Expression of CD34, VEGFR3 and eosinophil density in selected odontogenic tumors- a pilot study.

BACKGROUND: Limited statistically and clinically significant studies have been down on connective tissue factors in the odontogenic tumors. Therefore, the aim of this study was to determine the biological behavior of two selected epithelial odontogenic tumors (Ameloblastoma and Adenomatoid odontogenic tumor) by detecting CD34, VEGFR3 and eosinophil densities. METHODS: In this cross-sectional study, paraffin blocks including 20 cases of ameloblastoma and 20 (AOT), were selected. Totally, 4 sections were prepared for hematoxylin-eosin, Congo red staining, immunohistochemistry with CD34 and VEGFR3. Expression of VEGFR3, CD34 and lymphatic, blood vessels and eosinophil densities was examined. RESULTS: The mean of blood, lymphatic vessels and eosinophils densities in ameloblastoma were 14.9 ±â€¯6.4, 4.4 ±â€¯2 and 3.2 ±â€¯2.7, respectively; and in AOT, they were 8.9 ±â€¯3.4, 3.6 ±â€¯1.3 and 1.2 ±â€¯07, respectively. There was a significant difference in eosinophils and blood vessels densities between the two lesions (p = 0.005; p = 0.003). By increasing the density of eosinophils, the density of the blood vessels increased in both lesions (r = 0.539, P = 0.001) There was no positive relationship between eosinophils and lymphatic vessels densities in the two above mentioned odontogenic lesions (p = 0.288, R = 0.191). CONCLUSION: It can be suggested that tumor angiogenesis and eosinophil densities may play a more effective role than lymphangiogenesis in local invasive behavior of ameloblastoma rather than AOT.

Intraoral ancient schwannoma: A systematic review of the case reports.

Intraoral ancient schwannoma is a rare type of oral schwannoma, which is encapsulated and well demarcated from the surrounding tissues. Ancient schwannomas are associated with conventional features of neurilemmoma; however, they are distinguished from other types of schwannoma due to factors such as the long history, cellular architecture showing hypocellularity, and hyalinized matrices. This systematic review was performed through searching in databases such as PubMed and Google Scholar using related keywords (intraoral, oral, ancient, schwannoma, and neurilemmoma). Eventually, 26 case reports were systematically reviewed by the researchers. Required data were extracted by one researcher, and all the selected articles were reviewed in full text after screening. This systematic review aimed to determine the most significant influential factors in intraoral ancient schwannoma and evaluate the diagnostic and therapeutic methods in this regard.

Immunohistochemical Expression of CD56 and ALDH1 in Common Salivary Gland Tumors.

INTRODUCTION: Natural killer (NK) cells, of which CD56 is a specific marker, play an important role in host defense against tumors. Cancer stem cells, of which aldehyde dehydrogenase isoform 1 (ALDH1) is an immunohistochemical marker, are a group of tumorigenic cells which are involved in migration and tumor recurrences. We aimed to evaluate the expression of ALDH1 and CD56 in common salivary gland tumors, as well as their relationship with each other and with a number of clinicopathologic factors. MATERIALS AND METHODS: Forty-five paraffin blocks of salivary gland tumors (pleomorphic adenoma, mucoepidermoid carcinoma and adenoid cystic carcinoma, 15 samples each) were selected. Malignant tumors were classified into two groups: low-grade (including mucoepidermoid carcinoma grade I) and high-grade (including mucoepidermoid carcinoma grade III and adenoid cystic carcinoma). Immunohistochemical staining for ALDH1 and CD56 markers was performed. Data were analyzed using SPSS (20) and the Chi-square test. RESULTS: CD56 expression was significantly higher in benign and high-grade malignant tumors (P=0.01). ALDH1 overexpressed in all three salivary tumors, but not to statistically significant degree (P=0.54). There was no statistically significant correlation between ALDH1 and CD56 expression with demographic factors (age, gender, or location of tumor; P>0.05). CONCLUSION: It appears that the number of NK cells and their function change in different types of salivary gland tumors (benign/malignant) and stroma. NK cells are important components of the anti-tumor system; therefore immune dysfunction is associated with tumor progression in tumors of the salivary gland. ALDH1 overexpression suggests its role in tumorogenesis, but ALDH1 is not involved in the morphogenesis of salivary gland tumors.

