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de Arruda JAA, Villarroel-Dorrego M, Freire CH, Molina-Ávila I, Pimentel-Solá JM, Gilligan G, Piemonte E, Panico R, Panico JCR, Aranda-Romo S, Tejeda-Nava FJ, Israel MS, Cunha JLS, de Medeiros VA, Nonaka CFW, Alves PM, Cavalcante IL, Ventura JVL, de Lima FS, Drumond VZ, Abreu LG, Silva TA, Fonseca FP, Mesquita RA, Martínez-Flores R, Cordero-Torres K, Ahumada-Ossandón R, Guzmán J, Toro R, Xavier-Júnior JCC, Sousa-Neto SS, Arantes DAC, Mendonça EF, Palma VDM, de Oliveira MG, Visioli F, Ortega KL, Tenório JR, de Andrade BAB. Oral lesions of systemic lupus erythematosus: A collaborative Latin American study. Lupus 2024:9612033241252042. [PMID: 38686816 DOI: 10.1177/09612033241252042] [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] [Indexed: 05/02/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disease that may affect the oral mucosa. The variable spectrum of oral lesions observed in SLE can pose challenges in diagnosis, particularly when the lesions occur in isolation. The aim of this study was to describe the oral lesions occurring in patients with SLE from Latin America. METHODS This collaborative record-based study involving 11 oral and maxillofacial pathology and medicine services across Venezuela, Argentina, Chile, Brazil, and Mexico describes the clinicopathological profile of SLE-related oral lesions. RESULTS Seventy patients with SLE and oral lesions were included in the study. The majority were females (75.7%; female/male ratio: 3.1:1) and white (62.1%), with a mean age of 38.4 years (range: 11-77 years). The most common site of oral lesions was the hard/soft palate (32.0%). Clinically, oral lesions predominantly presented as ulcers (26.6%), erosions (26.6%), and white lesions (23.4%). Isolated oral lesions occurred in 65.2% of individuals, while cutaneous manifestations occurred in 80.3%. The main clinical diagnostic hypothesis in 71.4% of cases was an immune-mediated disease. Oral biopsies followed by histopathological analysis were performed in 50 cases. CONCLUSION Oral lesions of SLE exhibit a variety of clinical and histopathological features. A key point in diagnosis is that unusual oral changes without an obvious local cause may indicate a possible systemic condition presenting with oral lesions. A multidisciplinary approach, which includes regular oral examination, is warranted to identify oral lesions and provide treatment.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Gerardo Gilligan
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Eduardo Piemonte
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - René Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Juan Cruz Romero Panico
- Department of Oral Medicine, Facultad de Odontología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Saray Aranda-Romo
- Diagnostic Clinic, School of Dentistry, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | | | - Mônica Simões Israel
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - John Lennon Silva Cunha
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Vanessa Alves de Medeiros
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | | | - Pollianna Muniz Alves
- Department of Dentistry, School of Dentistry, Universidade Estadual da Paraíba, Campina Grande, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Dentistry, Universidade de Fortaleza, Fortaleza, Brazil
| | - José Victor Lemos Ventura
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Silva de Lima
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Felipe Paiva Fonseca
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - René Martínez-Flores
- Department of Oral Medicine and Oral Pathology, School of Dentistry, Universidad Andres Bello, Viña del Mar, Chile
| | - Karina Cordero-Torres
- Department of Oral Pathology and Diagnosis, School of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Richard Ahumada-Ossandón
- Department of Oral Pathology and Diagnosis, School of Dentistry, Universidad de Valparaíso, Valparaíso, Chile
| | - Jorge Guzmán
- Department of Oral Medicine, School of Dentistry, Universidad Central de Venezuela, Caracas, Venezuela
| | - Raiza Toro
- Department of Oral Medicine, School of Dentistry, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Cândido Caldeira Xavier-Júnior
- School of Medicine, Centro Universitário Católico Unisalesiano Auxilium, Araçatuba, Brazil
- Pathology Institute of Araçatuba, Araçatuba, Brazil
- Botucatu Medical School, Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, Brazil
| | - Sebastião Silvério Sousa-Neto
- Department of Oral Diagnosis, Piracicaba School of Dentistry, Universidade Estadual de Campinas, Piracicaba, Brazil
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Diego Antônio Costa Arantes
- Department of Stomatology (Oral Pathology), School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Victor de Mello Palma
- Department of Oral Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fernanda Visioli
- Department of Oral Pathology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Karem L Ortega
- Department of Stomatology, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Jural LA, Estanho D, Pereira JDSR, Ribeiro-Lages MB, Lima da Silva LS, Cavalcante IL, Maia LC, Andrade BABD, Tenório JR. Lesions in the oral mucosa associated with the use of checkpoint inhibitors: A bibliometric and critical review. Spec Care Dentist 2024; 44:300-313. [PMID: 37287115 DOI: 10.1111/scd.12887] [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: 03/13/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
AIMS Immune-related adverse events (irAEs) linked to the use of immune checkpoint inhibitors (ICIs) have become increasingly frequent. To perform a bibliometric and critical review of the general panorama of publications on oral mucosal lesions (OML) associated with ICIs. METHODS AND RESULTS Systematized searches were performed in four databases. The included studies were organized and bibliometric and clinical data were extracted and analyzed using VantagePoint and Microsoft Excel. Most of the 35 included studies were reports or case series (n = 33/94.2%). The American authors stood out (n = 17/48.5%), with the majority presenting only one publication. Independent groups carried out most of the publications (n = 31/88.5%). Over the years, publications have increased for users of nivolumab and pembrolizumab. In 21 studies (60%), OML were more common in men, between the 6th and 9th decades of life and who had lung carcinoma (n = 13/37.1%). Pembrolizumab (n = 17/48.5%) was the most used ICI. The patients were affected by one or more OML, including: ulcers (n = 28/80%) and erythema (n = 11/31.4%). Systemic corticosteroids (n = 24/68.5%) and the discontinuation of ICI use (n = 18/51.4%) were the main approaches used. CONCLUSION OML related to the use of ICIs have become increasingly common. More accurate data need to be published.
