Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis.

OBJECTIVES: To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility. MATERIALS AND METHODS: MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value. RESULTS: Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001). CONCLUSIONS: OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.

NDB-UFES: An oral cancer and leukoplakia dataset composed of histopathological images and patient data.

The gold standard for the diagnosis of oral cancer is the microscopic analysis of specimens removed preferentially through incisional biopsies of oral mucosa with a clinically detected suspicious lesion. This dataset contains captured histopathological images of oral squamous cell carcinoma and leukoplakia. A total of 237 images were captured, 89 leukoplakia with dysplasia images, 57 leukoplakia without dysplasia images and 91 carcinoma images. The images were captured with an optical light microscope, using 10x and 40x objectives, attached to a microscope camera and visualized through a software. The images were saved in PNG format at 2048 × 1536 size pixels and they refer to hematoxylin-eosin stained histopathologic slides from biopsies performed between 2010 and 2021 in patients managed at the Oral Diagnosis project (NDB) of the Federal University of Espírito Santo (UFES). Oral leukoplakias were represented by samples with and without epithelial dysplasia. Since the diagnosis considers socio-demographic data (gender, age and skin color) as well as clinical data (tobacco use, alcohol consumption, sun exposure, fundamental lesion, type of biopsy, lesion color, lesion surface and lesion diagnosis), this information was also collected. So, our aim by releasing this dataset NDB-UFES is to provide a new dataset to be used by researchers in Artificial Intelligence (machine and deep learning) to develop tools to assist clinicians and pathologists in the automated diagnosis of oral potentially malignant disorders and oral squamous cell carcinoma.

Neumotórax espontáneo bilateral en primigestante adolescente, reporte de un caso / Spontaneous bilateral pneumothorax in a primigestant adolescent, a case report

El neumotórax espontáneo es una patología extremadamente rara durante la gestación. Se define como la presencia de aire dentro de la cavidad pleural que puede generar principalmente dolor torácico y disnea. Esta patología tiene unas bajas incidencia y prevalencia en el embarazo, pero es relevante por una alta tasa de recurrencia, con un buen pronóstico para la madre y el feto si es tempranamente diagnosticada y oportunamente manejada. Se relaciona con factores de riesgo como las maniobras de Valsalva efectuadas durante el trabajo de parto, además de con comorbilidad como el tabaquismo, y con el biotipo longilíneo, entre otros, por lo que son muy importantes una adecuada anamnesis y la evaluación de la exploración física. El obstetra debe sospecharlo ante la clínica de dolor torácico asociado a disnea en gestantes en el trabajo de parto y el parto, y tenerlo en cuenta como diagnóstico diferencial. Es de vital importancia tener un manejo multidisciplinario compuesto por ginecoobstetra, internista, neumólogo y neonatólogo, incluido el apoyo por una unidad de cuidado intensivo para evitar complicaciones materno-perinatales que se puedan asociar al neumotórax espontáneo.

Spontaneous pneumothorax is an extremely rare pathology during pregnancy. It is defined as the presence of air inside the pleural cavity that can mainly generate chest pain and dyspnea. This pathology has a low incidence and prevalence in pregnancy, but a high rate of recurrence with a good prognosis for the mother and the fetus if it is diagnosed early and managed early. It is related to risk factors such as Valsalva maneuvers performed during labor, in addition to comorbidities such as smoking, longilinear biotype, among others, so it is very important to have an adequate history and evaluation of the physical examination. The obstetrician must be attentive to chest pain symptoms associated with dyspnea in pregnant women during labor and delivery, suspect this pathology and take it into account as a differential diagnosis. It is vitally important to have a multidisciplinary management composed of the gynecologist-obstetrician, internist, pulmonologist, neonatologist, including the support of an intensive care unit to avoid maternal-perinatal complications that may be associated with spontaneous pneumothorax.

