Publications by authors named "Jorge Esquiche León"

93 Publications

The role of CD68+ and CD163+ macrophages in immunopathogenesis of oral lichen planus and oral lichenoid lesions.

Immunobiology 2021 Feb 23;226(3):152072. Epub 2021 Feb 23.

Oral Medicine, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara, São Paulo, Brazil.

Macrophages are phagocytic cells with essential participation in immunological events of the oral cavity. However, the role of these cells in oral lichen planus (OLP) and oral lichenoid lesions (OLL) remains unclear. The present study aimed to evaluate the density of macrophages in OLP and OLL, and to compare it with that of oral inflammatory fibrous hyperplasia (OIFH) (control group). 14 cases of OLP, 14 cases of OLL and 14 cases of OIFH were selected for immunohistochemical analysis of CD68 (M1) and CD163 (M2) macrophage expression. CD68 and CD163 macrophages densities were measured in the intraepithelial and subepithelial areas. The statistical tests used were multivariate analysis of variance, as well as a correlation and linear regression. OLP has more CD68+ macrophages when comparing with OLL (p = 0.001) and OIFH (p = 0.045). There is a very strong relationship between the macrophages types (p < 0.0001) in OLP and OLL. The linear regression showed that to OLL development (p < 0.0001/R = 0.9584), the presence of different types of macrophages are more essential than to OLP (p < 0.0001/R = 0.8983). However, in the OLP these dependencies are also largely. CD68 macrophages may be associated with immunopathogenesis of OLP, indicating a pro-inflammatory activity and regulatory role in the type of T-cell response. Besides, CD68 macrophages can cooperate in the diagnosis of OLP. These results are essential to future studies that seek a therapeutic target for OLP and OLL.
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http://dx.doi.org/10.1016/j.imbio.2021.152072DOI Listing
February 2021

Estrogen deficiency affects tooth formation and gene expression in the odontogenic region of female rats.

Ann Anat 2021 Jul 16;236:151702. Epub 2021 Feb 16.

Department of Orthodontics, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Electronic address:

Background: There is some evidence that estrogen regulates the expression of several genes in different cells, including dental cells. Therefore, the aim of this study was to investigate the role of estrogen deficiency during tooth development regarding tooth structure morphology and its impact on the expression of odontogenesis-related genes.

Methods: A total of 40 female Wistar rats was divided into OVX (estrogen deficiency) and Sham (control) groups. Bilateral ovariectomy was performed in the OVX group, while Sham surgery was performed in the control group at the age of 21 days. At an age of 56 days, 16 rats were euthanized for gene expression analyses of Bmp4, Smad6, Tgfb1 and Runx2. At the age of 63 days, the remaining rats were euthanized for histological and morphometric analyses of teeth. The mandibles of the rats were submitted to μCT analysis. Tooth structures (enamel, dentin and dental pulp) were analyzed. T test was used to compare the mean differences between groups (p<0.05).

Results: In the μCT analysis, enamel and dentin thickness were significantly increased in the control group (p<0.0001). Pulp dimensions were significantly larger in the OVX group (p<0.0001). A reduction of tooth structures in the OVX group was confirmed in HE staining. Smad6 was differentially expressed in the OVX group (p=0.04).

Conclusion: Estrogen deficiency affects gene expression in the odontogenic region and tooth structure morphology.
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http://dx.doi.org/10.1016/j.aanat.2021.151702DOI Listing
July 2021

Fat-free pleomorphic lipoma of the buccal mucosa: An immunohistochemical study and literature review.

Oral Oncol 2021 Feb 15:105215. Epub 2021 Feb 15.

Laboratory of Morphology and Experimental Pathology, Institute of Technology and Research, Tiradentes University (UNIT), Aracaju, SE, Brazil.

Pleomorphic lipomas are extremely rare in the oral cavity. Due to the significant overlap of morphological findings with several benign and malignant soft tissue tumors, especially in the absence of adipocytes, the diagnosis is challenging. We reported the clinicopathological and immunohistochemical features of an uncommon case of a fat-free variant of pleomorphic lipoma in a 48-year-old female presenting clinically as a painless nodule on the buccal mucosa. Microscopically, the lesion showed atypical spindle cells, numerous floret-like giant multinucleated cells, and abundant ropey collagen fibers bundles. Immunohistochemistry showed strong positivity for vimentin and CD34. Mast cell tryptase highlighted numerous mast cells distributed throughout all tumor stroma. S-100 protein, pan-cytokeratin, desmin, α-SMA, EMA, CD68, STAT6, Bcl-2, MDM2, and CDK4 were negative. Conservative surgical excision was carried out, and no recurrence was observed after 13 months of follow-up. Careful histopathological and immunohistochemistry analysis of these lesions is recommended to ensure the correct diagnosis and provide adequate management through a conservative surgical approach. To the best of our knowledge, this is the second case of fat-free pleomorphic lipoma in the oral cavity.
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http://dx.doi.org/10.1016/j.oraloncology.2021.105215DOI Listing
February 2021

Microscopical Diagnosis of Oral Leishmaniasis: Kinetoplast.

