Síndrome de Jadassohn-Lewandowsky. Reporte del primer caso pediátrico en Cuba

El síndrome de Jadassohn-Lewandowsky o paquioniquia congénita tipo 1 pertenece al grupo de las enfermedades raras. A nivel mundial se han descrito hasta la fecha menos de mil casos y el que ahora se publica constituye el primer reporte en la edad pediátrica en Cuba. Es un paciente masculino, de siete años de edad ingresado en el Servicio de Clínicas Pediátricas del Hospital Pediátrico Provincial de Holguín con antecedentes de uñas amarillas e hipertróficas desde los nueve meses de edad. Al examen físico se constató la presencia de distrofia ungueal hipertrófica en las 20 uñas, queratosis folicular en codos, manos y miembros inferiores, queratodermia plantar focal y leucoqueratosis oral. Se identificó un patrón de herencia autosómico dominante. Basado en las características fenotípicas y los antecedentes familiares se clasificó el caso presentado como paquioniquia congénita tipo 1, para la cual aún no existe cura y la terapia génica se encuentra en investigación. Por lo poco común de la enfermedad y ser el primer caso en edad pediátrica en Cuba, se decidió su publicación.

Jadassohn-Lewandowsky syndrome or congenital pachyonychia type 1 belongs to the rare diseases' group. Worldwide, less than a thousand cases have been described to date and the one that is now published constitutes the first pediatric age report in Cuba. A seven-years-old male patient admitted to the Pediatric Clinic Service at the Holguín Provincial Pediatric Hospital with a history of yellow and hypertrophic nails since he was nine months old. The physical examination confirmed the presence of hypertrophic nail dystrophy in all 20 nails, keratosis follicularis on the elbows, hands and lower limbs, focal plantar keratoderma and oral leukokeratosis. An autosomal dominant inheritance pattern was identified. Based on the phenotypic characteristics and family history, the case presented was classified as congenital pachyonychia type 1, for which there is still no cure and gene therapy is under investigation. Due to the rareness of the disease and being the first pediatric age case in Cuba, its publication was decided.

Concordancia clínica e histopatológica de lesiones blancas en cavidad bucal

Introducción: Las lesiones blancas en cavidad bucal constituyen un problema de salud que responde a causas diversas y afectan a una cifra considerable de personas a nivel mundial. Las condiciones y resultados del diagnóstico clínico de las lesiones sin un basamento histopatológico solo exhiben deducciones empíricas basadas en la experiencia clínica acumulada, que pueden concordar o no con la real naturaleza de la enfermedad diagnosticada. El estudio de su concordancia permite evidenciar la certeza del diagnóstico clínico. Objetivo: Determinar la concordancia clínica e histopatológica de lesiones blancas presentes en cavidad bucal. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en 193 pacientes con lesiones blancas en cavidad bucal seleccionados mediante muestreo no probabilístico de tipo intencionado, que acudieron al Servicio de Estomatología del Policlínico Arturo Puig Ruiz de Villa del municipio Minas, provincia Camagüey, en el período comprendido de enero de 2020 a enero de 2022. Se realizó biopsia de las lesiones para correlacionar el diagnóstico clínico y el diagnóstico histopatológico. Se evaluó la concordancia de los resultados mediante el índice de Kappa. Resultados: Predominó el grupo de edades de 40-49 años, los pacientes más afectados correspondieron al sexo femenino y el color de piel blanca, la lesión que predominó fue la leucoplasia con displasia, el subsitio anatómico más afectado es la mucosa del carrillo y más de la mitad de los pacientes se relacionaron con el tabaquismo como factor de riesgo. La fuerza de concordancia de la leucoplasia fue muy buena respecto al liquen plano y la candidiasis crónica hiperplásica (buena). El carcinoma espinocelular tuvo un nivel de concordancia moderado. Conclusión: Se promediaron los resultados de concordancia para las lesiones blancas presentes en cavidad bucal en los 193 pacientes de la investigación y de manera general el estudio mostró buena concordancia.

Introduction: White lesions in the oral cavity constitute a health problem that responds to diverse causes and affects a considerable number of people worldwide. The conditions and results of the clinical diagnosis of lesions without a histopathological basis only show empirical deductions based on accumulated clinical experience, which may or may not agree with the real nature of the clinically diagnosed entity. The study of their concordance allows evidencing the certainty of the clinical diagnosis. Objective: To determine the clinical and histopathological concordance of white lesions present in the oral cavity. Methods: A cross-sectional descriptive observational study was carried out in 193 patients with white lesions in the oral cavity selected by non-probabilistic purposive sampling who attended the Department of Dentistry of the Arturo Puig Ruiz de Villa Polyclinic from January 2020 to January 2022. The lesions were biopsied to correlate the clinical diagnosis and histopathological diagnosis. The concordance of the results was evaluated using the Kappa index. Results: The predominant age group was 40-49 years, the most affected patients were female and white skin color, the predominant lesion was leukoplakia with dysplasia, the most affected anatomical subsite was the cheek mucosa and more than half of the patients were related to smoking as a risk factor. The concordance strength of leukoplakia was very good with respect to lichen planus and hyperplastic chronic candidiasis (good). Squamous cell carcinoma had a moderate level of concordance. Conclusion: The concordance results for white lesions present in the oral cavity in the 193 patients of the study were averaged and in general the study showed a good concordance.

Parámetros histomorfométricos de la mucosa bucal en pacientes portadores de leucoplasia con displasia epitelial / Histomorphometric Parameters of the Buccal Mucosa in Patients with Leukoplakia and Epithelial Dysplasia

RESUMEN Fundamento la leucoplasia es la lesión potencialmente maligna más frecuente en las membranas mucosas de la boca y se puede presentar con diferentes grados de displasia epitelial. El estudio histológico de esta lesión unido a la medición de parámetros morfométricos y estereológicos, permite la mejor comprensión de procesos tanto fisiológicos como patológicos. Objetivo: caracterizar los parámetros histomorfométricos de la mucosa bucal en pacientes portadores de leucoplasia bucal según grado de displasia epitelial. Método: se realizó un estudio de serie de casos, con el objeto de determinar indicadores morfométricos, de lesiones leucoplásicas de la mucosa oral en biopsias de pacientes atendidos en los Servicios de Anatomía Patológica y Maxilofacial del Hospital General Universitario Dr. Gustavo Aldereguía Lima, de la provincia Cienfuegos. La muestra se obtuvo por muestreo intencionado, la cual quedó constituida por 30 láminas histológicas (biopsias), distribuidas en tres grupos de diez láminas por cada grado de displasia epitelial. La variable de estudio fue la caracterización morfométrica de la leucoplasia de la mucosa oral con displasia. Se aplicó estadística descriptiva e inferencial. Resultados: predominaron tres parámetros en la clasificación de la displasia: alteración de los clavos interpapilares, hiperplasia y pérdida de la polaridad de las células basales. Se constató presencia de ortoparaqueratosis, epitelios hiperplásicos e infiltrado inflamatorio del corion, en más de la mitad de los casos. Hubo significación estadística en las relaciones que se establecieron entre la altura o profundidad de las papilas y la densidad relativa de células según grado de displasia epitelial, al aplicar la estadística inferencial. Conclusiones: predominaron tres parámetros en la clasificación de la displasia. Se constató presencia de ortoparaqueratosis, epitelios hiperplásicos e infiltrado inflamatorio del corion, en más de la mitad de los casos.

