Oral squamous cell carcinoma from users and nonusers of tobacco and alcohol: clinicopathologic features and immunoreactivity of VEGF, caspase-3, and p53.

OBJECTIVES: The objective of this study was to compare the clinicopathologic characteristics and immunoreactivity of vascular endothelial growth factor (VEGF), caspase-3, and p53 between oral squamous cell carcinomas from users and nonusers of tobacco and alcohol. DESIGN: We randomly selected 90 specimens of oral carcinomas, from patients diagnosed between 1991 and 2011 in Oral Medicine Division. The specimens were distributed into 3 groups according to exposure to risk factors: 30 specimens from smokers, 30 from smokers/alcohol drinkers, and 30 from individuals not exposed to these factors. The clinicopathologic characteristics of the lesions were evaluated and the proteins VEGF, caspase-3, and p53 were detected by immunohistochemistry. RESULTS: The group of nonsmokers/nonalcohol drinkers consisted mainly of women (P≤0.001), with a higher mean age (P=0.004). The group of smokers/alcohol drinkers exhibited larger tumors when compared with patients not exposed to smoking and alcohol (P=0.004). The histopathologic grading also differed between these groups (P=0.040), because a greater number of grade I lesions and fewer grade III lesions were found in patients who were nonsmokers/nonalcohol drinkers. No significant difference was observed in relation to immunoreactivity of VEGF (P=0.315), caspase-3 (P=0.860), and p53 (P=0.876) between the groups. CONCLUSIONS: There are substantial clinicopathologic differences between oral carcinomas in users and nonusers of tobacco and alcohol. Immunodetection of the proteins VEGF, caspase-3, and p53 is not influenced by smoking or alcohol consumption, suggesting that other molecular mechanisms are associated with the biological aggressiveness of oral carcinoma in patients exposed to these risk factors.

Aetiology and therapeutics of burning mouth syndrome: an update.

OBJECTIVE: To provide a review on the aetiology and therapeutic options for the management of patients with burning mouth syndrome (BMS). BACKGROUND: BMS is a chronic disorder that frequently affects women and is characterised by burning symptoms of the oral mucosa without clinical signs. This syndrome has a complex and multifactorial characteristics, but its aetiology remains unknown and this makes it difficult with regard to the treatment and management of such patients. Despite not being accompanied by evident organic changes and not presenting risks to health, BMS can significantly reduce the quality of life for patients. METHODS AND MATERIALS: The article reviews the literature regarding aetiologic factors, clinical implications and treatment of BMS. CONCLUSION: involvement of neurological, emotional and hormonal alterations is proposed in BMS aetiology. However the mechanisms of its development are complex and not completely understood. Tricyclic antidepressants, benzodiazepines and antipsychotic drugs are the most accepted options in treatment and show variable results. The correct diagnosis of BMS and the exclusion of possible local or systemic factors that can be associated with the symptoms are fundamental. It is also important to evaluate the quality of life for these patients to recognise the potential impact of this condition on their lives.

Characteristics of oral squamous cell carcinoma in users or non users of tobacco and alcohol / Características do carcinoma bucal de células escamosas em usuários ou não usuários de tabaco e álcool

Tobacco and alcohol are the main extrinsic etiological factors for the genesis of oral squamous cell carcinoma (SCC), but it is still not clear if the presence of these factors interfere with clinical, pathologic and molecular characteristics or with the prognosis of the disease. In the present study, these characteristics were reviewed, establishing comparisons between the lesions of patients exposed and not exposed to tobacco and alcohol. We observed that oral SCC in non smokers and non alcohol drinkers occur mainly in female patients, under 50 or over 70 years old. The lesions tend to be less aggressive in this group of patients and have a better prognosis. The molecular characteristics of these malignant tumors also appear to be influenced by the presence of these habits, once mutations of p53 have been associated with tobacco and alcohol use. The understanding of the differences between the neoplasms of these two groups of patients can contribute to the management of this cancer, which could lead to advances in the determination of more appropriate therapeutic measures.

