Browsing by Author "R. Keerthika"

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Acuity of Dental Undergraduate Students towards Oral Pathology and Microbiology as a Subject and Profession - An Evaluative Study
(Wolters Kluwer Medknow Publications, 2025) Akhilesh Chandra; Trupti Jain; R. Keerthika; Mahesh R. Khairnar; Vineet Chauhan; Rahul Agrawal
Aim and Objectives: Oral Pathology and Microbiology (OPM) is a branch of dentistry; the objectives of it have been underestimated by undergraduate (UG) dental students. Thus, the present study was formulated, which outlines the acuity of UG students toward OPM as subject and career prospects along with its gender‑wise comparison. Material and Methods: An institutional close‑ended questionnaire‑based, cross‑sectional study was conducted among 219 students including BDS IInd year (36), IIIrd year (42), IVth year (93) students and interns (48), aged between 19 and 24 years. The questionnaire comprised 13 questions related to students’ perception of OPM as a subject along with its career practice. Data obtained were analyzed using Chi‑square test (P < 0.05). Statistics and Results: Among all participants, 99 (45%) were males and 120 (55%) were females. On Chi‑square analysis, we found that the majority of interns (87.5%) and 41.7% of Bachelor of Dental Surgery (BDS) IV year opined that the subject was both research‑oriented as well as clinical with a statistically significant difference. Additionally, students from all four years agreed with the affirmation of career opportunities at cancer centres with significant differences and increased propensity for making Oncology Fellowship programs a prerequisite in addition to Master of Dental Surgery (MDS) certification. On gender comparisons, we observed mixed types of results and inconclusive perceptions. Conclusion: The study revealed that students of a higher grade (BDS final year and interns) possess adequate practical knowledge and scope of practice of OPM compared to the lower‑grade (BDS II and III years) UG dental students with a need for workshops and seminars in the future prospectus. © 2025 Indian Journal of Dental Research.
Association of Cellular Cannibalism with Immunohistochemical Expression of CD31, CD68 and BCL2 in Oral Squamous Cell Carcinoma: An Observational Study
(Springer, 2024) R. Keerthika; Anju Devi; Mala Kamboj; Anjali Narwal
Objective: Cellular cannibalism (CC) is a prime metabolic event to determine the aggressive potential of oral squamous cell carcinoma (OSCC). However, the etiology and mechanism behind this degradation are still ambiguous. The aim of the study was to explore the etiopathogenetic mechanism behind CC, along with its association with degree of differentiation, angiogenic, phagocytic and antiapoptotic activity in OSCC. Design: Seventy-three tissue sections of various histological grades of OSCC were retrieved from departmental archives and scanned for cannibalistic cells. Immunohistochemical analysis using CD31, CD68, and BCL2 was performed. The data obtained were analyzed using Chi-square, Spearman’s correlation test and multiple regression analysis (p < 0.05). Results: CCs were present significantly in various grades of OSCC (p < 0.00). Immunohistochemical analysis revealed a significant difference in CD68, BCL2 (p < 0.05 in both), and CD31 (p < 0.001) expression with CC. The internalized cells showed positivity for CD68 and negativity for BCL2. Regression analysis revealed that tumor grade, CD31 and BCL2 immunoreactivity were significant predictors of frequency of CC. Conclusion: The association of CC with degree of differentiation, CD31, CD68, and BCL2 expression could predict the biological behavior of OSCC and might serve as a promising histopathological parameter in future. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Comparison of haematological and serum lipid profile parameters in oral potentially malignant disorders and oral squamous cell carcinoma
