Melanotic Neuroectodermal Tumor of Infancy: A Case Image.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare benign neoplasm that can be mistaken for malignancies due to its unfamiliarity among clinicians and aggressive clinical appearance. We herein contributed by reporting an additional case of MNTI characterized by an extensive extraoral protrusion in a 2-month-old infant. The lesion involved the anterior maxilla, cheek, and infraorbital region, resulting the displacement of the nose to the contralateral side, and measuring approximately 10 cm in size. Surgical resection of the lesion was performed. After a 6-month follow-up, the patient has shown no evidence of recurrence. The rapid growth and aggressive behavior of MNTI emphasize the importance of an early diagnosis and prompt intervention in order to achieve favorable outcomes.

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.

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.

Unusual clinical presentations of plasma cell mucositis involving oral mucosa: Presentation of 2 cases and review of the literature.

OBJECTIVE: Plasma cell mucositis (PCM) is a non-neoplastic plasma cell disorder of the upper aerodigestive tract with a high impact on life quality. Less than 70 cases were reported in the literature. The objective of this study was to report 2 cases of PCM. A concise review of the literature is also presented. STUDY DESIGN: Two cases of PCM that presented during the COVID-19 quarantine are reported. The inclusion criteria for the literature review were English-indexed case reports of the last 20 years. RESULTS: Cases were treated with meprednisone. As mechanical trauma was proposed as a triggering factor, its control was also considered. Patients were followed with no relapses. There were 29 studies included. The mean age was 57 years, with a male predominance, different clinical phenotypes, and intensely erythematous mucosa as a classical finding. The most frequent site was the lip, followed by the buccal mucosa. The final diagnosis is clinicopathologic. CD138 expression is a hallmark of plasma cells, frequently aiding PCM diagnosis. Plasma cell mucositis treatment is mostly symptomatic, and several therapeutic modalities have been mostly unsuccessful. CONCLUSIONS: Diagnosing plasma cell mucositis becomes challenging as many lesions may mimic other conditions. Consequently, in these cases, the diagnostic process should gather clinical, histopathologic, and immunohistochemical data.

Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience.

BACKGROUND: Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS: A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS: A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION: Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.

Congenital Melanotic Macule of the Tongue: Report of Two Cases and Literature Review.

BACKGROUND: Congenital melanotic macule of the tongue (CMMT) has been described as a distinct entity, despite its unknown etiology. However, the diagnosis and management of affected newborns may challenge clinicians and pediatric dentists. METHODS: We document here the clinicopathological findings of two additional cases of CMMT. A literature review of CMMT reports identified across PubMed, Web of Science, Embase, and Scopus was also conducted. RESULTS: The patients, 2- and 4 month-old Venezuelan boys, respectively, presented at birth with a single or multiple dark-brown-pigmented macule exclusively on the dorsum of the tongue. Histopathological features revealed increased melanin pigmentation in the basal epithelial layer with overlying hyperkeratosis and pigment-laden subepithelial macrophages with normal morphological appearance. Nine studies comprising 17 cases of CMMT have been described hitherto. Most cases were from the USA and France (n = 6 each). Twelve (70.6%) patients were males, eight (50%) were white, and median age was 2.7 months. CMMT presented as brownish to black, solitary or multiple pigmentations located in the right or left region of the dorsum of the tongue, ranging in size from 3.0 to 30.0 mm. CONCLUSION: An important feature for the diagnosis of CMMT is the information about the manifestation at birth and consequent proportional growth. This report intends to draw the attention of pediatricians and dentists to this apparently underdiagnosed condition for decision-making and management of affected newborns.

Mucosal Leishmaniasis of the lip: Report of an Exuberant case in a Young man.

BACKGROUND: Leishmaniasis is a tropical disease caused by protozoan parasites of the genus Leishmania. Mucosal leishmaniasis has been described as secondary to the cutaneous form; however, isolated mucosal involvement can also occur. Specifically, mucosal leishmaniasis of the lip is poorly described and its diagnosis challenges clinicians. METHODS: We herein report a case of mucosal leishmaniasis affecting the lower lip without cutaneous involvement in a 20-year-old Venezuelan man. The patient had no relevant past medical history. Clinically, a mass-like lesion with ulcerations and crusts was observed. RESULTS: Microscopically, the lesion was composed of granulomatous inflammation along with macrophages containing intracytoplasmic inclusions similar to round-shaped Leishmania. The species Leishmania (Viannia) braziliensis was confirmed. Treatment with meglumine antimonate was effective. The lesion healed satisfactorily, and no side effects or recurrences were observed. CONCLUSION: Clinicians should be aware of isolated forms of mucosal leishmaniasis of the lip, even in cases where the cutaneous lesion is undetected or clinically manifests as self-limiting. Knowing the endemic areas in the scenario of the dynamics of the ecoepidemiology of leishmaniasis is also essential for surveillance and counselling of the population.