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Affiliation(s)
- Lucas Alves Jural
- Department of Pediatric Dentistry and Orthodontics, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniella Estanho
- Department of Oral Diagnosis and Pathology, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana da Silva Rangel Pereira
- Department of Oral Diagnosis and Pathology, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Batista Ribeiro-Lages
- Department of Pediatric Dentistry and Orthodontics, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Larissa Soares Lima da Silva
- Department of Pediatric Dentistry and Orthodontics, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Cavalcante IL, Silva Barros CCD, Colares DF, Cruz VMS, de Andrade BAB, Nonaka CFW, Rabenhorst SHB, Cavalcante RB. BubR1 and cyclin B1 immunoexpression in pleomorphic adenoma and polymorphous adenocarcinoma of minor salivary glands. Pathol Res Pract 2024; 253:154961. [PMID: 38043194 DOI: 10.1016/j.prp.2023.154961] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
The immunoexpression of BubR1 and cyclin B1 in pleomorphic adenoma (PA) and polymorphic adenocarcinoma (PAC) in minor salivary glands is poorly studied. Thus, a retrospective and observational study was performed to provide a better understanding of the role and immunopositivity patterns of these proteins in these lesions. Sixteen cases of PA and 16 cases of PAC were selected. Parenchyma cells were submitted to quantitative immunohistochemical analysis through the labeling index. Cytoplasmic immunoexpression of BubR1 was observed in neoplastic cells from all analyzed PA and PAC cases. All PA cases and 93.7% of PAC exhibited nuclear immunoexpression of BubR1. Higher cytoplasmic and nuclear immunoexpression of BubR1 was observed in PAC (p = 0.001 and p = 0.122, respectively). Cytoplasmic immunoexpression of cyclin B1 was observed in all cases of PA and PAC, with a higher labeling index in the latter (p < 0.001). There was a significant positive correlation between nuclear and cytoplasmic BubR1 immunoexpressions (p < 0.001) in PA and a significant negative correlation between BubR1 and cyclin B1 cytoplasmic immunoexpressions (p = 0.014) in PAC. The higher cytoplasmic and nuclear immunoexpression of BubR1 in PACs suggests the continuous maintenance of neoplastic cells in the cell cycle and migration. Higher immunoexpression of cyclin B1 supports this lesion's enhanced proliferative and migration ability.
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Affiliation(s)
- Israel Leal Cavalcante
- Oral Pathology Section, Department of Dentistry, University of Fortaleza, Fortaleza, CE, Brazil; Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Caio César da Silva Barros
- Postgraduate Program in Dental Sciences, Oral Pathology and Medicine, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Débora Frota Colares
- Postgraduate Program in Dental Sciences, Oral Pathology and Medicine, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Vitória Maria Sousa Cruz
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | | | | | - Silvia Helena Barem Rabenhorst
- Postgraduate Program in Biological Sciences, Molecular Genetics Laboratory, Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
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Cunha JLS, de Andrade BAB, Cavalcante IL, Freire CH, de Almeida Freire N, Antero SAF, Pires FR, Israel MS. Squamous Odontogenic Tumor in the Posterior Region of Maxilla. Head Neck Pathol 2023; 17:1067-1070. [PMID: 37768443 PMCID: PMC10739615 DOI: 10.1007/s12105-023-01585-3] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
Squamous odontogenic tumor (SOT) is a rare benign but locally infiltrative tumor often misdiagnosed as other entities, such as ameloblastoma and squamous cell carcinoma, due to overlapping morphological findings. We document here the clinicopathological and imaging findings of an aggressive intraosseous SOT in the posterior left region of the maxilla in a 25-year-old male patient. On intraoral examination, the tumor extended from the region of the left lateral incisor to the upper left premolar and was covered by reddish mucosa, with discrete areas of ulceration. Imaging exams revealed an osteolytic lesion causing thinning, erosion, and buccal and lingual cortical plate perforation associated with an impacted canine. Microscopically, the tumor showed a proliferation of islands of well-differentiated squamous epithelium in a variably collagenized background. The peripheral cells of the islands were flat or slightly cuboidal and did not exhibit nuclei with peripheral palisade and reverse polarization. The diagnosis of SOT was rendered. The patient underwent surgical resection and has been under clinical follow-up for approximately 12 months with no signs of recurrence. A careful morphological evaluation is essential to avoid misdiagnosis and ensure a satisfactory treatment approach.
