Salivary Tissue Research Articles

Functional Parotid Sparing: Does Sparing the Parotid Ducts Yield Improvements in Patient Reported Xerostomia?

Literature suggests that salivary gland stem cells, capable of regenerating salivary tissue, may preferentially reside in the large ducts of salivary glands. We conducted a prospective trial in patients receiving definitive chemoradiotherapy (CRT) for oropharyngeal cancer where we preferentially spared the major parotid ducts (localized via MRI sialography) during treatment planning. We hypothesized that (1) this technique would yield improvements in patient reported xerostomia (PRX) at 6- and 12-months post-CRT compared to a prospectively accrued cohort of similar patients, and (2) that parotid duct doses would be predictive for PRX.A total of 38 Patients were prospectively enrolled and underwent MRI sialography guided ductal sparing. 28/38 patients received de-escalated CRT (60Gy). PRX was classified as none/mild versus moderate to very severe. (1) PRX in the 28 de-escalated patients were compared using a fisher exact test to a cohort of 232 patients on the same clinical trials but who did not undergo ductal sparing. (2) Competing nested multivariate logistic models (+/- parotid duct doses) were assessed using dosimetric data from all 38 patients for their ability to predict PRX. Models included contralateral submandibular mean dose, mean parotid gland dose (both) +/- parotid duct mean dose (both). The two nested models were compared using a likelihood ratio test to determine if incorporating mean parotid duct doses significantly improved model fit.(1) Patients reporting moderate to very severe xerostomia was lower in patients with vs without parotid-ductal sparing at 6 months post-CRT (46% vs 67%, P = 0.03), and trended lower at 12 months post-CRT (32% vs 49%, P = 0.11). At 6 months post CRT, the mean parotid duct dose was the only covariate significantly associated with PRX (P = 0.047). At 12 months post CRT, no covariate was significantly associated with PRX but both mean contralateral submandibular dose and mean parotid duct dose approached significance (P = 0.06 and 0.07, respectively). (2) The models +/- parotid duct doses were compared and the addition of parotid ductal mean dose significantly improved model fit at 6- and 12-months post CRT (P = 0.030 and 0.047, respectively).The absolute rates of moderate to very severe patient reported xerostomia were approximately 20% lower for those undergoing MRI sialography guided parotid ductal sparing versus those without ductal sparing at 6- and 12-months post CRT. The significant improvement of model fit upon adding mean parotid ductal dose to the mean major salivary gland doses at 6 and 12 months suggests that the dose received by the parotid ducts relates to patient reported xerostomia severity even when considering traditional metrics such as mean parotid and contralateral submandibular dose.

Accessory salivary tissue presenting as a mid-cheek mass: A case report

Accessory parotid glands are salivary tissue collections seen as separate glandular mass detached from the main parotid gland lying on the masseter muscle. It develops from the branching of the blind end of the parotid tube and by glandular proliferation of secretory and stromal structures. They are anatomical variations seen in the mid cheek region with a frequency of 21% to 56% found in autopsy studies. The following case report depicts a case of accessory parotid gland presenting as a mid-cheek mass in the right buccal mucosa.

Laminin-1 Peptides Conjugated to Fibrin Hydrogels Promote Salivary Gland Regeneration in Irradiated Mouse Submandibular Glands.

Previous studies demonstrated that salivary gland morphogenesis and differentiation are enhanced by modification of fibrin hydrogels chemically conjugated to Laminin-1 peptides. Specifically, Laminin-1 peptides (A99: CGGALRGDN-amide and YIGSR: CGGADPGYIGSRGAA-amide) chemically conjugated to fibrin promoted formation of newly organized salivary epithelium both in vitro (e.g., using organoids) and in vivo (e.g., in a wounded mouse model). While these studies were successful, the model’s usefulness for inducing regenerative patterns after radiation therapy remains unknown. Therefore, the goal of the current study was to determine whether transdermal injection with the Laminin-1 peptides A99 and YIGSR chemically conjugated to fibrin hydrogels promotes tissue regeneration in irradiated salivary glands. Results indicate that A99 and YIGSR chemically conjugated to fibrin hydrogels promote formation of functional salivary tissue when transdermally injected to irradiated salivary glands. In contrast, when left untreated, irradiated salivary glands display a loss in structure and functionality. Together, these studies indicate that fibrin hydrogel-based implantable scaffolds containing Laminin-1 peptides promote secretory function of irradiated salivary glands.

