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Galíndez MF, Carrica A, Zarate AM, Secchi D, Don J, Barra JL, Brunotto M. DNA repair, NFKβ, and TP53 polymorphisms associated with potentially malignant disorders and oral squamous cell carcinoma in Argentine patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:339-346. [PMID: 33309268 DOI: 10.1016/j.oooo.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE An important strategy in cancer prevention is to identify individual susceptibilities for cancer development through the genomic profile. Developing countries such as Argentina have no data on genetic composition. The aim of this study was to evaluate the single nucleotide polymorphisms of genes related to DNA repair (XCCR3, XPD), cell cycle arrest/apoptosis (TP53), and inflammation (NFKβ) of patients with precancer and oral cancer and to contribute to recognizing potential risk of developing these pathologies, and incorporate the risk patients into a clinical follow-up program in Córdoba, Argentina. STUDY DESIGN A cross-sectional study was performed on 140 patients with oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMDs), and controls. Genotyping of single nucleotide polymorphisms was performed using allele-specific polymerase chain reaction or restriction fragment length polymorphism techniques. The variables were evaluated by bivariate and multivariate statistical methods, with P < .05 statistically significant. RESULTS The multiple correspondence analyses showed that patients with OSCC are clustered with the T allele of XRCC3 T241 M and the C allele of TP53 R72 P, and patients with OPMDs are clustered with the T allele of NFKβ-519. CONCLUSION Our preliminary results showed that the C allele of the Pro72 variant of TP53 was related to OSSC and OPMD, and the T allele of NFKβ-519 is related to OPMDs in Argentine patients.
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Affiliation(s)
- María Fernanda Galíndez
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - Andrés Carrica
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - Ana María Zarate
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - Dante Secchi
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - Julieta Don
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - José Luis Barra
- Universidad Nacional de Córdoba, Facultad de Ciencias Químicas, CIQUIBIC-CONICET, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina
| | - Mabel Brunotto
- Universidad Nacional de Córdoba, Facultad de Odontología, Departamento de Patología Bucal, Haya de la Torre S/N, Ciudad Universitaria, Córdoba, Argentina; Instituto de Investigaciones en Ciencias de la Salud, (INICSA-CONICET-UNC), Bv. de la Reforma esq. Enf. Gordillo, Ciudad Universitaria, Córdoba, Argentina.
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Lv Z, Cong R, Li J, Cao K, Bao Q, Li L, Yang F, Yuan J. PTHLH Predicts the Prognosis of Patients with Oral Leukoplakia. Onco Targets Ther 2020; 13:10013-10023. [PMID: 33116586 PMCID: PMC7549501 DOI: 10.2147/ott.s261124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Oral leukoplakia is the most common oral mucosal disease. A proportion of such cases can progress to oral squamous cell carcinoma (OSCC). The mechanism of oral leukoplakia malignant transformation is still unclear. In this study, we analyzed the expression of parathyroid hormone-like hormone (PTHLH) in oral leukoplakia and the effect on prognosis, so as to find reliable molecular markers that can predict oral leukoplakia malignant transformation. Methods We measured PTHrP which is coded by PTHLH in oral leukoplakia tissues of 79 cases (30 cases progressed to OSCC and 49 did not) and analyzed the clinical outcomes. Then, PTHLH expression was reduced using lentivirus-mediated small hairpin RNA (shRNA) interference to determine the biological role of PTHLH in DOK cells. Results PTHrP was found to be highly expressed in 38% of tissues of oral leukoplakia. There was weak or no PTHrP expression in 25 patients, moderate expression in 24 patients, and strong in 30 patients with oral leukoplakia. The expression level was associated with the degree of atypical hyperplasia and poor prognosis. The cell proliferation, invasion, migration, cell cloning, and cell cycle were affected after reducing PTHLH expression. Conclusion Our data suggest that either PTHLH or PTHrP plays a key role in the malignant transformation of oral leukoplakia and might be a reliable biomarker for predicting the carcinogenesis of oral leukoplakia.
