The stem cell markers expression CD44v6 and podoplanin in lip cancer: clinical significance.

This study aimed to analyze the immunoexpression of cancer stem cell markers, CD44v6, and podoplanin in 91 patients with lip squamous cell carcinomas (LSCC). The immunostaining of podoplanin and CD44v6 was evaluated in ten high-power fields (× 400 magnification) at the invasive front of LSCC, using a semi-quantitative score method. Chi-square test or Fisher's exact test was used to verify the association of podoplanin and CD44v6 expressions with clinicopathologic variables. Spearman's correlation test was used to analyze the correlation between the two antibodies in lip cancer. Disease-free survival probabilities in 5 and 10 years were estimated according to the Kaplan-Meier method and compared using the log-rank test. The independent effects of the significant variables were analyzed by Cox proportional hazards regression model. A strong podoplanin expression was observed in the membrane and cytoplasm of most lip tumor cells, and this was inversely associated with locoregional recurrence (p = 0.028) and with histopathological grade of malignancy (p = 0.026). Additionally, CD44v6 immunostaining was strongly expressed in the membrane of tumor cells in 95.4% of the LSCC. Patients with strong membranous (p = 0.016) or strong cytoplasmic (p = 0.030) podoplanin-positive tumors resulted in significantly better disease-free survival than those who had podoplanin weak/negative tumors, confirming podoplanin expression as a favorable independent prognostic factor. Podoplanin and CD44v6 were strongly expressed by tumor cells and podoplanin immunoexpression can help to determine lip cancer patients with lower risk for disease recurrence.

Valor prognóstico da imunoexpressão de podoplanina e de CD44v6 na recidiva locorregional dos pacientes com câncer de lábio / Prognostic value of podoplanin and CD44v6 immunoexpressions on locoregional recurrence of the patients with lip cancer

O objetivo deste estudo consistiu em avaliar a expressão imuno-histoquímica da podoplanina e do CD44v6 pelas células malignas, verificando a associação destas proteínas com as variáveis clínicas, microscópicas, com o índice histopatológico de malignidade e com a sobrevivência livre de doença de 91 pacientes portadores de carcinomas espinocelulares (CEC) de lábio inferior, tratados no Centro de Tratamento e Pesquisa do Hospital do Câncer A.C.Camargo, São Paulo. Os tumores foram corados, separadamente, com os anticorpos anti-podoplanina e anti-CD44v6, sendo avaliada a imunoexpressão destas proteínas pelas células neoplásicas, no front de invasão tumoral, por meio de um método semi-quantitativo de escores. A associação da expressão da podoplanina e do CD44v6 com as variáveis demográficas, clínicas e microscópicas foi feita pelo teste do qui-quadrado ou exato de Fisher. As taxas de sobrevivência livre de doença, acumuladas em cinco e dez anos, foram calculadas pelo teste de Kaplan-Meier e a influência das variáveis clínicas e microscópicas no prognóstico avaliadas pelo modelo de regressão de Cox. A correlação entre a podoplanina e o CD44v6 foi analisada pelo teste de Spearman. Em todos os testes estatísticos utilizou-se um nível de significância de 5%. Os resultados mostraram uma predominância da forte expressão membranosa e citoplasmática da podoplanina pelas células malignas. Verificou-se uma associação significativa da podoplanina citoplasmática com a recidiva locorregional (p=0,028) e da podoplanina membranosa com o índice histopatológico de malignidade tumoral (p=0,026). O CD44v6 foi fortemente expresso pelas células neoplásicas de 95,4% dos CECs e significativamente, associado com o estadiamento clínico T (p=0,034). Não houve correlação entre a podoplanina e o CD44v6 nos CECs de lábio inferior. A forte expressão de podoplanina membranosa (p=0,016) e citoplasmática (p=0,030) pelas células malignas foi fator de prognóstico favorável independente na sobrevivência livre de doença. Concluímos que a podoplanina e o CD44v6 são fortemente expressos pelas células neoplásicas e que a forte imunoexpressão membranosa e citoplasmática da podoplanina pode auxiliar na identificação do risco de recidiva locorregional nos pacientes portadores de carcinoma espinocelular de lábio inferior.(AU)

