Analysis of referrals to the stomatology service in a Southern Brazilian hospital: a retrospective study

This paper intends to describe the demand for referrals to the stomatology service requested by the medical teams for inpatients in a reference hospital in the south of Brazil. This research is a retrospective cross-sectional descriptive study focusing on data collection and assessment of information about referrals to the stomatology unit carried out from January 2008 to December 2018. All information was obtained from the hospital management software database, then transferred and analyzed individually for descriptive statistics. A total of 4433 cases were referred to the stomatology team, with an average of 403 cases by year. Hematology/hemato-oncology (37.3%) was the specialty asking for the majority of the referrals, followed by Oncology (20.4%) and Pneumology (8.2%). The mean patients’ profile was males (55.5%), receiving a diagnosis of oral mucositis (43.5%), and with the first and second decades of life being the most prevalent ones (34.9%), with a mean age of 34.8±22.3 years. The most common treatment performed by the stomatology team was the photobiomodulation therapy (44.8%). This retrospective study demonstrated the important profile of the stomatological care in hospitalized patients from a specific hospital, especially referred by the hematology/hemato-oncology team. These results evidenced the importance of the stomatology specialty in the hospital environment

Leucoplasia bucal: considerações a respeito do tratamento e do prognóstico

Oral leukoplakia is a predominantly white, non-removable, macule or plaque, that cannot be characterized as any other definable lesion. Its main risk factor is tobacco smoking. Any site of oral mucosa may be affected and lesions present a risk of malignant transformation. Several treatment approaches are available, being the surgical remotion the most used. Aim: to review the literature about therapeutic approaches and prognosis of oral leukoplakia. Results: besides conventional surgical excision, alternative surgical treatments such as the vaporization of the lesion using carbon dyoxide laser and cryosurgery have been used. Non-surgical treatments involve the application of retinoids, beta-carotene, bleomycin or drugs associated to photodynamic therapy. The choice of treatment is based on clinical experience of professional, lesion size and critical judgment of costbenefit. After partial remotion, lesions may increase, decrease or remain stable in size. Changes in size or surface might indicate malignant transformation. Total remotion is not capable to avoid that risk, neither the possibility of local recurrence or appearance of new lesions. Lesions located in the tongue and in the floor of the mouth, as well as lesions measuring more than 2 cm2 appears to have a worse prognosis. Conclusion: the largest clinical experience and the possibility of microscopic evaluation of all surgical specimens favor the use of conventional surgical removal. However, it is important to highlight that total remotion of the lesion does not eliminate the possibility of recurrence or malignant transformation, which are unpredictable, regardless of the chosen treatment. Therefore, oral leukoplakia patients should be submitted to a strict follow up program, aiming the early detection of malignization.Leucoplasia bucal é uma mancha ou placa predominantemente branca, não-removível por raspagem, que não pode ser caracterizada como nenhuma outra lesão. Seu principal fator de risco é o tabaco. Qualquer região da mucosa pode ser afetada e as lesões apresentam potencial de malignização. Diversas formas de tratamento estão disponíveis, sendo a excisão cirúrgica com bisturi a mais utilizada. Objetivo: realizar uma revisão de literatura a respeito dos tratamentos disponíveis e prognóstico da leucoplasia. Resultados: além da excisão cirúrgica convencional, tratamentos cirúrgicos alternativos como a vaporização da lesão pela aplicação de laser de dióxido de carbono e a criocirurgia vêm se difundindo. Os tratamentos não-cirúrgicos envolvem a aplicação de retinóides, beta-caroteno, bleomicina ou de outros fármacos, relacionados com a terapia fotodinâmica. A escolha do tipo de tratamento a ser empregado se baseia na experiência clínica do profissional, tamanho da lesão e julgamento crítico da relação custo-benefício. Conclusão: a maior experiência clínica e a possibilidade de avaliação microscópica de toda peça cirúrgica favorecem a utilização da remoção cirúrgica convencional. Contudo, é importante destacar que a remoção de toda lesão não descarta a possibilidade de recorrência e de malignização, as quais ocorrem de forma imprevisível, independentemente do tratamento escolhido. Portando, os pacientes com leucoplasia bucal devem ser submetidos a um rígido programa de acompanhamento clínico periódico, favorecendo a identificação precoce da ocorrência de transformação maligna

TGF-β1 and its association with clinicopathological features, proliferative activity and prognosis in oral squamous cell carcinoma: An immunohistochemical study

