Journal of Advanced Clinical and Research Insights

Vol. 3 | No.4 | July-August 2016 Issue

1.EDITORIAL

Oral potentially malignant disorders – More to unfold

Dr. M. G. Madhura

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:110–111 | No. of Hits: 241


ABSTRACT

Changes in oral mucosa related to tobacco habits are noticeable and can form a group of pathologies termed as potentially malignant disorders (PMDs).

How to cite this article: Madhura MG. Oral potentially malignant disorders - More to unfold… J Adv Clin Res Insights 2016;3:110-111.


2.ORIGINAL ARTICLE

Algorithm to reduce subjectivity in grading oral epithelial dysplasia - A preliminary study

M. G. Madhura, Lipika Kansal, B. Veerendra Kumar, V. Soumya Bhavana

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:112–117 | No. of Hits: 245 [No. of Citation: 1]


ABSTRACT

Background and Objectives: The most common oral potentially malignant disorder is leukoplakia with its microscopic picture varying from simple hyperkeratosis to severe epithelial dysplasia. Numerous grading systems for oral epithelial dysplasia (OED) have been reported over the years. However, inter- and intra-observer variations in the grading of OED are also well documented. The present study aimed at reducing interobserver variability in grading OED using an algorithm. The objectives were to review H and E stained sections of normal oral mucosal samples and cases of OED, by manual and by photographic methods.

Materials and Methods: A total of 50 cases (n = 50) constituted the study material. 10 cases of normal oral mucosa and 40 histopathologically confirmed cases of oral leukoplakia (both dysplastic and non-dysplastic) were retrieved from the archives of the department. Slides were reviewed by manual and by photographic methods. Five observers had participated in the study.

Results: Substantial agreement was found between the observers in grading OED (both by manual and by photographic methods).

Interpretation and Conclusions: An algorithm may be used as a tool to reduce the subjectivity of OED grading.

Keywords Algorithm, grading, leukoplakia, oral epithelial dysplasia

How to cite this article: Madhura MG, Kansal L, Kumar BV, Bhavana VS. Algorithm to reduce subjectivity in grading oral epithelial dysplasia - A preliminary study. J Adv Clin Res Insights 2016;3:112-117.


3.ORIGINAL ARTICLE

“Comparative assessment of cellular proliferative potential in oral lichen planus and oral lichenoid lesions by quantitative analysis of nucleolar organizer regions”

Sarita Yanduri, R. Janani, Veerendra B. Kumar, S. Suma, Tanu Tiwari

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:118–122 | No. of Hits: 2822


ABSTRACT

Background: The potential for malignant change in oral lichen planus (OLP) is still a matter of controversy. Adding to the persisting controversy, recently there is evidence that oral lichenoid lesions (OLL) may also possess a malignant potential. Increase in cellular proliferation rate enhances the chances that cells may undergo mutations during mitosis which in turn could result in a malignant phenotype.

Aims: The present study is aimed at comparing the proliferative rate of OLP and OLL based on quantitative argyrophilic nucleolar organizer region (AgNOR) analysis.

Materials and Methods: The study consisted of the use of 25 archival paraffi nembedded blocks of histopathologically diagnosed cases of OLP (n = 14) and OLL (n = 11). Sections were then stained using an AgNOR technique. Group mean AgNOR values were derived and independent student t-test was applied for statistical analysis.

Results: The mean AgNOR value in OLP group was 2.49 ± 0.91 and the same in OLL group was 2.31±0.43. There was no statistically signifi cant diff erence noted between the two groups with a probability value of 0.531(P ≥ 0.05).

Conclusion: On AgNOR analysis, OLP and OLL behave in a similar manner in terms of cellular proliferation. Accordingly, either OLP or OLL may have a similar predisposition to undergo malignant transformation.

Keywords Argyrophilic nucleolar organizer region, oral lichen planus, oral lichenoid lesions

How to cite this article: Yanduri S, Janani R, Kumar VB, Suma S, Tiwari T. “Comparative assessment of cellular proliferative potential in oral lichen planus and oral lichenoid lesions by quantitative analysis of nucleolar organizer regions”. J Adv Clin Res Insights 2016;3:118-122.


