From,Date: 08-10-2013
DR.YASHASWINI P, Bellary.
Post Graduate Student in M.D,
Department of Pathology,
VIMS, Bellary.
To,
The Principal,
Vijayanagar Institute of Medical Sciences,
Bellary.
THROUGH PROPER CHANNEL
Respected Sir,
Subject: Acceptance of registration and forwarding of synopsis.
In reference with the above cited subject, I the undersigned, studying Post Graduate coursein M.D Pathology have been allotted the dissertation topic “HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR LIKE LESIONS
OF ORAL CAVITY.” Under the guidance of Dr.C.BHARATH ,Professor and Head, Department of Pathology, VIMS, Bellary.
I request you to kindly forward the synopsis in the prescribed form to the University for approval.
Thanking you,
Yours faithfully
(Dr .Yashaswini P)
Post Graduate Student in M.D,
Signature of the Guide Department of Pathology,
VIMS,Bellary.
Dr.C.Bharath,
Professor and Head,
Department of Pathology.
VIMS,Bellary.
From, Date: 08-10-2013
The Professor and Head, Bellary.
Department of Pathology,
VIMS, Bellary.
To,
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore.
THROUGH PROPER CHANNEL
Respected Sir,
Sub: Submission of synopsis for registration and forwarding.
As per the regulations of the University for registration of dissertation topic, the following Post Graduate student in M.D. Pathology has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guides of the department of Pathology.
NAME / TOPIC / GUIDEDR. YASHASWINI P,
Post Graduate Student in M.D,
Dept. of Pathology,
VIMS, Bellary. / “HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR LIKE LESIONS OF ORAL CAVITY ”. / Dr.C. BHARATH ,
Professor and Head,
Department of Pathology,
VIMS, Bellary.
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG students at an early date.
Thanking you,
Yours faithfully,
(Dr.C.Bharath)
Professor and Head and guide,
Department of Pathology,
VIMS, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,KARNATAKA,BANGALORE.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the candidate andaddress / DR.YASHASWINI P
POST GRADUATE IN M.D.PATHOLOGY,
DEPARTMENT OF PATHOLOGY,
VIMS,BELLARY.
2 / Name of the Institution / VIJAYANAGAR INSTITUTE OF
MEDICAL SCIENCES,BELLARY.
3 / Course of the study and subject / MD IN PATHOLOGY.
4 / Date of admission to the course / 04.09.2013
5 / Title of the topic / “HISTOPATHOLOGICAL STUDY OF TUMOR AND TUMOR LIKE LESIONS OF ORAL CAVITY”.
6
7 / BRIEF RESUME OF INTENDED WORK
6.1. Need for study
Oral cavity is vulnerable to a limitless number of environmental insults because of its exposure to the external world. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction.1
In the western world oral/oropharyngeal cancer is rare, accounting for 2 to 4% of all malignant tumors, although there is evidence that the incidence is on the increase, particularly among young people. In Indian subcontinent, however, oropharyngeal cancer is the most common malignant tumor accounting for 40% of all cancers.
The incidence is greater in men than in women and it is predominantly a disease of elderly (those over 60years of age).The incidence in women is increasing, particularly in young patients. In Europe and North America the current trend of binge drinking and acute tobacco abuse has been observed to correlate with the rising incidence of tongue cancer in younger people.2
6.2 Review of Literature.
More than 95% of the carcinomas of the oral cavity are of squamous cell type. They constitute a major health problem in developing countries, representing a leading cause of death. The survival index continues to be small (50%), as compared to the progress in diagnosis and treatment of other malignant tumors. According to World Health Organization, carcinoma of oral cavity in male in developing countries, is the sixth commonest cancer after lung, prostate, colorectal, stomach and bladder cancer, while in females, it is the tenth commonest site of cancer after breast, colorectal, lung, stomach, uterus, cervix, ovary, bladder and liver.3
Verrucous carcinoma (VC) is a highly differentiated variant of squamous cell carcinoma (SCC) and is a very rare entity, first described by Ackerman in 1948.Various synonyms used to describe this tumor, including Ackerman's tumor, Buschke Loewenstein tumor, florid oral papillomatosis, epithelioma cuniculatum, and carcinoma cuniculatum.It is a special form of squamous cell carcinoma with specific clinical and histological features. The tumor is slow growing, locally destructive, invasive in nature and rarely metastasizes. It appears as a painless, white, warty, exophytic plaque attached by a broad base resembling a cauliflower. It is seen more commonly in men than in women in 6thor 7thdecade of life. The most common sites of oral mucosal involvement include the buccal mucosa, followed by the mandibular alveolar crest, gingiva, and tongue. Schraderet al.and Jordansuggested verrucous carcinoma as a slow-growing exophytic lesion that spreads by lateral extension and is locally destructive, but if neglected, can invade the periosteum and the bone. The exact etiology of verrucous carcinoma is unknown, tobacco chewing and smoking is found to be the causative factors. Poor oral hygiene, oral lichenoid reaction, and oral leukoplakia may act as predisposing factors.4
