High-Grade B-Cell Lymphoma Not Otherwise Specified (HGBL, NOS) in the Maxillary Sinus Mimicking Periapical Inflammation: Case Report and Review of the Literature

High-grade B-cell lymphoma not otherwise specified is listed as a new group in the WHO 2017 statement as a subtype of aggressive, mature B-cell lymphomas with a poor prognosis. To our knowledge, no description of this genetic type of maxillary lymphoma has appeared in the literature until now; thus, our case provides valuable data on its symptoms, clinical behavior, response to treatment and survival rate. The present report describes the early diagnosis and treatment of an extremely rare histological subtype of B-cell lymphoma, a case of high-grade B-cell lymphoma not otherwise specified, localized in the maxillary sinus and mimicking signs and symptoms of periapical inflammation. After chemotherapy, the presented patient showed complete remission without relapse and systemic spread. As far as we know, this is the first reported case of this rare type of lymphoma associated with the maxillary sinus. Considering that high-grade B-cell lymphomas are aggressive tumors with rapid growth and poor prognosis, which are often misdiagnosed in the early stages as inflammatory disease, it is relevant to highlight the importance of a detailed evaluation of clinical signs and radiological findings during diagnosis, especially if they contradict each other.

PECULIARITIES OF EFFECTIVE INDICATORS OF PHAGOCYTES AND MICROBIOLOGICAL PARAMETERS OF THE LOCAL FOCUS OF PERIAPICAL INFLAMMATION IN DIFFERENT FORMS OF CHRONIC PERIODONTITIS

In the last decade, single-stage dental implantation has become widespread, often with immediate loading. A significant part of the implants are installed in the zone of chronic periapical inflammation, however, until now there are no data on the relationship between the form of chronic periodontitis and the processes of osseointegration in the peri-implant zone. The aim of this study was to study the effector parameters of wound neutrophils and the spectrum of pathogens of the local focus of inflammation in various forms of chronic peridontitis. 74 surveyed persons were divided into four groups, depending on the form of chronic periodontitis: group 1 was represented by patients with chronic fibrous periodontitis; Group 2 — patients with chronic granulating periodontitis; Group 3 — subjects with chronic granulomatous periodontitis; Group 4 — control group, patients with healthy teeth removed for orthopedic or orthodontic indications. We studied the quantitative composition of wound phagocytes and functional parameters of wound neutrophils of the separated socket of the extracted tooth, and also studied the biocenosis. Comparative analysis of the effector indices of neutrophils of the socket of the extracted tooth of the patients of the control group and those examined with various forms of chronic periapical inflammation made it possible to reveal in the latter: a twofold increase in the relative activity of phagocytosis and phagocytic number; multiple excess of the control value of the indicators of the intensity of the phagocytic reaction; high rates of activity and intensity of spontaneous and induced NBT-reducing function of wound phagocytes. Microbiological research made it possible to determine the differences in the composition of the microflora of the detachable sockets of the extracted teeth in patients with various forms of chronic periodontitis. Despite statistically significant differences in a number of immunological parameters and the revealed different microbial spectrum of pathogens of a chronic periapical focus, in patients with all forms of chronic periodontitis, predictors of the development of inflammatory complications were identified in the context of the planned one-stage dental implantation when implants were installed in the sockets of teeth with chronic periodontal foci.

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Choosing an endodontic sealer clinical use is a decision that contributes to the long-term success of non-surgical root canal treatment. Sealers are used as a thin tacky paste which function as a lubricant and luting agent during obturation, allowing the core obturation material, such as gutta-percha points or other rigid materials, to slide in and become fixed in the canal. Sealers can fill voids, lateral canals, and accessory canals where core obturation materials cannot infiltrate. If the sealer does not perform its function, microleakage may cause root canal failure via clinically undetectable passage of bacteria, fluids, molecules or ions between the tooth and restorative material. It has been reported that extrusion of the sealer during root canal filling has cytotoxic effects on periapical tissues, causing periapical inflammation, necrosis and pain. Endodontic sealers are categorized by composition based on setting reaction and composition: zinc oxide eugenol, salicylate, fatty acid, glass ionomer, silicone, epoxy resin, tricalcium silicate, and methacrylate resin sealer systems. Aslan & Özkan (2021) reported on a trial that sought to evaluate the effect of two calcium silicate-based root canal sealers, Endoseal MTA and EndoSequence BC Sealer, on postoperative pain following single-visit root canal treatment on molar teeth compared to their epoxy/ amine resin-based counterpart AH Plus. The null hypotheses tested in this study were as follows:1. The type of sealer used would not change the incidence and the intensity of post-treatment endodontic pain2. The analgesic intake of patients following single-visit root canal treatment

