Comparative Analysis of the Histopathologic Features, ß-Catenin, and Ki67 Expression between Fibromatosis and Fibrosarcoma.

STATEMENT OF THE PROBLEM: The biologic behavior and histopathological features of fibromatosis are intermediate between those of fibroma and fibrosarcoma. PURPOSE: The aim of the present study was to determine useful histopathologic and immunohistochemical characteristics for the differentiation of these lesions. MATERIALS AND METHOD: In this cross-sectional descriptive study, 40 specimens comprising 20 fibrosarcoma and 20 fibromatosis biopsies were selected. The histopathologic characteristics of these lesions were identified and immunohistochemical staining for Ki67 and ß-catenin markers was performed. Sections were examined by light microscopy and positively stained cells were counted. Results were analyzed by SPSS 20 using Chi-square test, Mann-whitney test, and t-test (p< 0.05). RESULTS: Statistical significant differences were observed between fibromatosis and fibrosarcoma in terms of distribution frequency, mitotic rate, herringbone pattern, cellularity, overlapping of nuclei, mean Ki67 score, and atypia rate. The other features including age, gender, necrosis, clarity of nucleoli and mean ß-catenin were not significantly different. CONCLUSION: The present findings suggest the mitotic figures, Ki67, herringbone pattern, cellularity, and atypia are useful to differentiate fibromatosis from fibrosarcoma.

Study of Extrinsic Apoptotic Pathway in Oral Pemphigus Vulgaris Using TNFR 1 and FasL Immunohistochemical Markers and TUNEL Technique.

STATEMENT OF THE PROBLEM: Pemphigus vulgaris is characterized by intraepithelial vesicles, but pathogenesis of vesicle formation in this disease has not been substantiated yet. PURPOSE: The present study investigate extrinsic apoptotic pathway in oral pemphigus vulgaris using TUNEL and important immunohistochemical markers of extrinsic pathway, TNFR1 and FasL. MATERIALS AND METHOD: In the present cross sectional study, 25 oral pemphigus vulgaris samples and 6 normal oral mucosa were analyzed for the presence of apoptosis by TUNEL and the staining of TNFR1 and FasL in basal and parabasal layers around vesicle, vesicle floor, vesicle roof and acantholytic cells. The staining expression and intensity were measured and the obtained data were analyzed by Wilcoxon and Mann-Whitney tests. RESULTS: There was no or faint staining of TUNEL, FasL and TNFR1 in normal oral mucosa. In addition, there was no significant difference between the staining of TUNEL technique in different layers. The staining of TNFR1 marker was very high in all regions. FasL marker was not positive in the basal and parabasal layers around vesicle in 92% of samples but showed a varied and different staining in vesicle region. There was a significant difference between the each two markers in all layers (p <0.001). CONCLUSION: Apoptosis is probably is a preceding phenomenon to acantholysis in pemphigus vulgaris. It appears that the apoptosis occurs mostly by extrinsic pathway using proapototic mediators TNFR1 and FasL.

Rare and Extensive Malignant Melanoma of the Oral Cavity: Report of Two Cases.

Primary oral melanomas are uncommon malignant neoplasm of melanocytes origin. The most common site of oral melanoma is maxillary gingiva and hard palate. Oral mucosal melanoma exhibit a pathobiological behavior and clinical features different from cutaneous melanomas. Oral melanomas are often clinically silent which may consequently result in delayed diagnosis; thus, making the prognosis extremely poor. This case report presents clinical, histopathological and immunohistochemical features of two cases of advanced oral melanoma, one pigmented or melanotic melanoma in a 46-year-old female and another amelanotic melanoma in a 59-year-old male patient, with chief complaint of swelling in oral mucosa. Most oral melanomas are usually asymptomatic lesions with quick growing. Thus, the most cases are detected in late stage of diagnosis. Early diagnosis with careful examination by dentists, and early biopsy of pigmented and suspicious non-pigmented lesions would have an imperative role in more survival rate and better prognosis.

Stafne bone cavity with ectopic salivary gland tissue in the anterior of mandible.

Stafne bone cavities (SBCs) are uncommon well-demarcated defects of the mandible, which often occur in the posterior portion of the jaw bone and are usually asymptomatic. Furthermore, SBC is found in men aged 50-70-year-old. Anterior mandibular variants of SBC are very rare. This article describes a case of anterior SBC in a 45-year-old man that resembled endodontic periapical lesions. Upon histopathological examination, it turned out to be a normal salivary gland tissue.

Histological Evaluation of Wound Healing Process after Photodynamic Therapy of Rat Oral Mucosal Ulcer.

