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ORAL KAPOSI SARCOMA FIRST MISDIAGNOSED AS AN INFLAMMATORY DISEASE
ABSTRACTS
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SPONTANEOUS DORSUM LINGUAL BLEEDING: WHICH CAUSE?. JOYCE BARBOSA, JOSE ALEXANDRE DA ROCHA CURVELO, VALDIR MEIRELLES JUNIOR, NATHALIA SCHETTINI SETUBAL FERME, FABIANE MARQUES DOS SANTOS FREIRE, KELLY TAMBASCO BEZERRA and, MARIA ELISA RANGEL JANINI The patient GMFA, 52 years old and African-white, sought an oral diagnostic service because of a spontaneous bleeding complaint in the region of the tongue. She reported that episodes of profuse bleeding used to happen after feeding or brushing. The clinical examination revealed the presence of a reddish traumatized papule of approximately 1 mm at the dorsum lingual surface. A topical corticosteroid was prescribed, inducing an interruption of the bleeding episodes, and a reduction of the lesion was observed in the following appointments. Approximately 1 year later, the patient returned with the same initial complaint. When asked about being hypertensive, she confirmed and said that her blood pressure was uncontrolled. A sclerosing treatment was initiated with evident clinical improvement, and she was referred to the cardiologist for hypertension control. The patient is currently under clinical control, and no further bleeding is reported, proving that the bleeding came from her hypertensive crisis.
ORAL LESIONS OF THROMBOCYTOPENIC PURPLE: CASE REPORT. GILBERTO MARCUCCI, MARCELO MARCUCCI, e MAXIMO DIAS and, LEONARDO BRAUN GALVAO VINICIUS PIOLI ZANETIM A male patient, 72 years of age and white, complained of "bubbles in the mouth for 10 days." Past medical history: Received renal transplant (2001), diabetes mellitus, coronary artery bypass graft, and radiation therapy for basal cell carcinoma in the head region (2014). Extraoral examination showed basal cell carcinomas in the right and left ears and blood lesions in the arms. At intraoral examination, we observed hemorrhagic blister and ulcerated lesion with superficial shallow edges, preceded by blister both in the lower lip mucosa, blood injury, slightly high edges, blackish coloration, and located in the mucosa of the cheek. Differential diagnosis: Angina bullosa £ thrombotic thrombocytopenic purpura. Management: Cytologic examination of oral mucous membrane lesions, diagnosed with acute inflammatory process with presence of squamous cells of regenerative aspect. Complete blood count with platelet count of 66,000/mm3 was requested. Therapy: Mouthwash with chlorhexidine and hematologist evaluation.
ORAL KAPOSI SARCOMA FIRST MISDIAGNOSED AS AN INFLAMMATORY DISEASE. CAROLINA FREDES ACEVEDO, ALESSANDRA MEIRELLES MASSAUD DE PINHO, RAFAELA CARRI¸CO PORTO BAESSO, BRUNO TRAVASSOS DA COSTA DINIZ, FABIO RAMOA PIRES, SIMONE MACEDO AMARAL and, JULIANA DE NORONHA SANTOS NETTO Kaposi sarcoma is a malignant neoplasm associated with human herpesvirus type 8 (HHV-8) infection that usually affects HIV-positive patients. A 34-year-old man was referred because of a swelling in the palate lasting 4 months that was initially interpreted and treated as an inflammatory endoperiodontal disease
OOOO January 2020 affecting teeth 21 and 22. Medical history revealed HIV infection. Physical examination revealed multiple purplish patches in the skin of the arms. Oral examination showed an exophytic reddish growth in the gingiva and palatal area close to the described teeth and a purplish patch in the left posterior hard palate. Periapical radiograph showed a radiolucent image involving the apexes of the aforementioned teeth. Clinical diagnosis was Kaposi sarcoma, and a biopsy was performed. Histologic analysis showed a proliferation of neoplastic HHV-8 positive spindle cells confirming the diagnosis of Kaposi sarcoma. The patient was referred to the infectious disease specialist, is currently under highly active antiretroviral treatment, and has been followed-up for the oral lesions.
