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Felipe Carvajal V, Felipe Cardemil M, Vásquez BP, Oliva CE, Barría TA, Bruna MA, Moyano LA, Bustos FA, Muñoz PA, Araya CF, Oyarzún JE, Villa EA, Floriano FA, Del Rio AJ, Indo SR, Castellón EA, Contreras HR. Epidemiological and clinical description of patients with oropharyngeal cancer treated in a public oncology referral hospital in Chile. Ecancermedicalscience 2024; 18:1685. [PMID: 38566759 PMCID: PMC10984838 DOI: 10.3332/ecancer.2024.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The incidence of squamous carcinoma of the oropharynx (OPSCC) has presented an increase worldwide, a fact that occurs along with a phenomenon of epidemiological transition, whose pathogenesis is linked to human papilloma virus (HPV) in a significant part of the cases. Published evidence at the Latin American level is scarce. The present study aims to evaluate the epidemiological and clinical characteristics of patients with oropharyngeal cancer treated in a public oncology reference centre in Chile. Methodology A cross-sectional study was carried out. Patients with histological confirmation of OPSCC aged 18 years or older, referred to the National Cancer Institute of Chile between 2012 and 2023 were included. The association with HPV was determined by immunohistochemistry for p16. Results 178 patients were analysed, most of them in locoregionally advanced stages involving the palatine tonsil. Seventy-seven percent were male, with a median age of 60 years. Sixty-seven percent of patients were positive for p16, with a progressive increase to 85% in the last 2 years of the study. The p16(+) patients were younger and had fewer classical risk factors. Primary treatment was radiotherapy in 94% of patients. Conclusion The epidemiological profile of patients with OPSCC treated in a Chilean public oncology referral centre reflects the epidemiological transition observed in developed countries. This change justifies the need to adapt health policies and conduct research that considers the characteristics of this new epidemiological profile.
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Affiliation(s)
- V Felipe Carvajal
- Department of Radiotherapy, National Cancer Institute, Santiago 8380000, Chile
- Department of Radiotherapy, Hospital Base Valdivia, Los Ríos 5090145, Chile
- Department of Basic Clinical Oncology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - M Felipe Cardemil
- Department of Basic Clinical Oncology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
- Department of Otolaryngology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Beatriz P Vásquez
- Department of Radiotherapy, National Cancer Institute, Santiago 8380000, Chile
| | - Carolina E Oliva
- Department of Otolaryngology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
- Department of Basic Clinical Oncovirology, School of Medicine, Universidad de Chile, Santiago 7591047, Chile
| | - Tamra A Barría
- Department of Otolaryngology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
- Department of Otolaryngology, Clínica Las Condes, Región Metropolitana 7500922, Chile
- Department of Otolaryngology, Hospital del Salvador, Región Metropolitana 8380453, Chile
| | - Maribel A Bruna
- Department of Radiotherapy, National Cancer Institute, Santiago 8380000, Chile
| | - Leonor A Moyano
- Department of Anatomic Pathology, National Cancer Institute, Santiago 8380000, Chile
| | - Felipe A Bustos
- Department of Head and Neck Surgery, National Cancer Institute, Santiago 8380000, Chile
- Centro de Investigación y Especialidades Médicas (CDIEM), Santiago 7500859, Chile
| | - Paola A Muñoz
- Department of Radiotherapy, Hospital Regional de Talca, Talca 3460001, Chile
| | - Cristóbal F Araya
- Department of Head and Neck Surgery, National Cancer Institute, Santiago 8380000, Chile
- Department of Head and Neck Surgery, Clínica Alemana, Región Metropolitana 7650568, Chile
- School of Dentistry, Universidad de Chile, Santiago 8380453, Chile
| | - Jorge E Oyarzún
- Department of Radiotherapy, Hospital Base Valdivia, Los Ríos 5090145, Chile
| | - Eduardo A Villa
- School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Federico A Floriano
- Management Information Area, Medical Subdirectorate of Institutional Development, National Cancer Institute, Santiago 8380000, Chile
| | - Alexis J Del Rio
- School of Medical Technology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Sebastián R Indo
- Department of Medical Technology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Enrique A Castellón
- Department of Basic Clinical Oncology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Héctor R Contreras
- Department of Basic Clinical Oncology, School of Medicine, Universidad de Chile, Santiago 8380453, Chile
