Hemimandibulectomía por ameloblastoma multiquístico. A propósito de un caso / Multicystic ameloblastoma hemimandibulectomy. A propos of a case

RESUMEN El ameloblastoma es un tumor odontogénico benigno, localmente agresivo y recidivante, con predilección por la región posterior de la mandíbula. Se caracteriza por su agresividad local con muy baja tendencia a metastizarse. El objetivo fue reportar el caso clínico de un paciente con ameloblastoma multiquístico derecho, tratado a través de hemimandibulectomía. Se presentó un paciente masculino, de 44 años de edad, que refirió aumento de volumen del lado derecho de la mandíbula desde hacía aproximadamente un año, acompañado también de otros síntomas, atendido en el Servicio de Cirugía Maxilofacial del Hospital Militar Principal/Instituto Superior, en Luanda, Angola. Los estudios imagenológicos incluyeron radiografía panorámica y tomografía axial computarizada. El diagnóstico clínico patológico fue de ameloblastoma multiquístico. Este tipo de tumor requiere de un adecuado diagnóstico sobre la base de la presentación clínica, localización, tamaño, edad y tipo histológico; de ahí la importancia de conocer las características clínicas e imagenológicas, pues el tratamiento conlleva gran dificultad (AU).

ABSTRACT Ameloblastoma is a benign odontogenic tumor, locally aggressive and recidivist with predilection for back of the jaw, characterized by local aggressiveness and low tendency to metastasize. The aim was reporting the clinical case of a patient with right multicystic ameloblastoma treated through hemimandibulectomy. We presented a male patient aged 44 years, who referred a volume increase of the jaw right side for around a year, accompanied also by other symptoms; he attended the Maxillofacial Surgery Service of the Main Military Hospital/High Institute of Luanda, in Angola. The image studies included panoramic radiography and computerized axial tomography the clinical pathological diagnosis was multicystic ameloblastoma. This kind of tumor requires an adequate diagnosis based on the clinical presentation, location, size, age and histological kind, therefore the importance of knowing the clinical and image characteristics, because the treatment is very difficult (AU).

Tumor odontogénico adenomatoide en dos adolescentes / Adenomatoid odontogenic tumor in two adolescents

Se describen 2 casos clínicos de adolescentes de ambos sexos, quienes presentaron edemas en el lado izquierdo de la mandíbula con reabsorción dental y en la porción anterior del maxilar, respectivamente. La histopatología reveló una variante folicular intraósea del tumor odontogénico adenomatoide. El tratamiento quirúrgico empleado fue una enucleación con resultados satisfactorios.

Two cases reports of adolescents from both sexes are described, they presented edemas in the left side of the maxillary with dental reabsorption and in the anterior portion of the maxillary, respectively. The histopathology revealed an intraosseous folicular variety of the adenomatoid odontogenic tumor. The surgical treatment used was an enucleation with satisfactory results.

New WHO odontogenic tumor classification: impact on prevalence in a population

Abstract Objectives: This study approaches the history of reclassifications and redefinitions around the odontogenic keratocyst (OK), as proposed by the World Health Organization (WHO), and aims to understand the impact of those changes on the prevalence and epidemiology of odontogenic tumors (OTs). Methodology: Cases of OTs diagnosed in an Oral Pathology service between January 1996 and December 2016 were reviewed. Demographic data of patients such as age, gender and site of lesions were retrieved from their respective records. Results: Within the studied period, 7,805 microscopic reports were elaborated and 200 (2.56%) of these were diagnosed as OTs. Out of these 200, between 1996 and 2005, prior to the 2005 WHO classification, there were 41 (20.5%) OTs cases, being odontoma the most frequent (23; 56.09%), followed by ameloblastoma (8; 19.51%) and myxoma (03; 7.31%). Between 2006 and 2016, after the previous 2005 WHO classification there were 159 (79.5%) OTs, being odontogenic keratocystic tumor (KCOT) the most frequent (68; 42.76%), followed by odontoma (39; 24.52%) and ameloblastoma (21; 13.20%). Conclusions: As of today, the most recent WHO classification to be followed brings KCOT back to the cyst category, which will impact on the prevalence and epidemiology of OTs; thus, this study was able to identify a considerable increase (287.80%) in the prevalence of OTs when the 2005 WHO classification was utilized. Despite being an important academic exercise, classifying odontogenic lesions and determining whether to place the odontogenic keratocyst in a cyst or tumor category is crucial to establish the correct diagnosis and treatment to follow, whether by oral medicine or oral surgery specialist, or by the general practitioner.

Fibroma odontogénico periférico: reporte de un caso / Peripheral odontogenic fibroma: case report

El Fibroma Odontogénico Periférico fue definido por la OMS en el año 2005 como una neoplasia benigna rara constituida por tejido fibroso maduro y una cantidad variable de epitelio odontogénico inactivo. Dada su presentación clínica, localización y baja prevalencia suele ser mal diagnosticado como una lesión reaccional. Se presenta un caso clínico de fibroma odontogénico periférico tratado mediante remoción quirúrgica y se realiza una revisión de la bibliografía respecto a la patología con el propósito de esclarecer algunos aspectos de esta lesión, además de incluirla dentro de los posibles diagnósticos diferenciales de lesiones reaccionales gingivales. El objetivo del siguiente artículo es presentar un caso clínico de FOP tratado mediante remoción quirúrgica y aportar en el diagnóstico diferencial de las lesiones reaccionales gingivales.

