Release of Matrix Metalloproteinases by Macrophages in Radicular Cysts and Residual Radicular Cysts.

INTRODUCTION: Radicular cysts (RCs) and residual radicular cysts (RRCs) are the sequelae of dental caries and that leads to proliferation of epithelial rests of Malassez in periapical tissues. OBJECTIVES: The aim was to evaluate the relationship between Langerhans cells, macrophages, matrix metalloproteinases (MMP-9, MMP-13), and tumor necrosis factor-alpha (TNF-α) in the capsule and lining epithelium of cystic lesions. MATERIALS AND METHODS: Twenty RCs and 20 RRCs were submitted to immunohistochemical analysis with anti-CD68, anti-CD1a, anti-MMP-9, anti-MMP-13, and anti-TNF-α antibodies. The Mann-Whitney test and the Spearman correlation test were used for analysis of the data (P<0.05). RESULTS: The immunoexpression of MMP-13 and CD68 was significantly higher in RCs when compared with RRCs (P=0.011 and 0.012, respectively). The presence of an intense inflammatory infiltrate was significantly correlated with the immunoexpression of CD68 in RCs (P=0.025). Expression of CD68 showed a significant positive correlation with MMP-13 (P=0.015). A moderate correlation was observed between MMP-9 and MMP-13 (P=0.010). TNF-α expression was more common in RCs (P=0.001). CD1a was more frequently expressed in atrophic epithelium (P=0.041) and was significantly correlated with TNF-α (P=0.014). CONCLUSION: Langerhans cells induce a greater release of TNF-α which, in turn, is responsible for the stimulation of M1 macrophages. Higher immunoexpression of MMP-13 and MMP-9 is observed in the early stages of RCs compared with RRCs. Therefore, the toxins of microorganisms present in highly inflamed RCs are the main factors triggering a proinflammatory immune response and greater cystic expansion in the early stages of these lesions.

Langerhans Cells Correlate With Macrophages for Defense Mechanisms in the Atrophic Epithelium of Radicular Cysts.

Langerhans cells (LCs) play important roles in cell-mediated immune reactions, as well as in the pathogenesis of periapical lesions. The aim of this study is to evaluate the role of LCs in the proliferative epithelium of radicular cysts (RCs) and the release of the proinflammatory cytokine tumor necrosis factor α (TNF-α) associated with epithelial thickness. Thirty cases of RCs and 30 cases of residual RCs were randomly selected. Morphologic analysis was performed to evaluate the association between the inflammatory infiltrate, cystic epithelial thickness and lesion size, in addition to immunohistochemical assessment of CD1a, CD68, and TNF-α. The highest macrophage percentages and TNF-α scores were found in RCs (P=0.038 and 0.017, respectively). The largest number of LCs was observed in RCs (P=0.021), especially those exhibiting atrophic epithelium (P=0.05). In addition, LCs were positively correlated with the number of macrophages in both RCs and residual RCs (P=0.033 and 0.002, respectively). In contrast to LCs, the largest number of macrophages was detected in cases with an intense inflammatory infiltrate (P=0.022). In addition, the highest TNF-α scores were associated with an intense inflammatory infiltrate (P=0.024) when analyzed in the capsule of RCs (P=0.017). In conclusion, LCs participate in defense mechanisms and were present in all cases evaluated. Along with macrophages, these cells release proinflammatory cytokines such as TNF-α, which is responsible for inducing the continued proliferation of cystic epithelium.

Cystadenoma in a pediatric patient: a rare salivary gland neoplasm / Cistadenoma em paciente pediátrico: uma rara neoplasia de glândula salivar

ABSTRACT Salivary gland cystadenoma is a rare benign neoplasm, representing 1.4% of all benign salivary gland tumors. It presents a predilection for the major salivary gland and middle-aged or elderly adults. The present study reports a rare case of cystadenoma in the floor of the mouth a 5-year-old male patient, who was referred to an oral diagnosis center for evaluation of the lesion. After performing an incisional biopsy, microscopic analysis revealed a cystadenoma. The patient's treatment was excision of the lesion and he has been under follow-up for one year with no signs of recurrence.

RESUMEN El cistoadenoma de las glándulas salivales es una neoplasia benigna rara, responsable del 1,4% de todos los tumores benignos de las glándulas salivales. Tiene predilección por la glándula salival mayor y los adultos de mediana edad o ancianos. El presente estudio reporta un caso raro de cistoadenoma en piso de la cavidad oral de un paciente masculino de 5 años, quien fue derivado a un centro de diagnóstico oral para evaluación de la lesión. Después de realizar una biopsia incisional, el análisis microscópico reveló un cistoadenoma. El paciente fue tratado con la escisión de la lesión y ha sido seguido durante un año sin signos de recidiva.

