Hamartomas, choristomas, and teratomas of the oral cavity: A 49-years cross-sectional study in an oral diagnostic service.

BACKGROUND: To investigate the incidence and demographic profile of hamartomatous, choristomatous, and teratoid lesions in a Brazilian population over a 49 years-period. METHODS: A retrospective cross-sectional study was performed, and data regarding demographic and clinical aspects were obtained from the medical records of a Brazilian referral center (1970-2019). The collected data were submitted to descriptive analysis and Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests (p ≤ 0.05). RESULTS: In a total of 16,412 medical records analyzed, 300 (1.83 %) were hamartomatous, 2 (0.01 %) choristomatous, and 1 (0.01 %) teratoid lesions. Hamartomas were most diagnosed in females and adults. Statistical significance was observed between hamartoma and age group (p < 0.001). Odontoma was the most frequent hamartomatous lesion. In choristomatous and teratoid lesions, there was no occurrence in males. The jaws were the most affected anatomical site by hamartoma. Choristomas were observed on the mandible and tongue, while a teratoid lesion was seen on the floor of the mouth. CONCLUSIONS: Low occurrence of choristomatous and teratoid lesions over hamartomatous lesions and a heterogeneous occurrence profile regarding sex, age group, and anatomic site were observed. Hamartomas are relatively common and benign conditions that may cause damage and require special care during dental treatment. Thus, the dentist needs to be able to identify and treat them appropriately. Likewise, although choristomas and teratomas present no risk to patients and have a lower occurrence than hamartomas, they also require treatment.

Immunoexpression of HSP27 does not seem to influence the prognosis of oral tongue squamous cell carcinoma.

New methods of early detection and risk assessment have been studied aiming to predict the prognosis of patients and directing a specialized treatment of the oral tongue squamous cell carcinoma (OTSCC). In this context, several molecular biomarkers have been investigated for this purpose, and, among them, the heat shock protein 27 (HSP27) can be named. The study aimed to analyze whether heat shock protein 27 (HSP27) exerts any influence on OTSCC, correlating its immunoexpression with clinicopathological parameters, and patient survival. The sample comprised 55 OTSCC cases and 20 normal oral mucosa specimens. The malignancy grading systems proposed by the WHO in 2005, Brandwein-Gensler et al., and Almangush et al. were applied in a histomorphological study. HSP27 expressions were evaluated through the Immunoreactivity Score System (IRS). Significant values were considered at p <0.05 for all statistical tests. Higher IRS results were observed for normal oral mucosa specimens when compared to OTSCC cases (p <0.001). No significant associations between HSP27 immunostaining, the analyzed clinicopathological parameters and patient survival were observed. The results of the present study indicate lower HSP27 expression in OTSCC cases compared to normal oral mucosa specimens. Thus, HSP27 expression does not seem to influence patient prognosis.

Immunoexpression of HSP27 does not seem to influence the prognosis of oral tongue squamous cell carcinoma

Abstract New methods of early detection and risk assessment have been studied aiming to predict the prognosis of patients and directing a specialized treatment of the oral tongue squamous cell carcinoma (OTSCC). In this context, several molecular biomarkers have been investigated for this purpose, and, among them, the heat shock protein 27 (HSP27) can be named. The study aimed to analyze whether heat shock protein 27 (HSP27) exerts any influence on OTSCC, correlating its immunoexpression with clinicopathological parameters, and patient survival. The sample comprised 55 OTSCC cases and 20 normal oral mucosa specimens. The malignancy grading systems proposed by the WHO in 2005, Brandwein-Gensler et al., and Almangush et al. were applied in a histomorphological study. HSP27 expressions were evaluated through the Immunoreactivity Score System (IRS). Significant values were considered at p <0.05 for all statistical tests. Higher IRS results were observed for normal oral mucosa specimens when compared to OTSCC cases (p <0.001). No significant associations between HSP27 immunostaining, the analyzed clinicopathological parameters and patient survival were observed. The results of the present study indicate lower HSP27 expression in OTSCC cases compared to normal oral mucosa specimens. Thus, HSP27 expression does not seem to influence patient prognosis.

