Myofibroblasts in Odontogenic Cysts and Tumors: An Immunohistochemical Study.

Objective: The objective of this study was to assess immunohistochemically the presence of myofibroblasts both qualitatively and quantitatively in odontogenic cysts and tumors and to compare with the control cases of squamous cell carcinoma and to correlate the results with biologic behavior of these lesions. Materials and Methodology: Formalin-fixed, paraffin-embedded blocks of odontogenic cysts and tumors were retrieved from institutional archives. The sample size is 40; these include ten cases of odontogenic keratocyst (OKC) (n = 10), five cases of dentigerous cyst (n = 5), ten cases of solid ameloblastoma (n = 10), and five cases of unicystic ameloblastoma (n = 5). Ten cases of squamous cell carcinoma (n = 10) served as control. Sections were taken and stained immunohistochemically using alpha-smooth muscle actin for evaluation of myofibroblasts. The number of positive stromal cells was evaluated both for quantitative and qualitative analyses. Results: The present study showed that the mean number of myofibroblasts among the odontogenic cysts and tumors was higher in locally aggressive lesions such as OKC (23.79 ± 19.95), solid ameloblastoma (26.38 ± 17.00), and unicystic ameloblastoma (20.74 ± 14.86) which were comparable to squamous cell carcinoma (21.49 ± 9.76) when compared to benign lesions like dentigerous cyst which showed the least number of myofibroblasts (13.1 ± 7.71). Qualitatively, the staining intensity of myofibroblasts showed a significant variation within the same lesion and among different lesions. There was a distinct difference in the morphology, pattern of arrangement, and distribution of myofibroblasts among the studied lesions. Conclusion: We conclude that the increase in the number of myofibroblasts could be one of the contributory factors for the locally aggressive behavior of benign lesions such as ameloblastomas and OKCs. Further studies are suggested to understand the mechanism by which these important cellular elements exert their effects on stromal and epithelial tissue compartments.

Expression of heat shock protein 70 in oral epithelial dysplasia and squamous cell carcinoma.

BACKGROUND: Heat shock proteins (HSPs) are overexpressed in a variety of human malignancies. They are involved in tumor cell proliferation, differentiation, invasion, metastasis, death, and immune system detection. HSP 70 has been shown to resist cytotoxicity in cancer cells and even enhance tumor development through an immune escape mechanism, suggesting that HSP70 may play a role in carcinogenesis. The aim of our study was to evaluate the role of HSP70 as a predictive marker for malignant transformation in oral epithelial dysplasia. MATERIALS AND METHODS: Thirty samples of epithelial dysplasia (10 mild dysplasia, 10 moderate dysplasia, and 10 severe dysplasia/carcinoma-in-situ cases), 10 samples of well-differentiated oral squamous cell carcinoma (OSCC), and 10 samples of normal oral mucosa were routinely processed, formalin-fixed, paraffin-embedded, and immunohistochemically examined for HSP70 expressions. To determine the statistical difference between two groups, a one-way analysis of variance (ANOVA) and the Mann-Whitney test were used. RESULTS: HSP70 expression was high but not homogenous in normal mucosa. Dysplasia showed an initial drop, and the expression increased with increasing degrees of dysplasia. There was no statistically significant difference across various types of epithelial dysplasia. From dysplasias to well-differentiated carcinoma, HSP70 exhibited a considerable rise. CONCLUSION: Overexpression of HSP70 in clinically suspicious and histologically established epithelial dysplasia may suggest a likelihood of transformation to well-differentiated OSCC and may have a prognostic value. However, more studies with a bigger sample size are needed to prove HSP70's role as a predictor.

Immunohistochemical evaluation of myofibroblasts in oral epithelial dysplasia and oral squamous cell carcinoma.

Aim: The aim of the study is to evaluate the presence of myofibroblasts quantitatively in oral epithelial dysplasia, oral squamous cell carcinoma (OSCC). Materials and Methods: Formalin-fixed, paraffin-embedded blocks were retrieved from the institutional archives. The sample size is 35 and included 15 cases of oral epithelial dysplasia (n = 15), 15 cases of squamous cell carcinoma (n = 15) and 5 cases of normal oral mucosa which served as the control (n = 5). Histologic sections were subjected to immunohistochemical analysis using alpha-smooth muscle actin, and the mean number of myofibroblasts was evaluated. Results: There were no myofibroblasts in the stroma of normal oral mucosa and oral epithelial dysplasia. Whereas all cases of OSCC showed myofibroblasts (mean ± standard deviation: 21.49 ± 9.76). This difference of myofibroblasts between OSCC and oral epithelial dysplasia was statistically significant with a P < 0.05. There was no statistically significant difference in the mean number of Myofibroblasts(MF) between 3 histologic grades of OSCC. Conclusion: The presence of myofibroblasts in the stroma of OSCC and their absence in normal oral mucosa and epithelial dysplasia reveals that these cells may play a role in cancer cell invasion and progression so the treatment strategies targeting the myofibroblasts and their by products may be beneficial in OSCC patients.

