- Email: [email protected]
DIAGNOSIS AND TREATMENT OF AN UNUSUAL CICATRICIAL PEMPHIGOID: CASE REPORT
OOOO Volume 129, Number 1 Desmoplastic fibroma (DF) is a rare benign myofibroblastic tumor with a locally aggressive behavior and high recurrence rate. We describe a case of DF in a 27-year-old woman presenting a painful, soft exophytic lesion on the mandible with approximately 7 months of evolution. Panoramic radiograph showed a radiolucent unilocular lesion with sclerotic borders involving teeth 44, 45, and 47. Clinical diagnosis was ossifying fibroma, and incisional biopsy was performed. Histopathologic analysis revealed a neoplasm characterized by proliferation of round, ovoid, and spindle-shaped mesenchymal cells with indistinct borders and no atypia. Intense deposition of collagen fibers, interspersed with areas of low-to-moderate cellularity, were also found. Neoplastic cells showed immunopositivity for a smooth muscle actin, S-100, synaptophysin, neuron-specific enolase, and Ki-67 but no immunoexpression of desmin. The patient was referred for tumor excision. This case reinforces the importance of associating clinical, radiographic, histopathologic, and immunohistochemical findings for the correct diagnosis and management of DF.
PRIMARY ORAL SOFT TISSUE ANGIOSARCOMA OF ORAL CAVITY IN A YOUNG PATIENT: CASE REPORT. FILIPE NOBRE CHAVES, MARCELO BONIFACIO DA SILVA SAMPIERI, DENISE HELEN IMACULADA PEREIRA DE OLIVEIRA, FRANCISCO SAMUEL RODRIGUES CARVALHO, MARIO ROGERIO LIMA MOTA, ANA PAULA NEGREIROS NUNES ALVES and, KARUZA MARIA ALVES PEREIRA Angiosarcoma is a rare and aggressive malignant tumor that has a poor prognosis and occurs predominantly in elderly patients, usually in the trunk and limb region. It represents less than 1% of all malignant tumors occurring in the oral cavity. A 31-year-old man presented an extensive sessile nodule, which was asymptomatic and erythematous in the alveolar ridge extending to hard palate. Histologically, the tumor consisted of spindle and polygonal cells with hyperchromatic nuclei and prominent nucleoli. These cells are sometimes arranged in a stent-shaped pattern or form numerous vascular structures of varying calibers. The tumor had invasion in the surrounding tissue, and lymphovascular permeation was noted. Grocott staining was negative. Immunohistochemically, tumor cells were positive for CD34 in vessels and scattered cells, with Friend leukemia integration site 1 in spindle cells and Ki-67 labeling greater than 15%, concluding the pathologic diagnosis of angiosarcoma. Metastatic lesions are found in upper limbs and thorax. Radical surgery is now planned associated with chemotherapy.
CHORISTOMAS OF THE TONGUE: A SERIES OF 5 NEW CASES. MARIENE DA SILVA MONTEIRO, THAMYRES CAMPOS ^ CA, THAMIRIS DE CASTRO ABRANTES, FONSE MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MARIO JOSE e e ^ A ABRAHAO ROMANACH and, ALINE CORRE Choristoma is a mass of normal tissue in an abnormal location that occasionally may affect the oral cavity, particularly as tumor-like proliferation of osseous and cartilaginous tissues in the tongue. We contribute with 5 new cases of choristomas of the tongue. There were 2 female patients and 3 male patients, with mean age of 34 years. Lesions appeared as small, smooth-
ABSTRACTS
e101
surfaced, and normal-colored nodules; were hard-to-soft in consistency; and were mainly located in the dorsum (3 cases), base (1 case), and lateral border (1 case) of the tongue. Conservative surgical excision was performed in all cases. Microscopically, 4 cases were classified as osseous choristomas and 1 case as sebaceous choristoma of the tongue. Recurrence was not observed after follow-up from 0.5 to 4 years. Choristomas of the tongue are uncommon, being usually characterized by the occurrence of osseous tissues as a hardened small nodule in the dorsal tongue of young adults.
