Proliferative Verrucous Leukoplakia: AClinical Case

Indexación: Web of Science; Scielo.RESUMEN: La Leucoplasia Verrucosa Proliferativa (LVP) es una placa blanca, verrucosa, exofítica, de crecimiento lento, que no se desprende al raspado y que tiende a comprometer diversos sitios de la mucosa oral. Es resistente al tratamiento independiente de la terapia adoptada y presenta una alta tasa de recidiva posterior al tratamiento quirúrgico. Desde 1985, cuando fue descrita por primera vez por Hansen, hasta le fecha, se ha mantenido como una entidad patológica compleja. Reportamos un caso de una paciente de sexo femenino de 72 años de edad que consulta por una lesión blanca, verrucosa, asintomática, que no se desprende al raspado, en el borde y vientre lingual y piso de boca. Se realizaron 2 biopsias incisionales del borde lateral de la lengua. Al examen microscópico se observó en ambas biopsias un grueso revestimiento epitelial acantósico, con marcada hiperparaqueratosis, una membrana basal nítida y cambios displásicos mínimos. Al mes de realizadas las biopsias la lesión presentó recidiva, manteniendo las mismas características clínicas encontradas inicialmente. Considerando la evolución, comportamiento biológico y las características histopatológicas, la lesión se diagnosticó como una LVP. Hasta la fecha, no hay protocolo de tratamiento establecido para estas lesiones. En este caso en particular, tomando en cuenta la extensión de la lesión, los sitios comprometidos, las escasas atipias presentes al examen histopatológico, la edad y escaso nivel socioeconómico de la paciente, se decidió no realizar la remoción quirúrgica de la lesión y mantenerla en control clínico cada 3 meses. Después de varios controles realizados durante un periodo de 3 años, se observó que la lesión mantuvo sus características clínicas iniciales. Esto confirma que haber optado por un tratamiento conservador, en este caso en particular de LVP, fue la decisión correcta. Sin embargo, es importante considerar que, según lo reportado en la literatura, la tasa de transformación maligna es alta e impredecible, por lo que los controles clínicos periódicos son de vital importancia para diagnosticar precozmente su evolución a carcinoma espino celular o carcinoma verrucoso. PALABRAS CLAVE: Leucoplasia Verrucosa Proliferativa, leucoplasia oral, patología oral. -------------------------------------------------------------------------------- ABSTRACT: The proliferative verrucous leukoplakia (PVL) is a white plate, wart-like, exophytic , slow growth , which does not follow the scaling that tends to compromise various oral mucosal sites . It is resistent to independent therapy and has a high rate of recurrence after surgical treatment. Since 1985, when it was first described by Hansen, and to date it has remained a complex pathological disorder. We report a case of a 72-year-old female patient who complains of a white, verrucous and asymptomatic lesion. The lesion does not detach by scraping the edge, lingual belly or mouth floor. Two Incisional biopsies were performed on lateral border of the tongue. Upon microscopic examination of both biopsies, thick epithelial lining, with marked hyperparakeratosis, a basement membrane, and minimal dysplasia alterations were observed. One month following biopsies of the lesion were performed, lesion relapsed and maintained the same clinical features found initially. Considering the evolution, biological behavior and histopathological features, the lesion is diagnosed as an PVL. To date, there is no established treatment protocol for these injuries. In this particular case, taking into account the extent of the injury, compromised sites, the few atypia present histopathological examination, age and low socioeconomic level of the patient, it was decided not to perform surgical removal of the lesion and maintain clinical monitoring every 3 months. Following several examinations carried out over a three-year period, it was observed that the injury kept initial clinical features. This confirms that having opted for conservative treatment, in this particular case of PVL, was the right decision. However, it is important to consider that, as reported in the literature, there is a high and unpredictable rate of malignant transformation. Therefore periodic clinical controls are vital for early diagnosis of cell carcinoma or verrucous carcinoma. KEY WORDS: proliferative verrucous leukoplakia, oral leukoplakia, oral pathology.http://ref.scielo.org/zvg3s

