Hidden colon adenocarcinoma diagnosed from mouth metastasis: case report and literature review.

BACKGROUND: We report an unusual case of metastatic colon adenocarcinoma to the maxilla as an initial clinical sign of the disease, this being the second case reported in the palate. In addition, we show an extensive review of the literature, with clinical cases of adenocarcinoma with metastasis to the mouth. CASE PRESENTATION: An 80-year-old man complained of "swelling on the palate" with a 3-week evolution time. He reported suffering from constipation and high blood pressure. The intraoral examination revealed a pedunculated, red, and painless nodule on the maxillary gingiva. Under the diagnostic hypotheses of squamous cell carcinoma and malignant neoplasm of the salivary gland, an incisional biopsy was performed. Microscopically, the columnar epithelium was observed forming papillary areas, neoplastic cells with prominent nucleoli, hyperchromatic nuclei, atypical mitotic figures, and mucous cells, being positive for CK 20, suggesting the provisional diagnosis of metastatic adenocarcinoma, probably of gastrointestinal origin. The patient was submitted to endoscopy and colonoscopy exams, and a lesion in the sigmoid region of the colon was observed. After a colon biopsy, a moderately differentiated adenocarcinoma was confirmed, establishing the final diagnosis of metastatic neoplasia of colon adenocarcinoma to the oral lesion. The literature review revealed 45 clinical cases of colon adenocarcinoma with metastasis to the oral cavity. To the best of our knowledge, it is the second case on the palate. CONCLUSIONS: Colon adenocarcinoma with metastasis to the oral cavity is rare but should be included in the differential diagnosis of neoplasms of the oral cavity, even when there are no known primary tumors in some cases, and this may be the first indication of the presence of a tumor.

Intraosseous neurilemoma of the mandible with unusual multilocular presentation: a case report.

This case report describes an intraosseous neurilemoma, observed radiographically as a multilocular lesion, in a 12-year-old patient. Physical examination revealed facial asymmetry, swelling on the right side of the mandibular body, and bone expansion in the region of the base of the buccal sulcus. Panoramic radiography revealed a multilocular radiolucency on the right side of the mandibular body in the periapical region extending from the distal region of the first premolar root to the second molar and adjacent to the third molar. Evaluation of a radiograph obtained 3 years earlier for an orthodontic assessment revealed that the lesion was present, appearing as a unilocular radiolucency near the root of the mandibular right first molar. An incisional biopsy of the multilocular lesion was performed, and Antoni A and Antoni B histologic patterns were identified by microscopic analysis. Immunohistochemical analysis was conducted, and neoplastic cells stained positive for the S-100 protein. The patient underwent conservative surgical excision of the lesion, and no recurrence was observed during 7 years of clinical follow-up. Based on analysis of the present case and previous cases reported in the literature, intraosseous neurilemoma, especially its multilocular variant, is an uncommon neoplasm. In the present case, evaluation of the lesion when it was first radiographically detectable, prior to orthodontic treatment, would have permitted a more limited surgical approach for the excision of a small intraosseous lesion.

Influence of Titanium Alloy Scaffolds on Enzymatic Defense against Oxidative Stress and Bone Marrow Cell Differentiation.

Studies have been directed towards the production of new titanium alloys, aiming for the replacement of Ti-6 Aluminium-4 Vanadium (TiAlV) alloy in the future. Many mechanisms related to biocompatibility and chemical characteristics have been studied in the field of implantology, but enzymatic defenses against oxidative stress remain underexplored. Bone marrow stromal cells have been explored as source of cells, which have the potential to differentiate into osteoblasts and therefore could be used as cells-based therapy. The objective of this study was to evaluate the activity of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT) in porous scaffolds of Ti-6 Aluminium-4 Vanadium (TiAlV), Ti-35 Niobium (TiNb), and Ti-35 Niobium-7 Zirconium-5 Tantalum (TiNbZrTa) on mouse bone marrow stromal cells. Porous titanium alloy scaffolds were prepared by powder metallurgy. After 24 hours, cells plated on the scaffolds were analyzed by scanning electron microscopy (SEM). The antioxidant enzyme activity was measured 72 hours after cell plating. Quantitative real time PCR (qRT-PCR) was performed after 3, 7, and 14 days, and Runx2 (Runt-related transcription factor2) expression was evaluated. The SEM images showed the presence of interconnected pores and growth, adhesion, and cell spreading in the 3 scaffolds. Although differences were noted for SOD and CAT activity for all scaffolds analyzed, no statistical differences were observed (p > 0.05). The osteogenic gene Runx2 presented high expression levels for TiNbZrTa at day 7, compared to the control group (TiAlV day 3). At day 14, all scaffolds had more than 2-fold induction for Runx2 mRNA levels, with statistically significant differences compared to the control group. Even though we were not able to confirm statistically significant differences to justify the replacement of TiAlV regarding antioxidant enzymes, TiNbZrTa was able to induce faster bone formation at early time points, making it a good choice for biomedical and tissue bioengineering applications.