Percepção dos docentes de um curso de Odontologia sobre a terapia a laserde baixa intensidade / Perception of the professors of a Dentistry School about low intensity laser therapy

A tendência da Odontologia é a incorporação de métodos menos invasivos.Por isso, acredita-se que a terapia a laserde baixa intensidade (TLBI) seja uma opção de tratamento, na medida em que apresenta efeitos benéficos comprovados. O presente estudo tem o objetivo de traçar o padrão de ensino e a percepção dosprofessores sobre o uso de terapia a laserde baixa intensidade no curso degraduação em Odontologia da Universidade Federal do Espírito Santo.Além disso, busca analisar a presença da disciplina de laserterapia nos cursos de Odontologia brasileiros.A pesquisa foi realizada a partir de um estudo analítico, transversal e descritivo, com a aplicação de um questionário a44 professores da Odontologiada Universidade Federal do Espírito Santo. A partir deste estudo obteve-se que 9% de todo corpo docente afirmou utilizar o laserem alguma das atividades das disciplinasque ministram, sendo que esta baixa porcentagem foi justificada pelos professores devido à falta de recurso financeiro para obtenção dos aparelhos. Foi observado que a maior parte do corpo docente já teve conhecimento sobre o laser, sendo 45,4% durante a pós-graduação. Quando avaliada a estrutura curricular das 461instituições de ensino superior brasileiras de Odontologia em atividade, 13 oferecem a disciplina de laserterapia em sua matriz curricular.Pode-se concluir que existe um considerável nível de conhecimento sobre o laserentre os docentes. Porém, nota-se pouca disseminação de informação nas diferentes disciplinas do curso estudado (AU).

There is a tendency in Dentistry to incorporate less invasive methods of treatment. Therefore, since it has proven beneficial effects, it is believed that low-intensity laser therapy (LILT) can be a treatment option. The objective of this study is to outline the teaching pattern and perception of professors about their knowledge in the use of low -intensity laser therapy in Dentistry at the Federal University of Espírito Santo. In addition, it seeks to analyze the presence of Laser Therapy programs in the Dentistry Schools in Brazil. The research was carried out from an analytical, transversal and descriptive study. A questionnaire was applied to 44 professors of the course of Dentistry at the Federal University of Espírito Santo. From this study, it was found that 9% of all professors claimed to use the laser in some of the teaching activities. This percentage was justified by then due to the lack of financial resources to obtain the devices. It was observed that most of the professors had knowledge about the laser. According to 45.4% of then, this knowledge was acquired during the post-graduation. When evaluating the curricular structure of the courses of Dentistry at Brazilian Universities it was found that from the 461 in activity, 13 offer the disciplineof laser therapy. It can be concluded that there is a considerable level of knowledge about the laser among professors. However, there is little knowledge transmission in the different disciplines of the course studied (AU).

Abnormal Uterine Bleeding in Adolescence: When Menarche Reveals other Surprises.

INTRODUCTION: Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described. CLINICAL CASE: A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severe menstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma. DISCUSSION: Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.

INTRODUçãO: A hemorragia uterina anormal é mais frequente na adolescência. Apesar de maioritariamente de etiologia não estrutural, pode dever-se a qualquer causa descrita. CASO CLíNICO: Adolescente de 12 anos, sem antecedentes pessoais relevantes, com menarca há 1 mês, observada no serviço de urgência por hemorragia menstrual grave com agravamento progressivo e repercussão hemodinâmica com necessidade de suporte transfusional. Foi colocada a hipótese de disfunção ovulatória fisiológica associada a eventual coagulopatia desconhecida previamente e foi instituído tratamento médico. Por ausência de resposta a tratamento médico, foi submetida a observação sob sedação e aspiração uterina que evidenciou tratar-se de um Linfoma de Burkitt. DISCUSSãO: Apesar de as causas estruturais, e particularmente as neoplasias, do foro ginecológico ou não, serem uma causa rara de hemorragia uterina anormal nesta faixa etária, elas devem ser levadas em consideração potenciando assim um tratamento mais célere e adequado.

Abnormal Uterine Bleeding in Adolescence: When Menarche Reveals other Surprises / Hemorragia uterina anormal na adolescência: Quando a menarca revela outras surpresas

Abstract Introduction Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described. Clinical case A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severemenstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma. Discussion Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.

