Intratarsal Keratinous Cyst Clinically Misdiagnosed as a Chalazion.

The intratarsal keratinous cyst (IKC) is a recently described entity, often clinically misdiagnosed as a chalazion. We report a case of a 61-year-old male patient with a chief complaint of a small lesion on the upper eyelid that evolved over six months. On physical examination, an asymptomatic, firm nodule was identified on the left upper eyelid. The patient reported no history of trauma. A provisional diagnosis of chalazion was established, and an excisional biopsy was performed. Histopathologically, the lesion was lined with a stratified squamous epithelium, with a corrugated epithelial surface showing abrupt keratinization without keratohyalin granules, and compact keratinous-appearing material in the cystic lumen. The diagnosis was IKC. No signs of recurrence were observed after one year of follow-up. It is essential to accurately diagnose IKC and distinguish it from chalazion and epidermal inclusion cysts, because IKC requires complete surgical excision and can exhibit multiple recurrences if not properly removed.

Oral lymphatic malformations: A multicenter study of 208 cases and literature review.

BACKGROUND: To evaluate the frequency and analyze demographic and clinical characteristics of individuals with a histopathological diagnosis of oral lymphatic malformations (OLMs). METHODS: A multicenter study was performed, collecting biopsy record data from a consortium of Brazilian Oral and Maxillofacial Pathology Centers. A review was also conducted to compare this data with cases already available in the literature. RESULTS: This study retrieved 208 cases of OLM in the multicenter study and 1035 cases in the literature review. In both, OLMs affected male and female individuals equally, with the most affected site being the tongue. Individuals ≥60 years of age were uncommonly affected. Symptomatic and larger lesions were more commonly reported in the literature review. CONCLUSIONS: This study comprises the largest sample of OLMs to date. OLMs are rare conditions, without sex predilection. The elderly proved to be less frequently affected, and the tongue is the most commonly affected site.

Different applications forms of green tea (Camellia sinensis (L.) Kuntze) for the treatment of periodontitis: a systematic review and meta-analysis.

BACKGROUND: Scaling and root planning (SRP) is the gold standard for non-surgical periodontal treatment. Green tea as a supporting alternative in non-surgical periodontal treatment has been suggested as a therapeutic option in the treatment of periodontitis. OBJECTIVE: To analyse the comparative effectiveness of green tea (Camellia sinensis) in its different forms and applications for the treatment of periodontitis. METHODS: We included randomized clinical trials evaluating green tea as an adjuvant therapeutic agent to scaling and root planning (SRP) in the treatment of periodontitis. For the meta-analysis, we calculated standardized mean difference (SMD) and 95%CI comparing green tea and control (only SRP). We subgrouped by types of application forms of green tea. The certainty of the evidence was assessed through GRADE. RESULTS: Nine studies were included. The follow-up time of treatments varied from 21 days to 6 months. The subgroup meta-analysis showed that the green tea as sachet reduced probing bleeding (SMD = -0.71; 95%CI) and the gingival index (SMD = -0.78; 95%CI) compared to SRP with very low certainty of evidence. The sachet (SMD = -0.29; 95%CI) and dentifrice (SMD = -1.31; 95%CI) reduced plaque index with very low certainty compared to the control. All forms of application of green tea showed very low certainty of evidence (SMD = -0.27; 95% CI) in reducing the probing depth, as well as for the loss of clinical insertion (SMD = -0.42; 95% CI) with low certainty of evidence. CONCLUSION: There was not a difference in the effectiveness of green tea isolated or in combination with SRP to reduce probing depth. Green tea adjunct to periodontal therapy showed very low certainty of effectiveness for the treatment of periodontal disease.

Evaluation in vivo of biocompatibility of differents resin-modified cements for bonding orthodontic bands.

