Sociodemographic and clinical characterization of cases of 1,103 non-syndromic and 66 syndromic odontogenic keratocyst: a Brazilian multicenter study.

OBJECTIVES: This multicenter study aimed to evaluate cases of non-syndrome and syndromic odontogenic keratocyst, as well as cases of recurrence within these two groups. METHODS: This descriptive, analytical, retrospective cross-sectional study evaluated the sex, age and presence of multiple lesions in 1,169 individuals seen at 10 Brazilian oral and maxillofacial pathology centers. Of these, 1,341 odontogenic keratocysts were analyzed regarding clinical diagnosis, size, site, imaging appearance, signs and symptoms, type of biopsy, treatment, and recurrence. RESULTS: There was a similar distribution by sex. The median age of non-syndromic and syndromic patients was 32 and 17.5 years, respectively. The posterior mandible was the site most affected by small and large lesions in both groups and in recurrent cases. Unilocular lesions were more frequent, also in recurrent cases. Mainly small lesions showed this imaging appearance. Signs and symptoms were absent in most cases. Conservative treatment was the most frequent modality in all age groups, regardless of the patient's condition and recurrence. Recurrences were uncommon. CONCLUSION: This study showed a higher frequency of non-syndromic keratocysts in the population. Clinicopathological features related to the involvement of multiple sites, age, and recurrence may differ between syndromic and non-syndromic cases. Furthermore, we found an association between lesion size and some clinical features and between the time interval to recurrence and the syndromic spectrum. CLINICAL RELEVANCE: To contribute to a better understanding of the distribution and association between clinical, imaging, and sociodemographic characteristics in each spectrum of the lesion.

A rare case of squamous cell carcinoma of the gingiva: A diagnostic challenge.

BACKGROUND: Oral squamous cell carcinoma (OSCC) of the gingiva represents less than 6% of intraoral carcinomas. CASE REPORT: A 51-year-old male patient presented with a history of a symptomatic red spot with periods of remission and recurrence in the mandibular gingiva. On clinical examination red and white areas were observed in the gingiva, particularly around the left lower molars. Diagnosis of gingival lichen planus was suspected and topical corticosteroids was prescribed. A good clinical response was observed with reduction of symptom. The patient remained in regular follow-up and after 9 months, the lesion suddenly changed, became ulcerated and diagnosis of OSCC was established. CONCLUSION: The clinical manifestation of OSCC can eventually mimic other even more common lesions of the oral mucosa, highlighting the importance of considering OSCC as differential diagnosis of any unexplained and persistent lesion in the oral cavity.

Oral pigmented lesions: a retrospective analysis from Brazil / Lesiones pigmentadas orales: un análisis retrospectivo desde Brasil

Background: Pigmented lesions are uncommon in the oral mucosa, and studies investigating the incidence andtypes of these lesions are desired to improve the diagnostic knowledge of clinicians. The aim of this study was toanalyze the distribution of oral pigmented lesions in a Brazilian population.Material and Methods: A retrospective descriptive cross-sectional study was performed. Oral pigmented lesionswere retrieved from the files of two oral and maxillofacial pathology services from Brazil over a 45-year period(1974-2019). The clinical data and the diagnoses of each case were retrieved and included in a Microsoft Excel®database.Results: From 77.074 lesions diagnosed in this period, 761 (0.99%) represented pigmented lesions of the oralmucosa, including 351 (46.1%) melanocytic and 410 (53.9%) non-melanocytic lesions, with a higher incidence infemales (73.2%) between the fourth and seventh decades of life. Amalgam tattoo (53.6%) represented the most common lesion, followed by melanotic macule (18.3%) and racial pigmentation (10.8%). Other pigmented lesionsincluded nevus (9.9%), post-inflammatory pigmentation (3%), melanoma (2.1%), melanoacanthoma (1.4%), smoker'smelanosis (0.4%), drug-induced pigmentation (0.3%), and melanotic neuroectodermal tumor of infancy (0.1%). Thebuccal mucosa was the most commonly affected site (25.2%), followed by the alveolar ridge (14.5%), and gingiva(11.8%).Conclusions: The current findings were similar to previous studies with minor differences due methodology andcharacteristics of the services from where lesions were retrieved. The knowledge of these data may contribute to abetter understanding of oral pigmented lesions and assist clinicians to better recognize and manage them.(AU)

Oral cancer adjacent to dental implants mimicking benign lesions: a case series study.

