Unveiling an oral hemangiolymphangioma

Hemangiolymphangioma is a very rare vascular malformation that develops as a combination of dilated venous and lymphatic vessels. We describe an unusual case of hemangiolymphangioma of the tongue affecting an adult man who complained of an uncomfortable, slowly progressing exophytic irregular dark red-violaceous nodular mass on his tongue that impaired speech and swallowing for two weeks. The clinical differential diagnoses were Kaposi’s sarcoma and a COVID-19-related lesion. A complete blood count and serology for HIV-1 and 2 and RT-PCR for COVID-19 were requested and results were negative. An incisional biopsy was performed. Microscopically, the lesion exhibited several dilated vessels lined by normal-appearing endothelial cells, some filled with prominent intravascular erythrocytes and others containing proteinaceous eosinophilic material resembling lymphatic vessels, in close association with hyperkeratosis, papillomatosis, and acanthosis. From immunohistochemical analysis, most vessels were found to be CD34 positive, some highlighted by α-SMA, whereas D2-40 was focal. Positive staining for some lymphatic and blood vessel markers, i.e., D2-40 and CD34, respectively, indicates a mixed derivation of the lesion. HHV-8 was negative. Clinical features, the congested blood vessels with ectasia in intimate association with hyperplastic epithelium, and the immunohistochemical profile supported the final diagnosis of oral hemangiolymphangioma. The patient underwent minimally invasive surgical excision with no intercurrences. After 18 months of follow-up, there were no signs of relapse

Vascular leiomyoma in the oral cavity : report of two cases

Vascular leiomyomas (VL) are benign lesions of perivascular origin. We report two new cases and discuss their clinical, histological and immunohistochemical characteristics, in order to facilitate the diagnosis and treatment of such lesions. The patients, both male, presented asymptomatic nodules located in the bottom of the labial sulcus and buccal mucosa. In the second case, color doppler ultrasonography was performed, which showed no change in blood flow. After excisional biopsies, a limited lesion was observed histologically, with multiple tortuous vessels of varying sizes and calibers, and among them, spindle cells bundles, positive for smooth muscle actin. Oral VLs have clinical features similar to those of other more common lesions, making preoperative diagnosis difficult. Imaging examination, such as color doppler ultrasonography, may help in diagnosis. In general, excisional biopsy is performed, due to the ease of removal of the lesion during surgery. The treatment of choice is the complete excision of the lesion, which has an excellent prognosis and a low rate of recurrence

Avaliação da biocompatibilidade do enxerto osseo autogeno, da membrana de colageno absorvivel e carbonato de calcio natural pulverizado sobre o processo de reparo osseo

Orientador: Pedro Duarte NovaesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo deste trabalho foi analisar histologicamente e histometricamente a técnica de Regeneração Óssea Guiada (ROG) associada ou não ao enxerto ósseo autógeno e ao carbonato de cálcio natural pulverizado sobre o processo de reparo ósseo, nos defeitos bicorticais confeccionados, em calvária de ratas. Foram utilizadas 60 ratas adultas, em cada calota foram realizados 2 defeitos circulares de 4mm de diâmetro, sendo um do lado direito e outro do lado esquerdo da sutura sagital mediana. Os animais foram divididos aleatoriamente em seis grupos: grupo I controle; II enxerto ósseo autógeno; III carbonato de cálcio natural pulverizado; IV recebeu membrana de colágeno absorvível nas corticais ósseas interna e externa; V carbonato de cálcio entre as membranas de colágeno e VI enxerto ósseo autógeno entre as membranas. Os animais foram sacrificados nos períodos pós-operatórios de 14 e 28 dias. O material coletado foi analisado através de microscopia de luz e de luz polarizada. Os reultados histológicos sugeriram que no período de 14 dias o material que promoveu maior osteogênese foi o do grupo do osso autógeno e no período de 28 dias foi o grupo osso autógeno associado à membrana de colágeno. O carbonato de cálcio natural exibiu reação inflamatória de corpo estranho intensa e quando associado à membrana de colágeno houve formação de abcesso. Os resultados deste estudo demonstraram que o enxerto ósseo autógeno associado às membranas de colágeno exibiram reparo ósseo significantemente maior quando comparado aos outros gruposAbstract: The purpose of this study was to analyse histogically and histometrically the Guided Bone Regeneration (GBR) associated or not with autogenous bone graft and natural granular calcium carbonate in the treatment of a bicortical osseous defects created in rats skull. Sixty adult female rats received bilateral 4 mm trephine defects in the parietal area. The animals were assigned to one of following: group 1- control procedure; II- autogenous bone graft; III- natural granular calcium carbonate; IV - collagen membrane placed ecto-endocranially; V - calcium carbonate between collagen membranes and VI- autograft between collagen membranes. The animal were killed 14 and 28 days after surgery. The results were assessed by light and polarization microscopy. The best results as for bone regeneration was observed at 14 days with autogenous bone graft without collagen membranes and at 28 days with autograft between membranes. Natural granular calcium carbonate showed severe foreign-body inflammatory reaction and when associated with collagen membranes abcess formation was observed. The results of this study demonstraded that autogenous bone graft associated with collagen membranes exhibited significantly better bone healing as compared to another groupsMestradoMestre em Biologia e Patologia Buco-Denta

