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OBJECTIVE: To evaluate the oxidative DNA damage, through 8-hydroxy-2'-deoxyguanosine (8-OHdG), and its repair by base excision repair pathway [Redox factor-1 (Ref-1); X-ray Repair Cross Complementing-1 (XRCC-1)] in different epithelial dysplasia degrees in oral leukoplakia. DESIGN: Forty-four cases of oral leukoplakia and 10 normal oral mucosa were quantified for 8-OHdG, Ref-1, and XRCC-1 through immunohistochemistry. RESULTS: Cytoplasmic 8-OHdG and nuclear XRCC-1 were significantly associated with multiple synchronous lesions (p = 0.048; p = 0.034, respectively). Nuclear Ref-1 was significantly associated with oral leukoplakia on the tongue (p = 0.027). A significantly gradual cytoplasmic 8-OHdG expression increase was observed between normal oral mucosa and epithelial dysplasia (p < 0.05). Nuclear Ref-1 expression was significantly lower (p < 0.01) in non-dysplasia/mild dysplasia, while its cytoplasmic expression was significantly higher in non-dysplasia/mild dysplasia compared to moderate/severe dysplasia and normal oral mucosa (p = 0.03; p < 0.0001, respectively). A significantly higher cytoplasmic XRCC-1 expression was observed in non-dysplasia/mild and moderate/severe dysplasia compared to normal oral mucosa (p < 0.0001; p < 0.0001, respectively). All epithelial dysplasia degrees showed a correlation between nuclear and cytoplasmic expression of these proteins (p < 0.05). CONCLUSIONS: 8-OHdG formation may not play a role in the development of multiple synchronous oral leukoplakias. However, it is related to the severity of the epithelial dysplasia. The subcellular level of Ref-1 implies different roles according to the degree of epithelial dysplasia. Cytoplasmic XRCC-1 expression indicates a possible failure of the DNA repair mechanism and occurs in early morphological stages of epithelial dysplasia.

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Mucous membrane pemphigoid (MMP) is a blistering disease that predominantly involves the mucous membranes and that can lead to major negative impacts on patient quality of life. The first-line MMP treatment is based on the use of topical and systemic corticosteroids. In this report, we presented a 45-year-old female patient presented blisters in the inferior gingiva for over 8-months. The patient reported being allergic to corticosteroids. Under the clinical hypothesi s of oral lichen planus and MMP, an incisional biopsy was performed, and the histopathological diagnosis of MMP was established. Thus, it was instituted an alternative therapy with tacrolimus 0.03 %. The patient showed an excellent clinical outcome with no recurrence five months after the end of therapy. Tacrolimus 0.03 % may represent an effective therapeutic alternative in MMP treatment and may be used in cases of hypersensitivity to standard therapy.

El penfigoide de la membrana mucosa (PMM) es una enfermedad ampollosa que afecta predominantemente a las membranas mucosas y que puede provocar importantes impactos negativos en la calidad de vida del paciente. El tratamiento de primera línea de PMM se basa en el uso de corticosteroides tópicos y sistémicos. En este informe, presentamos un caso de una paciente femenina de 45 años que presentó ampollas en la encía inferior durante más de 8 meses. La paciente informó ser alérgica a los corticosteroides. Bajo la hipótesis clínica de liquen plano oral y PMM, se realizó una biopsia incisional y se estableció el diagnóstico histopatológico de PMM. Por lo tanto, se instituyó una terapia alternativa con tacrolimus tópico al 0,03 %. La paciente mostró un excelente resultado clínico sin recurrencia después de 5 meses de la terapia final. Tacrolimus 0,03 % puede representar una alternativa terapéutica efectiva en el tratamiento de PMM y se puede usar en casos de hipersensibilidad a la terapia estándar.

