RESUMEN
This paper aims to discuss clinical aspects of mucormycosis. This case series was conducted in two services, comprising six mucormycosis cases during COVID-19 pandemic. About gender, there are 4 (66.7%) males and 2 (33.3%) females with mean age (48.7 ± 9.4) years. All cases presented complaints of pain and swelling in oral cavity and had an aggressive clinical presentation. Five patients had diabetes and one had a nasal non-Hodgkin lymphoma. Histologically, large, branched, hyphae associated with necrotic areas were observed, confirming microscopically such as mucormycosis through PAS and GMS stains. In four cases, treatment consisted in surgical debridement associated with antifungal therapy. All patients were submitted to debridement and received antifungal treatment (amphotericin B). Five patients were followed up without clinical recurrence, but unfortunately one patient died. Diagnosis of mucormycosis should be early because it is related to high mortality. The treatment consists of surgical debridement associated with antifungal therapy.
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COVID-19 , Mucormicosis , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Mucormicosis/diagnóstico , Mucormicosis/etiología , Mucormicosis/terapia , Antifúngicos/uso terapéutico , Pandemias , Desbridamiento , COVID-19/complicaciones , COVID-19/terapia , HospitalesRESUMEN
Virtual microscopy (VM) is a technology for showing microscope slides using computers and could be considered a progression of classic methodology using optical microscopes. The aim of this study was to analyze the perceptions and performance of dental students in oral pathology regarding the use of conventional microscopy (CM) and VM in relation to teaching and learning. All fourth-semester dental students (N=165) in an oral pathology course at the Universidade Federal de Pernambuco in Brazil in 2016-17 were invited to participate in the study. Students first answered a questionnaire with ten multiple-choice items on VM in comparison with CM and then took an exam divided into two sections: the first contained three virtual slides on the computer; in the second, three glass slides were positioned in an optical microscope. Each slide question, asking students to identify the oral lesion shown, was worth two points. Both conventional and virtual slides were chosen from the main lectures in the oral pathology classes. Of the students, 132 completed the questionnaire (80% response rate), and 77 completed the exam (46.7% response rate). On the questionnaire results, most students perceived that VM was a superior method for teaching and learning compared to CM. Students earned a total of 312 points on the questions with virtual slides and earned 190 points on the questions with conventional slides. In this study, the use of VM in oral pathology teaching was favored by the students over CM and also contributed to these students' learning.
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Competencia Clínica , Instrucción por Computador/métodos , Evaluación Educacional/métodos , Microscopía/métodos , Patología Bucal/educación , Percepción , Estudiantes de Odontología/psicología , Humanos , Procesamiento de Imagen Asistido por Computador , AprendizajeRESUMEN
AIMS: The aim of this study was to investigate whether the expression of BRAF-V600E determines an aggressive clinical and molecular presentation of ameloblastoma. METHODS AND RESULTS: Ninety-three cases of solid ameloblastomas were arranged in a 1.0-mm tissue microarray (TMA) block. Immunohistochemistry against a large panel of cytokeratins (CK), epidermal growth factor receptor (EGFR), parathyroid hormone-related peptide (PTHrP), syndecan-1, Ki67, p53 and BRAF-V600E were performed. Clinicopathological parameters, including sex, age, tumour size, tumour duration, tumour location, treatment, recurrences, radiographic pattern, vestibular/lingual and basal cortical plates disruption and follow-up data, were obtained from patients' medical records. Immunoexpression of BRAF-V600E was investigated in 73 cases that remained available in TMA sections. Our results indicated that 46.6% (34 cases) demonstrated cytoplasm positivity (six weak and 28 strong positivity). BRAF-V600E expression was associated significantly with the expression of CK8 (P = 0.00077), CK16 (P = 0.05), PTHrP (P = 0.0082) and p53 (P = 0.0087). Additionally, a significant association was seen with the presence of recurrences (P = 0.0008), multilocular radiographic appearance (P = 0.044) and disruption of basal bone cortical (P = 0.05). Univariate analysis showed that BRAF-positive cases (P = 0.001), EGFR-negative/weak positive cases (P = 0.03) and multilocular tumours (P = 0.04) had a significantly lower disease-free survival rate, but these parameters were not considered independent prognostic factors in the multivariate analysis (P > 0.05). CONCLUSIONS: Our findings suggest an association of BRAF-V600E with parameters of a more aggressive behaviour of ameloblastoma, supporting the future use of BRAF inhibitors for targeted therapy of this neoplasm.
