Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Synchronous jawbone diseases: a multicenter retrospective study

Abstract The aim of this study is to report an original case series of synchronous jawbone diseases. Data of patients seen over 13 years were extracted from the files of three Oral Radiology and Pathology diagnostic centers in Brazil. The clinical, radiographic, and laboratory characteristics were tabulated and analyzed by the authors; the patients were described according to lesion type. Seventy-two synchronous jawbone diseases were included in this study. Florid osseous dysplasia, Gorlin-Goltz syndrome, and cherubism were the most frequent disorders reported in this case series. In addition, the posterior mandible area was the main site of manifestation. Florid osseous dysplasia and Gorlin-Goltz syndrome represented two-thirds of our samples. With the utilization of adequate demographic, clinical, and radiologic information, it is possible to diagnose most of the synchronous lesions of jawbones. Sometimes, however, we need complementary exams, such as histopathologic and biochemical analysis or dosing of calcium, phosphorus, and alkaline phosphatase.

Influência do programa de Educação pelo Trabalho na atuação em saúde bucal do agente comunitário de saúde / Influence of WORK-BASED educaTion program on oral health in performance of community HEALTH worker

Objetivo: Avaliar a influência das ações realizadas pelo Programa de Educação pelo Trabalho (PET-Saúde) no trabalho e conhecimento em saúde bucal de Agentes Comunitários de Saúde (ACS). Método: Utilizou-se um instrumento de pesquisa validado para a análise da influência do conhecimento em saúde bucal dos ACS, em estudo transversal desenvolvido em dois distritos administrativos municipais (DAGUA e DASAC). Os dados obtidos foram analisados estatisticamente pelo SPSS. Resultados: Os ACS eram em maioria do sexo feminino com idade entre 30 a 39 anos e renda familiar de um a três salários, a maioria residia na comunidade há mais de seis anos e atuava na comunidade entre 1 e 3 anos, abrangendo cerca de 500 a 599 indivíduos nas suas microáreas. Observou-se que a maioria dos ACS não realizava atividade de educação em saúde bucal por não terem recebido capacitação para tal, com exceção dos ACS do distrito administrativo sob área de cobertura da Universidade Federal do Pará, onde o PET-Saúde se fez pertinente. Sobre o conhecimento em saúde bucal, os ACS dos distritos DAGUA e DASAC obtiveram nível moderado. Conclusões: O PET-Saúde proporcionou construção coletiva do conhecimento para os ACS retornando em mudanças positivas sobre o cuidado em saúde bucal para as comunidades. Percebeu-se maior nível de conhecimentos relacionados à saúde bucal entre os ACS do DAGUA, apesar de não ter havido grande diferença entre os distritos analisados. As atividades do PET deveriam ser incorporadas nos projetos pedagógicos, dos cursos de graduação e ter caráter de continuidade nas comunidades fortalecendo as ações de integração ensino-serviço-comunidade.

Objective: To evaluate the influence of actions carried out by the Work-Based Education Program (WBEP-Health) on oral health work and the knowledge of Community Health Workers (CHW). Method: A validated research instrument was used to analyze the influence of oral health knowledge on CHW in a cross-sectional study developed in two municipal administrative districts (DAGUA and DASAC). Results obtained were submitted to statistical analysis using SPSS. Results: CHW were mostly females, between 30 and 39 years old, with a family income of one to three years, the majority resided in the community for more than six years and used to work in the community for 1 to 3 years, covering about 500 to 599 individuals within their micro area. It was observed that the majority of the CHW did not perform oral health education activity, due to a lack of training, except for the CHW of administrative district under the coverage area of the Federal University of Pará, where the WBEP-Health made itself relevant. In relation to knowledge about oral health, the CHW of the districts DAGUA and DASAC were classified as moderate. Conclusions: WBEP-Health provided a collective construction of knowledge for CHW, resulting in positive changes in oral health care for communities. It was observed that the knowledge level in relation to oral health was greater in the CHW from the district DAGUA, even though the difference between districts was insignificant. WBEP activities should be incorporated into pedagogical projects, undergraduate courses with continued work within communities strengthening integrated teaching-service-community actions.

