Immunoexpression of calcitonin and glucocorticoid receptors in central giant cell lesions of the jaws.

BACKGROUND: This study analyzed the immunoexpression of calcitonin receptor (CTR) and glucocorticoid receptor (GR) in central giant cell lesions (CGCLs) and verified potential associations with patient's response to clinical treatment with intralesional injection of triamcinolone. MATERIALS AND METHODS: Fifty-four cases of CGCLs, including 22 non-aggressive, and 32 aggressive, were investigated by immunohistochemistry. RESULTS: Surgery was the therapeutic choice for 53.1% of the aggressive CGCLs, and 46.9% were submitted to the conservative treatment with intralesional triamcinolone injections. Among patients submitted to conservative treatment, 60% (n = 9) showed favorable response. CTR expression was observed in 68.51%, and GR in 94.44% of the total sample. There were no differences in the expression of CTR, neither GR in mononucleated stromal cells (MSCs) or multinucleated giant cells (MGCs), in relation to aggressiveness, treatment performed for and the response to conservative treatment. Both markers showed a positive correlation between their expression in MSCs and MGCs in the total sample (P < 0.0001). CTR expression on MSCs showed a positive correlation with MGCs in the aggressive and non-aggressive groups (P < 0.0001). CONCLUSIONS: Calcitonin receptor and GR expression were diffuse and similar in non-aggressive and aggressive cases, and it did not influence the response to clinical treatment with triamcinolone in the sample studied.

Primordial Odontogenic Tumor: A Review of the Literature and Report of Three New Patients.

The primordial odontogenic tumor (POT) is a rare mixed odontogenic tumor composed of mesenchymal cells, columnar odontogenic epithelium, and fibromyxoid stroma affecting the posterior mandible of children and adolescents. Herein, we report 3 patients with POT and the clinicopathological features of POT previously reported in the literature. A 12-year-old, 19-year-old, and 4-year-old patient presented an asymptomatic swelling in the posterior maxilla and posterior mandible. Imaging exams revealed radiolucent lesions associated with unerupted teeth. The lesions were surgically removed, and the histopathological examination revealed spindle-to-ovoid mesenchymal cells in a fibromyxoid stroma surfaced by columnar odontogenic epithelial cells with reverse nuclear polarization. Deposition of mineralized tissue was observed. The final diagnosis was POT, and patients did not exhibit signs of recurrence. POT should be included in the differential diagnoses of intraosseous lesions in the posterior mandible in pediatric patients.

Clinicopathologic and imaging features of odontogenic myxomas: a multi-institutional study.

PURPOSE: This study aims to report clinicopathologic and imaging features of odontogenic myxomas (OM), highlighting uncommon findings. METHODS: Clinicopathologic and imaging data of OMs diagnosed in the five Brazilian diagnostic pathology centers were collected and analyzed. RESULTS: The series comprised 42 females (68.9%) and 19 males (31.1%), with a 2.2:1 female-to-male ratio and a mean age of 34.5±15.4 years (range: 4-80). Clinically, most OMs presented as painless intraoral swelling (n = 36; 70.6%) in the mandible (n=37; 59.7%). Multilocular lesions (n=30; 83.3%) were more common than unilocular lesions (n=6; 16.7%). There was no statistically significant difference between the average size of unilocular and multilocular OMs (p=0.2431). The borders of OMs were mainly well-defined (n=24; 66.7%) with different degrees of cortication. Only seven tumors caused tooth resorption (15.9%), while 24 (54.5%) caused tooth displacement. Cortical bone perforation was observed in 12 (38.7%) cases. Morphologically, OMs were characterized mainly by stellate or spindle-shaped cells in a myxoid background (n=53; 85.5%). Surgical resection was the most common treatment modality (n=15; 65.2%), followed by conservative surgery (n=8; 34.8%). Outcomes were available in 20 cases (32.3%). Seven of these patients had local recurrence (35%). Enucleation was the treatment with the highest recurrence rate (4/7; 57.1%). CONCLUSIONS: OM has a predilection for the posterior region of the jaws of female adults. Despite their bland morphological appearance, they displayed diverse imaging features. Clinicians must include the OM in the differential diagnosis of osteolytic lesions of the jaws. A long follow-up is needed to monitor possible recurrences.

Gingival rhabdomyosarcoma mimicking a non-neoplastic proliferative lesion: A diagnostic challenge.

