Giant Cell Lesions of the Jaws:A Review and Comparative Histopathological Study.

BACKGROUND AND OBJECTIVES: Giant cell lesions (GCLs) are rare lesions which prominently feature multinucleated giant cells in their histology. They include central giant cell granuloma (CGCG), giant cell tumour of bone (GCT), peripheral giant cell granuloma (PGCG), Cherubism (CHB), e.t.c. This study reviewed the clinico-demographic parameters of GCLs of the jaws and assessed the giant cells. METHODS: This was a retrospective study examining the histopathology records of which part of the body of two tertiary institutions. All entries of cases diagnosed as GCLs were retrieved and data were extracted. Also, the giant cells in tissue sections were assessed. Data were analysed using SPSS Inc. version 20 while Chi square test was used to test for association. This was considered significant quand p < 0.05. RESULTS: Over the study period, 2,862 biopsy reports were reviewed. GCLs constituted 48(1.7%) and M: F ratio was 1:1.6 while majority occurred in the 2nd and 3rd decades. The mandible was the most common site recording 27(56.3%) cases and CGCG was the most frequently diagnosed GCL constituting 22(45.8%). Assessment of the giant cells revealed CGCG had predominantly large giant cells, a dense dispersal of giant cells and irregularly shaped giant cells, while CHB mainly had large giant cells with dense dispersal, but round shaped giant cells. CONCLUSION: GCLs are rare lesions commonly seen in females in the 2nd and 3rd decades of life with preference for the mandible. CGCG was the most commonly encountered lesion, while the giant cells in CGCG and CHB were similar in size as well as dispersal.

CHARACTERIZATION OF ALVEOLAR SOFT PART SARCOMA OF THE TONGUE: A CLINICO-PATHOLOGIC STUDY AND SCOPING REVIEW.

BACKGROUND: Alveolar soft part sarcoma (ASPS) is a rare malignant soft tissue tumour. There is a dearth of literature analyzing its features on the tongue. OBJECTIVE: This study aims to conduct a scoping review to describe the essential clinico-pathologic features, treatment modalities and outcome of previously reported tongue ASPS (TASPS) and new cases at our center. METHODS: A search of databases (PubMed, Medline, Cochrane and Google Scholar) and the internet for articles on TASPS written in English was conducted. Information extracted included clinico-pathological and demographic data. Descriptive statistics was used for analysis. RESULTS: A total of 49 articles were eligible for this study. In all, 81 cases were utilized. Asian studies accounted for most cases 35(43.2%) and a slight female preponderance of 1.1 was seen. Most cases - 38 (46.9%), occurred in the 1st decade and the base of tongue was the most common location in 19 (39.6%) cases. Also, tumour metastasis was present in 14 (25.9%) cases. Transcription Factor E3 (TFE3) - 8 (24.2%) and Neuron Specific Enolase (NSE) - 8 (24.2%) were the most common immunohistochemical stains used and were both expressed 7 out of 8 cases (87.5%). Most common treatment modality was surgery and 42 (82.4%) cases managed by surgery alone were free of disease at ≤ 5 years of follow up. CONCLUSION: TASPS slightly affected the female gender and tongue base more commonly. It occurred more in the first two decades of life. Use of standard investigative tools for management will allow for better appraisal of research findings.

A Study of 31 Patients with Primary Complaint of Halitosis in a Tertiary Hospital in South-Western Nigeria.

BACKGROUND: Halitosis is a common cause of dental consulta-tion. Patients presenting with primary complaint of halitosis consist of dissatisfied people with genuine and pseudo-halitosis. OBJECTIVES: To assess the demographic and clinico-pathologic features of patients presenting with primary complaint of halitosis as well as evaluate the treatment outcome. METHODS: Consenting patients presenting with primary complaint of halitosis from 1st of March to 31st August, 2015 were recruited. All had intraoral examination, were screened for psychiatric morbidity and halitosis using the organoleptic method. Data concerning the complaint of halitosis was retrieved from all through an interviewer-administered structured questionnaire. All the patients were educated on the aetiology of halitosis, those with oral disease were treated and all had scaling and polishing, oral hygiene instruction/motivation in addition to hydrogen peroxide mouth rinse for two weeks. Patients' opinions were sought concerning the presence/intensity of halitosis at two weeks and six months post treatment. RESULTS: Thirty-one patients with a mean age of 38.48 years and male:female ratio of 1.3 were recruited. Intraoral pathology was observed in 48.4% of patients. None of the patients smoked cigarette or pipe. Twenty patients (64.5%) had been informed of the foulness of their breath by at least one person in the past; the information generated negative feelings in 19 of them. Six patients had psychiatric morbidity which was significantly associated with female gender and presence of body odour. At two weeks post treatment, 54.8% of patients were free of halitosis, while at six months only 25.8% were free. CONCLUSION: The patients who complained of halitosis were non-smokers with a mean age of 38.48±14.0 years. Intraoral pathologies were found in fifteen (15) patients, while six (6) had psychiatry morbidity. About half of the patients and about a quarter were free of halitosis following scaling and polishing and two weeks' hydrogen peroxide mouth rinse at 2 weeks and 6 months' reviews, respectively.

