ABSTRACT Ameloblastic carcinoma is a rare, malignant epithelial odontogenic tumor with a poor prognosis. Histopathologically it preserves an ameloblastomatous differentiation pattern but shows cytological features of malignancy. Due to its rarity, there is limited information on its biological behavior, which is recognized in the literature for being nonspecific and variable, as it may present as a lesion with characteristics compatible with a benign lesion or as a highly malignant aggressive pathological entity. The latter has been a difficulty not only in its diagnosis but also in the therapeutical planning. This article reports a case of a mandibular ameloblastic carcinoma occurring in a patient in the seventh decade of life, highlighting its variable clinical, imaging and histological characteristics that allowed us to reach a definitive diagnosis.

RESUMEN El carcinoma ameloblástico es un tumor odontogénico epitelial maligno, infrecuente y de mal pronóstico. Histopatológicamente es una lesión que conserva un patrón de diferenciación ameloblastomatoso, pero presenta características citológicas de malignidad. Debido a su rareza, existe poca información sobre su comportamiento biológico, el cual es reconocido en la literatura por ser inespecífico y variable, ya que puede presentarse como una lesión con características compatibles con una lesión benigna o como una entidad patológica agresiva altamente maligna. Esto último ha supuesto una dificultad no solo en su diagnóstico, sino también en la planificación terapéutica. Se reporta un caso de un carcinoma ameloblástico mandibular en un paciente perteneciente a la séptima década de la vida, destacando sus características clínicas, imagenológicas e histológicas variables que permitieron llegar a un diagnóstico correcto.

ABSTRACT Actinic prurigo (AP) is a type of photodermatosis that primarily affects the Latin American mestizo population. Histologically, AP cheilitis exhibits acanthosis with spongiosis and vacuolation of the basal cell layer overlying a dense lymphocytic inflammatory infiltrate that forms well-defined lymphoid follicles. Toluidine blue is a thiazide, acidophilic, and metachromatic dye used in vivo to selectively stain the acidic components of tissues such as sulfates, carboxylates, and phosphate radicals that are incorporated into DNA and RNA. It is necessary to develop a method that allows detecting, on clinical grounds the area of the lesion in which it is more feasible to find such structures. Thus to increase the sensitivity of the biopsy, in AP cheilitis to accurately identify where the lymphoid follicles reside, based on the higher concentration of DNA in such structures and thus confirm the diagnosis. In this study, staining was positive in 85% of patients with AP cheilitis, in 14 of whom 82% lymphoid follicles were observed by histopathology. One of the pathologist’s problems in establishing the diagnosis of AP is that the main histopathological characteristics are not always identified in the submitted samples because it is not easy to clinically identify the most representative site of the lesion selected for performing a biopsy. Based on our results, we propose using toluidine blue as an auxiliary method to choose a tissue sample to facilitate the diagnosis and allow clinicians to make clinical correlations between the histopathological and therapeutic findings.

Ameloblastoma is an odontogenic neoplasm with locally aggressive behavior. Some variants, like the unicystic or desmoplastic, have a better prognosis than solid/multicystic. The case is presented of a 76 year-old male, who suffered a mandibular interradicular radiolucent lesion of cystic appearance, which was surgically enucleated. Histologically, this was a desmoplastic lesion that exhibited a predominantly cystic area which was diagnosed as a desmoplastic ameloblastoma with cystic predominance. After 30 months of follow-up there are no signs of recurrence. The most important clinical and pathological features of these conditions are also discussed.

El ameloblastoma es una neoplasia odontogénica que muestra un comportamiento agresivo local. Algunas variantes como la uniquística y la desmoplásica tienen un mejor pronóstico que la sólida/multiquística. Presentamos un caso en un varón de 76 años con una lesión radiolúcida interradicular mandibular de apariencia quística, la cual se enucleó quirúrgicamente. Histológicamente correspondió a una lesión desmoplásica con una amplia zona quística que fue diagnosticada como ameloblastoma desmoplásico con predominio quístico. Trascurridos 30 meses no se evidencia recidiva. En este artículo se discuten los principales aspectos clinicopatológicos de estas entidades.

