Melanoacanthoma, Plasma Cell Cheilitis and Langerhans Cell Hyperplasia on the Lower Lip: An Unusual Association and Immunohistochemical Analysis.

Oral melanoacanthoma is an uncommon reactive lesion, characterized by basal and prickle cell keratinocyte proliferation surrounded by pigment-laden dendritic melanocytes. Plasma cell cheilitis (PCC) is an inflammatory disorder of unknown aetiology, microscopically presenting a dense plasma cell infiltrate. Most PCC cases affect the lower lip. Langerhans cell hyperplasia (LCHyp), a non-neoplastic counterpart of the LC proliferations, has been reported in association with chronic inflammatory skin diseases. Here, we present an unusual association of melanoacanthoma, PCC and LCHyp on the lower lip in a 59-old-year male, expanding the clinicopathological spectrum of these uncommon lesions. The dendritic melanocytes were highlighted by Fontana-Masson stain and HMB-45, whereas S100, CD1a and CD207 evidenced numerous LCs. MUM1/IRF4, EMA, and CD138 highlighted sheets of polyclonal plasma cells, with an IgG4+/IgG+ ratio of 24%. FTA-ABS test for syphilis was negative.

Evaluation of oncological outcomes in patients with oral cavity cancer treated in a lowvolume hospital

Introduction: Oral cavity cancer (OCC) is one of the 10 most common types of tumors in the world. Surgical resection is the most indicated initial treatment, followed by adjuvant therapy, depending on tumor stage. A few studies have suggested that patients treated in high-volume hospitals present better oncologic outcomes; however, particularly in continental countries, some patients are treated in regional hospitals. Objective: To evaluate the results of OCC patients treated in low-volume regional hospitals. Methods: This is a retrospective longitudinal study conducted with patients diagnosed with OCC and operated on in a low-volume hospital between January 2003 and December 2018. Results: 174 patients with OCC were treated at the institution - an average of 11 patients/year. The most common tumor location was the tongue (48.2%), followed by the lip (18.2%). Squamous cell carcinomas were the most frequent (94.7% of patients). Adjuvant radiotherapy and chemotherapy were performed in 46.7 and 31.9% of patients, respectively. Almost 21% of patients had some postoperative complication. Specific survival of 62.6% and global survival of 58.2% after 3 years were similar to the results reported in high-volume centers. Disease-free survival was 45.8% in the same period. Conclusion: Low-volume hospitals qualified for oncological treatments can present outcomes similar to those of high-volume centers, and are thus a regional option for patients with OCC.

Estudo da imunoexpressão do reg-gamma e da beta catenina em queilites actínicas e carcinomas de células escamosas de lábio inferior / Study of immunoexpression of reg-gamma and beta-catenin in actinic cheilitis and lower lip squamous cell carcinoma