Oral health assessment in school program health: who and how? / Avaliação de saúde bucal no programa saúde na escola: quem e como?

ABSTRACT Oral health is a constitutional right, with its own national policy which guides the relevance of its interrelation to general health within the integrality principles. This manuscript aims at understanding how oral health assessment and actions are observed within the School Program Health, through a qualitative study performed in the city of Belém, State of Pará, Brazil. The sample criterion consisted of 5 nurses, 5 teachers and 5 parents. A semi-structured script was used, written and transcribed with subsequent thematic analysis. The analysis revealed three thematic categories emphasizing the need for policy empowerment and practice in order to understand the meanings of oral health within the SHP as well as to enlarge its specificity in the interdisciplinary work scenario. Thus, it is clear that for the effective functioning of the school / health relationship, it is of utmost importance that SHP policy is applied and recognized while continuously seeking to strengthen the principle of integrality and extended clinic. The study also highlights permanent education and constant need for the participants' skill improvement so that both students' health care and life quality can be fully promoted.

RESUMO A saúde bucal apresenta-se como um direito constitucional, sendo condição relevante à integralidade de saúde. Este artigo objetivou compreender como a avaliação e ações de saúde bucal são contempladas no âmbito do Programa Saúde na Escola, através de pesquisa com abordagem qualitativa no município de Belém, Pará, utilizando roteiro semiestruturado com amostra de três categorias do Programa Saúde na Escola, selecionadas por conveniência e com base no critério de saturação: enfermeiros, professores e pais. A análise resultou três categorias distintas e inter-relacionadas que ressaltam a discussão acerca da necessidade de empoderamento para compreensão dos significados da saúde bucal dentro do PSE e ampliação de sua especificidade no cenário de trabalho transdisciplinar. Para o efetivo funcionamento da articulação escola/saúde, faz-se necessário reconhecer a aplicabilidade da política do Programa Saúde na Escola, buscando cada vez mais implementá-la nas escolas de modo a otimizar a interligação entre os envolvidos. Verificou-se a constante necessidade acerca do aperfeiçoamento de habilidades dos atores deste cenário de modo a atuar munidos de atitudes/comportamentos adequados para a melhoria da qualidade de vida do escolar.

Nuclear metallothionein in oral squamous cell carcinoma: clinicopathological parameters and patient survival

Abstract The aim of this study was to identify the immunoexpression of methallothionein in oral squamous cell carcinoma as well as to address the correlation with clinical features, histological grade and patient survival. Samples were collected from 93 patients with tongue squamous cell carcinoma who presented for follow-up. Immunohistochemical expression of methallothionein in all groups was performed. The scoring system has previously been published by Tsurutani in 2005, which is based on intensity and distribution of staining. We used Kappa index to evaluate the degree of observers' agreement under metallothionein immunostaining and histological grade. Associations between methallothionein expression and clinical parameters (age, gender, smoking, tumor size, lymph node metastasis and disease stage) were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). Our results showed no statistically significant association between methallothionein immunostaining and the selected clinicopathological variables. Immunohistochemistry results showed positive nuclear immunostaining for metallothionein in 62,37% (58/93) and negative for metallothionein 37,63% (35/93). The degree of examiners agreement by Kappa varied from substantial to perfect and both metallothionein immunostaining and histological grade were explored. The present study suggests that positive methallothionein expression found in tongue squamous cell carcinoma may not help to predict survival in the analyzed samples, as well as no relation between the protein and histological grade and clinical features was observed. In conclusion, the present study suggests that metallothionein is not associated with tongue squamous cell carcinoma clinicopathological characteristics and aggressiveness.

