- Email: [email protected]
VASCULAR EXTENSION OF PERIPHERAL GIANT CELL LESION: A CASE REPORT WITH IMMUNOHISTOCHEMICAL ANALYSIS
OOOO Volume 129, Number 1 ACQUIRED ORAL SYPHILIS: REPORT OF 2 CASES AND REVIEW OF THE LITERATURE. ^ LENI VERONICA DE OLIVEIRA SILVA, JOSE ALCIDES ALMEIDA DE ARRUDA, LAUREN FRENZEL SCHUCH, ADRIANA APARECIDA SILVA DA COSTA, FELIPE PAIVA FONSECA and, RICARDO ALVES MESQUITA Acquired oral syphilis (AOS) is an infectious disease caused by the bacterium Treponema pallidum. Transmission occurs mainly by sexual contact with infectious lesions. Two cases of AOS have been reported. A 29-year-old male patient presented with grayish-white mucous patches and reddish ulcers in the lips, lateral border of the tongue, floor of the mouth, and the oropharynx. The patient was a marijuana user. A 33-year-old female patient presented with pruritus of the tongue and throat, pain in the upper labial mucosa for 1month, and halitosis. Reddish ulcers 5 mm in size were detected in the upper labial mucosa, posterior dorsal surface of the tongue, gingiva, and palate. A maculopapular cutaneous rash was also observed. The patients did not report systemic comorbidities. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTAABS) were both positive, confirming the clinical diagnosis of syphilis. They patients were referred for adequate treatment and remission of the oral lesions was observed. Support: FAPEMIG.
MELKERSSON-ROSENTHAL SYNDROME: A CASE REPORT. LAUREN FRENZEL SCHUCH, FELIPE PAIVA FONSECA, EDUARDO MORATO DE OLIVEIRA, JOSE ALCIDES ALMEIDA DE ARRUDA, PATRICIA CARLOS CALDEIRA and, MARIA CASSIA FERREIRA DE AGUIAR A 20-year-old white man was referred to the oral medicine clinic, complaining of an asymptomatic swelling in the upper lip lasting for around 2 years. His medical history included stressinduced gastritis, bronchitis, allergic rhinitis, and episodes of facial paralysis. The extraoral examination showed a large and diffuse swelling affecting the upper lip vermillion and labial mucosa causing facial asymmetry. The lesion was nonpitting, had a rubbery consistency, and presented with a normal temperature. The vermillion border was dried and stretched, with no ulceration. The intraoral examination revealed deep grooves and fissures on the tongue dorsum. A previous biopsy of the lip showed a chronic inflammatory area. Based on the history and clinical features, the diagnosis of Melkersson-Rosenthal syndrome was made. The patient is under treatment with intralesional infiltration of triamcinolone acetonide in the upper lip. Moreover, he was referred for a physician to investigate a possible intestinal involvement. Support: FAPEMIG.
CLINICOPATHOLOGIC AND IMMUNOHISTOCHEMICAL CHARACTERIZATION OF LOCALIZED JUVENILE SPONGIOTIC GINe GIVAL HYPERPLASIA. IRENE LAFUENTE IBANEZ DE e MENDOZA, JUAN PABLO MUNOZ ZAPATA, FERNANDO GARCIA HERRERA, JUAN CARLOS COCA MENESES, JAVIER ALBERDI NAVARRO and, JOSE MANUEL AGUIRRE URIZAR Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a clinicopathologic entity that affects young patients, which
ABSTRACTS
e29
often involves the anterior gingiva of the upper maxillary. Its origin is controversial, and neither infectious nor hormonal factors have been recognized. Clinically, it appears as an irregular papillary and reddish mass. We present a series of 10 cases, 5 women and 5 men, whose mean age was 13 years. We analyze their main clinical and histologic characteristics, as well as their immunochemical profile (CK14, CK17, CK19, CD3, CD20, S100, VEGFa, and ki-67), with the aim of explaining its origin and possible etiopathogenesis. Based on obtained data, the results show that LJSGH is not an epuliform lesion of a reactive nature, but a specific clinicopathologic entity, strongly related to persistency of the junctional epithelium. This research was supported by a Research Group from UPV/EHU (PPG17/01).
