Estudo imunohistoquimico e analise univariada dos fatores prognosticos de tumores de glandula submandibular

Orientador : Luiz Paulo KowalskiTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo deste trabalho foi analisar as características clínicas, histopatológicas e a expressão de marcadores imunohistoquímicos em tumores de glândula submandibular. Foram avaliados 102 tumores, sendo 61 benignos e 51 malignos. Os tumores benignos consistiram de 60 adenomas pleomorfos e 1 adenoma de células basais. Entre os malignos, 23 foram carcinomas adenóide císticos, 16 carcinomas mucoepidermóides, 4 carcinomas espinoce1ulares, 4 adenocarcinomas sem outra especificação, 1 adenocarcinoma de células basais, 1 carcinoma de ducto salivar, 1 mioepitelioma maligno e 1 carcinoma indiferenciado. A idade média dos pacientes com tumores benignos foi de 36,3 anos e 61,7% dos pacientes eram do sexo feminino. Microscopicamente, a maioria dos adenomas pleomorfos apresentava áreas mixocondróides (Subtipo II). Todos os casos foram negativos para Ki-67 e p53. Com relação aos tumores malignos, a idade média foi 55,4 anos e 64,7% dos pacientes eram do sexo masculino. No momento do diagnóstico, 64,7% dos pacientes apresentaram tumores em avançado estádio clínico, 15,7% apresentaram metástases em linfonodos regionais e 7,84% metástases à distância. As sobrevi das global e livre de doença após 10 anos foram de 26,8% e 44,9%, respectivamente. A expressão de PCNA, Ki-67, cerbB-2, CEA e bcl-2 não apresentou associação com as variáveis clínicas e histológicas (p<O,O5). Entretanto, p53 correlacionou com os estádios T e N, morte e sobrevida global (p<0,05). Nossos resultados indicam que adenomas pleomorfos de glândula submandibular apresentam crescimento lento e têm bom prognóstico. Carcinoma adenóide cístico foi o tumor maligno mais freqüente e o prognóstico de tumores malignos em glândula submandibular é desfavorável, principalmente em tumores com avançado estadiamento clínico e que expressaram p53Abstract: The aim of this work was to analyze c1inocopathological and immunohistochemical expression in submandibular salivary gland tumors. A total of 112 tumors was evaluated, being 61 benign and 51 malignant. The benign tumors were compose of 60 pleomorphic adenomas and 1 basal cell adenoma. Among the malignancies, 23 were adenoid cystic carcinoma, 16 mucoepidermoid carcinomas, 4squamous cell carcinomas, 4adenocarcinomas NOS, 1 basal cell adenocarcinoma, 1 salivary duct carcinoma, 1 malignant myoepithelioma and 1 undifferentiated carcinoma. The patients with benign tumors presented a mean age of 36.3 years and 61.7% of them were females. Microscopically, most of the pleomorphic adenomas were rich in myxocondroid areas (subtype II) and all cases were negatives for p53 and Ki-67. Considering malignant tumors, the mean age was 55.4 years and 64.7% of the patients were males. At the time of diagnosis, 64.7% of the patients presented tumors in advanced c1inical stage, 15.7% presented regional lymph nodes metastases and 7.84% distant metastases. The expression of PCNA, Ki-67, c-erbB-2, CEA e bc1-2 was not correlated with c1inicopathological features (p<0.05). However, p53 expression was associated with T and N stages, death and overall survival (p<0.05). Our results showed that pleomorphic adenomas of submandibular glands presented low growth rate and good prognosis. Adenoid cystic carcinoma was the most common malignant tumor, and submandibular malignant tumors presented poor prognosis, mainly in tumors with advanced c1inical stage and with p53 expressionDoutoradoDoutor em Biologia e Patologia Buco-Denta

Periodontitis as a risk factor for head and neck cancer

Periodontitis may be associated with the development of head and neck cancer (HNC). A literature review was conducted to understand the possible association between them. Articles published in the PubMed database from January 1999 and May 2020 were retrieved. Limitations of the studies and biological mechanisms were discussed. A total of 4,232 articles were found. Of these, 13 were analyzed according to inclusion criteria. Most papers found some association between periodontitis and HNC, although differences in periodontal evaluation, sample size, study design and tumor sites were observed. Porphyromonas gingivalis appears to increase the chance of both diseases, and it may be one of their main potential risk factors. Genetic predisposition is increased by exposure to environmental factors which can directly induce epigenetic changes that contribute to these diseases. Understanding the mechanisms related to periodontitis and HNC has increased, however, well-designed clinical studies are needed for better conclusions. Furthermore, the advent of multiple "omic" technologies will help comprehend their possible association

