Dermoscopic Evaluation Improves Clinical Diagnosis of Oral Melanotic Macules: A Study in 50 Patients with Oral Pigmented Lesions

BACKGROUND: Dermoscopy is a non-invasive in vivo method rarely used for the diagnosis of oral pigmented lesions. OBJECTIVE: To analyze clinical, dermoscopic, and histologic features of Oral Melanotic Macules (OMMs), and to evaluate the usefulness of dermoscopy in the diagnosis of OMMs. METHODS: Fifty patients presenting solitary or multiple circumscribed pigmented lesions in the oral mucosa were included. RESULTS: OMMs were diagnosed in 19 patients (84% women and 16 % men); 52 % of patients had multiple lesions, 48% had one lesion. Lesion sites in decreasing order of frequency were the labial mucosa (63 %), gingiva (31.57 %), cheek mucosa (26.31%), labial semimucosa (21%), palate (10.52 %), alveolar ridge (5.26 %) and tongue (5.26 %). The dermoscopic pattern of OMMs was linear in 89 % of cases (47% parallel line, 35% fish scale-like, and 17% hyphal patterns). Histological analysis showed increased melanin in the basal cell layer in all cases with a linear dermoscopic pattern, slight acanthosis in 14 cases, and a slight increase in number of basal melanocytes in 13 cases. Globules were seen in 21% of cases corresponding histologically with increased melanin or melanophages in the lamina propria. The dermoscopic observation of symmetrical lines further enhances the diagnostic ability of dermoscopy in OMMs, with 73.68% sensitivity, 87.1% specificity, 77.78% positive predictive value, 84.38 % negative predictive value, 5.71 positive likelihood ratio, and 0.30 negative likelihood ratio. CONCLUSIONS: Dermoscopy may play a role in improving noninvasive diagnosis of oral pigmented lesions occurring on several areas of non-keratinized mucosa.

Manifestaciones bucales de enfermedades de transmisión sexual identificadas en tres servicios de estomatología en Sur América

Introducción: Las enfermedades de transmisión sexual se definen como un grupo de infecciones causadas por diversos agentes que se adquieren durante las relaciones sexuales. Éstas además suelen generar manifestaciones en boca. Objetivo: Determinar las lesiones características en cavidad bucal de enfermedades de transmisión sexual. Materiales y métodos: Estudio descriptivo transversal, con 37 pacientes que asistieron a los servicios de Estomatología de la Universidad de Buenos Aires, Universidad de Cartagena y el Hospital Alemán en Buenos Aires durante 2015 y 2016. Se realizó historia clínica completa con pruebas Venereal Disease Research Laboratory  (VDRL) y Fluorescent Treponemal Antibody Absortion (FTA-ABS) en pacientes con presunción de sífilis. Además de análisis histopatológico y Reacción en Cadena de la Polimerasa (PCR) en pacientes con presunción de Virus de Papiloma Humano (VPH). Resultados: El promedio de edad de los pacientes fue de 38 años, predominó el sexo masculino. El 54,1% fueron diagnosticados con sífilis y la lesión más encontrada en estos fue la pápula. El 45,9% restante fueron diagnosticados con VPH, la lesión predominante en estos fue la verrugosidad. Conclusiones: El odontólogo debe contribuir en la detección temprana de enfermedades de transmisión sexual identificando manifestaciones de éstas en boca; con el fin de evitar su evolución y prevenir su transmisión.

Genome-Wide Association Analysis Reveals Genetic Heterogeneity of Sjögren's Syndrome According to Ancestry

OBJECTIVE

The Sjögren's International Collaborative Clinical Alliance (SICCA) is an international data registry and biorepository derived from a multisite observational study of participants in whom genotyping was performed on the Omni2.5M platform and who had undergone deep phenotyping using common protocol-directed methods. The aim of this study was to examine the genetic etiology of Sjögren's syndrome (SS) across ancestry and disease subsets.

METHODS

We performed genome-wide association study analyses using SICCA subjects and external controls obtained from dbGaP data sets, one using all participants (1,405 cases, 1,622 SICCA controls, and 3,125 external controls), one using European participants (585, 966, and 580, respectively), and one using Asian participants (460, 224, and 901, respectively) with ancestry adjustments via principal components analyses. We also investigated whether subphenotype distributions differ by ethnicity, and whether this contributes to the heterogeneity of genetic associations.