FABRY DISEASE: ORAL FINDINGS AND POSSIBLE ASSOCIATION WITH AUTOIMMUNE DESQUAMATIVE GINGIVITIS. ADEMAR TAKAHAMA JUNIOR, GUILHERME LUCIANO DA SILVA, HELITON GUSTAVO DE LIMA and, FABIO AUGUSTO ITO Fabry disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme a-galactosidase A. We report a case of a 55-year-old woman, with previous diagnosis of Fabry disease that was referred complaining of pain in the gingiva for about 1 year. The physical examination revealed short fingers, angiokeratomas in the neck, fissured tongue and desquamative gingivitis. An incisional biopsy was performed in the gingival lesions and the histopathologic analysis revealed a subepithelial blister, compatible with the diagnosis of mucous membrane pemphigoid. A topical corticosteroid therapy was instituted associated with conventional periodontal treatment. After 3 weeks, all areas of erythema or ulceration were healed, and the symptoms had disappeared. Fabry disease is a rare disorder with a few cases of oral abnormalities described. A high incidence of autoantibodies has been reported in patients with Fabry disease, which may explain the development of the desquamative gingivitis condition.
VASCULAR EXTENSION OF PERIPHERAL GIANT CELL LESION: A CASE REPORT WITH IMMUNOHISTOCHEMICAL ANALYSIS. e STEPHANY PIMENTA CARVALHO, RICARDO NATA FONSECA SILVA, WILSON JOSE MARIANO JUNIOR, SARA CRISTINA DE ARAUJO, THAIS LANUSSE MELGACO, ¸ NADIA DO LAGO COSTA and, ENEIDA FRANCO VENCIO Peripheral giant cell lesions shares microscopic similarities to other entities and their origin remains unclear. A 47-year-old woman was referred for management of a painful swelling in the canine region with recent history of tooth removal. A slight asymmetry in the upper lip was detected. Intraoral exam revealed a lesion that appeared as a purplish-red nodule, pediculate on the anterior right alveolar crest, and associated with an unstable dental prosthesis. Superficial bone resorption was detected. The lesion was curetted after excision biopsy. Microscopically, an ulcerative, nonencapsulated lesion composed of densely cellular lobules of round mononuclear cells, prominent multinucleated giant cells (MGCs), and hemorrhage was surrounded by fibrous tissue. Apoptotic MCGs were also seen. Interestingly, vessels in the periphery exhibited transendothelial migration of MGCs were positive for matrix metallopeptidase 9 (MMP-9) and
ABSTRACTS
OOOO January 2020
e30
macrophage fusion marker CD44. Neovascularization was detected within cellular lobules. Serum tests were normal. Clinical significance of vascular extension must be further clarified. No recurrence has occurred after 1 year.
VASCULAR MALFORMATION ASSOCIATED WITH NUMEROUS PHLEBOLITHS: A CASE OF DIFFICULT DIAGNOSIS. HENRIQUE BEMFICA DE FARIA FREITAS, LUCIANA FONSECA, TULIO NAVARRO, GIOVANNA RIBEIRO SOUTO, HERMINIA MARQUES CAPISTRANO, PAULO EDUARDO ALENCAR DE SOUZA and, SORAYA DE MATTOS CAMARGO GROSSMANN A 65-year-old man was referred to our service presenting with an atypical radiograph. During the anamnesis, no significant history was reported. In the intraoral exam, a blue-colored tumor with imprecise borders and irregular surface that was easily compressible and located in the basal regions, dorsum, and lingual belly of the left side was observed. Panoramic radiographic was performed again and revealed multiple ovoid and rounded areas, radiopaque, and well delineated on the left side, with an extraosseous location. A cystlike, unilocular, radiolucent defect was observed in the mandible. The diagnostic hypotheses included vascular malformation associated with phlebolith, infectious diseases associated with metastatic calcifications, and bone diseases. The test for a vascular lesion was performed. The diagnosis was vascular malformation associated with numerous phleboliths. The patient was referred to a hospital. The patient is under follow-up care and has experienced an increase in the number of phleboliths (after tooth extraction).