Human Papilloma Virus and oral cancer: Narrative review of the literature

The Human Papilloma Virus (HPV) infection is now more common sexually transmitted diseases, with an incidence of 5.5 million worldwide, with 85% of the carrier of this virus adult population. Their oncogenic potential and increased oral lesions associated with oral HPV infection have led us to make a narrative of the literature on the role of HPV in oral cancer, especially types 16 and 18. Here we refer to the possible routes of infection, oncogenic mechanisms, both benign and potentially malignant oral lesions associated with the infection, different methods used for detection, prediction and prevention of infection. We stress the importance of the role of the dentist to identify individuals considered high risk and ease of performing detection in the oral cavity, through a quick and easy method as exfoliative cytology. Keywords: oral cavity, squamous cell carcinoma, HPV 16, HPV 18Virus Papiloma Humano y cáncer oral: Revisión narrativa de la literaturaEl Virus Papiloma Humano (VPH) en la actualidad constituye la infección por transmisión sexual más frecuente, presentando una incidencia de 5,5 millones en el mundo, siendo un 85% de la población adulta portadora de este virus. Su potencial oncogénico y el aumento de lesiones orales asociadas a infección oral por VPH nos han llevado a realizar una narración de la literatura referente al rol del VPH en el cáncer oral, especialmente de los subtipos 16 y 18. Nos referiremos a sus posibles vías de contagio, mecanismos oncogénicos, lesiones orales tanto benignas como potencialmente malignas asociadas a su infección, diferentes métodos utilizados para su detección, pronóstico y prevención de contagio. Destacamos la importancia del rol del odontólogo para identificar individuos considerados de alto riesgo y la facilidad de realizar su detección en la cavidad oral, a través de un método rápido y sencillo como es la citología exfoliativa. Palabras clave: cavidad bucal, carcinoma espinocelular, VPH 16, VPH 18

Asociación entre alteraciones psicológicas y la presencia de Liquen plano oral, Síndrome boca urente y Estomatitis aftosa recividante

OBJETIVO: El propósito de este estudio fue determinar la relación existente entre el Liquen Plano Oral (LPO),Estomatitis Aftosa Recividante (EAR), Síndrome de Boca Urente (SBU) y las alteraciones psicológicas del paciente, tales como el estrés, la ansiedad y la depresión. DISEÑO DEL ESTUDIO : Fueron estudiados 18 pacientes con EAR , 9 pacientes con LPO y 7 pacientes con SBU, que presentaron la lesión en el momento del examen, más un grupo control de 20 pacientes sanos. Ambos grupos fueron extraídos de centros hospitalarios y docentes, donde el diagnóstico clínico fue realizado por un equipo de patólogos orales. A los pacientes se les aplicó dos instrumentos de medición del estado psicológico del individuo: el Test de Experiencia Reciente, para medir el grado de estrés y la escala HAD, para determinar el nivel de ansiedad y depresión; los puntajes entregados por ellos fueron analizados estadísticamente a través del test T de Student no pareado y el Anova Tukey. RESULTADOS : Nuestros resultados sugirieron que hay una asociación estadísticamente significativa entre estos desórdenes psicológicos y las patologías de la mucosa oral en estudio. Se estableció que el nivel de estrés es mayor en los pacientes con EAR y LPO. Por otro lado la ansiedad es mayor en los tres grupos de pacientes con patología oral y la depresión es particularmente alta en los pacientes con SBU, todos estos datos respecto al grupo control. CONCLUSIONES : Existe una relación positiva entre alteraciones psicológicas y la EAR , LPO y SBU La EAR y el LPO se asociaron a altos niveles de estrés y ansiedad, mientras que el SBU se relacionó con importantes grados de ansiedad y depresión. De acuerdo a lo observado por nosotros, en el mantenimiento del estado de salud de los tejidos orales, los factores psicológicos desempeñan un papel importante.OBJECTIVE: The aim of this study was to determine the existing relation between the Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), Burning Mouth Syndrome (BMS) and psychological alterations of the patient, such as stress, anxiety and depression. DESIGN OF THE STUDY: 18 patients with RAS, 9 patients with OLP and 7 patients with BMS, that presented the condition at the moment of the examination, were studied, as well as a control group of 20 healthy patients. Both groups were extracted of hospitals and universitary centers, where the clinical diagnosis was made by a team of oral pathologists. Two measuring instruments were applied to them about their psychological condition: the Test of Recent Experience, to measure the stress level and scale H.A.D., to determine the level of anxiety and depression; the score given by them were statistically analyzed through T-test and the Anova Tukey test. RESULTS: Our results suggested a statistically significant association between these psychological disorders and the diseases of the oral mucosa in study. It was observed that the stress level is greater in patients with RAS and OLP, depression is particularly high in patients with BMS, and levels of anxiety are rised in the three groups, in comparison with the group control. CONCLUSIONS: A positive relationship can be established between psychological alterations and RAS, OLP and BMS. The RAS and the OLP stress and anxiety levels were considered as high, whereas the BMS was more related to important levels of anxiety and depression. According to these findings it is possible to assume that psychological factors should be taking into account when oral health wants to be maintain as normal

