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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/aim p16 and PTEN are tumor suppressor genes. Loss of these molecules in oral squamous cell carcinoma (OSCC) has been studied worldwide. In this study, we explored whether p16 cooperates with inactive PTEN during the pathogenesis of OSCC, especially in regard to tumor aggressiveness and proliferation. Materials and methods Immunocytochemistry and western blot analysis were used to examine the levels of p16 and PTEN. Sequencing analysis was performed to identify mutations in the PTEN gene and HPV infection. Fluorescence in situ hybridization was used to examine the presence of the PTEN locus. Results PTEN analysis showed high positivity in T4 samples. HPV-positive tumors correlated with tabagism, tumor size 3 and 4, disease stages 3 and 4, presence of lymph node metastasis (N1) and poor differentiation. Immunoexpression of p16 was strongly correlated with the presence of HPV. Conclusion PTEN demonstrated a higher reactivity in advanced disease stages and p16 was strongly associated with HPV. Viral presence decreases tumor aggressiveness. Patients with advanced stage lesions demonstrated lower survival rate.

Background The aim of this study was to integrate the available data published on radiation-induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors. Methods An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Results Forty-two publications with 122 radiation-induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery. Conclusions RISOC showed a poor survival rate of 15.1% in 5-year follow-up. Gender and histological type were independently associated with survival.

The aim of this study was to integrate the available data published on Liposarcomas (LPSs) of the oral cavity into an analysis of its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in January 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Forty-five publications (104 LPSs) were included. The lesion was more prevalent in males from the fifth to seventh decades of life. Treatment (P = .03) and distant metastasis (P = .0001) were independently associated with survival. A lower possibility of recurrence was statistically associated with age (younger patients) (P = .03), tumor size (smaller than 2.8 cm) (P = .001), and treatment (radical surgery) (P = .04). LPS presents a good survival for patients after 5 years of follow-up (66.4%). Patients who were treated with conservative surgery and presented with distant metastasis showed poor prognosis.

Odontogenic Keratocyst (OKC) is a benign, intraosseous, odontogenic cyst which originates from the basal cells of overlying epithelium or from the dental lamina remnants. Clinically, they are presented as asymptomatic swellings, although can sometimes be associated with pain. Growth of an OKC leads to expansion and destruction of bone as it infiltrates the tissue around it. It is commonly seen in males between the second and fourth decades of life. The aim of this study is to report on the clinicopathological characteristics of an odontogenic keratocyst in a 9-month-old female patient and posterior rehabilitation with a removable maxillary expander.

Objetivo: Avaliar a influência das ações realizadas pelo Programa de Educação pelo Trabalho (PET-Saúde) no trabalho e conhecimento em saúde bucal de Agentes Comunitários de Saúde (ACS). Método: Para a análise da influência do conhecimento em saúde bucal do ACS pela foi realizado estudo transversal desenvolvido em dois distritos administrativos municipais através de instrumento validado. Os dados obtidos foram analisados estatisticamente pelo SPSS. Resultados: Os ACS eram em maioria do sexo feminino com idade entre 30 a 39 anos, e renda familiar de um a três salários, a maioria residia na comunidade há mais de seis anos e atua na comunidade entre 1 e 3 anos, abrangendo cerca de 500 a 599 indivíduos na sua microárea. Observou-se que a maioria dos ACS não realiza atividade de educação em saúde bucal por não terem recebido capacitação para tal, com exceção dos ACS do distrito administrativo sob área de cobertura da Universidade Federal do Pará. Sobre o conhecimento em saúde bucal, os ACS dos distritos DAGUA e DASAC obtiveram nível moderado. Conclusões: O PET-Saúde proporcionou construção coletiva do conhecimento para os ACS retornando em mudanças positivas sobre o cuidado em saúde bucal para as comunidades. Percebeu-se maior nível de conhecimentos relacionados à saúde bucal entre os ACS do DAGUA, apesar de não ter havido grande diferença entre os distritos analisados. As atividades do PET deveriam ser incorporadas nos projetos pedagógicos, dos cursos de graduação e ter caráter de continuidade nas comunidades fortalecendo as ações de integração ensino-serviço-comunidade.

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.