Despite the long-term survival rates of osseointegrated dental implants, several biological complications are known to affect the peri-implant tissues, such as peri-implant mucositis and peri-implantitis. Occasionally, the clinical features of these more common benign lesions, or others nonrelated to implants, might be similar to oral malignancies, leading to misdiagnosis. The objective of this study was to present a case series of oral cancer located adjacent to dental implants, aimed to identify the reasons for initial misinterpretation of diagnosis. Thirteen patients, 10 females and 3 males, aged 59 to 90, were assessed. Among the differential diagnoses established, a malignant or premalignant lesion was not considered in 10 out of the 13 patients. Peri-implantitis was the most common preliminary diagnosis, followed by fungal infection, viral infections, and traumatic ulcers. The meantime for the diagnosis of oral cancer was 21.5 months. The clinical presentation of peri-implant malignancy, such as ulceration, white and red plaques, and exophytic lesions, might mimic benign diseases that are more common in the oral cavity. Suspicious lesions with treatment failure that persist for more than 2 weeks require biopsy and histopathological analysis to establish an early definitive diagnosis to improve the prognosis and quality of life of the patients.

Clinicopathological analysis and survival outcomes of primary salivary gland tumors in pediatric patients: A systematic review.

BACKGROUND: Salivary gland tumors are a diverse group of uncommon neoplasms that are rare in pediatric patients. The aim of this study was to evaluate the clinicopathological profile and survival outcomes of pediatric patients affected by salivary gland tumors. MATERIALS AND METHODS: An extensive search was carried out using the MEDLINE/PubMed, EMBASE, Scopus databases, and grey literature. The risk of bias was available in all papers included. RESULTS: A total of 2,830 articles were initially retrieved with 54 remaining for data extraction, resulting in 2,937 cases. This comprised forty-five case series' and nine cohort studies. These tumors were slightly more prevalent in females (57.4%). The patients' age ranged from 0.3 to 19 years old, with a mean age of 13.3 years. Parotid was the most affected site (81.9%), and 99.2% of cases clinically exhibited a swelling. Presence of pain/tenderness was reported in 13.5% of the cases, with an average duration of 12.6 months for the appearance of symptoms. Most of the reported cases were malignant tumors (75.4%), with mucoepidermoid carcinoma the most common tumor of all tumors (44.8%), followed by pleomorphic adenoma (24.1%). Surgery alone was the leading treatment choice in 74.9% cases, and the 5-year overall survival rate of patients was 93.1%. Patients with symptoms (P = .001), local recurrence (P < .001), metastasis (P < .001), and those not undergoing surgery or surgery combined with radiotherapy (P < .001) showed lower survival rates. CONCLUSION: The pediatric patients present a high frequency of malignant salivary neoplasms and a high overall survival rate.

An audit of cytopathology in the oral and maxillofacial region: 18 years of experience.

INTRODUCTION: The aim of this study was to perform an audit of oral and maxillofacial specimens submitted for cytological diagnosis to verify the importance of this complementary examination. METHODS: A retrospective analysis of our institutional cytopathology database was performed over an 18-year period. Clinical information and cytological data were collected. Associations between independent variables and outcomes were assessed using the Pearson χ2 test or Fisher's test, with a 5% significance level. When available, the histological diagnosis was compared with cytological diagnosis to identify the percentage of agreement and the specificity, sensitivity and accuracy of cytology in identifying malignant neoplasms. RESULTS: A total of 1082 cases were identified, which included 65 different cytological diagnoses. Exfoliative cytology (EC) was performed in 312 cases (29.1%) and fine needle aspiration cytology (FNAC) in 770 cases (70.9%). EC was mainly employed to diagnose oral infectious diseases (P < 0.001) and FNAC to diagnose neoplasms, cystic, reactive and miscellaneous lesions (P < 0.001). Cell-block was performed in 555 FNAC cases (51.3%). Panoptic, Papanicolaou and haematoxylin-eosin staining were performed in FNAC and periodic acid-Schiff in EC (P < 0.001). In 211 cases (19.5%), the histological diagnosis was available and the percentage agreement with the cytological diagnosis was 41.2%. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy to identify malignant neoplasms were 84.6%, 100%, 100%, 77.8% and 90.0%, respectively. CONCLUSIONS: EC was mainly performed for diagnosis of infectious diseases and FNAC for diagnosis of salivary gland tumours, odontogenic lesions, reactive lesions and cervical metastasis.

