Difference in EGFR expression and mean vascular density in normal oral mucosa, oral epithelial dysplasia and oral squamous cell carcinoma

To evaluate the expression of the epidermal growth factor receptor (EGFR) and mean vascular density (MVD) in normal oral mucosa (NOM), oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Material and methods: Descriptive case study. Nineteen histological samples diagnosed with NOM, 18 diagnosed with OED, and 19 with OSCC, were analyzed with immunohistochemistry against EGFR and CD31. EGFR expression was evaluated by extent and intensity of its expression in normal, dysplastic and neoplastic epithelium. MVD was determined through the detection of blood vessels by antibodies against CD31. Results: Extension of EGFR expression was highest in OSCC followed by OED and lowest in NOM, resulting in significant different between the degrees of extension (p<0.001). Intensity of EGFR was similar in NOM, OED and OSCC, without differences in its expression (p=0.533). Differences in MVD were found between NOM and OSCC groups (p<0.01), and between OED and OSCC groups (p<0.01), with no differences between NOM and OED groups (p=0.91). MVD was 21.17 +/- 4.98 in NOM, 23.40 +/- 5.77 in OED and 33.92 +/- 8.39 in OSCC. Conclusion: EGFR is expressed in normal, dysplastic or neoplastic oral epithelium. However, the extent of its expression is greater as malignancy increases. MVD varies according to the diagnosis.

Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life

Abstract To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.

Cáncer oromaxilofacial en niños: Parte II tumores odontogénicos y de glándulas salivales malignos / Maxillofacial cancer in children: Part II malignant odontogenic and salivary gland tumors

A nivel mundial, la información acerca de tumores malignos del territorio maxilofacial que afectan a niños es limitada. La mayoría de los resportes consiste principalmente en datos de la población adulta. Las neoplasias malignas originadas del aparato odontogénicos y glándulas salivales son lesiones que con cierta frecuencia pueden afectar a la población infantil. Los tumores odontogénicos malignos son entidades sumamente raras que, correspondiendo a menos del 5 % del total de tumores odontogénicos. Los sarcomas odontogénicos, si bien son poco frecuentes, corresponden a los tumores odontogénicos malignos más comunes en la infancia. Las neoplasias malignas de glándulas salivales corresponden al 35­60 % de los tumores de gándulas salivales en la infancia, siendo el más común de ellos el carcinoma mucoepidermoide. En general, el pronóstico de estas entidades es positivo sobre todo si es acompañado de un diagnóstico oportuno. A pesar de la baja frecuencia que presenta este grupo de patologías, no es menos cierto que es necesario saber con precisión cuales son los tejidos orales desde los cuales se pueden originar neoplasias malignas en los niños y tener una breve referencia diferencial entre ellos.

Globally, information about the maxillofacial malignant tumors affecting children is limited. Most reported data consists mainly of studies in the adult population. Malignant neoplasms arising from odontogenic apparatus and salivary glands are lesions that frequently can affect children. Malignant odontogenic tumors are extremely rare entities, corresponding to less than 5 % of all odontogenic tumors. Odontogenic sarcomas, although they are rare, correspond to the most common malignant odontogenic tumors in childhood. Malignant salivary gland neoplasms correspond to 35­60 % of tumors of salivary glands during childhood and the most common of these is mucoepidermoid carcinoma. In general, the prognosis of these entities is positive especially when there is a timely diagnosis. Despite the low frequency presented by this group of diseases, the fact remains that it is necessary to know precisely what the originating oral tissues are which can cause malignancies in children and have a brief reference differential between them.

Cáncer oromaxilofacial en niños: Parte I tumores malignos de tejido duro / Oromaxillofacial cancer in children: Part I hard tissue malignant tumors

Las enfermedades malignas de cabeza y cuello en la población pediátrica son poco frecuentes. Considerando todos los tumores de cabeza y cuello, tanto benignos como malignos, éstos están representados por una frecuencia entre un 2% a 5% de todos los tumores pediátricos. A nivel de los maxilares, los tumores malignos en niños está representado por un rango que varía entre un 7% a 51%. En Chile, se estiman menos de 500 casos nuevos por año y en el rango entre los 5 y 15 años constituyen la segunda causa de muerte, precedida por los accidentes, traumatismos y violencias. Es importante considerar, al estudiar este grupo de enfermedades, que existen diferencias con los tumores de adultos, tanto en su incidencia, biología, comportamiento, histología y manejo. Es por esta razón que nos parece necesario realizar una revisión de la literatura científica para obtener un perfil del cáncer bucomaxilofacial infantil, que aporte en el entendimiento y aplicación de programas adecuados en el contexto de la salud bucomaxilofacial. Adicionalmente, buscamos actualizar el conocimiento de estas patologías, caracterizándolas en relación a su epidemiología, etiopatogenia y tratamiento, de manera que contribuya a los cirujanos dentistas para realizar diagnósticos y la pronta derivación a un centro especializado de patología oral. Para un estudio preciso, esta revisión constará de tres partes: la primera es sobre "tumores malignos de tejido óseo", mencionando, entre ellos, al osteosarcoma, sarcoma de Ewing, linfomas tanto Hodgkin como No Hodgkin, fibrosarcoma e histiocitosis de células de Langerhans.

