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JUVENILE OSSIFYING FIBROMA: A CASE REPORT WITH DIAGNOSTIC CHALLENGE
OOOO Volume 129, Number 1 ulcerations related to cytomegalovirus (CMV) are uncommon and rarely described in patients with solid tumors. A 65-year-old male patient under oncologic treatment because of a high-grade astrocytoma was admitted to our service complaining of pain on the right lateral border of the tongue with 5 weeks of evolution, without clinical improvement with topical corticosteroid use. Physical examination revealed an oval ulcerated lesion approximately 0.5 cm in diameter with necrotic center. An excisional biopsy was performed, and results showed areas of superficial ulceration, a chorion with lymphoplasmacytic inflammatory infiltrate, and presence of occasional endothelial and stromal cells with massive cytoplasm and nuclear inclusions with cytopathic effect by cytomegalovirus, confirmed by immunohistochemistry. The lesion completed healed after 15 days, and no further treatment was necessary.
DIAGNOSTIC CHALLENGES OF ORAL LESIONS IN A PATIENT AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION. WANESSA MIRANDA-SILVA, CLAUDIA JOFFILY PARAHYBA, RAFAEL SARLO VILELA, YANA AUGUSTA NOVIS, FELIPE PAIVA FONSECA and, EDUARDO RODRIGUES FREGNANI Oncohematologic patients after hematopoietic stem cell transplantation (HSCT) are at risk of developing opportunistic oral infections and malignant neoplasms. The objective of this report is to describe 3 diagnostic challenges of oral lesions that affected the same posttransplant patient: an atypical herpes simplex virus lesion in ventral tongue, a gingival actinomycosis infection, and later a leukemic infiltration on the soft palate. A 57-year-old female patient first complained of a progressive and painful sublingual nodule for 3 days at D+35 of HSCT by extranodal natural killer/T-cell lymphoma, and final diagnoses were atypical herpes simplex virus 1 and 2 infection. Two months later, ulcerated lesions in the vestibular and palatal gingival margin of the left upper molars were noted, with final diagnosis of Actinomyces sp infection. Fifteen days later, an erythematous lesion with necrotic center was observed in the soft palate, and the diagnosis was palatal infiltration by extranodal natural killer/ T-cell lymphoma.
SURGICAL TREATMENT OF INFLAMMATORY DENTIGEROUS CYST ASSOCIATED WITH THIRD MOLAR IN MANDIBLE: CASE REPORT. RAFAEL SARAIVA TORRES, SAULO LOBO CHATEAUBRIAND DO NASCIMENTO, RENATA GUALBERTO DA CUNHA, PAULO MATHEUS HONDA TAVARES, JOEL MOTTA JUNIOR, VALBER BARBOSA MARTINS and, MARCELO VINICIUS DE OLIVEIRA Most dentigerous cysts are considered developmental, but some cases can present an inflammatory pathogenesis. We report a case of enucleation of a large inflammatory dentigerous cyst in a 20-year-old patient with tooth extraction involved. The patient presented to dental care to evaluate the noneruption of third molars. No significant changes were observed in the extraoral examination. The intraoral examination showed the growth of the vestibule region of tooth 48, and discrete bulging of the lingual cortical was observed. Computed tomography showed an extensive hypodense unilocular image associated with the crown of tooth 48. The lesion was enucleated together with element 48.
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The histologic examination concluded as an inflammatory dentigerous cyst. After 1 year and 6 months of follow-up, no recurrence was observed, and the patient had a great prognosis.
MUCOEPIDERMOID CARCINOMA ON THE HARD PALATE: A RARE CASE REPORT. CRISLYNE MENDES DA VERA CRUZ, LUIZA MADALENA MENDES DA VERA CRUZ, LEONARDO DE SOUZA LOUZARDO, ALEXANDRA GABRIELLY DE SOUSA BENTES, JOYCE HELENA MONTEIRO BARBOSA, BIANCA PANTOJA CAMPOS and, ANA LUIZA SARMENTO DOS SANTOS Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm most commonly found in the oral cavity, occurring mainly in the major salivary glands. The most used treatments for MEC include local surgery alone or surgery associated with radiotherapy with or without cervical emptying. The objective of this study was to report the case of 18-year-old L.C.M., who had a lesion on the left side of the hard palate, with an evolution period of 5 years and characteristics very representative of MEC. An incisional biopsy was performed in the lesion region to confirm the diagnosis. After confirmation, the patient was referred for removal of the lesion and radiotherapy treatment. Five years after the surgery and radiotherapy treatment, the patient is well and without signs of relapse. It is concluded that the faster the diagnosis and treatment, the greater the chances of the patient being cured.
