SOX2 Expression Is an Independent Predictor of Oral Cancer Progression.

Potentially malignant oral lesions, mainly leukoplakia, are common. Malignant transformation varies widely, even in the absence of histological features such as dysplasia. Hence, there is a need for novel biomarker-based systems to more accurately predict the risk of cancer progression. The pluripotency transcription factor SOX2 is frequently overexpressed in cancers, including oral squamous cell carcinoma (OSCC), thereby providing a link between malignancy and stemness. This study investigates the clinical relevance of SOX2 protein expression in early stages of oral carcinogenesis as a cancer risk biomarker, and also its impact on prognosis and disease outcome at late stages of OSCC progression. SOX2 expression was evaluated by immunohistochemistry in 55 patients with oral epithelial dysplasia, and in 125 patients with OSCC, and correlated with clinicopathological data and outcomes. Nuclear SOX2 expression was detected in four (7%) cases of oral epithelial dysplasia, using a cut-off of 10% stained nuclei, and in 16 (29%) cases when any positive nuclei was evaluated. Univariate analysis showed that SOX2 expression and histopathological grading were significantly associated with oral cancer risk; and both were found to be significant independent predictors in the multivariate analysis. Nuclear SOX2 expression was also found in 49 (39%) OSCC cases, was more frequent in early tumor stages and N0 cases, and was associated with a better survival. In conclusion, SOX2 expression emerges as an independent predictor of oral cancer risk in patients with oral leukoplakia. These findings underscore the relevant role of SOX2 in early oral tumorigenesis rather than in tumor progression.

The Emerging Role of NANOG as an Early Cancer Risk Biomarker in Patients with Oral Potentially Malignant Disorders.

NANOG, a key regulator of pluripotency and self-renewal in embryonic and adult stem cells, is frequently overexpressed in multiple cancers, including oral squamous cell carcinoma (OSCC). It has been frequently associated with poor outcomes in epithelial cancers, and recently implicated in laryngeal tumorigenesis. On this basis, we investigated the role of NANOG protein expression as an early cancer risk biomarker in oral potentially malignant disorders (OPMD), and the impact on prognosis and disease outcomes in OSCC patients. NANOG expression was evaluated by immunohistochemistry in 55 patients with oral epithelial dysplasia, and 125 OSCC patients. Correlations with clinical and follow-up data were assessed. Nuclear NANOG expression was detected in 2 (3.6%) and cytoplasmic NANOG expression in 9 (16.4%) oral dysplasias. NANOG expression increased with the grade of dysplasia. Cytoplasmic NANOG expression and the histopathological grading were significantly correlated with oral cancer risk, although dysplasia grading was the only significant independent predictor of oral cancer development in multivariate analyses. Cytoplasmic NANOG expression was also detected in 39 (31%) OSCC samples. Positive NANOG expression was significantly associated with tobacco and alcohol consumption, and was more frequent in pN0 tumors, early I-II stages. These data unveil the clinical relevance of NANOG in early stages of OSCC tumorigenesis rather than in advanced neoplastic disease. NANOG expression emerges as an early predictor of oral cancer risk in patients with OPMD.

Keratocyst Capnocytophaga superinfection.

INTRODUCTION: Capnocytophaga spp are Gram-negative bacteria that cause severe infections in immunosuppressed patients. This situation is extremely rare in immunocompetent patients. CASE REPORT: This clinical report describes the unusual infection of an immunocompetent patient with Capnocytophaga spp. The imaging studies showed the existence of a cyst in the left jawbone. After treatment and a microbiological study of the content, it was found to be an outbreak of septicaemia. DISCUSSION: Capnocytophaga spp, commensal bacteria of the oral cavity, can lead to serious illness and that is why an empirical treatment is needed until a diagnostic confirmation can be obtained.

Revisión sistemática del schwannoma localizado en el suelo oral. A propósito de un caso / Oral floor schwannoma. Systematic review and case report

Objetivos. Revisar de manera sistemática el schwannoma localizado en el suelo oral. Presentar un caso tratado en nuestro departamento. Material y método. Mediante la utilización de motores de búsqueda se identificaron artículos sobre schwannoma localizado en el suelo oral. Los criterios de inclusión fueron: a) diagnóstico definitivo de schwannoma localizado en el suelo oral; b) casos publicados en inglés, español o alemán. Se analizaron variables relacionadas con las características clínicas, diagnósticas y de tratamiento. Resultados. Se identificaron 19 artículos que cumplían los criterios de inclusión. Edad media: 44,3 años (rango 17-77); 42,1% mujeres y 57,8% hombres; tiempo de evolución de 8,7 meses (rango 1-60); tumoración localizada en el lado izquierdo del suelo oral 52,6%, en el lado derecho 42,1%; diámetro mayor medio 38,3 mm (rango 10-70); afectación del nervio hipogloso 15,7%, nervio lingual 15,7%, nervio milohioideo 5,2%, no se identificó nervio de origen en el 21,1% de los casos; punción aspiración con aguja fina no diagnóstica en el 31,5% e identificación de tumoración benigna en el 21%. La exéresis quirúrgica se realizó en el 100% de los casos con un tiempo de seguimiento de 34,3 meses (rango 1-120). No se documentaron recurrencias. Conclusiones. Los schwannomas localizados en el suelo de la boca son infrecuentes. Se presentan en torno a los 40 años, con leve predominancia por el sexo masculino y del lado izquierdo del suelo oral. El tiempo de evolución se encuentra próximo a los 9 meses. Usualmente asintomático. Los nervios hipogloso y lingual se afectan por igual. En proporción similar, el nervio de origen no puede ser identificado. La punción aspiración con aguja fina no es efectiva. El tratamiento de elección consiste en la enucleación del tumor una vez diagnosticado. No se documentaron recidivas (AU)

Objective. Systematically review the oral floor schwannoma. Report of a case treated in our department. Material and method. Published articles about oral floor schwannoma were identified. The inclusion criteria were: a) Final diagnosis of schwannoma located in the oral floor. b) Articles published in English, Spanish or German. The variables were analysed regarding clinical features, diagnosis and treatment. Results. Nineteen articles that met the inclusion criteria. Average age: 44.3 years (range 17-77); 42.1% were females and 57.8% males; time of lesion development was 8.7 months (range 1-60); side of the oral floor location: left side 52.6%, right side 42.1%; average diameter: 38.3 mm (range 10-70); hypoglossal nerve involvement: 15.7%, lingual nerve: 15.7%, mylohyoid nerve: 5.2%, nerve not identified in 21.1% of cases; fine needle aspiration biopsy: non diagnostic in 31.5%, benign tumor identified 21%. Surgical excision was performed in 100% of the cases with a follow up of 34.3 months (rank 1-120). No recurrences were reported. Conclusions. Schwannomas located on the floor of the mouth are uncommon. Environment are presented at age 40 with a slight predominance for males and mainly the left. The time evolution is close to 9 months. The hypoglossal and lingual nerves are affected equally. In similar proportion the nerve of origin cannot be identified. Fine needle aspiration biopsy is not efficient. The treatment of choice is enucleation of the tumor 11 diagnosed. No recurrences were observed (AU)