- Email: [email protected]
INTRANEURAL PERINEURIOMA IN THE LOWER LIP MIMICKING MUCOCELE
OOOO Volume 129, Number 1 COLUSSI, HENRIETTE DE TOLEDO LAGO, RICARDO RAITZ and, REGINA GARCIA DORTA A 51-year-old white man presented with a 3-month history of oral pain. He was edentulous and his intraoral examination revealed a mulberrylike granulomatous lesion on the right superior alveolar ridge and 2 adjacent ulcerations on the right upper lip. Biopsies of the oral lesions were performed revealing a granulomatous inflammatory response positive for Paraccocidioides brasiliensis. Systemic investigation showed pulmonary involvement. He was treated with itraconazole. A synchronous actinic cheilitis was detected. After 12 months of follow-up, a persistent white, rough, scaly area developed on the left vermilion lower lip and an incisional biopsy was performed. Histopathologic analysis demonstrated solar elastosis and superficially invasive squamous cell carcinoma. The patient was referred to a head and neck surgeon and vermilionectomy was the treatment employed. No recurrence was observed after a 7-month follow-up. This case report emphasizes the importance of global clinical evaluation and patient follow-up aiming at early oral lesion diagnosis.
ABSTRACTS
e49
ORTHOKERATINIZED ODONTOGENIC CYST IN AN ADOLESCENT: A CASE REPORT. GEORGIA RIBEIRO MARTINI, BUBACAR JUSSARA MARIA GONCALVES, EMBALO, ¸ PRISCILA SELL, EDUARDO MEURER, ELENA RIET CORREA RIVERO and, ROGERIO OLIVEIRA GONDAK Orthokeratinized odontogenic cyst (OOC) is an uncommon developmental cyst arising from the cell rests of the dental lamina. This report describes a case of OOC involving the right posterior mandible in a 14-year-old female patient. On clinical examination, a painless swelling on right side of face was noted. Panoramic radiography revealed a well-defined multilocular lesion located in the posterior mandible. Provisional diagnosis of odontogenic keratocyst was suggested. An incisional biopsy was performed with marsupialization, and the result was inconclusive. One month later, surgical enucleation of the lesion was performed and sent for histopathologic examination. A diagnosis of OOC was made. Currently the patient is under radiographic observation and without recurrence.
LINGUAL DERMOID CYST: A CASE REPORT WITH HISTOPATHOLOGIC CORRELATION. ^ ELIS ANGELA BATISTELLA, JUSSARA MARIA GONCALVES, ¸ ETIENE MUNHOZ and, ROGERIO GONDAK
TUMOR-ASSOCIATED DENTINOGENIC GHOST CELLS WITH COMPOUND ODONTOMA IN A PEDIATRIC PATIENT: A CASE REPORT. PAMELA OLIVEIRA SANTOS, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO
Dermoid cyst (DC) is an uncommon developmental cystic malformation, lined by epidermislike epithelium containing dermal annexes in the cystic wall. A 76-year-old woman presented with a painless submucosal nodule in the ventral surface of the tongue, right side, measuring 1 £ 1 cm, yellowish in color, with a soft consistency on palpation. A previous aspiration of the lesion revealed clear liquid contents. The patient, who has noticed the lesion in the past 15 days, reported no alcohol or smoking habits. DC, lipoma, and ranula were considered as possible clinical diagnoses. After biopsy, the microscopic examination revealed fragments of cystic capsule lined by a thin, stratified squamous epithelium. The cystic capsule was composed of dense fibrous connective tissue, and the cystic content exhibited an abundant amount of keratin. Minor salivary glands, nerve bundles, and muscular tissue completed the histopathologic diagnosis of a dermoid cyst. The patient remains under follow-up examination.