4.ORIGINAL ARTICLE

Correlation between transforming growth factor-beta expression and mast cell count in different grades of oral submucous fibrosis

Vivek Kumar, S. Suma, B. Veerendra Kumar, Sarita Yanduri, K. Shyamala

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:123–128 | No. of Hits: 389


ABSTRACT

Background and Objectives: In India, oral submucous fibrosis (OSF) is a commonly encountered precancerous disorder. It is a disease with a protracted course and characteristic clinical features caused by the habit of consuming areca nut. Histologically, the main pathology is extensive fibrosis of the mucosa. OSF can be categorized into four grades based on histology. Inflammatory cells and keratocytes are stimulated by the areca nut alkaloids, and they release transforming growth factor-beta (TGF-β). It has been advocated to play a major role in OSF pathogenesis by increasing collagen synthesis and preventing collagen degradation. Mast cells (MCs) are the additional key players in the pathogenesis of OSF. There is confusion regarding the functional relationship of MC with TGF-β. Few studies have shown TGF-β can repress MC function, whereas other studies have established that TGF-β is a chemotaxin for MCs. However, there is dearth in literature regarding their interaction in OSF. Hence, this study attempted to show a relationship between TGF-β and MC in different grades of the disease, so as to further explicate the pathogenesis of OSF.

Materials and Methods: A total of 48 OSF cases were stained using TGF-β antibody. Its staining intensity and staining area were calculated. Sections from same blocks were also stain MCs using 1% toluidine blue. The number of MCs was counted for all the cases. Expression of TGF-β was correlated with MC count in all OSF grades.

Results: On correlating TGF-β and MC between the histologic grades, there was a strong negative correlation for Grade I, moderately positive for Grade II and no correlation for Grade III OSF.

Interpretation and Conclusions: Among the different grades of OSF, the correlation between MC and TGF-β varies, depending on the severity of inflammation, and the concentration of TGF-β and further investigation in this field may elucidate their role in determining the severity of OSF.

Keywords Mast cells, oral submucous fibrosis, transforming growth factor-beta

How to cite this article: Kumar V, Suma S, Kumar BV, Yanduri S, Shyamala K. Correlation between transforming growth factor-beta expression and mast cell count in different grades of oral submucous fibrosis. J Adv Clin Res Insights 2016;3:123-128.


5.ORIGINAL ARTICLE

Gutkha ban - A myth?

Ganganna Kokila, Jayanna Vinayak Bharateesh

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:129–132 | No. of Hits: 833


ABSTRACT

Background: Gutkha contains harmful and carcinogenic chemicals. The government of Karnataka banned the manufacture, storage, distribution, and sale of gutkha and paan masala on 31st May 2013.

Objectives: The objective of the present study was to know the impact and awareness of gutkha ban after 2 ½ years on self-reported gutkha users among migrant workers in Tumkur city, Karnataka.

Materials and Methods: A cross.sectional study was conducted among self-reported gutkha using migrant workers in and around Tumkur city. The migrant workers working in construction sites such as roads and buildings were interviewed.

Results: The study was conducted among 124 migrant construction workers of which 98 were male and 26 were female aged between 18 and 57 years. 16 (12.90%) of them reported to have quit the habit of chewing gutkha after the ban. These 16 people who reported to have quit the use of gutkha were using other forms of tobacco with three resorting to smoking and 13 using khaini.

Conclusion: Despite the ban persons with a habit of tobacco usage had not quit the tobacco. The call of the hour is to educate and reinforce the ill effects of gutkha among its users along with the regulatory approach. If the ban has to be effectively implemented, “chewing tobacco” must also be brought under the ambit of the Act and its sale must be regulated or banned.

Keywords Cancer, gutkha, pan masala, tobacco

How to cite this article: Kokila G, Bharateesh JV. Gutkha ban - A myth? J Adv Clin Res Insights 2016;3:129-132.


6.ORIGINAL ARTICLE

Oral candidal carriage and species identification among betel quid chewers and oral submucous fibrosis patients

Preethi Somashekhar, V. V. Kamath, C. Ramanna

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:133–138 | No. of Hits: 1786


ABSTRACT

Background: The Candida species are saprophytic component of the normal oral microbiota. The disequilibrium in the homeostasis between Candida, host immune system and normal oral bacterial flora promotes a Candida carriage.

Aim of the Study: The present study was done to assess oral candidal carriage and species identification among healthy subjects, betel quid chewing (BQC), and oral submucous fibrosis (OSF) patients using CHROMagar® media.

Materials and Methods: Oral swabs collected from the reservoirs of Candida species (buccal mucosa and tongue) in study groups using sterile cotton swabs were inoculated on Sabouraud’s dextrose agar candidal medium and CHROMagar® Candida agar medium consecutively. Determination of Candida species was done based on morphology characteristics and pigment produced. The results were statistically analyzed using Chi-square test.