The focus of this study was to test the hypothesis that there would be no difference between the biocompatibility of resin-modified glass ionomer cements. Sixty male Wistar rats were selected and divided into four groups: Control Group; Crosslink Group; RMO Group and Transbond Group. The materials were inserted into rat subcutaneous tissue. After time intervals of 7, 15 and 30 days morphological analyses were performed. The histological parameters assessed were: inflammatory infiltrate intensity; reaction of multinucleated giant cells; edema; necrosis; granulation reaction; young fibroblasts and collagenization. The results obtained were statistically analyzed by the Kruskal-Wallis and Dunn test (P<0.05). After 7 days, Groups RMO and Transbond showed intense inflammatory infiltrate (P=0.004), only Group RMO presented greater expression of multinucleated giant cell reaction (P=0.003) compared with the control group. After the time intervals of 15 and 30 days, there was evidence of light/moderate inflammatory infiltrate, lower level of multinucleated giant cell reaction and thicker areas of young fibroblasts in all the groups. The hypothesis was rejected. The Crosslink cement provided good tissue response, since it demonstrated a lower level of inflammatory infiltrate and higher degree of collagenization, while RMO demonstrated the lowest level of biocompatibility.

Granulomas de anéis hialinos em mixoma odontogênico: um caso incomum / Hyaline ring granulomas in odontogenic myxoma: an unusual case

Os granulomas de anéis hialinos são achados histopatológicos incomuns, cuja etiopatogênese permanece incompletamente estabelecida. Na cavidade oral, estes achados microscópicos têm sido descritos em lesões extraósseas e intraósseas, com destaque para os cistos odontogênicos inflamatórios. No entanto, relatos sobre granulomas de anéis hialinos em tumores odontogênicos são escassos. Objetivo: Relatar o primeiro caso de granulomas de anéis hialinos em mixoma odontogênico, bem como, discutir a etiopatogênese e os aspectos clínico-patológicos destes achados microscópicos em tumores odontogênicos. Caso clínico: Paciente do sexo masculino, 30 anos, apresentava tumefação de consistência fibrosa, localizada no lado esquerdo do corpo de mandíbula, com aproximadamente 3,3 cm de extensão. Radiograficamente, observou- -se uma lesão osteolítica estendendo-se da distal do dente 35 até a região anterior do ramo ascendente da mandíbula. Foi realizada a biópsia incisional e o exame histopatológico revelou uma proliferação de células ovoides, fusiformes e estreladas dispostas em um estroma mixomatoso. Com base nestes achados, foi estabelecido o diagnóstico de mixoma odontogênico e o paciente foi submetido à ressecção parcial da mandíbula. O exame microscópico da peça cirúrgica, que confirmou o diagnóstico prévio de mixoma odontogênico, revelou a presença de pequenas e eventuais massas hialinas ovoides homogêneas/ fibrilares e estruturas arredondadas que circunscreviam material eosinofílico amorfo, compatíveis com granulomas de anéis hialinos. Conclusão: Os achados do presente caso revelam que, em tumores odontogênicos, os granulomas de anéis hialinos podem se apresentar como estruturas inconspícuas e, possivelmente, possuem uma origem exógena.

Hyaline ring granulomas are uncommon histopathological findings which their etiopathogenesis is still not well established. In the oral cavity, these microscopic findings have been described in extraosseous and intraosseous lesions, with emphasis in inflammatory odontogenic cysts. However, reports of hyaline ring granulomas in odontogenic tumors are scarce. Objective: To report the first case of hyaline ring granulomas in an odontogenic myxoma, as well as to discuss the etiopathogenesis and clinical-pathological aspects of these microscopic findings in odontogenic tumors. Case report: A 30-year-old male patient had a fibrous swelling in the left posterior region of the mandible with approximately 3.3 cm of extension. Radiographically, an osteolytic lesion extending from the distal region of tooth 35 to the anterior region of the ascending ramus of the mandible was observed. Incisional biopsy was performed and histopathological examination revealed a proliferation of ovoid, spindle and stellate-shaped cells within a myxomatous stroma. Based on these findings, the diagnosis of odontogenic myxoma was made and the patient underwent partial resection of the mandible. Microscopic examination of the surgical specimen, which confirmed the previous diagnosis of odontogenic myxoma, revealed the presence of small and occasional ovoid homogenous/ fibrillar hyaline masses and round structures enclosing amorphous eosinophilic material, which were compatible with hyaline ring granulomas. Conclusion: The findings of the present case reinforce that in odontogenic tumors, hyaline ring granulomas appear as inconspicuous structures and, probably have an exogenous origin.

