Heterotopic gastrointestinal mucosa in the oral cavity of adults.

Heterotopic gastrointestinal mucosa (HGM) is a rare entity observed in the head and neck region and occurs more frequently in male infants and children. The floor of the mouth and anterior aspects of the tongue are the most commonly affected sites. Histologically, HGM resembles gastric, intestinal or colonic mucosa with areas of squamous epithelium, which can be cystic or solid. In the current report, 2 cases of HGM affecting the oral mucosa in patients over 35 years of age are presented, and one of these cases presented 2 nodules in different locations. Both cases represented solid lesions instead of the more common cystic presentation showing gastric glandular-type tissue that was lined with pseudostratified columnar epithelium containing crypts and fundic glands. Immunohistochemical analysis revealed positive expression of cytokeratins 7, 8 and 18 and smooth muscle actin (SMA). In both cases, the final diagnosis was HGM, and conservative surgical excision was performed.

Nodular fasciitis of the oral cavity with partial spontaneous regression (nodular fasciitis).

Nodular fasciitis is a lesion found in the subcutaneous fascia that micoscopically presents as a benign proliferation of fibroblasts and myofibroblasts, which may be mistaken for a sarcoma due to clinically rapid growth. Diagnosis is by histopathology and of the immunohistochemical profile. We describe a case of nodular fasciitis in the oral cavity that demonstrated partial spontaneous regression. The patient was a 32-year-old man with a buccal mucosal mass, which had grown rapidly for 45 days. On microscopic examination, the lesion displayed a well-delineated but not encapsulated proliferation of spindle cells, with a nodular growth pattern. Immunohistochemical analysis showed positivity of the spindle cells for the antibodies against smooth muscle actin and muscle-specific actin (HHF-35). Treatment of such lesions typically involves complete conservative excision, but the lesion may regress eventually in the absence of definitive treatment.

Expression of laminin-5 and integrins in actinic cheilitis and superficially invasive squamous cell carcinomas of the lip.

The progression of carcinogenesis entails the detachment of cells, invasion and migration of neoplastic cells. Alterations in epithelial adhesion and basement membrane proteins might mediate the early stages of carcinogenesis. This study investigated the expression of adhesion molecules and the basement membrane protein laminin-5 in actinic cheilitis (AC) and incipient squamous cell carcinoma of the lower lip to understand early photocarcinogenesis. Ln-5γ2 chain as well as α3, ß1 subunits of α3ß1 heterodimer and ß4 subunit of integrin α6ß4 were evaluated by immunohistochemistry in 16 cases of AC and 16 cases of superficially invasive squamous cell carcinoma (SISCC). Most AC cases showed reduced expression of ß1, ß4 and α3 integrins, and SISCCs lacked ß1, ß4 and α3 integrins in the invasive front. AC cases were negative for the Ln-5γ2 chain. Five cases of SISCC (31%) showed heterogeneous Ln-5γ2 chain expression in the invasive front of the tumor. Integrin ß1, ß4 and α3 expression is lost during the early stages of lip carcinogenesis. Expression of Ln-5γ2 in the invasive front in cases and its correlation with tumor progression suggest that it mediates the acquisition of the migrating and invading epithelial cell phenotype.

Immunohistochemical study of stromal and vascular components of tonsillar polyps: high endothelial venules as participants of the polyp's lymphoid tissue.

