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The aim of this study was to evaluate the immunoexpression of chemokine CXCL12 and its receptor CXCR4 in radicular cysts (RCs), dentigerous cysts (DCs), and odontogenic keratocysts (OKCs), and to correlate the findings with morphologic parameters of RCs (inflammatory infiltrate and cystic epithelium). Twenty RCs, 20 DCs, and 20 OKCs were submitted to immunohistochemistry. The percentages of cytoplasmic (CXCL12 and CXCR4) and nuclear (CXCR4) staining in epithelial and fibrous capsule cells were determined. RCs and DCs exhibited higher epithelial expression of CXCL12 than OKCs (P0.05). The expression of CXCL12 in the fibrous capsule was higher in DCs than in RCs and OKCs (P0.05). Higher cytoplasmic expression of CXCR4 was observed in the epithelial lining and fibrous capsule of RCs and DCs compared with OKCs (P0.05). In the fibrous capsule, DCs exhibited higher nuclear expression of CXCR4 than OKCs (P0.05). No significant differences in the immunoexpression of CXCL12 or CXCR4 were observed according to the morphologic parameters of RCs (P0.05). Strong positive correlations were found between cytoplasmic and nuclear expression of CXCR4 in the epithelial lining of RCs and DCs and in the fibrous capsule of all groups (P0.05). The results suggest the participation of CXCL12 and CXCR4 in the pathogenesis of RCs, DCs, and OKCs. These proteins may be particularly relevant for the development of odontogenic cysts with less aggressive biological behavior, irrespective of their nature (inflammatory or developmental). In RCs, the expression of CXCL12 and CXCR4 may not be related to the intensity of the inflammatory infiltrate or the status of cystic epithelium.

Data on the occurrence and clinicopathological characteristics of actinic cheilitis (AC) and lip squamous cell carcinoma (LSCC) are well studied; however, they are based on studies limited to a single centre. Herein, we described the frequency of AC and LSCC submitted to microscopic examination from representative geographic regions of Brazil. A retrospective multicentre study was performed on biopsies obtained from 1953 to 2018 at 10 Brazilian oral and maxillofacial pathology centres. A total of 198,709 biopsy specimens were surveyed. Sociodemographic data and clinicopathologic characteristics were analysed. A total of 2017 cases of ACs (1.0%) and 850 cases of LSCCs (0.4%) were recorded. A strong fair-skinned (> 87%) male (> 70%) predilection was observed in both conditions. The mean age was 54.8 ± 18.7 for individuals with AC and 57.8 ± 19.0 for individuals with LSCC. The most commonly affected site was the lower lip (> 90%). This is a large multicentre study of AC and LSCC from Brazil. The frequency and clinicopathological features of AC and LSCC were similar to those described worldwide. This study provides robust and representative epidemiological data of these conditions for the scientific community.

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.

Introduction: Lipomas are benign soft tissue tumors commonly found in the human body. Although common in the head and neck region, in the oral cavity region they are uncommon, accounting for only 1% to 4% of benign oral cavity lesions. Objective: This study aims to identify the clinical and histopathological characteristics of oral cavity lipomas subjected to histopathological analysis at a pathology laboratory in the city of Fortaleza, Ceará, Brazil. Methods: Data from all cases of oral lesions diagnosed as lipoma and confirmed by histopathological examination over a period of 10 years were collected, including: gender, age, anatomical location, clinical diagnosis and histopathological subtypes. Results: During the period evaluated, 101 cases were diagnosed as lipomas, representing 1.01% of oral cavity biopsies. Females were more affected, with a male/female ratio of 1: 1.8, and with a peak of incidence between 50 and 70 years of age. The buccal mucosa was the most affected anatomical region, followed by the lower lip. Classic lipoma and fibrolipoma were the histological variants of lipoma most commonly found in the oral cavity, with 64 cases of classic lipoma and 29 cases of fibrolipoma. Other histological variants were: sialolipoma, angiolipoma, chondrolipoma, myxolipoma and intramuscular lipoma. Conclusion: Lipomas are uncommon lesions in the oral cavity, which present a higher prevalence in the buccal mucosa of adults, aged between 50 and 70 years, and with higher female preference.

