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Generative adversarial networks (GANs) have gained significant attention in the field of image synthesis, particularly in computer vision. GANs consist of a generative model and a discriminative model trained in an adversarial setting to generate realistic and novel data. In the context of image synthesis, the generator produces synthetic images, whereas the discriminator determines their authenticity by comparing them with real examples. Through iterative training, the generator allows the creation of images that are indistinguishable from real ones, leading to high-quality image generation. Considering their success in computer vision, GANs hold great potential for medical diagnostic applications. In the medical field, GANs can generate images of rare diseases, aid in learning, and be used as visualization tools. GANs can leverage unlabeled medical images, which are large in size, numerous in quantity, and challenging to annotate manually. GANs have demonstrated remarkable capabilities in image synthesis and have the potential to significantly impact digital histopathology. This review article focuses on the emerging use of GANs in digital histopathology, examining their applications and potential challenges. Histopathology plays a crucial role in disease diagnosis, and GANs can contribute by generating realistic microscopic images. However, ethical considerations arise because of the reliance on synthetic or pseudogenerated images. Therefore, the manuscript also explores the current limitations and highlights the ethical considerations associated with the use of this technology. In conclusion, digital histopathology has seen an emerging use of GANs for image enhancement, such as color (stain) normalization, virtual staining, and ink/marker removal. GANs offer significant potential in transforming digital pathology when applied to specific and narrow tasks (preprocessing enhancements). Evaluating data quality, addressing biases, protecting privacy, ensuring accountability and transparency, and developing regulation are imperative to ensure the ethical application of GANs.
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Corantes , Confiabilidade dos Dados , Humanos , Coloração e Rotulagem , Processamento de Imagem Assistida por ComputadorRESUMO
AIMS: Oral epithelial dysplasia (OED) often exhibits a lymphocytic/lichenoid immune response (LIR), imparting histological resemblance to lichenoid mucositis and rendering diagnosis challenging. The clinical appearances of OED and lichenoid inflammatory processes are generally divergent, presenting as well-demarcated hyperkeratotic plaques and diffuse white and/or red mucosal change with variably prominent Wickham striae, respectively. To date, clinicopathological characterisation of OED with LIR, including clinical/gross appearance, has not been depicted. METHODS AND RESULTS: Cases of solitary OED with LIR for which a clinical photograph was available were identified in the authors' institutional files. Clinical and histological features were documented. In 44 identified cases, dysplasia was mild (19 of 44, 43.2%), moderate (19 of 44, 43.2%) and severe (six of 44, 13.6%). Clinically/grossly, all 44 cases (100.0%), presented as well-demarcated hyperkeratotic plaques lacking diffuse white-and-red mucosal change or Wickham striae. Histologically, OED with LIR exhibited numerous 'lichenoid' features beyond the lymphocytic band in the superficial lamina propria, including: leucocyte transmigration (38 of 44, 86.4%), spongiosis (37 of 44, 84.1%), Civatte/colloid bodies (36 of 44, 81.8%), basal cell degeneration (29 of 45, 65.9%), sawtooth rete ridges (11 of 44, 25.0%) and subepithelial clefting (7 of 44, 15.9%). CONCLUSIONS: Virtually any lichenoid histological feature may be seen in OED with LIR, representing a significant diagnostic pitfall. The typical clinical appearance of OED with LIR is of a well-demarcated hyperkeratotic plaque, characteristic of keratinising dysplasia and devoid of lichenoid features. This suggests that pathologist access to clinical photographs during diagnostic interpretation of biopsied white lesions, which represents opportunity to perform gross examination of the disease process, may reduce interobserver variability and improve diagnostic accuracy in this challenging differential diagnosis.