Resumo Introdução A hemorragia uterina anormal é mais frequente na adolescência. Apesar de maioritariamente de etiologia não estrutural, pode dever-se a qualquer causa descrita. Caso clínico Adolescente de 12 anos, sem antecedentes pessoais relevantes, com menarca há 1 mês, observada no serviço de urgência por hemorragia menstrual grave com agravamento progressivo e repercussão hemodinâmica com necessidade de suporte transfusional. Foi colocada a hipótese de disfunção ovulatória fisiológica associada a eventual coagulopatia desconhecida previamente e foi instituído tratamento médico. Por ausência de resposta a tratamento médico, foi submetida a observação sob sedação e aspiração uterina que evidenciou tratar-se de um Linfoma de Burkitt. Discussão Apesar de as causas estruturais, e particularmente as neoplasias, do foro ginecológico ou não, serem uma causa rara de hemorragia uterina anormal nesta faixa etária, elas devem ser levadas em consideração potenciando assim um tratamento mais célere e adequado.

Prevalência de lesão periapical radiolúcida nos pacientes com síndrome de Sjögren primária / Prevalence of radiolucid periapical injury in patients with primary Sjögren syndrome

Introdução: Pacientes com Síndrome de Sjögren Primária (SSP) apresentam maior incidência de cárie dentária. Como consequência da cárie, podem ocorrer lesões periapicais radiolúcidas (LPR). Objetivo: Determinar a prevalência de LPR nos pacientes com SSP e caracterizar radiologicamente os dentes associados às LPR. Métodos: Estudo transversal envolvendo pacientes com SSP, recrutados em uma Clínica de Reumatologia (HUCAM-ES), que foram submetidos, inicialmente, a um questionário socioeconômico e avaliação clínica do fluxo salivar. Posteriormente, radiografias foram obtidas por um sistema digital intrabucal, com posicionador para a técnica periapical do paralelismo. Realizou-se a estatística descritiva por meio da média e desvio-padrão para as variáveis quantitativas, e frequências absoluta e relativa para as variáveis qualitativas. Realizou-se o teste qui-quadrado com IC95% e o teste t de Student para comparação dos pacientes com e sem lesão periapical. Resultados: No total, 24 pacientes fizeram parte do estudo, todos do sexo feminino (20 - 71 anos). O número médio de dentes/paciente foi de 23,3 ± 3,1, com prevalência de LPR dentária de 7,86%. Do total de pacientes, 70,8% tinham pelo menos uma LPR. Na comparação dos dentes com e sem LPR, os dentes com LPR apresentaram maior porcentagem de canal tratado e cárie. Conclusão: De acordo com os resultados, pode-se concluir que as LPR encontradas nos pacientes com SSP são uma condição frequente, principalmente quando associadas a dentes com canal(is) obturado(s) (AU).

Introduction: Patients with Primary Sjögren Syndrome (PSS) have a higher incidence of dental caries. As a conse- quence, radiolucent periapical lesions (RPL) may appear. Objective: To determine the prevalence of RPL in patients with PSS and to radiologically characterize the teeth associated with RPL. Methodology: Cross-sectional study involving patients with PSS, recruited at the Rheumatology Clinic (HUCAM-ES), who were initially submitted to a socioeconomic questionnaire and clinical evaluation of salivary flow. Subsequently, radiographs were obtained by a digital intraoral system with positioner for the periapical parallelism technique. Descriptive statistics were calculated by the mean and standard deviation for quantitative variables, and absolute and relative frequencies for qualitative variables. Chi-square test with 95% CI and Student t test were applied to compare patients with and without periapical lesion. Results: Over-all, 24 patients participated in the study and all were females (20-71 years). The mean number of teeth per patient was 23.3±3.1, with prevalence of dental RPL of 7.86%. Among all patients, 70.8% had at least one RPL. When comparing teeth with and without RPL, teeth with RPL showed higher percentage of treated canal and caries. Conclusion: According to the results, it can be concluded that RPL in patients with PSS is a frequent condition, especially when associated with teeth with obturated root canals (AU).

