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A SYNCHRONOUS PARACOCCIDIOIDOMYCOSIS AND SQUAMOUS CELL CARCINOMA: A CASE REPORT
ABSTRACTS
e48
BORGES ALVES, VALERIA SOUZA FREITAS, JENER GONCALVES ¸ DE FARIAS, MARIA EMILIA SANTOS PEREIRA RAMOS, BRUNO CUNHA PIRES and, MARCIO CAMPOS OLIVEIRA Papillary squamous cell carcinoma is uncommon in the oral cavity and when it occurs, it usually presents as a single ulcerative-vegetative lesion. We report a case of a 73-year-old man who sought care for inflammation in the mouth for 3 months and asked for a biopsy. This patient was edentulous, without comorbidities, and without history of smoking or alcohol use. On examination, left lymph node enlargement (level 1B) measuring 4 £ 3 cm and 2 ulcerated lesions, 1 in the retromolar region and other at the alveolar ridge and floor of the mouth interface, both on left side, were identified. Incisional biopsies and histopathologic examination were performed, the first lesion was diagnosed as carcinoma in situ and the second one as papillary squamous cell carcinoma, represented by the proliferation of malignant cells in basaloid morphology and arranged in papillary projections. The tumor was classified as T3 N2 aM0, stage III-B and the patient underwent chemotherapy and radiotherapy, along with close monitoring by a team of specialists.
MASSIVE EXTRUSION OF CALCIUM HYDROXIDE PASTE CONTAINING BARIUM SULFATE DURING ENDODONTIC TREAT ^ CA, NATALIA MENT. JESSICA MONTENEGRO FONSE RANGEL PALMIER, GLEYSON KLEBER DO AMARALSILVA, LADY PAOLA ARISTIZABAL ARBOLEDA, PABLO AGUSTIN VARGAS, MARCIO AJUDARTE LOPES and, ALAN ROGER SANTOS-SILVA A 31-year-old woman was referred for evaluation of persistent numbness on the left side of the lower lip, which began during endodontic treatment of the left mandibular first molar. Imaging exams showed a large amount of a radiopaque or hyperdense throughout the left mandibular body in close proximity to the lower alveolar nerve. Histologic analyses identified birefringent crystalloid foreign bodies widespread through soft tissue and bone leading to an inflammatory foreign body reaction, eventually demonstrated to be rich in barium and sulfur by the means of scanning electron microscopy coupled with energy dispersive x-ray detection. This scenario led to the diagnosis of lower alveolar nerve injury due to accidental extrusion of intracanal dressing material composed of calcium hydroxide (CaOH2) paste incorporated with BaSO4. The paresthesia was treated with the combination of citoneurin and prednisone, but no improvement in nerve sensitivity was noticed after 12 months of follow-up examination.
THE RISK OF FACIAL FILLINGS DURING AESTHETIC PROCEDURES: A CASE REPORT. ELIANDRO DE SOUZA FREITAS, DANIEL FROTA DE SOUZA, LARISSA LUZIA DA SILVA ARAUJO and, TIAGO NOVAES PINHEIRO Facial cosmetic procedures are increasing in demand for plastic surgeons and dental professionals nowadays. This study highlights some of the risks related to such procedures, reporting a case of a painful, fluctuating nodule in the midline of the vestibular sulcus, extending to the upper lip. The patient, a 32-yearold man, showed a normochromic swelling of the affected region with 2 years’ history of evolution. The patient stated that he
OOOO January 2020 underwent a rhinoplasty procedure 5 years earlier. An excisional biopsy was performed and the lesion was diagnosed as a foreign body granuloma caused by methylmethacrylate. A wide morphologic investigation with polarized light and fluorescence microscopy was applied in order to confirm the filling material. Multiple splintered synthetic spherules were noted; these spherules were surrounded by foreign body giant cells circumscribed by a thin fibrous capsule and infiltrated by lymphocytes. The clinical follow-up was uneventful after 7 months.