Novel Evaluation of Submandibular Salivary Gland Tissue for Use as an Alternative Postmortem Toxicology Specimen.

The collection of blood and tissue provides an opportunity for an objective comparison of autopsy results. Occasionally, a viable tissue sample is not available during autopsy. Expanding upon collected tissues to include a tissue that is accessible, is a possible drug depot, and is amendable to various analytical techniques may complement information obtained from other specimens. Given its absorption of ions, nutrients, and likely drugs via its rich blood supply, we evaluated the use of submandibular salivary gland tissue as an alternative postmortem specimen. The submandibular salivary glands of 52 decedents were excised. The tissue was homogenized, extracted, and analyzed via liquid chromatography tandem mass spectrometry for 43 opioids and 5 nonopioids. Liquid chromatography tandem mass spectrometry salivary tissue results were compared with the decedent's blood results. Results revealed that opioids were detected in salivary gland tissue at a sensitivity and specificity of 94.4% and 94.1%, respectively. Nonopioid drugs were detected at a sensitivity and specificity of 88.2% and 100.0%, respectively. This study suggests a comparable correlation exists between salivary gland tissue and blood results for certain drugs. Further evaluation is warranted. To our knowledge, this is the first report of salivary gland tissue being used for postmortem toxicology testing in humans.

The effect of systemic Isotretinoin on salivary tissue inhibitors of metalloproteinases 1 and 2 and salivary flow rate in periodontal disease.

AimsTo evaluate and compare changes in salivary flow rate and salivary levels of TIMP-1 and TIMP-2 in individuals taking oral Isotretinoin (INN) with those who do not take INN. To assess the variation in TIMP-1 and TIMP-2 as well as salivary flow rate observed at different stages of periodontal disease in comparison to those observed in the case of healthy periodontium.Materials and methodsAn examiner-blind case-control study involving 180 human adults divided into six groups based on their periodontal status. Clinical parameters, including pocket depth, clinical attachment level, and bleeding on probing were measured at six sites per tooth. Whole unstimulated saliva samples were collected from all subjects to evaluate salivary flow rate (SFR). Salivary TIMP-1 and TIMP-2 levels were detected using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using IBM SPSS Software. The Kruskal Wallis test and Mann-Whitney U-tests were employed to verify any significant differences between the groups for all parameters. Multi-regression analysis was performed for each parameter tested in each group. All tests were compared at a significance level of 0.05.ResultsSFR was statistically significantly lower among all INN groups in comparison to the control groups (P < 0.001). TIMP-1 and TIMP-2 were significantly higher in all INN groups in comparison to the control groups, in both gingivitis cases (P = 0.004, P < 0.0001 respectively) and periodontitis cases (P < 0.0001).ConclusionAlthough INN reduces salivary flow rate, the findings of the present study revealed that it had an anti-inflammatory effect in periodontal biomarkers. Specifically, it was positively correlated with an elevation of salivary TIMP-1 and TIMP-2. Hence, INN might be a future additive medication to be further evaluated for the treatment of periodontal diseases.

Immune-Intrinsic Myd88 Directs the Production of Antibodies With Specificity for Extracellular Matrix Components in Primary Sjögren's Syndrome.