Oral lipoma of unusual size and location: a case report

A lipoma is a slow-growth benign tumor of the adipocytes. In the oral cavity, it is more commonly observed in the buccal mucosa; other sites less affected are the tongue, floor of the mouth, and lips. The objective of this report is to describe an extensive tumor affecting the dorsum of the tongue and the therapeutic maneuver performed. A 63-year-old man was referred to our clinic for evaluation of a tumor in the dorsum of the tongue with 6 months of duration. The physical examination revealed an extensive nodule, asymptomatic, submucosal, in the dorsum of the tongue at the left that measured approximately 4 cm. On palpation, the lesion was mobile and had rubbery consistency. According to these findings, the diagnostic hypotheses were lipoma and neurofibroma. Hence, surgical excision was performed and during the procedure a yellowish and well-delimited lesion was observed. The surgical specimen floated in 10% formalin. The histopathological examination confirmed the diagnosis of lipoma. The patient is asymptomatic after 40 months of follow-up. This report describes an unusual presentation of lipoma on the dorsum of the tongue and demonstrates that this lesion can reach large proportions.

Sequestro ósseo após cirurgia de implante dentário

Background. Dental implants are used to rehabilitate missing teeth, and despite high success rates, failures are inevitable. Ostensibly avoidable human errors in planning or technique can contribute to implant failure. Case presentation. Herein, we report a case of an unsuccessful dental implant surgery due to an inadequate surgical technique and bone exposure in a 54-year-old healthy woman. Conclusions. This report underscores the relevance of reporting the consequences of these human factors, such as loss of the implant, alveolar bone segment, and three teeth.Contexto. Os implantes dentários estão cada vez mais sendo usados para reabilitar a falta de dentes e, apesar das altas taxas de sucesso, falhas são inevitáveis. Erros humanos ostensivamente evitáveis no planejamento ou na técnica podem contribuir para a falha do implante. Apresentação do caso. Relatamos aqui um caso de cirurgia de implante dentário malsucedida devido a uma técnica cirúrgica inadequada e exposição óssea em uma mulher saudável de 54 anos de idade. Conclusões. Este estudo ressalta a relevância de relatar as consequências desses fatores humanos, como perda do implante, segmento ósseo alveolar e três dentes

Solitary fibrous tumor of the tongue

Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm originally described in pleura with a rare presentation in the oral cavity. Herein, we report a case of a 28-year-old male patient who presented an asymptomatic slow-growing mass in the anterior part of the tongue. Intraoral examination revealed a well-circumscribed mass covered by normal mucosa with a fibrous consistency. Due to non-specific clinical findings, the initial diagnostic hypotheses include benign submucosal neoplasms such as leiomyoma, neurofibroma, SFT, and others. An excisional biopsy was performed. Microscopically, the tumor was surrounded by a thick fibrous capsule; hypo and hypercellular areas were arranged in a storiform pattern with a stroma formed by collagen and abundant vascularization. Tumor cells showed immunopositivity for CD34 and STAT-6 and no expression of CD99, AML, S-100, and Ki-67. According to these findings, the diagnosis of SFT was established. After 24 months, the patient is asymptomatic and has no evidence of recurrence. Although oral involvement is rare, SFT should be included in the differential diagnosis of oral submucosal lesions

Evaluation of socket healing in patients undergoing bisphosphonate therapy: experience of a single Institution

Objective: To assess the clinical features of exodontias performed in cancer patients who have been receiving intravenous bisphosphonates (BPs). Study Design: This is a retrospective cohort study using a sample of 20 patients receiving BPs who had 62 teeth extracted. An univariate analysis was applied to calculate socket healing time (HT), comparing among exodontias performed according to cause, such as periodontal disease or caries, type of BP, and use of corticosteroid. In order to analyze the influence of each variable on HT, multiple statistical analyses were performed through logistic multiple regression. Results: From the 62 tooth extractions performed, 5 exodontias had evolved to 4 sites of bisphosphonate-related osteonecrosis of the jaws (BOJ). Of another 57 exodontias without development of BOJ, HT was significantly better for tooth extraction performed in patients receiving corticosteroid (p= .01), for tooth extracted due to caries (p= .04), and for extractions under pamidronate (p= .03). Sockets after exodontias due to periodontal diseases had OR= 5.22 (95% CI 1.73-133.66, p=0.01) for delayed HT, exodontias performed under corticosteroid use had OR=0.04 (95% CI 0.01-0.40, p<0.001), and exodontias performed under zoledronate had OR=0.31 (95% CI 0.08- 1.25, p=0.10). Conclusions: Exodontias performed in patients under BP therapy had a low rate of BOJ occurrence. Zoledronate and periodontal diseases influence delayed socket healing. Adjuvant antibiotics could be relevant procedures aimed at reducing the risk of BOJ development