Laser excision of oral leukoplakia: Does it affect recurrence and malignant transformation? A systematic review and meta-analysis.

Oral leukoplakia (OL) is a white lesion with high potential of recurrence and malignant transformation. The variable clinical and histopathological features of OL may potentially impact both treatment and prognosis. Current literature shows that post treatment rates of recurrence and malignant transformation vary widely. The use of surgical lasers have been proposed with the objective of improving outcomes. We performed a systematic review and a comprehensive meta-analysis dedicated to pooling the rates of recurrence and malignant transformation of OL lesions treated using the main types of surgical lasers available. Scopus, MEDLINE/PubMed, and Embase were searched electronically. A total of 36 articles met the inclusion criteria. Selected studies included OL lesions that were treated by evaporation or excision using Nd:YAG laser, Er:YAG laser, CO2 laser, KTP laser, or diode laser. The results of this systematic review and meta-analysis suggest that surgical laser excision of OL may decrease recurrence rates but have no effect on the malignant transformation of OL when compared with conventional treatments.

Massive extrusion of calcium hydroxide paste containing barium sulphate during endodontic treatment.

A 31-year-old woman was referred for the evaluation of persistent lower lip numbness following endodontic treatment of tooth #36. Imaging examinations showed a large amount of radiopaque/hyperdense material spread in an angiographic distribution in the left mandibular body region. Laboratory analyses of tooth #36 and adjacent periapical tissue, surgically extracted in an external Service due to acute pain following endodontic treatment, identified chronic inflammatory reaction and birefringent crystalloid foreign bodies rich in barium and sulphur, leading to the diagnosis of alveolar nerve injury due to accidental extrusion of intracanal dressing material composed of calcium hydroxide [Ca(OH)2 ] paste incorporated with barium sulphate. Clinicians should be aware that Ca(OH)2 when in contact with periapical tissues may lead to persistent toxicities, such as necrosis, pain and paraesthesia. Therefore, injectable Ca(OH)2 systems should be used with caution because they can cause paste extrusion and damage to the lower alveolar nerve.

Potential role of nuclear magnetic resonance spectroscopy to identify salivary metabolite alterations in patients with head and neck cancer.

The analysis of the salivary metabolomic profile may offer an early phase approach to assess the changes associated with a wide range of diseases including head and neck cancer. The aim of the present study was to investigate the potential of nuclear magnetic resonance (NMR) spectroscopy for detecting the salivary metabolic changes associated with head and neck squamous cell carcinoma (HNSCC). Unstimulated whole-mouth saliva samples collected from HNSCC patients (primary tumour was located either in the larynx or in the oral cavity) and healthy controls were analysed by 1H-NMR spectroscopy. Reliably identified salivary metabolites were quantified and the determined concentration values were compared group-wise using a Mann-Whitney U-test. Multivariate discrimination function analysis (DFA) was conducted to identify such a combination of metabolites, when considered together, that gives maximum discrimination between the groups. HNSCC patients exhibited significantly increased concentrations of 1,2-propanediol (P=0.032) and fucose (P=0.003), while proline levels were significantly decreased (P=0.043). In the DFA model, the most powerful discrimination was achieved when fucose, glycine, methanol and proline were considered as combined biomarkers, resulting in a correct classification rate of 92.1%, sensitivity of 87.5% and specificity of 93.3%. To conclude, NMR spectrometric analysis was revealed to be a feasible approach to study the metabolome of saliva that is sensitive to metabolic changes in HNSCC and straightforward to collect in a non-invasive manner. Salivary fucose was of particular interest and therefore, controlled longitudinal studies are required to assess its clinical relevance as a diagnostic biomarker in HNSCC.

Expression of cell cycle proteins according to HPV status in oral squamous cell carcinoma affecting young patients: a pilot study.