Immediate placement of denture over undiagnosed ameloblastoma / Instalação de prótese total imediata sobre ameloblastoma não diagnosticado

Ameloblastoma is an odontogenic tumor that affects the bones of the jaw, often affecting posterior region of the mandible. It is a benign neoplasm and is frequently associated to an unerupted tooth. The purpose of this article is to report a case of failure in making an immediate full denture in a patient that had an ameloblastoma. A female patient aged 67 years complained of a hard swelling in the right mandible at the premolar region, that she noted after teeth extraction and confection of an immediate denture. Intraoral examination showed buccal and lingual cortical plate expansion and radiograph examination showed multilocular radiolucency with a well-defined margin. Aspiration was nonproductive and the provisional diagnosis was ameloblastoma. An incisional biopsy was performed and the histopathological report was conclusive of an acanthomatous ameloblastoma. The patient was sent for surgical excision of the lesion and after three years, the patient returned reporting that she was operated elsewhere in the past year and had an unsuccessful bone graft. She was sent to a prosthodontist to make a complete denture. In the present case the ameloblastoma was diagnosed only after the teeth extraction and immediate denture (AU)

O ameloblastoma é um tumor odontogênico que afeta os ossos maxilares, geralmente a região posterior de mandíbula. É uma neoplasia benigna frequentemente associada a um dente não irrompido. O objetivo deste artigo é relatar um caso de prótese total imediata confeccionada para uma paciente com ameloblastoma na região anterior da mandíbula. Paciente do sexo feminino, 67 anos, queixou-se de aumento de volume na região de pré-molares inferiores do lado direito após extração dentária e confecção de prótese total imediata. Ao exame clínico intrabucal foi observada expansão da cortical vestibular e lingual e o exame radiográfico revelou radiolucência multilocular com margem bem definida. A punção aspirativa não foi produtiva e o diagnóstico provisório foi de ameloblastoma. Foi realizada biópsia incisional e o laudo histopatológico foi conclusivo para ameloblastoma acantomatoso. A paciente foi encaminhada para ressecção cirúrgica da lesão e não retornou. Depois de três anos procurou atendimento e relatou que tinha sido submetida a cirurgia com colocação de enxerto ósseo para implante sem sucesso. O enxerto ósseo foi perdido e a paciente necessitava de nova prótese total. Ela foi encaminhada a um protesista. No presente caso, o diagnóstico de ameloblastoma foi feito somente após a instalação da prótese total imediata, quando a paciente notou aumento de volume (AU).

Effect of DLC Films with and without Silver Nanoparticles Deposited On Titanium Alloy.

Diamond-like carbon (DLC) film is a biocompatible hard coating material that can prevent the leaching of metal ions. This study evaluates the structural characteristics of DLC, with and without silver nanoparticles, deposited by plasma (PECVD) on titanium alloy (Ti-6Al-4V) and bone formation in contact with DLC films. Sixty Ti-6Al-4V samples were used divided in: uncoated, coated with DLC and coated with DLC-Ag. After structural characterization, samples were fixed bilaterally at the rabbit's mandible. After 15 and 90 days, samples were characterized again and bone formation in the area was analyzed by histomorphometry. Statistical analysis was performed by two-way ANOVA. Both the DLC and DLC-Ag films were firmly adhered and showed a high electrical resistance without significant changes in the Raman spectrum after in vivo integration. After 15 days, there were immature bone trabeculae in the interface and partially covering the surface. After 90 days, mature bone filled the interface and coved the surface. There was no statistically significant difference among the three groups in both periods. In conclusion, osseointegration with DLC, DLC-Ag and uncoated Ti-6Al-4V is similar. However, DLC and DLC-Ag coverings have the advantage of electrical insulation and can presumably control bacterial activity and ion leaching.

