Global prevalence of human papillomavirus-related oral and oropharyngeal squamous cell carcinomas: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review to determine the global prevalence of HPV in oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS: Literature was searched through October 2022 in main databases to address the question "What is the global prevalence of Human Papillomavirus in oral and oropharyngeal cancer?" Studies had to identify HPV by PCR, ISH, or p16 immunohistochemistry to be eligible. Quality was assessed using the JBI checklist for prevalence studies. Meta-analyses were performed, and reporting followed PRISMA guidelines. RESULTS: Sixty-five studies were included, and most of them had methodological limitations related to sampling and the HPV detection tool. The pooled prevalence of HPV-positivity was 10% (event rate = 0.1; 95% CI: 0.07, 0.13; P < 0.01; I2 = 88%) in the oral cavity and 42% (event rate = 0.42; 95% CI: 0.36, 0.49; P = 0.02; I2 = 97%) in oropharynx. The highest HPV prevalence in OSCC was reached by Japan, meanwhile, in OPSCC, Finland and Sweden were the most prevalent. HPV16 is the genotype most frequent with 69% in OSCC and 89% in OPSCC, being the tonsils the intraoral location more affected by HPV (63%, p < 0.01, I2 76%). CONCLUSION: The evidence points to an apparent burden in HPV-related OPSCC, mostly in North America, Northern Europe, and Oceania, especially due to the HPV16 infection suggesting different trends across continents. CLINICAL RELEVANCE: This updated systematic review and meta-analysis provide sufficient evidence about the global HPV prevalence in OSCC and OPSCC and the most frequent HPV subtype worldwide.

Clinicopathological Features of Metastasis to the Oral and Maxillofacial Region-Multicenter Study.

BACKGROUND: This study aimed to investigate the clinicopathological features of metastases in the oral and maxillofacial regions. METHODS: In this retrospective study, biopsy records were obtained from referral centers for oral and maxillofacial diagnosis in Brazil, Guatemala, Mexico, and South Africa. RESULTS: A total of 120 cases were evaluated. Of these, 53.78% affected female patients, with a mean age of 57.64 years. Intraosseous lesions were more frequent, particularly in the posterior region of the mandible (49.58%). Clinically, most cases presented with symptomatic swelling, with an average evolution time of 25 months. The clinical diagnostic hypothesis in most instances was that of a malignant lesion. Breast cancer was the most common primary tumor location in females, while lung origin was most common in males. In most cases, the primary cancer was an adenocarcinoma (44.73%). The follow-up period was available for 29 cases, and out of these, 20 had died due to the disease. CONCLUSION: Although this is a rare condition, clinicians should be aware that any oral lesions have the possibility of being metastatic, particularly in individuals with a previous history of cancer. The findings from this study could assist clinicians in prompt diagnosing these lesions and subsequent conducting oncologic assessments and treatment.

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Human Papillomavirus-Associated Oral Epithelial Dysplasia: Report of 5 Illustrative Cases from Latin America.

BACKGROUND: Human papillomavirus-associated oral epithelial dysplasia (HPV-OED) is a distinct oral epithelial disorder characterized by viral cytopathic changes caused by transcriptionally active high-risk HPV. The aim of the present study was to report 5 additional cases from Latin America. METHODS: Clinical data from five patients with HPV-OED were obtained from the archives of three oral pathology services from Brazil and Chile. All cases were submitted to morphological, p16 expression and in situ hybridization (ISH) for HPV analyses. RESULTS: Four patients were male and one patient was female, with a mean age of 55.4 years. Four patients were HIV seropositive and two were smokers. Three cases affected the buccal mucosa and commissure, one of which had an additional plaque in the soft palate, and one case each occurred on the floor of mouth and lower labial mucosa. Most cases presented as well-demarcated white plaques with a verrucous surface. One case presented multiple lesions ranging from normal to white-colored slightly elevated plaques with a cobblestone surface. Peripheral mucosal pigmentation was observed in two cases. All five cases presented with the characteristic microscopic features of HPV-OED, including severe dysplasia with numerous karyorrhectic and apoptotic cells, full-thickness "block positivity" for p16 and high Ki-67 index (> 90%) sharply demarcated from the adjacent non-dysplastic epithelium. Wide-spectrum DNA ISH-HPV was positive in 4 cases. All patients were treated with conservative surgical excision with no signs of recurrence after a mean of 39-month follow-up. CONCLUSION: This represents the first series of HPV-OED from Latin America; most cases presented as well-demarcated papillary white plaques affecting the buccal mucosa and commissure of HIV-positive middle-aged men, two of them exhibiting peripheral pigmentation caused by reactive melanocytes. The typical microscopic findings of HPV-OED were observed in all cases, which also showed strong p16 positivity in a continuous band through the full thickness of the epithelium and high Ki67.

