When to indicate radiotherapy after nipple-sparing mastectomy? Systematic review / Quando indicar radioterapia após mastectomia nipple-sparing? Revisão sistemática

Introduction: Nipple-sparing mastectomy (NSM) and preservation of the nipple-areola complex (NAC) represent a therapeutic option of breast cancer with a better aesthetic result, a positive impact on body image and more satisfaction than the reconstruction of the NAC. It is questioned the indication of radiotherapy when the NAC is maintained and its potential aesthetic impairment. Objective: To examine the indication of radiotherapy in NSM and, secondarily, the incidence of NAC involvement and local recurrence rates. Methods: Systematic review carried out in the PubMed database with the terms ("breast neoplasm" [Mesh] OR "breast cancer") AND ("radiotherapy" OR "radiation therapy") AND ("nipple sparing mastectomy" OR "mastectomies" OR "subcutaneous mastectomies"). The selection of the studies, the evaluation of its quality and data extraction were carried out independently by four reviewers. Results: The indications for radiotherapy after NSM were: positive axilla, tumors over 5 cm and retroareolar tissue remaining greater than 5 mm. The NAC involvement occurred in 5 to 26.1% in the definitive anatomopathological study. NAC recurrence occurred from 2.59 to 10%. NAC necrosis occurred in 2.2 to 43.4%. Conclusions: The radiotherapy indications for NSM seem to follow the same classical indications for radiotherapy after mastectomy. The relapse index in NAC was not shown to be larger and without difference for the type of radiotherapy used. Radiotherapy should be based on factors that suggest a high risk for NAC involvement

Introdução: A mastectomia nipple-sparing (MNS) e a conservação do complexo aréolo-papilar (CAP) representam uma manobra terapêutica do câncer de mama com melhor resultado estético, impacto positivo na imagem corporal e mais satisfação do que a reconstrução do CAP. Questiona-se a indicação de radioterapia quando da manutenção do CAP e seu potencial prejuízo estético. Objetivo: Examinar a indicação de radioterapia em MNS e, secundariamente, a incidência do envolvimento do CAP e as taxas de recorrência local. Métodos: Revisão sistemática realizada na base de dados do PubMed com os termos ("breast neoplasm" [Mesh] OR "breast cancer") AND ("radiotherapy" OR "radiation therapy") AND ("nipple sparing mastectomy" OR "mastectomies" OR "subcutaneous mastectomies"). A seleção dos estudos, a avaliação da qualidade do estudo e a extração de dados foram realizadas de forma independente por quatro revisores. Resultados: As indicações para radioterapia após MNS foram: axila positiva, tumores acima de 5 cm e tecido retroareolar remanescente maior que 5 mm. O envolvimento do CAP ocorreu em 5 a 26,1% no anatomopatológico definitivo. A recorrência no CAP ocorreu de 2,59 a 10%. A necrose do CAP ocorreu em 2,2 a 43,4%. Conclusão: As indicações de radioterapia para MNS parecem seguir as mesmas indicações clássicas para radioterapia após mastectomia. O índice de recidiva no CAP não mostrou ser maior com uso de radioterapia nem ter diferença quanto ao seu tipo. A decisão de realizar a radioterapia deve se basear em fatores que sugerem alto risco para envolvimento do CAP

Hypnosis as a Valuable Tool for Surgical Procedures in the Oral and Maxillofacial Area.

Hypnosis is a valuable tool in the management of patients who undergo surgical procedures in the maxillofacial complex, particularly in reducing and eliminating pain during surgery and aiding patients who have dental fear and are allergic to anesthesia. This case report demonstrates the efficacy of hypnosis in mitigating anxiety, bleeding, and pain during dental surgery without anesthesia during implant placement of tooth 14, the upper left first molar.

Salivary proteomics: A new adjuvant approach to the early diagnosis of familial juvenile systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is a chronic multisystemic disease characterized by autoimmune inflammatory disturbance. Pleomorphic manifestations are present and a potentially progressive and debilitating course can be detected. SLE rarely manifests before age 5, and its onset peaks is around puberty. Although clinical manifestations, immunological alterations and treatment do not differ between juvenile and adult SLE, children tend to present with a more aggressive disease course than adults. Hence, autoimmune rheumatic diseases are the most common cause of morbidity and mortality in pediatric populations. Blood serum analysis plays an especially important role in the detection and monitoring of autoantibodies in SLE. However, since blood sampling is an uncomfortable procedure, especially in children, novel less invasive techniques and approaches are of utmost importance to evaluate pediatric subjects. In this regard, saliva samples have several advantages, such as: easy access, fast collection, painless and riskless procedure. Saliva has antimicrobial, immunomodulatory and anti-inflammatory properties, as well as several other relevant features. The whole saliva is a complex mixture of major and minor salivary gland secretion, gingival crevicular fluid, transudates plasma protein, keratinocyte products and oral microbiota. This biological fluid reflects the physiological state of the body, including the emotional condition, and endocrine, nutritional and metabolic changes. Therefore, salivary proteomics is becoming increasingly used for the early diagnosis of several diseases such as breast cancer, oral cancer, Sjögren's syndrome, diffuse systemic sclerosis, rheumatoid arthritis, among others. Considering the detection of some potential markers related to SLE in serum and urine, this study aims to conduct an initial evaluation of the possible presence of such biomarkers in saliva. Furthermore, it is expected to track down new salivary proteins that could be correlated with the disease. As such, it is important to evaluate whether the analysis of the salivary proteome of children whose mothers have SLE may help identify biomarkers for the early detection and monitoring of the condition.

