Oral focal mucinosis of the hard palate and gingiva

Oral focal mucinosis (OFM) is an uncommon, asymptomatic, submucosal, slow-growing nodule representing a counterpart of the cutaneous focal mucinosis (CFM). OFM has a female predilection with the highest prevalence in the fifth decade of life. About 68% of OFMs occur in the gingiva and 14% in the palate. We present the case of a 41-year-old woman presenting a progressively growing mass on the palate, since the last 8 months. The diagnostic workup led to the diagnosis of an unusual OFM with the clinical presentation involving the gingiva and hard palate. This case report discusses the clinical and histopathological differential diagnosis

Oral focal mucinosis of the hard palate and gingiva

Oral focal mucinosis (OFM) is an uncommon, asymptomatic, submucosal, slow-growing nodule representing a counterpart of the cutaneous focal mucinosis (CFM). OFM has a female predilection with the highest prevalence in the fifth decade of life. About 68% of OFMs occur in the gingiva and 14% in the palate. We present the case of a 41-year-old woman presenting a progressively growing mass on the palate, since the last 8 months. The diagnostic workup led to the diagnosis of an unusual OFM with the clinical presentation involving the gingiva and hard palate. This case report discusses the clinical and histopathological differential diagnosis

e-caderin and b-catenin expression in carcinoma ex-pleomorphic adenoma carcinomatous area

O carcinoma ex-adenoma pleomórifoco (CXAP) é a contraparte maligna do Adenoma pleomórfico (AP), sendo sua malignização descrita em 10% dos AP. Histológicamente o CXAP apresenta grande variação morfológica vista a capacidade do componente maligno se originar de diferentes estruturas do componente misto do AP. Nota-se que grande parte dos CXAP apresentam caráter infiltrativo, metástase linfonodal e metástase tardia. Para que as células neoplásicas adquiram um fenótipo com maior capacidade infiltrava é necessário que passem por um processo de transição de um fenótipo epitelial para mesenquimal. Este processo é conhecido como Transição epitélio-mesênquima (TEM). Tal processo é visto em situações fisiológicas, tais quais, migração de células ectodérmicas durante o período embriológico, reparação e cicatrização e também em processos neoplásicos. O objetivo deste trabalho é avaliar a presença de proteínas inerentes ao processo de transição epitélio mesênquima e comparar a expressão destas proteínas com achados histopatológicos sugestivos de invasão e mestástase. A análise das proteínas E-caderina e Beta-catenina em células neoplásicas de CXAP foi realizada de forma semi-quantitativa conforme sugerido pela literatura. Os casos foram subdividos de acordo com a positividade da reação de imunohistoquímica. Onde houve ausência de células positivas o caso recebeu escore 0, casos onde houve 75% das células eram positivas. Tais achados foram relacionados com presença de invasão angiolinfática, perineural, metástase tardia, recorrência e metástase linfonodal. De um total de 16 casos de CXAP, o sitio mais acometido foi a parótida e 53% da nossa amostra era composta por homens, a idade média foi de 52,9 anos e a parótida foi o sitio mais acometido. A análise histopatológica demonstrou que quando havia marcação para E-caderina a mesma se dava em membrana celular. 12,5% ausência de marcação, 50% dos casos com marcação fraca 31,25% dos casos com expressão moderada e 6,25% dos casos com marcação intensa. Já para Beta-catenina um caso apresentou marcação citoplasmática e os restantes em membrana celular.18,75% ausente de marcação, 25 % com marcação fraca, 50% dos casos com marcação moderada e 6,25 dos casos com marcação intensa. A imuno-marcação estava distribuída de forma difusa tanto no front de invasão quanto no parênquima do carcinoma. Casos com maior presença de E-caderina apresentaram mais metástases linfonodais, p=0,035. Para outros critérios de invasão nenhuma relação estatística significante foi observada. Sugere-se que E-caderina e Beta-catenina não fazem parte do processo de invasão e metástase de CXAP nem são fatores relacionados a invasão dos tecidos adjacentes.Carcinoma ex-pleomorphic adenoma (CXAP) is the malignant counterpart of pleomorphic adenoma(PA), although malignant transformation of PA is unusual occurring in 10% of the PA cases. The CXAP histologically presents an intense morphologic variation due to the ability of the malignant tissue to originate from any structure of de mixed component. A significant number of CXAPs show an infiltrative behavior, lymph node metastasis and late metastasis. The cell component must undergo a morphologic alteration changing the epithelial phenotype to a mesenchymal one. That development process is known as epithelial-mesenchymal transiction (MET). This process is seen in physiologic situations, like cell migration on embryologic ectodermal evolution, tissue repair and int neoplastic processes. The main objective of this study was to evaluate immunohistochemical expression of epithelial-mesenchymal transiction proteins, e-caderin and beta-catenin in malignant areas of CXAP and correlate with pathologic parameters that indicates migration, like perineural and angiolymphatic invasion and metastasis as suggested by the literature. Immunohistochemical analysis was performed semiquantitatively according to the scores 0 (no positive cell), 1 (75% positive cells). These results were also correlated with pathological parameters of neoplastic aggressiveness using the Fisher\'s exact test. Of the16 cases, the parotid gland was the most involved site and men were affected in 53.8 % of our sample. The mean age was 52.9 year. The histopathological analysis showed that in all cases in which e-caderin was positive, the immunoreaction was of the cell membrane 12,5% of the cases showed absent of e-caderin expression, 50% showed weak expression, 31,25% showed moderate expression and 6,25 show strong one. In the other hand, b-catenin showed cytoplasmic expression in one case, all other cases showed protein in cell membrane. 18,75 showed absent expression, 25% showed weak expression, 50% showed moderate and 6,25% showed intense one. The immunohistochemical reaction was diffuse and presented itself in invasion front as well as in the carcinoma parenchyma. Cases presenting high expression of e-caderin developed more lymph node metastasis, p=0,035. For the others invasion parameters there was no statistic summary observed. This work suggest that e-caderin and b-catenin have no relation to CXAP carcinogenesis or invasion proces

