RESUMO
Primary effusion lymphoma (PEL) is an aggressive neoplasm often diagnosed in immunosuppressed patients demonstrating peritoneal, pleural, or pericardial effusions. This high-grade lymphoma is strongly associated with human herpesvirus 8 (HHV8) infection and most of the lesions also show the presence of Epstein-Barr virus in tumor cells, which lacks CD20 expression and reveals a plasmablastic morphology and phenotype. The extracavitary or solid variant of PEL is even rarer and usually affects the lymph nodes and is currently considered a clinical manifestation of the classic PEL. In the oral cavity, extracavitary PEL is extremely rare and only a few patients have been previously reported, with no detailed clinicopathological description. The recognition of oral extracavitary PEL is even more important given the occurrence of plasmablastic lymphoma in the oral mucosa, which shares many clinical, microscopic, and phenotypic features with PEL, therefore, demanding from pathologists the search for HHV8, especially in immunosuppressed patients, and an appropriate clinical evaluation. In this report, we aim to describe a very rare extracavitary PEL affecting the palate of a 36-year-old patient and to review the literature regarding the extracavitary presentation of this aggressive lymphoma. This report demonstrates the importance of searching for HHV8 infection in oral lymphomas with plasmablastic features.
Assuntos
Infecções por Vírus Epstein-Barr , Infecções por Herpesviridae , Linfoma de Efusão Primária , Linfoma , Humanos , Adulto , Linfoma de Efusão Primária/patologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4 , Boca/patologiaRESUMO
A proper antibody panel selection is one of the most important factors to reach an adequate diagnosis in challenging cases. This retrospective study was designed to determine the contribution of immunohistochemistry (IHC) in the primary diagnosis of oral diseases in one of the main services of oral pathology in the State of São Paulo, Brazil, and to identify the most common antibodies used, and recommend diagnostic algorithms based on our experience with challenging lesions. A total of 1698 IHC stains were performed in 401 cases from a total of 28,804 cases received from public dental clinics and private dental practitioners within a period of 13 years, representing a frequency of 1.4% of IHC solicitations. Among these, 112 (28%) were mandatory to reach a final diagnosis and 255 (63.6%) were confirmative. In 34 (8.4%) cases, it was not possible to reach a conclusive/final diagnosis, even with IHC. Regarding the nature of the lesions, 210 (52.3%) were benign, 163 (40.6%) were malignant tumors, 13 (3.2%) were reactive, 10 (2.5%) were premalignant, and 5 (1.2%) were lesions of uncertain malignancy. Small amount of tissue of some incisional biopsies, overlapping features of spindle cell lesions (epithelial, neural, melanocytic, smooth muscle, endothelial, and fibroblastic/myofibroblastic cell differentiation), and overlapping features of salivary gland lesions were the most frequent challenges in which IHC stains were requested. Spindle cell lesions were the most frequent (22%) among all cases that required IHC to reach a final diagnosis. The implementation of IHC for routine practice requires a wide range of markers, proper antibody selection, and knowledge to interpret the subjectivity of staining. The inherent limitation of incisional biopsies was pointed as a reason to inconclusive diagnosis, despite a wide range of antibodies that our laboratory displays.
Assuntos
Imuno-Histoquímica , Neoplasias Bucais , Patologia Bucal , Lesões Pré-Cancerosas , Brasil , Feminino , Humanos , Masculino , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/metabolismo , Neoplasias Bucais/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/metabolismo , Lesões Pré-Cancerosas/patologia , Estudos RetrospectivosRESUMO
Kaposiform hemangioendothelioma is a rare neoplasm with intermediate malignant behavior, mainly affecting infants and children. Involvement head and neck is uncommon, and there are only four cases reported in the oral cavity and oropharynx. Microscopically, it is characterized by a vascular proliferation permeated by spindle-to-ovoid cells resembling Kaposi sarcoma. Immunohistochemically, the tumor is positive for CD31, CD34 and negative for D2-40. Herein we present a rare case of intraoral Kaposiform hemangioendothelioma in a 10-year-old boy.
