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Chloroquine-induced oral pigmentation misdiagnosed as melanoma
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Abstracts
PREVALENCE OF ORAL CANDIDIASIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS Leite CA1,2, Galera MF3, Silva OG1, Fernandes V1, Lima PRTL1, Briezinski JP1, Dias EP2 - 1UNIVERSIDADE DE CUIABÁ, UNIC CUIABÁ/MT, 2UNIVERSIDADE FEDERAL FLUMINENSE, UFF - NITERÓI/RJ, 3UNIVERSIDADE FEDERAL DE MATO GROSSO, UFMT Background: Systemic lupus erythematosus (SLE) is an autoimmune disease and these patients have an increased risk for infection due the treatment with immunosuppressives. Aim: Determine the prevalence of oral candidiasis in patients with systemic SLE using oral cytopathology. Study design: Prospective observational study with 43 patients. Clinic examination was realized, scraps from the lesions and on lateral borders of the tongue were obtained, fixed and stained by Papanicolaou and PAS technique. Results: Oral candidiasis (OC) were found in 54% of the evaluations. Sites affected: lateral borders of the tongue (70%), palate (20%), other sites (10%). (26%) were associated with prosthesis. All cases of OC in lateral border of tongue, patients had no lesions clinically detected. Conclusion: OC is a frequent diagnosis (54%) in patients with SLE. Cytopathology was an effective method in the diagnosis of infections, especially oral candidiasis, in patients with or without clinically detectable lesions.
FREQUENCY OF ORAL SQUAMOUS CELL CARCINOMA AND ORAL EPITHELIAL DYSPLASIA: IREPO, UNIVERSITY OF CHILE, 1990-2009 Adorno D1, Martínez C1, Hernández M1 - 1UNIVERSITY OF CHILE - PATOLOGY Objective: To determinate the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral mucosa from Chilean population. Study design: This is a descriptive study from Chilean population between 1990 and 2009. A total of 399 cases were selected according to their histopathological diagnosis, this is hyperkeratosis, oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma. Data was analyzed with the software Sysat 13. Results: Most of the cases turned out to be squamous cell carcinoma (44.1%), which is first recognize clinically as cancer (78.41%), followed by hyperkeratosis (36.8%) and mild epithelial dysplasia (10.5%), which are clinically diagnosed as leukoplakia. Conclusions: Oral cancer is diagnosed mainly when their classical characteristics are already present, therefore early diagnosis should improve.
CHLOROQUINE-INDUCED ORAL PIGMENTATION MISDIAGNOSED AS MELANOMA Pereira DL1, Duarte NT1, Verrone JR1, Lopes RN1, Jaguar GC1, Alves FA1,2 1 HOSPITAL AC CAMARGO - STOMATOLOGY, 2FOUSP STOMATOLOGY Chloroquine is an antimalarial drug considered a diseasemodifying, which has also been used for decades in the treatment of lupus erythematosus and rheumatoid arthritis. It is indicated when anti-inflammatory non-steroids appears ineffective in the treatment of symptoms of rheumatic diseases. A 70 year-old-man was referred to suspicion of melanoma. His medical history revealed rheumatoid arthritis treated by chlo-
October 2012 roquine for 10 years. On physical examination was observed pigmented macules in the arm and leg. Intra-oral exam showed pigmented macules-irregularly shaped in the hard palate surface. The diagnosis of chloroquine-induced oral pigmentation was performed according to medical history and clinical features. The chosen treatment was conservative and the patient was instructed to follow sporadically in our department. These drugs may have reversible side effects witch can solve with the discontinuity of the drug. Therefore, the knowledge of this clinical manifestation is important to the differential diagnosis of melanoma.