Head Neck Pathol 2021 Feb 18. Epub 2021 Feb 18.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, SP, Brazil.

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http://dx.doi.org/10.1007/s12105-021-01304-wDOI Listing
February 2021

Immunohistochemical evaluation of Langerhans cells in oral lichen planus and oral lichenoid lesions.

Arch Oral Biol 2021 Apr 8;124:105027. Epub 2020 Dec 8.

Oral Medicine, Department of Diagnosis and Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara, São Paulo, Brazil. Electronic address:

Objective: the aim of this study was to evaluate the density of Langerhans cells in oral lichen planus (OLP) and oral lichenoid lesions (OLL).

Design: 14 cases of OLP, 15 cases of OLL and 14 cases of oral inflammatory fibrous hyperplasia (OIFH), were selected for immunohistochemical analysis of CD1a, CD207 and S100 expression. The OIFH group was subdivided according to the presence (OIFHL n = 14) or absence (OIFHNL n = 14) of lichenoid inflammatory infiltrate. Positive cells were counted in intraepithelial and subepithelial areas. Results were analyzed by multivariate comparative analysis, correlation analysis, linear regression models and Student's T-test.

Results: A significantly higher amount of CD207+ cells in OLL vs OLP was observed (p = 0.015). The prevailing reticular pattern observed was CD207 for OLP (p = 0.0329). A statistically significant difference in the expression of CD1a and CD207 was observed for intraepithelial vs subepithelial areas (p = 0.024 and p=0.015, for CD1a and CD207, respectively). Significant correlations were also observed between the expression of CD1a + and CD207+ cells in the pathogenesis of OLP and OLL.

Conclusion: High levels of CD207+cells in OLP compared with OLL may help explain the differences in the immunopathogenesis of both diseases. Additionally, CD1a + and CD207+ cells appear to be more essential to immunopathogenesis of OLL than to the pathogenesis of OLP.
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http://dx.doi.org/10.1016/j.archoralbio.2020.105027DOI Listing
April 2021

Post-traumatic lip lesion mimicking rhabdomyomatous mesenchymal hamartoma in a pediatric patient.

Dermatol Online J 2020 Nov 15;26(11). Epub 2020 Nov 15.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, School of Dentistry of Ribeirão Preto (FORP/USP), University of São Paulo, Ribeirão Preto, Sao Paulo.

We report a 7-year-old boy who presented with a nodule on the upper lip. A previous clinical history of mechanical trauma in the lesional area had been noted. After surgical excision, microscopy revealed fibrocollagenous fascicles associated with neurovascular bundles and skeletal striated muscle fibers in diffuse subepithelial distribution, suggesting rhabdomyomatous mesenchymal hamartoma. However, strict clinicopathological correlation favored a healing process with trapped striated skeletal muscle tissue. After three years of follow-up, an improvement in the aesthetic appearance of the upper lip was observed. To the best of our knowledge, a case of pseudo-rhabdomyomatous mesenchymal hamartoma has not been reported to date.
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November 2020

Juvenile Spongiotic Gingival Hyperplasia: Clinicopathological Features of Eight Cases and a Literature Review.

Oral Health Prev Dent 2020 10 27;18(1):953-958. Epub 2020 Oct 27.

Background: Juvenile spongiotic gingival hyperplasia (JSGH) is a benign proliferation of non-keratinised stratified squamous epithelium with evident spongiosis, exocytosis leukocytes and dilated vessels with varying numbers of inflammatory cells. Although uncertain, it has been suggested that the epithelial proliferation is probably related to trauma and local irritants. It emerges as a painless erythematous patch or papule with an irregular surface.

Case Reports: We present a series of eight cases and a literature review of the clinical presentation and treatment approaches for JSGH. This series includes four females and four males with a mean age of 11.6 years, all complaining of injury to the gums. All lesions were painless and not bleeding. One patient associated the lesion with the onset of trauma and another with a previous history of an eruption cyst. Periapical radiographs of the adjacent area did not show any alteration of bone or teeth. Based on these findings, the diagnostic hypotheses were a non-neoplastic proliferative process or a factitious injury. Incisional biopsy was performed and histopathologic diagnosis was conclusive for JSGH. Surgical excision was conducted in three cases, and the other five cases were supported by clinical observation and plaque control in order to prevent gingival recession defects. After a follow-up period of 11 months (mean), no recurrence was observed for surgically treated cases and mild improvement was achieved with periodontal treatment.

Conclusion: This case series illustrates the importance of diagnosis and follow-up of patients with JSGH. A conservative approach consisting of basic periodontal support instead of surgical excision may be indicated because of the risk of aesthetic defects at the involved areas.
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http://dx.doi.org/10.3290/j.ohpd.a45435DOI Listing
October 2020

Nodular lesion on the posterior dorsal surface of the tongue.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 May 27;131(5):e145-e150. Epub 2020 Aug 27.

Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, São Paulo State University (UNESP), Araraquara, Brazil. Electronic address:

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http://dx.doi.org/10.1016/j.oooo.2020.08.023DOI Listing
May 2021

Intraoral atypical lentiginous melanocytic lesion in a pediatric patient.

Oral Oncol 2021 01 25;112:105017. Epub 2020 Sep 25.

Department of Morphology and Children's Clinic, São Paulo State University (Unesp), School of Dentistry, Araraquara, São Paulo, Brazil.

We present a rare case of intraoral atypical lentiginous melanocytic lesion affecting a pediatric patient, in which the diagnosis of lentiginous junctional melanocytic nevus with cytologic atypia was favored. The main differential diagnosis is lentiginous melanoma, which is a slowly progressing lesion, affecting mainly older adults, and microscopically presenting lentiginous growth pattern of moderately atypical melanocytes, with focal nesting and pagetoid spread. It is strongly recommended that melanocytic lesions showing features of atypical lentiginous growth pattern should be treated with wide excision; however, the impact of these guidelines on pediatric patients needs to be better defined with the report of further cases.
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http://dx.doi.org/10.1016/j.oraloncology.2020.105017DOI Listing
January 2021

Primary intraosseous CD9-positive B-cell lymphoblastic lymphoma of the maxilla affecting a pediatric patient: Immunohistochemical and in situ hybridization analysis.

Oral Oncol 2020 09 6;108:104910. Epub 2020 Aug 6.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Electronic address:

Lymphoblastic lymphoma (LBL) is a clinically aggressive disease, representing approximately 2% of all non-Hodgkin lymphoma cases. In the oral and maxillofacial (OMF) region, approximately 39 cases, diagnosed as LBL, acute lymphoblastic leukemia (ALL) or ALL/LBL, have been reported to date. Noteworthy, the CD9 expression, which indicates a poor outcome in ALL, has not been reported in LBL and lymphoblastic neoplasms of the OMF region. Herein, we report an additional maxillary intraosseous B-cell LBL, affecting a 14-year-old girl, which also showed positivity for CD9, Bcl-6 and MUM1/IRF4. Aiming at diagnostic and prognostic criteria, further studies focusing CD9 expression in LBL is recommended.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104910DOI Listing
September 2020

Immunohistochemical characterization of immune cell infiltration in paediatric and adult Langerhans cell histiocytosis.

Scand J Immunol 2020 Dec 17;92(6):e12950. Epub 2020 Aug 17.

Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), Ribeirão Preto, Brazil.

Langerhans cell histiocytosis (LCH) is an inflammatory myeloid neoplasia commonly affecting children with frequent somatic mutations in MAPK pathway genes including BRAF and MAP2K1. Some studies suggest that LCH cells can recruit and modulate inflammatory cells, which could provide reciprocal survival signals. To characterize the immune profile of infiltrating inflammatory cells, and to clarify their participation in LCH pathogenesis, a detailed immunohistochemical analysis was performed. Fifteen (10 children, 5 adults) LCH cases were assessed through macrophage (CD68 and CD163), mature dendritic cell (mDC; CD83 and CD208), regulatory T cell (Treg; CD4, CD25 and FOXP3) and cytotoxic lymphocyte (CL; CD56, CD57, perforin and granzyme B) immunomarkers. Moreover, lymphocytic and LCH markers were also analysed. All cases were S100, CD1a, CD207 and CD4-positive. Bcl-2 and cyclin D1 expression was observed in 13 of 15 cases. In the immune microenvironment, M2-polarized macrophages and Tregs were the predominant cell populations, followed by significantly (P < .005) smaller levels of mDCs and CLs. Additionally, the number of CD3 + cells was significantly higher than that of CD20 + cells. In the CD3 + cell population, there were a significantly higher number of CD4 + cells than CD8 + cells. While there were no differences when comparing the paediatric and adult populations, FOXP3 + cells were significantly higher in patients with multisystem involvement and treated with chemotherapy, than single-site cases and those without chemotherapy. Our results suggest that M2-polarized macrophages and Treg infiltration can promote LCH development and survival, probably through pro-tumoral, immunosuppressive and/or cytokine-mediated mechanisms. This work highlights the need for further exploration of immune-targeted therapy for LCH.
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http://dx.doi.org/10.1111/sji.12950DOI Listing
December 2020

Unilateral enlargement of the lateral lingual tonsil: An immunohistochemical study and literature review.

Oral Oncol 2020 Jun 23;109:104857. Epub 2020 Jun 23.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address:

Besides the Waldeyer's ring, other lymphoid aggregates can also be detected in the soft palate, floor of the mouth and ventral tongue. The lingual tonsil is located at the base of the tongue and related to circumvallate papillae, whereas subepithelial lymphoid tissue at the posterior lateral portion of the tongue and related to foliate papillae constitutes the lateral lingual tonsil. Unilateral tonsillar enlargement is critical, because it can suggest malignancy, notably non-Hodgkin lymphoma or squamous cell carcinoma. Herein, we report an unusual presentation of unilateral enlargement of the lateral lingual tonsil, diagnosed as follicular lymphoid hyperplasia.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104857DOI Listing
June 2020

Gingival ossifying myopericytoma in a pediatric patient: Immunohistochemical analysis and literature review.