(Wolters Kluwer Medknow Publications, 2025) Akhilesh Chandra; Rahul Agrawal; R. Keerthika; Trupti Jain; Mahesh R. Khairnar; Akhilesh Kumar Singh; R. Maheswari
Introduction: Oral squamous cell carcinoma (OSCC) is sixth most common cancer in Indian subcontinent with a high morbidity and mortality rate. It is frequently preceded by oral potentially malignant disorders (OPMD). Early diagnosis of OSCC might halt the poor prognosis. Therefore, present study was aimed to evaluate the diagnostic significance of preoperative hematological parameters and serum lipid indices in OSCCs and OPMDs. Material and Methods: Study included 75 cases each of OSCC, OPMD, and controls. Mean and standard deviation of various hematological and lipid parameters were evaluated, including: a) RBC metrics: RBC count, hemoglobin (Hb%), hematocrit, MCV, MCH, RDW. b) WBC metrics: WBC count, neutrophils, lymphocytes, monocytes, atypical lymphocytes, immature leukocytes count, NLR. c) Platelet metrics: Platelet count, MPV, PDWSD, PCT, PLCR. d) Lipid metrics: Total Cholesterol, Triglycerides, HDL, LDL, VLDL, Non-HDL. The parameters were statistically analyzed using one-way ANOVA. Result: Mean values of neutrophil count, immature leucocytic cells, NLR, MPV, PDWSD, PLCR, and VLDL were found to be significantly increased (P < 0.00), while, mean values of RBC count, Hb%, atypical lymphocytes, platelet count and HDL were observed to be significantly decreased (P < 0.05) in OPMD and OSCC groups as compared to control. However, the remaining indices were found to be non-significant. Conclusion: Present study findings corroborate the role of hematological and serum lipid profile parameters in the etiology and progression of OPMDs and OSCCs. This highlights their potential as early diagnostic predictive markers to forecast the occurrence of high-risk OPMD and OSCC cases and also guiding personalized treatment strategies. © 2025 National Journal of Maxillofacial Surgery.
Diagnostic utility of cytomorphometric evaluation of exfoliated buccal mucosal cells in age estimation: a systematic review and meta-analysis
(Taylor and Francis Ltd., 2025) R. Keerthika; Akhilesh Chandra; Dinesh Raja; Mahesh R. Khairnar; Rahul Agrawal
Age estimation is a critical aspect of forensic odontology for victim identification. Exfoliative cytology has frequently been investigated for this purpose with variable results, necessitating further exploration. This systematic review and meta-analysis aims to analyze the diagnostic utility of cytomorphometrically evaluated exfoliated buccal cells in living individuals for age estimation. A thorough search was conducted using PubMed, Google Scholar, and Cochrane Library databases. Original research articles that performed exfoliative cytology on healthy individuals and evaluated cytomorphometric parameters were included in this review. The risk of bias was analyzed for each study using the Joanna Briggs Institute criteria, and Review Manager was used for the meta-analysis. Twelve studies, and two subgroups included for qualitative and quantitative data synthesis, revealed a significant decrease in cellular parameters and an increase in nuclear parameters in healthy individuals as age progressed. The random-effects model also confirmed that significantly decreased cellular parameters were associated with an increased risk of advanced age. Mounting evidence confirms that cytomorphometric evaluation of exfoliated buccal cells, specifically cellular parameters, is a useful tool for age estimation. However, it still lacks the credibility to be used as a sole factor for predicting an individual’s age. Therefore, a combination of factors should be considered for age estimation to provide more reliable results. © 2025 The Biological Stain Commission.