O tabaco e o álcool são os principais fatores etiológicos extrínsecos associados à gênese do carcinoma bucal de células escamosas (CCE), mas não está claro se estes fatores interferem nas características clínico-patológicas, moleculares ou no prognóstico da doença. No presente estudo, essas características foram revisadas, estabelecendo-se comparações entre as lesões de pacientes usuários ou não de tabaco e álcool. Observou-se que carcinomas bucais de não fumantes e não etilistas ocorrem, preferencialmente, em pacientes do sexo feminino, em faixa etária inferior a 50 ou superior 70 anos. Neste grupo de indivíduos, as lesões tendem a ser menos agressivas e apresentam melhor prognóstico. O tabagismo e o etilismo também parecem influenciar as características moleculares do carcinoma bucal, uma vez que mutações da proteína p53 nas lesões têm sido associadas a esses fatores de risco. A compreensão das diferenças entre os CCE bucais desses dois grupos de pacientes pode contribuir para uma melhor abordagem e avanços no desenvolvimento de medidas terapêuticas mais adequadas frente a esta neoplasia.

The role of epigenetic transcription repression and DNA methyltransferases in cancer.

Epigenetic alterations such as DNA methylation have been implicated in the development and progression of various cancers. DNA methylation consists of the reversible addition of a methyl group to the carbon 5 position of cytosine in CpG dinucleotides and is considered essential for normal embryonic development. However, global genomic hypomethylation and aberrant hypermethylation of regulatory regions of tumor suppressor genes have been associated with chromosomal instability and transcription repression, respectively, providing neoplastic cells with a selective advantage. DNA methyltransferases are the enzymes responsible for the addition of methyl groups to CpG dinucleotides, which, together with histone modifiers, initiate the events necessary for transcription repression to occur. It has been demonstrated that increased expression of DNA methyltransferases may contribute to tumor progression through methylation-mediated gene inactivation in various human cancers. Given their importance, this article reviews the main epigenetic mechanisms for regulating transcription and its implications in cancer development.

Perfil hematológico e níveis de vitamina B12, ferro e ácido fólico de pacientes com ulceração aftosa recorrente / Hematologic status and vitamin B12, iron and folic acid levels in patients with recurrent aphtous stomatitis

A ulceração aftosa recorrente (UAR) é uma das doenças mais comuns da mucosa bucal. Apesar das constantes investigações, sua etiologia permanece desconhecida e uma abordagem terapêutica curativa ainda não existe. O presente trabalho teve por objetivo investigar o perfil hematológico, os níveis séricos de vitamina B12, de ácido fólico e de ferro em pacientes com UAR e compará-los com os indivíduos de controle. Para tanto foram incluídos neste estudo quarenta pacientes com UAR e quarenta indivíduos de controle sem histórico conhecido da doença, emparelhados por sexo e idade. Os prontuários dos pacientes foram analisados, bem como os resultados dos exames laboratoriais: contagem de eritrócitos, hemtócrito, volume corpuscular médio, níveis de hemoglobina, de vitaminas B12, de ácido fólico e de ferro. Dez por cento dos pacientes com UAR apresentaram anemia e 7,5 por centoexibiram deficiência de vitamina B12 e de ácido fólico. Em 12,5 por cento dos casos foi observada deficiência de ferro. Não houve diferença significativa entre os grupos quanto às variáveis hematológicas e nutricionais investigadas, apesar de os pacientes com UAR terem exibido níveis inferiores de vitamina B12. Conclui-se que as alterações hematológicas e nutricionais analisadas não exibiram associação com UAR. Entretanto, o hemograma, as dosagens séricas de ferro, de ácido fólico e, principalmente, de vitamina B12 deveriam ser incluídos na investigação de pacientes com UAR, uma vez que a diminuição da espessura da mucosa promovida pelas alterações desses elementos pode predispor ao desenvolvimento de lesões aftosas

Prevalência de candidose bucal em pacientes hospitalizados e avaliação dos fatores de risco / Prevalence of oral candidiasis in hospitalized patients and evaluation of risk factors