Analysis of SARS-CoV-2 and ACE2, TMPRSS2 receptors in salivary glands and periodontal tissues: a biomolecular, immunohistochemical, and ultrastructural evaluation from COVID-19 fatal cases

O início de uma nova doença, cujo epicentro se deu em Wuhan - China - com sintomas similares a de uma pneumonia com alto potencial de disseminação, fez com que a Organização Mundial de Saúde decretasse o status de pandemia a está nova doença, chamando a, então, de COVID-19. O agente causador dessa doença foi identificado como um vírus da família coronoviridae denominado SARS-CoV-2. Tal patógeno apresenta como seu órgão alvo o pulmão, instalando um dano alveolar difuso e consequentemente a falência respiratória aguda levando milhares de pessoas a óbito através do mundo. Assim como outros vírus da família coronoviridae, o SARS-CoV-2 utiliza-se de receptores ACE2 e TMPRSS para ligar-se as células do hospedeiro, apresentando assim intenso tropismo por tecidos epiteliais. Neste racional o objetivo deste trabalho foi aprofundar o conhecimento sobre as interações do SARS-CoV-2 e os nichos epiteliais da cavidade oral a partir de autópsias de pacientes que foram a óbito por complicações da COVID-19, desenvolvendo novas metodologias de coletas e reflexões sobre o papel desta técnica na odontologia com diferentes ensaios. Foram realizadas 40 autopsias minimamente invasivas, coletando múltiplos sítios da cavidade oral com o intuito de identificar e caracterizar a presença do SARS-CoV-2 em tecidos de glândulas salivares e periodonto, assim como, avaliar clinicamente potenciais lesões orais. Por fim, avaliar a interação de agentes descontaminantes do vírus nos tecidos da cavidade oral e demonstrar a importância da utilização das autopsias para a odontologia em diversas abordagens metodológicas. Foram realizadas análises biomoleculares dos tecidos glandulares e periodontais sendo as amostras positivas em 5/7 periodontos e 22/35 das glândulas salivares maiores e 80% das menores. A avaliação IHC anti-SARS-CoV-2 foi positiva 55% dos casos. As reações de imunopostividade para os receptores ACE2 e TMPRSS2 foram francamente positivas em todos os casos de tecido periodontal e glândulas salivares. As avaliações das lesões orais se mostraram majoritariamente como coinfecções decorrentes da deterioração da saúde geral dos pacientes. Visto a cinética viral nos nichos orais, os relatos de casos corresponderam com o racional viral, não tendo capacidade sustentada de erradicar o vírus das amostras avaliadas. A utilização das autópsias para avaliação dos tecidos orais se mostrou uma técnica segura e que permite uma avaliação ampla das amostras, assim como, das interações do mesmo com outros órgãosResume: The beginning of a new disease, in Wuhan China that presents pneumonia symptoms and high transmissibility, made the World Health Organization decree a pandemic status, calling this disease COVID-19. The pathogen of this disease was a new virus, named SARS-CoV-2. The viruss main targets are the lung epithelial cells causing diffuse alveolar damage and consequently respiratory distress, leading thousands of people to death. Like other coronaviridae viruses, the SARS-CoV-2 uses ACE2 and TMPRSS2 receptors to bond into membrane host cells, showing intense epithelial tropism. The aim of this research is to understand and create knowledge about the relation between the SARS-CoV-2 and oral epithelial niches based on autopsies from COVID-19 deceased patients, developing new sample methodologies and insights about the autopsy role in dentistry in several methodological approaches. We performed 40 minimally invasive autopsies, sampling multiple oral cavity sites aiming to identify and characterize the SARS-CoV-2 presence in salivary glands and periodontal tissues, as well as, evaluate some clinically evident oral lesions. Finally, evaluate the decontaminate potential from chemical agents and show the value of autopsies in dentistry science. We did analyze tissues from salivary glands and gingiva using biomolecular assays that resulted positive for SARSCoV-2 in 5/7 periodontal tissues and 22/35 major salivary glands and 80% of minor ones. The immunohistochemistry analysis showed positivity in 55% of the cases. Immunopositivity for ACE2 and TMPRSS2 was frankly positive in all cases involving periodontal and glandular tissue. The evaluation of oral lesions showed in the vast majority as coinfections that appear in recurrence of the poor health status of the patients. The case reports using different methods of decontamination showed transient results, with recontamination during time in the analyzed sample. The use of autopsies to evaluate oral samples seems to be a secure method and allows us an overview of oral and systemic health, the use of new biomolecular techniques must be employed for further validation of new diseases using samples coming from deceased patient

