Acquired oral syphilis: A multicenter study of 339 patients from South America.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

FBXL7 Body Hypomethylation Is Frequent in Tumors from the Digestive and Respiratory Tracts and Is Associated with Risk-Factor Exposure.

Squamous cell carcinoma is the main histological tumor type in the upper aerodigestive tract (UADT), including the esophagus (ESCC) and the head and neck sites, as well as the oral cavity (OCSCC), larynx (LSCC) and oropharynx (OPSCC). These tumors are induced by alcohol and tobacco exposure, with the exception of a subgroup of OPSCC linked to human papillomavirus (HPV) infection. Few genes are frequently mutated in UADT tumors, pointing to other molecular mechanisms being involved during carcinogenesis. The F-box and leucine-rich repeat protein 7 (FBXL7) is a potential tumor-suppressing gene, one that is frequently hypermethylated in pancreatic cancer and where the encoded protein promotes the degradation of AURKA, BIRC5 and c-SRC. Thus, the aim of this study was to evaluate the methylation and expression profile of FBXL7 in the UADT and the gene's association with the clinical, etiological and pathological characteristics of patients, as well as the expression of its degradation targets. Here we show that the FBXL7 gene's body is hypomethylated in the UADT, independently of histology, but not in virus-associated tumors. FBXL7 body methylation and gene expression levels were correlated in the ESCC, LSCC, OCSCC and OPSCC. Immunohistochemistry analysis showed that FBXL7 protein levels are not correlated with the levels of its degradation targets, AURKA and BIRC5, in the UADT. The high discriminatory potential of FBXL7 body hypomethylation between non-tumor and tumor tissues makes it a promising biomarker.

Oral squamous cell carcinoma grading systems--analysis of the best survival predictor.

BACKGROUND: The TNM system has been used for decades in an attempt to predict clinical behavior and appropriate therapy for oral squamous cell carcinomas. Histopathologic classifications can be useful as an additional predictive tool. The purpose of this study was to apply four grading systems (Multiparameter Grading System, Malignancy Grading of the Deep Invasive Margins, World Health Organization grading system, and Histologic Risk Assessment) to oral squamous cell carncinomas and evaluate each system based on clinicopathologic parameters and patient survival. METHODS: The files of 53 patients diagnosed with primary oral squamous cell carcinoma at the Brazilian National Cancer Institute were evaluated. All hematoxylin and eosin-stained slides were reviewed to confirm the original diagnosis and to determine histopathologic grading. Clinicopathologic information was obtained from medical records and tumor registries. Statistical analysis was performed using Fisher's exact test or the chi-square test, the Kaplan-Meier method, and the log-rank test. RESULTS: The Multiparameter Grading System was statistically associated with pathologic staging (P = 0.02) and lymph node involvement (P = 0.0009). Differences in overall 5-year survival were significant for Histologic Risk Assessment (P = 0.015), pathologic staging (P = 0.001), lymph node status (P < 0.0001), and recurrence (P = 0.0001). Differences in cancer-specific 5-year survival were significant for Histologic Risk Assessment (P = 0.029), pathologic staging (P = 0.002), lymph node involvement (P < 0.0001), and recurrence (P < 0.0001). Poorly differentiated tumors were associated with the worst disease-free survival (P = 0.031) and recurrence (P = 0.043). CONCLUSION: Of the grading systems evaluated, Histologic Risk Assessment demonstrated the best results for survival prediction in oral squamous cell carcinoma.

Odontogenic tumors: a retrospective study of four Brazilian diagnostic pathology centers.

OBJECTIVE: This article presents the results of a retrospective study of the frequency and classification of odontogenic tumors recorded at four centers of diagnostic pathology in Rio de Janeiro, Brazil. STUDY DESIGN: All medical records and microscopic slides of odontogenic tumor specimens for the years 1997 to 2007 were retrieved from the files of four services of diagnostic pathology in Rio de Janeiro City. Diagnoses were re-evaluated and the tumors classified according to the latest (2005) World Health Organization Classification of Tumors. RESULTS: A total of 201 odontogenic tumors were found among 15,758 oral biopsies (1.3%). The frequencies of these tumors at the four centers ranged from 0.5% at the National Cancer Institute to 3.3% in a private laboratory. Chi-square analysis revealed statistically significant differences (p<0.05) between the proportions of odontogenic tumors in the studied centers. Of these, 94.5% were benign and 5.5% were malignant. Keratocystic odontogenic tumor (32.3%) was the most frequent lesion, followed by ameloblastoma (29.8%) and odontoma (18.4%). CONCLUSIONS: Odontogenic tumors are uncommon in Brazil. Different pathology laboratories reported divergent frequencies of odontogenic tumors, which may reflect institutional specializations and the patient populations served.

