Necrotizing sialometaplasia can hide the presence of salivary gland tumors: A case series

OBJECTIVE

Necrotizing sialometaplasia (NS) is an uncommon benign process which affects minor and, more rarely, major salivary glands. While self-limiting, the condition might be clinically and histologically mistaken for malignancy. Furthermore, NS may accompany neoplasms. The aim of this paper was to report a series of Italian patients affected by NS associated with an unusual high presence of neoplasms of minor and major salivary glands.

STUDY DESIGN

Clinical and histological features of twelve patients with NS were retrospectively evaluated.

RESULTS

Eight patients presented NS of the minor salivary glands of the palate, and two of them had associated neoplasms (pleomorphic adenoma and adenoid cystic carcinoma) at the same site. Four patients had NS of the parotid gland associated with a history of fine-needle aspiration biopsy performed to diagnose parotid neoplasms. These were epithelial-myoepithelial carcinoma, adenoid cystic carcinoma, Warthin's tumor, and oncocytoma, respectively.

CONCLUSION

Tumors of minor and major salivary glands might be associated with NS more frequently than previously reported. While NS of the parotid is generally the result of invasive diagnostic procedure and is detected after the excision of the tumor, NS of the minor salivary glands may obscure an underlying neoplasm, resulting in delays in referral or treatment.

Co-infection HBV and malaria: a striking association

BACKGROUND

Many geographical areas are highly endemic for infectious tropical diseases, although in disproportional fashion. Various infections often overlap in terms of presentation of various epidemiological and clinical manifestations that are linked to the mutual influence of pathogens. The epidemiological and clinical aspects of hepatitis B virus and malaria co-infection remain little known because there have not been many studies until recently.

METHODS

We performed a systematic search of the epidemiology of HBV/malaria co-infection, in particular, their overlapping clinical and histological features and their reciprocal conditioning. We examined published data regarding HBV and malaria.

RESULTS

The data we obtained varied substantially. The interaction between malarial parasites and HBV viruses, both in chronic HBV hepatitis patients and in carriers, did not vary or change the clinical evolution of either infection. The diversity of epidemiological and clinical results depended both on the geographical areas in which the studies were carried out and on the various stages of the infections at the time of the study.

CONCLUSION

Strategies to improve currently available diagnostic techniques, and studies dealing with vector control procedures and other operational tools and approaches are needed for better understanding of this health problem.

Comparison of the Stress Strain Capacity between Different Clear Aligners

Background:

The rife use of aesthetic appliance in orthodontic treatment requires the study of the properties of the materials they are made of.

Objective:

The aim of the present study was to evaluate the dimensional stability of clear aligners made of three different materials after the application of in-vivo dynamic stress and in-vitro static stress.

Methods:

Three different aligners made of different materials (PET-G; PET; SmartTrack®), prepared on the dental arch of the same patient, were tested. For each material, three aligner samples were manufactured: one to be used in-vivo, one to be tested in-vitro, and one to be used as a control.

To evaluate the effects of the dynamic stress produced in-vivo, each aligner was worn by a single patient 22 hours per day, followed by a wash-out period of two weeks. To evaluate the effects of static stress, each aligner was exposed to the in-vitro continuous force of 50N. The tested and control aligners were scanned, then linear measurements were taken to evaluate their dimensional stability after different types of stresses.

Results:

PET seems to have the lowest percentage of deformation; PET-G and SmartTrack® showed a reduced deformation going from the posterior to the anterior area. The contact with human saliva induces a greater deformation.

Conclusion:

Different materials show different behavior following application of static stresses and dynamic stresses in the oral cavity. PET showed the highest dimensional stability.

Laser versus LED polymerization: Comparison of in vitro preventive sealing procedures

Introduction:

The technique of sealing is a widely accepted procedure for prevention of caries. The aim of our in vitro study was to compare the effect of two different curing units (traditional LED source and innovative laser diode lamp) on the integrity of fissure sealant material and its interface with tooth enamel.

