Gingival and alveolar mucosal reactive hyperplastic lesions: a retrospective clinical and histological study of 996 cases

Background: gingival/alveolar mucosal reactive hyperplastic lesions (GRHL), including fibrous hyperplasia (FH), pyogenic granuloma (PG), peripheral ossifying fibroma (POF) and peripheral giant cell lesion (PGCL), are a common group of oral diseases. The aim of the present study was to access the frequency and distribution of the clinical and histological features of these disorders in a Brazilian population. Material and methods: all specimens diagnosed as GRHL in three Oral Pathology laboratories were selected for the study. Clinical information was retrieved from the laboratory biopsy forms and hematoxylin and eosin stained histological slides were reviewed for analysis of the histological characteristics. Results: final sample was composed of 996 specimens, including 463 FH (47%), 280 PG (28%), 183 POF (18%) and 70 PGCL (7%). Females were more affected by FH, PG, and POF, and most cases affected adults with mean ages ranging from 40 to 53 years. FH, PG, and POF were more common in the upper gingiva/alveolar mucosa. Most PG, POF and PGCL were pedunculated, in contrast with FH (p<0.001). PG, FH and POF were mostly red or normal mucosal in color, while PGCL were mostly red/purple (p<0.001). PGCL were larger, followed by POF, FH and PG (p<0.001). Some histological features were characteristically found in some conditions, but they were also encountered in other lesions with variable frequencies. Conclusions: Oral medicine specialists, oral pathologists and periodontists are usually the professionals in contact with patients presenting GRHL and it is of upmost relevance that they should be familiarized with their clinical and histological profile. (AU)

Social and behavioural associated factors of actinic cheilitis in rural workers.

OBJECTIVE: This cross-sectional study aimed to evaluate the prevalence and factors potentially associated with the development of actinic cheilitis (AC) in Brazilian rural workers. SUBJECTS AND METHODS: A professional performed all physical examinations and evaluations using semi-structured questionnaires in 240 rural workers. RESULTS: Eighty-three participants were diagnosed with AC (34.6%). It was more prevalent among workers older than 45 years (3.29-10.96 95% IC; OR = 3.30; p = .0018), Caucasians (phototypes I and II) (4.78-16.12 95% IC; OR = 10.81; p < .0001), illiterate individuals (2.16-21.59 95% IC; OR = 10.43; p = .0037), those with 6 or fewer years of formal schooling (2.03-7.89 95% IC; OR = 4.63; p = .0013), those regularly using pesticides (1.58-6.64 95% IC; OR = 2.79; p = .0260) and those who used the private health service in their last appointment (1.17-3.54 95% IC; OR = 2.72; p = .0083). CONCLUSION: There was a substantial prevalence of AC among rural workers with advanced age, white skin, and illiteracy, those with lower levels of education, those who regularly use pesticides, and those who utilised private health services in their last appointment. Thus, healthcare strategies that include rural workers are required for the control and prevention of AC in both public and private health services.

Immunoexpression of Wnt/ß-catenin signaling pathway proteins in ameloblastoma and calcifying cystic odontogenic tumor.

BACKGROUND: Wnt/ß-catenin signaling pathway is essential for the beginning of odontogenesis and may be involved in the development and progression of some odontogenic tumors. Thus, the aim of this study was to comparatively evaluate the immunohistochemical expression of Wnt/ß-catenin signaling pathway proteins in a series of AME and CCOT. MATERIAL AND METHODS: Immunohistochemical reactions were performed using antibodies against Wnt1, Wnt5a and ß-catenin in 17 cases of solid AME and 6 cases of CCOT. RESULTS: In the AME group, Wnt1 and Wnt5a were identified in the epithelium in most of the cases, and ß-catenin was mainly identified in the cytoplasm of the tumoral cells. In the CCOT group, Wnt1 and Wnt5a were identified in the epithelium and in the ghost cells in almost all the cases, and ß-catenin was mainly identified in the cytoplasm and in the nuclei of the tumoral cells. CONCLUSIONS: These results contribute to support the importance of Wnt/ß-catenin signaling pathway proteins in AME and CCOT tumorigenesis. The abnormal expression of cytoplasmic and/or nuclear ß-catenin appears to contribute to the development of both AME and CCOT. In addition, it is possible that Wnt1 and Wnt5a expression in ghost cells can contribute to its histogenesis in CCOT. Key words:Ameloblastoma, ß-catenin, calcifying cystic odontogenic tumor, immunohistochemistry, Wnt.

Automated algorithm for actinic cheilitis diagnosis by wide-field fluorescence imaging.