Malignant head and neck disease in the pediatric population are rare. Considering all head and neck tumors, both benign and malignant, they represent between 2% to 5% of all pediatric tumors. At the level of the jaws, malignant tumors in children present in a range that varies from 7% to 51%. In Chile, fewer than 500 new cases are reported each year and in the 5 to 15 year-range are estimated to constitute the second cause of death, preceded by accidents, injuries and violence. When studying this group of diseases it is important to consider the differences with adult tumors, both in incidence, biology, behavior, histology and management. Therefore we believe it necessary to conduct a review of scientific literature to obtain a profile of child oral maxillofacial cancer, contributing to the understanding and implementation of appropriate programs in the context of maxillofacial health. In addition, we seek to update knowledge of these pathologies, characterizing their epidemiology, pathogenesis and treatment, so as to contribute to dental surgeons for diagnosis and early referrals to specialized centers for oral pathology. For a detailed study, this review will consist of three parts: the first is on "malignant bone tumors", included among these are: osteosarcoma, Ewing's sarcoma, Hodgkin's lymphoma, non-Hodgkin's lymphoma, Langerhans cell histiocytosis and fibrosarcoma.

Human papilloma virus and oral cancer: narrative review of the literature / Virus papiloma humano y cáncer oral: revisión narrativa de la literatura

The Human Papilloma Virus (HPV) infection is now more common sexually transmitted diseases, with an incidence of 5.5 million worldwide, with 85 percent of the carrier of this virus adult population. Their oncogenic potential and increased oral lesions associated with oral HPV infection have led us to make a narrative of the literature on the role of HPV in oral cancer, especially types 16 and 18. Here we refer to the possible routes of infection, oncogenic mechanisms, both benign and potentially malignant oral lesions associated with the infection, different methods used for detection, prediction and prevention of infection. We stress the importance of the role of the dentist to identify individuals considered high risk and ease of performing detection in the oral cavity, through a quick and easy method as exfoliative cytology.

El Virus Papiloma Humano (VPH) en la actualidad constituye la infección por transmisión sexual más frecuente, presentando una incidencia de 5,5 millones en el mundo, siendo un 85 por ciento de la población adulta portadora de este virus. Su potencial oncogénico y el aumento de lesiones orales asociadas a infección oral por VPH nos han llevado a realizar una narración de la literatura referente al rol del VPH en el cáncer oral, especialmente de los subtipos 16 y 18. Nos referiremos a sus posibles vías de contagio, mecanismos oncogénicos, lesiones orales tanto benignas como potencialmente malignas asociadas a su infección, diferentes métodos utilizados para su detección, pronóstico y prevención de contagio. Destacamos la importancia del rol del odontólogo para identificar individuos considerados de alto riesgo y la facilidad de realizar su detección en la cavidad oral, a través de un método rápido y sencillo como es la citología exfoliativa.

Leucoplasia verrucosa proliferativa: a propósito de un caso clínico / Proliferative verrucous leukoplakia: a clinical case

La Leucoplasia Verrucosa Proliferativa (LVP) es una placa blanca, verrucosa, exofítica, de crecimiento lento, que no se desprende al raspado y que tiende a comprometer diversos sitios de la mucosa oral. Es resistente al tratamiento independiente de la terapia adoptada y presenta una alta tasa de recidiva posterior al tratamiento quirúrgico. Desde 1985, cuando fue descrita por primera vez por Hansen, hasta le fecha, se ha mantenido como una entidad patológica compleja. Reportamos un caso de una paciente de sexo femenino de 72 años de edad que consulta por una lesión blanca, verrucosa, asintomática, que no se desprende al raspado, en el borde y vientre lingual y piso de boca. Se realizaron 2 biopsias incisionales del borde lateral de la lengua. Al examen microscópico se observó en ambas biopsias un grueso revestimiento epitelial acantósico, con marcada hiperparaqueratosis, una membrana basal nítida y cambios displásicos mínimos. Al mes de realizadas las biopsias la lesión presentó recidiva, manteniendo las mismas características clínicas encontradas inicialmente. Considerando la evolución, comportamiento biológico y las características histopatológicas, la lesión se diagnosticó como una LVP. Hasta la fecha, no hay protocolo de tratamiento establecido para estas lesiones. En este caso en particular, tomando en cuenta la extensión de la lesión, los sitios comprometidos, las escasas atipias presentes al examen histopatológico, la edad y escaso nivel socioeconómico de la paciente, se decidió no realizar la remoción quirúrgica de la lesión y mantenerla en control clínico cada 3 meses. Después de varios controles realizados durante un periodo de 3 años, se observó que la lesión mantuvo sus características clínicas iniciales. Esto confirma que haber optado por un tratamiento conservador, en este caso en particular de LVP, fue la decisión correcta...

The proliferative verrucous leukoplakia (PVL) is a white plate, wart-like, exophytic , slow growth , which does not follow the scaling that tends to compromise various oral mucosal sites . It is resistent to independent therapy and has a high rate of recurrence after surgical treatment. Since 1985, when it was first described by Hansen, and to date it has remained a complex pathological disorder. We report a case of a 72-year-old female patient who complains of a white, verrucous and asymptomatic lesion. The lesion does not detach by scraping the edge, lingual belly or mouth floor. Two Incisional biopsies were performed on lateral border of the tongue. Upon microscopic examination of both biopsies, thick epithelial lining, with marked hyperparakeratosis, a basement membrane, and minimal dysplasia alterations were observed. One month following biopsies of the lesion were performed, lesion relapsed and maintained the same clinical features found initially. Considering the evolution, biological behavior and histopathological features, the lesion is diagnosed as an PVL. To date, there is no established treatment protocol for these injuries. In this particular case, taking into account the extent of the injury, compromised sites, the few atypia present histopathological examination, age and low socioeconomic level of the patient, it was decided not to perform surgical removal of the lesion and maintain clinical monitoring every 3 months. Following several examinations carried out over a three-year period, it was observed that the injury kept initial clinical features. This confirms that having opted for conservative treatment, in this particular case of PVL, was the right decision...