RESUMO
BACKGROUND: Pyogenic granuloma (PG) is a lesion characterized by the proliferation of blood vessels, commonly affecting the skin and the mouth. We aimed to compare clinical, microscopic, and immunohistochemical features of the two types of oral PG: lobular capillary hemangioma (LCH) and non-LCH (NLCH). METHODS: Epidemiological and clinical data from 2000 to 2018 were collected from the archives of our institution, and histopathological sections of PG were reviewed. Immunohistochemical analyses (CD34, D2-40, SMA, mast cell, and Ki-67) were performed in 34 cases. RESULTS: Sixty-two LCH and 107 non-LCH samples were included. The mean (±SD) age of the patients was 38.59 ± 16.96 years; 55.62% were female; 39.64% of cases occurred in the gingiva, 44% of the nodules were pedunculated, and 13.02% of patients reported a history of trauma. NLCH was more prevalent among older patients than LCH. The most prevalent site of LCH was the lips, while NLCH occurred more in the gingiva (P < 0.05). Epithelial atrophy, microvessels, SMA-positive areas, and Ki-67-positive nuclei were more prevalent in LCH (P < 0.05). CONCLUSIONS: PG accounted for 2.25% of lesions archived in the pathology service and most cases were NLCH. LCH and NLCH exhibited clinicopathological differences in terms of age, site, epithelial atrophy, vascularization, and proliferation rate.
Assuntos
Granuloma Piogênico/diagnóstico , Granuloma Piogênico/metabolismo , Mucosa Bucal/patologia , Neovascularização Patológica/patologia , Actinas/metabolismo , Adulto , Biópsia , Estudos de Casos e Controles , Feminino , Gengiva/patologia , Granuloma Piogênico/epidemiologia , Granuloma Piogênico/patologia , Humanos , Imuno-Histoquímica/métodos , Antígeno Ki-67/metabolismo , Lábio/patologia , Masculino , Pessoa de Meia-Idade , Boca/patologia , Mucosa Bucal/irrigação sanguínea , Mucosa Bucal/ultraestrutura , Prevalência , Estudos RetrospectivosRESUMO
BACKGROUND: Pyogenic granuloma (PG) is a benign nodular lesion with a prominent vascular component which may affect different sites. Recently, BRAF, KRAS, HRAS, NRAS, GNA11, and GNA14 mutations were reported on PGs of the skin. The present study assessed the role of the MAPK/ERK pathway in oral PG pathogenesis. METHODS: Mutations in hotspot regions of genes involved in the MAPK/ERK pathway activation were investigated by Sanger sequencing. The expression of phospho-ERK1/2 was evaluated by immunohistochemistry. RESULTS: Oral PGs did not show mutations in the sequenced regions of the genes BRAF, KRAS, HRAS, NRAS, GNA11, or GNA14. Our results also showed activation of the MAPK/ERK pathway demonstrated by phospho-ERK1/2 immunohistochemical positivity. CONCLUSIONS: Although oral PG shows MAPK/ERK pathway activation, the driver molecular event remains to be elucidated.
Assuntos
Granuloma Piogênico/metabolismo , Sistema de Sinalização das MAP Quinases , Mutação , Adolescente , Adulto , Idoso , Feminino , GTP Fosfo-Hidrolases/metabolismo , Subunidades alfa de Proteínas de Ligação ao GTP/metabolismo , Subunidades alfa Gq-G11 de Proteínas de Ligação ao GTP/metabolismo , Granuloma Piogênico/genética , Humanos , Masculino , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas B-raf/metabolismo , Proteínas Proto-Oncogênicas p21(ras)/metabolismo , Transdução de Sinais , Adulto JovemRESUMO
Congenital cutaneous pyogenic granuloma is a rare benign vascular tumor with clinical and histopathological features similar to infantile hemangioma. It usually presents as a red, pedunculated and highly friable papule. On histopathological analysis, one can see a capillary vessel proliferation with lobular pattern and endothelial proliferation. The differential diagnosis is based on negativity of glucose transporter 1 (GLUT1) immunochemistry studies. We report two infants with congenital pyogenic granuloma, one with a unique cutaneous lesion and the other with multiple lesions affecting both skin and mucosal surfaces. These two cases highlight the importance of the differential diagnosis based on the GLUT1 immunochemistry analysis considering the distinct treatments required to these infant vascular tumors.