Diagnostic Utility of Cytomorphometric Evaluation of Exfoliated Oral Mucosal Cells in Type II Diabetes Mellitus: A Systematic Review and Meta-analysis
(Springer, 2024) R. Keerthika; Akhilesh Chandra; Mahesh Khairnar; Trupti Jain; Neha Singh; Rahul Agrawal
Diabetes Mellitus (DM) is the sixth leading cause of mortality and morbidity in the world. Early diagnosis and periodic monitoring are mandatory to prevent complications. The custom of noninvasive exfoliative cytology diagnostic technique is the need of the hour in diabetes, where the invasive methods lose viability. The purpose of this meta-analysis is to analyze the cytomorphometric changes in the exfoliated cells of the oral mucosa, as an adjunct to the diagnosis of type II diabetes. A thorough search was made by using PubMed, Google Scholar, and Cochrane Library databases. Original research articles, that evaluated cytomorphometric parameters (nuclear area, cytoplasmic area, cytoplasmic nuclear ratio) in type II diabetes patients were included in this review. Risk of bias was analysed for each study using Joanna Briggs Institute and Review Manager was used for meta-analysis. All nine subgroups included for qualitative and quantitative data synthesis revealed that there was a significant increase in nuclear area and a decrease in cytoplasmic nuclear ratio in diabetic patients as compared to non-diabetics. Random-effects model also confirmed cytologically altered (nuclear area and cytoplasmic nuclear ratio) parameters to have a significantly increased risk of association with diabetes. Furthermore, these morphometry parameters were also associated with glycemic control and there was no gender disparity among them. Mounting evidence authenticate that cytomorphometric analysis of oral mucosal cells using exfoliative cytology might be aid as an adjunct non-invasive diagnostic tool for type II diabetes. © Association of Otolaryngologists of India 2024.
Exotic Keratin Pearl Degradation Mechanism by Giant Cells in Oral Squamous Cell Carcinoma and its Plausible Hypothesis
(Springer, 2024) R. Keerthika; Akhilesh Chandra; Rahul Agrawal
Introduction: Oral squamous cell carcinoma (OSCC) is a formidable malignancy in the Indian subcontinent, characterized by high morbidity and mortality, with a dismal 5-year survival rate of 40–50%. The tumor’s histopathological heterogeneity is well documented, particularly in its differentiation status, which ranges from well-differentiated lesions with prominent keratin pearls to poorly differentiated forms lacking such structures. Objectives: Existing literature has elucidated the role of neutrophils and macrophages in the degradation of keratin pearls, the involvement of multinucleated giant cells (MNGCs) in this process remains cryptic. Case report: This study reports a novel case of a 49-year-old male with moderately differentiated OSCC, characterized by ulcerative growth in the left buccal mucosa. Histopathological analysis revealed neoplastic cell infiltration, keratinization, and abnormal mitoses, alongside the degradation of keratin pearls by large foreign body and Langhans MNGCs. This intricate keratin pearl degradation by MNGCs in OSCC highlights tumor heterogeneity and aggressiveness, offering profound insights into surgical, radiotherapy, and chemotherapy strategies. Surgeons must meticulously consider this process as a marker of aggressive behavior, warranting precise surgical planning and a multidisciplinary approach for optimal outcomes. Conclusion: This case emphasizes the critical role of foreign body and Langhans MNGCs in the degradation of keratin pearls within OSCC, revealing a hitherto unrecognized facet of tumor biology. This discovery holds profound implications for understanding OSCC progression, prognosis, and therapeutic responsiveness, warranting further investigation into the molecular mechanisms underpinning this process. © The Association of Oral and Maxillofacial Surgeons of India 2024.
Exploring the role of angiogenesis in fibrosis and malignant transformation in oral submucous fibrosis: a systematic review and meta-analysis
(Korean Association of Oral and Maxillofacial Surgeons, 2024) R. Keerthika; Akhilesh Chandra; Dinesh Raja; Mahesh Khairnar; Rahul Agrawal
Angiogenesis is a crucial molecular driver of fibrosis in various inflammatory lesions. Oral submucous fibrosis (OSMF) is a chronic inflammatory fibrotic disorder with malignant potential. The angiogenetic pathways in OSMF remain obscure due to limited research, necessitating an in-depth review. This review aimed to illuminate the cryptic pathogenetic mechanisms of angiogenesis in the disease progression/fibrosis of OSMF and its malignant transformation, providing insights for improved treatment. Extensive literature searches were conducted across an array of databases until October 2023. Original research articles on angiogenesis in OSMF were included, and the risk of bias was assessed using the modified Newcastle-Ottawa scale. RevMan ver. 5.4 (Cochrane Collaboration) was used for data analysis. Thirty-four articles were included for qualitative synthesis and seven for quantitative analysis. Findings revealed that angiogenesis was significantly increased in early-stage OSMF but decreased as the disease advanced. It was also associated with the severity of epithelial dysplasia and malignant transformation. A random-effects model confirmed the upregulation of angiogenesis as a significant risk factor in early-stage fibrosis and malignant transformation. The mounting evidence reinforces that angiogenesis plays a crucial role in the progression of early-stage fibrosis of OSMF and its malignant transformation, opening avenues for diagnostic and therapeutic interventions. © 2024 The Korean Association of Oral and Maxillofacial Surgeons.