OBJECTIVES The aim of this study was to investigate the prevalence of oral sarcomas from geographic regions of Brazil. MATERIALS AND METHODS A cross-sectional study was conducted on biopsies obtained from January 2007 to December 2016 at twelve Brazilian oral and maxillofacial pathology centres. Gender, age, evolution time, clinical aspects, tumour location, tumour size at diagnosis, radiographic aspects and histopathological diagnosis were evaluated. Data were analysed using descriptive statistical methods. RESULTS From 176,537, a total of 200 (0.11%) oral sarcomas were reported, and the most prevalent were osteosarcomas (74 cases; 37%) and Kaposi's sarcomas (52 cases; 26%). Males were more affected than females at a mean age of 32.2 years old (range of 3-87 years). The most common symptoms were swelling¸ localised pain and bleeding at a mean evolution time of 5.14 months (range

A fim de discutir a importância de experiências multiprofissionais e o papel de inovação do PET - Saúde na formação acadêmica, este artigo relata a experiência do PET - Odontologia da UFPA junto à equipe multiprofissional de um CAPS AD localizado no município de Belém/PA, além de avaliar as condições de saúde bucal dos dependentes químicos. A experiência mostrou a integração entre os diferentes profissionais e motivou o desenvolvimento de habilidades dos discentes para o planejamento de ações integradas e criativas de promoção de saúde, através de metodologias ativas, apontando novos rumos de atenção à saúde, centrado na lógica da realidade da comunidade e não somente no ambiente clínico. As atividades realizadas pela equipe de Odontologia foram integradas às oficinas e grupos desenvolvidos na unidade, como oficinas culinárias e de confecção e o cuidado de hortas, que propiciaram momentos de educação em saúde bucal. Foram realizadas dinâmicas e rodas de conversas, sendo os usuários agentes ativos no processo de construção compartilhada de conhecimento. Ocorreu o “dia D no CAPS AD”, no qual os usuários participaram de atividade de escovação supervisionada e foram examinados por equipe médica e odontológica, com coleta de informações clínicas. Considera-se que a interação entre ensino, serviço e comunidade potencializada pelo PET - Saúde conduz a formação em saúde a um novo perfil, em que os profissionais se tornam mais capazes de responder às necessidades dos usuários e atuar de maneira compartilhada nos diferentes cenários.

Lymphomas of the oral cavity are rare and the most frequent type is diffuse large B-cell lymphoma (DLBCL). Epstein-Barr virus (EBV) is known to be associated with the development of different lymphomas. In 2008, the World Health Organization provisionally included the EBV-positive DLBCL of the elderly in the classification of hematopoietic and lymphoid tumors as a lymphoma occurring in older individuals without any known immunodeficiency. However, it has since been recognized that this entity may occur in younger individuals and present similar clinical parameters in both age groups. As a result, the 2017 revision has declined the term elderly and modified it to EBV-positive DLBCL, not otherwise specified (NOS). In this report, we describe a rare case of EBV-positive DLBCL, NOS, presenting as a painless swelling in the oral cavity. This entity shows a more aggressive clinical course than EBV-negative DLBCL, and other lymphoproliferative disorders should be considered in the differential diagnosis.

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

OBJECTIVE: To report the clinicopathologic features of acquired oral syphilis cases in South American countries. MATERIALS AND METHODS: Clinical data were retrospectively collected from the records of 18 oral diagnostic services in Argentina, Brazil, Chile, Colombia, Venezuela, Uruguay, and Peru. Serologies of nontreponemal and treponemal tests were used for diagnosis. RESULTS: The series comprised 339 cases of acquired oral syphilis. Secondary syphilis ranked as the most common stage (86.7%). Lesions were more frequent among males (58.0%) and young adults with a mean age of 33.3 years. Individuals aged 20-29 years were most affected (35.3%). The most commonly involved sites were the tongue (31.6%), lip/labial commissure (25.1%), and hard/soft palate (20.4%). Clinically, acquired oral syphilis usually presented as mucous patches (28.4%), papules (25.7%), and ulcers (18.1%). Skin manifestations occurred in 67.7% of individuals, while lymphadenopathy and fever were observed in 61.3% and 11.6% of all subjects, respectively. Most patients were treated with the benzathine penicillin G antibiotic. CONCLUSION: This report validates the spread of acquired oral syphilis infection among young adults in South America. Our directives include accessible diagnostic tools for proper disease screening, surveillance, and counselling of affected individuals, especially in low- and middle-income countries

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.

