Small cell carcinoma of the salivary gland: a systematic literature review and two case reports

Salivary gland small cell carcinoma is a rare neoplasm, accounting for less than 1% of salivary gland tumours. Little is known about the epidemiologic factors and treatment of this lesion. The authors report two cases and perform a systematic literature search from 1960 to 2011 for articles on salivary gland small cell carcinoma. Once the papers were reviewed, a database was generated to analyse clinical and pathological features, treatments and outcomes, and an attempt was made to identify prognostic factors. Available data were retrieved for 44 cases which fully satisfied the inclusion criteria; the median age was 64.25 years and the male:female ratio was 2.4:1. The parotid gland was the most common site (79.6%). The overall 1-, 2- and 5-year survival rates were 75.3%, 56.4% and 36.6%, respectively. According to the present review, patient age, tumour size, distant metastasis and cytokeratin-20 positive immunostaining were all significant prognostic factors in a univariate analysis. No particular treatment approach appeared to improve survival. This work reinforces knowledge about salivary gland small cell carcinoma's epidemiologic features, and identifies new prognostic markers. The optimal management of this lesion remains controversial.

Odontogenic tumours: 240 cases diagnosed over 31 years at a Brazilian university and a review of international literature

This study describes the epidemiology and clinical presentation of odontogenic tumours (OT) seen at a regional Brazilian oral and maxillofacial pathology service; to assess the quantitative impact of the most recent World Health Organization (WHO) classification of these lesions; and to compare this series with others available in international databases. The study was carried out by retrospectively analysing 240 cases diagnosed from 1978 to 2009, followed by a comprehensive review of the literature. The patients' mean age was 29 years, with a male to female ratio of 1:1.1. Benign lesions comprised 97.9% of the cases (mostly keratocystic odontogenic tumours (KCOT), odontomas and ameloblastomas) with the remaining tumours depicting a prevalence of less than 5%. Adenomatoid OT were less frequent than in most previous studies, while malignant OT were strikingly numerous. Most OT in children and in the anterior maxilla were odontomas, while maxillary ameloblastomas were rare. Lack of swelling was more frequent in KCOT than in ameloblastomas. The present study confirms the relative impact of KCOT in the epidemiology of OT and identifies more similarities between the present series with reports from the United States and Europe than with African and Asian populations.

Oral phaeohyphomycosis

This is the first description of solitary phaeohyphomycosis affecting the mucosal surface. The lesion developed in the inferior lip of a 57-year-old woman. After surgical resection, histopathological examination evidenced characteristic brownish fungal structures within granulomatous-purulent inflammation. Amplification and sequencing of rDNA obtained from paraffin-embedded tissue identified Alternaria species, as the causative agent.

Apoptosis in epithelial cells of apical radicular cysts

AIM

To investigate the occurrence of apoptotic cell death in the epithelium of radicular cysts and to compare its frequency in lesions presenting a distinct functional state.

METHODOLOGY

Twenty radicular cysts were selected and arranged into two groups with 10 lesions in each group: atrophic (quiescent) and hyperplastic (active) epithelium. Morphologic investigations of apoptosis were conducted by means of optic microscopy in haematoxylin and eosin slides. Immunohistochemical techniques to detect the bcl-2 protein were carried out by streptavidin-biotin-peroxidase assay. In both instances, 30 sequential high-power microscopic fields were observed to determine apoptotic (AI) and bcl-2 immunostaining (bcl-2I) indexes. The presence of AI and bcl-2I within the two groups was compared using the t-test. Correlation between the AI and the bcl-2I was investigated using the Spearman test.

RESULTS

Apoptosis was detected in the epithelium of all cysts. Higher AI levels were found in lesions with an atrophic (0.17 +/- 0.19) rather than a hyperplastic (0.10 +/- 0.10) epithelium. The same was found for the bcl-2I levels (0.06 +/- 0.03 vs. 0.04 +/- 0.01, respectively). However, these differences were not statistically significant. A positive and significant correlation was found between AI and bcl-2I.

CONCLUSIONS

Apoptosis was always present in the epithelium of the lesions and was more frequent in lesions with atrophic (quiescent) epithelium.

Unicystic ameloblastoma: a possible pitfall in periapical diagnosis

AIM

To report a clinical case of unicystic ameloblastoma previously misdiagnosed as radicular cyst.

SUMMARY

A 49-year-old white male was referred to a private practitioner complaining of an asymptomatic bony hard swelling of the left posterior mandible. The patient's dental history indicated that his left mandibular first molar had been extracted approximately 10 years previously. At that time, preoperative radiographic examination demonstrated a radiolucent area of 1.5 cm diameter with well-defined margins involving the distal root of tooth 36. The lesion was diagnosed as cystic and surgery for its removal was advised, but not performed. At presentation, radiography demonstrated a well-defined 3 cm diameter radiolucency extending from the second premolar to the second molar. The lesion was enucleated and histopathological examination confirmed a diagnosis of unicystic ameloblastoma.

