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El síndrome de Jadassohn-Lewandowsky o paquioniquia congénita tipo 1 pertenece al grupo de las enfermedades raras. A nivel mundial se han descrito hasta la fecha menos de mil casos y el que ahora se publica constituye el primer reporte en la edad pediátrica en Cuba. Es un paciente masculino, de siete años de edad ingresado en el Servicio de Clínicas Pediátricas del Hospital Pediátrico Provincial de Holguín con antecedentes de uñas amarillas e hipertróficas desde los nueve meses de edad. Al examen físico se constató la presencia de distrofia ungueal hipertrófica en las 20 uñas, queratosis folicular en codos, manos y miembros inferiores, queratodermia plantar focal y leucoqueratosis oral. Se identificó un patrón de herencia autosómico dominante. Basado en las características fenotípicas y los antecedentes familiares se clasificó el caso presentado como paquioniquia congénita tipo 1, para la cual aún no existe cura y la terapia génica se encuentra en investigación. Por lo poco común de la enfermedad y ser el primer caso en edad pediátrica en Cuba, se decidió su publicación.
Jadassohn-Lewandowsky syndrome or congenital pachyonychia type 1 belongs to the rare diseases' group. Worldwide, less than a thousand cases have been described to date and the one that is now published constitutes the first pediatric age report in Cuba. A seven-years-old male patient admitted to the Pediatric Clinic Service at the Holguín Provincial Pediatric Hospital with a history of yellow and hypertrophic nails since he was nine months old. The physical examination confirmed the presence of hypertrophic nail dystrophy in all 20 nails, keratosis follicularis on the elbows, hands and lower limbs, focal plantar keratoderma and oral leukokeratosis. An autosomal dominant inheritance pattern was identified. Based on the phenotypic characteristics and family history, the case presented was classified as congenital pachyonychia type 1, for which there is still no cure and gene therapy is under investigation. Due to the rareness of the disease and being the first pediatric age case in Cuba, its publication was decided.
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Abstract Oral cancer is a public health problem worldwide with approximately 300,000 new cases diagnosed every year and more than 170,000 deaths annually. Squamous cell carcinoma (SCC) accounts for approximately 90% of all oral malignancies and it is frequently preceded by lesions known as oral potentially malignant disorders (OPMDs). Screening programs for early detection of oral lesions have been conducted. Therefore, the objective of this research was to carry out an active search in a screening program in the city of Piracicaba, Brazil. High-risk patients were identified at the city's health center through their medical records and referred for dental consultation. Other patients who opportunistically sought dental care were also seen and if they did not present risk factors for SCC, they were considered low-risk. A total of 756 patients were examined, and 445 met the criteria for the high-risk group and 311 for the low-risk group. It was possible to diagnose 27 OPMDs and six SCCs - 21 OPMDs and six SCCs occurred in high-risk patients and six OPMDs in low-risk patients. A chi-square test was applied and a statistically significant value (p = 0.006) was obtained for the detection of OPMD and SCC in patients of the high-risk group. Screening of high-risk patients through active search proved to be an effective program for diagnosing OPMD and SCC. Therefore, we encourage its implementation on a large scale to reduce the current scenario of this disease.
