Carcinoma epidermóide no seio maxilar: Uma revisão analítica da literatura

O carcinoma epidermóide do seio maxilar é um tumor maligno incomum de origem epitelial que é diagnosticado quase sempre em uma fase tardia da doença, sendo assim de difícil tratamento e propenso à sequelas debilitantes. A faixa etária mais acometida é a sexta e sétima década de vida e o gênero masculino o mais afetado. O aspecto histopatológico é o mesmo descrito para esta lesão em outros sítios da cabeça e pescoço. Acredita-se ser causado por carcinógenos ambientais que atuaram por longo período de tempo sobre a mucosa sinusal. Em sua fase inicial apresentam sinais e sintomas inespecíficos semelhantes a uma inflamação crônica. Exames por imagem são fundamentais para avaliar a localização e extensão da doença. O tratamento envolve cirurgia, radioterapia e quimioterapia isolados ou em conjunto. O patologista oral deve conhecer esse tumor como forma de considerá-lo no diagnóstico de lesões que atingem os seios maxilares e ainda podem ter extensão para a cavidade oral

Cone Beam Computed Tomography Assessment of the Volume of Dental Tissue Removed During Endodontic Access

Introduction: The purpose of this study was to determine the volume of dental tissue removed during endodontic access preparation with cone-beam computed tomography (CBCT) comparing two different software. Methods and Materials: CBCT images of 20 teeth were obtained before and after endodontic access performed with spherical and conical diamond burs. The images were taken with i-CAT Precise system with 0.25 mm voxel size. Digital Imaging and Communications in Medicine (DICOM) images were loaded on two different software programs (Materialise® and InVersalius®), and a 3D reconstruction of the CBCT images was performed on both programs. The baseline volume (BV), and the final volume (FV) were obtained, and the lost tissue volume (LV) was calculated using the formula: LV=BV-FV. The t-test was used to compare initial and final volumes and also to compare the two programs, using a significance level of 5%. Results: The volumetric data calculated for the MaterialiseÒ and the InVesaliusÒ programs were, respectively: BV-mean of 441.79±85.08 mm3 and 442.01±84.83 mm3; FV-mean of 426.75±83.88 mm3 and 426.94±83.75 mm3; LV-mean of 15.04±4.32 mm3 and 15.07±4.16 mm3. No statistically significant difference was found in the volumes calculated by either program for initial, final, or removed tissue (P>0.05). However, there was a significant difference between the BV and LV calculated on the same program (P<0.05). Conclusion: Our in vitro study showed that CBCT was able to determine the volume of dental tissue removed in the endodontic access preparation of extracted human teeth, regardless of the software program used

Granulocytic sarcoma of the oral cavity in a chronic myeloid leukemia patient : an unusual presentation

Intraoral granulocytic sarcoma is an unusual manifestation of chronic or acute leukemia. The oral manifestations often involve enlargements of the gingival and mucosal tissue from direct leukemic cell infiltration. Only 38 cases have been reported in scientific literature to date. We present the case of a 47 year-old female who was diagnosed with chronic myeloid leukemia (CML) in December 2006. She was referred to a dentist for further evaluation, revealing generalized gingival overgrowth as well as periodontal, apical disease, and bleeding of the gums. An oral biopsy was performed and histological features revealed immature blast-like cells

Chondroblastic osteosarcoma mimicking periapical abscess

Lesions of non-endodontic origin may mimic periapical abscess. Osteosarcoma is a rare malignant lesion. Case report The present report describes a case of chondroblastic osteosarcoma in the periapical region of teeth #29, #30, and #31 of an 18-year-old male. Clinical history showed self-reported discomfort in the right posterior gingiva for over a month. Physical examination showed a small expansion and redness of the right mandibular buccal and lingual cortical plates, but no signs of pain or inflammation were observed. All the teeth responded positively to pulp sensibility. Periapical and panoramic radiographs showed slight periapical radiolucency in the roots of teeth #29 and #30, clear periodontal ligament space widening, and evident loss of lamina dura. Incisional biopsy was performed, and based on microscopic findings the diagnosis of chondroblastic osteosarcoma was confirmed. Conclusions Non-endodontic diseases associated with tooth root apex, such as chondroblastic osteosarcoma, should be included in differential diagnosis of jaw lesions that resemble periapical abscess

