In 2005 the World Health Organisation classified the odontogenic keratocyst (OKC) as a benign cystic neoplasm, using the term keratocystic odontogenic tumour. Significantly higher expression of proto-oncogenes and loss of expression of tumour suppressor genes have been demonstrated in the OKC when compared to more indolent jaw counterparts. This together with the higher mitotic activity in the epithelial lining of OKC could explain the aggressive behaviour of the OKC consistent with that of benign neoplasms. The BCL-6 proto-oncogene was identified in 1993 as a transcription factor whose deregulated expression is associated with B-cell non-Hodgkin lymphomas. In epithelial neoplasms, the BCL-6 transcription factor is associated with continuous growth and its absence triggers apoptosis. It has been suggested that BCL-6 may also participate prominently in the process of differentiation of epithelial cells. The aim of the study was to evaluate BCL-6 protein expression in the dentigerous cyst (n=10), radicular cyst (n=10) and OKC (n=20) by immunohistochemistry. Expression of BCL-6 was significantly higher in the OKC than in the dentigerous cyst and radicular cyst. In the OKC BCL-6 further showed a distinct predilection for the suprabasal compartment while in the dentigerous and radicular cysts the staining tended to be uniform throughout all the cell layers of the cyst lining. The study findings suggest that BCL-6 may play a role in the regulation of the suprabasal proliferative compartment of the OKC and in the keratinising epithelial cell differentiation of the OKC.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the degree of Master of Science in the branch of Dentistry / Orthokeratinised jaw cyst (OJC) is an entity distinct from odontogenic keratocyst (OKC) but that has not been fully characterised at the molecular level. The aim of this study was to compare the proliferative activity between the epithelial linings of OKC and OJC by immunohistochemical staining for Ki-67 and cyclin D1. The total numbers of Ki-67 and cyclin D1 positively (+) stained cells/10 consecutive lengths of a light microscope calibration ruler were counted for each case (OKC, n=15; OJC, n=15) and statistically compared in the basal compartment, suprabasal compartment and full thickness of the cyst lining between the 2 cyst types. OJC showed significantly fewer Ki-67+ cells and cyclin D1+ cells than OKC, consistent with the clinically more indolent behaviour of the OJC. Ki-67 expression was mainly detected in the suprabasal compartment in OKC. Expression of Ki-67 was more uniform in OJC and notably without a significant predilection for the suprabasal compartment. The accumulation of Ki-67 positive cells suprabasally in OKC raises the possibility that a process of asymmetrical cell division may be operational in OKC. Expression between Ki-67 and cyclin D1 differed significantly both quantitatively and by distribution pattern in OKC and OJC, which suggests that the presence of the cyclin D1 protein may not necessarily reflect production of this molecule by cycling cells in OKC and OJC.

published_or_final_version / Anatomy / Master / Master of Philosophy

Thesis (M. Phil.)--University of Hong Kong, 1995. / Includes bibliographical references (leave 177-200).

Thesis (doctoral)--University of Turku, 1980. / Bibliography: p. [48]-51.

