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Introduction: This study was intended to evaluate the expression of inflammatory cytokines commonly secreted by CD4+ T cells (IL-2, IL-5, IL-17, TGF-β, TNF-α, and IFN-γ) in apical granulomas and correlate with the clinical conditions and time elapsed since root canal treatment., Methods: Eighteen biopsy specimens obtained by periradicular surgery of teeth with post-treatment apical periodontitis and diagnosed as apical granuloma were available from the oral pathology laboratory. Silanized slides containing paraffin sections were used for immunohistochemical reactions. Images were analyzed by using an optical microscopy and each slide was subdivided into 5 fields at high magnification., Results: IFN-γ and TGF-β were the cytokines with the highest expression levels. There were statistically significant differences when comparing IL-2 and IFN-γ (P < .05), and IL-2 and TGF-β (P < .05). Comparison between the detected cytokines and clinical data and time of treatment demonstrated significant correlation (P < .05) between lower expression of IL-2 and the presence of painful symptoms, absence of sinus tract, and treatments performed more than 4 years before. It was also possible to observe a significant correlation between lower expression of IL-5 and treatments performed less than 4 years before (P < .05)., Conclusion: IFN-γ and TGF-β were highly expressed in apical granulomas. However, only IL-2 and IL-5 levels were associated with clinical data and time since previous root canal treatment., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Smoking can be considered a risk factor for chronic apical periodontitis (CAP). This study compared the immunoexpression of biomarkers receptor activator of nuclear factor kappa B ligand (RANKL), osteoprotegerin (OPG), osteopontin (OPN), and tumor necrosis factor alpha (TNF-α) in CAP in smokers and nonsmokers., Methods: Twelve smokers and 12 nonsmokers diagnosed with CAP and indicated for tooth extraction were selected. Exclusion factors were teeth with a diagnosis of root fracture, previous endodontic treatment, or endoperiodontal injury, in addition to individuals with systemic diseases, under 18 years of age, users of anti-inflammatory and/or antibiotics in the last 3 months, and drug users. Specimens were processed for histopathologic and immunohistochemical analysis., Results: Qualitative analysis of RANKL expression showed 66.66% weak/moderate and 33.33% strong in smokers and 100% weak/moderate in nonsmokers. OPG and OPN expressions were 100% negative to focal in the smoker group and 50% negative to focal and 50% weak/moderate in the nonsmoker group. TNF-α was 25% negative to focal and 75% weak/moderate in the smoker group and 33.33% negative to focal and 66.66% weak/moderate in the nonsmoker group. Quantitative analysis of the data using the Mann-Whitney U test showed that there was a significant difference in the immunoexpression of RANKL (P < .05), OPG (P < .05), and OPN (P < .05), but there was no statistical difference in the immunoexpression of TNF-α (P > .05) between the 2 groups., Conclusions: These findings suggest that smoking is capable of altering the inflammatory response, influencing the evolution of CAP., (Copyright © 2022 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the clinicopathologic features of mantle cell lymphoma (MCL) involving the oral and maxillofacial region., Methods: The MCL cases were retrieved from the pathosis database of 6 pathology laboratories. Original hematoxylin and eosin slides and immunohistochemical reactions were reviewed for confirmation of the initial diagnosis. Clinical data of the cases were obtained from the patients' pathosis and/or medical charts., Results: Twenty cases were included in the study, showing a male predominance and a mean age of 66 years. The oral cavity (12 cases) and the oropharynx (5 cases) were the most commonly involved subsites. Most cases presented as asymptomatic swellings, with 2 cases showing bilateral involvement of the palate. The classic histologic variant predominated (12/20 cases). All cases expressed CD20 with nuclear cyclin D1 positivity. SOX11 was seen in 9/13 cases, CD5 in 6/16 cases, Bcl2 in 16/19 cases, CD10 in 2/20 cases, and Bcl6 in 4/16 cases. Ki67 showed a mean proliferation index of 40.6%. The Epstein-Barr virus (EBV) was negative in all cases investigated. Follow-up data was available for 7 patients, with 5 currently alive and 2 deceased., Conclusion: Mantle cell lymphoma, albeit rare, may manifest in the oral and maxillofacial region. Its histologic heterogeneity demands a high degree of diagnostic skill from pathologists., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This review outlines the historical perspective, status, and future challenges of oral medicine (stomatology) in Brazil based on the records of the Brazilian Society of Stomatology and Oral Pathology (SOBEP) and the Brazilian Federal Dental Council as well as expert evidence input from academic leaders from 3 different generations of Brazilian oral medicine specialists. The beginning of oral medicine in Brazil dates to 1969, followed by the organization of SOBEP in 1974; however, official recognition as an independent specialty was achieved more recently within the Brazilian Federal Dental Council in 1992. After a 50-year maturation period of oral medicine in Brazil in terms of specialty crystallization across dentistry, medicine, and research, it is now time to follow the historical trends of the specialty internationally and establish a standard curriculum at a post-graduate level that will lead to uniformity of training for oral medicine in Brazil., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to compare the immunoexpression of biomarkers interleukin (IL)-17, IL-6, and IL-1β in primary chronic apical periodontitis in smokers and nonsmokers., Methods: Teeth with primary chronic apical periodontitis indicated for extraction in 16 cigarette smokers and 16 nonsmokers were selected. Silanized sections of tissue were used for immunohistochemical analysis after being stained with hematoxylin-eosin for histopathologic categorization. Subsequently, the images were analyzed with an optical microscope, and each slide was subdivided into 5 high-magnification fields, with scores (0-2) being assigned according to the amount of staining for each antibody., Results: The qualitative analysis of IL-17 cytokine expression showed no focal expression in 5.8%, weak to moderate expression in 17.6%, and strong expression in 76.4% of the smokers and no focal expression in 78.5% and weak to moderate expression in 21.4% of the nonsmokers. IL-6 expression was negative to focal in 13.3%, weak to moderate in 53.3%, and strong in 33.3% of the