Oral verruciform xanthomas mimicking potentially malignant disorders.

Verruciform xanthoma represents a reactive lesion, common in the skin and somewhat rare in the mouth. Cases description: Two cases of verrucous white plaques, located on the tongue and the floor of mouth of different 30-years-old man and woman and clinically diagnosed as leukoplakia, are described. The histopathological analyses confirmed the diagnosis of oral verruciform xanthomas for both lesions. Practical implications: Despite of uncommon in the oral cavity, the verruciform xanthoma, particularly when affecting regions with a higher risk of developing oral cancer, should be included in differential diagnosis of oral potentially malignant disorders. The histopathological analysis remains as "gold standard technique" for a more accurate diagnosis of oral verruciform xanthoma. Key words:Foam cells, Verruciform xanthoma, Leukoplakia, Tongue.

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review.

PURPOSE: This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. METHODS: Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. RESULTS: Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. CONCLUSIONS: The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.

Clinical behavior of recurrent pleomorphic adenoma in the palate: a systematic review

Purpose: This systematic review analyzed the clinical behavior and odds of malignancy of the palatal recurrent pleomorphic adenomas. Methods: Systematic review of patients with recurrent pleomorphic adenoma arising in the palate. Database search: MEDLINE, Scopus, Web of Science, Cochrane, EMBASE, Virtual Health Library, Google Scholar, and OpenGrey. A binomial logistic regression was performed to assess the odds of detecting recurrence five, 10 and 20 years after the treatment of primary tumor. Results: Thirteen studies (n = 18 patients) out of 336 were included. The recurrent pleomorphic adenoma in palate was more common in females (61.6%), average age was 49 years old (range 9-73 years old). Four patients progressed to malignant transformation. The odds ratio (OR) of detecting a recurrence at 10 (OR = 5.57; 95% confidence interval - 95%CI 1.13-27.52), and 20 years (OR = 18.78; 95%CI 3.18-110.84) after treatment of primary pleomorphic adenoma was significantly higher than at one-year follow-up. Conclusions: The recurrence of pleomorphic adenoma in palate remains a rare event of late occurrence. It mainly affects middle-aged female and carries a risk of malignant transformation. Although uncommon, patients with palatal pleomorphic adenoma should be warned about the possibility of recurrence or malignant transformation of tumor at advanced ages.

Histological implications of high-power laser use in the oral soft tissue lesions: a systematic review.

The objective of this study was to describe the histological artifacts caused by high-power laser use compared to cold scalpel surgery in oral soft tissue lesions. Clinical studies that evaluated and compared histological artifacts resulting from the use of high-power lasers and cold scalpels in oral soft tissue lesions biopsies were retrieved from seven databases and four grey literatures, up to July 2022. The risk of bias was investigated using the ROBINS-I tool. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Seven studies were eligible for qualitative analysis. Based on the results obtained, those four studies had a low risk of bias, and three studies had an unclear risk of bias. The certainty of the evidence was classified as low. Limited evidence showed that epithelial artifacts such as loss of intraepithelial and subepithelial adhesions, accompanied by pyknotic, fusiform, and/or hyperchromic nuclei, were more common when a high-power laser device was used. Four articles reported that the use of high-power lasers did not interfere with the histopathological diagnosis of oral soft tissue lesions. Due to the heterogeneity of the data, a meta-analysis was not performed. Compared to the use of cold scalpels, histological artifacts, particularly those observed in epithelial tissue, are more common when high-powered lasers are used in oral lesions biopsies. The eligibility criteria and adequate indications of high-power lasers in different oral soft tissue lesion treatments must be respected to avoid tissue artifacts that impair precise histopathological diagnosis.

Peculiar Histological Features of Oral Intravascular Papillary Endothelial Hyperplasia.

A 55-year-old male patient with single and well-circumscribed nodule in the lower lip. Accurate diagnosis is based only on histopathological examination using hematoxylin and eosin and immunohistochemical approach, which a large, organized thrombus within the dilated lumen of a poorly demarcated vein, associated with papillary projections of endothelial proliferation occupying vascular spaces. The final diagnosis was intravascular papillary endothelial hyperplasia (IPEH) associated with a thrombus. Oral IPEH is rare and has historically been difficult to diagnose due to its resemblance to other oral lesions. However, the distinctive histological features of oral IPEH associated with a thrombus now allow for its diagnosis through hematoxylin and eosin staining alone, without the need for additional techniques. Therefore, it is crucial for pathologists to be familiar with these unique morphological features to accurately diagnose oral IPEH and differentiate it from more common benign, malignant, or reactive vascular lesions in the oral cavity.

The role of granulocyte-macrophage colony-stimulating factor in head and neck cancer.

OBJECTIVE: To review the molecular mechanisms and biological roles of granulocyte-macrophage colony-stimulating factor (GM-CSF) in head and neck squamous cell carcinoma, highlighting its potential clinical applications. DESIGN: The search terms "granulocyte-macrophage colony-stimulating factor", "GM-CSF", "CSF2″ and "head and neck squamous cell carcinoma" or "head and neck cancer" were queried in the PubMed/MEDLINE and Scopus databases. RESULTS: Despite of being a widely expressed cytokine, the number of studies investigating the specific roles of GM-CSF in head and neck cancer was limited. Most of them investigated GM-CSF in conjunction with other cytokines. When studied alone, conflicting findings were observed in head and neck squamous cell carcinoma. GM-CSF has been shown to induce angiogenesis and local tumor invasion. Additionally, it has also been implicated in immune evasion. On the other hand, GM-CSF stimulated the differentiation of dendritic cells, which are responsible for presenting tumor antigens, and for the regulation of T cell function. Even with these paradoxical effects, there are few studies investigating the potential of GM-CSF as adjuvant therapy in head and neck cancer. CONCLUSION: The effects of GM-CSF in head and neck cancer may be pro- or antitumor. Understanding how one arm and not the other is activated is essential to assess the applicability and the safety of this cytokine as a therapeutic agent.

