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INTRAOSSEOUS ADENOID CYSTIC CARCINOMA OF MAXILLA: AN UNUSUAL PRESENTATION
OOOO Volume 129, Number 1 ACTINOMYCES OF THE JAW: CASE REPORT. BRUNA GALUPPO, BARBARA DE SOUZA MARIAN, ADRIANA PARISOTTO MACEDO, ALBERTO FEDELI JUNIOR and, DIOGO LENZI CAPELLA Actinomycosis is a rare chronic granulomatous infection that requires a correlation of histopathologic and microbiologic findings for diagnosis. The case refers to a 52-year-old patient with a lesion in the anterior mandibular region after oral surgery. Clinical examination showed pain symptoms unresponsive to pain killers, prostration and numbness in the lip and chin regions, and a chest x-ray that revealed multiple nodules in the lung. The lesion presented erythema, edema, and granulomatous aspect that extended from tooth 32 to 45. The consistency was fibrous and without suppuration. Radiographic examination revealed extensive radiolucent area with poorly defined boundaries and destruction of the buccal and lingual cortical. The histologic report of incisional biopsy revealed granulomatous tissue after cell culture. The diagnosis of actinomycosis was defined as a disease that has an excellent prognosis and a low mortality rate if diagnosed early.
NASOPALATINE DUCT CYST: CLINICOPATHOLOGIC, RADIOGRAPHIC, AND THERAPEUTIC FEATURES. FERNANDA e ARAGAO FELIX, ONDINA KARLA MOUSINHO DA SILVA ROCHA, CAIO CESAR DA SILVA BARROS, LUIZ ARTHUR BARBOSA DA SILVA, DAUREA ADILIA COBE SENA, ADRIANO ROCHA GERMANO and, MARCIA CRISTINA DA COSTA MIGUEL Nasopalatine duct cyst (NDC) is a nonodontogenic developmental cyst originating from the epithelial rests of the nasopalatine duct. We report the case of a 61-years-old male patient showing a swelling of softened consistency sensitive to palpation with texture and normal coloration in the anterior region of the maxilla close to the midline. The sensibility test revealed vitality of the adjacent teeth. Radiographically, we observed a well-circumscribed unilocular radiolucent defect. An excisional biopsy was performed, and the surgical specimen was sent for histopathologic analysis, which revealed the presence of a cystic lesion lined by pseudostratified columnar epithelium with few cell layers associated with a cyst wall of dense fibrous connective tissue. Thus, the diagnosis of nasopalatine duct cyst was established. After 2 years, the postoperative control did not reveal recurrence of the lesion.
MANAGEMENT OF BROWN TUMOR OF THE JAWS IN TERTIARY HYPERPARATHYROIDISM: A CASE REPORT. MARIA EDUARDA LANES BALDINO, VALESCA SANDER KOTH, LETICIA JACOBY, BETHINA DOS SANTOS, FERNANDA SALUM, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, KAREN CHERUBINI A 26-year-old white male patient with kidney transplant history (4 months earlier) presented with 2 asymptomatic firm purplish nodules in the mandible causing tooth mobility. Laboratory tests showed serum levels of alkaline phosphatase at 646 U/L and parathyroid hormone at 511.7 pg/mL. Computed tomography showed radiolucent images in the anterior, posterior, and basilar regions of the mandible. Radiographic examination of hand-wrist and pelvis also depicted osteolytic images. Biopsy of the oral lesions was performed, and the histopathologic examination was
ABSTRACTS
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compatible with central giant cell granuloma. Scintigraphy exhibited hyperfunctional parathyroid, and parathyroidectomy revealed nodular formations, chief cells, oxyphil cells, focal fibrosis, and calcification compatible with parathyroid hyperplasia. The clinical picture confirmed tertiary hyperparathyroidism. Mandible lesions were then subjected to intralesional injections of triamcinolone acetonide (20 mg/mL) and lidocaine (0.5%). After 8 sessions, the lesions had partial remission. The patient is under clinical and radiographic follow-up without any relapse of the disease.