Tonsillar polyps are nonneoplastic lesions usually composed of variable amounts of lymphoid and vascular and connective tissues. All of them are generally assumed to be hamartomatous proliferations, but the profile of vascular and connective components has yet to be explored. The vascular system of the tonsils is complex and includes highly specialized structures (i.e., high endothelial venules (HEVs)) involved in lymphocyte homing into lymphoid tissues. In 14 tonsillar polyps and 26 control tonsils, an immunohistochemical study was performed using CD34 (blood vessels and HEVs), MECA-79 (HEVs), D2-40 (lymphatic vessels), Ki-67, collagens I and III, fibronectin, and tenascin-C. The polyps showed increased total lymphatic area, whereas the number of blood vessels and lymphatics and the blood vascular area did not differ significantly from those of control tonsils. Rare Ki-67+ endothelial cells were found. In the polyps, we detected, possibly for the first time, HEVs amid lymphoid tissue, and that the amount of the latter correlated positively with HEV density. The polyps also presented lesser amounts of fibronectin and collagens I and III than in normal tonsils, which were distributed in a disorganized fashion. Tenascin-C expression was uncommon in the polyps and control tonsils. Tonsillar polyps are composed of disorganized connective tissue and lymphatic channels which can be considered hamartomatous proliferations. However, the lymphoid component is possibly reactive due to its relationship with the HEVs. The highly differentiated phenotype of the HEVs and their complex biology are not in agreement with what would be expected for a component of hamartomatous nature.

Diagnostic implications of oral intravascular papillary endothelial hyperplasia.

This study examined the clinical, histological, and immunohistochemical features as well as the differential diagnoses of oral intravascular papillary endothelial hyperplasia (IPEH) to aid clinicians and pathologists in its diagnosis. Clinical features of five oral IPEH cases were obtained from medical records, and all histopathological diagnoses were reviewed. Immunohistochemical reactions, including anti-CD-34, laminin, vimentin, estrogen receptor alpha, and Ki-67, were assessed. Microscopically, a reactive proliferation of vascular cells composed of small papillary structures with hypocellular and hyalinized cores arising in an organized thrombus was seen. CD-34, vimentin, and laminin staining were strongly positive, while estrogen receptor alpha was negative in all cases. A low percentage of cells were positive for Ki-67 in four of five lesions, but one case was strongly positive. A diagnosis of angiosarcoma was investigated and rejected. IPEH presents specific microscopic characteristics that along with clinical data lead to an accurate diagnosis. The general dentist, the first to participate in the diagnostic process, must share the responsibility for diagnosis with the pathologist, and they must work together to determine the correct diagnosis and management. Oral lesions of IPEH are uncommon. Their main significance is that they show a microscopic resemblance to angiosarcoma. Thus, clinicians should have more information regarding this benign entity. Finally, we suggest that in recurrent cases exhibiting strong immunolabeling of proliferative markers the possibility of angiosarcoma should be investigated.

Altered ß-catenin expression related to cancer progression on actinic cheilitis and squamous cell carcinoma of the lip.

ß-Catenin is a bifunctional protein related to cell adhesion and gene transcription when activated by Wnt pathway. Altered expression of ß-catenin was related to loss of differentiation, more aggressive phenotype, increase of tumor invasion, and poor prognosis in a number of different cancers. Actinic cheilitis is caused by excessive exposure to ultraviolet radiation and has a high potential to suffer malignant transformation into squamous cell carcinoma (SCC) of the lip, the most frequent oral malignancy. Studies of oral cancer have shown the correlation of ß-catenin expression and oral SCC prognosis, and loss of membrane expression may be considered as a potential marker for early tumor recurrence. Thirty-five cases of actinic cheilitis and 12 cases of SCC of the lip were select and submitted to immunohistochemical staining using ß-catenin antibody. ß-Catenin was positive on the membrane for all cases. Eighty-five percent of actinic cheilitis cases showed cytoplasmatic staining, and 22% nuclear staining. Eighty-three percent of SCC was positive for ß-catenin, and none of them had nuclear staining. Cytoplasmatic and nuclear staining of ß-catenin on studied cases point to pathway alterations. Results demonstrated that ß-catenin expression is altered on epithelial dysplasia, and it is related to degree of alterations.

