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BOTRYOID ODONTOGENIC CYST IN THE MAXILLA
ABSTRACTS
e32
paralysis, and fissured tongue. However, all 3 symptoms appear only in 8% to 25% of the cases. Cases with only 2 symptoms are considered oligosymptomatic forms. The orofacial granulomatosis is an idiopathic disorder and represents the most common symptom of the syndrome. We report the case of an 81-year-old man with a complaint of painless swelling on the lower lip of 3 months’ duration. During the clinical exam, a fissured tongue was noticed and there was no history of facial paralysis. An incisional biopsy was performed and a noncaseating granulomatous inflammation was observed histopathologically. No foreign material was present and special stains for fungal and bacteria were negative, confirming the diagnosis of granulomatous cheilitis. The patient was treated with systemic corticosteroid and there is a complete remission of the labial edema after 10 months of follow-up.
INTRAOSSEOUS MUCOEPIDERMOID CARCINOMA IN A YOUNG PATIENT: A CASE REPORT. CYNTIA HELENA PEREIRA DE CARVALHO, GEORGE BORJA DE FREITAS, ARTHUR BARBOSA DE FRANCA, ¸ ADILIS STEPPLE DA FONTE NETO, ATEFANNY TORRES DOS SANTOS, BARBARA e VANESSA DE BRITO MONTEIRO and, GEORGE JOAO FERREIRA DO NASCIMENTO Intraosseous mucoepidermoid carcinomas are rare, making up only 2% to 3% of all mucoepidermoid carcinomas reported. These tumors are common in the fourth and fifth decades of life and their occurrence in the first 2 decades is highly unusual. This work reports an uncommon case of intraosseous mucoepidermoid carcinoma arising in the mandible of a 16-year-old boy that exhibited a rapid and asymptomatic growth of the lingual cortex with negative aspiration puncture. Panoramic radiographic and computed tomography revealed a multilocular, radiolucent, hypodense lesion extending from the body to the angle of the right mandible associated with unerupted teeth numbers 47 and 48. After incisional biopsy, microscopic analysis showed salivary gland epithelial malignant proliferation presenting variable amounts of intermediate, epidermoid, and mucous cells building cystic cavities filled with a periodic acid-Schiff (PAS) and Alcian blue positive amorphous material compatible with mucin. Patient was referred for oncologic treatment and has been followed for 1 year with no recurrence.
ORAL PROLIFERATIVE VERRUCOUS LEUKOPLAKIA: A LONG-TERM CLINICAL, CYTOPATHOLOGIC, AND HISTOPATHOe NEZ LOGIC FOLLOW-UP. THAYLLA NU AMIN DICK, ELOA BORGES LUNA, JULIANA PORTES DE OLIVEIRA, ARLEY SILVA JUNIOR, ADRIANNA MILAGRES, ELIANE PEDRA DIAS and, KARIN SOARES CUNHA Proliferative verrucous leukoplakia (PVL) is an aggressive form of leukoplakia, which affects multiple oral sites, with high probability of recurrence and a high rate of malignant transformation. Clinically it may present as a homogeneous white plaque or leukoeritroplakia, with an exophytic or verrucous surface. We report a case with 8 years of follow-up of an 85-year-old woman with white plaques on the left buccal mucosa, inferior alveolar mucosa, floor of the mouth, and lateral border of the tongue. Combined cytopathologic and histopathologic examination was performed over 6 years, showing initially mild dysplasia and keratosis, which progressed to moderate and severe dysplasia. After 6 years of follow-up evaluation, an upper alveolar mucosa lesion
OOOO January 2020 was diagnosed as an in situ carcinoma. The patient was referred for treatment, and a surgical resection was performed. The patient is currently being monitored and evaluated with periodic cytopathologic exams.
