Oral solitary fibrous tumors: A collaborative clinicopathologic study of 19 cases.

OBJECTIVE: To report the clinicopathologic features of 19 oral solitary fibrous tumors (SFTs). METHODS: Clinical data were collected from the records of seven pathology services. All cases were re-evaluated by HE staining and confirmed by immunohistochemistry. RESULTS: The series comprised 11 females (57.9%) and 8 males (42.1%), with a mean age of 47.3 ± 14.7 years (range: 22-71 years) and a 1.3:1 female-to-male ratio. Most tumors affected the buccal mucosa (n = 7; 36.8%) and presented clinically as an asymptomatic solitary submucosal well-circumscribed nodule with coloration similar to the oral mucosa. Morphologically, most SFTs (n = 10; 52.6%) exhibited a classic hybrid pattern characterized by a well-circumscribed proliferation of densely cellular areas alternating with hypocellular areas in a variably collagenous vascular stroma. Remnants of accessory salivary glands were observed in two cases (n = 2; 10.5%). All tumors were positive for STAT6 and CD34 (n = 19; 100%). Outcome information was available from 6 patients (31.6%), with clinical follow-up ranging from 6 to 24 months (mean ± SD, 9.5 ± 6.8 months), and none developed local recurrence. CONCLUSIONS: Oral SFTs are rare and often clinically misdiagnosed. Pathologists should consider SFT in the differential diagnosis of oral spindle cell tumors. Accurate diagnosis requires careful morphological evaluation supported by immunohistochemical analysis.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Oral pyogenic granuloma: An 18-year retrospective clinicopathological and immunohistochemical study.

BACKGROUND: Pyogenic granuloma (PG) is a lesion characterized by the proliferation of blood vessels, commonly affecting the skin and the mouth. We aimed to compare clinical, microscopic, and immunohistochemical features of the two types of oral PG: lobular capillary hemangioma (LCH) and non-LCH (NLCH). METHODS: Epidemiological and clinical data from 2000 to 2018 were collected from the archives of our institution, and histopathological sections of PG were reviewed. Immunohistochemical analyses (CD34, D2-40, SMA, mast cell, and Ki-67) were performed in 34 cases. RESULTS: Sixty-two LCH and 107 non-LCH samples were included. The mean (±SD) age of the patients was 38.59 ± 16.96 years; 55.62% were female; 39.64% of cases occurred in the gingiva, 44% of the nodules were pedunculated, and 13.02% of patients reported a history of trauma. NLCH was more prevalent among older patients than LCH. The most prevalent site of LCH was the lips, while NLCH occurred more in the gingiva (P < 0.05). Epithelial atrophy, microvessels, SMA-positive areas, and Ki-67-positive nuclei were more prevalent in LCH (P < 0.05). CONCLUSIONS: PG accounted for 2.25% of lesions archived in the pathology service and most cases were NLCH. LCH and NLCH exhibited clinicopathological differences in terms of age, site, epithelial atrophy, vascularization, and proliferation rate.

Heat-killed Lactobacillus reuteri and cell-free culture supernatant have similar effects to viable probiotics during interaction with Porphyromonas gingivalis.

BACKGROUND AND OBJECTIVE: In the last decade, numerous studies have been published to clarify the role of probiotics, especially Lactobacillus reuteri, as an adjunct to conventional periodontal treatment. Although the health benefits of probiotics are numerous, they are live bacteria, and the administration of live organisms is not risk-free. We evaluated the antimicrobial effect of L reuteri and its cell-free culture supernatant on Porphyromonas gingivalis, a keystone periodontal pathogen, in vitro. We also evaluated the influence of this probiotic in its live, heat-killed (HKL, paraprobiotic) form and its supernatant on the Galleria mellonella invertebrate model after infection by P gingivalis. METHODS: The interaction assay was conducted with P gingivalis and L reuteri preparations (live cells and supernatant preparation). For this, P gingivalis and L reuteri preparations were added to tubes containing Brain Heart Infusion broth and incubated for 3 days. The suspensions were then seeded onto appropriate culture media for the calculation of colony-forming units per mL (CFU/mL). An in vivo assay with the G mellonella model was also performed. Live L reuteri, HKL, or supernatant was inoculated 2 hours prior to infection with P gingivalis. Survival was evaluated over 7 days, and the number of hemocytes in the hemolymph was estimated 3 hours after P gingivalis infection. Data were then subjected to statistical testing (α = 5%). RESULTS: Both live L reuteri and its supernatant had antimicrobial activity against P gingivalis (CFU reduction up to 86%, P < .05). Moreover, treatment with live and HKL had similar effects on G mellonella survival (increased survival up to 46%, P < .05). However, only live L reuteri was able to significantly increase the hemocyte density in this invertebrate model. CONCLUSION: Lactobacillus reuteri antimicrobial activity against P gingivalis and its effects on G mellonella survival after infection with a periodontopathogen do not depend on cell viability. This allows the development of products without live bacterium while maintaining similar effects.