STATEMENT OF THE PROBLEM: When the body defense is compromised, wounds can act as a route for entrance and colonization of microorganisms in the body. Photodynamic therapy with methylene blue is known as a promising antimicrobial modality. PURPOSE: The present study aimed to investigate the effects of this procedure on wound healing processes. MATERIALS AND METHOD: In this experimental study, 48 male Wistar rats were recruited. Experimental wounds were surgically made on their buccal mucosa. Based on the treatment modality, they were divided into 3 groups (n=16) of control (CG), laser (LG), photosensitizer+ laser (PLG) by methylene blue (MB). The treatment procedure in the two latter groups was done in days 1-4 and 6-9. After sacrificing on 2, 4, 7 and 14-day follow-ups, the microscopic grade of healing of the wounds was assigned on each interval according to histological grading criteria. RESULTS: A qualitative result was obtained that showed a healing progression in PLG at day 2 of follow-up. At day 4 of follow-up, no difference was seen in healing stage among the groups. However on day 7 of follow-up, samples of the LG showed a lower degree of healing compared with the other two groups. Likewise, on day 14 of follow- up, both PLG and LG showed lower degree of healing than CG. CONCLUSION: This study qualitatively showed that MB- mediated photodynamic therapy would have an inhibitory effect on healing process after 14 days of the wound creation.

Peripheral Primitive Neuroectodermal Tumor (pPNET) of the Parotid: Report of a Rare Case.

Primitive neuroectodermal tumors (PNETs) are a family of highly malignant soft tissue neoplasms mostly occurring in children and young adults. PNETs usually develop in the thoracopulmonary region, abdomen, pelvis, and rarely in the head and neck region. Here, a case of PNET located in the parotid gland is reported.

Comparative evaluation of eosinophils in normal mucosa, dysplastic mucosa and oral squamous cell carcinoma with hematoxylin-eosin, Congo red, and EMR1 immunohistochemical staining techniques.

BACKGROUND: Oral squamous cell carcinoma is the most common malignant lesion of the oral cavity, and it involves various molecular mechanisms. The development of oral squamous cell carcinoma is influenced by the host immune cells, such as eosinophils. The present study was conducted to compare the presence of eosinophils in normal mucosa, dysplastic mucosa, and oral squamous cell carcinoma by -hematoxylin- eosin staining, Congo red staining, and epidermal growth factor-like (EGF-like) module containing a mucin-like hormone receptor1 (EMR1) immunohistochemical marker. METHODS: In this cross-sectional study, 60 paraffinized samples were selected, consisting of 20 normal mucosae, 20 dysplastic mucosae, and 20 squamous cell carcinoma samples. After confirmation of the diagnosis, the mean number of eosinophils was evaluated by hematoxylin-eosin, Congo red, and immunohystochemical staining techniques. The data were analyzed by SPSS-10 software using the Kruskal-Wallis and Friedman tests. RESULTS: The results showed that the number of eosinophils in dysplastic mucosa was significantly higher than the number in normal mucosa, and the number of eosinophils in squamous cell carcinoma was significantly higher than the number in dysplastic mucosa in all staining techniques (p<0.001). Moreover, the comparison of staining techniques showed a significantly higher number of eosinophils in EMR1immunohistochemicalmarker than were observed when Congo red and hematoxylin - eosin (H&E) staining techniques were used (p<0.001). CONCLUSION: It can be argued that eosinophil contributes to the identification of lesions that have a higher potential of malignant transformation. Moreover, eosinophil can be suggested as an indicator in the differentiation of oral lesions in cases with borderline diagnosis and in targeted molecular therapy.

Study of Epstein-Barr virus expression in Burkitt's lymphoma by polymerase chain reaction and in situ hybridization: A study in Iran.

BACKGROUND: The association of Epstein-Barr virus (EBV) with Burkitt's lymphoma (BL) is variable in different geographic regions. In developing countries, the association of EBV with BL is regarded to be of an endemic-type in equatorial Africa (> 95%) and sporadic-type in the developed countries (15-30%). The purpose of this study is to assess the frequency of EBV infection in BL, in Iran. The study also aims to compare Ribonucleic acid (RNA) in situ hybridization (RISH), the standard diagnostic method, with the polymerase chain reaction (PCR)-based method for diagnosing BL. MATERIALS AND METHODS: In this epidemiological study, the paraffinized specimens of 18 cases of BL were selected. Next, the ISH of EBV-encoded RNA (EBER-RISH) and PCR assays that were based on Epstein Barr Nuclear Antigen 2 (EBNA2) amplification were used. The EBV strain was determined by PCR. The data were analyzed using the SPSS10 software and by performing Pearson correlation coefficient formula at a significant level of 0.05. RESULTS: EBV RNA was detected in 50% of the BL specimens. Type 1 and 2 accounted for 70 and 30% of the cases, respectively. Regarding RISH as the standard method for EBV diagnosis, the PCR assays showed a sensitivity and specificity of 100 and 88.9%, respectively. CONCLUSION: According to the obtained findings, the frequency of EBV in BL was 50% and PCR and RISH showed high concordance and sensitivity in EBV detection. Therefore, PCR can be used as a faster method for EBV detection in high-risk geographical regions.

