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Tosios KI, Kalogirou EM, Koutlas IG. Association of MDM2 Overexpression in Ameloblastomas with MDM2 Amplification and BRAF V600E Expression. Int J Mol Sci 2024; 25:2238. [PMID: 38396916 PMCID: PMC10889355 DOI: 10.3390/ijms25042238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Ameloblastoma is a rare tumor but represents the most common odontogenic neoplasm. It is localized in the jaws and, although it is a benign, slow-growing tumor, it has an aggressive local behavior and high recurrence rate. Therefore, alternative treatment options or complementary to surgery have been evaluated, with the most promising one among them being a targeted therapy with the v-Raf murine sarcoma viral oncogene homologue B (BRAF), as in ameloblastoma the activating mutation V600E in BRAF is common. Studies in other tumors have shown that the synchronous inhibition of BRAF and human murine double minute 2 homologue (MDM2 or HDM2) protein is more effective than BRAF monotherapy, particularly in the presence of wild type p53 (WTp53). To investigate the MDM2 protein expression and gene amplification in ameloblastoma, in association with BRAFV600E and p53 expression. Forty-four cases of ameloblastoma fixed in 10% buffered formalin and embedded in paraffin were examined for MDM2 overexpression and BRAFV600E and p53 expression by immunohistochemistry, and for MDM2 ploidy with fluorescence in situ hybridization. Sixteen of forty-four (36.36%) cases of ameloblastoma showed MDM2 overexpression. Seven of sixteen MDM2-positive ameloblastomas (43.75%) were BRAFV600E positive and fifteen of sixteen MDM2-positive ameloblastomas (93.75%) were p53 negative. All MDM2 overexpressing tumors did not show copy number alterations for MDM2. Overexpression of MDM2 in ameloblastomas is not associated with MDM2 amplification, but most probably with MAPK activation and WTp53 expression. Further verification of those findings could form the basis for the use of MDM2 expression as a marker of MAPK activation in ameloblastomas and the trial of dual BRAF/MDM2 inhibition in the management of MDM2-overexpressing/BRAFV600E-positive/WTp53 ameloblastomas.
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Affiliation(s)
- Konstantinos I. Tosios
- Department of Oral Pathology & Medicine and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni-Marina Kalogirou
- Faculty of Health and Rehabilitation Sciences, Metropolitan College, 15125 Athens, Greece;
| | - Ioannis G. Koutlas
- Division of Oral Pathology, School of Dentistry, University of Minnesota, Minneapolis, MN 55455, USA;
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Thermos G, Kalogirou EM, Tosios KI. Anti-epidermal growth factor receptor targeted therapy-associated ulcerations. Oral Oncol 2024; 148:106660. [PMID: 38086198 DOI: 10.1016/j.oraloncology.2023.106660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/25/2023]
Abstract
The well-studied role of epidermal growth factor receptor (EGFR) in metastatic colorectal cancer (mCRC) and non-small cell lung cancer (NSCLC) has enabled the development of drugs that target this molecule, including panitumumab for the former and osimertinib for the latter. Oral adverse events due to those agents are rarely described in the literature and their exact characterization is hampered by inadequate reporting and/or incorrect terminology used. We report two cases of panitumumab- and osimertinib-associated oral ulcerations with emphasis on their possible pathogenesis and optimal management.
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Affiliation(s)
| | - Eleni-Marina Kalogirou
- Faculty of Health and Rehabilitation Sciences, Metropolitan College, 15125 Athens, Greece.
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Kalogirou EM, Lekakis G, Petroulias A, Chavdoulas K, Zogopoulos VL, Michalopoulos I, Tosios KI. The Stem Cell Expression Profile of Odontogenic Tumors and Cysts: A Systematic Review and Meta-Analysis. Genes (Basel) 2023; 14:1735. [PMID: 37761874 PMCID: PMC10531260 DOI: 10.3390/genes14091735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Stem cells have been associated with self-renewing and plasticity and have been investigated in various odontogenic lesions in association with their pathogenesis and biological behavior. We aim to provide a systematic review of stem cell markers' expression in odontogenic tumors and cysts. METHODS The literature was searched through the MEDLINE/PubMed, EMBASE via OVID, Web of Science, and CINHAL via EBSCO databases for original studies evaluating stem cell markers' expression in different odontogenic tumors/cysts, or an odontogenic disease group and a control group. The studies' risk of bias (RoB) was assessed via a Joanna Briggs Institute Critical Appraisal Tool. Meta-analysis was conducted for markers evaluated in the same pair of odontogenic tumors/cysts in at least two studies. RESULTS 29 studies reported the expression of stem cell markers, e.g., SOX2, OCT4, NANOG, CD44, ALDH1, BMI1, and CD105, in various odontogenic lesions, through immunohistochemistry/immunofluorescence, polymerase chain reaction, flow cytometry, microarrays, and RNA-sequencing. Low, moderate, and high RoBs were observed in seven, nine, and thirteen studies, respectively. Meta-analysis revealed a remarkable discriminative ability of SOX2 for ameloblastic carcinomas or odontogenic keratocysts over ameloblastomas. CONCLUSION Stem cells might be linked to the pathogenesis and clinical behavior of odontogenic pathologies and represent a potential target for future individualized therapies.
