Barriers to early diagnosis and management of oral cancer in Latin America and the Caribbean.

OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.

Acquired oral syphilis: A multicenter study of 339 patients from South America.

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries.

Oral manifestations of Hydroa vacciniforme-like lymphoproliferative disorder: a clinicopathological study of a Peruvian population.

BACKGROUND: Hydroa vacciniforme-like lymphoproliferative disorder (HVLPD) is a chronic Epstein-Barr virus (EBV)-positive lymphoproliferative disease which may either present as an indolent condition or progress to a systemic T-cell lymphoma. METHODS: All HVLPD diagnosed over a 10-year period were retrieved, and clinical data regarding sex, age, oral and systemic manifestations, and clinical follow-up were obtained. Immunohistochemistry was done in order to characterize the lymphoid cells, and in situ hybridization was used to demonstrate the presence of EBV. RESULTS: Eleven cases were included, with a male predominance and a mean age of 25.1 years. Buccal mucosa and the lips were the most affected oral sites, appearing as painful ulcers. All patients exhibited facial oedema, usually affecting the lips, nose and periorbital region. The clinical course was gradual but progressive, with four patients having fever and 3 showing lymphadenopathies. All cases showed a moderate to severe lymphocytic infiltrate with angiotropism, angiocentricity and epidermotropism. Two cases affecting the lip skin exhibited a periappendageal lymphocytic infiltrate. Few large pleomorphic cells were found, surrounded by smaller and medium-sized lymphoid cells, as well as reactive plasma cells, macrophages, neutrophils and eosinophils. All lesions exhibited a cytotoxic T-cell (CD8+) phenotype with a variable proliferative index. All cases were associated with EBV, and all patients died due to complications of the disease. CONCLUSIONS: HVLPD is a rare disease that may show oral involvement with a cytotoxic T-cell phenotype, and is strongly associated with EBV. As shown in this series, HVLPD may show aggressive clinical behaviour.

Primordial odontogenic tumor: report of 2 new cases.

Primordial odontogenic tumor (POT) is a recently described benign odontogenic tumor, with only 16 cases reported in the literature. We present 2 new cases of POT affecting the mandible. Case 1 is that of 12-year-old girl with an asymptomatic, slow-growing mass, causing facial asymmetry. Radiography showed a well-defined unilocular radiolucency surrounding an impacted second premolar. Case 2 is that of a 13-year-old girl with a mass involving the crown of the unerupted third molar and showing similar radiographic features. Microscopically, both lesions were composed of variably cellular fibromyxoid tissue surrounded by thin ameloblastic epithelium, with stellate reticulum-like areas, but no mineralized tissue, yielding the diagnosis of POT. Immunohistochemical analysis showed diffuse expression of CK14 in epithelial cells, whereas CK19 was expressed mainly in the basal layer. Syndecan-1 (CD138) was expressed in the stellate-like regions and in the subepithelial zone. Both patients were treated surgically, with no signs of recurrence seen after 15 and 60 months, respectively.

Odontogenic Carcinosarcoma: Clinicopathologic Features of 2 Cases.

This study reports 2 odontogenic carcinosarcomas, including the clinicopathologic and immunoprofile characteristics of these rare tumors. The first case occurred in a 22-year-old male presenting a bilobular mass involving the gingiva and bone of the premolar region of the left mandible, with paresthesia of the lower lip. Microscopic examination revealed a tumor similar to ameloblastic fibrosarcoma, with atypical mesenchymal cells; however, the odontogenic epithelium also showed atypia. In the second case, a 16-year-old female had a painless, asymptomatic, large intraosseous mandibular lesion. The patient received radiotherapy to treat a rhabdomyosarcoma of the parotid 13 years before. The tumor was composed of atypical spindle cells, positive for vimentin and smooth muscle actin, intermingled with malignant odontogenic epithelium. Both epithelial and mesenchymal components of the tumors showed high index of p53- and Ki67-positive cells. The first case was diagnosed as odontogenic carcinosarcoma possibly originated from an ameloblastic fibrosarcoma, and the second as de novo odontogenic carcinosarcoma possibly caused by previous radiotherapy.

Leiomyomatous Hamartomas of the Oral Cavity: Clinicopathological and Immunohistochemical Features of 4 Cases and Literature Review.

