Oral cancer over six decades: a multivariable analysis of a clinicopathologic retrospective study

Abstract Studies have reported changes in the epidemiological profile of patients with oral cancer in recent decades, especially regarding gender and age. This study aimed to evaluate a historical series of oral malignant lesions prevalence over six decades and define characteristics associated with the occurrence, mainly, of oral squamous cell carcinoma (OSCC). A retrospective review of histopathological records from 1953 to 2019 was conducted in three oral pathology laboratories in South Brazil about age, sex, anatomical site, clinical aspect, and histopathological diagnosis. Descriptive and analytical analyses were performed comparing the histopathological diagnoses with other variables. Multivariable logistic regression was applied to determine the associated predictors of OSCC. Of the 53,065 records available in the institutions, 986 were oral malignant tumors (including all malignant neoplasms), representing 1.86% of all diagnoses. The occurrence of OSCC in the 1960's was 80.0%, decreasing over time reaching the lowest percentage of cases in the 1990's (75.8%) and significantly increasing to 88.7% in the 2010s. Females had a lower chance than males of having OSCC independently of the decade (odds ratio=0.30, p<0.001). This was the same for older individuals compared to those younger than 40 years. No interactions between sex, age, and decade were observed. The number of diagnoses of oral malignant lesions increased over time, and the occurrence of OSCC varied. Older individuals and males had higher chances of having OSCC independently of the decade. Therefore, in this study sample, no changes were observed in the epidemiological profile over the years concerning these predictors.

Resumo Alguns estudos relataram mudanças no perfil epidemiológico dos pacientes com câncer bucal nas últimas décadas, principalmente quanto ao gênero e a idade. Este estudo teve como objetivo avaliar, em uma série histórica, a prevalência de todas as lesões malignas bucais ao longo de seis décadas e definir características associadas na ocorrência, principalmente, de carcinoma espinocelular (CEC). Um levantamento retrospectivo dos registros histopatológicos de 1953 a 2019 foi realizado em três laboratórios de Patologia Bucal no Sul do Brasil em relação à idade, gênero, sítio anatômico, aspecto clínico e diagnóstico histopatológico. Análises descritivas e analíticas foram realizadas comparando-se os diagnósticos histopatológicos com as outras variáveis. A regressão logística multivariada foi aplicada para determinar os possíveis preditores associados ao CEC. Dos 53.065 prontuários disponíveis nas instituições, 986 eram tumores malignos bucais (incluindo todas as neoplasias malignas), representando 1,86% de todos os diagnósticos. A ocorrência de CEC na década de 1960 foi de 80,0%, diminuindo ao longo do tempo, atingindo o menor percentual de casos na década de 1990 (75,8%) e aumentando significativamente para 88,7% na década de 2010. As mulheres tiveram menor risco de desenvolver CEC do que os homens, independentemente da década (OR=0,30, p<0,001). Este foi o mesmo para indivíduos com idade mais avançada em comparação com aqueles com menos de 40 anos de idade. Não foram observadas interações entre gênero, idade e década. O número de diagnósticos de lesões malignas bucais aumentou ao longo das décadas e a ocorrência de CEC variou. Indivíduos com mais de 40 anos e do sexo masculino tiveram maiores chances de ter CEC, independentemente da década analisada. Portanto, nessa amostra estudada, não foram observadas mudanças no perfil epidemiológico ao longo dos anos com relação a esses preditores.

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

Abstract Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

Transmission electron microscopy in oral cytopathology: a pilot study / Microscopia eletrônica de transmissão em citopatologia bucal: um estudo piloto