ABSTRACT Background: leukoplakia is the most frequent potentially malignant lesion in the mucous membranes of the mouth and can present with different degrees of epithelial dysplasia. The histological study of this lesion, together with the measurement of morphometric and stereological parameters, allows a better understanding of both physiological and pathological processes. Objective: to characterize the histomorphometric parameters of the oral mucosa in patients with oral leukoplakia according to the degree of epithelial dysplasia. Method: a case series study was carried out in order to determine morphometric indicators of leukoplastic lesions of the oral mucosa in biopsies of patients treated at the Pathology and Maxillofacial Anatomy services of the Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos province. The sample was obtained by intentional sampling, which was made up of 30 histological slides (biopsies), distributed in three groups of ten slides for each degree of epithelial dysplasia. The study variable was the morphometric characterization of oral mucosal leukoplakia with dysplasia. Descriptive and inferential statistics were applied. Results: three parameters prevailed in the classification of dysplasia: alteration of the interpapillary nails, hyperplasia and loss of polarity of the basal cells. The presence of orthoparakeratosis, hyperplastic epithelia and inflammatory infiltrate of the chorion was confirmed in more than half of the cases. There was statistical significance in the relationships established between the height or depth of the papillae and the relative density of cells according to the degree of epithelial dysplasia, when applying inferential statistics. Conclusions: three parameters predominated in the classification of dysplasia. The presence of orthoparakeratosis, hyperplastic epithelia and inflammatory infiltrate of the chorion was confirmed in more than half of the cases.

Variaciones celulares de la mucosa bucal en pacientes portadores de prótesis dental completa / Cellular variations of the oral mucous in patients with complete dental prosthesis i: en

Introducción: La prótesis dental completa genera una reacción tisular en el medio bucal, cuyo diagnóstico puede ser confirmado mediante el estudio citológico, que constituye una herramienta imprescindible para identificar cambios displásicos tempranos de la mucosa subprótesis. Objetivo: Identificar las posibles variaciones celulares de la mucosa bucal en pacientes portadores de prótesis completa. Métodos: Se realizó un estudio descriptivo y transversal en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, de junio de 2014 a enero de 2019, de 100 pacientes atendidos en la consulta de Prótesis Estomatológica, a los cuales se les realizó el raspado citológico de la mucosa del paladar y los rebordes para su posterior análisis microscópico según variables de interés. Para el procesamiento estadístico se empleó el porcentaje como medida de resumen y el estadígrafo de la Χ2, con un nivel de significación de 0,05. Resultados: En la serie predominaron las displasias leves (66,7 %), que resultaron más frecuentes en las edades de 20 a 39 años (12,5 %), en tanto, las moderadas y las graves figuraron principalmente en el grupo etario de 60 y más años (9,3 y 27,7 %, respectivamente). Todos los tipos de displasia primaron en los pacientes que habían portado la prótesis por más de 5 años y afectaron mayormente la queratina; de igual modo, entre las lesiones observadas, la estomatitis afectaba a un mayor porcentaje (31,2), sobre todo en el paladar (82,3 %), mientras que 8,3 % correspondió a la leucoplasia. Conclusión: Las pruebas citológicas son imprescindibles para la confirmación diagnóstica de cambios displásicos y posibilitan la prevención temprana del cáncer bucal.

Introduction: The complete dental prosthesis generates a tisular reaction in the oral cavity which diagnosis can be confirmed by means of citological study that constitutes an indispensable tool to identify early dysplastic changes of the subprosthesis mucous. Objective: To identify the oral possible cellular variations of the oral mucous in patients with complete prosthesis. Methods: A descriptive and cross sectional study was carried out in Mártires del Moncada Provincial Stomatological Clinic of Santiago de Cuba, from June, 2014 to January, 2019, with 100 patients, assisted in the Stomatological Prosthesis Department to whom the cytological scrapings of the palate and the edges were carried out for their later microscopic analysis according to variables of interest. For the statistical procedures, the percentage was used as summary measure and the Chi squared statistician, with a significance level of 0,05. Results: In the series the mild dysplasias prevailed (66,7%) that were more frequent in the 20 to 39 age group (12,5%), while the moderate and the serious dysplasias figured mainly in the age group of 60 and over (9,3 and 27,7%, respectively). All the dysplasia types prevailed in the patients that had carried the prosthesis for more than 5 years and they mostly affected the keratin; in a same way, among the observed lesions, the stomatitis affected a higher percentage (31,2), mainly in the palate (82,3%), while 8,3% corresponded to the leukoplakia. Conclusion: The cytological checkups are indispensable for the diagnostic confirmation of dysplasic changes and they allow to prevent early oral cancer.

Dysregulation in the secretion of the stress-related catecholamines in oral cancer patients: predictors and prognostic value / Desregulação da secreção das catecolaminas relacionadas ao estresse em pacientes com câncer de boca: valor preditivo e prognóstico

Introdução: Pacientes com câncer podem apresentar uma hiperativação do Sistema Nervoso Simpático (SNS). Como consequência, uma desregulação na secreção das catecolaminas relacionadas ao estresse norepinefrina (NE) e epinefrina (EPI) têm sido implicadas na progressão de alguns tipos de tumores malignos. No entanto, a associação entre os níveis sistêmicos das catecolaminas e o prognóstico do câncer, bem como seus fatores preditores são pobremente conhecidos. Pacientes e métodos: O presente estudo investigou os níveis plasmáticos de NE e EPI em 168 pacientes com carcinoma espinocelular (CEC) de boca, 70 pacientes com leucoplasia bucal e 54 voluntários saudáveis; bem como sua associação com variáveis demográficas, clínicopatológicas, biocomportamentais e psicológicas nos pacientes oncológicos. Os níveis plasmáticos de NE e EPI foram medidos por cromatografia líquida de alta eficiência com detecção eletroquímica (CLAE-ED) e o estado psicológico de humor foi avaliado pela Escala de Humor de Brunel (BRUMS). Análise de Kaplan-Meier e regressão de Cox foram usadas para investigar as associações entre os níveis de NE e EPI e a sobrevida global e específica após 5 anos de follow-up em 82 pacientes com câncer de boca. Os níveis sistêmicos das catecolaminas também foram avaliados em 32 pacientes após o tratamento da doença e comparados com os níveis pré-tratamento. Resultados: As concentrações plasmáticas de NE e EPI foram significativamente maiores em pacientes com CEC de boca em comparação aos pacientes com leucoplasia bucal (p< 0,0001 e p=0,024, respectivamente). Os pacientes com CEC de boca também apresentaram níveis plasmáticos de NE mais elevados do que os voluntários saudáveis (p= 0,0002). As concentrações plasmáticas de NE nos pacientes com leucoplasia bucal foram menores do que os voluntários saudáveis (p= 0,032). Análises de regressão múltipla mostraram que níveis aumentados de NE foram significativamente associados com uma sensação de "sentir-se sem energia", um descritor medido pelo BRUMS (OR= 2,9; p= 0,023). Baixa escolaridade e ocorrência de comorbidades com maior severidade foram independentemente associados a altos níveis de EPI (OR= 4,0; p= 0,004 e OR= 7,2; p= 0,005; respectivamente). Além disso, a presença de um estado de humor de raiva e "não estar em alerta" foram associados a altos níveis plasmáticos de EPI (OR= 2,6; p= 0,039 e OR= 3,2; p= 0,010, respectivamente). Os resultados mostraram que os pacientes com CEC de boca não casados e que tinham pior renda familiar foram preditivos para menor sobrevida global dos pacientes com CEC de boca (p< 0,05). Estágio clínico avançado foi associado à diminuição da sobrevida global (HR= 5,2; p= 0,000) e específica do câncer (HR= 4,2; p= 0,000). A análise de regressão de Cox também evidenciou que níveis sistêmicos aumentados tanto de NE como de EPI foram associados à menor sobrevida global (HR= 3,4; p= 0,002 e HR= 2,8; p=0,006, respectivamente). Os pacientes com CEC de boca apresentaram níveis plasmático de NE mais baixos após o tratamento do câncer em comparação com a fase pré-tratamento (p= 0,0008). Conclusão: Os resultados do presente estudo mostram que pacientes com câncer de boca podem apresentar níveis sistêmicos elevados das catecolaminas norepinefrina e epinefrina, e que esta desregulação hormonal associada com fatores clinicopatológicos e psicológicos é preditiva para pior sobrevida global(AU)

