Leukoplakia and intraoral malignancies: female cases increase in Greece

Predictive value of p63, ki-67, and survivin expression in oral leukoplakia: A tissue microarray study

The aim of this study was to analyze the immunohistochemical expression of survivin, ki-67, and p63 in oral leukoplakic lesions, histopathologically differentiated into dysplastic and nondysplastic. A tissue microarray containing 57 samples of biopsies from clinically classified lesions, such as leukoplakia, was immunolabeled for survivin, ki-67, and p63. Samples were scored for percentage of positively stained. Scores were designated as follows: low = less than 25% of positive cells; and high = more than 25% of positive cells. On performing histopathological diagnosis, 20 dysplastic lesions and 37 nondysplastic lesions were seen, in which female patients (56.1%) were predominant with an average age of 58.27 years. The study showed a high expression of 37.5% for survivin, 43.7% for ki-67, and 88.2% for p63 in dysplastic lesions. However, there was a high expression of 16.7% for survivin, 16.7% for ki-67, and 92% for p63 in nondysplastic lesions. There is a positive correlation of expression among the three antibodies. In the association of immunoreactivity, in both dysplastic and nondysplastic lesions, increased expression of survivin reflects on the increased expression of ki-67, and there is an overexpression of p63. In leukoplakia, the expression of survivin associated with that of ki-67 reinforces the assumption that all these lesions are potentially malignant, regardless of histopathology; and the overexpression of p63 may indicate carcinogenic potential. These findings may help in the treatment of patients with this type of lesion.

Oral verrucous lesions: Controversies in diagnosis and management

AIMS

Oral verrucous lesions, typically presenting as slowly enlarging, grey or white, warty, exophytic overgrowths on the buccal mucosa or gingiva may be verrucous carcinoma (VC), verrucous hyperplasia (VH), proliferative verrucous leukoplakia (PVL), or may show the conventional invasive pattern of squamous cell carcinoma (SCC). This study was undertaken with the aim to report the demography of different types of oral verrucous lesions and evaluate their long-term outcome.

MATERIAL & METHODS

This clinical study comprised 15 patients with verrucous lesions of the oral cavity who underwent biopsy for confirmation of diagnosis.

RESULTS

Among these, 12 (80%) were male and only three (20%) were female. The age distribution ranged from 32 to 74 years with a median age of 45 years at the time of diagnosis. The most common site of VC within the oral cavity was the buccal mucosa (46.7%). 5 were proven cases of VC, 3 PVL and 7 VH. All cases of VH, PVL were managed by surgical excision, while VC was managed by surgical excision with superficial ostectomy followed by two cycles of chemotherapy additionally, if micro-invasion was observed on histopathological examination. The 2-year overall survival and tumour control rate was 93.4%. Recurrence was not seen in any patient till the time of analysis at a follow up of 3-5 years.

CONCLUSION

Accurate diagnosis of the verrucous lesions is important and should be differentiated from grade I squamous cell carcinoma. Management should be based upon the nature, behaviour and malignant potential of the lesion.

Association between expression of embryonic lethal abnormal vision-like protein HuR and cyclooxygenase-2 in oral squamous cell carcinoma

BACKGROUND

Increased cytoplasmic HuR expression has been noted in several cancer types, where it may contribute to the increased cyclooxygenase-2 (COX-2) expression observed during tumorigenesis and metastasis.

METHODS

To assess the correlation between COX-2 and HuR in oral squamous cell carcinoma (OSCC), the expression patterns of HuR and COX-2 were assessed via immunohistochemistry analyses of 103 OSCC samples.

RESULTS

Cytoplasmic HuR expression was significantly associated with COX-2 expression (p < .025) and lymph node metastasis (p < .050) and distant metastasis (p < .025). In multivariate analysis, cytoplasmic HuR expression was identified as an independent prognostic parameter for reduced overall survival. The inhibition of HuR expression by siRNA or leptomycin B (LMB) caused a reduction in the inducibility of COX-2 in oral cancer cells.

CONCLUSION

Our results indicate that the cytoplasmic expression of HuR is associated with COX-2 expression in OSCCs and HuR can regulate COX-2 expression in oral cancer cell lines.