EXPRESSION IMMUNOHISTOCHEMISTRY OF PROTEIN GLUT-1 AND HIF-1␣ IN VASCULAR LESIONS OF ORAL MUCOSA Oliveira DHIP1, Silveira EJD1, Medeiros AMC1, Andrade ALDL1, Vasconcelos RC1, Oliveira PT2, Queiroz LMG1 - 1UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE - PROGRAMA DE PÓS-GRADUAÇÃO EM PATOLOGIA ORAL, 2UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE - ODONTOLOGIA Background: The correct histological diagnosis of vascular lesions in the oral mucosa is critical. Objectives: Investigate the accuracy immunohistochemical expression of GLUT-1 to reclassify vascular lesions. In addition, evaluated the immunohistochemical expression of HIF-1␣. Study design: Analyzed 30 cases with histological diagnosis of hemangioma (HEM) and 30 cases of oral pyogenic granuloma (PG). Results: Of the 30 lesions initially classified as HEM, only 7 showed immuno-positivity for GLUT-1, remaining with the initial diagnosis. The remaining 23 were reclassified as vascular malformation (VM) (13 cases) and PG (10 cases). All cases with an initial diagnosis of PG were negative for GLUT-1. Concerning to the immunoexpression of HIF-1␣, the Mann-Whitney test revealed a statistically significant difference between the cases of GP and MV (p⬍0,05%). Conclusion: So, this study showed that a histological diagnosis alone is not always sufficient for the correct diagnosis and that HIF-1␣ participates in the pathogenesis of vascular lesions.
EXTRANODAL NATURAL KILLER (NK)/T-CELL LYMPHOMA, NASAL TYPE: CASE REPORT Guimarães DM1, FONSECA FP2, PAVANELLO KC1, BRAZAO SILVA MT, PONTES FSC3, PONTES HAR3 - 1UNIVERSIDADE DE SAO PAULO, 2UNIVERSIDADE ESTADUAL DE CAMPINAS, 3 UNIVERSIDADE FEDERAL DO PARA Extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type is recognized as a unique clinicopathologic sub type of non-Hodgkin’s lymphoma (NHL), is a rare disease occurring in adults, with a male predominance. with prevalence in Asians, Mexicans, Central and South Americans of American Indian descent. It is universally associated with EBV, and genetic factors play a role in susceptibility to the disease. ENKTL is generally considered to be a very aggressive lymphoma. This work reports a case of 42 years old female, with chef complain gingival bleeding being diagnosed initially as aggressive periodontitis. The incisional biopsy revealed a variable lymphoid infiltrate with subtle-to-extensive necrosis, the neoplastic cells showed cytologic spectrum predominantly medium-sized cells. The immunohistochemical analysis was positive for LCA, CD3 granzyme B, CD43, CD45RO, CD30, CD56, Ki-67 and CD34, leading to
e50
Abstracts
PREVALENCE OF ORAL CANDIDIASIS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS Leite CA1,2, Galera MF3, Silva OG1, Fernandes V1, Lima PRTL1, Briezinski JP1, Dias EP2 - 1UNIVERSIDADE DE CUIABÁ, UNIC CUIABÁ/MT, 2UNIVERSIDADE FEDERAL FLUMINENSE, UFF - NITERÓI/RJ, 3UNIVERSIDADE FEDERAL DE MATO GROSSO, UFMT Background: Systemic lupus erythematosus (SLE) is an autoimmune disease and these patients have an increased risk for infection due the treatment with immunosuppressives. Aim: Determine the prevalence of oral candidiasis in patients with systemic SLE using oral cytopathology. Study design: Prospective observational study with 43 patients. Clinic examination was realized, scraps from the lesions and on lateral borders of the tongue were obtained, fixed and stained by Papanicolaou and PAS technique. Results: Oral candidiasis (OC) were found in 54% of the evaluations. Sites affected: lateral borders of the tongue (70%), palate (20%), other sites (10%). (26%) were associated with prosthesis. All cases of OC in lateral border of tongue, patients had no lesions clinically detected. Conclusion: OC is a frequent diagnosis (54%) in patients with SLE. Cytopathology was an effective method in the diagnosis of infections, especially oral candidiasis, in patients with or without clinically detectable lesions.
FREQUENCY OF ORAL SQUAMOUS CELL CARCINOMA AND ORAL EPITHELIAL DYSPLASIA: IREPO, UNIVERSITY OF CHILE, 1990-2009 Adorno D1, Martínez C1, Hernández M1 - 1UNIVERSITY OF CHILE - PATOLOGY Objective: To determinate the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral mucosa from Chilean population. Study design: This is a descriptive study from Chilean population between 1990 and 2009. A total of 399 cases were selected according to their histopathological diagnosis, this is hyperkeratosis, oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma. Data was analyzed with the software Sysat 13. Results: Most of the cases turned out to be squamous cell carcinoma (44.1%), which is first recognize clinically as cancer (78.41%), followed by hyperkeratosis (36.8%) and mild epithelial dysplasia (10.5%), which are clinically diagnosed as leukoplakia. Conclusions: Oral cancer is diagnosed mainly when their classical characteristics are already present, therefore early diagnosis should improve.