Oral Oncol 2020 08 4;107:104826. Epub 2020 Jun 4.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Avenida do Café S/N, 14040-904 Ribeirão Preto, SP, Brazil.

Myopericytoma is a rare mesenchymal tumor characterized by a hemangiopericytoma-like vascular pattern with perivascular myoid differentiation. To date, only 11 cases of oral myopericytoma have been reported. To the best of our knowledge, myopericytoma with gingival involvement and associated with calcifications has not been reported, expanding their clinicopathological spectrum. Herein, we report a 12-year-old girl female patient who presented a gingival nodule diagnosed as ossifying myopericytoma, which should be considered in the differential diagnosis when assessing oral soft tissue lesions, especially in pediatric patients.
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http://dx.doi.org/10.1016/j.oraloncology.2020.104826DOI Listing
August 2020

Activin A triggers angiogenesis via regulation of VEGFA and its overexpression is associated with poor prognosis of oral squamous cell carcinoma.

Int J Oncol 2020 Jul 4;57(1):364-376. Epub 2020 May 4.

Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba, SP 13414‑018, Brazil.

Poor prognosis associated with the dysregulated expression of activin A in a number of malignancies has been related to with numerous aspects of tumorigenesis, including angiogenesis. The present study investigated the prognostic significance of activin A immunoexpression in blood vessels and cancer cells in a number of oral squamous cell carcinoma (OSCC) cases and applied in vitro strategies to determine the impact of activin A on angiogenesis. In a cohort of 95 patients with OSCC, immunoexpression of activin A in both blood vessels and tumor cells was quantified and the association with clinicopathological parameters and survival was analyzed. Effects of activin A on the tube formation, proliferation and migration of human umbilical vein endothelial cells (HUVECs) were evaluated in gain‑of‑function (treatment with recombinant activin A) or loss‑of‑function [treatment with activin A‑antagonist follistatin or by stable transfection with short hairpin RNA (shRNA) targeting activin A] conditions. Conditioned medium from an OSCC cell line with shRNA‑mediated depletion of activin A was also tested. The profile of pro‑ and anti‑angiogenic factors regulated by activin A was assessed with a human angiogenesis quantitative PCR (qPCR) array. Vascular endothelial growth factor A (VEGFA) and its major isoforms were evaluated by reverse transcription‑qPCR and ELISA. Activin A expression in blood vessels demonstrated an independent prognostic value in the multivariate analysis with a hazard ratio of 2.47 [95% confidence interval (CI), 1.30‑4.71; P=0.006) for disease‑specific survival and 2.09 (95% CI, 1.07‑4.08l: P=0.03) for disease‑free survival. Activin A significantly increased tubular formation of HUVECs concomitantly with an increase in proliferation. This effect was validated by reduced proliferation and tubular formation of HUVECs following inhibition of activin A by follistatin or shRNA, as well as by treatment of HUVECs with conditioned medium from activin A‑depleted OSCC cells. Activin A‑knockdown increased the migration of HUVECs. In addition, activin A stimulated the phosphorylation of SMAD2/3 and the expression and production of total VEGFA, significantly enhancing the expression of its pro‑angiogenic isoform 121. The present findings suggest that activin A is a predictor of the prognosis of patients with OSCC, and provide evidence that activin A, in an autocrine and paracrine manner, may contribute to OSCC angiogenesis through differential expression of the isoform 121 of VEGFA.
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http://dx.doi.org/10.3892/ijo.2020.5058DOI Listing
July 2020

Oral hairy leukoplakia in a child using a corticosteroid nasal spray.

Pediatr Dermatol 2020 Jul 5;37(4):721-723. Epub 2020 May 5.

Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, São Paulo State University (Unesp), São José dos Campos, Brazil.

We report a case of atypical oral hairy leukoplakia (OHL) in a 9-year-old immunocompetent girl treated with fluticasone propionate nasal spray for allergic rhinitis. The OHL in childhood is uncommon and should be included in a differential diagnosis of white lesions in the oral mucosa.
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http://dx.doi.org/10.1111/pde.14194DOI Listing
July 2020

Effect of ovariectomy on maxilla and mandible dimensions of female rats.

Orthod Craniofac Res 2020 Aug 12;23(3):342-350. Epub 2020 Apr 12.

Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.

Objective: The role of oestrogen in craniofacial growth still remains unclear. Therefore, the present study aimed to assess the effect of oestrogen deficiency on maxilla and mandible dimensions.

Setting And Sample Population: The study was conducted at the Department of Pediatric Dentistry at the School of Dentistry of Ribeirão Preto, University of São Paulo, and used forty female Wistar rats.

