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2.
Chin J Dent Res ; 23(2): 95-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32548599

RESUMO

In December 2019, some new and unexplained cases of pneumonia were found in Wuhan, Hubei province, China, and were later named as coronavirus disease 2019 by the World Health Organisation. The number of cases increased rapidly, and the virus spread continuously. Tens of thousands of medical staff throughout the country have since rushed to Wuhan to provide intensive medical treatment. Due to high levels of stress and work intensity, insufficient sleep and a lack of access to water after entering the isolation ward, staff may suffer from oral mucosal ulcers and other oral mucosal diseases. Police officers, community workers, family members in quarantine and even patients with mild coronavirus 2019, as well as those who have previously had oral mucosal disease, have also reported experiencing discomfort as a result of stress-induced oral mucosal disorders, such as recurrent aphthous ulcers, chronic cheilitis and oral lichen planus. This article will offer some suggestions for the prevention, treatment and care of the above-mentioned oral mucosal diseases during the fight against coronavirus 2019, focusing on measures to deal with the oral mucosal damage caused in response to stress.


Assuntos
Coronavirus , Úlceras Orais , Betacoronavirus , China , Infecções por Coronavirus , Surtos de Doenças , Humanos , Pandemias , Pneumonia Viral
3.
Ned Tijdschr Tandheelkd ; 127(4): 231-235, 2020 Apr.
Artigo em Holandês | MEDLINE | ID: mdl-32459218

RESUMO

An 18-year old woman was referred to the department of oral and maxillofacial surgery with 1 to 2 week episodes of tongue ulcerations that had lasted for a year. Food intake was limited due to pain, resulting in a loss of 10 kg during the previous year. Following a clinical diagnosis of 'aphthous ulcers', she was treated with tetracycline and clobetasol mouthwash, which had little effect. An injection with triamcinolone acetonide did not prove effective either. Some time later, the patient reported at the emergency department with a deep, ulcerative wound to the tongue with characteristic features of bite trauma. She said she had consistently worn her protective mouthguard. The symptoms suggested self-mutilation. The patient was admitted to a psychiatric department, where a diagnosis of anxiety disorder and self-mutilation was reached.


Assuntos
Úlceras Orais , Automutilação , Doenças da Língua , Adolescente , Feminino , Humanos , Antissépticos Bucais , Língua
4.
Br Dent J ; 228(6): 397-398, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32221424
5.
Eur J Paediatr Dent ; 21(1): 66-69, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32183532

RESUMO

AIM: Oro-facial granulomatosis is a descriptive term commonly encompassing a variety of conditions that exhibit similar clinical and microscopic features. It is generally used to describe persistent enlargement of the soft tissues of the oral and maxillofacial region. MATERIALS AND METHODS: We report on the salient clinical features of 8 cases of Crohn's disease in paediatric patients (age range from 9 to 13 years old), with oral lesions as first clinical manifestations. RESULTS: The clinical presentation of oro-facial granulomatosis is highly variable but usually recurrent facial swelling, mainly in the lips with or without intraoral manifestations, is the single most common clinical sign at onset. The association with systemic conditions such as sarcoidosis and Crohn's disease has been widely reported in literature. In paediatric age, oro-facial granulomatosis may frequently represent an extra-intestinal manifestation of Crohn's disease and oral lesions can be the first sign of an unknown intestinal disease. The diagnosis in paediatric patients is challenging as oro-facial granulomatosis may precede Crohn's disease by several years, frequently remaining the only evident active focus of the disease. CONCLUSION: The detection of specific oral manifestations often preceded by painless gingival enlargement (diffuse lip and buccal mucosal swelling, oral cobblestoning, buccal sulcus ulceration and mucosal tags) and/or unspecific or ancillary ones (cheilitis, scaly perioral erythematous rashes and frank intraoral abscess formation, labial and tongue fissuring, glossitis and aphthous stomatitis) is mandatory for the early diagnosis of intestinal Crohn's disease.


