Clinicopathological and immunohistochemical comparative study between central, conventional and peri-implant giant cell lesions

Orientador: Fábio Ramôa PiresDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: As lesões de células gigantes periféricas são lesões comuns da cavidade oral. Acredita-se que a etiopatogênese destas lesões esteja relacionada a trauma persistente de baixa intensidade. Acomete com maior frequência gengiva e rebordo alveolar e é mais prevalente no gênero feminino. Lesões de células gigantes periféricas peri-implantares têm sido descritas na literatura, mas sua etiopatogênese ainda é incerta. Estudos imunoistoquímicos comparando o perfil das lesões de células gigantes periféricas e centrais não têm demonstrado diferenças significativas. O objetivo deste estudo foi comparar o perfil clínico-patológico e imunoistoquímico das lesões de células gigantes centrais, periféricas convencionais e peri-implantares. Com esta finalidade, foram selecionados espécimes provenientes de procedimentos cirúrgicos de 36 lesões de células gigantes (10 lesões centrais de células gigantes e 26 lesões periféricas de células gigantes: 13 convencionais e 13 peri-implantares). Após a confirmação dos diagnósticos em hematoxilina e eosina, os tecidos foram submetidos a técnica imunoistoquímica. Foi verificada a expressão dos seguintes antígenos: ?-SMA, Bcl-2, GLUT-1, CD68, RANK, OPG, Ki67 e CD34. As reações foram analisadas quantitativamente com auxílio do software Imagescope (Aperio). Os resultados dos escores de imunomarcação foram analisados com software SPSS versão 22, com nível de significância para todos os testes de 5%. Os escores de positividade para CD68 e Bcl-2 foram maiores para as lesões de células gigantes convencionais e centrais do que nas lesões de células gigantes peri-implantares (p=0.033 para CD68 e p<0.0001 para Bcl-2). A densidade microvascular (avaliada pela contagem de vasos CD34+) foi maior nas lesões periféricas de células gigantes convencionais (p=0.002) do que nas outras lesões. O índice de proliferação celular (avaliado pela porcentagem de núcleos Ki67+) foi mais alto nas lesões de células gigantes peri-implantares; porém, não houve diferença estatisticamente significante entre os grupos. Em conclusão, o presente estudo demostrou diferenças na densidade microvascular, na atividade proliferativa e na expressão de CD68 e Bcl-2 nas lesões de células gigantes convencionais, peri-implantares e centraisAbstract: Giant cell lesions (GCL) are common lesions in the soft tissues of the oral cavity and in the jaws. Although their pathogenesis remains understood, chronic trauma is suggested as a probable etiologic factor. Peripheral GCL occur mostly in the gingiva and alveolar ridge of females. Peripheral peri-implant GCL have been recently reported in the literature; however, their etiopathogenesis is not fully understood. Few studies have compared the immunophenotype of conventional and peri-implant GCL. The aim of this study was to evaluate and to compare the clinicopathological features and immunophenotype of conventional peripheral GCL, central GCL and peri-implant GCL. Thirty-six GCL were retrospectively selected, and after diagnosis confirmation in HE-stained slides, immunohistochemistry was performed in 10 central GCL, 13 conventional peripheral GCL and 13 peri-implant GCL. The primary antibodies used in this study were: ?-SMA, Bcl-2, GLUT-1, CD68, RANK, OPG, Ki67 e CD34. Immunohistochemical reactions for the antibodies mentioned above were performed and digitally scored by using the Imagescope software (Aperio). Digital scores for CD68 and Bcl-2 were higher in conventional PGCL and CGCL than in peri-implant PGCL (p=0.033 for CD68 and p<0,0001 for Bcl-2). Microvessel density was higher in the conventional PGCL than in CGCL and peri-implant PGCL (p =0.002). The cellular proliferative index was higher in peri-implant PGCL than in the other studied lesions; however, no significant statistical differences were noted among the groups. In conclusion, the current study demonstrated some differences in microvessel density, proliferative activity and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant PGCL and CGCLMestradoEstomatologiaMestra em Estomatopatologia33003033009P4CAPE

Hyperpigmentation of hard palate induced by chloroquine therapy

Abstract The antimalarials are one of the most commonly prescribed drugs for conditions such as lupus erythematosus and rheumatoid arthritis, and the side effects, though infrequent, are well known. The antimalarial agent chloroquine diphosphate usually causes pigmentary changes in the oral mucosa characterized by a bluish-grey to black discolorations mainly in the hard palate. Considering only the hard palate hyperpigmentation caused by chloroquine, to the best of our knowledge, only 13 cases have been reported in the English language literature. We described an additional case of palate hyperpigmentation related to the chronic use of chloroquine diphosphate in a 60-year-old Mexican woman. Although the diagnosis is usually made based on medication history and clinical presentation, a biopsy specimen may be helpful to confirm the diagnosis. Clinicians must be aware of these drugs and their adverse effects in order to make the correct diagnosis and decide on the optimal treatment for the condition. Key words: Oral cavity, hard palate, hyperpigmentation, chloroquine, antimalarial

