Reação tipo corpo estranho a preenchimento facial com poliamida / Foreign body reaction to polyamide filling in the face

O uso de substâncias para preenchimento dérmico é crescente, e o número de complicações devido à sua utilização, significativo. Neste trabalho, relatamos um caso de granulomas de corpo estranho após preenchimento facial com gel de poliamida, chamado AqualiftTM, produto não encontrável nas bases de dados da literatura científica. São discutidos aspectos clínicos, terapêuticos e histopatológicos. Faz-se uma advertência relativa ao uso desta substância.

Dermal fillers are increasingly used, and the number of complications due to their use is significant. In this work, we report the case of foreign body granulomas due to the facial injection of a polyamide gel, named AqualiftTM, a product not found in scientific literature databases. Clinical, therapeutic and hystopathological aspects are discussed. A warning is made, concerning the use of this substance.

Extensive presentation of central ossifying fibroma treated with conservative surgical excision.

Central ossifying fibroma is a benign slow-growing tumor of mesenchymal origin and it tends to occur in the second and third decades of life, with predilection for women and for the mandibular premolar and molar areas. Clinically, it is a large asymptomatic tumor of aggressive appearance, with possible tooth displacement. Occasionally treated by curettage enucleation, this conservative surgical excision is showing a recurrence rate extremely low. The objective of this study was to report a case of a 44-year-old woman, presenting a very large ossifying fibroma in the mandible, which was successfully treated with curettage, and to conduct a brief literature review of this lesion, focusing on the histology, clinical behavior, and management of these uncommon lesions.

BRCA1 and γH2AX as independent prognostic markers in oral squamous cell carcinoma.

Oral squamous cell carcinomas (OSCC) are believed to originate from sequential mutations that can develop as a consequence of genetic instability acquired over time. BRCA1 are linked to DNA recombination and repair processes, being of importance for its role in regulation of RAD51 and H2AX (γH2AX). The aim of this study was to investigate the relationship between BRCA1 expression status and evaluate its prognostic impact. We selected from 150 OSCC patients, and evaluated BRCA1 expression in OSCC by immunohistochemistry and qRT-PCR, comparing its expression with homologous recombination markers (RAD51, γH2AX and p53), clinicopathological and survival data. Expression of BRCA1 was observed in 61 cases (43.88%) and was related to tumor size (T stage) (p=0.001), and gender (p=0.017). mRNA from BRCA1 showed a borderline relationship with perineural invasion (p=0.053). BRCA1 [p=0.030; HR: 2.334 (C.I.: 1.087-5.012)], γH2AX [p=0.045; HR: 0.467 (C.I.: 0.222-0.628)] and gender [p=0.001; HR: 10.386 [(C.I.: 2.679-10.623)] were independent prognostic factors for DSS. BRCA1 and γH2AX expression by OSCC cells are associated with reduced overall survival time, independent of other variables in patients, as well as gender, and our findings shed some light about DSB markers in OSCC and its role as prognostic factors.

Multiple oral radiopaque masses leading to Gardner's syndrome diagnosis.

Gardner's syndrome, an autosomal dominant syndrome, is linked to familial adenomatosis polyposis (FAP), which is known mainly as a colorectal disease. FAP also presents extracolonically as intestinal polyposis, multiple osteomas, cutaneous cysts, or fibromas. This article reports the case of a 66-year-old white woman who was referred to the Oral Medicine Clinic, School of Dentistry, Universidade Vale do Rio Verde, Brazil, for evaluation of multiple sclerotic, asymptomatic masses in the jaws that were observed in a routine periapical radiographic exam by a dentist. The patient presented with intestinal poliposis, periosteal osteoma in the face, and fibromas and multiple endosteal osteomas in the maxilla, which are indications of Gardner's syndrome. The clinical differential diagnosis included multiple buccal exostoses, idiopathic osteosclerosis, cemento-osseous dysplasias, multiple odontomas, osteomas, and Gardner's syndrome. Patients with a suspected diagnosis of Gardner's syndrome should be referred to a dermatologist, have a colonoscopy performed, and be followed up by a dentist.

Jael syndrome: removal of a knife blade impacted in the maxillofacial region under local anaesthesia.