"Dry oral and ocular manifestations and autoantibodies characteristic of primary Sjögren's syndrome in multiple sclerosis".

INTRODUCTION: The relationship between primary Sjögren syndrome (pSS) and demyelinating diseases is still not well understood. These diseases seem to coexist amidst autoimmunity, raising questions about clinical characteristics, relationship with immunomodulatory treatment, and possible common immunological background underlying their pathogenesis. OBJECTIVE: calculate the frequency of dry oral and ocular manifestations and autoantibodies characteristic of primary Sjögren's Syndrome in Multiple Sclerosis. METHODS: 202 patients with multiple sclerosis answered a questionnaire to identify complaints of xerostomia and xerophthalmia, according to diagnostic criteria for primary Sjögren's syndrome; 43 answered positively to at least one question; 27 had comorbidities or used drugs that cause dry symptoms and were excluded; 16 patients were selected for examinations for oral, ocular and serum anti-Ro/SS-A autoantibody evaluation. RESULTS: Eleven (68.75%) patients complained of xerostomia; 14 (87.5%) of xerophthalmia. Sialometry < 0.1 ml/min was observed in three (18.8%); 13 patients underwent minor salivary gland biopsy and histopathological examination: focal score > 1 in three (23.1%). Schirmer test was < 5 mm/5 min in four (25%). Lyssamine green/fluorescein dye score was > 5 in three (18.8%). Anti-Ro/SS-A > 10 UI/mm in two (12.5%). Three (1,49%) patients met current criteria for primary Sjögren's syndrome. CONCLUSIONS: Patients with MS may report xerostomia and/or xerophthalmia even in the absence of comorbidities and use of medications capable of causing these symptoms, which may fulfill the diagnostic criteria for pSS. In this study, the frequency of pSS according to current criteria was within the range observed in the literature with older criteria. But the question remains whether the association between these diseases is fortuitous or whether there is a pathogenic link.

Oral squamous cell carcinoma: clinicopathological features in patients with and without recurrence.

AIM: To compare the clinicopathological profile of oral squamous cell carcinoma (OSCC) in groups with and without recurrence. METHODS: Records of all patients who underwent surgery for primary OSCC at a single institution during 1999 were identified. Patient demographics, lesion site, clinical and pathologic stage, pathologic grading, pattern of invasion, lymphocytic infiltrate, perineural invasion, and treatment and survival data were collected. Descriptive statistics were calculated for each variable and survival was calculated using Kaplan-Meier and Cox models. Patients were divided into 2 groups: with (n = 25) and without (n = 28) recurrence. RESULTS: Tongue (p = 0.02) and poorly differentiated (p = 0.04) tumors were associated with recurrence. Kaplan-Meier and Cox models revealed tobacco use and the absence of lymphocytic infiltrate to be associated with the poorest survival in recurrent OSCC. CONCLUSION: The tumor site, tobacco use, and pathological features were involved in the recurrence of OSCC and should be taken into account for OSCC treatment and follow-up.

HPV Infection Leaves a DNA Methylation Signature in Oropharyngeal Cancer Affecting Both Coding Genes and Transposable Elements.

HPV oncoproteins can modulate DNMT1 expression and activity, and previous studies have reported both gene-specific and global DNA methylation alterations according to HPV status in head and neck cancer. However, validation of these findings and a more detailed analysis of the transposable elements (TEs) are still missing. Here we performed pyrosequencing to evaluate a 5-CpG methylation signature and Line1 methylation in an oropharyngeal squamous cell carcinoma (OPSCC) cohort. We further evaluated the methylation levels of the TEs, their correlation with gene expression and their impact on overall survival (OS) using the TCGA cohort. In our dataset, the 5-CpG signature distinguished HPV-positive and HPV-negative OPSCC with 66.67% sensitivity and 84.33% specificity. Line1 methylation levels were higher in HPV-positive cases. In the TCGA cohort, Line1, Alu and long terminal repeats (LTRs) showed hypermethylation in a frequency of 60.5%, 58.9% and 92.3%, respectively. ZNF541 and CCNL1 higher expression was observed in HPV-positive OPSCC, correlated with lower methylation levels of promoter-associated Alu and LTR, respectively, and independently associated with better OS. Based on our findings, we may conclude that a 5-CpG methylation signature can discriminate OPSCC according to HPV status with high accuracy and TEs are differentially methylated and may regulate gene expression in HPV-positive OPSCC.