An Overview of Epidemiology and Common Risk Factors for Oral Squamous Cell Carcinoma

Understanding the epidemiologic picture and the risk factors for oral cancer can help identify and treat patients at risk for oral cancers. Early diagnosis of an oral cancer continues to be important to achieving a favorable prognosis. Absent a diagnosis of oral/pharyngeal cancer, there clearly can-lot be an effective treatment plan. Discovering a potentially malignant or malignant lesion and through biopsy reaching a diagnosis for the lesion begins by performing an examination with the purpose of detecting oral/pharyngeal lesions. An oral cancer screening can be performed in less than five minutes without any expensive diagnostic aids. Despite the ease with which this exam can be performed and the noninvasive nature of the examination,most patients report that they have never had an oral cancer examination. Late stage diagnosis continues to be a common situation resulting in high rates of morbidity and mortality. Without early recognition it seems that the trend of late stage diagnosis will continue. Physicians, dentists, and other health care providers should be performing the oral cancer screening examination on a routine basis for all of their patients.Note: For the interested clinician, the author highly recommends an excellent comprehensive text on the subject of oral cancer. Sol Silverman's(with multiple contributors) The American Cancer Society's Atlas of Clinical Oncology Oral Cancer: Fifth Edition by BC Decker Publishers is an excellent overview of oral cancer covering in greater detail many of the subjects that could not be covered in this brief article. Additionally, there are excellent color photographs of the common presentations of oral malignancies that can be helpful in assessing oral/pharyngeal lesions.

Ultrastructural changes of the palatal mucosa following application of 4-nitroquinoline-l-oxide (4NQO) in rats subjected to major salivary gland excision

OBJECTIVE

It has been suggested that saliva exerts a protective role against the carcinogenic effect of various substances in the oral cavity. The objective of this study was to examine the ultrastructural changes of the palatal mucosa caused by the application of 4-nitroquinoline-l-oxide (4NQO) in the presence or absence of saliva.

STUDY DESIGN

Wistar-Furth rats subjected and not subjected to total bilateral excision of the major salivary glands were either painted with an aqueous solution of 4NQO or with propylene glycol only (controls). Two animals of each group were humanely killed periodically. The areas of the palatal lesions were immediately sliced and processed for TEM examination.

RESULTS

Ultrastructurally, the progressive changes to squamous cell carcinoma were observed in the animals painted with 4NQO. In the desalivated animals group, the ultrastructural alterations appeared earlier than in the group with salivary glands.

CONCLUSIONS

Saliva appeared to delay but not hinder tumor induction by 4NQO.

Intra-oral carcinomas in Maiduguri, north-eastern Nigeria

OBJECTIVE

To document the pattern of intra-oral carcinomas diagnosed in north-eastern Nigeria.

DESIGN AND SETTING

A retrospective clinical and histopathological review seen in a tertiary care hospital (January 1987-December 2002).

MATERIALS AND METHODS

Information on socio-demographic characteristics of patients and details of cancer management were retrieved from the files and histopathology records of cases diagnosed at the hospital.

RESULTS

A total of 378 biopsies, 317 primary cancers including 279 carcinomas of the head and neck were diagnosed during the study period. Intra-oral carcinomas constitute 43 (15.4%) of all head and neck carcinomas reported, with no occurrence in children. The overall mean age of occurrence was 51.2 +/- 15.6 years (male = 56.2 +/- 13.7 years; females = 47.5 +/- 16.2 years) and an overall male-female ratio of 3:4. Carcinomas were commonly reported in the palate 19 (44.2%) and lip six (13.9%) and floor of mouth four (9.3%). Squamous cell carcinoma 28 (65.1%), adenoidcystic carcinoma seven (16.3%) and mucoepidermoid carcinoma five (11.6%) were the commonly reported carcinomas. Squamous cell carcinoma was the most common carcinoma in all sites, in the sixth decade of life, of equal gender distribution and commonly reported in users of kola nuts and tobacco. The occupation of patients diagnosed with oral carcinoma and squamous cell carcinoma was farming (50%, 61.5%). All the staged cancers patients (n = 7) reported in the late stages (III/IV) of the disease. The mean interval between symptoms and presentation for the different carcinomas ranged between 9 and 25 months, with the least interval reported for mucoepidermoid carcinoma.

CONCLUSIONS

Squamous cell carcinoma was the most common oral carcinoma, commonly reported in the palate, among farmers and in the sixth decade of life. Its occurrence in under 40 year olds is three to six times greater than reported for the USA and Europe and may be associated with poor diet and the habitual use of kola nuts and tobacco. The survival rates of patients diagnosed with intra-oral carcinomas, although not available, would be expectedly low in view of the prognostic indicators recorded in this series. The routine oral cancer screening of each patient, and counselling of patients with high-risk habits, by dentists is recommended to improve the prognosis of the disease.