T regulatory cell markers in oral squamous cell carcinoma: Relationship with survival and tumor aggressiveness

Tumor-infiltrating lymphocytes (TILs) are a heterogeneous cell family which plays an important role in tumor-associated immune response. Of these, T regulatory (Treg) cells have also been shown to inhibit anti-tumor response. We aimed to evaluate the expression of T regulatory cell markers (CD4, CD25, CTLA-4 and FoxP3) in samples of oral cavity squamous cell carcinoma (OCSCC) and lip SCC (LSCC) by immunohistochemistry. The relationship of Treg markers with survival data and the proliferative index were also evaluated. We observed similar numbers of CD4-, CD25- and FoxP3(+) cells in OCSCC and LSCC. On the other hand, numbers of CTLA-4(+) cells were significantly lower in OCSCC than in LSCC. OCSCC samples with high numbers of CD4 exhibited a high proliferative index, while samples with high CTLA-4 counts demonstrated a low tumoral proliferative index. A log-rank test showed that patients with OCSCC that presented high counts of CD4 showed a significantly decreased survival compared with patients with low cell counts. In contrast, high CD25(+) cell counts were associated with increased survival. Our results suggest an association of CD4 with poor prognosis, while CD25 expression is related with favorable prognosis. These findings result from the heterogeneity of TIL subsets that display an antagonistic role in tumor immune cell response.

Density and migration of mast cells in lip squamous cell carcinoma and actinic cheilitis

Mast cells (MCs) display a diversity of roles that may contribute to the stromal microenvironment alterations during tumor progression. The aim of this study was to investigate MC populations expressing tryptase and c-kit in lip squamous cell carcinoma (lip SCC) (n=37), actinic cheilitis (AC) (n=15) and normal lip mucosa (control) (n=6), as well as their relationship with microscopic parameters (collagen degeneration, elastin changes, angiogenesis and proliferative index). Tryptase, c-kit, CD31 and Ki-67 expressions were analyzed by means of immunohistochemistry and collagen and elastic fibers were visualized with Picrosirus and Verhoeff's stain, respectively. The numbers of tryptase+ MC were significantly higher in lip SCC when compared with control (P=0.01), while a similar density of these cells was observed in AC and lip SCC (P=0.09). The density of c-kit+ MC was similar in all groups examined (P=0.65). MC migration (c-kit+/Tryptase+ relationship) was 69% in lip SCC, 60% in AC and 100% in control. The number of CD31+ blood vessels was significantly higher in the lip SCC when compared with control and AC (P<0.01). The increase of MCs and angiogenesis in lip SCC may reflect an important modification in the tumor microenvironment during squamous photo-carcinogenesis.

Chondrosarcoma of the temporomandibular joint: a case report in a child

This article reports a rare case of a temporomandibular joint (TMJ) chondrosarcoma in a child. Chondrosarcoma is a malignant cartilaginous neoplasm that resembles synovial chondromatosis. In the head and neck region, chondrosarcoma is uncommon, corresponding to 6.4% to 12% of all reported cases. The majority of patients with chondrosarcoma are in the third to fourth decades of life. A Pubmed search showed that 20 TMJ chondrosarcoma cases had been reported up to 2008. The present case was of an 11-year-old girl referred to an Oral Disease Center and presenting with a preauricular swelling on the right side and normal ENT evaluation. The patient was healthy. Discrete pain and mild limitation of mouth opening were observed. A panoramic radiograph as well as computed tomography (CT), ultrasound, and magnetic resonance imaging (MRI) revealed an osteolytic lesion in the right TMJ. The skull base and adjacent spaces were preserved but adjacent anatomic structures were displaced. After an incisional biopsy, the patient underwent high condylectomy. Microscopic findings showed a tumor exhibiting cartilaginous tissue proliferation with cellular pleomorphism, nuclear hyperchromasia, and mixoid changes in the matrix. The immunohistochemical analysis of the expression of Ki-67 and Cyclin B1 proteins (cellular proliferation markers) revealed a very low proliferative cell index. The 3.5 years of clinical and imaging follow-up have shown no evidence of recurrence or metastasis, but signs of myofascial disorders could be observed. It is concluded that cartilaginous lesions in the jaws must be regarded with suspicion, since benign and malignant lesions may show similar clinical features. This case emphasized the importance of interdisciplinary approaches to minimize the possibility of misdiagnosis.