Oral manifestation of multiple myeloma: a case report

O Mieloma múltiplo (MM) é uma condição oncohematológica relativamente incomum caracterizada pela proliferação anormal de células plasmáticas. Manifestações orais de MM podem ocorrer tanto em partes moles quanto intraósseas. Apresentamos o caso de um homem de 69 anos, diagnosticado com MM e em tratamento quimioterápico, levado a tratamento odontológico por uma queixa de inchaço nodular no maxilar. Uma biópsia incisional foi realizada e a análise histopatológica revelou uma proliferação monoclonal de células plasmáticas com imunofenótipo CD 138, levando ao diagnóstico de plasmocitoma extramedular. O desfecho do caso foi desfavorável, com o paciente indo a óbito. Enfatizamos a importância do diagnóstico de MM extramedular na região maxilofacial.Multiple myeloma (MM) is a relatively uncommon oncohematological condition characterized by abnormal proliferation of plasma cells. Oral manifestations of MM can occur in soft and intraosseous parts. We present a case of a 69-year-old man diagnosed with MM and undergoing chemotherapy, referred to the dental service complaining of a nodular swelling in the maxilla. An incisional biopsy was conducted and the histopathological analysis showed a monoclonal proliferation of plasma cells with a positive CD 138 immunophenotype, which allowed the diagnosis of extramedullary plasmacytoma. The outcome of the case was unfavorable and the patient died. We emphasize the importance of diagnosing MM extramedullary disease in the maxillofacial region

Apresentação clínica peculiar de sífilis primária na cavidade oral

Syphilis, a sexually transmitted infection, has increased in incidence over the years, especially among the adult popu­lation. The oral manifestation of primary syphilis is usually characterized by a clinical course variable in which it pro­gresses to the next stages if not treated. In this report, we present two cases of oral manifestation of primary syphilitic lesion with peculiar clinical characteristics, and we emphasize the importance of a correct diagnosis. Biopsies were needed for differential diagnosis and serological exams were requested. The histopathological analysis suggested the diagnosis and the immunohistochemistry confirmed the presence of Treponema pallidum. Antibiotic therapy was ini­tiated with complete remission of the lesion. Therefore, a thorough anamnesis and a thorough clinical examination are essential for establishing the correct diagnosis, to begin the treatment of syphilis as soon as possible, thus avoiding the disease’s progression.A sífilis, uma infecção sexualmente transmissível, aumentou sua incidência ao longo dos últimos anos, especialmente entre a população adulta. A manifestação oral da sífilis primária é geralmente caracterizada por um curso curto, no qual ela não é tratada e progride para os próximos estágios. Neste relato, apresentamos dois casos de manifestação oral de lesão sifilítica primária com apresentação clínica peculiar e enfatizamos a importância do diagnóstico cor­reto. Biópsias foram necessárias para diagnóstico diferencial e exames sorológicos foram solicitados. A análise histopatológica sugeriu o diagnóstico, e a imuno-histoquímica confirmou a presença do Treponema pallidum. Antibioticoterapia foi iniciada com remissão completa da lesão. Portanto, anamnese e um exame clínico minuciosos são essenciais para estabelecer o diagnóstico correto, a fim de estabelecer o tratamento da sífilis o quanto antes, evitando-se assim a progressão da doença