RESUMO O cistadenoma de glândula salivar é uma neoplasia benigna rara; representa 1,4% de todos os tumores benignos de glândula salivar. Apresenta predileção pela glândula salivar maior e por adultos de meia idade ou idosos. O presente estudo relata um caso raro de cistadenoma em assoalho bucal de um paciente do sexo masculino, 5 anos de idade, que foi encaminhado a um centro de diagnóstico oral para avaliação da lesão. Após realização de biópsia incisional, a análise microscópica revelou um cistadenoma. O tratamento do paciente foi a excisão da lesão, e ele se encontra em acompanhamento há um ano sem sinais de recidiva.

Neurofibromas of the oral and maxillofacial complex: A 48-year retrospective study.

Neurofibromas are benign neoplasms of the peripheral nerve sheath, characterized by the proliferation of Schwann cells, perineural cells and endoneural fibroblasts. Their occurrence in the oral and maxillofacial complex is uncommon. This study aimed to evaluate the clinical and histopathological characteristics of neurofibromas of the oral and maxillofacial complex excised at our institution over a 48-year period. Using light microscopy, two previously trained oral pathologists re-evaluated all hematoxylin and eosin slides. From a total of 15,375 cases diagnosed at a referred Oral Pathology Service, 24 cases were diagnosed as neurofibromas. Eighteen neurofibroma patients were female, with a mean age of 39.1 years. Three patients presenting neurofibromas exhibited neurofibromatosis type I. Clinically, most of the lesions presented as asymptomatic nodules, and the most frequent sites were the tongue (n = 6; 25.0%), gingiva (n = 6; 25.0%) and intraosseous maxillary bone region (n = 3; 12.5%). Histopathologically, the lesions were predominantly well delimited, exhibiting interlocking bundles of spindle-shaped cells that usually displayed wavy nuclei, associated with delicate collagen fibers. Thus, knowledge of their clinical and histopathological features by dentists and oral pathologists is essential for the correct diagnosis of these lesions.

Accuracy of computer-assisted image analysis in the diagnosis of maxillofacial radiolucent lesions: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to search for scientific evidence concerning the accuracy of computer-assisted analysis for diagnosing maxillofacial radiolucent lesions. METHODS: A systematic review was conducted according to the statements of Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols and considering 10 databases, including the gray literature. Protocol was registered at the International Prospective Register of Systematic Reviews (CRD42018089945). The population, intervention, comparison and outcome strategy was used to define the eligibility criteria and only diagnostic test studies were included. Their risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal tool. Random-effects model meta-analysis was performed and heterogeneity among the included studies was estimated using the I2 statistic. The grade of recommendation, assessment, development, and evaluation (GRADE) tool assessed the quality of evidence and strength of recommendation across included studies. RESULTS: Out of 715 identified citations, four papers, published between 2009 and 2017, fulfilled the criteria and were included in this systematic review. A total of 191 lesions, classified as periapical granuloma and cyst, dentigerous cyst or keratocystic odontogenic tumor, were analyzed. All selected articles scored low risk of bias. The pooled accuracy estimation, regardless of the classification method used, was 88.75% (95% CI = 85.19-92.30). Heterogeneity test reached moderate values (I2 = 57.89%). According to the GRADE tool, the analyzed outcome was classified as having low level of certainty. CONCLUSIONS: The overall evaluation showed all studies presented high accuracy rates of computer-aided diagnosis systems in classifying radiolucent maxillofacial lesions compared to histopathological biopsy. However, due to the moderate heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of computer-assisted analysis is not possible.

Parotid follicular lymphoid hyperplasia - a rare entity: the challenges in differential diagnosis / Hiperplasia linfoide folicular em parótida - uma rara entidade: os desafios no diagnóstico diferencial

ABSTRACT A 61-year-old female patient presented a nodular lesion located in the right buccal mucosa with a 3-month evolution. Clinical hypotheses of salivary duct cyst and mucocele were proposed, and the patient underwent excisional biopsy. Microscopically, a well-circumscribed and encapsulated lymphoid aggregate fragment was observed, characterized by layers of well-differentiated small lymphocytes and collections of reactive lymphoblasts. These findings, associated with immunohistochemistry, established the diagnosis of follicular lymphoid hyperplasia. Currently, the patient is well, under follow-up after six months.

