Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia

Sickle cell anemia (SCA) is a hemoglobin disorder that occurs more commonly among Afro-descendants. The authors report the case of a 28-year-old Afro-descendent male patient with the diagnosis of homozygotic sickle cell disease (SCD) referred for evaluation of mandibular lesions. The patient’s main complaints included pain and bilateral teeth mobility. An intraoral examination revealed gingiva recession affecting the lower molars with extensive root exposure. A panoramic x-ray showed two radiolucent symmetrical periapical lesions evolving both the first and the second lower molars, bilaterally. The diagnostic hypotheses comprised odontogenic infection, among others. Besides antimicrobial therapy, the two molars of both sides were extracted and bone was collected for histopathological and microbiological analyses. Osteomyelitis was diagnosed, and Streptococcus viridans was recovered from the culture media. Mandibular osteomyelitis should be considered as a diagnosis in patients with SCD. The present case offers an alert to clinicians about the importance of knowing jaw lesions related to SCA

Ameloblastoma with distinctive granular cell pattern: an 8 case study

Ameloblastoma with granular cell pattern (AGC) is classified as an unusual histological subtype of solid/multicystic ameloblastoma, characterized by granular changes in stellate-like cells located within the inner portion of the epithelial follicles. Studies have revealed that lysosomal overload causes cytoplasmic granularity; however, the mechanism involved remains poorly understood. Here we report on eight cases of granular cell ameloblastoma, in the posterior region of the mandible. The age of the patients included in this case series ranged from 35 -64 years old and 87.5% of cases occurred in non-Caucasians, with a slight gender predilection for men (62.5%). There was no evidence of recurrence, and the majority of the cases were treated with surgical resection (87.5%). All tumors displayed histopathological features consistent with the diagnosis of ameloblastoma with granular cell pattern

Ameloblastoma with distinctive granular cell pattern

Ameloblastoma with granular cell pattern (AGC) is classified as an unusual histological subtype of solid/multicystic ameloblastoma, characterized by granular changes in stellate-like cells located within the inner portion of the epithelial follicles. Studies have revealed that lysosomal overload causes cytoplasmic granularity; however, the mechanism involved remains poorly understood. Here we report on eight cases of granular cell ameloblastoma, in the posterior region of the mandible. The age of the patients included in this case series ranged from 35 -64 years old and 87.5% of cases occurred in non-Caucasians, with a slight gender predilection for men (62.5%). There was no evidence of recurrence, and the majority of the cases were treated with surgical resection (87.5%). All tumors displayed histopathological features consistent with the diagnosis of ameloblastoma with granular cell pattern

Invasión ósea del carcinoma de células escamosas de la cavidad oral, análisis clínico-patológico de 62 casos

Prognosis for patients with squamous cell carcinoma (SCC) in oral cavity with bone invasion presence is concerning. Bone invasion patterns can be used to indicate aggressiveness and can be correlated with tumor clinical behavior. Objective: To evaluate bone invasion histopathological patterns in patients with oral cavity SCC and correlate them with the survival rate. Materials and methods: 62 patients with presence of SCC in the oral cavity as well as bone invasion were recruited for this study. Epidemiological and histopathological characteristics were tabulated and analyzed. Fischer's Square and Exact Tests were used to verify any statistical associations between the data. Results: More men were affected, especially in the fifth decade of life, and a strong association with smoking and chronic alcoholism was observed. Deaths were reported in 58% of patients, over a period of 5 years. The most prevalent histological pattern was the infiltrative, associated with lower survival rates. Conclusion: An analysis of the histopathological patterns of oral cavity SCC can be used as a prognostic factor thereby assisting with the decision of which oncological treatment approach to use.El pronóstico de pacientes con carcinoma de células escamosas (CEC) de la cavidad oral con presencia de invasión ósea continua sombrío. El patrón de invasión ósea puede ser usado como indicador de agresividad y correlacionado con el comportamiento clínico del tumor. Objetivo: Evaluar los patrones histopatológicos de invasión ósea en pacientes con CEC de la cavidad oral y correlacionarlos con la tasa de sobrevida. Material y métodos: La muestra fue constituida por 62 pacientes con presencia de CEC en la cavidad oral e invasión ósea. Las características epidemiológicas e histopatológicas fueron tabuladas y analizadas. Los Test Chi- cuadrado y exacto de Fischer fueron empleados para verificar las asociaciones estadísticas entre los datos. Resultados: Fueron afectados más hombres en la quinta década de vida y observada una fuerte asociación con tabaquismo y etilismo crónico. Fueron relatadas muertes en 58% de los pacientes, en un periodo de 5 años. El patrón histológico más prevalente fue el infiltrativo, asociado a menores tasas de sobrevida. Conclusión: El análisis del patrón histopatológico de los CEC de la cavidad oral, puede ser usado como factor pronóstico auxiliando en la decisión del abordaje del tratamiento oncológico.   &nbsp