Ki-67 protein predicts survival in oral squamous carcinoma cells: an immunohistochemical study

Abstract The aim of this study was to identify the expression of Ki-67 and MCM3 in oral squamous cell carcinoma (OSCC) as well as to address the correlation with patient survival and clinical features. Samples were collected from 51 patients with OSCC who presented for follow-up. Immunohistochemical expression of Ki-67 and MCM3 in all groups was performed. The scoring system was previous published by Tsurutani in 2005. We used Kappa index to evaluate observers agreement degree. The associations between protein expression and clinical variables were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). The overall survival time for a patient with positive immunostaining for Ki-67 is shorter than for a patient with negative immunostaining, (log-rank test, p = 0.00882). Patients with tumor size T3 and T4 showed a statistically significant relationship with Ki-67 immunoexpression (log-rank test, p = 0.0174). The relationship between Ki-67 expression and the relation between age, gender, smoking, tumor site, lymph node metastasis and disease stage was not significant. The examiners agreement degree by Kappa presented p value < 0.05. There was not a significant correlation when we evaluated MCM3 expression regarding clinical characteristics and survival rate. From these results, the present study suggests that positive Ki-67 expression found in OSCC patients may contribute to predict the survival in OSCC samples, as well as the relation between the protein and the tumor size.

Copaiba oil effect on experimental jaw defect in Wistar rats

PURPOSE: To evaluate the effects of copaiba oil on jaw defects repair in Wistar rats treated with bioglass or adipose tissue. METHODS: A jaw defect was randomly created in forty-two rats and filled with bioglass or adipose tissue. The two groups (Gbio and Gcell) were subdivided in three subgroups with seven animals each according to gavage administration: control (distillated water), oil (copaiba oil) and melox (meloxicam). Euthanasia was performed after forty post-operative days. The bone formation was analyzed regarding the histological aspects. RESULTS: The osteoclasts activity was observed only in four subgroups (p=0.78). Regarding the osteoblasts presence, it was very similar between the subgroups, the difference was due to Gcell-melox (p=0.009) that presented less osteoblastic activity. The inflammatory cells were more evident in Gcell-melox subgroup, however, there was no difference in comparison with the other subgroups (p=0.52). Bone formation was observed in all subgroups, just two animals showed no bone formation even after 40 days. More than 50% of bone matrix mineralization was observed in 56% (23 animals) of the analyzed areas. The bone matrix mineralization was not different between subgroups (p=0.60). CONCLUSIONS: The subgroups that received copaiba oil showed bone repair, although not statistically significant in comparison to subgroups treated whit meloxicam or controls. Copaiba oil administered by gavage had no effect on bone repair in this experimental model. .

Effect of andiroba oil on periodontitis in Wistar rats

PURPOSE: To evaluate the effects of andiroba oil on the periodontitis in rats. METHODS: The periodontitis was induced by the placement of cotton ligatures around the cervix of the second upper molars on fifteen rats, and waiting fifty days. The animals were randomly distributed into three groups: saline group, andiroba oil group and meloxican group, differentiated by substance used in the treatment of periodontitis. The groups received the respective substance by gavage for seven days, after the periodontitis induced. It was analyzed the score of inflammatory cells and the measurement from the cemento-enamel junction to the bone crest. RESULTS: The andiroba oil group (p=0.008) and meloxican group (p=0.0347) show a less score of inflammatory cells than saline group, however there weren't difference between them (p=0.2754). Regarding the analysis of measurement from the cemento-enamel junction to the bone crest, there was no difference between groups studied (p=0.3451). CONCLUSION: Andiroba oil decreased the quantity of inflammatory cells, however, it didn't have an effect on the measurement of alveolar bone loss, like the treatment with Meloxican®.

Extranodal Nasal NK/T-Cell Lymphoma: A Rare Oral Presentation and FASN, CD44 and GLUT-1 Expression

Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant tumor with distinctive clinicopathological features, characterized by vascular invasion and destruction, prominent necrosis, cytotoxic lymphocyte phenotype and a strong association with Epstein-Barr virus. Here is reported an extranodal nasal NK/T-cell lymphoma case, involving the maxillary sinus, floor of the orbit, and interestingly extending to the oral cavity through the alveolar bone and buccal mucosa, preserving the palate, leading to a primary misdiagnosis of aggressive periodontal disease. Moreover, this work investigated for the first time the immunohistochemical expression of fatty acid synthase (FASN) and glucose transporter 1 (GLUT-1) proteins in this neoplasia. FASN showed strong cytoplasmatic expression in the neoplastic cells, whereas GLUT-1 and CD44 were negative. These findings suggest that the expression of FASN and the loss of CD44 might be involved in the pathogenesis of the extranodal nasal NK/T-cell lymphoma, and that GLUT-1 may not participate in the survival adaptation of the tumor cells to the hypoxic environment. Further studies with larger series are required to confirm these initial results.

