FOXP3+ and CD25+ cells are reduced in patients with stage IV, grade C periodontitis: A comparative clinical study.

BACKGROUND AND OBJECTIVE: Some studies suggest that regulatory T cells (Tregs) have suppressive effects on inflammatory osteolysis. The aim of this study was to evaluate Treg immunomarkers in periodontitis-affected tissues from patients with periodontitis and clinically healthy gingiva (control). MATERIAL AND METHODS: The presence and distribution of positive cells for CD4, CD25 and FOXP3 (Treg immunomarkers) in periodontitis-affected tissues (epithelium and lamina propria) of 30 patients (ten per group) with a diagnosis of stage IV, grade C periodontitis (IV-C), stage III, grade B periodontitis (III-B) and the control were evaluated. A two-way ANOVA followed by Fisher's LSD test was used to demonstrate differences between the groups and immunomarkers; Student's t test was used to demonstrate differences between the epithelium and the lamina propria. RESULTS: Both IV-C and III-B periodontitis presented a significantly high proportion of immune-stained cells for all immunomarkers when compared to the control group. Notably, CD25+ and FOXP3+ cells were detected in a significantly higher number in III-B than IV-C periodontitis (P < .05). CONCLUSION: Our results suggest the participation of Tregs on the osteoimmunological mechanisms in IV-C and III-B periodontitis patients, notably contributing to strategies for alveolar bone regeneration in clinical treatment decisions.

Ecstasy Abuse and Its Effects on the Oral Mucosa.

Ecstasy is an illicit drug that has been increasingly abused by young people. This synthetic drug has both stimulant and hallucinogenic effects and is usually consumed in a tablet. The side effects of ecstasy use include nausea, muscle cramping, fever, and symptoms mostly linked to muscular tension including jaw pain, facial pain, and headaches. There are few studies assessing the ecstasy effects on the oral mucosa, both clinically and histopathologically. The authors report 2 young women (22- and 27-year-old) who presented multifocal oral erosions and ulcerations. The lesions were painful and covered by a yellow-white pseudomembrane with a bright erythematous halo. By microscopy, it was observed superficial ulceration surrounded by acanthotic squamous epithelium with marked spongiosis, interstitial edema within the corion and perivascular lyphoid infiltrate, suggesting drug-induced oral mucositis. In conclusion, ecstasy use may be associated with the development of oral ulcers, which should be considered in the differential diagnosis when assessing multifocal oral ulcerations, especially in young people.

Surgical Management of Traumatic Peripheral Osteoma of the Mandible.

Osteomas are benign osteogenic lesions that result from the proliferation of mature bone. Three variants are known: central, peripheral, and extraskeletal. The peripheral variant is the most common and it most frequently affects the paranasal sinuses, rarely occurring in the jaws. This article describes the case of a 33-year-old white male patient who was referred complaining of facial asymmetry. Clinical examination revealed an increase in volume at the base of the right side of the mandible, hard bony consistency and well delimited, painless to the touch, without signs of infection or intraoral alterations. Radiographic examination revealed an oval lobulated, radiopaque sessile lesion adhered to the mandibular base near the insertion of the masseter muscle. The patient reported practicing martial arts many years ago. Owing to the limited access, it was decided to perform the complete lesion removal through an extraoral surgical approach, by using a skin crease in the upper neck region below the lesion. The patient recovered well and the histopathological analysis confirmed the diagnosis of osteoma. The etiopathogenesis of osteoma is not completely elucidated, and 3 theories are more accepted: developmental defect, neoplastic nature, and reactive lesion owing to trauma or local infection. The clinicopathological correlation in the present case supports a traumatic origin. Traumatic peripheral osteoma should be considered in the differential diagnosis of nodular bone-forming lesions affecting the mandible.

Cryotherapy for localized juvenile spongiotic gingival hyperplasia: preliminary findings on two cases.