[Stafne's bone cavity in a venezuelan population. Prevalence study]. / Cavidad ósea de Stafne en una población venezolana. Estudio de prevalencia.

Objective: To determine the prevalence of the Stafne´s bone cavity in a Venezuelan population and to characterize it radiographically. Method: Descriptive and cross-sectional study. Of 500 panoramic radiographs, those that had radiolucent images in the mandible, circumscribed and not associated with any dental organ, as well as those that could correspond to the mandibular fossa, were selected. Results were collated and discrepancies resolved by consensus. The selected ones were characterized radiographically. The variables were compared using the student's t test for equality of means, applying the Levene test, values of p <0.05 were considered statistically significant. Results: Of the 500 radiographs evaluated, 22 presented images corresponding to deep mandibular fossa or Stafne bone cavities, which represented 4.4%. Of which 5 presented bilaterally (22.7%) and 17 (77, 3%) unilocularly. Among the radiographic characteristics studied, images located in the posterior area (81.81%), without sclerosis (54.54%), continuous to the basal mandibular area, round shape (59.09%) and partial radiolucency (72%) were presented with a higher prevalence). They were more common in male patients with 63.63%. Conclusions: Our results show a higher prevalence of Stafne's bone cavity in a Venezuelan population than that reported in other studies in other populations.

Decompression induces inflammation but do not modify cell proliferation and apoptosis in odontogenic keratocyst.

BACKGROUND: Odontogenic keratocyst (OKC) is a development cyst, of odontogenic origin, that differs from other entities by its infiltrating and aggressive biological behavior. Among conservative treatments for large lesions, surgical decompression stands out, with a variable recurrence rate. Aim: To evaluate the histological effects of decompression treatment on OKC, including cell proliferation and apoptosis of epithelial cyst. MATERIAL AND METHODS: 21 OKC cases were included. Samples were taken before and after surgical decompression for histological evaluation and immunohistochemical staining of Ki-67, MCM4/7, Bax and Bcl2. Data were analyzed and compared using Student's t and Wilcoxon tests for related samples, and p values <0,05 were considered statistically significant. RESULTS: After decompression treatment an increase in inflammation of the cystic wall (p=0,029), loss of parakeratinization of the epithelium (p=0,007) and absence of palisade cell distribution in the basal layer were observed (p=0,002). There were no statistically significant changes in the expression of Ki-67 (p=0,323), MCM4/7 (p=0,079), Bax (p=0,392) or Bcl-2 when compared before and after decompression. CONCLUSIONS: Surgical decompression generates histological structural changes in OKC both in the epithelium and connective wall, however, these findings do not seem to alter induction of the cell cycle or epithelial apoptosis. Key words:Odontogenic keratocyst, MCM, Bax, Bcl2, Ki-67, apoptosis, decompression.

Chronic mandibular hypomobility related to a unilateral accessory condyle. A case report.

BACKGROUND: Chronic mandibular hypomobility is characterized by a long-standing limitation of the mouth opening related to multiple etiologies, including elongation of the coronoid apophysis. Unlike the most frequent pathologies that cause coronoid elongation, such as hyperplasia, osteoma (OM), and osteochondroma (OC), the accessory mandibular condyle (AMC) is a rare entity. Clinical Presentation: The AMC shows a configuration similar to a normal mandibular condyle with an articular surface covered by fibrocartilage that articulates with the temporal wall of the zygomatic bone, and histologically, does not show neoplastic growth. The patient was treated with a coronoidectomy, removing the coronoid apophysis as well as the AMC. CLINICAL RELEVANCE: This case report presents a case of an AMC to describe the clinical, imaging, surgical, and histological characteristics, establishing its differential diagnosis with hyperplasia, OM, and OC of the coronoid apophysis.

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.

Perilipin 1 and adipophilin immunoexpression suggests the presence of lipid droplets in tooth germ, ameloblastoma, and ameloblastic carcinoma.

