THESIS SYNOPSIS
DR. MADHVIKA PATIDAR
DEPARTMENT OF ORAL PATHOLOGY AND
MICROBIOLOGY
A.B. SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES, DERALAKATTE,
MANGALORE – 575 018
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
4th BLOCK, JAYANAGAR,BANGALORE,KARNATAKA
ANNEXURE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
CANDIDATE
DR . MADHVIKA PATIDAR
AND
POST GRADUATE STUDENT,
DEPT OF ORAL PATHOLOGY AND
ADDRESS
MICROBIOLOGY,
A.B.SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES.
DERALAKATTE- MANGALORE – 575 018
2.
NAME OF THE
A.B.SHETTY MEMORIAL INSTITUTE OF
INSTITUTION
DENTAL SCIENCES.
DERALAKATTE – MANGALORE – 575 018
3.
COURSE OF THE STUDY
MASTER OF DENTAL SURGERY
AND SUBJECT
DEPARTMENT OF ORAL PATHOLOGY AND
MICROBIOLOGY.
4.
DATE OF ADMISSION TO
MAY - 2008
COURSE
5.
TITLE OF THE TOPIC
“LEVELS OF ALBUMIN, PREALBUMIN, TOTAL PROTEIN, INORGANIC
PHOSPHATE AND PRESENCE OF KERATINOCYTES IN THE CYSTIC
FLUID
OF
ODONTOGENIC
KERATOCYSTS
(KERATOCYSTIC
ODONTOGENIC TUMORS) IN COMPARISON TO NONKERATINISING
ODONTOGENIC CYSTS”
6.
BRIEF RESUME OF THE INTENDED STUDY:
6.1) NEED FOR THE STUDY:
Odontogenic keratocyst (Keratocystic odontogenic tumor) is a clinicopathologically
distinct form of odontogenic cyst, known for its pathognomic microscopic features,
aggressiveness and high recurrence rate.
Odontogenic Keratocysts classically exhibit several characteristic histologic features; a
uniform thickness of epithelial lining composed of 6-10 cell layers with a well polarized
basal cell layer and a parakeratinised luminal surface that is usually corrugated1
This lesion is now categorized as an odontogenic tumor according to the latest WHO
recommendations because the mitotic activity of the epithelial cells is greater than that of
odontogenic jaw cysts2.
Conservative methods of treatment such as enucleation
and marsupilization,
consistently have produced less than optimal results in OKC compared to that of
nonkeratinising odontogenic cysts like dentigerous cyst and radicular cyst. Hence various
surgical modalities were advised for an attempt to improve the recurrence rate like
curretage, peripheral ostectomy, osseous reconstruction with or without continuity
defect3.
Preoperative diagnosis of OKC improves the treatment outcome in formulating an
appropriate treatment plan and adequately counseling the patients3.
Studies have reported significant differences between the concentration of total protein,
prealbumin, albumin as well as keratin and keratinocytes levels in cystic fluid of OKCs
and other forms of odontogenic cysts4.
Very few studies have been conducted to determine the levels of inorganic phosphate and
cytological aspects of the fluid for the preoperative diagnosis of the odontogenic
keratocyst.
Hence the present study is planned to evaluate the level of albumin, prealbumin, total
protein, inorganic phosphate and presence of keratinocytes in the cystic fluid to diagnose
and appropriately plan the treatment of odontogenic keratocysts and other odontogenic
cysts.
6.2 REVIEW OF LITERATURE:
1. The fluid of 44 dental cysts, 19 dentigerous cysts, 36 odontogenic keratocysts and 12
ameloblastomas have been investigated. The incidence of epithelial cells,
inflammatory cells, cholesterol crystals and bacteria was recorded in smears. There
was high incidence of epithelial cells and albumin levels in OKC and not in other
lesions. The amount of total protein level was low as compared to other cysts4.
2. Cystic fluid from 17 odontogenic keratocysts and 71 non-keratinizing dental cysts
was analysed for major fraction with a mobility anodal to albumin on
electrophoresis. They found that the fluid contained a lower concentration of soluble
protein. The prealbumin band seen in 7 of the 17 odontogenic keratocysts was not
seen in a series of 71 non-keratinizing dental cysts5.