Teledentistry and the Unified Health System : an important tool for the resumption of Primary Health Care in the context of the COVID-19 pandemic

O preprint foi submetido para publicação em um periódico.Este “short communication” descreve as possibilidades de utilização da Teleodontologia para ampliação e qualificação do cuidado em saúde nas redes de atenção à saúde bucal. A OMS já recomendava aos seus países membros, mesmo antes da pandemia, o Telessaúde como estratégia para melhorar a qualidade dos serviços, especialmente nos sistemas universais, como é o caso do Sistema Único de Saúde. A Teleodontologia abre oportunidades para que a saúde bucal retome a oferta de diversos serviços, de forma remota, como: 1. rastreamento, busca ativa, monitoramento de usuários prioritários, de risco e com problemas sistêmicos, de suspeitas de COVID-19 e contactantes, através do Telemonitamento; 2. escuta inicial, atividades educativas individuais ou coletivas, através da Teleorientação; 3. discussão de casos clínicos para a definição da oportunidade/necessidade de procedimentos operatórios, matriciamento, compartilhamento, solução de dúvidas entre profissionais e entre estes e instituições de ensino e pesquisa, por Teleconsultorias, entre outros. Além de uma revisão sobre a Teleodontologia no contexto da pandemia, conceituamos os termos utilizados e possibilidades que oferecem aos profissionais do SUS, além de especificar os protocolos possíveis para registro dessas atividades, a fim de fornecer dados seguros para seu monitoramento e avaliação. Ademais, trazemos uma breve discussão com experiências promissoras, realizadas nos contextos pré e trans pandemia, que podem ser importantes estratégias para a retomada da saúde bucal no cenário pós pandemia.This “short communication” describes the possibilities of using Teleodontology to expand and qualify health care in oral health care networks. WHO already recommended to its member countries, including Brazil, even before the pandemic, the use of Telehealth as a strategy to improve the quality of its services, especially in the context of universal health systems, as the Unified Health System In the current context, Teleodontology opens opportunities for oral health to resume the offer of various services, remotely, such as: 1. tracking, active search, monitoring users of priority groups, at risk and with systemic problems, monitoring of suspected cases of COVID-19 and its contacts, via telemonitoration; 2. initial listening, individual and collective educational activities, among others, through teleorientation; 3. discussion of clinical cases to define the opportune moment to perform operative procedures among professionals of different levels of care, matrix support, sharing and soluting doubts between professionals or between professionals and teaching and research institutions, through teleconsulting, among others . In addition to a literature review on Teleodontology in the context of the pandemic, an important contribution of this “short communication” is the conceptualization of the terms used and possibilities they offer to SUS professionals, in addition to specifying the possible protocols for recording these activities, in order to provide service managers with secure data for monitoring and evaluating the work process. In addition, we bring a brief discussion with some promising experiences, carried out in the pre and transpandemic context, which can consolidate themselves as important strategies for the resumption of oral health in the post-pandemic scenario

Salivary glands are a target for SARS- CoV- 2: a source for saliva contamination

The ability of the new coronavirus SARS- CoV- 2 to spread and contaminate is one of the determinants of the COVID- 19 pandemic status. SARS- CoV- 2 has been detected in saliva consistently, with similar sensitivity to that observed in nasopharyngeal swabs. We conducted ultrasound- guided postmortem biopsies in COVID- 19 fatal cases. Samples of salivary glands (SGs; parotid, submandibular, and minor) were obtained. We analyzed samples using RT- qPCR, immunohistochemistry, electron microscopy, and histopathological analysis to identify SARS- CoV- 2 and elucidate qualitative and quantitative viral profiles in salivary glands. The study included 13 female and 11 male patients, with a mean age of 53.12- years (range 8- 83- years). RT- qPCR for SARS- CoV- 2 was positive in 30 SG samples from 18 patients (60% of total SG samples and 75% of all cases). Ultrastructural analyses showed spherical 70- 100- nm viral particles, consistent in size and shape with the Coronaviridae family, in the ductal lining cell cytoplasm, acinar cells, and ductal lumen of SGs. There was also degeneration of organelles in infected cells and the presence of a cluster of nucleocapsids, which suggests viral replication in SG cells. Qualitative histopathological analysis showed morphologic alterations in the duct lining epithelium characterized by cytoplasmic and nuclear vacuolization, as well as nuclear pleomorphism. Acinar cells showed degenerative changes of the zymogen granules and enlarged nuclei. Ductal epithelium and serous acinar cells showed intense expression of ACE2 and TMPRSS receptors. An anti- SARS- CoV- 2 antibody was positive in 8 (53%) of the 15 tested cases in duct lining epithelial cells and acinar cells of major SGs. Only two minor salivary glands were positive for SARS- CoV- 2 by immunohistochemistry. Salivary glands are a reservoir for SARS- CoV- 2 and provide a pathophysiological background for studies that indicate the use of saliva as a diagnostic method for COVID- 19 and highlight this biological fluid’s role in spreading the disease. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168288/1/path5679_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168288/2/path5679.pd