The aim of this study was evalute the podoplanin and CD44v6 immunohistochemical expression by malignant cells and its association with the clinical and microscopic variables, tumor histopathological grading and disease-free survival of 91 patients with lip squamous cell carcinomas (SCC), submitted to surgical treatment at Research and Treatment Center of the Cancer Hospital A.C. Camargo, São Paulo. The tumors were stained separately, with the antibodies anti-podoplanin and anti-CD44v6, and the immunoexpression of these proteins, by the neoplastic cells in the invasion front, was evaluated by a semi-quantitative scores method. Chi-square test or Fishers exact test was used to analyze the association of podoplanin and CD44v6 expression with demographic, clinical, and microscopic variables. Disease-free survival in five and ten years, were calculated by the Kaplan-Meier method and the influence of clinical and microscopic variables on prognosis were evaluated by the Cox regression model. The correlation between podoplanin and CD44v6 expression was analyzed by Spearman's test and a significance level of 5% was used in all statistical tests. The results showed a predominance of strong membranous and cytoplasmic podoplanin expression by malignant cells. An association between cytoplasmic podoplanin and locorregional recurrence (p=0,028) and membranous podoplanin with tumor histopathological grading (p=0,026). CD44v6 was strongly expressed in 95.4% of the SCCs neoplastic cells and significantly associated with the clinical staging T (p=0,034). There was no correlation between podoplanin and CD44v6 expression in the lower lip SCC. The strong expression of membranous (p=0.016) and cytoplasmic (p=0.030) podoplanin by malignant cells was a favorable independent prognostic factor in disease-free survival. Concluding, the podoplanin and CD44v6 are strongly expressed by neoplastic cells and the strong membranous and cytoplasmic immunoexpression of podoplanin can help the identification of locoregional recurrence risk in patients with squamous cell carcinoma of the lower lip.(AU)

Verruciform xanthoma in the hard palate: a case report and literature review.

Oral verruciform xanthoma (OVX) is an uncommon lesion that appears on the oral mucosa. The aim of this paper was to discuss the probable etiopathogenesis of OVX in the hard palate, reinforcing the importance of including this lesion in the differential diagnosis of verrucous lesions. A 43-year-old male smoker presented with a painless lesion with a verrucous surface and erythematous spots on the hard palate. Excisional biopsy revealed oral mucosa consisting of hyperkeratosis, acanthosis, and elongated rete pegs. Subjacent connective tissue showed numerous foam cells with clear cytoplasm and pyknotic nucleus, negative on periodic acid-Schiff staining. Immunohistochemical analysis revealed foam cells positive for anti-CD68 antibody, while anti-KI-67 antibody was restricted to the basal layer of the oral epithelium. A final diagnosis of OVX was established. The patient showed no signs of recurrence after seven months of follow-up. Physical trauma and smoking habits can be directly related to the etiology of verruciform xanthoma because the lesion is chronic and inflammatory with slow growth, and sites if high trauma are more often affected by such a lesion. The hard palate is the second most commonly affected site, and local trauma caused by smoking can be a cause of this type of lesion.

Squamous cell carcinoma arising from inverted schneiderian papilloma: a case report with oral involvement.

Inverted Schneiderian papilloma is an uncommon benign tumor that presents tendency to recur and propensity to be associated with malignancy in approximately 10% of the cases. Some of these lesions are isolated in the maxillary sinus, and predominantly affect white males with mean age of 50 years. We report a case of squamous cell carcinoma arising from inverted Schneiderian papilloma in the maxillary sinus extending to the mouth. The patient was submitted to extraction of a maxillary molar tooth four months before the exacerbation of the symptoms of nasal airway obstruction and facial enlargement. Computed tomography scan revealed a sinonasal mass causing opacification of the right maxillary sinus with destruction of the lateral nasal wall and maxillary sinus floor. The patient was referred to an oncology center for treatment and died from tumor progression one year after the cancer was diagnosed. The intention of this report is to alert dentists to include the inverted Schneiderian papilloma, either associated with squamous cell carcinoma, or not, in the differential diagnosis of maxillary sinus tumors with aggressive behavior, which may extend to the oral cavity or involve roots of teeth.

