Controversies in ameloblastoma management: evaluation of decision making, based on a retrospective analysis / Controversias en el manejo del ameloblastoma: Evaluación de la toma de decisiones, basada en un análisis retrospectivo

Background: The ameloblastoma management is still challenging to the high recurrence rates and significantmorbidity associated with radical treatment. The purpose of this 10-year retrospective study was to analyze theinfluence of ameloblastoma type and treatment strategy on the long-term outcomes and recurrence rates.Material and Methods: The retrospective analyses of 64 histologically-confirmed ameloblastoma cases was per-formed. The possible risk factors for recurrence and the development of complications were estimated statistically.Results: The treatment strategy applied for this group of patients was the following: thirty-four patients (53.1%)were treated conservatively with enucleation or extended bone curettage. Radical treatment (bone resection) wasapplied in 30 (46.9%) cases. The follow-up period ranged from 2 to 10 years (mean value 4.28 ± 3,26). General re-currence rate consisted 32.8%. This study did not find significant correlations between clinical or histopathologi-cal features of the ameloblastoma and the recurrence rate. The only factor that significantly influence recurrencerate was the treatment strategy (41% in conservative treatment vs 15% in radical treatment, p<0.05). Postoperativecomplications were observed in 42 patients (65.6%) and included face asymmetry and disfigurement (17.2%), tem-porary paresthesia of the inferior alveolar nerve (IAN) - 23.4%, permanent paresthesia of IAN - 20.3%, paresisof a marginal branch of the facial nerve - 6.3%, infection 12.5%, and swelling - 20.3%. The complication rates,esthetic and functional deficiency were significantly higher in radically treated patients (p<0.05)Conclusions: Our study confirms that higher recurrence rate is associated with conservative treatment for am-eloblastoma, while radical treatment leads to an increased number of postoperative complications that affect thepatient's quality of life.(AU)

Retrospective analysis of jaw biopsies in young adults. A study of 1599 cases in Southern Brazil

Background: To evaluate the prevalence and the characteristics of jaw lesions diagnosed in young adults aged 20 to 30 years in a southern Brazil reference center, over a period of 25 years. And to analyze the concordance between clinical and histological diagnosis. Material and Methods: In this cross-sectional retrospective study, the biopsies files from this center were retrieved and data regarding sex, age, bone localization, clinical and histological diagnosis were collected. The histological diagnosis were grouped into the categories Cystic lesions of odontogenic origin, Periapical inflammation, Odontogenic tumors, Bone diseases, Health tissue and Nonspecific diagnostic. Absolute and relative frequencies were estimated with descriptive analysis. The agreement between clinical and histological diagnosis was measured through Kappa statistic. Results: A total of 18,181 histopathological analysis were performed during the period of the study, registering 1,599 jaw lesions in young adults. The average age of individuals was 24,59 years (SD 3,1). Nine hundred ninety-one (62%) lesions were found in females and 608 (38%) in males. More than half of pathologies were cystic lesions of odontogenic origin (822/51.4%), followed by periapical inflammation (282/17.6%). Regarding the site of lesions, more than half occurred in posterior mandible (877/54.8%), followed by posterior maxilla (339/21.2%). The most frequent entities were periapical cyst, chronic periapical granuloma, dental follicle and paradental cyst, corresponding to a total of 1,202 (75.2%) evaluated cases. In relation to the analysis of concordance between clinical and histological diagnosis the general Kappa index was 0.5, which is considered moderate. Finally, the findings confirm data from literature about the most frequent jaw pathologies in young adults and serve as aid for preventive measures of some entities. Additionally, they can improve the formulation of differential diagnosis and the patient management (AU)

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Transformación maligna de un tumor odontogénico queratósico con gran componente inflamatorio. Presentación de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumor with a large inflammatory component. Case report and a review of the literature