Master Regulator: Angiogenesis in the Pathogenetic Mechanism of Oral Submucous Fibrosis
(Springer, 2025) R. Keerthika; Akhilesh Chandra; Rahul Agrawal
[No abstract available]
Mitochondrial Dysfunction in Oral Carcinogenesis: Insights from Exfoliative Cytology
(Springer, 2025) R. Keerthika; Jadhav Sachin Kumar; Akhilesh Chandra; Rahul Agrawal
Background: Oral squamous cell carcinoma (OSCC), a growing global health concern, is often preceded by oral potentially malignant disorders (OPMDs). Emerging evidence suggests mitochondrial dysfunction is crucial in carcinogenesis, affecting malignancy’s aggressiveness. This study uses Janus Green B (JGB) staining to investigate mitochondrial dysfunction in OPMDs and OSCC and examines its relationship with tobacco exposure to better understand its etiopathogenesis. Materials and Methods: Utilizing the exfoliative cytology technique, thirty buccal smears of epithelial cells from normal, OPMD and OSCC samples were collected and subjected to JGB staining. The intensity of staining and the total percentage of positively stained cells were quantified and subsequently correlated with clinicopathological parameters. Results: The mean values of varying grades of staining intensity including mild, moderate, and high as well as the total percentage of positive cells, demonstrated statistically increased significant differences among control, OPMD, and OSCC cases. Additionally, moderate, high-grade staining intensity and the total positive stained cells exhibited significant correlations with tobacco use frequency and duration. A cut-off value of 44.31 and 51.32 of JGB-positive cells was found to categorize the cases into high-risk OPMDs and OSCC transformation. Conclusion: The progressive increase in staining intensity and the number of positive cells from OPMDs to increasing histopathological grades of OSCC highlights mitochondrial dysfunction as a key factor in oral carcinogenesis and a reliable indicator for assessing malignant transformation in OPMDs and aggressive potential in OSCC. Furthermore, the study underscores tobacco as a primary cause of mitochondrial dysfunction in both OPMDs and OSCC. © Association of Otolaryngologists of India 2025.
Presence of Epstein-Barr Virus in Periapical Pathoses: A Systematic Review and Meta-Analysis
(Elsevier Inc., 2025) Jagveer Yadav; Mala Kamboj; Gopikrishnan Vijayakumar; Anjali Narwal; Anju Devi; Adarsh Kumar; R. Keerthika
Background: Periapical lesions, often arising from polymicrobial infections, exhibit varied clinical manifestations. The role of herpes viruses, particularly Epstein-Barr virus (EBV), in the etiopathogenesis of these conditions remains underexplored despite evidence that suggests its involvement in inflammatory processes. Objective: This systematic review and meta-analysis aimed to evaluate the presence of EBV in periapical diseases and to assess its probable role in their etiopathogenesis. Material and Methods: Literature searches were conducted across PubMed, Scopus, Web of Science, and Google Scholar until July 2024. Original research that examined the association of EBV in periapical diseases was included for review. The risk of bias for each study was assessed using the modified Newcastle-Ottawa scale and Review Manager 5.4 was used to generate the results. Results: A total of 31 studies were included for qualitative synthesis, with 15 contributing to quantitative analysis. Findings revealed higher EBV detection rates in periapical lesions, particularly in symptomatic cases and lesions with larger sizes. Meta-analysis using random effects models also affirmed that EBV-positive transcripts significantly enhanced the risk of periapical lesions and symptomatic cases. Conclusion: This review highlights a significant association between EBV and periapical lesions, particularly in symptomatic cases and larger lesions. The findings warrant further investigation into the mechanisms by which EBV contributes to the pathogenesis of periapical diseases and the implications for clinical management, including potential antiviral therapies. PROSPERO Registration Number: CRD4202344796. © 2025 American Association of Endodontists
