Leorik Pereira da Silva

Ameloblastic fibrodentinosarcoma: a rare malignant odontogenic tumor.

a Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Odontologia, Patologia Oral, Natal, RN, Brazil b Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia de Cabeça e Pescoço, Recife, PE, Brazil c Instituto São Leopoldo Mandic, Centro de Pesquisas, SLMandic, São Paulo, SP, Brazil d Universidade Federal de Campina Grande (UFCG), Faculdade de Odontologia, Centro Acadêmico de Ciências Biológicas, Patologia Oral, Patos, PB, Brazil e Universidade de Pernambuco (UPE), Faculdade de Odontologia, Patologia Oral, Camaragibe, PE, Brazil

Central mucoepidermoid carcinoma radiographically mimicking an odontogenic tumor: A case report and literature review

Central mucoepidermoid carcinoma (CMC) of the jaw bones is a rare malignant salivary gland tumor of unknown pathogenesis, comprising about 4% of all mucoepidermoid carcinomas (MECs). Most cases are histologically classified as a low-grade tumor and radiographically appear as a well-defined unilocular or multilocular radiolucent lesion. Block resection or wide local excisions are the treatment of choice and patients usually show a good overall prognosis although a long-term follow-up is necessary. This report describes a case of a 28-year-old male with MEC in the posterior region of the mandible and discusses its clinical, radiographic and histopathological findings. Although rare, CMC may be considered a differential diagnosis in cases of proliferative and osteolytic lesions in the oral cavity even when its clinical and/or radiographic findings do not suggest malignancy.

Cervical Necrotizing Fasciitis Caused by Dental Extraction

Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

Tooth Calcification in Low-Weight Human Fetuses

La calcificacion del diente comienza durante la vida intrauterina y se relaciona con el estado nutricional del feto. El proposito de este estudio fue evaluar el estado de calcificacion dental de 15 fetos humanos de bajo peso entre las 14 y 28 semanas de vida intrauterina mediante analisis radiograficos y tecnica histoquimica von Kossa, especifica para la deteccion de calcio y otras sales minerales en los tejidos. Despues de su diseccion, las mandibulas fueron sometidas a radiografias laterales y oclusales. Secciones de 3 mm de espesor de las mandibulas fueron tenidas con la tecnica Von Kossa. El analisis radiografico no mostro ninguna imagen sugerente de mineralizacion dentaria, aunque rudimentos de la osificacion mandibular podrian tenerse en cuenta. Las secciones de H-E revelaron la presencia de los germenes dentarios en las fases avanzadas de odontogenesis, pero con un retraso relativo en el desarrollo normal. La tincion de von Kossa no mostro positividad a la deposicion de sales minerales en germenes dentarios, lo que apoya nuestros hallazgos relacionados con el retraso de desarrollo dental que se encontro en la muestra estudiada. Se sugiere que existe relacion entre el bajo peso del feto y el estado de calcificacion y maduracion de los dientes.

Differential expression of cyclooxygenase-2 and cyclin D1 in salivary gland tumors

PurposeSalivary gland tumors are complex and have a great histomorphological diversity; more than 30 histological subtypes are currently described and the study of proteins that help understand and differentiate these tumors is essential. We aimed to analyze the immunoexpression of cyclooxygenase-2 (COX-2) and cyclin D1 proteins in pleomorphic adenomas (PA), mucoepidermoid carcinomas (MEC) and adenoid cystic carcinomas (AdCC) of salivary glands.MethodsA total of 38 PA, 12 AdCC and 12 MEC underwent immunohistochemical study by the polymeric biotin-free technique. Immunopositive cells were analyzed semi-quantitatively. For statistical analysis, a significance level was set at p ≤ 0.05.ResultsOverall, these tumors were more prevalent in women (n = 37). The mean age of these patients was 58-year-old and the parotid gland was the most affected anatomic site (n = 33). All cases of AdCC and MEC showed immunopositivity to cyclin D1; however, 39.5% of the PAs were negative (p < 0.001). Regarding COX-2 immunoexpression, we observed that all cases of CME were positive, whereas 60.5% of the PA and 75% of the CAC analyzed were completely negative (p = 0.042).ConclusionsThe overexpression of COX-2, observed only in MEC, emphasizes that salivary gland tumors have different profiles. Cyclin D1 is more immunoexpressed in malignant tumors. Together, these immunohistochemical findings may be useful in differentiating the studied tumors.

