Fresh Frozen Amniotic Membrane and Buccal Pad of Fat for Reconstruction of Oral Mucosal Defect After Surgical Excision of Leukoplakia

Objective: To compare the use of Fresh Frozen Amniotic Membrane (FFAM) and Buccal Pad of Fat (BPF) for reconstruction of oral mucosal defect after surgical excision of leukoplakia. Material and Methods: Twenty patients were randomly selected and divided into two groups. Group 1 use amniotic membrane graft and Group 2 BPF. Both groups were evaluated preoperatively and postoperatively. Incisal opening, epithelialization and fibrosis were evaluated after one month of surgery. Chi square and Student t tests were used. Results: According to the presence of smoking habits, the highest frequencies were for smoking (30%) and betel leaf areca nut with tobacco (30%). Regarding the diameter of oral leukoplakia, in 40% of the participants it was 2x3 cm2. In Group1, after one month of surgery preoperative and postoperative inter-incisal opening values were 44.20 ± 3.37 and 42.05 ± 3.47 (p<0.001). In Group 2, preoperative and postoperative inter-incisal opening values were 44.09 ± 3.32 and 43.01±3.38 (p>0.05). When FFAM was used complete epithelialization in 70% and incomplete epithelialization in 30% patients. When BPF was used the results were almost similar. Fibrosis occurred in 30% in Group 1. There were no complications like flap necrosis, infectiona and hematoma formation. Conclusion: Incisal opening was significantly better in Fresh Frozen Amniotic Membrane Group, epithelialization and fibrosis were almost same in both groups after surgical excision of oral leukoplakia.

Proliferative verrucous leukoplakia: diagnosis, management and current advances / Leucoplasia verrucosa proliferativa: diagnóstico, conduta e avanços atuais

Abstract Introduction: Proliferative verrucous leukoplakia is a multifocal and progressive lesion of the oral mucosa, with unknown etiology, and commonly resistant to all therapy attempts with frequent recurrences. It is characterized by a high rate of oral squamous cell carcinoma and verrucou carcinoma transformations. Objective: To analyze the studies about Proliferative verrucous leukoplakia and develop a concise update. Methods: A Pubmed search identifying studies (laboratory research, case series and reviews of literature) that examined patients with Proliferative verrucous leukoplakia was realized. Results: There are not enough studies about Proliferative verrucous leukoplakia in the literature. The few found studies not present a consensus about its etiology and diagnosis criteria. Although several treatment strategies have been proposed, most of them still show a high recurrence rate. Conclusion: More research about Proliferative verrucous leukoplakia is necessary to understand and treat this disease.

Resumo Introdução: Leucoplasia verrucosa proliferativa (LVP) é uma lesão multifocal e progressiva da mucosa oral, com etiologia desconhecida e comumente resistente a todas as tentativas terapêuticas, com recorrências frequentes. É caracterizada por uma alta taxa de transformação em carcinoma de células escamosas e carcinoma verrucoso da cavidade oral. Objetivo: Analisar os estudos sobre LVP e elaborar uma atualização resumida. Método: Foi realizada uma pesquisa na base de dados Pubmed que identificou estudos (pesquisas laboratoriais, séries de casos e revisões de literatura) que avaliaram pacientes com LVP. Resultados e discussão: Não há estudos suficientes sobre LVP na literatura. Os poucos estudos encontrados não apresentam consenso quanto aos critérios de etiologia e diagnóstico. Embora várias estratégias de tratamento tenham sido propostas, a maioria ainda apresenta alta taxa de recorrência. Conclusão: Mais pesquisas sobre LVP são necessárias para entender e tratar essa doença.

Proliferative Veruccous Leukoplakia: An Extensive Red and White Lesion.

Proliferative verrucous leukoplakia (PVL) is a rare form of leukoplakia, which was first described by Hansen et al. in the year 1985. PVL is a disease with aggressive behavior due to its high rate of recurrence and a high rate of malignant transformation, usually more than 70%. This is a long-term progressive condition, which is observed more frequently in females over the age of 60 years. In the course of time, PVL tends to become multifocal with progressive deterioration of the lesions, making it more and more difficult to control. Unlike other cases of leukoplakia, tobacco use does not seem to have a significant influence on the appearance and progression of PVL. As this condition is seen in non-smokers, the etiology of PVL remains unclear making the management and diagnosis difficult. The aim of this article is to present a case which is diagnosed based on the diagnostic criteria proposed by Cerero-Lapiadra et al.

