Bukola Folasade Adeyemi

Head and neck cancer--a clinicopathological study in a tertiary care center.

Head and neck cancers display diverse patterns of biological behavior and considerable variation in geographical distribution. This study presents an analysis of head and neck cancer in a Nigerian tertiary healthcare center. It comprises cases diagnosed at the University College Hospital, Ibadan, Nigeria, 1991-2005. Out of 1,750 head and neck tumors, 972 (55.5%) were malignant and 778 (44.5%) were benign. Cancers displayed male predominance, with a gender ratio of 1.8:1. The mean age of cancer patients was 43.8 +/- 19.6 years. Carcinomas constituted 71.7% of head and neck cancers, with 2.4% occurring in children and overall mean age of 48.2 years. Squamous cell carcinoma comprised 66.7% of carcinomas and 47.8% of all head and neck cancers. Hematopoietic malignancies constituted 20.4% of head and neck cancers, and comprised mainly lymphomas, which accounted for 19.3% of all head and neck cancers. The mean age of patients with hematopoietic malignancies was 34.9 years. The most common childhood malignancy was Burkitts lymphoma, which comprised 28.2% of pediatric head and neck cancers. Connective tissue tumors constituted 7.9% of all cancers, the most common being rhabdomyosarcoma, accounting for 44.2% of sarcomas. The mean age of patients with sarcomas was 26.5 years. There is a need for uniformity in the definition of head and neck cancer so as to permit comparison of international studies. In addition, prospective population-based studies are required to determine the national incidence and to identify risk factors for head and neck cancer in the Nigerian population.

A review of 413 salivary gland tumours in the head and neck region

Objectives: Salivary gland tumours (SGTs) are a group of heterogeneous lesions with complex clinico-pathological characteristics and distinct biological behaviours. Previous studies have reported geographic variations in site distribution, incidence and histological types of SGTs. The aim of this study was to describe the demography of SGTs seen at a tertiary health centre and compare findings with previous studies. Study design: Data on SGTs from archives of the Department of Oral Pathology and the Department of Pathology, University College Hospital Ibadan were retrieved. Information about histological types, age, sex and location were analyzed using SPSS for Window (version 20.0; SPSS Inc. Chicago, IL). Reactive and tumor-like lesions such as sialometaplasia, benign lymphoepithelial lesion, lymphoepithelial cyst, mucocele, mucous extravasation phenomenon, ranula, and sialosis were excluded from the study. Results: 413 SGTs consisting of 221 (53.5%) malignant and 192 (46.5%) benign lesions were seen. SGTs occurred more in females (50.6%) than males (49.4%) with a mean age of 43.7 (±16.9) years and peak age in the fifth decade of life. The parotid with 171 (41.4%) cases was the commonest site, followed by palate with 89 (21.5%) cases, while only 7(1.7%) cases were seen in sublingual gland. Pleomorphic adenoma with 169 (40.9%) was the most frequent SGT followed by adenoid cystic carcinoma with 93 (22.5%) cases which also was the most frequent malignant SGT while only 3 (0.7%) cases of Warthin’s tumour were seen. Conclusion: This report is one of few that showed a higher occurrence of malignant SGTs compared to their benign counterparts. The findings were essentially similar to findings in Africa but showed SGTs to be more common in females. The reason(s) for high occurrence of malignant SGTs in minor salivary glands and the rarity of Warthins tumour in this study and other African series compared to those from America needs further investigation. Key words:Salivary gland tumours, parotid gland, pleomorphic adenoma, adenoid cystic carcinoma, warthin’s tumour.

Ameloblastic fibrosarcoma: Report of a case.

Ameloblastic fibrosarcoma (AFS) is a rare odontogenic malignancy with benign epithelial and malignant ectomesenchymal components. About 66 cases have been reported in the medical literature. We therefore report an additional case as well as a review of literature to add to the existing knowledge on this rare lesion.