El desarrollo de un carcinoma de células escamosas a partir del revestimiento epitelial de un tumor odontogénico queratósico (TOQ) corresponde a una neoplasia maligna infrecuente exclusiva de los huesos maxilares, denominada también cómo carcinoma de células escamosas intraóseo primario (CCEIP). Afecta principalmente a personas de mediana edad, especialmente a hombres (2:1) y se localiza usualmente en la zona posterior de la mandíbula. Aunque la patogénesis del CCEIP es desconocida y no se le puede atribuir asociación con factores predisponentes para el desarrollo de carcinoma de células escamosas de la mucosa oral, actualmente se refuerza la idea del componente inflamatorio como predisponente de malignización. Se presenta un caso clinicopatológico de un varón de 61 años de edad con diagnóstico de CCEIP derivado de un TOQ con un gran componente inflamatorio asociado (AU)

The development of a squamous cell carcinoma from the epithelial lining of a keratotic odontogenic tumor (KOT) corresponds to a rare malignant neoplasm exclusive to the jawbone, also referred to as primary intraosseous squamous cell carcinoma (PIOC). It mainly affects middle-aged people, especially men (2: 1) and is usually located in the rear area of the jaw. The pathogenesis of PIOC is unknown and no predisposing factor for the development of squamous cell carcinoma of the oral mucosa has been identified. However, many authors support the hypothesis that a component of a chronic inflammatory process could prove to be the underlying factor of malignant change. We present a case of a 61-year-old male diagnosed with PIOC derived from a KOT associated with an extensive inflammatory process (AU)

Ameloblastoma desmoplásico con predominio quístico: presentación de un caso clínico / Desmoplastic ameloblastoma with cystic predominance: presentation of a clinical case

El ameloblastoma es una neoplasia odontogénica que muestra un comportamiento agresivo local. Algunas variantes como la uniquística y la desmoplásica tienen un mejor pronóstico que la sólida/multiquística. Presentamos un caso en un varón de 76 años con una lesión radiolúcida interradicular mandibular de apariencia quística, la cual se enucleó quirúrgicamente. Histológicamente correspondió a una lesión desmoplásica con una amplia zona quística que fue diagnosticada como ameloblastoma desmoplásico con predominio quístico. Trascurridos 30 meses no se evidencia recidiva. En este artículo se discuten los principales aspectos clinicopatológicos de estas entidades (AU)

Ameloblastoma is an odontogenic neoplasm with locally aggressive behavior. Some variants, like the unicystic or desmoplastic, have a better prognosis than solid/multicystic. The case is presented of a 76 year-old male, who suffered a mandibular interradicular radiolucent lesion of cystic appearance, which was surgically enucleated. Histologically, this was a desmoplastic lesion that exhibited a predominantly cystic area which was diagnosed as a desmoplastic ameloblastoma with cystic predominance. After 30 months of follow-up there are no signs of recurrence. The most important clinical and pathological features of these conditions are also discussed (AU)

Clinical findings and risk factors to oral squamous cell carcinoma in young patients: A 12-year retrospective analysis

BACKGROUND: In recent years have been observed an increased incidence of OSCC in young individuals. Based on this, the aim this study was to describe the clinical characteristics of all cases of OSCC in younger patients, diagnosed in two oncology referral hospitals, at the northeast region of Brazil within a 12-year period. MATERIAL AND METHODS: Data regarding general characteristics of patients (age, gender and tobacco and/or alcohol habits) and information about the lesions (tumor location, size, regional lymph node metastasis, distant metastasis and clinical stage) were submitted to descriptive and inferential analysis. Statistical analysis included Chi-square and Fisher's exact tests ( < 0.05). RESULTS: Out of 2311 registered cases of OSCC, 76 (3.3%) corresponded to OSCC in patients under 45 years old. Most of them were male (n = 62, 81.6%) and tobacco and/or alcohol users (n = 40, 52.8%). The most frequent site was the tongue (n = 31, 40.8%), with predominance of cases classified at advanced clinical stage (III and IV, n = 46, 60.5%). The advanced stage of OSCC (III and IV) was statistically associated with male gender (P = 0.035), lower education level (P=0.007), intraoral sites (P < 0.001), presence of pain symptomatology (P = 0.006), and consumption of tobacco and/or alcohol (P=0.001). CONCLUSIONS: The profile of OSCC in young patients resembles to the commonly characteristics reported for overall population. The late diagnosis in young patients usually results in poor prognosis, associated with gender, harmful habits and tumor location. Although prevalence is low, stimulus to prevention and to early diagnosis should be addressed to young individuals exposed to risk factors