ATYPICAL BILATERAL EXOSTOSIS IN MAXILLA—CASE REPORT. CARLOS HENRIQUE COSTA BAPTISTA DE MELLO, JOSE ALEXANDRE DA ROCHA CURVELO, GUSTAVO DE SOUZA VIEIRA, CLARA GOMES CALDEIRA BARBOSA, MARIANA CAMPELLO NUNES, KELLY TAMBASCO BEZERRA and, MARIA ELISA RANGEL JANINI Patient M.C.J., a 34-year-old woman, was referred to the oral diagnostic service complaining of a bilateral bone protrusion extending through the vestibular surface of the alveolar bone of maxilla. She reported discomfort after meals due to food accumulation provided by the plateau formed in the region. At physical examination, the hypothesis of exostosis was raised, which was confirmed by computed tomography. Upon receiving the diagnosis, the patient was informed that the most appropriate course would be preservation of her condition. Exostoses are bone excrescences located on the vestibular surface of the alveolar bone. They are rarely a source of pain or discomfort, and their treatment is not necessary except for prosthetic considerations or in cases of recurrent trauma to the mucosa of the region.
JUVENILE OSSIFYING FIBROMA: A CASE REPORT WITH DIAGNOSTIC CHALLENGE. ANANDA AMARAL SANTOS, FERNANDA PAULA YAMAMOTO-SILVA, WILSON JOSE MARIANO JUNIOR, MARCONDES SENA FILHO, LEONARDO AMARAL DOS REIS, OSLEI PAES DE ALMEIDA and, BRUNNO SANTOS DE FREITAS SILVA A 23-year-old woman presented to our specialized department complaining of an asymptomatic lesion observed by her orthodontist. Intraoral examination showed a volume increase in the left
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mandible with bone consistency. Extraoral examination showed a slight bulging in the retromolar region with normal color of oral mucosa and the #37 tooth partially erupted. Panoramic radiograph showed a mixed radiolucent-radiopaque and expansive area on the left mandible including teeth #37 and #36; computed tomography reveled a thinning of buccal and lingual cortical without presenting a disruption. An excisional biopsy was performed, and histologic analysis revealed a benign fibro-osseous lesion. Correlation of clinical and aggressive radiographic finding without histopathologic characteristics of malignancy resulted in clinical diagnosis of juvenile ossifying fibroma. We emphasize the importance of considering the incidental radiographic findings and associating them with clinical and histopathologic characteristics to provide correct diagnosis and adequate treatment to patients. The patient is under follow-up.
ACTINIC PRURIGO OF THE LOWER LIP: CASE REPORT. ISADORA OLIVEIRA CORREA, LUISA AGUIRRE BUEXM, ANA e LEITE, SIMONE DE FLAVIA SCHUELER DE ASSUMPC ¸ AO QUEIROZ CHAVES LOURENCO, ¸ RODRIGO FIGUEIREDO DE BRITO RESENDE, JOSIANE COSTA RODRIGUES DE SA and, ADRIANA TEREZINHA NEVES NOVELLINO ALVES A 53-year-old black woman was referred complaining of "lip infection" 4 months ago. After medical consultation she was diagnosed as having a stress injury. Anamnesis revealed systemic arterial hypertension. Extraoral examination showed swollen resected lower lip, painful ulcers covered by crusts and pseudomembrane throughout lower lip, and periodic pulsatile pain. Intraoral examination was normal. Diagnostic hypotheses were exfoliative cheilitis and actinic prurigo. Treatment consisted of local hydration with dexpanthenol cream and ketoconazole, betamethasone, and neomycin topical cream. After 15 days, there was significant clinical improvement, but erythematous regions remained. The medication was maintained for another 15 days without complete resolution. Final clinical diagnosis was actinic prurigo of the lip. Actinic prurigo is an idiopathic photodermatosis that affects skin exposed to sunlight and labial and conjunctival mucosa. It more often affects young women and presents clinically as pruritic lower lip cheilitis that normally does not respond to conventional therapy.
