Caracterização clínico-patológica da papilomatose laríngea / Clinical-pathological characterization of laryngeal papillomatosis

A papilomatose laríngea (PL) é uma doença rara e grave, dividida em dois grupos: juvenil (PLJ) e adulta (PLA), ambas causadas pelo papilomavírus humano (HPV). Seu curso pode ser agressivo, com inúmeras recidivas, risco de malignização, disseminação pulmonar e obstrução das vias aéreas. Para identificar os casos mais agressivos e nortear os tratamentos foram desenvolvidas escalas laringoscópicas, dentre elas; a escala desenvolvida por Derkay et al. (1998). O objetivo deste projeto foi caracterizar a PL e correlacionar suas características clínico-patológicas com com a escala laringoscópica de Derkay. Os dados e biópsias de 36 pacientes com PLJ e 56 com PLA foram coletados e analisados por meio da microscopia de luz. Os pacientes foram separados em grupos de acordo com os índíces de Derkay: ≥20 para os mais agressivos e <20 para os casos menos agressivos. Foram realizadas reações de imuno-histoquímicas anti- Fator XIIIa, CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 e MUM-1. As células inflamatórias foram quantificadas. Todas as características clínico-patológicas e os resultados da reação imuno-histoquímica encontrados foram comparados entre os grupos propostos através do teste estatístico de Qui-Quadradro e correlacionados através do teste de correlação de Spearman. O nível de significância considerado foi de 5%. Ao comprar a severidade entre os grupos PLJ e PLA, o grupo PLJ foi considerado mais agressivo (P=0,02). Os pacientes entre as amostras com score ≥20 apresentaram maior incidência de traqueostomia e dificuldade respiratória grave. As displasias de alto grau foram associadas à presença de células FatorXIII+ e CD68+ (P<0,05) e tanto para PLJ quanto para PLA não houve associação destas displasias com a severidade (P=0,55 e P=0,87, respectivamente). A média do índice de Derkay para as amostras com mitoses acima da camada basal e atípicas foi 10,65 (± 5,93), maior do que a média das amostras que não apresentavam esta característica (8,02 ± 4,64), sendo estatisticamente significante (P=0,03). Amostras de PLA apresentaram maior quantidade de células CD3+. CD8+ e MUM1+ (P<0,05). A presença de CD15+ é diretamente proporcional ao índice de Derkay (P<0,05), enquanto MUM-1 é inversamente proporcional (P=0,01). Baseados nestes resultados, conclui-se que a PL é mais severa no pacientes jovens; mitoses atípicas e nas camadas mais superiores do epitélio foram mais frequentes na PLJ e estas foram correlacionadas com a maior severidade. As células inflamatórias também foram relacionadas a severidade e diferiram entre os grupos PLJ e PLA (AU)

Laryngeal papillomatosis (LP) is a rare and serious disease, divided into two groups: juvenile (JLP) and adult (ALP), both caused by the human papillomavirus (HPV). Its course can be aggressive, with numerous relapses, risk of malignancy, pulmonary dissemination and airway obstruction. To identify the most aggressive cases and guide the treatments, laryngoscopic scales were developed, among them; the scale developed by Derkay et al. (1998). The objective of this project was to characterize LP and to correlate its clinical-pathological characteristics with Derkay's laryngoscopic scale. The data and biopsies of 36 patients with JLP and 56 patients with ALP were collected and analyzed by light microscopy. The patients were separated into groups according to the Derkay indices: ≥20 for the most aggressive and <20 for the less aggressive cases. Anti-Factor XIIIa, CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 immunohistochemical reactions were performed and the inflammatory cells were quantified. All the clinical-pathological characteristics and the results of the immunohistochemical reaction were compared between the groups proposed using the Chi-Square test and correlated through the Spearman correlation test. The significance level considered was 5%. When comparing aggressivity between the JLP and ALP groups, the JLP group was considered more aggressive (P = 0.02). Patients among the samples with score ≥20 had a higher incidence of tracheostomy and severe respiratory distress. High-grade dysplasias were associated with the presence of Factor XIII+ and CD68+ cells (P <0.05), and for both JLP and ALP there was no association of these dysplasias with aggressivity (P = 0.55 and P = 0.87, respectively). The mean of the Derkay index for the samples with mitoses above the basal and atypical layer was 10.65 (± 5.93), higher than the mean of the samples that did not show this characteristic (8.02 ± 4.64), (P = 0.03) being statistically significant. The ALP samples showed higher quantities of CD3+ cells, CD8+ and MUM1+ (P <0.05). The presence of CD15+ is directly proportional to the Derkay index (P <0.05), while MUM-1 is inversely proportional (P = 0.01). Based on these results, it is concluded that LP is more aggressive in young patients; atypical mitoses and in the uppermost layers of the epithelium were more frequent in JLP and these were correlated with aggressivity. Inflammatory cells were also related to aggressiveness and differed between the groups PLJ e PLA (AU)