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Introducción: Las lesiones blancas en cavidad bucal constituyen un problema de salud que responde a causas diversas y afectan a una cifra considerable de personas a nivel mundial. Las condiciones y resultados del diagnóstico clínico de las lesiones sin un basamento histopatológico solo exhiben deducciones empíricas basadas en la experiencia clínica acumulada, que pueden concordar o no con la real naturaleza de la enfermedad diagnosticada. El estudio de su concordancia permite evidenciar la certeza del diagnóstico clínico. Objetivo: Determinar la concordancia clínica e histopatológica de lesiones blancas presentes en cavidad bucal. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en 193 pacientes con lesiones blancas en cavidad bucal seleccionados mediante muestreo no probabilístico de tipo intencionado, que acudieron al Servicio de Estomatología del Policlínico Arturo Puig Ruiz de Villa del municipio Minas, provincia Camagüey, en el período comprendido de enero de 2020 a enero de 2022. Se realizó biopsia de las lesiones para correlacionar el diagnóstico clínico y el diagnóstico histopatológico. Se evaluó la concordancia de los resultados mediante el índice de Kappa. Resultados: Predominó el grupo de edades de 40-49 años, los pacientes más afectados correspondieron al sexo femenino y el color de piel blanca, la lesión que predominó fue la leucoplasia con displasia, el subsitio anatómico más afectado es la mucosa del carrillo y más de la mitad de los pacientes se relacionaron con el tabaquismo como factor de riesgo. La fuerza de concordancia de la leucoplasia fue muy buena respecto al liquen plano y la candidiasis crónica hiperplásica (buena). El carcinoma espinocelular tuvo un nivel de concordancia moderado. Conclusión: Se promediaron los resultados de concordancia para las lesiones blancas presentes en cavidad bucal en los 193 pacientes de la investigación y de manera general el estudio mostró buena concordancia.
Introduction: White lesions in the oral cavity constitute a health problem that responds to diverse causes and affects a considerable number of people worldwide. The conditions and results of the clinical diagnosis of lesions without a histopathological basis only show empirical deductions based on accumulated clinical experience, which may or may not agree with the real nature of the clinically diagnosed entity. The study of their concordance allows evidencing the certainty of the clinical diagnosis. Objective: To determine the clinical and histopathological concordance of white lesions present in the oral cavity. Methods: A cross-sectional descriptive observational study was carried out in 193 patients with white lesions in the oral cavity selected by non-probabilistic purposive sampling who attended the Department of Dentistry of the Arturo Puig Ruiz de Villa Polyclinic from January 2020 to January 2022. The lesions were biopsied to correlate the clinical diagnosis and histopathological diagnosis. The concordance of the results was evaluated using the Kappa index. Results: The predominant age group was 40-49 years, the most affected patients were female and white skin color, the predominant lesion was leukoplakia with dysplasia, the most affected anatomical subsite was the cheek mucosa and more than half of the patients were related to smoking as a risk factor. The concordance strength of leukoplakia was very good with respect to lichen planus and hyperplastic chronic candidiasis (good). Squamous cell carcinoma had a moderate level of concordance. Conclusion: The concordance results for white lesions present in the oral cavity in the 193 patients of the study were averaged and in general the study showed a good concordance.
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As Desordens Potencialmente Malignas Orais (DPMO) descrevem um grupo de doenças com risco aumentado de desenvolver o Carcinoma Espinocelular (CEC), e a mais comum é a Leucoplasia Oral (LO), que apresenta uma variante agressiva denominada Leucoplasia Verrucosa Proliferativa (LVP). Descrita pela primeira vez em 1985 por Hansen et al., a LVP é considerada uma forma multifocal incomum da doença, com curso clínico agressivo e implacável para malignidade, sem associação com os fatores de risco tradicionais da LO. O diagnóstico e manejo dessa variante é um desafio, pois, além da ausência de biomarcadores comprovados que possam predizer seu curso evolutivo, a subjetividade existente na sua avaliação clínica e histopatológica, faz com que a presença ou grau de Displasia Epitelial Oral (DEO) não consiga determinar se haverá ou não transformação maligna da lesão. O objetivo desse trabalho foi realizar uma Revisão da Literatura Tradicional, focando especificamente nos aspectos sobre diagnóstico, transformação maligna, manejo e tratamento da LVP, variante agressiva da LO. Concluímos que, ainda hoje, não existem biomarcadores que possam predizer o avanço das LO, tornando-se obrigatório o acompanhamento e/ou tratamento de toda e qualquer LO, inclusive os casos de Queratose de significado incerto.