Oral hairy leukoplakia in a child using a corticosteroid nasal spray.

We report a case of atypical oral hairy leukoplakia (OHL) in a 9-year-old immunocompetent girl treated with fluticasone propionate nasal spray for allergic rhinitis. The OHL in childhood is uncommon and should be included in a differential diagnosis of white lesions in the oral mucosa.

Multicentre retrospective study of 97 cases of intraoral lipoma.

BACKGROUND: Lipomas are benign neoplasms derived from adipose tissue that are unfrequently found in the oral cavity. The objective of this study is to identify the main clinicopathological characteristics of this tumour in a case series of oral lipomas (OL) in a population from Spain and Brazil. MATERIAL AND METHODS: A multicentre retrospective observational study was conducted in collaboration with the Oral Pathology Unit of the São Paulo State University (UNESP), São José dos Campos, in Brazil, and the Oral Medicine and Pathology Units of the University of Santiago de Compostela (USC) and the University of the Basque Country (UPV/EHU) in Spain. RESULTS: This multicentre series consists of a total of 97 of OL cases, 31 (32%) of which correspond to Spain, and 66 (68%) to Brazil with an overall prevalence of 0.33%. The average age of the patients is 56.44 years old, with a range of 10-92 (SD = 15.52). Buccal mucosa was the most frequent location (42.3%). Cases from Spain coexisted with other lesions in a significant number of cases, 12.9%, vs Brazil, 1.5% (P = 0.018). According to the progression time, Brazil has an average of 60.35 months (CI: 27.20-93.51), compared to 5.41 months in Spain (CI: 3.17-7.65) (P = 0.022). Average size is 12.55 mm (SD = 11.06), ranging from 2 to 75 mm. A positive correlation is also seen between the increase in the lesion size and a greater progression time (CC = 0.367; P = 0.008). CONCLUSIONS: Correct differential diagnosis of the clinical lesion is key, followed by a good histopathological study, to achieve the final diagnosis.

Intraosseous xanthoma of the mandible: A multi-institutional case series with a literature review.

BACKGROUND: The aim of the present study was to report the clinicopathologic, radiographic and immunohistochemical features of five South American cases of intraosseous xanthomas of the mandible and to compare them to those detected in a literature review. METHODS: Clinical data were collected from the records of three Oral and Maxillofacial Pathology services in South America and compared with those compiled from a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus). All cases were evaluated by haematoxylin and eosin staining and immunohistochemistry for CD68 and S-100. RESULTS: The series comprised four females (80%) and one male (20%) with a mean age of 23.3 ± 10.9 years (range: 13-45 years). In four cases, there was involvement of the posterior region of the mandible (80%). The lesions presented radiographically as unilocular (60%) radiolucencies with punched-out margin (80%). All cases predominantly consisted of CD68-positive and S-100-negative xanthomatous cells. No recurrences were observed after curettage, with a median follow-up of 27 months. CONCLUSION: Intraosseous xanthoma of the jaws is a rare benign disorder. We report here five additional cases affecting the mandible, for a total of 36 cases of the jaws reported in the literature. Overall, this lesion has predilection for posterior sites of the mandible of asymptomatic young adults.

Oral intramuscular hemangioma: Report of three cases.