Rhabdomyosarcoma (RMS) is a soft tissue sarcoma that develops from skeletal striated muscle cells. RMSs are exceedingly rare in the oral cavity, particularly in the gingiva. Herein, we reported the clinicopathological and immunohistochemical features of a rare case of RMS in a 30-year-old female presenting clinically as a painful polypoid nodule on the mandibular gingiva. Microscopically, the tumor showed atypical spindle cells with elongated nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. In focal areas, the tumor cells exhibited rhabdomyoblastic differentiation. Immunohistochemistry showed strong positivity for desmin, myogenin (scattered cells), and MyoD1. The patient underwent surgical resection followed by postoperative complementary radio- and chemotherapy. However, the patient had a local recurrence seven months after the initial treatment. She was submitted to a total mandibulectomy associated with adjuvant radiotherapy. However, she died two months after reoperation due to complications secondary to radiation therapy. Because of the rarity in the oral cavity and non-specific signs and symptoms, the clinical diagnosis of RMS is difficult and often overlooked. Therefore, careful histopathological and immunohistochemistry analysis of these tumors is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.

A retrospective multicenter study of oral and maxillofacial lesions in older people.

Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study.

Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

A retrospective multicenter study of oral and maxillofacial lesions in older people

Abstract Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.

Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study

Abstract Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.

Clear cell variant of calcifying epithelial odontogenic tumor: Case report with immunohistochemical findings.

Calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm, locally aggressive, characterized by sheets and nests of polyhedral epithelial cells exhibiting eosinophilic cytoplasm or less often clear cytoplasm. Additional features include nuclear pleomorphism without mitotic activity, concentric calcifications, and deposits of amyloid. Herein, we present an additional example of clear cell variant of CEOT occurring in a 25-year-old female. Microscopically, the tumor consisted on proliferation of epithelial cells with eosinophilic, clear vacuolated cytoplasm interspersed with focal areas of amyloid deposition. Tumor cells were immunopositive for AE1/AE3, CK14, CK19, ß-catenin, CD138, and p63. Key words:Calcifying epithelial odontogenic tumor, clear cell, histopathology, immunohistochemistry.

Peripheral ossifying fibroma on the mandible: report of atypical presentation case / Fibroma ossificante periférico na mandíbula: relato de caso atípico

ABSTRACT Peripheral ossifying fibroma (POF) is a benign lesion, nodular, firm on palpation; the base is sessile or pedunculated; similar in color to the mucosa and epithelium; it may be preserved or ulcerated. It is prevalent in female and exclusively affects the gingiva. It is usually associated with irritating factors such as caries, dental plaque, among others. The objective of the present study is to report the case of a 27-years-old female patient, presenting a lesion in the mandible, complaining of an increased volume. Surgical excision was the treatment of choice. The patient is 24 months postoperatively with no signs of relapse.

RESUMEN El fibroma osificante periférico es una lesión benigna, nodular, firme a la palpación, de base sésil o pediculada, de color similar a la mucosa y al epitelio; puede estar intacto o ulcerado. Se observa más en mujeres y acomete solamente la encía. La lesión se asocia a factores irritantes, como caries, cálculo dental, entre otros. El objetivo del presente estudio es reportar el caso de una paciente de 27 años de edad, que ha presentado lesión en la mandíbula, quejando-se de aumento de volumen. La escisión quirúrgica ha sido el tratamiento de elección. La paciente encuentra se con 24 meses de postoperatorio, sin señales de recidva.

RESUMO O fibroma ossificante periférico (FOP) é uma lesão benigna, nodular, firme à palpação, de base séssil ou pediculada, com coloração semelhante à mucosa e ao epitélio; pode estar íntegro ou ulcerado. Prevalece no gênero feminino e acomete exclusivamente a gengiva. Associa-se a fatores irritantes, como cárie, cálculo dentário, entre outros. O objetivo do presente estudo é relatar o caso de uma paciente de 27 anos de idade, que apresentou lesão em mandíbula, queixando-se de aumento de volume. A excisão cirúrgica foi o tratamento de escolha. A paciente encontra-se com 24 meses de pós-operatório, sem sinais de recidiva.

Aumento gengival associado à terapia de reposição hormonal / Gingival overgrowth associated to hormone replacement therapy ­ case report

Os aumentos gengivais são lesões proliferativas de evolução lenta e indolor que acometem os tecidos gengivais e envolvem várias possibilidades diagnósticas. O presente trabalho teve como objetivo relatar um caso clínico de aumento gengival em uma paciente jovem sob tratamento de reposição hormonal, ressaltando os aspectos clínicos e histopatológicos desta inter-relação.