O câncer de boca é uma neoplasia maligna de etiologia multifatorial ligada a fatores intrínsecos e extrínsecos ao indivíduo. Atualmente, representa um dos agravos que mais são diagnosticados tardiamente. Dessa forma, a educação popular em saúde torna-se grande aliada na atenuação desse processo. O projeto de extensão Prevenção ao Câncer de Boca: de Ponto a Ponto, de Vila em Vila na Amazônia faz uso dessa ferramenta para compartilhar e discutir informações acerca das principais características do câncer de boca e a realização do autoexame de boca . Entretanto, com a pandemia de COVID-19, houveram mudanças estratégicas e novas perspectivas para o projeto. Este manuscrito busca relatar a experiência da extensão universitária em meio à pandemia de acadêmicos de odontologia, ressaltando os mecanismos encontrados para contornar as limitações da pandemia e atingir os objetivos propostos. De ordem prática, o projeto buscou confeccionar conteúdos audiovisuais acerca dos principais fatores de risco, sinais e realização do autoexame de boca e palpação ganglionar de cabeça e pescoço com base em “Virais” que estavam circulando na internet, a fim de trazer maior proximidade com os internautas. Além disso, os integrantes do projeto criaram postagens para a rede social com aspectos relacionados a câncer de boca, covid-19 e assuntos transversais ao público alvo do projeto. Foram utilizados cinco indicadores que forneceram subsídio para entender a relevância e abrangência do conteúdo postado. Concluiu-se que a internet representou um alicerce para a continuidade das atividades propostas pelo projeto e constituiu uma inovação mediante as adversidades impostas pela pandemia.

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.

Introdução: a violência destaca-se pelo impacto e ameaça à vida; tem merecido lugar de destaque entre as preocupações cotidianas, gerando necessidade de atençaõ e políticas públicas. Objetivo: caracterizar os impactos à saúde bucal de crianças e adolescentes vítimas de violência na cidade de Belém do Pará, Brasil. Materiais e Métodos: A amostra foi de 129 participantes atendidos no Pró-Paz Integrado do Centro de Perícias Científicas Renato Chaves. O exame clínico foi realizado individualmente em sala específica do Pró-Paz. Foi utilizada ficha de coleta validada com questões de identificação, condições da violência e avaliação da saúde bucal utilizando o índice CPO-D/ceo-d. Resultados: a maior parte da amostra sofreu violência sexual (89,9%), o estupro foi o principal subtipo encontrado (50,4%) e a penetração vaginal foi a mais prevalente (51%). O CPO-D médio dos analisados foi de 2,5. Observou-se a formação de três grupos com perfis para os episódios de violência. Crianças de 2-6 anos, sem cárie, vítimas de outros tipos de violência. Meninos, brancos, de 7-12 anos com cárie dentária vítimas de violência sexual associada a outros tipos de violência no ambiente extrafamiliar. Meninas pardas e negras de 13-17 anos, vítimas de violência sexual no ambiente intrafamiliar. Conclusões: o profissional de Odontologia encontra-se em uma posição única para detectar e relatar sobre o abuso, este profissional pode contribuir para que medidas de prevenção da violência sejam adotadas pelas autoridades afim de que a vítima não sofra outros tipos de violência associadas à cárie dentária.

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.