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Linfócitos , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Idoso , Linfócitos/patologia , Linfócitos/imunologia , Mucosa Bucal/patologia , Mucosa Bucal/imunologia , Idoso de 80 Anos ou mais , Adulto JovemRESUMO
BACKGROUND: Artificial intelligence (AI)-based tools have shown promise in histopathology image analysis in improving the accuracy of oral squamous cell carcinoma (OSCC) detection with intent to reduce human error. OBJECTIVES: This systematic review and meta-analysis evaluated deep learning (DL) models for OSCC detection on histopathology images by assessing common diagnostic performance evaluation metrics for AI-based medical image analysis studies. METHODS: Diagnostic accuracy studies that used DL models for the analysis of histopathological images of OSCC compared to the reference standard were analyzed. Six databases (PubMed, Google Scholar, Scopus, Embase, ArXiv, and IEEE) were screened for publications without any time limitation. The QUADAS-2 tool was utilized to assess quality. The meta-analyses included only studies that reported true positives (TP), true negatives (TN), false positives (FP), and false negatives (FN) in their test sets. RESULTS: Of 1267 screened studies, 17 studies met the final inclusion criteria. DL methods such as image classification (n = 11) and segmentation (n = 3) were used, and some studies used combined methods (n = 3). On QUADAS-2 assessment, only three studies had a low risk of bias across all applicability domains. For segmentation studies, 0.97 was reported for accuracy, 0.97 for sensitivity, 0.98 for specificity, and 0.92 for Dice. For classification studies, accuracy was reported as 0.99, sensitivity 0.99, specificity 1.0, Dice 0.95, F1 score 0.98, and AUC 0.99. Meta-analysis showed pooled estimates of 0.98 sensitivity and 0.93 specificity. CONCLUSION: Application of AI-based classification and segmentation methods on image analysis represents a fundamental shift in digital pathology. DL approaches demonstrated significantly high accuracy for OSCC detection on histopathology, comparable to that of human experts in some studies. Although AI-based models cannot replace a well-trained pathologist, they can assist through improving the objectivity and repeatability of the diagnosis while reducing variability and human error as a consequence of pathologist burnout.
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Carcinoma de Células Escamosas , Aprendizado Profundo , Neoplasias Bucais , Humanos , Inteligência Artificial , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Bucais/patologia , Neoplasias Bucais/diagnóstico por imagemRESUMO
BACKGROUND AND OBJECTIVE: The accurate diagnosis of temporomandibular disorders continues to be a challenge, despite the existence of internationally agreed-upon diagnostic criteria. The purpose of this study is to review applications of deep learning models in the diagnosis of temporomandibular joint arthropathies. MATERIALS AND METHODS: An electronic search was conducted on PubMed, Scopus, Embase, Google Scholar, IEEE, arXiv, and medRxiv up to June 2023. Studies that reported the efficacy (outcome) of prediction, object detection or classification of TMJ arthropathies by deep learning models (intervention) of human joint-based or arthrogenous TMDs (population) in comparison to reference standard (comparison) were included. To evaluate the risk of bias, included studies were critically analysed using the quality assessment of diagnostic accuracy studies (QUADAS-2). Diagnostic odds ratios (DOR) were calculated. Forrest plot and funnel plot were created using STATA 17 and MetaDiSc. RESULTS: Full text review was performed on 46 out of the 1056 identified studies and 21 studies met the eligibility criteria and were included in the systematic review. Four studies were graded as having a low risk of bias for all domains of QUADAS-2. The accuracy of all included studies ranged from 74% to 100%. Sensitivity ranged from 54% to 100%, specificity: 85%-100%, Dice coefficient: 85%-98%, and AUC: 77%-99%. The datasets were then pooled based on the sensitivity, specificity, and dataset size of seven studies that qualified for meta-analysis. The pooled sensitivity was 95% (85%-99%), specificity: 92% (86%-96%), and AUC: 97% (96%-98%). DORs were 232 (74-729). According to Deek's funnel plot and statistical evaluation (p =.49), publication bias was not present. CONCLUSION: Deep learning models can detect TMJ arthropathies high sensitivity and specificity. Clinicians, and especially those not specialized in orofacial pain, may benefit from this methodology for assessing TMD as it facilitates a rigorous and evidence-based framework, objective measurements, and advanced analysis techniques, ultimately enhancing diagnostic accuracy.
