Introduction: Desmosomes together with adherens junctions represent the major adhesive cell-cell junctions of epithelial cells. Any damage to these junctions leads to loss of structural balance. Aim: The present study was designed to analyze the desmosomal junctions in different odontogenic cysts and compare them with their corresponding hematoxylin and eosin (H and E)   stained sections. Materials and Methods: Ten cases each of odontogenic keratocyst (OKC), dentigerous cysts (DCs), radicular cysts (RCs) and normal mucosa were stained with hematoxylin and eosin. Scanning electron microscopy (SEM) analysis of the sections was then carried out of all the sections. The area of interest on H and E stained section was marked and this marking was later superimposed onto the corresponding unstained sections and were subjected to SEM analysis. Results and Observations: OKC at ×1000 magnification showed many prominent desmosomes. However, an increase in the intercellular space was also noted. SEM analysis demonstrated similar findings with the presence of many desmosomes, though they were seen to be damaged and fragile. H and E stained DC under oil immersion did not show any prominent desmosomes. SEM analysis of the same confirmed the observation and very minimal number were seen with a very condense arrangement of the epithelial cells. RC at ×1000 magnification revealed plenty of desmosomes, which were again confirmed by SEM. Conclusion: The number and quality of desmosomal junctions in all the cysts has a role in the clinical behavior of the cyst.

Background: Central and Peripheral giant cell granulomas of jaws are uncommon, benign, reactive disorders that are characterized by the presence of numerous multinucleated giant cells and mononuclear cells within a stroma. The origin of the multinucleated giant cells is controversial; probably originating from fusion of histiocytes, endothelial cells and fibroblasts. Objective: To assess the expression of CD34 and CD68 in central and peripheral giant cell granulomas to understand the origin of these multinucleated giant cells. Materials and Methods: Twenty cases of Central and Peripheral giant cell granulomas were evaluated immunohistochemically for CD34 and CD68 proteins expression. Results: Immunopositivity for CD34 was seen only in cytoplasm of endothelial cells of blood vessels; whereas, consistent cytoplasmic immunopositivity for CD68 was seen in few stromal cells. Statistical significance was seen in mean number of multinucleated giant cells, mean number of nuclei in multinucleated giant cells, CD68 expression and ratio of macrophages to multinucleated giant cells among two lesions. Conclusion: Although the central giant cell granulomas share some clinical and histopathological similarities with peripheral giant cell granulomas, differences in mean number of nuclei in multinucleated giant cells and CD68 immunoreactivity may underlie the distinct clinical behavior.

Context: Squamous cell carcinoma (SCC) comprises 80% of the cancers of the oral cavity. Metastases to the cervical lymph nodes affects prognosis. Studying lymph node reactivity may help to understand host immune reaction against the tumor and thus influence prognosis. Aims: This study observed patterns of lymph node reactivity, metastases and grades of metastases in cervical lymph nodes and compared them with the histopathology of the primary tumor. Materials and Methods: Lymph nodes from 30 patients of oral squamous cell carcinoma (OSCC) were taken. 10 of these were well-differentiated SCC (WDSCC), 10 moderately differentiated SCC (MDSCC) and 10 poorly differentiated SCC (PDSCC). Four immunomorphological patterns were observed: lymphocyte predominance, germinal centre predominance, mixed pattern (sinus histiocytosis) and unstimulated pattern. Statistical Analysis Used: Chi square test. Results: The predominant lymph node reactive patterns were germinal centre predominance (79.27%), unstimulated pattern (14.63%) and lymphocyte predominance (6.10%). Positive nodes showed invasion in the form of islands (57.14%), cords (39.29%) and total replacement pattern (3.57%). Tumor involvement in positive nodes showed grade 3 invasion, (53.57%), grade 2 invasion (26.79%), grade 4 invasion (17.86%) and grade 1 invasion (1.79%). Statistically significant association was found between: · Lymph node reactive pattern and histopathological grade of primary tumor. Higher numbers of germinal centre predominance lymph nodes were found in WDSCC and MDSCC · Histopathological grade of primary tumor and the grade of lymph node invasion. Conclusions: Immuno-morphological assessment of draining lymph nodes reflects the immune status of the patient with respect to metastases. This may facilitate identification of high and low risk patients and help in planning appropriate therapy for the high-risk patients.