Primary Sjögren’s syndrome is an autoimmune disease that is predominantly seen in women. The disease is characterized by exocrine gland dysfunction in combination with serious systemic manifestations. At present, the causes of pSS are poorly understood. Pulmonary and renal inflammation are observed in pSS mice, reminiscent of a subset of pSS patients. A growing body of evidence indicates that inflammation mediated by Damage-Associated Molecular Patterns (DAMPs) contributes to autoimmunity, although this is not well-studied in pSS. Degraded extracellular matrix (ECM) constituents can serve as DAMPs by binding pattern-recognition receptors and activating Myd88-dependent signaling cascades, thereby exacerbating and perpetuating inflammatory cascades. The ECM components biglycan (Bgn) and decorin (Dcn) mediate sterile inflammation and both are implicated in autoimmunity. The objective of this study was to determine whether these ECM components and anti-ECM antibodies are altered in a pSS mouse model, and whether this is dependent on Myd88 activation in immune cells. Circulating levels of Bgn and Dcn were similar among pSS mice and controls and tissue expression studies revealed pSS mice had robust expression of both Bgn and Dcn in the salivary tissue, saliva, lung and kidney. Sera from pSS mice displayed increased levels of autoantibodies directed against ECM components when compared to healthy controls. Further studies using sera derived from conditional knockout pSS mice demonstrated that generation of these autoantibodies relies, at least in part, on Myd88 expression in the hematopoietic compartment. Thus, this study demonstrates that ECM degradation may represent a novel source of chronic B cell activation in the context of pSS.

Pleomorphic Adenoma of Three Different Sites: a Consecutive Case Series

Background: Pleomorphic adenomas are benign salivary gland tumors predominantly arising from the superficial lobe of the parotid gland and rarely from the small salivary glands located at various locations including parotid, lacrimal duct, lip, floor of the mouth etc. Surgical excision of the tumor mass is the treatment of choice with utmost care taken to preserve the facial nerve in cases involving the parotid gland. Case details: This case series highlights three consecutive cases of pleomorphic adenoma arising from three different locations. Conclusion: Pleomorphic adenoma is the commonest salivary gland tumor characterized by diverse histomorphological features and can occur at any site where salivary tissue is present. Careful histopathological analysis should be done in all tumors arising especially in the head and neck region.

Antizyme inhibitor 2 (AZIN2) associates with better prognosis of head and neck minor salivary gland adenoid cystic carcinoma.

The key regulator of the polyamine biosynthetic pathway is ornithine decarboxylase (ODC). ODC is activated by antizyme inhibitor 1 (AZIN1) and 2 (AZIN2). AZIN1 and recently AZIN2 have been related to cancer; however, their functions in adenoid cystic carcinoma (ACC) have not been studied. We performed immunohistochemical study on minor salivary and mucous gland ACC tissue samples of patients treated at the Helsinki University Hospital (Helsinki, Finland) during 1974-2012. We scored AZIN1 and 2 immunoexpression in 42 and 45 tumor tissue samples, respectively, and correlated them with clinicopathological factors and survival. Enhanced AZIN2 expression was associated with better survival. In addition, both AZINs were seen more commonly in cribriform and tubular than in solid growth patterns. AZIN1 expression did not correlate with the studied clinicopathological factors. It seems that AZIN2 expression is higher in cancer tissue with secretory functions. In ACC tissue, high AZIN2 expression could be related to well-differentiated histological type which still has a functioning vesicle transportation system. Thus, AZIN2 could be a prognostic factor for better survival of ACC patients.

A rare case of static bone cavity in the anterior mandibular region of a 10-year-old boy.

IntroductionStatic bone cavity (SBC) is a bone defect that develops as a result of localized pressure from tissues surrounding the mandible. It is most commonly observed in the mandibular angle of adult males caused by the submandibular gland. The condition is asymptomatic and requires no treatment. The frequency of onset is rare, especially in the anterior mandible, and SBC is extremely difficult to diagnose in children.Presentation of caseThis report is on a case of SBC in the anterior mandible of a 10-year-old boy. The condition could not be diagnosed after panoramic radiograph and Magnetic Resonance Imaging (MRI) analyses. Computed-topography (CT) imagery revealed an oval-shaped depression 6 × 5 × 3 mm in size at the lingual apex of the mandibular left lateral tooth. Diagnosing the patient was difficult and a tumor was suspected. For treatment, the tumor-like lesion was resected and the fistula in the periosteum was sutured and closed. One year later, the defect on the lingual mandibular bone had ossified and recovered.ConclusionThe incidence of SBC in children is rare and the condition is difficult to diagnose because of the small size of the lesions, however in this study, CT imagery proved to be useful. SBC was detected in the subject in early childhood, and his postoperative course suggested that the lesion developed as a result of glandular tissues herniating through the periosteum and causing compression on the mandible, which resulted in bone resorption. In other words, herniation of normal salivary glandular tissues were a cause of SBC.

