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AGGRESSIVE IDIOPATHIC BILATERAL CENTRAL GIANT CELL GRANULOMA OF THE JAW: A CASE REPORT
OOOO Volume 129, Number 1 retromandibular region. Orthopantomography and cone beam computerized tomography revealed a mixed multiloculated osteolytic lesion in the right mandibular angle and ramus with expansion into cortical bone. A segmental mandibular resection with safety margins was done, and autologous vascular iliac crest graft was fixed with a plate for osteosynthesis. Clinical-radiographic control at 1 year showed preserved mandibular mobility, bone neoformation, and absence of recurrence. The absence of capsule facilitates the tumor infiltration and explains its high recurrence. For odontogenic myxomas of <3 cm, conservative surgical treatment is proposed, while for larger odontogenic myxomas, surgical resection with safety margins of at least 1 cm and immediate functional reconstruction are required.
AGGRESSIVE IDIOPATHIC BILATERAL CENTRAL GIANT CELL GRANULOMA OF THE JAW: A CASE REPORT. RODRIGO ANDRES GUTIERREZ DIAZ, LUIS MARTIN CASTRO HERRERA, e NIGA FELIPE IGNACIO FUENTES ZU and, JUAN PABLO AITKEN SAAVEDRA Central giant cell granuloma (GCCG) is a benign osteolytic proliferation with diverse clinical and radiologic behavior patterns, characterized by the presence of multinucleated giant cells in a vascular stroma. A 25-year-old man presented with bilateral swelling in the posterior mandibular region of 2-month duration with painful symptomatology. Intraoral exam showed bilateral expansion of the vestibular cortical bones in the mandibular retromolar region. Panoramic radiograph and computed tomography revealed extensive bilateral multilocular mandibular areas causing bilateral expansion of the vestibular cortical bones. The histopathologic examination showed benign fibroblasts matrix with variable number of giant cells and hemorrhagic content. Immunohistochemistry for CD-68 glycoprotein showed positive immunoreactivity. Biochemical examination showed no signs of hyperparathyroidism. Diagnosis of CGCG is a complex task, even more so when the clinical presentation is unusual. Currently, it is known that the occurrence of multiple lesions of CGCG is associated with different systemic diseases.
ORAL LEIOMYOMA: UNUSUAL CLINICAL MANIFESTATION OF A RARE LESION. ROGERIO JARDIM CALDAS, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MARIO JOSE e ROMANACH, FLAVIA CRISTINA ROSAS DE CARVALHO, DANIELLE CASTEX CONDE, HELITON SPINDOLA ANTUNES and, PAULO SERGIO DA SILVA SANTOS Oral leiomyoma is a benign smooth muscle neoplasm of rare incidence, described as an asymptomatic nodule. We report a case of solid leiomyoma with a distinctive clinical manifestation in the anterior tongue. A 46-year-old woman complained of pain in her tongue with impairment of chewing and speaking for 2 months. Clinically, she presented with a depression covered by a pink-colored smooth mucosa, also surrounded by whitish prominent borders. The lesion was firm measuring 7 mm. Incisional biopsy was performed. Histologic examination revealed a noncapsulated proliferation of spindle cells with pale, eosinophilic, and vacuolated cytoplasm containing elongated cigar-shaped nuclei, which were organized in sweeping fascicles intermingled with muscle tissue, blood vessels, and inflammatory infiltrate. No evidence of cellular atypia was found. Tumor cells were strongly marked with muscle-
ABSTRACTS
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specific actin antibody, but negative for S-100 protein. The final diagnosis was leiomyoma. After 3 months of complete excision, no pain or signs of recurrence were noted.
