Relevant proteins for the monitoring of engraftment phases after allogeneic hematopoietic stem cell transplantation

Introduction: Hematopoietic Stem Cell Transplant (HSCT) has been successfully used as standard therapy for hematological disorders. After conditioning therapy, patients undergoing allogeneic HSCT, present three different phases of engraftment: early pre-engraftment, early post-engraftment, and late engraftment. Severe complications are associated with morbidity, mortality, and malignancies in these phases, which include effects on the oral cavity. Objectives: The changes in the salivary composition after HSCT may contribute to identifying relevant proteins that could map differences among the phases of diseases, driven for personalized diagnostics and therapy. Methods: Unstimulated whole saliva was collected from patients submitted to HSCT. The samples were submitted to trypsin digestion for a Mass spectrometry analysis. MaxQuant processed the Data analysis, and the relevant expressed proteins were subjected to pathway and network analyses. Results: Differences were observed in the most identified proteins, specifically in proteins involved with the regulation of body fluid levels and the mucosal immune response. The heatmap showed a list of proteins exclusively expressed during the different phases of HSCT: HBB, KNG1, HSPA, FGB, APOA1, PFN1, PRTN3, TMSB4X, YWHAZ, CAP1, ACTN1, CLU and ALDOA. Bioinformatics analysis implicated pathways involved in protein processing in the endoplasmic reticulum, complement and coagulation cascades, apoptosis signaling, and cholesterol metabolism. Conclusion: The compositional changes in saliva reflected the three phases of HSCT and demonstrated the usefulness of proteomics and computational approaches as a revolutionary field in diagnostic methods

Síndrome de Sjögren primária: aspectos relevantes para os dentistas

Objetivo: Esta revisão de literatura tem o propósito de oferecer aos cirurgiões-dentistas entendimento sobre os principais achados clínico-epidemiológicos da síndrome de Sjögren primária (SSp), bem como ressaltar os principais aspectos etiopatogênicos e histopatológicos da doença. Métodos: Buscou-se na base de dados Pubmed/Medline e ScienceDirect os descritores “síndrome de Sjögren”, “glândulas salivares”, “xerostomia”, “diagnóstico”, “glândula salivar menor”, “etiologia”, “biopsia” entre os anos de 1991 a 2017. Discussão: A SSp é uma exocrinopatia autoimune que tem como substrato, em especial, as glândulas lacrimais e salivares, culminando com os sintomas de xeroftalmia e xerostomia. Seu principal achado morfológico é a presença de agregados de leucócitos mononucleares ao redor dos ductos e ácinos. Outras manifestações sistêmicas podem estar presentes, acarretando considerável morbidade nos pacientes acometidos. Atualmente, foi publicado o mais novo conjunto de critérios diagnósticos da doença, sendo um marco histórico no diagnóstico precoce da enfermidade, fundamental para diminuir os altos números de subdiagnósticos e otimizar a conduta clínica. Conclusão: Esta revisão abordou os aspectos clínicos-epidemiológicos, histopatológicos e etiopatogênicos da SSp, objetivando melhor compreensão dessa doença multifatorial e, portanto, a necessidade de uma conduta multidisciplinar e do papel fundamental do cirurgião-dentista no manejo dos pacientes acometidos por essa síndrome.Objective: The aim of this present review is to provide dentists a better understanding of Primary Sjögren’s syndrome (SSp), clinical and epidemiological findings, also the etiopathogenic and histopathological features of the disease. Methods: The search was based on Pubmed/Medline and ScienceDirect database from 1991 to 2017. It was used keywords: “Sjögren’s syndrome”, “salivary gland”, “xerostomia”, “pathogenesis”, “diagnosis”, “minor salivary gland”, “ethiology”, “biopsy”. Discussion: Primary Sjögren’s syndrome (SSp) is an autoimmune exocrinopathy involving mainly the lacrimal and salivary glands, resulting in reduced secretory functions and classical sicca symptoms, such as dry eyes and dry mouth. The hallmark of the histopathological features is the presence of aggregates of mononuclear leukocytes surrounding ducts and acini. Others systemic manifestations can also be present, leading to considerable morbidity in the affected patients. The lastest diagnosis criteria of SSp was published in 2017, becoming a historical landmark in the early diagnosis of the disease, reducing the high number of underdiagnosis and improving therapeutic intervention. Conclusion: This review approached the clinical-epidemiological and histopathological features, and etiopathogenic factors of SSp, supporting a better comprehension of this multifactorial disease and needing a multidisciplinary approach and the role of the dentist in the clinical conduct of the patients affected by this syndrome

Primary oral mucosal melanomas: study of clinical-pathological aspects and immunoglobulin and integrins expression in 35 cases

