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Made available in DSpace on 2020-12-12T01:47:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-03-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Background: SMARCB1 (INI-1)-deficient carcinomas and NUT carcinomas are aggressive neoplasms, often affecting the sinonasal region. Not uncommonly, their diagnoses are made retrospectively. Methods: Through SMARCB1 (INI-1) and NUT immunomarkers, 643 head and neck carcinomas were assessed retrospectively. Moreover, SMARCB1 (INI-1)-deficient and NUT carcinomas were additionally evaluated by immunohistochemistry, as well as in situ hybridization analysis for HPV and EBV. Results: Four SMARCB1 (INI-1)-deficient carcinomas (located in lower lip, soft palate, hypopharynx and vocal cord, this latter high-risk HPV positive) and three NUT carcinomas (all located in oropharynx) were detected, previously diagnosed as nonkeratinizing or moderately differentiated squamous cell carcinoma. All cases showed squamous differentiation. NUT carcinomas than SMARCB1 (INI-1)-deficient carcinomas showed low overall survival rate. Conclusion: The current cases expand the clinicopathological spectrum of SMARCB1 (INI-1)-deficient carcinomas and NUT carcinomas. Notably, the diagnosis of these cases is easily reached through immunohistochemistry, with impact on their accurate classification, treatment, and prognosis. Oral Pathology Department of Stomatology Public Oral Health and Forensic Dentistry Ribeirão Preto Dental School (FORP/USP) University of São Paulo Oral Medicine Department of Diagnosis and Surgery Araraquara Dental School São Paulo State University (UNESP) Department of Pathology and Forensic Medicine Ribeirão Preto Medical School (FMRP/USP) University of São Paulo Oral Medicine Department of Diagnosis and Surgery Araraquara Dental School São Paulo State University (UNESP) FAPESP: 2016/02713-2 FAPESP: 2016/11419-0 FAPESP: 2018/12734-2

O carcinoma espinocelular (CEC) é a neoplasia maligna mais comum (>90%) na região de cabeça e pescoço (CECCP). Apesar dos avanços científicos nos seus mecanismos moleculares e protocolos terapêuticos, a taxa de sobrevida global em 5 anos permanece em 90%) in the head and neck region (HNSCC). Despite scientific advances in its molecular mechanisms and therapeutic protocols, the overall 5-year survival rate remains at

Cementoblastoma is a benign ectomesenchymal odontogenic tumor characterized by the formation of cementum mass continuous with the tooth root, preferentially a permanent mandibular first molar. Clinically, the tumor shows a tender, sometimes painful, cortical plate expansion, frequently in male patients under 30 years old. Radiographically, the lesion exhibits a radiopaque mass, surrounding by a thin radiolucent rim, and attached to the tooth root. Microscopically, it is visualized a calcified matrix lined by large hyperchromatic cementoblasts with radiating columns at the periphery. Treatment of choice is surgery. Interestingly, rare cases of residual (after tooth extraction only) and recurrent (after tumor removal plus tooth extraction) cementoblastomas have been reported, which can be misdiagnosed if an appropriate clinicopathological correlation is not considered. Here, we present a rare case of residual cementoblastoma affecting an 18-year-old male patient at level of permanent mandibular first molar. Thus, residual cementoblastoma is an unusual presentation which should be included in the differential diagnosis of cementum-forming and bone-forming tumors affecting the jaws.

Background M2 macrophages are often detected in oral squamous cell carcinoma (OSCC), which, influenced by hypoxic conditions, appear to have high angiogenesis-inducing capacity. However, the effects of immunosenescence on tumor-associated macrophages (TAMs) and angiogenesis in OSCC are unknown. Methods Fifty-seven OSCCs were divided into 3 groups (I: 65 years [n = 20]). Immunohistochemistry for CD68 and CD163 (TAMs), and CD34 and D2-40 for microvessel density (MVD), microvessel area (MVA), and total vascular area (TVA) were performed. Results All groups showed similar clinicopathological and immunohistochemical findings. Similar CD68 and CD163 expression, confirmed a M2 phenotype. MVD, MVA, and TVA were similar, however, with significant predominance of blood vessels. No significant correlation between macrophage and angiogenic markers was observed. Conclusions A similar TAM and angiogenesis profile suggests the participation of other mechanisms, instead immunosenescence, in young and elderly OSCC patients.