Low-Grade Myofibroblastic Sarcoma of the Oral and Maxillofacial Region: An International Clinicopathologic Study of 13 Cases and Literature Review.

Low-grade myofibroblastic sarcoma (LGMS) represents an atypical tumor composed of myofibroblasts with a variety of histological patterns and with a high tendency to local recurrence and a low probability of distant metastases. LGMS has predilection for the head and neck regions, especially the oral cavity. This study aimed to report 13 new cases of LGMS arising in the oral and maxillofacial region. This study included LGMS cases from five oral and maxillofacial pathology laboratories in four different countries (Brazil, Peru, Guatemala, and South Africa). Their clinical, radiographic, histopathological, and immunohistochemical findings were evaluated. In this current international case series, most patients were females with a mean age of 38.7 years, and commonly presenting a nodular lesion in maxilla. Microscopically, all cases showed a neoplasm formed by oval to spindle cells in a fibrous stroma with myxoid and dense areas, some atypical mitoses, and prominent nucleoli. The immunohistochemical panel showed positivity for smooth muscle actin (12 of 13 cases), HHF35 (2 of 4 cases), ß-catenin (3 of 5 cases), desmin (3 of 11 cases), and Ki-67 (range from 5 to 50%). H-caldesmon was negative for all cases. The diagnosis of LGMS was confirmed in all cases. LGMS shows predominance in young adults, with a slight predilection for the female sex, and maxillary region. LGMS should be a differential diagnosis of myofibroblastic lesions that show a proliferation of spindle cells in a fibrous stroma with myxoid and dense areas and some atypical mitoses, supporting the diagnosis with a complementary immunohistochemical study. Complete surgical excision with clear margins is the treatment of choice. However, long-term follow-up information is required before definitive conclusions can be drawn regarding the incidence of recurrence and the possibility of metastasis.

Can SARS-CoV-2 screening in oral biopsies aid epidemiological surveillance?

BACKGROUND: Three years after the first confirmed COVID-19 case in Brazil, the outcomes of Federal government omissions in managing the crisis and anti-science stance heading into the pandemic have become even more evident. With over 36 million confirmed cases and nearly 700 000 deaths up to January 2023, the country is one of the hardest-hit places in the world. The lack of mass-testing programs was a critical broken pillar responsible for the quick and uncontrolled SARS-CoV-2 spread throughout the Brazilian population. Faced with this situation, we aimed to perform the routine SARS-CoV-2 screening through RT-qPCR of oral biopsies samples to aid in the asymptomatic epidemiological surveillance during the principal outbreak periods. METHODS: We analyzed 649 formalin-fixed paraffin-embedded oral tissue samples from five important oral and maxillofacial pathology laboratories from the north, northeast, and southeast geographic regions of Brazil. We also sequenced the whole viral genome of positive cases to investigate SARS-CoV-2 variants. RESULTS: The virus was detected in 9/649 analyzed samples, of which three harbored the Variant of Concern Alpha (B.1.1.7). CONCLUSION: Although our approach did not value aiding asymptomatic epidemiological surveillance, we could successfully identify a using FFPE tissue samples. Therefore, we suggest using FFPE tissue samples from patients who have confirmed diagnosis of SARS-CoV-2 infection for phylogenetic reconstruction and contraindicate the routine laboratory screening of these samples as a tool for asymptomatic epidemiological surveillance.

