Immunohistochemical expression of OCT4 and CD44 in major and minor salivary gland neoplasms

Abstract The aim of this study was to identify tumor parenchyma cells exhibiting immunohistochemical profile of stem cells by evaluating the immunoreactivity of OCT4 and CD44 in a number of cases of salivary gland neoplasms. The sample consisted of 20 pleomorphic adenomas, 20 mucoepidermoid carcinomas, and 20 adenoid cystic carcinomas located in major and minor salivary glands. The expression of OCT4 and CD44 was evaluated by the percentage of positive cells and the intensity of expression. All studied cases showed positive expression of OCT4 and CD44 and higher values than the control groups. For OCT4, luminal and non-luminal cells were immunostained in the case of pleomorphic adenomas and adenoid cystic carcinomas. Moreover, the immunoreactivity of CD44 was particularly evident in the non-luminal cells of these lesions. In mucoepidermoid carcinomas, there was immunoreactivity for both markers in squamous and intermediate cells and absence of staining in mucous cells. For both markers, a significantly higher immunostaining was verified in neoplasms located in the major salivary glands compared with lesions in minor salivary glands (p<0.001). In the total sample and in minor salivary glands, malignant neoplasms exhibited higher immunoreactivity for OCT4 than pleomorphic adenoma. A significant moderate positive correlation (r = 0.444 and p ≤ 0.001) was found between OCT4 and CD44 immunoexpression in the total sample. The high expression of OCT4 and CD44 may indicate that these proteins play an important role in identifying tumor stem cells.

Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis

Abstract: BACKGROUND: Recurrent aphthous ulcerations are common benign ulcerated lesions on the mouth, whose etiology is poorly understood, with controversial treatment and difficult to control in clinical practice. OBJECTIVE: To evaluate the cases of recurrent aphthous ulcerations with a focus on treatment, diagnosis and etiology. METHODS: This is a retrospective study of the cases of the Oral Diagnosis service of the Rio Grande do Norte Federal University in Natal/RN. Data such as sex, age, race, location, smoking habits, types of treatment, relapsing episodes, laboratory test results and clinical characteristics were collected. The associations between the variables were analyzed using the Pearson Chi-square test (p <0.05). RESULTS: A total of 4895 patients were seen in the service over a period of 11 years. Of these, 161 (3.3%) had complaints of oral aphthous ulcerations, of which 76 (47.2%) were diagnosed as suffering from recurrent aphthous ulcerations and 68 (42.2%) with clinical information necessary for evaluation. The tongue was the most affected anatomical region, with 27 individuals (39.7%), followed by the buccal mucosa, with 22 cases (32.3%). STUDY LIMITATIONS: Retrospective study with data from medical records. CONCLUSION: Dental surgeons, dermatologists and otorhinolaryngologists are the main responsible for the first contact with patients with this disease and should be attentive to the clinical aspects and treat each patient in an individualized way, since the therapy is palliative, its diagnosis is by exclusion and its etiology is unknown.

Complex rehabilitation of atrophic mandible with implant-supported prosthesis

ABSTRACT: In this study, we report the case of a patient presenting a severe atrophic mandible that was treated with short implants and stable internal fixation, without using bone grafts or biomaterials. The patient had a long history of failure of several previous consecutive treatments. Cone-bean tomography revealed a small amount of mandibular bone, suggesting a high risk of fracture of the mandible during drilling and installation of osseointegrated implants. We opted to place 5 implants (4.0 × 7.0 mm) between the mental foramens. Since the mandible presented a high risk of fracture, we inserted a titanium plate (2.3 mm) as bone reinforcement along the entire length of the mandible, including the bilateral mandibular angles. A Branemark type prosthesis was installed 5 days after the procedure. After 24 months, the patient continues to be satisfied and presents good masticatory functions without any complications.

