RESUMO
BACKGROUND: Paracoccidioidomycosis (PCM) is the leading cause of death among systemic mycoses in Brazil. On the other hand, oral squamous cell carcinoma (OSCC) is the most prevalent malignant neoplasm of the mouth. Both lesions rarely affect the tongue dorsum and may share similar clinical characteristics. This study aimed to retrieve cases of single oral ulcers diagnosed as PCM or OSCC. MATERIAL AND METHODS: A cross-sectional retrospective study was conducted. All patients who had a single ulcer on dorsum of the tongue and confirmed diagnosis of PCM or OSCC were evaluated. RESULTS: A total of 9 patients (5 women and 4 men) were evaluated, 5 patients had OSCCs (mean age = 69,8 years old), and 4 patients PCM (mean age = 51 years old). Most of the lesions were infiltrated and indurated in the palpation exam. Duration ranged from 1 to 12 months (mean time of 5.2 months and 4.7 months for OSCC and PCM, respectively). OSCC was the main clinical diagnosis hypothesis. CONCLUSIONS: Although uncommon, PCM and OSCC should be considered as a diferential diagnosis hypothesis in infiltrated ulcers on the tongue dorsum. Iincisional biopsy is mandatory to confirm the diagnosis and indicate the appropriate treatment.
Assuntos
Carcinoma de Células Escamosas , Paracoccidioidomicose , Neoplasias da Língua , Humanos , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Estudos Transversais , Paracoccidioidomicose/diagnóstico , Idoso , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Neoplasias da Língua/diagnóstico , Úlceras Orais/diagnóstico , Úlceras Orais/microbiologia , Úlceras Orais/etiologia , Doenças da Língua/diagnóstico , Doenças da Língua/microbiologia , Adulto , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: The aim of this study is to relate all the superficial mucoceles found in a cancer center, described the association with oncological conditions, and discuss its etiology and pathology that we found in the past few years. MATERIAL AND METHODS: Sixteen cases of superficial mucocele were retrieved from the patients' records of the Stomatology Department of the A. C. Camargo Cancer Center, São Paulo, Brazil, and demographic and clinical data were collected from electronic medical records. RESULTS: There were 16 patients, 8 patients were men and 8 women, with ages varying from 26 to 70 years old. Superficial mucoceles were observed in patients submitted to head and neck radiotherapy (n=6), graft versus host disease (n=4), one associated with oral mucositis related to allogenic bone marrow stem cells transplantation (n=1), systemic lupus (n=1), Sjögren's syndrome (n=1), oral lichenoid lesion associated with pembrolizumab (n=1) and no local or systemic inflammatory associated found (n=2). CONCLUSIONS: This study reports a series of superficial mucoceles from a single stomatology unit. Most patients had superficial mucoceles secondary to head and neck radiotherapy and graft versus host diseases. However, two patients (12.5%) had mucoceles related to systemic inflammatory conditions (Sjögren's Syndrome and Systemic Lupus).
Assuntos
Doença Enxerto-Hospedeiro , Mucocele , Medicina Bucal , Síndrome de Sjogren , Masculino , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Mucocele/etiologia , Mucocele/patologia , Síndrome de Sjogren/complicações , Estudos Retrospectivos , Brasil/epidemiologia , Doença Enxerto-Hospedeiro/complicaçõesRESUMO
BACKGROUND: The purpose of this study was to compare jaw and cervical vertebrae bone density in computed tomography (CT) analyses of oncological patients undergoing antiresorptive medication with control patients, aiming to find information that may assist the radiologist and clinician in predicting risks and monitoring osteonecrosis in the jaw. MATERIAL AND METHODS: Thirty-one patients treated with zoledronic acid and 37 control were included in the study. Two areas in regions of interest were chosen and standardized, one in the lower portion of the mandible and another in the axial cervical vertebra (C2) of patients undergoing antiresorptive drug treatment (experimental group) and the control group. Density analysis was performed using Hounsfield scale grayscale values obtained from multislice CT exams. Interclass correlation coefficient test (ICC) was performed to assess reproducibility and repeatability. The test of normality of the samples was demonstrated using the Shapiro-Wilk test and the comparison performed using Mann-Whitney U non-parametric test. RESULTS: When compared to patients in the control group, patients undergoing antiresorptive medication depicted an increase in bone density in both jaw bone (p=0.021) and cervical vertebrae (p=0.002). The same pattern could be observed in patients who used the medication on a monthly basis for analysis of jaw bone (p=0.021), the cervical vertebrae (p=0.002), and the cervical vertebrae of the patients who used the medication on a quarterly basis (p=0.003). CONCLUSIONS: CT can be a potentially useful method for detecting alterations associated with antiresorptive therapy, serving as a possible tool in the prediction of the disease progression.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Conservadores da Densidade Óssea , Humanos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/diagnóstico por imagem , Densidade Óssea , Reprodutibilidade dos Testes , Conservadores da Densidade Óssea/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Difosfonatos/uso terapêuticoRESUMO