Peripheral odontogenic fibroma was described by the World Health Organization (WHO) in 2005, as a rare benign tumor containing mature fibrous connective tissue with a varying amount of inactive odontogenic epithelium. Though its clinical presentation, localization and low prevalence, it tends to be misdiagnosed as a reactive lesion. We present a case report of a Peripheral Odontogenic Fibroma treated by surgical resection and a narrative review of the literature with the purpose of clarifying different aspects of this lesion besides considering it as a possible differential diagnosis of reactive gingival lesions. The purpose of this article is to present a case report of peripheral odontogenic fibroma treated by surgical resection. Also to contribute to the differential diagnosis of gingival reactive lesions.

Cementoblastoma: oito novos casos, revisão da literatura e considerações sobre melhor manejo clínico / Cementoblastoma: report of eight cases, literature review and considerations of best approach

Cementoblastoma é um tumor odontogênico benigno incomum de origem mesenquimalque usualmente afeta ossos gnáticos de indivíduos jovens, produzindo dor ou desconforto. Pode ser erroneamente diagnosticado como outras lesões, devido sua variada apresentação clínica era diográfica. Frequentemente o tratamento sugerido é a ressecção tumoral em conjunto como dente associado. Entretanto, abordagem mais conservadora pode ser uma opção em alguns casos assintomáticos e estáveis, como observado neste estudo. Apresentamos oito novos casos e uma breve revisão da literatura a fim de melhor caracterizar o comportamento biológico desta relativamente rara lesão.

Cementoblastoma is an uncommon benign odontogenic tumour of mesenchymal originthat affects the jaws of generally young persons, producing pain or discomfort. It may be mistakenfor several other lesions, due to its varied clinical and radiographic features. The suggestedtreatment is often tumour resection in conjunction with the associated tooth. However, a moreconservative approach could be an option in asymptomatic and stable lesions as seen in thepresent study. Eight new cases and a brief review of the literature are presented here to bettercharacterize the biological behavior of this relatively rare lesion.

Odontogenic Myxoma Involving the Maxilla: Case Report of a Rare Entity.

Odontogenic myxomas (OMs) are rare, benign, slow-growing tumors that may arise in the maxilla. They are known to have a female predilection and present as a painless mass commonly in the second or third decade of life, comprising 3-6% of all odontogenic tumors. They show a locally aggressive behavior, are radioresistant tumor and hence the need for early recognition and surgical resection. A high rate of recurrence has also been noted owing to its infiltrative pattern of growth and lack of capsule. Clinical and radiological aspects of maxillary OMs are not conclusive hence it is necessary to have a histopathological exam for the final diagnosis. We present a case of OM involving the maxilla in a 51-year-old female patient. The various histopathological differentials are also discussed.

Ameloblastic Fibrodentinoma: A 12 Years follow-up of a Rare Entity.

Ameloblastic fibrodentinoma (AFD), according to the WHO is a neoplasm similar to ameloblastic fibroma, but also showing inductive changes that lead to the formation of dentine. AFD is a very rare odontogenic mixed tumor and only <40 cases have been reported so far. The origin, like other mixed odontogenic tumors is from the odontogenic apparatus. Two schools of thought exist, one to consider it as a variant of ameloblastic fibroodontoma and the other categorize it as a separate entity. An AFD in an 1½-year-old male patient with 12-year follow-up after treatment is presented.

Estudo epidemiológico, clínico e imaginológico das lesões ósseas dos maxilares / Epidemiological, clinical and imaginologic study of bone lesions of the jaws

Introdução. O cirurgião-dentista é na maioria das vezes, o responsável pelo diagnóstico e tratamento das lesões ósseas dos maxilares. O diagnóstico é decisivo na conduta terapêutica a ser seguida. Na literatura, análises retrospectivas são vistas com maior frequência, onde foram coletados resultados de exames histopatológicos. Contudo, para algumas lesões, o diagnóstico é clínico e radiográfico, não sendo indicada a realização de biópsia. Objetivo. O objetivo deste estudo foi descrever a prevalência das lesões ósseas dos maxilares, assim como avaliar suas características clínicas e radiográficas. Correlacionar a principal hipótese diagnóstica com o diagnóstico final. Pacientes e Métodos. Estudo com 130 pacientes com lesões ósseas dos maxilares diagnosticadas no Centro de Diagnóstico Oral da Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo (CDO-FOUSP), entre Agosto de 2013 e Outubro de 2014. Os pacientes foram divididos em 4 grupos: 1: Tumores benignos odontogênicos e não odontogênicos. 2: Cistos odontogênicos e não odontogênicos. 3: Tumores malignos. 4: Outras lesões. Análise estatística foi realizada buscando estabelecer informações relevantes quanto aos dados epidemiológicos, clínicos e radiográficos destas lesões. Resultados. A idade média foi de 35,2 anos ±17,86, (variou entre 8 e 77 anos). Dos 130 pacientes, 71 eram mulheres (54,62%) e 87 leucodermas (66,92%). A mandíbula foi mais acometida (71,43%), do que a maxila (28,57%). As características clínicas mais observadas foram: aumento de volume em 60 casos (42,85%), dor em 38 (27,14%) e 16 casos (11,43%) apresentaram drenagem de secreção purulenta. O exame complementar de imagem mais utilizado foi a radiografia panorâmica, 124 exames (88,57%).