DIAGNOSIS AND TREATMENT OF AN UNUSUAL CICATRICIAL PEMPHIGOID: CASE REPORT. ELOA BORGES LUNA, e THAYLLA NUNEZ AMIN DICK, BRUNA LAVINAS SAYED PICCIANI, ARLEY SILVA JUNIOR, ELIANE PEDRA DIAS, DANIELLE CASTEX CONDE and, RAFAELA ELVIRA ROZZA-DE-MENEZES Cicatricial pemphigoid is a chronic autoimmune blistering disease in which autoantibodies are produced against the basement membrane zone (BMZ). A 65-year-old black man was referred by the dermatology clinic to our oral diagnostic clinic, complaining of a lip painful ulcer with 2 years of evolution. There was a previous biopsy, but the histopathologic analysis was inconclusive. Oral examination revealed an ulcer covered by a pseudomembrane on the lower lip measuring 2 cm. He had no other lesions. The hypotheses were pemphigus vulgaris, squamous cell carcinoma associated with actinic cheilitis, and actinic prurigo. An incisional biopsy was performed, and the histopathologic analysis revealed cicatricial pemphigoid. Indirect immunofluorescence showed linear deposits of IgG, IgA, IgM, and C3 along the BMZ. The use of topical and systemic corticoids associated with low-level laser therapy provided a complete remission of the lesion in 3 months. The patient is being followed-up for 1 month without recurrence.
EPIDERMOID CYST OF THE BUCCAL REGION OF THE FACE. PAULA HELENA DE ^ NIO ARANTES, ACCIOLY COSTA, EUGE ^ CA, MARCIA THAMYRES CAMPOS FONSE GRILLO e CABRAL, MARIO JOSE ROMANACH, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, ALINE e ^ A ABRAHAO CORRE Epidermoid cyst is a common cutaneous cyst that occasionally affects the oral cavity. A 52-year-old black woman presented a subcutaneous well-defined swelling in the right cheek, which caused considerable facial asymmetry with duration of 15 years. The lesion was asymptomatic, was firm in consistency, and measured 5 cm. Intraoral examination showed a submucosal nodule in the buccal mucosa. Intraoral conservative surgical removal was performed and grossly, a brownish fragment of irregular cut surface was observed. Microscopic evaluation showed a cystic cavity filled by keratin and lined by orthokeratinized stratified squamous epithelium with highly pigmented basal cells, suggesting origin from the entrapment of the superficial pigmented epithelium of the skin face. The final diagnosis was epidermal cyst of the face with extension to the buccal mucosa. Exuberant epidermal cyst may cause facial asymmetry, and intraoral surgical approach may be required to avoid postsurgical esthetic concerns.
PRIMARY ORAL SOFT TISSUE ANGIOSARCOMA OF ORAL CAVITY IN A YOUNG PATIENT: CASE REPORT. FILIPE NOBRE CHAVES, MARCELO BONIFACIO DA SILVA SAMPIERI, DENISE HELEN IMACULADA PEREIRA DE OLIVEIRA, FRANCISCO SAMUEL RODRIGUES CARVALHO, MARIO ROGERIO LIMA MOTA, ANA PAULA NEGREIROS NUNES ALVES and, KARUZA MARIA ALVES PEREIRA Angiosarcoma is a rare and aggressive malignant tumor that has a poor prognosis and occurs predominantly in elderly patients, usually in the trunk and limb region. It represents less than 1% of all malignant tumors occurring in the oral cavity. A 31-year-old man presented an extensive sessile nodule, which was asymptomatic and erythematous in the alveolar ridge extending to hard palate. Histologically, the tumor consisted of spindle and polygonal cells with hyperchromatic nuclei and prominent nucleoli. These cells are sometimes arranged in a stent-shaped pattern or form numerous vascular structures of varying calibers. The tumor had invasion in the surrounding tissue, and lymphovascular permeation was noted. Grocott staining was negative. Immunohistochemically, tumor cells were positive for CD34 in vessels and scattered cells, with Friend leukemia integration site 1 in spindle cells and Ki-67 labeling greater than 15%, concluding the pathologic diagnosis of angiosarcoma. Metastatic lesions are found in upper limbs and thorax. Radical surgery is now planned associated with chemotherapy.