A saúde bucal apresenta-se como um direito constitucional, sendo condição relevante à integralidade de saúde. Este artigo objetivou compreender como a avaliação e ações de saúde bucal são contempladas no âmbito do Programa Saúde na Escola, através de pesquisa com abordagem qualitativa no município de Belém, Pará, utilizando roteiro semiestruturado com amostra de três categorias do Programa Saúde na Escola, selecionadas por conveniência e com base no critério de saturação: enfermeiros, professores e pais. A análise resultou três categorias distintas e inter-relacionadas que ressaltam a discussão acerca da necessidade de empoderamento para compreensão dos significados da saúde bucal dentro do PSE e ampliação de sua especificidade no cenário de trabalho transdisciplinar. Para o efetivo funcionamento da articulação escola/saúde, faz-se necessário reconhecer a aplicabilidade da política do Programa Saúde na Escola, buscando cada vez mais implementá-la nas escolas de modo a otimizar a interligação entre os envolvidos. Verificou-se a constante necessidade acerca do aperfeiçoamento de habilidades dos atores deste cenário de modo a atuar munidos de atitudes/comportamentos adequados para a melhoria da qualidade de vida do escolar. Oral health is a constitutional right, with its own national policy which guides the relevance of its interrelation to general health within the integrality principles. This manuscript aims at understanding how oral health assessment and actions are observed within the School Program Health, through a qualitative study performed in the city of Belém, State of Pará, Brazil. The sample criterion consisted of 5 nurses, 5 teachers and 5 parents. A semi-structured script was used, written and transcribed with subsequent thematic analysis. The analysis revealed three thematic categories emphasizing the need for policy empowerment and practice in order to understand the meanings of oral health within the SHP as well as to enlarge its specificity in the interdisciplinary work scenario. Thus, it is clear that for the effective functioning of the school / health relationship, it is of utmost importance that SHP policy is applied and recognized while continuously seeking to strengthen the principle of integrality and extended clinic. The study also highlights permanent education and constant need for the participants’ skill improvement so that both students’ health care and life quality can be fully promoted. NASCIMENTO, L.S.; PONTES, F.S.C. Universidade Federal do Pará

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.

Ranula consists of a pathological process induced by ductal disruption of the minor salivary glands followed by extravasation of mucous material surrounding adjacent structures. A swelling causing breathing and feeding problems associated with tongue displacement is frequently observed. It is a disease that generally involves the younger age group. In newborns congenital ranula may occur, an uncommon variance that differs from common ranula by not relate to post-traumatic reactions. There are reports that indicate a salivary gland duct atresia as the main cause of this pathology. The aim of this study is to analyze the clinicopathological characteristics of congenital ranula by reporting a new case report of this salivary cyst and reviewing the case reports previously published in the English literature.

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.

Multiple myeloma (MM) is a malignant neoplasm characterized by an abnormal intramedullary plasma cell proliferation. It accounts for approximately 10% of all hematologic malignancies. It generally occurs between fourth and seventh decades of life, and it is predominant in male patients. Patients lower than 40 years are considered young, and only very few cases have been reported. We present a rare case of a 27-year-old man whose initial findings of MM were a swelling at the ramus of the mandible.

Objectives The aim of this study is to analyse allelic loss of the PTEN gene and its protein immunoexpression in dysplastic oral lesions and oral squamous cell carcinomas (OSCCs). Materials And Methods Samples were collected from 153 patients (20 ranulas used as a control – C, 30 leukoplakias with mild dysplasia – MD, 30 leukoplakias with moderate to severe dysplasia – MSD, and 73 OSCC). PTEN protein expression was investigated using immunohistochemistry, and PTEN allelic loss was analysed by fluorescence in situ hybridisation (FISH). Differences among groups were evaluated using the Chi-square test. Results PTEN expression was higher in MSD (p=0.002) and OSCC (p=0.0259) compared with the C group; additionally, a higher expression was observed in MSD (p=0.0035) and OSCC (p=0.049) than MD. Regarding FISH analysis, a higher hemizygous (single copy) loss was observed in OSCC than C (p=0.0467) and OSCC than MD (p=0.0175), as well as a higher homozygous deletion in OSCC compared with C (p=0.0159) and OSCC than MD (p=0.0145). Conclusion The results of this work suggest that PTEN allelic loss is an important mechanism in the late stage of the development of oral potentially malignant lesions into oral cancer. This article is protected by copyright. All rights reserved.

