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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists
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Table of Contents
January-April 2021
Volume 25 | Issue 1
Page Nos. 1-206
Online since Friday, May 14, 2021
Accessed 73,134 times.
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EDITORS DESK
From the Editor's Desk
p. 1
T Smitha
DOI
:10.4103/0973-029X.316076
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GUEST EDITORIAL
Supportive care for oral cancer patients during the COVID-19 pandemic role of an oral and maxillofacial pathologist
p. 2
P Sharada
DOI
:10.4103/0973-029X.316065
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LIVING LEGEND
Dr. Hemavathy S
p. 4
Shyamala Karnam
DOI
:10.4103/0973-029X.316067
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INVITED REVIEW ARTICLE
Coronavirus disease 2019 and its vaccines: An update
p. 5
Nadeem Jeddy, LJ Sai Lakshmi
DOI
:10.4103/jomfp.jomfp_90_21
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by coronavirus. Most of the people infected with the COVID-19 virus will experience mild-to-moderate respiratory illness and recover without requiring special treatment. Older people and those with underlying medical problems are more likely to develop serious illness. In December 2019, a novel coronavirus designated as severe acute respiratory syndrome (SARS) coronavirus 2 emerged in the city of Wuhan, China, and caused an outbreak of unusual viral pneumonia. Being highly transmissible, this novel coronavirus disease, also known as COVID-19, has spread fast all over the world. It has overwhelmingly surpassed SARS and Middle East respiratory syndrome in terms of both the number of infected people and the epidemic areas. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. Infections caused by these viruses are an enormous global health threat. Hence, the government has established fast-tracking research to develop rapid diagnostic test kits and vaccines at low cost. This review highlights the vaccines available against COVID 19 worldwide and its implications.
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EMERGING HOT TOPICS - ORIGINAL ARTICLE
Importance and correlation of sudden onset, presence and recovery of olfactory and gustatory dysfunctions in COVID-19 patients: A cross-sectional study
p. 12
Himani Tiwari Chaturvedi, Varsha Prabhubhai Patel, Rahul Ramanbhai Vasava, Chandrashekher Chaturvedi
DOI
:10.4103/jomfp.jomfp_88_21
Background:
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), may be associated with acute onset of smell and taste dysfunction along with other common presenting symptoms such as cough, fever and myalgia. Our study aims to analyze the presence of olfactory and gustatory dysfunctions Olfactory and gustatory dysfunctions (OGDs) in patients with COVID-19 and to assess their onset and recovery.
Materials and Methods:
The cross-sectional study was conducted in March 2021 retrospectively at Care Multispecialty Hospital, Vadodara. A total 301 patients were admitted, among those 280 qualify according to inclusion criteria and 3 patients denied to participate in the study. All patients presenting with laboratory-confirmed real-time reverse transcriptase polymerase chain reaction test for SARS-CoV-2 were included in the study. All 277 patients were undergone a diagnostic questionnaire through telephonic conversation which include patient main symptoms and self-assessment of loss of smell and taste and their onset and recovery.
Results:
Two hundred and seventy-seven patients were included in this study. One hundred and fifty-three patients (55%) reported olfactory and gustatory disorders. Loss of taste and smell were more frequently reported in female patients (72.8%) than male patients (48%). Onset of these symptoms concomitant with other typical symptoms of COVID-19 is in 58.2% of cases. Recovery of symptoms in most patients was in 5–10 days and faster in younger patients.
Conclusion:
Olfactory and gustatory disorders (OGDs) related to COVID-19 are frequently reported and more common in female patients. Rapid recovery was observed in most cases. Altogether OGDs can possibly act pivot screening or diagnostic tool for COVID-19 pandemic.
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EMERGING HOT TOPICS - REVIEW ARTICLE
Saliva and COVID 19: Current dental perspective
p. 18
Aman Chowdhry, Priyanka Kapoor, Om P Kharbanda, Deepika Bablani Popli
DOI
:10.4103/jomfp.jomfp_63_21
Oral health care providers are at a higher risk of being infected by novel coronavirus due to close proximity to patient's face and exposure to saliva while working on the patient. Thus, there is an urgent need to interpret the available literature in order to establish safe practices for dental professionals as well as limit the spread of infection through saliva. The study intends to provide up-to-date, compiled evidence-based information related to saliva and its association with COVID-19. It further provides suggestions for safe practices in dentistry in current pandemic times. Oral symptoms may be strongly suggestive of early diagnosis and disease progression in COVID-19 patients. Viral loads in saliva are reported higher than standard nasopharyngeal swabs in few studies, majorly in the 1
st
week of symptom onset. Besides, salivary diagnostics has many additional advantages of being noninvasive, comfortable to the patients with the possibility of point-of-care testing for diagnosing COVID-19. High-efficiency particulate arrestor filter, rubber dam application and high-volume evacuator can reduce spatter and droplets/aerosol production. Povidone-iodine-based mouthwash maybe mouthwash of choice before any dental examination or procedures due to its ability to decrease severe acute respiratory syndrome- coronavirus 2 viral loads in the mouth. Salivary diagnostics related to COVID-19 should be integral part of dental teaching programs. There is a tremendous scope to study saliva in health and diseases.
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LETTERS TO EDITOR
Root carving in tooth morphology – Is it really necessary?
p. 22
B Sivapathasundharam, GB Protyusha
DOI
:10.4103/0973-029X.316066
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Relevance of innovative course modules for teaching tooth morphology in today's scenario
p. 23
Suhasini Palakshappa Gotur, Vijay Wadhwan
DOI
:10.4103/jomfp.jomfp_51_21
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ORIGINAL ARTICLES
Prevalence of oral neurofibroma in Central Indian population: A retrospective study of 20 years
p. 25
Suchitra R Gosavi, Riya S Jain, Abhay Datarkar
DOI
:10.4103/jomfp.JOMFP_237_20
Context:
Neurofibroma is a benign peripheral nerve sheath tumor. Commonly found in the peripheral soft tissues, it can manifest as a solitary mass or as a component of neurofibromatosis.
Aims:
The purpose of the retrospective cross-sectional study was contributing to the literature by providing data about the prevalence of oral neurofibroma in Central Indian population. Settings and Design: Retrospective, cross-sectional study.
Subjects and Methods:
All histopathologically diagnosed cases of oral neurofibroma were retrieved from the archives of our department and were reviewed. All the cases that met the inclusion criteria were reviewed in terms of the year when the patient reported, patient's age, gender, location of the lesion, i.e., soft tissue or intraosseous, clinical appearance, i.e., growth or swelling, histopathologic diagnosis and immunohistochemistry results if available. The results were aggregated and described qualitatively using Microsoft Excel 2013.
Results:
In our retrospective analysis of 20 years (2000–2019), we came across 14 reported cases of oral neurofibroma, in five males and nine females. Two of these cases showed a recurrent nature and one case showed transformation into atypical neurofibroma. Two cases were encountered in the mandible as an intraosseous oral neurofibroma.
Conclusions:
In our study, we found that oral neurofibroma was more common in the third decade with a female predilection. Gingiva was the most common site. Of the 14 cases that were encountered, two cases showed recurrence and one case showed malignant transformation. Hence, in spite of being a benign neoplasm, oral neurofibroma is locally aggressive and should be diagnosed accurately.
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Peels as an alternative to ground sections – An
in vitro
microscopic study
p. 31
Rachna Rath, Vandana Raghunath
DOI
:10.4103/jomfp.JOMFP_99_20
Background:
The routine approach to delve into the organization of mineralized and nonmineralized structures of teeth is by studying whole tooth or slices of it by making thin section which requires laborious grinding or employing specialized equipment and also leads to specimen wastage. Peels hitherto utilized for fossil studies hold promise in overcoming the aforesaid shortcomings. Although the acetate peel technique has been modified for the study of tooth structure, the field remains largely unexplored.
Aim:
The current study was taken up to explore the usefulness of cellulose acetate peels in reproducing microscopic structures of teeth as seen in routine ground sections and further if they could supplement or replace the same.
Materials and Methods:
Extracted human teeth were embedded in plaster blocks in longitudinal and transverse orientation, ground and polished with silicon carbide paper. Following etching, washing and drying, the polished surface was wet with acetone and precut cellulose acetate film was placed over it and allowed to dry. As the acetate polymer dissolved in acetone and subsequently re-polymerized after setting into the micro reliefs produced by tooth etching, it registered the microscopic tooth details on its surface. The peels were mounted and secured on a glass slide and subjected to routine light and phase contrast microscopy for observing captured details of the tooth structure.
Results and Conclusion:
Acetate peels successfully reproduced most of the microscopic tooth details which were better than those observed in ground tooth sections. Hence, this technique could be considered as a quick, durable and inexpensive alternative or supplement to routine thin ground sections of dental hard tissues.
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Horoscopic role of CD105 (Endoglin) in progression of oral lichen planus: An immunohistochemical study
p. 37
Poornima Parvathala, P Venkat Baghirath, C Narendra Reddy, B Hari Vinay, A Bhargavi Krishna, Parameshwar P Naishadham
DOI
:10.4103/jomfp.JOMFP_82_20
Context:
Role of CD105(Endoglin) in Pathogenesis and progression of OLP.