Introduction Previous studies on the glandular odontogenic cyst (GOC) have largely focused on the application of immunohistochemistry for determining how the GOC lining epithelium compares with that of other odontogenic cysts. Studies on the histochemical composition of the mucous cells in the GOC are, however, lacking. This study therefore aimed to determine the mucin phenotype of the mucous cells in the GOC and compared these findings with the mucous cells in the epithelial linings of other odontogenic cysts and with normal salivary gland mucous acinar cells. Materials and Methods Twenty-seven cases made up of 10 GOCs, 9 dentigerous cysts (DC) with mucous cells and 8 radicular/residual radicular cysts (RC) with mucous cells were stained using the combined alcian blue pH 2.5-PAS (AB-PAS) histochemical technique. AB-PAS allows for differentiation between acidic- (type I mucous cells), neutral- (type II mucous cells) and mixed mucin-containing cells (type III mucous cells). Submandibular, sublingual and palatal salivary gland tissue was also subjected to AB-PAS staining. The odontogenic cysts and salivary glands were evaluated for the frequency of type I, II and III mucous cells in these tissues. Results There were significant differences between the level of type I, type II and type III mucous cells within each of the three cyst types; GOC (p=0.006), DC (p=0.0004), RC (p=0.0017). There were no significant differences in the cell counts for each mucous cell type between the 3 cyst types;type I mucous cells (p=0.54); type II mucous cells (p=0.73) and type III mucous cells (p=0.97).All 3 odontogenic cysts showed a predominance of type III mucous cells and this mirrored the mucin phenotype of the submandibular and sublingual salivary glands. Conclusion The mucin phenotype of the GOC is shared by DC and RC with mucous metaplasia. The overlapping mucin phenotypes of the different odontogenic cysts unfortunately does not support the use of the AB-PAS stain as a potential histochemical marker to distinguish between the GOC and other odontogenic cysts with mucous metaplasia. Similarities in the mucin phenotype between odontogenic cysts, submandibular and sublingual salivary glands may suggest a common ectodermal histogenetic origin for the mucous cells in odontogenic cysts and major salivary glands.

Orientador: Fábio Ramôa Pires / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-19T10:43:01Z (GMT). No. of bitstreams: 1 Romanach_MarioJose_D.pdf: 5231704 bytes, checksum: 202539e51f52c9c5972d8aedecc9f4c9 (MD5) Previous issue date: 2011 / Resumo: Cistos gengival do adulto (CGA), periodontal lateral (CPL) e odontogênico glandular (COG) são cistos odontogênicos raros que apresentam características microscópicas similares e comportamento clínico distinto. O objetivo deste trabalho foi comparar o perfil clínico-patológico e imunoistoquímico de 45 casos destes três tipos de cistos odontogênicos (CGA = 14, CPL = 15, COG = 16) oriundos de 4 diferentes laboratórios de Patologia Oral. Os CGAs acometeram principalmente na gengiva da região de pré-molares inferiores de mulheres com média de idade de 56 anos. Os CPLs acometeram principalmente as regiões anterior e de pré-molares da mandíbula de mulheres com média de idade de 54 anos. Os COGs acometeram principalmente a região de molares mandibulares de mulheres com média de idade de 50 anos. Microscopicamente, epitélio com espessura maior que 5 camadas contendo estruturas intra-epiteliais pseudo-ductais, células colunares e mucosas foram observadas predominantemente nos COGs quando comparados aos CGAs e CPLs. A positividade para CK 5 e CD138 foi encontrada principalmente nas camadas basal e intermediária enquanto que CKs 8 e 19 marcaram as camadas intermediária e superficial dos três tipos de cistos. COGs apresentaram índice de positividade para p63 aumentado (59%) em relação aos encontrados em CGAs (26%) e CPLs (48%). A cápsula de COGs mostrou maior positividade para actina de músculo liso-alfa e CD138 quando comparada aos CPLs e CGAs. Concluimos que CGA, CPL e COG possuem características histopatológicas e imunoistoquímicas similares que podem justificar uma provável origem comum / Abstract: Gingival cyst of adult (GCA), lateral periodontal cyst (LPC) and glandular odontogenic cyst (GOC) are rare odontogenic cysts that present similar microscopic features