Morphea “en coup de sabre”: an unusual oral presentation

Morphea, or localized scleroderma, is an inflammatory disease that leads to sclerosis of the skin and underlying tissues due to excessive collagen deposition. Oral involvement is unusual and it may produce white linear fibrotic areas with a scar-like appearance, atrophy of tongue papillae, gingival recession and alveolar bone resorption. We report a case of a 13-year-old girl who consulted for progressive recession on the attached gingiva of her upper left incisors. She also presented a hypopigmented line on the left side skin of her upper lip, which continued through the vermilion and the lip mucosa, including the gingiva of the affected teeth. Clinical examination, blood tests, computerized axial tomography, echo-Doppler ultrasound and histopathological evaluation confirmed the diagnosis of morphea. Treatment with methotrexate and systemic corticosteroids was conducted. After 24 months, no other lesions appeared. No adverse side effects have been reported so far

Oromaxillofacial Cancer in Children: Part I Hard Tissue Malignant Tumors

Indexación: Web of Science; Scielo.RESUMEN: Las enfermedades malignas de cabeza y cuello en la población pediátrica son poco frecuentes. Considerando todos los tumores de cabeza y cuello, tanto benignos como malignos, éstos están representados por una frecuencia entre un 2% a 5% de todos los tumores pediátricos. A nivel de los maxilares, los tumores malignos en niños está representado por un rango que varía entre un 7% a 51%. En Chile, se estiman menos de 500 casos nuevos por año y en el rango entre los 5 y 15 años constituyen la segunda causa de muerte, precedida por los accidentes, traumatismos y violencias. Es importante considerar, al estudiar este grupo de enfermedades, que existen diferencias con los tumores de adultos, tanto en su incidencia, biología, comportamiento, histología y manejo. Es por esta razón que nos parece necesario realizar una revisión de la literatura científica para obtener un perfil del cáncer bucomaxilofacial infantil, que aporte en el entendimiento y aplicación de programas adecuados en el contexto de la salud bucomaxilofacial. Adicionalmente, buscamos actualizar el conocimiento de estas patologías, caracterizándolas en relación a su epidemiología, etiopatogenia y tratamiento, de manera que contribuya a los cirujanos dentistas para realizar diagnósticos y la pronta derivación a un centro especializado de patología oral. Para un estudio preciso, esta revisión constará de tres partes: la primera es sobre "tumores malignos de tejido óseo", mencionando, entre ellos, al osteosarcoma, sarcoma de Ewing, linfomas tanto Hodgkin como No Hodgkin, fibrosarcoma e histiocitosis de células de Langerhans.SUMMARY: Malignant head and neck disease in the pediatric population are rare. Considering all head and neck tumors, both benign and malignant, they represent between 2% to 5% of all pediatric tumors. At the level of the jaws, malignant tumors in children present in a range that varies from 7% to 51%. In Chile, fewer than 500 new cases are reported each year and in the 5 to 15 year-range are estimated to constitute the second cause of death, preceded by accidents, injuries and violence. When studying this group of diseases it is important to consider the differences with adult tumors, both in incidence, biology, behavior, histology and management. Therefore we believe it necessary to conduct a review of scientific literature to obtain a profile of child oral maxillofacial cancer, contributing to the understanding and implementation of appropriate programs in the context of maxillofacial health. In addition, we seek to update knowledge of these pathologies, characterizing their epidemiology, pathogenesis and treatment, so as to contribute to dental surgeons for diagnosis and early referrals to specialized centers for oral pathology. For a detailed study, this review will consist of three parts: the first is on "malignant bone tumors", included among these are: osteosarcoma, Ewing's sarcoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, Langerhans cell histiocytosis and fibrosarcoma.http://ref.scielo.org/4j5qv