An infrequent histopathological subtype of ameloblastoma: Adenoid granular cell ameloblastoma with dentinoid.

Adenoid ameloblastoma with dentinoid is a rare odontogenic tumor. Granular cell ameloblastoma also is a less common histological subtype of ameloblastoma. In this report, the patient was a 31-year-old male. The lesion was located in the right mandible and was unicystic with well-defined borders. The tumor tissue was showing a combination of follicular, plexiform, and desmoplastic patterns of ameloblastoma with wide areas of granular cells, fibrous stroma, glandular pattern, and dentinoid calcified. Very few cases of distinct forms of ameloblastoma that show the formation of dentinoid has been reported. However, there are no cases of adenoid granular cell ameloblastoma with dentinoid reported.

A 40-year Retrospective Clinicopathological Study of Ameloblastoma in Iran.

Ameloblastoma is the most common epithelial odontogenic tumor. It may show locally invasive behavior resulting in recurrence and malignancy. Therefore, appropriate diagnosis of this tumor is necessary. The aim of this study was to evaluate clinicopathological characteristics of ameloblastomas in an Iranian population. We present a 40-year retrospective study of patients diagnosed from 1971 to 2010 in the Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Mashhad, Iran. Information gathered from patient records included age, gender, tumor location and histologic type. The frequency of odontogenic tumors among all lesions was 2.08% and ameloblastoma with 88 samples demonstrated the greatest prevalence (41.5%). Regarding gender, 60% of samples occurred in males. The mean age of studied patients was 33.02± 15.74 years with a peak of occurrence in the third decade of life. The most frequent location of tumor was the mandibles (93.2%). Eighty five (96.6%) tumors were recorded as benign and 3 (3.4%) as malignant. Of benign tumors, 62 (72.9%), 20 (23.5%) and 3 (3.6%) cases were of conventional, unicyctic and peripheral types, respectively. In contrast to most previous studies, the most common histologic subtype in the present study was plexiform. Knowledge of the incidence of ameloblastoma and its clinicopathologic features including most common location, gender and age distribution in different ethnogeographic backgrounds is necessary for accurate diagnosis and proper treatment.

Evaluation of c-kit protein (CD117) expression in common salivary gland neoplasms.

BACKGROUND: Adenoid cystic carcinoma (AdCC) is a malignant salivary gland neoplasm with poor long-term prognosis. Differentiating between AdCC and other salivary gland neoplasms can be a diagnostic challenge, particularly in examining tissues obtained from small incisional biopsies. AIM: The aim of this study was to evaluate c-kit expression in four common benign and malignant salivary gland neoplasms. MATERIALS AND METHODS: Immunohistochemical techniques were used to analyze the level of c-kit expression in normal salivary gland (n = 10) and four different types of salivary gland tumors: Pleomorphic adenoma (PA) (n = 17), AdCC (n = 9), polymorphous low-grade adenocarcinoma (PLGA) (n = 4) and mucoepidermoid carcinoma (MEC) (n = 6). Samples were immunostained using monoclonal antibody against c-kit. RESULTS: The immunoreactivity for c-kit was found in all cases of AdCC, PLGA and MEC and majority of PAs. Positive reactivity was observed in more than 50% of the tumor cells of AdCC and less than 50% in PLGA. PA did not show strong immunostaining and c-kit was predominantly localized to the cell membrane. Furthermore, the difference in the expression of c-kit between the benign and malignant neoplasms was not statistically significant. CONCLUSIONS: CD117 expression itself cannot be used as a marker in differential diagnosis of salivary gland neoplasms. However, the percentage of the CD117 immunoreactive cells and the staining intensities appeared to be important factors in distinguishing AdCC from PLGA and PA.

