Neutrophil-to-lymphocyte ratio and chemotherapy response score as prognostic markers in ovarian cancer patients treated with neoadjuvant chemotherapy.

BACKGROUND: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is the recommended approach in patients with advanced epithelial ovarian cancer (EOC). However, most patients eventually relapse despite the initial high response rate to chemotherapy. Neutrophil-to-lymphocyte ratio is a well-known biomarker that reflects severe inflammation, critical illness, and mortality in various diseases. Chemotherapy response score (CRS) and neutrophil-to-lymphocyte ratio (NLR) have been identified as potential biomarkers of platinum resistance and disease prognosis. We retrospectively evaluated 132 patients with stage IIIc or IV ovarian/fallopian tube/primary peritoneal cancer who had received NACT followed by IDS from 01/01/2003 to 31/12/2018. CRS was assessed on omental specimens collected from IDS according to ICCR guidelines. RESULTS: Median age was 64.57 years (SD: 9.72; range 39.2-87.1). Most ovarian tumors were serous epithelial (90.9%; 120/132). An elevated NLR (defined as > 3) was observed in 72% (95/132) of patients in contrast with 28% (37/132) of patients characterized by low NLR status. Median PFS (mPFS) and median overall survival (mOS) were 13.05 months (95% CI: 11.42-14.67)) and 34.69 months (95% CI: 23.26-46.12) respectively. In univariate analysis, CRS3 score was significantly associated with prolonged mPFS (CRS1/2: 12.79 months vs CRS3: 17.7 months; P = 0.008). CRS score was not associated with mOS (P = 0.876). High NLR was not significantly associated with mPFS (P = 0.128), however it was significantly associated with poor mOS (P = 0.012). In multivariate analysis, only performance of surgery maintained its statistical significance with both PFS (P = 0.001) and OS (P = 0.008). CONCLUSION: NLR could serve as a useful predictor of OS but not PFS in ovarian cancer patients receiving NACT. In accordance with our previous study, CRS score at omentum was found to be associated with PFS but not OS in ovarian cancer patients treated with NACT and IDS.

Biomarkers that would predict response to neoadjuvant chemotherapy in advanced ovarian cancer patients are eagerly needed:• Neutrophil to Lymphocyte Ratio (NLR) is an indicator of systemic inflammatory response to the malignancy.• NLR was evaluated in 132 patients undergoing Neoadjuvant Chemotherapy for advanced ovarian cancer.• Elevated NLR was associated with worse prognosis.• No association between NLR and response to chemotherapy was noted.

Immune checkpoint inhibitor administration during pregnancy: a case series.

BACKGROUND: Immune checkpoint inhibitors have been widely implemented in current clinical practice. Although cancer occurs in ∼1 out of 1000 pregnancies, treatment remains challenging. Until now, limited data exist regarding immunotherapy administration during pregnancy. This systemic review aims to synthesize all available data from immunotherapy administration in pregnant women and evaluate the efficacy and safety of immunotherapy during pregnancy. PATIENTS AND METHODS: Eligible studies were identified by a search of the PubMed Medline database and Food and Drug Administration Adverse Events Reporting System Public Dashboard for the period 1 January 2000 to 1 April 2021; the algorithm consisted of a predefined combination of the words 'immunotherapy', 'cancer' and 'pregnancy'. PRISMA guidelines were applied in this study. RESULTS: Overall, seven articles (seven pregnancies, nine neonates) were retrieved. The mean duration of immunotherapy administration was 9.8 weeks [standard deviation (SD): 11.27; median: 7.0; range: 1-32]. In all cases specified, melanoma was the malignancy reported. The mean gestational age at delivery was 30.4 weeks (SD: 5.03; median: 32.0; range: 24-38), whereas the mean weight of neonates at delivery was 1267 g (SD: 412.0; median: 1400; range: 590-1701). Only one neonate was born term at 38 weeks of pregnancy (11.1%; 1/9). Complications during pregnancy were observed in 71.4% of cases: intrauterine growth restriction (three cases), HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count) (one case), placental insufficiency (one case) and low fetal heart rate (one case). The mean progression-free survival and overall survival were 16.0 and 25.2 months, respectively. CONCLUSION: The administration of immune checkpoint inhibitors during pregnancy is associated with increased incidence of pregnancy complications, prematurity and low birth weight. The administration of these regimens is not recommended during gestation. Whenever applied, close monitoring of the mother and the fetus is required.

Palatal schwannoma in a young female patient: report of a case and review of the literature.

