João Adolfo Costa Hanemann

Immunolocalization of podoplanin in benign odontogenic tumours with and without ectomesenchyme.

OBJECTIVES To investigate podoplanin expression in epithelial odontogenic tumours with and without ectomesenchyme and verify the association between its immunoexpression and proliferative activity in keratocystic odontogenic tumours (KCOTS) and orthokeratinized odontogenic cysts (OOCs). DESIGN Eight ameloblastomas, nine adenomatoid odontogenic tumours, twenty KCOTS, five OOC, one calcifying epithelial odontogenic tumour, two ameloblastic fibromas, four ameloblastic fibro-odontomas and five calcifying cystic odontogenic tumours were immunohistochemically analysed with anti-podoplanin antibody. For KCOTS and OOC, the cell proliferation index was determined with Ki-67 immunostaining and compared by Spearman correlation coefficient. RESULTS Podoplanin was expressed in the peripheral odontogenic epithelium of most tumours. Ectomesenchyme was negative, except for odontoblasts. KCOTS exhibited positive podoplanin expression while in OOC it was absent/weak. There was statistically significant correlation (p=0.006) between podoplanin expression and cellular proliferation index of KCOTS and OOC. CONCLUSION Podoplanin seems to be related to the proliferative activity of KCOTS and may have a role in the process of local invasion of odontogenic tumours with and without ectomesenchyme.

Expression of E-cadherin and β-catenin in basaloid and conventional squamous cell carcinoma of the oral cavity: are potential prognostic markers?

BackgroundBasaloid squamous cell carcinoma presents with a preference for the head and neck region, and shows a distinct aggressive behavior, with frequent local recurrences, regional and distant metastasis. The alterations in the cadherin-catenin complex are fundamental requirements for the metastasis process, and this is the first study to evaluate the immunostaining of E-cadherin and β-catenin in oral basaloid squamous cell carcinoma.MethodsSeventeen cases of this tumor located exclusively in the mouth were compared to 26 cases of poorly differentiated squamous cell carcinoma and 28 cases of well to moderately differentiated squamous cell carcinoma matched by stage and tumor site. The immunostaining of E-cadherin and β-catenin were evaluated in the three groups and compared to their clinicopathological features and prognosis.ResultsFor groups poorly differentiated squamous cell carcinoma and basaloid squamous cell carcinoma, reduction or absence of E-cadherin staining was observed in more than 80.0% of carcinomas, and it was statistically significant compared to well to moderately differentiated squamous cell carcinoma (p = .019). A strong expression of β-catenin was observed in 26.9% and 20.8% of well to moderately differentiated squamous cell carcinoma and poorly differentiated squamous cell carcinoma, respectively, and in 41.2% of basaloid squamous cell carcinoma. The 5-year and 10-year overall and disease-free survival rates demonstrated no significant differences among all three groups.ConclusionsThe clinical and biological behavior of three groups of the oral cavity tumors evaluated are similar. E-cadherin and β-catenin immunostaining showed no prognostic value for basaloid and conventional squamous cell carcinomas.

Idiopathic bone cavity: case series involving children and adolescents.

AIM This study aimed at reviewing a series of clinical cases of children and adolescents treated for idiopathic bone cavity (IBC). METHODS Ten lesions diagnosed as IBC in nine patients treated between February 2000 and December 2008 were reviewed, focusing on clinical and radiographic aspects, as well the therapeutic approach. RESULTS Most of the patients were Caucasian with no sex predilection (55.5% males and 45.5% females), and all were in the second decade of life at the time of IBC diagnosis. The lesions were asymptomatic and detected during routine radiographic examinations. All the lesions were located in the mandible, and the anterior region was the most affected. The most adopted therapeutic approach was simple curettage of the bone cavity, and all surgically-treated patients presented complete bone healing after 6 months, postoperatively. CONCLUSIONS Clinical and radiographic diagnoses associated with surgical exploration are the most important treatment options in order to avoid radical surgery or unnecessary endodontic treatment, mainly when idiopathic bone cavities are detected in children and adolescents. Further studies aimed at elucidating the etiopathogenesis of this condition and defining the most appropriate treatment should be conducted.

Histologic grading and nucleolar organizer regions in oral squamous cell carcinomas

Objective The purposes of this study were to histologically assess different types of oral squamous cell carcinoma and the silver-binding nucleolar organizer region (AgNOR) morphology in neoplastic cells, as well as to quantify the number of AgNORs in each type of carcinoma in order to relate AgNOR count and histologic grading. Material and Methods Twenty-eight cases of oral squamous cell carcinoma were divided into 4 groups, namely well-differentiated, moderately differentiated, poorly differentiated, and undifferentiated. For NOR study, 3-µm-thick sections were stained with 50% aqueous silver nitrate solution. The predominant microscopic pattern of NORs was determined. Quantitative analyses of NORs were obtained of all cells present on each histological field using a 0.025 mm2 eyepiece graticule. Different histological fields were analyzed until the total number of NORs was 120 cells for each tumor. Kruskall-Wallis test was applied to compare the groups of sample data at a significance level of p=0.05. Results The mean number of AgNORs per nucleus was 3.20 for the well-differentiated group, 5.33 for the moderately differentiated one, 8.27 for the poorly differentiated one, and 10.08 for the undifferentiated one. AgNOR count was significantly different (p<0.05) among all of the studied groups. Conclusion AgNOR staining technique seems to be a useful diagnostic tool since differences in AgNOR numeric values can be identified in the different types of oral squamous cell carcinoma. This technique is easy to handle and inexpensive, thus justifying its large use in histopathology.