Introduction: Cytopathology is a collection method that allows cell analysis through the different techniques. The oral mucosa exfoliated cells observation demonstrates morphological, biochemical and/or molecular aspects depending on the type of processing of the sample. Aim: This study tested the use of oral cytopathology associated with transmission electron microscopy (TEM) to observe the morphology of cells, mainly in relation to the cell nucleus, the cytoplasmic membrane, and cell junctions. Materials and Methods: Exfoliated epithelial cells from the oral mucosa were analyzed by TEM from individuals exposed to tobacco and alcohol, with leukoplakia or with a histopathological diagnosis of squamous cell carci-noma. Results: The cytoplasmic cell-cell junctions in the malignant samples lost the characteristic irregular pattern formed by the numerous interdigitations and the junctional process of normal cells and started to present a straight cytoplasmic surface. The nuclei of cells from leukoplakia and squamous cell carcinoma samples showed heterogeneous staining, while non-lesional cells were homogeneous. Discussion: The analysis of oral cytopathological smears by TEM contributes to the un-derstanding of the changes that occur during the process of malignancy of the oral mucosa, especially with regard to the cytoplasmic membrane and intercellular junctions. Conclusion: TEM may be a good analytical method to investigate morphological changes in exfoliated cells of the oral epithelium.

Introdução: A citopatologia é um método de coleta que permite a análise celular por meio de diferentes técnicas. A observação das células esfoliadas da mucosa bucal demonstra aspectos morfológicos, bioquímicos e/ou moleculares dependendo do tipo do processamento empregado. Objetivo: Este estudo testou o emprego da técnica de citopatologia bucal associada à microscopia eletrônica de transmissão (MET) para observar a morfologia das células, principalmente com relação à membrana citoplasmática, as junções celulares e ao núcleo da célula. Materiais eMétodos: Células epiteliais esfoliadas da mucosa bucal foram analisadas por MET de indivíduos expostos a tabaco e álcool, apresentando leucoplasia ou com diagnóstico de carcinoma espinocelular. Resultados:As junções citoplasmáticas célula-célula nas amostras malignas perderam o padrão irregular característico formado pelas inúmeras interdigitações e o processo juncional das células normais e passaram a apresentar uma superfície citoplasmática reta. O núcleo das células das amostras de leucoplasia e do carcinoma espinocelular apresentou coloração heterogênea, enquanto as células não lesionais foram homogêneas. Discussão: A análise de esfregaços citopatológicos bucais por MET contribui para o entendimento das alterações que ocorrem durante o processo de malignidade da mucosa bucal, principal-mente no que diz respeito à membrana citoplasmática e as junções intercelulares. Conclusão: A MET pode ser um bom método analítico para investigar alterações morfológicas em células esfoliadas do epitélio bucal.

Fibroma ossificante trabecular juvenil: um relato de caso / Juvenile ossifying fibroma: a case report

Objetivo: o fibroma ossificante trabecular juvenil (FOJT) é uma lesão fibro-óssea incomum, benigna, porém de comportamento agressivo. Ocorre, frequentemente, em crianças e adolescentes, com maior acometimento em maxila e mandíbula. O presente relato aborda os aspectos clínicos, imaginológicos, histopatológicos, imuno-histoquímicos e o tratamento de um caso de FOTJ. Além de discutir suas similaridades com o osteossarcoma de baixo grau e as alternativas para o seu diagnóstico. Relato de caso: paciente do sexo masculino, com 12 anos de idade, apresentando aumento de volume em mandíbula no lado esquerdo, perda de função mastigatória e de fala, com tempo de evolução de seis meses. Radiograficamente, a lesão apresentava aspecto unilocular, com limites definidos e de padrão misto. O tratamento consistiu em cirurgia de enucleação total da lesão, seguida de curetagem sob anestesia geral. A histopatologia e a ausência de marcação para MDM2 e CDK4 na imuno-histoquímica confirmaram o diagnóstico de FOTJ e excluíram o de osteossarcoma de baixo grau. No controle pós-operatório de 20 dias, o paciente relatou melhora da parestesia, da função mastigatória e da fala e ausência de dor. Não se observou recidiva no acompanhamento de 1 ano após a cirurgia. Considerações finais: a similaridade dos aspectos clínico, imaginológico e microscópico entre FOJT e osteossarcoma de baixo grau pressupõe o estudo imuno-histoquímico com os arcadores MDM2 e CDK4, minimizando equívocos no diagnóstico e orientando de forma mais eficiente o plano de tratamento adotado.(AU)