Introduction: The prognostic value of transforming growth factor beta-1 (TGF-ß1) in oral cancer remains unclear. Therefore, the aim of this study was to evaluate TGF-β1 expression in oral squamous cell carcinoma (OSCC) samples and its association with clinicopathological data, tumor proliferative activity and patients’ prognosis. Methods: Sixty-eight patients with histopathological diagnosis of OSCC were included, as 9 cases of normal oral mucosa for comparison purposes. OSCC sample was categorized according to patients’ outcomes in favorable prognosis (n=30) or unfavorable prognosis (n=38). Immunohistochemical staining for TGF-β1 and Ki-67 was performed. The slides were semi-quantitatively and quantitatively evaluated for TGF-β1 and Ki-67, respectively. Results: TGF-β1 was significantly increased in OSCC compared to normal oral mucosa (<0.01). An inverse correlation was found between TGF-β1 and Ki67 staining in OSCC (p=0.01). No association was found between TGF-β1 expression and OSCC clinicopathological features, prognosis or survival. Conclusion: TGF-β1 had no prognostic value and appears to maintain it’s suppressive role concerning cell proliferation.   Keywords: Head and neck neoplasms; prognosis; transforming growth factor

Acinic cell carcinoma of the oral and maxillofacial region: an international multicenter study

Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region

Leucoplasia bucal: considerações a respeito do tratamento e do prognóstico

Leucoplasia bucal é uma mancha ou placa predominantemente branca, não-removível por raspagem, que não pode ser caracterizada como nenhuma outra lesão. Seu principal fator de risco é o tabaco. Qualquer região da mucosa pode ser afetada e as lesões apresentam potencial de malignização. Diversas formas de tratamento estão disponíveis, sendo a excisão cirúrgica com bisturi a mais utilizada. Objetivo: realizar uma revisão de literatura a respeito dos tratamentos disponíveis e prognóstico da leucoplasia. Resultados: além da excisão cirúrgica convencional, tratamentos cirúrgicos alternativos como a vaporização da lesão pela aplicação de laser de dióxido de carbono e a criocirurgia vêm se difundindo. Os tratamentos não-cirúrgicos envolvem a aplicação de retinóides, beta-caroteno, bleomicina ou de outros fármacos, relacionados com a terapia fotodinâmica. A escolha do tipo de tratamento a ser empregado se baseia na experiência clínica do profissional, tamanho da lesão e julgamento crítico da relação custo-benefício. Conclusão: a maior experiência clínica e a possibilidade de avaliação microscópica de toda peça cirúrgica favorecem a utilização da remoção cirúrgica convencional. Contudo, é importante destacar que a remoção de toda lesão não descarta a possibilidade de recorrência e de malignização, as quais ocorrem de forma imprevisível, independentemente do tratamento escolhido. Portando, os pacientes com leucoplasia bucal devem ser submetidos a um rígido programa de acompanhamento clínico periódico, favorecendo a identificação precoce da ocorrência de transformação maligna

TGF-β1 and its association with clinicopathological features, proliferative activity and prognosis in oral squamous cell carcinoma: An immunohistochemical study

Introduction: The prognostic value of transforming growth factor beta-1 (TGF-ß1) in oral cancer remains unclear. Therefore, the aim of this study was to evaluate TGF-β1 expression in oral squamous cell carcinoma (OSCC) samples and its association with clinicopathological data, tumor proliferative activity and patients’ prognosis.Methods: Sixty-eight patients with histopathological diagnosis of OSCC were included, as 9 cases of normal oral mucosa for comparison purposes. OSCC sample was categorized according to patients’ outcomes in favorable prognosis (n=30) or unfavorable prognosis (n=38). Immunohistochemical staining for TGF-β1 and Ki-67 was performed. The slides were semi-quantitatively and quantitatively evaluated for TGF-β1 and Ki-67, respectively.Results: TGF-β1 was significantly increased in OSCC compared to normal oral mucosa (&lt;0.01). An inverse correlation was found between TGF-β1 and Ki67 staining in OSCC (p=0.01). No association was found between TGF-β1 expression and OSCC clinicopathological features, prognosis or survival.Conclusion: TGF-β1 had no prognostic value and appears to maintain it’s suppressive role concerning cell proliferation. Keywords: Head and neck neoplasms; prognosis; transforming growth factors