Semaforinas e neuropilinas em tumores de glândulas salivares

Orientador: Pablo Agustin VargasTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Tumores de glândulas salivares correspondem a aproximadamente 3% de todas as neoplasias de cabeça e pescoço e as neoplasias malignas derivadas destas estruturas anatômicas ainda representam um grande desafio para a oncologia de cabeça e pescoço devido a sua difícil abordagem cirúrgica e pobre resposta às outras abordagens terapêuticas. Um melhor entendimento do seu perfil molecular contribuiria significativamente para um melhor manejo terapêutico futuro e o estudo do potencial angiogênico dos tumores de glândulas salivares representa um interessante alvo de investigação. Tem sido demonstrado que as semaforinas induzem a apoptose de células tumorais, modulam a migração celular neoplásica e inibem a angiogênese em diferentes neoplasias humanas, competindo com o fator de crescimento endotelial vascular (VEGF) pela ligação aos seus principais receptores, as neuropilinas-1 e -2, desta forma inibindo os efeitos mitogênicos e pró-angiogênicos de VEGF. Assim, o objetivo deste estudo é investigar a expressão das semaforinas de classe 3 A e B (Sema3A e Sema3B), e dos seus receptores neuropilinas-1 e -2 (Np-1 e Np-2) em tumores de glândulas salivares, determinando seus significados clínicos. Duzentos e quarenta e oito tumores benignos e malignos de glândulas salivares selecionados de quatro instituições brasileiras foram organizados em blocos de parafina em microarranjo tecidual em matriz e submetidos a reações de imunoistoquímica contra CD34, Sema3A, Sema3B, Np-1 e Np-2. As imunoreações foram quantificadas utilizando algoritmos digitais e os resultados foram correlacionados com parâmetros clinicopatológicos e índices de sobrevida. Tumores malignos apresentaram uma maior densidade vascular, porém uma menor área vascular do que sua contraparte benigna. Em glândulas salivares normais a expressão de Np-1 e -2 esteve restrita às células ductais, enquanto que Sema3A e Sema3B estiveram principalmente no componente acinar. Tumores benignos e malignos revelaram uma expressão similar de todos os marcadores e a co-expressão de Np-1/Np-2 correlacionou-se significativamente com a ocorrência de parestesias e estágios mais avançados dos tumores. Apesar de não ser estatisticamente significativa, a sobre-expressão simultânea de ambos os receptores também indicou uma menor taxa de sobrevida. Desta forma, Sema3A, Sema3B, Np-1 e Np-2 devem estar envolvidas no desenvolvimento das glândulas salivares normais e na patogênese das neoplasias benignas e malignas derivadas destas estruturas; entretanto, a expressão destas proteínas não apresentou um potencial prognóstico estatisticamente significativo no presente estudoAbstract: Salivary gland tumors correspond to approximately 3% of all head and neck neoplasms and the malignant neoplasias derived from these anatomic structures still represent a major pitfall in head and neck oncology because of their difficult surgical approach and poor response to other therapies. A better understanding of their molecular basis would significantly aid to an improved future management and the study of salivary gland tumors angiogenic potential represents an interesting target of investigation. It has been shown that semaphorins induce tumor cell apoptosis, modulate tumor cell migration and inhibit angiogenesis in different human neoplasms, competing with vascular endothelial growth factor (VEGF) for biding to their main receptors, the neuropilins-1 and -2, thereby inhibiting mitogenic and pro-angiogenic effects of VEGF. Hence, the objective of this study is to investigate the expression of class 3 Semaphorins A and B, and their receptors neuropilins-1 and -2 in salivary gland tumors, determining their clinical significance. Two hundred and forty eight benign and malignant salivary gland tumors selected from four Brazilian institutions were organized in tissue microarray paraffin blocks and submitted to immunohistochemical reactions against CD34, Sema3A, Sema3B, Np-1 and Np-2. The immunoreactions were quantified using digital algorithms and the results were correlated with clinicopathological parameters and survival rates. Malignant tumors presented an increased vascular density but a lower vascular area than their benign counterparts. In normal salivary glands Np-1 and Np-2 expression was restricted to ductal cells, whereas Sema3A and Sema3B were positive mainly in serous acinar compartment. Benign and malignant tumors revealed a similar expression of all markers and the co-expression of Np-1/Np-2 significantly correlated with the occurrence of paresthesia and higher stages of the tumors. In addition, although not statistically significant, simultaneous overexpression of both receptors also indicated an inferior survival rate. Hence, these results suggest that Sema3A, Sema3B, Np-1 and Np-2 may be involved in the development of normal salivary glands and in the pathogenesis of benign and malignant neoplasms derived from these structures; however, the expression of these proteins did not present a statistically significant prognostic potential in the current studyDoutoradoPatologiaDoutor em Estomatopatologi