Squamous cell carcinoma (SCC) of the oral cavity is a malignant epithelial tumor that most commonly involves the tongue, and mainly affects men between the fifth and seventh decades of life. This study compared the lymphatic vessel density and VEGF-C expression in SCCs of the tongue between young and old patients.Thirty-four SCCs of the tongue, 17 diagnosed in young patients (≤40y) and 17 diagnosed in old patients (50y), were evaluated by immunohistochemistry. Lymphatic microdensity was determined based on the number of vessels immunoreactive to anti-D2-40 antibody. The percentage of neoplastic cells exhibiting cytoplasmic staining for VEGF-C was established for each case.Assessment of intratumoral lymphatic microdensity (ILMD) disclosed a median number of 6.20 lymphatic vessels in young patients and of 6.60 in old patients (p=0.809). Analysis of peritumoral lymphatic microdensity (PLMD) revealed a median number of 3.60 lymphatic vessels in young patients and of 3.40 in old patients (p=0.769). In the tumor core, analysis of the percentage of immunopositive cells for VEGF-C revealed a median number of 95.95% in young patients and of 55.48% in old patients (p0.001). In the deep invasive front, the median number of immunopositive cells for VEGF-C was 97.93% in young patients and 66.09% in old patients (p0.001).The results of this study suggest that the more aggressive biological behavior of SCC of the tongue in young patients may be related to a higher expression of VEGF-C.

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.

Objective The aim of this study was to assess vascular endothelial growth factor C (VEGF-C) and VEGF-D expressions, tumor lymphatic density (D2–40) and endothelial lymphatic proliferation (D2–40/Ki-67 double labeling) in a series of salivary gland neoplasm cases. Materials and methods Twenty pleomorphic adenomas (PA), 20 adenoid cystic carcinomas (ACC) and 20 mucoepidermoid carcinomas (MEC) were assessed, as well as 10 normal minor salivary gland (SG) tissues for comparison. Results All cases presented positive VEGF-C expression in the peritumoral and intratumoral regions, and no differences in immunoexpression were detected between groups. However, the ACC group presented a significant difference in VEGF-C immunoexpression according to the predominant histological pattern. Most cases presented poor VEGF-D labeling in the peritumoral and intratumoral regions. Concerning peritumoral, intratumoral and total lymphatic endothelial density, the assessed groups revealed an increasing gradient, with lower values for PA, followed by MEC and ACC. Conclusion No correlation was detected between VEGF-C and VEGF-D immunoexpression in relation to lymphatic tumor density and endothelial lymphatic proliferation. Western blotting (WB) revealed no difference between VEGF-C and VEGF-D expression among the lesions, corroborating the immunohistochemistry findings.

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.

The aim of the present study was to investigate the profile of tumor-infiltrating lymphocytes (TIL) in osteosarcomas of the jaws (OSJ). A total of 21 OSJ samples were analyzed in a retrospective and cross-sectional multicenter study. Immunohistochemistry was performed to determine the recognition of TIL such as CD4+, CD8+, granzyme B+ (GrB), programmed cell death protein+ (PD-1), and cytotoxic T lymphocyte-associated antigen 4+ (CTLA-4) in intratumoral and peripheral (stromal) regions. Positivity was determined based on the percentage and density of TIL+ per square millimeter [1 = absent ( 130 cells/mm2)]. The association of TIL density with clinicopathologic data was determined by the Mann-Whitney test (p

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.

β-Catenin exerts multiple functions in several neoplasms, playing a major role in cell signaling and tumor progression. This study analyzed possible CTNNB1 mutations in salivary gland pleomorphic adenomas (PAs) and adenoid cystic carcinomas (ACCs), and determined possible differences in β-catenin immunoexpression in relation to these mutations, as well as histopathological aspects of these tumors. Twenty-four PAs (15 cell-rich and 9 cell-poor tumors) and 24 ACCs (10 tubular, 8 cribriform, and 6 solid tumors) were selected for the analysis of β-catenin distribution and cellular localization. Furthermore, β-catenin expression was evaluated using the H-score scoring system. Mutations in CTNNB1 exon 3 were investigated by the single-strand conformational polymorphism test. Diffuse β-catenin expression was more frequently observed in ACCs compared to PAs (P = 0.008). No significant difference in β-catenin cellular localization was observed between these tumors (P = 0.098). Comparisons between PA and ACC cases revealed a higher median H-score in the latter (P = 0.036). Cell-rich PAs exhibited a trend for higher H-score than cell-poor tumors (P = 0.060), whereas lower H-scores were observed in cribriform ACCs when compared to tubular and solid ACCs (P = 0.042). Mutations in CTNNB1 were observed in 6 PAs and 7 ACCs, with no significant difference in H-scores for β-catenin according to mutation status (P = 0.135). β-Catenin is important in the pathogenesis of salivary gland PAs and ACCs. In addition, CTNNB1 exon 3 mutations do not seem to significantly influence β-catenin cytoplasmic/membranous expression or nuclear translocation in these tumors.