BACKGROUND: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a distinct subtype of inflammatory gingival hyperplasia that shows lack of response to traditional periodontal treatment, and after surgical excision, recurrence rate of 6-16% has been reported. CASE REPORT: Two girls (11- and 9-year-old) with multifocal red patches along the maxillary and mandibular labial gingiva showed no regression of the lesions after basic periodontal treatment. Surgical excision of focal lesion in each case was performed, which showed typical features of LJSGH. In both cases, the lesions presented recurrence. Hence, cryotherapy sessions in all lesions were performed. CONCLUSION: Cryotherapy appears to be successfully in LJSGH and well received by paediatric patients.

Mandibular Osteolytic Lesion Associated with Exuberant Hyaline Ring Granuloma Reaction.

OBJECTIVE: To report an unusual case of oral hyaline ring granuloma (HRG) that caused an extensive osteolytic lesion. CLINICAL PRESENTATION AND INTERVENTION: A 22-year-old female was referred to our hospital with a large expansile cystic lesion in the left mandibular ramus associated with a clinically visible, partially erupted third molar. A diagnosis of paradental cyst was made. After marsupialization of the lesion, histopathological analysis of the surgical specimen showed an unusual exuberant HRG reaction supported by scarce fibrous stroma. CONCLUSION: This was a case of exuberant HRG reaction that caused extensive bone destruction.

Focal osteoporotic bone marrow defect mimicking a mandibular cystic lesion.

An unusual presentation of a focal osteoporotic bone marrow defect (FOBMD) of the mandible mimicking a cystic lesion is documented. A definitive diagnosis could be established only on the basis of the histopathologic evaluation. A 66-year-old Brazilian woman was referred by her dentist for well-defined radiolucency of the mandibular molar region suggesting a cystic lesion of odontogenic origin. The computed tomography scan confirmed that the lesion did not affect the corticals. The biopsy confirmed the diagnosis of FOBMD. The diagnostic difficulty in the current case is obvious, because FOBMD, usually exhibiting an ill-defined radiolucency, is seldom suspected preoperatively when a differential diagnosis is considered for focal well-defined radiolucent areas in the jaws.

Cytotoxicity evaluation of Chlorhexidine and Blue®M applied to a human gingival fibroblast (HGF-1) and keratinocytes (NOK-SI): In vitro study.

Chlorhexidine (CHX) is a prime choice to control the oral microbiota. However, it's a chemical agent leading to side effects such as teeth strains, taste disturbance, and desquamation of oral mucosa. Alternatively, the lactoferrin and oxygen-based Blue®M has been introduced as an alternative to the CHX, not disturbing tissue repair. Therefore, the study aimed to evaluate the effects of Blue®M and CHX on oral human fibroblasts (HGF-1) and keratinocytes (NOK-SI). Cell cultures using HGF-1 and NOK-SI evaluated cell proliferation, cell cycle, apoptosis and necrosis, and migration. In the dose-effect test, Blue®M reduced the HGF-1 sample in a 4-fold concentration than CHX (CHX: 173.07 ±10.27; Blue®M: 43.86 ±3.04). The proliferation test revealed an eightfold reduction of the sample for CHX, while for Blue®M, the proliferation rate was eighteen times lower. The apoptosis and necrosis rates increased by 25% (p<0.0001) for HGF-1 for both substances. In NOK-SI, the apoptosis rates increased by 10% (p=0.02) and 15% (p=0.001) for CHX and Blue®M, respectively. Furthermore, the fibroblast had a lower capacity for wound closure in the Scratch Assay (monolayer cell migration) for Blue®M. Despite the limitations of this in vitro study, the results of the lactoferrin and oxygen-based Blue®M demonstrated cytotoxicity in doses over the Minimum inhibitory concentration and Minimum bactericidal concentration for Oral fibroblasts (HGF- 1) and Keratinocytes (NOK-SI).

Crystal-storing histiocytosis: a rare lesion in periapical pathology.