smokers and negative to focal in 33.3%, weak to moderate in 25%, and strong in 41.6% of the nonsmokers. IL-1β expression was weak to moderate in 87.5% and negative to focal expression in 12.5% of the smokers and negative to focal expression in 100% of the nonsmokers. Quantitative evaluation of the data using the Mann-Whitney U test showed a significant difference in the immunoexpression of IL-17 (P < .0001) and IL-1β (P < .0001) and no significant difference in the immunoexpression of IL-6 (P = .46) between the 2 groups (P < .05)., Conclusions: The cytokines IL-17 and IL-1β were more highly expressed in smokers than nonsmokers, whereas IL-6 expression was similar in the 2 groups., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study was to describe the clinicopathological, molecular, and prognostic features of oral/oropharyngeal diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma., Study Design: All cases were retrieved from 7 Brazilian institutions. Immunohistochemical reactions were performed to confirm the diagnoses and to categorize the tumors. In situ hybridization was used to detect Epstein-Barr virus (EBV) and fluorescence in situ hybridization was used to identify gene rearrangements., Results: Most cases involved the oral cavity (76.8%). Males and females, with a mean age of 60 years, were evenly affected. Tumors mostly presented as painful swellings. Forty cases represented germinal center B-cell type (58%). Five cases presented double-hit translocation and 3 harbored rearrangement for MYC/BCL2/BCL6. EBV was detected in 3 cases (4.3%). The 5-year overall survival was 44.4%. Female sex, presence of pain and ulcer, microscopic "starry sky pattern" and necrosis, co-expression of c-Myc/Bcl2, and translocation of MYC were associated with a lower survival in univariate analysis (P = .05, P = .01, P = .01, P = .03, P = .05, P = .006, P = .05, respectively)., Conclusion: Patients affected by oral/oropharyngeal DLBCL have a low survival rate. High-grade B-cell lymphoma (17.7%) and EBV-positive DLBCL, not otherwise specified (4.3%) account for a small number of cases., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Introduction: This study evaluated the effects of a high-fat diet (HFD) on the progression of apical periodontitis (AP) in rats., Methods: Eight-week old Wistar rats (N = 24) were included in this study. Half of the animals received an HFD and the other half a control diet (CD). AP lesions were induced 8 weeks later by creating pulp exposure of the mandibular left first molars. The animal's body mass was verified on a weekly basis. After 21 and 40 days, the animals were sacrificed. Blood was collected for biochemical tests, and the liver was removed for hepatic triglycerides analysis. The left hemimandibles were removed, radiographed, and then prepared for histologic evaluation. The right hemimandibles (region near molars) were removed for bone mineral density analysis by dual-energy X-ray absorptiometry., Results: Radiographs showed that AP lesions were significantly larger in the HFD group compared with the CD group (P < .05). Histologic analysis confirmed that the AP lesions were larger and revealed a more severe inflammatory infiltrate in the HFD group. Bone mineral density was reduced in the HFD group compared with the CD groups (P < .05). The HFD resulted in a significant increase in body mass (P < .05), liver mass (P < .05), relative liver mass (P < .05), and hepatic triglycerides (P < .05). The levels of triglycerides and very-low-density lipoprotein were significantly higher in the 40-day HFD group compared with the 21-day HFD and 21- and 40-day CD groups (P < .05)., Conclusions: Findings suggest that an HFD can influence the progression and severity of AP., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The management of initial planting density can be a strategy to increase barium phytoextraction from soil, reducing the time required for soil decontamination. To delimit the ideal planting density for barium (Ba) phytoremediation using Typha domingensis, we conducted a 300-day experiment in an area accidentally contaminated with barite. Four initial planting densities were tested: 4, 8, 12, and 16 plantsm -2 (D4, D8, D12, and D16 treatments, respectively). Plant development was evaluated periodically, and the phytoextraction efficiency was determined at the end of the trial. The initial planting density affected Ba phytoremediation by T. domingensis monoculture. Phytoextraction potential was better represented by the mass-based translocation factor (mTF) than the concentration-based translocation factor. D16 promoted the highest final number of plants and biomass production, but the mass of Ba in the aerial part did not differ among D8, D12, and D16. D4 resulted in more Ba accumulated belowground than aboveground (6.3 times higher), whereas D12 and D16 achieved the greatest mTFs. Higher absorption of Ba from soil can be achieved using less T. domingensis individuals at the beginning of the treatment (D4 and D8) but with high accumulation in belowground tissues. We conclude that the D8 density is considered the most appropriate if considering the phytoextraction potential and field management facilitated using fewer plants., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Idiopathic bone cavity (IBC) is an uncommon bone lesion that usually affects youngsters as an unilocular radiolucency with predilection for the posterior mandible. Because the lesion is frequently located in proximity to the adjacent teeth, chronic apical periodontitis is commonly included as a differential diagnosis. The aim of the present study was to analyze the clinical and radiologic features of a series of IBCs diagnosed in a single service., Methods: All cases diagnosed as IBC were retrieved from the files of an oral pathology laboratory, and the clinical and radiologic characteristics were described with a focus on the differential diagnosis with chronic apical periodontitis., Results: Thirty cases composed the final sample. The mean age of the affected patients was 22 years old; there was no sex predilection, and most lesions were located on the posterior (47%) and anterior (43%) mandible. Most lesions presented as unilocular radiolucencies (87%), and 90% were located in close association with the adjacent teeth. The associated teeth presented no endodontic involvement, and all proved to be vital., Conclusions: IBC usually affects young patients as an unilocular radiolucency in close association with the adjacent teeth. Careful radiologic analysis and vitality tests of the adjacent teeth are essential to rule out chronic apical periodontitis, thus avoiding any unnecessary endodontic treatment., (Copyright © 2020 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

