Carla Patricia Martinelli-Kläy

Eosinophils and Oral Squamous Cell Carcinoma: A Short Review

The eosinophil cell has been related as a prognostic indicator for cancers. However, its exact function in tumour behaviour is still not clearly defined. In the oral cavity the presence of eosinophils can be a favourable prognostic indicator as well as it may be associated with a poor prognosis. In this short review, we briefly summarize the role of the eosinophils in the general context of immunoregulation and its relation to oral squamous cell carcinoma.

Unicystic ameloblastoma in children: systematic review of clinicopathological features and treatment outcomes

The purpose of this study was to review the clinical, radiological, and histopathological profile of unicystic ameloblastoma (UA) in children using data from available case reports and reviews published between 1992 and 2012. A total of 513 publications were evaluated. A structured search of the literature was performed, with predefined criteria, using computer and manual searches. An evaluation and critical appraisal was done in three separate rounds. A total of 25 articles describing 51 cases satisfied the selection criteria and were thus included in the final review. UA was mostly found to be located in the mandible, often exhibiting a unilocular radiographic image. Enucleation alone resulted in the highest recurrence rate. According to the results of this study, luminal UAs are less aggressive and respond better to conservative treatment. In contrast, plexiform and mural types frequently result in recurrence. The use of Carnoys solution in preventing recurrence remains to be established.

New perspectives on the dynamic behaviour of oral lichen planus

Lichen planus, a chronic inflammatory disease that affects the skin and mucous membranes, is one of the most frequent dermatological disorders of the oral cavity. The prevalence of oral lichen planus ranges from 0.2% to 4%. The triggering factors remain unknown. Oral lichen planus can be considered to be a chronic disease of long duration with a dynamic evolution and frequent changes in clinical appearance. Three successive active stages can be distinguished, without sharp limits between them: an initial stage; a protracted intermediate stage with alternate periods of variable activity and quiescence, which carries a progressively increasing risk of malignant transformation; and a late stage that often ends in a clinically little-known, inactive cicatricial post-lichen stage, which does not respond to steroid treatment but retains the same risk.

Immunohistochemical expression of RANKL, RANK and OPG in gingival tissue of patients with periodontitis

Abstract Objectives. To evaluate the expression of the receptor activator of NF-κB (RANK), the receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG), in the gingival tissue of patients with periodontitis. Materials and methods. Gingival tissue was obtained from 14 systemically healthy subjects with chronic periodontitis during conventional periodontal surgery. Immunohistochemistry was used to detect the expression of RANK, RANKL and OPG in the oral and periodontal pocket epithelium as well as in the connective tissue cells. Results. RANKL was negatively expressed in both oral and periodontal pocket epithelium. OPG was also negative or weakly positive in the whole epithelium. RANK showed moderate/strong positive staining mainly in the basal and suprabasal layer of oral and periodontal pocket epithelium. In most of the cases, more than 60% of the inflammatory cell infiltrate stained for RANK and RANKL. In these cases the intensity of the stained cells ranged from moderate-to-strong. In less than half of the cases, OPG was positive in more than 60% of the stained cells of the inflammatory cell infiltrate. Conclusion. The RANK, RANKL and OPG proteins are differentially expressed in periodontal tissues and may play a major role in the bone loss occurring in periodontitis.

Analysis of the expression of heat-shock protein 27 in patients with oral lichen planus.

OBJECTIVE Heat-shock protein 27 (hsp27) has been implicated in several biological events. In this experimental study, we aimed at analysing, for the first time, the expression of hsp27 in the diverse stages of oral lichen planus (OLP) lesions. MATERIALS AND METHODS Thirty-six biopsy specimens of patients with OLP and 10 of healthy patients were selected. OLP specimens were divided into three groups: G1 - moderate or mildly active OLP; G2 - active or moderately active atrophic OLP; G3 - mild or inactive atrophic OLP. Hsp27 expression was analysed by immunohistochemistry (staining intensity and percentage of stained cells), and results of staining were compared between the different groups. Gender, age and anatomical location were also studied. RESULTS In the basal layer, an increase of hsp27 expression in both G2 and G3 was observed when compared to G1 and control group. In contrast, a decrease of hsp27 expression in the superficial layer was observed in all groups when compared to control group. CONCLUSION The increased expression of Hsp27 in the basal layer observed during the OLP evolution and the less staining in the superficial layers in all cases of OLP suggest that hsp27 may have a role in the OLP pathogenesis.