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Affiliation(s)
- John Lennon Silva Cunha
- Department of Dentistry, State University of Paraíba (UEPB), Rua das Baraúnas, 351, Bairro Universitário, Campina Grande, PB, 58429-500, Brazil.
| | | | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Department of Dentistry, Universidade de Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Nathália de Almeida Freire
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Sarah Aparecida Ferreira Antero
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Fábio Ramôa Pires
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Mônica Simões Israel
- Department of Diagnosis and Therapeutics, School of Dentistry, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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5
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de Arruda JAA, Freire CH, Leite TDB, Noce CW, Cavalcante IL, Vogel JDO, Mesquita RA, Tenório JR, de Andrade BAB. Orofacial Manifestations in a Middle-Aged Woman with Cowden Syndrome: A Case Image. Head Neck Pathol 2023; 17:1071-1074. [PMID: 37735289 PMCID: PMC10739688 DOI: 10.1007/s12105-023-01586-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
A 56-year-old Brazilian woman sought dental care, presenting with multiple asymptomatic papillomatous lesions with a coalescent pattern and intermingled cobblestone-like clefts along the alveolar ridge and marginal and attached gingivae. Multiple whitish papules were also observed on the face, neck, and limbs. Incisional biopsies of these lesions were performed. Microscopically, the skin lesion revealed epithelial clear cells and intraepithelial keratinization with areas of orthokeratosis, while the gingival lesions showed a parakeratinized stratified squamous epithelium with collagenous connective tissue. These features were consistent with those of a trichilemmoma and fibroepithelial hyperplasia, respectively. This article illustrates a case of Cowden syndrome (CS), a rare multisystem genetic condition in which both cutaneous and mucosal tissues were affected. Fewer than 40 cases of CS with oral involvement affecting middle-aged adults have been documented hitherto.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, Belo Horizonte, MG, Brazil.
| | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taísa Domingues Boehmer Leite
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - César Werneck Noce
- Oral Medicine Service, Hospital de Força Aérea do Galeão, Rio de Janeiro, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Dentistry, University of Fortaleza, Fortaleza, Brazil
| | - Jéssica de Oliveira Vogel
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, room 3202 D. Pampulha, Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Cunha JLS, Cavalcante IL, Rodrigues ABR, Catão NEDS, Cruz VMS, Turatti E, Cavalcante RB, Fonseca FP, Gordón-Núñez MA, Alves PM, Nonaka CFW, Andrade BABD. A retrospective multicenter study of oral and maxillofacial lesions in older people. Braz Oral Res 2023; 37:e098. [PMID: 38055516 DOI: 10.1590/1807-3107bor-2023.vol37.0098] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/16/2023] [Indexed: 12/08/2023] Open
Abstract
Few studies on the distribution of oral diseases in older people are available in the literature. This study aimed to investigate the prevalence and demographic characteristics of oral and maxillofacial lesions in geriatric patients (age ≥ 60 years). A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from archives of three Brazilian oral pathology centers over a 20-year period. Data on sex, age, anatomical site, skin color, and histopathological diagnosis were collected and analyzed. Pearson's chi-square test was used to evaluate differences in the frequency of the different oral and maxillofacial lesion groups. A total of 7,476 biopsy records of older patients were analyzed. Most cases were diagnosed in patients aged 60 to 69 years (n = 4,487; 60.0%). Females were more affected (n = 4,403; 58.9%) with a female-to-male ratio of 1:0.7 (p < 0.001). The tongue (n = 1,196; 16.4%), lower lip (n = 1,005; 13.8%), and buccal mucosa (n = 997; 13.7%) were the most common anatomical sites. Reactive and inflammatory lesions (n = 3,840; 51.3%) were the most prevalent non-neoplastic pathologies (p < 0.001), followed by cysts (n = 475; 6.4%). Malignant neoplasms were more frequent (n = 1,353; 18.1%) than benign neoplasms (n = 512; 6.8%). Fibrous/fibroepithelial hyperplasia (n = 2,042; 53.2%) (p < 0.001) and squamous cell carcinoma (n = 1,191; 88.03%) (p < 0.001) were the most common oral lesions in older adults. Biopsy data allow the accurate characterization of the prevalence of oral and maxillofacial lesions, supporting the development of public health policies that can enable the prevention, early diagnosis, and appropriate treatment of these lesions. Also, they bring valuable information that helps dentists and geriatricians diagnose these diseases.
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Affiliation(s)
- John Lennon Silva Cunha
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Israel Leal Cavalcante
- Universidade Federal do Rio de Janeiro - UFRJ, School of Dentistry, Department of Oral Diagnosis and Pathology, Rio de Janeiro, RJ, Brazil
| | | | | | - Vitória Maria Sousa Cruz
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Eveline Turatti
- Universidade de Fortaleza - Unifor, School of Dentistry, Fortaleza, CE, Brazil
| | | | - Felipe Paiva Fonseca
- Universidade Federal de Minas Gerais - UFMG, Faculty of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | | | - Pollianna Muniz Alves
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Campina Grande, PB, Brazil
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7
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Cunha JLS, Andrade ADO, Cavalcante IL, Barros CCDS, Sousa Neto SSD, Barros JMD, Leite LSDS, Félix FA, Turatti E, Carvalho FSR, Sousa SFD, Mendonça EFD, Anbinder AL, Pires FR, Alves PM, Nonaka CFW, Andrade BABD. Clinicopathologic analysis of oral dermoid and epidermoid cysts: a Brazilian multicenter study. Braz Oral Res 2023; 37:e107. [PMID: 38055524 DOI: 10.1590/1807-3107bor-2023.vol37.0107] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/05/2023] [Indexed: 12/08/2023] Open
Abstract
Dermoid cysts (DCs) and epidermoid cysts (ECs) are uncommon developmental cysts affecting the oral cavity. This study aims to evaluate patients with oral DCs and ECs and their demographic and clinicopathologic features. A retrospective descriptive cross-sectional study was performed. A total of 105,077 biopsy records of oral and maxillofacial lesions from seven Brazilian oral pathology centers were analyzed. All cases diagnosed as oral DCs and ECs were reviewed, and clinical, demographic, and histopathological data were collected. The series comprised 32 DCs (31.4%) and 70 ECs (68.6%). Most of the DCs occurred on the floor of the mouth (n = 14; 45.2%) of women (n = 17; 53.1%) with a mean age of 34.6 ± 21.6 years. All DCs were lined partially or entirely by stratified squamous epithelium (100%). Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were observed in the fibrous capsule . Most of the ECs affected the labial mucosa (n = 20; 31.7%) of men (n = 39; 56.5%) with a mean age of 48.0±19.8 years. Microscopically, most ECs (n = 68; 97.1%) were lined entirely by stratified squamous epithelium. Two cysts (2.9%) showed areas of respiratory metaplasia. Chronic inflammatory cells, melanin pigmentation, multinucleated giant cell reaction, and cholesterol clefts were also observed in the fibrous capsule. Conservative surgical excision was the treatment of choice in all cases. Oral DCs and ECs are uncommon and often clinically misdiagnosed lesions. Clinicians should consider DCs and ECs in the differential diagnosis of soft tissue lesions in the oral cavity, mainly located on the floor of the mouth and labial mucosa.
