Oncologic outcomes of microscopic tumor cut-through in locally advanced oral squamous cell carcinoma

Introduction: The gold standard treatment of oral cavity squamous cell carcinoma (OCSCC) is surgical resection; however, standardization of the margins and the role of frozen section are still debatable. Microscopic tumor cut-thought (MTCT) occurs when the surgeon has an initial positive frozen section margin that is cleared with further resection to negative. Objective: This study aims to determine the impact of MTCT on local recurrence and disease-specific survival in patients with locally advanced T3-T4 OCSCC and compare it with other clinicopathological variables. Methods: A retrospective database analysis of patients diagnosed with locally advanced T3-T4 OCSCC surgically treated and submitted to intraoperative frozen section guiding the margin status. Survival was analyzed using the Kaplan-Meier estimator followed by the Cox model for multivariate analysis. Results: We analyzed 475 patients who met inclusion criteria: MTCT occurred in 29 patients (6.11%) and local recurrence was observed in 131 patients (27.6%). MTCT had an impact on univariate (HR 2.205; 95% CI 1.243 ­ 3.914; p=0.007) and multivariate (HR 1.851; 95% CI 1.285 ­ 2.666; p=0.001) analyses. Similar results were found for disease-specific survival: univariate (HZ 1.669; 95% CI 1.056 ­ 2.635; p=0.028) and multivariate (HZ 1.307; 95% CI 0.816 ­ 2.092; p=0.265) analyses. A total of 231 patients (48.6%) had died of cancer by the end of follow-up. The best predictor for compromised frozen sections was tumor depth of invasion. Conclusion: Even after negative final margins, MTCT is an important factor associated with poorer outcome, and treatment intensification should be considered in these patients.

Does smoking habit affect dendritic cell expression in oral squamous cell carcinoma?

Abstract: The aim of this study was to determine the presence of immature CD1a+ and mature CD83+ dendritic cells in oral squamous cell carcinoma, to compare immunoreactivity between smokers and nonsmokers, and to correlate the results with histopathological grading. In this observational study, twenty-eight paraffin-embedded biopsies of oral squamous cell carcinoma were retrospectively retrieved and submitted to immunohistochemistry for immature CD1a+ and mature CD83+. Descriptive and statistical analyses were performed. The sample consisted of 18 man (64.3%) and 10 women (35.7%), with a mean age of 64.6 years in the nonsmoker group and 53.2 years in the smoker group. The tongue (11 cases, 39.2%) was the most commonly affected anatomical site, followed by gingiva (6 cases, 21.4%). Histopathological grading revealed 7 low-grade and 7 high-grade malignancy cases in each group, and no correlation with the number of positive DCs. The number of immature CD1a+ was not significantly different between smoker and nonsmoker groups, while a lower number of mature CD83+ was detected in the smoker group (p = 0.001). Smoking changes the oral immune system and decreases the ability to activate and mature dendritic cells, which may influence the development and progression of oral squamous cell carcinoma.

Carcinoma escamocelular bucal. Caso clínico y revisión de la literatura / Oral squamous cell carcinoma. Case report and review of literature

Introducción: el cáncer escamocelular (CEC) representa el 90-95% de todos los tipos de cáncer. En México, la frecuencia de CEC bucal (CECB) se ha incrementado y presenta una incidencia entre el 1 y el 5%. El CECB se asocia con sujetos en la quinta y séptima década de la vida, el sexo masculino, positivos a tabaquismo, alcoholismo, factores genéticos, inmunosupresión, infección por virus del papiloma humano (VPH) y estilos de vida poco saludables, entre otros. El objetivo de este trabajo fue presentar un caso clínico como ejemplo de las características emergentes en un paciente con CECB. Caso clínico: mujer de 38 años, con úlcera indurada, parcialmente adherida a planos profundos y dolorosa, asociada con un aumento de volumen, ubicada en vientre y borde lateral de lengua. Se realizó biopsia y con el diagnóstico histopatológico de carcinoma escamocelular invasor bien diferenciado, se procedió a determinar la presencia delVPH y resultó positivo a VPH 16. Se realizó tratamiento oncológico combinado (quirúrgico-radiación-quimioterapia), con buenos resultados para la paciente respecto a la estética y función. Conclusiones: se analizaron varios estudios que evalúan la presencia del VPH en lesiones de CECB, como un factor de riesgo que involucra con mayor frecuencia casos de pacientes jóvenes, la localización en lengua y antecedentes negativospara tabaquismo y alcoholismo frente a casos de CECB no asociados al VPH. Se requieren datos que contribuyan a dilucidar diversos aspectos aún desconocidos sobre la infección bucal por VPH y su relación con el CECB.