Cirurgia do periápice para remoção de lesões granulomatosas: relato de caso

Periapical granuloma is a histological term that refers to the formation of a mass of granulomatous tissue around the apex of a tooth resulting from inflammation and necrosis of the pulp tissue. It consists of an infiltrate of inflammatory cells such as macrophages, plasmocytes and lymphocytes, as well as fibroblasts, collagen fibers and capillaries. Periapical surgery is an alternative for preserving the tooth in the oral cavity in cases where periapical inflammation is persistent even after treatment of root canals. The objective of this study was to report a clinical case in which the surgical technique was used to remove granulomatous lesions from a patient, female, with a history of recurrent periapical abscess without painful symptomatology in the region of the anterior 11,12 and 13 teeth. The histopathological exam demonstrated the presence of a granulomatous tissue with intense inflammatory infiltrate mixed, permeated with lymphocytes and high number of plasmocytes, confirming the diagnosis of periapical granuloma. The treatment was considered successful since the patient remained asymptomatic and there was incorporation of the inorganic bovine bone graft and initiation of bone neoformation in the periapical region.

Metaloproteinases da matriz: papel no desenvolvimento das lesões periapicais e modulação após tratamento endodôntico

Introduction: Apical periodontitis represents a local immune response directed against the progression of microorganisms from the dental pulp to the apical foramen and periapical tissues, which results in bone and dental resorption. The aim of this review is to describe the expression of this group of proteases in apical periodontitis and its modulation during the periapical healing phase following root canal treatment. Literature review: The pathogenesis of apical periodontitis involves degradation of several extracellular matrix components. Matrix metalloproteinases (MMPs) are expressed in response to specific stimuli by resident cells of connective tissue during tissue remodeling and by inflammatory cells that arrive into the surrounding tissues during inflammatory events. MMPs have been reported in apical periodontitis, either experimentally induced or obtained from humans and there is evidence that these enzymes show diff erent expression patterns in granulomas and periapical cysts. Root canal therapy is important for the reduction of periapical inflammation as well as the synthesis of MMPs, especially when using a calcium hydroxide-based dressing. Conclusion: Apical periodontitis show high expression of matrix metalloproteinases and root canal treatment results in less expression of MMPs when compared to untreated apical periodontitis.

FEATURES OF THE FUNCTIONAL ACTIVITY OF NEUTROPHILS AND THE LEVEL OF CYTOKINES OF THE LOCAL FOCUS OF INFLAMMATION IN PATIENTS WITH CHRONIC PERIODONTITIS

Subject. The risks of an unfavorable outcome of simultaneous implantation in most cases are associated with the installation of an implant in the tooth wells with chronic foci of odontogenic infection. The goal is to study the effector indicators of phagocytes and the level of cytokines of the local focus of inflammation in patients with various forms of chronic periodontitis. Methodology. The study involved 65 dental patients with a diagnosis of "K 04.5―K 04.9" (ICD-10, 1997), a comprehensive examination using laboratory immunological methods which included the study of the functional activity of neutrophils (phagocytic activity and intensity on a model of latex particle absorption; lysosomal activity and index of the total luminescence of lysosomes; HCT-reducing activity and intensity according to spontaneous and induced tests) and the concentration of IL-1-RA IL-1β, IL-2, IL-8, IFN–α, IFN-γ (PCG/ml) wound detachable wells of the extracted tooth. Results. A study of the immunological parameters of the local foci of periapical inflammation in patients with various forms of chronic periodontitis revealed some features of the cytokine profile and the functional activity of neutrophils in the wound detachable hole of the extracted tooth. The data obtained in patients with chronic fibrous periodontitis allowed us to determine the signs of activity of chronic inflammation. In subjects who had their teeth removed due to chronic granulating periodontitis, immunological predictors of a prolonged course of inflammatory and reparative processes were revealed. In patients with chronic granulomatous lesions of the periapical zone, evidence of prolonged contamination of the periapical zone was obtained, which may lead to changes in effector parameters against the background of the preserved bactericidal potential of neutrophilic granulocytes. Findings. Immunological predictors of the development of infectious and inflammatory complications were identified in the context of the planned simultaneous dental implantation when implants are inserted into the wells of the teeth with chronic periodontal foci.