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

Computed tomography bone density variations in oncological patients undergoing antiresorptive medication

The purpose of this study was to compare jaw and cervical vertebrae bone density in computed tomography (CT) analyses of oncological patients undergoing antiresorptive medication with control patients, aiming to find information that may assist the radiologist and clinician in predicting risks and monitoring osteonecrosis in the jaw. Thirty-one patients treated with zoledronic acid and 37 control were included in the study. Two areas in regions of interest were chosen and standardized, one in the lower portion of the mandible and another in the axial cervical vertebra (C2) of patients undergoing antiresorptive drug treatment (experimental group) and the control group. Density analysis was performed using Hounsfield scale grayscale values obtained from multislice CT exams. Interclass correlation coefficient test (ICC) was performed to assess reproducibility and repeatability. The test of normality of the samples was demonstrated using the Shapiro-Wilk test and the comparison performed using Mann-Whitney U non-parametric test. When compared to patients in the control group, patients undergoing antiresorptive medication depicted an increase in bone density in both jaw bone (p=0.021) and cervical vertebrae (p=0.002). The same pattern could be observed in patients who used the medication on a monthly basis for analysis of jaw bone (p=0.021), the cervical vertebrae (p=0.002), and the cervical vertebrae of the patients who used the medication on a quarterly basis (p=0.003). CT can be a potentially useful method for detecting alterations associated with antiresorptive therapy, serving as a possible tool in the prediction of the disease progression

The effects of ionizing radiation on the development of human caries lesions in vitro

A radioterapia é associada a diversos efeitos colaterais, entre eles a cárie de radiação. O objetivo desse estudo foi avaliar o efeito da radiação ionizante no desenvolvimento de lesões cariosas utilizando um sistema bacteriano in vitro. Foram selecionados quinze terceiros molares humanos inclusos que foram seccionados em fragmentos vestibular (A, controle) e lingual (B, irradiado), e foram mantidos pareados até o término do estudo. O grupo B foi submetido à radioterapia de acordo com protocolo utilizado no tratamento radioterápico de cabeça e pescoço. Ambos os grupos foram expostos a um desafi o cariogênico utilizando um sistema bacteriano com S. mutans por 10, 20 e 30 dias (n = 5). As variáveis de profundidade, extensão e área das lesões formadas no limite amelo-dentinário foram medidas por um software acoplado ao microscópio de luz. A Tomografi a de coerência óptica (TCO) foi utilizada para visualizar as características morfológicas das lesões. Os resultados da microscopia de luz mostraram que, no período de 20 dias de desafi o bacteriano, ocorreu um resultado signifi cante, comparando a profundidade das lesões formadas entre os grupos A e B (p = 0.013). A análise de TCO não permitiu visualizar as camadas de cárie das lesões. Podemos concluir, dentro das limitações do estudo, que o tratamento radioterápico pode levar à formação de lesões de cárie mais profundas do que aquelas que se desenvolvem em dentes sem exposição à radiação ionizante.Radiotherapy is associated with several undesired side effects, such as rampant radiation caries. The aim of this study was to evaluate the effect of ionizing radiation on the development of carious lesions using a bacterial system in vitro. Fifteen sound human molars were selected and sectioned into buccal (A, control) and lingual (B, irradiated) dental fragments, which were considered dependent. Group B was submitted to radiotherapy according to the protocol for head and neck oncological treatment. The two groups were exposed to a cariogenic challenge using a bacterial system with S. mutans for 10, 20 and 30 days (n = 5). The variabels depth, extension and area for lesions formed at the enamel-dentin junction were measured by software coupled with light microscopy. Optical coherence tomography (OCT) was used to visualize the morphological characteristics of the lesions. Only the 20-day period of culture immersion for caries development resulted in signifi cantly better lesion comparisons, by light microscopy. Of the three lesion dimensions analyzed, lesion depth (lD) differed statistically between groups A and B (p = 0.013). Analysis using OCT allowed the visualization of carious lesions without showing the carious layers. Within the limitations of this study, we can conclude that radiation treatment of sound teeth before a cariogenic challenge in vitro causes deeper carious lesions than in those teeth not subjected to radiation treatment