Introdução: A candidose bucal (CB) é uma infecção fúngica oportunista,prevalente principalmente em pacientes imunossuprimidos. Objetivo:Investigar a prevalência de CB nos pacientes internados em dois hospitais universitários da Pontifícia Universidade Católica do Paraná,em Curitiba (PR), relacionando-a com fatores predisponentes locais e sistêmicos. Material e métodos: Um total de 160 pacientes foi avaliado entre os meses de julho e outubro de 2006. Além da análise do prontuário, cada paciente foi interrogado e avaliado de modo clínico intraoral e extraoralmente, buscando o reconhecimento delesões compatíveis com candidose. Resultados: Os resultados foram analisados pelos testes do qui-quadrado (x2) e da diferença entreduas proporções, com nível de significância de 5%. A prevalência de candidose foi de 30% (n = 48). Em relação aos fatores de risco locais,a prevalência foi dependente estatisticamente do uso de prótese total ou parcial removível superior, do tempo de uso da mesma prótese,da utilização da prótese no período de internação, da condição dehigiene, da frequência de higienização e do uso contínuo da prótese(p < 0,05). Entre os fatores sistêmicos analisados, a prevalência da doença manifestou relação significante com a idade do paciente eo uso de sonda nasogástrica (p < 0,05). Conclusão: Os resultados indicam que fatores de risco locais apresentam forte associação comCB em pacientes hospitalizados, enfatizando a importância quantoaos cuidados de higiene bucal e com a prótese desses pacientes,principalmente de usuários de sonda nasogástrica.

Introduction: Oral candidiasis (OC) is an opportunistic fungal infection, prevalent mainly in immunosuppressed patients. Objective:To investigate the prevalence of OC in hospitalized patients in two university hospitals of Pontifical Catholic University of Paraná, Curitiba-PR, relating with local and systemic predisposing factors. Material and methods: A total of 160 patients were evaluated between the monthsof July to October 2006. Besides the analysis of medical records, each patient was questioned and intra-and extra-oral clinically evaluated,looking for injuries consistent with candidiasis. Results: The results were analyzed by the tests of the chi-square (x2) and the difference between two ratios, with a level of significance of 5%. Prevalence oforal candidiasis was 30% (n = 48). In relation to the local risk factors,prevalence of oral candidiasis was statistically dependent on the use ofupper removable total or partial prosthesis, on the time of use of the same prosthesis, on the use of prosthesis during hospitalization, on the hygiene condition, on the frequency of cleaning and on the continued use of the prosthesis (p < 0.05). Among the systemic factors analyzed,prevalence of oral candidiasis was statistically dependent on the age ofthe patients and on the use of nasogastric probe (p < 0.05). Conclusion:Results indicate that local risk factors have a strong association with the prevalence of OC in hospitalized patients, emphasizing the importance regarding the oral hygiene care and the prosthesis of these patients,especially the ones that use a nasogastric probe.

DNA ploidy in oral lichen planus, determined by image cytometry.

BACKGROUND: The objective of this study was to use image cytometry to determine the degree and frequency of DNA ploidy in biopsies of reticular and atrophic-erosive oral lichen planus and to analyze 14 karyometric measurements of the nuclei of epithelial cells from each specimen. METHODS: A total of 40 slides were analyzed, each of them representing one biopsy of one oral lichen planus (OLP) lesion from each one of the 40 patients (cases) studied. Specimens were embedded in paraffin and comprised 20 slides of reticular oral lichen planus (group R) and 20 slides of atrophic-erosive oral lichen planus (group AE). RESULTS: Group R, the reticular lichen samples, had 18 diploid cases and two aneuploid cases. Group AE, the atrophic-erosive lichen samples, had 10 diploid cases, one tetraploid case, and nine aneuploid cases. Of the 14 karyometric measurements of the nuclei of OLP epithelial cells analyzed, the group R mean values for mean density and minimum density were significantly greater than the group AE mean values, and mean roundness in group AE was significantly greater than in group R (t-test: P < 0.05). CONCLUSIONS: The most common degree of DNA ploidy in OLP lesions was diploidy. Comparing the two groups (chi-square test of association P = 0.021) demonstrated that diploidy was associated with the reticular clinical form of OLP, while aneuploidy was associated with the atrophic-erosive clinical form of oral lichen planus.