O linfoma de células natural killers (NK)/T extranodal é um tumor maligno agressivo com características clinicopatológicas distintas, caracterizadas por invasão e destruição vasculares, necrose proeminente, fenótipo linfocítico citotóxico e uma forte associação com o vírus Epstein-Barr. Relatamos aqui um caso de linfoma de células NK/T nasal extranodal, envolvendo o seio maxilar, assoalho de órbita, e interessantemente estendendo-se para a cavidade oral através do osso alveolar e mucosa vestibular, preservando o palato, levando a um diagnóstico inicial equivocado de doença periodontal agressiva. Ainda, nós investigamos pela primeira vez a expressão imunoistoquímica das proteínas Fatty acid sinthase (FASN) e glucose transporter 1 (GLUT-1) nesta neoplasia. FASN revelou uma forte expressão citoplasmática nas células neoplásicas, enquanto GLUT-1 e CD44 foram negativas. Estes achados sugerem que a expressão de FASN e a perda de CD44 podem estar envolvidas na patogênese do linfoma de células NK/T nasal extranodal, e que GLUT-1 não deve participar da adaptação das células tumorais ao ambiente de hipóxia. Estudos adicionais com séries maiores são necessários para confirmar nossos resultados iniciais.

Retalho miomucoso de bucinador: Relato de caso e revisão de literatura / Buccinator myomucosal flap: Case report and literature review

A reconstrução de pequenos defeitos da região maxilofacial é realizada normalmente com retalhos locais, enquanto os grandes defeitos podem ser reconstruídos com retalhos regionais vascularizados ou com retalhos livres, entretanto defeitos de tamanho moderado, muitas vezes, representam um desafio aos cirurgiões. Uma alternativa é o uso de retalhos compostos por tecidos muscular e mucoso, como o retalho miomucoso do músculo bucinador. Esse retalho apresenta vantagens, como sua anatomia constante, o fornecimento de um volume muscular adequado, uma rápida cicatrização e uma menor morbidade pós-operatória, além de sua boa capacidade de rotação, que permite recobrir a maioria dos defeitos ipsilaterais do palato e da maxila, devendo possuir um local de destaque na escolha da técnica cirúrgica adequada para a correção de defeitos orais de tamanho moderado. O objetivo deste trabalho é relatar um caso no qual se utilizou o retalho miomucoso de bucinador para a reconstrução de um defeito na região de palato duro assim como discutir os aspectos mais importantes dessa técnica cirúrgica.

The reconstruction of small defects in the maxillofacial region is usually done with local flaps, whereas large defects are reconstructed with a variety of vascularized regional flaps or free flaps, however, defects of moderate size many times represent a challenge to the surgeon. An alternative is the use of flaps that contain both muscle and mucosal tissue, such as the buccinator myomucosal flap. This flap presents advantages like its constant anatomy, the possibility of providing sufficient muscle bulk, a good healing and a minimal post-operatory morbidity, besides its reliable arc of rotation, which can cover most ipsilateral defects of the palate and maxilla, leading to this technique a preferential place for the reconstruction of moderate size defects of the oral cavity. The aim of this paper is to report a case in what the buccinator myomucosal flap was used to reconstruct a moderate defect in the hard palate region, as well as to discuss the most important aspects of this surgical technique.

