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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.

Thrombocytopenia-absent radius (TAR) syndrome is a congenital malformation in which affected individuals present reductions in the number of platelets, hypoplasia, or absence of radial bone unilaterally or bilaterally. Hematologic, skeletal, cardiac (particularly tetralogy of Fallot and septal-atrial defects), and gastrointestinal anomalies are most commonly associated with TAR syndrome. Skeletal changes result in a higher risk of dental and craniofacial trauma in patients with the syndrome. Thus, it is important for the dentist to be aware of the characteristics of TAR syndrome and its clinical management for better care of these patients. The objective of this study is to describe a case report of a 26-year-old patient with TAR syndrome with a history of trauma and root fracture of tooth 11 and alveolar bone ridge. During anamnesis, root fractures requiring the extraction of the 11 tooth, alveolar bone ridge fracture in the adjacent region, and dental trauma were observed. A hematological evaluation and blood and radiological examinations were performed. Osseointegrated implant was performed using the guided surgery and flapless technique, as well as prosthetic rehabilitation in the affected region. This report discusses the importance of careful planning, such as the use of incisions and conservative surgery, techniques for alveolar ridge preservation, gingival manipulation, and prosthesis confection. The patient was attended by a hematologist throughout the treatment. Key words:TAR syndrome, absent radii and thrombocytopenia, dental implants, oral surgery.

The present study is a systematic review of the evaluation of screening programs as a strategy for early detection of oral cancer. The aim of this study was to assess whether screening through visual inspection is able to identify injuries in early stages, to increase survival, and to decrease the incidence and mortality of oral cancer. Studies using visual inspection to screen for oral cancer and potentially malignant lesions in apparently healthy individuals over 18 years without previous diagnosis of the disease were included. The MEDLINE/PubMed, Cochrane databases Library, EMBASE, and LILACS, including manual search and gray literature, were searched through January 2021 with no language or date restrictions. The risk of bias and the methodological quality were evaluated according to the appropriate tool for each study design. The analysis of the results was narrative. Seventeen studies were reviewed that included cohort, accuracy, and randomized clinical trial studies. The tracking type performed was opportunistic and organized in a variety of environments. The age of participants ranged between 18 and 60 years old and, in some programs, only people with risk habits for oral cancer were included. The screeners were healthcare professionals, physicians, and dentists. Two studies reported data on the incidence rate of severe cases and mortality and showed a reduction when patients were at risk for the disease and participated in the program more than once. A limitation of this review was the great variability observed in the estimates of the screening effectiveness among the studies, which made comparisons difficult. If a screening program is continuous and able to ensure the inclusion of high-risk individuals, it can contribute to improvement in survival rates with a change of stage and can have a significant impact on incidence and mortality due to the disease. Registration in the Open Science Framebook (OSF) with the osf.io/zg8nr link.

In the oral cavity, a broad spectrum of differential diagnostics includes lesions composed of clear cells. Under this umbrella, Clear Cell Odontogenic Carcinoma (CCOC) and Hyalinizing Clear Cell Carcinoma (HCCC) are rare malignancies that arise from different histological origins. However, the histology is similar; therefore, differentiation of CCOC and HCCC lesions is difficult and, in some cases, impossible to distinguish morphologically and immunohistochemically. Herein, we report an unusual presentation of a well-defined nodular lesion affecting the maxillary gingiva in a 19-year-old female, which presented clinically as a benign or reaction etiology lesion. Microscopic evaluation showed a tumor composed of cell sheets with clear cytoplasm, separated by septa of fibrous tissue and invading the connective tissue. Tumor cells were positive for p63 and AE1/AE3 and negative for PAX8, smooth muscle actin (AML) and estrogen receptor. The diagnosis was carcinoma with a clear cell pattern, and it was not possible to distinguish between HCCC and CCOC. In this study, clinicopathologic, histologic, and immunohistochemistry features of CCOC and HCCC were discussed due to the challenging histological diagnosis. Radical surgical treatment and rehabilitation of the patient through graft and dental implants were performed. The patient is under follow-up with no signs of recurrence.