Assuntos
Doença de Crohn , Úlceras Orais , Estomatite Aftosa , Adolescente , Criança , Humanos
6.
Rev. ADM ; 77(1): 11-16, ene.-feb. 2020. ilus, tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1087826

RESUMO

Introducción: La epidemiología sobre alteraciones en tejidos blandos bucales es limitada cuando se compara con caries, enfermedades periodontales y maloclusiones, por lo que su estudio representa un paso adelante en la odontología más allá de los dientes. Objetivo: Describir la prevalencia de las lesiones bucales en tejido blando encontradas en la Clínica de Estomatología de la Facultad de Odontología de la ULA, del 2015 al 2018, con la finalidad de proporcionar una fuente de datos actualizada, que oriente a una mejor prevención y oportuno diagnóstico. Material y métodos: Se realizó una investigación descriptiva, documental, retrospectiva y multivariable. Resultados: De 1,000 fichas clínicas estudiadas, las patologías más frecuentes fueron: lengua saburral (50.6%), queilitis (33.4%), traumatismo de la mucosa de los carrillos (27.6%), várices linguales (18.3%), anquiloglosia (13.7%) y agrandamiento de rugas palatinas (11.7%). La zona con mayor alteración fue la lengua (92.1%), mientras que el paladar fue la menos afectada (29%). De los hábitos predisponentes a la formación de lesiones, el mordisqueo de mucosa fue el más común (16.5%). En cuanto a los factores locales asociados, una higiene oral regular/ deficiente resultó el principal (53.8%). Conclusión: La educación del paciente sigue siendo considerada la clave para disminuir la aparición de patologías y su evolución a entidades más graves (AU)


Introduction: Epidemiological studies on soft tissue alterations in the mouth are limited when compared with caries, periodontal diseases and malocclusions, so their study represents a step forward in dentistry beyond the teeth. Objective: To describe the prevalence of soft tissue oral lesions found in the Stomatology Clinic of the ULA School of Dentistry, from 2015 to 2018, in order to provide an up-to-date data source, to guide better prevention and timely diagnosis. Material and methods: A descriptive and documentary, retrospective and multivariable research was carried out. The statistical package IBM SPSS Statistics v 23 was applied for the analysis. Results: 1,000 clinical records studied, the most frequent pathologies were: saburral tongue (50.6%), cheilitis (33.4%), traumatism of the cheek mucosa (27.6%), lingual varices (18.3%), ankyloglossia (13.7%) and enlargement of palatal rugas (11.7%). The tongue was the most affected (92.1%), while the palate was the least affected (29%). Of the predisposing habits to the formation of lesions, mucosal nipping was the most common (16.5%). Regarding the associated local factors, a regular / deficient oral hygiene was the main one (53.8%). Conclusion: Patient education is still considered the key to diminish not only the appearance of pathologies but their evolution to more serious entities (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Doenças da Boca/classificação , Doenças da Boca/epidemiologia , Mucosa Bucal/lesões , Faculdades de Odontologia , Estomatite Aftosa/epidemiologia , Língua Fissurada/epidemiologia , Hábitos Linguais , Língua Pilosa/epidemiologia , Leucoplasia Oral/epidemiologia , Queilite/epidemiologia , Epidemiologia Descritiva , Análise Estatística , Estudos Retrospectivos , Colômbia , Úlceras Orais/epidemiologia , Distribuição por Idade e Sexo , Glossite Migratória Benigna/epidemiologia , Macroglossia/epidemiologia
7.
Rev. ADM ; 77(1): 28-36, ene.-feb. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1087974

RESUMO

Las alteraciones hematológicas pueden tener el primer signo en la cavidad oral y los signos varían dependiendo de la línea celular que se encuentre afectada: eritrocitos, leucocitos y plaquetas. La formación de las células sanguíneas se lleva a cabo en la médula ósea a través de un proceso denominado hematopoyesis que se encarga de la formación, desarrollo y especialización de todas sus células sanguíneas funcionales, pasan de células troncales pluripotenciales a células hematopoyéticas maduras que emergen a la sangre periférica. El odontólogo debe ser capaz de identificar los distintos signos en la cavidad oral que podrían sugerir que el paciente padece un trastorno hematológico, el cual podría complicar el tratamiento dental. La identificación oportuna de estos signos a través de una minuciosa exploración física y la historia clínica completa evita que se presenten complicaciones en el paciente y que éstas puedan poner en riesgo su vida, por lo que al encontrar algún signo sugerente de un trastorno hematológico debe referirse al paciente con el hematólogo (AU)