Material And Methods: Ovariectomy (OVX) and placebo surgery (Sham) were performed when animals were twenty-one days old (prepubertal stage). Dimensions of the maxilla and mandible were assessed by craniometric analysis using radiographs, during and after puberty of the animals (45 and 63 days old, respectively). Quantitative real-time PCR and immunohistochemical analyses were performed to determine the expression and localization, respectively, of oestrogen receptor alpha (ERα) and oestrogen receptor beta (ERβ) in different growth sites of the evaluated structures at puberty. The differences between the groups for each outcome were evaluated using the t test with an established alpha error of 5%.

Results: There were significant differences between the OVX and Sham groups for horizontal and vertical linear measurements in the maxilla and the mandible at both pubertal and post-pubertal stages (P < .05). The ovariectomized rats showed significantly greater measures for all dimensions assessed. No differences in gene expression of ERα and ERβ were identified at the different growth sites between the OVX and Sham groups (P > .05). Immunohistochemical analyses revealed the presence of both oestrogen receptors in osteoblasts and chondrocytes in the midpalatal suture and mandibular condyle, respectively, in the OVX and Sham groups.

Conclusion: Our results suggest that oestrogen deficiency from the prepubertal stage might increase the growth of the maxilla and mandible in female rats.
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http://dx.doi.org/10.1111/ocr.12376DOI Listing
August 2020

EBV-negative lymphoepithelial-like carcinoma of the lower lip.

Autops Case Rep 2020 Jan-Mar;10(1):e2020138. Epub 2019 Dec 13.

Universidade de São Paulo (USP), Faculdade de Odontologia de Ribeirão Preto, Patologia Oral, Departamento de Estomatologia, Saúde Coletiva e Odontologia Legal. Ribeirão Pareto, SP, Brasil.

Lymphoepithelial-like carcinoma (LEC) is a rare malignant neoplasm, which can be associated with Epstein-Barr virus (EBV) infection. Histologically, LEC is an undifferentiated carcinoma with an intermixed reactive lymphoplasmacytic infiltrate. LEC appears to be an uncommon tumor type of lip carcinoma. An 82-year-old white woman presented a lesion on her lower lip that developed over the last year. The lesion was characterized by ulceration with flat edges, hardened base, painful, and absence of regional lymphadenopathy. Microscopical analysis evidenced an intense inflammatory infiltrate, composed of lymphoplasmacytic cells, associated with scarce pleomorphic epithelial cells. Immunohistochemistry highlighted the LEC cells with strong expression of pan-CK AE1/AE3, EMA, p63, and p53. CD138 was also faintly positive. Ki-67 was >85%. In situ hybridization analysis did not show evidence of EBV. A diagnostic of EBV-negative LEC was made. We present an uncommon type of lip carcinoma, which can represent a diagnostic challenge for clinicians and pathologists.
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http://dx.doi.org/10.4322/acr.2020.138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945326PMC
December 2019

Role of epstein-barr virus in the severity of recurrent respiratory papillomatosis.

Laryngoscope 2020 11 20;130(11):E611-E618. Epub 2019 Dec 20.

Center for Translational Investigation in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.

Objective: The objective was to investigate the prevalence of the Epstein-Barr virus (EBV) and its association with human papilloma virus (HPV) detection, clinicopathological features, and the severity of recurrent respiratory papillomatosis (RRP).

Methods: Cases of juvenile recurrent respiratory papillomatosis (JRRP) (n = 36) and adult recurrent respiratory papillomatosis (ARRP) (n = 44) were collected retrospectively and subdivided into low- and high-risk severity groups based on the Derkay score. We performed HPV detection and genotyping using a reverse hybridization protocol and investigated the presence of EBV by polymerase chain reaction (PCR) and in situ hybridization. CD21 levels were accessed by immunohistochemistry.

Results: All samples were HPV-positive, including 49 cases of HPV 6, 26 cases of HPV 11, four cases of HPV 6 and 11 coinfections, and one case of HPV 16. EBV-DNA was detected in nine samples by PCR, although none of the cases were positive by means of in situ hybridization. CD21 immunoexpression was not statistically associated with any of the variables analyzed. HPV 6 detection was significantly higher in ARRP cases (P = 0.03), whereas HPV 11 was more prevalent in JRRP cases (P = 0.02) and was even more prevalent in JRRP cases of greater severity (Derkay laryngoscopic scale ≥20) (P = 0.04).

Conclusion: The presence of EBV does not seem to play an important role in the progression/severity of RRP.

Level Of Evidence: 4 Laryngoscope, 130:E611-E618, 2020.
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http://dx.doi.org/10.1002/lary.28465DOI Listing
November 2020

Relationship between inflammation and the severity of Recurrent Respiratory Papillomatosis.

Am J Otolaryngol 2020 Mar - Apr;41(2):102321. Epub 2019 Nov 18.

Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - UNESP, São José dos Campos, Brazil. Electronic address:

Objective: To characterize inflammatory cells in Recurrent Respiratory Papillomatosis (RRP) and to correlate it with severity using the Derkay laryngoscopic scale.

