Juan Carlos de Vicente

Expression of cyclin D1 and Ki-67 in squamous cell carcinoma of the oral cavity: clinicopathological and prognostic significance.

The prognostic and clinicopathologic significance of cyclin D1 and Ki-67 expressions was studied in oral squamous cell carcinomas. We performed an immunohistochemical study to determine the level of expression of cyclin D1 and Ki-67 labelling index in tumor specimens obtained from 35 patients, of whom 14 died as a result of recurrent disease, and 20 were free of recurrence at the end of the follow-up period. Overexpression of cyclin D1 was significantly associated with regional lymph node metastases (P=0.00005) and advanced tumor stage (P=0.0007). The relative risk for nodal metastases in the cases that overexpressed cyclin D1 was 2.6. The Ki-67 labelling index was significantly (P=0.001) higher in tumors with poor histologic grade of differentiation. Our results showed that cyclin D1 is a useful prognostic factor, and suggested it could be a marker to help determine the appropriate treatment for patients with oral squamous cell carcinoma. Cyclin D1 and Ki-67 overexpression were positively correlated.

PROGNOSTIC SIGNIFICANCE OF P53 EXPRESSION IN ORAL SQUAMOUS CELL CARCINOMA WITHOUT NECK NODE METASTASES

Background. Aberrations of the p53 gene and overexpression of its protein are widely recognized markers of malignancy including oral squamous cell carcinomas. This study was performed to evaluate the relationship of immunoexpression of p53 protein in series of 91 squamous cell carcinomas of the oral cavity with clinicopathologic parameters and to investigate whether p53 immunoexpression might influence the clinical outcome of the disease.

Microvascular Free Tissue Transfer for Tongue Reconstruction After Hemiglossectomy: A Functional Assessment of Radial Forearm Versus Anterolateral Thigh Flap

PURPOSE The purpose of this study was to evaluate tongue function and donor site morbidity in patients with oral cancer surgically treated and reconstructed with radial or anterolateral thigh free flaps. PATIENTS AND METHODS Twenty patients underwent primary reconstruction after hemiglossectomy between January 2002 and June 2004. Ten patients were reconstructed using a free forearm flap and the remaining with an anterolateral thigh flap. Eight patients on each group underwent postoperative radiotherapy (average, 60 Gy). All of them were followed postoperatively to determine after 6 months their functional outcome as it related to speech, deglutition, tongue mobility, and donor site morbidity. The intelligibility, deglutition, and tongue mobility were each scored on a scale ranging from 1 to 7 by an independent investigator. Data were analyzed by the 2-tail Mann-Whitney U test. RESULTS No differences in mean speech intelligibility, tongue mobility, or deglutition mean scores were seen between radial forearm flap and anterolateral thigh flap (P > .05). In all anterolateral thigh flap-treated cases, the donor site was closed directly and no complications were seen. However, in all forearm flaps donor site closure was carried out with skin grafts and dorsal forearm splinting was applied for 1 week postoperatively. In 4 cases a partial skin graft failure was observed and donor sites healed for second intention. CONCLUSION Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, and low donor site morbidity, could be the ideal flap for hemiglossectomy defect reconstruction.

Granular-cell tumours: an immunohistochemical study

The granular cell tumour (myoblastoma, Abrikosoffs tumour) and the congenital epulis in newborns (Neumann tumour) are two lesions rarely found in the oral cavity, whose histogenetic origin is highly controversial. This work analyses using immunohistochemical techniques 15 cases of myoblastomas and two of congenital epulis with different mono- and poly-clonal antibodies. Positive immunostaining was found for S-100 protein and neuron-specific enolase in all the cases of myoblastoma, and for vimentin and carcinoembryonic antigen in some cases. No immunoreactivity was observed for any of the other 13 antibodies used in congenital epulis.

Maxillary sinus augmentation with autologous bone harvested from the lateral maxillary wall combined with bovine‐derived hydroxyapatite: clinical and histologic observations

OBJECTIVE The aim of this study was to determine the clinical efficacy of a mixture of autologous bone harvested from the lateral wall of the maxilla using bone shavers and bovine-derived hydroxyapatite (HA) placed as a graft to elevate the maxillary sinus floor. The histological picture of tissue found in the sinus, the survival rate and the success of the implants were all evaluated. MATERIAL AND METHODS A total of 90 titanium implants were placed in 34 patients. In all of them, the lateral maxillary wall was harvested as a particulate bone graft, subsequently mixed with bovine-derived HA and packed in the sinus cavity. The lateral access window was then covered with a bioresorbable porcine-derived collagen membrane. In 32 sinuses, a two-stage surgery was performed, while in the remaining 10 cases a one-stage surgery was carried out. In the two-stage approach, 14 randomly selected biopsies were obtained at the time of implant insertion after a healing period of 9 months. The histological specimens were histologically and histomorphometrically evaluated. RESULTS One implant was lost, leading to a survival rate of 98.9%. The new bone consisted of lamellae of living bone contained osteocytes and in close contact with bovine bone particles that were partly infiltrated by newly formed bone. Bovine bone particle resorption could not be found. The histomorphometric analysis showed the following averages: 29% of newly formed bone and 21% of anorganic bovine bone. The marrow spaces made up the remaining 50% of the specimens. CONCLUSION Sinus lift graft with autologous bone harvested from the maxillary lateral wall combined with demineralized bovine bone leads to a predictable outcome regarding the amount of bone formation in sinus floor augmentation.

