Apoptotic signaling in salivary mucoepidermoid carcinoma.

BACKGROUND: Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. Apoptosis plays an important role in organogenesis of glandular structures, and aberrations of apoptotic mechanisms is associated with a wide array of pathologic conditions. METHODS: The immunoexpression of proteins associated with apoptosis and proliferation was evaluated in 40 mucoepidermoid carcinoma cases. RESULTS: Par-4, Survivin, MUC1, PHLDA1, Fas, and Ki-67 were predominantly expressed in mucoepidermoid carcinoma. FasL was rarely expressed, and Caspase-3 expression was observed in almost 50% of the cases. SPARC expression was associated with low-grade tumors, and Ki-67 expression was associated with lymph node metastasis. Expression of Fas and decreased expression of Ki-67 and Caspase-3 were associated with better overall cancer-specific survival rates. CONCLUSIONS: The association of SPARC and Ki-67 expression with pathological features and the association of Fas, Caspase-3, and Ki-67 with survival probabilities suggest that these proteins may be useful prognostic markers for mucoepidermoid carcinoma.

Molecular events in relapsed oral squamous cell carcinoma: Recurrence vs. secondary primary tumor.

Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carcinoma (OSCC) patients. Current classification criteria are imprecise and need improvements. Recent advances in understanding of OSCC relapses on a molecular level provide new possibilities to better classify true recurrences and second primary tumors. This review discusses the limitations of the current OSCC relapse classification method and presents possible alternatives to improve this classification based on molecular techniques. Moreover, these molecular techniques add to the further understanding of these lesions and may provide tools for clinical management.

For early-stage oral tongue cancer, depth of invasion and worst pattern of invasion are the strongest pathological predictors for locoregional recurrence and mortality.

Despite early diagnosis and treatment, almost 20% of patients with early-stage (cT1-cT2N0) oral tongue squamous cell carcinoma (OTSCC) still die of their disease. The prognosis of OTSCC patients is influenced by several demographic, clinical, and histopathologic factors. The aim of this multicenter international study was to find which of the factors age, gender, stage, grade, lymphocytic host response, perineural invasion, worst pattern of invasion, or depth of invasion has the strongest prognostic power in early-stage OTSCC. Patient data of 479 patients with early-stage (cT1-2N0) OTSCC in Finland, Brazil, and the USA were retrieved and analyzed using Cox proportional hazards regression models. Our results indicate that depth of invasion (DOI) and worst pattern of invasion (WPOI) are the strongest pathological predictors for locoregional recurrence, with a hazard ratio (HR) for 4 mm DOI of 1.67 (95% confidence interval (CI) 1.07-2.60) and HR for WPOI of 1.46 (95% CI 0.95-2.25). In addition, mortality from early OTSCC was also predicted by DOI (HR 2.44, 95% CI 1.34-4.47) and by WPOI (HR 2.34, 95% CI 1.26-4.32). We suggest that clinically early-stage oral tongue carcinomas 4 mm or deeper, or with a growth pattern of small cell islands or satellites, should be considered as high-risk tumors which require multimodality treatment.

Activin A immunoexpression as predictor of occult lymph node metastasis and overall survival in oral tongue squamous cell carcinoma.

BACKGROUND: The presence of regional lymph node metastasis has an important impact on clinical management and prognostication of patients with oral tongue squamous cell carcinoma (SCC). Approximately 30% to 50% of patients with oral tongue SCC have regional metastasis at diagnosis, but the limited sensibility of the current diagnostic methods used for neck staging does not allow detection of all cases, leaving a significant number of undiagnosed metastasis (occult lymph node metastasis). In this study, we evaluated whether clinicopathologic features and immunohistochemical detection of carcinoma-associated fibroblasts (CAFs) and activin A could be predictive markers for occult lymph node metastasis in oral tongue SCC. METHODS: One hundred ten patients with primary oral tongue SCC, who were classified with early stage tumor (stage I and II) and received surgical treatment with elective neck dissection, were enrolled in the study. RESULTS: Among all examined features, only high immunohistochemical expression of activin A was significantly associated with presence of occult lymph node metastasis (p = .006). Multivariate survival analysis using the Cox proportional hazard model showed that the expression of activin A was an independent marker of reduced overall survival with a 5-year survival of 89.7% for patients with low expression compared to 76.5% for those with high expression (hazard ratio [HR], 2.44; 95% confidence interval [CI], 1.55-3.85; p = .012). CONCLUSION: Our results demonstrated that immunodetection of activin A can be useful for prognostication of oral tongue SCC, revealing patients with occult lymph node metastasis and lower overall survival.

Does elective neck dissection in T1/T2 carcinoma of the oral tongue and floor of the mouth influence recurrence and survival rates?

The aim of this study was to evaluate the results of elective neck dissection compared with observation (control group) in selected cases of early carcinoma of the oral tongue and floor of the mouth. It was a retrospective analysis of 222 patients who had the tumour resected (161 also had elective neck dissection). Occult lymph node metastases were detected in 33/161 (21%), and neck recurrences were diagnosed in 10 of the 61 patients in the control group (16%). Occult lymph node metastases reduced the 5-year disease-specific survival from 90% to 65% (p=0.001) and it was 96% among the controls. The 5-year disease-specific survival was 85% in the group treated by neck dissection and 96% in the observation group (p=0.09). Rigorous follow-up of selected low risk patients is associated with high rates of salvage, and overall survival was similar to the observed survival in patients treated by elective neck dissection. Observation is a reasonable option in the treatment of selected patients.

