Carcinoma de células escamosas bucal: uma revisão de literatura entre o perfil do paciente, estadiamento clínico e tratamento proposto

O carcinoma de células escamosas (CEE) é uma neoplasia maligna, com origem no epitélio de revestimento da boca, sendo responsável por cerca de 95% das lesões malignas nesta região. No Brasil, a boca representa a quinta localização de maior incidência de câncer em homens e a sétima em mulheres. Este trabalho teve como objetivo analisar as variáveis: perfil (gênero, cor, idade, ocupação e escolaridade), fatores etiológicos (tabagismo, etilismo e exposição ao sol), com o estadiamento clínico (sistema TNM) e, conseqüentemente, o tratamento indicado. Foram incluídos 75 artigos. Verificou-se um predomínio das lesões na língua (32,7%), seguido pelo assoalho bucal (23,3%). A lesão foi predominantemente encontrada em feodermas, entre a 5ª e a 7ª décadas de vida. No momento do diagnóstico, a maioria dos pacientes se encontrava em estádio avançado da lesão (III ou IV). Os fatores mais associados ao desenvolvimento do CCE bucal foram: tabagismo, etilismo e radiação solar, considerando-se que estes podem complicar seu curso e prognóstico. Verificou-se que quanto maior o nível do estadiamento clínico, mais complexo foi o tratamento indicado

Cell proliferation and apoptosis in keratocystic odontogenic tumors

Objectives: Keratocystic odontogenic tumors (KOTs), also known as odontogenic keratocysts, were recently classified as a benign neoplasia due to the aggressive clinical behavior. Although several studies have shown the high proliferative activity of the epithelial lining, few studies have evaluated apoptosis in KOTs. Therefore, the aim of this study is to evaluate and compare the proliferation index (PI) and the apoptotic index (AI) of the epithelial lining in sporadic KOTs, KOTs associated with the Nevoid Basal Cell Carcinoma Syndrome (NBCCS KOTs), and dentigerous cysts. Material and methods: A total of 11 sporadic KOTs, 15 NBCCS KOTs, and 11 dentigerous cysts were evaluated. The PI was assessed by immunohistochemical detection of the cell proliferation marker Ki-67. The AI was assessed by morphological evaluation of sections stained by methyl green-pyronin. The TUNEL assay was used to confirm the occurrence of apoptosis. Differences in the PI and the AI between sporadic KOTs, NBCCS KOTs, and dentigerous cysts were analyzed using the Kruskal-Wallis test. Differences in the PI and the AI between the epithelial layers of each lesion were analyzed using the Wilcoxon test. Results: The PI and AI were higher in sporadic and NBCCS KOTs than in dentigerous cysts. No difference in these indexes was observed between sporadic and NBCCS KOTs. In dentigerous cysts, the PI was higher in the basal layer. In sporadic and NBCCS KOTs, the PI was higher in suprabasal layer. No difference in the AI was observed between the basal layer and the suprabasal layer in the three lesions. The AI was higher in the superficial layer of sporadic and NBCCS KOTs. Conclusions: The present study demonstrates that the epithelial lining of KOTs shows a distinct pattern of cell proliferation and apoptosis, reflecting its high cell turnover and reinforcing its classification as an odontogenic tumor

ÚLCERAS AFTOSAS MAIORES ASSOCIADAS A QUADRO DE ANEMIA EXACERBADAS PELO USO DO APARELHO ORTODÔNTICO

Carro

Advanced osteosarcoma of the maxilla : a case report

Osteosarcomas are primary malignant bone tumours in which mesenchymal cells produce osteoid. It is generally the most common malignant bone neoplasm, although lesions of the jaw are uncommon. Osteosarcoma of the jaw (JOS) presents a lower incidence of metastasis and a better prognosis than osteosarcoma of the long bones. However, patients with JOS can exhibit advanced tumours, mainly when early diagnosis is not performed. This article reports on a case of an advanced osteosarcoma of the maxilla. A 38-year-old woman was referred for evaluation and treatment of recurrent fibrous dysplasia of the facial bones. The patient related that she had been diagnosed with fibrous dysplasia four years earlier and, since the first diagnosis, she was submitted to four surgical interventions, all followed by recurrences. The main clinical findings were redness and swelling of the facial skin, upper lip ulceration, and hard palate swelling. Computed tomography showed a large hyperdense mass in right maxilla extending to right orbit and left maxillary sinus. An incisional biopsy was performed and microscopic examination showed areas of osteoid and chondroid formation surrounded by a cellular stroma. The diagnosis of osteosarcoma was established and the patient was recommended for oncologic treatment. Unfortunately, she died six months after the diagnosis due to uncontrollable local spread

Hypersensitivity to conventional and to nickel-free orthodontic brackets

The aim of this study was to evaluate the allergenic potential of orthodontic brackets, comparing the cutaneous sensitivity provoked by metals present in conventional metallic brackets to that provoked by brackets with a low concentration of nickel, known as "nickel-free". A sample was selected from 400 patients undergoing treatment in the orthodontic clinic of the Pontifical Catholic University of Minas Gerais (Belo Horizonte, MG, Brazil), in the period from the beginning of 2002 to the end of 2003. A cutaneous sensitivity patch test containing 5% nickel sulphate was used in 58 patients (30 males and 28 females), aged between 11 and 30, which were using fixed appliances with Morelli® brackets in both arches. In a second phase, 30 days later, a comparative test of cutaneous sensitivity was applied to the whole sample with two types of test specimens, in the form of a disc. Two alloys were tested: discs composed of the alloy used in the construction of conventional brackets and discs composed of a nickel-free alloy. The internal part of the forearm was chosen for testing, and 20 test specimens of each experiment (corresponding to the twenty brackets of a complete fixed appliance) were applied. Of the 58 patients evaluated, 16 patients were sensitive to the patch test with 5% nickel sulphate. Out of these 16 patients, 12 developed an allergic reaction to experiment 1 (test specimen with nickel), while in experiment 2, only 5 patients showed sensitivity to that sample. The McNemar test revealed that the nickel-free test specimens provoked less allergic reaction when compared with the conventional alloy (p = 0.016)