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Affiliation(s)
- John Lennon Silva Cunha
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Campina Grande, PB, Brazil
| | - Allany de Oliveira Andrade
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Graduate Program in Dentistry, Campina Grande, PB, Brazil
| | - Israel Leal Cavalcante
- Universidade Federal do Rio de Janerio - UFRJ, School of Dentistry,Department of Oral Diagnosis and Pathology, Rio de Janeiro, RJ, Brazil
| | - Caio César da Silva Barros
- Universidade Federal do Rio Grande no Norte - UFRN, Department of Dentistry, Graduate Program in Dental Sciences, Natal, RN, Brazil
| | | | | | - Larissa Sandy da Silva Leite
- Universidade Estadual Paulista - Unesp, Institute of Biosciences, Department of Biosciences and Oral Diagnosis, São José dos Campos, SP, Brazil
| | - Fernanda Aragão Félix
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | - Eveline Turatti
- Universidade de Fortaleza - Unifor, Department of Dentistry, Fortaleza, CE, Brazil
| | | | - Sílvia Ferreira de Sousa
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Oral Surgery and Pathology, Belo Horizonte, MG, Brazil
| | | | - Ana Lia Anbinder
- Universidade Estadual Paulista - Unesp, Institute of Biosciences, Department of Biosciences and Oral Diagnosis, São José dos Campos, SP, Brazil
| | - Fábio Ramoa Pires
- Universidade Estadual do Rio de Janeiro - Uerj, School of Dentistry, Department of Dentistry, Rio de Janeiro, RJ, Brazil
| | - Pollianna Muniz Alves
- Universidade Estadual da Paraíba - UEPB, Department of Dentistry, Graduate Program in Dentistry, Campina Grande, PB, Brazil
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8
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Cunha JLS, Cavalcante IL, Barros EF, de Sousa Neto SS, Cavalcante RB, Turatti E, de Mendonça EF, de Albuquerque-Júnior RLC, Anbinder AL, Fragata da Silva D, Duarte IX, Nonaka CFW, Alves PM, de Almeida OP, de Andrade BAB. Oral solitary fibrous tumors: A collaborative clinicopathologic study of 19 cases. Oral Dis 2023. [PMID: 37731190 DOI: 10.1111/odi.14737] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE To report the clinicopathologic features of 19 oral solitary fibrous tumors (SFTs). METHODS Clinical data were collected from the records of seven pathology services. All cases were re-evaluated by HE staining and confirmed by immunohistochemistry. RESULTS The series comprised 11 females (57.9%) and 8 males (42.1%), with a mean age of 47.3 ± 14.7 years (range: 22-71 years) and a 1.3:1 female-to-male ratio. Most tumors affected the buccal mucosa (n = 7; 36.8%) and presented clinically as an asymptomatic solitary submucosal well-circumscribed nodule with coloration similar to the oral mucosa. Morphologically, most SFTs (n = 10; 52.6%) exhibited a classic hybrid pattern characterized by a well-circumscribed proliferation of densely cellular areas alternating with hypocellular areas in a variably collagenous vascular stroma. Remnants of accessory salivary glands were observed in two cases (n = 2; 10.5%). All tumors were positive for STAT6 and CD34 (n = 19; 100%). Outcome information was available from 6 patients (31.6%), with clinical follow-up ranging from 6 to 24 months (mean ± SD, 9.5 ± 6.8 months), and none developed local recurrence. CONCLUSIONS Oral SFTs are rare and often clinically misdiagnosed. Pathologists should consider SFT in the differential diagnosis of oral spindle cell tumors. Accurate diagnosis requires careful morphological evaluation supported by immunohistochemical analysis.
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Affiliation(s)
- John Lennon Silva Cunha
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
- Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- School of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | | | - Sebastião Silvério de Sousa Neto
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
- Department of Dentistry, Federal University of Goiás (UFG), Goiânia, Brazil
| | | | - Eveline Turatti
- School of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | | | | | - Ana Lia Anbinder
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, Brazil
| | | | | | | | | | - Oslei Paes de Almeida
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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Rosendy G, Cavalcante IL, Barros CCDS, López-Labady J, González N, Pérez-Alfonzo R, González MG, Freire CH, de Arruda JAA, de Andrade BAB, Villarroel-Dorrego M. Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience. Head Neck Pathol 2023; 17:631-637. [PMID: 37247174 PMCID: PMC10513972 DOI: 10.1007/s12105-023-01563-9] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.