Assuntos
Transportador de Glucose Tipo 1/metabolismo , Granuloma Piogênico , Proteínas de Neoplasias/metabolismo , Neoplasias Vasculares , Diagnóstico Diferencial , Feminino , Granuloma Piogênico/congênito , Granuloma Piogênico/diagnóstico , Granuloma Piogênico/metabolismo , Granuloma Piogênico/patologia , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias Vasculares/congênito , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/metabolismo , Neoplasias Vasculares/patologiaRESUMO
Reactive proliferations of the gingiva comprise lesions such as pyogenic granuloma (PG), inflammatory fibroepithelial hyperplasia (IFH), peripheral ossifying fibroma (POF), and peripheral giant cell lesion. Osteopontin (OPN) has a dual role, it promotes mineralization when it is bound to solid substrate, and on the other hand, it inhibits mineralization when it is seen in association with solution. Objectives The study aimed to evaluate the expression of osteopontin in normal gingival tissue and different types of focal reactive proliferations of gingival tissue, and its role in the development of calcification within it. Material and Methods The presence and distribution of osteopontin was assessed using immunohistochemistry in five cases of normal gingival tissue and 30 cases of focal reactive proliferations of gingiva. Results There was no expression of osteopontin in normal subjects. Few cases of pyogenic granuloma, inflammatory fibroepithelial hyperplasia, and all the cases of peripheral ossifying fibroma showed positivity for osteopontin in the inflammatory cells, stromal cells, extracellular matrix, and in the calcifications. Conclusion The expression of osteopontin in all the cases of peripheral ossifying fibroma speculates that the majority of the cases of peripheral ossifying fibroma originate from the periodontal ligament cells. The treatment modalities for peripheral ossifying fibroma should differ from other focal reactive proliferations of gingiva.
Assuntos
Gengiva/metabolismo , Doenças da Gengiva/metabolismo , Osteopontina/metabolismo , Neoplasias Ósseas/metabolismo , Estudos de Casos e Controles , Fibroma Ossificante/metabolismo , Tumores de Células Gigantes/metabolismo , Granuloma Piogênico/metabolismo , Humanos , Hiperplasia/metabolismo , Imuno-Histoquímica , Valores de ReferênciaRESUMO
Reactive proliferations of the gingiva comprise lesions such as pyogenic granuloma (PG), inflammatory fibroepithelial hyperplasia (IFH), peripheral ossifying fibroma (POF), and peripheral giant cell lesion. Osteopontin (OPN) has a dual role, it promotes mineralization when it is bound to solid substrate, and on the other hand, it inhibits mineralization when it is seen in association with solution. Objectives The study aimed to evaluate the expression of osteopontin in normal gingival tissue and different types of focal reactive proliferations of gingival tissue, and its role in the development of calcification within it. Material and Methods The presence and distribution of osteopontin was assessed using immunohistochemistry in five cases of normal gingival tissue and 30 cases of focal reactive proliferations of gingiva. Results There was no expression of osteopontin in normal subjects. Few cases of pyogenic granuloma, inflammatory fibroepithelial hyperplasia, and all the cases of peripheral ossifying fibroma showed positivity for osteopontin in the inflammatory cells, stromal cells, extracellular matrix, and in the calcifications. Conclusion The expression of osteopontin in all the cases of peripheral ossifying fibroma speculates that the majority of the cases of peripheral ossifying fibroma originate from the periodontal ligament cells. The treatment modalities for peripheral ossifying fibroma should differ from other focal reactive proliferations of gingiva. .
Assuntos
Humanos , Gengiva/metabolismo , Doenças da Gengiva/metabolismo , Osteopontina/metabolismo , Neoplasias Ósseas/metabolismo , Estudos de Casos e Controles , Fibroma Ossificante/metabolismo , Tumores de Células Gigantes/metabolismo , Granuloma Piogênico/metabolismo , Hiperplasia/metabolismo , Imuno-Histoquímica , Valores de ReferênciaRESUMO
OBJECTIVE: The aim was to investigate a possible association between the immunoexpression of interleukin (IL)-4 and clinicopathological parameters with the periodontal breakdown observed in gingival pyogenic granuloma (PG). MATERIALS AND METHODS: Paraffin-embedded samples of gingival PG (n = 46) were prepared for histological and immunohistochemical assessment. Demographic and clinical parameters were assessed by criteria based on age stratum, gender, smoking habit, evolution course, location, lesion size, macroscopic appearance, predisposing factors, recurrence, and periodontal breakdown. Histological assessment included the appearance of epithelial lining, microvessel density, inflammatory infiltrate density, interstitial fibrosis, and histological arrangement. A staining intensity distribution (SID) score was used to assess IL-4 immunoreactivity. The association between candidate predictor variables and periodontal breakdown was analyzed individually and adjusted for confounding using a bivariate binary logistic regression model. RESULTS: Mean IL-4 SID values were significantly increased for long-standing and large lesions, presence of periodontal breakdown, high microvessel density, and moderate-to-severe inflammatory infiltrate density. While bivariate and univariate analyses revealed a positive association of the evolution course ≥12 months, lesion size >1 cm, high microvessel density, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 with periodontal breakdown, after bivariate logistic regression analysis, only the evolution course ≥12 months, moderate-to-severe inflammatory infiltrate density, and IL-4 SID score ≥8.04 remained as robust predictors of periodontal damage. Confounding and interaction effects between candidate predictor variables were also noted. CONCLUSION: These findings suggest that while evolution course, inflammatory infiltrate density, and the overexpression of IL-4 may act as predictors of periodontal breakdown in gingival PG, there are mutual confounding and synergistic biological interactive effects with respect to the lesion size and microvessel density in the susceptible host that may be also associated with the bone resorption and tissue destruction. CLINICAL RELEVANCE: Although the first-line therapy of gingival PG continues to be the surgical excision, this approach poses unwanted complications such as severe mucogingival defects and recurrence. Hence, early diagnosis and detection of these three significant predictor variables as well as timely surgical excision might help prevent the periodontal tissue destruction observed in some of these lesions.