Vascular leiomyoma in the oral cavity - Report of two cases.

Vascular leiomyomas (VL) are benign lesions of perivascular origin. We report two new cases and discuss their clinical, histological and immunohistochemical characteristics, in order to facilitate the diagnosis and treatment of such lesions. The patients, both male, presented asymptomatic nodules located in the bottom of the labial sulcus and buccal mucosa. In the second case, color doppler ultrasonography was performed, which showed no change in blood flow. After excisional biopsies, a limited lesion was observed histologically, with multiple tortuous vessels of varying sizes and calibers, and among them, spindle cells bundles, positive for smooth muscle actin. Oral VLs have clinical features similar to those of other more common lesions, making preoperative diagnosis difficult. Imaging examination, such as color doppler ultrasonography, may help in diagnosis. In general, excisional biopsy is performed, due to the ease of removal of the lesion during surgery. The treatment of choice is the complete excision of the lesion, which has an excellent prognosis and a low rate of recurrence. Key words:Vascular leiomyoma, spindle cells, thrombus, Doppler.

Cyclosporine A - Induced gingival overgrowth and proliferating cell nuclear antigen expression in experimental periodontitis.

The most important microscopic characteristic of Cyclosporine A-induced gingival overgrowth is fibroepithelial hyperplasia. OBJECTIVE: The objective was to investigate the influence of previous exposure to Cyclosporine A over gingival epithelium in experimental periodontitis in rats. METHODS: Twenty Wistar rats with 12 weeks-old were divided into four groups with 5 animals each: Control Group (CG); Cyclosporine Group (CsAG); Ligature group (LG) and Cyclosporine and Ligature Group (CsALG). Daily doses of CsA (10 mg/kg) were applied to CsAG and CsALG during 60 days since the beginning of the experiment and, a ligature was placed in LG and CsALG 30 days after the beginning of the experiment. After 60 days, animals were euthanized and gingival tissue was processed to histomorphometric analysis of epithelial thickness (mm2), immunohistochemical expression of PCNA (%) and inflammatory response. Data were analyzed by Kruskal-Wallis and Mann Whitney at 0.05 significance level. RESULTS: Considering epithelial thickness, CG was thinner than all groups, CsALG was the largest and CsAG and LG were similar between each other. Regarding the PCNA expression CG (16.46 ± 9.26) was similar to CsAG (34.47 ± 19.75) and, LG (59.02 ± 10.33) was similar to CsALG (40.59 ± 18.25). Significant difference (p < 0.05) occurred only in inflammation presence comparing CG/LG and CsAG/CsALG. A weak positive correlation between the number of PCNA+ and inflammatory cells (p = 0.001; r = 0.611) was observed. CONCLUSION: Based on these results it was concluded that the enlargement of gingival epithelium observed in experimental periodontitis can be increased by previous exposition to CsA and inflammatory conditions enhanced proliferative activity of the keratinocytes.

In vitro and in vivo biological performance of porous Ti alloys prepared by powder metallurgy.