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Affiliation(s)
- Gabriela Rosendy
- Master's Program in Stomatologic Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Israel Leal Cavalcante
- Department of Dentistry, University of Fortaleza, Fortaleza, Brazil
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil
| | - Caio César da Silva Barros
- Postgraduate Program in Dental Sciences, Department of Dentistry, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Jeaneth López-Labady
- Master's Program in Stomatologic Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Nieves González
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Ricardo Pérez-Alfonzo
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Maria Gabriela González
- Dermatology Service, Instituto de Biomedicina, Hospital Dr. José María Vargas, Caracas, Venezuela
| | - Clara Herrera Freire
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology, and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st Floor, Cidade Universitária, Rio de Janeiro, RJ, CEP 21.941-902, Brazil.
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10
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de Arruda JAA, Gómez R, Bracho V, Cavalcante IL, Pérez-Alfonzo R, Villarroel-Dorrego M, de Andrade BAB. Congenital Melanotic Macule of the Tongue: Report of Two Cases and Literature Review. Head Neck Pathol 2023; 17:581-586. [PMID: 36723851 PMCID: PMC10293539 DOI: 10.1007/s12105-023-01530-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Congenital melanotic macule of the tongue (CMMT) has been described as a distinct entity, despite its unknown etiology. However, the diagnosis and management of affected newborns may challenge clinicians and pediatric dentists. METHODS We document here the clinicopathological findings of two additional cases of CMMT. A literature review of CMMT reports identified across PubMed, Web of Science, Embase, and Scopus was also conducted. RESULTS The patients, 2- and 4 month-old Venezuelan boys, respectively, presented at birth with a single or multiple dark-brown-pigmented macule exclusively on the dorsum of the tongue. Histopathological features revealed increased melanin pigmentation in the basal epithelial layer with overlying hyperkeratosis and pigment-laden subepithelial macrophages with normal morphological appearance. Nine studies comprising 17 cases of CMMT have been described hitherto. Most cases were from the USA and France (n = 6 each). Twelve (70.6%) patients were males, eight (50%) were white, and median age was 2.7 months. CMMT presented as brownish to black, solitary or multiple pigmentations located in the right or left region of the dorsum of the tongue, ranging in size from 3.0 to 30.0 mm. CONCLUSION An important feature for the diagnosis of CMMT is the information about the manifestation at birth and consequent proportional growth. This report intends to draw the attention of pediatricians and dentists to this apparently underdiagnosed condition for decision-making and management of affected newborns.
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Affiliation(s)
- José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosanna Gómez
- Department of Oral Medicine, Dental School, Universidad Central de Venezuela, Caracas, Venezuela
| | - Verónica Bracho
- Dermatology Programme, Biomedicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
- Department of Dentistry, Universidade de Fortaleza, Fortaleza, Brazil
| | - Ricardo Pérez-Alfonzo
- Dermatology Programme, Biomedicine Institute, Universidad Central de Venezuela, Caracas, Venezuela
| | | | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil.
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11
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Cavalcante IL, Cunha JLS, da Silva CCB, Nonaka CFW, Cavalcante ER, de Almeida OP, Ribeiro NRB, Turatti E, Cavalcante RB, de Andrade BAB. Gingival rhabdomyosarcoma mimicking a non-neoplastic proliferative lesion: A diagnostic challenge. Oral Oncol 2023; 137:106281. [PMID: 36549241 DOI: 10.1016/j.oraloncology.2022.106281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Rhabdomyosarcoma (RMS) is a soft tissue sarcoma that develops from skeletal striated muscle cells. RMSs are exceedingly rare in the oral cavity, particularly in the gingiva. Herein, we reported the clinicopathological and immunohistochemical features of a rare case of RMS in a 30-year-old female presenting clinically as a painful polypoid nodule on the mandibular gingiva. Microscopically, the tumor showed atypical spindle cells with elongated nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. In focal areas, the tumor cells exhibited rhabdomyoblastic differentiation. Immunohistochemistry showed strong positivity for desmin, myogenin (scattered cells), and MyoD1. The patient underwent surgical resection followed by postoperative complementary radio- and chemotherapy. However, the patient had a local recurrence seven months after the initial treatment. She was submitted to a total mandibulectomy associated with adjuvant radiotherapy. However, she died two months after reoperation due to complications secondary to radiation therapy. Because of the rarity in the oral cavity and non-specific signs and symptoms, the clinical diagnosis of RMS is difficult and often overlooked. Therefore, careful histopathological and immunohistochemistry analysis of these tumors is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.
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Affiliation(s)
- Israel Leal Cavalcante
- Department of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil; Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | - John Lennon Silva Cunha
- Department of Dentristy, State University of Paraíba (UEPB), Campina Grande, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| | - Caio Cesar Barros da Silva
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte (UFRN), Natal, Brazil
| | | | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Eveline Turatti
- Department of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil.
