Unusual presentation of localized gingival enlargement associated with a slow-growing odontogenic myxoma

Unusual presentation of localized gingival enlargement associated with a subjacent tumoural pathology is reported. The patient was a 55-year-old black male, whose chief complaint was a progressive gingival overgrowth for more than ten years, in the buccal area of the anterior left mandible. According to the clinical features and the radiological diagnosis of odontogenic keratocyst, a conservative surgery with enucleation and curettage was performed. Tissue submitted for histopathological analysis rendered the diagnosis of odontogenic myxoma. After 12-month of follow-up, no evidence of recurrence was found. Clinicians should be cautious when facing any gingival enlargement to avoid diagnostic pitfalls and to indicate the appropriate treatment

A Gray-purple mass on the floor of the mouth: gigantic mucogingival pyogenic granuloma in a teenage patient

Pyogenic granuloma is defined as a benign neoplasm of vascular phenotype. This case describes the clinical and histopathological features of a gigantic mucogingival pyogenic granuloma, in a 14-year-old healthy black boy. This exophytic gray-purple mass, related to a toothpick injury, had more than twelve-month evolution on the anterior mandible involving lingual area besides to the floor of the mouth pressing the right salivary duct. Conservative excision was performed, followed by uncomplicated healing with no recurrence in two years. The histopathological examination reported a pyogenic granuloma (lobular capillary haemangioma). The authors provide a discussion of the presurgical differential diagnosis of the lesion. This case report presents an extremely uncommon location of a gigantic pyogenic granuloma, involving mucogingival complex and affecting the salivary outflow. This clinical manuscript may shed light on the controversies about possible mechanisms inducing oral pyogenic granulom

Distinctive patterns of placental lesions in preeclampsia versus fetal growth restriction and their association with fetoplacental Doppler

OBJECTIVES: The aim of this study was to describe placental histopathological findings in a large cohort of pregnancies complicated by preeclampsia and/or fetal growth restriction, and to investigate its association with fetoplacental Doppler. METHODS: This was a prospective observational study including pregnancies complicated by: 1) normotensive FGR defined as birthweight 95th centile for uterine and umbilical artery, or <5th centile for middle cerebral artery and CPR. Placental lesions were categorized to vascular (maternal/fetal side), inflammatory and other lesions according to the 2014 Amsterdam Placental Workshop Group Consensus Statement. Univariate and multiple regression analysis were performed for the comparison between the study groups. Logistic regression was used to determine abnormal Doppler association with placental lesions. RESULTS: Maternal side vascular lesions are significantly higher in PE compared to controls and normotensive FGR (PE&FGR: 73%, PE: 46%, FGR: 38% vs. controls: 31%; p=0.01) including 2 types of lesions: developmental (PE&FGR: 13%, PE: 5%, FGR: 3% vs. controls: 2%, p<0.001) and malperfusion (PE&FGR: 70%, PE: 39%, FGR: 32% vs. controls: 25%, p=0.001). In contrast, fetal side developmental lesions are significantly higher in normotensive FGR compared to controls and PE (PE&FGR: 0%, PE: 3%, FGR: 8% vs. controls 2%, p=0.001). All cases displayed lower prevalence of infectious lesions, with a high prevalence of immune lesions in PE&FGR (PE&FGR: 17.5%, PE: 7.8%, FGR: 9.8% vs. controls 9.4%, p=0.001). All fetoplacental Doppler parameters are associated with maternal side vascular lesions -mainly malperfusion- [uterine arteries mean PI (Odds ratio(OR)=2.45, 95% confidence interval (CI): 1.51 - 3.97), umbilical artery PI (OR=2.05, 95% CI: 1.02 - 4.47), middle cerebral artery PI (OR=2.75, 95% CI: 1.4 - 5.42), CPR (OR=1.75, 95% CI: 1.04 - 2.95)]. This association was evident mainly in the FGR groups -with and without PE-, being nonsignificant in controls or PE without FGR. No significant associations were observed between fetoplacental Doppler parameters and other placental lesions in any of the study groups. CONCLUSIONS: PE and FGR exhibit different patterns of placental histopathological lesions in accordance with the clinical manifestation of the placental disorder (maternal vs. fetal). Fetoplacental Doppler shows an association with placental malperfusion lesions in the maternal side, reinforcing its use as a surrogate of placental insufficiency

Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis

Aim: To investigate microbial profiles in placentas from a population of East African mothers with and without adverse pregnancy outcomes and with regard to their periodontal status. Material and Methods: Thirty-six placentas from pregnant women from Tanzania were classified into three groups according to both pregnancy outcome and the mother's periodontal health. The microbial composition in each group was then compared using 16S rRNA metagenomics. Additionally, placenta specimens were analyzed histologically for chorioamnionitis by a single pathologist blinded to the clinical data. Results: The greatest differences were observed in the group of mothers with periodontitis. The microbial load was low in all three groups of mothers. Periodontitis had a notable influence on the structure of the placental microbiota. Three phyla and 44 genera were associated with periodontitis, whereas only the Tenericutes phylum was associated with the adverse pregnancy variable. Streptococcaceae and Mycoplasmataceae families were associated with both periodontitis and adverse pregnancy outcomes. Finally, although the differences for chorioamnionitis were not significant, this intra-amniotic infection was more frequent in the placentas from mothers with periodontitis

Premature placental aging in term small-for-gestational-age and fetal-growth-restricted fetuses

Objective The aim of this study was to perform a comprehensive assessment of the placental aging process through senescence and apoptotic markers in late-onset small fetuses classified as SGA or FGR. Study Design A prospective nested case-control study in singleton pregnancies delivering at term including 21 normally grown fetuses and 36 small fetuses classified into SGA (if birthweight was between the 3rd and 9th centile and normal fetoplacental Doppler; n=18) and FGR (if birthweight <3rd centile and/or abnormal cerebroplacental ratio or uterine artery Doppler; n=18). Telomerase activity, telomere length and RNA expression of senescence (Sirtuin 1,3,6) and apoptotic markers (p53, p21, BAX, Caspase 3 and 9) were analyzed in placental samples collected at birth. Results Compared with normally grown fetuses, both SGA and FGR presented signs of accelerated placental aging including lower telomerase activity (controls mean±SD 12.8% ± 6.6 vs SGA 7.98% ± 4.2 vs FGR 7.79% ± 4.6, p=0.008), shorter telomeres (controls 1.20 T/S ± 0.6 vs SGA 1.08 T/S ± 0.9 vs FGR 0.66 T/S ± 0.5, p=0.017), and reduced Sirtuin1 RNA expression (controls 1.55 2-' ' Ct ± 0.8 vs SGA 0.91 2-' ' Ct ± 0.8vs FGR 0.63 2-' ' Ct ± 0.5, p<0.001) together with increased p53 RNA expression (controls median(IQR) 1.072-' ' Ct (3.2) vs SGA 5.39 2-' ' Ct (15) vs FGR 3.75 2-' ' Ct (7.8), p=0.040), with a significant linear tendency across severity stages. In addition, FGR cases presented signs of apoptosis with increased RNA levels of Caspase 3 (controls 0.94 2-' ' Ct (1.1) vs FGR 3.98 2-' ' Ct (30), p=0.031) and Caspase 9 (controls 1.21 2-' ' Ct (4.0) vs FGR 3.87 2-' ' Ct (8.7), p=0.037) as compared to controls

Fetal Liver Volume Assessment Using Magnetic Resonance Imaging in Fetuses With Cytomegalovirus Infection

Objective: To assess fetal liver volume (FLV) by magnetic resonance imaging (MRI) in cytomegalovirus (CMV)-infected fetuses compared to a group of healthy fetuses. Method: Most infected cases were diagnosed by the evidence of ultrasound abnormalities during routine scans and in some after maternal CMV screening. CMV-infected fetuses were considered severely or mildly affected according to prenatal brain lesions identified by ultrasound (US)/MRI. We assessed FLV, the FLV to abdominal circumference (AC) ratio (FLV/AC-ratio), and the FLV to fetal body volume (FBV) ratio (FLV/FBV-ratio). As controls, we included 33 healthy fetuses. Hepatomegaly was evaluated post-mortem in 11 cases of congenital CMV infection. Parametric trend and intraclass correlation analyses were performed. Results: There were no significant differences in FLV between infected (n = 32) and healthy fetuses. On correcting the FLV for AC and FBV, we observed a significantly higher FLV in CMV-infected fetuses. There were no significant differences in the FLV, or the FLV/AC or FLV/FBV-ratios according to the severity of brain abnormalities. There was excellent concordance between the fetal liver weight estimated by MRI and liver weight obtained post-mortem. Hepatomegaly was not detected in any CMV-infected fetus. Conclusion: In CMV-infected fetuses, FLV corrected for AC and FBV was higher compared to healthy controls, indicating relative hepatomegaly. These parameters could potentially be used as surrogate markers of liver enlargement. Keywords: fetal brain abnormalities; fetal cytomegalovirus infection; fetal liver; magnetic resonance imaging; pregnancy