Cryosurgery in the Management of Potentially Malignant Lesions: A Report of Two Cases.

Cryosurgery is a therapeutical approach that uses freezing to obtain a tissue inflammatory or destructive response. It has been successfully used for both cutaneous and oral conditions. The characteristics of oral mucosa like humidity and smoothness makes it an ideal site for this approach. Oral submucous fibrosis is a potentially malignant disorder of the oral mucosa, with areca nut chewing being the primary causative agent. Leukoplakia is a potentially malignant lesion associated with excessive consumption of alcohol and tobacco. Although there are no specific treatment modalities to prevent recurrence, abandoning habits can decrease the chance of recurrence, as well as the transfiguration into malignant tumors of these disorders. However, with the advent of cryosurgery, oral surgeons are provided with a new modality for treating oral potentially malignant disorders. This case report highlights the pioneering effect of nitrous oxide cryosurgery in treating two cases of oral submucous fibrosis with leukoplakia and oral leukoplakia respectively showing promising results during follow-up.

Análise histopatológica de lesões leucoqueratósicas da mucosa oral avaliadas pelos exames de luminescência, cromoscopia e microscopia confocal reflectante / Histological analysis identified and assessed by tests of luminescence, chromoendoscopy and confocal reflectance leukokeratosis lesions

O câncer de mucosa oral é um problema de saúde pública, com maior incidência em homens acima de 50 anos. Uma das manifestações clínicas mais precoces do câncer da mucosa oral são as lesões leucoqueratósica. O aspecto clínico não homogêneo e o tamanho maior de 200mm2, em mucosa não queratinizada como a do assoalho da boca e ventre da língua, são aspectos que implicam na possibilidade de evolução da lesão. A dificuldade do diagnóstico das lesões precoces está na seleção do local a ser biopsiado principalmente frente a lesões extensas e heterogêneas. O objetivo desta pesquisa é avaliar se a utilização do exame clínico juntamente com os métodos auxiliares de diagnóstico das lesões leucoqueratósica da mucosa oral (VELscope®, Azul de toluidina e Solução de lugol) contribui para uma maior precisão do diagnóstico de displasias nestas lesões quando comparado ao histopatológico. E, identificar os padrões morfológicos destas lesões quando avaliadas por meio da microscopia confocal reflectante. Foram selecionados 30 pacientes, maiores de 18 anos, portadores de lesão clínica compatível com leucoplasia oral triados no ambulatório da disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo e que precisavam ser submetidos à biópsia para o estabelecimento do diagnóstico final. Foram realizados os testes de Azul de Toluidina, Solução de Lugol, VELscope®, microscopia confocal reflectante e posteriormente, a biópsia incisional para obtenção do diagnóstico final. Os pacientes incluídos possuíam média de idade 60,66 anos, sendo 70% (21/30) do gênero feminino e 30% (9/30) do gênero masculino. O tabagismo foi relatado por 16,7% (5/30) dos pacientes, sendo 60% (3/5) homens. A associação do tabagismo e etilismo foi relatada em 10% (3/30) dos pacientes, o tabagismo isoladamente por 6,6% (2/30) e o de etilismo por 3,3%(1/30)...