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Aprendizado Profundo , Transtornos da Articulação Temporomandibular , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico , Sensibilidade e EspecificidadeRESUMO
The zoonotic infectious disease mpox (previously known as monkeypox) is caused by the monkeypox virus (MPXV) from the Poxviridae family. Presently, mpox is receiving worldwide attention because of its emergence in countries that have never previously documented the illness, resulting in a public health emergency. MPXV is transmitted via human-to-human contact, and sexual contact is especially implicated in spread of the disease. Affected individuals experience fever, headache, malaise, and early lymphadenopathy, followed by a secondary mucotaneous rash. Oral ulcers and perioral papules may be the first evidence of the disease. Although there are numerous articles in medical publications documenting the cutaneous presentations of mpox, there is limited information in the dental literature regarding oral lesions. The objective of this article is to review the oral manifestations of mpox and strategies for management of the disease.
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Mpox , Úlceras Orais , Humanos , Saúde PúblicaRESUMO
Implant failures have been associated with a diversity of etiologic processes, predominately arising from bone loss (peri-implantitis) due to inadequate maintenance of oral hygiene or excess luting agents. The aim of this article is to report a novel case of the apparent failure of a dental implant to undergo osseointegration in the presence of submerged pencil graphite. Practitioners are advised to carefully evaluate the clinical and radiographic site of a proposed implant for occult foreign substances. Embedded pencil graphite in the jawbone may promote a foreign body reaction and should be considered in the list of possible contributing factors to dental implant complications.
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Implantes Dentários , Grafite , Humanos , Implantes Dentários/efeitos adversos , Grafite/efeitos adversos , Cimentos Dentários , Higiene Bucal , Complicações Pós-OperatóriasRESUMO
OBJECTIVE: This article reports a case of a longstanding, slowly enlarging intraoral spindle cell lipoma (SCL) that had become increasingly painful during mastication. BACKGROUND: The SCL represents an uncommon variant of the conventional lipoma. There is limited information regarding this lesion in the gerodontologic literature. MATERIALS AND METHODS: A 68-year-old patient underwent an excisional biopsy of a 9-mm slightly yellow papule along the buccal mucosa. RESULTS: The surgical specimen was composed of mature adipocytes with abundant spindle cell populations and was diagnosed as a SCL. CONCLUSIONS: Timely removal of the SCL may reduce the incidence of clinical and surgical complications, particularly in older adults. The management of a SCL is complete excision, and recurrence is rare. Lesions must be carefully distinguished microscopically from its malignant counterpart, the spindle cell liposarcoma.
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Lipoma , Mucosa Bucal , Humanos , Idoso , Mucosa Bucal/patologia , Diagnóstico Diferencial , Lipoma/diagnóstico , Lipoma/cirurgia , Lipoma/patologia , BiópsiaRESUMO
OBJECTIVES: This report describes an unusual case of a multilocular idiopathic bone cavity (IBC) that presented as a botryoid odontogenic cyst situated between the mandibular lateral incisor and canine in an older adult. BACKGROUND: The IBC represents an intraosseous concavity that appears radiographically as a unilocular or multilocular radiolucent lesion found in various skeletal sites, including the jaw. Atypical cases of gnathic IBC have not been appreciated in the gerodontologic literature. MATERIALS AND METHODS: The teeth adjacent to the bony lesion had normal pulpal responses to cold. A full-thickness flap was elevated and provided a direct entry into a bony concavity, which was devoid of an epithelial lining and fluid. RESULTS: The lack of a cystic lining within the empty osseous lesion following surgical entry, concomitant with the vital pulpal status of the proximal teeth, led to a diagnosis of an IBC. The bony walls underwent curettage and copious irrigation prior to primary closure. A 10-month follow-up revealed partial evidence of osseous repair. The patient will continue to be monitored. CONCLUSION: Timely surgical intervention of central lesions of the jaws may improve clinical outcomes. Variants of the IBC should be included in the differential diagnosis of multilocular lesions, particularly in the geriatric population.
