Resumo Objetivos: O objetivo deste trabalho foi analisar a prevalência das lesões de cavidade oral e estruturas anexas, em pacientes pediátricos em dois centros de referência. Métodos: Foi realizado um estudo transversal, descritivo, observacional, retrospectivo em que foram pesquisados arquivos em dois centros de referência. Foram coletadas as variáveis: sexo, idade, localização da lesão, tempo de evolução, hipótese diagnóstica, diagnóstico definitivo e recidiva. A análise descritiva foi realizada por meio de médias e proporções. Também foi avaliada a associação das variáveis do estudo com as categorias diagnósticas e faixa etária, tendo sido considerados significativos valores de p<0,05. Resultados: A distribuição entre os sexos foi semelhante. A idade variou de 3 meses a 18,9 anos (média 11,8 anos), a faixa etária mais acometida foi 13 a 18 anos, 12 recidivas foram achadas. As lesões mais prevalentes foram mucocele, cisto dentígero e odontoma. Conclusões: O conhecimento das lesões orais mais frequentes em pacientes pediátricos contribui para o diagnóstico precoce e manejo adequado de cada caso.

Abstract Objectives: This study aimed to analyze the prevalence of diseases of the oral cavity and adjacent structures in pediatric patients at two reference centers. Methods: A retrospective, transversal, observational, descriptive study was conducted. Files from two referral centers were searched for pediatric oral lesions. The following data were collected: sex, age, location of the lesion, evolution time, diagnostic hypothesis, definitive diagnosis, and recurrence. Descriptive analysis was performed using means and proportions. The association of study variables with diagnostic categories and age groups was investigated, with p values <0.05 considered significant. Results: The sex distribution was similar. Patients were aged 3 months to 18.9 years (mean 11.8 years old), and the most affected age group was 13 to 18 years. Only 12 lesions recurred. The most prevalent lesions from the three most common categories were mucocele, dentigerous cyst, and odontoma. Conclusions: If dentists can diagnose and treat the most common lesions found in children and adolescents, they can probably manage correctly more than half of the cases involving pediatric patients.

RESUMO Objetivo Verificar a prevalência das anomalias dentárias de número, posição e forma, além da presença de alterações ósseas, por meio de radiografias panorâmicas. Métodos Levantamento das anomalias dentárias e alterações ósseas em crianças de 6 a 12 anos, com radiografia panorâmica registrada no Banco de Imagens Radiográficas da Universidade Federal do Espírito Santo nos anos de 2012 a 2016. Foram registradas informações clínico-demográficas referentes aos pacientes atendidos. As fichas clínicas foram recuperadas para obtenção da história médica de síndromes ou outras doenças que interfiram nas anomalias e alterações. Foram realizados os testes estatísticos qui-quadrado ou exato de Fischer. Resultados Foram encontradas 83 radiografias panorâmicas que mostravam algum tipo de alteração em 301 analisadas. Foram descritas 169 anomalias ou alterações (média de 2,04±1,38 anomalias/paciente), envolvendo 201 dentes. A anomalia mais prevalente foi a impactação (26,63%) que afetou mais os caninos, seguida da hipodontia (24,26%) que ocorreu mais em segundos pré-molares, em ambas o sexo feminino foi mais acometido. A hiperdontia e as lesões radiolúcidas tiveram a mesma prevalência (18,93%), os dentes mais acometidos foram da região ântero-superior e os primeiros molares inferiores, respectivamente. As menos prevalentes foram dilaceração (7,69%), taurodontia (2,37%) e lesões radiopacas (1,18%). As anomalias ósseas estavam significativamente mais em mandíbula e na região posterior, o que confirma a prevalência em molares inferiores. Conclusão Não houve diferença estatisticamente significativa em relação ao gênero. Mas houve alta prevalência de anomalias e alterações na população estudada, o que denota a importância do diagnóstico por meio desse importante exame complementar.

