Comparative analysis of three histologic grading methods for squamous cell carcinoma of the lip.

OBJECTIVES: The aim of this study was to evaluate three histologic grading methods for squamous cell carcinoma (SCC) of the lip, the conventional three-grade model proposed by the World Health Organization, tumor budding and depth of invasion (BD) model, and histologic risk assessment (HRA) model, and to correlate them with prognosis. MATERIALS AND METHODS: Fifty-three patients with lip SCC were evaluated. RESULTS: The mean age was 65 years, 69.8% of the participants were men, and 66.0% of the patients had early-stage tumors. Using the BD and conventional three-grade methods, 52.8% and 64.2% of the cases were graded as low risk, respectively. The HRA model graded 54.7% of the cases as medium risk. In the BD model, the higher histologic grade was associated with worse prognosis (P = 0.045). Overall survival at 5 years was 87.8%. Tumor size (T3 + T4) and lymph node involvement (N+) were associated with reduced overall survival and recurrence-free survival (RFS) (P = 0.002 and 0.005; 0.007 and 0.01, respectively). Surgical treatment combined with radiotherapy was associated with lower RFS (P = 0.03). CONCLUSIONS: High-grade lip SCC in advanced stages is associated with a poor prognosis. The BD model is a simple and effective tool for the prognostic evaluation of lip SCC.

Parathyroid hormone/parathyroid hormone-related peptide receptor 1 expression in odontogenic cystic lesions.

AIM: To evaluate parathyroid hormone/parathyroid hormone-related peptide receptor 1 (PTHR1) expression in odontogenic cystic lesions and to compare immunoexpression between the lesions. METHODOLOGY: Thirty-five radicular cysts, 22 dentigerous cysts and 17 keratocystic odontogenic tumours were evaluated. Immunohistochemical reactions against PHTR1 were carried out in 3-µm histological sections, and the expression and the intensity of PTHR1 expression were evaluated. For statistical analysis, the Fisher exact test was used, with a significance of 5%. RESULTS: The intensity of expression in the epithelial lining was significantly weaker in the radicular cyst (P = 0.007). However, in the fibrous capsule, the radicular cyst presented higher positivity for PTHR1 (P = 0.04). CONCLUSIONS: The probable co-expression of PTHrP and PTHR1 in odontogenic cystic lesions may eventually have an autocrine and/or paracrine stimulus in the epithelial and mesenchymal cells, inducing proliferation and lesion growth.

Clinicopathological study and treatment outcomes of 121 cases of ameloblastomas.

The aim of this paper is to evaluate the clinical, radiographic, and histopathological findings and treatment modalities in all cases of ameloblastomas treated at the Sao Paulo Cancer Hospital, between 1953 and 2003. 121 case reports were retrieved from the medical files. Data were reviewed and statistical analysis was performed using Kaplan-Meyer method and Cox proportional risk model. The patients' age ranged from 2 to 82 years (mean 33.2 years), with a slight female prevalence. Most cases were located in the posterior mandible (80%). Radiographically, 60% showed a multilocular pattern. 113 casees were solid ameloblastomas, and plexiforme subtype was the most common. Solid tumours were treated by wide resection, curettage and criosurgery, or curettage alone, and unicystic tumours by curettage and/or cryotherapy. The global mean recurrence rate was 22%, with a mean follow-up of 9.7 years. The ameloblastomas were predominantly solid, affecting the posterior mandible. Important factors for outcome were radiographically multilocular lesions, the presence of ruptured basal cortical bone and histologically follicular tumours.

Low-energy laser therapy for prevention of oral mucositis in hematopoietic stem cell transplantation.

AIM: To evaluate the clinical effects of laser therapy on the prevention and reduction of oral mucositis in patients who underwent hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS: From January 2003 to September 2004, 24 patients received prophylactic laser therapy (L+ group). The applications started from the beginning of the conditioning regimen up to day +2. The oral assessment was performed daily until day +30. This group was compared with historical controls, namely 25 patients, who did not receive laser therapy (L- group). RESULTS: All patients developed some grade of mucositis. However, the L- group presented initial mucositis by 4.36 days, whereas the L+ group presented it in 6.12 days (P = 0.01). The maximum mucositis occurred between day +2 and day +6 with healing by day +25 in the L- group and between day +2 and day +7 with healing by day +14 for the L+ group (P = 0.84). Laser therapy also reduced the time of oral pain from 5.64 to 2.45 days (P = 0.04), and decreased the consumption of morphine (P = 0.07). CONCLUSION: This study suggests that laser therapy can be useful in oral mucositis to HSCT patients and improve the patient's quality of life. However, controlled randomized trials should be performed to confirm the real efficacy of laser therapy.

Peripheral osteoma of the maxilla: report of a case.

Osteomas are benign osteogenic lesions with very slow growth, which may arise from proliferation of either cancellous or compact bone. In the jaw, these are uncommon lesions. Excluding the maxillary sinus, there are only eight cases of maxillary osteoma reported in the English-language literature. This paper reports an additional case of maxillary osteoma in a 40-year-old man. We discuss the clinical data from the previously described cases and the main differential diagnoses.

Fine needle aspiration cytology as an additional tool in the diagnosis of odontogenic keratocyst.

OBJECTIVE: The aim of this study was to assess the use of fine needle aspiration cytology (FNAC) in diagnosis of odontogenic keratocyst (OKC), as well as to describe the cytological and immunohistochemical features. METHODS: Eight consecutive patients submitted to FNAC and diagnosed with OKC were included in this study. FNAC was performed using 24-gauge needles attached to a 10-ml syringe, supported by a mechanical-syringe holder to facilitate aspiration. All cases provided a liquid or viscous content for smears that were either air-dried for Diff-Quick staining or immediately fixed in 95% alcohol and stained by the Papanicolaou technique. Incisional biopsies were carried out to confirm the diagnosis. Immunohistochemical reactions against anti-pan-cytokeratin (CK), CK14 and CK19 were performed in 3 microm sections obtained from cell blocks and biopsy specimens. RESULTS: Cytologically many isolated or groups of keratinocytes with normal or ill defined nuclei were seen, besides numerous anucleated squamous cells and keratinous debris. Immunohistochemically, the keratin lamellae were positive for pan-cytokeratin and CK19, but negative for CK14. In biopsy specimens, CK14 expression was restricted to basal cells, while only the superficial cells were positive for CK19. CONCLUSIONS: In summary, FNAC is useful, reliable and safe tool for the preoperative diagnosis of OKC.