Introduction: Cancer patients may have a hyperactivation of the Sympathetic Nervous System (SNS). Therefore, dysregulation in the secretion of the stress-related catecholamines norepinephrine (NE) and epinephrine (EPI) have been implicated in the progression of some types of cancer. However, the association between systemic levels of catecholamines and cancer prognosis, as well as its predictors, are poorly understood. Patients and methods: The present study investigated the plasma NE and EPI levels in 168 patients with oral squamous cell carcinoma (OSCC), 70 patients with oral leukoplakia and 54 healthy volunteers; as well as its association with demographic, clinicopathological, biobehavioral and psychological variables in cancer patients. Plasma NE and EPI levels were measured by high performance liquid chromatography with electrochemical detection (HPLC-ED) and psychological mood states was assessed by the Brunel Mood Scale (BRUMS). Kaplan-Meier analysis and Cox regression were used to investigate associations between the systemic levels of catecholamines and overall and specific survival after 5 years of follow-up in 82 patients with oral cancer. Systemic levels of catecholamines were also evaluated in 32 patients after oral cancer treatment and were compared with pre-treatment levels. Results: Plasma NE and EPI concentrations were significantly higher in patients with oral SCC compared to patients with oral leukoplakia (p<. 0001 and p=.024, respectively). Patients with oral SCC also displayed higher plasma NE levels than healthy volunteers (p=.0002). Patients with oral leukoplakia had lower plasma NE levels than healthy volunteers (p=.032). Multiple regression analyzes showed that increased NE levels were associated with a feeling of "no energy", a descriptor measured by BRUMS (OR= 2.9; p= .023). Low education and the occurrence of severe comorbidities were independently associated with high levels of EPI (OR= 4.0; p= .004 and OR= 7.2; p= .005; respectively). Furthermore, the presence of an angry mood state and denial of "being on alert" were associated with high EPI levels (OR= 2.6; p= .039 and OR= 3.2; p= .010, respectively). The results showed that nonmarried oral SCC patients and those who had a lower family income had lower overall survival in patients with oral SCC (p< 0.05). Advanced clinical stage was associated with decreased overall (HR=5.2; p=.000) and cancer-specific (HR=4.2; p=.000) survival. Cox regression analysis also showed that increased levels of both NE and EPI were associated with worse overall survival (HR=3.4; p=.002 and HR=2.8; p=.006, respectively). Patients with oral SCC had lower plasma NE levels after cancer treatment compared to the pre-treatment period (p=.0008). Conclusion: The results of the present study reveal that patients with oral cancer may have high systemic levels of the catecholamines norepinephrine and epinephrine, and that this hormonal dysregulation is associated with clinicopathological and psychological factors and predictive for worse overall survival(AU)

Desordenes orales potencialmente malignos-Lo que el odontólogo debe conocer / Oral potentially malignant disorders-What the dentist should know

RESUMEN Objetivo: El objetivo de este estudio es actualizar los conocimientos sobre Desordenes Orales Potencialmente Malignos, dando énfasis a datos epidemiológicos, apariencia clínica, sintomatología, diagnóstico diferencial y manejo terapéutico, así como también resaltar el rol del odontólogo general en el examen clínico. Material y métodos: Fue realizada una búsqueda de la literatura en las bases de datos científicas "Medline", "Pubmed" y "SciELO", utilizando las palabras clave "Leukoplakia", "Erythroplasia", "Cheilitis", "Nevus, Pigmented", "Oral Submucous Fibrosis", "Lichen Planus". La búsqueda fue orientada hacia artículos de revisión, estudios clínicos y reportes de caso, priorizando los artículos publicados en los últimos 5 años y sin hacer distinciones por el idioma. Resultados: Como resultado de la búsqueda se obtuvieron 165 artículos, los cuales fueron revisados cuidadosamente para conservar solo aquellos que se dedicaran a describir, comparar o tratar desordenes con potencial de malignidad, incluyendo datos de relevancia como epidemiología, apariencia clínica, sintomatología, diagnóstico diferencial y manejo terapéutico. De esta manera, el estudio se limitó a 41 artículos. Conclusiones: Al adoptar medidas preventivas, así como un meticuloso examen clínico sobre tejidos blandos, se puede facilitar la detección temprana de Desordenes Orales Potencialmente Malignos. La eliminación de lesiones sospechosas o un control de las condiciones cancerígenas puede evitar en gran mayoría el desarrollo de tumores malignos.

SUMMARY Objective: The objective of this study is to update scientific knowledge about OPMDs, emphasizing epidemiological data, clinical appearance, symptomatology, differential diagnosis and therapeutic management, as well as highlighting the role of the general dentist in the clinical examination. Material and methods: A literature search was carried out, making use of the keywords "Leukoplakia", "Erythroplasia", "Cheilitis", "Nevus, Pigmented", "Oral Submucous Fibrosis" and "Lichen Planus". Prioritizing articles published in the last 5 years on the scientific databases "Medline", "Pubmed" and "SciELO". Results: As a result of the search, 165 articles were obtained, which were carefully reviewed to preserve only those that were dedicated to describe, compare or treat lesions with malignant potential, including relevant data such as epidemiology, clinical appearance, symptomatology, differential diagnosis and management. therapeutic. In this way, the study was limited to 41 articles. Conclusions: By taking preventive measures, as well as through a clinical examination of soft tissues, early detection of potentially malignant disorders can be facilitated. The removal of suspicious lesions or a control of their carcinogenic conditions can largely prevent the development of malignant tumors.

