Luiz Fernando Barbosa de Paulo

Involvement of oral tissues by AL amyloidosis: a literature review and report of eight new cases.

ObjectiveAmyloidosis is a term used to describe a group of diseases in which there is an extracellular deposition of amorphous fibrillar proteins known as amyloid. The aim of this study was to present clinicopathological data from eight oral amyloidosis-affected patients and a deep review of the literature about the disease.Materials and methodsA retrospective study was conducted based on the records of oral amyloidosis-affected patients diagnosed in our institution between 1978 and 2012. The clinicopathological features and immunohistochemical (IHC) staining with anti-kappa and anti-lambda light chain antibodies were carried out and analyzed.ResultsEight patients were diagnosed with the disease; the tongue and women in their sixth decade of life were mostly affected. All lesions demonstrated apple-green birefringence and immunoreactivity for kappa-light chain, and four cases also showed lambda positivity. According to our series, four cases were diagnosed with localized amyloidosis and four with systemic amyloidosis. Prognosis for the systemic ones was gloomy, but good for the localized ones, which was characterized by a slow pattern of deposition without evolution to systemic involvement.ConclusionsThis study reinforces our knowledge about predilections, outcomes, and the importance of making a correct and quick diagnosis of oral amyloidosis and shows the necessity of more studies detailing oral amyloidosis predilection on a global scale. The importance and utility of IHC in the typing of the biochemical nature of amyloid deposits are becoming increasingly necessary for proper management of the patient. Correct classification of the type of amyloid is important for treatment consequences.Clinical relevanceThis article highlights the clinicopathological data of patients with amyloidosis affecting oral tissues and compare these new findings with other worldwide descriptions. Because of its rarity, such data are often unfamiliar to most clinicians and pathologists.

The approach of ameloblastoma of the mandible: a case treated by hyperbaric oxygen therapy and bone graft reconstruction

BackgroundReconstruction of mandibular defects after tumor resection is a challenge to the head and neck surgeon because of associated functional and esthetic problems. The intention of mandibular reconstructive surgery is to achieve maximum possible functionality, which means the restoration of masticatory function and speech with a good esthetic result. Hyperbaric oxygen therapy (HBO) is already a well-accepted adjunct in the treatment of extensive bone defects. It has been shown to enhance osteogenesis and improve soft tissue wound healing in a variety of circumstances.Case reportThe following case report describes a 29-year-old woman who was diagnosed with mandibular ameloblastoma. The treatment of choice is resection with mandibular base maintenance. The patient underwent 10 sessions of hyperbaric oxygen therapy and subsequent nonvascularized iliac crest graft. Six months after, mandibular reconstruction is possible to observe the preservation of mandibular contouring and facial esthetics. A panoramic radiograph revealed good positioning of the bone graft and volume maintenance.DiscussionThe mandibular reconstruction is extremely important for the rehabilitation of the patient who underwent bone resection. The restoration of mandibular function and facial esthetics is essential to maintain the quality of life. The use of HBO in mandibular reconstruction is an important adjunct to successful treatment, however, more studies are needed to establish the best modalities of rehabilitation.

Stevens-Johnson syndrome: An oral viewpoint

The Stevens-Johnson syndrome (SJS) is a severe variant of erythema multiforme (EM) that occasionally can rise to systemic upset and possibly compromise life. In this report, we described important oral and dermatologic aspects of a case of SJS triggered by Mycoplasma pneumoniae infection.

Oral paracoccidioidomycosis as a differential diagnosis of oral cancer

Paracoccidioidomycosis (PCM) is a deep mycosis characterized by mucocutaneous lesions, lymphadenopathy, and pulmonary involvement caused by Paracoccidioides brasiliensis , which mainly affects the skin, lymph nodes, lungs, and oral, nasal, and gastrointestinal mucous membranes. The main clinical differential diagnosis of oral and laryngeal mucous membrane lesions is cancer (i.e., squamous cell carcinoma). Depending on the specific immunity of the host, the infection can assume many forms and to affect multiple organs, and can eventually become a severe or fatal disease. In this paper, we highlight the important aspects for the differentiation of infectious diseases such as PCM and malignant neoplasm.

Congenital oral synechia and ankyloblepharon filiforme adnatum: Case report and literature review

INTRODUCTION Congenital intraoral synechias are adhesions of intraoral structures involving soft tissue. These conditions and another anomaly called ankyloblepharon filiforme adnatum, which is partial fusion of the eyelid margins by bands of tissue, are rarely reported in the literature. The association of both anomalies of the craniomaxillofacial region is an even more unusual finding. PURPOSE This article adds more information to the literature by reporting a case of a neonate with a rare association of bilateral synechia between the jaws, fusion of buccal mucosa to the ridges and between the tongue and palate, and ankyloblepharon filiforme adnatum in both eyes, without any other facial or systemic malformation. METHODS A literature review of similar cases published in PUBMED/MEDLINE was conducted followed by a discussion and comparison to the new case. CONCLUSION The rare association of these congenital defects, without the presence of syndromic symptoms, could be diagnosed and treated easily with good prognostic evolution.

Primary amelanotic mucosal melanoma of the oronasal region: report of two new cases and literature review

Primary amelanotic mucosal melanoma is a rare entity with challenging histopathological features. Because these tumors are thought to be biologically more aggressive, they have a poorer prognosis than that of pigmented melanomas. In this work, we present a literature review about the clinical, histopathological, and immunohistochemical features of primary amelanotic mucosal melanoma of the oronasal region and report two new cases. Amelanotic mucosal melanoma commonly affects men in the seventh decade of life and tend to have a poor prognosis, as seen by the high incidence of metastasis, recurrences, and, ultimately, death. There is a similar pattern in the clinic-pathological predilections (such as age, gender, primary site, and metastatic potential) of amelanotic mucosal melanoma when comparing with data reported for pigmented lesions. This work reinforces knowledge about amelanotic mucosal melanomas and epidemiologic predilections. The optimal management of this lesion remains controversial.

Reduced CD8+ T cells infiltration can be associated to a malignant transformation in potentially malignant oral epithelial lesions

ObjectiveThe aim of this study was to evaluate the immunohistochemical expressions of PD1, CD4+, and CD8+ in premalignant lesions (OPML) that were transformed into oral squamous cell carcinoma OSCC (OPML-OSCC), in OSCC and also in premalignant lesions that were not transformed into OSCC (OPML-NOSSC).Materials and methodsRetrospective analyses were performed in order to verify the demographic characteristics of the patients. CD4, CD8, and PD1 IMH studies were carried out on OPML and OSCC samples from 11 patients with OPML-OSCC and OPML, together with samples from 14 patients with OPML-NOSCC. The differences between OPML-OSCC and OPML-NOSCC were analyzed.ResultsNon-homogenous leukoplakia, together with the related oral subsite, and the lack of an exposure to tobacco, were all associated with malignant transformations. There were no statistical differences in the PD1 expression and the CD4+ cells in OPML-OSCC and OPML-NOSCC. A significant increment in the CD8+ cells was noted in the OPML that evolved into carcinomas when compared with OPML-NOSCC (p = 0.05), whereas there were higher CD8+ cells levels in the carcinomas when compared with the OPML that evolved into carcinomas (p = 0.027).ConclusionsCD8+ cells infiltrate more in OPML-NOSCC than in OPML-OSCC. Carcinoma is more infiltrated by CD8+ cells than its associated OPML.Clinical relevanceUnderstanding immunological factors associated with malignant transformation of oral premalignant lesions can open a new way to treat this disease.