In anoxic environmental conditions and with a drastic reduction of the redox potential, the barium sulphate used in petroleum drilling fluids becomes a hazard to the ecosystem. A field study was conducted in Brazil in an area with a history of accidental Barium (Ba) contamination to evaluate the role of frequent plant cutting on phytoremediation. The plant species Typha domingensis and Eleocharis acutangula, cultivated in a combined plantation, were subjected to four different cut frequencies: every 90 days (four cuts), 120 days (three cuts), 180 days (two cuts), or 360 days (one cut). The total amount of Ba extracted from the soil by the plants was evaluated for each treatment and at different soil depths Overall, total Ba in the soil decreased the most dramatically for cut frequencies of 120 (37.83%) and 180 (47.73%) days at 0-0.2 m below the surface, and with cut frequencies of 120 (51.98%) and 360 (31.79%) at 0.2-0.4 m depth. Further, total Ba in the plant biomass was greatest in the 120 and 360-days frequency groups. Thus, cuts at intervals of 120 days or more are associated with high levels of Ba in the plant tissue and a decrease of soil Ba., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Cowden syndrome (CS) is a phosphatase and tensin homolog gene (PTEN)-associated condition characterized by multiple mucocutaneous hamartomas and an increased risk of malignancies. We reported an isolated case and another of several individuals in one family affected by CS. The isolated case showed typical features, including fibrocystic breast disease, benign thyroid nodules, and multiple papillomatous lesions in the face and oral cavity, and the cause was a novel nonsense mutation-guanine (G) to thymine (T) transition at position 940 (c.940 G>T)-in PTEN. In the family, the proband showed erythema nodosum, duodenal ulcer, intestinal polyps, cervical lipoma, renal cysts, and glaucoma, whereas multiple members of her family were found to have intestinal polyps, and a sister had been diagnosed with breast cancer at early age. An intronic mutation-T>G transition at the +32 position of intron 8 (c.1026+32 T>G)-was found in this family, with in silico analysis revealing the creation of a new donor splice site. This study confirmed the involvement of PTEN in CS and the variable clinical expressivity of disease., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: The aim of the present study was to compare the immunoexpression of CD34, intercellular adhesion molecule-1 (ICAM-1), and podoplanin and the presence of mast cells with clinical, demographic, radiologic, and histologic features from periapical granulomas, periapical cysts, and residual cysts., Methods: Thirty-one lesions (5 granulomas, 15 periapical cysts, and 11 residual cysts) were selected. Histologic sections in silanized slides were used for the immunohistochemical reactions. The analysis of the images was performed by using an optical microscope, and data were analyzed with 5% significance (P < .05)., Results: Cysts presented atrophic and hyperplastic epithelium in 11 cases (35.5%) and 15 cases (48.8%), respectively (P > .05). The intensity of the inflammatory infiltrate was similar when comparing the 3 groups (P > .05). CD34 and podoplanin expression and the presence of mast cells were similar when comparing the 3 groups; ICAM-1 expression was more intense in granulomas than cysts (P < .05). There were no statistically significant differences associated with the expression of the evaluated markers according to the intensity of the inflammatory infiltrate., Conclusions: There were no differences in the expression of CD34 and podoplanin and in the presence of mast cells when the 3 groups were compared. ICAM-1 expression was more common in periapical granulomas., (Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the oral and maxillofacial manifestations of patients diagnosed with chronic kidney disease-mineral and bone disorders., Study Design: Over a 13-year period, clinicopathologic data of patients diagnosed with CKD-MBD who had oral and maxillofacial alterations were retrieved from the files of 4 Brazilian institutions. Data included clinical, radiographic, microscopic, and biochemical findings; treatment employed; and follow-up status., Results: Twenty-one cases were identified, with 13 patients diagnosed as brown tumor of hyperparathyroidism (BTH) and 8 as osteitis fibrosa/renal osteodystrophy (OF/RO) (4 of them clinically consistent with Sagliker syndrome). The mean age was 32.7 years, and the mandible was the most affected site (42.8%). OF/RO had an ill-defined "ground glass" radiographic appearance, and BTH produced well-defined radiolucent images. Biochemically the following mean values were obtained: parathormone 1511.07 pg/mL, calcium 9.25 mg/dL, phosphorus 5.19 mg/dL, alkaline phosphatase 941.55 U/L, urea 125.42 mg/dL, and creatinine 7.14 mg/dL. Treatment comprised vitamin D and calcium intake, parathyroidectomy, hemodialysis, renal transplantation, and local surgery. During follow-up, 5 patients with BTH were free of lesions, whereas 2 affected by OF/RO/Sagliker syndrome died., Conclusions: Oral and maxillofacial manifestations of BTH and OF/RO are uncommon, but they can be associated with an important life-threatening scenario., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to compare the expression of proliferative markers and apoptosis-associated proteins in the oral mucosa adjacent to bone sequestrum associated with osteonecrosis (ON) of the jaws and florid osseous dysplasia (OD)., Study Design: Oral mucosal samples derived from surgical procedures performed for treatment of ON and OD (10 cases each) were retrieved. Histologic analysis was done on hematoxylin and eosin-stained slides; immunohistochemical reactions against epidermal growth factor (EGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), Bcl-2 protein, interleukin-6 (IL-6), and Ki-67 antigen were performed with the immunoperoxidase technique., Results: The epithelium was hyperplastic in 60% and 22% of ON and OD samples, respectively. Cytoplasmic EGF and KGF expression; Bcl-2, VEGF, and IL-6 expressions; and the mean epithelial proliferative index were not statistically different between the 2 groups. Membranous EGF expression was more evident in samples showing hyperplastic epithelium., Conclusions: Exposure to bisphosphonates did not alter the expression of KGF, EGF, VEGF, Bcl-2, IL-6, and the epithelial proliferating index in comparison with inflamed oral mucosa not exposed to bisphosphonates., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: The biologic effects of surgical decompression on the epithelium and connective tissues of periapical cysts are not fully understood. The aim of this study was to evaluate the expression of tissue repair and inflammatory biomarkers in periapical cysts before and after surgical decompression., Study Design: Nine specimens of periapical cysts treated with decompression before undergoing complete enucleation were immunohistochemically analyzed to investigate the expression of interleukin-1β, tumor necrosis factor-α, transforming growth factor-β1, matrix metalloproteinase-9, Ki-67, and epidermal growth factor receptor. Expression of the biomarkers was classified as positive, focal, or negative. Ki-67 immunoexpression was calculated as a cell proliferation index. The expression of the biomarkers was compared in the specimens from decompression and from the final surgical procedure., Results: Computed tomography demonstrated that volume was reduced in all cysts after decompression. There were no differences in the immunoexpression of the proinflammatory and tissue repair biomarkers when comparing the specimens obtained before and after the decompression., Conclusions: Surgical decompression was efficient in reducing the volume of periapical cysts before complete enucleation. When comparing the specimens obtained from surgical decompression and from complete surgical removal, the immunohistochemical analysis did not show a decrease in proinflammatory biomarkers; neither did it show an increase in tissue repair biomarkers., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: The present study evaluated the cleaning and shaping ability of 3 instrumentation systems in oval canals of extracted vital teeth using a correlative analytic approach., Methods: Oval distal canals from 33 freshly extracted mandibular molars with pulp vitality were scanned by micro-computed tomographic (micro-CT) imaging for sample selection. Specimens matched by anatomic similarities were distributed into 3 experimental groups according to the instrument system to be evaluated: the Self-Adjusting File (SAF; ReDentNOVA, Ra'anana, Israel), TRUShape (Dentsply Sirona, Tulsa, OK), and XP-endo Shaper (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The irrigant was 5.25% sodium hypochlorite heated at 37°C. After rescanning with micro-CT imaging, the unprepared surface areas were identified, measured, and then histologically evaluated for the amount of pulp remnants in each root third., Results: When the apical 4-mm canal segment was evaluated, the SAF exhibited significantly less unprepared areas than the XP-endo Shaper (P < .05), and there were no significant differences for the other comparisons (P > .05). Analysis of the full canal length showed no statistically significant differences between the 3 tested systems (P > .05). Likewise, the tested systems did not differ significantly in cleaning the unprepared walls (P > .05)., Conclusions: There was no significant difference in the amount of unprepared surface areas between the 3 instrument systems, except for the comparison between the SAF and XP-endo Shaper in the apical 4-mm segment. None of them prepared 100% of the root canal walls. The cleaning ability of the 3 systems was similar., (Copyright © 2017 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