Resumen Introducción. La odontogénesis es el proceso de formación de los órganos dentarios, en el cual se expresan diversas moléculas, dentro de las cuales encontramos las citoqueratinas 14 y 19 (CK14, CK19). Una vez concluido el proceso de formación del diente quedan restos del epitelio odontogénico, el cual se ha sugerido se encuentra implicado en el desarrollo del ameloblastoma, uno de los tumores odontogénicos más frecuentes. Se ha sugerido que las CK14 y CK19 tienen utilidad como marcadores de diferenciación ameloblástica, y podrían tener implicación dentro del comportamiento tumoral de los ameloblastomas. El objetivo del presente estudio fue describir los patrones de expresión inmunohistoquímica de estas dos citoqueratinas en gérmenes dentarios y ameloblastomas. Materiales y métodos. Se incluyeron 6 ameloblastomas sólidos multiquísticos y 5 gérmenes dentarios a los cuales se les realizó técnica de inmunohistoquímica para CK14 y CK19. Resultados. Este estudio permitió visualizar la inmunoexpresión de CK14 y CK19 en el epitelio y la negatividad en el ectomesénquima, tanto en los gérmenes dentarios como en ameloblastomas. También permitió concluir que CK19 puede ser considerada como un eficiente marcador de diferenciación ameloblástica, mientras que CK14 es gradualmente remplazada por CK19 en el epitelio interno del órgano del esmalte, evidenciándose marcada inmunoexpresión de esta última en ameloblastos secretores

Abstract Introduction. Odontogenesis is the process by which teeth form, and where different molecules are expressed, among them some cytokeratins (CK) like CK14 and CK19. Remnants of odontogenic epithelium may persist once the development process is complete, which has been suggested to be involved in the development of ameloblastoma, one of the most common benign odontogenic tumours. It has been suggested that CK14 and CK19 are useful markers of ameloblast differentiation and that they could have implications for tumour behaviour. The aim of this study is to describe the patterns of immunohistochemical expression of these cytokeratins in tooth germs and ameloblastomas. Materials and methods. We worked with 6 solid multicystic ameloblastomas and 5 tooth germs. The immunohistochemistry technique was used to visualise CK14 and CK19. Results. We detected CK14 and CK19 immunoexpression in the epithelium and no expression in the ectomesenchyme in both tooth germs and ameloblastomas. It was concluded that CK19 can be considered an efficient marker of ameloblast differentiation, whereas CK14 is gradually replaced by CK19 in the inner epithelium of the enamel organ, showing strong immunoexpression in secretory ameloblasts

Todas las células de los mamíferos contienen un sistema citoplasmático de fibras esencial para la movilidad celular, el citoesqueleto, el cual se encuentra integrado por tres unidades estructurales principales y proteínas asociadas: microfilamentos, microtúbulos y filamentos intermedios. Las citoqueratinas son filamentos intermedios que forman una red compleja que se extiende desde la superficie del núcleo a la porción periférica de la célula, donde se insertan en desmosomas y hemidesmosomas. Las citoquerarinas 14 y 19 han sido utilizadas como marcadores de diagnóstico y pronóstico en diversas neoplasias de origen epitelial, no sólo permiten identificar a una célula como epitelial, sino que permiten identificar diferentes etapas durante diferenciación del epitelio y caracterizar el tumor. Existen numerosos trabajos en la literatura biomédica que han ejemplificado la utilidad de citoqueratinas 14 y 19 para identificar epitelio odontogénico. Esta revisión analiza la utilidad de su inmunoexpresión en los diferentes quistes y tumores odontogénicos

All mammal cells include a cytoplasmic fiber system essential for cell mobility, the cytoskeleton, formed by three main structural units and associated proteins: microfilaments, microtubules and intermediate filaments. Cytokeratins are intermediate filaments forming a complex network which extends from the nucleus surface to the peripheral cell sector, where they are inserted into desmosomes and hemidesmosomes. Cytokeratins 14 and 19 have been used as diagnosis and prognosis markers in various tumors of epithelial origin, not only to identify a cell as epithelial, but also to identify different stages during epithelial differentiation and to characterize the tumor. There are numerous studies in biomedical literature that have exemplified the utility of cytokeratins 14 and 19 to identify odontogenic epithelium. This review analyzes the utility of their immunologic expression in the different cysts and odontogenic tumors

Lipomas are benign mesenchymal tumors of mature adipocytes. They correspond to almost 50% of soft tissue tumors, 1 to 5% of them localized in the oral cavity, especially in the oral mucosa, floor of mouth and lateral edges of the tongue. Oral lipomas are usually asymptomatic and the color depends of the thickness of the overlying mucosa. Histologically there are lobules of mature adipocytes surrounded by a fibrous capsule, and there are several types according to the additional tissue, being the most frequent the single lipomas and fibrolipomas. The course is benign and the definitive treatment is surgical excision. This article reports two cases of fibrolipoma, a common tumor in an unusual presentation.