LOW-GRADE OSTEOSARCOMA OF THE MANDIBLE: A CASE REPORT. RUBIA ^ TEODORO STUEPP, LISIANE CANDIDO and, ROGERIO GONDAK Osteosarcoma of the jaws is a rare and aggressive malignant mesenchymal tumor characterized by the formation of osteoid tissue. A 32-year-old male patient reported a complaint of a painless, slow swelling on the right side of the mandible and paresthesia of the lower lip. Intraoral examination revealed a smooth nodular mass in the lower right alveolar ridge and dental mobility of the lower second molar. Computed tomography showed a mixed density lesion of the right body of the mandible with irregular margins and cortical erosions. There was a widened periodontal ligament space of the first and second lower molars. After incisional biopsy, the histologic sections revealed areas of mineralization and proliferation of stellate and spindle cells in a myxoid matrix. The cells showed moderate nuclear pleomorphism and minimal mitotic activity. A diagnosis of a low-grade osteosarcoma was given. The patient underwent surgical resection. There have been no signs of recurrence after 2 years of follow-up care.
CALCIFYING EPITHELIAL ODONTOGENIC TUMOR: A CASE REPORT. RUBIA TEODORO STUEPP, ANDRE LUIS BIM, FILIPE ^ S MEURER and, MODOLO SIQUEIRA, MARIA INE ROGERIO GONDAK Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign odontogenic neoplasm with aggressive biologic behavior. A 29-year-old woman presented at the university hospital with a complaint of a painless swelling in the right mandibular region that was fibrous in consistency on palpation. Computed tomography (CT) revealed a well-defined radiolucency (3.5 £ 2.8 £ 2.0 cm) in the mandibular body, permeated by foci of calcification, associated with the crown of an unerupted molar. Cortical expansion and focal areas of perforation were identified. Based on CT, the differential diagnosis included: calcifying cystic odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibro-odontoma and adenomatoid odontogenic tumor. The microscopic examination revealed sheets of polyhedral, neoplastic, odontogenic epithelial cells with prominent cellular outlines and intercellular bridges. Calcified areas and eosinophilic amyloidlike material were identified. The diagnosis of CEOT was given. Mandibular segmental resection and reconstruction with titanium plate was performed with no recurrence after 3 years’ follow-up.
A SYNCHRONOUS PARACOCCIDIOIDOMYCOSIS AND SQUAMOUS CELL CARCINOMA: A CASE REPORT. PATRICIA DE SOUSA FILGUEIRAS, FABRICIO PASSADOR-SANTOS, VICTOR ANGELO MARTINS MONTALLI, ARTHUR
OOOO Volume 129, Number 1 COLUSSI, HENRIETTE DE TOLEDO LAGO, RICARDO RAITZ and, REGINA GARCIA DORTA A 51-year-old white man presented with a 3-month history of oral pain. He was edentulous and his intraoral examination revealed a mulberrylike granulomatous lesion on the right superior alveolar ridge and 2 adjacent ulcerations on the right upper lip. Biopsies of the oral lesions were performed revealing a granulomatous inflammatory response positive for Paraccocidioides brasiliensis. Systemic investigation showed pulmonary involvement. He was treated with itraconazole. A synchronous actinic cheilitis was detected. After 12 months of follow-up, a persistent white, rough, scaly area developed on the left vermilion lower lip and an incisional biopsy was performed. Histopathologic analysis demonstrated solar elastosis and superficially invasive squamous cell carcinoma. The patient was referred to a head and neck surgeon and vermilionectomy was the treatment employed. No recurrence was observed after a 7-month follow-up. This case report emphasizes the importance of global clinical evaluation and patient follow-up aiming at early oral lesion diagnosis.
ABSTRACTS
e49
ORTHOKERATINIZED ODONTOGENIC CYST IN AN ADOLESCENT: A CASE REPORT. GEORGIA RIBEIRO MARTINI, BUBACAR JUSSARA MARIA GONCALVES, EMBALO, ¸ PRISCILA SELL, EDUARDO MEURER, ELENA RIET CORREA RIVERO and, ROGERIO OLIVEIRA GONDAK Orthokeratinized odontogenic cyst (OOC) is an uncommon developmental cyst arising from the cell rests of the dental lamina. This report describes a case of OOC involving the right posterior mandible in a 14-year-old female patient. On clinical examination, a painless swelling on right side of face was noted. Panoramic radiography revealed a well-defined multilocular lesion located in the posterior mandible. Provisional diagnosis of odontogenic keratocyst was suggested. An incisional biopsy was performed with marsupialization, and the result was inconclusive. One month later, surgical enucleation of the lesion was performed and sent for histopathologic examination. A diagnosis of OOC was made. Currently the patient is under radiographic observation and without recurrence.
