Isadora Peres Klein

Diagnosis of HIV infection on the basis of histoplasmosis-related oral ulceration

Histoplasmosis is an endemic systemic mycosis caused by the dimorphic fungus Histoplasma capsulatum. In immunocompromised patients, histoplasmosis generally occurs as an opportunistic disease, with dissemination to various organs. Cutaneous involvement is observed in 38% to 85% of cases, with oral mucosal involvement in 30% to 60% of cases. This article describes the case study of a 32-year-old woman who presented an extensive tongue ulcer due to histoplasmosis and had the HIV infection diagnosis based on laboratory tests requested by the dentist.

Spontaneous alveolar bone loss after 4NQO exposure in Wistar rats

OBJECTIVE This study evaluated the effect of an experimental carcinogenic, 4-Nitroquinoline 1-oxide (4NQO), in the spontaneous alveolar bone loss (ABL) in an animal model. DESIGN Twenty-two male Wistar rats were included in this study. They were randomly divided into two groups: the control group (n = 10) received food and water ad libitum, and the test group (n = 12) receive the same food; however, 25 ppm of 4NQO was diluted in the drinking water. All animals were euthanized after 20 weeks, and the tongues were removed and analyzed macroscopically to determine the presence of oral mucosal lesions. All specimens were paraffin-embedded and histological sections were obtained. The microscopic analysis was based on routine procedure (haematoxylin and eosin stain). The analysis of spontaneous ABL was performed by a calibrated examiner using standardized photographs and imaging software. Differences in spontaneous ABL were assessed among the three resulting groups: control, 4NQO with oral squamous cell carcinoma (OSCC), and 4NQO without OSCC. RESULTS In the 4NQO-treated group, nine animals developed OSCC. The animals in the 4NQO with OSCC group presented significantly more spontaneous ABL (0.65 ± 0.21 mm) than the control group (0.34 ± 0.05) (p < 0.001). The animals in the 4NQO without OSCC group showed a mean spontaneous ABL of 0.47 ± 0.13 mm, which was not statistically significant different when compared to the control group (p = 0.096). CONCLUSIONS It was concluded that the presence of OSCC enhanced spontaneous ABL in Wistar rats when compared to control animals. Additionally, it was shown that, solely, administration of 4NQO may not be considered responsible for alveolar bone destruction.

Analysis of the epithelium-mesenchymal transition process on oral squamous cell carcinomas

The aim of this study is to evaluate the immunohistochemical expression of E-cadherin, N-cadherin and Bmi-1, and their association with clinical parameters and with the degree of histopathological differentiation in oral squamous cell carcinomas. 65 squamous cell carcinoma samples were used for constructing a tissue microarray block, and then immunohistochemistry was performed for different markers. A semi-quantitative analysis of the amount of positive tumor cells was performed by two blind and calibrated observers (Kappa>0.75). The statistical Mann-Whitney and Kruskal-Wallis tests were used to evaluate the data. The correlation between variables was investigated by the Spearman test, and the significance level set at p<0.05. We observed higher expression of Bmi-1 in tumors located in the palate (p<0.0001). In addition, poorly differentiated tumors had a greater amount of Bmi-1 positive cells (p=0.0011). Regarding the other correlations between variables, no significant associations were detected. In conclusion, poorly differentiated squamous cell carcinomas located in the palate have higher immunostaining of Bmi-1, which can characterize activation of the Epithelial-Mesenchymal Transition process in these tumors.

Painful keratocystic odontogenic tumor due to secondary infection associated to pulp necrosis

The keratocystic odontogenic tumor (KCOT) is defined as a benign, odontogenic, unior multicystic intraosseous tumor with infiltrative behavior. KCOTs occur over a broad age range, predominantly in the second and third decades of life. This odontogenic tumor is usually asymptomatic and diagnosed incidentally on routine radiographs. Growth is typically medullary and there is no bone expansion in the majority of cases. In the present case, the patient exhibited pain and expansion of buccal cortical bone, unusual findings in this tumor. This could be related to pulp necrosis of the adjacent decayed tooth, leading to a secondary infection of the KCOT. These circumstances become the diagnosis difficult, because the clinical signals and symptoms strongly mimic an inflammatory lesion.

Slow-growing mass and expansive swelling in the maxilla

CLINICAL PRESENTATIONA 40-year-old white man was referred to the oralmedicine clinic with the chief complaint of pressure inthe region from where the right maxillary first molarhad been extracted. The patient presented with diffuseswelling of the right maxilla that had persisted throughthe past year and had worsened during the 6 monthspreceding his admission to our clinic. The patient hadalso experienced trauma to the maxillary right centralincisor, which required endodontic treatment. The pa-tient was a woodworker, and his medical history wasnot informative. He reported a history of smoking,regular alcohol consumption, and occasional use ofmarijuana.Extraoral examination revealed fixed cervical lymphnodes that were enlarged and asymptomatic on palpa-tion. The right side of his face was slightly asymmetricwithout inflammation of the skin. Intraoral examinationrevealed a swelling with undefined borders, measuringapproximately 6.0 5.5 3.2 cm. The lesion extendedfrom the right upper incisor to the right second molar,was firm on palpation, and caused cortical plateexpansion, as well as displacement and mobility of theright maxillary premolars. The color and surface of thecovering mucosa were clinically normal except forsome red punctate areas that drained blood underpressure. Further, the maxillary right central incisor,which required endodontic treatment, showed coronaldiscoloration, suggesting pulp necrosis (Figures 1Aand 1B).A panoramic radiograph showed an ill-definedradiolucency in the region of the first right maxillarymolar, opacification of the antrum, and disruption of itsfloor. In addition, a well-defined radiolucency of 3 cmdiameter with sclerotic margins was present in theanterior region of the maxilla, consistent with aradicular cyst (Figure 2). A periapical radiographrevealed radiolucency with borders that had a moth-eaten appearance in the region of the first molar. Thelesion involved the periradicular portions of the adja-cent teeth, which presented no signs of dental rootresorption (Figure 3).DIFFERENTIAL DIAGNOSISThe clinical presentation, radiographic findings, andthe vitality of all the adjacent teeth excluded thepresence of inflammatory lesions. An expansiveintraosseous mass causing tooth displacement andbone destruction suggested an aggressive neoplasticprocess. Therefore, we considered squamous cellcarcinoma of the maxillary sinus, malignant salivarygland tumor (e.g., adenoid cystic carcinoma, mucoe-pidermoid carcinoma) and lymphoma as the maindifferential diagnoses. Further, the presence of abenign, locally aggressive odontogenic tumor, suchas a keratocystic odontogenic tumor (KOT) or amyxoma, was possible. Non-neoplastic lesions, suchas a central giant cell lesion or an aneurysmal bonecyst, could also display the features of this patient’slesion.A swelling with aggressive behavior suggested thepossibility of a malignancy that originated in themaxillary sinus. Among those tumors, squamous cellcarcinoma of the maxillary sinus (SCCMS) is one of themost frequent. Although its symptoms are nonspecific,the most common manifestation is facial swelling, fol-lowed by epistaxis and nasal obstruction that resemblesinusitis.