GATA 3 Reactivity in Adenoid Cystic Carcinoma and Pleomorphic Adenoma of Salivary Glands

Objectives: The main targets is evaluate clinicopathological distribution and comparison of immunohistochemical (IHC) expression of GATA 3 between in adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) of salivary . Design and Methods: This retrospective analysis, open surgical specimens of salivary gland that were done , and consisting of 150 cases that divided into three groups: normal salivary gland tissues (n=50), adenoid cystic carcinoma(n=50), and pleomorphic adenoma(n=50). Clinical data (age, sex, previous diseases ), physical examination, and investigations are done for all patients. In addition. These 150 cases of paraffin embedding blocks of salivary tissue were stained by ordinary stained (hematoxylin and eosin staining ). Manual IHC staining of GATA 3 was done. Results: Age groups is younger for normal salivary gland tissues than PA, and ACC . Sex distribution was slightly increase in male in comparison to female in normal salivary gland tissues and PA. GATA 3 staining was showing more positivity in normal salivary gland tissues (43/50 patients) than PA (27/50 patients) and ACC (14/50 patients). This positivity in GATA 3 IHC staining were more in male sex, regarding 55.8% in normal salivary gland tissues than ACC 50% and PA 51.9% . Age group 31-40, 40-50 and 61-70 years were showing more positive GATA 3 IHC staining in normal salivary gland tissues, PA, and ACC respectively. there was insignificant association between GATA 3 IHC staining with either age groups or sex groups distribution . Conclusion: GATA3 IHC is good marker and can used for searching salivary gland tumor origin, assisting in diagnosis Salivary gland tumors subtypes but GATA3 IHC staining has no association to specific sex or age groups in Salivary gland tumors. Usage of surgical operations for histopathological specimens preparation are better and give good efficiency for IHC markers staining.

GATA 3 Reactivity in Adenoid Cystic Carcinoma and Pleomorphic Adenoma of Salivary Glands

Objectives:The main targets is evaluate clinicopathological distribution and comparison of immunohistochemical (IHC) expression of GATA 3 between in adenoid cystic carcinoma (ACC) and pleomorphic adenoma (PA) of salivary . Design and Methods: This retrospective analysis, open surgical specimens of salivary gland that were done , and consisting of 150 cases that divided into three groups: normal salivary gland tissues (n=50), adenoid cystic carcinoma(n=50), and pleomorphic adenoma(n=50). Clinical data (age, sex, previous diseases ), physical examination, and investigations are done for all patients. In addition.These 150 cases of paraffin embedding blocks of salivary tissue were stained by ordinary stained (hematoxylin and eosin staining ). Manual IHC staining of GATA 3 was done. Results: Age groups is younger for normal salivary gland tissues than PA, and ACC . Sex distribution was slightly increase in male in comparison to female in normal salivary gland tissues and PA. GATA 3 staining was showing more positivity in normal salivary gland tissues (43/50 patients) than PA (27/50 patients) and ACC (14/50 patients). This positivity in GATA 3 IHC staining were more in male sex, regarding 55.8% in normal salivary gland tissues than ACC50% and PA 51.9% . Age group 31-40, 40-50 and 61-70 years were showing more positive GATA 3 IHC staining in normal salivary gland tissues, PA, and ACC respectively. there was insignificant association between GATA 3 IHC staining with either age groups or sex groups distribution .Conclusion: GATA3 IHC is good marker and can used for searching salivary gland tumor origin, assisting in diagnosis Salivary gland tumors subtypes but GATA3 IHC staining has no association to specific sex or age groups in Salivary gland tumors. Usage of surgical operations for histopathological specimens preparation are better and give good efficiency for IHC markers staining.