Molecular genetic study of novel biomarkers for early diagnosis of oral squamous cell carcinoma

OBJECTIVES: Early detection and treatment of an oral squamous cell carcinoma (OSCC) is critical because of its rapid growth, frequent lymph-node metastasis, and poor prognosis. However, no clinically-valuable methods of early diagnosis exist, and genetic analysis of OSCCs has yielded no biomarkers. Study DESIGN: We investigated the expression of genes associated with inflammation in OSCCs via a quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) analysis of microarray data. Tumor and normal tissues from five patients with an OSCC were used for microarray analysis. Differentially-expressed genes, identified using permutation, local pooled error (LPE), t-tests, and significance analysis of microarrays (SAM), were selected as candidate genetic markers. RESULTS: Two groups corresponding to tissue identity were evident, implying that their differentially-expressed genes represented biological differences between tissues. Fifteen genes were identified using the Student's pairedt-test (p < 0.05) and the SAM, with a false discovery rate of less than 0.02. Based on gene expression, these 15genes can be used to classify an OSCC. A genetic analysis of functional networks and ontologies, validated by using a qRT-PCR analysis of the tissue samples, identified four genes, ADAM15, CDC7, IL12RB2 and TNFRSF8,that demonstrated excellent concordance with the microarray data. CONCLUSIONS: Our study demonstrated that four genes (ADAM15, CDC7, IL12RB2 and TNFRSF8) had potential as novel biomarkers for the diagnosis and the treatment of an OSCC

Serum vitamin D levels of patients with oral squamous cell carcinoma (OSCC) and expression of vitamin D receptor in oral precancerous lesions and OSCC

BACKGROUND: Resistance to programmed cell death (apoptosis) is a crucial factor for the carcinogenesis of oral squamous cell carcinoma (OSCC). Vitamin D (calcitriol) may overcome apoptosis resistance in tumor cells of OSCC. Vitamin D receptor (VDR) expression in oral precancerous lesions of OSCC has not been analyzed and serum vitamin D level seems to be a predictor of cancer development. MATERIAL AND METHODS: Expression of VDR was analyzed in normal oral mucosa (n=5), oral precursor lesions(simple hyperplasia, n=11; squamous intraepithelial neoplasia, SIN I-III, n=35), and OSCC specimen (n=42) by immunohistochemistry (IHC). Moreover, serum vitamin D levels were measured by 25(OH)D3 (calcidiol) in patients with OSCC (n=42) and correlated with IHC results. RESULTS: Expression of VDR was significantly increased in precancerous and OSCC compared with normal tissue. Compared with SIN I-III lesions VDR expression significantly decreased in OSCC. Severe vitamin D deficiency was detected in our OSCC patient cohort but there was no significant correlation analyzed between serum vitamin D levels and corresponding immunohistochemically detected VDR expression in OSCC. CONCLUSIONS: Our survey provides the first evidence of VDR expression in precancerous lesions of OSCC. Apoptosis induction of VDR+ cells in oral precancerous lesions and OSCC by natural vitamin D or synthetic vitamin D compounds could be useful for chemoprevention. Moreover, systemically and/or locally applied, these compounds may act as sensitizers for apoptosis mediated by radio-, and chemotherapy treatment in OSCC

Analysis of methylation and mRNA expression status of FADD and FAS genes in patients with oral squamous cell carcinoma

BACKGROUND: Apoptosis is an important mechanism that is responsible for the physiological deletion of harmful, damaged, or unwanted cells. Changed expression of apoptosis-related genes may lead to abnormal cell prolifera tion and finally to tumorigenesis. Our aims were to analyze the promoter methylation and gene expression profiles of FADD and FAS genes in risk of OSCC. MATERIAL AND METHODS: we analyze the promoter methylation status of FADD and FAS genes using Methylation - Specific PCR (MSP) in 86 OSCC tissues were kept in paraffin and 68 normal oral tissues applied as control. Also, FADD and FAS genes expression were analyzed in 19 cases and 20 normal specimens by Real-Time Reverse- Transcripts PCR. RESULTS: Aberrant promoter methylation of FADD and FAS genes were detected in 12.79 % (11 of 86) and 60.46 % (52 of 86) of the OSCC cases, respectively, with a significant difference between cases and healthy controls for both FADD and FAS genes (P<0.001). The gene expression analysis showed statistically significant difference between cases and healthy controls for both FADD (p < 0.02) and FAS (p < 0.007) genes. CONCLUSIONS: To the best our knowledge, the data of this study are the first report regarding, the effect of promoter hypermethylation of the FADD and FAS genes in development of OSCC. To confirm the data, it is recommended doing further study in large sample sizes in various genetic populations

