Abstract: Inflammatory periapical lesions are characterized by infiltration of different immune cell types, the functions of which depend on an effective vascular network. This study aimed to evaluate the mast cells density (MCD) in inflamatory odontogenic cysts capsules concerning microvascular density (MVD), microvascular area (MVA), and microvascular perimeter (MVP), and correlate such findings with the type of lesion, intensity of the inflammatory infiltrate, and thickness of the epithelial lining. Twenty inflamatory dentigerous cysts (IDCs), twenty radicular cysts (RCs), and twenty residual radicular cysts (RRCs) were submitted to immunohistochemical analysis using anti-tryptase and anti-CD34 antibodies. RCs exhibited the highest MCD, MVD, MVA, and MVP indexes (p = < 0.001, p = 0.008, p = 0.003 and p = < 0.001, respectively), and lesions with inflammatory infiltrate grade III showed the highest MVD (p = 0.044). Considering epithelial thickness, a higher MVP index was identified in lesions with hyperplastic epithelium (p = 0.018). In IDCs, RCs, and RRCs, a strong positive correlation was observed between MVA and MVP (r = 0.950 and p = < 0.001; r = 0.914 and p = < 0.001; r = 0.713 and p = < 0.001, respectively). In IDCs, a moderate correlation was observed between MCD and both MVA and MVP (r = 0.660 and p = 0.002; r = 0.634 and p = 0.003, respectively). These results suggest that tryptase-positive mast cells might play an important role in the angiogenic activity of IDCs, while RCs had the highest indexes. Our findings also confirmed that the intensity of the inflammatory infiltrate and epithelial thickness influence angiogenesis.

Resumo Os cistos teratóides são hamartomas, que contém tecidos derivados do endoderma, mesoderme e ectoderma, relativamente raros na cavidade oral, onde são frequentemente encontrados na região da linha média do assoalho bucal. Este estudo relata um caso de cisto teratoide assintomático, localizado em região sublingual, em paciente do sexo feminino lactente, com 1 ano de idade, com histórico de dificuldade de amamentação. A lesão foi removida cirurgicamente e após 2 anos de acompanhamento não foram observados sinais de recidivas. Após a avaliação morfológica, foi classificado como coristoma por conter epitélio gastrointestinal, epitélio respiratório e anexos dérmicos. Concluímos enfatizando a relevância do correto diagnóstico do cisto teratoide para o estabelecimento da conduta adequada, considerando as implicações clínicas capazes de comprometer as funções de deglutição, mastigação e respiração do indivíduo afetado.

Abstract Teratoid cysts are hamartomas, which contain tissues derived from the endoderm, mesoderm, and ectoderm, and are relatively rare in the oral cavity, where they are often found in the midline region of the oral floor. This study reports a case of an asymptomatic teratoid cyst located in a sublingual region, in a 1-year-old female infant with a history of breastfeeding difficulty. The lesion was surgically removed, and, after 2 years of follow-up, no signs of recurrence were observed. After morphological evaluation, it was classified as a choristoma due to containing gastrointestinal epithelium, respiratory epithelium, and dermal appendages. We emphasize the importance of a correct diagnosis of the teratoid cyst for the establishment of appropriate management, considering the clinical implications that can compromise the swallowing, chewing, and breathing functions of the affected individual.

RESUMO O carcinoma ameloblástico (CA) é um tumor odontogênico raro que representa o equivalente maligno de um ameloblastoma. Existem poucos casos de CA na literatura em inglês: nos últimos 10 anos, foram relatados apenas 16 casos surgidos de ameloblastomas preexistentes. Múltiplas recorrências locais desse tumor precedem essa transformação. Neste relato, descrevemos um caso de CA em região posterior de maxila em uma mulher de 42 anos de idade, submetida à ressecção cirúrgica. Em um período de quatro anos, ocorreram três recidivas do ameloblastoma. Exames de imagem exibiram uma massa radiodensa com destruição da cortical óssea e invasão do seio maxilar. A análise histológica revelou ilhas e ninhos característicos de transformação maligna epitelial, atipias, pleomorfismo celular, hipercromatismo nuclear, necrose e desmoplasia. O CA representa um raro e desafiador diagnóstico histológico. O acesso cirúrgico com ampliação das margens de tecido duro e mole é essencial para o impacto na sobrevida do paciente. A descrição de novos casos pode revelar, por meio do tratamento e do acompanhamento clínico, características que ajudem a entender melhor o comportamento do CA.