CHLOROQUINE-INDUCED ORAL PIGMENTATION MISDIAGNOSED AS MELANOMA Pereira DL1, Duarte NT1, Verrone JR1, Lopes RN1, Jaguar GC1, Alves FA1,2 1 HOSPITAL AC CAMARGO - STOMATOLOGY, 2FOUSP STOMATOLOGY Chloroquine is an antimalarial drug considered a diseasemodifying, which has also been used for decades in the treatment of lupus erythematosus and rheumatoid arthritis. It is indicated when anti-inflammatory non-steroids appears ineffective in the treatment of symptoms of rheumatic diseases. A 70 year-old-man was referred to suspicion of melanoma. His medical history revealed rheumatoid arthritis treated by chlo-
October 2012 roquine for 10 years. On physical examination was observed pigmented macules in the arm and leg. Intra-oral exam showed pigmented macules-irregularly shaped in the hard palate surface. The diagnosis of chloroquine-induced oral pigmentation was performed according to medical history and clinical features. The chosen treatment was conservative and the patient was instructed to follow sporadically in our department. These drugs may have reversible side effects witch can solve with the discontinuity of the drug. Therefore, the knowledge of this clinical manifestation is important to the differential diagnosis of melanoma.
EXPRESSION IMMUNOHISTOCHEMISTRY OF PROTEIN GLUT-1 AND HIF-1␣ IN VASCULAR LESIONS OF ORAL MUCOSA Oliveira DHIP1, Silveira EJD1, Medeiros AMC1, Andrade ALDL1, Vasconcelos RC1, Oliveira PT2, Queiroz LMG1 - 1UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE - PROGRAMA DE PÓS-GRADUAÇÃO EM PATOLOGIA ORAL, 2UNIVERSIDADE FEDERAL DO RIO GRANDE DO NORTE - ODONTOLOGIA Background: The correct histological diagnosis of vascular lesions in the oral mucosa is critical. Objectives: Investigate the accuracy immunohistochemical expression of GLUT-1 to reclassify vascular lesions. In addition, evaluated the immunohistochemical expression of HIF-1␣. Study design: Analyzed 30 cases with histological diagnosis of hemangioma (HEM) and 30 cases of oral pyogenic granuloma (PG). Results: Of the 30 lesions initially classified as HEM, only 7 showed immuno-positivity for GLUT-1, remaining with the initial diagnosis. The remaining 23 were reclassified as vascular malformation (VM) (13 cases) and PG (10 cases). All cases with an initial diagnosis of PG were negative for GLUT-1. Concerning to the immunoexpression of HIF-1␣, the Mann-Whitney test revealed a statistically significant difference between the cases of GP and MV (p⬍0,05%). Conclusion: So, this study showed that a histological diagnosis alone is not always sufficient for the correct diagnosis and that HIF-1␣ participates in the pathogenesis of vascular lesions.
EXTRANODAL NATURAL KILLER (NK)/T-CELL LYMPHOMA, NASAL TYPE: CASE REPORT Guimarães DM1, FONSECA FP2, PAVANELLO KC1, BRAZAO SILVA MT, PONTES FSC3, PONTES HAR3 - 1UNIVERSIDADE DE SAO PAULO, 2UNIVERSIDADE ESTADUAL DE CAMPINAS, 3 UNIVERSIDADE FEDERAL DO PARA Extranodal natural killer (NK)/T-cell lymphoma (ENKTL), nasal type is recognized as a unique clinicopathologic sub type of non-Hodgkin’s lymphoma (NHL), is a rare disease occurring in adults, with a male predominance. with prevalence in Asians, Mexicans, Central and South Americans of American Indian descent. It is universally associated with EBV, and genetic factors play a role in susceptibility to the disease. ENKTL is generally considered to be a very aggressive lymphoma. This work reports a case of 42 years old female, with chef complain gingival bleeding being diagnosed initially as aggressive periodontitis. The incisional biopsy revealed a variable lymphoid infiltrate with subtle-to-extensive necrosis, the neoplastic cells showed cytologic spectrum predominantly medium-sized cells. The immunohistochemical analysis was positive for LCA, CD3 granzyme B, CD43, CD45RO, CD30, CD56, Ki-67 and CD34, leading to