Oral Potentially Malignant Disorders (OPMDs) describe a group of diseases at increased risk of leading to Squamous Cell Carcinoma (SCC). The most common is Oral Leukoplakia (OL), which presents itself through an aggressive variant known as Proliferative Verrucous Leukoplakia (PVL). First described in 1985 by Hansen et al., PVL is considered an uncommon multifocal form of the disease, with an aggressive and relentless clinical course towards malignancy, and lacks association with traditional OL risk factors. The diagnosis and management of this disease form posits a significant challenge since, in addition to the absence of proven biomarkers that can predict its evolutionary course, the subjectivity existing in its clinical and histopathological evaluation means that the presence or degree of Oral Epithelial Dysplasia (OED) is not enough to determine whether or not the lesion will undergo a malignant transformation. The objective of this work was to carry out a Traditional Literature Review focused specifically on aspects of diagnosis, malignant transformation, management and treatment of PVL, an aggressive variant of OL. Our conclusion is that, to this day, there are no biomarkers able to predict the progress of OL, making it necessary to monitor and/or treat all OL cases, including cases of Keratosis of unknown significance.
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ABSTRACT Objective: To determine the frequency of oral potentially malignant disorders and Oral Squamous Cell Carcinoma (OSCC) and evaluate the consistency between their clinical and pathological features. Material and Methods: This retrospective study was conducted on records with a diagnosis of oral leukoplakia, oral erythroplakia, erythroleukoplakia, actinic cheilitis, lichen planus, and OSCC in the Pathology Department of Kerman dental school from September 1997 to September 2017. Data were analyzed in SPSS 21 at the significance level of ≤5%. Results: There were 378 cases of oral potentially malignant disorders and 70 cases of OSCC with a mean age of 46.82 ± 15.24 years. Buccal mucosa was the most frequent site, and lichen planus the most common lesion. Females were significantly older than males in leukoplakia and carcinoma in situ lesions. Clinical diagnosis and histopathology were consistent in 69.03% of cases. Conclusion: Clinical and histopathological diagnoses were consistent in 69.03% of records. The highest degree of clinical compliance with histopathology was observed in OSCC. Dentists should pay attention to oral potentially malignant disorders for early diagnosis to prevent their transformation to malignancy.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Leucoplasia Oral , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas/patologia , Diagnóstico Clínico/diagnóstico , Prontuários Médicos , Líquen Plano Bucal , Patologia Bucal , Queilite , Epidemiologia Descritiva , Estudos Retrospectivos , Interpretação Estatística de Dados , Diagnóstico Precoce , Eritroplasia , Irã (Geográfico)RESUMO
Abstract The purpose of this study was to analyze the differential expression of DEC1 in oral normal mucosa (NM), oral leukoplakia (OLK) and oral squamous cell carcinoma (OSCC). Surgically excised specimens from patients with OLK (n = 47), OSCC (n = 30) and oral normal mucosa (n=11) were immunostained for DEC1. The expression of DEC1 protein was evaluated, and its association with the clinicopathological features was analyzed. The expression of DEC1 in NM, OLK and OSCC tissues increased in turn, and significant differences were observed among the groups (P < 0.0001). In terms of the association between DEC1 expression and epithelial dysplasia, DEC1 expression was lower in hyperkeratosis without dysplasia (H-OLK) than in OLK with moderate to severe dysplasia (S-OLK), and these differences were significant (p < 0.05). The expression of DEC1 in OSCC with OLK was significantly higher than that in OSCC without OLK (p < 0.01). Therefore, DEC1 could be a potential biomarker of malignant transformation in the carcinogenesis of OSCC, which may provide a new research direction for the transformation of oral potentially malignant disorders (OPMDs) into OSCC.
