An unusual case of oral phleboliths without evidence of associated vascular anomalies.

Phleboliths are calcified thrombi found within a dilated blood vessel. When located in the maxillofacial region, they are commonly associated with hemangiomas or vascular malformations. This article reports an unusual case of a 59-year-old woman presenting with noncalcified phleboliths without evidence of associated vascular anomalies. Therefore, although a radiographic finding of phleboliths in the soft tissues of the head and neck represents evidence that a vascular malformation may be present, these lesions can occur without associated vascular anomalies. The association between the estimated age and elemental composition of the phleboliths in the present case suggests that the calcification process is relatively slow.

Reabilitação estética com resina composta em paciente jovem: relato de caso clínico / Aesthetic rehabilitation with composite resin in a young patient: a case report

Objetivo: o presente trabalho tem como objetivo relatar um caso clínico de reabilitação de dentes anteriores com facetas em resina composta. Caso clínico: Paciente do sexo masculino, 23 anos, queixava-se de insatisfação com a estética do seu sorriso. No exame clínico foram observadas restaurações insatisfatórias nas incisais e interproximais dos incisivos centrais superiores. Os elementos 12, 22 e 23 apresentavam-se em desarmonia com a face. Após plano de tratamento, foi realizado registro de cor inicial e três sessões de clareamento dental. Na consulta seguinte foi feita profilaxia com pedra pomes extrafina, confecção da guia de silicone através do enceramento, remoção das resinas antigas, seguido de condicionamento ácido e sistema adesivo. Com a guia de silicone e tiras de poliéster em posição foram realizados incrementos de resina composta de dentina e esmalte. Na sequência os excessos foram removidos com pontas diamantadas multilaminadas finas e extrafinas, verificando os contatos oclusais. Posteriormente, foi realizado polimento com borracha de silicone, discos sof-lex e de feltro, associados à pasta diamantada. Ao final do tratamento obteve- se um sorriso esteticamente harmônico e consequentemente a satisfação por parte do paciente. Conclusão: A reabilitação de dentes anteriores com facetas dentárias em resina composta é um tratamento viável para se alcançar um sorriso harmônico.

Objective: The present study aimed to report a clinical case of rehabilitation of anterior teeth with facets in composite resin. Case report: A male patient, 23 years-old, complained with the aesthetics of his smile. In the clinical examination, unsatisfactory restorations were observed in the incisals and interproximal of the upper central incisors. The teeth 12, 22 and 23 were in disharmony with the face. After the treatment plan, initial color registration and three dental bleaching sessions were performed. In the following visit, prophylaxis was made with extrafine pumice stone, preparation of the silicone guide by waxing, removal of the old resins, followed by acid conditioning and adhesive system. With the guide of silicone and polyester strips in place were made increments of resin composed of dentin and enamel. In the sequence, the excesses were removed with thin and extrafine multilaminated diamond tips, checking the occlusal contacts. Subsequently, it was polished with silicone rubber, sof-lex and felt discs, associated to the diamond paste. At the end of the treatment, an aesthetically harmonious smile was obtained and consequently patient satisfaction. Conclusion: The rehabilitation of anterior teeth with dental veneers in composite resin is a viable treatment to achieve a harmonious smile.

Beta adrenergic receptor activation inhibits oral cancer migration and invasiveness.

OBJECTIVE: The aim of this study was to verify ß2-AR expression in oral squamous cell carcinoma cell lines (SCC-9 and SCC-25), and to investigate the role of this receptor in migration and invasion of these neoplastic cells. DESIGN: SCC-9 and SCC-25 cells were investigated for gene and protein expression of ß2-AR. Cell migration and invasion were analyzed by wound healing assay and transwell invasion camera system. Different concentrations (0.1, 1 and 10 µM) of norepinephrine were used to stimulate, and 1 µM propranolol was used to block the beta-adrenergic receptors on cancer cells. Differences in median values of SCC-9 and SCC-25 and ß2-AR protein expression were analyzed by Friedman test and in case of significant differences; pairwise comparisons were performed using Bonferroni correction. RESULTS: The results showed that the ß2-AR gene and protein expression were observed in both oral cancer cell lines. The concentration of 10 µM of norepinephrine significantly inhibited (p ≤ 0.05) migration of SCC-9 and SCC-25 cell lines. Furthermore, there was a significant reduction (p ≤ 0.05) in the effect of norepinephrine on cell migration when the ß2-AR was inhibited by propranolol. The blockade by propranolol showed a tendency to reverse the effect of norepinephrine on the invasiveness of SCC-9 and SCC-25. CONCLUSIONS: The use of beta-adrenergic receptor agonists could become an adjuvant therapeutic target in the treatment of this malignancy.