RESUMEN Paciente del sexo femenino de 61 años de edad exhibió lesión nodular localizada en mucosa yugal derecha con tiempo de evolución de tres meses. Se establecieron las hipótesis clínicas de quiste del ducto salival y mucocele, y la paciente se sometió a una biopsia excisional. Microscópicamente, se observó un fragmento de agregado linfoide bien circunscrito y encapsulado, caracterizado por capas de linfocitos pequeños bien diferenciados y colecciones de linfoblastos reactivos. Esos hallazgos, asociados al estudio inmunohistoquímico, basaron el diagnóstico de hiperplasia folicular linfoide. Al presente, la paciente se encuentra bien, bajo seguimiento seis meses después.

RESUMO Paciente do sexo feminino, 61 anos de idade, exibiu lesão nodular localizada em mucosa jugal direita com evolução há três meses. As hipóteses clínicas de cisto do ducto salivar e mucocele foram estabelecidas, e a paciente foi submetida à biópsia excisional. Microscopicamente, foi observado fragmento de agregado linfoide bem circunscrito e encapsulado, caracterizado por camadas de pequenos linfócitos bem diferenciados e coleções de linfoblastos reativos. Esses achados, associados ao estudo imuno-histoquímico, estabeleceram o diagnóstico de hiperplasia linfoide folicular. Atualmente, a paciente encontra-se bem, sob proservação após seis meses.

Juvenile ossifying fibroma: series of seven cases focusing on clinical and pathological aspects / Fibroma ossificante juvenil: série de sete casos com enfoque nos aspectos clinicopatológicos

ABSTRACT Juvenile ossifying fibroma (JOF) is an uncommon benign fibro-osseous lesion that affects young individuals and deserves attention because it presents an aggressive clinical behavior and high rates of recurrence. This paper aims to report seven cases diagnosed as JOF - age ranging from 11 to 39 years - in a referral center, correlating our findings with clinical and pathological aspects in the literature. The mandible was the most common location, and in three cases, painful symptoms were reported. Regarding the histopathological findings, the majority of cases exhibited a cellularized pattern, and the trabecular subtype was the most commonly found. Regarding treatment, three cases relapsed, and, in two of them, conservative treatments were performed. Accordingly, knowing the clinical-pathological aspects of JOF is important for the correct diagnosis and the establishment of an appropriate treatment that decreases the high recurrence rate of this lesion.

RESUMEN El fibroma osificante juvenil (FOJ) es una lesión fibro-ósea benigna pocofrecuente que acomete personasjóvenesy merece realce, puespresenta comportamiento clínico agresivo y altas tasas de recidivas. Reportamos siete casos diagnosticados como FOJ - con pacientes entre 11 y 39 anos de edad - en un centro de referencia, relacionando nuestros hallazgos con los aspectos clínicos y patológicos existentes en la literatura. La mandíbula fue la ubicación más común; en tres casos se reportaron síntomas dolorosos. En lo que respecta a los hallazgos histopatológicos, la mayor parte de los casos se mostró altamente celularizada, siendo el subtipo trabecular el más común. En cuanto al tratamiento, de los tres casos que presentaran recurrencia, en dos se realizaron tratamientos conservadores. Ante eso, se resalta la importancia de conocer los aspectos clínicos y patológicos del FOJ para hacer el diagnóstico preciso y establecer un tratamiento adecuado que reduzca el alto índice de recidivas de esa lesión.

RESUMO O fibroma ossificante juvenil (FOJ) é uma lesão fibro-óssea benigna incomum que acomete indivíduos jovens e merece destaque por apresentar um comportamento clínico agressivo e altas taxas de recidivas. Este trabalho tem como objetivo relatar sete casos diagnosticados como FOJ - com variação de idade entre 11 e 39 anos - em um centro de referência, correlacionando nossos achados com os aspectos clinicopatológicos existentes na literatura. A mandíbula foi a localização mais comum; em três casos foi relatada sintomatologia dolorosa. Com relação aos achados histopatológicos, a maioria dos casos exibiu um padrão bem celularizado, sendo o subtipo trabecular o mais encontrado. No que diz respeito ao tratamento, dos três casos que apresentaram recidiva, em dois, foram realizados tratamentos conservadores. Diante disso, ressalta-se a importância do conhecimento dos aspectos clínicos epatológicos do FOJ para a realização de um diagnóstico correto e o estabelecimento de um tratamento adequado que diminua o alto índice de recidivas dessa lesão.

