Contribution of public oral pathology services to the diagnosis of oral and oropharyngeal cancer in Brazil

Abstract This study aimed to evaluate the contribution of oral and maxillofacial pathology laboratories (OMPLs) in Brazilian public universities to the diagnosis of lip, oral cavity, and oropharyngeal squamous cell carcinoma (SCC). A cross-sectional study was performed using biopsy records from a consortium of sixteen public OMPLs from all regions of Brazil (North, Northeast, Central-West, Southeast, and South). Clinical and demographic data of patients diagnosed with lip, oral cavity, and oropharyngeal SCC between 2010 and 2019 were collected from the patients' histopathological records. Of the 120,010 oral and maxillofacial biopsies (2010-2019), 6.9% (8,321 cases) were diagnosed as lip (0.8%, 951 cases), oral cavity (4.9%, 5,971 cases), and oropharyngeal (1.2%, 1,399 cases) SCCs. Most cases were from Brazil's Southeast (64.5%), where six of the OMPLs analyzed are located. The predominant profile of patients with lip and oral cavity SCC was Caucasian men, with a mean age over 60 years, low schooling level, and a previous history of heavy tobacco consumption. In the oropharyngeal group, the majority were non-Caucasian men, with a mean age under 60 years, had a low education level, and were former/current tobacco and alcohol users. According to data from the Brazilian National Cancer Institute, approximately 9.9% of the total lip, oral cavity, and oropharyngeal SCCs reported over the last decade in Brazil may have been diagnosed at the OMPLs included in the current study. Therefore, this data confirms the contribution of public OMPLs with respect to the important diagnostic support they provide to the oral healthcare services extended by the Brazilian Public Health System.

Revisão dos aspectos morfológicos e imunoistoquímicos do linfoma difuso de grandes células B (LDGCB) com ênfase em boca / Review of the morphological and immunohistochemical aspects of diffuse large B cell lymphoma (DLBCL) with emphasis on the mouth

Os linfomas compreendem um grupo diverso de neoplasias malignas, provenientes de células do sistema imunológico em diferentes estágios de diferenciação. Objetivo: o propósito deste artigo é facilitar o diagnóstico do linfoma difuso de grandes células B (LDGCB) por meio de seus aspectos clínicos, morfológicos e imunoistoquímicos, além de suas peculiaridades como manifestação primária em boca. Revisão de literatura: foi realizada uma revisão narrativa da literatura por intermédio de artigos selecionados nas bases de dados PubMed, Medline, SciELO e Lilacs, pela busca por palavras-chave. Aspectos relacionados a classificação e manifestações clínicas também foram considerados, a fim de facilitar o entendimento da lesão e de suas particularidades em boca. Verificou-se que o LDGCB representa a variante mais comum em boca. Os sinais e sintomas clínicos relacionados a essa condição podem ser: aumento de volume, dor, ulceração, alteração de cor da mucosa ou até mesmo parestesia. Morfologicamente, os LDGCBs apresentam células grandes, com padrão de crescimento difuso, citoplasma escasso, nucléolos evidentes e mitoses. Na imunoistoquímica, os LDGCBs são geralmente positivos para CD20 e outros marcadores da linhagem B (CD19, CD79a, PAX5 e CD138), dependendo do estágio de maturação em que se encontram as células B. Considerações finais: o diagnóstico do LDGCB em boca representa um desafio contínuo para os patologistas, em função da heterogeneidade de suas características morfológicas e imunofenotípicas.(AU)

Lymphomas comprise a diverse group of malignant neoplasias from cells of the immune system at different stages of differentiation. Objective: this article aimed to facilitate the diagnosis of diffuse large B-cell lymphoma (DLBCL) through its clinical, morphological, and immunohistochemical aspects, as well as its particularities as a primary manifestation in the mouth. Literature Review: hence, a narrative review of the literature was performed using articles selected in the PubMed, Medline, SciELO, and Lilacs databases through keyword search. Aspects related to classification and clinical manifestations were also considered to facilitate the understanding of the lesion and its particularities in the mouth. It was verified that the diffuse large B-cell lymphoma (DLBCL) represents the most common variant in the mouth. The clinical signs and symptoms related to this condition may be increased volume, pain, ulceration, changed mucosal color, or even paresthesia. Morphologically, DLBCL presents large cells with diffuse growth pattern, scarce cytoplasm, evident nucleoli, and mitoses. In immunohistochemistry, DLBCL is usually positive for CD20 and other markers of lineage B (CD19, CD79a, PAX5, and CD138) depending on the maturation stage in which B cells are found. Final considerations: the diagnosis of oral DLBCL represents a continuous challenge for pathologists due to the heterogeneity of its morphological and immunophenotypic characteristics.(AU)

