Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors

Fibrolipoma of the oral cavity - case report

O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas do lipoma.Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma

Impact of the lymphocytic host response on the prognosis of oral squamous cell carcinoma: histopathological and immunohistochemical evaluation

A resposta linfocitária do hospedeiro (RLH) presente no microambiente tumoral de carcinomas de células escamosas de boca (CCEB) vêm sendo alvo de pesquisas em busca de biomarcadores inflamatórios que possam atuar como fatores prognósticos adicionais que possibilitem um tratamento mais individualizado e um melhor prognóstico para essa doença. O objetivo desse trabalho foi avaliar o impacto prognóstico do infiltrado linfocitário em pacientes acometidos por CCEB, diagnosticados no Instituto Nacional de Câncer (INCA). Nesse estudo retrospectivo, as células CD4+, CD8+ e CD20+ foram avaliadas imuno-histoquimicamente, através de uma análise semiquantitativa, em 255 pacientes com CCE de língua e assoalho de boca diagnosticados e tratados cirurgicamente no INCA. A associação entre a imunoexpressão dos anticorpos e as variáveis sociodemográficas, clínico-patológicas, perfil do infiltrado inflamatório linfocitário na interface tumor-hospedeiro e classificações histopatológicas adotadas na literatura para o CCEB foram avaliadas através do teste do Qui-quadrado e teste exato de Fisher. Na análise de sobrevida, foram realizados os métodos de Kaplan-Meier, o teste log-rank e o modelo de risco proporcional de Cox. Homens brancos, com idade entre 41 - 59 anos, baixo nível de escolaridade, tabagistas e etilistas foram os mais afetados. Predominaram os tumores em estágio clínico inicial (I e II) (58%) e patológico avançado (III e IV) (78,4%), moderadamente diferenciados (87,5%) pela classificação da OMS, classificados como de risco intermediário (49,4%) pela Avaliação Histopatológica de Risco (AHR) e de alto risco (57,3%) no Modelo Brotamento tumoral e Profundidade de invasão tumoral (BP). Predominaram os casos com RLH do tipo forte, com alta imunoexpressão (>30%) de células CD4+ (54,5%) e CD8+ (63,5%) e com baixa imunoexpressão (<50%) de CD20+ (54,9%). A RLH forte apresentou associação com tumores localizados exclusivamente em língua (p£0,0001) e com margens tumorais livres (p=0,035). Houve associação significativa entre a alta imunoexpressão de CD4 com margens tumorais livres (p=0,016), pacientes que não apresentaram progressão da doença (p=0,050) ou segundo tumor primário (p=0,044). Observou-se associação estatisticamente significante da alta imunoexpressão de CD8 com alto CD20 (p£0,0001) e RLH forte (p=0,014). O anticorpo anti-CD20 demonstrou associação estatisticamente significativa entre a sua alta imunoexpressão com RLH forte (p≤0,0001) e entre a baixa imunoexpressão do CD20 e pacientes que vieram a óbito (p=0,003) e com tumores classificados como de alto risco pela AHR (p=0,004). Pacientes com RLH fraca (p=0,029), classificados como de alto risco pela AHR (p£0,0001) e baixa imunoexpressão do CD20 (p£0,0001) foram associados com baixa sobrevida global, dos quais AHR (p£0,0001) e a imunoexpressão do CD20 (p=0,002) permaneceram como uma variável de valor independente. Os linfócitos B CD20+ presentes na interface tumoral demonstram ser um fator prognóstico independente significante e um possível biomarcador para os CCE de boca. A diferença na imunoexpressão das células inflamatórias presentes no microambiente tumoral dos CCE de boca pode auxiliar novos estudos em busca de alvo para terapias imunes.The lymphocytic host response (RLH) present at tumor microenvironment of oral squamous cell carcinomas (OSCC) has been the target of research in search of inflammatory biomarkers that can act as additional prognostic factors that enable a more individualized treatment and a better prognosis for this disease. The objective of this work was to evaluate the prognostic impact of lymphocytic infiltrate on the OSCC diagnosed and surgically treated at the Brazilian National Cancer Institute (INCA). In this retrospective study, CD4+, CD8+ and CD20+ cells were evaluated immunohistochemically, through a semi-quantitative analysis, in 255 cases of the tongue and floor of the mouth SCC. The association between antibody immunoexpression and sociodemographic, clinical-pathological variables, profile of lymphocytic infiltrate at the tumor-host interface and histologic grading methods for oral SCC were assessed using the Chi-square test and Fisher's exact test. Survival was performed using Kaplan-Meier survival method, log-rank test, and Cox's proportional hazard model. White men aged 41 - 59 years, low academic background, smokers and alcohol-drinkers were the most affected. Predominated tumors at initial clinical stage (I and II) (58%) and advanced pathological stage (III and IV) (78.4%), moderatelydifferentiated (87.5%) by WHO grading, classified as intermediate-risk (49.4%) by Histologic Risk Assessment (HRA) and high-risk (57.3%) by Budding and Depth of invasion (BD) model. Lymphocytic host response (LHR) strong was predominated. The cases of high immunoexpression (> 30%) of proteins CD4 (54.5%) and CD8 (63.5%) predominated. Prevailed cases with low immunoexpression (<50%) (54.9%) of CD20 cells. LHR strong was associated with tumors located exclusively on the tongue (p£0.0001) and with free tumor margins (p=0.035). There was a significant association between high CD4 immunoexpression with free tumor margins (p=0.016), patients who did not show disease progression (p=0.050) or second primary tumor (p=0.044). There was significant association of high CD8 immunoexpression with high CD20 (p£0.0001) and LHR strong (p=0.014). There was significant association of high CD20 immunoexpression with LHR strong (p≤0.0001) and between low CD20 immunoexpression and patients who died (p=0.003) and with tumors classified as highrisk by HRA (p=0.004). Patients with LHR weak (p=0.029), high risk for HRA (p£0.0001) and low CD20 (p£0.0001) was associated with lower overall survival, which HRA (p£0.0001) and CD20 immunoexpression (p=0.002) remained with an independent value variable. The CD20+ B lymphocytes present at the tumor interface prove to be a significant independent prognostic factor and a possible biomarker for oral SCC. In addition, the difference in the immunoexpression of inflammatory cells present in the tumor microenvironment of the oral SCC may help further studies in search of a target for immune therapies.64f