Immunohistochemical expression of p16 protein in oral squamous cell carcinoma and lichen planus.

Epithelial carcinogenesis is a multistep process. Specific genetic events lead to malignant transformation of oral epithelium. Oral squamous cell carcinoma (OSCC) may be preceded by potentially malignant lesions such as oral lichen planus (OLP). The p16 protein functions as a negative regulator of the cell cycle progression. Altered pattern of p16 serves as a biomarker for oral mucosal dysplasia and malignant growth. The purpose of this study was to evaluate p16 expression in OSCC and OLP to determine whether it can be a useful marker for early detection of carcinogenesis. We examined p16 expression in 45 OSCCs (15 grade I, 15 grade II, and 15 grade III), 15 OLPs without dysplasia, and 8 normal mucosal specimens with immunohistochemistry. p16 was interpreted as positive if more than 70% of tumor cells showed brown nuclear and cytoplasmic staining. All of the OSCC and control group samples showed negative immunoreactivity, whereas 26.7% of OLP samples were positive for p16. Our findings suggest that p16 expression could not be used as a helpful marker for detection of development toward malignancy in OLP samples.

A Large Ameloblastic Fibro-odontoma of the Maxillary Sinus.

INTRODUCTION: Ameloblastic fibro-odontoma is a rare, benign, asymptomatic tumor. The term ameloblastic fibro-odontoma was first used by Hooker in 1967 as a separate lesion from ameloblastic odontoma. CASE REPORT: This case report describes an eleven years old female with large ameloblastic fibro-odontoma in the right maxillary sinus. CONCLUSION: There is a low potential for recurrence after complete Enucleation of ameloblastic fibro-odontoma, but due to the risk of ameloblastic sarcoma after recurrence, the surgery should be perfect along with a careful follow up.

Ameloblastic fibrodentinoma: report of a rare case.

AIM: This is to report a rare case of ameloblastic fibrodentinoma (AFD), including detailed history, histopathologic as well as radiographic findings. Her condition, a mixed odontogenic tumor, has rarely been reported in publications. We also included the gist of theories put forward regarding the histogenesis of this lesion. BACKGROUND: AFD is a rare and controversial entity; it boasts a variety of classifications and terminology based on its unique biological nature as well as histopathological features. CASE DESCRIPTION: The patient was a 13-year-old girl with a chief complaint of central unerupted tooth on the left mandible. Cone beam computed tomographic images revealed a mixed pericoronal and multilocular lesion surrounding the crown of the aforementioned tooth, displacing it apically to a large extent. CONCLUSION: It is important to differentiate AFD from other benign mixed odontogenic tumors with similar radiographic appearance because of different therapeutic approaches in some of these tumors. CLINICAL SIGNIFICANCE: From the clinical point of view, it is of paramount significance for dental practitioners to assess any delayed tooth eruption (more than 6 months and in comparison with its counterpart on the opposite side) radiographically to ascertain or rule out any such similar lesions.

Malignant inflammatory myofibroblastic tumor of the maxillary sinus.

Inflammatory myofibroblastic tumors (IMTs) are extremely rare neoplasms with a variable natural history and biologic behavior, ranging from completely benign to malignant tumors with fatal outcome. They have no common identifiable cause, although some authors have assumed that any inflammatory stimulus may cause these pseudotumors. They are most commonly found in the lungs. Extrapulmonary sites include abdomen, retroperitoneum and extremities. IMTs rarely affect the head and neck, but the most common subsites in this region include the orbit, larynx, mouth, tonsils, parapharyngeal space, thyroid, parotid and lacrimal glands. There are few reports of inflammatory pseudotumors in the paranasal sinuses. In the maxillary sinus, the initial presenting sign is usually a nonspecific sinonasal mass, which has been growing over a period of weeks or months. On rare occasions, IMT may exhibit malignant transformation. Herein we present a rare case of pathologically proved IMT with malignant transformation which originated in the maxillary sinus of a 29-year-old male.

