Burkitt's lymphoma of the jaws in the Amazon region of Brazil

Objectives: To describe the clinicopathologic and immunohistochemical features of Burkitt's lymphoma of the jaws in 7 patients of Northern Brazil. Study Design: Clinical data concerning gender, age, affected site, clinical presentation, symptomatology and follow-up were collected from the clinical files. Histopathology was complemented with a broad immunohistochemical panel and in situ hybridization for Epstein-Barr virus (EBV). Results: Most of the patients were infants and 5 out of 7 were males. The mandible was affected in 5 cases and all patients also presented abdominal involvement. All cases were positive for CD45, CD20, CD79a, CD10, Bcl-6 and EBV. Ki-67 proliferative index was approximately 100%. Six patients were treated with R-CHOP (Rituximab + Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) chemotherapy, and 2 of these died of the disease. One young adult patient refused treatment and died 3 months after initial diagnosis. Conclusions: Burkitt's lymphoma of the jaws diagnosed in the Amazon region of Brazil present similar clinicopathologic features to those described in endemic areas of Africa, including EBV positivity

Modulation of blood redox status by the progression of induced apical periodontitis in rats

This study aimed to investigate if apical periodontitis in different periods changes systemic levels of the antioxidant and pro-oxidant parameters in Wistar rats. Twenty-four rats were randomly allocated into healthy animals, apical periodontitis at 14 days (AP14) and apical periodontitis at 28 days (AP28). The first mandibular molars were accessed in the AP groups, and the pulp chamber was exposed to the oral environment, inducing the apical lesion. After 14 and 28 days, the animals were anesthetized, euthanized, and hemimandibles were collected for micro-computed tomography (micro-CT) analysis to measure lesion volume, bone volume (BV), percent of bone to total tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular space (Tb.Sp). A histological examination of the remaining bone was also performed. Finally, blood samples were collected for oxidative biochemistry analysis, investigating glutathione (GSH), Trolox equivalent antioxidant capacity (TEAC), and lipid peroxidation (TBARS). The lesion volume was greater at 28 than at 14 days, as shown by micro-CT. AP14 and AP28 had decreased BV and Tb.Th, but only AP28 showed a reduction in BV/TV. Tb.N and Tb. Sp were increased in apical periodontitis at 28 days. In the histopathological analysis, AP14 had focal regions of moderate mononuclear inflammatory infiltrate, and AP28 had an intense inflammatory infiltrate with bacterial colonies. In the biochemical evaluation, GSH, TEAC, and TBARS were increased after 14 days. However, GSH returned to control levels, TEAC was similar to AP14, and TBARS increased significantly after 28 days. Therefore, the oxidative biochemistry response was modulated according to the progression of periapical damage. After 14 days, the organism could still react to the injury. However, at 28 days, the antioxidant response decreased, associated with an increase in TBARS

HIV Infection and Oral Manifestations: An Update

Human immunodeficiency virus (HIV) causes a complete depletion of the immune system; it has been a major health issue around the world since the 1980s, and due to the reduction of CD4+ T lymphocytes levels, it can trigger various opportunistic infections. Oral lesions are usually accurate indicators of immunosuppression because these oral manifestations may occur as a result of the compromised immune system caused by HIV infection; therefore, oral lesions might be initial and common clinical features in people living with HIV. So, it is necessary to evaluate and understand the mechanism, prevalence, and risk factors of oral lesions to avoid the increase morbidity among those with oral diseases

Sensitizing Mucoepidermoid Carcinomas to chemotherapy by disrupting the population of Cancer Stem Cells using HDAC inhibitors