Laser de baixa intensidade no tratamento da mucosite oral induzida pela radioterapia: relato de casos clínicos / Low-energy laser in the management of radiation-induced oral mucositis: report of two cases

A mucosite oral é uma complicação comum e dose-limitante do tratamento oncológico. A mucosite grave pode tornar necessária a alteração ou até mesmo a interrupção do tratamento com sérias conseqüências na resposta tumoral e sobrevida do paciente, aumentando o risco de infecções local e sistêmica. As lesões aparecem mais comumente na mucosa não-queratinizada. Os sinais e os sintomas variam desde um leve desconforto até lesões ulcerativas graves, comprometendo a nutrição e a ingestão hídrica do paciente. O laser de baixa intensidade tem sido proposto para o tratamento da mucosite oral, com resultados satisfatórios dos pontos de vista clínico e funcional, acelerando o processo de cicatrização das feridas e diminuindo o quadro doloroso. Este artigo, ilustrado por dois casos clínicos realizados no Hospital do Câncer de Pernambuco, tem como objetivo relatar a eficiência do laser de baixa potência no tratamento da mucosite oral induzida pela radioterapia.

Low energy laser for prevention of oral mucositis in patients receiving radiotherapy and/or chemotherapy in Pernambuco Cancer Hospital

Oral mucositis induced by antineoplastic therapy causes wide-range pain and discomfort resulting in decreased quality of life. The present study evaluated the benefits of low intensity laser and 0.12% chlorhexidine gluconate in the prevention of oral mucositis induced by radiation, associated or not with chemotherapy, and considered degrees/severity, time of appearanceof the lesions and functional loss. Eighty-four outpatients were considered and 49 were included in this study and dividedinto two groups: Group 1 received laser treatments in three stages, starting three days before treatment until the end of therapy. Group 2 was instructed to do daily mouth rinses with chlorhexidine gluconate. The prevalence of clinical mucositis was 49%, and of functional mucositis, 28.6%, when the two groups were considered together. This percentage was smaller in the laser group, 44% for the clinical mucositis group and 24% for the functional. The two protocols were well tolerated andshowed benefits, mainly from the point of view of functionality, and delayed the onset and development of mucositis.

Relação entre a doença periodontal e partos prematuros e bebés de baixo peso / Relationship between periodontal disease and preterm birth and low birth weight

O objetivo desta revisão de literatura foi o de analisar criticamente os trabalhos referentes ao papel das doenças periodontais como possível fator de risco para o parto prematuro de bebés de baixo peso. As infecções maternas durante a gravidez podem resultar em parto prematuro e/ou bebês de baixo peso.A doença periodontal, caracterizada como uma infecção Gram-negativa, pode estar associada a esse processo. Mediadores inflamatórios que ocorrem nas doenças periodontais, como a IL-1, TNF-a e as PGs, também possuem uma participação importante na iniciação do trabalho de parto, sendo considerados mecanismos biologicamente plausíveis que podem ligaras duas condições. A maioria dos autores acredita ser a infecção periodontal um fator de risco no desenvolvimento de prematuridade, podendo ser tão danoso quanto o álcool e o fumo. Esta associação deve ser investigada para que se estabeleça sua relação, causal ou incidental, e para determinar os possíveis benefícios da intervenção para a população em geral.

Prevalência de perda precoce de molares decíduos em crianças atendidas na Faculdade de Odontologia da Universidade de Pernambuco (FOP-UPE) em 2002 e 2003 / Prevalence of early loss of deciduos molars in children attended at Faculty of Dentistry of University of Pernambuco (FOP-UPE) in 2002 and 2003

Foi realizado um estudo transversal com objetivo de determinar a prevalência de perda precoce de molares decíduos e sua relação com o sexo. a faixa etária e o arco dentário. A amostra foi constituída dos prontuários de 1056 crianças de ambos os sexos, na faixa etária de 3 a 9 anos, atendidas na Faculdade de Odontologia da Universidade de Pernambuco (FOP/UPE), no período de 2002 e 2003. Analisaram-se os prontuários das referidas crianças observando-se a idade, o sexo e também os odontogramas nos quais estavam notificados dentes presentes e ausentes. 0s resultados mostraram uma prevalência de perda precoce de 26%; a causa mais comum das perdas foi a cárie dentária; o sexo feminino foi mais acometido que o masculino, mas a diferença não foi estatisticamente significante; a faixa etária de 6 a 9 anos apresentou o maior número de perdas, observando-se diferença estatisticamente significante; a mandíbula foi mais afetada que a maxila. Após a avaliação dos dados concluiu-se que a prevalência de perda precoce foi baixa; o dente mais frequentemente perdido foi o primeiro molar superior esquerdo; o sexo feminino e o arco dentário inferior foram os mais afetados; e houve diferença significante em relação às faixas etárias

Oncocytoma of an Intraoral Minor Salivary Gland: Case Report and Review of Literature

Oncocytoma is a rare benign tumor of the salivary glandrepresenting not more than 1% of salivary tumors. It iscomposed of large epithelial cells, the oncocytes, whichare predominantly found, in senior adults, being moreprevalent in the eighth decade of life. It is located mainlyin larger salivary glands especially in parotid glands.The tumor usually presents as a solid mass, painless, ofslow growth, and rarely it is larger than 4 cm ofdiameter. There are few reports in literature on minorsalivary glands neoplasias. This work aims to presentand discuss a clinical case of a 71-year-old male patientwith a 20 X 10 mm asymptomatic nodular lesion, ofapproximately 14 years duration, located in the oralmucosa on the left side of the mouth, with clinical andsurgical diagnosis of fibroma. An excisional biopsy ofthe lesion was made and the specimen was embedded in10% formaldehyde solution and delivered to the OralPathology Laboratory of the Federal University ofPernambuco for analysis. The histopathologicalexamination was carried out by hematoxylin/eosin andPAS staining with and without diastase. The specimenwas diagnosed as a minor salivary gland oncocytoma.