P53 and bcl-2 immunoexpression in patients with oral lichen planus a nd oral squamous cell carcinoma

Objective : The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). Study D esign : We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. Results : We found p53 immunoexpression in 71.4 % OLP cases and 68.7 % OSCC cases, with no immunoexpression in control cases. Bcl-2 was negative for all OLP and OSCC cases, and mild positivity was observed in normal tissue. We found significant correlation among p53 expression and OSCC malignancy. Conclusions : Our results suggest that TP53 system mainly promotes a hyperproliferative state by cell cycle arrest of the OLP epithelial cells for repairing damaged DNA nor apoptosis and that anti-apoptotic action of bcl-2 is not important in this disease

Value of the toluidine blue test as an aid to determine the biopsy site in actinic prurigo cheilitis

Actinic prurigo (AP) is a type of photodermatosis that primarily affects the Latin American mestizo population. Histologically, AP cheilitis exhibits acanthosis with spongiosis and vacuolation of the basal cell layer overlying a dense lymphocytic inflammatory infiltrate that forms well-defined lymphoid follicles. Toluidine blue is a thiazide, acidophilic, and metachromatic dye used in vivo to selectively stain the acidic components of tissues such as sulfates, carboxylates, and phosphate radicals that are incorporated into DNA and RNA. It is necessary to develop a method that allows detecting, on clinical grounds the area of the lesion in which it is more feasible to find such structures. Thus to increase the sensitivity of the biopsy, in AP cheilitis to accurately identify where the lymphoid follicles reside, based on the higher concentration of DNA in such structures and thus confirm the diagnosis. In this study, staining was positive in 85% of patients with AP cheilitis, in 14 of whom 82% lymphoid follicles were observed by histopathology. One of the pathologist’s problems in establishing the diagnosis of AP is that the main histopathological characteristics are not always identified in the submitted samples because it is not easy to clinically identify the most representative site of the lesion selected for performing a biopsy. Based on our results, we propose using toluidine blue as an auxiliary method to choose a tissue sample to facilitate the diagnosis and allow clinicians to make clinical correlations between the histopathological and therapeutic findings

Hiperplasia multifocal del epitelio: reporte de nueve casos

La hiperplasia multifocal del epitelio (HME) conocida también como hiperplasia epitelial focal, enfermedad de Heck ó hiperplasia multifocal del epitelio por papiloma virus, se caracteriza por la aparición de lesiones múltiples en la mucosa de la cavidad bucal en población pediátrica y se asocia a la presencia del virus papiloma humano. El objetivo de este estudio fue conocer las características clínico-patológicas de los casos diagnosticados de esta enfermedad en el Servicio de Dermatología del Hospital Manuel Gea González. Se revisaron los archivos de esta institución y se seleccionaron los casos diagnosticados como HME. Se encontraron 9 casos. La mayoría de los pacientes fueron menores de 20 años (67%) y del sexo femenino (78%), todos los casos presentaron lesiones múltiples y siempre hubo parientes directos con lesiones similares. Los lugares que se afectaron con mayor frecuencia fueron: mucosa bucal, labio inferior, paladar y comisuras. La HME es una condición de la mucosa de la cavidad bucal que solamente necesita tratamiento de aquellas lesiones que representan un problema cosmético ó aquellas que se traumatizan secundariamente. Las demás remitirán conforme avanza la edad del paciente. Se sugiere usar el nombre de hiperplasia multifocal del epitelio pues describe mejor las características clínico-patológicas y microscópicas de la enfermedad.Multifocal epithelial hyperplasia (MEH) is also known as focal epithelial hyperplasia, Heck's disease or multifocal papillomavirus- induced epithelial hyperplasia. It is characterised by the presence of multiple lesions in the oral mucosa of children and it has been associated with the presence of the human papillomavirus. The aim of this study was to determine the clinicopathological features of the cases diagnosed as MEH in the Service of Dermatology of the Hospital Manuel Gea González (SDHMGG). The files of the SDHMGG were reviewed and all cases diagnosed as MEH were retrieved. Nine MEH cases were found. Most of the patients were 20 year-old or younger (67%) and females were more commonly affected (78%). All patients presented multiple lesions and always, close relatives with similar lesions were found. Lesions were located most commonly in the buccal mucosa, lower lip and comissures. MEH is a soft tissue intraoral condition that needs treatment solely of the traumatised lesions or those with cosmetic problems. Remaining lesions will disappear with the age of the patients. It is suggested that this entity should be named multifocal epithelial hyperplasia since this name describes better the clinico-pathological and microscopic features of the disease

Apoptosis and apoptotic pathway in actinic prurigo by immunohistochemistry

Background: Actinic prurigo (AP) is an idiopathic photodermatosis, this entity requires exposure to UV-B and -A to develop lesions. Apoptosis is a physiological death program that can be initiated by a permanently active mechanism (extrinsic pathway) or irreparable damage (intrinsic pathway). Material and methods: Descriptive study, the sample size comprised 64 paraffin blocks of tissue with a diagnosis of AP. In H&E-stained slides, the diagnosis of AP was corroborated, and 1-µm-thick sections were processed for immunohistochemistry (IHC). A database was constructed with SPSS version 20, Inc., Chicago, IL, USA, and descriptive statistics were analyzed by X2 test and comparison of means. Results: A total of 64 cases were processed, of which 40 (62.5%) were cheilitis AP and 24 (37.5%) were AP in the skin. Of the 40 cheilitis samples, 27 were positive for Bcl-2 and caspase 3 (67.5%), p53 was expressed in 30 (75%). Of the skin lesions, p53 and caspase 3 were expressed in 18 of 24 cases (75%), and 13 were positive for Bcl-2 (54%). Conclusions: We propose that apoptosis is the last step in the type IV subtype a-b hypersensitivity responseactivation of the intrinsic pathway indicates that external factors, such as UV-A and -B are the trigger

