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Background Lymphomas in the oral and oropharyngeal regions are relatively uncommon, and their diagnosis is challenging and complex due to the myriad histopathological subtypes. Herein, we report a large series of oral and oropharyngeal lymphomas and compare our data with the currently available literature. Methods All cases diagnosed as lymphomas affecting the oral and oropharyngeal regions were retrospectively retrieved from seven Brazilian institutions. Clinicodemographic data and histopathological features were evaluated and described, while a comprehensive literature review was undertaken in order to compare our findings. Results A total of 304 cases of oral and oropharyngeal lymphomas were obtained, mostly affecting individuals aged 60-69 years (n = 68) with a mean age at diagnosis of 54.2 ± 20.1 years. Males and females were equally affected. Mature B-cell neoplasms (87.2%) were the most common group, followed by mature T- and NK-cell neoplasms (11.2%) and precursor lymphoid neoplasms (1.6%). The most frequent subtypes in each group were diffuse large B-cell lymphomas, not otherwise specified (n = 99), extranodal NK/T-cell lymphomas, nasal type (n = 12), and B-lymphoblastic leukaemia/lymphomas, not otherwise specified (n = 4). The most commonly involved sites were the palate (26.3%), mandible (13%), and maxilla (10.5%). Conclusion Diffuse large B-cell lymphoma, not otherwise specified, remains the most common subtype of lymphomas in the oral and oropharyngeal region. Older patients are the most affected, with no gender predilection and the palate and jaw are usually affected.

Background Plasma cell neoplasms are characterized by the proliferation of a single clone of plasma cells with production of a monoclonal immunoglobulin. They can manifest as a single lesion (plasmacytoma) or as multiple lesions (multiple myeloma). Methods Paraffin-embedded tissue blocks of patients microscopically diagnosed with plasma cell neoplasms in the jaws were retrieved from five pathology files. Data including clinical, radiographic, microscopic and immunohistochemical findings, treatment employed, and follow-up status were retrieved from the pathology reports. Results Fifty-two cases were retrieved (mean age: 59.4 years) without sex predilection. The mandible was the most affected site (67.3%), usually associated with pain and/or paresthesia (53.8%). Lesions in other bones besides the jaws were reported for 24 patients (46.2%). Radiographically, tumors usually presented as poorly defined osteolytic lesions with unilocular or multilocular images, while microscopy revealed diffuse proliferation of neoplastic plasma cells with nuclear displacement and abundant eosinophilic cytoplasm. Two cases were classified as anaplastic, and amyloid deposits were found in two other cases. Immunohistochemistry was positive for plasma cell markers and negative for CD20 and CD3, and monoclonality for kappa light chain predominated. The overall survival rate after 5-years of follow-up was 26.6%. Conclusion Plasma cell neoplasms are aggressive tumors with a poor prognosis and involvement of the jaws may be the first complaint of the patient. Thus, oral pathologists, head and neck surgeons and dentists should be aware of their clinical, radiographic and microscopic manifestations.

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

IgG4-related disease is a fibroinflammatory and immune-mediated condition, which has extremely variable clinical manifestations. In this study, we aim to investigate the clinicopathological features of IgG4-related disease involving the oral and maxillofacial region.Cases of IgG4-related disease manifesting in the oral and maxillofacial region were retrieved from three Brazilian institutions. Clinical and serological data were obtained from the patients' medical charts, while microscopic and immunohistochemical findings were revised by oral pathologists. Diagnosis followed the American College of Rheumatology/European League against Rheumatism criteria.Seven patients diagnosed with IgG4-related disease were included in this study. Women were affected in all analysed cases, with a mean age of 55.4 years. Two patients presented with the clinical involvement of more than one oral and maxillofacial anatomic site. Therefore, our sample comprised nine oral and maxillofacial anatomic sites affected by IgG4-related disease. The submandibular gland was affected in four cases, the tongue and the parotid gland in two cases each, and the palate in one case. In a few cases, exploratory lower lip biopsy was used as a diagnostic approach. A moderate-to-severe lymphoid infiltrate containing plasma cells and lymphocytes, with an increased IgG4/IgG ratio, was common. Treatment varied and steroids were the most frequently used (57.4%). Six patients remained alive, while one died from unknown causes.Although major salivary glands are commonly affected by IgG4-related disease, the oral cavity can also be involved, and lower lip biopsy may be an auxiliary diagnostic tool.