Glandular odontogenic cyst: report of an unusual case in the posterior mandible / Cisto odontogênico glandular: relato de um caso incomum na região posterior de mandíbula

ABSTRACT The glandular odontogenic cyst (GOC) is an uncommon developmental cyst that presents glandular differentiation and has potential for recurrence. Clinically, it is asymptomatic and it has slow growing. This report proposes to describe a clinical case of GOC diagnosed at the Service of Pathological Anatomy of a university in the northeast of Brazil, in the posterior region of the mandible, which was treated with mandibular resection and bone graft with iliac crest. One may conclude that clinical, microscopic and radiographic parameters were crucial tools for treatment choice.

RESUMEN El quiste odontogénico glandular (QOG) es un quiste del desarrollo poco frecuente que presenta diferenciación glandular y es propenso a la recurrencia. Clinicamente, es asintomático y de crecimiento lento. El presente trabajo tiene como objetivo describir un caso clinico de QOG diagnosticado en la región posterior de la mandíbula en un paciente masculino de 36 anos de edad, atendido en el servicio de Anatomia Patológica de una universidad en el nordeste de Brasil. Se decidió tratarlo por resección mandibular e injerto óseo de la cresta ilíaca. La conclusión a que podemos llegar es que los parâmetros clínicos, microscópicos y radiográficos fueran herramientas esencialespara la elección del tratamiento.

RESUMO O cisto odontogênico glandular (COG) é um cisto de desenvolvimento incomum que apresenta diferenciação glandular e tem potencial de recidiva. Clinicamente, é assintomático e de crescimento lento. Este relato propõe-se a descrever um caso clínico de COG diagnosticado em região posterior de mandíbula em um paciente do gênero masculino, 36 anos de idade, atendido no Serviço de Anatomia Patológica de uma universidade no nordeste do Brasil. Como tratamento, optou-se por ressecção mandibular e enxerto ósseo da crista ilíaca. Conclui-se que os parâmetros clínicos, microscópicos e radiográficos foram ferramentas essenciais na escolha do tratamento realizado.

Ameloblastic carcinoma arising from a preexistent ameloblastoma / Carcinoma ameloblástico decorrente de um ameloblastoma preexistente

ABSTRACT Ameloblastic carcinoma (AC) is a rare odontogenic tumor that represents the malignant counterpart of an ameloblastoma. There are few cases of AC in the English-language literature, with only 16 cases arising from preexisting ameloblastomas reported in the last 10 years. Multiple local recurrences of ameloblastomas precede this transformation. In the current report, we describe a case of AC at the posterior maxilla in a 42-year-old female submitted to surgical resection, with three recurrences of ameloblastoma in a period of four years. Imaging exams showed a radiodense mass with cortical bone disruption and maxillary sinus invasion. Histologic analysis demonstrated features of islands and nests of malignant epithelium transformation, atypia, pleomorphic cells, nuclear hyperchromatism, necrosis and desmoplasia. AC represents a rare and challenging histologic diagnosis. Surgical access with adequate hard and soft tissue margins is essential for influencing survival. The description of new cases may reveal, through of treatment and clinical follow-up, characteristics that allow us better understanding of AC behavior.

RESUMEN El carcinoma ameloblástico (CA) es un tumor odontogénico raro que representa el equivalente maligno de un ameloblastoma. Hay pocos casos de CA en la literatura en lengua inglesa: en los últimos 10 años, sólo se reportaron 16 casos originados de ameloblastomas previos. Múltiples recidivas locales de este tumor preceden esa transformación. En este reporte, describimos un caso de CA en región posterior de maxila en una mujer de 42 años de edad, sometida a resección quirúrgica. En un periodo de cuatro años, se produjeron tres recurrencias del ameloblastoma. Exámenes de imagen muestran una masa radiodensa con destrucción cortical e invasión del seno maxilar. El análisis histológico ha revelado islas y nidos característicos de transformación epitelial maligna, atipias, pleomorfismo celular, hipercromatismo nuclear, necrosis y desmoplasia. El diagnóstico histológico del CA representa un raro desafío. El abordaje quirúrgico con ampliación de los márgenes de tejido duro y blando es esencial en la sobrevida del paciente. La descripción de nuevos casos puede revelar, mediante tratamiento y acompañamiento clínico, características que ayuden a comprender mejor el comportamiento del CA.