Titanium (Ti) and Ti-6 Aluminium-4 Vanadium alloys are the most common materials in implants composition but ß type alloys are promising biomaterials because they present better mechanical properties. Besides the composition of biomaterial, many factors influence the performance of the biomaterial. For example, porous surface may modify the functional cellular response and accelerate osseointegration. This paper presents in vitro and in vivo evaluations of powder metallurgy-processed porous samples composed by different titanium alloys and pure Ti, aiming to show their potential for biomedical applications. The porous surfaces samples were produced with different designs to in vitro and in vivo tests. Samples were characterized with scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and elastic modulus analyses. Osteogenic cells from newborn rat calvaria were plated on discs of different materials: G1-commercially pure Ti group (CpTi); G2-Ti-6Al-4V alloy; G3-Ti-13 Niobium-13 Zirconium alloy; G4-Ti-35 Niobium alloy; G5-Ti-35 Niobium-7 Zirconium-5 Tantalum alloy. Cell adhesion and viability, total protein content, alkaline phosphatase activity, mineralization nodules and gene expression (alkaline phosphatase, Runx-2, osteocalcin and osteopontin) were assessed. After 2 and 4 weeks of implantation in rabbit tibia, bone ingrowth was analyzed using micro-computed tomography (µCT). EDS analysis confirmed the material production of each group. Metallographic and SEM analysis revealed interconnected pores, with mean pore size of 99,5µm and mean porosity of 42%, without significant difference among the groups (p>0.05). The elastic modulus values did not exhibit difference among the groups (p>0.05). Experimental alloys demonstrated better results than CpTi and Ti-6Al-4V, in gene expression and cytokines analysis, especially in early experimental periods. In conclusion, our data suggests that the experimental alloys can be used for biomedical application since they contributed to excellent cellular behavior and osseointegration besides presenting lower elastic modulus.

Presence of mast cells and the expression of metalloproteinase 9 in the gingiva of ovariectomized rats with periodontal disease.

BACKGROUND: The host's answer has an important role in periodontal disease, and the mast cells have a prime role. Such cells seem to be influenced by estrogen deficiency. The objective was to evaluate the mast cells and the expression of metalloproteinase(MMP)-9 in periodontal disease induced in ovariectomized rats. METHODS: For that purpose, 36 rats were used; 18 ovariectomized (OVX) and another 18 Sham-operated (SHAM). After 60 days the periodontal disease was induced by a ligature around the first lower right molars (group P). The opposite side was the control group (group C). The euthanasia occurred 3, 7 and 14 days after the placement of the ligature. The gingiva was removed and analyzed histochemically and immunohistochemically to quantify the mast cells and to analyze MMP 9 expression. RESULTS: By comparing the groups SHAM-P and C and groups OVX-C and P, it was noted that mast cells from group C were higher than P in all experimental periods. When comparing groups SHAM-C and OVX-C, significant factors were not found. When comparing groups SHAM-P and OVX-P, there was an inclination for mast cells reduction with time. The MMP-9 expression was related to the presence of periodontitis. CONCLUSIONS: It was concluded that periodontitis led to mast cells reduction and MMP-9 increase. The ovariectomy itself did not alter the MMP-9 expression and did not influence the presence of mast cells in rat papilla, however, when associated to inflammation led to a reduction of mast cells.

The relationship between ras protein and odontogenic lesions / Relação entre a proteína ras e as lesões odontogênicas

Odontogenic lesions comprise a diverse group of lesions which usually affect the oral cavity and are derived from embryonic dental tissues. Their mechanisms of development and progression are still not fully known, but there are some studies investigating the participation of specific proteins in these events. Objective: The objective of this study was to investigate the expression of KRAS protein in these pathologies and also to associate the protein expression with the behaviour of the lesions studied. Material and Methods: Immunohistochemical analysis of 20 cases was performed for each one of the following lesions: dentigerous cyst (DC), odontogenic keratocyst (OKC) and ameloblastoma (AB), totalising 60 cases to be analysed. Results: By considering the KRAS immunoexpression, there were 11 cases (55%) presenting overexpression (score 3) in the basal layer of DC and 13 cases (65%) in the suprabasal layer. A similar finding was observed in the analysis of OKC, with eight cases (40%) in the suprabasal layer (score 3) and only five cases (25%) in the basal layer. As for AB, the overexpression was observed in six cases (30%). Conclusion: Therefore, it one suggests that the KRAS expression in odontogenic lesions is inversely proportional to their aggressive behaviour. (AU)

