Association of HPV and EBV in Oral Verrucous Squamous Cell Carcinoma and Oral Verrucous Hyperplasia

Objective Oral verrucous squamous cell carcinoma or oral verrucous carcinoma (OVC) is a rare verrucous variant of oral squamous cell carcinoma (OSCC), which accounts for 2 to 12% of all oral carcinomas. Oral verrucous hyperplasia (OVH) is clinically similar to OVC and has been proposed to be a precursor lesion of OVC. Etiopathogenesis of both lesions is still inconspicuous. Oncogenic viruses such as human papillomavirus (HPV) and Epstein–Barr virus (EBV) have been reported to be associated with some cases of OSCC, and we hypothesized that it may act as a causative agent of these verrucous lesions. This study aimed to investigate frequency of HPV and EBV infections in OVC and OVH. Material and Methods Using polymerase chain reaction (PCR), a total of 35 formalin-fixed paraffin-embedded (FFPE) tissue samples, including 27 OVC samples and 8 OVH samples, were investigated for HPV and EBV infection. HeLa and B95-8 cell lines were used as positive controls of HPV and EBV PCR, respectively. Results All OVC and OVH samples show a positivity to GAPDH, whereas neither HPV nor EBV PCR products was detected in both OVC and OVH samples. Conclusions In summary, our study demonstrated that HPV and EBV are not involved in pathogenesis of OVC and OVH. Other etiologic factors contributing to OVC and OVH need to be further clarified.

Warty Lesion Over Amputated Stump

Introduction: Amputation can disturb the quality of life, and it can be worsened when the amputated stump suffers from any dermatoses. It is mandatory for an amputee and the doctor to know about the common dermatoses that an amputated limb can suffer from. The prosthesis should be properly fitting, and hygiene has to be maintained. Case Presentation: A 49-year-old male presented with a warty lesion over the amputated limb. Histopathological examination revealed verrucous hyperplasia, and further examination showed improperly fitted prosthesis. A well-fitted prosthesis with proper padding cured his lesion. Conclusions: The case report highlights how a properly fitted prosthesis corrects the lymphatic flow and thereby reduces complications. It is also important to maintain stump hygiene, as the humid, relatively anaerobic environment inside the prosthesis can trigger the growth of various organisms.

Contiguous squamous proliferations in syringocystadenoma papilliferum: A retrospective study of 14 cases

Background: Syringocystadenoma papilliferum is a benign adnexal neoplasm. Contiguous squamous proliferation has been rarely described in syringocystadenoma papilliferum. Aims: This study aimed to evaluate the spectrum and pathogenesis of contiguous squamous proliferation in syringocystadenoma papilliferum. Materials and Methods: All cases of syringocystadenoma papilliferum diagnosed over the past 12 years were screened for contiguous squamous proliferation. Cases with associated nevus sebaceous were excluded from the study. Immunohistochemistry for GATA3, CK7, BRAFV600E and p16 was performed. PCR for human papilloma virus, type 16 and 18, was carried out. Results: Of a total of 30 cases, 14 cases showed associated contiguous squamous proliferation which included four cases of verrucous hyperplasia, six cases with papillomatosis, two cases with mild squamous hyperplasia and one case each of Bowen’s disease and squamous cell carcinoma. In the cases with non-neoplastic contiguous squamous proliferations, the squamous component did not express CK7 or GATA3. However, the squamous component of premalignant and malignant lesions expressed CK7 and GATA3 concordant with the adenomatous component. BRAF was positive in adenomatous component in five cases while the contiguous squamous proliferation component was negative for BRAF in all but one case. p16 was negative in both components of all cases and PCR for human papilloma virus was negative in all cases. Limitations: Due to the rarity of disease, the sample size of our study was relatively small with two cases in the 2nd group, that is, syringocystadenoma papilliferum with malignant contiguous squamous proliferation. Detailed molecular studies such as gene sequencing were not performed. Conclusion: Syringocystadenoma papilliferum with contiguous squamous proliferation is underreported, and most commonly displays verrucous hyperplasia. The premalignant and malignant contiguous squamous proliferations likely arise from syringocystadenoma papilliferum while the hyperplastic contiguous squamous proliferations likely arise from the adjacent epidermis. Relationship with high-risk human papilloma virus is unlikely. However, further molecular analysis of larger number of cases is required to establish the pathogenesis.