and distinct clinical behavior. The aim of the present study was to compare the clinicopathological and immunohistochemical profile of 45 cases of these 3 types of odontogenic cysts (GCA = 14, LPC = 15, GOC = 16) from 4 different Oral Pathology laboratories. GCA mainly affected the gingiva of the lower pre-molars region of women with median age of 56 years-old. LPC mainly affected the anterior and pre-molars regions of the mandible of women with median age of 54 years-old. GOC mainly affected the mandibular molars region of women with median age of 50 years-old. Microscopically, epithelium with more than 5 layers containing duct-like intraepithelial structures and colunar and mucous cells were predominantly observed in GOC when compared to GCA and LPC. The positivity for CK 5 and CD138 was mainly observed in the basal and intermediate layers while CK 8 and CK 19 staining was seen in the intermediate and superficial layers of the cystic epithelium in all cysts. GOC presented higher p63 positivity index (59%) comparing with those found in GCA (26%) and LPC (48%). The connective tissue capsule of GOC exhibited higher positivity for smooth muscle actin and CD138 when comparing with GCA and LPC. We conclude the GCA, LPC and GOC share similar microscopic and immunohistochemical features that could justify a likely common origin / Doutorado / Patologia / Doutor em Estomatopatologia

Introdução. O cirurgião-dentista é na maioria das vezes, o responsável pelo diagnóstico e tratamento das lesões ósseas dos maxilares. O diagnóstico é decisivo na conduta terapêutica a ser seguida. Na literatura, análises retrospectivas são vistas com maior frequência, onde foram coletados resultados de exames histopatológicos. Contudo, para algumas lesões, o diagnóstico é clínico e radiográfico, não sendo indicada a realização de biópsia. Objetivo. O objetivo deste estudo foi descrever a prevalência das lesões ósseas dos maxilares, assim como avaliar suas características clínicas e radiográficas. Correlacionar a principal hipótese diagnóstica com o diagnóstico final. Pacientes e Métodos. Estudo com 130 pacientes com lesões ósseas dos maxilares diagnosticadas no Centro de Diagnóstico Oral da Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo (CDO-FOUSP), entre Agosto de 2013 e Outubro de 2014. Os pacientes foram divididos em 4 grupos: 1: Tumores benignos odontogênicos e não odontogênicos. 2: Cistos odontogênicos e não odontogênicos. 3: Tumores malignos. 4: Outras lesões. Análise estatística foi realizada buscando estabelecer informações relevantes quanto aos dados epidemiológicos, clínicos e radiográficos destas lesões. Resultados. A idade média foi de 35,2 anos ±17,86, (variou entre 8 e 77 anos). Dos 130 pacientes, 71 eram mulheres (54,62%) e 87 leucodermas (66,92%). A mandíbula foi mais acometida (71,43%), do que a maxila (28,57%). As características clínicas mais observadas foram: aumento de volume em 60 casos (42,85%), dor em 38 (27,14%) e 16 casos (11,43%) apresentaram drenagem de secreção purulenta. O exame complementar de imagem mais utilizado foi a radiografia panorâmica, 124 exames (88,57%). Em 47 lesões (33,57%), o diagnóstico foi realizado através do exame clínico, radiográfico e conduta cirúrgica (displasias ósseas, cistos ósseos simples, escleroses ósseas, dentre outras). Lesões com imagens radiolúcidas representaram 89 casos (63,57%), a forma unilocular esteve presente em 114 casos (81,43%) e 101 lesões (72,14%) apresentaram relação com o ápice dental. Dos casos que houve análise histopatológica (93 casos), o cisto periapical foi a lesão mais frequente totalizando 38 casos, 12 cistos dentígeros, 9 odontomas (7 compostos e 2 complexos), 8 TOQ, 6 cistos residuais, 5 ameloblastomas, e outras lesões. Houve 3 casos de tumores malignos, sendo 1 osteossarcoma, 1 carcinoma mucoepidermóide e 1 mieloma múltiplo. O percentual de acerto entre a principal hipótese diagnóstica com o diagnóstico final foi de 76,82%. Conclusões. Lesões ósseas foram frequentes e representaram aproximadamente 30% das primeiras consultas. Lesões com características radiográficas radiolúcidas e uniloculares foram as mais frequentes. Em um terço dos casos, não foi indicado (necessário) o exame histopatológico para a conclusão do diagnóstico. Sendo utilizadas as informações clínicas, radiográficas e abordagem cirúrgica (casos de cisto ósseo