Marcelo Gadelha Vasconcelos

Significance of galectins-1, -3, -4 and -7 in the progression of squamous cell carcinoma of the tongue

The aim of this study was to analyze the immunohistochemical expression of galectins-1, -3, -4, and -7 in 65 cases of squamous cell carcinoma of the tongue and to correlate this expression with clinical (disease outcome, metastasis, and clinical stage) and morphological parameters (histological grade of malignancy). Clinical data were obtained from the patient records. The histological grading system of malignancy proposed by Bryne (1998) [9] was used for the analysis of morphological parameters. The results were analyzed statistically by χ(2) test (p < 0.05). Galectin-1 expression was observed in 87.7% of cases and was significantly correlated with metastasis (p = 0.033) and clinical stage (p = 0.016). Immunoexpression of galectin-3 was observed in 87.7% of cases and was correlated with the presence of metastasis (p = 0.033) and histological grade of malignancy (p = 0.031). Galectin-4 showed no significant correlation with any of the parameters studied. Expression of galectin-7 was observed in 73.8% of cases and was significantly correlated with the histological grade of malignancy (p = 0.005). In conclusion, the intense immunoexpression of galectins-1, -3, and -7 suggests the participation of these proteins in oral carcinogenesis and their use as markers of biological behavior and tumor progression in squamous cell carcinoma of the tongue.

Comparative analysis of the immunohistochemical expression of collagen IV, MMP-9, and TIMP-2 in odontogenic cysts and tumors.

OBJECTIVE The aim of this study was to evaluate the immunohistochemical expression of collagen IV, matrix metalloproteinase (MMP) 9 and tissue inhibitor of MMP (TIMP) 2 in dentigerous cysts (DCs), radicular cysts (RCs), keratocystic odontogenic tumors (KOTs), and ameloblastomas. STUDY DESIGN Twenty cases of DCs, 20 RCs, 20 KOTs, and 20 ameloblastomas were selected and analyzed by immunohistochemistry. RESULTS Most DCs and RCs showed continuous and >50% staining for collagen IV in the basement membrane of the epithelium, whereas predominantly discontinuous thin and ≤ 50% staining was observed in KOTs and ameloblastomas, with a significant difference in staining percentage (P < .001). MMP-9 was diffusely distributed and localized in both epithelial and mesenchymal cells of all of the lesions analyzed. The staining percentage was higher in the epithelium (P = .058) and mesenchyme (P = .005) of KOTs and ameloblastomas. Moreover, the distribution pattern, location, and percentage of expression of TIMP-2 were similar in the lesions studied, except for ameloblastoma, with a significant difference in staining percentage (P < .001). CONCLUSION These results demonstrate that the interaction between collagen IV, MMP-9, and TIMP-2 is an important factor for the establishment of differences in the biologic behavior of the odontogenic cysts and tumors studied.

Peripheral and central giant cell lesions: etiology, origin of giant cells, diagnosis and treatment

INTRODUCTION AND OBJECTIVE: The peripheral and central giant cell lesions (PGCL and CGCL) are a group of pathological entities with similar histopathological features and whose origin has not been fully elucidated. The former is reactive and the latter exhibits a non-neoplastic proliferative behavior. This article aims to review the literature on peripheral giant cell lesions (PGCL) and central giant cell lesions (CGCL) by discussing the most important aspects pertaining to each of them. RESULTS: These lesions are found in different locations and show diverse clinical signs despite having the same histopathological features. The treatment consists in the surgical resection by different techniques depending on the type of the lesion and clinical conditions. In the case of CGCL, drug therapy may also be employed. CONCLUSION: Although there is no consensus in the literature, it is essential to know the etiology of these lesions as well as the exact origin of the giant cells. Due to their singular biological behavior, it is of utmost importance to establish a differential diagnosis between the two lesions and other processes that have similar clinical, radiological and histological characteristics, inasmuch as this procedure is essential to provide a suitable treatment and establish a prognosis.