Assuntos
Granuloma Piogênico/imunologia , Granuloma Piogênico/metabolismo , Interleucina-4/metabolismo , Periodontite/imunologia , Periodontite/metabolismo , Adolescente , Adulto , Idoso , Criança , Feminino , Granuloma Piogênico/patologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Periodontite/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: The aim of this study was to perform a retrospective study of histopathologic features of a series of cases of pyogenic granuloma (PG), peripheral giant cell lesion (PGCL), and peripheral ossifying fibromas (POF) that constitutes the group called reactional lesions, located in gingiva and alveolar ridge. STUDY DESIGN: Cases of PG, PGCL, and POF were selected for this study. The morphological analysis of the lesions constituted the following: intensity of inflammatory infiltrate (IF), presence of vascular proliferation (VP), fibroblastic proliferation (FP), areas of ulceration (AU), bacterial colony (BC), presence of mineralization (PM), multinucleated giant cells (MGC), hemosiderin deposition (HD), hemorrhage area (HA). RESULTS: Of the 288 cases analyzed, 162 (56.3%) were PG, 72 (25%) were PGCL, and 54 (18.8%) were POF. The IF, VP, AU, and BC were more prominent in PG (85.8%, 98.8%, 91.4%, and 46.9%, respectively) and PM in POFs (98.1%). FP was more frequent in POF (98.1%) and PGCL (100%) and MGC in PGCL (100%), although some cases of POF (7.4%) and PG (0.6%) exhibited MGC. HD was more frequent in PGCL (40.3%) and HA in PG (53.1%). CONCLUSIONS: This study demonstrated that IF, VP, AU, BC, and HA are the common features in PG, MGC, FP, and HD are the most common in PGCL, and PM associated with FP are the most common in POF, which can help in the histopathologic differential diagnosis between these lesions. In addition, it may suggest a possible development and maturation of the PG in POF with reduction in the inflammatory component and increase in the fibrous component.
Assuntos
Processo Alveolar , Fibroma Ossificante , Gengiva , Granuloma Piogênico , Neoplasias Maxilomandibulares , Processo Alveolar/metabolismo , Processo Alveolar/patologia , Proliferação de Células , Feminino , Fibroblastos/metabolismo , Fibroblastos/patologia , Fibroma Ossificante/metabolismo , Fibroma Ossificante/patologia , Células Gigantes/metabolismo , Células Gigantes/patologia , Gengiva/metabolismo , Gengiva/patologia , Granuloma Piogênico/metabolismo , Granuloma Piogênico/patologia , Humanos , Inflamação/metabolismo , Inflamação/patologia , Neoplasias Maxilomandibulares/metabolismo , Neoplasias Maxilomandibulares/patologia , Masculino , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim was to investigate the relationship between patient clinical background, histological features, and immunoexpression of COX-2 and IL-10 in oral pyogenic granuloma (PG). DESIGN: Paraffin-embedded samples of oral PG (n=57) were prepared for histological and immunohistochemical assessment. Based on the histological features, the samples were categorised into lobular capillary hemangioma (LCH) and non-LCH subtypes. The epithelial lining, angiogenic index, inflammatory infiltrate density, and interstitial fibrosis, were assessed in haematoxylin-eosin stained sections. In addition, the marker expression estimation (stained cells/total cell number) was used to assess immunoreactivity for each sample. RESULTS: Although there were no significant differences between histological subtypes regarding demographic and clinical parameters, mean values of microvessel count and inflammatory infiltrate density were significantly greater in the non-LCH PG subtype. Also, whilst cellular immunolocalisation patterns of COX-2 and IL-10 were similar, mean values of expression estimation of each immunomarker were significantly higher in non-LCH PGs in comparison with LCH subtypes. Furthermore, significant variations for immunohistochemical parameters were evident regarding to angiogenic index and inflammatory infiltrate density, but not concerning demographic and clinical data. Finally, linear regression analysis showed a significant positive correlation between the expression estimation of the two immunomarkers. CONCLUSION: These findings suggest a role for COX-2 and IL-10 in the etiopathogenesis of oral PG and indicate that LCH and non-LCH histological subtypes represent different stages in the evolution of a single lesion with varying degrees of proliferative, angiogenic, and inflammatory activity.