Immunohistochemical expression of protein 53, murine double minute 2, B-cell lymphoma 2, and proliferating cell nuclear antigen in odontogenic cysts and keratocystic odontogenic tumor.

INTRODUCTION: Even though odontogenic cysts share a similar histogenesis, they show different growth and differentiation profile due to differences in the proliferative cellular activity. AIMS: We perform an immunohistochemical assessment of protein 53 (p53), proliferating cell nuclear antigen (PCNA), B-cell lymphoma 2 (bcl-2), and murine double minute 2 (MDM2) expression in odontogenic cysts and keratocystic odontogenic tumor analyzing their correlation with the biological behavior of these lesions. MATERIALS AND METHODS: By the streptavidin-biotin-peroxidase method with antibodies against p53, PCNA, bcl-2, and MDM2 proteins, 11 radicular cysts, 11 dentigerous cysts, and 11 keratocystic odontogenic tumor were analyzed. The non-parametric Mann-Whitney U-test and Kruskall-Wallis test (P ≤ 0.05) were used to analyze the data. RESULTS: Immunopositivity for PCNA was observed in all cases appraised, predominantly in the suprabasal layer of keratocystic odontogenic tumor epithelial lining (SD ± 19.44), but no significant differences were found among the groups of lesions. Bcl-2 immunoexpression was observed especially in the basal layer of keratocystic odontogenic tumor. PCNA LI was significantly higher than bcl-2 LI in keratocystic odontogenic tumor. MDM2 and p53 immunoexpression were not detected in the lesions studied. Among the evaluated lesions, the keratocystic odontogenic tumor showed different immunoexpression of the proliferation and apoptosis markers. CONCLUSION: The results of this study suggest that the keratocystic odontogenic tumor presents distinct biological behavior of the odontogenic cysts, as for the processes of proliferation, apoptosis, and differentiation, reinforcing the information in favor of the neoplastic nature of this lesion.

Aggressive spindle cell rhabdomyosarcoma in an 11-month-old boxer dog.

Rhabdomyosarcoma (RMS) is a malignant neoplasm derived from mesenchymal tissue with a tendency toward myogenic differentiation associated with the embryogenesis of skeletal muscle. According to the histological features, it can be classified in embryonal, botryoid, alveolar, and pleomorphic, which usually correspond to clinical behavior and prognosis. The spindle cell (SCRMS) variant is a rare subtype of the embryonal RMS and is considered to be less aggressive lesion. The aim of the present paper is to report an unusual case of SCRMS in an 11-month-old male boxer dog diagnosed as extensive SCRMS that affected the frontal region of the skull. Due to the aggressive nature of the lesion and poor clinical prognosis the dog's owners preferred euthanasia as a treatment. A full postmortem examination was carried out. Microscopically, the lesion was composed of a highly cellular proliferation of spindle cells arranged in long and intersecting fascicles. After performing the immunohistochemical studies (HHF-35, smooth muscle actin, desmin and MyoD1), the present case was diagnosed as SCRMS.

Matrilysins may not predict the metastatic potential in squamous cell carcinoma of the tongue.

OBJECTIVE: To examine immunoexpression of matrix metalloproteinase (MMP)-7 and -26 in squamous cell carcinoma (SCC) of the tongue and its relation with cervical metastasis. MATERIAL AND METHODS: Twenty-four cases were selected and divided into two groups: a metastatic group (n = 12) and a non-metastatic group (n = 12). Cases were graded as either negative (score 0), positive (score +) or strongly positive (score ++). RESULTS: MMP-7 expression was identical in both groups, with 17% of the cases graded as score 0, 50% as score + and 33% as score ++. MMP-26 expression was 25% score 0, 8% score + and 67% score ++ in the metastatic group, and 8% score 0, 50% score + and 42% score ++ in the non-metastatic group. Statistical analysis showed no differences between the studied groups and no correlations between proteins. CONCLUSIONS: MMP-7 and -26 immunostaining is not a useful indicator of the metastatic potential of SCCs of the tongue. However, the role of these proteins in the process of invasion and metastasis cannot be ruled out since their more marked presence along the tumor invasion front compared to more central areas of the tumors indicates higher secretion of these proteases in this region, facilitating the invasion process.