Intraosseous lipoma of the mandible: A diagnostic challenge / Lipoma intra-ósseo de mandíbula: um desafio diagnóstico

PURPOSE: To report a rare case of intraosseous lipoma of the mandible and to discuss the most important features of the lesion, emphasizing the diagnostic pitfall that this entity may represent for general dentists and radiologists. CASE DESCRIPTION: An 18-year-old male patient presented an asymptomatic radiolucent lesion in the mandible in the region of the teeth 43 and 44 with no clinical alteration. After the incisional biopsy the histopathological exam revealed a capsulated lesion predominantly composed of mature adipose tissue and some areas of dystrophic calcification confirming the diagnosis of intraosseous lipoma. The lesion was surgically removed and no signs of recurrence could be observed after six months of follow-up. CONCLUSION: Due to the unspecific clinical and radiographic features and its rarity the intraosseous lipoma of the mandible may be a diagnostic challenge for general dentists and radiologists. Therefore, the histopathological examination is required for the correct diagnosis of the lesion.

OBJETIVO: Relatar um caso raro de lipoma intra-ósseo em mandíbula e discutir os aspectos mais importantes desta lesão, enfatizando a desafio diagnóstico que esta entidade pode representar para cirurgiões dentistas e radiologistas. DESCRIÇÃO DO CASO: Paciente do sexo masculino, 18 anos de idade apresentava uma lesão radiolúcida assintomática na mandíbula na região dos dentes 43 e 44 sem qualquer alteração clínica. Após a biópsia incisional, o exame histopatológico evidenciou uma lesão encapsulada composta majoritariamente por tecido adiposo benigno e algumas áreas de calcificações distróficas confirmando o diagnóstico de lipoma intra-ósseo. A lesão foi cirurgicamente removida e nenhum sinal de recorrência foi observado após seis meses de acompanhamento. CONCLUSÃO: Devido às características clínicas e radiográficas inespecíficas e à sua raridade, o lipoma intra-ósseo de mandíbula pode representar um desafio diagnóstico para cirurgiões dentistas e radiologistas. Portanto, o exame histopatológico é fundamental para o correto diagnóstico da lesão.

Computed tomography and scintigraphy exams for diagnosis and treatment planning of the condylar osteochondroma: A case report / Exames de tomografia computadorizada e cintilografia para diagnóstico e plano de tratamento de osteocondroma condilar: Relato de caso

Purpose: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. Case description: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. Conclusion: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.

Objetivo: Relatar um caso incomum de osteocondroma afetando o côndilo mandibular de uma paciente jovem e ilustrar as importantes contribuições dos diferentes exames por imagem para o diagnóstico e plano de tratamento desta lesão. Descrição do caso: Paciente do sexo feminino, 24 anos, com queixa principal de uma crescente assimetria facial e dor na região pré-auricular esquerda, além de apresentar redução da abertura bucal, desvio de mandíbula e mordida cruzada posterior, por um período de 18 meses. A radiografia panorâmica revelou um aumento do côndilo esquerdo, enquanto secções de tomografia computadorizada e reconstrução 3D exibiram um crescimento ósseo bem definido originando-se do côndilo. O exame de cintilografia revelou uma atividade osteogênica anormal na região de articulação tempormandibular esquerda. O côndilo foi cirurgicamente removido e após 18 meses de acompanhamento a radiografia panorâmica e a tomografia computadorizada não revelaram nenhum sinal de recorrência. Conclusão: Apesar de o osteocondroma ser um tumor ósseo benigno que raramente surge na região crânio maxilofacial, ele deve ser considerado como diagnóstico diferencial para massas de crescimento lento na área temporomandibular e o uso de diferentes exames por imagem contribuem significativamente para o correto diagnóstico e plano de tratamento desta condição patológica.

Tumor odontogênico cístico calcificante em mandíbula: relato de caso e revisão de literatura / Calcyfing cystic odontogenic tumor: case report and literature review

Objetivo: Relatar um caso de tumor odontogênico cístico calcificante (TOCC) e discutir o diagnóstico diferencial. Relato do caso: Paciente do sexo masculino, 33 anos, exibindo tumefação assintomática da região anterior de mandíbula. Exames por imagem exibiram a presença de imagem radiolúcida com focos radiopacos, cujo exame histopatológico confirmou o diagnóstico de TOCC. Após enucleação da lesão, nenhum sinal de recidiva foi observado. Considerações finais: O TOCC é uma lesão odontogênica que pode apresentar comportamento clínico variável e características radiográficas semelhantes às exibidas por outras neoplasias odontogênicas, dificultando seu correto diagnóstico.

Objective: To report a case of calcifying cystic odontogenic tumor (CCOT) and to discuss the differential diagnosis. Case report: 33-year-old male patient, exhibiting an asymptomatic swelling in the anterior portion of the mandible. Imaging exams revealed the presence of a radiolucid image with radiopaque foci that associated with the histopathological exam confirmed the TOCC diagnosis. After the enucleation of the lesion no sign of recurrence was observed. Final considerations: The CCOT is an odontogenic lesion that may present variable clinical behavior and radiographical features resembling other odontogenic tumors, offering difficulties to perform its correct diagnosis.

Reconstrução com retalho de platisma: uma opção viável? / Reconstruction with platysma flap: a doable option?

Introdução: o retalho do músculo platisma (RMP) vem sendo utilizado em reconstruções cirúrgicas de cabeça e pescoço sem a devida importância que ele merece. Objetivo: avaliar os resultados de reconstruções a custa do RMP. Pacientes e método: analisamos nove casos em que se utilizou o RMP para fechar a área cruenta após a ressecção oncológica em câncer de cabeça e pescoço em instituição de referência em Oncologia. Cinco casos foram para reconstruir o soalho da boca, dois para a mucosa jugal, um para hipofaringe e um para o palato duro. Resultados: Desses nove casos, em quatro não houve qualquer complicação. Houve epidermólise em dois, deiscência parcial da sutura em dois e uma perda total. Conclusão: O RMP é uma boa opção para reconstrução em casos selecionados.

Introduction: the platysma flap is used in reconstructions in head and neck surgery without the concernment that it deserves. Objective: to analyze the outcome in reconstruction with this flap. Patients and methods: We evaluated nine cases in which the platysma flap was done in order to reconstruct the wound area after the resection of head and neck cancer in a reference institution. Five cases were performed in the floor of the mouth, two in jugal mucosa, one in hypopharynx and one in the hard palate. Results: Out of the nine cases, no complications was found in four. On the other hand, we hadepidermiolisis in two cases, partial dehiscence in two, and total lost in one patient. Conclusion: The platysma flap is a good option to reconstruction in selective cases.

Avaliação in vitro da expressão das proteínas PTEN, Akt, Mdm2 e p53 em células de carcinoma epidermóide de cabeça e pescoço submetidas a ação de EGF e 17-AAG / In vitro evaluation of the expression of PTEN protein, Akt, Mdm2 and p53 in cells of squamous cell carcinoma of head and neck under the action of EGF and 17-AAG

O carcinoma epidermóide de cabeça e pescoço é responsável por 90% das neoplasias malignas, nesta região. Molecularmente, inúmeras vias de sinalização, ainda não muito bem compreendidas, são responsáveis pelo seu crescimento e invasão para tecidos vizinhos, além de metástases para órgãos distantes. Este trabalho destinou-se a avaliar o crosstalk entre as vias de sinalização do PTEN, Akt, Mdm2 e p53 em quatro linhagens de células de carcinoma epidermóide (HN6, HN19, HN30 e HN31) e queratinócitos imortalizados (HaCat), estimulados com EGF (fator de crescimento epitelial) e 17-AAG. Para observar a localização e os níveis de PTEN, Akt, Mdm2 e p53 nos diferentes compartimentos celulares estas proteínas foram localizadas e quantificadas no interior celular através das técnicas de imunofluorescência e western blot, respectivamente. Os resultados mostraram que a ativação da via do PI3K/Akt, pelo EGF, promoveu a proliferação celular, sendo HN31 a linhagem celular de melhor resposta proliferativa. Quando as células foram tratadas com 17-AAG a linhagem HN31 foi a que melhor traçou um perfil apoptótico com diminuição dos níveis de Akt, ausência de Mdm2 e aumento dos níveis de PTEN e p53. As linhagens celulares HN6 e HN19 continuaram apresentando níveis significativos de Akt e Mdm2, o que sugere um potencialmais agressivo devido a manutenção do comportamento proliferativo e anti-apoptótico destas linhagens.