Materials and methods:

Sixty healthy third molars were randomly assigned to two groups. In group A were teeth intended for polymerization by LED B lamp, and group B comprised teeth to be polymerized by an innovative laser diode. Both groups were treated with the traditional sealing technique, subjected to a metallization process, and analyzed by scanning electron microscope.

Results:

Micro-gaps between the sealant and the enamel were found in specimens in both A (43%) and B (40%) groups ( p=0.793), and sealant shrinkage was seen. Significant differences between the groups emerged in the percentage of perimetric micro-erosion sites (80% vs. 100%, p=0.010) and the presence of holes and micro-bubbles on the sealant surface (21% vs. 63%, p=0.001).

Conclusions:

Although macroscopic clinical polymerization occurred with both instruments, the microscopic evaluation showed significant differences between the studied groups in terms of perimetric micro-erosion sites and micro-bubbles, which were higher in laser-cured samples.

Overexpression of ADAR1 into the cytoplasm correlates with a better prognosis of patients with oral squamous cells carcinoma

BACKGROUND

ADAR1 is an enzymatic protein, which catalyzes a RNA editing reaction by converting Adenosine to Inosine, and its expression has been found to be dysregulated in many cancer types. The aim of this study was to analyze the expression of ADAR1 in oral squamous cells carcinoma.

METHODS

In order to analyze the ADAR1 mRNA expression, data from The Cancer Genome Atlas (TCGA) database were downloaded and analyzed. In addition, immunohistochemistry analysis was performed on an institutional database including 46 samples of oral squamous cell carcinoma in a tissue microarray (TMA).

RESULTS

No statistically significant correlation linked the mRNA ADAR1 expression to any clinic-pathological variables in the TCGA database. Immunohistochemistry analysis of ADAR1 showed different expressions between normal mucosa and tumor tissue. Focusing on the subcellular localization, the nuclear expression of ADAR1 correlated with higher grading of differentiation (ρ = 0.442; P-value = 0.002); the general expression of ADAR1 either in cytoplasm or in nuclei, correlated with the Gender of patients (Cytoplasm expression: ρ = -0.295; P-value = 0.049; while for nuclear expression: ρ = +0.374; P = 0.011); cytosol expression resulted to be an independent protective prognostic factor (HR = 0.047; C.I. 95% 0.007-0.321; P-value = 0.002).

CONCLUSION

Higher expression of ADAR1 into the cytoplasm resulted to be an independent prognostic factor. In order to understand ADAR1 role in cancer, further studies should be performed, in bigger cohort and under a bio-molecular point of view.

High PD-L1 expression in the tumour cells did not correlate with poor prognosis of patients suffering for oral squamous cells carcinoma: A meta-analysis of the literature

OBJECTIVES

Oral cancer represents one of the most common malignancies in humans. Its prognosis is still poor, despite the most recent improvements in therapies. An increasing attention is placed on the role of programmed death ligand 1 (PD-L1) in the tumour immunity and its potential function as a marker for tumour prognosis. Whether PD-L1 expression is a prognostic factor for the poor outcomes in oral squamous cell carcinoma is still controversial. This study aimed to investigate, through a meta-analysis, a potential correlation between PD-L1 expression and the prognostic outcomes in patients with oral squamous cell carcinoma.

MATERIALS AND METHODS

The studies were identified by searching PubMed, SCOPUS, Web of Science and were assessed by two of the authors. After the selection process, 11 articles met eligibility criteria and were included in the meta-analysis. Quality assessment of studies was performed according to the REMARK guidelines, and the risk of biases across studies was investigated through Q and I² tests. Meta-analysis was performed to investigate the association between the PD-L1 expression either overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS), gender and lymph node metastasis.