Actinic cheilitis (AC) is a disease caused by prolonged and cumulative sun exposure that mostly affects the lower lip, which can progress to a lip squamous cell carcinoma. Routine diagnosis relies on clinician experience and training. We investigated the diagnostic efficacy of wide-field fluorescence imaging coupled to an automated algorithm for AC recognition. Fluorescence images were acquired from 57 patients with confirmed AC and 46 normal volunteers. Three different algorithms were employed: two based on the emission characteristics of local heterogeneity, entropy and intensity range, and one based on the number of objects after K-mean clustering. A classification model was obtained using a fivefold cross correlation algorithm. Sensitivity and specificity rates were 86% and 89.1%, respectively.

Metalloproteinases 2 and 9 Immunoexpression in Periapical Lesions from Primary Endodontic Infection: Possible Relationship with the Histopathological Diagnosis and the Presence of Pain.

INTRODUCTION: The aim of this study was to evaluate the possible associations among the histopathological diagnosis, the inflammatory infiltrate profile, the presence of pain, and the immunoexpression of matrix metalloproteinases MMP-2 and MMP-9 in periapical lesions from primary endodontic infection. METHODS: Fifty-one primary periapical lesions obtained from extracted teeth were selected for this study. Patients were previously evaluated for the presence of pain and sinus tract related to the tooth to be extracted. Tissues were processed for microscopic examination and MMP-2 and MMP-9 immunoexpression. Microscopically, samples were classified as periapical granulomas or periapical cysts and the inflammatory infiltrate as chronic or mixed. The percentage of immunopositive cells for MMP-2 and MMP-9 of each case was performed based on 10 consecutive microscopic fields. The Student t or chi-square tests were used in the statistical analysis. RESULTS: Of the total, 28 cases were classified as periapical granulomas (54.90%) and 23 cases as periapical cysts (45.10%). Seventeen patients (33.33%) reported pain associated with the extracted tooth, with 12 cases of periapical granulomas (70.58%) and 5 cases of periapical cysts (29.42%). All cases showed immunopositivity for MMP-2 and MMP-9 in a high percentage of cells, mainly in the cytoplasm of the leukocytes. MMP-2 was expressed more in periapical granulomas than periapical cysts (P < .05) and in symptomatic cases (P < .05). CONCLUSIONS: According to the results, we may conclude that MMP-2 and MMP-9 are highly expressed in periapical lesions from a primary endodontic infection. Moreover, we may suggest MMP-2 is expressed more in periapical granuloma and in cases associated with pain.

Brazilian Oral pathology: a retrospective survey of 245 casesfrom a Surgical Pathology Hospital Laboratory / Patologia oral: uma pesquisa retrospectiva brasileira de 245 casos provenientes do Laboratório Hospitalar de Patologia Cirúrgica

The aim of this study was to determine the range of oral histopathological diagnoses in a Brazilian survey obtained from a surgical pathology hospital laboratory. Materials and Methods: A retrospective cross-sectional study was performed, and all histological slides from the oral and maxillofacial region during a 14-year period were reviewed. The diagnoses were grouped intofive major diagnostic categories, and age and sex were specified. Results: A total of 769 samples were collected and submitted for histopathological analysis. There were 245 oral cases, which were divided into 48 different diagnoses. There was no sex predilection, and the mean age was about 44 year sold. Proliferative non-neoplastic lesions (43.2%) and malignant neoplasms (26.5%) comprised the main two groups of diagnoses. Conclusion: The malignant neoplasms prevalence observed in this Brazilian sample may be due to the nature of the populationor, most probably, to the nature of the source, are ferral hospital center in the city...

O objetivo deste estudo foi determinar avariação de diagnósticos histopatológicos da cavidade oral em uma amostra brasileira obtida a partir de um laboratório hospitalar de patologia cirúrgica. Material e Métodos: Um estudo transversal retrospectivo foi realizado e todas as lâminas histopatológicas da região oral e maxilofacial durante um período de 14 anos foram revisadas. Os diagnósticos foram agrupados em cinco categorias principais de diagnóstico, sendo o sexo e a idade especificados. Resultados: Um total de 769 amostras foram coletadas e submetidas a análise histopatológica. Foram identificados 245 casos de lesões orais, que foram subdivididas em 48 diferentes diagnósticos. Não houve predileção por sexo, e idade média foi de 44 anos. Lesões proliferativas não-neoplásicas (43,2%) e neoplasias malignas (26,5%) representaram os dois principais grupos de diagnóstico. Conclusão: A prevalência de neoplasias malignas observada nesta amostra brasileira pode ser explicada devido a natureza da população ou, mais provavelmente, pela natureza da fonte, um hospital de referência na cidade...