3. Cystic fluid from 8 odontogenic keratocysts was obtained using fine needle
aspiration technique. Cytologically many isolated or groups of keratinocytes with
normal or ill-defined nuclei were seen, besides numerous anucleated squamous cells
and keratinous debris6.
4. Fluid aspirates from 65 cysts and 2 cystic ameloblastomas were examined.
Gylcosaminoglycans and proteoglycans were analysed in keratinizing and non
keratinizing odontogenic cysts fluids. They concluded that hyaluronic acid showed
the highest incidence and abundance amongst the gylcosaminoglycans detected.
Heparan sulphate showed the highest incidence and abundance in keratinocytes than
the other cysts7.
5. Fluid from 29 radicular cysts, 12 dentigerous cysts and 27 keratocysts was
investigated using qualitative and quantitative immunodiffusion
method. They
found that the presence of lactoferrin in aspirates of odontogenic cyst fluid might be
a useful preoperative diagnostic marker for odontogenic keratocysts8.
6.3 AIM OF THE STUDY
To evaluate the levels of albumin, prealbumin, total protein, inorganic phosphate and
presence of keratinocytes in the cystic fluid to diagnose and appropriately plan the
treatment of Keratocystic odontogenic tumors and other odontogenic cysts.
6.4 OBJECTIVES OF THE STUDY
1. To study the albumin, prealbumin and total protein level in cystic fluid using fine
needle aspiration
2. To study the inorganic phosphate level in cystic fluid
3. To study the presence of keratinocytes in the cystic fluid
4. To compare the albumin, prealbumin and total protein level in keratinising and
nonkeratinising odontogenic cysts.
5. To compare the inorganic phosphate level in cystic fluid of keratinising and
nonkeratinising odontogenic cysts.
6. To compare the presence of keratinocytes in the cystic fluid of keratinising and
nonkeratinising odontogenic cysts.
7.
MATERIALS AND METHODS
7.1 SOURCE OF THE DATA
The study set up is at A.B. Shetty Memorial Institute of Dental Sciences,
Deralakatte, Mangalore.
The study group will comprise of
Group I - 15 cases of Odontogenic Keratocysts
Group II - 15 cases of nonkeratinised odontogenic cysts reported to A.B. Shetty
Memorial Institute of Dental Sciences and also cases which come from other hospitals in
Mangalore.
INCLUSION CRITERIA
1. A cyst which is showing classical features of Odontogenic Keratocyst after
histopathological examination.
2. Histopathologically diagnosed Nonkeratinising odontogenic cysts like Radicular
cyst, Dentigerous cyst, Lateral periodontal cyst and Residual cyst.
EXCLUSION CRITERIA
1. Cysts which show malignant changes in any part of the epithelial lining.
2. A lesion which does not show classical histopathological features of cysts at any
part of the lesion.
3. Other keratinizing cyst like Calcifying Epithelial Odontogenic cyst.
7.2 METHOD OF COLLECTION OF DATA
Cystic fluid is aspirated using an 18 gauge needle from the most prominent and fluctuant
part of the swelling by fine needle aspiration technique.
1ml of the fluid is used for biochemical evaluation for the estimation of total protein,
prealbumin, albumin using gel electrophoresis method and inorganic phosphate levels
using Fiske Subbarao method.
The remaining cystic fluid is transferred to a clean dry centrifuge tube. The tube is placed
for centrifugation at 1500rpm for 10 min. Following centrifugation, the cells appear at
the base of the centrifuge tube as a cell button. The supernatant is then poured off
carefully into a suitable disinfectant. The resulting cell suspension is carefully removed
using a pipette, and a single small drop is placed towards one end of a clean, labeled
glass slide. The material is rapidly spread using another glass slide.
3 smears are prepared using the above method. For Hematoxyline & Eosine stain and
Papanicolaou (PAP) stain, the smears are fixed immediately in ether alcohol. For May
Grunweld Giemsa stain (MGG) (Romanowsky stains), the smears are air dried and then
fixed in methanol.
