Rodrigo Porpino Mafra

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.

Oral pigmentations in Laugier-Hunziker syndrome: a case report and review of diagnostic criteria

Laugier-Hunziker syndrome (LHS) is a rare mucocutaneous disorder, of unknown etiology, characterized by multiple hyperpigmented macules, dispersed mostly on the oral mucosa, occasionally associated with longitudinal ridging of the nails. The diagnosis requires exclusion of other conditions, such as Addison’s disease and Peutz-Jeghers syndrome. We report a case of a 34-year-old male patient, presenting with hyperpigmented macules on the lips, buccal mucosa and palate, as well as mild dark striations on toenails. After careful clinical and laboratorial investigations, the diagnosis of LHS was established. Given the lack of aesthetic complaints and symptoms, no treatment was necessary.

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.

Expressão imunoistoquímica da endoglina (CD105) e do fator de von Willebrand em carcinoma epidermoide oral e sua relação com parâmetros clinicopatológicos

Background Angiogenesis has been linked with progression of malignant neoplasms and although studies have been conducted investigating angiogenic markers in oral squamous cell carcinoma (OSCC), contradictory results are reported in the literature. Objectives To evaluate immunohistochemical expression of CD105 and von Willebrand factor (vWF) in OSCC and their relationships with clinical parameters of the tumors. Methods Immunoexpression of these biomarkers was analyzed in 30 cases of OSCC and correlated with clinical parameters of the tumors (age and sex of patients, anatomic site and Tumor, Node and Metastasis clinical staging [TNM]). Results In OSCC specimens, immunostaining was more effective using the anti-vWF antibody than using the anti-CD105 antibody. Angiogenic indices, determined by microvascular count (MVC) technique, were different for the floor of the mouth and the retromolar region, with statistical significance (p = 0.004). There were no statistically significant relationships between results for the two biomarkers and TNM clinical staging or angiogenic indices. Conclusions The findings of this study suggest that vascular remodeling is involved in oral carcinogenesis, although there was no evidence of a significant association with clinical stage of 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.

LÍQUEN PLANO ORAL EM LÁBIO INFERIOR: RELATO DE CASO

Introduction: Oral lichen planus (OLP) is a relatively common chronic mucocutaneous disease with unknown etiology, which may be associated with a cell-mediated immune response. It is characterized by the presence of symmetrical and bilateral lesions or multiple lesions, mainly affecting the buccal mucosa, tongue and gingiva. The most commonly reported clinical forms are reticular, erosive, papular, plaque, atrophic and bullous. Objective: To report an unusual clinical case of OLP in the lower lip. Case Report: Male patient, 54 years old, attended the Naval Hospital Dental Service in the city of Natal, complaining of a white lesion on his lower lip. On examination, we observed a white and flat lesion with a rough surface, showing areas of striations. The possible clinical diagnoses of the lesions were reticular lichen planus and leukoplakia. Incisional biopsy was performed and microscopic examination revealed oral mucosa lined by orthokeratinized stratified squamous epithelium, showing hydropic degeneration on the entire basal layer. The underlying lamina propria consisted of fibrous tissue, with lymphocytic inflammatory infiltrate in the sub-epithelial layers. Based on the histopathological characteristics, the lesion was diagnosed as OLP. Conclusion: Considering that OLP is a relatively common disease and has variable clinical manifestations, as evidenced in this report, we emphasize the importance of knowledge regarding this entity, in order to provide a correct diagnosis. DESCRIPTORS: Oral, Lichen Planus. Oral, Pathology. Oral, Surgery.