A queilite actínica (QA) é uma lesão potencialmente maligna que ocorre principalmente em homens leucodermas com histórico de exposição crônica ao sol. Atualmente, não é possível predizer quais os casos de QA progredirão para o Carcinoma de células escamosas (CCE), portanto alguns marcadores biomoleculares têm sido alvo de pesquisas. A ß-catenina é uma proteína multifuncional que está envolvida nos processos de adesão célula-célula. A alteração do complexo caderina-catenina tem sido demonstrada no CCE e correlacionada com a invasão tumoral, metástase e com pior prognóstico dos pacientes. O REGγ é um ativador de proteassoma que pode promover a degradação de múltiplas proteínas incluindo p53 e MDM2. Estudos mostram que o REGγ está superexpresso em numerosos tipos de câncer, sugerindo que a superexpressão do REGγ está envolvida na progressão do câncer. O objetivo deste estudo foi analisar a expressão imuno- histoquímica da ß-catenina e do REGγ em casos de QA e Carcinoma de células escamosas de lábio inferior (CCELI), comparando os achados imunohistoquímicos com os dados clínicopatológicos, afim de averiguar se há uma correlação com a progressão tumoral e se as mesmas atuam de forma sinérgica nesse processo. A imunoexpressão de ß-catenina e REGγ foi analisada semi-quantativamente em 30 casos de QA e 30 casos de CCELI de acordo com os escores: 0 (sem marcação); 1 (1-25% de células positivas); 2 (26-50% de células positivas); 3 (51-75% de células positivas); 4 (> 75% células positivas). Para a análise estatística, foram realizados os testes de Mann-Whitney e de Spearman (p < 0,05). Tantos as QAs quanto os CCELIs expressaram a proteína ß-catenina, sendo evidenciado um aumento da expressão citoplasmática e nuclear nos casos de Displasias moderadas e severas. Nos CCELIs a imunoexpressão de ß-catenina membranar foi maior nos casos de baixo grau de malignidade. Tantos as QAs quanto os CCELIs expressaram a proteína REG-γ porém não verificamos significância estatística entre a sua expressão e o grau displasia epitelial, bem como, entre a imunoexpressão do REG-γ e os parâmetros clinicopatológicos analisados nos CCELIs. Os resultados do presente estudo sugerem que a superexpressão de REG-γ e a redução na expressão membranar de ß-catenina podem ser eventos importantes na carcinogênese labial. No entanto, acreditamos que esta proteína esteja envolvida no processo da carcinogênese oral. Nesse processo, correlacionando a expressão imuno-histoquímica da ß-catenina com a expressão do REG-γ, não resultados estatisticamente significativos, sugerimos então que a expressão de ßcatenina pode não ser influenciada diretamente pelos níveis de expressão de REGγ (AU).

Actinic cheilitis (QA) is a potentially malignant lesion that occurs mainly in men with light skin and a history of chronic sun exposure. Currently, it is not possible to predict which cases of QA will progress to Squamous Cell Carcinoma (SCC), so some biomolecular markers have been researched. Β-catenin is a multifunctional protein that is involved in cell-cell adhesion processes. The alteration of the cadherin-catenin complex has been demonstrated in SCC and correlated with tumor invasion, metastasis and worse prognosis of patients. REGγ is a proteasome activator that can promote the degradation of multiple proteins including p53 and MDM2. Studies show that REGγ is overexpressed in numerous cancers, suggesting that REGγ overexpression is involved in cancer progression. The aim of this study was to analyze the immunohistochemical expression of ß-catenin and REGγ in cases of QA and lower lip squamous cell carcinoma (CCELI), comparing the immunohistochemical findings with the clinical and pathological data, in order to verify if there is any a correlation with tumor progression and whether they act synergistically in this process. Β-catenin and REGγ immunoexpression was analyzed semi-quantitatively in 30 cases of QA and 30 cases of CCELI according to the scores: 0 (no labeling); 1 (1-25% positive cells); 2 (26-50% positive cells); 3 (51-75% positive cells); 4 (> 75% positive cells). For statistical analysis, Mann-Whitney and Spearman tests were performed (p <0.05). Both QAs and CCELIs expressed the ß-catenin protein, showing an increase in cytoplasmic and nuclear expression in cases of moderate and severe dysplasias. In CCELIs, membrane ß-catenin immunoexpression was higher in cases of low grade malignancy. Both QAs and CCELIs expressed the REG-γ protein but no statistical significance between its expression and the degree of epithelial dysplasia was found, as well as between the immunoexpression of REG-γ and the clinicopathological parameters analyzed in the CCELIs. The results of the present study suggest that REG-γ overexpression and reduction in membrane expression of ß-catenin may be important events in lip carcinogenesis. However, we believe that this protein is involved in the process of oral carcinogenesis. In this process, correlating the immunohistochemical expression of ß-catenin with the expression of REG-γ, as we did not obtain statistically significant results, we suggest that ß-catenin expression may not be directly influenced by the levels of REGγ expression (AU).