Resumo Novos métodos de detecção precoce e avaliação de risco estão sendo estudados com o intuito de predizer o prognóstico dos pacientes e direcionar um tratamento diferenciado. Neste contexto, vários biomarcadores moleculares têm sido investigados com esta finalidade, dentre eles a heat shock protein 27 (HSP27). Esta pesquisa objetivou analisar se a HSP27 exerce alguma influência nos carcinomas de células escamosas de língua oral (CCELO), correlacionando a sua imunoexpressão com parâmetros clinicopatológicos e com a sobrevida dos pacientes. A amostra foi constituída por 55 casos de CCELO e 20 espécimes de mucosa oral normal. Os sistemas de gradação de malignidade propostos pela OMS em 2005, Brandwein-Gensler et al. e Almangush et al. foram aplicados em um estudo histomorfológico. A expressão da HSP27 foi avaliada através do Sistema de Escore de Imunorreatividade (IRS). Para todos os testes estatísticos foram considerados valores significativos com p<0,05. Foi observado um maior IRS para a mucosa oral normal quando comparado aos casos de CCELO (p<0,001). Não foram encontradas associações significativas entre a imunomarcação da HSP27 com os parâmetros clinicopatológicos analisados e com a sobrevida dos pacientes. Os resultados do presente estudo indicam uma menor expressão da HSP27 nos casos de CCELO quando comparados aos espécimes de mucosa oral normal. Assim, a expressão da HSP27 parece não influenciar o prognóstico dos pacientes.

Morphological analysis of cell cannibalism: An auxiliary tool in the prediction of central giant cell granuloma clinical behavior.

Central giant cell granuloma (CGCG) is a benign jaw lesion with variable clinical behavior. Cell cannibalism is a cellular process associated with aggressiveness and invasion in malignant neoplasms. Here, we morphologically investigated cell cannibalism as an auxiliary method to predict CGCG clinical behavior. Cell cannibalism was quantitatively evaluated in 19 cases of peripheral giant cell granuloma (PGCG), 38 cases of CGCG (non-aggressive and aggressive), and 19 cases of giant cell tumor of bone (GCT) stained with hematoxylin and eosin. T-test was performed to assess the differences between the variables analyzed (p ≤ 0.05). Cell cannibalism was identified in 21% of non-aggressive CGCGs and 68.4% of aggressive CGCGs. A significantly higher amount of cannibal multinucleated giant cells (CMGC) was observed in aggressive CGCG compared to PGCG and non-aggressive CGCG (p = 0.042; p = 0.044, respectively). There were no significant differences in the CMGC index between non-aggressive CGCG and PGCG (p = 0.858) and between aggressive CGCG and GCT (p = 0.069). CGGC cases that exhibited rapid growth and tooth displacement and/or root resorption had a higher amount of CMGC (p = 0.035; p = 0.041, respectively). Cell cannibalism can be identified in CGCG through routine anatomopathological examination. The quantification of CMGC can help to predict the clinical behavior of central giant cell granuloma.

Inflammatory Fibrous Hyperplasia Associated with Chondroid Metaplasia - Report and Morphological Analysis of Five Cases

Inflammatory fibrous hyperplasia (IFH) is a common reactive lesion in dental prostheses users that may be associated with chondroid metaplasia (CM). Metaplasia is an adaptive cellular process that may be caused by trauma. We reported here five cases of IFH associated with CM and analyzed morphologically the deposition of collagen in these lesions. Patients had a mean age of 58.8 years-old and were ill-fitting dental prostheses users. They presented nodular lesions located in the anterior maxilla. Microscopically, it was observed hyperplastic fibrous connective tissue with chronic inflammatory infiltrate and hyaline cartilage. No morphological differences were observed in collagen deposition under light microscopy, but quantitative analysis revealed a significantly higher collagen deposition at the connective tissue near CM (p = 0.015). IFH associated with CM affects ill-fitting dental prostheses users. The presence of CM is not significant to the lesion prognosis. However, its formation and the higher collagen deposition near it reinforces the IFH reactive origin.

La hiperplasia fibrosa inflamatoria (HFI) es una lesión reactiva común en los usuarios de prótesis dentales que puede estar asociada con la metaplasia cartilaginosa (MC). La metaplasia es un proceso celular adaptativo que puede ser causado por un trauma. El presente informe analizó cinco casos de HFI asociados a MC y se analizaron morfológicamente la deposición de colágeno en estas lesiones. Los pacientes tenían una edad media de 58,8 años y eran usuarios de prótesis dentales mal adaptadas. Se observaron lesiones nodulares localizadas en el la parte anterior del maxilar Microscópicamente se observó tejido conectivo fibroso hiperplásico con infiltrado inflamatorio crónico y cartílago hialino. No se observaron diferencias morfológicas en la deposición de colágeno bajo microscopía óptica, pero el análisis cuantitativo reveló una deposición de colágeno significativamente mayor en el tejido conectivo cerca de MC (p = 0,015). La HFI asociada con la MC afecta a los usuarios de prótesis dentales mal adaptadas. La presencia de MC no es significativa para el pronóstico de la lesión. Sin embargo, su formación y la mayor deposición de colágeno cerca de MC refuerza el origen reactivo de HFI.

