Intraosseous maxillary mucoepidermoid carcinoma: a rare case report / Carcinoma mucoepidermoide intraósseo maxilar: um raro relato de caso

ABSTRACT An unusual case of intraosseous mucoepidermoid carcinoma is reported in a 22-year-old female, located in the posterior maxilla region. The article summarizes the main characteristics of the disease, including clinical-pathologic characteristics, treatment and prognosis.

RESUMEN Reportamos un caso raro de carcinoma epidermoide intraóseo ubicado en región posterior de la maxila en una paciente de 22 años de edad. El artículo resume las principales características del proceso neoplásico, incluyendo las características clínico-patológicas, el tratamiento y el pronóstico.

RESUMO Relatamos um raro caso de carcinoma mucoepidermoide intraósseo localizado em região posterior da maxila em uma paciente de 22 anos de idade. O artigo resume as principais características do processo neoplásico, incluindo as características clinicopatológicas, o tratamento e o prognóstico.

A retrospective multicentre study of cystic lesions and odontogenic tumours in older people.

OBJECTIVE: The aim of this study was to investigate the frequency and some characteristics of odontogenic tumours, odontogenic cysts and non-odontogenic cysts in an elderly population (≥60 years). BACKGROUND: Few studies describe the distribution of oral lesions in older people. MATERIALS AND METHODS: A retrospective descriptive cross-sectional study was performed. Biopsy records were obtained from the archives of four Brazilian referral centres between 2000 and 2016. Data such as gender, age, anatomical location, symptomatology and histopathological diagnosis were collected and categorised. Statistical analyses were performed adopting a P-value of ≤.05 and a 95% confidence interval. RESULTS: A total of 7259 biopsy records of elderly participants were analysed; 642 cases were cystic lesions and odontogenic tumours, 491 of which being classified as odontogenic cysts (76.5%), 75 as odontogenic tumours (11.7%) and 76 as non-odontogenic cysts (11.8%). The most frequent lesions in each group were radicular cyst (n = 268), ameloblastoma (n = 51) and salivary duct cyst (n = 21), respectively. Overall, women were more affected (n = 351, mean age: 68 years). Intraosseous lesions were more common in the mandible (n = 342), and soft tissue cysts occurred more in the lip (n = 13). CONCLUSION: Odontogenic cysts were relatively common, whereas odontogenic tumours and non-odontogenic cysts were rarer among the older people studied in the present investigation.

A multicentre study of 268 cases of calcifying odontogenic cysts and a literature review.

OBJECTIVES: To investigate the frequency of calcifying odontogenic cysts (COCs) that have been submitted for microscopic examination from representative geographic regions of Brazil and to compare it with literature data. MATERIALS AND METHODS: A retrospective study was conducted on biopsies obtained from 1953 to 2016 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,350 biopsy specimens were analysed. Demographic data and histopathological diagnosis were evaluated descriptively and statistically. In addition, a literature review of case series was carried out in four electronic databases. RESULTS: A total of 268 cases of COC were surveyed, representing 0.1% of the oral lesions at the centres studied. Female patients in their second decade of life and the maxilla were more affected. The mean lesion size of symptomatic individuals was larger than that of cases without symptoms (p = 0.026). The literature review showed a higher frequency in Asia and Europe, mainly affecting men in the third decade of life. CONCLUSIONS: COC is a rare lesion. Novel data on the clinicopathological features of 268 cases have been added to the literature. Data regarding gender and age of the Brazilian patients reported herein contrast with findings of case series and retrospective studies reported elsewhere.

Oral and Maxillofacial Lesions Diagnosed in Older People of a Brazilian Population: A Multicentric Study.

OBJECTIVES: The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among older adults (≥60 years) from representative regions in Brazil. DESIGN: Retrospective descriptive cross-sectional study. SETTING: Biopsy records were obtained from the archives of four Brazilian referral centers of oral diagnosis between 2000 and 2016. PARTICIPANTS: A total of 45,506 biopsy records of all patients were analyzed, of these 7,259 persons aged 60 and older were selected. MEASUREMENTS: Data such as gender, age, race, anatomical location, and histopathological diagnosis were collected and categorized. Pearson's chi-square test (P < .005) was used to evaluate differences in the frequency of the several groups of oral lesions. RESULTS: Oral and maxillofacial lesions were diagnosed in 7,259 older people, including 59.4% women (P < .001) and 61.3% white patients (P = .07). The most commonly affected sites were the cheek mucosa (20.3%) and mandible (8.9%) (P < .001). Reactive and inflammatory lesions were the most common lesions, followed by neoplasms. Oral squamous cell carcinoma was the most prevalent neoplasm (83.4%) (P < .001). CONCLUSION: Knowledge of oral diseases obtained from biopsy records provides more accurate data about the diagnosis and oral health of elderly patients. These indicators thus support the development of specific health policies for the prevention and treatment of oral and maxillofacial lesions that affect this population.