How pathological criteria can impact prognosis of tongue and floor of the mouth squamous cell carcinoma.

other: Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. OBJECTIVE: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). METHODOLOGY: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). RESULTS: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. CONCLUSION: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

Solitary fibrous tumor of the floor of the mouth.

BACKGROUND: A solitary fibrous tumor (SFT) of the oral cavity is an extremely rare entity. Its diagnosis is complicated because of its diverse morphology and similarity to other mesenchymal diseases. CASE REPORT: A rare case of SFT involving floor of the mouth is presented. The tumor was well circumscribed and almost spherical, measuring approximately 3 cm in diameter. Patient was submitted to biopsy and histopathologic examination showed a tumor composed of spindle to epithelioid cells showing pale to eosinophilic cytoplasm, oval or elongated nuclei with inconspicuous nucleoli. Tumor cells showed strong positivity for CD34, vimentin and Bcl-2. SFTs may present as a diagnostic challenge. The patient was followed for 8 years without recurrences. RESULTS: SFT is an uncommon disease in maxillofacial region; however it should be considered in the differential diagnosis of spindle cell neoplasms with oral manifestation. Only a few cases have been reported in the floor of mouth. We describe a new case of SFT arising at this location. Key words:Solitary fibrous tumors, mouth floor, oral diagnosis.

Papiloma escamoso oral: relato de três casos / Oral squamous papilloma: three case reports

Os papilomavírus humanos (HPVs) pertencem à família Papillomaviridae e podem infectar a epiderme e os epitélios da cavidade oral, orofaringe, laringe, árvore brônquica, esôfago, bexiga, ânus e trato genital. Na boca, o HPV está relacionado com o surgimento de lesões verrucosas benignas, sendo a mais frequente o papiloma escamoso oral. Essa lesão apresenta crescimento exofítico, assintomático e normalmente solitário. Dessa forma, o presente estudo teve por objetivo relatar três casos de papiloma escamoso oral com características distintas. Nos três casos foram realizadas biópsias excisionais e os espécimes avaliados por histopatologia. Os pacientes foram acompanhados por um período mínimo de doze meses, sem histórias de recidivas. Acredita-se que o conhecimento das principais características clínicas e histopatológicas dessa lesão auxilie o dentista no processo de diagnóstico e tratamento dessa patologia.

Human papillomaviruses (HPVs) belong to the Papillomaviridae family and can infect the host's epithelial cells, generating lesions. They have more than one hundred subtypes and these can infect the epidermis and epithelium of the oral cavity, oropharynx, larynx, bronchial tree, esophagus, bladder, anus and genital tract. In the mouth, HPV is related to the appearance of benign verrucous lesions, the most frequent the oral squamous papilloma. This lesion reveal exophytic growth, asymptomatic and usually solitary. Thus, the present paper aimed to report three cases of oral squamous papilloma with different characteristics. In the three cases, excisional biopsies were performed and the specimens were evaluated by histopathology. Patients were followed for a minimum period of twelve months, with no recurrences. It is believed that the knowledge of the main clinical and histopathological characteristics of this lesion helps the dentist in the process of diagnosis and treatment of this pathology.

Fenômeno de extravasamento de muco: relato de dois casos clínicos / The mucous retention phenomenom: tho clinical cases report

O fenômeno de extravasamento de muco, também referido como mucocele, é uma lesão comum da mucosa oral resultante da ruptura de um ducto da glândula salivar com extravasamento da mucina. O principal fator etiológico é o trauma local. A localização mais comum é o lábio inferior, mas outros locais podem ser afetados. Existe a necessidade de diagnóstico diferencial uma vez que, pelo aspecto clínico e localização, as mucoceles assemelham-se a outras lesões que afetam a boca. Diante desse cenário, o objetivo deste trabalho foi relatar dois casos clínicos de fenômeno de extravasamento de muco (mucocele), evidenciando suas características clínicas, histopatológicas, tratamento e prognóstico. Acredita-se que o conhecimento das principais características dessa condição patológica possa auxiliar o clínico na adoção dos principais procedimentos na avaliação, conduta e tratamento desses pacientes.

