Abstract: This study aimed to analyze the 100 most-cited articles on intraoral squamous cell carcinoma and its risk factors. A literature search was conducted on November 12, 2020 using the Web of Science database. Bibliometric data were collected after study selection. Bibliometric maps were generated using VOSviewer software. Articles were ranked based on the number of citations, ranging from 108 to 1513 per study. Eleven studies presented at least 400 citations. Articles were published between 1950 and 2017 and were mostly case-control studies (n = 39) and narrative reviews (n = 29). The author and institution in most articles were S. Franceschi (n = 10) and the International Agency for Research on Cancer (n = 10), respectively. The most prominent countries were the United States (n = 35), the United Kingdom (n = 16), and France (n = 9). Among the 100 most-cited articles, only one article was from Brazil, and the authors were affiliated with the Ludwig Institute for Cancer Research. Bibliometric maps showed strong associations between the terms alcohol, smoked/smokeless tobacco, and human papillomavirus. Emerging terms, such as areca nut and betel quid, were cited in recent articles. In conclusion, alcohol, tobacco, and human papillomavirus were the most prominent risk factors. Case-control design was the most common study design, and the majority of studies were conducted in the United States by the International Agency for Research on Cancer.

Resumo Introdução As lesões hiperplásicas reativas se desenvolvem em resposta a uma lesão crônica que estimula uma resposta acentuada de reparo tecidual. Elas representam uma das lesões orais mais comuns, inclusive hiperplasia fibrosa inflamatória, granuloma piogênico oral, fibroma de células gigantes, fibroma periférico ossificante e lesão periférica de células gigantes. Objetivo A incidência dessas lesões foi investigada em um serviço de patologia bucal e as características clínicas, os fatores etiológicos associados e a concordância entre os diagnósticos clínico e histopatológico foram determinados. Método Foram selecionados 2.400 registros de pacientes entre 2006 e 2016. As características clínicas foram registradas a partir de laudos de biópsia e dos prontuários dos pacientes. Resultados Um total de 534 casos de lesões hiperplásicas reativas foram recuperados e retrospectivamente estudados, representando 22,25% de todos os diagnósticos. A lesão mais frequente foi hiperplasia fibrosa inflamatória (72,09%), seguida por granuloma piogênico oral (11,79%), fibroma de células gigantes, (7,30%), fibroma periférico ossificante (5,24%) e lesão periférica de células gigantes (3,55%). O sexo feminino foi predominante (74,19%), a gengiva e a crista alveolar foram o local anatômico predominante (32,89%) e o traumatismo crônico foi demonstrado como o principal fator etiológico. A idade variou desde a 1ª década de vida até a 7ª. Clinicamente, as LHR consistiram em pequenas lesões (0,5 a 2 cm) que apresentaram uma forte semelhança de cor com a mucosa oral. A concordância entre o diagnóstico clínico e histopatológico foi alta (82,5%). Conclusão As lesões hiperplásicas reativas apresentaram alta incidência entre as patologias bucais. A compreensão das características clínicas ajuda na realização de um diagnóstico clínico e etiológico mais claro, bem como determinar os fatores relacionados ao seu desenvolvimento. Dessa forma contribui para um tratamento adequado e um prognóstico positivo.

Abstract Introduction Reactive hyperplastic lesions develop in response to a chronic injury simulating an exuberant tissue repair response. They represent some of the most common oral lesions including inflammatory fibrous hyperplasia, oral pyogenic granuloma, giant cell fibroma, peripheral ossifying fibroma, and peripheral giant cell lesions. Objective The incidence of those lesions was investigated in an oral pathology service, and the clinical characteristics, associated etiological factors, concordance between the clinical and histopathological diagnostic was determined. Methods A total of 2400 patient records were screened from 2006 to 2016. Clinical features were recorded from biopsy reports and patients' files. Results A total of 534 cases of reactive hyperplastic lesions were retrieved and retrospectively studied, representing 22.25% of all diagnoses. The most frequent lesion was inflammatory fibrous hyperplasia (72.09%), followed by oral pyogenic granuloma (11.79%), giant cell fibroma (7.30%), peripheral ossifying fibroma (5.24%), and peripheral giant cell lesions (3.55%). Females were predominantly affected (74.19%), the gingiva and alveolar ridge were the predominant anatomical site (32.89%), and chronic traumatism was presented as the main etiological factor. The age widely ranges from the 1st decade of life to the 7th. Clinically, the reactive hyperplastic lesions consisted of small lesions (0.5-2 cm) and shared a strong likeness in color to the oral mucosa. The concordance between the clinical and histopathological diagnostic was high (82.5%). Conclusion Reactive hyperplastic lesions had a high incidence among oral pathologies. The understanding of their clinical features helps to achieve a clearer clinical and etiological diagnosis, and the knowledge of factors related to their development. This may contribute to adequate treatment and positive prognosis.

