ABSTRACT
O tratamento do câncer de cabeça e pescoço depende da idade do paciente, presença de comorbidades, tamanho do tumor, localização, grau, estágio, presença de linfonodos afetados e de metástases, e inclui cirurgia, radioterapia e quimioterapia, combinadas ou separadamente. As complicações bucais da radioterapia em região de cabeça e pescoço são amplamente conhecidas, tais como, mucosite, xerostomia, disgeusia, trismo, cárie de radiação e osteorradionecrose. A prevenção ou redução da incidência e severidade dessas complicações são fundamentais para a manutenção da saúde bucal, tendo o dentista um papel primordial antes, durante e após a radioterapia. Dessa forma, este relato de caso visa discutir o atendi¬mento odontológico de uma paciente irradiada em região de cabeça e pescoço, salientando as principais complicações bucais, manejo odontológico e a importância da Odontologia na equipe multidisciplinar no tratamento do câncer bucal
The head and neck cancer treatment depend on age, comorbidities, tumor size, site, stage, grade, lymph nodes status and metastases, and include surgery, radiotherapy and chemotherapy, combined or separately. Oral complications of radiotherapy in the head and neck region are widely known, such as mucositis, xerostomia, dysgeusia, trismus, radiation caries and osteoradionecrosis. The prevention or reduction of incidence and severity of oral complications are essential in the maintenance of oral health, and the dentist having a primary role before, during and after radiotherapy. Thus, this case report aims to discuss the dental care of a patient irradiated in the head and neck region, highlighting the main oral complications, dental management and the importance of Dentistry in the multidisciplinary team in the treatment of oral cancer
ABSTRACT
Abstract Plasmablastic lymphoma is a non-Hodgkin lymphoma characterized by its plasmacytic differentiation and predilection for the oral cavity. It is among the lymphomas most commonly associated with AIDS. This report details a case of a HIV-positive patient with a 1-month history of an exophytic mass in the gingival area of the upper left quadrant. The diagnosis of plasmablastic lymphoma was made based on its histopathological and immunophenotypical features. She was treated with chemotherapy followed by autologous hematopoietic stem cell transplantation. Despite complete resolution of the lesion, the patient died of cardiorespiratory arrest. This case illustrates plasmablastic lymphoma as the first clinical manifestation of AIDS, highlighting the importance of differentiating between a potentially malignant lesion and other pathologic processes.
Subject(s)
Humans , Female , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/virology , Lymphoma, AIDS-Related/pathology , Plasmablastic Lymphoma/pathology , Plasmablastic Lymphoma/virology , Biopsy , Mouth Neoplasms/therapy , Immunohistochemistry , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/pathology , Lymphoma, AIDS-Related/therapy , Plasmablastic Lymphoma/therapyABSTRACT
Abstract Oral manifestations are common findings in human immunodeficiency virus (HIV) infected patients and frequently influence the overall health. Oral hairy leukoplakia (OHL) is strongly associated with HIV infection demonstrating its relationship with the individual's immune status and progression of immunosuppression. This study aims to retrospectively evaluate OHL in HIV patients, analyzing its incidence, demographic aspects and possible changes in clinical and epidemiological profile of the disease over 17 years. The records of 1600 HIV-infected patients were reviewed. The data were correlated and analyzed, considering HIV exposure category, age, gender, harmful habits, CD4 level, use and type of antiretroviral. OHL was observed in 215 (13.4%) patients. Most were men in the fourth decade of life, 171 (79.5%) and 112 (52,1%) respectively, but an increase in the incidence of OHL among female patients and those in the fifth decade of life was observed. Tobacco smoking was the most frequent harmful habit reported by 114 (68%) patients. OHL occurred mostly in patients with CD4 counts between 200 and 500 cells/mm3 35 (55.5%). The lower incidence of OHL was found among patients using at least one non-nucleoside reverse transcriptase inhibitor (NNRTI). OHL is related to CD4 count, use of ARVT and tobacco smoking and is also more prevalent in men in the fourth decade of life. These characteristics were recognized in absolute values, but when verifying the behavior over the years we noticed that the incidence of OHL is decreasing and its epidemiological characteristics changing.