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Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Leucoplasia Oral/patologia , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas/patologia , Proteínas Supressoras de Tumor/análise , Valores de Referência , Imuno-Histoquímica , Biomarcadores Tumorais/análise , Transformação Celular Neoplásica/patologia , Reprodutibilidade dos Testes , Fatores de Risco , Análise de Variância , Fatores Etários , Estatísticas não Paramétricas , Pessoa de Meia-IdadeRESUMO
Abstract Oral leukoplakia (OL) is a white lesion of an indeterminate risk not related to any excluded (other) known diseases or disorders that carry no increased risk for cancer. Many biological markers have been used in an attempt to predict malignant transformation; however, no reliable markers have been established so far. Objective To evaluate cell proliferation and immortalization in OL, comparing non-dysplastic (Non-dys OL) and dysplastic OL (Dys OL). Methodology This is a cross-sectional observational study. Paraffin-embedded tissue blocks of 28 specimens of Non-dys OL, 33 of Dys OL, 9 of normal oral mucosa (NOM), 17 of inflammatory hyperplasia (IH), and 19 of oral squamous cell carcinomas (OSCC) were stained for Ki-67 and BMI-1 using immunohistochemistry. Results A gradual increase in BMI-1 and K-i67 expression was found in oral carcinogenesis. The immunolabeling for those markers was higher in OSCC when compared with the other groups (Kruskal-Wallis, p<0.05). Ki-67 expression percentage was higher in OL and in IH when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). Increased expression of BMI-1 was also observed in OL when compared with NOM (Kruskal-Wallis/Dunn, p<0.05). No differences were observed in expression of both markers when non-dysplastic and dysplastic leukoplakias were compared. A significant positive correlation between Ki-67 and BMI-1 was found (Spearman correlation coefficient, R=0.26, p=0.01). High-grade epithelial dysplasia was associated with malignant transformation (Chi-squared, p=0.03). Conclusions These findings indicate that BMI-1 expression increases in early oral carcinogenesis and is possibly associated with the occurrence of dysplastic changes. Furthermore, our findings indicate that both Ki-67 and BMI-1 are directly correlated and play a role in initiation and progression of OSCC.
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Humanos , Animais , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Leucoplasia Oral/patologia , Neoplasias Bucais/patologia , Carcinoma de Células Escamosas/patologia , Antígeno Ki-67/análise , Complexo Repressor Polycomb 1/análise , Mucosa Bucal/patologia , Imuno-Histoquímica , Estudos Transversais , Fatores de Risco , Estatísticas não Paramétricas , Progressão da Doença , Proliferação de Células , Carcinogênese/patologiaRESUMO
Objective: To compare the use of Fresh Frozen Amniotic Membrane (FFAM) and Buccal Pad of Fat (BPF) for reconstruction of oral mucosal defect after surgical excision of leukoplakia. Material and Methods: Twenty patients were randomly selected and divided into two groups. Group 1 use amniotic membrane graft and Group 2 BPF. Both groups were evaluated preoperatively and postoperatively. Incisal opening, epithelialization and fibrosis were evaluated after one month of surgery. Chi square and Student t tests were used. Results: According to the presence of smoking habits, the highest frequencies were for smoking (30%) and betel leaf areca nut with tobacco (30%). Regarding the diameter of oral leukoplakia, in 40% of the participants it was 2x3 cm2. In Group1, after one month of surgery preoperative and postoperative inter-incisal opening values were 44.20 ± 3.37 and 42.05 ± 3.47 (p<0.001). In Group 2, preoperative and postoperative inter-incisal opening values were 44.09 ± 3.32 and 43.01±3.38 (p>0.05). When FFAM was used complete epithelialization in 70% and incomplete epithelialization in 30% patients. When BPF was used the results were almost similar. Fibrosis occurred in 30% in Group 1. There were no complications like flap necrosis, infectiona and hematoma formation. Conclusion: Incisal opening was significantly better in Fresh Frozen Amniotic Membrane Group, epithelialization and fibrosis were almost same in both groups after surgical excision of oral leukoplakia.