The present work aims to report a case of dentinogenic ghost cell tumor (DGCT) associated with compound odontoma (CO). An 8-year-old patient was referred to the oral medicine discipline presenting with dental retention. Computerized tomography (CT) scan revealed a well-defined unilocular radiolucent lesion involving an irregular mass, associated with an unerupted permanent upper central incisor (tooth 21). Excisional biopsy was performed. Histopathologic analysis revealed enamel matrix, loose connective tissue resembling dental pulp, enveloped in a fibrous capsule, associated with odontogenic epithelium sheets presenting aberrant keratinization, and containing abundant dentinoid and osteoid material. Based on clinical and histopathologic findings, the final diagnosis was DGCT and CO. Since spontaneous eruption failed to occur within the expected time frame (6 months’ follow-up), surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. Up to now, the patient is under follow-up care in the orthodontics clinic.
€ ORAL MANIFESTATION OF SJOGREN SYNDROME: A REPORT OF 2 CASES. GEORGIA RIBEIRO MARTINI, BUBACAR EMBALO, JUSSARA MARIA GON¸CALVES, MELISSA ALKMIN, CLAUDIA RAQUEL SEVEGNANI and, ROGERIO GONDAK
INTRANEURAL PERINEURIOMA IN THE LOWER LIP MIMICKING MUCOCELE. PAMELA OLIVEIRA SANTOS, CRISTIANE CANTIGA DA SILVA and, TIAGO NOVAES PINHEIRO
Sjogren syndrome (SS) is a systemic autoimmune disease characterized by hypofunction of the salivary and lacrimal glands. The objective of this study is to report 2 clinical cases emphasizing the importance of labial salivary gland (LSG) biopsy for the diagnosis of SS. Both cases are of women with a mean age of 57 years and a history of oral and ocular dryness. LSG biopsy of each patient was performed and the histopathologic examination revealed focal lymphocytic sialadenitis. AntiSSA/SSB positivity followed by Schirmer testing and oral symptoms favored the SS diagnosis. Currently, the patients have been followed by a multidisciplinary team to control the oral and systemic manifestations of the disease.
Intraneural perineurioma is a rare lesion of the peripheral nervous system with unique ultrastructural features, and it is distinct from Schwann cell-derived entities (schwannoma and neurofibroma). The present case aims to report a lesion in the lower lip in a 33-year-old female patient. Clinical examination showed a nodular growth, sessile, and smooth surfaced from an undetermined etiology. Histopathologic examination revealed slender spindle cells, arranged in 2 fascicles, and focal areas showing a distinct storiform pattern, surrounding by histiocytes. Histopathologic investigation comprised of toluidine blue, Masson trichrome, and picrosirius red showed presence of mast cells, collagen organization, and type III prevalence. Based on clinical
ABSTRACTS
e50
and histopathologic findings, the final diagnosis was intraneural perineurioma. Eight-month follow-up showed no recurrence. We will discuss histopathologic and histochemical aspects of interest for intraneural perineurioma diagnosis.
LARGE SIMPLE BONE CYST WITH FLORID CEMENTO-OSSEOUS DYSPLASIA A CASE REPORT. CLAUDINEIA DE PAULA CHINCKR, LAURA VITORIA CALDEIRA TINOCO, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO We present a case of an early stage florid cemento-osseous dysplasia with a large simple bone cyst. The patient, a 40-yearold woman with light brown skin color, presented to the oral medicine service complaining of pain and swelling in the right body of the mandible. Imaging examination revealed a large multiloculated lesion with a well-delimited bilobular radiopacity measuring together 3 £ 1.4 cm. The cystic cavity was accessed surgically and was empty. A saucerization of the bone was performed thereby stimulating blood to fill the cavity. Also, an incisional biopsy was performed in part of the dysplastic bone. Histopathologic examination confirmed it to be a cemento-osseous dysplasia. Patient was monitored for 12 months, with satisfactory improvement of the bone in the surgically accessed site.