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Fonsêca TC, Jural LA, Marañón-Vásquez GA, Magno MB, Roza ALOC, Ferreira DMTP, Maia LC, Romañach MJ, Agostini M, Abrahão AC. Global prevalence of human papillomavirus-related oral and oropharyngeal squamous cell carcinomas: a systematic review and meta-analysis. Clin Oral Investig 2023; 28:62. [PMID: 38158517 DOI: 10.1007/s00784-023-05425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To conduct a systematic review to determine the global prevalence of HPV in oral squamous cell carcinoma (OSCC) and oropharyngeal squamous cell carcinoma (OPSCC). MATERIALS AND METHODS Literature was searched through October 2022 in main databases to address the question "What is the global prevalence of Human Papillomavirus in oral and oropharyngeal cancer?" Studies had to identify HPV by PCR, ISH, or p16 immunohistochemistry to be eligible. Quality was assessed using the JBI checklist for prevalence studies. Meta-analyses were performed, and reporting followed PRISMA guidelines. RESULTS Sixty-five studies were included, and most of them had methodological limitations related to sampling and the HPV detection tool. The pooled prevalence of HPV-positivity was 10% (event rate = 0.1; 95% CI: 0.07, 0.13; P < 0.01; I2 = 88%) in the oral cavity and 42% (event rate = 0.42; 95% CI: 0.36, 0.49; P = 0.02; I2 = 97%) in oropharynx. The highest HPV prevalence in OSCC was reached by Japan, meanwhile, in OPSCC, Finland and Sweden were the most prevalent. HPV16 is the genotype most frequent with 69% in OSCC and 89% in OPSCC, being the tonsils the intraoral location more affected by HPV (63%, p < 0.01, I2 76%). CONCLUSION The evidence points to an apparent burden in HPV-related OPSCC, mostly in North America, Northern Europe, and Oceania, especially due to the HPV16 infection suggesting different trends across continents. CLINICAL RELEVANCE This updated systematic review and meta-analysis provide sufficient evidence about the global HPV prevalence in OSCC and OPSCC and the most frequent HPV subtype worldwide.
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Affiliation(s)
- Thamyres Campos Fonsêca
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Avenida Professor Rodolpho Paulo Rocco, 325, 1º Andar. Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, Brazil
| | - Lucas Alves Jural
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Guido Artemio Marañón-Vásquez
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | | | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Avenida Professor Rodolpho Paulo Rocco, 325, 1º Andar. Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Avenida Professor Rodolpho Paulo Rocco, 325, 1º Andar. Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, Brazil
| | - Aline Correa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Avenida Professor Rodolpho Paulo Rocco, 325, 1º Andar. Cidade Universitária, Ilha Do Fundão, Rio de Janeiro, Brazil.
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Skelin J, Luk HY, Butorac D, Boon SS, Tomaić V. The effects of HPV oncoproteins on host communication networks: Therapeutic connotations. J Med Virol 2023; 95:e29315. [PMID: 38115222 DOI: 10.1002/jmv.29315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 12/21/2023]
Abstract
Human papillomavirus (HPV) infections are a leading cause of viral-induced malignancies worldwide, with a prominent association with cervical and head and neck cancers. The pivotal role of HPV oncoproteins, E5, E6, and E7, in manipulating cellular events, which contribute to viral pathogenesis in various ways, has been extensively documented. This article reviews the influence of HPV oncoproteins on cellular signaling pathways within the host cell, shedding light on the underlying molecular mechanisms. A comprehensive understanding of these molecular alterations is essential for the development of targeted therapies and strategies to combat HPV-induced premalignancies and prevent their progress to cancer. Furthermore, this review underscores the intricate interplay between HPV oncoproteins and some of the most important cellular signaling pathways: Notch, Wnt/β-catenin, MAPK, JAK/STAT, and PI3K AKT/mTOR. The treatment efficacies of the currently available inhibitors on these pathways in an HPV-positive context are also discussed. This review also highlights the importance of continued research to advance our knowledge and enhance therapeutic interventions for HPV-associated diseases.
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Affiliation(s)
- Josipa Skelin
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ho Yin Luk
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
| | - Dražan Butorac
- Department of Gynecology and Obstetrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Siaw Shi Boon
- Department of Microbiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR
| | - Vjekoslav Tomaić
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
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Dalianis T, von Buchwald C, Näsman A, Syrjanen S. Special Issue "HPV in the Head and Neck Region 2.0". Viruses 2023; 15:v15051119. [PMID: 37243205 DOI: 10.3390/v15051119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Members of the human papillomavirus (HPV) family have been known for causing cancers and condylomas in the anogenital tract for some time, as reflected by the Nobel Prize in Medicine given to Professor Harald zur Hausen 2008 [...].
