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AN EXTENSIVE AND UNUSUAL PRESENTATION OF PYOGENIC GRANULOMA OF THE LOWER LIP
OOOO Volume 124, Number 2 A well-defined white patch in the left buccal mucosa was observed. Radiographic documentation revealed a radiopaque submucosal round object in the maxilla middle line. Excisional biopsy was performed in different sites of the injury. Specimens were identified separately and subjected to histopathologic examination. Histopathologic examination diagnosed: verrucous carcinoma, leukoplakia with mild dysplasia, and foreign body granuloma. The patient was referred to the local oncologic hospital for expansion of surgical margins and is in clinical follow-up for the last year.
CPP19 - THE USE OF INJECTABLE TRIAMCINOLONE IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS. MICHELLE DA SILVA SCALERCIO, NATHÁLIA DE ALMEIDA FREIRE, WAGNER CHAGAS, SARAH ANTERO, MARIA ELIZA BARBOSA RAMOS, ROSEMIRO DE MENEZES MACIEL, MÔNICA SIMÕES ISRAEL. Oral lichen planus (OLP) is a relatively common chronic disease of the mucous membranes that may have more transient cutaneous manifestations. It has a number of well-recognized clinical signs and a wide range of symptoms, ranging from none through mild discomfort to severe debilitating intra-oral erosions and ulceration. Efforts have been made in a continued searching for new therapies for symptomatic OLP; among them, an intralesional injection of triamcinolone acetonide (TA). This study aimed to evaluate the efficacy and safety of intralesional TA injection for ulcerative OLP in a black male patient, 64 years old, who attended the Oral Medicine Clinic complaining about painful lesions of erosive OLP. Intralesional TA injection in ulcerative OLP was effective and safe in achieving lesion and pain regression.
CPP20 - ORAL MANIFESTATIONS OF CHRONIC NEUTROPENIA: CASE REPORT. GABRIELA ALACARINI FARINA, STEFANIE THIEME PEROTTO, MARIA CRISTINA MUNERATO. Chronic neutropenia (CN) is a primary hematologic disease where neutrophil levels fall to very low amounts in 3 to 4 weeks. CN is characterized by mouth sores, fever, lymphadenopathy, malaise, diarrhea, and severe infections. A male patient, 59 years old, brown-colored, had recurrent episodes of painful mouth ulcers, fever, and diarrhea for 2 years’ duration. During the investigative process, inflammatory bowel diseases were discarded and the initial diagnosis was recurrent aphthous ulcerations. He was initially treated with 4 mg dexamethasone weekly for 6 months without improvement. Blood tests conducted over the past 3 months showed recurrent severe neutropenia that was associated with other parameters, and led to the diagnosis of CN. The patient was referred for hematologic evaluation to confirm the diagnosis, its correct management, as well as the most accurate research of his overall health, because this situation is commonly seen in cancer patients receiving chemotherapy or in patients with autoimmune diseases.
CPP21 - MACROSTOMIA IN ASSOCIATION WITH PRE-AURICULAR TAGS: A CASE REPORT. RODRIGO SOARES DE ANDRADE, RENATO ASSIS MACHADO, RICARDO DELLA COLETTA, EDMILSON MARTINS DE FREITAS, CARLA PATRÍCIA OLIVEIRA PARRELA, LUÍS ANTÔNIO DOS SANTOS, HERCILIO MARTELLI JUNIOR.
ABSTRACTS Abstracts e59 Macrostomia is a rare congenital anomaly with an incompletely described pathogenesis and several distinct non-syndromic phenotypes are associated. Macrostomia and pre-auricular tags can usually be correlated with syndromes, but in isolated cases are less common. Herein we report on a case of a young female patient presenting with macrostomia and pre-auricular tags isolated without syndromic association or other apparent causes. In anamnesis, the parents dismissed all possible pregnancy problems. The purpose of this study was to relate a clinical case of unilateral Tessier’s 7 cleft along with macrostomia and preauricular tags in a female patient. Significant alterations beyond macrostomia and pre-auricular tags were not found in ectoscopic tests, ultrasound, and intraoral physical examination. Although rare in occurrence, further studies are required to increase knowledge, leading to a more effective diagnosis and treatment of the patient.