Upper and lower lip soft tissue thicknesses differ in relation to age and sex / Grosores de los tejidos blandos de los labios superior e inferior difieren en relación con la edad y el sexo

This study was performed to determine age- and sex-related differences in lip thickness. Lateral cephalometric images of 220 healthy individuals were taken and the thicknesses of the upper and lower lips were measured. The measurements were performed in three different age groups. Our results indicate that the lower lip thickness, as well as the distance between the most anterior point of contact between the upper and lower lips and the most protruding point of the upper incisor teeth, differed between the two sexes. The lips of males were thicker than those of females. Receiver operating curve analysis was performed to determine the cutoff values to differentiate thickness between males and females. Our results showed that knowledge of upper and lower lips thickness in relation to age and sex may be beneficial to forensic anthropologists, to plastic and reconstructive surgeons, and to orthodontists for more detailed examination, effective treatment, and optimised outcomes.

Este estudio se realizó para determinar las diferencias en el grosor de los labios relacionadas con la edad y el sexo. Se tomaron imágenes cefalométricas laterales de 220 individuos sanos y se midió el grosor de los labios superior e inferior. Las mediciones se realizaron en tres grupos de edades diferentes. Nuestros resultados indicaron que el grosor del labio inferior, así como la distancia entre el punto más anterior de contacto, entre los labios superior e inferior y el punto más sobresaliente de los dientes incisivos superiores, difieren entre los dos sexos. Los labios de los hombres eran más gruesos que los de las mujeres. Se realizó un análisis de la curva de operación del receptor para determinar los valores de corte para diferenciar el espesor entre hombres y mujeres. Nuestros resultados demostraron que el conocimiento del grosor de los labios, superior e inferior, en relación con la edad y el sexo puede ser beneficioso para los antropólogos forenses, cirujanos plásticos y reconstructivos y para los ortodoncistas al momento de realizar un examen detallado, e implemantar un tratamiento más eficaz, alcanzando resultados optimizados.

Estudo da expressão de CLIC4 e proteínas associadas em queilites actínicas e carcinomas de células escamosas de lábio inferior / Study of the expression of CLIC4 and associated proteins in actinic cheilitis and lower lip squamous cell carcinomas

A proteína do canal de cloro intracelular 4 (CLIC4) regula a passagens dos íons de cloro e relaciona-se com a proteína p53, fator de necrose tumoral α (TNF-α), fator de crescimento transformante-ß (TGF-ß) e com a diferenciação de fibroblastos em miofibroblastos (-SMA) em alguns cânceres humanos. O objetivo desse estudo foi analisar a expressão imuno-histoquímicade CLIC4 e proteínas associadas em queilitesactínicas (QA) e carcinomas de células escamosas de lábio inferior (CCELI), bem como verificar a relação destas entre si e com as características clínicas e morfológicas das lesões.A amostra foi composta de 50casos de QAs e 50de CCELIs com dados clínicos, que inicialmente foram submetidos ao estudo morfológico para sua gradação do risco de transformação maligna (sistema binário) e do grau histológico de malignidade (Bryne, 1992), respectivamente.Todos os casos foram submetidos ao método da imunoperoxidase usando os anticorpos paraCLIC4, p53, TGF-, TNF- e - SMA, os quais foram submetidos à análise semiquantitativa, com exceção de p53, que inicialmente foi analisado de forma quantitativa e em sequência categorizada como as demais. Para a análise da expressão de CLIC4 foi considerada sua localização celular.Comparações das imunomarcações com os parâmetros clínicos e morfológicos das lesões foram realizadas pelo teste U de Mann-Whitney e o coeficiente de Spearmanfoi calculado para avaliar correlações entre as proteínas. A expressão nuclear da CLIC4 e TGF-ß estava aumentadaem QAs de baixo risco, quando comparada ao grupo de alto risco (p<0.0001), enquantoCLIC4 citoplasmática,p53 e TNF-α exibiram maior expressão em QAs de alto risco (p<0.05). No que diz respeito às características clínicas e morfológicas dos CCELIs, a expressão de CLIC4 citoplásmatica foi maior nos casos apresentando metástase linfonodal, casos com estágios clínicos mais avançados ou com alto grau de malignidade (p = 0,005; p = 0,029; p<0,0001). A expressão de p53 foi maior em CCELIs de alto grau de malignidade (p= 0,001) e a TGF-ß diminuiu significativamente conforme o avanço do estágio clínico e do grau histológico dos tumores (p< 0,05).As QAs exibiram uma expressão aumentada de CLIC4 (no núcleo, ou núcleo e citoplasma) e TGF-ß, comparadas aos CCELIs (p < 0,0001). Em contraste, houve aumento na marcação de CLIC4 citoplasmática e α-SMA nos casos de CCELI, quando comparados às QAs (p < 0,0001).Nas QAs observou-se correlação negativa entre a expressão de CLIC4 nuclear ea CLIC4 citoplasmática (r = -0,554; p = <0,0001), e entre a marcação de TGF-ß e α-SMA (r = -0,309; p = 0,029). Nos carcinomas, a expressão de p53 exibiu correlação positiva com TNF-α (r = 0,528; p = 0,0001) e αSMA (r = 0,435; p = 0,002).Os nossos resultados sugeremque uma mudança no padrão de expressão nuclear para citoplasmática de CLIC4 está envolvida no processo decarcinogênese labial, acompanhada de alterações na expressão de p53, TGF-ß, TNF-α e α-SMA, e se relacionamcom alguns dos aspectos morfológicos e clínicos das QAs e CCELIs (AU).

