Clear Cell Squamous Cell Carcinoma of the Maxillary Gingiva Associated with PIK3CA and HRAS Mutations: Report of a Case and Literature Review

The version of record of this article, first published in Head and Neck Pathology, is available online at Publisher’s website: https://doi.org/10.1007/s12105-023-01580-8.Background: Squamous cell carcinoma (SCC) is the most common oral malignancy, and somatic mutations in some driver genes have been implicated in SCC development. Clear cell SCC (CCSCC) is a rare histological variant of SCC, and various clear cell neoplasms must be considered in the differential diagnosis of CCSCC in the oral cavity. Based on a limited number of CCSCC cases reported in the oral cavity, CCSCC is considered an aggressive variant of SCC with a poor prognosis; however, its genetic characteristics remain unknown. Methods: A maxillary gingival tumor in an 89-year-old female was described and investigated using immunohistochemical staining, special staining, fluorescence in situ hybridization, and next-generation sequencing (NGS) with a custom panel of driver genes, including those associated with SCC and clear cell neoplasm development. Results: Histopathological examination revealed a proliferation of atypical epithelial cells with abundant clear cytoplasm and enlarged and centrally placed round nuclei. The tumor was exophytic with deep, penetrating proliferation. The atypical clear cells were continuous with the conventional SCC cells. Immunohistochemical analysis showed that the clear cells were positive for CK AE1/AE3 and CK5/6 and nuclear-positive for p63. In contrast, the clear cells were negative for αSMA, S100, HMB45, Melan-A, CD10, and p16. p53 immunoreactivity exhibited a wild-type expression pattern. Additionally, the clear cells were positive for periodic acid-Schiff (PAS) and negative for diastase-PAS, mucicarmine, and Alcian blue. Based on these results, the diagnosis of CCSCC was confirmed. Molecular analysis of the clear cells identified PIK3CA p.E542K (c.1624G>A) and HRAS p.G12A (c.35 G>C) somatic mutations classified as oncogenic. No pathogenic variants were identified in TP53, EWSR1, AKT1, PTEN, BRAF, KRAS, NRAS, RASA1, or MAML2. Conclusions: We report a case of CCSCC of the oral cavity with PIK3CA and HRAS mutations. The identification of PIK3CA and/or HRAS mutations is rare in SCC; however, both mutations are important potential targets for antitumor therapy. A detailed analysis of gene mutations in CCSCC may lead to a better understanding of its biological behavior and an improved prognosis, as well as a differential diagnosis from other clear cell neoplasms

Stereoscopy in Dental Education:An Investigation

The aim of this study was to investigate whether stereoscopy can play a meaningful role in dental education. The study used an anaglyph technique in which two images were presented separately to the left and right eyes (using red/cyan filters), which, combined in the brain, give enhanced depth perception. A positional judgment task was performed to assess whether the use of stereoscopy would enhance depth perception among dental students at Osaka University in Japan. Subsequently, the optimum angle was evaluated to obtain maximum ability to discriminate among complex anatomical structures. Finally, students completed a questionnaire on a range of matters concerning their experience with stereoscopic images including their views on using stereoscopy in their future careers. The results showed that the students who used stereoscopy were better able than students who did not to appreciate spatial relationships between structures when judging relative positions. The maximum ability to discriminate among complex anatomical structures was between 2 and 6 degrees. The students' overall experience with the technique was positive, and although most did not have a clear vision for stereoscopy in their own practice, they did recognize its merits for education. These results suggest that using stereoscopic images in dental education can be quite valuable as stereoscopy greatly helped these students' understanding of the spatial relationships in complex anatomical structures

A standardized evaluation of artifacts from metallic compounds during fast MR imaging

Objectives: Metallic compounds present in the oral and maxillofacial regions (OMRs) cause large artefacts during MR scanning. We quantitatively assessed these artefacts embedded within a phantom according to standards set by the American Society for Testing and Materials (ASTM). Methods: Seven metallic dental materials (each of which was a 10-mm(3) cube embedded within a phantom) were scanned [i.e. aluminium (Al), silver alloy (Ag), type IV gold alloy (Au), gold-palladium-silver alloy (Au-Pd-Ag), titanium (Ti), nickel-chromium alloy (NC) and cobalt-chromium alloy (CC)] and compared with a reference image. Sequences included gradient echo (GRE), fast spin echo (FSE), gradient recalled acquisition in steady state (GRASS), a spoiled GRASS (SPGR), a fast SPGR (FSPGR), fast imaging employing steady state (FIESTA) and echo planar imaging (EPI; axial/sagittal planes). Artefact areas were determined according to the ASTM-F2119 standard, and artefact volumes were assessed using OsiriX MD software (Pixmeo, Geneva, Switzerland). Results: Tukey-Kramer post hoc tests were used for statistical comparisons. For most materials, scanning sequences eliciting artefact volumes in the following (ascending) order FSE-T-1/FSE-T-2 < FSPGR/SPGR < GRASS/GRE < FIESTA < EPI. For all scanning sequences, artefact volumes containing Au, Al, Ag and Au-Pd-Ag were significantly smaller than other materials (in which artefact volume size increased, respectively, from Ti < NC < CC). The artefact-specific shape (elicited by the cubic sample) depended on the scanning plane (i.e. a circular pattern for the axial plane and a "clover-like" pattern for the sagittal plane). Conclusions: The availability of standardized information on artefact size and configuration during MRI will enhance diagnosis when faced with metallic compounds in the OMR

A quantitative experimental phantom study on MRI image uniformity

Objectives: Our goal was to assess MR image uniformity by investigating aspects influencing said uniformity via a method laid out by the National Electrical Manufacturers Association (NEMA). Methods: Six metallic materials embedded in a glass phantom were scanned (i.e. Au, Ag, Al, Au-Ag-Pd alloy, Ti and Co-Cr alloy) as well as a reference image. Sequences included spin echo (SE) and gradient echo (GRE) scanned in three planes (i.e. axial, coronal, and sagittal). Moreover, three surface coil types (i.e. head and neck, Brain, and temporomandibular joint coils) and two image correction methods (i.e. surface coil intensity correction or SCIC, phased array uniformity enhancement or PURE) were employed to evaluate their effectiveness on image uniformity. Image uniformity was assessed using the National Electrical Manufacturers Association peak-deviation non-uniformity method. Results: Results showed that temporomandibular joint coils elicited the least uniform image and brain coils outperformed head and neck coils when metallic materials were present. Additionally, when metallic materials were present, spin echo outperformed gradient echo especially for Co-Cr (particularly in the axial plane). Furthermore, both SCIC and PURE improved image uniformity compared to uncorrected images, and SCIC slightly surpassed PURE when metallic metals were present. Lastly, Co-Cr elicited the least uniform image while other metallic materials generally showed similar patterns (i.e. no significant deviation from images without metallic metals). Conclusions: Overall, a quantitative understanding of the factors influencing MR image uniformity (e.g. coil type, imaging method, metal susceptibility, and post-hoc correction method) is advantageous to optimize image quality, assists clinical interpretation, and may result in improved medical and dental care