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.

Oral squamous cell carcinoma: clinicopathological features from 346 cases from a single Oral Pathology service during an 8-year period

Epidemiological data from oral squamous cell carcinoma (OSCC) is mostly derived from North American, European and East Asian populations. OBJECTIVE: The aim of this study was to report the demographic and clinicopathological features from OSCC diagnosed in an Oral Pathology service in southeastern Brazil in an 8-year period. MATERIAL AND METHODS: All OSCC diagnosed from 2005 to 2012 were reviewed, including histological analysis of all hematoxylin and eosin stained slides and review of all demographic and clinical information from the laboratory records. RESULTS: A total of 346 OSCC was retrieved and males represented 67% of the sample. Mean age of the patients was 62.3 years-old and females were affected a decade older than males (p<0.001). Mean time of complaint with the tumors was 10 months and site distribution showed that the border of the tongue (37%), alveolar mucosa/gingiva (20%) and floor of mouth/ventral tongue (19%) were the most common affected sites. Mean size of the tumors was 3.4 cm, with no differences for males and females (p=0.091) and males reported both tobacco and alcohol consumption more frequently than females. Histological grade of the tumors revealed that 27%, 40% and 21% of the tumors were, respectively, classified as well-, moderately- and poorly-differentiated OSCC, 26 cases (7.5%) were microinvasive OSCC and 17 cases were OSCC variants. OSCC in males mostly affected the border of tongue, floor of mouth/ventral tongue and alveolar mucosa/gingival, while they were more frequent on the border of tongue, alveolar mucosa/gingival and buccal mucosa/buccal sulcus in females (p=0.004). CONCLUSIONS: The present data reflect the epidemiological characteristics of OSCC diagnosed in a public Oral Pathology laboratory in southeastern Brazil and have highlighted several differences in clinicopathological features when comparing male and female OSCC-affected patients. .

Cisto do ducto nasopalatino: considerações microscópicas e de diagnóstico diferencial / Nasopalatine duct cyst: microscopic and differential diagnosis considerations

Os cistos do ducto nasopalatino são entidades incomuns dos maxilares, mas que podem assemelhar-se clínica e radiograficamente a outras lesões císticas e sólidas da região anterior mediana da maxila. O objetivo deste trabalho foi reportar 4 casos de cisto do ducto nasopalatino buscando discutir suas características microscópicas e de diagnóstico diferencial relevantes na prática clínica odontológica. As informações demográficas, clínicas e imaginológicas foram obtidas a partir dos registros laboratoriais dos pacientes e as lâminas histológicas coradas em hematoxilina e eosina dos 4 casos foram revisadas sob microscopia ótica. Os 4 casos acometeram homens com média de 53 anos de idade e todas as lesões eram assintomáticas. As imagens radiográficas eram radiolúcidas uniloculares, localizadas entre os incisivos centrais superiores e com tamanho médio de 2,0 cm (variando de 1,0 a 4,0 cm). Todos os casos foram tratados através de enucleação cirúrgica e a análise microscópica revelou que 3 dos 4 casos eram revestidos por mais de um tipo de epitélio, sendo o epitélio pavimentoso estratificado não queratinizado o mais comum. Conclui-se que os cistos do ducto nasopalatino acometem usualmente homens adultos, assemelhando-se aos cistos periapicais associados aos incisivos centrais superiores e que devem ser tratados através de procedimentos cirúrgicos conservadores com posterior avaliação microscópica minuciosa do espécime removido.

Nasopalatine duct cysts are uncommon maxillary lesions that can clinically and radiographically resemble other cystic and solid lesions from the maxillary midline area. The aim of this study was to report 4 additional cases of nasopalatine duct cyst focusing on the daily clinical importance of their microscopic and differential diagnosis characteristics. Demographic, clinical and radiographic information was obtained from the patient´s laboratory registries and hematoxilin and eosin stained histological slides from all cases were reviewed under light microscopy. The 4 cases affected males with a mean age of 53 years and all lesions were asymptomatic. Radiographic images were radiolucent and unilocular, between the roots of the upper central incisors measuring a mean of 2,0 cm (ranging from 1,0 to 4,0 cm). All cases were managed through surgical enucleation and microscopic analysis revealed that 3 of the 4 cases were lined by more than one epithelium type, the most common being stratified squamous epithelium. In conclusion, nasopalatine duct cyst usually affect adult males, are similar to periapical cysts associated to upper central incisors, and should be managed by conservative surgical approach followed by careful microscopic evaluation of the surgical specimen.