Assuntos
Hemangioendotelioma/diagnóstico , Síndrome de Kasabach-Merritt/diagnóstico , Neoplasias Bucais/diagnóstico , Sarcoma de Kaposi/diagnóstico , Biomarcadores Tumorais/análise , Criança , Diagnóstico Diferencial , Hemangioendotelioma/patologia , Hemangioendotelioma/cirurgia , Humanos , Síndrome de Kasabach-Merritt/patologia , Síndrome de Kasabach-Merritt/cirurgia , Masculino , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Radiografia Panorâmica , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/cirurgiaRESUMO
AIMS: The hallmarks of type 2 diabetes (T2D) are hyperglycaemia and insulin resistance. These factors, at the cellular level, are associated with mitochondrial dysfunction and increased glucose uptake. Such events are poorly explored in the context of the salivary glands. In this study, we present a series of eight cases of a distinct salivary gland lesion characterised by multiple oncocytic cysts, and we provide new pathological insights regarding its pathogenesis. METHODS AND RESULTS: Seven patients (87.5%) had confirmed T2D, and obesity was identified in five (62.5%) patients. Clinically, the patients showed bilateral parotid gland swelling with recurrent episodes of pain and enlargement. Imaging examination revealed multiple cystic lesions in both parotid glands. Microscopically, the parotid glands showed multiple cysts of different sizes, lined by oncocytic epithelial cells. Intraluminally, strongly eosinophilic glass-like crystalloid material was observed. Immunohistochemical studies were performed, and the most notable finding was glucose transporter 1 (GLUT1) overexpression in the oncocytic cysts which is not observed in any other oncocytic lesion of patients without T2D. In addition, high expressions of mitochondrial antigen, fission 1 protein and mitofusin-2 were observed in the oncocytic epithelium of the cysts. Furthermore, most of the oncocytic cysts showed a pattern of cytokeratin expression consistent with striated ducts. CONCLUSIONS: These results strongly suggest that T2D is associated with alterations in GLUT1 expression in the cells of striated ducts with mitochondrial dysfunction, causing a hyperplastic process characterised by multiple oncocytic cysts. For this lesion, the designation of 'diabetes-associated-bilateral multiple oncocytic cysts of the parotid gland' is proposed.
Assuntos
Cistos/patologia , Diabetes Mellitus Tipo 2/complicações , Transportador de Glucose Tipo 1/metabolismo , Células Oxífilas/patologia , Doenças Parotídeas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/etiologia , Cistos/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Células Oxífilas/metabolismo , Doenças Parotídeas/etiologia , Doenças Parotídeas/metabolismo , Glândula Parótida/metabolismo , Glândula Parótida/patologiaRESUMO
OBJECTIVES: To evaluate clinical and pathologically cases of respiratory scleroma diagnosed in a 30-year period in Guatemala. MATERIAL AND METHODS: Fifty-one cases of respiratory scleroma diagnosed from 1988 to 2018 in a single pathology service in Guatemala were confirmed using Warthin-Starry staining. Immunohistochemical reactions against CD68, LCA, CD20, CD3, and CD138 were performed to illustrate the inflammatory infiltrate. Scanning electron microscopy (SEM) was performed to illustrate bacteria morphology. RESULTS: All 51 cases affected patients from poor areas of Guatemala, particularly women (66.7%), with a mean age of 31 years (range 7-66 years). Nose was affected in most cases (96.1%). Other sites involved included pharynx, larynx, palate, maxillary sinuses, and upper lip. Depending on the stage, the disease manifested as ulcerations, nasal deformities, or laryngeal stenosis. Nasal obstruction, epistaxis, dysphonia, fetid discharge, and pain were the main symptoms. Mikulicz cells (CD68+) in a plasma cell-rich inflammatory background (CD138+, CD20+, CD3+/-) were the typical microscopic presentation. In SEM, each macrophagic vacuole contained few to dozens of Klebsiella rhinoscleromatis diplobacilli. Treatment consisted of long-term trimethoprim and sulfamethoxazole, with adequate control of disease. CONCLUSION: Respiratory scleroma is a rare infectious disease affecting the upper respiratory tract, in poor regions of the world, including Guatemala.