Study of the biologic behavior of odontogenic keratocyst and orthokeratinaized odontogenic cyst using TGF-alpha and P53 markers.

Odontogenic keratocyst (OKC) is an aggressive cyst, and its recurrence rate is higher than that of other odontogenic cysts. Orthokeratinized odontogenic cyst (OOC) is less aggressive than OKC, but bears the probability of carcinomatous changes. In this study, we evaluated the expression and intensity of P53 and TGF-alpha in order to compare the biologic behavior or probable carcinomatous changes of these two cysts. In this cross-sectional study, 15 OKC and 15 OOC were stained immunohistochemically for P53 and TGF-alpha using the Novolink polymer method. Then, all slides were examined by an optical microscope with 400× magnification, and the stained cells in the basal and parabasal layers were counted. Finally, the results were analyzed by the Mann-Whitney and Wilcoxon tests (P-value<0.05). The difference between the expression of P53 and TGF alpha in the basal layer of OKC and OOC was not statistically significant (P-value>0.05), but the expression of P53 and TGF-alpha in the parabasal layer in OKC was statistically higher compared to OOC (P<0.05). Considering the known role of P53 and TGF-alpha in malignant changes and the higher expression of P53 and TGF-alpha in OKC compared to those in OOC, the probability of carcinomatous changes was higher in OKC than in OOC.

A comparative study of histological grade and expression of Ki67 protein in oral squamous cell carcinoma in young and old patients.

BACKGROUND: Oral squamous cell carcinoma (SCC) is the most common cancer of oral region. The characteristic feature of SCC is invasion of dysplastic epithelium into the connective tissue. Oral SCC is more common in old patients. It is believed that etiology and pathogenesis of SCC in young patients differ from old patients and it is related to different molecular mechanism. In this study, histopathologic differentiation and proliferation activity (by Ki67) in oral SCC lesions of young patient (<40 years) and old patients (>50 years) have been compared. MATERIALS AND METHODS: In a cohort study, Formalin Fixed and paraffin-embedded tissue sections of 20 oral SCC of young patients and 20 oral SCC of old patients were stained by H and E and immunohistochemically by biotin-streptavidin method. They were observed by two pathologists. Histological grade and Ki67 labeling index (LI) were determined. Data were analyzed by t-test and Mann-Whitney. RESULTS: In cases of oral SCC in young patients, 80% were grade I and 20% were grade II and Ki67 LI was 21/5% in this age group. In cases of oral SCC in old patients, 75% were grade I and 25% were grade II and Ki67 LI was 21/6% in this age group. CONCLUSION: Histological and immunohistochemical evidence of this study show that oral SCC of young patients and oral SCC lesions of old patients didn't show any differences in histopathological differention and proliferative activity.

Study of apoptosis in oral pemphigus vulgaris using immunohistochemical marker Bax and TUNEL technique.

BACKGROUND: Pemphigus vulgaris (PV) is an autoimmune mucocutaneous disease presenting clinically with blisters or erosions of the skin and mucous membrane. The main histopathologic characteristic of this disease is suprabasal vesicles due to loss of cell-cell adhesion between keratinocytes named acantholysis. Studies have shown that apoptosis is increased in PV. The purpose of this study is to investigate the role of apoptosis in blister formation in PV. METHODS: This cross-sectional study was conducted on 25 specimens of oral PV. The presence of apoptosis was evaluated using the TUNEL technique in the normal perilesional region, vesicle area, and acantholytic cells. Also, the expression of Bax pro-apoptotic marker was assessed by the biotin-streptavidin immunohistochemical method. SPSS software was used for Wilcoxon test analysis. P values <0.05 were considered significant. RESULTS: The percentage and intensity staining of TUNEL-positive cells were noteworthy. There were statistically significant differences between basal and parabasal (P = 0.05), tombstone with vesicle roof (P = 0.038) and basal with tombstone (P = 0.038). However, the expression and staining intensity of pro-apoptotic marker Bax were weak, and no statistically significant differences were observed between the various areas. CONCLUSION: The results obtained in the present study suggest that the process of apoptosis occurs early in PV because it was observed in the perilesional normal appearing tissue. Also, the process of apoptosis may cause exacerbation or speeding of the bulla formation. In other words, inhibition of apoptosis in the patients could reduce the severity of the lesions.