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Humanos , Leucoplasia Oral/diagnóstico , Neoplasias Bucais/patologia , Fumar Tabaco , Âmnio , Mucosa Bucal/patologia , Distribuição de Qui-Quadrado , Estatísticas não ParamétricasRESUMO
Objective: To determine the prevalence of Candida species in the saliva of patients with clinically suspected oral potentially malignant disorders (OPMD) and healthy cohorts. Material and Methods: Unstimulated saliva was collected from patients with OPMD (n=100) and age and sex matched healthy subjects (n=170). The samples were inoculated onto Sabouraud Dextrose Agar and incubated for a week. The colonies of the isolates were enumerated using a colony counter. The isolates were identified using standard phenotypic methods. The significance of oral candidal carriage was calculated using Independent T test. Odds and Risk ratio was calculated using Pearson's Chi-square test. Results: Oral candida carriage was present in 51% of patients with OPMD while healthy cohorts had a prevalence of 20.6%. A good statistical significance was observed for the prevalence of oral candidal carriage for patients with OPMD in comparison to healthy cohorts (p=0.013). Significant Odds and risk ratio was observed for the prevalence of Candida species among OPMD. Majority of the isolates in both groups were C. albicans. Colony forming units were high among patients with OPMD. Conclusion: A significant association of oral candidal carriage to oral potentially malignant disorders in comparison to healthy cohorts was observed. Candidal species may be potent risk factor for transition of OPMD to oral Squamous Cell Carcinoma.
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Humanos , Masculino , Feminino , Fenótipo , Candidíase Bucal/prevenção & controle , Leucoplasia Oral , Neoplasias Bucais/patologia , Estudos de Casos e Controles , Fibrose Oral Submucosa/patologia , Candida albicans , Distribuição de Qui-Quadrado , ÍndiaRESUMO
RESUMEN Fundamento: la detección precoz de la leucoplasia, como la lesión premaligna más común de la cavidad oral, y cuya presencia supone un marcador de aumento del riesgo de cáncer bucal, se incluye entre las nuevas perspectivas en el diagnóstico precoz de este cáncer. Objetivo: caracterizar la leucoplasia bucal. Métodos: se realizó un estudio observacional descriptivo transversal, el universo estuvo compuesto por 114 pacientes diagnosticados con leucoplasia bucal y la muestra quedó conformada por similar número de pacientes. Los datos obtenidos procedentes de las boletas de biopsia fueron recogidos en un formulario a propósito de la investigación. Resultados: predominaron los pacientes entre 50 y 59 años. El hábito de fumar se encontró en 58 pacientes mientras que el consumo de alcohol solo en 10. En los pacientes menores de 50 años la aparición de displasia estuvo influenciada por el consumo de tabaco, se encontró asociación entre el tamaño igual o mayor a tres centímetros y la aparición de manifestaciones clínicas cuando se trató de lesiones únicas. Conclusiones: en la mayoría de los pacientes estudiados se constató hábito de fumar y al examen clínico no mostraron síntomas. El tamaño se asoció a la aparición de manifestaciones clínicas en los pacientes con lesiones únicas y no así en aquellos con lesiones múltiples. En un grupo de pacientes se detectó la presencia de alteraciones microscópicas con predominio de la displasia leve.
ABSTRACT Background: early detection of leukoplakia, the most common premalignant lesion of the oral cavity, and whose presence is a marker of increased risk of oral cancer, is included among the new perspectives in the early diagnosis of this cancer. Objective: to characterize the oral leukoplakia. Methods: a cross-sectional analytical study was carried out, the universe was composed of 114 patients clinically diagnosed with oral leukoplakia and the sample was composed of equal numbers of patients. The data obtained from biopsy ballots was collected in a form about the investigation. Results: patients were predominantly between 50 and 59 years. Smoking was found in 58 patients while alcohol only in 10. In patients younger than 50 years, the development of dysplasia was influenced by the consumption of tobacco; it was found association between the size equal to or greater than three centimeters and the appearance of clinical symptoms when treated with single lesions. Conclusions: most of the studied patients had smoking habits and they were clinically asymptomatic. The size was associated with the onset of clinical manifestations in patients with single lesions and not in those with multiple injuries. In a group of patients, the presence of microscopic alterations with prevalence of mild dysplasia was detected.
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Abstract Introduction: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Objective: To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. Methods: A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. Results: There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. Conclusion: More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.