THE IMPORTANCE OF CONE BEAM COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF STAFNE BONE DEFECT. MARILEIDE URDAX ABBUD, KAREN RAMOS BARIFOUSE RAMADA, RODRIGO VILLAMARIM SOARES, BERNARDO QUIROGA SOUKI, KYRIA SPYRO SPYRIDES, FLAVIO LUCENA ANTUNES and, EDUARDO MURAD VILLORIA Stafne bone defects are asymptomatic lingual bone depressions of the lower jaw that are frequently caused by submandibular salivary gland inclusion. A 64-year-old male patient was referred to the radiology clinic for evaluation of a root fracture in the left mandibular first permanent molar using cone beam computed tomography (CBCT). On the panoramic reconstruction, a hypodense image was observed, with a rounded shape, well delimited by a hyperdense halo, located in the mandibular body and below the mandibular canal, suggestive of a Stafne bone defect or cystic and tumor lesion. Through the multiplanar and 3-dimensional reconstructions, an image compatible with bone depression was identified in the lingual cortical bone, confirming the diagnosis of Stafne bone defect. The CBCT is a complementary exam indicated for the diagnosis of the Stafne bone defect, since it allows visualization of the concavity present in the lingual cortical bone, ruling out other pathologies.
SQUAMOUS CELL CARCINOMA OF THE TONGUE: A CASE REPORT. GEORGE VELOSO SILVA, INAMARI SOUZA DE ALMEIDA and, ADNA BARROS ISMERIM A 60-year-old female patient with light brown skin color and a 27-year smoking history attended a family health unit with a complaint of aphthous lesion under the tongue that did not heal for 3 months. Extraoral clinical examination was normal. On intraoral examination, an ulcerated, exophytic lesion with hardened edges was observed on the ventral surface of the tongue,
OOOO January 2020 with no painful symptomatology. The patient was referred to the stomatology service where laboratory tests and electrocardiogram were requested with normal findings. Facing the suspicion of malignancy, incisional biopsy was performed. Histopathologically, invasive malignant neoplasm was evident with atypical cells of pleomorphic nuclei with keratinization and infiltration of the margins compatible with moderately differentiated carcinoma. The patient was referred to the oncology hospital, where the treatment of choice was exclusively surgery. The anatomopathologic study was conclusive for well-differentiated squamous cell carcinoma, T1 N0 M0 staging. The patient underwent surgery 1 year ago, and up to now has no signs of recurrence.
CHEMICAL INJURY ASSOCIATED WITH ESCITALOPRAM: A CASE REPORT. TUANY RAFAELI SCHMIDT, VINCIUS COELHO CARRARD, GUSTAVO MACHADO OTTO, MARCO ANTONIO TREVIZANI MARTINS and, MANOELA DOMINGUES MARTINS Physical and chemical injuries of the oral mucosa can be caused by an accidental, iatrogenic, and factitious trauma. The present case describes chemical burn of oral mucosa caused by escitalopram oxalate. It belongs to a group of medicines used for relief of the symptoms of depression. A 27-year-old female patient presented with a 1-month history of an oral lesion with a burning sensation. Intraoral examination revealed a solitary white plaque on the ventral surface of the tongue. The patient reported medical treatment for anxiety and panic syndrome with a single daily dose of escitalopram (Lexapro) oral solution (20 mg/mL) dripped under the tongue. Patient was instructed to dilute the medication in water and switch to tablet treatment. After 2 weeks follow-up, no lesion or symptoms were observed. The final diagnosis was chemical injury caused by escitalopram. Proper guidance and patient education are required regarding the use of this medication as a prophylactic measure to prevent this type of injury.
EXTENSIVE MULTICYSTIC AMELOBLASTOMA IN THE MANDIBLE. GABRIELE ANGELICA SILVA SANTOS, JULIANA SANTOS DE JESUS AZEVEDO, JULIA VIANNA NERI ANDRADE REIS, JULIANA BORGES DE LIMA DANTAS, ^ SILVIA REGINA DE ALMEIDA REIS, ANTONIO MARCIO ^ TEIXEIRA MARCHIONNI and, ANTONIO LUCINDO PINTO DE CAMPOS SOBRINHO Multicystic ameloblastoma is a benign odontogenic tumor with aggressive characteristics, capable of causing, if not treated, many sequelae with a consequent decrease in the patient’s quality of life. The present study aims to report a case of multicystic ameloblastoma in the mandible treated by radical surgery. A 34year-old female patient sought dental care for a history of increased volume in the anterior mandible. After clinical examination, there was an increase in volume in the anterior buccal and lingual regions of the mandible. In radiographic examination, an extensive multilocular radiolucent area involving the entire anterior region was detected. The proposed treatment was a surgical approach of marginal block resection, preserving the mandibular base for arch maintenance. The patient has been under follow-up care for 1-year and is currently asymptomatic; implant reconstruction is being planned.