The present study reports two cases of oral perineuriomas, including a clinicopathologic review of the 39 published cases (17 intraneural and 22 extraneural perineuriomas) in the English language literature. In the first case, the tumor occurred in an 84-year-old male as a painless, asymptomatic, 20-mm submucosal nodule on the right lower mucobuccal fold near to the premolar area. In the second case, a 46-year-old female presented with a painless, 25-mm, slow-growing, fibrous, pedunculated nodule on the right buccal mucosa. In the first case, the tumor was composed of spindle cells arranged in a storiform pattern, classified as intraneural perineurioma; and in the second, it was an extraneural perineurioma, showing a whorled myxoid stroma. Immunohistochemical analysis confirmed the diagnosis by showing positivity for vimentin, EMA, and Glut-1 in case 1 and EMA, Glut-1, Claudin-1, and CD34 (focally) in case 2. Complete surgical removal was performed for both tumors, and there was no evidence of local recurrence after a long-term follow-up., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to correlate the clinical, demographic, and radiographic aspects of 82 cases of florid osseous dysplasia (FOD) from four countries assessed by five reviewers., Study Design: Retrospective data of patients diagnosed with FOD were obtained from archives of five institutes and analyzed according to clinical and radiographic criteria., Results: A total of 82 cases of FOD were included in the study. In the majority (77.5%) of FOD cases, black women were affected. The disease mainly affected the mandible (100%), and the stage of the lesion was directly correlated with the age (P < .05). The rates of convergence showed confluence of assessment in the mandible (posterior), and the highest rate of divergence between the reviewers was in assessing involvement in the maxilla. There were no differences among the characteristics of the lesion provided by the five institutions, except for the variable proportion of black patients affected by the disease., Conclusions: FOD mostly affects the mandible of middle-aged black women, and its stage is correlated with patient age. Although panoramic radiography is used for diagnosis, the divergence in assessment of the maxilla might indicate that this method is not the most suitable to evaluate this area., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: This study tested the hypothesis that the inflammatory cell profile (CD3-, CD4-, CD8-, CD20-, and CD68-positive cells) and the expression of immunologic markers (tumor necrosis factor α, interferon-γ, interleukin-6, and interleukin-18) in chronic apical periodontitis are the same between non-HIV-infected patients and HIV-infected patients undergoing highly active antiretroviral therapy (HAART)., Methods: Thirty-four surgically excised chronic apical periodontitis lesions were sampled from 34 patients (17 HIV-infected and 17 non-HIV-infected). The lesions were extracted from teeth with no previous endodontic treatment. All HIV-infected patients were undergoing HAART. The specimens were submitted to histopathologic and immunohistochemical analyses by using an optical microscope. Immunoexpression was graded into 2 levels, focal to weak and moderate to strong. The χ(2), Fisher exact, and Mann-Whitney tests were used to analyze all significant differences between groups., Results: Periapical cysts represented 70.6% and 52.9% of the lesions in the HIV-infected and non-HIV-infected groups, respectively; however, no statistically significant difference was observed (P = .481). There were no statistically significant differences between groups for the inflammatory cell profile and for any of the immunologic markers (P > .05)., Conclusions: There are no statistically significant differences of the cellular profile and expression of immunologic markers in chronic apical periodontitis between non-HIV-infected patients and HIV-infected patients undergoing HAART., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