Aim:
To assess the role of neoangiogenesis in the progression of OLP by determining the expression of CD105 in OLP and normal mucosa.
Settings and Design:
The present study includes a total of 70 formalin-fixed paraffin-embedded blocks of which the study group comprises 50 tissue sections histopathologically confirmed as OLP. They were subdivided into two groups - Group I (Reticular OLP) and Group II (Erosive OLP) - 25 each. The control group (designated as Group III) included 20 sections of normal mucosa.
Materials and Methods:
All the sections were 4 μm thick and stained with CD105 antibodies. After identifying areas of highest vascularity (hot spots) in low power (×10) magnification, individual microvessels were counted manually at high power (×40) magnification.
Statistical Analysis Used:
Analysis of variance test was used to determine the difference of microvessel density (MVD) between variants of OLP and normal mucosa and Cohen's kappa statistic was used to check interobserver variability.
Results:
CD105 staining showed a mean MVD of 1.31 ± 1.8 in the normal mucosa compared to 1.68 ± 1.4 and 4.14 ± 2.7 in the reticular and erosive variants, respectively, with a P = 0.000*, which is statistically significant (*P < 0.05 is statistically significant).
Conclusion:
Based on our observations, it is evident that compared to normal mucosa, MVD is greater in lichen planus. Within the two variants of OLP, MVD is higher in Erosive variant compared with Reticular variant, foreshadowing the role of neoangiogenesis in the progression of OLP and its possible malignant transformation.
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Tumor-associated macrophages: Harbingers of aggressiveness in oral squamous cell carcinoma
p. 46
Anupama Mukherjee, Anita Spadigam, Anita Dhupar
DOI
:10.4103/jomfp.JOMFP_302_20
Background:
The significance of the tumor microenvironment (TME) as a modulator of tumor behavior was acknowledged by Hanahan and Weinberg in 2011 as the emerging hallmarks and enabling characteristics of the hallmarks of cancer. Subsequently, the role of inflammation, in conferring aggressiveness to a tumor, was regarded as a fundamental process in the evolution of the TME. Tumor-associated macrophages (TAMs) are distinctly polarized inflammatory cells and key shapers of a protumorigenic microenvironment.
Aims:
The aim of the study was to evaluate the distribution of TAMs and the expression of CD-163 as a marker to evince tumor aggressiveness, in oral squamous cell carcinoma (OSCC).
Settings and Design:
A retrospective institutional study was approved by the institutional ethics committee, and random sampling was carried out. Cases fulfilling the inclusion criteria were subjected to S(site), T(tumor), N( node), M( metastasis), P(pathology) STNMP staging along with immunohistochemical evaluation of CD-163.
Methods:
Samples for this study included 58 archival cases of OSCC. Demographic details were recorded, and the STNMP stage ascertained, following which, each case was reevaluated histopathologically for the invasive front. Cases with sufficient stroma and demonstrating the invasive front were further subjected to immunohistochemical evaluation of CD-163 for TAMs. The density of CD-163-positive cells was assessed by three pathologists, independently, in a double-blinded evaluation using Image-J©.
Statistical Analysis:
Descriptive data were evaluated and analyzed statistically using Spearman's/Pearson's correlation tests based on the distribution of data.
Results:
The density of TAMs was noted to be directly proportional to the STNMP stage. In addition, a strong positive, statistically significant correlation was noted between the density of TAMs and tumor size, nodal status and STNMP stage. Conclusion: The crucial role of the tumor microenvironment must be considered when evaluating OSCC. TAMs prove to be a reliable marker for assessing tumor aggressiveness and could aid in improved prognostication of OSCC, while also being potential targets for therapy.
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Prevalence of recurrent herpes labialis in Western Maharashtr
p. 51
SR Ashwini Rani, Girish Suragimath, Vijaya Rajmane, Yojari Rajmane
DOI
:0.4103/jomfp.JOMFP_204_20
Background:
Recurrent herpes labialis (RHL) is a disorder with serious health and social consequences and which affects most of the adults. However, high degree of research paucity pertaining to its prevalence was observed, especially from India.
Objective:
The objective of this study was to assess the prevalence of RHL in western Maharashtra.
Materials and Methods:
In this prospective study, 1368 patients of either sex, satisfying the inclusion criteria, were included in the study after screening 34,560 patients for RHL lesions. Demographic data such as age, gender and risk factors, namely stress, menstruation and common cold, were recorded. Further, data regarding history of itching, fever, malaise and burning on lips followed by vesicles and frequency of lesions and duration were also recorded. After clinical examination site, size and nature of lesion were noted on a clinical pro forma. Results were compared statistically, and
P
< 0.05 was considered statistically significant.
Results:
The majority of the patients were in the age group of 30–39 years, with a female predominance (63.89%) (male:female = 0.33:0.59). Stress (43%) was the most common risk factor in the occurrence of RHL, followed by disturbed menstruation cycle (21%). Most of the patients had two episodes of RHL (42.4%), whereas some had just one episode of recurrence (25.4%) in the past 1 year. The most commonly occurring location for RHL was upper lip (47%), especially the left side (19.1%) and right side (18.2%) of the upper lip. The overall prevalence rate of RHL in our study was 3.9%.
Conclusion:
An established prevalence (3.9%) of RHL occurs among patients in western Maharashtra.
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Broder versus Bryne's histologic grading parameters on incision biopsy specimens: A comparative study with P53 and KI67 expression
p. 55
Gopikrishnan Vijayakumar, Gitika Sharma, Anjali Narwal, Mala Kamboj
DOI
:10.4103/jomfp.JOMFP_328_20
Objective:
Various histological grading of oral squamous cell carcinoma has been contributed to the literature at different periods, but the reliability of such grading systems is controversial. This study attempted to measure the efficacy of Bryne's parameters on the full thickness of incisional biopsies which are representative of the original lesion with the proven molecular malignancy markers P53 and Ki67.
Materials and Methods:
One hundred incisional biopsy specimens of oral squamous cell carcinoma were obtained and histologically graded according to Broder's grading system. The same was graded using Bryne's parameters on full thickness of obtained incision sample. Immunohistochemistry was carried out for both p53 and Ki67.
Results:
We found a high discrepancy in the grading of lesions with Broader as well as Bryne grading parameters within the same lesion. When compared with the molecular expression percentages of p53 and Ki67, highly significant correlation was found in Bryne's parameters (Pearson Chi-square,
P
value 0.000) in incisional biopsies than Broder's.
Conclusion:
The use of parameters by Bryne on invasive front of excision biopsies can provide significant grading on incisional biopsies which are more comparable to the molecular behavior of tumor given by the p53 and Ki67 expression.
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Cheiloscopy and dermatoglyphics in normal and obese individuals: A study in Indian subpopulation
p. 61
Hosmath G Shivakumar, DB Nandini, KP Mohan Kumar, M Selvamani, NK Priya, GS Madhushankari
DOI
:10.4103/jomfp.JOMFP_228_19
Background:
The prevalence of obesity has been steadily increasing worldwide. Reliable and noninvasive tools that can be used to diagnose such conditions may help us in mass screening and prevention. Finger prints and lip prints have been used as the genetic markers in some diseases such as diabetes mellitus. Studies to correlate a possible association of such markers among obese individuals have not been reported in India to date. The present study was conducted to determine and compare the lip print and finger print patterns in normal and obese individuals and also to evaluate any possible correlation between the lip prints and finger prints in both the study groups.
Methodology:
Lip and finger print patterns of 100 obese and equal number of age- and sex-matched healthy individuals were analyzed. Right thumb, right index, left thumb and left index finger prints were evaluated. Gender-wise comparison was also made.
Results:
Lip prints revealed no significant difference between obese and nonobese individuals. Predominant Type I lip print was observed in both the study groups. Comparison of finger prints between obese and nonobese individuals revealed a highly significant results for all the fingers. Predominant finger print patterns in the right thumb, right index, left thumb and left index among obese individuals were whorl (51%), loop (83%), whorl (79%) and arch (74%), respectively. No correlation between the lip prints and finger prints was noted.
Conclusion:
Finger prints in the obese individuals showed significant differences when compared to the normal controls while lip prints failed to reveal any significant difference. Lip prints did not correlate with the finger prints. Right thumb revealed a significant gender difference among obese individuals.
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Evaluation of aryl hydrocarbon receptor expression in oral squamous cell carcinoma and normal oral mucosa using western blot
p. 68
Vinod Mony, R Madhavan Nirmal, V Parvathi, RL Parvathy, BR Varun, P Jayanthi
DOI
:10.4103/jomfp.JOMFP_287_20
Background:
Aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor that acts as a binding site for toxic chemicals, particularly the dioxin group of chemicals. Elevated levels of AHR have been observed in various human cancers, including lung carcinomas, hepatic carcinomas and in mammary tumors. However, the expression of AHR in oral squamous cell carcinoma (OSCC) patients who are tobacco users are less explored.