PERIPHERAL DESMOPLASTIC AMELOBLASTOMA IN THE MANDIBLE. DARCY FERNANDES, HEITOR ALBERGONI DA SILVEIRA, CAMILA DE OLIVEIRA BARBEIRO, MARIEL RUIVO BIANCARDI, LUCAS RIBEIRO TEIXEIRA, ANDREIA BUFALINO and, JORGE ESQUICHE LEON The peripheral ameloblastoma, desmoplastic histologic type, is a rare, benign tumor among the odontogenic tumors. Both the mandible and maxilla can be affected; it is characterized by slow growth, and usually is asymptomatic. A 58-year-old male patient was referred presenting with a painless nodule in the gingiva. Intraoral examination revealed an extraosseous submucosal nodule with 10 £ 10 mm located at the mucus-gingival junction on the right side of the mandible. An excisional biopsy was performed. Microscopy showed a desmoplastic stroma that compressed the tumor epithelial cells within islands and a myxoid stroma surrounding the tumoral nests. Cytokeratin AE1, cytokeratin AE3, and p63 were positive, Ki-67 was low (<2%), and p53 was negative by immunohistochemistry. The clinicopathologic features sustained the diagnosis of peripheral ameloblastoma, desmoplastic histologic type. The patient did not present with recurrence after 8 months of follow-up. This report contributes to a better understanding of the origin and behavior of this condition.
ORAL MANIFESTATIONS OF CHRONIC GRAFT-VERSUS-HOST DISEASE: REPORT OF 2 CASES. CONSTANZA MARIN MARQUEZ, RENE MARTINEZ FLORES and, SVEN NIKLANDER EBENSPERGER Chronic graft-versus-host disease (GVHD) is a major late complication in patients treated by allogeneic hematopoietic stem cell transplantation. It is defined as a multisystem alloimmune and autoimmunelike disorder characterized by immune dysregulation, immune deficiency, impaired end-organ function, and decreased survival. Chronic GVHD resembles both clinically and histologically, many autoimmune disorders and other immunologic diseases. The oral cavity is the second most commonly involved organ system, behind skin involvement and can present as mucosal erythema, lichenoid lesions, ulcerated mucosa, and leukoplakia lesions that may be considered a potential risk factor for the development of oral cancer. We report the clinical features of 2 cases, occurring in a 41-year-old man and a 60-yearold woman. Both patients had a favorable outcome treated with topical or systemic corticosteroids and, in 1 of the cases, with the cyclosporine adjustment.
BOTRYOID ODONTOGENIC CYST IN THE MAXILLA. KARINE DUARTE DA SILVA, JULIO CESAR TANOS DE LACERDA, MARIA CASSIA FERREIRA DE AGUIAR, RICARDO ALVES MESQUITA and, PATRICIA CARLOS CALDEIRA A 53-year-old woman presented an asymptomatic lesion in the anterior maxilla, causing a discrete bone expansion and
OOOO Volume 129, Number 1 covered by healthy oral mucosa. Cone beam computed tomography showed coalescent and well-defined hypodense areas at the periapical region of teeth 11, 12, and 13, measuring 12 mm, with buccal cortical bone discontinuity. The diagnosis hypothesis of an odontogenic cyst was confirmed by microscopic examination after incisional biopsy. The lesion was enucleated and tooth 12 was removed. The surgical specimen analysis revealed multiple cystic spaces lined by a thin, nonkeratinized epithelium with plaquelike thickenings. Some clear cells were noticed. The cystic wall was of a fibrous connective tissue. The final diagnosis was of botryoid odontogenic cyst. After 9 months of follow-up, there are no clinical or radiographic signs of recurrence. SUPPORT: FAPEMIG.
HEREDITARY HEMORRHAGIC TELANGIECTASIA: A CASE REPORT. MARINA FERNANDES BINIMELIZ, DANIEL FALHEIRO, BRUNO TURELI, RICART GIL MACEDO, LUCIENE SILVEIRA and, CESAR W. NOCE Hereditary hemorrhagic telangiectasia (HHT) is a rare mucocutaneous disease, inherited by autosomal dominant trait. Its diagnosis can be established by the identification of 3 of the following criteria: (1) frequent episodes of epistaxis; (2) telangiectasias of the skin and mucosa; (3) arteriovenous malformations involving lungs, liver, or central nervous system; and (4) family history of HHT. The purpose of this study is to perform a case report of HHT, attended at a stomatology service. The patient was a 70-year-old female, with numerous vascular lesions affecting the oral mucosa, hands, and feet. Endoscopic analysis also showed telangiectasias in the gastric mucosa. The patient had anemia and frequent episodes of epistaxis, and also reported a family history of these manifestations, involving her father, sister, and children. The diagnosis was defined as HHT. The dentist should be aware of the different manifestations of HHT and consider it as a possible diagnosis for patients with various vascular lesions.
