Bcl-2 Protein Expression in Oral Squamous Cell Carcinoma and Associated Clinicopathological Features at a Tertiary Teaching Institution in Uganda

Authors

  • Waiswa Ali Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda Author
  • Andrew Livex Okwi Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda Author
  • Kalungi Sam Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda Author
  • Betty Kasimo Abbo Department of Pathology, Busitema University, P.O Box 236, Tororo, Uganda Author
  • Katongole Fauz Department of Pathology, Mulago Specialised Women and Neonatal Hospital, P.O Box 22081, Kampala, Uganda Author
  • Nyakato Veronica Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda Author
  • Boaz Mwesigwa Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda Author
  • Mawanda Anatoli Department of Pathology, P.O. Box 88, King Ceasor University, Kampala, Uganda Author
  • Tonny Okecha Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda Author
  • Hawa Nalwoga Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda Author

DOI:

https://doi.org/10.47363/JCHR/2026(5)110

Keywords:

Oral Squamous Cell Carcinoma, Bcl-2 Protein, Immunohistochemistry, Prognosis, Uganda, Basaloid Subtype

Abstract

Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity and a significant public health challenge in sub-Saharan Africa. Conventional histopathology often fails to predict clinical outcomes accurately, leading to a search for molecular biomarkers. The B-cell lymphoma 2 (Bcl-2) protein, an anti-apoptotic factor, is 
involved in cell survival and treatment resistance. This study determined the prevalence of Bcl-2 expression in OSCC and its association with clinicopathological features in Uganda.


Methods: This cross-sectional laboratory study analyzed 104 archived formalin-fixed paraffin-embedded (FFPE) tissue blocks of OSCC cases from Makerere University (2010–2020). Histological subtyping and grading followed WHO (2017) criteria. Immunohistochemistry (IHC) was performed using the anti-Bcl-2 clone 124. Expression was scored semi quantitatively (intensity + percentage of positive cells). Data were analyzed using Chi-square tests and multivariate logistic regression.


Results: Bcl-2 was expressed in 29.8% (31/104) of OSCC cases, predominantly in a granular cytoplasmic pattern. In well-differentiated tumors, staining was most intense at the invasive periphery. Multivariate analysis identified male sex (aOR = 4.76, p = 0.025) and the basaloid histological subtype (aOR = 38.77, p = 0.003) as independent predictors of 
Bcl-2 expression. No significant associations were found with age, tumor site, or histological grade.


Conclusion: Approximately 30% of OSCC cases in Uganda express Bcl-2, with significant associations noted for male patients and the aggressive basaloid subtype. These findings 
suggest Bcl-2 as a prognostic indicator and potential therapeutic target.

Author Biographies

  • Waiswa Ali, Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda

    Waiswa Ali, Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda

  • Andrew Livex Okwi, Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

    Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

  • Kalungi Sam, Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda

    Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda

  • Betty Kasimo Abbo, Department of Pathology, Busitema University, P.O Box 236, Tororo, Uganda

    Department of Pathology, Busitema University, P.O Box 236, Tororo, Uganda

  • Katongole Fauz, Department of Pathology, Mulago Specialised Women and Neonatal Hospital, P.O Box 22081, Kampala, Uganda

    Department of Pathology, Mulago Specialised Women and Neonatal Hospital, P.O Box 22081, Kampala, Uganda

  • Nyakato Veronica, Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda

    Division of Pathology and Laboratory Medicine, Uganda Cancer Institute, P.O.BOX 3935, Kampala, Uganda

  • Boaz Mwesigwa, Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda

    Department of Pathology, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda

  • Mawanda Anatoli, Department of Pathology, P.O. Box 88, King Ceasor University, Kampala, Uganda

    Department of Pathology, P.O. Box 88, King Ceasor University, Kampala, Uganda

  • Tonny Okecha, Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

    Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

  • Hawa Nalwoga, Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

    Department of Pathology, Makerere University, P.O. Box 7072, Kampala, Uganda

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Published

2026-03-17

Issue

Vol. 5 No. 1 (2026): Volume 5 Issue 1

Section

Articles