CPP22 - DIAGNOSIS AND TREATMENT OF LARGE KERATOCYST ODONTOGENIC TUMOR INVADING THE RIGHT MAXILLARY SINUS. JÉSSICA BARROSO BARBOSA, LIONEY NOBRE CABRAL, MARCO TÚLLIO BRAZÃO-SILVA, TIAGO NOVAES PINHEIRO. Keratocyst odontogenic tumor (KCOT) is one of the most prevalent benign odontogenic tumors. Clinically, KCOT shows a more aggressive behavior and a high recurrence rate. Here in we present a case of KCOT found during orthodontic documentation in a melanoderma 18-year-old male patient. The patient was referred to the oral medicine service and clinical examination revealed right nasal obstruction. Computerized tomography scan revealed a large cystic lesion extending from the interdental area of teeth 12 and 13 filling two thirds of the right maxillary sinus. Puncture in the malar bone defect obtained 20 ml of bright yellowish material. Incisional biopsy with cystic decompression was performed and histopathologic examination confirmed the KCOT diagnosis. After 6 month complete enucleation of the remaining lesion was performed, followed by cauterization with Carnoy solution. After 18 months of clinical and tomographic follow-up, no recurrence was observed.
CPP23 - AN EXTENSIVE AND UNUSUAL PRESENTATION OF PYOGENIC GRANULOMA OF THE LOWER LIP. MARCELO BONIFÁCIO DA SILVA SAMPIERI, FILIPE NOBRE CHAVES, KARUZA MARIA ALVES PEREIRA, THÂMARA MANOELA MARINHO BEZERRA, FÁBIO WILDSON GURGEL COSTA, ANA PAULA NEGREIROS NUNES ALVES, MARIO ROGÉRIO LIMA MOTA. Pyogenic granuloma is a benign mucocutaneous lesion that occurs as a reactive inflammatory hyperplasia because of exuberant tissue response to local irritation or trauma. These lesions present as single nodule or sessile papule with smooth or lobulated surface and are red, elevated, and usually ulcerated. Herein we report on a 13-year-old male patient with a pedunculated, exophytic growth on the mucosal surface of the lower lip measuring about 2 cm 1 cm in diameter. The surface was covered by a yellowish white pseudomembrane with some areas of ulceration. Based on clinical features, a working diagnosis of pyogenic granuloma was given. The treatment of choice was excisional biopsy. Biopsy results showed areas of ulcerated stratified squamous keratinized epithelium with underlying granulation tissue. Numerous varied caliber of blood vessels were
ORAL AND MAXILLOFACIAL PATHOLOGY e60 Abstracts seen in the connective tissue, suggestive of pyogenic granuloma. There was no evidence of recurrence during the 6-month postoperative period.
CPP24 - MUCOEPIDERMOID CARCINOMA IN A YOUNG WOMAN: A CASE REPORT. TARSILA DE CARVALHO FREITAS RAMOS, JENER GOLÇALVES DE FARIAS, TÉRCIO GUIMARÃES REIS, ÉRICKA JANINE DANTAS DA SILVEIRA, MÁRCIA CRISTINA DA COSTA MIGUEL, VALÉRIA SOUZA FREITAS, MÁRCIO CAMPOS OLIVEIRA. Mucoepidermoid carcinoma is a tumor of the salivary glands that mainly affects the parotid gland and the palate of adults. It is the most common malignant salivary gland neoplasia and the average patient age is 44 years. This study reports on a clinical case of this pathology in a 19-year-old female patient who was referred to the Reference Center with a non-painful swelling in the hard and soft left palate that had been present for about 5 years. The intraoral mucosa was intact and red in color, and a firm swelling was present without facial asymmetry. CT images revealed a discreet bone involvement. The incisional biopsy revealed islands and nests of epidermoids, mucous, and intermediate cells. The microscopic diagnosis was low-grade mucoepidermoid carcinoma. Based on the biopsy report and the radiographic appearance of the lesion, surgery was the treatment of the choice and the prognosis was good.