Caracterización clinicoepidemiológica de pacientes con cáncer bucal y otras lesiones del complejo bucomaxilofacial / Clinical and epidemiological characterization of patients with oral cancer and other lesions of the bucomaxillofacial complex

Introducción: La mucosa bucal puede estar afectada por lesiones traumáticas, infecciones virales, micóticas y bacterianas, así como también por tumores benignos y malignos, malformaciones del desarrollo y enfermedades autoinmunes, genéticas y psicosomáticas, entre otras. Objetivo: Caracterizar clínica y epidemiológicamente a pacientes con cáncer bucal y otras lesiones del complejo bucomaxilofacial. Métodos: Se realizó un estudio descriptivo y transversal de 56 pacientes de ambos sexos, con alguna alteración morfológica evidente en el complejo bucomaxilofacial, atendidos en el Servicio de Estomatología del Policlínico Eduardo Mesa Llull del municipio II Frente de Santiago de Cuba, desde septiembre de 2015 hasta igual mes de 2017. Entre las variables analizadas figuraron: edad, sexo, color de la piel, localización anatómica, diagnóstico definitivo y tipo histológico. La información primaria se obtuvo de las entrevistas y de las historias clínicas. Por otra parte, se efectuó un examen físico exhaustivo y se tomó muestra para biopsia con vistas a diagnosticar las afecciones presentes. Resultados: En la casuística prevalecieron los pacientes de 35-59 años, los mestizos y el sexo femenino. Las zonas mayormente afectadas fueron la mucosa del carrillo y el labio inferior para el cáncer bucal y los rebordes alveolares residuales y la mucosa del carrillo para las otras lesiones. La leucoplasia bucal resultó el diagnóstico definitivo más común y el carcinoma epidermoide la variedad histológica preponderante. Conclusiones: La educación para la salud, la promoción y la prevención resultan primordiales en el mundo de la estomatología, de ahí que se impone evaluar y renovar los programas para que esta sea más preventiva y educacional.

Introduction: The oral mucosa can be affected by traumatic lesions, viral, fungal and bacterial infections, as well as by benign and, malignant tumors, development malformations and autoinmmune genetic and psychosomatic diseases, among others. Objective: To characterize clinically and epidemiologically patients with oral cancer and other lesions of the bucomaxillofacial complex. Methods: A descriptive and cross-sectional study of 56 patients of both sexes, with some evident morphological change in the bucomaxillofacial complex, assisted in the Stomatology Service of Eduardo Mesa Llull Polyclinic, II Frente municipality in Santiago de Cuba was carried out from September, 2015 to the same month in 2017. Among the analyzed variables there were: age, sex, skin color, anatomical localization, definitive diagnosis and histological type. The primary information was obtained from the interviews and of the medical records. On the other hand, an exhaustive physical examination was made and a sample for biopsy was taken with the aim of diagnosing the present disorders. Results: The 35-59 years patients, mestizos and the female sex prevailed in the case material. The most affected areas were the cheek mucosa and the lower lip for the oral cancer and the residual alveolar edges and the cheek mucosa for the other lesions. Oral leukoplakia was the most common definitive diagnosis and the carcinoma epidermoid the preponderant histological variety. Conclusions: Health education, promotion and prevention, are essential in the Stomatology environment, so that it is imperative to evaluate and renew programs for they to have more influence on education and prevention.

Caracterización clínico e histopatológica de la leucoplasia bucal / Clinical and histopathological description of oral leukoplakia

RESUMEN Fundamento: la detección precoz de la leucoplasia, como la lesión premaligna más común de la cavidad oral, y cuya presencia supone un marcador de aumento del riesgo de cáncer bucal, se incluye entre las nuevas perspectivas en el diagnóstico precoz de este cáncer. Objetivo: caracterizar la leucoplasia bucal. Métodos: se realizó un estudio observacional descriptivo transversal, el universo estuvo compuesto por 114 pacientes diagnosticados con leucoplasia bucal y la muestra quedó conformada por similar número de pacientes. Los datos obtenidos procedentes de las boletas de biopsia fueron recogidos en un formulario a propósito de la investigación. Resultados: predominaron los pacientes entre 50 y 59 años. El hábito de fumar se encontró en 58 pacientes mientras que el consumo de alcohol solo en 10. En los pacientes menores de 50 años la aparición de displasia estuvo influenciada por el consumo de tabaco, se encontró asociación entre el tamaño igual o mayor a tres centímetros y la aparición de manifestaciones clínicas cuando se trató de lesiones únicas. Conclusiones: en la mayoría de los pacientes estudiados se constató hábito de fumar y al examen clínico no mostraron síntomas. El tamaño se asoció a la aparición de manifestaciones clínicas en los pacientes con lesiones únicas y no así en aquellos con lesiones múltiples. En un grupo de pacientes se detectó la presencia de alteraciones microscópicas con predominio de la displasia leve.

ABSTRACT Background: early detection of leukoplakia, the most common premalignant lesion of the oral cavity, and whose presence is a marker of increased risk of oral cancer, is included among the new perspectives in the early diagnosis of this cancer. Objective: to characterize the oral leukoplakia. Methods: a cross-sectional analytical study was carried out, the universe was composed of 114 patients clinically diagnosed with oral leukoplakia and the sample was composed of equal numbers of patients. The data obtained from biopsy ballots was collected in a form about the investigation. Results: patients were predominantly between 50 and 59 years. Smoking was found in 58 patients while alcohol only in 10. In patients younger than 50 years, the development of dysplasia was influenced by the consumption of tobacco; it was found association between the size equal to or greater than three centimeters and the appearance of clinical symptoms when treated with single lesions. Conclusions: most of the studied patients had smoking habits and they were clinically asymptomatic. The size was associated with the onset of clinical manifestations in patients with single lesions and not in those with multiple injuries. In a group of patients, the presence of microscopic alterations with prevalence of mild dysplasia was detected.

Prevalência e correlação clínico-patológica dos casos de leucoplasia bucal diagnosticados no Laboratório de Histologia da ULBRA Canoas/RS / Clinical and pathological prevalence and correlation of the cases of oral leukoplakia diagnosed in the Histology Laboratory of ULBRA Canoas/RS

Purpose: To conduct an analytical cross ­ sectional study of the cases of oral leukoplakia confirmed by histopathological diagnosis by the Laboratory of Histology of ULBRA Canoas/ RS. Methodology: The present research was carried out based on the evaluation of the biopsy records, specifying cases of oral leukoplakia confirmed by histopathological analysis, during the period from January 2006 to December 2016. The statistical analysis of 59 cases was performed by the processor STATA®, Version 12.0, using the Chi-Square and Fisher Tests to obtain the bivariate analysis. Results: Individuals of the population under analysis belong more to the male gender (61.0%) and are between the fifth and sixth decades of life (82.8%). Smoking was more prevalent in men (59.9%), most of the sample did not consume alcoholic beverages (60.6%), and the association of drinking and smoking habits was present in 23.5% of the cases. Homogeneous lesions were the most prevalent (84.5%), and most histopathological diagnoses were non-dysplastic lesions (65.9%). There was an association between the severity of the histopathological diagnosis with the male gender (p = 0.026) and also between the male gender and the combination of vicious habits (p = 0.025). Conclusion: A higher histopathological severity of leukoplakias was observed in men who smoked and consumed alcoholic beverages; however, this result was not related to the clinical classification of the lesions. The results indicate the need for an adequate conduct of clinical and histopathological diagnosis, implementation of measures to qualify professionals and guide the population.

