/dL), and lowest in the control group (1113.58 ± 88.92 mg/dL). One-way ANOVA demonstrated a statistically significant difference in mean IgG levels among the three groups (P = 0.00087), indicating a progressive elevation of IgG with disease severity.

Conclusions: IgG levels were highest in OSCC, with a positive correlation to OSMF severity, suggesting its potential as a biomarker. Age, gender, and lifestyle factors significantly influenced disease onset and progression across the studied groups.

Background: Oral squamous cell carcinoma (OSCC) is the most common diagnostic entity of head and neck malignant neoplasms. The classic histopathologic grading system does not provide insights for predicting the prognosis. Tumour budding (TB) has been evolving as a promising histopathological tool for predicting prognosis in OSCC.

Aims and objectives: This study was conducted to study the prognostic value of TB in OSCC patients.

Materials and methods: The study included a cohort of clinically and histopathologically diagnosed 120 excisional biopsy cases of OSCC. TB was evaluated on the hematoxylin and eosin-stained sections. The cut value of less than 5 buds or greater than five buds per field was used to assess the TB. Chi-squared test was used to study the effect of TB with various clinicopathologic parameters. The Kaplan-Meier curve was used for survival analysis. P ≤0.05 was considered statistically significant.

Results: High TB (more than five buds) had a significant statistical association with perineural invasion (P = 0.05), the worst pattern of invasion (P = 0.05), and with recurrence/metastasis (P = 0.02).

Conclusion: TB is a marker of aggressive tumor behavior in OSCC. Assessment of TB can help in planning adjuvant therapy for better clinical outcomes.

Context: The postmortem interval refers to the amount of time elapsed between death and discovery of the body and estimation of which is challenging with the traditional methods.

Aims: This study aims to investigate the potential of histologic autolytic features of buccal mucosa for the assessment of postmortem interval.

Settings and design: The study was conducted between February 2023 and November 2024 in the Department of Oral and Maxillofacial Pathology, Guru Nanak Institute of Dental Sciences and Research, in collaboration with the Department of Forensic Medicine and Toxicology, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal.

Materials and methods: A total of 75 postmortem and 10 ante-mortem tissue samples were compared using hematoxylin and eosin and van Gieson's stains. The postmortem samples were categorized according to three PMI stages as early (<10 hours since death), intermediate (10-20 hours since death), and late (>20 hours since death up to the bloat stage).

Statistical analysis used: Kruskal-Wallis test was performed to statistically analyze the obtained data.

Results: The epithelial connective tissue separation was found to be significantly different among the three postmortem interval groups, whereas significant changes in the connective tissue, such as myofibril degradation, fatty tissue degeneration, and neural tissue degeneration were also noted. Moreover, decreased staining intensity of connective tissue through van Gieson's stain was also found to be statistically significant with the progression of postmortem interval.

Conclusion: These findings indicate that microscopic evaluation of the buccal mucosa may be helpful for postmortem interval prediction.

Introduction: Salivary gland tumours (SGTs) are characterized by exceptional heterogeneity, diversity, and frequent morphological overlap among different entities. Fine needle aspiration cytology (FNAC) plays a pivotal role in evaluating salivary gland lesions (SGLs), facilitating prompt and accurate diagnosis and treatment. The Milan System of Reporting Salivary Gland Cytology (MSRSGC) is a six-tiered reporting system that aims to standardize SG reporting, fostering consistency in clinical management.

Aims/objectives: To assess the cytomorphological patterns of various SGLs and categorize them according to MSRSGC. To study the frequency of SGLs by demographics, evaluate the efficacy of FNAC, and determine the risk of malignancy (ROM) through cyto-histo correlation.

Materials and methods: This descriptive cross-sectional study involved 80 FNAC cases of SGLs sent to the pathology department from January 2018 to September 2022 (five years). Cytological findings were meticulously evaluated, categorized according to the MSRSGC, and correlated with histology wherever available.

Observation and results: Out of a total of 80 cases, 34 were available for histopathological examination. The predominant age group affected was 51-60 years (23.75%) and the male-to-female ratio was 1.9:1. The parotid gland was most commonly involved (69%), followed by the submandibular gland (26%) and the minor salivary gland (5%). The frequency of case distribution according to MSRSGC in Categories I, II, III, IVA, IVB, V, and VI was 8%, 11%, 5%, 53%, 16%, 3%, and 5%, respectively. The ROM reported for each category was 0%, 0%, --, 6.25%, 40%, 100%, and 100%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were of 80%, 100%, 100%, 94.44%, and 95.45%, respectively, underscoring its clinical utility. Among the available histological follow-up cases, maximum cases were available in Category IVB (77%), followed by Category VI (75%).

Conclusion: FNAC proves to be a reliable diagnostic tool for SGLs, despite the inherent challenges of heterogeneity. Employing the MSRSGC enhances diagnostic precision, mitigating the risk of false positives and false negatives, thereby improving clinical outcome.