Estudo imunohistoquimico das citoqueratinas, do indice de proliferação celular e da resposta inflamatoria na paracoccidioidomicose bucal

Orientador: Oslei Paes de AlmeidaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A paracoccidioidomicose (Pmicose) é uma micose sistêmica, comum na América Latina, com apresentação clínica variável. Na sua forma crônica, freqüentemente envolve a mucosa bucal com lesões múltiplas de aspecto moriforme. Microscopicamente, caracteriza-se por hiperplasia pseudoepiteliomatosa (HPE) e resposta inflamatória granulomatosa, além de acúmulos de neutrófilos no epitélio e no conjuntivo. Os objetivos deste trabalho foram descrever, através da imunohistoquímica, a expressão de citoqueratinas (CKs) e a proliferação celular da HPE, assim como a distribuição das células inflamatórias nos tecidos epitelial e conjuntivo. Adicionalmente, foi descrito um caso clínico de Pmicose bucal. HPE foi evidente nos 28 espécimes de Pmicose bucal oriundas da mucosa jugal, lábio, gengiva e palato duro avaliados quanto à expressão de CKs (AE1/AE3, 34j3E12, CK1, CK5, CK6, CK7, CK8, CK10, CK14, CK16, CK18 e CK19) e proliferação celular (Ki-67). Na camada basal, os resultados foram semelhantes para todas as CKs, nos casos de mucosa bucal normal (MBN) e HPEs. As diferenças observadas na camada suprabasal entre a MBN e a Pmicose estão descritas a seguir. Na Pmicose, CK1 e CK10 não foram expressas nas camadas espinhosa e superficial do lábio, gengiva e palato duro; CK14 foi expressa na camada suprabasal da mucosa jugal e lábio; CK6 foi mais freqüentemente expressa apenas na camada espinhosa do lábio, gengiva e palato duro, entretanto a expressão de CK16 foi menor nas camadas espinhosa e superficial da gengiva e palato duro. O índice de proliferação celular foi determinado utilizando-se a marcação imunohistoquímica para Ki-67 e quantificado com o auxílio do analisador de imagem Kontron 400. Os índices de proliferação foram de 7,7 (:t3,6) e 28,2 (:t9,8) para a MBN e HPE, respectivamente. Assim sendo, na HPE a proliferação celular mostrou-se aumentada, resultando no aumento da espessura e diminuição da queratinização. Para comparação, também foram incluídos 13 casos de displasia epitelial bucal de grau moderado, os quais revelaram índice médio de proliferação de 46,0 (:t14,0). Quanto ao infiltrado inflamatório, nos granulomas organizados predominaram as células CD68+, com os linfócitos CD4+ distribuídos na periferia. Nas áreas não granulomatosas, houve equilíbrio entre células CD4+ e CD8+. Linfócitos B (CD20+) estavam esparsamente distribuídos no tecido conjuntivo inflamado. Células dendríticas (8100+) foram observadas no epitélio, assim como no tecido conjuntivo subepitelial e na periferia dos granulomas organizados. Neutrófilos (CD15+) predominaram nos microabscessos intraepiteliais e nas ulcerações. Adicionalmente, descreve-se