Aims and Objectives:
The aim of the present study is to evaluate and compare AHR levels in OSSC patients and in normals using Western blot technique in an attempt to explore the possible role of AHR in oral carcinogenesis.
Materials and Methods:
The study sample consisted of ten oral squamous cell carcinoma cases which were diagnosed clinically and confirmed histopathologically as OSCC and four samples of the normal oral mucosa. AHR protein expression was evaluated using Western blot technique and chemiluminescence detection kit. The densitometry was performed on a Microtek scan maker MSP flatbed scanner and quantified using Image J software. Mean AHR protein levels were calculated and compared between OSCC and normal oral mucosa using Student's
t
-test.
Results:
The mean AHR protein level in OSCC samples (
n
= 10) was 2878.90 ± 1231.27 and 975.75 ± 227.27 in the normal oral mucosa (
n
= 4). The OSCC samples showed significantly higher levels of AHR protein compared to the normal oral mucosa (
P
= 0.008).
Conclusion:
The study showed a significantly higher expression of AHR in oral squamous cell carcinoma samples when compared to the normal oral mucosa, suggesting a possible role of AHR in the initiation, promotion and progression of oral squamous cell carcinoma.
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Assessment of immunohistochemical expression of p16 in head and neck squamous cell carcinoma and their correlation with clinicopathological parameters
p. 74
Pinki Pandey, Megha Ralli, Alok Dixit, Savita Agarwal, Vineet Chaturvedi, Anshul Sawhney, Roopak Agarwal
DOI
:10.4103/jomfp.JOMFP_252_20
Introduction:
Oral squamous cell carcinoma is a major cause of death throughout the developed world. It is associated with tobacco chewing, paan chewing and alcohol consumption. Human papillomavirus (HPV) type 16 has also been suggested to play a role in the etiology of head-and-neck squamous cell carcinoma (HNSCC). p16 expression is now being used as a surrogate marker of HPV infection in squamous cell carcinoma.
Materials and Methods:
In this cross-sectional observational study, a total of 100 cases of HNSCC were taken. p16 expression was determined by immunohistochemical (IHC) staining and correlated with clinicopathological parameters. The obtained results were analyzed and evaluated using Chi-square test, value of
P
< 0.05 was taken significant.
Results:
P16 was positive in 60% of cases. A statistically significant direct association was observed between p16 with age, site of the tumor, abnormal sexual habits and lymph node involvement.
Conclusion:
IHC expression of p16 can be used as a surrogate marker of HPV. Study of p16 expression may provide clinicians with more exact information in order to evaluate tumor aggressiveness, treatment modalities and can provide support for vaccination program in a high-risk group.
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Salivary malondialdehyde in oral submucous fibrosis – A marker for oxidative damage
p. 82
Shyam Raj Ganta, Samatha Chittemsetti, Taneeru Sravya, Venkateswara Rao Guttikonda
DOI
:10.4103/jomfp.JOMFP_279_18
Background:
Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa and its malignant transformation rate accounts to about 7%–13%. Oxidative damage and lipid peroxidation plays an important role in OSMF. Lipid peroxidation has not been widely investigated in OSMF patients with respect to clinical staging and histopathological grading. As human saliva is a diagnostic fluid which can be obtained in a noninvasive procedure as compared to the blood for serum analysis, the present study was aimed at evaluating the salivary malondialdehyde (MDA) levels in OSMF and comparison with respect to clinical staging and histopathological grading.
Aim:
This study aims to evaluate salivary MDA levels in OSMF and compare the levels with respect to clinical and histopathological grading systems.
Materials and Methods:
Forty cases of clinically diagnosed and histopathologically proven cases of OSMF were included for the purpose of this study. As controls 40 age-matched individuals without any systemic disease were selected. Unstimulated whole saliva was collected from each individual, centrifuged and frozen at − 20°C until analysis. Lipid peroxidation products MDA were analyzed by thiobarbituric acid reaction.
Results:
Salivary MDA levels were significantly increased in OSMF patients compared to controls. The progressively increased salivary MDA levels showed a positive correlation with the clinical stages and histopathological grades of OSMF and the results were statistically significant.
Conclusion:
The increased salivary MDA levels in OSMF patients compared to the control group suggests an increased oxidative stress levels in the potentially malignant disorders such as OSMF. The mean salivary MDA levels were increased significantly as the clinical stage and histopathological grade of OSMF advances, suggesting MDA to be used as a reliable biochemical marker and also a prognostic marker to assess the extent of oxidative damage in OSMF.
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Natural stain (
Kumkum
) formulated by the extract of
Curcuma aromatica
and slaked lime in histostaining of oral tissues: An observational study
p. 88
A Lavanya, SV Sowmya, Roopa S Rao, Dominic Augustine, Vanishri C Haragannavar
DOI
:10.4103/jomfp.JOMFP_90_20
Background:
The pharmacological actions of
Curcuma aromatica
(wild turmeric) such as anti-inflammatory, antitumor, antifungal, antimicrobial and wound healing have been recognized since ages. However, its role as a natural histological stain has not been explored till date.
Aim:
To evaluate the efficacy of natural substance-
Kumkum
prepared from the extract of
C. aromatica
and slaked lime in staining the biopsied oral tissues
Materials and Methods:
A cohort study that used 60 formalin fixed paraffin embedded soft and hard tissue specimens from institutional archives were subjected to sectioning and stained using
Kumkum
and hematoxylin and eosin (H and E). The slides were evaluated for their staining efficacy and results were statistically analyzed using Wilcoxon signed-rank test and Independent 't' test.
Results:
The mean of the overall parameters assessed for staining efficacy did not show statistically significant difference between the study groups in normal and pathological specimens for tooth (
P
= 0.410 and 0.484), bone (
P
= 0.133 and 0.157) and soft tissues (
P
= 0.186 and 0.113), respectively. This suggests that
Kumkum
staining efficacy is equivalent to that of routine H and E for oral tissues. Structures such as dentinoenamel junction, dentinal tubules, incremental lines of cementum, reversal and resting lines, osteocytic canaliculi, mature and immature bone could be appreciated better in
Kumkum
stained slides, thereby rendering a special staining property to
Kumkum
stain.
Conclusion:
To our knowledge, this study is the first of its kind to have used
Kumkum
stain obtained from
C. aromatica
for the differentiation of the components of tooth, bone and soft tissue structures in histostaining of oral tissues. The naturally prepared
Kumkum
stain possesses dual staining property both in routine and differential staining. This facilitates diagnosis of fibro-osseous lesions, bony, collagen and muscular pathologies. The natural stain also finds application in forensic odontology for age estimation.
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Evaluation of immunohistochemical expression of epithelial–mesenchymal transition markers E-cadherin, Twist and Snail in oral submucous fibrosis and their possible association with malignant transformation
p. 97
Mahadevi B Hosur, Rudrayya S Puranik, Shrinivas S Vanaki, Surekha Rudrayya Puranik, M Sudhakara, Sushma Das
DOI
:10.4103/jomfp.jomfp_454_20
Background:
Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition of the oral mucosa, predominantly seen in people of Asian descent. The reported malignant transformation rate of OSMF is 7%–13%. In the context of the understanding progression of OSMF, the study of prime molecular expressions is essential. Various markers have received more attention, one of them is E-cadherin. Various factors which promote epithelial–mesenchymal transition (EMT) and inhibit E-Cadherin include Snail1, Snail2, Twist and EF1/ZEB1. The intended study was undertaken to evaluate the possible role of E-cadherin and its regulatory markers Twist1 and Snail1 in OSMF.
Aims and Objectives:
To evaluate the expression of E-cadherin, Twist1 and Snail1 in OSMF
To evaluate their possible association with malignant transformation of OSMF.
Materials and Methods:
Histologically proven 20 cases of each OSMF with and without dysplasia were taken as the study group, 20 normal mucosa as control group and were subjected for immunohistochemical (IHC) expression with E-cadherin, Twist1 and snail1.
Results:
Immunohistochemical expression of all the three markers showed statistically significant expression of all the three markers. Intensity and percentage of staining between the groups were statistically significant for E-cadherin between normal oral mucosa (NOM) and OSMF with dysplasia (OSMFD), no significance was found between NOM and OSMF, whereas Snail1 and Twsit1 were statistically significant between NOM and OSMF and also between NOM and OSMFD. However, no significance was found for all the three markers when compared between the groups OSMF and OSMFD.
Conclusion:
The increased expression of Snail1 and Twist1 with concomitant loss of E -cadherin in OSMF suggests the role of the EMT.
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Do patients with oral squamous cell carcinoma express receptor tyrosine kinase-like orphan receptor 1? Results of an observational study
p. 105
Swati Nema, Shreenivas Kallianpur, Ashok Kumar, Rajeev Nema, Supriya Vishwakarma, Sandeep Kumar Nema
DOI
:10.4103/jomfp.JOMFP_293_18
Context:
The receptor tyrosine kinase-like orphan receptor 1 (ROR1) is a transmembrane protein of the receptor tyrosine kinase family. The expression of ROR1 has been linked to cancers.
Aims:
This study aimed to investigate the expression of ROR1 in oral squamous cell carcinoma (OSCC).