BACKGROUND: A few cases of oral schwannomas in paediatric patients have appeared in the literature so far; however, there are no studies focusing solely on paediatric oral schwannomas. The aim of this study is to report a case of palatal schwannoma in a young female patient and review the pertinent literature on oral schwannomas in paediatric patients. CASE REPORT: A 12-year-old girl presented with a growing swelling of 2 weeks duration on the hard palate. With a provisional diagnosis of a salivary gland neoplasm an incisional biopsy was performed under local anesthesia and the histologic examination disclosed an Antony A type schwannoma. TREATMENT: Complete surgical resection of the lesion was performed under local anaesthesia through a palatal mucosa incision and paraffin gauze was sutured on the surgical area for protection during secondary healing. The bone underlying the tumor was normal. The postoperative period was uneventful and 2 weeks after excision the gauze were removed. FOLLOW-UP: There have been no signs of recurrence during a 18-month follow up period. CONCLUSION: A palatal swelling in a child or adolescent may represent a neoplasm, such as a schwannoma and requires careful clinical and radiographic evaluation of the dentition.

Oral verruciform xanthoma: Report of 13 new cases and review of the literature.

BACKGROUND: Oral verruciform xanthoma (OVX) is a rare lesion. The purpose of the present study is to describe the clinical features of 13 OVXs and review all cases reported in the English literature. MATERIAL AND METHODS: Thirteen cases of OVX diagnosed during a 47-year period were retrospectively collected. The patients gender and age, as well as the main clinical features of the lesions were retrieved from the biopsy request forms. Pubmed, Scopus and Google ScholarTM electronic databases were searched with the key word verruciform xanthoma. Only cases of histologically confirmed OVX were included in the study. RESULTS: The 13 OVXs represented approximately 0.04% of 35,617 biopsies accessioned during the study period. They affected 13 patients, 8 males and 5 females with a mean age of 48.8±14 years. They mainly appeared as asymptomatic granular nodules or plaques, with elastic or normal consistency and white color, in the gingiva or hard palate. Literature review yielded 416 cases of OVX. With the addition of cases of the present study, 429 cases of OVX have been presented in the English literature. OVX has a slight male predominance with a male to female ratio of 1.4:1 and the majority of patients are in the 5th to 7th decade of life. Clinically, OVX mainly presents as an asymptomatic, single, papillary or granular plaque or nodule, with elastic or soft consistency and white, red or pink color. It measures approximately 1cm and is most commonly located on the gingiva, tongue, hard palate or buccal mucosa. The treatment of choice is surgical excision with little rates of recurrence. CONCLUSIONS: Verruciform xanthoma is a rare lesion most often encountered on the ginigival mucosa. As its clinical presentation is not pathognomonic, it should be included in the differential diagnosis of verrucous or papillary lesions.

Localized gingival enlargements. A clinicopathological study of 1187 cases.

BACKGROUND: To describe the incidence, demographic and clinical features of 1187 localized gingival enlargements. MATERIAL AND METHODS: 1187 cases of localized gingival enlargements diagnosed during a 20-year period were retrospectively collected. The patients' gender and age, as well as the main clinical features of the tumors were retrieved from the biopsy report forms. RESULTS: The 1187 localized gingival enlargements represented 6.23% of 19.044 biopsies performed during the study period. 756 females and 427 males were affected with a mean age of 41.92±19.68 years. The lesions appeared as smooth (52.4%), granular (17.9%) or rough (13.16%) tumors, elastic (50.73%) or soft (29.56%) in consistency and red (60.8%), normal (28.58%) or white (8.17%) in color. The majority of the lesions (85.17%) were reactive in origin with pyogenic granuloma being the most common. In 1.1% of the cases a diagnosis of malignant lesion was rendered. CONCLUSIONS: All localized gingival enlargements should be submitted for microscopic examination because in approximately 1% of cases they are malignant.

Lichenoid lesions of the upper lip: A retrospective study of 24 cases.