Oral benign fibrous histiocytoma in a pediatric patient: case report

Benign fibrous histiocytoma (BFH) is a common mesenchymal lesion on the skin where it is better known as dermatofibroma. It mainly affects areas of the integument exposed to the sun. It can occur in the mucous membranes, being quite unusual in the oral cavity. This article presents a rare case of benign oral fibrous histiocytoma in childhood. An eleven-year-old male patient sought the stomatology clinic of the dentistry course at a reference university in northeastern Brazil, complaining of an asymptomatic increase in volume on the cheek, with an evolution of approximately two years. On intraoral examination, a lesion in the cheek mucosa was observed, measuring approximately 4 cm. The lesion had a nodular, circumscribed, reddish appearance, showing ulcerated areas covered by a yellowish pseudomembrane on its surface. The clinical diagnostic hypothesis was pleomorphic adenoma. Excisional biopsy was performed and, after morphological and immunohistochemical evaluation, the diagnosis of BFH was reached. Although it is a lesion with an excellent prognosis, BFH must be carefully analyzed for the differential diagnosis with malignant neoplasms that may have a mild appearance, such as fibrosarcoma or dermatofibrosarcoma. In addition, other benign lesions such as desmoplastic fibroblastoma, myofibroma, myopericytoma and nodular fasciitis may, in some histological sections, mimic the microscopic appearance of benign fibrous histiocytoma. In this reported case, immunohistochemical evaluation was essential to conclude the diagnosis of BFH(AU)

DNA damage through oxidative stress is an important event in oral leukoplakia.

OBJECTIVE: To evaluate the oxidative DNA damage, through 8-hydroxy-2'-deoxyguanosine (8-OHdG), and its repair by base excision repair pathway [Redox factor-1 (Ref-1); X-ray Repair Cross Complementing-1 (XRCC-1)] in different epithelial dysplasia degrees in oral leukoplakia. DESIGN: Forty-four cases of oral leukoplakia and 10 normal oral mucosa were quantified for 8-OHdG, Ref-1, and XRCC-1 through immunohistochemistry. RESULTS: Cytoplasmic 8-OHdG and nuclear XRCC-1 were significantly associated with multiple synchronous lesions (p = 0.048; p = 0.034, respectively). Nuclear Ref-1 was significantly associated with oral leukoplakia on the tongue (p = 0.027). A significantly gradual cytoplasmic 8-OHdG expression increase was observed between normal oral mucosa and epithelial dysplasia (p < 0.05). Nuclear Ref-1 expression was significantly lower (p < 0.01) in non-dysplasia/mild dysplasia, while its cytoplasmic expression was significantly higher in non-dysplasia/mild dysplasia compared to moderate/severe dysplasia and normal oral mucosa (p = 0.03; p < 0.0001, respectively). A significantly higher cytoplasmic XRCC-1 expression was observed in non-dysplasia/mild and moderate/severe dysplasia compared to normal oral mucosa (p < 0.0001; p < 0.0001, respectively). All epithelial dysplasia degrees showed a correlation between nuclear and cytoplasmic expression of these proteins (p < 0.05). CONCLUSIONS: 8-OHdG formation may not play a role in the development of multiple synchronous oral leukoplakias. However, it is related to the severity of the epithelial dysplasia. The subcellular level of Ref-1 implies different roles according to the degree of epithelial dysplasia. Cytoplasmic XRCC-1 expression indicates a possible failure of the DNA repair mechanism and occurs in early morphological stages of epithelial dysplasia.

Necrotizing sialometaplasia: A report of two cases and review of the literature.

Necrotizing sialometaplasia (NS) affects salivary glands, and despite being a benign condition, its clinical and histopathological features sometimes mimic other malignant pathologies of epithelial origin. This article presents two cases of NS and discusses clinicopathological features and the differential diagnosis of this condition. The first case, a 76-year-old woman with a 6-month history of painful oral thrush. Intraoral examination showed an ulcerative lesion located on the hard palate. The clinical hypothesis was squamous cell carcinoma. Second, a 26-year-old man with a 40-days ulcerative lesion on the soft palate. Intraoral examination revealed a reddish ulcer measuring 0.5 cm. Clinical hypothesis was traumatic ulcer. In both cases, a biopsy was performed, and a histopathological diagnosis of NS was established. NS cause is poorly understood, and its clinical features resemble other oral lesions with ulcerative aspects. Thus, dentists must be aware of the clinical features of oral ulcers with more than a 2-week duration without defined etiology.