Los lipomas son tumores mesenquimales benignos compuestos por adipocitos maduros. Corresponden a casi el 50% de los tumores de tejidos blandos, presentes entre el 1 y 5% en cavidad oral, especialmente en mucosa yugal, piso de la boca y márgenes laterales de la lengua. Suelen ser asintomáticos y su color depende del espesor de la mucosa que lo cubre. Histológicamente están conformados por lóbulos de adipocitos maduros rodeados por una cápsula fibrosa. Las variedades histológicas están determinadas por el tejido adicional que contienen; los más frecuentes son el lipoma simple y el fibrolipoma. Su curso es benigno y el tratamiento consiste en la escisión quirúrgica. En el presente artículo se reportan dos casos de fibrolipoma, un tumor común en una localización poco frecuente.

Odontogenic myxoma are intraosseous lesions originating in embrionic connective tissue. They are benign lesions but locally aggressive and moderately recurrent. Objective: Surgical tumor resection with immediate primary reconstruction to return function and aesthetics. Case report: A 29 year old female patient attending ambulatory practice of the Maxillofacial Surgery Clinic for assessment and treatment. She presented volume increase and asymmetry in the right hemifacial region due to a tumor of approximately 5 year evolution, previously surgically treated to excise the lesion. Histological study reported piogenic granuloma. After surgery the patient experienced a slow and progressive recurrence of the tumor, disabling the patient in mastication, deglutition and breathing functions, and causing facial disfigurement. Treatment: Incisional biopsy was performed. It reported odontogenic myxoma. In the operating theatre, with the patient under general anaesthesia, it is decided to perform the tumor resection with immediate primary reconstruction of the orbital region with an autogenous graft of the iliac crest to later manufacture a palatine obturator.

Es una lesión intraósea derivada del tejido conectivo embrionario asociada a la odontogénesis, de tipo benigno pero localmente agresiva y de moderada recurrencia. Objetivo: Resección quirúrgica tumoral con reconstrucción primaria inmediata con la finalidad de devolver funcionalidad y estética. Presentación del caso: Paciente femenino de 29 años de edad, que se presenta en la consulta externa del servicio de Cirugía Maxilofacial para valoración y tratamiento. Presenta aumento de volumen y asimetría en región hemifacial derecha por tumoración con evolución aproximada de 5 años, previamente tratada de manera quirúrgica para excisión de lesión. El estudio histopatológico reporta granuloma piógeno; posteriormente, inicia con aumento de volumen lento y progresivo de masa tumoral recurrente, discapacitando a la paciente en su masticación, deglución y respiración ocasionándole desfiguramiento facial. Tratamiento: Se toma biopsia incisional la cual reporta mixoma odontogénico, se decide realizar en quirófano bajo anestesia general la resección tumoral con reconstrucción primaria inmediata de región orbitaria con injerto autólogo de cresta iliaca y, posteriormente, elaboración de obturador palatino.

It is very hard to find two different lesions in the jaws, but to find a central odontogenic fibroma coexisting with another lesion is even harder. This article presents a case of a 14 years old patient with a central odontogenic fibroma. and a central giant cell granuloma. A literature review is provided.

En pocas ocasiones encontramos dos lesiones distintas en los maxilares, pero es todavía menos común ubicar entre ellas a lesiones tan poco frecuentes como el fibroma odontogénico central. Presentamos el caso de un paciente de 14 años de edad con una lesión osteolítica mandibular que el examen histopatológico reportó como fibroma odontogénico central combinado con un granuloma central de células gigantes y se presenta una revisión de la literatura sobre el tema.

Abstract: A literature review and a case of a twenty year-old patient with diagnosis of gigantiform cementoma (GC) of the jaws are presented. The gigantiform cementoma is classified by the World Health Organization (WHO) within the osseous dysplasias and its prevalence is very low. The GC is a painless, well circumscribed tumor with limited growth, which generally requires surgical treatment. We discuss differential diagnosis and the treatment course of the patient.

