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.

Epithelial odontogenic tumors: analysis of 156 cases in a Brazilian population / Tumores odontogénicos epiteliales: análisis de 156 casos en una población brasileña

The objective of this study was to determine the distribution of epithelial odontogenic tumors diagnosed histologically in a period of 41 years in a Brazilian population according to age, gender, site affected and compare these data with previously reported studies from other countries. Data of epithelial odontogenic tumors diagnosed were collected from the files of the Oral Pathology Laboratory of Federal University of Rio Grande do Norte, Natal, RN, Brazil, and entered in a standardized form for later comparisons. Clini-cal features obtained from the patient records and microscope slides were reviewed according to the 1992 World Health Organization classification. A total 156 epithelial odontogenic tumor were reported. Of these, all of them were benign. Ameloblastoma was the most frequent type (85.9 %), followed by adenomatoid odontogenic tumor (10.9 %) and calcifying epithelial odontogenic tumor (3.2 %). The mean age of the patients was 38 years, with a wide range (11­80 years). The posterior region of mandible was the anatomic site most frequently affected by this disease, and no significant differences were found between sexes in the diagnosis of odontogenic tumors. A marked geographic variation in the relative incidences of various epithelial odontogenic tumors was found. It was particularly notable in ameloblastomas and adenomatoid odontogenic tumors, with the incidences observed in the present study being similar, sometimes different to earlier studies in others parts of the world.

El objetivo fue determinar la distribución de los tumores odontogénicos epiteliales diagnosticados histológicamente en un período de 41 años en una población brasileña según edad, sexo y la zona afectada y comparar estos datos con estudios anteriores de otros países. Los datos de los tumores odontogénicos epiteliales diagnosticados fueron obtenidos de los archivos del Laboratorio de Patología Oral de la Universidad Federal de Rio Grande do Norte, Natal, RN, Brasil, e introducidos en un formulario estandarizado para comparaciones futuras. Las características clínicas obtenidas a partir de los registros de los pacientes y los portaobjetos de microscopio fueron revisados de acuerdo a la clasificación de la Organización Mundial de la Salud 1992. Se informó de un total de 156 tumores epiteliales odontogénicas. De estos, todos eran benignos. Ameloblastoma fue el tipo más frecuente (85,9 %), seguido por el tumor odontogénico adenomatoide (10,9 %) y el tumor odontogénico epitelial calcificante (3,2 %). La edad media de los pacientes fue de 38 años, con un rango amplio (11­80 años). La región posterior de la mandíbula era el sitio anatómico más afectado por esta enfermedad, y no se encontraron diferencias significativas entre sexos en el diagnóstico de los tumores odontogénicos. Se encontró una marcada variación geográfica en las incidencias relativas de diversos tumores odontogénicos epiteliales. Fue particularmente notable en ameloblastomas y tumores odontogénicos adenomatoide, con las incidencias observadas en este estudio siendo a veces similares, y a veces diferentes de los estudios anteriores en otras partes del mundo.

Análisis clínico e histomorfológico de la mucosa oral normal, hiperplasia fibroepitelial inflamatoria oral y displasia oral / Clinical and histomorphological analysis of normal oral mucosa, oral inflammatory hyperplasia and oral epithelial displasia

El desarrollo del cáncer oral puede darse a partir de una mucosa aparentemente normal o a partir de una lesión precursora inicial, las cuales pueden representar pasos diferentes del proceso de carcinogénesis epitelial oral. El objetivo de este estudio fue analizar morfológicamente, a través de la técnica de la hematoxilina / eosina, la mucosa oral normal, con hiperplasia fibroepitelial oral y displasia epitelial oral, con el propósito de obtener mayor información sobre las alteraciones epiteliales que pueden preceder al establecimiento y evolución de una neoplasia propiamente tal. Fue observado que muchas de las alteraciones morfológicas observadas en las hiperplasias fibroepiteliales orales probablemente eran asociadas al proceso inflamatorio, donde es conocida la acción de mediadores químicos con capacidad de promover modificaciones morfológicas celulares y en la estructura tisular y no necesariamente representan alteraciones comunes de lesiones potencialmente malignas. Correlacionando el aspecto clínico de las lesiones con el diagnóstico histopatológico de displasia epitelial oral, no fue observada diferencia expresiva; sin embargo, la mayoría de los especímenes tuvo diagnostico clínico de leucoplasia. Se concluyó que la simple observación de las características morfológicas de las alteraciones de la mucosa oral puede ayudar el establecimiento del diagnóstico de las lesiones sufridas por la mucosa; sin embargo, no ofrecen muchas información sobre cuáles serían los eventos que llevarían al establecimiento de una determinada lesión.

The oral cancer development can be from apparently normal mucosa, or from precursory lesions, that can represent different step of oral epithelial carcinogenesis process. This study aimed to analyze morphologically trough the hematoxilina/eosine technique normal oral mucosa, oral fibroepithelial inflammatory hyperplasia and oral epithelial dysplasia (OED) to get more informations about the epithelial alterations that can to precede the installation and evolution of oral cancer. Its was observed that some of the morphologic alterations in the oral fibroepitelial hyperplasia were provably associated to the inflammatory process, where exist the action of chemical mediators with capacity to promote cellular morphologic modifications and alterations of the tissue architecture but not to common alterations of lesions potentially malignant. Correlating the clinical aspect of the lesions with the histopatologic diagnosis of oral epithelial dysplasia its was not observed expressive difference, however the majority of the OED specimens had clinical diagnosis of leucoplasia. Its was concluded that the simple observation of the morphologic characteristics of epithelial alterations in the oral mucosa can to improve the diagnostic of the lesions suffered by this mucosa, however, its not offers much informations about which would be the events that would lead to the establishment of a determined lesion.