Evaluation of osteopontin and CD44v6 expression in odontogenic cystic lesions by immunohistochemistry.

Odontogenic cysts are common lesions with different biological behavior. Odontogenic keratocysts (OKCs) and calcifying odontogenic cysts (COCs) with ameloblastoma-like epithelium are more aggressive than dentigerous cysts (DCs) and radicular cysts (RCs). Therefore, they were included in the list of odontogenic tumors by WHO. Osteopontin (OPN) is a calcium-binding glycoprotein present in many normal tissues. It plays a role in the migration and invasion of transformed epithelial cells. Binding of OPN to its receptor CD44v6 can enhance cell motility and migration. The purpose of this study was to compare the expression of these markers between odontogenic cysts of varying biological behavior. We examined OPN and CD44v6 expression in tissue sections of 14OKCs, 14COCs, 14RCs and 14DCs by immunohistochemistry. OPN and CD44v6 immunostaining was observed in all lining epithelial cells of the studied lesions with different degrees. The highest level of OPN and CD44v6 expression was found in OKCs, followed by COCs, RCs and DCs. Comparison of both markers among four groups revealed significant differences (P<0.001). Our findings suggest that higher level of OPN and CD44v6 expression in epithelial cells of some lesions such as OKC and COC can explain the local aggressive behavior of them.

Thirty years clinicopathological study of 60 calcifying cystic odontogenic tumors in Iranian population.

AIM: To reevaluate all cases previously diagnosed as calcifying odontogenic cyst (COC) from the archives of the Department of Oral Pathology at Mashhad Faculty of Dentistry from 1978 to 2008. MATERIALS AND METHODS: Clinical histories and microscopic slides of all cases diagnosed as COC were reviewed and analyzed statistically. The information about patients such as age, sex, clinical features, radiographic view and other necessary data was gathered from biopsy files. RESULTS: The majority of cases occurred in mandible and four cases were peripherally. Thirteen cases were associated with other odontogenic tumors and 11 cases were odontoma type. In two cases, recurrence was reported after surgical treatment which underwent malignant transformation. CONCLUSION: Calcifying cystic odontogenic tumor (CCOT) in Iranian population occurs in younger age group with slightly male predilection and more mandibular, unicystic and simple type. CLINICAL SIGNIFICANCE: It is better to address the noncystic CCOT lesions with their specific terms in order to make histopathological characteristics clear.

Glandular odontogenic cyst of the posterior maxilla.

The glandular odontogenic cyst is an uncommon developmental odontogenic cyst described as a distinct entity by Gardner et al. in 1988. The Glandular odontogenic cyst occurs more commonly in middle-aged people and has a predilection for the mandible. Only histopathological examinations allow for certain diagnosis of the cyst. The increased recurrence rate can be due to its multilocularity and incomplete removal of the lining following conservative treatment. This article presents a case of glandular odontogenic cyst in a 28-year-old male patient in the posterior region of the maxilla, which is quite rare.

The expression of heat shock proteins 27 and 105 in squamous cell carcinomaof the tongue and relationship with clinicopathological index

Introduction: In oral cavity, the tongue is the most common site prone to development of squamous cell carcinoma(SCC). Considering malignant transformation as a cellular stress, the expression of heat shock proteins (HSPs)may be affected in this process. In this study we assessed the expression of HSP105 and HSP27 as two of the mostinterested stress proteins and investigated their relationship with grade and stage of the tongue SCC.Material and Methods: Fifty-six specimens including 31 early and 25 advanced tongue SCC were gathered. Allspecimens were graded histologically from I to III. Sixteen sections of normal oral mucosa were used as controlgroup. The cellularity and intensity of HSP105 and HSP27 expression were studied immunohistochemically inboth case and control groups. Results were expressed by histochemical score (HSCORE).Results: Significant differences were observed between expression of HSPs and stage of the disease. From earlyto advanced stage, the expression of HSP105 and HSP27 increased and decreased, respectively. There was norelationship between histological grade of lesion and HSCORE of HSP105 expression (P=0.5), although, HSP27expression had reverse relationship with the SCC histological grade.Conclusion: HSP27 and HSP105 may be indicated for prognostic purposes in evaluation of tongue SCC. HSP 27may be used for more accurate microscopic grading of tongue SCC. Increased expression of HSP105 in advancedstage may lead to using this protein for immunotherapy of tongue SCC (AU)