CPP25 - DIAGNOSIS, TREATMENT, AND REHABILITATION OF A PATIENT WITH INFLAMMATORY PSEUDOTUMOR. MATHEUS CAVALCANTE TOMAZ BEZERRA, TIAGO NOVAES PINHEIRO, MARCO ANTÔNIO CRUZ ROCHA, BRIGITTE NICHTHAUSER, LUIZ ROBERTO COUTINHO MANHÃES JR., FABRICIO PASSADOR SANTOS, FLÁVIO TENDOLO FAYAD. A male patient, 34 years old, presented with a history of increased volume on the left infraorbital region, pain complaint, firm to palpation, sessile, adhered, and slow evolution of about 2 years. Puncture was performed with negative result. The cytologic examination provided a diagnosis of peripheral blood. Incisional biopsy of the lesion adhered to the infraorbital nerve was performed, giving a suggestive diagnosis of malignant tumor of peripheral nerve sheath. Scintillography and CT noted active bone growth in the region. Full left maxillectomy was performed and suggested a diagnosis of inflammatory pseudotumor. Immunohistochemical examination was performed, with a diagnosis of unspecific chronic inflammatory process and areas exhibiting multiple blood vessels. After about 2 years of followup, the patient has undergone multidisciplinary treatment with the production of maxillofacial prosthesis, and awaits further surgery for rehabilitation with screen and screws system in the region.
CPP26 - CENTRAL OSSIFYING FIBROMA ASSOCIATED WITH CENTRAL GIANT CELL GRANULOMA OF THE MANDIBULAR CONDYLE. DANIELLE CASTEX CONDE, ROBERTO PRADO, SÉRGIO LUIS DE MELO GONÇALVES. Lesions composed of elements of different pathologies are referred to as hybrid lesions. Hybrid lesions composed of central
OOOO August 2017 giant cell granuloma with fibro-osseous components are rare. A 13-year-old female patient was referred by her orthodontist after a radiologic finding in her panoramic radiography. The radiographic exam revealed a well-defined multilocular radiolucency with a focal radiopacity area and with scalloping margin, about 4 cm in diameter, located in the right mandibular condyle region. There was no history of pain, swelling, or paresthesia. An excisional biopsy was carried out under general anesthesia. The histopathologic examination showed cellular fibrous tissue with bony trabeculae with peripheral osteoid and osteblastic rimming. Numerous multinucleated giant cells in a background of ovoid and spindle-shaped cells were also observed. The diagnosis of central ossifying fibroma associated with central giant cell granuloma was concluded. After 16 months, no evidences of recurrence were observed.
CPP27 - SCHWANNOMAS OF THE SUBMANDIBULAR REGION. DANIELLE CASTEX CONDE, CAROLINE CIRAULO FARAJ, JULIANA PORTES DE OLIVEIRA, ALEXANDRE MORAES. Schwannomas are benign tumors originating from schwann cells. They are uncommon in the head and neck region. A 53year-old female patient presented with a slow-growing mass in the right submandibular region. She had no pain or any other complaint, apart from the gradual increase of the tumor. Extraoral examination revealed a mobile mass with smooth surface. CT confirmed a circumscribed and well-defined soft tissue in the right submandibular region. A clinical diagnosis of pleomorphic adenoma was made. Excisional biopsy was performed under general anesthesia. Histologic examination showed 2 distinct growth patterns in high variable proportions: spindle-shaped cells forming a palisaded arrangement around central acellular eosinophilic area (Antoni A pattern) and an area with spindle cells randomly arranged within a loose, myxomatous stroma (Antoni B pattern). With these histopathologic features, a diagnosis of schwannoma was concluded. The patient was discharged after 3 days following an uneventful post-operative course.
CPP28 - PARRY-ROMBERG SYNDROME: A CASE REPORT. LUANA LIMA GONÇALVES ARAÚJO, JAMILLI BATISTA PEDREIRA, JAMILE DE OLIVEIRA SÁ, ALENA PEIXOTO MEDRADO, SÍLVIA REGINA DE ALMEIDA REIS, ANTÔNIO MÁRCIO TEIXEIRA MARCHIONNI. Progressive hemifacial atrophy, also known as ParryRomberg syndrome, is a rare disorder, devastating to facial appearance, etiology unclear. It is characterized by a slow and progressive atrophy of the tissues of a hemiface, can affect all tissues, and can also display neurological and ocular manifestations. Although there is no treatment protocol to be established in these cases, it is known that surgery should only be conducted after stabilizing the patient’s condition. We report on a female patient, 18 years old, with mild enophthalmos in the right eye, mild facial atrophy involving skin and muscle in the right zygomatic maxillary region, and anterior open bite. The patient reported neurological disorders and epileptic seizures. The multidisciplinary approach of these patients is essential to promote a better quality of life because the disease can cause a major facial deformity. This work will discuss the clinical aspects and treatment protocol to be established for this rare syndrome.