Analysis of TIMP-1 expression in leukoplakia and oral squamous cell carcinoma / Análise da expressão de TIMP-1 em leucoplasia e carcinoma de boca de células escamosas

ABSTRACT Introduction: The current study about transition of oral epithelial dysplasia, present in lesions such as leukoplakia, for squamous cell carcinoma (SCC) involves not only the histopathological aspects, but also the analysis of the presence of biomarkers which influence the microenvironment where cells are embedded. Objective: To evaluate the tissue inhibitor of metalloproteinase-1 (TIMP-1) profile in cases of leukoplakia and SCC classified into different degrees of dysplasia and histological grading, respectively. The immunohistochemical findings were confronted with microscopic features adopted in the classification of each lesion. Material and methods: Cases of leukoplakia and SCC were recovered from files of The Oral Pathological Anatomy Service of the Dental School at the Universidade Federal do Espírito Santo (SAPB-UFES), between the years 2004 and 2010. New slides were obtained and submitted to immunohistochemical assay to determine TIMP-1 expression profile. Parenchyma, as well as the different layers of the epithelium and stroma was evaluated. Results: In all cases the presence of TIMP-1 was detected in the stroma and parenchyma. In mild leukoplakia, the basal layer with hyperplasia showed intense immunolabeling, whereas cells with loss of polarity presented weaker expression. In moderate leukoplakia, all epithelium layers, except the cornea, were labeled. Severe leukoplakia had the spinous layer most intensely labeled, with no variation in areas with pleomorphism. Stage I SCC showed the deepest islands with intense labeling in cells with pleomorphism and mitoses. In the tumor islands, less differentiated cells were weakly labeled, and in keratin pearl, labeling was weak or absent in central cells. In stage II SCC, labeling was observed in basal cell with hyperplasia and in cells of the spinous layer, however, the parabasal layer was not labeled. Also, on tumor islands, less differentiated cells did not express the protein and keratin pearls were not labeled. Conclusion: It was possible to detect TIMP-1 immunolabeling in all specimens, ranging in intensity and location. The absence of expression in less differentiated cell suggests that more aggressive lesions present reduced enzyme expression. The microenvironment is important for the various cellular activities, and TIMP is an enzyme that participates in matrix remodeling, therefore changes in its expression can be a valuable tool in the better understanding oral carcinogenesis.

RESUMEN Introducción: El estudio actual de la transición de displasia epitelial oral, presente en lesiones como la leucoplasia, hacia carcinoma epidermoide, implica no solo aspectos histopatológicos, sino también el análisis de la presencia de biomarcadores que influyen en el microambiente en el que se insertan las células. Objetivo: Evaluar el perfil del inhibidor tisular metaloproteinasa-1 (TIMP-1) en casos de leucoplasia y carcinoma de células escamosas (CCE) clasificados en diferentes grados de displasia y grados histopatológicos, respectivamente. Confrontar los hallazgos inmunohistoquímicos con los aspectos microscópicos adoptados en la clasificación de lesiones. Material y métodos: Casos de leucoplasia y CCE fueron recuperados del Servicio de Anatomía Patológica Bucal del Curso de Odontología de la Universidad Federal de Espírito Santo (SAPB-UFES), entre los años 2004-2010. Se obtuvieron nuevos portaobjetos y se los sometieron a ensayos inmunohistoquímicos para determinar el perfil de expresión de TIMP-1. Se evaluó el parénquima, así como las diferentes capas del epitelio y estroma. Resultados: En todos los casos se detectó TIMP-1 en estroma y parénquima. En la leucoplasia leve, la capa basal y con hiperplasia mostró inmunotinción intensa, mientras que las células con pérdida de polaridad tuvieron menos expresión. En la leucoplasia moderada, todas las capas del epitelio, excepto la córnea, mostraron inmunotinción. En la leucoplasia grave la capa espinosa tuvo inmunotinción más intensa, sin variación en áreas con pleomorfismo. El CCE grado I mostró las islas más profundas con tinción intensa en células con pleomorfismo y mitosis. En las islas tumorales, las células menos diferenciadas tuvieron tinción menor, y en las perlas de queratina la tinción fue débil o ausente en las células centrales. En el CCE grado II, se observó tinción en células basales con hiperplasia y, en células de la capa espinosa, la capa parabasal no fue marcada. También en las islas, las células menos diferenciadas no expresaron la proteína y no hubo tinción en las perlas de queratina. Conclusión: Fue posible detectar inmunotinción para TIMP-1 en todos los especímenes, con variación en intensidad y ubicación. La ausencia de expresión en células menos diferenciadas sugiere que las lesiones más agresivas tienen enzima reducida. El microambiente es importante para las diversas actividades celulares, y el TIMP es una enzima que participa en la remodelación de la matriz; por lo tanto, la alteración en su expresión puede ser una herramienta valiosa en el mejor entendimiento de la carcinogénesis de la mucosa oral.