Head and neck squamous cell carcinoma (HNSCC) represents 90% of all head and neck malignancies. Cancer growth, invasion and metastasis are due to several signaling pathways that, unfortunately, are not completely understood. The aim of this study was the crosstalk evaluation among PTEN, Akt, Mdm2 and p53 signaling pathways in four different HNSCC cell lines (HN6, HN19, HN30 and HN31) and HaCat cell line (immortalized keratinocytes), all of than treated with 10ng/ml EGF (epidermal growth factor) and 2ìM 17-AAG. Western blot and imunofluorescence were performed in order to analyze PI3K/Akt signaling key target proteins: PTEN, Akt, Mdm2 and p53. Treatment of HNSCC cell lines with EGF resulted in activation of the PI3K/Akt pathway and enhanced cell proliferation. The results showed higher proliferative activity in HN31 cell line. The treatment of HNSCC cell lines with 17-AAG inhibited the proliferation in various levels. HN31 cell lines expressed PTEN and p53 in high levels and low expression for Akt and Mdm2 proteins. These findings suggest that 17-AAG can induce p53-dependent apoptosis in HN31 cell lines. On the contrary, HN6 and HN19 cell lines displayed high levels of Akt and Mdm2 proteins, resulting in decreased apoptosis and increased aggressive potential.

Lesão periférica de células gigantes: relato de caso / Peripheral giant cells lesion: case report

Neste trabalho os autores relatam um caso clínico de lesão periférica de células gigantes localizada na maxila de uma jovem paciente. São abordados os aspectos clínicos, radiográficos e histopatológicos da lesão.

Tatuagem por amálgama-relato de caso / Amalgam tatoos-case report

Introdução: A tatuagem por amálgama é uma lesão que pode ser observada na clínica odontológica resultante da introdução de partículas de amálgama, que é uma liga de metal composta por consideráveis porções de prata (Ag) e mercúrio (Hg), no interior do tecido bucal. Objetivo: O presente trabalho se propõe a relatar um caso clínico de tatuagem por amálgama, considerando os aspectos clínicos e radiográficos da lesão, assim como mostrar a necessidade de desenvolver o diagnóstico diferencial com lesões semelhantes, algumas fatais, como o melanoma. Método: O dados contidos no caso clínico foram obtidos através de anamnese, exame clínico, manobra de diascopia e exame radiográfico, estabelecendo-se o diagnóstico diferencial com lesões enegrecidas da mucosa bucal a fim de permitir o tratamento adequado. Considerações Finais: O importante diante de uma tatuagem por amálgama é a exclusão de lesão patológica de mau prognóstico. Por não possuir conotação patológica, nenhum procedimento cirúrgico foi realizado no caso relatado

Neuroblastoma / Neuroblastoma

O neuroblastoma é um tumor maligno, agressivo, sólido e congênito, que tem sua origem a partir das células embrionárias da crista neural, que são responsáveis pela formação das células ganglionares do sistema nervoso simpático e da camada medular da adrenal. Esse tumor atinge tecidos moles, podendo desenvolver metástases que envolvem linfonodos regionais, como destruir estruturas ósseas mais distantes. O tratamento consiste em cirurgia, quimioterapia, radioterapia, incluindo transplante de medula óssea autólogo, ou uma associação desses tratamentos. Este artigo relata um caso clínico de neuroblastoma olfativo em uma criança de sete meses de idade e realiza uma breve

Miíase gengival: relato de um caso clínico / Gingival myiasis: a clinical case report

É apresentado um caso clínico de miíase gengival, em um paciente de 16 anos de idade, portador de deficiência mental. Realizou-se também, uma breve revisäo de literatura, enfocando sua etiologia, classificaçäo, aspectos clínicos e tratamento