RESECTION OF A LARGE AMELOBLASTOMA: A CASE REPORT. AMANDA LIMA DE OLIVEIRA, ELIZABETH GOMES DA COSTA, VALBER BARBOSA MARTINS, MARCELO VINICIUS OLIVEIRA, TATIANA NAYARA LIBORIO KIMURA, DIRCEU VIRGOLINO DE OLIVEIRA and, GUSTAVO CAVALCANTI DE ALBUQUERQUE
TENORIO, NATHALIA TUANY DUARTE, MARINA TUMA, ROSANA SAINT CLAIR, KAREM LOPEZ MAUES ORTEGA and, MARINA GALLOTTINI A 54-year-old white female patient presented with bilateral angular cheilitis and several painful ulcerated oral lesions, 11 years after kidney transplantation. The lesions affected the buccal mucosa, the soft palate, and dorsum of the tongue for 8 months. Her current immunosuppressive regimen includes mycophenolate mofetil, tacrolimus, and prednisone. Periodic acidSchiff (PAS) exfoliative cytology was positive for Candida species. An incisional biopsy was performed on the tongue lesion and the histopathologic examination revealed intense mixed inflammatory infiltrate in the connective tissue. Serologic tests excluded cytomegalovirus and herpes simplex infection. Thus, the diagnosis of oral candidiasis and ulcers associated with mycophenolate mofetil was established. Local therapy with antifungal and corticosteroid agents healed the lesions in buccal mucosa and soft palate. The tongue lesion did not respond to therapy. Buccal mucosa lesions recurred after a follow-up period of 1 month. The patient was referred to the nephrologist to evaluate for the possibility of changing the immunosuppressive therapeutic regimen.
MANAGEMENT OF PATIENTS WITH CANCER USING ANTIRESORPTIVE AND ANTIANGIOGENIC MEDICATIONS. JULIANA L SCHUSSEL, VITOR HUGO C FERREIRA, ARISTILIA P T KEMP, JOANA VENDRUSCOLO, ROBERTA T STRAMANDINOLI-ZANICOTTI and, LAURINDO M SASSI The increasing success of antiresorptive and antiangiogenic drugs in cancer treatment has significantly increased the risks of medication-related osteonecrosis of the jaw. In addition to bisphosphonates, monoclonal antibodies have often been associated with this serious complication. The objective is to report the experience of the creation of an outpatient clinic for the treatment and prevention of osteonecrosis of the jaws at a public reference hospital in oncology in the south of Brazil. Our experience has shown that most patients do not receive fundamental guidelines regarding the contraindications of dental treatment in the use of these medications. Most patients are at high risk for the development of osteonecrosis such as generalized periodontal disease, decayed teeth, and presence of residual roots. In general, the patients have metastatic disease with a reserved prognosis and each case should be evaluated individually with regard to the preventive or curative management for the disease.
Ameloblastoma is an odontogenic tumor that accounts for 1% of all facial tumors, is characterized by slow and painless growth, and is often diagnosed due to local volume increase or by routine radiography. A 34-year-old female patient attended the surgery service, reporting pain, dysphagia, dysphonia, and increased right hemiface volume for 10 years. Clinical examination revealed a large bulge in the right mandibular region, with firm consistency and palpation. Oral and lingual bulging caused tongue detachment, dental dislocation, and trauma in the lesion. Computed tomography revealed multilocular areas, bone expansion, and extension of the lesion to the contralateral molar region. An incisional biopsy was performed, which was diagnosed as a multicystic ameloblastoma with a plexiform pattern. The patient underwent immediate reconstruction of the area, using a customized acrylic resin prosthesis with a reconstruction plate 2.4. The patient is currently in the postoperative follow-up period, free of pain and rehabilitated with a total prosthesis.