Resumo Introdução Os ameloblastomas (AM) são considerados os tumores odontogênicos mais comuns da cavidade bucal, apresentando grande importância clínica devido à sua agressividade, capacidade infiltrativa e comportamento recorrente. De maneira semelhante, o ceratocisto odontogênico (CO) desperta a atenção por ter um comportamento agressivo e altas taxas de recorrência em relação aos outros cistos de desenvolvimento. Objetivo Avaliar e comparar o índice de proliferação epitelial e a presença de miofibroblastos em CO e AM, por meio dos anticorpos Ki-67 e α-SMA, respectivamente. Metodologia Foram selecionados 15 casos de AM e 24 casos de CO para investigação imuno-histoquímica das proteínas Ki-67 e α-SMA. Um grupo de sete folículos pericoronários (FP) foi incluído como controle de tecido odontogênico normal. A média de células positivas foi calculada para cada marcador. Resultado O teste de Kruskal-Wallis revelou que a expressão de ambos os marcadores foi maior nos casos de CO, quando comparada à expressão em AM e FP. Segundo o teste de Mann-Whitney, a expressão dos marcadores foi semelhante entre os subtipos de AM. Conclusão A alta expressão de Ki-67 e α-SMA observada em CO poderia estar associada ao comportamento agressivo desta lesão em relação aos outros cistos de desenvolvimento. Por outro lado, a expressão semelhante destas proteínas nos casos de AM e FP, assim como nos subtipos de AM, poderia indicar que outros fatores, além do potencial proliferativo, estariam associados ao comportamento clínico agressivo do AM.

Abstract Introduction Ameloblastomas (AM) are considered the most common odontogenic tumors, with great clinical importance linked to its locally aggressive, infiltrative, and recurrent behavior. The odontogenic keratocyst (OK) represents a peculiar cyst that also draws attention because of its aggressive behavior and high rates of local recurrence. Objective The aim of this study was to evaluate the cell proliferation index and the presence of myofibroblasts in AM and OK using Ki-67 and α-SMA antibodies, respectively. Methodology Fifteen cases of AM and 24 cases of OK were selected for immunohistochemical investigation of the proteins α-SMA and Ki-67. A group of 7 pericoronal follicles (PF) was included as control for normal odontogenic tissue. The mean percentage of positive cells was calculated for each protein. Result Kruskal-Wallis test for both markers showed that expression was higher in OK, when compared to AM and PF. Mann-Whitney test showed no statistical difference when comparing the expression of both markers between the subtypes of AM. Conclusion Elevated expression of Ki-67 and α-SMA in OK may be associated with the aggressive clinical behavior of this cyst in comparison to other development cysts. The similar expression of the markers observed among AM and PF cases, as well as among subtypes of AM, may indicate that other factors, besides proliferative potential, are associated with the aggressive behavior of AM.

Abstract The aim of this study was to evaluate the immunohistochemical expression of receptor activator of nuclear factor kappa-B ligand (RANKL) and of osteoprotegerin (OPG), important proteins correlated with osteoclastogenesis, in central giant cell lesions (CGCL) and peripheral giant cell lesions (PGCL) and to compare their expression with the histological and clinical parameters for quantification of multinucleated giant cells (MGC) and their nuclei, lesion size, and recurrences. Twenty cases of each lesion type were selected to quantify the number of MGCs and nuclei/mm2 of connective tissue. The immunoreactivity of RANKL and OPG was expressed as a percentage of the marked area in the stroma. Clinical data were collected from pathoanatomical and medical reports. No statistical differences were found for the number of MGCs (p = 0.24) between PGCL and CGCL, but the number of nuclei within the MGCs was higher in CGCL (p = 0.01). RANKL expression was higher in CGCL than in PGCL (p = 0.04) and all recurrent lesions showed higher RANKL and OPG expressions than nonrecurrent lesions. We report higher RANKL expression and a greater number of nuclei in CGCL, which may explain the difference in clinical behaviour between these lesions and their pathogenesis.