Settings and Design:
This prospective observational study was conducted at a tertiary referral center for treatment of oral carcinoma from November 2013 to December 2016.
Subjects and Methods:
One-step quantitative reverse transcription-polymerase chain reaction (30 oral cancer tissues and ten normal oral tissue samples) was performed to characterize the expression of the ROR1 gene in oral cancer.
Statistical Analysis Used:
Analyses of all tumor samples were carried out at least twice, and the mean value was calculated. The differences in ROR1 messenger RNA (mRNA) expression between OSCC tissue and nontumorous gingival tissue was statistically analyzed using Mann–Whitney U-test. The correlations between the clinicopathological parameters and ROR1 mRNA expression were analyzed using Kruskal–Wallis test χ
2
value.
Results:
There were 17, 5, 3 and 1 cases of OSCC of buccal mucosa, tongue and lower alveolus lip, respectively. Nearly 88.5% of cases had a history of tobacco consumption. The most common OSCC type was T2N1M0. There was no difference in ROR1 fold change between controls and cases (
P
= 0.06), but there was a trend for downregulation of ROR1 expression from controls to cases. Subgroup analysis revealed the downregulation of ROR1 expression in controls versus Grade II that was significant (
P
= 0.04).
Conclusions:
There was no change in the expression of ROR1 between cases and controls. A study involving a larger sample size needs to be formulated and conducted for investigating the relation between expression and regulation of ROR1 in OSCC.
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Serum aflatoxin B1 antibody titer, percent hemolysis and transaminases in oral submucous fibrosis
p. 110
Rahul R Bhowate, Vidya K Lohe, Mrunal Ghusaji Meshram, Suwarna B Dangore
DOI
:10.4103/jomfp.JOMFP_226_20
Introduction:
Areca nut is deeply rooted sociocultural habit in India. Areca nut reported to be infested by fungi during the field and storage conditions. Areca nut alkaloids, nitrosamines, tobacco and aflatoxin are cytotoxic, immunotoxic to red blood cell and epithelial cell. Hence, the present study was conducted to assess the serum aflatoxin B
1
(AFB
1
) antibody titer, percent hemolysis and transaminases in oral submucous fibrosis (OSMF) patients.
Materials and Methods:
In this study, 128 participants of which 88 were suffering from OSMF. Twenty participants were areca nut habitual without OSMF (habitual control) and 20 participants without any habit (healthy control). For the detection of AFB
1
antibody titer, AFB
1
antigen (Sigma) A6636 from
Aspergillus
flavus was used. Percent hemolysis was estimated as per the procedure described by Mathuria and Verma. Serum Glutamic oxalo acetic transaminase (SGOT) and Serum Glutamic pyruvic transaminase (SGPT) were estimated by the optimized ultraviolet method using the enzyme-linked immunosorbent assay kit.
Results:
Mean SGOT, SGPT, percent hemolysis and AFB
1
antibody titer were significantly higher in participants with OSMF than the habitual and healthy controls. AFB
1
antibody titer and % hemolysis in both OSMF and habitual without OSMF were showed significant correlation, i.e., increased AFB
1
antibody titer with increased % hemolysis.
Conclusions:
A study result demonstrates that aflatoxin causes increase in serum transaminases which is indicative of liver damage in OSMF. The combined toxic effects of areca nut alkaloids, tobacco and AFB
1
on red blood cell (RBC) cell wall might be responsible for increased percent hemolysis in OSMF and habitual control.
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A comparative study to assess risk of oral candidiasis in pregnant and nonpregnant women
p. 118
Shaimaa, Heena Zainab, Deepa Hugar, Ameena Sultana
DOI
:10.4103/jomfp.JOMFP_255_20
Background:
The major hormonal changes observed in pregnant women lead to an imbalance in the oral environment. Hence, recent studies suggest that the placenta may harbor a unique microbiome that may have originated in the maternal oral microbiome.
Aim:
The present study aimed to assess the risk factor of oral candidiasis in pregnancy and to evaluate the prevalence of
Candida
species in the oral cavity of pregnant women in all three trimesters. The comparison was also done between pregnant and nonpregnant women to evaluate the cause of the prevalence of candidal species.
Materials and Methods:
Thirty pregnant and thirty nonpregnant women aged between 20 and 30 years were included in the study that were healthy and who did not have any obvious lesion in the oral cavity. The sterile swabs were used to collect samples from the oral cavity from both the groups by brushing the dorsum of the tongue and buccal mucosa. The pregnant women were followed throughout the pregnancy, i.e., in every trimester, for the sample collection. The samples were then cultured on Sabouraud Dextrose Agar media. The positive growth on culture plates was then inoculated on HiCrome agar differential agar media for speciation.
Results:
Statistical analysis was done by comparing the positive growth in pregnant and nonpregnant women using Fisher's exact test. The pregnant women were compared in three trimesters using the McNemar Chi-square test.
Conclusion:
The study concludes that there was no significant presence of Candidal species when compared between pregnant and nonpregnant groups. The prevalence of
Candida
species also remained the same.
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Expression of β-catenin in oral leukoplakia and oral submucous fibrosis: An immunohistochemical study
p. 124
Pritha Chowdhury, BR Nagamalini, Jaya Singh, BK Ashwini, Sharada
DOI
:10.4103/jomfp.JOMFP_41_20
Background:
Oral potentially malignant disorders have increased propensity to turn malignant than its apparently normal counterparts. Histopathological examination, although gold standard, needs adjunct technique to give accurate diagnosis. Immunohistochemistry has proved to be a promising adjunct to aid in the diagnosis so far. The quest for a definitive marker is still on. Beta-catenin (β-catenin), a structural protein has been evaluated to identify its likely role in malignant transformation of potentially malignant lesions and possibly designate it as one of the identifiable signature molecules in the transformation.
Aim and Objective:
To evaluate and estimate the expression of β-catenin in different grades of dysplasia, oral submucous fibrosis (OSMF) and normal mucosa and compare the same.
Methodology:
A total number of 40 cases including different grades of dysplasia, OSMF and normal mucosa were immunohistochemically stained, location and intensity of its expression were evaluated for β-catenin. The results were statistically analyzed using the one-way analysis of variance and Chi-square test.
Results:
The expression of β-Catenin in the cytoplasm as well as in the nucleus increased from mild-to-moderate dysplasia to OSMF and to severe epithelial dysplasia in an increasing order. The expression is seen to translocate from membranous to cytoplasm to nucleus indicating a proliferative potential in these group of lesions.
Conclusion:
β-catenin is a promising marker which indicates the malignant transformation potential in the higher grades of dysplasia and OSMF.
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Expression of podoplanin in tumor cells and lymphatic vessels in both tumoral and peritumoral areas and correlation with metastatic potential of oral squamous cell carcinoma
p. 131
Geeta Sharma, Randhir Kumar, Harkanwal Preet Singh, Manu Gupta, Manish Gupta
DOI
:10.4103/jomfp.jomfp_481_20
Aim:
This study aims to study the expression of podoplanin in tumor cells as well as the lymphatic vessels (LVs) in both tumoral and peritumoral areas and correlate the importance of the lymphatic microvascular density (LMVD) in oral squamous cell carcinoma (OSCC) and its metastatic potential.
Materials and Methods:
D2–40 expression and LV density (LVD) were assessed using antibody D240, in 45 diagnosed cases of all the three grades of OSCC. D2–40 expression was evaluated in both epithelial cells as well as the LVs.
Results:
D2–40 expression in OSCC showed two different patterns - diffuse and focal. LMVD was calculated and difference in peritumoral and intra tumoral LVs was also assessed. A marked increase was seen we progressed from well-differentiated tumor to poorly differentiated ones, but this difference was found to be statistically nonsignificant. D2–40 immunostaining also highlighted the presence of lymphatic invasion present within the tumors which was detected by the presence of tumor emboli within the LVs. Overall, no significant correlation was found between D240 epithelial positivity and LVD.
Conclusion:
The expression of podoplanin in tumor cells and lymphatics when correlated with histopathological status and clinically with the lymph node status can definitely help in the adjuvant therapies used in OSCC.
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Expression of stem cell marker cytokeratin 19 in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma – A comparative analysis
p. 136
CN V Akhila, G Sreenath, A Ravi Prakash, M Rajini Kanth, A Vikram Simha Reddy, S Naveen Kumar
DOI
:10.4103/jomfp.JOMFP_316_19
Background:
The process of odontogenesis is complex involving epithelial–mesenchymal interactions, along with the molecular signaling pathways triggering the initiating process. The triggering factors and cells precisely involved in the pathogenesis of odontogenic cysts and tumors are unknown. There is a vast array of biomarkers used to stain different sites, thereby helpful in diagnosing and evaluating the prognosis of these cysts and tumors. Cytokeratins are the intermediate filament proteins which maintain cell integrity and alter their properties in cysts and tumors. In the following study, cytokeratin 19 expression patterns are assessed quantitatively in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma.
Aim:
The aim of present study is to assess expression of CK 19, a stem cell marker in reduced enamel epithelium, dentigerous cyst and unicystic ameloblastoma, quantitatively.