Carcinoma de células escamosas intraóseo primario derivado de un tumor odontogénico queratoquístico: reporte de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumour: Report of a case and a review of the literature

El carcinoma de células escamosas intraóseo primario (CCEIP) derivado de un tumor odontogénico queratoquístico (TOQ) es un tumor odontogénico maligno que se presenta con poca frecuencia y exclusivamente en los huesos maxilares. Afecta a personas de mediana edad, principalmente hombres y usualmente se localiza en la zona posterior mandibular. Clínicamente puede presentar las características clásicas de un tumor odontogénico benigno, aunque también puede asociarse a sintomatología dolorosa y alteraciones de la sensibilidad. Presentamos el caso de una mujer de 86 an˜ os de edad en la que se diagnosticó CCEIP derivado de un TOQ. Se describen las características clínicas, radiológicas e histológicas, discutiendo la importanciade tomar biopsia de distintas zonas de una lesión quística caracterizada por afectar amplias zonas de los huesos maxilares (AU)

Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a keratocystic odontogenic tumour (KCOT) is a rare malignant bone tumour that exclusively involves the maxillary bones. It affects middle-age patients, mainly men, and is usually located in the posterior mandibular area. Clinically, it may exhibit classic characteristics of benign odontogenic tumors, though it may also be associated with pain and sensitive alterations We present the case of an 86-year-old woman who was diagnosed with a PIOSCC derived from a KCOT. The imaging, clinical, and histological characteristics are described, and the importance of taking a biopsy from different parts of a cystic lesion that is characterized by extensive anatomical area involved are discussed (AU)

A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the North of Portugal

OBJECTIVES: Our aim was to analyze the clinical, pathological, and outcome characteristics of oral squamous cell carcinomas (OSCC) from a population of the North of Portugal. MATERIAL AND METHODS: We conducted a descriptive study of 128 OSCC diagnosed between the years of 2000 and 2010 in the Centro Hospitalar do Porto. Through of the review of the clinical records we studied several clinical, pathological, and outcome variables. The overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and log-rank test. Cox regression method was used for multivariate analysis. RESULTS: Of 128 patients with OSCC, 83 (64.8%) were male and 45 (35.2%) were female, (mean age of 62.13±15.57 years). The most affected location was the tongue (n=52; 40.6%). The most common cause of reference was a non-healing ulcer (n=35; 28.9%) followed by oral pain (n=27; 22.3%). Sixty (60.6%) patients were tobacco consumers and 55 (57.3%) alcohol consumers. The cumulative 3-years OS rate was 58.6% and DFS was 55.4%. In multivariable analysis for OS, we found an adverse independent prognostic value for advanced tumour size (p < 0.001) and for the presence of perineural permeation (p = 0.012). For DFS, advanced stage tumours presented adverse independent prognostic value (p < 0.001). CONCLUSION: OSCC occurred most frequently in males, in older patients, and in patients with tobacco and/or alcohol habits. TNM and tumour stage additionally to the perineural permeation were the most important prognostic factor for the survival of these patients, contributing to identify high-risk subgroups and to guide therapy

Ameloblastoma: un estudio retrospectivo de 48 casos / Ameloblastoma: a retrospective study of 48 cases

