Investigação da amplificação do EGFR em carcinoma de células escamosas de boca em pacientes jovens

Pós-graduação em Biopatologia Bucal - ICT

Investigação da amplificação do EGFR em carcinoma de células escamosas de boca em pacientes jovens

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Undifferentiated pulmonary adenocarcinoma of clear cells associated to hypertrophic osteopathy in a dog

Background: Most of the primary pulmonary tumors in dogs are malignant and from epithelial origin, being bronchioalveolar tumors more prevalent. Adenocarcinoma of clear cells, however, is a very rare pulmonary tumor and its origin is still unknown. It is related to several clinical abnormalities, including hypertrophic osteopathy, an unusual paraneoplastic syndrome characterized by a periosteal reaction along the shaft of long bones. Because of the unusual presentation of the pulmonary adenocarcinoma, the aim of this study was to describe the radiographic, histopathological, and immunohistochemical fi ndings of a dog affl icted with hypertrophic osteopathy secondary to an undifferentiated pulmonary adenocarcinoma of clear cells. Case: A 12-year-old, 45 kg, not castrated male Great Dane dog was presented with painful swelling of all four limbs and moderate respiratory distress. Radiographic examination and computed tomography of the limbs showed palisade-like periosteal bone proliferation involving radius, ulna, femur, patella, tibia, fi bula, tarsus, metacarpal, metatarsal and digits, suggesting hypertrophic osteopathy. Radiographic examination and computed tomography of the lungs also showed a round mass well delimited localized in the right diaphragmatic lobe. A lobectomy of the right diaphragmatic lobe and partial lobectomy of accessory lobe were performed. A poorly differentiated clear squamous cell carcinoma was diagnosed by histological examination. An immune-panel of CK5/CK6, CK7, p63 and TTF-1 was used for immunophenotyping. Immunostaining was weakly positive for CK5/CK6 and negative to all others. Therefore, the diagnosis was poorly differentiated clear cell adenocarcinoma. The dog showed improvement in clinical signs seven days after surgery. One month postoperatively, radiographic examination of the limbs showed less intense periosteal reaction and initiation of bone remodeling. Discussion: Primary pulmonary tumors are considered very infrequent in small animals, but its true incidence rate is dif- fi cult to establish in animal populations. The histological origin of the tumor in the present case, as verifi ed in the literature, is not well established by histological analysis. In these situations, the immunohistochemistry panel may be useful. The modifi cation of the diagnosis between histological analysis and by immunohistochemistry, among other factors, might be due to transdifferentiation from one phenotype to another at various stages in the neoplastic process. The clear cell appearance observed in this case may be verifi ed in all types of carcinoma due to intracellular accumulation of glycogen, most of which is dissolved during the preparation of paraffi n sections. This uncommon neoplasm apparently did not infl uence the radiographic or tomographic fi ndings of the hypertrophic osteopathy in the present case. The frequency of metastases depends on the histological type of the tumor, being common in the pulmonary adenocarcinoma and usually to tracheobronchial lymph nodes and pulmonary parenchyma. Although in this case the imaging studies did not show metastases to other pulmonary lobes, the histological exams showed metastatic lesions that may be associated to the dog’s death after the surgery.

Penectomia em equino com carcinoma de células escamosas

The presence of increased volume in penis and prepuce of horses can be of neoplastic or non-neoplastic origin. Squamous cell carcinoma (SCC), papilloma, fibropapiloma, melanoma and sarcoidorigin. Squamous cell carcinoma (SCC), papilloma, fibropapilloma, melanoma and sarcoid are detached as neoplastic causes. The non-neoplastic causes can be parasitic as habronemiasis and pythiosis, or inflammation, resulting in the formation of exuberant granulation tissue. The penile disorders can be easily confused with each other because they have similar clinical signs. Among epithelial neoplasms affecting penis and prepuce, squamous cell carcinoma is the most common in horses. Thus, it was aimed to report a case of squamous cell carcinoma in a horse and describe the main differential diagnosis for this disease. The additional tests to obtain an accurate diagnosis and the institution of appropriate treatment are essential for the satisfactory repair of penile neoplasms in this species.

Modulação da imunidade adaptativa por produtos solúveis de células de carcinoma espinoceular de cabeça e pescoço (HNSCC): um papel da galanina derivada do tumor?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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

Modulação da imunidade adaptativa por produtos solúveis de células de carcinoma espinoceular de cabeça e pescoço (HNSCC): um papel da galanina derivada do tumor?