WHITE SPONGE NEVUS: CASE REPORT WITHOUT A FAMILY HISTORY. SABRINA OLIVEIRA VARELA, JOSEPH COTTA VIANA, ^ e VELLOSO, PATRICIA RONCON TANIA REGINA GRAO ^ BIANCHI, MARTHA ALAYDE ALCANTARA SALIM VENAN, DANIELLE RESENDE CAMISASCA and, LILIANA APARECIDA PIMENTA DE BARROS White sponge nevus (WSN) is a rare autosomal dominant disorder with variable expressivity and high penetrance. Oral mucosa is the most affected region. Usually, this entity occurs at birth or later in childhood or adolescence. A 42-year-old man complained of white, asymptomatic lesions, which were present for more than 3 years. No family history of similar lesions was reported. Intraoral examination revealed nonremovable, symmetric, diffuse white plaques, all over the buccal mucosa, bilaterally, with a corrugated surface. An incisional biopsy was performed and histopathologic analysis revealed stratified squamous epithelium, with hyperparakeratosis, an extensive area with acanthosis and keratotinocytes with perinuclear eosinophilic condensation. Based on clinical and microscopic aspects, the diagnosis made was WSN. Further material was collected for cytopathologic examination in order to confirm the diagnosis. Treatment is not necessary due to the benign nature of WSN. Correct diagnosis is
ABSTRACTS
e33
important to exclude other more serious lesions with similar characteristics.
BURKITT LYMPHOMA IN A PEDIATRIC PATIENT: A CASE REPORT. JOSE ALEXANDRE DA ROCHA CURVELO, DEBORAH SUTTER AYRES PEREIRA, JOSIANNE PEREIRA DE OLIVEIRA, ADRIANA MARTINS DE SOUSA, FABIO RIBEIRO GUEDES, MARCIA GRILLO CABRAL and, MARIA ELISA RANGEL JANINI Burkitt lymphoma (BL) is a very rare non-Hodgkin lymphoma with an extremely short doubling time that tends to affect children in the jaw. Here we report the case of a 6-year-old boy who visited the emergency service complaining of jaw pain, jaw swelling, and dental mobility for 20 days. Biopsy was performed and the diagnosis of BL was established. The patient was immediately admitted at the oncohematology center of a pediatric institute for treatment. Admission examination revealed generalized lymphadenopathy, sagittal sinus thrombosis, and tumor infiltration in the sphenoidal and maxillary sinuses, liver, lung, both kidneys, pancreas, and spinal canal, curving the spinal cord backwards. Treatment started immediately according to the nonHodgkin lymphoma Berlin-Frankfurt-Munster-95 (NHL-BFM95) protocol and currently, the patient is in complete remission without signs of disease. This report demonstrates that rapid and precise diagnosis with immediate treatment was essential for therapeutic effectiveness and should be considered for improved BL prognosis.
LOW-GRADE FIBROMYXOID SARCOMA OF THE MAXILLA. REPORT OF A CASE. RENE MARTINEZ FLORES, BERNARDO VENEGAS ROJAS, VICTOR MORAGA GOMEZ and, CARLO LOZANO BURGOS Low-grade fibromyxoid sarcoma (LGFS) is a variant of fibrosarcoma that commonly arises in the deep soft tissues of the lower extremities in young or middle-aged adults. It is characterized by high rates of local recurrence and late metastases, despite its deceptively benign image. We report the case of a 45-yearold man referred for a swelling of his left maxilla for 15 years’ duration. An incisional biopsy showed a proliferation of bland spindle and stellate-shaped cells, deposited in an alternating myxoid and fibrous stroma. Diagnosis of odontogenic myxoma and LGFS were proposed. A computed tomography showed an expansive and well-defined tumor in the left maxillary sinus and maxilla, without regional lymph node involvement or metastases. A complete resection of the tumor was performed and the diagnosis of LGFS was confirmed. Adjuvant treatment was not required and after 1 year follow-up, the patient remains free of disease.