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Cistos Odontogênicos , Idoso , Humanos , Cistos Odontogênicos/diagnóstico por imagem , Cistos Odontogênicos/cirurgia , Arcada Osseodentária , Diagnóstico Diferencial , Incisivo/patologiaRESUMO
PURPOSE: To provide a detailed overview of the fundamentals of saliva constituents and production. The review outlines the clinical manifestations as a consequence of salivary gland dysfunction and management strategies for patients with salivary gland dysfunction. Prosthodontic implications of saliva and salivary gland dysfunction are presented. MATERIALS AND METHODS: English-language literature relating to saliva constituents, physiologic saliva production, clinical manifestations secondary to salivary gland dysfunction, salivary biomarkers, and management strategies were retrieved via electronic search. Relevant articles were summarized for this manuscript with a view toward providing pragmatic information. RESULTS: Saliva is produced by three pairs of major and minor salivary glands. The major salivary glands, namely, the parotid, submandibular, and sublingual glands, contribute approximately 90% of saliva production. Saliva contains serous and mucinous secretions produced by different types of cells within salivary glands. Parasympathetic and sympathetic fibers innervate the major salivary glands, and upon stimulation, the parasympathetic innervation increases serous secretions, while the sympathetic innervation increases protein secretion. Stimulated saliva is mainly derived from the parotid glands which are composed of serous acini, while unstimulated saliva is mainly derived from the submandibular glands which are composed of mixed seromucous acini. As major salivary glands contribute the most to salivary flow, local or systemic factors influencing those glands can disrupt saliva production resulting in clinically significant oral manifestations. CONCLUSION: This review provides a fundamental overview of saliva production. In addition, the review highlights the various clinical manifestations secondary to salivary gland dysfunction, explores salivary biomarkers for screening of systemic diseases, discusses management strategies for patients with salivary gland dysfunction, and outlines the prosthodontic implications of saliva and salivary gland dysfunction.
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Prostodontia , Saliva , Humanos , Glândulas Salivares/metabolismo , Glândula Parótida/metabolismo , Biomarcadores/metabolismoRESUMO
PURPOSE: An interdisciplinary clinical review on denture stomatitis formulated by experts from prosthodontics, oral medicine, and oral microbiology is presented. The review outlines the etiopathogenesis, clinical features, and management strategies of denture stomatitis from an interdisciplinary perspective. MATERIALS AND METHODS: English-language articles relating to the definition, incidence, gender distribution, geographical distribution, etiology, pathogenesis, symptoms, signs, treatment, and prognosis of denture stomatitis were retrieved via electronic literature search. Relevant articles were summarized for this manuscript with a view toward providing pragmatic information. RESULTS: Denture stomatitis represents a very common, multifactorial infectious, inflammatory, and hyperplastic condition which is primarily caused by poor oral hygiene, poor denture hygiene, and full-time; mainly night-time denture wear, bringing about the emergence of advanced Candida-containing polymicrobial biofilms in close proximity to the host's mucosal tissues. Denture stomatitis shares clinically relevant associations with dental caries, periodontitis, median rhomboid glossitis, angular cheilitis, aspirational pneumonia, and associated mortality. CONCLUSIONS: Effective, long-term treatment of denture stomatitis relies upon sustained patient-driven behavioral change which should focus on daily prosthesis-level cleaning and disinfection, removal of dentures at night, every night, engagement with professional denture maintenance, and when required, denture replacement. Antifungal medications offer limited benefits outside of short-term use due to the emergence of antifungal resistance. For frail, older, medically compromised, and nursing home populations, treatment of denture stomatitis lowers the risk of aspirational pneumonia and associated mortality.
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Cárie Dentária , Pneumonia , Estomatite sob Prótese , Humanos , Estomatite sob Prótese/microbiologia , Antifúngicos , Pneumonia/complicações , Candida albicansRESUMO
Cancer is a heterogeneous disease with multifaceted drug resistance mechanisms (e.g., tumour microenvironment [TME], tumour heterogeneity, and immune evasion). Natural products are interesting repository of bioactive molecules, especially those with anticancer activities. Prodigiosin, a red pigment produced by Serratia marcescens, possesses inherent anticancer characteristics, showing interesting antitumour activities in different cancers (e.g., breast, gastric) with low or without harmful effects on normal cells. The present review discusses the potential role of prodigiosin in modulating and reprogramming the metabolism of the various immune cells in the TME, such as T and B lymphocytes, tumour-associated macrophages (TAMs), natural killer (NK) cells, and tumour-associated dendritic cells (TADCs), and myeloid-derived suppressor cells (MDSCs) which in turn might introduce as an immunomodulator in cancer therapy.