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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

Photodynamic therapy in actinic cheilitis: clinical and anatomopathological evaluation of 19 patients

BACKGROUND: Actinic cheilitis, a common disease caused by chronic solar exposure and tobacco use, is considered a premalignant lesion with potential to develop into squamous cell carcinoma. Some of the available treatments are invasive, have unaesthetic results and require multiple sessions. OBJECTIVE: To assess the efficacy of a therapy and its cosmetic results. METHODS: In this uncontrolled clinical trial a single photodynamic therapy (PDT) session using 16% methyl-aminolevulinate was performed on actinic cheilitis of the lower lip. A standardized questionnaire was applied in order to assess the clinical improvement from the patients' point of view and the satisfaction with the treatment. Anatomopathological evaluation was performed before the treatment and two months afterwards. RESULTS: The sample was composed of 19 patients (10 males and 9 females), phototypes I to III, with average age of 62 years. Main adverse effects were: sudden pain, scabs, herpes flare-up, and edema. The average score of pain during the procedure was 5,8+2,9. At the final assessment the patients reported improvement of 80% and satisfaction of 85% (p<0.01). Anatomopathological analysis showed a significant decrease of dysplasia (p=0.03) in spite of its presence in 84% of cases. There was no significant correlation between the level of dysplasia with either the subjective impression of clinical improvement (p=0.82) or with the patients' final satisfaction (p=0.96). CONCLUSION: PDT is effective in the treatment of actinic cheilitis, but it is associated with a significant level of pain. Due to the persistence of dysplasia, more research needs to be done in order to define the ideal number of sessions for the effective treatment of these lesions.

In Silico Analysis and Immunohistochemical Characterization of NaPi2b Protein Expression in Ovarian Carcinoma With Monoclonal Antibody Mx35

Introduction: Ovarian adenocarcinoma is frequently detected at the late stage, when therapy efficacy is limited and death occurs in up to 50% of the cases. A potential novel treatment for this disease is a monoclonal antibody that recognizes phosphate transporter sodium-dependent phosphate transporter protein 2b (NaPi2b). Materials and Methods: To better understand the expression of this protein in different histologic types of ovarian carcinomas, we immunostained 50 tumor samples with anti-NaPi2b monoclonal antibody MX35 and, in parallel, we assessed the expression of the gene encoding NaPi2b (SCL34A2) by in silico analysis of microarray data. Results: Both approaches detected higher expression of NaPi2b (SCL34A2) in ovarian carcinoma than in normal tissue. Moreover, a comprehensive analysis indicates that SCL34A2 is the only gene of the several phosphate transporters genes whose expression differentiates normal from carcinoma samples, suggesting it might exert a major role in ovarian carcinomas. Immunohistochemical and mRNA expression data have also shown that 2 histologic subtypes of ovarian carcinoma express particularly high levels of NaPi2b: serous and clear cell adenocarcinomas. Serous adenocarcinomas are the most frequent, contrasting with clear cell carcinomas, rare, and with worse prognosis. Conclusion: This identification of subgroups of patients expressing NaPi2b may be important in selecting cohorts who most likely should be included in future clinical trials, as a recently generated humanized version of MX35 has been developed.

Characterization of a Novel Oral Glucocorticoid System and Its Possible Role in Disease

Synthetic corticosteroids are used widely for the treatment of a variety of diseases of the mouth. However, little is known as to whether the oral mucosa is able to modulate the local concentration of active corticosteroids or to produce steroids de novo. This has important clinical implications, because tissue-specific regulation of glucocorticoids is a key determinant of the clinical efficacy of these drugs. In the present study, we show that oral fibroblasts and keratinocytes expressed ACTH receptor (MC2R), glucocorticoid receptor (GR), and 11 beta-hydroxysteroid dehydrogenases (11 beta-HSDs). Unlike keratinocytes, fibroblasts lacked 11 beta-HSD2 and could not effectively deactivate exogenously administered cortisol. However, both cell types were able not only to activate cortisone into the active form cortisol, but also to synthesize cortisol de novo following stimulation with ACTH. 11 beta-HSD2, the enzyme controlling cortisol deactivation, exhibited different patterns of expression in normal (squamous epithelium and salivary glands) and diseased oral mucosa (squamous cell carcinoma and mucoepidermoid carcinoma). Blocking of endogenous cortisol catabolism in keratinocytes with the 11 beta-HSD2 inhibitor 18 beta-glycyrrhetinic acid mimicked the effect of exogenous administration of hydrocortisone and partially prevented the detrimental effects induced by pemphigus vulgaris sera. Analysis of the data demonstrates that a novel, non-adrenal glucocorticoid system is present in the oral mucosa that may play an important role in disease.

Is it safe to utilize in vitro reconstituted human oral epithelium? An oncogenetic pathway study

Cell therapy is a therapeutic strategy used to replace or repair damaged tissue. The epithelium transplantation of cultivated keratinocytes has been applied to several modalities of reconstruction, like oral, urethra and ocular surface. Life and death signals work coordinately to ensure cellular quality control and the viability of an organism. The aim of this study is to verify that culture conditions did not induce genetic mutations through the analysis of the key genes: pAKT, Pten, p53 and MDM2 and investigate the presence of the related proteins in human oral keratinocytes obtained by primary culture and in vitro cultivated. Formalin fixed and paraffin embedded tissues from the oral cavity were utilized as control for normal expression of the related markers and two oral squamous cell carcinoma cell lines provided the expression pattern of the proposed markers in the event of cellular transformation. Akt, PTEN, p53 and MDM2 immunohistochemistry and Western-Blotting analyzes were performed. The results showed the expression levels and intracellular localizations of the four proteins evaluated. These analyzes confirmed that the produced in vitro epithelium is bio-compatible for its utilization as reconstruction and reparatory tissue, however further analyses and additional research on other biomarkers should be performed to analyse the long term engraftment of transplantable primary culture of oral keratinocytes and the long term resistance to cellular transformation.

