Abstract The aim of this study is to evaluate the immunohistochemical expression of E-cadherin, N-cadherin and Bmi-1, and their association with clinical parameters and with the degree of histopathological differentiation in oral squamous cell carcinomas. 65 squamous cell carcinoma samples were used for constructing a tissue microarray block, and then immunohistochemistry was performed for different markers. A semi-quantitative analysis of the amount of positive tumor cells was performed by two blind and calibrated observers (Kappa>0.75). The statistical Mann-Whitney and Kruskal-Wallis tests were used to evaluate the data. The correlation between variables was investigated by the Spearman test, and the significance level set at p<0.05. We observed higher expression of Bmi-1 in tumors located in the palate (p<0.0001). In addition, poorly differentiated tumors had a greater amount of Bmi-1 positive cells (p=0.0011). Regarding the other correlations between variables, no significant associations were detected. In conclusion, poorly differentiated squamous cell carcinomas located in the palate have higher immunostaining of Bmi-1, which can characterize activation of the Epithelial-Mesenchymal Transition process in these tumors.
Resumo O objetivo deste estudo foi avaliar a associação entre a expressão imunoistoquímica de E-caderina, N-caderina e Bmi-1, com os parâmetros clínicos e o grau de diferenciação em carcinomas espinocelulares bucais. Sessenta e cinco amostras foram selecionadas para a construção de um bloco de microarranjo tecidual, e a técnica de imunoistoquímica foi realizada para os diferentes marcadores. Uma análise semi-quantitativa das células tumorais positivas foi realizada por dois observadores calibrados e cegos (Kappa>0.75). Os testes estatísticos Mann-Whitney e Kruskal-Wallis foram utilizados para a análise dos dados e a correlação entre as variáveis foi investigada com o teste de Spearman. O nível de significância foi determinado em p <0.05. Observamos maior expressão de Bmi-1 em tumores localizados em palato (p <0.0001). Além disso, tumores pobremente diferenciados apresentaram maior quantidade de células positivas para Bmi-1 (p=0.0011). Não encontramos outras correlações ou associações significativas. Em conclusão, carcinomas espinocelulares pobremente diferenciados e localizados no palato apresentam maior marcação imunoistoquímica de Bmi-1, o que pode caracterizar a ativação do processo de transição epitélio-mesênquima nesses tumores.
Abstract: The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability.
Abstract The present study aimed to assess the rate of agreement between clinical and histopathological diagnoses and to report the frequency of completed forms for specimens that were subjected to histopathological examination and retrospectively examined. Data from 8,168 specimens submitted to histopathological examination were retrieved from the records. A total of 5,368 cases were included. Agreement was defined based on the definition of lesion nature according to its diagnostic category. Sensitivity, specificity, and positive and negative predictive values were calculated for each diagnostic category. The highest rate of agreement was observed for periapical lesions (92.6%), followed by potentially malignant disorders (90.1%) and non-neoplastic proliferative disorders (89.3%). Low rates of histopathological confirmation of the clinical impression were observed for mesenchymal tumors (25.0%) and cysts (44.2%). Sensitivity values were > 0.70 for all lesions, except for cysts (0.51). Specificity was relatively high, ranging from 0.97 to 1.00. The frequency of incomplete biopsy forms ranged from 16.8% (malignant tumors of oral mucosal epithelium) to 51.0% (nonspecific inflammatory reaction). The most frequently completed biopsy forms corresponded to epithelial malignant tumors (83.2%) and glandular inflammation (72.3%). In conclusion, there was an acceptable level of agreement. The low level of completeness of biopsy forms indicates little awareness about the relevance of gathering detailed information during clinical examination.