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Introdução: a queilite esfoliativa é uma condição dermatológica incomum que ocorre principalmente em mulheres jovens e que afeta o vermelhão dos lábios. Embora a doença seja de etiologia desconhecida, ela tem sido associada a períodos de estresse e ansiedade, como também a hábitos parafuncionais. O seu diagnóstico e manejo constituem um desafio devido à semelhança clínica entre a queilite esfoliativa e outras lesões labiais, o que muitas vezes resulta em recorrência. Objetivo: relatar dois casos clínicos de queilite esfoliativa enfatizando o diagnóstico diferencial com outras lesões que podem acometer os lábios. Relato de Casos: O primeiro caso ocorreu em um paciente do sexo masculino, 21 anos, leucoderma, com queixa de que há dois anos sentia ardência e coceira nos lábios associada a formação de crostas. Ele relatou ter realizado tratamento prévio e possuir problemas de saúde de ordem geral. Exames complementares foram realizados e não mostraram alterações. Assim, a hipótese de queilite esfoliativa foi estabelecida. O paciente foi submetido à biópsia incisional, sob anestesia local, no qual o exame histopatológico confirmou o diagnóstico clínico de queilite esfoliativa, sendo tratado com laserterapia, porém não houve sucesso no tratamento. No segundo caso, uma paciente do sexo feminino, 43 anos, melanoderma, exibindo manchas, fissuras e crostas nos lábios, além de prurido como sintomatologia. Foram solicitados exames complementares que apresentaram padrões de normalidade, assim, o diagnóstico clínico foi de prurigo actínico. Após a realização de biópsia incisional, sob anestesia local, o diagnóstico de queilite esfoliativa foi estabelecido. A paciente foi tratada com corticosteroide tópico, havendo regressão da lesão. Conclusão: o diagnóstico e manejo clínico da queilite esfoliativa é um desafio, deste modo, se faz necessário o estabelecimento de um diagnóstico correto, descartando a hipótese de outras doenças com o auxílio de exames complementares(AU)

Introducción: la queilitis exfoliativa es una condición dermatológica inusual que ocurre principalmente en mujeres y que afecta la superfície de los labios. Aunque es una enfermedad de causa desconocida, ha sido asociada a estrés y ansiedad, así como a hábitos parafuncionales. Su diagnóstico y manejo es un desafío debido a la similitud clínica entre la queilitis exfoliativa y otras lesiones labiales, ya que a menudo estas lesiones tienen recurrencia. Objetivo: describir dos casos clínicos de queilitis exfoliativa enfatizando en el diagnóstico diferencial. Presentación de casos: el primer caso ocurrió en un paciente del sexo masculino de 21 años, raza blanca. Relató que hace dos años sentía ardor en los lábios asociado a la formación de costras. Afirma haber realizado tratamiento previo y no presentar ningún problema de salud. Se realizaron exámenes complementarios y no mostraron ninguna alteración. Así, se estableció la hipótesis de queilitis exfoliativa. El paciente fue sometido a biopsia incisional, bajo anestesia local, en el cual el examen histopatológico confirmó el diagnóstico clínico de queilitis exfoliativa, siendo tratado con laserterapia, sin embargo, no hubo éxito en el tratamiento. En el segundo caso, una paciente de sexo femenino, 43 años, raza negra, exhibiendo manchas, fisuras en los labios, además de prurito como sintomatología. Se solicitaron exámenes complementarios que presentaron valores dentro de la normalidad, por lo que el diagnóstico clínico fue de prurito actínico. Después de la realización de la biopsia incisional, bajo anestesia local, fue establecido el diagnóstico de queilitis exfoliativa. La paciente fue tratada con corticoesteroides tópicos, habiendo regresión de la lesión. Conclusiones: el diagnóstico y manejo clínico de la queilitis exfoliativa es un desafío, por lo que se hace necesario el establecimiento de un diagnóstico correcto, excluyendo otras afecciones con el apoyo de exámenes complementarios(AU)

Introduction: exfoliative cheilitis is an infrequent skin condition that occurs mostly in women, affecting the skin of the lips. Though its etiology is unknown, it has been associated to stress and anxiety, as well as to parafunctional habits. Diagnosis and management are challenging, due to the clinical similarity between exfoliative cheilitis and other lesions of the lips, since these are often recurrent. Objective: describe two clinical cases of exfoliative cheilitis, focusing on the differential diagnosis. Case presentation: the first case was a white male 21-year-old patient who reported having had a burning sensation on his lips associated to crust formation for two years. The patient stated having been under treatment and being in good general health. Complementary tests were indicated which did not reveal any alteration. Thus, the hypothesis of exfoliative cheilitis was put forth. Incisional biopsy was performed under local anesthesia, histopathological examination confirming the clinical diagnosis of exfoliative cheilitis. Laser therapy was indicated, but the treatment was not successful. The second case was a black female 43-year-old patient presenting with spots and fissures on her lips, as well as itching. Complementary tests were indicated which yielded normal values, and thus the clinical diagnosis was actinic prurigo. Incisional biopsy performed under local anesthesia led to the diagnosis of exfoliative cheilitis. The patient was treated with topical corticosteroids, with regression of the lesion. Conclusions: exfoliative cheilitis diagnosis and clinical management are challenging, hence the need to make an accurate diagnosis, excluding other conditions with the aid of complementary tests(AU)