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.

To evaluate and compare the number of CD1a+ dendritic cells (DCs) in oral lichen planus (OLP), amalgam lichenoid reaction (ALR), and normal oral mucosa (NOM).Fourteen cases of OLP and ALR, diagnosed both clinically and histologically, were obtained from an archive of an oral pathology service. Seven specimens of NOM were collected and served as controls. Immunohistochemistry was used to identify CD1a+ DCs. Densities were calculated using specimens of epithelium and lamina propria. For OLP and ALR, specimens of lamina propria included cells from inflammatory infiltrate (region A), and from below inflammatory infiltrate (region B). Comparisons and statistical analyses were performed among OLP, ALR, and NOM.A higher density of CD1a+ DCs was observed in OLP compared to ALR in region A (P .05) and regions A+B (P .05). A higher density of CD1a+ DCs was also observed in OLP compared with NOM in the regions A+B (P .05). Statistically significant differences were not observed for analyses involving epithelial tissue.The observation that there is a lower quantity of DCs in ALR specimens compared with specimens from individuals with OLP suggests that the role for DCs in the 2 diseases may be different. The difference in cell density could be used in the differential diagnosis of these 2 diseases, but the overlapping intervals in the statistical analysis may limit the application of this approach in surgical practice.

An 11-year-old female, melanodermal, was referred to stomatology service to evaluate a diffuse, brownish macule on the oral mucosa, asymptomatic, with a 7-day course. The intra-oral examination revealed brownish macules in the upper gingiva inserted, dark brown macule involving gingival inserted between teeth 32 and 36, left alveolar mucosa, and lip mucosa. The diagnostic hypotheses were physiologic pigmentation, oral melanoacanthoma, and melanoma. An incisional biopsy was performed on the region of the left buccal mucosa. Histologic sections revealed a mucosal fragment layered by squamous, stratified, parakeratinized epithelium with areas of acanthosis and the presence of numerous dendritic melanocytes between the cells of the upper layers. Based on these findings, the lesion was diagnosed as oral melanoacanthoma. During the follow-up of 15 days and 30 days, a partial regression of the lesion was observed. After 4 months of the diagnosis, complete regression of the lesion was observed.

An 18-year-old white woman was referred to our service with complaint of “ulcerations on the tongue.” The lesions worsened in the last 6 months when the orthodontic appliance was placed. The patient was vegetarian, and she reported a prolonged menstrual period. Oral examination revealed multiple symptomatic ulcerations with irregular shape with pseudomembrane involving the lower lip, tongue, and buccal mucosa bilaterally. Laboratory tests were requested, which showed sickle cell trait of anemia with presence of microcytic red blood cells as well as iron deficiency and ferritin. The diagnosis was of major aphthous ulcerations associated with anemia exacerbated by the use of the orthodontic appliance. The patient was advised regarding the feeding and constant use of wax use for mucosal protection and was prescribed topical steroid. The patient was referred to the hematologist, gynecologist, and nutritionist because of anemia manifestation. She is being followed up in our service with sporadic episodes of ulcerative lesions.

Oral melanoacanthoma is an uncommon acquired pigmentation. An 11-year-old black female patient was assessed because of an asymptomatic macular lesion on the labial and buccal mucosa with evolution of 1 week. Medical history did not contribute. Intraoral examination showed a dark brown and flat lesion with irregular borders measuring around 30 mm on the left side. Diagnostic hypotheses were oral melanoacanthoma, physiologic macula, and melanoma. Incisional biopsy was performed. Histologic slices showed numerous benign dendritic melanocytes scattered throughout the lesional epithelium. The final diagnosis was oral melanoacanthoma. After 2 weeks, a partial remission of the oral lesions was observed.