Study of intussusceptive angiogenesis in inflammatory regional lymph nodes by scanning electron microscopy.

The aim of the present study was to verify the occurrence of intussusceptive angiogenesis in blood vessels from submandibular lymph nodes responsible for lymphatic drainage of the tongue. A surgical wound inflicted on the ventral tongue of male Wistar rats and submandibular regional lymph nodes were evaluated at different postoperative periods. Scanning electron microscopy (SEM) was used to observe 123 lymph nodes at times 2, 3, 7, 10, 14, and 21 postoperative days. During the analysis of the vascular models with SEM, intussusceptive angiogenesis was observed in all groups evaluated. This was more extensive on the second and third postoperative days (83.33% and 80%, respectively), representing in these groups the expansion of the vascular chain of lymph nodes. At 21 postoperative days, intussusceptive angiogenesis (42.85%) was suggestive of vascular remodeling.

Amalgam tattoo in a patient with prior history of melanoma: a case report / Tatuagem por amálgama em paciente com história pregressa de melanoma: relato de caso

Purpose: Black macules on the oral mucosa may be diagnostic of melanotic macule, melanotic nevus, amalgam tattoo or oral pigmented lesions caused by endodontic sealers, vascular lesions and melanoma. The differential diagnosis of such lesions is important as melanoma may be quite serious and must be treated quickly. A case of black macule on the oral mucosa is reported here, focusing on the importance of the differential diagnosis instituted. Case description: A 56-year-old female patient with a previous history of cutaneous melanoma consulted the Stomatology Service for evaluation of a black macule on the floor of the mouth. The diagnosis was found to be amalgam tattoo, although a radiographic exam had not shown an image compatible with amalgam. Conclusion: The diagnosis of amalgam tattoo can be confirmed by the detection of a metallic fragment in a radiographic exam, a situation that dispenses with the institution of treatment. However, if such a fragment is not detected, a biopsy is necessary to rule out the diagnostic hypothesis of melanocytic neoplasia.

Objetivo: As máculas negras que acometem a mucosa oral incluem os diagnósticos de mácula melânica, nevo melânico, tatuagem por amálgama ou por cimento endodôntico, lesões vasculares e melanoma. O diagnóstico diferencial de tais lesões é importante considerando-se a gravidade desta última. Os autores relatam um caso de mácula negra na mucosa oral enfatizando a importância do diagnóstico diferencial e a conduta instituída. Descrição do caso: Paciente do sexo feminino, 56 anos de idade, com história prévia de melanoma cutâneo, consultou o Serviço de Estomatologia para avaliação de mácula negra em assoalho de boca. O diagnóstico foi de tatuagem por amálgama, embora o exame radiográfico não exibisse imagem compatível com fragmento metálico. Conclusão: O diagnóstico de tatuagem por amálgama pode ser confirmado por meio da detecção de fragmentos metálicos ao exame radiográfico, situação que dispensa a instituição de tratamento. Entretanto, se os fragmentos não forem detectados, a biópsia se faz necessária para descartar a hipótese de neoplasia melanocítica.

Oral erythroplakia and speckled leukoplakia: retrospective analysis of 13 cases.

UNLABELLED: Erythroplakia and speckled leukoplakia are oral precancerous lesions that have a high potential for malignant transformation. AIM: A retrospective analysis was conducted to investigate the clinicopathologic features of 13 cases of oral erythroplakia and speckled leukoplakia in patients who were seen at a center specialized in stomatology and Histopathological diagnosis of oral diseases. MATERIALS AND METHODS: All cases diagnosed with erythroplakia and speckled leukoplakia between 1978 and 2006 were retrieved from the service archives. RESULTS: The lesions exhibited a predilection for males with a female-to-male ratio of 1:3.3. Mean age was 57 years old and soft palate was the site affected in 77% of the cases. Pain symptoms were reported by 61.5% of the patients and association with risk factors such as smoking and excessive alcohol intake was seen in 100% and in 46% of the cases, respectively. The lesions showed epithelial dysplasia, where more than 50% were diagnosed as in situ or invasive carcinoma. CONCLUSIONS: Despite low prevalence, oral homogeneous erythroplakia and speckled leukoplakia show Histopathological alterations vary from epithelial dysplasia to invasive carcinoma. These lesions must be included among those oral lesions with the highest potential for malignant tranformation.