Myd88 activation in immune cells governs distinct disease manifestations in primary Sjögren’s syndrome

Abstract Studies in mice and humans identify Myd88 activation as an important driver of autoimmune disease, although the role of this adapter molecule in primary Sjögren’s syndrome (pSS) is poorly understood. In pSS, patients exhibit exocrine gland dysfunction along with serious systemic disease manifestations. Although Myd88-dependent signaling networks are essential for pSS disease pathogenesis, these pathways remain incompletely understood in the context of pSS. The objective of this study was to establish the contribution of Myd88 activation in immune cells to local and systemic pSS manifestations. To this end, we generated a novel conditional knockout pSS mouse model lacking Myd88 in the hematopoietic compartment. We found that ablation of Myd88 in immune cells altered inflammatory mediators in salivary tissue, but did not affect the degree of lymphocytic infiltration in exocrine glands or salivary production. Nephritis was diminished and pulmonary inflammation was increased in mice lacking Myd88 in hematopoietic cells. Finally, we found total IgM titers and autoreactive IgM and IgG were attenuated in pSS mice lacking Myd88 in immune cells. Thus, we demonstrated that Myd88 activation in the hematopoietic compartment is essential for distinct aspects of disease. This study establishes a rationale for design of targeted therapeutics that modulate Myd88 activation in a tissue-specific manner to ameliorate salivary inflammation and systemic disease manifestations characteristic of pSS.

The possible protective effect of Graviola extract on salivary gland against cytotoxicity during cisplatin treatment (Histological, Biochemical and Immuno-histochemical Study)

• Objectives Chemotherapeutic agents affect both normal and cancer cells. Salivary glands are easily damaged. Protecting normal salivary tissues against the harmful side effects of cisplatin therapy is of great need. This study was designed to evaluate the cytoprotective effect of Graviola extract against cisplatin cytotoxicity on parotid and submandibular salivary glands.• Methods 30 adult male albino rats weighing 200-250 g were divided randomly into 3 equal groups: control group receiving only saline, cisplatin group receiving 6 mg/kg of cisplatin intraperitoneal and Graviola group receiving 6 mg/kg of cisplatin intraperitoneal followed by 100 mg/kg of Graviola extract daily orally for 14 days. At the end of the experiment parotid and submandibular glands were processed for H&E, VEGF and Ki-67 stains. Glutathione levels were detected from gland homogenates. • Results Histological evaluation of cisplatin group with H&E showed total loss of architecture and vacuolization in the parotid gland and serous part of the submandibular gland while the mucous part showed separation between the acinar cells and the intra-lobular ducts. With immunohistochemical stains, decreased number of proliferative cells was observed with Ki-67 stain and with VEGF stain the glandular cells showed the least levels of positive staining. Also, glutathione levels recorded the least values among the study groups. In the Graviola group, partial improvement of glandular architecture and decreased vacuolization in both glands, increased proliferative cells with Ki-67 and increase of VEGF expression and the highest value of glutathione levels were observed. • ConclusionGraviola extract partially ameliorates the cisplatin deleterious effect on the parotid and submandibular salivary glands at the histological and biochemical levels.

Ectopic carcinoma ex-pleomorphic adenoma in the lower neck: a rare entity at a rare location

Ectopic salivary gland tissue (ESGT) is salivary tissue located outside the major, minor and accessory salivary glands. Neoplasms rarely arise from ESGT, let alone carcinoma expleomorphic adenoma (CEPA) which is a malignant tumour that arises from the epithelial component of pleomorphic adenoma. It usually occurs in the parotid gland and in lesser instances, from submandibular gland or minor salivary glands. Herein, we report a rare case of CEPA in right supraclavicular ESGT of a 67-year-old lady.She underwent complete surgical excision of the mass and is free from any recurrence to date. Brief review of pathogenesis, clinical features and treatment of ectopic CEPA are discussed. A thorough review of the English literature reveals that our patient may be the second case of ectopic CEPA in the neck region ever reported to date.&#x0D; Bangladesh Journal of Medical Science Vol.20(3) 2021 p.658-661

Large Neck Teratoma in a Newborn with Respiratory Distress Syndrome.