Low-grade gingival leiomyosarcoma in a child

Leiomyosarcoma (LMS) of the oral cavity, a rare mesenchymal tumor exhibiting smooth-muscle differentiation, is extremely uncommon in childhood. The most frequent location of childhood LMS is the gastrointestinal tract, particularly the stomach. The purpose of this paper is to report a case of leiomyosarcoma affecting the gingival tissues and mandible of a 9-year-old girl with peculiar clinical, microscopic, and radiographic features. Clinical and radiographical examinations revealed a gingival growth affecting the primary mandibular right first molar with inflammatory features. The lesion was initially suspected to be pyogenic granuloma and was removed by excisional biopsy. Microscopic findings showed a hypercellular proliferation of mesenchymal spindle cells, suggesting malignant spindle cell neoplasm. Immunohistochemical, histochemical, and radiographic studies were undertaken, and the final diagnosis established was a low-grade leiomyosarcoma in the gingiva.

Association of CCL2 with lymph node metastasis and macrophage infiltration in oral cavity and lip squamous cell carcinoma

AIMS/METHODS

We investigated the expression of CCL2 by immunohistochemistry in samples of oral cavity squamous cell carcinoma (OCSCC), lip squamous cell carcinoma (LSCC) and metastatic and nonmetastatic lymph nodes. The relationship of CCL2 with survival data was also evaluated.

RESULTS

The percentage of CCL2+ cells in tumor parenchyma was similar in OCSCC and LSCC. In stroma, OCSCC showed a higher number of CCL2+ cells when compared with LSCC. In contrast, higher CD68+ macrophage counts were observed in LSCC. Low macrophage counts were significantly related to a greater proliferative index in tumoral cells. The density of CCL2+ nodal cells was significantly higher in metastatic lymph nodes when compared with nonmetastatic lymph nodes. When considering CCL2 in the parenchyma, the mean survival time for the patients with high CCL2+ cell counts was lower than that for patients with low CCL2+ cell counts. In contrast, in stroma, the mean survival time for the patients with high CCL2+ cell percentages was higher than for those with low CCL2+ cell percentages.

CONCLUSION

Our findings suggest a role for CCL2 in the spreading of tumoral cells to the lymph node in OCSCC. Furthermore, the CCL2-independent macrophage infiltration may play a role in determining less aggressive behavior.

Dual role of CCL3/CCR1 in oral squamous cell carcinoma: implications in tumor metastasis and local host defense

Chemokines are small chemotactic cytokines that can induce the migration of leukocytes, activate inflammatory/immune responses and have recently been implicated in the regulation of tumor growth and organ-specific spread. In this setting, the macrophage inflammatory protein-1alpha (CCL3) chemokine displays a diversity of roles that may contribute to the directional migration of squamous cells into cervical lymph nodes or to the defense against tumor initiation and progression. Thus, the aim of this study was to determine, for the first time, the expression of CCL3 and their receptors, CCR1 and CCR5, by real-time polymerase chain reaction in samples obtained from oral squamous cell carcinoma (OSCC) and healthy gingival tissue (control). In addition, we investigated the immunoexpression of these molecules in neoplastic cells (parenchyma), inflammatory/immune cells (stroma) in primary OSCC and in metastatic and non-metastatic lymph node tissues. The relationship of CCL3/CCR1 with survival data was also evaluated. The analysis of mRNA expression revealed a significantly higher expression of CCL3 and CCR1 in OSCC compared with the controls (P<0.05). The expression of CCR5 was not different in the two groups. The percentages of CCL3+ and CCR1+ cells were observed to be similar in parenchyma and stroma in the OSCC without lymph node metastasis when compared with OSCC with lymph node metastasis (P>0.05). However, we observed the density of CCL3+ nodal cells to be significantly higher in metastatic lymph nodes when compared with non-metastatic lymph nodes in the same patients (P<0.05). Considering CCL3 in stroma, the mean survival rate for patients with high CCL3+ cell percentage was better than for those with low CCL3+ cell percentage. Our findings suggest that the CCL3/CCR1 axis may have a role in the spread of tumoral cells to the lymph nodes and also in the local host defense against the tumor.

Unicystic ameloblastoma in a child: a differential diagnosis from the dentigerous cyst and the inflammatory follicular cyst

Unicystic ameloblastoma (UA) is a benign epithelial odontogenic tumor of the jaws with an aggressive potential that commonly occurs in children. This cystic odontogenic neoplasm is generally asymptomatic and found during routine radiographs. The purposes of this report were to describe a case of UA involving the crown of the unerupted right mandibular second premolar in an 11-year-old girl under orthodontic treatment, and discuss its diagnosis and radiographic and microscopic findings, emphasizing its distinction from the dentigerous cyst and the inflammatory follicular cyst.