Background: Squamous cell cancer (SCC) represents 90-95% of all types of cancer. In Mexico, the frequency of oral SCC (OSCC) has increased, with an incidence between 1 and 5%. OSCC is associated with subjects in the 5 and 7th decade of life, males, positive for smoking, alcoholism, genetic factors, immunosuppression, human papillomavirus (HPV) infection, and unhealthy lifestyles, among others. Theobjectiveof thisworkwas to presenta clinical case as an example of the emerging characteristics in a patient with OSCC. Clinical case: 38-year-old female patient, with indurated ulcer, partially adhered to deep planes and painful, associated with an increase in volume, located on the belly and lateral edge of the tongue. A biopsy was performed and with the histopathological diagnosis of well differentiated invasive squamous cell carcinoma, the presence of HPV was determined, resulting positive for HPV-16. Combined cancer treatment was performed (surgical radiation-chemotherapy), with good results for the patient regarding aesthetics and function. Conclusions: We analyzed several studies evaluating the presence of HPV in lesions of OSCC, as a risk factor that involves more frequently cases of young patients, with location in tongue, and negative antecedents for smoking and alcoholism compared to cases of OSCC not associated with HPV. Data are required to help elucidate various still unknown aspects of oral HPV infection and its relationship with OSCC.

Aggressive parotid gland and neck metastasis caused by cutaneous squamous cell carcinoma of the scalp: a case report / Metástasis agresiva de glándula parótida y cuello causada por carcinoma cutáneo de células escamosas decuero cabelludo: reporte de un caso

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

Introducción: La cabeza y el cuello son sitios frecuentes de desarrollo de cáncer cutáneo y el carcinoma epidermoide de piel (CEC) es una de las neoplasias malignas sin melanoma más frecuentes en Chile (436 por 100.000 habitantes). Entre el 5% y el 10% del CCE cutáneo progresa de forma agresiva y genera metástasis en los ganglios linfáticos parótidos y cervicales. Reporte de Caso: Varón de 82 años, presenta lesión dolorosa de aumento de volumen en zona mandibular. Tiene antecedentes de hipertensión arterial crónica, insuficiencia renal aguda, CCE del cuero cabelludo, tuberculosis extrapulmonar, exposición crónica al sol y tabaquismo. El examen extraoral mostró una lesión de 4 cm en el tercio posterior de la rama mandibular, con bordes indefinidos, consistencia firme y dolorosa a la palpación. Intraoralmente se observa mucosa eritematosa, así como falta de lubricación, dolor a la palpación y expansión del hueso cortical. Se realiza biopsia incisional, se solicitan exámenes de imagen e histológicos. Los resultados indican la presencia de CCE y, por tanto, derivación a atención secundaria. Son muchos los factores de riesgo asociados al desarrollo de CEC, siendo la radiación ultravioleta la más relevante en este caso, favoreciendo su aparición en el cuero cabelludo. La probabilidad de metástasis es baja, pero cuando ocurre, la mayoría de los casos que comenzaron en el cuero cabelludo se diseminan a la región parotídea y cervical. Conclusión: El SCC tiene un buen pronóstico. Sin embargo, existen antecedentes, como tamaño y ubicación, que deben alertar al profesional para realizar el seguimiento, cribado precoz, control de ganglios metastásicos en zona maxilofacial.

Sex, pain, alcoholism and anxiety symptoms are predictive for systemic cortisol levels in oral cancer patients / Sexo, dor, etilismo e sintomas de ansiedade são preditivos para níveis sistêmicos de cortisol em paciente com câncer de boca

Pacientes com câncer podem apresentar uma desregulação do eixo hipotálamohipófise-adrenal (HPA) e secreção aumentada do hormônio cortisol. Níveis elevados de cortisol têm sido associados a pior prognóstico de diferentes tipos de câncer. Embora alterações psicológicas como ansiedade e depressão possam deflagrar uma secreção anormal de cortisol, pouco se sabe sobre a influência destas desordens emocionais na desregulação do eixo HPA em pacientes com câncer quando avaliadas em conjunto com variáveis demográficas, clinicopatológicas e biocomportamentais. Este estudo transversal avaliou os níveis plasmáticos de cortisol em 133 pacientes com carcinoma espinocelular (CEC) de boca e sua associação com variáveis demográficas, clínicopatológicas, biocomportamentais e psicológicas. Os níveis plasmáticos de cortisol foram mensurados por eletroquimioluminescência, e os níveis de ansiedade e depressão foram avaliados pelo Inventário de Ansiedade (BAI) e de Depressão (BDI) de Beck, respectivamente. Os dados demográficos, clinicopatológicos e biocomportamentais foram coletados dos prontuários dos pacientes. Os resultados da análise multivariada mostraram que homens com CEC de boca apresentaram 4,5 vezes mais chances de terem níveis elevados de cortisol plasmático do que as mulheres com a doença (OR=4,472; p=0,018). A presença de dor relacionada ao tumor primário também foi preditivo para maiores níveis de cortisol (OR=5,388; p=0,003). A ausência de histórico de consumo crônico de álcool foi um fator protetor para concentrações muito elevadas do hormônio nos pacientes com CEC de boca (OR=0,104; p= 0,004). Sintomas de ansiedade mensurados pelo BAI como "mãos trêmulas" (OR=0,192; p= 0,016) e estar "nervoso" (OR=0,207; p= 0,0004) foram associados a menores níveis de cortisol. Por outro lado, o sentimento de "medo de perder o controle" foi um fator de risco para níveis muito elevados de cortisol plasmático (OR=6,508; p= 0,0004). O score global e os sintomas específicos de depressão mensurados pelo BDI não foram preditivos para os níveis plasmáticos hormonais (p< 0,05). Juntos, os resultados mostram que sexo, dor, consumo de álcool e sintomas de ansiedade são variáveis independentes para os níveis sistêmicos de cortisol nos pacientes com câncer de boca. Portanto, intervenção psicológica, bem como o controle da dor e do alcoolismo devem ser considerados para a prevenção dos efeitos negativos da desregulação da secreção de cortisol nos pacientes diagnosticados com câncer de boca(AU)

