Emanuel Sávio de Souza Andrade

Odontogenic tumors: clinical and pathology study of 238 cases

UNLABELLED Odontogenic tumors are neoplasms that develops exclusively in the gnathic bones; they originate from odontogenic tissues, by epithelial or mesenchymal proliferation, or both. AIM To evaluate the incidence of odontogenic tumors in a specific institution, and to compare these findings with other studies in the literature. STUDY FORMAT: A cross-sectional cohort retrospective study. MATERIAL AND METHOD The sample was obtained from the files of patients with odontogenic tumors diagnosed between January 1992 and March 2007 (15 years). Cases in which the diagnosis could be adapted to the new World Health Organization (WHO) of 2005 were included. Data such as gender, age, anatomical site, histological type and symptomatology were analyzed. RESULTS Odontogenic tumors were 4.76% of all biopsied lesions within the studied period. The mean age was 30.7 years; 57% of the patients were male. The keratocystic odontogenic tumor was the most prevalent histological type (30%), followed by the ameloblastoma (23,7%). The rate of asymptomatic cases was 75.7%. CONCLUSION Odontogenic tumors occurred more frequently in females, in the second and third decades of life, and more commonly in the mandible; most cases were asymptomatic.

Tumores odontogênicos: estudo clínico-patológico de 238 casos

Os tumores odontogenicos sao neoplasias que se desenvolvem exclusivamente nos ossos gnaticos, originando-se dos tecidos odontogenicos por proliferacao de tecido epitelial, mesenquimal ou ambos. OBJETIVO: Avaliar a incidencia de tumores odontogenicos em determinada instituicao e comparar com outros estudos da literatura mundial. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E METODO: O material do estudo foi levantado a partir dos registros de pacientes com tumores odontogenicos, no periodo de janeiro de 1992 a marco de 2007 (15 anos). Foram incluidos os casos de pacientes que se enquadravam na Classificacao Histologica da Organizacao Mundial de Saude (OMS) de 2005. Foram analisados os indicadores genero, faixa etaria, localizacao anatomica, tipo histologico e presenca de sintomatologia. RESULTADOS: Os tumores odontogenicos constituiram 4,76% dentre todas as lesoes biopsiadas dentro do periodo estudado. A idade media dos pacientes foi de 30,7 anos, 57% dos pacientes eram do genero masculino. O tumor odontogenico ceratocistico foi o tipo histologico mais prevalente (30%), seguido do ameloblastoma (23,7%). Quanto a presenca de sintomatologia, 75,7% dos casos apresentaram-se assintomaticos. CONCLUSAO: Os tumores odontogenicos parecem ter discreta predilecao pelo genero feminino, segunda e terceira decadas de vida, sendo mais frequentes na mandibula e, na maioria dos casos apresentam-se assintomaticos.

Use of zoledronic acid in the treatment of Gorham's disease

Gorhams disease (Gorham-Stout syndrome) is a rare condition of unknown etiology involving a localized endothelial proliferation of lymph vessels resulting in destruction with bone resorption. The syndrome is rarely seen in the facial skeleton and has a large variety of prognoses and treatments. A case of this syndrome in a 9-year-old boy is presented. The clinical aspects are described, together with the treatment involving zoledronic acid. Other treatments described in the literature are reviewed. The authors believe that this report is one of the first cases in which a child afflicted in the first decade of life survives.

Role of inflammation in oral carcinogenesis (Part II): CD8, FOXP3, TNF-α, TGF-β and NF-κB expression

Due to the frequent presence of inflammation in cases of carcinoma and its use as a parameter for the assessment of tumor aggressiveness, the role of inflammation in oral carcinogenesis was investigated. This was performed by evaluating the expression of cellular markers, cytokines and nuclear transcription factors that identify the cells that participate in the antitumor defense in cases of oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). A semi-quantitative immunohistochemical analysis was performed for the transcription factors cluster of differentiation 8 (CD8), forkhead box P3 (FOXP3), transforming growth factor (TGF)-β, tumor necrosis factor (TNF)-α and nuclear factor κ-light chain enhancer of activated B-cells (NF-κB), in cases of OED and OSCC. CD8, TGF-β, TNF-α and NF-κB participated in the processes of tumor transformation and progression. The presence of inflammatory infiltrate in cases of OED favors the transformation and invasion process when stromal TNF-α and NF-kB are overexpressed, as NF-kB activated by TNF-α during inflammation predisposes the lesion to transformation, functioning as a link between inflammation and cancer. The control of these inflammatory mediators may prevent malignant transformation in the oral cavity.