RESULTS

A total of 1060 patients were analysed in the 11 studies included in the meta-analysis. Pooled analysis revealed that the expression of PD-L1 did not correlate with poor OS (HR, 0.60; 95% CI: [0.33, 1.10]; P = 0.10), DFS (HR, 0.62; 95% CI: [0.21, 1.88]; P = 0.40), DSS (HR, 2.05; 95% CI: [0.53, 7.86]; P = 0.29 and lymph node metastasis (HR, 1.15; 95% CI: [0.74, 1.81]; P = 0.53). Furthermore, results of the meta-analysis showed that high expression of PD-L1 is two times more frequent in female patients (OR, 0.5; 95% CI: [0.36, 0.69]; P < 0.0001) compared to males. For all the three outcomes analysed, a high rate of heterogeneity was detected (I²  > 50%).

DISCUSSION

High PD-L1 expression did not correlate with poor prognosis of patients suffering for oral squamous cell carcinoma. Studies published on the topic showed a significant variation in results, limiting the use of PD-L1 expression by immunohistochemistry as prognostic biomarker in clinical practice.

The Effects of Adjuvant Fermented Wheat Germ Extract on Cancer Cell Lines: A Systematic Review

Fermented wheat germ extract (FWGE; trade name AVEMAR) is a natural compound derived from industrial fermentation of wheat germ. Its potential anticancer properties has emerged from recent studies. The aim of this systematic review is to summarize the data available in the scientific literature concerning the in vitro activity of FWGE on malignant cells. A systematic review of English articles in electronic databases has been performed. The primary outcomes of the review regarded types of cancer cell lines subjected to the investigation and the main results concerning cell viability, proliferation, and apoptosis observed within the studies. Sixteen articles were included in the final qualitative analysis. Various types of cancer cells treated with FWGE have been analyzed, showing mainly cytotoxic effects, alteration of the cell cycle, antiproliferative effects, and induction of apoptosis. FWGE can be a promising drug component in cancer treatment; however, further in vitro and in vivo studies are necessary to prove its effectiveness and safety in humans.

Ethnicity based variation in expression of E-cadherin in patients with squamous cell carcinoma of the oral tongue

The oral tongue is the most common site for tumours within the oral cavity. Despite intense research, there has been no improvement in the survival rate for patients with oral tongue squamous cell carcinoma (OTSCC) during the last decades. Differences between oral cancer patients based on ethno-geographical distribution have been reported. The present study used immunohistochemistry to evaluate commonly used markers of cancer cell phenotypes, E-cadherin, β-catenin and cytokeratins 5 and 19, in 120 patients with OTSCC. To evaluate the impact of ethnicity, patients from Sweden and Italy were included. A higher proportion of Swedish patients exhibited high expression of E-cadherin in their tumours (P=0.039), and high levels of E-cadherin in Swedish OTSCC patients that had succumbed to their disease were associated with poor prognosis. These data demonstrated differences in the pathological characteristics of OTSCC between two different European populations. The findings emphasise the need to take ethnicity/geographical location of patients into account when comparing results from different studies of OTSCC.

The Dental Management of Patients at Risk of Medication-Related Osteonecrosis of the Jaw: New Paradigm of Primary Prevention

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents; it is a potentially painful and debilitating condition that can considerably affect the quality of life of patients. Furthermore, even if its epidemiology and pathogenesis have still not been fully clarified, several risk factors related to MRONJ have been recognized in prevention protocols. Three main risk factors are as follows: (i) the type of ONJ-related medications: antiresorptive (e.g., Bisphosphonates, Denosumab) and antiangiogenic drugs (e.g., Bevacizumab, Sunitinib); (ii) the category of patient at MRONJ risk: cancer versus non-cancer patient; (iii) the typologies and timing of dental treatments (e.g., before, during, or after the drug administration). The aim of this paper is to describe the new paradigm by the Italian Society of Oral Pathology and Medicine (SIPMO) on preventive dental management in patients at risk of MRONJ, prior to and during/after the administration of the aforementioned ONJ-related drugs. In reducing the risk of MRONJ, dentists and oral hygienists are key figures in applying a correct protocol of primary prevention for pre-treatment and in-treatment patients. However, the necessity of a multidisciplinary standardized approach, with a sustained dialogue among specialists involved, should be always adopted in order to improve the efficacy of preventive strategies and to ameliorate the patient's quality of life.

