Trifid nasopalatine canal: case report of a rare anatomical variation and its surgical implications / Conducto nasopalatino Trifid: presentación de caso de una variación anatómica rara y sus implicaciones quirúrgicas

The nasopalatine canal is a long slender structure present in the midline of the anterior maxilla that connects the palate to the floor of the nasal cavity. The nasopalatine canal contains the nasopalatine nerve, the terminal branch of the nasopalatine artery, fibrous connective tissue, adipose tissue, and minor salivary glands. The purpose of this article was to report a case of a trifid nasopalatine canal detected by cone beam computed tomography prior to dental implant placement. A 47-year-old female patient was submitted to cone beam computed tomography. Axial and sagittal sections revealed a trifurcation of the nasopalatine canal. Each canal was separated from the other by bony septa and extended independently from the floor of the nasal cavity to the incisive foramen in the remnant of the alveolar process in the anterior region of the maxilla. Cone beam computed tomography has permitted better visualization of the details and anatomical variations of the nasopalatine canal. Detailed knowledge of variations in the shape, number and size of the nasopalatine canal is fundamental for surgical procedures, such as local anesthesia in the anterior maxillary region and placement of dental implants, in order to prevent damage to important arteries and nerves(AU)

El canal nasopalatino es una larga estructura delgada presente en la línea media del maxilar anterior que conecta el palato al suelo de la cavidad nasal. El canal nasopalatino contiene el nervio nasopalatino, la rama terminal de la arteria nasopalatina, el tejido conectivo fibroso, el tejido adiposo y las glándulas salivales menores. El propósito de este artículo es presentar el caso de un canal nasopalatino trifid detectado a través de tomografía computarizada de haz cónico anterior a la colocación de implantes dentales, en una paciente de femenino 47 años de edad. Secciones axiales y sagitales revelaron la trifurcación del canal nasopalatino. Cada canal se apartó del otro por tabiques ósea y extendida independientemente del suelo de la cavidad nasal para el agujero incisivo en el remanente del proceso alveolar en la región anterior del maxilar. La tomografía computarizada de haz cónico ha permitido una mejor visualización de los detalles y variaciones anatómicas del canal nasopalatino. El conocimiento detallado de las variaciones en su forma, el número y el tamaño del canal nasopalatino es fundamental para los procedimientos cirúrgicos, así como la anestesia local en la región anterior del maxilar superior y la colocación de los implantes dentales, con el fin de prevenir el daño a las arterias y a los nervios importantes(AU)

Association between radiographic features and cell proliferation in keratocystic odontogenic tumor / Asociación entre las características radiográficas y la proliferación celular en el tumor odontogénico queratoquístico

The radiographic features of an intraosseous lesion are usually associated with the biological behavior of the tumor. In view of the fact that the growth and behavior of keratocystic odontogenic tumors (KCOT) is mainly associated with the proliferation of the cystic epithelium, the objective of the present study was to evaluate the relationship between cell proliferation markers and radiographic features of this tumor. Thirty-seven radiographs of KCOT obtained from 30 patients were scanned and evaluated on a monitor. Sections were submitted to immunohistochemistry for Ki-67, p63, and p53 proteins on an EnVision system. Thirty-one KCOTs were observed in the posterior of the mandible, and the unilocular aspect was predominant (n= 26). Nineteen KCOTs distorted the mandibular canal and 11 displaced teeth. Satellite cysts were associated with a multilocular aspect (P= 0.016). p53 was in KCOTS with diffuse margins (p=0.049), p63 with NBCCS (p=0.049) KOT and higher KI-67 positive cells was observed in KCOTs presenting distortion of the mandibular canal (p=0.042). The distribution of Ki-67, p63, and p53 positive cells was similar between KCOTs with uni- and multilocular aspects. The results of the present study suggest that cell proliferation in KCOT contributes to the radiographic features of this tumor.

Las características radiográficas de una lesión intraósea se asocian generalmente con el comportamiento biológico del tumor. Debido a esto, el crecimiento y comportamiento de los tumores odontogénicos queratoquísticos se asocian principalmente con la proliferación del epitelio quístico. El objetivo del estudio fue evaluar la relación entre los marcadores de proliferación celular y las características radiológicas de este tumor. Se escanearon y evaluaron 37 radiografías de tumores odontogénicos queratoquísticos obtenidos de 30 pacientes y las secciones de sus biopsias fueron sometidas a evaluación inmunohistoquímica para las proteíneas Ki-67, p63 y p53 en un sistema Envision. Se observaron 31 tumores odontogénicos queratoquísticos en el área posterior de la mandíbula, con predominio del aspecto unilocular (n= 26). Diecinueve tumores odontogénicos queratoquísticos distorsionaron el canal mandibular y se observaron 11 dientes desplazados. Los quistes satélites se asociaron con el aspecto multilocular (P= 0,016). La distribución de células positivas para Ki-67, p63 y p53 fue similar entre tumores odontogénicos queratoquísticos con aspectos uniformes y multiloculares, y no estaban relacionadod con la distorsión del canal mandibular (P>0,05) o con el desplazamiento del diente (P>0,05). Los resultados del presente estudio sugieren que la proliferación celular en tumores odontogénicos queratoquísticos contribuye a las características radiográficas de este tumor.