Assuntos
Doenças Respiratórias/diagnóstico , Doenças Respiratórias/microbiologia , Rinoscleroma/diagnóstico , Rinoscleroma/microbiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Guatemala , Humanos , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/ultraestrutura , Macrófagos/microbiologia , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Obstrução Nasal , Doenças Respiratórias/patologia , Rinoscleroma/patologia , Adulto JovemRESUMO
BACKGROUND: Salivary gland tumors (SGT) account for 3-10% of all head and neck neoplasms, and little is known about their angiogenic properties. Despite semaphorins and neuropilins have been demonstrated to be prognostic determinants in many human cancers, they remain to be investigated in SGT. Therefore, the objective of this study was to analyze the clinical significance of the expression of class 3 semaphorins A (Sema3A) and B (Sema3B) and neuropilins-1 (Np-1) and neuropilins-2 (Np-2), in SGT. METHODS: Two hundred and forty-eight SGT were organized in tissue microarray paraffin blocks and expression of CD34, Sema3A, Sema3B, Np-1, and Np-2 was determined through immunohistochemistry. The immunoreactions were quantified using digital algorithms and the results correlated with clinicopathological parameters. RESULTS: Malignant tumors had an increased vascular density than their benign counterparts and their increased vascular area significantly correlated with recurrences (P < 0.05). Patients older than 40 years and the presence of recurrences determined an inferior survival rate (P = 0.0057 and P = 0.0303, respectively). In normal salivary glands, Np-1 and Np-2 expression was restricted to ductal cells, whereas Sema3A and Sema3B were positive in the serous acinar compartment. Tumors were positive for all markers and the co-expression of Np-1/Np-2 significantly correlated with the presence of paresthesia and advanced stages of the tumors (P = 0.01 and P = 0.04, respectively). CONCLUSION: Sema3A, Sema3B, Np-1, and Np-2 may be involved in the pathogenesis of SGT, but their expression did not present a statistically significant prognostic potential in this study.
Assuntos
Neuropilinas/biossíntese , Neoplasias das Glândulas Salivares/metabolismo , Semaforinas/biossíntese , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos CD34/sangue , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Criança , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neuropilinas/genética , Prognóstico , Neoplasias das Glândulas Salivares/genética , Neoplasias das Glândulas Salivares/patologia , Semaforinas/genética , Taxa de Sobrevida , Adulto JovemRESUMO
Verruciform xanthoma of the oral cavity is an uncommon benign lesion that usually affects the palate and gingiva mainly as a well-circumscribed solitary yellowish to whitish plaque or nodule, which is promptly recognized microscopically by identification of sub-epithelial foamy macrophages. The aim of this study was to evaluate the clinicopathologic and immunohistochemical features of 20 cases of oral verruciform xanthoma. All cases were evaluated by conventional hematoxylin/eosin staining and six of those were submitted to immunohistochemical reactions for CD68, CD63, CD163, syndecan-1 (CD138), S-100 protein and cytokeratins (CK) 8, 14 and 19. Oral verruciform xanthoma presented as yellowish papillary nodules affecting mainly the palate (30%), buccal mucosa (30%) and gingiva (25%) of middle-aged male patients. Most cases presented papillary epithelial hyperplasia and sub-epithelial foamy cells, which were immunopositive for CD68, CD63 and CD163 in all cases. The orange parakeratin superficial layer was negative for CK14 and presented a distinct granular membrane pattern of positivity for CD138. S-100 protein, CK8, and CK19 were negative.