Background The diagnosis of oral and maxillofacial mature T/NK-cell neoplasms is challenging because of their rarity, morphological heterogeneity and complex immunophenotype, with scarce available data describing their clinical and microscopic aspects. Therefore, in this study we investigated a series of mature T/NK-cell neoplasms affecting this anatomical region and provided an updated literature review. Methods Cases diagnosed as mature T/NK cell lymphomas affecting the oral and maxillofacial region were retrospectively retrieved from six pathology files and their diagnoses were confirmed using haematoxylin and eosin-stained slides, immunohistochemical reactions and in situ hybridization for Epstein-Barr virus (EBV) detection. Patients' clinical data were collected from their pathology forms. Results A total of 22 cases were included in this study. Eleven (50%) consisted of extranodal NK/T-cell lymphomas, nasal type; eight (36.4%) were peripheral T-cell lymphomas, NOS; two (9.1%) were adult T-cell leukaemia/lymphomas, and one (4.5%) was an ALK-positive anaplastic large cell lymphoma. Overall, males predominated, with a mean age of 55.7 years. The palate was the most affected site (50%), and tumours usually presented as destructive and painful ulcers. EBV was present in all cases of extranodal NK/T cell lymphoma nasal type, but was absent in the other subtypes. Conclusion Among mature T/NK-cell lymphomas of the oral and maxillofacial region, extranodal NK/T cell lymphoma, nasal type and peripheral T-cell lymphoma, NOS predominated. Older men were the most affected patients, and this heterogenous group of neoplasms has a very aggressive clinical behaviour.

Made available in DSpace on 2022-04-29T08:36:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Oral Pathology Department João de Barros Barreto University Hospital/Universidade Federal do Pará Graduate student Oral Pathology Department João de Barros Barreto University Hospital/Universidade Federal do Pará Graduate student Department of Surgery and Diagnosis Universidade Estadual Paulista - UNESP- Araraquara Undergraduate student Oral Pathology Department João de Barros Barreto University Hospital/ Universidade Federal do Pará Department of Pathology Biological Sciences Institute Universidade Federal de Minas Gerais (UFMG) Graduate student Department of Surgery and Diagnosis Universidade Estadual Paulista - UNESP- Araraquara

Xeroderma pigmentosum (XP) is a rare inherited disease caused by deficiencies in DNA damage repair, which mainly results from the failure of nucleotide excision repair or defects in translesion DNA synthesis. The development of multiple malignancies is one of the most prominent features of this condition, which is clinically characterized by the occurrence of hyperpigmentation and lesions associated with sunlight exposure. Lip squamous cell carcinoma in patients with XP has rarely been reported, and information regarding the genetic analysis of these patients is limited. In this report, a case of a 20-year-old patient who developed squamous cell carcinoma in the lower lip is described. Although the tumor was surgically excised, the patient presented with recurrence a few months later. Targeted sequencing using a customized panel of DNA repair genes revealed a mutation in POLH, the gene encoding DNA polymerase eta. Therefore, molecular characterization is important to further improve the understanding of possible phenotype-genotype correlations and mechanisms involved in the pathogenesis of XP.

Purpose To integrate the available data published on central odontogenic fibroma (COF) into a comprehensive analysis of its clinical/radiologic/histological features. Methods An electronic search was undertaken in September 2017. Eligibility criteria included publications reporting cases of COF having enough clinical, radiological and histological information to confirm the diagnosis. Demographic data, lesion site and size, treatment approach, and recurrence were analysed. The cases included in the analysis presented follow-up time. Concerning recurrence analysis, tumour location, cortical bone perforation, lesion locularity, radiopacities, lesions associated with a tooth, tooth displacement, histological type and treatment used were evaluated. Results Eighty-three publications reporting 173 COFs were included. Lesions were slightly more prevalent in men than women (M: F – 1.13: 1); mean age was 31.6 years, with the highest prevalence in the second decade of life. Lesions were more prevalent in the posterior mandible. The difference in recurrence rate (when information about recurrence was provided) presented a statistically significant result for COF for location, cortical bone perforation and locularity of the lesion. Conclusions Our paper highlights that patients with COF who present a lesion located in the maxilla with multilocular aspects and cortical bone perforation tend to show a higher recurrence rate.

