Expression of BMP-4 in dentigerous cyst and ameloblastoma: Is it a differentiation measure?

Purpose: This study aimed to determine the expression of Bone Morphogenic Protein-4 (BMP-4) in dentigerous cyst (DC), unicystic-ameloblastoma (UA), and Multicysticameloblastoma (MA), and assess whether this marker can be a differentiation measure. Materials and methods: This study included 30 DC, 30 UA, and 30 MA blocks if the histopathologic diagnosis of the lesion was definitive, the clinical information and medical records were complete, and the microscopic slides and the paraffin block were available. Age, gender, and location of the lesion were recorded. The samples were analyzed after the immunohistochemical staining (Envision technique). BMP-4 marker was evaluated and reported using Intensity Score (IS), Proportional Score (PS), and Total score (TS). The data were analyzed using SPSS version 21.0. Kruskal-Wallis and Mann-Whitney U tests were applied at the significance level of 0.05. Results: In this study, DCs, UA, and MA had a significant tendency to occur in males compared to females (p<0.001, p<0.001, and p<0.001 respectively), and in the mandible compared to the maxilla (p=0.02, p=0.024, and p=0.02 respectively). The epithelial IS was significantly different among three lesions (p<0.001). IS was higher in MA than UA and DC (p<0.001 and p=0.006, respectively). The IS was not significantly different among the three lesions in connective tissue and around micro-vessels (p=0.3 and p=0.26 respectively). The PS in the epithelium and connective tissue of DC, UA, and MA had no statistical difference (p=0.549 and p=0.540 respectively). The epithelial TS was statistically different among DC, UA, and MA (p<0.001). The TS was higher in UA than MA and DC (p=0.004 and p<0.001 respectively). Conclusion: The expression of BMP-4 in the epithelium was higher in ameloblastoma compared to DCs. BMP-4 is a potential measure to differentiate different types of ameloblastoma and dentigerous cyst. The differentiation of these lesions is important as the right treatment plan changes according to the diagnosis.

Comparative Analysis of P63, Maspin and Matrix Metalloproteinase 2 Expression in Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma of Salivary Glands.

STATEMENT OF THE PROBLEM: The tumor suppressor role of myoepithelial cells and related mechanisms in breast tumors are well understood. However, the role of these cells in tumors of salivary glands is debatable. PURPOSE: The present study was designed to determine the expression of p63, mammary serine protease inhibitor (maspin) and matrix metalloproteinase 2 (MMP-2) in mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma (ADCC) of salivary glands due to various cellular differentiation and structure. The association between the expression of these markers and clinicopathologic features and myoepithelial differentiation were also evaluated. MATERIALS AND METHOD: P63, maspin, and MMP-2 expression were immunohistochemically studied in 67 cases including35 cases of MEC and 32 cases of ADCC. The smooth muscle actin (SMA) staining was also applied to confirm the presence of myoepithelial differentiation. Data was analyzed using Chi-square test, Mann-Whitney U test and t-test. RESULTS: The expression of p63 (p= 0.009) and maspin (p= 0.012) significantly differed between the study groups. P63 positive cells in MEC were negative for SMA staining in contrast to ADCC. Furthermore, the expression of P63 (p= 0.045) and maspin (p= 0.019) significantly and inversely correlated with histologic grade in ADCC. Likewise, positive significant correlation was detected between histologic grade and expression of P63 (p= 0.018) and MMP-2 (p= 0.003) in MEC samples. CONCLUSION: Our findings showed that MEC is devoid of myoepithelial cells. The difference in expression of P63 and maspin in ADCC and MEC highlighted the role and presence of myoepithelial cells in ADCC. Indeed, the high expression of P63 and maspin in well-differentiated ADCCs suggests the tumor suppressor effect of myoepithelial cells. Considering the association between the evaluated markers and histological grade, p63 in both tumors, maspin in ADCC and MMP-2 in MEC may be efficient predictors of clinical behavior.

Mandibular Mural Ameloblastoma with Unusual Histopathologic Features: a Rare Challenging Case.

Ameloblastomas demonstrate various clinical and microscopic patterns. They typically have been described as possessing three biologic variants including solid, cystic (unicystic) and peripheral, of which about 13% to 21% of all cases are unicystic. Granular cell subtype is a rare variant especially when both the inner and peripheral layers of tumoral islands composed exclusively of eosinophilic granular cells. The purpose of this case report is to present a unique case of cystic ameloblastoma with an unusual radiographic and microscopic pattern affecting a 25-year-old female. Awareness of these rare histopathologic features for oral pathologist is essential to help correct diagnosis.

Are CD68 and Factor VIII-RA Expression Different in Central and Peripheral Giant Cell Granuloma of Jaw: An Immunohistochemical Comparative Study.

