An evaluation of Shandon Papspin liquid based oral test utilizing a novel cytologic scoring system

Magister Chirurgiae Dentium - MChDBackground and Aims: While a single “high quality” oral liquid based cytology (LBC) study has shown a high sensitivity and specificity for the technique in detection of oral dysplasia and malignancy, the high unit cost of this technology cannot be borne by the developing African countries. This study aims to evaluate the efficiency of an alternative cost-effective technique, Shandon PapSpin (PS) LBC in diagnosis of oral and oropharyngeal dysplasia and malignancy. Materials and Methods.We compared the diagnostic accuracy of Shandon PS LBC with that of scalpel biopsy in 69 patients. Transepithelial cytology specimens were obtained using a cervical Cytobrush. The cytology specimens were graded and scored using a novel oral cytologic grading and scoring system respectively. Results: Histological diagnosis of dysplasia or invasive squamous cell carcinoma was made in 51 of the 69 cases. Histology confirmed the cytological diagnosis of dysplasia or malignancy in 49 of the 51 cases. There were two false negative and no false positive cases. The sensitivity was 96% and the specificity 100%. The cytologic grade correlated positively with histologic grade. The best cut off value for distinguishing reactive/mildly dysplastic lesions from high 9 grade/invasive squamous cell carcinoma was determined as a cytologic score of 3, representing a sensitivity of 95% and a specificity of 96%. Conclusion: The Shandon PS LBC in association with transepithelial brush biopsy technique (TBBT) is a highly sensitive, specific and economical screening test in detection of oral and oropharyngeal dysplasia and malignancy. The proposed oral cytologic grading system correlates well with histology. The novel oral cytologic scoring system shows promise as a simple, reliable and reproducible scoring system. In addition, the liquid residual allows for immunocytochemical (Podoplanin) testing.South Afric

The role of high-risk human papillomavirus in periocular cancers

Philosophiae Doctor - PhDPURPOSE: High risk human papillomavirus (HR-HPV) is well established as a causative agent of squamous cell carcinoma (SCC) of the orophaynx. HR-HPV has also been reported in periocular cancers and precancers, but controversy exists about its overall incidence and clinicopathologic profile. The purpose of this study is to evaluate the role of HR-HPV infection in periocular cancers and precancers, using multiple methods of detection. DESIGN: Retrospective observational case series with laboratory investigations. METHODS: Sequential surgical samples of 87 carcinomas (invasive SCC, SCC in situ and sebaceous carcinoma) from three different periocular sites (conjunctiva, lacrimal sac and the eyelid) diagnosed over a 15-year period (2000-2015) were selected for evaluation. Unstained paraffin sections of 87 cases of periocular carcinomas were analyzed with immunohistochemistry (IHC) for p16 as a screening test. p16 positive conjunctival- and lacrimal sac SCC were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by DNA Polymerase Chain Reaction (DNA PCR). p16 positive periocular sebaceous carcinomas (SC) were analyzed with PCR, and a subset of 18cases was further studied with a novel method of mRNA ISH, an advanced technique with an enhanced sensitivity and specificity. Relevant patient clinical information was obtained from review of the electronic medical records

The role of high-risk human papillomavirus in periocular cancers

Philosophiae Doctor - PhDPurpose: High risk human papillomavirus (HR-HPV) is well established as a causative agent of squamous cell carcinoma (SCC) of the orophaynx. HR-HPV has also been reported in periocular cancers and precancers, but controversy exists about its overall incidence and clinicopathologic profile. The purpose of this study is to evaluate the role of HR-HPV infection in periocular cancers and precancers, using multiple methods of detection. Design: Retrospective observational case series with laboratory investigations. Methods: Sequential surgical samples of 87 carcinomas (invasive SCC, SCC in situ and sebaceous carcinoma) from three different periocular sites (conjunctiva, lacrimal sac and the eyelid) diagnosed over a 15-year period (2000-2015) were selected for evaluation. Unstained paraffin sections of 87 cases of periocular carcinomas were analyzed with immunohistochemistry (IHC) for p16 as a screening test. p16 positive conjunctival- and lacrimal sac SCC were further evaluated for HR-HPV using DNA in situ hybridization (DNA ISH), and a subset was also analyzed by DNA Polymerase Chain Reaction (DNA PCR). p16 positive periocular sebaceous carcinomas (SC) were analyzed with PCR, and a subset of 18cases was further studied with a novel method of mRNA ISH, an advanced technique with an enhanced sensitivity and specificity. Relevant patient clinical information was obtained from review of the electronic medical records

