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HEAD AND NECK AMYLOIDOSIS AS THE FIRST MANIFESTATION OF MULTIPLE MYELOMA—A CASE REPORT
ABSTRACTS
e104
part in the rehabilitation of patients who underwent mutilating surgical treatments.
CHONDROLIPOMA IN AN UNCOMMON LOCATION: CASE REPORT. KHALIL FERNANDES VIANA, ERASMO BERNARDO MARINHO, STHEFANE GOMES FEITOSA, ROBERTA BARROSO CAVALCANTE, EVELINE TURATTI, FABRICIO BITU SOUSA and, KARUZA MARIA ALVES PEREIRA Chondrolipoma is a benign mesenchymal tumor that may occur anywhere in the body, such as soft tissues of the skeletal system, but is rarely seen in oral cavity. This lesion is a rare histologic variant of the lipoma with uncertain pathogenesis. A 68-year-old woman presented a nodule that was sessile, erythematous, and measured 1 cm in the region of the middle line in the upper alveolar ridge with complaint of painful symptomatology and bleeding, associated with the use of poorly adapted upper prosthesis. Excisional biopsy was performed and histopathologic examination revealed a proliferation of mature adipocytes interspersed with myxoid connective tissue with focus of cartilaginous tissue, being conclusive as a chondrolipoma. The histopathologic diagnosis of chondrolipoma is determinant, especially in a lesion in an unusual location. The treatment of choice for these tumors consists of surgical excision. The patient is under follow-up with no recurrence of the lesion during a 1-year follow-up period.
DENTAL CARE TO PATIENTS WITH RARE CLINICAL FIDINGS OF GOLTZ SYNDROME—CASE REPORT. LIA DE VASCONCELOS ROCHA, JOSE VITOR MOTA LEMOS, e e IANA ARAGAO MAGALHAES, JULIANA XIMENES DAMASCENO, MARILIA LEITE DIAS, THALES SALLES ANGELIM VIANA and, ANYA PIMENTEL GOMES FERNANDES VIEIRA MEYER Goltz syndrome or focal dermal hypoplasia is a rare hereditary genetic disease of the dominant X chromosome. Multisystemic manifestations of a wide phenotypic variety with involvement of the maxillomandibular region are observed. A 6-year-old female patient with the syndrome sought a specialized dental service, presenting as main complaint the need for dental treatment for extensive carious lesions. Physical and intraoral examination showed delayed tooth eruption, agenesis, enamel hypoplasia, and atypical anatomy of the teeth as well as unusual clinical findings of the syndrome, such as abnormal tongue morphology and cleft lip and palate. Occlusal and panoramic radiographies were performed. The care plan began with health promotion, followed by instruction in oral hygiene for parents and children, prophylaxis, topical application of fluoride, restorative treatments, exodontia, and laser therapy. Management techniques such as positive reinforcement, voice control, say-show-making, and awards were used. Currently, the patient is being followed up.
FACTITIOUS CHEILITS: A CASE REPORT. LETICIA ALMEIDA OLIVEIRA, PAULA LIMA FREITAS, LETICIA ALECRIM DE SOUZA, LIGIA GONZAGA FERNANDES, KARINE CARLI FRANK, VICTOR PEREZ TEIXEIRA and, JOSE NARCISO ROSA e JUNIOR ASSUNC ¸ AO A 24-year-old white man, nonsmoker and nonalcoholic, presented to the stomatology ambulatory department with the
OOOO January 2020 complaint of desquamation on his lips that started 9 years ago. On intraoral examination, lesions were observed in all extension of the upper and lower lips, sometimes of yellowish color, sometimes whitish, with painless and crusted areas. He reported putting his lips between his teeth in a chronic way and a habit of nibbling. The patient performed previous topical treatments without resolution of the condition. After an incisional biopsy with results that showed an unspecific chronic inflammatory process and the associated clinical examination, the final diagnosis was factitious cheilitis. After diagnosis, manipulated topical treatment of 9 g Vaseline + 1 g lanolin + 2 g glycerin, in gel, was instituted for 2 months, and total lesion regression was observed. The patient has been followed up for 6 months, evolving with normal aspects in the labial mucosa.