Clinical, histopathological and immunohistochemical study of oral squamous papillomas

Abstract Objective. The aim of this study was to analyze the clinicopathological and immunohistochemical features of oral papillomas. Materials and methods. Biopsies of oral papillomas analyzed in the laboratory between 1996–2012 were extracted from the database and used to conduct this retrospective review. The following clinical data were extracted: sex, age, location, clinical appearance, time of evolution, recurrence and first clinical diagnosis. Immunohistochemical analysis for Human Papillomavirus (HPV)and histological evaluation of the lesions were performed. Results. A total of 205 papillomas were identified in 197 patients (♂=110, ♀ = 87; mean age = 48.4 ± 17.9 years).The majority of the lesions (n = 47) occurred on the soft palate (23%). The border of the tongue was the second most common site (n = 20, 9.8%). Lesions were more common in males than in females (ratio = 1.26:1). Statistical analysis did not show any correlation between the assessed variables. Clinically, papillomas were predominantly described by the practitioners as small nodules, with a papillary surface (98.1%) and pedunculated attachment(83.1%). Data supported a low recurrence (2.0%) and multiplicity (2.0%). Evolution time varied from a few weeks to several years. Most frequent misdiagnosis was condyloma. Immunohistochemistry rarely showed HPV presence (9.3%). Microscopically, lesions were very often keratinized (93.2%) and showed chronic inflammatory cells (68.8%). Conclusions. In this series papillomas showed a slight male predilection and occurred mostly in the sixth decade of life. Histologically, they were usually keratotic and exhibited variable inflammation. HPV virus was rarely detected by immunohistochemistry. No statistical correlation could be established between clinicopathological features.

Anfängliche Fehldiagnose eines oralen malignen Melanoms als ethniespezifische Pigmentierung: Ein Fallbericht

Orale maligne Melanome (OMM) sind selten; sie machen weniger als 0,5% aller malignen Erkrankungen im Mundraum aus. Die häufigsten Lokalisationen sind der Gaumen und die maxilläre Gingiva. Die histologische Untersuchung ist von entscheidender Bedeutung für die Diagnosestellung bei verdächtigen pigmentierten Läsionen in der Mundhöhle, vor allem, wenn eine präzise klinische Diagnose nicht möglich ist. Wir stellen einen Fall von OMM vor, der 2 Jahre zuvor in einem anderen Zentrum als ethniespezifische Pigmentierung fehldiagnostiziert worden war. Die klinische Untersuchung ergab multiple Makulae und Noduli auf dem harten und weichen Gaumen, der oberen Alveolarmukosa und Gingiva. Diese Läsionen waren schmerzlos und variierten farblich von dunkelblau bis schwarz. Die histologische Analyse zeigte Lagen und Nester atypischer Melanozyten verschiedener Formen (plasmazytoid, epithelioid, rund) im oberflächlichen Korium mit Ausbreitung in tiefere Gewebeschichten. Manche Tumorzellen enthielten variable Mengen an Melanin. Eingesprosste Blutgefäße oder Nervenfasern waren nicht zu sehen. Die immunhistochemische Analyse ergab, dass die neoplastischen Zellen positiv für HMB-45, Melan-A und S-100 und negativ für AE1/AE3 waren, was die Melanomdiagnose bestätigte. Der Ki-67-Labeling-Index lag bei rund 25%. Die Patientin lehnte jegliche Behandlung ab und verstarb 11 Monate später. Übersetzung aus Dermatopathology 2016;3:1-7 (DOI:10.1159/000444049)