The presence of retained foreign bodies in the maxillofacial region as a consequence of penetrating injuries from knives is poorly documented in the scientific literature. This manuscript reports the case of a 30-year-old Caucasian with a knife blade lodged in the maxillofacial skeleton. Following clinical and radiographic exams, it was determined that the object had penetrated through the left nostril and nasal septum, in the direction of the right maxillary sinus, and remained impacted without causing injury to important anatomical structures. After systemic assessment and determination of the exact location of the knife blade, the object was removed in an outpatient setting under local anaesthesia. This manuscript aims to report a rare case of a transfacial penetrating injury involving a knife blade that was removed in an outpatient setting while also discussing the proper conduct and treatment options for similar cases in the context of a brief literature review.

CD44/CD24 immunophenotypes on clinicopathologic features of salivary glands malignant neoplasms.

BACKGROUND: Salivary glands malignant neoplasms (SGMNs) account for 3-6% of head and neck cancers and 0.3% of all cancers. Tumor cells that express CD44 and CD24 exhibit a stem-cell-like behavior. CD44 is the binding site for hyaluronic acid, and CD24 is a receptor that interacts with P-selectin to induce metastasis and tumor progression. The present study aims to evaluate the expression of CD44 and CD24 on SGMNs and correlated these data with several clinicopathologic features. METHODS: Immunohistochemical stains for CD44 and CD24 were performed on tissue microarrays containing SGMN samples from 69 patients. The CD44, CD24 and CD44/CD24 expression phenotypes were correlated to patient clinicopathologic features and outcome. RESULTS: CD44 expression was associated with the primary site of neoplasm (p = 0.046). CD24 was associated with clinical stage III/IV (p = 0.008), T stage (p = 0,27) and lymph node (p = 0,001). The CD44/CD24 profiles were associated with the primary site of injury (p = 0.005), lymph node (p = 0.011) and T stage (p = 0.023). Univariate analysis showed a significant relationship between clinical staging and disease- free survival (p = 0.009), and the overall survival presents relation with male gender (p = 0.011) and metastasis (p = 0.027). CONCLUSION: In summary, our investigation confirms that the clinical stage, in accordance with the literature, is the main prognostic factor for SGMN. Additionally, we have presented some evidence that the analysis of isolated CD44 and CD24 immunoexpression or the two combined markers could give prognostic information associated to clinicopathologic features in SGMN. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1284611098470676.

Report of a case of solitary fibrous tumour of the orbit.

BACKGROUND: Solitary fibrous tumors of the orbit are uncommon lesions, only one relatively large series having been published. Neoplasms, formerly considered as separate entities, including hemangiopericytoma, are presently encompassed as solitary fibrous tumors, a unifying designation. There is a tendency towards recurrence and some cases are malignant. Their rarity justifies the publication of new cases, in order to increase the amount of information about this pathological entity. CASE REPORT: A 40-year-old female patient developed swelling in the left lower lid and after slow progression of the symptom during 2 years, presented herself to our elective surgery service. Image exams showed a 20-mm encapsulated tumor. Surgical treatment was performed: complete excision, made difficult by the growth of the lesion amid the inferior rectus and inferior oblique muscles. Histopathological and immunochemical examinations with CD34 positivity, diagnosed a solitary fibrous tumor, without suggestive signs of malignancy. After a follow-up of 40 months, no recurrence has been detected. DISCUSSION: Solitary fibrous tumors, though uncommon, should be considered in the differential diagnosis of orbital expansive lesions. The key point to diagnosis is finding CD34 positivity in immunohistochemical examination. Such tumors have a tendency for recurrence, even after more than 5 years.

Topoisomerase expression in oral squamous cell carcinoma: relationship with cancer stem cells profiles and lymph node metastasis.