RESUMO O carcinoma ameloblástico (CA) é um tumor odontogênico raro que representa o equivalente maligno de um ameloblastoma. Existem poucos casos de CA na literatura em inglês: nos últimos 10 anos, foram relatados apenas 16 casos surgidos de ameloblastomas preexistentes. Múltiplas recorrências locais desse tumor precedem essa transformação. Neste relato, descrevemos um caso de CA em região posterior de maxila em uma mulher de 42 anos de idade, submetida à ressecção cirúrgica. Em um período de quatro anos, ocorreram três recidivas do ameloblastoma. Exames de imagem exibiram uma massa radiodensa com destruição da cortical óssea e invasão do seio maxilar. A análise histológica revelou ilhas e ninhos característicos de transformação maligna epitelial, atipias, pleomorfismo celular, hipercromatismo nuclear, necrose e desmoplasia. O CA representa um raro e desafiador diagnóstico histológico. O acesso cirúrgico com ampliação das margens de tecido duro e mole é essencial para o impacto na sobrevida do paciente. A descrição de novos casos pode revelar, por meio do tratamento e do acompanhamento clínico, características que ajudem a entender melhor o comportamento do CA.

Update of dental and maxillofacial alterations in patients with pycnodysostosis / Atualização das alterações dentárias e dos ossos gnáticos em pacientes com picnodisostose

ABSTRACT Pycnodysostosis is a rare, autosomal recessive genetic condition, which causes a decrease in bone remodeling, resulting in different clinical and radiographic manifestations. This case series aims to describe two clinical cases diagnosed at the Department of Oral and Maxillofacial Surgery and Traumatology of a University on the Northeast of Brazil. There are two complex cases involving osteomyelitis and dental and bone alterations of the jaws. It is concluded that the knowledge of oral and maxillofacial characteristics of this syndrome are required to plan appropriate treatment for patient in order to avoid complications of dental treatments due to inadequate bone remodeling.

RESUMEN La picnodisostosis es una enfermedad genética rara autosómica, recesiva, con disminución de la remodelación ósea, que ocasiona varias manifestaciones clínicas y radiográficas. Este estudio describe dos casos clínicos diagnosticados en el servicio de cirugía y traumatología bucomaxilofacial de una universidad en el nordeste de Brasil. Los casos son complejos y envuelven osteomielitis, alteraciones dentales y óseas de las mandíbulas. Es necesario conocer las características orales y maxilofaciales de este síndrome para planear el tratamiento adecuado al paciente, con la intención de evitar complicaciones de tratamientos dentales debido a la remodelación ósea inadecuada.

RESUMO A picnodisostose é uma condição genética rara, autossômica recessiva, que ocasiona diminuição da remodelação óssea, resultando em várias manifestações clínicas e radiográficas. Este estudo pretende descrever dois casos clínicos diagnosticados no Serviço de Cirurgia e Traumatologia Bucomaxilofacial de uma universidade no nordeste do Brasil. São dois casos complexos que envolvem osteomielite e alterações dentárias e ósseas dos maxilares. É necessário o conhecimento das características orais e maxilofaciais dessa síndrome para planejar o tratamento adequado para o paciente, a fim de se evitar complicações de tratamentos dentários em virtude do remodelamento ósseo inadequado.

Immunohistochemical expression of MMP-9 and VEGF in squamous cell carcinoma of the tongue.

Squamous cell carcinomas (SCCs) account for approximately 95% of all oral malignant neoplasms and for about 38% of all malignant head and neck tumors, especially affecting the tongue and lips. The aim of this study was to evaluate the immunohistochemical expression of MMP-9 and VEGF in oral SCC according to the occurrence of metastasis. Eighteen cases of tongue SCC without metastases and 17 cases of tongue SCC with metastases were subjected to immunohistochemical methods. High immunohistochemical expression of MMP-9 and VEGF by neoplastic cells and stroma was observed in tongue SCCs at the invasion front. Metastatic tumors tended to express higher levels of MMP-9 and VEGF than non-metastatic tumors, but the difference was not significant (P > 0.05). Spearman's correlation test showed no significant correlation between VEGF-immunopositive vessels and metastasis (P > 0.05). The present results demonstrate the importance of the expression of MMP-9 and VEGF for the development of SCC of the tongue. However, no significant association was observed between the overexpression of MMP-9 or VEGF and the presence of metastases.

Immunoexpression of MMP-9, VEGF, and vWF in central and peripheral giant cell lesions of the jaws.

