Radiological aspects of lymphomas and leukaemias affecting the jaws: A systematic review.

BACKGROUND: This systematic review aimed to investigate the radiological features of lymphomas and leukaemias affecting the jaws. METHODS: A systematic literature review was conducted using the electronic databases of PubMed, Web of Science and Scopus. Articles that contained sufficient radiographic examinations (periapical, panoramic or computed tomography images) for individual cases were included. Additionally, either immunohistochemical or molecular confirmation was required prior to inclusion. Three authors evaluated and described the image quality and radiological features. RESULTS: From an initial 1079 articles screened, 129 cases were included, containing 88 tomographic, 76 panoramic and 26 periapical examinations. The quality of the majority of images was sufficient for evaluation. Diffuse large B-cell lymphoma, Burkitt lymphoma, leukemic infiltration, plasmablastic lymphoma and extranodal Natural killer (NK)/T-cell lymphoma, nasal type were the most common subtypes. Involved teeth presented with mobility in 37.2% of the cases and a provisional diagnosis of inflammatory/infectious dental disease was considered in 49.2% of cases. Computed tomography exams were available for 76% of the cases, with most presented with an osteolytic lesion with ill-defined borders. Periosteal reactions were uncommon. CONCLUSION: Lymphoma/leukaemia infiltrates of the jaw bones are usually of high-grade subtypes and rarely present with periosteal reactions.

Clinical and radiologic spectrum of glandular odontogenic cysts: A multicenter study of 92 cases.

OBJECTIVE: The purpose of this multicenter retrospective study was to report the clinical and radiologic features of 92 glandular odontogenic cysts (GOCs) diagnosed over a 20-year period. STUDY DESIGN: Histologically confirmed cases of GOC were retrospectively reviewed from 4 oral pathology laboratories in South Africa and Brazil to categorize the clinical and radiologic spectrum of GOCs. RESULTS: The mean age of patients was 46 years (range 17-87) with a male-to-female ratio of 1.2:1. GOCs had a mandibular predilection (68%), with 42% of all cases located anteriorly. Additionally, 42% of cases crossed the midline. Radiologically, most lesions were unilocular (53%) and uniformly radiolucent (97%), with well-demarcated borders (93%). Cortical expansion (62%), loss of cortical integrity (71%), and maxillary sinus (67%) and nasal cavity encroachment (72%) were common findings. Significant differences in lesions between the 2 countries were discovered in sex predilection, clinical signs and symptoms, and lesion locations within the mandible and maxilla. CONCLUSION: GOCs present with a wide spectrum of clinical and radiologic features, ranging from cysts with typical GOC-like presentations to more aggressive lesions. The need for advanced imaging in the surgical planning of GOCs exhibiting radiologic signs of aggression is justified based on the high recurrence rate.

Estudo dos aspectos radiográficos dos linfomas e leucemias em maxila e mandíbula / Radiological aspects of lymphomas and leukemias affecting the jaws

Introdução: linfomas e leucemias são neoplasias linfohematopoiéticas que podem acometer região oral e maxilofacial, incluindo os ossos gnáticos, com aspectos imaginológicos semelhantes a outras neoplasias e processos reativos. Objetivo: Investigar os aspectos radiográficos de linfomas e leucemias em maxila e mandíbula. Metodologia: Uma revisão sistemática foi realizada nas bases eletrônicas Pubmed, Web of Science e Scopus utilizando estratégias específicas de busca. Os critérios de inclusão compreenderam artigos que forneceram imagens do tipo periapical, panorâmica ou tomografia computadorizada (TC) dos casos individualizados e o diagnóstico de leucemia/linfoma pôde ser confirmado por imunoistoquímica. Três avaliadores analisaram e descreveram individualmente as imagens e a qualidade dos exames radiográficos. Resultados: Do total de 1079 artigos escaneados, foram selecionados 129 casos contendo 88 tomografias computadorizadas, 77 panorâmicas e 26 exames periapicais, a maioria (54%) classificados com uma qualidade excelente. O linfoma difuso de grandes células B, sem outras especificações (LDGCB SOE) (32,6%), linfoma de Burkitt (17,1%), infiltrado leucêmico (14,7%), linfoma plasmablástico (7,8%) e linfoma de células NK/T (5,4%) foram os subtipos mais comuns. Os dentes envolvidos apresentaram mobilidade em 37,2% dos casos e um diagnóstico primário de doenças infecciosa/inflamatória foi considerado em 49,2% dos pacientes. A maioria dos casos eram radiolúcidos em exames periapical e panorâmico e a TC estava disponível em 76% dos casos, com um aspecto hipodenso e de bordas mal definidas. Reação periosteal foi pouco comum (4,7%). Conclusões: linfomas/leucemia com destruição dos ossos gnáticos usualmente representam subtipos de alto grau e raramente apresentam reação periosteal na imagem radiográfica.