Carcinoma mucoepidermóide (CME) é o tumor maligno de glândulas salivares mais comum, representando cerca de 30% dos tumores malignos. O tratamento do CME é a ressecção cirúrgica com eventual radioterapia. Assim, o tratamento do CME pode levar a varias complicações estéticas e funcionais. A quimioterapia tem sido utilizadas apenas em casos recorrentes ou com metástases à distancia. Vários relatos na literatura tem mostrado que o tratamento com drogas isoladas ou combinadas possuem uma resposta insatisfatória e de curta duração em grande parte devido a aquisição de resistência a quimioterapia. Recentemente, a quimiorresistência tem sido relacionada com a presença de Células-Tronco Tumorais (CTT). Essa resistência tem sido associada ao fato de que as essa células são quiescentes e possuem altos níveis de proteínas associadas ao reparo do DNA e baixos níveis das proteínas que levam a apoptose. Recentemente mostrou-se que a resistência a quimioterapia tem sido relacionada com modificações de histonas, uma vez que as células quimiorresistentes possuem núcleo pequeno e baixos níveis de acetilação de histonas, adicionalmente as células sensíveis são relacionadas com núcleo aumentado. O objetivo desse estudo foi avaliar os efeitos do tratamento com IHDAC e cisplatina sobre a população de CTT de CME. Inicialmente analisamos os níveis de acetilação do histona através da expressão imuno-histoquímica de acetil histona H3 em casos de CME, sendo encontrado altos níveis de acetilação de histona principalmente nas células epiteliais do ducto excretor. Adicionalmente, demonstramos que o tratamento com SAHA (inibidor de histona deacetilase) impacta diretamente a população de CTT, de uma maneira mais eficiente do que a cisplatina ou da combinação de SAHA e cisplatina. É interessante que o tratamento com cisplatina resultou no acúmulo de uma subpopulação especifica de CTT em um processo que inclui o aumento na expressão da via de sinalização do mTOR. Estes achados sugerem que o uso de IHDAC constitui uma forma eficiente de tratamento de CME através da depleção da população de CTT , porém mais estudos são necessários para validar estes achados para uso clinico.Mucoepidermoid carcinoma (MEC) is the most common malignant salivary tumor compromising about 30% of all salivary malignances. Managing MEC patients remain challenging especially due to the heterogeneous response of tumor cells to available therapy. For this reason clinical outcome remains unpredictable. Current treatment of MEC encompasses surgical resection with eventual adjuvant radiotherapy, which frequently leads to functional and aesthetic complications. The use of chemotherapy is often reserved for recurrent and metastatic tumors. Administration of single-agent or combination therapy has showed activity, however overall response rates are unsatisfactory and of short duration. Emerging evidences suggest that the modest response of tumor cells to therapy resulting in high recurrence rates and poor survival, are associated with the presence of cancer stem cells (CSC). Quiescence of CSC is achieved by the reduced levels of transcription in a process that requires tight folding of DNA driven by core histone proteins. Changes in DNA folding are responsible for different cellular phenotypes mediated by a cell type-specific chromatin organization. Of interest, we also found that acetylation of HNSCC tumor histones driven by histone deacetylase (HDAC) inhibitors abrogate tumor resistance to chemotherapy. We investigate the effects of HDACi and cisplatin in the population of CSCs of MEC. Initially, we found that MEC tumors are composed by a heterogeneous population of squamous-like and mucous-like cells presenting distinct acetylation levels of histone 3 (Lys9). Tumor cells where treated with cisplatin and SAHA, a Food and Drug Administration (FDA) approved histone deacetylase inhibitor. Surprisingly, we found that administration of SAHA resulted in complete depletion of MEC CSCs. In facts, SAHA alone surpassed the inhibitory therapeutic effects of cisplatin and the combined therapy using SAHA and cisplatin over the population of CSCs. We also found that administration of cisplatin to MEC tumor cells result in unexpected accumulation of a sub population of CSC (paraclones), suggesting a correlation between the administration of intercalating agents such as cisplatin to the development of resistance of MEC cells to chemotherapy

Ocorrência simultânea de cisto dentígero e odontoma composto-complexo causando impacção dentária