INTRODUÇÃO: O Folículo Pericoronário envolve a coroa do germe dental durante seu desenvolvimento. Quando o dente permanece incluso, alterações do folículo podem originar doenças, como cistos e tumores odontogênicos. OBJETIVO: Analisar as alterações histológicas no tecido mole circundante a terceiros molares inclusos e semi-inclusos, independentemente de alterações patológicas aparentes em suas radiografias correspondentes, além de relacionar o diagnóstico histológico com o diagnóstico radiográfico dos casos. MATERIAL E MÉTODO: A partir de terceiros molares extraídos de 26 pacientes, foram analisados espécimes histológicos de folículos pericoronários por dois examinadores calibrados. O diagnóstico histopatológico obtido foi relacionado ao radiográfico, sendo este realizado por meio de radiografias periapicais e, quando necessário, complementado por radiografias panorâmicas. RESULTADO: Dos 37 folículos pericoronários avaliados, 30% mostraram alterações histológicas compatíveis com cistos dentígeros; 51% eram folículos normais, e 19% continham apenas fragmentos de mucosa. Radiograficamente, 100% dos casos demonstraram características de folículos sem alterações. CONCLUSÃO: Esses dados exemplificam que anormalidades podem estar presentes nos tecidos pericoronários sem que haja evidências clínicas e radiográficas. O exame histopatológico provê um diagnóstico mais preciso e deve ser considerado para a construção do diagnóstico definitivo.

INTRODUCTION: Dental follicles remain adjacent to the crown of an unerupted or impacted tooth. Changes in dental follicles can occur and form a solitary cyst around the crown of the tooth, deemed dentigerous cysts. OBJECTIVE: The aim of this study was to determine the incidence of soft tissue changes around unerupted or impacted third molars. MATERIAL AND METHOD: Pericoronal tissue of patients who were referred to our clinic for removal of third molars for a variety of reasons was examined histopathologically. Follicular spaces were measured from periapical and panoramic radiographs by each author independently. RESULT: Of the 37 specimens submitted for histopathologic examination, 19 normal follicular tissues (51%), 11 arrangements typical of a cyst (30%) and 7 normal tissues of oral mucous (11%) were found. CONCLUSION: Cystic changes may be encountered in the histopathologic examination of radiographically normal unerupted or impacted third molar follicles.

Introdução: A formação do Cisto Radicular (CR) está associada à proliferação dos restos epiteliais de Malassez por estímulos inflamatórios, provenientes da proliferação bacteriana do canal radicular de um dente não vital. Quando o dente é removido, esse cisto passa a ser denominado Cisto Residual (CRe). O tratamento de escolha para o CR é endodôntico, com o objetivo de eliminar a inflamação presente no periápice. No entanto, em alguns casos, o cisto pode continuar a crescer, necessitando de tratamento cirúrgico, o que ocorre na maioria dos casos de CRe.Objetivo:Avaliar o metabolismo do epitélio de revestimento de CR e CRe, utilizando a quantificação das AgNORs, e verificar a influência da presença de inflamação sobre o crescimento desses cistos.Material e método: Vinte casos de CR e dez de CRe foram submetidos à técnica de AgNOR. A análise quantitativa das NORs foi realizada utilizando-se o software 'Contando células'. O teste estatístico pós-hock de Newman-keuls foi realizado para a comparação do número médio de AgNORs entre CR e CRe, e entre áreas inflamadas e não inflamadas.Resultado: Diferença estatisticamente significante (p=0,0094) foi observada entre áreas inflamadas (1,86±0,26) e não inflamadas (1,65±0,20). Na comparação entre CR (1,81±0,28) e CRe (1,73±0,16), não houve diferença estatisticamente significante (p=0,37).Conclusão: A inflamação interfere no metabolismo epitelial de CR e CRe, o que reflete a ação de fatores de crescimento na proliferação do epitélio, contribuindo para o crescimento do cisto, independentemente da presença do fator etiológico associado com a origem da lesão.

