Reactive localised inflammatory hyperplasia of the oral mucosa.

OBJECTIVE: To document the histopathological pattern and distribution of reactive localised inflammatory hyperplastic lesions of the oral mucosa diagnosed at the University of Nairobi Dental Hospital over a 14 year period. DESIGN: A retrospective, cross-sectional descriptive study. SETTING: Division of Oral Pathology and Oral Medicine, histopathology laboratory, School of Dental Sciences, University of Nairobi. SUBJECTS: A total of 3135 oral biopsies were accessioned in the oral diagnostic histopathological Laboratory registry over a period of 14 years from March 1991 to December 2005. RESULTS: Three hundred and thirty three cases were histopathologically diagnosed as reactive inflammatory hyperplasias of the oral mucosa. This constituted 10.6% of the total oral biopsy specimens analysed during this period. Fibrous epulis was the most common histological sub-type with 129 cases (38.7%) followed by pyogenic granuloma with 94 (28.3%) cases. Six (1.8%) cases were peripheral giant cell granuloma and three cases (0.9%) were those of denture irritation hyperplasia. The age distribution ranged from 2 to 78 years (mean = 30.5 years) with a peak at 20-29 years. Gender distribution showed that 107 (32%) cases occurred in males and 226 (68%) cases females. Similar trends were observed in most of the histological sub-types. Fibrous epulis occurred in 41 male (31.8%) cases and in 88 (68.2%) females with an age range of 2 to 78 years (mean = 30.5 years). As for the pyogenic granuloma, 26 (27.7%) lesions occurred in males and 68 (72.3%) in females with an age range of 2 to 75 years (mean = 30.1 years). Among all the histopathological sub-types it was shown that 223 (67.0%) cases were fibrous, 104 (31.2%) vascular and six (1.8%) peripheral giant cell granuloma. Gingival lesions were the most common with 257 (77.2%) cases followed by 28 (8.4%) in the tongue, 16 (4.8%) lips, 15 (4.5%) cheek, six (1.8%) palate and the rest on the floor of the mouth and other mucosal sites. The duration of these lesions was recorded in 182 (54.7%) cases and ranged from 1 week to 16 years (mean = 1.8 years). Only 15 (4.5%) cases were reported to have recurred and all of them were gingival lesions. CONCLUSION: The present study has shown that the prevalence of reactive localised inflammatory hyperplasia (RLIHs) of the oral mucosa was 10.6% with fibrous epulis and pyogenic granuloma having been the most common histopathological sub-types predominantly affecting females. Although RLIHs are distinguished on clinical or histopatholocal grounds, it is important to appreciate that they are variations of the same basic process.

An audit of oral diseases at a Nairobi centre, 2000-2004.

OBJECTIVES: To describe oral diseases diagnosed in an urban referral centre in Kenya in terms of age, gender and anatomical distribution and to compare this with reports in the literature. METHODOLOGY: A retrospective histopathological audit. SETTING: Oral Pathology Laboratory at the University of Nairobi Dental Hospital, a tertiary referral centre in Kenya. RESULTS: 548 (53.83%) patients were diagnosed with oral and maxillofacial tumours. Benign tumours (mean age +/- SD = 29.93 +/- 18.27 years) peaked in the third decade and tended to affect men at a younger age (p = 0.001). The most common benign tumour was the ameloblastoma (50.23%: n = 109), which predominantly affected the mandible, and also occurred in male patients at a younger age (p = 0.023). Peak incidences for malignant disease were observed in the sixth decade (mean age +/- SD = 46.94 +/- 18.99 years). Oral squamous cell carcinoma (OSCC) was the most common malignant tumour (59.55%; n = 187); occurring in the tongue, floor of the mouth, buccal mucosa and palate. 10.30% of OSCC occurred in patients under 40 years of age. 147 patients presented with cysts, which were mainly (68.10%) of odontogenic origin. Reactive lesions, infections, salivary gland diseases and autoimmune conditions constituted 26.60% of the case load. CONCLUSION: The tendency of oral squamous cell carcinoma to occur in younger age groups may be an indication of carcinogenic factors that could be peculiar to this population. There is an urgent need for the expansion of reporting systems for oral diseases as an integral part of development of appropriate strategies in the improvement of general health in Kenya.

