Adriele Ferreira Gouvêa

Clinicopathological features and immunohistochemical expression of p53, Ki-67, Mcm-2 and Mcm-5 in proliferative verrucous leukoplakia.

BACKGROUND Proliferative verrucous leukoplakia (PVL) is a distinct and aggressive type of oral leukoplakia which affects elderly women without risk behavior and presents high rates of malignant transformation. The objective of the present study was to evaluate the clinicopathological characteristics and the distribution of cell proliferation markers, aiming to elucidate the distinct biological behavior of the PVL. METHODS Clinical and microscopical features of 12 patients with PVL were reviewed. Immunohistochemical analysis for p53, Ki-67, Mcm-2 and Mcm-5 were performed and the data were correlated. RESULTS All patients were women, above 50 years of age, 91.7% were non-smoker and 100% were non-habitual drinker. Alveolar ridge (66.6%), tongue (50%) and buccal mucosa (41.6%) were the most affected sites. Four patients developed squamous cell carcinoma (SCC). The immunohistochemical findings showed higher positivity for p53, Ki-67, Mcm-2 and Mcm-5 in SCCs. However, some patients with mild or moderate dysplasia, specially the patients who developed SCC, presented high expression of Mcm-2 and Mcm-5. CONCLUSIONS High immunoexpression of Mcm-2 and Mcm-5 in mild and moderate dysplasia could be helpful to predict the malignant transformation of PVL.

Cleidocranial dysplasia: oral features and genetic analysis of 11 patients

BACKGROUND Cleidocranial dysplasia (CCD) is a dominantly inherited autosomal disease characterized by typical bone defects including short stature, persistently open or delayed closure of the cranial sutures, and hypoplastic or aplastic clavicles. Oral features are frequent and include supernumerary teeth, delayed eruption or impaction of the permanent teeth, and malocclusion. Heterozygous mutations in RUNX2 gene, which encodes a transcription factor essential for osteoblast differentiation, were identified as the etiological cause of CCD. OBJECTIVE AND METHODS Herein, we performed physical and radiographic examination and screening for RUNX2 mutations in 11 patients from five families with CCD. RESULTS All patients demonstrated the classical phenotypes related to CCD. Families whose affected members had several dental alterations such as multiple impacted and supernumerary teeth demonstrated heterozygous missense mutations (R190Q and R225Q) that impair the runt domain of RUNX2. On the other hand, CCD patients from families with low frequency of dental abnormalities showed no mutation in RUNX2 or mutation outside of the runt domain (Q292fs→X299). CONCLUSION The current findings suggest a correlation between dental alterations and mutations in the runt domain of RUNX2 in CCD patients. Further clinical and genetic studies are needed to clarify the relationship between phenotypes and genotypes in CCD and to identify other factors that might influence the clinical features of this uncommon disease.

Bilateral central ossifying fibroma affecting the mandible: report of an uncommon case and critical review of the literature

Ossifying fibroma (OF) is a well demarcated benign neoplasm primarily found in the jaw and composed of fibrocellular tissue and mineralized material. Occurrence of multiple OFs (synchronous) is rare in the jaws, and only 10 cases have been documented. The aim of this report was to present an additional case of bilateral central OF in the mandible of a patient not affected by the hyperparathyroidism–jaw tumors syndrome (HPTJT), emphasizing the features that distinguish this lesion from HPT-JT and performing a critical review of the current literature and concepts. Benign fibro-osseous lesions (FOLs) are a poorly defined and to some extent controversial group of lesions affecting the jaws and craniofacial bones. FOL refers to a group of pathologic processes in which normal bone is replaced by fibroblasts and collagen fibers containing variable amounts of mineralized material. This group encompasses fibrous dysplasia, benign fibro-osseous neoplasms (central ossifying fibroma), and a heterogeneous group of reactive lesions (osseous dysplasias). Because of the histopathologic similarities among these lesions, the definitive diagnosis requires a precise correlation of the clinical, histopathologic, and imaging findings.

High incidence of DNA ploidy abnormalities and increased Mcm2 expression may predict malignant change in oral proliferative verrucous leukoplakia

To assess the DNA content of cases of oral proliferative verrucous leukoplakia (PVL) and correlate the DNA ploidy findings with the expression of Mcm2, geminin, and Ki67, and with clinicopathological data.

Insights into immune responses in oral cancer through proteomic analysis of saliva and salivary extracellular vesicles.

