|Year : 2020 | Volume
| Issue : 12 | Page : 1695-1701
Descriptive Epidemiology of Odontogenic Tumors in Nigeria: An African Oral Pathology Research Consortium Multicenter Study
DS Okoh1, AO Akinshipo2, A Butali3, OG Omitola4, OF Sigbeku5, OO Soyele6, OD Osunde7, AO Taiwo8, AA Ibikunle8, KU Omeje9, AO Lawal5, B Fomete10, HA Adeola11
1 Department of Dental and Maxillofacial Surgery, Oral and Maxillofacial Pathology and Medicine Unit, Federal Medical Centre, Asaba, Delta State, Nigeria
2 Department of Oral and Maxillofacial Pathology and Biology, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Oral Pathology, Radiology and Medicine, University of Iowa, Iowa City, IA, USA
4 Department of Oral Pathology and Biology, University of Port Harcourt, Port Harcourt, Nigeria
5 Department of Oral Pathology, College of Medicine, University of Ibadan, Ibadan, Nigeria
6 Department of Oral Maxillo-facial Surgery and Oral Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria
7 Department of Dental and Maxillofacial surgery, Faculty of Dentistry, College of Medical Sciences University of Calabar, Cross River state, Nigeria
8 Department of Dental and Maxillofacial surgery, Usman Danfodiyo University Teaching Hospital, Sokoto, Nigeria
9 Department of Oral and Maxillofacial surgery, Faculty of Dentistry, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
10 Department of Oral and Maxillofacial surgery, Faculty of Dentistry, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
11 Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of the Western Cape and Tygerberg Hospital; Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
|Date of Submission||30-May-2020|
|Date of Acceptance||21-Jul-2020|
|Date of Web Publication||23-Dec-2020|
Dr. H A Adeola
Division of Dermatology, Department of Medicine, Faculty of Health Sciences and Groote Schuur Hospital, University of Cape Town, Observatory 7925, Cape Town
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Many studies have investigated the burden of odontogenic tumor (OT) in Nigeria; however, the true burden and prevalence of these lesions are not known because these studies are based on a center/region. Aims: Hence, the aim of this study is to evaluate the true burden of OTs in Nigeria, using a multicenter approach. Materials and Methods: This is a 10-year retrospective cross-sectional study of OT seen in eight tertiary health institutions in different geographic locations in Nigeria. Results: A total of 990 cases were included in this study. The highest prevalence of OT was in the third decade of life (n = 274, 27.7%). Most lesions were benign (n = 961, 97.1%), with a slight male preponderance; and the mandible was the commonest site (n = 814, 82.2%). There were a significant association between the diagnosed OTs and the age group and site (P = 0.002 and 0.031, respectively). Conclusion: OTs showed a slightly higher preponderance in males, occurring mostly in the third decade. Benign lesions were frequent and ameloblastoma was the commonest OT. Variations exist in the occurrence of OTs from the different geographic locations in Nigeria. This study essentially sheds a broader light on the clinicopathological distribution of OTs across Nigeria, using a large multicenter approach.
Keywords: Ameloblastoma, descriptive epidemiology, multicenter, Nigeria, odontogenic tumors
|How to cite this article:|
Okoh D S, Akinshipo A O, Butali A, Omitola O G, Sigbeku O F, Soyele O O, Osunde O D, Taiwo A O, Ibikunle A A, Omeje K U, Lawal A O, Fomete B, Adeola H A. Descriptive Epidemiology of Odontogenic Tumors in Nigeria: An African Oral Pathology Research Consortium Multicenter Study. Niger J Clin Pract 2020;23:1695-701
|How to cite this URL:|
Okoh D S, Akinshipo A O, Butali A, Omitola O G, Sigbeku O F, Soyele O O, Osunde O D, Taiwo A O, Ibikunle A A, Omeje K U, Lawal A O, Fomete B, Adeola H A. Descriptive Epidemiology of Odontogenic Tumors in Nigeria: An African Oral Pathology Research Consortium Multicenter Study. Niger J Clin Pract [serial online] 2020 [cited 2023 Jan 28];23:1695-701. Available from: https://www.njcponline.com/text.asp?2020/23/12/1695/304423
| Introduction|| |
Odontogenic tumors are a group of tumors arising from odontogenic apparatus during or after odontogenesis., These lesions can present as hamartomatous-like lesion, benign neoplasm, and frank malignancy that are derived from tooth forming tissue (epithelium, ectomesenchyme, or mesenchyme). They may occur centrally within the jawbone or may be found in the soft tissue of the gingival.
These tumors show wide variation in distribution in different parts of the world. While ameloblastoma is noted to be the most frequent odontogenic tumor in Africa and Asia, odontotoma has been reported as the most frequent in Europe and America., The differences in presentation may be due to racial genetic, access to proper health facilities and the source of data.