Desmoplasic ameloblastoma in maxilla: report of case and review of the literature

El ameloblastoma es una neoplasia benigna de origen epitelial odontogenica de crecimiento lento, localmente invasiva y constituye el tumor odontogenico mas comun en los maxilares. Histologicamente, existen varios tipos descritos en la literatura. La variante desmoplastica es rara y se caracteriza por diferencias en los hallazgos tipicos del ameloblastoma, incluso la localizacion y aspectos radiograficos e histologicos. Los objetivos de este articulo son relatar un caso de ameloblastoma desmoplasico en el lado izquierdo del maxilar superior y presentar una revision de la literatura relevante, enfatizando aspectos peculiares de esta rara lesion

Intra-oral spitz naevus: a case report

The Spitz nevus, also known as benign juvenile melanoma or a nevus of epitheloid and spindle cells2, was first described by Sophie Spitz in 19481 and is most common in children and adolescents.3 They can present in three different ways: solitary nodular, multiple grouped, and multiple disseminated.3 The great majority of lesions are solitary, nodular, and are present in children and adolescents (57%–70%), with a slight preference for the female gender. The regions where they are most frequently found are the lower extremities, the head and neck, and the trunk.4 A Spitz nevus is usually pink, brown, or black in color. After an initial period of growth, the majority of Spitz nevi tend to stabilize their growth, reaching, in 95% of patients, a final size smaller than 6 mm.5 Histopathologically, a Spitz nevus is very similar to a melanoma due to the large size of the spindle or polygonal cells, frequently containing considerable cellular and nuclear pleomorphisms, the presence of inflammatory infiltrate, and, on the base of the lesion, a diminished cell size and spread among the collagen fibers of the conjunctive tissue. The difference between the Spitz nevus and a malignant melanoma can be hard to detect, but its structural pattern, which resembles a normal nevus, and its cytological traits, such as the large spindle and epithelioid cells, can be useful in making this distinction. The majority of Spitz Nevi are small and well circumscribed.5 Those lesions that are particularly hard to distinguish from malignant melanoma are called atypical or malignant Spitz nevi and Spitzoid cells.6,7,8 Immunohistochemical studies can help, but they are still not definitive.9,7 A Spitz Nevus expresses the S100 protein, but HMB-45 tends to be distributed more within the junctional and superficial components of the skin. HMB-45 correlates with melanosome production and thus, HMB-45-positive cells are of melanocytic origin. Therefore, HMB-45 may correlate best with factors that stimulate melanocytic proliferation and the production of melanosomes.8 The treatment indicated is complete excision to determine the lesion’s depth and extension.10 Despite the fact that the Spitz nevus is a benign lesion, its transformation into a malignant lesion has been reported. Therefore, its proservation must be recommended.11

Squamous cell carcinoma of the tongue: clinical and morphological analysis of 57 cases and correlation with prognosis

Introduction: Oral squamous cell carcinoma (OSCC), which represents more than 90% of head and neck malignant neoplasms, has a poor prognosis due to its high frequency of lymph node metastasis and local invasion. Previous studies have investigated parameters related to the biological behavior of OSCC and its correlation with disease outcome (DO). Objective: To evaluate clinical and morphological data in cases of tongue squamous cell carcinoma (TSCC), correlating these findings with prognosis. Material and methods: Fifty-seven specimens of TSCC were obtained from patients undergoing surgical excision at a referral hospital in Natal, Brazil. Clinical data, such as tumor-node-metastasis (TNM) stage and DO, were collected from medical records. Hematoxylin and eosin-stained sections were analyzed regarding histological grade of malignancy (HGM), based on the system proposed by Bryne (1998) Results: The majority of patients (38.6%) were diagnosed as TNM stage III, and 57.9% developed metastases. Remission of the tumor occurred in 77.2% of the cases. The parameter “metastasis” exhibited a significant association with DO (p = 0) and TNM stage (p = 0.001), thus constituting a good indicator of tumor progression. Correlation of HGM and TNM stage with DO was not evidenced. Nevertheless, statistical analysis showed a significant association between HGM and TNM stage (p = 0.006). Conclusion: TNM clinical staging and HGM, evaluated in association, may be useful to estimate the prognosis of TSCC.

CONDUTA ODONTOLÓGICA EM PACIENTES HIPERTENSOS

Objective: The aim of this systematic review was to evaluate the literature on dental care provided to hypertensive individuals, in order to establish a better approach of the clinic dental care for these patients. Material and methods: Bibliographical searches were carried out in the following electronic databases: MEDLINE, LILACS, BBO, and Science Direct, including the papers published in the period from 2006 to 2011. Results: The literature reports that the use of antihypertensive drugs may lead to oral complications such as decrease in salivary secretion and increased gingival tissue. Furthermore, the incorrect use of local anesthetics, with or without a vasoconstrictor, can further worsen the patients hypertension. Conclusion: It is very important to emphasize the need of knowing the possible local and/or systemic complications due to drug therapy used in hypertensive individuals, so that dental treatment can be provided in a safe and effective way in these patients. DESCRIPTORS Hypertension. Oral Manifestations. Dental Care.

