Solitary fibrous tumor of the floor of the mouth

A solitary ?brous tumor (SFT) of the oral cavity is an extremely rare entity. Its diagnosis is complicated because of its diverse morphology and similarity to other mesenchymal diseases. A rare case of SFT involving floor of the mouth is presented. The tumor was well circumscribed and almost spherical, measuring approximately 3 cm in diameter. Patient was submitted to biopsy and histopathologic examination showed a tumor composed of spindle to epithelioid cells showing pale to eosinophilic cytoplasm, oval or elongated nuclei with inconspicuous nucleoli. Tumor cells showed strong positivity for CD34, vimentin and Bcl-2. SFTs may present as a diagnostic challenge. The patient was followed for 8 years without recurrences. SFT is an uncommon disease in maxillofacial region; however it should be considered in the differential diagnosis of spindle cell neoplasms with oral manifestation. Only a few cases have been reported in the floor of mouth. We describe a new case of SFT arising at this location

Odontogenic tumors : a retrospective study of four Brazilian diagnostic pathology centers

Objective: This article presents the results of a retrospective study of the frequency and classification of odontogenic tumors recorded at four centers of diagnostic pathology in Rio de Janeiro, Brazil. Study Design: All medical records and microscopic slides of odontogenic tumor specimens for the years 1997 to 2007 were retrieved from the files of four services of diagnostic pathology in Rio de Janeiro City. Diagnoses were re-evaluated and the tumors classified according to the latest (2005) World Health Organization Classification of Tumors. Results: A total of 201 odontogenic tumors were found among 15,758 oral biopsies (1.3%). The frequencies of these tumors at the four centers ranged from 0.5% at the National Cancer Institute to 3.3% in a private laboratory. Chi-square analysis revealed statistically significant differences (p<0.05) between the proportions of odontogenic tumors in the studied centers. Of these, 94.5% were benign and 5.5% were malignant. Keratocystic odontogenic tumor (32.3%) was the most frequent lesion, followed by ameloblastoma (29.8%) and odontoma (18.4%). Conclusions: Odontogenic tumors are uncommon in Brazil. Different pathology laboratories reported divergent frequencies of odontogenic tumors, which may reflect institutional specializations and the patient populations served

Immunoexpression of cleaved caspase-3 shows lower apoptotic area indices in lip carcinomas than in intraoral cancer

Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors

Lower lip squamous cell carcinoma in patients with photosensitive disorders : analysis of cases treated at the Brazilian National Cancer Institute (INCA) from 1999 to 2012

Lower lip squamous cell carcinoma (LLSCC) is a common malignancy of the head and neck, being mainly a consequence of a chronic exposure to ultraviolet (UV) light solar radiation. Here, we evaluated the clinicopathological profile of patients with photosensitive disorders (xeroderma pigmentosum, lupus erythematosus and albinism) that developed LLSCC. Data from patients who had a diagnosed LLSCC with a prior xeroderma pigmentosum, lupus erythematosus or albinism diagnosis that were treated at INCA from 1999 to 2012 were collected from patients? medical records (n=16). The control group was composed of 68 patients with LLSCC without a medical history of photosensitivity. The clinicopathological data of this study population were collected and the association between these variables was analyzed by Fisher?s exact test. Survival curves were constructed using the Kaplan?Meier method and compared by log-rank test. All statistical analyses were performed using SPSS statistics package. The mean age of patients in the photosensitive and non-photosensitive groups was 42 years and 67 years, respectively (p<0.0001). A previous history of malignant diseases was more common in the photosensitive group (p=0.001). In both groups, most tumors showed a pathological stage I/II disease. Overall and cancer-specific survival were not statistically different. However, disease-free interval showed a significant difference (p=0.01) between the photosensitive and non-photosensitive patients. Photosensitive patients presented LLSCC at earlier age but it usually was not the primary tumor in these patients. Furthermore, a more aggressive pathological behavior was not seen when compared with tumors from non-photosensitive patients. The disease-free interval was lower in photosensitive patients, as expected

