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To describe the use of cell block (CB) preparation from fine-needle aspiration cytology for diagnosing oral and maxillofacial diseases. We performed a retrospective analysis of 568 samples collected by our laboratory for CB preparation from fine-needle aspiration cytology of the oral and maxillofacial region between January 2001 and October 2021. We performed cytologic diagnoses and compared them with the available histopathologic diagnoses to calculate the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation for identifying malignant lesions. The most frequent diagnosis was pleomorphic adenoma (n = 44, 7.7%), followed by metastatic squamous-cell carcinoma (n = 28, 4.9%) and odontogenic keratocyst (n = 26, 4.6%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CB preparation, which revealed detailed morphologic and architectural patterns, were 70.0%, 100.0%, 100.0%, 62.5%, and 80.0%, respectively. Cell block preparation from fine-needle aspiration cytology of the oral and maxillofacial region may be a useful adjunctive diagnostic tool for diagnosing oral and maxillofacial diseases because it reveals morphologic and architectural patterns similar to those shown on histopathologic slides, leading to the better categorization of diseases. [ABSTRACT FROM AUTHOR]

This study aimed to report an analysis of the epidemiological, clinical, and imaging characteristics of patients diagnosed with metastases to the oral cavity. Patient charts from two different medical centers were retrospectively reviewed. The study identified 8 cases of metastasis to the oral cavity, with a mean age of 63 years, and the majority (7 patients) were male. The probable primary sites of these metastatic lesions were identified as the colon, breast, lung, prostate, and kidney. The final diagnoses were established through a combination of microscopic analysis, imaging, and immunohistochemistry. It's noteworthy that metastasis to the oral cavity is relatively uncommon and, in some instances, may represent the initial presentation of the primary tumor. Therefore, healthcare providers should include distant metastasis in the differential diagnosis, even when there is no previously reported primary tumor. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to report the clinicopathologic features of 105 new cases of adenomatoid odontogenic tumor (AOT) from Brazil, Guatemala, Mexico, and South Africa.Study Design: Clinical and radiographic data were collected from records of 5 oral pathology laboratories, and all cases were microscopically reviewed.Results: This series of cases included 36 (34.2%) from South Africa; 33 (31.4%) from Brazil; 23 (21.9%) from Mexico; and 13 (12.3%) from Guatemala. Seventy-two patients (68.5%) were females and 33 patients (31.4%) were males, with an average age of 19.2 years. The tumors predominantly affected the anterior maxilla (48.5%), followed by the anterior mandible (29.5%); posterior mandible (15.2%); and posterior maxilla (6.6%). Sixty-three tumors (63.6%) were follicular, 34 (34.3%) were extrafollicular, and 2 (2%) were peripheral. In most cases, the tumors caused considerable cortical expansion (average size 3.4 cm). Microscopically, most cases showed rosette-like and duct-like structures.Conclusions: This is one of the largest case series of AOTs reported in the literature and the first multicenter study involving populations from Latin America and South Africa. In a fifth of the present cases, the posterior regions of the gnathic bones were affected and the tumors demonstrated larger sizes compared with cases occurring in other populations. [ABSTRACT FROM AUTHOR]

During oral pathology daily practice, true amyloid may be identified in oral amyloidosis and several odontogenic tumors. However, histologic examination often reveals other oral and perioral diseases with similar eosinophilic, acellular, amorphous substances. These include extensive areas of collagenous sclerosis, fibrin deposition, elastic fiber degeneration, and dentinoid material, which may resemble amyloid under light microscopic examination. These materials are often termed "amyloid-like" due to their close histologic resemblance to true amyloid. The rarity of most of these conditions and their strong histologic similarity may hamper an accurate diagnosis. Definitive diagnosis of these lesions may require clinical correlation; laboratory evaluation; histochemical or immunohistochemical reactions; and, in some cases, genetic investigation. In this review, we describe the main clinicopathologic features of this group of diseases that may manifest in the oral and/or perioral regions and that have in common the presence of amyloid-like material deposition. [ABSTRACT FROM AUTHOR]