Evaluation in vivo of biocompatibility of differents resin-modified cements for bonding orthodontic bands

ABSTRACT The focus of this study was to test the hypothesis that there would be no difference between the biocompatibility of resin-modified glass ionomer cements. Sixty male Wistar rats were selected and divided into four groups: Control Group; Crosslink Group; RMO Group and Transbond Group. The materials were inserted into rat subcutaneous tissue. After time intervals of 7, 15 and 30 days morphological analyses were performed. The histological parameters assessed were: inflammatory infiltrate intensity; reaction of multinucleated giant cells; edema; necrosis; granulation reaction; young fibroblasts and collagenization. The results obtained were statistically analyzed by the Kruskal-Wallis and Dunn test (P<0.05). After 7 days, Groups RMO and Transbond showed intense inflammatory infiltrate (P=0.004), only Group RMO presented greater expression of multinucleated giant cell reaction (P=0.003) compared with the control group. After the time intervals of 15 and 30 days, there was evidence of light/moderate inflammatory infiltrate, lower level of multinucleated giant cell reaction and thicker areas of young fibroblasts in all the groups. The hypothesis was rejected. The Crosslink cement provided good tissue response, since it demonstrated a lower level of inflammatory infiltrate and higher degree of collagenization, while RMO demonstrated the lowest level of biocompatibility.

Evaluation of hypoxia, angiogenesis, and lymphangiogenesis in actinic cheilitis.

BACKGROUND: Actinic cheilitis is a potentially malignant condition caused mainly by chronic sun exposure. Here we aim to evaluate the role of hypoxia, angiogenesis, and lymphatic density in the clinical and morphological progression of a series of cases of actinic cheilitis. MATERIALS AND METHODS: Immunohistochemistry was used to evaluate positivity to hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF)-C, and D2-40 in 40 cases of actinic cheilitis of the lower lip. RESULTS: The cases studied exhibited variable degrees of positivity to the markers. The median number of lymphatic vessels was 3.2, 2.4, and 3.0 in lesions showing no epithelial dysplasia (NED) and with mild (MED) and moderate (MOED) epithelial dysplasia, respectively. The median VEGF-C positivity index was 82.44% (NED), 92.74% (MED), and 82.83% (MOED), and the median HIF-1α positivity index was 11.57% (NED), 5.26% (MED), and 13.55% (MOED). No significant differences in lymphatic density or median VEGF-C and HIF-1α positivity indices were observed between histological grades or clinical presentations of actinic cheilitis (P > 0.05). CONCLUSIONS: Although representing early events in lip carcinogenesis, the present results suggest that hypoxia, angiogenesis, and lymphangiogenesis do not influence the morphological or clinical progression of actinic cheilitis.

Green LED light has anti-inflammatory effects on burns in rats.

PURPOSE: The aim of this study was to evaluate the effects of green LED light on inflammatory cells in skin burns: a histological study in rats. METHODS: In this study, 40 rats were randomly divided into 2 groups: G1 - Control (CTR) and G2 - Green Led (LED). Immediately after injury, green light (60J/cm(2), 10s, λ520 at 550nm) was applied in a timely manner in the four coinciding points of the wound angles and at each point, the amount of 60J/cm (2) with a time of 10s was delivered, totaling 240J/cm(2) per session with 24h intervals until the day before animal sacrifice at 3, 7, 14 and 21 days with a lethal dose of intraperitoneal anesthetic. RESULTS: In the histological analysis, animals treated with green LED, from 7 days, showed a significant decrease (p<0.05) in inflammatory cells when compared to control group. CONCLUSIONS: Green LED light provides an anti-inflammatory effect on skin burns of rats.

Immunoexpression of Th17-related cytokines in oral lichen planus.