Objective: juvenile Trabecular Ossifying Fibromas (JTOF) are uncommon benign fibro-osseous lesions with a local aggressive behavior. They frequently occur in children and adolescents involving the jaw bones. This report addresses the clinical, imaging, histopathological, and immunohistochemical aspects and the treatment of a case of JTOF. In addition, it discusses similarities between JTOF and low-grade osteosarcomas and alternatives for their diagnosis. Case report: male patient, 12 years old, with a tumor in his left mandible, loss of masticatory function and speech, with a 6-month time course. Radiographically, the lesion had an unilocular aspect, with defined borders and a mixed image pattern. Treatment consisted surgical enucleation, followed by bone curettage, under general anesthesia. Histopathology presented fibrous stroma interspaced with bone trabeculae without signs of cellular malignancy. MDM2 and CDK4 markers in immunohistochemistry, confirmed the diagnosis of JTOF and excluded low-grade osteosarcoma. At the 20-day postoperative follow-up, the patient reported improvement in paresthesia, masticatory function and speech, and the absence of pain. Evaluation 1 year after surgery showed no signs of local recurrence. Final considerations: the similarity of clinical, imaging, and microscopic aspects between JTOF and low-grade osteosarcoma prompts an immunohistochemical study including MDM2 and CDK4 markers in order to improve final diagnosis and guide the treatment plan more efficiently.(AU)

An analysis of the completeness of referral forms and cases evaluated by an oral medicine specialized service

Introduction: Oral lesions are present in approximately 30% of the population worldwide. Although the mouth is an anatomical region that can be easily accessed for direct visual examination, most dentists of dental surgeons have reported difficulties in the diagnosis and management of oral diseases. The primary aim of this study was to assess the completeness of referral forms of the patients referred by dentists from the primary care basic health units to an Oral Medicine service. The secondary aim was to analyze if the complexity of the cases justify the referral to a specialist. Methods: Data from 131 referral forms of patients referred from June 2014 to April 2016 were retrieved from the records. The referral's completeness analysis comprised two stages. Stage 1 mainly comprised patient and applicant's information. In the Stage 2, the documents were scored according to amount of information, including the description of the lesion characteristics and the procedures required for the patients' diagnosis and management. The referral was considered justifiable if some procedures not available at primary care were required for diagnosis or treatment. Results: Five (9.8%) referral forms were considered well filled. Diagnosis agreement was 71.4%. Regarding the need of referral, 40,6% of the cases (n = 50) could be settle at the primary care. Conclusion: In conclusion, few referral forms had high-quality information and the many cases could be managed at primary care health services. (AU)

Effects of diabetes and hypertension on oral mucosa and tgfß1 salivary levels

Abstract The aim of this study was to investigate salivary levels of TGFβ1 and proliferation/ maturation of epithelial mucosa cells in diabetic and hypertensive patients. Design: in this cross-sectional study, whole stimulated saliva and oral mucosa exfoliative cytology specimens were collected from 39 patients that were healthy (control, n=10) or presented history of arterial hypertension (HAS, n=9), diabetes mellitus (DM, n=10) or both (DM+HAS, n=10). Salivary flow rate (SFR), TGFβ1 level in saliva, AgNORs and the epithelial maturation were evaluated. Non-parametric Kruskal-Wallis test, followed by Dunn's multiple comparison post-test and the Spearman test correlation analysis were used. SFR showed a significant decreased in DM and DM+HAS (0.47±0.11 and 0.64±0.43 mL/min) when compared to control (1.4±0.38 mL/min). DM+HAS presented the highest value of TGFβ1 concentration (24.72±5.89 pg/mL). It was observed a positive correlation between TGFβ1 and glycaemia (R=0.6371; p<0.001) and a negative correlation between TGFβ1 and saliva (R=-0.6162; p<0.001) and glycaemia and SFR (R=-0.5654; P=0.001). AgNORs number and status of maturation of mucosa cells were similar for all conditions. DM and DM+HAS presented the lowest SFR, which correlated with increased TGFβ1 levels. Despite the higher TGFβ1 secretion it was not observed changes in the morphology or proliferation of epithelial cells when diabetes or hypertension was present.