Survival-related epithelial-mesenchymal transition proteins in oropharyngeal squamous cell carcinoma: A systematic review and meta-analysis.

OBJECTIVE: To aim of this systematic review was to explore the relationship between Human papillomavirus (HPV) and epithelial-mesenchymal transition (EMT) related to the prognosis of oropharyngeal squamous cell carcinoma (OPSCC). DESIGN: For this systematic review, searches were performed in PubMed, Web of Science, Scopus, Science Direct, and Cochrane, and a random-effects model was used for meta-analysis. The presence of EMT was confirmed by the loss of E-cadherin immunoexpression and overexpression of vimentin. RESULTS: In summary, EMT-related proteins were expressed regardless of HPV status; however, overall survival was better in HPV-positive OPSCC cases, with a 5.88 times lower death risk compared to HPV-negative patients (OR=0.17; 95%CI=0.10-0.30). Likewise, the maintenance of E-cadherin in OPSCC was associated with an 11.11 times lower risk of death due to the disease (OR=0.09; 95%CI=0.01-0.88). CONCLUSIONS: More advanced clinical stages (III/IV) and the presence of lymph node metastases (N1-3) were common in OPSCC but were not significantly associated with HPV status.

Assessment of the presence of interleukin 17+ macrophages and Th17 cells in situ in lip and oral tongue cancer.

Increasing clinical evidence indicates that Th17 cells may promote or inhibit tumor progression, however the exact role of these cells in Oral Squamous Cell Carcinoma (OSCCs) pathogenesis and progression remains unclear. Tumor associated macrophages are highly plastic phenotype cells which can differentiate as M1 or M2. The mechanism and cellular phenotype of IL-17 expressing macrophages are unknown. 40 cases of lip and 28 of tongue SCCs were submitted to immunohistochemical analysis, and histologically graded. In tongue cases TNM was analyzed. The number of IL-17+ T cells was higher in lip SCC (p = 0.028). IL-17+ macrophages was greater in tongue SCC (p = 0.014). There were more IL-17+ macrophages in the high-grade malignancy oral tongue SCCs (p = 0.016), yet there was no significant difference in the numbers of RORγt+ lymphocytes by histopathological or TNM analysis. This study provides evidence concerning IL-17's pleiotropic roles, being possibly dependent on its cellular sources in the tumor microenvironment.

Immunoexpression of calcitonin and glucocorticoid receptors in central giant cell lesions of the jaws.

BACKGROUND: This study analyzed the immunoexpression of calcitonin receptor (CTR) and glucocorticoid receptor (GR) in central giant cell lesions (CGCLs) and verified potential associations with patient's response to clinical treatment with intralesional injection of triamcinolone. MATERIALS AND METHODS: Fifty-four cases of CGCLs, including 22 non-aggressive, and 32 aggressive, were investigated by immunohistochemistry. RESULTS: Surgery was the therapeutic choice for 53.1% of the aggressive CGCLs, and 46.9% were submitted to the conservative treatment with intralesional triamcinolone injections. Among patients submitted to conservative treatment, 60% (n = 9) showed favorable response. CTR expression was observed in 68.51%, and GR in 94.44% of the total sample. There were no differences in the expression of CTR, neither GR in mononucleated stromal cells (MSCs) or multinucleated giant cells (MGCs), in relation to aggressiveness, treatment performed for and the response to conservative treatment. Both markers showed a positive correlation between their expression in MSCs and MGCs in the total sample (P < 0.0001). CTR expression on MSCs showed a positive correlation with MGCs in the aggressive and non-aggressive groups (P < 0.0001). CONCLUSIONS: Calcitonin receptor and GR expression were diffuse and similar in non-aggressive and aggressive cases, and it did not influence the response to clinical treatment with triamcinolone in the sample studied.