Clinicopathologic analysis and syndecan-1 and Ki-67 expression in calcifying cystic odontogenic tumors, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma.

OBJECTIVE: Benign and malignant tumor cells can express altered adhesion properties, and these features can be associated with their proliferative and invasive characteristics. This study aimed to evaluate syndecan-1 and Ki-67 expression in ghost cell-containing odontogenic tumors. STUDY DESIGN: Clinical data were retrieved from laboratory records, and hematoxylin-eosin-stained slides and sections, labeled with monoclonal antibodies anti-syndecan-1 and anti-Ki-67 using the immunoperoxidase technique, were evaluated. RESULTS: Included were 21 central calcifying cystic odontogenic tumors (CCOTs) (4 associated with odontoma), 2 peripheral CCOTs, 1 dentinogenic ghost cell tumor, and 1 ghost cell odontogenic carcinoma (GCOC). Syndecan-1 was mainly expressed in cells resembling stellate reticulum and in stromal cells from the fibrous capsule. The mean Ki-67 labeling index was 4.1% (49.3% for GCOC), but it was not associated with syndecan-1 expression. CONCLUSIONS: Syndecan-1 is variably expressed in cells resembling the stellate reticulum, stromal cells, and basal cells and might be associated with the biology of these tumors.

Calcifying epithelial odontogenic tumor (CEOT): a clinicopathologic and immunohistochemical study and comparison with dental follicles containing CEOT-like areas.

OBJECTIVE: To describe the clinicopathologic, immunohistochemical, and scanning electron microscopic features of 19 cases of calcifying epithelial odontogenic tumor (CEOT) in comparison to 4 cases of dental follicles containing CEOT-like areas (DF-CEOT). STUDY DESIGN: A collaborative Latin American retrospective study. RESULTS: CEOT and DF-CEOT showed a slight predilection for females, mostly affecting the posterior mandible. CEOTs were classified as epithelium-rich (8 cases), amyloid-rich (4), and calcification-rich (3), and 4 cases showed similar proportion of the 3 components. DF-CEOTs contained odontogenic epithelium, amyloid, calcification, and clear cells. Epithelial cells were positive for cytokeratins CK5 and CK19, E-cadherin, and syndecan 1 (CD138), and focally for amyloid A. In CEOT, amyloid was positive for CD138 and amyloid A, and calcification for CK5, CD138, and amyloid A. In DF-CEOT, calcification was positive for amyloid A. CEOT showed higher Ki-67 protein and minichromosome maintenance complex component 2 (MCM-2) labeling indices than did DF-CEOT. In scanning electron microscopy, CEOT calcified material resembled bone in the 3 cases classified as calcification-rich. CONCLUSIONS: CEOT and DF-CEOT showed histomorphologic and immunohistochemical similarities, and the histogenetic significance of these features should be further studied.

Usefulness of tissue autofluorescence imaging in actinic cheilitis diagnosis.

Actinic cheilitis (AC) is a potentially malignant disorder of the lips. Because of its heterogeneous clinical aspect, it is difficult to indicate representative biopsy area. The purpose of this study was to evaluate the usefulness of tissue autofluorescence in AC diagnosis. The system was composed of a 405-nm light-emitting diode, sent to the sample by a dichroic, that allows the fluorescence signal to reach a camera directly plugged in the system. Fifty-seven patients with clinical diagnosis of AC and 45 normal volunteers were selected. According to clinical and fluorescence features, one or more areas were selected for biopsies in the AC group and epithelial dysplasia (ED) grades were established. The autofluorescence images were processed by a clustering algorithm for AC automated diagnosis. The tissue autofluorescence image revealed a heterogeneous pattern of loss and increase of fluorescence in patients with AC. ED was found in 93% of the cases, and most of the areas graded as moderate or severe ED were chosen with the aid of autofluorescence. The processed autofluorescence images from AC patients showed a higher number of spots in an irregular pattern. Tissue autofluorescence image system is a useful technique in association with clinical examination for AC diagnosis.

Leiomyosarcomas of the oral cavity: report of a radiation-associated and a metastatic case.