Gingival overgrowth are proliferative lesions of painless and slow evolutive character, wich envolve the gingival tissues. This paper shows a case report of this lesion in a young female patient under hormone replacement therapy, highlightening the clinical and histopathologic aspects of this relationship.

Fibroma ossificante periférico ­ Relato longitudinal de dois casos clínicos / Long-term follow-up of peripheral ossifying fibroma ­ report of two cases

O fibroma ossificante periférico é uma lesão não neoplásica proliferativa, não patognomônico, de evolução lenta e indolor, que acomete os tecidos gengivais. O presente trabalho teve como objetivo relatar dois casos clínicos desta lesão em um acompanhamento em longo prazo, ressaltando os aspectos clínicos e histopatológicos, bem como seu tratamento e prognóstico.

The peripheral ossifying fibroma is a non-neoplasic, proliferative lesion of painless and slow evolutive character, which involves the gingival tissues. This paper reports on two clinical cases in a long-term follow-up highlightening their clinical and histopathologic aspects, treatment, and outcomes.

Hiperplasia condilar associada à recidiva de deformidade dentofacial / Condylar hyperplasia associated with relapse of a dentofacial deformity

O diagnóstico prévio de patologias envolvendo a articulação temporomandibular é de extrema importancia para o planejamento das cirurgias ortognáticas. Em caso de patologias da articulação temporomandibular que não sejam diagnosticadas ou sejam ignoradas, é esperada a piora do quadro clínico de disfunção temporomandibular ou a recidiva da deformidade dentoesquelética após a cirurgia ortognática. A hiperplasia condilar causa o aumento do tamanho do côndilo mandibular, que se repercute por toda a mandíbula, com consequente deformidade dentofacial. O tratamento da hiperplasia condilar consiste na remoção da área do côndito, responsável por este crescimento excessivo e posterior correção da deformidade facial remanescente. O objetivo deste trabalho é o de relatar um caso clínico de recidiva da assimetria facial devido à falha no diagnóstico e ao tratamento da hiperplasia condilar, ressaltando a importância da articulação temporomandibular na cirurgia ortognática.

The prior diagnosis of pathological conditions of the temporomandibular joint is extremely important for the planning of orthognathic surgery. If such conditions are ignored or not diagnosed, the worsening of the clinical features or postoperative relapse of the dentofacial deformity are to be expected. Condylar dsyplasia leads to an increase in the size of the mandibular condyle with repercussions for the entire jaw and resulting dentofacial deformity. The treatment of condylar hyperplasia consists in the resection of the area of the condyle responsible for this excessive growth and subsequent correction of the remainig facial deformity. The aim of this paper is to report a clinical case of relapse of facial asymmetry due to a failure to diagnose and treat condylar hyperplasia, emphasizing the importance of the temporomandibular joint in orthognathc surgery.

Uso de azitromicina no tratamento de abscesso periodontal em paciente diabético descompensado / The use of azithromycin in the treatment of periodontal abscess in a poorly controlled diabetic patient. Case report

O objetivo do presente trabalho foi relatar um caso clínico de uma paciente diabética descompensada portadora de abscesso periodontal. O tratamento foi realizado por meio de drenagem, raspagem subgengival, irrigação com iodo-povidine e prescrição de azitromicina por três dias. O exame clínico e radiográfico após seis meses demonstrou remissão do quadro clínico e estabilidade dos tecidos periodontais. Desta forma, a azitromicina associada ao tratamento local foi efetiva no tratamento de abscesso periodontal em paciente diabético descompensado.

Perfil Epidemiológico de 23 casos de neoplasias malignas da cavidade oral atendidos em uma instituição odontológica de nível secundário / Epidemiological profile of 23 cases of malignant neoplasm of the oral cavity treated in a secondary dentistry institution