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

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.

Objective To integrate the available data published on central mucoepidermoid carcinoma (CMC) into a comprehensive analysis of its clinical aspects, histology, treatment, and prognostic factors. Methods An electronic search was undertaken in July 2017. Eligibility criteria for publications included having clinical, histological, treatment, and time of follow-up data to confirm the diagnosis. Results • 36 publications (147 CMCs) were included. • The lesion showed a slightly higher prevalence among women than men. • There was a high prevalence in the fifth to seventh decades of life. • The most common symptom was swelling and the most commonly observed area was the mandible. • Histologically, low-grade tumors were the most common. • The treatment of choice was tumor resection. In addition, gender, histological grade, conservative treatment, and lymph node metastasis were significant independent prognostic factors. Conclusion Male patients with histological grade III CMC of the jaw bone, who used conservative treatment as the main treatment, and presented with lymph node metastasis, were more likely to have a worse prognosis.

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.

Extranodal natural killer (NK)/T-cell lymphoma is an aggressive malignant neoplasia, and the nasal cavity is the most commonly involved site. We present the clinicopathologic features of 3 patients including 2 women and 1 man with age varying from 41 to 70 years. The patients exhibited painful, extensive, destructive lesions with large ulceration predominantly affecting the hard palate. They also revealed other complications such as nasal obstruction, facial asymmetry, fever, and weight loss. Microscopically, all cases revealed a diffuse lymphoid infiltrate composed of small-to-medium–sized neoplastic cells with large areas of necrosis and the angiocentric and angiodestructive growth pattern. Positivity for LCA, CD3, CD43, CD56, and granzyme B was observed. A low Ki-67 labeling index and positivity for Epstein-Barr virus were also observed. Two patients died, and 1 remains alive under treatment. Extranodal nasal NK/T-cell lymphoma presents a poor prognosis, and its diagnosis can be challenging. Support: FAPEMIG.

Histiocytosis is part of histiocyte-related proliferative diseases. The term histiocyte involves all types of macrophages and other dendritic cells (antigen-presenting cells: dermal dendrocytes, Langerhans cells (CL), and indeterminate cells). An 11-year-old male patient presented with an initial complaint of dental pain. Intraoral examination revealed exophytic and ulcerated lesions associated with the left maxillary first and second premolar and with left mandibular first and second molar with a time-course evolution of 2 months. An incisional biopsy was performed, and histopathologic examination revealed the presence of histiocytes with nuclei shaped like kidney beans, permeated by eosinophils. There also were lymphocytes and giant cells. Immunohistochemistry was positive for S-100, concluding the diagnosis of histiocytosis. The patient underwent chemotherapy, and there has been no recurrence after 2 years of follow-up.

Fibrosarcoma is a malignant tumor of fibroblasts, which affects the head and neck region in 10% of cases. A 17-year-old woman sought treatment at an oral pathology center presenting a tumor-like lesion within the angle of the mandible with a time-course evolution of 10 months. The clinical and radiologic examination revealed expansive radiolucent lesion with bone cortical rupture. The tomographic examination revealed a hypodense image involving submandibular region and mandibular body. An incisional biopsy was performed. Histopathologic examination revealed fusiform cells with areas of mitosis and little pleomorphism. Immunohistochemistry was performed with results of low Ki67, positive vimetin, negative S100, negative HHF35, negative CD31, and negative β-catenin, concluding diagnosis of low grade fibrosarcoma. The patient went through surgical excision with a wide margin of safety, and after 1 year of clinical follow-up there were no signs of lesion recurrence.

A 25-year-old man was referred to an oral medicine center with a lower lip lesion of 1 month duration; he reported the occurrence of a local trauma. Clinical examination revealed a sessile lesion, with a red-purplish color, a firm consistency, and a soft surface. An initial diagnosis of hematoma was established and conducted with puncture of the lesion and removal of a fragment for biopsy. After histopathologic examination and immunohistochemistry positive for CD34 and human herpesvirus 8 (HHV-8), the diagnosis of Kaposi sarcoma was established. An anti–human immunodeficiency virus (HIV) test was requested, which turned out to be positive. The patient was referred to an oncologist and an infectious diseases specialist, and is currently under follow-up care.