BACKGROUND: The relationship between predictive proteins and tumors presenting cancer stem cells (CSCs) profiles in oral tumors is still poorly understood. This study aims to identify the relationship between topoisomerases I, IIα, and IIIα and putative CSCs immunophenotype in oral squamous cell carcinoma (OSCC) and determine its influence on prognosis. METHODS: The following data were retrieved from 127 patients: age, gender, primary anatomic site, smoking and alcohol intake, recurrence, metastases, histologic classification, treatment, and survival. An immunohistochemical study for topoisomerases I, IIα, and IIIα was performed in a tissue microarray containing 127 paraffin blocks of OSCCs. RESULTS: In univariate analysis, topoisomerases expression showed significant differences according to CSCs profiles and p53 immunoexpression, but not with survival. Topoisomerases IIα and IIIα also showed significant relationship with lymph node metastasis. The multivariate test confirmed these associations. CONCLUSIONS: The results that all topoisomerases correlates with OSCC CSCs may indicate a role for topoisomerases in head and neck carcinogenesis. Notwithstanding, it is plausible that other members of topoisomerases family could represent novel therapeutical targets in oral squamous cell carcinoma.

Carcinoma mucoepidermoide de las glándulas salivares en Brasil: resultados clinicopatológicos y una breve revisión / Mucoepidermoid carcinoma of the salivary glands in Brazil: clinicopathological outcomes and a brief review

The biological features and the clinical behavior of the mucoepidermoid carcinoma are varied and not known yet. The aim of present paper was to analyze the potential prognostic factors affecting the survival of patients diagnosed with primary mucoepidermoid carcinoma of head and neck. A retrospective study was conducted in 16 patients treated between 1990 and 2008 in the General Hospital of Riberirao Preto, USP Medicine School, Brazil. The following variables were studied: age, sex, anatomical location, tumor size, clinical stage, histological degree, relapse, metastasis, involved surgical edges ant treatment on the clinical-pathological results. The survival curves were designed using the Kaplan-Meier method and the statistic analysis was made using the log-rank test. The 68.7 percent of patients was of male sex, all patients were between 13 and 83 years old. The 75 percent of tumors was located in the great salivary glands, the 56.3 percent in the parotid glands ones, the mucoepidermoid carcinomas of low degree and of II stage were the 37.5 percent. The surgical resection was carried out in all patients. The follow-up period in present study fluctuates between 6 and 217 months. The general rate of 5- y years or 10-years survival was of 85.6 percent whereas the rates of disease-free survival were of 81.8 percent at 5 years and of 68.2 percent at 10 years. The were statistically significant influences of the tumor size (p = 0.05), presence of metastasis (p = 0.04) and of the primary anatomical location (p = 0.04) on the rates of disease-free survival. The results obtained show the significance of the primary anatomical location of the tumor, of its size and of the presence of metastasis in the survival of mucoepidermoid carcinomas(AU)

Las características biológicas y el comportamiento clínico del carcinoma mucoepidermoide son muy variados y aún poco conocidos. El propósito de este estudio fue analizar los factores pronósticos que puedan afectar la supervivencia de los pacientes con diagnóstico de carcinoma mucoepidermoide primario de cabeza y cuello. Se realizó un estudio retrospectivo de 16 pacientes tratados entre 1990 y 2008 en el Hospital General de Ribeirao Preto, Escuela de Medicina USP, Brasil. Se estudiaron las variables: edad, sexo, localización anatómica, tamaño del tumor, estadio clínico, grado histológico, recidiva, metástasis, bordes quirúrgicos comprometidos y tratamiento, sobre los resultados clínico-patológicos. Las curvas de supervivencia fueron construidas utilizando el método de Kaplan-Meier y el análisis estadístico fue realizado mediante la prueba del log-rank. Se constató 68,7 por ciento de pacientes del sexo masculino, todos los pacientes comprendidos en las edades entre 13 y 83 años. El 75 por ciento de los tumores se localizó en las glándulas salivales mayores, 56,3 por ciento en parótida, los carcinomas mucoepidermoides de bajo grado y estadio II con 37,5 por ciento. La resección quirúrgica fue realizada en todos los pacientes. El período de seguimiento en este estudio varió entre 6 y 217 meses. La tasa general de supervivencia, tanto a los 5 como a los 10 años fue de 85,6 por ciento, mientras que las tasas de supervivencia libre de enfermedad fueron de 81,8 por ciento a los 5 años y de 68,2 por ciento a los 10 años. Se demostró la existencia de influencias estadísticamente significativas del tamaño del tumor (p = 0,05), presencia de metástasis (p = 0,04), y de la localización anatómica primaria (p = 0,04) sobre las tasas de supervivencia libre de enfermedad. Los resultados obtenidos demuestran la importancia de la localización anatómica primaria del tumor, de su tamaño y de la presencia de metástasis, en la supervivencia de los carcinomas mucoepidermoides(AU)