Queilite actínica: avaliação das alterações teciduais e graduação histológica em 458 casos / Actinic chelitis: evaluation of tissue changes and histological graduation in 458 case

A queilite actinica é uma lesão que acomete o vermelhão do lábio, principalmente o inferior, devido à exposição crônica e prolongada à radiação ultravioleta solar. Sabe-se'";que uma parcela dos casos de queilite actinica evoluirá para carcinoma epidermoide de lábio, mas quantos casos e quais, exatamente, ainda não é possível dizer. O prognósticoda queilite actinica, assim como a decisão terapêutica, são, atualmente, baseados em seu aspecto histopatológico mais importante: a displasia epitelial. O objetivo deste trabalhofoi avaliar as alterações citológicas e arquiteturais do epitélio de uma ampla amostra de casos de queilite actinica. Após essa etapa, os casos foram classificados segundo doissistemas de graduação: o proposto pela OMS e o binário. Depois dessa fase, foram selecionados casos de todas as graduações para serem submetidos, pela técnica deimuno-histoquímica, aos anticorpos anti-Ki 67 e anti-p53 mutada. Um total de 458 casos foram examinado. As alterações epiteliais mais frequentemente encontradas foi a perdade polaridade do estrato basal, o pleomorfismo nuclear e celular e o hipercromatismo. As graduações mais frequentes foram lesão de baixo risco e displasia epitelial moderada.Os resultados para as proteínas Ki 67 e p53 não mostraram relação estatisticamente significante com os graus histológicos. Que seja de nosso conhecimento, esta é a maior sériede queilites actínicas já analisada histologicamente e conclui-se que fatores como a determinação de quais as alterações teciduais devem ser consideradas, a representatividade do corteexaminado e a correspondência entre as alterações morfológicas e a instabilidade genética dos tecidos comprometem o uso prognóstico dos diferentes graus de displasia epitelial.

Actinic cheilitis is a lesion that affects the lip vermilion, due to chronic and prolonged exposure to solar ultraviolet radiation. It is known that a proportion of the actiniccheilitis cases wiIl evolve into squamous ceIl carcinoma of the lip, but how many cases and which ones wiIl suffer this process is not yet possible to say. The actinic cheilitisprognosis, as weIl as, the therapeutic decision are currendy based on epithelial dysplasia degree presented, which is considered the main histological characteristic. The aim ofthis study was to evaluate the epithelium architectural and cytological changes presented in a large sample of cases of actinic cheilitis. AfteIWards, the cases were classifiedfolIowing two grading systems: After this stage, cases were classified by two grading systems: the one proposed by WHO and the binary system. After, cases of allhistological grades were selected and submitted by means of immunohistochemistry, to the antibodies against Ki-67 and mutated p53. A total of 458 cases were exarnined andthe epithelial changes most frequendy found were the loss of polarity of basal ceIl; nuclear and celIular pleomorphism; and hyperchromatism. The grades most frequendyfound were low risk and moderate epithelial dysplasia. Results for p53 protein and Ki 67 showed no statistically significant relationship with the histological grades. To the best ofour knowledge, this is the largest series of actinic cheilitis histologically analyzed. It was concluded that factors such as determining which histological changes should beconsidered, the section representativeness, hence the correspondence between the morphological changes and genetic instability, compromise the prognostic use of epithelial dysplasia grading.

Follicular lymphoma in the palate with clinical appearance similar to salivary gland tumors.

Intraoral presentation of follicular lymphoma is rare, and only three cases in the palate have been reported to date. The present case report describes an uncommon case of follicular lymphoma affecting the palate. The clinical aspect was similar to salivary gland neoplasm, and an incisional biopsy was important to establish the correct diagnosis and consequently to plan the treatment. Also discussed is the differential diagnosis among follicular lymphoma, mucosa-associated lymphoid tissue lymphoma, and follicular lymphoid hyperplasia with regard to the histopathologic and immunohistochemical features.