Within Nigeria, there are several studies on these lesions that are usually center based.,,, This may not give us the true pattern of distribution of these important lesions. We therefore conducted this multicenter study using the platform of African Oral Pathology Consortium. The aim of this study is to determine the relative frequency of the different types of odontogenic tumors (based on the experience from different tertiary centers) and to evaluate the age, gender, and the site of occurrence of these tumors in Nigeria. This will allow us to have an idea of the true burden of this lesion in Nigeria.
| Materials and Methods|| |
This is a retrospective cross-sectional study that reviewed histopathologic archives and slides of cases histopathologically diagnosed as odontogenic tumors from the Department of Oral and Maxillofacial Pathology and Oral and Maxillofacial Surgery of eight tertiary health institutions across the Northern and Southern geographic regions of Nigeria within a 10-year period (from 2009 to 2018).
Secondary archived data were collected from five Southern and three Northern tertiary dental hospitals, respectively, namely: Lagos University Teaching Hospital, University College Hospital Ibadan, Obafemi Awolowo University Teaching Hospital Complex Ile-Ife, University of Port Harcourt Teaching Hospital, University of Calabar Teaching Hospital- all in Southern Nigeria; and Ahmodu Bello University Teaching Hospital Zaira, Aminu Kano Univeristy Teaching Hospital Kano and Usman Danfodio Teaching Hospital Sokoto – all in Northern Nigeria.
This study analyzed hospital-based records from multiple centers across Nigeria, ensuring that patient anonymity and confidentiality was preserved. The study was conducted following ethical guidelines according to the “Declaration of Helsinki.”
Case selection and exclusion criteria
Tumors recognized in the 2017 classification of odontogenic tumors were included in this study. Furthermore, cases with insufficient clinical and histopathological data were excluded from this study.
Data such as age, gender, site and histopathologic diagnosis of the cases were collected and entered into the Statistical Package for Social Science (SPSS version 21; IBM SPSS 21 Chicago, Illinois, USA) for analysis. The level of significance was set at P value < 0.05. Using a Jarqua-–Bera test with skewness and kurtosis, we observed that the data were normally distributed. Inferential analysis on the association between tumor occurrence, age, gender, and location was done using the Pearson's Chi-square test.
| Results|| |
Overall, a total of 990 cases histopathologically diagnosed as odontogenic tumors and recognized in the 2017 classification of odontogenic tumors were included in this study from the eight tertiary health institutions within a 10-year period from 2009 to 2018.
Overall, ameloblastoma was the most common histopathologically diagnosed odontogenic tumor (n = 705, 71.2%), followed by Fibromyxoma (n = 83, 8.4%). Cementoblastoma and odonto-ameloblastoma were the least commonly diagnosed tumors in this study with 1 case (0.1%) each [Table 1].
|Table 1: Frequency of the histopathological types of the odontogenic tumors|
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The age range of the patients was from 3 to 88 years, with a mean age of 32.23 ± 3.77 years. The peak age group was in the third decade of life (n = 274, 27.7%) [Figure 1]. There was a significant association between the odontogenic tumors with the age groups (P = 0.002) [Table 2].
There were 527 males (53.2%) and 463 females (46.8%) giving a male to female ratio of 1.14: 1. Association between gender distribution and odontogenic tumors was significant (P = 0.030) [Table 3].
The mandible (n = 814, 82.2%) was the most commonly affected site [Figure 2]. There was a significant association between the odontogenic tumors and the site of the tumor (P = 0.031) [data are shown in [Table 4]].
Some variability exists in the frequency of occurrence of these tumors from the different centers across the geographic location [Table 5].
|Table 5: Comparison of the most common pattern of distribution of the odontogenic tumors from different geographic locations in Nigeria|
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| Discussion|| |
From this study, we identified that odontogenic tumors occur more within the third decade (20–29) age group, which is consistent with previous studies and corroborated by a recent study. Aregbesola et al. reviewed 582 odontogenic tumors, using the WHO histological typing, and found more benign than malignant lesions. Furthermore, epithelial and mixed odontogenic tumor lesions were the most and least common lesions, respectively. As observed in this study, they also found a mandibular predilection as well as a peak age in the third decade of life.
As identified in previous studies, ameloblastoma in this study consistently remains the most common odontogenic tumors in Nigeria (71.2%) followed by Fibromyxoma (8.9%) and adenomatoid odontogenic tumors (AOT) (5.6%), using histologically diagnosed cases based on the 2017 WHO odontogenic tumor classification. These findings are slightly at variance with the recent study by Aregbesola et al. The high mandibular site predilection of odontogenic tumors (OTs) agrees with similar studies done in Nigeria and other African countries.,,,
From our analyses, there appears to be no gender predilection for most of the tumors except for calcifying epithelial odontogenic tumor (CEOT; also known as Pindborg tumor), ameloblastic carcinoma, primary intraosseous carcinoma, odontogenic carcinoma, odonto-amelobastoma, and cemento-ossifying fibroma. However, previous studies did not report any sex difference in CEOT, and for ameloblastic carcinoma. It is possible that the sex differences in our population are either due to sampling bias or increased genetics risk in the African population driving the male predilection. We observed that more males had primary intraosseous Odontogenic carcinoma than females, and this is consistent with what has been previously reported., There is also a male predilection for odonto-amelobastoma, which is also consistent with what others have reported. More women were observed to have Cemento-ossifying Fibroma in line with the literature.,, There is a sixfold increase in the number of tumors in the mandible compared to the maxilla and 80 times more than in soft tissues. Our observation is consistent with what has been previously reported for craniofacial tumors., We also showed consistent results with previously reported ages for AOT.