El ameloblastoma es un tumor odontogénico benigno, localmente invasivo y recidivante, que constituye aproximadamente el 11% de los tumores odontogénicos. Estos tumores ocurren más frecuentemente en la mandíbula. El cuadro clínico se caracteriza generalmente por presentar deformaciones faciales, crecimiento lento y asintomático. El tratamiento depende del tipo, la localización y el tamaño del tumor, así como de la edad del paciente. El objetivo del presente trabajo es realizar un estudio retrospectivo de los casos diagnosticados de ameloblastomas en los datos existentes de los archivos del Departamento de Patología Oral de la Pontifícia Universidade Católica de Minas Gerais, Brasil. Se analizaron los archivos de pacientes en el periodo de enero de 1978 a marzo de 2012, con un diagnóstico definitivo de ameloblastoma. Método. Fueron analizadas las informaciones con respecto a sexo, raza, edad del paciente, presencia de síntomas, aspecto radiográfico del tumor, diagnóstico histopatológico y ubicación anatómica. Resultados. Dentro de los 48 pacientes con ameloblastoma se observó mayor incidencia en la mandíbula en la zona del cuerpo y ángulo (45,8%), que afecta por igual a hombres y mujeres, con un promedio de edad de 36 años y en su gran mayoría se mostraron asintomáticos (81,2%). El tipo más frecuente fue el multiquístico (66,7%), seguido por el uniquístico (31,2%) y el periférico (2,1%). La mayoría de lesiones fueron observadas en la raza blanca (56,3%) y radiográficamente se mostró más frecuente la imagen multilocular (60,4%). Conclusión. Los datos de los ameloblastomas reportados en este estudio fueron similares a los de otras series publicadas en la literatura médica (AU)

Ameloblastoma is a benign, locally invasive and recurrent, odontogenic tumor, which accounts for about 11% of odontogenic tumors. These tumors occur more frequently in the mandible. The clinical picture presented is generally characterized by slow growing and asymptomatic facial deformities. Treatment depends on the type, location and size of the tumor, as well as the age of the patient. The aim of this paper is to present a retrospective study of diagnosed cases of ameloblastoma in existing data files of the Department of Oral Pathology Catholic University of Minas Gerais, Brazil. Data was collected from the files of patients with a definitive diagnosis of ameloblastoma during the period January 1978 to February 2012. Method: An analysis was made of the data, including sex, race, patient age, symptoms, radiographic appearance of the tumor, the histopathological diagnosis and anatomic location. Results: Of the 48 patients with ameloblastoma there was an increased incidence in the jaw and the angle (45.8%). It affected both men and women, with a mean age of 36 years, and the large majority were asymptomatic (81.2%). The most frequent histological type was multicystic (66.7%), followed by unicystic (31.2%), and peripheral (2.1%). Most lesions were observed in white people (56.3%) and radiographically, it was more often a multilocular image (60.4%). Conclusion: The data reported in this study of ameloblastomas were similar to other series reported in the medical literature (AU)

Fibroma ameloblástico asociado a un odontoma compuesto. La importancia del estudio histopatológico / Ameloblastic fibroma associated with a compound odontoma. Importance of the histopathological study

El fibroma ameloblástico es un tumor odontogénico mixto benigno de rara aparición, que constituye el 2% de todos los tumores odontogénicos, es de crecimiento lento, más común en niños y adultos jóvenes, compuesto por tejido conjuntivo fibroso embrionario y epitelio odontogénico primitivo, se caracteriza por la proliferación de tejido epitelial y mesenquimático. Aparece con más frecuencia en la mandíbula en zona de molares y premolares de pacientes jóvenes sin predilección de sexo, asociándose a veces a un diente incluido. El presente artículo tiene como objetivo describir un caso clínico de un paciente en la segunda década de vida, con aparente anodoncia en el maxilar superior, que se encontraba asintomático y en el cual fue diagnosticado fibroma ameloblástico en maxilar superior, zona de incisivos anteriores, lado izquierdo, se realiza una breve revisión de la literatura y diagnósticos diferenciales, se analizan sus características clínicas e histológicas y la actitud terapéutica a tomar. El tratamiento quirúrgico conservador con extirpación seguida de curetaje parece ser la opción terapéutica más adecuada, y teniendo presente que el porcentaje de recidiva es del 18,3% principalmente debido a escisión incompleta de la lesión, se deben realizar controles radiográficos postoperatorios 6 meses después y cada año por los siguientes 5 años (AU)