Cancer of the oral mucosa is a public health problem, with higher incidence in men above 50 years. One of the earliest manifestations of cancer of the oral mucosa lesions are leukokeratosis. The inhomogeneous clinical aspect and the larger size of 200mm2 in non-keratinized mucosa as the floor of the mouth and constipation of the tongue, are aspects that imply the possibility of evolution of the lesion. The difficulty of diagnosis of early lesions is in the selection of the site to be biopsied primarily against large and heterogeneous lesions. The objective of this research is to evaluate the use of clinical examination along with diagnostic aids leucoqueratósica of oral lesions (VELscope ®, Toluidine blue and Lugol solution) methods contributes to greater accuracy of diagnosis of dysplasia in these lesions when compared the histopathological. And identify the morphological patterns of these lesions when evaluated by reflectance confocal microscopy. 30 patients older than 18 years, with clinical lesion compatible with oral leukoplakia screened in the outpatient discipline of Clinical Dentistry, Faculty of Dentistry, University of São Paulo and that needed to be biopsied to establish the final diagnosis were selected. Tests toluidine blue, Lugol's solution, VELscope ®, reflectance confocal microscopy (RCM) and subsequently, incisional biopsy to obtain the final diagnosis were performed. Patients enrolled had a mean age 60.66 years, 70% (21/30) were female and 30% (9/30) were male. Smoking was reported by 16.7% (5/30) of patients, 60% (3/5) homens.A association of smoking and alcohol use was reported in 10% (3/30) of patients, smoking alone by 6.6% (2/30) and of alcoholism by 3.3% (1/30)...

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

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

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

Associação entre nível de expressão de microRNAS e aspectos hitopatológicos de displasia em leucoplasia bucal / Relationship between microRNA expression levels and histopathological features of dysplasia in oral leukoplasia

A leucoplasia bucal (LB) é a principal lesão cancerizável da boca. O diagnóstico deve ser confirmado pelos achados histológicos, para excluir qualquer outra alteração da mucosa bucal e verificar sinais de malignidade, além da gradação da displasia epitelial, microRNAs (miRNAs) são pequenas moléculas com função importante no processo de expressão gênica. Aumento de expressão de microRNAs (miRNAs) - miR-21, miR-345 e miR-181b - tem sido demonstrado em LB que evoluíram para o carcinoma de células escamosas de boca (CCEB). Este achado sugere um potencial valor prognóstico para os miRNAs. Com base nesses resultados, este estudo objetiva-se investigar a associação dos níveis de expressão desses 3 miRNAs com as características citológicas e histopatológicas que são usados para determinar o grau de displasia bucal...

Leucoplasia verrugosa proliferativa / Proliferative verrucous leukoplakia

Una leucoplasia es según la definición de la Organización Mundial de la Salud (OMS) una placa blanca de la mucosa bucal, de cuestionableriesgo, habiéndose excluido otras enfermedades conocidas o desórdenes que no tienen aumentado el riesgo de transformación encáncer. Su diagnóstico se realiza por exclusión de otras enfermedades con aspecto clínico similar, pero que no acarrean riesgo aumentadode cáncer. Es el desorden potencialmente maligno que sufre transformación con mayor frecuencia, con rango de transformación entreel 0,13 y el 17.5%Una variante rara de la leucoplasia, es la leucoplasia verrugosa proliferativa (LVP), descripta por primera vez en 1985 por Hansen etal. Anterior a esa fecha era conocida como papilomatosis florida. La LVP, fue clasificada por la OMS en 2005 como un desorden potencialmente maligno (OMS 2005) por presentar una alta probabilidad de transformarse en un carcinoma espinocelular o un carcinomaverrugoso. Esto indica un comportamiento biológico agresivo.En la mayoría de los casos el diagnóstico de LVP es retrospectivo, lo que enlentece su tratamiento. Su etiología es incierta, pudiendo estar relacionada con el virus del papiloma humano (VPH), con el virus de Epstein-Barr, o con infecciones por cándida, pero aún no hasido posible establecer una correlación definitiva. Sigue considerándosele como lesión de etiología desconocida.

A leukoplakia is, as defined by the World Health Organization (WHO), a white plate of the oral mucosa, of questionable risk having excluded other known diseases or disorders that have no increased risk of cancer transformation. The diagnosis is made by excludingother diseases with similar clinical appearance but carry no increased risk of cancer. It is the potentially malignant disorder that most often suffers transformation within a range between 0.13 and 17.5%. A rare variant of leukoplakia is the proliferative verrucous leukoplakia (PVL) first described in 1985 by Hansen et al. Previously it wasknown as florid papillomatosis. WHO in 2005 classified the PVL as a potentially malignant disorder (WHO 2005) for presenting a high probability of becoming a squamous cell carcinoma (squamous) or warty carcinoma; this indicates an aggressive biological behavior.In most cases the diagnosis of PVL is retrospective, slowing the treatment. Its etiology is uncertain and may be related to human papillomavirus (HPV), the Epstein-Barr virus or even yeast infections, but has not been possible yet to establish a definitive correlation. Still it is considered an injury of unknown etiology.