Materials And Methods: The data and biopsies from 36 patients with Juvenile (JRRP) and 56 patients with Adult (ARRP) were collected and analyzed under light microscopy. The patients were separated into groups according to the Derkay index: ≥20 for the most severe and < 20 for the less severe cases. Immunohistochemical analysis using CD3, CD4, CD8, CD15, CD20, CD68, FoxP3 and MUM-1 antibodies was performed, and the inflammatory cells were quantified. All the clinicopathological characteristics and the results of the immunohistochemical analysis were compared among the groups proposed using the Chi-Square test and correlated through the Spearman correlation test.

Results: The ARRP showed significantly higher quantities of CD3+, CD8+ and MUM1+ cells (p < .05) than the JRRP samples. The presence of CD15+ cells showed positive correlation with the Derkay index (p < .05), while the MUM-1+ cells showed an inverse correlation (p = .01).

Conclusion: There are differences between the inflammatory cells population in the juvenile and adult groups and it can be related to disease severity.
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http://dx.doi.org/10.1016/j.amjoto.2019.102321DOI Listing
August 2020

Primary intraosseous carcinoma of the maxilla arising from an odontogenic keratocyst: a case report and review of the literature.

Gen Dent 2019 Nov-Dec;67(6):26-32

A 47-year-old man was referred for treatment of a painful lesion of 5 months' duration located on the left side of the maxilla. A small perforation in the buccal cortex was observed during the intraoral examination. Cone beam computed tomography (CBCT) showed an extensive, well-delimited radiolucent lesion extending from the alveolar ridge to the nasal cavity. An incisional biopsy was performed, and a cystic lesion consistent with an odontogenic keratocyst (OKC) was observed microscopically. The initial treatment option was decompression to be followed by enucleation. However, 3 months after decompression of the lesion, the patient returned because there was a significant increase in the size of the perforation. A destructive lytic lesion that involved the left side of the maxilla and crossed the midline was evident in the CBCT. The examination of a second incisional biopsy specimen showed epithelial neoplasia comprising islands and projections toward the surface. There was abundant keratin deposition, resulting in the formation of pearls and plugs. A diagnosis of primary intraosseous carcinoma arising from an OKC was confirmed, and the patient underwent a maxillectomy. After 1 year of follow-up, there were no signs of recurrence.
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December 2019

Association between oestrogen receptors and female temporomandibular disorders.

Acta Odontol Scand 2020 Apr 24;78(3):181-188. Epub 2019 Oct 24.

Department of Dentistry, School of Health Sciences, Universidade Positivo, Curitiba, Brazil.

To evaluate if temporomandibular disorders (TMDs) are associated with genetic polymorphisms in and , which are genes encoding oestrogen receptor alpha () and beta (). Also, we included an animal model to check if and are expressed in the temporomandibular joint (TMJ) during adolescence. A total of 139 teenagers and 93 adults were diagnosed according to the (RDC/TMDs). The DNA was collected and the markers and were genotyped. Additionally, immunohistochemistry was performed in TMJ tissues from female rats during puberty. All data were submitted to statistical analysis with confidence interval of 95%. Teenagers presented more disc displacement and arthralgia than adults ( < .05). The genetic polymorphism in was associated with disc displacement ( = .040; OR = 10.50/95%CI 1.17-98.74) and arthralgia ( = .036; OR = 7.20/95%CI 1.10-46.88) in adults. The and are expressed in rat TMJ tissues. We provide evidence that is associated with TMD and could be a genetic marker for this condition in adult women. Furthermore, oestrogens receptors are presented in TMJ of adolescent female rats.
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http://dx.doi.org/10.1080/00016357.2019.1675904DOI Listing
April 2020

Intraoral epidermoid cyst with extensive elastofibromatous changes: an unusual finding.

Oral Maxillofac Surg 2019 Dec 6;23(4):493-497. Epub 2019 Jun 6.

Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, Ribeirão Preto Dental School, University of São Paulo (FORP/USP), Ribeirão Preto, SP, Brazil.

Introduction: Epidermoid cysts (ECs) are rare and occur in the head and neck regions with an incidence from 1.6 to 7% of all cysts. In the oral cavity, approximately 80 ECs have been reported, representing less than 0.01% of all cysts.

Case Report: We report a case of a 26-year-old man who developed a large EC in the midline floor of the mouth causing nodular swelling in the submental region and speech and swallowing difficulties. The lesion was surgically excised by intraoral approach and microscopically revealed an EC associated with extensive elastofibromatous changes in the cystic capsule.

Conclusion: Oral EC with extensive elastofibromatous changes is a finding extremely rare. The meaning of this finding is unknown, but a traumatic origin or deposit disorder of elastic fibers is suggested. To the best of our knowledge, intraoral EC with elastofibromatous changes has not been reported to date.
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http://dx.doi.org/10.1007/s10006-019-00785-yDOI Listing
December 2019

Myoepithelial carcinoma with rhabdoid features in the maxillary sinus: Immunohistochemical and in situ hybridization analysis of a rare case.

Oral Oncol 2019 06 30;93:116-119. Epub 2019 Apr 30.

Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, SP, Brazil.