Materials and Methods:
The present study is carried out with 15 samples in each group. Reduced enamel epithelium is derived from the patients undergoing treatment for impacted teeth. Histopathologically diagnosed cases of dentigerous cyst and unicystic ameloblastoma were considered for the study. With the help of Olympus BX 43 microscope, with ProgRes microscope camera, the 45 slides obtained were examined. The region of interest was selected in each slide and number of cells positively stained was counted. Data were analyzed using SPSS software version 23. Descriptive for scale data, One way anova with post hoc Tukey's test for intergroup comparison.
Results:
The results showed significant P value <0.05. Expression of CK 19 was highest in reduced enamel epithelium, followed by dentigerous cyst and unicystic ameloblastoma.
Conclusion:
CK 19 can be used as diagnostic marker to differentiate between odontogenic cyst and tumor.
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Prevalence of herpes virus in chronic periodontitis patients with and without type 2 diabetes mellitus: A clinico-microbiological study
p. 141
Jai Abooj, Siddhartha A Varma
DOI
:10.4103/jomfp.JOMFP_154_20
Background:
Unfavorable modifications of tooth and its surrounding structures result in periodontal complications. Viruses, in specific herpes virus, are known to increase disease severity in periodontal patients. Periodontitis is known to be more established in type 2 diabetes mellitus (DM2) patients. Hence, the detection of the viral load, its effect on the prevalence of periodontitis and the glycemic control status of patients are to be evidenced. The study aimed to reveal the association of herpes virus with periodontal parameters and its prevalence in DM2 patients.
Materials and Methods:
The cross-sectional study involved a total of 120 patients falling into three groups; Group I (healthy), Group II (periodontitis without DM2) and Group III (periodontitis with DM2) were subjected for sampling. Subgingival samples of periodontitis patients were tested for clinical parameters, and DNA extraction was performed. The presence of herpes virus (Epstein–Barr virus [EBV-1] and human
Cytomegalovirus
[HCMV]) was detected using multiplex polymerase chain reaction primers. Glycemic status of patients was recorded as glycosylated hemoglobin and scored accordingly. Chi-square test was performed to analyze the association between the categorical variables, and
t
-test/Mann–Whitney U-test/analysis of variance/Kruskal–Wallis test was used for continuous data.
Results:
Significant levels of EBV-1 were detected in Group III (
n
= 21, 52.5%), followed by Group II (
n
= 16, 40%) and Group I (
n
= 2, 5%) (
P
< 0.0001). HCMV was not detected. A significant association of EBV-1 to periodontal site-specific parameters was observed in Group II patients (
P
< 0.05). EBV-1 was predominant with poor glycemic status patients.
Conclusion:
This study revealed that the incidence of herpes virus infection in periodontal patients was higher in diabetic patients and the examined patients were prone to EBV-1 infections.
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Association of oral candidal species with human immunodeficiency virus patients of West Godavari district, Andhra Pradesh – An
in vitro
study
p. 147
R Mounika, Govindraj K Nalabolu, N Pallavi, Smita S Birajdar
DOI
:10.4103/jomfp.jomfp_504_20
Introduction
: Human immunodeficiency virus (HIV) infection is a major worldwide health problem characterized by progressive immunosuppression. The morbidity of HIV patients is due to its association with opportunistic infections among which oral candidiasis is common. Regardless of HIV status, candidiasis can prevail when their immune system is depressed. Oral candidiasis can thus serve as a useful marker for both restoration of immune functions and HIV disease progression. Routine identification of Candida species is laborious and time-consuming. HICHROM agar stains different species into different colors facilitating rapid reliable identification of candida species as they differ in their virulence and sensitivity to antifungal drugs.
Materials and Methods:
This cross-sectional study includes a total of 200 HIV seropositive patients from Anti-Retroviral Therapy Centre, West Godavari District. Unstimulated saliva samples were collected in a screw-capped universal container. Five microliters of each sample using a sterile inoculating loop is streaked on the chromogenic agar culture media. The colonies formed are counted using a magnifying glass and LAPIZ colony counter. Candidal colony-forming units per milliliter were analyzed, compared and correlated among different study groups. Different candida species were also identified in the study.
Results:
Nonalbicans
Candida
was the most common species isolated in our study accounting for 53% and
Candida albicans
accounting for 47%. Considering initial and final CD4 counts, there is improvement in patients on retroviral therapy.
Conclusion:
Identification of the species is important for epidemiological reasons and for treatment purposes to ensure a better prognosis since some species present reduced susceptibility to azoles.
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Site specificity and expression profile of miR-21 in oral squamous cell carcinoma
p. 154
NS Priya, Ramakant Nayak, Kishore Bhat, Manohar Kugaji, K Vijayalakshmi, Kavita Rao
DOI
:10.4103/jomfp.jomfp_360_20
Background:
Oral Squamous Cell Carcinoma (OSCC) is the most common epithelial malignancy of the oral cavity which has evolved globally as a grave and growing health problem. It shares a wide geographic variation with respect to the incidence rate and exhibits anatomic adaptation to oral environment with varied clinical presentation along with a spectrum of histological mélange. Besides, in recent cancer research, both genetics and epigenetics add on at the molecular level and accounts for this diversification and tumor heterogeneity of OSCC and thereby substantiates to the miRNA expression profiling in OSCC.
Aims and Objectives:
In the present study, subsite specificity of miR-21 expression in tissue specimens of OSCC of Tongue, Buccal mucosa, and Gingivo buccal (GB) sulcus were analyzed.
Materials and Methods:
Quantification of miR-21 was done on 30 tissue samples of OSCC using real-time polymerase chain reaction (RT-PCR).
Results:
Results indicated that miR-21 expression was significantly expressed at the subsites. Out of 30 samples, 22 showed upregulation, and 8 showed down-regulation with reference to endogenous control. The comparative Ct method was used to analyze the differences in subsite specific expression of miR-21 in OSCC cases. It was significantly upregulated in the buccal mucosa (p=0.002), followed by GB sulcus (p=0.01) and Tongue (p=0.25).
Conclusion:
In conclusion, the study could identify the differential miR-21 expression at sub-sites, indicating that it may serve as a diagnostic marker with further elaboration on a larger sample size..
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CASE REPORTS
Maxillary ameloblastic carcinoma: A diagnostic conundrum
p. 159
Manisha Shrikaar, S Suwasini, Kabita Chatterjee, Shuchita Sinha
DOI
:10.4103/jomfp.JOMFP_71_20
Ameloblastic carcinoma (AC) is a rare malignant epithelial proliferation that is associated with an ameloblastoma or histologically resembles an ameloblastoma. It is considered to be an aggressive neoplasm that is locally invasive and spread to regional lymph nodes or distant sites. It requires aggressive surgical treatment, and regular follow-up, therefore, differs from ameloblastoma. Sometimes, ameloblastomas exhibit a mild-to-moderate degree of cytological atypia; hence, in such cases, a correlation should be established between the clinical, radiological and histopathological findings, thus detecting the aggressiveness of the tumor. Here, we present the case report of a 52-year-old male patient diagnosed as AC based on histopathological and immunohistochemical findings.
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Oral carcinoma cuniculatum
p. 163
Elampavai Elangovan, Abhishek Banerjee, Abhinandan, Bireswar Roy
DOI
:10.4103/jomfp.JOMFP_272_20
Oral Carcinoma cuniculatum(OCC) is rare variant of squamous cell carcinoma. The histopathological features of this type of carcinoma makes it special in the literature of Pathology. The appearance of deep invading epithelial islands with pool of keratin cores very similar to rabbit burrows gives the term cuniculatum to the carcinoma. Here we present a case of OCC on the lateral surface of the tongue. Early diagnosis of such case is very important to distinguish it distinctly from the other entities of squamous cell carcinoma like verrucous carcinoma. The knowledge of existence of such entity of squamous cell carcinoma occurring in the oral cavity is very important to facilitate correct treatment planning and management.
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Peripheral adenomatoid odontogenic tumor of mandible - A synchronous presentation or a subtype?!
p. 167
S Nithya, Susmita Saxena, Jitin Kharbanda
DOI
:10.4103/jomfp.jomfp_450_20
Adenomatoid odontogenic tumor (AOT) with its unique and varied presentations histologically and clinically has always been an enigma. AOTs are multifaceted in their appearance with reports pointing out to its occurrence as a synchronous tumor, a purely cystic variant or with multiple foci; however, the three commonly encountered forms are Follicular/Coronal, Extra Follicular/Extra Coronal and Peripheral variants. Here, we present a subtype of the Peripheral AOT (PAOT) seen synchronous with an intraosseous cystic variant of AOT in a 16-year-old female in the anterior mandible. This case is unique in that a PAOT occurring adjacent to a focally aggressive intraosseous cystic AOT (not associated with impacted tooth) could either be synchronous with no connection to the intraosseous component or could actually be an erupted intraosseous cystic variant with peripheral manifestation. Features of cortical expansion, perforation and displacement of teeth without resorption were seen. Histologically, all the classical features of AOT along with abundant eosinophilic amorphous fibrinous deposits, cellular vacuolization, clearing of cells, dystrophic and reactive bone formation and a cystic lining were seen. Thus, this case of PAOT would add to the myriad presentation of AOT making it one of the most often discussed odontogenic tumor.
