Oral exfoliative cytology and corrosion of metal piercings. Tissue implications.

OBJECTIVES: A group of adolescents with oral piercings was studied to determine the presence of metallic particles in cells exfoliated from the mucosa surrounding their metal oral piercings and the association between such particles and the metal jewelry, and to evaluate subsequent tissue implications. MATERIALS AND METHODS: Sixteen teenage patients who had tongue and/or lip piercings were included. The clinical features of the oral mucosa and lip skin were evaluated. Exfoliative cytology was performed in the area surrounding the piercing. The surface of used and unused jewelry was studied by scanning electron microscopy and energy dispersive X-ray analysis. RESULTS: Hyperplastic, leukoedematous, and lichenoid lesions were observed in the mucosa, as well as lesions associated with metallosis of the lip skin. Cytological smears showed the presence of particles inside the epithelial cells; the particles were found to contain aluminum, tungsten, and molybdenum. In one case requiring surgical removal of the piercing, histological examination of the tissue associated with the piece of jewelry showed the presence particles containing aluminum, iron, and tin inside multinucleated giant cells. Although surface finish defects were observed on both unused and used piercing jewelry, they were more evident on the used pieces. CONCLUSIONS: Ion particles are released from the metal piercings and could have been adjuvant factors in the development of the observed lesions. Cells exfoliated from the oral mucosa surrounding metal piercings may serve as bioindicators of corrosion processes. CLINICAL RELEVANCE: We propose the use of exfoliative cytology to monitor corrosion processes and for routine clinical follow up.

Helicobacter pylori and oral pathology: relationship with the gastric infection.

Helicobacter pylori (H. pylori) has been found in the oral cavity and stomach, and its infection is one of the most frequent worldwide. We reviewed the literature and conducted a Topic Highlight, which identified studies reporting an association between H. pylori-infection in the oral cavity and H. pylori-positive stomach bacterium. This work was designed to determine whether H. pylori is the etiologic agent in periodontal disease, recurrent aphthous stomatitis (RAS), squamous cell carcinoma, burning and halitosis. Record selection focused on the highest quality studies and meta-analyses. We selected 48 articles reporting on the association between saliva and plaque and H. pylori-infection. In order to assess periodontal disease data, we included 12 clinical trials and 1 meta-analysis. We evaluated 13 published articles that addressed the potential association with RAS, and 6 with squamous cell carcinoma. Fourteen publications focused on our questions on burning and halitosis. There is a close relation between H. pylori infection in the oral cavity and the stomach. The mouth is the first extra-gastric reservoir. Regarding the role of H. pylori in the etiology of squamous cell carcinoma, no evidence is still available.

Primary melanoma of the oral cavity: Ten cases and review of 177 cases from literature

Oral melanoma is an infrequent but aggressive neoplasm. In contrast to cutaneous melanoma, it does not have a defined set of clinical and pathologic classification criteria. We present 10 cases of primary melanoma of the oral mucosa, and review 177 cases published in the international literature. Patients and methods: We compiled a database of patients seen at our department between years 1990 and 2004. A retrospective study of this data was performed. Age, sex, localization and histopathology were all considered. Tobacco consumption and the presence of traumatic factors in the oral cavity were also compared. We compiled another database with 177 cases reported in the international literature during the same time period. Primary and metastatic cases were included. Age, sex and localization were among the factors taken into account. Results: Of the total of 23,685 patients seen at our department in this period, 399 (1.68%) were diagnosed with cancer, 10 (2.5%) of whom were diagnosed with primary oral melanoma. The gender distribution was 1:1, and ages ranged from 30 to 88 years old, with a mean of 67.5 years old. In 80% of the cases, the oral melanoma was localized in the maxillary, and in 20% of the cases, it was localized in the mandible. No connection was found with tobacco consumption. In 60% of the cases, we believe there was a link with prosthetic microtrauma. Of the 177 cases described in the literature, 89% were primary and 11% secondary. The gender distribution was 46.9% female and 53.1% male. Ages ranged from 16 to 91 years old, with a mean of 59.2 years old. Localization: 68.36% maxillary, 11.30% mandible and 20.34% in various oral localizations (AU)

Primary melanoma of the oral cavity: ten cases and review of 177 cases from literature.