Crystal-storing histiocytosis is a rare manifestation of plasma cell dyscrasia/monoclonal gammopathies and lymphoproliferative disorders, characterized by cytoplasmic accumulation of crystallized immunoglobulins in histiocytes. Nevertheless, some reported cases of crystal-storing histiocytosis raise the possibility that this lesion may also be reactive. Crystal-storing histiocytosis in the oral cavity is extremely rare; only one case affecting the tongue has been reported in the English-language literature. In this report, we discuss the case of a 38-year-old man who presented a persistent periapical lesion affecting the maxillary left lateral incisor. Histopathological analysis showed numerous crystal-laden histiocytes associated with a mild plasma cell infiltrate within a fibrous stroma. The plasma cells failed to show clonal light-chain restriction, and the patient had no associated hematologic disorder or systemic disease. Thus, this lesion was probably the result of hypersecretion of immunoglobulins by polyclonal plasma cells found in the periapical lesion. Crystal-storing histiocytosis should be considered in the differential diagnosis of periapical lesions.

Spongiotic hyperplasia of the oral mucosa: case series and immunohistochemical analysis.

The localized juvenile spongiotic gingival hyperplasia (LJSGH) mainly affects the maxillary vestibular attached gingiva of juvenile patients, without sex predilection. Similar lesions involving extragingival sites have not been reported to date. Here, we report 2 cases of extragingival soft tissue lesions with similar clinicopathological features to those reported in LJSGH and 12 cases of intraoral reactive soft tissue lesions microscopically showing LJSGH-like focal areas. The 2 cases were adult patients, affecting the maxillary alveolar ridge (55-year-old female) and hard palate (78-year-old male), which were diagnosed as "spongiotic hyperplasia of the oral mucosa." The 12 intraoral reactive soft tissue lesions (6 men and 6 women; mean age, 49.5 years) were diagnosed as inflammatory fibrous hyperplasia (n = 6), peripheral ossifying fibroma (n = 3), and pyogenic granuloma (n = 3), each of them presenting LJSGH-like focal areas. By immunohistochemistry, the spongiotic hyperplasia areas showed positivity for CK19, CK14, CK34ßE12, and CAM5.2 (weak/focal), while CK4 was negative. Considering the anatomical locations (extragingival) of these 2 cases, the term "spongiotic hyperplasia of the oral mucosa" is suggested. Moreover, LJSGH-like focal areas can be detected when microscopically assessing common intraoral reactive soft tissue lesions.

Maxillary dentigerous cyst showing squamous odontogenic tumor-like proliferation: surgical approach and literature review.

Squamous odontogenic tumor (SOT) is a rare benign neoplasm of the jaw that likely arises from remnants of the dental lamina. It is a slow-growing lesion, with a radiolucent appearance in the central variant. Microscopically, SOT shows islands of squamous epithelium supported by fibrous stroma. In rare cases, squamous odontogenic tumor-like proliferation (SOT-LP) can be observed arising from odontogenic cysts (SOT-LPOC). Herein, we describe the case of a 42-year-old man who presented with discreet bleeding in the maxillary gingiva. Imaging revealed a well-defined, ovoid-shaped lesion with sclerotic margins involving tooth #18 in the intraosseous location. Fine needle aspiration supported the cystic nature of the lesion. After surgery, microscopy revealed a dentigerous cyst showing SOT-LP features. There was no recurrence after a 3-year follow-up. To the best of our knowledge, this is the first report of a dentigerous cyst showing SOT-LP features in the maxilla. Such cysts should be identified to avoid misdiagnosis, with the finding having therapeutic and prognostic implications.

Activity of Free and Liposomal Antimony Trioxide in the Acute Promyelocytic Leukemia Cell Line NB4.

BACKGROUND/AIM: Antimony is a chemical element used in the therapy of parasitic diseases with a promising anticancer potential. The aim of this study was to evaluate in vitro activity of free or liposomal vesicle-packed antimony trioxide (AT or LAT) in the t(15;17)(q22;q21) translocation-positive acute promyelocytic leukemia (APL) cell line NB4. MATERIALS AND METHODS: Cytotoxicity was analysed with trypan blue exclusion, the MTT assay and neutral red exclusion assay; cell proliferation with PicoGreen®; and reactive oxygen species (ROS) production with DCFDA. RESULTS: Liposomal particles did not change the pH of the cell culture medium and entered the cells. Both formulations resulted in a time- and concentration-dependent cytotoxicity and production of ROS. LAT showed higher toxicity at lower concentrations compared to AT. CONCLUSION: LAT may be used to decrease drug dosage and maintain high anti-tumoral effects on APL cells.