The present work illustrates and discusses this disease that represents the most common odontogenic tumor in clinical practice, the Odontoma. However, an unusual variation of the same is included here in the literature, characterizedby the exams as a form of compound-complex odontoma additionally causing dentigerous cyst formation and dental impaction. The unusual case occurred in a 21-year-old woman, complaining of missing the tooth 23. The details of the exams allowed the visualization of compound and complex areas in the lesion, cystic formation and dental impaction. The histopathological findings confirmed the diagnosis of the Odontoma, and the interpretation with the set of other exams led to the final diagnosis of Compound-complex odontoma with dentigerous cyst. The present case highlights the need for early removal of Odontoma due to the possibility of developing cysts, compromising adjacent structures, in addition to its growth potential already reported in the literature.O presente trabalho ilustra e discute essa doença que representa o tumor odontogênico mais comum da prática clínica, o Odontoma. Para tal, apresenta um caso clínico com imagens clínicas e radiográficas esclarecedoras dos aspectos dessa doença, bem como discussão a partir de revisão narrativa de literatura direcionada para a caracterização da doença. Relata-se o caso de um odontoma composto-complexo, uma forma incomum de odontoma, mas que mantém os demais aspectos usuais, sendo uma mulher de 21 anos com lesão radiopaca em maxila detectada devido à não erupção do 23. A remoção cirúrgica seguiu a partir de acesso anterior na maxila e o exame histopatológico mostrou os aspectos típicos de um Odontoma composto e complexo juntos. Independentemente da variante, nota-se que o Odontoma é quase sempre indolente, porém requer cuidados de remoção precoce devido à possibilidade de crescimento, de desenvolvimento de cistos e comprometimento de estruturas adjacentes devido a sua localização e possibilidade de crescimento

Oral mucosal lesions in patients with SARS-CoV-2 infection. Report of four cases. Are they a true sign of COVID-19 disease?

Background Vesiculobullous and macular lesions in the oral mucosa have been reported in patients positive for SARS‐CoV‐2 infection. Nonetheless, the significance and physiopathology of oral manifestations have not been clearly established in the clinical progression or outcome of the infection. Aim To describe the clinico‐pathological oral mucosal lesions in four patients with confirmed SARS‐CoV‐2 infection. Methods and Results Four patients with COVID‐19 disease and confirmed by polymerase chain reaction (PCR) presented angina bullosa hemorragica‐like lesion, vascular disorder, and nonspecific stomatitis, one patient with histological analysis demonstrated perivascular reactive lymphocitic infliltrate, focal capillary thrombosis, and hemorrhage. According to the discrimination of other local and systemic conditions and the synchronous onset of oral and systemic symptoms, the diagnosis of oral lesions probably associated with COVID‐19 was established. Conclusion Infection with SARS‐CoV‐2 may result in oral manifestations with various clinical presentations, which presumably support the hypothesis of thrombi formation and vasculitis; nevertheless, these findings need more evidence and a long‐term follow up of patients to accurately establish the significance of the oral mucosa affection in the COVID‐19 disease

Ameloblastomas: diagnosis considerations and therapeutic approaches.

Objetivo: Demostrar as considerações atuais no diagnóstico, mudança na classificação e abordagem terapêuticas, para o tratamento dos ameloblastomas. Método: trata-se de revisão narrativa de literatura aliada a demonstração de casos clínicos originais com o propósito de aproximar o conteúdo teórico revisto com exemplares de aplicação prática da atuação do profissional.  A consulta pela literatura pautou-se em livros de referência mundial como o da Organização Mundial da Saúde associado a busca eletrônica nas bases de dados Medline, Lilacs e SciELO. Resultados: O ameloblastoma é uma neoplasia odontogênica benigna de evolução lenta, assintomática. Em aspecto de exames de imagem as lesões variam entre o radiolúcido unilocular ao multilocular, podendo provocar alterações em dentes próximos. Em aspecto transcirúrgico e histopatológico há diferenças entre ameloblastoma e ameloblastoma cístico para as lesões intraósseas, e o tratamento será influenciado por esse fator, além de idade do paciente, tamanho da lesão e localização. Há ainda na literatura uma certa preferência para as abordagens radicais. As terapias direcionadas contra o gene BRAF parecem um futuro promissor. Conclusão: O conhecimento de variantes do ameloblastoma é primordial e orienta uma reflexão terapêutica do tipo custo/benefício a ser estabelecida em cada caso individualmente a partir de discussão multidisciplinar e escolha do paciente.Objective: To demonstrate the current considerations in the diagnosis, change in the classification and therapeutic approach, for the treatment of ameloblastomas. Method: it is a narrative review of literature combined with the demonstration of original clinical cases to approximate the revised theoretical content with examples of the practical application of the professional's performance. The literature search was based on world reference books such as the World Health Organization's associated electronic search in the Medline, Lilacs and SciELO databases. Results: Ameloblastoma is a slow, asymptomatic benign odontogenic neoplasm. In terms of imaging exams, the lesions vary from unilocular to multilocular radiolucent, which can cause changes in nearby teeth. In trans-surgical and histopathological aspects, there are differences between ameloblastoma and cystic ameloblastoma for intraosseous lesions, and the treatment will be influenced by this factor, in addition to the patient's age, lesion size and location. There is still a certain preference in the literature for radical approaches. Therapies targeting the BRAF gene look like a promising future. Conclusion: The knowledge of ameloblastoma variants is paramount and guides a therapeutic reflection of the cost/benefit type to be established in each case individually based on multidisciplinary discussion and patient choice