SOLITARY INFANTILE MYOFIBROMA OF THE MANDIBLE IN A 2-YEAR-OLD CHILD: DIAGNOSIS AND TREATMENT OF A RARE LESION. VICTOR MONTALLI, FABRICIO PASSADOR, ROGERIO JORGE, ANTONIO AUGUSTO CAMPANHA, ALBINA ALTEMANI, PAULO DE CAMARGO MORAES and, VERA CAVALCANTI DE ARAUJO A 2-year-old male patient came to our service with the complaint of swelling located in the left side of the lower jaw. There was a history of trauma 3 months prior to the lesion formation. The swelling was initially noticed as a small nodule, which increased in size gradually. On palpation, the swelling was well localized, firm, nonmobile, 3 £ 3 cm in diameter, nontender, fixed to the underlying bone, and nonadherent to the superficial skin. No submandibular lymphadenopathy was noted. Computed tomography scan of the jaws with a 3-dimensional reconstruction image showed the presence of a soft tissue lesion with bone erosion of the inferior aspect of the left side of the body of the mandible. Histologically, a typical biphasic cellular arrangement was noted. Immunohistochemical markers have been useful for the definitive diagnosis of this uncommon neoplasm. The clinical, radiologic, histologic and immunohistochemical aspects corroborate the diagnosis of infantile myofibroma.
SURGICAL CONSERVATIVE TREATMENT OF AMELOBLASTIC FIBRODENTINOMA. GUSTAVO LUIZ ALKMIN PAIVA, PABLO e MORANDO, AGUSTIN VARGAS, FERNANDO SIMOES ALAN ROGER DOS SANTOS SILVA, GUSTAVO GROTHE MACHADO and, ANDRE CAROLI ROCHA Although controversial, the World Health Organization has recently categorized ameloblastic fibrodentinoma (AFD) as part of the spectrum of odontomas, pointing out that it may be a “developing odontoma.” The aim of this presentation is to report the case of a 9-year-old girl with a painless swelling in the posterior right mandible. Intraoral examination revealed a firm and slightly tender swelling on palpation. Panoramic radiograph showed a massive well-defined radiolucency affecting the mandibular body and ascending ramus presenting the so-called "soap bubble pattern" and root resorption. The diagnosis of AFD was provided by incisional biopsy. Primary treatment was performed by an intraoral approach and conservative surgical excision. After 9 months of treatment and follow-up, a discreet radiolucency with sclerotic borders was detected near the condylar neck and managed by another conservative surgery via retromandibular approach. No recurrence was noticed after a 3 years of follow-up.
OLIGOSYMPTOMATIC FORM OF MELKERSSON-ROSENTHAL SYNDROME: A CASE REPORT. JULIANA PORTES DE OLIVEIRA, e NEZ THAYLLA NU AMIN DICK, DANIELLE CASTEX CONDE, ELIANE PEDRA DIAS, KARIN GON¸CALVES CUNHA, ARLEY SILVA JUNIOR and, ADRIANNA MILAGRES The Melkersson-Rosenthal syndrome is characterized by the presence of the classic triad: orofacial granulomatosis, facial
AGGRESSIVE IDIOPATHIC BILATERAL CENTRAL GIANT CELL GRANULOMA OF THE JAW: A CASE REPORT. RODRIGO ANDRES GUTIERREZ DIAZ, LUIS MARTIN CASTRO HERRERA, e NIGA FELIPE IGNACIO FUENTES ZU and, JUAN PABLO AITKEN SAAVEDRA Central giant cell granuloma (GCCG) is a benign osteolytic proliferation with diverse clinical and radiologic behavior patterns, characterized by the presence of multinucleated giant cells in a vascular stroma. A 25-year-old man presented with bilateral swelling in the posterior mandibular region of 2-month duration with painful symptomatology. Intraoral exam showed bilateral expansion of the vestibular cortical bones in the mandibular retromolar region. Panoramic radiograph and computed tomography revealed extensive bilateral multilocular mandibular areas causing bilateral expansion of the vestibular cortical bones. The histopathologic examination showed benign fibroblasts matrix with variable number of giant cells and hemorrhagic content. Immunohistochemistry for CD-68 glycoprotein showed positive immunoreactivity. Biochemical examination showed no signs of hyperparathyroidism. Diagnosis of CGCG is a complex task, even more so when the clinical presentation is unusual. Currently, it is known that the occurrence of multiple lesions of CGCG is associated with different systemic diseases.