Results: Candida carriage was more in samples of buccal mucosa followed by the tongue. Candida albicans was the major isolate in both healthy subjects and BQC but with greater frequency in BQC. Candida tropicalis was the major isolate in OSF patients predominantly in buccal mucosa followed by the tongue.

Conclusion: C. tropicalis, a non-C. albicans species, was the major isolate in OSF. This unique finding implicates an immunological change of oral environment brought about by BQC and OSF.

Keywords Betel quid chewing, Candida albicans, Candida tropicalis, CHROMagar®, oral submucous fibrosis

How to cite this article: Somashekhar P, Kamath VV, Ramanna C. Oral candidal carriage and species identification among betel quid chewers and oral submucous fibrosis patients. J Adv Clin Res Insights 2016;3:133-138.


7.ORIGINAL ARTICLE

Evaluation of micronuclei in betel quid chewers, potentially malignant oral disorders, and oral squamous cell carcinoma patients: A cytological assay

Preethi Somashekhar, V. V. Kamath

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:139–142 | No. of Hits: 360 [No. of Citation: 1]


ABSTRACT

Background: The micronuclei are round to oval extranuclear cytoplasmic bodies associated with chromosomal aberrations. Micronuclei are reported to be prognostic biomarkers in the screening of potentially malignant disorders (PMDs) and oral cancer. The present study was done to determine, compare, and correlate micronuclei count in normal participants, betel quid chewers, PMDs, and oral squamous cell carcinoma patients (OSCC).

Materials and Methods: The buccal smears in each group were stained by Papanicolaou technique using commercially available staining kit RAPIDPAP®. Micronuclei were identified and counted in all the cases using standardized techniques. Comparative statistical evaluation was done within and among the groups.

Results: The median value of micronuclei in each group was assessed using Kruskal-Wallis test. Intergroup comparison was done using Dunn’s Multiple Comparison Test. A significant increase in the median values of micronuclei in betel quid chewers was found compared to normal participants. The median values of micronuclei were significantly higher in OSCC patients followed by OSF, leukoplakia, oral lichen planus, and betel quid chewers as compared to normal participants.

Conclusion: The median values of micronuclei are indicative of cytogenetic damage induced by potential carcinogens. Micronuclei counts are reliable cytogenetic tools in the progression of carcinogenesis.

Key words Biomarker, epithelial cells, micronuclei, oral squamous cell carcinoma

How to cite this article: Somashekhar P, Kamath VV. Evaluation of micronuclei in betel quid chewers, potentially malignant oral disorders, and oral squamous cell carcinoma patients: A cytological assay. J Adv Clin Res Insights 2016;3:139-142.


8.ORIGINAL ARTICLE

Leukoplakia and erythroplakia: A clinicians perspective and histopathologist verdict - A retrospective study

S. V. Sreelatha, Supreetha Chuppa, Dhivya Bharati, Chitta Ranjan Chowdhury, Pushparaj Shetty

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:143–146 | No. of Hits: 966


ABSTRACT

Background: Precancerous lesions and conditions which are replaced by the term potentially malignant disorders (PMDs) may precede oral cancer. The PMDs present as visible clinical changes may belie the true nature of the lesion. Histopathologic diagnosis is the gold standard in evaluating these lesions for dysplasia and malignant potential. The aim of the present study is to evaluate the clinicopathological findings of oral leukoplakia and erythroplakia.

Materials and Methods: Pathological report of cases, which were clinically diagnosed as leukoplakia and erythroplakia, were studied retrospectively from 2013 to 2015.

Results: Of the 20 cases reviewed, 12 were homogenous leukoplakia, 3 speckled leukoplakia, and 5 erythroplakia cases. Age ranged from 27 to 77 years. Males 14 and females 6. The buccal mucosa was the common site. Histopathology study revealed out of 12 cases of homogenous leukoplakia, 9 showed hyperkeratosis and mild epithelial dysplasia was seen in 3 cases. In 3 cases of speckled leukoplakia, mild epithelial dysplasia was seen in 2 cases (2/3) and severe epithelial dysplasia was seen in 1 case (1/3). In 5 cases of erythroplakia, 2 showed mild dysplasia, 1 showed severe dysplasia, and 1 squamous cell carcinoma (SCC).

Conclusion: Oral leukoplakia and erythroplakia can demonstrate a wide spectrum of histopathological features ranging from hyperkeratosis, dysplasia to SCC.

