Oral syphilis: report of three cases and characterization of the inflammatory cells.

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. This study reports 3 cases of syphilis and highlights the importance of identifying oral lesions for its final diagnosis. Case 1: a 48-year-old male patient presented with a bleeding ulcer in the lower lip. Overall clinical examination revealed patchy alopecia and skin target lesions. Case 2: a 61-year-old male patient presented with white spots on the lateral tongue and nodules on the dorsum of the tongue. Overall clinical examination showed erythematous target lesions on the abdomen, forearm, palms of the hand, and soles of the feet. Case 3: a 17-year-old male patient presented with an ulcerated lesion on the tongue and lymph node involvement. The following serologic tests were requested: Venereal Disease Research Laboratory, fluorescent treponemal antibody-absorption, anti-HIV-1 and anti-HIV-2, and anti-hepatitis C virus. An incisional biopsy revealed epithelial hyperplasia associated with intense and diffuse mononuclear inflammatory cell infiltration consisting mainly of plasma cells, in a perivascular and perineural distribution. The final diagnosis in the 3 patients was syphilis. Treatment consisted of 1 weekly dose of penicillin (2.4 million units, intramuscular) for 2 or 3 weeks. Immunohistochemical reactions for XIIIa, CD3, CD20, CD68, CD163, S100, CD1a, CD11c, CD83, CD138, and CD208 were performed. Clinicians should be familiarized with oral syphilis lesions in order to be able to diagnose this emerging infectious disease of variable clinical presentation.

Análise da proteína EGFR em carcinoma espinocelular de lábio / EGFR protein analysis in squamous cell carcinoma of the lip

O carcinoma espinocelular de lábio (CEC) é uma das neoplasias malignas mais comuns, acometendo principalmente lábio inferior devido à exposição solar. Este trabalho teve como objetivo avaliar 3 métodos degradação histológica (OMS, BD e MRH), analisar a expressão da proteína EGFR no CEC de lábio, comparar com queilite actínica (QA) e correlaciona-las com o prognóstico. Dados de 53 pacientes com CEC de lábio foram coletados para a avaliação clinicopatológica e histológica. 22 casos de CEC e 19 de QA foram submetidos à reação imuno-histoquímica com a proteína EGFR e analisados por um analisador automatizado para avaliação da expressão proteica. A média de idade foi de 65 anos, 69,8%foram homens, o lábio inferior foi o local de predileção com 94,4% e 66,03% dos pacientes estavam em estadios precoces (T1+T2). 28(52,83%) e 34 (64,15%) casos respectivamente foram graduados embaixo risco prognóstico ou grau 1 pelas escalas BD e OMS, o modelo MRH graduou a 29 (54,72%) casos como médio risco prognóstico ou grau 2. O modelo de gradação mais simples e fácil de ser aplicado em CEC de lábio foi a Escala BD e o mais eficaz, pois quando em alto grau histológico foi associado à menor sobrevida global (P=0,045). A sobrevida global foide 87,8% em 5 anos. Estadiamento clínico avançado (T3+ T4) e envolvimento linfonodal (N1) foram associados à menor sobrevida global e sobrevida livre de recorrência (P=0,002; 0,005; 0,007 e 0,01). O tratamento cirúrgico combinado ao radioterápico foi associado à menor sobrevida livre de recorrência (P=0,03). Na expressão da proteína EGFR não houve diferença estatisticamente significante entre QA e CEC de lábio. O CEC de lábio quando em estadios e graus histológicos avançados, é associado a um pior prognóstico, o diagnóstico precoce é essencial para a escolha do melhor tratamento e sobrevida dos pacientes,evitando mutilações e consequentemente, perda na qualidade de vida

Lip squamous cell carcinoma (SCC) is one of the most common malignancies affecting especially lower lip due to sun exposure. This study aimed to evaluate three methods of histological grading (WHO, BD andMRH), analyze the expression of EGFR protein on the lip of SCC,compared with actinic cheilitis (AC) and correlates them with theprognosis. Data from 53 patients with lip SCC were collected for the clinico pathological and histological evaluation. 22 cases of SCC and 19AC underwent immunohistochemical reaction with EGFR protein and analyzed by an automated analyzer for evaluation of protein expression.The average age was 65 years, 69,8% were men, lower lip was the site of predilection with 94,4% and 66,03% of patients were in early stages (T1 +T2). 52.83% and 64.15% cases respectively were graduates in low risk prognosis or grade 1 by BD and WHO scales, the MRH model graduated 54.72% cases as medium risk prognosis or grade 2. The simplest gradingmodel and easy to apply in lip SCC was the BD scale and more efficient because when in high histological grade was associated with lower overall survival (P = 0.045). Overall survival was 87,8% at 5 years. Advanced clinical stage (T3 + T4) and lymph node involvement (N1) were associated with lower overall survival and recurrence-free survival (P = 0.002; 0.005;0.007 and 0.01). Surgical treatment combined with radio therapy was associated with lower recurrence-free survival (P = 0.03). The expression of EGFR protein had no statistically significant difference between AC andlip SCC. The lip SCC when in advanced stages and high histological grades, is associated with a worse prognosis, early diagnosis is essential for choosing the best treatment and survival of patients, avoid ingmutilation and consequently, loss in quality of life