ORAL LEIOMYOMA: UNUSUAL CLINICAL MANIFESTATION OF A RARE LESION. ROGERIO JARDIM CALDAS, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MARIO JOSE e ROMANACH, FLAVIA CRISTINA ROSAS DE CARVALHO, DANIELLE CASTEX CONDE, HELITON SPINDOLA ANTUNES and, PAULO SERGIO DA SILVA SANTOS Oral leiomyoma is a benign smooth muscle neoplasm of rare incidence, described as an asymptomatic nodule. We report a case of solid leiomyoma with a distinctive clinical manifestation in the anterior tongue. A 46-year-old woman complained of pain in her tongue with impairment of chewing and speaking for 2 months. Clinically, she presented with a depression covered by a pink-colored smooth mucosa, also surrounded by whitish prominent borders. The lesion was firm measuring 7 mm. Incisional biopsy was performed. Histologic examination revealed a noncapsulated proliferation of spindle cells with pale, eosinophilic, and vacuolated cytoplasm containing elongated cigar-shaped nuclei, which were organized in sweeping fascicles intermingled with muscle tissue, blood vessels, and inflammatory infiltrate. No evidence of cellular atypia was found. Tumor cells were strongly marked with muscle-
ABSTRACTS
e31
specific actin antibody, but negative for S-100 protein. The final diagnosis was leiomyoma. After 3 months of complete excision, no pain or signs of recurrence were noted.
SOLITARY INFANTILE MYOFIBROMA OF THE MANDIBLE IN A 2-YEAR-OLD CHILD: DIAGNOSIS AND TREATMENT OF A RARE LESION. VICTOR MONTALLI, FABRICIO PASSADOR, ROGERIO JORGE, ANTONIO AUGUSTO CAMPANHA, ALBINA ALTEMANI, PAULO DE CAMARGO MORAES and, VERA CAVALCANTI DE ARAUJO A 2-year-old male patient came to our service with the complaint of swelling located in the left side of the lower jaw. There was a history of trauma 3 months prior to the lesion formation. The swelling was initially noticed as a small nodule, which increased in size gradually. On palpation, the swelling was well localized, firm, nonmobile, 3 £ 3 cm in diameter, nontender, fixed to the underlying bone, and nonadherent to the superficial skin. No submandibular lymphadenopathy was noted. Computed tomography scan of the jaws with a 3-dimensional reconstruction image showed the presence of a soft tissue lesion with bone erosion of the inferior aspect of the left side of the body of the mandible. Histologically, a typical biphasic cellular arrangement was noted. Immunohistochemical markers have been useful for the definitive diagnosis of this uncommon neoplasm. The clinical, radiologic, histologic and immunohistochemical aspects corroborate the diagnosis of infantile myofibroma.
SURGICAL CONSERVATIVE TREATMENT OF AMELOBLASTIC FIBRODENTINOMA. GUSTAVO LUIZ ALKMIN PAIVA, PABLO e MORANDO, AGUSTIN VARGAS, FERNANDO SIMOES ALAN ROGER DOS SANTOS SILVA, GUSTAVO GROTHE MACHADO and, ANDRE CAROLI ROCHA Although controversial, the World Health Organization has recently categorized ameloblastic fibrodentinoma (AFD) as part of the spectrum of odontomas, pointing out that it may be a “developing odontoma.” The aim of this presentation is to report the case of a 9-year-old girl with a painless swelling in the posterior right mandible. Intraoral examination revealed a firm and slightly tender swelling on palpation. Panoramic radiograph showed a massive well-defined radiolucency affecting the mandibular body and ascending ramus presenting the so-called "soap bubble pattern" and root resorption. The diagnosis of AFD was provided by incisional biopsy. Primary treatment was performed by an intraoral approach and conservative surgical excision. After 9 months of treatment and follow-up, a discreet radiolucency with sclerotic borders was detected near the condylar neck and managed by another conservative surgery via retromandibular approach. No recurrence was noticed after a 3 years of follow-up.
OLIGOSYMPTOMATIC FORM OF MELKERSSON-ROSENTHAL SYNDROME: A CASE REPORT. JULIANA PORTES DE OLIVEIRA, e NEZ THAYLLA NU AMIN DICK, DANIELLE CASTEX CONDE, ELIANE PEDRA DIAS, KARIN GON¸CALVES CUNHA, ARLEY SILVA JUNIOR and, ADRIANNA MILAGRES The Melkersson-Rosenthal syndrome is characterized by the presence of the classic triad: orofacial granulomatosis, facial