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Rhabdomyosarcoma (RMS) is a soft tissue sarcoma that develops from skeletal striated muscle cells. RMSs are exceedingly rare in the oral cavity, particularly in the gingiva. Herein, we reported the clinicopathological and immunohistochemical features of a rare case of RMS in a 30-year-old female presenting clinically as a painful polypoid nodule on the mandibular gingiva. Microscopically, the tumor showed atypical spindle cells with elongated nuclei and eosinophilic cytoplasm arranged in a fascicular pattern. In focal areas, the tumor cells exhibited rhabdomyoblastic differentiation. Immunohistochemistry showed strong positivity for desmin, myogenin (scattered cells), and MyoD1. The patient underwent surgical resection followed by postoperative complementary radio- and chemotherapy. However, the patient had a local recurrence seven months after the initial treatment. She was submitted to a total mandibulectomy associated with adjuvant radiotherapy. However, she died two months after reoperation due to complications secondary to radiation therapy. Because of the rarity in the oral cavity and non-specific signs and symptoms, the clinical diagnosis of RMS is difficult and often overlooked. Therefore, careful histopathological and immunohistochemistry analysis of these tumors is essential to correct diagnosis. Early surgical excision with tumor-free margins and prolonged follow-up are strongly recommended.

Metastases in the oral cavity are rare and frequently associated with widespread disease and poor prognosis. Clear cell renal cell carcinoma (ccRCC) is the most common subtype of renal cell carcinoma (RCC), known for its propensity for metastatic spread. The diagnosis of oral metastases from ccRCC is challenging, especially when the patient has no history of primary neoplasm. Herein, we reported a rare metastatic ccRCC in a 58-year-old female presenting clinically as a painless nodule on the tongue mimicking a benign lesion. Microscopically, the tumor showed a proliferation of clear cells organized in nests with a predominantly lobular arrangement. The dense connective tissue stroma was highly vascularized, exhibiting some areas with a hyalinized aspect. Immunohistochemistry showed focal positivity for pan-cytokeratin AE1/AE3 and strong positivity for CK8, CK18, epithelial membrane antigen (EMA), vimentin, and CD10. S-100 protein, HMB-45, CK7, and CK20 were negative. The definitive diagnosis was metastatic ccRCC. The treatment was initiated with sunitinib. However, the disease progressed, and the patient was submitted to palliative care. Despite the low survival rate of patients with metastases, the clinician's experience in identifying an oral metastatic lesion may reveal undiagnosed primary tumors and provide better prognosis and survival rates.

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

To identify chromosome deletions in 1q25, 1p36 and 1pTEL, and chromosome 17 ploidy status in oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC).Samples from 57 OED and 63 OSCC were selected. FISH was performed using centromeric probes 17 and n LSIR 1p36/LSI 1q25 Dual Color Probe.In OED, deletions were found only in 1pTEL region (29.8%). In OSCC, there was a higher frequency of deletion in 1pTEL (79.4%), followed by 1p36 (73.0%), and 1q25 (20.6%). Advanced TNM clinical stages (III/IV) showed all the deletions studied; at early clinical stages (I/II) of OSCC, deletions were observed only in 1pTEL. The frequency of deletion in 1p36 was 17.0 times higher in OSCC at advanced clinical stages (PR: 17.00). The median number of cell nuclei with chromosome 17 aneuploidy was higher in OSCC than in OED (P 0.001). Early clinical stages of OSCC showed lower median number nuclei with aneuploidy when compared to advanced tumors (P 0.05). Tumors harboring deletions in 1p36, 1q25 and 1pTEL revealed higher median numbers of trisomic/polysomic nuclei when compared to lesions exhibiting no abnormalities in chromosome 1 (P 0.05).A higher prevalence of chromosomal abnormalities was found in OSCC than in OED, while in OSCC, higher abnormalities were present in lesions with higher TNM staging. 1pTEL deletion and monosomy of chromosome 17 are possible markers for progression of OED to OSCC. 1p36 deletion and trisomy/polysomy of chromosome 17 could be markers of worse prognosis of OSCC.