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Affiliation(s)
- Tina Dalianis
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Christian von Buchwald
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet, Bioclinicum J6:20, Karolinska University Hospital, 171 64 Stockholm, Sweden
- Department of Clinical Pathology, CCK R8:02, Karolinska University Hospital, 171 64 Stockholm, Sweden
| | - Stina Syrjanen
- Department of Oral Pathology and Radiology, Faculty of Medicine, University of Turku, FI-20014 Turku, Finland
- Department of Pathology, University of Turku, Turku University Hospital, FI-20014 Turku, Finland
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Carrillo-Beltrán D, Osorio JC, Blanco R, Oliva C, Boccardo E, Aguayo F. Interaction between Cigarette Smoke and Human Papillomavirus 16 E6/E7 Oncoproteins to Induce SOD2 Expression and DNA Damage in Head and Neck Cancer. Int J Mol Sci 2023; 24:ijms24086907. [PMID: 37108069 PMCID: PMC10138975 DOI: 10.3390/ijms24086907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Even though epidemiological studies suggest that tobacco smoking and high-risk human papillomavirus (HR-HPV) infection are mutually exclusive risk factors for developing head and neck cancer (HNC), a portion of subjects who develop this heterogeneous group of cancers are both HPV-positive and smokers. Both carcinogenic factors are associated with increased oxidative stress (OS) and DNA damage. It has been suggested that superoxide dismutase 2 (SOD2) can be independently regulated by cigarette smoke and HPV, increasing adaptation to OS and tumor progression. In this study, we analyzed SOD2 levels and DNA damage in oral cells ectopically expressing HPV16 E6/E7 oncoproteins and exposed to cigarette smoke condensate (CSC). Additionally, we analyzed SOD2 transcripts in The Cancer Genome Atlas (TCGA) Head and Neck Cancer Database. We found that oral cells expressing HPV16 E6/E7 oncoproteins exposed to CSC synergistically increased SOD2 levels and DNA damage. Additionally, the SOD2 regulation by E6, occurs in an Akt1 and ATM-independent manner. This study suggests that HPV and cigarette smoke interaction in HNC promotes SOD2 alterations, leading to increased DNA damage and, in turn, contributing to development of a different clinical entity.
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Affiliation(s)
- Diego Carrillo-Beltrán
- Instituto de Bioquímica y Microbiología, Facultad de Ciencias, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Julio C Osorio
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Rancés Blanco
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Carolina Oliva
- Laboratorio de Oncovirología, Programa de Virología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Enrique Boccardo
- Department of Microbiology, Institute of Biomedical Sciences, University of Sao Paulo, Sao Paulo 05508-900, Brazil
| | - Francisco Aguayo
- Departamento de Biomedicina, Facultad de Medicina, Universidad de Tarapacá, Arica 1000000, Chile
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Accuracy of p16 IHC in Classifying HPV-Driven OPSCC in Different Populations. Cancers (Basel) 2023; 15:cancers15030656. [PMID: 36765613 PMCID: PMC9913822 DOI: 10.3390/cancers15030656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
High-risk human papillomavirus (HPV) infection is a defined etiopathogenetic factor in oropharyngeal carcinogenesis with a clear prognostic value. The P16 IHC (immunohistochemistry) is a widely accepted marker for HPV-driven carcinogenesis in oropharyngeal squamous cell carcinoma (OPSCC); in the present paper, we discuss its reliability as a standalone marker in different populations. The literature suggests that rates of p16 IHC false positive results are inversely correlated with the prevalence of HPV-driven carcinogenesis in a population. We propose a formula that can calculate such a false positive rate while knowing the real prevalence of HPV-driven OPSCCs in a given population. As it has been demonstrated that p16 positive/HPV negative cases (i.e., false positives at p16 IHC) have the same prognosis as p16 negative OPSCC, we conclude that despite the valuable prognostic value of p16 IHC, relying only on a p16 IHC positive result to recommend treatment de-intensification could be risky. For this aim, confirmation with an HPV nucleic acid detection system, especially in areas with a low prevalence of HPV-related OPSCCs, should be pursued.