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Ameloblastoma/patología , Neoplasias Maxilomandibulares/patología , Proteínas Proto-Oncogénicas B-raf/biosíntesis , Adulto , Ameloblastoma/mortalidad , Biomarcadores de Tumor , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunohistoquímica , Neoplasias Maxilomandibulares/mortalidad , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Proteínas Proto-Oncogénicas B-raf/análisis , Análisis de Matrices TisularesRESUMEN
INTRODUCTION: The maxillary sinus can be affected by dental infections because of its close relationship with upper teeth. This study aimed to assess the most common types of maxillary sinus alterations and to associate them with odontogenic conditions using cone-beam computed tomographic (CBCT) images. METHODS: CBCT scans of 400 patients showing sinus disease in 1 or both maxillary sinuses were evaluated. Sinus alteration was considered as follows: generalized or localized mucosal thickening (MT), maxillary sinusitis (MS), and retention cysts (RCs). The odontogenic conditions evaluated were inadequate endodontic treatment, periapical lesions, and periodontal bone loss. Descriptive and multiple logistic regression analyses were performed. RESULTS: Sinus diseases were observed in 85.9% of the maxillary sinuses. The most prevalent condition was generalized MT (65.2%) followed by localized MT (24.8%), MS (6.4%), and RCs (3.6%). Generalized MT was more related to males (odds ratio = 1.45, P < .05) and periodontal bone loss (P < .05). Localized MT was associated with periapical lesions (odds ratio = 3.09, P < .05) and showed a close anatomic relationship between teeth and the sinus floor (odds ratio = 2.77, P < .05). There were no statistically significant associations between either MS or RCs and the odontogenic conditions studied. CONCLUSIONS: The most prevalent sinus diseases were the generalized and localized MT, and they were the only ones related to odontogenic conditions (periodontal bone loss and periapical lesions, respectively). We emphasize that CBCT imaging is an appropriate method for evaluating the maxillary sinus findings and their associated odontogenic conditions.
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Tomografía Computarizada de Haz Cónico/métodos , Seno Maxilar/diagnóstico por imagen , Sinusitis Maxilar/diagnóstico por imagen , Odontogénesis/fisiología , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Seno Maxilar/anatomía & histología , Seno Maxilar/patología , Sinusitis Maxilar/etiología , Sinusitis Maxilar/patología , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/patología , Enfermedades Periapicales/diagnóstico por imagen , Enfermedades Periapicales/patología , Adulto JovenRESUMEN
The oncoprotein ErbB2 (HER-2/neu) is a tyrosine kinase cell surface receptor overexpressed in several human malignancies, including oral squamous cell carcinoma (OSCC). ErbB2 was recently shown to regulate the expression of fatty acid synthase (FAS), a multifunctional enzyme complex responsible for the de novo biosynthesis of saturated fatty acids. Here we evaluated the relationship between the immunohistochemical expression of ErbB2, FAS, and Ki-67 with the clinicopathologic characteristics of tongue squamous cell carcinoma (SCC). One hundred and two patients with tongue SCC treated from 1990 to 1995 were studied. Clinical and treatment data were obtained from the medical records and histopathological features revised. Paraffin-embedded tissues were submitted to standard immunohistochemical reactions for ErbB2, FAS and Ki-67. A strong positive correlation between ErbB2 labeling at the cell membrane and FAS expression was found in the tongue SCC samples (p<0.0001). The intracytoplasmatic expression of ErbB2 as well as Ki-67 nuclear staining were significantly associated with a high risk of recurrence by predicting both disease free survival (log-rank test, p=0.0096 and p=0.0047, respectively) and overall survival (log-rank test, p=0.0029 and p=0.0001, respectively). Taken together, our results suggest that the immunolocalization of ErbB2 at the cell surface of malignant oral keratinocytes is linked to FAS expression whereas the intracytoplasmatic ErbB2 or Ki-67 staining predict high risk of recurrence of tongue SCC.