Fechamento de diastema com resina composta: relato de caso / Closure of diastema with composite resin: case report

Este trabalho tem o objetivo relatar um caso clínico de fechamento de diastema inter incisivos pela técnica de restauração direta em com resina composta. Paciente, sexo feminino, compareceu a Clínica Integrada de Adultos queixando-se da estética do seu sorriso devido à coloração amarelada e um espaço presente entre os dentes incisivos superiores. No exame clínico notou-se a presença de diastema mesial entre os dentes 11 e 21. Foi feito um plano de tratamento, no qual foi sugerido a paciente o fechamento do diastema por meio de restaurações diretas com resina composta. Após a aprovação da paciente, foi selecionada a cor dos dentes com o auxílio da Escala Vita e proposto a realização de um clareamento antes do tratamento restaurador. Realizado o clareamento e após ter aguardado 21 dias para estabilização da cor, deu início a etapa restauradora, a qual consistiu no ataque ácido seguido pela aplicação do sistema adesivo. A resina composta foi sendo colocada em incrementos de 1mm com o auxílio de fita de poliéster a fim de restabelecer a parede palatina e o contato interproximal. Posteriormente, a resina foi sendo colocada até a face vestibular respeitando a anatomia dentária. Uma semana após a restauração, foi realizado acabamento e polimento com pontas diamantadas tronco-cônicas de granulação fina, discos de lixa, disco de feltro e pasta diamantada. O resultado satisfatório após o fechamento do diastema pela técnica direta em resina composta demonstrou-se uma opção de tratamento viável, uma vez que restabeleceu a função e a estética do sorriso da paciente.

This paper aims to report a clinical case of closure of inter-incisive diastema by the technique of direct restoration with composite resin. A female patient attended the Integrated Adult Clinic complaining about the aesthetics of her smile due to the yellow color and a space between the upper incisor teeth. In the clinical examination, the presence of mesial diastema between teeth 11 and 21 was noted. A treatment plan was made, in which the patient was suggested to close the diastema by means of direct restorations with composite resin. After the patient's approval, the color of the teeth was selected with the aid of the Vita Scale and it was proposed to perform a whitening procedure before the restorative treatment. After bleaching and after waiting 21 days for color stabilization, the restorative stage began, which consisted of the acid attack followed by the application of the adhesive system. The composite resin was placed in 1mm increments with the aid of polyester tape in order to reestablish the palatal wall and interproximal contact. Subsequently, the resin was placed up to the buccal surface, respecting the dental anatomy. One week after the restoration, finishing and polishing was carried out with fine-grained cone-shaped diamond tips, sanding discs, felt disc and diamond paste. The satisfactory result after the closure of the diastema by the direct technique in composite resin proved to be a viable treatment option, since it restored the function and aesthetics of the patient's smile.

A Case of Oral Histoplasmosis Concomitant with Pulmonary Tuberculosis.

The superficial intraoral lesions of histoplasmosis occurring concomitant to tuberculosis, in a 46-year-old man, are reported. The human immunodeficiency virus (HIV) infection test was negative. The immunosuppression caused by tuberculosis in our patient probably had an important role in the development of intraoral lesions of histoplasmosis. Here, we discussed the role of the dentist in the diagnosis of these infectious diseases, highlighting the importance of anamnesis and the histopathology/immunohistochemistry exams.

An unusual clinical manifestation of oral melanocytic nevus.

Melanocytic nevi are acquired or congenital benign neoplasms, often found in skin but rarely in the oral mucosa. This article reports an atypical case of oral hypopigmented melanocytic nevus in a 39-year-old woman referred for evaluation of a well-circumscribed papule with discrete brownish spots in the buccal mucosa. An excisional biopsy was performed, the results of which led to a clinical diagnosis of inflammatory fibrous hyperplasia. The histopathologic analysis resulted in a diagnosis of hypopigmented intramucosal melanocytic nevus. This unusual clinical manifestation of melanocytic nevus reinforces the importance of including nonpigmented or hypopigmented melanocytic nevi in the differential diagnosis of papules arising in the oral mucosa. A biopsy and subsequent histologic examination of the specimen are recommended to establish an accurate diagnosis.

Conhecimento dos Professores do Ensino Fundamental Quanto ao Manejo Emergencial de Traumatismo Dentários / Knowledge of Primary School Teachers in Emergency Management of Tooth Injuries

Objetivo: Avaliar o nível de conhecimento e segurança de professores do ensino fundamental para lidar com injúrias traumáticas na dentição permanente, antes e após assistirem uma palestra educativa. Materiais e Métodos: Os dados foram coletados por meio de questionários aplicados aos professores de ensino fundamental do 1º ao 9º ano do município de Mineiros-GO, antes e após assistirem uma palestra sobre traumatismo dentário. A amostra foi composta por 32 professores do ensino fundamental de escolas privadas e estaduais do município. Estes professores responderam a um questionário, o qual primeiramente avaliava o perfil do participante e em uma segunda parte avaliava o conhecimento do mesmo sobre traumatismo dentário. Os dados obtidos foram submetidos à uma análise estatística descritiva, para verificar a frequência das respostas de cada questão antes e após a realização da palestra de orientação. Resultados: Apesar da maioria dos professores apresentar um bom tempo de experiência profissional e ter pós-graduação, 80% dos participantes relataram sentir-se despreparados para agir diante de um trauma dentário. Após as orientações fornecidas nas palestras educativas foram observados resultados bastante positivos, aumentando significativamente, de 12,5% para 46,8%, o número de participantes que se sentia preparado para socorrer um aluno com trauma dentário. Conclusão: A falta de conhecimento dos professores em relação a injúria dentária foi evidente. Desse modo, a realização de palestras educativas para esse público mostra ser de grande valia e imprescindível para o sucesso e longevidade do tratamento.

Objective: To evaluate the level of knowledge and safety of primary school teachers in dealing with traumatic injuries in permanent teeth, before and after attending an educational lecture. Materials and methods: Data were collected through questionnaires applied to primary school teachers from the 1st to the 9th year of the city of Mineiros-GO, before and after attending a lecture on dental injuries. The sample consisted of 32 school teachers from private and state schools. These teachers answered a questionnaire, which first evaluated the participant's profile and in a second part evaluated their knowledge about tooth injuries. The data were submitted to a descriptive statistical analysis, to verify the frequency of the answers of each question before and after the orientation lecture. Results: Even though most teachers have a good amount of professional experience and have a postgraduate degree, 80% of the participants reported feeling unprepared to act in the face of tooth injuries. Following the guidelines provided in the educational lectures were observed quite positive results, significantly increasing, of 12.5% to 46.8%, the number of participants who felt prepared to succor a student with tooth injuries. Conclusion: The teachers' lack of knowledge about dental injuries was evident. Thus, educational lectures for this audience showed to be of great value and essential for the success and longevity of the treatment.

Immunoexpression of proteins involved in cytoskeleton remodeling in benign odontogenic lesions.

OBJECTIVE: The present study was designed to analyze the immunolocalization of proteins involved in cytoskeleton remodeling, such as moesin and Rho-A, in benign odontogenic lesions that present with expansive growth and invasive clinical behavior. MATERIALS AND METHODS: Expressions of moesin and Rho-A in odontogenic epithelium were evaluated by immunohistochemical analysis in 45 odontogenic lesions using monoclonal antibodies. RESULTS: Our results demonstrated strong membranous and cytoplasmic expressions of moesin in the epithelial cells in 66.7% and 44.4% of the odontogenic lesions, respectively. Furthermore, Rho-A expression in odontogenic epithelium was strong in the membrane and cytoplasm of 51.1% and 62.2% of the odontogenic lesions, respectively. A statistically significant correlation was found between the membranous and cytoplasmic expressions of moesin (p = 0.000) and those of Rho-A (p = 0.048) in odontogenic epithelial cells, while no statistically significant correlation was found between moesin and Rho-A expressions (p > 0.05). CONCLUSIONS: The present study confirmed the strong expressions of moesin and Rho-A by odontogenic epithelial cells, suggesting their involvement in the development of benign odontogenic lesions. However, this study has failed to detect the connection between the moesin and Rho-A interaction in expansive growth and local invasiveness of these lesions.

Moesin expression by tumor cells is an unfavorable prognostic biomarker for oral cancer.

BACKGROUND: Moesin is a member of the ERM (ezrin, radixin and moesin) proteins that participate in cell migration and tumor invasion through transductional signals sent to actin filaments by glycoproteins, such as podoplanin. METHODS: This study aimed to evaluate the participation of moesin and podoplanin in the invasive tumor front of oral squamous cell carcinomas, and their influence on patients' prognosis. Podoplanin and moesin immunoexpressions were evaluated by a semi-quantitative score method, based on the capture of 10 microscopic fields, at 400X magnification, in the invasive tumor front of oral squamous cell carcinomas. The association of moesin and podoplanin expression with clinicopathological variables was analyzed by the chi-square, or Fisher's exact test. The 5 and 10 years survival rates were calculated by the Kaplan-Meier method and the survival curves were compared by using the log-rank test. RESULTS: The immunohistochemical expression of moesin in the invasive front of oral squamous cell carcinomas was predominantly strong, homogenously distributed on the membrane and in the cytoplasm of tumor cells. The expression of moesin was not associated with clinical, demographic and microscopic features of the patients. Otherwise, podoplanin expression by malignant epithelial cells was predominantly strong and significantly associated with radiotherapy (p = 0.004), muscular invasion (p = 0.006) and lymph node involvement (p = 0.013). Strong moesin expression was considered an unfavorable prognostic factor for patients with oral squamous cell carcinomas, clinical stage II and III (p = 0.024). CONCLUSIONS: These results suggested that strong moesin expression by malignant cells may help to determine patients with oral squamous cell carcinoma and poor prognosis.

Burkitt Lymphoma in Adult With Atypical Clinical Presentation Primarily Involving the Oral Soft Tissue.

Non-Hodgkin lymphoma is the second most common neoplasm of the head and neck after squamous cell carcinoma. However, it accounts for only 3.5% of all malignancies of the oral cavity. Oral lesions are often a component of disseminated disease process that may involve regional lymph nodes or may at times represent the primary extra nodal form of the disease. Although, isolated oral lymphoma in adults is extremely rare, this paper presents a patient with Burkitt lymphoma in an adult male with atypical clinical presentation primarily involving the oral soft tissue. It is believed that the prognosis of Burkitt lymphoma depends on the extent of the disease, the patient's age, and the timing of diagnosis. Therefore, the role of the dentist in the early diagnosis and prompt referral of patients with Burkitt lymphoma cannot be overemphasized.

Unicystic Ameloblastoma with Mural Proliferation Managed by Conservative Treatment.

Unicystic ameloblastoma is a distinguishable entity of ameloblastomas, characterized by slow growth and being relatively locally aggressive. Three histological types are recognized according to the degree of ameloblastomatous epithelial extension, namely, luminal, intraluminal, and mural types. This classification has a direct bearing on their biological behavior, treatment, and prognosis. However, there is difficulty in determining the most appropriate form of treatment for unicystic ameloblastoma. We present a case of unicystic ameloblastoma that occurred in the right posterior mandible of 19-year-old girl, which was enucleated and did not recur after 12-month follow-up.

Tuberous Sclerosis with Severe Cutaneous Manifestation and Multiples Facial Angiofibromas.

Tuberous sclerosis is an extremely variable disease that can affect virtually any organ in the body. The most common findings are cutaneous manifestations, that are critical features in helping to establish diagnosis. We present a case of young man with diagnosis of tuberous sclerosis presenting multiple shagreen patches around the trunk, in the neck and genital region; large plaques with uneven surfaces on the right side of the lower back; and multiple papular lesions in his face, particularly around the nasolabial region, eyebrows and forehead. Considering that tuberous sclerosis is a disease with a highly variable clinical presentation, thus dentists and doctors should be aware of the different manifestations that may be found.