This study evaluated the lymphatic density and HIF-1α immunoexpression in lower lip squamous cell carcinoma (LLSCC) and their correlation with clinicopathological (nodal metastasis, clinical stage, histological grade, recurrence and disease outcome) and survival parameters in 20 metastatic and 20 non-metastatic LLSCCs. Lymphatic density was established by counting microvessels (D2-40+) at the tumor core (intratumoral lymphatic density, ILD) and at the invasive front (peritumoral lymphatic density, PLD) and percentages of immunopositive cells for HIF-1α were established. No statistically significant differences in lymphatic densities in relation to clinicopathological parameters were observed (P > 0.05). All cases exhibited nuclear and cytoplasmic HIF-1α immunoexpression, with relatively high percentages of positivity, but this expression was not statistically different in relation to clinicopathological variables (P > 0.05). Positive correlations were observed between ILD and PLD (P = 0.002), and between nuclear HIF-1α immunoexpression at the tumor core and ILD (P = 0.001). The results suggest ILD and PLD are not directly related to the development of lymph node metastasis in LLSCC. The striking expression of HIF-1α suggests the involvement of this protein in the etiopathogenesis of LLSCCs, possibly stimulating lymphangiogenesis at the tumor core. However, this protein does not seem to exert a determining influence on the biological aggressiveness of these tumors.

Background Multinucleated giant cell (MGC) reactions have been identified in several malignancies, but their frequency and significance in lower lip squamous cell carcinoma (SCC) are not established. This study evaluated the MGC reactions and their association with clinicopathological parameters in lower lip SCCs. The polarization profile of these cells (M1 or M2 macrophages) was also assessed. Methods The presence and distribution of MGC reactions in high-power fields (400×) were evaluated in hematoxylin/eosin-stained histological sections of 91 lower lip SCCs. The histopathological grade of malignancy was evaluated using two grading systems (World Health Organization [WHO] and Malignancy Grading of the Deep Invasive Margins). The histiocytic nature (CD68) and polarization profile (M1-HLA-DR+ or M2-CD163+) of MGCs were evaluated by immunohistochemistry. Results MGC reaction was identified in 36 (39.6%) cases, and its frequency was 3.3 times higher in well/moderately differentiated tumors than in poorly differentiated tumors (WHO grading system) (P=0.006). For Malignancy Grading of the Deep Invasive Margins, the frequency was 2.03 times higher in highly/moderately keratinized tumors than in tumors with minimal/no keratinization (P=0.012). No significant associations were observed between the presence/distribution of MGCs and clinical parameters (tumor size, lymph node metastasis, distant metastasis, and clinical stage) (P>0.05). All MGCs were positive for CD68 and there was a predominance of HLA-DR+ over CD163+ MGCs (P=0.031). Conclusions MGC reactions may not be involved in tumor progression in lower lip SCCs. In this microenvironment, MGCs tend to exhibit a predominantly M1 phenotype and may represent a foreign body reaction to SCC keratin pearls. This article is protected by copyright. All rights reserved.

Oral lymphoepithelial cyst (OLC) is a rare developmental cyst of soft tissue. Clinically, OLC exhibits as a small and asymptomatic mass, with color ranging from rose to yellowish. OLC develops manly in floor of mouth and lateral and ventral surfaces of tongue. Based on this, we aimed to report a case of OLC in a young patient. A 17-year-old male patient presented a painless nodular aspect located in floor of mouth with a history of evolution of 2 months. Clinical hypothesis was ranula. Excisional biopsy was performed, and histopathologic analysis revealed a cystic cavity lined by keratinized stratified epithelium; cystic lumen showed desquamated epithelial cells. Cystic capsule was composed of connective tissue exhibiting numerous lymphocytes, sometimes arranged in germinal centers. Superficially, epithelium of oral mucosa was observed. Based on pathologic findings, final diagnosis was OLC. After 12 months of follow-up, no sign of recurrence was observed.

Squamous odontogenic tumor-like proliferations (SOT-LPs) are an uncommon histopathological finding occurring in the fibrous capsule of odontogenic cysts, which share certain microscopic features with squamous odontogenic tumor (SOT). A 36-year-old woman presented with an 18-month history of a painless, slow-growing swelling in the maxilla. Her medical history was unremarkable. Computed tomography revealed a well-defined, unilocular hypodense lesion extending from nonvital tooth #21 to tooth #11, with expansion and rupture of vestibular cortical bone, measuring approximately 1.5 cm. Under the diagnostic hypothesis of radicular cyst, an excisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by nonkeratinized stratified squamous epithelium exhibiting hyperplasia, exocytosis, and spongiosis. The fibrous capsule revealed conspicuous islands of well-differentiated squamous epithelium, some of them exhibiting foci of microcystic degeneration. The final diagnosis was radicular cyst with SOT-LPs. The patient remains under close follow-up.