Objetivo: Realizar um estudo transversal analítico dos casos de leucoplasia bucal confirmados por diagnóstico histopatológico pelo Laboratório de Histologia da ULBRA Canoas/ RS. Metodologia: A presente pesquisa foi realizada a partir da avaliação das fichas de biópsia dos casos de leucoplasia bucal confirmados por meio de análise histopatológica durante o período de janeiro de 2006 a dezembro de 2016. A análise estatística de 59 casos foi realizada pelo processador STATA®, Versão 12.0, utilizando-se dos Testes Qui-Quadrado e Fisher para obtenção da análise bivariada. Resultados: Os indivíduos da população em análise pertencem em maior número ao gênero masculino (61,0%) e estão entre a quinta e sexta décadas de vida (82,8%). O tabagismo foi mais prevalente em homens (59,9%). A maioria da amostra não consome bebidas alcoólicas (60,6%), e a associação dos hábitos de beber e fumar esteve presente em 23,5% dos casos. As lesões homogêneas foram as mais prevalentes (84,5%), e a maioria dos diagnósticos histopatológicos foram de lesões não displásicas (65,9%). Houve associação entre a gravidade do diagnóstico histopatológico com o gênero masculino (p = 0,026) e também entre o gênero masculino e a combinação de hábitos viciosos (p = 0,025). Conclusão: Percebeu-se uma maior gravidade histopatológica das leucoplasias em homens que têm como hábito fumar e ingerir bebidas alcoólicas, embora esse resultado não tenha sido relacionado com a classificação clínica das lesões. Os resultados indicam a necessidade de uma adequada conduta de diagnóstico clínico e histopatológico, implementação de medidas que qualifiquem os profissionais e orientem a população.

Evaluación del programa de detección precoz del cáncer bucal / Assessment of the program of early detection of oral cancer

FUNDAMENTO: el Programa Nacional de Atención Estomatológica Integral a la Población contiene el Programa de Detección de Cáncer Bucal. El carcinoma de cavidad bucal es la octava causa de muerte en Cuba. OBJETIVO: evaluar el Programa de Detección Precoz del Cáncer Bucal en el servicio estomatológico del Policlínico Camilo Torres. MÉTODOS: se realizó un estudio descriptivo retrospectivo en el servicio estomatológico del Policlínico Camilo Torres Restrepo desde enero de 2012 y octubre de 2013. El universo estuvo constituido por 35 pacientes remitidos a la consulta del Programa de Detección de Cáncer Bucal. Las principales variables fueron: edad, sexo, factores de riesgo tales como el alcoholismo, tabaquismo, ingestión de café; tipo de lesión, localización de las mismas y nivel de conocimiento de los pacientes sobre el Programa de Detección de Cáncer Bucal. RESULTADOS: el sexo más afectado fue el masculino, el grupo de edad 19-59 años, la leucoplasia fue la lesión más importante, la localización de la mucosa del carrillo y el nivel de conocimiento de la población fue regular. CONCLUSIONES: el Programa de Detección de Cáncer Bucal debe incrementar su funcionalidad en nuestra área de salud y debe cumplir los objetivos para el cual fue creado.

BACKGROUND: the National Program of Comprehensive Stomatological Attention for the Population includes the Oral Cancer Detection Program. Oral cavity carcinoma is the eighth cause of death in Cuba. OBJECTIVE: to assess the Oral Cancer Detection Program in the stomatological service of the Camilo Torres Restrepo Polyclinic. METHOD: a restrospective, descriptive study was conducted in the Camilo Torres Restrepo Polyclinic from January, 2012 to October, 2013. The universe was composed of 35 patients referred to the consultation of the Oral Cancer Detection Program. The main variables were: age; sex; risk factors like alcoholism, smoking habits, and coffee consumption; type of lesion and its position; and the level of knowledge of the patients about the Oral Cancer Detection Program. RESULTS: the most affected sex was male; the most affected age group was 19-59 years old; leukoplakia was the most significant lesion; the location of the cheek mucosa and the level of knowledge of the population were regular. CONCLUSIONS: the Oral Cancer Detection Program must increase its usefulness in our health area and fulfill the objectives it was created with.

Parámetros morfométricos de la mucosa en pacientes portadores de leucoplasia bucal con displasia epitelial / Morphometric parameters of the mucosa in patients that carry oral leukoplakia with epithelial dysplasia

Fundamento: la leucoplasia bucal es la lesión premaligna más frecuente, puede presentarse con displasia epitelial, que es el rasgo más importante de sus diversos cambios histopatológicos. Los métodos morfométricos y estereológicos permiten complementar el análisis histopatológico convencional de la displasia epitelial. Objetivo: caracterizar las lesiones de la mucosa con leucoplasia bucal según grado de displasia epitelial a través de indicadores morfométricos y estereológicos. Método: se realizó un estudio observacional descriptivo. El universo lo conformaron 68 biopsias de pacientes con diagnóstico clínico e histopatológico de leucoplasia y la muestra fue de 15 biopsias de leucoplasias displásicas, en las que se analizaron parámetros morfométricos y estereológicos. Resultados: se encontró que la altura de las crestas epiteliales y la altura del epitelio aumentan a medida que avanza el grado de la displasia epitelial. El valor promedio y su desviación estándar del factor de forma en la displasia ligera fue de 0,86 ± 0,08, en la displasia moderada fue de 0,88 ± 0,09 y en la displasia severa fue de 0,85 ± 0,11. El promedio y la desviación estándar del volumen nuclear y la densidad de perfiles nucleares epiteliales descienden al aumentar la displasia. Conclusiones: a partir del análisis de las variables analizadas en esta investigación podemos sugerir el estudio y la evaluación de la posibilidad de la existencia de algún modelo de relación volumen nuclear-perfiles nucleares-altura del epitelio como instrumento para determinar el comportamiento de la displasia.