um caso clínico de Pmicose que apresentou uma lesão crônica, ulcerada e solitária, com aspecto clínico similar ao carcinoma espino celular em rebordo alveolarAbstract: Paracoccidioidomycosis (Pmycosis) is a common systemic mycosis in Latin America, with variable clinical presentation. The chronic form frequently involves the oral mucosa, showing multiple moriform like lesions. Microscopically, oral Pmycosis is cha_acterized by pseudoepitheliomatous hyperplasia (PEH), and granulomatous inflammatory response, besides polimorphonuclear (PMN) accumulation in the epithelium and connective tissue. This work describes, by immunohistochemistry, cytokeratins (CKs) expression and cellular proliferation in PEH, as well as the distribution of inflammatory cells in the epithelial and connective tissues. Additionally, a clinical case of oral Pmycosis is described. PEHs were evident in ali 28 oral Pmycosis specimens from the buccal mucosa, lip, gingiva and hard palate used to study CKs expression (AE1/AE3, 34_E12, CK1, CK5, CK6, CK7, CK8, CK10, CK14, CK16, CK18 and CK19) and cell proliferation (Ki-67). In the basal cell layer, the results were similar for ali CKs, in normal oral mucosa (NOM) and PEHs. Differences found in the suprabasal layer of NOM and PEH are described below. In Pmycosis, CK1 and CK10 were not expressed in spinous and superficial layers of the lip, gingiva and hard palate. CK14 was positive in suprabasallayer of the buccal mucosa and lip. CK6 was more frequently expressed in spinous layer of the lip, gingiva and hard palate, nevertheless CK16 expression was decreased in the spinous and superficial layers of the gingiva and hard palate. Cellular proliferation index was determined by Ki-67 immunostaining and quantification with the aid of an image analyzer system (Kontron 400). The proliferation index was 7.7 (:t3.6) and 28.2 (:t9.8) for NOM and PEH, respectively. Therefore in PEH, epithelial proliferation was increased, resulting in a thicker and parakeratotic epithelium. Proliferative index of moderate oral dysplasia, included for comparison was 46.0 (:t14.0). Organized granulomas showed a predominance of CD68+ cells, with CD4+ cells at the periphery. Similar number of CD4+ and CD8+ cells were found in non granulomatous areas. B Iymphocytes (CD20+) were sparsely distributed throughout the connective tissue. Dendritic cells (S100+) were found in the epithelium, sub-epithelial connective tissue and periphery of organized granulomas. PMN (CD15+) predominated in areas of intraepithelial microabscesses and ulcerations. Additionally, a clinical case of Pmycosis is described that showed a solitary chronic ulcerated lesion, similar to a spinous cell carcinoma of the alveolar ridgeDoutoradoEstomatologiaDoutor em Estomatopatologi

Investigação da etiopatogenia do carcinoma de células escamosas primário de boca em pacientes jovens