Intramuscular hemangioma (IMH) represents less than 1% of all hemangiomas. In the head and neck region, it occurs mostly in the masseter, temporalis and sternocleidomastoid muscles. Despite its infiltrative growth pattern and several worrisome histological features, such as increased mitotic activity, plumpness of the nuclei, intraluminal papillary projections or perineural infiltration, the lesion is benign, and complete surgical excision is the preferred treatment for such oral lesions. Herein, we report three rare cases of IMH in the tongue and lip, discuss the clinical and histological aspects, and review the literature regarding this lesion.

Inhibitory effect of probiotic Lactobacillus supernatants from the oral cavity on Streptococcus mutans biofilms.

Probiotics can release bioactive substances that can inhibit the growth and biofilm formation of pathogenic microorganisms such as Streptococcus mutans. In this context, we evaluated whether the supernatants of Lactobacillus strains isolated from caries-free subjects can inhibit S. mutans, one of the most important bacteria for dental caries. First, the supernatants of 22 Lactobacillus strains were screened for antibacterial activity against S. mutans in planktonic cultures. All 22 Lactobacillus strains studied (100%) showed antibacterial activity. Thereafter, the Lactobacillus strains with the greatest reductions in the planktonic S. mutans cultures were tested on biofilms. The L. fermentum 20.4, L. paracasei 11.6, L. paracasei 20.3 and L. paracasei 25.4 strains could significantly reduce the number of S. mutans cells in biofilms formed in hydroxyapatite (p < 0.05). This reduction was also confirmed by scanning electron microscopy analysis and was not caused by the decreased pH value in the medium (p > 0.05). In addition, the supernatants of these probiotic strains could also reduce the total biomass of S. mutans biofilms (p < 0.05). In conclusion, most of the Lactobacillus strains tested have some antibacterial activity against S. mutans. L. fermentum 20.4, L. paracasei 11.6, L. paracasei 20.3 and L. paracasei 25.4 produce bioactive substances that caused a significant reduction in S. mutans biofilms.

Immunomodulatory effect of photodynamic therapy in Galleria mellonella infected with Porphyromonas gingivalis.

Porphyromonas gingivalis is an important pathogen in the development of periodontal disease. Our study investigated if the treatment with antimicrobial photodynamic therapy (aPDT) that employs a nontoxic dye, followed by irradiation with harmless visible light can attenuate the experimental infection of P. gingivalis in Galleria mellonella. Firstly, different concentrations of P. gingivalis ranging from 102 to 106 cells/larva were injected into the animal to obtain a lethal concentration. Next, the following groups of G. mellonella infected with P. gingivalis were evaluated: inoculation of the photosensitizer and application of laser (P + L+), inoculation of physiologic solution and application of laser (P-L+), inoculation the photosensitizer without laser (P + L-) and inoculation of physiologic solution without Laser (P-L-). The effects of aPDT on infection by P. gingivalis were evaluated by survival curve analysis and hemocytes count. A lethal concentration of 106 cells/larva was adopted for evaluating the effects of aPDT on experimental infection with P. gingivalis. We found that after 120 s of PDT application, the death of G. mellonella was significantly lower compared to the control groups (p = 0.0010). Moreover, the hemocyte density in the P+L+ group was increased by 9.6 × 106 cells/mL (2.62-fold increase) compared to the infected larvae with no treatment (L-P- group) (p = 0.0175). Finally, we verified that the aPDT led to a significant reduction of the number of P. gingivalis cells in G. mellonella hemolymph. In conclusion, PDT application was effective against P. gingivalis infection by increasing the survival of G. mellonella and was able to increase the circulating hemocytes indicating that PDT activates the G. mellonella immune system.

Effects of diode laser irradiation and fibroblast growth factor on periodontal healing of replanted teeth after extended extra-oral dry time.