ORAL AMYLOIDOSIS ASSOCIATED WITH MULTIPLE MYELOMA - A CASE REPORT. VALESCA SANDER KOTH, MARIANA KLEIN, MARIA EDUARDA LANES BALDINO, GABRIELA ALACARINI FARINA, FERNANDA GONCALVES ¸ SALUM, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, KAREN CHERUBINI A 54-year-old black female patient undergoing dexamethasone and bortezomib therapy for multiple myeloma presented with asymptomatic papules and nodules on the border of the tongue. The lesions were firm in consistency, with light yellowish color and ranging in size from 0.2 to 0.6 cm. A biopsy was performed, and the histopathologic examination with hematoxylin and eosin showed an extracellular deposition of eosinophilic material within the connective tissue. Congo red stain confirmed the diagnosis of amyloidosis. Amyloid deposition associated with multiple myeloma is progressive and can involve any organ. Currently, there is no treatment for this condition. Therefore, the patient has been kept under clinical follow-up showing involvement of the tongue, floor of the mouth, and lower and upper lip, which present with reduced tissue elasticity.
PERIPHERAL COMPOUND ODONTOMA: CASE REPORT. CARLA SAMILY DE OLIVEIRA COSTA, ONDINA KARLA MOUSINHO DA SILVA ROCHA, CAIO CESAR DA SILVA BARROS, AFONSO NOBREGA DANTAS, LUIZ ARTHUR BARBOSA DA SILVA, HECIO HENRIQUE ARAUJO DE MORAIS and, MARCIA CRISTINA DA COSTA MIGUEL Peripheral odontoma is an odontogenic hamartoma considered extremely uncommon whose development results from the rests of odontogenic epithelium that resides in the soft tissues of the maxillomandibular complex. We report here a case of an 11year-old female patient showing an asymptomatic nodular exophytic lesion on the anterior region of the palate with normochromic coloration, hardened consistency, and 1 year of duration. From the observed clinical features and under the hypothesis of fibroma, an excisional biopsy was performed. Anatomopathologic analysis revealed the presence of teeth-like structures formed by enamel and dentin matrix sometimes associated with the dental papilla or surrounding pulp tissue; thus, the diagnosis of compound odontoma was established. The patient has been under follow-up for 6 months without signs of recurrence.
INTRAOSSEOUS ADENOID CYSTIC CARCINOMA OF MAXILLA: AN UNUSUAL PRESENTATION. ROSE MARA ORTEGA, FRANCIELLE SILVESTRE VERNER, MAURICIO AUGUSTO AQUINO DE CASTRO, CARLOS EDUARDO ^ PINTO DE ALCANTARA, CELESTE SANCHEZ ROMERO,
ABSTRACTS
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OSLEI PAES DE ALMEIDA and, SIBELE NASCIMENTO DE AQUINO Adenoid cystic carcinoma (ACC) is a relatively rare tumor of epithelial cell origin. Palatal minor salivary glands are the most commonly affected locations followed by parotid, and submandibular glands. Bone lesions are rare. The mandible is more commonly involved than the maxilla. A 36-year-old woman presented with a painless swelling in the right maxilla, resulting in a marked facial asymmetry. Intraorally, a swelling affecting gingiva and crossing the midline of the hard palate was observed. Panoramic radiograph showed an ill-defined radiolucency, involving the right maxilla at the level of alveolar ridge and opacifying the maxillary sinus. Microscopy revealed basophilic cribriform islands and solid sheets of neoplastic cells invading bone trabeculae. Most of the tumoral cells presented myoepithelial characteristics and few true luminal/epithelial. Immunohistochemistry showed positivity for AE1/AE3, CK5, CK7, CK14, CK18, CK19, CK20, p63, a smooth muscle actin, calponin, CD117, S-100, and Ki-67. ACC in the maxilla are rare but should be considered as differential diagnosis.
