Diagnosis and Treatment of an Odontogenic Epithelial Tumor in a Dog With Features of Squamous Odontogenic Tumor.

A 9-year-old standard poodle presented for a comprehensive oral health assessment and treatment, at which time a left rostral mandibular swelling was recognized. The mass was biopsied and eventually excised by a left rostral mandibulectomy en bloc resection. Histopathology supported the diagnosis of a benign, intraosseous, epithelial tumor that was otherwise unclassified. The clinical, radiological, and histological features of this case are similar to those reported for squamous odontogenic tumor (SOT) in humans. This case study relays the diagnosis, treatment, and follow-up of the first SOT-like tumor in a dog.

A squamous odontogenic tumor following an orthodontic micro-screw: A rare case report and review of the literature.

We reported a very rare case of squamous odontogenic tumor(SOT) in a 23-year-old female. The tumor arose after an implanting operation of an orthodontic micro-screw, and was definitely diagnosed by the histopathological examination. Based on the case report and a review of the literature, we discussed about the general features, differential diagnosis and pathogenesis of SOT.

Retrospective analysis of jaw biopsies in young adults. A study of 1599 cases in Southern Brazil

Background: To evaluate the prevalence and the characteristics of jaw lesions diagnosed in young adults aged 20 to 30 years in a southern Brazil reference center, over a period of 25 years. And to analyze the concordance between clinical and histological diagnosis. Material and Methods: In this cross-sectional retrospective study, the biopsies files from this center were retrieved and data regarding sex, age, bone localization, clinical and histological diagnosis were collected. The histological diagnosis were grouped into the categories Cystic lesions of odontogenic origin, Periapical inflammation, Odontogenic tumors, Bone diseases, Health tissue and Nonspecific diagnostic. Absolute and relative frequencies were estimated with descriptive analysis. The agreement between clinical and histological diagnosis was measured through Kappa statistic. Results: A total of 18,181 histopathological analysis were performed during the period of the study, registering 1,599 jaw lesions in young adults. The average age of individuals was 24,59 years (SD 3,1). Nine hundred ninety-one (62%) lesions were found in females and 608 (38%) in males. More than half of pathologies were cystic lesions of odontogenic origin (822/51.4%), followed by periapical inflammation (282/17.6%). Regarding the site of lesions, more than half occurred in posterior mandible (877/54.8%), followed by posterior maxilla (339/21.2%). The most frequent entities were periapical cyst, chronic periapical granuloma, dental follicle and paradental cyst, corresponding to a total of 1,202 (75.2%) evaluated cases. In relation to the analysis of concordance between clinical and histological diagnosis the general Kappa index was 0.5, which is considered moderate. Finally, the findings confirm data from literature about the most frequent jaw pathologies in young adults and serve as aid for preventive measures of some entities. Additionally, they can improve the formulation of differential diagnosis and the patient management (AU)

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Clear cell odontogenic carcinoma, diagnostic difficulties. A case report.

INTRODUCTION: Clear cell odontogenic carcinoma (COCC) is a rare tumor described by Hansen et al. in 1985. The clinical and radiological manifestations are multiple and the diagnosis is histological. OBSERVATION: A 64-year-old patient consulted us for a right mandibular osteolytic lesion associated to a homolateral labial hypoesthesia. A biopsy was performed under local anesthesia. Histology was consistent with a metastatic lesion of clear kidney cell carcinoma, COCC, or odontogenic squamous tumor. Additional tests eliminated a metastatic lesion. A wide excision of the lesion by hemi-mandibulectomy associated with lymph node dissection and reconstruction by a fibula osteoseptocutaneous flap was performed. Presence of a fission of the EWSR1 gene on the histological examination of the surgical specimen made the diagnosis of COCC. DISCUSSION: Our observation illustrates the difficulty of diagnosing COCC. The new contribution of the cytogenetic techniques such as FISH-type techniques makes possible the improvement of the diagnosis.

