ABSTRACT The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

Resumo O fator induzível por hipóxia 1 alfa (HIF-1α) e o fator de crescimento endotelial vascular (VEGF) são proteínas que estimulam a proliferação e a migração de células endoteliais. Estas proteínas têm sido descritas em muitas condições patológicas e inflamatórias, mas o envolvimento dessas no desenvolvimento de periodontite não foi completamente investigado. Este estudo comparou a expressão imunohistoquímica destas proteínas, envolvidas na angiogênese e hipóxia, na doença periodontal e em tecidos gengivais saudáveis por meio de contagem de células inflamatórias e endoteliais imunomarcadas. As amostras de tecido gengival foram divididas da seguinte forma: 30 amostras com periodontite crônica, 30 com gengivite crônica e 30 de gengiva saudável. Os resultados foram analisados estatisticamente pelos testes de Kruskal-Wallis e Mann-Whitney (p=0.01). As células inflamatórias e endoteliais foram positivas para estas proteínas. A porcentagem média de células positivas para HIF-1α foi de 39,6% nos casos de periodontite, 22,0% nos casos de gengivite e de 0,9% no grupo de gengiva saudável (p = 0,001). A porcentagem média de células imunopositivas para o VEGF foi de 68,7% nos casos de periodontite, 66,1% nos casos de gengivite, e 19,2% em espécimes gengivais saudáveis (p<0,001). Correlação significativa entre o VEGF e HIF-1α foi observada em gengival. A expressão elevada do HIF-1α e VEGF em periodontite, comparada a gengivite e gengiva saudável, sugere ativação da via do HIF-1α, na doença periodontal avançada. A correlação entre o HIF-1α e expressão de VEGF na gengiva saudável, sugere uma função fisiológica para estas proteínas em condições de homeostase. Na doença periodontal, a expressão de HIF-1α e VEGF pode ser regulada por outros fatores, além da hipóxia, tais como endotoxinas bacterianas e citocinas inflamatórias.

Abstract Hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor (VEGF) are proteins that stimulate the proliferation and migration of endothelial cells. These proteins have been described in many pathologic and inflammatory conditions, but their involvement in the development of periodontitis has not been thoroughly investigated. This study compared the immunohistochemical expression of these proteins, involved in angiogenesis and hypoxia, by imunnostained inflammatory and endothelial cells in periodontal disease and healthy gingival tissues. Gingival tissue samples were divided as follows: 30 samples with chronic periodontitis, 30 with chronic gingivitis, and 30 of healthy gingiva. Results were analyzed statistically by the Kruskal-Wallis, Mann-Whitney and Spearman correlation tests (p=0.01). Inflammatory and endothelial cells were found to express these proteins. Periodontitis showed median percentage of HIF-1α-positive cells of 39.6%, 22.0% in cases of gingivitis and 0.9% in the healthy gingiva group (p=0.001). For VEGF, median percentage of immunopositive cells was 68.7% for periodontitis, 66.1% in cases for gingivitis, and 19.2% for healthy gingival specimens (p<0.001). Significant correlation between VEGF and HIF-1α was also observed in healthy gingiva (p<0.001).The increased expression of HIF-1αα and VEGF in periodontitis, compared to gingivitis and healthy gingiva, suggests possible activation of the HIF-1α pathway in advanced periodontal disease. The correlation between HIF-1α and VEGF expression in healthy gingiva suggests a physiological function for these proteins in conditions of homeostasis. In periodontal disease, HIF-1 and VEGF expression may be regulated by other factors, in addition to hypoxia, such as bacterial endotoxins and inflammatory cytokines.