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Affiliation(s)
- Eleni-Marina Kalogirou
- Faculty of Health and Rehabilitation Sciences, Metropolitan College, 10672 Athens, Greece
| | - Georgios Lekakis
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.L.); (A.P.); (K.C.); (K.I.T.)
| | - Aristodimos Petroulias
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.L.); (A.P.); (K.C.); (K.I.T.)
| | - Konstantinos Chavdoulas
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.L.); (A.P.); (K.C.); (K.I.T.)
| | - Vasileios L. Zogopoulos
- Centre of Systems Biology, Biomedical Research Foundation, Academy of Athens, 11527 Athens, Greece; (V.L.Z.); (I.M.)
| | - Ioannis Michalopoulos
- Centre of Systems Biology, Biomedical Research Foundation, Academy of Athens, 11527 Athens, Greece; (V.L.Z.); (I.M.)
| | - Konstantinos I. Tosios
- School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.L.); (A.P.); (K.C.); (K.I.T.)
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Aktypi-Bampouranou A, Kalogirou EM, Skamnakis I, Vlachodimitropoulos D, Tosios KI. Spongiotic Gingival Hyperplasia in a Child with Asperger Syndrome: a Case Report. J Oral Maxillofac Res 2023; 14:e5. [PMID: 37969953 PMCID: PMC10645472 DOI: 10.5037/jomr.2023.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/30/2023] [Indexed: 11/17/2023]
Abstract
Background Asperger syndrome is a type of autism spectrum disorder that may affect oral health and dental management. Spongiotic gingival hyperplasia is a rare lesion with unique clinicopathological features and unknown pathogenesis that has not been previously reported in a patient with autism spectrum disorder. The purpose of this case report is to present the first case of spongiotic gingival hyperplasia in a child with Asperger syndrome. Methods A 14-year-old boy with Asperger syndrome was referred for diagnosis and management of bright red granular overgrowths of the marginal gingiva and interdental papilla of the mandibular right incisors and marginal gingiva of the mandibular left incisor. A biopsy was performed on the interdental papilla between the mandibular right incisors. Results Microscopic examination and cytokeratin 19 immunopositivity confirmed the diagnosis of spongiotic gingival hyperplasia. The parents of the patient declined any further intervention, and four months later the gingival lesions, including the biopsied area, did not show any significant difference from the initial examination. Conclusions Patients with autism spectrum diseases, such as Asperger syndrome, cannot achieve a good level of oral hygiene. Thus, it is expected that the incidence of spongiotic gingival hyperplasia should be higher in this group of patients, in case oral microbiome participates in its pathogenesis. Management of such lesions is challenging, as such patients do not comply with a proper oral hygiene program and do not cooperate with surgical excision.
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Affiliation(s)
| | | | | | | | - Konstantinos I. Tosios
- Private practice in oral medicine, AthensGreece.
- Department of Oral Medicine, Pathology, and Hospital Dentistry, School of Dentistry, University of Athens, AthensGreece.
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Kalogirou EM, Foutadakis S, Koutsi MA, Vatsellas G, Vlachodimitropoulos D, Petsinis V, Sklavounou A, Agelopoulos M, Tosios KI. Decoding a gene expression program that accompanies the phenotype of sporadic and Basal Cell Nevus Syndrome-associated odontogenic keratocyst. J Oral Pathol Med 2022; 51:649-658. [PMID: 35665542 DOI: 10.1111/jop.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Odontogenic keratocyst (OKC) is characterized by local aggressive behavior and a high recurrence rate, as well as the potential to develop in association with the Basal Cell Nevus Syndrome (BCNS). The aim of this study was to decode the gene expression program accompanying OKC phenotype. METHODS 150-bp paired-end RNA-sequencing was applied on 6 sporadic and 6 BSCN-associated whole-tissue OKC samples in comparison to 6 dental follicles, coupled to bioinformatics and complemented by immunohistochemistry. RESULTS 2,654 and 2,427 differentially expressed genes were captured to characterize the transcriptome of sporadic and BCNS-associated OKCs, respectively. Gene ontologies (GOs) related to "epidermis/skin development" and "keratinocyte/epidermal cell differentiation" were enriched among the upregulated genes (KRT10, NCCRP1, TP63, GRHL3, SOX21), while "extracellular matrix (ECM) organization" (ITGA5, LOXL2) and "odontogenesis" (MSX1, LHX8) GOs were overrepresented among the downregulated genes in OKC. Interestingly, upregulation of various embryonic stem cells (ESCs) markers (EPHA1, SCNN1A) and genes committed in cellular reprogramming (SOX2, KLF4, OVOL1, IRF6, TACSTD2, CDH1) was found in OKC. These findings were highly shared between sporadic and BCNS-associated OKCs. Immunohistochemistry verified SOX2, KLF4, OVOL1, IRF6, TACSTD2/TROP2, CDH1/E-cadherin, and p63 expression predominantly in the OKC suprabasal epithelial layers. CONCLUSION The OKC transcriptomic profile is characterized by a prominent epidermal and dental epithelial fate, a repressed dental mesenchyme fate combined with deregulated ECM organization, and enhanced stemness gene signatures. Thus, we propose a developed epidermis-like phenotype in the OKC suprabasal epithelial cells, established in parallel to a significant upregulation of marker genes related to ESCs and cellular reprogramming. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Eleni-Marina Kalogirou
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyros Foutadakis
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Marianna A Koutsi
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Giannis Vatsellas
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | | | - Vassilis Petsinis