Post-radiotherapy recurrence of conventional oral squamous cell carcinoma showing sarcomatoid components: an immunohistochemical study.

Spindle cell squamous cell carcinoma (SpSCC) is a rare biphasic malignant neoplasm, uncommonly affecting the oral cavity. The SpSCC diagnosis is difficult, especially when it exhibits inconspicuous morphology, inadequate tissue sampling, or association with an exuberant inflammatory reaction. Post-radiotherapy recurrent SpSCC occurring at the same site of conventional SCC is a rare phenomenon. A 59-year-old man was complained of "painful injury on the tongue" with 20 days of duration. He reported smoking and alcohol consumption. Medical history revealed conventional SCC on the tongue treated with surgery and radiotherapy 10 years ago. Intraoral examination showed a polypoid lesion with ulcerated areas, measuring 3 cm in diameter, on the tongue and floor of the mouth, at the same site of previous conventional SCC. The microscopical analysis showed small foci of carcinomatous component admixed with an exuberant inflammatory reaction. Immunohistochemistry highlighted the sarcomatoid component. Both malignant components were positive for EMA, CD138, p40 (deltaNp63), p63, and p53. Moreover, CK AE1/AE3 evidenced the carcinomatous component, whereas vimentin stained the sarcomatoid component. The Ki-67 was >10%. The current case emphasizes the importance of immunohistochemistry in the differential diagnosis of SpSCC from mimics and documents a rare complication of Ionizing Radiation.

Unilateral enlargement of the lateral lingual tonsil: An immunohistochemical study and literature review.

Besides the Waldeyer's ring, other lymphoid aggregates can also be detected in the soft palate, floor of the mouth and ventral tongue. The lingual tonsil is located at the base of the tongue and related to circumvallate papillae, whereas subepithelial lymphoid tissue at the posterior lateral portion of the tongue and related to foliate papillae constitutes the lateral lingual tonsil. Unilateral tonsillar enlargement is critical, because it can suggest malignancy, notably non-Hodgkin lymphoma or squamous cell carcinoma. Herein, we report an unusual presentation of unilateral enlargement of the lateral lingual tonsil, diagnosed as follicular lymphoid hyperplasia.

Ameloblastic fibro-odontoma: a conservative surgical approach.

Ameloblastic fibro-odontoma (AFO) is a rare benign mixed odontogenic tumor that occurs predominantly in children and young adults with no gender predilection and anatomic site, usually appearing as a painless swelling. We present a case of an 11-year-old non-Caucasian boy complaining of large painless isolated swelling in the right mandibular body. Intraoral examination revealed a tumoral mass with cortical bone expansion, covered by normal mucosa measuring 4.0 x 2.0 cm, located on both the lingual and buccal surfaces of the right body of the mandible, with displacement of the neighboring teeth. Panoramic radiography revealed an expansile, radiolucent and well circumscribed lesion with scattered foci of calcified material, which contained several radiopaque bodies of varying sizes and shapes. The provisional diagnoses were odontoma or AFO/ Biopsy confirmed AFO. The patient was treated with conservative surgery. After two years of follow-up, no alteration or recurrence was detected.

Intraoral epidermoid cyst with extensive elastofibromatous changes: an unusual finding.