Myoepithelial carcinomas of the head and neck are often located in the major salivary glands, notably in the parotid glands, being less frequent in the minor salivary glands. Noteworthy, myoepithelial carcinoma in the maxillary sinus is extremely rare. In fact, only five cases have been previously published to date. Here, we present, for the first time, a detailed immunohistochemical and in situ hybridization analysis of a SMARCB1 (INI-1)-intact myoepithelial carcinoma with rhabdoid features, expanding the histopathological spectrum of high-grade sinonasal carcinomas.
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http://dx.doi.org/10.1016/j.oraloncology.2019.04.015DOI Listing
June 2019

Hypercementosis and Cementoblastoma: Importance of the Histopathologic Analysis for the Correct Diagnosis.

J Oral Maxillofac Surg 2019 07 18;77(7):1322-1323. Epub 2019 Apr 18.

Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto (FORP), University of São Paulo, Ribeirão Preto, Brazil.

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http://dx.doi.org/10.1016/j.joms.2019.02.046DOI Listing
July 2019

Ecstasy Abuse and Its Effects on the Oral Mucosa.

J Craniofac Surg 2019 May/Jun;30(3):e189-e191

Oral Medicine, Department of Diagnosis and Surgery, Araraquara Dental School, Univ Estadual Paulista (UNESP), Araraquara.

Ecstasy is an illicit drug that has been increasingly abused by young people. This synthetic drug has both stimulant and hallucinogenic effects and is usually consumed in a tablet. The side effects of ecstasy use include nausea, muscle cramping, fever, and symptoms mostly linked to muscular tension including jaw pain, facial pain, and headaches. There are few studies assessing the ecstasy effects on the oral mucosa, both clinically and histopathologically. The authors report 2 young women (22- and 27-year-old) who presented multifocal oral erosions and ulcerations. The lesions were painful and covered by a yellow-white pseudomembrane with a bright erythematous halo. By microscopy, it was observed superficial ulceration surrounded by acanthotic squamous epithelium with marked spongiosis, interstitial edema within the corion and perivascular lyphoid infiltrate, suggesting drug-induced oral mucositis. In conclusion, ecstasy use may be associated with the development of oral ulcers, which should be considered in the differential diagnosis when assessing multifocal oral ulcerations, especially in young people.
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http://dx.doi.org/10.1097/SCS.0000000000005033DOI Listing
July 2019

Clinicopathological and immunohistochemical analysis of spindle cell squamous cell carcinoma of the tongue: a rare case.

Einstein (Sao Paulo) 2019 Feb 18;17(1):eRC4610. Epub 2019 Feb 18.

Universidade Estadual da Paraíba, Campina Grande, PB, Brazil.

Spindle cell squamous cell carcinoma of the tongue is a rare variant of squamous cell carcinoma. This paper reports the case of a spindle cell squamous cell carcinoma of the tongue, in a 64-year-old male patient, and presents a review of the etiopathogenesis, clinicopathological and immunohistochemical features and treatment of the malignancy. The patient presented for evaluation of a painful swelling on his tongue. Extraoral examination revealed palpable submandibular and superior cervical lymph nodes. Based on the presumptive diagnoses of squamous cell carcinoma or malignant salivary gland neoplasm, an incisional biopsy was performed. Histopathological analysis showed a proliferation of atypical spindle cells, exhibiting extensive pleomorphism. Tumor cells were positive for vimentin, P53 and alpha-smooth muscle actin, focally positive for epithelial membrane antigen and P63, and negative for pan-cytokeratin (AE1/AE3), CK7, CD138, CD34, CD56, and S-100. The positivity index for Ki-67 was approximately 40%. The diagnosis of spindle cell squamous cell carcinoma was established and the patient was referred to a head and neck surgery service. In the oral cavity, spindle cell squamous cell carcinoma of the tongue is an aggressive variant of squamous cell carcinoma, which usually presents as an exophytic mass located on the tongue of elderly males. Due to its distinct histopathological characteristics, immunohistochemistry is a valuable and helpful tool to establish the diagnosis of spindle cell squamous cell carcinoma of the tongue.
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http://dx.doi.org/10.31744/einstein_journal/2019RC4610DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377040PMC
February 2019

Epstein-Barr Virus-Positive Mucocutaneous Ulcer Mimicking Peri-Implantitis in a Patient With Systemic Lupus Erythematosus.

J Oral Maxillofac Surg 2019 May 5;77(5):977-984. Epub 2019 Jan 5.

Professor of Oral Pathology, Department of Stomatology, Public Oral Health and Forensic Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.

Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU) is characterized by cutaneous and/or mucosal ulcers in patients receiving immunosuppressive medication or with age-related immunosenescence. Its microscopic appearance often leads to a diagnostic challenge, sometimes mimicking an overt lymphoma. A 47-year-old woman, with a previous diagnosis of systemic lupus erythematosus, was referred for evaluation of a gingival ulcer, present for about 2 months and located in the maxillary peri-implant mucosa around implants, resembling peri-implantitis. An incisional biopsy was performed, and the microscopic evaluation showed a polymorphic infiltrate with some Reed-Sternberg-like cells. Immunohistochemistry showed positive findings for CD20, CD30, CD45, PAX-5, MUM-1, LMP-1 and EBER1/2, establishing the diagnosis of EBVMCU. After 2 months, total regression of the lesion was noted without any intervention. We discuss the possible association between the EBVMCU and systemic lupus erythematosus; to our knowledge, this is the first report of an EBVMCU simulating peri-implantitis.
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http://dx.doi.org/10.1016/j.joms.2018.12.035DOI Listing
May 2019

Squamous Cell Carcinoma Originating from Adult Laryngeal Papillomatosis: Case Report and Review of the Literature.

Case Rep Otolaryngol 2018 19;2018:4362162. Epub 2018 Dec 19.

DDs, PhD, Associated Professor at the Department of Bioscience and Oral Diagnosis, Science and Technology Institute, Universidade Estadual Paulista (UNESP), Sao José dos Campos, Brazil.

Background: The malignant transformation of laryngeal papillomatosis (LP) into squamous cell carcinoma (SCC) can occur in up to 4% of LP cases. The low-risk HPV types 6 and 11 are those that are most commonly related to LP; however, high-risk HPV types may be present. The present study reviews the literature on cases of malignant transformation of LP in adults and reports a clinical case.

Case Report: A 47-year-old male patient exhibiting hoarseness for 4 months presented an exophytic lesion in the right palatine tonsil and a digitiform-like lesion in the right vocal fold. The biopsy revealed a well-differentiated SCC in the vocal cord, which showed a transition zone with a squamous papillomatous lesion. By using the chromogenic hybridization (CISH) test, both lesions showed a positive result for high-risk HPV types 16 and 18 and negative for low-risk HPV types 6 and 11. The final diagnosis was SCC arising from LP. The patient underwent surgical treatment. After 36 months of follow-up, no signs of recurrence were observed.

Results: The literature review revealed 25 cases of malignant transformation into SCC of LP with adult onset. Of these, only 9 cases were assessed by CISH and/or PCR for HPV identification, of which 7 were positive. The current study focuses on the eighth case, suggesting the involvement of the high-risk HPV types in its pathogenesis.

Conclusions: LP is considered a benign lesion with the potential for malignant transformation, which reinforces the need for its early diagnosis and the constant monitoring of patients with LP.
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http://dx.doi.org/10.1155/2018/4362162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313995PMC
December 2018

Histopathological features of juvenile-onset laryngeal papillomatosis related to severity.

Head Neck 2019 05 8;41(5):1412-1417. Epub 2019 Jan 8.

Department of Bioscience and Oral Diagnosis, Institute of Science and Technology, São Paulo State University - Unesp, São José dos Campos, Brazil.

Background: Laryngeal papillomatosis (LP) is a disease that presents in both juvenile (JLP) and adult patients (ALP). This study correlated papillomatosis characteristics with the Derkay score.

Methods: Retrospective data and biopsies of 36 patients with JLP and 56 with ALP were collected and separated into groups according to their scores.

Results: The mean of the Derkay score, in the JLP group was 10.97 and in Group ALP was 8.26. The JLP group presented a more aggressive result than in the adult group (P = .02). In the JLP group, the respiratory difficulty (P = .01) and tracheostomy were correlated to a higher Derkay score (P < .05). Microscopically, the JLP samples presented a higher incidence of atypical mitosis and mitosis above the basal cells layer of the epithelium (P < .05) and these characteristics were correlated with a higher Derkay index (P = .03).

Conclusion: Findings suggest that ALP and JLP can present different clinical courses and histopathological features. There was a higher degree of LP severity in JLP.
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http://dx.doi.org/10.1002/hed.25602DOI Listing
May 2019

Fatty acid synthase and Ki-67 immunoexpression can be useful for the identification of malignant component in carcinoma ex-pleomorphic adenoma.

J Oral Pathol Med 2019 Mar 16;48(3):232-238. Epub 2019 Jan 16.

Department of Oral Diagnosis, Oral Pathology, Piracicaba Dental School, State University of Campinas (FOP-UNICAMP), Piracicaba, Brazil.

Background: Fatty acid synthase (FASN) is the key molecule for catalyzing fatty acid synthesis and have been associated with several malignant tumors.

Methods: We analyzed the expression of FASN and Ki-67, by immunohistochemistry on 29 carcinomas ex-pleomorphic adenoma (CXPAs) and 25 pleomorphic adenomas (PAs).

Results: Ki-67 proliferation index and FASN expression were significantly higher in patients with CXPA than patients with PA (P < 0.001). We found intense immunoreactivity for FASN in the malignant component of CXPAs, and these malignant areas also had intense nuclear immunoreactivity for Ki-67.

Conclusions: The present results suggest that overexpression of FASN in CXPAs might be associated with malignant transformation of ductal epithelial cells and/or myoepithelial cells from PA. FASN associated with Ki-67 may be useful diagnostic markers for CXPA.
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http://dx.doi.org/10.1111/jop.12820DOI Listing
March 2019