Traumatic bone cyst of the mandible: a review of 26 cases

UNLABELLED The traumatic bone cyst is characterized by the presence of an asymptomatic sinus devoid of epithelial lining, which is rarely found in the jaws. OBJECTIVE To describe the clinical, surgical and radiographic findings of traumatic bone cysts. MATERIAL AND METHOD A retrospective study was made of patients diagnosed with traumatic bone cysts at an oral pathology department from 1992 to 2007. Data on the clinical, radiographic and surgical complications were gathered. RESULTS Twenty-six cases of traumatic bone cyst were diagnosed in 15 years; 17 were male and 09 were female. Most patients were within first two decades of life and had no pain or history of trauma in the affected area. The multilocular pattern was observed in only seven cases, its radiographic appearance suggests a tumor. Air was found inside the lesion in about 70% of cases; serous fluid with blood and blood only were uncommon within the lesions. CONCLUSION A higher prevalence in young patients, absence of a history of trauma, and a small number of lesions containing serous fluid with blood reflects the need to discuss the true pathogenesis of traumatic bone cysts.O cisto osseo traumatico e uma entidade patologica caracterizada pela presenca de uma cavidade ossea assintomatica desprovida de revestimento epitelial, sendo raramente encontrado nos maxilares. OBJETIVO: Descrever as caracteristicas clinico-cirurgicas e radiograficas dos cistos osseos traumaticos. MATERIAL E METODO: Estudo de carater retrospectivo dos pacientes diagnosticados com cisto osseo traumatico em um servico de patologia oral no periodo de 1992 a 2007. Informacoes referentes as caracteristicas clinicas, radiograficas e cirurgicas foram coletadas. RESULTADOS: Vinte e seis casos de cisto osseo traumatico foram diagnosticados no periodo de 15 anos, 17 pertencentes ao sexo masculino e 09 ao sexo feminino. A maioria dos pacientes afetados pertencia as duas primeiras decadas de vida, nao relatava sintomatologia dolorosa, bem como historia de trauma na regiao da lesao. O padrao multilocular foi observado em apenas sete casos, dando as lesoes uma aparencia radiografica tumoral. A presenca de ar no interior da cavidade patologica foi relatada em aproximadamente 70% dos casos, sendo rara a presenca de conteudo serossanguineo e seroso. CONCLUSAO: A maior prevalencia de casos em pacientes jovens, a infrequente historia de trauma e o pequeno numero de lesoes com conteudo serossanguineo refletem a necessidade de se discutir a real patogenese do cisto osseo traumatico.

Comparison between human and rat TMJ: anatomic and histopathologic features

PURPOSE To describe and evaluate normal rat temporomandibular joints from anatomic and histopathologic point of view and make a comparison between this joint in rats and humans. METHODS Twelve male adult Wistar rats (12 same side joints) were used in this procedure. The following anatomical structures were histologically evaluated in a qualitative fashion: condyle, disc, temporal bone, retrodiscal tissue and synovia. The macroscopical and microscopic study of the human TMJ was based on the current literature. RESULTS The TMJ is surrounded by a thin capsule, consisting of fibrous tissue, and a synovial lining. The mandibular angle has a prominent shape. The glenoid fossa is flat, with no eminences. Histologically, the TMJ is composed of different tissues that comprise the mandibular head, mandibular fossa and fibrocartilaginous disc. A layer of hyaline cartilage covers the articulating cortical condyle and temporal bone. CONCLUSION Morphologically and histologically, the articular structure of rats is, on the whole, similar to that of humans. In these animals there is no articular eminence.

Histological comparison of demineralized bone matrix and the Ricinus communis polymer on bone regeneration

AIM The aim of the present study is to make a histologic analysis the effects of a human demineralized bone matrix and a polyurethane resin derived from the Ricinus communis, on bone regeneration process. MATERIALS AND METHODS For this, 24 rabbits were submitted to two surgical calvaria bone defects, one on the right and another on the left side of the parietal suture. The animals were divided in two groups. In group I the experimental defect (right side) was treated with a human demineralized bone matrix, while in group II the experimental cavity was treated with the polyurethane resin derived from Ricinus communis. The control defects were filled with the animals own blood. The animals were slaughtered after subsequent periods of 04, 07 and 15 weeks. RESULTS The histological analysis revealed that all groups (control and experiment), presented increased bone regeneration with time, but this repair was faster in the control group, even showing important decrease in defect thickness. CONCLUSION Both materials proved to be biologically compatible, however polyurethane was more slowly resorbed presented considerable better results when compared with demineralized bone matrix.