Melanoma primário da mucosa oral (MPMO) é um tumor raro e agressivo. Estudos recentes demonstraram uma correlação entre o aumento da invasão tumoral e o fenótipo metastático com uma alteração no padrão de expressão das moléculas de adesão. Neste estudo analisamos a expressão de integrinas e imunoglobulinas nos melanomas primários da mucosa oral e relacionamos os resultados com os parâmetros clínicos. As análises imunoistoquímicas dos padrões de expressão destas moléculas foram realizadas em 35 casos de melanomas primários da mucosa oral, e os resultados foram correlacionados com características clínicas e histológicas. Observou-se que a subunidade beta-4 de integrina foi negativa em casos com invasão vascular. A presença de integrina beta-3 e de CD166 (ALCAM) estavam estatisticamente associadas à extensa invasão vascular (p < 0,05). A menor expressão de CD54 (ICAM) foi marginalmente relacionada a casos com necrose extensa, enquanto a maioria dos casos com doença metastática foi negativa para CD66 (CEACAM). Conclusão: padrões alterados de expressão de moléculas de adesão, principalmente integrinas e imunoglobulinas, podem participar da patogênese e do desenvolvimento dos melanomas primários da mucosa oralPrimary oral mucosal melanoma is a rare and an aggressive tumor. Recent studies have demonstrated the correlation among increased tumor invasion, the metastatic phenotype and altered adhesion molecule expression profiles. The present study analyzed the expression of integrins and immunoglobulin-like adhesion molecules in oral mucosal melanomas and correlated results with clinical parameters. Immunohistochemical analyses of their expression patterns were performed on thirty-five cases of primary oral mucosal melanomas. The results were correlated with clinical and histological features of the cohort. The beta-4 subunit of integrin was negative and this was related with vascular invasion. Positivity of integrin beta-3 and CD166 (ALCAM) was statistically associated with extensive vascular invasion (p < 0.05). Lower expression of CD54 (ICAM) was associated with cases with extensive necrosis. Most cases with metastatic disease were negative for CD66 (CEACAM). Conclusion: Altered patterns of adhesion molecule expression, mainly integrins and immunoglobulin-like proteins, may participate in the pathogenesis and outcome of primary oral mucosal melanoma

Lichen planus sialadenitis: a mucosal analog of lichen planopilaris and lichen planoporitis

Lichen planus (LP) is the most prevalent dermatological disorder with oral manifestation. Oral lesions comprise a broad spectrum of clinical presentations. We report the case of a 56-year-old woman who presented erosive LP on the buccal and lower lip mucosae. Besides typical erosions, small white keratotic papules on an erythematosus background on the lower lip mucosa were observed. Biopsy of lower lip lesions showed an unusual histopathological presentation consisting of a lichenoid inflammation targeted to salivary gland ducts. This is probably a salivary gland analog of lichen planopilaris and lichen planoporitis

A Rare Case of Concomitant Maxilla and Mandible Brown Tumours, Papillary Thyroid Carcinoma, Parathyroid Adenoma, and Osteitis Fibrosa Cystica

Objective. The brown tumour of hyperparathyroidism is a result of a metabolic disorder caused by primary hyperparathyroidism. Report. We described a case of a 37-year-old female patient presenting bimaxillary intraoral lesions and swelling in the neck. Incisional biopsy of the oral lesion was performed and histopathological examination revealed a central giant cell lesion composed by intense haemorrhagic exudate, abundant presence of giant cells, and areas with hemosiderin pigment. The patient also presented high levels of serum calcium and parathyroid hormone, hyperfunctioning parathyroid tissue, bilateral parenchymal nephropathy, and densitometry lower than expected, showing an advanced stage of osteitis fibrosa cystica. Synchronous parathyroid adenoma and papillary thyroid carcinoma were confirmed by imaging exams and histopathologically. Conclusion. The composition of all the clinical, pathological, and imaging findings led to the final diagnosis of brown tumour of hyperparathyroidism. The occurrence of parathyroid adenoma, papillary thyroid carcinoma, and brown tumours of hyperparathyroidism in their late stage (osteitis fibrosa cystica) associated with oral brown tumours involving the mandible and maxilla is extremely rare

Lichenoid sialadenitis in chronic graft versus host disease

Chronic graft versus host disease (cGVHD) remains the principal long-term life-threatening complication in hematopoietic stem cell transplant recipients. We present a case of lichenoid sialadenitis in a 23-year-old-man with systemic cGVHD. The histological examination showed a lymphocytic inflammatory infiltrate adjacent to the salivary gland duct, similar to the histological aspects described in the typical manifestations of oral lichen planus and lichen planopilaris. This consists of a band-like inflammatory infiltrate not only targeting the cutaneous epithelium but also adnexal structures, such as hair follicles and salivary gland ducts. It is well described that the oral lesions in cGVHD share most of morphological and clinical manifestations with those described in oral lichen planus. The mechanisms of lichenoid salivary gland ducts destruction might be similar, although xerostomy appears to be specific to cGVHD, which may represent a clinical sign of massive salivary gland impairment related to ductal lichenoid destruction in patients with cGVHD