Pattern of occurrence of head and neck cancer presenting at Kenyatta National Hospital, Nairobi.

BACKGROUND: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. OBJECTIVE: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. DESIGN: Retrospective hospital-based descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULT: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. CONCLUSION: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.

Ameloblastic fibroma at the University of Nairobi Dental Hospital.

OBJECTIVE: To document the occurrence of cases of ameloblastic fibroma. DESIGN: A retrospective study. SETTING: The Division of Oral Pathology and Oral Medicine histopathology laboratory at the Faculty of Dental Sciences, University of Nairobi, January 1991 to December 2000. RESULTS: Seven complete records of histopathologically confirmed cases of ameloblastic fibroma were identified. There were four male and three female cases with an age range of 10 to 22 years (mean=14 years). Remarkably, six of the cases had lesions in the molar regions of the mandible with a single case with a maxillary molar area lesion. One of the cases had the neoplasm associated with an unerupted tooth. From the clinical notes all the patients were managed by meticulous enucleation and curettage of the lesions. After follow up periods ranging from several months to eight years no recurrences had been recorded. CONCLUSION: Evidently ameloblastic fibroma is an uncommon neoplasm as noted in the earlier literature. Although the lesions can be quite extensive at the time of diagnosis, the recurrence rate appears to be relatively low if the neoplasms are meticulously extirpated.

Osteosarcoma of the maxillofacial bones in Kenyans.

Osteosarcoma (OS) is a highly malignant tumour and is the most common primary neoplasm of bone; although rare, especially in the maxillofacial skeleton. This article presents 14 Kenyan cases of OS of the maxillofacial bones seen between January 1991 and July 1997: 11 in the mandible, two in the maxilla and one in the right zygomatic arch. Patients ranged in age from one week to 50 years (Mean = 29.7), with an equal gender distribution. While pain and rapid swelling were the commonest clinical features, the radiographic and histopathological characteristics were as varied as has been described elsewhere. Generally, effective management of most of the cases was poor due to late presentation for treatment.

Clinico-pathological analysis of jaw tumours and tumour-like conditions at the Kenyatta national hospital.

This paper presents an analysis of 568 jaw tumours and tumour-like conditions seen at the Kenyatta National Hospital over a period of fifteen years. For descriptive purposes, the term tumour is used here in its wider context to cover both neoplastic and dysplastic jaw lesions which present primarily as jaw swellings. The study reveals a pattern consistent with other African series and suggests a more aggressive progression and younger age at onset than elsewhere.

Oral tumours and tumour-like conditions in Kenya: I. Histological distribution.

A histological analysis of 3141 cases of oral tumours and tumour-like lesions diagnosed at Kenyatta National Hospital between 1978 and 1992 has been carried out. Squamous cell carcinoma, salivary gland tumours and lymphoid tumours form the majority of lesions. In general, the histological distribution of the oral tumours do not differ significantly from those reported in non African series save for the Burkitt's lymphoma.

Oral tumours and tumour-like conditions in Kenya: II. Age, sex and site distribution.

This paper presents the age, sex and site distribution of oral tumours and tumour like conditions in Kenya. It confirms some important points. First, there is an overall lower mean age for oral tumours in African series compared to non African series. Secondly, sex bias in the distribution of oral tumours is less marked for most tumours in Africans. Thirdly, there is difference in site distribution and oral tumours between Africans and non-African populations.

Congenital epulis of the newborn: a report of two cases.

Congenital epulis of the newborn is a rare lesion whose histogenesis and natural clinical history have remained obscure. Even with the advent of modern histopathological techniques, it has not been possible to depict specific cellular features unique to this lesion. However, it is important that new cases are reported from all populations so that their occurrence and frequency may be easily noted. Furthermore, the lesion is important as a differential diagnosis of other aggressive lesions early in life. This report presents two Kenyan cases.

Focal epithelial hyperplasia (Heck's disease) in three Kenyan girls: case reports.

We report the first three patients diagnosed with focal epithelial hyperplasia (Heck's disease) in Kenya. Clinically they presented as focal or diffuse papillomatous lesions in the oral mucosa. Histopathological features rule out other similar lesions inter alia multiple fibro-epithelial and viral warts.

Primary malignant fibrous histiocytoma of the mandible: a case report.

A case report of a primary malignant fibrous histiocytoma (MFH) in the mandible of a young adult male is presented and relevant literature reviewed. The clinical presentation and course of the case is typical of MFH of the jaw as reported in the literature.

Oral verrucous carcinoma: report of two cases and review of literature.

Verrucous carcinoma is a rare and distinct pathological and clinical variant of well-differentiated squamous cell carcinoma. Two case reports of histologically proven oral verrucous carcinoma are presented. One case presented with a history of tobacco chewing, snuff taking and miraa chewing. While the relationship between tobacco chewing or snuff dipping and verrucous carcinoma has been investigated and described, the role played by miraa chewing is still unknown and thus requires further study. Both cases were successfully managed by only conservative surgical excision. No radiotherapy was used. Clinical and histo-pathological examination of verrucous carcinoma is therefore very important in its diagnosis and treatment planning.

Salivary gland tumours in Kenya.

Four hundred and seventeen tumours of salivary glands in Kenya were analysed. There is no evidence of higher incidence of salivary tumours than in non-African countries. The pattern of distribution differed from that of western countries, but in conformity with most African series showed a low proportion of tumours of the parotid gland and high proportion of tumours in the submandibular gland and the palate. The involvement of the palate by salivary gland tumour is very prominent in the African series and particularly more so in the females. Malignant tumours of the palate and parotid glands were frequent but were lower than those reported in other African series. On the other hand malignant salivary gland tumours of the submandibular glands while lower than those of the western countries, were higher than those of other African series.

Fibrous dysplasia of the jaws: a review of literature.

This communication reviews the literature on fibrous dysplasia of the jaws particularly the available published reports on this condition from Africa. It reveals that few cases appear to have been reported from Africa, reflecting the lack of research work and case reports. The majority of these cases are generally reported in advanced stages indicating the late presentation for treatment and delayed diagnosis. Information regarding follow-up records appears scanty and this probably may have contributed to the difficulty in determining the prognosis and any recurrent rate. Much effort still needs to be directed at research on oral lesions to determine their true occurrence and distribution in the African continent.

Ossifying fibroma of the jaws: a case report.

This communication presents the first case report of ossifying fibroma of the jaw from Kenya and reviews the literature including the available published case reports from Africa. The relationship between ossifying fibroma and other related benign fibro-osseous lesion of the jaws is briefly discussed. Intensified research work on this condition in Africans is called for so that more cases should be published since it is reportedly more common in black race. The majority of the African cases are generally reported in advanced stages indicating neglect or delay in seeking for medical help. Since ossifying fibroma is a well encapsulated and expansile benign bone neoplasm, surgical enucleation appears to be the treatment of choice; recurrence is rare.

Adenomatoid odontogenic tumour (adenoameloblastoma)--a review.

The adenomatoid odontogenic tumour (AOT) is a rare benign neoplasm of odontogenic origin. A review of the available published literature reports on AOT from Africa reveals that 33 cases appear to have been reported and that the tumour tends to occur in young patients, from 10-28 years with a mean age of 16.2 years. Females are affected more than males, with a female:male ratio of 3:2. 65.6% of cases were in the maxilla and 34.4% in the mandible, the majority of which (92.3%) are located in the anterior region of the jaws. 66.7% of the cases are associated with unerupted teeth. Clinically, AOT shows increasingly painless swellings which may eventually cause facial deformity. Tentative clinical diagnosis based on radiology is not pathognomonic for AOT; histopathological confirmation is necessary since incorrect diagnosis may lead to mutilating surgery whereas the lesion is benign with limited growth potential and treatment requires only simple surgical enucleation. Recurrence is rare.