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Carcinoma de Células Escamosas/metabolismo , Ácido Graso Sintasas/metabolismo , Proteínas de Neoplasias/metabolismo , Receptor ErbB-2/metabolismo , Neoplasias de la Lengua/metabolismo , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Supervivencia sin Enfermedad , Femenino , Expresión Génica , Genes erbB-2/fisiología , Humanos , Inmunohistoquímica/métodos , Antígeno Ki-67/metabolismo , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Neoplasias de la Lengua/mortalidad , Neoplasias de la Lengua/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Nerve sheath myxoma (NSM) is an extremely rare benign neoplasm in the oral cavity. This paper describes the first case, to our knowledge, of NSM in the gingival mucosa of an 84-year-old female patient. METHODS: Intraoral examination revealed a painless and well-defined nodule in the lingual gingival mucosa of the right mandibular lateral incisor, which measured approximately 1.0 cm in diameter. The lesion was fully excised under local anesthesia, without intercurrences. Hematoxylin and eosin staining was performed in 5-microm sections for histopathologic analysis. Immunohistochemical reactions against vimentin and S-100 protein were carried out in 3-microm histologic sections in accordance with manufacturers' instructions. RESULTS: The patient's medical history and an extraoral exam did not reveal other abnormalities. The patient wore a removable partial denture in the affected area. A trauma-induced gingival hyperplasia was the main diagnostic hypothesis. Microscopically, the lesion was composed of an abundant myxoid matrix and stellated and spindle-shaped cells arranged in lobules separated by fine fibrous septa. The cells presented strong positivity for vimentin and S-100 protein. According to the histopathologic and immunohistochemical features, the diagnosis of NSM was established. After 9 months of treatment, no signs or symptoms of recurrences have been observed. CONCLUSION: Although NSM is an extremely rare oral tumor, it should be considered in the clinical differential diagnosis of gingival nodules.
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Neoplasias Gingivales/diagnóstico , Mixoma/diagnóstico , Neoplasias de la Vaina del Nervio/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Hiperplasia Gingival/diagnóstico , Neoplasias Gingivales/patología , Humanos , Incisivo/patología , Mandíbula/patología , Mixoma/patología , Neoplasias de la Vaina del Nervio/patología , Proteínas S100/análisis , Vimentina/análisisRESUMEN
OBJECTIVE: The aim of this study was to report the clinicopathological features of 18 epithelial tumors of the lacrimal gland treated in a single institution. STUDY DESIGN AND SETTING: Clinical data and treatment were recorded and histological features reviewed. RESULTS: Twelve tumors (66.7%) were adenoid cystic carcinoma (ACC), 5 (27.8%) pleomorphic adenoma (PA), and 1 (5.5%) carcinoma ex pleomorphic adenoma. All patients with ACC presented with advanced clinical stage, and most were treated by wide surgical resection followed by adjuvant radiotherapy. No recurrence was observed in 4 cases of ACC; however, 7 patients died from persistence of disease or by local and/or distant recurrence. All PA patients were successfully treated by surgical resection. CONCLUSIONS: Epithelial lacrimal gland tumors are mainly PA and ACC, and malignancies are more common than benign tumors. Although ACC presented typically with advanced clinical stage, 33% of the patients survived without tumor recurrence or metastasis.