Anacélia Mendes Fernandes

Oral mucosa alterations in a socioeconomically deprived region: prevalence and associated factors.

This study aimed to evaluate the prevalence and factors associated with oral mucosa alterations in patients from Vale do Jequiti-nhonha, Brazil. The sample consisted of 511 patients of both genders. Questionnaires were used to obtain information about patient gender, age, race, systemic disease state, medication use, cigarette use and alcohol consumption. Physical examinations were then performed to identify lesions of the oral mucosa. Descriptive analyses, Chi-squared tests and logistic regressions were then used to analyze the results (p < 0.05, 95% CI). In this population, 84.9% (434/511) of patients were found to have alterations in their oral mucosa. The most common alterations were melanotic maculae (36.0%), linea alba (33.9%), traumatic ulcers (21.5%), Fordyces granules (20.4%), coated tongue (12.5%) and fissured tongue (10.0%). Melanotic maculae were more frequently observed in black patients, with an odds ration (OR) of 7.51. Being female was a statistically significant predictive factor for having a visible linea alba (OR: 1.90) and a fissured tongue (OR: 2.11). No statistically significant association was found between the presence of oral lesions and systemic disease, medication use, alcohol use and smoking. The high observed prevalence of melanotic maculae and Fordyces granules suggests that these alterations could be considered typical characteristics of the population of the Vale do Jequitinhonha. Coated tongue may be related to the socioeconomic deprivation in the region. Furthermore, the high prevalence of traumatic ulcers may be associated with the traumatic agents that caused patients to seek dental care.

Immunoexpression of hMSH2 and hMLH1 in oral squamous cell carcinoma and its relationship to histological grades of malignancy

BACKGROUND The aim of this study was to describe the human mutS homolog 2 (hMSH2) and human mutL homolog 1 (hMLH1) immunoexpression in different areas of oral squamous cell carcinoma (OSCC) - central/superficial (C/S) and invasive tumor front (ITF) - in an attempt to verify if the histological grade of malignancy interferes in this expression. METHODS Forty-six samples of OSCC were analyzed histologically. Twenty-six cases (56.5%) presented ITF. Histological grades of malignancy were evaluated in all samples, and immunohistochemistry was applied using specific antibodies against hMSH2 and hMLH1 proteins. Immunoexpression was semiquantitatively scored, and results were correlated with their histological grades of malignancy. RESULTS The hMSH2 immunoexpression in both C/S and ITF was not correlated with histological grades of malignancy, whereas hMLH1 overexpression was correlated (P = 0.043) and associated (P = 0.041) with well-differentiated tumors. In addition, hMHL1 reduction or negative expression was detected in poorly differentiated tumors. Moreover, negative expression for hMSH2 and hMLH1 proteins was demonstrated in some cases of OSCC. CONCLUSIONS The findings of the present study indicate that the histological grade of malignancy interferes in hMLH1 immunoexpression. The negativity for both hMSH2 and hMLH1 proteins in some cases suggests a possible association between OSCC and hereditary non-polyposis colorectal cancer. Further investigation from future studies is needed to elucidate this supposition.

The importance of intraoral examination in the differential diagnosis of paracoccidioidomycosis

Male, 24 years old, African-Brazilian, came to us complaining of a dental abscess. During the interview he reported a pro-gressive weight loss in the past three years, cough, and he said he tested negative for neck lymph node tuberculosis. According to the patient, having the negative result of the lymph node biopsy, no other tests were carried out in order to find the cause of the symptoms, nor was any type of tre-atment installed. During the physical exam we observed macrocheilia and a moriform ulcerated lesion (Figs. 1A and 1B). After an incisional biopsy (Fig. 1C), the histopatho-logy exam showed the presence of a granu-lomatous chronic inflammation, multinucle-ated gigantic cells and the Paracoccidioides brasiliensis fungus (Fig. 1F). The patient was then referred to the pneumologist, however the refused treatment.

Primary diffuse large B-cell lymphoma of the oral cavity

Lymphomas arising within the oral cavity account for only 3.5% of all oral malignancies. Diffuse large B-cell lymphoma is a non-Hodgkin lymphoma subtype characterized by diffuse proliferation of large neoplastic B lymphoid cells. This paper reports a case of diffuse large B-cell lymphoma affecting the oral cavity of a Brazilian woman, along with its clinical, microscopical, immunohistochemical, and molecular features.