The purpose of this study was to evaluate the immunoexpression of vascular endothelial growth factor C (VEGF-C) and VEGF receptor 3 (VEGFR-3) and their correlation with intratumoural lymphatic density (ILD) and peritumoural lymphatic density (PLD) in metastatic and non-metastatic lower lip squamous cell carcinoma (LLSCC). Twenty-five LLSCC with regional nodal metastasis and 25 LLSCC without metastasis were selected. The percentages of VEGF-C and VEGFR-3 staining in each tumour core and at the deep invasive front were assessed. PLD and ILD were determined using anti-podoplanin antibody. Immunohistochemical findings were correlated with nodal metastasis, clinical staging, local recurrence, clinical outcome, and histological grade. Cytoplasmic immunoexpression of VEGFR-3 in the tumour core was associated with metastasis (P=0.009), patient death (P=0.008), and histological grade (P0.005). PLD, ILD, and VEGF-C expression showed no significant associations with clinicopathological parameters (P0.05). PLD and ILD were not significantly correlated with the immunoexpression of VEGF-C or VEGFR-3 (P0.05). There was a significant positive correlation between PLD and ILD (P=0.004), and between cytoplasmic immunoreactivity of VEGF-C and VEGFR-3 (P=0.011). These results suggest an important role for VEGFR-3 in the progression of LLSCC, and highlight the possible influence of its expression on the prognosis of these tumours. ILD and PLD may not be associated with lymph node metastasis in LLSCC.

Aim To investigate the presence of myofibroblasts (MFBs) in epithelial odontogenic lesions by immunohistochemistry and to correlate the findings with tumor aggressiveness, as well as to analyze the expression of TGF-β1 and IFN-γ during the differentiation of these cells. Methods and Results Twenty solid ameloblastomas (SAs), 10 unicystic ameloblastomas (UAs), 20 keratocystic odontogenic tumors (KCOTs), and 20 adenomatoid odontogenic tumors (AOTs) were selected. For evaluation of the presence of MFBs, anti-α-SMA-immunoreactive cells were quantified in connective tissue near the epithelium. The expression of TGF-β1 and IFN-γ was evaluated in epithelial and connective tissue by determining the percentage of immunoreactive cells. A higher concentration of MFBs was observed in SAs (mean of 30.55), followed by KCOTs (22.50), UAs (20.80), and AOTs (19.15) (P = 0.001). There was no significant correlation between the immunoexpression of TGF-β1 or IFN-γ and the number of MFBs (P > 0.05). Conclusions The larger number of MFBs suggests that these cells are one of the factors responsible for the more aggressive biological behavior of these lesions. The lack of correlation between the number of MFBs and immunoexpression of TGF-β1 and IFN-γ indicates that these proteins are not involved in the differentiation of this type of contractile cell in the lesions studied and that only the use of immunohistochemistry to establish such a correlation is a limiting factor.

Objective: To analyze the frequency and clinical and demographic features of oral lymphoepithelial cyst (OLEC) from 5 Brazilian services of oral and maxillofacial pathology. Study Design: Ethical approval (80249117.0.0000.5149). A cross-sectional retrospective study was conducted in 5 oral pathology services. The biopsy records were reviewed from 1952-2018. Cases with a microscopic diagnosis of OLEC were retrieved. Hematoxylin-eosin slides were reviewed by a single pathologist to confirm the diagnosis. Lesions of major salivary glands were excluded. Frequency and clinical and demographic data were analyzed descriptively. Results: Seventy-seven OLECs were found, representing 0.05% of the lesions submitted to diagnosis in the centers (n = 146,150). OLEC was predominantly diagnosed in females (n = 54; 70.1%). The mean age was 46.51 years (range [SD], 13-84 [14.80]). Lesions arose mainly in the tongue, lateral border (n = 31; 40.3%). The lesions measured up to 1 cm in size (n = 47; 61.0%) and were asymptomatic (n = 50; 64.9%). Twenty-four cases (31.2%) were white in color. Conclusion: OLECs are very uncommon diagnoses in oral pathology services. Lesions usually affect women, are small and asymptomatic, and located in the lateral border of the tongue. Detailed microscopic and immunohistochemical features will be accessed in the next step of this study. Support: CAPES, FAPEMIG, CNPq.

Objective: To evaluate the immunoexpression of autophagy-related proteins (p62 and Atg7) in odontogenic keratocysts associated with Gorlin syndrome (SOKCs) and nonsyndromic odontogenic keratocysts (NSOKCs).Study design: The percentages of immunopositive cells (nuclear and cytoplasmic/membrane) for p62 and Atg7 in the epithelial component of 25 SOKCs and 25 NSOKCs were assessed. The results were analyzed statistically using the nonparametric Mann-Whitney U test and Spearman correlation test. Results: Expression of p62 and Atg7 was observed in all cases studied. Compared with NSOKCs, SOKCs exhibited higher nuclear expression of p62 (P