NOONAN SYNDROME WITH MULTIPLE GIANT CELL LESIONS, CASE REPORT. MACARENA SHERMAN ALLENDORF, VICTOR RIVAS OSSES and, CAMILA DELGADO SALAS Noonan syndrome with multiple giant cell lesions (NS/ MGCLS) is a term used to describe a subgroup of people with Noonan syndrome, a rare condition with phenotypic overlap with NS. Once thought to be a specific and separate entity, it is now suggested to be a variant of the NS spectrum. Here we report a 22-year-old patient misdiagnosed as having Rubinstein-Taybi syndrome (microcephaly, congenital heart disease, ventricular septal defect, cryptorchidism, pterygium coli, inguinal hernia, and short stature and neck). He had multiple dental retentions; therefore, a cone beam computed tomography was requested, which showed multiples radiolucent lesions of both sides of the jaw. An excisional biopsy of larger lesion was performed, and the results indicated giant cell granuloma. Patient was referred to the Genetics department because of suspicion of Noonan
OOOO January 2020 syndrome, which was confirmed after molecular study. Postoperative control shows bone formation in treated lesion on the right side and growth of the lesion on the left side.
PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE MANDIBLE: A CASE REPORT. JULIANA MOTA SIQUEIRA, FABIO ^ DE ABREU ALVES, CLOVIS ANTONIO LOPES PINTO, FLAVIO DE MELO GARCIA, DAPHINE CAXIAS TRAVASSOS, RAPHAEL DE LIMA CHAPARIN and, GRAZIELA CHAGAS JAGUAR This report presents an intraosseous lymphoma that was previously misdiagnosed as periodontal disease. After 3 months of periodontal treatment in a private clinic, a 51-year-old male patient was referred to the stomatology department presenting mandibular swelling and paresthesia lasting 4 months. In his previous history, the patient reported prostatic cancer treated 3 years ago. During intraoral evaluation, an extensive mass with teeth mobility in the right mandible was observed. The radiographic examinations showed an extensive osteolytic lesion, with no limits and cortical perforation in the mandible. The main clinical hypothesis was oral metastasis. An incisional biopsy was performed, and the immunohistochemistry established the diagnosis of diffuse large B-cell lymphoma. Six cycles of chemotherapy were given, resulting in complete remission of the tumor. After 7 months, the patient is under follow-up with no recurrence. Although uncommon in the oral cavity, lymphoma should be considered in the differential diagnosis.
MAXILLARY DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT. LIGIA GONZAGA FERNANDES, GIOVANE NOSCHESE, MICHELLE CASAL COLETA DE BARROS, HELDER DOMICIANO DANTAS MARTINS, ROSANE TRONCHIN GALLO, MARILIA TRIERVEILER MARTINS and, CAMILA DE BARROS GALLO A 65-year-old woman was referred for the evaluation of a large mass on the right maxilla, which rapidly grew after tooth extraction in this region. Intraoral examination revealed an extensive well-defined nodular lesion located in the maxillary alveolar process, expanding both vestibular and palatal cortices, covered by normal oral mucosa pervaded by telangiectasia, of fibrous consistency, and asymptomatic. Panoramic x-ray did not present marked bone involvement, and an incisional biopsy was performed with the clinical hypothesis of maxillary sinus carcinoma and salivary gland malignant tumors. Histologic analysis showed neoplastic infiltration with lymphoid differentiation, and the final diagnosis was diffuse large B-cell lymphoma. The patient was referred to the oncologist and started a chemotherapy protocol with a remarkable reduction of the lesion after the first month of treatment with low adverse effects. Lymphomas of the oral cavity are rare, representing only 3.5% of the cases reported in the literature.
