Rodrigo Gadelha Vasconcelos

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.

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.

Use of Clinical Cases in a Virtual Learning Environment as an Approach to Teaching Human Embryology

El objetivo del trabajo fue evaluar la eficacia de un metodo de ensenanza de la Embriologia en ambiente virtual. Para complementar el contenido discutido en clases, fueron organizados en un blog, casos clinicos abordando seis ejes tematicos de Embriologia Humana. Articulos cientificos estuvieron disponibles para consolidacion de los contenidos teoricos y el eje etico-humanistico fue abordado en foros de discusion. Al final del semestre la media de las notas de los alumnos fue comparada con la media de un semestre anterior donde la metodologia no fue utilizada. La percepcion de los alumnos con relacion a la eficacia del uso del blog en el aprendizaje fue evaluada a traves de un cuestionario electronico. Se observo aumento considerable de la media de las notas al ser comparadas con las notas del periodo lectivo anterior. El analisis de los cuestionarios revelo que los alumnos consideraron el blog como un instrumento practico y util de aprendizaje. Se concluye que esta metodologia represento una herramienta eficiente em la ensenanza de los contenidos de Embriologia Humana.

Clinical Efficacy of Fluoride Varnish and Low-Level Laser Radiation in Treating Dentin Hypersensitivity

The objective of this study was to compare the efficacy of fluoride varnish (Fluorniz(r)) and irradiation with a gallium-arsenide-aluminum diode laser in the treatment of cervical dentin hypersensitivity. Cervical dentin hypersensitivity (CDH) is a painful condition that is highly prevalent in the worlds adult population, with one in six patients presenting this symptom. Eighty-six teeth were divided into two groups: Group 1, teeth treated with Fluorniz; Group 2, teeth irradiated with a GaAlAs laser at a 4 J/cm2 dose. The two treatments were applied to the buccal cervical region in four sessions, at intervals of 72 to 96 h. The response of the patient to tactile and thermal-evaporative stimuli was rated on a visual analog scale. The results showed a reduction of hypersensitivity in response to tactile and thermal-evaporative stimulation at the end of treatment in both groups. In conclusion, short-term treatment with Fluorniz was found to be more effective than low-level laser radiation in reducing cervical dentin hypersensitivity.

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.

Maxillary brown tumor associated with chronic kidney failure: a case report

The brown tumor is a bone lesion that may affect the entire skeleton, including the maxillary bones. These tumors are characterized as focal giant cell lesions that may be associated with primary or secondary hyperparathyroidism (HPT). Brown tumors are invasive in some cases and an association with chronic renal failure (CRF) has been reported. With the aim to facilitate the differential diagnosis of bone lesions that may affect dialysis patients, this paper describes a case of brown tumor in a 36- year old patient with CRF, secondary HPT carrier, who had a lesion on the right maxilla for approximately five months.

Expressão de MMPs, marcadores angiogênicos e proliferação celular em tumores odontogênicos

INTRODUCTION AND OBJECTIVE: The study of biological behavior of odontogenic lesions is essential to the establishment of appropriate therapeutic approach and prognosis. The production of extracellular matrix metalloproteinases (MMPs), angiogenesis and cell proliferation contribute to tumor growth. This paper aims to review the literature on odontogenic tumors (OT) selected according to the new World Health Organization classification (WHO- 2005) by evaluating the expression of MMPs, angiogenic and cell proliferation. Furthermore, it aims to verify the relation between these markers and the biological behavior of these lesions. RESULTS: it was found that MMPs -1, -2, -7, -9 and -26 had a higher expression in both epithelial component and stroma, and 13 particularly in the stroma. Increased angiogenesis was observed in more aggressive OT. CD105 expression was higher in keratocystic odontogenic tumour (KOT) and CD34 in solid ameloblastomas (SA). It was observed a higher expression of Ki-67 and p53 in SA and KOT and a low cell proliferation rate in the adenomatoid odontogenic tumour (AOT). CONCLUSION: These results show that MMPs are involved in invasion and recurrence of some odontogenic lesions and are associated with the biological behavior of these tumors. Angiogenesis is critical to provide support to cell proliferation and these concomitant events are correlated with different levels of biological behavior in OT when compared to odontogenic cysts, hence the use of angiogenic inhibitors may be a potential therapeutic approach in these lesions.

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.

Myofibroblasts and mast cells: influences on biological behavior of odontogenic lesions

Odontogenic lesions differ in their rate of recurrence and aggressiveness. This study aimed to evaluate the presence of myofibroblasts and mast cells in odontogenic lesions. Sample consisted of 20 cases each of dentigerous cysts, odontogenic keratocysts, and solid ameloblastomas. Histologic sections were submitted to immunohistochemistry using anti-α-smooth muscle actin and anti-tryptase antibodies. Myofibroblasts and mast cells were counted at ×400 magnification in 5 and 10 fields, respectively. Myofibroblasts were more frequent in ameloblastomas (24.41), followed by odontogenic keratocysts (16.21) and dentigerous cysts (11.85; P=.002). Granulated and degranulated mast cells were more frequent in dentigerous cysts (7.88 and 8.96, respectively), followed by odontogenic keratocysts (6.53 and 7.08) and ameloblastomas (5.21 and 1.88). The difference was only significant for degranulated mast cells (P<.05). Analysis of the correlation between myofibroblasts and mast cells (granulated and degranulated) revealed a moderate positive correlation only in ameloblastomas (R=0.621, P=.003). Probably, myofibroblasts are related to the biological behavior of the odontogenic lesions studied, particularly their aggressiveness. On the other hand, mast cells seem to be associated with inflammatory processes, which are more frequent in cystic lesions than in benign neoplasms. In addition, mast cells may induce the differentiation of fibroblasts into myofibroblasts, thus increasing the number of the latter.