Hematological alterations may be the first sign in the oral cavity and symptoms vary depending on the cell line that is affected: Erythrocytes, leukocytes and platelets. The formation of blood cells are held in the bone marrow through a process called hematopoiesis, which is responsible for training, development and specialization in all its functional blood cells, they move from pluripotent stem cell to hematopoietic cells mature emerging to peripheral blood. The dentist must be able to identify the different signs in the oral cavity that could suggest that the patient has a haematological disorder, which could complicate dental treatment. The timely identification of these signs through a thorough physical examination and the complete clinical history prevents complications from occurring in the patient and may put their lives at risk, so when finding any sign suggestive of a hematological disorder should refer to the patient with the hematologist (AU)


Assuntos
Humanos , Manifestações Bucais , Transtornos da Coagulação Sanguínea/classificação , Doenças Hematológicas , Doenças Periodontais , Plaquetas , Assistência Odontológica para Doentes Crônicos , Úlceras Orais , Eritrócitos , Leucócitos
8.
Clin Oral Investig ; 24(4): 1591-1597, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31916035

RESUMO

OBJECTIVES: The present research aimed to explore the effect of a mucoadhesive containing Jasminum grandiflorum leaves on the process of oral wound healing in animal samples. MATERIALS AND METHODS: The present double-blinded research was conducted on animals. To this aim, 28 rats were randomly selected and assigned to groups of control and experiment. The lesion was created by punch no. 3 in the midline of the mandibular labial mucosa of all mice. Each group received either a medicine or a placebo exclusively coded. The extent of contraction and wound healing was clinically assessed. To compare the two research groups, chi-squared test, repeated-measure ANOVA, and Mann-Whitney U test were run. SPSS software was used to do the statistical analyses. RESULTS: Statistically significant differences were found between the percentage of wound contraction on the 3rd day (40.91% vs. 16.5%, p = 0.04) and the 7th day (92.9% vs. 69.2%, p = 0.05), wound recovery (57.1% vs. 21.4%, p = 0.05) and degree of inflammation on the 7th day (p = 0.00), type (p = 0.04) and thickness of epithelium (p = 0.00) and type of connective tissue (p = 0.00) on the 14th day. CONCLUSION: Investigations showed that the drug was more effective than the placebo in accelerating wound healing in clinical and histopathological terms. CLINICAL RELEVANCE: Accelerating wound healing in dental treatments and oral ulcers can also affect the quality of life of individuals.


Assuntos
Jasminum/química , Úlceras Orais/tratamento farmacológico , Preparações de Plantas/uso terapêutico , Cicatrização , Animais , Biópsia , Masculino , Distribuição Aleatória , Ratos
9.
J Clin Pediatr Dent ; 44(1): 52-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995413

RESUMO

Oral ulcerations in children and adolescents is a common occurrence and affects about 20-30% of this population. This case report describes a unique and serious autoimmune condition that presented with distinct oral findings that significantly supported the differential diagnosis of Juvenile Systemic Lupus Erythematosus in a 15 year-old female. Pediatric and general dentists should familiarize themselves with the condition to facilitate diagnosis with collaborative efforts with the medical team.


Assuntos
Doenças Autoimunes , Lúpus Eritematoso Sistêmico , Úlceras Orais , Adolescente , Criança , Diagnóstico Diferencial , Feminino , Humanos
10.
Life Sci ; 243: 117243, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31917994

RESUMO

The present study aimed to evaluate the healing process of ulcers in the jugal mucosa of Wistar rats treated with abatacept. The rats were randomly assigned to four groups: saline-treated control (0.3 mL/kg) abatacept-treated groups at dosages of 3.2, 8.0 and 20.0 mg/kg/week. After two weeks of subcutaneous (SC) administration, ulcers were introduced into the left jugal mucosa with an 8-mm diameter punch. SC administration was continued until euthanasia (after 1, 3, 7, 14 and 21 days of ulceration), and ulcers were clinically measured and animals weighed. Histological slides were evaluated (healing scores and polymorphonuclear, mononuclear, vessel, and fibroblast/myofibroblast counts). We also performed collagenesis analysis (Picrosirius Red) and immunohistochemistry (induced nitric oxide synthase (iNOS), interleukin (IL)-1beta (1ß), -6, -10, plus the analysis of CD8 and CD30). The experiment was repeated to perform a vascular permeability assay. ANOVA 1-way or 2-way/Bonferroni and Kruskal-Wallis/Dunn tests were used for statistical analysis (GraphPad Prism 5.0®, p < 0.05). Abatacept treatment reduced the ulcer diameter and the numbers of polymorphonuclear and mononuclear cells; reduced the CD8+/CD30+ ratio and vascular permeability; and increased collagenesis and IL-10 expression at the beginning of the protocol. At the highest dose, there was a delay in repair and vascular proliferation; a reduction in the number of fibroblasts/myofibroblasts; and prolongation of iNOS, IL- and IL- expression. We conclude that abatacept accelerates the healing of oral ulcers by reducing the migration of inflammatory cells, but overdose of abatacept leads to delayed repair and prolongation of proinflammatory cytokine expression.