Cancer patients may have a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal secretion of cortisol. Increased cortisol levels have been associated with worse prognosis in different types of cancer. Although anxiety and depression can trigger an abnormal cortisol secretion, little is known regarding the influence of these emotional disorders on HPA axis dysregulation in cancer patients when evaluating together with demographic, clinicopathological and biobehavioral variables. This crosssectional study analyzed the plasma cortisol levels of 133 patients with oral squamous cell carcinoma (OSCC) and its association with demographic, clinicopathological, biobehavioral and psychological variables. Plasma cortisol levels were measured by electrochemiluminescence, and anxiety and depression symptoms were assessed using Beck Anxiety Inventory (BAI) and Depression (BDI), respectively. Demographic, clinicopathological and biobehavioral data were collected from patients' medicalrecords. Results from multivariate analysis showed that men with OSCC were 4.5 times more likely to have higher plasma cortisol levels than women (OR = 4.472, p = 0.018). The presence of cancer-induced pain was predictive for higher cortisol levels (OR = 5.388, p = 0.003). The absence of chronic alcohol consumption history was a protective factor for highest hormonal concentrations in oral cancer patients (OR = 0.104, p = 0.004). Anxiety symptoms measured by BAI as "hands trembling" (OR = 0.192, p = 0.016) and being "nervous" (OR = 0.207, p = 0.0004) were associated with lower cortisol levels. In contrast, the feeling of "fear of losing control" was a risk factor for highest systemic levels cortisol (OR = 6.508, p = 0.0004). The global score and specific symptoms of depression measured by the BDI were not predictive for plasma hormone levels (p < 0.05). Together, our results show that sex, pain, alcohol consumption and anxiety symptoms are independent variables for systemic cortisol levels in patients with oral cancer. Therefore, psychological intervention, as well as control of pain and alcohol consumption, should be considered to prevent the negative effects of cortisol secretion dysregulation in patients with oral câncer(AU)

Evaluación de una intervención educativa sobre tabaquismo y su relación con la cavidad bucal / Evaluation of an educational intervention on smoking and its relationship with the oral cavity

Introducción: El tabaquismo se considera una epidemia de carácter universal y es una gravosa carga para el individuo, la familia y la sociedad. La cavidad bucal se afecta en toda su extensión y esto trae como resultado, efectos negativos sobre los tejidos que la conforman. Objetivo: Determinar las modificaciones en el nivel de conocimientos sobre tabaquismo y su relación con la cavidad bucal, con la aplicación de una intervención educativa. Métodos: Se realizó un estudio longitudinal en 55 voluntarios fumadores, de ambos sexos, adultos, del Hospital Militar Central Dr. Carlos J. Finlay, en el período comprendido de diciembre de 2017 a enero de 2018. Se les aplicó un cuestionario para determinar el nivel de conocimientos sobre tabaquismo y la cavidad bucal, antes y después de una intervención educativa. Se compararon los resultados de ambas aplicaciones. Resultados: El nivel de conocimientos fue suficiente en el 23,63 por ciento de los sujetos; después de aplicada la intervención aumentó al 83,63 por ciento. En relación con la enfermedad periodontal, predominaron los conceptos erróneos antes de la intervención (83,63 por ciento insuficiente) y después, respondió acertadamente el 65,45 por ciento. Conclusiones: La intervención aplicada fue efectiva para aumentar el nivel de conocimiento sobre el tabaquismo, relacionado con el cáncer oral y la enfermedad periodontal(AU)

Introduction: smoking is considered an epidemic of a universal nature and is a burden for the individual, the family and society. The oral cavity is affected to its full extent and this results in negative effects on its tissues. Objective: to determine the changes in the level of knowledge about smoking and its relationship with the oral cavity, with the application of an educational intervention. Methods: a longitudinal study was carried out in 55 smoking volunteers, of both sexes, adults, from the Hospital Militar Central Dr. Carlos J. Finlay, in the period from December 2017 to January 2018. A questionnaire was applied to determine the level of knowledge about smoking and the oral cavity, before and after an educational intervention. The results of both applications were compared. Results: the level of knowledge was sufficient in 23.63 percent of the subjects; after the intervention was applied, it increased to 83.63 percent. In relation to periodontal disease, misconceptions prevailed before the intervention (83.63 percent insufficient) and afterwards, 65.45 percent responded correctly. Conclusions: the intervention applied, was effective increasing the level of knowledge about smoking and oral cavity(AU)

Desordenes orales potencialmente malignos-Lo que el odontólogo debe conocer / Oral potentially malignant disorders-What the dentist should know