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Affiliation(s)
- Zhongjing Lv
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Rong Cong
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Jiafeng Li
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Kun Cao
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Qiang Bao
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Linlin Li
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Pathology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Feng Yang
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
| | - Jian Yuan
- School of Stomatology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China.,Department of Stomatology, Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province, Mainland China
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Association of the glycaemic index and glycaemic load with colorectal cancer in the population of Córdoba (Argentina): results of a case-control study using a multilevel modelling approach. Br J Nutr 2019; 122:575-582. [PMID: 30678740 DOI: 10.1017/s0007114519000035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The glycaemic index (GI) and glycaemic load (GL) are involved in the aetiology of different diseases, and they could be related to the development of colorectal cancer (CRC). The aim of this study was to evaluate the association between the quality and quantity indicators of carbohydrates consumed by the population of Córdoba (Argentina) and the odds of developing CRC in 2008-2016 period. A case-control study was conducted with 492 participants (161/331 cases/controls), interviewed through a validated FFQ. Multilevel logistic regression models were used to assess the effect of GI, GL and the quantity or weekly intake of high-GI foods on CRC occurrence, following adjustment for individual/first-level covariates, and using level of urbanisation as the contextual variable. The models were stratified by sex. Participants in the highest v. lowest tertile of dietary GL and weekly intake of high-GI foods had increased odds of CRC presence in the entire sample (OR 1·64, 95 % CI 1·16, 2·34 and OR 1·11, 95 % CI 1·09, 1·14, respectively) and in women (OR 1·98, 95 % CI 1·24, 3·18 and OR 1·41, 95 % CI 1·09, 1·83, respectively). In men, the second tertile of GL and weekly intake of high-GI foods were associated with CRC (OR 1·44, 95 % CI 1·04, 1·99 and OR 1·48, 95 % CI 1·32, 1·65, respectively). Also, GI was associated with CRC in women (highest v. lowest tertile OR 2·12, 95 % CI 1·38, 3·27). In addition to the quantity and quality of carbohydrates intake, it is important to consider the frequency of consumption of high-GI foods in CRC prevention.
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Osaka R, Hayashi K, Onda T, Shibahara T, Matsuzaka K. Evaluation of Liquid Based Cytology for Tongue Squamous Cell Carcinoma: Comparison with Conventional Cytology. THE BULLETIN OF TOKYO DENTAL COLLEGE 2019; 60:29-37. [PMID: 30700642 DOI: 10.2209/tdcpublication.2018-0015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Oral exfoliative cytology is now used by general practitioners in Japan to screen for oral cancer. With conventional cytology, however, the number of cells that can be sampled is small. Moreover, cell deformation and piling of cells when preparing specimens has been reported. The purpose of this study was to compare conventional and liquid based cytology (LBC), which has been employed with increasing frequency in recent years. We believe that identifying potential pitfalls in oral exfoliative cytology will help improve diagnostic accuracy. A total of 153 patients with tongue squamous cell carcinoma who were diagnosed and treated initially at our hospital between January 2000 and December 2010 were included. Of these, 124 underwent conventional cytology, while the remaining 29 underwent LBC. Histopathological and clinical findings were used as criteria. Conventional cytology yielded a positive rate of 54.8% and LBC 79.3%, while values of 28.2% and 13.8% were obtained for a suspected positive rate, respectively. Liquid based cytology yielded a significantly higher percentage of accurate diagnoses and fewer suspected positives (p<0.05) in cases clinically classified as endophytic and those classified as ulcerative in terms of clinical growth pattern. No significant difference was observed between conventional cytology and LBC in cases of an infiltrative growth pattern, however.The present results suggest that LBC is superior to conventional cytology in achieving an accurate diagnosis based on oral exfoliative cytology. The present findings also suggest that exophytic type, and especially leukoderma type clinical growth patterns constitute pitfall cases in oral exfoliative cytology.
