A recurrent case of central odontogenic fibroma in maxilla showing root resorption: a case report / Fibroma odontogênico central: relato de caso recorrente e localmente agressivo na maxila

Objective: The aim of this report is present an aggressive recurrent case of central odontogenic fibroma (COF) with tooth resorption in anterior maxilla, and discuss both events based on literature. Case description: A 29-year-old woman was referred for examination of a non-swelling intraosseous lesion detected by routine radiographic exams for orthodontic planning. Panoramic exam revealed a well-defined multiloculated radiolucency in the right anterior maxilla. Periapical radiography highlighted dental resorption of canine and first premolar. After the incisional biopsy the COF diagnosis was confirmed. Tumor was removed by enucleation. Recurrence was detected three years later and the lesion was removed together with involved teeth. No indication of recurrence has been observed in the past eight years. Conclusion: COF is a benign tumor and can be aggressive. Recurrence and root resorption simultaneously are rare features reported in literature. The treatment must include tooth removal and curettage. Prognosis is good and follow-up is important.

Objetivo: O objetivo deste relato é apresentar um caso clínico de fibroma odontogênico central (FOC) recorrente e com reabsorção dental em região anterior de maxila, e discutir estes dois eventos baseados na literatura. Descrição do Caso: Paciente do sexo feminino, 29 anos, foi encaminhada para avaliação de lesão intraóssea não-expansiva, detectada por exames radiográficos solicitados para planejamento ortodôntico. Exames radiográficos mostraram uma área radiolúcida multiloculada bem delimitada com reabsorção radicular de canino e primeiro pré-molar direito. Após biópsia incisional e exame histopatológico, a lesão foi diagnosticada como fibroma odontogênico central. O tumor foi enucleado e três anos depois, detectou-se recorrência. A lesão recorrente foi removida junto aos dentes adjacentes. Nenhuma recorrência foi observada nos últimos oito anos de acompanhamento. Conclusão: FOC é um tumor benigno que pode apresentar comportamento agressivo. Recorrência e reabsorção radicular simultâneas são características raramente relatadas na literatura. O tratamento deve incluir exodontia e curetagem do sítio cirúrgico. O acompanhamento é importante, embora seja uma lesão de prognóstico favorável.

Expression of hypoxia-induced factor-1 alpha in early-stage and in metastatic oral squamous cell carcinoma.

To investigate hypoxia-induced factor-1 alpha expression in distinct oral squamous cell carcinoma subtypes and topographies and correlate with clinicopathological data. Hypoxia-induced factor-1 alpha expression was assessed by immunohistochemistry in 93 cases of OSCC. Clinical and histopathological data were reviewed from medical records. Hypoxia-induced factor-1 alpha status was distinct according to tumor location, subtype and topography affect. In superficial oral squamous cell carcinomas, most tumor cells overexpressed hypoxia-induced factor-1 alpha, whereas hypoxia-induced factor-1 alpha was restricted to the intratumoral region in conventional squamous cell carcinomas. All basaloid squamous cell carcinomas exhibited downregulation of hypoxia-induced factor-1 alpha. Interestingly, metastatic lymph nodes (91.7%, p = 0.001) and the intratumoral regions of corresponding primary tumors (58.3%, p = 0.142) showed hypoxia-induced factor-1 alpha-positive tumor cells. Overall survival was poor in patients with metastatic lymph nodes. Hypoxia-induced factor-1 alpha has distinct expression patterns in different oral squamous cell carcinoma subtypes and topographies, suggesting that low oxygen tension promotes the growth pattern of superficial and conventional squamous cell carcinoma, but not basaloid squamous cell carcinoma. Indeed, a hypoxic environment may facilitate regional metastasis, making it a useful diagnostic and prognostic marker in primary tumors.

Angiotensin II type 1 receptor blockade restores angiotensin-(1-7)-induced coronary vasodilation in hypertrophic rat hearts.

The aim of the present study was to investigate the coronary effects of Ang-(1-7) [angiotensin-(1-7)] in hypertrophic rat hearts. Heart hypertrophy was induced by abdominal aorta CoA (coarctation). Ang-(1-7) and AVE 0991, a non-peptide Mas-receptor agonist, at picomolar concentration, induced a significant vasodilation in hearts from sham-operated rats. These effects were blocked by the Mas receptor antagonist A-779. Pre-treatment with L-NAME (N(G)-nitro-L-arginine methyl ester) or ODQ (1H-[1,2,4]oxadiazolo[4,3-a]quinozalin-1-one) [NOS (NO synthase) and soluble guanylate cyclase inhibitors respectively] also abolished the effect of Ang-(1-7) in control hearts. The coronary vasodilation produced by Ang-(1-7) and AVE 0991 was completely blunted in hypertrophic hearts. Chronic oral administration of losartan in CoA rats restored the coronary vasodilation effect of Ang-(1-7). This effect was blocked by A-779 and AT2 receptor (angiotensin II type 2 receptor) antagonist PD123319. Acute pre-incubation with losartan also restored the Ang-(1-7)-induced, but not BK (bradykinin)-induced, coronary vasodilation in hypertrophic hearts. This effect was inhibited by A-779, PD123319 and L-NAME. Chronic treatment with losartan did not change the protein expression of Mas and AT2 receptor and ACE (angiotensin-converting enzyme) and ACE2 in coronary arteries from CoA rats, but induced a slight increase in AT2 receptor in aorta of these animals. Ang-(1-7)-induced relaxation in aortas from sham-operated rats was absent in aortas from CoA rats. In vitro pre-treatment with losartan restored the Ang-(1-7)-induced relaxation in aortic rings of CoA rats, which was blocked by the Mas antagonist A-779 and L-NAME. These data demonstrate that Mas is strongly involved in coronary vasodilation and that AT1 receptor (angiotensin II type 1 receptor) blockade potentiates the vasodilatory effects of Ang-(1-7) in the coronary beds of pressure-overloaded rat hearts through NO-related AT2- and Mas-receptor-dependent mechanisms. These data suggest the association of Ang-(1-7) and AT1 receptor antagonists as a potential therapeutic avenue for coronary artery diseases.