An experimental model for the study of craniofacial deformities / Modelo experimental para o estudo de deformidades craniofaciais

PURPOSE: To develop an experimental surgical model in rats for the study of craniofacial abnormalities. METHODS: Full thickness calvarial defects with 10x10-mm and 5x8-mm dimensions were created in 40 male NIS Wistar rats, body weight ranging from 320 to 420 g. The animals were equally divided into two groups. The periosteum was removed and dura mater was left intact. Animals were killed at 8 and 16 weeks postoperatively and cranial tissue samples were taken from the defects for histological analysis. RESULTS: Cranial defects remained open even after 16 weeks postoperatively. CONCLUSION: The experimental model with 5x8-mm defects in the parietal region with the removal of the periosteum and maintenance of the integrity of the dura mater are critical and might be used for the study of cranial bone defects in craniofacial abnormalities.

OBJETIVO: Desenvolver um modelo experimental em ratos para o estudo de deformidades craniofaciais. MÉTODOS: Foram realizados defeitos ósseos de espessura total com diâmetro de 5 x 8 mm e 10 x 10mm na calota craniana em 40 ratos, machos, NIS Wistar, com peso de 320 a 420 g divididos igualmente em dois grupos. O periósteo foi retirado e a dura-máter mantida intacta. Os animais foram sacrificados na 8ª e 16ª semana de pós-operatório e amostras de tecido ósseo foram extraídas para realização da análise histológica. RESULTADOS: Os defeitos cranianos permaneceram abertos mesmo após 16 semanas após a cirurgia. CONCLUSÃO: O modelo experimental com defeitos de 5x8mm na região parietal, com remoção do periósteo e manutenção da integridade da dura-máter são considerados críticos, e poderá ser utilizado para o estudo dos defeitos ósseos cranianos nas anomalias craniofaciais.

An experimental model for the study of craniofacial deformities.

PURPOSE: To develop an experimental surgical model in rats for the study of craniofacial abnormalities. METHODS: Full thickness calvarial defects with 10x10-mm and 5x8-mm dimensions were created in 40 male NIS Wistar rats, body weight ranging from 320 to 420 g. The animals were equally divided into two groups. The periosteum was removed and dura mater was left intact. Animals were killed at 8 and 16 weeks postoperatively and cranial tissue samples were taken from the defects for histological analysis. RESULTS: Cranial defects remained open even after 16 weeks postoperatively. CONCLUSION: The experimental model with 5x8-mm defects in the parietal region with the removal of the periosteum and maintenance of the integrity of the dura mater are critical and might be used for the study of cranial bone defects in craniofacial abnormalities.

Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits / Expansão craniana com molas: efeitos globais nas áreas suturais e parassuturais. Estudo experimental em coelhos

Purpose: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. Methods: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. Conclusion: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

Objetivo: O uso de molas na expansão craniana tem provado ser efetivo no tratamento da craniossinostoses. A expansão com molas tem sido estudada nas regiões sagital e parassagital, especialmente nas escafocefalias. Um modelo com coelho foi usado no presente estudo para analizar os efeitos das molas sobre a calota craniana e suturas. Métodos: Treze coelhos Nova Zelândia, com quarto semanas de vida, foram divididos em quatro grupos: no grupo I, somente marcadores de amálgama foram implantados como controle; no grupo II, marcadores de amálgama foram implantados e foi retirada a sutura sagital; no grupo III, marcadores de amálgama foram implantados, foi retirada a sutura sagital e foi colocada uma mola expansora na região interparietal e no grupo IV, marcadores de amálgamas foram implantados, uma craniectomia linear parassagital foi realizada e foi colocada uma mola expansora. Os animais foram sacrificados com 2, 4, 8 e 12 semanas. Foi realizado controle radiológico e histológico nas áreas de implantação das molas. RESULTADOS: Nos grupos que utilizaram molas a distração das margens ósseas de craniectomia foi maior do que nos grupos que não utilizaram molas. Neoformação óssea foi observada em todos os grupos, tendo sido mais rápida no grupo II. O crescimento ósseo teve início a partir das margens e da profundidade. A regeneração óssea apresentou padrões histológicos similares nos grupos com o uso de molas na região sagital e parassagital. Conclusões: O modelo experimental com coelho provou ser adequado para a análise proposta pelo estudo. O uso das molas nos grupos com osteotomia sagital e parassagital promoveu uma distração similar dos marcadores de amálgamas e ambos os grupos tiveram padrão histológico de ossificação similar.