BACKGROUND: Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are pathological conditions of the jaws that share the same microscopic features, but differ clinically in terms of their behavior. Our aim was to compare the immunoexpression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in CGCL and PGCL, relating them to the angiogenic index. METHODS: Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of MMP-9 and VEGF in multinucleated giant cells (MGC) and mononucleated cells (MC). Angiogenic index was determined by microvessel count (MVC) using anti-von Willebrand factor antibody. RESULTS: The CGCL showed slightly higher expression of MMP-9 than PGCL. In comparison with PGCL, the CGCL showed higher expression of VEGF both in MC (P < 0.05) and in total cells (P < 0.05). PGCL exhibited higher MVC than CGCL (P < 0.05). CONCLUSIONS: MMP-9 and VEGF might play an important role in the osteoclastogenesis process in CGCL. The higher MVC in PGCL might be related to the reactive nature of these lesions.

Neutropenia e mucosite oral: fatores de risco para candidiase em crianças com câncer / Neutropenia and oral mucositis: risck factors for candidiasis in children with cancer

A mucosite oral (MO) representa uma complicação estomatológica desafiante em pacientes com câncer, a qual pode causar significativa morbidade e comprometimento dos protocolos de tratamento, podendo ainda representar um risco significativo de infecções oportunista, particularmente em pacientes neutropênicos. Mediante inspeção clinica foi avaliada a ocorrência de MO e candidíase em 40 crianças com neoplasias. A MO foi observada em 13 crianças com neoplasias sistêmicas (n = 25) e 3 com tumores sólidos (n = 15), sem diferença estatisticamente significativa na ocorrência desta complicação entre as crianças com neoplasias sistêmicas e aquelas com tumores sólidos (p = 1,69). Observou-se que 5 crianças em tratamento para neoplasias sistêmicas desenvolveram em conjunto 10 lesões de candidíase, porém sem diferença estatisticamente significativa na ocorrência desta infecção entre as crianças com neoplasias sistêmicas e aquelas com tumores sólidos (p = 0,08). Constatou- se a ocorrência de 26 (7,3%) episódios de neutropenia, sendo 5 destes associados à ocorrência candidiase, nenhum dos quais ocorreu associado à presença concomitante de MO. A neutropenia contribui para o desenvolvimento de candidíase, a qual pode ser agravada pela falta de higiene oral, entre outros fatores.

The oral mucositis (OM) is a challenging stomatologic complication in patients with cancer, which may cause significant morbidity and impairment of treatment protocols and may represent a significant risk of opportunistic infections, particularly in neutropenic patients. Upon inspection clinic was assessed the occurrence of OM and candidiasis in 40 children with malignancies. By hematologic laboratorial exam was availed de absolute neutrophil count (ANC). The OM was observed in 13 children with systemic neoplasms (n = 25) and 3 with solid tumors (n = 15), no statistically significant difference was observed in the occurrence of this complication among children with systemic malignanciesand those with solid tumors (p = 1, 69). It was observed that 5 children in treatment for systemic cancers developed together 10 lesions of candidiasis, but no statistically significant difference was observed in the occurrence of this infection among children with systemic malignancies and those with solid tumors (p = 0.08). It was observed the occurrence of 26 (7.3%) episodes of neutropenia, 5 of them associated with the occurrence of candidiasis, none of which were associated with concomitant presence of OM. The neutropenia contributes to the development of candidiasis, which may be aggravated by defficient oral hygiene, among other factors.

Assessment of angiogenic markers in oral hemangiomas and pyogenic granulomas.

The purpose of this research was to evaluate the immunohistochemical expression of the vascular endothelial growth factor (VEGF-C1) and measuring the angiogenic activity by the staining for von Willebrand factor (vWF) and CD31 in oral pyogenic granulomas and hemangiomas. The results showed that there was no statistically significant difference in the angiogenesis index between the lesions evaluated. The average microvessel density determined for MVC (microvessel count) using CD31 was 60.64 for hemangiomas and 59.64 for pyogenic granulomas, while angiogenic index determined using vWF was 64.24 and 62.20 in these lesions. The results showed that the cells highlighted by staining for vWF were more uniform than in those stained for CD31. There was no statistically significant difference between the lesions for the number of cells highlighted by staining for VEGF-C1. However, the mean number of cells highlighted in pyogenic granuloma specimens was higher (153.23) when compared to oral hemangioma specimens (115.17). The VEGF-positive cells were endothelial cells and fibroblasts in hemangiomas and macrophages and fibroblasts in pyogenic granulomas. These results effort the role of the angiogenic factors in the etiopathogenesis of the hemangiomas and pyogenic granulomas, however, it showed that microvessel quantification is not useful in the differential diagnosis of these lesions.