BACKGROUND: Periodontitis may be associated with the development of head and neck cancer (HNC). A literature review was conducted to understand the possible association between them. MATERIAL AND METHODS: Articles published in the PubMed database from January 1999 and May 2020 were retrieved. Limitations of the studies and biological mechanisms were discussed. RESULTS: A total of 4,232 articles were found. Of these, 13 were analyzed according to inclusion criteria. Most papers found some association between periodontitis and HNC, although differences in periodontal evaluation, sample size, study design and tumor sites were observed. Porphyromonas gingivalis appears to increase the chance of both diseases, and it may be one of their main potential risk factors. Genetic predisposition is increased by exposure to environmental factors which can directly induce epigenetic changes that contribute to these diseases. CONCLUSIONS: Understanding the mechanisms related to periodontitis and HNC has increased, however, well-designed clinical studies are needed for better conclusions. Furthermore, the advent of multiple "omic" technologies will help comprehend their possible association.
Assuntos
Neoplasias de Cabeça e Pescoço , Periodontite , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/etiologia , Humanos , Periodontite/epidemiologia , Porphyromonas gingivalis , Fatores de RiscoAssuntos
Neoplasias Mandibulares/diagnóstico por imagem , Neoplasias Mandibulares/patologia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/patologia , Biomarcadores , Biópsia , Criança , Terapia Combinada , Humanos , Imuno-Histoquímica , Neoplasias Mandibulares/terapia , Radiografia Dentária , Sarcoma de Ewing/terapia , Resultado do TratamentoRESUMO
AIMS: The aim of this study was to compare the clinical and demographic features of 62 patients presenting sporadic odontogenic keratocysts (OKCs) or OKCs associated with nevoid basal cell carcinoma syndrome (NBCCS). In conjunction with this, we also evaluated the immunohistochemical expression of Shh, Ptch1, Ptch2, Smo, Gli1, Gli2 and Gli3 proteins in 86 OKCs. By doing this, we add to the understanding of the biology of this type of lesion, providing tools that will help facilitate the early diagnosis of NBCCS in those patients where the first manifestation is that of OKCs. METHODS: This is a retrospective study; patients were classified into two groups: group 1 which consisted of those who were not affected by NBCCS (49 patients and 57 OKCs) and group 2 which consisted of those who were diagnosed with NBCCS (13 patients and 29 OKCs). The clinical and demographic features were studied and the immunohistochemical expression of Sonic Hedgehog proteins (Shh, Ptch1, Ptch2, Smo, Gli1, Gli2, and Gli3) was analyzed in all samples. RESULTS: There was an increase in the expression of three proteins in the syndromic OKC, when compared to that of sporadic cysts. Shh and Gli1 showed higher cytoplasmic expression, while Smo revealed stronger nuclear and cytoplasmic expressions. CONCLUSION AND CLINICAL RELEVANCE: Our findings suggest that the expression patterns of important Shh pathway proteins can represent valuable markers for early diagnosis of NBCCS-associated OKCs, as the major criterion for the diagnosis of NBCCS is currently based on the late appearance of basal cellular carcinomas. Thus, standardizing a new diagnostic tool for diagnosis of NBCCS could be of great importance in the identification of therapeutic targets. We therefore suggest, as based on our findings, that OKCs showing high expression of Shh, Smo, and Gli1 are potentially associated with NBCCS.
Assuntos
Síndrome do Nevo Basocelular/metabolismo , Proteínas Hedgehog/metabolismo , Neoplasias Maxilomandibulares/metabolismo , Cistos Odontogênicos/metabolismo , Transdução de Sinais/fisiologia , Adolescente , Adulto , Idoso , Biomarcadores Tumorais/metabolismo , Criança , Feminino , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/metabolismo , Proteínas Nucleares/metabolismo , Receptor Patched-1/metabolismo , Receptor Patched-2/metabolismo , Estudos Retrospectivos , Proteína GLI1 em Dedos de Zinco/metabolismo , Proteína Gli2 com Dedos de Zinco/metabolismo , Proteína Gli3 com Dedos de Zinco/metabolismoRESUMO
A total of 115 patients who used everolimus were evaluated. The mean age was 57 (±13.3) years old, and 87 patients were women (75.6%). mTOR inhibitor-associated stomatitis (mIAS) was observed in 36 patients (31.3%). The lesions ranged from 0.5 cm to 1.5 cm, and the tongue was the main site affected. In addition, 21 patients (58.3%) required a dose reduction of everolimus due to mIAS. Patients who had breast cancer presented 2.29-fold higher risk for developing mIAS when compared to patients with kidney or neuroendocrine tumors. This study emphasizes the high prevalence of mIAS in patients using everolimus, in particular, in patients with breast cancer.
