Glandular odontogenic cysts: A collaborative investigation of 22 cases and proteins related to invasiveness.

BACKGROUND: A glandular odontogenic cyst (GOC) has an intriguing, aggressive behaviour whose mechanisms have not yet been clarified. OBJECTIVE: To conduct a collaborative cross-sectional study on the clinical, demographic, microscopic and immunohistochemical characteristics of GOCs, emphasizing the histopathological characteristics and expression of proteins related to invasiveness. METHODS: Twenty-two cases of GOC from three oral and maxillofacial pathology services in Brazil were selected from 1988 to 2018. Clinical and demographic data were collected. Histopathological features were evaluated in detail. Sixteen cases of GOC were also submitted to immunohistochemistry to detect MT1-MMP, TKS4, TKS5 and cortactin, the key regulators of invadopodia formation. RESULTS: Glandular odontogenic cysts were primarily seen in men over 40 years of age, in the posterior mandible and the anterior maxilla as a unilocular, radiolucent lesion. All cases presented hobnail cells, clear cells and variable thickness of the lining epithelium, 3 of the 10 key histopathological parameters to be evaluated in GOCs. Immunohistochemistry revealed a greater expression of the studied proteins in the GOCs than in the controls (p < 0.0001). CONCLUSION: Overexpression of proteins that regulate cell invasiveness was identified, and the present study's findings suggest that invadopodia activity is a possible mechanism used by GOCs to promote local invasion, which could partly explain its intriguing biological behaviour.

A Brazilian multicentre study of 2,497 isolated cases of odontogenic keratocysts.

We present the frequency of cases of isolated odontogenic keratocysts submitted to microscopic examination at 10 Brazilian referral centres in Oral and Maxillofacial Pathology. In a retrospective (1953-2017) analysis, data on clinicoradiographic features and treatment of these lesions were collected and analysed descriptively. Among the 258,867 cases retrieved, 2,497 (0.96%) were isolated odontogenic keratocysts. In summary, an overview of individuals affected with isolated odontogenic keratocysts is reported herein. This lesion showed predilection for the posterior mandible of young adult men.

Profile of usage of a reference diagnostic service on oral pathology: a 10-year evaluation.

BACKGROUND: Despite the professional and academic relevance of the Brazilian oral pathology diagnostic laboratories, no information about their usage profile is available in the English literature. The objective of the present study is to report data about the histopathological and immunohistochemical exams performed in a Brazilian regional reference laboratory of oral pathology, as well as its main users. METHODS: Information about all histopathological exams performed between 2002 and 2012 was retrieved from the files of the Oral and Maxillofacial Pathology Service of the School of Dentistry of Universidade Federal de Minas Gerais. Data collected included: 1) requestor of exam; 2) diagnosis classification; and 3) immunohistochemical tests. Descriptive statistical analyses were done. RESULTS: 13,522 histopathological exams were performed, mean 1,229/year. The Public Health System of the city of Belo Horizonte was the main requestor of exams (77.13%), followed by private professionals (19.26%), and other cities (2.03%). Most lesions were considered benign (12,599/ 93.17%), with 854 malignant lesions (6.32%). 469 immunohistochemical tests were performed; 324 (69.08%) were from benign diagnosis, and 145 (30.92%) from malignant diagnosis. The most used antibodies were against S100, vimentin, smooth muscle actin, actin muscle specific HHF-35, and pan-cytokeratin AE1/AE3. CONCLUSIONS: Public Health System is the major user of the diagnostic service on oral pathology in our institution. Most diagnoses were of benign lesions, although many malignant lesions were detected. Immunohistochemistry was particularly important in solving challenging cases.

Clinical and demographic overlaps among immunologically mediated oral diseases: a challenge for clinicians.

This study sought to assess and compare retrospective demographic and clinical data of oral lesions of lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid from the records of the Department of Oral Pathology and Surgery, School of Dentistry, Universidade Federal de Minas Gerais, Brazil, covering a period of 55 years. Out of 25,435 specimens, these immunologically-mediated diseases accounted for 301 (1.18%) cases, of which 250 (0.98%) were lichen planus, 27 (0.11%) were pemphigus vulgaris, and 24 (0.09%) were mucous membrane pemphigoid. Lichen planus presented mainly as white asymptomatic plaques on buccal mucosa. Pemphigus vulgaris was usually characterized by multiple symptomatic erithematous ulcers on the buccal mucosa. Painful ulcers and/or blisters on the gingiva were the most common presentation for mucous membrane pemphigoid. Desquamative gingivitis was noted for all 3 diseases, but mainly for mucous membrane pemphigoid. Overall, lesions were more frequent in white women >50 years. Oral manifestations of immunologically-mediated diseases are relatively rare, and the correct diagnosis can be a challenge for dentists as the lesions often share similar clinical and demographic features.

