The need for integrated research autopsies in the era of precision oral medicine

BACKGROUND

Autopsy has benefited the practice of medicine for centuries; however, its use to advance the practice of oral health care is relatively limited. In the era of precision oral medicine, the research autopsy is poised to play an important role in understanding oral-systemic health, including infectious disease, autoimmunity, craniofacial genetics, and cancer.

TYPES OF STUDIES REVIEWED

The authors reviewed relevant articles that used medical and dental research autopsies to summarize the advantages of minimally invasive autopsies of dental, oral, and craniofacial tissues and to outline practices for supporting research autopsies of the oral and craniofacial complex.

RESULTS

The authors provide a historical summary of research autopsy in dentistry and provide a perspective on the value of autopsies for high-resolution multiomic studies to benefit precision oral medicine. As the promise of high-resolution multiomics is being realized, there is a need to integrate the oral and craniofacial complex into the practice of autopsy in medicine. Furthermore, the collaboration of autopsy centers with researchers will accelerate the understanding of dental, oral, and craniofacial tissues as part of the whole body.

CONCLUSIONS

Autopsies must integrate oral and craniofacial tissues as part of biobanking procedures. As new technologies allow for high-resolution, multimodal phenotyping of human samples, using optimized sampling procedures will allow for unprecedented understanding of common and rare dental, oral, and craniofacial diseases in the future.

PRACTICAL IMPLICATIONS

The COVID-19 pandemic highlighted the oral cavity as a site for viral infection and transmission potential; this was only discovered via clinical autopsies. The realization of the integrated autopsy's value in full body health initiatives will benefit patients across the globe.

ORAL LESIONS ON A COVID-19 PATIENT: AN AUTOPSY STUDY TO ELUCIDATE COINFECTION

We present a case of a patient who died of complications of COVID-19. A 29-year-old woman presented multiple bleeding ulcerous lesions involving lips and inner lip mucosa. The patient was pregnant (29th week) and presented fever, diarrhea, dyspnea, nausea, dysgeusia, and anosmia in a 27-day evolution until death. The patient was admitted to the intensive care unit, submitted to mechanical ventilation and extracorporeal membrane oxygenation, developed fetal distress, and was submitted to an emergency C-section. Cause of death was a cardiogenic shock. During minimally invasive autopsy, oral lesions were identified and postmortem biopsy was performed. Clinical hypotheses were SARS-CoV-2 vs herpes virus. The histopathologic analyses revealed mononuclear inflammatory infiltrate, and keratinocytes showed no viral inclusion or cytopathic alterations. A large amount of a cuboid shaped gram-positive coccus in a tetrad packet arrangement was observed, compatible with Sarcina ventriculi. An abundant amount of Candida spp. was also observed. Samples were negative for immunohistochemistry to anti-SARS-CoV-2, herpes simplex virus, and cytomegalovirus.

Can immunohistochemical biomarkers distinguish epithelial dysplasia degrees in actinic cheilitis? A systematic review and meta-analysis

BACKGROUND

Actinic cheilitis (AC) is a potentially malignant disorder of the lip, characterized by epithelial and connective tissue alterations caused by chronic exposure to ultraviolet radiation. In the past decades, diverse studies have been conducted in lip carcinogenesis and many biomarkers have been identified in lip lesions, yet there is no scientific evidence that determines its usefulness in the clinical setting or in histopathological routine. Therefore, we conducted the first systematic review in this field to summarize the results of published studies on immunohistochemical biomarkers in lip carcinogenesis, to evaluate if there is a marker than can distinguish the different histological grades of AC.

MATERIAL AND METHODS

Retrospective studies that investigated immunohistochemical biomarkers in AC defined on standardised histological assessment were gathered from five databases and evaluated. Each study was qualitatively evaluated using the Critical Appraisal Tools from SUMARI.

RESULTS

The proliferation marker Ki-67 was the most studied biomarker and we observed, through meta-analysis, that it was differently expressed between AC and lip cancer, but not in AC subgroups. Most articles had a high risk of bias.

CONCLUSIONS

In summary, the literature lacks quality follow up studies in actinic cheilitis. Multi-centre cohort studies, with patients stratified by treatment type and the use of image analysis software, could be the solution to further address the issues of investigating potentially malignant lesions and help change clinical practice, in terms of individualizing patients' treatment and prognosis prediction.

Incidental finding of subgemmal neurogenous plaque upon retrospective evaluation of oral lymphoepithelial cysts

PURPOSE

We aimed to compare the histomorphological features of oral lymphoepithelial cysts (OLC) in different locations of the oral cavity and to verify the association between oral lymphoepithelial cysts and subgemmal neurogenous plaque (SNP) on biopsies from the lateral border of the tongue.

METHODS

All cases diagnosed as OLC from the Oral Pathology Service at the School of Dentistry/University of São Paulo were retrieved. For all the cysts located in the tongue, their association to SNP was analyzed. Immunohistochemical staining against S100 was performed to confirm the diagnosis of SNP.

RESULTS

Thirty-one cases were selected for morphological analysis and SNP was identified in 40% of cases, all of them positive for S100. In these cases, macroscopic analysis demonstrated two independent fragments. Microscopic analysis showed that cysts located in the floor of the mouth and ventral surface of the tongue showed less intense exocytosis, less formation of lymphoid follicles, and predominantly a moderate inflammatory infiltrate.

CONCLUSIONS

OLC have a similar histological pattern regardless the location within the oral cavity and. In some cases, the biopsy specimen may be accompanied by a SNP as an adjacent independent structure.