Survey of pathology reports with no definitive diagnosis in oral lesions: the necessary skills for the clinicians.

PURPOSE: Biopsy plays a crucial role in definitive diagnosis of lesions and consequently, appropriate treatment of them. Clinicians should correctly do the biopsy in accordance to the existing principles and guidelines to prevent adverse effects on the pathologist's diagnosis. This study aimed to determine the frequency and reasons for not providing definitive histopathological diagnosis of the biopsy samples belong to the laboratory of the Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Hamadan University of Medical Sciences. METHODS: Archival reports belong to 2006-2016 period of the related laboratory were studied to determine the reports with no definitive histopathological diagnosis. RESULTS: Out of 1018 archived reports; 90 reports (8.84%) had no definitive diagnosis. The most common reasons found were incompatibility between the clinical/radiographical diagnosis and histopathological findings for 42 cases (46.66%), absence of adequate information about the clinical/radiographical findings for 17 cases (18.88%) and inappropriate quality of samples for 13 cases (14.44%), respectively. CONCLUSION: The reasons for not providing definitive histopathological diagnosis of the biopsy samples in present study indicated that preparation, assessment and diagnosis of microscopic slide by pathologists do not separate from the clinician performance.

Explanation for different behavior of peripheral and central giant cell granuloma by CD44 and CD34 immunostaining.

AIM: Despite their histopathological similarity, unlike peripheral giant cell granuloma (PGCG), central giant cell granuloma (CGCG) is an osteolytic lesion. Low motility of osteoclasts as bone-resorbing agents decreases osteolysis where CD44 plays a role. The lesion requires angiogenesis to grow which in turn may cause bone resorption. This study aims to compare CD44 and CD34 expression in PGCG and CGCG. METHODS: 30 PGCG (group A) and 30 CGCG (group B) including non-aggressive (B1, N = 14) and aggressive (B2, N = 16) subgroups were evaluated for CD44 and CD34 expression through immunohistochemistry. RESULTS: CD44 staining intensity distribution (SID) score and CD44 labelling index (LI) in PGCG were significantly higher than those in CGCG, while microvessel density assessed by CD34 (MVD-CD34) was significantly higher in CGCG compared with PGCG. CD44-SID score and CD44-LI were higher for B1 whereas MVD-CD34 was higher for B2 (P < .05). CONCLUSION: Different CD44 expression among the studied groups may be indicative of the different motility of osteoclastic giant cells which may influence bone resorption. Lower CD44 expression probably indicates higher osteoclastic giant cell motility in CGCG, which with its higher angiogenesis may explain the different clinical behavior of CGCG compared with that of PGCG.

Comparative study of ß-catenin and CD44 immunoexpression in oral lichen planus and squamous cell carcinoma.

BACKGROUND: Dysfunction of adhesion molecules is believed to play an early and important role in developing cancer. Accordingly, this study aims to compare beta-catenin (ß-catenin) and CD44 expression in oral lichen planus (OLP) as a condition with malignant potential and oral squamous cell carcinoma (OSCC). METHODS: ß-Catenin and CD44 expression were evaluated in 15 patients with epithelial hyperplasia (group A), 20 OLP (group B), and 20 OSCC (group C) by immunohistochemistry. RESULTS: Quantitative and semi-quantitative evaluations revealed ß-catenin, and CD44 membranous expression had significant differences among the three groups. Expression of these markers in the OSCC group decreased significantly compared to that of the OLP. Also, nuclear/cytoplasmic expression of ß-catenin was significantly different among the three groups, considering that nuclear expression was not observed in any of the epithelial hyperplasia and OLP samples. CONCLUSIONS: According to the findings of this study, ß-catenin and CD44 can differentiate between behavior of OLP and OSCC, while the precancerous nature of OLP and malignant transformation potential of it are not suggested.

Study of P21 Expression in Oral Lichen Planus and Oral Squamous Cell Carcinoma by Immunohistochemical Technique.

