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FIBROMATOSIS: A RARE BENIGN TUMOR IN THE FACE
ABSTRACTS
e68
Amyloidosis refers to extracellular and progressive deposition of the fibrillar protein that can be localized or generalized. In the head and neck region, amyloidosis is uncommon. When it occurs in the mouth, the tongue is the most affected site. The present study reports 2 cases of male patients who attended the stomatology clinic to investigate oral lesions without diagnosis. The first one at 60 years old and no systemic alterations presented an increase in submandibular, sublingual glands, and papular lesions in the bilateral buccal mucosa and tongue. A radiographic examination confirmed sialectasis in the submandibular gland. The second one at 82 years old and several systemic alterations, such as red and white series deregulation, diabetes, high levels of amylase, uranium, and creatinine among others, presented multiple papules in the tongue. In both cases, an incisional biopsy was performed, and the histopathologic examination confirmed amyloidosis. The patients continue to be monitored.
SIALOLITHIASIS OF MINOR SALIVARY GLAND IN THE BUCCAL MUCOSA: A CLIN ICAL FINDING. HELDER DOMICIANO DANTAS MARTINS, GIOVANE NOSCHESE, DANIELE HEGUEDUSCH, WELLINGTON HIDEAKI YANAGUIZAWA, GUILHERME TRAFANI SANCHES, MARILIA TRIERVEILER MARTINS and, CAMILA DE BARROS GALLO Sialolithiasis is the most common salivary gland disease, represented by a solid structure composed of calcium phosphate and organic matrix that may cause obstructive sialadenitis of the affected gland. Regularly diagnosed in the submandibular gland duct, it does not exhibit age or sex predilection. A 43-year-old female patient attended for dental evaluation had a small single asymptomatic yellow nodule with fibrous consistency in the buccal mucosa. An excisional biopsy was performed with clinical hypothesis of fibrous hyperplasia and lipoma. The histopathologic analysis showed an acellular mineralized tissue. The final diagnosis was sialolithiasis of the minor salivary gland. Sialolithiasis of the minor salivary gland is a rarely diagnosed disease and more commonly observed in the upper lip and buccal mucosa, suggesting its inclusion in the differential diagnose of minor salivary glands lesions, and this report emphasizes the importance of a complete clinical examination since it was a clinical finding.
SEVERE CLINICAL ATTACHMENT LOSS IN DECIDUOUS DENTITION CONCOMITANT TO GRAFT-VS-HOST DISEASE IN 2 SIBLINGS WITH AMEGAKARYOCYTIC PURPURA. BARBARA SOLDATELLI BALLARDIN, ARTHUR MAGNO MEDEIROS DE ARAUJO, ROBERTA TARGA STRAMANDINOLI-ZANICOTTI, GEISLA MARY SILVA SOARES, JULIANA LUCENA SCHUSSEL, JOSE MIGUEL AMENABAR CESPEDES and, CASSIUS CARVALHO TORRES-PEREIRA Amegakaryocytic purpura (AP) is a rare disease characterized by isolated thrombocytopenia and decreased megakaryocytes in the bone marrow, with hematopoietic stem cell transplantation (HSCT) being one of the main treatments. Two siblings, 4 and 6 years old, with AP, after HSCT showed severe periodontal attachment loss (PAL) with generalized gingival
OOOO January 2020 retraction. The condition did not follow the eruption of permanent teeth, being restricted to deciduous teeth. The siblings presented skin, gut, and oral graft-vs-host disease (GVHD) manifestations immediately after HSCT. GVHD is an immunologic reaction where the immunocompromised host rejects the graft stem cells from an immunocompetent donor. It occurs in 30% to 70% of patients undergoing HSCT, reaching the skin, liver, oral, and gastrointestinal mucosae. The present report explores the possibility that this PAL may be associated and/or has been aggravated as atypical GVHD manifestations since both started after HSCT.