Primordial odontogenic tumor (POT) is a recently described benign odontogenic tumor, with only 16 cases reported in the literature. We present 2 new cases of POT affecting the mandible. Case 1 is that of 12-year-old girl with an asymptomatic, slow-growing mass, causing facial asymmetry. Radiography showed a well-defined unilocular radiolucency surrounding an impacted second premolar. Case 2 is that of a 13-year-old girl with a mass involving the crown of the unerupted third molar and showing similar radiographic features. Microscopically, both lesions were composed of variably cellular fibromyxoid tissue surrounded by thin ameloblastic epithelium, with stellate reticulum-like areas, but no mineralized tissue, yielding the diagnosis of POT. Immunohistochemical analysis showed diffuse expression of CK14 in epithelial cells, whereas CK19 was expressed mainly in the basal layer. Syndecan-1 (CD138) was expressed in the stellate-like regions and in the subepithelial zone. Both patients were treated surgically, with no signs of recurrence seen after 15 and 60 months, respectively. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the influence of viral load and lymphocyte count on survival of patients who presented with human immunodeficiency virus (HIV)-associated oral Kaposi's sarcoma.Study Design: Thirty-one cases (from January 2010 to December 2019) of oral Kaposi's sarcoma in patients with HIV from 2 oral pathology centers in Brazil were reviewed, considering clinical data and correlation of viral load and lymphocyte count with overall survival. Overall survival rates were estimated by a Kaplan-Meier analysis and compared using a log-rank test. The factors introduced stepwise into a Cox proportional hazard model to identify the independent predictors of survival. A P value <.05 was considered significant.Results: Most of the patients were males (90.3%) with a mean age of 32.4 years (range, 19-58). Hard palate, soft palate, and tongue were the most affected sites. Treatment, viral load >999 copies/mL, CD4+ level ≤200 cells/mm3, CD4+/CD8+ level ≤0.39 cells/mm3, and CD4+ nadir level <50 cells/mm3 were related to overall survival.Conclusions: Survival of patients affected by oral HIV-associated Kaposi's sarcoma is influenced by treatment, viral load, CD4+, CD4+/CD8+, and CD4+ nadir count. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe the clinicopathologic features of a series of gnathic epithelioid osteoblastomas. As high levels of Proto-oncogene c-Fos proteins resulting from FOS-FOSB translocation were recently demonstrated in osteoblastomas, we also evaluated the immunoexpression of these proteins.Study Design: Records of all cases of epithelioid osteoblastoma of the jaws were retrieved from oral pathology services, and their clinicopathologic and immunohistochemical data were collected. Immunohistochemistry was also performed by using anti-FOS and anti-FOSB antibodies.Results: Six cases of epithelioid osteoblastomas were obtained, 4 in men and 2 in women, and they were mainly located in the posterior body of the mandible (n = 4). Radiographically, the tumors showed mixed radiolucent and radiopaque images, most with poorly defined margins. Microscopically, large epithelioid cells with eccentrically located nuclei predominated among osteoid and immature bone trabeculae. Sharp delineation from adjacent normal bone was observed in all cases. FOS immunostaining was diffuse and strong in the cytoplasm and nucleus of neoplastic cells in all cases, whereas FOSB was only focally positive, with few epithelioid osteoblasts showing nuclear staining.Conclusions: Although epithelioid osteoblastomas of the jaws are locally aggressive, widespread metastasis does not occur, and, as with conventional osteoblastomas, there is wide expression of the FOS protein. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the proteome of adenoid cystic carcinoma (AdCC) and polymorphous adenocarcinoma (PAc) and to identify a protein signature useful in distinguishing these two neoplasms. Ten cases of AdCC and 10 cases of PAc were microdissected for enrichment of neoplastic tissue. The samples were submitted to liquid chromatography–tandem mass spectrometry (LC-MS/MS), and the proteomics data were analyzed by using the MaxQuant software. LC-MS/MS spectra were searched against the Human UniProt database, and statistical analyses were performed with Perseus software. Bioinformatic analyses were performed by using discovery-based proteomic data on both tumors. LC-MS/MS analysis identified 1957 proteins. The tumors shared 1590 proteins, and 261 were exclusively identified in AdCC and 106 in PAc. Clustering analysis of the statistically significant proteins clearly separated AdCC from PAc. Protein expression 10 times higher in one group than in the other led to a signature of 16 proteins—6 upregulated in AdCC and 10 in PAc. A new clustering analysis showed reverse regulation and also differentiated both tumors. Global proteomics may be useful in discriminating these two malignant salivary neoplasms that frequently show clinical and microscopic overlaps, but additional validation studies are still necessary to determine the diagnostic potential of the protein signature obtained. [ABSTRACT FROM AUTHOR]

Dentinogenic ghost cell tumor (DGCT), a rare, benign odontogenic tumor with aggressive behavior, causes bone destruction and cortical expansion. We report here a case of DGCT in a 38-year-old male, presenting with enormous extraoral protrusion, which radiographically was predominantly radiolucent with radiopaque areas. Microscopically, it was observed to be a solid ameloblastomatous proliferation with pseudoglandular structures associated with clusters of ghost cells. Abundant dentinoid material adjacent to the epithelial sheets containing entrapped epithelial tumor cells was also evident. Immunohistochemistry revealed positivity for pan-cytokeratin (CK), CK-14, CK-7, and CK-19; CD138; and β-catenin. The Ki-67 proliferative index was very low (<1%). The clinical, histopathologic, and immunohistochemical features led to the diagnosis of DGCT. The patient underwent partial mandibulectomy, and no recurrences have occurred. To our knowledge, this is the largest DGCT described in the English language literature. [ABSTRACT FROM AUTHOR]

SMARCB1 (INI-1)-deficient sinonasal carcinoma is a newly recognized rare and aggressive subtype of sinonasal undifferentiated carcinoma and defined by the loss of nuclear SMARCB1 (INI-1) expression by immunohistochemistry. This report describes a case of SMARCB1-deficient sinonasal carcinoma in a 62-year-old male. Clinical examination revealed an expansive lesion on the left hemiface that affected the orbital cavity, paranasal region, nose, upper lip, maxilla, buccal mucosa, and oropharynx. Computed tomography confirmed an infiltrative mass of the paranasal sinus, with intraoral and orbital extension. Incisional biopsy from the mass was taken and reported as sinonasal undifferentiated carcinoma. Immunohistochemistry showed that the tumor cells were positive for AE1/AE3 and p63. Accordingly, BRD4-NUT, CD99, Chromogranin, EBV, INSM1, NKX2.2, p16, SMARCA4, S100, and Synaptophysin were all negative. INI-1 stain showed loss of expression. Unfortunately, the patient died before receiving the diagnosis of SMARCB1 (INI-1)-deficient sinonasal carcinoma. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to describe the clinicopathologic and immunohistochemical features of acute lymphoblastic leukemia/lymphoma (ALL/LBL) of the oral and maxillofacial region (OMF).Study Design: Cases diagnosed as ALL/LBL of the OMF region were retrieved from the files of 2 Brazilian and 1 Guatemalan oral pathology services from 2005 to 2017. Microscopic and immunohistochemical features of each case were reviewed and fully described, and clinical data were retrieved from the pathology reports.Results: During the period considered, 6 cases were identified. Male patients were the most affected (4:2), with a mean age of 19 years old. The mandible was involved in 2 cases, the maxilla in 2, the cheek mucosa in 1, and the parotid gland in 1. Painful swelling was the most common presentation, and 3 patients also had systemic complaints. Microscopically, tumors revealed solid infiltrations of small to medium-sized immature cells. "Puzzle-like" and "starry-sky" patterns were observed, and "single lane" growth was also identified. Immunohistochemically, 2 cases were diagnosed as T-cell ALL/LBL with the leukocyte common antigen (LCA)+/cCD3+/CD79 a+focal/CD20-/PAX5-/CD99+/CD34-/CD10+/terminal deoxynucleotidyl transferase (TdT)+ phenotype and 4 as B-cell ALL/LBL with the LCA+/CD3-/CD20-/CD79 a+/CD10+/CD34 variable/TdT+ predominant phenotype. The Ki67 index ranged from 80% to 99%.Conclusion: OMF ALL/LBL is rare, but its microscopic features and immunohistochemical profiles CD3+or CD79 a+/CD10+/CD34+variable/CD99+/TdT+ contribute to the correct diagnosis. [ABSTRACT FROM AUTHOR]