Carcinoma de células escamosas intraóseo primario derivado de un tumor odontogénico queratoquístico: reporte de un caso y revisión de la literatura / Primary intraosseous squamous cell carcinoma derived from a keratocystic odontogenic tumour: Report of a case and a review of the literature

El carcinoma de células escamosas intraóseo primario (CCEIP) derivado de un tumor odontogénico queratoquístico (TOQ) es un tumor odontogénico maligno que se presenta con poca frecuencia y exclusivamente en los huesos maxilares. Afecta a personas de mediana edad, principalmente hombres y usualmente se localiza en la zona posterior mandibular. Clínicamente puede presentar las características clásicas de un tumor odontogénico benigno, aunque también puede asociarse a sintomatología dolorosa y alteraciones de la sensibilidad. Presentamos el caso de una mujer de 86 an˜ os de edad en la que se diagnosticó CCEIP derivado de un TOQ. Se describen las características clínicas, radiológicas e histológicas, discutiendo la importanciade tomar biopsia de distintas zonas de una lesión quística caracterizada por afectar amplias zonas de los huesos maxilares (AU)

Primary intraosseous squamous cell carcinoma (PIOSCC) derived from a keratocystic odontogenic tumour (KCOT) is a rare malignant bone tumour that exclusively involves the maxillary bones. It affects middle-age patients, mainly men, and is usually located in the posterior mandibular area. Clinically, it may exhibit classic characteristics of benign odontogenic tumors, though it may also be associated with pain and sensitive alterations We present the case of an 86-year-old woman who was diagnosed with a PIOSCC derived from a KCOT. The imaging, clinical, and histological characteristics are described, and the importance of taking a biopsy from different parts of a cystic lesion that is characterized by extensive anatomical area involved are discussed (AU)

Avaliação imuno-histoquímica da BMP-2, BMP-4 e seus receptores BMPRIA e BMPRII em ameloblastomas e tumor odontogênico adenomatóide / Immunohistochemical evaluation of BMP-2, BMP-4 and its BMPRIA and BMPRII receptors in ameloblastomas and adenomatoid odontogenic tumor

As BMPs são componentes da superfamília de ligantes do fator transformador de crescimentoß (TGF-ß), secretados no meio extracelular, com mecanismos de comunicação intercelular por meio de ligantes e receptores específicos em diversas células-alvo, sendo reconhecidas por sua influência na indução osteogênica, também desempenhando importante papel na homeostase tecidual, proliferação celular, no controle de diferenciação, além de estar presente no desenvolvimento de diversas neoplasias. O objetivo deste estudo foi comparar a expressão imuno-histoquímica da BMP-2, BMP-4 e seus receptores BMPRIA e BMPRII em casos de Ameloblastoma e Tumor odontogênico adenomatóide. A amostra foi constituída de 20 casos de Ameloblastoma sólido (AS), 10 casos de Ameloblastoma unicístico (AU) e 16 casos de Tumor odontogênico adenomatóide (TOA). A expressão das BMPs e seus receptores foi avaliada no parênquima e estroma das lesões, estabelecendo-se o percentual de células imunopositivas (0 ­ negativo; 1 - 1% a 10% das células positivas; 2 - 11% a 25% das células positivas; 3 - 26% a 50% das células positivas; 4 - 51% a 75% das células positivas; 5 - mais 75% de células positivas). A análise da expressão de BMP-2 não revelou diferenças estatisticamente significativas no componente parênquimatoso (p = 0,925) e estromal (p = 0,345) entre as lesões estudadas, assim como a BMP-4 (p = 0,873 / p = 0,131). No parênquima, o AS e TOA apresentaram maior frequência do escore 5. Por sua vez, todos os casos de AU foram classificados como escore 5. A análise do componente estromal revelou não haver diferença estatisticamente significativa entre os grupos em relação às medianas dos escores de positividade para BMPRIA (p = 0,768) e BMPRII (p = 0,779). No parênquima do AS e do AU, não foram observadas correlações estatisticamente significativas entre as imunoexpressões das proteínas analisadas. Por sua vez, no grupo dos TOAs, foram constatadas correlações positivas, estatisticamente significativas, entre os escores de expressão de todas as proteínas avaliadas. No componente estromal, foram constatadas correlações positivas, estatisticamente significativas, apenas no grupo do AS em BMP-4 e BMPRII (r = 0,476; p = 0,034) e do AU em BMP-4 e BMPRIA (r = 0,709; p = 0,022). Os resultados do presente estudo sugerem que as BMPs e seus receptores estão envolvidos no processo de desenvolvimento de tumores odontogênicos. A BMP-4, por sua vez, além de estar presente em tumores odontogênicos possui a capacidade de formação de material mineralizado. (AU)