Keywords Epithelial dysplasia, erythroplakia, leukoplakia

How to cite this article: Sreelatha SV, Chuppa S, Bharati D, Chowdhury CR, Shetty P. Leukoplakia and erythroplakia: A clinicians perspective and histopathologist verdict - A retrospective study. J Adv Clin Res Insights 2016;4:143-146.


9.ORIGINAL ARTICLE

Carbon dioxide laser: A surgical modality in the treatment of oral leukoplakia

Sunil Vasudev, Chinmay Dilip Vakade, Roshan Cherian Paramesh, Roopa Ganta

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:147–151 | No. of Hits: 497


ABSTRACT

Introduction: The purpose of this study was to assess the clinical usefulness of carbon dioxide (CO2) laser as a surgical modality in the excision of oral leukoplakia.

Aims and Objectives: (1) Hemostasis intraoperatively, (2) post-operative inflammation, healing, short-term recurrences if any.

Materials and Methods: A total of 23 patients with oral leukoplakia were included in this study; Surgical CO2 laser unit with power output between 0.5 and 15 W and focal length of 12.5 cm was used in this study.

Results: Minimal intraoperative bleeding was seen. All patients had complete epithelization by 5 weeks and the ones who took longer than 3 weeks for epithelization to complete, had lesions >4 cm. Slight contraction of the wound was seen at three months. Mouth opening was not restricted during followed up period. There was no short-term recurrence observed in any of the patients within the regular followed up period.

Conclusion: CO2 laser is an effective tool in the surgical treatment of oral leukoplakia and gives predictable results in the management of these lesions.

Keywords Carbon dioxide laser, Leukoplakia, Potentially malignant disorder

How to cite this article: Vasudev S, Vakade CD, Paramesh RC, Ganta R. Carbon dioxide laser: A surgical modality in the treatment of oral leukoplakia. J Adv Clin Res Insights 2016;3:147-151.


10.REVIEW ARTICLE

Role of curcumin in management of potentially malignant disorders: A review of literature

Sunil Vasudev, Chinmay Dilip Vakade, Roshan Cherian Paramesh, Priyanka Belgal

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:152–155 | No. of Hits: 1198 [No. of Citation: 2]


ABSTRACT

Potentially malignant disorders (PMD) are premalignant lesions or conditions having a high rate of malignant transformation. The risk of malignancy accounts for more than 50% in the commonly occurring oral PMD. There is a need to identify oral PMD early on and prevent their transformation into malignancy. Oxidative stress plays a major role in the pathogenesis of oral PMD. Curcumin, an antioxidant has shown promising results in oral PMD by reducing oxidative stress by various mechanisms. The aim of this article is to shed light on the use of curcumin in different oral PMD, its benefits, and shortcomings based on previously published literature.

Keywords Oral PMD, Curcumin, Antioxidant, Leukoplakia, OSMF, Erythroplakia and Lichen Planus

How to cite this article: Vasudev S, Vakade CD, Paramesh RC, Belgal P. Role of curcumin in management of potentially malignant disorders: A review of literature. J Adv Clin Res Insights 2016;3:152-155.


11.REVIEW ARTICLE

Enigma of oral potentially malignant disorders - A brief overview

N. K. Priya, R. Shruthy, Ashwini Ramakrishna, N. K. Sowmya, G. S. Madhushankari

Year:2016 | Month:July-August | Volume:3 | Number:4 | Pages No:156–159 | No. of Hits: 628 [No. of Citation: 1]


ABSTRACT

Oral cancer is a unique cancer, nevertheless detected at the later stage. It is of note that oral cancer develops from oral potentially malignant disorders (OPMDs) that comprises premalignant lesions and conditions. Dearth of awareness and lack of knowledge in the detection of oral cancer along with patients presenting in the advanced stage of cancer have led to delay in diagnosis. Present treatise consideration will be mainly on the malignant potentiality of rare OPMDs, especially dyskeratosis congenital, epidermolysis bullosa, lupus erythematosus, Plummer-Vinson syndrome, and xeroderma pigmentosum. An English literature search engine was done for articles relating to OPMDs using Medline journals and National Library of Medicine.

Keywords Lupus erythematosus, malignant transformation, oral potentially malignant disorders, xeroderma pigmentosum

How to cite this article: Priya NK, Shruthy R, Ramakrishna A, Sowmya NK, Madhushankari GS. Enigma of oral potentially malignant disorders - A brief overview. J Adv Clin Res Insights 2016;3:156-159.