The ameloblastic fibroma is a benign mixed, rare odontogenic tumour, which accounts for 2% of all odontogenic tumours. It is slow growing, and more common in children and young adults. It is composed of embryonic fibrous connective tissue and early odontogenic epithelium, and characterised by the proliferation of epithelial and mesenchymal tissue. It appears most frequently in the jaw area of molars and premolars of young patients with no sex predilection, and is sometimes associated with an impacted tooth. This article aims to describe a clinical case of a child in the second decade of life, with apparent anodontia in the maxilla, which was asymptomatic and later diagnosed as an ameloblastic fibroma in the left side maxilla incisors area. A brief review of the literature and differential diagnoses was carried out, including an analysis of its clinical and histological features, and the therapeutic approach to take. Conservative surgical excision followed by curettage seems to be the most appropriate treatment option. It should be noted that the recurrence rate is 18.3%, mainly due to incomplete excision of the lesion. Radiographic controls should be performed six months postoperatively, and every year for the following five years (AU)

Evaluation of p53, Caspase-3, Bcl-2, and Ki-67 markers in oral squamous cell carcinoma and premalignant epithelium in a sample from Alava Province (Spain)

Objectives: The objective of this study was to determine whether alterations in the expression of p53, caspase-3 Bcl-2, and ki-67 appear early in premalignant oral epithelium and show clonal behavior. Study Design: Samples from 41 tumors with their adjacent non-tumor epithelia were immunohistochemically analyzed using monoclonal antibodies that recognize p53, caspase-3, Bcl-2, and Ki-67 Results: A statistically significant association was found between the expression in tumor and adjacent epithelium of p53, caspase-3, and Bcl-2 but not of k-67. A significant association was observed between the expression of ki-67 and p53 in both localizations. In non-tumor (premalignant) epithelium samples, there was a significant inverse relationship between the expressions of p53 and caspase-3 and a significant direct relationship between the expressions of p53 and Bcl-2. Conclusions: Alterations in these proteins appear to operate in combination with premalignant epithelia to create hyperproliferative cell states that favor the acquisition of summative oncogenic errors that confer invasive capacity (AU)

Prevalence trends of oral squamous cell carcinoma. Mexico City’s General Hospital experience

Objective: Recent reports suggest an increase in oral squamous cell carcinoma (OSCC) frequency. To improve programs in public health, it is necessary to understand the epidemiological conditions. The aim of this study was to analyze the trend in gender, age, anatomic zone and OSCC stage from Mexico City’s General Hospital patients from 1990 to 2008.Study design: A retrospective review of all OSCC cases diagnosed by the Pathology Department of the Mexico City General Hospital was performed. Demographic data, in addition to anatomic zone and histological degree of differentiation were obtained. Central tendency, dispersion and prevalence rate per 100,000 individuals were determined. Results: A total of 531 patients were diagnosed with OSCC; 58.4% were men, giving a male: female ratio of 1.4:1, and the mean age was 62.5 ± 14.9 years. The predominant anatomic zone was the tongue (44.7%), followed by the lips (21.2%) and gums (20.5%). The most frequent histological degree was moderately differentiated in 325 cases (61.2%). The rates of OSCC prevalence showed similar (..) (AU)

erbB expression changes in ethanol and 7, 12- dimethylbenz (a) anthracene-induced oral carcinogenesis

Objetive: The aim of this study was to determine erbB expression in normal mucosa, oral dysplasia, and invasive carcinomas developed in the hamster’s buccal pouch chemical carcinogenesis model. Study design: Fifty Syrian golden hamsters were equally divided in five groups (A-E); two controls and three experimental group exposed to alcohol, DMBA, or both for 14 weeks. Number of tumors per cheek, volume, histological condition, erbB expression were determined and results were analyzed by the Mann–Whitney U and Dunn’s test. Results: Control groups and those exposed to alcohol (A, B and C respectively) only presented clinical and histological normal mucosa; while those exposed to DMBA or DMBA plus alcohol (D and E groups) developed dysplasia and invasive carcinomas. erbB2, erbB3, and erbB4 increased their expression in alcohol-exposed mucosa, dysplasia, and invasive carcinomas. We observed a similar expression level for erbB2 in dysplasia and carcinomas; while, erbB3 and erbB4 were similar only in carcinomas. Conclusion: The DMBA and alcohol can be considered as carcinogen and promoter for oral carcinogenesis. TheerbB expression is different according to their histological condition, suggesting differential participation of theerbB family in oral carcinogenesis induced by alcohol and DMBA (AU)