SIMULTANEOUS MANIFESTATION OF GLANDULAR CHEILITIS AND ACTINIC CHEILITIS IN THE LOWER LIP - CASE REPORT. GIOVANA EMANUELLE LIMA LEONARDI, CAMILA PEIXOTO FABRIMILCENT, MELISSA ^ RODRIGUES DE ARAUJO, MARIA ANGELA NAVAL ^ MACHADO, ANGELA FERNANDES and, ANTONIO ADILSON SOARES DE LIMA Glandular cheilitis is a rare, chronic and inflammatory disease of the minor salivary glands. The etiology is still uncertain, but several conditions are reported in the literature as predisposing or causal factors. The purpose of this study is to report a case of a patient who presented both glandular cheilitis and actinic cheilitis. A male patient, a 40-year-old farmer, was hospitalized for treatment of alcoholism. The patient reported no complaints about the lips but visually presented a significant aesthetic impairment. Oral examination revealed an increase in volume and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands. An incisional biopsy was performed, and anatomopathologic examination confirmed the diagnosis of actinic and glandular cheilitis. The lip was treated with an association of retinol and cholecalciferol. The patient was followed up weekly for 30 days when the lesion regression was observed.
FIBROMATOSIS: A RARE BENIGN TUMOR IN THE FACE. RAYLANE FARIAS DE ^ ALBUQUERQUE, ROMULO OLIVEIRA DE HOLLANDA VALENTE, FELIPE DA SILVA MARINHO, MARIANA DE ALBUQUERQUE BORGES, ELIANE e CRISTINA VIANA REVOREDO, JAIR CARNEIRO LEAO and, IGOR HENRIQUE MORAIS SILVA The 40-year-old white female patient complained of increased volume on face with no relevant past medical history. Extraoral physical examination showed painless volume increase in the right hemiface with 2 years of evolution, involving the parotid and masseter region, which was firm to palpation extending to the oral cavity without causing changes in the mucosa. Computed tomography scan of the face showed a calcified, multilocular, expansive lesion with precise limits invading chewing space on the right side causing erosion in the mandibular ramus. Incisional biopsy was performed, and the histologic slices in hematoxylin and eosin showed cellular proliferation infiltrating mucosa and skeletal striated muscle with nodular areas. Immunohistochemical analysis was positive for Ki-67, smooth muscle actin, and P16 and was negative for P63, ER, caldesmon, CD34, S100, desmin, and b-catenin. With the laboratory findings the diagnosis of fibromatosis was reached. Because of the
OOOO Volume 129, Number 1 impossibility of surgical resection, chemotherapy was started using tamoxifen, and the patient is being followed up.
GIANT COMPLEX ODONTOMA OF MAXILLA WITH EXPOSURE INTO ORAL CAVITY. RAQUEL FELICIANO DA SILVA, CICERO DAYVES DA SILVA BEZERRA, FABIO DAUMAS NUNES, WASHINGTON GERALDO PELLEGRINI ROCHA JUNIOR, RUBENS CAMINO JUNIOR, ESTEVAM RUBENS UTUMI and, FABIO LUIZ CORACIN A 32-year-old female patient was referred with a painful swelling on the right side of the maxilla. Medical history, trauma experience, and drug prescriptions were not significant. Clinically, the patient presented with asymmetry of the face with an extensive necrotic bone exposed into the mouth. The overlying skin was normal with no tenderness with normal mouth opening. The orthopantomogram revealed a large, well-defined radiopacity with radiolucent halo with corticated margin extending from the alveolar bone to zygomatic bone. An incisional biopsy was performed, and the microscopic analysis revealed an odontoma. The surgical approach with complete excision and the microscopic analysis of surgical sample revealed an odontoma associated with odontogenic cyst, and the patient is very well since the surgery. The dentists must be well aware of the clinical and radiologic findings of such lesions to provide prompt treatment with better prognosis.
MELANOACANTHOMA ON THE ORAL MUCOSA OF CHILD: CASE REPORT. TATIELLY KARINE COSTA ALVES, HENRIQUE CHIARI RIZZO, SORAYA DE MATTOS CAMARGO GROSSMANN, MILENE APARECIDA TORRES SAAR MARTINS, HERMINIA MARQUES CAPISTRANO and, GIOVANNA RIBEIRO SOUTO Oral melanoacanthoma is an uncommon acquired pigmentation. An 11-year-old black female patient was assessed because of an asymptomatic macular lesion on the labial and buccal mucosa with evolution of 1 week. Medical history did not contribute. Intraoral examination showed a dark brown and flat lesion with irregular borders measuring around 30 mm on the left side. Diagnostic hypotheses were oral melanoacanthoma, physiologic macula, and melanoma. Incisional biopsy was performed. Histologic slices showed numerous benign dendritic melanocytes scattered throughout the lesional epithelium. The final diagnosis was oral melanoacanthoma. After 2 weeks, a partial remission of the oral lesions was observed.
