Complex regional pain syndrome Type II (causalgia) in head neck region: A case report

Complex regional pain syndrome (CRPS) with localized erythema and hyperthermia of skin can be a perplexing clinical situation and has created varied diagnostic dilemmas for clinicians. Various cases of CRPS in the extremities have been documented, but in the head neck region, it is quite uncommon and only 13 cases have been reported since 1947 and here lies the importance of reporting the case. A 30-year-old female reported to the OPD with complain of severe pain, occasional swelling, change in overlying skin temperature, and color in left lower one-third region of face near mandibular angle since 2½ years. She had a trauma to that region 3 years back. The history and clinical examination revealed that the patient met “Budapest Clinical Criteria” for diagnosis of CRPS Type II and was treated with amitriptyline, pregabalin, methylcobalamine, steroids, and other supportive treatments. The patient showed marked improvement in pain control. Therefore, history and clinical examination and early diagnosis are crucial for the better treatment outcome in CRPS Type II

Synchronous multiple oral squamous cell carcinoma in a female patient: A case report and review

Oral squamous cell carcinoma (OSCC) is a common oncological problem in India. However, the frequency of developing synchronous carcinomas, i.e., development of second primary tumor (SPT) either simultaneously or within 6 months of the index tumor, in the orofacial region are rare and ranges from 8% to 21%. These lesions are more aggressive, treatment-resistant, and metastasize early. The onset of SPT decreases the 5-year survival by 18–30% as compared to those with a single tumor. Astonishingly, it was found that synchronous OSCCs showed 100% male predominance, with no female predilection. This case of synchronous OSCC in a 58-year-old female had an index tumor involving right side of the mandible and a SPT in the left buccal mucosa. Both the lesions were histopathologically diagnosed well-differentiated squamous cell carcinoma. Hence, the importance of reporting this case lies on the rarity, aggressiveness, and poor prognosis of the lesion and the patient being a female

Hanhart syndrome: A rare case report and review of literature

Hanhart syndrome is a rare congenital and genetic disease, in which the most common signs are short, incompletely developed tongue (hypoglossia), absent or partially missing fingers and/or toes (hypodactylia), malformed arms and/or legs (peromelia), and small jaw (micrognathia). Here, we report a case of Hanhart syndrome in an 18-year-old boy. The boy presented with few extraoral and intraoral abnormalities such as short toes and phalanges along with partial syndactyly in the left hand only were the most relevant. Other features such as micro and retrognathic face, incompetent lips, and wide nasal bridge were also significant. The boy was suffering for difficulties in speech and swallowing due to small tongue size, high arched palate, crowding, and few missing teeth. To provide adequate treatment to a patient with Hanhart syndrome, this study aimed to review and to analyze this literature and treatment protocols

Study of Caspase 8 mutation in oral cancer and adjacent precancer tissues and implication in progression.

It is hypothesized that same driver gene mutations should be present in both oral leukoplakia and cancer tissues. So, we attempted to find out mutations at one of the driver genes, CASP8, in cancer and adjacent leukoplakia tissues. Patients (n = 27), affected by both of cancer and adjacent leukoplakia, were recruited for the study. Blood and tissue DNA samples were used to identify somatic mutations at CASP8 by next generation sequencing method. In total, 56% (15 out of 27) cancer and 30% (8 out of 27) leukoplakia tissues had CASP8 somatic mutations. In 8 patients, both cancer and adjacent leukoplakia tissues, located within 2-5 cm of tumor sites, had identical somatic mutations. But, in 7 patients, cancer samples had somatic mutations but none of the leukoplakia tissues, located beyond 5cm of tumor sites, had somatic mutations. Mutated allele frequencies at CASP8 were found to be more in cancer compared to adjacent leukoplakia tissues. This study provides mutational evidence that oral cancer might have progressed from previously grown leukoplakia lesion. Leukoplakia tissues, located beyond 5cm of cancer sites, were free from mutation. The study implies that CASP8 mutation could be one of the signatures for some of the leukoplakia to progress to oral cancer