BACKGROUND: Leiomyosarcoma is rare in the oral cavity, where it may arise as primary, radiation-associated, or metastatic tumor. This article reports two cases of oral leiomyosarcoma, discussing the range of clinicopathological features and the significance of these presentations. CASE REPORT: One case is a radiation-associated leiomyosarcoma arising in the tongue of a 71-year-old male occurring 22 years after radiation therapy for tonsil squamous cell carcinoma that was surgically treated. The other one is a mandible metastasis from a retroperitoneal widespread leiomyosarcoma in a 69-year-old man, who was treated by surgery and chemotherapy but died from the disease. DISCUSSION: Post-radiotherapy sarcomas of the oral cavity and oral metastasis from soft tissue sarcomas are very uncommon, but based on patient's clinical history, they should be considered by oral health care providers in order to allow an early diagnosis and proper and timely management. Finally, to the best of our knowledge, this seems to be the first reported case of tongue leiomyosarcoma arising in a previously irradiated field.

Histopathological features of keratocystic odontogenic tumor: a descriptive study of 177 cases from a Brazilian population.

The aim of this study was to describe the clinicopathologic features of 177 keratocystic odontogenic tumors (KCOTs) diagnosed in a Brazilian population. A total of 177 KCOTs were reviewed and affected 158 patients with ages ranging from 5 to 79 years (mean age = 32 years) with a slight female predominance. Mandible was the most common affected site (69.3%), and a unilocular radiolucency was the most common radiographic image. Microscopically, all cases showed at least focal areas of classic KCOT, but several histological aspects were also observed, including diffuse and focal epithelial lining hyperplasia (48.6%), epithelial budding (12.4%), reactive cytological alterations (11.3%), dystrophic calcification (7.9%), daughter cysts (7.8%), odontogenic epithelial remnants (4.5%), focal areas of orthokeratinization (2.8%), and ameloblastomatous epithelium (1.7%). These variations may make KCOT diagnosis challenging in some cases, so careful full-sample analysis and knowledge of these uncommon histological features associated with KCOT are essential for correct diagnosis.

Synchronous oral paracoccidioidomycosis and oral squamous cell carcinomas with submandibular enlargement.

Oral paracoccidioidomycosis and oral squamous cell carcinoma may occur in the same patient. As both lesions may present similar clinical and histopathological features, the diagnosis is sometimes challenging. This paper describes the case of a 54-year-old male who was a farm worker and heavy alcohol and tobacco user. He developed paracoccidioidomycosis and two lesions of squamous cell carcinoma in the oral cavity. During the follow-up, the patient presented enlargement of the submandibular lymph nodes, which was thought to be regional metastasis but was diagnosed as paracoccidioidomycosis. Therefore, the significance of this association is emphasized and discussed.

Metastatic renal cell carcinoma to the oral cavity and clear cell mucoepidermoid carcinoma: comparative clinicopathologic and immunohistochemical study.

BACKGROUND: Metastatic clear cell renal cell carcinoma (CCRCC) should be considered in differential diagnosis of intraoral clear cell tumors, including mucoepidermoid carcinoma (MEC). OBJECTIVE AND STUDY DESIGN: We compared the clinical, histologic, histochemical, and immunohistochemical characteristics of 9 oral metastatic CCRCCs and 8 intraoral clear cell MECs. RESULTS: Oral metastatic CCRCC affected salivary-gland containing tissues in 7 cases (78%). Microscopically, oral metastasis revealed a proliferation of neoplastic clear cells arranged in an alveolar pattern with central blood vessels, features that were not seen in any intraoral clear cell MEC. Mucicarmine staining was positive only in clear cell MEC. Immunohistochemistry showed similarities in cytokeratin expression; vimentin and CD10 were expressed in all oral metastatic CCRCCs but in only 1 clear cell MEC each. CONCLUSIONS: Besides clinical history, the alveolar pattern, vessel distribution, absence of mucicarmine staining, and vimentin and CD10 immunoexpression are useful in histologic differential diagnosis of CCRCC and clear cell MEC.

Clinicopathological and immunohistochemical features of oral spindle cell carcinoma.