The development and progression of oral cavity squamous cell carcinoma (OSCC) involves complex cellular mechanisms that contribute to the low five-year survival rate of approximately 20% among diagnosed patients. However, the biological processes essential to tumor progression are not completely understood. Therefore, detecting alterations in the salivary proteome may assist in elucidating the cellular mechanisms modulated in OSCC and improve the clinical prognosis of the disease. The proteome of whole saliva and salivary extracellular vesicles (EVs) from patients with OSCC and healthy individuals were analyzed by LC-MS/MS and label-free protein quantification. Proteome data analysis was performed using statistical, machine learning and feature selection methods with additional functional annotation. Biological processes related to immune responses, peptidase inhibitor activity, iron coordination and protease binding were overrepresented in the group of differentially expressed proteins. Proteins related to the inflammatory system, transport of metals and cellular growth and proliferation were identified in the proteome of salivary EVs. The proteomics data were robust and could classify OSCC with 90% accuracy. The saliva proteome analysis revealed that immune processes are related to the presence of OSCC and indicate that proteomics data can contribute to determining OSCC prognosis.

Head and neck amyloidosis: clinicopathological features and immunohistochemical analysis of 14 cases

BACKGROUND Amyloidosis is associated with or caused by amyloid deposition. These fibrillar proteins may be deposited extracellularly causing tissue damage or impairment. OBJECTIVES The aim of the study was to retrospectively review pathology archives in two oral diagnostic centers for cases fulfilling criteria of amyloidosis and to differentiate AA and AL types of amyloidosis. METHODS The clinicopathological features, alkaline Congo red staining, with and without pretreatment with potassium permanganate, and immunohistochemical (IHC) staining with anti-AA, anti-kappa (κ), and anti-lambda (λ) light chain antibodies were carried out and analyzed. RESULTS The search identified 14 cases. Ten patients were women and four were men, with a mean age of 58 years. Eleven patients had systemic involvement by amyloidosis (associated either with multiple myeloma or plasma cell dyscrasia/monoclonal gammopathies), while three presented the localized type, one of them associated with plasmacytoma. All cases showed positivity for κ or λ light chains (AL-amyloid) and presented resistance to the potassium permanganate pretreatment. CONCLUSIONS Our results show that the head and neck region is preferentially affected by systemic AL-amyloidosis, usually associated with plasma cell dyscrasia. Interestingly, two cases affected by inflammatory rheumatic diseases presented AL-amyloid deposition. Moreover, even after pretreatment with potassium permanganate, which was helpful in highlighting the presence of AL-amyloid, in agreement with the IHC findings, clinical classifications should be carefully made in systemic amyloidosis.

Atypical presentations of simple bone cysts of the mandible: A case series and review of literature

Simple bone cysts are well-defined intraosseous radiolucencies that often extend between the roots and appear clinically like empty cavities. This article aims to provide more information about this lesion with limited prominence in academic literature, to illustrate atypical cases, and to provide a review of the current literature. A series of six atypical cases of simple bone cysts is presented and their clinical, radiographic and microscopic characteristics, differential diagnosis, treatment and follow-up are discussed. Correct diagnosis of this entity is of key importance, since it presents with clinical & radiographic similarities to other bone lesions, some exhibiting more aggressive behaviour.

Nodular lesion in the anterior hard palate

CLINICAL PRESENTATION A 13-year-old boy was referred to the Oral Diagnosis Clinic (Orocentro—Piracicaba Dental School, University of Campinas, Sao Paulo, Brazil) for evaluation of an asymptomatic oral swelling that had been present for 7 years. According to his father, the swelling had suddenly grown recently. The clinical examination showed a well delimited bilobulated nodular lesion on the anterior region of the right-sided hard palate that measured about 2.0 1.5 cm and was nontender and firm on palpation (Figure 1). A small ulcer was noticed on the anterior lobe, probably due to contact with the lower teeth. There was no report of local trauma, the patient presented no parafunctional habits, and the medical history was noncontributory. In addition, there was no mobility of the teeth, and no radiographic changes were seen.

Synchronous oral paracoccidioidomycosis and oral squamous cell carcinomas with submandibular enlargement

Oral paracoccidioidomycosis and oral squamous cell carcinoma may occur in the same patient. As both lesions may present similar clinical and histopathological features, the diagnosis is sometimes challenging. This paper describes the case of a 54-year-old male who was a farm worker and heavy alcohol and tobacco user. He developed paracoccidioidomycosis and two lesions of squamous cell carcinoma in the oral cavity. During the follow-up, the patient presented enlargement of the submandibular lymph nodes, which was thought to be regional metastasis but was diagnosed as paracoccidioidomycosis. Therefore, the significance of this association is emphasized and discussed.

Mandibular unilocular well-defined radiolucency.

A 13-year-old girl was referred to the oral surgeon forassessment of a well-defined radiolucency on the rightlower first premolar roots. This asymptomatic lesion wasdetected at x-ray analysis for orthodontic planning. Theclinical examination did not show any pathologic alteration,and the related canine and first premolar had vital pulp (Fig1). Her medical history was noncontributory. A panoramicx-ray displayed an inter-radicular, well-defined, round radi-olucent lesion measuring approximately 0.8 1 cm withslightly radiopaque margins, resulting in displacement ofthese roots (Fig 2). The periapical x-ray clearly showed theperiodontal ligament space and the lamina dura on bothteeth.