As lesões odontogênicas compreendem um grupo diversificado de lesões que comumente acometem a cavidade oral e são derivadas dos tecidos que originam o dente. Seus mecanismos de desenvolvimento e progressão ainda não são completamente conhecidos, porém alguns estudos investigam a participação de algumas proteínas específicas nesses eventos. Objetivo: O objetivo desse estudo foi investigar a expressão da proteína KRAS nestas patologias e associar a expressão proteica com o comportamento das lesões estudadas. Material e Métodos: A análise imuno-histoquímica foi realizada em 20 casos cada uma das lesões: cisto dentígero (CD), ceratocisto odontogênico (CO) e ameloblastoma (Am), totalizando 60 casos analisados. Resultados: Considerando-se a imunoexpressão de KRAS na camada basal do CD, 11 (55%) casos apresentaram hiperexpressão (score 3), já na camada suprabasal em 13 (65%) casos. Resultado semelhante foi observado na análise do CO, onde a camada suprabasal obteve 8 (40%) casos com score 3, enquanto a camada basal atingiu esse nível em apenas 5 (25%) casos. Em relação ao Am a hiperexpressão foi observada em 6 (30%) dos casos. Conclusão: Portanto, sugere-se que a expressão de KRAS nas lesões odontogênicas seja inversamente proporcional ao comportamento agressivo dessas lesões. (AU)

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report.

Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Chondroid Tenosynovial Giant Cell Tumor of the Temporomandibular Joint: A Rare Case Report

Abstract Tenosynovial giant cell tumor of diffuse type (TGCT-d) or pigmented villonodular synovitis (PVNS) is a locally aggressive lesion that mostly affects the joints of long bones. Chondroid tenosynovial giant cell tumor (CTGCT) or PVNS with chondroid metaplasia is a rare distinct subset of synovial tumors that has a predilection for the TMJ. We report a rare case of CTGCT in the TMJ, initially misdiagnosed as temporomandibular disorder (TMD). A 51-year-old woman was referred to the surgeon with the chief complaint of TMJ pain for 5 years and a past history of an unsuccessful TMD treatment. Extraoral examination revealed discrete preauricular swelling and restricted mandibular range of motion. Panoramic radiograph and computerized tomography showed destruction of the mandibular fossa and condyle. Histologically, the tumor was composed by large mononuclear cells with prominent eosinophilic cytoplasm and grooved nuclei, small histiocytoid cells, osteoclast-like multinucleated cells, brown pigmentation and areas of chondroid metaplasia. Morphological and immunohistochemical characteristics lead to the final diagnosis of CTGCT. The rarity of CTGCT could be attributed to the lack of recognition of this lesion, with cases diagnosed as chondroblastomas, synovial chodromatosis and chondrosarcoma. The patient received immediate reconstruction and recurrence was found 22 months after initial intervention. TGCT-d and CTGCT of the TMJ can present similar symptoms to TMD, but clinicians must distinguish both lesions by complete examination, imaging and, when necessary, histopathologic evaluation.

Resumo Tumor de células gigantes tenossinovial do tipo difuso (TCGT-d) ou sinovite vilonodular pigmentada (SVP) é uma lesão localmente agressiva que afeta principalmente as articulações dos ossos longos. Tumor de células gigantes tenossinovial condroide (TCGTC) ou SVP com metaplasia condroide é um tipo distinto e raro de tumor sinovial que tem a predileção pela articulação temporomandibular (ATM). Nós relatamos um caso raro de TCGTC da ATM, inicialmente diagnosticado, equivocadamente, como disfunção temporomandibular (DTM). Uma mulher de 51 anos foi encaminhada ao cirurgião com a queixa principal de dor na ATM por 5 anos, e uma história de tratamento de DTM sem sucesso. O exame extrabucal revelou discreto aumento de volume preauricular e movimentação mandibular restrita. A radiografia panorâmica e a tomografia computadorizada evidenciaram destruição da fossa mandibular e côndilo. Histologicamente, o tumor era composto por células mononucleares grandes, com amplo citoplasma eosinofílico e núcleo sulcado, pequenas células histiocitoides, células multinucleadas semelhantes a osteoclastos, pigmentação acastanhada e áreas de metaplasia condroide. As características morfológicas e imuno-histoquímicas levaram ao diagnóstico final de TCGTC. A raridade desta lesão pode estar associada ao seu não reconhecimento, sendo casos diagnosticados como condroblastoma, condromatose sinovial ou condrossarcoma. A paciente recebeu reconstrução imediata e recorrência foi observada 22 meses após a intervenção inicial. TCGT-d e TCGTC da ATM podem apresentar sintomas similares à DTM, mas os clínicos devem diferenciar ambas as lesões por meio do exame clínico completo, exames de imagem e, quando necessário, avaliação histopatológica.