Squamous cell carcinoma (SCC) is the most frequent malignant neoplasm of the oral cavity. SCC presents several histologic variants, such as clear cell, signet-ring, basaloid, desmoplastic, verrucous, cuniculatum, lymphoepithelial, and pigmented. This latter is a rare variant of oral SCC. We present a case of pigmented oral SCC, emphasizing its differential diagnosis. A 60-year-old male patient was referred presenting with a nodular lesion, reddish coloration, 3 cm in diameter, asymptomatic, and arising from the lateral border of the tongue. Microscopically, typical SCC was revealed, and in addition to the tumor cells, dendritic cells with dark intrinsic pigments were found surrounding the tumor cells. The pigments were negative for Ziehl-Neelsen and periodic-acid Schiff stains, and positive for Fontana-Masson stain. To date, only 16 cases of pigmented oral SCC have been reported, with variable clinical presentation despite detection of melanin in these tumors.

Intra-oral juvenile xanthogranuloma (JXG) is a non‐Langerhans cell histiocytosis often affecting infants and children. Approximately 10% of these cases represent “adult xanthogranulomas.” To date, 33 intra-oral JXG cases have been reported. Due to its benign and self‐limiting nature, this disorder can be considered a reactive rather than a neoplastic process, although its pathogenesis remains unknown. There are 2 clinical JXG variants: papular and nodular. A 46-year-old female patient was referred presenting with a yellowish oval nodule, with circumscribed margin, measuring 1 cm in diameter, smooth-surfaced, asymptomatic, and located on the right buccal mucosa. Microscopically, it was composed mainly by numerous mononuclear macrophages containing fine cytoplasmic vacuoles in the cytoplasm, with a lipidized or xanthomatous appearance. Immunohistochemistry showed positivity for CD11c, CD68, CD163, HLA-DR, and FXIIIa. The Ki-67 labeling index was 3%. The predominant xanthomatous appearance in intra-oral JXG is uncommon, but it should be considered to exclude other xanthomatous lesions.

Carcinoma cuniculatum (CC) is a rare variant of oral squamous cell carcinoma (OSCC). To date, 50 cases of oral CC have been reported. A 67-year-old white female patient presented complaining of a painless tumor mass in the left mandibular body with several months of evolution. Previous dental history indicated extraction of teeth #37 and #38 and chronic osteomyelitis. Intraoral examination revealed an irregular exophytic mass in the region of the extracted teeth, which exhibited a yellow purulent discharge during palpation. Radiograph evidenced an osteolytic lesion with irregular and ill-defined borders. An incisional biopsy was performed, which showed an intense squamous epithelial proliferation, with frequent invaginations that delimited pseudocystic cavities filled with parakeratin and peeled cells. In the deepest part, foci of osseous resorption permeated by squamous epithelium were visualized. In conclusion, oral CC should be considered in the differential diagnosis, especially when assessing persistent "reactive inflammatory process."

Objective Tetraspanins are proteins involved in several cellular processes, including association with tumor progression. In this study, the immunoexpression of tetraspanins in head and neck squamous cell carcinoma (HNSCC) were assessed, aiming to evaluate the participation of these molecules in carcinogenesis. Study Design An immunohistochemical study was carried out using the tissue microarray technique to evaluate the tetraspanins CD9 and CD63. One hundred and twenty-one HNSCCs were analyzed (male, n = 97; female, n = 24; mean age, 60.4 years). The anatomic sites were 84 oral cavity, 23 oropharynx, 3 skin, 7 paranasal sinuses, 2 larynx, 1 nasopharynx, and 1 pharynx. Results Only 103 HNSCCs were available for analysis. For CD9, 69 (67%) HNSCCs were positive (46 oral cavity, 17 oropharynx, 5 paranasal sinuses, and 1 skin). For CD63, 11 (10.7%) HNSCCs were positive (7 oral cavity, 2 oropharynx, 1 paranasal sinuses, and 1 skin). Conclusions Our results suggest participation of tetraspanins CD9 and CD63 in the HNSCC pathogenesis. Further studies are necessary to determinate their prognostic effect with therapeutic implications. FAPESP grant 2016/11419-0.