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Immunohistochemical detection of p53 and PCNA in ameloblastoma and adenomatoid odontogenic tumor.

Although ameloblastoma and adenomatoid odontogenic tumor (AOT) belong to the same group according to the World Health Organization, they show different biologic behaviors. PCNA, an amplifier of cell proliferation, and p53, a tumor suppressor protein, are overexpressed in some odontogenic lesions. The purpose of this study was to immunohistochemically evaluate the expression of p53 and PCNA to clarify the possible role of these proteins in different behaviors of ameloblastoma and AOT. The immunohistochemical expression of PCNA and p53 was determined in 30 solid ameloblastomas and 12 AOTs. Statistical tests including one-way ANOVA, t-test, chi-square, Mann-Whitney U and Kendall were used to analyze the data. All tissue sections (except one specimen of plexiform ameloblastoma) exhibited immunoexpression for p53. PCNA was expressed in all specimens. There was no significant difference in PCNA expression between ameloblastomas and AOTs (P > 0.05). For p53, there was no statistical difference between subtypes of ameloblastomas (P > 0.05), whereas statistical differences were observed between ameloblastomas and AOTs (P < 0.001). There was no statistical difference in PCNA intensity of staining between ameloblastomas and AOTs (P > 0.05), whereas the p53 intensity in ameloblastomas was stronger than AOTs (P < 0.05). Positive correlation between PCNA and p53 was observed. We concluded that PCNA overexpression is not responsible for the difference in clinical behavior of these two lesions, whereas the expression of p53 in ameloblastoma may explain the more aggressive nature of this tumor compared with AOT.

The expression of heat shock proteins 27 and 105 in squamous cell carcinoma of the tongue and relationship with clinicopathological index.

INTRODUCTION: In oral cavity, the tongue is the most common site prone to development of squamous cell carcinoma (SCC). Considering malignant transformation as a cellular stress, the expression of heat shock proteins (HSPs) may be affected in this process. In this study we assessed the expression of HSP105 and HSP27 as two of the most interested stress proteins and investigated their relationship with grade and stage of the tongue SCC. MATERIAL AND METHODS: Fifty-six specimens including 31 early and 25 advanced tongue SCC were gathered. All specimens were graded histologically from I to III. Sixteen sections of normal oral mucosa were used as control group. The cellularity and intensity of HSP105 and HSP27 expression were studied immunohistochemically in both case and control groups. Results were expressed by histochemical score (HSCORE). RESULTS: Significant differences were observed between expression of HSPs and stage of the disease. From early to advanced stage, the expression of HSP105 and HSP27 increased and decreased, respectively. There was no relationship between histological grade of lesion and HSCORE of HSP105 expression (P=0.5), although, HSP27 expression had reverse relationship with the SCC histological grade. CONCLUSION: HSP27 and HSP105 may be indicated for prognostic purposes in evaluation of tongue SCC. HSP 27 may be used for more accurate microscopic grading of tongue SCC. Increased expression of HSP105 in advanced stage may lead to using this protein for immunotherapy of tongue SCC.

Detection of nucleoproteins in squamous cell carcinoma, and dysplastic and normal mucosa in the oral cavity by methyl green-pyronin staining.