KEY LEARNING POINTS

*Despite a clinical diagnosis of periapical disease of endodontic origin, a nonendodontic lesion may be present. *Unicystic ameloblastoma located on the periapical area of a tooth can lead to a pulp-periapical misdiagnosis, and should be considered in differential diagnosis. *All tissue specimens recovered in apical surgery should be submitted to histopathological analysis.

A comparative histological evaluation of the biocompatibility of materials used in apical surgery

AIM

To evaluate the biological properties of a variety of materials that could be used in apical surgery.

METHODOLOGY

The intraosseous implant technique recommended by the FDI (1980) and ADA (1982) was used to test the following materials: zinc oxide-eugenol (ZOE), mineral trioxide aggregate (MTA), and Z-100 light-cured composite resin. Thirty guinea-pigs, 10 for each material, divided into experimental periods of 4 and 12 weeks, received one implant on each side of the lower jaw symphysis. The connective tissue response alongside the lateral wall outside the cup served as a negative control for the technique. At the end of the observation periods, the animals were killed and the specimens prepared for routine histological examination to evaluate their biocompatibility.

RESULTS

The reaction of the tissue to the materials diminished with time. The ZOE cement was highly toxic during the 4-week experimental period, but this profile changed significantly after 12 weeks, when it showed biocompatible characteristics. MTA and Z-100 showed biocompatibility in this test model at both time periods.

CONCLUSIONS

MTA and Z-100 composite were biocompatible at 4 and 12 weeks in this experimental model.

Levels of GM-CSF, IL-3, and IL-6 in fluid and tissue from human radicular cysts

Cytokines released by immune system cells play an important role in cyst enlargement. This study aimed to determine, by ELISA, the levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin 3 (IL-3), and IL-6 in fluid and tissue from human radicular cysts. GM-CSF was found in 42.8% of the fluid samples (164.3 pg/mL) and IL-6 in 92.8% (641.4 pg/mL). No IL-3 was detected in any fluid samples. In the tissue samples, 28.6% were positive for IL-3 (369.2 pg/mL), 86.4% for IL-6 (92.4 pg/mL), and 95.8% for GM-CSF (200.5 pg/mL). It can be concluded that GM-CSF and IL-6 were widely found in the fluid and tissue samples. In contrast, IL-3 was found only in the cystic tissue, even though in few lesions. These cytokines may contribute to the inflammation, cystic growth, and bone resorption that characterize cystic lesions.

Exfoliative cytology: a helpful tool for the diagnosis of paracoccidioidomycosis

OBJECTIVE

To describe the main cytological findings associated with smears collected from oral lesions of paracoccidioidomycosis and to appraise the use of cytology as a diagnostic tool for the disease.

STUDY DESIGN

Cytological smears and biopsies were collected from 40 lesions with a clinical suspicion of paracoccidioidomycosis. Evaluation of the sensitivity, specificity, positive and negative predictive values, accuracy and the positive likeness ratio of the oral smear when compared with the histological diagnosis, was performed. The latter is considered the 'gold standard' for comparison.

RESULTS

The main morphological findings were the rounded-shaped, birefringent and multiple-budded fungi, Langhans' giant cells and epithelioid cells. The following associative measures were found: sensitivity, 67.9%; specificity, 91.7%; positive predictive value, 95.0%; negative predictive value, 55.0%; accuracy, 75.0%; and positive likeness ratio, 8.14.

CONCLUSION

The cytological findings of paracoccidioidomycosis are characteristic and cytology is accurate in the diagnosis of the disease. Positive patients should be treated. Negative patients should be submitted to biopsy to confirm or to dismiss the diagnosis of this mycosis.

Mucus extravasation phenomenon in newborn babies: report of two cases

Two rare cases of congenital mucoceles in newborn babies are reported. The patients presented with nodular swellings on their lower lips at birth with no obvious local aetiology. In both cases the mucoceles interfered with normal feeding. The lesions were excised by surgical approach under general anaesthesia and histopathological examination confirmed the lesions to be extravasation-type mucoceles. The article includes a brief discussion of the epidemiology and ethiopathogeny of mucoceles.

AgNOR count in exfoliative cytology of normal buccal mucosa. Effect of smoking

OBJECTIVE

To compare the argyrophilic nucleolar organizer region (AgNOR) count of cells collected from normal buccal mucosa of cigarette smokers with that obtained from nonsmokers.