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Fungi, a diverse group of eukaryotic organisms, play distinct roles in health and disease. Recent advances in the field of mycobiology have enabled the characterization of the "human mycobiome." The human mycobiome has extensively been studied in various disease models. However, to date, the role of the oral mycobiome in oral carcinogenesis has yet to be elucidated. Candida albicans, the most common oral colonizer, has been speculated to display tumorigenic effects; however, the literature lacks consistent documentation from mechanistic studies on whether oral mycobiota act as drivers, facilitators, or passive colonizers of oral premalignancy and cancer. This review article provides an overview of existing hypothesis-driven mechanistic models that outline the complex interplay between the oral mycobiome and oral epithelial dysplasia as well as their potential clinical implications.
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Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Micobioma , Humanos , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
Pemphigus vulgaris (PV) is a rare painful and blistering autoimmune mucocutaneous disorder that appears in middle-aged adults. Oral lesions typically precede cutaneous involvement and tend to be more recalcitrant to therapy. The objective of this article is to present a case of oral and cutaneous PV in an atypical patient, a 23-year-old woman. The case was distinguished by the patient's age, which was 2 to 3 decades younger than the reported mean age of onset, and its coincidence with celiac disease, an immunopathologic process rarely seen in association with PV. Intravenous administration of the monoclonal antibody rituximab provided rapid clinical improvement in the cutaneous lesions and gradual improvement in the oral lesions after 2 infusions. Dental practitioners should remain vigilant for oral manifestations of dermatologic disease and refer affected patients to appropriate healthcare providers for long-term management.
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Doenças Autoimunes , Pênfigo , Pessoa de Meia-Idade , Adulto , Feminino , Humanos , Adulto Jovem , Pênfigo/diagnóstico , Pênfigo/tratamento farmacológico , Rituximab/uso terapêutico , Odontólogos , Papel Profissional , Anticorpos Monoclonais/uso terapêuticoRESUMO
Pterostilbene is a natural nonflavonoid polyphenolic compound. It shows a remarkable range of biological activities, including antiproliferative, antiinflammatory, and antioxidant activity. However, the mechanism of action of PT in breast cancer cells containing mutant p53 protein has not been fully elucidated. Therefore, the present study was aimed at investigating the influence of PT on signaling pathways involved in the apoptosis of mutant p53-breast cancer cell lines. Immunocytochemistry and Western Immunoblotting techniques were used in this study. The present data showed that the viabilities and the proliferations of MDA-MB-231 and T-47D decreased significantly (P < 0.001) after treatment with different concentrations of PT. In addition, the morphological characteristics of both cell lines were changed after treatment with PT. Decreased protein expression of mutant p53 (R280 K, L194F) in MDA-MB-231 and T-47D breast cancer cell lines has also been achieved. In addition, overexpression of pro-apoptotic (Bax) protein, caspase-3 activity and histone release were increased after treatment of both cell lines with different PT concentrations. Furthermore, the protein expressions of cyclin D1, mTOR, and oncogenic ß-catenin were significantly downregulated after treatment of both cell lines with PT. In conclusion, downregulations of protein expression of mutant p53, cyclin D1, mTOR, and ß-catenin were increased after both cell lines had been treated with pterostilbene. PT could point to a promising use against the development and the progression of breast cancer as a natural therapeutic agent.