MEDICATION-RELATED OSTEONECROSIS OF THE JAW AFTER A SINGLE DOSE OF DENOSUMAB. HELENA AYRES ALONSO DOS SANTOS, MARIA FERNANDA CALAZANS, ANA LUIZA ROZA, ELLLEN BRILHANTE DE ALBUQUERQUE CORTEZZI, BRUNO AUGUSTO BENEVENUTO DE e ANDRADE, MARIO JOSE ROMANACH and, MICHELLE AGOSTINI Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive (bisphosphonates and denosumab) and antiangiogenic therapy of oncologic and osteoporotic patients. We report a case of an 85-years-old female patient who developed MRONJ 4 months after a single subcutaneous injection of denosumab therapy (Prolia 60 mg) for osteoporosis. The patient presented painful fistula with purulent secretion in the posterior region of the mandible, with no bone exposure, showing a small bony sequestrum only revealed by computerized tomography. The patient was conservatively managed with amoxicillin 500 mg/potassium clavulanate 125 mg and paracetamol 500 mg/codeine phosphate 7.5 mg. Complete healing was observed after 21 days of treatment, and no surgical intervention was required. The patient did not present new events after 1 year of follow-up, with no use of removable denture.
DIAGNOSIS AND TREATMENT OF MESIODENS IN A PATIENT WITH SPECIAL NEEDS: CASE REPORT. JOYCE HELENA MONTEIRO BARBOSA, SAMIR COSTA NUNES, LUIZA MADALENA MENDES DA VERA CRUZ, CRISLYNE MENDES DA VERA CRUZ, KAIO SILVA ARAUJO, GISELLE KAROLINA DE LIMA REIS and, ERICK NELO PEDREIRA Mesiodens is a supernumerary tooth located in the midline between the 2 maxillary central incisors, with varied morphology and undefined etiology, having a higher prevalence in mixed and permanent dentition of men and boys. This article reports a clinical case of a 7-year-old male patient that has attention deficit hyperactivity disorder (ADHD) and bipolar affective disorder under control, and he had mixed dentition, malocclusion, regular oral hygiene, and normal periodontal aspects. His main complaint
OOOO January 2020 was pain in element 64. After clinical examination, the patient was diagnosed as having erupted conical mesiodens. The treatment plan was established by means of radiographic examinations, medical release report, and complete blood count for mesiodens extraction, element 64 pulpectomy, and dental restorations. The patient continued the dental treatment, returning 6 days after the extraction for suture removal, and he was posteriorly referred to orthodontic treatment to correct the malocclusion.
MULTIPLE ORTHOKERATINIZED ODONTOGENIC CYSTS IN A 17-YEAR-OLD PATIENT. AGNELO LUCAMBA, JESSICA VILAS BOAS, EDER MAGNO, ANDRESA BORGES SOARES, LUCAS NOVAES TEIXEIRA, VERA CAVALCANTI DE ARAUJO and, FABRICIO PASSADOR-SANTOS A 17-year-old white male patient sought dental treatment because of asymptomatic lesions identified in a routine panoramic radiograph. Intraoral and extraoral physical examinations revealed a small expansion of the left body of the mandible and teeth mobility involving elements 35 to 37. A large unilocular radiolucent lesion with well-demarked borders involving teeth 31 to 38 was noticed. On the right side, a unilocular radiolucent lesion with well-demarked borders was identified adjacent to the distal root of tooth 47. The diagnostic hypotheses included keratocysts related to Gorlin syndrome. Excisional and incisional biopsies were performed on the right and left sides of the mandible, respectively. Histopathologic analysis showed cystic capsules lined by orthokeratinized stratified epithelium presenting a flat surface with the connective tissue capsule and no palisading of the basal cells. The left side lesion has been decompressed, and there were no signs of recurrence after a 4-month follow-up period.
LICHENOID MUCOSITIS: REPORT OF A CASE AND LITERATURE REVIEW. ANA LETICIA MARQUES DE SOUZA ASSIS, ^ S, ALESSANDRA LAIS PINHO EDUARDO COSTA MERCE VALENTE PIRES, JEAN NUNES DOS SANTOS, MARCIO e CAMPOS OLIVEIRA, ANGELA GUIMARAES MARTINS and, VALERIA SOUZA FREITAS This study aims to report a case of lichenoid mucositis and to carry out a literature review highlighting the relevant issues for differential diagnosis. A 69-year-old man, a chronic smoker, reported complaints of “alteration in his cheek.” During anamnesis, chronic obstructive pulmonary disease, diabetes, and hypertension were reported, with medication use of antiulcer drugs, antihypertensive drugs, and oral hypoglycemic agents. In addition, there was a family history of squamous cell carcinoma in the tongue. Under clinical examination, he presented isolated lesions in the region of the buccal mucosa and tongue in the form of white striae with erythematous areas and white plaque. Under clinical suspicion of oral lichen planus, he was submitted to incisional biopsy, resulting in lichenoid mucositis. Therapy was based on topical corticosteroids and patient follow-up, and the lesion has stabilized after 6 years of follow-up. Accurate clinical and histopathologic examinations are essential for the correct diagnosis of this disease.