UNLABELLED: Oral melanoma is an infrequent but aggressive neoplasm. In contrast to cutaneous melanoma, it does not have a defined set of clinical and pathologic classification criteria. We present 10 cases of primary melanoma of the oral mucosa, and review 177 cases published in the international literature. PATIENTS AND METHODS: We compiled a database of patients seen at our department between years 1990 and 2004. A retrospective study of this data was performed. Age, sex, localization and histopathology were all considered. Tobacco consumption and the presence of traumatic factors in the oral cavity were also compared. We compiled another database with 177 cases reported in the international literature during the same time period. Primary and metastatic cases were included. Age, sex and localization were among the factors taken into account. RESULTS: Of the total of 23,685 patients seen at our department in this period, 399 (1.68%) were diagnosed with cancer, 10 (2.5%) of whom were diagnosed with primary oral melanoma. The gender distribution was 1:1, and ages ranged from 30 to 88 years old, with a mean of 67.5 years old. In 80% of the cases, the oral melanoma was localized in the maxillary, and in 20% of the cases, it was localized in the mandible. No connection was found with tobacco consumption. In 60% of the cases, we believe there was a link with prosthetic microtrauma. Of the 177 cases described in the literature, 89% were primary and 11% secondary. The gender distribution was 46.9% female and 53.1% male. Ages ranged from 16 to 91 years old, with a mean of 59.2 years old. Localization: 68.36% maxillary, 11.30% mandible and 20.34% in various oral localizations.

Sensitivity of direct immunofluorescence in oral diseases. Study of 125 cases.

UNLABELLED: Direct immunofluorescence (DIF) is widely used for the diagnosis of bullous diseases and other autoimmune pathologies such as oral lichen planus. There is no evidence in the literature on how the following variants influence the detection rate of DIF: intraoral site chosen for the biopsy, perilesional locus or distant site from the clinical lesion, number of biopsies and instrument used. OBJECTIVES: to determine if the following variants influenced the sensitivity (detection rate): intraoral site chosen for the biopsy, perilesional or distant site from the clinical lesion, number of biopsies and instrument used (punch or scalpel). MATERIAL AND METHODS: A retrospective study was done at the Cátedra de Patología y Clínica Bucodental II at the Facultad de Odontología, Universidad de Buenos Aires; 136 clinical medical histories were revised for the period March 2000 - March 2005 corresponding to patients with clinical diagnosis of OLP and bullous diseases (vulgar pemphigus, bullous pemphigoid and cicatricial pemphigoid). RESULTS: DIF detection rate was 65.8% in patients with OLP, 66.7% in cicatricial pemphigoid patients, in bullous pemphigoid 55.6%, in pemphigus vulgaris 100%, and in those cases in which certain diagnosis could not be obtained, the DIF positivity rate was 45.5% (Pearson chi(2) (4)= 21.5398 Pr= 0.000). There was no statistically significant difference between the different sites of biopsy (Fisher exact test: 0.825). DIF detection rate in perilesional biopsies was 66.1% and in those distant from the site of clinical lesion was 64.7% (Pearson chi(2) v1)= 0.0073 Pr= 0.932. When the number of biopsies were incremented, DIF detection rate also incremented (Pearson chi(2) = 8.7247 Pr= 0.003). The biopsies taken with punch had a higher detection rate than those taken with scalpel (39.1% versus 71.7%) (Pearson chi(2) = 49.0522 Pr= 0.000). CONCLUSION: While not statistically significant, the tendency outlined in this study indicates there are intraoral regions in which the detection rate of the DIF technique is higher than others: mouth floor, hard palate, superior labial mucosa, ventral face of tongue. This finding could allow a choice of accessible locations and easy operator manipulation, even in distant places from the clinical lesion. Perilesional biopsies have a detection rate similar to those taken distant from the clinical lesion, and those taken with punch have a higher sensitivity rate than those taken with scalpel (both differences were statistically significant).

Malignant transformation of atypical oral lichen planus: a review of 32 cases.