Oral medicine case book 61: Oral malignant melanoma

A 45-year old male patient presented at the Oral and Maxillofacial Clinic, Tygerberg, with a pathological fracture of the left mandible following an extraction. The medical records of the patient revealed a history of multiple myeloma that was treated with Aredia (pamidronate disodium, an intravenous form of bisphosphonate), cyclophosphamide (an alkylating agent) and dexamethaxone (an anti-inflammatory and immunosuppressant drug). An orthopantomograph revealed osteonecrosis and pathological fracture of the left mandible, thought to be due to the earlier biphosphonate administration. The patient received conservative management for the osteonecrosis and was stable at the time of the publication, (19 months after the initial presentation with the pathological fracture).DHE

Oral medicine case book 74: marijuana-induced Oral Leukoplakia

A 55-year-old male presented at the Oral Medicine Clinic of the University of the Western Cape, Oral Health Centre, Tygerberg Campus, for the evaluation of a persistent white patch on his right edentulous mandibular ridge. He had been referred from the Prosthodontics Clinic where he was seen for complete denture rehabilitation. The patient had no significant medical history and informed us that he had been smoking marijuana five times a day for more than twenty years and consumed alcohol occassionally. He had never worn a dental prosthesis and did not use tobacco in any form.DHE

Oral medicine case book 47: oral neurofibroma

A 29-year-old male patient presented at the Oral Medicine Clinic with the complaint of slow-growing growths on his tongue, causing discomfort. Extra-oral examination revealed several painless soft tissue nodules on his face (Figure 1 and 2), trunk (Figure 3), back (Figure 4) and arms. The patient reported that the lesions had appeared during childhood and had since increased in size and number. He was unaware of any family history of the disease. Intra-oral examination showed two soft tissue nodules on the midline of the dorsal surface of the tongue, 3,5cm and 0,5 cm in diameter respectively (Figure 5).Department of HE and Training approved lis

Oral medicine case book 46: squamous cell carcinoma of the tongue

A 38-year-old-female presented at the Oral Medicine Clinic complaining of pain under her tongue that became worse during chewing, and radiated to her right ear. The pain started two months earlier and gradually increased in intensity. The patient reported that she smoked about twelve cigarettes per day, a habit that she maintained for the last twenty years. She also admitted that she consumed alcohol as a social habit, mainly over the weekends. Her medical history revealed no other abnormalities and she was not using any chronic medication.Department of HE and Training approved lis

Adenomatoid odontogenic tumour in the anterior mandible: a case report

Adenomatoid odontogenic tumours are hamartomatous lesions that rarely deviate from their well-recognised radiological features. However, increasing numbers with atypical radiological features have been reported in recent years. This study reports on a large extrafollicular lesion in the anterior mandible with uncommon radiological features in a 17-year-old female. Treatment included enucleation with a histopathological confirmation. Healing was uneventful

Oral medicine case book 52: pleomorphic adenoma of the upper lip

A 46-year old female presented at the Oral Medicine Clinic complaining of a large and painless swelling of her upper lip. The lesion had slowly enlarged over the past year and was causing an increasing aesthetic and speech impairment. Her medical history revealed nothing of note. Extra-orally, the patient presented with a swelling involving the right side of the upper lip and extending from the right alar of the nose, to the right commissure (Figure 1). The intra-oral examination revealed a firm and well circumscribed mass in the upper right labial mucosa, opposite the upper second incisor, canine and first premolar. The mass was approximately 2x3 cm in size and the overlying mucosa was of normal consistency and colour for the region (Figure 2). A fine needle aspiration biopsy (FNAB) of the mass was performed (Figure 3).Department of HE and Training approved lis

Oral medicine case book 49: plasmablastic lymphoma

A 25-year-old male patient presented at the Oral Medicine Clinic with a painful bleeding lesion on the palate causing him discomfort during speech, mastication, and sleep. The lesion started approximately five months earlier as a small growth that gradually increased in size. The patient was rather vague about his medical history and habits but he did reveal that he smoked two cigarettes per day as well as using cocaine, a habit for which he was receiving therapy, for drug-induced hallucinations, at a local psychiatric hospital. He was not aware of any other medical conditions or allergies. The extraoral examination revealed nothing of note, however, on intraoral examination a large and firm pedunculated exophytic soft tissue mass was seen on the hard palate. It covered a large portion of the hard palate extending from the back of the upper incisors posteriorly onto the anterior part of the soft palate and into the right vestibule. It extended laterally to the gingival margins of all the teeth in the first quadrant, resulting in an appearance of gingival hyperplasia. The growth had an erythematous appearance with surface patches of necrosis and other areas that easily bled on touch (Figure 1).Department of HE and Training approved lis