The Human Papillomavirus (HPV) has been strongly implicated in development of some cases of oral squamous cell carcinoma (OSCC). However, the immunological system somehow reacts against the presence of this virus. Among the cells involved in such mechanism of defense Langerhans cells (LC) stand out, which are responsible for processing and presenting antigens. OBJECTIVES: The purposes of this study were to investigate the presence of HPV DNA and to evaluate the immunohistochemical reactivity for Langerhans cells between HPV-positive and HPV-negative OSCC. Twenty-seven cases of OSSC were evaluated. MATERIAL AND METHODS: DNA was extracted from paraffin-embedded tissue samples and amplified by Polymerase Chain Reaction (PCR) for the detection of HPV DNA. Viral typing was performed by dot blot hybridization. Immunohistochemistry was performed by the Streptavidin-biotin technique. RESULTS: From the 27 cases, 9 (33.3%) were HPV-positive and 18 (66.0%) HPV-negative. HPV 18 was the most prevalent viral type (100% cases) and infection with HPV-16 (co-infection) was detected in only 1 case. In the OSCC specimens examined, immunoreactivity to S-100 antibody was detected in all cases, with a mean number of 49.48±30.89 Langerhans cells positive for immunostaining. The mean number of immunostained Langerhans cells was smaller in the HPV-positive cases (38 cells/case) than in the HPV-negative cases (42.5 cells/case), but this difference was not significant (p=0.38). CONCLUSIONS: The low frequency of detection of HPV DNA in OSCC indicates a possible participation of the virus in the development and progression of only a subgroup of these tumors. There was no association between the immunohistochemical labeling for Langerhans cells (S-100+) and HPV infection of in OSSC. These findings suggest that the presence of HPV in such OSCC cases could not alter the immunological system, particularly the Langerhans cells.

This study investigated the presence of human papillomavirus (HPV) DNA and viral types in 33 cases of oral squamous cells carcinoma (OSCC) and compared the immunohistochemical expression of the cell-cycle markers p21 and pRb between cases of the disease with and without HPV. DNA was extracted from paraffin-embedded tissue and amplified by PCR for the detection of HPV DNA. Viral typing was performed by dot blot hybridization. Immunohistochemistry was performed by the streptavidinbiotin technique. HPV DNA was detected in 11 (33.33%) of the 33 cases. The prevalent viral type was HPV 18 (81.81%). A significant association was observed between the presence of HPV and immunohistochemical expression of pRb, but not between p21 expression and the presence of the virus. The low frequency of detection of HPV DNA in OSCC suggests a possible participation of the virus in the development and progression of only a subgroup of these tumors.

A hiperplasia epitelial focal, ou doença de Heck, é uma enfermidade rara, benigna, que afeta a mucosa oral de crianças e adultos jovens de diversas regiões do mundo e em diferentes grupos étnicos, como indígenas e esquimós. Apresenta correlação com o papilomavírus humano (HPV) no qual os tipos 13 e 32 têm sido consistentemente detectados nessas lesões. Este artigo relata um caso de uma paciente de 18 anos de idade, descendente de índios potiguares, que compareceu ao serviço de estomatologia da Universidade Federal do Rio Grande do Norte (UFRN), exibindo lesões bem definidas, arredondadas, planas, localizadas em cavidade oral, com tempo de evolução de aproximadamente dois anos. As lesões foram submetidas a biópsias incisionais, constatado-se no exame histopatológico alterações epiteliais, como acantose, cristas epiteliais em forma de "taco de golfe" além de células mitosóides. Esses achados histopatológicos foram compatíveis com a hipótese clínica de hiperplasia epitelial focal (doença de Heck).

The focal epithelial hyperplasia or Heck's disease is a benign rare pathology, that affects children and young adults oral mucosal in many world regions, and different ethnic groups, for example Indians and Eskimos. Presents correlation with the subtypes 13 and 32 of human papillomavirus (HPV). This article report a case of an 18-year-old patient, descent of potiguar indian, attended in stomatology service of Federal University of Rio Grande do Norte (UFRN), presenting well defined lesions, round, plane, localized in oral cavity with an evolution of two years. The lesions were submitted to incisional biopsies, verifying in histopathologic exam, epithelial alterations, like acanthosis, epithelial projections in "parquet block of golf" beyond mitosoid cells. These histopathological findings were compatible with clinical hypothesis of focal epithelial hyperplasia (Heck's disease).