Inmunohistochemical detection of mastocytes in tissue from patients with actinic prurigo

Background: Actinic prurigo (AP) is a type of photodermatosis, the pathophysiology of which has not been determined. AP has been suggested to be a hypersensitivity reaction to the presence of eosinophils and the local production of IgE. Material and Methods: Descriptive study, using paraffin blocks of tissue that have been diagnosed with AP from the Dermopathology department, Hospital General Dr. Manuel Gea González. In 66 blocks from 63 patients, eosinophils were identified by hematoxylin and eosin staining, and mastocytes were labeled by immunohistochemistry. Three random microphotographs (40x) were used, and cell counts were calculated as the mean count in the 3 microphotographs. Results: Forty cases (63.5%) were female, and 23 (36.5%) were male. The mean age was 26.49 ±14.09 years; regarding the evolution time of the disease, the average was 11.93 years ±11.39. In 38 of 63 cases (60%), the lip, skin, and conjunctiva were affected clinically. In 22 of 63 cases (34%), AP cheilitis was the sole manifestation, and in 4 of 63 cases (6%), there were lesions in the skin and conjunctiva. The mean eosinophil count was 9 per case, the average number of mastocytes/field was 28.48 (range 0 to 66) Kruskal-W allis p =0.001. Conclusions: There are elements in AP that mediate the reaction of hypersensitivity type IV b, necessitating the identification of triggering factors

Prevalence of oral lesions in patients with psoriasis

Aim: To determine the prevalence of oral lesions (OL) in patients with psoriasis, and compare these findings with the ones found in patients without this condition. Materials and methods: In the present observational and comparative study, we evaluated 207 patients, with and without psoriasis, attending the dermatological consulting service of a concentration hospital in Mexico City. The possible association between OL and psoriasis was analyzed through a logistic regression model; the Odds Ratio (OR) and its Confidence Interval (CI) was calculated to be 95%. Results: Two hundred and seven cases were examined (80 with psoriasis and 127 without psoriasis). Of these, 75 (36.2%) were men and 132 (63.7%) women. Oral lesions were found in 54 (67.5%) psoriatic patients and in 63 (49.6%) of the comparative group (p 0.05) regarding the use of tobacco. Alcohol consumption was greater (55.0%) among patients with psoriasis than among those without psoriasis (26.7%) (p 0.05). Conclusions: The high prevalence of GT and FT in patients with psoriasis suggests that these lesions should be taken into account in new studies as possible predictors or markers of the severity of this dermatosis, in order to confirm the association of these entities

Mucositis de células plasmáticas: Reporte de dos casos y revisión de la literatura

La mucositis de células plasmáticas es una entidad poco frecuente, de etiología desconocida, que se caracteriza por lesiones muy eritematosas, de superficie lobulada y edematosa, que puede afectar labios, mucosa oral, encías, paladar, lengua, epiglotis, laringe e incluso mucosa genital. Histológicamente se observa un denso infiltrado de células plasmáticas. Comunicamos dos casos: el primero, en una mujer de 50 años de edad que acudió a consulta por presentar dos placas eritematosas en mucosa de labio superior de dos años de evolución. Se manejó con esteroide tópico, con buena respuesta a corto plazo, aunque la paciente se perdió en su seguimiento. El segundo, una mujer de 47 años, con lesiones también localizadas en mucosa de labio superior y en papilas interdentales de encía vestibular superior, que respondieron con tratamiento esteroide sistémico en esquema de reducción gradual. La biopsia demostró en ambos casos un denso infiltrado compuesto por células plasmáticas. Los estudios de inmunohistoquímica demostraron en el segundo caso positividad a cadenas kappa y lambda. Se discuten los hallazgos clinicopatológicos sobresalientes de esta condición, su manejo y diagnóstico diferencial

Epitelioma cuniculatum: a propósito de un caso

Epithelioma cuniculatum is one of the infrequent forms of verrucous carcinoma, a variant of well-differentiated squamous cell carcinoma with low malignant and metastatic rate. Buscke-Löwenstein tumor, oral florid papillomatosis and papilomatosis cutis are the other variants of verrucous carcinoma. We present a 61-year-old patient with a tumoral lesion of verrucous appearance overlying the sole of the right foot. The patient underwent multiple destructive chemical and mechanical treatments with the clinical suspect of plantar wart.El epitelioma cuniculatum (EC) corresponde a una de las formas inusuales del carcinoma verrugoso, una variante del carcinoma espinocelular bien diferenciado, de bajo grado de malignidad y potencial metastásico. El tumor de Buscke-Löwenstein, la papilomatosis oral florida y la papilomatosis cutis comprenden las otras variantes del carcinoma verrugoso. Se presenta el caso de un hombre de 61 años de edad, con una tumoración de aspecto verrugoso en planta del pie derecho, de 20 años de evolución, sometida a múltiples tratamientos destructivos, químicos y mecánicos, con la sospecha clínica de una verruga plantar

Alopecia Secondary to Hyaluronic Acid Embolization: Trichoscopic Findings

Fillers are frequently used in aesthetic medicine and, although usually safe, complications can occur. Vascular occlusion leading to tissue necrosis is a rare but severe complication. Alopecia after hyaluronic acid injection has been recently reported, being a vascular compromise the most probable physiopathological mechanism. The trichoscopic findings in this entity have not been described yet. A case report of a 30-year-old female who developed this complication following a hyaluronic acid injection as well as the description of the trichoscopic findings are presented in this report