Resumo Introdução: Leucoplasia verrucosa proliferativa (LVP) é uma lesão multifocal e progressiva da mucosa oral, com etiologia desconhecida e comumente resistente a todas as tentativas terapêuticas, com recorrências frequentes. É caracterizada por uma alta taxa de transformação em carcinoma de células escamosas e carcinoma verrucoso da cavidade oral. Objetivo: Analisar os estudos sobre LVP e elaborar uma atualização resumida. Método: Foi realizada uma pesquisa na base de dados Pubmed que identificou estudos (pesquisas laboratoriais, séries de casos e revisões de literatura) que avaliaram pacientes com LVP. Resultados e discussão: Não há estudos suficientes sobre LVP na literatura. Os poucos estudos encontrados não apresentam consenso quanto aos critérios de etiologia e diagnóstico. Embora várias estratégias de tratamento tenham sido propostas, a maioria ainda apresenta alta taxa de recorrência. Conclusão: Mais pesquisas sobre LVP são necessárias para entender e tratar essa doença.
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Humanos , Masculino , Feminino , Leucoplasia Oral/diagnóstico , Leucoplasia Oral/etiologia , Leucoplasia Oral/patologia , Leucoplasia Oral/terapiaRESUMO
INTRODUCTION: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. OBJECTIVE: To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. METHODS: A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. RESULTS: There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. CONCLUSION: More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.
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Leucoplasia Oral , Feminino , Humanos , Leucoplasia Oral/diagnóstico , Leucoplasia Oral/etiologia , Leucoplasia Oral/patologia , Leucoplasia Oral/terapia , MasculinoRESUMO
Abstract Potentially malignant disorders (PMDs) of oral cavity and oral cancer remain a cause of serious concern despite intensive research and development. Diet and immunity have been identified to play a crucial role as modifying factors in these diseases. Our study intended to explore this relationship by estimating and comparing the serum levels of copper, iron and circulating immune complexes (CICs) in patients diagnosed with PMDs and oral cancer and normal healthy individuals. In this study, 40 histopathologically diagnosed cases of PMDs and oral cancer were included along with 30 healthy controls and 5 ml of venous blood was drawn using venipuncture. Serum estimation of copper, iron and CIC then followed using the colorimetric and spectrophotometric methods. The data obtained was subjected to statistical analysis using one way ANOVA and Pearson's Product-Moment Correlation Test. The mean serum copper level was measured as 138.98 ± 10.13µg/100ml in the PMD group and 141.99 ± 21.44 µg/100ml in the oral cancer as compared to 105.5 + 18.81µ/100ml in the controls. The mean serum CIC levels was highest in the oral cancer (9.65 ± 0.16OD470) followed by the PMD group (0.18 + 0.21 OD470) and least in the control group (0.048 ± 0.02OD470). Whereas, the serum levels of iron showed a significant decrease in the PMD group (110.9 ± 10.54 µg/100ml) and the oral cancer group (114.29 ± 25.83 µg/100ml) as compared with the control group (136.85 ± 14.48 µg/100ml). There was no positive correlation obtained between the three groups with respect to the chosen parameters indicating that the variables were independent of each other. It can be thus be ascertained that trace elements like copper and iron as well as humoral responses (CICs) have a close relationship with PMDs and oral cancers.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Fibrose Oral Submucosa/sangue , Neoplasias Bucais/sangue , Carcinoma de Células Escamosas/sangue , Líquen Plano Bucal/sangue , Cobre/sangue , Ferro/sangue , Complexo Antígeno-Anticorpo/sangue , Lesões Pré-Cancerosas/sangue , Valores de Referência , Biomarcadores/sangue , Estudos de Casos e Controles , Fatores de Risco , Análise de Variância , Distribuição por Sexo , Distribuição por Idade , Diagnóstico Precoce , Pessoa de Meia-IdadeRESUMO
Fundamento: se ha postulado que el hábito de fumar invertido intensifica la severidad de las enfermedades de la mucosa bucal y expone a las personas a riesgos severos en la salud oral. Objetivo: revisar la literatura científica acerca de las enfermedades de la mucosa oral asociadas con el hábito de fumar invertido. Método: se realizó una revisión sistemática de investigaciones observacionales y experimentales publicadas en las bases de datos Medline-Pubmed y SCIELO desde 1960 hasta 2012. Se utilizaron términos en diferentes combinaciones: nicotinic stomatitis, reverse smoking, reverse smokers, oral cancer, oral premalignant lesions y tobacco. Se excluyeron las series de casos, resultados duplicados debido a las combinaciones de los términos de búsqueda, datos no disponibles, cartas al editor y revisiones históricas. Desarrollo: se detectó en todos los estudios revisados que el hábito de fumar invertido es más frecuente en mujeres que en hombres. Doce investigaciones mostraron asociación entre el hábito de fumar invertido y carcinoma del paladar duro o tumores microinvasivos. Se observó que los fumadores invertidos tienen muchas más probabilidades de presentar parches y áreas rojas en el paladar, además de leucoplasias y carcinomas. El riesgo estimado de presentar carcinoma del paladar duro fue 132 veces mayor en mujeres con el hábito de fumar invertido. Las tasas de mortalidad ajustadas por edad fueron casi dos veces más altas para los fumadores invertidos en comparación con aquellas personas que no fumaban. Conclusiones: el hábito de fumar invertido está asociado con el cáncer oral y con otras enfermedades avanzadas de la mucosa bucal. Se deben realizar estudios de intervención para tratar de persuadir a las poblaciones acerca del abandono de los hábitos de tabaquismo.