Lesões Orais Malignas e Potencialmente Malignas: Percepção de Cirurgiões-Dentistas e Graduandos de Odontologia / Lesiones Orales Malignas y Potencialmente Malignas: Percepción de los Odontólogos y Estudiantes de Odontología / Malignant and Potentially Malignant Oral Lesions: Level of Knowledge of Dentists and Dental Students

Introducción: El cáncer oral es un problema de salud pública em muchos países, a pesar de que es una enfermedad que se puede prevenir debido a sua sociación bien estabelecida com ciertos factores de riesgo que pueden ser fácilmente identificados por el professional durante la evaluación clínica del paciente. Objetivo: Analizar la percepción de los odontólogos y estudiantes de odontología em los factores de riesgo y diagnóstico de lesiones bucales malignas y potencialmente malignas. Método: Los datos fueron recolectados através de um cuestionario validado y adaptado para este estudio, incluyendo, preguntas sobre datos sociodemográficos y la percepción del conocimiento de las lesiones bucales potencialmente malignas y el cáncer oral. De acuerdo com la puntuación obtenida, se establecier on cuatro conceptos, A (nivel óptimo de lainformación), B (bueno), C (regular) y D (insatisfactorio). Resultados: De las 292 personas, lamayoríatenía entre 20 y 29 años (48,97%) y erandel sexo femenino (62%). Los participantes más jóvenes, estudiantes yrecién graduados, tenían mejores conceptos em relación com el cáncer oral (p=0,000). La leucoplasia fue una de las lesiones buçales potencialmente malignas más relacionada com el cáncer oral (76,4%). Sólo el 12,7% de los participantes obtuvo el concepto, sin embargo, el 85,4%requeríanactualizarsesobre el tema de cáncer oral. Conclusión: Se observo un bajo nivel de consciência em el conocimiento de las lesiones bucales potencialmente malignas y cáncer oral, sin embargo, los jóvenes participantes, estudiantes y recién graduados de odontólogos, tenían mejores conceptos. Palabras clave: Diagnóstico; Factores de Riesgo; Neoplasias de la Boca

Introduction: Oral cancer is a public health problem in many countries. However, it is a disease that is preventable because of its well-established association with certain risk factors that can be easily identified by health care professionals during the clinical evaluation of patients. Objective: To analyze the knowledge (real and perceived) that dentists and dental students have regarding the diagnosis of and risk factors for malignant and potentially malignant oral lesions. Method: Data were collected with a previously validated questionnaire, adapted for use in this study, including questions designed to collect sociodemographic data and information about the level of knowledge of potentially malignant oral lesions and oral cancer. According to the score, the level of knowledge was categorized as follows: A (excellent); B (good); C (satisfactory); and D (poor). Results: A total of 292 individuals completed the questionnaire. Most (48.97%) of the respondents were between 20 and 29 years of age, and the majority (62.0%) were female. Younger participants, students, and recent graduates displayed the best knowledge of oral cancer (p=0.000). The clinical aspect that was most commonly associated with oral cancer (by 76.4% of the respondents) was leukoplakia. Although 85.4% of the respondents reported being up to date on the topic of oral cancer, only 12.7% had an A level of knowledge. Conclusion: Overall, the level of knowledge of potentially malignant oral lesions and oral cancer was low. However, younger respondents, students, and recent graduates displayed better knowledge of the topic. Key words: Diagnosis; Risk Factors; Mouth Neoplasms.

Introdução: O câncer oral é um problema de saúde pública em vários países do mundo, entretanto é uma doença que pode ser prevenida em razão da sua bem estabelecida associação com certos fatores de riscos que podem ser facilmente identificados pelo profissional no momento da avaliação clínica do paciente. Objetivo: Analisar a percepção dos cirurgiões-dentistas e universitários de Odontologia em relação ao diagnóstico e a fatores de risco das lesões orais malignas e potencialmente malignas. Método: Os dados foram coletados por meio de um questionário validado e adaptado para a presente pesquisa, incluindo perguntas sobre dados sociodemográficos e percepção do conhecimento das lesões orais potencialmente malignas e câncer oral. De acordo com a pontuação obtida, atribuíram-se quatro conceitos, A (ótimo nível de informação); B (bom); C (regular); e D (insatisfatório). Resultados: Duzentos e noventa e dois indivíduos participaram do estudo, a maioria tinha entre 20 e 29 anos (48,97%) e era do sexo feminino (62%). Os participantes mais jovens, estudantes e graduados apresentaram melhores conceitos com relação ao câncer oral (p=0,000). A leucoplasia foi a lesão oral potencialmente maligna mais relacionada ao câncer (76,4%). Apenas 12,7% dos participantes obtiveram conceito A, embora 85,4% referissem atualizar-se sobre esse tema. Conclusão: Notou-se baixo nível de percepção no conhecimento das lesões orais potencialmente malignas e câncer oral, entretanto os participantes mais jovens, estudantes e graduados com menos tempo de formado apresentaram melhores conceitos.