LINGUAL DERMOID CYST: A CASE REPORT WITH HISTOPATHOLOGIC CORRELATION. ^ ELIS ANGELA BATISTELLA, JUSSARA MARIA GONCALVES, ¸ ETIENE MUNHOZ and, ROGERIO GONDAK
TUMOR-ASSOCIATED DENTINOGENIC GHOST CELLS WITH COMPOUND ODONTOMA IN A PEDIATRIC PATIENT: A CASE REPORT. PAMELA OLIVEIRA SANTOS, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO
Dermoid cyst (DC) is an uncommon developmental cystic malformation, lined by epidermislike epithelium containing dermal annexes in the cystic wall. A 76-year-old woman presented with a painless submucosal nodule in the ventral surface of the tongue, right side, measuring 1 £ 1 cm, yellowish in color, with a soft consistency on palpation. A previous aspiration of the lesion revealed clear liquid contents. The patient, who has noticed the lesion in the past 15 days, reported no alcohol or smoking habits. DC, lipoma, and ranula were considered as possible clinical diagnoses. After biopsy, the microscopic examination revealed fragments of cystic capsule lined by a thin, stratified squamous epithelium. The cystic capsule was composed of dense fibrous connective tissue, and the cystic content exhibited an abundant amount of keratin. Minor salivary glands, nerve bundles, and muscular tissue completed the histopathologic diagnosis of a dermoid cyst. The patient remains under follow-up examination.
The present work aims to report a case of dentinogenic ghost cell tumor (DGCT) associated with compound odontoma (CO). An 8-year-old patient was referred to the oral medicine discipline presenting with dental retention. Computerized tomography (CT) scan revealed a well-defined unilocular radiolucent lesion involving an irregular mass, associated with an unerupted permanent upper central incisor (tooth 21). Excisional biopsy was performed. Histopathologic analysis revealed enamel matrix, loose connective tissue resembling dental pulp, enveloped in a fibrous capsule, associated with odontogenic epithelium sheets presenting aberrant keratinization, and containing abundant dentinoid and osteoid material. Based on clinical and histopathologic findings, the final diagnosis was DGCT and CO. Since spontaneous eruption failed to occur within the expected time frame (6 months’ follow-up), surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. Up to now, the patient is under follow-up care in the orthodontics clinic.
€ ORAL MANIFESTATION OF SJOGREN SYNDROME: A REPORT OF 2 CASES. GEORGIA RIBEIRO MARTINI, BUBACAR EMBALO, JUSSARA MARIA GON¸CALVES, MELISSA ALKMIN, CLAUDIA RAQUEL SEVEGNANI and, ROGERIO GONDAK
INTRANEURAL PERINEURIOMA IN THE LOWER LIP MIMICKING MUCOCELE. PAMELA OLIVEIRA SANTOS, CRISTIANE CANTIGA DA SILVA and, TIAGO NOVAES PINHEIRO
Sjogren syndrome (SS) is a systemic autoimmune disease characterized by hypofunction of the salivary and lacrimal glands. The objective of this study is to report 2 clinical cases emphasizing the importance of labial salivary gland (LSG) biopsy for the diagnosis of SS. Both cases are of women with a mean age of 57 years and a history of oral and ocular dryness. LSG biopsy of each patient was performed and the histopathologic examination revealed focal lymphocytic sialadenitis. AntiSSA/SSB positivity followed by Schirmer testing and oral symptoms favored the SS diagnosis. Currently, the patients have been followed by a multidisciplinary team to control the oral and systemic manifestations of the disease.