- Department of Oral and Maxillofacial Surgery, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Marios Agelopoulos
- Center of Basic Research, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine & Pathology and Hospital Dentistry, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Kalogirou EM, Foutadakis S, Sklavounou A, Petsinis V, Nikitakis NG, Agelopoulos M, Tosios KI. DECODING THE GENE EXPRESSION PROGRAM EVOLVED IN ODONTOGENIC KERATOCYST BY THE COMBINATION OF DEEP TRANSCRIPTOMICS ANALYSES AND COMPUTATIONAL BIOLOGY TOOLS. Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chatzipetros E, Damaskos S, Tosios KI, Christopoulos P, Donta C, Kalogirou EM, Yfanti Z, Tsiourvas D, Papavasiliou A, Tsiklakis K. The effect of nano-hydroxyapatite/chitosan scaffolds on rat calvarial defects for bone regeneration. Int J Implant Dent 2021; 7:40. [PMID: 34027572 PMCID: PMC8141479 DOI: 10.1186/s40729-021-00327-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study aims at determining the biological effect of 75/25 w/w nano-hydroxyapatite/chitosan (nHAp/CS) scaffolds on bone regeneration, in terms of fraction of bone regeneration (FBR), total number of osteocytes (Ost), and osteocyte cell density (CD), as well as its biodegradability. METHODS Two critical-size defects (CSDs) were bilaterally trephined in the parietal bone of 36 adult Sprague-Dawley rats (18 males and 18 females); the left remained empty (group A), while the right CSD was filled with nHAp/CS scaffold (group B). Two female rats died postoperatively. Twelve, 11, and 11 rats were euthanized at 2, 4, and 8 weeks post-surgery, respectively. Subsequently, 34 specimens were resected containing both CSDs. Histological and histomorphometric analyses were performed to determine the FBR, calculated as [the sum of areas of newly formed bone in lateral and central regions of interest (ROIs)]/area of the original defect, as well as the Ost and the CD (Ost/mm2) in each ROI of both groups (A and B). Moreover, biodegradability of the nHAp/CS scaffolds was estimated via the surface area of the biomaterial (BmA) in the 2nd, 4th, and 8th week post-surgery. RESULTS The FBR of group B increased significantly from 2nd to 8th week compared to group A (P = 0.009). Both the mean CD and the mean Ost values of group B increased compared to group A (P = 0.004 and P < 0.05 respectively). Moreover, the mean value of BmA decreased from 2nd to 8th week (P = 0.001). CONCLUSIONS Based on histological and histomorphometric results, we support that 75/25 w/w nHAp/CS scaffolds provide an effective space for new bone formation.
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Affiliation(s)
- Emmanouil Chatzipetros
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, 11527, Goudi, Athens, Greece.
| | - Spyros Damaskos
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, 11527, Goudi, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Panos Christopoulos
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Catherine Donta
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, 11527, Goudi, Athens, Greece
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Zafeiroula Yfanti
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, 11527, Goudi, Athens, Greece
| | - Dimitris Tsiourvas
- Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research "Demokritos", Aghia Paraskevi, Attiki, Greece
| | - Aggeliki Papavasiliou
- Institute of Nanoscience and Nanotechnology, National Centre for Scientific Research "Demokritos", Aghia Paraskevi, Attiki, Greece
| | - Kostas Tsiklakis
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, 2 Thivon Str, 11527, Goudi, Athens, Greece
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Karveleas I, Kyriakouli A, Koukou M, Koufatzidou M, Kalogirou EM, Tosios KI. The relationship between Facebook behaviour and e-professionalism: A questionnaire-based cross-sectional study among Greek dental students. Eur J Dent Educ 2021; 25:151-158. [PMID: 32780448 DOI: 10.1111/eje.12585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The social media attitude of health science students might affect patients' opinion about the health profession and have negative impact on e-professionalism. The aim of this study is to investigate the behaviour of Greek dental students on Facebook, focusing on potentially unprofessional posts and the online student-patient relationship. MATERIALS AND METHODS Five hundred and twelve dental students in Greece answered an anonymous, 23-item questionnaire including multiple-choice questions about various topics, including Facebook profile settings and content shared by dental students, student-patient relationship via Facebook; and students' perception about the impact of their online behaviour. RESULTS 93.2% of responders had a Facebook profile and 80.5% admitted that their online attitude might affect patients' opinion about dental profession. However, 71.7% posted pictures from holidays, 41.5% from nightclubs, and 26.2% photographs wearing swimwear/underwear, while 12.8% expressed online political party predilection. One quarter of students in clinical years were Facebook friends with patients and 58% and 30% of them had online discussion about topics related or not to dentistry, respectively, while 6.8% of dental students had posted defamatory comments about the dental school, faculty members or academic staff on Facebook. DISCUSSION In accordance with studies in other countries, most Greek dental students had a Facebook profile and, although the majority realised the impact of Facebook behaviour on e-professionalism, a considerable percentage posted unprofessional content. CONCLUSION Dental students might fall into pitfalls when it comes to e-professionalism. As social media are becoming an integral part of life, there is need to include e-professionalism in dental education curriculum.