Infecção por Papilomavírus Humano e Câncer Oral: Revisão da literatura atual

A infecção pelo HPV tem sido reconhecida como fator de risco individual para o desenvolvimento de carcinomas epidermoides de cabeça e pescoço, sendo relacionada ao desenvolvimento de lesões em pacientes que não apresentam os fatores clássicos de risco, como o tabagismo e o etilismo. O contato oral oral e oral genital possivelmente se apresentam como vias de transmissão do HPV entre humanos, justificando ainda, a relação entre o câncer e o comportamento sexual. A literatura atual sugere que os carcinomas epidermoides HPV-positivos apresentam um comportamento biológico diferenciado, e isso tem estimulado a investigação da relação entre a infecção pelo HPV e o desenvolvimento destas neoplasias, além dos possíveis benefícios de uma campanha de imunização contra o HPV na prevenção deste tipo de câncer

TWIST and p-Akt immunoexpression in normal oral epithelium, oral dysplasia and in oral squamous cell carcinoma

Objectives: The aim of this study was to evaluate the immunoexpression of TWIST and p-Akt proteins in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), correlating their expressions with the histological features of the lesions. Study design: Immunohistochemical studies were carried out on 10 normal oral epithelium, 30 OL and 20 OSCC formalin-fixed, paraffin-embedded tissue samples. Immunoperoxidase reactions for TWIST and p-Akt proteins were applied on the specimens and the positivity of the reactions was calculated for 1000 epithelial cells. Results: Kruskal-Wallis and Dunn's post tests revealed a significant difference in TWIST and p-Akt immunoexpression among normal oral mucosa, OL and OSCC. In addition, a significant positive correlation was found between TWIST and p-Akt expressions according to the Pearson's correlation test. Conclusions: The results obtained in the current study suggest that TWIST and p-Akt may participate of the multi-step process of oral carcinogenesis since its early stages. © Medicina Oral S. L

Exames de tomografia computadorizada e cintilografia para diagnóstico e plano de tratamento de osteocondroma condilar: relato de caso

PURPOSE: To report an uncommon case of osteochondroma affecting the mandibular condyle of a young patient and to illustrate the important contributions of different imaging resources to the diagnosis and treatment planning of this lesion. CASE DESCRIPTION: A 24-year-old female patient with the chief complaint of an increasing facial asymmetry and pain in the left pre-auricular region, revealing a reduced mouth opening, mandibular deviation and posterior cross-bite over a period of 18 months. Panoramic radiography revealed an enlargement of the left condyle, whereas computed tomography (CT) sections and three-dimensional CT showed a well-defined bone growth arising from condylar neck. The scintigraphy exam showed an abnormal osteogenic activity in the left temporomandibular joint. The condyle was surgically removed and after 18 months follow-up the panoramic radiography and CT scans showed no signs of recurrence. CONCLUSION: Although osteochondroma is a benign bone tumor that rarely arises in cranial and maxillofacial region, it should be considered in the differential diagnosis of slow-growing masses of the temporomandibular area and the use of different imaging exams significantly contribute to the correct diagnosis and treatment planning of this pathological condition.OBJETIVO: Relatar um caso incomum de osteocondroma afetando o côndilo mandibular de uma paciente jovem e ilustrar as importantes contribuições dos diferentes exames por imagem para o diagnóstico e plano de tratamento desta lesão. DESCRIÇÃO DO CASO: Paciente do sexo feminino, 24 anos, com queixa principal de uma crescente assimetria facial e dor na região pré-auricular esquerda, além de apresentar redução da abertura bucal, desvio de mandíbula e mordida cruzada posterior, por um período de 18 meses. A radiografia panorâmica revelou um aumento do côndilo esquerdo, enquanto secções de tomografia computadorizada e reconstrução 3D exibiram um crescimento ósseo bem definido originando-se do côndilo. O exame de cintilografia revelou uma atividade osteogênica anormal na região de articulação tempormandibular esquerda. O côndilo foi cirurgicamente removido e após 18 meses de acompanhamento a radiografia panorâmica e a tomografia computadorizada não revelaram nenhum sinal de recorrência. CONCLUSÃO: Apesar de o osteocondroma ser um tumor ósseo benigno que raramente surge na região crânio maxilofacial, ele deve ser considerado como diagnóstico diferencial para massas de crescimento lento na área temporomandibular e o uso de diferentes exames por imagem contribuem significativamente para o correto diagnóstico e plano de tratamento desta condição patológica