The intracellular chloride channel protein 4 (CLIC4) regulates chloride ions and is related to p53, tumor necrosis factor α (TNF-α), transforming growth factor-ß (TGFß), and with the differentiation of fibroblasts in myofibroblasts (-SMA) in some human cancers. The objective of this study was to analyze the immunohistochemical expression of CLIC4 and associated proteins in actinic cheilites (AC) and squamous cell carcinomas of the lower lip (SCCLL), as well as to verific their relationship with each other and with the clinical and morphological characteristics of the lesions . The sample consisted of 50 cases of AC and 50 of SCCLL with clinical data, which were initially submitted to the morphological study for their gradation of malignant transformation risk (binary system) and histological grade of malignancy (Bryne, 1992). All cases were submitted to the immunoperoxidase method using CLIC4, p53, TGF-ß, TNF- and - SMA antibodies, which were submitted to semiquantitative analysis, except for p53, which was initially analyzed quantitatively and a categorized sequence like the others. For the analysis of CLIC4 expression, its cellular location was considered. Comparisons of the immunoblots with the clinical and morphological parameters of the lesions were performed by the Mann-Whitney U test and the Spearman coefficient was calculated to evaluate correlations between the proteins. Nucleic expression of CLIC4 and TGF-ß was increased in low-risk AC compared to high-risk group (p <0.0001), whereas cytoplasmic CLIC4, p53 and TNF-α showed higher expression in high-risk AC (p < 0.05). As regards the clinical and morphological characteristics of SCCLL, the expression of cytoplasmic CLIC4 was higher in cases presenting lymph node metastasis, cases with more advanced clinical stages or with a high degree of malignancy (p = 0.005, p = 0.029, p <0, 0001). Expression of p53 was higher in highgrade malignant SCCLL (p = 0.001) and TGF-ß decreased significantly as the clinical stage progressed and tumor grade histologically (p <0.05). Increased CLIC4 (in the nucleus, or nucleus and cytoplasm) and TGF-ß, compared to SCCLL (p <0.0001). In contrast, there was an increase in the labeling of cytoplasmic CLIC4 and α-SMA in SCCLL cases, when compared to AC (p <0.0001). In the AC, a negative correlation was observed between nuclear CLIC4 expression and cytoplasmic CLIC4 (r = -0.554, p = <0.0001), and between TGF-ß and α-SMA (r = -0,309; = 0.029). In carcinomas, p53 expression exhibited a positive correlation with TNF-α (r = 0.528, p = 0.0001) and αSMA (r = 0.435, p = 0.002). Our results suggest that a change in CLIC4 cytoplasmic nuclear expression pattern is involved in the process of lip carcinogenesis, accompanied by changes in the expression of p53, TGF-ß, TNF-α and α-SMA, and are related to some of the morphological aspects and clinicians of AC and SCCLL (AU).