ABSTRACTS
e49
ORTHOKERATINIZED ODONTOGENIC CYST IN AN ADOLESCENT: A CASE REPORT. GEORGIA RIBEIRO MARTINI, BUBACAR JUSSARA MARIA GONCALVES, EMBALO, ¸ PRISCILA SELL, EDUARDO MEURER, ELENA RIET CORREA RIVERO and, ROGERIO OLIVEIRA GONDAK Orthokeratinized odontogenic cyst (OOC) is an uncommon developmental cyst arising from the cell rests of the dental lamina. This report describes a case of OOC involving the right posterior mandible in a 14-year-old female patient. On clinical examination, a painless swelling on right side of face was noted. Panoramic radiography revealed a well-defined multilocular lesion located in the posterior mandible. Provisional diagnosis of odontogenic keratocyst was suggested. An incisional biopsy was performed with marsupialization, and the result was inconclusive. One month later, surgical enucleation of the lesion was performed and sent for histopathologic examination. A diagnosis of OOC was made. Currently the patient is under radiographic observation and without recurrence.
LINGUAL DERMOID CYST: A CASE REPORT WITH HISTOPATHOLOGIC CORRELATION. ^ ELIS ANGELA BATISTELLA, JUSSARA MARIA GONCALVES, ¸ ETIENE MUNHOZ and, ROGERIO GONDAK
TUMOR-ASSOCIATED DENTINOGENIC GHOST CELLS WITH COMPOUND ODONTOMA IN A PEDIATRIC PATIENT: A CASE REPORT. PAMELA OLIVEIRA SANTOS, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO
Dermoid cyst (DC) is an uncommon developmental cystic malformation, lined by epidermislike epithelium containing dermal annexes in the cystic wall. A 76-year-old woman presented with a painless submucosal nodule in the ventral surface of the tongue, right side, measuring 1 £ 1 cm, yellowish in color, with a soft consistency on palpation. A previous aspiration of the lesion revealed clear liquid contents. The patient, who has noticed the lesion in the past 15 days, reported no alcohol or smoking habits. DC, lipoma, and ranula were considered as possible clinical diagnoses. After biopsy, the microscopic examination revealed fragments of cystic capsule lined by a thin, stratified squamous epithelium. The cystic capsule was composed of dense fibrous connective tissue, and the cystic content exhibited an abundant amount of keratin. Minor salivary glands, nerve bundles, and muscular tissue completed the histopathologic diagnosis of a dermoid cyst. The patient remains under follow-up examination.
The present work aims to report a case of dentinogenic ghost cell tumor (DGCT) associated with compound odontoma (CO). An 8-year-old patient was referred to the oral medicine discipline presenting with dental retention. Computerized tomography (CT) scan revealed a well-defined unilocular radiolucent lesion involving an irregular mass, associated with an unerupted permanent upper central incisor (tooth 21). Excisional biopsy was performed. Histopathologic analysis revealed enamel matrix, loose connective tissue resembling dental pulp, enveloped in a fibrous capsule, associated with odontogenic epithelium sheets presenting aberrant keratinization, and containing abundant dentinoid and osteoid material. Based on clinical and histopathologic findings, the final diagnosis was DGCT and CO. Since spontaneous eruption failed to occur within the expected time frame (6 months’ follow-up), surgical exposition of the crown and bonding of an orthodontic appliance for traction was done to facilitate eruption. Up to now, the patient is under follow-up care in the orthodontics clinic.