RESUMEN Objetivo: El objetivo de este estudio es actualizar los conocimientos sobre Desordenes Orales Potencialmente Malignos, dando énfasis a datos epidemiológicos, apariencia clínica, sintomatología, diagnóstico diferencial y manejo terapéutico, así como también resaltar el rol del odontólogo general en el examen clínico. Material y métodos: Fue realizada una búsqueda de la literatura en las bases de datos científicas "Medline", "Pubmed" y "SciELO", utilizando las palabras clave "Leukoplakia", "Erythroplasia", "Cheilitis", "Nevus, Pigmented", "Oral Submucous Fibrosis", "Lichen Planus". La búsqueda fue orientada hacia artículos de revisión, estudios clínicos y reportes de caso, priorizando los artículos publicados en los últimos 5 años y sin hacer distinciones por el idioma. Resultados: Como resultado de la búsqueda se obtuvieron 165 artículos, los cuales fueron revisados cuidadosamente para conservar solo aquellos que se dedicaran a describir, comparar o tratar desordenes con potencial de malignidad, incluyendo datos de relevancia como epidemiología, apariencia clínica, sintomatología, diagnóstico diferencial y manejo terapéutico. De esta manera, el estudio se limitó a 41 artículos. Conclusiones: Al adoptar medidas preventivas, así como un meticuloso examen clínico sobre tejidos blandos, se puede facilitar la detección temprana de Desordenes Orales Potencialmente Malignos. La eliminación de lesiones sospechosas o un control de las condiciones cancerígenas puede evitar en gran mayoría el desarrollo de tumores malignos.

SUMMARY Objective: The objective of this study is to update scientific knowledge about OPMDs, emphasizing epidemiological data, clinical appearance, symptomatology, differential diagnosis and therapeutic management, as well as highlighting the role of the general dentist in the clinical examination. Material and methods: A literature search was carried out, making use of the keywords "Leukoplakia", "Erythroplasia", "Cheilitis", "Nevus, Pigmented", "Oral Submucous Fibrosis" and "Lichen Planus". Prioritizing articles published in the last 5 years on the scientific databases "Medline", "Pubmed" and "SciELO". Results: As a result of the search, 165 articles were obtained, which were carefully reviewed to preserve only those that were dedicated to describe, compare or treat lesions with malignant potential, including relevant data such as epidemiology, clinical appearance, symptomatology, differential diagnosis and management. therapeutic. In this way, the study was limited to 41 articles. Conclusions: By taking preventive measures, as well as through a clinical examination of soft tissues, early detection of potentially malignant disorders can be facilitated. The removal of suspicious lesions or a control of their carcinogenic conditions can largely prevent the development of malignant tumors.

A Comparative Study of Maximum Mouth Opening amongst Postoperative Oral Cancer Patients with or without Radiotherapy

Introduction: Restricted mouth opening is a long-termsequelae of head neck cancer treatment. This is a majorconcern as it leads to multiple problems in maintenanceof oral hygiene, speech, chewing, swallowing, prostheticrehabilitation, and follow-up intra-oral examination. Inthis study, our aim was to assess maximum mouth opening(MMO) amongst postoperative oral cancer patients withor without conventional radiotherapy over a period ofone year.Material and methods: A prospective longitudinal study wasdone in oral cancer patients, within three years, to compareeffect of post-operative radiotherapy (PORT) on MMO overa follow-up period of one year with control of post-operativecases without radiation. Level of significance was set at alphalevel 0.05.Results: Among 18 patients of PORT and 19 patients ofcontrol group, repeated measure ANOVA were significantfor the following parameters: within subject effect in eachgroup; between subject effect and interaction effect of monthand radiation. Multiple pairwise comparison showed MMOat 3rd, 6th, 9th and 12th month were significantly different inPORT group, in comparison to preoperative MMO. In thecontrol group however, only postoperative MMO at 1st monthwas significantly different. After one-year, mean MMO, inPORT and control was 32.56±4.29mm and 46.37±4.65mm,respectively and total trismus in radiotherapy group was66.67% and that of control group was nil.Conclusion: Conventional radiotherapy in oral cancer patientscan lead to high rate of trismus as a late effect. Strict exerciseprotocol along with close monitoring is recommended to havebeneficial effect to the patients.

Granular cell tumor in female neonate: a case report / Tumor de células granulares em neonato do sexo feminino: relato de caso

ABSTRACT The granular cell tumor (GCT) is a neoplasm of connective tissue which rarely occurs in children. This case report aims to describe and discuss the presentation of this tumor in a female neonate. Compared to previous literature, the case report demonstrated a rare form of presentation of this tumor in an unusual age group.

RESUMEN O tumor de células granulares (TCG) é uma neoplasia de tecido conjuntivo que ocorre raramente em crianças. Este relato de caso descreve e discute a apresentação desse tumor em um neonato do sexo feminino. Em comparação com estudos anteriores, o caso reportado demonstrou uma forma rara de apresentação em uma faixa etária não usual.