Correlation of intratumoral lymphatic microvessel density, vascular endothelial growth factor C and cell proliferation in salivary gland tumors.

Lymphatic dissemination is one of the most important pathways for metastasis in many solid tumors, including head and neck carcinomas. The lymphatic growth of cancer has been used as a significant independent adverse prognostic factor and provides information about tumor progression. Salivary gland tumors present different prognoses and have the ability to develop metastases; however, this information regarding the lymphatic spread is scarce. This paper quantifies the lymphatic microvessel density (LMD) in benign and malignant salivary gland tumors and analyzes the relationship between LMD and tumor expression of vascular endothelial growth factors C (VEGF-C) and the proliferative index. The results show that there is no correlation between LMD, VEGF-C and the proliferative index in the majority of salivary gland tumors analyzed, apart from polymorphous low-grade carcinoma which exhibits statistical correlation between LMD and the proliferative index (p < 0.05). This correlation probably does not indicate a poor prognosis for this PLGA, since this is a low metastasizing carcinoma of the salivary glands. Different from other solid tumors, such as breast or prostatic carcinomas, there is no correlation between VEGF-C and LMD in salivary gland tumors, and so these traits are not able to estimate the metastatic risk or the prognosis of these tumors.

Effects of ovariectomy, estrogen and soy isoflavones in rats submandibular glands / Efeitos da ovariectomia, estrógeno e isoflavonas da soja em glândulas sumandibulares de ratos

Objetivo: Diminuição das células granulares do túbulo contorcido granular e dos ácinos ocorre nas glândulas submandibulares de ratas fêmeas ovariectomizadas, enquanto que nas ratas submetidas a reposição hormonal e fitoterapia com isoflavona da soja, este efeito é revertido. Este estudo tem como objetivo elucidar os mecanismos pelo qual estas alterações ocorrem. Material e Métodos: 84 ratas foram ovariectomizadas e 21 foram sham-operatadas. As ratas ovariectomizadas foram aleatoriamente subdivididas e receberam administração oral dos seguintes medicamentos: 17 ß-estradiol (OVX-E; n=21), 15 mg/ kg/day do extrato de isoflavona da soja (OVX-I; n=21), 17 ß-estradiol + extrato de isoflavona da soja (OVX-A; n=21); e água como placebo (OVX; n=21). As ratas foram eutanasiadas 3, 5 e 8 semanas após a ovariectomia. As glândulas submandibulares foram submetidas a análise histológica por meio do processamento histológico de coloração com HE e imunohistoquímica utilizando o complexo peroxidase-biotina-streptavidina. A área celular e a expressão do antígeno de proliferação celular nuclear e receptor ß estrogênico foram avaliados. Resultados: Os resultados foram estatisticamente analisados por meio do teste ANOVA e Tukey. Foi observada diminuição na área de células GCT cells no grupo OVX, em contraste com o aumento no grupoe OVX-E. PCNA nas células acinares e receptores de estrógeno estavam aumentados no grupo OVX-I. Conclusão: A castração exerce um efeito indutivo imediato no volume das células GCT. Estrógeno, isoflavona da soja e sua combinação têm diferentes mecanismos de ação sobre a homeostase da glândula. Estrógeno causa um aumento da área de células GCT, enquanto a isoflavona aumenta a proliferação celular e a expressão do receptor-ß de estrógeno. A associação destes não mostrou aumento adicional nos efeitos estudados (AU)

Objective: A decrease in granular convoluted tubule (GCT) cells and acini occurs in the submandibular glands of castrated female rats, while in rats submitted to hormone replacement and phytotherapy with soy isoflavones, this effect is reversed. This study aimed to elucidate the mechanisms through which these changes occur. Material and Methods: Rats (n=84) were ovariectomized and 21 were sham-operated. Ovariectomized rats were randomly subdivided and orally administered the following: 17 ß-estradiol (OVX-E; n=21), 15 mg/kg/day of soy isoflavone extract (OVX-I; n=21), 17 ß-estradiol + soy isoflavone extract (OVX-A; n=21); and water as placebo (OVX; n=21). The rats were euthanized three, five and eight weeks after ovariectomy. The submandibular salivary glands were submitted to histological processing with HE stain and immunohistochemistry was performed using the streptavidin-biotinperoxidase complex. The cell area and the expression of proliferating cell nuclear antigen and estrogen receptor ß were evaluated. Results: The results were statistically analyzed by ANOVA and Tukey test. A decrease in the area of GCT cells in the OVX, was observed, in contrast with an increase in the OVX-E. PCNA in the acinar cells and estrogen receptors were elevated in the OVX-I group. Conclusion: Castration exerts an immediate reductive effect on the volume of GCT cells. Estrogens, soy isoflavones and their combination have different mechanisms of action on the homeostasis of the gland. Estrogens cause an increase in GCT cells area, while isoflavones enhance cell proliferation and the expression of estrogen receptor-ß. Their association showed no additional increase in the effect studied. (AU)