Clinical, tomographic aspects and relevance of torus palatinus: case report of two sisters.

Despite the nomenclature suggested to be a tumor, torus palatinus (TP) is an overgrowth of the bone in the palatal region and represents an anatomic variation. Its prevalence varies among the population studied and its etiology is still unclear; however, it seems to be a multifactorial disorder with genetics and environmental involvement. Surgical removal of the TP is indicated in the following circumstances: (1) deglutition and speech impairment, (2) cancer phobia, (3) traumatized mucosa over the torus, and (4) prosthetic reasons. The aim of this case report is describe cases that occurred in two sisters, emphasizing the genetic etiology of this anatomic variation. In addition, intra-oral exam and computed tomography scan (axial, coronal and sagittal view) provided a detailed assessment of the TP and elimination of other possible diagnoses, furthermore allowed a better analyzes of the anatomic relation with adjacentes structures. No surgical removal was indicated for both cases.

Lesão traumática na papila incisiva: relato de caso / Traumatic lesion in the incisive papilla: case report

A papila incisiva, localizada abaixo do forame incisivo, é uma estrutura anatômica propensa a traumas que podem vir a apresentar sinais de infl amação, gerando confusão e erros de diagnóstico, caso não seja realizado um exame clínico detalhado, levando, assim, o paciente a uma terapia inadequada. Dessa forma, por meio da apresentação de um relato de caso, os autores buscam salientar a importância do exame clínico detalhado, além da avaliação e do conhecimento das imagens clínicas e radiográfi cas para a realização de um diagnóstico diferencial adequado. Abordam, mais precisamente, o diagnóstico diferencial entre traumatismo físico e cisto do ducto nasopalatino, discutindo, ainda, como a falta de anamnese e o exame físico criterioso levaram a um erro de diagnóstico e tratamento incorreto do paciente.

The incisive papilla, located beneath the incisive foramen, is an anatomical structure that, when it is exposed to trauma, shows signs of infl ammation, leading the problem to a misdiagnosis an inadequate therapy due to a mistake and confusion during the clinical examination. Thus, by a case report, the authors highlight the importance of a detailed clinical examination besides the evaluation and knowledge of clinical and radiographic images for an appropriated diff erential diagnosis. That can address, more precisely, the diff erential diagnosis between physical trauma and the nasopalatine duct cyst, beyond discuss how the lack of anamnesis and accurate physical examination led to a misdiagnosis and a wrong treatment.

Correlação da imunoexpressão de podoplanina e ezrin em carcinomas espinocelulares de lábio / Correlation of podoplanin and ezrin immunoexpression in lip squamous cell carcinoma

A podoplanina humana consiste em uma proteína associada ao processo de invasão das células epiteliais neoplásicas, sendo sua alta expressão correlacionada com um pior prognóstico para os pacientes com câncer de cabeça e pescoço. A porção citoplasmática da podoplanina pode se ligar a ezrin, uma proteína que vem sendo associada com a ocorrência de metástases e menor sobrevida para os pacientes com neoplasias malignas. O objetivo do presente estudo foi avaliar em 48 carcinomas espinocelulares de lábio inferior a expressão imuno-histoquímica da podoplanina e da ezrin, nas células do front de invasão tumoral, e verificar a correlação entre a expressão das duas proteínas nas células epiteliais neoplásicas. A expressão membranosa e citoplasmática da podoplanina e da ezrin foi avaliada nas células neoplásicas periféricas e centrais das ilhotas tumorais, por meio de um método semi-quantitativo de escores. A associação entre a expressão membranosa e citoplasmática da podoplanina e da ezrin nos tumores foi feita pelo teste de qui-quadrado, com nível de significância de 5% e a correlação entre a expressão das duas proteínas foi realizada pelo teste de correlação de Spearman. Os resultados demonstraram uma forte expressão membranosa e citoplasmática da podoplanina nas células periféricas do front de invasão tumoral com ausência desta expressão na região central das ilhotas tumorais. A imunomarcação da ezrin foi homogênea nos tumores e predominantemente citoplasmática. Uma diferença estatisticamente significativa foi encontrada entre a expressão da podoplanina nas células neoplásicas periféricas e centrais (p<0,001), como também entre a expressão da ezrin membranosa e citoplasmática (p<0,001) nos carcinomas espinocelulares de lábio. Houve uma correlação positiva, porém sem significância estatística, entre a expressão da podoplanina membranosa e da ezrin membranosa ou citoplasmática nas células neoplásicas periféricas. Estes resultados comprovam que a podoplanina...