A recently described lineage of lymphocytes, Th17 cells, has been associated with inflammatory and autoimmune diseases. The aim of this article was to assess the immunoexpression of cytokines related to this lineage, interleukin-17 (IL-17) and IL-23 and in reticular and erosive oral lichen planus (OLP). The sample included 41 cases of OLP (23 reticular and 18 erosive) and 10 cases of inflammatory fibrous hyperplasia (IFH). Lymphocytes exhibiting cytoplasmic immunostaining were counted. Epithelial immunostaining was also evaluated. There was no statistical differences in the number of IL-17 and IL-23 lymphocytes between the OLP (55.40 and 48.40, respectively) and IFH (39.30 and 44.40, respectively). A significantly higher number of IL-23 lymphocytes was found in erosive OLP group (63.80) when compared with reticular (41.40) and IFH lesions (44.40) (P=0.019). Furthermore, epithelial immunopositivity for IL-17 and IL-23 was higher in OLP lesions than in IFH (P=0.012 and P=0.011, respectively). A significantly higher number of IL-23 lymphocytes in erosive OLP and the strong epithelial immunopositivity for IL-23 and IL-17 in OLP group could suggest an important participation of TCD4 Th17 response in this disorder.

Retrospective analysis of the histopathologic features of 288 cases of reactional lesions in gingiva and alveolar ridge.

INTRODUCTION: The aim of this study was to perform a retrospective study of histopathologic features of a series of cases of pyogenic granuloma (PG), peripheral giant cell lesion (PGCL), and peripheral ossifying fibromas (POF) that constitutes the group called reactional lesions, located in gingiva and alveolar ridge. STUDY DESIGN: Cases of PG, PGCL, and POF were selected for this study. The morphological analysis of the lesions constituted the following: intensity of inflammatory infiltrate (IF), presence of vascular proliferation (VP), fibroblastic proliferation (FP), areas of ulceration (AU), bacterial colony (BC), presence of mineralization (PM), multinucleated giant cells (MGC), hemosiderin deposition (HD), hemorrhage area (HA). RESULTS: Of the 288 cases analyzed, 162 (56.3%) were PG, 72 (25%) were PGCL, and 54 (18.8%) were POF. The IF, VP, AU, and BC were more prominent in PG (85.8%, 98.8%, 91.4%, and 46.9%, respectively) and PM in POFs (98.1%). FP was more frequent in POF (98.1%) and PGCL (100%) and MGC in PGCL (100%), although some cases of POF (7.4%) and PG (0.6%) exhibited MGC. HD was more frequent in PGCL (40.3%) and HA in PG (53.1%). CONCLUSIONS: This study demonstrated that IF, VP, AU, BC, and HA are the common features in PG, MGC, FP, and HD are the most common in PGCL, and PM associated with FP are the most common in POF, which can help in the histopathologic differential diagnosis between these lesions. In addition, it may suggest a possible development and maturation of the PG in POF with reduction in the inflammatory component and increase in the fibrous component.

Immunoexpression of MMP-9, VEGF, and vWF in central and peripheral giant cell lesions of the jaws.

BACKGROUND: Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are pathological conditions of the jaws that share the same microscopic features, but differ clinically in terms of their behavior. Our aim was to compare the immunoexpression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in CGCL and PGCL, relating them to the angiogenic index. METHODS: Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of MMP-9 and VEGF in multinucleated giant cells (MGC) and mononucleated cells (MC). Angiogenic index was determined by microvessel count (MVC) using anti-von Willebrand factor antibody. RESULTS: The CGCL showed slightly higher expression of MMP-9 than PGCL. In comparison with PGCL, the CGCL showed higher expression of VEGF both in MC (P < 0.05) and in total cells (P < 0.05). PGCL exhibited higher MVC than CGCL (P < 0.05). CONCLUSIONS: MMP-9 and VEGF might play an important role in the osteoclastogenesis process in CGCL. The higher MVC in PGCL might be related to the reactive nature of these lesions.

Immunoexpression of bone morphogenetic protein-2 (BMP-2), BMP receptor type IA, and BMP receptor type II in metastatic and non-metastatic lower lip squamous cell carcinoma.