Manejo quirúrgico del ameloblastoma / Surgical management of ameloblastoma

El ameloblastoma es un tumor odontogénico de estirpe epitelial. Aunque se clasifica como una tumoración benigna, suele ser localmente agresiva presentando elevada invasión local, con gran tendencia a la recidiva y con posibilidad metastásica ocasional. Se manifiesta preferentemente durante la tercera, cuarta y quinta décadas de la vida, sin predilección por razón de sexo, aunque puede darse en cualquier grupo de edad, incluidos los niños. Lamayoría de los ameloblastomas se encuentran sobre todo enmandíbula (al nivel del ángulo y rama). En el tratamiento se debe valorar su tipología clínica (sólido, multiquístico, uniquístico, mixto o periférico), su localización y el tamaño del tumor, así como la edad y las condiciones clínicas del paciente. Presentamos una revisión de los pacientes afectos de ameloblastomas tratados en nuestro Centro durante los últimos 10 años. Se aportan datos acerca de su aparición clínica, sus características histológicas, el manejo terapéutico realizado y analizamos el seguimiento y comparamos la aparición de recidivas en los pacientes presentados. Las características clínicas, incluso si se complementan con radiografías y/omuestras histológicas, no son siempre determinantes del comportamiento biológico y, por tanto tampoco lo son del pronóstico de un ameloblastoma individual(AU)

The ameloblastoma is an odontogenic tumour of epithelial origin. Although it is classified as benign, there is usually aggressive local invasion, a great tendency to recurrence, and occasional metastatic potential. It generally appears during the third, fourth and fifth decades of life, without gender predilection, although it can occur at any age, including in children. Ameloblastomas are mostly found in the mandible (angle and branch). In treatment, its clinical type (solid, unicystic, desmoplastic, mixed or peripheral), its location and size, must be assessed, as well as the age and clinical condition of the patient. We present a review of patients diagnosed and treated for ameloblastoma in our hospital during the last 10 years.We present data on clinical appearance, histological characteristics, and therapeutic management, and we analyse and compare the rate of recurrence in these patients. The clinical features, even if they are supplemented with radiographs and/or histological samples, are not always biological determinants of its behaviour, or of the individual prognosis of the ameloblastoma(AU)

The role of mast cells on angiogenesis in oral squamous cell carcinoma

Objective: Angiogenesis or neovascularization has long been known to aid in progression and metastasis of malignant tumors. Tumor angiogenesis is a complex event mediated by angiogenic factors released from cancer cells and or by host immune cells. Mast cells may induce tumor progression and potentiate metastasis by stimulating angiogenesis. The purpose of the present study was to validate topographic distribution of micro vessel density(MVD) and mast cell density (MCD) and help to elucidate the possible role of mast cells in tumor angiogenesis and correlating this with advanced disease parameters. Study Design: MVD and MCD were investigated in tumor specimens from 30 patients diagnosed with different histologic grades of oral squamous cell carcinoma (OSCC). Intratumor vessels were stained with collagen Type IV antibody and mast cells with Toluidine blue before being measured by light microscopy. Results: There was a significant correlation between MVD and disease progression and number of blood vessels increased from well to poorly differentiated OSCC where as MCD decreased. Conclusions: These findings suggest that angiogenesis indeed occur in OSCC and might be used as an index to inflect the aggression of the disease however mast cells make up only a part of complex process of angiogenesis along with other factors secreted by tumor (AU)