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CASE SERIES
Cytodiagnosis of unusual metastases in parotid gland
p. 171
Sophia Thomas, Arvind Bhake
DOI
:10.4103/jomfp.JOMFP_267_20
Documentation of metastatic lesions in the parotid gland diagnosed by fine-needle aspiration cytology (FNAC) is limited in the cytopathology literature. The metastases within the parotid masquerades clinically as primary neoplasm of parotid. The authors of present case report intent to highlight the importance of FNAC in the diagnosis of metastases in parotid. These diagnoses enable the search for the locations of unknown primaries. The nodules within the parotid masquerading as primary neoplasm have undergone FNAC in five cases. The cytomorphological interpretation of the smears was performed. The diagnosis on cytology was compared with subsequent histological evaluation of the suggested primary neoplasm. FNAC in the five cases revealed the following cytodiagnosis: metastases of ductal carcinoma (2), melanoma (1), deposits of small cell carcinoma (1) and metastases of clear cell renal cell carcinoma (RCC) (1). There was complete concordance when these cytodiagnoses were compared with histological evaluation from the suggested sites of primaries as well-differentiated ductal carcinoma of the breast (2), melanoma of the scalp (1), small cell carcinoma of the lung (1) and clear cell RCC of the kidney (1). The metastases within the parotid can masquerade as primary neoplasm. The cytomorphological patterns and features of metastases are similar to that of their primary neoplasm. Therefore, FNAC over the nodules within the parotid unsuspected for metastases provides valuable information to search for primary neoplasm.
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REVIEW ARTICLE
Neutrophils defending the defenders
p. 177
Roli Singh, Preeti Sharma, Vijay Wadhwan
DOI
:10.4103/jomfp.jomfp_495_20
Neutrophils are the most abundant granulocytes which are involved in defense mechanism. As innate immune cells, they are first-line defenders and can perform different functions in the human body to maintain equilibrium. Neutrophils are the main leukocyte and their role in healthy oral cavity is to face pathological changes within oral environment. With regard to these, it has been observed that neutrophils are highly heterogeneous in their behavior. The aim of this review is to give an overview of the role of neutrophils in context of various physiological and pathological conditions.
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FORENSIC CORNER
Sexual dimorphism using permanent maxillary and mandibular incisors, canines and molars: An odontometric analysis
p. 183
N Soundarya, Vijay Kumar Jain, Shibani Shetty, BK Akshatha
DOI
:10.4103/jomfp.jomfp_400_20
Introduction:
Sex identification of skeletal remains is one of the prime factors employed in identification of an individual. Teeth, the most hard and stable human tissue, which is resistant to physical insults, serve as a valuable material for forensic, anthropological, odontologic and genetics. Among the four main attributes of biological identity, gender determination is usually the first step in the human identification process. Hence, the main objective of the present study was to assess the dimorphic status of mesiodistal (MD) width, labiolingual (LL) width as well as cervicoincisal (CI) length of the crown in both maxillary and mandibular permanent incisors, canines and first molars.
Materials and Methods:
The present study comprised a set of 100 casts (50 males and 50 females) between the age group of 20–50 years of age. Impressions were made using alginate impression and study models were prepared using dental stone. The CI length of the crown, maximum MD width and maximum LL width of both maxillary and mandibular permanent incisors, canines and first molars were evaluated using digital Vernier calipers. The obtained data were analyzed using linear discriminant analysis and logistic regression method.
Results:
This study concludes that MD dimension of maxillary canine and CI dimension of mandibular first molar as reliable indicators for gender determination than mandibular canine, maxillary and mandibular central incisors and maxillary first molar dimensions.
Conclusion:
This study concludes that MD dimension of maxillary canine and CI dimension of mandibular first molar as reliable indicators for gender determination than mandibular canine, maxillary and mandibular central incisors and maxillary first molar dimensions.
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Reliability of odontometric parameters in stature analysis
p. 189
K Ramya, Ashwini Deshpande, A D N Deepika, G Subba Rayudu, Siva Kumar Pendyala, Kameswari Kondreddy
DOI
:10.4103/jomfp.jomfp_17_21
Background:
To emphasize the role of odontometric parameters which may be used as a reliable forensic tool especially in cases with partial remains of the individual
Aim:
To assess the reliability of odontometric parameters in stature analysis
Materials and Methods:
The study was conducted on 100 patients (50 male and 50 Female). Mesiodistal width of anterior teeth, inter-canine width, Inter-premolar width and maxillary arch length were the parameters included. The results were tabulated with a linear regression formula obtained for each parameter.
Statistical Analysis:
The data collected was statistically analysed using SPSS version 20 and a linear regression formula was obtained thereafter.
Results:
Mesio-distal widths of individual maxillary canines, total mesiodistal width of maxillary anteriors and arch length showed a significant co-relation with stature. The combined linear regression formula was obtained for all parameters.
Conclusion:
Odontometric parameters of mesio - distal widths of individual maxillary canines, total mesiodistal width of maxillary anteriors and arch length can be used as reliable parameters for stature analysis.
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SHORT COMMUNICATION
Predatory science: Unraveling a secret journey of fake journals and conferences
p. 193
Sameera Begum, Riaz Abdulla
DOI
:10.4103/jomfp.jomfp_493_20
The fraudulent behaviour of predatory journals/conferences through E-mail solicitations and author's perspective in unknowingly becoming victims of predatory publishing scheme, by being unaware of the fact that the journals in which they are involved are possibly predatory are highlighted here.
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KNOW THE FIELD
Ghost cell
p. 195
Snehal Uttam Chavhan, Sonal S Dhanawade, Chetan Fukate, Shivani P Bansal
DOI
:10.4103/jomfp.jomfp_112_21
Ghost cells (GCs) have been a curious topic since a great deal of time. Extensive research has been done to deduce the true characteristics and formation of these cells. GCs are balloon-shaped, elliptical, pale eosinophilic epithelial cells with pyknotic nuclei, leaving only a faint outline. In routine H and E staining, these cells give shadowy appearance and hence are also called shadow cells or translucent cells. The present article is an attempt to describe in detail about the origin, microscopic appearance, staining property, immunohistochemistry profile and diagnostic importance of GCs.
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ONLINE ONLY ARTICLES - ORIGINAL ARTICLES
Comparative cytopathologic evaluation using acridine orange with Papanicolaou stain in psychoactive substances abusers with potentially malignant and malignant disorders
p. 198
Falguni H Patel, Rashmi Bhavasar, Shreyas Shah, Vandana Shah, Pratik D Patel
DOI
:10.4103/jomfp.JOMFP_275_20
Introduction:
Oral cancer is a major health problem and its early detection is advantageous for therapeutic purposes. According to available evidence, the risks of oral malignancies increase with the usage of tobacco and other psychoactive substances (PSs). The present study showed expression pattern of nuclear and cytoplasmic changes from normal individuals without habit to oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) in PS abusers with the help of fluorescence acridine orange (AO) stain and Papanicolaou (PAP) stain.
Aim and Objectives:
This study aimed to investigate and compare diagnostic efficacy of fluorescence microscopic evaluation of AO stain in cytological smears with PAP staining under light microscopy in PS abusers having oral potentially malignant and malignant lesions.
Materials and Methods:
Oral smears from 120 individuals among which 40 from potentially malignant disorders, 40 from oral malignancy and 40 normal buccal mucosa smears were prepared. One set of smears was stained by AO staining and the other by PAP staining and examined under fluorescence and light microscope, respectively. The results of both the stainings were evaluated by grading cytology smears in class-I to class-V cytology.
Results:
The AO fluorescence stain reliably demonstrated malignant cells based on the differential fluorescence. The efficacy of AO fluorescence stain was higher than PAP stain in screening of oral lesions suspicious of malignancy. The sensitivity of PAP staining and AO staining is 57.50% and 61.25%, respectively.
Conclusion:
As compared to PAP staining method, fluorescent AO method is more effective in screening of OPMD and OSCC in PS abusers.
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Comparative evaluation of the concentration-dependent effect of proton-pump inhibitor in association with calcium hydroxide and chlorhexidine on
Enterococcus faecalis
: An
in vitro
study
p. 198
R Anija, Chandana Kalita, AC Bhuyan, MD Iftikar Hussain, Anindita Saikia, Lima Das
DOI
:10.4103/jomfp.JOMFP_303_20
Background:
Enterococcus faecalis
is the most persistent organism in the root canal which resists most of the intracanal medicaments. There is always a constant attempt to eliminate this endodontic pathogen from the root canal system.
Aim:
The aim of this study was to evaluate the efficacy of the association of different concentrations of proton-pump inhibitor (PPI) (Lansoprazole) with calcium hydroxide (CH) and chlorhexidine (CHX) against
E. faecalis
using a broth dilution method.