Objective: To analyze the determinant clinical and histologic aspects in the establishment of the diagnosis of the glandular odontogenic cyst (GOC).Study Design: A cross-sectional study was performed in 2 oral pathology services. All slides of GOCs were reviewed and clinical data were obtained from the patient records. The determination of the diagnosis followed predetermined microscopic parameters according to the World Health Organization. Statistical analysis was performed in order to identify the predictive parameters for the diagnosis of GOC. Results: From the 9 patient cases of GOCs, 55.5% were male, with a mean age of 50.6 years, and 66.6% were located in the mandible. All cases presented with intraepithelial microcysts or duct-like spaces, clear or vacuolated cells, variable thickness of the cyst lining, and papillary projections into the lumen. Multiple compartments, surface eosinophilic cuboidal cells, and epithelial spheres or plaque-like thickenings were observed in 8 (88%) cases. Apocrine snouting of hobnail cells were present in 6 (66%), mucous goblet cells in 3 (33.3%), and cilia in only 1 (11%). Conclusion: The association between the predictive clinical and histopathological aspects for the diagnosis of this rare lesion is fundamental, since GOC has the potential to mimic other potentially more aggressive lesions.

Objective: To evaluate DNA base excision repair (BER) in APE-1 and XRCC1; and nucleotide excision repair (NER) in XPF proteins in benign epithelial odontogenic lesions with different biological behaviors. Study design: Thirty solid ameloblastomas (AMEs), 30 isolated odontogenic keratocysts (NSOKCs), 29 syndromic odontogenic keratocysts (SKOCs), 30 dentigerous cysts (DCs; n = 30), and 20 dental follicles (DFs) were evaluated quantitatively for APE-1, XRCC1 and XPF through immunohistochemistry. Results: All the odontogenic lesions studied revealed a statistically significant expression of APE-1 (nuclear), XRCC1 (nuclear), and XPF (nuclear and cytoplasmic) compared with DFs (P

Pyogenic granuloma (PG) is a non-neoplastic vascular tissue growth, which occurs in response to several stimuli. A 15-year-old nonwhite male patient presented with a nonsymptomatic lesion in the lower lip, which was noted for the first time 4 months before. Clinical examination revealed a rigid, brownish, well-delimited, and pediculated nodule, features that led to the clinical diagnosis of cutaneous horn. In an attempt to promote a better wound healing, total removal of the lesional area using the high-power diode laser (808 nm; 1.5 W; continuous mode) was decided. Microscopic examination revealed intense endothelial cells proliferation and new blood vessel formation, besides extensive ulceration areas. Based on these morphologic features, the final diagnosis of PG was established. The patient had very good healing of the incised area on the postsurgical examination and underwent long-term follow-up.

Oral squamous cell carcinoma (OSCC) is a more common malignant neoplasm in the oral cavity, being rare as simultaneous primary tumors. Based on this, we aimed to report a rare case of simultaneous OSCC. A 76-year-old female patient presented in intraoral examination 2 lesions, one localized in palate and the other localized in alveolar ridge, with history of evolution of 4 months. Both lesions had a tumoral aspect and corrugated and whitish surface. For lesion in palate was observed area of ulcerations. Incisional biopsy was performed for both lesions, and histopathologic analysis revealed a proliferation of atypical squamous cells in nests and sheets exhibiting atypical mitosis, moderate hyperchromatic nuclei, and nuclear pleomorphism. Final diagnosis was simultaneous differentiated moderate OSCC. Treatment indicated was surgery and radiotherapy, and after 12 months of follow-up, no sign of recurrence was observed.

Calcifying odontogenic cyst (COC) is a rare, developmental odontogenic cyst that usually arises in the anterior region of the jaws. An 18-year-old, dark-skinned man was referred for evaluation of a painless, slow-growing swelling in the maxilla, extending from tooth #21 to tooth #25. Extraoral examination revealed slight elevation of the left nasal ala, producing discrete facial asymmetry. Computed tomography showed an expansive, unilocular hypodense lesion with small hyperdense foci, measuring approximately 3.0 cm in diameter. Under the diagnostic hypothesis of COC, an incisional biopsy was performed. Histopathological analysis disclosed a cystic cavity lined by ameloblastoma-like epithelium, with focal accumulation of ghost cells. Calcifications within the ghost cells could also be observed. The definitive diagnosis was COC. The patient was referred for surgical treatment and remains under close follow-up.