BMPs are components superfamily ligands transformation growth fator-ß (TGF-ß) secreted into the extracellular environment, with mechanisms of intercellular communication through specific ligands and receptors in various target cells, being recognized for its influence in osteogenic induction, also play an important role in tissue homeostasis, cell proliferation, differentiation control , in addition to being present in the development of various malignancies. The aim of this study was to compare the immunohistochemical expression of BMP-2, BMP-4 and its receptors BMPRIA and BMPRII in cases of ameloblastoma and adenomatoid odontogenic tumor. The sample consisted of 20 cases of solid ameloblastoma (SA), 10 cases of ameloblastoma unicystic (UA) and 16 cases of adenomatoid odontogenic tumor (AOT). The expression of BMPs and their receptors was evaluated in the parenchyma and stroma of lesions, establishing the percentage of immunopositive cells (0 - negative; 1-1 % to 10 % of cells positive; 2 - 11% to 25% of positive cells; 3 - 26% to 50% of cells positive; 4 - 51% to 75 % of positive cells; 5 - more than 75% positive cells). Analysis of the expression of BMP-2 revealed no statistically significant differences in parenchymal (p = 0.925) and stromal component (p = 0.345) between the groups, as well as BMP-4 (p = 0.873 / p = 0.131). In the epithelial component, SA and AOT had a higher frequency of score 5. In turn, all cases of UA were classified as score 5. The analysis of the stromal component showed no statistically significant difference between groups with respect to median scores BMPRIA positivity (p = 0.768) and BMPRII (p = 0.779). In the epithelial component of SA and UA, no statistically significant correlations between imunoexpression proteins analyzed were observed. In turn, the group of AOT, statistically significant positive correlations between the scores of expression of all studied proteins were found. In the stromal component, statistically significant positive correlations were found only in the SA group in BMP -4 and BMPRII (r = 0.476; p = .034), in the UA in BMP-4 and BMPRIA (r = 0.709; p = 0.022). The results of this study suggest that the BMPs and their receptors are involved in the development process odontogenic tumors. BMP-4, in turn, besides being present in odontogenic tumors have the capacity to form mineralized material. (AU)

A clinical-pathological and survival study of oral squamous cell carcinomas from a population of the North of Portugal

OBJECTIVES: Our aim was to analyze the clinical, pathological, and outcome characteristics of oral squamous cell carcinomas (OSCC) from a population of the North of Portugal. MATERIAL AND METHODS: We conducted a descriptive study of 128 OSCC diagnosed between the years of 2000 and 2010 in the Centro Hospitalar do Porto. Through of the review of the clinical records we studied several clinical, pathological, and outcome variables. The overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier method and log-rank test. Cox regression method was used for multivariate analysis. RESULTS: Of 128 patients with OSCC, 83 (64.8%) were male and 45 (35.2%) were female, (mean age of 62.13±15.57 years). The most affected location was the tongue (n=52; 40.6%). The most common cause of reference was a non-healing ulcer (n=35; 28.9%) followed by oral pain (n=27; 22.3%). Sixty (60.6%) patients were tobacco consumers and 55 (57.3%) alcohol consumers. The cumulative 3-years OS rate was 58.6% and DFS was 55.4%. In multivariable analysis for OS, we found an adverse independent prognostic value for advanced tumour size (p < 0.001) and for the presence of perineural permeation (p = 0.012). For DFS, advanced stage tumours presented adverse independent prognostic value (p < 0.001). CONCLUSION: OSCC occurred most frequently in males, in older patients, and in patients with tobacco and/or alcohol habits. TNM and tumour stage additionally to the perineural permeation were the most important prognostic factor for the survival of these patients, contributing to identify high-risk subgroups and to guide therapy

Fibroma ameloblástico asociado a un odontoma compuesto. La importancia del estudio histopatológico / Ameloblastic fibroma associated with a compound odontoma. Importance of the histopathological study

