EKSPRESI P53 MUTAN DAN GADD45 PADA BERBAGAI TIPE AMELOBLASTOMA DI RSUP DR SARDJITO YOGYAKARTA JANUARI 2008-JUNI 2014 (Penelitian Retrospektif Analitik)

RITA KOEN WIDHIANINGRUM, drg Masykur Rahmat, SpBM(K) dan drg Soetji Poerwati Rahajoe, SpBM

2016 | Tesis-Spesialis | SP ILMU BEDAH MULUT

Ameloblastoma merupakan tumor jinak rahang dengan sifat destruksidan rekurensi yang tinggi. Mekanisme molekular yang mengatur pertumbuhan sel belum dipahami tetapi adanya mutasi p53 dan kegagalan fungsi perbaikan DNA oleh protein Gadd45 dianggap memiliki peran yang penting dalam proses tumorigenesis.Penelitian ini bertujuan untuk mengamati ekspresi p53 mutan dan Gadd45 pada berbagai tipe ameloblastoma. Sampel penelitian diambil dari blok parafin penderita tumor ameloblastoma Poliklinik Bedah Mulut dan Maksilofasial RSUP Dr Sardjito pada instalasi Patologi Anatomi RSUP Dr SardjitoYogyakarta kurun waktu Januari 2008-Juni 2014. Sampel yang diperoleh tipe pleksiform 14 (37,8%), folikuler 10 (27,0%), akantomatosa 6 (16,2%), periferal 2 (5,4%), unikistik 1 (8,1%), desmoplastik dan karsinoma ameloblastik masing-masing 1 (2,7%). Setiap sampel diberi pewarnaan HE dan imunohistokimia p53 mutan dan Gadd45, diikuti penilaian imunoskordan analisa data. Pewarnaan imunohistokimia seluruhnya menunjukkan hasil positif dengan imunoskor yang bervariasi. Uji Mann-Whitney menunjukkan perbedaan yang signifikan ekspresi Gadd45 antara tipe folikuler dengan akantomatosa (p=0,021), sedangkan ekspresi p53 mutan menunjukkan perbedaan signifikan pada tipe pleksiform dengan folikuler (p=0,047) dan tipe folikuler dengan akantomatosa (p=0,021). Uji Kruskal-Wallis menunjukkan agresifitas tertinggi berdasarkan ekspresi p53 mutan dan Gadd45 adalah tipe akantomatosa diikuti pleksiform dan folikuler. Kesimpulan penelitian ini adalah ekspresi p53 mutan dan Gadd45 yang tinggi dijumpai pada tipe akantomatosa diikuti pleksiform dan akantomatosa, yang menunjukkan tipe akantomatosa bersifat lebih agresif dibanding tipe lain.

An odontogenic tumor located in the jaw, ameloblastoma is widely known for its potentially destructive behavior and high recurrence. Despite that the molecular mechanisms that regulate its cell growth are not well learnt, p53 mutation and DNA repair failure by Gadd45 protein might contribute significantly the process of tumorigenesis. This study is therefore aimed at observing the expressions of p53 mutant and Gadd45 in different types of ameloblastomas. Serving as the subjects were patients from the paraffin block of ameloblastoma in the Polyclinic of Oral and Maxillofacial Surgery in the Laboratorium of AnatomicalPathology of Dr. Sardjito Hospital Yogyakarta between January 2008 and June 2014. Among the observed subjects, 14 (37.8%) belonged to the plexiform type, 10 (27.0%) were in the follicular type, 6 (16.2%) refered to acanthomatous type, 2 (5.4%) was categorized into periferal type, 1 (8.1%) was unicystic typed, 1 (2.7%) belonged to the desmoplastic and ameloblactic carcinoma type respectively. Each subject was stained with HE and immunohistochemical p53 mutant and Gadd45 in which the immunoscore and data analysis were subsequently conducted. An immunohistochemical staining-based observation showed positive value with varied immunoexpressions. Mann-Whitney test showed a significant difference in Gadd45 expression between the groups of follicular type and acanthomatous type (p=0.021) whereas a significant difference in p53 mutant expression was found between the plexiform type and follicular type (p=0.047) and so was the follicular type and acanthomatous type (p=0.021). Kruskal-Wallis test indicated that on the basis of p53 mutant and Gadd45 expressions, the acanthomatous type was the most aggressive, followed by the plexiform type and the follicular type. Conclusion is acanthomatous type has higher aggressivity than other type, proved by high expression of p53 mutan and Gadd45 in acanthomatous type followed by the plexiform type and the follicular type.

Kata Kunci : ameloblastoma, p53 mutan, Gadd45/ameloblastoma, p53 mutant, Gadd45