EPSTEIN-BARR VIRUS POSITIVE MUCOCUTANEOUS ULCER IN A PATIENT PRESENTING WITH MONOCLONAL GAMMOPATHY. PATRICIA MARIA FERNANDES, FELIPE D’ALMEIDA, FRED LOUVEIRA AYRES, MARCIO AJUDARTE LOPES and, FABIO ABREU ALVES A 74-year-old man presenting with a gingival ulcer of 2 months’ duration was referred for evaluation. His medical history
e32
paralysis, and fissured tongue. However, all 3 symptoms appear only in 8% to 25% of the cases. Cases with only 2 symptoms are considered oligosymptomatic forms. The orofacial granulomatosis is an idiopathic disorder and represents the most common symptom of the syndrome. We report the case of an 81-year-old man with a complaint of painless swelling on the lower lip of 3 months’ duration. During the clinical exam, a fissured tongue was noticed and there was no history of facial paralysis. An incisional biopsy was performed and a noncaseating granulomatous inflammation was observed histopathologically. No foreign material was present and special stains for fungal and bacteria were negative, confirming the diagnosis of granulomatous cheilitis. The patient was treated with systemic corticosteroid and there is a complete remission of the labial edema after 10 months of follow-up.
INTRAOSSEOUS MUCOEPIDERMOID CARCINOMA IN A YOUNG PATIENT: A CASE REPORT. CYNTIA HELENA PEREIRA DE CARVALHO, GEORGE BORJA DE FREITAS, ARTHUR BARBOSA DE FRANCA, ¸ ADILIS STEPPLE DA FONTE NETO, ATEFANNY TORRES DOS SANTOS, BARBARA e VANESSA DE BRITO MONTEIRO and, GEORGE JOAO FERREIRA DO NASCIMENTO Intraosseous mucoepidermoid carcinomas are rare, making up only 2% to 3% of all mucoepidermoid carcinomas reported. These tumors are common in the fourth and fifth decades of life and their occurrence in the first 2 decades is highly unusual. This work reports an uncommon case of intraosseous mucoepidermoid carcinoma arising in the mandible of a 16-year-old boy that exhibited a rapid and asymptomatic growth of the lingual cortex with negative aspiration puncture. Panoramic radiographic and computed tomography revealed a multilocular, radiolucent, hypodense lesion extending from the body to the angle of the right mandible associated with unerupted teeth numbers 47 and 48. After incisional biopsy, microscopic analysis showed salivary gland epithelial malignant proliferation presenting variable amounts of intermediate, epidermoid, and mucous cells building cystic cavities filled with a periodic acid-Schiff (PAS) and Alcian blue positive amorphous material compatible with mucin. Patient was referred for oncologic treatment and has been followed for 1 year with no recurrence.
ORAL PROLIFERATIVE VERRUCOUS LEUKOPLAKIA: A LONG-TERM CLINICAL, CYTOPATHOLOGIC, AND HISTOPATHOe NEZ LOGIC FOLLOW-UP. THAYLLA NU AMIN DICK, ELOA BORGES LUNA, JULIANA PORTES DE OLIVEIRA, ARLEY SILVA JUNIOR, ADRIANNA MILAGRES, ELIANE PEDRA DIAS and, KARIN SOARES CUNHA Proliferative verrucous leukoplakia (PVL) is an aggressive form of leukoplakia, which affects multiple oral sites, with high probability of recurrence and a high rate of malignant transformation. Clinically it may present as a homogeneous white plaque or leukoeritroplakia, with an exophytic or verrucous surface. We report a case with 8 years of follow-up of an 85-year-old woman with white plaques on the left buccal mucosa, inferior alveolar mucosa, floor of the mouth, and lateral border of the tongue. Combined cytopathologic and histopathologic examination was performed over 6 years, showing initially mild dysplasia and keratosis, which progressed to moderate and severe dysplasia. After 6 years of follow-up evaluation, an upper alveolar mucosa lesion
OOOO January 2020 was diagnosed as an in situ carcinoma. The patient was referred for treatment, and a surgical resection was performed. The patient is currently being monitored and evaluated with periodic cytopathologic exams.