AIM: The search for effective protocols to reduce the incidence of root resorption and allow periodontal ligament repair is still challenging, given the unpredictable outcome of late tooth replantation. The aim of this study was to assess the effects of both high-power diode laser irradiation (DL) and basic fibroblast growth factor (FGF) on the periodontal healing of replanted teeth after extended extra-oral dry time. METHODS: Maxillary incisors of 50 male rats were extracted and assigned to three experimental and two control groups (n = 10). DL: root surfaces treated with DL (810 nm, continuous mode, 1.0 W, 30 s), FGF: topical application of FGF gel to the root surface and in the alveolar wound, DL + FGF: DL and topical application of FGF gel, C+: no treatment after extraction and immediate replantation and C-: no treatment after extraction and replantation after 60 min. In the experimental groups, the specimens were kept dry for 60 min, the pulps were removed and the canals were filled with calcium hydroxide paste prior to tooth replantation. The animals were euthanized after 60 days. The specimens were processed for radiographic, histological and immunohistochemical analyses. RESULTS: The radiographic analysis showed fewer resorptive areas in DL + FGF (P < 0.05). The histological and immunohistochemical analyses showed that the DL group had lower mean values of ankylosis, replacement and inflammatory resorption when compared to C-, not differing statistically from C+. DL + FGF produced significantly more collagen fibers (type I and type III) than C-, not differing from C+ in the case of type I fibers (P < 0.05). CONCLUSIONS: DL, with or without FGF, reduced the occurrence of external root resorption and ankylosis. Periodontal healing was favored and some fiber reinsertion occurred only when FGF was used.

Oral focal mucinosis: review of the literature and two case reports.

Oral focal mucinosis is a rare condition, clinically characterized by an asymptomatic swelling, without distinct, specific features, which occurs predominantly in adults of the female gender. Its clinical aspect leads to various differential diagnoses, and final diagnosis is only possible by means of histopathological exam, in which a well-delimited myxomatous area containing mucinous material is observed. In the present study, a review of the English-language literature about the lesion, was conducted, covering the period from 1974 to March 2015. We report two new cases, thereby contributing to the knowledge and differential diagnosis of this entity.

Graphite oral tattoo: case report.

Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentat oral tattoos, such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of grafite and amalgam tattoos. Oral tattoos affect women more frequently in the region of the alveolar ridge. Graphite tattoos occur in younger patients when compared with the amalgam type. Histologically, amalgam lesions represent impregnation of the reticular fibers of vessels and nerves with silver, whereas in cases of graphite tattoos, this impregnation is not observed, but it is common to observe a granulomatous inflammatory response, less evident in cases of amalgam tattoos. Both types of lesions require no treatment, but in some cases a biopsy may be done to rule out melanocytic lesions.

Essential oil of Melaleuca alternifolia for the treatment of oral candidiasis induced in an immunosuppressed mouse model.

BACKGROUND: The search for alternative therapies for oral candidiasis is a necessity and the use of medicinal plants seems to be one of the promising solutions. The objective of this study was to evaluate the in vitro and in vivo effects of the essential oil of Melaleuca alternifolia on Candida albicans. METHODS: The minimum inhibitory concentration (MIC) and minimum biofilm eradication concentration (MBEC) of M. alternifolia were determined by the broth microdilution assay. For the in vivo study, twelve immunosuppressed mice with buccal candidiasis received topical applications of M. alternifolia with MBEC. After treatment, yeasts were recovered from the mice and quantified (CFU/mL). Mice were killed for morphologic analysis of the tongue dorsum by optical and scanning electron microscopy. Data were analyzed using Student's t test or Mann-Whitney test. RESULTS: The MIC of M. alternifolia was 0.195% and the MBEC was 12.5%. Treatment with M. alternifolia achieved a 5.33 log reduction in C. albicans and reduced the microscopic lesions of candidiasis. CONCLUSIONS: M. alternifolia oil at a 12.5% was effective to eradicate a C. albicans biofilm formed in vitro and to reduce yeasts of C. albicans in an immunosuppressed mouse model.

Healing of normal and osteopenic bone with titanium implant and low-level laser therapy (GaAlAs): a histomorphometric study in rats.

The study investigates the influence of low-level laser therapy (LLLT) on bone healing in the femur of osteopenic and normal rats with titanium implants. Ovariectomy and control group were randomly submitted to LLLT, which was applied by gallium-aluminum-arsenium (GaAlAs) laser at the surgical site before and after placing the implant, for seven times. Histomorphometric and statistical analysis were performed. Most irradiated groups showed higher values than the nonirradiated groups. The GaAlAs infrared diode laser may improve the osseointegration process in osteopenic and normal bone, particularly based on its effects in the initial phase of bone formation.

