Avaliação epidemiologica de 8.875 diagnosticos histopatologicos orais realizados pelo Serviço de Diagnostico Oral da Disciplina de Patologia Bucal da FOP/UNICAMP em um periodo de 32 anos

Orientador : Pablo Agustin VargasDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Estudos epidemiológicos de doenças orais são importantes para verificar a prevalência relativa de lesões reativas, infecciosas, císticas e neoplásicas e, para determinar estratégias de prevenção e tratamento. A freqüência de lesões orais possui diferenças geográficas, sendo importante obter informações não somente dos países, mas também de suas sub-regiões. Por exemplo, o Brasil possui enormes diferenças econômicas, culturais e demográficas entre suas regiões o que pode refletir em diferentes prevalências de lesões orais. Assim, este trabalho, composto por dois artigos, teve como objetivos: 1- analisar a freqüência dos 8.875 casos de doenças bucais encaminhados ao Serviço de Diagnóstico Oral da FOP/UNICAMP num período de 32 anos; 2- verificar especificamente a freqüência dos Tumores Odontogênicos (TO) no mesmo período. 3- Desenvolver um banco de dados informatizado com a finalidade de agrupar os dados e facilitar a análise da casuística. A metodologia utilizada em comum para os dois artigos consistiu na revisão histológica e revisão dos dados clínicos disponíveis por dois examinadores, lançamentos dos dados no software desenvolvido e posterior estudo epidemiológico. Como resultados do primeiro trabalho, verificou-se que a maioria dos casos foram lesões reativas ou infecciosas tais como hiperplasias fibrosas (26%), lesões periapicais (11%) e periodontites (10%). O carcinoma espinocelular foi responsável por 5% dentre todos os casos e 86% de todas as neoplasias malignas. Paracoccidioidomicose mostrou um grande número de casos (150) e os TO representaram 1,26% do total. Como resultados do segundo trabalho, diagnosticamos 113 casos de TO, sendo 39,4% odontomas, 22,1% ameloblastomas e apenas um caso maligno (Ameloblastoma maligno). Além disso, os TO ocorreram predominantemente entre a 2a e 3a décadas de vida e a região posterior da mandíbula foi o local anatõmico mais acometido para os ameloblastomas e região anterior de maxila para os odontomasAbstract: Epidemiological studies of oral diseases are important to verify the relative prevalence of reactive, infectious, cystic and neoplastic lesions, and to determine strategies of prevention and treatment. Moreover, geographical differences may lead to clues regarding the causes of these lesions. Frequency of oral diseases varies throughout the world, and it is important to have information not only of countries, but also of each specific region. For example, Brazil has enormous differences among its regions relating to economical, cultural and demographic aspects that may reflect different prevalence of oral lesions. So, the purpose of this study, presented as two distinct publications, is to: 1. - show the frequency of 8,875 oral and perioral lesions submitted to the Oral Diagnostic Service of the Oral Pathology Department at the School of Dentistry of Piracicaba - UNICAMP, Brazil during a 32-year period; 2 - to verify particularly the Odontogenic Tumors frequency at the same period of time; 3- a computer database software was developed to collect and store the data. The assessment method consisted of reviewing ali microscopic slides and available clinical data by two examiners; data storage on the developed software and finally, the epidemiological analysis. As a result of the first work, it could be seen that the majority of the oral biopsies were taken from either infectious or reactive lesions as fibrous hyperplasias (26%), periapicallesions (11 %) and periodontitis (10%). Squamous cell carcinoma was responsible for 5% of the total cases and corresponded to 86% of ali malignant neoplasms. It is interesting to notice the occurrence of 150 cases of paracoccidioidomycosis. Odontogenic tumours corresponded to 1.26% of the total. As for the results of the second article, it is noticed that among the 113 Odontogenic Tumors cases, 39.4% were odontomas, 22.1 % ameloblastomas and only one malignant case, diagnosed as malignant Ameloblastoma. In addition, the cases occurred predominantly in the second and third decades of life, and the posterior region of the mandible was the most affected site to ameloblastomas whereas anterior maxilla was to odontomasMestradoPatologiaMestre em Estomatopatologi

Clinicopathological and ultrastructural characterization of periapical actinomycosis

The aim of the present study was to analyze the clinicopathological and the ultrastructural features of periapical actinomycosis (PA) cases. Data from the files of an oral pathology laboratory were retrieved and the findings of histopathological analysis were evaluated. Hematoxylin?eosin (HE), a modified Brown & Brenn, and Grocott stains as well as ultrastructural analysis using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) were utilized. Six cases were obtained, 4 females and 2 males, with a mean age of 34 year-old. Two cases were symptomatic, lower teeth and the anterior region were more commonly affected, and all cases were characterized by periapical radiolucencies. All cases presented sulfur granules with a ray-fungus or club-shaped pattern of the Splendore-Hoeppli phenomenon in HE-stained sections, with filamentous gram-positive bacteria aggregates highlighted by the modified Brown & Brenn stain. SEM analysis revealed abundant packed rod-like and filamentous bacteria associated with an extracellular amorphous material. EDX analysis showed predominant picks of calcium and sulfur in actinomycotic colonies. Our findings suggest that PA manifests either clinically and radiologically as a non-specific and heterogeneous condition and that the actinomycotic colonies consist in a calcium- and sulfur-rich matrix. Furthermore, the results highlight the importance of submitting periapical specimens after surgical removal to histopathological analysis