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)

Caracterización histopatológica de la leucoplasia bucal en La Habana durante 10 años / Histopathological characterization in the leukoplakia buccalis in Havana during 10 years

La displasia epitelial es considerada el más fuerte predictor histológico de la futura transformación maligna de la leucoplasia bucal. El objetivo del presente trabajo fue determinar la presencia y severidad de la displasia epitelial y su asociación con las alteraciones histológicas de los tejidos epitelial y conectivo de la mucosa en la leucoplasia bucal. Se efectuó una investigación descriptiva y transversal de 83 biopsias procesadas mediante la técnica de inclusión en parafina y coloreadas con hematoxilina y eosina, de pacientes con diagnóstico de leucoplasia bucal entre los años 1991 y 2001, procedentes de la Facultad de Estomatología de la Universidad de Ciencias Médicas de La Habana, Cuba. Se encontró que 92,8 por ciento de los pacientes con diagnóstico clínico de esta enfermedad tuvieron displasia epitelial, de estos y acorde a su grado de severidad, se encontró displasia epitelial ligera en 53,0 por ciento, displasia epitelial moderada en 36,4 por ciento y displasia epitelial severa en 10,4 por ciento. La paraqueratosis se manifestó como sigue: asociada a la displasia epitelial ligera en 43,9 por ciento de los pacientes, a la displasia epitelial moderada en 78,6 por ciento y a la displasia epitelial severa en 100,0 por ciento. La hiperplasia epitelial se presentó en 57,1 por ciento de los casos y el infiltrado inflamatorio en 79,2 por ciento de las muestras examinadas. Se concluyó que en la muestra de leucoplasia bucal estudiada existió un porcentaje elevado de displasia epitelial, con predominio de su grado ligero y una asociación entre el grado de severidad con los diversos patrones de queratinización y la intensidad del infiltrado inflamatorio, lo que se consideró importante al analizar su evolución ante un diagnóstico determinado y su pronóstico.

The epithelial dysplasia is considered the stronger predictor of a future malignant transformation of the leukoplakia buccalis. The aim of present paper was to determine the presence and severity of this type of dysplasia and its association with the histological alterations of epithelial and connective tissues of mucosa in the leukoplakia buccalis. A cross-sectional and descriptive research was conducted in 83 biopsies processed by technique of paraffin inclusion and stained with Hematoxylin and Eosin of patients diagnosed with this entity between 1991-2001 from the Stomatology Faculty of the Medical Sciences University of La Habana. The 92.8 percent of patients with a clinical diagnosis of leukoplakia buccalis had slight epithelial dysplasia, from these and according to its grade of severity, there was found a slight epithelial dysplasia in the 53.0 percent, moderate epithelial dysplasia in the 36.4 percent and a severe epithelial dysplasia in 10.4 percent. The parakeratosis was manifested in the 43.9 percent associated with a slight epithelial dysplasia, 78.6 percent with a moderate dysplasia and in the 100 percent with the severe one. The epithelial dysplasia was present in the 57.1 percent of cases and the inflammatory infiltrate in the 79.2 percent of study samples. Authors conclude that in the study sample of leukoplakia buccalis there is a high percentage of epithelial dysplasia with predominance of its slight degree and a association between its severity degree with the different patterns of keratinization and the intensity of inflammatory infiltrate, something important in the analysis of its course in face a determined diagnosis y its prognosis.

Diagnostic efficiency of toluidine blue with Lugol's iodine in oral premalignant and malignant lesions.