simples). / Introduction. The dentist is the main professional responsible for the diagnosis and treatment of bone lesions of the jaws. The diagnosis is crucial to therapeutic decision. In the literature, retrospective analyzes are more frequents, and the data are collected from histopathological exams. However, for some lesions, the diagnosis is clinical and radiographic, and the biopsy is not indicated. Objective. The aim of this study was to describe the prevalence of bone lesions of the jaws, and evaluate its clinical and radiographic features. In addition, the correlation between the main diagnosis and the final diagnosis was performed. Patients and Methods. A study which evaluated a total of 130 patients with bone lesions of the jaws. All cases were diagnosed in Oral Diagnosis Center of the Stomatology Discipline, School of Dentistry, University of São Paulo (CDO-FOUSP), between August 2013 and October 2014. Patients were divided into 4 groups: 1: Benign odontogenic and non odontogenic tumors. 2: Odontogenic and non odontogenic cysts. 3: Malignant tumors. 4: Other lesions. Statistical analysis was performed to establish relevant information on the epidemiological, clinical and radiographic data of these lesions. Results. The mean age of the patients was 35,2 years ± 17.86 (range, 8 to 77 years). Among 130 patients, 71 were women (54.62%) and 87 were Caucasians (66.92%). The mandible was more affected (71.43%) than the maxilla (28.57%). The most frequent clinical signs were swelling in 60 cases (42.85%), pain in 38 (27.14%) and 16 cases (11.43%) showed purulent drainage. The panoramic radiograph was the most used imaging exam, 124 exams (88.57%). In 47 lesions (33.57%), the diagnosis was done by clinical examination, radiographic and surgical management (bone dysplasia, simple bone cysts, bone sclerosis, and others). Radiolucent lesions accounted for 89 cases (63.57%), the unilocular form was present in 114 cases (81.43%) and 101 lesions (72.14%) were related to the dental apex. A total of 93 cases had histopathological analyses; periapical cyst was the most frequent lesion, representing 38 cases, 12 dentigerous cysts, 9 odontomas (7 compounds and 2 complexes), 8 OKT, 6 residual cysts, 5 ameloblastomas and other lesions. There were 3 malignant tumors, 1 osteosarcoma, 1 mucoepidermoid carcinoma and 1 multiple myeloma. The correlation between the main diagnosis hypotheses with a final diagnosis showed a success rate of 76.82%. Conclusions. Bone lesions were frequent and represented approximately 30% of the first visit patients. Lesions that presented radiolucent and unilocular radiograph pattern were the most frequent. In one third of cases, it was not indicated (necessary) the histopathological examination to conclude the diagnosis. Being used data of clinical, radiographic and surgical approach (cases of simple bone cyst).

Introdução. O cirurgião-dentista é na maioria das vezes, o responsável pelo diagnóstico e tratamento das lesões ósseas dos maxilares. O diagnóstico é decisivo na conduta terapêutica a ser seguida. Na literatura, análises retrospectivas são vistas com maior frequência, onde foram coletados resultados de exames histopatológicos. Contudo, para algumas lesões, o diagnóstico é clínico e radiográfico, não sendo indicada a realização de biópsia. Objetivo. O objetivo deste estudo foi descrever a prevalência das lesões ósseas dos maxilares, assim como avaliar suas características clínicas e radiográficas. Correlacionar a principal hipótese diagnóstica com o diagnóstico final. Pacientes e Métodos. Estudo com 130 pacientes com lesões ósseas dos maxilares diagnosticadas no Centro de Diagnóstico Oral da Disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo (CDO-FOUSP), entre Agosto de 2013 e Outubro de 2014. Os pacientes foram divididos em 4 grupos: 1: Tumores benignos odontogênicos e não odontogênicos. 2: Cistos odontogênicos e não odontogênicos. 3: Tumores malignos. 