Taxonomic and Functional Dysregulation in Salivary Microbiomes During Oral Carcinogenesis

Exploring microbial community compositions in humans with healthy versus diseased states is crucial to understand the microbe-host interplay associated with the disease progression. Although the relationship between oral cancer and microbiome was previously established, it remained controversial, and yet the ecological characteristics and their responses to oral carcinogenesis have not been well studied. Here, using the bacterial 16S rRNA gene amplicon sequencing along with the in silico function analysis by PICRUSt2 (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2), we systematically characterized the compositions and the ecological drivers of saliva microbiome in the cohorts of orally healthy, non-recurrent oral verrucous hyperplasia (a pre-cancer lesion), and oral verrucous hyperplasia–associated oral cancer at taxonomic and function levels, and compared them with the re-analysis of publicly available datasets. Diversity analyses showed that microbiome dysbiosis in saliva was significantly linked to oral health status. As oral health deteriorated, the number of core species declined, and metabolic pathways predicted by PICRUSt2 were dysregulated. Partitioned beta-diversity revealed an extremely high species turnover but low function turnover. Functional beta-diversity in saliva microbiome shifted from turnover to nestedness during oral carcinogenesis, which was not observed at taxonomic levels. Correspondingly, the quantitative analysis of stochasticity ratios showed that drivers of microbial composition and functional gene content of saliva microbiomes were primarily governed by the stochastic processes, yet the driver of functional gene content shifted toward deterministic processes as oral cancer developed. Re-analysis of publicly accessible datasets supported not only the distinctive family taxa of Veillonellaceae and Actinomycetaceae present in normal cohorts but also that Flavobacteriaceae and Peptostreptococcaceae as well as the dysregulated metabolic pathways of nucleotides, amino acids, fatty acids, and cell structure were related to oral cancer. Using predicted functional profiles to elucidate the correlations to the oral health status shows superior performance than using taxonomic data among different studies. These findings advance our understanding of the oral ecosystem in relation to oral carcinogenesis and provide a new direction to the development of microbiome-based tools to study the interplay of the oral microbiome, metabolites, and host health.

TO SEE THE HISTO-PATHOLOGICAL PATTERN OF ORAL MUCOSAL LESIONS

Background & Method: This prospective observational study was carried out with total number of patients 60 in the Department of Otorhinolaryngology and head and neck surgery, Amaltas Institute of Medical Sciences, Dewas, M.P., w.e.f. from August 2018 to September 2020. Patient was thoroughly investigated for complete haemogram, blood sugar, blood urea, serum creatinine, bleeding & Clotting time, coagulation profile, chest x-ray for any secondary focus. Result: Out of 35 cases of clinically premalignant lesions 30 cases were positive for malignant cells on histology. 5 were suspicious for malignant cells. Out of the 25 cases of clinically malignant lesions 25 cases were positive for malignant cells on histology and nil cases of suspicious for malignancy. In this present study, on histopathology premalignant lesions was found in 8.33% and malignancy was seen 91.66% cases. On histopathological examination, squamous cell carcinoma was the most common type among all cases (78.33%). In squamous cell carcinoma, keratinizing type was found in 33.33% and non- keratinizing type was found in 45%. Verrucous carcinoma was seen in 6.66% cases and verrucous hyperplasia was seen in 3.33% cases. Conclusion: We Concluded in the study as diagnosed by histopathology were found premalignant in 8.33% and malignant 91.66% cases. The type of cancer was determined by histo-pathological examination after biopsy. Squamous cell carcinoma was the most common type among all cases (78.33%). In squamous cell carcinoma, keratinizing type were found in 33.33% and non-keratinizing type were found in 45%, followed by verrucous carcinoma was seen in 6.66% cases, and verrucous hyperplasia was seen in 3.33% cases. Keywords: Histo-pathological, Oral Mucosal Lesions.