Prevalence of Paediatric Head and Neck Malignancies in the North Region of Brazil: A Cross-sectional Study

Introduction: Head and Neck Cancer (HNC) ranks sixth among the most common men’s tumours. The prevalence of HNC in children has increased in several countries, and the prevalence varies worldwide. In several regions in Brazil and the world, a lack of epidemiological data records on childhood HNC is observed, demonstrating little knowledge about the demographic profile of these patients. Aim: To determine the prevalence of HNC in paediatric patients over the years at a reference centre in the North region of Brazil. Materials and Methods: A cross-sectional study was conducted with the objective of quantitatively and qualitatively analysing the prevalence of HNC in a reference oncology hospital. The electronic medical records of patients aged 0 to 19 years were reviewed at a referral centre in Northern Brazil from October 2015 to February 2022. Demographic variables, topographic location of tumours, city of origin, patient outcome, and histopathological diagnosis were collected. Results: A total of 4,113 medical records were analysed, and 126 met the criteria for analysis. Males had a higher incidence n=75 (59.52%) of HNC than females n=51 (40.47%). The age group with the highest percentage of HNC was > 4 to 9-year-old n=40 (31.74%). The most common diagnosis were lymphoma 78 (61.90%), sarcoma 22 (17.46%); carcinoma 14 (11.11%), and histiocytosis 10 (7.93%). Conclusion: In Northern Brazil, the most common tumour was Hodgkin’s lymphoma, and the most prevalent group affected were males aged > 4-9-year-old

Ki-67 protein predicts survival in oral squamous carcinoma cells: an immunohistochemical study

<div><p>Abstract The aim of this study was to identify the expression of Ki-67 and MCM3 in oral squamous cell carcinoma (OSCC) as well as to address the correlation with patient survival and clinical features. Samples were collected from 51 patients with OSCC who presented for follow-up. Immunohistochemical expression of Ki-67 and MCM3 in all groups was performed. The scoring system was previous published by Tsurutani in 2005. We used Kappa index to evaluate observers agreement degree. The associations between protein expression and clinical variables were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). The overall survival time for a patient with positive immunostaining for Ki-67 is shorter than for a patient with negative immunostaining, (log-rank test, p = 0.00882). Patients with tumor size T3 and T4 showed a statistically significant relationship with Ki-67 immunoexpression (log-rank test, p = 0.0174). The relationship between Ki-67 expression and the relation between age, gender, smoking, tumor site, lymph node metastasis and disease stage was not significant. The examiners agreement degree by Kappa presented p value < 0.05. There was not a significant correlation when we evaluated MCM3 expression regarding clinical characteristics and survival rate. From these results, the present study suggests that positive Ki-67 expression found in OSCC patients may contribute to predict the survival in OSCC samples, as well as the relation between the protein and the tumor size.</p></div