Sobrevida e fatores prognóstico do Carcinoma Epidermóide de Boca e Orofaríngeo: análise de 1776 casos / Survival and prognostic factors of oral and oropharyngeal squamous cell carcinoma: analysis of 1776 cases

O carcinoma epidermóide (CE), destaque para o de boca (CEB) e orofaríngeo (CEOf), é o tipo de câncer mais frequente na região de cabeça e pescoço, com mais de 90% de apresentação nessas regiões, representando 6% de todos os carcinomas. Avaliação epidemiológica dessa patologia com base populacional ainda é escassa e essa neoplasia é um problema de saúde pública no Brasil e no mundo. Diante desses fatos, este estudo tem o propósito de descrever e analisar a sobrevida com destaque para os principais fatores associados ao seu prognóstico. Para isso foi realizado um estudo de prognóstico retrospectivo em bancos de dados e prontuários, onde foram selecionados todos os casos com diagnóstico de CEB e CEOf da Liga Norte Riograndense Contra o Câncer, dos últimos 11 anos. As sobrevidas foram calculadas com Kaplan-Meier e comparação das funções com Log-Rank. Os riscos calculados em modelos univariados de Cox e modelos preditivos na análise multivariada de Cox. Para Sobrevida Livre da Doença (SLD) do CEB destacaram-se como fatores de pobre prognóstico, o Sistema de Gradação Histopatológica de Malignidade (SGHM) da Organização Mundial da Saúde (OMS) em pouco diferenciada, localização na região retromolar, não ter companheiro conjugal, estadiamento avançados e tratamentos mais complexos. Essas características se repetiram na Sobrevida Global (SG) para CEB, com exceção do estado conjugal atual. Na SG do CEOf, a localização em base de língua e o consumo de álcool obtiveram os piores prognósticos. Já para SLD do CEOf, o SGHM OMS em pouco diferenciado, tabagismo e não ter companheiro conjugal, obtiveram os piores prognósticos. O SGHM OMS parece ser um fator prognóstico eficaz para o CEB. Não ter companheiro pode comprometer a SLD (CEB e CEOf), com repercussão na qualidade de vida do paciente, adesão e manutenção do tratamento. Os fatores de riscos já bem estabelecidos, como consumo de álcool e fumo, parecem se comportar como fatores prognóstico importantes no CEOf, mas devem ser abordados com cautela, principalmente quando não verifica-se o tipo, tempo e quantidade utilizados. Mesmo com a melhora na sobrevida do CEO e CEOf mediante avanços no tratamento, ela ainda preocupa a medida que aumenta a dificuldade do diagnóstico (Lábio>Oral>Orofaringe). Tanto para CEB como para o CEOf as sobrevidas foram consideradas medianas, reafirmando fatores prognósticos já bem estabelecidos, como estadiamento clínico e localização, outros ainda controversos, como SGHM, habito de fumar e de beber, ganharam força como fatores prognósticos independentes e um coadjuvante inesperado, o estado conjugal atual (AU).

The most common type of cancer in the head and neck region is the squamous cell carcinoma (SCC), which is more frequent in the mouth (SCCM) and oropharyngeal (SCCO), with a presentation of more than 90% in these regions, representing 6% of all carcinomas. Epidemiological evaluation of this population-based pathology is still scarce and this neoplasm is a public health problem in Brazil and in the world. Faced with these facts, this study aims to describe and analyze survival, highlighting the main factors associated with its prognosis. For this, a retrospective prognostic study was carried out in databases and medical records, where all the cases diagnosed with SCCM and SCCO of the North League Riograndense Against Cancer of the last 11 years were selected. Survival were calculated with Kaplan-Meier and comparison of functions with Log-Rank. The risks calculated in univariate Cox models and predictive models in the multivariate analysis of Cox. For SCCM's Disease Free Survival (DFS) the poor prognostic factors, the histopathological gradation system of malignancy (HGSM) of the World Health Organization (WHO) in little differentiated, location in the retromolar region, not having conjugal companion, advanced staging and more complex treatments. These characteristics were repeated in the Global Survival (GS) for SCCM, with the exception of the current marital status. In the GS of the SCCO, localization in basis of language and alcohol consumption obtained the worst prognoses. Already for DFS of SCCO, the HGSM in little differentiated, smoking and having no marital partner, obtained the worst prognoses. The HGSM appears to be an effective prognostic factor for SCCM. Not having a partner can compromise DFS (SCCM and SCCO), with repercussion on patient's quality of life, adherence and maintenance of treatment. Wellestablished risk factors, such as alcohol and smoking, seem to be important prognostic factors in SCCO, but should be approached with caution, especially when the type, time, and quantity used are not checked. Even with the improvement in the SCCM's and SCCO's survival through advances in treatment, she is still worrisome, as the difficulty of diagnosis increases (Lip> Oral> Oropharynx). Both SCCM and SCCO were considered median, reaffirming already well established prognostic factors, such as clinical staging and localization, others still controversial, such as HGSM, smoking and drinking habits, gained strength as independent prognostic factors and an unexpected coadjutant, the current marital status. Keywords: Epidermoid carcinoma; mouth; oropharynx; prognosis (AU).