Oral Squamous Cell Carcinoma, Socioeconomic Status and History of Exposure to Alcohol and Tobacco

Oral squamous cell carcinoma, traditionally a disease of elderly men with a history of chronic exposure to the carcinogenic effects of tobacco and alcohol, is presently being more frequently diagnosed both in a younger patient population and in those not exposed to these carcinogenic substances. At our center, most patients with oral squamous cell carcinoma are not involved in the use of tobacco or alcoholic beverages and are mainly of a low socioeconomic class. This hospital-based case-control study was designed to assess if the risk of developing intraoral squamous cell carcinoma in Ibadan, Nigeria, was associated with the use of tobacco, alcohol, or socioeconomic status. Medical records of patients with histological diagnosis of squamous cell carcinoma of the oral cavity at the University College Hospital, Ibadan, between January 1990 and December 2008 were analyzed. Only 26% of patients gave a positive history of exposure to tobacco, alcohol, or both; of this number, 20.3% used tobacco, while 18.8% consumed alcohol and 13% used both. Although 24.6% of the cases were of high socioeconomic class, there was no significant difference in the distribution of oral cancer patients in the 2 socioeconomic classes. This study revealed an important deviation from expected amongst the oral squamous cell carcinoma patients diagnosed at Ibadan, thus raising the possibility of a different etiology for oral cancer in our population and the need for research focused on identifying possible risk factors.

Serum antioxidant vitamins and the risk of oral cancer in patients seen at a tertiary institution in Nigeria

OBJECTIVESnTobacco and alcohol are major risk factors of oral cancer, but nutritional deficiency may also contribute to development of oral cancer. This study compared serum antioxidant vitamin levels in oral cancer patients and controls in order to validate the role of vitamin deficiencies in the etiology of oral cancer.nnnMATERIALS AND METHODSnSerum vitamin A, C, and E levels of 33 oral cancer patients and 30 controls at University College Hospital, Ibadan, Nigeria, were determined using standard methods. The data obtained were analyzed using the Student t-test, odds ratio, and logistic regression.nnnRESULTSnMean vitamin A, C, and E levels were significantly lower in oral cancer patients (P=0.022, P=0.000, and P=0.013 respectively). Risk of oral cancer was 10.89, 11.35, and 5.6 times more in patients with low serum vitamins A, C, and E, respectively. However, on logistic regression analysis, only low serum vitamin E independently predicted occurrence of oral cancer.nnnCONCLUSIONSnThe lower serum vitamin A, C, and E levels in oral cancer patients could be either a cause or an effect of the oral cancer. Further studies using a larger sample size and cohort studies with long-term follow-up of subjects are desirable.

Keratoameloblastoma of the mandible

Keratoameloblastoma is a very rare ameloblastoma variant defined by extensive squamous metaplasia and keratinization. There are 13 previously reported cases in the literature, with a male predilection of 3:1. A 38-year-old male presented with a painless mandibular swelling which had been progressively increasing in size for 18 months. The incisional biopsy was misdiagnosed as basaloid squamous carcinoma. Owing to financial constraints, the patient had mandibular resection a decade after first noticing the growth, during which the clinical course was essentially benign, thus casting doubt on the initial diagnosis. The final histological diagnosis for both the incisional and resection biopsy specimens was keratoameloblastoma.

Stoichiometric expression of MMP-2/TIMP-2 in benign and malignant tumours of the salivary gland

The aim of this study was to determine the expression of matrix metalloproteinase 2 (MMP-2) and tissue inhibitors of matrix metalloproteinase 2 (TIMP-2) and the MMP-2/TIMP-2 expression ratio in salivary gland tumours (SGTs). Forty-three FFPE SGTs were prepared for antibody processing to MMP-2 and TIMP-2. Two investigators utilizing Sinicrope’s method scored the uptake of immuno-stains. Cytoplasmic staining was considered as positive. Data was analysed using SPSS version 20. The significance level was set at pu2009<u20090.05. In benign SGTs, the mean score for MMP-2 was not significantly lower than that of TIMP-2 (pu2009=u20090.37). However, the mean scores for MMP-2 stain intensity and proportion were significantly higher in malignant than benign SGTs (pu2009=u20090.01 and pu2009=u20090.02 respectively). There was no significant difference in the mean MMP-2/TIMP-2 expression ratio of the malignant SGTs according to histological grade and histogenesis (pu2009=u20090.4 and pu2009=u20090.19 respectively). The MMP-2/TIMP-2 expression ratio has a higher prognostic value than the separate expressions of MMP-2 and TIMP-2.