BACKGROUND: Lichenoid lesions of the upper labial mucosa, without other oral or extraoral manifestations seem to be rare. The clinicopathologic features of 24 such cases are presented and the pertinent literature is reviewed. MATERIALS AND METHODS: 24 Caucasian patients that clinically presented lichenoid features on the upper labial mucosa, with or without lichenoid lesions on the adjacent gingiva, were included in the study. Clinical features were extracted from the patients' records, while dental plaque/calculus accumulation and composite resin restorations of the adjacent teeth were recorded. Four cases where an incisional biopsy was performed were further evaluated. RESULTS: There were 8 males and 16 females, with a mean age of 62.7 years. 64.2% were under hypertensive therapy. In 13 cases gingival involvement was noticed, 16 cases exhibited calculus deposition, while 6 cases presented with composite resin fillings of the adjacent teeth. In 4 cases an incisional biopsy was performed showing features of lichenoid reaction. In 37.5% significant improvement was observed after topical treatment with corticosteroids and antimicrobial agents. CONCLUSION: Lichenoid lesions of the upper lip may represent a distinct variety of oral lichenoid lesions, but as the number of cases reported so far is too small for definite conclusions on pathogenesis and management to be made, a long-term follow-up is mandatory.

Orofacial granulomatosis as early manifestation of Crohn's disease: report of a case in a paediatric patient.

BACKGROUND: Orofacial granulomatosis (OFG) is a controversial entity mainly characterised by recurrent or permanent soft tissue swelling of sudden onset in the orofacial area with a histologic appearance of granulomatous inflammation. Differential diagnosis includes local diseases and systemic conditions, such as Crohn's disease (CD). A case of OFG in a paediatric patient is reported here, focusing on the clinical features, diagnostic procedures, treatment and long-term outcome. CASE REPORT: A 7 year-old boy presented with persistent and prominent lip swelling and painful oral mucosa lesions of six months duration. A biopsy of the lower labial mucosa revealed granulomatous inflammation consistent with OFG. The oral manifestations were managed with topical and intralesional corticosteroids. His medical history included gastrointestinal disturbances, perianal skin folds and bloody stools that raised the suspicion of CD. Colonoscopy showed inflammation without clear evidence of CD. One year later, repeated bowel investigation provided evidence suggestive of CD and the patient was placed under systemic treatment. Two years after the initial diagnosis the patient is free of oral or other pathological findings. CONCLUSION: The differential diagnosis in cases of orofacial swellings with histological granulomatous inflammation includes a variety of local and systemic diseases, diagnosis and management of which require full investigation and cooperation by a team of healthcare providers.

Multicenter external validation of the ABCD2 score in triaging TIA patients.

OBJECTIVES: A simple clinical score (ABCD(2) score) has been introduced to triage TIA patients with a high early risk of stroke. External validation studies have yielded inconsistent results regarding the predictive ability of the ABCD(2) score. We aimed to prospectively validate the former score in a multicenter case series study. METHODS: We prospectively calculated the ABCD(2) score (age [> or = 60 years: 1 point]; blood pressure [systolic >140 mm Hg or diastolic >90 mm Hg: 1[; clinical features [unilateral weakness: 2, speech disturbance without weakness: 1, other symptom: 0]; duration of symptoms [ <10 minutes: 0, 10-59 minutes: 1, > or = 60 minutes: 2]; diabetes mellitus [yes: 1]) in consecutive TIA patients hospitalized in 3 tertiary care neurology departments across 2 different racial populations (white and Asian). RESULTS: The 7-day and 90-day risks of stroke in the present case series (n = 148) were 8% (95% CI 4%-12%) and 16% (95% CI 10%-22%). The ABCD(2) score accurately discriminated between TIA patients with high 7-day (c statistic 0.72, 95% CI 0.57-0.88) and 90-day (c statistic 0.75, 95% CI 0.65-0.86) risks of stroke. The 90-day risk of stroke was 7-fold higher in patients with an ABCD(2) score >3 points (28%, 95% CI 18%-38%) than in patients with an ABCD(2) score < or = 3 points (4%, 95% CI 0%-9%). After adjustment for stroke risk factors, race, history of previous TIA, medication use before the index TIA and secondary prevention treatment strategies, an ABCD(2) score of >2 was associated with a nearly 5-fold greater 90-day risk of stroke (hazard ratio 4.65, 95% CI 1.04-20.84, p = 0.045). CONCLUSION: Our findings externally validate the usefulness of the ABCD(2) score in triaging TIA patients with a high risk of early stroke in a multiethnic sample of hospitalized patients. The present data support current guidelines endorsing the immediate hospitalization of patients with an ABCD(2) score >2.

Small cell carcinoma metastatic to the mandible. Report of a case.

Small cell carcinoma either primary or metastatic is an uncommon malignancy in the oral and perioral tissues. We are reporting such a case.

Elevated serum levels of the apoptosis related molecules TNF-alpha, Fas/Apo-1 and Bcl-2 in oral lichen planus.

