Association of Stromal Factors With the Histologic Risk Assessment Model in Oral Squamous Cell Carcinoma.

The aim of the present study was to evaluate angiogenesis, lymphangiogenesis, and mast cell density in association with the histologic risk assessment (HRA) model in oral squamous cell carcinoma. One hundred oral squamous cell carcinomas were graded according to the HRA system and immunostained with antibodies against D2-40, CD34, and CD105 to determine lymphvessel density (LVD) and microvessel density (MVD). Mast cells were detected by toluidine blue and counted in all samples. Assessments were made between the evaluated factors and the histologic variables of HRA. Kruskal-Wallis and Mann-Whitney U test were used for statistical analysis and P<0.05 was considered significant. There were 32, 26, and 42 cases of low, intermediate, and high-grade neoplasms, respectively. Only LVD (P=0.05) and CD34MVD (P=0.03) showed significant associations with lymphocytic infiltration and were both higher in score 0 cases compared with score 3 tumors (P=0.05 and <0.001, respectively). None of the other variables showed significant relationships with the HRA risk scores or subcategories (P>0.05). According to our findings, it appears that the role of lymphangiogenesis and angiogenesis is limited in the HRA system. The significant relationship of lymphocytic infiltration with LVD and CD34MVD, but not CD105MVD, might indicate that "inflammatory lymphangiogenesis/angiogenesis" may differ from that induced by noninflamed neoplastic tissues. It also seems that the vasculature in inflamed tumor tissues is not entirely newly formed.

Longitudinal assessment of immunological and oral clinical conditions in patients undergoing anticancer treatment for leukemia.

OBJECTIVE: The aim of this study was to evaluate the evolution of the immunological and oral clinical conditions of children and adolescents undergoing anticancer treatment for leukemia (ATL). METHODS: Twenty patients aged 3-15 years undergoing chemotherapy seen at a referral center for cancer treatment in the State of Maranhão, Brazil, from 2008 to 2009, were evaluated at baseline (1st). Twenty-two controls were selected in public schools. Oral lesions, caries experience (deft and DMFT), plaque index (PI), gingival index (GI) and salivary IgA were analyzed. Patients and controls were evaluated after 6 months (2nd). The Shapiro Wilk, Mann-Whitney, Wilkoxon and Spearman correlation tests were carried out (alpha=5%). RESULTS: Gingivitis and mucositis were the most frequent manifestations in oral mucosae during the two phases. The mean DMFT index increased from 3.9 ± 4.2 (1st) to 4.4 ± 4.3 (2nd) (p = 0.04). The mean deft index was the same in the 1st (1.9 ± 2.7) and 2nd (1.9 ± 2.7) evaluation (p = 0.86). The GI also did not vary between assessments: 1st (1.3 ± 0.4) and 2nd (1.3 ± 0.3) - (p = 0.12), except on the lingual and distal surfaces, where increased from the 1st to 2nd evaluation (p < 0.01). The PI varied from 0.9 to 1.1, but this difference was not significant (p = 0.48), except for the lingual surface, where increased from 0.6 to 1.0 (p = 0.04). There was a reduction in salivary IgA levels from 2.9 to 1.9 µg/mL (p = 0.04), and mean IgA was significantly higher in the control group (5.4 µg/mL) if compared to cases (p < 0.01). CONCLUSION: The clinical and immunological oral conditions of children and adolescents undergoing ATL presented an unfavorable evolution. This study highlights the need for monitoring oral conditions during the ATL and draws attention to the additional responsibility of the otolaryngologist in referring ATL patients to the dentist, especially in the presence of clinical evidence of oral problems. We suggest that the planning of ATL take into account the oral health, in a multidisciplinary oncology team.

Assessment of p53 and HER-2/neu genes status and protein products in oral squamous cell carcinomas.

Identification of the genes involved in tumor initiation and progression has led to development of new markers and generated targets for new drugs. This study aimed to evaluate p53 and HER-2/neu genes status of and their protein products in oral cancer patients. Tumor specimens from 116 cases diagnosed with oral squamous cell carcinoma were analyzed. P53 and HER-2/neu immunoreactivity were studied. FISH analysis was performed to elucidate p53 and HER-2/neu gene status. Male cases represented 84% of the group. The majority of cases were between 51-60 years and moderately differentiated oral carcinoma had an incidence of 58.6%. Thirty-four cases showed p53 overexpression, negative immunoreaction was observed in 16.37% of cases. 66.38% of cases had p53 deletion, with an increased rate observed in neoplasms of the tongue. Immunohistochemical analysis of HER-2/neu receptor protein revealed that 76.72% were negative, 5.17% had weak immunostaining, 14.65% had +2 score, the others had +3 score. 24.1% of cases were analyzed using FISH technique, of which 25% were without amplification, but with polysomy for chromosome 17. 18.1% of total cases were amplified, with the rate HER-2/neu:CEP17 higher than 2. Of the 77 cases with a single p53 allele, 20 associated HER-2/neu amplification, 31 had positive anti-HER-2/neu immunoreaction, but did not have HER-2/neu:CEP17 rate >2. There was a significant association between HER-2/neu amplification and deletion of a p53 allele. These results could justify more extensive research to assess p53 and HER-2/neu gene status as significant prognostic factors in oral cancers.

Immunomorphological assessment of regional lymph nodes for predicting metastases in oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma is the most common neoplasm and comprises of approximately 80% of the cancers occurring in the oral cavity. The role of the host response to this neoplasm has been recognized, and for many years the regional lymph node in tumor-bearing hosts has been considered as an anatomic barrier to the systematic dissemination of tumor cells. Morphological evaluation of the regional nodes has aided in understanding the immune response. AIM: The current study was carried out to observe the morphological changes occurring in the regional lymph nodes and to evaluate whether these features could be helpful in assessing the immunological status of the patient, and thereby, the prognosis of the patient. MATERIALS AND METHODS: The study was based on lymph nodes from 63 patients with oral squamous cell carcinoma, who underwent radical neck dissection or modified neck dissection. In the lymph node, four morphological patterns were observed that included lymphocyte predominance, germinal center predominance, mixed pattern (sinus Histiocytosis), and an unstimulated pattern. The cases were then divided into four groups according to the predominant immunoreactivity pattern based on the World Health Organization (WHO) standardized system for reporting human lymph node morphology. RESULTS: Revealed that risk of metastases to cervical lymph nodes in patients with lymphocyte predominance was less (28.6%) when compared to the high risk of metastases with germinal center predominance (68%), and these results were statistically significant (P < 0.05). Patients with a mixed pattern showed less risk of metastases (45.4%), while those with an unstimulated pattern had increased risk of metastases (66.6%), but the results were not statistically significant. It was also found that in the positive nodes, germinal center hyperplasia (50.2%) was the predominant pattern. CONCLUSION: The present study revealed that patients with lymphocyte predominance had less risk of metastases and patients with germinal center predominance had a high risk of metastases to the lymph node.