Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas

The present study aimed to investigate the efficiency of exfoliative cytology by correlating the clinical lesions of oral squamous cell carcinoma (OSCC) with exfoliative cytology and histopathological findings. Cases of OSCC diagnosed between 1984 and 2010 were analyzed. The inclusion criteria for the present study were the availability of detailed clinical findings and a diagnosis of the disease through exfoliative cytology and histopathology. The cases were assessed and assigned scores, which were then submitted to modal expression analysis, which considers the higher frequency scores, thus relating the variables. The cytological findings demonstrated that the majority of the cases had malignant potential. Exfoliative cytology should be used as a supplementary tool for the diagnosis of OSCC, as it enables the early detection of these lesions. However, cytology should not be used as a substitute for histopathological examination.

Genetic determinants of methicillin resistance and virulence among Staphylococcus aureus isolates recovered from clinical and surveillance cultures in a Brazilian teaching hospital

Aims. To quantify the presence of SCCmec types and virulence genes among Staphylococcus aureus colonizing and infecting patients from a teaching hospital. Methods. We analyzed 225 and 84 S. aureus isolates recovered from surveillance and clinical cultures, respectively. Strains were studied for the presence and type of SCCmec, as well as for several virulence genes. Univariate and multivariable analysis were performed in order to identify predictors of invasiveness (defined as isolation from clinical cultures). Results. The presence of SCCmec types III (OR, 2.19, 95% CI, 1.08-4.45) and IV (OR, 5.28 95% CI, 1.35-20.63) and of genes coding for exfoliative toxin B (etb, OR, 6.38, 95% CI, 1.48-27.46) and Panton-Valentine leukocidin (pvl, OR, 2.38, 95% CI, 1.16-4.86) was independently associated with invasiveness. Conclusions. SCCmec types III and IV and virulence genes are associated with greater invasiveness of S. aureus. Patients colonized with methicillin-resistant S. aureus, as well as with strains harboring etb or pvl, may be prone to develop invasive disease. Infection-preventing strategies should be more intensively applied to this group.

Análise da proteína EGFR em carcinoma espinocelular de lábio

Pós-graduação em Biopatologia Bucal - ICT

Programa de diagnóstico e prevenção de câncer da boca: uma estratégia simples e eficaz

The program of diagnosis and prevention of oral cancer of Univag - University Center aims to increase preventive and early oral diseases with emphasis on oral cancer, aiming to reduce the morbidity and mortality through educative actions, spreading of the auto-examination, performed by dental students of UNIVAG since the second half of 2005 to the present day. The dental students of 1st, 2nd, 3rd and 4th semesters were trained using practice-theoretical classes, for realization the exams preventives and diagnostics, such as self-examination, exfoliative cytology and biopsy of oral mucosa, and even present educative actions. Analyzing the preliminary results were observed increase in the number of diagnoses and referral of diagnosed with oral cancer for treatment in referral services. It was concluded that the program of diagnosis and prevention of oral cancer can make possible early diagnosis and adoption of preventive measures, consequently improving survival rates and life quality in population.

Perfil epidemiológico dos participantes do Programa de diagnóstico e prevenção do câncer de boca em Mato Grosso

To determine the profile of the patients who participated in the program of oral cancer diagnosis and prevention in Mato Grosso, from 2008 to 2009. Materials and Methods: The medical records of the treated patients were examined. Results: 1.293 records were analyzed, with a predominance of female patients (60%) and a greater participation of patients from 10 to 19 years of age (20%). Reports of pre-existing illnesses amounted to 302 recorded cases. In addition, 292 variations of normality could be also identified. During the period, 25 participants were recommended for exfoliative cytology and 133 for biopsy, as they presented oral lesions that raised the suspicion of malignancy. Conclusions: Campaigns to raise awareness of and prevent oral cancer are very important and should be extended to the entire population of the state of Mato Grosso, either by means of the local University Center (UNIVAG), or by other agencies and health institutions.

Estudo comparativo da expressão da survivina na citologia esfoliativa da mucosa bucal de pacientes com carcinoma de células escamosas intra-bucal e fumantes crônicos

Survivin protein is an inhibitor of apoptosis that plays a role in cell cycle control and the mechanism of carcinogenesis. The aim of this study was to verify the clinic pathological correlation of survivin expression in exfoliative cytology of chronic smokers, mucosa of patients with intra-oral squamous cell carcinoma (OSCC) and also from mucosa after surgical removal of OSCC. Patients were divided in 03 groups: Group 1: 26 patients who smoked more than 20 cigarettes/day/10years with no history of oral malignant neoplasm, or any clinical sign visible at examination. Group 2: 26 patients who had OSCC and Group 3: 22 patients surgically treated of OSCC for at least 01 month. Immunohistochemistry of the smears from each group was analyzed by light microscopy to extent and intensity of survivin positive cells. Survivin expression was observed in 100% of cases in group 1, 88.5% in group 2 and 100% in group 3. Groups 1 and 3 showed cytoplasmic expression in 100% of the cases, while group 2 showed it in 87.5%. Cytoplasmic and nuclear expression was 7.69% observed only in group 2. The results were association with clinicopathological data by Fisher's exact test and it was significant to smoke cessation in group 2 on intensity (p=0.015) of survivin expression. The intensity of survivin expression was related to smoking cessation in group 2. Smoking history (pack/years) showed no influence survivin expression