SYMMETRIC PALATE ULCERS IN A PATIENT AFTER RENAL TRANSPLANTATION: CASE REPORT. THAIS TORRES BARROS DUTRA,
NASOPALATINE DUCT CYST: CLINICOPATHOLOGIC, RADIOGRAPHIC, AND THERAPEUTIC FEATURES. FERNANDA e ARAGAO FELIX, ONDINA KARLA MOUSINHO DA SILVA ROCHA, CAIO CESAR DA SILVA BARROS, LUIZ ARTHUR BARBOSA DA SILVA, DAUREA ADILIA COBE SENA, ADRIANO ROCHA GERMANO and, MARCIA CRISTINA DA COSTA MIGUEL Nasopalatine duct cyst (NDC) is a nonodontogenic developmental cyst originating from the epithelial rests of the nasopalatine duct. We report the case of a 61-years-old male patient showing a swelling of softened consistency sensitive to palpation with texture and normal coloration in the anterior region of the maxilla close to the midline. The sensibility test revealed vitality of the adjacent teeth. Radiographically, we observed a well-circumscribed unilocular radiolucent defect. An excisional biopsy was performed, and the surgical specimen was sent for histopathologic analysis, which revealed the presence of a cystic lesion lined by pseudostratified columnar epithelium with few cell layers associated with a cyst wall of dense fibrous connective tissue. Thus, the diagnosis of nasopalatine duct cyst was established. After 2 years, the postoperative control did not reveal recurrence of the lesion.
MANAGEMENT OF BROWN TUMOR OF THE JAWS IN TERTIARY HYPERPARATHYROIDISM: A CASE REPORT. MARIA EDUARDA LANES BALDINO, VALESCA SANDER KOTH, LETICIA JACOBY, BETHINA DOS SANTOS, FERNANDA SALUM, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, KAREN CHERUBINI A 26-year-old white male patient with kidney transplant history (4 months earlier) presented with 2 asymptomatic firm purplish nodules in the mandible causing tooth mobility. Laboratory tests showed serum levels of alkaline phosphatase at 646 U/L and parathyroid hormone at 511.7 pg/mL. Computed tomography showed radiolucent images in the anterior, posterior, and basilar regions of the mandible. Radiographic examination of hand-wrist and pelvis also depicted osteolytic images. Biopsy of the oral lesions was performed, and the histopathologic examination was
ABSTRACTS
e73
compatible with central giant cell granuloma. Scintigraphy exhibited hyperfunctional parathyroid, and parathyroidectomy revealed nodular formations, chief cells, oxyphil cells, focal fibrosis, and calcification compatible with parathyroid hyperplasia. The clinical picture confirmed tertiary hyperparathyroidism. Mandible lesions were then subjected to intralesional injections of triamcinolone acetonide (20 mg/mL) and lidocaine (0.5%). After 8 sessions, the lesions had partial remission. The patient is under clinical and radiographic follow-up without any relapse of the disease.
ORAL AMYLOIDOSIS ASSOCIATED WITH MULTIPLE MYELOMA - A CASE REPORT. VALESCA SANDER KOTH, MARIANA KLEIN, MARIA EDUARDA LANES BALDINO, GABRIELA ALACARINI FARINA, FERNANDA GONCALVES ¸ SALUM, MARIA ANTONIA ZANCANARO DE FIGUEIREDO and, KAREN CHERUBINI A 54-year-old black female patient undergoing dexamethasone and bortezomib therapy for multiple myeloma presented with asymptomatic papules and nodules on the border of the tongue. The lesions were firm in consistency, with light yellowish color and ranging in size from 0.2 to 0.6 cm. A biopsy was performed, and the histopathologic examination with hematoxylin and eosin showed an extracellular deposition of eosinophilic material within the connective tissue. Congo red stain confirmed the diagnosis of amyloidosis. Amyloid deposition associated with multiple myeloma is progressive and can involve any organ. Currently, there is no treatment for this condition. Therefore, the patient has been kept under clinical follow-up showing involvement of the tongue, floor of the mouth, and lower and upper lip, which present with reduced tissue elasticity.