Comportamento dos tecidos peri-implantares quando utilizada carga imediata em implantes unitários na região anterior de maxila: uma revisão sistemática / Peri-implantation tissue behavior when used immediate loading in unit implants in the previous region of maxila: a systematic review

Objetivo: Avaliar o comportamento dos tecidos peri-implantares (moles e duros) após a carga imediata de implantes unitários em áreas estéticas de maxila. Material e Métodos: Uma busca eletrônica foi realizada nas bases de dados BVS e PubMed por dois avaliadores independentes. Quando não houve consenso entre os avaliadores, depois de ler o artigo completo, um terceiro revisor foi incluído. Foram acrescidos textos completos de ensaios clínicos dos últimos 15 anos que avaliaram os seguintes parâmetros: altura da crista óssea, altura da papila interdental e recessão gengival vestibular. Resultados: Um total de nove artigos foi selecionado. Os dados mostraram que o comportamento dos tecidos peri-implantares em implantes com carga imediata foi muito semelhante aos observados em implantes com carga tardia. Além disso, em maiores períodos de acompanhamento, foi verificado que as papilas podem migrar coronalmente ao longo do tempo e que os tecidos duros apresentaram perda óssea média a 1,0 mm, independentemente da utilização ou não de carga imediata. No que diz respeito à estética, em geral, os pacientes ficaram satisfeitos e as perdas notadas ao longo do tempo parecem não interferir da satisfação estética do paciente. Conclusões: A perda de papilas, recessão gengival vestibular e perda óssea podem ocorrer silenciosamente, sendo o tempo mais importante para sua ocorrência que a utilização de carga imediata ou não, o que torna a carga imediata uma alternativa viável e promissora em regiões estéticas sem comprometer o comportamento dos tecidos peri-implantares. (AU)

Objective: Evaluate the behavior of peri-implant tissues (soft and hard) after loading. Low implants in aesthetic maxilla units. Material and methods: Therefore an electronic search was performed in the VHL and PubMed databases by two independent evaluators. When there was no consensus among the reviewers, after reading the full article, a third reviewer was included. We included complete texts of clinical trials of the last 15 years, which ancestors the respective parameters: height of the bone crest, height of the interdental papilla and gingival vestibular recession. Results: A total of nine articles were selected. The data showed that the behavior of the peri-implant tissues in loaded implants. There were very important observations in late load implants. In addition, at longer follow-up periods, it was verified that as papillae may migrate coronally over time and with hard tissues they presented mean bone loss of 1.0 mm, regardless of whether or not the load was used. With regard to aesthetics, patients were generally satisfied and perceived losses over time without interference from the aesthetic satisfaction of the patient. Conclusions: Thus, a loss of papillae, vestibular gingival recession and bone loss can occur silently, being the most important time for its occurrence that the use of load, there is not, which makes a load of a viable and promising alternative in aesthetic regions without Compromise the behavior of peri-implant tissues. (AU)

Expression of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of the oral tongue