Objective: To investigate the radiographic features of lymphomas and leukemias in the jaws. Study Design: A systematic review was carried out in the electronic databases Pubmed, Web of Science and Scopus using specific search strategies. Inclusion criteria comprised articles that provided periapical, panoramic or computed tomography (CT) images for individual cases and diagnoses of lymphoma/leukemia confirmed by immunohistochemistry. Three experts evaluated and described individually the images and the quality of the radiographic exams. Results: From 1079 reports screened, 129 cases containing 88 tomographic, 77 panoramic and 26 periapical exams were selected, most of them classified as excellent (54%). Diffuse large B-cell lymphomas NOS (DLBCL), Burkitt lymphoma, leukemic infiltration, T/NKcell lymphoma and plasmablastic lymphoma were the most common subtypes. Involved teeth presented mobility in 37.2% of the cases and a provisional diagnosis of inflammatory/infectious dental disease was considered in 49.2% of the patients. Most cases were radiolucent in plain exams and conventional CT exams were available for 76% of the cases, with hypodense aspect and ill-defined borders. Periosteal reactions were uncommon. Conclusion: Lymphoma/leukemia with gnathic bone destruction are usually of high-grade subtypes and rarely present periosteal reactions.

Defeito ósseo de Stafne em região anterior associado a reabsorção radicular externa: relato de um caso raro / Anterior Stafne bone defect associated with external root resorption: an unusual presentation

O defeito ósseo de Stafne (DOF) é incomum e normalmente se apresenta como uma depressão óssea lingual assintomática que acomete a região de ângulo da mandíbula, abaixo do canal mandibular. Devido sua rara localização anterior este relato descreve o caso de uma paciente mulher de 37 anos com imagens radiográficas que revelam uma imagem unilocular radiolúcida e bem definida localizada abaixo dos ápices dos incisivos e canino inferior esquerdo e adjacente a raiz do primeiro pré-molar, com aspecto sugestivo de reabsorção da raiz do canino. O exame intraoral mostrou dentes com ausência de lesões cariosas e positivos ao teste de vitalidade pulpar. Tomografia computadorizada de feixe cônico revelou invaginação da cortical lingual, lesão bem corticalizada e que se estende do primeiro pré-molar ao incisivo central inferiores do lado esquerdo. O ápice do incisivo lateral apresenta discreta reabsorção radicular e o canino apresenta severa reabsorção radicular externa. Uma biópsia incisional foi realizada e o exame microscópico demonstrou a presença de tecido glandular salivar e o diagnóstico foi de defeito ósseo de Stafne em região anterior associado a reabsorção radicular externa e este relato discute as hipóteses para patogênese desse achado único.

Stafne bone defect (SBD) is an uncommon lingual bone depression usually asymptomatic that often occur near the angle of the mandible below the mandibular canal. Due to the rare anterior localization this article describes a 37-years-old female with radiographic images that revealed well-defined unilocular radiolucent lesion below the apices of the lower left incisors, canine and adjacente to first premolar, with root resorption of the canine. Intraoral examination showed non-carious teeth and positive vitality tests. Cone beam computed tomography revealed an invagination of the lingual cortex, well corticated, which reaches the buccal cortex, extending from first premolar to central incisor tooth in the inferior left side. Lateral incisor presented mild apical resorption while canine tooth presented severe root resorption. Incisional biopsy was performed and microscopic examination showed the presence of salivary gland tissue. The diagnosis was anterior SBD associated with external apical root resorption and the article discuss the hypothesis for the pathogenesis of this unique finding.