Evaluation of hypoxia, angiogenesis, and lymphangiogenesis in actinic cheilitis.

BACKGROUND: Actinic cheilitis is a potentially malignant condition caused mainly by chronic sun exposure. Here we aim to evaluate the role of hypoxia, angiogenesis, and lymphatic density in the clinical and morphological progression of a series of cases of actinic cheilitis. MATERIALS AND METHODS: Immunohistochemistry was used to evaluate positivity to hypoxia-inducible factor (HIF)-1α, vascular endothelial growth factor (VEGF)-C, and D2-40 in 40 cases of actinic cheilitis of the lower lip. RESULTS: The cases studied exhibited variable degrees of positivity to the markers. The median number of lymphatic vessels was 3.2, 2.4, and 3.0 in lesions showing no epithelial dysplasia (NED) and with mild (MED) and moderate (MOED) epithelial dysplasia, respectively. The median VEGF-C positivity index was 82.44% (NED), 92.74% (MED), and 82.83% (MOED), and the median HIF-1α positivity index was 11.57% (NED), 5.26% (MED), and 13.55% (MOED). No significant differences in lymphatic density or median VEGF-C and HIF-1α positivity indices were observed between histological grades or clinical presentations of actinic cheilitis (P > 0.05). CONCLUSIONS: Although representing early events in lip carcinogenesis, the present results suggest that hypoxia, angiogenesis, and lymphangiogenesis do not influence the morphological or clinical progression of actinic cheilitis.

Retrospective analysis of the histopathologic features of 288 cases of reactional lesions in gingiva and alveolar ridge.

INTRODUCTION: The aim of this study was to perform a retrospective study of histopathologic features of a series of cases of pyogenic granuloma (PG), peripheral giant cell lesion (PGCL), and peripheral ossifying fibromas (POF) that constitutes the group called reactional lesions, located in gingiva and alveolar ridge. STUDY DESIGN: Cases of PG, PGCL, and POF were selected for this study. The morphological analysis of the lesions constituted the following: intensity of inflammatory infiltrate (IF), presence of vascular proliferation (VP), fibroblastic proliferation (FP), areas of ulceration (AU), bacterial colony (BC), presence of mineralization (PM), multinucleated giant cells (MGC), hemosiderin deposition (HD), hemorrhage area (HA). RESULTS: Of the 288 cases analyzed, 162 (56.3%) were PG, 72 (25%) were PGCL, and 54 (18.8%) were POF. The IF, VP, AU, and BC were more prominent in PG (85.8%, 98.8%, 91.4%, and 46.9%, respectively) and PM in POFs (98.1%). FP was more frequent in POF (98.1%) and PGCL (100%) and MGC in PGCL (100%), although some cases of POF (7.4%) and PG (0.6%) exhibited MGC. HD was more frequent in PGCL (40.3%) and HA in PG (53.1%). CONCLUSIONS: This study demonstrated that IF, VP, AU, BC, and HA are the common features in PG, MGC, FP, and HD are the most common in PGCL, and PM associated with FP are the most common in POF, which can help in the histopathologic differential diagnosis between these lesions. In addition, it may suggest a possible development and maturation of the PG in POF with reduction in the inflammatory component and increase in the fibrous component.

Immunoexpression of α2ß1, α3ß1, and α5ß1 integrins in pleomorphic adenoma and adenoid cystic carcinoma.