Objective. To present 4 new cases of oral leiomyomatous hamartomas (OLH), describing its clinical, microscopical, and immunohistochemical features, and a literature review. Methods. The OLH cases were retrieved from the files of 2 Brazilian and 1 Peruvian oral pathology services. Clinical data were obtained from the pathology reports. Microscopical features were reviewed, and immunohistochemical reactions were performed. A review of the English-language literature about OLH was done. Results. The sample was composed of 3 females (4-, 10-, and 15-year-old) and 1 male (3-year-old). Three cases affected the dorsum of the tongue and one the incisive papilla, and all presented sessile or pedunculated smooth nodules. Microscopically, the lesions were composed of varying-size fascicles of smooth muscle fibers in a fibrous connective tissue background. Immunohistochemistry revealed positivity of the smooth muscle bundles for myogenic markers. The English-language literature review revealed 38 OLH cases reported, most were congenital or diagnosed up to 5 years old. The main locations were tongue and anterior maxilla. Conclusions. Although OLH is a rare lesion, it must be considered in the differential diagnosis of midline tongue or maxillary masses in newborns, infants, and youngsters.

Comparison of fatty acid synthase and cyclooxygenase-2 immunoexpression in embryonal, benign, and malignant odontogenic tissues.

OBJECTIVES: The aim of this study was to analyze the immunohistochemical expression of fatty acid synthase (FASN) and cyclooxygenase-2 (COX-2) in tooth germ (TG), ameloblastoma (AM), ameloblastic carcinoma (AC), ameloblastic fibroma (AF), and ameloblastic fibrosarcoma (AFS). STUDY DESIGN: Immunohistochemistry for FASN and COX-2 was performed in 10 TG, 44 AM, 10 AC, 9 AF, and 5 AFS specimens. The results were analyzed by using the immunoreactive score (IRS) and Kruskal-Wallis test followed by Dunn's post-test. RESULTS: Most TG specimens were strongly positive for FASN, whereas COX-2 was weak or negative. All AM and AC specimens expressed both proteins. In AF specimens, FASN and COX-2 were variably expressed in the epithelium and negative in the mesenchyme. In AFS specimens, FASN was strongly positive in the malignant mesenchyme and variable in the epithelium; COX-2 was focal or weak in both components. FASN expression showed significant differences in the following comparisons: TG vs AC, AM vs AC, and AF vs AFS. Differences in COX-2 were significant when comparing TG specimens with AM, AC, and AF specimens. CONCLUSIONS: The results suggest that FASN and COX-2 overexpression may have a role in the pathogenesis of AM and AC, whereas in AFS, FASN seems to be mainly involved. Further studies are necessary to clarify these mechanisms and their clinical implications.

Coronectomy - An alternative approach to remove impacted teeth in oncological patients.

BACKGROUND: Coronectomy involves the section of the tooth crown leaving the roots in the socket. Possibility of inferior alveolar nerve injury and mandibular fracture are the main indications for this approach. Herein, we describe a case series of coronectomy to highlight its indication in normal and oncological patients. MATERIAL AND METHODS: A total of 9 patients were submitted to coronectomy, 6 of them were oncological. Three patients were evaluated before head and neck radiotherapy (HNRT), 2 after HNRT and 1 before bone marrow transplantation. RESULTS: Mean age of the patients was 49 years, most of them male (n=7). Lower third molars were the main teeth that received this procedure, and all cases presented intimate anatomic relationship between the roots and the mandibular canal. Moreover, three cases also presented evident mandibular fracture risk in removing the tooth. During the follow-up period, none complications were observed related to coronectomy and oncological treatment. CONCLUSIONS: Coronectomy is a safe approach including for cancer patients and it should be considered in high-risk impacted teeth extractions. Key words:Coronectomy, impacted teeth, oncological patients, postoperative complications.

Comparative histological and immunohistochemical study of ameloblastomas and ameloblastic carcinomas