Background and Objectives: In vivo stains are prompt resources, which have emerged, in the recent years, to aid as clinical diagnostic tools in detecting early premalignant and malignant lesions. The aim of the study was to determine the diagnostic efficiency of toluidine blue with Lugol's iodine in oral premalignancies and malignancies and to evaluate the reliability of in vivo staining with toluidine blue and Lugol's iodine in the lesions at risk of malignancy. Materials and Methods: The study group comprised 30 subjects with clinically suspicious premalignant lesions and 30 subjects with clinically suspicious malignant lesions. All the lesions were stained consecutively with toluidine blue and Lugol's iodine and the dye retention were recorded with photographs. Depending on the retention of the dyes, the biopsy site was determined. The biopsy specimens were sent for histological confirmation and results were statistically analyzed. Results: The overall diagnostic accuracy of Lugol's iodine when used consecutively with toluidine blue stain in distinguishing premalignant lesions and malignant lesions was 90%. As the degree of differentiation of malignant lesions progressed toward more severity, they failed to show the retention of Lugol's iodine and the result was highly significant statistically, with a P value < 0.001. Interpretation and Conclusion: Lugol's iodine when used with toluidine blue helped in delineating the inflammatory lesions and was the mean source in determining clinically the degrees of differentiation of malignant lesions as the poorly differentiated malignant lesions without glycogen content failed to show Lugol's iodine retention. Toluidine blue with Lugol's iodine can be used as a pretherapeutic assessment of the biologic aggressiveness of the disease.

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos / Potentially malignant oral lesions: clinical and morphological analysis of 205 cases

OBJETIVOS: O objetivo desta pesquisa foi realizar uma análise clínica e morfológica em lesões orais com potencial de malignização. MATERIAL E MÉTODO: Os dados clínicos e morfológicos referentes a tais lesões foram obtidos a partir das fichas clínicas e dos laudos histopatológicos, respectivamente. RESULTADOS: Dos 205 casos analisados, a lesão mais prevalente foi a leucoplasia (70,7 por cento), seguida da queilite actínica (16,1 por cento), eritroplasia (9,8 por cento) e eritroleucoplasia (3,4 por cento). Verificou-se uma associação significativa entre o sexo e as lesões (p < 0,001), sendo o sexo feminino mais prevalente nas leucoplasias e eritroplasias. A raça branca foi mais acometida em todas as lesões. Quanto à localização anatômica, o rebordo alveolar prevaleceu na leucoplasia (21 por cento), na eritroplasia e eritroleucoplasia, o palato foi mais acometido com 47,4 por cento e 57,1 por cento, respectivamente. Com relação à idade, não houve diferença significativa entre as lesões (p > 0,05), sendo mais frequentes nas quinta, sexta e sétima décadas de vida. Observou-se que, na maioria dos casos de eritroplasias e eritroleucoplasias, os diagnósticos clínicos foram incompatíveis com o morfológico. Verificou-se associação significativa entre transformação maligna e lesões (p < 0,001), pois a eritroplasia apresentou uma taxa de malignização de 20 por cento, enquanto na leucoplasia o índice foi de 2,1 por cento. CONCLUSÃO: A prevalência das lesões orais com potencial de malignização foi semelhante ao encontrado na literatura, mas com algumas diferenças em relação ao perfil epidemiológico das mesmas, ressaltando-se que estas entidades merecem uma atenção especial por parte do clínico, especialmente as eritroplasias, que apresentaram um elevado percentual de malignização e o maior índice de equívocos no diagnóstico clínico.

OBJECTIVE: The objective of this study was to perform a clinical and morphological analysis of potentially malignant oral lesions. MATERIAL AND METHOD: The clinical and morphological data related to these lesions were obtained from clinical and histopathological records, respectively. RESULTS: Out of 205 cases, the most prevalent lesion was oral leukoplakia (70.7 percent), followed by actinic cheilitis (16.1 percent), erythroplakia (9.8 percent) and erythroleukoplakia (3.4 percent). There was a significant association between the lesions and gender (p < 0.001). The female gender was the most affected in leukoplakias and erythroplakias. Caucasians were mostly affected in all conditions. As far as anatomical location is concerned, the alveolar ridge was the most prevalent site in oral leukoplakias (21 percent); the palate was the most affected in erythroplakia (47.4 percent) and erythroleukoplakia (57.1 percent). There was no significant difference among the lesions as to age (p > 0.05), although they were more frequent in the 5th, 6th and 7th decades of life. In most cases of erythroplakias and erythroleukoplakias, it was observed that clinical and morphological diagnoses were incompatible. There was a significant association between malignant transformation and lesions (p < 0.001) as the erythroplakia presented a malignization rate of 20 percent, whereas in leukoplakias the rate was 2.1 percent. CONCLUSION: The prevalence of potentially malignant oral lesions was similar to other findings in the medical literature, but with some differences in their epidemiological profile. It is important to highlight that these entities require further medical investigation, mainly erythroplakias, which showed high risk of malignization and the highest rate of clinical misdiagnosis.