€ ORAL MANIFESTATION OF SJOGREN SYNDROME: A REPORT OF 2 CASES. GEORGIA RIBEIRO MARTINI, BUBACAR EMBALO, JUSSARA MARIA GON¸CALVES, MELISSA ALKMIN, CLAUDIA RAQUEL SEVEGNANI and, ROGERIO GONDAK
INTRANEURAL PERINEURIOMA IN THE LOWER LIP MIMICKING MUCOCELE. PAMELA OLIVEIRA SANTOS, CRISTIANE CANTIGA DA SILVA and, TIAGO NOVAES PINHEIRO
Sjogren syndrome (SS) is a systemic autoimmune disease characterized by hypofunction of the salivary and lacrimal glands. The objective of this study is to report 2 clinical cases emphasizing the importance of labial salivary gland (LSG) biopsy for the diagnosis of SS. Both cases are of women with a mean age of 57 years and a history of oral and ocular dryness. LSG biopsy of each patient was performed and the histopathologic examination revealed focal lymphocytic sialadenitis. AntiSSA/SSB positivity followed by Schirmer testing and oral symptoms favored the SS diagnosis. Currently, the patients have been followed by a multidisciplinary team to control the oral and systemic manifestations of the disease.
Intraneural perineurioma is a rare lesion of the peripheral nervous system with unique ultrastructural features, and it is distinct from Schwann cell-derived entities (schwannoma and neurofibroma). The present case aims to report a lesion in the lower lip in a 33-year-old female patient. Clinical examination showed a nodular growth, sessile, and smooth surfaced from an undetermined etiology. Histopathologic examination revealed slender spindle cells, arranged in 2 fascicles, and focal areas showing a distinct storiform pattern, surrounding by histiocytes. Histopathologic investigation comprised of toluidine blue, Masson trichrome, and picrosirius red showed presence of mast cells, collagen organization, and type III prevalence. Based on clinical
ABSTRACTS
e50
and histopathologic findings, the final diagnosis was intraneural perineurioma. Eight-month follow-up showed no recurrence. We will discuss histopathologic and histochemical aspects of interest for intraneural perineurioma diagnosis.
LARGE SIMPLE BONE CYST WITH FLORID CEMENTO-OSSEOUS DYSPLASIA A CASE REPORT. CLAUDINEIA DE PAULA CHINCKR, LAURA VITORIA CALDEIRA TINOCO, DANIEL FROTA DE SOUZA and, TIAGO NOVAES PINHEIRO We present a case of an early stage florid cemento-osseous dysplasia with a large simple bone cyst. The patient, a 40-yearold woman with light brown skin color, presented to the oral medicine service complaining of pain and swelling in the right body of the mandible. Imaging examination revealed a large multiloculated lesion with a well-delimited bilobular radiopacity measuring together 3 £ 1.4 cm. The cystic cavity was accessed surgically and was empty. A saucerization of the bone was performed thereby stimulating blood to fill the cavity. Also, an incisional biopsy was performed in part of the dysplastic bone. Histopathologic examination confirmed it to be a cemento-osseous dysplasia. Patient was monitored for 12 months, with satisfactory improvement of the bone in the surgically accessed site.
THE IMPORTANCE OF CONE BEAM COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF STAFNE BONE DEFECT. MARILEIDE URDAX ABBUD, KAREN RAMOS BARIFOUSE RAMADA, RODRIGO VILLAMARIM SOARES, BERNARDO QUIROGA SOUKI, KYRIA SPYRO SPYRIDES, FLAVIO LUCENA ANTUNES and, EDUARDO MURAD VILLORIA Stafne bone defects are asymptomatic lingual bone depressions of the lower jaw that are frequently caused by submandibular salivary gland inclusion. A 64-year-old male patient was referred to the radiology clinic for evaluation of a root fracture in the left mandibular first permanent molar using cone beam computed tomography (CBCT). On the panoramic reconstruction, a hypodense image was observed, with a rounded shape, well delimited by a hyperdense halo, located in the mandibular body and below the mandibular canal, suggestive of a Stafne bone defect or cystic and tumor lesion. Through the multiplanar and 3-dimensional reconstructions, an image compatible with bone depression was identified in the lingual cortical bone, confirming the diagnosis of Stafne bone defect. The CBCT is a complementary exam indicated for the diagnosis of the Stafne bone defect, since it allows visualization of the concavity present in the lingual cortical bone, ruling out other pathologies.