Loss of cytokeratin 10 indicates malignant transformation in actinic cheilitis.

OBJECTIVES: The aim of this study was to investigate the relationship the expression of cytokeratins (CK10 and CK13) and the cell proliferation index determined by Ki-67 of lip squamous cell carcinoma and actinic cheilitis with different degrees of dysplasia. MATERIALS AND METHODS: Forty-five paraffin-embedded actinic cheilitis with and without dysplasia and 20 lip squamous cell carcinoma were analyzed by immunohistochemistry using anti-human anti-CK10, anti-CK13, and anti-Ki-67 antibodies. RESULTS: The majority of actinic cheilitis showed immunopositivity for CK10 and CK13 with decrease or loss of expression in dysplastic areas. In lip squamous cell carcinoma of the lip, heterogeneous expression of CK13 and immunonegativity for CK10 were observed. There was a statistically significant difference between CK10 expression in lip squamous cell carcinoma and in actinic cheilitis with or without dysplasia (p < 0.001). The cell proliferation index was higher in actinic cheilitis with dysplasia and lip squamous cell carcinoma than in actinic cheilitis without epithelial dysplasia. A significant correlation was found between the intensity of the epithelial dysplasia and the cell proliferation index (p < 0.001). CONCLUSION: These results provide evidence that there is a downregulation of CK10 expression in dysplastic areas of patients with actinic cheilitis and in those with lip squamous cell carcinoma (LSCC) and that the index of cell proliferation, determined by Ki-67, is directly correlated with the intensity of the epithelial dysplasia. CLINICAL RELEVANCE: Altogether, these results suggest that CK10 expression and the epithelial cell proliferation index can help to identify malignant transformation in the lip region.

Avaliação da expressão de ß-catenina e ciclina D1 como biomarcadores preditivos para o câncer de lábio / Evaluation of ß-catenin and cyclin D1 expression as predictive biomarkers for lip cancer

Um dos objetivos da pesquisa científica, atualmente, é encontrar biomarcadores que possam auxiliar na definição da probabilidade de progressão das lesões orais displásicas, e ainda sejam capazes de identificar os principais agentes moleculares envolvidos na carcinogênese de um determinado tipo de tumor. Assim, o objetivo deste estudo foi investigar a expressão de ß-catenina, ciclina D1 e Ki-67 em 15 espécimes de epitélio oral normal, 45 queilites actínicas displásicas e em 30 carcinomas espinocelulares de lábio. Essa amostra foi constituída por pacientes tratados na Faculdade de Medicina de Botucatu (Brasil) e no Hospital Clínico San Cecílio de Granada (Espanha). O grau de displasia epitelial e de diferenciação tumoral foi classificado com base nos critérios definidos pela Organização Mundial da Saúde. A avaliação dos biomarcadores foi realizada por meio da técnica imunohistoquímica, dividindo a espessura do epitélio em quatro compartimentos (basal, suprabasal, terço médio e terço superior) para o grupo controle e para as queilites actínicas e em três compartimentos (basal, suprabasal e região interna) para o grupo dos carcinomas espinocelulares de lábio. Para a comparação da média de expressão de cada marcador, nas diferentes localizações do epitélio foi utilizado o teste estatístico de Kruskal-Wallis. Para a correlação da expressão dos três marcadores entre os grupos foi utilizada a correlação de Spearman, com nível de significância de 5%. Os resultados demonstraram uma perda discreta da expressão membranosa de ß-catenina na camada basal das queilites actínicas com displasia epitelial intensa (Cis) e nos carcinomas espinocelulares de lábio, assim como uma expressão citoplasmática e nuclear, discreta e diretamente proporcional à desorganização epitelial nas camadas basal e suprabasal das queilites actínicas e carcinomas espinocelulares de lábio. Notou-se também um aumento da expressão de ciclina D1 e Ki-67 na camada basal à medida que aumentava a desorganização epitelial. Houve uma associação estatisticamente significativa da expressão de ciclina D1 e Ki-67 na camada suprabasal do grupo controle (p=0,030) e das queilites actínicas (p=0,001) e ainda na região interna dos carcinomas espinocelulares de lábio (p=0,000). Não houve correlação significativa entre as expressões nucleares de ß-catenina e de ciclina D1. Nossos resultados reforçam que a ß-catenina, a ciclina D1 e o Ki-67, podem ser utilizados como biomarcadores preditivos para o câncer de lábio. Além disso, sugerem que a ß-catenina e a ciclina D1 participam da carcinogênese labial, em eventos independentes da via de sinalização/Wnt.(AU)