PERIPHERAL DESMOPLASTIC AMELOBLASTOMA IN THE MANDIBLE. DARCY FERNANDES, HEITOR ALBERGONI DA SILVEIRA, CAMILA DE OLIVEIRA BARBEIRO, MARIEL RUIVO BIANCARDI, LUCAS RIBEIRO TEIXEIRA, ANDREIA BUFALINO and, JORGE ESQUICHE LEON The peripheral ameloblastoma, desmoplastic histologic type, is a rare, benign tumor among the odontogenic tumors. Both the mandible and maxilla can be affected; it is characterized by slow growth, and usually is asymptomatic. A 58-year-old male patient was referred presenting with a painless nodule in the gingiva. Intraoral examination revealed an extraosseous submucosal nodule with 10 £ 10 mm located at the mucus-gingival junction on the right side of the mandible. An excisional biopsy was performed. Microscopy showed a desmoplastic stroma that compressed the tumor epithelial cells within islands and a myxoid stroma surrounding the tumoral nests. Cytokeratin AE1, cytokeratin AE3, and p63 were positive, Ki-67 was low (<2%), and p53 was negative by immunohistochemistry. The clinicopathologic features sustained the diagnosis of peripheral ameloblastoma, desmoplastic histologic type. The patient did not present with recurrence after 8 months of follow-up. This report contributes to a better understanding of the origin and behavior of this condition.
ORAL MANIFESTATIONS OF CHRONIC GRAFT-VERSUS-HOST DISEASE: REPORT OF 2 CASES. CONSTANZA MARIN MARQUEZ, RENE MARTINEZ FLORES and, SVEN NIKLANDER EBENSPERGER Chronic graft-versus-host disease (GVHD) is a major late complication in patients treated by allogeneic hematopoietic stem cell transplantation. It is defined as a multisystem alloimmune and autoimmunelike disorder characterized by immune dysregulation, immune deficiency, impaired end-organ function, and decreased survival. Chronic GVHD resembles both clinically and histologically, many autoimmune disorders and other immunologic diseases. The oral cavity is the second most commonly involved organ system, behind skin involvement and can present as mucosal erythema, lichenoid lesions, ulcerated mucosa, and leukoplakia lesions that may be considered a potential risk factor for the development of oral cancer. We report the clinical features of 2 cases, occurring in a 41-year-old man and a 60-yearold woman. Both patients had a favorable outcome treated with topical or systemic corticosteroids and, in 1 of the cases, with the cyclosporine adjustment.
BOTRYOID ODONTOGENIC CYST IN THE MAXILLA. KARINE DUARTE DA SILVA, JULIO CESAR TANOS DE LACERDA, MARIA CASSIA FERREIRA DE AGUIAR, RICARDO ALVES MESQUITA and, PATRICIA CARLOS CALDEIRA A 53-year-old woman presented an asymptomatic lesion in the anterior maxilla, causing a discrete bone expansion and
OOOO Volume 129, Number 1 covered by healthy oral mucosa. Cone beam computed tomography showed coalescent and well-defined hypodense areas at the periapical region of teeth 11, 12, and 13, measuring 12 mm, with buccal cortical bone discontinuity. The diagnosis hypothesis of an odontogenic cyst was confirmed by microscopic examination after incisional biopsy. The lesion was enucleated and tooth 12 was removed. The surgical specimen analysis revealed multiple cystic spaces lined by a thin, nonkeratinized epithelium with plaquelike thickenings. Some clear cells were noticed. The cystic wall was of a fibrous connective tissue. The final diagnosis was of botryoid odontogenic cyst. After 9 months of follow-up, there are no clinical or radiographic signs of recurrence. SUPPORT: FAPEMIG.
HEREDITARY HEMORRHAGIC TELANGIECTASIA: A CASE REPORT. MARINA FERNANDES BINIMELIZ, DANIEL FALHEIRO, BRUNO TURELI, RICART GIL MACEDO, LUCIENE SILVEIRA and, CESAR W. NOCE Hereditary hemorrhagic telangiectasia (HHT) is a rare mucocutaneous disease, inherited by autosomal dominant trait. Its diagnosis can be established by the identification of 3 of the following criteria: (1) frequent episodes of epistaxis; (2) telangiectasias of the skin and mucosa; (3) arteriovenous malformations involving lungs, liver, or central nervous system; and (4) family history of HHT. The purpose of this study is to perform a case report of HHT, attended at a stomatology service. The patient was a 70-year-old female, with numerous vascular lesions affecting the oral mucosa, hands, and feet. Endoscopic analysis also showed telangiectasias in the gastric mucosa. The patient had anemia and frequent episodes of epistaxis, and also reported a family history of these manifestations, involving her father, sister, and children. The diagnosis was defined as HHT. The dentist should be aware of the different manifestations of HHT and consider it as a possible diagnosis for patients with various vascular lesions.