The aim of this study was to evaluate the frequency of oral mucosal lesions and their associations with sociodemographic, health, and behavioral factors in a southern Brazilian population. Information was collected from participants (n = 801) using a structured questionnaire during an oral cancer screening campaign held at an agribusiness show in southern Brazil in 2009. Data were described using frequency distributions or means and standard deviations. Associations between independent variables and outcomes were assessed using the Chi-squared test. A total of 465 lesions were detected (actinic cheilitis: n = 204, 25.5%; candidiasis: n = 50, 6.2%; fibrous inflammatory hyperplasia: n = 42, 5.2%; ulceration, n = 33, 4.1%; hemangioma: n = 14, 1.7%; leukoplakia: n = 11, 1.4%). Candidiasis, actinic cheilitis, and fibrous inflammatory hyperplasia were associated significantly with literacy. Actinic cheilitis was also associated significantly with sun exposure and hat use, and leukoplakia was associated with smoking. The high frequency of oral mucosal lesions observed highlights the importance of education about risk factors. Additionally, training of health professionals, mainly those from public health services, in the use of preventive and community education strategies is needed.
The aim of this study was to evaluate the demographic, clinical, and therapeutic characteristics and predictive factors of poor prognosis in patients with primary oral squamous cell carcinoma (OSCC) in Uruguay. Medical records of patients with the diagnosis of primary OSCC treated between 2000 and 2010 in Uruguayan public hospitals were selected. Data on demographic characteristics, risk factors, clinical features, treatment, and outcome were collected. Associations of independent variables with outcomes were assessed using Pearson chi-squared and Fisher's tests. Of 200 patients with OSCC, 79.4% were men (3.8:1 male:female ratio), with a mean age of 60.75 ± 11.26 years. Tobacco and alcohol consumption were reported by 85.3% and 63.5% of patients, respectively. The most commonly affected location was the tongue (42.5%), with lesions exhibiting ulcerous aspects in 87.9% of cases and pain at the time of diagnosis in 70.4% of cases. One hundred sixty-one (82.1%) patients had advanced-stage (III/IV) OSCC. Surgery was the most common treatment option, and the overall 5-year survival rate was 58.5%. Univariate analysis showed that the predictors of poor prognosis were clinical aspect, size, regional metastasis, clinical stage, and treatment. In Uruguay, OSCC is diagnosed late, which is associated with a low survival rate. Educational and preventive measures and investment to improve early diagnosis should be undertaken.
OBJECTIVES: The aim of this study was to analyze the immunolabeling of two cell cycle protein regulators, p53 and p21WAF1, in non-dysplastic leukoplakias with different epithelial alterations: acanthosis, hyperkeratosis and acanthosis combined with hyperkeratosis, and compare them with dysplastic leukoplakias. MATERIAL AND METHODS: This was a prospective cohort study involving 36 patients with oral homogeneous leukoplakias. excisional biopsies were performed and the patients remain under clinical follow-up. The leukoplakias were divided into four groups: 6 acanthosis, 9 hyperkeratosis, 10 acanthosis combined with hyperkeratosis, and 11 epithelial dysplasias. Paraffin-embebeded sections were immunostained for p53 and p21WAF1. Five hundred cells from the basal layer and 500 from the parabasal layer were counted to determine the percentage of positive cells. A qualitative analysis was also carried out to determine the presence or absence of immunohistochemical staining in the intermediate and superficial layers. Groups were compared with ANOVA (p<0.05). Pearson's correlation coefficient was used to test for associations between the two markers, p53 and p21WAF1. RESULTS: No leukoplakia recurred and no malignant transformation was observed whitin a follow-up period of 3-6 years. The mean percentage of p53 staining in the basal and parabasal layers was similar in all groups. p21WAF1 staining differed between layers was as follows: in the basal, only 3 to 4% of cells were stained, while in the parabasal, between 16 and 28% of the epithelial cells were stained in the four different studied groups with no statistically significant difference (p>0.05). CONCLUSIONS: Our findings failed to differentiate the non-dysplastic lesions by means of p53 and p21WAF1 immunostaining, notwithstanding similar profiles between non-dysplastic and dysplastic leukoplakias were observed.