El fibroma ameloblástico es un tumor odontogénico mixto benigno de rara aparición, que constituye el 2% de todos los tumores odontogénicos, es de crecimiento lento, más común en niños y adultos jóvenes, compuesto por tejido conjuntivo fibroso embrionario y epitelio odontogénico primitivo, se caracteriza por la proliferación de tejido epitelial y mesenquimático. Aparece con más frecuencia en la mandíbula en zona de molares y premolares de pacientes jóvenes sin predilección de sexo, asociándose a veces a un diente incluido. El presente artículo tiene como objetivo describir un caso clínico de un paciente en la segunda década de vida, con aparente anodoncia en el maxilar superior, que se encontraba asintomático y en el cual fue diagnosticado fibroma ameloblástico en maxilar superior, zona de incisivos anteriores, lado izquierdo, se realiza una breve revisión de la literatura y diagnósticos diferenciales, se analizan sus características clínicas e histológicas y la actitud terapéutica a tomar. El tratamiento quirúrgico conservador con extirpación seguida de curetaje parece ser la opción terapéutica más adecuada, y teniendo presente que el porcentaje de recidiva es del 18,3% principalmente debido a escisión incompleta de la lesión, se deben realizar controles radiográficos postoperatorios 6 meses después y cada año por los siguientes 5 años (AU)

The ameloblastic fibroma is a benign mixed, rare odontogenic tumour, which accounts for 2% of all odontogenic tumours. It is slow growing, and more common in children and young adults. It is composed of embryonic fibrous connective tissue and early odontogenic epithelium, and characterised by the proliferation of epithelial and mesenchymal tissue. It appears most frequently in the jaw area of molars and premolars of young patients with no sex predilection, and is sometimes associated with an impacted tooth. This article aims to describe a clinical case of a child in the second decade of life, with apparent anodontia in the maxilla, which was asymptomatic and later diagnosed as an ameloblastic fibroma in the left side maxilla incisors area. A brief review of the literature and differential diagnoses was carried out, including an analysis of its clinical and histological features, and the therapeutic approach to take. Conservative surgical excision followed by curettage seems to be the most appropriate treatment option. It should be noted that the recurrence rate is 18.3%, mainly due to incomplete excision of the lesion. Radiographic controls should be performed six months postoperatively, and every year for the following five years (AU)

Tumor odontogênico queratocístico: atualidades / Keratocyst odontogenic tumor: an update

O tumor odontogênico queratocístico (TOQ) é uma neoplasia benigna dos ossos gnáticos, que apresenta agressividade local e alta taxa de recorrência. O TOQ é uma lesão intra-óssea, invasiva e destrutiva dos maxilares que apresenta crescimento lento e infiltrativo sendo, geralmente, uma lesão assintomática. A radiografia e a tomografia computadorizada auxiliam no diagnóstico, sendo necessária a biópsia e análise histopatológica para diagnóstico definitivo. Entre as técnicas de tratamento estão a ressecção, a enucleação, a curetagem, a descompressão e a marsupialização. É de suma importância que o cirurgião conheça a neoplasia e a recente classificação da Organização Mundial da Saúde para que, após o diagnóstico, os tratamentos sejam adequadamente escolhidos. Este estudo visou abordar atualidades acerca do TOQ por meio da revisão da literatura.

The keratocystic odontogenic tumor (KOT) is a benign neoplastic lesion of the jaws, disclosing a high local aggressiveness and a high recurrence rate. The KOT is an asymptomatic slow growing tumor of the jaws with an infiltrative, invasive and destructive intraosseous behavior. Radiography and computed tomography images aid the diagnosis but biopsy and histopathology must be carried out to point a definitive diagnosis. The treatment is a surgical procedure. The techniques are resection, enucleation, curettage, decompression and marsupialization. It is paramount that the surgeon knows the lesion features after the recent World Health Organization remarks to perform the best treatment after diagnosis. This study aimed to address updates about KOT through a literature review.