Lesões brancas da cavidade oral: uma abordagem estomatológica / White lesions of the oral cavity: a stomatology approach

Introdução: As lesões brancas da cavidade oral constituem um complexo conjunto de entidades, cuja principal característica clínica se evidencia pela presença de áreas esbranquiçadas na boca. Sua etiologia é extremamente variada, sendo que certas lesões não apresentam uma causa única, mas o resultado da interação de diversos fatores. Objetivo e Método: Pretende-se, com este trabalho, realizar uma revisão de literatura sobre essas lesões, onde serão discutidas as algumas das lesões brancas da cavidade oral, seus fatores etiológicos e características clínicas além de enfocar aspectos necessários para o estabelecimento do diagnóstico diferencial das referidas lesões. Conclusão: Pode-se inferir que é necessário o conhecimento das lesões brancas da cavidade oral pelo cirurgião-dentista, a fim de que seja estabelecido o diagnóstico correto das lesões para que seja instituído o tratamento adequado a cada tipo, e então, recuperada a condição de saúde do paciente.

Introduction: White lesions of oral cavity constitute a complex group of entities, whose the main clinical characteristic is evidenced by the presence of white areas in the mouth. Your aetiology is extremely varied and some lesions don't present an only cause, but they are the result of the interaction of several factors. Aim and methods:It is intended, with this work, to accomplish a literature revision on those lesions, where it is discussedthe main white lesions of the oral cavity, your aetiology factors and clinical characteristics besides focusing necessary aspects for the establishment of the diferencial diagnosis of the referred lesions. Conclusion: It can be inferred that is necessary the knowledge of the white lesions of the oral cavity for the dentist, to established the correct diagnosis of the lesions to institute the appropriate treatment to each type, and then, the condition of the patient's health.

Leucoplasia oral: tratamento cirúrgico com laser de CO2 e de diodo e análise por imunoo-histoquímica da expressão de proteínas relacionadas à carcinogênese (p53, COX-2 e EGFR) / Oral leukoplakia surgical treatment with CO2 and diode lasers and analysis of the expression of proteins related to carcinogenesis (p53, COX-2 e EGFR)

Leucoplasia oral (LO) é uma lesão potencialmente malígna, dentina como uma platca branca que não pode ser caracterizada como outra doença da mucosa oral, Dentro de certo consenso, as LOs devem ser tratadas, mas nenhum tratamento disponível tem a capacidade de prevenir a transformação malígna. Este trabalho teve como objetivo avaliar a eficácia do tratamento cirúrgico da LOs por lasers de CO2 e diodo e verificar a ocorrência de desfechos clínicos de recidivas, desenvolvimento de novas lesões ou transformação malígna após o tratamento. Adicionalmente foi realizado estudo imunohistoquímico em material biopsiado das lesões e em tecido normal gengival (grupo controle). Fatores reconhcidamente de risco como hábitos nocivos (álcool e tabagismo), características clínicas das lesões, grau de displasia, bem como a expressão dos anticorpos investigados, foram analisados e relacionados com a ocorrência de desfechos clínicos em 40 pacientes atendidos no ambulatório de Estomatologia Clínica. Os corte histológicos das lesões foram classificadso de acordo com o grau de displasia e com um sistema binário, e subsequentemente foram testados para os anticorpos anti-p53, anti-COX-2 e anti-EGFR através de reação imuno-histoquímica. Análise de Kaptan-Meier, seguida do teste de logrank e análise de regressão de Cox avaliaram a ocorrência de recorrência, desenvolvimento de novas lesões e transformação malígna e possíveis fatores relacionados com esses desfechos clínicos. Teste de odds ratio e de x² avaliaram a expressão dos anticorpos investigados em LOs e grupo controle. Pacientes com LO apresentaram idade média de 60,5 anos e a relãção homem/mulher foi de 1,35.1. Hábitos de tabagismo e etilismo foram prevalentes em homens. A maior parte das lesões era < 2 cm (57,1%), tinha aspecto homogênio (67,3%) e displasia epitelial (61,2%); apenas 7 lesões eram de "alto risco" (sistema binário)...