Neonatal tumours in the neck region are a rare finding. Teratomas typically comprise all three germ cell layers with tissues usually foreign to the anatomic site of origin. Head and neck teratomas account a smaller part of congenital teratomas. They can cause major airway obstruction due to the external compression that oropharyngeal or neck masses produce. In addition, there can be an intrinsic lesion in the larynx or trachea. We describe a premature, 30-gestational week-old newborn with large subcutaneous neck mass. Pre-delivery ultrasound showed heterogeneous tumor structure and displaced larynx. The intubation was successful. The newborn developed respiratory distress syndrome immediately after birth which rendered the surgical removal of the neck tumor impossible. An autopsy was done, and the histopathology revealed mature teratoma comprising muscle, brain, salivary and pulmonary tissues, as well as well-developed hyaline membranes in the alveoli. The combination of the respiratory distress syndrome and the neck tumor compression proved fatal. Prenatal diagnosis, therapeutic options and ex utero intrapartum treatment (EXIT) procedures are discussed for the diagnosis and management of this very rare tumor.

Protective effect of nano vitamin D against fatty degeneration in submandibular and sublingual salivary glands: A histological and ultrastructural study

BackgroundPoor nutritional habits and a low level of physical activity are associated with obesity, leading to increased caloric and fat intakes. A high-fat diet can significantly impact oral health through the accumulation of lipids in the salivary glands, which ultimately affect salivary gland function. Recently, an increasing number of supplement nano-formulations, such as nano vitamin D, have become available. However, only few studies have explored the effects of nano vitamin D on the maintenance of oral health. ObjectiveThis study aimed to compare the histological effects of nano vitamin D to those of regular vitamin D on fatty degeneration in submandibular and sublingual salivary glands using a rat model. MethodsTwenty-four adult male albino Sprague–Dawley rats were divided into the following groups: untreated group, high-fat diet group, high-fat diet and regular vitamin D group, and high-fat diet and nano vitamin group.Thereafter, samples of the submandibular and sublingual salivary glands were dissected for histological and electron microscopic studies. Morphometric digital image analysis was used to quantitatively measure the changes in the size and number of acini and secretory granules. ResultsRegular vitamin D had a partial protective effect. However, vitamin D could fully restore cellular structures to their normal state, thereby protecting against fatty degeneration of the salivary tissue and immune cell infiltration, particularly in the submandibular serous tissue. Nano vitamin D was more efficacious than regular vitamin D at restoring the number and size of submandibular serous secretory granules. ConclusionEmploying nano vitamin D as a supplement to high-fat diets could protect against high-fat diet-induced salivary gland damage in rats.

Development of a functional salivary gland tissue chip with potential for high-content drug screening

Radiation therapy for head and neck cancers causes salivary gland dysfunction leading to permanent xerostomia. Limited progress in the discovery of new therapeutic strategies is attributed to the lack of in vitro models that mimic salivary gland function and allow high-throughput drug screening. We address this limitation by combining engineered extracellular matrices with microbubble (MB) array technology to develop functional tissue mimetics for mouse and human salivary glands. We demonstrate that mouse and human salivary tissues encapsulated within matrix metalloproteinase-degradable poly(ethylene glycol) hydrogels formed in MB arrays are viable, express key salivary gland markers, and exhibit polarized localization of functional proteins. The salivary gland mimetics (SGm) respond to calcium signaling agonists and secrete salivary proteins. SGm were then used to evaluate radiosensitivity and mitigation of radiation damage using a radioprotective compound. Altogether, SGm exhibit phenotypic and functional parameters of salivary glands, and provide an enabling technology for high-content/throughput drug testing.

Tissue-specific activation of Myd88-dependent pathways governs disease severity in primary Sjögren's syndrome.