Refining Tumor Grading: an Enhanced Method for Evaluating Intratumoral Budding in Pre-Operative Biopsies of Oral Squamous Cell Carcinoma
(Springer, 2025) R. Keerthika; Akhilesh Chandra; Rahul Agrawal
Background: Oral squamous cell carcinoma (OSCC) is a globally prevalent malignancy marked by aggressive behaviour and varied clinical outcomes. Intratumoral budding (ITB) has emerged as a marker of OSCC aggressiveness. This study aimed to compare the prognostic accuracy of traditional (ITB-T) and refined (ITB-N) grading systems, along with 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs, in pre-operative OSCC biopsies. Materials and methods: This retrospective study analyzed 381 pre-operative OSCC biopsy cases. ITB was graded using both the traditional ITB-T (TB1: 0–4, TB2: 5–9, TB3: ≥10 buds) and refined ITB-N systems (TB0: 0, TB1: 1–4, TB2: 5–9, TB3: ≥10 buds), with additional 5-bud (ITB-5) and 10-bud (ITB-10) cutoffs. Statistical tests included Kruskal-Wallis, nominal, and logistic regression analyses. Results: ITB grades varied significantly across OSCC differentiation, with poorly differentiated OSCC showing highest ITB grades. The refined ITB-N and ITB-10 demonstrated superior sensitivity in distinguishing WDSCC from MDSCC and MDSCC from PDSCC. Nominal regression indicated higher predictive accuracy for ITB-N and ITB-10 compared to ITB-T and ITB-5, with the highest classification accuracy at 62.2%. Logistic regression further confirmed a significant association between higher ITB grades in ITB-N and ITB-10 and increased mortality risk, underscoring their prognostic value. Conclusion: The refined ITB-N grading system, incorporating a zero-budding category (TB-0) and a ten-bud cutoff (ITB-10), has emerged as a remarkably potent prognostic indicator across diverse grades of OSCC. This highlights the potential for adopting ITB-N grading system and ITB-10 cutoff to enhance risk stratification and tailor treatment plans for OSCC patients. © Association of Otolaryngologists of India 2025.
Role of Intratumoural Budding and Its Association with Tumour-Associated Macrophages in Preoperative Biopsies of Oral Squamous Cell Carcinoma
(Sultan Qaboos University, 2025) Anju Devi; R. Keerthika; Mala Kamboj; Anjali Narwal
Objectives: Intratumoural budding (ITB) is an emerging entity in oral squamous cell carcinoma (OSCC) and serves as a prime histopathological predictor of aggressive potential. This study aimed to investigate the incidence of ITB in OSCC due to its limited representation in the literature. Methods: This retrospective study was conducted in the Department of Oral Pathology and Microbiology, Post Graduate Institute of Dental Sciences, Rohtak, India, between 2017 and 2021. A total of 73 haematoxylin and eosin-stained sections of various grades of OSCC were examined for ITB and tumour-associated macrophages (TAMs), focusing on correlating these findings with clinicopathological parameters. Immunohistochemical analysis using a cluster of differentiation 68 (CD68) was performed. Additionally, the expression of CD68+ TAMs was studied in the centre of the tumour mass and correlated with ITB to ascertain the biological behaviour of OSCC. The data obtained were analysed using chi-square and Pearson correlation tests (P < 0.05). Results: ITB significantly increased in higher histopathological grades of OSCC (P = 0.000). Conversely, CD68+ TAMs in OSCC decreased significantly as the histopathological grades increased (P = 0.000), whereas on correlating with ITB, a non-significant difference was observed, revealing a negative correlation (r = −0.149; P = 0.208). Conclusions: The inverse association between ITB and TAMs with increasing histopathological grades may help identify ITB as a precise histopathological parameter for evaluating the aggressive biological potential in OSCC. Additionally, this relationship suggests the involvement of the anti-tumour immune response of TAMs within tumour mass. © 2025 Published by Sultan Qaboos University Sultan Qaboos University Medical Journal.