To analyze the expression of biomarkers of cell proliferation and apoptosis in a murine model of sarcoma 180 (S180) treated with ethanolic extract of Himatanthus bracteatus (EEHB). S180 cells were transplanted to 30 mice treated with saline solution, 5-fluorouracil (5-FU), and EEHB (30 mg/kg) for 7 days. After euthanasia, tumor growth inhibition (TGI) and morphologic features of the tumors were assessed. Histochemical detection of in situ DNA fragmentation (TUNEL) and immunohistochemical expression of Ki-67, caspase-3, and cleaved caspase-3 were also analyzed. No significant difference was observed between the TGI in 5-FU (71.8 ± 8.1%) and EEHB (58.1 ± 6.0%; P >.05). Ki-67 expression was higher in saline (39.8 ± 2.3%) than in 5-FU (23.9 ± 1.0%; P <.005) and EEHB (24.2 ± 0.5%; P <.05), whereas TUNEL, caspase-3, and cleaved caspase-3 expressions were significantly lower in saline (6.1 ± 0.6, 1.3 ± 0.09, 4.8 ± 0.5, respectively) than in 5-FU (18.0 ± 1.5, 2.5 ± 0.06, 16.8 ± 0.8, respectively; P <.001) and EEHB (16.9 ± 1.3, 1.7 ± 0.06, 16.3 ± 0.4, respectively; P <.05). The data suggest the involvement of the caspase-dependent apoptotic pathway in the antitumor activity promoted by EEHB. [ABSTRACT FROM AUTHOR]

Hydroa vacciniforme–like lymphoproliferative disorder (HVLPD) is a chronic Epstein-Barr virus (EBV)-positive lymphoproliferative disease that may either present as an indolent condition or progress to a systemic T-cell lymphoma. This study presents the clinicopathologic data, microscopic findings, and EBV status of 11 cases of HVLPD with oral involvement. A male predilection (7:4) was observed, with mean patient age of 25.1 years. The lips and buccal mucosa were the most affected sites. Lesions appeared as painful ulcers. The patients also showed facial edema and erythema. Microscopic findings included moderate to severe T-cell infiltrate with angiotropism, angiocentricity, and epidermotropism. Two cases affecting the skin on the lip exhibited a periappendageal lymphocytic infiltrate. Immunohistochemistry reactions confirmed the cytotoxic T-cell (CD8+) phenotype, and in situ hybridization showed the presence of EBV in all cases. The clinical course was aggressive, and all patients died. HVLPD is a rare and aggressive disease that may show oral involvement. [ABSTRACT FROM AUTHOR]

Myofibroblastic sarcoma (MS) has been described as a rare malignant mesenchymal tumor showing myofibroblastic differentiation, with a predilection for the head and neck region. We report a case of an aggressive MS in a 27-year-old male patient presenting as an ulcerated mass affecting the posterior mandible region. Radiographic images showed diffuse bone destruction. Histopathologic analysis revealed an intense proliferation of fusiform and round highly pleomorphic cells, randomly arranged in a vascularized and myxoid stroma. Immunohistochemically, tumor cells were positive for vimentin, smooth muscle actin, and calponin. The Ki-67 proliferation index was high. S-100 protein, desmin, pan-cytokeratin (AE1AE3), CD99, and h-caldesmon were negative. Hence, a diagnosis of myofibroblastic sarcoma was yielded. After the incisional biopsy, the lesion rapidly increased in size. The patient was admitted to intensive care and started a chemotherapy regimen but died 3 months later. [ABSTRACT FROM AUTHOR]