STUDY DESIGN

Cytologic smears of normal buccal mucosa from 20 smokers and 20 nonsmokers were stained for AgNORs. The AgNOR count was established on 100 cells. The count values of groups were compared and analyzed using Student's unpaired t test.

RESULTS

The AgNORs were round and had a clustered distribution in both groups. The mean AgNOR count was statistically higher in cells of smokers than nonsmokers (P < .01).

CONCLUSION

Analysis of AgNORs suggests that cigarette smoking influences proliferative activity in cells of normal buccal mucosa.

Intraosseous leiomyoma of the mandible

An intraosseous leiomyoma arising within the mandible was diagnosed in a 24-year-old woman. Clinically, a nodular swelling of the lower border of the mandible was noted. Radiographically, a unilocular ellipsoid radiolucency, loss of the lower border of the mandible, and tooth resorption were observed. The mitotic count was 0.4 per 10 high-power fields, which supported the benign nature of the tumor. The clinical and histologic parameters for distinguishing between benign and malignant smooth muscle neoplasms are discussed.

Study of minor salivary gland mucoepidermoid carcinoma differentiation based on immunohistochemical expression of cytokeratins, vimentin and muscle-specific actin

The expression of cytokeratins (CKs) 7,8,10,13,14,18,19, vimentin and muscle-specific actin (MSA) was investigated in 17 mucoepidermoid carcinomas (MEC) by the streptavidin-biotin technique. The results revealed that CKs 7, 8 and 18 were positive for intermediate, luminal columnar and mucous cells. For epidermoid cells, the expression was heterogeneous and discrete. The reaction with CK19 was similar to that seen for the above CKs, except for the fact that mucous cells were negative. CK 14 was preferentially expressed in the intermediate cells localised in basal, parabasal and epidermoid cells. CK13 was localised in intermediate, epidermoid and luminal columnar cells. In stratified epithelium, CK13 was expressed in intermediate cells and negative in basal cells. These findings were more expressive in cystic areas of the tumours. CK10 was negative for all the cases studied. MSA was positive only in stromal elements, and only two cases of CME were heterogeneously positive for vimentin. The result obtained showed that the immunoprofile of MEC, for the studied antigens, is similar to that exhibited by the excretory duct of normal salivary glands.

Alveolar and extra-alveolar granular cell lesions of the newborn: report of case and review of literature

Multiple congenital granular cell lesions occurring on the maxillary alveolar ridge and ventral aspect of the tongue were identified in a 22-day-old girl. The prevalence, histogenesis, and treatment of this lesion are discussed and the literature is reviewed.

Anti-Toxoplasma gondii immunoglobulins A and G in human saliva and serum

Paired human saliva and serum samples from 60 individuals were tested for specific IgA and IgG antibodies to Toxoplasma gondii. The study in both fluids was carried out by indirect immunoenzymatic assay (ELISA). Saline antigenic extract of T. gondii was used to coat plastic surfaces upon which the samples were then incubated; monospecific conjugates of anti-IgA and anti-IgG-peroxidase were then incubated with the samples after a washing procedure to separate the unbound antibodies. The enzymatic activity was measured and the results expressed in terms of ELISA index. Toxoplasma-specific IgG antibodies were detected in 43 of the serum samples (71.7%) and in 12 of the saliva samples (20.0%) whereas Toxoplasma-specific IgA antibodies were detected in 18 of the serum samples (30.0%) and in 12 of the saliva samples (20.0%). No association was observed when the Toxoplasma-specific IgG reactive and non-reactive serum samples were compared with the reactive and non-reactive saliva samples for this class of immunoglobulin. On the other hand, a significant association was observed when the Toxoplasma-specific IgA reactive and non-reactive serum samples were compared with the reactive and non-reactive saliva for this type of antibody. In conclusion, our results show that the detection of salivary IgA reflects the serum level of this isotype but salivary IgG does not. Moreover, the isolated detection of salivary IgG may not contribute to epidemiological studies of chronic toxoplasmic infections.

p53 In biopsies of oral squamous cell carcinoma. A comparative study with a malignancy grading system

The relationship between the histological grading of malignancy and p53 protein expression was studied in 40 biopsies of oral squamous cell carcinomas. An immunohistochemical analysis was carried out using the streptavidin method preceded by a treatment with citric acid in a microwave oven. All cases were classified according to the histological malignancy grading system proposed by Anneroth et al. (Scandinavian Journal of Dental Research 1987, 95, 229-249). The expression of p53 was found in 62.5% of the carcinomas studied. Positivity of p53 staining showed a correlation with the histological grade of malignancy and with the degree of keratinisation, nuclear polymorphism and number of mitoses.