A violência de gênero é um problema de saúde pública que requer estratégias para o seu enfrentamento, prevenção e reparação de danos. Quando há ocorrência de violência física em mulheres, a cabeça e pescoço despontam como regiões frequentemente afetadas. Também, o sistema estomatognático sofre com agravos de ordem crônica e silenciosa. Este estudo analisou a condição de saúde bucal de 120 mulheres em situação de violência atendidas na Delegacia de Atendimento Especializado em Belém do Pará/Brasil no ano de 2017 e 2018. Identificou-se as características sociodemográficas e quanto a sua saúde bucal. Os resultados mostraram que 40 (33%) apresentavam entre 26 e 35 anos, 74 (61,67%) se autodeclararam pardas, 50 (41,67%) eram donas de casa/desempregadas, e) 56 (46,67%) possuíam o ensino médio completo. A análise de correspondência indicou que o tipo de violência e as categorias relacionadas à satisfação com as condições dos seus dentes e boca, sensibilidade dentinária e índice CPO-D são dependentes, apresentando um nível de significância de 0,05 (5%) e do critério Beta (?) maior ou igual a 3. Assim percebe-se que a alta prevalência de agravos bucais associada à situação de violência corrobora para a insatisfação e autoimagem feminina.

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.

Objetivo: Avaliar o índice de Anos Potenciais Perdidos por pessoas diagnosticadas com Carcinoma oral de células escamosas no Estado do Pará. Métodos: Estudo observacional e ecológico. Realizou-se uma análise da distribuição do Carcinoma oral de células escamosas no Estado do Pará com dados obtidos de 318 pacientes acometidos por este carcinoma e atendidos em um hospital de referência, no período de janeiro de 2007 a agosto de 2016. Calculou-se o índice de anos potenciais de vida perdidos pela fórmula adaptada de Romeder e McWhinie. Realizou-se consulta por meio do Termo de cessão de dados (TCD). Resultados: A idade de maior acometimento é na sexta década de vida, onde os homens se sobressaem em ralação às mulheres. Cerca de 61% dos pacientes eram tabagistas ao diagnóstico e aproximadamente 44,65% não faziam uso de bebidas alcoólicas. A língua se mostrou como sítio de maior acometimento das lesões. Foi calculado 921,5 anos de vidas perdidas para os pacientes estudados. Conclusão: Estes estudos servem como base para verificar impactos econômicos e sociais que o carcinoma carrega, ajudando a direcionar políticas públicas para o diagnóstico precoce e uma melhor capacitação dos profissionais que trabalham nesta área, podendo evitar gastos dispendiosos para a saúde no futuro.

Objetivo: Verificar a situação e impacto do monitoramento e avaliação dos indicadores e informações de saúde bucal sobre o desempenho das Equipes de Saúde Bucal (ESB) no estado do Pará. Métodos: Estudo ecológico descritivo que utilizou dados secundários das ESB participantes do 2º ciclo do PMAQ-AB Pará. Para avaliação da relação entre o monitoramento de indicadores e o desempenho das ESB, foram utilizados os testes qui-quadrado e regressão logística multinominal. Resultados: Participaram 500 ESB. A maioria das equipes não realiza monitoramento e análise dos indicadores e informações de saúde bucal (245; 49,0%), tendendo a apresentar desempenho regular e insuficiente. Cento e oitenta e três (36,6%) equipes recebem apoio para a discussão dos dados de monitoramento, apresentando diferenças estatisticamente significativas entre as equipes que recebem e as que não recebem este apoio (p

Objetivo: estudar a relação entre perdas dentárias e o excesso de peso em adultos de Belém do Pará. Métodos: trata-se de um estudo transversal, realizado no período de janeiro a novembro de 2018. Para a avaliação da relação da perda dentária e do excesso de peso dos indivíduos entrevistados, foi utilizado o teste de correlação de Spearman para duas variáveis quantitativas, considerando-se o valor de p < 0,05. Resultados: participaram 51 adultos usuários do Sistema Único de Saúde da rede municipal, sendo 68,63% do sexo feminino e 31,37% do sexo masculino com média de idade de 38,9 anos. A média do Índice de Massa Corpórea foi de 29,7 kg/m2. O índice CPO-D médio foi 11,68 e a média de dentes perdidos foi de 7,86. Verificou-se que não houve correlação entre a perda dentária e o excesso de peso, não apresentando correlação entre estas variáveis. Conclusão: a relação nutricional e saúde bucal é fundamental considerar outros fatores associados. Assim a saúde oral não deve ser expressa como um indicador de excesso de peso corporal, sendo necessária a condução de outros estudos.

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