Incidence and prevalence of salivary gland tumours in Valparaiso, Chile

Background : To determine the incidence and prevalence of salivary gland tumours in the province of Valparaíso, Chile. Material and Methods : Retrospective review of salivary gland tumours diagnosed between the years 2000 and 2011 from four local pathology services. Information on demographics and histopathology were retrieved from the medical records. Results : The study sample consisted of 279 salivary gland tumours. Prevalence and incidence rates per 100.000 persons were 15.4 and 2.51, respectively. Most of the neoplasms corresponded to benign tumours (70.3%). The most affected gland was the parotid gland. Pleomorphic adenoma was the most common benign tumour (53.8%) and mucoepidermoid carcinoma was the most common malignant tumour (7.2%). Conclusions : Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomor- : Salivary gland tumours are uncommon neoplasms that usually arise in the parotid gland. Pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant tumours reported in this series

Solitary intraosseous neurofibroma of the mandible. Apropos of a case

Neurofibroma is a benign neoplasm derived from peripheral nerves. Most of these are associated with Neurofibromatosis but may also occur as solitary lesions. When found on the head and neck they are generally located in the soft tissue. Intraosseous location is very rare. The following report describes a case of an intraosseous neurofibroma located in the left mandibular ramus of a 14-year-old child. The patient did not had clinical evidence of the lesion and it was found on a routine radiographic examination. Surgical excision of the lesion was scheduled and the sample was submitted to histopathological study. Representative sample cuts were studied using conventional techniques of hematoxylin-eosin and immunohistochemistry using primary antibodies anti S-100 protein, vimentin, and neuroespecific enolase. A review of clinical, radiographic, histologic and immunohistochemical features of other cases of intraosseuos neurofibromas located in the jaws together with the possible differential diagnosis of the lesion are discussed. Our case corresponds to a intraosseous neurofibroma of controveltial diagnosis because even though it presents typical neurofibroma histomorphological features it has immunophenotype different from usual. © Medicina Oral S. L

Lipoma da cavidade bucal — análise de 46 casos

Forty six cases of lipomas were presented. They represent 0,42% of the biopsies diagnosed at the Oral Pathology Department and 1 ,5% of the oral benign neoplasm registered between 1960 and 1980. They were the vestibular sulcus were more frequently involved, microscopically, the simple lipoma was seen in 56% of the cases and in 43% the fibrolipoma. In spite of the number of cases reported here, we were not able to provide further information about the pathogenesis of this lesion.O lipoma é uma neoplasia benigna de tecido adiposo, de desenvolvimento lento e assintomático. É bastante frequente onde existe tecido adiposo, mas raro na cavidade bucal (ao redor de 2% de todas as neoplasias bucais). Foi feita a análise de 46 lipomas intra bucais vistos durante um período de 20 anos, no Departamento de Patologia Oral da Faculdade de Odontologia da Universidade do Chile. Esta lesão afetou mais frequentemente mulheres entre a e década de vida e com localização mais frequente na mucosa jugal. Histologicamente a variante mais comum foi o fibrolipoma