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Affiliation(s)
- Ilias Karveleas
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Athina Kyriakouli
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Melina Koukou
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Koufatzidou
- Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Berry S, Javed F, Rossouw PE, Barmak AB, Kalogirou EM, Michelogiannakis D. Influence of thyroxine supplementation on orthodontically induced tooth movement and/or inflammatory root resorption: A systematic review. Orthod Craniofac Res 2020; 24:206-213. [PMID: 32991769 DOI: 10.1111/ocr.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023]
Abstract
The role of thyroxine administration on orthodontically induced tooth movement and/or inflammatory root resorption remains unclear. The aim was to assess the influence of thyroxine administration on orthodontically induced tooth movement and/or inflammatory root resorption. The study protocol was registered in PROSPERO (CRD42020164151). An electronic search of indexed databases was conducted without time or language restrictions up to and including May 2020. The following eligibility criteria were imposed: (a) original prospective controlled clinical studies and/or experimental studies on animal models; (b) subjects undergoing orthodontic therapy with fixed appliances; (c) presence of a control group [orthodontic tooth movement without thyroxine administration]; and (d) intervention: orthodontic tooth movement with thyroxine administration. Review articles, commentaries, letters to the editor, case reports/series, studies with no control group, cross-sectional studies, retrospective studies and studies where thyroxine was administered along with other interventions such as calcitonin and prostaglandins were excluded. Quality of available evidence and risk of bias within studies were assessed. Any disagreements were resolved via consensus discussions. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 8 animal studies were included. Four studies reported that thyroxine administration increases the rate of orthodontic tooth movement; 3 studies did not show a significant difference. Three studies showed that thyroxine administration decreases orthodontically induced inflammatory root resorption; 2 studies found no significant difference. The risk of bias among studies was high. In conclusion, the influence of thyroxine administration on orthodontic tooth movement and/or orthodontically induced inflammatory root resorption in animal models remains unclear.
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Affiliation(s)
- Stefani Berry
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Fawad Javed
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Paul Emile Rossouw
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Abdul Basir Barmak
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | | | - Dimitrios Michelogiannakis
- Division of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
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Kotsailidi EA, Kalogirou EM, Michelogiannakis D, Vlachodimitropoulos D, Tosios KI. Hypersensitivity reaction of the gingiva to chlorhexidine: case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 130:156-160.e1. [PMID: 32527627 DOI: 10.1016/j.oooo.2020.04.814] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/15/2020] [Accepted: 04/26/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this case report was to document a case of delayed-type hypersensitivity reaction of the gingiva to chlorhexidine and review the literature on oral mucosal hypersensitivity reactions associated to chlorhexidine-containing oral hygiene products. STUDY DESIGN A 58-year-old man presented with a well-demarcated erythematous area on the right upper anterior gingiva. Incisional biopsy was performed. Postoperatively, chlorhexidine digluconate gel was prescribed twice a day, but the patient did not use it because he experienced intense burning immediately after the first application. The microscopic diagnosis was nonspecific mucositis. Hypersensitivity reaction was suspected. The patient reported use of 0.004% chlorhexidine digluconate-based toothpaste twice a day in the past few years. A delayed-type hypersensitivity reaction to the toothpaste was hypothesized, and its use was discontinued. Chlorhexidine, the common ingredient of both the toothpaste and the gel, was considered the allergen. The literature was reviewed on chlorhexidine-induced oral hypersensitivity reactions. RESULTS Two weeks after cessation of toothpaste use, complete remission of the lesion was observed without additional intervention. Four years later, no recurrence has been reported. The literature review yielded 7 studies reporting 20 patients with intraoral manifestations of hypersensitivity reactions associated with chlorhexidine-containing oral hygiene products. CONCLUSIONS Clinicians should be aware that oral hygiene products containing even low concentrations of chlorhexidine might induce hypersensitivity reactions.
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Affiliation(s)
- Elli Anna Kotsailidi
- Department of Periodontics, Eastman Institute for Oral Health, University of Rochester, New York, USA
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, New York, USA
| | | | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece.
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Karveleas I, Kalogirou EM, Tosios KI, Nikitakis NG. Synchronous occurrence of two lateral periodontal cysts in the same patient. Report of a rare case and review of the literature. J Clin Exp Dent 2020; 12:e418-e423. [PMID: 32382392 PMCID: PMC7195683 DOI: 10.4317/jced.56802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/27/2020] [Indexed: 11/18/2022] Open
Abstract
We present a case of a patient with two lateral periodontal cysts in the maxilla and the mandible, respectively, and review the English literature on multiple lateral periodontal (LPCs) cysts and/or gingival cysts (GCs) and botryoid odontogenic cysts (BOCs). The patient was a 59 year-old female with two fluctuant swellings covered by semi-lucent mucosa on the attached gingiva between the maxillary and mandibular right canine and first premolar teeth, respectively. Periapical radiographs revealed at the respective sites between the roots of the canine and first premolar teeth areas unilocular radiolucencies. Intra-operatively, the presence of bone cavities was confirmed at both sites. The microscopic features were consistent with LPC. The review of the English literature on multiple LPCs and/or GCs and BOCs found seven reports of multiple LPCs, four of multiple GCs, and two with an LPCs and a GC. It is concluded that multiple LPCs have been rarely reported in the literature, but should be included in the differential diagnosis of multifocal radiolucencies lateral to vital teeth. The possibility of multiple lesions in different locations should direct to a thorough clinical and radiographic examination in a patient diagnosed with an LPC or GC. Key words:Jaw cysts odontogenic cyst, lateral periodontal cyst, multifocal unilocular radiolucencies.
