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The biological behavior of lesions is highly dependent on the imbalance between their proliferative and apoptotic capacity. This study evaluated a correlation between the proliferative and apoptotic rates of different oral vascular anomalies (VAs) by analyzing the immunoexpression of proliferation (Ki-67) and apoptosis (Bcl-2 and Bax) markers in endothelial cells of 20 cases of GLUT-1 positive infantile hemangiomas (IHs), 20 cases of pyogenic granulomas (PGs) and 20 cases of vascular malformations (VMs). Immunoexpression analysis of Ki-67, Bcl-2 and Bax revealed a lower median percentage of positive cells in VMs cases compared to IHs and PGs cases (P

The Inhibitor of Growth (ING) gene family is a group of tumor suppressor genes that play important roles in cell cycle control, senescence, DNA repair, cell proliferation, and apoptosis. However, inactivation and downregulation of these proteins have been related in some neoplasms. The present study aimed to evaluate the immunohistochemical profiles of ING3 and ING4 proteins in a series of benign epithelial odontogenic lesions. Methods: The sample comprised of 20 odontogenic keratocysts (OKC), 20 ameloblastomas (AM), and 15 adenomatoid odontogenic tumors (AOT) specimens. Nuclear and cytoplasmic immunolabeling of ING3 and ING4 were semi-quantitatively evaluated in epithelial cells of the odontogenic lesions, according to the percentage of immunolabelled cells in each case. Descriptive and statistics analysis were computed, and the p-value was set at 0.05. Results: No statistically significant differences were found in cytoplasmic and nuclear ING3 immunolabeling among the studied lesions. In contrast, AOTs presented higher cytoplasmic and nuclear ING4 labeling compared to AMs (cytoplasmic p-value = 0.01; nuclear p-value < 0.001) and OKCs (nuclear p-value = 0.007). Conclusion: ING3 and ING4 protein downregulation may play an important role in the initiation and progression of more aggressive odontogenic lesions, such as AMs and OKCs. Resumo Objetivos: A família dos Genes Inibidores de Crescimento (ING) é um grupo de genes supressores tumorais que desempenham papéis importantes no controle do ciclo celular, na senescência, no reparo do DNA, na proliferação celular e na apoptose. No entanto, a inativação e a regulação negativa dessas proteínas têm sido relacionadas em algumas neoplasias. O objetivo do presente estudo foi avaliar o perfil imuno-histoquímico das proteínas ING3 e ING4 em uma série de lesões odontogênicas epiteliais benignas. Métodos: A amostra foi composta por espécimes de 20 ceratocistos odontogênicos (CO), 20 ameloblastomas (AM) e 15 tumores odontogênicos adenomatoides (TOA). A imunoexpressão nuclear e citoplasmática de ING3 e ING4 foram avaliadas semi-quantitativamente nas células epiteliais das lesões odontogênicas, de acordo com a porcentagem de células imunomarcadas em cada caso. As análises descritivas e estatísticas foram computadas, e o valor de p estabelecido foi de 0,05. Resultados: Não foram encontradas diferenças estatisticamente significativas na imunoexpressão citoplasmática e nuclear de ING3 entre as lesões estudadas. Em contrapartida, os TOAs apresentaram maior marcação citoplasmática e nuclear de ING4 em comparação aos AMs (valor de p citoplasmático=0,01; valor de p nuclear

Introdução: O carcinoma de células escamosas (CCE) constitui a neoplasia maligna mais comum da boca, afetando, principalmente, indivíduos com mais de 50 anos. Clinicamente, apresenta-se, geralmente, como úlcera persistente com bordas endurecidas, podendo a lesão estar ou não associada a vegetações, máculas eritroplásicas ou leucoplásicas. As localizações mais acometidas borda lateral de língua e assoalho oral. Objetivo: relatar um caso clínico de CCE microinvasivo em língua, enfatizando a importância do diagnóstico precoce e acompanhamento do cirurgião-dentista durante e após o tratamento oncológico. Descrição do caso clínico: Paciente do sexo masculino, 42 anos de idade, apresentou-se para avaliação placa leucoplásica em borda lateral de língua, do lado direito, com aproximadamente 2,0 cm em seu maior diâmetro, de superfície rugosa, contornos irregulares e limites bem definidos, o qual tinha aparecido há cerca de dois meses. Sob a hipótese diagnóstica de leucoplasia, realizou-se biópsia incisional, cujo resultado histopatológico foi CCE microinvaisvo. O diagnóstico final de CCE predominantemente in situ foi observado, após remoção cirúrgica radical da lesão. O paciente complementou o tratamento oncológico com radioterapia e foi acompanhado no período trans-operatório pela equipe da odontologia, para prevenir e tratar as complicações consequentes do tratamento radioterápico. O paciente não apresentou sinais de recidiva um ano após a cirurgia e ainda encontra-se em proservação. Considerações finais: O diagnóstico precoce foi de fundamental importância para o bom prognóstico da doença. Além disso, a equipe de odontologia foi de suma importância durante todo o tratamento oncológico.