Functional lower lip reconstruction with the modified Bernard-Webster flap.

BACKGROUND: Lower lip defects after squamous cell carcinoma (SCC) excisions have been repaired by several surgical techniques. However, the functional reconstruction of full-thickness defects of the lower lip remains a therapeutic challenge. We therefore evaluated functional results of the modified Bernard-Webster flap for the reconstruction of full-thickness lower lip defects after SCC excisions. METHODS: A prospective study was performed on all patients with lower lip full-thickness defects after SCC excisions greater than 1/3 of the lip, reconstructed with the modified Bernard-Webster flap in 2011-2013. Functional (sphincter, motor, and sensory functions) postoperative results were evaluated according to criteria previously adopted. RESULTS: Twelve lower lip defects were reconstructed without complications, except for two (16.7%) wound dehiscence successfully managed. Ten (83.3%) patients presented transient and permanent functional abnormalities in the recent and late postoperative assessments. Ten (83.3%) patients classified the late functional results as satisfactory. CONCLUSIONS: The modified Bernard-Webster flap proved to be an excellent alternative to repair full-thickness lower lip defects with more than 1/3 of the lower lip length, as it allowed the use of similar neighboring tissues, could be performed in one stage, and was functionally effective.

Retalho de Bernard-Webster para reconstrução do lábio inferior após exérese de carcinoma espinocelular: uma análise dos resultados funcionais / Use of Bernard-Webster flap for lower lip reconstruction after excision of squamous cell carcinoma: analysis of functional results

INTRODUÇÃO Defeitos dos lábios inferiores após exéreses de carcinoma espinocelular (CEC) vêm sendo reparados com inúmeras técnicas cirúrgicas. No entanto, a reconstrução funcional de defeitos de espessura total do lábio inferior continua a ser um desafio. O objetivo deste estudo, portanto, foi descrever as estratégias cirúrgicas para a reconstrução de defeitos de espessura total do lábio inferior, subsequentes a exéreses cirúrgicas de CEC, bem como avaliar resultados funcionais. MÉTODO: Trata-se de um estudo retrospectivo de todos os pacientes com defeitos de espessura total de lábio inferior após exérese de CEC maiores que um terço do lábio, reconstruídos com retalhos de Bernard-Webster, no período de 2011 a 2014. Os resultados funcionais (funções esfincteriana, motora e sensorial) foram avaliados de acordo com critérios previamente utilizados. RESULTADOS: Seis defeitos labiais foram reconstruídos com retalhos de Bernard-Webster, sem complicações. No período pós-operatório, os pacientes relataram incontinência para líquidos (16,67%), incontinência salivar intermitente (16,67%) e dificuldade para abrir a boca completamente (33,33%). Os testes revelaram déficits sensoriais nas regiões mentoniana (100%) e de lábio inferior (33,33%). Houve recuperação completa de todas as alterações funcionais, em média, três meses após as intervenções cirúrgicas. Os resultados funcionais tardios foram considerados satisfatórios. CCONCLUSÕES: O retalho de Bernard-Webster mostrou-se uma excelente alternativa para reparar defeitos que comprometem mais de um terço do lábio inferior, pois permitiu a utilização de tecidos vizinhos semelhantes, pôde ser realizado em tempo único e foi funcionalmente eficaz.

INTRODUCTION Defects in the lower lips after the excision of squamous cell carcinoma (SCC) are usually repaired using several surgical techniques. However, the functional reconstruction of full-thickness defects in the lower lip remains a challenge. Therefore, the objectives of this study were to describe surgical strategies for the reconstruction of full-thickness defects of the lower lip after surgical excision of the SCC and evaluate the functional results. METHODS: This was a retrospective study of all patients with full-thickness defects in the lower lip after excisions of SCC that were greater than one third of the lip that were repaired using the Bernard-Webster flap between 2011 and 2014. The functional results (sphincteric, motor and sensory function) were evaluated according to previously used criteria. RESULTS: Six lip defects were reconstructed without complications using Bernard-Webster flaps. During the postoperative period, the patients reported liquid incontinence (16.67%), intermittent salivary incontinence (16.67%), and difficulty fully opening the mouth (33.33%). The tests revealed sensory deficits in the labiomental areas (100%) and lower lip (33.33%). There was full recovery of all functional changes an average of 3 months after surgery. The observed late functional results were considered satisfactory. CONCLUSIONS: The Bernard-Webster flap was an excellent alternative to repairing the defects that affect more than one third of the lower lip since it allowed the use of similar local tissues, a single surgery could be performed, and the result was functionally efficient.