WHITE SPONGE NEVUS: CASE REPORT WITHOUT A FAMILY HISTORY. SABRINA OLIVEIRA VARELA, JOSEPH COTTA VIANA, ^ e VELLOSO, PATRICIA RONCON TANIA REGINA GRAO ^ BIANCHI, MARTHA ALAYDE ALCANTARA SALIM VENAN, DANIELLE RESENDE CAMISASCA and, LILIANA APARECIDA PIMENTA DE BARROS White sponge nevus (WSN) is a rare autosomal dominant disorder with variable expressivity and high penetrance. Oral mucosa is the most affected region. Usually, this entity occurs at birth or later in childhood or adolescence. A 42-year-old man complained of white, asymptomatic lesions, which were present for more than 3 years. No family history of similar lesions was reported. Intraoral examination revealed nonremovable, symmetric, diffuse white plaques, all over the buccal mucosa, bilaterally, with a corrugated surface. An incisional biopsy was performed and histopathologic analysis revealed stratified squamous epithelium, with hyperparakeratosis, an extensive area with acanthosis and keratotinocytes with perinuclear eosinophilic condensation. Based on clinical and microscopic aspects, the diagnosis made was WSN. Further material was collected for cytopathologic examination in order to confirm the diagnosis. Treatment is not necessary due to the benign nature of WSN. Correct diagnosis is
ABSTRACTS
e33
important to exclude other more serious lesions with similar characteristics.
BURKITT LYMPHOMA IN A PEDIATRIC PATIENT: A CASE REPORT. JOSE ALEXANDRE DA ROCHA CURVELO, DEBORAH SUTTER AYRES PEREIRA, JOSIANNE PEREIRA DE OLIVEIRA, ADRIANA MARTINS DE SOUSA, FABIO RIBEIRO GUEDES, MARCIA GRILLO CABRAL and, MARIA ELISA RANGEL JANINI Burkitt lymphoma (BL) is a very rare non-Hodgkin lymphoma with an extremely short doubling time that tends to affect children in the jaw. Here we report the case of a 6-year-old boy who visited the emergency service complaining of jaw pain, jaw swelling, and dental mobility for 20 days. Biopsy was performed and the diagnosis of BL was established. The patient was immediately admitted at the oncohematology center of a pediatric institute for treatment. Admission examination revealed generalized lymphadenopathy, sagittal sinus thrombosis, and tumor infiltration in the sphenoidal and maxillary sinuses, liver, lung, both kidneys, pancreas, and spinal canal, curving the spinal cord backwards. Treatment started immediately according to the nonHodgkin lymphoma Berlin-Frankfurt-Munster-95 (NHL-BFM95) protocol and currently, the patient is in complete remission without signs of disease. This report demonstrates that rapid and precise diagnosis with immediate treatment was essential for therapeutic effectiveness and should be considered for improved BL prognosis.
LOW-GRADE FIBROMYXOID SARCOMA OF THE MAXILLA. REPORT OF A CASE. RENE MARTINEZ FLORES, BERNARDO VENEGAS ROJAS, VICTOR MORAGA GOMEZ and, CARLO LOZANO BURGOS Low-grade fibromyxoid sarcoma (LGFS) is a variant of fibrosarcoma that commonly arises in the deep soft tissues of the lower extremities in young or middle-aged adults. It is characterized by high rates of local recurrence and late metastases, despite its deceptively benign image. We report the case of a 45-yearold man referred for a swelling of his left maxilla for 15 years’ duration. An incisional biopsy showed a proliferation of bland spindle and stellate-shaped cells, deposited in an alternating myxoid and fibrous stroma. Diagnosis of odontogenic myxoma and LGFS were proposed. A computed tomography showed an expansive and well-defined tumor in the left maxillary sinus and maxilla, without regional lymph node involvement or metastases. A complete resection of the tumor was performed and the diagnosis of LGFS was confirmed. Adjuvant treatment was not required and after 1 year follow-up, the patient remains free of disease.
EPSTEIN-BARR VIRUS POSITIVE MUCOCUTANEOUS ULCER IN A PATIENT PRESENTING WITH MONOCLONAL GAMMOPATHY. PATRICIA MARIA FERNANDES, FELIPE D’ALMEIDA, FRED LOUVEIRA AYRES, MARCIO AJUDARTE LOPES and, FABIO ABREU ALVES A 74-year-old man presenting with a gingival ulcer of 2 months’ duration was referred for evaluation. His medical history