Coexistência de pênfigo vulgar e infecção pelo vírus herpes simples na mucosa oral Coexistence of pemphigus vulgaris and herpes simplex virus infection in oral mucosa

O pênfigo vulgar é uma doença mucocutânea, imunomediada, caracterizada por lesões vesiculobolhosas, enquanto a infecção pelo vírus herpes simples (HSV) é comum na cavidade oral. A coexistência das duas doenças tem sido relatada por alguns autores. Este artigo relata o caso de um paciente com múltiplas lesões em várias áreas da mucosa oral, cujo procedimento foi raspagem e biópsia incisional, que resultou no diagnóstico de pênfigo vulgar associado à infecção pelo HSV. Destaca-se a inusitada associação das doenças e a identificação citopatológica de duas populações celulares com aspectos morfológicos distintos e característicos, capazes de determinar o correto diagnóstico, sendo fundamental para a conduta e terapêutica adequada.<br>Pemphigus vulgaris is an autoimmune mucocutaneous disease, characterized by vesiculobullous lesions. Herpes simplex virus (HSV) infection is common in the oral cavity and the coexistence of pemphigus vulgaris and HSV infection has been reported by some authors. In this work, we report a case of a patient with multiple lesions involving several areas of the oral mucous membrane. Based on scraping cytology and incisional biopsy findings, the diagnosis was pemphigus vulgaris associated with HSV infection. We call attention to the uncommon association of both diseases and the cytological identification of two cell populations with different and characteristic morphological aspects, able enough to establish the correct diagnosis and define an appropriate therapeutic approach

Nevo Azul: relato de caso

A 44-years-old male patient, was referred to the stomatologist by the clinical dentist who detected the lesion on the palate. During anamnesis, the patient reported having used crack and cocaine and currently uses marijuana and alcoholic beverages, with a history of peeling and burning in the oral mucosa after use of “ether spray”. On the intraoral exam, pigmented macula was observed on the hard palate, well circumscribed, measuring approximately 4mm, with unknown evolution time. The diagnostic hypothesis was of melanocytic macule. An excisional biopsy was performed and the material was sent for microscopic analysis with histopathological diagnosis of blue nevus. The blue nevus is a benign pigmented lesion composed of nevus or melanocytic cells. It is the second most common melanocytic nevus in the oral cavity, being the palate the most frequent site. The relevance of this report consist on the fact that the blue nevus makes differential diagnosis with the melanoma, malignant neoplasm of melanocytic origin. Therefore, oral pigmented lesions with unknown evolution should be investigated to avoid this possibility.Paciente do sexo masculino, 44 ??anos, encaminhado ao estomatologista pelo dentista clínico que detectou a lesão no palato. Durante a anamnese, a paciente relatou ter usado crack e cocaína e atualmente usa maconha e bebidas alcoólicas, com histórico de descamação e queimação na mucosa oral após o uso de “spray de éter”. No exame intraoral, observou-se mácula pigmentada no palato duro, bem circunscrito, medindo aproximadamente 4mm, com tempo de evolução desconhecido. A hipótese diagnóstica foi de mácula melanocítica. Uma biópsia excisional foi realizada e o material foi enviado para análise microscópica com diagnóstico histopatológico de nevo azul. O nevo azul é uma lesão pigmentada benigna composta de nevo ou células melanocíticas. É o segundo nevo melanocítico mais comum na cavidade oral, sendo o palato o mais site freqüente. A relevância deste relato consiste no fato de que o nevo azul faz diagnóstico diferencial com o melanoma, neoplasia maligna de origem melanocítica. Portanto, lesões pigmentares orais com evolução desconhecida devem ser investigadas para evitar essa possibilidad

Fibrolipoma em cavidade oral - Relato de caso

Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma.O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas do lipoma

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors