Comparative Immunohistochemical Analysis of p53 and Alpha-SMA in Ameloblastoma, AOT and OKC

OBJECTIVES

Ameloblastoma is a benign but highly infiltrative tumour, a behaviour that is lacking in adenomatoid odontogenic tumour but partly shared by the odontogenic keratocyst which possesses a unique intrinsic growth potential with marked ability for destroying bone and a high tendency recurrence. High frequency of stromal myofibroblasts (assessed with alpha smooth muscle actin (α-SMA) correlates with aggressive behaviour while p53-cell cycle regulation system is critical in odontogenic tumours with immunoreactivity signifying prognostic status. This study aims to determine and compare the immunoreactivity of these selected tumours to p53 and α-SMA in order to establish if a relationship exists between the frequency and pattern of distribution of myofibroblasts and the behaviour of these lesions.

MATERIALS AND METHODS

69 blocks of ameloblastoma, and 23 each of adenomatoid odontogenic tumor (AOT), and odontogenic keratocyst (OKC/KCOT) were retrieved. Immunohistochemistry technique was applied for evaluation of these two markers staining with primary antibodies to p53 and -SMA and the frequency and pattern of distribution of myofibroblasts and immunoreactivity to p53 analysed and compared using ANOVA. p was set at <0.05.

RESULTS AND CONCLUSION

Immunoreactivity to p53 and α-SMA was highest in ameloblastoma (solid compared to unicystic) with highest mean positive cells to α-SMA (29.7±20.1) and p53 (28.3±24.5) in plexiform ameloblastoma. This suggests that ameloblastoma was the most aggressive of tumours studied. Different pharmacological agents that can regulate stromal MF are useful aids to decrease the need for radical surgery in extensive and aggressive odontogenic tumours.

Distribution of Medical Conditions among Dental Patients

Aims

The aim of the study was to determine the distribution of medical conditions among dental patients in our local environment.

Settings and Design

This is a descriptive cross-sectional study conducted at the Oral Diagnosis (OD) Clinic of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Osun State.

Materials and Methods

Participants were selected using a simple random method from the pool of dental patients who presented at the OD Clinic of OAUTHC during the study period. Information was obtained from each participant using a structured questionnaire organized into sections. Section 1 collected information on participants' biodata such as age, sex, and weight. Section 2 recorded data on the history of the presence of relevant oral and systemic symptoms, while section 3 collected information on findings from intraoral and extraoral examination.

Statistical Analysis Used

The results were analyzed using STATA 13 statistical software.

Results

Of the 1503 patients who visited dental hospital during the study period, 176 (11.7%) had medical problems. The mean age of patients with medical problems was 48.5 ± 21.0 years. The mean age was higher in men compared to women (P = 0.013). More than one-fifth (21.6%) of the patients were first diagnosed in the dental clinic. Hypertension was the most frequently seen medical condition, closely followed by peptic ulcer and diabetes mellitus. Patients whose medical problems were first diagnosed following dental consultation were significantly older than those with known medical conditions.

Conclusions

Prevalence of medical conditions in dental patients is high. Hypertension is the most frequently associated systemic conditions among dental patients. Medical conditions were common among older age group (>50 years), males, and those with gum problems.

Giant Cell Lesions of the Jaws:A Review and Comparative Histopathological Study

BACKGROUND AND OBJECTIVES

Giant cell lesions (GCLs) are rare lesions which prominently feature multinucleated giant cells in their histology. They include central giant cell granuloma (CGCG), giant cell tumour of bone (GCT), peripheral giant cell granuloma (PGCG), Cherubism (CHB), e.t.c. This study reviewed the clinico-demographic parameters of GCLs of the jaws and assessed the giant cells.

METHODS

This was a retrospective study examining the histopathology records of which part of the body of two tertiary institutions. All entries of cases diagnosed as GCLs were retrieved and data were extracted. Also, the giant cells in tissue sections were assessed. Data were analysed using SPSS Inc. version 20 while Chi square test was used to test for association. This was considered significant quand p < 0.05.