Oral leukoplakia (OL) is a potentially malignant lesion, defined as a white patch that cannot be characterized as any other disease of the oral mucosa. In general. OL should be treated; however no treatment available has been able to prevent malignant transformation. The aim of this study was to evaluate the efficacy of surgical treatment with CO2 and diode lasers in 40 patients with OL and the occurrence of clinical outcomes of recurrence, development of new lesions of malignant transformation, after treatment. Additonally, an immunohistochemistry study was performed in OL biopsy-specimen and in gingival normal tissue (control group). Recognized risk factors such as habits (alcohol and tobacco), clinical charracteristics of lesions, grade of dysplasia, as well as the expression of immunchistochemistry reaction were analyzed. Histological slides of lesions were classified according to the grade of dysplasia and a binary system, and subsequently tested for the anti-p53, anti-COX-2 and anti-EGFR antibodies by immunohistochemistry assay. Kapplan-Meier analysis along with log-rank test and Cox regression analysis were used to assess the occurrence of clinical outcomes and the association with risk factors. Odds ratio and x² tests evaluated the expression of the investigated antibodies in OLs and in the control group. Pattents with OL had a mean age of 60,5 years and the men/women ratio was of 1.35.1. Smoking ans alcohol habits were more prevalent among men than in women. lessions were clinically characterized as measuring less than 2 cm (57.1%) with a homogenous aspect 67.3%) and histologically with epithelial dysplasia (61.2%) only 7 lesions were classified as of high-risk (binary system). Clinical outcomes (recurrence, development of wew lesions and malignant transformation) were observed in 37,5% patients; 2 patients developed malignancy in areas distant from the initial OL site...

Correlación clínico - patológica de lesiones diagnosticadas inicialmente como leucoplasia bucal y el diagnóstico histopatológico de displasia epitelial en una muestra de 11250 pacientes adultos Facultad de Odontología Universidad Central Venezuela / Correlation clinical - pathological lesions initially diagnosed as oral leukoplakia and histopathological diagnosis of epithelial dysplasia in a sample of 11250 adult patients Facultad de Odontología Universidad Central de Venezuela

La Leucoplasia Bucal (LB) es reconocida como una lesión que presenta características histopatológicas de Displasia Epitelial (DE). La proporción de DE que progresa a carcinoma Espino Celular es variada y se encuentra en un rango de 6,6 a 36 por ciento. El objetivo de este estudio fue establecer la correlación entre LB de la mucosa bucal con diagnóstico histopatológico de DE, para tal fin se revisaron un total de 11.250 historias, pudiéndose determinar que 180 de éstas correspondían a la patología a estudiar. Estos datos fueron analizados de acuerdo a su localización anatómica, sexo, edad, grupo étnico y grado de DE, 180 casos representaron LB con diferentes grados de Displasias, de las cuales 97(52,8 por ciento) eran DE leves, 67(37,2 por ciento) DE moderadas y 18(10,0 por ciento) DE severas. La localización anatómica más frecuentemente afectada fue la mucosa del reborde alveolar con 42 casos (24,1 por ciento), seguido por la mucosa del carrillo 35 casos (19,2 por ciento). La mayor prevalencia de edad fue del grupo de 50-59años (30,2 por ciento). El sexo femenino obtuvo el mayor número de casos. 102 casos (56,4 por ciento). En cuanto al grupo étnico el caucasoideo fue el más afectado con 98 casos (53,8 por ciento). Se reportó un 43 por ciento de pacientes con hábitos tabáquicos. Al correlacionar clínico-patológicamente los casos de este estudio se pudo evidenciar que el diagnóstico clínico de Leucoplasia esta más frecuentemente relacionada con el diagnóstico histopatológico de Displasia leve