BACKGROUND: The aim of this study was to evaluate the expression of bone morphogenetic protein-2 (BMP-2), BMPR-IA, and BMPR-II in metastatic and non-metastatic lower lip squamous cell carcinoma (LLSCC). METHODS: Twenty LLSCC with regional nodal metastasis and 20 LLSCC without metastasis were selected for analysis of the immunoexpression of BMP-2, BMPR-IA, and BMPR-II. The percentage of positive cells was evaluated according to the following parameters: score 1 (staining in 0-50% of cells), score 2 (staining in 51-75% of cells), and score 3 (staining in >75% of cells). Immunostaining intensity was evaluated according to the following scores: score 1 (absent or weak expression) and score 2 (strong expression). RESULTS: Regarding the percentage of positive cells, most tumors with and without metastasis showed score 3 for both BMP-2 (P = 0.655) and BMPR-IA (P = 0.655). For BMPR-II, metastatic tumors exhibited higher percentage of positive cells in comparison with non-metastatic tumors (P = 0.049). With respect to immunostaining intensity, most LLSCCs with and without metastasis showed score 2 for BMP-2 (P = 1.000) and score 1 for BMPR-II (P = 1.000). For BMPR-IA, most metastatic tumors presented score 2, whereas most non-metastatic tumors showed score 1 (P < 0.001). Strong expression of BMPR-IA showed a statistically significant association with advanced clinical staging (P < 0.001) and high score of malignancy (P = 0.028). CONCLUSIONS: The results of this study suggest that disturbances in the BMP-2 signaling pathway may be involved in the development of LLSCC and that the strong expression of BMPR-IA might be indicative of the development of metastasis in these lesions.

Chondrolipoma of the tongue: a case report.

Chondrolipomas are benign mesenchymal tumors characterized by the proliferation of mature adipocytes associated with variable amounts of mature cartilaginous tissue. We describe here a case of chondrolipoma of the tongue in a 30-year-old man. The patient reported the presence of the lesion for approximately 10 years. Intraoral clinical examination revealed a nodular, sessile, pink mass of firm consistency, which was located along the midline of the posterior region on the dorsal surface of the tongue. An excisional biopsy was performed and histopathological examination revealed a well-delimited proliferation of mature adipocytes arranged in lobules and separated by fibrous connective tissue septa. Islands of mature cartilaginous tissue were identified in close proximity to the fibrous connective tissue septa, as well as lacunae filled with chondrocytes. No myxoid areas, lipoblasts, atypias, hyperchromasia or mitosis were detected. After 5 years of follow-up, the patient shows no signs of recurrence. Chondrolipomas are uncommon in the oral cavity, with only nine cases being reported in the international literature (Pubmed Database).

Ossifying fibromyxoid tumor in the mandibular gingiva: case report and review of the literature.

BACKGROUND: Ossifying fibromyxoid tumors (OFTs) are uncommon soft tissue neoplasms. Only one case arising in the gingiva has been described. METHODS: A 21-year-old woman presented with a painless exophytic mass located in the right posterior mandibular gingiva, which was identified 6 months earlier. Radiographs showed irregular calcifications inside the lesion, discrete irregularity of alveolar bone, and integrity of buccal and lingual cortical bone. An incisional biopsy was performed based on the clinical diagnostic hypothesis of peripheral ossifying fibroma or peripheral giant cell granuloma. Microscopic features were compatible with the diagnosis of ossifying fibroma. The entire mass was excised and submitted to histopathologic and immunohistochemical analysis. RESULTS: Histopathologic analysis revealed proliferation of round to spindle-shaped cells arranged in cords and nests and embedded in a fibromyxoid matrix. An incomplete shell of bone trabeculae located beneath the fibrous pseudocapsule was observed at the periphery. Immunohistochemical analysis showed positivity for vimentin and S-100 protein and negativity for smooth muscle actin, muscle-specific actin, and glial fibrillary acidic protein. The definitive diagnosis was OFT. The patient showed no clinical signs of recurrence 7 months after surgical excision. CONCLUSIONS: OFTs located in the gingiva are extremely rare. At this site, these tumors are clinically indistinguishable from other reactive or neoplastic lesions. Although many cases present an indolent biologic behavior, the local recurrence of OFTs has been reported; therefore, long-term follow-up is mandatory.