Nesse estudo, a expressão do antígeno nuclear de proliferação celular (PCNA) e da proteína p53, foi analisada em 16 casos de ameloblastoma e 8 casos de tumor odontogênico adenomatóide (TOA). Os casos de ameloblastoma eram do tipo sólido e, do ponto de vista morfológico, apresentavam-se nos diferentes subtipos histológicos. Em alguns casos, contudo, havia mais de um subtipo histológico na mesma lesão. As lesões foram então categorizadas em função da predominância dos achados histológicos, tendo sido identificados 7 casos de ameloblastoma com padrão folicular, 4 plexiformes, 3 foliculares + acantomatosos e 2 de células basais.Todas as lesões exibiram positividade para o PCNA e para a proteína p53, embora a expressão imunoistoquímica para o PCNA tenha sido mais forte nos casos de ameloblastoma folicular, enquanto a expressão da proteína p53 tenha se apresentou mais forte em ameloblastomas do subtipo plexiforme. A análise estatística (ANOVA e Teste de Tukey) não revelou diferença signficante (p>0.05) entre os tipos histológicos do ameloblastoma. Estes achados sugerem que os padrões histológicos do ameloblastoma não apresentaram correlação direta com o comportamento clinico e, conseqüentemente, com o prognóstico destas lesões. Os resultados também indicam que o ameloblastoma tem maior potencial proliferativo do que o TOA, o que contribui para explicar sua característica mais agressiva e invasiva.

In this study, proliferating cell nuclear antigen (PCNA) and p53 protein expressions were analyzed in 16 cases of ameloblastoma and 8 cases of adenomatoid odontogenic tumor (AOT). The cases of ameloblastoma consisted of solid type tumors and histologic arrangements of different subtypes were observed. In some specimens, more than one histologic subtype was identified in the same lesion, and each tumor was categorized according to the predominant cell pattern. The odontogenic tumors were grouped as follows: follicular ameloblastoma (n=7), plexiform ameloblastoma (n=4), acanthomatous + follicular ameloblastoma (n=3), basal cell ameloblastoma (n=2), adenomatoid odontogenic tumor (n=8). PCNA immunohistochemical expression revealed stronger quantitative labeling index for the follicular ameloblastoma, while for p53 protein the strongest quantitative labeling index was detected in the plexiform type. Nevertheless, statistical analysis using ANOVA and Tukey's test did not detect significant differences (p>0.05) among the histologic subtypes of ameloblastoma. The findings of this study suggest that the different histologic patterns of ameloblastoma did not show a direct correlation with their clinical behavior and consequently with the prognosis of the cases. The results also indicated that the ameloblastoma has greater proliferative potential than the AOT, which can contribute to explain its more aggressive and invasive characteristics.

A relação entre o aspecto clínico e as características histológicas das leucoplasias bucais foi avaliada em 28 pacientes adultos, que apresentaram lesões leucoplásicas na mucosa bucal. As lesões foram divididas quanto ao aspecto clínico em homogêneas e não-homogêneas, e classificadas segundo suas características histopatológicas em seis grupos: hiperceratose com ausência de displasia epitelial; displasia epitelial leve; displasia epitelial moderada; displasia epitelial severa, carcinoma in situ e carcinoma invasivo. Os resultados clínicos mostraram maior ocorrência de leucoplasias homogêneas (78,6%) do que não-homogêneas (21,4%). Os achados histopatológicos demonstraram que 32,2% dos casos apresentaram hiperceratose com ausência de displasia epitelial, 53,5% evidenciaram displasia epitelial (39,3% leve, 7,1% moderada e 7,1% severa) e 14,3% diagnosticados como carcinoma invasivo. As leucoplasias homogêneas apresentaram alterações celulares discretas, enquanto as não-homogêneas evidenciaram displasia epitelial severa e carcinoma invasivo. Os resultados sugerem um maior cuidado no diagnóstico e controle de leucoplasias dada a possibilidade de transformação maligna.

The relation between the clinical aspects and histologic characteristics of oral leukoplakias was evaluated on 28 adult patients presenting with oral leukoplakia. The lesions were clinically classified as homogeneous and nonhomogeneous, and divided regarding their histopathologic characteristics in six groups: hyperkeratosis without epithelial dysplasia; mild epithelial dysplasia; moderate epithelial dysplasia; severe epithelial dysplasia, squamous cell carcinoma in situ and invasive carcinoma. Homogeneous leukoplakia comprised 78.6% of the cases and nonhomogeneous, 21.4%. Microscopically, 32.2% of the lesions disclosed hyperkeratosis without evidences of epithelial dysplasia, 53.5% epithelial dysplasia (39.3% mild, 7.1% moderate, and 7.1% severe) and 14.3% invasive carcinoma. Homogeneous leukoplakia showed discreet histologic changes, while nonhomogeneous lesions evidenced histologic characteristics of severe epithelial dysplasia and even of invasive carcinoma. The results suggest great precaution in the diagnosis and follow-up of leukoplakia, considering the possibility of malignant transformation.