Fibrolipoma of the oral cavity - case report

O fibrolipoma é uma neoplasia benigna, caracterizada pela presença de células adiposas maduras, separadas por largas bandas de tecido conjuntivo fibroso denso. Esta patologia é uma variante microscópica do lipoma e pode acometer qualquer parte do corpo, no entanto, sua ocorrência em cavidade oral é infrequente. Em geral, é uma lesão de superfície lisa, base séssil ou pediculada, assintomática, de crescimento lento, coloração amarelada ou rósea quando mais profunda, mole a palpação, ocorrendo principalmente na mucosa jugal. Assim, o objetivo deste trabalho é descrever as principais características clínicas, histopatológicas e tratamento de um caso clínico de fibrolipoma. Paciente do sexo feminino, 67 anos, leucoderma, apresentava um nódulo pediculado de cor normocrômica, assintomático, firme a palpação, consistência fibrosa e superfície lisa, com tempo de evoluçã de aproximadamente dois anos, localizado em mucosa jugal esquerda. As hipóteses de diagnóstico foram de lipoma, fibroma, fenômeno de extravasamento de muco e fibroma de células gigantes. A paciente foi submetida a biópsia excisional e o exame histopatológico revelou o diagnóstico definitivo de fibrolipoma. O paciente encontra-se em proservação, sem sinal de recidiva. Conclui-se que, apesar de o fibrolipoma ser uma lesão benigna, o seu crescimento pode alcançar grandes dimensões, reforçando a necessidade de excisão cirúrgica. Deve também ressaltar a importância do exame histopatológico para diferenciar as variações histopalógicas do lipoma.Fibrolipoma is a benign neoplasm characterized by the presence of mature adipose cells separated by broad bands of dense fibrous connective tissue. This pathology is a microscopic variant of lipoma and can affect any part of the body. However, its occurrence in the oral cavity is uncommon. It is usually a smooth-surface lesion, asymptomatic, slow-growing, pedicled, asymptomatic, yellowish or pinkish color when deeper, soft on palpation, occurring mainly in the jugal mucosa. Thus, the aim of this paper is to describe the main clinical, histopathological and treatment characteristics of a clinical case of fibrolipoma. A 67-year-old female patient, leukoderma, had a normochromic, asymptomatic, firm palpation nodule, fibrous consistency, and smooth surface, with a time course of approximately two years, located in the left jugal mucosa. The diagnostic hypotheses were lipoma, fibroma, mucus extravasation phenomenon and giant cell fibroma. The patient underwent excisional biopsy and histopathological examination revealed the definitive diagnosis of fibrolipoma. The patient is in preservation, with no sign of relapse. It is concluded that, although fibrolipoma is a benign lesion, its growth can reach large dimensions, reinforcing the need for surgical excision. It should also emphasize the importance of histopathological examination to differentiate histopathological variations of lipoma

Reabsorção dentária fisiológica: estudo dos mecanismos (apoptose) e das moléculas desencadeadoras (Bmp-4 e gelatinase B) em dentes decíduos de gatos.