The mucous retention phenomenon, also called as oral mucocele, is a common lesion of the oral mucosa resulting from the rupture of a salivary gland duct. The main etiological factor is local trauma. The most common location is the lower lip, but other locations can be affected. Differential diagnosis is important because mucoceles resemble other oral lesions. Thus, the aim of the present study was to report two cases of mucocele, demonstrating its clinical and histopathological characteristics, treatment and prognosis.. It is believed that knowledge of the main characteristics of this lesions can help the clinician in carrying out the main procedures in the evaluation, conduct and treatment of these patients.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer.

OBJECTIVE: This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. MATERIAL AND METHODS: A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. RESULTS: From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). CONCLUSIONS: Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Fibrolipoma em cavidade oral: relato de caso / Fibrolipoma of the oral cavity: case report

Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma.

O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas

How pathological criteria can impact prognosis of tongue and floor of the mouth squamous cell carcinoma

Abstract Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. Objective: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). Methodology: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). Results: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. Conclusion: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

Maxillary ameloblastic fibroma: a case report.

Ameloblastic fibroma is a relatively rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. An 8-year-old Caucasian boy was referred to the dentist for evaluation of failed eruption of the maxillary left first molar. The panoramic radiograph showed a well-circumscribed unilocular radiolucency involving an unerupted maxillary left first permanent molar. The lesion was enucleated and the material was sent for histopathologic examination. Microscopically, it was composed by cords and islands of odontogenic epithelium in a myxoid cell-rich stroma that closely resemble the dental papilla with histopathological diagnosis of ameloblastic fibroma. After 24 months of follow-up no recurrence was observed and the maxillary left first molar erupted spontaneously through the buccal mucosa and was aligned with a fixed orthodontic appliance. This case emphasized the importance of careful differential diagnosis of intraosseous oral lesions and reported a rarity of the lesion and its atypical location.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Expression of Bcl-2 family proteins and associated clinicopathologic factors predict survival outcome in patients with oral squamous cell carcinoma.

The aims of this study were to assess the expression levels of three proteins involved in apoptosis--Bcl-2, Bcl-X, and Bax--and evaluate their relationship with clinicopathologic features and survival in oral squamous cell carcinoma (OSCC). Immunohistochemistry was used to evaluate protein expression in 53 primary OSCCs treated by radical surgery with free margins at a single institution in 1999. Histologic specimens were graded and analyzed for perineural invasion, lymphocytic infiltrate, and pattern of invasion. Digital image analysis was performed to quantify immunostaining. Survival was analyzed using the Kaplan-Meier method and Cox's proportional hazard model. Cancer-specific 5-year survival (CSS) was 61% (56% overall survival (OS), and 51% disease-free interval (DFI)). Kaplan-Meier analysis identified pathologic stage (p=0.0007, log-rank test, OS), negative nodes status (pN) (p<0.0001, log-rank test, OS), presence of lymphocytic infiltrate (p=0.0084, log-rank test, OS), and high Bax expression (p=0.025, log-rank test, OS) to each be associated with both better OS and CSS. Tongue tumors (p=0.0179, log-rank test), worst pattern of invasion (p=0.0293, log-rank test), lack of lymphocytic infiltrate (p=0.0328, log-rank test), perineural invasion (p=0.0448, log-rank test), poorly differentiated tumors (p=0.0318, log-rank test), and low Bcl-X expression (p=0.044, log-rank test) were all associated with a low DFI. Cox regression found pN, lymphocytic infiltrate, and Bax expression to be independent prognostic factors for OS and CSS, whereas lymphocytic response and tongue tumors were predictors of DFI. Bcl-2 expression emerged as an independent marker of favorable CSS. Lymphocytic infiltrate was the most meaningful histopathologic parameter in survival analysis, whereas expression of Bcl-2 family members seems to be an important marker of a favorable prognosis in OSCC.