Leiomyosarcomas are rare malignant tumors that affect smooth muscle tissue. In the oral cavity, leiomyosarcomas are exceedingly rare. The diagnosis is challenging due to the overlap of morphologic findings with several spindle cell tumors. Herein, we reported a rare recurrent case of leiomyosarcoma in a 73-year-old woman presenting clinically as a painful nodule on the buccal mucosa. Microscopically, the tumor showed atypical spindle cells with elongated, blunt-ended nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. Immunohistochemistry showed positivity for vimentin, α-SMA, HHF35, h-Caldesmon, and focal positivity for desmin. S-100 protein, CD34, myogenin, and pan-cytokeratin (AE1/AE3) were negative. Surgical excision followed by chemotherapy was performed. No recurrence was observed after 12 months of follow-up. Careful histopathologic analysis, supported by immunohistochemistry, is essential to ensure a correct diagnosis. Early wide surgical excision and prolonged follow-up is strongly recommended. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate hMutS proteins in developing human tooth, ameloblastomas, and ameloblastic carcinoma and to determine whether the expression of these proteins has any prognostic potential.Study Design: Ten cases of developing human tooth, 39 ameloblastomas, and 2 ameloblastic carcinomas were used to determine the distribution of the proteins during the process of carcinogenesis. Simultaneously, another sample of 73 ameloblastomas was arranged in tissue microarray, and their clinical, microscopic, and radiographic features; treatment outcome; presence of BRAF-V600E mutation; and follow-up data were assessed to determine the prognostic relevance of the expression of hMutS (hMSH2, hMSH3, hMSH6) and Ki-67. hMSH2 and hMSH6 were significantly downexpressed in ameloblastomas (P = .0059) compared with developing human tooth (P < .0001).Results: hMSH2, hMSH3 expression were significantly associated with BRAF-V600E mutation (P < .05). Simultaneous overexpression of hMutS was associated with recurrence (P = .035); however, these did not predict the disease-free survival of patients (P > .05).Conclusions: hMutS proteins are downregulated in ameloblastoma; moreover, simultaneous overexpression of these proteins in ameloblastoma was associated with recurrence but did not predict disease-free survival. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that intravenous (IV) bisphosphonate (BP) therapy thickens or alters the micromorphology of cementum and periodontal ligament (PDL) in cancer patients.Study Design: Thirty-two teeth extracted from 24 cancer patients and separated into test (patients who have undergone IV BP therapy, n = 16) and control (patients naive to BP therapy, n = 16) groups were studied. Cementum thickness was measured in 3 different areas of the dental root with polarized light microscopy. PDL was assessed by optical light microscopy and the immunohistochemical expression of periostin.Results: No significant difference was detected in cementum thickness (apical, P = .06; medium, P = .16; cervical, P = .18) between groups. The numbers of fibroblasts in PDL (P = .56), incremental lines of cementum (P = .51) and the immunohistochemical patterns of periostin expression in PDL (P = .68) did not differ between groups.Conclusion: IV BP therapy does not thicken cementum or change the micromorphology of PDL. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to characterize the histomorphometric features of subgemmal neurogenous plaques (SNPs) to better understand their relationship to surrounding microanatomy included in the tissue biopsy samples of the tongue.Study Design: A 12-year retrospective study on the files of 3 oral pathology centers yielded 28 SNPs. Hematoxylin and eosin-stained sections were used for histologic analysis, and immunohistochemical staining for S100 protein was performed to better characterize the neural structures. Slides were scanned and histomorphometric analysis carried out using ImageScope software.Results: Twenty-one women (75%) and 6 men (21.4%) comprised the sample (mean age 46.4 and 49 years, respectively). Twenty cases (71.4%) were juxtaposed to the tongue epithelium and 16 cases (57.1%) were associated with lymphoid tissue. The mean area of the SNPs was 0.160 mm2, and the mean distance to the overlying epithelium was 0.312 mm.Conclusions: SNPs are normal neural structures located on the posterior border of the tongue that represent a non-neoplastic regional anatomic variation. In some cases, signs or symptoms may be present, and further investigation should be performed. Pathologists should be aware of this entity to avoid confusion with neural lesions. [ABSTRACT FROM AUTHOR]

Objective: The progression of pleomorphic adenoma (PA) to carcinoma ex-pleomorphic adenoma (CXPA) encompasses several genomic alterations involving complex pathways. Tumor suppressor genes seem to play important roles in the tumorigenesis of both tumors. The aim of this study was to evaluate copy number and methylation of tumor suppressor genes' status in PA and CXPA samples.Study Design: Eight cases of PA, 2 cases of residual PA in CXPA, and 5 cases of CXPA were studied; the latter were classified according to invasiveness and histopathological subtype. Changes in 41 tumor suppressor genes were evaluated by multiplex ligation-probe dependent amplification analysis.Results: Copy number losses of CASP8, MLH1, and RARB genes were associated with PA and CXPA, while KLK3 and AI69125 copy number losses were exclusive to CXPA. The sarcomatoid carcinoma showed more copy number alterations compared with other subtypes. Hypermethylation of RASSF1 was found mainly in PA and less frequently in malignant tumors.Conclusions: CASP8, MLH1, and RARB tumor suppressor genes were altered by copy number losses during PA progression to CXPA. Lastly, RASSF1 inactivation by methylation was also detected in both tumors. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinicopathologic and immunohistochemical features of five cases of oral solitary fibrous tumor.Study Design: Clinical data were collected from charts of two oral pathology laboratories of Latin America. All cases were evaluated by conventional hematoxylin and eosin staining and an extended immunohistochemical panel comprising vimentin, CD34, CD99, bcl-2, HHF-35, smooth muscle actin, calponin, S-100 protein, h-caldesmon, and Ki-67.Results: The study included 1 male (20%) and 4 female (80%) patients, with a median age of 43 years. The most common affected site was the buccal mucosa (40%). Tumors were characterized by proliferation of spindled and ovoid cells in a variably vascular and collagenized stroma. All tumors were positive for vimentin, CD34, bcl-2, and CD99. Recurrence was not observed after complete surgical enucleation.Conclusions: Oral solitary fibrous tumors usually appear as well-delimited submucous nodules with a firm-rubbery consistency and covered by intact mucosa. Immunoreactivity for CD34, bcl-2, and CD-99 is helpful to confirm the diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: A subgroup of tonsillar squamous cell carcinoma (SCC) is associated with human papillomavirus (HPV). Nevertheless, the prevalence of HPV seems to be variable in different regions and ethnic groups. There are no reports of HPV in tonsillar carcinomas in Guatemala, and data from Brazil are scarce. The aim of this study is to analyze and compare HPV presence in samples of tonsillar SCC from these countries.Study Design: This study describes the histologic features, expression of p16 by immunohistochemistry (IHC), and HPV by in situ hybridization (ISH) in 13 Guatemalan and 13 Brazilian patients.Results: All cases of tonsillar SCC from Guatemala were positive for p16, 92% expressed HPV by ISH, and 75% corresponded to the high-risk genotype 16/18. From the Brazilian patients, only four expressed p16, and all were negative for HPV.Conclusions: Cases from Guatemala, which were mostly nonkeratinizing SCC and originated from the crypt/reticular epithelium of the tonsil, had high-risk integrated HPV, whereas in Brazilian cases, which were mostly keratinizing SCC that originated from the surface epithelium, there was no association with HPV. [ABSTRACT FROM AUTHOR]