RESULTS

Over the study period, 2,862 biopsy reports were reviewed. GCLs constituted 48(1.7%) and M: F ratio was 1:1.6 while majority occurred in the 2nd and 3rd decades. The mandible was the most common site recording 27(56.3%) cases and CGCG was the most frequently diagnosed GCL constituting 22(45.8%). Assessment of the giant cells revealed CGCG had predominantly large giant cells, a dense dispersal of giant cells and irregularly shaped giant cells, while CHB mainly had large giant cells with dense dispersal, but round shaped giant cells.

CONCLUSION

GCLs are rare lesions commonly seen in females in the 2nd and 3rd decades of life with preference for the mandible. CGCG was the most commonly encountered lesion, while the giant cells in CGCG and CHB were similar in size as well as dispersal.

Concordance between clinical and histopathologic diagnosis and an audit of oral histopathology service at a Nigerian tertiary hospital

Introduction

Although histopathological diagnosis remains the gold standard; good clinical impression is potentially a key diagnostic tool in rural resource-limited settings. Thus, good concordance between clinical impression and histopathological diagnosis is thus a very crucial diagnostic oral pathology tool in low- and middle-income countries (LMICs).

Methods

This retrospective study was performed at the Oral pathology and Oral diagnoses units of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Osun state. Clinicopathological reports of all biopsies between the period of 2008-2017 were retrieved and analyzed. Descriptive analysis of data was done using Stata 14. Frequency of oral lesions and rates of accurate clinical diagnoses were evaluated for lesional sites and clinician's qualification/specialization.

Results

In 592 biopsied cases, the mean age was 36.1years with higher female predilection (54.4%). Odontogenic tumors (OTs) were the most prevalent category of lesions (25.3%, n=149), followed by reactive lesions (12%, n=71). Absolute concordance was recorded for 54.6% (k=0.5) of the cases; with highest concordance observed in fibro-osseous lesions (65.6%, k=0.43), and least in pulp/periapical lesions (3.5%). Concordance was higher in females (59.5%, k=0.53) than males (48.3%, k=0.44). Oral medicine specialists had the highest concordance index (62.5%, k=0.59).

Conclusion

The findings in this research indicate that, on a general note, the degree of concordance between clinical and histopathological diagnosis is poor. Hence, improvement in diagnostic skills (irrespective of clinical specialty) is important to improve treatment outcomes, particularly in LMICs. Continuous personnel training and utilization of advanced diagnostic techniques can potentially help bridge the diagnostic gaps.

Review of 109 cases of primary malignant orofacial lesions seen at a Nigerian Tertiary Hospital

Background

Orofacial malignancy is a growing health issue common in developing regions of the world. Presentation patterns are myriad with geographic variations. Advanced stage owing to late presentation constitutes a significant public health burden. The site and type of the lesions are valuable in diagnosis and patient management.

Aim

This study aims to review cases of primary orofacial malignancies at the OAUTHC Dental Hospital.

Objectives

The objective of the study was to determine the prevalence of histologically diagnosed orofacial malignancies, the relative frequencies, types and site of distribution.

Materials and Methods

Records of patients with orofacial malignancies at the OAUTHC, Dental Hospital over a period of 10 years (January 2008-December 2017) were reviewed, demographic data (age, gender and site), history of tobacco use were retrieved and entered into a pro forma. The data obtained were analysed with STATA 11. Statistical significance was set at P < 0.05.