Cisto paradentário: importância dos achados clínicos, radiográficos,trans-cirúrgicos e microscópicos no diagnóstico / Paradental cyst: the importance of clinical, radiological, surgical and microscopic features on diagnosis

O cisto paradentário é um cisto odontogênico inflamatório incomum localizado aderido à junção amelo-cementária,possivelmente originado de remanescentes do epitélio reduzido do órgão do esmalte ou de restosepiteliais no periodonto. Localiza-se preferencialmente na região de trígono retromolar associado a terceirosmolares semi-inclusos com história de pericoronarite prévia. Apresenta-se como uma lesão radiolúcida bemdelimitada adjacente a dentes semi-inclusos, usualmente localizada distalmente a estes. Seu diagnósticodiferencial inclui o cisto radicular inflamatório lateral a raiz e o cisto dentígero inflamado, e o tratamento incluia remoção cirúrgica conservadora, quase sempre associada a remoção dos dentes associados. O objetivodeste trabalho é apresentar dois casos clínicos de cisto paradentário acometendo terceiros molares, ressaltandosua dificuldade diagnóstica microscópica e a necessidade da avaliação conjunta dos dados clínicoradiográficose trans-cirúrgicos. Ambos os casos apresentavam-se como áreas radiolúcidas unilocularesbem delimitadas localizadas distalmente aos terceiros molares inferiores do lado direito. O tratamento deambos os casos incluiu a remoção cirúrgica dos cistos e dos dentes associados e ambos os pacientes nãomostraram sinais de recidiva local. O cisto paradentário é um cisto incomum, de diagnóstico complexo, quenecessita de informações clínicas e imaginológicas adequadas para seu diagnóstico, devendo ser tratadode forma cirúrgica conservadora, com excelente prognóstico.

Paradental cyst is an uncommon inflammatory odontogenic cyst adhered to the enamel-cementum junction,possibly originated from remnants of the reduced enamel epithelium or epithelial remnants on the periodontium.It is usually located adjacent to the distal portion of partially-erupted lower third molars with previoushistory of pericoronaritis, as a radiolucent unilocular well-defined area. Differential diagnosis includes lateralradicular inflammatory cyst and lateral inflammed dentigerous cyst, and treatment includes conservative surgicalexcision almost always associated to removal of the associated tooth. The aim of this paper is to presenttwo cases of paradental cyst, both associated to lower third molars, discussing their microscopical diagnosticdifficulties and the importance of clinical, radiological and surgical information. The two cases presented aswell-defined unilocular radiolucences distal to the teeth, and treatment included surgical removal of the cystsand associated teeth, with no signs of recurrence until now. Paradental cyst is an uncommon cyst, whichneeds adequate clinical and imaginological information for correct final diagnosis, and should be managedthrough conservative surgery, with excellent prognosis.

Cisto nasolabial: importância do diagnóstico diferencial / Nasolabial cyst: importance of differential diagnosis

O objetivo deste trabalho é relatar um caso de cisto nasolabial discutindo a importância de seu diagnóstico diferencial. Mulher de 44 anos apresentou aumento de volume assintomático no lábio superior do lado direito com duração de três meses. O exame radiográfico mostrou a presença de uma área radiolúcida próxima aos ápices dos dentes 12 e 13 e todos os dentes da região mostravam vitalidade pulpar. Biópsia incisional da lesão mostrou diagnóstico de cisto nasolabial, confirmado após sua remoção completa sob anestesia geral. A paciente permanece em acompanhamento há 24 meses sem sinais de recidiva local.

Sialolitíase: aspectos clínicos e sócio-demográficos de 10 casos / Sialolithiasis: clinical and socio-demographic features of 10 cases

Sialolitíases são alterações frequentes das glândulas salivares. O objetivo deste trabalho é apresentar as características sócio-demográficas, clínicas, imaginológicas e de tratamento de 10 casos de sialolitíase atendidos em um ambulatório de Estomatologia. Homens adultos representaram o grupo de predileção e a glândula mais acometida foi a submandibular. Aumento de volume local, dor e infecção local foram frequentes e os exames de imagem utilizados no diagnóstico incluíram especialmente radiografias panorâmicas e oclusais inferiores e ultra-sonografias. O tratamento realizado inclui manobras clínicas e remoção cirúrgicas dos sialolitos, eventualmente associados à remoção da glândula afetada, sem evidências de recidiva nos 10 casos.

Tumor odontogênico adenomatóide associado à cisto dentígero: relato de um caso e revisäo da literatura / Adenomatoid odontogenic tumor associated with a dentigerous cyst: a report of a case and review of the literature

É apresentado um caso de Tumor Odontogênico Adenomatóide que se desenvolveu na cápsula de um cisto dentígeno. Säo discutidas as opçöes de tratamento mais comuns na literatura odontológica, levando em consideraçäo o aspecto do tratamento radical em contraposiçäo ao conservador, no qual o dente envolvido à aproveitado