INTRAOSSEOUS SYNOVIAL SARCOMA OF THE MANDIBLE: A CASE REPORT. EVELIN JANNER, EDUARDO ZAMBALDI DA CRUZ, ANDERSON ABDO RODRIGUES, LUCAS NOVAES TEIXEIRA, ANA CLAUDIA GARCIA ROSA, FABRICIO PASSADOR-SANTOS and, VERA CAVALCANTI DE ARAUJO A 22-year-old man reported a painful swelling on the left side of the mandible for the last 7 months. The patient was otherwise healthy. Radiologic features revealed an extensive multilocular radiolucency involving the left side of the body and ramus of the mandible. Microscopic examination showed a fragment of neoplasm composed by areas with different levels of cellularity. The neoplastic cells exhibited a fusiform morphology with vesicular nuclei and evident nucleolus. Immunohistochemistry analysis revealed that neoplastic cells were positive for cytokeratins (AE1/AE3, focal areas), cytokeratin 7 (focal areas), vimentin (diffusely), CD-99 (focal areas), transducin-like enhancer protein 1 (TLE-1, diffusely) and negative for CD-34, S-100, smooth muscle actin, and HHF-35. These findings in combination supported the diagnosis of synovial sarcoma. The patient was referred for treatment, and hemimandibulectomy on the left side with wide surgical margins is the surgical approach planned.
HEAD AND NECK AMYLOIDOSIS AS THE FIRST MANIFESTATION OF MULTIPLE MYELOMA—A CASE REPORT. PAOLA ARISTIZABAL ARBOLEDA, NATALIA RANGEL PALMIER, JESSICA MONTENEGRO FONSECA, ISADORA FERRARI TEIXEIRA, PABLO AGUSTIN VARGAS, MARCIO AJUDARTE LOPES and, ALAN ROGER DOS SANTOSSILVA A 76-year-old man with medical history of anemia was referred for clinical investigation of hoarseness and dysphagia over the last 2 years. Extraoral head and neck examination revealed diffuse hardened skin. Intraoral examination revealed macroglossia with restricted tongue movement and hardening of the lower lip mucosa. Digital panoramic radiograph revealed discreet radiolucent areas affecting the mandible. Incisional biopsy was performed under local anesthesia on the tongue and lower lip. Histopathologic analysis revealed a deposition of hyaline material, mainly surrounding minor salivary glands. Congo red histochemical stain showed apple-green birefringence under polarized light microscopy, confirming the diagnosis of amyloidosis. Laboratory examinations were performed, and the patient was referred to a hematooncologist, who confirmed the diagnosis
OOOO Volume 129, Number 1 of multiple myeloma. This report emphasizes the importance of dentists in the diagnoses of systemic conditions, such as primary amyloidosis due to multiple myeloma.
ATYPICAL FIBROUS DYSPLASIA—CASE REPORT. MARIANA CAMPELLO NUNES, FABIANE MARQUES DOS SANTOS FREIRE, JOYCE BARBOSA, CARLOS HENRIQUE COSTA BAPTISTA DE MELLO, VALDIR MEIRELLES and, MARIA ELISA RANGEL JANINI MJC, 56-year-old woman with melanoderma, attended the clinic of stomatology to evaluate the increase of volume in the jaw discovered in routine examination. The intraoral examination found a volume increase in mandible body region of molars in the lingual face, which was painless and covered by an integrated and normochromic mucosa. The diagnostic hypotheses were fibro-osseous lesion and osteoma. A cone beam computed tomography was performed, where a mixed-aspect image with expansion and preservation of the cortical bone was observed. It was also possible to observe that the base of bone implantation of the lesion was pediculated. An incisional biopsy was performed with osteoplasty. The fragments were sent for histopathologic examination. The report was of fibrous dysplasia, with an extremely atypical clinical and radiographic aspect. The patient continues to be clinically and radiographically asymptomatic, with no complaints, signs of exacerbation of the condition, or involvement of other skeletal bones.