Lichenoid sialadenitis in chronic graft versus host disease

Chronic graft versus host disease (cGVHD) remains the principal long-term life-threatening complication in hematopoietic stem cell transplant recipients. We present a case of lichenoid sialadenitis in a 23-year-old-man with systemic cGVHD. The histological examination showed a lymphocytic inflammatory infiltrate adjacent to the salivary gland duct, similar to the histological aspects described in the typical manifestations of oral lichen planus and lichen planopilaris. This consists of a band-like inflammatory infiltrate not only targeting the cutaneous epithelium but also adnexal structures, such as hair follicles and salivary gland ducts. It is well described that the oral lesions in cGVHD share most of morphological and clinical manifestations with those described in oral lichen planus. The mechanisms of lichenoid salivary gland ducts destruction might be similar, although xerostomy appears to be specific to cGVHD, which may represent a clinical sign of massive salivary gland impairment related to ductal lichenoid destruction in patients with cGVHD

Oral Mucosal Melanoma of the Mandibular Gingiva: A Case Report

Orla mucosal melanoma is rare and is reported to be more aggressive than cutaneous melanoma. The incidence of oral mucosal melanoma peaks at 41 to 60 years of age and the male to female ratio is 2 to 1. Preferred sites in the oral mucosa include the hard palate and maxillary alveolar crests. Risk factors have not been clearly identified, but melanotic pigmentation is present in one-third of patients prior to the diagnosis of melanoma. We report an unusual case of oral mucosal melanoma of the mandibular gingiva with the main characteristics of an in situ lesion and areas of superficial invasion in a 45-year-old woman. The patient was treated with surgical resection of the lesion and a 54-month follow-up shows no evidence of recurrence. Oral mucosal melanomas are aggressive neoplasms that may arise from prior pigmented lesions in the oral mucosa. Classification of these tumors is not well-established and the main prognostic factor appears to be lymph node compromise. The main treatment modality is surgical resection. Cutis. 2010;86:89-93.FAPESP Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[06/56625-5]FAPESP Fundacao de Amparo a Pesquisa do Estado de Sao Paulo[07/50319-2

Lesões faciais por osteodistrofia renal em paciente com insuficiência renal crônica: relato de caso

PURPOSE: Chronic renal insufficiency (CRI) is the last stage of a chronic renal condition in which the kidney loses its filtration and endocrine functions. Chronic endocrine hypofunction causes generalized damage to the body known as Uremic Syndrome, which affects the central nervous system as well as the cardiovascular, hematologic, dermatologic, ophthalmic, endocrine, respiratory, gastrointestinal and skeletal systems. The present study reports the case of a female patient with CRI who presented facial osteodystrophy of the osteitis fibrosa type, and highlights the main features of this condition. CASE DESCRIPTION: A 24-year old, female, Caucasian patient presented chronic glomerulonephritis recurrence and lost the transplanted kidney five years before, undergoing arteriovenous fistula hemodialysis three times a week. She presented swelling of the left masseter area with a hard consistency on palpation, covered by intact skin, swelling at the bottom of the left atrium, with a hard consistency on palpation, a mucosa-like color and absence of inflammation signs, suggesting expansive bone lesions on the face. These features were compatible with hyperparathyroidism brown tumor and/or osteodystrophy. The CT scan showed expansive bone lesions of heterogeneous appearance on the left jaw, maxilla/nasal floor, and right frontotemporal suture areas. The clinical and histopathological characteristics of the lesion, in association with PHT hormone high serum levels led to renal osteodystrophy diagnosis. The patient was referred to the nephrology services. CONCLUSION: Osteodystrophic bone alterations have a high prevalence in renal disease patients, and the dentist must take these alterations into consideration in bone lesion diagnosis for this specific group of patients

Primary Oral Mucosal Melanoma: A Series of 35 New Cases From South America

Oral mucosal melanoma is rare and reported to be more aggressive than its cutaneous counterpart. Due to the rarity of this entity, data on epidemiology, tumor behavior, treatment, follow-up, and Survival of patients are mainly based oil single case reports. The few existing series of patients show that oral mucosa melanoma has its peak between 4 1 and 60 years of age, and male to female ratio is 2: 1. Preferred oral sites include hard palate and maxillary alveolar crests. Risk factors have not been clearly identified, and surgical treatment is still the treatment of choice for oral mucosal melanomas. The authors retrospectively studied 35 patients with primary melanoma of the oral cavity to report their clinical and pathological features, Such as age, sex, site of the tumor, metastasis, treatment, response to therapy, and Outcome. We found no significant sex predominance, and the mean age of the patients was 60.6 years, with a range From 9 to 91 years. The majority of the patients (71.42%) had palate commitment, and invasive histopathological aspect was observed in 80% of the specimens (grade 3). Long-distance metastasis was found in 60% of the cases. Fourteen patients were submitted to wide Surgical resections, with local relapse being observed in 11 of them (78.5%). The authors Suggest that improved outcome in oral malignant melanoma requires the development of new therapies and the prevention of distant metastasis.FAPESP Fundacao de Amparoa Pesquisa do Estado de Sao Paulo[06/56625-5