Comparison of the whole slide imaging and conventional light microscopy in the grading of oral epithelial dysplasia: a multi-institutional study

BACKGROUND: Whole Slide Imaging (WSI) is an alternative method to light microscopy (LM). However, few studies have compared the diagnostic agreement between WSI and LM, especially to grade oral epithelial dysplasia (OED). The purpose of this study was to evaluate the variability in grading OED by the World Health Organization grading system, using WSI and conventional LM, and to investigate whether the access to clinical information, and psychologic or physical states of the pathologists could interfere with the diagnosis. MATERIAL AND METHODS: eleven experienced pathologists from seven Brazilian universities independently evaluated twenty-five OED cases. The analyses were performed in duplicate for each method, with an interval of at least 30 days, and the time consumed in each analysis was measured. Physical and psychologic states were evaluated by blood pressure levels, heart rate and two questionnaires: State-Trait Anxiety Inventory and Perceived Stress Scale. Clinical information was provided after the second evaluation using WSI and the pathologist could change their diagnostic decision or not. RESULTS: LM showed a higher inter-examiner agreement (k=0.53) than WSI (k=0.45) and a smaller time consumed by the pathologists (mean of 65.53 seconds compared to 91.02 seconds in WSI). In the first analysis using conventional microscopy, there was a positive correlation between kappa values and anxiety (r=0.47, p = 0.02), and stress (r=0.64, p < 0.01), and an inverse correlation with heart rate (r=-0.48, p = 0.02). In the digital analysis, there was also a positive correlation between kappa values and anxiety (r=0.75, p < 0.001). After clinical information was given, there was a slight change in 11.3% of the cases, and a great discrepancy in 1.1% of the cases, mainly increasing the OED grade. CONCLUSIONS: both microscopy systems had similar results, although LM had slightly higher kappa values, and WSI was more time consuming

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20-year Follow-up of Recurrent Glandular Odontogenic Cyst Mimicking a Periapical Lesion.

Periapical lesions usually are caused by root canal infection; nevertheless, other pathologies may eventually involve the tooth apex, making the correct diagnosis more difficult. Glandular odontogenic cysts (GOCs) are uncommon and, despite their cystic nature, may present an aggressive behavior and a high recurrence rate. This report describes a recurrent GOC mimicking a periapical lesion that was followed up for 20 years. A 45-year-old woman described tooth discomfort for several years in the anterior region of the mandible that was not exacerbated during eating or occlusion. Clinical examination revealed no signs of swelling, redness, or inflammation in the gingival or surrounding soft tissue. Nevertheless, periapical radiography showed a well-defined large radiolucent lesion in the periapical region of teeth #22, #23, #24, and #25. The pulp test confirmed that all these teeth were vital. An incisional biopsy was performed, and with the histopathological diagnosis of an odontogenic cyst, the lesion was enucleated surgically. After recurrence, the extensive periapical multilocular lesions were again surgically removed. Based on the microscopic findings, the final diagnosis was GOC. One year later, there were no signs of recurrence. GOCs associated with the root apex may mimic periapical inflammatory diseases. Clinical, radiographic, and histopathological findings are essential for the diagnosis of inconclusive radiolucent findings in the periapical region. Biopsy specimens should be sent to a specialized oral pathology laboratory.

Prognostic significance of cyclooxygenase 2 and phosphorylated Akt1 overexpression in primary nonmetastatic and metastatic cutaneous melanomas.

Cyclooxygenase 2 (COX-2) and phosphorylated Akt1 (p-Akt1) are associated with tumor spreading, cell proliferation, high metabolism, and angiogenesis in solid tumors. This study aimed to investigate COX-2 and p-Akt1 expression in primary and metastatic melanomas by correlating with the cellular proliferation index (as revealed by minichromosome maintenance 2 expression) and the outcome of patients with malignant melanomas. Seventy-seven biopsies of malignant melanomas, including 42 primary nonmetastatic melanomas (PNMMs), 12 primary metastatic melanomas (PMMs), and 23 metastatic melanomas (MMs), were retrospectively selected. Tissue microarrays were developed and submitted for immunohistochemical staining for COX-2, p-Akt1, and minichromosome maintenance 2. Increased COX-2 cytoplasmic staining patterns were observed in PMM and MM when compared with PNMM (P=0.0011). Higher nuclear and cytoplasmic expression of p-Akt1 was more closely associated with PMM than with MM and PNMM (P<0.00001). Coexpression of these biomarkers was closely correlated with lower overall survival rates in melanomas. Furthermore, we observed a statistically significant positive correlation between the mitosis index and increased COX-2 expression (P=0.0135) and between p-Akt1 (P=0.0038) and the cellular proliferation index (P=0.0060). Taken together, our findings demonstrate that COX-2 and p-Akt1 play an important combined role during melanoma progression and are associated with highly metastatic tumors and survival rates in patients with MM. In addition, these biomarkers can be used to predict melanoma prognosis independently of metastatic status. However, further studies are required to elucidate the biological role of these biomarkers during the progression of MM events.

Oral encapsulated vascular malformation: An undescribed presentation in the mouth.

UNLABELLED: Vascular lesions have been classified in two broad categories, hemangiomas and malformations. Encapsulated vascular lesions have not been reported in the oral cavity, but they were described in other sites, mainly in the orbit. Herein, we present a case of an oral encapsulated vascular lesion located in the right buccal mucosa of a 69-year-old male, including histological and immunohistochemical description and a literature review. KEY WORDS: Buccal mucosa, hemangioma, vascular malformation, oral cavity.

Molecular signature of salivary gland tumors: potential use as diagnostic and prognostic marker.

Salivary gland tumors are a highly heterogeneous group of lesions with diverse microscopic appearances and variable clinical behavior. The use of clinical and histological parameters to predict patient prognosis and survival rates has been of limited utility, and the search for new biomarkers that could not only aid in a better understanding of their pathogenesis but also be reliable auxiliaries for prognostic determination and useful diagnostic tools has been performed in the last decades with very exciting results. Hence, gene rearrangements such as CRTC1-MAML2 in mucoepidermoid carcinomas have shown excellent specificity, and more than that, it has been strongly correlated with low-grade tumors and consequently with an increased survival rate and better prognosis of patients affected by neoplasms carrying this translocation. Moreover, MYB-NFIB and EWSR1-ATF1 gene fusions were shown to be specifically found in cases of adenoid cystic carcinomas and hyalinizing clear cell carcinomas, respectively, in the context of salivary gland tumors, becoming reliable diagnostic tools for these entities and potential therapeutic targets for future therapeutic protocols. Finally, the identification of ETV6-NTRK3 in cases previously diagnosed as uncommon acinic cell carcinomas, cystadenocarcinomas, and adenocarcinomas not otherwise specified led to the characterization of a completely new and now widely accepted entity, including, therefore, mammary analogue secretory carcinoma in the list of well-recognized salivary gland carcinomas. Thus, further molecular investigations of salivary gland tumors are warranted, and the recognition of other genetic abnormalities can lead to the acknowledgment of new entities and the acquirement of reliable biomarkers.

Oral carcinoma cuniculatum: two cases illustrative of a diagnostic challenge.

Carcinoma cuniculatum is a rare variant of squamous cell carcinoma originally described on the sole of the foot and for a long time believed to be restricted to the skin. However, since its first description in 1954, several cases have been reported at other sites. Carcinoma cuniculatum characteristically invades the underlying subcutaneous, submucosal, or bone tissues, forming so-called "rabbit burrows," with crypts filled with keratin that are of utmost importance for distinguishing this neoplasm from other variants of squamous cell carcinoma. Oral carcinoma cuniculatum is an even rarer entity that is frequently misdiagnosed initially, a phenomenon described in about one-third of previously reported cases. The aim of this report is: (1) to describe the clinicopathologic features of 2 new cases of oral carcinoma cuniculatum, initially misdiagnosed as infected orthokeratinized cyst and abscess, respectively; and (2) to review the related English language literature.

Oral vascular malformation in a patient with hereditary hemorrhagic telangiectasia: a case report.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited mucocutaneous disease characterized by recurrent epistaxis, lesions on skin and oral mucosa, and arteriovenous malformations of the soft tissues. This article describes the treatment of a 64-year-old woman with a bleeding nodule, which was diagnosed as an arteriovenous malformation of the gingival mucosa. She was treated using sclerotherapy. Patients with HHT can be treated in the dental office and vascular malformations of these patients can be successfully managed with sclerotherapy, which eliminates the need for invasive surgical procedures and the possibility of postsurgical complications.

Clínica integrada e mudança curricular: desempenho clínico na perspectiva da integralidade / Integrated clinic and curriculum change: clinical performance in the perspective of integrality

Introdução: Diante da necessidade estabelecida de mudança na formação profissional em função das novas demandas em saúde, busca-se a construção de um modelo pedagógico capaz de equilibrar excelência técnica e relevância social, visando à integralidade da atenção. No curso de odontologia a instituição da Clínica Integrada seria a responsável por resgatar essa condição de totalidade e unicidade da prática odontológica. Objetivo: Investigar o desempenho clínico de estudantes na perspectiva da integralidade em uma clínica integrada, comparando duas turmas da Faculdade de Odontologia (FO) da Universidade Federal de Goiás (UFG), uma do currículo antigo (G1) e outra da nova matriz curricular (G2). Metodologia: Neste estudo adotou-se multimétodos, sendo realizada análise documental do histórico escolar dos estudantes e dos prontuários de pacientes, aplicação de questionário autoavaliativo de desempenho clínico e grupo focal com os estudantes. Resultados: Durante o período analisado os estudantes do G1 realizaram 102 procedimentos preventivos e os do G2 272; mais de 55% dos estudantes do G1 consideraram ser suficiente a produção realizada de procedimentos preventivos. Estudantes apontaram como principais fatores relacionados ao desempenho clínico problemas operacionais da clínica (G1-88,5%; G2-54,9%) e formação científica (G1-71,2%; G2-66,7%). Conclusão: Os estudantes da nova matriz curricular apresentaram maior produtividade de atividades preventivas, enquanto os estudantes do currículo antigo apresentaram caráter curativista, entretanto, a autoavaliação de desempenho dos estudantes nem sempre se mostrou compatível com os dados de produção registrados nos prontuários. Além disso, os estudantes apontaram a formação científica e o processo organizacional como os principais fatores relacionados aos seus desempenhos.

Introduction: Given the need for a change in professional training following the new demands in health care, there has been a search to build a pedagogic model capable of balancing technical excellence and social relevance, setting comprehensive health care as the goal. In a Dental School, the institution of an integrated clinic could be a form to restore this condition of wholeness and oneness of dental practice. Objective: To investigate the clinical performance of students from a comprehensive point of view in an integrated clinic, comparing two groups of students from the Dental School of Federal University of Goiás (UFG), Brazil, one taught by the old curriculum (G1) and the other by the new curriculum (G2). Methods: For this purpose, a multi-method approach was adopted according to which the students' school records and the patients' clinical records were reviewed, self-evaluation questionnaires of clinical performance were applied and focal groups were performed with the students. Results: In the analyzed period, the students from G1 performed 102 preventive procedures and those from G2 performed 272. More than 55% of the students from G1 considered sufficient their production of preventive procedures. The students indicated as main factors related to the clinical performance the organizational process (G1-88.5%, G2-54.9%) and scientific training (G1-71.2%, G2-66.7%). Conclusions: Students from the new curriculum had higher productivity of preventive activities, while students from the old curriculum presented a curative behavior. However, self-evaluation of student performance was not always compatible with the production data from medical records. Additionally, the students indicated scientific training and organizational process as the main factors related to their performance.

Oral vascular malformation in a patient with hereditary hemorrhagic telangiectasia: a case report.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited mucocutaneous disease characterized by recurrent epistaxis, lesions on skin and oral mucosa, and arteriovenous malformations of the soft tissues. This article describes the treatment of a 64-year-old woman with a bleeding nodule, which was diagnosed as an arteriovenous malformation of the gingival mucosa. She was treated using sclerotherapy. Patients with HHT can be treated in the dental office and vascular malformations of these patients can be successfully managed with sclerotherapy, which eliminates the need for invasive surgical procedures and the possibility of postsurgical complications.