Oral Adenosquamous Carcinoma Mimicking a Pyogenic Granuloma: a Challenging Diagnosis.

Adenosquamous carcinoma is an aggressive variant of squamous cell carcinoma. This report describes a case of adenosquamous carcinoma with clinical features of a benign lesion and discusses the differential diagnoses, especially regarding histopathological and immunohistochemical analyses. A 45-year-old male was referred to our outpatient clinic complaining about a rapid-growing enlargement in hard palate. Clinical examination revealed an erythematous and pedunculated nodule with lobulated non-ulcerated surface. Excisional biopsy was performed following clinical diagnosis of pyogenic granuloma. Histologically, the specimen consisted of areas characterizing both well-differentiated squamous cell carcinoma and true adenocarcinoma. After a broad list of immunohistochemical markers was evaluated (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 and Ki67), the diagnosis of adenosquamous carcinoma was rendered and the patient referred to complementary surgery. Adenosquamous carcinoma represents a challenge in diagnostic routine due to its rarity, diverse range of clinical presentations and histological features. Furthermore, classical clinical benign features may be present in malignant lesions; hence the submission of every surgical specimen to histological analysis is mandatory to provide the patient the adequate treatment.

Oral Adenosquamous Carcinoma Mimicking a Pyogenic Granuloma: a Challenging Diagnosis

Abstract Adenosquamous carcinoma is an aggressive variant of squamous cell carcinoma. This report describes a case of adenosquamous carcinoma with clinical features of a benign lesion and discusses the differential diagnoses, especially regarding histopathological and immunohistochemical analyses. A 45-year-old male was referred to our outpatient clinic complaining about a rapid-growing enlargement in hard palate. Clinical examination revealed an erythematous and pedunculated nodule with lobulated non-ulcerated surface. Excisional biopsy was performed following clinical diagnosis of pyogenic granuloma. Histologically, the specimen consisted of areas characterizing both well-differentiated squamous cell carcinoma and true adenocarcinoma. After a broad list of immunohistochemical markers was evaluated (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 and Ki67), the diagnosis of adenosquamous carcinoma was rendered and the patient referred to complementary surgery. Adenosquamous carcinoma represents a challenge in diagnostic routine due to its rarity, diverse range of clinical presentations and histological features. Furthermore, classical clinical benign features may be present in malignant lesions; hence the submission of every surgical specimen to histological analysis is mandatory to provide the patient the adequate treatment.

Resumo O carcinoma adenoescamoso é uma variante agressiva do carcinoma de células escamosas. Este relato descreve um caso de carcinoma adenoescamoso que apresenta características clínicas de uma lesão benigna e discute o diagnóstico diferencial, especialmente em relação à análise histopatológica e imuno-histoquímica. Um homem de 45 anos foi encaminhado ao nosso serviço queixando-se um aumento de volume de rápido crescimento no palato duro. O exame clínico revelou um nódulo eritematoso e pedunculado com superfície lobulada não ulcerada. Foi realizada biópsia excisional seguindo a hipótese clínica de granuloma piogênico. Histologicamente o fragmento consistia em áreas de carcinoma de células escamosas bem diferenciado e áreas de adenocarcinoma verdadeiro. Após a avaliação de uma ampla lista de marcadores imuno-histoquímicos (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 e Ki67), o diagnóstico de carcinoma adenoescamoso foi atribuído e o paciente foi encaminhado à cirurgia complementar. O carcinoma adenoescamoso representa um desafio na rotina de diagnóstico, devido à sua raridade, diversificada gama de apresentações clínicas e características histológicas. Além disso, características clínicas benignas podem estar presentes em lesões malignas, por isto a submissão de todas as peças cirúrgicas à análise histológica é obrigatória para fornecer ao paciente o tratamento adequado.