BACKGROUND: Increased lipogenesis and lipid droplet accumulation are observed in diverse tumors, and these processes are associated with poor prognosis in several tumors, representing potential therapeutic targets. The presence of lipid droplets in odontogenic tissues and/or tumors is unknown. METHODS: Immunohistochemistry for perilipin 1 and adipophilin was performed in 12 human tooth germs (TG), 27 conventional ameloblastoma (AM), and 8 ameloblastic carcinoma (AC) samples. Cytoplasmic staining was analyzed using an immunoreactive score (IRS), and the results were compared for the TG, AM, and AC samples by Kruskal-Wallis test followed by Dunn's post-test and confirmed by Mann-Whitney U test. RESULTS: Perilipin 1 was negative in 91.7% of the TG samples, positive in 48.2% of the AM samples, and positive in 87.5% of the AC samples. Adipophilin was positive in 100% of the TG samples, 92.6% of the AM samples, and 100% of the AC samples. The perilipin 1 and adipophilin IRS revealed statistically significant differences between the TG, AM, and AC samples (p = .007 and p = .018, respectively). The perilipin 1 levels among the TG and AC samples were statically significant (**p = .0085), as well as the adipophilin levels when TG and AM samples were compared (**p < .0029). CONCLUSIONS: Adipophilin exhibits significant activity in human tooth development. The immunoexpression of perilipin 1 and adipophilin in the AM and AC samples suggests the presence of lipid droplets, providing further evidence of metabolic alterations in these tumors. Additional studies with larger samples and alternative techniques are necessary to confirm these findings.

Expression of caveolin-1 in tooth germ, ameloblastoma and ameloblastic carcinoma / Expresión de caveolina-1 en germen dental ameloblastoma y carcinoma ameloblástico

Background: The caveolin-1 protein (structural component of membrane caveolae) plays important roles in sev-eral biological functions, such as endocytosis, cell adhesion, and cell signaling. However, this protein has been as-sociated with mechanisms of tumorigenesis in several neoplasms. The expression patterns and roles of caveolin-1in the oral epithelium and in embryonic and odontogenic tumor tissues are still unclear.Material and Methods: The expression of caveolin-1 was evaluated in samples of the normal gingival epithelium(n=7), human tooth germ (TG) (n=12), ameloblastoma (AM) (n=83), and ameloblastic carcinoma (AC) (n=9) byimmunohistochemistry. Additionally, AM samples were analyzed by qRT-PCR and Western blot.Results: Most TG (91.7%), AM (73.5%) and AC (100%) samples showed diverse patterns of immunohistochemicalpositivity for caveolin-1, while only one gingival sample was positive. The transcript levels of cav-1 were signifi-cantly upregulated by 14.9-fold in AM tissue (P = 0.0014) compared to those in normal gingival epithelial tissue,as shown by qRT-PCR. Presence of caveolin-1 protein was confirmed by Western blot analysis. The caveolin-1immunoexpression patterns throughout the stages of TG show its importance during odontogenesis.Conclusions: The overexpression of caveolin-1 in AM and AC compared to its expression in normal gingivalepithelium (adult tissue) suggests a possible role of caveolin-1 in protumoral events, but due to the similar immu-noexpression observed in AM and AC, caveolin-1 may not necessarily participate in the malignant transformationprocess. However, future studies are needed to clarify and confirm these hypotheses.(AU)

Expression of Interleukin-1ß and Interleukin-8 in Oral Potentially Malignant Disorders and Carcinomas.

Objective: To evaluate interleukin-1ß (IL-1ß) and interleukin-8 (IL-8) epithelial expressions in potentially malignant disorders of the oral mucosa as malignant predictive markers. Study design: About 55 tissues embedded in paraffin, comprising 15 oral lichen planus (OLP) lesions, 15 leukoplakias, 15 oral squamous cell carcinomas (OSCC), and 10 samples of normal oral mucosa were included in the study. IL-1ß and 8 expressions were assessed by immunohistochemistry using antibodies antihuman IL-1ß human (sc-7884, Santa Cruz® H-153) and antihuman IL-8 (ab7747, abcam®). The number of positive cells was compared using Student's t-test. Any p-value < 0.05 was considered statistically significant. Results: Nuclear and cytoplasmatic keratinocyte staining were positive for both cytokines in all study groups. However, a statistically significant decrease was observed within all cases compared to normal mucosa, both staining for IL-1ß and 8. Moreover, IL-8 showed significant differences between OLP and leukoplakia, and when compared to OSCC. Conclusions: Oral epithelial expression of IL-1ß and 8 seems to decrease when the malignant transformation of the oral mucosa increases.

Oral manifestations associated with antimalarial therapy in patients with systemic lupus erythematosus.

INTRODUCTION: Lupus erythematosus (LE) is an autoimmune disease often treated with antimalarial drugs. The prolonged use of chloroquine and hydroxychloroquine can cause hyperpigmentation in the skin, oral mucosa and retinal pigment epithelium, which in turn can trigger toxicity in this epithelium, which in some cases causes vision loss. The objective of the present work was to establish the association between the presence of oral pigmented macules by antimalarial and secondary retinal toxicity. METHODS: A total of 105 patients diagnosed with LE being treated with chloroquine/hydroxychloroquine were evaluated. All patients were ophthalmologically evaluated for retinopathy screening. When the patient showed oral hyperpigmented maculae, an incisional biopsy was performed with the corresponding histopathological study with informed consent. The variables were compared using the chi-square test for quantitative variables and the non-parametric Mann-Whitney U-test for categorical variables. The confidence level was established at 95%, and p-values of ≤0.005 were considered statistically significant. RESULTS: Only 9.5% of the patients showed oral brown spots. Histopathologically, 100% of the oral macules showed characteristics of oral pigmentation by drug and 100% ophthalmological parameters of normality. Two patients presented with a diagnosis of pre-retinopathy, but none showed oral lesions. CONCLUSION: Hyperpigmented macules in the buccal mucosa in lupus patients receiving antimalarial treatment are not frequent and do not represent a predictive finding of toxicity of the drug.