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12
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Romo SA, de Arruda JAA, Nava FJT, Martínez LEM, Cavalcante IL, de Andrade BAB. Idiopathic gingival papillokeratosis with crypt formation: a clinicopathological entity in the young population? Int J Dermatol 2023; 62:e291-e293. [PMID: 36633181 DOI: 10.1111/ijd.16579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/05/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Saray Aranda Romo
- Periodontics Specialty, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Dentistry, Universidade de Fortaleza, Fortaleza, Brazil
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13
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Nogueira ZGPF, Cunha JLS, Cavalcante IL, Da Silva Barros CC, De Alencar RB, De Almeida OP, De Albuquerque-Junior RLC. SIALOLIPOMA OF MINOR SALIVARY GLANDS: REPORT OF A RARE CASE IN THE TONGUE. Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.147] [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: 10/15/2022]
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14
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Santos VRP, Cavalcante IL, Da Silva Barros CC, Cruz VMS, Correia-Neto IJ, Cunha JLS, Kalinin Y. ORAL KAPOSI'S SARCOMA IN AN HIV-POSITIVE PATIENT: AN EXUBERANT AND WIDESPREAD CASE REPORT. Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.451] [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: 10/15/2022]
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15
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Miranda GGB, Chaves-Junior SDC, Lopes MP, da Rocha TB, Colares DF, Ito FA, Cavalcante IL, Cavalcante RB, de Andrade BAB, Nonaka CFW, Alves PM, de Albuquerque-Júnior RLC, Cunha JLS. Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases. Braz Dent J 2022; 33:81-90. [PMID: 36287502 PMCID: PMC9645162 DOI: 10.1590/0103-6440202204965] [Citation(s) in RCA: 5] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023] Open
Abstract
Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.
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Affiliation(s)
- Georgea Gabriela Barreto Miranda
- Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University(UNIT), Aracaju, Brazil
| | | | | | - Talytha Barbosa da Rocha
- Postgraduate Program of Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil
| | - Débora Frota Colares
- Departament of Dentistry, Federal University of Rio Grande do Norte(UFRN), Natal, Brazil
| | - Fábio Augusto Ito
- Department of Oral Medicine and Pediatric Dentistry, State University of Londrina (UEL), Londrina, Brazil
| | | | | | | | - Cassiano Francisco Weege Nonaka
- Postgraduate Program of Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil
| | - Pollianna Muniz Alves
- Postgraduate Program of Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil
| | | | - John Lennon Silva Cunha
- Postgraduate Program of Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Paraíba, Brazil
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16
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De Alencar RB, Nogueira ZGPF, Da Silva Barros CC, Cunha JLS, Turatti E, Cavalcante RB, Cavalcante IL. CLINICOPATHOLOGICAL ANALYSIS OF ORAL MELANOCYTIC NEVI: A 20-YEAR RETROSPECTIVE STUDY. Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.591] [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: 11/24/2022]
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17
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Santos VRP, Da Silva Barros CC, Cunha JLS, Turatti E, De Albuquerque RLC, Cavalcante RB, Cavalcante IL. CLINICOPATHOLOGICAL FEATURES OF ORAL NEUROFIBROMA: A 20-YEAR RETROSPECTIVE STUDY. Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.593] [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: 11/28/2022]
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18
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Nogueira ZGPF, Colares DF, Cunha JLS, Cavalcante IL, Da Silva Barros CC, Cavalcante RB, De Almeida OP. ORAL MUCOCELES: A MULTI-INSTITUTIONAL STUDY OF 1901 CASES FROM BRAZIL. Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.590] [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: 10/15/2022]
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19
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Santos ALS, Leite-Filho AM, Da Silva Barros CC, Cavalcante IL, Neto IJC, Tomo S, Cunha JLS. ANGINA BULLOSA HEMORRHAGICA: A RARE OR UNDIAGNOSED CONDITION? Oral Surg Oral Med Oral Pathol Oral Radiol 2022. [DOI: 10.1016/j.oooo.2022.01.192] [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: 10/15/2022]
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20
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Silva Cunha JL, Cavalcante IL, da Silva Barros CC, Alves PM, Nonaka CFW, Albuquerque AFM, de Almeida OP, de Andrade BAB, Cavalcante RB. Intraosseous rhabdomyosarcoma of the maxilla with TFCP2 fusion: A rare aggressive subtype with predilection for the gnathic bones. Oral Oncol 2022; 130:105876. [PMID: 35550988 DOI: 10.1016/j.oraloncology.2022.105876] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/08/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 12/25/2022]
Abstract
Rhabdomyosarcomas (RMS) are malignant tumors with skeletal muscle differentiation extremely rare in intraosseous sites. We reported a rare case of an aggressive intraosseous RMS found in the maxilla of a 17-year-old female patient with five months of evolution. Computed tomography revealed a large osteolytic lesion extending from tooth 21 to 27, causing buccal and lingual cortical plate perforation. Microscopically, the lesion showed a proliferation of spindle-shaped cells with elongated nuclei and eosinophilic cytoplasm, arranged in an interlaced fascicle pattern. The nuclei ranged from vesicular with distinct nucleoli to hyperchromatic. A focal component of plump to epithelioid cells with a moderate amount of eosinophilic cytoplasm was seen at the periphery of the tumor. The immunohistochemical analysis revealed positivity for desmin, MyoD1, and myogenin (scattered cells). S-100, SOX10, HMB45, β-catenin, and CD34 were negative. Ki-67 was positive in 30% of tumor cells. Fluorescence in situ hybridization (FISH) analysis showed the presence of a FUS-TFCP2 fusion. The diagnosis was intraosseous RMS with TFCP2 fusion. Surgical excision followed by chemo- and radiotherapy was carried out; however, the patient died of disease nine months after the treatment. Because of the rarity and non-specific signs and symptoms, the clinical diagnosis of intraosseous RMS is difficult and often overlooked. Therefore, careful histopathological evaluation, supported by immunohistochemical and molecular analysis, is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.