The human podoplanin consists in a protein associated to the invasion process of the epithelial malignant cells, being your high expression correlated with poor prognosis in patients with head and neck cancer. The cytoplasmic tail of the podoplanin can bind to ezrin, a protein that have been associated with metastasis and lower survival rate in patients with malignant neoplasms. The aim of this study was evaluate in 48 squamous cell carcinomas of the lower lip, the immunohistochemical expression of podoplanin and ezrin, in the invasive front, and verify correlation between the expression of both proteins by epithelial neoplastic cells. The membranous and cytoplasmic expression of podoplanin and ezrin was evaluated in peripheral and central areas of the tumor islets, using a semi-quantitative score method. The association between the membranous and cytoplasmic expression of podoplanin and ezrin in the tumors was performed by chi-square test, using a significance level of 5% and the correlation between the expression of both proteins was performed by Spearman correlation test. The results showed a high membranous and cytoplasmic podoplanin expression in the peripheral cells of the invasive front, with no expression of this protein in the central cells. The ezrin immunostaining was homogeneous and observed mainly in the cytoplasm of malignant cells. A statistically significant difference was found between the expression of podoplanin in peripheral and central tumor cells (p<0,001), as well between the membranous and cytoplasmic expression of ezrin (p<0.001) in squamous cell carcinoma of the lip. There was a positive correlation, but without statistical significance, between the expression of membranous podoplanin and membranous or cytoplasmic ezrin in the peripheral tumor cells. These results prove that podoplanin and ezrin are strongly expressed by malignant cells of the invasive front tumor and suggest that both proteins may be participating in the invasive...

Avaliacão clínica e tratamento das complicações bucais pós quimioterapia e radioterapia / Clinical evaluation and treatment of oral complications after chemotherapy and radiotherapy

Este caso clínico se propõe a demonstrar a efetividade de opções terapêuticas para a o tratamento de complicações bucais decorrentes da quimioterapia e radioterapia. Paciente do gênero feminino, 48 anos de idade, leucoderma, com histórico de neoplasia de cabeça e pescoço com recidivas, apresentou complicações decorrentes da quimioterapia e radioterapia: mucosite oral, xerostomia, candidíase pseudomembranosa e herpes simples. As lesões foram tratadas respectivamente com laser de baixa intensidade, saliva artificial e lanolina médica, bochechas com nistatina e aciclovir sistêmico. Todos os tratamentos foram efetivos e bem tolerados pela paciente. O conhecimento do Cirurgião-Dentista, especialmente do Estomatologista quanto ao diagnóstico e tratamento das complicações bucais decorrentes da terapia antineoplásica foram fundamentais para a melhora na qualidade de vida da paciente.

This case report aims to demonstrate the effectiveness of therapeutic options for the treatment of oral complications after chemotherapy and radiotherapy. A female patient, a 48-year-old Caucasian with a history of head and neck neoplasms with recurrences, was referred to our clinic 1 month after the end of the radiotherapy sessions. She presented oral mucositis, hyposalivation, pseudomembranous candidiasis, and herpes simplex. The lesions were treated respectively with Low Levei Laser Therapy, artificial saliva, medicallanolin, nystatin oral suspension, and systemic acyclovir. These treatments were successful and sustained by the patient. The knowledge of dentists, especially stomatologists, in the diagnosis and treatment of complications arising from oral antineoplastic therapy were fundamental to improving the patient's quality of life.