Association of Squamous Cell Carcinoma of the Tongue with Cigarette and Alcohol Exposure: A Retrospective Clinicopathological Study.

BACKGROUND: Squamous cell carcinoma of the oral tongue (SCCOT) has been linked to modifiable risk factors; such as tobacco use and excessive alcohol consumption. OBJECTIVE: To describe the clinical presentation of SCCOT as well as its association with history of tobacco and alcohol use. METHODS: A retrospective review of SCCOT at Oral Pathology Department from 1990 to 2012. Information retrieved from patients' medical records includes: age, gender, occupation, history of alcohol and tobacco use. Also, the first symptoms observed by patients at the onset of disease, and what was done for patients at the place of first consultation were documented. RESULTS: SCCOT accounted for 26% of all oral squamous cell carcinoma (SCC); mean age at presentation was 58.3 ±12.6 years. Two patients diagnosed of SCCOT before 40 years as well as female SCCOT patients denied exposure to either alcohol or tobacco; while about 80% and 70% of males with complete history were exposed to tobacco and alcohol respectively. At the onset of disease, 70.2% of patients noticed a lingual ulcer, 13% experienced pain, but at presentation, only one patient was not experiencing pain. About 85.3% of patients presented with stage III and IV disease. All patients but two were treated with antibiotics and analgesics at first presentation in a hospital. CONCLUSION: The most common symptoms at the onset of disease were ulceration and pain. Men above age forty years had exposure to alcohol and tobacco.

PERCEPTION AND UTILIZATION OF ORAL HISTOPATHOLOGY SERVICES BY GENERAL PRACTICE DENTIST IN SOUTHWEST NIGERIA.

BACKGROUND: Oral histopathology services are oral diagnostic procedures. General Dental Practitioners (GDPs) are routinely exposed to oral lesions that require biopsies. Hence, the study's objective of assessing the perception and the utilization of oral histopathology services by GDPs. METHOD: This was a cross-sectional study conducted at dental clinics distributed across Southwest Nigeria. A self-administered questionnaire consisting of sections addressing the socio-demographic/professional aspects; the beliefs of GDPs and their utilization of oral histopathology services was used to collect data. A modified 5-point Likert rating scale was used to indicate the extent of agreement or disagreement with statement constructs. Analysis was done using SPSS for windows version 20.0. Significance was assessed at 5%. RESULTS: There were 56.1% males and 43.9% females. The peak age range was 30-39 years (35.4%), while 58.5% had ≤ 10 years of practice and 79.3% work in government dental centres. Many of the respondents (61.0%) thought suspicious lesions should be biopsied, 47.6% thought that specialists' skills were not required for biopsy. Furthermore, 53.7% had poor perception scores while 81.1% of those who had seen oral lesions that required biopsies, had poor utilization scores. CONCLUSION: The GDPs had a poor perception and utilization of oral histopathology services. Continuous medical education is needed to increase awareness amongst dentists.

Non-surgical extraction of a massive sialolith in the Wharton's duct of a Nigerian.

BACKGROUND: Sialolithiasis is the most common salivary gland disorder characterized by calculi formation within the gland and/or its duct. The submandibular gland is most frequently affected due to the peculiar anatomy of the duct and the nature of its secretion. Varying sizes have been described for salivary calculi and unusually large sialoliths measuring above 3.5cm have been reported. Similarly, a few giant sialoliths have been reported in Africans. We therefore report the case of a large sialolith in the Wharton's duct of a Nigerian male. CASE PRESENTATION AND MANAGEMENT: A 54 year old Nigerian man presented with a hard, painless, left floor of mouth swelling of one year duration. There were recurrent episodes of moderate pain at meal times. Intraoral examination revealed a hard, mobile, non tender, creamy mass on the left side of the floor of the mouth protruding out of the Wharton's duct orifice. A lower occlusal radiograph revealed a large radio-opacity in the floor of the mouth and a diagnosis of left submandibular sialolithiasis was made. The sialolith was removed non-surgically and measured 4.4 cm by 1.8 cm. The patient was discharged and follow up period was uneventful. CONCLUSION: Large sialoliths are rarely reported in Africans, non-surgical extraction can be attempted for accessible and mobile sialoliths after full evaluation. Complex cases should be referred to the oral and maxillofacial surgeon.