ORAL METASTASIS OF RENAL CELL CARCINOMA. BARBARA BARRETO PACHECO VALENTIM, GUILHERME LIMA, ALINE e ^ A ABRAHAO, CORRE NATHALIE HENRIQUES SILVA CANEDO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MICHELLE AGOSTINI and, MARIO JOSE e ROMANACH Renal cell carcinoma (RCC) is the third most common neoplasm to metastasize to the oral cavity, eventually as the first manifestation of the disease. An otherwise healthy 76-year-old man was referred for evaluation of a 5 £ 4 cm reddish, lobulated, and ulcerated mass located in the upper posterior gingiva. A well-defined lytic lesion in the left maxilla was revealed by computerized tomography. Microscopic examination revealed sheets of neoplastic clear cells arranged in an alveolar pattern, with many central blood vessels. Tumor cells were positive for CD10 and epithelial membrane antigen and negative for CK7, CK20, and vimentin. The final diagnosis was oral metastasis of RCC. The patient was referred to an oncologist for clinical and imaging check-up, which showed uptake in the liver and kidney. RCC was confirmed after incisional biopsy of the kidney. Gingival metastasis of RCC may present as a clear cell tumor in patients who are unaware of their cancer.
A RARE CASE OF ORAL SARCOMA: CLINICAL AND HISTOPATHOLOGIC CHALLENGE. THAIS GIMENEZ MINIELLO, RENNAN LUIZ OLIVEIRA DOS SANTOS, ROSANE TRONCHIN GALLO, LARA CRISTINA OLIVER GIMENEZ, FABIO DAUMAS NUNES, ANDRE CAROLI ROCHA and, NORBERTO NOBUO SUGAYA
ABSTRACTS
e105
A 75-year-old woman presented to the clinic complaining of a progressive, painless, nodular growth in the right anterior portion of her mandible with 1-year duration. Diabetes was the only remark in her medical history. The extraoral examination perceived growth was palpable intraorally showing rubbery consistency, no pain, and no changes in mucosal lining. Radiographs showed no bone damage. A working diagnosis of myofibroblastic tumor was inconclusive on morphologic and immunohistochemical basis. Second biopsy results allowed a suggestion of an ossifying fibromyxoid tumor. Nevertheless, the patient presented pain and a new overgrowth leading to a hospital referral. A wider surgical intervention showed an infiltrative behavior of the tumor, and another microscopic study concluded it was a highgrade osteoblastic sarcoma. The patient underwent hemimandibular resection and radiotherapy. She is currently under clinical and radiographic monitoring.
CASE REPORT: KAPOSI SARCOMA IN AN HIV-POSITIVE PATIENT. RACHEL LAMARCK, ANDERSON MAURICIO PAIVA E COSTA, RAIRA DE BRITO SILVA, SAMEH BRGLAH, LIGIA AKIKO NINOKATA MIYAHARA, PRISCILLA FLORES SILVA ^ GONCALVES ¸ and, DR. HELDER ANTONIO REBELO PONTES Kaposi sarcoma (KS) is a malignant vascular neoplasia with occurrence in 15% to 20% of patients with AIDS. It presents multiple macules and purple papules on the skin. Treatment depends on subtype and disease stage, with variable prognosis. Oral lesions are rare. A 31-year-old male patient was attended with a 6-month painless, erythematous, exophytic, bleeding lesion with variable surface texture located in the hard palate, soft palate, and alveolar ridge. He also presented skin patches, left eye lesion, and weight loss of 20 kg in 2 months. The diagnosis was confirmed through histopathologic examination and blood test. The patient was HIV-positive but unaware of it. Treatment was made with antiretroviral medication and 12 sessions of chemotherapy with great improvement in lesion size and weight gain. The diagnosis and treatment of this lesion depends on the immune state of the patient; therefore, a systemic approach is essential for a better understanding of oral pathologies.
ORAL LEUKOPLAKIA: A DIFFERENT CASE REPORT. HERIKA CRISTINA SILVA DE SOUZA, BRUNO AUGUSTO BENEVENUTO e DE ANDRADE, MARIO JOSE ROMANACH GONZALEZ SOBRINHO, BIANCA ZACHARIAS FORTUNATO, SILVIA PAULA DE OLIVEIRA, ALESSANDRA OLIVEIRA FERRARI GOMES and, LUISA AGUIRRE BUEXM Oral leukoplakia is a potentially malignant lesion characterized by plaques or white patches that cannot be rubbed off. It presents higher prevalence in men, those older than 40 years, and smokers. Surgical treatment must be performed when moderate to intense epithelial dysplasia is present. A male patient who was 87 years old and a nonsmoker sought dental care complaining of "discomfort caused by prosthesis." Intraoral examination showed a poorly adapted upper prosthesis. There was in the upper right buccal vestibule, extending to buccal mucosa, a heterogeneous white plaque, asymptomatic and unique, which could not be scraped off. The toluidine blue test was performed, which guided the site of incisional biopsy. Hypothesis of clinical diagnosis was
e104
part in the rehabilitation of patients who underwent mutilating surgical treatments.
