Clinical Metabolomics Identifies Blood Serum Branched Chain Amino Acids as Potential Predictive Biomarkers for Chronic Graft vs. Host Disease.

The allogeneic hematopoietic stem cell transplantation procedure-the only curative therapy for many types of hematological cancers-is increasing, and graft vs. host disease (GVHD) is the main cause of morbidity and mortality after transplantation. Currently, GVHD diagnosis is clinically performed. Whereas, biomarker panels have been developed for acute GVHD (aGVHD), there is a lack of information about the chronic form (cGVHD). Using nuclear magnetic resonance (NMR) and gas chromatography coupled to time-of-flight (GC-TOF) mass spectrometry, this study prospectively evaluated the serum metabolome of 18 Brazilian patients who had undergone allogeneic hematopoietic stem cell transplantation (HSCT). We identified and quantified 63 metabolites and performed the metabolomic profile on day -10, day 0, day +10 and day +100, in reference to day of transplantation. Patients did not present aGVHD or cGVHD clinical symptoms at sampling times. From 18 patients analyzed, 6 developed cGVHD. The branched-chain amino acids (BCAAs) leucine and isoleucine were reduced and the sulfur-containing metabolite (cystine) was increased at day +10 and day +100. The area under receiver operating characteristics (ROC) curves was higher than 0.79. BCAA findings were validated by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) in 49 North American patients at day +100; however, cystine findings were not statistically significant in this patient set. Our results highlight the importance of multi-temporal and multivariate biomarker panels for predicting and understanding cGVHD.

Cryosurgery as an Option for the Treatment of Vascular Lesions of the Oral Cavity.

Cryosurgery is a treatment modality consisting in the destruction of tissue by the application of extremely low temperatures. This causes irreversible damage to cellular metabolism, leading to tissue destruction within minutes, a mechanism that may be beneficial when used in diseased tissues. Because cryosurgery is effective, simple, and easy to perform, it has been used in the treatment of lesions in both medical and dental fields. This technique provides many advantages, such as easy operation, absence of intraoperative bleeding, and low infection rate. We report the case of a patient with a hemangiomatous lesion of the oral cavity who was treated with liquid nitrogen spray cryosurgery, with successful results at 18-month follow-up.

Peripheral osteoma of the maxillary sinus: a case report.

BACKGROUND: Paranasal sinus osteomas are rare benign tumors. Although various theories such as trauma and infection have been proposed, it is difficult to establish the pathogenesis of osteoma. Osteomas may be detected with routine radiographic examination or the tumors may enlarge and cause symptoms. Osteomas most frequently occur in the frontal and ethmoid sinuses, and are rare in the maxillary sinus. CASE REPORT: In the present study, we report a case of an 18-year-old woman with a maxillary sinus osteoma. Radiographically, the tumor was characterized as a radiopaque, well-delimited lesion in the periapical region of teeth 27 and 28 that had positive sensitivity test. After computed tomographic scanning and complete removal of the tumor, the histopathological diagnosis was osteoma. After 1 year of follow-up, the patient shows no signs of recurrence.

Intraoral acinic cell carcinoma: case report and review of the literature.

Acinic cell carcinoma (ACC) is an uncommon salivary gland tumor that primarily affects the parotid gland. Involvement of minor salivary glands is rare. This report describes a 47-year-old man with an ACC on the left buccal mucosa. Histologically, the tumor was characterized by cells that resembled the serous cells. The patient was treated with surgical excision and showed no signs of recurrence two years later.

Angiomyolipoma of the upper lip: case report and review of the literature.

Angiomyolipoma (AML) is a hamartomatous growth that usually affects the kidney. One third of patients with AML present with manifestations of tuberous sclerosis. Oral AML is rare with only 6 cases reported in the English-language literature. In the present case, AML was located in the upper lip of a 43 year-old woman. Clinically, it presented as a firm nodule, well circumscribed and measuring 1 x 2 cm. It was surgically excised. Histopathological analysis showed a lesion composed of an admixture of smooth muscle cells, blood vessels, and adipose tissue. The immunohistochemical study revealed positivity for vimentin, smooth muscle actin, pan specific muscle actin and desmin. CD68, CD34 and mast cell antibodies showed focal immunoreactivity. S100 protein, Ki-67, and HMB-45 were negative. Based on these histological and immunohistochemical features the diagnosis was of oral AML. No recurrence was observed after 2 years of follow-up.