HSP27 and HSP70 expression in squamous cell carcinoma: An immunohistochemical study.

BACKGROUND: Heat shock proteins (HSPs) are a family of proteins that are known to play a significant role in the repair of denatured proteins in the cell. It seems that cytoprotective properties of HSPs may help in malignant progression by facilitating tumor cell growth and survival. The purpose of this study is to evaluate HSP27 and HSP70 expression in various histopathological grades of squamous cell carcinoma (SCC). MATERIALS AND METHODS: In this retrospective-analytical study, the sections of 51 formalin-fixed paraffin-embedded biopsy specimens of SCC from various sites of oral and paraoral regions and 10 normal oral mucosa were immunostained by Novolink Polymer technique to determine the expression of HSP27 and HSP70. Then the data were analyzed according to the Kruskal-Walis, Mann-Whitney and the Spearman correlation tests (P<0.05). RESULTS: The expression of HSP27 in well-differentiated SCC was significantly higher than normal epithelium (P=0.007) and in moderately differentiated SCC higher than poorly-differentiated SCC (P=0.023). Inverse correlation was observed between HSP27 expression and SCC's histopathological grade (P=0.001, r=-0.448). There was no significant difference between HSP70 staining of specimens (P=0.38). CONCLUSIONS: The present study revealed that the expression level of HSP27 was inversely related to histopathological grade of SCC and it may provide prognostic value for patients with SCC, but there was no significant relationship between the expression of HSP70 and histopathological grades of SCC.

Metastatic anaplastic large cell lymphoma of the oral cavity.

Lymphoma is a malignant neoplasm of lymphoid tissue which is divided into 2 groups: Hodgkin and non-Hodgkin. About 85% of non-Hodgkin lymphomas are B-cell lymphomas, and T-cell lymphomas are unusual. Anaplastic large cell lymphoma (ALCL) is a kind of non-Hodgkin lymphoma with T or NK cell origin that is rarely seen in the oral cavity and only 10 cases have been reported up to now. Here we present a case of ALCL metastasized to the oral cavity in a 32- year- old man with pervious history of ALCL which caused an ulceration in the posterior area of the hard palate. Radiography showed irregular resorption of alveolar bone. Histopathologic examination of the incisional biopsy revealed neoplastic proliferation of large and bizarre cells with hyperchromatic nuclei and numerous giant cells and atypical mitoses. Immunohistochemistry markers (CK, LCA, CD3, CD30, CD20) confirmed the diagnosis of ALCL.

Comparative study of TGF-alpha and P53 markers' expression in odontogenic keratocyst and orthokeratinaized odontogenic cyst.

BACKGROUND: Odontogenic keratocyst (OKC) is an aggressive cyst and its recurrence is higher than other odontogenic cysts, orthokeratinized odontogenic cyst (OOC) is a cyst with moderate biological behavior in comparison with OKC, but with the probability of carcinomatous changes. The present study aims to evaluate the quantity and intensity of the expression of P53 protein and transforming growth factor alpha (TGF-alpha) in OKC and OOC in order to compare the biologic behavior of these two cysts. MATERIALS AND METHODS: This is a cross-sectional study. The samples include 30 cysts (15 OKC and 15 OOC), all stained immunohistochemically for P53 protein and TGF-alpha by the Novolinke polymer method. Then, all the cases were examined with an optical microscope with Χ400 magnification and the stained cells were counted in the basal and parabasal layers. Finally the results were analyzed by the Mann-and Wilcoxon tests (P value < 0.05). RESULTS: The difference between the expression of P53 protein in the basal layer in OKC and OOC was not statistically significant (P value = 0.076). The difference between the expression of P53 protein in the parabasal layer in OKC and OOC was statistically significant (P value = 0.003); moreover, the difference between the expression of TGF-alpha in the basal layer in OKC and OOC was not statistically significant (P value = 0.284). The difference between the expression of TGF-alpha in the parabasal layer in OKC and OOC was statistically significant (P value = 0.015). CONCLUSION: Since there was a higher expression of P53 protein and TGF-alpha in OKC compared to those in OOC, the probability of carcinomatous changes was at least theoretically higher in OKC than in OOC.