4: Outras lesões. Análise estatística foi realizada buscando estabelecer informações relevantes quanto aos dados epidemiológicos, clínicos e radiográficos destas lesões. Resultados. A idade média foi de 35,2 anos ±17,86, (variou entre 8 e 77 anos). Dos 130 pacientes, 71 eram mulheres (54,62%) e 87 leucodermas (66,92%). A mandíbula foi mais acometida (71,43%), do que a maxila (28,57%). As características clínicas mais observadas foram: aumento de volume em 60 casos (42,85%), dor em 38 (27,14%) e 16 casos (11,43%) apresentaram drenagem de secreção purulenta. O exame complementar de imagem mais utilizado foi a radiografia panorâmica, 124 exames (88,57%). Em 47 lesões (33,57%), o diagnóstico foi realizado através do exame clínico, radiográfico e conduta cirúrgica (displasias ósseas, cistos ósseos simples, escleroses ósseas, dentre outras). Lesões com imagens radiolúcidas representaram 89 casos (63,57%), a forma unilocular esteve presente em 114 casos (81,43%) e 101 lesões (72,14%) apresentaram relação com o ápice dental. Dos casos que houve análise histopatológica (93 casos), o cisto periapical foi a lesão mais frequente totalizando 38 casos, 12 cistos dentígeros, 9 odontomas (7 compostos e 2 complexos), 8 TOQ, 6 cistos residuais, 5 ameloblastomas, e outras lesões. Houve 3 casos de tumores malignos, sendo 1 osteossarcoma, 1 carcinoma mucoepidermóide e 1 mieloma múltiplo. O percentual de acerto entre a principal hipótese diagnóstica com o diagnóstico final foi de 76,82%. Conclusões. Lesões ósseas foram frequentes e representaram aproximadamente 30% das primeiras consultas. Lesões com características radiográficas radiolúcidas e uniloculares foram as mais frequentes. Em um terço dos casos, não foi indicado (necessário) o exame histopatológico para a conclusão do diagnóstico. Sendo utilizadas as informações clínicas, radiográficas e abordagem cirúrgica (casos de cisto ósseo simples). / Introduction. The dentist is the main professional responsible for the diagnosis and treatment of bone lesions of the jaws. The diagnosis is crucial to therapeutic decision. In the literature, retrospective analyzes are more frequents, and the data are collected from histopathological exams. However, for some lesions, the diagnosis is clinical and radiographic, and the biopsy is not indicated. Objective. The aim of this study was to describe the prevalence of bone lesions of the jaws, and evaluate its clinical and radiographic features. In addition, the correlation between the main diagnosis and the final diagnosis was performed. Patients and Methods. A study which evaluated a total of 130 patients with bone lesions of the jaws. All cases were diagnosed in Oral Diagnosis Center of the Stomatology Discipline, School of Dentistry, University of São Paulo (CDO-FOUSP), between August 2013 and October 2014. Patients were divided into 4 groups: 1: Benign odontogenic and non odontogenic tumors. 2: Odontogenic and non odontogenic cysts. 3: Malignant tumors. 4: Other lesions. Statistical analysis was performed to establish relevant information on the epidemiological, clinical and radiographic data of these lesions. Results. The mean age of the patients was 35,2 years ± 17.86 (range, 8 to 77 years). Among 130 patients, 71 were women (54.62%) and 87 were Caucasians (66.92%). The mandible was more affected (71.43%) than the maxilla (28.57%). The most frequent clinical signs were swelling in 60 cases (42.85%), pain in 38 (27.14%) and 16 cases (11.43%) showed purulent drainage. The panoramic radiograph was the most used imaging exam, 124 exams (88.57%). In 47 lesions (33.57%), the diagnosis was done by clinical examination, radiographic and surgical management (bone dysplasia, simple bone cysts, bone sclerosis, and others). Radiolucent lesions accounted for 89 cases (63.57%), the unilocular form was present in 114 cases (81.43%) and 101 lesions (72.14%) were related to the dental apex. A total of 93 cases had histopathological analyses; periapical cyst was the most frequent lesion, representing 38 cases, 12 dentigerous cysts, 9 odontomas (7 compounds and 2 complexes), 8 OKT, 6 residual cysts, 5 ameloblastomas and other lesions. There were 3 malignant tumors, 1 osteosarcoma, 1 mucoepidermoid carcinoma and 1 multiple myeloma. The correlation between the main diagnosis hypotheses with a final diagnosis showed a success rate of 76.82%. Conclusions. Bone lesions were frequent and represented approximately 30% of the first visit patients. Lesions that presented radiolucent and unilocular radiograph pattern were the most frequent. In one third of cases, it was not indicated (necessary) the histopathological examination to conclude the diagnosis. Being used data of clinical, radiographic and surgical approach (cases of simple bone cyst).