Em 47 lesões (33,57%), o diagnóstico foi realizado através do exame clínico, radiográfico e conduta cirúrgica (displasias ósseas, cistos ósseos simples, escleroses ósseas, dentre outras). Lesões com imagens radiolúcidas representaram 89 casos (63,57%), a forma unilocular esteve presente em 114 casos (81,43%) e 101 lesões (72,14%) apresentaram relação com o ápice dental. Dos casos que houve análise histopatológica (93 casos), o cisto periapical foi a lesão mais frequente totalizando 38 casos, 12 cistos dentígeros, 9 odontomas (7 compostos e 2 complexos), 8 TOQ, 6 cistos residuais, 5 ameloblastomas, e outras lesões. Houve 3 casos de tumores malignos, sendo 1 osteossarcoma, 1 carcinoma mucoepidermóide e 1 mieloma múltiplo. O percentual de acerto entre a principal hipótese diagnóstica com o diagnóstico final foi de 76,82%. Conclusões. Lesões ósseas foram frequentes e representaram aproximadamente 30% das primeiras consultas. Lesões com características radiográficas radiolúcidas e uniloculares foram as mais frequentes. Em um terço dos casos, não foi indicado (necessário) o exame histopatológico para a conclusão do diagnóstico. Sendo utilizadas as informações clínicas, radiográficas e abordagem cirúrgica (casos de cisto ósseo simples).

Introduction. The dentist is the main professional responsible for the diagnosis and treatment of bone lesions of the jaws. The diagnosis is crucial to therapeutic decision. In the literature, retrospective analyzes are more frequents, and the data are collected from histopathological exams. However, for some lesions, the diagnosis is clinical and radiographic, and the biopsy is not indicated. Objective. The aim of this study was to describe the prevalence of bone lesions of the jaws, and evaluate its clinical and radiographic features. In addition, the correlation between the main diagnosis and the final diagnosis was performed. Patients and Methods. A study which evaluated a total of 130 patients with bone lesions of the jaws. All cases were diagnosed in Oral Diagnosis Center of the Stomatology Discipline, School of Dentistry, University of São Paulo (CDO-FOUSP), between August 2013 and October 2014. Patients were divided into 4 groups: 1: Benign odontogenic and non odontogenic tumors. 2: Odontogenic and non odontogenic cysts. 3: Malignant tumors. 4: Other lesions. Statistical analysis was performed to establish relevant information on the epidemiological, clinical and radiographic data of these lesions. Results. The mean age of the patients was 35,2 years ± 17.86 (range, 8 to 77 years). Among 130 patients, 71 were women (54.62%) and 87 were Caucasians (66.92%).

The mandible was more affected (71.43%) than the maxilla (28.57%). The most frequent clinical signs were swelling in 60 cases (42.85%), pain in 38 (27.14%) and 16 cases (11.43%) showed purulent drainage. The panoramic radiograph was the most used imaging exam, 124 exams (88.57%). In 47 lesions (33.57%), the diagnosis was done by clinical examination, radiographic and surgical management (bone dysplasia, simple bone cysts, bone sclerosis, and others). Radiolucent lesions accounted for 89 cases (63.57%), the unilocular form was present in 114 cases (81.43%) and 101 lesions (72.14%) were related to the dental apex. A total of 93 cases had histopathological analyses; periapical cyst was the most frequent lesion, representing 38 cases, 12 dentigerous cysts, 9 odontomas (7 compounds and 2 complexes), 8 OKT, 6 residual cysts, 5 ameloblastomas and other lesions. There were 3 malignant tumors, 1 osteosarcoma, 1 mucoepidermoid carcinoma and 1 multiple myeloma. The correlation between the main diagnosis hypotheses with a final diagnosis showed a success rate of 76.82%. Conclusions. Bone lesions were frequent and represented approximately 30% of the first visit patients. Lesions that presented radiolucent and unilocular radiograph pattern were the most frequent. In one third of cases, it was not indicated (necessary) the histopathological examination to conclude the diagnosis. Being used data of clinical, radiographic and surgical approach (cases of simple bone cyst).

Avaliação da expressão imuno-histoquímica das proteínas p53 e pRB em ameloblastomas e tumores odontogênicos queratocísticos / Evaluation of immunohistochemistry expression of the proteins p53 and pRB in ameloblastomas and keratocystic odontogenic tumorP

Tumores odontogênicos constituem grupo abrangente de afecções tumorais, sendo ameloblastomas e tumores odontogênicos queratocísticos as lesões benignas de maior frequência, cujas características biológicas são pouco conhecidas. Objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas pRB e p53 em ameloblastoma e tumor odontogênico queratocístico. Foram avaliadas amostras de material parafinado de 21 casos de ameloblastoma e de 20 casos de tumor odontogênico queratocístico para ensaio de imuno-histoquímica com os anticorpos anti-pRB e anti-p53. A contagem da imuno-marcação foi realizada a partir de fotografias de alta resolução processadas no software ImageJ para quantificação manual em campo de 1000 células. A localização da imuno-marcação para ambos anticorpos foi semelhante, sendo em ameloblastomas predominantemente nas células da periferia e, em tumores odontogênicos queratocísticos, nas camadas suprabasais. Quantitativamente, as porcentagens de células marcadas foram estatisticamente maior nos ameloblastoma para anti-p53 (p=0,01) e maior nos tumores odontogênicos queratocísticos para anti-pRB (p=0,04). Não houve correlação estatística entre a porcentagem de células marcadas para anti-p53 e anti-pRB nos ameloblastomas, porém, esta correlação foi positiva e moderada nos tumores odontogênicos queratocísticos (r=0,537; p=0,018). Nota-se ligeira diferença na quantificação das imuno-marcações para o anti-p53 e anti-pRB. Tais resultados devem ser ponderados pela reduzida casuística, porém, sugerem perfis distintos em mecanismos biológicos determinantes para ambos os tumores.

Odontogenic tumors are a comprehensive group of tumor diseases, being ameloblastomas and keratocystic odontogenic tumors the most frequent benign odontogenic tumors. Their biological characteristics are little unknown. The aim of present study was to evaluate the immunohistochemical profile of pRB and p53 proteins in 21 cases of ameloblastomas and 20 cases of keratocystic odontogenic tumors for anti-pRB and anti-p53 antibodies. The quantification of immunostaining was performed manually with high-resolution photographs processed in the ImageJ software to quantify positive cells in a 1000 cells-field. The location of immunostaining for both antibodies was similar. In ameloblastomas, positive cells are located mainly in the peripheral layers, whereas in keratocystic odontogenic tumors the positive cells are located in the suprabasal layers. Quantitatively, the percentage of labeled cells was statistically higher in ameloblastomas for anti-p53 (p = 0.01) and higher in keratocystic odontogenic tumors for anti-pRB (p = 0.04). There was no statistical correlation between the percentage of labeled cells to anti-p53 and anti-pRB in ameloblastomas, however, its correlation was positive and moderate in keratocystic odontogenic tumors (r = 0.537; p = 0.018). It is possible to identify a slight difference in immuno-quantification for anti-p53 and anti-pRB among these lesions. These results must be pondered by the small sample, however, is suggests a different profile in a preponderant key biological mechanisms for odontogenic tumors.

Estudo clinicopatológico retrospectivo dos casos de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da FOUSP no período de 1957 a 2012 / Retrospective clinicopathological study of cases of odontogenic tumors diagnosed in the FOUSP Surgical Pathology Service in 1957 and 2012

Os tumores odontogênicos formam um grupo complexo de lesões, de comportamento clínico variado e encontrado exclusivamente na região bucomaxilofacial. Originam-se a partir das células que normalmente teriam a função de formar o dente, processo esse denominado odontogênese, que tem seu início entre a sexta e a sétima semanas de vida intrauterina. O objetivo deste trabalho foi realizar um estudo clinicopatológico de tumores odontogênicos diagnosticados no Serviço de Patologia Cirúrgica da Faculdade de Oodontologia da Universidade de São Paulo de 1957 a 2012. Foram compilados das fichas de requisição de exames e/ou prontuários dados referentes ao sexo, idade no momento do diagnóstico, cor da pele (branca, negra, ou outras), sintomatologia, tamanho da lesão, duração, localização anatômica, aspectos radiográficos, diagnóstico clínico e histopatológico. Os casos diagnosticados como tumores odontogênicos foram revisados, por um examinador previamente calibrado, com o objetivo de reclassificação das lesões conforme proposição atual da Organização Mundial da Saúde em 2005. Todos os dados obtidos foram inseridos e tabulados no Microsoft Office Excel 2013 e analisados no software BioEstat 5.0. Medidas de frequência central e de dispersão foram obtidas e os resultados apresentados em forma de tabelas e gráficos. Na análise estatística, foi empregado o teste Z de duas proporções com nível de significância de 5%. No período compreendido de 01 de janeiro de 1957 a 31 de dezembro de 2012, foram diagnosticados 2.114 casos de tumores odontogênicos.

Do total de casos diagnosticados, 75 casos foram retirados da análise, pois representavam a mesma lesão em diferentes momentos. Portanto, 2.039 casos de tumores odontogênicos foram incluídos e, após revisão dos casos e reclassificação diagnóstica dos tumores odontogênicos, os 2.039 casos foram agrupados em 16 tipos histológicos diferentes, entre os quais 2.029 (99,51%) eram benignos e 10 (0,49%) malignos. De uma maneira geral, os tumores odontogênicos afetam pacientes na segunda e terceira décadas de vida, sem predileção por sexo, apresentam-se menores do que 1cm de diâmetro e são diagnosticados, em média, 2 anos após seu surgimento. A maioria das lesões acometem a região posterior da mandíbula, com exceção do odontoma e tumor odontogênico adenomatóide, e apresentam aspecto radiográfico radiolúcido inespecífico, o que dificulta um diagnóstico preciso sem a avaliação anatomopatológica.