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Nodular fasciitis is a benign, idiopathic, reactive proliferation of myofibroblasts found in the subcutaneous fascia; intraoral occurrence is very rare. An 18-year-old woman was referred to the oral diagnosis service with a 1-month history of a nodular mass in the gingiva. Clinical examination disclosed a well-circumscribed, mobile, pedunculated mass in the left mandibular gingiva. The clinical diagnoses included pyogenic granuloma. She underwent an excisional biopsy under local anesthesia through an intraoral approach. Microscopic examination showed a proliferation of spindle cells arranged in intersecting fascicles. The spindle cells exhibited plump, vesicular nuclei without significant pleomorphism. Scattered multinucleated giant cells also were present. Immunohistochemical stains showed that the lesional cells were positive for smooth muscle actin and vimentin and negative for S-100 protein. The features were those of an inflammatory, benign myofibroblastic lesion, consistent with intraoral nodular fasciitis.

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The glandular odontogenic cyst (GOC) is an uncommon jaw bone cyst of odontogenic origin with unpredictable and potentially aggressive behaviour. It also has the propensity to grow to a large size and tendency towards recurrence. GOC can be easily misdiagnosed microscopically as a central mucoepidermoid carcinoma. This paper reports a case of GOC in a 56-year-old male and reviews the main criteria for accurate diagnosis. The diagnosis of GOC can be extremely difficult due to the rarity of the cyst and lack of clear diagnostic criteria.

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UNLABELLED: Oral squamous cells carcinoma (OSCC) shows unfavorable prognosis due to its invasion potential around the neighboring tissues and the elevated incidence of metastasis. AIM: the present paper aims at analyzing the immunohistochemical expression of the nm23 protein in metastatic and non-metastatic SCCs of tongue. METHODS: the immuno-expression to the nm23-hl protein was diagnosed in 35 tongue SCC (15 of which exhibiting metastasis). Nm23-hl immuno-scores were assigned as follow: score 0 = absent, 1 = focal and 2 = diffuse expression. RESULTS: The Fisher's exact test was performed and there was no statistical difference between the nm23-hl immuno-scores and the tongue SCCs studied cases (p=0.365), although 66.7% of metastatic cases presented negative nm23-hl expression. CONCLUSIONS: Protein nm23 was not associated with a positiveness for tongue SCC without metastasis. Thus, several others factors inherent to host and malignancy can be associated with the mechanisms that suppress the metastatic process in this disease.

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El papel de la respuesta inmunológica en la patogénesis de la enfermedad periodontal constituye tema constante de investigación por diversos autores. En el presente trabajo se propuso realizar un análisis inmunohistoquímico de la densidad y del patrón de distribución de la población celular macrofágica utilizando el anticuerpo anti-CD68 en 17 casos de gingivitis crónica y 25 de periodontitis crónica. Las células CD68+ se distribuyeron difusamente por todo el tejido conectivo. El análisis estadístico reveló diferencia significativa entre los especimenes estudiados (p < 0,05), siendo la densidad de las células macrofágicas mayor en la gingivitis crónica. Los resultados observados sugieren una mayor participación de esas células en la patogénesis de la gingivitis.

The important function of immunological reaction in periodontal disease has been studied by several reports. In order to achieve contributive information to the knowledge of the pathogeny of this disease, an immunohistochemical analysis of the density and distribution of macrophagic cells was realized using anti-CD68 antibody  in 17 cases of chronic gingivitis and 25 cases of chronic periodontitis. The CD68+ cells exhibited diffuse distribution in the connective tissue. The statistical analysis shown differences in relation to the density of this cells between the groups (p < 0,05), where the density of macrophacgic cells was higher in the chronic gingivitis. Its results can infer that the macrophagic cells has greated role in the pathogenesis of gingivitis.