Resumo O objetivo deste estudo foi investigar os níveis de TGFβ1 na saliva e a proliferação/maturação das células epiteliais da mucosa em paciente diabéticos e hipertensos. Neste estudo transversal, saliva estimulada e amostras de citologia exfoliativa de mucosa oral foram coletadas de um total de 39 pacientes que se apresentavam saudáveis (controle, n=10) ou com história de hipertensão arterial (HAS, n=9), diabetes mellitus (DM, n=10) ou ambos (DM+HAS, n=10). Taxa de fluxo salivar (SFR), níveis de TGFβ1 na saliva, AgNORs e maturação epitelial foram avaliados. Teste não-paramétrico de Kruskal-Wallis, seguido de comparação múltipla de Dunn e correlação de Spearman foram utilizados para as análises. SFR diminuiu significantemente em DM e DM+HAS (0,47±0,11 e 0,64±0,43 mL/min) quando comparado ao controle (1,4±0,38 mL/min). DM+HAS apresentou os maiores valores de concentração de TGFβ1 (24,72±5,89 pg/mL). Foi observada uma correlação positiva entre TGFβ1 e glicemia (R=0,6371; p<0,001) e uma correlação negativa entre TGFβ1 e saliva (R=-0,6162; p<0,001) e glicemia e SFR (R=-0,5654; p=0,001). Número de AgNORs e o padrão da maturação das células epiteliais foram similares entre os todos grupos. DM e DM+HAS apresentaram os menores valores de SFR, os quais foram correlacionados com o aumento nos níveis de TGFβ1. Apesar da maior secreção de TGFβ1, não foram observadas mudanças na morfologia ou proliferação das células epiteliais quando o paciente apresentava diabetes ou hipertensão.

Analysis of the Epithelium-Mesenchymal Transition Process on Oral Squamous Cell Carcinomas

Abstract The aim of this study is to evaluate the immunohistochemical expression of E-cadherin, N-cadherin and Bmi-1, and their association with clinical parameters and with the degree of histopathological differentiation in oral squamous cell carcinomas. 65 squamous cell carcinoma samples were used for constructing a tissue microarray block, and then immunohistochemistry was performed for different markers. A semi-quantitative analysis of the amount of positive tumor cells was performed by two blind and calibrated observers (Kappa>0.75). The statistical Mann-Whitney and Kruskal-Wallis tests were used to evaluate the data. The correlation between variables was investigated by the Spearman test, and the significance level set at p<0.05. We observed higher expression of Bmi-1 in tumors located in the palate (p<0.0001). In addition, poorly differentiated tumors had a greater amount of Bmi-1 positive cells (p=0.0011). Regarding the other correlations between variables, no significant associations were detected. In conclusion, poorly differentiated squamous cell carcinomas located in the palate have higher immunostaining of Bmi-1, which can characterize activation of the Epithelial-Mesenchymal Transition process in these tumors.

Resumo O objetivo deste estudo foi avaliar a associação entre a expressão imunoistoquímica de E-caderina, N-caderina e Bmi-1, com os parâmetros clínicos e o grau de diferenciação em carcinomas espinocelulares bucais. Sessenta e cinco amostras foram selecionadas para a construção de um bloco de microarranjo tecidual, e a técnica de imunoistoquímica foi realizada para os diferentes marcadores. Uma análise semi-quantitativa das células tumorais positivas foi realizada por dois observadores calibrados e cegos (Kappa>0.75). Os testes estatísticos Mann-Whitney e Kruskal-Wallis foram utilizados para a análise dos dados e a correlação entre as variáveis foi investigada com o teste de Spearman. O nível de significância foi determinado em p <0.05. Observamos maior expressão de Bmi-1 em tumores localizados em palato (p <0.0001). Além disso, tumores pobremente diferenciados apresentaram maior quantidade de células positivas para Bmi-1 (p=0.0011). Não encontramos outras correlações ou associações significativas. Em conclusão, carcinomas espinocelulares pobremente diferenciados e localizados no palato apresentam maior marcação imunoistoquímica de Bmi-1, o que pode caracterizar a ativação do processo de transição epitélio-mesênquima nesses tumores.