BACKGROUND: This study aimed to compare the histological and immunohistochemical characteristics of ameloblastomas (AM) and ameloblastic carcinomas (AC). MATERIAL AND METHODS: Fifteen cases of AM and 9 AC were submitted to hematoxilin and eosin (H&E) and immunohistochemical analysis with the following antibodies: cytokeratins 5,7,8,14 and 19, Ki-67, p53, p63 and the cellular adhesion molecules CD138 (Syndecan-1), E-cadherin and β-catenin. The mean score of the expression of Ki-67 and p53 labelling index (LIs) were compared between the groups using the t test. A value of p < 0.05 was considered to be statistically significant. RESULTS: All cases were positive for CKs 5, 14 and 19, but negative for CKs 7 and 8. CKs 5 and 19 were positive mainly in the central regions of the ameloblastic islands, while the expression in AC was variable in intensity and localization. CK14 was also variably expressed in both AM and AC. Ki-67 (P=.001) and p53 (P=.004) immunoexpression was higher in AC. All cases were positive for p63, but values were higher in AC. CD138 was mainly expressed in peripheral cells of AM, with a weak positivity in the central areas, while it was positive in most areas of ACs, except in less differentiated regions, where expression was decreased or lost. E-cadherin and β-catenin were weakly positive in both AM and AC. CONCLUSIONS: These results shows that Ki-67, p53 and p63 expression was higher in AC as compared to AM, suggesting that these markers can be useful when considering diagnosis of malignancy, and perhaps could play a role in malignant transformation of AM. Pattern of expression of CKs 5 and 19 in AC were different to those found in AM, suggesting genetic alterations of these proteins in malignant cells. It was confirmed that CK19 is a good marker for benign odontogenic tumors, such as AM, but it is variably expressed in malignant cases

Immunohistochemical expression of cyclooxygenase-2 (COX-2) in oral nevi and melanoma.

BACKGROUND: Cyclooxygenase-2 (COX-2) catalyses the conversion of arachidonic acid to prostaglandin, and its overexpression has been demonstrated in different malignant tumors, including cutaneous melanoma. However, no data about the expression of this protein in oral melanocytic lesions are available to date. The aim of this study was to evaluate the immunohistochemical expression of COX-2 in oral nevi and melanomas, comparing the results with correspondent cutaneous lesions. METHODS: COX-2 was evaluated by immunohistochemistry in 49 oral melanocytic lesions, including 36 intramucosal nevi and 13 primary oral melanomas, and in four cutaneous nevi and eight melanomas. RESULTS: All cases of oral and cutaneous melanomas were positive for COX-2. On the other hand, all oral and cutaneous melanocytic nevi were negative. CONCLUSION: COX-2 is highly positive in oral melanomas and negative in oral nevi and might represent a useful marker to distinguish melanocytic lesions of the oral cavity.

Primary intraosseous squamous cell carcinoma arising in an odontogenic keratocyst previously treated with marsupialization: case report and immunohistochemical study.

A rare case of primary intraosseous squamous cell carcinoma arising in an odontogenic keratocyst (OKC) is presented here, with the clinical and histologic features of the first biopsy showing characteristics of OKC and the second biopsy disclosing a squamous cell carcinoma. Immunoprofile of this case was compared with five cases of classical OKC by using cytokeratins CK5, CK14, and CK19, CD138, p63, Ki-67, p53, and bcl-2. Classic OKCs showed expected positivity, mainly in the basal and/or suprabasal layers with most antibodies, except for p53, which was negative, whereas the present case showed irregular positivity in all layers, indicating that this can be useful for differential diagnosis and suggesting a possible role in malignant transformation into primary intraosseous squamous cell carcinoma. In conclusion, immunohistochemical differences between the first biopsy of the present case and classic OKC suggest that immunohistochemistry can be helpful in cases with areas of subtle initial malignant transformation.

Oral helminthic infestations.

Oral infections caused by helminths (worms) are rarely encountered in clinical practice, and consequently, there is a paucity of information in the medical and dental literature about these conditions. In the present article, we review the English literature related to oral helminthic infestations. The main oral infections caused by helminths include four roundworm (trichinosis, trichuriasis, filariasis, and larva migrans) and three tapeworm infections (cysticercosis, sparganosis, and echinococcosis). Cases are mainly encountered in endemic areas and mainly present a benign clinical picture. The diagnosis of oral helminthic infections is mostly established after histopathological examination, which shows parasitic larvae lined by fibrous tissue and inflammatory cells. Surgical excision is the preferred treatment of isolated oral lesions caused by helminths; however, patients should undergo thorough medical evaluation to exclude the possible involvement of other body systems.