Carcinoma mucoepidermoide de glándulas salivales en Brasil: relación clinicopatológica / Mucoepidermoid carcinoma of the salivary glands in Brazil: clinicopathological outcomes

The biological features and clinical behavior of mucoepidermoid carcinomas are widely variable and poorly understood. This study aimed to investigate prognostic factors that may affect survival in patients with a primary diagnosis of head and neck mucoepidermoid carcinomas. The effects of age, gender, anatomic localization, tumor size, clinical stage, histological grade, recurrence, metastasis, compromised surgical margins and treatment on clinicopathological outcomes were investigated. Survival curves were generated using the Kaplan-Meier method and analyses were performed using the log rank test. A total of 16 cases were analyzed over a period of 18 years; males were 68.7 percent, with ages ranging from 13 to 83 years. The 75 percent of the tumors developed in the major salivary glands, 56.3 percent in the parotid gland and they were predominantly classified as stage II 37.5 percent and low-grade lesions 37.5 percent at diagnosis. Surgical resection was performed in all patients. The follow-up period in this study ranged from 6 to 217 months. The 5 and 10-year overall survival rates were both 85.6 percent. Disease-free survival rates were 81.8 percent (5 years) and 68.2 percent (10 years). There were statistically significant effects of tumor size (p= 0.05), metastasis (p= 0.04) and primary anatomic localization (p= 0.04) on disease-free survival rates. Through a long follow-up period in present study we could highlight the relevance of primary anatomical site, tumor size and metastasis as useful prognostic factors that may affect survival in patients with a primary diagnosis of head and neck mucoepidermoid carcinomas(AU)

Las características biológicas y el comportamiento clínico del carcinoma mucoepidermoide son muy variados y aún poco conocidos. El propósito de este estudio fue investigar los factores pronósticos que puedan afectar la supervivencia de los pacientes con diagnóstico primario de carcinoma mucoepidermoide de cabeza y cuello. Se estudiaron la edad, el sexo, la localización anatómica, el tamaño del tumor, el estadio clínico, el grado histológico, la recidiva, la metástasis, los bordes quirúrgicos comprometidos y el tratamiento, sobre los resultados clínico-patológicos. Las curvas de supervivencia fueron construidas con el método de Kaplan-Meier y el análisis estadístico fue realizado mediante la prueba del log-rank. Fueron analizados 16 casos durante un periodo de 18 años. Se constató un 68,7 por ciento de pacientes del sexo masculino y de edades comprendidas entre los 13 y los 83 años. El 75 por ciento de los tumores se localizó en las glándulas salivales mayores, el 56,3 por ciento en parótida y las clasificaciones predominantes en el momento del diagnóstico fueron lesiones de bajo grado y estadio II con un 37,5 por ciento. La resección quirúrgica fue realizada en todos los pacientes. El periodo de seguimiento en este estudio varió entre 6 y 217 meses. La tasa general de supervivencia, tanto a los 5 como a los 10 años fue de 85,6 por ciento, mientras que las tasas de supervivencia libre de enfermedad fueron de 81,8 por ciento a los 5 años y de 68,2 por ciento a los 10 años. Se demostró la influencia estadísticamente significativa del tamaño del tumor (p= 0,05), la presencia de metástasis (p= 0,04) y de la localización anatómica primaria (p= 0,04) sobre las tasas de supervivencia libre de enfermedad. Los resultados obtenidos demostraron la importancia de la localización anatómica primaria del tumor, de su tamaño y de la presencia de metástasis, en la supervivencia de los pacientes con diagnóstico primario de carcinoma mucoepidermoide(AU)

Ameloblastoma: report of two cases and a brief literature review / Ameloblastoma: presentación de dos casos y una breve revisión de la literatura