SURGICAL MANAGEMENT OF MANDIBULAR ODONTOGENIC MYXOMA: A CASE REPORT. FELIPE IGNACIO FUENTES e NIGA, ZU LUIS MARTIN CASTRO HERRERA, RODRIGO GUTIERREZ ANDRES DIAZ, MAXIMILIANO ANDRES e MUNOZ REPPETO and, ANA LUISA ALARCON ARRATIA
EXTENSIVE ULCERATIONS ASSOCIATED WITH THE USE OF MYCOPHENOLATE MOFETIL IN A PATIENT WITH HISTORY OF RENAL TRANSPLANT. JEFFERSON DA
Odontogenic myxoma is a locally aggressive benign odontogenic tumor that mainly affects women. It occurs commonly in the mandible, being asymptomatic and slow growing. A male patient, 52 years old, was diagnosed with odontogenic myxoma. He presented with a painless swelling in the right
ROCHA
MELKERSSON-ROSENTHAL SYNDROME: A CASE REPORT. LAUREN FRENZEL SCHUCH, FELIPE PAIVA FONSECA, EDUARDO MORATO DE OLIVEIRA, JOSE ALCIDES ALMEIDA DE ARRUDA, PATRICIA CARLOS CALDEIRA and, MARIA CASSIA FERREIRA DE AGUIAR A 20-year-old white man was referred to the oral medicine clinic, complaining of an asymptomatic swelling in the upper lip lasting for around 2 years. His medical history included stressinduced gastritis, bronchitis, allergic rhinitis, and episodes of facial paralysis. The extraoral examination showed a large and diffuse swelling affecting the upper lip vermillion and labial mucosa causing facial asymmetry. The lesion was nonpitting, had a rubbery consistency, and presented with a normal temperature. The vermillion border was dried and stretched, with no ulceration. The intraoral examination revealed deep grooves and fissures on the tongue dorsum. A previous biopsy of the lip showed a chronic inflammatory area. Based on the history and clinical features, the diagnosis of Melkersson-Rosenthal syndrome was made. The patient is under treatment with intralesional infiltration of triamcinolone acetonide in the upper lip. Moreover, he was referred for a physician to investigate a possible intestinal involvement. Support: FAPEMIG.
CLINICOPATHOLOGIC AND IMMUNOHISTOCHEMICAL CHARACTERIZATION OF LOCALIZED JUVENILE SPONGIOTIC GINe GIVAL HYPERPLASIA. IRENE LAFUENTE IBANEZ DE e MENDOZA, JUAN PABLO MUNOZ ZAPATA, FERNANDO GARCIA HERRERA, JUAN CARLOS COCA MENESES, JAVIER ALBERDI NAVARRO and, JOSE MANUEL AGUIRRE URIZAR Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a clinicopathologic entity that affects young patients, which
ABSTRACTS
e29
often involves the anterior gingiva of the upper maxillary. Its origin is controversial, and neither infectious nor hormonal factors have been recognized. Clinically, it appears as an irregular papillary and reddish mass. We present a series of 10 cases, 5 women and 5 men, whose mean age was 13 years. We analyze their main clinical and histologic characteristics, as well as their immunochemical profile (CK14, CK17, CK19, CD3, CD20, S100, VEGFa, and ki-67), with the aim of explaining its origin and possible etiopathogenesis. Based on obtained data, the results show that LJSGH is not an epuliform lesion of a reactive nature, but a specific clinicopathologic entity, strongly related to persistency of the junctional epithelium. This research was supported by a Research Group from UPV/EHU (PPG17/01).
FABRY DISEASE: ORAL FINDINGS AND POSSIBLE ASSOCIATION WITH AUTOIMMUNE DESQUAMATIVE GINGIVITIS. ADEMAR TAKAHAMA JUNIOR, GUILHERME LUCIANO DA SILVA, HELITON GUSTAVO DE LIMA and, FABIO AUGUSTO ITO Fabry disease is an X-linked metabolic disease caused by the deficiency of the lysosomal enzyme a-galactosidase A. We report a case of a 55-year-old woman, with previous diagnosis of Fabry disease that was referred complaining of pain in the gingiva for about 1 year. The physical examination revealed short fingers, angiokeratomas in the neck, fissured tongue and desquamative gingivitis. An incisional biopsy was performed in the gingival lesions and the histopathologic analysis revealed a subepithelial blister, compatible with the diagnosis of mucous membrane pemphigoid. A topical corticosteroid therapy was instituted associated with conventional periodontal treatment. After 3 weeks, all areas of erythema or ulceration were healed, and the symptoms had disappeared. Fabry disease is a rare disorder with a few cases of oral abnormalities described. A high incidence of autoantibodies has been reported in patients with Fabry disease, which may explain the development of the desquamative gingivitis condition.