Epithelial Dysplasia in Actinic Cheilitis: Microscopic Study of 70 Cases from Brazil.

To compare two grading systems of epithelial dysplasia-World Health Organization (WHO) and binary system (BS) -in actinic cheilitis (AC). Seventy cases diagnosed as AC in an Oral Pathology Laboratory from Brazil in the last 12 years were retrospectively retrieved, including the demographic data of each patient. All conventionally stained slides were reviewed, and epithelial dysplasia was evaluated by two independent observers using both WHO and BS grading systems. Data correlation was performed using kappa and chi-square tests (p < 0.05). Most patients were white men with a mean age of 57 years old and history of chronic exposure to sunlight. Most of the lesions were clinically described as whitish plaques with irregular surface located in the lower lip semi-mucosa. Most cases were microscopically graded as severe epithelial dysplasia and low-risk by both observers. The interobserver and intraobserver agreement between systems was slight. All reddish lesions were graded as severe epithelial dysplasia, showing an equal distribution between low and high-risk grading. Most ulcerated lesions showed severe epithelial dysplasia but was graded as low-risk of malignant transformation. Statistical significance was observed among the presence of "irregular stratification", severe epithelial dysplasia and high-risk lesions (p < 0.05) likewise among the presence of "loss of polarity of basal cells" and "drop-shaped ridges" (p < 0.05) with high-risk lesions. The absence of "increased mitotic figures", "dyskeratosis" and "keratin pearls" (p < 0.05) were strongly correlated to low-risk lesions. The presence of "hyperchromasia" was statistically significant with severe epithelial dysplasia (p < 0.05) as well the absence of "atypical mitotic figures" with low-risk lesions (p < 0.05). Although there was slight agreement between microscopic grading systems, microscopic analysis indicated that architectural epithelial changes individually may be the more reliable criteria to indicate the risk of malignant transformation in AC in both grading systems.

Análise imuno- histoquímica das proteínas BRCA1 e Acetil Histona H3 no carcinoma de células escamosas oral / Immunohistochemical analysis of BRCA1 and Acetyl Histone H3 proteins in oral squamous cell carcinoma

O carcinoma de células escamosas da região de cabeça e pescoço é o 4° tipo de câncer mais comum em homens no mundo. A Carcinogênese oral é caracterizada por uma heterogeneidade clínica, patológica e biológica, gerando instabilidade genômica e ocasionando a progressão e desenvolvimento de uma desordem potencialmente maligna. O mecanismo DDR (DNA damage response) age como um mecanismo de autodefesa responsável pela manutenção da integridade da cromatina. Sua eficácia é dependente de seu acesso ao local do dano pelas proteínas envolvidas no processo, como as histonas (proteínas que compõem os nucleossomos e que auxiliam no desempacotamento da cromatina). O desequilíbrio da acetilação e deacetilação das histonas em regiões promotoras contribui para a desregulação da expressão gênica e tem sido associado à carcinogênese e à progressão do câncer. O mecanismo DDR é composto por diversas vias de sinalização interconectadas, como as vias do BRCA1. A proteína BRCA1 regula a transcrição, o remodelamento da cromatina, a ubiquitinação e o reparo da quebra de fita dupla de DNA, entre outras funções. Sua identificação tem sido relacionada à quimiorresistência e pior prognóstico, principalmente, em carcinomas de mama e ovário. Assim, o objetivo do estudo foi avaliar a imunoexpressão das proteínas BRCA1 e Acetil Histona H3 em espécimes de biópsia incisional de carcinomas de células escamosas oral (CCEO) em língua móvel, e correlacionar sua expressão com dados epidemiológicos e com a gradação histopatológica dos tumores. Biopsias incisionais de 43 CCEO de língua móvel foram submetidas a análise imuno-histoquímica para os anticorpos BRCA1 e AcH3. As amostram foram microscopicamente subdividas em bem diferenciado (BD) e pouco diferenciado (PD) Todos os casos de CCEO apresentaram marcação nuclear positiva para a ACH3 e não houve correlação estatisticamente significativa entre este anticorpo e a gradação histológica (p=0.391). Todos os casos foram também positivos para a proteína BRCA1. O grupo PD apresentou uma expressão aberrante do BRCA1, com a maioria dos casos possuindo menos que 10% da marcação nuclear (p<0.01). Todos os casos do grupo PD apresentaram marcação citoplasmática (p=0.034). O grupo dos BD mostrou uma expressão majoritariamente nuclear com a maioria dos casos expressando mais de 50% das células positivas (p<0.01). Nossos resultados mostraram que as proteínas AcH3 e BRCA1 foram encontradas expressas em todos os casos de CCEO. Em geral, casos de CCEO apresentaram-se hipoacetilados. Houve uma diminuição significante na expressão da proteína BRCA1 no grupo PD em comparação ao BD. Além disso, a imunomarcação do BRCA1 nos casos PD foi exclusivamente citoplasmática. Nossos estudos corroboram com os achados de trabalhos anteriores para imuno-histoquímica de ambas proteínas BRCA1 e AcH3 em CCEO. O status hipoacetilado do CCEO evidencia a importância das mudanças epigenéticas na carcinogênese oral e na progressão tumoral como sendo um campo de investigação promissor. A imunoexpressão da proteína BRCA1 mostrou um declínio significativo nos casos PD com a proteína, em sua maioria, sendo encontrada no citoplasma. Apesar do estudo ter usado espécimes de biópsia incisional, nosso BRCA1 reproduziu o mesmo observado nos CCEO e em outras neoplasias, sugerindo a possibilidade de seu uso como um marcador prognóstico. (AU)