NEUROFIBROMATOSIS TYPE 1 INVOLVING THE UPPER MAXILLA, CASE REPORT. MACARENA SHERMAN ALLENDORF, JUAN MUNZENMAYER and, CAMILA DELGADO SALAS Von Recklinghausen disease or neurofibromatosis type 1 (NF1) is an autosomal dominant disease with a wide clinical expression, with manifestations ranging from multiple cafe-au-
DIAGNOSTIC CHALLENGES OF ORAL LESIONS IN A PATIENT AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION. WANESSA MIRANDA-SILVA, CLAUDIA JOFFILY PARAHYBA, RAFAEL SARLO VILELA, YANA AUGUSTA NOVIS, FELIPE PAIVA FONSECA and, EDUARDO RODRIGUES FREGNANI Oncohematologic patients after hematopoietic stem cell transplantation (HSCT) are at risk of developing opportunistic oral infections and malignant neoplasms. The objective of this report is to describe 3 diagnostic challenges of oral lesions that affected the same posttransplant patient: an atypical herpes simplex virus lesion in ventral tongue, a gingival actinomycosis infection, and later a leukemic infiltration on the soft palate. A 57-year-old female patient first complained of a progressive and painful sublingual nodule for 3 days at D+35 of HSCT by extranodal natural killer/T-cell lymphoma, and final diagnoses were atypical herpes simplex virus 1 and 2 infection. Two months later, ulcerated lesions in the vestibular and palatal gingival margin of the left upper molars were noted, with final diagnosis of Actinomyces sp infection. Fifteen days later, an erythematous lesion with necrotic center was observed in the soft palate, and the diagnosis was palatal infiltration by extranodal natural killer/ T-cell lymphoma.
SURGICAL TREATMENT OF INFLAMMATORY DENTIGEROUS CYST ASSOCIATED WITH THIRD MOLAR IN MANDIBLE: CASE REPORT. RAFAEL SARAIVA TORRES, SAULO LOBO CHATEAUBRIAND DO NASCIMENTO, RENATA GUALBERTO DA CUNHA, PAULO MATHEUS HONDA TAVARES, JOEL MOTTA JUNIOR, VALBER BARBOSA MARTINS and, MARCELO VINICIUS DE OLIVEIRA Most dentigerous cysts are considered developmental, but some cases can present an inflammatory pathogenesis. We report a case of enucleation of a large inflammatory dentigerous cyst in a 20-year-old patient with tooth extraction involved. The patient presented to dental care to evaluate the noneruption of third molars. No significant changes were observed in the extraoral examination. The intraoral examination showed the growth of the vestibule region of tooth 48, and discrete bulging of the lingual cortical was observed. Computed tomography showed an extensive hypodense unilocular image associated with the crown of tooth 48. The lesion was enucleated together with element 48.
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The histologic examination concluded as an inflammatory dentigerous cyst. After 1 year and 6 months of follow-up, no recurrence was observed, and the patient had a great prognosis.
MUCOEPIDERMOID CARCINOMA ON THE HARD PALATE: A RARE CASE REPORT. CRISLYNE MENDES DA VERA CRUZ, LUIZA MADALENA MENDES DA VERA CRUZ, LEONARDO DE SOUZA LOUZARDO, ALEXANDRA GABRIELLY DE SOUSA BENTES, JOYCE HELENA MONTEIRO BARBOSA, BIANCA PANTOJA CAMPOS and, ANA LUIZA SARMENTO DOS SANTOS Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm most commonly found in the oral cavity, occurring mainly in the major salivary glands. The most used treatments for MEC include local surgery alone or surgery associated with radiotherapy with or without cervical emptying. The objective of this study was to report the case of 18-year-old L.C.M., who had a lesion on the left side of the hard palate, with an evolution period of 5 years and characteristics very representative of MEC. An incisional biopsy was performed in the lesion region to confirm the diagnosis. After confirmation, the patient was referred for removal of the lesion and radiotherapy treatment. Five years after the surgery and radiotherapy treatment, the patient is well and without signs of relapse. It is concluded that the faster the diagnosis and treatment, the greater the chances of the patient being cured.