Grossing and microscopic examination of the received specimens in a histopathological laboratory is a routine procedure for achieving a final diagnosis. Errors in either of the steps may lead to an inaccurate diagnosis since wrong orientation of the specimen may either cause diagnostic delays or pose a diagnostic dilemma. Stereomicroscope is an important accessory instrument which can be used to study a variety of specimens. It not only enables us to study the surface details but also aids in minute work including dissection and microsurgery to name a few. Aim: To assess the effectiveness of stereomicroscope in routine grossing and its role in arriving at a final diagnosis. Materials and Methods: Cases from the archives of the department for which stereomicroscopic evaluation was done were retrieved and reviewed. Results and Conclusion: Stereomicroscopic images aided not only in the proper orientation of the specimen but also in the diagnosis.

Objective: The present study was undertaken to estimate and compare salivary interleukin-2 (IL-2) levels in patients with recurrent aphthous stomatitis, among healthy controls and their variation with age and sex. Study Design: Saliva was collected from 60 patients within the age range of 16-60 years which included 30 patients (17 Females and 13 Males) with recurrent aphthous stomatitis and healthy control group consisted of 30 participants (18 Females and 12 Males). IL-2 estimation was done in both the groups using enzyme linked immunosorbent assay (ELISA). Statistical analysis of the data was done using Independent 't' test. Results: The results showed increased salivary IL-2 levels in patients with recurrent aphthous stomatitis compared to the healthy controls. The IL-2 levels were also increased in patients with the age group of 16-30 years compared to other age groups. Similar increase of IL-2 was also seen in female patients. Conclusion: Age related and sex related alterations of IL-2 in recurrent aphthous stomatitis patients were observed.

Introduction: Odontogenic cysts and tumors arise from the structures and remnants associated with tooth development. Cysts and tumors derived from the odontogenic tissues constitute an unusually diverse group of lesions. This diversity reflects the complex development of the dental structures, since all these lesions originate through some alteration from the normal pattern of odontogenesis. Cytokeratin (CK) 14 is the typical intermediary filament of odontogenic epithelium, CK 18 is the major components of the intermediate filaments of simple or single layered epithelial tissue; it is not expressed in stratified squamous epithelium. The present study was undertaken to understand the expression pattern of these cytokeratins in dentigerous cyst, dental follicular tissue, adenomatoid odontogenic tumor (AOT) and unicystic ameloblastoma. Materials and Methods: The present study consists of 60 specimens consisting of 20 samples of Dentigerous cyst, 20 samples of Reduced enamel epithelium/dental follicles, 10 samples of Follicular type of AOT, 10 samples of unicystic ameloblastoma. The sections of these specimens were stained for CK 14 and CK 18. The number of cells positive for CK 14 and CK 18 was counted per 100 cells. The cells were counted in four randomly selected high-power fields and the mean was calculated. Scoring of cytokeratin 14 expressions was done using Remmele score. Results: The highest expression of cytokeratin 14 was noted in AOT, least was seen in dental follicle/Reduced enamel epithelium (REE). CK18 was negative in all the cases included in the present study. Conclusion: In the present study, the expression of CK14 was noted in AOT, Dentigerous cyst (DC), Unicystic Ameloblastoma (UCA) and Dental follicle/REE. The expressions between these lesions were compared. These expression pattern may provide an insight to the histogenesis of AOT.

Introduction: Glut-1 is a glucose transporter protein, the expression of which is upregulated in malignant cells which show increased glucose uptake. Alterations in expression of Glut-1 have been reported in several pre-malignant and malignant lesions. The objectives of the present study were to compare the expression of Glut-1 in normal persons and in patients with oral squamous cell carcinoma (OSCC), to correlate the expression of Glut-1 with respect to clinical staging of OSCC and to evaluate the expression of Glut-1 with respect to different histopathological grades of OSCC. Materials and Methods: Thirty cases of OSCC were staged clinically and graded histopathologically. Immunohistochemical method was used to detect the expression of Glut-1 in OSCC and the same was compared with the normal subjects. The scores were compared using the chi-square test. Results: Glut-1 expression was detected in all grades of OSCC. A significant correlation with a P value of 0.00004 was found in immunostaining between normal and OSCC. The expression of Glut-1 was significant when compared with different clinical stages with significant P value of 0.0004 and in different histopathological grades of OSCC with a P value of 0.00001. Conclusion: Higher immunohistochemical staining scores were obtained with increased clinical staging and histopathological grades of OSCC. High expression of Glut-1 may be related to poor prognosis in OSCC.