Photodynamically dealing with bisphosphonate-related osteonecrosis of the jaw: Successful case reports

• Treating bisphosphonate-related osteonecrosis with PDT and focusing on the infection resolution and bone neoformation.

Peripheral compound odontoma erupting in the gingiva.

BackgroundPeripheral odontoma arising in the extraosseous soft tissues is rare and if not removed early, may enlarge over time and eventually erupt in the oral cavity.Case presentationA 15-year-old girl presented with “denticles on the gingiva”. During the intraoral examination, seven small tooth-like structures were found. These were exposed in the anterior left gingiva between the permanent maxillary lateral incisor and canine teeth, and the left first premolar was absent. Radiographic examination revealed irregular tooth-like structures without evidence of bone involvement.ConclusionThe lesion was surgically removed, and the specimens were analyzed histopathologically. The diagnosis of compound odontoma was established.Clinical significanceThis is the twelfth reported case of peripheral odontoma in the gingiva and the first one that erupted in the oral cavity.

Warthin tumor of the upper lip: an unusual location of a benign salivary gland tumor.

Warthin tumor (papillary cystadenoma lymphomatosum) is a benign salivary gland tumor involving almost exclusively the parotid gland. The lip is a very unusual location for this type of tumor, which develops only rarely in minor salivary glands. The case of 42-year-old woman with Warthin tumor arising in minor salivary glands of the upper lip is reported.Warthin tumor (papillary cystadenoma lymphomatosum) is a benign salivary gland tumor involving almost exclusively the parotid gland. The lip is a very unusual location for this type of tumor, which develops only rarely in minor salivary glands. The case of 42-year-old woman with Warthin tumor arising in minor salivary glands of the upper lip is reported.

Extensive cutaneous lesions in paracoccidioidomycosis successfully treated with itraconazole and β-glucan.

Georg Stary, MD Alexandra Geusau, MD Division of Immunology Allergy and Infectious Diseases Departmentof Dermatology Medical University of Vienna Vienna Austria E-mail: alexandra.geusau@meduniwien.ac.at References 1 Workowski KA, Berman SM. Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR Morb Mortal Wkly Rep 2006; 55: 1–94. 2 David G, Perpoint T, Boibieux A, et al. Secondary pulmonary syphilis: report of a likely case and literature review. Clin Infect Dis 2006; 42: 11–15. 3 Woehrl S, Geusau A. Clinical update: syphilis in adults. Lancet 2007; 369: 1912–1914. 4 Mahto M, Mohammed F, Wilkins E, et al. Pseudohepatic tumor associated with secondary syphilis in an HIV-positive male. Int J STD AIDS 2006; 17: 139–141. 5 Hamlyn E, Taylor C. Sexually transmitted proctitis. Postgrad Med J 2006; 82: 733–736. 6 Geusau A, Mayerhofer S, Schmidt B, et al. The year 2002 re-emergence of syphilis in Austria. Int J STD AIDS 2004; 15: 496–497. 7 Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases. Lancet 1998; 351(Suppl. 3): 2–4. 8 Müller H, Eisendle K, Bräuninger W, et al. Comparative analysis of immunohistochemistry, polymerase chain reaction and focus-floating microscopy for the detection of Treponema pallidum in mucocutaneous lesions of primary, secondary and tertiary lesions. Br J Dermatol 2011; 165: 50–60. 9 Guarner J, Greer PW, Bartlett J, et al. Congenital syphilis in a newborn: an immunopathologic study. Mod Pathol 1999; 12: 82–87.

Correlation between clinical and histopathological diagnoses in periapical inflammatory lesions.

AIM   The purpose of the present study was to evaluate the correlation between clinical and histopathological diagnoses of periapical inflammatory lesions, focusing mainly on cystic conditions. METHODS   Files dating from 1998 to 2006 at the Oral Pathology Laboratory, School of Dentistry, Alfenas Federal University, Brazil, were reviewed to identify cases with histopathological diagnoses of periapical inflammatory lesions. A total of 1788 files were analyzed, and 255 cases were identified with clinical diagnoses of periapical inflammatory lesions. RESULTS   The most prevalent clinical diagnosis was apical periodontal cyst (59%), followed by periapical granuloma (20%), and dentoalveolar abscess (2%). After histopathological analysis, 53% of the cases represented apical periodontal cyst, 42% periapical granuloma, and 5% dentoalveolar abscess. CONCLUSIONS   The outcomes of the present study show a high prevalence of periapical cysts among periapical inflammatory lesions. Moreover, this study highlights the importance of histopathological evaluation for the correct diagnosis of periapical inflammatory lesions.

Uncommon Foreign Body Reactions Occurring in the Lip: Clinical Misdiagnosis and the Use of Special Techniques of Analysis

This study reports three interesting cases of nodular submucosal lip lesions where foreign-body reactions of unknown origin were detected on hematoxylin and eosin (H&E) analysis. These materials were evaluated under polarized light microscopy, scanning electron microscopy and by energy dispersive X-ray analysis. The results revealed the following materials: an interdental toothbrush bristle, silica, and iron. Unusual mucosal foreign body reaction cases have been reported, but few publications used special techniques to identify the specific foreign material. Clinicians and pathologists might consider these techniques for identifying the precise origin of these foreign bodies.