Epithelioid rhabdomyosarcoma: Report of the first case in the jaw.

OBJECTIVES: Epithelioid rhabdomyosarcoma (EpiRMS) is a novel morphologically distinct variant of rhabdomyosarcoma, with an unusually challenging microscopic diagnosis. The occurrence of rhabdomyosarcomas in the jaws is extremely rare. This study presents the first case of EpiRMS in the jaw (mandible) and a literature review of the previous 35 cases of EpiRMS. STUDY DESIGN: Here, we report a case of EpiRMS affecting an 18-year-old male patient. Clinical, imaging, microscopic, and immunohistochemical features are discussed and previously reported cases of EpiRMS are reviewed. RESULTS: An 18-year-old male patient presented with an exophytic sessile growth on the buccal gingiva, and orthopantomography revealed irregular bone loss. Microscopic analysis showed a large number of cells with epithelioid appearance. Immunohistochemistry staining was positive for desmin, myogenin, MyoD1, smooth muscle actin, h-caldesmon, INI-1, and AE1-AE3. The patient's disease was staged as T4aN1M0 and was treated with surgical excision combined with chemotherapy. CONCLUSIONS: The occurrence of RMS in the mandible is rare, and this is the first case of EpiRMS in the jaw. EpiRMS is an unusual histologic subtype that mimics other sarcomas and epithelial malignancies, making diagnosis a challenge. A specific immunohistochemistry panel aids in the diagnosis. EpiRMS has an aggressive course and an unfavorable prognosis.

A Retrospective Brazilian Multicenter Study of Biopsies at the Periapical Area: Identification of Cases of Nonendodontic Periapical Lesions.

INTRODUCTION: The purpose of this study was to analyze the features of lesions obtained from biopsies at the periapical area of teeth with a radiographic or clinical initial diagnosis of apical periodontitis. METHODS: A retrospective study was conducted on biopsies obtained from 1953-2018 at 3 Brazilian oral and maxillofacial pathology centers. Cases of endodontic and nonendodontic periapical lesions (NPLs) with a clinical diagnosis of endodontic pathoses were retrieved. Data regarding patient age, sex, and anatomic location were obtained from patients' records. The frequency and percentage of cases with clinical diagnoses of a periapical cyst, periapical granuloma, or dentoalveolar abscess were recorded, and the final histopathologic diagnosis was documented. RESULTS: Among 66,179 oral biopsies, 7246 (10.94%) were clinically diagnosed as periapical disease, 306 (4.22%) of which were histopathologically diagnosed as NPLs. The most frequent NPLs were odontogenic keratocysts (n = 107, 34.96%) followed by dentigerous cysts (n = 48, 15.68%). The mean age at diagnosis was 39.68 years with a range of 6-80 years. A total of 159 (51.96%) cases occurred in females and 147 (48.03%) in males (female to male ratio = 1.08:1). Most lesions (137, 44.77%) were located in the posterior mandible. CONCLUSIONS: A wide variety of histopathologic diagnoses, including benign odontogenic and nonodontogenic cystic and tumorous lesions, infectious diseases, and malignant neoplasms, was reported in the present survey. The features presented in this study were consistent with previous findings reported in the literature.

A Systematic Review of Pulp Revascularization Using a Triple Antibiotic Paste.

Purpose: The purpose of this systematic review was to summarize the clinical and radiographic results of pulp revascularization procedures employing a triple antibiotic paste in teeth with incomplete root formation. Methods: Electronic searches were conducted in February 2017 using PubMed, Medline, Web of Science, Scopus, The Cochrane Library, ProQuest, Lilacs and The Brazilian Library of Dentistry, UK National Institute for Health and Care Excellence, U.S. National Institutes of Health, Clinical Trials, and Google. The search was updated in March 2019. Clinical trials in English, Portuguese, and Spanish, without any restrictions regarding the year of publication, were included. The quality of the studies was analyzed using the Cochrane Collaboration tool. Results: The search retrieved 1,768 references, and eight studies were included for a qualitative analysis. In these eight studies, the risk of bias across the Cochrane tool's domains varied from low to unclear. The included studies demonstrated that the clinical and radiographic success of pulp revascularization using calcium hydroxide or triple antibiotic paste appears to resolve symptoms and periapical healing. Conclusions: Triple antibiotic paste is effective in the pulp revascularization therapy of teeth with incomplete root formation. Absence of symptoms and the achievement of periapical integrity have been observed. (Pediatr Dent 2019;41(5):341-53).