Estudo comparativo da expressão da survivina na citologia esfoliativa da mucosa bucal de pacientes com carcinoma de células escamosas intra-bucal e fumantes crônicos

Survivin protein is an inhibitor of apoptosis that plays a role in cell cycle control and the mechanism of carcinogenesis. The aim of this study was to verify the clinic pathological correlation of survivin expression in exfoliative cytology of chronic smokers, mucosa of patients with intra-oral squamous cell carcinoma (OSCC) and also from mucosa after surgical removal of OSCC. Patients were divided in 03 groups: Group 1: 26 patients who smoked more than 20 cigarettes/day/10years with no history of oral malignant neoplasm, or any clinical sign visible at examination. Group 2: 26 patients who had OSCC and Group 3: 22 patients surgically treated of OSCC for at least 01 month. Immunohistochemistry of the smears from each group was analyzed by light microscopy to extent and intensity of survivin positive cells. Survivin expression was observed in 100% of cases in group 1, 88.5% in group 2 and 100% in group 3. Groups 1 and 3 showed cytoplasmic expression in 100% of the cases, while group 2 showed it in 87.5%. Cytoplasmic and nuclear expression was 7.69% observed only in group 2. The results were association with clinicopathological data by Fisher's exact test and it was significant to smoke cessation in group 2 on intensity (p=0.015) of survivin expression. The intensity of survivin expression was related to smoking cessation in group 2. Smoking history (pack/years) showed no influence survivin expression

A retrospective study of oral manifestations in patients with paracoccidioidomycosis

South American blastomycosis, paracoccidioidomycosis (Pb mycosis) or Lutz disease is an endemically fungal infection in Latin America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis and may cause oral mucosal lesions. The incidence of Pb mycosis oral lesions was evaluated in patients assisted at a Brazilian Dental School's Specialized Oral Diagnosis Service with special focus on the different clinical forms of these lesions, its location, patients' occupation, deleterious habits, and diagnosis methodology. Students' and professionals' initial diagnoses were compared with the definitive diagnosis. Lesions were detected 31 cases (18 patients). The results show that 88.8% of the patients were male with a mean age of 50 years and 39% work(ed) with activities related to agriculture. As much as 88.9% were smokers and 72.2% were alcohol users. Exfoliative cytology was performed in 66.6% of the patients. Oral mucosa (30%), gingiva (16.6%) and lips 16.6% were the most common sites of Pb mycosis oral lesions. Comparing the initial with the definitive diagnosis made by the professionals their accuracy was 33% (6 out of 18 patients). Students' diagnosis was more accurate demonstrating 72.5% of initial correct diagnosis (13 out of 18). Statistical analysis by ANOVA (α=0.05, SPSS WIN) demonstrated a significant difference between the diagnosis of Pb mycosis made by students and professionals when considering initial diagnosis and final diagnosis (after histopathological analysis) (p=0.25). Incisional biopsy and exfoliate cytology are efficient for an early diagnosis of this disease in mouth. Students' training in diagnosis of oral pathologies to recognize lesions is urgent to improve public health.

Estudo clínico-histológico da quelite actímica crônica tratada por dois protocolos de laser de CO2 de baixa morbidade

Objetivo: Este ensaio clínico-histológico teve por meta avaliar a resposta terapêutica de dois protocolos de reconhecida baixa morbidade em passagem única. Métodos: Pacientes com queilite actínica crônica multicêntrica (n=40) comprovada pela microscopia foram randomicamente submetidos a dois protocolos de laser de CO2 pulsátil através de modelo comparativo bilateral (protocolo de pulsos de 350 mJ, 3,5 W, amplitude de 0,1s versus protocolo de pulsos de 250 mJ, 5 W, amplitude de 0,05s). Realizou-se em 26 pacientes análise comparativa dos níveis de atipia epitelial de espécimes de biópsia entre o status quo e o período pós-operatório de ambos os protocolos e entre si. Foram avaliados outros fenômenos do espectro da doença. Resultados: Houve presença clínica pós-operatória de lesões em 10% dos pacientes para cada protocolo e uma significante redução dos níveis de atipia epitelial (p<0,001), por vezes completa. Conclusão: Não houve diferença de resultados entre os protocolos estudados (p> 0,05).

Queilitis actínica tratada con imiquimod 5%

Los inmunomoduladores tópicos han demostrado utilidad en las enfermedades orales inflamatorias resistentes a corticoesteroides tópicos, en enfermedades sistémicas con mucosa oral primeramente comprometida y en lesiones severas que involucren la mucosa oral. La queilitis actínica es una lesión potencialmente maligna, con riesgo de progresar a Carcinoma espinocelular, por ello es necesario su tratamiento temprano.