RESUMO Introdução: O estudo atual da transição da displasia epitelial oral, presente em lesões como a leucoplasia, para o carcinoma de células escamosas (CCE), envolve não somente aspectos histopatológicos, como também a análise da presença de biomarcadores, os quais influenciam o microambiente em que as células estão inseridas. Objetivo: Avaliar o perfil da expressão do inibidor tecidual de metaloproteinase 1 (TIMP-1) em casos de leucoplasias e CCE classificados em diferentes graus de displasia e graus histopatológicos, respectivamente, e confrontar os achados imuno-histoquímicos com os aspectos microscópicos adotados na classificação das lesões. Material e métodos: Foram resgatados casos de leucoplasia e CCE do Serviço de Anatomia Patológica Bucal do curso de Odontologia da Universidade Federal do Espírito Santo (SAPB-UFES), entre os anos 2004-2010. Novas lâminas foram obtidas ao serem submetidas ao ensaio imuno-histoquímico para determinação do perfil de expressão de TIMP-1. Foram avaliados parênquima, bem como as diferentes camadas do epitélio e estroma. Resultados: Em todos os casos, foi detectada a presença de TIMP-1 no estroma e no parênquima. Na leucoplasia leve, a camada basal e com hiperplasia apresentou imunomarcação intensa; as células com perda de polaridade tiveram expressão menor. Na leucoplasia moderada, todas as camadas do epitélio, exceto a córnea, apresentaram marcação. A leucoplasia severa teve a camada espinhosa marcada mais intensamente, sem variação em áreas com pleomorfismo. O CCE grau I apresentou as ilhas mais profundas com marcação intensa em células com pleomorfismo e mitoses. Nas ilhas tumorais, células menos diferenciadas tiveram marcação menor, e em pérolas córneas a marcação foi fraca ou ausente nas células centrais. No CCE grau II, foi observada a marcação em células basais com hiperplasia e, em células da camada espinhosa, a camada parabasal não foi marcada. Também nas ilhas, células menos diferenciadas não expressaram a proteína e não houve marcação em pérolas córneas. Conclusão: Foi possível detectar imunomarcação para TIMP-1 em todos os espécimes, com variação em intensidade e localização. A ausência de expressão em células menos diferenciadas sugere que lesões mais agressivas possuem redução da enzima. O microambiente é importante para as diversas atividades celulares, e TIMP é uma enzima que participa da remodelação da matriz. Portanto, alteração na sua expressão pode ser uma valiosa ferramenta para um melhor entendimento da carcinogênese da mucosa bucal.

A primary cutaneous anaplastic large cell lymphoma mimicking labial herpes.

INTRODUCTION: A primary cutaneous CD-30 positive T -cell lymphoproliferative disorders are rare and heterogeneous group of primary skin tumors, which include primary cutaneous anaplastic large cell lymphoma (PCALCL) and lymphomatoid papulois. CASE REPORT: We report a rare an atypical case of PCALCL with an aggressive and refractory behavior that occurred in the lip vermilion, and that had been initially diagnosed as aggressive herpes. The lesion was recurrent and refractory to the CHOEP chemotherapy protocol followed by radiotherapy, but after hyper CVAD (acronym) + brentuximab with a considerable improvement. After 4 cycles of hyper CVAD plus brentuximab, the patient underwent 100% compatible sibling bone marrow transplantation, with success in the procedure. CONCLUSION: Primary cutaneous anaplastic large cell lymphoma is a rare disease of difficult diagnosis and may be confused with chronic infectious diseases, postponing treatment.

