Modulation of MMP-2 and MMP-9 in Churg-Strauss syndrome respiratory mucosa: potential monitoring parameters.

Churg-Strauss (CSS) syndrome is rare and of unknown etiology. It is associated with vasculitis, blood eosinophilia and granulomatosis, and affects multiple organs and systems at various stages of the disease. Specific diagnostic and monitoring tests are not yet available. This study aims to assess the changes in MMP-2 and MMP-9 along with the histopathological alterations in two cases of CSS, as possible potential diagnostic and monitoring criteria. Two adult male patients were diagnosed with CSS in the otorhinolaryngology clinic in the University of Palermo, based on multiple clinical and histopathologic criteria. Biopsies of respiratory mucosa were taken after the consent of the patients, processed for routine histopathology and immunohistochemistry as well as quantitative polymerase chain reaction (qPCR). Similar biopsies were also taken from a non- CSS patient. The Assessment of MMP-2 and MMP-9 was performed using both immunohistochemistry and qPCR techniques. Histopathological alterations in the respiratory mucosa were consistent with vasculitis and granulomatous tissue formation, in addition to inflammatory cell infiltration with abundance of eosinophils. Immunohistochemistry assay performed on the samples derived from the two CSS patients showed a relative and remarkable increase of both MMP-2 and MMP-9 compared to controls. Such an increase was consistent with the qPCR results which depicted a significant increase between 20 and 30% for both MMP-2 and MMP-9, respectively. Since the secretion of MMPs is an essential step in angiogenesis, could these enzymatic factors be used as parameters to diagnose or monitor the evolution of CSS? The small number of samples analyzed in this study does not allow us to suggest a general statement correlating the increase in expression of MMP-2 and MMP-9 to the appearance or evolution of vasculitis; it is only speculative.

Management of primary ameloblastoma of the jaw: a 15 years' experience.

AIM: The aim of this retrospective study was to describe our 15-year experience in the management of primary ameloblastoma of the jaw. METHODS: We investigated 26 patients who had undergone surgical treatment for a single lesion, comprising six lesions of the maxillary bone and 20 tumors of the mandible: 73% had a radiolucent multilocular lesion; 23% a unicystic lesion; and 4% had an extraosseous form of the tumor. The smaller lesions (diameter <3 cm) were treated by conservative approaches; the larger lesions required radical surgical resection. Two groups were created according to whether the patients had received conservative or aggressive surgery. RESULTS: The recurrence rate was estimated for a minimum duration of follow-up of 10 years; 23 patients met this criterion. Tumor recurrence was observed in all the patients who had undergone conservative surgery but not in those who had received aggressive surgery. Comparison of the healing curves (log rank test) showed statistically significant differences between the two groups (P=0.4522). CONCLUSION: All recurrent lesions were ameloblastomas primarily treated with enucleation and/or curettage. On the basis of our study we suggest that when an ameloblastoma is small it can be removed with a marginal aggressive resection with a 1-cm margin beyond the radiological limit; in contrast, if an ameloblastoma is larger than 3 cm we suggest aggressive segmental resection of lesion with a margin 1.5-2-cm beyond the radiological limits.

Expression of gelatinases (MMP-2, MMP-9) and cyclooxygenases (COX-1, COX-2) in some benign salivary gland tumors.

Salivary gland tumors, most of which are rare benign tumors, represent a histologically heterogenous group with the greatest diversity of morphological and cellular features. The aim of this study is to analyse the expression and possible interactions between gelatinases (MMP-2, MMP-9) and cyclooxygenases (COX-1, COX-2) in some benign salivary gland tumors. We investigated the expression of gelatinases and cyclooxigenases in control salivary gland, Pleomorphic adenoma and Warthin's tumor through immunohistochemistry and Reverse Transcription - Polymerase Chain Reaction (PCR). We identified the expression of both classes of enzyme in normal samples and in the two types of pathological samples without any quantitative differences. From the present data no significant differences emerge in the expression of these enzymes among the different pathologies examined. Nevertheless, due to the small number of samples included in this study, general statements regarding correlation between the degree of severity of the tumoral pathology and the quantitative expression of these potential tumoral markers can not be made.

Sweet's syndrome induced by removable partial denture using a CoCr alloy: case report.

Sweet's syndrome is an acute febrile neutrophilic dermatosis characterized by fever, neutrophilia and erythematous skin lesions. This disease typically occurs as a reactive event in response to infective, inflammatory or neoplastic processes. The aim of this work was to describe a rare case of Sweet's syndrome induced by dental removable partial denture using a CoCr alloy.

Immunohistochemical and transcriptional expression of the matrix metalloproteinases MMP-2 and MMP-9 in normal and pathological human oral mucosa.

The oral cavity is exposed to chronic or recurrent, physical and chemical trauma that could lead to mucosal reactions (e.g. hyperplasia, dysplasia and tumors). The objective of this study is to investigate the expression and the possible changes of the two matrix metalloproteinases MMP-2 and MMP-9 in normal and pathological human oral mucosa samples. Normal oral mucosa samples and three different types of pathological conditions (hyperplasia, dysplasia and carcinoma) were used for this study. Immunohistochemical analysis was used to evaluate protein expression for the two enzymes, while Reverse Transcription ? Polymerase Chain Reaction (RT-PCR) was used to investigate gene expression. Image analysis was used to give a quantitative evaluation of the immunohistochemical data. In control samples we identified a weak expression of both MMP-2 and MMP-9 in the epithelial layers. In hyperplasia samples MMPs expression is limited to epithelial layers but the immunoreactivity is more intense than in the control. In dysplasia and carcinoma samples the two matrix metalloproteases are expressed not only in epithelium but also in some cells of the connective tissue and in the vessel walls. Qualitative RT-PCR and image analysis confirmed the immunohistochemical data. The results obtained in this study suggest the existence of a possible relationship between the entity of morphological disorganization of the oral mucosa in different pathologies and the increase of MMP-2 and MMP-9 expression.

