Carcinoma ameloblástico mandibular: un diagnóstico infrecuente y desafiante / Mandibular ameloblastic carcinoma: an infrequent and challenging diagnosis

El carcinoma ameloblástico es un tumor odontogénico epitelial maligno, infrecuente y de mal pronóstico. Histopatológicamente es una lesión que conserva un patrón de diferenciación ameloblastomatoso, pero presenta características citológicas de malignidad. Debido a su rareza, existe poca información sobre su comportamiento biológico, el cual es reconocido en la literatura por ser inespecífico y variable, ya que puede presentarse como una lesión con características compatibles con una lesión benigna o como una entidad patológica agresiva altamente maligna. Esto último ha supuesto una dificultad no solo en su diagnóstico, sino también en la planificación terapéutica. Se reporta un caso de un carcinoma ameloblástico mandibular en un paciente perteneciente a la séptima década de la vida, destacando sus características clínicas, imagenológicas e histológicas variables que permitieron llegar a un diagnóstico correcto. (AU)

Ameloblastic carcinoma is a rare, malignant epithelial odontogenic tumor with a poor prognosis. Histopathologically it preserves an ameloblastomatous differentiation pattern but shows cytological features of malignancy. Due to its rarity, there is limited information on its biological behavior, which is recognized in the literature for being nonspecific and variable, as it may present as a lesion with characteristics compatible with a benign lesion or as a highly malignant aggressive pathological entity. The latter has been a difficulty not only in its diagnosis but also in the therapeutical planning. This article reports a case of a mandibular ameloblastic carcinoma occurring in a patient in the seventh decade of life, highlighting its variable clinical, imaging and histological characteristics that allowed us to reach a definitive diagnosis. (AU)

Macroglosia en Amiloidosis Primaria como Clave Diagnostica: Reporte de un Caso

RESUMEN: Amiloidosis se refiere a un grupo de enfermedades caracterizadas por el deposito extracelular de proteínas insolubles llamadas amiloide. La presentación intraoral de amiloidosis con macroglosia como signo primario es una entidad extraña, la cual puede afectar la funcionalidad de los pacientes aparte de la patología subyacente. Reportamos el caso de una paciente femenina de 85 años sin antecedentes mórbidos que al examen físico presenta macroglosia. La biopsia del tejido afectado fue estudiada bajo inmunohistoquimíca con tinción rojo congo, asociada al análisis de laboratorio que consignó un aumento en el componente monoclonal de cadenas livianas lambda. Se diagnosticó como amiloidosis primaria (AL). Se considera fundamental el entrenamiento al odontólogo general para el diagnóstico precoz de estos signos clínicos, por la baja sobrevida de la amiloidosis y la probabilidad de patologías ocultas como mieloma múltiple, el cual está asociado en un 20 % con AL.

ABSTRACT: Amyloidosis groups a large set of diseases characterized by the deposit of an extracellular insoluble protein known as amyloid. Intraoral presentation of macroglossia induced by amyloidosis is a rare entity that can impair patient function and hide other pathological conditions. We report a case of an 85-year-old woman with no morbid background were the physical examination revealed macroglossia. Primary systemic amyloidosis (AL) definitive diagnosis was made after the tongue biopsy resulted positive under congo red histochemical staining, and serum immunoelectrophoresis had elevated levels for lambda light chains. Primary dental dentistry training on semiotics is imperative to diagnose early stages of hidden pathologies with low life expectancy such as AL, which in 20 % of cases are associated with life threatening diseases like multiple myeloma.