Complete spontaneous regression of Merkel cell carcinoma.

Merkel cell carcinoma (MCC) is a very aggressive primary cutaneous neoplasm most often occurring on the head and neck of the elderly. Spontaneous regression of MCC was first described in 1986. A 79-year-old woman with MCC on the right cheek underwent spontaneous regression of the malignancy, documented by photographic follow-up, computed tomography, and histologic studies. A review of the literature is presented. Complete clinical and histologic regression of MCC was observed in the present case. Although the literature documents 11 similar cases, only 6 can be regarded as complete spontaneous regressions following exclusive performance of a biopsy (primary complete spontaneous regression). Primary complete spontaneous regression of MCC is infrequent, and most case reports describe this phenomenon in women with MCC on the cheek. The reasons underlying regression are unknown.

Clinical experiences with bisphosphonate-associated osteonecrosis of the jaws: analysis of 21 cases

PURPOSE The aim of the present study was to analyze the clinical presentation, risk factors, radiologic features, histopathologic and microbiological findings, treatment, and evolution of bisphosphonate-associated osteonecrosis of the jaws (BONJ). METHODS This study made a retrospective review of 21 patients who underwent treatment and diagnosis of BONJ during 2004 to 2007 in a tertiary health care center reference for 1,100,000 inhabitants. RESULTS The mean patient age at the time of presentation was 65.1 years. Of the 21 patients observed, 19 (90.4%) were receiving intravenous zoledronate. Of the 21 patients, 15 were treated with bisphosphonates for bone metastasis (71.4%), 5 for multiple myeloma (23.8%), and 1 for rheumatoid arthritis (4.7%). In 17 patients, the lesions occurred in the mandible. Fifteen patients had previous tooth extractions at the same site of bone necrosis. CONCLUSION In our series, most patients improved with conservative surgical debridement. Prospective clinical trials would enable clinicians to make accurate judgments about risk, treatment, and outcome for patients with BONJ.

Podoplanin expression in oral leukoplakia: Tumorigenic role

OBJECTIVES Recent studies have identified podoplanin, a mucin-type transmembrane glycoprotein, as a biomarker for oral cancer risk in patients with oral leukoplakia (OPL). The aim of this study was to investigate the potential association between podoplanin and the risk of malignant transformation of OPL with epithelial dysplasia. MATERIALS AND METHODS In this retrospective study, podoplanin immunoexpression was analyzed in 58 patients with oral leukoplakia that showed epithelial dysplasia. Lesions with podoplanin expression in the basal and suprabasal layers of oral epithelium at one area or showing suprabasal expression at two or more areas were considered as positive. Association between podoplanin expression and oral cancer development was analyzed. RESULTS Twenty-two of the 58 lesions (38%) were classified as podoplanin-positive, and the remaining 36 (62%) lesions were considered podoplanin-negative. The expression of podoplanin was correlated with the grade of dysplasia (p<0.0005), and with the risk of progression to oral cancer (p<0.0005). In multivariate survival analysis, only premalignant oral lesions displaying positive podoplanin expression showed a significantly increased risk of developing an oral squamous cell carcinoma (hazard ratio=8.738, p=0.007). CONCLUSION Podoplanin could be a valuable biomarker for risk assessment of malignant transformation in patients with OPL along with histological assessment.

Bone regeneration after radicular cyst removal with and without guided bone regeneration.

In order to determine the degree of bone regeneration after removal of radicular cysts using guided bone regeneration (GBR), a prospective, controlled and randomized clinical study was performed. Thirty patients with radicular cysts were divided into three groups. One group, the control group (n=10 patients), was treated by enucleation and primary closure. The other two groups were treated by enucleation and primary closure but GBR was used in addition, using a resorbable membrane (n=10) and a nonresorbable membrane (n=10). The membranes were fixed with nonresorbable Memfix System screws. The residual volume and the density of the newly formed tissue was measured by computer-assisted tomography and computer-assisted digital image analysis before enucleation and three and six months postoperatively. No statistical significance was found in density and residual volume between the three treatment groups after six months. These results suggest that GBR using membranes does not contribute to increased bone regeneration.

Salivary duct carcinoma: An unusual case of long-term evolution☆☆☆

Salivary duct carcinoma is a highly malignant adenocarcinoma of salivary origin. Its pathologic features are distinct from the other salivary gland tumors and bear a remarkable histologic resemblance to ductal breast carcinoma. The clinical course is rapid and the prognosis is dismal. Aggressive therapy is warranted, including primary tumor resection, cervical neck dissection, and radiotherapy. We present a case of salivary duct carcinoma of parotid origin with a very long-term evolution in clear contrast to its supposed aggressiveness. Tumor cells expressed low- and high-molecular-weight cytokeratins, epithelial membrane antigen, carcinoembryonic antigen, and c-erbB-2 but not estrogen and progesterone receptors, actin, and S-100.