PERIPHERAL COMPOUND ODONTOMA: CASE REPORT. CARLA SAMILY DE OLIVEIRA COSTA, ONDINA KARLA MOUSINHO DA SILVA ROCHA, CAIO CESAR DA SILVA BARROS, AFONSO NOBREGA DANTAS, LUIZ ARTHUR BARBOSA DA SILVA, HECIO HENRIQUE ARAUJO DE MORAIS and, MARCIA CRISTINA DA COSTA MIGUEL Peripheral odontoma is an odontogenic hamartoma considered extremely uncommon whose development results from the rests of odontogenic epithelium that resides in the soft tissues of the maxillomandibular complex. We report here a case of an 11year-old female patient showing an asymptomatic nodular exophytic lesion on the anterior region of the palate with normochromic coloration, hardened consistency, and 1 year of duration. From the observed clinical features and under the hypothesis of fibroma, an excisional biopsy was performed. Anatomopathologic analysis revealed the presence of teeth-like structures formed by enamel and dentin matrix sometimes associated with the dental papilla or surrounding pulp tissue; thus, the diagnosis of compound odontoma was established. The patient has been under follow-up for 6 months without signs of recurrence.
INTRAOSSEOUS ADENOID CYSTIC CARCINOMA OF MAXILLA: AN UNUSUAL PRESENTATION. ROSE MARA ORTEGA, FRANCIELLE SILVESTRE VERNER, MAURICIO AUGUSTO AQUINO DE CASTRO, CARLOS EDUARDO ^ PINTO DE ALCANTARA, CELESTE SANCHEZ ROMERO,
ABSTRACTS
e74
OSLEI PAES DE ALMEIDA and, SIBELE NASCIMENTO DE AQUINO Adenoid cystic carcinoma (ACC) is a relatively rare tumor of epithelial cell origin. Palatal minor salivary glands are the most commonly affected locations followed by parotid, and submandibular glands. Bone lesions are rare. The mandible is more commonly involved than the maxilla. A 36-year-old woman presented with a painless swelling in the right maxilla, resulting in a marked facial asymmetry. Intraorally, a swelling affecting gingiva and crossing the midline of the hard palate was observed. Panoramic radiograph showed an ill-defined radiolucency, involving the right maxilla at the level of alveolar ridge and opacifying the maxillary sinus. Microscopy revealed basophilic cribriform islands and solid sheets of neoplastic cells invading bone trabeculae. Most of the tumoral cells presented myoepithelial characteristics and few true luminal/epithelial. Immunohistochemistry showed positivity for AE1/AE3, CK5, CK7, CK14, CK18, CK19, CK20, p63, a smooth muscle actin, calponin, CD117, S-100, and Ki-67. ACC in the maxilla are rare but should be considered as differential diagnosis.
MEDICATION-RELATED OSTEONECROSIS OF THE JAW AFTER A SINGLE DOSE OF DENOSUMAB. HELENA AYRES ALONSO DOS SANTOS, MARIA FERNANDA CALAZANS, ANA LUIZA ROZA, ELLLEN BRILHANTE DE ALBUQUERQUE CORTEZZI, BRUNO AUGUSTO BENEVENUTO DE e ANDRADE, MARIO JOSE ROMANACH and, MICHELLE AGOSTINI Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive (bisphosphonates and denosumab) and antiangiogenic therapy of oncologic and osteoporotic patients. We report a case of an 85-years-old female patient who developed MRONJ 4 months after a single subcutaneous injection of denosumab therapy (Prolia 60 mg) for osteoporosis. The patient presented painful fistula with purulent secretion in the posterior region of the mandible, with no bone exposure, showing a small bony sequestrum only revealed by computerized tomography. The patient was conservatively managed with amoxicillin 500 mg/potassium clavulanate 125 mg and paracetamol 500 mg/codeine phosphate 7.5 mg. Complete healing was observed after 21 days of treatment, and no surgical intervention was required. The patient did not present new events after 1 year of follow-up, with no use of removable denture.