CPP19 - THE USE OF INJECTABLE TRIAMCINOLONE IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS. MICHELLE DA SILVA SCALERCIO, NATHÁLIA DE ALMEIDA FREIRE, WAGNER CHAGAS, SARAH ANTERO, MARIA ELIZA BARBOSA RAMOS, ROSEMIRO DE MENEZES MACIEL, MÔNICA SIMÕES ISRAEL. Oral lichen planus (OLP) is a relatively common chronic disease of the mucous membranes that may have more transient cutaneous manifestations. It has a number of well-recognized clinical signs and a wide range of symptoms, ranging from none through mild discomfort to severe debilitating intra-oral erosions and ulceration. Efforts have been made in a continued searching for new therapies for symptomatic OLP; among them, an intralesional injection of triamcinolone acetonide (TA). This study aimed to evaluate the efficacy and safety of intralesional TA injection for ulcerative OLP in a black male patient, 64 years old, who attended the Oral Medicine Clinic complaining about painful lesions of erosive OLP. Intralesional TA injection in ulcerative OLP was effective and safe in achieving lesion and pain regression.
CPP20 - ORAL MANIFESTATIONS OF CHRONIC NEUTROPENIA: CASE REPORT. GABRIELA ALACARINI FARINA, STEFANIE THIEME PEROTTO, MARIA CRISTINA MUNERATO. Chronic neutropenia (CN) is a primary hematologic disease where neutrophil levels fall to very low amounts in 3 to 4 weeks. CN is characterized by mouth sores, fever, lymphadenopathy, malaise, diarrhea, and severe infections. A male patient, 59 years old, brown-colored, had recurrent episodes of painful mouth ulcers, fever, and diarrhea for 2 years’ duration. During the investigative process, inflammatory bowel diseases were discarded and the initial diagnosis was recurrent aphthous ulcerations. He was initially treated with 4 mg dexamethasone weekly for 6 months without improvement. Blood tests conducted over the past 3 months showed recurrent severe neutropenia that was associated with other parameters, and led to the diagnosis of CN. The patient was referred for hematologic evaluation to confirm the diagnosis, its correct management, as well as the most accurate research of his overall health, because this situation is commonly seen in cancer patients receiving chemotherapy or in patients with autoimmune diseases.
CPP21 - MACROSTOMIA IN ASSOCIATION WITH PRE-AURICULAR TAGS: A CASE REPORT. RODRIGO SOARES DE ANDRADE, RENATO ASSIS MACHADO, RICARDO DELLA COLETTA, EDMILSON MARTINS DE FREITAS, CARLA PATRÍCIA OLIVEIRA PARRELA, LUÍS ANTÔNIO DOS SANTOS, HERCILIO MARTELLI JUNIOR.
ABSTRACTS Abstracts e59 Macrostomia is a rare congenital anomaly with an incompletely described pathogenesis and several distinct non-syndromic phenotypes are associated. Macrostomia and pre-auricular tags can usually be correlated with syndromes, but in isolated cases are less common. Herein we report on a case of a young female patient presenting with macrostomia and pre-auricular tags isolated without syndromic association or other apparent causes. In anamnesis, the parents dismissed all possible pregnancy problems. The purpose of this study was to relate a clinical case of unilateral Tessier’s 7 cleft along with macrostomia and preauricular tags in a female patient. Significant alterations beyond macrostomia and pre-auricular tags were not found in ectoscopic tests, ultrasound, and intraoral physical examination. Although rare in occurrence, further studies are required to increase knowledge, leading to a more effective diagnosis and treatment of the patient.