Abstract Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) act in the proteolysis of basement membrane and extracellular matrix structures, facilitating tumor invasion. The purpose of this study was to evaluate the relationship between these proteins and clinicopathological parameters in squamous cell carcinoma of the oral tongue (SCCOT). Sixty cases of SCCOT were submitted to immunohistochemistry and analyzed semiquantitatively at the invasion front and in the tumor core. The results were associated with lymph node metastasis, clinical stage, locoregional recurrence, clinical outcome and histological grade of malignancy. A higher expression of uPA was observed in cases of tumors of high-grade versus low-grade malignancy (p = 0.010). Moreover, the cases with the worst pattern of invasion presented an overexpression of uPA (p = 0.011). The presence of locoregional recurrence was associated with uPAR (p = 0.039), and the expression of both biomarkers was much higher at the invasion front than in the tumor core (p < 0.001). The results suggest uPA and uPAR are involved in the progression and aggressiveness of SCCOT, mainly at the tumor-host interface.

Implante dentário e temporização imediata em área estética com enxerto conjuntivo subepitelial e biomaterial xenogênico / Immediate dental implant and temporization in the esthetic zone using the subepithelial connective tissue technique and a xenogeneic biomaterial

O presente relato de caso discutiu as vantagens da implantação e temporização imediata de elementos unitários em áreas estéticas, sem abertura total de retalho, com a utilização de enxerto conjuntivo subepitelial e preenchimento alveolar com biomaterial. O acompanhamento a longo prazo desta técnica (nove meses) mostrou que essa proposta favoreceu a manutenção da arquitetura tecidual, permitindo excelência na finalização protética.

This case report discusses the advantages of immediate implant placement and temporization of several elements in the esthetic zone without complete flap opening, and still using the subepithelial connective tissue graft and the alveolar filling with a biomaterial. The long-term results (nine months) demonstrated a favorable response at the tissue architecture, with excellent prosthetic delivery.

Expressão imunoistoquímica da endoglina (CD105) e do fator de von Willebrand em carcinoma epidermoide oral e sua relação com parâmetros clinicopatológicos / Immunohistochemical expression of endoglin (CD105) and von Willebrand factor in oral squamous cell carcinoma and its relationship with clinicopathological parameters

CONTEXTO: A angiogênese tem sido associada à progressão de neoplasias malignas e, embora haja estudos acerca de marcadores angiogênicos no carcinoma epidermoide oral (CEO), existem resultados conflitantes na literatura. OBJETIVOS: Avaliar a expressão imunoistoquímica do CD105 e do fator de von Willebrand (FvW) em CEO e sua relação com parâmetros clínicos do tumor. MÉTODOS: A imunoexpressão dos referidos biomarcadores foi analisada em 30 casos de CEO e correlacionada a parâmetros clínicos do tumor (idade e sexo dos pacientes, localização anatômica e estadiamento clínico Tumor, Nodo e Metástase, TNM). RESULTADOS: A imunomarcação com o anticorpo anti-FvW foi mais efetiva que a do CD105 no CEO. No que concerne à localização anatômica, o assoalho bucal e a região retromolar apresentaram diferenças estatisticamente significativas quanto aos índices angiogênicos (p = 0,004), determinados pela técnica de contagem microvascular (MVC). Não houve relação estatisticamente significativa entre o estadiamento clínico TNM e os índices angiogênicos, com os dois biomarcadores. CONCLUSÕES: Com base nos achados deste estudo, sugere-se um envolvimento da neoformação vascular na carcinogênese oral, embora não tenha sido evidenciada associação significativa com o estágio clínico da lesão.

BACKGROUND: Angiogenesis has been linked with progression of malignant neoplasms and although studies have been conducted investigating angiogenic markers in oral squamous cell carcinoma (OSCC), contradictory results are reported in the literature. OBJECTIVES: To evaluate immunohistochemical expression of CD105 and von Willebrand factor (vWF) in OSCC and their relationships with clinical parameters of the tumors. METHODS: Immunoexpression of these biomarkers was analyzed in 30 cases of OSCC and correlated with clinical parameters of the tumors (age and sex of patients, anatomic site and Tumor, Node and Metastasis clinical staging [TNM]). RESULTS: In OSCC specimens, immunostaining was more effective using the anti-vWF antibody than using the anti-CD105 antibody. Angiogenic indices, determined by microvascular count (MVC) technique, were different for the floor of the mouth and the retromolar region, with statistical significance (p = 0.004). There were no statistically significant relationships between results for the two biomarkers and TNM clinical staging or angiogenic indices. CONCLUSIONS: The findings of this study suggest that vascular remodeling is involved in oral carcinogenesis, although there was no evidence of a significant association with clinical stage of lesions.