Human Papilloma Virus and oral cancer: Narrative review of the literature

The Human Papilloma Virus (HPV) infection is now more common sexually transmitted diseases, with an incidence of 5.5 million worldwide, with 85% of the carrier of this virus adult population. Their oncogenic potential and increased oral lesions associated with oral HPV infection have led us to make a narrative of the literature on the role of HPV in oral cancer, especially types 16 and 18. Here we refer to the possible routes of infection, oncogenic mechanisms, both benign and potentially malignant oral lesions associated with the infection, different methods used for detection, prediction and prevention of infection. We stress the importance of the role of the dentist to identify individuals considered high risk and ease of performing detection in the oral cavity, through a quick and easy method as exfoliative cytology.El Virus Papiloma Humano (VPH) en la actualidad constituye la infección por transmisión sexual más frecuente, presentando una incidencia de 5,5 millones en el mundo, siendo un 85% de la población adulta portadora de este virus. Su potencial oncogénico y el aumento de lesiones orales asociadas a infección oral por VPH nos han llevado a realizar una narración de la literatura referente al rol del VPH en el cáncer oral, especialmente de los subtipos 16 y 18. Nos referiremos a sus posibles vías de contagio, mecanismos oncogénicos, lesiones orales tanto benignas como potencialmente malignas asociadas a su infección, diferentes métodos utilizados para su detección, pronóstico y prevención de contagio. Destacamos la importancia del rol del odontólogo para identificar individuos considerados de alto riesgo y la facilidad de realizar su detección en la cavidad oral, a través de un método rápido y sencillo como es la citología exfoliativa

Caracterización epidemiológica del cáncer oral. Revisión de la literatura

Oral cancer is a disease with high impact globally, ranking sixth most frequent among all cancers place. Despite a widely known and easy access to diagnostic pathology, calls the attention the lack of epidemiological data reported in the last 10 years in Chile Globally, the World Health Organization (WHO) has developed a project called "GLOBOCAN" to collect Cancer Epidemiological findings from their data, highlights the high incidence and high mortality in males, parameter showing a tendency to replicate in both America and Chile. Therefore these data, it was conducted a narrative review of the literature concerning epidemiological profile of the different forms of oral cancer in the last 15 years. The diagnosis of oral cancer crosses transversely to Dentistry, forcing us to establish working triads between oral and maxillofacial surgeons, pathologists and dentists of various specialties in order to enable timely investigation, appropriate biopsies and histopathological studies completed in order to on the one hand, to obtain timely and accurate diagnoses also maintain current epidemiological indicators.El cáncer oral es una patología de alto impacto a nivel mundial, ocupando el sexto lugar más frecuente entre todos los tipos de cáncer. A pesar de una patología ampliamente conocida y de fácil acceso al diagnóstico, llama la atención la falta de datos epidemiológicos reportados en los últimos 10 años en Chile. A nivel mundial, la Organización Mundial de Salud (OMS) ha desarrollado un proyecto denominado “GLOBOCAN” con el fin de recolectar datos epidemiológicos mundiales del cáncer, entre sus datos, destaca la gran incidencia y elevada tasa de mortalidad en el sexo masculino, parámetro que muestra tendencia a replicarse en tanto América como en Chile. En consecuencia a estos datos, se realizó una revisión narrativa de la literatura, referente al perfil epidemiológico de las diferentes formas de cáncer oral en los últimos 15 años. El diagnóstico del cáncer oral cruza de manera transversal a la Odontología, obligándonos a establecer triadas de trabajo entre cirujanos orales y maxilofaciales, patólogos y odontólogos de las diversas especialidades, para permitir así una oportuna pesquisa, biopsias adecuadas y estudios histopatológicos acabados con la finalidad de, por una parte, obtener diagnósticos oportunos y certeros, además, mantener actualizados los indicadores epidemiológicos