Clinical and demographic features of minor salivary gland tumors: A collaborative study of 480 cases.

OBJECTIVE: To describe the frequency, clinical, and demographic features of minor salivary gland tumors and possible associated factors. MATERIALS AND METHODS: A cross-sectional study was conducted. Clinical and demographic data were collected from biopsy records of two oral pathology services. Chi-square test, Fisher's exact test, and descriptive statistical analysis were performed. RESULTS: A total of 480 (0.89%) minor salivary gland tumors were retrieved, 272 (56.7%) benign and 147 (30.7%) malignant. Sixty-one (12.6%) had no subtype specification. Most patients were women (307/64.0%), in sixth decade of life (80/16.7%), with a mean age of 45.32 years. Palate was the most common site (336/70.1%). Pleomorphic adenoma (PA; 245/51.1%), mucoepidermoid carcinoma (MEC; 70/14.6%), and adenoid cystic carcinoma (ACC; 43/8.9%) were the most frequent tumors. Symptomatic case, recurrence, and tobacco use were associated with malignancy (p < 0.05). PA and MEC were more frequent in palate (p < 0.05). No association between the three most frequent histological types and gender or age group was observed (p > 0.05). CONCLUSIONS: This represents one of the largest exclusive series of minor salivary gland tumors in Brazil and worldwide. PA, MEC, and ACC were the most frequent tumors. Clinical and demographic data are similar from Brazilian studies or from other countries.

Knowledge of Oral Cancer by a Brazilian Population.

The aim of the present study was to investigate the knowledge about oral cancer in a Brazilian population, including initial clinical signs, causal factors, and the health professional of first choice when suspected of the disease. A total of 2261 participants were interviewed in a cross-sectional study, to investigate associations between sociodemographic descriptive variables and knowledge of oral cancer, risk factors, disease precursor lesions, and health professional of choice for diagnosis. The variables were descriptively analyzed and possible associations investigated considering p values < 0.05. A total of 83.4% of participants reported knowing about oral cancer, and 59.5% reported knowing about potentially malignant lesions; both variables were associated (p < 0.0001). Tobacco was identified as the main risk factor (83.6%), followed by family history (66.2%), and poor oral hygiene (54.5%). Interviewees with higher education level had greater knowledge about cancer (p < 0.0001), and the dentist was the health professional of choice for 43.1% of those who knew about the disease (p = 0.007), with the generalist being the most sought specialist. The population evaluated had a low knowledge of oral cancer given the lack of specific clarifications on etiological factors and risk situations. Health education initiatives are necessary to increase population awareness of potentially malignant oral lesions and improve early diagnosis and recognition of the dentist as a qualified professional for diagnosis of the disease.

A Th2-Type Response Is Associated With Exuberant Lesions in Pregnant Women Infected With Leishmania braziliensis.

Background: Cutaneous leishmaniasis (CL) is characterized by an exaggerated inflammatory response. During pregnancy there is a decreased inflammatory response, and we have shown that pregnant women with CL develop exuberant lesions. Methods: Cytokine production by peripheral blood mononuclear cells and the frequency of cells expressing cytokines in lesions from pregnant and nonpregnant women with CL were evaluated. Results: We observed that CL lesions from pregnant women displayed a more intense cellular infiltrate, associated with an increase in neutrophils and CD4+ cells. While no difference was observed regarding the number of interferon-gamma (IFN-γ)+ cells in lesions from pregnant compared to nonpregnant women with CL, interleukin-10 (IL-10) and IL-4 expression were approximately 3-times higher in lesions in pregnant women. Main sources of IL-4 and IL-10 were CD4+ and CD68+ cells, respectively. Expression of IL-4, but not IFN-γ or IL-10, was positively correlated with the intensity of inflammatory infiltrate in lesions from pregnant women. Conclusions: These results provide evidence of an IL-4-mediated pathology in Leishmania braziliensis-infected pregnant women. These differences in lesion pathogenesis in pregnant and nonpregnant women may open possibilities for new therapies for CL treatment during pregnancy, which are currently lacking.

Prevalence profile of odontogenic cysts and tumors on Brazilian sample after the reclassification of odontogenic keratocyst.

PURPOSE: The aim of this study was to evaluate the impact of the reclassification of odontogenic keratocyst (OKC) as a tumor on the prevalence profile of odontogenic cysts (OCs) and odontogenic tumors (OTs). STUDY DESIGN: Two referral Oral and Maxillofacial Pathology services in Brazil were evaluated. All cases diagnosed as OCs or OTs were selected and classified according to the 1992 WHO-classification (cases before 2005 WHO classification of tumors excluding OKC) and the 2005 WHO classification of tumors, going forward including cases of odontogenic keratocyst tumor (KCOT). The frequency and prevalence of OCs and OTs were compared before and after the reclassification. RESULTS: Among 27,854 oral biopsies, 4920 (17.66%) were OCs and 992 (3.56%) were OTs. The prevalence of OTs before 2005 WHO classification of tumors was 2.04%, while the prevalence after 2005 WHO classification was 11.51% (p < 0.0001). Before 2006, the most frequent tumor diagnosed was odontoma with 194 cases (39.67%), and after 2005 WHO classification of tumors the KCOT was the most frequent with 207 cases (41.07%). CONCLUSIONS: The increase in the prevalence of OTs after 2005 WHO is related to the improvement of pathology services and to the inclusion of KCOT in the OTs group.

Anatomic variations and lesions of the maxillary sinus detected in cone beam computed tomography for dental implants.