The objective of this thesis was to compile results of clinical, immunohistochemical and molecular studies on the demographics and etiopathogeny of primary oral squamous cell carcinoma (SCC) in young people (aged 40 years or younger). Initially, we carried out an epidemiological survey using medical records from patients treated at the ambulatory care unit of the Head and Neck Surgery Department of AC Camargo Cancer Center. We found 125 young patients (test group), who were then matched to 250 patients aged 50 years or older (control group), having tumors of similar topographies, clinical stages, and dates of treatment. Men were the most affected in both groups, being the tongue and the floor of the mouth the most affected regions. Tumors in advanced clinical stages and well differentiated were the most frequent types. Interestingly, the young group was less exposed to tobacco (p=0.04). Although this group showed higher relapse rates (p=0.02), no differences were found between the groups studied in terms of their Overall Survival (OS) (p=0.86) and Disease-Free Survival (DFS) curves. Involvement of lymph nodes, poorly differentiated tumors, tumors in advanced clinical stages, and radiotherapy as the sole primary treatment all brought down DFS rates. OS was higher in non-smoker women, in gingivae and soft palate lesions, and in early clinical stages. From the findings of this survey, we were able to carry out all subsequent research work. In Chapter 3.2, we carried out investigation on CCND1 amplification and cyclin D1 expression in SCC of young people, and compared the findings against the control group. Protein overexpression was found in 47.7% against 32.8% (p=0.03), and amplification was found in 46.2% against 18.6% (p<0.01). In the young group, overexpression was correlated with OS decrease; however, this difference was not statistically significant (p=0.06). Amplification was not correlated with OS in either of the groups. DFS was lower...O objetivo desta tese foi reunir os resultados de estudos clínicos, imunohistoquímicos e moleculares que investigaram o perfil demográfico e a etiopatogenia do carcinoma de células escamosas primário (CEC) de boca em pacientes jovens (com idade ≤40 anos). Além disso, a data do tratamento primário foram próximas. Inicialmente, foi realizado um levantamento epidemiológico através dos prontuários dos pacientes atendidos no ambulatório de Cirurgia de Cabeça e Pescoço do AC Camargo Cancer Center. Foram encontrados 125 pacientes jovens (grupo teste) que foram pareados com 250 pacientes com idade ≥50 anos (grupo controle) que apresentaram tumores em topografia, estadiamento clínico e época de tratamento similares. Em ambos os grupos, a o sexo masculino foi o mais afetado, sendo a língua seguida do soalho bucal os locais acometidos. Tumores em estadios clínicos avançados e bem difernciados foram características mais frequente. Interessantemente, o grupo jovem foi menos exposto ao tabaco (p=0.04). Este grupo apresentou mais recorrências (p=0.02), embora não se tenha observado diferenças nas curvas de sobrevidas global (SG) (p=0.86) e livre de doença (SLD) entre os grupos avaliados. Linfonodos comprometidos, tumores avançados, pobremente diferenciados e a radioterapia como tratamento primário exclusivo diminuíram a SLD. A SG foi melhor nas mulheres, não usuárias de tabaco, lesões localizados em gengiva/palato duro e em estadios clínicos precoce. À partir deste levantamento, foi possível realizar os trabalhos subsequentes. No capítulo 3.2, foi realizado investigação da amplificação do CCND1 e expressão protéica da ciclina D1 em CEC de jovens e resultados encontrados foram comparados ao grupo controle. A superexpressão protéica foi observada em 47.7% vs 32.8% (p=0.03) e amplificação foi encontrada em 46.2% vs 18.6% (p<0.01). No grupo jovem, a superexpressão foi correlacionada com diminuição da SG, embora a...Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Oral syphilis: report of three cases and characterization of the inflammatory cells

Syphilis is a sexually transmitted infectious disease caused by Treponema pallidum. This study reports 3 cases of syphilis and highlights the importance of identifying oral lesions for its final diagnosis. Case 1: a 48-year-old male patient presented with a bleeding ulcer in the lower lip. Overall clinical examination revealed patchy alopecia and skin target lesions. Case 2: a 61-year-old male patient presented with white spots on the lateral tongue and nodules on the dorsum of the tongue. Overall clinical examination showed erythematous target lesions on the abdomen, forearm, palms of the hand, and soles of the feet. Case 3: a 17-year-old male patient presented with an ulcerated lesion on the tongue and lymph node involvement. The following serologic tests were requested: Venereal Disease Research Laboratory, fluorescent treponemal antibody-absorption, anti-HIV-1 and anti-HIV-2, and anti-hepatitis C virus. An incisional biopsy revealed epithelial hyperplasia associated with intense and diffuse mononuclear inflammatory cell infiltration consisting mainly of plasma cells, in a perivascular and perineural distribution. The final diagnosis in the 3 patients was syphilis. Treatment consisted of 1 weekly dose of penicillin (2.4 million units, intramuscular) for 2 or 3 weeks. Immunohistochemical reactions for XIIIa, CD3, CD20, CD68, CD163, S100, CD1a, CD11c, CD83, CD138, and CD208 were performed. Clinicians should be familiarized with oral syphilis lesions in order to be able to diagnose this emerging infectious disease of variable clinical presentation

Proliferative verrucous leukoplakia mimicking oral lichen planus: case report and literature review