AIMS: To assess the prevalence of malignant transformation of atypical lichen planus in our medium and describe the clinico-pathological features of the cases that had a premalignant potential. MATERIALS AND METHODS: we performed a retrospective analysis of the records of patients seen at the Stomatology Department of the School of Dentistry, University of Buenos Aires, during the period 1991-1997. A total of 719 patients (7.02%) had oral lichen planus (481 women and 238 men). From a clinico-pathological point of view, 228 (31.7%) were typical forms and 491 (68.3%) were atypical forms. In all of the cases, lichen planus was confirmed histologically and a clinical protocol was followed. RESULTS: Thirty-two (6.51%) patients were known to have developed malignant changes. In these cases the lesions had been diagnosed as atypical lichen planus at the outset. The most frequent clinical presentations were the keratotic (plaque-like) and erosive forms. Most of the lesions were on the tongue. The results support a premalignant potential for atypical lichen planus. CONCLUSION: Oral lichen planus is a precancerous condition. The atypical form, particularly in its keratotic and erosive presentations, has a premalignant potential in our medium. The most frequent localization is the tongue.

Lingual thyroid: a clinical case.

Lingual thyroid is an abnormal formation appearing as the result of a deficient descent during embryological development of the thyroid gland through the thyroglossal duct to its normal pretracheal location. The lesion consists of a tumor mass of thyroid tissue located at the base of the tongue, in the region of the foramen caecum linguae. The size can vary from a few millimeters to several centimeters in diameter. More than 400 cases of lingual thyroid have been documented in the literature to date. Lingual thyroid has been identified in 10% of the tongues examined in some autopsy series. Its identification is of great significance, since it may constitute the only functional thyroid tissue in the body, and may inadvertently be destroyed as a result of histological biopsy procedures. The present study presents a clinical case of lingual thyroid in a 17-year-old female.

Transformación maligna del Liquen Plano Bucal atípico: análisis de 32 casos / Atypical Oral Lichen Planus: a review of 32 cases

Objetivos: Conocer la prevalencia de la transformación maligna del liquen bucal atípico en nuestro medio y las características clinicopatológicas de estos casos. Material y métodos: Se realizó un estudio analítico retrospectivo sobre los pacientes atendidos en el Servicio de Patología y Clínica Bucodental II de la Facultad de Odontología, Universidad de Buenos Aires, República Argentina, desde 1991 hasta 1997. Presentaron liquen plano bucal 719 (7,02 por ciento), en 481 mujeres y 238 hombres. Clinicopatológicamente correspondían 228 (31,7 por ciento) a líquenes típicos, y 491 (68,3 por ciento) a líquenes atípicos. En todos los casos se cumplimentó un protocolo clínico y se confirmaron histológicamente. Resultados: Se reconoció transformación maligna en 32 casos (6,51 por ciento), todos ellos inicialmente diagnosticados como líquenes atípicos. Las formas clínicas más comunes fueron las queratósicas (en placa) y laserosivas. La lengua fue la localización más frecuente. Los resultados obtenidos sustentan el potencial maligno de los líquenes atípicos. Conclusión: El liquen plano bucal es un estado precanceroso que en sus formas atípicas constituye una lesión cancerizable en nuestro medio, fundamentalmente en las formas queratósicas y erosivas, y la localización más frecuentemente afectada es la lengua (AU)

Presentación de un caso clínico: tiroides lingual / Lingual thyroid: a clinical case

La tiroides lingual (TL) es una formación anormal, que aparece como consecuencia de un defecto en el descenso del tejido tiroideo a través del conducto tirogloso, hasta su normal posición pretraqueal. Está representada por una masa tumoral de tejido tiroideo, localizada en la raíz de la base de la lengua, en la región del foramen caecum. Su tamaño puede variar, de unos pocos milímetros a varios centímetros de diámetro. Esta anormalidad está descrita, en más de 400 casos de la literatura. la TL ha sido encontrada en el 10 per cent de lenguas examinadas en algunas series de autopsias, y es el resultado de un desarrollo embriológico aberrante. La identificación de la TL es de gran significancia; porque puede ser el único tejido tiroideo funcional presente del organismo, y ser inadvertidamente inutilizado durante una práctica de examen histológico. El propósito de esta presentación, es remarcar la práctica clínica y la investigación en una joven de 17 años con TL (AU)

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