Background: Pleomorphic adenoma (PA) accounts for 45-74% of all the salivary gland neoplasms, of which 40-70% are present in minor salivary glands. Studies have depicted variations in histological typing and classification of these tumors. Its pleomorphism is attributed to the cytological differentiations of the epithelial components and the diverse stromal components. Biochemical investigations of saliva have revealed "mucins" to be its main component. Mucins reflect in their composition, the functional state of the mucosa, both in health and disease. Many reviews on histochemical classification and identification have been put forward to explain the intricacies of mucins; however, no attempts have been made to classify salivary gland tumors based on their mucin profiles and assess its prognostic significance. Thus, this study was executed to analyze the clinical, histopathological and histochemical behavior of PA of minor salivary glands and decipher a correlation. Materials and Methods: Twenty-six diagnosed cases of PA of minor salivary glands and five controls of normal minor salivary glands of the hard palate were included in the study. Blocks were retrieved, sectioned and stained with hematoxylin and eosin (H and E) stain as well as combined Alcian blue (AB)-periodic acid-Schiff (PAS) stains. Results: The stained slides revealed an array of epithelial and stromal patterns and varying heterogeneity of mucin expression of normal and neoplastic minor salivary glands. Conclusion : The study elucidated the role of mucins in tumorigenesis and its prognostic implications.

Background: Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. Aim: To evaluate the incidence of orofacial lesions in treated leprosy patients. Materials and Methods: Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated. Results: On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%). Conclusion: Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae.

Oral soft tissues are affected by numerous pathologic conditions of variable etiology and hence their appropriate management relies on their accurate diagnosis. Clinical identification of intact vesicle and bulla in the oral cavity is really a challenge due to the regular irritation and the friable nature of oral mucosa. Rupture of these lesions leads to erosions or ulcerations on the surface, hence making the diagnosis of vesiculobullous (VB) lesions is even more difficult due to the fact that the differential diagnosis along with VB lesions will also include ulcerative, immunological-mediated diseases, and neoplasms and systemic diseases. Hence, knowledge of the clinical presentation of these disorders and the relevant diagnostic procedures is important not just for dermatologists, but also for general practitioners and dentists. In this article, the various procedures have been explained that can be used for the diagnostic purpose of VB lesions.

Melanocytes are neural crest derivatives that exhibit a ubiquitous presence in the epidermis. They determine the complexion of an individual and most importantly, provide a barrier against ultraviolet radiations from the sun. Their presence in the oral cavity is a consistent finding, especially in the gingiva and buccal mucosa of the dark complexioned. Melanocytes occasionally form a part of the histology of a variety of odontogenic cysts and tumors. How these cells make their way into the lesional tissue and the diagnostic relevance of their presence remains elusive. This write up attempts to trace the path melanocytes take to find themselves within odontogenic tumors and also offer possible explanations for the same.

Colposcopy is an established technique for diagnosis in gynecology. Many premalignant and malignant lesions in these areas have discernible characteristics which can be detected using a colposcope, providing an enlarged view of the areas, allowing the colposcopist to visually distinguish normal from abnormal appearing tissue and take directed biopsies for further pathological examination. The diagnosis of a dysplastic lesion of the oral mucosa cannot be based solely on clinical findings. Therefore, histological evaluation of a representative biopsy specimen is necessary. The site for the biopsy is a subjective choice that sometimes raises doubts about its representativeness. So far, no simple and reliable method is available for selecting the most appropriate area for biopsy. Intraoral microscopy (oral application of the colposcopy technique) of mucosal lesions seems to offer advantages in selecting more representative sites for biopsy than routine clinical examination alone. The biopsy sites identified by direct oral microscopy show more advanced histologic signs than those selected by routine clinical examination. This article enlightens the application of colposcopy in diagnosis of oral premalignant lesions and malignant lesions.

Gorham's disease is a rare disorder of uncertain etiology characterized by spontaneous and progressive osteolysis of one or more skeletal bones. Till date, less than 200 cases have been reported in the international literature with about 51 cases involving the maxillofacial site. The radiographic findings associated with Gorham's disease are particularly dramatic, as in some cases a complete resorption of the involved bone can occur, leading to the definition of phantom bone or disappearing bone disease. The purpose of this review is to make our community aware of this rare entity and to discuss the etiopathology, clinical presentation, radiographic findings, histopathology, differential diagnoses and treatment modalities for patients with vanishing bone disease.