A 21-year-old man sought treatment at an oral pathology center presenting with thick, brownish and peeling crusts along the upper and lower lips with a time-course evolution of 5 years. His main complaints were pruritus, burning sensation, and lack of aesthetics. Concomitantly with the onset of the lesions, the patient was diagnosed with anxiety disorder and depression. The diagnosis of exfoliative cheilitis was made based on the clinical characteristics and symptomatology reported by the patient. Tacrolimus monohydrate 0.1 % (2 times a day) and dexpanthenol 50 mg/mL (3 times a day) were prescribed, and in only 2 weeks, there was complete remission of all crusted lesions, partial regression of edema, and absence of pruritus. Currently, the patient remains using the medication only twice a week and there is no crust formation as well as no symptomatology.

Oral myiasis is a condition caused by the invasion of fly larvae in body tissues. This work aims to notify a clinical case of an oral myiasis in the oral cavity. The patient is 12 years old, male, white, and a carrier of cerebral palsy. He was attended by public health care presenting releasing of larvae through the vestibular face and in adjacent palatine next to elements 12 and 13. The clinical examination verified lack of hygiene, caries, necrotic ulceration, acute inflammation, exhaling fetid smell, bleeding in anterosuperior region, and larvae in this area. Treatment was Vaseline as asphyxiant during 3 days and single-dose ivermectin. In return, multiple larvae were detected within the lesion, the patient was anesthetized, an incision for displacement of the palatine area was made, and 55 larvae were removed. After intervention and surgical finalization, PerioGard was prescribed for cleaning. Therefore, therapeutics is effective.

Adenoid cystic carcinoma is the most common malignant salivary gland tumor in most of the studies. It can affect any salivary gland, but it more commonly involves the minor salivary glands of the palate and the parotid glands, presenting as an asymptomatic slow-growing swelling in middle-aged adults. The aim of this report is to present a case of adenoid cystic carcinoma affecting a 45-year-old female patient that demonstrated a painful swelling on the floor of the mouth. The microscopic analysis revealed a salivary gland neoplasm involving the submandibular gland presenting a cribriform architectural growth pattern with the presence of basaloid and hyperchromatic neoplastic cells. Perineural infiltration was also found. Immunohistochemical positivity for AE1/AE3, CK14, and smooth muscle actin was observed, and a low proliferative index measured by Ki67 expression was seen. The patient was then referred for oncologic treatment and is under follow-up in our department. Support: FAPEMIG

Osteosarcoma is the most frequent primary malignant bone tumor, but osteosarcomas of the jaws are uncommon and account for only 2% to 10% of all cases diagnosed. The aim of this study is to present 3 new cases of osteosarcoma affecting the gnathic bones. The mandible was affected in 2 cases, whereas the maxilla was involved in 1. Age ranged from 10 to 25 years, and all patients were female. An asymptomatic expansive swelling was the chief complaint in all cases. Microscopically, a diffuse proliferation of pleomorphic cells with presence of osteoid material and variable number of atypical mitotic features were observed. Ki67 staining showed a proliferative index of approximately 15%, and positivity for D2-40 and CDK4 were also observed. All patients are currently under oncological treatment. Support: FAPEMIG.

Plasmablastic lymphoma is non-Hodgkin's lymphoma usually found in the head and neck region. It is a rare and aggressive subtype of B-cell lymphoma that affects, in most cases, HIV-positive individuals; it has a propensity for the oral cavity, presenting primary oral lesion with superficial ulceration and mass of rapid evolution as the only clinical finding. A 24-year-old seropositive man was referred to an oral pathology center presenting with a 2-month history of lesion in the left posterior mandible. Clinically, there was a lesion with no defined limits, involving teeth with a high degree of mobility. An incisional biopsy was performed. The anatomopathologic examination revealed a proliferation of diffuse neoplastic cells, and immunohistochemical reactions were positive for leukocyte common antigen and CD-138, showed high Ki-67, and were negative for CD-20 and CD-3, concluding the diagnosis of plasmablastic lymphoma. The patient was referred to a hematology center to start treatment.