Background: oral leukoplakia is the most frequent premalignant lesion; it can appear with epithelial dysplasia that is the most important feature of its various histopathological changes. Morphometric and stereological methods allow complementing the conventional histopathological analysis of epithelial dysplasia. Objective: to characterize the lesions of the mucosa with oral leukoplakia according to the degree of epithelial dysplasia through morphometric and stereological indicators. Method: a descriptive, observational study was conducted. The universe was composed of 68 biopsies from patients with a histopathological and clinical diagnosis of leukoplakia; the sample was composed of 15 biopsies from patients with dysplastic leukoplakias in which morphometric and stereological parameters were analyzed. Results: it was found that as the degree of epithelial dysplasia becomes greater, the more the height of the epithelial crest and the height of the epithelium rise. The average value and its standard deviation of the shape factor in minor dysplasia was of 0.86 ± 0.08, in moderate dysplasia was of 0.88 ± 0.09, and in serious dysplasia was of 0.85 ± 0.11. As the dysplasia becomes greater, the average and the standard deviation of the nuclear volume and the density of epithelial nuclear profile decrease. Conclusions: from the analysis of the variables through this investigation, we can suggest the study and evaluation of the possibility of the existence of a model of nuclear volume-nuclear profile-height of the epithelium relation, as an instrument to determine the behavior of dysplasia.

Características histomorfométricas de la leucoplasia bucal homogénea / Histomorphometric characteristics of homogeneous oral leucoplakia

Se efectuó un estudio descriptivo de 35 pacientes con leucoplasia bucal homogénea asociada al tabaquismo, atendidos en la consulta de Cirugía Maxilofacial del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde enero de 2007 hasta igual mes de 2009, con vistas a determinar las características histomorfométricas de las biopsias correspondientes, lo cual podría contribuir a precisar su diagnóstico. Se realizó el examen histomorfométrico del grosor epitelial, así como también de los diámetros nuclear y citoplasmático; también se midió la densidad del infiltrado linfocitario y vascular en la lámina propia y de la hipercromatosis. Los valores más pequeños del diámetro nuclear fueron los más frecuentemente encontrados, con una fuerte asociación con el citoplasmático. Estos parámetros resultaron ser los de mayor significado para el diagnóstico de la mencionada afección.

A descriptive study of 35 patients with homogeneous oral leucoplakia associated with the smoking habit, assisted in the Maxillofacial Surgery Department of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from January, 2007 to the same month of 2009, aimed at determining the histomorphometric characteristics of the corresponding biopsies, which could contribute to specify its diagnosis. The histomorphometric examination of the epithelial thickness was carried out as well as that of the nuclear and cytoplasmic diameters; the density of the lymphocytic and vascular infiltrate was also measured in the lamina propria and in the hyperchromatosis. The smallest values of the nuclear diameter were the most frequently found, with a strong association with the cytoplasmic one. These parameters turned out to be the most significant for the diagnosis of the aforementioned disorder.

Identificación del papilomavirus humano en la leucoplasia bucal / Identification of the human papilomavirus in oral leukoplakia

Con el propósito de evaluar los resultados del diagnóstico clínico e histopatológico del papilomavirus humano asociado a la leucoplasia bucal, se efectuó un estudio descriptivo y transversal de 75 pacientes con la citada afección, tratados en la consulta estomatológica del Policlínico de Especialidades del Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde septiembre del 2009 hasta igual mes del 2012. A los afectados se le realizó biopsia para conocer la presencia de coilocitos que producían alteraciones epiteliales y del corion en el tejido lesionado, así como su localización topográfica. En la casuística prevalecieron el sexo masculino, la mucosa de carrillo como el sitio anatómico de mayor incidencia y la displasia epitelial como la más relevante. Asimismo, la pérdida de la relación núcleo-citoplasma y la hiperplasia de la capa basal fueron las alteraciones hísticas más frecuentes.

With the purpose of evaluating the results of the clinical and histopathological diagnosis of the human papilomavirus associated with oral leukoplakia, a descriptive and cross-sectional study was carried out in 75 patients with this condition, who were treated at the Stomatology Department of the Polyclinic of Specialties from "Saturnino Lora" Provincial Teaching Clinical Surgical Hospital of Santiago de Cuba, from September 2009 to the same month of 2012. Biopsies were taken from patients to detect the presence of koilocytes producing chorion and epithelial changes in damaged tissue, as well as their topographic location. Male sex, buccal mucosa as the anatomical site of highest incidence and epithelial dysplasia as the most significant prevailed in the case material. Likewise, the loss of the nuclear-cytoplasmic ratio and hyperplasia of the basal layer were the most frequent tissue alterations.

Revisión sistemática de los efectos del hábito de fumar invertido sobre la mucosa oral / Systematic revision of the effects of the reversed smoking habit on the oral mucosa

Fundamento: se ha postulado que el hábito de fumar invertido intensifica la severidad de las enfermedades de la mucosa bucal y expone a las personas a riesgos severos en la salud oral. Objetivo: revisar la literatura científica acerca de las enfermedades de la mucosa oral asociadas con el hábito de fumar invertido. Método: se realizó una revisión sistemática de investigaciones observacionales y experimentales publicadas en las bases de datos Medline-Pubmed y SCIELO desde 1960 hasta 2012. Se utilizaron términos en diferentes combinaciones: nicotinic stomatitis, reverse smoking, reverse smokers, oral cancer, oral premalignant lesions y tobacco. Se excluyeron las series de casos, resultados duplicados debido a las combinaciones de los términos de búsqueda, datos no disponibles, cartas al editor y revisiones históricas. Desarrollo: se detectó en todos los estudios revisados que el hábito de fumar invertido es más frecuente en mujeres que en hombres. Doce investigaciones mostraron asociación entre el hábito de fumar invertido y carcinoma del paladar duro o tumores microinvasivos. Se observó que los fumadores invertidos tienen muchas más probabilidades de presentar parches y áreas rojas en el paladar, además de leucoplasias y carcinomas. El riesgo estimado de presentar carcinoma del paladar duro fue 132 veces mayor en mujeres con el hábito de fumar invertido. Las tasas de mortalidad ajustadas por edad fueron casi dos veces más altas para los fumadores invertidos en comparación con aquellas personas que no fumaban. Conclusiones: el hábito de fumar invertido está asociado con el cáncer oral y con otras enfermedades avanzadas de la mucosa bucal. Se deben realizar estudios de intervención para tratar de persuadir a las poblaciones acerca del abandono de los hábitos de tabaquismo.

Background: It is been said that the reversed smoking habit intensifies the seriousness of the diseases of the buccal mucosa and put people at serious risks regarding oral health. Objective: to revise the scientific literature related to the diseases of the oral mucosa associated to reversed smoking habit. Method: a systematic revision of observational and experimental investigations published in the Medline-PubMed and SciELO data bases from 1960 to 2012 was made. Terms were used in different combinations: nicotinic stomatitis, reverse smoking, reverse smokers, oral cancer, oral premalignant lesions y tobacco. Series of cases, duplicated results due to combinations of search terms, non-available data, letters to the editor and historical revisions were excluded. Results: in all the revised studies it was revealed that reversed smoking habit is more frequent in women than in men. Twelve investigations showed association between reversed smoking habit and carcinoma of the hard palate or microinvasive tumors. It was observed that inverted smokers are at more risk of presenting blotches and red areas in the palate, as well as leukoplakias and carcinomas. The estimated risk of presenting carcinoma of the hard palate was 132 times higher in women that have the reverse smoking habit. Mortality rates set by age were almost twice higher for reverse smokers compared to non-smokers. Conclusions: reversed smoking habit is associated to oral cancer and to other advanced diseases of the buccal mucosa. Intervention studies should be conducted in order to try to persuade populations to quit smoking.

Detecção do HPV por nPCR em leucoplasias bucais: estudo caso-controle / Detection of HPV by nPCR in oral leukoplakia: case-control study

A leucoplasia bucal é considerada uma lesão cancerizável para o desenvolvimento do carcinoma espinocelular (CEC), e vários fatores de risco podem estar relacionados a essa carcinogênese, incluindo o papiloma vírus humano (HPV). Na mucosa bucal tem sido feita a associação da leucoplasia bucal com o HPV. O objetivo desse estudo foi detectar a presença do DNA do HPV em amostras de tecidos fresco, saliva, plasma e células exfoliadas orais, extraídas de pacientes com e sem leucoplasia bucal, analisadas através da técnica de nested PCR (nPCR). Para este estudo foram avaliados 32 pacientes portadores de leucoplasia bucal e 24 pacientes selecionados de forma caso-controle. Foi realizada a extração de DNA das amostras, e em seguida a sua amplificação através da PCR. A nPCR para detecção do HPV revelou a presença do vírus em 68,75% das amostras de tecido fresco, 50% no plasma, 28,1% no citobrush, 62,5% na saliva no grupo de pacientes com leucoplasia em comparação com 45,8%, 54,2%, 45,8%, 50% nas amostras de tecido fresco, plasma, citobrush e saliva do grupo controle respectivamente. Baseado no presente estudo o HPV poderia ser um co-fator etiológico na patogênese da leucoplasia oral...

The oral leukoplakia is considered as a pre-malignant lesion for the development of the oral squamous cell carcinoma, and several risk factors can be related to this carcinogenesis, including the human papillomavirus (HPV). HPV is the main cause of cervix cancer, and your role in the oral carcinogenesis is still controversial. The aims of this study was to detect the presence of HPV DNA in fresh tissue samples, plasma and oral exfoliated cells extracted from patients 32 with oral leukoplakia, and 24 controls analyzed through the technique of nPCR and make a comparison among these biological materials sources. It was performed the extraction of DNA from 37 patients with oral leukoplakia, and amplification of the human β-globin gene was carried out in all samples to confirm the presence and integrity of DNA. Nested PCR assays revealed the presence of HPV DNA in 68.75% of fresh tissue, 50.0% of plasma, 62.5% of saliva, and in 28.1% of oral exfoliated cells extracted from patients. Based on the current experiment, HPV could potentially be an etiologic co-factor in the pathogenesis of oral leukoplakia...

Leucoplasia bucal: levantamento epidemiológico dos casos encontrados no Serviço de Diagnóstico Histopatológico do Instituto de Ciências Biológicas da Universidade de Passo Fundo / Oral leukoplakia: epidemiological survey of cases found at the Histopathologic Diagnosis Service of the Institute of Biological Sciences, University of Passo Fundo

Objetivo: O presente estudo teve como objetivo realizar um estudo epidemiológico observacional transversal dos casos de leucoplasia bucal registrados no Serviço de Diagnóstico Histopatológico do Instituto de Ciências Biológicas (ICB) da Universidade de Passo Fundo (UPF).Materiais e Métodos: Foram considerados os casos diagnosticados como “leucoplasia bucal” entre os anos de 1989 e 2011. Os dados que dizem respeito à idade, sexo eraça dos pacientes, bem como os dados de localização da enfermidade na cavidade bucal foram obtidos das requisições de exame histopatológico de cada paciente. Foram observados a presença de hábitos deletérios nos pacientes acometidos e as características clínicas das lesões levantadas. Os dados coletados foram analisados por meio de estatística descritiva de frequência e expressos em tabelas e/ou gráficos, a fim de serem confrontados com os dados da literatura. Resultados e conclusão: Pôde-se inferir que a época da vida mais afetada pela leucoplasia foi a 7ª década da vida, a cor branca foi predominante, o sexo masculino o mais afetado e a região mais acometida foi a mucosa jugal na linha de oclusão. Exposição solar, trauma e fumo foram as principais causas encontradas no estudo, porém houve muitos laudos incompletos, o que leva à dúvida quanto aos demais casos (a maior parte neste estudo). O tempo de evolução das lesões foi relativamente rápido, a maioria aparecendo de 0-6 meses em boca, e normalmente assintomáticas. A coloração branca, sem presença de displasia, foi predominante e as características das lesões se assemelharam em todos os casos.

Objective: This study aimed to conduct a transversal observational epidemiological study in reported cases of oral leukoplakia in the Department of Diagnostic Histopathology of the Institute of Biological Sciences (ICB), University of Passo Fundo (UPF). Materials and Methods: We considered the cases that were diagnosed as “oral leukoplakia” between the years 1989 and 2011. The data pertaining to age, sex and race of patients, as well as the location data of the disease in the oral cavity were obtained from histopathological examination of requests for each patient. We observed the presence of harmful habits in affected patients and the clinical features of raised lesions. The collected data were analyzed using descriptive statistics and expressed as frequency tables and/or graphics in order to be compared with data found in literature. Results and conclusion: It might be inferred that the period of life most affected by leukoplakia was the 7th decade of life, was predominantly white, male sex the most affected and most affected region was the buccal mucosa in the line of occlusion. Sun exposure, smoking and trauma were the main causes in the study, but there were many reports are incomplete, which leads to doubt as to the other cases (most of this study). The time evolution of the lesions was relatively quick, most appearing tomouth from 0-6 months, and usually asymptomatic. The white color, without the presence of dysplasia was predominant and lesion characteristics were similar in all cases.

Predicción del riesgo de leucoplasia bucal en personas mayores de 60 años / Prognosis of risk for oral leukoplakia in people over 60 years

Se realizó un estudio de casos y controles, con vistas a identificar los factores de riesgo de leucoplasia bucal en personas mayores de 60 años, pertenecientes al Policlínico "30 de Noviembre" de Santiago de Cuba, desde septiembre del 2009 hasta julio del 2010. Se conformaron 2 grupos: uno de 13 integrantes con diagnóstico confirmado de esta afección (casos) y el otro con 26 de la misma comunidad (controles) que fueron seleccionados a razón de 1:2, según edad y sexo. Para determinar la asociación estadística se utilizó el odds ratio y se tuvieron en cuenta los criterios de causalidad. Los factores de riesgo asociados a la leucoplasia bucal fueron: el tabaco, la ingestión de alcohol y la presencia de bordes filosos en las prótesis.

A case-control study was carried out in order to identify the risk factors for oral leukoplakia in people over 60 years, belonging to "30 de Noviembre" Polyclinic of Santiago de Cuba from September 2009 to July 2010. Two groups were divided: one of 13 members with a confirmed diagnosis of this condition (cases) and the other with 26 of the same community (control) that were selected at a rate of 1:2, according to age and sex. To determine the statistical association odds ratio was used and criteria of causation were taken into account. Risk factors associated with oral leukoplakia were smoking habit, alcohol consumption and presence of sharp edges in the prosthesis.