AGGRESSIVE BEHAVIOR AND PUZZLING MANAGEMENT OF MULTIPLE BROWN TUMORS RELATED TO PRIMARY HYPERPARATHYROIDISM. DANIELE HEGUEDUSCH, SAMANTA VICENTE DE OLIVEIRA, THAIS GIMENEZ MINIELLO, FABIO DE ABREU ALVES, MARCOS CUSTODIO, SUZANA CANTANHEDE ORSINI MACHADO DE SOUSA and, CAMILA DE BARROS GALLO A 16-year-old female patient complaining of a maxillary mass with 6-month duration, causing asymmetry, spontaneous bleeding, and feeding difficulty presented at intraoral examination a large erythematous and ulcerated pedunculated mass arising from the
ABSTRACTS
e69
expanded maxilla. The anterior mandible was also enlarged but covered by normal oral mucosa. Anamnesis included primary hyperparathyroidism with parathyroidectomy in the past 6 months. Panoramic x-ray showed a radiolucent and mixed area in the maxilla and anterior mandible associated with tooth displacement and resorption. Incisional biopsy of the pedunculated mass in maxilla was performed to improve the patients quality of life, and histologic examination revealed a proliferation of ovoid to fusiform cells accompanied by numerous multinucleated giant cells, confirming the hypothesis of central giant cell granuloma, precisely, brown tumor. Brown tumors rarely involve maxilla and can behave aggressively, and the excision of parathyroid lesions results in controlled serum levels leading to a gradual decrease in the maxillary tumors.
GINGIVAL CYST OF THE ADULT: A REPORT OF AN UNUSUAL LESION. DANIELE HEGUEDUSCH, SAMANTA VICENTE DE OLIVEIRA, TAMIRES FELICIANO FLORIANO, RENNAN LUIZ OLIVEIRA DOS SANTOS, PAULO SERGIO SOUZA PINA, DECIO DOS SANTOS PINTO JUNIOR and, CAMILA DE BARROS GALLO A 78-year-old black female patient attended the oral medicine clinic complaining of a 2-month gum lesion that was painful during tooth brushing. Intraoral examination demonstrated a firm rounded nodule in the attached gingiva of the right inferior lateral incisor and canine. Periapical radiograph was noncontributory, and the patient was submitted to excisional biopsy. The histopathologic aspect showed a mucosal fragment covered by a parakeratinized stratified squamous epithelium exhibiting mild spongiosis and exocytosis with a cystic lesion at the subjacent connective tissue with a thin capsule of flat epithelial lining forming plaque-like structures. Thus, the final diagnosis was gingival cyst of the adult (GVA). GVA is a rare odontogenic cyst from the rests of dental lamina, frequently observed in the soft tissues of mandibular canine and premolar regions. Treatment of gingival cysts of the adult is definitive and have shown good prognosis after surgical excision.
AMYLOIDOSIS IN ORAL CAVITY: CASE REPORT. RAISSA SOARES DOS ANJOS, ROBERTO VIEIRA DE MELO, SERGIO ^ RICARDO SOARES DE MOURA, MARLOS LEONCIO DA ^ PAZ, ROMULO OLIVEIRA DE HOLLANDA VALENTE, e and, IGOR HENRIQUE MORAIS JAIR CARNEIRO LEAO SILVA A 67-year-old black male patient complained of nodules in the mouth and face for approximately 6 months before the initial consultation. His medical history included diagnosis of surgically-treated bilateral carpal tunnel syndrome. Extraoral physical examination showed nodular lesions, which were firm to palpation, painless, and of the same skin color in the nose, labial, and eyelid commissures. Intraorally, nodular, painless, and nonbleeding lesions were observed on the lips, buccal mucosa, and tongue. Incisional biopsy was performed on the lower lip in addition to collection of minor salivary glands where histologic slices stained in hematoxylin and eosin showed deposits of amorphous eosinophilic material on the stroma and vascular wall that assumed the apple-green birefringence when stained with Congo red and analyzed under polarized light microscopy. The diagnosis of amyloidosis was established in view of the laboratory
e68
Amyloidosis refers to extracellular and progressive deposition of the fibrillar protein that can be localized or generalized. In the head and neck region, amyloidosis is uncommon. When it occurs in the mouth, the tongue is the most affected site. The present study reports 2 cases of male patients who attended the stomatology clinic to investigate oral lesions without diagnosis. The first one at 60 years old and no systemic alterations presented an increase in submandibular, sublingual glands, and papular lesions in the bilateral buccal mucosa and tongue. A radiographic examination confirmed sialectasis in the submandibular gland. The second one at 82 years old and several systemic alterations, such as red and white series deregulation, diabetes, high levels of amylase, uranium, and creatinine among others, presented multiple papules in the tongue. In both cases, an incisional biopsy was performed, and the histopathologic examination confirmed amyloidosis. The patients continue to be monitored.