Spring-mediated skull expansion: overall effects in sutural and parasutural areas. An experimental study in rabbits.

PURPOSE: The use of springs in cranial expansion has proven to be effective in the treatment of craniosynostosis. Spring-mediated expansion has been studied both in the sagittal and in parasagittal regions, especially in scaphocephaly. A rabbit model was used in the present study to analyze the effects of springs on the cranial vault and sutures. METHODS: Thirteen 4-week-old New Zealand rabbits were divided into 4 groups: in group I, only amalgam markers were used as control; in group II, amalgam markers were used and sagittal suturectomy was performed; in group III, amalgam markers were used, a sagittal suturectomy was performed and an expansible spring was fitted in the interparietal region and in group IV, markers were used and linear parasagittal craniectomy was carried out with springs. Animals were sacrificed after 2, 4, 8 and 12 weeks. Radiological control and histological analysis were performed in the area of spring implantation. RESULTS: In the groups using springs distraction of the craniectomy borders was greater than in those that did not use springs. New bone formation was observed in all groups, and was faster in group II. Bone growth started from the borders and depth. Bone regeneration presented a similar histological pattern in the groups with spring in the sagittal and parasagittal region. CONCLUSION: The rabbit model proved to be adequate for the analysis proposed by the study. The use of springs in the groups with sagittal and parasagittal osteotomy led to a similar distraction of amalgam markers and both groups had similar ossification histological pattern.

Tratamento de deiscência com exposição óssea peri-implantar na mandíbula / Treatment of dehiscence and peri-implant bone exposure in the lower jaw: a case report

A deiscência é uma das possíveis complicações pós-operatórias. Trata-se da abertura espontânea de suturas, que pode vir concomitantemente a eventos como a exposição óssea. Sabe-se que ela pode ser tratada por métodos específicos ou pela simples remoção do material necrótico presente e abundante irrigação com solução fisiológica, permitindo assim condições para a regeneração tecidual. No caso clínico presente, houve a oportunidade de realizar a estimulação da reparação tecidual através de focos de sangramentos provocados, associado ao tratamento convencional da deiscência em região peri-implantar da mandíbula. E após um acompanhamento de cerca de três meses foram apresentados resultados satisfatórios que culminaram com a confecção de uma nova prótese reabilitando o paciente. Este relato de caso mostra que existem diversas maneiras para tratar a deiscência e obter sucesso e ressalta a importância do acompanhamento freqüente do paciente.

Arthrocentesis in the treatment of loose bodies of the temporomandibular joint associated with synovial chondromatosis.

Synovial chondromatosis is a benign disorder of joints of unknown aetiology, characterised by the presence of loose bodies in the articular space. We present a case that affected the temporomandibular joint (TMJ) and was treated with arthrocentesis, which is an efficient, conservative, and inexpensive treatment.

Galectin-3 immunoprofile in adenoid cystic carcinoma and polymorphous low-grade adenocarcinoma of salivary glands.