Objective To evaluate the mature dendritic cells density in samples of pemphigus vulgaris lesions in the oral mucosa. Study Design The study was approved by the Ethics Committee. We selected files, paraffin-embedded blocks, and slides of 15 patients diagnosed with pemphigus vulgaris by our service; and used 15 samples of normal mucosa as a control group. In both groups, the quantitative evaluation of the inflammatory infiltrate was made through the hematoxylin and eosin (H&E)-stained slides. The mature dendritic cells were identified using immunohistochemistry. The analysis of the immunoexpression was made in all the epithelium and lamina propria extension, to obtain the densities/mm2. The data was submitted to SPSS software for statistical analysis. Results The pemphigus vulgaris cases were composed of women and men (13:2), with the average age in years of 47.0 ± 14.7. Most of the lesions were symptomatic and multiples. There were no differences between the densities of mature dendritic cells (P > .005), though the inflammatory infiltrate was significantly bigger in the samples of pemphigus, compared to normal mucosa. Conclusions The mature dendritic cells do not seem to have an important role in the mechanism of the immunologic response in the pemphigus vulgaris oral lesions.

A 65-year-old man was referred to our service presenting with an atypical radiograph. During the anamnesis, no significant history was reported. In the intraoral exam, a blue-colored tumor with imprecise borders and irregular surface that was easily compressible and located in the basal regions, dorsum, and lingual belly of the left side was observed. Panoramic radiographic was performed again and revealed multiple ovoid and rounded areas, radiopaque, and well delineated on the left side, with an extraosseous location. A cystlike, unilocular, radiolucent defect was observed in the mandible. The diagnostic hypotheses included vascular malformation associated with phlebolith, infectious diseases associated with metastatic calcifications, and bone diseases. The test for a vascular lesion was performed. The diagnosis was vascular malformation associated with numerous phleboliths. The patient was referred to a hospital. The patient is under follow-up care and has experienced an increase in the number of phleboliths (after tooth extraction).

Objective To demonstrate clinical and epidemiologic profile of 621 cases of oral lichen planus from Brazilian pathology services. Study Design A retrospective study in which medical records of oral lichen planus from 1975 to 2017 of patients seen in the Clinic of Oral Pathology and in the Oral and Maxillofacial Pathology Service were evaluated. Data of sex, age, ethnicity, and characteristics of the lesion were compiled. This study was approved by the ethics committee (016/03). Results Oral lichen planus represents 1.69% (n = 621) of the lesions. Women (69.7%) and white persons (74.0%) were most common affected. Plaque lesions on buccal mucosa were the most common form. Plaque and ulcer lesions presented a higher frequency of symptomatology (P = .03). Conclusion The clinical profile of patients and histologic presentation of lichen planus is varied. To recognize the heterogeneity of this entity is important for differential diagnosis. Support: FAPEMIG.

Objectives This study aimed to evaluate the expression of the cancer stem cell marker ALDH1 and its association with tumor budding, a morphological marker of cancer invasion, in oral squamous cell carcinoma (OSCC). Findings 163 OSCC samples were obtained by incisional biopsies. Immunohistochemistry was performed to detect positive cells for ALDH1 (cancer stem cell marker) and for AE1/AE3 (multi-cytokeratin to identify OSCC cells in tumor budding evaluation). A positive expression of ALDH1 was observed in 47.24% of the samples. In the tumor budding evaluation, samples were classified as low-or high-intensity tumor budding. Association between the ALDH1 expression and tumor budding was assessed using the chi-square test. However, no association was observed (p>0.05). In samples with high-intensity tumor budding, differences in the ALDH1 expression between the budding area and the area outside the budding were evaluated using the McNemar test. The ALDH1 expression was higher in the budding area than in the area outside the budding (p Conclusion The findings reinforce the idea that cells at the tumor budding area show phenotypic characteristics of cancer stem cells. The debate concerning the model of oral carcinogenesis by cancer stem cells was also strengthen. Supported by FAPEMIG (APQ-01806/14 and PPM-00653-16).