Silent intruders: Hematolymphoid neoplasms revealed in the jaws: a series of three cases
(Wolters Kluwer Medknow Publications, 2025) Trupti Jain; Sudeep Kumar; Shivangni Rajoria; R. Keerthika; Akhilesh Chandra; Rahul Agrawal
The head and neck regions, rich in lymph nodes, are common initial sites for nodal and extranodal hematolymphoid neoplasms, particularly B-cell neoplasms. Lymphomas, including Hodgkin’s and non-Hodgkin’s types, range from indolent to aggressive and often affect the oral and maxillofacial areas. Plasma cell neoplasms, such as solitary bone plasmacytoma (SBP) and solitary extramedullary plasmacytoma (SEP), must be distinguished from multiple myeloma (MM) due to varied treatment modalities. Diagnosing these neoplasms is challenging, requiring thorough examination. Timely recognition and management of plasma cell tumors in the head and neck, especially SBP, are essential to prevent disease progression. These tumors can mimic other malignancies and indicate early MM, necessitating detailed evaluation. Healthcare providers should be aware of the higher risk of oral NHL in HIV-positive patients and consider NHL in the differential diagnosis of intraoral lesions to improve outcomes. Herein, we present three cases with usual presentations in the oral cavity that resulted in unusual diagnoses. © 2025 Indian Journal of Pathology and Microbiology.
The intriguing role of IL33/ST2 axis signaling in oral diseases - A systematic review
(Medical University of Bialystok, 2024) Mala Kamboj; R. Keerthika; Anjali Narwal; Ambika Gupta; Anju Devi; Adarsh Kumar; Gitika Sharma
Purpose: Oral diseases act as a silent epidemic, and the pathogenetic role of interleukin-33/suppression of tumorigenicity-2 axis (IL-33/ST2) remains unclear due to a lack of literature. This review has attempted to highlight the importance of this axis in oral diseases, which may be helpful in developing therapeutic modalities required to halt disease progression. Materials and methods: A thorough search was conducted using various databases. Original research articles that assessed both IL-33 and ST2 levels in oral diseases using different techniques were included in the review. The risk of bias for each study was analyzed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool and Review Manager 5.4 was used to output the results. Results: In the qualitative data synthesis we included 13 published articles. The most commonly used method was serum estimation, while methods with optimistic results were saliva, real-time quantitative polymerase chain reaction and immunohistochemistry. The predominant mechanism of action was nuclear factor kappa B signaling and type 2 immune response. However, salivary gland epithelial cell activation, activation of mast cells, type 1 immune response, and upregulated angiogenesis are crucial in mediating IL-33/ST2 signaling in oral diseases. Conclusions: Accumulating evidence demonstrates that the IL-33/ST2 axis is a fundamental pathogenetic mechanism of oral diseases of inflammatory, autoimmune, or neoplastic origin. © 2024 Medical University of Bialystok
The Mystifying Role of Mast Cells in the Pathogenesis of Periapical Pathologies - A Systematic Review
(Elsevier Inc., 2025) Mala Kamboj; Shashibala Malik; R. Keerthika; Anjali Narwal; Anju Devi; Gopikrishnan Vijayakumar; Adarsh Kumar
Introduction: Oral periapical lesions present a significant global health burden, with their pathogenesis shrouded in complexity due to multifaceted mechanisms. Despite extensive research, the precise role of mast cells in their pathogenesis remains elusive. The present systematic review aimed to elucidate the mechanism of mast cells in the immunopathology of periapical lesions. Methods: An extensive literature search conducted across databases (MEDLINE via PubMed, Scopus, Cochrane Library, and EMBASE and gray literature) of original research articles that examined the role of mast cells in periapical lesions were investigated and selected for review. The risk of bias for each study was meticulously assessed using the QUADAS-2, and Review Manager 5.4 (RevMan v5.4, The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark) was utilized to generate the results. Results: A total of 41 published articles were included for data synthesis. The findings revealed significant variations in mast cell number within the fibrous capsule of periapical granuloma and periapical cyst, with notably elevated counts in the latter. Periapical granuloma manifested a predominance of granulated mast cells in the subepithelial region. In contrast, the periapical cyst exhibited a preponderance of degranulated mast cells in the deeper areas of the capsule. Conclusions: The current evidence substantiates that mast cells play a crucial role in the pathogenesis, progression, fibrosis, and chronicity of periapical lesions. © 2025 American Association of Endodontists