CHONDROLIPOMA IN AN UNCOMMON LOCATION: CASE REPORT. KHALIL FERNANDES VIANA, ERASMO BERNARDO MARINHO, STHEFANE GOMES FEITOSA, ROBERTA BARROSO CAVALCANTE, EVELINE TURATTI, FABRICIO BITU SOUSA and, KARUZA MARIA ALVES PEREIRA Chondrolipoma is a benign mesenchymal tumor that may occur anywhere in the body, such as soft tissues of the skeletal system, but is rarely seen in oral cavity. This lesion is a rare histologic variant of the lipoma with uncertain pathogenesis. A 68-year-old woman presented a nodule that was sessile, erythematous, and measured 1 cm in the region of the middle line in the upper alveolar ridge with complaint of painful symptomatology and bleeding, associated with the use of poorly adapted upper prosthesis. Excisional biopsy was performed and histopathologic examination revealed a proliferation of mature adipocytes interspersed with myxoid connective tissue with focus of cartilaginous tissue, being conclusive as a chondrolipoma. The histopathologic diagnosis of chondrolipoma is determinant, especially in a lesion in an unusual location. The treatment of choice for these tumors consists of surgical excision. The patient is under follow-up with no recurrence of the lesion during a 1-year follow-up period.
DENTAL CARE TO PATIENTS WITH RARE CLINICAL FIDINGS OF GOLTZ SYNDROME—CASE REPORT. LIA DE VASCONCELOS ROCHA, JOSE VITOR MOTA LEMOS, e e IANA ARAGAO MAGALHAES, JULIANA XIMENES DAMASCENO, MARILIA LEITE DIAS, THALES SALLES ANGELIM VIANA and, ANYA PIMENTEL GOMES FERNANDES VIEIRA MEYER Goltz syndrome or focal dermal hypoplasia is a rare hereditary genetic disease of the dominant X chromosome. Multisystemic manifestations of a wide phenotypic variety with involvement of the maxillomandibular region are observed. A 6-year-old female patient with the syndrome sought a specialized dental service, presenting as main complaint the need for dental treatment for extensive carious lesions. Physical and intraoral examination showed delayed tooth eruption, agenesis, enamel hypoplasia, and atypical anatomy of the teeth as well as unusual clinical findings of the syndrome, such as abnormal tongue morphology and cleft lip and palate. Occlusal and panoramic radiographies were performed. The care plan began with health promotion, followed by instruction in oral hygiene for parents and children, prophylaxis, topical application of fluoride, restorative treatments, exodontia, and laser therapy. Management techniques such as positive reinforcement, voice control, say-show-making, and awards were used. Currently, the patient is being followed up.
FACTITIOUS CHEILITS: A CASE REPORT. LETICIA ALMEIDA OLIVEIRA, PAULA LIMA FREITAS, LETICIA ALECRIM DE SOUZA, LIGIA GONZAGA FERNANDES, KARINE CARLI FRANK, VICTOR PEREZ TEIXEIRA and, JOSE NARCISO ROSA e JUNIOR ASSUNC ¸ AO A 24-year-old white man, nonsmoker and nonalcoholic, presented to the stomatology ambulatory department with the
OOOO January 2020 complaint of desquamation on his lips that started 9 years ago. On intraoral examination, lesions were observed in all extension of the upper and lower lips, sometimes of yellowish color, sometimes whitish, with painless and crusted areas. He reported putting his lips between his teeth in a chronic way and a habit of nibbling. The patient performed previous topical treatments without resolution of the condition. After an incisional biopsy with results that showed an unspecific chronic inflammatory process and the associated clinical examination, the final diagnosis was factitious cheilitis. After diagnosis, manipulated topical treatment of 9 g Vaseline + 1 g lanolin + 2 g glycerin, in gel, was instituted for 2 months, and total lesion regression was observed. The patient has been followed up for 6 months, evolving with normal aspects in the labial mucosa.