PERIAPICAL PATHOLOGY: COMPARISON OF CLINICAL DIAGNOSIS AND HISTOPATHOLOGICAL FINDINGS.

BACKGROUND: Periapical lesions are often diagnosed on clinical and radiological basis that may be different from the histological finding. The purpose of this study was to compare clinical and radiographic features with histological diagnosis of periapical pathology. METHODOLOGY: A 22 year retrospective analysis of records of teeth diagnosed with periapical lesions that had periradicular surgery and the specimen sent for histopathological examination. Cases with incomplete records were excluded. Age, gender, site of lesion, clinical diagnosis, radiographic report and histopathological diagnosis etc were extracted from the records. The data were analyzed using SPSS version 20.0. Chi square test was used to test association between clinical and histological diagnosis at 95% level of confidence (i.e. p=0.05). RESULTS: Nineteen cases were analyzed in patients within age range of 17 to 57years with a mean age of 32.2±11.7 years and male to female ratio of 1.1:1. All the affected teeth were upper incisors. Majority (n= 13; 68.4%) of the cases were clinically diagnosed to be periapical cyst. While on histological analysis, majority (n=16; 84.2%) of the total cases were diagnosed as periapical granuloma. Ten cases (76.9%) out of 13 diagnosed clinically to be periapical cyst had sclerotic border (p=0.003). CONCLUSION: This study showed sensitivity and specificity of radiographs in detecting periapical lesions were reduced when compared with histology. The insufficiency of conventional radiography in diagnosing periapical lesions could lead to unnecessary surgery for the patient, thus the need for advanced imaging to provide improved quality of diagnosis, treatment planning and prognosis.

Periapical lesions of the jaws: a review of 104 cases in ibadan.

BACKGROUND: Periapical lesions (PLs) occur as a result of pulpal inflammation and may rarely be seen in the absence of pulpal diseases. They are the most common pathological lesions affecting the alveolar bone. OBJECTIVE: This study aims to describe the clinicopathological features of PLs of the jaws with emphasis on the two most common types. METHODS: Histopathology records of PLs diagnosed from January 1990 to December 2012 at the Department of Oral Pathology, University College Hospital Ibadan, were examined and categorized into periapical cysts (PCs); periapical granuloma (PGs) and others. Clinical data and histopathological features of these PLs were reviewed and analyzed. RESULTS: One hundred and four lesions met the criteria for this study and consisted of PGs with 71 (68.3%) cases and PCs with 31 (29.8%) cases and one case each of apical scar and pleomorphic adenoma. Age range of cases was 9 to 80 years (mean=35.6 ± 15.8years) with a peak at age group of 20-29 years. Females were more frequently affected with 51.9% of cases. PLs were most frequently diagnosed in the anterior maxillary region with 58 (56.9%) cases, while the most frequently involved tooth was the left maxillary central incisor with 23 (22.1%) cases. CONCLUSION: Findings in this study are consistent with those of previous studies. It is important for all periapical pathological specimens to be submitted for histological examination to establish an accurate diagnosis and aid in the identification of sinister lesions that may present in the Periradicular region of teeth.

Histological grading of oral squamous cell carcinoma patients in Ibadan using Bryne's and Broders' grading systems--a comparative study.

BACKGROUND: Several histological grading systems for oral squamous cell carcinoma (OSCC) have been used previously to guide treatment and prognostication, amongst which are the Broders and the Bryne's methods. The Bryne's invasive tumour front (ITF) protocol has been adjudged to have good prognostic significance. We compared the use of Bryne's ITF system and Broders' grading system in grading OSCC at our centre in relation to clinico-demographic profile of patients. METHODS: Thirty two formalin fixed paraffin embedded (FFPE) tissue samples of histologically diagnosed OSCC patients at the University College Hospital (UCH) Ibadan were selected, demographic data and site of lesions were retrieved from the medical records of the patients. The haematoxylin and eosin (H&E) slides of the 32 cases were prepared and evaluated using Bryne's ITF system and Broders classification. RESULTS: Using Bryne's system, 28% of the cases had a high malignancy score while 72% had a low malignancy score. The high malignancy score lesions were most commonly seen in the palate (15.5%). Also Broders classification showed that 31.3% of cases were well differentiated tumours, 50% were moderately differentiated while 18.7% were poorly differentiated. CONCLUSION: Either the Bryne's system or Broders classification can be used to grade OSCC with similar results being obtained.