SOX2 and BCL-2 Expressions in Odontogenic Keratocyst and Ameloblastoma

The purpose of this experimental study was to compare the immunohistochemical expression of SOX2 and BCL-2 in Odontogenic Keratocyst (OKC) and Ameloblastoma (AB) specimens, and to identify a possible correlation in their expression. Immunohistochemical analysis was performed to evaluate SOX2 and BCL-2 expression in OKC (n = 20) and AB (n = 20). The immunoexpression was analyzed by a quantitative and qualitative scoring system. The comparison between the immunoexpression of SOX 2 and BCL-2 was assessed by the Mann-Whitney U-test. Spearman?s correlation coefficient evaluated the correlation between SOX2 and BCL-2 expressions. SOX2 and BCL-2 expression was observed in all specimens of OKC in the full thickness of the epithelium lining. SOX2 immunostaining was higher in OKC, in comparison with AB samples (P<0.05). BCL-2 immunostaining between OKC and AB was not statistically significant. There was no significant correlation between SOX2 and BCL-2 in OKC and AB specimens. SOX2 and BCL-2 expressions in OKC may suggest their relationship with the biological behavior of this lesion, and the higher expression of SOX2 might be an upstream influence on the Hh signaling pathway

Expression of CD90 and P75NTR stem cell markers in ameloblastomas : a possible role in their biological behavior

Multicystic and unicystic ameloblastomas are benign odontogenic tumors that present distinct biological behavior. The investigation of stem cells has become an important branch of tumor biology, with several studies addressing the possible role of these cells in tumor growth, angiogenesis, progression, infiltration and invasiveness. This study evaluated the immunohistochemical expression of CD90(Thy-1) and P75NTR stem cell markers in multicystic and unicystic ameloblastomas. Seventeen (17) samples of ameloblastomas (multicystic, n = 10; unicystic, n = 7) were submitted to immunohistochemical reactions and graded semi-quantitatively. The Kolmogorov-Smirnov test was used to verify possible differences in CD90 and P75NTR expressions between multicystic and unicystic ameloblastomas (p < 0.05). CD90 immunostaining was observed in all multicystic ameloblastoma specimens (n = 10), in the cytoplasm of the fibroblasts and vascular endothelial cells of the tumor stroma, near the neoplastic odontogenic epithelia. The staining of stromal CD90 was significantly higher in multicystic than in unicystic ameloblastomas (p = 0.003). Nuclear P75NTR immunostaining was observed in all ameloblastoma specimens. A significant difference was seen in the epithelial staining of P75NTR between multicystic and unicystic types (p = 0.007). The increased expression of CD90 and P75NTR found in multicystic ameloblastomas suggests a behavioral biological difference between multicystic and unicystic ameloblastomas, as well as a difference in ameloblastoma development

Avaliação do conhecimento sobre radioproteção dos cirurgiões-dentistas da cidade de Goiânia/GO.

Objetivo: Avaliar o conhecimento sobre radioproteção dos cirurgiões-dentistas da cidade de Goiânia-GO. Método: Participaram da pesquisa 102 cirurgiões-dentistas, de ambos os gêneros, da rede pública e particular, atuantes na cidade de Goiânia-GO. Responderam a um questionário autoaplicável contendo 15 perguntas fechadas à respeito dos métodos de radioproteção preconizados pela portaria da Secretaria de Vigilância Sanitária (SVS) nº 453/98. Resultados: Verificou-se que entre os cirurgiões-dentistas entrevistados 82,14% utilizam avental plumbífero associado ao colar de tireóide como medida de radioproteção aos seus pacientes, enquanto 17,86% utilizam apenas o avental plumblífero. Em relação as medidas de autoproteção 51,45% se distanciam dois metros da fonte de radiação, 14,19% utilizam o avental plumbífero e 20,29% utilizam o biombo de chumbo ou outra barreira. A maioria dos profissionais (56,86%) desconhecem a portaria 453/98. Conclusão: Com base nos resultados do presente trabalho pôde-se concluir que, os cirurgiões-dentistas entrevistados neste estudo sempre utilizam alguma medida protetiva para o paciente, mesmo que parcialmente. Sobre as medidas de auto-proteção, a maioria demonstrou conhecimentos superficiais sobre radioproteção, utilizando basicamente a distância para sua própria proteção. Adicionalmente, pôde-se observar que grande parte do cirurgiões-dentistas desconhecem, ou apresentam conhecimento limitado, sobre a portaria 453/98 da Vigilância Sanitária, resultado este que não tem relação com a experiência profissional e tempo de formado, tendo em vista que a maioria dos entrevistados relataram ter menos de dez anos de formatura