Expression of Glucose Transporters 1 and 3 in Metastatic and Non-Metastatic Lower Lip Squamous Cell Carcinoma

This study aimed to evaluate the immunoexpression of glucose transporters 1 (GLUT-1) and 3 (GLUT-3) in metastatic and non-metastatic lower lip squamous cell carcinoma (LLSCC). Twenty LLSCCs with regional nodal metastasis and 20 LLSCCs without metastasis were selected. The distribution of staining and the percentage of GLUT-1 and GLUT-3 staining in each tumor core and at the deep invasive front were assessed. Most tumors (70%) exhibited peripheral staining for GLUT-1 in nests, sheets and islands of neoplastic cells, whereas predominantly central staining was observed for GLUT-3 (72.5%). A high percentage of GLUT-1-positive cells was observed at the deep invasive front and in the tumor core of metastatic and non-metastatic tumors (p>0.05). The percentage of GLUT-1-positive cells was much higher than that of GLUT-3-positive cells both in the deep invasive front (p<0.001) and in the tumor core (p<0.001) of LLSCCs. No significant differences in the percentage of GLUT-1- and GLUT-3-positive cells were observed according to nodal metastasis, clinical stage or histological grade of malignancy (p>0.05). In conclusion, the results of the present study suggest an important role of GLUT-1 in glucose uptake in LLSCCs, although this protein does not seem to be involved in the progression of these tumors. On the other hand, GLUT-3 expression may represent a secondary glucose uptake mechanism in LLSCCs.

Este estudo objetivou avaliar a imunoexpressão dos transportadores de glicose 1 (GLUT-1) e 3 (GLUT-3) em carcinomas de células escamosas de lábio inferior (CCELI) metastáticos e não-metastáticos. Vinte CCELIs com metástase nodal regional e 20 CCELI sem metástase foram selecionados. Foram analisados a distribuição da imunomarcação e o percentual de imunorreatividade para GLUT-1 e GLUT-3 no centro tumoral e no front de invasão tumoral. A maioria dos tumores (70%) revelou marcação para GLUT-1 em áreas periféricas dos ninhos, lençóis e ilhas de células neoplásicas, ao passo que GLUT-3 revelou predomínio de marcação em áreas centrais (72.5%). Um alto percentual de células positivas para GLUT-1 foi observado no front de invasão e no centro tumoral das lesões metastáticas e não-metastáticas (p>0,05). O percentual de células positivas para GLUT-1 foi superior ao percentual de células positivas para GLUT-3, tanto no front de invasão (p<0,001) quanto no centro tumoral (p<0,001) dos CCELIs. Não foram observadas diferenças significativas no percentual de células positivas para GLUT-1 e GLUT-3 em relação à mestástase nodal, ao estádio clínico ou ao grau histológico de malignidade (p>0,05). Em conclusão, os resultados do presente estudo sugerem um importante papel para GLUT-1 na absorção de glicose nos CCELIs, embora esta proteína não pareça estar envolvida na progressão destes tumores. Por outro lado, a expressão de GLUT-3 pode representar um mecanismo secundário para a absorção de glicose nos CCELIs.