Evaluación mediante radiología, tomografía computarizada y resonancia magnética de un ameloblastoma sólido. Reporte de un caso / Evaluation of a solid ameloblastoma using radiology, computed tomography and magnetic resonance imaging. A case report

De acuerdo con la Organización Mundial de la Salud (OMS), el ameloblastoma es un tumor odontogénico benigno, siendo una de sus variantes intraóseas más frecuentes el ameloblastoma sólido o multiquístico, el cual tiene un comportamiento local agresivo por su capacidad de alcanzar grandes dimensiones y desplazar estructuras anatómicas vecinas. Se reporta el caso de un paciente masculino que presentaba un ameloblastoma sólido en la mandíbula, de 7 años de evolución, que producía marcada asimetría facial y limitación de la función de la zona anatómica afectada. Debido a las dimensiones de la lesión, se utilizaron diversas técnicas imaginológicas con la finalidad de contribuir en el diagnóstico, determinar la extensión de la lesión y planificar el tratamiento. Se presenta una revisión de la literatura sobre tomografía computarizada (TC) e imagen por resonancia magnética (IRM) del ameloblastoma, cuyo objetivo es contribuir a definir sus características imaginológicas. Se enfatiza la importancia de estas técnicas de imagen modernas en el proceso de diagnóstico, planificación del tratamiento quirúrgico y el seguimiento a largo plazo de esta patología...

According to the World Health Organization (WHO) ameloblastoma is a benign odontogenic tumor. The most frequent intraosseous variety is the solid or multicystic ameloblastoma, which exhibits a locally aggressive behavior due to its potential to reach large dimensions and displace adjacent anatomic structures. We report a case of mandibular solid ameloblastoma in a 33 year old male, with an evolution time of 7 years. The lesion produced marked facial asymmetry as well as functional limitations of the involved anatomical areas. Given the dimensions of the tumor, proper imaging techniques were used to assist the diagnosis, determine the extent of the lesion and guide treatment planning. A review of the literature regarding the characteristics of the solid ameloblastoma in computed tomography and magnetic resonance imaging is presented in order to better understand its imaging features. The value of these modern imaging techniques in diagnosis, surgical treatment planning and the long term follow up of this lesion is emphasized...

Immunohistochemical expression of Skp2 protein in oral nevi and melanoma

Objective: The aim of this study was to analyze the immunohistochemical expression of Skp2 protein in 38 oralnevi and 11 primary oral melanomas. Study Design: Expression of this ubiquitin protein was evaluated by immunohistochemistry in 49 oral melanocyticlesions, including 38 intramucosal nevi and 11 primary oral melanomas. The labeling index (LI) was assessed considering the percentage of cells expressing nuclear positivity out of the total number of cells, counting1000 cells per slide. Results: Skp2 protein was rarely expressed in intramucosal nevi, in contrast to oral melanomas, which showedhigh levels of this protein. Conclusion: These results indicate that Skp2 protein may play a role in the development and progression of oral melanomas, and it also could be useful as an immunohistochemical marker for differential diagnosis of oral benign and malignant melanocytic lesions (AU)

Immunohistochemical expression of Skp2 protein in oral nevi and melanoma.

OBJECTIVE: The aim of this study was to analyze the immunohistochemical expression of Skp2 protein in 38 oral nevi and 11 primary oral melanomas. STUDY DESIGN: Expression of this ubiquitin protein was evaluated by immunohistochemistry in 49 oral melanocytic lesions, including 38 intramucosal nevi and 11 primary oral melanomas. The labeling index (LI) was assessed considering the percentage of cells expressing nuclear positivity out of the total number of cells, counting 1000 cells per slide. RESULTS: Skp2 protein was rarely expressed in intramucosal nevi, in contrast to oral melanomas, which showed high levels of this protein. CONCLUSION: These results indicate that Skp2 protein may play a role in the development and progression of oral melanomas, and it also could be useful as an immunohistochemical marker for differential diagnosis of oral benign and malignant melanocytic lesions.

Expression of minichromosome maintenance 2, Ki-67, and geminin in oral nevi and melanoma.

Evaluation of cell cycle using antibodies against nuclear proteins involved in regulating DNA replication has gained special interest in the effort to predict biologic behavior of benign and malignant tumors. The aim of this study was to analyze the expression of minichromosome maintenance 2, Ki-67, and geminin in oral nevi and melanomas. Expression of these cell proliferation markers was evaluated by immunohistochemistry in 49 oral melanocytic lesions, including 38 intramucosal nevi and 11 primary oral melanomas. The labeling index of each proliferation marker was assessed considering the percentage of cells expressing nuclear positivity out of the total number of cells, counting 1000 cells per slide. Minichromosome maintenance 2, Ki-67, and geminin were rarely expressed in intramucosal nevi, in contrast to oral melanomas, which showed high levels of these cell proliferation markers, particularly minichromosome maintenance 2, indicating it is a more sensitive marker in primary oral melanomas than Ki-67 and geminin. These results indicate that these markers may be involved in the pathogenesis of oral melanomas and could be eventually useful as an additional diagnostic tool for differential diagnosis of oral benign and malignant melanocytic lesions.