STATEMENT OF THE PROBLEM: Lichen planus is a mucocutaneous disease that is relatively common in middle aged individuals. Some studies have shown that oral lichen planus has a potential to progress to squamous cell carcinoma.p21 is a cyclin-dependent kinase inhibitor that regulates the cell cycle, thus it acts as an inhibitor in cell proliferation. PURPOSE: This study was aimed to evaluate and compare the immunostaining of p21 (as a proliferation inhibitory factor) in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). MATERIALS AND METHOD: In this descriptive cross-sectional study, p21expression was investigated in 24 samples of oral lichen planus (OLP), 24 samples of oral squamous cell carcinoma (OSCC) and 24 samples of oral epithelial hyperplasia (OEH) by employing immunohistochemical staining. RESULTS: The mean percentage of p21-positive cells in OSCC (54.5±6.6) was significantly higher than that in OLP (32.8±6.08) and OEH (9.4±3.8). Moreover, OLP samples expressed p21 significantly higher than the OEH. Kruskal Wallis test revealed a statistically significant difference between the groups regarding the intensity of staining (p< 0.001). CONCLUSION: According to the findings of this study, the expression of p21 might be related to the potential carcinogenic transformation of lichen planus to SCC. Therefore, continuous follow-up periods for OLP are recommended for diagnosis of the malignant transformations in early stages.

A clinicopathological study of odontogenic cysts and tumors in hamadan, iran.

STATEMENT OF THE PROBLEM: Odontogenic cysts and tumors are the most frequent osseous destructive lesions of the jaws; however, there is little information regarding the relative frequency of these lesions among the Iranian population. PURPOSE: The purpose of this study was to determine the distribution of clinically and histologically- diagnosed odontogenic cysts and tumors during a period of 13 years in Hamadan, and also its correlation with age, gender, and the site of the lesion. MATERIALS AND METHOD: A descriptive cross-sectional study was performed on 413 oral and maxillofacial specimens during 1996 to 2008.The age and the gender of patients, as well as the site of lesion were recorded. The data were analyzed using SPSS software. RESULTS: Totally, 70 specimens were recorded as odontogenic cysts and 11 specimens were diagnosed as odontogenic tumors. The most frequent odontogenic cysts were dentigerous cysts (27.2%), followed by radicular cysts (18.6%) and odontogenic keratocysts (18.6%). In addition, cysts were more frequent in male than female individuals. Ameloblastoma was the most frequent odontogenic tumor (64%). CONCLUSION: Odontogenic cysts were in correlation with age, gender and location. These results showed that dentigerous cyst and odontogenic keratocyst were more frequent than other studies. More investigations should be performed to determine the frequency of odontogenic tumors in Iran.

A clinical, histopathological and immunohistochemical approach to the bewildering diagnosis of keratoacanthoma.

Keratoacanthoma (KA) is a comparatively common low-grade tumor that initiates in the pilo-sebaceous glands and pathologically mimics squamous cell carcinoma (SCC). Essentially, strong debates confirm classifying keratoacanthoma as a variant of invasive SCC. The clinical behavior of KA is hardly predictable and the differential diagnosis of keratoacanthoma and other conditions with keratoacanthoma-like pseudocarcinomatous epithelial hyperplasia is challenging, both clinically and histopathologically. This article aims to illustrate and explicate some of these complicated issues by presenting two cases of KA and a relevant review of literature. It also targets the clinical, histopathologic, and immuno-histochemical features of these two cases. Both presented lesions of this study had appeared on the vermilion border of the lower lip and no vascular or perineural invasion was observed. The results of the immuno-histochemical survey, particularly in staining with marker CD30, confirmed the differential diagnosis of keratoacanthoma from keratoacanthoma-like pseudocarcinomatous proliferations which was consequent to the CD30(+) lymphoid infiltration. Histopathological and immunohistochemical investigation is necessary to disprove the invasive biologic behavior of keratoacanthoma and also to refute all conditions with keratoacanthoma-like pseudocarcinomatous epithelial hyperplasia.

Report of a rare and aggressive case of oral malignant melanoma.