Adenoid cystic carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA) are malignant neoplasms of salivary glands, which are similar in histologic patterns but very different in clinical behavior, treatment and prognosis. Galectin-3 is a multifunctional protein of a growing family of beta-galactoside-binding animal lectins, which is implicated in a variety of biological events such as tumor cell adhesion, proliferation, differentiation and angiogenesis. This protein was found to be implicated in cellular transformation and a correlation between its expression and cancer progression and metastasis has been described. The aim of this study was to determine the galectin-3 immunoprofile in 14 cases of ACC (2 cases of tubular subtype, 4 cases of solid subtype and 8 cases of cribriform subtype) and in 12 cases of PLGA with different histologic patterns, including lobular, tubular and cribriform aspects. Moreover, slides of normal salivary glands were included. In normal salivary glands there was strong nuclear and cytoplasmic staining for galectin-3 in ductal luminal cells. ACC showed specific staining in luminal cells mainly in the nuclei. In the tubular subtype of ACC, galectin-3 strongly stained luminal cells of the ductiform structures. The cribriform and solid subtypes showed a few positive luminal cells of small ducts present in the cribriform structures and in solid nests respectively. In the cases of PLGA, independent of the histologic architecture, all tumor cells revealed a positive cytoplasmic reaction. Galectin-3 expression seems to be related to cell differentiation more than to tumor progression and prognosis in the neoplasms studied.

Immunoprofile of reactive salivary myoepithelial cells in intraductal areas of carcinoma ex-pleomorphic adenoma.

The myoepithelial cell (MC) is a component of various secretory glands, including salivary glands. Besides its function, a tumor suppressor and a tumor facilitating functions have been attributed to this cell. We investigated the immunoprofile of benign MC in intraductal areas of carcinoma ex-pleomorphic adenoma (CXPA), comparing them with the MC in duct-like areas of pleomorphic adenoma, origin of the malignant tumor. Antibodies against myoepithelial markers-CK14, alpha-SMA, calponin, P63, CD10, and D2-40-plus laminin and maspin was applied in four selected cases of intracapsular and minimal invasive CXPA with only luminal differentiation presenting areas of intraductal carcinoma. The immunohistochemical reactions of all the antibodies showed stronger staining in benign MC surrounding the malignant epithelial cells than in benign MC in duct-like areas of pleomorphic adenoma, thus revealing that in the malignization process the benign MC become differentiated and produce important proteins related to the tumor suppressor function.

Oral cysticercosis: case report and review of the literature.

Cysticercosis is a condition that occurs when man is infested by the larvae of Taenia solium, acting as an intermediate host instead of definitive. Oral cysticercosis is a rare event, and it represents a difficulty in clinical diagnosis. A case of oral cysticercosis in a 23-year-old white female who presented a painless swelling in the dorsal portion of the tongue is reported. An excisional biopsy was performed and histopathological examination revealed a cystic cavity containing the tapeworm.

Root resorption and ankylosis associated with guided tissue regeneration.

BACKGROUND: Root resorption and ankylosis have been reported rarely as sequelae to guided tissue regeneration (GTR). The authors describe a clinical case of root resorption following GTR that involved the use of a bioabsorbable membrane. CASE DESCRIPTION: Two years after GTR was performed on a Class II furcation defect, the clinical examination revealed root resorption reaching the pulp chamber. The furcation defect was filled with epithelium and connective tissue, which contained inflammatory infiltrate and fragments of the membrane. The authors also observed areas of the tooth that exhibited points of ankylosis and root resorption. CLINICAL IMPLICATIONS: Clinical trials have reported favorable clinical and histologic results with GTR. However, this case report, along with other case reports and studies in animals, suggests a high risk of root resorption and ankylosis after GTR, which could limit the indications for this technique.

Oral cysticercosis: case report and review of the literature

A cisticercose é uma doença que ocorre quando o indivíduo é infectado pela larva da Taenia solium, atuando como hospedeiro intermediário ao invés de definitivo. A cisticercose em cavidade oral é rara e seu diagnóstico clínico é difícil. Neste trabalho, é relatado um caso de cisticercose oral em paciente de 23 anos, sexo feminino que apresentou um crescimento indolor na região de dorso de língua. Foi realizada uma biópsia excisional e o exame histopatológico revelou uma cavidade cística apresentando em seu interior a larva.