Oral squamous cell carcinoma (OSCC) is the most common cancer of the head and neck region and is the fourth most prevalent cancer in men worldwide. The oral carcinogenesis is characterized by a clinical, pathological and biological heterogeneity, causing genomic instability with the progression and development of potentially malignant disorders. The DDR (DNA damage response) pathway acts as a mechanism of self-defense responsible for the detection of the chromatin integrity. Its efficacy is dependent on its access to the site of damage by the proteins involved in the process, such as the histones (proteins that constitute the nucleosomes and assist the packing of the chromatin). The instability of histone acetylation or deacetylation in promoter regions contribute for the dysregulation of the gene expression and has been associated to the carcinogenesis and cancer progression. The DDR mechanism is composed of several interconnected signaling pathways, such as BRCA1 pathways. The BRCA1 protein regulates transcription, chromatin remodeling and repair of double strand DNA breaks and other functions. Its identification has been related to chemoresistance and poor prognostic, especially in mama and ovarian carcinoma. The aim of the study was to evaluate the immunoexpression profile of BRCA1 and AcH3 proteins in fragments of incisional biopsy oral squamous cell carcinomas of the mobile tongue and correlate with the epidemiological data and histopathological gradation of the tumors. Incisional biopsy samples of 43 oral squamous cell carcinoma of the mobile tongue were submitted to immunohistochemical for AcH3 and BRCA1 antibodies. Samples were microscopically graded in well differentiated and the poor differentiated. All OSCC cases showed AcH3 positive nuclear expression and there was no correlation between AcH3 and histological grading (p=0.391). All the OSCC cases were positive for BRCA-1 expression. The PD group showed an aberrant expression of the BRCA1 protein, with most of the cases with less than 10% of nuclear staining (p<0.01). Moreover, all PD cases showed cytoplasmatic staining (p=0.034). The WD cases showed nuclear staining with most of the cases showing more than 50% of positive cells (p<0.01). Our results pointed that the AcH3 and BRCA1 protein were found to be expressed in all OSCC. In general, OSCC cases were hypoacetylated. There was a significant decrease in BRCA1 protein expression in the poor differentiated group in comparison to the well differentiated. Also, BRCA1 immunostaining was cytoplasmatic in the poor differentiated cases. Our results corroborate the few previous studies for both AcH3 and BRCA1 protein immunohistochemistry findings in OSCC. The hypoacetylated status of OSCC highlights the importance of epigenetics changes in oral carcinogenesis and tumor progression as a promising field of investigation. The BRCA1 protein imunnoexpression showed a significant decrease in the PD cases and the protein was mostly found into the cytoplasm. Although the present study used biopsy specimens, our BRCA1 results were the same observed not only in OSCC but in other cancers suggesting it as a promising prognostic marker.