Presentación de tres pacientes con reconstrucción del labio inferior con la técnica Bernard (modificada) / Presentation of Three Patients with Lower Lip Reconstruction through Bernard Technique (Modified)

Introducción: el tratamiento quirúrgico de los tumores malignos que afectan el labio inferior requiere de la resección de una gran parte de esta área anatómica. Varias técnicas están descritas para la reparación del defecto que genera, entre ellas, la técnica de Bernard, descrita por primera vez en 1853 y que ha asimilado ciertas modificaciones que la hacen más funcional y estética. Objetivo: presentar tres pacientes a los cuales se les realizó reconstrucción de defectos del labio inferior con el empleo de la técnica quirúrgica Bernard (modificada). Métodos: se presentaron tres pacientes sometidos a tratamiento quirúrgico por carcinoma espinocelular que requirieron resección de más de un tercio del labio inferior y queiloplastia reconstructiva por la técnica de Bernard (modificada). Resultados: en los tres pacientes, la excéresis tumoral fue completada y se lograron resultados estéticos y funcionales favorables. Conclusiones: la técnica quirúrgica de Bernard modificada es muy útil para la reconstrucción de grandes defectos del labio inferior lográndose un labio funcional y estético.

Introduction: surgical treatment of malignant tumors affecting the lower lip requires the removal of a large part of this anatomical area. Several techniques are described for generating defect repair, including Bernard technique, first described in 1853 and has assimilated some changes that make it more functional and aesthetic. Objective: to present three patients that underwent reconstruction of lower lip defects with the use of the Bernard surgical technique (modified). Methods: three patients underwent surgical treatment for squamous cell carcinoma requiring resection of more than one third of the lower lip and reconstructive cheiloplasty by Bernard technique (modified). Results: in all three patients, the tumor exeresis was completed and achieved favorable aesthetic and functional results. Conclusions: Bernard surgical technique (modified) is very useful for the reconstruction of large defects of the lower lip achieving a functional and esthetic lip.

Tooth fragment reattachment after late retrieval (three months) from the lower lip: case report / Colagem de fragmento dentário recuperado tardiamente (após três meses) do interior do lábio inferior: relato de caso

OBJECTIVE: To present and discuss a case of child who sustained a complicated crown fracture,with the lost portion of tooth embedded in his lower lip. RESULTS: Tooth fragment was surgicallyremoved and successfully reattached to the tooth using acid etch and dentin bonding resin technique.

OBJETIVO: Apresentar e discutir um caso de criança que sofreu fratura complicada de coroadentária, com parte do dente perdida e alojada no lábio inferior. RESULTADOS: O fragmentodentário foi cirurgicamente removido do lábio e colado, com sucesso, ao dente, utilizando-seataque ácido e cimentação com compósito.

Carcinoma de células escamosas de labio inferior: asociación entre grado de angiogénesis, graduación histológica y frente de invasión tumoral / Lower lip squamous cell carcinoma: relationship between angiogenesis grade, histological grading and invasion tumoral front

El carcinoma de células escamosas de la cavidad oral presenta una alta prevalencia en nuestro país, siendo el labio inferior el sitio más comúnmente afectado. El objetivo de este estudio fue determinar el grado de angiogénesis en el carcinoma de células escamosas de labio inferior, y su asociación con el grado de diferenciación según la Clasificación Internacional de Tumores y el Frente de Invasión Tumoral según el sistema de medición de Bryne, en pacientes con carcinoma de células escamosas de labio inferior, diagnosticados en los hospitales de Talca y Curicó, entre los años 1995 y 2005.

Squamous cell carcinoma of the oral cavity present a high prevalence in our country, become the lower lip the most common site affected. The aim of this study was determinated the angiogenesis grade in the lower lip squamous cell carcinoma and their relationship whit the histological grading according to the International Tumours Classification and the Invasion Tumoral Front according to the Bryne's system measuring in patients with lower lip squamous cell carcinoma diagnosed in the Talca´s and Curico´s Hospital between 1995 and 2005 years.