Myd88 activation is an important driver of autoimmunity. Primary Sjögren's syndrome (pSS) is an autoimmune disease characterized by exocrine gland dysfunction in combination with serious systemic disease manifestations. Myd88-dependent signaling networks remain incompletely understood in the context of pSS. The objective of this study was to establish the contribution of tissue-specific Myd88 activation to local (exocrine) and systemic pSS manifestations. To this end, we generated two novel conditional knockout pSS mouse models; one lacking Myd88 in hematopoietic cells and a second strain in which Myd88 was deleted in the stromal compartment. Spontaneous production of inflammatory mediators was altered in salivary tissue, and nephritis was diminished in both conditional knockout strains. In contrast, pulmonary inflammation was increased in mice lacking Myd88 in hematopoietic cells and was reduced when Myd88 was ablated in stromal cells. Finally, anti-nuclear autoantibodies (ANAs) were attenuated in pSS mice lacking Myd88 in immune cells. Additionally, the ANA-specific B cell repertoire was skewed in the Myd88-deficient strains. Collectively, these data demonstrate that Myd88 activation in specific cell types is essential for distinct aspects of pSS pathology.

The Potential of Light Microscopic Features of the Oral Mucosa in Predicting Post-mortem Interval.

ObjectivesThe post-mortem interval (PMI) refers to the amount of time elapsed between death and discovery of the body. This study aimed to evaluate light microscopic cellular changes in the oral mucosa and identify the potential of this method for predicting PMI.MethodsThis prospective study was conducted between July 2016 and January 2018 at the Institute of Dental Sciences, Siksha ‘O’ Anusandhan University, Bhubaneswar, India. A total of 150 post-mortem (including 75 gingival and 75 buccal mucosa samples) and 40 ante-mortem (including 20 gingival and 20 buccal mucosa samples) tissue samples were compared using haematoxylin and eosin, periodic acid-Schiff (PAS) and van Gieson stains. Microscopic changes in the epithelium and connective tissue were categorised according to PMI stage as early (<12.5 hours since death), intermediate (12.5–20.5 hours since death) or late (>20.5 hours since death).ResultsMost epithelial cellular changes occurred early, except for arc-shaped nuclei and epithelial shredding which were intermediate and late changes, respectively. However, microscopic changes in the connective tissue were only observable at ≥12.5 hours. There was a progressive decrease in intensity in van Gieson stains and an increase in intensity in PAS stains as PMI increased. Several microscopic features were found to be significant predictors of PMI including epithelial homogenisation, cytoplasmic vacuolation, nuclear degeneration, arc-shaped nuclei, chromatin clumping, red blood cell clumping and lysis, melanin incontinency, myofibril degeneration, salivary gland acini degeneration and epithelial connective tissue separation (P <0.050 each).ConclusionThese findings indicate that microscopic evaluation of the oral mucosa may be helpful for PMI prediction.

Salivary Gland Heterotopia, a Clinical and Pathological TNM Staging Challenge - Carcinoma ex Pleomorphic Adenoma Arising in a Parotid Lymph node

IntroductionHeterotopia is the presence of a particular tissue / tumor at a non-physiological / ectopic site. The study primary goals: To review the current data investigating heterotopic, normal appearing, and diseased salivary gland tumors, in lymph nodes. To describe the meticulous pathological investigation and multidisciplinary decision-making process of a heterotopic carcinoma ex pleomorphic adenoma arising in an intra-parotid lymph node. Materials and MethodsA literature search in the "PubMed" database using key words "carcinoma ex pleomorphic adenoma", "parotid lymph node", "salivary gland" and "heterotopia" was conducted. We describe the thorough pathological investigation and clinical decision-making process, focusing TNM staging system limitations. ResultsA few case reports presented either normal appearing salivary tissue, benign tumors or low and high-grade salivary malignancies arising in lymph nodes. We present the investigation, controversies and treatment decision process of a 46-year-old man with CXPA in intra-parotid lymph node. ConclusionsThe staging scheme does not distinguish between nodal spread and primary tumor arising in a lymph node. Multidisciplinary input regarding prognosis and follow-up plans, may consider heterotopia differently from the usual pattern of nodal spread.