Introduction: Radicular Cyst (RC) development is associated with the activation and proliferation of epithelial rests of Malassez. This occurs due to inflammatory stimuli resulting from bacteria proliferation in the root canal of a non-vital tooth. When the tooth is removed, the cyst becomes known as Residual Cyst (ReC). The RC common treatment is the endodontic therapy, with the aim of eliminating the inflammation in the periapical region. Nonetheless, this treatment is not always effective and the cyst may continue to grow, what happens in most cases of ReC.Objective: To evaluate the metabolism of the RC and ReC epithelial lining through the technique of AgNOR quantification and of the influence of the presence of inflammation in the growth of these cysts.Material and method: 20 cases of RC and 10 of ReC, were processed by the AgNOR technique. The AgNOR quantitative analysis was performed using the "Counting cells" software. The statistical post-hock Newman-Keuls test was applied to compare the RC and ReC mean number of AgNORs in inflamed and non-inflamed areas.Result: Statistically significant difference (p=0.0094) was observed between inflamed (1.86±0.26) and non-inflamed (1.65±0.20) areas. No statistically significant difference (p=0.37) was observed in the comparison between RC (1.81±0.28) and ReC (1.73±0.16).Conclusion: Inflammation interferes in the epithelial metabolism of RC and ReC, reflectings the action of growth factors in epithelial proliferation and contributing to the growth of the cyst, regardless the presence of the etiologic factor associated with the injury origin.

Odontogenic tumors (OTs) are lesions that develop exclusively on maxillary bones, and form a heterogeneous group. They vary from hamartomatous lesions to benign and malign tumors. Although they are rarely observed in dentistry clinics, it is extremely important for the dentist to be aware of them. The aim of this study was to investigate the incidence of odontogenic tumors diagnosed in the population of Florianópolis, Santa Catarina, Brazil. Cases of odontogenic tumors were selected from the anatomopathological diagnostic services at Federal University of Santa Catarina from 1998 to 2011. Clinical data on these cases were collected from biopsy reports and patient files. Seventy-eight cases of odontogenic tumors were surveyed. Of these diagnoses, 51% were keratocystic odontogenic tumors (KCOTs); the remaining cases were mainly ameloblastomas and odontomas. The most frequently observed lesion in this retrospective study was KCOT (more than half of cases). Thus, this study shows that modifying the classification of the OTs altered the frequency of the lesions, possibly making KCOT the most common lesion observed in diagnostic services worldwide.

The objective of this study was to evaluate the cytological content of ameloblastomas of the jaw. Nine cases of ameloblastoma were punctured, and the intralesional material was processed using the cell block technique. After centrifugation, the pellet obtained from the punctured material was fixed in formaldehyde and routinely processed to inclusion in paraffin. The obtained sections were stained with haematoxylin and eosin (H&E). Immunohistochemical reactions against anti-pan-cytokeratin (AE1/AE3) were performed to measure the presence of epithelial cells. Cytological analyses of the obtained slides revealed the presence of epithelial cells (as evidenced by AE1/AE3 labelling) and acellular amorphous eosinophilic materials. These cytological findings, in light of clinical and imaging data, can be helpful in the presumptive diagnosis of this disease entity by eliminating other possible diagnoses. Nonetheless further studies are needed in order to determine the nature of the acellular amorphous eosinophilic material and to ascertain the immunoprofile of epithelial cells.

This study investigated the viability of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Thirty-three clinically diagnosed jawbone lesions with a cystic appearance were subjected to aspiration. The aspirated material was processed by the cell block technique, and the lesions were biopsied and treated. Cytological findings (cell block) and histopathology analyses (gold standard) were compared by the chi-square test. There were associations between cysts and cholesterol crystal clefts, between keratocystic odontogenic tumors (KOT) and epithelial cells, and between KOT and parakeratin. The occurrence of cholesterol crystal clefts in cell block slides was correlated with cystic lesions, and the parakeratin presence was a KOT indicator. The cell block technique proved to be fast, easy-to-handle, and low-cost, making it an attractive auxiliary method for the preliminary diagnosis of jawbone lesions.