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Affiliation(s)
- John Lennon Silva Cunha
- Department of Dentristy, State University of Paraíba (UEPB), Campina Grande, Brazil; Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
| | - Israel Leal Cavalcante
- Department of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil; Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
| | | | - Pollianna Muniz Alves
- Postgraduate Program in Dentistry, Department of Dentistry, State University of Paraíba (UEPB), Campina Grande, Brazil.
| | | | | | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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21
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Cunha JLS, Roza ALOC, Cruz VMS, Ribeiro JL, Cavalcante IL, Cavalcante RB, Anbinder AL, Abrahão AC, de Andrade BAB, Romañach MJ, Pires FR, dos Santos-Silva AR, Lopes MA, Vargas PA, Soares CD, de Almeida OP. Oral Lymphoepithelial Cyst: A Collaborative Clinicopathologic Study of 132 Cases from Brazil. Head Neck Pathol 2021; 16:268-277. [PMID: 34185247 PMCID: PMC9018938 DOI: 10.1007/s12105-021-01352-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
The oral lymphoepithelial cyst (OLC) is an uncommon lesion whose pathogenesis remains poorly understood. The aim of this study was to report the clinicopathologic features of the OLCs and to verify a possible association between OLCs and subgemmal neurogenous plaque (SNP) in the posterior lateral region of the tongue. A retrospective descriptive cross-sectional study was carried out. A total of 106,282 biopsy records of oral and maxillofacial lesions from six oral pathology services in Brazil were analyzed. All cases of OLCs were reviewed, and clinical and histopathological data were collected. Immunohistochemical reactions for S-100 protein were performed to confirm the diagnosis of SNP. Among all lesions, there were 132 (0.11%) cases of OLCs. The series comprised 83 females (62.9%) and 49 males (37.1%), with a 1.7:1 female-to-male ratio and a mean age of 45.8 ± 17.7 years. Most cases involved the tongue (n = 80; 62.0%) and presented clinically as asymptomatic papules or nodules with a yellow or whitish color. Microscopically, most of the cysts were entirely lined by parakeratinized stratified epithelium (n = 89; 67.4%) and filled with desquamated cells, keratin debris, amorphous eosinophilic material, and inflammatory cells in varying amounts. Connection with the epithelium of oral mucosa was observed in 18 cases (13.6%). SNP was found in 9/80 (11.2%) cases involving the tongue. The clinical and demographic features of OLCs were similar to those described in previous studies. Overall, this lesion has a predilection for the posterior region of the tongue of female adults. Clinicians must include the OLC in the differential diagnosis of yellow/white papules and nodules of the oral cavity.
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Affiliation(s)
- John Lennon Silva Cunha
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | - Vitória Maria Sousa Cruz
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Jaqueline Lemes Ribeiro
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, Brazil
| | | | | | - Ana Lia Anbinder
- Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (UNESP), São José dos Campos, Brazil
| | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Mário José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Fábio Ramôa Pires
- School of Dentistry, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Alan Roger dos Santos-Silva
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Ciro Dantas Soares
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil ,Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira 901, P.O. Box 52, Piracicaba, São Paulo 1314-903 Brazil
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Cunha JLS, de Sousa SF, Mota CP, Rocha Silva JV, Cavalcante IL, Marinho EB, Soares CD, de Albuquerque-Júnior RLC, Cavalcante RB, Abrahão AC, Agostini M, Romañach MJ, de Andrade BAB, Vargas PA, de Almeida OP. Sialolipomas of minor salivary glands: A multi-institutional study and literature review. J Oral Pathol Med 2021; 50:210-219. [PMID: 33187016 DOI: 10.1111/jop.13124] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/19/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sialolipoma is a rare histological variant of lipoma commonly misdiagnosed and composed of a proliferation of mature adipocytes with secondary entrapment of normal salivary gland tissue. The purpose of the present study is to report the clinicopathologic and immunohistochemical features of 10 new cases of sialolipomas in conjunction with a review of the literature. METHODS A retrospective descriptive cross-sectional study was performed. A total of 54,190 biopsy records of oral and maxillofacial lesions from four oral and maxillofacial pathology services in Brazil were analysed. All cases of lipomas were reviewed, and clinical, demographic and histopathological data were collected of all cases compatible with sialolipomas. In addition, immunohistochemistry stains (AE1/AE3, CK7, 34βE12, S-100, HHF35, α-SMA and Ki-67) and a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus) were performed. RESULTS Among all lipomas reviewed, there were 10 cases of sialolipomas. The series comprised of 7 females (70.0%) and 3 males (30.0%), with a mean age of 46.1 ± 21.5 years (range: 11-71 years) and a 2.3:1 female-to-male ratio. The lower lip (n = 3, 30.0%) and tongue (n = 2, 20.0%) were the most common locations, presenting clinically as a nodule of slow growth and normal colour. Conservative surgical excision was the treatment in all cases. No recurrence was observed. CONCLUSION Sialolipomas are a rare histological variant of lipoma, affecting the salivary glands, mainly in the parotid gland and palate of female adults. Pathologists must recognise sialolipomas to avoid misdiagnoses with other lipomatous tumours that can affect salivary glands.