Assuntos
Abatacepte/uso terapêutico , Antígenos CD8/imunologia , Imunossupressores/uso terapêutico , Interleucinas/metabolismo , Antígeno Ki-1/imunologia , Úlceras Orais/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Abatacepte/administração & dosagem , Abatacepte/farmacologia , Animais , Relação Dose-Resposta a Droga , Imunossupressores/administração & dosagem , Imunossupressores/farmacologia , Úlceras Orais/imunologia , Úlceras Orais/metabolismo , Úlceras Orais/patologia , Ratos , Ratos Wistar
11.
Cytogenet Genome Res ; 160(1): 11-17, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31982875

RESUMO

Small supernumerary marker chromosomes (sSMCs) are characterized as additional centric chromosome fragments which are too small to be classified by cytogenetic banding alone and smaller than or equal to the size of chromosome 20 of the same metaphase spread. Here, we report a patient who presented with slight neutropenia and oral aphthous ulcers. A mosaic de novo sSMC, which originated from 5 discontinuous regions of chromosome 8, was detected in the patient. Formation of the sSMC(8) can probably be explained by a multi-step process beginning with maternal meiotic nondisjunction, followed by post-zygotic anaphase lag, and resulting in chromothripsis. Chromothripsis is a chromosomal rearrangement which occurs by breakage of one or more chromosomes leading to a fusion of surviving chromosome pieces. This case is a good example for emphasizing the importance of conventional karyotyping from PHA-induced peripheral blood lymphocytes and examining tissues other than bone marrow in patients with inconsistent genotype and phenotype.


Assuntos
Cromossomos Humanos Par 8/genética , Cromossomos Humanos Par 8/ultraestrutura , Neutropenia/genética , Úlceras Orais/genética , Estomatite Aftosa/genética , Pré-Escolar , Aberrações Cromossômicas , Transtornos Cromossômicos/genética , Citogenética , Feminino , Marcadores Genéticos , Genótipo , Humanos , Cariotipagem , Linfócitos/metabolismo , Metáfase , Mosaicismo , Neutropenia/complicações , Neutropenia/diagnóstico , Análise de Sequência com Séries de Oligonucleotídeos , Úlceras Orais/complicações , Úlceras Orais/diagnóstico , Fenótipo , Estomatite Aftosa/complicações , Estomatite Aftosa/diagnóstico
12.
Rheumatology (Oxford) ; 59(1): 171-175, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31280296

RESUMO

OBJECTIVES: To evaluate the efficacy and safety of apremilast in treating oral ulcers (OUs), the cardinal and high-disabling feature of Behçet's disease (BD). METHODS: Twelve consecutive patients affected by BD with recurrent/relapsing OUs resistant and/or intolerant to conventional therapy were enrolled and prospectively followed. The primary endpoint was the number of OUs at week 12. Secondary endpoints were modification from baseline to week 12 in Behçet's Syndrome Activity Score (BSAS), Behçet's Disease Current Activity Form (BDCAF) score, Behçet's Disease Quality of Life (BDQOL) scale and pain of OUs, as measured by a visual analogue scale (VAS). All adverse events (AEs) were recorded during follow-up. Non-parametric tests (Wilcoxon rank test) were used and a P-value <0.05 was considered statistically significant. RESULTS: After 12 weeks of apremilast, there was a significant reduction in the number of OUs [0.58 (s.d. 0.67) vs 3.33 (s.d. 1.45) at baseline, P = 0.02] that was paralleled by improvement in disease activity: BSAS was 16.8 (s.d. 9.1) [from 45.9 (s.d. 19.6) at baseline] (P = 0.02), BDCAF score was 0.72 (s.d. 0.65) [vs 2.45 (s.d. 1.0) at baseline] (P = 0.04) and the VAS score for pain decreased to 23.3 (s.d. 13.7) [vs 67.9 (s.d. 17.2) at baseline] (P = 0.02). Consistently, an improvement of BDQOL was assessed (P = 0.02). Clinical improvement led to complete steroid discontinuation in six patients and a tapering of the prednisone dose in two patients (P = 0.016). Colchicine was discontinued in six of nine patients (P = 0.031). AEs related to apremilast occurred in four patients (mainly due to gastrointestinal AEs), leading to drug discontinuation in all of them. CONCLUSION: Our preliminary real-world data support the use of apremilast as an effective therapeutic strategy against BD-related recurrent OUs resistant or intolerant to first-line therapy.