Padronização da análise de mutações no gene TP53 em carcinomas de células escamosas de boca em material parafinado / Standardization of TP53 gene mutations analysis on oral squamous cell carcinoma from paraffin-embedded tissues

Introduction: The tumor protein p53 gene (TP53) is a constant target of investigation in cancer pathogenesis. Analysis by immunohistochemistry provides limited data about p53 in oral carcinogenesis, and TP53 sequencing can contribute to this analysis. However, obtaining high-quality and contamination-free deoxyribonucleic acid (DNA) for a proper amplification can be a difficult task when using paraffin-embedded tissues. Objective: Standardize DNA extraction, polymerase chain reaction (PCR) amplification and DNA sequencing techniques for TP53 mutation analysis. Material and methods: Thirty-nine cases of oral squamous cell carcinoma (OSCC) were selected from the Pathology Division of Instituto Nacional de Câncer (Inca). The DNA extraction method used was the QIAamp® DNA minikit® system. After DNA quantification by spectrophotometry, 250 ng of genetic material obtained from TP53 gene were amplified by PCR for exon 2 and by nested PCR for exon 6. Out of the total sample, 11 cases were selected for exon 2 sequencing. Results: The DNA samples presented mean concentration of 119.74 ± 88.86 ng/µl (28.9-556.4) and purity of 1.69 ± 0.18 (1-1.9). Thirty-three (84.6%) samples were amplified for exon 2, and all samples for exon 6 (39/100%). Readable sequencing data were obtained in 10 (90.9%) cases. Conclusion: Optimization of conditions for TP53 sequencing was obtained, and this will facilitate the analysis of mutations in paraffin-embedded tissues, allowing molecular retrospective studies...

Introdução: O gene TP53 (proteína tumoral p53) é alvo constante de investigação na patogênese do câncer. A imuno-histoquímica fornece dados limitados na análise de p53 no processo da carcinogênese bucal e o sequenciamento de TP53 pode contribuir nessa investigação. Contudo, a obtenção de ácido desoxirribonucleico (DNA) com qualidade para amplificação e livre de contaminação pode constituir uma tarefa difícil na utilização de material parafinado. Objetivo: Padronizar as técnicas de extração de DNA, amplificação por reação em cadeia da polimerase (PCR) e sequenciamento para a análise de mutações em TP53. Material e métodos: Foram selecionados 39 casos de carcinomas de células escamosas bucal da Divisão de Patologia do Instituto Nacional de Câncer (Inca). O DNA foi extraído utilizando o sistema comercial QIAamp® DNA minikit®. Após quantificação do DNA por espectrofotometria, 250 ng de amostra foram amplificados pela técnica de PCR para o éxon 2 e por nested PCR para o éxon 6 do gene TP53. Da amostra total, 11 casos foram selecionados para a padronização da reação de sequenciamento do éxon 2. Resultados: As amostras de DNA apresentaram concentração média de 119,74 ng/µl ± 88,86 (28,9-556,4 ng/µl) e pureza de 1,69 ± 0,18 (1-1,9). Do total das amostras analisadas, 33 (84,6%) foram amplificadas para o éxon 2, e todas (39/100%), para o éxon 6. No sequenciamento do éxon 2 obtiveram-se sequências passíveis de leitura em 10 (90,9%) casos. Conclusão: A otimização das condições para o sequenciamento de TP53 foi obtida, o que facilitará a análise de mutações em tecidos parafinados, permitindo...

Maxillary ameloblastic fibroma: a case report

Ameloblastic fibroma is a relatively rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. An 8-year-old Caucasian boy was referred to the dentist for evaluation of failed eruption of the maxillary left first molar. The panoramic radiograph showed a well-circumscribed unilocular radiolucency involving an unerupted maxillary left first permanent molar. The lesion was enucleated and the material was sent for histopathologic examination. Microscopically, it was composed by cords and islands of odontogenic epithelium in a myxoid cell-rich stroma that closely resemble the dental papilla with histopathological diagnosis of ameloblastic fibroma. After 24 months of follow-up no recurrence was observed and the maxillary left first molar erupted spontaneously through the buccal mucosa and was aligned with a fixed orthodontic appliance. This case emphasized the importance of careful differential diagnosis of intraosseous oral lesions and reported a rarity of the lesion and its atypical location.