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Neoplasias da Mama , Proteína Supressora de Tumor p53 , Apoptose , Neoplasias da Mama/tratamento farmacológico , Linhagem Celular Tumoral , Proliferação de Células , Feminino , Humanos , Células MCF-7 , Compostos Fitoquímicos , Estilbenos , Proteína Supressora de Tumor p53/genéticaRESUMO
There is a paucity of evidence surrounding the potential detrimental effects of electronic nicotine delivery systems (ENDS) for both systemic and oral health. The effects of conventional cigarettes on the development of oral cancer are well known; however, the role of ENDS in oral carcinogenesis is yet to be elucidated. Furthermore, the exponential rise of the use of ENDS by the general public means that dental healthcare providers are more likely to encounter questions on their safety in the oral cavity, and on their effectiveness as a smoking cessation aid. Herein, we review the most up to date literature on the systemic and oral health complications of ENDS. Moreover, evidence-based recommendations on the use of ENDS as a smoking cessation tool within the dental setting are discussed.
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Sistemas Eletrônicos de Liberação de Nicotina , Neoplasias Bucais , Abandono do Hábito de Fumar , Produtos do Tabaco , Humanos , Neoplasias Bucais/etiologia , Saúde BucalRESUMO
BACKGROUND: Recently, there is increasing awareness focused on the identification of naturally occurring anticancer agents derived from natural products. Manuka honey (MH) has been recognized for its biological properties as antimicrobial, antioxidant, and anticancer properties. However, its antiproliferative mechanism in hepatocellular carcinoma is not investigated. The current study focused mainly on investigating the molecular mechanism and synergistic effect of anticancer properties of MH on Doxorubicin (DOX)-mediated apoptotic cell death, using two different p53 statuses (HepG2 and Hep3B) and one non-tumorigenic immortalized liver cell line. RESULTS: MH treatment showed a proliferative inhibitory effect on tested cells in a dose-dependent manner with IC50 concentration of (6.92 ± 0.005%) and (18.62 ± 0.07%) for HepG2 and Hep3B cells, respectively, and induced dramatic morphological changes of Hep-G2 cells, which considered as characteristics feature of apoptosis induction after 48 h of treatment. Our results showed that MH or combined treatments induced higher cytotoxicity in p53-wild type, HepG2, than in p53-null, Hep3B, cells. Cytotoxicity was not observed in normal liver cells. Furthermore, the synergistic effect of MH and Dox on apoptosis was evidenced by increased annexin-V-positive cells and Sub-G1 cells in both tested cell lines with a significant increase in the percentage of Hep-G2 cells at late apoptosis as confirmed by the flow cytometric analysis. Consistently, the proteolytic activities of caspase-3 and the degradation of poly (ADP-ribose) polymerase were also higher in the combined treatment which in turn accompanied by significant inhibitory effects of pERK1/2, mTOR, S6K, oncogenic ß-catenin, and cyclin D1 after 48 h. In contrast, the MH or combined treatment-induced apoptosis was accompanied by significantly upregulated expression of proapoptotic Bax protein and downregulated expression of anti-apoptotic Bcl-2 protein after 48 h. CONCLUSIONS: Our data showed a synergistic inhibitory effect of MH on DOX-mediated apoptotic cell death in HCC cells. To our knowledge, the present study provides the first report on the anticancer activity of MH and its combined treatment with DOX on HCC cell lines, introducing MH as a promising natural and nontoxic anticancer compound.
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Carcinoma Hepatocelular , Mel , Neoplasias Hepáticas , Apoptose , Carcinoma Hepatocelular/tratamento farmacológico , Linhagem Celular , Doxorrubicina/farmacologia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Sistema de Sinalização das MAP Quinases , beta CateninaRESUMO
Munchausen syndrome (MunS), or factitious disorder imposed on self, is an exceedingly rare and immensely difficult syndrome to identify and manage and is considered a diagnosis of exclusion. Few reports exist in the dental literature to date, so the objective of this article is to describe a case of MunS in a 60-year-old woman who sought treatment for bilateral jaw pain and uncontrolled jaw movements. The patient's symptoms started 19 months previously, following placement of a 6-unit metal-ceramic bridge. Her pain started as a mild, intermittent ache that lasted for 30 minutes. However, gradually her symptoms became severe and constant. In addition, she started to experience episodes of uncontrolled jaw contractions that were associated with bilateral episodes of stabbing and shooting pain. Results from her comprehensive clinical assessment and investigations suggested that the patient had masticatory myalgia pain disorder and oromandibular dystonia. She experienced significant relief of symptoms with pharmacologic intervention. However, after an intermittent period of relief, she returned to the clinic with an inconsistent history, irregular clinical examination, and history of erratic behavior. The patient was referred to a psychiatrist, who eventually rendered a diagnosis of MunS. This article will also address considerations for the dental team, including how to identify cases of MunS, relevant courses of action, including appropriate referral, and the consequences of overdiagnosis of MunS.