The role of Osterix protein in the pathogenesis of peripheral ossifying fibroma

Abstract Peripheral ossifying fibroma (POF) is a reactive lesion of oral tissues, associated with local factors such as trauma or presence of dental biofilm. POF treatment consists of curettage of the lesion combined with root scaling of adjacent teeth and/or removal of other sources of irritants. This study aimed to analyze the clinical and pathological features of POF and to investigate the immunoexpression of Osterix and STRO-1 proteins. Data such as age, gender, and size were obtained from 30 cases of POF. Microscopic features were assessed by conventional light microscopy using hematoxylin-eosin staining and immunohistochemical markers, and by polarized light microscopy using Picrosirius red staining. The age range was 11-70 years and 70% of the patients were female. Moreover, the size of POF varied from 0.2 to 5.0 cm; in 43.33% of the cases, the mineralized content consisted exclusively of bony trabeculae. The immunohistochemical analysis showed nuclear staining for Osterix in 63% and for STRO-1 in 20% of the cases. Mature collagen fibers were observed in mineralized tissue in 76.67% of the cases. The clinical and microscopic features observed were in agreement with those described in the literature. Osterix was overexpressed, while STRO-1 was poorly expressed. Osterix was expressed particularly in cells entrapped in and around mineralized tissue, indicating the presence of a stimulus that triggers the differentiation of these cells into osteoblasts or cementoblasts, i.e., cells that produce mineralized tissue. Based on our results, Osterix may play a role in the pathogenesis of POF.

Mini-implante dentário como alternativa terapêutica para resolução de agenesia de incisivo lateral com cirurgia flapless e provisionalização imediata: relato de caso com 84 meses de acompanhamento / Mini dental implant as an alternative therapy for lateral incisor agenesis with flapless surgery and immediate provisionalization a case report with 84 months of follow-up

O presente estudo apresenta um caso de paciente do gênero masculino, 18 anos de idade, com agenesia do elemento 12, que optou pela utilização de um mini-implante associado à técnica de cirurgia sem retalho e realização de provisionalização imediata. Foi realizado acompanhamento clínico semanal no primeiro mês pós-implantação, não tendo sido observada qualquer complicação, assim como nos controles mensais seguintes, demonstrando sucesso nos resultados estéticos e funcionais. Após seis meses, a reabilitação protética foi finalizada com uma coroa In-Ceram e reabilitação cosmética do sorriso. O presente caso ressalta a importância do correto planejamento protético-cirúrgico, a experiência do profissional e os acompanhamentos clínicos de longo prazo

This case report illustrates a 18 years-old male patient with agenesis of tooth 22 receiving a mini dental implant with flapless surgery and immediate provisionalization. Postoperative control was performed every week in the first month and monthly thereafter demonstrating esthetic and functional success. Six months later, an In-Ceram crown was delivered for cosmetic smile design. This case highlights the importance of adequate surgical and prosthetic procedures, professional experience, and long-term clinical follow-ups.

HAART therapy does not reduce the proteinase and phospholipase secretion by oral Candida albicans isolated from HIV-positive patients

Production of exoenzymes, specifically the proteinase and phospholipase, is considered one of the most important of pathogenicity mechanisms of C. albicans, which is crucial for tissue invasion. This study aimed at evaluating the production of these exoenzymes in 50 oral C. albicans isolates from HIV-positive (HIV+) patients treated with highly active anti-retroviral therapy (HAART), and from 50 control individuals. For testing the production of phospholipase and proteinase, the culture media containing egg yolk and bovine albumin were used, respectively. The results were obtained by measuring the diameter of the colony and divided by the diameter of colony plus the precipitation zone, defined as Pz. Data were statistically analyzed by Student’s t test (5). Statistically significant difference (p = 0.001) was observed between the mean values of Pz for proteinase in isolates from HIV+ patients (Pz = 0.358±0.295) and from control group (Pz = 0.660±0.370). The same results were observed for phospholipase production (Pz = 0.399±0.227 for HIV+ group; Pz =0.635±0.292 control group). Both enzymes were highly produced by C. albicans isolated from HIV+ patients when compared with those secreted by C. albicans obtained from control group, suggesting that HAART did not reduce the secretion of these enzymes by this pathogenic fungus infecting HIV+ patients.