Clinicopathological analysis of fibrous dysplasia and central ossifying fibroma of the jaws : an international collaborative study

Orientador: Pablo Agustin VargasTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A displasia fibrosa (DF) e o fibroma ossificante central (FOC) fazem parte de um grupo de lesões conhecido como fibro-ósseas benignas (LFOB) e afetam principalmente a maxila, a mandíbula e ossos da região craniofacial. Caracterizam-se pela substituição do tecido ósseo normal por uma matriz de tecido conjuntivo fibroso com níveis variados de material mineralizado. As DFs e os FOCs costumam apresentar características clínicas e histopatológicas similares, entretanto, possuem padrões distintos de progressão e comportamento biológico. Portanto é muito importante fazer a distinção diagnóstica entre estas lesões. Este trabalho teve como objetivos analisar e comparar as características demográficas, clínicas, imaginológicas e histopatológicas de pacientes diagnosticados com DFs e FOCs. Foi realizada uma análise retrospectiva internacional e multi-institucional que selecionou 68 casos de DF e 37 casos de FOC e permitiu o estudo de características clinicopatológicas. As DFs (n=41; 60,2%) e os FOCs (n=24; 64,9%) foram mais comuns em pacientes do gênero feminino na segunda e terceira década de vida. As DFs acometeram preferencialmente a maxila (n=38; 56%) e os FOCs a mandíbula (n=23; 62,2%). Com relação aos aspectos imaginológicos, as DFs apresentaram-se predominantemente como lesões radiopacas com limites mal definidos e os FOCs como lesões radiolúcidas bem delimitadas. Microscopicamente, foi possível evidenciar continuidade do osso lesional com a cortical óssea de revestimento nas DFs e, interessantemente, um fenômeno de separação entre as trabéculas ósseas lesionais e o estroma adjacente também foi evidente nas DFs. Nos FOCs, foi possível evidenciar a descontinuidade da lesão com a cortical óssea de revestimento externo e a presença de estruturas semelhante ao cemento. Em conclusão, o diagnóstico de DF e FOC deve ser realizado a partir da correlação das características clínicas, imaginológicas e histopatológicas. No entanto, foi possível observar algumas características peculiares em cada uma das lesões, o que poderá auxiliar o diagnóstico e consequentemente favorecer o tratamento dos pacientes acometidos por estas patologias ósseasAbstract: Fibrous dysplasia (FD) and ossifying fibroma (OF) comprehend a group of benign fibro-osseous lesions (BFOL) which mainly affects the maxilla, mandible and craniofacial bones. They are characterized by the replacement of normal bone tissue by a matrix of fibrous connective tissue with varying degrees of mineralization. Both lesions frequently share clinical and microscopic features and the final diagnose require a combined analysis of clinical, radiologic and histological data. There might be significant cosmetic and functional impairment despite having a distinct pattern of progression and biological behavior, therefore, it is important to distinguish them from each other at the final diagnose. This research focused on the study and comparison of the demographic, clinical, imaging and microscopic aspects of patients with FD and OF, at the moment of the diagnostics. A retrospective multiinstitucional research was conducted in which there were 68 FD cases and 37 of OF. Characteristics such as gender, age and anatomic site of the tumor samples were obtained from the medical records. FDs (n=41; 60,2%) and OFs (n=24; 64,9%) were more frequently detected in female patients who were at the second or third decade of life. The maxilla was more prominently affected among the FD cases (n=38; 56%) contrasting to the prevalence of the mandible in the OF cases (n=23 62.2%). According to the radiographic aspects, FDs frequently presented as radiopaque lesions, with ill-defined limits, and OFs had well defined margins and were radiolucid. Microscopically, a continuity of the lesion with the bone cortical was evident in the FDs, as well as a separation phenomenon between the bone trabeculae and the surrounding connective tissue of the adjacent stroma. In OFs, the discontinuity of the lesion with the bone cortical was noticed, so were the presence of cement-like structures. In conclusion, the diagnose of FD and OF must be done based on the sum of the clinical, radiographic and microscopic features, although it was possible to observe a few peculiar characteristics in each one of them, which might serve as a diagnostic tool and therefore improve the treatment of the patientsDoutoradoPatologiaDoutor em Estomatopatologi

Gênero, Poder e Violência: Breve ensaio sobre origem e manifestações do poder patriarcal

O presente trabalho busca desmistificar o conceito de gênero e demonstrar o caráter opressor e violento de suas categorizações, consolidadas em diversas manifestações explícitas e implícitas na construção social histórica e contemporânea. Busca-se compreender a origem e finalidade da ideologia do binarismo de gênero, utilizando-se, para tanto, da análise das diversas teorias que justificaram sua existência ao longo dos tempos, tais como as biológicas, filosóficas, econômicas, psicanalíticas e estruturalistas, para, ao final, apresentar a proposta de retorno ao ser universal, que reúne em si todas as qualidades ditas femininas e masculinas: o Ser Humano como gênero.