The smears are stained with May Grunweld Giemsa (MGG) (Romanowsky stains),
Hematoxyline and Eosine stain and Papanicolaou (PAP) stain. The stained sections are
examined under light microscopy for keratin and keratinocytes.
After surgical excision of the cystic lining, the tissue is processed and sectioned using
paraffin embedded technique for confirmation of the diagnosis.
The data collected will be statistically evaluated using Mann Whitney U Test and
Students ‘t’ test.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED IN PATIENTS OR OTHER HUMANS
OR ANIMALS?
No.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION :
Yes, ethical clearance has been obtained and the letter is enclosed.
8.
LIST OF REFERENCES
1. Rodu B, Tate AL, Martinez Jr MG. The implications of inflammation in
odontogenic keratocysts. Journal of Oral Pathology and Medicine 1987;16:
518-21
2. Pathology and Genetics of Head and Neck Tumours, Leon Barnes, John W.
Eveson, Peter Reichart,David Sidransky, IARCPress Lyon, 2005: 306 – 307
3. M.Anthono Pogrel, MD, DDS, FRCS, FACS and Brian L. Schmidt, DDS, MD,
PhD. Oral and Maxillofacial Surgery Clinics of North America; August 2003.
4. R. M.Browne, Some observations on the fluids of odontogenic cysts. Journal of
Oral Pathology and medicine.1976; 5: 74-87
5. J Southgate, J.T Whicher, J.D Davies, D.St.J O’Reilly, and R.W Matthews. A
protein of Squamous keratinizing epithelium from odontogenic keratocyst fluid;
Virchows Arch (Pathol Anat) 1986; 409: 705-713
6. P.A Vargas, D.E. da Cruz Perez, G M Mata, O P de Almeida, A V Jones and R
Gerhard. Fine needle aspiration cytology as an additional tool in the diagnosis of
Odontogenic Keratocyst. Cytopathology 2007 Dec; 18(6): 361-66
7. G Smith, A J Smith and R M Browne. Glycosaminoglycans in fluid aspirates
from odontogenic cysts. Journal of Oral Pathology 1984; 13: 614-621
8. A J Smith, J B Matthews, G I Mason, R M Browne. Lactoferrin in aspirates of
odontogenic cyst fluid. Journal of Clinical Pathology 1988; 41: 1117-1119
9. Z J Sun, B Liu and Y F Zhao. Radiopacity in syndrome keratocystic Odontogenic
tumor, Dentomaxillofacial Radiology 2008; 37: 175-178
10. Mervyn Shear and Paul M Speight, Cyst of Oral and Maxillofacial Regions 4th
edition, 2007; 6 – 58.
11. Yoko Suyama, Yasutaka Kubota, Tomohiro Ninomiya, Kanemitsu Shirasuna.
Immunohistochemical analysis of interleukin-Iα, its type I receptor and antagonist
in keratocystic odontogenic tumors. Journal of Oral Pathology and Medicin
2008; 37: 560-564
12. Neville WB, Damm DD, Allen MC, Bouquot EJ. Oral and Maxillofacial
Pathology, 2nd ed.: Elsevier, 2002; 589-609
9.
SIGNATURE OF THE
CANDIDATE
10.
REMARKS OF THE GUIDE
Pilot study was done. The study may be done under
my guidance.
11.
NAME & DESIGNATION OF
(In block letters)
11.1 GUIDE
PROF. (DR.) PUSHPARAJA SHETTY
HEAD OF THE DEPARTMENT
DEPARTMENT OF ORAL PATHOLOGY &
MICROBIOLOGY
A.B.SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES, DERALAKATTE,
MANGALORE- 575 018.
11.2 SIGNATURE OF
GUIDE
11.3 CO-GUIDE ( if any )
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
DR. PUSHPARAJA SHETTY
PROFESSOR & HEAD,
DEPARTMENT OF ORAL PATHOLOGY &
MICROBIOLOGY,
A.B.SHETTY MEMORIAL INSTITUTE OF
DENTAL SCIENCES, DERALAKATTE,
MANGALORE- 575 018.
11.6 SIGNATURE
12
12.1 REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
Diagnostic utility
12.2 SIGNATURE
PROF. (DR.) B.RAJENDRA PRASAD