Background: It is been said that the reversed smoking habit intensifies the seriousness of the diseases of the buccal mucosa and put people at serious risks regarding oral health. Objective: to revise the scientific literature related to the diseases of the oral mucosa associated to reversed smoking habit. Method: a systematic revision of observational and experimental investigations published in the Medline-PubMed and SciELO data bases from 1960 to 2012 was made. Terms were used in different combinations: nicotinic stomatitis, reverse smoking, reverse smokers, oral cancer, oral premalignant lesions y tobacco. Series of cases, duplicated results due to combinations of search terms, non-available data, letters to the editor and historical revisions were excluded. Results: in all the revised studies it was revealed that reversed smoking habit is more frequent in women than in men. Twelve investigations showed association between reversed smoking habit and carcinoma of the hard palate or microinvasive tumors. It was observed that inverted smokers are at more risk of presenting blotches and red areas in the palate, as well as leukoplakias and carcinomas. The estimated risk of presenting carcinoma of the hard palate was 132 times higher in women that have the reverse smoking habit. Mortality rates set by age were almost twice higher for reverse smokers compared to non-smokers. Conclusions: reversed smoking habit is associated to oral cancer and to other advanced diseases of the buccal mucosa. Intervention studies should be conducted in order to try to persuade populations to quit smoking.
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Oral leukoplakias (OL) are potentially malignant lesions that are typically white in color. Smoking is considered a risk factor for developing OL, and dysplastic lesions are more prone to malignant transformation. The aim of this study was to describe the clinical features observed in dysplastic and non-dysplastic OL in both smokers and non-smokers. A total of 315 cases of OL were retrieved and separated into either dysplastic or non-dysplastic lesions, and these cases were further categorized as originating in either smokers or non-smokers. Frequencies of the type of OL lesion, with respect to whether the patients smoked, were established. The results demonstrated that 131 cases of OL were dysplastic (74 smokers and 57 non-smokers), and 184 were non-dysplastic (96 smokers and 88 non-smokers). For OL cases in smokers for which information about alcohol consumption was also available (84 cases), the results revealed no significant difference in the amount of dysplastic and non-dysplastic lesions. Dysplastic lesions were more frequent in male smokers and in non-smoking females. The median age of smokers with cases of OL was significantly lower than in non-smokers; the lowest median ages were observed for female smokers with dysplastic OL. The most frequent anatomical sites of dysplastic lesions were the floor of the mouth in smokers and the tongue in non-smokers. Dysplastic lesions in smokers were significantly smaller than non-dysplastic lesions in non-smokers. Being a male smoker, being female, being younger, and having smaller lesions were associated with dysplastic features in OL. These clinical data may be important for predicting OL malignant transformation.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucoplasia Oral/patologia , Fumar/patologia , Distribuição de Qui-Quadrado , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Estatísticas não Paramétricas , Fumar/efeitos adversos , Língua/patologiaRESUMO
Leukoplakia is the most prevalent precancerous lesion of the oral cavity, and given it is malignant potential, patients must periodically be followed up. The aim of this article was to report a clinical case a woman patient, alcohol abuser and smoker for over 25 years, who is an oral leukoplakia carrier. Histopathological examination indicated the presence of a moderate epithelial dysplasia while immunohistochemistry for Ki-67 and cyclin D1 revealed the presence of cellular proliferation in suprabasal layers. Therefore, the removal of the lesion with surgical laser was the elected treatment. Since then, the patient has been followed up for 3 years, however, after two sequential follow up absences, she returned with recurrence of the lesion, with a history of eight months progression. Histopathological examination revealed the presence of a well differentiated carcinoma.