INTRODUÇÃO: A busca por novos métodos que auxiliem e simplifiquem de maneira eficaz o diagnóstico de lesões maxilares, cistos e tumores, objetiva beneficiar os pacientes e facilitar a atuação dos profissionais da área de diagnóstico bucal. Além dos dados clínicos, radiográficos e histopatológicos classicamente utilizados nos protocolos de investigação das lesões maxilares, a adaptação de técnicas já consagradas na medicina pode ser de grande valia. A técnica de cell block se propõe a auxiliar nesse processo, pois consiste na análise citológica de materiais, efusões e líquidos, coletados de lesões passíveis de punção aspirativa, como cistos e tumores císticos dos maxilares. OBJETIVO: Demonstrar a aplicabilidade da técnica de cell block para avaliação citológica de material biológico coletado a partir de lesões císticas dos maxilares. RESULTADOS: Das 20 lesões, das quais o conteúdo foi processado pela técnica, a avaliação citológica de cinco casos de tumores odontogênicos ceratocísticos (TOCs) demonstrou a presença predominante de ceratina, sempre com áreas de paraceratina. Nos demais casos (cinco cistos dentígeros, cinco cistos radiculares e cinco cistos residuais) foi observada a presença de hemácias, células inflamatórias e fendas de cristais de colesterol. CONCLUSÃO: A avaliação citológica, a partir da técnica de cell block, foi útil no estabelecimento do diagnóstico diferencial entre TOC e demais lesões estudadas, cistos radicular, residual e dentígero.

INTRODUCTION: The search for new methods that aid and optimize the diagnosis of cystic and tumoral maxillary lesions aims to benefit both patients and professionals from oral diagnosis. In addition to clinical, radiographic and histological findings traditionally used in research protocol for maxillary lesions, the adaptation of widely used medical techniques may be very helpful. The cell block procedure streamlines this process, inasmuch as it consists of cytopathological analysis of materials, liquids and effusions, collected from aspirated lesions such as maxillary cysts and cystic maxillary tumors. OBJECTIVE: To demonstrate the applicability of cell block technique for cytological assessment of biological material collected from cystic maxillary lesions. RESULTS: The cytological evaluation revealed that five out of 20 lesions, whose content had been processed by this technique, were odontogenic keratocystic tumors (TOCs), predominantly with keratin and always with parakeratin areas. In the other cases (five dentigerous, five radicular and five residual cysts) there were erythrocytes, inflammatory cells, and cholesterol clefts. CONCLUSION: The cytological assessment through cell block technique was useful as to establishing the differential diagnosis between TOC and other lesions, radicular, residual and dentigerous cysts.

OBJECTIVE: To evaluate the applicability of the cell block technique as a complementary method for presumptive diagnosis in the analysis of cyst-like aspirates from jaw lesions prior to histopathological diagnosis. MATERIAL AND METHODS: The sample was made up of 17 cyst-like jaw lesions. After puncture, the aspirates were centrifuged, fixed in formalin, embedded in paraffin and processed. All lesions were biopsied and submitted to histopathological examination. RESULTS: In 9 cases, the cytopathological analysis using the cell block method showed a predominant presence of erythrocytes, inflammatory cells and few epithelial cells. In the other 8 cases, the cell block technique demonstrated the presence of parakeratin, whose histopathological analysis confirmed the occurrence of keratocystic odontogenic tumors (KOTs). CONCLUSIONS: According to the studied cases, the cell block method was proven to be a simple, fast and low-cost technique to effectively differentiate KOTs from other lesions with similar clinical and radiographic features. The cell block technique comprises cellular preparations useful to determine a clinical diagnosis and help to develop a therapeutic plan for those lesions.

O papilomavírus humano (HPV) constitui um grupo de vírus associados com lesões benignas e malignas do epitélio da pele e das mucosas. Alguns tipos de HPV, ditos oncogênicos, especialmente os HPVs 16 e 18, estão fortemente correlacionados com os cânceres cervical e anogenital, e também têm sido implicados na gênese do carcinoma epidermóide de boca. O objetivo deste estudo foi investigar a incidência de infecção pelo HPV, em 40 casos de carcinoma epidermóide de boca emblocados ou não em parafina, utilizando-se para isso a amplificação do DNA viral por PCR. Foram utilizados os iniciadores GP5+/GP6+, que amplificam parte da região L1 do vírus, comum a mais de 22 tipos de HPVs. Como controle positivo para as reações, foi utilizado um caso de condiloma, o qual foi positivo para os HPVs 16 e 18 na hibridização in situ. A amplificação para o HPV foi constatada apenas no controle positivo; nenhum dos casos de carcinoma epidermóide em estudo mostrou amplificação para o DNA viral. A ausência de amplificação de DNA do HPV nos casos de carcinoma epidermóide estudados sugere que esse vírus nem sempre participa do processo de carcinogênese. Essa diferença em relação a outros estudos provavelmente se dá por questões populacionais, ou mesmo de metodologia entre os diferentes trabalhos citados na literatura.