Squamous cell carcinoma (SCC) is the most malignant neoplasm of the oral cavity. The mortality rate associated with head and neck cancers remains high, and thus detection techniques are important. In the present study, methyl green-pyronin staining was applied to 5 normal mucosa specimens, 10 cases of dysplastic mucosa, 12 cases of SCC (grade I), 10 cases of SCC (grade II) and 5 cases of SCC (grade III) in the oral cavity. This is the first study in which nuclear and nucleolar cytomorphometric parameters (diameter, area and number) in such oral lesions were evaluated using this method. As methyl green-pyronin selectively stains nucleic acids, it can differentiate between DNA (green) and RNA (red). The results reveal that the proposed method can be used to evaluate changes in the nucleus and nucleolus in premalignant lesions in the oral cavity.

Mast cell density and angiogenesis in oral dysplastic epithelium and low- and high-grade oral squamous cell carcinoma.

OBJECTIVE: Oral squamous cell carcinoma (OSCC) is one of the 10 most common malignant tumors and SCC accounts for approximately 94% of all oral malignancies. The risk of malignant transformation in dysplastic lesions is greater than that of normal oral mucosa. The definite roles of mast cells and angiogenesis in OSCC have been under debate. The aim of this study was to compare mast cell count (MCC) and microvessel density (MVD) among normal oral mucosa, oral dysplastic epithelium and low- and high- grade OSCC. MATERIAL AND METHODS: A total of 42 specimens of OSCC (21 high- and 21 low-grade) were collected, along with six normal and 22 dysplastic oral mucosa. The mean MCC and MVD, as well as the correlation between them, were evaluated by immunohistochemical staining. RESULTS: Statistically significant increases in mean MCC and MVD were observed between normal oral mucosa and epithelial dysplasia, normal oral mucosa and OSCC and epithelial dysplasia and OSCC (P < 0.05), but there were no statistically significant differences in MCC and MVD between low- and high-grade OSCC. Also, the Spearman's correlation coefficient showed a significant correlation between MCC and MVD (r = 0.727, P < 0.001). CONCLUSIONS: The significant correlation found between MCC and MVD is in agreement with the idea that mast cells promote tumor progression via upregulation of angiogenesis. MCC and the degree of angiogenesis can potentially be used as indicators of the evolution of SCC from epithelial dysplasia.

Immunohistochemical analysis of p53 and PCNA expression in calcifying odontogenic cyst.

Calcifying odontogenic cyst (COC) is a developmental odontogenic cyst in the jaw. Because of its diverse histopathologic features and biological behavior, there has long been confusion with regard to its nature as a cyst or neoplasm. This study evaluated the proliferative activity of 57 COC samples, including simple cyst (10 cases), cystic neoplasm (34 cases), solid neoplasm (6 cases) and combined lesion (7 cases) by p53 and PCNA immunohistochemical staining. For assessment of p53 and PCNA positivity, the number of positively stained cells with brown-stained nuclei was counted in 1000 cells from each sample. p53 and PCNA expression in the solid neoplasm subtype were significantly higher when compared to cystic neoplasm and simple cyst (P < 0.05). The lowest p53 and PCNA expression was found in the simple cyst subtype. p53 and PCNA expression in the basal and suprabasal layers was significantly higher in the solid subtype when compared to others, and the difference between COC groups was significant. The results demonstrated that within benign types of COC, the amount of p53 and PCNA in proliferative epithelium is significantly higher when compared to non-proliferative epithelium. p53 and PCNA markers are possible parameters for differentiation of COC subtypes.

Sebaceous adenoma of the submandibular gland: a case report.

Sebaceous adenoma of the salivary gland is a rare tumor comprising 0.1% of all salivary gland neoplasms and less than 0.5% of salivary adenomas. Histologically, sebaceous adenomas are benign neoplasms consisting of sebaceous cells arranged in nests forming acinar and duct-like structures. Oncocytic metaplasia may also occur in some areas. We describe a case of sebaceous adenoma in the submandibular gland. Under a presumptive diagnosis of sialadenitis/sialolithiasis, the patient was administered multiple courses of antibiotics; however, these were not effective. Excisional biopsy resulted in a diagnosis of sebaceous adenoma. A 1-year follow-up showed no recurrence.