Enamel-Renal-Syndrome: case report.

AIMS: to describe a case in which dental changes were observed and investigation proceeded to consider Enamel-Renal-Syndrome (ERS), a rare disorder that associates amelogenesis imperfecta with nephrocalcinosis. CASE REPORT: an 11-year-old male patient upon intraoral examination revealed generalized gingival hyperplasia, a few teeth were absent clinically and the remaining ones were yellowish-brown in color. The enamel alterations were suggesting of amelogenesis imperfecta. Unerupted teeth with increased pericoronal spaces, suggesting hyperplasic follicles or dentigerous cysts and an enamel with lower thickness and density were observed in the panoramic radiography. The patient was referred for an assay to investigate mucopolysaccharidosis; however, it was negative. A renal ultrasound showed bilateral nephrocalcinosis and laboratory exams, including calcium, phosphate, and creatinine levels were below the average. An incisional gingival biopsy showed numerous round to ovoid basophilic calcifications in the connective tissue. The final diagnosis was ERS. CONCLUSION: Dentists should refer patients with similar clinical presentation for renal ultrasound evaluation in order to rule out the possible diagnosis of ERS.

Expressão da laminina 332 em vasos de carcinomas de células escamosas orais / Expression of laminin 332 in vessels of oral squamous cell carcinomas

Objetivo: Analisar expressão da cadeia γ2 da laminina 332 na membrana basal de vasos de carcinoma de células escamosas orais (CCE) e seu aspecto de continuidade para detecção de possíveis processos invasivos vasculares, importante evento na progressão da doença. Ainda, associar os aspectos clínicos do paciente e da lesão com os achados microscópicos. Material e Métodos: Foi realizada técnica imuno-histoquímica para detecção da cadeia γ2 da laminina 332 em 16 casos de CCE, sendo oito Bem Diferenciado e oito Moderadamente Diferenciado. Os aspectos microscópicos avaliados foram expressão da molécula na membrana basal de vasos e o seu aspecto de continuidade. Possíveis associações entre dados clínicos e achados microscópicos foram avaliadas. Resultados: Um total de 15 casos (93,75%) apresentaram vasos com expressão da cadeia γ2. Em CCE Bem Diferenciados, 85,71% das lesões apresentaram vasos com perda de continuidade da membrana basal, enquanto que em CCE Moderadamente Diferenciados 100% dos casos tiveram vasos com esse aspecto. Em relação às associações entre aspectos clínicos e integridade da membrana basal vascular, nos CCE Bem Diferenciados foram observadas correlações positivas da perda de continuidade com o gênero e idade acima de 60 anos (p < 0,0001). Para CCE Moderadamente Diferenciado, as associações foram com gênero masculino (p < 0,0001), hábito de fumar (p < 0,0001) e idade < 60 anos (p < 0,0001). Conclusão: Nossos dados sugerem que a expressão da cadeia γ2 em estruturas vasculares está presente em lesões de CCE e pode estar associada ao comportamento mais agressivo da doença.