Subgemmal neurogenous plaque of posterolateral region in tongue: A case report and review of literature.

INTRODUCTION: The subgemmal neurogenous plaque is a well-defined subepithelial neural plexus associated with taste buds, located within foliate, fungiform, and circumvallate papillae of the human tongue, that is poorly known by dentists and medical professionals. The hyperplasia of subgemmal neurogenous plaque may occur and it manifests as a papule, nodule, plaque, or ulcer in the lateral posterior border of the tongue inducing the overdiagnosis of reactive, cystic, or neoplastic lesions. The aims of this study are to report a case of a patient with subgemmal neurogenous plaque, and to provide a comprehensive review of other subgemmal neurogenous plaque in the posterolateral tongue with challenging diagnosis. PRESENTATION OF CASE: A 28-year-old female with a little yellowish nodule, asymptomatic, located in posterior left lateral border of the tongue. Accurate diagnosis was based in excisional biopsy and histopathological examination showing a superficial neurofibroma-like pattern, and a neuroma-like in the deep zone. The final diagnosis was subgemmal neurogenous plaque. DISCUSSION: The subgemmal neurogenous plaque has an erythematous nodule or papule in the border of the tongue that are frequently misdiagnosis as foliate papillitis and lymphoepithelial cyst. Despite the subgemmal neurogenous plaque be considered a normal structure, the biopsy is recommended for differential diagnosis with other benign or malignant lesions in tongue. CONCLUSION: Contributing with the dentists and medical professionals in their clinical practice, we reviewed the literature and added a case of subgemmal neurogenous plaque in the posterolateral region of the tongue, highlighting the importance of its recognition to avoid misdiagnosis.

Assessment of the knowledge of canalis sinuosus amongst dentists and dental students: An online-based cross-sectional study.

INTRODUCTION: Canalis sinuosus (CS) is a neurovascular canal that corresponds to a small branch of the infraorbital canal. This study aimed at assessing the knowledge and detection performance of CS amongst dentists and dental students. MATERIALS AND METHODS: Four-hundred and five dentists and dental students answered a questionnaire with three parts: 1. Socio-demographical; 2. Clinical cases with cone- beam computed tomography (CBCT) sections showing CS and 3. Previous knowledge about CS. The chi-squared test and Spearman's correlation test were used to compare results as appropriate. p-values below .05 were considered statistically significant. RESULTS: Most participants did not identify CS in any CBCT. There was an association between the number of correct answers and dental specialties. Most individuals had not learned about CS previously. There was an association between past knowledge of CS and gender, highest academic degree, working environment, dental specialty and number of correct answers but not with age or experience in Dentistry. CONCLUSION: This study suggests that most dentists are not aware about CS and do not know how to diagnose it. Previous knowledge about CS positively influenced its identification in CBCT.

Beta-adrenergic pathway activation enhances aggressiveness and inhibits stemness in head and neck cancer.

Chronic stress leads to the activation of the beta-adrenergic pathway. Its activation has been implicated in the progression of different types of cancer but its role on head and neck squamous cell carcinomas (HNSCCs) remains undefined. The aim of this study was to investigate the influence of the beta-adrenergic pathway activation in the progression of HNSCCs and offer a panel of potential treatments for patients with the active beta-adrenergic pathway. Five hundred and twenty TCGA patients with primary HNSCCs were divided in two groups: ADRB2low / SLC6A2low and ADRB2high / SLC6A2high. Differentially expressed genes (DEGs) were identified through differential expression analysis. The association of clinicopathological and genomic features between the groups was analyzed using a bioinformatic approach. Potential drugs for treatment of HNSCC were identified based on the DEGs. There was association between ADRB2 and SLC6A2 expressions with age, race, tumor site, histologic grade, perineural invasion, and HPV p16 status. It was identified 898 DEGs between the groups. High ADRB2/SLC6A2 expression stimulated HNSCC proliferation, adhesion, invasion, and angiogenesis. On the other hand, genes related to cell stemness were downregulated in patients with activation of the beta- adrenergic pathway. Finally, 56 FDA-approved antineoplastic and immunotherapeutic drugs were identified as potential targets for the personalized treatment.

Structural muscular adaptations in upper limb after stroke: a systematic review.

BACKGROUND: Stroke is a leading cause of disability in the adult population, impairing upper limb (UL) movements affecting activities of daily living. Muscle weakness has been associated to disabilities in this population, but much attention is given to central nervous system alterations and less to skeletal muscles. OBJECTIVE: The objective of this review is to carry out a systematic literature review to identify structural muscle alterations in the UL of poststroke individuals. METHOD: The search was performed in December, 2017. MEDLINE, PubMed, SCOPUS, CINAHL, and Science Direct were used as electronic databases. There was no restriction regarding language and publication dates. Studies conducted on poststroke subjects and results on UL skeletal muscle alterations identified by imaging tests were included. RESULTS: Seven studies were included. The sample size and the variables varied among the studies. All the studies compared the paretic UL with the nonparetic UL and one of the studies also compared healthy subjects. Ultrasonography was the most used measurement tool to assess muscle adaptation. CONCLUSIONS: This review demonstrated little evidence with poor to fair quality on the structural muscle adaptations in the poststroke subjects, showing muscle atrophy, a higher stiffness, and amount of fibrous and fat tissue without alterations in lean tissue of distal muscles of the paretic UL compared to the nonparetic limb. However, the nonparetic side also presented alterations, which makes it an inappropriate comparison. Thus, well-designed studies addressing this issue are required.