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient.5
Human papilloma virus (HPV) is one of the most common virus groups affecting the skin and mucosal areas of the body in the world today. It is also a known fact that HPV causes many lesions in the oral cavity. The most common conditions induced by oral HPV infection are usually benign-like oral papillomas, oral condylomas, and focal epithelial hyperplasia. Oral HPV infection has been found to be associated with some cases of oropharyngeal cancer, but it is not the main risk factor for this kind of cancer. HPV is been proved to be the causative agent in causation of cervical cancers without doubt, but its role as a etiologic agent in causing oral cancers needs to be evaluated and studied more to come into any conclusion.6
Pyogenic granuloma (PG) is a tumor-like growth in the oral cavity. It is manifested as a painless sessile or pedunculated, erythematous, exophytic and specific papular or nodular with a smooth or lobulated surface, which may have a fibrinous covering. The lesion usually bleeds easily on a slight provocation. PG is considered to be a non-neoplastic in nature. It is a reactive lesion, also classified in pregnancy associated gingival diseases. It occurs due to irritation or physical trauma from calculus or cervical restorations as also some contribution by hormonal factors and usually affects the gingiva, but can be seen in areas of frequent trauma such as lower lip, tongue, oral mucosa, and palate. The growth is typically seen on or after the third month of pregnancy and may grow rapidly to acquire a large size, thus, requiring surgical removal.7
6.3. OBJECTIVES OF THE STUDY
To study the morphological spectrum of tumor and tumor like lesions of oral cavity.
To compare the observed findings to similar studies with relation to age,
sex and site distribution.
MATERIALS AND METHODS
7.1. SOURCE OF DATA
The present study will be carried out in the Department of Pathology,
Vijayanagara Institute Of Medical Sciences, Bellary.All biopsies and resected
specimens with clinical diagnosis of tumor and tumor like lesions of oral cavity in
the department of ENT and Dentistry at VIMS, Bellary forms the material for the
study.
7.2.a) METHOD OF COLLECTION OF DATA
The present study will be a prospective study conducted from January 2014 to June 2015. Biopsies and resected specimen will be received in 10% formalin, gross findings are noted, tissue processed and stained with routine haematoxylin and eosin and histopathological examination under light microscope will be carried out.
Sample Size:All the biopsies and resected specimens of tumor and tumor like lesions of oral cavity received from January 2014 to June 2015 will be subjected for the study.
INCLUSION CRITERIA
The tumor and tumor like lesions ofthe:-
Lips, the inside lining of the lips and cheeks( buccal mucosa).
The teeth, the gums, the front two-thirds of the tongue, the floor of the mouth below the tongue.
The bony roof of the mouth (hard palate). The area behind the wisdom teeth (retromolar trigone).
will be included.
EXCLUSION CRITERIA
The tumor and tumor like lesions of the base of the tongue, the soft palate, the tonsilsand the side and back wall of the throat.
The patients who are not cooperative.
The patients who are already diagnosed.
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS?
NIL
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Yes. Ethical Clearance has been obtained from Institutional Ethical
Committee(IEC) of VIMS, Bellary.
LIST OF REFERENCES:
- Simi S M, Nandakumar G, Anish T S. White lesions in the oral cavity: A clinicopathological study from a tertiary care dermatology centre in Kerala, India. Indian J Dermatol 2013Jul-Aug;58(4):269-74.
- Williams S,Bulstrode J K, O’connell P,Editors. Oropharyngeal Cancer.In:Smith.P, Editor. Bailey and Love. 25th ed. London: Edward Arnold;2008.p.734-751.
- Mehrotra R, Yadav S. Oral squamous cell carcinoma: Ethiology, pathogenesis and prognostic value of genomic alterations.Indian J can 2006Apr;43(2):60-66
- Agnihotri A, Agnihotri D. Verrucous carcinoma: A study of 10 cases. Indian J Oral Sci 2012;3(2):79-83
- Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, and Biasotto M. Oral Lesions and Lymphoproliferative Disorders.Journal of Oncology 2010; vol.2010:1-10
- Kumaraswamy K L, Vidhya M. Human papilloma virus and oral infections: An update. J Can Res Ther 2011;7(2):120-7
- Esmaeil N, Sharmila B, Sangeeta M, Rahul K. A case report of pregnancy tumor and its management using the diode laser. J Dent Lasers 2012;6(2):68-71
9 / Signature of the candidate
10 / Remarks of the guide
11 / 11.1. Name and designation of the guide / Dr.C.BHARATH,
PROFESSOR AND HEAD,
DEPARTMENTOF PATHOLOGY,
VIMS, BELLARY.
11.2. Signature
11.3. Head of the Department / Dr. C.BHARATH,
PROFESSOR AND HEAD,
DEPARTMENT OF PATHOLOGY,
VIMS, BELLARY.
11.4. Signature
12 / 12.1. Remarks of the Chairman
and Principal
12.2. Signature.