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Affiliation(s)
- Ryuta Osaka
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College.,Department of Oral and Maxillofacial Surgery, Ikegami General Hospital
| | | | - Takeshi Onda
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College
| | - Takahiko Shibahara
- Department of Oral and Maxillofacial Surgery, Tokyo Dental College.,Oral Cancer Center, Tokyo Dental College
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Zarate AM, Don J, Secchi D, Carrica A, Galindez Costa F, Panico R, Brusa M, Barra JL, Brunotto M. Study of the TP53 codon 72 polymorphism in oral cancer and oral potentially malignant disorders in Argentine patients. Tumour Biol 2017; 39:1010428317699113. [PMID: 28459200 DOI: 10.1177/1010428317699113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this work was to evaluate the prevalence of TP53Arg72Pro mutations and their possible relationship with oral carcinoma and oral potentially malignant disorders in Argentine patients. A cross-sectional study was performed on 111 exfoliated cytologies from patients with oral cancer (OC), oral potentially malignant disorders (OPMD) and controls. The TP53Arg72Pro mutations were determined using conventional PCR. We evaluated univariate and multivariate study variables, setting p < 0.05. We found: (a) a low frequency of Pro72 variant in control group and a high frequency in OC and OPMD, as well in OC and oral leukoplakia (OL) diagnosis; (b) multivariate association among the TP53CC genotype and females over 45 years with no tobacco nor alcohol habits with oral lichen planus pathology; (c) multivariate association between the TP53GC genotype and males with alcohol and tobacco habits and OC and OL pathologies. Our results showed that the wild-type Arg72variant was related to control patients and Pro72variant was related to OC and OPMD, in Argentine patients.
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Affiliation(s)
- Ana Maria Zarate
- 1 Departamento de Biología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Julieta Don
- 1 Departamento de Biología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Dante Secchi
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Andres Carrica
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Fernanda Galindez Costa
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Rene Panico
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Martin Brusa
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - José Luis Barra
- 3 Facultad de Ciencias Químicas, CIQUIBIC-CONICET, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Mabel Brunotto
- 2 Departamento de Patología Bucal, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
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Sekine J, Nakatani E, Hideshima K, Iwahashi T, Sasaki H. Diagnostic accuracy of oral cancer cytology in a pilot study. Diagn Pathol 2017; 12:27. [PMID: 28298213 PMCID: PMC5353886 DOI: 10.1186/s13000-017-0618-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/01/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recently, cytology has been applied to the diagnosis of oral lesions. We aimed to explore the diagnostic accuracy of oral cytology based on the histological diagnosis. METHODS Histological diagnoses of 327 cases were classified as Negative, Borderline lesion -, Borderline lesion +, oral intraepithelial neoplasia/carcinoma in situ (OIN/CIS), or Positive. Cytological diagnoses were classified as NILM (negative for intraepithelial lesion or malignancy), LSIL (low-grade squamous intraepithelial lesion), HSIL (high-grade squamous intraepithelial lesion), or SCC (squamous cell carcinoma). The cytology slides were evaluated by 10 raters and the results were compared with the histology results. RESULTS In 142 cases that were histologically negative, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 77 (54.2%), 47 (34.3%), 8 (5.6%), and 10 (7.0%), respectively. Among 32 cases of Borderline lesion -, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 11 (34.3%), 11 (34.3%), 9 (28.1%), and 1 (3.1%), respectively. Also, in 4 cases of Borderline lesion +, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 2 (50.0%), 0 (0.0%), 0 (0.0%), 2 (50.0%), respectively. Among 12 cases of OIN/CIS, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 1 (8.3%), 2 (16.7%), 4 (33.3%), and 5 cases (41.7%), respectively. Among 137 cases with a histological diagnosis of Positive, the number of NILM, LSIL, HSIL, and SCC and other malignancy was 7 (5.1%), 22 (16.1%), 19 (13.9%), and 89 (65.0%), respectively. Sensitivity, specificity, and positive predictive and negative predictive values were 93.5, 50.6, 62.4, and 89.8%, respectively, when the cytological diagnosis of Negative was assumed to be NILM; they were 77.8, 83.9, 81.0 and 81.1%, respectively, if the cytological diagnosis of Negative was assumed to be NILM and LSIL. The number of false-positive and false-negative diagnosis affected cases with LSIL and HSIL may indicate the difficulty in the cytological diagnosis of borderline lesions. While the negative predictive value was relatively high (89.8%) when cytological Negative was assumed to be NILM only. CONCLUSION Histopathological examination should be recommended in cases with cytological diagnoses of LSIL, HSIL, and SCC.
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Affiliation(s)
- Joji Sekine
- Japanese Society of Clinical Cytology, Tokyo, Japan.