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., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: The receptor activator of nuclear factor kappa B (RANK)-RANK ligand (RANKL)-osteoprotegerin (OPG) system is important in osteoclastogenesis and may play a role in the development of apical periodontitis. This immunohistochemical study evaluated the distribution of the expression of these regulators of bone resorption in periradicular cysts., Methods: Biopsy specimens from 40 consecutive periradicular cysts registered in the files of the Oral Pathology Laboratory were selected for the study on the basis of an initial analysis of archived histopathologic slides. Sections were stained with hematoxylin-eosin for preliminary analysis, and then silanized slides were used for immunohistochemical reactions with anti-RANK, anti-RANKL, and anti-OPG antibodies by the immunoperoxidase technique. The expression of these molecules in different tissue compartments and in the inflammatory infiltrate of cysts was compared., Results: Analysis of the distribution of each marker in different areas of the cyst revealed no significant difference in the expression of RANK, RANKL, or OPG in areas of normal epithelium when compared with areas of hyperplastic epithelium. As for the connective tissue, higher expression of both RANK (P < .05) and RANKL (P < .05), but not OPG, was observed in the chronic inflammatory infiltrate, in comparison with the acute infiltrate. When the expression of the 3 molecules was compared per area of the cystic lesion, higher expression of RANK in comparison with OPG was verified in the areas of both normal and hyperplastic epithelium. RANKL was also significantly more expressed in the normal epithelium than OPG (P < .05). In the connective tissue, RANK expression was higher than OPG in both chronic and mixed infiltrates (P < .05) and also higher than RANKL expression in mixed infiltrate (P < .05). RANKL expression in chronic infiltrate was higher in comparison with OPG expression (P < .05)., Conclusions: The results demonstrated that the type of inflammatory infiltrate present in periradicular cysts appears to influence the expression of RANK, RANKL, and OPG. The chronic infiltrate is likely to have increased osteolytic activity because of a higher RANKL/OPG ratio., (Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Interleukin (IL)-17 expression has been detected in apical periodontitis lesions, but its role in the disease process remains unclear. The present study compared the expression of IL-17 in periradicular cysts and granulomas and evaluated the association of this cytokine with clinical and radiographic findings., Methods: Apical periodontitis lesions (18 cysts and 20 granulomas) were obtained from 38 patients subjected to periradicular surgery. Some clinical, radiographic, and cone-beam computed tomographic features were recorded. Silanized slides containing paraffin sections were used for the immunohistochemical reactions using anti-IL-17 antibody. Image analysis was performed using an optical microscope, and each sample was divided into 5 high-power fields, which were evaluated for the expression of IL-17 in the epithelium and connective tissues. Results were evaluated for correlations with the lesion size and the occurrence of symptoms and sinus tract., Results: Expression of IL-17 was significantly higher in cysts than in granulomas (P = .02). Among the periradicular cysts, a thin epithelium showed significantly increased labeling for IL-17 when compared with a hyperplastic epithelium (P = .003). IL-17 expression was usually associated with focal accumulations of polymorphonuclear leukocytes. No association of IL-17 expression with symptoms, sinus tract, or lesion size was observed (P > .05)., Conclusions: The present study reinforces the notion that IL-17 may take part in the pathogenesis of apical periodontitis lesions. A role in the exacerbation of chronic inflammation and cyst formation is suspected. Further studies are required to shed light on the specific functions of IL-17 in periradicular inflammatory processes., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: Benign and malignant tumor cells can express altered adhesion properties, and these features can be associated with their proliferative and invasive characteristics. This study aimed to evaluate syndecan-1 and Ki-67 expression in ghost cell-containing odontogenic tumors., Study Design: Clinical data were retrieved from laboratory records, and hematoxylin-eosin-stained slides and sections, labeled with monoclonal antibodies anti-syndecan-1 and anti-Ki-67 using the immunoperoxidase technique, were evaluated., Results: Included were 21 central calcifying cystic odontogenic tumors (CCOTs) (4 associated with odontoma), 2 peripheral CCOTs, 1 dentinogenic ghost cell tumor, and 1 ghost cell odontogenic carcinoma (GCOC). Syndecan-1 was mainly expressed in cells resembling stellate reticulum and in stromal cells from the fibrous capsule. The mean Ki-67 labeling index was 4.1% (49.3% for GCOC), but it was not associated with syndecan-1 expression., Conclusions: Syndecan-1 is variably expressed in cells resembling the stellate reticulum, stromal cells, and basal cells and might be associated with the biology of these tumors., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: Mast cells and macrophages are important components of the inflammatory infiltrate found in inflammatory periapical diseases. Several cytokines participate in the mechanisms of inflammation, tissue repair, and bone resorption associated with periapical cysts. The aim of the present study was to evaluate the distribution of mast cells and macrophages and the expression of interleukin-6 (IL-6) in periapical cysts., Methods: Thirty periapical cysts were selected for the study, and clinical, demographic, and gross information from the cases was obtained from the laboratory records. Five-micrometer sections stained with hematoxylin-eosin were reviewed for analysis of the microscopic features of the cysts, and 3-μm sections on silanized slides were used for immunohistochemical reactions with anti-tryptase, anti-CD68, and anti-IL-6., Results: There was no statistically significant difference in the mean number of mast cells and macrophages when comparing superficial and deep regions of the fibrous capsule of the cysts. Mean number of mast cells on the superficial region of the fibrous capsule was higher in cysts showing intense superficial inflammation and exocytosis. Macrophages were more commonly found in areas showing IL-6 expression, and IL-6 was less expressed in deep regions of the fibrous capsule in cysts showing greater gross volume., Conclusions: The results reinforced the participation of mast cells and macrophages in the pathogenesis of periapical cysts and suggested that IL-6 is not the major bone resorption mediator in larger periapical cysts., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To describe the clinicopathologic, immunohistochemical, and scanning electron microscopic features of 19 cases of calcifying epithelial odontogenic tumor (CEOT) in comparison to 4 cases of dental follicles containing CEOT-like areas (DF-CEOT)., Study Design: A collaborative Latin American retrospective study., Results: CEOT and DF-CEOT showed a slight predilection for females, mostly affecting the posterior mandible. CEOTs were classified as epithelium-rich (8 cases), amyloid-rich (4), and calcification-rich (3), and 4 cases showed similar proportion of the 3 components. DF-CEOTs contained odontogenic epithelium, amyloid, calcification, and clear cells. Epithelial cells were positive for cytokeratins CK5 and CK19, E-cadherin, and syndecan 1 (CD138), and focally for amyloid A. In CEOT, amyloid was positive for CD138 and amyloid A, and calcification for CK5, CD138, and amyloid A. In DF-CEOT, calcification was positive for amyloid A. CEOT showed higher Ki-67 protein and minichromosome maintenance complex component 2 (MCM-2) labeling indices than did DF-CEOT. In scanning electron microscopy, CEOT calcified material resembled bone in the 3 cases classified as calcification-rich., Conclusions: CEOT and DF-CEOT showed histomorphologic and immunohistochemical similarities, and the histogenetic significance of these features should be further studied., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to report the clinicopathologic and radiologic features of 143 benign fibro-osseous lesions (BFOLs)., Study Design: Clinical and radiologic information were retrieved from the patients files, and histologic features were reviewed from hematoxylin and eosin-stained histologic slides., Results: There were 22 ossifying fibromas (OFs), 21 fibrous dysplasias (FDs) and 100 osseous dysplasias (ODs; 65 florid, 18 focal, and 17 periapical). The mean age of the FD/OF patients was a decade lower than those with OD. The mandible was more affected than the maxilla, except in FDs. All FDs and OFs presented local swelling, whereas this was observed in <40% of the ODs. Radiologic images of the florid/periapical ODs and OFs were predominantly mixed, whereas FDs and focal ODs were predominantly radiopaque., Conclusions: Florid OD, OF, and FD were the most common diagnoses, and the clinicopathologic and radiologic features were somewhat distinct from the characteristics of other populations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Metastatic clear cell renal cell carcinoma (CCRCC) should be considered in differential diagnosis of intraoral clear cell tumors, including mucoepidermoid carcinoma (MEC)., Objective and Study Design: We compared the clinical, histologic, histochemical, and immunohistochemical characteristics of 9 oral metastatic CCRCCs and 8 intraoral clear cell MECs., Results: Oral metastatic CCRCC affected salivary-gland containing tissues in 7 cases (78%). Microscopically, oral metastasis revealed a proliferation of neoplastic clear cells arranged in an alveolar pattern with central blood vessels, features that were not seen in any intraoral clear cell MEC. Mucicarmine staining was positive only in clear cell MEC. Immunohistochemistry showed similarities in cytokeratin expression; vimentin and CD10 were expressed in all oral metastatic CCRCCs but in only 1 clear cell MEC each., Conclusions: Besides clinical history, the alveolar pattern, vessel distribution, absence of mucicarmine staining, and vimentin and CD10 immunoexpression are useful in histologic differential diagnosis of CCRCC and clear cell MEC., (Copyright 2010 Mosby, Inc. All rights reserved.)