Cell proliferation markers at the invasive tumor front of oral squamous cell carcinoma: comparative analysis in relation to clinicopathological parameters of patients

Abstract Objectives To evaluate the number of AgNORs per nucleus and the expression of Ki-67 at the tumor invasion front (TIF) in relation to clinical parameters (TNM), TIF classification and the prognosis of oral squamous cell carcinomas in an Uruguayan population. Material and Methods This study was conducted through a retrospective survey from 2000 to 2010 at the National Institute of Cancer Montevideo, Uruguay and included 40 patients. The samples were obtained from the resection of the tumor and the TIF was defined according with Bryne, et al.5 (1992). Expression of Ki-67 was assessed by the percentage of positive tumor cells and the AgNOR was recorded as the mean AgNOR (mAgNOR) and the percentage of AgNOR per nucleus (pAgNOR). All analyzes were performed by a blinded and calibrated observer. Results No statistically significant association was observed between immunostaining of Ki-67 and AgNOR with the different types of TIF, regional metastasis and patients prognosis, however it was observed an increase in Ki-67 expression associated with worse patient's clinical staging, although not statistically significant. Conclusions Our results suggest that proliferation markers as AgNOR and Ki-67 are not prognostic markers at the tumor invasive front of carcinoma of oral squamous cell.

Optimizing Fixation Protocols to Improve Molecular Analysis from FFPE Tissues

Abstract Most Departments of Pathology around the world have a considerable archive of formalin-fixed paraffin-embedded (FFPE) tissue suitable for molecular assessment. This article points out the potential DNA damage that may occur if basic steps are not followed during processing and storage of these samples. Furthermore, it hopes to establish parameters to optimize quality and quantity of DNA extracted from FFPE tissues.

Resumo A maioria dos Departamentos de Patologia em todo o mundo têm um considerável acervo de tecidos embebidos em parafina e fixados em formalina, que são passíveis para análises moleculares. Este artigo apresenta os danos ao DNA que podem ocorrer se passos básicos não forem seguidos durante o processamento e armazenamento destas amostras. Além disso, procura estabelecer parâmetros para otimizar a qualidade e quantidade do DNA extraído de tecidos FFPE.

Expression of E-cadherin and involucrin in leukoplakia and oral cancer: an immunocytochemical and immunohistochemical study

Abstract To assess the immunocytochemical and immunohistochemical correlation of adhesion (E-cadherin) and cell differentiation (involucrin) molecules in oral leukoplakia and oral squamous cell carcinoma. Cytological samples and biopsies were obtained from male and female patients aged over 30 years with oral leukoplakia (n = 30) and oral squamous cell carcinoma (n = 22). Cell scrapings and the biopsy were performed at the site of the lesion and histological slides were prepared for the immunocytochemical analysis of exfoliated oral mucosal cells and for the immunohistochemical analysis of biopsy tissues using E-cadherin and involucrin. Spearman’s correlation and kappa coefficients were used to assess the correlation and level of agreement between the techniques. Immunostaining for E-cadherin and involucrin by both techniques was similar in the superficial layers of the histological sections compared with cell scrapings. However, there was no statistical correlation and agreement regarding the immunocytochemical and immunohistochemical expression of E-cadherin and involucrin in oral leukoplakia (R = 0.01, p = 0.958) (Kappa = 0.017, p = 0.92) or in oral squamous cell carcinoma (R = 0.26, p = 0.206) (Kappa = 0.36, p = 0.07). The immunoexpression of E-cadherin and involucrin in tissues is consistent with the expression patterns observed in exfoliated oral mucosal cells, despite the lack of a statistically significant correlation. There is an association of the histopathological characteristics of leukoplakia with the expression E-cadherin and of the microscopic aspects of oral squamous cell carcinoma with immunohistochemical expression of involucrin.