O tumor odontogênico queratocístico (TOQ) é uma neoplasia cística benigna originada de remanescentes epiteliais da odontogênese, que se destaca pela alta recorrência e eventual associação com a síndrome do carcinoma nevóide de células basais (SCNCB). O presente estudo buscou responder questionamentos relacionados à sua terapêutica cirúrgica e suprir a carência de pesquisas atuais sobre as lesões associadas à SCNCB, que são ainda mais recorrentes, analisando uma amostra formada por 40 TOQs primários. As variáveis de interesse determinaram grupos amostrais, que receberam análise dos tempos livres de recorrência por função Kaplan-Meier, comparação desses tempos pelo teste log-rank com nível de significância de 5% (p < 0,05) e determinação do risco acumulado para o evento nos primeiros cinco anos. Vinte e sete lesões foram tratadas por exérese (GE) e 13 receberam terapêutica descompressiva (GD). Tratamentos complementares ocorreram em 38 (95%) lesões, sendo ostectomia periférica isolada em 10 (GO) e combinada à solução de Carnoy em 28 (GC). Treze eram associadas à SCNCB (GS) e as demais (n = 27) representaram lesões não sindrômicas (GnS). No período de acompanhamento médio de 43,5 meses (12 102 meses), seis (15%) recorrências foram diagnosticadas. Não houve diferença significativa entre os tempos livres de recorrência nos grupos comparados (p > 0,05), nem expressividade do risco acumulado para o evento na terapêutica descompressiva (15,4%) e na associação com a SCNCB (12,5%). A aplicação da solução de Carnoy não aumentou a efetividade da ostectomia periférica, mas se relacionou com risco acumulado de recorrência de 0% ao final do quinto ano de acompanhamento pós-exérese nas lesões sindrômicas. Portanto: 1) a terapêutica descompressiva não aumentou o risco para recorrências; 2) a ostectomia periférica mostrou efetividade similar quando combinada à solução de Carnoy, pelo menos nas lesões não associadas à SCNCB; 3) o risco de recorrência das lesões associadas à SCNCB também foi controlado por tratamentos complementares. / The keratocystic odontogenic tumor (KOT) is a benign cystic neoplasm originating from odontogenic epithelial remnants which is highlighted by its high recurrence rate and occasional association with the nevoid basal cell carcinoma syndrome (NBCCS). The present study aimed to answer questions related to its surgical therapy and to fulfill the lack of recent researches over the lesions associated to the NBCCS, which are even more recurrent, analyzing a sample ok 40 primary KOTs. Variables of interest determined sample groups that underwent recurrence-free period analyses by Kaplan-Meier function, comparing these results by log-rank test with a significance level of 5% (p < 0.05) and determination of cumulative risk for the recurrence event within the first five years. Twenty seven lesions were treated by exeresis (GE) and 13 underwent decompressive therapeutic (GD). Complementary treatment occurred in 38 (95%) lesions being as isolated peripheral ostectomy in 10 (GO) and combined with Carnoys solution in 28 (GC). Thirteen were associated to NBCCS (GS) and the others (n = 27) represented non syndromic lesions (GnS). For the mean follow-up period of 43.5 months (12 102 months), six (15%) recurrences were diagnosed. There was no significant difference among recurrence-free periods for the compared groups (p > 0.05) or cumulative risk expression for the decompressive therapeutic (15.4%) or for the association with NBCCS (12.5%). Carnoys solution application did not increase the efficacy of the peripheral ostectomy but was related to the cumulative recurrence risk of 0% at the end of the fifth year of post-exeresis follow-up for syndromic lesions. Therefore: 1) the decompressive therapeutic did not increase the recurrence risk; 2) peripheral oostectomy demonstrated similar efficacy when combined to Carnoys solution, at least for lesions not associated to NBCCS; 3) the recurrence risk of lesions associated to NBCCS was also controlled by complementary treatments.