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Affiliation(s)
| | - Eleni-Marina Kalogirou
- DDS, MSc, PhD Candidate, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Konstantinos I Tosios
- DDS, PhD, Associate Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Greece
| | - Nikolaos G Nikitakis
- MD, DDS, PhD, Professor and Chair, Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens, Greece
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Tosios KI, Kalogirou EM, Nikitakis NG. A solitary, red, papillary-verrucous lesion on the mandibular alveolar mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 131:e41-e44. [PMID: 31902666 DOI: 10.1016/j.oooo.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/28/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Konstantinos I Tosios
- Associate Professor, Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens, Greece.
| | - Eleni-Marina Kalogirou
- PhD Candidate, Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens
| | - Nikolaos G Nikitakis
- Professor and Director, Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens
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Kalogirou EM, Tosios KI. Fixed drug eruption on the tongue associated with piroxicam: report of two cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:393-398. [DOI: 10.1016/j.oooo.2019.01.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/14/2019] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
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Thermos G, Kalogirou EM, Tosios KI, Sklavounou A. Oral ulceration with bone sequestration: Retrospective study of eight cases and literature review. Oral Dis 2018; 25:515-522. [PMID: 30383915 DOI: 10.1111/odi.13000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/07/2018] [Accepted: 10/23/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature. SUBJECTS AND METHODS This is a retrospective study of OUBS cases, diagnosed and managed during 2007-2017. Inclusion criteria were the presence of oral ulcer with exposed non-vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases. RESULTS Eight patients (5 males and 3 females, aged 27-75 years) were diagnosed with OUBS during years 2007-2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible. CONCLUSION Oral ulceration with bone sequestration is a distinct, probably under-reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non-vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis.
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Affiliation(s)
- Grigorios Thermos
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Zampeli E, Kalogirou EM, Piperi E, Mavragani CP, Moutsopoulos HM. Tongue Atrophy in Sjögren Syndrome Patients with Mucosa-associated Lymphoid Tissue Lymphoma: Autoimmune Epithelitis beyond the Epithelial Cells of Salivary Glands? J Rheumatol 2018; 45:1565-1571. [DOI: 10.3899/jrheum.180101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/22/2022]
Abstract
Objective.Primary Sjögren syndrome (pSS), an autoimmune epithelitis, bears the risk of evolving to non-Hodgkin lymphoma and most frequently to the mucosa-associated lymphoid tissue (MALT) subtype. Based on the observation that pSS patients with MALT present a more atrophic and more intensely fissured tongue, we aimed to semiquantify severity of tongue atrophy and clinically assess lingual appearance in pSS patients with and without MALT, and investigate whether tongue atrophy and fissured appearance could serve as clinical indicators/signs of MALT.Methods.A blinded complete oral examination was performed in pSS patients with and without MALT. Tongue atrophy was scored using a semiquantified atrophy score. Clinical and laboratory variables were recorded for all patients.Results.After excluding pSS patients with oral candidiasis, iron deficiency, and megaloblastic anemia, 19 pSS patients with salivary MALT were matched 1:3 for age, sex, and disease duration with 57 pSS patients without MALT. The pSS-MALT patients had increased prevalence of salivary gland enlargement, lymphadenopathy, monoclonal gammopathy, rheumatoid factor positivity, higher focus and Tarpley scores in the minor salivary gland biopsy, and hyposalivation, compared to the pSS non-MALT patients. A significantly higher prevalence of tongue atrophy (68% vs 30%, p = 0.006) and fissured tongue (89% vs 33%, p < 0.001) was observed in the former group. Multivariate analysis showed that fissured tongue appearance, hyposalivation, and lymphadenopathy associate independently with salivary MALT in pSS.Conclusion.These results suggest that pSS patients with lymphoid malignancy exhibit a more atrophic and more fissured tongue. This particular clinical tongue appearance can serve as an additional clinical sign for salivary MALT lymphoma in pSS patients.