Lipomas are mesenchymal neoplasms consisting of mature adipocytes, which account for only 1% to 5% of all oral benign tumors. These lesions are occasionally altered by an admixture of other mesenchymal elements that comprise an intrinsic part of the tumor. A 76-year-old white woman was referred for evaluation of a painless, slow-growing swelling on the tongue that had been identified 3 years earlier. Her medical history was unremarkable. Intraoral examination revealed a yellowish, soft, sessile nodule on the right lateral border and ventral surface of the tongue, measuring approximately 2 cm. Under the diagnostic hypothesis of lipoma, an excisional biopsy was performed. Histopathologic analysis revealed a well-delimited proliferation of mature adipocytes arranged in lobules and separated by thin septa of fibrovascular connective tissue. The final diagnosis was lipoma. Eight months after surgical excision, clinical signs of recurrence were not detected. The patient remains under clinical follow-up.

Central odontogenic fibroma (COF) is a rare, benign mesenchymal odontogenic neoplasm that has a wide patient age range and a relatively similar distribution in the maxilla and mandible. A 60-year-old woman was referred for evaluation of a painless, slow-growing swelling in the mandible, extending from the left ramus to the distal root of tooth #36, covered by normal mucosa. Computed tomography showed an expansive, unilocular hypodense lesion with hyperdense foci, associated with unerupted tooth #38, measuring approximately 4.5 cm in diameter. Under the diagnostic hypothesis of calcifying epithelial odontogenic tumor, an incisional biopsy was performed. Histopathological analysis disclosed a moderately cellular, fibroblastic connective tissue intermixed with inactive-looking odontogenic epithelial islands and strands. The definitive diagnosis was COF. The treatment consisted of enucleation, curettage, and extraction of the associated tooth. No signs of recurrence were observed after 14 months of surgical excision. The patient remains under clinical and radiographic follow-up.

The aim of the present study was to describe a case report on the treatment of recurrent herpes using photodynamic therapy as a therapy of choice. A 21-year-old white man presented for evaluation of vesicles arranged in a skin region just below the transition zone between mucosa and skin of lower lip. The clinical diagnosis was of recurrent herpes and, for treatment, photodynamic therapy was applied, with application of 0.1% methylene blue as photosensitizer and a pre-irradiation time of 5 minutes. The low power device used was Therapy XT, with wavelength of 660 nm, power of 100 mW, in a spot area of 0.028 cm2, using the total energy of 4.0 J. It was possible to observe total repair after 10 days of treatment and the patient remained in follow-up for 8 months without recurrences.

Condyloma acuminatum is induced disease by human papillomavirus that commonly affects the genital region and is rarely observed on oral mucosa. Pathogenesis is associated with sexual contact or trauma, and when it develops in children it can indicate sexual abuse. Based on this, we aimed to report a case of condyloma acuminatum in a child. A 9-year-old male patient clinically presented verrucous nodule, asymptomatic, with history of evolution of 18 months, measuring 1 cm, and localized in left side of lower lip. No signs of other lesions in the skin were present. Clinical hypothesis was squamous papilloma or condyloma acuminatum. Excisional biopsy was performed, and histopathologic analysis revealed hyperplasia of parakeratinized squamous epithelium, with exophytic projections exhibiting acanthosis and exocytosis. Clear cytoplasm cells, suggestive of koilocytosis, were also observed. Subjacent fibrovascular connective tissue was also seen. Based on histopathologic findings, final diagnosis was condyloma acuminatum. After 12 months of follow-up, no sign of recurrence was observed.

Squamous cell carcinoma (SCC) with a rhabdoid phenotype (SCCRP) is an extremely rare entity in the maxillofacial region. To date, only 2 oral SCCRP cases have been reported. The presence of this phenotype is associated with a worse prognosis than conventional SCC. A 44-year-old man was referred presenting painful facial asymmetry evidenced by increase of volume in the left maxilla with several months of evolution. Computerized tomography examination showed extensive osteolytic lesion on the left maxilla and maxillary sinus. The histopathologic analysis showed typical morphologic features of SCCRP constituted by polygonal and discohesive cells with large hyaline cytoplasmic inclusions and eccentric nuclei with single prominent nucleoli. Immunohistochemistry revealed positivity for CK AE1/AE3, epithelial membrane antigen (EMA), vimentin, CD138, INI-1, focally for α–smooth muscle actin, and CD68. Ki-67 was > 40%. Although rare, SCCRP should be considered in the differential diagnosis when assessing malignant neoplasms affecting the maxilla. FAPESP (2016/11419-0 and 2017/02502-4).