The aim of the present study was to compare the expression of α2ß1, α3ß1, and α5ß1 integrins between 28 pleomorphic adenomas (PAs) and 10 adenoid cystic carcinomas (ACCs), and investigate differences in the expression of these integrins according to histologic subtypes of ACCs. It was taken into consideration the presence or absence, distribution, and localization of integrin immunoexpression. There was immunoreactivity in the intercellular contacts of the strands, nests, and solid sheets of PAs, as well as in the luminal and nonluminal cells of the duct-like structures, with a predominant immunoexpression in the luminal cells. The immunoexpression in ACCs varied with histologic subtype of the tumor. It was verified for a tendency of absence and/or reduced expression of all integrins in the solid subtype of ACCs. In general, PAs revealed a more diffuse and remarkable immunoexpression of all studied integrins than ACCs. The reduced integrins expression in ACC may be related to a lesser degree of cell differentiation in this neoplasm. Moreover, the absence and/or reduced expression of the studied integrins in solid ACC suggest a possible role in pathogenesis and more aggressive biological behavior of this histologic subtype.

Significance of galectins-1, -3, -4 and -7 in the progression of squamous cell carcinoma of the tongue.

The aim of this study was to analyze the immunohistochemical expression of galectins-1, -3, -4, and -7 in 65 cases of squamous cell carcinoma of the tongue and to correlate this expression with clinical (disease outcome, metastasis, and clinical stage) and morphological parameters (histological grade of malignancy). Clinical data were obtained from the patient records. The histological grading system of malignancy proposed by Bryne (1998) [9] was used for the analysis of morphological parameters. The results were analyzed statistically by χ(2) test (p < 0.05). Galectin-1 expression was observed in 87.7% of cases and was significantly correlated with metastasis (p = 0.033) and clinical stage (p = 0.016). Immunoexpression of galectin-3 was observed in 87.7% of cases and was correlated with the presence of metastasis (p = 0.033) and histological grade of malignancy (p = 0.031). Galectin-4 showed no significant correlation with any of the parameters studied. Expression of galectin-7 was observed in 73.8% of cases and was significantly correlated with the histological grade of malignancy (p = 0.005). In conclusion, the intense immunoexpression of galectins-1, -3, and -7 suggests the participation of these proteins in oral carcinogenesis and their use as markers of biological behavior and tumor progression in squamous cell carcinoma of the tongue.

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.

Immunoexpression of bone morphogenetic protein-2 (BMP-2), BMP receptor type IA, and BMP receptor type II in metastatic and non-metastatic lower lip squamous cell carcinoma.

BACKGROUND: The aim of this study was to evaluate the expression of bone morphogenetic protein-2 (BMP-2), BMPR-IA, and BMPR-II in metastatic and non-metastatic lower lip squamous cell carcinoma (LLSCC). METHODS: Twenty LLSCC with regional nodal metastasis and 20 LLSCC without metastasis were selected for analysis of the immunoexpression of BMP-2, BMPR-IA, and BMPR-II. The percentage of positive cells was evaluated according to the following parameters: score 1 (staining in 0-50% of cells), score 2 (staining in 51-75% of cells), and score 3 (staining in >75% of cells). Immunostaining intensity was evaluated according to the following scores: score 1 (absent or weak expression) and score 2 (strong expression). RESULTS: Regarding the percentage of positive cells, most tumors with and without metastasis showed score 3 for both BMP-2 (P = 0.655) and BMPR-IA (P = 0.655). For BMPR-II, metastatic tumors exhibited higher percentage of positive cells in comparison with non-metastatic tumors (P = 0.049). With respect to immunostaining intensity, most LLSCCs with and without metastasis showed score 2 for BMP-2 (P = 1.000) and score 1 for BMPR-II (P = 1.000). For BMPR-IA, most metastatic tumors presented score 2, whereas most non-metastatic tumors showed score 1 (P < 0.001). Strong expression of BMPR-IA showed a statistically significant association with advanced clinical staging (P < 0.001) and high score of malignancy (P = 0.028). CONCLUSIONS: The results of this study suggest that disturbances in the BMP-2 signaling pathway may be involved in the development of LLSCC and that the strong expression of BMPR-IA might be indicative of the development of metastasis in 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.

Chondrolipoma of the tongue: a case report.

Chondrolipomas are benign mesenchymal tumors characterized by the proliferation of mature adipocytes associated with variable amounts of mature cartilaginous tissue. We describe here a case of chondrolipoma of the tongue in a 30-year-old man. The patient reported the presence of the lesion for approximately 10 years. Intraoral clinical examination revealed a nodular, sessile, pink mass of firm consistency, which was located along the midline of the posterior region on the dorsal surface of the tongue. An excisional biopsy was performed and histopathological examination revealed a well-delimited proliferation of mature adipocytes arranged in lobules and separated by fibrous connective tissue septa. Islands of mature cartilaginous tissue were identified in close proximity to the fibrous connective tissue septa, as well as lacunae filled with chondrocytes. No myxoid areas, lipoblasts, atypias, hyperchromasia or mitosis were detected. After 5 years of follow-up, the patient shows no signs of recurrence. Chondrolipomas are uncommon in the oral cavity, with only nine cases being reported in the international literature (Pubmed Database).