SIALOLITHIASIS OF MINOR SALIVARY GLAND IN THE BUCCAL MUCOSA: A CLIN ICAL FINDING. HELDER DOMICIANO DANTAS MARTINS, GIOVANE NOSCHESE, DANIELE HEGUEDUSCH, WELLINGTON HIDEAKI YANAGUIZAWA, GUILHERME TRAFANI SANCHES, MARILIA TRIERVEILER MARTINS and, CAMILA DE BARROS GALLO Sialolithiasis is the most common salivary gland disease, represented by a solid structure composed of calcium phosphate and organic matrix that may cause obstructive sialadenitis of the affected gland. Regularly diagnosed in the submandibular gland duct, it does not exhibit age or sex predilection. A 43-year-old female patient attended for dental evaluation had a small single asymptomatic yellow nodule with fibrous consistency in the buccal mucosa. An excisional biopsy was performed with clinical hypothesis of fibrous hyperplasia and lipoma. The histopathologic analysis showed an acellular mineralized tissue. The final diagnosis was sialolithiasis of the minor salivary gland. Sialolithiasis of the minor salivary gland is a rarely diagnosed disease and more commonly observed in the upper lip and buccal mucosa, suggesting its inclusion in the differential diagnose of minor salivary glands lesions, and this report emphasizes the importance of a complete clinical examination since it was a clinical finding.
SEVERE CLINICAL ATTACHMENT LOSS IN DECIDUOUS DENTITION CONCOMITANT TO GRAFT-VS-HOST DISEASE IN 2 SIBLINGS WITH AMEGAKARYOCYTIC PURPURA. BARBARA SOLDATELLI BALLARDIN, ARTHUR MAGNO MEDEIROS DE ARAUJO, ROBERTA TARGA STRAMANDINOLI-ZANICOTTI, GEISLA MARY SILVA SOARES, JULIANA LUCENA SCHUSSEL, JOSE MIGUEL AMENABAR CESPEDES and, CASSIUS CARVALHO TORRES-PEREIRA Amegakaryocytic purpura (AP) is a rare disease characterized by isolated thrombocytopenia and decreased megakaryocytes in the bone marrow, with hematopoietic stem cell transplantation (HSCT) being one of the main treatments. Two siblings, 4 and 6 years old, with AP, after HSCT showed severe periodontal attachment loss (PAL) with generalized gingival
OOOO January 2020 retraction. The condition did not follow the eruption of permanent teeth, being restricted to deciduous teeth. The siblings presented skin, gut, and oral graft-vs-host disease (GVHD) manifestations immediately after HSCT. GVHD is an immunologic reaction where the immunocompromised host rejects the graft stem cells from an immunocompetent donor. It occurs in 30% to 70% of patients undergoing HSCT, reaching the skin, liver, oral, and gastrointestinal mucosae. The present report explores the possibility that this PAL may be associated and/or has been aggravated as atypical GVHD manifestations since both started after HSCT.