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Siamantas I, Kalogirou EM, Tosios KI, Fourmousis I, Sklavounou A. Spongiotic Gingival Hyperplasia Synchronously Involving Multiple Sites: Case Report and Review of the Literature. Head Neck Pathol 2018; 12:517-521. [PMID: 29512024 PMCID: PMC6232213 DOI: 10.1007/s12105-018-0903-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/27/2018] [Indexed: 11/25/2022]
Abstract
Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a gingival lesion with unique clinicopathologic features that may involve synchronously multiple sites. We present a case with lesions clinically consistent with LJSGH in four jaw quadrants, confirmed by biopsy and review the English literature on multifocal LJSGH cases. A 19 year-old woman presented with circumscribed, erythematous overgrowths on the right and left maxillary and mandibular gingiva. With the provisional diagnosis of multifocal LJSGH, total excision of four maxillary lesions was performed. Clinical, microscopic and immunohistochemical examination with cytokeratin 19 confirmed the diagnosis of LJSGH in multiple sites. The excised lesions showed partial to complete recurrence after 4 months, while spontaneous regression of all but one lesion was observed after 15 months. Twenty cases with synchronous involvement of the gingiva of at least two teeth were previously reported. Their clinical features were comparable to that of solitary LJSGH. Only one case involved all four jaw quadrants. Spontaneous remission has not been documented before. The recognition of multiple lesions with clinicopathologic features diagnostic of LJSGH in the same adult patient argue against the designations "localized" and "juvenile". Recurrences are common, while remission might occur.
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Affiliation(s)
| | - Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece.
| | - Ioannis Fourmousis
- Department of Periodontology, Dental School, National and Kapodistrian University of Athens, 2 Thivon Street, Athens, Greece
| | - Alexandra Sklavounou
- Department of Oral Medicine and Pathology, Dental School, National and Kapodistrian University of Athens, 2 Thivon Street, 11527, Athens, Greece
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Tosios KI, Kalogirou EM, Sklavounou A. Drug-associated hyperpigmentation of the oral mucosa: report of four cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:e54-e66. [DOI: 10.1016/j.oooo.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 10/14/2017] [Accepted: 10/23/2017] [Indexed: 12/22/2022]
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Kalogirou EM, Kalyvas D, Tosios KI, Tsiklakis K, Sklavounou A. Recurrence in a patient with a 10-year history of sinonasal mucosal melanoma manifesting as facial swelling. J Clin Exp Dent 2018; 9:e1492-e1495. [PMID: 29410768 PMCID: PMC5794130 DOI: 10.4317/jced.54466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/05/2017] [Indexed: 11/05/2022] Open
Abstract
Sinonasal mucosal melanoma is a rare tumor that develops slowly and may manifest with non specific signs and symptoms, causing significant delay in diagnosis. Local recurrence is common and usually occurs within the first two years after the initial treatment. Prognosis of recurrent lesions is poor and 5-year survival ranges between 10-47%. We report the clinical, radiographic, histopathological and immunohistochemical findings of a recurrent sinonasal mucosal melanoma which was diagnosed 10 years after the initial treatment, in a patient who presented with unilateral facial swelling and one-sided difficulty in breathing of two years duration. We discuss the causes of late diagnosis and review the negative predictive factors for recurrence and survival. As early diagnosis is of paramount importance for prognosis, we emphasize the signs and symptoms of patients with a history of sinonasal mucosal melanoma which should raise the suspicion for recurrence, in spite of a long time interval since diagnosis. Key words: Mucosal melanoma, nasal cavity, sinus, recurrence.
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Affiliation(s)
- Eleni-Marina Kalogirou
- DDS, MSc, PhD Candidate, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Demos Kalyvas
- DDS, PhD, Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- DDS, PhD, Assistant Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Kostas Tsiklakis
- DDS, MSc, PhD, Professor, Department of Oral Diagnosis and Radiology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Kalogirou EM, Piperi EP, Tosios KI, Tsiambas E, Fanourakis G, Sklavounou A. Cover Image. J Oral Pathol Med 2018. [DOI: 10.1111/jop.12691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Kalogirou EM, Piperi EP, Tosios KI, Tsiambas E, Fanourakis G, Sklavounou A. Ductal cells of minor salivary glands in Sjögren's syndrome express LINE-1 ORF2p and APOBEC3B. J Oral Pathol Med 2017; 47:179-185. [PMID: 29057505 DOI: 10.1111/jop.12656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Type I interferon activation is a hallmark event in Sjögren's syndrome. L1 retroelements stimulate plasmacytoid dendritic cells, activating the type I interferons, and are regulated by various mechanisms, including the APOBEC3 deaminases. As L1s are potential trigger factors in autoimmunity, we aimed to investigate the immunohistochemical localization of L1 ORF2p and its inhibitor APOBEC3B protein in minor salivary glands of Sjögren's syndrome patients. METHODS Twenty minor salivary gland-tissue samples from 20 Sjögren's syndrome patients, classified according to Tarpley's histological criteria, and 10 controls were evaluated for L1 ORF2p and APOBEC3B expression via immunohistochemistry. RESULTS L1 ORF2p was expressed in 17/20 SS patients and all controls. APOBEC3B expression was observed in 15/20 Sjögren's syndrome patients, 5/5 chronic sialadenitis, and 3/5 normal minor salivary glands. Both antibodies stained the cytoplasm of the ductal epithelial cells. Negative staining was observed in the acinar cells. L1 ORF2p-positive immunostaining was significantly lower in Tarpley IV Sjögren's syndrome patients than controls (P = .039), and APOBEC3B-positive staining was significantly lower in Tarpley I compared to Tarpley II Sjögren's syndrome patients (P = .008) and controls (P = .035). CONCLUSIONS L1 ORF2p and APOBEC3B are expressed in the ductal epithelial cells of minor salivary glands that are among the key targets in Sjögren's syndrome. L1 ORF2p expression may promote the L1 ability to act as an intrinsic antigen in Sjögren's syndrome. The potential future use of L1 ORF2-reverse transcriptase inhibitors in autoimmunity supports further investigation of L1 epigenetic regulation by APOBEC3 enzymes.