Estudo imuno-histoquímico da presença de miofibroblastos e da expressão do fator transformador de crescimento-beta1, interferon gama, mataloproteinase de matriz 13 e indutor de metaloproteinases de matriz em lesões odontogênicas epiteliais / Immunohistochemical study of the presence of myofibroblasts and the expression of transforming growth factor-beta1, interferon gamma, mataloproteinase matrix 13 and matrix metalloproteinase inducer in odontogenic epithelial lesions

Os miofibroblastos são células que apresentam um fenótipo híbrido exibindo características morfológicas de fibroblastos e de células musculares lisas, sendo a aquisição de tal fenótipo denominada diferenciação, passando então a expressar a a-SMA, a qual é importante na identificação dessas células. Estudos têm sugerido que os miofibrobíastos apresentam relação com a agressividade de diversas lesões e que o seu processo de diferenciação estaria relacionado à expressão do TGF-pl e do IFN-y atuando, respectivamente, no estímulo e na inibição dessa diferenciação. O objetivo deste trabalho foi investigar o papel dos miofibroblastos em lesões odontogênicas epiteliais, relacionando-os à agressividade das lesões e analisar por meio da imuno-histoquímica. a expressão do TGF-pl e IFN-y no processo de diferenciação, além da análise da MMP-13 que é ativada por miofibroblastos e do indutor de metaloproteinases de matriz (EMMPRIN) como precursor desta MMP. A amostra foi constituída por 20 ameloblastomas sólidos, 10 ameloblastomas unicfsticos, 20 ceratocistos odontogênicos e 20 tumores odontogênícos adenomatóides. Para a avaliação dos miofibroblastos, foram quantificadas as células imunorreativas ao anticorpo a-SMA presentes no tecido conjuntivo, próximo ao tecido epitelial. As expressões de TGF-pl, IFN-y, MMP-13 e EMMPRIN, foram avaliadas no componente epitelial e no conjuntivo, estabelecendo-se o percentual de imunorreatividade e atribuindo-se escores de 0 a 4. A análise dos miofibroblastos evidenciou maior concentração nos ameloblastomas sólidos (média de 30,55), seguido pelos ceratocistos odontogênicos (22,50), ameloblastomas unicísticos (20,80) e tumores odontogênicos adenomatóides (19,15) com valor de p= 0,001. Não foi encontrada correlação significativa entre TGF-pl e IFN-y no processo de diferenciação dos miofibroblastos, bem como na relação entre a quantidade de miofibroblastos e a expressão da MMP-13. Constatou-se, correlação estatística entre MMP-13 e TGF-pi (r= 0,087; p= 0,011) além de significante correlação entre MMP-13 e IFN-y (r=0,348; p=0,003). Entre EMMPRÍN e MMP-13 verificou-se significância (r= 0,474; p<0,001) assim como entre EMMPRIN e IFN-y (r=0,393; p=0,001). A maior quantidade de miofibroblastos evidenciada nos ameloblastomas sólidos, ceratocistos odontogênicos e ameloblastomas unicísticos sugere que estas células podem ser um dos fatores responsáveis para um comportamento biológico mais agressivo destas lesões, embora a população de miofibroblastos não tenha apresentado correlação com TGF- -pi, IFN-y ,MMP-13 e EMMPRIN. Quanto a correlação evidenciada entre MMP-13 e TGF-pl, isto pode sugerir um papel indutor do TGF-pl para a expressão da MMP-13, assim como os resultados deste estudo reforçam a relação bem estabelecida do EMMPRIN como indutor da MMP-13. Constatou-se também relação entre EMMPRIN e IFN-y assim como entre MMP-13 e IFN-y sugerindo, dessa forma, um sinergismo na ação anti-fibrótica desses marcadores.