Eritroplasia e leucoeritroplasia oral: análise retrospectiva de 13 casos / Oral erythroplakia and speckled leukoplakia: retrospective analysis of 13 cases

Eritroplasia e leucoeritroplasia são lesões orais cancerizáveis com elevado potencial de transformação maligna. OBJETIVOS: Neste estudo retrospectivo foram analisadas as características clínico-patológicas de 13 casos de eritroplasias e leucoeritroplasias orais de pacientes atendidos em um Serviço especializado em Estomatologia e diagnóstico histopatológico. MATERIAL E MÉTODO: Foram revisados os registros de biópsia de pacientes atendidos entre os anos de 1978 e 2006. Foram registradas e características clínicas e histopatológicas das lesões, bem como sexo, idade dos pacientes e associação com fatores de risco. RESULTADOS: As lesões exibiram predileção por pacientes do sexo masculino na proporção de 1:3.3. A média etária dos indivíduos foi de 57 anos e o palato mole foi o sítio envolvido em 77 por cento dos casos. Sintomatologia dolorosa foi relatada por 61,5 por cento dos pacientes e associação com tabagismo e etilismo foi observada em 100 por cento e em 46 por cento dos casos, respectivamente. As lesões analisadas exibiam displasia epitelial e mais de 50 por cento foram diagnosticadas como carcinoma in situ ou carcinoma invasivo. CONCLUSÕES: Apesar de apresentarem baixa prevalência, as eritroplasias homogêneas e as leucoplasias salpicadas exibem alterações epiteliais que vão de displasia epitelial a carcinoma invasivo, o que justifica sua inclusão entre as lesões bucais com maior potencial de malignização.

Erythroplakia and speckled leukoplakia are oral precancerous lesions that have a high potential for malignant transformation. AIM: A retrospective analysis was conducted to investigate the clinicopathologic features of 13 cases of oral erythroplakia and speckled leukoplakia in patients who were seen at a center specialized in stomatology and Histopathological diagnosis of oral diseases. MATERIALS AND METHODS: All cases diagnosed with erythroplakia and speckled leukoplakia between 1978 and 2006 were retrieved from the service archives. RESULTS: The lesions exhibited a predilection for males with a female-to-male ratio of 1:3.3. Mean age was 57 years old and soft palate was the site affected in 77 percent of the cases. Pain symptoms were reported by 61.5 percent of the patients and association with risk factors such as smoking and excessive alcohol intake was seen in 100 percent and in 46 percent of the cases, respectively. The lesions showed epithelial dysplasia, where more than 50 percent were diagnosed as in situ or invasive carcinoma. CONCLUSIONS: Despite low prevalence, oral homogeneous erythroplakia and speckled leukoplakia show Histopathological alterations vary from epithelial dysplasia to invasive carcinoma. These lesions must be included among those oral lesions with the highest potential for malignant tranformation.

Angioarchitecture of the ventral surface of the tongue from Wistar rats.

The goal of this study was to describe the angioarchitecture of the ventral surface of the tongue from Wistar rats using a vascular corrosion casting technique associated with scanning electron microscopy (SEM). Six Wistar rats were used for the vascular casting method with Mercox resin. Following the resin polymerization, the tongue of each animal was dissected and corroded in a 5% sodium hydroxide solution. Once the corrosion and drying of the specimens were completed, the specimens were mounted on aluminum stubs, coated with carbon and gold and analyzed under SEM. The results showed that the ventral surface of the tongue presents simple, even and abundant vasculature constituted by a vascular plexus consisting of a superficial vascular network and by the ranine veins. The superficial vascular network, made up of the ascending and descending branches, presents as a loose network, with little morphological variation between the capillary loops.