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Affiliation(s)
- Eleni-Marina Kalogirou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia P Piperi
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Tsiambas
- Department of Immunohistochemistry & Molecular Biology, 401 Military Hospital of Athens, Athens, Greece
| | - Galinos Fanourakis
- Department of Oral Biology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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21
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Sykara M, Ntovas P, Kalogirou EM, Tosios KI, Sklavounou A. Oral lymphoepithelial cyst: A clinicopathological study of 26 cases and review of the literature. J Clin Exp Dent 2017; 9:e1035-e1043. [PMID: 28936296 PMCID: PMC5601105 DOI: 10.4317/jced.54072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/28/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Τo describe the clinicopathological features of 26 oral lymphoepithelial cysts (LECs) and review the literature. Material and Methods Twenty-six cases of oral LECs diagnosed during a 37-year period were retrospectively collected. The patients’ gender and age, as well as the main clinical features of the cysts were retrieved from the requisition forms. The main microscopic features were recorded after reevaluation of all cases. Pubmed and Google Scholar electronic databases were searched with the key word “oral LEC”. Inclusion criteria were the microscopic confirmation of LEC diagnosis and the report at least two of three main clinical features (gender, age and cyst’s location). Results The 26 oral LECs represented 0.08% of 31,564 biopsies accessioned during the study period. They affected 25 patients, 14 females and 11 males with a mean age of 33.04±9.81 years. They appeared as smooth (92%) nodules, with soft (24%) or firm (76%) consistency and normal (28%), yellow to normal (20%), yellow (32%) or white (20%) hue, in the tongue (69.23%) or the floor of mouth (30.77%). They were covered by parakeratinized squamous (92.31%) or non-keratinized (7.69%) epithelium and contained desquamated epithelial cells, amorphous eosinophilic material and/or inflammatory cells (100%). The lymphoid tissue surrounded the cystic cavity partially (34.62%) or completely (65.38%), often in a follicular pattern with prominent germinal centers (53.85%). Literature review yielded 316 cases of oral LECs derived from 25 case reports, 3 case studies/retrospective studies with detailed information for each case and 7 studies with summarized data. Conclusions Oral LEC is a pathologic entity with discrete clinical presentation that is, however, commonly misdiagnosed in clinical practice as other, mostly benign, entities. Its pathogenesis remains obscure, as its clinicopathologic features are consistent with both theories suggested up to date. Key words:Oral lymphoepithelial cyst; developmental cyst; non odontogenic cyst; lymphoid tissue; oral tonsil.
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Affiliation(s)
- Maria Sykara
- DDS, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ntovas
- DDS, Postgraduate Student, Department of Operative Dentistry, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni-Marina Kalogirou
- DDS, MSc, PhD Candidate, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- DDS, PhD, Assistant Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Kalogirou EM, Katsoulas N, Tosios KI, Lazaris AC, Sklavounou A. Non-healing tongue ulcer in a rheumatoid arthritis patient medicated with leflunomide. An adverse drug event? J Clin Exp Dent 2017; 9:e325-e328. [PMID: 28210457 PMCID: PMC5303339 DOI: 10.4317/jced.53428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/18/2016] [Indexed: 11/25/2022] Open
Abstract
Leflunomide is a member of the disease modifying anti-rheumatic drugs group used as a treatment modality in active rheumatoid and psoriatic arthritis. “Oral ulcers” are reported in 3-5% of leflunomide medicated rheumatoid arthritis patients with adverse events, but they are not described in detail in the literature. We present a case of an ulcer in the tongue of a rheumatoid arthritis patient managed with leflunomide and contemplate on its pathogenesis.
Key words:Leflunomide, oral ulcer, DHODH.
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Affiliation(s)
- Eleni-Marina Kalogirou
- DDS, MSc, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Katsoulas
- DDS, MSc, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- DDS, PhD, Assistant Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas C Lazaris
- MD, PhD, Professor, 1st Department of Pathology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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Kalogirou EM, Tosios KI, Nikitakis NG, Kamperos G, Sklavounou A. Transient lingual papillitis: A retrospective study of 11 cases and review of the literature. J Clin Exp Dent 2017; 9:e157-e162. [PMID: 28149482 PMCID: PMC5268094 DOI: 10.4317/jced.53283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Transient lingual papillitis (TLP) is a common, under-diagnosed, inflammatory hyperplasia of one or multiple fungiform lingual that has an acute onset, and is painful and transient in nature. MATERIAL AND METHODS Eleven cases of TLP were diagnosed based on their clinical features. Information on demographics, clinical characteristics, symptoms, individual or family history of similar lesions, medical history, management and follow-up were extracted from the patients' records. The English literature was reviewed on TLP differential diagnosis, pathogenesis and management. RESULTS The study group included 8 females and 3 males (age: 10-53 years, mean age 31.7±12.88 years). Seven cases were classified as generalized form of TLP and 4 as localized form. Nine cases were symptomatic. Time to onset ranged from 1 to 14 days. A specific causative factor was not identified in any case and management was symptomatic. CONCLUSIONS Although TLP is not considered as a rare entity, available information is limited. Diagnosis is rendered clinically, while biopsy is required in cases with a differential diagnostic dilemma. TLP should be included in the differential diagnosis of acute, painful tongue nodules. Key words:Transient lingual papillitis, fungiform papillary glossitis, tongue, nodules.