Langerhans Cell Histiocytosis (LCH) is a disease process characterized by accumulation and infiltration of cells, showing ultrastructural and immunohistochemical similarities to Langerhans' cell, in the affected tissues. It exhibits extreme clinical heterogeneity. LCH was historically divided into 3 clinical entities based on extent of tissue involvement and severity of presentation. These 3 entities were eosinophilic granuloma, Hand-Schuler-Christian disease, Letterer-Siwe disease. Owing to similarities of their histologic appearance, they were grouped together under the term histiocytosis X. It was recently changed to LCH, emphasizing the primary cell involved in the disease process. LCH is a rare disease with an incidenceestimated to be 4.0 to 5.4 per million population. Males are affected twice as frequently as females. The disease may occur at any age with peak incidence in children aged 1 to 3 years. We describe an unusual case of a 65-year-old man who presented with painless swelling in anterior region of mandible.

Necrotizing sialometaplasia (NS) is a benign, self-limiting inflammatory reaction of salivary gland tissue which may mimic squamous cell carcinoma or mucoepidermoid carcinoma, both clinically and histologically, that creates diagnostic dilemma leading to unwarranted aggressive surgery. Most commonly affected site is the minor salivary glands of the palate. The pathogenesis is unknown but is believed to be due to ischemia of vasculature supplying the salivary gland lobules. A simple incisional biopsy is required to confirm the histological diagnosis and to rule out more serious disease processes. It is a self-limiting disease process and requires no treatment. It will be prudent to do repeat biopsy in case if the lesion does not heal within 3 months.

Chondrosarcoma (CHS) is a rare malignant neoplasm of the jaws. Based on the morphologic features alone, a correct diagnosis of CHS may be difficult. Therefore, correlation of radiological and clinicopathological features are mandatory for the diagnosis of CHS. A case of CHS of the maxilla is reported. A brief discussion on the etiopathogenesis, radiologic and histologic presentation of the tumor and the treatment modalities of this unusual tumor is discussed.

Parosteal osteosarcomas are rare, low-grade juxtacortical variant of osteosarcoma, especially in the jaws, representing 1.6% of all bony malignant tumours and upto 5% of all osteosarcomas. Only 12 cases of intraoral parosteal osteosarcomas have been reported in the English literature. In the jaws males are more commonly affected with peak occurrence at 39 years and nearly equal site predilection for maxilla and mandible. Radiographically, parosteal osteosarcomas are radiodense, lobulated masses with a broad stalk to the cortex of the bone with no periosteal reaction and medullary invasion. Microscopically, shows well-differentiated tumor with minimum atypia and rare mitotic figures separating trabeculae of woven bone. Unlike classical and periosteal osteosarcoma, it is considered to have a good prognosis. A case report of this rare entity in 22-year-old female patient with bony hard, painless swelling of 9 months duration in maxillary premolar-molar region is presented. The need for differential diagnostic approach is emphasized from other seemingly benign clinical entities.

Granular cell tumor (GCT) usually occurs as a single tumor, although sometimes multiple lesions can occur. In present report we analyze the clinicopathological and immunohistochemical features of a multiple GCT involving the tongue of a 14-year-old girl, with no other abnormalities, with a metachronous occurrence of a second GCT in vulva, after a period of 10 years. Both tumors revealed S-100, vimentin and CD57 positivity. In addition, over expression of calretinin was observed in tumor cells located in the vicinity of pseudoepitheliomatous hyperplasia (PEH) of the tongue. Tumor vasculature situated close to the PEH showed marked CD105 reactivity, data not described so far, suggesting an interaction between PEH cells and underlying stroma, since GCT completely lacks CD105 vessels. Our study emphasizes that patients with GCT, especially young patients, should be followed long-term, looking for multiple tumors or other abnormalities suggestive of a systemic syndrome, given the associations described in multiple GCT.

Clear cell odontogenic carcinoma (CCOC) is a rare, potentially aggressive odontogenic epithelial tumor with tendency for recurrence. It was first described as a clinicopathological entity in 1985 and to date only 73 cases has been reported in English literature. A case of CCOC in 64-year-old male patient in mandibular anterior region is presented which when recurred in soft tissue 5 years after wide surgical resection of mandible, revealed a biphasic pattern as against monophasic pattern of primary neoplasm and was unusually associated with primary squamous cell carcinoma, suggestive of hybrid tumor.