Assuntos
Síndrome de Behçet/tratamento farmacológico , Mucosa Bucal/patologia , Qualidade de Vida , Talidomida/análogos & derivados , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Síndrome de Behçet/complicações , Síndrome de Behçet/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Úlceras Orais/tratamento farmacológico , Úlceras Orais/epidemiologia , Úlceras Orais/etiologia , Estudos Prospectivos , Recidiva , Talidomida/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
13.
BMJ Case Rep ; 12(11)2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31791990

RESUMO

Sarcoidosis is a chronic, multisystemic, granulomatous disease of unknown aetiology characterised by the formation of non-caseating granuloma. It shows slight female predominance and has a bimodal age distribution. Lungs, skin, eye and liver are commonly affected. The oral lesion, though uncommon, may present as submucosal nodule, papule or superficial ulceration. Occasionally, oral lesion may be the first manifestation of underlying systemic disease. This case is interesting because it emphasises that dental practitioners may play a key role in early recognition of the clinical presentation of this multifaceted disease, and thereby aid in the diagnosis of the systemic condition. The present report deals with a case of sarcoidosis affecting the buccal mucosa in a 48-year-old woman. The patient was treated with oral prednisolone and within 4 months of corticosteroid therapy, the oral lesion regressed with no recurrence or new lesion noted over a period of 1 year.


Assuntos
Úlceras Orais/diagnóstico , Sarcoidose/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Úlceras Orais/etiologia , Úlceras Orais/patologia , Sarcoidose/complicações , Sarcoidose/patologia
14.
Clin Exp Rheumatol ; 37 Suppl 121(6): 3-17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856939

RESUMO

Several epidemiologic studies report on the prevalence of Behçet's syndrome (BS) and demographic and clinical findings in patients from different countries and ethnicities. Although these studies point out geographic differences in disease course, methodologic differences make it difficult to compare the results of these studies. Recent data suggest that neutrophil extracellular trap levels are elevated in patients with BS, and that it may be a potential therapeutic target for the reduction or prevention of BS-associated thrombotic risk. Details on the mode of functioning of ERAP have been delineated and further epigenetic data reported. Wall thickness of lower extremity veins is increased among BS patients without any apparent clinical involvement. Magnetic resonance (MR) venography and Doppler ultrasonography (USG) were comparable in the diagnosis of chronic deep vein thrombosis, while MR venography is more effective in detecting collateral formations. Results were also collected on some dietary and non-dietary factors in triggering oral ulcers, while smoking seems to have a protective role. With regards to the therapy, it has been demonstrated that endovascular interventions carry the risk of inducing pathergy phenomenon. Apremilast has been convincingly shown to be useful for oral ulcers of BS and classical immunosuppressives are effective as first line therapy in more than half of patients with uveitis. While infliximab and adalimumab seem to be equally effective in the treatment of refractory uveitis of BS, the combination of adalimumab and immunosuppressives appears to be superior to immunosuppressives alone for venous thrombosis of the extremities. In addition, tocilizumab might be an alternative to anti-TNF agents for patients with arterial involvement refractory to immunosuppressives. On the other hand, the place of IL-17 inhibition in the treatment of BS still remains questionable.


Assuntos
Síndrome de Behçet , Imunossupressores/uso terapêutico , Adalimumab , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Predisposição Genética para Doença , Humanos , Úlceras Orais/etiologia , Prevalência , Fator de Necrose Tumoral alfa/uso terapêutico , Uveíte/etiologia , Trombose Venosa/etiologia
15.
Clin Exp Rheumatol ; 37 Suppl 121(6): 98-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856935