Background: Several studies have reported the clinical aspects of oral syphilis, but few papers have considered the involved immunoinflammatory mechanisms.Objective: To analyze the clinicopathologic features and expression of immunoinflammatory and vascular proteins in oral secondary syphilis.Study Design: Fifteen patients with oral secondary syphilis were included; histologic features were analyzed using hematoxylin-eosin-stained histologic slides and immunohistochemical reactions were performed against intercellular adhesion molecule 1 (ICAM-1), vascular endothelial growth factor (VEGF), and CD34.Results: Lesions presented as multiple plaques and ulcers mostly located on the tongue, lips, and palate. They were covered by a stratified epithelium of irregular thickness showing exocytosis associated with a subjacent plasma cell infiltrate arranged in perivascular and perineural patterns. ICAM-1 and VEGF were expressed on endothelial cells and leukocytes, and microvessel density was similar on the superficial and deep regions of the connective tissue.Conclusions: Expression of immunoinflammatory and vascular proteins was intense, suggesting their participation on the pathogenesis of oral secondary syphilis. [ABSTRACT FROM AUTHOR]

To analyze the effect of topical application of a photopolymerizable hydrogel based on methacrylated gelatin containing 2% ethanolic extract of Himatanthus bracteatus (GelMA-HB) on wound healing in rodents. Standard-sized (0.8 cm diameter) round-shaped wounds were made in the back of Wistar rats treated with photopolymerizable hydrogel based on methacrylated gelatin (GelMA), GelMA-HB, and saline (CTR). The animals were euthanized after 3, 7, and 14 days. Wound retraction index (WRi), wound healing histologic grading (WHHG), and immunohistochemical expression of α-SMA and CD105 were assessed for myofibroblastic differentiation (MFd) and microvascular density (MVd) analysis, respectively. The WRi and WHHG in GelMA-HB were significantly greater than in GelMA (P <.05) and CTR (P <.01) over the full time course of the experiment. Both the MFd and MVd were greater in GelMA-HB than in CTR on day 3 (P <.05) and day 7 (P <.001). The GelMA-based formulation containing ethanolic extract of H. bracteatus improved wound healing in a rodent model, and such biological effects might be related to the modulation of myofibroblastic and microvascular differentiation over the course of wound healing. [ABSTRACT FROM AUTHOR]

This retrospective study was designed to determine the contribution of immunohistochemistry (IHC) in the primary diagnosis of oral diseases in one of the main services of oral pathology in the state of São Paulo, Brazil, as well as to identify the most common antibodies used and recommend algorithms based on our experience with controversial lesions. Among 27,677 cases received from 2007 to 2019, 371 cases required a total of 1549 immunohistochemical stains (1.3%). The most used antibodies were Ki-67, S-100, α-SMA, and CD34. Among the definitive diagnoses, 41.2% were malignant tumors, 52.3% benign, 1% lesions of uncertain malignancy, 2.7% premalignant, 2.4% reactive, and 0.2% inconclusive. Only a small percentage of cases required IHC and only 25.3% of IHCs performed were mandatory to reach the diagnoses. The inherent limitation of incisional biopsies was also cited as a reason for inconclusive diagnoses, despite a wide range of antibodies our laboratory displays. [ABSTRACT FROM AUTHOR]

The aim of the present study was to evaluate the clinicopathologic features of oropharyngeal squamous cell carcinoma (OPSCC) in a population from Rio de Janeiro, Brazil. One hundred fifty-two patients were diagnosed with primary OPSCC in an oral pathology laboratory between 2014 and 2020. Demographic and clinical data were retrospectively collected from the records and all cases were microscopically classified as keratinizing, nonkeratinizing, or nonkeratinizing with maturation. Immunohistochemistry for p16INK4a was performed in 46 cases (30.2%) and the positive ones were submitted to DNA in situ hybridization (ISH) for human papillomavirus (HPV). There were 29 females and 123 males, with a mean age of 61 years (range, 39-89). Most patients regularly consumed tobacco (69%) and alcohol (50.7%) and lived in low socioeconomic status areas. Most tumors measured more than 2 cm and were located mainly in the soft palate (48%), followed by unspecified oropharynx, tonsil, and base of the tongue. The 3 histologic subtypes were similarly distributed among the cases. Five cases were positive for p16INK4a (10.9%), and of these, 4 were positive for HPV by DNA ISH (8.7%), most of them nonkeratinizing. HPV prevalence is low in OPSCC cases from this Brazilian population. [ABSTRACT FROM AUTHOR]