BACKGROUND: Oral melanoma is a very rare malignancy with unknown etiology. Its higher incidence is between 41 and 60 years of age. A high localization of oral melanoma was found in the maxilla. Gender distribution was reported as 1:1. Oral melanoma represents 0.2% to 8% of the all the total cases of melanoma of the body. CASE REPORT: In this article we report an aggressive case of oral melanoma in a 71-year-old male with chief complaint of black swelling of the gingiva, paresthesia, and denture ill fitting. DISCUSSION: Most oral melanomas are asymptomatic and painless in early stages and unfortunately diagnosis delayed until symptoms occurred. Early detection of suspected melanotic lesions by patient, dentist, and physician is very important.

Assessment of cellular proliferation in oral verrucous carcinoma and well-differentiated oral squamous cell carcinoma using Ki67: a non-reliable factor for differential diagnosis?

BACKGROUND: Non-invasive oral verrucous carcinoma (OVC) and invasive well-differentiated oral squamous cell carcinoma (OSCC) have similar histopathologic findings but different biological behavior. These two malignancies must be correctly differentiated by pathologists. The aim of this study was to determine immunohistochemical (IHC) expression of Ki67 in OVC and well-differentiated OSCC. METHODS: Expression of Ki67 was evaluated by IHC in 15 cases of epithelial hyperplasia with no dysplasia (A group), 15 cases of OVC (B group), 12 cases of microinvasive OSCC(C group) and 15 cases of well-differentiated OSCC (D group). RESULTS: There was a significant difference in Ki67 expression based on pattern distribution of immunostaining positive cells, with quantitative and semi-quantitative analyses, among the four groups ; also, between A group and each of the other three groups (P=0.0001). But there was no significant difference between B and C, C and D, and B and D groups (P>0.05). CONCLUSIONS: The three evaluation methods of Ki67 expression showed Ki67 (Mib-1) is not a good immunohistochemical marker to assess invasion status and differentiate OVC from well-differentiated OSCC; also, it cannot be used as a diagnostic tool to distinguish between variants of OSCC with similar grade.

A comparative in vivo study of tissue reactions to four suturing materials.

INTRODUCTION: The purpose of this study was to compare the histopathologic reaction of four suturing materials: silk, polyvinylidene fluoride (PVDF), polyglycolic acid, and catgut in the oral mucosa of albino rabbits. MATERIALS AND METHODS: The twenty-one male mature albino rabbits which were used in this study were randomly divided into three groups of seven each. Silk, PVDF, polyglycolic acid and catgut suture materials were tested in the oral mucosa of these animals. The animals were sacrificed 2, 4, and 7 days after suturing. Two pathologists evaluated the samples by determining the presence and level of inflammation, granulation tissue, and fibrosis formation. Data were statistically analyzed by Kruskal Wallis and Mann-Whitney U tests. RESULTS: Histological features of the samples showed that PVDF and plain catgut suture materials produced more fibrous tissue (favorable response) on the fourth day in comparison with silk suture (P=0.02). Also, in the 7-day samples PVDF sutures produced the mildest inflammation when compared with the silk sutures (P=0.015). CONCLUSION: According to the results of this study, it can be convey that PVDF suture materials created mild tissue reactions and can be a reasonable candidate for suturing oral tissues.

Pattern of Antibiotic Prescription among Dentists in Iran.

INTRODUCTION: This study examines the antibiotic prescription in dentists participated in 9(th) Congress of Iranian Association of Endodontists in Esfahan/2006. MATERIALS AND METHODS: A questionnaire for this cross sectional study was designed for evaluating the patterns of antibiotic prescription. It included some demographic information, clinical signs, and conditions in need for antibiotic and prophylactic prescription and their choices. Data was analyzed using Pearson's Chi-square test. RESULTS: High percentage of responders prescribe antibiotic for fever (78.2%) and diffuse swelling (85.1%). However, some situations such as acute pulpitis, chronic periapical lesions and marginal gingivitis were irrationally prescribed. CONCLUSION: This study showed a fairly good pattern of antibiotic prescription but it was far from ideal.