SQUAMOUS CELL CARCINOMA OF THE TONGUE: A CASE REPORT. GEORGE VELOSO SILVA, INAMARI SOUZA DE ALMEIDA and, ADNA BARROS ISMERIM A 60-year-old female patient with light brown skin color and a 27-year smoking history attended a family health unit with a complaint of aphthous lesion under the tongue that did not heal for 3 months. Extraoral clinical examination was normal. On intraoral examination, an ulcerated, exophytic lesion with hardened edges was observed on the ventral surface of the tongue,
OOOO January 2020 with no painful symptomatology. The patient was referred to the stomatology service where laboratory tests and electrocardiogram were requested with normal findings. Facing the suspicion of malignancy, incisional biopsy was performed. Histopathologically, invasive malignant neoplasm was evident with atypical cells of pleomorphic nuclei with keratinization and infiltration of the margins compatible with moderately differentiated carcinoma. The patient was referred to the oncology hospital, where the treatment of choice was exclusively surgery. The anatomopathologic study was conclusive for well-differentiated squamous cell carcinoma, T1 N0 M0 staging. The patient underwent surgery 1 year ago, and up to now has no signs of recurrence.
CHEMICAL INJURY ASSOCIATED WITH ESCITALOPRAM: A CASE REPORT. TUANY RAFAELI SCHMIDT, VINCIUS COELHO CARRARD, GUSTAVO MACHADO OTTO, MARCO ANTONIO TREVIZANI MARTINS and, MANOELA DOMINGUES MARTINS Physical and chemical injuries of the oral mucosa can be caused by an accidental, iatrogenic, and factitious trauma. The present case describes chemical burn of oral mucosa caused by escitalopram oxalate. It belongs to a group of medicines used for relief of the symptoms of depression. A 27-year-old female patient presented with a 1-month history of an oral lesion with a burning sensation. Intraoral examination revealed a solitary white plaque on the ventral surface of the tongue. The patient reported medical treatment for anxiety and panic syndrome with a single daily dose of escitalopram (Lexapro) oral solution (20 mg/mL) dripped under the tongue. Patient was instructed to dilute the medication in water and switch to tablet treatment. After 2 weeks follow-up, no lesion or symptoms were observed. The final diagnosis was chemical injury caused by escitalopram. Proper guidance and patient education are required regarding the use of this medication as a prophylactic measure to prevent this type of injury.
EXTENSIVE MULTICYSTIC AMELOBLASTOMA IN THE MANDIBLE. GABRIELE ANGELICA SILVA SANTOS, JULIANA SANTOS DE JESUS AZEVEDO, JULIA VIANNA NERI ANDRADE REIS, JULIANA BORGES DE LIMA DANTAS, ^ SILVIA REGINA DE ALMEIDA REIS, ANTONIO MARCIO ^ TEIXEIRA MARCHIONNI and, ANTONIO LUCINDO PINTO DE CAMPOS SOBRINHO Multicystic ameloblastoma is a benign odontogenic tumor with aggressive characteristics, capable of causing, if not treated, many sequelae with a consequent decrease in the patient’s quality of life. The present study aims to report a case of multicystic ameloblastoma in the mandible treated by radical surgery. A 34year-old female patient sought dental care for a history of increased volume in the anterior mandible. After clinical examination, there was an increase in volume in the anterior buccal and lingual regions of the mandible. In radiographic examination, an extensive multilocular radiolucent area involving the entire anterior region was detected. The proposed treatment was a surgical approach of marginal block resection, preserving the mandibular base for arch maintenance. The patient has been under follow-up care for 1-year and is currently asymptomatic; implant reconstruction is being planned.