Objective: Ectomesenchymal chondromyxoid tumor is a rare oral soft tissue neoplasm that should be differentiated from other neural and chondromyxoid entities. The aim of this study was to report the clinical, histological, and immunohistochemical features of 3 additional cases of this condition., Methods: Clinical data were obtained from the clinical records and all cases were evaluated through light microscopy and immunohistochemistry to cytokeratins, vimentin, S100 protein, desmin, smooth muscle actin, and glial fibrilary acidic protein., Results: All 3 cases affected the tongue as a long-lasting submucosal swelling and were managed through conservative surgery. They all showed myxoid and chondroid histological patterns, and vimentin, S100, and glial fibrilary acidic protein immunoexpression., Conclusions: These findings reinforce the typical features of ectomesenchymal chondromyxoid tumor previously described, helping to confirm and establish the clinical, histopathological, and immunohistochemical profile of this uncommon lesion.

Objective: The objective of this study was to compare the clinicopathological features of oral sebaceous hyperplasia and sebaceous adenoma., Study Design: Clinical data, microscopical characteristics, and ki-67 immunoexpression were comparatively analyzed on 2 intraoral sebaceous adenomas, 6 intraoral sebaceous hyperplasias, and 21 normal intraoral sebaceous glands., Results: Clinically, sebaceous glands presented as multiple separated papules, sebaceous hyperplasias as a single enlarged papule, and sebaceous adenoma as a well-defined nodule. Microscopically, sebaceous adenoma presented an increased number of lobules, smaller lobules, and a greater number of germinative/squamous cells. Sebaceous hyperplasia also had an increased number of lobules and fewer number of germinative/squamous cells, as compared to normal oral sebaceous glands. Ki-67 expression was seen only in germinative cells and counts were higher in sebaceous adenomas followed by hyperplasias and normal glands., Conclusions: Sebaceous hyperplasias and adenomas showed different clinical, microscopic, and proliferative characteristics, suggesting the usefulness of the studied criteria on diagnosis of these uncommon oral lesions.