VASCULAR EXTENSION OF PERIPHERAL GIANT CELL LESION: A CASE REPORT WITH IMMUNOHISTOCHEMICAL ANALYSIS. e STEPHANY PIMENTA CARVALHO, RICARDO NATA FONSECA SILVA, WILSON JOSE MARIANO JUNIOR, SARA CRISTINA DE ARAUJO, THAIS LANUSSE MELGACO, ¸ NADIA DO LAGO COSTA and, ENEIDA FRANCO VENCIO Peripheral giant cell lesions shares microscopic similarities to other entities and their origin remains unclear. A 47-year-old woman was referred for management of a painful swelling in the canine region with recent history of tooth removal. A slight asymmetry in the upper lip was detected. Intraoral exam revealed a lesion that appeared as a purplish-red nodule, pediculate on the anterior right alveolar crest, and associated with an unstable dental prosthesis. Superficial bone resorption was detected. The lesion was curetted after excision biopsy. Microscopically, an ulcerative, nonencapsulated lesion composed of densely cellular lobules of round mononuclear cells, prominent multinucleated giant cells (MGCs), and hemorrhage was surrounded by fibrous tissue. Apoptotic MCGs were also seen. Interestingly, vessels in the periphery exhibited transendothelial migration of MGCs were positive for matrix metallopeptidase 9 (MMP-9) and
ABSTRACTS
OOOO January 2020
e30
macrophage fusion marker CD44. Neovascularization was detected within cellular lobules. Serum tests were normal. Clinical significance of vascular extension must be further clarified. No recurrence has occurred after 1 year.
VASCULAR MALFORMATION ASSOCIATED WITH NUMEROUS PHLEBOLITHS: A CASE OF DIFFICULT DIAGNOSIS. HENRIQUE BEMFICA DE FARIA FREITAS, LUCIANA FONSECA, TULIO NAVARRO, GIOVANNA RIBEIRO SOUTO, HERMINIA MARQUES CAPISTRANO, PAULO EDUARDO ALENCAR DE SOUZA and, SORAYA DE MATTOS CAMARGO GROSSMANN A 65-year-old man was referred to our service presenting with an atypical radiograph. During the anamnesis, no significant history was reported. In the intraoral exam, a blue-colored tumor with imprecise borders and irregular surface that was easily compressible and located in the basal regions, dorsum, and lingual belly of the left side was observed. Panoramic radiographic was performed again and revealed multiple ovoid and rounded areas, radiopaque, and well delineated on the left side, with an extraosseous location. A cystlike, unilocular, radiolucent defect was observed in the mandible. The diagnostic hypotheses included vascular malformation associated with phlebolith, infectious diseases associated with metastatic calcifications, and bone diseases. The test for a vascular lesion was performed. The diagnosis was vascular malformation associated with numerous phleboliths. The patient was referred to a hospital. The patient is under follow-up care and has experienced an increase in the number of phleboliths (after tooth extraction).