Assuntos
Ciclo-Oxigenase 2/metabolismo , Granuloma Piogênico/metabolismo , Interleucina-10/metabolismo , Adulto , Análise de Variância , Biomarcadores/metabolismo , Biópsia , Distribuição de Qui-Quadrado , Ciclo-Oxigenase 2/imunologia , Feminino , Granuloma Piogênico/imunologia , Humanos , Imuno-Histoquímica , Interleucina-10/imunologia , Modelos Lineares , Masculino , Distribuição Aleatória , Reprodutibilidade dos Testes , Coloração e Rotulagem , Estatísticas não ParamétricasRESUMO
The objective of this study was to assess angiogenic activity by analyzing anti-CD105 and anti-CD34 immunostaining in 20 cases of vascular malformations (VMs) and 20 cases of oral pyogenic granulomas (OPG). In addition, the usefulness of these markers for the differential diagnosis of these two oral tumors was evaluated. The results showed no significant difference in mean microvessel count between the anti-CD105 (P = 0.803) and anti-CD34 (P = 0.279) antibody. The mean number of vessels was 18.75 and 59.72 for oral VMs immunostained with anti-CD105 and anti-CD34 antibody, respectively, whereas in OPG the mean number was 20.22 and 48.09, respectively. CD34 was found to be more effective than CD105 in identifying blood vessels. However, the anti-CD105 antibody seems to be more related to vascular neoformation. Overall, this study supports the role of angiogenic factors in the etiopathogenesis of oral VMs and PG, but the results showed that quantification of angiogenesis cannot be used as a marker for the differential diagnosis of these two types of lesions.
Assuntos
Antígenos CD34/biossíntese , Antígenos CD/biossíntese , Granuloma Piogênico/imunologia , Mucosa Bucal/irrigação sanguínea , Neoplasias Bucais/imunologia , Neovascularização Patológica/imunologia , Receptores de Superfície Celular/biossíntese , Malformações Vasculares/imunologia , Adulto , Antígenos CD/imunologia , Antígenos CD34/imunologia , Biomarcadores Tumorais/biossíntese , Biomarcadores Tumorais/imunologia , Diagnóstico Diferencial , Endoglina , Feminino , Granuloma Piogênico/metabolismo , Granuloma Piogênico/patologia , Humanos , Imuno-Histoquímica , Masculino , Mucosa Bucal/imunologia , Mucosa Bucal/metabolismo , Neoplasias Bucais/metabolismo , Neoplasias Bucais/patologia , Neovascularização Patológica/metabolismo , Receptores de Superfície Celular/imunologia , Malformações Vasculares/metabolismo , Malformações Vasculares/patologiaRESUMO
BACKGROUND: The origin of spindle cells (SC) in oral Kaposi's sarcoma (OKS) is still an intriguing aspect. Thus the aim of the present study was to compare the clinical, histological and immunohistochemical characteristics of OKS and oral pyogenic granuloma (OPG), in order to contribute to the knowledge of the cells involved in Kaposi's sarcoma pathogenesis. METHODS: In this retrospective, observational and comparative study, 39 OKS and 30 OPG cases were included. Immunohistochemical studies were performed for vimentin, alpha SMA, desmin, C-kit, CD34, D2-40 and LANA-1 [human herpesvirus-8(HHV-8)]. Statistical comparisons were done using the chi-square and Wilcoxon-Mann-Whitney rank sum tests. RESULTS: Fourteen (35.9%) OKS cases also affected the skin, and 83.8% involved the palate. All OKS and OPG were positive for vimentin and CD34. OKS samples were positive for alpha SMA, and 25.6% expressed C-kit. All OKS cases were positive for HHV-8, and the number of positive cells increased significantly from early / intermediate to late histological stage. D2-40 was expressed in the cellular component and vascular walls of all OKS cases, but it was negative in OPG. HHV-8 expression was increased in late histological stages of OKS lesions. CONCLUSIONS: The expression of D2-40 marker in the vascular walls and SC supports the view of a lymphatic differentiation in neoplastic cells of OKS. Desmin, alpha SMA, D2-40, C-kit and HHV-8 were the main markers differently expressed in OKS and OPG.