Ameloblastoma in the Northeast region of Brazil: A review of 112 cases

Context: Ameloblastomas are benign tumors of the jaws with locally invasive capacity. Aim: The aim of this study was to review 112 cases of ameloblastoma seen over an 18-year period (1992-2009) at the Pernambuco Dental School, University of Pernambuco and at Federal University of Sergipe, in the northeast region of Brazil. Materials and Methods: The following data were selected for analysis: age, gender, race, site distribution, radiographic appearance, association with an impacted tooth, size, presence of symptoms, clinicopathologic subtypes and recurrence. Settings and Design: In this retrospective study, Pearsons χ2 test and t-test were employed. The critical level of significance was set at P < 0.05. Results: The mean age of the patients at presentation was 35.1 ± 16.8 years with a slight female preference. The peak prevalence was in the 11- to 20-year age group and declined with increasing age. Total 75 patients were black and 37 were white, for a 2:1 black: white ratio. The location of the ameloblastomas showed a marked predominance in the mandible (84.8%) and 69% of the cases presented with a multilocular radiographic appearance. The tumor was associated with an embedded tooth in 14 cases (12.7%): nine unilocular and five multilocular ameloblastomas. The maximum radiological extension of the lesions on panoramic radiographs was 0.5-20 cm (mean ± SD: 5.2 ± 3.3 cm) and most cases were symptom-free (75.9%). Solid/multicystic ameloblastoma was the most common clinicopathologic subtype. There was an association between the clinicopathologic subtypes and radiographic appearance (P < 0.001). Recurrence was observed in 13.3% of cases. Conclusion: We propose that racial factors may have strong influence on the incidence of ameloblastomas in the northeast region of Brazil, since most people have African descent. Data related to gender, location, radiographic appearance, size, symptoms, clinicopathologic subtypes and recurrence were similar to previous studies conducted in various parts of the world.

Focal fibrous hyperplasia: A review of 193 cases

Context: Focal fibrous hyperplasia, also known as irritation or traumatic fibroma, is a reactive, inflammatory hyperplastic lesion of the connective tissue. Aim: The aim of this study is to perform a retrospective study of a focal fibrous hyperplasia of 18 years. Materials and Methods: We retrospectively reviewed 193 cases of focal fibrous hyperplasia of the oral cavity from the medical and histological reports of the Department of Oral Pathology, Pernambuco University, Brazil, during the period between January 1992 and December 2009. Settings and Design: Data with regard to age, gender, location, size of the lesion (equal to or less than 1 cm, between 1 and 2 cm and greater than 2 cm), pain, history of trauma, treatment, length of follow-up (from diagnosis to release or last review) and recurrence, were collected. Results: The most commonly affected site was the buccal mucosa (n = 119, 61.7%). Almost two-thirds of the cases were concentrated from the second to the fifth decade of life. Females were more affected than men and a history of trauma was related by 90.7% of the patients. Two recurrences were notified (1.0%). Conclusion: Further studies are needed on the distribution of the lesion in different ethnic and geographical populations. The influence of sex hormones on the development of focal fibrous hyperplasia must be clarified.

Extenso nevo azul intraoral: relato de caso

O nevo e uma ma-formacao congenita pigmentada, raramente encontrado na mucosa bucal. Cerca de 1/3 dos casos localizados nesta regiao anatomica sao do tipo azul, uma variante histologica com consideravel tendencia a malignizacao. Este artigo relata o caso de um paciente do sexo masculino, tabagista cronico, portador de um nevo azul de 5 cm de diâmetro no palato duro. A excisao da lesao sem biopsia previa foi a conduta terapeutica de eleicao para o caso, uma vez que ainda existe controversia na literatura a respeito da realizacao de biopsia incisional em lesoes pigmentadas malignas ou com potencial de malignizacao. O paciente foi acompanhado por um periodo de 2 anos, sem sinais de recorrencia ou transformacao maligna