Graphite oral tattoo: case report.

Pigmented oral lesions compose a large number of pathological entities, including exogenous pigmentat oral tattoos, such as amalgam and graphite tattoos. We report a rare case of a graphite tattoo on the palate of a 62-year-old patient with a history of pencil injury, compare it with amalgam tattoos, and determine the prevalence of oral tattoos in our Oral Pathology Service. We also compare the clinical and histological findings of grafite and amalgam tattoos. Oral tattoos affect women more frequently in the region of the alveolar ridge. Graphite tattoos occur in younger patients when compared with the amalgam type. Histologically, amalgam lesions represent impregnation of the reticular fibers of vessels and nerves with silver, whereas in cases of graphite tattoos, this impregnation is not observed, but it is common to observe a granulomatous inflammatory response, less evident in cases of amalgam tattoos. Both types of lesions require no treatment, but in some cases a biopsy may be done to rule out melanocytic lesions.

Spindle Cell Lipoma Occurring in the Buccal Mucosa: An Unusual Location of This Benign Lipomatous Neoplasm.

Spindle cell lipoma is a benign lipomatous neoplasm, which rarely occurs in the oral cavity. The aims of this paper are to report a case of spindle cell lipoma located in buccal mucosa and discuss the main clinical, histological, and immunohistochemical findings of this entity. Thus, we report a 4-year history of an asymptomatic smooth surface nodule in an elderly Caucasian man with clinical hypothesis of fibroma. The histopathological examination showed spindle cells, mature adipose tissue, and many mast cells in a stroma of connective tissue presenting ropey collagen fibers bundles. After immunohistochemical analysis, the final diagnosis was spindle cell lipoma.

Porous titanium and Ti-35Nb alloy: effects on gene expression of osteoblastic cells derived from human alveolar bone.

Tests on titanium alloys that possess low elastic modulus, corrosion resistance and minimal potential toxicity are ongoing. This study aimed to evaluate the behavior of human osteoblastic cells cultured on dense and porous Titanium (Ti) samples comparing to dense and porous Ti-35 Niobium (Ti-35Nb) samples, using gene expression analysis. Scanning electronic microscopy confirmed surface porosity and pore interconnectivity and X-ray diffraction showed titanium beta-phase stabilization in Ti-35Nb alloy. There were no differences in expression of transforming growth factor-ß, integrin-ß1, alkaline phosphatase, osteopontin, macrophage colony stimulating factor, prostaglandin E synthase, and apolipoprotein E regarding the type of alloy, porosity and experimental period. The experimental period was a significant factor for the markers: bone sialoprotein II and interleukin 6, with expression increasing over time. Porosity diminished Runt-related transcription factor-2 (Runx-2) expression. Cells adhering to the Ti-35Nb alloy showed statistically similar expression to those adhering to commercially pure Ti grade II, for all the markers tested. In conclusion, the molecular mechanisms of interaction between human osteoblasts and the Ti-35Nb alloy follow the principal routes of osseointegration of commercially pure Ti grade II. Porosity impaired the route of transcription factor Runx-2.

An Isolated Phlebolith on the Lip: An Unusual Case and Review of the Literature.

Background. Calcified thrombi are a common finding, especially in the pelvic veins. There are generally multiple thrombi, and they are generally associated with vascular malformations. Design. Herein we report a rare case of a single labial phlebolith, not associated with any other vascular lesion. We aim to alert clinicians to the possibility of the occurrence of vascular thrombi in the mouth and to describe the clinical and histological characteristics of such lesions in order to simplify the diagnosis and treatment. Furthermore, we have reviewed the English-language literature published since 1970 reporting oral (including masticatory muscles) phleboliths. Results. Twenty-nine cases of phleboliths have been reported in the literature since 1970. Only three of the reported phleboliths were solitary and not associated with other vascular lesions, as in the case presented here. Conclusion. Although phleboliths not associated with other vascular lesions are not common, clinicians should be aware of the existence of this pathology and include it as differential diagnosis of oral lesions.