Papillary cystadenocarcinoma (PCC) is a rare malignant tumor of the salivary glands featured by cysts and papillary endocystic projections. The differential diagnosis includes cystadenoma, papillary-cystic variant of acinic cell carcinoma polymorphous low-grade adenocarcinoma (PLGA), salivary duct carcinoma, and adenoid cystic carcinoma (ACC). Nuclear pleomorphism, mitosis, and infiltrative growth pattern affirm the malignancy of PCC. A 66-year-old man presented with a swelling in the upper alveolar ridge and hard palate. Intraorally, an exophytic, friable and ulcerated lesion was observed. Computed tomography scan showed a large soft tissue mass destroying the left maxilla. An incisional biopsy was performed. Based on the histopathologic features of papillary projections extending into the cystic lumen, the diagnosis of PCC was confirmed. The patient was referred to an oncology center where chemotherapy and radiotherapy were chosen as the appropriate treatment. Currently, no signs of recurrence were detected after 2 years of clinical follow-up.

Objectives The aim of this study was to evaluate the expression of Akt, PTEN, Mdm2 and p53 proteins in three different head and neck squamous cell carcinoma (HNSCC) cell lines (HN6, HN19 and HN30), all of them treated with epidermal growth factor (EGF) and 17-allylamino-17-demethoxygeldanamycin (17-AAG), an inhibitor of Hsp90 protein. Material and methods Immunofluorescence and western blot were performed in order to analyze the location and quantification, respectively, of proteins under the action 17-AAG and EGF. Results Treatment with EGF resulted in increased levels of Akt, PTEN and p53 in all cell lineages. The expression of Mdm2 was constant in HN30 and HN6 lineages, while in HN19 showed slightly decreased expression. Under the action 17-AAG, in HN6 and HN19, the expression of PTEN and p53 proteins was suppressed, while Akt and Mdm2 expression was reduced. Finally, in the HN30 cell lineage were absolute absence of expression of Akt, Mdm2 and p53 and decreased expression of PTEN. Conclusion These data allow us to speculate on the particular utility of 17-AAG for HNSCC treatment through the inhibition of Akt protein expression, especially in the cases that retain the expression of PTEN protein.

Background The aim of this study was to evaluate, through immunohistochemical reaction in samples of oral squamous cell carcinoma, the correlation between the expression status of protein kinase B (p-Akt) and patient survival as well as histological grade and some clinicopathological features. Methods Samples were collected from 46 patients with oral squamous cell carcinoma. The immunohistochemical expression of p-Akt was analysed, as were clinicopathological features including the use of tobacco, tumour stage, size and infiltration of metastatic lymph nodes. The association of immunostaining with histological grade was analysed in 40 patients. The associations were examined for statistical significance using a chi-square test. Overall survival rates were estimated by the Kaplan–Meier method and compared using a log rank test (P > 0.05). Results The results indicated a statistically significant association with p-Akt immunostaining for the variables lymph node metastasis (P = 0.006), tumour size (P = 0.044) and survival rate (P = 0.0298). Conclusion From these results, the present study suggests that high p-Akt expression found in oral squamous cell carcinoma patients may contribute to tumour growth, metastasis to regional lymph nodes and shorter survival time.

Background The aim of this study was to identify the expression of MCM3, Ki-67 and p27 in normal mucosa, leucoplakia and oral squamous cell carcinoma (OSCC) and determine whether altered expression could serve as a prognostic marker of a malignant progression of dysplastic lesions. Methods The samples were collected from 37 patients with oral leucoplakia (13 with mild dysplasia – MLD, 12 with moderate dysplasia – MD and 12 with severe dysplasia – SD). Eleven samples of mouth floor mucocele (M) and 50 floor mouth and tongue samples OSCC of untreated patients were included in this study. Immunohistochemical expression of MCM3, Ki-67 and p27 of all the groups was analysed. Kruskal–Wallis and Dunn's test were used to determine differences among groups, and a Pearson's correlation test was used to evaluate the correlation between the proteins. Results Ki-67 expression was higher in OSCC than M (P