A retrospective study was performed to describe the demographic and clinicopathological characteristics of cases of vascular anomalies in a Brazilian population. The data of cases diagnosed as vascular anomalies over a period of 46 years, were retrieved from the archives of the Pathological Anatomy Service of the Department of Dentistry of Federal University of Rio Grande do Norte. Information about sex, age, race, diagnosis, location, and clinical characteristics was extracted. A database was created for analysis in the SPSS system and description of the results. The sample consisted of 597 cases categorized as follows: pyogenic granuloma (n = 454), infantile hemangioma (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymph angioma (n = 10), vascular thrombus (n = 7), hemangio endothelioma (n = 5), angiofibroma (n = 1), hemangioendothelio sarcoma (n = 1), and Kaposi sarcoma (n = 5). Overall, there was a predominance of females (64.2 %), white race (54.2 %), and patients in the 3rd and 4th decades of life. Most cases affected the gingiva/ ridge (44.75 %), had a red/reddish color (60.07 %), sessile implantation (52.4 %), soft consistency (52.7 %) and nodular appearance (53, 9 %), and were non-hemorrhagic (51.3 %) and asymptomatic (76.6 %). The demographic and clinicopathological findings obtained for most of the vascular lesions analyzed are similar to those reported in published studies involving other populations. Knowledge of the particularities of these disorders is important for appropriate diagnosis and treatment decision.

Com base em uma revisão de literatura, este estudo teve como objetivo abordar e esclarecer alguns conceitos referente às vesículas extracelulares (VE) e sua nomenclatura. Realizou-se uma busca por artigos científicos e revisões bibliográficas relativos às VE publicados de 2010 a 2021 em língua inglesa nas bases de dados eletrônicas Scielo, Lilacs e Medline/PubMed. Trinta e três artigos pertinentes ao tema foram selecionados para compor esse estudo. VE são partículas nano/micrométricas, delimitadas por uma membrana celular e produzidas por organismos vivos, que desempenham um papel importante na comunicação celular. Dentre as principais classes de VE, encontram-se os exossomos, microvesículas e corpos apoptóticos. Contudo, essas vesículas compartilham algumas características comuns, dificultando sua caracterização. Embora diversos estudos tenham tentado isolar os diferentes tipos de VE, ainda não há métodos eficazes de purificação nem marcadores específicos. Com base na literatura atual, o presente artigo reforça a importância de uma descrição detalhada acerca dos métodos de isolamento e caracterização em estudos que se utilizam de VE. Além disso, de modo a tentar reduzir possíveis vieses e facilitar a comparação entre estudos, sugere também que se padronize o uso do termo “VE” em detrimento a termos mais específicos.

Ameloblastic fibroma (AF) is a rare mixed odontogenic tumor that may present with aggressive behavior and may have potential for malignant transformation. Despite its very well-established histopathologic patterns, AF may have different types of tissues that might affect the final diagnosis, treatment choices, and outcome. An 11-year-old female patient presented with a well-defined multilocular lesion related to the impacted left inferior second molar, which was submitted to incisional biopsy. At the microscopic analysis, mesenchymal (resembling dental papilla) and epithelial (resembling odontogenic epithelium and disposed in small nests and cords) proliferating components were observed, characterizing as AF. Moreover, cystic degenerations, clear cells, ameloblastoma-like nests, and an epithelial fragment with ghost cells resembling the calcifying odontogenic cyst lining were found. The patient underwent another incisional biopsy, but no additional unusual features were found. Thus, treatment was decided as the total removal of the lesion and long-term follow-up.

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.

Osteoblastoma is a rare benign tumor that accounts for less than 1% of all bone tumors. About 10% of osteoblastomas are found in the skull bones and almost half of these cases involve the mandible, especially the posterior segments. This report describes the case of a 27-year-old female patient with a unilocular radiopaque expansive lesion in the left mandible, which had well-delimited margins and caused mild bone expansion. Microscopic analysis revealed the presence of mineralized material in the form of irregularly arranged vital trabeculae at different stages of mineralization. Osteocytes were trapped inside these trabeculae, which contained osteoclast-like multinucleated cells and voluminous pavement cells with hyperchromatic nuclei, sometimes interpreted as osteoblasts. Many bone-producing lesions have clinical, radiologic and histopathologic features that resemble osteoblastoma. The understanding and correlation of these findings are extremely important since they contribute to the correct diagnosis and appropriate treatment of this rare entity, improving its prognosis.

