Extreme ameloblastoma of the mandible with hypoproteinemia: a case report and review of clinicopathological features

Ameloblastoma is a tumor of odontogenic epithelium. It has an intermediate malignant potential, thus positioning it in a gray zone between benign and malignant neoplasms. Invasive ameloblastomas of excessive size are rarely confronted. Although these ameloblastomas are benign, they are life threatening. Many have eventuated in death due to airway obstruction, starvation from restriction of feeding, and complications of hypoproteinemia. These tumors cause significant expansion of skin and lips [tissue expanders]. Due to its metabolic demands, a tumor of enormous size will have numerous feeding vessels. Patients with extreme ameloblastomas are usually from rural areas of developing countries who delay the treatment due to fear of surgery. We present a case of extreme ameloblastoma in a 35 year old female which was a consequence of patient negligence. The tumor reached an enormous size over 10 years causing gross facial deformities and posed considerable problems in management

Keratinocytes in oral submucous fibrosis: A cytomorphometric analysis using computer aided image analyser

Aim: To examine and compare cytomorphometric changes in the keratinocytes obtained from buccal mucosa of oral submucous fibrosis (OSF) cases in different clinical stages with healthy subjects and oral squamous cell carcinoma (OSCC) cases. Materials and Methods: Buccal mucosal smears of OSF cases [n = 30], OSCC cases [n = 30] and age-sex matched healthy controls [n = 30] were stained with Papanicolou stain and observed under light microscope (40x objective magnification) and 100 cells in each case were analysed cytomorphometrically using an image analyser. The average nuclear area (NA), cell area (CA), ratio of nuclear area/cell area, nuclear diameter (ND), cell diameter (CD) and ratio of nuclear diameter/cell diameter was obtained for each case. One-way ANOVA and Tukey-HSD procedure (P < 0.05) were used to analyze all the parametric variables. Results: The comparison of mean values of the NA, CA, NA:CA, ND, CD, ND:CD shows statistically significant difference among the healthy, OSF and OSCC groups [P < 0.05]. OSF group showed significant increase in nuclear dimensions and N/C ratio and significant decrease in cell dimensions compared to healthy group (P < 0.05). Among the parameters analysed ND:CD and NA:CA showed a highly statistically significant difference between the OSF and healthy group (P < 0.001). Conclusions: There are significant alterations in the cell and nuclear dimensions of the buccal mucosal cells in OSF patients. These alterations could be attributed to usage of various tobacco and areca nut preparations and due to the mucosal changes (atrophic epithelium, high epithelial turnover) in the OSF. Atrophic epithelium, in OSF is envisaged to predispose malignant transformation with persistent exposure oral carcinogens. As the mean values of CA, NA:CA in stage IV OSF are close to OSCC cases, it strengthens the view that advancement of fibrosis increases the risk of development of epithelial dysplasia

Cervical lymph node metastasis in oral squamous cell carcinoma: A correlative study between histopathological malignancy grading and lymph node metastasis

Background: Histologic grading has been used as a prognostic factor and for clinical behavior evaluation of oral squamous cell carcinoma for the past several decades. At the same time, the prognostic value of different grading classifications remains controversial. A major problem for most histopathological grading systems is the intraobserver and interobserver disagreement. Aims and Objectives: To validate the prognostic efficiency of the histologic assessment of the primary tumor in predicting cervical metastasis, to identify those histologic features in the tumor most closely associated with cervical metastasis and to evaluate the reliability of the multifactorial grading (MFG) system by measuring intraobserver and interobserver agreement using kappa statistic. Materials and Methods: A set of 60 cases were chosen at random out of the 292 squamous cell carcinoma cases reported in our institution from 2007 to 2010. All cases were graded according to: Modified Broders′ descriptive system and Anneroth et al., MFG system. Two Pathologists independently graded the tumor forefront blinded to the node metastasis. Results: The MFG showed a significant relation between the degree of histologic malignancy and presence of metastasis in the nodes. Among the components of grading, a significant difference was observed in the nuclear polymorphism and the pattern of invasion between the metastatic and non-metastatic patients. Intraobserver and interobserver agreement was acceptable and satisfactory. Conclusions: Moderate to good agreement between observers greatly increases the validity of the MFG system. The multifactorial malignancy grading could serve as a predictor for metastasis in the cervical lymph nodes

Comparing the efficacy of coconut oil and xylene as a clearing agent in the histopathology laboratory

Background: The commonly used clearing agent, xylene is supposed to be highly toxic and carcinogenic. As previous research studies have shown the effectiveness of different vegetable oils as clearants, this study was designed to evaluate the efficacy of coconut oil. Materials and Methods: Two equal halves of 60 soft tissue specimens were processed simultaneously in xylene and coconut oil as clearing agents. The Xylene-treated specimens (XY-S) and Coconut oil-treated specimens (CO-S) were checked for gross and histological features and comparison was done between the two groups. Results: Significant shrinkage was noted in XY-S compared to that in CO-S. No difference was found in either of the sections when checked for cellular details and staining quality. Morphometrically, there was significant reduction in the mean cell area in XY-S compared to that in CO-S. Conclusion: Coconut oil may be substituted for the highly hazardous xylene as a clearing agent without compromising the quality of histological details

Serum alkaline phosphatase in oral squamous cell carcinoma and its association with clinicopathological characteristics

Context: Biochemical changes occur in biological fluids and tissues of different types of malignancies. Tumor markers in serum, tissue, and other body fluids during neoplastic process are of clinical value in the management of patients with cancers. Serum alkaline phosphatase (ALP) activity is potentially a useful indicator for detection of malignancies, but its status in oral squamous cell carcinoma (OSCC) is less explored. Aims: The aim of this study is to evaluate the serum level of ALP in OSCC patients and assess its relation with the clinicopathological features. Settings and Design: A total of 175 participants (145 OSCC patients and 30 healthy controls) were included in the study. One hundred and forty-five patients with OSCC who underwent treatment at our institution were included to obtain the clinicopathological data. Materials and Methods: Fasting blood ALP activity was evaluated using ALP assessment kit and biochemistry analyzer. Statistical Analysis Used: The data were analyzed by SPSS-21 software (SPSS Statistics for Windows, Version 21.0, Armonk, NY, USA), using t-test, Mann–Whitney U, and Kruskal–Wallis tests. Results: Raised ALP was seen in 24% of OSCC patients. The mean ALP in OSCC was significantly higher than the control. ALP level in patients with advanced stage was significantly higher than with early stage. The serum ALP level in OSCC patients with bone involvement (BI) by local extension of tumor was significantly higher than without BI. Conclusion: ALP showed statistically significant differences in relation to tumor stages and BI. Hence, ALP could be useful in advanced stage disease for expressing the endurance of patient and tumor expansion. Elevated ALP in OSCC patients may indicate BI

Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm

Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health records across hospitals has substantially increased the amount of data available to investigators and has shown promise in advancing AKI research. In addition, progress in the finding and validation of different forms of biomarkers of AKI within diversified clinical environments and has provided information and insight on testing, etiology and further prognosis of AKI, leading to future of precision and personalized approach to AKI management. In this this article, we discussed the changing paradigms in AKI: From mechanisms to diagnostics, risk factors, and management of AKI