Fibroma ameloblástico é um tumor odontogênico benigno relativamente raro, em que ambos os componentes epiteliais e ectomesenquimais são neoplásicos. Menino de oito anos de idade, branco, foi encaminhado ao dentista para avaliar a falha na erupção do primeiro molar maxilar do lado esquerdo. A radiografia panorâmica revelou imagem radiolúcida, unilocular, bem circunscrita, envolvendo o primeiro molar permanente maxilar esquerdo incluso. A lesão foi enucleada e o material encaminhado para avaliação histopatológica. Microscopicamente, era composta de ilhas e cordões de epitélio odontogênico num estroma mixóide rico em células, que se assemelhava à papila dentária, com diagnóstico histopatológico de fibroma amelobástico. Após 24 meses de acompanhamento, nenhuma recorrência foi observada e o primeiro molar permanente maxilar irrompeu espontaneamente através da mucosa bucal e foi alinhado com aparelho ortodôntico fixo. Esse caso enfatiza a importância do cuidadoso diagnóstico diferencial das lesões orais intra-ósseas e relato de lesão rara e sua localização atípica.

Análise de sobrevida global em pacientes diagnosticados com carcinoma de células escamosas de boca no INCA no ano de 1999 / Overall survival analysis in oral squamous cell carcinoma patients diagnosed at the National Cancer Institute in 1999

O carcinoma de células escamosas de boca compreende cerca de 90 a 95 por cento de todas as neoplasias malignas da boca e é um dos tipos de câncer mais frequentes no Brasil. O índice de sobrevida em 5 anos é baixo e permaneceu estável nas últimas décadas, apesar dos avanços nas terapias. O objetivo deste estudo foi analisar o perfil e a sobrevida global dos pacientes diagnosticados com carcinoma de células escamosas de boca no ano de 1999 no Instituto Nacional de Câncer. Dos 320 pacientes incluídos no estudo, 79,4 por cento eram homens. A idade média foi de 56,7 anos, e 82,2 por cento deles fumavam e/ou bebiam. A língua, seguida do assoalho de boca foram os locais mais acometidos. A maioria (68,9 por cento) dos pacientes foi diagnosticada em estádios tardios e submetida à radioterapia exclusiva (53,6 por cento). A sobrevida média no período do estudo foi de 29,4 meses. Os pacientes dos estádios iniciais apresentaram maior sobrevida, assim como aqueles submetidos apenas à cirurgia como forma de tratamento e os que não apresentaram linfonodos acometidos ao diagnóstico. Tumores localizados em palato duro e mucosa jugal apresentaram pior prognóstico. Foram fatores preditivos independentes de melhor sobrevida os tumores T1 ou T2 (p=0,001), sem acometimento de linfonodos (p=0,012) e não localizados em mucosa jugal (p=0,021). O diagnóstico do câncer oral ainda se faz em estádios tardios, o que influencia negativamente a sobrevida global dos pacientes. Maior ênfase deve ser dada à capacitação dos profissionais para o reconhecimento precoce do câncer e à conscientização da população de risco.

Oral squamous cell carcinoma accounts for 90 to 95 percent of all malignant neoplasms of the mouth and it is one of most common cancers in Brazil. Five-year survival rates remain low and have not improved over the past decades, despite advances in therapy. The purpose of this study was to analyze the features and overall survival of patients diagnosed with oral squamous cell carcinoma in 1999 at the National Institute of Cancer. Male patients (79.4 percent) with a medium age of 56.7 years, with smoking or drinking habits (82.2 percent) comprised most of the sample. Tongue and floor of the mouth were the most prevalent sites of occurrence. Patients were diagnosed mainly at advanced stages of the disease (68.9 percent stages III and IV) and were treated with radiation therapy alone (53.6 percent). Mean survival was 29.4 months, and patients diagnosed in early stages had better survival rates, as well as those who were surgically treated and those who did not show cervical node metastasis at diagnosis. Tumors located in the palate or in the buccal mucosa presented the worst prognosis. Cox regression analysis showed that T1 or T2 lesions (p=0.001), with no neck metastasis (p=0.012) and anatomic site other than buccal mucosa (p=0.021) were independent predictive factors of a better survival rate. Oral cancer diagnosis still occurs in advanced stages, and it negatively influences overall survival, so there should be efforts to prepare and train professionals to recognize lesions at early stages and to make the population at greatest risk aware of the disease.