Human Papilomaviruses (HPV) are a group of viruses associated with benign and malignant lesions of cutaneous and mucosal epithelia. Some "high risk" HPV types, especially HPV 16 and 18, are strongly correlated with cervical and anogenital cancers and are also related to the genesis of oral squamous cell carcinomas (OSCC). The aim of this work was to investigate the incidence of HPV infection in 40 paraffin-embedded or fresh specimens of OSCC, using PCR amplification of the viral DNA. Literature based primers (GP5+/GP6+) were used in order to amplify HPV DNA from the L1 gene, present in more than 22 types of HPV. A condyloma case with HPV 16 and 18 detected by in situ hybridization was used as a positive control. Amplification of HPV was observed only in the positive control. No squamous cell carcinoma cases showed DNA viral amplification. Absence of HPV DNA amplification by PCR in the analyzed specimens of OSCCs suggests that this virus not always plays a role in the carcinogenesis process. Discrepancy with some studies found in the literature may be related to methodology or population differences.

A leucoplasia pilosa (LP) é uma lesão associada ao comprometimento do sistema imune e seu diagnóstico é determinado pela demonstração da presença do vírus Epstein-Barr (EBV) no tecido lesionado. O objetivo deste trabalho foi desenvolver uma metodologia simples para auxiliar no diagnóstico da LP, utilizando-se a técnica da PCR como uma alternativa para evidenciar o EBV em esfregaços da lesão. Amostras de DNA foram obtidas por meio de raspado de borda lateral de língua, de 38 pacientes adultos, sendo estes: 29 pacientes HIV positivos (4 com evidência clínica de leucoplasia pilosa, 4 que haviam apresentado LP previamente, mas não no momento da coleta, e 21 sem evidência clínica de leucoplasia pilosa) e 9 voluntários sadios para o grupo controle. O DNA foi extraído do material obtido por raspagem e amplificado pela PCR utilizando-se iniciadores específicos para o EBV. Dos 29 casos de pacientes portadores do vírus HIV, 22 (75,86%) foram positivos para o EBV, sendo: 2 de pacientes com evidência clínica de LP, 4 de pacientes que haviam apresentado LP previamente e 16 de pacientes sem sinais clínicos de LP. No grupo controle, as amostras de 5 (55,56%) indivíduos clinicamente sadios mostraram amplificação para o EBV. Concluímos que o uso da PCR em esfregaços sugere uma alta sensibilidade e baixa especificidade no diagnóstico da leucoplasia pilosa.

Oral hairy leukoplakia (OHL) is a lesion associated with a compromised immune system, and its diagnosis is determined by the demonstration of the presence of Epstein-Barr virus (EBV) in lesional tissue. The purpose of this article was to develop a simple technique to help the diagnosis of OHL, using PCR as an alternative technique to evidence EBV in scrapings. DNA samples were obtained by scraping the lateral border of the tongue of 38 adult patients: 29 HIV-positive patients (4 with clinical evidence of OHL; 4 with history of OHL, but without lesion at the moment the samples were collected; and 21 without clinical evidence of OHL), and 9 healthy volunteers for the control group. DNA was extracted from scrapes and amplified by PCR using specific primers for EBV. Of the 29 cases of HIV-positive patients, 22 (75.86%) were positive for EBV: 2 patients with clinical evidence of OHL, 4 patients with history of OHL, but without lesion at the moment the samples were collected, and 16 patients without clinical evidence of OHL. In the control group, samples of 5 (55.56%) healthy volunteers presented amplification for EBV. We concluded that the use of PCR in oral scrapes suggests a high sensitivity but low specificity for the diagnosis of OHL.