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.

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.

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 To perform an oral vascular anomalies (OVAs) retrospective analysis in a Brazilian population, in order to investigate its frequency distribution, demographic peculiarities and clinical-pathology characteristics. Study Design Data about the sex, age, race, clinical characteristics, location, and histopathologic diagnosis were extracted from cases recorded as OVAs in a reference center in the period between 1970 and 2016. Then, a database was created for analysis in the SPSS 20.0 system, in which they were submitted to a descriptive analysis. Results A total of 14,560 records were analyzed, of which 597 cases were histologically confirmed as OVA, indicating a 4.1% incidence. The lesions were grouped as the following: pyogenic granuloma (n = 454), hemangioma of childhood (n = 57), vascular malformation (n = 37), lymphangioma (n = 20), hemangiolymphangioma (n = 10), vascular thrombus (n = 7), hemangioendothelioma (n = 5), Kaposi sarcoma (n = 5), angiofibroma (n = 1), and hemangioendotheliosarcoma (n = 1). The patients’ sociodemographic profile was predominantly women (64.2%) and white people (48.2%), with a greater occurrence between the second and fourth decades of life. The majority was located in the gingiva or alveolar ridge (42.9%), presenting a red color (50.9%), sessile implantation (42%), soft consistency (44.5%), nodular appearance (38.3%), nonhemorrhagic (42.9%), and asymptomatic (32.8%). Conclusions These lesions particularities knowledge is important for a correct diagnosis and adequate treatment decision.

Inflammatory myofibroblastic tumor (IMT) is a rare benign neoplasm composed by myofibroblasts and fibroblasts admixed with inflammatory cells. Here, we report a case of IMT in the oral cavity of left mandible of a 12-year-old boy. Histopathological investigation revealed a proliferation of fibroblasts and myofibroblasts (positive for alpha-smooth muscle actin and vimentin) associated with inflammatory cells. The patient is still under follow-up and without evidence of recurrence. Oral IMT is a challenge for the clinician in diagnosis due to the nonspecific clinical presentation. Thus, histology and immunohistochemistry are required to reach an accurate diagnosis of this lesion.Descriptors: Neoplasms; Diagnosis; Immunohistochemistry.

Vascular anomalies (VAs) include a group of distinct lesions, such as vascular system congenital malformations, as well as benign and malignant vascular tumors. These lesions may present similar clinical and histopathological features, leading to mistaken diagnoses and incorrect treatment choices. It is important that professionals responsible for monitoring the development of VAs conduct precise investigations and use the appropriate terminology. The human glucose transporter protein isoform 1 (GLUT1) has been proposed as a tool to aid in differential diagnosis between different VAs, given that it is a sensitive and specific marker for identification of infantile hemangiomas (HIs) in any organ. This article presents a review of the literature on this protein as an effective tool for identification and possible differential diagnosis between several VAs. As anomalias vasculares (AVs) incluem um grupo de lesões distintas, como as más formações congênitas e os tumores vasculares benignos ou malignos. Estas lesões podem apresentar características clínicas e histopatológicas semelhantes, ocasionando equívocos diagnósticos e terapêuticos. Uma investigação precisa e o uso de terminologia adequada são fundamentais para as decisões do profissional responsável pelo acompanhamento da evolução de uma AV. A isoforma 1 da proteína humana transportadora de glicose (GLUT1) tem sido proposta como uma ferramenta auxiliar para o estabelecimento de diagnóstico diferencial entre AVs, uma vez que representa um marcador sensível e específico para a identificação de hemangiomas da infância de qualquer órgão. Este estudo objetiva fazer uma revisão da literatura acerca desta proteína como ferramenta eficaz na identificação e no possível diagnóstico diferencial entre as diversas AVs.

An 11-year-old female patient complained of "a blister in the mouth." Intraoral examination evidenced a bullous lesion in the left mouth floor measuring approximately 4 cm with exophytic growing, bluish coloration, defined limits, soft consistency, smooth surface, and 5 days of evolution. Clinical diagnosis was ranula. Micromarsupialization was performed after infiltrative anesthesia, and surgical knots were made far from the mucosa by the interposition of a hemostatic clamp, forming fistulas originating from the epithelization around the thread, allowing salivary flow. In the transoperative period, there was immediate drainage of part of the content retained within the lesion, reducing its initial volume. Surgical knots were removed after 7 days, and the patient was followed up for 3 months. The lesion regressed entirely without signals of recurrence, ruling out the need of excision. Therefore, micromarsupialization stands as a conservative therapy for the treatment of ranulas and mucoceles of significant size.

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.

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.