RESULTS

We observed significant associations in established regions of the major histocompatibility complex (MHC), IRF5, and STAT4 (P = 3 × 10^-42 , P = 3 × 10^-14 , and P = 9 × 10^-10 , respectively), and several novel suggestive regions (those with 2 or more associations at P < 1 × 10^-5 ). Two regions have been previously implicated in autoimmune disease: KLRG1 (P = 6 × 10^-7 [Asian cluster]) and SH2D2A (P = 2 × 10^-6 [all participants]). We observed striking differences between the associations in Europeans and Asians, with high heterogeneity especially in the MHC; representative single-nucleotide polymorphisms from established and suggestive regions had highly significant differences in the allele frequencies in the study populations. We showed that SSA/SSB autoantibody production and the labial salivary gland focus score criteria were associated with the first worldwide principal component, indicative of higher non-European ancestry (P = 4 × 10^-15 and P = 4 × 10^-5 , respectively), but that subphenotype differences did not explain most of the ancestry differences in genetic associations.

CONCLUSION

Genetic associations with SS differ markedly according to ancestry; however, this is not explained by differences in subphenotypes.

Oral and oropharynx cancer in South America

Objectives:

To describe the incidence and mortality of oral and oropharynx cancers in South America using available public databases and to discuss the main pitfalls for acquiring reliable data.

Methods:

The incidence data for oral cavity and oropharynx cancers for South America were obtained from Cancer Incidence in Five Continents/International Agency for Research on Cancer for the period 1998–2007. Mortality rates in South America were obtained from the World Health Organization/IARC database for the period 1999–2012. The number of cases for Brazil was obtained from the National Cancer Institute/missing stage for the period 2000–2010, whereas the São Paulo cancer registry was used to collect data from the most populated state in Brazil for the period 2000–2008.

Results:

The incidence of oral and oropharynx cancers in South America varied, with the highest rates observed in Brazil among males. The mortality data in selected South American countries ranged from 0.72 to 6.04/100,000 and the proportion of ill-defined deaths in South America varied from 5.0% to 22.0%. Mortality trends for males decreased about 2.5% in most of the countries, excluding Brazil, whereas among females, a significant decrease occurred only in Colombia, with an increase in Brazil and Peru.

Conclusion:

Although there is a lack of reliable databases in South America, the available data demonstrate a decrease in mortality trends in most countries and the highest incidence in Brazil. The development and improvement of national cancer public databases in South America are highly desirable and necessary to better understand the characteristics and distribution of these neoplasms.

Associations between salivary gland histopathologic diagnoses and phenotypic features of Sjögren's syndrome among 1,726 registry participants

OBJECTIVE

To examine associations between labial salivary gland (LSG) histopathology and other phenotypic features of Sjögren's syndrome (SS).

METHODS

The database of the Sjögren's International Collaborative Clinical Alliance (SICCA), a registry of patients with symptoms of possible SS as well as those with obvious disease, was used for the present study. LSG biopsy specimens from SICCA participants were subjected to protocol-directed histopathologic assessments. Among the 1,726 LSG specimens exhibiting any pattern of sialadenitis, we compared biopsy diagnoses against concurrent salivary, ocular, and serologic features.

RESULTS

LSG specimens included 61% with focal lymphocytic sialadenitis (FLS; 69% of which had focus scores of ≥1 per 4 mm²) and 37% with nonspecific or sclerosing chronic sialadenitis (NS/SCS). Focus scores of ≥1 were strongly associated with serum anti-SSA/SSB positivity, rheumatoid factor, and the ocular component of SS, but not with symptoms of dry mouth or dry eyes. Those with positive anti-SSA/SSB were 9 times (95% confidence interval [95% CI] 7.4-11.9) more likely to have a focus score of ≥1 than were those without anti-SSA/SSB, and those with an unstimulated whole salivary flow rate of <0.1 ml/minute were 2 times (95% CI 1.7-2.8) more likely to have a focus score of ≥1 than were those with a higher flow rate, after controlling for other phenotypic features of SS.

CONCLUSION

Distinguishing FLS from NS/SCS is essential in assessing LSG biopsies, before determining focus score. A diagnosis of FLS with a focus score of ≥1 per 4 mm², as compared to FLS with a focus score of <1 or NS/SCS, is strongly associated with the ocular and serologic components of SS and reflects SS autoimmunity.

Study of the vascular pattern in oral lichen planus

Oral Lichen Planus is a relatively frequent disease. Its etiopathogenesis is still unknown and it can undergo malignant transformation during its evolution. Thus, data which could contribute to the knowledge of the biology of this disease are particularly significant. The present study involves a quantitative evaluation of the vascular pattern of oral lichen planus. A portion of biopsy specimens taken for histopathologic diagnosis was processed to mark vascular walls using the histoenzymic technique for ATPase activity demonstration. Stained Sections were then evaluated in a semi-automatic magnetic image analyser. The stereologic parameters studied, showed there is no vascular increase in lichen with regard to normal mucosae or leukoplakias, since the number of vascular walls did not show significant differences. Instead, a significant increase was observed in the vascular area. The association of these parameters, indicates that lichen is a more congestive lesion than the other two conditions studied. These findings indicate that the modifications of the vascular pattern could play a role in the etiopathogenesis of oral lichen planus and suggest that the observation of these changes could be a useful element in the histopathologic diagnosis.