Human papillomavirus in oral squamous cells carcinoma in a population of 75 Brazilian patients.

PURPOSE: In the present study, we investigated the presence of human papillomavirus (HPV) DNA and viral types in 75 cases of oral squamous cells carcinoma from Brazil to obtain data that would contribute to a better understanding of the role of HPV in the pathogenesis of this tumor. MATERIALS AND METHODS: DNA was extracted from paraffin-embedded tissue and amplified by polymerase chain reaction using a pair of primers designated PCO3+ and PCO4+ for the detection of a fragment of the human beta-globin gene, followed by polymerase chain reaction for the detection of HPV DNA using a pair of generic primers, GP5+ and GP6+. Viral typing was performed by dot blot hybridization. RESULTS: Human papillomavirus DNA was detected in 18 (24%) of the 75 cases positive for the human beta-globin gene. No significant association was observed between HPV and age, sex, or anatomical location of the tumor. The most prevalent viral type was HPV-18 (77,8%). CONCLUSION: The low frequency of detection of HPV DNA in oral epidermoid carcinomas suggests a possible participation of the virus in the development and progression of only a subgroup of these tumors.

Osteossarcoma de mandíbula inicialmente mimetizando lesão do periápice dental: relato de caso / Osteosarcoma of mandible initially resembling lesion of dental periapex: a case report

O osteossarcoma é um tumor mesenquimal maligno, no qual as células cancerosas produzem matriz óssea. É o tumor maligno primário mais comum do osso, responsável por aproximadamente 20 por cento dos sarcomas, sendo que 5 por cento destes ocorrem nos maxilares. Possuem variados aspectos não só clínicos e histopatológicos como também no curso e prognóstico. Este artigo apresenta um relato de caso de paciente do sexo feminino, com 20 anos de idade, que nos foi encaminhada apresentando aumento de volume na região de pré-molar inferior esquerdo. Após diagnóstico clínico de lesão do periápice dental, a paciente foi submetida previamente a tratamento endodôntico do dente envolvido, a partir do qual, em um período de 11 dias, pode-se observar um considerável aumento da lesão provocando visível assimetria facial. A radiografia oclusal mostrava imagem compatível com área de destruicão óssea e formacão de osso anormal na região, com cortical externa exibindo evidente radiopacidade semelhante a raios de sol, sugerindo o diagnóstico de osteossarcoma. A lesão foi biopsiada e obteve-se o diagnóstico histopatológico de osteossarcoma. A paciente foi então submetida à mandibulectomia parcial e uma reconstrucão da área, usando osso de costela e enxerto de pele da nádega, para o revestimento da mucosa oral envolvida. Aos 8 meses após a cirurgia houve recorrência local da lesão e a paciente foi a óbito aproximadamente 1 ano depois da recidiva.

O papel das proteínas da matriz extracelular e das metaloproteinases em carcinomas de cabeca e pescoco: uma atualizacão bibliográfica / The role of matrix extracellular proteins and metalloproteinases in head and neck carcinomas: an updated review

Interacões entre células neoplásicas e constituintes da matriz extracelular (MEC) interferem fortemente no desenvolvimento tumoral, incluindo os localizados em cabeca e pescoco, pois influenciam a proliferacão e sobrevivência celular, bem como a sua capacidade de migrar do sítio primário para outros tecidos e formar metástases. Essa migracão celular é facilitada pela destruicão parcial da MEC, a qual é realizada pelas metaloproteinases (MMPs), que representam uma família de mais de vinte endopeptidases, com atividade controlada pela expressão de inibidores específicos (TIMPs). Diversos estudos utilizando-se de marcadores para constituintes da MEC bem como pelas MMPs têm fornecido informacões adicionais sobre o diagnóstico e prognóstico em carcinomas de cabeca e pescoco. Nesta revisão consideraremos o papel da MEC e das MMPs na progressão desses tumores, enfatizando que não somente a degradacão proteolítica está envolvida neste processo, como também interacões entre vários constituintes da MEC fornecem substrato para regulacão e crescimento destes tumores.

The role of matrix extracellular proteins and metalloproteinases in head and neck carcinomas: an updated review.

