Malignancy and overdiagnosis of malignancy in Peutz Jeghers polyposis.

Peutz Jeghers (PJ) polyps are rare hamartomatous tumors of the gastrointestinal tract frequently associated with skin and mucosal pigmentation. Despite their benign nature there is a certain increased risk of progression to malignancy in some cases, justifying a sustained follow-up of the patients. We present 3 cases of Peutz Jeghers syndrome (PJS) diagnosed in our hospital on gastrointestinal specimens obtained by endoscopy and opened surgery. We analyzed different degrees of dysplastic changes, epithelial intussusception, association with other types of polypoid lesions and other various aspects possibly related with disease progression. Clinico-pathological correlations were made. Two of these cases were related (mother and daughter); both of them were operated in another hospital for small bowel tumors with a subsequent diagnosis of adenocarcinoma. The daughter (28 years old) was referred to our hospital for endoscopic follow-up; a small polyp of the transverse large bowel was excised by colonoscopy with a histopathologic diagnosis of PJ polyp; a careful histopathologic reevaluation of both specimens of enterectomy (slides and paraffin blocks) revealed an overdiagnosis of cancer due to the epithelial cystic dilatation and pseudoinvasion in both patients. The other case showed diagnostic changes of PJS and also various aspects of adenomatous polyps some of them with mild and moderate dysplastic changes. When a PJ polyp is diagnosed, the possibility of pseudoinvasion should be kept in mind, in order to avoid overdiagnosis of malignancy; also, due to the fact that the malignant transformation of a PJ polyp is still on debate (hamartoma-dysplasia-carcinoma sequence versus malignant transformation of an adenomatous aria of a hamartoma versus coincidental association of a digestive cancer due to genetic aberrations of PJS), all the other associated microscopic aspects of the lesion should be carefully analyzed.

Local immune alterations in oral mucosa of the edentulous patients; possible cause of teeth loss?

UNLABELLED: Edentulous patients represent a difficult group of patients, especially in those cases when restorative prostheses are tempted on few remaining elements that eventually will be lost. MATERIAL AND METHOD: We performed a comparative histopathological and immunohistochemical (IHC) analysis of 20 oral mucosa biopsies in total edentulous patients (15 cases - group A) and ofnontumoral mucosa in oncologic patients (5 cases - group B, control). RESULTS: In group A the inflammatory infiltrate was dominated by the presence of numerous plasma cells (80%) and in 60% of the cases more numerous T cells than B cells were identified. We noticed various aspects of inflammatory infiltrate distribution in cases with epithelial ulceration (either CD8+ T cells intraepithelial and CD4+ T cells beneath the epithelium and perivascular or both CD4+ and CD8+ T cells in both lamina propria and intraepithelial location). 5 of seven cases which included salivary gland tissue revealed moderately to severe inflammatory infiltrate consisting of lymphocytes and plasma cells with lymphoepithelial lesion stage 1 aspects (71.42%). The control group (group B) presented plasma cell inflammatory infiltrate in one case (20%). None of the control cases had lymphoepithelial-like lesions within the salivary tissue. CONCLUSIONS: Presence of intraepithelial T citotoxic cells (CD8+) is correlated with presence of ulceration of the alveolar crest covering mucosa in the edentulous patients. Lymphoepithelial-like lesions of the minor salivary tissue in edentulous patients suggest an autoimmune response in local mucosa.