CHORISTOMAS OF THE TONGUE: A SERIES OF 5 NEW CASES. MARIENE DA SILVA MONTEIRO, THAMYRES CAMPOS ^ CA, THAMIRIS DE CASTRO ABRANTES, FONSE MICHELLE AGOSTINI, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MARIO JOSE e e ^ A ABRAHAO ROMANACH and, ALINE CORRE Choristoma is a mass of normal tissue in an abnormal location that occasionally may affect the oral cavity, particularly as tumor-like proliferation of osseous and cartilaginous tissues in the tongue. We contribute with 5 new cases of choristomas of the tongue. There were 2 female patients and 3 male patients, with mean age of 34 years. Lesions appeared as small, smooth-
ABSTRACTS
e101
surfaced, and normal-colored nodules; were hard-to-soft in consistency; and were mainly located in the dorsum (3 cases), base (1 case), and lateral border (1 case) of the tongue. Conservative surgical excision was performed in all cases. Microscopically, 4 cases were classified as osseous choristomas and 1 case as sebaceous choristoma of the tongue. Recurrence was not observed after follow-up from 0.5 to 4 years. Choristomas of the tongue are uncommon, being usually characterized by the occurrence of osseous tissues as a hardened small nodule in the dorsal tongue of young adults.
DIAGNOSIS AND TREATMENT OF AN UNUSUAL CICATRICIAL PEMPHIGOID: CASE REPORT. ELOA BORGES LUNA, e THAYLLA NUNEZ AMIN DICK, BRUNA LAVINAS SAYED PICCIANI, ARLEY SILVA JUNIOR, ELIANE PEDRA DIAS, DANIELLE CASTEX CONDE and, RAFAELA ELVIRA ROZZA-DE-MENEZES Cicatricial pemphigoid is a chronic autoimmune blistering disease in which autoantibodies are produced against the basement membrane zone (BMZ). A 65-year-old black man was referred by the dermatology clinic to our oral diagnostic clinic, complaining of a lip painful ulcer with 2 years of evolution. There was a previous biopsy, but the histopathologic analysis was inconclusive. Oral examination revealed an ulcer covered by a pseudomembrane on the lower lip measuring 2 cm. He had no other lesions. The hypotheses were pemphigus vulgaris, squamous cell carcinoma associated with actinic cheilitis, and actinic prurigo. An incisional biopsy was performed, and the histopathologic analysis revealed cicatricial pemphigoid. Indirect immunofluorescence showed linear deposits of IgG, IgA, IgM, and C3 along the BMZ. The use of topical and systemic corticoids associated with low-level laser therapy provided a complete remission of the lesion in 3 months. The patient is being followed-up for 1 month without recurrence.
EPIDERMOID CYST OF THE BUCCAL REGION OF THE FACE. PAULA HELENA DE ^ NIO ARANTES, ACCIOLY COSTA, EUGE ^ CA, MARCIA THAMYRES CAMPOS FONSE GRILLO e CABRAL, MARIO JOSE ROMANACH, BRUNO AUGUSTO BENEVENUTO DE ANDRADE and, ALINE e ^ A ABRAHAO CORRE Epidermoid cyst is a common cutaneous cyst that occasionally affects the oral cavity. A 52-year-old black woman presented a subcutaneous well-defined swelling in the right cheek, which caused considerable facial asymmetry with duration of 15 years. The lesion was asymptomatic, was firm in consistency, and measured 5 cm. Intraoral examination showed a submucosal nodule in the buccal mucosa. Intraoral conservative surgical removal was performed and grossly, a brownish fragment of irregular cut surface was observed. Microscopic evaluation showed a cystic cavity filled by keratin and lined by orthokeratinized stratified squamous epithelium with highly pigmented basal cells, suggesting origin from the entrapment of the superficial pigmented epithelium of the skin face. The final diagnosis was epidermal cyst of the face with extension to the buccal mucosa. Exuberant epidermal cyst may cause facial asymmetry, and intraoral surgical approach may be required to avoid postsurgical esthetic concerns.