Seminário de Integração como Dispositivo Pedagógico de Inovação Curricular no Ensino da Saúde: a Percepção do Estudante sobre o Paciente / Integration Seminars as Pedagogical Devices for Curricular Innovation in Health Education: Student Perceptions of Patients

RESUMO Pesquisa exploratória documental de abordagem qualitativa cujo objetivo foi compreender como está se constituindo a formação do estudante de Odontologia em relação ao cuidado em saúde, a partir de uma atividade de ensino interdisciplinar ocorrida no segundo ano da formação do cirurgião-dentista. Foi realizado um levantamento retrospectivo do material produzido pelos estudantes do terceiro semestre do curso de Odontologia da Universidade Federal do Rio Grande do Sul, no Seminário de Integração IV, de 2006 a 2013. O corpus de análise foi formado por relatos de acompanhamento de pacientes e narrativas. Foram analisados 95 relatos de casos de pacientes e 67 narrativas pelo método da análise temática de conteúdo de Bardin. A análise do material resultou em 17 unidades de significação/categorias emergentes. A inclusão das narrativas no Seminário de Integração como estratégia metodológica de ensino na saúde trouxe a qualificação dos relatos e aproximou os estudantes do ser humano a ser cuidado, passando por sua queixa principal, história de vida e subjetividades. Currículos inovadores e integrados na área da saúde devem ser acompanhados permanentemente com base na experiência concreta nesta e em outras instituições de educação superior do País.

ABSTRACT This documentary exploratory research project with a qualitative approach aimed to understand how dental students are being trained in terms of healthcare, by means of an interdisciplinary teaching activity held in the second year of dental school. A retrospective survey was performed from the material produced by the students during the third semester of the dentistry course at the Federal University of Rio Grande do Sul, by means of the IV Integration Seminar held in 2006-2013. The analysis corpus consisted of reports featuring patient monitoring and narratives. We analyzed 95 patient case reports and 67 narratives using the thematic analysis method on Bardin content. Analysis of the material resulted in 17 meaning units/emerging categories. The inclusion of narratives in the Integration Seminar as a methodological strategy for health education facilitated the qualification of reports and brought students closer to the human beings under care, by means of exposing the students to the patients’ chief complaint, life history and subjective factors. The specific experiences of this study as well as those of other Brazilian educational institutions suggest that innovative and integrated curricula in the healthcare field must be implemented on a permanent basis.

Influence of factors in the oral mucosa maturation pattern: a cross-sectional study applying multivariate analyses

Aim: To evaluate the association between oral health status, socio-demographic and behavioralfactors with the pattern of maturity of normal epithelial oral mucosa. Methods: Exfoliative cytologyspecimens were collected from 117 men from the border of the tongue and floor of the mouth onopposite sides. Cells were stained with the Papanicolaou method and classified into: anucleated,superficial cells with nuclei, intermediate and parabasal cells. Quantification was made by selectingthe first 100 cells in each glass slide. Sociodemographic and behavioral variables were collected froma structured questionnaire. Oral health was analyzed by clinical examination, recording decayed,missing and filled teeth index (DMFT) and use of prostheses. Multivariable linear regression modelswere applied. Results: No significant differences for all studied variables influenced the patternof maturation of the oral mucosa except for alcohol consumption. There was an increase of cellsurface layers of the epithelium with the chronic use of alcohol. Conclusions: It is appropriate to usePapanicolaou cytopathological technique to analyze the maturation pattern of exposed subjects,with a strong recommendation for those who use alcohol - a risk factor for oral cancer, in which achange in the proportion of cell types is easily detected.

Agreement between clinical and histopathologic diagnoses and completeness of oral biopsy forms

Abstract The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.

Cell phone radiation effects on cytogenetic abnormalities of oral mucosal cells

The aim of this study was to evaluate the effects of exposure to cell phone electromagnetic radiation on the frequency of micronuclei, broken eggs cells, binucleated cells, and karyorrhexis in epithelial cells of the oral mucosa. The sample was composed of 60 cell phone users, who were non-smokers and non-drinkers, and had no clinically visible oral lesions. Cells were obtained from anatomical sites with the highest incidence of oral cancer: lower lip, border of the tongue, and floor of the mouth. The Feulgen reaction was used for quantification of nuclear anomalies in 1,000 cells/slide. A slightly increase in the number of micronucleated cells in the lower lip and in binucleated cells on the floor of the mouth was observed in individuals who used their phones > 60 minutes/week. The analysis also revealed an increased number of broken eggs in the tongue of individuals owning a cell phone for over eight years. Results suggest that exposure to electromagnetic waves emitted by cell phones can increase nuclear abnormalities in individuals who use a cell phone for more than 60 minutes per week and for over eight years. Based on the present findings, we suggest that exposure to electromagnetic radiation emitted by cell phones may interfere with the development of metanuclear anomalies. Therefore, it is demonstrated that, despite a significant increase in these anomalies, the radiation emitted by cell phones among frequent users is within acceptable physiological limits.