Analysis of CD57+ natural killer cells and CD8+ T lymphocytes in periapical granulomas and radicular cysts.

The aim of this study was to compare the number of CD57+ natural killer (NK) cells and CD8+ T lymphocytes between periapical granulomas (PGs) and radicular cysts (RCs). Twenty-fives cases of PGs and 25 of RCs were submitted to histological analysis and immunohistochemistry using anti-CD57 and anti-CD8 biomarkers. Positive cells were counted in 10 fields (400× magnification) and the median value was calculated for each case. Statistical tests were used to evaluate differences in the number of CD57+ NK cells and CD8+ T lymphocytes according to type of lesion, intensity of the infiltrate and thickness of the lining epithelium. The number of CD57+ NK cells and CD8+ T lymphocytes was higher in PGs than in RCs (p = 0.129 and p = 0.541, respectively). Comparison of the number of CD57+ NK cells in atrophic and hyperplastic epithelium revealed a larger number of cells in the atrophic epithelium (p = 0.042). A larger number of CD57+ NK cells and CD8+ T lymphocytes were observed in grade III infiltrates compared to grade I/II (p = 0.145 and p = 0.725, respectively). CD8+ T lymphocytes were more prevalent than CD57+ NK cells in most cases when PGs and RCs were analyzed separately or in combination (p < 0.0001). CD57+ NK cells and CD8+ T lymphocytes play a key role in antiviral defense and the presence of these cells supports evidence suggesting the participation of these microorganisms in the pathogenesis of PGs and RCs. The response mediated by CD8+ T lymphocytes was more frequent, indicating greater participation of the adaptive immunity in these chronic lesions.

Angioleiomioma oral: relato de um caso e revisão dos achados atuais / Oral angioleiomyoma: case report and a review of current findings

Resumo O angioleiomioma é uma neoplasia benigna que, a partir da nova classificação da OMS (2013) para os tumores de tecidos moles, deixou de ser considerado um tumor de origem muscular lisa, passando a ser considerado um tumor de origem perivascular. Raramente os angioleiomiomas ocorrem na cavidade oral. A lesão é tratada cirurgicamente, com prognóstico considerado favorável. Este trabalho revisa os casos de angioleiomioma oral relatados na literatura nos últimos 5 anos e descreve esse tumor em um homem de 44 anos que apresentou um nódulo assintomático localizado em lábio superior, com evolução de 6 meses. As hipóteses diagnósticas foram de adenoma pleomórfico e adenoma canalicular. A lesão foi submetida à biópsia e análise histopatológica e imuno-histoquímica (S100, CD34, α-SMA, H-caldesmon e desmina) confirmaram o diagnóstico de angioleiomioma. Destacamos a imuno-histoquímica como um importante método auxiliar no diagnóstico diferencial do angioleiomioma com outras lesões e, principalmente, com o miopericitoma.

Abstract Angioleiomyoma is a benign neoplasm that was considered a tumor of smooth-muscle origin until the most recent (2013) WHO classification of soft tissue tumors, in which it was reclassified as a tumor of perivascular origin. Angioleiomyomas rarely occur in the oral cavity. These lesions are treated surgically with good prognosis. This article presents a review of reports of oral angioleiomyoma in the literature from the last 5 years and describes the case of a 44-year-old man who presented with an asymptomatic nodule in the upper lip that had developed over a 6-month period. Diagnostic hypotheses of pleomorphic adenoma or canalicular adenoma were raised. Biopsy of the lesion, histopathological and immunohistochemical analysis (S100, CD34, H-caldesmon, and desmin) confirmed a diagnosis of angioleiomyoma. It is noteworthy that immunohistochemistry is an important auxiliary method for differential diagnosis of angioleiomyoma from other tumors, particularly myopericytoma.

Multinucleated giant cell reaction in lower lip squamous cell carcinoma: a clinical, morphological, and immunohistochemical study.