ABSTRACT Ameloblastic carcinoma (AC) is a rare odontogenic tumor that represents the malignant counterpart of an ameloblastoma. There are few cases of AC in the English-language literature, with only 16 cases arising from preexisting ameloblastomas reported in the last 10 years. Multiple local recurrences of ameloblastomas precede this transformation. In the current report, we describe a case of AC at the posterior maxilla in a 42-year-old female submitted to surgical resection, with three recurrences of ameloblastoma in a period of four years. Imaging exams showed a radiodense mass with cortical bone disruption and maxillary sinus invasion. Histologic analysis demonstrated features of islands and nests of malignant epithelium transformation, atypia, pleomorphic cells, nuclear hyperchromatism, necrosis and desmoplasia. AC represents a rare and challenging histologic diagnosis. Surgical access with adequate hard and soft tissue margins is essential for influencing survival. The description of new cases may reveal, through of treatment and clinical follow-up, characteristics that allow us better understanding of AC behavior.

RESUMEN El carcinoma ameloblástico (CA) es un tumor odontogénico raro que representa el equivalente maligno de un ameloblastoma. Hay pocos casos de CA en la literatura en lengua inglesa: en los últimos 10 años, sólo se reportaron 16 casos originados de ameloblastomas previos. Múltiples recidivas locales de este tumor preceden esa transformación. En este reporte, describimos un caso de CA en región posterior de maxila en una mujer de 42 años de edad, sometida a resección quirúrgica. En un periodo de cuatro años, se produjeron tres recurrencias del ameloblastoma. Exámenes de imagen muestran una masa radiodensa con destrucción cortical e invasión del seno maxilar. El análisis histológico ha revelado islas y nidos característicos de transformación epitelial maligna, atipias, pleomorfismo celular, hipercromatismo nuclear, necrosis y desmoplasia. El diagnóstico histológico del CA representa un raro desafío. El abordaje quirúrgico con ampliación de los márgenes de tejido duro y blando es esencial en la sobrevida del paciente. La descripción de nuevos casos puede revelar, mediante tratamiento y acompañamiento clínico, características que ayuden a comprender mejor el comportamiento del CA.

Abstract: The aim of this study was to evaluate macrophage M1 and M2 subpopulations in radicular cysts (RCs) and periapical granulomas (PGs) and relate them to clinical and morphological aspects. M1 macrophages were evaluated by the percentage of CD68 immunostaining associated with the inflammatory cytokine TNF-α, and M2 macrophages, by its specific CD163 antibody. The CD68+/CD163+ ratio was adopted to distinguish between the two macrophage subpopulations. Clinical, radiographic, symptomatology, treatment, and morphological parameters of lesions were collected and a significance level of p = 0.05 was adopted for statistical analysis. The results showed that the CD68+/CD163+ ratio was higher in the RCs (median = 1.22, p = 0.002), and the highest TNF-α immunostaining scores were found in RCs (p = 0.018); in PGs, the CD68+/CD163+ ratio was lower and associated with a greater CD163+ immunostaining (median = 1.02, p <0.001). The TNF-α in cyst epithelium had a score of 3 in 10 cases and predominance of M1 macrophages by CD68+/CD163+ (median = 2.23). In addition, CD68+ cells had higher percentage of immunostaining in smaller RCs (p = 0.034). Our findings suggest that increased CD68 immunostaining associated with TNF-α cytokine in RCs results in a greater differentiation of the M1 phenotype. The higher CD163 immunostaining in PGs results in greater differentiation of the M2 phenotype. Therefore, the inflammatory state promoted by M1 macrophages is related to growth and progression of RCs; on the other hand, the immunomodulatory state of M2 macrophages is related to maintenance of PGs.

ABSTRACT: Multiple salivary gland tumors represent an unusual event characterized by the development of composite lesions originated from minor or major salivary glands. These neoplasms can be categorized into three perspectives: Histologic type, time of appearance and topographic distribution. We report an unusual case of a 73-year-old black man with an acinic cell carcinoma (ACC) of the oral mucosa discovered incidentally during surgical removal of an adjacent mucocele. Approximately one year after the first consultation, the patient was seen at the local cancer reference center with a third lesion that was diagnosed as an adenoid cystic carcinoma (AdCC) of the upper lip. The patient underwent surgical reconstruction of the treated areas and has been free of the disease for the past year. To our knowledge, the combination of ACC and AdCC in intraoral sites has not been reported in the literature.

RESUMEN: Los tumores de glándulas salivales múltiples representan un evento inusual caracterizado por el desarrollo de lesiones compuestas, originadas en glándulas salivales menores o mayores. Estos neoplasmas se pueden categorizar en tres perspectivas: tipo histológico, tiempo de aparición y distribución topográfica. Reportamos un caso inusual de un hombre negro de 73 años con un carcinoma de célula acínica (ACC) de la mucosa oral descubierta incidentalmente durante la extirpación quirúrgica de un mucocele adyacente. Aproximadamente un año después de la primera consulta, el paciente se presentó en el centro de referencia del cáncer local con una tercera lesión que fue diagnosticada como carcinoma adenoide quístico (AdCC) del labio superior. El paciente se sometió a la reconstrucción quirúrgica de las áreas tratadas y durante el último año no ha presentado recurrencia de la enfermedad. De acuerdo a nuestro conocimiento la combinación de ACC y AdCC en sitios intraorales no se ha informado en la literatura.