Ameloblastoma is an uncommon odontogenic neoplasm that accounts for approximately 10 percent of all tumors originating from gnathic bones. Although its growth is localized, the tumor can also be infiltrative and persistent; however, its behavior is usually benign. The mandible is the most commonly affected site, and ameloblastoma is most frequently diagnosed between the fourth and fifth decades of life. In addition to a brief review of the literature, the present study discusses the clinical, imaging, histopathological and prognostic characteristics of these tumors by presenting two case reports. In these cases, the patients were aged 40 and 66 years, of different sexes and ethnicities and presented with the same complaint regarding localized and asymptomatic swelling. Both cases occurred in the posterior region (but on opposite sides) of the mandible. The patients were initially subjected to clinical examination and imaging of the face, followed by incisional biopsy to confirm (in both cases) the diagnosis of multicystic intraosseous ameloblastoma with a plexiform pattern. Both patients were treated by wide resection of the lesion (with safety margins), and only one patient experienced tumor recurrence. After 42 and 68 months of follow-up, the patients are still alive and show no signs of recurrence. Clinical and imaging findings aid in the differential diagnosis of ameloblastomas; however, histopathological evaluation is essential for its definitive diagnosis. Early diagnosis and precise detection of the borders to provide adequate safety margins during the surgical resection of the tumor are necessary to achieve successful treatment and recurrence-free survival for solid ameloblastomas.

El ameloblastoma es un tumor odontogénico infrecuente que representa aproximadamente 10 por ciento de todos los tumores que se originan a partir del maxilar y mandíbula. Aunque su crecimiento es localizado, el tumor puede ser infiltrante y persistente, y su comportamiento suele es benigno. La mandíbula es el sitio más comúnmente afectado, y el ameloblastoma se diagnostica con más frecuencia entre la cuarta y quinta década de la vida. Junto con una breve revisión de la literatura, el presente estudio analiza los datos clínicos, imágenes, características histopatológicas y pronóstico de estos tumores mediante la presentación de dos casos. En estos casos, los pacientes tenían entre 40 y 66 años, eran de diferentes sexos y grupos étnicos, que presentan la misma queja en relación con aumento de volumen localizado y asintomática. Ambos casos ocurrieron en la región posterior (pero en lados opuestos) de la mandíbula. Los pacientes fueron sometidos inicialmente a un examen clínico e imagenológico, seguido de la biopsia incisional para confirmar (en ambos casos) el diagnóstico de ameloblastoma multiquístico intraóseo tipo plexiforme. Ambos pacientes fueron tratados con amplia resección de la lesión (con márgenes de seguridad), y sólo un paciente presentó recurrencia del tumor. Después de 42 y 68 meses de seguimiento, los pacientes están vivos y sin signos de recurrencia. Los resultados clínicos e imagenológicos ayudan en el diagnóstico diferencial del ameloblastomas, sin embargo, la evaluación histopatológica es esencial para su diagnóstico definitivo. El diagnóstico prematuro y la precisa detección de las márgenes de la lesión proporcionan márgenes de seguridad adecuadas durante la resección quirúrgica del tumor y son necesarios para lograr el éxito del tratamiento y la supervivencia libre de recurrencia en los ameloblastomas sólidos.

Prognostic factors in patients with malignant salivary gland neoplasms in a Brazilian population.

Due to the difficulty of follow-up for long periods, information about the survival rates of malignant salivary gland tumors is deficient in the global scientific literature. This study was aimed at investigating the epidemiological profile and prognostic factors that might affect survival in patients with primary malignant salivary gland tumors in Brazil. Patients were investigated regarding histopathological subtypes, age, gender, anatomic localization, smoking and alcohol intake, tumor size, clinical stage, histological grade, recurrence, metastasis, and treatment on clinicopathological outcomes. Survival curves were generated using the Kaplan-Meier method, and both univariate and multivariate analyses were performed using the log rank test and Cox regression, respectively. A total of 63 cases were analyzed, females being slightly predominant (50.8%), with ages ranging from 13 to 87 years. The most common diagnosis was adenoid cystic carcinoma and the most affected anatomical location was the parotid. Tumors were predominantly classified as stage I and high-grade at the diagnosis. The 5- and 10-year overall survival rates were 84.6% and 74.7%, respectively. Disease-free survival (DFS) rates were 71.6% (5 years) and 56.6% (10 years). Univariate analysis showed significant effects of tumor size and clinical stage on the DFS (P<0.0001 for both), and Cox regression analysis confirmed clinical stage as an independent prognostic factor (P = 0.035). Our results highlight the relevance of clinical stage as an independent prognostic parameter for malignant salivary gland tumors.