Odontogenic tumors are a complex group of lesions, varied clinical behavior and found exclusively in the oral and maxillofacial region. Originate from cells that would normally have the function of forming the tooth, a process called odontogenesis, which begins between the sixth and seventh weeks of intrauterine life. The aim of this study was a clinicopathological study of odontogenic tumors diagnosed in Surgical Pathology Service of Oodontologia of the University of São Paulo from 1957 to 2012 were compiled from surveys of request forms and / or records data on gender, age at diagnosis, skin color (white, black, or other), symptoms, lesion size, duration, anatomic location, radiographic findings, clinical and histopathological diagnosis. The cases diagnosed as odontogenic tumors were reviewed by a calibrated examiner, in order to reclassify injuries as current proposition of the World Health Organization in 2005. All data were entered and tabulated in Microsoft Office Excel 2013 and analyzed in software BioEstat 5.0. Central frequency and dispersion measurements were obtained and the results presented in tables and graphs. In the statistical analysis, we used the Z test for similar proportions with 5% significance level. In the period of January 1, 1957 to December 31, 2012 were diagnosed 2,114 cases of odontogenic tumors. Of all diagnosed cases, 75 cases

were removed from the analysis because they represented the same injury at different times. Therefore, 2,039 odontogenic tumors were included and, after review of the cases and diagnostic reclassification of odontogenic tumors, 2,039 cases were grouped into 16 different histological types, including 2 029 (99.51%) were benign and 10 (0, 49%) malignant. In general, the odontogenic tumors affect patients in the second and third decades of life, with no gender preference, are presented less than 1cm in diameter and are diagnosed on average two years after its inception. Most injuries involve the posterior mandible, except for the odontoma and adenomatoid odontogenic tumor, and feature radiolucent radiological findings nonspecific, which hinders accurate diagnosis without pathological assessment.

Keratocystic odontogenic tumor: clinicopathological aspects and treatment / Tumor odontogénico queratoquístico: aspectos clínico-patológicos y tratamiento

The keratocystic odontogenic tumor is a benign intraosseous neoplasm derived from remnants of the dental lamina and it occurs with high frequency. Regarding histological characteristics, it has a high recurrence rate which is one of the main therapeutic problems. Also, it presents high local aggressiveness, expressed in cortical expansion, delayed eruption and displacement of teeth, blood vessels and nerves. At present, there are various treatments, being ideal the one which presents the lowest risk of recurrence with low morbidity for the patient. In this review, the main histopathological, clinical and therapeutic aspects of this oral pathology are discussed.

El tumor odontogénico queratoquístico es una neoplasia intraósea benigna que deriva de restos de la lámina dental, y que se presenta con alta frecuencia. Sus características histológicas le confieren una elevada tasa de recidiva, siendo este uno de sus principales problemas terapéuticos. Presenta además una considerable agresividad local, la cual se expresa con la expansión de corticales óseas, retardo en la erupción y desplazamiento de dientes, vasos sanguíneos y nervios. En la actualidad existen diversos tratamientos, siendo el ideal aquel que presente el menor riesgo de recidiva con una baja morbilidad para el paciente. En la presente revisión se discuten los principales aspectos histopatológicos, clínicos y terapéuticos de esta patología oral.

Tumor odontogénico queratoquístico: revisión de la literatura a propósito de un caso clínico / Keratocystic odontogenic tumor: a review of the literature in reference to a clinical case

El Tumor odontogénico queratoquístico es una entidad benigna de prevalencia relativamente alta que surge desde los remanentes de la lámina dental, el cual tiene un potencial comportamiento agresivo y alta recurrencia. Este tiende a crecer lentamente dentro del canal medular en sentido anteroposterior transformándose en una gran lesión sin causar una expansión obvia. Esta revisión describe la clínica, imagenología y tratamientos actuales del Tumor Odontogénico Queratoquístico a propósito de un paciente de sexo masculino 30 años diagnosticado con esta entidad.

Keratocystic Odontogenic tumor is a benign entity with relatively high prevalence that arises from remains of dental lamina. It has a potentially aggressive behaviour, high recurrence and anteroposterior slow growth in the medullar canal, which can become large lesion without obvious expansion. This review describes clinical, imagenological and current treatments of Keratocystic Odontogenic Tumor in 30- year-old male patient diagnosed with this entity.