BACKGROUND: Oral spindle cell carcinoma (SpCC) is a rare variant of oral squamous cell carcinoma (SCC). The aims of this study were to compare the clinicopathologic and immunohistochemical features of oral SpCC with conventional oral SCC. METHODS: Five cases of oral SpCC and 10 cases of oral SCC (five well-differentiated and five poorly differentiated) were evaluated through conventional hematoxylin and eosin staining and immunohistochemical reactions to cytokeratins (CK), vimentin, desmin, smooth muscle actin, muscle-specific actin, S-100 protein, epithelial membrane antigen (EMA), p53, and ki-67. RESULTS: Oral SpCC showed predilection for males on their sixth decade of life, presenting clinically as painful infiltrative ulcers or ulcerated exophytic polypoid masses, preferably located on the alveolar mucosa. Mesenchymal markers were expressed in the spindle cell but not in the carcinomatous component of SpCC, and it was negative in all SCC. CKs AE1/AE3, 6, 14, and EMA were positive on both carcinomatous and spindle cell components of most SpCCs. These tumors also presented higher p53 and ki-67 expression and no CK 1 expression in contrast to well-differentiated SCC. CONCLUSION: Oral SpCC presented a different clinical profile than conventional SCC and histopathologic features and p53 and ki-67 expression closer to poorly differentiated SCC. Besides mesenchymal markers, CK AE1/AE3, 6, 14, and EMA expression on spindle cells may be useful as an adjunct on microscopical differential diagnosis of SpCC.

Clinical, histological and immunohistochemical features of ectomesenchymal chondromyxoid tumor.

OBJECTIVE: Ectomesenchymal chondromyxoid tumor is a rare oral soft tissue neoplasm that should be differentiated from other neural and chondromyxoid entities. The aim of this study was to report the clinical, histological, and immunohistochemical features of 3 additional cases of this condition. METHODS: Clinical data were obtained from the clinical records and all cases were evaluated through light microscopy and immunohistochemistry to cytokeratins, vimentin, S100 protein, desmin, smooth muscle actin, and glial fibrilary acidic protein. RESULTS: All 3 cases affected the tongue as a long-lasting submucosal swelling and were managed through conservative surgery. They all showed myxoid and chondroid histological patterns, and vimentin, S100, and glial fibrilary acidic protein immunoexpression. CONCLUSIONS: These findings reinforce the typical features of ectomesenchymal chondromyxoid tumor previously described, helping to confirm and establish the clinical, histopathological, and immunohistochemical profile of this uncommon lesion.

Comparative clinicopathological study of intraoral sebaceous hyperplasia and sebaceous adenoma.

OBJECTIVE: The objective of this study was to compare the clinicopathological features of oral sebaceous hyperplasia and sebaceous adenoma. STUDY DESIGN: Clinical data, microscopical characteristics, and ki-67 immunoexpression were comparatively analyzed on 2 intraoral sebaceous adenomas, 6 intraoral sebaceous hyperplasias, and 21 normal intraoral sebaceous glands. RESULTS: Clinically, sebaceous glands presented as multiple separated papules, sebaceous hyperplasias as a single enlarged papule, and sebaceous adenoma as a well-defined nodule. Microscopically, sebaceous adenoma presented an increased number of lobules, smaller lobules, and a greater number of germinative/squamous cells. Sebaceous hyperplasia also had an increased number of lobules and fewer number of germinative/squamous cells, as compared to normal oral sebaceous glands. Ki-67 expression was seen only in germinative cells and counts were higher in sebaceous adenomas followed by hyperplasias and normal glands. CONCLUSIONS: Sebaceous hyperplasias and adenomas showed different clinical, microscopic, and proliferative characteristics, suggesting the usefulness of the studied criteria on diagnosis of these uncommon oral lesions.

Comparative cytokeratin expression in the different cell types of salivary gland mucoepidermoid carcinoma.

Mucoepidermoid carcinoma is the most common malignant salivary gland tumor, composed of several different cell types, with controversial histogenesis. The aim of this study was to assess the expression of cytokeratins in mucoepidermoid carcinoma, comparing to cytokeratin expression in normal salivary glands, in order to establish a possible correlation between tumor cells immunostaining and mucoepidermoid carcinoma histogenesis and differentiation. Eighty cases of salivary gland mucoepidermoid carcinoma were immunohistochemically examined with the use of antibodies against cytokeratins 6, 7, 8, 13, 14, 18, and 19. Cytokeratin expression varied according to the cellular type: squamous cells presented high expression of cytokeratins 6, 7, 8, 14, 18, and 19; intermediate and mucous cells of cytokeratin 7; clear and columnar cells of cytokeratins 6, 7, 8 and the latter also expressed cytokeratin 18. Cytokeratin 13 expression was low in all cell types. Cytokeratin immunoexpression in mucoepidermoid carcinoma was variable according to the cellular type; but regardless of the cellular type studied, cytokeratins 7 and 13 were, respectively, constantly high and low expressed. The immunoprofile of the normal salivary glands was variable according to the component but, in general, cytokeratin profile in mucoepidermoid carcinoma showed similarity to the immunoexpression on the excretory duct unit of normal salivary glands.