Treatment of oral hemangioma with sclerotherapy: case report / Tratamento de hemangioma oral com escleroterapia: relato de caso

Hemangiomas are benign neoplasms that are common in the head and neck, but relatively rare in the oral cavity. They can cause esthetic and functional impairment, depending on location. The most common site is the upper lip, but they can occur in other areas, such as the tongue, buccal mucosa and palate. Treatment is primarily dependent on correct diagnosis of the lesion and on its anatomic location. The purpose of this article is to provide a description of a case of a hemangioma on the upper lip, treated by therapeutic sclerosis with monoethanolamine oleate (Ethamolin®), covering clinical characteristics and methods for diagnosing these lesions. Precise diagnosis and appropriate therapeutic management resulted in satisfactory esthetic and functional results, with total regression of the lesion and no signs of relapse at 1-year follow-up...

O hemangioma é uma neoplasia benigna comum na região de cabeça e pescoço, e é relativamente rara na cavidade oral, podendo causar prejuízo estético e funcional a depender da sua localização. Sua localização mais frequente é o lábio superior, mas pode ocorrer em outras regiões, como língua, mucosa jugal e palato. O seu tratamento depende, principalmente, do correto diagnostico da lesão, bem como da localização anatômica da mesma. A proposta deste artigo é relatar um caso de hemangioma em lábio superior tratado com esclerose terapêutica com oleato de monoetanolamina (Ethamolin®), considerando as características clínicas e os métodos de diagnóstico desta lesão. Por meio de um diagnóstico preciso e uma conduta terapêutica adequada, o caso apresenta-se com um acompanhamento de um ano, sem sinais de recidiva, e com um resultado estético funcional satisfatório, com regressão total da lesão...

Avaliação clínica e histopatológica e hábitos associados ao surgimento de leucoplasias e eritroplasias orais / Clinical and histopathological evaluation and habits associated with the onset of oral leukoplakia and erythroplakia

Objective: This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer. Material and method: A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearson's chi-squared test and Fisher's exact test (p ≤ 0.05) were used. Results: Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years. Conclusion: Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment...

Objetivo: Esta pesquisa objetiva estabelecer a prevalência, os fatores associados ao surgimento e as características clínicas e histopatológicas das leucoplasias e eritroplasias orais, a fim de que estes dados possam contribuir na estratégia de prevenção ao desenvolvimento dessas lesões e, consequentemente, do câncer oral. Material e método: Foi realizado estudo retrospectivo em um serviço de referência da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2000 a 2012. Para verificar a associação das variáveis foi utilizado o teste qui-quadrado e o exato de Fisher (p ≤ 0,05). Resultados: Foram investigados 6.560 prontuários, tendo sido selecionados 54 casos, dos quais 44,4% do sexo masculino e 55,6% do feminino, com idade média de 56,93 anos. Com relação aos hábitos, 72,2% eram fumantes e 25% usuários de álcool, sendo que 17,9% exibiam associação dos dois hábitos. As leucoplasias orais foram as lesões mais prevalentes (0,65%), e as eritroplasias orais apresentaram maior associação com apresentação maligna no diagnóstico histopatológico (p = 0,001). A maioria das lesões não apresentou sintomatologia (p = 0,004). A leucoplasia oral foi mais frequente em mulheres fumantes com média de idade de 57 anos. Conclusão: O conhecimento dos fatores associados e das características clínicas das eritroplasias e leucoplasias orais é essencial para o estabelecimento do correto diagnóstico e tratamento...