Oral manifestations and histopathology of minor salivary gland from patients with Sjögren's Syndrome and its diagnosis in a public health system

Objective: to analyze the oral manifestations, sialometry and the histopathology of the minor salivary glands of patients with Sjögren Syndrome (SS) treated in a public health system and diagnosed according to European American Consensus Group (EACG) criteria. Material and Methods: the 32 patients were submitted to Shirmer test, oral cavity exam, unstimulated and stimulated salivary flow measurement and, in some cases, to the serological testing. For certain patients a minor salivary gland biopsy was carried out. Results: 10 patients were diagnosed with Sjögren Syndrome (SS), among whom: 40% were diagnosed with primary (pSS) and 60% with secondary Sjögren Syndrome (sSS). All patients diagnosed with this condition complained of xerostomia and xeropthalmia. Besides xerostomia, the most frequent oral manifestations were difficulty in swallowing, dry lips, hyperemic gums and atrophic change in tongue papillae. The average scores of the Schirmer and salivary flow tests were lower in patients with sSS. Conclusion: the oral signs and symptoms are extremely important in the multisystem involvement of the SS, which emphasizes the dental surgeon responsibility in managing these patients. The establishment of multidisciplinary diagnostic centers is of utmost importance, as well as the ability to offer more objective exams in the public health system aiming at increasing the accuracy of Sjögren Syndrome diagnosis.

Manifestações bucais em pacientes portadores de doenças sexualmente transmissíveis / Oral manifestations in subjects with sexually transmitted diseases

Introdução: a despeito dos avanços tecnológicos ocorridos na área médica nas últimas décadas, as DST persistem em nosso meio como importanteagravo de Saúde Pública, ancorado, quiçá, na falta de conhecimento dos seus mecanismos de transmissão. Particularmente a cavidade oral não tem sido objeto de muitos estudos aprofundados sobre o seu papel na transmissão e no desenvolvimento das DST. O presente estudo visa diminuir tal vácuo de informações em nosso município, assim como contribuir para o conhecimento da epidemiologia das DST em nosso meio. Objetivo: averiguar a prevalência de manifestações intraorais em pacientes portadores de doenças sexualmente transmissíveis (DST) na cidade de Manaus, Amazonas, no ano de 2008. Métodos: foram avaliados 157 portadores de doenças sexualmente transmissíveis em atendimento na Fundação Alfredo da Matta. As lesões orais foram detectadas por exame clínico oral, exames citopatológicos (raspados das lesões) e histopatológicos (biópsias). Resultados: em 24,2% dos participantesforam encontradas 46 (29,1%) lesões orais possivelmente relacionadas com as DST. Observou-se associação signifi cativa entre o nível educacional e o conhecimento acerca da relação entre lesões orais e DST, porém não se obteve associação entre a presença de lesões orais e práticas do sexo oral, nível de escolaridade ou grau de higienização bucal. As análises estatísticas foram feitas no SPSS (nível de confi ança 95%) e foram aplicados testes de qui-quadrado. Conclusão: este estudo evidenciou a existência de demanda reprimida de portadores de DST com relação ao diagnóstico de lesões em mucosa oral, assim como de tratamento e/ou encaminhamento para outros serviços especializados. A necessidade de implantação e oferta de atenção à saúde na área de estomatologia no Amazonas deve ser considerada

Introduction: despite the technological progresses that have taken place in the medical fi eld in the last decades, STD persist to be an aggravating factor in public health. This is perhaps due to the lack of knowledge of our transmission mechanisms. Particularly, the role of the oral cavity in the transmission and development of STD has not been the subject of many detailed studies. This study aims to reduce the information vacuum in our municipality, as well as contribute to the knowledge of epidemiology in STD in our . Objective: investigating the prevalence of oral manifestations of sexually transmitted diseases (STD) in infected individuals in Manaus, Amazon, in the year 2008. Methods: 157 people with confi rmed clinical and laboratorial STD diagnosis undergoing treatment at the Alfredo da Matta Foundation. The oral lesions were detected by oral clinical examination and microscopic techniques for cells and tissue studies. Results: in 24,2% participants 46 (29,1%) oral lesions were observed, which could possibly linked to STDs. Direct correlation was observed between educational level and knowledge of oral lesions and STD, but no correlation was found between oral lesions and oral sexual practice,educational level or oral hygiene. The statistical analysis was done on SPSS (95% confi dence level) and chi-square tests were applied. Conclusion: this study showed the existence of a hidden population of individuals with needs on precocious oral lesions diagnosis, treatment and referring for other specialized services, for example, the Oncology, considering the risk of malignancy of some lesions. The necessity to establish a stomatology service in the Amazon must be considered.