ORAL MANIFESTATION OF DIFFUSE LARGE B-CELL LYMPHOMA. CLAUDIA YUMI MAEDA, DANIELA GUALTER MARTINS, ANA MARIA DA CUNHA MERCANTE, LOURDES MARANGONI GUALDANI, SERGIO ADAMOLI, ROSANA MASTROFRANCISCO and, MARCELO MARCUCCI Oral manifestation of diffuse large B-cell lymphoma (DLBCL) usually represents late involvement of disseminated and advanced disease. In this case, the oral lesion was the first sign of the disease. A 66-year-old male patient complained of difficulty adapting the upper total prosthesis for the last month. No underlying diseases have been reported except recent fatigue and weight loss complaint. Physical examination revealed a submucosal tumor in the maxillary region, which was 4 cm, exophytic, painless, and of fibrous consistency, and mucosa of recoating with areas of ulceration. Computed tomography showed an infiltrative, unilocular, isodense, expansive lesion with maxillary bone alteration as well as multiple bilateral supra and infradiaphragmatic lymphadenopathy. An incisional biopsy of the lesion was performed, and the morphologic profile associated with the immunohistochemical profile favored the diagnosis of DLBCL. The patient was submitted to the rituximab, cyclophosphamide, doxorubicin (hydroxydaunorubicin), vincristine (Oncovin), and prednisone regimen associated with intrathecal chemotherapy with complete remission of the oral lesion.
DIAGNOSIS OF PARACOCCIDIOIDOMYCOSIS THROUGH ORAL MANIFESTATIONS: CASE REPORT. VIVIANE LIMONGI e ALYNE AMORIM DE ARAUJO, ZIMBRAO, NATTALIA DI LANARO, ADRIANA THEREZINHA NEVES NOVELLINO e LEITE, ALVES, ANA FLAVIA SCHUELER DE ASSUMPC ¸ AO SIMONE HENRIQUES MACHADO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ A 51-year-old white man sought dental care, with his major complaints of pain, numbness, and burning in the tongue and oropharynx occurring for about 3 months. Clinically, it was an ulcerated lesion, granular in appearance, with multiple hemorrhagic spots. The clinical diagnostic hypotheses were paracoccidioidomycosis and histoplasmosis. Incisional biopsies were performed on the buccal mucosa and hard palate, and the specimen was sent for histopathologic examination. The histopathologic diagnosis was paracoccidioidomycosis. The patient was referred to the infectious disease specialist, pulmonologist, and dermatologist. Chest x-rays and laboratory tests were requested. He is currently under treatment with sulfamethoxazole, trimetroprim, and itraconazole. Paracoccidioidomycosis is a systemic
e112
SPONTANEOUS DORSUM LINGUAL BLEEDING: WHICH CAUSE?. JOYCE BARBOSA, JOSE ALEXANDRE DA ROCHA CURVELO, VALDIR MEIRELLES JUNIOR, NATHALIA SCHETTINI SETUBAL FERME, FABIANE MARQUES DOS SANTOS FREIRE, KELLY TAMBASCO BEZERRA and, MARIA ELISA RANGEL JANINI The patient GMFA, 52 years old and African-white, sought an oral diagnostic service because of a spontaneous bleeding complaint in the region of the tongue. She reported that episodes of profuse bleeding used to happen after feeding or brushing. The clinical examination revealed the presence of a reddish traumatized papule of approximately 1 mm at the dorsum lingual surface. A topical corticosteroid was prescribed, inducing an interruption of the bleeding episodes, and a reduction of the lesion was observed in the following appointments. Approximately 1 year later, the patient returned with the same initial complaint. When asked about being hypertensive, she confirmed and said that her blood pressure was uncontrolled. A sclerosing treatment was initiated with evident clinical improvement, and she was referred to the cardiologist for hypertension control. The patient is currently under clinical control, and no further bleeding is reported, proving that the bleeding came from her hypertensive crisis.
ORAL LESIONS OF THROMBOCYTOPENIC PURPLE: CASE REPORT. GILBERTO MARCUCCI, MARCELO MARCUCCI, e MAXIMO DIAS and, LEONARDO BRAUN GALVAO VINICIUS PIOLI ZANETIM A male patient, 72 years of age and white, complained of "bubbles in the mouth for 10 days." Past medical history: Received renal transplant (2001), diabetes mellitus, coronary artery bypass graft, and radiation therapy for basal cell carcinoma in the head region (2014). Extraoral examination showed basal cell carcinomas in the right and left ears and blood lesions in the arms. At intraoral examination, we observed hemorrhagic blister and ulcerated lesion with superficial shallow edges, preceded by blister both in the lower lip mucosa, blood injury, slightly high edges, blackish coloration, and located in the mucosa of the cheek. Differential diagnosis: Angina bullosa £ thrombotic thrombocytopenic purpura. Management: Cytologic examination of oral mucous membrane lesions, diagnosed with acute inflammatory process with presence of squamous cells of regenerative aspect. Complete blood count with platelet count of 66,000/mm3 was requested. Therapy: Mouthwash with chlorhexidine and hematologist evaluation.