Tumor odontogênico queratocístico: uma análise retrospectiva de 97 casos em 10 anos / Keratocystic odontogenic tumor: a retrospective analysis of 97 cases in 10 years

A presente pesquisa objetivou realizar um levantamento epidemiológico retrospectivo do tumor odontogênico queratocístico no Serviço de Patologia Bucal do Curso de Graduação em Odontologia da Universidade de Fortaleza, no período de novembro de 2001 a março de 2011. Os dados foram coletados pela revisão das fichas de requisição de exame histopatológico e seus respectivos laudos, buscando dados relativos à idade, sexo, raça, localização, tipo de biópsia, associação com dentes inclusos, presença de sintomatologia e hipótese diagnóstica no momento da biópsia. Foram coletados 97 casos, consistindo 14,51% dos cistos odontogênicos neste período. O perfil demográfico encontrado foi formado, na maioria, por pacientes do sexo masculino em 50 casos (48,4%), leucodermas 40 (54%), com idade média de 34,3 anos, variando de 9 a 77, acometendo predominantemente a região posterior da mandíbula em 51 (67,1%), sendo assintomáticos em 52 (72,2%) dos casos

This research aimed to perform a retrospective epidemiological study of keratocystic odontogenic tumor at the Department of Oral Pathology of the Graduate Program in Dentistry, of the Universidade de Fortaleza, from November of 2001 to March 2011.Data were collected through review of histopathology test request form and its reports, searching for data regarding: age, gender, race, location, type of biopsy, association with impacted teeth, presence of symptoms and diagnosis hypothesis in case of biopsy. Ninety seven cases were selected, corresponding to 12.9% of odontogenic cysts collected in this period. The demographic profile was found to be composed mostly of male patients in 50(48.4%), Caucasian 40(54%), with a average age of 34.3 years, ranging from 9 to 77 years , affecting mainly the posterior region of the mandible in 51 patients (67.1%) and asymptomatic in other 52 cases (72.2%)

Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.

Aplicabilidade da técnica de cell block na avaliação citológica do conteúdo de lesões de aspecto cístico dos maxilares / Applicability of cell block technique for cytological evaluation of biological material collected from maxillary cystic lesions

INTRODUÇÃO: A busca por novos métodos que auxiliem e simplifiquem de maneira eficaz o diagnóstico de lesões maxilares, cistos e tumores, objetiva beneficiar os pacientes e facilitar a atuação dos profissionais da área de diagnóstico bucal. Além dos dados clínicos, radiográficos e histopatológicos classicamente utilizados nos protocolos de investigação das lesões maxilares, a adaptação de técnicas já consagradas na medicina pode ser de grande valia. A técnica de cell block se propõe a auxiliar nesse processo, pois consiste na análise citológica de materiais, efusões e líquidos, coletados de lesões passíveis de punção aspirativa, como cistos e tumores císticos dos maxilares. OBJETIVO: Demonstrar a aplicabilidade da técnica de cell block para avaliação citológica de material biológico coletado a partir de lesões císticas dos maxilares. RESULTADOS: Das 20 lesões, das quais o conteúdo foi processado pela técnica, a avaliação citológica de cinco casos de tumores odontogênicos ceratocísticos (TOCs) demonstrou a presença predominante de ceratina, sempre com áreas de paraceratina. Nos demais casos (cinco cistos dentígeros, cinco cistos radiculares e cinco cistos residuais) foi observada a presença de hemácias, células inflamatórias e fendas de cristais de colesterol. CONCLUSÃO: A avaliação citológica, a partir da técnica de cell block, foi útil no estabelecimento do diagnóstico diferencial entre TOC e demais lesões estudadas, cistos radicular, residual e dentígero.

INTRODUCTION: The search for new methods that aid and optimize the diagnosis of cystic and tumoral maxillary lesions aims to benefit both patients and professionals from oral diagnosis. In addition to clinical, radiographic and histological findings traditionally used in research protocol for maxillary lesions, the adaptation of widely used medical techniques may be very helpful. The cell block procedure streamlines this process, inasmuch as it consists of cytopathological analysis of materials, liquids and effusions, collected from aspirated lesions such as maxillary cysts and cystic maxillary tumors. OBJECTIVE: To demonstrate the applicability of cell block technique for cytological assessment of biological material collected from cystic maxillary lesions. RESULTS: The cytological evaluation revealed that five out of 20 lesions, whose content had been processed by this technique, were odontogenic keratocystic tumors (TOCs), predominantly with keratin and always with parakeratin areas. In the other cases (five dentigerous, five radicular and five residual cysts) there were erythrocytes, inflammatory cells, and cholesterol clefts. CONCLUSION: The cytological assessment through cell block technique was useful as to establishing the differential diagnosis between TOC and other lesions, radicular, residual and dentigerous cysts.

Peripheral squamous odontogenic tumor.

A case of peripheral squamous odontogenic tumor is described in a 60-year-old female who presented with a sessile growth in the right posterior mandible. Radiographic examination revealed no evidence of a central lesion in bone. With the characteristic histopathological picture of benign-appearing islands of squamous epithelium scattered randomly against a background of mature fibrous connective tissue, the tumor was diagnosed as peripheral squamous odontogenic tumor (PSOT). The epithelial islands showed peripheral cuboidal or flattened cells, microcyst formation, individual cell keratinization, and keratin pearl formation.