ABORDAGEM TERAPÊUTICA EM CISTO RADICULAR DE GRANDES PROPORÇÕES – RELATO DE CASO

Radicular cyst is a lesion of inflammatory nature that represents the most common odontogenic cyst. It has a frequency rate of 7-54% among the periapical radioluscences. Typically, the lesion is asymptomatic, usually located in the anterior maxilla and in most of the times ranging from 5 mm to 1.5 cm. In extensive lesions, when they occur, one can observe swelling, tooth mobility and displacement. Radiographically, there is a well-defined unilocular radiolucent image surrounding the apex of a tooth. As for treatment, tooth extraction and nonsurgical endodontic treatment are the most executed procedures; in extensive lesions, conservative endodontic treatment followed by biopsy and decompression have been successfully performed. The authors report a case of radicular cyst of great proportions in a patient aged 18 years. After diagnosis was confirmed by clinical and radiographic examinations, treatment plan consisted of surgical and nonsurgical endodontic treatment of the left maxillary canine. No signs of recurrence were found during follow-up. The present work aims at reporting a case of a large cystic lesion of 3.4 cm in the anterior maxilla in a young patient, and it is made a brief review of the literature regarding such pathological entity. DESCRIPTORS: Radicular Cyst. Decompression. Surgery, Oral.

Immunoexpression of Glucose Transporters 1 and 3 and Macrophage Colony-Stimulating Factor in Central and Peripheral Giant Cell Lesions of the Jaws.

PURPOSE The peripheral giant cell lesion (PGCL) is a reactive process associated with a local irritating factor that shows low recurrence after treatment, especially if the irritating factor is eliminated. In contrast, the central giant cell lesion (CGCL) presents variable clinical behavior ranging from slow and asymptomatic growth without recurrence to rapid, painful, and recurrent growth. The immunoexpression of glucose transporter (GLUT)-1, GLUT-3, and macrophage colony-stimulating factor (M-CSF) was compared in CGCL and PGCL. MATERIALS AND METHODS Twenty nonaggressive CGCLs, 20 aggressive CGCLs, and 20 PGCLs were selected for analysis of the immunoexpression of GLUT-1, GLUT-3, and M-CSF in multinuclear giant cells (MGCs) and mononuclear cells (MCs). RESULTS There was a difference in the percentage of immunoreactive cells of GLUT-1 and GLUT-3 in MC components among lesions and in the intensity of GLUT-1 in MCG and MC components, GLUT-3 in MGC components, and M-CSF in MC components. CONCLUSIONS These results suggest that GLUT-1, GLUT-3, and M-CSF could play a role in the pathogenesis of the lesions studied. The stronger immunostaining of these proteins in MCs shows that these cells have greater metabolic activity and osteoclastogenesis, especially in aggressive CGCL. The MCs showed a stronger relation than the MGCs to the pathogenesis of the studied lesions.

OSTEOMA MAXILAR: RELATO DE CASO

Introduction: Osteoma consists of a benign neoplasm originated from the bone tissue, which affects mainly young adults and may occur in the gnathic bones, with a predilection for the mandible. Its clinical appearance is a sessile or pedunculated tissue swelling, and may manifest as solitary or multiple lesions. In radiographic exams, it displays a circumscribed radiopaque image with sclerotic borders. Objective: This study aims to report a case of osteoma in the anterior maxilla. Case Report: A 14-year old female patient was referred to the Department of Dentistry, UFRN, complaining of an asymptomatic swelling in gingiva. Intraoral examination revealed a sessile nodule, with lobulated surface and hard consistency, in gingiva next to the dental element 21. Panoramic radiograph revealed a circular radiolucent-radiopaque area in left hemimaxila, and on lateral norm teleradiograph, a discrete circumscribed radiopaque area was observed in the region of upper incisors. The diagnostic hypothesis of osteoma was suggested, proceeding to excisional biopsy. Histopathological examination showed mature compact bone with sparse marrow elements, chronic inflammatory cells and dystrophic calcifications. Based on the clinical, radiographic and histopathological findings, diagnostic hypothesis of osteoma was confirmed. The patient is under clinical follow-up for 01 year, without signs of recurrence. Conclusion: We emphasize the relevance of histopathological analysis for the diagnosis of osteoma, whereas this neoplasm may present clinical and radiographic similarities with other lesions. Considering the cases of relapse reported in the literature, it is recommended the clinical follow-up of the patient after surgical therapy. DESCRIPTORS: Osteoma. Maxillary. Pathology, Oral.