Reconstrucción mandibular con combinación de injertos autólogos libres e instalación de implantes dentales: Reporte de Caso / Mandibular Reconstruction with autologous grafts combination and installation of dental implants: Case repor

Entre los tumores mandibulares, destacamos el ameloblastoma como una patología frecuente en el área maxilofacial, descrito como un crecimiento local persistente, agresivo e invasivo con potencial de recidiva considerable, por lo que la integración clínica, imaginológica e histopatológica histopatológica nos dirige a establecer diagnósticos para definir el tratamiento quirúrgico. Con el conocimiento de técnicas quirúrgicas maxilofaciales, indicadas para la ablación de tumores en el Maxilar inferior empleamos la mandibulectomía parcial o segmentaria con reconstrucción inmediata y posterior rehabilitación con implantes, demostrando efectividad en el tratamiento. La combinación de injertos autólogos ofrece: contención y estabilidad que da la cortical externa de calota craneana hacia el particulado de cresta ilíaca, y el volumen óseo obtenido es brindado por el injerto particulado para facilitar la instalación de implantes.

Among the tumors mandibular ameloblastoma highlighted as a common pathology in the maxillofacial area, described as a persistent local l growth, aggressive and invasive with significant potential for recurrence, so that clinical integration, imagiologic and histopathologic diagnoses directs us to define surgical treatment. With knowledge of maxillofacial surgical techniques, indicated for ablation of tumors in the lower jaw used the partial or segmental mandibulectomy with immediate reconstruction with implants and subsequent rehabilitation, demonstrating effectiveness in treatment. The combination of autologous grafts provides: containment and stability which gives the particulate calvaria into the iliac crest bone volume obtaining suitable for the installation of the implant provided by particulate graft.

Seguimiento de un fibroma ameloblástico con transformación maligna a fibrosarcoma ameloblástico / Ameloblastic fibroma with a malignant transformation to ameloblastic fibrosarcoma

La transformación maligna de un tumor odontogénico es poco común y puede desarrollarse a partir de un tumor odontogénico benigno. Se presenta el caso de una paciente de sexo femenino de 19 años de edad, con el seguimiento secuencial de las radiografías y tomografía computarizada de una lesión inicialmente diagnosticada como Ameloblastoma, que posterior al tratamiento quirúrgico se establece como Fibroma ameloblastico y al cabo de seis años sufre una transformación maligna determinado con un diagnostico histológico a Fibrosarcoma ameloblastico. El objetivo del presente reporte es exponer un caso que llego al Servicio de Medicina, Cirugía y Patología Oral de la Universidad Peruana Cayetano Heredia donde se recopilo los datos de la historia médica con los estudios de imágenes.

Malignant transformation of an odontogenic tumor is rare and can develop from a benign odontogenic tumor. We report the case of a female patient of 19 years old, with tracking sequential radiographs and CT scan of a lesion initially diagnosed as ameloblastoma, after surgical treatment that is established as ameloblastic fibroma, six years after malignant transformation occurs with a histologic diagnosis given to ameloblastic fibrosarcoma. The objective of this report is to present this case to be referred to the Department of Medicine, Surgery and Oral Pathology, Peruvian University Cayetano Heredia where collected data on medical history with imaging studies.

Immunohistochemical expression of p16, p21, p27 and cyclin D1 in oral nevi and melanoma.

The acquisition of abnormalities at G1/S is considered a crucial step in the genesis and progression of melanoma. The expression of cell cycle regulators has also been used in various neoplasms as an adjunct to diagnosis. The aim of this study was to compare the expression of p16, p21, p27 and cyclin D1 in oral nevi and melanomas. Expression of these cell cycle regulatory proteins was evaluated by immunohistochemistry in 51 oral melanocytic lesions, including 38 intramucosal nevi and 13 primary oral melanomas. p16 and p27 were highly expressed in intramucosal nevi, whereas p21 and cyclin D1 expression was higher in oral melanomas. The results indicate that p21 and cyclin D1 may be involved in the development of oral melanomas, and eventually they may be useful in the differential diagnoses of oral benign and malignant melanocytic lesions.