Interactions involving tumor cells and the extracellular matrix (ECM) strongly influence tumor development, including head and neck tumors, affecting cell proliferation and survival as well as the ability to migrate beyond the original location into other tissues to form metastases. These cell migration is often facilitated by partial destruction of the surrounding ECM, which is catalyzed by matrix metalloproteinases (MMPs), a family of more than 20 endopeptidases that is controlled by regulated expression of specific inhibitors (TIMPs). Several studies of ECM and MMPs markers have provided additional diagnostic and prognostic information in head and neck carcinomas. In this review, we are considering the role of ECM and MMPs in tumor progression, emphasizing its proteolytic contributors to this process, and interactions between several members of ECM providing substrate to regulation of this process.

Osteosarcoma of mandible initially resembling lesion of dental periapex: a case report.

Osteosarcoma is a malignant mesenchymal tumor whose cancerous cells produce osteoid matrix. It is the most common primary malignant bone tumor, accounting for approximately 20% of the sarcomas, but only 5% of the osteosarcomas occur in the jaws. They present various clinical and histological aspects, as well as variable disease progression and outcome. This article shows a case report of a 20-year-old woman who presented swelling near the mandibular left premolar. After clinical diagnosis of lesion of the dental periapex, the patient initially underwent endodontic treatment of the tooth involved. Thereafter, in a period of eleven days, a significant increase of the lesion could be observed, resulting in visible facial asymmetry. The occlusal radiographic view showed an area of bone destruction and abnormal bone formation in the region. The external cortical portion showed clear radiopacity resembling sunrays, suggesting the diagnosis of osteosarcoma. The treatment comprised partial mandibulectomy and reconstruction of the area, using bone of the rib and skin graft from the buttock for the oral mucosa involved. Eight months after surgery, there was local recurrence of the lesion and the patient died approximately one year after relapse.

Origin of stellate giant cells in oral fibrous lesions determined by immunohistochemical expression of vimentin, HHF-35, CD68 and factor XIIIa.

AIMS: To determine the origin of mono-, bi- and multinucleate stellate giant cells in giant cell fibroma, fibrous hyperplasia and fibroepithelial polyp of the oral mucosa. METHODS: Ten cases of each lesion were studied immunohistochemically using anti-vimentin, -HHF-35, -CD68 and -factor XIIIa antibodies. Immunoreactivity of the cells was determined in the papillary and reticular lamina propria of these lesions. RESULTS: Vimentin positivity in both the papillary and reticular lamina propria was observed for most samples, especially giant cell fibroma cases. CONCLUSIONS: The immunohistochemical findings of the present study suggest that the mono-, bi- or multinucleate stellate giant cells observed in the lesions studied derived from the fibroblastic lineage.

Neurofibroma paciniano: relato de um caso raro de localização intra-oral / Pacinian neurofibroma: report of a rare intraoral case

O neurofibroma paciniano é uma lesão rara encontrada predominantemente em mãos, incluindo digitais, em nádegas e pés. As lesões podem ser solitárias ou múltiplas como componente da doença de Von Recklinghausen. Na cavidade oral, o neurofibroma paciniano é um achado incomum, existindo apenas um caso relatado na literatura mundial. O objetivo deste trabalho é apresentar um caso de neurofibroma paciniano localizado em mucosa gengival, bem como descrever as suas características clínicas e histopatológicas, contribuindo, assim, para um melhor conhecimento desta entidade.

Correlation of c-erbB-2 and S-100 expression with the malignancy grading and anatomical site in oral squamous cell carcinoma.

An immunohistochemical analysis of 32 cases of oral squamous cell carcinoma (eight in the inferior lip, eight in the lateral angle of the tongue, eight in the palate and eight in the mouth floor) was performed to evaluate the expression pattern of c-erbB-2 protein and S-100-positive cells in the lesions. The immunohistochemical expression was correlated with the tumour anatomical site and histological grading of malignancy. A higher frequency of c-erbB-2-positive cases was found in the tongue, even though no correlation could be detected between the protein expression and the tumour histological grading. With respect to the S-100-positive cells, it was observed that a quantitative decrease was present in the cases classified as high-grade tumours when compared to the low ones (P = 0.0007). Thus, c-erbB-2 immunohistochemical expression is correlated with anatomical localization, and the expression of the S-100 Langerhans' cell markers is decreased significantly in high-grade carcinomas.