Significance of topoisomerase IIIß expression in breast ductal carcinomas: strong associations with disease-specific survival and metastasis.

Topoisomerases are ubiquitous nuclear enzymes that regulate DNA structure in eukaryotic cells. The role of topoisomerase IIIß, the newest member of the topoisomerase family, in the clinical outcome of breast cancer is still poorly understood. This study aims to investigate the immunoexpression of topoisomerase IIIß in breast cancer and its relationships with clinicopathologic features and immunohistochemical markers of prognostic significance in breast pathology. Using tissue microarrays containing 171 cases of primary invasive breast cancer, we analyzed the immunoexpression of topoisomerase IIIß, estrogen receptor, progesterone receptor, HER-2, BRCA-1, p53, and Ki67. Immunostaining for topoisomerase IIIß was found in 33.9% of breast carcinomas, and immunopositivity was correlated with distant metastasis (P = .036) and death (P = .006). Decreased expression of topoisomerase IIIß correlated with low expression of Ki67 (P < .001) and negativity for HER-2 (P < .001), BRCA-1 (P = .001), and p53 (P < .001). In the multivariate analysis, topoisomerase IIIß expression was a significant predictor of survival (hazard ratio, 3.006 [95% confidence interval, 1.582-5.715]; P = .001). In conclusion, topoisomerase IIIß expression can be a useful marker in assessing the prognosis of patients with breast cancer and is an independent predictor of survival.

Stem cells in human breast cancer.

Increasing data support cancer as a stem cell-based disease. Cancer stem cells (CSCs) have been found in different human cancers, and recent evidence indicates that breast cancer originates from and is maintained by its own CSCs, as well as the normal mammary gland. Mammary stem cells and breast CSCs have been identified and purified in in vitro culture systems, transplantation assays and/or by cell surface antigen identification. Cell surface markers enable the functional isolation of stem cells that can initiate and propagate tumorigenesis in mammary gland. These observations have dramatic biological and clinical significance due to increasing evidence suggesting that the recurrence of human cancer and treatment failure may reflect the intrinsic quiescence and drug resistance of CSCs. Thus, the CSC hypothesis provides fundamental implications for understanding breast carcinogenesis and for developing new strategies for breast cancer prevention and therapy for advanced disease. Further strategies to isolate breast CSCs, to find additional trustworthy surface markers, and to compare gene expression pathways profiles with their normal stem cells counterparts are necessary to more accurately define putative breast cell-lineage markers for the different cell types present in the mature mammary gland and to identify potential therapeutical targets in breast cancer. This review discusses the current knowledge about stem cells and CSCs, focusing on mammary stem cells and breast CSCs, and their consequences for breast tumorigenesis and implications for breast cancer susceptibility, prognosis, and treatment.

Prognostic factors and survival analysis in a sample of oral squamous cell carcinoma patients.

OBJECTIVES: The aims of this report were to describe the 5-year overall survival (OS) in a group of oral squamous cell carcinoma (OSCC) patients and to investigate the effects of age, gender, anatomic localization, tumor evolution time, smoking and alcohol intake, nodal status, tumoral recurrences, histologic classification, p53 and p63 immunoexpression, human papillomavirus DNA presence, and treatment on the prognostic outcome. STUDY DESIGN: Survival curves were generated using Kaplan-Meier method, and univariate and multivariate analyses were made using the log rank test and Cox regression, respectively. RESULTS: The 5-year OS was 28.6%, and the univariate analysis showed significant results for p53 and p63 immunoexpression, age, and anatomic localization. The Cox regression demonstrated poor OS for tumors with p53 immunoexpression and for patients aged over 60 years. There were also significant differences in survival depending on the anatomic localizations. CONCLUSION: These results highlight the influence of p53 immunoexpression, age, and anatomic localization in OSCC evolution.

HPV infection in Brazilian oral squamous cell carcinomapatients and its correlation with clinicopathological outcomes.