DIAGNOSIS AND TREATMENT OF MESIODENS IN A PATIENT WITH SPECIAL NEEDS: CASE REPORT. JOYCE HELENA MONTEIRO BARBOSA, SAMIR COSTA NUNES, LUIZA MADALENA MENDES DA VERA CRUZ, CRISLYNE MENDES DA VERA CRUZ, KAIO SILVA ARAUJO, GISELLE KAROLINA DE LIMA REIS and, ERICK NELO PEDREIRA Mesiodens is a supernumerary tooth located in the midline between the 2 maxillary central incisors, with varied morphology and undefined etiology, having a higher prevalence in mixed and permanent dentition of men and boys. This article reports a clinical case of a 7-year-old male patient that has attention deficit hyperactivity disorder (ADHD) and bipolar affective disorder under control, and he had mixed dentition, malocclusion, regular oral hygiene, and normal periodontal aspects. His main complaint
OOOO January 2020 was pain in element 64. After clinical examination, the patient was diagnosed as having erupted conical mesiodens. The treatment plan was established by means of radiographic examinations, medical release report, and complete blood count for mesiodens extraction, element 64 pulpectomy, and dental restorations. The patient continued the dental treatment, returning 6 days after the extraction for suture removal, and he was posteriorly referred to orthodontic treatment to correct the malocclusion.
MULTIPLE ORTHOKERATINIZED ODONTOGENIC CYSTS IN A 17-YEAR-OLD PATIENT. AGNELO LUCAMBA, JESSICA VILAS BOAS, EDER MAGNO, ANDRESA BORGES SOARES, LUCAS NOVAES TEIXEIRA, VERA CAVALCANTI DE ARAUJO and, FABRICIO PASSADOR-SANTOS A 17-year-old white male patient sought dental treatment because of asymptomatic lesions identified in a routine panoramic radiograph. Intraoral and extraoral physical examinations revealed a small expansion of the left body of the mandible and teeth mobility involving elements 35 to 37. A large unilocular radiolucent lesion with well-demarked borders involving teeth 31 to 38 was noticed. On the right side, a unilocular radiolucent lesion with well-demarked borders was identified adjacent to the distal root of tooth 47. The diagnostic hypotheses included keratocysts related to Gorlin syndrome. Excisional and incisional biopsies were performed on the right and left sides of the mandible, respectively. Histopathologic analysis showed cystic capsules lined by orthokeratinized stratified epithelium presenting a flat surface with the connective tissue capsule and no palisading of the basal cells. The left side lesion has been decompressed, and there were no signs of recurrence after a 4-month follow-up period.
LICHENOID MUCOSITIS: REPORT OF A CASE AND LITERATURE REVIEW. ANA LETICIA MARQUES DE SOUZA ASSIS, ^ S, ALESSANDRA LAIS PINHO EDUARDO COSTA MERCE VALENTE PIRES, JEAN NUNES DOS SANTOS, MARCIO e CAMPOS OLIVEIRA, ANGELA GUIMARAES MARTINS and, VALERIA SOUZA FREITAS This study aims to report a case of lichenoid mucositis and to carry out a literature review highlighting the relevant issues for differential diagnosis. A 69-year-old man, a chronic smoker, reported complaints of “alteration in his cheek.” During anamnesis, chronic obstructive pulmonary disease, diabetes, and hypertension were reported, with medication use of antiulcer drugs, antihypertensive drugs, and oral hypoglycemic agents. In addition, there was a family history of squamous cell carcinoma in the tongue. Under clinical examination, he presented isolated lesions in the region of the buccal mucosa and tongue in the form of white striae with erythematous areas and white plaque. Under clinical suspicion of oral lichen planus, he was submitted to incisional biopsy, resulting in lichenoid mucositis. Therapy was based on topical corticosteroids and patient follow-up, and the lesion has stabilized after 6 years of follow-up. Accurate clinical and histopathologic examinations are essential for the correct diagnosis of this disease.
SYMMETRIC PALATE ULCERS IN A PATIENT AFTER RENAL TRANSPLANTATION: CASE REPORT. THAIS TORRES BARROS DUTRA,