Resumen: Presentamos la revisión de la literatura en conjunto con el caso de un paciente de 20 años de edad con diagnóstico de cementoma gigantiforme (CG) de los maxilares. El cementoma gigantiforme se clasifica según la Organización Mundial de la Salud (OMS) dentro de las displasias óseas y su incidencia es muy baja. El CG se caracteriza por presentar una tumoración con márgenes bien definidos, de crecimiento autolimitado, generalmente asintomática y que por lo general requiere de tratamiento quirúrgico. Se discuten los diagnósticos diferenciales y el curso del tratamiento del paciente.

Oral melanoacanthoma (MA) is a rare, benign pigmented lesion, similar to cutaneous MA, characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes. The pathogenesis of oral MA remains uncertain, although its clinical behavior is suggestive of a reactive origin. The most common intraoral sites are the buccal mucosa, lip, palate and gingiva. The average age of presentation is 28 years, mainly in blacks, with a strong female predilection. The oral melanotic macule (MM) is a small, well-circumscribed brown-to-black macule that occurs on the lips and mucous membranes. The etiology is not clear and it may represent a physiologic or reactive process. The average age of presentation is 43 years, with a female predilection. A biopsy is recommended to distinguish these lesions from each other and from other oral melanocytic lesions. We depict four cases each of oral MA and MM, affecting Caucasian and Latin American mestizo patients. The clinicopathological features of these cases reflect its ample spectrum, and to the best of our knowledge, it is the first example of oral MA affecting a Caucasian boy reported in the English literature. Therefore oral MA and MM should be considered in the differential diagnosis of pigmented lesions in the oral mucosa in these populations.

Aim: To identify the severity of Frey’s syndrome and its response to botulinum toxin type A. Methods: Minor test was performed in all cases to assess the extent of the affected area, using the contralateral side as control. Severity was assessed according to the proposal of Luna-Ortiz et al. Response was evaluated after 3 and 6 months, and was compared with the basal data. Results: Frey’s syndrome was documented in 38 patients, but only 23 cases accepted the botulinum toxin type A treatment. Severity was moderate in 8 (35%) and severe in 15 (65%) cases. Mean applied dose was 1.41 MU/cm² in 21 patients (91%), whereas one patient was treated with 10 MU for a 0.8 cm² affected area (12.5 MU/cm²) and another patient with 10 MU for a 0.5 cm² affected area (20 MU/cm²) due to severity of their symptomatology. Average affected area at the beginning was 14.2 cm², while after 3 and 6 months of treatment it was 4.1 cm² and 4.4 cm² respectively (p<0.001). The two patients that received higher doses of botulinum toxin A had complete response. Complete response was observed in 13 patients (56.5%) at 3 months, but in only nine (39%) this lack of symptomatology persisted at 6 months. In three cases (13%) no response was obtained at 3 months, and the application of an additional dose of botulinum toxin type A produced no response in two of them after 6 months. Comparison of the severity score of the average basal value vs. that obtained at 3 and 6 months revealed a significant difference (p< 0.05); however, no statistically significant difference was found when comparing outcome at 3 vs. 6 months. There were no statistically significant differences using the independent samples test when comparing outcome after treatment in relation to gender, type of surgery, or use of postoperative radiation therapy (p>0.05). In conclusion, botulinum toxin A remains as the treatment of choice for Frey’s syndrome.

Objective: To study the effects of pilocarpine hydrochloride on whole salivary gland production in Mexican patients affected by hyposalivation secondary to radiotherapy of the head and neck region. Study design: With previous written informed consent, 20 patients affected by hyposalivation secondary to head and neck radiation therapy (> 40Gy) were evaluated through the whole saliva test (WST) before, during and after ten weeks of treatment with pilocarpine hydrochloride (5 mg t.i.d.). Hyposalivation-related symptomatology was assessed before and at every week by means of a questionnaire with an ordinal scale ranging from 0-10. Salivary production values recorded at the end of the study and those obtained before treatment were compared by means of Student´s t test. A paired Wilcoxon test was used to compare the differences in the oral symptoms, such as oral dryness, soreness, ability for speaking and swallowing before and after treatment. Results: Initial WST had a mean salivary production of 0.8 cm (s.d. 0.7), with a range from 0 to 2.9 cm). After ten weeks of treatment salivary production increased to a mean of 2.24 cm (s.d. 0.7), with a range from 1.2 to 4.0 cm. There was a salivary flow increase of 64.5% (p<0.001). In addition, there were significant improvements in oral dryness, mouth comfort, ability to speak and ability to swallow (p<0.01). Adverse effects were usually minimal and they did not cause withdraw from the study in any case. Conclusions: Administration of 5-mg pilocarpine hydrochloride tablets three times daily significantly improved salivary production and clinical symptomatology secondary to radiation-induced hyposalivation with minimal side-effects. In addition, this study showed that WST is a fast, technically simple and highly reliable method to study salivary production in prospective studies.