OBJECTIVE: To evaluate the presence of anatomic variations and lesions of the maxillary sinus in cone beam computed tomography (CBCT) of the maxilla required for dental implant planning. MATERIAL AND METHODS: This transversal prevalence study evaluated a sample of 500 consecutive CBCT exams. The inclusion criteria were CBCT exams of the maxilla required for dental implant planning. The CBCT exams were independently evaluated by two oral and maxillofacial radiologists who assessed the presence of anatomic variations and lesions of the maxillary sinus. As most of the CBCT exams did not allow the evaluation of the area close to the maxillary sinus roof, anatomic variations that take place at this site were not assessed. RESULTS: The anatomic variations detected were pneumatization (83.2%), antral septa (44.4%), hypoplasia (4.8%), and exostosis (2.6%). The identified lesions were mucosal thickening (≤3 mm in 54.8% and >3 mm in 62.6%), polypoid lesions (21.4%), discontinuity of the sinus floor (17.4%), air-fluid level (4.4%), bone thickening of the maxillary sinus wall (3.8%), antroliths (3.2%), discontinuity of the sinus lateral wall (2.6%), sinus opacification (1.8%), and foreign body (1.6%). CONCLUSION: Anatomic variations and lesions of the maxillary sinus were common findings in CBCT exams of the maxilla required for dental implant planning. As some of these conditions can modify dental implant planning and must require specialized treatment, its recognition is noteworthy in dental practice, and especially in implantology. The amount and significance of the anatomic variations and lesions detected in this study reinforces the importance of computed tomography in preoperative dental implant planning.

NFATc1 and TNFalpha expression in giant cell lesions of the jaws.

BACKGROUND: Activation mutations of SH3BP2 gene have been demonstrated in cherubism and central giant cell lesion (CGCL). In the present study we first attempted to investigate the SH3BP2 gene in peripheral giant cell lesion (PGCL). The effect of SH3BP2 gene mutations on the transcription of the downstream genes nuclear factor of activated T cells (NFATc1) and the cytokine tumor necrosis factor-alpha (TNF-alpha) was also investigated together with the immunolocalization of NFATc1 protein in a set of cases of PGCL, CGCL and cherubism with and without SH3BP2 mutation. METHOD: Fresh samples of five PGCL, five CGCL and one cherubism cases were included in this study. One of the samples of CGCL presented a somatic heterozygous mutation c.1442A>T in exon 11. The cherubism case showed a heterozygotic substitution c.320C>T in both blood and lesion. These mutations were previously published. All coding and flanking regions of the SH3BP2 gene were sequenced in the cases of PGCL. The real-time polymerase chain reaction (RT-PCR) was performed to analyze the transcription of NFATc1 and TNF-alpha genes. The immunohistochemical analysis of the NFATc1 protein was also performed. RESULTS: No SH3BP2 gene mutation was found in PGCL. The RT-PCR showed increased expression of NFATc1 and decreased transcription of TNF-alpha in all the samples. The immunohistochemical analysis of the NFATc1 protein showed a predominant nuclear staining in the multinucleated giant cells. CONCLUSION: The development of giant cells lesions of the jaws and cherubism are possibly mediated by overexpression of NFAT in the nucleus of the multinucleated cells.

Advanced osteosarcoma of the maxilla: a case report.

Osteosarcomas are primary malignant bone tumours in which mesenchymal cells produce osteoid. It is generally the most common malignant bone neoplasm, although lesions of the jaw are uncommon. Osteosarcoma of the jaw (JOS) presents a lower incidence of metastasis and a better prognosis than osteosarcoma of the long bones. However, patients with JOS can exhibit advanced tumours, mainly when early diagnosis is not performed. This article reports on a case of an advanced osteosarcoma of the maxilla. A 38-year-old woman was referred for evaluation and treatment of recurrent fibrous dysplasia of the facial bones. The patient related that she had been diagnosed with fibrous dysplasia four years earlier and, since the first diagnosis, she was submitted to four surgical interventions, all followed by recurrences. The main clinical findings were redness and swelling of the facial skin, upper lip ulceration, and hard palate swelling. Computed tomography showed a large hyperdense mass in right maxilla extending to right orbit and left maxillary sinus. An incisional biopsy was performed and microscopic examination showed areas of osteoid and chondroid formation surrounded by a cellular stroma. The diagnosis of osteosarcoma was established and the patient was recommended for oncologic treatment. Unfortunately, she died six months after the diagnosis due to uncontrollable local spread.

A novel mutation of the SH3BP2 gene in an aggressive case of cherubism.

Cherubism is an autosomal dominant inherited syndrome characterized by excessive bone degradation of upper and lower jaw and its replacement with large amounts of fibrous tissue, which causes a characteristic facial swelling. A correlation with a mutation in the gene SH3BP2 has been previously demonstrated, but a model for its pathogenesis is not yet available. Here we describe a novel mutation in an aggressive case of cherubism located in the pleckstrin homology domain (PH) of the SH3BP2.

Systemic leukocyte activation in patients with central giant cell lesions.

BACKGROUND: Central giant cell lesion (CGCL) is a reactive lesion of the jaws with an associated inflammatory infiltrate. Since cell circulation allows for intense communication between different compartments in the body, we investigated whether the CGCL would lead to phenotypic and/or functional changes in circulating leukocytes. METHODS: We obtained lymphocytes and monocytes from CGCL patients and control subjects, to evaluate cytokine and adhesion molecule expression using flow cytometry. RESULTS: Our results revealed that CD4(+) T cells and CD14(+) monocytes from CGCL express elevated levels of CD11a and CD11b, respectively, when compared with controls. The frequencies of CD4(+) T cells expressing interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha and the frequencies of CD4(+) and CD14(+) cells expressing interleukin (IL)-10 were increased in CGCL group, when compared with controls. CONCLUSIONS: Our data indicate that, although CGCL is a localized lesion, the patients show systemic functional alterations in circulating leukocytes, suggesting their role in the inflammatory pathogenesis of CGCL.