Background: Tobacco is one of the main reasons behind the occurrence of oral cancer. Oral cancer, even though being the tenth most common cancer in the world, gets diagnosed at an advanced stage and ends up with poor prognosis. So early diagnosis is the need of the hour. Our study aimed to evaluate the genotoxic changes in patients with different tobacco habits using buccal exfoliated cells. Methods: Buccal smears were taken from smokers (30), smokeless tobacco users (30), combined tobacco users (30) and controls (30) with clinically normal oral mucosa. All the smears were stained with Papanicolaou stain and Feulgen stain and viewed under light microscope for the evaluation of mean number of micronuclei, mean micronuclei per cell, frequency of cells showing micronuclei, nuclear area, cytoplasmic area, nuclear-cytoplasmic ratio. Results: Mean number of micronuclei, mean micronuclei per cell, frequency of cells showing micronuclei, and nuclear area were significantly increased in tobacco users than controls, especially in combined tobacco users. Nuclear-cytoplasmic ratio was increased and cytoplasmic area was decreased in tobacco users than controls. Conclusion: Tobacco in any consumable form is genotoxic. Smoking and smokeless tobacco, when consumed together, synergistically causes higher genetic damage. Different tobacco habits have different deleterious effects on oral mucosa, and these effects are more pronounced when the patients have combined habits. So, detecting the genotoxic changes through exfoliative cytology can be used as a simple yet reliable marker for early detection of carcinogenesis.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a poorly understood entity and is probably a misnomer too. Although this lesion is thought to be predominantly found in young children, a significant number of cases have also been reported in adults. A 41-year-old female patient presented with an erythematous, velvety-appearing gingival mass in the mandibular anterior region. The lesion was recurrent in nature, although it was asymptomatic. A diagnosis of LJSGH was made after correlating the clinical and histopathological features. A literature search revealed that a large number of cases have been reported in adults, some as old as 87 years old. There seems to be no gender predilection, and the lesion is frequently noticed in relation to maxillary anterior gingiva. Recurrence is a characteristic feature of this lesion, although its etiology and pathogenesis are poorly understood till date. Since it has a unique behavior in terms of high recurrences, dentists and periodontists need to be made aware about spongiotic gingival hyperplasia since the lesion may be mistaken for common reactive lesions.

Background: With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations. Aim: To analyse the impact of manipulating digital images on their diagnosis. Design: Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted k statistics was used to measure and assess the levels of agreement between observers. Results: Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade. Conclusion: Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible.

Inverted sinonasal papilloma (ISP) is a benign epithelial neoplasm arising from the Schneiderian membrane. We report a case of ISP in a 50-year-old male that clinically presented as a polypoid mass in the nasal cavity. Imaging studies revealed it to be an aggressive lesion showing intracranial extension. On histopathological examination of the excised specimen, a diagnosis of ISP was arrived at. However, an extensive sampling of the tissue revealed no evidence of any malignant transformation. Taking into account the suggested viral aetiology for such lesions and the aggressiveness observed in this case, human papillomavirus (HPV) profiling was done but it turned out to be negative. Only one other case of inverted sinonasal papilloma arising from the nasal cavity and involving the brain has been reported in the literature to date. Considering the alarming clinical course in spite of its benign nature, it is important for the pathologist and surgeon to be well informed about this lesion.

Introduction: Foldscope is an origami-based portable paper microscope, developed in 2014, that can provide up to 2000 times magnification. It has the potential use as a low-cost diagnostic alternative in areas with limited resources. Oral cancer screening camps rely on visual examination of the patients’ oral cavity. In-field diagnosis of cytological smears can be very beneficial, although it requires more resources. Therefore, we designed a study to compare the accuracy of Foldscope in the identification of features in cytology smears, when compared with light microscope. Methodology: Two examiners with adequate experience evaluated 35 oral cytology smears. The Foldscope was used twice for evaluation by each examiner, with a gap of 15 days between the two evaluations. Both examiners also evaluated the same set of slides using a light microscope. Accuracy of identification of cells using Foldscope, when compared with the light microscope was evaluated. Interobserver agreement in the identification of various features was also determined using kappa statistics, for light microscope examination, and two Foldscope examinations. Results: We found that both examiners could identify epithelial cells accurately using the Foldscope. Mucous cells, inflammatory cells, and microorganisms could also be identified, with slightly lesser accuracy. Interobserver agreement was good in the light microscope. However, with the Foldscope, especially after the second sitting, the interobserver agreement was found to be comparably good. Conclusion: With adequate training and practice, Foldscopes could be valuable tools for rapid and immediate diagnosis of exfoliative cytology smears in mass oral cancer screening camps.