CPP22 - DIAGNOSIS AND TREATMENT OF LARGE KERATOCYST ODONTOGENIC TUMOR INVADING THE RIGHT MAXILLARY SINUS. JÉSSICA BARROSO BARBOSA, LIONEY NOBRE CABRAL, MARCO TÚLLIO BRAZÃO-SILVA, TIAGO NOVAES PINHEIRO. Keratocyst odontogenic tumor (KCOT) is one of the most prevalent benign odontogenic tumors. Clinically, KCOT shows a more aggressive behavior and a high recurrence rate. Here in we present a case of KCOT found during orthodontic documentation in a melanoderma 18-year-old male patient. The patient was referred to the oral medicine service and clinical examination revealed right nasal obstruction. Computerized tomography scan revealed a large cystic lesion extending from the interdental area of teeth 12 and 13 filling two thirds of the right maxillary sinus. Puncture in the malar bone defect obtained 20 ml of bright yellowish material. Incisional biopsy with cystic decompression was performed and histopathologic examination confirmed the KCOT diagnosis. After 6 month complete enucleation of the remaining lesion was performed, followed by cauterization with Carnoy solution. After 18 months of clinical and tomographic follow-up, no recurrence was observed.
CPP23 - AN EXTENSIVE AND UNUSUAL PRESENTATION OF PYOGENIC GRANULOMA OF THE LOWER LIP. MARCELO BONIFÁCIO DA SILVA SAMPIERI, FILIPE NOBRE CHAVES, KARUZA MARIA ALVES PEREIRA, THÂMARA MANOELA MARINHO BEZERRA, FÁBIO WILDSON GURGEL COSTA, ANA PAULA NEGREIROS NUNES ALVES, MARIO ROGÉRIO LIMA MOTA. Pyogenic granuloma is a benign mucocutaneous lesion that occurs as a reactive inflammatory hyperplasia because of exuberant tissue response to local irritation or trauma. These lesions present as single nodule or sessile papule with smooth or lobulated surface and are red, elevated, and usually ulcerated. Herein we report on a 13-year-old male patient with a pedunculated, exophytic growth on the mucosal surface of the lower lip measuring about 2 cm 1 cm in diameter. The surface was covered by a yellowish white pseudomembrane with some areas of ulceration. Based on clinical features, a working diagnosis of pyogenic granuloma was given. The treatment of choice was excisional biopsy. Biopsy results showed areas of ulcerated stratified squamous keratinized epithelium with underlying granulation tissue. Numerous varied caliber of blood vessels were
ORAL AND MAXILLOFACIAL PATHOLOGY e60 Abstracts seen in the connective tissue, suggestive of pyogenic granuloma. There was no evidence of recurrence during the 6-month postoperative period.
CPP24 - MUCOEPIDERMOID CARCINOMA IN A YOUNG WOMAN: A CASE REPORT. TARSILA DE CARVALHO FREITAS RAMOS, JENER GOLÇALVES DE FARIAS, TÉRCIO GUIMARÃES REIS, ÉRICKA JANINE DANTAS DA SILVEIRA, MÁRCIA CRISTINA DA COSTA MIGUEL, VALÉRIA SOUZA FREITAS, MÁRCIO CAMPOS OLIVEIRA. Mucoepidermoid carcinoma is a tumor of the salivary glands that mainly affects the parotid gland and the palate of adults. It is the most common malignant salivary gland neoplasia and the average patient age is 44 years. This study reports on a clinical case of this pathology in a 19-year-old female patient who was referred to the Reference Center with a non-painful swelling in the hard and soft left palate that had been present for about 5 years. The intraoral mucosa was intact and red in color, and a firm swelling was present without facial asymmetry. CT images revealed a discreet bone involvement. The incisional biopsy revealed islands and nests of epidermoids, mucous, and intermediate cells. The microscopic diagnosis was low-grade mucoepidermoid carcinoma. Based on the biopsy report and the radiographic appearance of the lesion, surgery was the treatment of the choice and the prognosis was good.