To report the clinicopathologic features of a large series of oral mucoceles from Brazil. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records of oral and maxillofacial lesions from 4 pathology services in Brazil were analyzed. All cases of oral mucoceles were reviewed, and clinical and demographic data were collected. The study comprised 1002 females (56.2%) and 782 males (43.8%) with a mean age of 19.8 ± 16.4 years (range, 01-87 years). The lower lip (n = 1,160, 67.4%) and floor of mouth (n = 172, 10.0%) were the most common affected sites, presenting clinically as nodules (n = 978, 79.4%) with a smooth surface (n = 428, 77.5%) and normal color (n = 768, 46.7%). Excisional biopsy was the treatment in most cases (n = 1392, 78.0%). Recurrent oral mucoceles represented 6.2% of all diagnosed cases (n = 117). Our results confirm the findings of previous studies regarding the major clinical features of oral mucoceles. Mucoceles are lesions commonly seen in oral pathology and oral medicine services, mainly affecting the lower lip of children and young adults. [ABSTRACT FROM AUTHOR]

To report the clinicopathologic features of 132 cases of the oral lymphoepithelial cyst (OLC). A retrospective descriptive cross-sectional study was performed. A total of 106,282 biopsy records of oral and maxillofacial lesions from 6 oral pathology services in Brazil were analyzed. All cases of OLCs were reviewed and clinical, demographic, and histopathologic data were collected. Among all lesions, there were 132 cases of OLC (0.11%). The series included 83 females (62.9%) and 49 males (37.1%), with a mean age of 45.8 ± 17.7 years (range, 04-88 years). Patients in the fifth and sixth decades of life were most affected (n = 24; 18.2% for both decades). Most cases involved the tongue (n = 80; 62.0%), followed by floor of the mouth (n = 32; 24.8%). Tumor size varied from 0.4 to 2.0 cm (0.45 ± 0.28) and most lesions were asymptomatic (n = 93; 91.2%). No recurrences were observed after surgical excision. Clinical and demographic features were similar to those described in previous studies. Overall, this lesion has a predilection for the posterior region of the tongue of female adults. [ABSTRACT FROM AUTHOR]

Intraoral sebaceous carcinoma (SC) is extremely rare on the tongue. The clinical-pathologic and immunohistochemical characteristics of a rare case of SC in a 59-year-old man is presented. The patient had painful ulcers in the posterior region of the tongue. Microscopically, the tumor was composed of atypical basaloid cells with rounded to oval nuclei and prominent nucleoli arranged in lobes, with prominent sebaceous differentiation and areas of holocrine secretion. Staining with periodic acid-Schiff and staining with mucicarmine were negative in neoplastic cells. By immunohistochemistry, tumor cells were positive for pan-cytokeratin AE1/AE3 and epithelial membrane antigen. The sebaceous cells were positive for adipophilin and perforin. The diagnosis was SC. Ample surgical excision was performed followed by adjuvant chemotherapy and radiotherapy. Careful histopathologic analysis of these lesions is essential to ensure a correct diagnosis and increase the patient's survival time. [ABSTRACT FROM AUTHOR]

Oncocytic lipoadenoma (OL) is a rare salivary gland tumor characterized by the presence of oncocytic cells and mature adipose tissue. To date, only 30 cases of OL have been reported in the English-language literature. We present 3 additional OL cases involving the parotid. Microscopically, the tumors were composed of a mixed population of oncocytes and adipocytes in varying proportions surrounded by a thin, connective tissue fibrous capsule. Oncocytes were positive for pan-cytokeratins AE1/AE3, epithelial membrane antigen, CK-5, CK-7, CK-14, CK-18, and CK-19. Calponin, p63, smooth muscle actin, and carcinoembryonic antigen were negative. Vimentin and S-100 protein were positive only in adipose cells. Despite distinctive morphologic features, OL is often misdiagnosed, given its rarity. Pathologists and surgeons must recognize OLs to avoid misdiagnoses and provide adequate management through conservative surgical excision. [ABSTRACT FROM AUTHOR]

Ectomesenchymal chondromyxoid tumor (ECT) is a rare benign tumor that occurs mainly in the tongue. ECTs on the hard palate are exceedingly rare. We report the clinicopathologic and immunohistochemical features of a rare case of ECT in a 22-year-old male patient positive for human immunodeficiency virus who presented a painless multilobulated swelling measuring 2.0 cm in diameter on the hard palate. Panoramic radiograph revealed no bone changes. An incisional biopsy was performed. Microscopically, the tumor was well-circumscribed and composed of spindle and ovoid cells organized in a lobular arrangement in a chondromyxoid stroma. Immunohistochemistry showed positivity for protein S-100, GFAP, and D2-40. Pan-cytokeratin AE1/AE3, CD34, CD31, and HHV8 were negative. The diagnosis was ECT. The treatment was conservative surgical removal. At 6-month follow-up, no evidence of recurrence was observed. Clinicians and pathologists should consider ECT in the differential diagnosis of oral soft tissue lesions to provide adequate management through conservative surgical removal. [ABSTRACT FROM AUTHOR]