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Bussu F, Muresu N, Crescio C, Gallus R, Rizzo D, Cossu A, Sechi I, Fedeli M, Cossu A, Delogu G, Piana A. Low Prevalence of HPV Related Oropharyngeal Carcinogenesis in Northern Sardinia. Cancers (Basel) 2022; 14:cancers14174205. [PMID: 36077741 PMCID: PMC9454854 DOI: 10.3390/cancers14174205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
HPV infection is a clear etiopathogenetic factor in oropharyngeal carcinogenesis and is associated with a markedly better prognosis than in smoking- and alcohol-associated cases, as specified by AJCC classification. The aim of the present work is to evaluate the prevalence of HPV-induced OPSCC in an insular area in the Mediterranean and to assess the reliability of p16 IHC (immunohistochemistry) alone, as accepted by AJCC, in the diagnosis of HPV-driven carcinogenesis in such a setting. All patients with OPSCC consecutively managed by the referral center in North Sardinia of head and neck tumor board of AOU Sassari, were recruited. Diagnosis of HPV-related OPCSS was carried out combining p16 IHC and DNA testing on FFPE samples and compared with the results of p16 IHC alone. Roughly 14% (9/62) of cases were positive for HPV-DNA and p16 IHC. Three more cases showed overexpression of p16, which has a 100% sensitivity, but only 75% specificity as standalone method for diagnosing HPV-driven carcinogenesis. The Cohen’s kappa coefficient of p16 IHC alone is 0.83 (excellent). However, if HPV-driven carcinogenesis diagnosed by p16 IHC alone was considered the criterion for treatment deintensification, 25% of p16 positive cases would have been wrongly submitted to deintensified treatment for tumors as aggressive as a p16 negative OPSCC. The currently accepted standard by AJCC (p16 IHC alone) harbors a high rate of false positive results, which appears risky for recommending treatment deintensification, and for this aim, in areas with a low prevalence of HPV-related OPSCC, it should be confirmed with HPV nucleic acid detection.
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Affiliation(s)
- Francesco Bussu
- Department of Medicine, Surgery and Pharmacy, University of Sassari-ENT Division, AOU Sassari, 07100 Sassari, Italy
| | - Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, 07100 Sassari, Italy
| | - Claudia Crescio
- Otolaryngology Division, Azienda Ospedaliera Universitaria, 07100 Sassari, Italy
- Correspondence: ; Tel.: +39-079-228-552
| | - Roberto Gallus
- Otolaryngology, Mater Olbia Hospital, 07026 Olbia, Italy
| | - Davide Rizzo
- Department of Medicine, Surgery and Pharmacy, University of Sassari-ENT Division, AOU Sassari, 07100 Sassari, Italy
| | - Andrea Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Illari Sechi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Mariantonietta Fedeli
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Delogu
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Piana
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
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Cosoroabă RM, Gaje NP, Ceauşu AR, Dumitru CŞ, Todor L, Popovici RA, Porumb A, Domocoş D, Miron MI, Miron MI. The mast cell reaction in premalignant and malignant lesions of the head and neck. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2022; 63:407-411. [PMID: 36374145 PMCID: PMC9804062 DOI: 10.47162/rjme.63.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most frequent and aggressive neoplasms of this anatomical region. Many studies evaluated the neoplastic cells, but few works focused on the tumor microenvironment. In the present study, we investigated the distribution and mast cell density (MCD) in malignant and premalignant lesions of the oral cavity, tongue, pharynx, and larynx. There were analyzed 52 specimens of HNSCC, and 15 biopsies taken from patients with dysplasia. Results were compared with those found in a control group of 10 biopsies of oral mucosa from patients with inflammatory diseases. Slides stained with Hematoxylin-Eosin were used for the histopathological diagnosis and grade, and mast cells (MCs) were identified by immunohistochemistry, using anti-MC tryptase. MCs were counted using a method similar to that proposed for microvessel density. We found a significant increase in the number of MCs from the normal oral mucosa until overt carcinoma. Unlike normal tissues, in HNSCC, many MCs were found between tumor cells. We found no relationship between MCs and blood vessels in the tumor area. A significant statistical correlation was found between dysplastic and malignant tumors, but not between tumors with a different grade. Also, it was not found relationship between MCD and the anatomical location of the tumor. Based on these results, we believe that MCD evaluated by anti-MC tryptase is an independent factor of prognosis and reflects an unfavorable outcome.
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Affiliation(s)
- Raluca Mioara Cosoroabă
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Romania; ; Discipline of Management, Legislation and Communication in Dental Medicine, 1st Department of Dentistry, Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania;
| | - Nela Puşa Gaje
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Amalia Raluca Ceauşu
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Cristina Ştefania Dumitru
- Department of Microscopic Morphology/Histology, Angiogenesis Research Center Timişoara, Faculty of Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Liana Todor
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | - Ramona Amina Popovici
- Discipline of Management, Legislation and Communication in Dental Medicine, 1st Department of Dentistry, Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
| | - Anca Porumb
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | - Daniela Domocoş
- Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Romania
| | - Mariana Ioana Miron
- Department 2, Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania
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