ATYPICAL BILATERAL EXOSTOSIS IN MAXILLA—CASE REPORT. CARLOS HENRIQUE COSTA BAPTISTA DE MELLO, JOSE ALEXANDRE DA ROCHA CURVELO, GUSTAVO DE SOUZA VIEIRA, CLARA GOMES CALDEIRA BARBOSA, MARIANA CAMPELLO NUNES, KELLY TAMBASCO BEZERRA and, MARIA ELISA RANGEL JANINI Patient M.C.J., a 34-year-old woman, was referred to the oral diagnostic service complaining of a bilateral bone protrusion extending through the vestibular surface of the alveolar bone of maxilla. She reported discomfort after meals due to food accumulation provided by the plateau formed in the region. At physical examination, the hypothesis of exostosis was raised, which was confirmed by computed tomography. Upon receiving the diagnosis, the patient was informed that the most appropriate course would be preservation of her condition. Exostoses are bone excrescences located on the vestibular surface of the alveolar bone. They are rarely a source of pain or discomfort, and their treatment is not necessary except for prosthetic considerations or in cases of recurrent trauma to the mucosa of the region.
JUVENILE OSSIFYING FIBROMA: A CASE REPORT WITH DIAGNOSTIC CHALLENGE. ANANDA AMARAL SANTOS, FERNANDA PAULA YAMAMOTO-SILVA, WILSON JOSE MARIANO JUNIOR, MARCONDES SENA FILHO, LEONARDO AMARAL DOS REIS, OSLEI PAES DE ALMEIDA and, BRUNNO SANTOS DE FREITAS SILVA A 23-year-old woman presented to our specialized department complaining of an asymptomatic lesion observed by her orthodontist. Intraoral examination showed a volume increase in the left
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mandible with bone consistency. Extraoral examination showed a slight bulging in the retromolar region with normal color of oral mucosa and the #37 tooth partially erupted. Panoramic radiograph showed a mixed radiolucent-radiopaque and expansive area on the left mandible including teeth #37 and #36; computed tomography reveled a thinning of buccal and lingual cortical without presenting a disruption. An excisional biopsy was performed, and histologic analysis revealed a benign fibro-osseous lesion. Correlation of clinical and aggressive radiographic finding without histopathologic characteristics of malignancy resulted in clinical diagnosis of juvenile ossifying fibroma. We emphasize the importance of considering the incidental radiographic findings and associating them with clinical and histopathologic characteristics to provide correct diagnosis and adequate treatment to patients. The patient is under follow-up.
ACTINIC PRURIGO OF THE LOWER LIP: CASE REPORT. ISADORA OLIVEIRA CORREA, LUISA AGUIRRE BUEXM, ANA e LEITE, SIMONE DE FLAVIA SCHUELER DE ASSUMPC ¸ AO QUEIROZ CHAVES LOURENCO, ¸ RODRIGO FIGUEIREDO DE BRITO RESENDE, JOSIANE COSTA RODRIGUES DE SA and, ADRIANA TEREZINHA NEVES NOVELLINO ALVES A 53-year-old black woman was referred complaining of "lip infection" 4 months ago. After medical consultation she was diagnosed as having a stress injury. Anamnesis revealed systemic arterial hypertension. Extraoral examination showed swollen resected lower lip, painful ulcers covered by crusts and pseudomembrane throughout lower lip, and periodic pulsatile pain. Intraoral examination was normal. Diagnostic hypotheses were exfoliative cheilitis and actinic prurigo. Treatment consisted of local hydration with dexpanthenol cream and ketoconazole, betamethasone, and neomycin topical cream. After 15 days, there was significant clinical improvement, but erythematous regions remained. The medication was maintained for another 15 days without complete resolution. Final clinical diagnosis was actinic prurigo of the lip. Actinic prurigo is an idiopathic photodermatosis that affects skin exposed to sunlight and labial and conjunctival mucosa. It more often affects young women and presents clinically as pruritic lower lip cheilitis that normally does not respond to conventional therapy.