Langerhans cell sarcoma (LCS) is a high-grade neoplasm with overtly malignant cytological features and a Langerhans cell phenotype. Only one previous case has been reported in the oral cavity. A 79-year-old male patient presented for evaluation of multiple lesions affecting the lower lip, hard palate, upper alveolar mucosa, and skin. Biopsy of the lesions affecting the lower lip and palate showed a proliferation of histiocytic cells presenting atypia, pleomorphism, and atypical mitoses. Diagnosis of LCS was supported by immunoreactivity of the neoplastic cells for S-100, CD1a, CD207, and CD83. The patient died from widespread disease 3 months after diagnosis. Due to its rarity, LCS poses a diagnostic problem in the oral cavity and should be considered in the differential diagnosis of histiocytic proliferations. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease is a rare histiocytic disorder of unknown etiology. This study aims to report an uncommon case of the disease in the submandibular region. A 7-year-old female patient presented with submandibular swelling of 3 months' duration. No intraoral manifestations were observed. Computed tomography scan demonstrated reabsorption of the mandibular cortical bone. An incisional biopsy was performed, and microscopic examination showed a diffuse mononuclear cell infiltration, with xanthomatous cells and emperipolesis of the lymphocytes. Immunohistochemistry was positive for LCA, CD3, CD20, VS38C, CD68, and S100 and the Ki-67 index was high, leading to the diagnosis of Rosai-Dorfman disease. Blood count evidenced anemia. Other affected sites were discarded by bone scintigraphy. Corticoid therapy with prednisone 40 mg for 6 months was prescribed. The patient was lost to follow-up. Rosai-Dorfman disease involving gnathic bones is rare and requires early diagnosis due to the possibility of spontaneous remission and conservative treatment. [ABSTRACT FROM AUTHOR]

Drug-induced sarcoidosis-like reaction (DISR) is almost indistinguishable from sarcoidosis, and it manifests as a systemic granulomatous tissue reaction occurring in a temporal association with initiation of an offending drug. This study presents a rare case of DISR with oral involvement. A 63-year-old woman with a history of rheumatoid arthritis who has been treated with adalimumab presented with multiple ulcerative nodules on the hard palate, with 15 days of duration. Imaging exams did not exhibit any alteration. Blood tests and serological investigations were negative. An incisional biopsy was performed. Microscopic examination demonstrated a granulomatous inflammatory process in the connective tissue, consisting of multiple granulomas, without evidence of caseating necrosis or microorganisms. Histochemical reactions were negative for acid-fast bacilli and fungi, and immunohistochemical assessment for CD3, CD20, and CD68 highlighted the presence of normal lymphocytes and histiocytes. Adalimumab was ceased and after 17 months complete resolution of the lesions was observed. [ABSTRACT FROM AUTHOR]

Plasma cell neoplasms represent the proliferation of single clone of plasma cells with production of monoclonal immunoglobulins. This study aims to report a case series of plasmacytoma (PMC) and multiple myeloma (MM) of the oral cavity. Data were retrospectively retrieved and clinical, radiographic, microscopic, immunohistochemistry, and follow-up status were collected. Eight cases were included (3 PMC and 5 MM) with a mean age of 53.6 years old (range, 27-78) and a male predilection. Lesions mostly presented as painful swellings in the mandible. Radiographic aspects evidenced multilocular poorly defined lesions and microscopic examinations showed proliferation of plasma cells with abundant eosinophilic cytoplasm. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, with kappa light chain monoclonality predominance. Overall survival was poor, and 6 patients died, with a mean follow-up time of 5.7 months (range, 1-22). PMC and MM are aggressive neoplasms with a poor prognosis. [ABSTRACT FROM AUTHOR]

The aim of the present study is to report the clinicopathologic features of 2 new cases of ameloblastic fibrosarcoma (AFS). Case 1 was a 9-year-old boy presenting with a painful ulcerated swelling in the posterior mandible causing facial asymmetry. Case 2 presented as an asymptomatic swelling in the anterior mandible of a 14-year-old female patient. Imaging exams revealed destructive multilocular radiolucencies with irregular margins, associated with impacted teeth, causing exuberant cortical expansion and tooth displacement. Microscopically, both cases showed mesenchymal cells with marked hypercellularity and nuclear pleomorphism containing small islands of odontogenic epithelium with peripheral palisading. Both patients were treated by surgical excision; case 1 showed recurrence after 2 years of follow-up. AFS usually affects the posterior mandible of young adults with previous history of ameloblastic fibroma; nevertheless, clinicians should also consider this rare odontogenic sarcoma when evaluating aggressive ill-defined radiolucent lesions in the mandible of pediatric patients. [ABSTRACT FROM AUTHOR]

Sialolipoma is a histologic variant of lipoma characterized by proliferation of mature adipocytes with secondary entrapment of normal salivary gland tissue. These tumors occur mainly in the parotid gland and palate of female adults. Herein, we report a rare case of a sialolipoma in a 42-year-old male patient, presenting as a painless yellowish nodular lesion of soft consistency on the border of the tongue. A provisional diagnosis of lipoma was established, and an excisional biopsy was performed. Histopathologic analysis revealed a proliferation of mature adipocytes in a lobular arrangement with secondary entrapment of normal salivary gland tissue. The diagnosis was sialolipoma. The patient remains with no evidence of recurrence at 5-month follow-up. Pathologists must recognize sialolipomas to avoid misdiagnoses with other lipomatous tumors that can affect salivary glands. [ABSTRACT FROM AUTHOR]