Tissue microarray construction for salivary gland tumors study

Objective: To describe and discuss the design, building and usefulness of tissue microarray (TMA) blocks for the study of salivary gland tumors (SGTs). Study Design: Two hundred thirty-eight formalin-fixed, paraffin-embedded SGTs were arranged in blocks of TMA using a manual tissue arrayer. Three representative cores of 1.0, 2.0 or 3.0mm were taken from each original block and their characteristics were analyzed and described. Results: It was created 12 TMA blocks that presented highly representative neoplastic cylinders. However, those neoplasias rich in cystic spaces such as mucoepidermoid carcinoma and Warthin tumor presented more difficulties to be sampled, as the neoplastic tissue available was scarce. Tissue damage and loss during TMA construction was estimated as 3.7%. Conclusion: Representative areas of SGTs, with relatively small loss of tissue, can be obtained with the construction of TMA blocks for molecular studies. However, tumors rich in cystic spaces present more difficulties to be adequately sampled

Epigenetic alterations in ameloblastomas : a literature review

Ameloblastoma is a locally aggressive tumor, originated from odontogenic epithelium, and affects the jawbones with an elevated recurrence rate. The molecular mechanisms involved with the pathogenesis of this tumor remain undetermined. This review aimed t

Oral and maxillofacial lesions in older individuals and associated factors : a retrospective analysis of cases retrieved in two different services

Studies on the oral and maxillofacial lesions (OMLs) in older people usually assess data of laboratory services and data from oral medicine clinic have been poorly described. The aim of this study was to describe and to compare OMLs in older individuals considering two data sources, besides to assess associated factors with the three most frequent lesions. A retrospective study was conducted with individuals aged 60 years or older. Data of individuals and lesions reported in both services were collected. Univariate analysis was used to test the association between the occurrence of the lesion and the independent variables. The level of significance was set at 5%. A total of 1,695 (37.3%) records were from the Oral Medicine clinic and 2,848 (62.7%) from the Laboratory service. Inflammatory/reactive lesion group was the most frequent in both services (40.4% in Oral Medicine Clinic and in 44.2% Laboratory). The second and third groups of lesions in the Oral Medicine clinic were infectious diseases (18.5%), and variations of normality (10.8%), while in the laboratorial service were the malignant neoplasms (17.6%) and potentially malignant disorders (13.3%). Differences between services regarding the frequency of lesion groups occurred (p<0.05), except for pigmented (p=0.054) and infectious (p=0.054) groups. Females (OR: 2.08; CI: 1.81?2.39) and individuals who wore a removable prosthesis (OR: 3.99; CI: 2.83?5.62) were also likely to have inflammatory fibrous hyperplasia. Old?old individuals (OR: 1.70; CI: 1.30?2.21), male (OR: 3.63; CI: 3.00?4.39), smoking (OR: 6.05; CI: 4.84?7.56) or alcohol use (OR: 3.95; CI: 3.12?5.01) were likely to have squamous cell carcinoma. The results showed different frequencies of OMLs in older individuals according to the data sources and age group. The findings are important to direct public policies for this age group

Late recurrence of Burkitt’s lymphoma in the jaw: numb chin syndrome as the only symptom

The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve’s distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient’s complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS

Distribution of dendritic cells in AIDS-associated oral kaposi’s sarcoma

The aim of this study was to determine if the distribution of Langerhans cells (LC) and interstitial dendritic cells (IDC) is altered in AIDS-associated oral Kaposi’s sarcoma when compared to HIV-negative highly vascular oral lesions. Fifty-one cases of AIDS-associated oral Kaposi’s sarcoma and 20 of highly vascular oral lesions were retrospectively retrieved. All cases of Kaposi’s sarcoma were confirmed with immunoreactions against CD34 and HHV-8. Clinical data regarding sex, age and lesions location were obtained from pathology reports. Immunohistochemistry against CD207 (immature dendritic cells) and CD83 (mature dendritic cells) were done. LC were in the epithelium and IDC in the stroma. CD207+ cells predominated in the epithelium of the lesions, whereas CD83+ cells predominated in their stromal compartment. Kaposi’s sarcoma had a lower CD207+ immature LC count (p=0.02) and an increased CD207+ IDC than highly vascular oral lesions (p<0.001). Moreover, Kaposi’s sarcoma also showed an increased number of mature CD83+ IDC than highly vascular oral lesions (p<0.001). There were significant alterations in the distribution of LC and IDC in AIDS-associated Kaposi’s sarcoma when compared to HIV-negative vascular oral lesions, suggesting that changes in their concentrations may play a role in the pathogenesis of Kaposi’s sarcoma306617625O objetivo deste estudo foi determinar se a distribuição das células de Langerhans (CL) e das células dendríticas intersticiais (CDI) está alterada no sarcoma de Kaposi oral associado à AIDS quando comparado às lesões orais altamente vasculares HIV-negativas. 51 casos de sarcoma de Kaposi oral associado à AIDS e 20 de lesões orais altamente vasculares foram recuperados retrospectivamente. Todos os casos de sarcoma de Kaposi foram confirmados pela positividade para os anticorpos CD34 e HHV-8. Dados clínicos sobre sexo, idade e localização das lesões foram obtidos dos laudos histopatológicos. Foram realizadas imunoistoquímica contra CD207 (células dendríticas imaturas) e CD83 (células dendríticas maduras). As CL estavam presentes no epitélio enquanto as CDI estavam presentes no estroma. As células CD207+ predominaram no epitélio das lesões, enquanto as células CD83+ predominaram no estroma. O sarcoma de Kaposi teve uma contagem mais baixa de CD imaturas CD207+ (p = 0,02) e número aumentado de CDC CD207+ do que lesões orais altamente vasculares (p<0,001). Além disso, o sarcoma de Kaposi também mostrou um número aumentado de CDI CD83+ maduras do que lesões orais altamente vasculares (p<0,001). Houve alterações significativas na distribuição de CL e CDI no sarcoma de Kaposi associado à AIDS quando comparado às lesões orais vasculares HIV-negativas, sugerindo que alterações na distribuição das mesmas podem desempenhar um papel na patogênese do sarcoma de Kapos

TWIST and p-Akt immunoexpression in normal oral epithelium, oral dysplasia and in oral squamous cell carcinoma

Objectives: The aim of this study was to evaluate the immunoexpression of TWIST and p-Akt proteins in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), correlating their expressions with the histological features of the lesions. Study design: Immunohistochemical studies were carried out on 10 normal oral epithelium, 30 OL and 20 OSCC formalin-fixed, paraffin-embedded tissue samples. Immunoperoxidase reactions for TWIST and p-Akt proteins were applied on the specimens and the positivity of the reactions was calculated for 1000 epithelial cells. Results: Kruskal-Wallis and Dunn's post tests revealed a significant difference in TWIST and p-Akt immunoexpression among normal oral mucosa, OL and OSCC. In addition, a significant positive correlation was found between TWIST and p-Akt expressions according to the Pearson's correlation test. Conclusions: The results obtained in the current study suggest that TWIST and p-Akt may participate of the multi-step process of oral carcinogenesis since its early stages. © Medicina Oral S. L

Exames de tomografia computadorizada e cintilografia para diagnóstico e plano de tratamento de osteocondroma condilar: relato de caso