Evaluación del grado de queratinización y el recuento de AgNORs en citología exfoliativa de mucosa oral normal de individuos fumadores y no fumadores / Evaluation of keratinization and AgNORs count in exfoliative cytology of normal oral mucosa from smokers and non-smokers

Objetivos. En individuos fumadores con mucosa oral clínicamente sana, se han observado cambios citológicos como una mayor queratinización, existiendo también reportes de un mayor grado de actividad nucleolar. En estos estudios, las células para frotis se han obtenido por medio de espátula de madera. Nuestro objetivo es evaluar la profundidad de muestras citológicas de mucosa oral obtenidas con cepillo para frotis (endobrush) y comparar el grado de queratinización y la actividad nucleolar en pacientes fumadores y no fumadores. Diseño del estudio. Se obtuvieron frotis de mucosa oral de borde de lengua clínicamente normal de 30 individuos fumadores y 30 no fumadores, utilizando espátula de madera y endobrush. Las muestras fueron teñidas con Papanicolaou y con la tinción AgNORs. Resultados. Con la espátula de madera se obtuvo un mayor porcentaje de células epiteliales superficiales anucleadas (P= 0.016) y con el endobrush se obtuvieron células más profundas (tipo intermedias) (P= 0.035). Los individuos fumadores presentaron un mayor porcentaje de células superficiales anucleadas con ambas técnicas, diferencia que fue estadísticamente significativa con la técnica endobrush (P=0.005). El promedio de AgNORs en las células nucleadas fue mayor en los individuos fumadores (3.83) que en los no fumadores (2.79) (P= 0.003). Conclusiones. El endobrush permite obtener células de estratos más profundos. Los individuos fumadores con mucosa clínicamente normal presentan un mayor porcentaje de células queratinizadas y una mayor actividad nucleolar, sugiriendo que el consumo de cigarrillo influye en la actividad celular de la mucosa del borde de lengua (AU)

Objetive.In smokers with clinically normal buccal mucosa, cytological changes such as increased keratinization, and higher nucleolar activity have been observed. In these studies the cells for cytological smears were obtained with a wooden spatula. Our objectives were to evaluate the depth of cytological smears of oral mucosa obtained with both a brush (endobrush) and a wooden spatula, and to compare the degree of keratinization and the nucleolar activity in smokers and non-smokers. Design. We obtained cytological smears of clinically normal lateral tongues of 30 smokers and 30 non-smokers using both a wooden spatula and endobrush. The samples were dyed with Papanicolaou and the AgNORs. Results. With the wooden spatula we found a greater percentage of enucleated superficial epithelial cells (P = 0.016) and deeper cells were obtained with an endobrush (intermediate cells) (P = 0.035). The smokers showed a greater percentage of enucleated superficial cells with both techniques, however this difference was significantly greater with Endobrush (P=0.005). The average of AgNORs in the nucleated cells was greater in smokers (3.83) than in non-smokers (2.79) (P=0.003). Conclusion. The Endobrush allows the clinician to obtain deeper cells of buccal mucosa. Smokers with clinically normal mucosa show a greater percentage of keratinized cells and a greater nucleolar activity, suggesting that cigarette smoking influences the cellular activity of the mucosa of the lateral tongue (AU)

Evaluation of keratinization and AgNORs count in exfoliative cytology of normal oral mucosa from smokers and non-smokers.

OBJECTIVE: In smokers with clinically normal buccal mucosa,cytological changes such as increased keratinization, and higher nucleolar activity have been observed. In these studies the cells for cytological smears were obtained with a wooden spatula. Our objectives were to evaluate the depth of cytological smears of oral mucosa obtained with both a brush (endobrush) and a wooden spatula, and to compare the degree of keratinization and the nucleolar activity in smokers and non-smokers. DESIGN: We obtained cytological smears of clinically normal lateral tongues of 30 smokers and 30 non-smokers using both a wooden spatula and endobrush. The samples were dyed with Papanicolaou and the AgNORs. RESULTS: With the wooden spatula we found a greater percentage of enucleated superficial epithelial cells (P = 0.016) and deeper cells were obtained with an endobrush (intermediate cells) (P = 0.035). The smokers showed a greater percentage of enucleated superficial cells with both techniques, however this difference was significantly greater with Endobrush (P = 0.005). The average of AgNORs in the nucleated cells was greater in smokers(3.83) than in non-smokers (2.79) (P = 0.003). CONCLUSION: The Endobrush allows the clinician to obtain deeper cells of buccal mucosa. Smokers with clinically normal mucosa show a greater percentage of keratinized cells and a greater nucleolar activity, suggesting that cigarette smoking influences the cellular activity of the mucosa of the lateral tongue.