Objective: 1) To analyze the γ2 chain expression of laminin 332 in the basement membrane of vessels of oral squamous cell carcinoma (OSCC), and the appearance of continuity, to identify possible vascular invasive procedures which are important events in the disease progression. 2) To examine the association between clinical aspects from patients and microscopic findings from lesions. Material and Methods: Immunohistochemistry was performed to detect γ2 chain of laminin 332 in 16 cases of OSCC; of which, eight were classified as being "Well Differentiated" and eight as being "Moderately Differentiated." Microscopic aspects were evaluated, including the expression of the molecule in the basement membrane of vessels and the appearance of continuity. Results: 15 cases (93.75%) showed vessels with γ2 chain expression. In OSCC defined as being "Well Differentiated," 85.71% of lesions presented with loss of vessel continuity of the basement membrane, whereas in OSCC defined as being "Moderately Differentiated," 100% of presented vessels with this aspect. Regarding associations between clinical aspects of patients and integrity of the vascular basement membrane, in OSCC defined as being "Well Differentiated," positive correlations were observed between loss of continuity and both gender and age >60 years (p < 0.0001). For OSCC defined as being "Moderately Differentiated," positive associations were observed for being male (p < 0.0001), currently smoking (p < 0.0001) and being <60 years old (p < 0.0001). Conclusion: Our data suggest that the γ2 chain expression in vascular structures is present in OSCC and is associated with more aggressive disease.

Oral lichen planus: clinical profile and determination of oral epithelial dysplasia / Liquen plano oral: perfil clínico y determinación de la displasia epitelial oral

Oral lichen planus (OLP) is the most common noninfectious oral disease and is considered a potentially malignant disorders (OPMDs). The etiology and pathogenesis of OLP are not completely understood and the malignant transformation remains under discussion. The aim was to asses the cytological and histological features of OLP, and establish relationship between clinical and microscopic profiles. A total of 10 patients diagnosed with OLP were investigated. Slides were prepared and stained with Hematoxylin­Eosin to identify 8 histological features and 8 cytological alterations. Finally, oral epithelial dysplasia degree was determined. Hyperplasia and loss of polarity of basal cells were detected in 90 % of cases. Anisonucleosis, nuclear pleomorphism and hyperchromasia affected 100 % of the sample. Six cases were classified as mild-grade OED, with no cases of severe-grade. Microscopic alterations were higher in women (P <0.0001) and moderate-grade OED was diagnosed only in this group (P <0.0014). The findings demonstrated that microscopic and clinical data association should be analyzed to a better understand of disease behavior. OED was absence only in one case, so the periodic follow-up of patients diagnosed with OLP is mandatory to avoid the malignant transformation.

El liquen plano oral (LPO) es la enfermedad no infecciosa más común y se considera un trastorno potencialmente maligno. La etiología y la patogénesis del LPO no se conoce y la transformación maligna sigue siendo objeto de debate. El objetivo de este estudio fue evaluar las características citológicas e histológicas del LPO y establecer la relación entre los perfiles clínicos y microscópicos. Un total de 10 pacientes diagnosticados con LPO fueron investigados. Secciones histológicas se prepararon y tiñeron con hematoxilina-eosina para identificar 8 características histológicas y 8 alteraciones citológicas. Finalmente, se determinó el grado de displasia epitelial. La hiperplasia y la pérdida de la polaridad de las células basales se detectaron en el 90 % de los casos. Anisonucleosis, pleomorfismo nuclear e hipercromasia afectaron al 100 % de las muestras. Seis casos fueron clasificados como displasia epitelial oral (DEO) de grado leve y no se reportaron casos de grado severo. Las alteraciones microscópicas fueron mayores en las mujeres (p <0,0001) y DEO de grado moderado fue diagnosticado sólo en este grupo (p <0,0014). Los resultados demostraron que la asociación de datos microscópicos y clínicos deben ser analizados para una mejor comprensión del comportamiento de la enfermedad. La DEO estuvo ausente sólo en un caso, por lo que el seguimiento periódico de los pacientes diagnosticados con LPO es necesario para evitar la transformación maligna.

Recomendações para o tratamento da síndrome de Sjögren / Recommendations for the treatment of Sjögren's syndrome

RESUMOAs recomendações propostas pela Comissão de Síndrome de Sjögren da Sociedade Brasileira de Reumatologia para tratamento da síndrome de Sjögren foram baseadas em uma revisão sistemática da literatura nas bases de dados Medline (PubMed) e Cochrane até outubro de 2014 e opinião de especialistas na ausência de artigos sobre o assunto. Foram incluídos 131 artigos classificados de acordo com Oxford & Grade. Essas recomendações foram elaboradas com o objetivo de orientar o manejo adequado e facilitar o acesso aos tratamentos para aqueles pacientes com adequada indicação de recebê-los, considerando o contexto socioeconômico brasileiro e os medicamentos disponíveis no país.