ABSTRACT Objective To verify the prevalence of dental anomalies in terms of number, position and shape, and the presence of bone alterations, through analysis of panoramic radiographs. Methods This study evaluated dental anomalies and bone alterations in children aged 6 to 12 years-old, detected on panoramic radiographies recorded in the radiographic database of the Federal University of Espírito Santo between 2012 and 2016. Clinical and demographic information were registered. Dental records were retrieved to obtain the medical history involving syndromes or other diseases that may interfere with the anomalies and alterations. Chi-square and exact Fischer’s statistical tests were performed. Results There were alterations in 83 out of 301 panoramic radiographs analyzed. There were 169 anomalies or alterations (mean of 2,04±1,38 anomalies/patient), involving 201 teeth. The most prevalent anomaly was tooth impaction (26.63%), which affected the canines more frequently, followed by hypodontia (24.26%), more often found in the second premolar, and both affected mostly females. Hyperdontia and radiolucent lesions showed the same prevalence (18.93%), the most affected teeth were those of the anterosuperior region and the first mandibular molars, respectively. The least prevalent anomalies were dilaceration (7.69%), taurodontism (2.37%) and radiopaque lesions (1.18%). Bone alterations were significantly more found in mandible and in the posterior region, which confirms the prevalence in the lower molars. Conclusion Although there was no statistically significant difference regarding sex, there was a high prevalence of anomalies and alterations in our study population, which indicates the importance of its diagnosis by means of a panoramic x-ray examination.

Abstract Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. Objective: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). Methodology: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). Results: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. Conclusion: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

ABSTRACT Objective This study aimed to evaluate apoptosis by assessing cleaved caspase-3 immunoexpression in hyperplastic, potentially malignant disorder (PMD), and malignant tumors in intraoral and lower lip sites. Material and Methods A retrospective study using paraffin blocks with tissues from patients with inflammatory fibrous hyperplasia (IFH), actinic cheilitis, oral leukoplakia, lower lip and intraoral squamous cell carcinoma (SCC) was performed. The tissues were evaluated by immunohistochemical analysis with anti-cleaved caspase-3 antibody. Apoptotic area index was then correlated with lesion type. Results From 120 lesions assessed, 55 (46%) were cleaved caspase-3-positive. The SCC samples (n=40) had the highest apoptotic area indices (n=35; 87.5%). Significant differences were detected between SCCs and PMDs (p=0.0003), as well as SCCs and IFHs (p=0.001), regarding caspase-3 immunopositivity. Carcinomas of the lower lip had lower apoptotic area indices than intraoral cancer (p=0.0015). Conclusions Cleaved caspase-3 immunoexpression showed differences in oral SCCs and PMDs and demonstrated a distinct role of apoptosis in carcinogenesis of intraoral and lower lip cancer. In future, the expression of cleaved caspase-3 with other target molecules in oral cancer may be helpful in delineating the prognosis and treatment of these tumors.

Introdução:O gene TP53 (proteína tumoral p53) é alvo constante de investigação na patogênese do câncer. A imuno-histoquímica fornece dados limitados na análise de p53 no processo da carcinogênese bucal e o sequenciamento de TP53 pode contribuir nessa investigação. Contudo, a obtenção de ácido desoxirribonucleico (DNA) com qualidade para amplificação e livre de contaminação pode constituir uma tarefa difícil na utilização de material parafinado.Objetivo:Padronizar as técnicas de extração de DNA, amplificação por reação em cadeia da polimerase (PCR) e sequenciamento para a análise de mutações em TP53.Material e métodos:Foram selecionados 39 casos de carcinomas de células escamosas bucal da Divisão de Patologia do Instituto Nacional de Câncer (Inca). O DNA foi extraído utilizando o sistema comercial QIAamp® DNA minikit®. Após quantificação do DNA por espectrofotometria, 250 ng de amostra foram amplificados pela técnica de PCR para o éxon 2 e por nested PCR para o éxon 6 do gene TP53. Da amostra total, 11 casos foram selecionados para a padronização da reação de sequenciamento do éxon 2.Resultados:As amostras de DNA apresentaram concentração média de 119,74 ng/µl ± 88,86 (28,9-556,4 ng/µl) e pureza de 1,69 ± 0,18 (1-1,9). Do total das amostras analisadas, 33 (84,6%) foram amplificadas para o éxon 2, e todas (39/100%), para o éxon 6. No sequenciamento do éxon 2 obtiveram-se sequências passíveis de leitura em 10 (90,9%) casos.Conclusão:A otimização das condições para o sequenciamento de TP53 foi obtida, o que facilitará a análise de mutações em tecidos parafinados, permitindo a realização de estudos moleculares retrospectivos.