Exame das mucosas: uma responsabilidade profissional que pode salvar vidas / Oral mucosa examination: a professional responsibility that may save lives

Considerando-se o processo de diagnóstico ampliado em saúde, na primeira consulta odontológica, assim como nas consultas de manutenção é de extrema importância que o profissional, após adequada entrevista com o paciente, ao proceder o exame físico, realize o exame das mucosas. Esse ato tem por objetivo inspecionar todas as áreas de tecidos moles intrabucais, em busca de alterações da normalidade. Paralelamente, a inspeção de tecidos duros é realizada. Os achados mais frequentes no exame das mucosas incluem pequenas alterações anatômicas ou lesões benignas. Entretanto, apesar de, na maioria das vezes, o exame de mucosas apontar para a necessidade de acompanhamento de lesões, essa é a principal manobra para a prevenção de câncer de boca. Em que se pese a baixa prevalência do câncer de boca, quando o diagnóstico não é prontamente realizado, a evolução da doença pode inclusive levar o indivíduo à morte. Assim, o presente texto tem por objetivo alertar os profissionais da odontologia e motivá-los a efetivamente realizar o exame das mucosas como rotina. Essa prática, além de ampliar o espectro de atuação profissional, pode salvar vidas

Considering the comprehensive diagnostic process in health, in the first dental appointment, as well as in the maintenance visits, it is of extreme importance that the professional, after thorough interview with the patient, during the physical examination, perform oral mucosal exam. This has the aim of inspecting all intraoral soft tissues searching for normality alterations. Additionally, hard tissue inspection is performed. The most frequent findings in oral mucosal examination include anatomic alterations or benign lesions. However, despite the fact that, most of the time, oral mucosal examination points to the necessity of observation of lesions, this is the main approach for prevention oral cancer. Even though oral cancer has a low prevalence, when the diagnosis is not promptly performed, the evolution of the disease may lead to death. Therefore, the present text has the aim of alerting dental practitioners, as well as motivating them to effectively perform oral mucosal examination as routine. This broadens the spectrum of professional roles as well as may save lives

A 10-year study of specimens submitted to oral pathology laboratory analysis: lesion occurrence and demographic features

The purpose of the present paper was to describe the range of lesions histologically diagnosed in an oral pathology laboratory in southern Brazil. A retrospective study of 8,168 specimen analyses recorded between 1995 and 2004 was conducted. The records were retrieved from the Oral Pathology Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, RS, Brazil. A total of 6,831 valid cases (83.63%) were examined. Of these, inflammatory lesions were the most common occurrences (n = 4,320; 63.24%). Benign and malignant tumors accounted for 7.66% (n = 523) and 1.9% (n = 130) of the occurrences, respectively. Significant associations were observed between nonneoplastic proliferative disorders and benign mesenchymal tumors in females, and between squamous cell carcinoma and leukoplakia in males. Most diagnoses were benign in nature and had an inflammatory etiology. The association of some demographic characteristics with the occurrence of lesions suggests that these characteristics should be considered in performing differential diagnoses.

Expression of the cell cycle regulation proteins p53 and p21WAF1 in different types of non-dysplastic leukoplakias