Orbital apex syndrome affecting head and neck cancer patients : a case series

Orbital apex syndrome (OAS) is a complex and uncommon disorder that typically damages multiple cranial nerves in association with optic nerve dysfunction. OAS is associated with several different pathologies, however; only a few cases have been reported in association with head and neck cancer (HNC) so far. A case series of HNC patients diagnosed with OAS is described including clinicopathological data, image findings, and disease outcome. Ptosis and diplopia were diagnosed in four male patients with mean age of 61.2 years who were undergoing treatment for late-stage carcinomas of the tongue, larynx, and nasopharynx, eventually leading to the diagnosis of OAS. The mean overall survival rate after the diagnosis of OAS was 9.5 months. The current study reinforces evidence that OAS indicates poor prognosis and highlights the importance of early diagnosis

Osteolipoma of the buccal mucosa

Lipomas are benign mesenchymal neoplasms of soft tissue that can be found in any part of the human body. Conversely, their presence in the oral mucosa is rather uncommon, with approximately 4% of the cases occurring in the oral cavity. In such cases, they are likely to have originated from mature adipose tissue and to be among several described histological variants of lipomas, which are identified according to the predominant type of tissue. There is a rare lipoma, known as an osteolipoma or an ossifying lipoma; however, little has been written this type of lipoma characterized by a classical lipoma with areas of osseous metaplasia. Considering the few cases of oral osteolipomas previously described in the English-related literature and the consequent risk of misdiagnosis and overtreatment, this paper describes an extreme case of an osteolipoma affecting the buccal mucosa of an adult patient. This paper focuses particularly on the pathogenesis of this lesion and the discussion of a correct diagnosis

Tongue metastasis of cutaneous melanoma : report of two cases and literature review

Malignant metastases to the oral cavity are rare and metastatic melanomas of the tongue are considered exceptionally uncommon, with less than 10 cases published in the English literature so far. Two female patients in the 7th decade of life presented to our dental service with nodules in the tongue. Both patients had multiple metastases at the time of oral diagnosis and primary melanoma originated on the skin. An intra-oral incisional biopsy was performed under local anesthesia and the histopathologic analysis was characterized by the proliferation of atypical epithelioid cells displaying a poorly delimited cytoplasm and hyperchromatic nucleus which contained eosinophilic macronucleoli. Immunohistochemistry was performed in both cases to confirm the clinical hypothesis of metastatic melanoma. After the diagnosis of oral metastatic melanoma, the patients were maintained under palliative care and close medical follow-up. Both patients died four and a half months and 20 months after the diagnosis of tongue metastasis. Although rare, metastatic melanoma should be included in the differential diagnosis of tongue lesions detected in patients with a previous medical history of cutaneous melanoma

Radiation-related superficial oral mucoceles : an under-recognized acute toxicity in head and neck cancer patients

Acute toxicity is usually defined as adverse changes occurring immediately or a short time after the start of oncological treatment. Cross-sectional retrospective study performed with head and neck cancer patients who underwent radiotherapy from 2013 to 2016. Ten (1.2%) patients developed SOMs during radiotherapy, most (80%) of which were men with a mean age of 59.5 years at diagnosis. SOMs mainly affected the floor of the mouth (60%) between the fourth and the sixth weeks of radiation therapy. All lesions were asymptomatic and spontaneously ruptured approximately 9 days after diagnosis. Although rare, SOMs may be regarded as an acute oral toxicity of head and neck radiotherapy

Calcified carotid artery atheromas on panoramic radiographs of head and neck cancer patients before and after radiotherapy

The aims of this study were to verify if head and neck radiotherapy (RT) is able to induce calcified carotid artery atheroma (CCAA) in a large head and neck cancer (HNC) population and also to compare the socio-demographic and clinical findings of patients with and without CCAA detected on panoramic radiographs. Panoramic radiographs taken before and after head and neck radiotherapy (RT) of 180 HNC patients were selected and analyzed in order to identify the presence of CCAA. In addition, CCAA presence or absence on panoramic radiographs were compared and correlated with clinicopathological findings. A high overall prevalence of CCAA was found on panoramic radiographs (63 out of 180 = 35%) of HNC patients. No significant difference of CCAA before and after RT was observed. There were also no differences between groups (with and without CCAA) regarding age, gender, tobacco and alcohol use, arterial hypertension, diabetes mellitus, acute myocardial infarction, hypercholesterolemia, tumor location, clinical stage of disease and RT dose. However, there was a greater prevalence of strokes in patients with CCAA (p<0.05). Although CCAA were frequently found in panoramic radiographs of patients with HNC, RT seems not to alter the prevalence of these calcifications

The barriers dentists face to communicate cancer diagnosis:self-assessment based on SPIKES protocol

This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient?s emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. The lack of training and low confidence in dealing with patients? emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals

Morphological patterns of circumpulpal dentin affected by radiation-related caries

The aim of this work was to evaluate the microscopic characteristics through polarized light microscopy, scanning electron microscopy and the mineral content of circumpulpal dentin of irradiated (IT) and non-irradiated teeth (NIT), with deep caries that reached the root canal. A total of 25 IT were analyzed macroscopically, and radiographed. 5 NIT were used as controls. Two 100-?m-thick sections, per specimen, were evaluated in a polarized light microscopy and a scanning electron microscope. Demographics and clinical data were collected. The results did not demonstrate distinct morphology of the IT compared with NIT. Mineral content values by weight percentage of Ca and P were also similar, corresponding to 66.65% and 33.21% in the IT and 66.60% and 33.29% in the NIT. The Ca/P ratio did not show statistical differences between groups being respectively 2.74 and 2.72, in the IT and NIT (p> 0.05). Radiotherapy does not change morphology and mineral content of circumpulpal dentin in IT