Immunohistochemistry assessment of Langerhans cells and microvascular density in oral squamous cell carcinomas / Avaliação imuno-histoquímica de células de Langerhans e densidade microvascular em carcinoma oral de células escamosas

The aim of this study was to assess and correlate microvascular density (MVD) and the quantity of Langerhans cells (LC) present in oral squamous cell carcinoma (OSCC), well as the correlation between this microvascular density and number of Langerhans cells (LCs) with the intensity of the infiltrate, the histologic grading and staging, according to the TNM system. Twenty-three paraffin-embedded blocks of SCC lesions were analyzed using the immunohistochemical technique in which the two anti-CD1a and anti-CD207 markers were used to quantify the Langerhans cells and the CD34 marker to assess MVD. Immunostaining for CD1a, CD207 and CD34 was observed in 100% of the cases analyzed, showing a statistically significant association (p = 0.0001, Fisher’s test). No statistical correlation between MVD and LC or between immunostainings and histological grading of malignancy were found. However, immunostaining for CD1a and CD207 showed a statistically significant correlation (p value = 0.001, Spearman test) and a positive correlation was found between MVD and lymph node involvement. The LCs and MVD seem to involved in immunopathogenesis of oral carcinoma, although no statistically significant correlation was found between these two findings

O objetivo deste estudo foi avaliar e correlacionar a densidade microvascular (MVD) e a quantidade de células de Langerhans (LC) presente no carcinoma epidermoide de boca (CEB), bem como a correlação entre esta densidade microvascular e número das células de Langerhans (CL), com a intensidade do infiltrado, a classificação histológica e de teste, de acordo com o sistema TNM. Vinte e três blocos de parafina-encaixados de lesães SCC foram analisados utilizando a técnica de imuno-histoquímica em que os dois marcadores anti-CD1a e anti-CD207 foram usados para quantificar as células de Langerhans e o marcador CD34 para avaliar MVD. A imunocoloração para CD1a, CD207 e CD34 foi observada em 100% dos casos analisados, demonstrando uma associação estatisticamente significativa (p = 0,0001, teste de Fisher). Não houve correlação estatística entre MVD e LC ou entre imunomarcações e gradação histológica de malignidade foram encontrados. No entanto, a imunocoloração para CD1a e CD207 mostraram uma correlação estatisticamente significativa (p = 0,001, teste de Spearman) e foi encontrada uma correlação positiva entre MVD e comprometimento de linfonodos. O LCs e MVD parecem envolvidos em imunopatogênese de carcinoma oral, embora não foi encontrada correlação estatisticamente significativa entre estes dois resultados.

Via Hedgehog em carcinoma escamocelular de boca: associação com macrófagos CD163+, angiogênese, ploriferação e diferenciação celular / Hedgehog pathway in mouth squamous cell carcinoma: association with CD163 + macrophages, angiogenesis, and cell differentiation ploriferação

INTRODUÇÃO/OBJETIVO: O Carcinoma Escamocelular de Boca (CEB) corresponde a mais de 95% dos casos de câncer diagnosticados na cavidade bucal e consiste numa neoplasia invasiva e agressiva. Sabendo-se que a via Hedgehog (HH) está envolvida na patogênese de diversos tumores, o presente trabalho propôs-se a avaliar a expressão de componentes desta via em CEB, associando a expressão destas moléculas com aspectos clínicos, angiogênese, graus de diferenciação tumoral, potencial proliferativo e macrófagos CD163+. MATERIAL E MÉTODOS: Vinte e oito casos de CEB, 9 casos de margens tumorais (MAT) e 4 casos de mucosa bucal não neoplásica (MNN) foram submetidos à reação imuno-histoquímica para as proteínas MCM3, SHH, IHH, GLI1, CD163 e CD105 utilizando o sistema polimérico AdvanceTM. A co-localização das proteínas IHH/CD163 e GLI1/CD105 foi avaliada através de dupla marcação imuno-histoquímica. As análises das proteínas MCM3, SHH, IHH e GLI1 foram realizadas em 5 áreas coincidentes de cada caso, de acordo com os parâmetros semi-quantitativos descritos por Gurgel et al. (2008). A densidade de macrófagos (DM) e microdensidade vascular (MDV) foram mensuradas considerando-se a população destas células e vasos neoformados em 5 áreas e os resultados expressos em cel/mm² e vasos/mm². A análise estatística foi realizada utilizando GraphPad Prism versão 6.03. RESULTADOS: Todos os casos de CEB foram positivos para a proteína MCM3, em citoplasma e núcleo de células do parênquima tumoral, sendo o escore 4+ predominante (n=19; 67,85%)...

INTRODUCTION/OBJETIVE: The Oral Squamous Cell Carcinoma (OSCC) accounts for over 95% of all cancers diagnosed in the oral cavity and it consists on an invasive and aggressive type of tumor. The Hedgehog pathway (HH) has been involved in the pathogenesis of different tumors. The aim of this study was to evaluate the components of the HH pathway in OSCC, correlating the results with clinical aspects, angiogenesis, tumor differentiation, proliferative potential and macrophages CD163+. MATERIAL AND METHODS: Twenty-eight cases of OSCC, 9 cases of tumor margins (TM) and 4 cases of non-neoplastic oral mucosa (NNM) were submitted to immunohistochemical reaction for MCM3, SHH, IHH, GLI1, CD163 and CD105 proteins using the AdvanceTM polymer system. Co-localization for IHH/GLI1 and CD163/CD105 proteins was evaluated using double staining method. The analysis of MCM3, SHH, IHH and GLI1 proteins were conducted in 5-matching areas and data described using the semi-quantitative parameters described by Gurgel et al. (2008). The density of macrophages (MD) and microvessel density (MVD) were measured considering the population of these cells and newly formed vessels in 5-matching areas and the results expressed in cells/mm² and vessels/mm², respectively. Statistical analysis were performed using GraphPad Prism v. 6.03. RESULTS: All cases of OSCC were positive for MCM3 protein on the cytoplasm and nucleus of tumor cells, and 4+ was the main score (n= 19; 67.85%)...