Oral Leucoplakia (OL) is a term used to describe predominantly white lesions of the oral mucous which cannot be characterized as other specific lesions and which have a potential for malignant transformation. OL is recognized as a lesion with the histopathological characteristics of epithelial dysplasia. The proportion of epithelial dysplasia (ED) which progress to spin cellular carcinomas varies within a range of 6.6 percent to 36 percent. The purpose of this study was to determine the relationship between ED of the oral mucous clinically diagnosed as Leucoplakia. To that end a total of 11,250 micro histories were reviewed, representing all the samples analized from October 1968 to December 1998. It was found that 180 of these cases reflected the pathology of interest. These data were analyzed according to their anatomical location, sex, age, ethnic group, and degree of epithelial dysplasia. 180 cases represented oral Leucoplakias with differing degrees of dysplasia, of which 97 (52.8 percent) were mild ED, 67 (37. 2 percent) were moderate ED and 18 (10 percent) were severed ED. The most frequent anatomical location reported in this study was the mucous of the alveolar ridge, with 42 cases (24. 1 percent). Next came and the cheek mucous, with 35 cases (19.2 percent). The leading age group was 50 - 59 years (30.2 percent) Females had a higher predisposition with 102 cases (56.4 percent). The Caucasian ethnic group was the most frequently affected, with 98 cases (53.8 percent). 43 percent of the patients were reported to be smokers. A clinical - pathological correlation of the cases reviewed in this study shows that Leucoplakia is most often related to histopathological diagnosis of mild dysplasia

Prevención del cáncer bucal: lesiones cancerizables de la cavidad bucal / Prevention of oral cancer: cancerous lesions of the oral cavity

El cáncer bucal representa el 3 por ciento de los tumores malignos humanos. En nuestro país, la sobrevida es del 39 por ciento a los 5 años, lo que significa la muerte de la mayoría de los pacientes (61 por ciento) a los cinco años. Mundialmente, existen campañas con el fin de concientizar a la población sobre la existencia y prevención del cáncer bucal. La forma de prevenirlo es reconocer por parte del odontólogo, las lesiones que más frecuentemente pueden transformarse en cáncer, como ser el liquen no reticular en su forma erosiva, atrófica y queratósica, la ulceración traumática, la queilitis crónica y la leucoplasia. En este artículo se darán pautas claras y simples para reconocer, identificar y controlar las mencionadas lesiones, con el objetivo de orientar el diagnóstico precoz.

Diagnóstico diferencial e manejo da leucoplasia bucal- caso clínico: acompanhamento de 4 anos / Oral leukoplakia differential diagnosis and management- case report: accompaniment of 4 years

A leucoplasia é a lesão cancerizável mais prevalente na cavidade bucal. Seu diagnóstico é eminentemente clínico e baseia-se na exclusão de outras lesões brancas. Devido ao potencial de transformação maligna, os pacientes devem ser orientados quanto à importância da remoção dos fatores de risco e à necessidade de acompanhamento constante. A coloração com o azul de toluidina é um instrumento complementar para o acompanhamento de lesões cancerizáveis, auxiliando na escolha do melhor momento para a realização da biópsia e sitio onde deve ser realizada. Neste artigo, descreve-se um caso de leucoplasia bucal com acompanhamento de quatro anos ressaltando a importância do diagnóstico diferencial, utilização da coloração com o azul de toluidina e proservação do caso.

Leucoplasia bucal: revisão dos critérios de diagnóstico clínico e histopatológico / Oral leukoplakia: review of clinical and histopatologic diagnose criterion

A leucoplasia apresenta-se como a lesão cancerizável mais comum da mucosa bucal. Trata-se de um diagnóstico de exclusão e não de uma entidade, pois suas características clínicas e histopatológicas não são específicas. O critério utilizado para predizer o comportamento dessas lesões consiste na presença ou na ausência de displasia epitelial; entretanto mostra-se subjetivo. Estudos vêm propondo classificações baseadas nos apectos clínicos e/ou hispotalogógicos com a finalidade de uniformizar e facilitar diagnóstico conduta e tratamento. Este trabalho tem como objetivo revisar e discutir tais classificações, devido à necessidade de se estabelecer parâmetros mais fidedignos das lesões cancerizáveis.