Qualidade de vida de profissionais de enfermagem no climatério / Quality of life on climacteric nursing professionals / Calidad de vida de profesionales de enfermería en el climaterio

O climatério apresenta algumas particularidades em relação ao funcionamento corporal, as mulheres vivenciam mudanças de diversas ordens neste período da vida, sendo importante estudar a qualidade de vida de profissionais de enfermagem. Propôs-se a analisar a repercussão do climatério na qualidade de vida de profissionais de enfermagem que atuavam diretamente na assistência. Por meio de estudo exploratório, descritivo, desenvolvido com nove profissionais de enfermagem no climatério em Hospital Universitário do Rio de Janeiro, RJ, Brasil, em 2010, procedeu-se à coleta de dados, por meio de entrevista semiestruturada, submetidos à análise de conteúdo. As entrevistadas vivenciavam mudanças na qualidade de vida após os 35 anos, no trabalho, na alimentação, nas atividades de lazer e físicas, entre outros hábitos e estilos de vida. Conclui-se que o climatério interfere na qualidade de vida de profissionais de enfermagem em suas relações pessoais, no trabalho, na alimentação, na atividade física, no padrão de sono e lazer.

The climacteric has some unique features, especially related to body function, where women experience changes of several orders, then, it is important to study the quality of life of climateric nursing professionals. It was proposed to analyze the impact of climacteric on the quality of life of nursing professionals who work directly with care. Through an exploratory, descriptive study developed with nine nursing professionals under climacteric in a University Hospital of Rio de Janeiro, in 2010, we proceeded to collect data through semi-structured interviews and the results were submitted to content analysis. All respondents experience changes in their quality of life after 35 years of age, at work, concerning eating, leisure activities, physical activities and other habits and lifestyles. It was concluded that climacteric affects the quality of life of nursing professionals in relationships, at work, concerning eating, physical activities, sleeping patterns and leisure.

El climaterio tiene particularidades en relación con la función del cuerpo, las mujeres experimentan cambios de diversas órdenes, siendo importante estudiar la calidad de vida de profesionales de enfermería en el climaterio. Se propuso analizar las repercusiones del climaterio en la calidad de vida de profesionales de enfermería que trabajan directamente en la atención. A través de estudio exploratorio, descriptivo, desarrollado con nueve profesionales de enfermería en Hospital Universitario del Rio de Janeiro, RJ, Brasil, en 2010, se recopilaron los datos por medio de la entrevista semiestructurada, sometidos a análisis de contenido. Los encuestados experimentaban cambios en la calidad de vida después de 35 años, en el trabajo, alimentación, actividades de ocio, física, entre otros hábitos y estilos de vida. El climaterio afecta la calidad de vida de profesionales de enfermería en sus relaciones personales, trabajo, actividad física, estándar del sueño y ocio.

Repercussions of the climateric among nurses – an exploratory study

The climacteric presents some unique features, especially in relation to body functioning. Although women may experience symptoms due to hormonal, physical and psycho-emotional changes, they may claim that there is a lack of information. Aim: To identify the physical effects of the climacteric on professional nurses who are involved directly in healthcare. Methodology: This is an exploratory, descriptive study carried out with climacteric professional nurses at a University Hospital in Rio de Janeiro in 2010. Data were collected through semi-structured interviews and the results were subjected to content analysis. Results: Exhausting working hours associated with the physical effects of the climacteric increases the chances of alterations in nurses' personal and professional lives. Conclusion: Considering that nursing is still a predominantly female profession, it is important to look at these professionals from a specific viewpoint, and take the repercussions of the climacteric period into consideration, including in terms of their professional processes and, ultimately, their life as a whole.