One of the goals of scientific research today is to find predictive biomarkers that can help define the probability of progression of dysplastic oral lesions, and are still able to identify key molecular agents involved in the carcinogenesis of a particular type of tumor. The objective of this study was to investigate ß-catenin, cyclin D1 and Ki-67 expression in 15 specimens of normal oral epithelium, 45 dysplastic actinic cheilitis and 30 squamous cell carcinoma of the lip. This sample consisted of patients treated at the Botucatu Medicine School (Brazil) and the Clinical Hospital San Cecilio of Granada (Spain). The degree of epithelial dysplasia and tumor differentiation was classified based on the criteria defined by the World Health Organization. The evaluation of biomarkers was performed by immunohistochemical technique, dividing the thickness of the epithelium into four compartments (basal, suprabasal, middle third and upper third) for the control group and actinic cheilitis and three compartments (basal, suprabasal and inner region) to the group of squamous cell carcinoma of the lip. For comparing the average expression of each marker in different locations of the epithelium we used the statistical test of Kruskal-Wallis. For the correlation of the three markers expression between the groups was used Spearman, with 5% significance level. The results showed a slight loss of membranous expression of ß-catenin in the basal layer of actinic cheilitis with severe epithelial dysplasia (Cis) and squamous cell carcinoma of the lip, and a cytoplasmic and nuclear expression, slight and directly proportional to the epithelial disorganization in layers basal and suprabasal of actinic cheilitis and squamous cell carcinoma of the lip. It was also noted an increase in expression of cyclin D1 and Ki-67 in the basal layer as increased epithelial disorganization. There was a statistically significant association of cyclin expression D1 and Ki-67 in the suprabasal layer of the control group (p=0.030) and actinic cheilitis (p=0.001) and also in the inner region of squamous cell carcinoma of the lip (p=0.000). There was no significant correlation between the nuclear expression of ß-catenin and cyclin D1. Our results emphasize that ß-catenin, cyclin D1 and Ki-67 can be used as predictive biomarkers for lip cancer. Moreover, they suggest that ß-catenin and cyclin D1 acts on the lip carcinogenesis, in independent events signaling pathway/Wnt.(AU)

Focal osteoporotic bone marrow defect involving dental implant: a case report.

In oral implantology, the most serious complications occur intraoperatively or within a short period. We describe an unusual case of focal osteoporotic bone marrow defect involving dental implant in the posterior mandibular region of the adult woman. Despite the fact that this condition requires no treatment, it could lead to the displacement of the dental implant. Additionally, this case report reinforces that histopathological analysis is mandatory for precise diagnosis of the radiolucency into posterior mandibular region of the adult woman associated or not with dental implant placement.

Peripheral compound odontoma erupting in the gingiva.

BACKGROUND: Peripheral odontoma arising in the extraosseous soft tissues is rare and if not removed early, may enlarge over time and eventually erupt in the oral cavity. CASE PRESENTATION: A 15-year-old girl presented with "denticles on the gingiva". During the intraoral examination, seven small tooth-like structures were found. These were exposed in the anterior left gingiva between the permanent maxillary lateral incisor and canine teeth, and the left first premolar was absent. Radiographic examination revealed irregular tooth-like structures without evidence of bone involvement. CONCLUSION: The lesion was surgically removed, and the specimens were analyzed histopathologically. The diagnosis of compound odontoma was established. CLINICAL SIGNIFICANCE: This is the twelfth reported case of peripheral odontoma in the gingiva and the first one that erupted in the oral cavity.