Cripto-1 is overexpressed in carcinoma ex pleomorphic adenoma of salivary gland

IntroductionCripto-1 is a member of the epidermal growth factor—Cripto-1/FRL-1/Cryptic family. Besides being critical for early embryonic development, Cripto-1 is also associated with the development and behavior of several cancers. Objective: We analyzed the immunoexpression of Cripto-1 in normal salivary glands (NSGs), pleomorphic adenomas (PAs), and carcinoma ex pleomorphic adenomas (CaExPAs) of salivary glands.MethodsA total of 12 NSGs, 16 PAs and 12 CaExPAs underwent immunohistochemical study by the polymeric biotin-free technique. Immunopositive cells were evaluated semiquantitatively (scores 0–3). For statistical analysis, Mann–Whitney and Kruskal–Wallis tests were performed and a significance level of p ≤ 0.05 was established.ResultsMost CaExPAs (n = 10) were strong positive (score 3) for Cripto-1, and only three cases of PAs and two specimens of NSGs exhibited some expression (score 1), being statistically significant these findings (p < 0.001). No difference between the expression of this protein in tumors of major and minor salivary glands was observed. Overexpression was found mainly in cases of CaExPAs with invasive growth (n = 8) when compared to those without capsular invasion (intracapsular pattern) (p = 0.036). Patients with or without lymph node metastasis showed no difference (p = 0.294).ConclusionThe results revealed a significantly higher expression of Cripto-1 in CaExPA compared to PA and NSG, suggesting this protein is possibly deregulated in PA malignant transformation. Furthermore, the increased expression of this protein is associated with a more aggressive behavior (invasive growth) in salivary gland tumors.

Expression of urokinase-type plasminogen activator and its receptor in squamous cell carcinoma of the oral tongue

Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) act in the proteolysis of basement membrane and extracellular matrix structures, facilitating tumor invasion. The purpose of this study was to evaluate the relationship between these proteins and clinicopathological parameters in squamous cell carcinoma of the oral tongue (SCCOT). Sixty cases of SCCOT were submitted to immunohistochemistry and analyzed semiquantitatively at the invasion front and in the tumor core. The results were associated with lymph node metastasis, clinical stage, locoregional recurrence, clinical outcome and histological grade of malignancy. A higher expression of uPA was observed in cases of tumors of high-grade versus low-grade malignancy (p = 0.010). Moreover, the cases with the worst pattern of invasion presented an overexpression of uPA (p = 0.011). The presence of locoregional recurrence was associated with uPAR (p = 0.039), and the expression of both biomarkers was much higher at the invasion front than in the tumor core (p < 0.001). The results suggest uPA and uPAR are involved in the progression and aggressiveness of SCCOT, mainly at the tumor-host interface.

CANALICULAR ADENOMA OF THE UPPER LIP: A CASE REPORT

Objective: Canalicular adenoma is a relatively rare benign tumor of the salivary glands, found almost exclusively in the minor salivary glands of the upper lip. We report a case of canalicular adenoma in the upper labial mucosa of a male patient, highlighting the clinical and histopathological differential peculiarities compared to other lesions of similar location. The immunohistochemistry was considered decisive for diagnosis confirmation and differentiation from lesions that may have similar histological characteristics. Case Description: A 68-year-old melanoderm male patient sought dental care for an asymptomatic lesion in the upper lip, measuring 7 mm, with 1 year of evolution. Excisional biopsy, microscopic evaluation, and immunohistochemical assays were performed using antibodies against CK7, S-100, and vimentin antigens. The final diagnosis of canalicular adenoma was established through the consolidation of clinical, histological, and immunohistochemical data, taking into account the differential diagnosis of this lesion. After 1 year, the patient had no recurrences. Conclusion: Immunohistochemistry was a definitive tool for the final diagnosis, ruling out the possibility of other lesions with similar morphology.

Case reportAmeloblastic fibrodentinosarcoma: a rare malignant odontogenic tumorFibrodentinossarcoma ameloblástico: um raro tumor odontogênico maligno☆

a Universidade Federal do Rio Grande do Norte (UFRN), Departamento de Odontologia, Patologia Oral, Natal, RN, Brazil b Hospital Universitário Oswaldo Cruz, Departamento de Cirurgia de Cabeça e Pescoço, Recife, PE, Brazil c Instituto São Leopoldo Mandic, Centro de Pesquisas, SLMandic, São Paulo, SP, Brazil d Universidade Federal de Campina Grande (UFCG), Faculdade de Odontologia, Centro Acadêmico de Ciências Biológicas, Patologia Oral, Patos, PB, Brazil e Universidade de Pernambuco (UPE), Faculdade de Odontologia, Patologia Oral, Camaragibe, PE, Brazil

RECIDIVA DE AMELOBLASTOMA PARA TECIDOS MOLES APÓS TRATAMENTO RADICAL

Introduction: Ameloblastomas are locally aggressive jaw tumors with a high propensity for recurrence and believed to originate from remnants of dental lamina or odontogenic epithelium. Radical surgery still remains the first-choice therapy. Case Report: Herein we report the case of a 69-year-old patient admitted to the University Hospital Oswaldo Cruz in Pernambuco, Brazil, exactly eight years after undergoing hemi-mandibulectomy for treatment of a multicystic ameloblastoma. The patient complained of painful, well-delimited swelling measuring about 4 cm in submucosa next to a titanium bone plate that was used for reconstruction. Computed tomographic imaging and incisional biopsy were performed. The lesion was diagnosed as a ameloblastoma. The tumor was resected and histopathological analyses showed predominance of follicular and acanthomatous ameloblastoma within a highly fibrotic area, thus completing the diagnosis of soft-tissue recurrence. Considerations: This report shows the need of monitoring ameloblastomas for a long-term period even after radical treatment. DESCRIPTORS Neoplasm Recurrence Local. Ameloblastoma. Maxillofacial surgery.