Exacerbation of oral lichen planus lesions during treatment of chronic hepatitis C with pegylated interferon and ribavirin.

It is estimated that 170-200 million people in the world are chronically infected with the hepatitis C virus. This fact indicates that the prevention and treatment of hepatitis C virus infection are a priority in public health care. To date, the best treatment consists of the combination of pegylated interferon (IFN) and ribavirin. IFN is costly and associated with low tolerance and severe side effects. Ribavirin is also problematic because it causes secondary anemia in most patients. It has been described that oral lichen planus (OLP) can appear or be exacerbated during the treatment of chronic hepatitis C. The improvement of the lesions of OLP after the discontinuation of therapy suggests that IFN may induce or worsen these lesions in some patients. This study examines three cases of exacerbation of OLP during the treatment of chronic hepatitis C with pegylated IFN and ribavirin.

Prevalence profile of odontogenic cysts and tumors on Brazilian sample after the reclassification of odontogenic keratocyst.

PURPOSE: The aim of this study was to evaluate the impact of the reclassification of odontogenic keratocyst (OKC) as a tumor on the prevalence profile of odontogenic cysts (OCs) and odontogenic tumors (OTs). STUDY DESIGN: Two referral Oral and Maxillofacial Pathology services in Brazil were evaluated. All cases diagnosed as OCs or OTs were selected and classified according to the 1992 WHO-classification (cases before 2005 WHO classification of tumors excluding OKC) and the 2005 WHO classification of tumors, going forward including cases of odontogenic keratocyst tumor (KCOT). The frequency and prevalence of OCs and OTs were compared before and after the reclassification. RESULTS: Among 27,854 oral biopsies, 4920 (17.66%) were OCs and 992 (3.56%) were OTs. The prevalence of OTs before 2005 WHO classification of tumors was 2.04%, while the prevalence after 2005 WHO classification was 11.51% (p < 0.0001). Before 2006, the most frequent tumor diagnosed was odontoma with 194 cases (39.67%), and after 2005 WHO classification of tumors the KCOT was the most frequent with 207 cases (41.07%). CONCLUSIONS: The increase in the prevalence of OTs after 2005 WHO is related to the improvement of pathology services and to the inclusion of KCOT in the OTs group.

Peripheral osteoma of the mandible: case report and review of the literature.

BACKGROUND: Osteoma is a benign often asymptomatic neoplasm, consisting of well-differentiated mature bone. This paper reports a case of peripheral osteoma located in the anterior mandibular region and provides a review of the literature about this lesion in the jaws. PATIENT AND METHODS: A 43-year-old white woman presented with a swelling in the left mandible of 7 years duration. The English literature was reviewed over the past 76 years and data about location, histopathology and number of the peripheral osteomas, sex, and age of the patients were evaluated. RESULTS: Data analysis showed 69 well-documented cases of peripheral osteoma. Peripheral osteomas are more frequent in the mandible than the maxilla and the cancellous type was most frequent; males and females are equally affected in the mandible; the age range was 9-85 years. CONCLUSION: The peripheral type of osteoma is most common in the lower jaws, occurs at the surface of the cortical bone and is sessile or pedicled.

Is salivary epidermal growth factor a biomarker for oral leukoplakia? A preliminary study.

OBJECTIVES: The aim of this study was to compare the salivary epidermal growth factor (EGF) levels between patients with oral leukoplakia (OL) and clinically healthy individuals, to evaluate the association between salivary and tissular EGF, and to correlate EGF with clinicopathologic data, including the presence of dysplasia. STUDY DESIGN: Salivary EGF levels were measured in 32 patients and 32 controls. The tissue expressions of EGF and its receptor (EGFR) were immunohistochemically evaluated. RESULTS: Salivary EGF levels were similar in patients with OL compared with controls. There was no association between the salivary levels and immunohistochemical expression of EGF. An absence of EGF detection by immunohistochemistry was associated with development of multiple lesions. Dysplastic lesions showed a tendency toward presenting higher salivary EGF levels. CONCLUSIONS: Currently, it is not possible to indicate salivary EGF as a biomarker for OL. Further studies are needed to elucidate the role of EGF in oral carcinogenesis. A follow-up study is necessary to evaluate the changes in EGF values following the surgical excision of OL.