Peri-implant peripheral giant cell lesions : report of 13 new cases and comparative histological and immunohistochemical analysis with peripheral and central giant cell lesions

Few cases or peri-implant peripheral giant cell lesions (PGCL) have been reported in the literature. The aim of this study was to report 13 new cases of peri-implant PGCL and compare the expression of smooth muscle actin, Bcl-2 protein, GLUT-1, CD68, osteoprotegerin, receptor activator of nuclear factor kappa-B, Ki-67 and CD34 in these cases with PGCL and central giant cell lesions (CGCL). Clinical data were retrieved from the laboratory records and histological analysis was performed using HE-stained slides. Immunohistochemical reactions for the above mentioned antibodies were performed and digitally scored. Peri-implant PGCL mostly affected the posterior mandible of adult females. CD68 and Bcl-2 expressions were higher in conventional PGCL and CGCL than in peri-implant PGCL (p=0.033 for CD68 and p<.0001 for Bcl-2). Microvessel density was higher in conventional peripheral than in central and peri-implant PGCL (p=0.002). Proliferative index of the mononuclear cells showed no statistically significant differences comparing the three groups but it was higher in peri-implant PGCL. The current study demonstrated that peri-implant PGCL is more common in the posterior mandible of adult females. There were some differences in microvessel density, proliferative activity and expression of CD68 and Bcl-2 among conventional PGCL, peri-implant and CGCL. Further studies are encouraged to better understand these early findings

Ossifying fibromyxoid tumor of the oral cavity: rare case report and long-term follow-up

Ossifying fibromyxoid tumor (OFMT) is a rare mesenchymal soft tissue benign neoplasm with an uncertain line of differentiation, which arises most frequently in extremities. The head and neck region involvement is uncommon, with only ten intraoral cases published in the English-language literature. One additional case of OFMT is reported here, including a literature review of intraoral reported cases. A 45-year-old female patient presented a painless nodule involving the buccal mucosa of approximately two years duration, measuring nearly 1.3 cm in maximum diameter. The main histopathological features include ovoid to round cells embedded in a fibromyxoid matrix with a perpheral shell of lamellar bone. Immunohistochemically, the tumor showed immunoreactivity for vimentin and S100. No recurrence has been detected after 7 years of follow-up

Prevalence, antifungal susceptibility and virulence determinants of oral yeast species isolated from immunodeficient patients in Northeastern Brazil

Background and Objectives: Oral candidiasis has a common occurrence in immunocompromised patients. However, other emergent infections have become increasingly common. The aim of this study was to investigate the prevalence, virulence determinants and the antifungal susceptibility of yeast colonizing the mucosa of immunocompromised patients in Northeastern Brazil. Methods: Samples from sixty HIV-positive patients seen at the Specialized Service / Hospital Dia - Hospital Universitário Prof. Alberto Antunes from the Federal University of Alagoas were collected from subgingival sites and seeded on CHROMagar for presumptive confirmation of Candida spp. followed by PCR and sequencing. In addition, we tested virulence determinants, phospholipase and protease and evaluated in vitro the Minimum Inhibitory Concentration of antifungals amphotericin B and fluconazole. This project was approved by the Research Ethics Committee of the Center for Higher Studies in Maceió. Results: Approximately 63% of the patients were colonized by yeasts, with C. albicans as the predominant species, while non-Candida albicans species accounted for 49% of the isolates, with C. dubliniensis and C. parapsilosis being the commonest, but C. intermedia, Bullera penniseticola and Naganishia liquefaciens were also found. The virulence determinants protease and/or phospholipase were also produced by Candida spp. and some uncommon opportunistic isolates such as Kodamaea ohmeri, N. liquefaciens and Saitozyma podzolica. Furthermore, most of Candida spp. strains and some uncommon opportunistic species showed high values of minimal inhibitory concentration. Conclusion: Results obtained indicate that C. albicans continues to be the predominant species in oral cavity of immunodeficient patients and along with other unusual species may present high resistance to the antifungals tested

Risk factors associated with hypovitaminosis D in HIV/aids-infected adults

Objective To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. Subjects and methods This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher’s exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. Results The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study