Matrix metalloproteinase-2 matrix metalloproteinase-9 and inducible nitric oxide synthase in oral leukoplakia: immunohistochemistry and RT-PCR analysis.

Oral leukoplakia is the most common and potentially malignant disorder of the oral mucosa. The definition of leukoplakia given by the World Health Organization is ?a white plaque that cannot be characterized either from a clinical or from a histopathological point of view?, thus the diagnosis of leukoplakia is based on the exclusion of other lesions of the oral mucosa. We believe it is necessary to identify molecular and immunohistochemical parameters that can contribute to discriminating between the different leukoplakia clinical subtypes coded by the epidemiology. In the present work we show the preliminary results of this research project. We investigated the expression of matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and inducible nitric oxide synthase (iNOS) in a verrucous proliferative leukoplakia sample. By immunohistochemistry we detected the presence of all the three proteins both in the leukoplakia samples and in healthy oral mucosa, while the reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed in both samples only the expression of MMP-2 and MMP-9 but not iNOS.

Maxillary bone necrosis following the use of formaldehyde containing paste: management and case series.

Paraformaldehyde is used both as a disinfectant and to devitalise inflamed pulps when local anaesthesia is ineffective. Despite the clinical benefits, paraformaldehyde is not confined to the pulp, but penetrates the dentine and is gradually released as formaldehyde. This case series describes the effects on periodontal and bone tissues of paraformaldehyde used as a devitalising or disinfectant agent.

[Desmoplastic ameloblastoma. Clinical and histopathological diagnostic criteria]. / L'ameloblastoma desmoplastico. Criteri diagnostici anatomo-clinici.

A rare case of desmoplastic ameloblastoma observed in a 62-year old man presenting a swelling in the anterior mandible area with abnormal mobility of 33, 34, 43, 45, is described. Diagnosis of desmoplastic ameloblastoma was based on: anterior localization, radiopaque appearance, severe desmoplastic stroma and increasing infiltrate pattern of the tumor. The authors suggest to consider the desmoplastic histotype as a different nosological entity defined "desmoplastic ameloblastoma" since these clinical and histopathological features are missing in the other histologic variants of common ameloblastoma. A radical surgical treatment is suggested for this neoplasia.

[Adenoid cystic carcinoma of the anterior segment of the tongue]. / Carcinoma adenoideo-cistico del segmento anteriore della lingua.

The authors describe a rare case of adenoid-cystic carcinoma localized in the anterior tongue. The neoplasia is made up of epithelial and myo-epithelial cells, organized frequently in islands with cribriform aspect, was circumscribed by a thin fibrous capsule that was focally infiltrated in the proximity of the deep margin. At the physical examination no local regional lymph nodes were absent. The surgical excision and radiotherapy constituted the only therapeutic protocol. Absence of local relapse and/or distant metastasis after eight years from the operation confirm the low aggressiveness of the neoplasia when localized in the anterior part of the tongue.

[Major aphthous stomatitis (Sutton's disease): etiopathogenesis, histological and clinical aspects]. / Stomatite aftosa major (malattia di Sutton). Etiopatogenesi, quadri istologici ed aspetti clinici.

Major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis differentiated by its high level of morbidity. It is generally found in areas of non-keratinized mucosa and is characterised by the presence of necrotic giant ulcers accompanied by intense pain. While this pathology has been the subject of molecular studies, its etiopathogenesis is still unknown. The most widely accredited hypothesis is that it represents an immune mechanism, namely the immunological response of mucosa with antigenic anomalies, modulated by altered local reactivity and influenced by triggering factors. After an extensive review of the various etiopathogenetic hypotheses, clinical and pathological aspects, the authors outline a number of therapeutic protocols including the use of topical and systemic cortisone, immunomodulators and alternative therapies like laser and ultrasound, or medications to protect the ulcers. They stress that the lack of etiopathogenetic uniformity precludes any specific treatment.

Malignant myoepithelioma of the minor salivary glands arising in a pleomorphic adenoma.

This paper reports a case of carcinoma expleomorphic adenoma of the minor salivary glands, where the carcinomatous component was a malignant myoepithelioma (myoepithelial carcinoma). Immunohistochemical investigation showed that the carcinoma cells were positive for cytokeratin, S-100 protein and vimentin, and focally positive for actin and desmin. A moderate level of positivity was found fo laminin and collagen IV around the neoplastic islands. These data are the confirmation that the carcinoma cells were myoepithelial. The number of mitoses, the istotype, the minimal extent of extracapsular infiltration and the absence of vascular invasion made it possible to include this particular case among those with a better prognosis.

[Adamantinoma from odontogenic cysts]. / Adamantinoma da cisti odontogena.

The observation of an adamantinoma's case propped up an odontogenic cyst to check the complicated histogenic problem connected to this eventuality. After considering several theories they suppose a probable derivation from the odontogenic epithelium that has undoubted potentiality.

[Oral lichen planus: a possible precancerous lesion]. / Il lichen planus orale: una possibile precancerosi.

An case of epidermoid carcinoma coexisting on lichen planus is presented. After same clinical and histologic characteristics; orals lichen planus developing in carcinoma are examinated. In conclusion the authors explain an own monitoring's plain for the check in these patients.