Background: Mandibular metastasis as the first manifestation of undiscovered synchronous double primary cancers is extremely rare, so, it is presented in the current study. Case History: This study reports a 73-year-old man, complaining of a painful mass in the mandible. After history taking, physical examination and panoramic radiographic evaluation; an incisional biopsy was performed intraorally. Histological studies revealed a metastatic tumor of epithelial origin with nonspecific primary site. During metastatic workup of the patient, it was accidentally found that three organs including prostate, lung and thyroid were involved with cancer. Using immunohistochemical study (prostate-specific antigen (PSA), thyroid transcription factor 1 (TTF-1) and thyroglobulin), a final diagnosis of thyroid carcinoma metastasis to the mandible was established. Discussion: This case report showed that the practitioners should always maintain a high index of suspicion to the possibility that a patient with an orofacial metastatic lesion may have two or more synchronous primary cancers.

Leiomyosarcoma (LMS) is a malignant neoplasm composed of cells showing distinct smooth muscle features. Majority of the tumors are located in the retroperitoneum, including the pelvis and the uterus but are rare in the oral and pharyngeal region. Intraorally, they are present as painless, lobulated, fixed masses of the submucosal tissues in middle-aged or older individuals. Lesions are usually slow growing and are less than 2 cm in diameter at the time of diagnosis. Here we report the clinico-pathological findings of a case of primary LMS of the maxilla in 63-year-old male patient with an emphasis on the judicious use of ancillary diagnostic modalities to arrive at a definitive diagnosis.

Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.

The purpose of this paper is to report a case of chondroblastic osteosarcoma in the region of the maxilla, with 5 months of evolution. The term osteosarcoma refers to a heterogeneous group of malignancies with bone formation or mesenchymal tissue with histopathological evidence of osteogenic differentiation. The pattern of chondroblastic osteosarcoma represents 25% of all reported cases of this neoplasm. Its histopathological diagnosis is based on the predominance of a chondroid matrix formed in the midst of neoplastic cells. A woman patient, 27-year old, melanoderm, presented on extraoral exam with facial asymmetry caused by the a swelling in the premaxillary region with upper lip protrusion. Intraoral exam showed a maxillary tumefaction with involvement of the vestibular and palatine regions. The computerized tomography (CT) analysis exhibited a radiolucent mass with dispersed areas of radiopacity, with poorly defined and indistinct peripheral edges. The patient was subjected to incisional biopsy and histopathological examination showed the presence of a malignant neoplasm of mesenchymal origin characterized by the presence of irregular bone trabeculae dispersed among mildly atypical chondroblastic cells. The World Health Organization (WHO) recognizes several variants that differ in location, clinical behavior and degree of cellular atypia. The conventional or classical osteosarcoma is the most frequent variant, which develops within the medullary bone. This report illustrates the rapid evolution of one of the histological variants of osteosarcoma.

The teratoid cyst is a rare variant of the dermoid cyst which seldom occurs in the oral cavity. If seen, they generally present as slow growing cysts of the floor of mouth, reported commonly in the 2 ^nd and 3 ^rd decade of life in males. Histopathologically, dermoid cyst is classified as epidermoid cyst, true dermoid cyst and teratoid cyst depending on the presence of adnexal structures and derivatives of all three germ layers. Herewith we report a rare case of teratoid cyst of the floor of the mouth, in a 2-year-old female child, which was present since birth.

Myoepithelial carcinoma (MC) is a malignant salivary gland neoplasm whose tumor cells demonstrate cytologic differentiation toward myoepithelial cells and lack ductal or acinar differentiation. It is a relatively rare tumor and many a times remains undiagnosed because of histopathological heterogeneity. It represents about 0.4-0.6% of all salivary gland tumors and 1.2-1.5% of carcinomas. It occurs predominantly in the parotid gland with a mean age of presentation being 55 years (range 14-86) with no sex predilection. MC appears to be a low grade malignancy when arising in a pleomorphic adenoma, but tends to be more aggressive and has a higher metastatic potential when arising de novo. The clinical behavior of MC is variable and there are no pathologic features that correlate with patients' outcome. Most tumors that display marked cytologic atypia, high mitotic activity and necrosis tend to behave aggressively. The current case is of a 42-year-old male with recurrent tumor mass in the mandibular right posterior region. The purpose of this article was to describe the clinicopathological and immunohistochemical features of intraoral MC and to discuss review of literature of this rare tumor.

Solitary bone cysts (SBCs) are bone cavities that lack a true epithelial lining. They are more commonly seen during the first 2decades of age.Very few cases have been reported over 40 years of age.SBCs are usually discovered as an accidental coexisting finding during a routine radiologic examination or during another unrelated dental complaint. They present as a unilocular or multilocular radiolucent lesion associated with vital teeth with mild or no cortical expansion. Bilateral presentation is however very rare. We present a case of 52-year-old female patient with bilateral presentation of SBCs.