Plasmablastic lymphoma is an aggressive neoplasm with poor response to therapeutic management. It is commonly associated with HIV infection and it is strongly associated with Epstein-Bairr virus (EBV) in most of the cases, although negative cases to EBV can be ocassionaly identified. The aim of this report is to describe an original case of a 52-year old male patient referred to our department due to maxillary swelling causing facial asymmetry of the right side. His medical history was positive for HIV infection. The extraoral examination revealed hemifacial edema on the right side, involving the middle and lower thirds of the face, while intraoral exam showed an ulcerated swelling extending through the hard and soft palate on the right side, involving the buccal vestibule. CT scan revealed the presence of a hypodense image destroying the maxilla, involving the maxillary sinus, floor of the orbit and the nasal cavity. Incisional biopsy was done revealing a sheet-like proliferation of atypical large cells with plasmablastic appearance. Individually, these cells had eosinophilic cytoplasm with high nuclear-to-cytoplasmic ratio. Centrally and eccentrically cellular nuclei, with vesicular chromatin and evident nucleoli, with a starry-sky appearance were found. Immunohistochemistry was positive for CD138, EMA and MUM1, negative for CD20 and LCA, demonstrating monoclonality to lambda light chain. EBER was negative and final dignosis was rendered as EBV-negative plasmablastic lymphoma. Unfortunately, the patient died two months after diagnosis.

The ameloblastic fibro-odontoma is defined as a tumour with the general features of the ameloblastic fibroma but that also contains enamel and dentine. AFO normally presents as a painless swelling in the posterior portion of the maxilla or mandible. Radiographs show a well-defined radiolucent area containing various amounts of radiopaque material of irregular size and form. The most appropriate treatment for a large AFO has not been completely determined. This paper reports four large AFO cases and reviews the relevant literature regarding the clinical and surgical features of this lesion.

Ameloblastic carcinoma is rare, accounting for 1.5%-2.0% of all odontogenic tumors. Few small series are available, but data on its clinicopathologic characteristics derive mainly from single case reports; therefore, descriptions of new cases may help to better understand the biological characteristics of this rare odontogenic malignancy. In the current report we describe an ameloblastic carcinoma affecting a 27-year-old female patient who had a previous diagnosis of ameloblastoma 7 years before. The carcinoma featured extensive areas of squamous differentiation resembling a primary intraosseous squamous cell carcinoma, as well as areas of dedifferentiation, a poorly documented histologic characteristic of ameloblastic carcinoma. This case provides new insights on the microscopic spectrum of ameloblastic carcinoma, permitting a critical discussion of the current World Health Organization classification of this odontogenic tumor.

Carcinoma cuniculatum is a rare variant of squamous cell carcinoma originally described on the sole of the foot and for a long time believed to be restricted to the skin. However, since its first description in 1954, several cases have been reported at other sites. Carcinoma cuniculatum characteristically invades the underlying subcutaneous, submucosal, or bone tissues, forming so-called "rabbit burrows," with crypts filled with keratin that are of utmost importance for distinguishing this neoplasm from other variants of squamous cell carcinoma. Oral carcinoma cuniculatum is an even rarer entity that is frequently misdiagnosed initially, a phenomenon described in about one-third of previously reported cases. The aim of this report is: (1) to describe the clinicopathologic features of 2 new cases of oral carcinoma cuniculatum, initially misdiagnosed as infected orthokeratinized cyst and abscess, respectively; and (2) to review the related English language literature.

Leiomyosarcoma of the oral cavity is a very rare tumor associated with aggressive clinical behavior and low survival. In this paper, we report 2 cases of leiomyosarcoma, affecting the gingival mucosa of a 54-year-old female and the maxillary bone of a 63-year-old male. Histologically, the tumors were composed of variably oriented fascicles of spindle-shaped cells with cigar-shaped nuclei and eosinophilic cytoplasm. The lesions were treated by surgical resection. Immunoreactivity to anti-vimentin, anti-smooth muscle actin, anti-desmin, anti-laminin, and anti-muscle-specific actin antibodies were found; conversely, the tumor cells were negative for anti-S100 and AE1/AE3 proteins. This report emphasizes the role of immunohistochemical study for correct diagnosis of leiomyosarcoma.

Mandibular nerve has an important role in the field of oral maxillofacial surgery. Furthermore, several anatomical variations can be found and are clinically relevant mainly in procedures involving the posterior mandible. The unknown of these anatomical variations of the inferior alveolar nerve have been implicated with complications in the performance of surgical procedures and anesthesia in dental and maxillofacial practice. The present paper reports a rare anatomical variation of inferior alveolar nerve mimicking a recurrence of keratocystic odontogenic tumor.