Oral leukoplakia: malignant transformation after four years ofsurgical excision / Leucoplasia bucal: transformação maligna após quatro anos da excisão cirúrgica

Leukoplakia is the most prevalent precancerous lesion of the oral cavity, and given it is malignant potential, patients must periodically be followed up. The aim of this article was to report a clinical case a woman patient, alcohol abuser and smoker for over 25 years, who is an oral leukoplakia carrier. Histopathological examination indicated the presence of a moderate epithelial dysplasia while immunohistochemistry for Ki-67 and cyclin D1 revealed the presence of cellular proliferation in suprabasal layers. Therefore, the removal of the lesion with surgical laser was the elected treatment. Since then, the patient has been followed up for 3 years, however, after two sequential follow up absences, she returned with recurrence of the lesion, with a history of eight months progression. Histopathological examination revealed the presence of a well differentiated carcinoma.

A leucoplasia é a lesão cancerizável mais prevalente da boca, foi definida pela Organização Mundial de Saúde como mancha ou placa branca, que não se caracterizada como outra lesão bucal. Devido ao seu potencial de malignização, os pacientes com leucoplasias devem ser acompanhados periodicamente. O objetivo desde artigo é relatar o caso de uma paciente do gênero feminino, etilista e tabagista há mais de 25 anos com leucoplasia bucal. O exame histopatológico indicou a presença de displasia epitelial moderada e a imunomarcação pelo Ki-67 e ciclina D1 revelou a presença de proliferação celular em camadas suprabasais. Por essa razão, optou-se pela remoção da lesão com o laser cirúrgico. A paciente permaneceu em acompanhamento semestral por três anos, entretanto, após faltar a duas revisões, retornou com recidiva da lesão com história de evolução de oito meses e cujo exame histopatológico revelou a presença de carcinoma espinocelular bem diferenciado.

Diagnóstico clinicohistopatológico de la leucoplasia bucal / Clinical and histopathological diagnosis of oral leukoplakia

Se realizó un estudio descriptivo y transversal de los 116 pacientes con leucoplasia bucal, atendidos en la consulta de estomatología del Policlínico de Especialidades perteneciente al Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde junio del 2007 hasta igual mes del 2010, a fin de evaluar los resultados del diagnóstico clinicohistopatológico de esta afección y vincularlos con el tabaquismo y los síntomas subjetivos. Las muestras para biopsias se depositaron en un frasco de cristal con formol al 10 %, se fijaron en formalina al 5 %, se procesaron por la técnica clásica de inclusión en parafina y luego se colorearon con hematoxilina-eosina, con lo cual se confirmó la presencia de cambios celulares. En la casuística primaron el sexo masculino, la ausencia de dichos síntomas, la displasia epitelial y la hiperparaqueratosis como alteraciones epiteliales más comunes, así como la displasia severa en fumadores con más años de serlo. Sobre la base de las transformaciones registradas, deben realizarse investigaciones que permitan precisar la connotación biológica e histológica de esta enfermedad.

A descriptive and cross-sectional study was carried out in 116 patients with oral leukoplakia, assisted in the Stomatology Department of the Specialties Polyclinic belonging to "Saturnino Lora Torres" Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba, from June, 2007 to the same month of 2010, in order to evaluate the results of the clinical and histopathological diagnosis of this disorder and their relation to the smoking habit and subjective symptoms. The samples for biopsies were deposited in a glass flask with 10 % formol, they were fixed in 5 % formaline, they were processed through the classic technique of inclusion in paraffin and then they were colored with hematoxiline-eosine, through which the presence of cellular changes was confirmed. Male sex, the absence of these symptoms, the epithelial dysplasia and the hyperparakeratosis prevailed in the case material, as the most common epithelial changes, as well as the severe dysplasia in heavier smokers. On the bases of the detected transformations, investigations allowing to specify the biological and histological implications of this disease should be carried out.

Relación histopatológica de la displasia epitelial con la oncoproteína p53 en la leucoplasia bucal / Histopathological relation of epithelial dysplasia to p53 oncoprotein in oral leukoplakia

La leucoplasia bucal es una lesión precancerosa bien conocida debido a su asociación con la presencia de displasia epitelial y su tendencia a la transformación maligna. Con el fin de eliminar la subjetividad en la determinación de los grados de la displasia epitelial se han utilizado marcadores biológicos, entre ellos, el AcM anti p53. Por ello se propuso evaluar la expresión del AcM anti p53 en los diferentes grados de displasia epitelial en la leucoplasia bucal. Se emplearon las biopsias de 46 pacientes con diagnóstico de leucoplasia bucal, procedentes del Departamento de Patología Bucal de la Facultad de Estomatología de La Habana. Las muestras fueron procesadas por la técnica de inclusión en parafina y coloreadas con la técnica inmunohistoquímica del complejo avidina-biotina-peroxidasa para el AcM p53. Se estudió la correlación entre el patrón de inmunoensayo para p53 y el grado de displasia epitelial. Se evidenció que existe una asociación significativa entre la inmunocoloración de las células basales y suprabasales del epitelio con la oncoproteína p53, en los distintos grados de severidad de la displasia epitelial, lo que pudiera estar relacionado con el incremento progresivo de atipia celular observada. Se concluyó que en las muestras estudiadas existió una relación coincidente del aumento del grado de severidad de la displasia epitelial, con el marcaje de la oncoproteína p53. Estas evidencias sugirieron que el análisis inmunohistoquímico de p53 en conjunto con los parámetros histológicos, principalmente relacionados con el grado de severidad de la displasia epitelial, pudiera ser utilizado para lograr un diagnóstico más certero y contribuir a la prevención del cáncer bucal(AU)

The oral leukoplasia is a well known precancerous injury due to its association with the presence of epithelial dysplasia and its trend to malignant transformation. To eliminate the subjectivity in the determination of the epithelial dysplasia degrees, biological markers have been used among them the AcM.antip53 Thus, authors assessed the expression of AcM antip53 in the different degrees of epithelial dysplasia in the oral leukoplasia. Biopsies from 46 patients diagnosed with oral leukoplasia were used from the Oral Pathology Department of the Stomatology Faculty of La Habana. Samples were processed by the paraffin-inclusion technique and stained with immunohistochemical technique of the avidin-biotin-peroxidase complex for the AcM p53. The correlation between the immunoassay pattern for p53 and the degree of epithelial dysplasia was studied. It was demonstrated that there is a significant association between the immunostain of basal and supra-basal cells of epithelium with the p53 oncoprotein in the different degrees of severity of the epithelial dysplasia, which could be related to the progressive increase of the observed cellular atypia. We concluded that in the study samples there was a coincident relation of the increase in the degree of severity of the epithelial dysplasia, with the marking of the p53 oncoprotein. These evidences suggested that the immunohistochemical analysis of p53 overall with the histological parameters mainly those related to the degree of severity of the epithelial dysplasia could be used to made a more accurate diagnosis and to contribute to prevention of oral cancer(AU)