Immunohistochemical evaluation of the signaling pathway Sonic Hedgehog proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 e Gli3) in keratocystic odontogenic tumors and their associated with the nevoid basal cell carcinoma syndrome

O Tumor Odontogênico Queratocístico (TOQC) é considerado uma entidade com alta taxa de recidiva e agressividade local, apresentando também frequente associação com a Síndrome do Carcinoma Basocelular Neviode (SCBCN), por isso a patogêneses de este tumor tem sido intensamente estudada. A transformação e proliferação de células neoplásicas normalmente envolvem a desregulação de vias de sinalização que participam do desenvolvimento embrionário normal, principalmente a via Sonic Hedgehog (Shh). A expressão de certas proteínas presentes nesta via foi detectada em vários tumores odontogênicos, sugerindo que desempenha um papel importante nas interações epiteliais e na proliferação de células tumorais. Embora o papel da via de sinalização Shh não esteja bem estabelecida no desenvolvimento de TOQCs, sugere-se que sua ativação pode ser correlacionada com o comportamento clínico agressivo destas lesões. O objetivo deste estudo foi avaliar a expressão imunoistoquímica das proteínas da via de sinalização Shh em TOQCs esporádicos e associados a SCBCN, além de comparar a sua expressão entre lesões recorrentes e não recorrentes. Para isso foi realizado um estudo retrospectivo onde as características clinicopatológicas de 62 pacientes foram avaliadas, a expressão imunoistoquímica das proteínas Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 e Gli3 foi analisada em todas as amostras, comparando TOQCs sindrômicos (29 lesões) e TOQCs esporádicos (57 lesões), assim como sua respectiva recorrência. Com este estudo foi possível observar que as proteínas Shh, Smo e Gli1 revelaram aumento da expressão em TOQCs associados a SCBCN, em comparação com tumores esporádicos. Shh mostrou expressão citoplasmática intermédia dentro da camada basal em tumores sindrômicos, Smo por sua vez revelou forte expressão nuclear e citoplasmática nas camada basal e suprabasal de tumores sindrômicos, enquanto que a expressão de Gli1 foi mais elevada apenas no citoplasma de TOQCs associados a síndrome em comparação com tumores esporádicos. No que diz respeito a sua recorrência, as proteínas Ptch1 e Gli2 mostraram maior expressão em TOQCs esporádicos e recorrentes, enquanto que a expressão Gli1 foi mais relevante nos tumores recorrentes e associados a SCBCN. Os nossos resultados sugerem que a maior expressão das proteínas Shh, Smo e Gli1 em TOQCs pode contribuir para o diagnóstico precoce de lesões associadas com a SCBCN. Da mesma forma, as proteínas Ptch1 e Gli2 pode predizer o risco de recorrência de TOQCs esporádicos, enquanto Gli1 sugere uma potencial associação de recorrência em tumores sindrômicos.Keratocystic Odontogenic Tumor (KCOT) is considered an entity of high recurrence rates and local aggressiveness, also often presenting association with Nevoid basal cell carcinoma syndrome (NBCCS), and the pathogenesis of this tumor has been therefore intensively studied. The transformation and proliferation of neoplastic cells usually involve deregulation of signaling pathways participating in normal embryonic development, mainly via Sonic Hedgehog (Shh). The expression of certain proteins of this pathway has been detected in several odontogenic tumors, suggesting that plays an important role in epithelial interactions and proliferation of tumor cells. Although the role of Shh signaling pathway is not well established in the development of KCOTs it has been suggested that its activation can be correlated to the aggressive clinical behavior of these lesions. The aim of this study is therefore to evaluate the immunohistochemical expression of proteins of Shh signaling pathway in sporadic KCOTs and associated with NBCCS and to compare their expression between recurring and non-recurring lesions.thus, a retrospective study was performed where the clinicopathological features of 62 patients were evaluated, the immunohistochemical expression of the Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 and Gli3 protein, was analyzed in all samples, comparing syndromic KCOTs ( 29 lesions) and sporadic KCOTs (57 lesions), and also their respective recurrence. The results showed that the expression of Shh, Smo and Gli1 proteins was increased in KCOTs associated with NBCCS compared to sporadic tumors. Shh showed intermediate cytoplasmic expression within the basal layer syndromic tumors, Smo in turn showed strong nuclear expression and cytoplasmic in basal and suprabasal layers of syndromic tumors, while Gli1 cytoplasm expression was higher only in KCOTs associated syndrome compared with sporadic tumors. Regarding recurrent tumors, Ptch1 and Gli2 proteins showed higher expression in sporadic and recurrent KCOTs, while Gli1 expression was more significant in recurrent tumors and associated NBCCS. Our results suggest that increased expression of Shh, Smo and Gli1 proteins in KCOTs can contribute to early diagnosis of KCOTs associated with the NBCCS. Likewise, Ptch1 and Gli2 proteins can predict the risk of recurrence of sporadic KCOTs, while Gli1 suggest a potential association to recurrence into syndromic tumors