Presentación inusual de cavidad ósea de Stafne: estudio mediante tomografía computarizada y resonancia magnética / Unusual Stafne ́s osseous cavity presentation: computerized tomography and magnetic resonance imaging study

La cavidad ósea de Stafne (CS) ha sido descrita como una radiolucencia oval, de bordes definidos y corticalizados, localizada por debajo del conducto mandibular entre el primer molar y el ángulo de la mandíbula. Casos atípicos de presentación de la cavidad en forma lobulada con márgenes irregulares, escleróticos o incompletos, así como una localiza- ción inusual requieren el empleo de métodos imagenológicos que posibiliten realizar un diagnóstico diferencial, evitando un procedimiento invasivo. El objetivo del presente trabajo fue describir un caso de CS en un paciente masculino de 74 años de edad, con antecedente de cáncer de próstata. Las imágenes de tomografía computarizada de haz cónico evidenciaron una cavidad abierta hacia la tabla lingual por debajo del conducto mandibular. Las imágenes de resonancia magnética y tomografía computarizada mul- ticorte permitieron identificar el contenido del defecto, identificado en ambos méto- dos imagenólogicos como tejido adiposo. El examen radiográfico de una CS de aspecto atípico debe ser complementado con estudios tomográficos y de resonancia magnética, estos proporcionan información relevante para el diagnóstico definitivo, limitando la rea- lización de una exploración quirúrgica. En el caso clínico presentado, la caracterización de la extensión del defecto, su relación con los dientes y estructuras vecinas, así como la identificación del contenido permitieron descartar la presencia de una metástasis de cáncer de próstata.

The Stafne bone cavity (SC) has been described as an oval radiolucence, with defined and corticalized edges located below the jaw duct between the first molar and the angle of the jaw. Atypical cases of presentation of the cavity in lobed form with irregular, scle- rotic or incomplete margins, as well as an unusual location require the use of imaging methods that make possible a differential diagnosis, avoiding an invasive procedure. The purpose of this work was to describe a case of SC in a 74-year-old male patient, with a history of prostate cancer. Cone beam computed tomography images showed an open cavity toward the lingual table below the mandibular canal. Magnetic resonance imaging and multi-cut computerized tomography allowed identifying the defect content, found adipose tissue. The radiographic examination of an atypical SC should be complemented with tomographic and magnetic resonance studies; these provide relevant information to the definitive diagnosis, limiting the performance of a surgical examination. In the clinical case presented, the characterization of the extension of the defect, its relationship with neighboring teeth and structures, as well as the identification of the content allowed us to rule out the presence of a prostate cancer metastasis

Estudio de apoptosis y adhesión intercelular en mucosa oral de pacientes con osteonecrosis inducida por bifosfonatos / Study of apoptosis and intercellular adhesion in oral mucosa of patients with osteonecrosis induced by biphosphonates

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Detection of MAPK/ERK pathway proteins and KRAS mutations in adenomatoid odontogenic tumors.

OBJECTIVE: This study aimed to assess the frequency of KRAS mutation and its association with the presence of the MAPK/ERK signaling pathway proteins in adenomatoid odontogenic tumors. STUDY DESIGN: Paraffin-embedded tissue samples from nine cases of adenomatoid odontogenic tumor were used. Genomic DNA was extracted from each sample; in one case, genetic mutations in 50 cancer-associated genes were examined by next-generation sequencing. Hotspot mutations in the RAS family were analyzed by Luminex assay using the remaining eight cases. Subsequently, immunohistochemistry for KRAS, CRAF, BRAF, EGFR, ERK, MEK, and BRAFV600E was performed. RESULTS: A KRAS G12D missense mutation was detected in the DNA sequence of the tumor cells, but it was not detected in the stromal tissue. KRAS G12V and KRAS G12R mutations were detected in two and four cases, respectively. For immunohistochemistry, all the cases were EGFR, KRAS, BRAF, CRAF positive, one case was ERK negative,and one case was MEK and ERK negative, all the other remaining cases were MEK and ERK positive. CONCLUSION: KRAS mutation at codon 12 and the presence of MAPK/ERK pathway proteins were detected suggesting their association with tumorigenesis of adenomatoid odontogenic tumors.