INTRAOSSEOUS SYNOVIAL SARCOMA OF THE MANDIBLE: A CASE REPORT. EVELIN JANNER, EDUARDO ZAMBALDI DA CRUZ, ANDERSON ABDO RODRIGUES, LUCAS NOVAES TEIXEIRA, ANA CLAUDIA GARCIA ROSA, FABRICIO PASSADOR-SANTOS and, VERA CAVALCANTI DE ARAUJO A 22-year-old man reported a painful swelling on the left side of the mandible for the last 7 months. The patient was otherwise healthy. Radiologic features revealed an extensive multilocular radiolucency involving the left side of the body and ramus of the mandible. Microscopic examination showed a fragment of neoplasm composed by areas with different levels of cellularity. The neoplastic cells exhibited a fusiform morphology with vesicular nuclei and evident nucleolus. Immunohistochemistry analysis revealed that neoplastic cells were positive for cytokeratins (AE1/AE3, focal areas), cytokeratin 7 (focal areas), vimentin (diffusely), CD-99 (focal areas), transducin-like enhancer protein 1 (TLE-1, diffusely) and negative for CD-34, S-100, smooth muscle actin, and HHF-35. These findings in combination supported the diagnosis of synovial sarcoma. The patient was referred for treatment, and hemimandibulectomy on the left side with wide surgical margins is the surgical approach planned.
HEAD AND NECK AMYLOIDOSIS AS THE FIRST MANIFESTATION OF MULTIPLE MYELOMA—A CASE REPORT. PAOLA ARISTIZABAL ARBOLEDA, NATALIA RANGEL PALMIER, JESSICA MONTENEGRO FONSECA, ISADORA FERRARI TEIXEIRA, PABLO AGUSTIN VARGAS, MARCIO AJUDARTE LOPES and, ALAN ROGER DOS SANTOSSILVA A 76-year-old man with medical history of anemia was referred for clinical investigation of hoarseness and dysphagia over the last 2 years. Extraoral head and neck examination revealed diffuse hardened skin. Intraoral examination revealed macroglossia with restricted tongue movement and hardening of the lower lip mucosa. Digital panoramic radiograph revealed discreet radiolucent areas affecting the mandible. Incisional biopsy was performed under local anesthesia on the tongue and lower lip. Histopathologic analysis revealed a deposition of hyaline material, mainly surrounding minor salivary glands. Congo red histochemical stain showed apple-green birefringence under polarized light microscopy, confirming the diagnosis of amyloidosis. Laboratory examinations were performed, and the patient was referred to a hematooncologist, who confirmed the diagnosis
OOOO Volume 129, Number 1 of multiple myeloma. This report emphasizes the importance of dentists in the diagnoses of systemic conditions, such as primary amyloidosis due to multiple myeloma.
ATYPICAL FIBROUS DYSPLASIA—CASE REPORT. MARIANA CAMPELLO NUNES, FABIANE MARQUES DOS SANTOS FREIRE, JOYCE BARBOSA, CARLOS HENRIQUE COSTA BAPTISTA DE MELLO, VALDIR MEIRELLES and, MARIA ELISA RANGEL JANINI MJC, 56-year-old woman with melanoderma, attended the clinic of stomatology to evaluate the increase of volume in the jaw discovered in routine examination. The intraoral examination found a volume increase in mandible body region of molars in the lingual face, which was painless and covered by an integrated and normochromic mucosa. The diagnostic hypotheses were fibro-osseous lesion and osteoma. A cone beam computed tomography was performed, where a mixed-aspect image with expansion and preservation of the cortical bone was observed. It was also possible to observe that the base of bone implantation of the lesion was pediculated. An incisional biopsy was performed with osteoplasty. The fragments were sent for histopathologic examination. The report was of fibrous dysplasia, with an extremely atypical clinical and radiographic aspect. The patient continues to be clinically and radiographically asymptomatic, with no complaints, signs of exacerbation of the condition, or involvement of other skeletal bones.
ORAL METASTASIS OF RENAL CELL CARCINOMA. BARBARA BARRETO PACHECO VALENTIM, GUILHERME LIMA, ALINE e ^ A ABRAHAO, CORRE NATHALIE HENRIQUES SILVA CANEDO, BRUNO AUGUSTO BENEVENUTO DE ANDRADE, MICHELLE AGOSTINI and, MARIO JOSE e ROMANACH Renal cell carcinoma (RCC) is the third most common neoplasm to metastasize to the oral cavity, eventually as the first manifestation of the disease. An otherwise healthy 76-year-old man was referred for evaluation of a 5 £ 4 cm reddish, lobulated, and ulcerated mass located in the upper posterior gingiva. A well-defined lytic lesion in the left maxilla was revealed by computerized tomography. Microscopic examination revealed sheets of neoplastic clear cells arranged in an alveolar pattern, with many central blood vessels. Tumor cells were positive for CD10 and epithelial membrane antigen and negative for CK7, CK20, and vimentin. The final diagnosis was oral metastasis of RCC. The patient was referred to an oncologist for clinical and imaging check-up, which showed uptake in the liver and kidney. RCC was confirmed after incisional biopsy of the kidney. Gingival metastasis of RCC may present as a clear cell tumor in patients who are unaware of their cancer.