Materials and Methods:
E. faecalis
was inoculated into brain–heart infusion broth at 37°C for 5 h. The master broth was then treated with CH (Group 1); CH + 2% CHX (Group 2); CH + PPI 6.25 μg/ml (Group 3A); CH + PPI 25 μg/ml (Group 3B); 2% CHX + PPI 6.25 μg/ml (Group 4A); 2% CHX + PPI 25 μg/ml (Group 4B); CH + 2% CHX + PPI 6.25 μg/ml (Group 5A), and CH + 2% CHX + PPI 25 μg/ml (Group 5B). The groups were spectrophotometrically analyzed at 630 nm at 24 h to determine the group with the least optical density.
Statistical Analysis:
Comparison between the groups was done by the one-way analysis of variance and Kruskal–Wallis test for multiple comparisons.
Results:
The mean percentage inhibition of
E. faecalis
by Group 5A (CH + 2% CHX + PPI 6.25 μg/ml) was the highest compared to other groups. The lowest mean value was observed in Group 3A (CH + PPI 6.25 μg/ml) indicating least efficiency.
Conclusion:
There was a concentration-dependent effect of PPI on CH and CHX against
E. faecalis.
The maximum efficacy was found when the lower concentration of PPI was associated with CH/CHX mixture.
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Toward developing natural histologic stains using anthocyanins: A novel approach
p. 199
Sanpreet Singh Sachdev, Tabita Joy Chettiankandy, Sarang Gautam Sonawane, Manisha Ahire Sardar, Prajwalit Prakash Kende, Vivek Pakhmode
DOI
:10.4103/jomfp.JOMFP_228_20
Introduction:
In the present-day scenario, wherein histotechnological laboratory personnel come into contact with numerous hazardous chemicals every day, laboratories are emphasizing on development of safer and environment-friendly alternatives globally which are easily available and feasible. In this context, we have attempted to utilize anthocyanins, a family of pigments naturally occurring in fruits and flowers and which are already used as natural food colorants, for assessing their utility as histological stains.
Materials and methods:
Juices of thin consistency from well-ripened pomegranates were obtained by using a juicer with blender functions. Formalin-fixed paraffin-embedded 4 μm thin sections were immersed in this solution for 2 h, during which the solution was periodically monitored. Several modifications were attempted such as the addition of
Citrus limon
(lemon) extract or acetic acid, change in orientation of the slides and refrigeration of the solution during the staining procedure.
Results:
A peculiar pattern of reasonably diagnostic staining was observed in which the basal and suprabasal cells, basement membrane, inflammatory cells and collagen fibers stained prominently with a magenta color. The addition of lemon, horizontal orientation of slides and refrigeration each separately led to an improvement in staining characteristics. The addition of 4% acetic acid and refrigeration of the solution each led to an improvement in longevity of the staining solution.
Conclusion:
Anthocyanins could potentially be used as viable histological stains having advantages of availability, feasibility, color stability and nontoxicity, although numerous modifications to improve longevity of staining solution and staining characteristics are warranted by further research for which the present study could serve as a pretext.
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Differences of oral cancer in men and women of West Bengal, India
p. 200
Tathagata Bhattacharjee, Mrinmoy Kerketa, N Aravindha Babu
DOI
:10.4103/jomfp.jomfp_476_20
Introduction:
Oral cancer constitutes a major public health problem in South East Asia, as it causes profound social and economic consequences for people in this area. Nowadays, pattern of tobacco and alcohol use among females is changing and at the same time incidence of oral squamous cell carcinoma (SCC) among females is increasing.
Objectives:
The aim of the study was to evaluate the possible differences between male and female patients suffering from oral SCC.
Materials and Methods:
One hundred and sixteen patients with oral SCC, who were diagnosed between 2017 and 2018, were evaluated retrospectively. Special attention was paid to tobacco and alcohol use, as well as to patients without the risk factors. Data obtained were entered into a Microsoft Excel Spreadsheet and then were analyzed by SPSS 24.0.
Results:
The men: women ratio was 2.5:1. Mean age for diagnosis of oral cancer in men was 57.5 and mean age for diagnosis of oral cancer in women was 46.33. Majority of men oral cancer patients had smoking habits (61.45%) and majority of women oral cancer patients had chewing habits (66.67%). Tongue was the most common site for women oral cancer patients and palate, retromolar area and tonsillar area were the most common site for men oral cancer patients who never used any habit products.
Conclusion:
Compared to earlier studies women gets diagnosis of oral cancer earlier than men in our study. Gutkha use in men and Gudaku use in women were associated with oral cancer in early age. Further studies should be performed in women tongue cancer patients and men patients with cancer of maxillary area, retromolar and tonsillar area without risk factors to find etiology.
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Characterization of anti-nuclear antibodies in patients with oral submucous fibrosis and its clinicopathologic implications – An immunofluorescence study
p. 201
Aprna Gupta, Surya Narayan Das, Bijoy Kumar Das, Lipsa Bhuyan
DOI
:10.4103/jomfp.jomfp_376_20
Background:
Oral submucous fibrosis (OSF), widespread in the Indian subcontinent, is a chronic debilitating disease of the oral cavity having a high potential for malignancy. The etiology of OSF is debatable. However, recently, autoimmunity had been suggested to play a significant role in its etiology, yet unproven. Hence, this study was conducted to explore the presence of antinuclear antibodies (ANAs) in the serum of OSF patients which is one of the serum markers of autoimmune diseases and its possible clinicopathologic associations.
Materials and Methods:
A total of 105 blood samples were collected from patients with OSF (
n
= 45), age- and sex-matched healthy controls with (
n
= 30) and without (
n
= 30) areca nut chewing habit. Serum positivity of ANA was determined by immunofluorescence and correlated with the oral habits and severity of the disease measured by maximum mouth opening (MMO) and site of involvement.
Results:
Significantly higher incidence of ANA (35.6%) was found in 45 OSF patients than in the healthy group (
P
= 0.001). Prevalence of ANA positivity was found higher in females (
n
= 11; 68%) than males (
P
< 0.001). A significantly lower MMO (
P
= 0.00) was found in ANA positive patients (17 ± 6.21 mm) in contrast to MMO in ANA-negative patients (28.74 ± 6.58 mm). The mean duration of habit and frequency of habit between ANA positive and negative patients was not significant. A significantly more number of sites of involvement was seen in ANA positive cases (
P
= 0.004). Out of 16 ANA positive OSF cases, 10 cases showed + 2 and 6 cases showed + 3 fluorescence intensity. Speckled (
n
= 8), homogeneous (
n
= 5) and nucleolar pattern (
n
= 3) were the fluorescence patterns observed.
Conclusion:
The presence of autoantibodies such as ANA, female predilection, alteration of humoral and cellular immunity justifies OSF as an autoimmune disease. This study provides broader prospective to adopt therapies that selectively target autoimmune pathways.
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Scanning electron microscope characterization of noncarious cervical lesions in human teeth
p. 202
Ratthapong Worawongvasu
DOI
:10.4103/jomfp.JOMFP_232_20
Aims:
Abfraction is a theoretical process whereby occlusal forces create microfractures in enamel and dentin along the cervical area and predispose it to erosion and abrasion, forming noncarious cervical lesions. However, the theory is not yet proven. The aim of this study was to elucidate the role of abfraction as an etiology of these lesions.
Materials and Methods:
Ten human premolars with these lesions from 10 patients requiring tooth extraction, one tooth from each patient, were used in this study. After extractions, all teeth were stored in 10% formalin until required, then prepared routinely for scanning electron microscopy.
Results:
In all 10 teeth, at low magnification, noncarious cervical lesions appeared as crescent-shaped lesions. The upper edges of the lesions were on the enamel surfaces and their lower edges were on the cemental surfaces. In four teeth, the lesions showed evidence of microfractures characterized by the presence of fracture lines and fracture surfaces. In addition, in the first tooth of these teeth, the surface was also covered by a network of poorly fixed collagen fibers. In the third tooth, linear scratches, the openings of the dentinal tubules, a dentin matrix which consisted of a network of poorly fixed collagen fibers, and numerous dentinal tubules were also observed. In the remaining six teeth, they showed linear scratches, and the presence of the dentinal tubules or the exposed collagen fibers.
Conclusions
: It appears that abrasion and erosion are associated etiologic factors in forming noncarious cervical lesions and an ultrastructural finding that supports the abfraction theory of these lesions is observed.
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Cytomorphometric analysis of squames obtained from normal mucosa, leukoplakia and oral squamous cell carcinoma
p. 202
T Suresh, T Sabastian Bastian, BR Ahmed Mujib
DOI
:10.4103/jomfp.jomfp_455_20
Introduction:
Exfoliative cytology is becoming increasingly important in the early diagnosis of oral cancers, as a procedure for obtaining cell samples, which can be analyzed by sophisticated diagnostic techniques. Quantitative techniques, based on the evaluation of parameters such as nucleus area, cytoplasm area and nucleus-to-cytoplasm area ratio, may increase the sensitivity of exfoliative cytology for early diagnosis of oral cancers, since these techniques are precise, objective and reproducible.