Comparação entre análise fractal e avaliação da radiopacidade como instrumentos para estudo do reparo ósseo em sítios enxertados com biomateriais em modelo animal / Comparison between fractal analysis and radiopacity evaluation as a tool for studying repair of an osseous defect in an animal model using biomaterials

Objetivo: Avaliar a reparação de defeitos ósseos em modelo animal de rato por meio da análise fractal e radiopacidade em imagens radiográficas. Metodologia: 120 ratos Wistar tiveram seu primeiro molar extraído e foram divididos em quatro grupos (n=6/grupo) de acordo com o material de enxertia utilizado para preencher o defeito ósseo: Osso bovino mineralizado (OBM); Osso bovino desmineralizado (OBD); Coágulo sanguíneo como controle negativo (CN); Osso bovino Bio-Oss® como controle positivo (BO). Os animais foram sacrificados após 1, 7, 14, 21 e 49 dias e submetidos à análise radiográfica por dimensão fractal em um único ROI de 30x30 pixels e níveis de radiopacidade em três pontos (apical, médio e coronal) de 5x5 pixels. A avaliação histológica foi realizada como padrão ouro por meio da histomorfometria da neoformação óssea e maturação da matriz óssea. Resultados: A avaliação histomorfométrica sugere que o grupo OBD apresenta deposição mineral acelerada e um osso estatisticamente mais maduro aos 49 dias em relação ao CN. O grupo OBM apresenta características similares ao BO, porém, com menor percentual de deposição óssea. Em relação à maturação óssea, não houve diferença com significância estatística em nenhum momento da análise. A análise de radiopacidade mostra diferença com significância estatística entre OBD e o CN aos 49 dias. A análise fractal não mostrou diferenças estatísticas, mas seguiu padrão semelhante. Conclusão: A análise da radiopacidade mostrou-se mais efetiva na quantificação do reparo ósseo em relação à análise fractal no grupo desmineralizado. Não houve diferença entre os dois métodos no grupo mineralizado, concluindo que os dois métodos tem efetividade semelhante.

The aim of this study was to evaluate bone repair of an osseous defect in a rat animal model through fractal analysis and radiopacity analysis in radiographic images. Materials and methods: 120 Wistar rats were subjected to extraction of their first molar and were divided into four groups (n=6/group) according to the material used for bone grafting: mineralized bovine bone (MBB), demineralized bovine bone (DBB), blood clot (BC; as a negative control) or Bio-Oss (BO®; as a positive control). The animals were sacrificed after 1, 7, 14, 21 and 49 days and subjected to radiographic evaluation. For fractal analysis (FA), a rectangular ROI of 30x30 pixels was used, and radiopacity was measured as the mean gray scale (MGS) value for three points of 5x5 pixels in the apical, medial and coronal regions of the defect. Histomorphometric evaluation was realized as the gold standard for measuring bone neo-formation and the maturation of the new osseous matrix. Results: the histomorphometric evaluation suggested that DBB showed faster mineralized deposition and resulted in more mature bone at the final time point of evaluation. MBB and BO presented similar results. The mineralized groups did not show significant differences in bone maturation. The radiopacity analysis revealed a significant difference (p<0.05) between the DBB and BC groups at the final time point. FA did not show any significant differences at the final time point. Conclusion: Radiopacity analysis seemed to be more effective for the quantification of bone repair than fractal analysis in the demineralized group in this animal model. The results for the mineralized groups did not reveal a significant difference, leading to the conclusion that both methods are effective

Actinomyces israelii in radicular cysts: a molecular study.

OBJECTIVE: To investigate whether the microscopic filamentous aggregates observed in radicular cysts are associated with the molecular identification of Actinomyces israelii. Moreover, to verify whether this bacterium can be detected in radicular cyst specimens not presenting aggregates. STUDY DESIGN: Microscopic colonies suggestive of Actinomyces were found in 8 out of 279 radicular cyst samples (case group). The case and control groups (n = 12; samples without filamentous colonies) were submitted to the semi-nested polymerase chain reaction to test the presence of A israelii. DNA sequencing was performed to validate polymerase chain reaction results. RESULTS: Two and 3 samples in the case and control groups, respectively, did not present a functional genomic DNA template and were excluded from the study. A israelii was identified in all samples of the case group and in 3 out of 9 samples of the control group. CONCLUSIONS: Although A israelii is more commonly identified in radicular cysts presenting filamentous aggregates, it also appears to be detected in radicular cysts without this microscopic finding.