Unravelling the Significance of NLRP3 and IL-β1 in Oral Squamous Cell Carcinoma and Potentially Malignant Oral Disorders: A Diagnostic and Prognostic Exploration
(Springer, 2024) Trupti Jain; Akhilesh Chandra; Surendra Pratap Mishra; Mahesh Khairnar; Shivangni Rajoria; R. Maheswari; R. Keerthika; Shivam Tiwari; Rahul Agrawal
Background: Nucleotide-binding domain-like receptor protein 3 (NLRP3), an inflammasome, is reported to be dysregulated or aberrantly expressed in chronic inflammation, leading to a myriad of inflammatory disorders, autoimmune diseases, and cancer. This study aimed to explore the expression and role of NLRP3 protein and the secreted cytokine IL-β1 in oral squamous cell carcinoma (OSCC) and potentially malignant oral disorders (PMOD). Material & Methods: Tissue NLRP3 expression was quantified using sandwich ELISA in 30 cases each of OSCC, PMOD, and normal oral mucosa. Serum IL-β1 level was also measured by ELISA to determine their correlation. In surgically treated OSCC cases, pathological parameters such as tumor size, depth of invasion (DOI), pTNM stage, and perineural & lymphovascular invasion were assessed and correlated with NLRP3 & IL-β1 levels to investigate their roles in tumor progression, invasion, and metastasis. Results: Tissue NLRP3 expression was markedly elevated in OSCC, with significant IL-β1 levels observed in the serum of both OSCC and PMOD cases. Both markers showed a pronounced increase with the severity of dysplasia, indicating a strong association (p = 0.003%). The expression levels of tissue NLRP3 and serum IL-β1 were positively correlated with DOI and tumor size. Furthermore, their elevated levels, alongside higher histological grades, indicate roles in the dedifferentiation and progression of tumor cells. Conclusion: The findings indicated that increased expression of NLRP3 and IL-β1 in PMOD correlates with higher transformation rates, along with tumor progression and dedifferentiation in OSCC. Consequently, these markers hold promise as valuable targets for prognostic assessment, diagnostics, and therapeutic strategies in OSCC. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
Unveiling Lipid Metabolic Shifts in Different Stages of Oral Submucous Fibrosis: A New Horizon in Predicting Malignant Transformation
(Springer, 2025) Akhilesh Chandra; R. Keerthika; Rahul Agrawal; Arpita Rai; Mahesh R. Khairnar
Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive condition linked to areca nut consumption, with a high potential for malignant transformation into oral squamous cell carcinoma (OSCC). Changes in lipid metabolism have been implicated in cancer biology, yet the relationship between lipid profiles and OSMF progression remains underexplored. This study investigates the alterations in serum lipid parameters across different clinical stages of OSMF and their association with malignant transformation. Materials and methods: A cross-sectional study was conducted over 69 OSMF patients, divided into five groups (Stage 1 to 3 and Stage 4a, 4b) based on clinical staging. Serum lipid profiles, including total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and triglycerides (TG), were analyzed. Statistical analysis was performed using ANOVA and Tukey’s post hoc test. Results: Lipid levels (TC, HDL, LDL, VLDL, TG) showed a significant decline from Stage 1 to Stage 4a (p-0.00), followed by a sharp increase in Stage 4b (p-0.00), coinciding with malignant transformation. Particularly, HDL, VLDL, and TG were significantly elevated in Stage 4b compared to earlier stages. Conclusion: Alterations in lipid metabolism (hypolipidemia) were observed from Stage 1 to 4a, with a marked shift (hyperlipidemia) during malignant transformation (Stage 4b). Increased levels of HDL, VLDL, and TG in advanced OSMF stages suggest their potential as predictive biomarkers for malignancy. Further research is required to elucidate the mechanisms linking lipid metabolism with OSMF progression and malignancy, paving the way for targeted therapeutic strategies. © Association of Otolaryngologists of India 2024.