Citoqueratinas como biomarcadores preditivos para o câncer de lábio em pacientes com queilite actínica / Cytokeratins as predictive biomarkers for lip cancer in patients with actinic cheilitis

A presença de áreas displásicas em queilites actínicas constitui um fator preditivo importante para o câncer de lábio. Entretanto, a determinação histopatológica da presença e intensidade da displasia epitelial nestas lesões continua sendo um aspecto subjetivo para os patologistas. O objetivo do presente estudo foi verificar em 45 queilites actínicas e 20 carcinomas espinocelulares (CECs) de lábio tratados no Departamento de Otorrinolaringologia e Oftalmologia, da Faculdade de Medicina de Botucatu, UNESP, a expressão imuno-histoquímica da citoqueratina 10 (CK10) e citoqueratina 13 (CK13) na região labial e comparar a expressão dessas citoqueratinas com o índice de proliferação celular determinado pela imunomarcação com o Ki-67. A intensidade da displasia epitelial nas queilites actínicas foi determinada em coloração de Hematoxilina e Eosina com base nos critérios definidos pela Organização Mundial da Saúde. A associação entre a expressão da CK10 e da CK13 nas queilites actínicas com e sem displasia e nos CECs foi calculada pelo teste do qui-quadrado ou teste exato de Fisher, com nível de significância de 5%. Os resultados demonstraram uma positividade para CK13 no vermelhão do lábio e mucosa labial, com perda de expressão nas áreas displásicas das queilites actínicas e marcação heterogênea nos CECs de lábio. A imunomarcação da CK10 foi observada no vermelhão do lábio e epiderme, com ausência total de expressão nas áreas displásicas e nos CECs de lábio. Houve uma associação estatisticamente significante entre a expressão da CK10 nos CECs quando comparada às queilites actínicas com displasia epitelial (p<0,001) e sem displasia epitelial (p<0,001). Não houve diferença significativa (p=0,104) no índice de proliferação celular, determinado pela imunomarcação do Ki-67, nas queilites actínicas sem e com displasia epitelial e nos carcinomas espinocelulares de lábio. Assim como também não houve associação, estatisticamente significativa, entre a expressão...

The presence of dysplastic areas in actinic cheilitis is an important predictive factor for lip cancer. However, the histopathologic evaluation of the presence and severity of epithelial dysplasia in these lesions remains subjective. The aim of this study was to evaluate the immunohistochemical expression of cytokeratin 10 (CK10) and cytokeratin 13 (CK13) in labial region and compare the expression of these cytokeratins with the cell proliferation index, which was determined by Ki-67 immunostaining. The sample was constituted by 45 cases of actinic cheilitis and 20 of squamous cell carcinomas (SCC) of the lip treated at the Department of Otorhinolaryngology and Ophthalmology of Botucatu School of Medicine, UNESP. The severity of epithelial dysplasia in actinic cheilitis was determined by hematoxylin and eosin staining based on World Health Organization criteria. The association between the expression of CK10 and CK13 in actinic cheilitis with and without dysplasia and SCC was calculated by Chi-square test or Fischer´s exact test, with significance level at 5%. The results showed positive correlation for CK13 in the lip vermilion and labial mucosa, with loss of expression in the dysplastic areas of actinic cheilitis, and heterogeneous positivity in SCC of the lip. There was a statistically significant association between the expression of CK10 in SCC and actinic cheilitis with epithelial dysplasia (p < 0.001) or without epithelial dysplasia (p < 0.001).There was not a statistically significant difference (p=0.104) for cell proliferation index in actinic cheilitis with and without dysplasia, and SCC. Furthermore, there was not a statistical association (p>0.05) between the expression of CK10 and CK13 and high cell proliferation index in actinic cheilitis with and without epithelial dysplasia. These results suggest that the cytokeratins 13 and 10 participate in the process of malignant transformation of actinic cheilitis, and absence...

Oral verrucous carcinoma mimicking a chronic candidiasis: a case report.

Verrucous carcinoma has a special propensity to mimic benign lesions of the oral cavity. A case of the oral verrucous carcinoma in maxillary alveolar ridge, extending to buccal vestibule, cheek, and labial mucosa, which was diagnosed and initially treated as chronic candidiasis, is presented. Clinical, histopathological, and therapeutic considerations related to diagnosis of the verrucous carcinoma in the oral cavity are discussed.