Mesenchymal chondrosarcoma in the mandible: report of a case with cytological findings.

Mesenchymal chondrosarcoma is an infrequent malignancy of bone and soft tissue, characterized by its peculiar bimorphic histological pattern. The use of fine-needle aspiration (FNA) in the diagnosis of bone tumors is controversial. A 31-year-old woman presented with a mandibular lesion detected on routine examination for orthodontic treatment. Radiography revealed an ill-defined mixed radiolucency in the premolar region of the right mandible with invasive characteristics such as root resorption and widening of the periodontal ligament space of neighboring teeth. Blood clots obtained at FNA were fixed in formalin and exhibited spindle cells surrounding islands of pleomorphic chondroblasts against a bloody background. Histopathologically, clusters of spindle cells juxtaposed with mesenchymal tissue were detected, with a large hemangiopericytomatous component. In the present case, cytological findings combined with clinical and radiological data provided valuable information in establishing the diagnosis of malignancy and in planning further procedures and treatment.

Embryonal carcinoma cell induction of miRNA and mRNA changes in co-cultured prostate stromal fibromuscular cells.

The prostate stromal mesenchyme controls organ-specific development. In cancer, the stromal compartment shows altered gene expression compared to non-cancer. The lineage relationship between cancer-associated stromal cells and normal tissue stromal cells is not known. Nor is the cause underlying the expression difference. Previously, the embryonal carcinoma (EC) cell line, NCCIT, was used by us to study the stromal induction property. In the current study, stromal cells from non-cancer (NP) and cancer (CP) were isolated from tissue specimens and co-cultured with NCCIT cells in a trans-well format to preclude heterotypic cell contact. After 3 days, the stromal cells were analyzed by gene arrays for microRNA (miRNA) and mRNA expression. In co-culture, NCCIT cells were found to alter the miRNA and mRNA expression of NP stromal cells to one like that of CP stromal cells. In contrast, NCCIT had no significant effect on the gene expression of CP stromal cells. We conclude that the gene expression changes in stromal cells can be induced by diffusible factors synthesized by EC cells, and suggest that cancer-associated stromal cells represent a more primitive or less differentiated stromal cell type.

Periodontal disease and oral hygiene benefits in HIV seropositive and AIDS patients.

OBJECTIVES: The frequency of gingival and periodontal disease in HIV-seropositive and AIDS patients was investigated in order to evaluate the oral hygiene benefits of using mechanical therapy. STUDY DESIGN: thirty-two consenting HIV-positive patients were examined. Their gingival and periodontal status were evaluated using the Gingival Index and the Simplified Oral Hygiene Index. The data were assessed at baseline, after three months and after six months. Subjects received mechanical therapy, which included calculus removal, scaling and root planning, tooth polishing and oral hygiene instructions. The maintenance of oral hygiene was performed weekly. HIV staging and CD4 counts were also investigated. RESULTS: At the baseline, gingival and periodontal disease was present in 71.9% of all subjects. Chronic gingivitis (43.8%) was the most frequent in all subjects. A clear improvement in gingival health was registered in 78.2% of subjects after six months of mechanical therapy. No association was registered between CD4 count and gingival/periodontal status or attachment loss with HIV staging. CONCLUSIONS: Chronic gingivitis was the most frequent disease in HIV infected and AIDS patients. Oral hygiene using mechanical therapy improves the gingival condition, suggesting that it is an important step in the maintenance of periodontal health.

Heterotopic ossification in the anterior maxilla: a case report and review of the literature.

A 13-year-old boy had complained of an asymptomatic swelling in the anterior maxilla for approximately 4 years. The patient reported no local trauma. The intra-oral examination revealed an exophytic lesion in the incisive papilla between the maxillary central and lateral incisor teeth. The radiographies detected no significant findings. Histopathologically, the lesion showed a dense fibrous tissue above the overlying mucosa. Bone ossification lay beneath a partially hypertrophic cartilage showing occasionally pleomorphic chondrocytes. Because of its microscopic aspects, heterotopic ossification may be mistaken for chondrosarcoma or other conditions involving periosteum, such as parosteal osteosarcoma. A case of heterotopic ossification in the anterior maxilla is presented, and clinicopathologic similarities with other osteochondromatous lesions are discussed.