Diagnostik im Spektrum: Vor, in und jenseits der Praxis

Jedem Dermatologen in der Ausbildung kommt dieses Bild bekannt vor: Im Dienst stellt sich ein Patient notfallmäßig mit juckenden Quaddeln vor. Der Patient hat das Schema 1-4-Oma (einfach-vierfach-Antihistaminika-Omalizumab) bereits durchlaufen, doch die Symptome persistieren. Spätestens jetzt wäre es hilfreich einen Fahrplan zu Differentialdiagnosen der chronischen Urtikaria parat zu haben. Dr. med. Thomas Buttgereit von der Charité Berlin gibt uns in dieser Ausgabe einen solchen an die Hand – und eröffnet damit unsere Serie zur dermatologischen Differenzialdiagnostik, die wir in den folgenden Ausgaben fortsetzen werden. Die überwundene Herausforderung, differentialdiagnostisch ins Schwarze getroffen zu haben, mag für den ein oder anderen von uns mit dem Moment zusammenfallen, über den Einstieg oder die Übernahme einer Praxis nachzudenken. Das Resümee nach einem Jahr in der Niederlassung lesen wir von Frau Dr. med. Anja Weber, niedergelassene Dermatologin in Groß-Gerau, Hessen. Eine ganz andere Art des Know-how ist bei der Diagnostik wissenschaftlicher Texte gefragt. Dr. Sven Riestenpatt gibt in seinem letzten Beitrag zum wissenschaftlichen Schreiben Einblicke in die hohe Kunst der Begutachtung wissenschaftlicher Artikel.

Respiratory Epithelium Lined Cyst of the Maxilla: Differential Diagnosis

Maxillary cysts, including the cysts lined by respiratory epithelium, can present a diagnostic challenge. We report an unusual case of a maxillary cyst on an endodontically treated tooth #16, in which the cavity was totally lined by a respiratory epithelium. The patient, a 35-year-old male, presented with a generalized chronic periodontitis and complained of a pain in the tooth #16 region. A periodontal pocket extending to the root apices with pus coming out from the gingival was found. A combined endodontic periodontal was observed on a panoramic radiography. CBCT-scan revealed a well-circumscribed radiolucent lesion at the apices of the distobuccal root of the 16. A communication with the right maxillary sinus cavity and a maxillary and ethmoidal sinusitis were also observed. The lesion was removed and histological examination revealed a cyst lined exclusively by respiratory epithelium. Ciliated and rare mucous cells were also observed. The diagnosis could evoke a surgical ciliated cyst mimicking the radicular cyst but the patient has no previous history of trauma or surgery in the maxillofacial region. It could also be an unusual radicular cyst in which the stratified squamous epithelium was destroyed by inflammation and replaced by a respiratory epithelium of the maxillary sinus.

Nerve Growth Factor Expression and Its Receptors TrkA and p75NTR in Peri-Implantitis Lesions

Background:Nerve growth factor (NGF) can, through its receptors TrkA and p75NTR, convey signals for cell survival or cell differentiation. These proteins are also involved in inflammation and in bone resorption. The aim of this study is to evaluate, for the first time, the expression of NGF and its receptors TrkA and p75NTR in peri-implantitis lesions. Materials and Methods:Fifteen biopsy specimens from patients with chronic peri-implantitis and 4 of healthy oral mucosa were immunostained with antibodies against NGF, TrkA, and p75NTR. The staining intensity and percentage of stained cells were semi-quantitatively evaluated and results were compared between the 2 groups. Results:In the peri-implant pocket epithelium and gingival epithelium, NGF and TrkA expressions were similar to the healthy oral mucosa, however, a decreased expression of p75NTR was observed. In all cases, more than 75% of the inflammatory cells stained positively for NGF and TrkA, and p75NTR was negatively expressed. Conclusion:The intense expression of NGF and TrkA in the inflammatory cell infiltrate associated with decreased expression of p75NTR in both gingival and pocket epithelium suggests that these proteins may have a role in peri-implantitis lesions.