Functional Profiling of Saliva Microbiome is Essential for Oral Cancer Prediction

Background: The association between microbiome and host disease has been documented in oral cancer, one of the leading cancers worldwide. Huge efforts are made to use the profile of oral microbiome and distinct signature species as markers to distinguish oral cancer patients from healthy individuals. The previous results, however, remain inconclusive. The assembly mechanisms of oral microbiome and their response to changes in oral carcinogenesis also have not been characterized. Here, using 16S rRNA gene amplicon sequencing and in-silico function prediction approaches, we analyzed the saliva microbiome in cohorts of orally healthy, oral verrucous hyperplasia, and oral cancer at taxon and function levels, and compared their corresponding predictive performance of oral cancer using machine learning algorithms.Results: Analyses of diversity and phylogenetic profiles of bacterial communities in saliva showed that microbiome dysbiosis was significantly linked to oral health status. As oral health deteriorated, the number of core species (>75% prevalence) as a percentage of overall species richness declined. In line with the null model-based analysis, taxonomic and functional assemblies of saliva microbiomes were primarily governed by the stochastic processes. Correspondingly, the quantitative assessment of partitioned beta-diversity suggested extremely high species turnover but low function turnover, revealing a functional redundancy of the oral ecosystem. Functional beta-diversity in salvia microbiome shifted from turnover to nestedness during carcinogenesis of oral verrucous hyperplasia, but this pattern was not observed at the taxon level. Moreover, using both taxon and function data as training features for machine learning-aided prediction on host health status supports a superior predictive performance when using functional profiling. Similar results were also obtained and validated using publicly accessible data.Conclusions: Our results suggest that altered oral bacterial communities are highly associated with carcinogenesis of oral verrucous hyperplasia. Partly owing to high taxonomic turnover and stochastic assembly processes of the oral ecosystem, discovering oral microbial consortia as universal biomarkers for oral cancer may prove difficult and arduous. Functional profiles are relatively stable and evolve a nestedness pattern during oral carcinogenesis, serving as a new benchmark to study the interplay of the oral microbiome and host health in the future.

EVALUATION OF CASES OF EXOPHYTIC VERRUCOUS HYPERPLASIA IN ORAL SUBMUCOUS FIBROSIS IN BIHAR

Verrucous hyperplasia probably represents a morphological variant of verrucous carcinoma by Slootwage J P and Muller H (1983). An essential feature in distinguishing verrucous hyperplasia from verrucous carcinoma is the location of the thickened epithelium with respect to adjacent normal appearing epithelium. In verrucous hyperplasia most of the hyperplastic broadened rete ridges lay above the adjacent normal epithelium while verrucous carcinoma on contrary exhibits a downward growth pattern of otherwise similar rete ridges. Hence based on above findings the present study was planned in Evaluation of Cases of Exophytic Verrucous Hyperplasia in Oral Submucous Fibrosis in Bihar. The present study was planned in Department of Dentistry, netaji subhash Medical College & Hospital, Bihta, Patna, Bihar. Conventional oral examination (COE) of 30 patients with Oral submucous fibrosis (OSMF) was performed using incandescent operatory light. Out of that 6 cases having Verrucopapillary lesion were evaluated in the present study. The data generated from the present study concluded that patients with highly suspicious malignant verrucous growths on VEL scope examination exhibited increased auto fluorescence and on histopathological examination revealed no signs of dysplasia or invasion. Exhibition of increased autofluorescence of these lesions on VELscope examination could greatly help to determine their nondysplastic nature. Keywords: Verrucous hyperplasia, Verrucous carcinoma, Oral Submucous Fibrosis, etc.