ORAL KAPOSI SARCOMA FIRST MISDIAGNOSED AS AN INFLAMMATORY DISEASE. CAROLINA FREDES ACEVEDO, ALESSANDRA MEIRELLES MASSAUD DE PINHO, RAFAELA CARRI¸CO PORTO BAESSO, BRUNO TRAVASSOS DA COSTA DINIZ, FABIO RAMOA PIRES, SIMONE MACEDO AMARAL and, JULIANA DE NORONHA SANTOS NETTO Kaposi sarcoma is a malignant neoplasm associated with human herpesvirus type 8 (HHV-8) infection that usually affects HIV-positive patients. A 34-year-old man was referred because of a swelling in the palate lasting 4 months that was initially interpreted and treated as an inflammatory endoperiodontal disease
OOOO January 2020 affecting teeth 21 and 22. Medical history revealed HIV infection. Physical examination revealed multiple purplish patches in the skin of the arms. Oral examination showed an exophytic reddish growth in the gingiva and palatal area close to the described teeth and a purplish patch in the left posterior hard palate. Periapical radiograph showed a radiolucent image involving the apexes of the aforementioned teeth. Clinical diagnosis was Kaposi sarcoma, and a biopsy was performed. Histologic analysis showed a proliferation of neoplastic HHV-8 positive spindle cells confirming the diagnosis of Kaposi sarcoma. The patient was referred to the infectious disease specialist, is currently under highly active antiretroviral treatment, and has been followed-up for the oral lesions.
ORAL MANIFESTATION OF DIFFUSE LARGE B-CELL LYMPHOMA. CLAUDIA YUMI MAEDA, DANIELA GUALTER MARTINS, ANA MARIA DA CUNHA MERCANTE, LOURDES MARANGONI GUALDANI, SERGIO ADAMOLI, ROSANA MASTROFRANCISCO and, MARCELO MARCUCCI Oral manifestation of diffuse large B-cell lymphoma (DLBCL) usually represents late involvement of disseminated and advanced disease. In this case, the oral lesion was the first sign of the disease. A 66-year-old male patient complained of difficulty adapting the upper total prosthesis for the last month. No underlying diseases have been reported except recent fatigue and weight loss complaint. Physical examination revealed a submucosal tumor in the maxillary region, which was 4 cm, exophytic, painless, and of fibrous consistency, and mucosa of recoating with areas of ulceration. Computed tomography showed an infiltrative, unilocular, isodense, expansive lesion with maxillary bone alteration as well as multiple bilateral supra and infradiaphragmatic lymphadenopathy. An incisional biopsy of the lesion was performed, and the morphologic profile associated with the immunohistochemical profile favored the diagnosis of DLBCL. The patient was submitted to the rituximab, cyclophosphamide, doxorubicin (hydroxydaunorubicin), vincristine (Oncovin), and prednisone regimen associated with intrathecal chemotherapy with complete remission of the oral lesion.
DIAGNOSIS OF PARACOCCIDIOIDOMYCOSIS THROUGH ORAL MANIFESTATIONS: CASE REPORT. VIVIANE LIMONGI e ALYNE AMORIM DE ARAUJO, ZIMBRAO, NATTALIA DI LANARO, ADRIANA THEREZINHA NEVES NOVELLINO e LEITE, ALVES, ANA FLAVIA SCHUELER DE ASSUMPC ¸ AO SIMONE HENRIQUES MACHADO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ A 51-year-old white man sought dental care, with his major complaints of pain, numbness, and burning in the tongue and oropharynx occurring for about 3 months. Clinically, it was an ulcerated lesion, granular in appearance, with multiple hemorrhagic spots. The clinical diagnostic hypotheses were paracoccidioidomycosis and histoplasmosis. Incisional biopsies were performed on the buccal mucosa and hard palate, and the specimen was sent for histopathologic examination. The histopathologic diagnosis was paracoccidioidomycosis. The patient was referred to the infectious disease specialist, pulmonologist, and dermatologist. Chest x-rays and laboratory tests were requested. He is currently under treatment with sulfamethoxazole, trimetroprim, and itraconazole. Paracoccidioidomycosis is a systemic