ABSTRACTThe recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 articles classified according to Oxford & Grade were included. These recommendations were developed in order to guide the management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.

Recommendations for the treatment of Sjögren's syndrome.

The recommendations proposed by the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology for the treatment of Sjögren's syndrome were based on a systematic review of literature in Medline (PubMed) and the Cochrane databases until October 2014 and on expert opinion in the absence of studies on the subject. 131 items classified according to Oxford & Grade were included. These recommendations were developed in order to guide the appropriate management and facilitate the access to treatment for those patients with an appropriate indication, considering the Brazilian socioeconomic context and pharmacological agents available in this country.

Conservative treatment of intraosseous hemangiomas in the mandible: case report with a 17-year follow-up period.

Intraosseous hemangiomas in the jaws are rare lesions and may lead to several complications. The authors present a case of a 12-year-old girl with a radiolucent periapical lesion between tooth 35 and 36 where nocturnal exsanguinating bleeding started to occur from periodontal sulcus during orthodontic treatment. Diagnosis of an intraosseous hemangioma in the mandible was based on positive needle aspiration for blood, computed tomography and arteriography. At first the family chose to only follow-up the lesion but episodes of nocturnal hemorrhage were becoming more frequent and a treatment was requested. Embolization and dental extraction were performed in order to treat the lesion. After a follow-up period of 17 years no more cases of hemorrhage occurred and lesion regressed.

Morfologia do terço apical da raiz e dos canais de dentes com hipercementose

Objetivo: esse estudo tem o objetivo de estudar a influência da hipercementose na morfologia radicular e dos canais radimiculares, utilizando diferentes métodos de observação: diafanização, radiográfico, estereomicroscopia e microscopia óptica. Métodos: foram selecionados 130 dentes para avaliação morfológica comparativa. Entre esses, 60 dentes com hipercementose e 30 sem foram selecionados para avaliação pela técnica de diafanização. A avaliação foi baseada em aspectos como tipo de hipercementose, número de canais radiculares e configuração, superfície radicular e presença de forame apical e de deltas apicais. Os 20 dentes com hipercementose remanescente foram comparados microscopicamente a 20 dentes com formação radicular normal utilizando a técnica de coloração de hematoxilina e eosina (H.E.), a fim de estudar o padrão de deposição de cemento e aspectos morfológicos do canal radicular. A avaliação foi realizada por dois examinadores e submetida ao teste kappa de concordância. Os dados obtidos foram comparados por meio do teste de Kruskal-Wallis de análise de variância, e o teste de Dunn foi utilizado para comparações individuais. Resultados: o exame com a diafanização demonstrou uma frequência maior de hipercementose do tipo dava (65%), seguido de hipercementose focal (35%). Dentes com hipercementose apresentaram aumento significativo da presença de deltas apicais (53,3%). Uma frequência maior de constrições do canal radicular (55%) e modificações no trajeto do canal radicular (46,6%) também foram observados. A avaliação microscópica fundamenta a influência da hipercementose nas características morfológicas do terço apical radicular de um dente com hipercementose, o que pode prejudicar o tratamento endodôntico.

Conservative treatment of odontogenic myxoma.

Odontogenic myxomas (OMs) are nonencapsulated rare benign tumors that can occur in gnathic bones. They are locally invasive and have a high recurrence rate. Radiologically, OMs show a multilocular (in the majority of cases) or unilocular radiolucency, with either distinct or poorly defined margins. Histopathologically, OMs are characterized by spindle-, wedge-, or stellate-shaped cells loosely arranged in an abundant mucoid background. Myxomas are mainly asymptomatic. Radical surgery, excision, and enucleation followed by curettage of the surrounding bony tissue have all been advocated as treatment options. This study presents a successful case of conservative treatment of OMs with a 5-year follow-up.