The purpose of the present paper was to describe the range of lesions histologically diagnosed in an oral pathology laboratory in southern Brazil. A retrospective study of 8,168 specimen analyses recorded between 1995 and 2004 was conducted. The records were retrieved from the Oral Pathology Laboratory, School of Dentistry, Federal University of Rio Grande do Sul, RS, Brazil. A total of 6,831 valid cases (83.63%) were examined. Of these, inflammatory lesions were the most common occurrences (n = 4,320; 63.24%). Benign and malignant tumors accounted for 7.66% (n = 523) and 1.9% (n = 130) of the occurrences, respectively. Significant associations were observed between nonneoplastic proliferative disorders and benign mesenchymal tumors in females, and between squamous cell carcinoma and leukoplakia in males. Most diagnoses were benign in nature and had an inflammatory etiology. The association of some demographic characteristics with the occurrence of lesions suggests that these characteristics should be considered in performing differential diagnoses.
This study compared the effect of two bioceramics on the process of bone repair: α-tricalcium phosphate (α-TCP) cement and β-tricalcium phosphate hydroxyapatite particles (β-TCP/HA). Calvarial defects were created in 50 rats, divided into two groups (α and β/HA). Software was used at 7, 21, 60, 90 and 120 days to assess bone formation. Mean new bone formation rates were as follows: α group, 1.6% at 7 days, 5.24% at 21 days, 24% at 60 days, 30.21% at 90 days and 50.59% at 120 days; β/HA group, 1.94% at 7 days, 2.53% at 21 days, 12.47% at 60 days, 26.84% at 90 days and 38.82% at 120 days; control group, 0.15% at 7 days, 10.12% at 21 days, 15.10% at 60 days, 18.94% at 90 days, 48.50% at 120 days. Both materials are osteoconductive and biocompatible. Perhaps the larger rate of new bone formation observed in the α-TCP group, it also occurs in the β-TCP/HA group within a longer time period.
OBJECTIVE: This study investigated the pulpal effect of topically applied betamethasone to the dentin of rat molars in the vascular phase of inflammation. MATERIAL AND METHODS: Deep cavities were prepared on the occlusal face of the maxillary right and left 1st molars with non-refrigerated inverted-cone steel burs at low speed. Three groups were formed: Group I was composed of right 1st molars; Group II was composed of left 1st molars that received the application of a drop of betamethasone on dentin surface for 5 min; and Group III (control) was composed of right 2nd molars that received no cavity preparation or betamethasone application. Changes in the vascular characteristics of the pulp tissue were checked by calculating the pulp vascular area in relation to its total area and the number of blood vessels per unit area. Data were subjected to ANOVA and Tukey's test (?=0.05). RESULTS: Group I presented a significantly larger number of vessels (p<0.05) than Group II. Regarding the vascular/total area ratio (%), Group I presented statistically significantly higher values (p=0.01) than Groups II and III. CONCLUSION: Betamethasone applied on the dentin of rat teeth proved to reduce the vascular phase of pulp inflammation regarding vessel diameter and number of blood vessels.
PURPOSE: To analyze the microscopic characteristics of the effect of Gallium-Aluminum Arsenid diode laser (GaAlAs - 830etam) applied during the activation and consolidation period to ovine mandibles submitted to distraction osteogenesis. METHODS: Eighteen sheep underwent surgery in order to have bone distractors implanted in the left side of the jaw area. They were divided into three groups: 1 - Control; 2 - Laser irradiation during the activation period; 3 - Laser irradiation during the fixation period. The irradiation was carried out in five sessions, on every other day, with 4,0J/cm² doses applied to four pre-established areas, totaling 16J per session. After four days of latency under post-operative care, ten days of distractor activation (at 1mm/day) and twenty-one days of fixation the animals were sacrificed and the devices removed for microscopic analysis. RESULTS: The groups that received laser irradiation (GaAlAs) presented a greater amount of mineralized bone trabeculae when compared to the Control Group. Despite that, cartilaginous tissues were also found in Group 2. CONCLUSION: The laser has been more favorable when used in the consolidation period, after bone elongation.