Objective To evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower-lip squamous cell carcinomas (LLSCCs), and to correlate the findings with clinicopathologic parameters (tumor size and extent, regional lymph node metastasis, clinical stage, risk of malignant transformation for AC and histopathologic grade of malignancy for LLSCCs). Study Design The percentage of HLA-DR–positive cells in the epithelial component of 24 cases of AC and 48 LLSCCs (24 with regional nodal metastasis and 24 without metastasis) were assessed. The results were analyzed statistically using the nonparametric Mann-Whitney test. Results Only 5 (20.8%) cases of AC (2 low risk and 3 high risk) exhibited expression of HLA-DR, with a very low mean percentage of immunopositivity. Most LLSCCs (97.7%) presented with expression of HLA-DR, with a relatively high mean of immunopositivity. The percentage of HLA-DR–positive cells tended to be higher in tumors with regional metastasis, and tumors in advanced clinical stages (P > .05). There was a tendency for higher expression of HLA-DR in low-grade LLSCCs, and in highly or moderately keratinized tumors (P > .05). Conclusions The results suggest a potential role for HLA-DR in lip carcinogenesis, particularly in the progression of LLSCCs. The expression of this protein can be related to the degree of cell differentiation in these tumors.

BACKGROUND Actinic cheilitis (AC) is a potentially malignant disorder that can progress to squamous cell carcinoma (SCC), but this process is not fully understood. This study evaluated the immunoexpression of glucocorticoid receptor alpha (GRα) isoform and apoptotic proteins (Bcl-2 and Bax) in AC and lower lip SCC (LLSCC). METHODS Twenty-two AC and 44 LLSCCs (22 with regional nodal metastasis and 22 without metastasis) were selected. The percentages of nuclear (GRα) and cytoplasmic (GRα, Bcl-2, and Bax) staining in epithelial cells were assessed and correlated with clinical (tumor size/extent and clinical stage) and histopathological parameters (risk of malignant transformation for AC and histopathological grade of malignancy for LLSCCs). RESULTS Expression of GRα was observed in all cases studied, with relatively high median percentages of positive staining. When compared to AC, LLSCCs exhibited lower nuclear expression and higher cytoplasmic expression of GRα (P < 0.05). Regarding clinicopathological parameters, significant differences were only found for cytoplasmic expression of GRα according to the histopathological grade of LLSCCs (P = 0.036). Higher expression of Bax compared to Bcl-2 was observed in AC and LLSCCs (P < 0.05). In LLSCCs, there was a positive correlation between nuclear and cytoplasmic expressions of GRα (P = 0.006). CONCLUSION Reduced nuclear translocation and increased cytoplasmic expression of GRα may be important events in lip carcinogenesis but are not involved in the progression of LLSCC. The role of GRα in lip cancer development does not seem to be primarily related to modulations in the expression of Bcl-2 or Bax.

Objective Actinic cheilitis (AC), a potentially malignant disorder, exhibits unpredictable progression to lip squamous cell carcinoma. Therefore, this study describes clinical and pathologic findings of cases of AC. Study Design Observational and cross-sectional study. Sample was composed of 60 cases of AC diagnosed in the period from 2011 to 2017 in an oral diagnosis referral center. Clinical data of patients (age, sex, and race) and lesions (anatomic site, size, symptomatology, and type of biopsy) were obtained from records. Morphologic analysis was graded according to the World Health Organization (WHO) (2017). Results Mean age of patients was 57.9 ± 12.9 years old; male were most affected (n = 45; 75%), with ratio of 3:1. White individuals were most affected (n = 30; 50.0%). Lower lip was the anatomic site more affected (n = 58; 96.7%). In relation to clinical aspect, AC showed predominance of white lesions (n = 30; 50.0%), aspect of plaque (n = 25; 41.7%), size ≤ 1 cm (n = 29; 48.3%) and asymptomatic (n = 37; 61.7%). Incisional biopsy was the most performed (n = 29; 48.3%). Histopathologically, most AC cases were classified as mild epithelial dysplasia (n = 26; 43.3%). Conclusions The results showed that clinical aspects of AC can reflect morphologic findings, so it is important to make a more accurate diagnosis.

A 53-year-old male patient presented with an approximately 8-year history of an asymptomatic "blood blister" on the lower lip. Extraoral examination revealed a soft, purplish, lobulated swelling on the left side of the lower lip skin. Intraoral examination showed a well-defined, purplish stain and papules on the left lower lip and alveolar mucosa, measuring approximately 1.5 × 1.0 cm. The diagnostic hypothesis was vascular lesion, which was later confirmed by a positive diascopy result. Under local anesthesia, the patient was submitted to 2 clinical sessions of photocoagulation with high-intensity diode laser (Thera Lase Surgery; 808∼830 nm ± 20 nm, 2.5 W, defocused 2 mm beam in continuous mode). The postoperative course was uneventful. After 6 months of follow-up, the patient reported only mild sensitivity in the region. Clinical examination revealed fibrosis compatible with the tissue repair process without aesthetic or functional impairment.