Myofibroblasts are cells that exhibit a hybrid phenotype, sharing the morphoíogical characteristics of fibroblasts and smooth muscle cells, which is acquired during a process called differentiation. These cells then start to express a-SMA, a marker that can be used for their identification. Studies suggest that myofibroblasts are related to the aggressiveness of different tumors and that TGF-pl and IFN-y play a role in myofibroblast differentiation, stimulating or inhibiting this differentiation, respectively. The objective of this study was to investigate the role of myofibroblasts in epithelial odontogenic tumors, correlating the presence of these cells with the aggressiveness of the tumor. Immunohistochemistry was used to evaluate the expression of TGF-pl and IFN-y in myofibroblast differentiation, as well as the expression of MMP-13, which is activated by myofibroblasts, and of EMMPRIN (extracellular matrix metalloproteinase inducer) as a precursor of this MMP. The sample consisted of 20 solid ameloblastomas, 10 unicystic ameloblastomas, 20 odontogenic keratocysts, and 20 adenomatoid odontogenic tumors. For evaluation of myofibroblasts, anti-a-SMA-immunoreactive cells were quantified in connective tissue close to the epithelium. Immunoexpression of TGF-pl, IFN-y, MMP-13 and EMMPRIN was evaluaíed in the epithelial and connective tissue components, attributing scores of 0 to 4. The results showed a higher concentration of myofibroblasts in solid ameloblastomas (mean of 30.55), followed by odontogenic keratocysts (22.50), unicystic ameloblastomas (20.80), and adenomatoid odontogenic tumors (19.15) (p=0.00). No significant correlation between TGF-pl and IFN-y was observed during the process of myofibroblast differentiation. There was also no correlation between the quantity of myofibroblasts and MMP-13 expression. Significant correlations were found between MMP-13 and TGF-pi (r=0.087; p=0.01 1), between MMP-13 and ÍFN-y (r=0.348; p=0.003), as well as between EMMPRIN and MMP-13 (r=0.474; /xO.001) and between EMMPRIN and IFN-y (r=0.393; p=0.00). The higher quantity of myofibroblasts observed in solid ameloblastomas, odontogenic keratocysts and unicystic ameloblastomas suggests that these cells are one of the factors responsible for the more aggressive biological behavior of these tumors, although the myofibroblast population was not correlated with TGF-01, IFN-y, MMP-13 or EMMPRIN. The correlation between MMP-13 and TGF-pl suggests that the latter induces the expression of this metalloproteinase. The present results also support the well-established role of EMMPRIN as an inducer of MMP-13. Furthermore, the relationship between EMMPRIN and IFN-y and between MMP-13 and IFN-y suggests synergism in the antifibrotic effect of these markers.

Tumor odontogenico queratoquistico: tratamiento conservador con injerto autologo combinado con plasma rico en plaquetas / Queratoquistico odontogenic tumor: conservative treatment combined with autologous platelet rich plasma

Muchos autores consideran que el origen del tumor Odontogénico Queratoquístico, es la lámina dental, otros autores lo asocian al órgano del esmalte. Éste es el segundo tumor odontogénico más común, considerado el más agresivo y con el mayor porcentaje de recidiva. En la década de los años 90, algunos investigadores propusieron entre las alternativas de tratamiento del tumor, el utilizar como coadyuvante en la reparación y cicatrización ósea, el gel de plasma rico en plaquetas más injertos óseos; con el objetivo de promover una maduración más rápida y una cicatrización óptima de los defectos óseos producto del curetaje. Se reporta un caso clínico de un paciente de sexo femenino, 35 años de edad, el cual es remitido, por presentar lesión radiolúcida extensa en zona de mentón, que compromete órganos dentarios 35 y 45. Se realiza punción aspirativa, obteniendo un contenido seroso con trazos sanguinolentos, que en conjunto con la biopsia incisional confirman el diagnóstico de tumor odontogénico queratoquístico. Se decidió realizar enucleación y curetaje óseo amplio del lecho quirúrgico, colocación de injerto heterólogo y autólogo, este último, obtenido de rama ascendente mandibular, combinado con gel de plasma rico en plaquetas con fines de regeneración ósea, posteriormente controles clínicos y radiográficos durante un año.

Many authors believe that the origin of the keratocysts Odontogenic Tumor is the dental lamina, others authors associate it with the enamel organ. This is the second most common odontogenic tumor, considered the most aggressive, with the highest rate of recurrence. During the 90´s, some researchers suggested the alternative treatment of the Tumor, using as an adjunct in the repair and bone healing, the gel of plasma rich in platelets plus bone grafts, to promote a more rapid maturation and an optimal healing of bone defects of the product curettage. It is reported a case of a female patient, 35 years old, which is transmitted by introducing large radiolucent lesion in the chin area, involving from tooth 35 to 45 in extension. Puncture aspiration is performed, obtaining a substance with serous bloody strokes, which together with the incisional biopsy confirmed the diagnosis of Tumor Odontogenic Keratocysts. It was decided to perform enucleation and bone curettage comprehensive surgical placement of autologous and heterologous graft, this latter obtained from the mandibular ramus, gel combined with platelet-rich plasma for bone regeneration, clinical and radiographic controls after one year.