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

Mandibular destructive radiolucent lesion: the first sign of multiple myeloma

The occurrence of a mandibular lesion as the first sign of multiple myeloma (MM) is uncommon. This report describes a case of MM diagnosed because of a mandibular lesion. A 62-year-old woman presented a destructive radiolucent lesion in the right mandibular ramus. The lesion caused rupture of the anterior cortical bone and extended from the retromolar area to the coronoid process. An incisional biopsy was performed. Histopathological examination revealed numerous pleomorphic plasma cells, some with binucleated nuclei. The tumor cells showed kappa lightchain restriction. Bone marrow biopsy showed findings of massive infiltration of neoplastic plasma cells, besides lesions in the vertebrae. The diagnosis of MM was established. The patient underwent autologous hematopoietic stem-cell transplantation. Currently, the patient is under regular follow up after 40 months of initial treatment. In conclusion, MM should be considered in the differential diagnosis of destructive mandibular lesions

Clinicopathological analysis of head and neck rhabdomyosarcoma : a series of 10 cases and literature review

To describe the clinicopathological characteristics of a series of head and neck rhabdomyosarcoma (RMS) and to review the literature. Cases diagnosed as RMS affecting the head and neck region were retrospectively retrieved from the files of two Brazilian institutions from January 2006 to January 2017. Data on clinical features (sex, age and affected site), microscopic subtype, immunohistochemical results, treatment employed and follow-up status were obtained from the patient?s medical charts. During the period considered, 10 cases of RMS were identified. Females predominated (4M:6F), the mean age at diagnosis was 16.5 years-old and the orbit was the most affected site (4 cases). Microscopically, most cases were classified as embryonal RMS (6 cases) and the Desmin/Myogenin/Myo-D1 immunohistochemical positivity was useful to confirm the diagnosis. Chemotherapy and radiotherapy were applied to 9 and 8 patients respectively, whereas 2 patients were treated by surgery. Recurrences occurred in 3 patients and distant metastasis in 2 cases. Nine patients were alive in their last follow-up, 3 of them with disease, whereas 1 patient died due to the disease. Head and neck RMS is an aggressive malignant neoplasm which demands especial concern to achieve early diagnosis and successful treatment

Dental Biofilm Microbiota Dysbiosis Is Associated With the Risk of Acute Graft-Versus-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation

Acute graft-versus-host disease (aGVHD) is one of the major causes of death after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Recently, aGVHD onset was linked to intestinal microbiota (IM) dysbiosis. However, other bacterial-rich gastrointestinal sites, such as the mouth, which hosts several distinctive microbiotas, may also impact the risk of GVHD. The dental biofilm microbiota (DBM) is highly diverse and, like the IM, interacts with host cells and modulates immune homeostasis. We characterized changes in the DBM of patients during allo-HSCT and evaluated whether the DBM could be associated with the risk of aGVHD. DBM dysbiosis during allo-HSCT was marked by a gradual loss of bacterial diversity and changes in DBM genera composition, with commensal genera reductions and potentially pathogenic bacteria overgrowths. High Streptococcus and high Corynebacterium relative abundance at preconditioning were associated with a higher risk of aGVHD (67% vs. 33%; HR = 2.89, P = 0.04 and 73% vs. 37%; HR = 2.74, P = 0.04, respectively), while high Veillonella relative abundance was associated with a lower risk of aGVHD (27% vs. 73%; HR = 0.24, P < 0.01). Enterococcus faecalis bloom during allo-HSCT was observed in 17% of allo-HSCT recipients and was associated with a higher risk of aGVHD (100% vs. 40%; HR = 4.07, P < 0.001) and severe aGVHD (60% vs. 12%; HR = 6.82, P = 0.01). To the best of our knowledge, this is the first study demonstrating that DBM dysbiosis is associated with the aGVHD risk after allo-HSCT

Myeloid sarcoma in the tongue

Leukemic cells are rarely present in the oral cavity, and there are very few reports regarding such cases. However, we identified some reports of leukemic cells infiltrating tissues in the oral cavity, including gingival involvement. Recurrent painful oral ulcerations and prominent generalized periodontal destruction are the most common oral features of neutrophil disorders, and they may even be the initial symptoms of the disease. The ulcers may affect any part of the oral mucosa, including the tongue and palate. The objective of this report is to describe and discuss a case of myeloid sarcoma in the oral cavity of a 48-year-old male patient

Uncommon Histopathological Oral Findings In An Autopsied Infant With Cystic Fibrosis

Cystic Fibrosis or Mucoviscidosis is a hereditary genetic disease that attacks mainly children and young adults. It is characterized by a general dysfunction of the exocrine glands. We described uncommon histopathological findings in tongue and sublingual gland of a patient with Cystic Fibrosis. The 11-month-old female patient, had a history of repeated bronchopneumonia, chronic diarrhea and malnutrition during internment. On investigation, a high dose of chlorine was detected in the perspiration, and the diagnosis of Mucoviscidosis was made. The patient did not respond to treatment, and died in August 1997. During the autopsy, was noted lungs with bronchiectasis and bronchopneumonia with abscesses, stomach containing a large quantity of thick mucus and hepatomegaly. The organ fragments were fixed in formalin and the histological cuts were stained with H/E, Gomori-Grocott, ZiehlNeelsen and Brown-Hopps. Microscopically, the lung tissue showed chronic bronchitis and abscesses with hemorrhagic areas, and in the pancreas the ducts were dilated and filled with thick mucus, as well as evident cystic areas. On the tongue and sublingual gland we noted dilated ducts full of thick mucus and cystic areas. Furthermore, on the tongue areas with squamous ductal metaplasia and in the sublingual gland periductal fibrosis were found.27353-35