Results

Of 375, 109 cases of neoplasms seen were primary malignant tumours, with prevalence rate of 29.1%. There were 71 (65.1%) males and 38 (34.9%) females (male:female ratio of 1.87:1), mean age (48.7 ± 19.3 years) and range (4-94 years). Affected sites were mandible (41, 37.6%), maxilla (39, 35.8%), palate (17, 15.6%) and others. Lesions were mainly squamous cell carcinomas (SCC: 46, 42.2%), salivary gland adenocarcinomas (SGAs, 25, 22.9%) including 8 (32%) cases of adenoid cystic carcinoma (ACC). Others were odontogenic carcinoma (18, 16.5%) and lymphoma (8, 7.3%). Most specimen analysed were hard tissues (n = 63, 57.8%). Thirty-four (73.9%) cases of SCC and 66 (60.6%) cases of primary malignancies were in the 5^th-9^th decades of life. This was statistically significant at P = 0.000.

Conclusion

SCC was more prevalent than salivary and odontogenic carcinomas. ACC and mucoepidermoid carcinoma were two most common SGAs. Metastatic tumours to the jaws are rare.

Ameloblastic carcinoma: a clinicopathologic analysis of cases seen in a Nigerian Teaching Hospital and review of literature

Introduction

Ameloblastic carcinoma is a rare malignant odontogenic neoplasm that exhibits histological features of ameloblastoma in combination with cytological atypia. It may arise de novo or secondarily through malignant de-differentiation of pre-existing ameloblastoma or odontogenic cyst. Secondary ameloblastic carcinomas often results from repeated surgical intervention, which is a mainstay of odontogenic tumor management in resource limited settings. To date, relatively few cases of ameloblastic carcinomas have been reported and many cases have been misdiagnosed as ameloblastoma. This is due to its wide range of clinicopathological feature which range from indolent to aggressive. It may present as an aggressive ulcerated mass or as a simple cystic lesion; hence, it often challenging to delineate from its benign counterpart, ameloblastoma.

Methods

this study reviewed the clinicopathological data on 157 cases of odontogenic tumors diagnosed over a 10 years period from the pathology archive of the Oral Pathology Unit of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria.

Results

of all these cases, we identified that 64.9% were Ameloblastomas, while 8.3% were ameloblastic carcinomas. Primary subtypes of ameloblastic carcinoma constituted 23.08%, while 69.23% of the cases were of the secondary subtype. We also found that the secondary subtype of ameloblastic carcinomas showed a higher mean duration value of 7.7 years. Most lesions were found in posterior mandible and presented with ulceration, perforation and ill-defined borders radiographically.

Conclusion

this study is among the few that have documented higher frequency of secondary ameloblastic carcinoma in the scientific literature.

Temporomandibular Joint Pain: Clinical Presentations and Response to Conservative Treatments in a Nigerian Tertiary Hospital

Aims and Objectives:

The aims of this study are to determine the prevalence, pattern of presentation, and response to conservative (medical) interventions among patients who presented with temporomandibular joint (TMJ) pain in a Nigerian teaching hospital.

Material and Methods:

Consecutive patients who presented in Oral Medicine and Periodontology Clinic of Obafemi Awolowo University Teaching Hospitals' Complex on account of TMJ pain from January 2015 to December 2015 were recruited for the study. They were all interviewed and examined. The severity of pain was recorded using visual analog scale (VAS). Patients were treated with medications and physiotherapy. They were reviewed at 2, 4, and 6 weeks. Those who could not make the appointment were contacted through phone. The findings were recorded and analyzed using STATA version 11.

Results:

A total of 401 participants were seen, 55 presented on account of TMJ pain. The mean age of patients with TMJ pain was 54 ± 16.9 with 60% being female. Pain was present in all participants; other signs include clicking joint sound (85%), jaw deviation (64%), attrition (24%), and reduced mouth opening (23%). The left joint was more frequently affected (75%). Following 6 weeks of conservative treatments, none of the respondents had VAS score of more than 3.

Conclusion:

The prevalence of TMJ pain was 13%. TMJ was found to be more common in participants above 50 years with female predilection. Pain was most common symptom seen, and response to conservative treatments as assessed using VAS following 6-week of treatment showed complete remission of the pain.