Immunohistochemical study of linear gingival erythema from HIV-positive patients

Severe forms of periodontal disease are frequent in patients with acquired immunodeficiency syndrome (AIDS). Linear gingival erythema (LGE) is a progressive disease described in HIV-positive patients and is considered to be an early stage of necrotizing periodontitis. Although clinical and microbiological differences are reported in LGE and non-specific gingivitis (NSG), a comparative immunopathological approach of both has not been performed yet. The purpose of this study was to compare relative populations of T-lymphocytes, B-lymphocytes, neutrophils, macrophages and IgG bearing plasma cells in gingival biopsies from sites exhibiting LGE and from sites exhibiting NSG. A biotin-streptavidin amplified system was used for identification of the following antigens: CD3 (T-lymphocytes), CD20 (B-lymphocytes), elastase (neutrophils), CD68 (macrophages) and IgG (plasma cell's secretors of IgG). The results have demonstrated decrease proportions of T-lymphocytes, macrophages and high percentage of neutrophils and IgG bearing plasma cells in LGE. In contrast with NSG, many neutrophils cells in LGE were found inside oral gingival epithelium. Our results highlight the idea that progressive periodontal disease is not only characterized by increased tissue inflammation, but, in addition, by significant changes in the proportion of specific inflammatory cells. The high number of neutrophils along the gingival epithelium is probably associated with the severe gingival necrosis reported in AIDS patients.

Minor salivary gland tumours. A retrospective study of 164 cases in a Brazilian population

One hundred and sixty-four cases of intraoral salivary gland tumours retrieved from the files of the Surgical Oral Pathology laboratory of the University of São Paulo (Brazil), between 1970 and 1993, were studied. Of these, 164 tumours, 62% were classified as benign and 38% malignant. The palate was the main site of occurrence of the tumours followed by the buccal mucosa and upper lip. There was a slight predominance for female patients, with a female to male ratio of 1.3:1. The mean age for benign tumours was 39.9 years (40.8 for females, and 39.7 for males). For malignant tumours the mean age was 43.5 years (42.6 for females and 44.7 for males). Pleomorphic adenoma was the most common of the benign tumours, whereas mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common malignant tumours. In general, benign tumours presented as an asymptomatic nodule. On the other hand, pain, ulceration and radiographic changes were more frequently associated with malignant lesions.

Peripheral giant cell granuloma. An immunohistochemical and ultrastructural study

OBJECTIVE

To study the nature of multinucleated and mononuclear cells from peripheral giant cell granuloma (PGCG).

MATERIALS AND METHODS

Formalin-fixed, paraffin-embedded sections of 40 cases of PGCG were immunohistochemically stained for vimentin, alpha I-antichymotrypsin, CD68, S-100 protein, lysozyme, leucocyte common antigen (LCA), factor VIII-related antigen and muscle cell actin. Six cases of PGCG were also studied by transmission electron microscopy.

RESULTS

Vimentin, alpha I-antichymotrypsin and CD68 were expressed in both the mononuclear and multinucleated giant cells. Dendritic mononuclear cells, positive for S-100 protein, were noted in 67.5% of the lesions, whereas lysozyme and leucocyte common antigen were detected in occasional mononuclear cells. Ultrastructural examination showed mononuclear cells with signs of phagocytosis and sometimes interdigitations with similar cells. Others presented non-specific characteristics and the third type exhibited cytoplasmic processes and occasional Birbeck granules. Some multinucleated giant cells showed oval nuclei, abundant mitochondria and granular endoplasmic reticulum whereas others presented with irregular nuclei and a great number of cytoplasmic vacuoles.

CONCLUSIONS

Immunohistochemical and ultrastructural results suggest that PGCGs of the jaws are composed mainly of cells of the mononuclear phagocyte system and that Langerhans cells are present in two thirds of the lesions.

Calcifying odontogenic cyst in infancy: report of case associated with compound odontoma

A case of calcifying odontogenic cyst associated with compound odontoma in an unerupted primary tooth in a three-year-old patient is reported. Some considerations regarding the age of the patient, differential diagnosis and treatment are discussed. Although the cyst can occur at any age, the majority of cases appear before the fourth decade of life. This malady represents less than 2 percent of all odontogenic tumors and cysts.

[Clinical case--squamous odontogenic tumor]

The work proposes to report a case of Squamous Odontogenic Tumor describing all clinical, radiographic and histopathological findings. A review on literature discussing the tumor etiology is presented.

[Epithelial remnants in the capsule of dentigerous cysts]

The authors studied 15 cases of dentigerous cysts presenting epithelial remnants in their capsule. Epithelial proliferation, mineralizations and squamous metaplasia and ameloblastomathoid differentiation were observed and analysed in relation to aging and localization. Neoplasic potentiality of the epithelial remnants were discussed and a new denomination were suggested to those lesions that presented ameloblastomathoid differentiation.