Integrative Histologic and Bioinformatics Analysis of BIRC5/Survivin Expression in Oral Squamous Cell Carcinoma

Survivin is a well-known protein involved in the inhibition of apoptosis in many different cancer types. The aim of this study was to perform an integrated bioinformatic and histologic analysis in order to study the expression and prognostic role of Survivin and its related gene BIRC5 in oral cancer. Publicly available databases were accessed via Gene Expression Omnibus and Oncomine, in addition raw data from The Cancer Genome Atlas (TCGA) were also obtained in order to analyze the rate of gene mutation, expression and methylation in patients with oral squamous cells carcinoma (OSCC). Immunohistochemistry (IHC) was also performed in order to evaluate the nuclear and cytoplasmic expression of Survivin and their correlation with cell proliferation in samples from OSCC patients. Results of this study revealed that Survivin is rarely mutated in OSCC samples and upregulated when compared to non-cancerous tissue. A negative correlation between the methylation of the island cg25986496 and BIRC5 mRNA expression was detected from TCGA data. IHC staining revealed that cytoplasmic (and not nuclear) expression of Survivin is associated with poor overall survival in OSCC patients, while the nuclear expression correlates with higher proliferation rate. In addition, data from TCGA database revealed that BIRC5 gene expression is an independent prognostic factor for OSCC patients.

Non-surgical Treatment of Condylar Fracture in an 11-Year-Old Patient: a Case Report

Background

Mandibular condylar fractures commonly occur after trauma and account for 25 to 35% of all mandibular fractures; its appropriate therapy still remains a point of controversy in children. The purpose of this paper is to describe the treatment of an 11-years-old male patient affected by neck-condylar fracture as result of trauma in evolutive age.

Methods

No surgical treatment was performed. A functional therapy was applied with a jaw splint. A closed treatment for mandibular condyle fractures was preferred because the amount of condylar displacement wasn’t considerable.

Results

The early treatment with functional therapy generated a functional adaptation of the condyle in the glenoid fossa and a normal mandibular function. After a 12-month follow-up the fracture resolution and an optimal condylar position were recorded.

Conclusions

The current case report and literature review showed that non-surgical therapy of neck-condylar fracture in a child with lower resin splint can restore mandibular movements and aesthetics. Facial growth after one year treatment resulted normal. A conservative treatment may be appropriate for children in selected cases with minimally displaced condyle.

Aryl hydrocarbon receptor, a tumor grade‑associated marker of oral cancer, is directly downregulated by polydatin: A pilot study

Oral squamous cell carcinoma (OSCC) is one of the most aggressive and deadliest tumors worldwide. The aryl hydrocarbon receptor (AHR) is a nuclear transcription factor known as a dioxin receptor and mediates the toxic effects of industrial contaminants. In addition, AHR has been implicated in multiple cellular processes and its expression has been shown to play a critical role in tumorigenesis, including human oral cancer cell lines. In the present study, we evaluated the expression of AHR/HSP-90 in 25 formalin‑fixed, paraffin-embedded human oral cancer specimens by IHC analysis. CYP1A1 expression was regarded as an AHR reporter gene. The data indicated a complete correlation between AHR expression and cancer grade enabling us to propose AHR as a prognostic marker of oral cancer. Moreover, in OSCC cell line CAL27, we observed the modulatory effect of polydatin, a widespread natural substance and direct precursor of resveratrol, on AHR expression. A computational approach was performed to predict the site of interaction of polydatin on the AHR surface. Our studies confirm the involvement of AHR signaling in the clinicopathological specimens of oral cancer and suggest the use of polydatin for oral cancer prevention.