RESUMO

OBJECTIVES: The aim of this multicentre study was to understand patients' needs and to evaluate the oral ulcer activity with the Composite Index (CI), according to different treatment modalities in Behçet's syndrome (BS). METHODS: BS patients (n=834) from 12 centres participated in this cross-sectional study. Oral ulcer activity (active vs. inactive) and the CI (0: inactive vs. 1-10 points: active) were evaluated during the previous month. The effects of treatment protocols [non-immunosuppressive: non-IS vs. immunosuppressive: (ISs)], severity (mild vs. severe), disease duration (<5 years vs. ≥5 years) and smoking pattern (non-smoker vs. current smoker) were analysed for oral ulcer activity. RESULTS: Oral ulcer activity was observed in 65.1% of the group (n=543). In both genders, the activity was higher in mild disease course with non-IS treatment group compared to severe course with ISs (p<0.05). As a resistant group, patients with mild disease course whose mucocutaneous symptoms were unresponsive to non-IS medications were treated with ISs in a limited period and achieved the highest CI scores in females. Oral ulcer activity and poor CI score were associated with disease duration less than 5 years compared to others in male patients (p<0.05). CONCLUSIONS: Oral ulcer activity pattern is affected by both the combination of disease course, treatment protocols and disease duration. CI scores reflected the oral clinical activity and CI might be a candidate scale to evaluate the efficacy of treatments during the follow-up of oral ulcer activity in BS.


Assuntos
Síndrome de Behçet , Imunossupressores/uso terapêutico , Úlceras Orais , Síndrome de Behçet/classificação , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Úlceras Orais/classificação , Recidiva , Índice de Gravidade de Doença
16.
Cutis ; 104(5): 297-300, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31886782

RESUMO

We report a case of a 7-year-old Chinese boy who presented with acute fever, multiple oral ulcers, and skin nodules. A diagnosis of systemic Epstein-Barr virus (EBV)-positive T-cell lymphoma of childhood was established using systemic laboratory examination, imaging studies, bone marrow and skin biopsy with immunohistochemistry, and in situ hybridization for EBV-encoded RNA (EBER) and gene rearrangements. Notable features of this case include the absence of pancytopenia and hemophagocytic syndrome as well as spontaneous resolution without chemotherapy for several months; however, the condition relapsed, and the patient died.


Assuntos
Infecções por Vírus Epstein-Barr/diagnóstico , Linfoma de Células T/diagnóstico , Neoplasias Cutâneas/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica , Criança , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Evolução Fatal , Febre/etiologia , Humanos , Linfoma de Células T/complicações , Linfoma de Células T/tratamento farmacológico , Masculino , Úlceras Orais/etiologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico
18.
World J Surg Oncol ; 17(1): 184, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706333

RESUMO

BACKGROUND: Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is a rare self-limiting condition of the oral mucosa. The lesion manifests as an isolated ulcer that can be either asymptomatic or associated with mild to severe pain, and in most cases, it affects the tongue. TUGSE lesions may mimic malignancy such as squamous cell carcinoma, CD30 positive lymphoproliferative disorder, or infectious diseases such as primary syphilis, tuberculosis, or Epstein-Barr virus mucocutaneous ulcer. Histologically dominating cells are lymphocytes, histiocytes, and eosinophils. CASE PRESENTATION: We describe a TUGSE case of a patient with a solitary ulcer on the lower left retromolar buccal plane. Upon presentation, the patient reported a swelling on the buccal mucosa of the left lower jaw since 1 year with rapid growth over the last days and mild pain while chewing. The diameter of the intraoral lesion on the lower left retromolar buccal plane was approximately 4 × 3 cm; the lesion presented as indurated base with a central superficial ulceration of 2 × 1 cm, indicative for a malignant process. Histologically, the ulceration showed an expanding, infiltrative, and vaguely granulomatous morphology, involving the superficial mucosa and the fatty tissue, and extended between the deep striated muscle fibers. The lesion was rich in lymphocytes, histiocytes, and eosionophils intermingled with activated T-blasts without phenotypic abnormalities. TUGSE was then diagnosed based on the phenotype (especially the lacking expression of CD30, the retained T-cell phenotype, and the absence of Epstein-Barr virus), the clinical presentation, and the morphology. Twenty-six months after diagnosis, no recurrence of the ulceration was seen. CONCLUSIONS: As TUGSE may mimic malignancy or infectious diseases, biopsy is mandatory and should be combined with thorough clinical examination. A screening for infectious diseases (mainly syphilis, Epstein-Barr virus, and HIV infections) must be performed routinely. In most cases, the lesions resolve spontaneously, obviating the need of further actions other than clinical follow-up. The pathogenesis of TUGSE lesions is still under debate, although local traumatic events and a locotypic immune response have been suggested to be major contributing factors.