SIMULTANEOUS MANIFESTATION OF GLANDULAR CHEILITIS AND ACTINIC CHEILITIS IN THE LOWER LIP - CASE REPORT. GIOVANA EMANUELLE LIMA LEONARDI, CAMILA PEIXOTO FABRIMILCENT, MELISSA ^ RODRIGUES DE ARAUJO, MARIA ANGELA NAVAL ^ MACHADO, ANGELA FERNANDES and, ANTONIO ADILSON SOARES DE LIMA Glandular cheilitis is a rare, chronic and inflammatory disease of the minor salivary glands. The etiology is still uncertain, but several conditions are reported in the literature as predisposing or causal factors. The purpose of this study is to report a case of a patient who presented both glandular cheilitis and actinic cheilitis. A male patient, a 40-year-old farmer, was hospitalized for treatment of alcoholism. The patient reported no complaints about the lips but visually presented a significant aesthetic impairment. Oral examination revealed an increase in volume and eversion of the lower lip as a result of hypertrophy and inflammation of the minor salivary glands. An incisional biopsy was performed, and anatomopathologic examination confirmed the diagnosis of actinic and glandular cheilitis. The lip was treated with an association of retinol and cholecalciferol. The patient was followed up weekly for 30 days when the lesion regression was observed.
FIBROMATOSIS: A RARE BENIGN TUMOR IN THE FACE. RAYLANE FARIAS DE ^ ALBUQUERQUE, ROMULO OLIVEIRA DE HOLLANDA VALENTE, FELIPE DA SILVA MARINHO, MARIANA DE ALBUQUERQUE BORGES, ELIANE e CRISTINA VIANA REVOREDO, JAIR CARNEIRO LEAO and, IGOR HENRIQUE MORAIS SILVA The 40-year-old white female patient complained of increased volume on face with no relevant past medical history. Extraoral physical examination showed painless volume increase in the right hemiface with 2 years of evolution, involving the parotid and masseter region, which was firm to palpation extending to the oral cavity without causing changes in the mucosa. Computed tomography scan of the face showed a calcified, multilocular, expansive lesion with precise limits invading chewing space on the right side causing erosion in the mandibular ramus. Incisional biopsy was performed, and the histologic slices in hematoxylin and eosin showed cellular proliferation infiltrating mucosa and skeletal striated muscle with nodular areas. Immunohistochemical analysis was positive for Ki-67, smooth muscle actin, and P16 and was negative for P63, ER, caldesmon, CD34, S100, desmin, and b-catenin. With the laboratory findings the diagnosis of fibromatosis was reached. Because of the
OOOO Volume 129, Number 1 impossibility of surgical resection, chemotherapy was started using tamoxifen, and the patient is being followed up.
GIANT COMPLEX ODONTOMA OF MAXILLA WITH EXPOSURE INTO ORAL CAVITY. RAQUEL FELICIANO DA SILVA, CICERO DAYVES DA SILVA BEZERRA, FABIO DAUMAS NUNES, WASHINGTON GERALDO PELLEGRINI ROCHA JUNIOR, RUBENS CAMINO JUNIOR, ESTEVAM RUBENS UTUMI and, FABIO LUIZ CORACIN A 32-year-old female patient was referred with a painful swelling on the right side of the maxilla. Medical history, trauma experience, and drug prescriptions were not significant. Clinically, the patient presented with asymmetry of the face with an extensive necrotic bone exposed into the mouth. The overlying skin was normal with no tenderness with normal mouth opening. The orthopantomogram revealed a large, well-defined radiopacity with radiolucent halo with corticated margin extending from the alveolar bone to zygomatic bone. An incisional biopsy was performed, and the microscopic analysis revealed an odontoma. The surgical approach with complete excision and the microscopic analysis of surgical sample revealed an odontoma associated with odontogenic cyst, and the patient is very well since the surgery. The dentists must be well aware of the clinical and radiologic findings of such lesions to provide prompt treatment with better prognosis.
MELANOACANTHOMA ON THE ORAL MUCOSA OF CHILD: CASE REPORT. TATIELLY KARINE COSTA ALVES, HENRIQUE CHIARI RIZZO, SORAYA DE MATTOS CAMARGO GROSSMANN, MILENE APARECIDA TORRES SAAR MARTINS, HERMINIA MARQUES CAPISTRANO and, GIOVANNA RIBEIRO SOUTO Oral melanoacanthoma is an uncommon acquired pigmentation. An 11-year-old black female patient was assessed because of an asymptomatic macular lesion on the labial and buccal mucosa with evolution of 1 week. Medical history did not contribute. Intraoral examination showed a dark brown and flat lesion with irregular borders measuring around 30 mm on the left side. Diagnostic hypotheses were oral melanoacanthoma, physiologic macula, and melanoma. Incisional biopsy was performed. Histologic slices showed numerous benign dendritic melanocytes scattered throughout the lesional epithelium. The final diagnosis was oral melanoacanthoma. After 2 weeks, a partial remission of the oral lesions was observed.