Centers such as Ibadan and Lagos (South-west Nigeria) and Zaria (North central) recorded the highest numbers of cases of odontogenic tumors in this study compared to locations like Calabar in (South – South Nigeria) that recorded the least number of cases. This is because centers like Ibadan and Lagos are more established with a good number of trained specialist personnel. The presence of oral and maxillofacial pathologist to facilitate diagnosis and the extent of reporting of cases contribute to the number of cases seen in the different centers. The mean ages from the different geographic locations show variation from the lowest 28.95 ± 13.63 years in Sokoto to the highest 38.03 ± 11.20 years observed in Calabar. This variation may be due to the clinico-demographic pattern. The level of awareness of patients in the different regions can affect the time of presentation. Therefore, it is probable that the level of awareness of availability of care may be lower in locations with a higher mean age. In our environment, patients present late with resultant higher mean age. Most centers in the Southern regions except Calabar reported the third decade of life as the most frequent which is like previous reports, while the centers in the Northern region reported mostly the second and fourth decades of life. In most locations, male preponderance was observed consistent with previous reports, except Lagos and Port-Harcourt that show some female preponderance.
The mandible was the most common site and ameloblastoma was the most common tumor in all the different geographic locations. These findings are similar to earlier reports., Furthermore, most centers in the South reported fibromyxoma as the second most common tumor. However, of the three centers in the Northern region, two centers observed cemento-ossifying fibroma as the second most common tumor seen. Aregbesola et al. (2018), in their 12-year review from four centers reported AOT as the second most common tumor in their series. There would be need for more studies to understand the variation that exist between the North and the South vis-à-vis second most common odontogenic tumor after ameloblastoma, in these regions.
Ameloblastoma has consistently been reported to be the commonest odontogenic tumor in studies from the sub-Saharan Africa subcontinent.,,, The studies in Europe and North America reported odontoma as the commonest odontogenic tumor. However, a study from the UK which used the 2017 classification reported ameloblastoma as the most common odontogenic tumor followed by odontomas and odontogenic fibromyxoma. While this study shows ameloblastoma to be the most common odontogenic tumor in both local and referral cases, it is worth noting that odontomas might still be commoner in Europe since odontoma (comprising 43% of cases) was more in local cases of odontogenic tumors in their report. In a study by Jaeger et al. from Brazil, odontoma was also reported as the most common odontogenic tumor prior to the 2005 classification. However, keratocystic odontogenic tumor was the most frequent OT with 207 cases (41.07%) after 2005. In addition, some studies from Europe and America have reported ameloblastoma and fibromyxoma as the most common odontogenic tumor, after odontoma.
The reason for predilection of ameloblastoma in black Africans is still a subject of speculation. This highlights the value of leveraging multicenter studies to unravel the basis for disparity in aetiology and pathogenesis of dental pathologies across different population groups. This study thus serves as an essential prerequisite for future studies on genetics and genomics of Amelobalstoma and other odontogenic tumors. These will then drive us closer to personalized medicine as well as improve our ability to design strategies for prevention.
In conclusion, this study presents (to our knowledge) the largest multi-center assessment of odontogenic tumors in Nigeria, and possibly on the African continent. As carried out in this study, pooling odontogenic tumor data from eight tertiary dental hospitals across the Northern and Southern regions of Nigeria has reveal in depth, the true burden of odontogenic tumors in Nigeria. We identified here that ameloblastoma is the commonest odontogenic tumor in Nigeria and the commonest site is the mandible. Odontogenic tumors are slightly commoner in males, but the gender predilection varies from lesion to lesion. There are regional variations with regards to the second most common odontogenic tumor (fibromyxoma vs cemento-ossifying fibroma) in Northern and Southern Nigerian dental hospitals. This warrants further molecular studies. Important limitations of this study included the lack of specific details on jaw sites (i.e., anterior or posterior) as well overall burden of odontogenic tumors among all other orofacial lesions. This would further improve our understanding of odontogenic tumors in Nigeria and should be strongly considered in future multicenter studies. Collaborative studies are poised to improve our understanding of the epidemiological and molecular landscape of dental pathologies in Africa. This would foster judicious allocation of government fiscals in the healthcare sector. Not least, it would identify areas of greatest disease-specific research need.
HAA thanks the SAMRC for a mid-career scientist and Self-initiated research grant; and the South African National Research Foundation (NRF) for research development grants for rated researchers. AB thanks the NIDCR K99/R00 Grant DE022378-04 and Robert Wood Johnson Foundation Grant number 72429. The funders played no role in the design or interpretation of the paper or the decision to publish.
Financial support and sponsorship
Conflicts of interests
The Authors declare that they have no conflict of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]