Report of intraosseous intravascular papillary endothelial hyperplasia associated with an odontogenic cyst in the maxilla and literature review.

Intravascular papillary endothelial hyperplasia (IPEH) represents an uncommon reactive endothelial hyperplastic proliferation. A 46-year-old man experienced increased volume in the right maxilla, elevation of the nasal ala, and swelling of the hard palate with a reddish hue for 3 months. Computed tomography revealed an expansive hypodense region and cortical bone destruction associated with an impacted supernumerary tooth and an endodontically treated tooth. Under the differential diagnoses of a radicular cyst, dentigerous cyst, and ameloblastoma, an exploratory aspiration and incisional biopsy were performed. This revealed the formation of blood vessels of various diameters lined by endothelium, forming intravascular papillae positive for CD-34. The definitive diagnosis was IPEH, and the patient was treated by embolization and surgery. Histological analysis confirmed the presence of IPEH associated with an odontogenic cyst. After 12 months of follow-up, no recurrence was observed. Also, we reviewed case reports of IPEH affecting the maxilla and mandible. Fourteen intraosseous cases were reported in the maxilla and mandible, with a preference for males and affecting a wide age range. Complete surgical excision was the treatment of choice, and recurrences were not reported. The pathogenesis of IPEH is controversial and may originate from trauma or inflammatory processes. To the best of our knowledge, this is the first report of an association of IPEH with an odontogenic cyst. The importance of IPEH in the differential diagnosis of intraosseous lesions in the jaws is emphasized, and preoperative semiotic maneuvers are needed to prevent surgical complications.

Heat-killed Limosilactobacillus reuteri ATCC PTA 6475 prevents bone loss in ovariectomized mice: A preliminary study.

Osteoporosis is an important health problem that occurs due to an imbalance between bone formation and resorption. Hormonal deficiency post-menopause is a significant risk factor. The probiotic Limosilactobacillus reuteri has been reported to prevent ovariectomy (Ovx)-induced bone loss in mice and reduce bone loss in postmenopausal women. Despite the numerous health benefits of probiotics, as they are live bacteria, the administration is not risk-free for certain groups (e.g., neonates and immunosuppressed patients). We evaluated the effects of L. reuteri (ATCC PTA 6475) and its heat-killed (postbiotic) form on Ovx-induced bone loss. Adult female mice (BALB/c) were randomly divided into four groups: group C-control (sham); group OVX-C-Ovx; group OVX-POS-Ovx + heat-killed probiotic; group OVX-PRO-Ovx + probiotic. L. reuteri or the postbiotic was administered to the groups (1.3x109 CFU/day) by gavage. Bacterial morphology after heat treatment was accessed by scanning electron microscopy (SEM). The treatment started one week after Ovx and lasted 28 days (4 weeks). The animals were euthanized at the end of the treatment period. Bone microarchitecture and ileum Occludin and pro-inflammatory cytokines gene expression were evaluated by computed microtomography and qPCR techniques, respectively. The Ovx groups had lower percentage of bone volume (BV/TV) and number of bone trabeculae as well as greater total porosity compared to the control group. Treatment with live and heat-killed L. reuteri resulted in higher BV/TV and trabecular thickness than the Ovx group. The heat treatment caused some cell surface disruptions, but its structure resembled that of the live probiotic in SEM analysis. There were no statistical differences in Occludin, Il-6 and Tnf-α gene expression. Both viable and heat-killed L. reuteri prevented bone loss on ovariectomized mice, independently of gut Occludin and intestinal Il-6 and Tnf-α gene expression.

Synchronous ossifying fibromas of maxilla and mandible.

Ossifying fibroma is a benign neoplasm composed of fibrocellular tissue and mineralized material of varying appearance, which is most commonly seen in the posterior region of the mandible as a solitary lesion. We report an unusual case of synchronous ossifying fibroma of maxilla and mandible. To the best of our knowledge, only 13 similar cases have been previously reported.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.