Malignant salivary gland tumours of the head and neck region: a single institutions review

Introduction Malignant salivary gland tumours (MSGTs) comprise about 3% of all head and neck cancers; they demonstrate an unpredictable clinical course. The purpose of this study is to review MSGTs seen at a tertiary Health centre, and compare findings with those of previous studies. Methods The records of the Department of Oral Pathology and the Department of Pathology, University College Hospital Ibadan were reviewed over a 19 year period and lesions diagnosed as MSGTs according to 2005 WHO histological classification were analysed for age, gender and site using SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). Results MSGTs were more common in males (55.2%) than females (44.8%). The mean age of was 47.9 (±17.0) years and peak age was the fifth decade. The parotid gland was the commonest site with 62 (28.1%) cases. The palate was the commonest intraoral site with 61(27.6%). The nose with 19 (8.6%) was the commonest minor extra-oral site. Conclusion The findings were essentially similar to reports from Europe and America. Adenoid Cystic Carcinoma was the most common MSGT in this series. A high proportion of salivary gland tumours in sublingual gland were malignant. The reason(s) for high proportion of MSGTs in sublingual glands requires further investigation.

Review of thirty-one cases of salivary gland tumours in children and adolescents seen in a tertiary health care centre in Nigeria

Introduction. Salivary gland tumours (SGTs) are rare neoplasms. When compared to salivary gland inflammatory lesions, SGTs are relatively rare in children/adolescents with estimated annual incidence for all juvenile age groups of 1-2 tumours per 100,000 persons. This study reviewed SGTs in children/ adolescents seen at a reference tertiary hospital in Nigeria. Material and methods. This was a review of all SGTs in subjects aged 19 years and below from archival records of the University College Hospital Ibadan. All lesions were analysed for age, gender and site using SPSS for Windows (version 20.0; SPSS Inc. Chicago, IL). Inflammatory and non-neoplastic swellings were excluded from the study. Result. Out of a total of 413 SGTs that were diagnosed over the study period, 31 (7.5%) were seen in children/adolescents. The male:female ratio was 2.1:1. The mean age was 14.2 (±3.4) years (range = 6-19 years) and majority (93.5%) occurred at the age of 10 years and above. There were 19 benign cases (61.3%) while 12 (31.8%) were malignant. Pleomorphic adenoma in 16 (51.6%) cases was the most common lesion seen followed by mucoepidermoid carcinoma with 7 (22.6%) cases. Malignant SGTs in children occurred more often in the minor salivary glands (50.0%) compared with five (41.7%) cases that occurred in the parotid gland. Conclusion. This study showed that SGTs are relatively rare in children/adolescents and benign SGTs are more commonly seen than their malignant counterparts in

Relative expression of α-smooth muscle actin and matrix metalloproteinases-2 in ameloblastoma of a black African sub-population.

BACKGROUNDnAmeloblastoma although a benign odontogenic tumor, is locally invasive. The abundant presence of myofibroblasts (marked by α-smooth muscle actin [α-SMA]) in the stroma and expression of matrix metalloproteinase-2 (MMP-2) in the neoplastic or stromal cells have been linked with the tumors ability for both local and distant spread. We aim to estimate the relative expression of α-SMA and MMP-2 in ameloblastoma from a black African subgroup to gauge their relative potential for enhancing local invasiveness and hence, their prospects as possible chemotherapeutic targets.nnnMATERIALS AND METHODSnTwenty-five formalin-fixed paraffin-embedded blocks of ameloblastoma cases from Nigeria were prepared for antibody processing to α-SMA (Dako Monoclonal Mouse Anti-Human α-SMA antibody clone 1A4) and MMP-2 (Abcam Mouse Monoclonal Anti-MMP-2 antibody [CA-4001/CA719E3C] ab3158). The score for percentage positivity of the tumor cells and the score for staining intensities were then multiplied in order to generate an immunoreactive score.nnnRESULTSnα-smooth muscle actin was only expressed in the fibrous connective tissues adjacent to the tumor islands while MMP-2 was expressed in the ameloblasts, stellate reticulum, and the connective tissues in varying proportions. All the variants analyzed expressed α-SMA mildly or moderately, except for the follicular variant that either did not express α-SMA or expressed it mildly. The highest number of strong immunoreactivity to MMP-2 in the ameloblast region was found in the plexiform variant.nnnCONCLUSIONnChemotherapeutic targeting of both molecules may, therefore, be a vital step in the control of local ameloblastoma invasiveness.