BACKGROUND: The serum circulatory levels of apoptosis related molecules measured in patients with oral lichen planus (OLP) and healthy individuals in order to investigate possible alterations associated with the clinical forms of OLP. METHODS: Serum levels of tumor necrosis factor (TNF)-alpha, soluble Fas (sFas) and Bcl-2 studied by enzyme-linked immunosorbent assay in whole blood samples in 13 OLP reticular, 13 OLP atrophic-erosive form patients and 26 healthy subjects. RESULTS: Significantly elevated levels of TNF-alpha and sFas detected in OLP patients as compared with controls. Serum concentrations of Bcl-2 although increased in 17/26 patients, they were not statistically significant. Reticular OLP exhibited slightly elevated TNF-alpha and significantly elevated Bcl-2 serum levels, compared with erosive OLP. CONCLUSIONS: These data suggest that a putative dysfunction in the Fas/FasL mediated apoptosis might be involved in the OLP pathogenesis. A downregulation of Bcl-2 serum levels in the atrophic-erosive OLP may be associated with promotion of the disease activity.

Oral manifestations of papular-purpuric 'gloves and socks' syndrome due to parvovirus B19 infection: the first case presented in Greece and review of the literature.

Papular-purpuric 'gloves and socks' syndrome (PPGSS) is a novel, rare, self-limited dermatosis initially described in 1990. It is characterized by painful, pruritic edema and erythema, rapidly evolving to papular-purpuric lesions on the distal extremities, in a gloves-and-socks distribution, accompanied by fever and oral lesions such as petechiae, vesiculopustules and small erosions. Parvovirus B19 has been implicated in most cases as the etiological factor. Herein we present the first case of PPGSS in a 42-year-old Greek man with von Willebrand disease. On admission the patient was febrile, and presented acral edema and erythema rapidly followed by purpuric lesions on the same sites, and palatal petechiae. Complete remission of the exanthem occurred 7 days after hospitalization. Clinical and laboratory evaluation including serologic tests and PCR, confirmed the presence of parvovirus B19. Review of the existing literature on this novel syndrome and its association with parvovirus B19 is also presented.

Alteration of integrin expression in oral squamous cell carcinomas.

OBJECTIVE: This study examines the intensity of expression of beta 1, alpha 2, alpha 3, alpha 5, alpha 6 integrin subunits in oral squamous cell carcinoma (SCC) as opposed to normal oral epithelium, and the intensity of expression and distribution pattern of the above subunits in relation to tumour differentiation grade. MATERIALS AND METHODS: Cryostat sections of 25 cases of oral SCC and 15 cases of normal oral epithelium were studied by immunohistochemistry (APAAP method). RESULTS: The intensity of expression of beta 1, alpha 2 (Pearson chi 2 P < 0.001) and alpha 6 (Test for Trend P < 0.05) integrin subunits was reduced significantly in SCC compared to normal oral epithelium. All integrin subunits were mainly expressed in the peripheral cell layer of tumour islands. No correlation was found between the intensity of integrin expression and the degree of differentiation in SCC. The same applied to the distribution pattern of the integrin subunits. By means of cross examination of all integrins, the loss of intensity of alpha 2 beta 1 integrin expression was found to have the strongest correlation with oral SCC (Ordered Logistic Regression). CONCLUSIONS: Reduced intensity of expression of all subunits was found in oral SCC compared to normal epithelium. Further investigation is needed to determine whether alpha 2 beta 1 integrin expression can be used as a prognostic evaluator for the behaviour of the disease.

[The immune pathogenesis of lichen planus]. / O rolos anosologikon antidraseon sten pathogeneia tou omalou leichena.

Lichen planus (L.P.) is a chronic inflammatory skin disease of unknown etiology which also affects oral mucous membranes with high frequency. Oral lesions can occur even in the absence of skin manifestations in 25-35% of the cases. A considerable number of recent publications strongly favor an immune pathogenesis although the particular aspects of reported studies varies. Immunological pictures of humoral and cellular immunity have been implicated as possible pathogenic mechanisms and are critically reviewed in the present study.

[Improper use of antimycotics in oral diseases]. / Adikaiologete chrese antimyketiasikon se nosemata tou stomatos.

Antimycotics are the drugs of choice in the treatment of mycotic infections including oral candidiasis. Furthermore their complementary use in the treatment of oral conditions in which Candida albicans is implicated aetiopathogenically is also effective. However, according to the results of a retrospective study based on a random sample of 1000 cases from the files of the Oral Pathology Clinic of the Dental School of the University of Athens, it became apparent that these drugs are used either by patients themselves or prescribed by dentists and physicians for a broad spectrum of oral diseases.