OBJETIVO: Avaliar as características microscópicas do efeito do laser diodo de Arsenieto de Gálio-Alumínio (AsGaAl - 830etam), aplicado no período de ativação e consolidação de mandíbulas de ovelhas submetidas a distração osteogênica. MÉTODOS: Dezoito ovinos foram submetidos a procedimento cirúrgico para colocação de distrator ósseo em região de mandíbula do lado esquerdo, sendo divididos em três grupos: 1 - Controle; 2 - Irradiação de laser no período de ativação; 3 - Irradiação de laser no período de contenção. As irradiações foram feitas em cinco seções em dias alternados, com doses de 4,0J/cm² em quatro pontos pré-determinados, somando 16J por seção. Após quatro dias de latência no pós-operatório, 10 dias de ativação do distrator (1 mm/dia) e 21 dias de contenção os animais foram mortos e as peças removidas para análise microscópica. RESULTADOS: Os resultados foram que os grupos irradiados com laser (AsGaAl) apresentaram maior disposição de trabéculas ósseas mineralizadas em relação ao grupo controle, contudo, no Grupo 2 foi observada a presença de tecido cartilaginoso. CONCLUSÃO: O laser atuou de forma mais favorável quando utilizado no período de consolidação, após o alongamento ósseo.
The objective of this study was to investigate the distribution of CD8+ and CD20+ lymphocytes in chronic periapical inflammatory lesions. A total of 90 periapical inflammatory lesions (chronic abscesses, abscessed cysts, and inflammatory cysts) were evaluated. The biotin-streptavidin immunohistochemical technique was used to identify cytotoxic/suppressor T-lymphocytes (CD8) and B-lymphocytes (CD20). Age ranged from 10 to 67 years. Patients between 26 and 45 years old (54.4%), females (52.2%), and white patients (74.4%) were more frequently affected. CD8+ cell distribution was as follows: 1) fibrous capsule: diffuse in 58.8% of chronic abscesses and absent in 64.1% of abscessed cysts and in 70.6% of inflammatory cysts; 2) infiltration zone: diffuse in 100% of abscessed cysts and in 82.4% of inflammatory cysts; 3) sub-epithelial zone: absent in 53.0% of inflammatory cysts and diffuse in 56.4% of abscessed cysts; 4) suppurative zone: diffuse in 100% of chronic abscesses and in 97.5% of abscessed cysts. CD20+ cell distribution was as follows: 1) fibrous capsule: absent in 100% of inflammatory cysts, in 94.8% of abscessed cysts, and in 88.3% of chronic abscesses; 2) infiltration zone: diffuse in 100% of abscessed cysts and in 53% of inflammatory cysts; 3) sub-epithelial zone: absent in 58.8% of inflammatory cysts and focal in 46.2% of abscessed cysts; 4) suppurative zone: diffuse in 100% of abscessed cysts and in 100% of chronic abscesses. The distribution of the lymphocytic infiltrate in the lesions was usually diffuse for both types of lymphocytes.
O objetivo deste estudo foi o de investigar a distribuição de linfócitos CD8+ e CD20+ em lesões inflamatórias periapicais. Para tanto foram estudados 90 casos entre abscessos crônicos, cistos abscedados e cistos inflamatórios. A tecnica de imunohistoquímica pelo método da estreptavidina-biotina foi utilizada para identificar linfócitos T citotóxico/supressor (CD8) e linfócito B (CD20). Dentre os resultados encontrados notou-se uma distribuição das células CD8+ da seguinte forma: 1) difusa na capsula fibrosa dos abscessos crônicos (58,8%) e ausente nos cistos abscedados (64,1%) e cistos inflamatórios (70,6%); 2) zona infiltrativa: difusa nos cistos abscedados (100%) e cistos inflamatórios (82,4%); 3) zona subepitelial: ausente nos cistos inflamatórios (53,0%) e difusa nos cistos abscedados (56,4%); 4) zona de supuração: difusa nos abscessos crônicos (100%) e cistos abscedados (97,5%). As células CD20+ apresentavam a seguinte distribuição: 1) cápsula fibrosa: ausente nos cistos inflamatórios (100%), cistos abscedados (94,8%) e abscessos crônicos (88,3%); 2) zona infiltrativa: difusa nos cistos abscedados (100%) e cistos inflamatórios (53%); 3) zona subepitelial: ausente nos cistos inflamatórios (58,8%) e focal nos cistos abscedados (46,2%); 4) zona de supuração: difusa nos cistos abscedados (100%) e abscessos crônicos (100%). Em conclusão é possível afirmar que a distribuição linfocitária é predominantemente difusa para ambos os tipos de linfócitos.