Assuntos
Doenças da Boca/metabolismo , Doenças da Boca/patologia , Xantomatose/metabolismo , Xantomatose/patologia , Adulto , Idoso , Antígenos CD/metabolismo , Antígenos de Diferenciação Mielomonocítica/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Queratinas/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores de Superfície Celular/metabolismo , Proteínas S100/metabolismo , Sindecana-1/metabolismo , Tetraspanina 30/metabolismoRESUMO
AIMS: To assess the DNA content of cases of oral proliferative verrucous leukoplakia (PVL) and correlate the DNA ploidy findings with the expression of Mcm2, geminin, and Ki67, and with clinicopathological data. METHODS AND RESULTS: DNA quantification was performed by image cytometry using the ACIS III Automated Cellular Imaging System. Expression of Ki67, Mcm2 and geminin was determined by immunohistochemistry. There were 21 cases of PVL, the female/male ratio was 6:1, and the average age was 65.5 years. Seventeen patients (81.0%) did not report tobacco and alcohol consumption. Nine patients (42.9%) developed verrucous or squamous cell carcinoma. Levels of Mcm2 expression showed a positive correlation with increasingly severe epithelial changes (P = 0.03). Twenty patients had their DNA examined by ACIS III, and 19 (95%) showed aneuploidy. The frequency and severity of aneuploidy (P < 0.0001), the mean values of the DNA heterogeneity index (P < 0.0001) and the 5n-exceeding fractions (P = 0.0007) increased according to epithelial alterations. Abnormal DNA content was observed even in the more indolent lesions. CONCLUSIONS: Mcm2 expression and DNA ploidy analysis could be used to predict areas of malignant transformation. The clinicopathological findings associated with the immunohistochemical and DNA ploidy results support the distinct and aggressive profile of this entity.
Assuntos
Aneuploidia , Carcinoma Verrucoso/patologia , Proteínas de Ciclo Celular/metabolismo , Leucoplasia Oral/patologia , Neoplasias Bucais/patologia , Proteínas Nucleares/metabolismo , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Carcinoma Verrucoso/genética , Carcinoma Verrucoso/metabolismo , Proliferação de Células , Transformação Celular Neoplásica , DNA de Neoplasias/genética , Feminino , Geminina , Humanos , Citometria por Imagem , Imuno-Histoquímica , Antígeno Ki-67/metabolismo , Leucoplasia Oral/genética , Leucoplasia Oral/metabolismo , Masculino , Pessoa de Meia-Idade , Componente 2 do Complexo de Manutenção de Minicromossomo , Neoplasias Bucais/genética , Neoplasias Bucais/metabolismo , Estudos RetrospectivosRESUMO
OBJECTIVE: To analyze the expression of ErbB-1 (Her-1 or EGFR), ErbB-2 (Her-2 or neu), ErbB-3 (Her-3) and ErbB-4 (Her-4) and their correlation in 3 different types of salivary gland tumors. STUDY DESIGN: Immunohistochemical expression of epidermal growth factor (EGF), EGFR, ErbB-2, fatty acid synthase (FAS) and Ki-67 were analyzed in 41 pleomorphic adenoma (PA), in 30 mucoepidermoid carcinoma (MEC) and in 30 adenoid cystic carcinoma (ACC) and correlated with their histologic patterns. RESULTS: EGF was more common in MEC and PA, but MEC had a higher percentage of strongly positive cases. EGFRc and EGFRm were both more frequent in MEC and ACC. Higher scores of ErbB-2c were observed in PA, followed by MEC and ACC. In contrast, higher scores of ErbB-2m were more common in MEC as compared to ACC and PA. FAS was most commonly found in PA and MEC. Moreover, MEC showed the highest percentage of strongly positive cases. Ki-67 was higher in MEC and ACC than in PA. From a correlation of immunomarkers with the histologic patterns, it was observed that cribriform ACC presented more expression of EGFR and high grade MEC showed a higher percentage of ErbB-2, FAS and Ki-67. CONCLUSION: EGF, EGFR, ErbB-2 and FAS were commonly found and seem to be important in the tumorigenesis of salivary gland tumors, particularly in percentage of strongly positive cases. Ki-67 was higher in MEC and ACC than in PA. From a correlation of immunomarkers with the histologic patterns, it was observed that cribriform ACC presented more expression of EGFR and high grade MEC showed a higher percentage of ErbB-2, FAS and Ki-67. CONCLUSION: EGF, EGFR, ErbB-2 and FAS were commonly found and seem to be important in the tumorigenesis of salivary gland tumors, particularly in MEC. (Anal Quant Cytol Histol 2009;31:280-287)