Intraneural perineurioma is a rare lesion of the peripheral nervous system with unique ultrastructural features, and it is distinct from Schwann cell-derived entities (schwannoma and neurofibroma). The present case aims to report a lesion in the lower lip in a 33-year-old female patient. Clinical examination showed a nodular growth, sessile, and smooth surfaced from an undetermined etiology. Histopathologic examination revealed slender spindle cells, arranged in 2 fascicles, and focal areas showing a distinct storiform pattern, surrounding by histiocytes. Histopathologic investigation comprised of toluidine blue, Masson trichrome, and picrosirius red showed presence of mast cells, collagen organization, and type III prevalence. Based on clinical
e48
BORGES ALVES, VALERIA SOUZA FREITAS, JENER GONCALVES ¸ DE FARIAS, MARIA EMILIA SANTOS PEREIRA RAMOS, BRUNO CUNHA PIRES and, MARCIO CAMPOS OLIVEIRA Papillary squamous cell carcinoma is uncommon in the oral cavity and when it occurs, it usually presents as a single ulcerative-vegetative lesion. We report a case of a 73-year-old man who sought care for inflammation in the mouth for 3 months and asked for a biopsy. This patient was edentulous, without comorbidities, and without history of smoking or alcohol use. On examination, left lymph node enlargement (level 1B) measuring 4 £ 3 cm and 2 ulcerated lesions, 1 in the retromolar region and other at the alveolar ridge and floor of the mouth interface, both on left side, were identified. Incisional biopsies and histopathologic examination were performed, the first lesion was diagnosed as carcinoma in situ and the second one as papillary squamous cell carcinoma, represented by the proliferation of malignant cells in basaloid morphology and arranged in papillary projections. The tumor was classified as T3 N2 aM0, stage III-B and the patient underwent chemotherapy and radiotherapy, along with close monitoring by a team of specialists.
MASSIVE EXTRUSION OF CALCIUM HYDROXIDE PASTE CONTAINING BARIUM SULFATE DURING ENDODONTIC TREAT ^ CA, NATALIA MENT. JESSICA MONTENEGRO FONSE RANGEL PALMIER, GLEYSON KLEBER DO AMARALSILVA, LADY PAOLA ARISTIZABAL ARBOLEDA, PABLO AGUSTIN VARGAS, MARCIO AJUDARTE LOPES and, ALAN ROGER SANTOS-SILVA A 31-year-old woman was referred for evaluation of persistent numbness on the left side of the lower lip, which began during endodontic treatment of the left mandibular first molar. Imaging exams showed a large amount of a radiopaque or hyperdense throughout the left mandibular body in close proximity to the lower alveolar nerve. Histologic analyses identified birefringent crystalloid foreign bodies widespread through soft tissue and bone leading to an inflammatory foreign body reaction, eventually demonstrated to be rich in barium and sulfur by the means of scanning electron microscopy coupled with energy dispersive x-ray detection. This scenario led to the diagnosis of lower alveolar nerve injury due to accidental extrusion of intracanal dressing material composed of calcium hydroxide (CaOH2) paste incorporated with BaSO4. The paresthesia was treated with the combination of citoneurin and prednisone, but no improvement in nerve sensitivity was noticed after 12 months of follow-up examination.
THE RISK OF FACIAL FILLINGS DURING AESTHETIC PROCEDURES: A CASE REPORT. ELIANDRO DE SOUZA FREITAS, DANIEL FROTA DE SOUZA, LARISSA LUZIA DA SILVA ARAUJO and, TIAGO NOVAES PINHEIRO Facial cosmetic procedures are increasing in demand for plastic surgeons and dental professionals nowadays. This study highlights some of the risks related to such procedures, reporting a case of a painful, fluctuating nodule in the midline of the vestibular sulcus, extending to the upper lip. The patient, a 32-yearold man, showed a normochromic swelling of the affected region with 2 years’ history of evolution. The patient stated that he
OOOO January 2020 underwent a rhinoplasty procedure 5 years earlier. An excisional biopsy was performed and the lesion was diagnosed as a foreign body granuloma caused by methylmethacrylate. A wide morphologic investigation with polarized light and fluorescence microscopy was applied in order to confirm the filling material. Multiple splintered synthetic spherules were noted; these spherules were surrounded by foreign body giant cells circumscribed by a thin fibrous capsule and infiltrated by lymphocytes. The clinical follow-up was uneventful after 7 months.