CPP25 - DIAGNOSIS, TREATMENT, AND REHABILITATION OF A PATIENT WITH INFLAMMATORY PSEUDOTUMOR. MATHEUS CAVALCANTE TOMAZ BEZERRA, TIAGO NOVAES PINHEIRO, MARCO ANTÔNIO CRUZ ROCHA, BRIGITTE NICHTHAUSER, LUIZ ROBERTO COUTINHO MANHÃES JR., FABRICIO PASSADOR SANTOS, FLÁVIO TENDOLO FAYAD. A male patient, 34 years old, presented with a history of increased volume on the left infraorbital region, pain complaint, firm to palpation, sessile, adhered, and slow evolution of about 2 years. Puncture was performed with negative result. The cytologic examination provided a diagnosis of peripheral blood. Incisional biopsy of the lesion adhered to the infraorbital nerve was performed, giving a suggestive diagnosis of malignant tumor of peripheral nerve sheath. Scintillography and CT noted active bone growth in the region. Full left maxillectomy was performed and suggested a diagnosis of inflammatory pseudotumor. Immunohistochemical examination was performed, with a diagnosis of unspecific chronic inflammatory process and areas exhibiting multiple blood vessels. After about 2 years of followup, the patient has undergone multidisciplinary treatment with the production of maxillofacial prosthesis, and awaits further surgery for rehabilitation with screen and screws system in the region.
CPP26 - CENTRAL OSSIFYING FIBROMA ASSOCIATED WITH CENTRAL GIANT CELL GRANULOMA OF THE MANDIBULAR CONDYLE. DANIELLE CASTEX CONDE, ROBERTO PRADO, SÉRGIO LUIS DE MELO GONÇALVES. Lesions composed of elements of different pathologies are referred to as hybrid lesions. Hybrid lesions composed of central
OOOO August 2017 giant cell granuloma with fibro-osseous components are rare. A 13-year-old female patient was referred by her orthodontist after a radiologic finding in her panoramic radiography. The radiographic exam revealed a well-defined multilocular radiolucency with a focal radiopacity area and with scalloping margin, about 4 cm in diameter, located in the right mandibular condyle region. There was no history of pain, swelling, or paresthesia. An excisional biopsy was carried out under general anesthesia. The histopathologic examination showed cellular fibrous tissue with bony trabeculae with peripheral osteoid and osteblastic rimming. Numerous multinucleated giant cells in a background of ovoid and spindle-shaped cells were also observed. The diagnosis of central ossifying fibroma associated with central giant cell granuloma was concluded. After 16 months, no evidences of recurrence were observed.
CPP27 - SCHWANNOMAS OF THE SUBMANDIBULAR REGION. DANIELLE CASTEX CONDE, CAROLINE CIRAULO FARAJ, JULIANA PORTES DE OLIVEIRA, ALEXANDRE MORAES. Schwannomas are benign tumors originating from schwann cells. They are uncommon in the head and neck region. A 53year-old female patient presented with a slow-growing mass in the right submandibular region. She had no pain or any other complaint, apart from the gradual increase of the tumor. Extraoral examination revealed a mobile mass with smooth surface. CT confirmed a circumscribed and well-defined soft tissue in the right submandibular region. A clinical diagnosis of pleomorphic adenoma was made. Excisional biopsy was performed under general anesthesia. Histologic examination showed 2 distinct growth patterns in high variable proportions: spindle-shaped cells forming a palisaded arrangement around central acellular eosinophilic area (Antoni A pattern) and an area with spindle cells randomly arranged within a loose, myxomatous stroma (Antoni B pattern). With these histopathologic features, a diagnosis of schwannoma was concluded. The patient was discharged after 3 days following an uneventful post-operative course.
CPP28 - PARRY-ROMBERG SYNDROME: A CASE REPORT. LUANA LIMA GONÇALVES ARAÚJO, JAMILLI BATISTA PEDREIRA, JAMILE DE OLIVEIRA SÁ, ALENA PEIXOTO MEDRADO, SÍLVIA REGINA DE ALMEIDA REIS, ANTÔNIO MÁRCIO TEIXEIRA MARCHIONNI. Progressive hemifacial atrophy, also known as ParryRomberg syndrome, is a rare disorder, devastating to facial appearance, etiology unclear. It is characterized by a slow and progressive atrophy of the tissues of a hemiface, can affect all tissues, and can also display neurological and ocular manifestations. Although there is no treatment protocol to be established in these cases, it is known that surgery should only be conducted after stabilizing the patient’s condition. We report on a female patient, 18 years old, with mild enophthalmos in the right eye, mild facial atrophy involving skin and muscle in the right zygomatic maxillary region, and anterior open bite. The patient reported neurological disorders and epileptic seizures. The multidisciplinary approach of these patients is essential to promote a better quality of life because the disease can cause a major facial deformity. This work will discuss the clinical aspects and treatment protocol to be established for this rare syndrome.