Abstract This report presents the clinical, microscopic and immunohistochemical aspects of a case of proliferative verrucous leukoplakia (PVL) mimicking oral lichen planus (OLP) in a 66-year-old woman. We also review the literature reporting cases of PVL mimicking OLP, where we found a higher prevalence in women who do not consume tobacco or alcohol. The initial manifestation of lichenoid areas was around the age of 59, with the diagnosis of PVL being established on average 6 years later, while malignant transformation occurred in 8 of the 22 cases at an average of 3.7 years after the final diagnosis of PVL. We emphasize the need for a close follow-up of any patient presenting white lesions of the oral mucosa. Lesions that are clinically and microscopically compatible with lichenoid reactions or OLP must be investigated and differentiated from PVL, which has a worse prognosis

Cystic Odontoma in a Patient with Hodgkin’s Lymphoma

Cystic odontoma is a rare entity, which is characterized by the association of a cyst with complex/compound odontoma. The aim of this study was to report the case of a 5-year-old male patient diagnosed previously with Hodgkin’s lymphoma and treated successfully with chemotherapy and radiotherapy, who developed a mandibular odontogenic lesion. Physical examination revealed a swelling on the right side of the mandible. Radiographically, a well-defined radiolucent area surrounded by radiopaque material was observed. An incisional biopsy was performed and microscopic analysis showed a cystic lesion consisting of an atrophic epithelium comprising 2-3 cell layers and the absence of inflammation in the cystic capsule. The cyst was decompressed and the lesion was removed after 3 months of follow-up. Microscopic analysis of the surgical specimen showed a cystic hyperplastic epithelium surrounded by an intense chronic inflammatory cell infiltrate, which was in close contact with mineralized tissue resembling dentin and cementum. The final diagnosis was cystic odontoma. Since chemotherapy can affect the growth and development of infant teeth, a relationship between chemotherapy-associated adverse events and cystic odontoma is suggested in the present case

Multiple supernumerary teeth in non-syndromic patients. Report of 5 clinical cases

numerary tooth is one that is additional to the normal series and can be found in almost any region of the dental arch. They have been described in both primary and permanent dentition. Multiple supernumerary teeth are rare in non-syndromic patients. The purpose of this study was to evaluate non-syndromic patients with five or more supernumerary teeth, by general and local clinical examinations, periapical, occlusal and panoramic radiographs. The patients data were collected regarding to the number of supernumerary teeth, location, shape, position and association to pathological lesion. Thirty-five supernumerary teeth were found, 17 in the mandible and 18 in the maxilla. In the lower arch, 16 supernumerary teeth were localized in the premolar region and 1 in a distomolar region. However, in the upper arch, there were 7 in the premaxilla, 6 in the premolar and 5 in the distomolar region. From the total, 28 were supplemental and 7 were found in a rudimentary shape. Completing the observations, 29 included teeth were detected and one showed a radiolucent area that suggested a dentigerous cyst. Six other teeth showed a widened follicular space. One of the upper molar from the normal series was related to an odontoma. We could conclude that mandible and maxilla were equally affected and most of the teeth morphology was similar in size and shape to normal tooth (supplemental). Twenty-nine teeth were impacted; however few have caused pathologies

Prevalence and microscopic features of enamel pearls from permanent human molars

Enamel pearls are ectopic structures observed mainly on the roots of permanent teeth and could be related to periodontal diseases. Aim: To evaluate the prevalence of enamel pearls in extracted human molars and characterize their structures using light and scanning electron microscopy. Methods: The study comprised 2,201 extracted human permanent molars. The teeth were analyzed and classified according to morphological features. The presence, location and shape of enamel pearls were investigated. Fifteen human molars with enamel pearls were embedded in acrylic resin and observed by light microscopy. Results: Seventy-one enamel pearls were identified on third molar root. Microscopically, most pearls were composed of prismatic irregular enamel and normal dentin. The dentinoenamel junction presented an irregular course. The number of dentinal tubules was normal and they presented curvature to continue within the root dentin of the carrier tooth. Dentinal tubules below the enamel pearls were closer to each other. Conclusions: Scanning electron microscopic analysis revealed that the enamel pearls were similar to coronal enamel