Salivary glands are a target for SARS‐CoV‐2: a source for saliva contamination

The ability of the new coronavirus SARS- CoV- 2 to spread and contaminate is one of the determinants of the COVID- 19 pandemic status. SARS- CoV- 2 has been detected in saliva consistently, with similar sensitivity to that observed in nasopharyngeal swabs. We conducted ultrasound- guided postmortem biopsies in COVID- 19 fatal cases. Samples of salivary glands (SGs; parotid, submandibular, and minor) were obtained. We analyzed samples using RT- qPCR, immunohistochemistry, electron microscopy, and histopathological analysis to identify SARS- CoV- 2 and elucidate qualitative and quantitative viral profiles in salivary glands. The study included 13 female and 11 male patients, with a mean age of 53.12- years (range 8- 83- years). RT- qPCR for SARS- CoV- 2 was positive in 30 SG samples from 18 patients (60% of total SG samples and 75% of all cases). Ultrastructural analyses showed spherical 70- 100- nm viral particles, consistent in size and shape with the Coronaviridae family, in the ductal lining cell cytoplasm, acinar cells, and ductal lumen of SGs. There was also degeneration of organelles in infected cells and the presence of a cluster of nucleocapsids, which suggests viral replication in SG cells. Qualitative histopathological analysis showed morphologic alterations in the duct lining epithelium characterized by cytoplasmic and nuclear vacuolization, as well as nuclear pleomorphism. Acinar cells showed degenerative changes of the zymogen granules and enlarged nuclei. Ductal epithelium and serous acinar cells showed intense expression of ACE2 and TMPRSS receptors. An anti- SARS- CoV- 2 antibody was positive in 8 (53%) of the 15 tested cases in duct lining epithelial cells and acinar cells of major SGs. Only two minor salivary glands were positive for SARS- CoV- 2 by immunohistochemistry. Salivary glands are a reservoir for SARS- CoV- 2 and provide a pathophysiological background for studies that indicate the use of saliva as a diagnostic method for COVID- 19 and highlight this biological fluid’s role in spreading the disease. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168288/1/path5679_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168288/2/path5679.pd

Single-cell and spatially resolved interactomics of tooth-associated keratinocytes in periodontitis.

Funder: ADA Science & Research Institute (Volpe Research Scholar Award), Chan Zuckerberg Initiative (Pediatric Networks for the Human Cell Atlas), American Academy of Implant Dentistry Foundation (Large Research Grant)Periodontitis affects billions of people worldwide. To address relationships of periodontal niche cell types and microbes in periodontitis, we generated an integrated single-cell RNA sequencing (scRNAseq) atlas of human periodontium (34-sample, 105918-cell), including sulcular and junctional keratinocytes (SK/JKs). SK/JKs displayed altered differentiation states and were enriched for effector cytokines in periodontitis. Single-cell metagenomics revealed 37 bacterial species with cell-specific tropism. Fluorescence in situ hybridization detected intracellular 16 S and mRNA signals of multiple species and correlated with SK/JK proinflammatory phenotypes in situ. Cell-cell communication analysis predicted keratinocyte-specific innate and adaptive immune interactions. Highly multiplexed immunofluorescence (33-antibody) revealed peri-epithelial immune foci, with innate cells often spatially constrained around JKs. Spatial phenotyping revealed immunosuppressed JK-microniches and SK-localized tertiary lymphoid structures in periodontitis. Here, we demonstrate impacts on and predicted interactomics of SK and JK cells in health and periodontitis, which requires further investigation to support precision periodontal interventions in states of chronic inflammation