Síndrome de Melkersson-Rosenthal : um diagnóstico a ponderar numa doente com edema do lábio

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

Análise comparativa da imunoexpressão do IMP-3 e Ki-67 em queilites actínicas e carcinoma epidermóide de lábio inferior

Epithelial changes observed in actinic cheilitis (AC) and squamous cell carcinoma of the lower lip (LLSCC) are mainly caused by chronic exposure to ultraviolet rays (UV) and are studied using different immunohistochemical markers trying to evaluate the process of carcinogenesis. The objective of this study was to comparatively evaluate the expression of Ki-67 proteins and IMP-3 in AC and LLSCC to contribute with additional information on carcinogenesis in lower lip. A total of 33 cases of AC and 33 cases of LLSCC were studied, analyzed the clinical and pathological features and immunostaining of Ki-67 and IMP-3. Immunohistochemical analysis of Ki-67 was made through the determination of the proliferation index (PI) and subsequent classification of the cases according to the scores: 0 (0% positive cells) +1 (≤30%) + 2 (> 30% and ≤60%) and +3 (> 60%). For statistical tests cases were classified as unmarked (score 0), low expression (score +1) and high expression (scores +2 and +3). For the expression of IMP-3, the percentage of immunostained epithelial cells was established, and assigned scores: 0 (corresponding to 0%), +1 (up to 30% of positive cells); +2 (From 30% to 60% of immunostained cells) and +3 (over 60% of positive cells). Statistical tests chi-square test, Mann-Whitney and Wilcoxon were used. The significance level was 5%. Most AC chaos was male (78.8%) with mean age of 50 years and cases of LLSCC also were male (69.89%) with an average of 62 years. The Ki-67 was expressed in all cases of AC and in cases of LLSCC, predominantly in the two injuries the score 2, corresponding to 81.8% of cases in ACs and 54.5% in the CELI. The expression of IMP-3 in ACs occurred in 72.7% of cases, predominantly in 36.3% of LLSCC cases score 1. Already in the IMP-3 was expressed in 60.6% of cases, especially in 27.3% of the score of the cases 3. These results allow us to conclude that the expression of IMP3 and proliferative activity are early events in carcinogenesis independently lower lip state of change.

Queilite actínica: expressão imuno-histoquímica da cox-2 e avaliação do diclofenaco sódico gel como uma terapia alternativa

Actinic cheilitis (AC) is a potentially malignant disorder which affects the lip vermilion and results from chronic exposure to sunlight. Currently, it is not possible to predict which cases of AC may progress to squamous cell carcinoma, and therefore, some biomolecular markers have been researched. Cyclooxygenase 2 (COX-2) is an enzyme associated with inflammatory response which is overexpressed in oral cancer; however, little is known about the role of this protein in actinic cheilitis. About the treatment of this lesion, currently available therapeutic modalities to AC may cause cytotoxic effects and deleterious results to patients. Therefore, the aim of this study was to evaluate the immunoexpression of COX-2 in AC of different risks of malignant transformation and analyse, through clinical follow-up, the efficacy of diclofenac sodium 3% gel in the treatment of this condition. Epithelial immunoexpression of COX-2 was analysed semi-quantitatively in 90 cases of AC classified as low risk (n = 55) and high risk (n = 35) of malignant transformation, in which the scores were assigned: (0) 0 to 5% of positive cells - Negative; (1) 6 to 30% of positive cells - Low expression; (2) 31 to 100% of positive cells - High expression. The chi-square test of Pearson was conducted to verify possible associations between immunoexpression of COX-2 and histologic grade of actinic cheilitis. The weighted kappa coefficient denoted a good interobserver agreement (0.677). Nineteen patients diagnosed with AC were instructed to perform topical application of the gel three times a day for a period of 90 days. In each biweekly visit, a follow-up record was accomplished through digital photographs and after treatment was completed, two researchers analysed all the images to assess clinical aspects of the lip. Furthermore, tolerability to the drug and patient satisfaction after treatment were evaluated. COX-2 was overexpressed in 74.4% of AC cases. Both low and high-risk groups revealed predominance of score 3, followed by scores 2 and 1. There was no significant association (p = 0.315) between COX-2 expression and histological grading. Among the total number of participants of this clinical study, ten showed total remission of all clinical features of the lesion and three had partial improvement of these characteristics. One participant presented worsening of the clinical condition. In five cases, the treatment was discontinued due to development of mild adverse effects at the site of gel application. Regarding analysis of satisfaction and tolerability to the drug, most patients were fully satisfied with the therapy (n = 11) and reported that the drug was not irritating to the lips (n = 9). Our study demonstrates that high expression of COX-2 is common in AC; however, this protein was not associated with malignant transformation risk of the analysed cases. Topical application of diclofenac sodium 3% gel provided a convenient and well tolerated approach in most cases, and may be a promising alternative for the treatment of actinic cheilitis.

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos

Silveira , E. J. D. et al. Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos. J. Bras. Patol. Med. Lab., v. 45, n. 3, p. 233-238, jun 2009. ISBN 1676-2444.

Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos

Silveira , E. J. D. et al. Lesões orais com potencial de malignização: análise clínica e morfológica de 205 casos. J. Bras. Patol. Med. Lab., v. 45, n. 3, p. 233-238, jun 2009. ISBN 1676-2444.