Unveiling the Lipid Paradox in Oral Leukoplakia: Metabolic Signatures of Dysplasia and Disease Progression
(Springer, 2025) Akhilesh Chandra; R. Keerthika; Rahul Agrawal; Anju Gautam; Richik Tripathi; S. Sandhiya
Oral Leukoplakia (OLK) is the most prevalent oral potentially malignant disorder with an increased risk of malignant transformation. Altered lipid metabolism, often driven by tobacco-induced oxidative stress, may contribute to oral carcinogenesis. However, the relationship between serum lipid profiles and OLK remains ambiguous. This study aimed to evaluate lipid profiles across OLK subtypes and their association with dysplasia and tobacco use to their assess diagnostic and prognostic potential. This cross-sectional prospective study included 114 participants, 57 clinically and histologically confirmed OLK cases and 57 healthy controls. OLK cases were categorized into homogeneous OLK, erythroleukoplakia, verrucous OLK, and OLK with oral submucous fibrosis (OSMF) and their dysplastic status was also evaluated. Serum lipid parameters (TC, TG, HDL, LDL, VLDL) were measured. Statistical comparisons were performed using Mann–Whitney U and Kruskal–Wallis tests (p < 0.05). Although OLK patients showed higher mean lipid levels than controls, the differences were not statistically significant (p > 0.05). Among OLK subtypes, significantly elevated levels of TC, TG, LDL, and VLDL were found in homogeneous OLK, while the lowest levels were observed in erythroleukoplakia (p < 0.00). Lipid levels were significantly lower in dysplastic lesions (p < 0.001). Patients with tobacco use > 5 years had higher TC and LDL levels (p < 0.05), whereas habit frequency showed no significant association. Serum lipid alterations, particularly reduced TC, TG, LDL, and VLDL in dysplastic and high-risk OLK variants, may serve as non-invasive prognostic biomarkers for early risk assessment. © Association of Otolaryngologists of India 2025.
Unveiling the Pathogenetic Role of Mast Cells in Oral Lichen Planus: A Systematic Review and Meta-analysis
(Springer, 2025) R. Keerthika; Akhilesh Chandra; Rahul Agrawal
Oral Lichen Planus (OLP) is a chronic inflammatory disorder of the oral mucosa characterized by diverse clinical manifestations and an uncertain aetiology. Emerging evidence suggests a critical role for mast cells in the pathogenesis and progression of OLP. This systematic review and meta-analysis investigated the involvement of mast cells in OLP, with a focus on their contribution to disease chronicity and severity. A comprehensive literature search (up to September 2024) identified 34 studies for qualitative synthesis and 14 for quantitative analysis. Risk of bias was assessed using the modified Newcastle–Ottawa Scale, and data were analyzed using Review Manager 5.4. Mast cell density was significantly higher in OLP tissues compared to controls, particularly in erosive and atrophic subtypes. Mast cells were commonly located near blood vessels and inflammatory infiltrates, contributing to a pro-inflammatory microenvironment and tissue remodelling. Notably, increased mast cell degranulation was observed, further amplifying the inflammatory response. Meta-analysis confirmed that elevated mast cell degranulation is significantly associated with progression to erosive OLP. The mounting evidence highlights the central role of mast cells in the pathogenesis, chronic inflammation, and clinical advancement of OLP. © Association of Otolaryngologists of India 2025.