RESUMO O tumor de células granulares (TCG) é uma neoplasia de tecido conjuntivo que ocorre raramente em crianças. Este relato de caso descreve e discute a apresentação desse tumor em um neonato do sexo feminino. Em comparação com estudos anteriores, o caso reportado demonstrou uma forma rara de apresentação em uma faixa etária não usual.

Oral carcinoma development after 23 years of renal transplantation

Renal transplant patients are treated with immunosuppressive drugs that decrease the effectiveness of the immune system, making them more prone to developing cancer. Skin and lip carcinomas are common malignancies encountered after transplantation, whereas oral carcinomas are rare. We report the case of a 51-year-old female Caucasian patient, with no history of smoking, who presented white lesions on the tongue and an ulcerated lesion on the lower lip beginning 4 months prior. Diagnosis of squamous cell carcinoma for both lesions was made following incisional biopsies. Interestingly, the patient reported a renal transplantation 23 years prior, and was maintained on a combination of cyclosporine, mycophenolate sodium and prednisone. The patient also presented a history of several basal and squamous cell carcinomas on sun-exposed areas of the skin. Both lesions were surgically excised. No sign of recurrence or new lesions in the oral cavity have been observed; however, new skin lesions are frequently diagnosed. This case report highlights that oral cancers may occur in transplant patients in the absence of classical risk factors. Thus, clinicians must be aware of the importance of thorough oral examination in transplant patients in routine follow-up.

Determination of Factors Associated with Critical Weight Loss in Oral Cavity Carcinoma Patients: A Retrospective Cohort Study

Abstract Introduction Critical weight loss is defined as an unintentional weight loss of ≥ 5% at 1 month or ≥ 10% at 6 months from the start of treatment. Critical weight loss leads to deterioration of the immune function and reduced tolerance to treatment (surgery ± radiochemotherapy) as well as increased complication rates. Objective Critical weight loss, defined as a weight loss of ≥ 5% after 1 month or ≥ 10% after 6 months from the start of treatment, is not uncommon in head and neck cancer patients. We aimed to assess the factors associated with critical weight loss during the treatment of oral cavity squamous cell carcinoma patients. Methods A retrospective cohort study was performed at the Aga Khan University Hospital, in Karachi, Pakistan, on 125 patients. Patients receiving adjuvant therapy were considered exposed, and the outcome was critical weight loss. Results The mean age of presentation was 46.9 ± 12.8 years in patients undergoing surgery and adjuvant therapy, with 119 (79.3%) of them being male and 31 (20.7%) female. One hundred and twelve patients (81.3%) developed critical weight loss at 6 months from the start of treatment, and the only significant variable associated with critical weight loss was the stage of the disease (p= 0.03). Conclusion A large proportion of patients with oral cancer developed critical weight loss requiring a need for intervention. The overall stage of the disease is a significant predictor of critical weight loss in patients undergoing treatment.

Single-photon emission computed tomography for the diagnosis of mandibular invasion caused by oral cancers: a systematic review and Meta-analysis / 华西口腔医学杂志

Objective This review aimed at assessing the diagnostic efficacy of contrast-enhanced single-photon emission computed tomography (SPECT) in the diagnosis of mandibular invasion by oral cancers. Methods Five databases were searched electronically on August 5, 2016. The reference lists of included studies were hand searched. Quality assessment was performed by two reviewers in duplicate with tools suggested by Cochrane's handbook. Furthermore, the data extraction of included studies was delivered. Meta-analysis was performed using STATA 11.0. Results Ten studies with 460 participants were included. One study had a low risk of bias, and two studies had a high risk of bias. The remaining seven studies had an unclear risk of bias. Meta-analysis results showed that SPECT had a pooled sensitivity of 0.99 [95% confidence interval=0.87-
1.00]. Sensitivity was 0.99 on Q* point. The specificity of 0.61 and the area under summary receiver operating characteristic curve (SROC) were 0.93 [95% confidence interval=0.90-
0.95]. The pooled positive likelihood ratio was 2.555. The negative likelihood ratio was 0.015. The diagnostic odd ratio was 5.115. Conclusion SPECT had high sensitivity, which became suitable for excluding bone invasion by oral cancers. However, its specificity was relatively low, indicating its limited capability in confirming diagnosis. Therefore, surgeons should perform this method under certain conditions.

Estaniocalcina 2 modula eventos importantes para a tumorigênese oral e é um marcador prognóstico para pacientes com carcinoma de células escamosas oral / Staniocalcin 2 modulates important events for oral tumorigenesis and is a prognostic marker for patients with oral squamous cell carcinoma