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Síndrome de Munchausen , Odontólogos , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome de Munchausen/diagnósticoRESUMO
Thymomas are neoplasms associated with paraneoplastic disorders. Severe hypersensitivity reactions involving the oral cavity may be the first sign of an undiagnosed thymoma. Oral manifestations of an underlying thymoma may present as recurrent severe painful lesions with associated significant morbidity, often not responding to standard therapeutic measures. This case report describes the treatment of a 75-year-old woman who presented with severe oral lichenoid hypersensitivity reactions secondary to an undiagnosed underlying thymoma. No substantial improvement of the oral conditions was achieved with conventional therapies (topical and systemic steroids); however, almost complete resolution of the lesions was achieved following completion of radiation therapy for the thymic neoplasm. This article is intended to serve as a resource for clinicians to understand early, rare manifestations of an undiagnosed thymoma.
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Erupções Liquenoides , Síndromes Paraneoplásicas , Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Erupções Liquenoides/diagnóstico , Erupções Liquenoides/etiologia , Mucosa Bucal , Timoma/complicações , Timoma/terapia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/terapiaRESUMO
BACKGROUND: Central sensitization (CS) is a form of neuroplasticity characterized by changes in the neural sensitivity, responsiveness, and/or output that are not contingent on peripheral input nor activity-dependent. CS is characterized by activation of unmyelinated C-fibers resulting in a cascade of events at molecular and cellular levels which eventuate into generation of synaptic currents at rest. CS, therefore, contributes to heightened generalized pain sensitivity, further complicates the process of reaching a diagnosis, and increases the possibility of treatment failure. BODY: Trigeminal nerve is the main sensory supplier of the anterior part of the head, including the intraoral structures. Primary afferent nociceptors of the trigeminal nerve and low threshold mechanoreceptors synapse with wide dynamic range (WDR) neurons in the pons. This multifaceted network of nerve interactions which is further complicated by the modulatory circuits that can suppress or heighten the activity of WDR neurons is one of the main contributors to CS. The importance of CS in orofacial pain disorders is emphasized in the context of chronic pain development. As for all chronic pain conditions, it is crucial to consider the biopsychosocial aspects of chronic orofacial pain in managing this diverse group of conditions. This review highlights current understanding of the biopsychosocial model and central mechanisms contributing to the pathogenesis of chronic orofacial pain.
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Dor Facial , Nociceptores , Nervo Trigêmeo , Dor Facial/fisiopatologia , Dor Facial/terapia , Humanos , Estimulação Física , Nervo Trigêmeo/fisiopatologiaRESUMO
BACKGROUND: Recently, there has been a momentous drive to apply advanced artificial intelligence (AI) technologies to diagnostic medicine. The introduction of AI has provided vast new opportunities to improve health care and has introduced a new wave of heightened precision in oncologic pathology. The impact of AI on oncologic pathology has now become apparent, and its use with respect to oral oncology is still in the nascent stage. DISCUSSION: A foundational overview of AI classification systems used in medicine and a review of common terminology used in machine learning and computational pathology will be presented. This paper provides a focused review on the recent advances in AI and deep learning in oncologic histopathology and oral oncology. In addition, specific emphasis on recent studies that have applied these technologies to oral cancer prognostication will also be discussed. CONCLUSION: Machine and deep learning methods designed to enhance prognostication of oral cancer have been proposed with much of the work focused on prediction models on patient survival and locoregional recurrences in patients with oral squamous cell carcinomas (OSCC). Few studies have explored machine learning methods on OSCC digital histopathologic images. It is evident that further research at the whole slide image level is needed and future collaborations with computer scientists may progress the field of oral oncology.