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.

INTRODUCTION The aim of this study was to perform a retrospective study of histopathologic features of a series of cases of pyogenic granuloma (PG), peripheral giant cell lesion (PGCL), and peripheral ossifying fibromas (POF) that constitutes the group called reactional lesions, located in gingiva and alveolar ridge. STUDY DESIGN Cases of PG, PGCL, and POF were selected for this study. The morphological analysis of the lesions constituted the following: intensity of inflammatory infiltrate (IF), presence of vascular proliferation (VP), fibroblastic proliferation (FP), areas of ulceration (AU), bacterial colony (BC), presence of mineralization (PM), multinucleated giant cells (MGC), hemosiderin deposition (HD), hemorrhage area (HA). RESULTS Of the 288 cases analyzed, 162 (56.3%) were PG, 72 (25%) were PGCL, and 54 (18.8%) were POF. The IF, VP, AU, and BC were more prominent in PG (85.8%, 98.8%, 91.4%, and 46.9%, respectively) and PM in POFs (98.1%). FP was more frequent in POF (98.1%) and PGCL (100%) and MGC in PGCL (100%), although some cases of POF (7.4%) and PG (0.6%) exhibited MGC. HD was more frequent in PGCL (40.3%) and HA in PG (53.1%). CONCLUSIONS This study demonstrated that IF, VP, AU, BC, and HA are the common features in PG, MGC, FP, and HD are the most common in PGCL, and PM associated with FP are the most common in POF, which can help in the histopathologic differential diagnosis between these lesions. In addition, it may suggest a possible development and maturation of the PG in POF with reduction in the inflammatory component and increase in the fibrous component.

Objectives To evaluate cases diagnosed as “oral hemangiomas” based on the immunohistochemical expression of human glucose transporter protein (GLUT-1) and on histopathological features, and to investigate whether the classification proposed by the ISSVA was used correctly to classify these lesions. Material and methods All cases stored in the archives of an Oral Pathology Service and diagnosed as “oral hemangiomas” were reviewed. Seventy-seven cases were analyzed regarding the expression of GLUT-1. GLUT-1(+) specimens were classified as true infantile hemangioma (IH) and GLUT-1(−) specimens were reclassified based on their histopathological features. The nomenclature of these lesions was evaluated and some cases were reclassified. Results Only 26 (33.8%) of the specimens were indeed IHs. Among the GLUT-1(−) specimens, 20 (26.0%) were reclassified as pyogenic granulomas (PGs) and 31 (40.2%) as vascular malformations. Considering the previously applied nomenclature, only 47.5% of the cases initially diagnosed as “hemangiomas” were IHs. In the group of “capillary hemangiomas”, most cases (56.2%) were PGs. Among the three “cellular hemangiomas”, two were PGs and one was IH. Most (88.8%) “cavernous hemangiomas” were vascular malformations. Conclusion Careful and parameterized review of cases of vascular anomalies is necessary using auxiliary tools such as GLUT-1, since the exclusive use of histopathological findings might be insufficient to differentiate some anomalies. Clinical relevance Accurate clinical examination and the use of biomarkers such as GLUT-1 are essential for the diagnosis.

Oral squamous cell carcinoma (SCC) is a malignant epithelial tumor that is uncommon in individuals younger than 45 years. This study compared the cell proliferation and angiogenic index in SCCs of the tongue between young and older patients. Forty SCCs of the tongue, 20 diagnosed in young patients (≤ 40 y) and 20 diagnosed in older patients (>50 y) were evaluated by immunohistochemistry. Cell proliferation was evaluated using the Ki-67 labeling index (LI). The angiogenic index was determined by microvessel count (MVC) using anti- von Willebrand factor antibody. The mean Ki-67 LI in SCCs of the tongue was 43.8% (range, 26.0% to 72.4%) in young patients and 42.5% (range, 9.0% to 59.4%) in older patients (P=0.968). No significant difference in the Ki-67 LI was observed in relation to clinical stage or histologic grade of malignancy in either group (P>0.05). The mean MVC in SCCs of the tongue was 24.3 (range, 8.6 to 51.6) in young patients and 25.6 (range, 5.4 to 42.4) in older patients (P=0.543). There was no significant difference in MVC in relation to clinical stage or histologic grade of malignancy in either group (P>0.05). In addition, no significant correlation was observed between the Ki-67 LI and the angiogenic index (P>0.05). The results of this study suggest that the more aggressive biological behavior of SCC of the tongue in young patients may not be related to a higher cell proliferation rate or a higher angiogenic index.

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