BACKGROUND: Multinucleated giant cell (MGC) reactions have been identified in several malignancies, but their frequency and significance in lower lip squamous cell carcinoma (SCC) are not established. This study evaluated the MGC reactions and their association with clinicopathological parameters in lower lip SCCs. The polarization profile of these cells (M1 or M2 macrophages) was also assessed. METHODS: The presence and distribution of MGC reactions in high-power fields (400×) were evaluated in hematoxylin/eosin-stained histological sections of 91 lower lip SCCs. The histopathological grade of malignancy was evaluated using two grading systems (World Health Organization [WHO] and Malignancy Grading of the Deep Invasive Margins). The histiocytic nature (CD68) and polarization profile (M1-HLA-DR+ or M2-CD163+) of MGCs were evaluated by immunohistochemistry. RESULTS: Multinucleated giant cell reaction was identified in 36 (39.6%) cases, and its frequency was 3.3 times higher in well/moderately differentiated tumors than in poorly differentiated tumors (WHO grading system) (P = 0.006). For Malignancy Grading of the Deep Invasive Margins, the frequency was 2.03 times higher in highly/moderately keratinized tumors than in tumors with minimal/no keratinization (P = 0.012). No significant associations were observed between the presence/distribution of MGCs and clinical parameters (tumor size, lymph node metastasis, distant metastasis, and clinical stage) (P > 0.05). All MGCs were positive for CD68 and there was a predominance of HLA-DR+ over CD163+ MGCs (P = 0.031). CONCLUSIONS: Multinucleated giant cell reactions may not be involved in tumor progression in lower lip SCCs. In this microenvironment, MGCs tend to exhibit a predominantly M1 phenotype and may represent a foreign body reaction to SCC keratin pearls.

Analysis of CD57+ natural killer cells and CD8+ T lymphocytes in periapical granulomas and radicular cysts

Abstract: The aim of this study was to compare the number of CD57+ natural killer (NK) cells and CD8+ T lymphocytes between periapical granulomas (PGs) and radicular cysts (RCs). Twenty-fives cases of PGs and 25 of RCs were submitted to histological analysis and immunohistochemistry using anti-CD57 and anti-CD8 biomarkers. Positive cells were counted in 10 fields (400× magnification) and the median value was calculated for each case. Statistical tests were used to evaluate differences in the number of CD57+ NK cells and CD8+ T lymphocytes according to type of lesion, intensity of the infiltrate and thickness of the lining epithelium. The number of CD57+ NK cells and CD8+ T lymphocytes was higher in PGs than in RCs (p = 0.129 and p = 0.541, respectively). Comparison of the number of CD57+ NK cells in atrophic and hyperplastic epithelium revealed a larger number of cells in the atrophic epithelium (p = 0.042). A larger number of CD57+ NK cells and CD8+ T lymphocytes were observed in grade III infiltrates compared to grade I/II (p = 0.145 and p = 0.725, respectively). CD8+ T lymphocytes were more prevalent than CD57+ NK cells in most cases when PGs and RCs were analyzed separately or in combination (p < 0.0001). CD57+ NK cells and CD8+ T lymphocytes play a key role in antiviral defense and the presence of these cells supports evidence suggesting the participation of these microorganisms in the pathogenesis of PGs and RCs. The response mediated by CD8+ T lymphocytes was more frequent, indicating greater participation of the adaptive immunity in these chronic lesions.

Epidemiological survey of mucus extravasation phenomenon at an oral pathology referral center during a 43 year period / Levantamento epidemiológico de fenômeno de extravasamento de muco de um centro de referência em patologia oral por um período de 43 anos

ABSTRACT INTRODUCTION: Mucoceles are common benign pseudocystic lesions of the oral cavity; their main etiological factors are trauma and ductal obstruction. Two histological patterns are found: mucus retention phenomenon (MRP) and mucus extravasation phenomenon (MEP). Mucus extravasation phenomenon is the more common histological subtype and it mainly affects the lower lip. The knowledge of its main clinical features and management is important to assist health professionals in clinical practice. OBJECTIVE: This study aimed to determine the relative frequency and distribution of oral mucoceles in an oral pathology reference center. METHODS: Cross-sectional historical study that analyzed all cases pathologically diagnosed as mucus extravasation phenomenon by the department of anatomic pathology of an oral pathology referral center from June of 1970 to May of 2014, considering the clinical characteristics of the lesion and those relating to the patient. SPSS v. 20.0 software for Windows was used for descriptive analysis. RESULTS: During 43 years, 719 cases of mucus extravasation phenomenon (54.7% men and 45.3% women) were registered, with the lower lip as the most commonly affected site (n = 484; 67.3%). The average age of patients was 20.8 years (SD ± 14.4) with a peak occurrence in the second decade of life. Most professionals had oral mucocele/ranula (n = 606; 84.3%) as the initial clinical impression. CONCLUSION: Mucus extravasation phenomenon is a lesion that primarily affects young patients, affecting mainly the lower lip, and is commonly found in oral diagnostic services.