A reabsorção dentária fisiológica em dentes decíduos representa um fenômeno natural e programado pelo organismo, seguido pela substituição da dentição temporária pela permanente. Para estudar os mecanismos e moléculas desencadeadoras envolvidas na indução da reabsorção fisiológica foram utilizados caninos e incisivos decíduos de gatos com dois meses de vida. O caráter programado da reabsorção dentária fisiológica motivou o estudo da participação da apoptose neste processo e sua marcação positiva foi evidenciada pela técnica TUNEL modificada nos cementoblastos, fibroblastos do tecido pulpar, do ligamento periodontal e nos restos epiteliais de Malassez dos dentes decíduos. Uma das proteínas envolvidas na indução da apoptose em eventos fisiológicos, a proteína morfogenética óssea 4 (BMP-4), foi detectada nos cementoblastos e células do ligamento periodontal do dente decíduo por hibridização in situ com radioisótopos. Topograficamente observou-se uma similaridade entre a expressão de Bmp-4 e a técnica TUNEL modificada em cortes idênticos. Uma intensa marcação de Bmp-4 foi também observada nos ameloblastos do dente permanente. Para a análise da participação dos clastos na rizólise, foi avaliada via hibridização in situ, a expressão de gelatinase B, uma metaloproteinase da matriz extracelular sintetizada por estas células. Os resultados encontrados indicam a morte celular programada como o provável gatilho biológico" da reabsorção dentária fisiológica e a proteína BMP-4 como uma das moléculas indutoras da apoptose na reabsorção dentária fisiológica, por mecanismo autócrino e parácrino. A marcação de gelatinase B nos clastos presentes na reabsorção foi a mesma localizada nos clastos, da reabsorção óssea, indicando semelhança entre estas células.The physiologic tooth resorption occurs as a natural and programmed phenomenon and results in the shedding of deciduous teeth. The resorptive process is not continuos, but alternates with periods of repair. To study the activators and effectors that trigger the physiologic tooth resorption, we used cat deciduos incisors and canines. These animals were two months old and showed different stages of tooth resorption. We analysed the participation of apoptosis by TUNEL staining in physiologic tooth resorption because of it programmed pattern. Some cementoblasts showed positive in TUNEL staining along the primary roots at the same and at the opposite side of dental follicle. Many apoptotic positive cells were found in periodontal ligament that propably were fibroblasts, and some groups of cells suggesting epithelium rests of Malassez. Some apoptotic pulp cells were also identified. In situ hybridization was used to detect Bmp-4 mRNA on tissues sections using [35S] UTP-labeled riboprobes as described by VAINIO et al. in 1991. We detected in primary tooth, the expression of Bmp-4 mRNA in cementoblasts and in some cells in the periodontal ligament. Indeed we found this molecule in ameloblasts of permanent germ. We found strong correlation between the results obtained by TUNEL and the expression of Bmp-4. Some apoptotic cells in primary tooth were also expressing Bmp-4. To analyse the distribution of clasts in physiological resorption we used gelatinase B, matrix metalloproteinase, in situ hybridization in identical sections. We observed abundant clasts expressing gelatinase B mRNA in radicular surface and the same expression inside of the clasts in bone resorption. These results imply that programmed cell death could trigger the physiological tooth resorption and the expression of molecule Bmp-4 mediates apoptosis by autocrine and paracrine control. The same expression of gelatinase B by clasts associated with bone and tooth resorption indicate similarity between these cells. These results were analysed in microscope with bright and dark field and the images were digitalized.These findings contribute to further understand tooth resorption mechanism, to develop specific terapies to control inflammatory tooth resorption and to accelerate or paralyse the physiological tooth resorption in special clinical situations

Reabsorção dentária fisiológica: estudo dos mecanismos (apoptose) e das moléculas desencadeadoras (Bmp-4 e gelatinase B) em dentes decíduos de gatos.