LOW-GRADE OSTEOSARCOMA OF THE MANDIBLE: A CASE REPORT. RUBIA ^ TEODORO STUEPP, LISIANE CANDIDO and, ROGERIO GONDAK Osteosarcoma of the jaws is a rare and aggressive malignant mesenchymal tumor characterized by the formation of osteoid tissue. A 32-year-old male patient reported a complaint of a painless, slow swelling on the right side of the mandible and paresthesia of the lower lip. Intraoral examination revealed a smooth nodular mass in the lower right alveolar ridge and dental mobility of the lower second molar. Computed tomography showed a mixed density lesion of the right body of the mandible with irregular margins and cortical erosions. There was a widened periodontal ligament space of the first and second lower molars. After incisional biopsy, the histologic sections revealed areas of mineralization and proliferation of stellate and spindle cells in a myxoid matrix. The cells showed moderate nuclear pleomorphism and minimal mitotic activity. A diagnosis of a low-grade osteosarcoma was given. The patient underwent surgical resection. There have been no signs of recurrence after 2 years of follow-up care.
CALCIFYING EPITHELIAL ODONTOGENIC TUMOR: A CASE REPORT. RUBIA TEODORO STUEPP, ANDRE LUIS BIM, FILIPE ^ S MEURER and, MODOLO SIQUEIRA, MARIA INE ROGERIO GONDAK Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign odontogenic neoplasm with aggressive biologic behavior. A 29-year-old woman presented at the university hospital with a complaint of a painless swelling in the right mandibular region that was fibrous in consistency on palpation. Computed tomography (CT) revealed a well-defined radiolucency (3.5 £ 2.8 £ 2.0 cm) in the mandibular body, permeated by foci of calcification, associated with the crown of an unerupted molar. Cortical expansion and focal areas of perforation were identified. Based on CT, the differential diagnosis included: calcifying cystic odontogenic tumor, calcifying epithelial odontogenic tumor, ameloblastic fibro-odontoma and adenomatoid odontogenic tumor. The microscopic examination revealed sheets of polyhedral, neoplastic, odontogenic epithelial cells with prominent cellular outlines and intercellular bridges. Calcified areas and eosinophilic amyloidlike material were identified. The diagnosis of CEOT was given. Mandibular segmental resection and reconstruction with titanium plate was performed with no recurrence after 3 years’ follow-up.
A SYNCHRONOUS PARACOCCIDIOIDOMYCOSIS AND SQUAMOUS CELL CARCINOMA: A CASE REPORT. PATRICIA DE SOUSA FILGUEIRAS, FABRICIO PASSADOR-SANTOS, VICTOR ANGELO MARTINS MONTALLI, ARTHUR
OOOO Volume 129, Number 1 COLUSSI, HENRIETTE DE TOLEDO LAGO, RICARDO RAITZ and, REGINA GARCIA DORTA A 51-year-old white man presented with a 3-month history of oral pain. He was edentulous and his intraoral examination revealed a mulberrylike granulomatous lesion on the right superior alveolar ridge and 2 adjacent ulcerations on the right upper lip. Biopsies of the oral lesions were performed revealing a granulomatous inflammatory response positive for Paraccocidioides brasiliensis. Systemic investigation showed pulmonary involvement. He was treated with itraconazole. A synchronous actinic cheilitis was detected. After 12 months of follow-up, a persistent white, rough, scaly area developed on the left vermilion lower lip and an incisional biopsy was performed. Histopathologic analysis demonstrated solar elastosis and superficially invasive squamous cell carcinoma. The patient was referred to a head and neck surgeon and vermilionectomy was the treatment employed. No recurrence was observed after a 7-month follow-up. This case report emphasizes the importance of global clinical evaluation and patient follow-up aiming at early oral lesion diagnosis.
ABSTRACTS
e49
ORTHOKERATINIZED ODONTOGENIC CYST IN AN ADOLESCENT: A CASE REPORT. GEORGIA RIBEIRO MARTINI, BUBACAR JUSSARA MARIA GONCALVES, EMBALO, ¸ PRISCILA SELL, EDUARDO MEURER, ELENA RIET CORREA RIVERO and, ROGERIO OLIVEIRA GONDAK Orthokeratinized odontogenic cyst (OOC) is an uncommon developmental cyst arising from the cell rests of the dental lamina. This report describes a case of OOC involving the right posterior mandible in a 14-year-old female patient. On clinical examination, a painless swelling on right side of face was noted. Panoramic radiography revealed a well-defined multilocular lesion located in the posterior mandible. Provisional diagnosis of odontogenic keratocyst was suggested. An incisional biopsy was performed with marsupialization, and the result was inconclusive. One month later, surgical enucleation of the lesion was performed and sent for histopathologic examination. A diagnosis of OOC was made. Currently the patient is under radiographic observation and without recurrence.