Contribution to the study of the vasculature of submandibular and sublingual glands and lymph nodes of rats by corrosion cast technique combined with scanning electron microscopy.

The study of anatomical structures in their normal state allows the identification of pathological changes that can occur in them. Angiogenesis and the vasculature have been widely studied, mainly because of their association with the development of neoplasms. One of the methods applied for such purposes is the corrosion cast technique, which provides a copy of the vessels with normal as well as pathological structures. The replica of the vasculature provided by this technique allows the three-dimensional analysis of vessels by means of scanning electron microscopy. The aim of the present study was to demonstrate, by means of corrosion casts, the angioarchitecture of the submandibular and sublingual glands and lymph nodes. Scanning electron microscopy showed that the three structures have distinct vascular patterns. The corrosion cast technique can be employed in the study of the angioarchitecture of the submandibular and sublingual glands and lymph nodes, but requires specific precautions. The removal of the structures en bloc and the handling of the replicas with the aid of a stereoscopic magnifier reduce the risk of fractures.

Extensive myiasis infestation over a squamous cell carcinoma in the face. Case report.

Human myiasis is a parasitosis found in tropical and underdeveloped countries. It usually affects the elderly, unhealthy and mentally disabled individuals. It is caused by dipterous that lay their eggs in necrotic or infected tissues, although areas of the body that are apparently healthy can also be affected. Frequently the fly deposits several eggs on the peripheral parts of scratches and wounds. The treatment of myiasis involves mechanical removal of the larvae with hemostatic pincers. Larvae rupture must be avoided. Application of topical ether or similar volatile substance is useful. Preventive approach measures, including basic health care, hygiene, access to primary health service, and safe water and drainage, are fundamental to prevent human myiasis. The authors present a case report of myiasis infestation over an extensive head and neck squamous cell carcinoma from a 72-year-old patient living in a rural area. Approximately 200 larvae were removed and the patient was taken to the hospital's head and neck surgery service.

Vascular corrosion casting technique steps.

The vascular corrosion casting technique produces a replica of vascular beds of normal or pathological tissues. Once associated with scanning electron microscopy (SEM), this technique provides details of the three-dimensional anatomic arrangement of the vascular replica, which is the main advantage of this method. The present study is intended to describe the steps of the vascular corrosion casting technique and the different ways to perform them. them.

Association between recurrent aphthous stomatitis and salivary thiocyanate levels.

The aim of this work was to investigate the association between recurrent aphthous stomatitis (RAS) and salivary thiocyanate levels. The sample comprised men and women of age ranging from 15 to 55 years, who were allocated to four groups: 28 patients in RAS active phase (group 1); 28 patients in RAS remission phase (group 2); 29 smokers (group 3); 26 non-smokers without RAS (group 4). Samples of whole saliva mechanically stimulated were collected, and thiocyanate levels were measured. The results were analyzed by ANOVA and paired t-test. Mean salivary thiocyanate values were 0.55 mM, 0.64 mM, 2.36 mM and 0.96 mM in groups 1 (active RAS), 2 (remission RAS), 3 (smokers) and 4 (control), respectively. There was no significant difference in thiocyanate levels when groups 1 and 2 were compared with group 4. Group 3 showed a significantly higher thiocyanate concentration when compared with groups 1, 2 and 4 (P < 0.05). There was no significant difference in thiocyanate levels between groups 1 and 2 (P > 0.05). It is therefore suggested that there is no association between RAS and salivary thiocyanate levels.

Squamous cell carcinoma of the tongue after bone marrow transplantation in a patient with Fanconi anemia.