J Oral Pathol Med (2010) 39: 605–610 Background: The most important risk factor linked to the development of oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) is tobacco use. Tobacco contains carcinogens that influence the DNA repair, cell cycle control and may produce chromosomal aberrations. The loss or acquisition of one or more chromosomes is defined as aneuploidy. Methods: Aneuploidy was determined by means of the DNA-content included in cells obtained by exfoliative cytology and Feulgen’s staining. The cells were collected from the clinically healthy lateral margin of the tongue of non-smokers without oral lesions, smokers without oral lesions, smokers with OL, and smokers with OSCC, using the CytoBrush®. Each group was composed of 20 individuals. A Carl Zeiss image analyzer system and the KS300 software were used. Statistical analysis was performed with BioEstat® software. Results: The mean percentage of aneuploid nuclei was statistically higher in the smokers (79.65%), smokers with OL (68.4%), and smokers with OSCC (93.65%), as compared to non-smokers (39.3%) (P

Background Odontogenic tumors exhibited variable biologica behaviors. Metallothionein (MT) is correlated with the cellular homeostasis of essential metals, cellular differentiation, and proliferation. The core goals of this study are (i) to report and to compare MT expression among benign epithelial odontogenic tumors; (ii) to correlate MT with cellular proliferation index; and (iii) to evaluate the influence of the inflammatory infiltrate on MT expression. Materials and Methods Ten cases of solid ameloblastomas (SABs), 4 squamous odontogenic tumors (SOTs), 5 adenomatoid odontogenic tumors (AOTs), and 3 calcifying epithelial odontogenic tumors (CEOTs) were subjected to immunohistochemical to anti-MT, anti-Ki-67, and anti-PCNA. Statistical analysis was performed using BioEstat® 4.0. Results Metallothionein staining was found to be the highest in the SABs (93.1%), followed by SOTs (52.9%), AOTs (38.4%), and CEOTs (0%). MT staining exhibited statistically significant differences between the SABs and the SOTs (P = 0.0047) and the AOTs (P = 0.0022). A weak-to-strong positive correlation between IMT and IK or IP was observed in SABs and SOTs, whereas a strong negative correlation was observed in AOTs. No differences in IMT, IK, and IP were observed between inflammation groups A and B. Conclusions The increased MT expression observed in the SABs might be correlated with clinical behavior (local invasiveness and high rate of recurrence). In the SABs and SOTs, MT plays a role in the stimulation of cellular proliferation. In contrast, MT can inhibit cellular proliferation in the AOT. The IMT, IK, and IP are not affected by inflammation.

Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federalde Minas Gerais, Belo Horizonte, BrazilBACKGROUND: Theglucosetransportertype1(GLUT-1)protein is a useful marker for perineurial cells. Because ofthe possible neuroectodermal histogenesis of the granu-lar cell tumour and congenital granular cell epulis, theaim of this study was to assess the immunoexpression ofGLUT-1 protein in granular cell tumour and congenitalgranular cell epulis to aid in clarifying their histogenesis.METHODS: The protocol of this study was approved bythe Committee of Bioethics in Research at UniversidadeFederal Minas Gerais. Six cases of granular cell tumourand three cases of congenital granular cell epulis weresubmitted to immunohistochemistry for GLUT-1 and S-100 using the streptavidin-biotin standard protocol.RESULTS: Five cases of granular cell tumour werelocated on the tongue and one case on the upper lip.All cases of congenital granular cell epulis were observedin the alveolar ridge of newborns. All lesions evaluatedproved to be immunonegative for GLUT-1. S-100 wasfound to be positive in all granular cell tumours andnegative in congenital granular cell epulis.CONCLUSIONS: Neither granular cell tumour nor con-genital granular cell epulis is directly related to perineur-ial cells.J Oral Pathol Med (2013) 42: 450–453Keywords: congenital epulis; GLUT-1 protein; granular celltumour; immunohistochemistry