Introduction:The tumor protein p53 gene (TP53) is a constant target of investigation in cancer pathogenesis. Analysis by immunohistochemistry provides limited data about p53 in oral carcinogenesis, and TP53sequencing can contribute to this analysis. However, obtaining high-quality and contamination-free deoxyribonucleic acid (DNA) for a proper amplification can be a difficult task when using paraffin-embedded tissues.Objective:Standardize DNA extraction, polymerase chain reaction (PCR) amplification and DNA sequencing techniques for TP53 mutation analysis.Material and methods:Thirty-nine cases of oral squamous cell carcinoma (OSCC) were selected from the Pathology Division of Instituto Nacional de Câncer (Inca). The DNA extraction method used was the QIAamp® DNA minikit® system. After DNA quantification by spectrophotometry, 250 ng of genetic material obtained from TP53 gene were amplified by PCR for exon 2 and by nested PCR for exon 6. Out of the total sample, 11 cases were selected for exon 2 sequencing. Results: The DNA samples presented mean concentration of 119.74 ± 88.86 ng/µl (28.9-556.4) and purity of 1.69 ± 0.18 (1-1.9). Thirty-three (84.6%) samples were amplified for exon 2, and all samples for exon 6 (39/100%). Readable sequencing data were obtained in 10 (90.9%) cases.Conclusion:Optimization of conditions for TP53 sequencing was obtained, and this will facilitate the analysis of mutations in paraffin-embedded tissues, allowing molecular retrospective studies.

O carcinoma de células escamosas de boca compreende cerca de 90 a 95% de todas as neoplasias malignas da boca e é um dos tipos de câncer mais frequentes no Brasil. O índice de sobrevida em 5 anos é baixo e permaneceu estável nas últimas décadas, apesar dos avanços nas terapias. O objetivo deste estudo foi analisar o perfil e a sobrevida global dos pacientes diagnosticados com carcinoma de células escamosas de boca no ano de 1999 no Instituto Nacional de Câncer. Dos 320 pacientes incluídos no estudo, 79,4% eram homens. A idade média foi de 56,7 anos, e 82,2% deles fumavam e/ou bebiam. A língua, seguida do assoalho de boca foram os locais mais acometidos. A maioria (68,9%) dos pacientes foi diagnosticada em estádios tardios e submetida à radioterapia exclusiva (53,6%). A sobrevida média no período do estudo foi de 29,4 meses. Os pacientes dos estádios iniciais apresentaram maior sobrevida, assim como aqueles submetidos apenas à cirurgia como forma de tratamento e os que não apresentaram linfonodos acometidos ao diagnóstico. Tumores localizados em palato duro e mucosa jugal apresentaram pior prognóstico. Foram fatores preditivos independentes de melhor sobrevida os tumores T1 ou T2 (p=0,001), sem acometimento de linfonodos (p=0,012) e não localizados em mucosa jugal (p=0,021). O diagnóstico do câncer oral ainda se faz em estádios tardios, o que influencia negativamente a sobrevida global dos pacientes. Maior ênfase deve ser dada à capacitação dos profissionais para o reconhecimento precoce do câncer e à conscientização da população de risco.