INTRODUCTION: Epidermoid cysts (ECs) are rare and occur in the head and neck regions with an incidence from 1.6 to 7% of all cysts. In the oral cavity, approximately 80 ECs have been reported, representing less than 0.01% of all cysts. CASE REPORT: We report a case of a 26-year-old man who developed a large EC in the midline floor of the mouth causing nodular swelling in the submental region and speech and swallowing difficulties. The lesion was surgically excised by intraoral approach and microscopically revealed an EC associated with extensive elastofibromatous changes in the cystic capsule. CONCLUSION: Oral EC with extensive elastofibromatous changes is a finding extremely rare. The meaning of this finding is unknown, but a traumatic origin or deposit disorder of elastic fibers is suggested. To the best of our knowledge, intraoral EC with elastofibromatous changes has not been reported to date.

Dentoalveolar Abscesses Not Associated with Caries or Trauma: A Diagnostic Hallmark of Hypophosphatemic Rickets Initially Misdiagnosed as Hypochondroplasia.

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

Post-radiotherapy recurrence of conventional oral squamous cell carcinoma showing sarcomatoid components: an immunohistochemical study

Spindle cell squamous cell carcinoma (SpSCC) is a rare biphasic malignant neoplasm, uncommonly affecting the oral cavity. The SpSCC diagnosis is difficult, especially when it exhibits inconspicuous morphology, inadequate tissue sampling, or association with an exuberant inflammatory reaction. Post-radiotherapy recurrent SpSCC occurring at the same site of conventional SCC is a rare phenomenon. A 59-year-old man was complained of "painful injury on the tongue" with 20 days of duration. He reported smoking and alcohol consumption. Medical history revealed conventional SCC on the tongue treated with surgery and radiotherapy 10 years ago. Intraoral examination showed a polypoid lesion with ulcerated areas, measuring 3 cm in diameter, on the tongue and floor of the mouth, at the same site of previous conventional SCC. The microscopical analysis showed small foci of carcinomatous component admixed with an exuberant inflammatory reaction. Immunohistochemistry highlighted the sarcomatoid component. Both malignant components were positive for EMA, CD138, p40 (deltaNp63), p63, and p53. Moreover, CK AE1/AE3 evidenced the carcinomatous component, whereas vimentin stained the sarcomatoid component. The Ki-67 was >10%. The current case emphasizes the importance of immunohistochemistry in the differential diagnosis of SpSCC from mimics and documents a rare complication of Ionizing Radiation.

Anterior lingual mandibular bone cavity: a case report / Cavidade óssea mandibular lingual anterior: um relato de caso

Stafne's bone cavity (SBC) is an asymptomatic lingual bone cavity situated near the angle of the mandible. The anterior variant of SBC, which shows a radiolucent unilateral ovoid lingual bone concavity in the canine-premolar mandibular region, is uncommon. A 73-year-old man was referred for assessment of loss of mandibular bone. Panoramic radiographs and computerized tomography scans showed a well-defined lingual bony defect in the anterior mandible. Analysis of imaginological documentation, made 14 years ago, revealed a progressive increase in mesiodistal diameter and intraosseous bony defect. The soft tissue obtained within the bony defect, microscopically revealed fibrous stroma containing blood vessels of varied caliber. The current anterior lingual mandibular bone defect case is probably caused by the salivary gland entrapped or pressure resorption, which can explain the SBC pathogenesis (AU)

A cavidade óssea de Stafne (COS) é uma cavidade assintomática, localizada próximo ao ângulo da mandíbula, por lingual. A variante anterior da COS, a qual apresenta uma concavidade óssea lingual radiolúcida, ovoide e unilateral na região do caninopré-molar mandibular, é incomum. Um homem de 73 anos foi encaminhado para avaliação da perda óssea mandibular. A radiografia panorâmica e a tomografia computadorizada mostraram um defeito ósseo lingual bem definido na região anterior da mandibula. A análise da documentação imaginológica, realizada há 14 anos, revelou um aumento progressivo do diâmetro mesiodistal e defeito ósseo intraósseo. A biópsia do tecido mole obtido do defeito ósseo revelou microscópicamente estroma fibroso contendo vasos sanguíneos de calibre variado. O presente caso de defeito ósseo mandibular na região lingual anterior é provavelmente causado por glândula salivar aprisionada ou reabsorção por pressão, o que pode explicar a patogênese da COS. (AU)