OBJECTIVE: Central giant cell granuloma and peripheral giant cell granuloma of the jaw and oral cavity are identical in histopathologic features, although they are different in pathogenesis and clinical behavior. The aim of present study was to compare CD 68 and factor VIII related antigen (VIII-RA ) immunoreactivity in central giant cell granuloma and peripheral giant cell granuloma to determine the biologic nature and clinical behavior of these lesions which may lead to a better or new treatment modality. MATERIAL AND METHOD: CD68 and factor VIII-RA expression were examined immunohistochemically in 22 cases of central giant cell granuloma (10 aggressive and 12 non- aggressive ) and 19 cases of peripheral giant cell granuloma. The Kruskal-Wallis test followed by the Dunn test was used for data analysis. RESULTS: CD68 expression was observed in approximately 100% of multinucleated giant cells and 50% of mononuclear cells. Overexpression of factor VIII-RA in the endothelial cells of capillary like vessels in the periphery of the lesions was prominent. A statistical significant difference for CD68 intensity score in mononuclear cells among three groups (P=0.016) was observed. Indeed, factor VIII-RA intensity score in the endothelial cells of central giant cell granuloma and peripheral giant cell granuloma showed significant difference (P=0.004). CONCLUSION: These findings support the histiocyte/macrophage nature of multinucleated giant cells and mononuclear cells. Overexpression and high intensity score of CD68 in mononuclear cells and the high intensity score of factor VIII-RA in endothelial cells represent less aggressive behavior in central giant cell granuloma.

Salivary Gland Tumors: A 15- year Report from Iran.

OBJECTIVE: The aim of this study was to document the clinicopathologic characteristic of salivary gland tumors in Tehran, Iran, over a 15-year period. MATERIAL AND METHOD: A retrospective study was conducted on salivary gland tumors diagnosed at two pathology centers of Shahid Beheshti University of Medical Sciences from March 2000 to March 2015. Patient age, sex, tumor site and frequency, as well as clinical and radiographic features and histopathologic diagnosis constituted the main analysis outcome measures. RESULTS: Of the 45429 biopsies conducted over 15 years, 6065 (13.3%) cases were oral and maxillofacial lesions and 937 (15.4%) of these had tumoral diagnoses. Of the 937 tumoral cases, 184 (19.6%) were salivary gland tumors and among 184 cases, 65 (35.3%) were benign and 119 (64.7%) were malignant. Pleomorphic adenoma was the most frequently occurring tumor, comprising 32.6% of all tumors, followed by mucoepidermoid carcinoma (27.1%) and adenoid cystic carcinoma (22.2%). Tumors were frequently reported in minor salivary glands (75%), particularly in the palate with 89 (48.4%) cases. The peak ages of incidence were the fourth and sixth decades of life. Malignant salivary gland tumors showed a predilection for females (72.9%), which was statistically significant (P < 0.01). CONCLUSION: The data presented herein are similar to previously published reports in other countries and other areas of Iran. However, some differences were observed in our study, such as higher overall frequency, a lower mean age of patients with malignant tumors, and the particular sites of involvement. These differences can be attributed to racial factors, the pathology centers of sample collection, and the duration of the studies.

The correlation between p16 expression and INK4a locus mutation with grades and stages in oral squamous cell carcinoma.

OBJECTIVE: p16INK4a is a tumor suppressor gene playing a critical role. Researches have indicated the gene to be altered in oral squamous cell carcinoma. Present studies have tried to assess the correlation between p16INK4a expression and INK4a locus mutation in relation to grades and stages of this tumor. MATERIALS AND METHODS: Expression of p16INK4a was studied immunohistochemically in 58 oral squamous sell carcinoma samples and INK4a locus mutation was determined by polymerase chain reaction (PCR) and conformation sensitive gel electrophoresis (CSGE). RESULTS: Expression of p16INK4a was higher in stage1 compared to stage 2, 3, and 4 (P = 0.234). The difference was not significant in grade 1, 2, and 3 (P = 0.671). The average values of total score (TS) were significantly higher in stage1 compared to stage 2, 3, and 4 (P = 0.035). The average values of complete score (CS) were higher in stage 1 compared to stage 2, 3, and 4 (P = 0.061). The research did not show a significant correlation between lymph node involvement and p16INK4a expression (P = 0.491). It seems that 5.1% (3/58) of samples have mutation in INK4a locus. CONCLUSION: Loss of p16INK4a expression occurred in initial stages of oral squamous cell carcinoma. Evaluation of TS and CS for p16INK4a might be a useful clinical indicator concerning the tumor. However, gene mutation is believed to have minor rate of genetic alteration in carcinogenesis.