Fibroma odontogénico central, tipo WHO: reporte de un caso y revisión de la literatura / Central odontogenic fibroma, WHO type: a case report and literature review

El fibroma odontogénico central es una neoplasia benigna muy poco frecuente. Clásicamente se ha dividido en dos variantes histológicas: un tipo pobre en epitelio y otro tipo rico en epitelio con focos de material calcificado. En la mayoría de los casos muestra un crecimiento lento y progresivo con o sin sintomatología. Radiográficamente es habitual observar una imagen radiolúcida y unilocular que en raras ocasiones exhibe radiolucidez mixta. El tratamiento indicado en todos los casos es la enucleación del tumor. Se reporta el caso de una mujer de 36 años de edad, sin antecedentes mórbidos, con una lesión asintomática de radiolucidez mixta, expansiva de ambas corticales óseas, en la zona del cuerpo y ángulo mandibular izquierdo, asociada a un tercer molar incluido. Basándose en el estudio histopatológico inicial, se diagnosticó como fibroma odontogénico, y con el posterior tratamiento definitivo de la lesión, se determinó la subvariedad tipo OMS. La paciente no ha tenido recidiva en 16 meses de seguimiento(AU)

The central odontogenic fibroma is a rare benign neoplasm. Classically has been divided into two histological variants, a poor type epithelium and other rich epithelium with foci of calcified material. It shows in most cases, a slow and progressive growing with or without symptoms. Radiographically it is common to observe a radiolucent, unilocular, rarely exhibiting mixed radiolucency. The treatment in all cases is enucleation of the tumor. We report the case of a 36 year old woman, no morbid history, with an asymptomatic lesion of mixed radiolucency, cortical bone expansion in the area of the body and the left mandibular angle associated with a third molar. Based on the initial histopathology it was diagnosed as odontogenic fibroma and subsequent definitive treatment of the injury rate was determined sub manifold WHO. The patient had no recurrence at 16 months of follow-up(AU)

Tumor odontogénico de células escamosas asociado a un quiste residual / Squamous cell odontogenic tumor associated to a residual cyst

El tumor odontogénico de células escamosas (TOCE) es una neoplasia sumamente infrecuente, derivada de restos de la lámina dental o restos de Malassez. Esta lesión denota una expresividad variable. Se presenta el caso de una mujer de 72 años con un aumento de volumen asintomático en el lado izquierdo del maxilar inferior con diagnóstico presuntivo de quiste residual y diagnóstico histopatológico de TOCE. Se discute y actualiza su presentación clínica, radiográfica y su tratamiento y se actualiza la información sobre la patología.(AU)

Tumor odontogénico de células escamosas asociado a un quiste residual / Squamous cell odontogenic tumor associated to a residual cyst

El tumor odontogénico de células escamosas (TOCE) es una neoplasia sumamente infrecuente, derivada de restos de la lámina dental o restos de Malassez. Esta lesión denota una expresividad variable. Se presenta el caso de una mujer de 72 años con un aumento de volumen asintomático en el lado izquierdo del maxilar inferior con diagnóstico presuntivo de quiste residual y diagnóstico histopatológico de TOCE. Se discute y actualiza su presentación clínica, radiográfica y su tratamiento y se actualiza la información sobre la patología.

Expressão imuno-histoquimica metaloproteinases -1, -2 e -9 em ameloblastoma sólido e tumor odontogênico adendomatóide / imuno-histoquímica expression of metaloproteinase -1, -2 and -9 in ameloblastoma solid and odontogênico tumor adenomatóide