This study aims to investigate human papilloma virus (HPV) frequency in Brazilian patients with oral squamous cell carcinoma (OSCC) in order to establish a clinicopathological profile. It will also examine the correlation between patient survival and HPV expression in primary tumors (PTs), and their matched samples (MSs) of recidives, lymph nodal metastasis (LNM) or necropsies. Eighty-seven PTs and their corresponding 87 MSs were tested for HPV infection by polymerase chain reaction (PCR) using general and type-specific HPV primers. The following data were obtained from patient medical files: primary site, age, gender, tobacco consumption, histological differentiation, recurrences, metastasis, disease-free survival (DFS) and overall survival (OS). Of the 87 patients investigated, 17 (19.5%) were found to have HPV DNA in their tumors. An investigation of all the paraffin-embedded specimens revealed the presence of HPV DNA in 18 of the 174 samples (10.4%), 10 (11.5%) from PTs and 8 (9.2%) from MSs. No virus was detected in the corresponding PT of 7 (8.1%) MSs, and only one patient demonstrated HPV DNA positivity in both samples. The HPV genotypes 16 and 18 were detected in 4 (22.2%) and 3 (16.7%) of the positive samples, respectively. Infection with both genotypes was found in 6 (33.3%) investigated samples, and the HPV genotype was unidentified in 5 (27.8%) samples. The tongue was the most prevalent infected anatomical site. We did not find any significant association between HPV infection and gender, age, histological differentiation, DFS or OS. A significant number of HPV samples were positive among non-smoking patients. Although a possible influence of the virus on tumoral induction cannot be ruled out, the low frequency of OSCC cases that contain HPV does not suggest that this virus has the same etiological influence on patients as tobacco consumption does.

Ocorrência, extensão e gravidade da doença periodontal em pacientes que serão submetidos à radioterapia e/ou quimioterapia / Occurrence, extension, and severity of the periodontal disease in patients to be submitted to radiotherapy and/or chemotherapy

O propósito deste estudo foi avaliar a ocorrência, extensão e gravidade da doença periodontal (DP) em um grupo de pacientes com câncer, previamente aos esquemas terapêuticos contra o tumor. As variáveis investigadas através da análise dos prontuários médicos e do exame periodontal foram gênero, idade, consumo de tabaco, tipo e localização tumoral, tratamento oncológico, presença de doença sistêmica e perda de inserção clínica (PIC). Os dados foram submetidos à análise estatística comparando-se as médias individuais de PIC. Foram avaliados 37 pacientes, com predomínio de pacientes do gênero masculino, brancos, menores de 60anos, fumantes e sem doenças sistêmicas. O carcinoma epidermóide foi o tumor predominante (91,9%). Em apenas um paciente o tumor não estava localizado na região de cabeça e pescoço e a maioria foi encaminhada à radioterapia (70,3%). A DP esteve presente em todos os pacientes avaliados, sendo encontrado um predomínio do padrão generalizado e moderado (94,6% e 40,6%, respectivamente). As médias de PIC foram significativamente maiores nos pacientes com doenças sistêmicas. A DP previamente a oncoterapia esteve presente em todos os pacientes avaliados. Através da caracterização da ocorrência, extensão e gravidade da DP previamente ao tratamento oncológico, pode-se melhorar a capacidade de planejar os cuidados orais básicos, objetivando o declínio na prevalência das graves conseqüências orais que acometem estes pacientes.

Prognostic significance of p53 and p63 immunolocalisation in primary and matched lymph node metastasis in oral squamous cell carcinoma.

This study evaluates the prognostic significance of p53 and p63 immunolocalisation in oral squamous cell carcinoma samples from 45 matched primary tumors (PT) and lymph node metastases (LNM). Data regarding patient age, gender, primary site, histological differentiation, metastasis, disease-free survival (DFS) and overall survival (OS) were available. p53 and p63 immunolabeling was detected in 17 (37.8%) and 23 (51.1%) of the PT, respectively. For LNM, there was p53 and p63 labeling in 23 (51.1%) and 26 (57.8%) cases, respectively. Most cases showed similar labeling in PT and the corresponding LNM (73.3% for p53 and 53.3% for p63, respectively). No statistically significant associations were found between p53 and p63 immunolabeling and histological differentiation; p63 positive tumors showed higher DFS (p=0.006) and OS (p=0.049); and p53-negative tumors had a higher DFS interval (p=0.009). Our findings suggest that initially p53-negative tumors and initially p63-positive tumors that retain this labeling pattern may follow less aggressive biological courses and present better prognoses.

Prognostic impact of p53 and p63 immunoexpression in oral squamous cell carcinoma.