Differential Expression of Heat Shock Protein 27 in Oral Epithelial Dysplasias and Squamous Cell Carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the most devastating neoplasm with dramatic increase in morbidity and mortality. The detection and prognostic evaluation of precancerous lesions could aid in early control of cancer. Heat shock protein (HSP) 27 has found to be a biomarker and therapeutic target in different types of cancer. AIM: This study aims to investigate the role of HSP 27 as prognostic molecular indicator of malignant transformation in oral epithelial dysplasias. MATERIALS AND METHODS: Thirty samples of epithelial dysplasia (10 mild dysplasia, 10 moderate dysplasia, and 10 severe dysplasia/carcinoma in situ cases), 10 samples each of well-differentiated OSCC and normal oral mucosa were routinely processed, formalin-fixed, paraffin-embedded, and analyzed for HSP27 expression by immunohistochemistry. Statistical analysis was done by one way-ANOVA and Mann-Whitney test to assess the differences between two individual groups. RESULTS: Normal mucosa showed intense, but nonuniform, expression of HSP27. An initial decline was noted in dysplasias. A significant correlation of HSP27 expression was observed with the severity of dysplasia and well-differentiated OSCC (P < 0.05). CONCLUSION: Low HSP 27 expression can be considered as early molecular indicator of initial dysplastic change in normal mucosa. An overexpression of HSP 27 in clinically and histologically confirmed dysplasia could indicate likely transformation to well-differentiated OSCC and could be of prognostic value. However, further studies with a larger sample size are required to confirm the role of HSP 27 as predictive indicator.

Hemangiomatous ameloblastoma: Case report with a brief review.

Ameloblastoma is a benign epithelial odontogenic tumor with many histological variants. Hemangiomatous ameloblastoma (HA) is a very rare variant which shows unique histopathological features varying from conventional ameloblastoma. We present a case of a 35-year-old female patient with a swelling over right lower back region of jaw, showing mixed radiolucent-opacity. Incisional biopsy showed microscopic features of desmoplastic ameloblastoma showing extensive desmoplasia and compressed odontogenic epithelial islands. Excisional biopsy revealed ameloblastomatous areas with extensive vascular component microscopically. Based on these findings, a diagnosis of HA was made.

An Endocrine Jaw Lesion: Dentist Perspective in Diagnosis.

Brown tumor is a rare nonneoplastic focal giant cell lesion that occurs in hyperparathyroidism patients with a prevalence rate of 0.1% in jaws. We report an extremely rare case of brown tumor in mandible of a 40-year-old female patient that presented as the first clinical manifestation of hyperparathyroidism. Dentist played a pivotal role in the present case by the early diagnosis of lesion and its intervention.

Ectopic compound odontoma in the buccal mucosa: report of a rare case.

Eruption of tooth into extraosseous locations is an extremely rare condition. We report a case of a six-year-old girl child with tooth-like structure erupting from the right buccal mucosa. Clinical, radiographic, and histopathologic examination suggested the diagnosis of compound odontoma. Very few cases have been reported so far, where tooth has been located completely in the soft tissue and a variety of names have been used for that condition. A brief review of the literature and the ambiguity in naming the situation is discussed.

Evaluation of initial stability and crestal bone loss in immediate implant placement: An in vivo study.

OBJECTIVES: (1) To measure the crestal bone levels around implants immediately, and one month, three months, and six months after immediate implant placement, to evaluate the amount of bone level changes in six months. (2) To measure the initial stability in immediate implant placement. MATERIALS AND METHODS: Ten patients were selected and a total of ten implants were placed in the immediate extraction sites. The change in the level of crestal bone was measured on standardized digital periapical radiographs taken at baseline, first month, third month, and sixth months for each patient, using the SOPRO imaging software. The initial stability of implants was measured with resonance frequency analysis (RFA) and an engine-driven torque. The measurements were statistically analyzed. The student's t-test was used, to identify the significance of the study parameters. RESULTS: When mesial and distal bone losses were averaged, the radiographic evaluation with the SOPRO imaging software showed an average of 0.80 mm, with a standard deviation of ± 0.18 mm bone loss at the first month, followed by 1.03 mm with a standard deviation of ± 0.19 mm at the third month, and 1.23 mm with standard deviation of ± 0.6 mm at the sixth month. The initial stability with the RFA instrument showed a mean of 55 implant stability quotient (ISQ) values and the torque showed a value of 36.50 Nm. CONCLUSIONS: The implant has to be placed 2 mm below the crestal bone level to compensate the crestal bone loss. The initial stability is achieved by apical preparation of the socket wall and use of straight screw implants. When the defect is more than 2 mm, autogenous grafts with membranes are the best choice.

Myofibroblasts in oral lesions: A review.

Myofibroblasts (MFs) are modified fibroblasts that express features of smooth muscle differentiation and were first observed in granulation tissue during wound healing. These cells play a key role in physiologic and pathologic processes like wound healing and tumorigenesis. The presence of MFs has been reported in normal oral tissues and pathologic conditions like reactive lesions, benign tumors, locally aggressive tumors and malignancies affecting the oral cavity. This article briefly reviews the important hallmarks related to the discovery, characterization and tissue distribution of MFs in oral health and disease.

HIV Associated Intra-oral Burkitt's Lymphoma: A Case Report.

Immunodeficiency associated Burkitt's lymphoma is the most common in patients with HIV/AIDS. It accounts for 30-40% of Non-Hodgkin's lymphomas and may be the first sign of underlying immunosuppression. This report illustrates a case of Burkitt's lymphoma of maxillary alveolar ridge, which was the first manifestation in an HIV positive patient, with a brief discussion on clinicopathologic features, aetiopathogenesis and treatment.