Introdução: O Câncer Bucal representa atualmente um dosgraves problemas de saúde pública no Brasil. Conforme dados doInstituto Nacional do Câncer (INCA), para o ano de 2012, estimase14.170 novos casos. Objetivo: Avaliar o perfil epidemiológicode 23 pacientes portadores de neoplasias malignas atendidos emuma instituição odontológica de atenção secundária no períodoentre maio de 2007 e setembro de 2009. Método: Prontuáriosde 23 pacientes com resultado histopatológico de lesão malignada cavidade oral foral revisados. Gênero, idade, sítio anatômicoe associação com tabagismo e etilismo foram avaliados.Resultados: O carcinoma espinocelular foi o mais prevalente,correspondendo a 87% dos casos. Houve maior prevalência nogênero masculino (60,9%) e na faixa etária entre 50 e 60 anos.Os sítios anatômicos mais acometidos foram língua (34,8%) eassoalho bucal (21,7%). Verificou-se uma associação entre aocorrência das lesões malignas e o hábito de tabagismo umavez que, do total de pacientes acometidos, 47,8% eram fumantese 43,5% eram ex-fumantes. O perfil epidemiológico encontradocondiz com os achados de estudos anteriormente realizados.Conclusões: A caracterização dos casos de câncer bucalpermite definir o perfil epidemiológico dos pacientes acometidose possivelmente represente grande contribuição para oestabelecimento de políticas preventivas relacionadas à doença.

Efeito da pedra umes no processo de cicatrização tecidual. Estudo histológico em dorso de ratos / Effect of postassium alumina on wound healing. Histological study in rats

O uso de cristais de alúmen de potássio, conhecidos popularmente como pedra umes, é bastante difundido entre a população que frequenta postos públicos de atendimento odontológico, após pequenas cirurgias, como irrigante local e agente hemostático. O objetivo deste trabalho foi avaliar histologicamente o efeito do uso da pedra umes no reparo tecidual de feridas produzidas no dorso de ratos. Quinze ratos da raça Wistar foram divididos aleatoriamente em três grupos de cinco animais cada, de acordo com o tempo do período experimental: Grupo 1 (n = 5) sacrificados no 1º dia; Grupo 2 (n = 5) sacrificados no 7º dia e grupo 3 (n = 5) sacrificados no 14º dia. Quatro feridas foram realizadas com um bisturi tipo punch no dorso dos animais, sendo irrigadas uma vez ao dia, com uma das quatro substâncias: soro, clorexidina, pedra umes segundo diluição do fabricante, pedra umes segundo diluição de uso popular. Os resultados após 24 horas da aplicação da pedra umes sugerem um atraso na cicatrização, provavelmente devido ao seu potencial hemostático, porém nos demais períodos experimentais nenhuma diferença foi constatada entre os grupos. A pedra umes parece ser prejudicial no período inicial do processo de cicatrização, porém não apresenta nenhuma influência em seus eventos subsequentes

The use of potassium alumina is widely spread among the population. They frequently use it after minor surgical procedures, as a local irrigating solution, for bleeding control. The goal of the present work was to evaluate histologically the effects of two different dilutions of pedra umes at the healing response on experimental wounds in rats and to compare them with two other agents commonly used after surgical procedures: chlorhexidine and saline solution. Fifteen rats (Wistar rats) were divided into 3 groups accordingly to the day they were sacrificed: Group 1 (n=5), sacrificed at 1º day; Group 2 (n=5) sacrificed at the 7º day and e group 3 (n=5) sacrificed at the 14º day. Four wounds were made at their dorsum and irrigated once a day with one of the four substances: saline solution, chlorhexidine, potassium alumina diluted accordingly to the manufacturer recommendation and potassium alumina diluted in a popular used manner. The results suggested that wound healing may be delayed by the use of the potassium alumina at 1st day, however no difference was found between test (potassium alumina in two different dilutions) and control groups (saline and chlorhexidine) at the other experimental times.

Tratamento de pigmentação melânica racial por meio de três técnicas distintas / Surgical treatment of racial melanin pigmentation by three distinct techniques. Case report

A pigmentação melânica racial é o resultado da produção excessiva de melanina pelos melanócitos situados na camada basal do epitelio. Em algumas situações, mesmo sendo uma condição fisiológica, pode causar um problema estético aos pacientes. A despigmentação gengival pode ser realizada por meio de técnicas cirúrgicas manuais ou rotatórias, uso de substâncias químicas, criocirurgia e laserterapia. 0 objetivo do presente artigo foi descrever um caso clínico de pigmentação melânica racial tratada por meio de três técnicas cirúrgicas, comparando-as com relação à sua efetividade. Após seis meses de acompanhamento, observou-se resultado clínico favorável e similar com as técnicas utilizadas e satisfação estética relatada pela paciente.