Lethal congenital contracture syndrome 11: A case report and literature review

Lethal congenital contracture syndrome 11 (LCCS11) is caused by homozygous or compound heterozygous variants in the GLDN gene on chromosome 15q21. GLDN encodes gliomedin, a protein required for the formation of the nodes of Ranvier and development of the human peripheral nervous system. We report a fetus with ultrasound alterations detected at 28 weeks of gestation. The fetus exhibited hydrops, short long bones, fixed limb joints, absent fetal movements, and polyhydramnios. The pregnancy was terminated and postmortem studies confirmed the prenatal findings: distal arthrogryposis, fetal growth restriction, pulmonary hypoplasia, and retrognathia. The fetus had a normal chromosomal microarray analysis. Exome sequencing revealed two novel compound heterozygous variants in the GLDN associated with LCCS11. This manuscript reports this case and performs a literature review of all published LCCS11 cases

Validity of a minimally invasive autopsy for cause of death determination in stillborn babies and neonates in Mozambique: an observational study

Background Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs) the gold standard for cause of death determination are difficult to perform in most high-burden settings. Therefore, validation of simpler and more feasible methods is needed. Methods and findings In this observational study, the validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in 18 stillbirths and 41 neonatal deaths by comparing the results of the MIA with those of the CDA. Concordance between the categories of diseases obtained by the 2 methods was assessed by the Kappa statistic, and the sensitivity, specificity, positive, and negative predictive values of the MIA diagnoses were calculated. A cause of death was identified in 16/18 (89%) and 15/18 (83%) stillborn babies in the CDA and the MIA, respectively. Fetal growth restriction accounted for 39%, infectious diseases for 22%, intrapartum hypoxia for 17%, and intrauterine hypoxia for 11% of stillborn babies. Overall, the MIA showed in this group a substantial concordance with the CDA (Kappa = 0.78, 95% CI [0.56-0.99]). A cause of death was identified in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. In this group, the majority of deaths were due to infectious diseases (66%). The overall concordance of the MIA with the CDA in neonates was moderate (Kappa = 0.40, 95% CI [0.18-0.63]). A high percentage of accuracy was observed for the MIA in all the diagnostic categories in both stillbirths and neonates (>75%). The main limitation of this study is that some degree of subjective interpretation is inherent to cause-of-death attribution in both the MIA and the CDA; this is especially so in stillbirths and in relation to fetal growth restriction. Conclusions The MIA could be a useful tool for cause-of-death determination in stillbirths and neonatal deaths. These findings may help to accelerate progress towards meeting global health targets by obtaining more accurate information on the causes of death in these age groups, which is essential in guiding the design of new interventions and increasing the effectiveness of those already implemented

THE ROLE OF TUMOUR SUPPRESSOR GENES IN LARYNGEAL SQUAMOUS CELL CARCINOMA

We offer a general overview on tumour suppressor gene alterations identified in laryngeal squamous cell carcinoma. Addressing the retinoblastoma susceptibility gene inactivation by molecular genetic methods is a hard task due to its enormous size. However, loss of immunohistochemical expression of retinoblastoma protein is an infrequent event that we have observed in only one out of 37 cases (3%). p53 can be inactivated by a number of mechanisms. p53 protein overexpression is detected in a half of the cases, but p53 mutations are detected in only 34% of cases. Thus, a number of cases with p53 protein overexpression occur in the absence of detectable gene mutation. The implication of HPV in the development of these tumours seems, at most, marginal. p21WAF1 is expressed with independence of the p53 gene status and is related to squamous cell differentiation. p16INK4a can be inactivated by mutation and allelic deletion or homozygous deletion (22% each), or promoter hypermethylation in less than 10% of cases.<br /