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Eiji Nakatani
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Katsumi Hideshima
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Teruaki Iwahashi
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Hiroshi Sasaki
- Japanese Society of Clinical Cytology, Tokyo, Japan
- Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, Kashiwa, Japan
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Silva ADD, Maraschin BJ, Laureano NK, Daroit N, Brochier F, Bündrich L, Visioli F, Rados PV. Expression of E-cadherin and involucrin in leukoplakia and oral cancer: an immunocytochemical and immunohistochemical study. Braz Oral Res 2017; 31:e19. [PMID: 28273205 DOI: 10.1590/1807-3107bor-2017.vol31.0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/24/2017] [Indexed: 12/11/2022] Open
Abstract
To assess the immunocytochemical and immunohistochemical correlation of adhesion (E-cadherin) and cell differentiation (involucrin) molecules in oral leukoplakia and oral squamous cell carcinoma. Cytological samples and biopsies were obtained from male and female patients aged over 30 years with oral leukoplakia (n = 30) and oral squamous cell carcinoma (n = 22). Cell scrapings and the biopsy were performed at the site of the lesion and histological slides were prepared for the immunocytochemical analysis of exfoliated oral mucosal cells and for the immunohistochemical analysis of biopsy tissues using E-cadherin and involucrin. Spearman's correlation and kappa coefficients were used to assess the correlation and level of agreement between the techniques. Immunostaining for E-cadherin and involucrin by both techniques was similar in the superficial layers of the histological sections compared with cell scrapings. However, there was no statistical correlation and agreement regarding the immunocytochemical and immunohistochemical expression of E-cadherin and involucrin in oral leukoplakia (R = 0.01, p = 0.958) (Kappa = 0.017, p = 0.92) or in oral squamous cell carcinoma (R = 0.26, p = 0.206) (Kappa = 0.36, p = 0.07). The immunoexpression of E-cadherin and involucrin in tissues is consistent with the expression patterns observed in exfoliated oral mucosal cells, despite the lack of a statistically significant correlation. There is an association of the histopathological characteristics of leukoplakia with the expression E-cadherin and of the microscopic aspects of oral squamous cell carcinoma with immunohistochemical expression of involucrin.
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Affiliation(s)
| | - Bruna Jalfim Maraschin
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Natalia Koerich Laureano
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Natália Daroit
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Fernanda Brochier
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Leonardo Bündrich
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Fernanda Visioli
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Pantelis Varvaki Rados
- Universidade Federal do Rio Grande do Sul - UFRGS, Department of Oral Pathology, Porto Alegre, RS, Brazil
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Nanayakkara PGCL, Dissanayaka WL, Nanayakkara BG, Amaratunga EAPD, Tilakaratne WM. Comparison of spatula and cytobrush cytological techniques in early detection of oral malignant and premalignant lesions: a prospective and blinded study. J Oral Pathol Med 2015; 45:268-74. [PMID: 26403502 DOI: 10.1111/jop.12357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND The use of oral cytology to diagnose malignant and premalignant lesions at an early stage is considered crucial. The aim of this study was to evaluate the diagnoses of the spatula and the cytobrush techniques compared with the gold standard histopathological findings, analysed according to different diagnostic criteria. METHODS Cytological smears were obtained from 76 suspicious oral malignant lesions and 116 oral leukoplakia lesions using two techniques: cytobrush plus cell collector and metal spatula. Subsequently, a surgical biopsy was performed on each lesion to achieve a histopathological diagnosis. Evaluation was conducted with respect to three different diagnostic criteria. RESULTS The sensitivity for diagnosing carcinoma in clinically malignant cases was 89.58% and 60.42% for cytobrush and spatula techniques, respectively. Inclusion of severe dysplastic cases for 'high-risk' lesions increased the sensitivity up to 96.36% and 78.18% for two techniques, respectively. In leukoplakia lesions, malignant and severely dysplastic cells were diagnosed at a sensitivity of 88.89% in the cytobrush and 55.56% in the spatula techniques. Extending the criteria by defining malignant or any dysplastic findings as positive, sensitivity was increased to 98.02% and 89.11% for the spatula and the cytobrush techniques, respectively. Specificity for both techniques increased to 100%. The difference between the diagnoses of histopathology and the spatula cytology was statistically significant (P < 0.01), while no such difference was found with the cytobrush technique (P > 0.1). CONCLUSION The cytobrush, unlike the spatula, is a useful screening instrument for early diagnosis of suspicious oral lesions and could therefore contribute to improved oral cancer prognosis.
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Affiliation(s)
| | - W L Dissanayaka
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - B G Nanayakkara
- Faculty of Medicine, University of Ruhuna, Karapitiya, Sri Lanka
| | - E A P D Amaratunga
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - W M Tilakaratne
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
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