A Quest for miRNA Bio-Marker: A Track Back Approach from Gingivo Buccal Cancer to Two Different Types of Precancers

<div><p>Deregulation of miRNA expression may contribute to tumorigenesis and other patho-physiology associated with cancer. Using TLDA, expression of 762 miRNAs was checked in 18 pairs of gingivo buccal cancer-adjacent control tissues. Expression of significantly deregulated miRNAs was further validated in cancer and examined in two types of precancer (leukoplakia and lichen planus) tissues by primer-specific TaqMan assays. Biological implications of these miRNAs were assessed bioinformatically. Expression of <i>hsa-miR-1293, hsa-miR-31, hsa-miR-31*</i> and <i>hsa-miR-7</i> were significantly up-regulated and those of <i>hsa-miR-206, hsa-miR-204</i> and <i>hsa-miR-133a</i> were significantly down-regulated in all cancer samples. Expression of only <i>hsa-miR</i>-31 was significantly up-regulated in leukoplakia but none in lichen planus samples. Analysis of expression heterogeneity divided 18 cancer samples into clusters of 13 and 5 samples and revealed that expression of 30 miRNAs (including the above-mentioned 7 miRNAs), was significantly deregulated in the cluster of 13 samples. From database mining and pathway analysis it was observed that these miRNAs can significantly target many of the genes present in different cancer related pathways such as “proteoglycans in cancer”, <i>PI3K-AKT</i> etc. which play important roles in expression of different molecular features of cancer. Expression of <i>hsa-miR-31</i> was significantly up-regulated in both cancer and leukoplakia tissues and, thus, may be one of the molecular markers of leukoplakia which may progress to gingivo-buccal cancer.</p></div

A Quest for miRNA Bio-Marker: A Track Back Approach from Gingivo Buccal Cancer to Two Different Types of Precancers - Figure 3

<p><b>A: Manhattan plot of p-values for 520 miRNAs from the cluster of 13 samples.</b> The plot of relative location of 520 miRNAs (along the horizontal axis) across the human chromosome and their corresponding –log₁₀ transformed p-value (along the vertical axis). Benjamini-Hochberg corrected P-value cut off was 0.00298 (Horizontal line in the middle of figure). <b>B: Heat map diagram of ΔΔCt values of 30 miRNAs</b>. Expression of these miRNAs was significantly deregulated in the cluster of 13 samples. Each row represents a miRNA and each column represents a sample. Sky-blue colored cells stand for failed assay (i.e.no data in those cells). Red and green colors signify up- and down-regulation of expression, respectively. Heat map was constructed using Heatmap 2 of R's “gplot” package. <b>C: Highly correlated expression of miR-411* and miR-411</b>.</p

Demography of 18 leukoplakia patients.

<p><b>*</b>All except two (LK5 & LK9) patients had tobacco habits.</p

Reported targets associated with 7 miRNAs significantly deregulated in 18 cancer samples.

@<p>: Up-regulation of expression of miRNAs.</p>$<p>: Down regulation of expression of miRNAs.</p>∧<p>Benjamini-Hochberg corrected p-value cut off at 5% level: 6.5E⁻⁰⁴.</p><p><b>ΔΔCt</b> =  ΔCt _{of a gene in cancer tissue} - ΔCt _{of that gene in control tissue}.</p>#<p>; Expression of <i>has-miR-1</i> is not significantly deregulated and shown for comparison only.</p><p>MN- Mouth Neoplasm, HN- Head and Neck Cancer, SCC- Squamous Cell Carcinoma, LN- Laryngeal Neoplasm, EN- Esophageal Neoplasm, OLP-Oral Leukoplakia, <i>GCN1L1</i>- general control of amino-acid synthesis 1-like 1.</p

Demography of 18 cancer patients and their tumor differentiation status.

<p><b>*</b>All patients had tobacco habits;</p>@<p>Mx: metastasis status not known.</p