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Master's Dissertation
DOI
https://doi.org/10.11606/D.23.2011.tde-15032012-162045
Document
Author
Full name
Luana Eschholz Bomfin
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Alves, Fábio de Abreu (President)
Lopes, Marcio Ajudarte
Sugaya, Norberto Nobuo
Title in Portuguese
Avaliação dos parâmetros clínico, histopatológico e imunoistoquímico dos tumores odontogênicos queratocísticos associados ou não à Síndrome do Carcinoma basocelular nevóide
Keywords in Portuguese
Queratocisto
Síndrome de Gorlin
Síndrome do Carcinoma Nevóide Basocelular
Tumor Odontogênico Queratocístico.
Abstract in Portuguese
Introdução. O Tumor Odontogênico Queratocístico (TOQC) é uma lesão de origem odontogênica que se apresenta exclusivamente nos ossos gnáticos e possui alto potencial de agressividade local. Pode estar associado à Síndrome do Carcinoma Nevóide Basocelular (SCNBC), que se caracteriza por apresentar inúmeras alterações de desenvolvimento, múltiplos carcinomas basocelulares (CBCs) além de anormalidades esqueléticas. Cerca de 65 a 100% dos pacientes com a síndrome podem apresentar múltiplos TOQCs. Objetivo. Avaliar e correlacionar os achados clínicos, histopatológico e expressão imunoistoquímica (IQ) dos marcadores de prognóstico (p53 e ki-67) e de histogênese tumoral (Citoqueratinas 14, 17 e 19) em TOQCs associados ou não à SCNBC diagnosticados entre 1970 e 2009 no Hospital AC Camargo, São Paulo. Pacientes e Métodos. Estudo retrospectivo em que foram avaliados 74 pacientes, 60 não portadores da SCNBC (Grupo 1) e 14 portadores da SCNBC (Grupo 2). Os dados clínicos dos pacientes foram obtidos a partir dos prontuários médicos e sumarizados em fichas clínicas padronizadas para o estudo. Os pacientes do Grupo 1 apresentaram 61 TOQCs primários e 15 TOQCs recorrentes. O Grupo 2 apresentou 31 TOQCs primários e 8 recorrentes. Resultados. No Grupo 1, houve predomínio de pacientes nas 3ª e 4ª décadas de vida e no Grupo 2, na 2ª década (p = 0.02). De acordo com o sexo, houve predileção pelas mulheres em ambos os Grupos (53,33% no Grupo 1 e 64,29% no Grupo 2). A mandíbula foi mais frequentemente acometida nos dois Grupos (81,96% no Grupo 1 e 58,06% no Grupo 2). Contudo, a discrepância em relação à distribuição entre mandíbula e maxila foi menor no Grupo 2 (p = 0.009). O padrão radiográfico multilocular foi mais frequente no Grupo 1 (39,34%) e unilocular no Grupo 2 (48,39%) (p = 0.008). A associação de enucleação e curetagem foi frequentemente realizada em ambos os Grupos (55,74% no Grupo 1 e 96,78 no Grupo 2). A taxa de recorrência foi de 21,31% no Grupo 1 e 22,58% no Grupo 2. As manifestações clínicas mais comuns dos pacientes com SCNBC foram CBCs, calcificação da foice cerebral e pits palmares. De acordo com a análise imunoistoquímica dos marcadores CQ 14, CQ 17, CQ 19, p53 e ki-67, não foram observadas diferenças no padrão de expressão entre os Grupos de TOQCs avaliados. Conclusões. Os TOQCs associados à SCNBC acometem mais frequentemente indivíduos do sexo feminino e em idade mais precoce do que os TOQCs esporádicos. Múltiplos TOQCs foram frequentemente observados em pacientes sindrômicos e consequentemente houve menor discrepância em relação à distribuição entre mandíbula e maxila. O aspecto radiográfico unilocular é mais frequente em TOQCs associados à SCNBC e multilocular em TOQCs esporádicos. As taxas de recorrências foram similares em TOQCs associados e não associados à SCNBC.
Title in English
Evaluation of clinical, histopathological and immunohistochemistry parameters of Keratocystic Odontogenic Tumor associated or not with Nevoid Basal Cell Carcinoma Syndrome
Keywords in English
Gorlin Syndrome
Keratocyst
Keratocystic odontogenic tumor
Nevoid basal cell carcinoma syndrome
Abstract in English
Introduction. Keratocystic odontogenic tumor (KCOT) is a lesion of odontogenic origin which arise exclusively in gnatic bones and demonstrates high potential of local aggressiveness. KCOT may be associated with Nevoid Basal Cell Carcinoma Syndrome (NBCCS) which is characterized by development defects, multiple basal cell carcinoma (BCC) and skeletal anomalies. Around 65 to 100% of patients with NBCCS present multiple KCOT affecting jaws. Objective. Evaluate clinical, histopathological and immunohistochemical (IHC) expression of prognostic markers (p53 and ki-67) and tumor histogenesis (citokeratin 14, 17 and 19) in KCOT associated or not to NBCCS diagnosed between 1970 and 2009 at AC Camargo Hospital (São Paulo). Patients and methods. Retrospective study which has evaluated 74 patients, being 60 not associated with NBCCS (Group 1) and 14 associated with NBCCS (Group 2). Clinical data of patients was obtained from medical charts and summarized into standardized records for this study. The patients of Group 1 presented 61 primary KCOT and 15 recurrent KCOT. Group 2 presented 31 primary KCOT and 8 recurrent KCOT. Results. In Group 1, patients was frequently affected in 3rd and 4th decades and Group 2, in 2nd decade (p = 0.02). According to gender, a predilection for females was observed in both groups (53.33% in Group 1 and 64.29% in Group 2). The mandible was more affected in both Groups (81.96% in Group 1 e 58.06% in Group 2). However, the discrepancy regarding the distribution between mandible and maxilla was shorter in Group 2 (p = 0.009). Radiographic pattern more observed was multilocular in Group 1 (39.34%) and unilocular in Group 2 (48.39%) (p = 0.008). The treatment mostly performed was association of enucleation and curettage in both Groups (55.74% in Group 1 and 96.78 and Group 2). Recurrent rates were 21.31% in Group 1 and 22.58% in Group 2. Most clinical manifestations of NBCCS patient´s beyond KCOT were BCC, falx cerebri calcification and palmar pits. According to IHC analyses of Ck14, Ck 17, Ck19, p53 and ki-67, there were no differences of expression in all groups of KCOT evaluated. Conclusions. KCOT associated with NBCCS affects more commonly female individuals and in earlier age than in KCOT not related to NBCCS. Multiple KCOT were frequently observed in patients with NBCCS and consequently there was less discrepancy in relation to the distribution between maxilla and mandible. Multilocular pattern is more frequent in sporadic KCOT and unilocular in syndromic KCOT. Recurrence rates were similar in KCOT associated and not associated to NBCCS.
 
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Publishing Date
2012-07-03
 
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