OBJECTIVES: The aim of this study was to analyze the immunolabeling of two cell cycle protein regulators, p53 and p21WAF1, in non-dysplastic leukoplakias with different epithelial alterations: acanthosis, hyperkeratosis and acanthosis combined with hyperkeratosis, and compare them with dysplastic leukoplakias. MATERIAL AND METHODS: This was a prospective cohort study involving 36 patients with oral homogeneous leukoplakias. excisional biopsies were performed and the patients remain under clinical follow-up. The leukoplakias were divided into four groups: 6 acanthosis, 9 hyperkeratosis, 10 acanthosis combined with hyperkeratosis, and 11 epithelial dysplasias. Paraffin-embebeded sections were immunostained for p53 and p21WAF1. Five hundred cells from the basal layer and 500 from the parabasal layer were counted to determine the percentage of positive cells. A qualitative analysis was also carried out to determine the presence or absence of immunohistochemical staining in the intermediate and superficial layers. Groups were compared with ANOVA (p<0.05). Pearson's correlation coefficient was used to test for associations between the two markers, p53 and p21WAF1. RESULTS: No leukoplakia recurred and no malignant transformation was observed whitin a follow-up period of 3-6 years. The mean percentage of p53 staining in the basal and parabasal layers was similar in all groups. p21WAF1 staining differed between layers was as follows: in the basal, only 3 to 4% of cells were stained, while in the parabasal, between 16 and 28% of the epithelial cells were stained in the four different studied groups with no statistically significant difference (p>0.05). CONCLUSIONS: Our findings failed to differentiate the non-dysplastic lesions by means of p53 and p21WAF1 immunostaining, notwithstanding similar profiles between non-dysplastic and dysplastic leukoplakias were observed.

Definição do grupo de risco para leucoplasias bucais: estudo retrospectivo entre os anos de 1999 e 2009 / Definition of risk group for oral leukoplakia: retrospective study between the years 1999 and 2009

Objetivo: Definir o perfil do grupo de risco para leucoplasias bucais a partir do banco de dados dos casos diagnosticados no Laboratório de Patologia Bucal da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul no período 1999 a 2009. Metodologia: O estudo foi baseado nas fichas de biópsia do arquivo do Laboratório de Patologia da Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul. Os dados dos 177 casos foram tabulados no programa SPSS 14.0®; realizou-se a análise descritiva e aplicou-se o teste estatístico qui-quadrado (x²) com nível de significância de 5%, a fim de se verificar possíveis relações estatísticas entre as variáveis. Resultados: Ao correlacionar a variável localização anatômica e diagnóstico histopatológico e localização anatômica e idade, obteve-se significância estatística. A maior prevalência das lesões encontra-se entre a quinta e a sexta décadas de vida. Conclusão: O grupo de risco para leucoplasias está entre a quinta e sexta décadas de vida, localizadas na gengiva inserida, e a característica histológica mais encontrada foi de hiperplasia epitelial com hiperceratose.

Cisto periodontal lateral - relato de caso e revisão de literatura / Lateral periodontal cyst - case report and literature review

Introdução: O cisto periodontal lateral é um tipo de cisto odontogênico, de etiologia desconhecida, cuja prevalência na população não é frequente. Essa lesão ocorre geralmente na região de pré-molares inferiores, é assintomática e, em alguns casos, ocasiona expansão da cortical óssea. Radiograficamente, apresenta radio-lucidez unilocular bem definida. Objetivo e relato de caso: Este estudo tem por objetivo relatar o caso de um paciente do gênero masculino, 44 anos de idade, que procurou atendimento com queixa de aumento de volume associado a desconforto na região do segundo pré-molar inferior direito. Após criterioso processo de diagnóstico, procedeu-se à excisão cirúrgica e o exame microscópico revelou se tratar de cisto periodontal lateral, conforme a hipótese de diagnóstico clínico prévia. Considerações finais: Esse relato de caso clínico discute a importância da utilização de um protocolo de diagnóstico diferencial para estabelecer a conduta terapêutica adequada ao paciente.

Squamous odontogenic tumor: with recurrence and 12 years of follow-up / Tumor odontogênico escamoso: com recidiva e doze anos de acompanhamento

O tumor odontogênico escamoso é uma neoplasia benigna rara que pode ser única ou múltipla. Os autores apresentam uma revisão das características clínicas, radiográficas e histopatológicas do tumor odontogênico escamoso e relatam um caso de um paciente com recidiva com acompanhamento de doze anos e discutem os critérios de diagnóstico e abordagens terapêuticas.

Squamous odontogenic tumor is a rare benign neoplasm and may affect multiple sites in the mouth. The authors review the clinical, radiographic and histopathological features of Squamous odontogenic tumor and report a case of a patient with recurrent Squamous odontogenic tumor and 12 years of followup and discuss diagnostic criteria and therapeutic approaches.