PURPOSE: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. CASE DESCRIPTION: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. CONCLUSION: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.OBJETIVO: Relatar um caso incomum de osteocondroma afetando o côndilo mandibular de uma paciente jovem e ilustrar as importantes contribuições dos diferentes exames por imagem para o diagnóstico e plano de tratamento desta lesão. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 24 anos, com queixa principal de uma crescente assimetria facial e dor na região pré-auricular esquerda, além de apresentar redução da abertura bucal, desvio de mandíbula e mordida cruzada posterior, por um período de 18 meses. A radiografia panorâmica revelou um aumento do côndilo esquerdo, enquanto secções de tomografia computadorizada e reconstrução 3D exibiram um crescimento ósseo bem definido originando-se do côndilo. O exame de cintilografia revelou uma atividade osteogênica anormal na região de articulação tempormandibular esquerda. O côndilo foi cirurgicamente removido e após 18 meses de acompanhamento a radiografia panorâmica e a tomografia computadorizada não revelaram nenhum sinal de recorrência. CONCLUSÃO: Apesar de o osteocondroma ser um tumor ósseo benigno que raramente surge na região crânio maxilofacial, ele deve ser considerado como diagnóstico diferencial para massas de crescimento lento na área temporomandibular e o uso de diferentes exames por imagem contribuem significativamente para o correto diagnóstico e plano de tratamento desta condição patológica

CD1a+ and CD207+ cells are reduced in oral submucous fibrosis and oral squamous cell carcinoma

The objective of this study investigated the distribution of immature dendritic cells (DCs), Langerhans cells and plasmacytoid DCs in oral submucous fibrosis (OSMF), OSMF associated with oral squamous cell carcinoma (OSMF-OSCC), oral leukoplakia (OL), and oral squamous cell carcinoma (OSCC). Fourteen cases of OSMF, 9 of OSMF-OSCC, 8 of OL¸ 45 of OSCC and 8 of normal epithelium were retrospectively retrieved and their diagnoses confirmed. Immunoreactions against CD1a, CD207 e CD303 were performed and the number of positive cells quantified. A significant decrease of CD1a+ was found in OSMF (p?0.05), OSMF-OSCC (p ? 0.01), and OSCC (p ? 0.001) when compared to normal epithelium. For CD207+ the significance decrease was observed in OSMF-OSCC (p ? 0.05), and OSCC (p ? 0.01) when compared with normal epithelium, and in OSMF when compared with OL (p ? 0.05). There was no significant difference for CD303, but increased in CD303+ was observed in OSCC when compared with normal epithelium. The decrease in the number of CD1a+ and CD207+ cells may be associate to the development of oral OSCC, and in OPMDs they might be indicators of malignant transformation

Benign epithelial oral lesions ? association with human papillomavirus

The presence of human papilloma virus in benign oral lesions has been studied by different techniques obtaining extremely variable results. The objective of this study was to determine the presence of human papillomavirus in 83 cases of benign hyperplastic epithelial oral lesions. Eighty-three oral lesions with clinical or histopathological features suggestive of HPV infection were retrieved from the files of four oral pathology services. Demographic data were obtained from patient´s medical charts. All cases had available clinical image, H&E preparations and paraffin blocks with enough tissue for HPV detection by in situ hybridization, and immunohistochemical reactions for Ki67. Episomal positivity for wide spectrum HPV was observed in 24% of the cases; most of them (70%) HPV 6/11 positive. HPV 16/18 was not detected. Condyloma acuminatum was the most common lesion associated with HPV (75%), followed by verruca vulgaris (15%), squamous papilloma and multifocal epithelial hyperplasia, 5% each. Koilocytes were identified in all the HPV positive cases. Ki67 showed an abnormal proliferation pattern in 90% of the HPV positive cases; most of them (70%) showing groups of proliferating cells in focal superficial regions, and in 20% positivity was seen almost in the whole thickness of the epithelium. HPV negative cases showed Ki67 positive cells restricted to the basal layer. Regarding oral lesions associated with HPV, condyloma is the most common lesion expressing low-risk subtypes. The etiology of squamous papilloma remains controversial as HPV was found in 1.9% of the cases. The identification of koilocytes and the pattern of expression of Ki67 reflect HPV infection and are helpful for classification. Papillary oral lesions not associated to HPV deserve further studies to better clarify its etiology