RESECTION OF A LARGE AMELOBLASTOMA: A CASE REPORT. AMANDA LIMA DE OLIVEIRA, ELIZABETH GOMES DA COSTA, VALBER BARBOSA MARTINS, MARCELO VINICIUS OLIVEIRA, TATIANA NAYARA LIBORIO KIMURA, DIRCEU VIRGOLINO DE OLIVEIRA and, GUSTAVO CAVALCANTI DE ALBUQUERQUE
TENORIO, NATHALIA TUANY DUARTE, MARINA TUMA, ROSANA SAINT CLAIR, KAREM LOPEZ MAUES ORTEGA and, MARINA GALLOTTINI A 54-year-old white female patient presented with bilateral angular cheilitis and several painful ulcerated oral lesions, 11 years after kidney transplantation. The lesions affected the buccal mucosa, the soft palate, and dorsum of the tongue for 8 months. Her current immunosuppressive regimen includes mycophenolate mofetil, tacrolimus, and prednisone. Periodic acidSchiff (PAS) exfoliative cytology was positive for Candida species. An incisional biopsy was performed on the tongue lesion and the histopathologic examination revealed intense mixed inflammatory infiltrate in the connective tissue. Serologic tests excluded cytomegalovirus and herpes simplex infection. Thus, the diagnosis of oral candidiasis and ulcers associated with mycophenolate mofetil was established. Local therapy with antifungal and corticosteroid agents healed the lesions in buccal mucosa and soft palate. The tongue lesion did not respond to therapy. Buccal mucosa lesions recurred after a follow-up period of 1 month. The patient was referred to the nephrologist to evaluate for the possibility of changing the immunosuppressive therapeutic regimen.
MANAGEMENT OF PATIENTS WITH CANCER USING ANTIRESORPTIVE AND ANTIANGIOGENIC MEDICATIONS. JULIANA L SCHUSSEL, VITOR HUGO C FERREIRA, ARISTILIA P T KEMP, JOANA VENDRUSCOLO, ROBERTA T STRAMANDINOLI-ZANICOTTI and, LAURINDO M SASSI The increasing success of antiresorptive and antiangiogenic drugs in cancer treatment has significantly increased the risks of medication-related osteonecrosis of the jaw. In addition to bisphosphonates, monoclonal antibodies have often been associated with this serious complication. The objective is to report the experience of the creation of an outpatient clinic for the treatment and prevention of osteonecrosis of the jaws at a public reference hospital in oncology in the south of Brazil. Our experience has shown that most patients do not receive fundamental guidelines regarding the contraindications of dental treatment in the use of these medications. Most patients are at high risk for the development of osteonecrosis such as generalized periodontal disease, decayed teeth, and presence of residual roots. In general, the patients have metastatic disease with a reserved prognosis and each case should be evaluated individually with regard to the preventive or curative management for the disease.
Ameloblastoma is an odontogenic tumor that accounts for 1% of all facial tumors, is characterized by slow and painless growth, and is often diagnosed due to local volume increase or by routine radiography. A 34-year-old female patient attended the surgery service, reporting pain, dysphagia, dysphonia, and increased right hemiface volume for 10 years. Clinical examination revealed a large bulge in the right mandibular region, with firm consistency and palpation. Oral and lingual bulging caused tongue detachment, dental dislocation, and trauma in the lesion. Computed tomography revealed multilocular areas, bone expansion, and extension of the lesion to the contralateral molar region. An incisional biopsy was performed, which was diagnosed as a multicystic ameloblastoma with a plexiform pattern. The patient underwent immediate reconstruction of the area, using a customized acrylic resin prosthesis with a reconstruction plate 2.4. The patient is currently in the postoperative follow-up period, free of pain and rehabilitated with a total prosthesis.
SURGICAL MANAGEMENT OF MANDIBULAR ODONTOGENIC MYXOMA: A CASE REPORT. FELIPE IGNACIO FUENTES e NIGA, ZU LUIS MARTIN CASTRO HERRERA, RODRIGO GUTIERREZ ANDRES DIAZ, MAXIMILIANO ANDRES e MUNOZ REPPETO and, ANA LUISA ALARCON ARRATIA
EXTENSIVE ULCERATIONS ASSOCIATED WITH THE USE OF MYCOPHENOLATE MOFETIL IN A PATIENT WITH HISTORY OF RENAL TRANSPLANT. JEFFERSON DA
Odontogenic myxoma is a locally aggressive benign odontogenic tumor that mainly affects women. It occurs commonly in the mandible, being asymptomatic and slow growing. A male patient, 52 years old, was diagnosed with odontogenic myxoma. He presented with a painless swelling in the right
ROCHA