Oral squamous cell carcinoma accounts for 90 to 95% of all malignant neoplasms of the mouth and it is one of most common cancers in Brazil. Five-year survival rates remain low and have not improved over the past decades, despite advances in therapy. The purpose of this study was to analyze the features and overall survival of patients diagnosed with oral squamous cell carcinoma in 1999 at the National Institute of Cancer. Male patients (79.4%) with a medium age of 56.7 years, with smoking or drinking habits (82.2%) comprised most of the sample. Tongue and floor of the mouth were the most prevalent sites of occurrence. Patients were diagnosed mainly at advanced stages of the disease (68.9% stages III and IV) and were treated with radiation therapy alone (53.6 %). Mean survival was 29.4 months, and patients diagnosed in early stages had better survival rates, as well as those who were surgically treated and those who did not show cervical node metastasis at diagnosis. Tumors located in the palate or in the buccal mucosa presented the worst prognosis. Cox regression analysis showed that T1 or T2 lesions (p=0.001), with no neck metastasis (p=0.012) and anatomic site other than buccal mucosa (p=0.021) were independent predictive factors of a better survival rate. Oral cancer diagnosis still occurs in advanced stages, and it negatively influences overall survival, so there should be efforts to prepare and train professionals to recognize lesions at early stages and to make the population at greatest risk aware of the disease.

O carcinoma de células escamosas de boca compreende cerca de 90 a 95% de todas as neoplasias malignas da boca e é um dos tipos de câncer mais frequentes no Brasil. O índice de sobrevida em 5 anos é baixo e permaneceu estável nas últimas décadas, apesar dos avanços nas terapias. O objetivo deste estudo foi analisar o perfil e a sobrevida global dos pacientes diagnosticados com carcinoma de células escamosas de boca no ano de 1999 no Instituto Nacional de Câncer. Dos 320 pacientes incluídos no estudo, 79,4% eram homens. A idade média foi de 56,7 anos, e 82,2% deles fumavam e/ou bebiam. A língua, seguida do assoalho de boca foram os locais mais acometidos. A maioria (68,9%) dos pacientes foi diagnosticada em estádios tardios e submetida à radioterapia exclusiva (53,6%). A sobrevida média no período do estudo foi de 29,4 meses. Os pacientes dos estádios iniciais apresentaram maior sobrevida, assim como aqueles submetidos apenas à cirurgia como forma de tratamento e os que não apresentaram linfonodos acometidos ao diagnóstico. Tumores localizados em palato duro e mucosa jugal apresentaram pior prognóstico. Foram fatores preditivos independentes de melhor sobrevida os tumores T1 ou T2 (p=0,001), sem acometimento de linfonodos (p=0,012) e não localizados em mucosa jugal (p=0,021). O diagnóstico do câncer oral ainda se faz em estádios tardios, o que influencia negativamente a sobrevida global dos pacientes. Maior ênfase deve ser dada à capacitação dos profissionais para o reconhecimento precoce do câncer e à conscientização da população de risco.

Oral squamous cell carcinoma accounts for 90 to 95% of all malignant neoplasms of the mouth and it is one of most common cancers in Brazil. Five-year survival rates remain low and have not improved over the past decades, despite advances in therapy. The purpose of this study was to analyze the features and overall survival of patients diagnosed with oral squamous cell carcinoma in 1999 at the National Institute of Cancer. Male patients (79.4%) with a medium age of 56.7 years, with smoking or drinking habits (82.2%) comprised most of the sample. Tongue and floor of the mouth were the most prevalent sites of occurrence. Patients were diagnosed mainly at advanced stages of the disease (68.9% stages III and IV) and were treated with radiation therapy alone (53.6 %). Mean survival was 29.4 months, and patients diagnosed in early stages had better survival rates, as well as those who were surgically treated and those who did not show cervical node metastasis at diagnosis. Tumors located in the palate or in the buccal mucosa presented the worst prognosis. Cox regression analysis showed that T1 or T2 lesions (p=0.001), with no neck metastasis (p=0.012) and anatomic site other than buccal mucosa (p=0.021) were independent predictive factors of a better survival rate. Oral cancer diagnosis still occurs in advanced stages, and it negatively influences overall survival, so there should be efforts to prepare and train professionals to recognize lesions at early stages and to make the population at greatest risk aware of the disease.