O hormônio glicoproteico estaniocalcina 2 (STC2) está envolvido na carcinogênese e progressão de muitos tipos de câncer. No entanto, seu significado clínico e mecanismos moleculares no carcinoma de células escamosas oral (CCEO) foram pouco estudados e permanecem incertos. O presente estudo investigou associações da expressão da STC2 com parâmetros clinicopatológicos e de sobrevida em pacientes com CCEO. Além disso, foram avaliados os efeitos biológicos causados pela redução dos níveis de STC2 em linhagens celulares de CCEO e fibroblastos associados ao câncer (do inglês CAF ­ carcinoma associated fibroblasts). A análise imunoistoquímica em 100 casos de CCEOs primários indicou que a superexpressão da STC2 foi associada com o parâmetro N do sistema TNM e foi um fator de risco independente para sobrevida específica da doença e sobrevida livre de doença em pacientes com CCEO. Usando ensaios in vitro, foi demonstrado que o silenciamento da STC2 em linhagens de CCEO promoveu a apoptose e reduziu a proliferação celular, migração, invasão e transição epitélio-mesenquimal. Análises adicionais revelaram que o CAF expressa maiores níveis de STC2 do que as células de CCEO. O silenciamento da STC2 no CAF reduziu a invasão celular do CCEO, sugerindo que a STC2 liberada por CAFs contribui para um fenótipo mais invasivo no CCEO. Esses resultados sugerem que a STC2 modula eventos importantes para a tumorigênese oral e pode ser um biomarcador prognóstico para pacientes com CCEO (AU).

The glycoprotein hormone stanniocalcin 2 (STC2) is involved in carcinogenesis and progression of several cancer types. However, its clinical significance and molecular mechanisms in oral squamous cell carcinoma (OSCC) have been partially studied and remain uncertain. In the present study, we investigated associations of STC2 expression with clinicopathological and survival parameters of OSCCs patients. We also determined the biological effects caused by STC2 downregulation in OSCC and cancer associated fibroblasts (CAF) cell lines. Immunohistochemical analysis in 100 cases of primary OSCC indicated that STC2 overexpression was associated with N stage (TNM staging) and was an independent risk factor for disease-specific survival and disease-free survival in patients with OSCC. Using in vitro assays, we demonstrated that STC2 knockdown in OSCC cell lines promoted apoptosis, and reduced cell proliferation, migration, invasion and epithelial-mesenchymal transition. Further analysis revealed that CAF expresses higher levels of STC2 than OSCC cells. Knockdown of STC2 in CAF reduced OSCC cell invasion, suggesting that STC2 released by CAF contributes to a more invasive phenotype in OSCC. These results suggest that STC2 modulates important events for oral tumorigenesis and can be a prognostic biomarker for OSCC (AU).

Lipoma gigante en el labio inferior: Un caso inusual / Giant lipoma on lower lip: an unusual case

Introducción: los lipomas son tumores mesenquimales benignos que consisten esencialmente en adipocitos maduros, poco comunes en la cavidad oral comparada con otras superficies corporales. Lesiones de gran tamaño son relativamente raras y el labio inferior no es un sitio muy habitual. Se caracteriza por ser una lesión de crecimiento lento que puede alcanzar grandes dimensiones y son generalmente asintomáticos. Objetivo: caracterizar un caso de lipoma gigante en el labio inferior con algunas características clínicas e histopatológicas de esta lesión. Presentación del caso: se describe un caso de lipoma gigante que afecta el labio inferior de un paciente de 55 años de edad, de sexo masculino con una evolución asintomática de ocho años. Se realizó una exéresis completa y el examen histopatológico reveló un lipoma. Conclusiones: el paciente está bajo seguimiento y sin signos de recidiva. Las características clínicas y microscópicas fueron de gran importancia para el diagnóstico(AU)

Introduction: lipomas are benign mesenchymal tumors which consist essentially of mature adipocytes, and are relatively uncommon in the oral cavity comparing with other body surfaces. Large lesions are relatively rare and lower lip is not a very usual site. This is characterized as a slow growing lesion which might reach large dimensions and are usually asymptomatic. Objective: to show a case of giant lipoma affecting lower lip and to comment on its clinical and microscopic features. Case report: in this study, we describe a case of giant lipoma affecting lower lip of a 55 years-old male with an asymptomatic evolution of eight years. We performed a complete excision, and the histopathological examination revealed a lipoma. Conclusions: actually, the patient is under follow up without signs of recurrence. The clinical and microscopic characteristics were very important for the diagnosis(AU)

Dysregulation and detection methods of EGFR in oral cancer: a narrative review / Desregulación y métodos de detección del EGFR en cáncer oral: revisión narrativa

Abstract: epidermal growth factor receptor (EGFR) is a transmembrane glycoprotein, with an intracellular domain and tyrosine kinase function (TK) involved in cell proliferation. Dysfunctions in EGFR signaling pathways have been associated with oral malignant tumors such as oral squamous cell carcinoma (OSCC). Dysfunctions of EGFR may result from: increased EGF ligand; EGFR overexpression and copy number gain of the EGFR gene (EGFR CNG); EGFR mutations; failure in the downregulation of EGFR; and EGFR crosstalk. Of these alterations, overexpression of EGFR is by far the most studied dysfunction in OSCC. Clinicians should identify possible alterations of EGFR in the oral mucosa of patients, as EGFR can act as a biomarker for the diagnosis and prognosis of OSCC. Currently, there are several methods and techniques for detecting EGFR. Immunohistochemistry (IHC), fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR), are used to identify overexpression of EGFR, EGFR CNG and EGFR mutations, respectively. Detection of EGFR as a biomarker is key to identify any oral malignant transformation. Consequently, it becomes imperative to implement a non-invasive and inexpensive method of early diagnosis for OSCC in clinical practice.