OBJECTIVE: Tobacco and alcohol consumption are considered the main risk factors for oral squamous cell carcinoma (OSCC); however, the role of these factors in patients younger than 40 years is controversial, so it has been suggested that genomic instability and high-risk human papillomavirus (HR-HPV) infection may be contributing factors to oral carcinogenesis at a young age. Therefore, the aim of this study was to evaluate the immunoexpression of cell cycle proteins according HPV status in OSCC affecting young patients. METHODS: A tissue microarray construction based on 34 OSCC samples from young patients (<40 years old) was subjected to immunohistochemical reactions for Ki67, cyclin D1, C-ErbB2, p21, Myc, epidermal growth factor receptor, p53, and p16 antibodies. RESULTS: The clinicopathologic features and the immunoexpression of all tested proteins were similar in both groups. Patients with HPV-related OSSC tended to have better cancer-specific survival (CSS; 39% vs 60% 5-y CSS), and overall survival (OS; 29.2% vs 60% 5-year OS). However, this difference was not statistically significant. CONCLUSION: No significant difference exists in the expression of cell cycle proteins studied between HR-HPV DNA-positive and HR-HPV DNA-negative OSCC affecting young patients.

Osseous oral hyaline ring granuloma mimicking a mandible tumor in a child with congenital agenesis of the corpus callosum.

BACKGROUND: Hyaline ring granuloma (HRG) of the oral cavity is an uncommon disorder considered to be a foreign-body reaction resulting from implantation of food vegetable particles. Microscopically, it is characterized by the presence of structures of hyaline rings in an inflamed fibrous tissue background, which contains multinucleated giant cells. MATERIAL AND METHODS: We present the case of a 4-year-old boy diagnosed with a mandible osseous HRG, which showed clinical and tomographic aspects suggestive of an aggressive bone tumor. RESULTS: The patient underwent surgical exploration and histopathologic analysis showed fragments composed predominantly of widespread dense connective tissue with an acute and chronic inflammatory infiltrate containing multinucleated giant cells and scattered areas of eosinophilic material associated with hyaline rings, strongly suggestive of vegetable particles. The eosinophilic material was positive for periodic acid-Schiff (PAS) and resistant to diastase digestion. These features led to diagnosis of osseous HRG. Scanning electron microscopy (SEM) analysis was performed for illustrative purposes and the multiple structures resembling vegetable particles were characterized in more detail. CONCLUSIONS: Although rare, this case highlights the importance of the clinician's awareness regarding the existence of an osseous counterpart of HRG. Key words:Agenesis of the corpus callosum, child, hyaline ring granuloma, intraosseous, mandible, pulse granuloma.

Proliferative verrucous leukoplakia, squamous cell carcinoma and axillary metastasis

Proliferative verrucous leukoplakia (PVL) is an aggressive form of oral leukoplakia with multifocal presentation,high rates of recurrence and malignant transformation. Although development of regional lymph node metastasisis relatively frequent in patients with oral squamous cell carcinoma, axillary metastasis is quite uncommon. This paper presents a case of a 64-year-old female patient who was diagnosed with PVL and developed five oral squamouscell carcinomas and later an axillary lymph node metastasis (AU)

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Histopathological findings of pleomorphic adenomas of the salivary glands

Objectives: To describe the histopathological features of pleomorphic adenoma (PA) with special reference tothe epithelial and mesenchymal components. Study design: 189 PA were selected and classified as myxoid orstroma-rich, cellular or cell-rich and classic (balanced amount of epithelial and stromal components). The epithelialcomponent was analyzed according to the presence of plasmacytoid, spindle, clear, squamous, basaloid, cubic,oncocytoid and mucous cells and the morphological pattern (trabecular, ductal, cystic and solid). The stromalcomponent was analyzed according to the presence of myxoid, hyaline, chondroid or calcified tissue. Results:Plasmacytoid cells were the most commonly found cellular type followed by fusiform and cuboidal cells. Trabeculaeand duct-like structures were the most frequent patterns formed by the epithelial cells. Myxoid and chondroidstroma were the most frequently found mesenchymal-like tissue usually forming the so called myxochondroidstroma. Conclusion: The knowledge of the immense variety of cells, architectures and morphological characteristicspresent in PA of the salivary gland is essential for a correct diagnosis (AU)