Objective Biological behavior of oral squamous cell carcinoma (OSCC) in young patients is controversial. Therefore, this study compared prognostic factors of OSCC between young and older patients, through a systemic review. Study Design Electronic search in the databases Pubmed/Scopus/Ovid/Proquest/Cochrane Library/Web of Science/Lilacs was performed until April 2018, without filters by language or year of publication. Only cohort studies were included and evaluated by Newcastle-Ottawa scale for risk of bias. Analysis of titles and abstracts was made by 2 calibrated researchers (kappa = 0.94). Results A total of 5370 articles were reviewed, and 10 of the most relevant articles that are suitable to the criteria were selected. All included studies had a low risk of bias. Independent of age group, male was more affected, and tongue was anatomic site more frequent. Main risk factors were smoking and alcoholism in both age groups. Most patients in both age groups were diagnosed in early clinical stages (I/II). Regarding to histologic grading, majority of OSCC was classified as moderately differentiated in both age groups. Lower survival was observed in older patients. Conclusions Among all prognostic factors evaluated, survival showed difference in age groups, suggesting, then, that OSCC in older patients could exhibit more aggressive biologic behavior.

Lower lip squamous cell carcinoma (LLSCC) represents frequent lip malignant neoplasms, and the majority is preceded by actinic cheilitis (AC), a potentially malignant disorder. In this context, we report 3 cases of AC and 1 of LLSCC, emphasizing the importance of thermography as an auxiliary tool in diagnosis. In AC and LLSCC, thermography showed, respectively, whitish areas with higher heat emission and reddish circular area of irregular thermal distribution. After acquisition of thermography images, incisional biopsies were performed to evaluate microscopic alterations according to the criteria described by the World Health Organization (2017). Of the AC cases, 1 was diagnosed as mild epithelial dysplasia and 2 were moderate epithelial dysplasia. LLSCC was confirmed on anatomopathologic examination. As a result, we observed that thermography is not able to distinguish the different degrees of epithelial dysplasia found in AC, but it is a new imaging method useful in distinguishing AC from LLSCC.

Ameloblastoma is a benign epithelial odontogenic neoplasm characterized by locally aggressive behavior. This lesion is often asymptomatic, and some cases are detected during routine radiographic examination. A 33-year-old female patient undergoing orthodontic treatment presented with a 1-month history of a painful swelling in the posterior mandible. Her medical history was noncontributory. Panoramic radiograph showed a well-defined, multilocular radiolucency on the left side of the mandible extending from tooth #37 to the mandibular ramus. A panoramic radiograph obtained for orthodontic documentation 7 years earlier revealed a well-defined, unilocular radiolucency associated with the crown of unerupted tooth #38. Under the diagnostic hypothesis of odontogenic keratocyst, an incisional biopsy was performed. Histopathologic findings confirmed the diagnosis of ameloblastoma. The patient was referred for surgical treatment and remains under close follow-up. This case emphasizes the importance of a detailed analysis of patient images, irrespective of the diagnostic goal, before any dental treatment planning.

Lelia Batista de SOUZA (d) Leao PEREIRA P INTO (d) Cassiano Francisco Weege NONAKA (a) (a)Universidade Estadual da Paraiba - UEPB, Dental School, Department of Dentistry, Campina Grande, PB, Brazil. (b) Universidade de Fortaleza - Unifor, Dental School, Department of Oral Pathology, Fortaleza, CE, Brazil. Universidade Federal do Ceara – UFC, (c) Dental School, Department of Oral Surgery, Fortaleza, CE, Brazil.Universidade Federal do Rio Grande do (d) Norte – UFRN, Dental School, Department of Oral Pathology, Natal, RN, Brazil. Analysis of GLUT-1, GLUT-3, and angiogenic index in syndromic and non-syndromic keratocystic odontogenic tumors The aim of this study was to evaluate the immunoexpression of glucose transporters 1 (GLUT-1) and 3 (GLUT-3) in keratocystic odontogenic tumors associated with Gorlin syndrome (SKOTs) and non-syndromic keratocystic odontogenic tumors (NSKOTs), and to establish correlations with the angiogenic index. Seventeen primary NSKOTs, seven recurrent NSKOTs, and 17 SKOTs were selected for the study. The percentage of immunopositive cells for GLUT-1 and GLUT-3 in the epithelial component of the tumors was assessed. The angiogenic index was determined by microvessel count. The results were analyzed statistically using the nonparametric Kruskal-Wallis test and Spearman’s correlation test. High epithelial immunoexpression of GLUT-1 was observed in most tumors (p = 0.360). There was a higher frequency of negative cases for GLUT-3 in all groups. The few GLUT-3-positive tumors exhibited low expression of this protein in epithelial cells. No significant difference in the angiogenic index was observed between groups (p= 0.778). GLUT-1 expression did not correlate significantly with the angiogenic index (p > 0.05). The results suggest that the more aggressive biological behavior of SKOTs when compared to NSKOTs may not be related to GLUT-1 or GLUT-3 expression. GLUT-1 may play an important role in glucose uptake by epithelial cells of KOTs and this process is unlikely related to the angiogenic index. GLUT-1 could be a potential target for future development of therapeutic strategies for KOTs.Keywords: Odontogenic Cysts; Odontogenic Tumors; Glucose Transporter Proteins, Facilitative.