Resumen: el receptor del factor de crecimiento epidérmico (EGFR) es una glicoproteína transmembrana, con un dominio intracelular y función tirosina quinasa (TK) que participa en la proliferación celular. Las fallas en las vías de señalización del EGFR se han asociado con la formación de tumores malignos orales como el carcinoma oral de células escamosas (COCE). El incorrecto funcionamiento del EGFR puede producirse por: aumento del ligando EGF; sobreexpresion del EGFR y ganancia en el número de copias del gen EGFR (GNC EGFR); mutaciones del EGFR; falla en la regulación negativa del EGFR; y diafonía del EGFR. De las alteraciones mencionadas, la sobreexpresion de EGFR es por lejos la disfunción más estudiada en COCE. Para el clínico es importante poder identificar las posibles alteraciones del EGFR en la mucosa oral del paciente, esto debido a que el EGFR puede actuar como un biomarcador de diagnóstico y pronóstico para COCE. En la actualidad existen diversos métodos para detectar el EGFR. La inmunohistoquímica (IHC), la hibridación fluorescente in situ (FISH) y la reacción en cadena de la polimerasa (PCR), son técnicas utilizadas para identificar la sobreexpresion del EGFR, GNC EGFR y mutaciones del EGFR, respectivamente. La necesidad de detección de estas alteraciones se debe a la transcendencia del EGFR como biomarcador de transformación maligna. Lo anterior, hace necesario implementar un método de diagnóstico precoz para COCE que sea no invasivo y de bajo costo para la práctica clínica.

Cáncer oral en Chile: revisión de la literatura / Oral cancer: review of the Chilean literature

Background: Oral cancer is a public health problem. Its world incidence in 2012, was 4.0 new cases per 100,000 inhabitants. Aim: To review the published literature on oral cancer in Chile. Material and Methods: Narrative review of the literature using databases such as Pubmed, Scielo and Google Scholar. The Key words oral cancer in Chile, Oral Cancer, Oral Cancer AND Chile were used. A critical appraisal the articles was carried out. Results: Of 27 eligible studies, 11 studies were included and data from population registries were used. Oral and Oropharyngeal cancer mortality is 1% and morbidity corresponds to 1.6% of all cancers in Chile. By 2010 according to different authors, the male: female ratio ranges from 1.3: 1 to 1.4: 1 and the five years survival, from 46% to 56.9%. The main risk factors are smoking and alcohol use. Conclusions: The number of articles published in Chile about oral cancer is low.

In vitro investigation on the mechanism of cyclooxygenase-2 upregulation induced by spleen tyrosine kinase-nuclear factor κB signaling in cancer pain caused by oral cancer-associated macrophage / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study explores the mechanism of cyclooxygenase-2 (COX-2) upregulation in oral cancers associated with macrophage by using molecular biology techniques and primary culture of murine macrophage.</p><p><b>METHODS</b>Murine macrophage was induced by macrophage colony-stimulating factor (M-CSF) and Cal27 conditional medium (CM). Purity of the macrophage was detected through CD68 immunofluorescence staining. Inhibitors of spleen tyrosine kinase (Syk) and nuclear factor κB (NFκB) were used to inhibit these pathways. In addition, real-time polymerase chain reaction and Western blot analysis were used to detect alterations in COX-2 and pathway-related proteins.</p><p><b>RESULTS</b>All of the induced cells specifically expressed CD68. Cal27 CM could significantly induce COX-2 expression (P<0.001). Moreover, inhibition of Syk pathway attenuated NFκB-P65 phosphorylation and reduced COX-2 expression (P<0.01), and inhibition of NFκB pathway exerted no effects on Syk phosphorylation but significantly inhibited COX-2 upregulation (P<0.01).</p><p><b>CONCLUSIONS</b>Syk-NFκB is responsible for COX-2 overexpression in oral cancer associated with macrophages. Targeting this pathway is possibly a new approach to control oral cancer-related pain.
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Câncer bucal: um problema de saúde pública / Oral cancer: a public health problem

O presente estudo teve por objetivo investigar a epidemiologia do câncer bucal no Brasil, por meio da revisão de literatura publicada nos últimos anos. Com isso, pretendeu-se descrever o perfil dos pacientes diagnosticados e susceptíveis ao câncer bucal, e ressaltar a importância da prevenção e diagnóstico precoce das lesões suspeitas. Observou-se que o perfil epidemiológico dos indivíduos mais acometidos pelo câncer de boca é caracterizado por homens, brancos, na faixa etária entre 50 e 70 anos de idade, trabalhadores expostos ao sol, usuários crônicos de tabaco, álcool ou a associação destes; os indivíduos de maior risco podem ainda apresentar trauma crônico devido ao uso de prótese; a localização da lesão é, principalmente, no dorso da língua e no lábio inferior. Considerando o câncer bucal como um problema de saúde pública, maiores esforços devem ser despendidos para a prevenção e combate dessa doença na população