Assuntos
Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Everolimo/efeitos adversos , Neoplasias Renais/tratamento farmacológico , Tumores Neuroendócrinos/tratamento farmacológico , Estomatite/induzido quimicamente , Adulto , Idoso , Antineoplásicos/uso terapêutico , Everolimo/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Serina-Treonina Quinases TOR/antagonistas & inibidoresRESUMO
BACKGROUND: The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis. METHODS: Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion. RESULTS: Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC. CONCLUSION: Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.
Assuntos
Hipersensibilidade a Leite/diagnóstico , Testes do Emplastro/métodos , Alérgenos/administração & dosagem , Alérgenos/imunologia , Animais , Bovinos , Pré-Escolar , Feminino , Humanos , Tolerância Imunológica/imunologia , Lactente , Masculino , Proteínas do Leite/administração & dosagem , Proteínas do Leite/imunologia , Sensibilidade e EspecificidadeRESUMO
BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effect of radiotherapy on the osseointegration of dental implants in the tibia and the action of platelet-rich plasma (PRP) as an adjuvant therapy. MATERIAL AND METHODS: A total of 18 rabbits received two implants in each tibial epiphysis, totalizing 72 implants. The control group (group I) was composed by six rabbits and did not receive radiotherapy. The test groups (II and III) received a single dose of 1727 cGy. Group II was composed by six irradiated animals and group III by six animals that received irradiation and PRP during implant placement. The implant success rate, the bone-implant contact (BIC), and the bone volume were analyzed. RESULTS: There was no osseointegration in four of the implants, three in group II and one in group III. Total BIC was significantly higher in group I, when compared to the other groups. There was a significant difference of osteoid BIC only between irradiated animals (group II, 8.5%; group III, 4.7%; p = 0.001). On the other hand, the mineralized BIC was significantly higher in group I. Furthermore, group II had a lower mineralized BIC than group III (p = 0.002). Bone volume was higher in the control group (41.3%), followed by group III (33.4%) and II (25.1%), with differences between groups I and II (p = 0.001) and groups II and III (p = 0.022). CONCLUSIONS: The present study showed that both the bone volume and BIC were higher in the control group. However, the failure rates of the implants were low in both irradiated groups. The PRP was a positive adjuvant in the osseointegration process.
Assuntos
Implantes Dentários , Osseointegração/efeitos da radiação , Tíbia/efeitos da radiação , Animais , Implantação Dentária Endóssea/métodos , Falha de Restauração Dentária , Masculino , Coelhos , Tíbia/cirurgia , TitânioRESUMO
OBJECTIVE: This study evaluated oral mucosal lesions in liver-transplanted children. METHODS: A retrospective study was performed on pediatric patients who underwent liver transplantation between 2002 and 2009, at A.C. Camargo Hospital, Sao Paulo-SP. Alterations, such as polypoid lesions over the dorsum of the tongue, lip swelling, angular cheilitis, fissures of the lips, mucosal tags, cobblestone appearance, and fissures of the tongue, were considered as orofacial granulomatosis (OFG)-like lesions. All clinical data were collected from medical records. Descriptive analyses and logistic regression were used to characterize and identify OFG-like lesion predictors. RESULTS: Of the 265 transplanted children, 56.6% were female, and 64.1% had biliary atresia. Fourteen patients died as a consequence of the transplantation surgery and were therefore excluded from the analysis related to oral lesions. Hence, among 251 patients, 64 showed OFG-like lesions. The lesions occurred around 26 months after transplantation, and the only therapy that all the patients were receiving in common was tacrolimus. Furthermore, patients aged 12 months old or less at transplantation presented higher risk to present oral lesions. CONCLUSIONS: This study described specific oral mucosal lesions in liver-transplanted children. Such lesions have recently been described as a novel entity. Although young age at transplantation has been associated to its development, the etiology of this condition is uncertain.