LINGUAL DERMOID CYST: A CASE REPORT WITH HISTOPATHOLOGIC CORRELATION. ^ ELIS ANGELA BATISTELLA, JUSSARA MARIA GONCALVES, ¸ ETIENE MUNHOZ and, ROGERIO GONDAK
TUMOR-ASSOCIATED DENTINOGENIC GHOST CELLS WITH COMPOUND ODONTOMA IN A PEDIATRIC PATIENT: A CASE REPORT. PAMELA OLIVEIRA SANTOS, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO
Dermoid cyst (DC) is an uncommon developmental cystic malformation, lined by epidermislike epithelium containing dermal annexes in the cystic wall. A 76-year-old woman presented with a painless submucosal nodule in the ventral surface of the tongue, right side, measuring 1 £ 1 cm, yellowish in color, with a soft consistency on palpation. A previous aspiration of the lesion revealed clear liquid contents. The patient, who has noticed the lesion in the past 15 days, reported no alcohol or smoking habits. DC, lipoma, and ranula were considered as possible clinical diagnoses. After biopsy, the microscopic examination revealed fragments of cystic capsule lined by a thin, stratified squamous epithelium. The cystic capsule was composed of dense fibrous connective tissue, and the cystic content exhibited an abundant amount of keratin. Minor salivary glands, nerve bundles, and muscular tissue completed the histopathologic diagnosis of a dermoid cyst. The patient remains under follow-up examination.
The present work aims to report a case of dentinogenic ghost cell tumor (DGCT) associated with compound odontoma (CO). An 8-year-old patient was referred to the oral medicine discipline presenting with dental retention. Computerized tomography (CT) scan revealed a well-defined unilocular radiolucent lesion involving an irregular mass, associated with an unerupted permanent upper central incisor (tooth 21). Excisional biopsy was performed. Histopathologic analysis revealed enamel matrix, loose connective tissue resembling dental pulp, enveloped in a fibrous capsule, associated with odontogenic epithelium sheets presenting aberrant keratinization, and containing abundant dentinoid and osteoid material. Based on clinical and histopathologic findings, the final diagnosis was DGCT and CO. Since spontaneous eruption failed to occur within the expected time frame (6 months’ follow-up), surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. Up to now, the patient is under follow-up care in the orthodontics clinic.
€ ORAL MANIFESTATION OF SJOGREN SYNDROME: A REPORT OF 2 CASES. GEORGIA RIBEIRO MARTINI, BUBACAR EMBALO, JUSSARA MARIA GON¸CALVES, MELISSA ALKMIN, CLAUDIA RAQUEL SEVEGNANI and, ROGERIO GONDAK
INTRANEURAL PERINEURIOMA IN THE LOWER LIP MIMICKING MUCOCELE. PAMELA OLIVEIRA SANTOS, CRISTIANE CANTIGA DA SILVA and, TIAGO NOVAES PINHEIRO
Sjogren syndrome (SS) is a systemic autoimmune disease characterized by hypofunction of the salivary and lacrimal glands. The objective of this study is to report 2 clinical cases emphasizing the importance of labial salivary gland (LSG) biopsy for the diagnosis of SS. Both cases are of women with a mean age of 57 years and a history of oral and ocular dryness. LSG biopsy of each patient was performed and the histopathologic examination revealed focal lymphocytic sialadenitis. AntiSSA/SSB positivity followed by Schirmer testing and oral symptoms favored the SS diagnosis. Currently, the patients have been followed by a multidisciplinary team to control the oral and systemic manifestations of the disease.
Intraneural perineurioma is a rare lesion of the peripheral nervous system with unique ultrastructural features, and it is distinct from Schwann cell-derived entities (schwannoma and neurofibroma). The present case aims to report a lesion in the lower lip in a 33-year-old female patient. Clinical examination showed a nodular growth, sessile, and smooth surfaced from an undetermined etiology. Histopathologic examination revealed slender spindle cells, arranged in 2 fascicles, and focal areas showing a distinct storiform pattern, surrounding by histiocytes. Histopathologic investigation comprised of toluidine blue, Masson trichrome, and picrosirius red showed presence of mast cells, collagen organization, and type III prevalence. Based on clinical