Nasopharyngeal angiofibroma is a benign but locally aggressive tumor of unknown etiology, typically occurring in the nasopharynx of male adolescents. A 21-year-old male patient was referred presenting left facial swelling and a nodular lesion arising from the upper vestibule. The imaginologic analysis showed a large mass occupying the left maxillary sinus. After incisional biopsy, microscopy exhibited a prominent vascular component constituted by vessels of variable size and shape, supported by cellular stroma, as well as collagenized and fibromyxoid areas. Immunohistochemistry showed positivity for vimentin, α–smooth muscle actin, and CD34 and focally for D2-40, desmin, and CD10. Moreover, CD68, CD163, FXIIIA, and CD209 highlighted numerous tumor-infiltrating immune cells, either macrophages or dendritic cells. The Ki-67 was 3%. The Weber Ferguson approach was used to remove the whole lesion. Besides growth factors and androgen receptors, the role of tumor-infiltrating immune cells in nasopharyngeal angiofibroma tumorigenesis should be clarified.

Objective Squamous cell carcinoma (SCC) of the head and neck region with neuroendocrine differentiation are rare neoplasms. These tumors can be poorly differentiated and usually have tendency for aggressive clinical behavior and propensity for both regional and distant metastasis. Their diagnosis is based on morphology and confirmation of origin by immunohistochemistry. The purpose of this study was to investigate the neuroendocrine differentiation profile in oral SSC (OSCC) and oropharyngeal SCC (OPSCC). Study Design One hundred thirteen cases (male, n = 95; female, n = 18; mean age, 60.4 years) diagnosed with OSCC (n = 85) and OPSCC (n = 28) were selected. Immunohistochemistry was performed using the tissue microarray technique to evaluate the immunomarkers chromogranin-A, synaptophysin, CD56, CD57, CD99, Ki-67, and cyclin D1. Results Our results showed positivity for chromogranin-A (8.3% OSCC; 0% OPSCC), synaptophysin (9.5% OSCC; 0% OPSCC), CD99 (28.8% OSCC; 3.8% OPSCC) and CD56 (1.2% OSCC; 11.1% OPSCC). CD57 was negative. The Ki-67 was 43.6% and 42.0% and cyclin D1 was 33.7% and 26.6% in OSCC and OPSCC, respectively. Conclusions Our results show similar proliferation index in both OSCC and OPSCC, and that neuroendocrine differentiation can be detected in some cases of OSCC and OPSCC and should be reclassified as such. FAPESP grant: 2016/11419-0.

Background. Field cancerization is a phenomenon in which prolonged exposure to carcinogens induces changes throughout the epithelium leaving the field ready for the appearance of premalignant or malignant lesions. These alterations can promote the development of multiple carcinomas and explain the appearance of recurrences and second primary tumors. The objective of this study was to report the case of a patient who developed six oral cavity tumors in five years of treatment and, also, demonstrate the immunohistochemical changes for p53 and Ki-67, routinely used to assess dysplasic regions. Case Report. When altered, p53 and Ki-67 suggest the presence of field cancers, an area with genetically altered cells, presenting a high risk of developing premalignant and malignant lesions. This phenomenon explains the recurrence of malignant neoplasms after tumor resections. Conclusion. In addition, early identification of potentially malignant lesions in cases of second primary tumors is essential for effective treatment and patient survival, which usually have an unwelcoming prognosis.