Odontoma is the most common type of odontogenic tumor and is most often diagnosed in the second decade of life. This benign tumor has a slow growth and is asymptomatic, which favors its persistence in the bone until some clinical sign emerges or the tumor or be detected in a routine radiograph. The aim of this case report was to present a clinic case of a 13-year-old male, who presented delayed exfoliation of the mandibular right primary canine. The radiographic exam revealed a radiopaque image in the anterior region of the mandible produced by structures that resembled the formation of teeth surrounded by a radiolucent area. Adjacent to the tumor, the impacted mandibular right canine was identified with deviation of its eruption axis. The clinical diagnosis was compound odontoma. Treatment consisted of the removal of the tumor and the surgically-assisted eruption of the tooth without orthodontic traction. After three years of follow up, the patient has exhibited positive results. It is possible to surgically assist the eruption of an impacted tooth, with a deviated axis, associated with an odontoma through the removal of the tumor and of the physical barrier (ostectomy) without orthodontic traction. RESUMO Os odontomas são considerados os tipos mais comuns de tumores odontogênicos e frequentemente diagnosticados na segunda década de vida. Possuem crescimento lento, comportamento benigno e assintomático, favorecendo sua permanência intraóssea por muito tempo até demonstrarem algum sinal clínico ou serem detectados em radiografias de rotina. O objetivo deste relato foi apresentar um caso clínico de um paciente de 13 anos de idade, sexo masculino, que apresentou atraso na esfoliação do canino decíduo inferior direito. No exame radiográfico, verificou-se uma imagem radiopaca na região anterior da mandíbula, produzida por estruturas que lembravam a formação de dentes, circundada por uma área radiolúcida. Adjacente à lesão, na parte basal, identificou-se a presença do canino permanente inferior direito incluso, apresentando desvio do seu eixo de erupção. O diagnóstico clínico foi definido como odontoma composto. O tratamento consistiu na remoção da lesão e erupção do dente incluso associado, por meio de intervenções cirúrgicas, sem tração ortodôntica, com três anos de acompanhamento e resultados positivos. Existe a possibilidade de erupção cirurgicamente guiada de dente retido, com desvio do seu eixo de erupção e associado à odontoma, através da remoção da lesão e da barreira física (ostectomia) sem tração ortodôntica.

J Oral Pathol Med (2012) 41: 194–199 Background: Peripheral giant cell lesion (PGCL) is a reactive process associated with a local irritating factor that shows low recurrence after treatment, especially if the irritating factor is eliminated. On the other hand, central giant cell lesion (CGCL) presents a variable clinical behavior ranging from slow and asymptomatic growth without recurrence to rapid, painful and recurrent growth. Our aim was to compare the immunoexpression of tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) in CGCL and PGCL. Methods: Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of TNF-α and TGF-β in multinucleated giant cells (MGC) and mononucleated cells (MC). Results: The PGCL showed lightly higher expression of TNF-α than CGCL. In comparison with PGCL, the CGCL showed higher expression of TGF-β in MC and MGC (P

J Oral Pathol Med (2011) 40: 338–344 Background: Central giant cell lesion (CGCL) and peripheral giant cell lesion (PGCL) are pathological conditions of the jaws that share the same microscopic features, but differ clinically in terms of their behavior. Our aim was to compare the immunoexpression of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in CGCL and PGCL, relating them to the angiogenic index. Methods: Twenty CGCL and 20 PGCL were selected for analysis of the immunoexpression of MMP-9 and VEGF in multinucleated giant cells (MGC) and mononucleated cells (MC). Angiogenic index was determined by microvessel count (MVC) using anti-von Willebrand factor antibody. Results: The CGCL showed slightly higher expression of MMP-9 than PGCL. In comparison with PGCL, the CGCL showed higher expression of VEGF both in MC (P