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Affiliation(s)
- Eleni-Marina Kalogirou
- DDS MSc, Department of Oral Medicine and Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- DDS, PhD, Assistant Professor, Department of Oral Medicine and Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Nikitakis
- DDS, MD, PhD, Associate Professor, Department of Oral Medicine and Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Kamperos
- DDS MSc, Department of Oral Medicine and Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
Background/Aim: Dental implants are a reliable treatment choice for rehabilitation of healthy patients as well as subjects with several systemic conditions. Patients with oral mucosal diseases often exhibit oral mucosal fragility and dryness, erosions, blisters, ulcers or microstomia that complicate the use of removable dentures and emphasize the need for dental implants. The aim of the current study is to review the pertinent literature regarding the dental implantation prospects for patients with oral mucosal diseases. Material and Method: The English literature was searched through PubMed and Google Scholar electronic databases with key words: dental implants, oral mucosal diseases, oral lichen planus (OLP), epidermolysis bullosa (EB), Sjögren’s syndrome (SS), cicatricial pemphigoid, bullous pemphigoid, pemphigus vulgaris, scleroderma/systemic sclerosis, lupus erythematosus, leukoplakia, oral potentially malignant disorders, oral premalignant lesions, oral cancer and oral squamous cell carcinoma (SCC). Results: Literature review revealed dental implantation in patients with OLP (14 articles), EB (11 articles), pemphigus vulgaris (1 article), SS (14 articles), systemic sclerosis (11 articles), systemic lupus erythematosus (3 articles) and oral SCC development associated with leukoplakia (5 articles). No articles regarding dental implants in patients with pemphigoid or leukoplakia without SCC development were identified. Most articles were case-reports, while only a few retrospective, prospective or observational studies were identified. Conclusions: Dental implants represent an acceptable treatment option with a high success rate in patients with chronic mucocutaneous and autoimmune diseases with oral manifestations, such as OLP, SS, EB and systemic sclerosis. Patients with oral possibly malignant disorders should be closely monitored to rule out the development of periimplant malignancy. Further studies with long follow-up, clinical and radiographic dental data are required to predict with accuracy the outcome of dental implants in patients with oral mucosal diseases.
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Kalogirou EM, Tosios KI, Piperi EP, Sklavounou A. mTOR inhibitor-associated stomatitis (mIAS) in three patients with cancer treated with everolimus. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:e13-9. [PMID: 25442249 DOI: 10.1016/j.oooo.2014.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/10/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022]
Abstract
Mammalian targets of rapamycin inhibitors (mTOR inhibitors, mTORI) are indicated for the management of several cancer types, including hormone receptor--positive or HER2-negative breast cancer, advanced renal cell carcinoma, advanced neuroendocrine tumors of pancreatic origin, and tuberous sclerosis complex-related tumors. Among the most common adverse events of mTORI medication are discrete, large, solitary or multiple, superficial ulcers, almost exclusively situated on nonkeratinized oral mucosa, described as mTORI-associated stomatitis (mIAS). We describe the clinical presentation, course, and management of mIAS in three patients receiving the mTORI everolimus (Afinitor, Novartis, East Hanover, NJ). In two patients, mIAS manifested 9 and 30 days after first using everolimus, respectively, whereas in the third patient, it recurred 3 months after re-introduction of everolimus. Oral rinses with a "magic mouthwash" solution (dexamethasone oral drops solution 2 mg/mL × 10 mL, lidocaine gel 2% × 30 g, doxycycline suspension 50 mg/5 mL × 60 mL, and sucralfate oral suspension 1000 mg/5 mL × 150 mL, dissolved in sodium chloride 0.9% × 2000 mL) four times daily proved helpful in alleviating the symptoms, and the ulcers healed in 4 to 15 days. No side effects were recorded, and dose reduction or discontinuation of everolimus was not necessitated in two cases.
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Affiliation(s)
- Eleni-Marina Kalogirou
- Postgraduate Student, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Assistant Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece.
| | - Evangelia P Piperi
- Lecturer, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece
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Kalogirou EM, Tosios KI, Petsinis V, Chatzistamou I, Sklavounou A. An asymptomatic tumor on the dorsal tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:659-62. [PMID: 24388534 DOI: 10.1016/j.oooo.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/11/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Eleni-Marina Kalogirou
- Postgraduate Student, Department of Oral Pathology and Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos I Tosios
- Assistant Professor, Department of Oral Pathology and Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Vassileios Petsinis
- Lecturer, Department of Oral Pathology and Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens; Department of Oral and Maxillofacial Surgery, Evaggelismos General Hospital, Athens, Greece
| | - Ioulia Chatzistamou
- Lecturer, Department of Basic Biomedical Sciences, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Sklavounou
- Professor, Department of Oral Pathology and Surgery, Faculty of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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