A case of extensive maxillary benign cementoblastoma.

AIM: The aim of the present paper is to report a case of benign cementoblastoma (BC) involving multiple maxillary teeth and discuss the importance of its diagnosis in clinical oral practice. BACKGROUND: BC is a rare, benign odontogenic neoplasm of ectomesenchymal origin. This neoplasm has characteristic radiologic and microscopic features, and it is intimately associated with the roots of teeth. CASE REPORT: The intra-oral examination in a 21-year-old white man revealed a palatine growth in the premolar-molar region. Dental panoramic and periapical radiographies showed a mixed radiodense/radiolucent lesion closely associated with the roots of three maxillary teeth. A biopsy was undertaken and confirmed the clinical hypothesis. SUMMARY: In most cases, initial BC is asymptomatic and early diagnosis can be performed by routine radiographic examination. BC was considered as an indolent lesion for several years. Nevertheless, recent studies have demonstrated that some BCs may exhibit aggressive biological behavior and can affect several teeth. CLINICAL SIGNIFICANCE: Because a benign cementoblastoma represents an odontogenic lesion, general practicing professionals must be able to identify the main features of this tumor. This case corroborates some papers that have demonstrated a possible aggressive behavior of BC. Therefore, a brief update concerning the clinical and radiographic features of this unique tumor is also provided.

Cytokeratin profile in mucoepidermoid carcinoma is not related to its histological grading of malignancy.

The objective of this experiment was to determine the relationship between the expression of cytokeratins (CKs) and histologic grading in MEC. Eleven cases of MEC were selected and graded as low, intermediate and high-grade tumors. The expression of CKs 7, 8, 10, 13 and 14 was assessed immunohistochemically using streptavidin-biotin complex method. The results showed that the studied CKs were expressed in most cases of MEC, independently of histologic grading. Nonetheless, low-grade tumors demonstrated intense staining of CK 7 and 8; additionally, CK 10 and 13 were more pronounced in this grade. The immunoexpression was variable according to cellular type and organization pattern of the tumor. Mucous cells were positive for CK 7 and 8; epidermoid cells were stained for CK 10, 13 and 14; CK 7, 8, 10 and 14 were observed in intermediate cells, and CK 7 was occasionally seen in clear cells. Cystic structures and duct-like elements in MEC were positive for CK 7 and 8, whereas solid nests showed positivity for all CKs. These results suggest that expression profile of these proteins does not reflect the biological behavior of MCE, however, it guides the detection of cellular types and differential diagnosis from other salivary gland tumors.

[Epidemiologic profile of salivary gland neoplasms: analysis of 245 cases]. / Perfil epidemiológico das neoplasias de glândulas salivares: análise de 245 casos.

AIM: The aim of the present study is to establish the relative frequency and distribution of benign and malignant epithelial neoplasms of salivary glands in the Pathology and Cytology Laboratory, STUDY DESIGN: Historic cohort. MATERIAL AND METHOD: in the state of Sergipe, during the period 1980-1999. The neoplasms were individualized by gender, age, race of the patients, anatomic localization of the lesions and histopathological diagnosis. RESULTS: Out of 162,312 registered cases, 245 were salivary gland epithelial neoplasms and 187 (76.33%) were benign and 58 (23.67%) were malignant. Pleomorphic adenoma was the most frequent benign neoplasm (89.94%) and adenoid cystic carcinoma represented the most prevalent malignant neoplasm (22.41%). The benign neoplasms occurred mainly between the second and third decades of life and showed preference for female, while malignant neoplasms were diagnosed between the sixth and seventh decades of life and in women. CONCLUSION: The data demonstrate that epidemiology profile of studied neoplasms corroborated the majority researched literature.

Tenascin and fibronectin expression in odontogenic cysts.

BACKGROUND: Odontogenic cysts (OCs) present distinct evolution and clinical behavior. This study was performed in order to investigate if some components of the extracellular matrix (ECM) may drive these differences. METHODS: Thirty OCs were selected: 10 radicular cysts (RCs), 10 dentigerous cysts (DCs), 10 non-syndrome odontogenic keratocysts (OKCs) and they were immunohistochemically analyzed to verify the expression pattern of tenascin and fibronectin. RESULTS: Tenascin immunostaining was mainly intense as a thick band deep to the epithelial-mesenchymal interface in both RCs and OKCs. The intense tenascin immunoexpression observed in the RCs was usually associated with inflammation. An intense fibronectin reactivity was observed in the basement membrane region and at the cystic wall of OKCs. CONCLUSIONS: Our results demonstrate differences between the expression of ECM proteins in the OCs studied. The higher tenascin and fibronectin expression in the capsule of OKCs suggests marked instability in the cystic structure and may contribute to its aggressive behavior.