Assuntos
Granuloma Eosinófilo/diagnóstico , Mucosa Bucal/lesões , Úlceras Orais/diagnóstico , Doenças Raras/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Granuloma Eosinófilo/etiologia , Granuloma Eosinófilo/patologia , Infecções por Vírus Epstein-Barr/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Úlceras Orais/etiologia , Úlceras Orais/patologia , Doenças Raras/etiologia , Doenças Raras/patologia , Remissão Espontânea , Sífilis/diagnóstico , Tuberculose/diagnóstico
19.
Acta Histochem ; 121(8): 151450, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31672390

RESUMO

INTRODUCTION: Traumatic Ulcerative Granuloma with Stromal Eosinophilia (TUGSE) is a rare oral ulcerated lesion of uncertain etiology, showing eosinophil-rich granulation tissue, with occasional large atypical CD30 positive mononuclear cells. It had been suggested that it may represent an oral counterpart of cutaneous lymphomatoid papulosis, with a potential to evolve into CD30 + T cell lymphoma OBJECTIVES: To compare TUGSE and non-specific oral ulcers (NSU) clinically, histopathologically and by clonality analysis for T-cell receptor re-arrangement, aiming to determine whether TGUSE with atypical cells is a lymphomatous premalignant condition, and whether therapeutic approach should be radical or conservative. MATERIALS AND METHODS: Retrospective archival analysis included 17 TUGSE and 8 NSU cases. Histopathological parameters included mean eosinophil number per high power field (HPF), presence of infiltration of deep soft tissues and presence of atypical cells. Immuno-morphometry comprised of the mean number of CD30+ atypical cells per HPF. T-cell receptor (TCR) gene rearrangement by polymerase chain reaction (PCR) was performed in all cases showing atypical cells. Clinical and follow up data were retrieved from files. RESULTS: TUGSE showed a significantly higher mean eosinophil number/HPF in comparison to NSU (7.0 + 4.2 cells and 2.3 + 1.72, respectively; p < 0.001). Atypical cells were found in 9 (53%) cases of TUGSE and in only 1 (11%) case of NSU. CD30+ atypical cells were found in 7 (41%) cases of TUGSE and only in 1 (11%) case of NSU. Mean number of CD30+ cells/HPF was 0.23 + 0.19 (range 0 - 0.54 cells/HPF) for TUGSE. In the only NSU case with CD30+ cells, their density was 0.52/HPF. All lesions with atypical cells were polyclonal for TCR. All cases were self-limiting, with no recurrences, after 3-9 years (mean 4.6 years) follow up. CONCLUSIONS: Analysis found no support to the suggestion that TUGSE with atypical cells represents the oral counterpart of lymphomatoid papulosis or predisposes the lesions for a hematolymphoid malignancy. Suggestions for radical therapeutic approach and long-term follow-up are probably unjustified, with no recurrences or malignancy recorded following conservative treatment alone for a period of up to 9 years of follow-up. Staining for CD30 and PCR for TCR gene rearrangement should be reserved only for rare cases with abundant large atypical cells and/or unusual clinical behavior.


Assuntos
Rearranjo Gênico do Linfócito T , Granuloma , Antígeno Ki-1 , Granulomatose Linfomatoide , Neoplasias Bucais , Proteínas de Neoplasias , Úlceras Orais , Ferimentos e Lesões , Idoso , Idoso de 80 Anos ou mais , Criança , Eosinofilia/genética , Eosinofilia/metabolismo , Eosinofilia/patologia , Feminino , Seguimentos , Granuloma/genética , Granuloma/metabolismo , Granuloma/patologia , Humanos , Antígeno Ki-1/genética , Antígeno Ki-1/metabolismo , Granulomatose Linfomatoide/genética , Granulomatose Linfomatoide/metabolismo , Granulomatose Linfomatoide/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/genética , Neoplasias Bucais/metabolismo , Neoplasias Bucais/patologia , Proteínas de Neoplasias/genética , Proteínas de Neoplasias/metabolismo , Úlceras Orais/genética , Úlceras Orais/metabolismo , Úlceras Orais/patologia , Estudos Retrospectivos , Ferimentos e Lesões/genética , Ferimentos e Lesões/metabolismo , Ferimentos e Lesões/patologia
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