BACKGROUND: The role of p53 and p63 proteins in the prognosis of oral squamous cell carcinoma (OSCC) is still debatable. Our aim here was to investigate the relationship between the immunoexpression of these proteins with some clinicopathologic parameters of prognostic significance in OSCC. METHODS: Formalin-fixed paraffin-embedded sections from 106 patients were used for study together with the following data: primary site, histologic differentiation, recurrences, metastasis, disease-free survival and overall survival (OS). RESULTS: In OSCCs, the positive rate for p63 protein immunoexpression (87.8%) was higher than p53 (52.8%). p53 expression correlated with metastasis. Tumors negative for p53 and with strong intensity for p63 expression had a significantly higher OS. CONCLUSIONS: p53 overexpression is associated with a larger number of metastases and is correlated with a poor outcome as well as decreased intensity in p63 immunoexpression.

Perfil da incidência e da sobrevida de pacientes com carcinoma epidermóide oral em uma população brasileira / Incidence and survival profile of patients with oral squamous cell carcinoma in a Brazilian population

INTRODUÇÃO: A incidência do câncer bucal no Brasil é uma das mais altas do mundo. OBJETIVOS: Avaliar o perfil, os fatores de risco e a sobrevida de pacientes diagnosticados com carcinoma epidermóide oral entre 1982 e 2002 em uma população brasileira. MATERIAL E MÉTODO: Idade, gênero, local da lesão, história pregressa, consumo de tabaco e bebidas alcoólicas, exposição actínica, traumatismo por prótese, recidivas, metástases e sobrevida foram obtidos dos prontuários. RESULTADOS: Dos 340 pacientes 84,4 por cento eram homens e 15,6 por cento, mulheres (5,4:1). As lesões linguais foram as mais freqüentes (27,9 por cento). Vinte por cento dos pacientes relataram traumatismo por prótese e em 73,8 por cento das lesões em lábio inferior foi relatada exposição actínica desprotegida. Não houve diferença entre as regiões anatômicas e o consumo de tabaco em relação a recidivas, metástases regionais e metástases à distância. O tempo médio de história pregressa foi de 13 meses, havendo diferença entre as regiões anatômicas. A sobrevida em cinco anos foi de 24 por cento. A sobrevida dos pacientes com recidivas e/ou metástases variou conforme a idade analisada (< 60 ou > 60 anos), mas não houve diferença quanto à história pregressa e às regiões anatômicas. A discrepância homem/mulher encontrada foi alta, diminuindo conforme o aumento da idade. O consumo de tabaco e álcool é elevado nessa população, mas não influenciou as recidivas e as metástases da doença. Foi grande o tempo de evolução das lesões até a procura pelo serviço. CONCLUSÕES: Os baixos índices de sobrevida refletem a necessidade de uma maior atenção ao câncer bucal nessa população.

BACKGROUND: The buccal cancer incidence in Brazil is one of the highest in the world. OBJECTIVES: To evaluate profile, risk factors and survival in patients with oral squamous cell carcinoma between 1982 and 2002 in a Brazilian population. MATERIAL AND METHOD: Age, gender, tumor site, previous clinical history, tobacco and alcohol consumption, actinic exposure, trauma by dental prosthesis, recurrences, metastases and survival rates were obtained from the medical files. RESULTS: From 340 patients, 84.4 percent were men and 15.6 percent, women (5.4:1). The lingual lesions were the most frequent ones (27.9 percent). Twenty percent of the patients reported trauma by dental prosthesis and in 73.8 percent of the lesions in lower lip an unprotected actinic exposure was reported. There was no difference between anatomical region and tobacco consumption concerning recurrences and regional or distant metastases. The average time of previous clinical history was 13 months, with significant differences among the anatomical regions. The 5-year-old survival rates were 24 percent. The survival rate of patients with recurrences and/or metastases varied according to age (< 60 or > 60), but not to previous medical history or anatomical regions. The man/woman discrepancy found was high, but decreased according to the rise of age. Tobacco and alcohol consumption is elevated in this population, but did not influence recurrences and metastases. The time of evolution of the lesions was long until the search for medical service. CONCLUSIONS: The low survival rates reflect the need of a more careful attention to buccal cancer in this population.