NOONAN SYNDROME WITH MULTIPLE GIANT CELL LESIONS, CASE REPORT. MACARENA SHERMAN ALLENDORF, VICTOR RIVAS OSSES and, CAMILA DELGADO SALAS Noonan syndrome with multiple giant cell lesions (NS/ MGCLS) is a term used to describe a subgroup of people with Noonan syndrome, a rare condition with phenotypic overlap with NS. Once thought to be a specific and separate entity, it is now suggested to be a variant of the NS spectrum. Here we report a 22-year-old patient misdiagnosed as having Rubinstein-Taybi syndrome (microcephaly, congenital heart disease, ventricular septal defect, cryptorchidism, pterygium coli, inguinal hernia, and short stature and neck). He had multiple dental retentions; therefore, a cone beam computed tomography was requested, which showed multiples radiolucent lesions of both sides of the jaw. An excisional biopsy of larger lesion was performed, and the results indicated giant cell granuloma. Patient was referred to the Genetics department because of suspicion of Noonan
OOOO January 2020 syndrome, which was confirmed after molecular study. Postoperative control shows bone formation in treated lesion on the right side and growth of the lesion on the left side.
PRIMARY DIFFUSE LARGE B-CELL LYMPHOMA OF THE MANDIBLE: A CASE REPORT. JULIANA MOTA SIQUEIRA, FABIO ^ DE ABREU ALVES, CLOVIS ANTONIO LOPES PINTO, FLAVIO DE MELO GARCIA, DAPHINE CAXIAS TRAVASSOS, RAPHAEL DE LIMA CHAPARIN and, GRAZIELA CHAGAS JAGUAR This report presents an intraosseous lymphoma that was previously misdiagnosed as periodontal disease. After 3 months of periodontal treatment in a private clinic, a 51-year-old male patient was referred to the stomatology department presenting mandibular swelling and paresthesia lasting 4 months. In his previous history, the patient reported prostatic cancer treated 3 years ago. During intraoral evaluation, an extensive mass with teeth mobility in the right mandible was observed. The radiographic examinations showed an extensive osteolytic lesion, with no limits and cortical perforation in the mandible. The main clinical hypothesis was oral metastasis. An incisional biopsy was performed, and the immunohistochemistry established the diagnosis of diffuse large B-cell lymphoma. Six cycles of chemotherapy were given, resulting in complete remission of the tumor. After 7 months, the patient is under follow-up with no recurrence. Although uncommon in the oral cavity, lymphoma should be considered in the differential diagnosis.
MAXILLARY DIFFUSE LARGE B-CELL LYMPHOMA: A CASE REPORT. LIGIA GONZAGA FERNANDES, GIOVANE NOSCHESE, MICHELLE CASAL COLETA DE BARROS, HELDER DOMICIANO DANTAS MARTINS, ROSANE TRONCHIN GALLO, MARILIA TRIERVEILER MARTINS and, CAMILA DE BARROS GALLO A 65-year-old woman was referred for the evaluation of a large mass on the right maxilla, which rapidly grew after tooth extraction in this region. Intraoral examination revealed an extensive well-defined nodular lesion located in the maxillary alveolar process, expanding both vestibular and palatal cortices, covered by normal oral mucosa pervaded by telangiectasia, of fibrous consistency, and asymptomatic. Panoramic x-ray did not present marked bone involvement, and an incisional biopsy was performed with the clinical hypothesis of maxillary sinus carcinoma and salivary gland malignant tumors. Histologic analysis showed neoplastic infiltration with lymphoid differentiation, and the final diagnosis was diffuse large B-cell lymphoma. The patient was referred to the oncologist and started a chemotherapy protocol with a remarkable reduction of the lesion after the first month of treatment with low adverse effects. Lymphomas of the oral cavity are rare, representing only 3.5% of the cases reported in the literature.
NEUROFIBROMATOSIS TYPE 1 INVOLVING THE UPPER MAXILLA, CASE REPORT. MACARENA SHERMAN ALLENDORF, JUAN MUNZENMAYER and, CAMILA DELGADO SALAS Von Recklinghausen disease or neurofibromatosis type 1 (NF1) is an autosomal dominant disease with a wide clinical expression, with manifestations ranging from multiple cafe-au-