Perfil de expressão das metaloproteinases de matriz (MMPs) e seus inibidores (TIMP e RECK) em tumores odontogênicos benignos / Expression profile of matrix metalloproteinases (MMPs) and their inhibitors (TIMP and RECK) in odontogenic tumors benign

Os tumores odontogênicos benignos compreendem um grupo de neoplasias originárias dos tecidos dentários. Pesquisas vêm buscando identificar moléculas envolvidas nos mecanismos moleculares que regulam a remodelação da matriz extracelular (MEC) e como isto influencia no comportamento localmente invasivo presente em alguns destes tumores. A Transição Epitélio-Mesenquimal (TEM conversão do fenótipo epitelial em mesenquimal) é bem caracterizada em diversos carcinomas, culminando em mestástase. MMPs são enzimas que degradam os componentes da MEC, geram moléculas bioativas, participam da TEM e o controle da remodelação da MEC dá-se pelo balanço entre elas, seus inibidores (TIMPs e RECK) e seu ativador (EMMPRIN). Assim, o objetivo deste trabalho foi delinear o perfil de expressão das MMPs (-2, -7, -9 e -14), seus inibidores (TIMPs -2, -3, -4 e RECK), seu ativador (EMMPRIN) e marcadores da TEM (Snail, Slug, N-caderina, Fibronectina, a-Actina de músculo liso e Vimentina) em Ameloblastomas (AB) e Tumores Odontogênicos Cístico Calcificantes (TOCC). Ainda, realizamos a comparação da expressão de cada molécula avaliada em cada compartimento celular (epitélio e estroma) e correlação entre as moléculas avaliadas no mesmo tumor. Utilizamos 19 casos de AB e 18 casos de TOCC (Serviço de Anatomia Patológica da FOUSP), localização das enzimas/proteínas por imunoistoquímica e analisadas nos compartimentos epitelial e estromal

Todas as proteínas/enzimas analisadas foram detectadas tanto nos AB quanto nos TOCC, sendo a maioria expressa em ambos os compartimentos. A N-caderina foi localizada apenas no epitélio dos AB e a Vimentina somente no estroma em ambos os tumores. Na comparação entre o epitélio x estroma dos ameloblastomas, verificamos que houve diferença estatisticamente significante (p<0,05) para a MMP-2, MMP-7, EMMPRIN/CD147, Fibronectina, a-Actina de músculo liso, N-caderina, Vimentina, Snail e Slug. Na comparação entre o epitélio x estroma dos TOCC, verificamos que houve diferença estatisticamente significante (p<0,05) para a MMP-9, RECK, EMMPRIN/CD147, Vimentina, N-caderina, Snail e Slug. Assim, entre o epitélio x estroma dos ameloblastomas e TOCC, verificamos que houve diferença estatisticamente significante (p<0,05) para a MMP-2, MMP-7, MMP-9, RECK, EMMPRIN/CD147, Fibronectina, Vimentina, a-Actina de músculo liso, N-caderina, Snail e Slug. Esta é a primeira vez que a EMMPRIN, RECK, TIMP-3, TIMP-4, Ncaderina, Snail e Slug são descritas em TOCC e TIMP-3, TIMP-4, Snail e Slug em ameloblastomas. Concluímos que estas proteínas/enzimas estão diferencialmente expressas tanto no epitélio quanto no estroma destes tumores e sugerimos que estes podem participar do comportamento localmente invasivo.

Odontogenic tumors comprise a group of benign neoplasms originating from dental tissues. Research looking for identify molecules involved in the molecular mechanisms that regulate extracellular matrix remodeling (ECM) and how this impacts on locally invasive behavior present in some of these tumors. Epithelial-Mesenchymal Transition (EMT - conversion of epithelial phenotype into mesenchymal phenotype) is well characterized in several carcinomas, leaving to metastasis. MMPs are enzymes that degrade ECM components, generate bioactive molecules, participating in the EMT and control ECM remodeling is given by the balance between them, their inhibitors (TIMPs and RECK) and its activator (EMMPRIN). The aim of this study was evaluate expression profile of MMPs (-2, -7, -9 and - 14), their inhibitors (TIMPs -2, -3, -4 and RECK), its activator (EMMPRIN) and EMT markers (Snail, Slug, N-cadherin, Fibronectin, -smooth muscle actin and Vimentin) in ameloblastomas (AB) and Calcifying Cystic Odontogenic Tumor (CCOT). We also compared the expression of each molecule assessed in each cellular compartment (epithelium and stroma) and correlation between molecules evaluated in the same tumor. We used 19 AB cases and 18 CCOT cases from files of Pathology Laboratory (FOUSP), localization of enzymes/proteins and analyzed by immunohistochemistry in epithelial and stromal compartments

All proteins/enzymes were detected in both AB and CCOT, mostly expressed in both compartments. N-cadherin was localized only in the epithelium of AB and Vimentin only in stromal in both tumors. Comparing "epithelium vs stroma" of AB, we observed a statistically significant difference (p <0.05) for MMP-2, MMP-7, EMMPRIN/CD147, Fibronectin, -smooth muscle actin, N-cadherin, Vimentin, Snail and Slug. Comparing "epithelium vs stroma" of CCOT, we observed a statistically significant difference (p <0.05) for MMP-9, RECK, EMMPRIN/CD147, Vimentin, N-cadherin, Snail and Slug. Analizing epithelium vs stroma" between AB and CCOT, we observed a statistically significant difference (p <0.05) for MMP-2, MMP-7, MMP-9, RECK, EMMPRIN/CD147, Fibronectin, Vimentin , -smooth muscle actin, N-cadherin, Snail and Slug. This is the first time that EMMPRIN, RECK, TIMP-3, TIMP-4, N-cadherin, Snail and Slug are described in CCOT and TIMP-3, TIMP-4, Snail and Slug in AB. We conclude that these proteins/enzymes are differentially expressed in both epithelium and stroma of these tumors and suggest that they may participate locally invasive behavior.

