Can Tumor Biomarkers Help in Prognostication of Benign Aggressive Lesions of Maxillofacial Region?

To understand benign aggressive lesions at protein expression level, several tumor biomarkers assist in diagnosis, early detection and nature of the lesion with prognostication. Cell proliferation is the foundation of tumor development. Cyclin D1 and Ki-67 are two proliferation markers. The p53 gene, located at the short arm of chromosome 17 is the best known tumor suppressor gene. In this study, immunohistochemical staining is done to assess the expression patterns of Ki-67, p53 and Cyclin D1 in the benign aggressive lesions of the maxillofacial region and relate it with the clinical, histopathological and radiological expression of the disease.

15 patients with biopsy proven benign aggressive lesions were enrolled for the present study which included 5 cases each of Odontogenic Keratocyst, Central Giant Cell Granuloma and Ameloblastoma. Analysis of data was done, and relationship with biomarkers was established based on the site, histopathological diagnosis, immunohistochemical expression as percentage cells and intensity and adverse features - cranial nerve involvement, root resorption, mobility of teeth and plate perforation. It was found out in the study that the Ki-67 intensity was significantly associated with root resorption of the teeth and Cyclin D1 immunoexpression was found significantly higher in lesions occurring in the posterior mandible.

Most of the cases with cyclin D1 score of ≤ 50% occurred in the posterior mandible which signifies the overexpression of cyclin D1 contributes to increased proliferative activity and tumor invasiveness. Ki-67 intensity showed a significant correlation with root resorption of teeth suggesting the role of Ki-67 as a proliferative marker in benign aggressive lesions.

Elevated levels of biomarkers point toward a more aggressive lesion thereby necessitating a more aggressive treatment approach. Benign aggressive lesions can express various tumor biomarkers which help the surgeon in formulating the treatment plan and predict the prognosis of disease.