A leucoplasia é a lesão cancerizável mais prevalente da boca, foi definida pela Organização Mundial de Saúde como mancha ou placa branca, que não se caracterizada como outra lesão bucal. Devido ao seu potencial de malignização, os pacientes com leucoplasias devem ser acompanhados periodicamente. O objetivo desde artigo é relatar o caso de uma paciente do gênero feminino, etilista e tabagista há mais de 25 anos com leucoplasia bucal. O exame histopatológico indicou a presença de displasia epitelial moderada e a imunomarcação pelo Ki-67 e ciclina D1 revelou a presença de proliferação celular em camadas suprabasais. Por essa razão, optou-se pela remoção da lesão com o laser cirúrgico. A paciente permaneceu em acompanhamento semestral por três anos, entretanto, após faltar a duas revisões, retornou com recidiva da lesão com história de evolução de oito meses e cujo exame histopatológico revelou a presença de carcinoma espinocelular bem diferenciado.
Assuntos
Carcinoma/diagnóstico , Carcinoma/patologia , Cirurgia Bucal , Leucoplasia OralRESUMO
Fundamento: el carcinoma de células escamosas, es un tumor maligno derivado de los queratinocitos de la piel y las membranas mucosas, manifiesta diferentes grados de malignidad, sus características más importantes son la anaplasia, rápido crecimiento, destrucción tisular local y capacidad para hacer metástasis. Caso clínico: se presenta el caso de una mujer blanca, con 38 años de edad, fumadora inveterada y antecedentes patológicos personales de leucoplasia del labio inferior, la cual evolucionó hacia un carcinoma de células escamosas invasivo diferenciado, acompañado de metástasis ganglionar regional. Conclusiones: este proceso oncoproliferativo cutáneo es infrecuente en el sexo femenino, se reporta fundamentalmente en hombres que sobrepasan la sexta década de la vida; ya que apareció en una paciente de 38 años, asociado a la exposición crónica a carcinógenos ambientales y al hábito de fumar; que propiciaron la aparición de lesiones cutáneas premalignas (leucoplasia), con alto potencial degenerativo, evolucionando finalmente hacia un carcinoma de células escamosas diferenciado.
membranes, it becomes apparent different grades of malignancy; its main important characteristics are anaplasia, quick growth, local tissular destruction and capacity to make metastasis. Clinical case: a 38 years old, white woman is presented, inveterate smoker and personal pathological antecedents of leukoplasia of the inferior lip, which evolved toward a differentiated invasive squamous cell carcinoma, accompanied by regional ganglionic metastasis. Conclusions: this cutaneous oncoproliferative process is uncommon in the female sex, it is reported fundamentally in men that exceed the sixth decade of life; since it appeared in a 38 year-old patient, associated to the chronic exposure to environmental carcinogens and to the smoking; that propitiated the appearance of premalignant cutaneous lesions (leukoplasia), with high degenerative potential, evolving finally toward a differentiated squamous cell carcinoma.