Angina bullosa hemorrhagica

BACKGROUND

In 1967, Badham used the term angina bullosa hemorrhagica (ABH) to describe an entity we already knew as traumatic oral hemophlyctenosis (TOH) (1933) and later renamed recurrent oral hemophlyctenosis (ROH) (1971).

OBJECTIVES

The objective of this study was to review and discuss the literature, and to report 54 new cases seen between 1989 and 1996.

MATERIALS AND METHODS

Fifty-four patients were thoroughly assessed to determine the clinical features, histology, etiology, pathogenesis, differential diagnosis, and therapy.

RESULTS

In 35 patients (64.8%), the lesions predominated on the palate and in nine (16.6%) on the oral mucosa. The incidence was similar in both sexes (women, 52%; men, 48%) and the condition affected mostly the 51-70-year age group. ABH was never documented in children under 10 years of age. In 24 cases (44.4%), diabetes mellitus, hyperglycemia, and/or a family history of diabetes was found.

CONCLUSIONS

ABH is a disorder more common than the literature would suggest. Although the causes may be multiple (mucosal trauma, inhaled corticosteroids), the available data indicate that, in these patients, the presence of an alteration in glucose metabolism should be considered.

p53, Rb, and cyclin D1 expression in human oral verrucous carcinomas

BACKGROUND

The verrucous carcinoma (VC), a tumor with low grade malignancy, appears to be associated with tobacco and human papillomavirus. The pathobiology of these tumors has not been extensively studied, and molecular genetic alterations have not been reported. In this study we investigated by immunohistochemistry the expression of p53, Rb, and cyclin D1 in a series of well-defined oral VC. Changes in the expression of these genes have been commonly reported in a variety of human tumors.

METHODS

We studied 29 cases of VC, fixed in formalin and embedded in paraffin. Immunohistochemistry was carried out using the avidin-biotin immunoperoxidase technique. Polyclonal antibody CM-1 was used for p53, a rabbit polyclonal human RB antibody, Rb-WL-1 antibody for Rb and a rabbit polyclonal human cyclin D antibody for cyclin D1.

RESULTS

Positive p53 expression (protein accumulation) was detected in 15 of the 29 VC analyzed. In some cases, p53-positive areas were small foci but in most of the cases extensive positive areas were observed. None of the cases studied showed alterations of Rb protein. The expression of cyclin D1 was determined in 18 cases of VC. Positive nuclear immunostaining was seen in 11 cases.

CONCLUSIONS

p53 protein accumulation is frequently observed in these tumors suggesting possible mutations of this gene in VC. Overexpression of cyclin D1 but no alterations of Rb staining were also observed in this low grade tumor suggesting that Rb may be functionally inactivated by overexpression of cyclin D1 or HPV infection.

Inhibition of benzoyl peroxide-induced tumor promotion and progression by copper(II)(3,5-diisopropylsalicylate)2

The ability of a biomimetic superoxide dismutase agent, copper(II)(3,5-diisopropylsalicylate)2 (CuDIPS), to modulate benzoyl peroxide (BzPo)-induced tumor promotion and progression in mouse skin multistage carcinogenesis was evaluated. The results showed a significant inhibition of tumor incidence by CuDIPS pretreatment during promotion-progression. Different types of tumors were developed: papillomas, keratoacanthomas and squamous cell carcinomas. There was a significant increase in the keratoacanthoma-papilloma ratio when the period of treatment with BzPo was prolonged, which was inhibited by CuDIPS pretreatment. CuDIPS induced a significant inhibition of malignant conversion. Our results suggest that reactive oxygen species could be important in BzPo-induced promotion and progression.

Morphometric study of nucleolar organizer regions in human oral normal mucosa, papilloma and squamous cell carcinoma

A morphometric study of nucleolar organizer regions (NOR) was performed to analyze their distribution, volume, number and shape in the different strata of human normal oral mucosa epithelium and papilloma and in squamous cell carcinoma employing microphotographs of silver-stained paraffin sections. The different NOR-related parameters evidenced significant differences between normal mucosa, papilloma and squamous cell carcinoma. The functional polarity of normal mucosa epithelium and of papilloma is also evidenced in terms of NOR-related parameters. The discriminative value of certain NOR parameters was demonstrated.