Decrease in mast cells in oral squamous cell carcinoma: Possible failure in the migration of these cells

It is becoming accepted that multiple cell types in stromal microenvironment are involved in tumorigenesis. In this setting, mast cells (MC) display a diversity of roles that may contribute to the defense against tumors or tumor progression. Thus, the aim of this study was to evaluate density and migration of MCs in OSCC (oral squamous cell carcinoma) and pre-malignant oral hyperkeratosis (leukoplakia) as well as their relationship with clinical and microscopic parameters. The tryptase and c-kit expression was analyzed in 38 cases of OSCC, 26 cases of leukoplakia, and 12 cases of clinically healthy oral mucosa (control) by means of immunohistochemistry. The tryptase(+) cell numbers were decreased in OSCC (P=0.0003) and leukoplakia (P=0.03) compared with control. Similar numbers of tryptase(+) cells were observed in leukoplakia and OSCC (P=0.31). The density of c-kit(+) MCs was also significantly lower in OSCC and leukoplakia in relation to control resulting in a reduced c-kit(+)/tryptase(+) relationship in OSCC (19%) in comparison with leukoplakia (59%) and control (63%). No correlation was observed between MC populations with clinical and microscopic characteristics of OSCC. Our findings suggest that the decrease in MC numbers in pre-malignant and malignant oral lesions may be related to the migration failure of these cells, possibly reflecting an important modification in the microenvironment during tumor initiation and progression.

Mast cells and lymphocyte subsets in pulps from healthy and carious human teeth

OBJECTIVE

To evaluate the presence of cytolytic T lymphocytes (CD8+), memory T cells (CD45RO+), helper T lymphocytes (CD4+), and mast cells in pulps from healthy and carious human teeth.

STUDY DESIGN

The teeth were separated into groups: I = unerupted; II = partially erupted, without caries; III = erupted, without caries; IV = erupted with shallow dentine caries; and V = teeth with pulp polyps. The immunoperoxidase staining procedure was used to detect CD8, CD45RO, CD4, and tryptase (mast cell marker) antigens. The number of each cell type was obtained by counting the number of cells per mm2.

RESULTS

Mast cells were only present in pulp polyps. Pulps from carious teeth contained more CD4+ and CD8+ cells than from noncarious teeth. There was a significant decrease in the number of lymphocytes in pulp polyps in comparison to the other groups.

CONCLUSIONS

Mast cells probably do not contribute to the early vascular or specific immune responses in the initial dental pulp pathosis, although they may be involved in a chronic phase of pulp inflammation such as pulp polyps. On the other hand, CD4+ and CD8+ T cells participate mainly in initial phenomena of the immune response to incipient caries and seem not to substantially contribute to the response in pulp polyps.

Rhinolith: a radiographic finding in a dental clinic

Rhinolith is a calcified mass found within the nasal cavity. This article is a case report of a 51-year-old woman with an unusual radiopaque lesion located in the nasal maxillary antrum cavity. It was asymptomatic and found accidentally on a routine panoramic radiograph. The rhinolith is presented along with the description of its clinical, radiographic (conventional and CT images), and histopathologic aspects. The objective of this report is to describe and discuss the differential diagnosis of the rhinolith with other oral injuries or conditions and to show how important it is for dental practitioners to be aware of their existence.

Failure of nitric oxide production by macrophages and decrease in CD4+ T cells in oral paracoccidioidomycosis: possible mechanisms that permit local fungal multiplication

Paracoccidioidomycosis is a chronic granulomatous disease that induces a specific inflammatory and immune response. The participation of nitric oxide (NO), a product of the inducible nitric oxide synthase enzyme (iNOS), as an important fungicidal molecule against Paracoccidioides brasiliensis has been demonstrated. In order to further characterize the Oral Paracoccidioidomycosis (OP), we undertook an immunohistochemical study of iNOS+, CD45RO+, CD3+, CD8+, CD20+, CD68+ cells and mast cells. The samples were distributed in groups according to the number of viable fungi per mm². Our results showed weak immunolabeling for iNOS in the multinucleated giant cells (MNGC) and in most of the mononuclear (MN) cells, and the proportion of iNOS+ MN/MNGC cells in the OP were comparable to Control (clinically healthy oral tissues). Additionally, our analysis revealed a similarity in the number of CD4+ cells between the Control and the OP groups with higher numbers of fungi. These findings suggest that a low expression of iNOS and a decrease in the CD4+ T cells in OP may represent possible mechanisms that permit the local fungal multiplication and maintenance of active oral lesions.

Quantification of mast cells in different stages of human periodontal disease

OBJECTIVE AND METHODS

Among the cells involved in immune and inflammatory responses in periodontal disease, mast cells have been shown to be capable of generating a large number of biologically active substances. The present study was undertaken to identify and quantify the presence of mast cells in different stages of human periodontal disease using histochemical (toluidine blue) and immunohistochemical (tryptase-positive mast cells) techniques.

