Papiloma escamoso oral: relato de três casos / Oral squamous papilloma: three case reports

Os papilomavírus humanos (HPVs) pertencem à família Papillomaviridae e podem infectar a epiderme e os epitélios da cavidade oral, orofaringe, laringe, árvore brônquica, esôfago, bexiga, ânus e trato genital. Na boca, o HPV está relacionado com o surgimento de lesões verrucosas benignas, sendo a mais frequente o papiloma escamoso oral. Essa lesão apresenta crescimento exofítico, assintomático e normalmente solitário. Dessa forma, o presente estudo teve por objetivo relatar três casos de papiloma escamoso oral com características distintas. Nos três casos foram realizadas biópsias excisionais e os espécimes avaliados por histopatologia. Os pacientes foram acompanhados por um período mínimo de doze meses, sem histórias de recidivas. Acredita-se que o conhecimento das principais características clínicas e histopatológicas dessa lesão auxilie o dentista no processo de diagnóstico e tratamento dessa patologia.

Human papillomaviruses (HPVs) belong to the Papillomaviridae family and can infect the host's epithelial cells, generating lesions. They have more than one hundred subtypes and these can infect the epidermis and epithelium of the oral cavity, oropharynx, larynx, bronchial tree, esophagus, bladder, anus and genital tract. In the mouth, HPV is related to the appearance of benign verrucous lesions, the most frequent the oral squamous papilloma. This lesion reveal exophytic growth, asymptomatic and usually solitary. Thus, the present paper aimed to report three cases of oral squamous papilloma with different characteristics. In the three cases, excisional biopsies were performed and the specimens were evaluated by histopathology. Patients were followed for a minimum period of twelve months, with no recurrences. It is believed that the knowledge of the main clinical and histopathological characteristics of this lesion helps the dentist in the process of diagnosis and treatment of this pathology.

Fibrolipoma em cavidade oral: relato de caso / Fibrolipoma of the oral cavity: case report

Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma.

O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer.

OBJECTIVE: This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. MATERIAL AND METHODS: A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. RESULTS: From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). CONCLUSIONS: Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Coexistência de pênfigo vulgar e infecção pelo vírus herpes simples na mucosa oral / Coexistence of pemphigus vulgaris and herpes simplex virus infection in oral mucosa

O pênfigo vulgar é uma doença mucocutânea, imunomediada, caracterizada por lesões vesiculobolhosas, enquanto a infecção pelo vírus herpes simples (HSV) é comum na cavidade oral. A coexistência das duas doenças tem sido relatada por alguns autores. Este artigo relata o caso de um paciente com múltiplas lesões em várias áreas da mucosa oral, cujo procedimento foi raspagem e biópsia incisional, que resultou no diagnóstico de pênfigo vulgar associado à infecção pelo HSV. Destaca-se a inusitada associação das doenças e a identificação citopatológica de duas populações celulares com aspectos morfológicos distintos e característicos, capazes de determinar o correto diagnóstico, sendo fundamental para a conduta e terapêutica adequada.

Pemphigus vulgaris is an autoimmune mucocutaneous disease, characterized by vesiculobullous lesions. Herpes simplex virus (HSV) infection is common in the oral cavity and the coexistence of pemphigus vulgaris and HSV infection has been reported by some authors. In this work, we report a case of a patient with multiple lesions involving several areas of the oral mucous membrane. Based on scraping cytology and incisional biopsy findings, the diagnosis was pemphigus vulgaris associated with HSV infection. We call attention to the uncommon association of both diseases and the cytological identification of two cell populations with different and characteristic morphological aspects, able enough to establish the correct diagnosis and define an appropriate therapeutic approach.

Epithelial Precursor Lesions and Squamous Cell Carcinoma Prevalence for a Period of 10-years in the Anatomic Pathology Service of the Antonio Pedro University Hospital, Fluminense Federal University

Oral squamous cell carcinoma represents approximately 90% of all oral malignancies and in some cases can be preceded by lesions considered epithelial precursor lesions. Early diagnosis of these lesions and intervention at an early stage constitute keys to reduce mortality, morbity and expenses with oral cancer treatment. The objective of this paper is to present the prevalence of epithelial precursor lesions and oral squamous cell carcinoma at the Anatomic Pathology Service of Antônio Pedro University Hospital, Fluminense Federal University in the last ten years. Considered data were sex, age, race, location, addictions, clinical and histological aspects. A total of 3,752 oral lesions were found and evaluated. The epithelial precursor lesions represented 4.23% of the oral biopsies, while the squamous cell carcinoma represented 4.21%. Leukoplakia was the most prevalent clinical aspect among the epithelial precursor lesions. The white women in their sixties were the mostaffected and the buccal mucosa was the most common anatomic localization. The most frequent histological finding was the epithelial hyperplasia without dysplasia. The squamous cell carcinoma showed up clinically as an ulceration in 80.3% of the cases. The white men in their sixties were the most affected. The tongue was the most affected area. In relation to the histological classification, the most frequent type was the moderately differentiated squamous cell carcinoma. The patientswith epithelial precursor lesions and with squamous cell carcinoma were smokers in its majority.