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Affiliation(s)
- John Lennon Silva Cunha
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Sílvia Ferreira de Sousa
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina Peres Mota
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - João Vitor Rocha Silva
- Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University (UNIT), Aracaju, Brazil
| | - Israel Leal Cavalcante
- Oral Pathology, School of Dentistry, University of Fortaleza (UNIFOR), Fortaleza, Brazil
| | - Erasmo Bernardo Marinho
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceara (UFC), Fortaleza, Brazil
| | - Ciro Dantas Soares
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | | | | | - Aline Corrêa Abrahão
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Michelle Agostini
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mario José Romañach
- Department of Oral Diagnosis and Pathology, School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Pablo Agustin Vargas
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Oral Pathology Section, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
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de Morais EF, Santos HBDP, Cavalcante IL, Rabenhorst SHB, Dos Santos JN, Galvão HC, Freitas RDA. Twist and E-cadherin deregulation might predict poor prognosis in lower lip squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 127:318-329. [PMID: 30598410 DOI: 10.1016/j.oooo.2018.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the expression of Twist and E-cadherin in lower lip squamous cell carcinoma (LLSCC) and their association with clinicopathologic parameters. STUDY DESIGN Fifty-nine cases of LLSCC were analyzed by applying immunohistochemistry techniques in a semiquantitative manner. The systems proposed by Bryne etal., Brandwein-Gensler etal., and Almangush etal. were applied for analysis of the histopathologic malignancy grading system. RESULTS Higher E-cadherin expression (general and membrane) was observed in cases presenting with disease-free survival after 5years of follow-up (P < .05). Higher Twist expression was observed in lesions classified as being in advanced stages, displaying recurrence, and having a high degree of malignancy. A significant negative correlation was detected between cytoplasmic Twist expression and membrane E-cadherin expression (P = .028). A statistically significant relationship was detected between high total Twist expression in tumors classified as high risk by Brandwein-Gensler etal., and no significant difference was observed among total, membrane, and cytoplasmic E-cadherin expressions in LLSCC cases and the 3 applied grading systems (P > .05). CONCLUSIONS The results of the present study suggest the potential involvement of Twist and E-cadherin in the modulation of events related to worse prognoses in LLSCC cases.
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Affiliation(s)
- Everton Freitas de Morais
- PhD Student, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Hellen Bandeira de Pontes Santos
- PhD Student, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Israel Leal Cavalcante
- PhD Student, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Silvia Helena Barem Rabenhorst
- Professor, Postgraduate Program in Biological Sciences, Molecular Genetics Laboratory, Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Jean Nunes Dos Santos
- Professor, Postgraduate Program in Oral Pathology, Department of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Hébel Cavalcanti Galvão
- Professor, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Roseana de Almeida Freitas
- Professor, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
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Leite RB, Cavalcante IL, Da Silva Barros CC, Prado JP, Goes Gonzaga AK, De Medeiros AMC, Teixeira Medeiros RC. Eagle's Sydrome: Diagnosis and Incidence in a Brazilian Population. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.02.600] [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: 10/28/2022]
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Xerez MC, Da Silva Castro Nóbrega LE, Leite RB, Da Silva Barros CC, Cavalcante IL, De Lucena Pereira L, De Lisboa Lopes Costa A. Lymphoepithelial Cyst in the Posterior Tongue: a Case Report. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.02.545] [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: 10/28/2022]
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De Lucena Pereira L, Cavalcante IL, Da Silva Barros CC, Leite RB, Xerez MC, De Oliveira PT, De Medeiros AMC. Case Report of Oral Manifestation of Mucous Membrane Pemphigoid: Treatment with Topical Tacrolimus. Oral Surg Oral Med Oral Pathol Oral Radiol 2018. [DOI: 10.1016/j.oooo.2018.02.520] [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: 11/26/2022]
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Barros CCDS, Santos HBDP, Cavalcante IL, Rolim LSA, Pinto LP, de Souza LB. Clinical and histopathological features of nasopalatine duct cyst: A 47-year retrospective study and review of current concepts. J Craniomaxillofac Surg 2017; 46:264-268. [PMID: 29248496 DOI: 10.1016/j.jcms.2017.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/19/2017] [Revised: 10/14/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the clinical and histopathological features of nasopalatine duct cysts (NDCs) stored in the archives of a referred Oral Pathology Service over a 47-year-period, and to review current concepts about these cysts. MATERIAL AND METHODS All NDCs were reviewed, and clinical data were obtained from the patient records. Thirty cases were re-evaluated microscopically by 2 oral pathologists. RESULTS Among 14,564 cases, 30 (0.20%) were NDCs. Fifteen (50.0%) of the patients were female, and the mean age was 42.7 years. The lesions measured on average 2.37 ± 1.69 cm. Histologically, stratified squamous epithelium, alone or in combination with other epithelia, was present in 13 (46.6%) cases. Goblet cells and subepithelial hyalinization were common. Fourteen (46.6%) cases exhibited a slight degree of inflammation. Nerves were observed in 15 (50%) cases and mucous glands in 7 (23.3%). Hyaline ring granulomas (which is described here for the first time in NDC) and cholesterol crystals were not common. CONCLUSION Knowledge of clinical-histopathological aspects of NDCs provides more accurate data about their nature and behavior. Our results suggest that the predominant epithelial lining of these cystic lesions is exclusively stratified squamous epithelium or combined with another type. Vessels, nerves, mucous glands and inflammatory infiltrate are frequently observed.
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Affiliation(s)
- Caio César da Silva Barros
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | | | - Israel Leal Cavalcante
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Larissa Santos Amaral Rolim
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Leão Pereira Pinto
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
| | - Lélia Batista de Souza
- Department of Dentistry, Postgraduate Program in Oral Pathology, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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