A reabsorção dentária fisiológica em dentes decíduos representa um fenômeno natural e programado pelo organismo, seguido pela substituição da dentição temporária pela permanente. Para estudar os mecanismos e moléculas desencadeadoras envolvidas na indução da reabsorção fisiológica foram utilizados caninos e incisivos decíduos de gatos com dois meses de vida. O caráter programado da reabsorção dentária fisiológica motivou o estudo da participação da apoptose neste processo e sua marcação positiva foi evidenciada pela técnica TUNEL modificada nos cementoblastos, fibroblastos do tecido pulpar, do ligamento periodontal e nos restos epiteliais de Malassez dos dentes decíduos. Uma das proteínas envolvidas na indução da apoptose em eventos fisiológicos, a proteína morfogenética óssea 4 (BMP-4), foi detectada nos cementoblastos e células do ligamento periodontal do dente decíduo por hibridização in situ com radioisótopos. Topograficamente observou-se uma similaridade entre a expressão de Bmp-4 e a técnica TUNEL modificada em cortes idênticos. Uma intensa marcação de Bmp-4 foi também observada nos ameloblastos do dente permanente. Para a análise da participação dos clastos na rizólise, foi avaliada via hibridização in situ, a expressão de gelatinase B, uma metaloproteinase da matriz extracelular sintetizada por estas células. Os resultados encontrados indicam a morte celular programada como o provável gatilho biológico" da reabsorção dentária fisiológica e a proteína BMP-4 como uma das moléculas indutoras da apoptose na reabsorção dentária fisiológica, por mecanismo autócrino e parácrino. A marcação de gelatinase B nos clastos presentes na reabsorção foi a mesma localizada nos clastos, da reabsorção óssea, indicando semelhança entre estas células.The physiologic tooth resorption occurs as a natural and programmed phenomenon and results in the shedding of deciduous teeth. The resorptive process is not continuos, but alternates with periods of repair. To study the activators and effectors that trigger the physiologic tooth resorption, we used cat deciduos incisors and canines. These animals were two months old and showed different stages of tooth resorption. We analysed the participation of apoptosis by TUNEL staining in physiologic tooth resorption because of it programmed pattern. Some cementoblasts showed positive in TUNEL staining along the primary roots at the same and at the opposite side of dental follicle. Many apoptotic positive cells were found in periodontal ligament that propably were fibroblasts, and some groups of cells suggesting epithelium rests of Malassez. Some apoptotic pulp cells were also identified. In situ hybridization was used to detect Bmp-4 mRNA on tissues sections using [35S] UTP-labeled riboprobes as described by VAINIO et al. in 1991. We detected in primary tooth, the expression of Bmp-4 mRNA in cementoblasts and in some cells in the periodontal ligament. Indeed we found this molecule in ameloblasts of permanent germ. We found strong correlation between the results obtained by TUNEL and the expression of Bmp-4. Some apoptotic cells in primary tooth were also expressing Bmp-4. To analyse the distribution of clasts in physiological resorption we used gelatinase B, matrix metalloproteinase, in situ hybridization in identical sections. We observed abundant clasts expressing gelatinase B mRNA in radicular surface and the same expression inside of the clasts in bone resorption. These results imply that programmed cell death could trigger the physiological tooth resorption and the expression of molecule Bmp-4 mediates apoptosis by autocrine and paracrine control. The same expression of gelatinase B by clasts associated with bone and tooth resorption indicate similarity between these cells. These results were analysed in microscope with bright and dark field and the images were digitalized.These findings contribute to further understand tooth resorption mechanism, to develop specific terapies to control inflammatory tooth resorption and to accelerate or paralyse the physiological tooth resorption in special clinical situations

Coexistência de pênfigo vulgar e infecção pelo vírus herpes simples na mucosa oral Coexistence of pemphigus vulgaris and herpes simplex virus infection in oral mucosa

O pênfigo vulgar é uma doença mucocutânea, imunomediada, caracterizada por lesões vesiculobolhosas, enquanto a infecção pelo vírus herpes simples (HSV) é comum na cavidade oral. A coexistência das duas doenças tem sido relatada por alguns autores. Este artigo relata o caso de um paciente com múltiplas lesões em várias áreas da mucosa oral, cujo procedimento foi raspagem e biópsia incisional, que resultou no diagnóstico de pênfigo vulgar associado à infecção pelo HSV. Destaca-se a inusitada associação das doenças e a identificação citopatológica de duas populações celulares com aspectos morfológicos distintos e característicos, capazes de determinar o correto diagnóstico, sendo fundamental para a conduta e terapêutica adequada.<br>Pemphigus vulgaris is an autoimmune mucocutaneous disease, characterized by vesiculobullous lesions. Herpes simplex virus (HSV) infection is common in the oral cavity and the coexistence of pemphigus vulgaris and HSV infection has been reported by some authors. In this work, we report a case of a patient with multiple lesions involving several areas of the oral mucous membrane. Based on scraping cytology and incisional biopsy findings, the diagnosis was pemphigus vulgaris associated with HSV infection. We call attention to the uncommon association of both diseases and the cytological identification of two cell populations with different and characteristic morphological aspects, able enough to establish the correct diagnosis and define an appropriate therapeutic approach