Background: Fine-needle aspiration biopsy (FNAB) is useful in diagnosis of major salivary gland adenoid cystic carcinoma (ACC), but it has been rarely reported on minor salivary gland ACC., Objective: The aim of this study was to report the utility of FNAB on diagnosis of ACC involving minor salivary glands., Study Design: Three patients presenting ACC involving the palate (2 cases) and buccal mucosa (1 case), with a mean age of 36 years and 2:1 female-to-male ratio, were included in the study. All of the patients were submitted to FNAB for diagnostic purposes., Results: All smears were stained with hematoxylin-eosin, Papanicolaou, and Diff-Quik and showed the presence of small polyhedral cells with hyperchromatic nuclei and extracellular basophilic globular amorphous substance, compatible with ACC. Diagnosis of the 3 cases was subsequently confirmed through histopathology., Conclusion: The FNAB was easy to perform and cost-effective, and proved to be an useful adjunctive tool in diagnosis of intraoral ACC.

Myofibroma is a benign mesenchymal neoplasm composed of myofibroblasts which has been described with different synonyms since the first report in 1951. It may show clinical and histologic features that may be misinterpreted as a malignancy. We describe 2 cases of oral myofibromas affecting infants; the first one showed a rapid growth with teeth displacement and ulceration; the second one presented a relatively slow growth with an indolent course. Differential diagnosis included benign and malignant mesenchymal neoplasms, salivary gland tumors, and reactive processes. Microscopic analysis of both lesions revealed a spindle cell tumor with immunoreactivity for vimentin, muscle-specific actin, and specific smooth muscle isoform alpha-actin, rendering the diagnoses of myofibroma. The patients were treated with surgical excision, and both are in follow-up without any signs of recurrence. Myofibroma presents a wide range of differential diagnosis, including benign and malignant neoplasms. Therefore, accurate diagnosis may avoid an unnecessary aggressive therapy.

Salivary gland tumors are uncommon and most reported series include tumors affecting both major and minor glands. Very few series have focused solely on intra-oral minor salivary gland tumors. The aim of this study is to report the clinicopathological data of intra-oral minor salivary gland tumors in our oral biopsy files during the last 14 years. A total of 546 minor salivary gland tumors, including 305 benign (55.9%) and 241 malignant (44.1%) lesions, were reviewed. The two most common tumors were pleomorphic adenoma (181 cases, 33.2%) and mucoepidermoid carcinoma (125 cases, 22.9%), and the most commonly affected site was the palate (181 cases, 33.2%). The highest incidence was found in patients in the 5-7th decade of life, and females were more commonly affected than males in the vast majority of various histological types of tumors. Large series of intra-oral minor salivary gland tumors help to understand their clinical and pathological aspects and consequently their proper management and prognosis.

Objective: The aim of this work was to study cytokeratin (Ck) expression in initial radiation-induced oral mucositis., Study Design: Eleven cases of initial radiomucositis of the buccal mucosa and 9 normal specimens were immunostained for Ck 1, 5, 6, 7, 8, 10, 14, 16, 18, and 19 by immunoperoxidase method., Results: Expression of Ck 1, 6, 10, and 16 was stronger in mucositis than in normal mucosa. Ck 7, 8, and 18 were negative for both control and study groups. Ck 5, 13, and 14 were positive for both groups, nevertheless suprabasal staining for Ck 14 was more evident in mucositis than in the control group. Sporadic staining for Ck 19 was observed in 1 case of mucositis and in 2 controls., Conclusions: Increased Ck expression can be associated with the reactive proliferation of the epithelium and increasing resistance of the oral mucosa during the initial phases of radiotherapy.