The relationship between infection by human immunodeficiency virus (HIV) and oral lymphoepithelial cyst (OLC) is uncertain. Herein, we presented a rare case of OLC on the tongue in a male patient with HIV. Intraoral examination revealed a yellow nodular lesion with a smooth surface on the tongue's right lateral border measuring 0.8 cm. Medical history revealed that the patient had been diagnosed with HIV 1 month earlier and was being treated with antiretroviral therapy. An excisional biopsy was performed. Histopathologic examination showed a cystic lesion covered by squamous epithelium surrounded by a fibrous capsule containing dense lymphoid infiltrate with prominent germinal centers. The diagnosis was OLC. No evidence of recurrence was observed after 1 year of follow-up. Although rare, OLC can arise in the context of HIV infection. The treatment of choice is conservative surgical removal, and recurrence is uncommon. [ABSTRACT FROM AUTHOR]

Plasmablastic lymphoma (PBL) is a rare large B-cell lymphoma usually affecting the oral cavity of patients positive for human immunodeficiency virus (HIV). Association with Epstein-Barr virus has been reported. A 61-year-old male patient with HIV presented with an asymptomatic, diffuse, and poorly delimited swelling on the left hard palate, covered by healthy mucosa, with unknown time of onset. Extraoral examination revealed no alteration. Incisional biopsy was performed, and microscopic examination revealed a hematologic neoplasm characterized by proliferation of plasmocytes showing cellular pleomorphism and numerous mitotic figures. Areas with a "starry-sky" appearance were noted. Immunohistochemistry was positive for plasma cell, lambda, and MUM-1. Ki-67 revealed a high proliferative index. In situ hybridization revealed positivity for Epstein-Barr virus. Based on these findings, PBL was diagnosed. The patient was referred for treatment, which included surgery and chemotherapy, with good therapeutic response. Currently, radiotherapy is being performed. [ABSTRACT FROM AUTHOR]

A 51-year-old man was referred to the Oral Medicine Clinic with an asymptomatic slow-growing palatal injury with a 15-year evolution history. Extraoral examination showed no gross abnormalities. Intraoral examination revealed a firm sessile nodule of normal coloration in the palatal mucosa adjacent to teeth #13 and #14, measuring approximately 2 cm. Imaging exams did not show bone changes. As diagnostic hypotheses, peripheral ossifying fibroma and inflammatory fibrous hyperplasia were considered. Excisional biopsy of the lesion was performed, and microscopic sections stained with hematoxylin and eosin revealed odontogenic epithelial islands in the oral lamina propria, composed of hyperchromatic columnar cells showing peripheral palisading, reverse polarization, and central stellate reticulum-like changes immersed in a dense connective tissue. Following clinicopathologic correlation, the diagnosis of peripheral ameloblastoma was established. Follow-up is ongoing and no recurrence has been detected so far. [ABSTRACT FROM AUTHOR]

A 37-year-old afrodescendant man presented a nodular lesion on the palate, with 2 years of evolution and history of pain and ulceration in the last 6 months. The provisional diagnosis was salivary gland neoplasia. An incisional biopsy revealed areas of typical pleomorphic adenoma (PA) associated with mucous, clear and atypical squamous cells, and cystic spaces. Immunohistochemical positivity for AE1/AE3, CK 7, CK14, CK19, p63, and Ki-67 (30%) was observed. The diagnosis was carcinoma ex-pleomorphic adenoma (CEPA). The tumor was resected, with a safety margin, and complementary chemo and radiotherapy were performed. No recurrence was observed after 1 year of follow-up. CEPA represents a malignant change in a pre-existing PA, which is extremely uncommon in minor salivary glands. Despite the rarity, this tumor must be considered in the differential diagnosis of intraoral salivary gland tumors with sudden changes in their clinical behavior. [ABSTRACT FROM AUTHOR]

Fibrous dysplasia (FD) associated with cystic degenerations has been reported. Diagnosis and management of these conditions are very challenging for dentists and surgeons. This study aimed to show a case of such an association involving craniofacial bones. A 55-year-old woman with a history of localized facial pain and ocular pressure was referred to us. She was submitted to a surgical procedure in another service followed by complete improvement of the symptoms. During our evaluation, the patient presented facial asymmetry on the right side. Computed tomography revealed a "ground glass" lesion involving multiple craniofacial bones in the right side. Moreover, an extensive hypodense and unilocular lesion was presented in the maxilla. Our main diagnosis hypothesis was FD associated with cystic degeneration. Treatment was proposed. The lesions were stable for 6 years. The knowledge of this association is essential to avoid unnecessary procedures. [ABSTRACT FROM AUTHOR]

Objective The aim of this case study was to describe an international case series of polymorphous low-grade adenocarcinoma (PLGA) affecting the upper lip. Material and Methods Over a 30-year-period, the files of five pathology services were reviewed for PLGA affecting the upper lip. Hematoxylin and eosin–stained slides were reviewed by three oral and maxillofacial pathologists, and microscopic features were described. Clinical data were retrieved from patients' medical records. Results The review identified 11 cases of upper lip PLGAs, with a complete set of clinical data available for 5 cases. There was a male predominance (1.2:1), and the mean age was 58.7 years. Most cases presented as small asymptomatic swellings that resembled benign tumors. All patients underwent surgery, and no recurrences or metastases were reported in the 8 cases from which follow-up data were available. Microscopically, the typical polymorphic architectural arrangement of PLGA was seen in all cases, with lobular, trabecular, papillary, and cribriform patterns identified. Perineural invasion, normal gland entrapment, Indian filing, and concentric growth were frequently identified. Conclusion PLGA must be included in the list of differential diagnoses of tumors affecting the upper lip because of its similar clinical presentation to benign entities. The follow-up data available from 8 of 11 cases suggest that these tumors follow a low-grade clinical course, similar to the majority of palatal cases of PLGA. [ABSTRACT FROM AUTHOR]