Objetivo: Estudiar los efectos del clorhidrato de pilocarpina sobre la producción salival total en pacientes mexicanos con hiposalivación secundaria a radioterapia de la región de cabeza y cuello. Diseño del estudio: Previo consentimiento informado, 20 pacientes con hiposalivación secundaria a radioterapia de la región de cabeza y cuello (> 40 Gy) fueron evaluados mediante el Test de Saliva Global (TSG) antes, durante y al final de 10 semanas de tratamiento con clorhidrato de pilocarpina (5 mg 3 veces al día). La sintomatología relacionada a la hiposalivación fue evaluada mediante un cuestionario con escala ordinal de 0 a 10. La cantidad de saliva producida al final del tratamiento se comparó con los valores obtenidos al inicio del tratamiento en cada paciente y estos datos fueron analizados mediante la prueba de t de Student pareada. La comparación de los síntomas bucales que incluyeron sensación de humedad, malestar, dificultades para hablar y para deglutir se realizó mediante una prueba de Wilcoxon pareada. Resultados: El TSG basal indicó un promedio de 0.8 cm (d.e. 0.7) de producción salival (rango de 0 a 2.9 cm). Al cabo de las diez semanas de tratamiento el promedio de saliva producido por los pacientes fue de 2.24 cm (d.e..0.7), con un rango de 1.2 a 4.0 cm. El incremento de la producción de saliva fue del 64.5% (p<0.001). Asimismo, al final del estudio se registró mejoría en cuanto a la sensación de humedad, dificultad para hablar relacionada con la falta de saliva en la cavidad bucal, deglución y molestias bucales relacionadas a la falta de saliva en comparación con los datos iniciales (p<0.01). Los trastornos colaterales detectados fueron generalmente leves, y en ningún caso fueron causa de suspensión del tratamiento. Conclusiones: El clorhidrato de pilocarpina en dosis de 5 mg 3 veces al día produjo un incremento significativo en la producción salival y mejoría clínica en cuanto a la sintomatología bucal secundaria a hiposalivación con mínimos efectos secundarios. Asimismo, el TSG representa un método rápido, técnicamente simple y de alta confiabilidad para el registro de la producción salival en estudios prospectivos.

Solitary fibrous tumor is a well-recognized entity that most commonly involves the pleura; however, it has been recently described in other locations including the head and neck region, where it occurs as a slowly growing and well-circumscribed lesion. Due to its low frequency it may be confused with other neoplasms, and for this reason microscopic, ultrastructural and immunohistochemical features are necessary to establish its diagnosis. Prognosis of this tumor depends on its location and size. We present a 20-year-old woman with a well circumscribed, rapidly enlarging solitary fibrous tumor located in the parotid region, which protruded into the oral cavity, measured 10 x 8.5 x 5.5 cm and exhibited benign histological features and positive immunoreactivity to CD34.

El tumor fibroso solitario es una entidad bien establecida, comúnmente localizada en la pleura, aunque recientemente se ha descrito en otras localizaciones, incluyendo la región de cabeza y cuello, en donde se presenta como una lesión bien circunscrita y de crecimiento lento. Debido a su baja frecuencia se puede confundir con otras neoplasias de esta área, por lo que las características microscópicas, ultraestructurales y de inmunohistoquímica ayudan a establecer su diagnóstico. El pronóstico esta relacionado con la localización y el tamaño del tumor. Se presenta un caso en una mujer de 20 años de edad, localizado en la región parotidea con protrusión a cavidad oral, de crecimiento rápido y con un tamaño de 10x8.5x5.5cm, bien circunscrita, y con características histológicas benignas e inmunoreactividad para CD34.