Objectives:
This study was undertaken to employ the cytomorphometric quantitative techniques to determine the value of exfoliative cytology and to assess this method to analyze the effectiveness in providing additional diagnostic test for the detection of early oral malignancy.
Materials and Methods:
The study consisted of three groups. The experimental group comprised of 20 subjects with oral leukoplakia and 20 subjects with oral squamous cell carcinoma of the buccal mucosa. The control group comprised of 10 apparently healthy subjects. They were subjected to clinical examination and cytosmear of the buccal mucosa. A standard wooden tongue spatula/metal spatula moistened with normal saline was used to obtain scrapings of buccal mucosa. The scrapings were spread on plain glass slides and immediately fixed in Biofix spray, followed by staining with the Papanicolaou technique. Then, the microscopic pictures were captured onto a computer and are cytomorphometrically analyzed using an image analyzer. Since this study involved multiple groups, one-way analysis of variance (ANOVA) was used for comparing the parameters for multiple groups. Where significant difference was seen, the ANOVA test was followed by Mann–Whitney test, for pairwise comparison.
Results:
The mean count of nuclear area and nuclear diameter showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of cell area and cell diameter showed a decrease from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant. The mean count of nuclear/cytoplasm area ratio showed an increase from Group I to Group II, Group I to Group III and Group II to Group III, which was statistically significant.
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ONLINE ONLY ARTICLES - CASE REPORTS
Metastasis in the mandible involving gingiva: An intriguing case with a perplexing pathology
p. 203
Sonalee J Shah, Biswajit Mishra, Sanjay Jadwani
DOI
:10.4103/jomfp.jomfp_342_20
Oral metastasis, although rare, tends to involve jawbones, particularly the posterior region of the mandible, and involvement of oral soft tissues, even when less likely, is most often seen on the gingiva and tongue. Clinically, the soft-tissue masses tend to mimic pyogenic granuloma, peripheral giant cell granuloma or an epulis and thus are difficult to diagnose and identify. The jaw bone is preferred by prostate carcinoma as a metastatic target. Prostate malignancy, which is more common in Western countries than in India, may be adenocarcinomas or carcinomas. Oftentimes, metastatic lesions develop in the alveolar region and are a cause for tooth mobility, yet, they tend to be detected only after extraction of the affected tooth. In such cases, the symptomatic presentation therefore, is vague and indicative of tooth mobility secondary to periodontal pathology unless, a detailed history and follow-up is done. We report a case of a male patient who presented to our department with a proliferative, painful, swelling postextraction of the left first molar region, and the lesion was seen at the extraction site as well as in the mandibular anterior tooth region. The swelling was associated with palpable lymph nodes. Orthopantomogram showed an irregular, radiolucent lesion extending from the lower left central incisor to the left first molar region in the mandibular alveolus. Incisional biopsy tissue came with provisional diagnosis of osteomyelitis or squamous cell carcinoma as the patient was a habitual bidi smoker for more than 20 years. Histologically, it was an undifferentiated tumor with tumor cells seen in deep connective tissue with a lack of lineage differentiation. An undifferentiated malignant tumor represents either a metastasis of unknown origin or a primary neoplasia without obvious cell line of differentiation. Immunohistochemistry (IHC) of undifferentiated tumors helps to categorize them into small round blue cell tumors or large cell tumors. The oral pathologist was perplexed as there was no mention of any other malignancy in the patient's history, which, however, was noted by the surgeons few days later. Hence, initially, a hematopoietic malignancy was suspected which was ruled out by IHC, and later, staining with cytokeratin 7 (CK7), CK-high molecular weight and P63 confirmed prostate metastases as all three were negative.
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Noncalcifying clear-cell variant of calcifying epithelial odontogenic tumor: A case report and review
p. 204
Sangeeta Patankar, Sheetal Choudhari, Shubhra Sharma, Snehal Dhumal
DOI
:10.4103/jomfp.JOMFP_212_20
Clear-cell tumors of the head and neck are biologically diverse consisting of benign, malignant and metastatic lesions. These tumors pose a diagnostic challenge. In the oral cavity, these may be derived from odontogenic/nonodontogenic epithelium or from mesenchyme or can be metastatic. Odontogenic tumors with clear-cell change are rare. Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor affecting the jaw. Here, we report a case of clear-cell variant of CEOT with its histopathological differential diagnosis. A 43-year-old male patient with swelling in his lower right back tooth region showed a well-defined radiolucent lesion with smooth corticated periphery on radiograph. On incisional biopsy, tumor showed small sheets, cords and islands of odontogenic epithelium with nests of clear cells with no evidence of calcification. A final diagnosis of CEOT was established by differentiating other odontogenic and nonodontogenic lesions on the basis of clinical, radiographic, histopathologic and special stain features.
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“Gigantic aggressive angiomyxoma” of the jaws: A rare case report
p. 205
Swapan Kumar Majumdar, Mohsina Hussain, Anirban Raha, Sanjit Barman
DOI
:10.4103/jomfp.JOMFP_233_20
Angiomyxomas are a group of rare myxoid benign mesenchymal tumors prone to local recurrences. Two types of angiomyxomas are well recognized in the literature: superficial and aggressive angiomyxoma. Aggressive angiomyxomas are relatively uncommon, poorly circumscribed, locally infiltrative myofibroblastic tumors with a specific predilection for the perineal regions and exceedingly rare in the head and neck region. To the best of our knowledge, we report the first case of a gigantic aggressive angiomyxoma occurring in both the maxilla and mandible in a 30-year-old male patient. Clinicians should carefully evaluate the clinical, radiological and histological data to derive the correct diagnosis of this myxoid intraoral soft-tissue neoplasm.
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Solitary plasmacytoma of jaw bone: A case report and systematic review of fifty cases from literature
p. 205
Harshal Suryavanshi, Sangeeta Patankar, Snehal Dhumal, Sheetal Choudhari
DOI
:10.4103/jomfp.JOMFP_251_20
Solitary plasmacytoma of bone (SPB) is a localized form of plasma cell neoplasm where jaw involvement is rare. Distinguishing SPB from other plasma cell neoplasms is critical for treatment and survival. Here, a case of SPB of mandible in an elderly female is reported. Histopathological diagnosis of plasma cell neoplasm was confirmed immunohistochemically with MUM1 and CD138 positivity and multiple myeloma (MM) was ruled out on performing systemic workup. Prognosis of SPB worsens when it transforms into MM. A systematic review was undertaken with the objective to determine the factors affecting conversion of SPB to MM. An electronic search was undertaken with PubMed/MEDLINE, Web of Science and Science Direct. Fifty cases of SPB of jaw from 29 publications were reviewed. SPB commonly presents as a painless swelling. Radiographically, it is commonly seen as multilocular radiolucency with well-defined borders. Follow-up data showed that nine cases turned into MM in a mean duration of 1 year 9 months and 12 patients died after median disease-free survival of 6 years 9 months. Prognosis of SPB is found to be affected by tumor size (≥5 cm), anaplasia of tumor cells, Ki-67 labeling index, vascularity of the tumor, presence of clonal bone marrow plasma cells, serum immune globulin level, dose of radiotherapy and persistence of M protein after treatment. There is a need to identify prognostic subgroups in SPB based on these factors. Furthermore, studies are necessary for standardization of treatment protocol to halt or prolong the progression of SPB to MM.
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A rare case of mandibular dentinogenic ghost cell tumor: Histopathological, clinical and surgical management
p. 206
Daniela Novembre, Elio Giofrè, Ida Barca, Francesco Ferragina, Maria Giulia Cristofaro
DOI
:10.4103/jomfp.JOMFP_185_20
Dentinogenic ghost cell tumor (DGCT) is a rare benign tumorous form of calcifying odontogenic cyst (COC) characterized by the presence of ghost cells but it seems to have more aggressive behavior. It represents 11.5% of COCs. In this work, we report a case of a 60-year-old male patient with DGCT in the posterior region of the right mandible treated with surgical enucleation.
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ONLINE ONLY ARTICLES - FORENSIC CORNER
Correlation of lip print with blood group in forensic science
p. 206
Pallavi Kesarwani, Anand Choudhary
DOI
:10.4103/jomfp.jomfp_55_21
Background:
Cheiloscopy is the study of furrows and grooves present on the red part, or the vermilion border of the human lips. The type of groves is unique for an individual and can be used for person identification.
Aim:
The aim of this study is to ascertain whether the uniqueness of lip print (LP) can help in identifying a person. In addition to evaluate the comparison of LP types and blood groups was taken up to see if there is any correlation between the two.
Materials and Methods:
A cross-sectional study was conducted on 200 participants (77 males and 123 females), aged between 25 to 45 years, to determine any correlation between LP types and blood groups. These lip patterns were analyzed and interpreted using Tsuchihashi's classification and later associated blood group matching was performed to determine the predominant LP type with the ABO and Rh blood grouping system.
Results:
The present study showed a positive correlation between LP pattern and blood group among males and females. Thus, distribution of LP patterns, and ABO blood groups might help in the identification of an individual.
Conclusion:
Since LP and blood group are unique for a person. Hence, cheiloscopy along with blood group can play a vital role in person identification.
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