The aim of this study was to investigate the epidemiology of oral cancer in Brazil, through a review of literature published in recent years. Thus, it was described the profile of diagnosed and susceptible to oral cancer patients, and it was emphasized the importance of prevention and early diagnosis of suspicious lesions. It was observed that the epidemiological profile of individuals most affected by mouth cancer is characterized by white men, between 50 to 70 years old, workers exposed to the sunlight, chronic users of tobacco, alcohol or a combination of them. The high risk individuals may still have chronic trauma due to the use of prosthesis. The lesion is mainly on the back of the tongue and lower lip. Whereas oral cancer as a public health problem, greater effort should be made to prevent and combat this disease in the population

Exérese de Extenso Lipoma em Região Submandibular: Relato de Caso / Excision of extensive Lipoma in Submandibular Region: A Case Report

Os lipomas são as neoplasias mesenquimais mais frequentes do corpo humano. No aspecto histopatológico, são constituídos basicamente de adipócitos maduros. Clinicamente, apresentam-se como massas nodulares, sésseis ou pedunculadas, de consistência amolecida, aspecto gelatinoso e de superfície lisa; frequentemente são assintomáticos e sem ulcerações. O presente artigo tem por objetivo fazer o relato de caso de um lipoma na região submandibular, em íntimo contato com a artéria carótida externa, num paciente de 62 anos de idade, em que o tratamento proposto foi a biópsia excisional sob anestesia geral e acesso extraoral. Após a remoção total da lesão, foi realizada a limpeza da ferida cirúrgica seguida da síntese por planos. O caso foi proservado durante 18 meses, sem evidências de recidiva.

Lipomas are the most common mesenchymal neoplasms of the human body. In histopathology consist primarily of mature adipocytes. Clinically, it presents as nodular masses, sessile or pedunculated, soft consistency, gelatinous appearance and smooth surface; often are asymptomatic and without ulceration. This article aims to make the case report of a lipoma in the submandibular region, in close contact with the external carotid artery in a patient 62 years of age, in which the treatment was excision biopsy under general anesthesia and access extra -oral. After removal of the lesion was performed to clean the wound followed by the synthesis. The case was proservado for 18 months without evidence of recurrence.

Tipos de tabaquismo como factor de riesgo asociado a cáncer bucal. Reporte de dos casos / Types of smoking as a risk factor for oral cancer. literature review and report of two cases

El tabaquismo corresponde a uno de los hábitos más comunes en la población mundial, tanto en hombres como en mujeres, siendo un factor de riesgo para el desarrollo de lesiones neoplásicas malignas y premalignas en la cavidad bucal. Las diferentes formas de utilización de este hábito, como fumar cigarrillo de manera convencional, tabaquismo invertido y pasivo, presentan variables en cuanto a la incidencia y prevalencia de aparición de tumores, así como el tipo, cantidad y la intensidad de tabaco consumido. Las células epiteliales que recubren la mucosa bucal reaccionan como mecanismos de defensa ante el estímulo del humo y la combustión, al igual que frente a los sustancias químico- tóxicas que de ellos provienen; manifestándose como lesiones que varían entre leucoedemas, hiperqueratosis nicotínicas, fibrosis epiteliales, lesiones precancerosas, carcinomas in situ, hasta el desarrollo de verdaderas neoplasias malignas. El estomatólogo juega un rol fundamental en el diagnóstico oportuno y la prevención de estas afecciones, puesto que está entrenado para detectar cualquier lesión en estado incipiente, y así simplificar su tratamiento, mejorando la calidad de vida del paciente; pero mucho más importante que detectar la lesión es prevenir que aparezca, orientando, población y combatiendo los factores de riesgo. Se presentan dos casos de pacientes fumadoras activas que acudieron al servicio de Estomatología y Cirugía Oral de la Fundación Universitaria San Martín, sede Puerto Colombia, por presentar lesiones tumorales en cavidad bucal semejantes clínicamente a carcinomas bucales; a quienes se les realizaron biopsias que confirmaron diagnósticos de carcinoma escamocelular.

Smoking corresponds to one of the most common habits in the world's population, both men and women, being a potential risk factor for developing pre-malignant and malignant lesions in the oral cavity malignancies. The different ways of using the cigarette smoking habit as conventionally, invested and passive smoking variables present in the incidence and prevalence of tumors and the type, amount and intensity of snuff consumed. The epithelial cells lining the mucosa of the oral cavity as defense mechanisms react to the stimulus of the smoke and combustion, as compared to the toxic chemicals from them, manifesting as lesions ranging from Leukoedema, nicotinic hyperkeratosis, pigmentation melanin, fibrosis epithelial precancerous lesions, carcinoma in situ, to the development of true malignancy. The stomatology plays a fundamental role in the early diagnosis and prevention of these conditions, since their task is to detect any injury in its infancy and so simplify treatment, improve the quality of life for patients, but more important to detect injury, is to prevent it appears, guiding, educating people and fighting the risk factors. Here are two new cases of active smokers who attended the Service of Stomatology and Oral Surgery of the University Foundation San Martin - Puerto Colombia, tumor lesions clinically similar oral cavity squamous carcinomas, who underwent biopsies confirmed diagnosis of squamous cell carcinoma.