O ameloblastoma e o tumor odontogênico adenomatóide são tumores odontogênicos derivados do epitélio odontogênico que possuem comportamentos distintos. Na tentativa de compreender a interação existente entre as células tumorais e a matriz extracelular, o presente trabalho teve como objetivo avaliar e comparar a expressão das metaloproteinases-1 (MMP-1), -2 (MMP-2) e -9 (MMP-9), através da técnica imuno-histoquímica em 20 casos de ameloblastoma e 10 de tumor odontogênico adenomatóide. A MMP-1 teve uma marcação predominante nos dois tumores, sendo observada tanto no parênquima como no estroma de todos os tumores estudados. Para a MMP-2, observou-se uma expressão variada, sendo 80% e 60% das células tumorais imunorreativas nos ameloblastomas e tumores odontogênicos adenomatóides, respectivamente. Em relação às células do mesênquima, 65% dos ameloblastomas e 80% tumores odontogênicos adenomatóides exibiram positividade. Verificou-se imunoexpressão para a MMP-9 nas células parenquimatosas e estromais em todos os casos, sendo que nos ameloblastomas, houve o predomínio de menos de 50% das células imunomarcadas; enquanto que em 60% dos tumores odontogênicos adenomatóides mais de 50% das células apresentaram positividade. Observou-se diferença estatisticamente significante na expressão da MMP-1 em relação à MMP-2 e -9 nos ameloblastomas (p<0,001). A análise estatística não pôde ser aplicada para os tumores odontogênicos adenomatóides, porém verificou-se tendência de maior expressão da MMP-1 em relação às outras MMPs avaliadas. Os resultados deste estudo sugerem que as MMPs-1, -2 e -9 estão relacionadas com crescimento e progressão dos tumores analisados e, particularmente no ameloblastoma, sua maior agressividade pode resultar, em parte, pela participação também do estroma presente de forma bem mais marcante permeando o parênquima tumoral e sendo fonte também das proteases estudadas (AU).

Ameloblastoma and adenomatoid odontogenic tumor are odontogenic tumors arising from the odontogenic epithelium with distinct clinical behavior. In attempt to comprehend the interaction between the odontogenic tumor cells and the extracellular matrix, the present work evaluated and compared the immunohistochemical expression of the matrix metalloproteinases-1 (MMP-1), -2 (MMP-2) and -9 (MMP-9) in 20 cases of ameloblastoma and 10 adenomatoid odontogenic tumor. MMP-1 exhibited exuberant expression in the parenchyma and in the stroma of both studied tumors, while the MMP-2 showed varied expression with about of 80% and 60% of the neoplastic cells exhibiting positivity in the ameloblastoma and adenomatoid odontogenic tumor, respectively. With relation to the MMP-2 expression by the mesenchymal cells, it was observed that 65% of the ameloblastoma and 80% of the adenomatoid odontogenic tumor were positive. The immunoreactivity of MMP-9 was detected in all studied cases, although its expression had occurred predominantely in less than 50% of the parenchyma cells of the ameloblastoma, while in about of 60% of the adenomatoid odontogenic tumor more than 50% of cells were positive. The mesenchymal cells were positive to MMP-9 in 65% of the ameloblastoma and in 80% of the adenomatoid odontogenic tumor, respectively. Statistically significant difference was observed to the MMP-1 expression with relation to MMP-2 and MMP-9 in the ameloblastoma (p < 0.001). It was not possible to perform statistical analysis to the cases of adenomatoid odontogenic tumor, however there was a tendency toward a differential expression of the MMP-1 with relation to other studied MMPs. These results suggest that MMP-1, - 2 and -9 are implicated in the growth and progression of both tumors analyzed as well as the more pronounced participation of the stroma in the ameloblastoma could together to be related to the higher clinical aggressiveness (AU).

Tumor odontogênico adenomatóide: relato de caso clínico / Adenomatoid odontogenic tumor: report of case

O tumor odontogênico adenomatóide é uma lesão benigna, não invasiva, de crescimento lento, porém progressivo. Apresenta predileção pela região anterior de maxila e por mulheres jovens. Geralmente apresenta - se assintomático e não excede 3 cm em seu maior diâmetro. Normalmente está associado com um canino incluso sendo que molares e incisivos laterais não erupcionados raramente são envolvidos. Propusemos relatar um caso de tumor odontogênico adenomatóide associado a um incisivo lateral em uma adolescente de 14 anos assim como revisar os aspectos clínicos, radiográficos, biológicos e tratamento do tumor odontogênico adenomatóide