AGGRESSIVE BEHAVIOR AND PUZZLING MANAGEMENT OF MULTIPLE BROWN TUMORS RELATED TO PRIMARY HYPERPARATHYROIDISM. DANIELE HEGUEDUSCH, SAMANTA VICENTE DE OLIVEIRA, THAIS GIMENEZ MINIELLO, FABIO DE ABREU ALVES, MARCOS CUSTODIO, SUZANA CANTANHEDE ORSINI MACHADO DE SOUSA and, CAMILA DE BARROS GALLO A 16-year-old female patient complaining of a maxillary mass with 6-month duration, causing asymmetry, spontaneous bleeding, and feeding difficulty presented at intraoral examination a large erythematous and ulcerated pedunculated mass arising from the
ABSTRACTS
e69
expanded maxilla. The anterior mandible was also enlarged but covered by normal oral mucosa. Anamnesis included primary hyperparathyroidism with parathyroidectomy in the past 6 months. Panoramic x-ray showed a radiolucent and mixed area in the maxilla and anterior mandible associated with tooth displacement and resorption. Incisional biopsy of the pedunculated mass in maxilla was performed to improve the patients quality of life, and histologic examination revealed a proliferation of ovoid to fusiform cells accompanied by numerous multinucleated giant cells, confirming the hypothesis of central giant cell granuloma, precisely, brown tumor. Brown tumors rarely involve maxilla and can behave aggressively, and the excision of parathyroid lesions results in controlled serum levels leading to a gradual decrease in the maxillary tumors.
GINGIVAL CYST OF THE ADULT: A REPORT OF AN UNUSUAL LESION. DANIELE HEGUEDUSCH, SAMANTA VICENTE DE OLIVEIRA, TAMIRES FELICIANO FLORIANO, RENNAN LUIZ OLIVEIRA DOS SANTOS, PAULO SERGIO SOUZA PINA, DECIO DOS SANTOS PINTO JUNIOR and, CAMILA DE BARROS GALLO A 78-year-old black female patient attended the oral medicine clinic complaining of a 2-month gum lesion that was painful during tooth brushing. Intraoral examination demonstrated a firm rounded nodule in the attached gingiva of the right inferior lateral incisor and canine. Periapical radiograph was noncontributory, and the patient was submitted to excisional biopsy. The histopathologic aspect showed a mucosal fragment covered by a parakeratinized stratified squamous epithelium exhibiting mild spongiosis and exocytosis with a cystic lesion at the subjacent connective tissue with a thin capsule of flat epithelial lining forming plaque-like structures. Thus, the final diagnosis was gingival cyst of the adult (GVA). GVA is a rare odontogenic cyst from the rests of dental lamina, frequently observed in the soft tissues of mandibular canine and premolar regions. Treatment of gingival cysts of the adult is definitive and have shown good prognosis after surgical excision.
AMYLOIDOSIS IN ORAL CAVITY: CASE REPORT. RAISSA SOARES DOS ANJOS, ROBERTO VIEIRA DE MELO, SERGIO ^ RICARDO SOARES DE MOURA, MARLOS LEONCIO DA ^ PAZ, ROMULO OLIVEIRA DE HOLLANDA VALENTE, e and, IGOR HENRIQUE MORAIS JAIR CARNEIRO LEAO SILVA A 67-year-old black male patient complained of nodules in the mouth and face for approximately 6 months before the initial consultation. His medical history included diagnosis of surgically-treated bilateral carpal tunnel syndrome. Extraoral physical examination showed nodular lesions, which were firm to palpation, painless, and of the same skin color in the nose, labial, and eyelid commissures. Intraorally, nodular, painless, and nonbleeding lesions were observed on the lips, buccal mucosa, and tongue. Incisional biopsy was performed on the lower lip in addition to collection of minor salivary glands where histologic slices stained in hematoxylin and eosin showed deposits of amorphous eosinophilic material on the stroma and vascular wall that assumed the apple-green birefringence when stained with Congo red and analyzed under polarized light microscopy. The diagnosis of amyloidosis was established in view of the laboratory