Subject(s)
Humans , Male , Female , HIV Infections/complications , HIV Infections/epidemiology , Leukoplakia, Hairy/etiology , Leukoplakia, Hairy/epidemiology , Brazil/epidemiology , Smoking/adverse effects , Logistic Models , Sex Factors , Incidence , Retrospective Studies , Risk Factors , Age Factors , CD4 Lymphocyte CountABSTRACT
O HTLV-1 (human T-cell lymphotropic virus type 1) foi o primeiro retrovírus humano a ser identificado. É comprovadamente o agente etiológico da leucemia/linfoma de células T no adulto (ATLL) e da paraparesia espástica tropical ou mielopatia associada ao HTLV (HAM/TSP). Porém se evidencia que o vírus possa estar relacionado a várias outras manifestações sistêmicas. A Síndrome de Sjögren (SS) é uma das desordens que têm sido associada ao HTLV-1. Embora a infecção pelo HTLV seja reconhecidamente endêmica no Brasil, não há informações sobre essa associação na população brasileira. Este trabalho propõe-se a investigar a prevalência de SS em pacientes infectados pelo HTLV e a prevalência de HTLV em pacientes diagnosticados com SS. Exames sorológicos para investigação do HTLV foram realizados em 50 pacientes da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) que apresentavam queixas compatíveis com a SS (grupo 1). No Instituto de Infectologia Emílio Ribas foram avaliados 129 pacientes HTLV+ que passaram pelo processo diagnóstico para a SS (grupo 2). Nenhum dos pacientes do grupo 1 apresentou soropositividade para o HTLV. No grupo 2, 46 (35,7%) apresentaram algum grau de xerostomia, 18 (13,95%) apresentaram xeroftalmia, 8 (6,2%) apresentaram hipossalivação, 2 (1,55%) apresentaram fluxo lacrimal alterado e 1 paciente (0,77%) apresentou autoanticorpos reagentes (anti-SSB). Foram executadas biópsias incisionais de glândulas salivares menores em 5 pacientes do grupo 2. Apenas 2 pacientes (1,55%) HTLV+ completaram os critérios para o diagnóstico de SS. A SS mostrou ser três vezes mais prevalente em pacientes HTLV+ do IIER do que nos pacientes que buscaram atendimento no serviço de Otorrinolaringologia da ISCMSP.
HTLV-1 (human T-cell lymphotropic virus type 1) was the first human retrovirus identified. It is proven to be the etiological agent of adult T-cell leukemia/lymphoma (ATLL) and of a neurological disease known as HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP). However, there is the evidence that the virus could be related to several other systemic manifestations. Sjögren's Syndrome (SS) is one of the disorders that have been associated with HTLV-1. Although HTLV infection is known to be endemic in Brazil, there is no information about this association in Brazilian population. This study proposes to investigate the prevalence of SS among patients infected with HTLV and the prevalence of HTLV among patients diagnosed with SS. Serological tests for HTLV were performed in 50 patients from Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) with complaints compatible with the SS (group 1). At Institute of Infectious Diseases Emilio Ribas (IIER), 129 HTLV+ patients were evaluated and the diagnostic process for SS was performed (group 2). None of the patients in group 1 was positive for HTLV. In group 2, 46 (35.7%) reported any degree of xerostomia, 18 (13.95%) had xerophtalmia, hyposalivation was present in 8 (6.2%) patients and decrease in tear secretion, in only one patient (0.77%) the auto-antibodies was positive ( Anti-SSB). Incisional biopsies of labial minor salivary glands were executed in 5 patients in group 2. Only 2 HTLV+ patients (1.55%) have fulfilled the classification criteria for SS. SS proved to be three times more prevalent in HTLV patients from IIER than in patients who sought care in the service of Otorhinolaryngology at ISCMSP.