Giant cell angiofibroma of the oral cavity: A case report and review of the literature

Giant cell angiofibroma is a well-circumscribed, normally encapsulated, distinctive orbital soft tissue tumor. However, it is now recognized that this lesion can also present in other locations, including the oral cavity. The morphological hallmark is a richly vascularized, patternless spindle cell proliferation containing pseudovascular spaces and floret-typemultinucleate giant cells. CD34 immunoreactivity, although not specific, represents the only immunohistochemical finding of potential diagnostic value. We present a case of a 44-year-old male Caucasian patient complaining of painless solitary nodule arising on the right buccal mucosa, which was diagnosed as giant cell angiofibroma. To the best of our knowledge, this is the third case of oral giant cell angiofibroma reported in the English-language literature

Oncocytic metaplasia in inflammatory fibrous hyperplasia: Histopathological and immunohistochemical analysis

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Oncocytic metaplasia (OM) is not a well-known feature in inflammatory fibrous hyperplasia (IFH) lesions, althoughit may be common, as proposed in our previous study about this lesion. In the present paper, we assessed the histopathological and immunohistochemical features of 18 cases of IFH containing OM areas. All the samples were examined on haematoxylin and eosin stained sections and cytokeratins (AE1/AE3, 34ßE12, CK5, CK7, CK8, CK13, CK14 and CK19), CD15, CD20, CD68, CD45Ro, and LCA primary antibodies were used. The vast majority of IFH occurredin women (n=14) and the most common site of presentation was the buccal vestibule. Oncocytic and salivary ductcells showed uniform immunoreactivity for AE1/AE3, CK7, CK8 and CK19. CD45Ro+ T-lymphocytes were the most common inflammatory cells surrounding the OM areas followed by CD20+ B-lymphocytes. These findings suggest that oncocytic cells present in IFH might develop from salivary duct epithelium, and T-lymphocytes mightplay an important role in its etiopathogenesis (AU)

Maxillary lesion presenting as a first sign of multiple myeloma: case report

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Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma(MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasmacells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amountsof monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is morefrequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urineexams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervoussystem dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in theearly diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generallypoor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxillathat prompted a MM diagnosis

Angiomiolipoma del labio superior: informe de caso y revisión de literatura / Angiomyolipoma of the upper lip: case report and review of the literature

El angiomiolipoma (AML) es un crecimiento tumoral hamartomatoso que usualmente afecta el riñón. Un tercio de los pacientes con AML cursan con manifestaciones de esclerosis tuberosa. El AML de la cavidad oral es raro y hasta la fecha se han reportado 6 casos en la literatura de habla inglesa. El presente caso constituye un AML localizado en el labio superior en una paciente de 43 años de edad. Clínicamente era un nódulo de 1x2cm., firme y bien circunscrito. Fue removido quirúrgicamente. El estudio histológico reveló una lesión compuesta por una mezcla de músculo liso, vasos sanguíneos y tejido adiposo. El análisis inmunohistoquímico reveló positividad para vimentina, actina alfa de músculo liso, pan-actina músculo específico y desmina. CD68, CD34 y anticuerpos anti-mastocitos mostraron inmunoreactividadfocal. Proteína S-100, Ki-67 y HMB-45 fueron negativos. Basados en estas características histológicas e inmunohistoquímicas se estableció el diagnóstico de AML oral. No se ha observado recurrencia 2 años después de su remoción

Angiomyolipoma (AML) is a hamartomatous growth that usually affects the kidney. One third of patients with AML present with manifestations of tuberous sclerosis. Oral AML is rare with only 6 cases reported in the English-language literature. In the present case, AML was located in the upper lip of a 43 year-old woman. Clinically, it presented as a firm nodule, well circumscribed and measuring 1x2 cm. It was surgically excised. Histopathological analysis showed a lesion composed of an admixture of smooth muscle cells, blood vessels, and adipose tissue. The immunohistochemical study revealed positivity for vimentin, smooth muscle actin, pan specific muscle actin and desmin. CD68, CD34 and mast cell antibodies showed focal immunoreactivity. S100 protein, Ki-67, and HMB-45 were negative. Based on these histological and immunohistochemical features the diagnosis was of oral AML. No recurrence was observed after 2 years of follow-up