Factors related to late stage diagnosis of oral squamous cell carcinoma

Aims: To identify factors related to advanced-stage diagnosis of oral cancer to disclose high-risk groups and facilitate early detection strategies. Study design: An ambispective cohort study on 88 consecutive patients treated from January 1998 to December2003. Inclusion criteria: pathological diagnosis of OSCC (primary tumour) at any oral site and suffering from a tumour at any TNM stage. Variables considered: age, gender, smoking history, alcohol usage, tumour site, macroscopic pattern of the lesion, co-existing precancerous lesion, degree of differentiation, diagnostic delay and TNM stage. Results: A total of 88 patients (mean age 60±11.3; 65.9% males) entered the study. Most patients (54.5%) suffered no delayed diagnosis and 45.5% of the carcinomas were diagnosed at early stages (I-II). The most frequent clinical lesions were ulcers (70.5%). Most cases were well- and moderately-differentiated (91%). Univariate analyses revealed strong associations between advanced stages and moderate-poor differentiation (OR=4.2; 95%CI=1.6-10.9)or tumour site (floor of the mouth (OR=3.6; 95%CI=1.2-11.1); gingivae (OR=8.8; 95%CI=2.0-38.2); and retromolar trigone (OR=8.8; 95%CI=1.5-49.1)).Regression analysis recognised the site of the tumour and the degree of differentiation as significantly associated to high risk of late-stage diagnosis. Conclusions: Screening programmes designed to detect asymptomatic oral cancers should be prioritized. Educational interventions on the population and on the professionals should include a sound knowledge of the disease presentation, specifically on sites like floor of the mouth, gingivae and retromolar trigone. More studies are needed in order to analyse the part of tumour biology on the extension of the disease at the time of diagnosis (AU)

Clinical and histopathological analysis of oral Squamouscell carcinoma of young patients in Mashhad, Iran: A retrospective study and review of literatures

Objectives: Oral Squamous cell carcinoma (OSCC) is primarily a disease that mainly occurs in males in their sixthand seventh decades of life and is rare in young adults.Study Design: In this retrospective study, records of patients under the age of 40, with the diagnosis of OSCC inthe Oral Medicine Department of Mashhad Dental Faculty during the past 13 years were analyzed. Their socioeconomicdata, demographic, clinical and histopathological characteristics, risk factors, familial history were assessedand applicable studies and case reports in the literatures were reviewed. PCR (Polymerase chain reaction)analysis was also done for detection of human papilloma virus (HPV).Results: From 158 cases of OSCC diagnosed in our centre, 21 patients were younger than 40 years. Most of themwere young men (12 cases). There was no significant risk factor in this group. The most common site of involvementwas the tongue. The most common clinical presentation was exophytic lesion with ulcer. No HPV DNA wasdetected in these patients.Conclusion: Characteristics of OSCC in young patients are different from older age group. Major risk factors (smokingand alcohol consumption and HPV) were not etiologic factors for OSCC in young patients in our province (AU)

Fibroma odontogénico central, tipo WHO: reporte de un caso y revisión de la literatura / Central odontogenic fibroma, WHO type: a case report and literature review

El fibroma odontogénico central es una neoplasia benigna muy poco frecuente. Clásicamente se ha dividido en dos variantes histológicas: un tipo pobre en epitelio y otro tipo rico en epitelio con focos de material calcificado. En la mayoría de los casos muestra un crecimiento lento y progresivo con o sin sintomatología. Radiográficamente es habitual observar una imagen radiolúcida y unilocular que en raras ocasiones exhibe radiolucidez mixta. El tratamiento indicado en todos los casos es la enucleación del tumor. Se reporta el caso de una mujer de 36 años de edad, sin antecedentes mórbidos, con una lesión asintomática de radiolucidez mixta, expansiva de ambas corticales óseas, en la zona del cuerpo y ángulo mandibular izquierdo, asociada a un tercer molar incluido. Basándose en el estudio histopatológico inicial, se diagnosticó como fibroma odontogénico, y con el posterior tratamiento definitivo de la lesión, se determinó la subvariedad tipo OMS. La paciente no ha tenido recidiva en 16 meses de seguimiento(AU)

The central odontogenic fibroma is a rare benign neoplasm. Classically has been divided into two histological variants, a poor type epithelium and other rich epithelium with foci of calcified material. It shows in most cases, a slow and progressive growing with or without symptoms. Radiographically it is common to observe a radiolucent, unilocular, rarely exhibiting mixed radiolucency. The treatment in all cases is enucleation of the tumor. We report the case of a 36 year old woman, no morbid history, with an asymptomatic lesion of mixed radiolucency, cortical bone expansion in the area of the body and the left mandibular angle associated with a third molar. Based on the initial histopathology it was diagnosed as odontogenic fibroma and subsequent definitive treatment of the injury rate was determined sub manifold WHO. The patient had no recurrence at 16 months of follow-up(AU)