Resumo Introdução: Mucoceles são lesões pseudocísticas benignas comuns da cavidade oral, que possuem como principais fatores etiológicos trauma ou obstrução ductal. Dois padrões histopatológicos são encontrados: fenômeno de retenção de muco (FRM) e fenômeno de extravasamento de muco (FEM). O FEM é o subtipo histológico mais comum e tem como principal local de acometimento o lábio inferior. O conhecimento acerca de suas principais características clínicas e formas de tratamento se faz importante para auxiliar profissionais da saúde na prática clínica. Objetivo: Este trabalho objetivou determinar a frequência relativa e a distribuição das mucoceles orais em um centro de referência em patologia oral. Método: Estudo transversal de caráter histórico, no qual foram analisados os casos diagnosticados histopatologicamente como FEM pelo serviço de anatomia patológica de um centro de referência em patologia oral no período de junho de 1970 a maio de 2014, considerando-se variáveis clínicas da lesão e relativas ao paciente. O programa estatístico SPSS 20.0 for Windows foi utilizado para a análise descritiva dos dados. Resultados: Durante 43 anos foram observados 719 casos de FEM (54,7% homens e 45,3% mulheres), sendo o lábio inferior (n = 484; 67,3%) o local de principal acometimento. A média de idade dos pacientes foi de 20,8 anos (DP ± 14,4), com pico de ocorrência na segunda década de vida. A maioria dos profissionais teve mucocele oral/rânula (n = 606; 84,3%) como primeira hipótese clínica. Conclusão: O FEM é uma lesão que afeta principalmente pacientes jovens, acometendo preferencialmente o lábio inferior, sendo comumente encontrada nos serviços de diagnóstico oral.

Link between immunoexpression of hMLH1 and hMSH2 proteins and clinical-epidemiological aspects of actinic cheilitis.

BACKGROUND: The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. OBJECTIVE: To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. METHODS: We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. RESULTS: Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. CONCLUSION: This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis.

Link between immunoexpression of hMLH1 and hMSH2 proteins and clinical-epidemiological aspects of actinic cheilitis

Abstract: Background: The studies found in the literature associate the immunoexpression of hMLH1 and hMSH2 proteins with histologic aspects, but do not correlate it with clinical and epidemiological data. Objective: To evaluate the immunoexpression of hMLH1 and hMSH2 in actinic cheilitis, correlating it with clinical characteristics. Methods: We analyzed 40 cases. Histological and immunohistochemical analyses were performed. The following clinical variables were evaluated: gender, age range, ethnicity, clinical aspect and occupational sunlight exposure. Statistical evaluation included the Student t-test, while the significance level was set at 5%. Results: Greater immunoexpression of hMLH1 and hMSH2 was observed in females, individuals aged over 40, and mixed-race/black patients. Furthermore, the immunoexpression of these proteins was greater in actinic cheilitis with a white-colored appearance and in patients without occupational sunlight exposure. No statistical differences were observed for the variables studied. Conclusion: This study uncovered variations of hMLH1 and hMSH2 protein expression upon evaluation of clinical aspects in actinic cheilitis.

Potentially malignant oral lesions: clinicopathological correlations.

OBJECTIVE: To determine the incidence of potentially malignant oral lesions, and evaluate and correlate their clinical and pathological aspects. METHODS: The sample consisted of cases clinically diagnosed as oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, and oral lichen planus treated at a diagnostic center, between May 2012 and July 2013. Statistical tests were conducted adopting a significance level of 5% (p≤0.05). RESULTS: Out of 340 patients, 106 (31.2%) had potentially malignant oral lesions; and 61 of these (17.9%) were submitted to biopsy. Actinic cheilitis was the most frequent lesion (37.5%) and the lower lip was the most affected site (49.6%). Among 106 patients in the sample, 48 (45.3%) reported nicotine consumption, 35 (33%) reported alcohol intake and 34 (32.1%) sun exposure while working. When clinical and histopathological diagnoses were compared, oral erythroplakia and atypical ulcer were the lesions that exhibited greater compatibility (100% each). CONCLUSION: In most cases, clinical and histopathological diagnoses were compatible. An association between the occurrence of erythroplakia, leukoplakia and erythroleukoplakia with smoking was observed. Similarly, an association between actinic cheilitis and sun exposure was noted. Erythroleukoplakia presented the highest malignancy grade in this study. Finally, dental surgeons should draw special attention to diagnosis of potentially malignant oral lesions, choose the best management, and control the lesions to avoid their malignant transformation.