Tumor odontogénico queratoquístico: presentación de un caso clínico y revisión de la bibliografía / Keratocystic odontogenic tumor: report of a clinical case and review of the literature

El tumor odontogénico queratoquístico (TOK) es una entidad patológica benigna de origen odontogénico con tendencia a la recidiva y controversial tratamiento. Cerca del 75 por ciento se presentan en zona de rama ascendente y cuerpo mandibular, mientras que en zona sinfisaria no alcanzan el 10 por ciento de los casos. Se presenta un caso clínico en zona sinfisaria con diagnóstico de TOQ. Se realiza el tratamiento y seguimiento a distancia, revisando las características clínicas y anatomopatológicas de la entidad.

Estudo da terapêutica cirúrgica dos tumores odontogênicos queratocísticos associados ou não à síndrome do carcinoma nevóide de células basais e análise do tempo livre de recorrência / Study of surgical treatment of keratocystic odontogenic tumors associated or not to the nevoid basal cell carcinoma syndrome and analysis of recurrence-free period

O tumor odontogênico queratocístico (TOQ) é uma neoplasia cística benigna originada de remanescentes epiteliais da odontogênese, que se destaca pela alta recorrência e eventual associação com a síndrome do carcinoma nevóide de células basais (SCNCB). O presente estudo buscou responder questionamentos relacionados à sua terapêutica cirúrgica e suprir a carência de pesquisas atuais sobre as lesões associadas à SCNCB, que são ainda mais recorrentes, analisando uma amostra formada por 40 TOQs primários. As variáveis de interesse determinaram grupos amostrais, que receberam análise dos tempos livres de recorrência por função Kaplan-Meier, comparação desses tempos pelo teste log-rank com nível de significância de 5% (p < 0,05) e determinação do risco acumulado para o evento nos primeiros cinco anos. Vinte e sete lesões foram tratadas por exérese (GE) e 13 receberam terapêutica descompressiva (GD).

Tratamentos complementares ocorreram em 38 (95%) lesões, sendo ostectomia periférica isolada em 10 (GO) e combinada à solução de Carnoy em 28 (GC). Treze eram associadas à SCNCB (GS) e as demais (n = 27) representaram lesões não sindrômicas (GnS). No período de acompanhamento médio de 43,5 meses (12 102 meses), seis (15%) recorrências foram diagnosticadas. Não houve diferença significativa entre os tempos livres de recorrência nos grupos comparados (p > 0,05), nem expressividade do risco acumulado para o evento na terapêutica descompressiva (15,4%) e na associação com a SCNCB (12,5%). A aplicação da solução de Carnoy não aumentou a efetividade da ostectomia periférica, mas se relacionou com risco acumulado de recorrência de 0% ao final do quinto ano de acompanhamento pós-exérese nas lesões sindrômicas. Portanto: 1) a terapêutica descompressiva não aumentou o risco para recorrências; 2) a ostectomia periférica mostrou efetividade similar quando combinada à solução de Carnoy, pelo menos nas lesões não associadas à SCNCB; 3) o risco de recorrência das lesões associadas à SCNCB também foi controlado por tratamentos complementares.

The keratocystic odontogenic tumor (KOT) is a benign cystic neoplasm originating from odontogenic epithelial remnants which is highlighted by its high recurrence rate and occasional association with the nevoid basal cell carcinoma syndrome (NBCCS). The present study aimed to answer questions related to its surgical therapy and to fulfill the lack of recent researches over the lesions associated to the NBCCS, which are even more recurrent, analyzing a sample ok 40 primary KOTs. Variables of interest determined sample groups that underwent recurrence-free period analyses by Kaplan-Meier function, comparing these results by log-rank test with a significance level of 5% (p < 0.05) and determination of cumulative risk for the recurrence event within the first five years. Twenty seven lesions were treated by exeresis (GE) and 13 underwent decompressive therapeutic (GD). Complementary treatment occurred in 38 (95%) lesions being as isolated peripheral ostectomy in 10 (GO) and combined with Carnoys solution in 28 (GC). Thirteen were associated to NBCCS (GS) and the others (n = 27) represented non syndromic lesions (GnS). For the mean follow-up period of 43.5 months (12 102 months), six (15%) recurrences were diagnosed.

There was no significant difference among recurrence-free periods for the compared groups (p > 0.05) or cumulative risk expression for the decompressive therapeutic (15.4%) or for the association with NBCCS (12.5%). Carnoys solution application did not increase the efficacy of the peripheral ostectomy but was related to the cumulative recurrence risk of 0% at the end of the fifth year of post-exeresis follow-up for syndromic lesions. Therefore: 1) the decompressive therapeutic did not increase the recurrence risk; 2) peripheral oostectomy demonstrated similar efficacy when combined to Carnoys solution, at least for lesions not associated to NBCCS; 3) the recurrence risk of lesions associated to NBCCS was also controlled by complementary treatments.