Expression of nonclassical molecule human leukocyte antigen-G in oral lesions

Introduction: Human leukocyte antigen (HLA)-G is a nonclassic class I molecule that acts as a modulator of immune responses, and the expression of these molecules in virus-infected cells has been associated with subversion of the immune response. Objective: In this study, we performed a cross-sectional study, systematically comparing the expression of the HLA-G in benign, premalignant, and malignant oral lesions and correlating it with the presence of high-risk and low-risk human papillomavirus (HPV) types. Specimens and Methods: Oral biopsies were collected from 51 patients and analyzed by immunohistochemistry using anti HLA-G antibody. Human papillomavirus detection and typing from oral biopsies were obtained by polymerase chain reaction using GP5+/GP6+ and specific primers. Results: The 51 biopsies were stratified into 3 groups according to lesion grade: oral benign lesions (oral hyperplasia and papilloma, n = 16), oral premalignant lesions (oral leukoplakia with dysplasia and lichen planus, n = 17), and malignant lesions (oral squamous cell carcinoma, n = 18). Human leukocyte antigen G overexpression was mainly observed in benign and premalignant oral lesions but was not related to HPV infection (P>.05). On the other hand, HPV DNA was detected in 24 (47%) oral lesions, mainly in benign and premalignant lesions, with the most frequent type detected being high-risk HPV type. Conclusion: The HLA-G molecule was expressed in a significant number of benign oral lesions and was not correlated with HPV infection or oral cancer. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.

Overall Survival Improvement in Patients with Lung Cancer and Bone Metastases Treated with Denosumab Versus Zoledronic Acid Subgroup Analysis from a Randomized Phase 3 Study

Introduction: Denosumab, a fully human anti-RANKL monoclonal antibody, reduces the incidence of skeletal-related events in patients with bone metastases from solid tumors. We present survival data for the subset of patients with lung cancer, participating in the phase 3 trial of denosumab versus zoledronic acid (ZA) in the treatment of bone metastases from solid tumors (except breast or prostate) or multiple myeloma. Methods: Patients were randomized 1:1 to receive monthly subcutaneous denosumab 120 mg or intravenous ZA 4 mg. An exploratory analysis, using Kaplan-Meier estimates and proportional hazards models, was performed for overall survival among patients with non-small-cell lung cancer (NSCLC) and SCLC. Results: Denosumab was associated with improved median overall survival versus ZA in 811 patients with any lung cancer (8.9 versus 7.7 months; hazard ratio [HR] 0.80) and in 702 patients with NSCLC (9.5 versus 8.0 months; HR 0.78) (p = 0.01, each comparison). Further analysis of NSCLC by histological type showed a median survival of 8.6 months for denosumab versus 6.4 months for ZA in patients with squamous cell carcinoma (HR 0.68; p = 0.035). Incidence of overall adverse events was balanced between treatment groups; serious adverse events occurred in 66.0% of denosumab-treated patients and 72.9% of ZA-treated patients. Cumulative incidence of osteonecrosis of the jaw was similar between groups (0.7% denosumab versus 0.8% ZA). Hypocalcemia rates were 8.6% with denosumab and 3.8% with ZA. Conclusion: In this exploratory analysis, denosumab was associated with improved overall survival compared with ZA, in patients with metastatic lung cancer.

Oral Lesions in Renal Transplant

To prevent rejection of kidney transplants, patients must be kept in immunosuppressive therapy for a long time, which includes the use of drugs such as cyclosporine, azathioprine, cyclophosphamide, and prednisone. The action of these drugs reduces the general immune response of transplant patients and thus increases their susceptibility to infections. Moreover, these drugs increase the potential of developing lesions. Therefore, oral hygiene in kidney transplant recipients contributes to maintenance of the transplanted organ and its function. Thus, an investigation of oral lesions could be counted as a notable work. The aim of this study was to investigate oral lesions in a group of 21 kidney transplant patients under immunosuppressive therapy attended during a 1-year period in the Nephrology Department of the Federal University of Sergipe, Brazil. Data related to sex, age, etiology of renal disease, types of renal transplant, time elapsed after transplantation, immunosuppressive treatment, use of concomitant agents, and presence of oral lesions were obtained. All patients received a kidney transplant from a living donor, and the mean posttransplantation follow-up time was 31.6 months; 71.5% used triple immunosuppressive therapy with cyclosporine A, azathioprine, and prednisone. Ten patients were also treated with calcium-channel blockers. Of the 21 transplant patients, 17 (81%) presented oral lesions. Gingival overgrowth was the most common alteration, followed by candidiasis and superficial ulcers. One case of spindle cell carcinoma of the lower lip was observed. Oral cavity can harbor a variety of manifestations related to renal transplantation under immunosuppressive therapy.