Abstract

Background:

Osteosarcoma is the most common primary bone malignancy, it is a

mesenchymal tumor in which osteoid is formed directly by tumor cells.
Osteosarcomas of the jaws are rare, representing less than 10% of all
osteosarcomas and have different demographic and prognostic characteristics.

Aims of the study:

Immunohistochemical evaluation and comparison of P53, Ki-67 and VEGF

expressions in jaw and long bones osteosarcomas and correlating those
expressions with the clinicopathological behavior in both sites.

Materials and Methods

Fifteen formalin fixed paraffin embedded tissue blocks of jaw osteosarcomas,
and another fifteen of long bones osteosarcomas were retrospectively collected
from laboratories archives and included in the study. Diagnostic confirmation was
performed through examination of hematoxylin and eosin (H&E) sections. Four
µm thick sections were cut and mounted on positively charged slides and stained
immunohistochemically with monoclonal antibodies to Ki-67 to assess the
proliferative capacity, P53 to assess the apoptotic potential and VEGF to assess
the angiogenic potential. Comparisons regarding the aforementioned markers’
expressions were carried out between the two sites involved in the study.
Results:
Ages of the patients with osteosarcomas of the jaws (OJ) ranged between 13
and 60 years with a mean of (27.86±13.36). For Osteosarcomas of the long bones
(OLB), the age ranged between 12 and 27 years with a mean of (17.00±3.66), a
highly significant statistical difference in the age distribution between the two
groups was found (p=0.005). The male/female ratio for (OJ) was 8/7 (1.14:1), and
it was 10/5 (2:1) for (OLB). Overall, the sample comprised 18 males and 12
females to give a total male/female ratio of (1.5:1). No statistically significant
difference was found regarding sex distribution between the groups. Regarding
the locations, nine cases of (OJ) were located in the maxilla and the other six were
in the mandible. Whereas (OLB) cases were distributed among Femur (10 cases),
Humerus(4 cases) and Fibula (1 case).
Histological subtype was recognized for each case of jaw and long bones
Osteosarcomas. Two thirds of the Jaw cases (10 of 15) were of chondroblastic
subtype, four of them were osteoblastic and a single fibroblastic case. While nine
of the fifteen long bone osteosarcomas were osteoblastic, and the remaining six
were chondroblastic, there was no statistically significant difference between the
two groups.
Ki-67 immunoreactivity was recognized in five of the fifteen jaw cases. In long
bones, eleven cases were positive for Ki-67 leaving four others to be negative. An
average Labeling index of (13.13% ±20.40) was calculated in the jaw cases, while
the index for the long bones was (32.26±25.04). Using Mann-Whitney test, there
was a statistically significant difference in the Ki-67 Labeling index between jaws
and long bones (p=0.03).
Collectively, 27 of the 30 cases (90%) were positive for P53 antibody with
different score values. Concerning the jaw bones, 12 of 15 (80%) cases were
positive to p53 antibody, whereas there was no p53 negative long bones cases.
There was no statistically significant difference in the P53 immunoexpression
between jaws and long bones osteosarcoma.

Twenty four of thirty total samples (80%) were positive to VEGF antibody. All
the cases with negative expression to VEGF antibody (6 cases) were located in
the jaws, whereas all 15 long bone cases were positive to different extents. There
was a statistically significant difference in the VEGF expression between jaw and
long bone cases (p=0.031).

Conclusions:

jaw and long bones osteosarcomas bear a comparable cell cycle dysregulation
when quantified with p53 immunostaining, whereas the long bones osteosarcomas
have a higher proliferative and angiogenic capacity than their jaw counterparts as
evaluated with Ki-67 and VEGF immunoexpressions respectively.