Expressão imuno-histoquímica de metaloproteinases em carcinoma epidermóide de lábio inferior e língua / Imuno-histochemical expression of metaloproteinases in epidermóide carcinoma of inferior lip and language

O carcinoma epidermóide oral é uma neoplasia maligna de alta incidência e uma importante causa de morbidade e mortalidade, que exibe, entretanto, variável comportamento biológico, em função de diversos fatores. O objetivo do presente estudo consistiu em avaliar a expressão imuno-histoquímica de MMP-1, MMP-2, MMP-7, MMP-9 e MMP-26 em carcinomas epidermóides, em relação à localização da lesão e ao seu grau histológico de malignidade. Foram selecionados 15 carcinomas epidermóides de lábio inferior e 15 de língua, que, após avaliação morfológica, foram classificados em neoplasias de baixo grau de malignidade (n=17) e alto grau (n=13), e subseqüentemente submetidos à marcação imuno-histoquímica para as MMPs. Todos os espécimes investigados expressaram pelo menos duas das metaloproteinases pesquisadas, que foram mais evidentes no citoplasma das células tumorais localizadas no front de invasão. Os carcinomas epidermóides de língua exibiram maior marcação imuno-histoquímica de MMPs pelas células neoplásicas que aqueles de lábio inferior, com diferença significativa estatisticamente para a MMP-9 (p=0,030). Os carcinomas epidermóides de alto grau demonstraram maior expressão de metaloproteinases, exceto para MMP-2, em comparação às lesões de baixo grau, com diferença significativa estatisticamente para MMP-7 (p=0,0001) e MMP-26 (p=0,016). Adicionalmente foi evidenciada uma relação direta entre os escores morfológicos de malignidade e a imunopositividade às MMPs, com significância estatística para MMP-7 e MMP-26. Com base nestes resultados, pode-se concluir que a maior expressão de MMPs pelas células tumorais, especialmente MMP-9, pode contribuir para o maior potencial invasivo dos carcinomas de língua em comparação aos labiais. Além disso, a gravidade histológica dos carcinomas epidermóides parece estar relacionada à marcação imuno- histoquímica de metaloproteinases, especialmente matrilisinas, o que sugere que a capacidade de degradar membrana basal parece ser determinante no padrão de diferenciação histológica das neoplasias pesquisadas. Os altos índices de positividade às MMPs encontrados nos espécimes estudados refletem a marcante participação destas enzimas no desenvolvimento dos carcinomas epidermóides de lábio inferior e língua (AU).

The oral epidermoid carcinoma is a malignant neoplasty with high incidence and an important cause of morbidity and mortality that presents, however, a variable biological behavior, due to several factors. The aim of this study has consisted in evaluating the immunohistochemical expression of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-26 in epidermoid carcinomas, regarding the location of the lesion and its histological grade of malignancy. 15 squamous cell carcinomas of lower lip and 15 of tongue were selected and, after morphological evaluation, they were classified in low malignancy grade (n=17) and high malignancy grade neoplasties (n=13), and subsequently submitted to immunohistochemical study for the MMPs. All the specimens investigated expressed at least two of the researched metalloproteinases, hat were more evident in the cytoplasm of tumor cells located in the invasion front. The tongue epidermoid carcinomas presented greater immunohistochemical expression of MMPs by neoplastic cells than those of lower lip, with statistically significant difference for MMP-9 (p=0.030). The high grade epidermoid carcinomas presented greater expression of metalloproteinases, except for MMP-2, in comparison to the low grade lesions, with statistically significant difference for MMP-7 (p=0,0001) and MMP- 26 (p=0,016). In addition it was evidenced a direct relation between the morphological scores of malignancy and immunoreactivity to MMPs, with statistic significance for MMP-7 and MMP-26. Based on these results we can conclude that a greater expression of MMPs by tumor cells, especially MMP-9, may contribute to a higher invasive potential of tongue carcinomas in comparison to lip carcinomas. Besides, the histological severity of epidermoid carcinomas seems to be related to immunohistochemical expression of metalloproteinases, especially matrilysins, which suggests that the capacity of degrading basal membrane seems to be determinant in the pattern of histological differentiation of neoplasties studied. The high levels of reactivity to MMPs found in the specimens studied reflect the outstanding participation of these enzymes in the development of epidermoid carcinomas in lower lip and tongue (AU).