A RARE CASE OF ORAL SARCOMA: CLINICAL AND HISTOPATHOLOGIC CHALLENGE. THAIS GIMENEZ MINIELLO, RENNAN LUIZ OLIVEIRA DOS SANTOS, ROSANE TRONCHIN GALLO, LARA CRISTINA OLIVER GIMENEZ, FABIO DAUMAS NUNES, ANDRE CAROLI ROCHA and, NORBERTO NOBUO SUGAYA
ABSTRACTS
e105
A 75-year-old woman presented to the clinic complaining of a progressive, painless, nodular growth in the right anterior portion of her mandible with 1-year duration. Diabetes was the only remark in her medical history. The extraoral examination perceived growth was palpable intraorally showing rubbery consistency, no pain, and no changes in mucosal lining. Radiographs showed no bone damage. A working diagnosis of myofibroblastic tumor was inconclusive on morphologic and immunohistochemical basis. Second biopsy results allowed a suggestion of an ossifying fibromyxoid tumor. Nevertheless, the patient presented pain and a new overgrowth leading to a hospital referral. A wider surgical intervention showed an infiltrative behavior of the tumor, and another microscopic study concluded it was a highgrade osteoblastic sarcoma. The patient underwent hemimandibular resection and radiotherapy. She is currently under clinical and radiographic monitoring.
CASE REPORT: KAPOSI SARCOMA IN AN HIV-POSITIVE PATIENT. RACHEL LAMARCK, ANDERSON MAURICIO PAIVA E COSTA, RAIRA DE BRITO SILVA, SAMEH BRGLAH, LIGIA AKIKO NINOKATA MIYAHARA, PRISCILLA FLORES SILVA ^ GONCALVES ¸ and, DR. HELDER ANTONIO REBELO PONTES Kaposi sarcoma (KS) is a malignant vascular neoplasia with occurrence in 15% to 20% of patients with AIDS. It presents multiple macules and purple papules on the skin. Treatment depends on subtype and disease stage, with variable prognosis. Oral lesions are rare. A 31-year-old male patient was attended with a 6-month painless, erythematous, exophytic, bleeding lesion with variable surface texture located in the hard palate, soft palate, and alveolar ridge. He also presented skin patches, left eye lesion, and weight loss of 20 kg in 2 months. The diagnosis was confirmed through histopathologic examination and blood test. The patient was HIV-positive but unaware of it. Treatment was made with antiretroviral medication and 12 sessions of chemotherapy with great improvement in lesion size and weight gain. The diagnosis and treatment of this lesion depends on the immune state of the patient; therefore, a systemic approach is essential for a better understanding of oral pathologies.
ORAL LEUKOPLAKIA: A DIFFERENT CASE REPORT. HERIKA CRISTINA SILVA DE SOUZA, BRUNO AUGUSTO BENEVENUTO e DE ANDRADE, MARIO JOSE ROMANACH GONZALEZ SOBRINHO, BIANCA ZACHARIAS FORTUNATO, SILVIA PAULA DE OLIVEIRA, ALESSANDRA OLIVEIRA FERRARI GOMES and, LUISA AGUIRRE BUEXM Oral leukoplakia is a potentially malignant lesion characterized by plaques or white patches that cannot be rubbed off. It presents higher prevalence in men, those older than 40 years, and smokers. Surgical treatment must be performed when moderate to intense epithelial dysplasia is present. A male patient who was 87 years old and a nonsmoker sought dental care complaining of "discomfort caused by prosthesis." Intraoral examination showed a poorly adapted upper prosthesis. There was in the upper right buccal vestibule, extending to buccal mucosa, a heterogeneous white plaque, asymptomatic and unique, which could not be scraped off. The toluidine blue test was performed, which guided the site of incisional biopsy. Hypothesis of clinical diagnosis was