Primary syphilis of oral mucosa: case report of an unusual manifestation.

Dental clinicians and other health care providers have long been concerned about a variety of infectious agents that may be transmitted within the dental setting. Many infectious diseases, including human immunodeficiency virus, hepatitis, tuberculosis, and syphilis are important both because of their potential transmissibility and because the first manifestations of the disease may appear in the oral cavity. Oral disease as a consequence of primary syphilis is rare. This article details a patient presenting with a labial nodule as her only clinical manifestation of undiagnosed primary syphilis.

Desmoplastic fibroblastoma (collagenous fibroma): a case identified in the buccal mucosa.

Desmoplastic fibroblastoma is a rare, benign, soft tissue tumor affecting mainly the subcutaneous and muscle tissue. Only five cases identified in the oral cavity have been reported in prior literature. This article presents a case report of a 56-year-old man, with no previous history of trauma, who presented a slow-growing mass in the buccal mucosa. Histopathology and immunohistochemistry staining studies were performed, and a diagnosis of the desmoplastic fibroblastoma was made. The patient has been disease-free for one year.

Calcifying odontogenic cyst associated with an orthokeratinized odontogenic cyst.

Odontogenic tumors composed of two or more distinct types of lesions are unusual. In this paper, a case of an odontogenic lesion characterized by simultaneous occurrence of areas of calcifying odontogenic cyst (COC) and orthokeratinized odontogenic cyst (OOC) is described. The lesion was asymptomatic and presented at the radiographic examination as a unilocular well-delimited radiolucency extending from left incisor to right premolar area in the mandible. To date, this is the first report of COC associated with an OOC.

Sympathetic nerve blocks in mandibular herpes zoster and postherpetic neuralgia.

Sympathetic blocks have been indicated for the diagnosis and treatment of painful neuropathic conditions, such as herpes zoster (HZ) and postherpetic neuralgia (PHN). The purpose of this article is to report a case of mandibular HZ and PHN in an HIV-positive patient, and discuss the efficacy of sympathetic nerve blocks for pain relief and prevention of PHN.

Odontogenic tumors: a study of 340 cases in a Brazilian population.

BACKGROUND: The aim of this study was to determinate the relative frequency of odontogenic tumors (OTs) in a Brazilian population and to compare this data with previous reports. METHODS: We reviewed the achieves of 19 123 specimens from oral pathology laboratory of Universidade Federal de Minas Gerais, from 1954 to 2004. Using the criteria of histologic typification published by the World Health Organization in 1992, we classified the OTs. RESULTS: A total of 340 OTs were found. The frequency of OTs comprises 1.78% of all pathologic specimens in our laboratory. The most frequent tumor was ameloblastoma (45.2%), followed by odontomas (24.91%), and myxomas (9.1%). CONCLUSIONS: Odontogenic tumors are uncommon lesions in this Brazilian population and malignant OTs are very rare. The relative frequency of various types of OTs, age, and gender distribution are similar to those reported in African, Asian but not to Chilean and North American series.

Cross-sectional study of oral mucosal conditions among a central Amazonian Indian community, Brazil.

BACKGROUND: A cross-sectional study on the oral mucosal conditions among the Waimiri Atroari Indians from central Amazonia, Brazil, has been conducted. These Indians keep their traditional way of life and are free from habits such as smoking, alcohol drinking, and use of pacifiers. METHODS: Clinical examinations of a representative, randomly selected sample of patients during routine dental treatment, following ethical procedures recommended by Brazilian laws were made. RESULTS: Out of 922 individuals, 587 were examined, among which 52.57% of the children up to 12 years old and 73.44% of patients aged 13 years or older presented at least one oral mucosal condition. The conditions more frequently observed were, in decreasing order of prevalence: fissured tongue, focal epithelial hyperplasia (FEH), lesions of traumatic origin, geographic tongue, Fordyce's spots, and candidiasis. Only one case of leukoplakia was identified. CONCLUSIONS: Conditions observed among theses Indians were essentially the same that have been described in other populations around the world, except for FEH, which, as a characteristic lesion of Indians, had high prevalence (20.95%). The lesions observed were related to the way of life of this specific population.