RESULTS

Mast cell densities (cells per mm(2)) were significantly increased in chronic periodontitis/gingivitis lesions compared with clinically healthy gingival tissues (Health) uniquely by immunohistochemical technique. Interestingly, mast cells were distributed specially in close apposition to mononuclear cells.

CONCLUSIONS

In human periodontal disease there is an increase in the number of mast cells that may be participating either in the destructive events or in the defense mechanism of periodontal disease via secretion of cytokines, including perpetuation of the Th2 response, and cellular migration and healing processes.

Lichen sclerosus et atrophicus of the oral mucosa

Lichen sclerosus et atrophicus (LSA) is a chronic, benign, depigmenting disease of the skin and mucous membranes most frequently affecting the female genitalia. Involvement of the oral mucosa without concurrent genital or skin lesions has been reported only occasionally in the literature. In view of the rarity of reported cases, one lesion affecting only the labial mucocutaneous area is presented along with a description of the disease's clinical and histopathological findings.

Comparative immunohistochemical study of the presence of mast cells in apical granulomas and periapical cysts: possible role of mast cells in the course of human periapical lesions

Cells other than macrophages and lymphocytes have recently been shown capable of producing cytokines and mediators. Among these are mast cells, a cell population now recognized for its immunoregulatory properties. Little is known about the complex interactions between cells, cytokines, and other inflammatory elements in periapical lesions. The objective of this investigation was to determine the immunohistochemical pattern of expression of mast cells tryptase in periapical lesions based on study of 20 apical granulomas and 20 periapical cysts. Microscopic analysis revealed mast cells to be present in greater numbers in periapical cysts than in apical granulomas, and in cysts were more numerous in regions of active inflammation. Mast cells tended to be more common in the peripheral regions of both periapical lesions, and were often found in close proximity to lymphocytes. These findings lead us to propose a functional relationship between these two cell populations that may facilitate elicitation of an immune response contributory to the pathogenesis of periapical lesions.

Comparative study of tissue response to polyglecaprone 25, polyglactin 910 and polytetrafluorethylene suture materials in rats

The authors evaluated the biocompatibility of three suture materials, polyglecaprone 25, polyglactin 910 and polytetrafluorethylene, implanted into subcutaneous tissue in the dorsal region of 20 Wistar albinus rats. After periods of 2, 7, 14 and 21 days, the rats were sacrificed and the specimens were processed for routine histotechnical analysis and stained with hematoxylin and eosin. The rate of fibrosis, angioblastic and fibroblastic proliferation, and also the intensity of inflammation were observed with the optic microscope. The results showed that polyglecaprone 25 suture material induced a mild inflammatory reaction, followed by polyglactin 910 and polytetrafluorethylene, respectively. Such biological behavior must be considered during the selection of the suture material to be used in oral surgery.

Paradental cyst mimicking a radicular cyst on the adjacent tooth: case report and review of terminology

A distinctive form of paradental cyst can occur on the buccal and apical aspects of erupted mandibular molars. This cyst has peculiar clinical and radiographic features, although the microscopic findings are the same as those of odontogenic inflammatory cysts. Diagnostic and therapeutic problems can occur when this lesion is misinterpreted as a radicular cyst. The purpose of this paper is to present an additional case of a paradental cyst in the buccal and mesial aspects of a mandibular second molar involving the apical area of a mandibular first molar. The difficulty of diagnosis, treatment, and controversies regarding terminology are also discussed.

Nitric oxide synthesis and severity of human periodontal disease

The expression of the inducible nitric oxide synthase enzyme (iNOS) is a response to an inflammatory stimulus and produces a large amount of nitric oxide (NO), which may act as a cytotoxic molecule against the invading microorganism and may be related to both harmful and beneficial effects to tissues.

OBJECTIVE AND MATERIAL AND METHODS

In order to further characterize the presence of NO in human periodontal disease, we undertook a quantitative study of iNOS positive cells in samples of clinically healthy gingival tissues, plaque-induced gingivitis and localized chronic periodontitis using immunohistochemistry.

RESULTS

A significant increase in the number of iNOS+ cells mm-2 was found in the samples of the gingivitis and periodontitis compared with those of the control. In all groups most of the polymorphonuclear cells showed intense immunoreactivity for iNOS independent of the disease stage, and the percentage of iNOS+ polymorphonuclear cells increased significantly in periodontal disease when compared with the control.

CONCLUSION

Our results indicate that iNOS increases in the presence of periodontal disease. In addition, our findings suggest that polymorphonuclear cells present an additional activation pathway in periodontal disease, expressing significant iNOS and probably representing an important source of NO in human periodontal disease that has not been previously reported.