Fanconi anemia (FA) is an autosomal recessive disorder that might cause a variety of congenital and developmental abnormalities. The most important features of FA are progressive bone marrow failure and development of malignancies, particularly acute myeloid leukemia and solid tumors. This paper reports the case of a 12-year-old patient with FA assisted at the Stomatology and Bucomaxillofacial Cancer Prevention Service of São Lucas Hospital, Brazil, who had been submitted to bone marrow transplantation (BMT) at the age of 5 and exhibited oral lesions characteristic of chronic graft versus host disease (GVHD). The patient was treated and followed-up for the oral lesions. Eleven years after the BMT, he developed squamous cell carcinoma of the tongue with an aggressive behavior, which was considered an untreatable condition. The patient died few months later from asphyxia at the age of 16. The reasons for development of these malignant conditions are unknown. However, chromosomal instability typically observed in FA cases, BMT factors and GVHD have been considered. Systematic follow-up of these patients allows early and less invasive therapeutic approaches.

Histologic evaluation of effect of thiocyanate topical application on hamster cheek pouch.

The present study was conducted to investigate the effect of topical thiocyanate (SCN(-)) application on hamster cheek pouch mucosa. Sixty-six hamsters were divided into two groups. The test substance containing potassium thiocyanate was applied on the hamsters' cheek pouches at 55 mg/kg dosages. Cheek pouches were grossly examined after 12 weeks. Histometric evaluation included height measurements from the epithelium without stratum corneum, stratum corneum, and full epithelium. Clear cells frequency was compared between groups. Results were analyzed using Student's t test. The experimental group showed a lower height of the stratum corneum (p=0.035) and higher frequency of clear cells (p<0.001). There was no height difference for the epithelium without stratum corneum (p=0.677) and full epithelium (p=0.904) between groups. SCN(-) promotes no gross alterations on hamsters' cheek pouch and does not induce dysplastic features at the epithelium or inflammation at the connective tissue. The ion promotes histologic alterations on mucosa that need to be investigated in further studies.

Bisfosfonatos e osteonecrose maxilar: revisão da literatura e relato de dois casos / Biphosphonates and maxillary osteonecrosis: literature review and two case reports

Os bisfosfonatos são medicamentos amplamente administrados a pacientes portadores de metástases tumorais em tecido ósseo e a pacientes com osteoporose. A droga reduz a reabsorção óssea, estimula a atividade osteoblástica,assim como inibe o recrutamento e promove a apoptose de osteoclastos. A associação entre o uso dos bisfosfonatose uma forma peculiar de osteonecrose dos maxilares tem sido relatada, principalmente, em pacientes submetidos a exodontias. No presente estudo, são apresentados dois casos de pacientes em uso de bisfosfonatos para tratamentode metástases ósseas, que desenvolveram osteonecrose maxilar. Na literatura, não há relatos de um tratamento eficaz para a enfermidade, porém o uso de antibióticos por um longo período parece apresentar os melhores resultados. Ainda, a possibilidade de substituição do medicamento deve ser considerada dentro de uma equipe multidisciplinar. Tendo em vista a dificuldade de tratamento e o risco representado pelas intervenções cirúrgicas dos maxilares, pacientes que serão submetidos ao uso de bisfosfonatos devem passar por um criterioso exame odontológico, e todos os procedimentos cirúrgicos necessários devem ser realizados previamente ao início da terapia com o medicamento.

Highly aggressive brown tumor in the jaw associated with tertiary hyperparathyroidism.

The purpose of this paper is to describe the case of a 12-year-old patient with end-stage chronic renal failure. The patient presented with an osteolytic lesion in the mandible with expansion of the buccal, lingual, and occlusal cortical bone, as well as dislocation of the teeth in the area. The calcium, creatinine, and parathormone (PTH) contents of the blood were elevated. A histopathological examination of the jaw lesion revealed the presence of a brown tumor lesion, which is associated with hyperparathyroidism (HPT). An adenoma was found in the upper left parathyroid, a finding compatible with the diagnosis of tertiary HPT. In spite of the continuous ambulatory peritoneal dialysis instituted, the osteolytic lesion kept on growing. A conservative treatment employing an association of intralesional corticosteroid and salmon calcitonin (inhaled) was carried out. After 14 months of therapy, a reduction in size and complete calcification of the lesion were achieved. Aesthetic osteoplasty of the jaw was then performed.