Objective: The aim of this study was to assess the clinical and histologic features of 6 cases of sublingual salivary gland tumors treated in a single institution., Study Design: The clinical data were obtained from the medical records, and the histopathologic slides were reviewed., Results: Four cases were adenoid cystic carcinoma (ACC) and 2 were mucoepidermoid carcinoma (MEC). Most cases were clinically staged as T3N0M0. Histologically, 3 cases of ACC were of the cribriform subtype and 1 was tubular. One MEC was classified as intermediate and 1 as high grade of malignancy. After surgical treatment, 3 patients (2 MEC and 1 ACC) did not show tumoral recurrence after a mean time of 162 months of follow-up (ranging from 120 to 216 months)., Conclusions: Sublingual salivary gland tumors are very rare and most are malignant; in our series, 3 cases of ACC had poor prognosis but the patients with MEC were considered cured of the disease.

Central mucoepidermoid carcinoma (MEC) is an entity whose origin is still controversial. Glandular odontogenic cyst (GOC) is a recently described lesion whose relationship to low-grade central MEC has been reported in the literature. Our aim was to assess the cytokeratin (CK) profile of central MEC and GOC, and compare the results with CK expression in salivary gland MEC and odontogenic cysts and tumors. Eighty-five cases, including 6 central MECs, 23 salivary gland MECs, 10 GOCs, 34 odontogenic cysts and 12 ameloblastomas, were studied through immunohistochemistry using eleven monoclonal anti-CK antibodies. All central MECs expressed CKs 5, 7, 8, 14, and 18 and all GOCs expressed CKs 5, 7, 8, 13, 14, and 19. Comparing CK expression from GOC and central MEC we found differences in CKs 18 (30% vs 100%) and 19 (100% vs 50%). Central MEC and GOC are probably distinct entities with CK profiles similar to lesions of glandular and odontogenic origins, respectively, and expression of CKs 18 and 19 could be useful in their differential diagnosis.

Hepatocellular carcinoma is a relatively common tumor that etiologically is closely linked to previous hepatitis B infection. Oral metastatic hepatocellular carcinoma is very rare, with only 61 cases reported in the literature. We describe a case of hepatocellular carcinoma metastatic to the anterior mandibular gingivae of a 60-year-old man. The patient also exhibited tumor metastases to the lungs, left knee, little finger of the left hand, scalp, and the skin of the neck. He died 6 months after the diagnosis of the oral metastasis because of systemic tumor dissemination.

Mel-CAM (CD146) is a cell-cell adhesion protein found in normal and tumoral tissues. The aim of this study was to analyse Mel-CAM expression in mucoepidermoid carcinoma (MEC), and assess its importance in prognosis and its utility in differentiating high-grade MEC from squamous cell carcinoma (SCC). Immunohistochemical expression of Mel-CAM in 41 parotid MEC was correlated with clinical parameters. Ten cases of oral cavity SCC were included for comparison. Mel-CAM expression was found in 92.7% of the MEC but was not expressed by the SCC. Mel-CAM expression was greater in intermediate/high grade tumors, was weaker in patients that presented local recurrence, regional and distant metastasis, but no correlation between Mel-CAM and clinical stage and survival of the patients was found. Decreased Mel-CAM expression can impair cellular contact properties, facilitating growth, cell spreading and metastasis in MEC. Mel-CAM can also be useful in differentiating high grade MEC from SCC.

Presentation with synchronous salivary gland tumors is rare, with the most typical combination being Warthin's tumor and pleomorphic adenoma of the parotid gland. Involvement of minor salivary glands in such occurrences is extremely uncommon. We report a case of simultaneous mucoepidermoid carcinoma of the tongue and pleomorphic adenoma of the submandibular gland in a 40-year-old woman. The submandibular mass was initially considered to represent regional lymph node tumor metastasis but later was shown to be an intraglandular primary neoplasm.

Basaloid squamous carcinoma (BSC) is an uncommon aggressive variant of squamous cell carcinoma (SCC) with a predilection for the head and neck. In the English literature, approximately 40 cases of BSC in the oral cavity have been described. In this study, the clinicopathologic features of 2 cases of BSC affecting the buccal mucosa are reported. In addition, we compare the proliferative and invasive potential of BSC cells with that of poorly differentiated SCC cells matched for age, sex, site, and TNM status. Proliferative activity was studied through use of the argyrophilic nuclear organizer region (AgNOR) method and immunohistochemical quantification of proliferating cell nuclear antigen (PCNA). The invasive potential was evaluated through use of the semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) for matrix metalloproteinases (MMPs). Alterations of p53 were also investigated through use of immunohistochemistry. The tumors showed many clinical and histopathologic similarities to tumors in cases previously reported. The AgNOR and PCNA indices were significantly higher in the 2 cases of BSC than in the cases of SCC. Immunostaining for p53 protein showed a higher percentage of positive cells and more intense staining in the BSC tissues than in the SCC tissues. RT-PCR studies clearly demonstrated that the expression of MMP-1, MMP-2, and MMP-9 was higher in cells from BSCs than in cells from SCCs. Taken together, the data described here are compatible with the concept that BSC has a more aggressive biologic behavior than conventional SCC.