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ORAL LEUKOPLAKIA: A DIFFERENT CASE REPORT
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
ABSTRACTS
e106
leukoplakia, confirmed by histopathology, which indicated intense epithelial dysplasia. The patient was referred for surgical treatment. The patient in this case was not exposed to oral cancer risk factors. Therefore, it reinforced the need of a detailed intraoral examination to detect early potentially malignant lesions.
A CASE REPORT OF OSTEOSARCOMA IN THE MANDIBLE. ANA MARIA DIAS DA ^ NIO RODRIGUES, RODRIGO COSTA, EUGE RESENDE, LUISA AGUIRRE BUEXM, FERNANDO DIAS, ADRIANA TEREZINHA NEVES NOVELLINO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ The report describes a case of mandibular osteosarcoma in a 25-year-old black male patient complaining of increase of volume in mandible with evolution of 4 months. The anamnesis stated a previous history of mucoepidermoid carcinoma in the left retroauricular region treated by parotidectomy 18 years ago. Physical examination revealed the swelling of the left body of the mandible with face asymmetry and an expansive increase of volume in the buccal region of the mandible, extending to vestibule depth, associated with pain on palpation and paresthesia. Panoramic radiograph revealed a poorly defined radiolucent image without sclerotic border, with destruction of the periodontal ligament corresponding to tooth 36. Incisional biopsy was performed, and the histopathologic report was compatible with osteosarcoma. The patient was referred for oncology treatment. Osteosarcomas in the mandible are extremely rare, and this case justifies investigation as the patient had already presented another type of tumor in the proximal region.
EXTENSIVE SIALOLIPOMA IN THE MOUTH FLOOR OF AN 11-YEAR-OLD CHILD: A CASE REPORT. ERASMO BERNARDO MARINHO, EALBER CARVALHO MACEDO LUNA, FABRICIO BITU SOUSA, KARUZA MARIA ALVES PEREIRA, EVELINE TURATTI and, ROBERTA BARROSO CAVALCANTE An 11-year-old boy was referred to our department complaining of painless swelling in the neck and floor of the mouth with an evolution time of approximately 2 months. Extraoral examination revealed a soft tumefaction on the right side of the sublingual region with normal surface color. Intraoral examination revealed a soft tumefaction on the anterior right side of the floor of mouth with normal surface color. Panoramic radiograph and complete blood count ruled out infection of odontogenic origin. Negative aspiration puncture ruled out cystic lesions. Salivary gland tumor was considered as diagnostic hypothesis. Incisional biopsy under local anesthesia was planned. However, surgical procedure was favorable, and the lesion was completely removed. Histologic sections showed mature adipocytes septated by delicate bundles of collagen fibers and interspersed by islands of salivary parenchyma, obtaining a histopathologic conclusion of sialolipoma. No evidence of recurrence was observed after 19-month follow-up.
MICROMARSUPIALIZATION AS TREATMENT OF CHOICE FOR RANULA IN LACTATING. ANA LUISA CABRAL DOS SANTOS, ALYNE AMORIN DE ARAUJO, LIVIAN TOMELIN MARTINS, SILVIA PAULA DE OLIVEIRA, JESSIE
OOOO January 2020 CAPOBIANGO SOARES DE MOURA, LUISA AGUIRRE BUEXM and, ALESSANDRA OLIVEIRA FERRANI GOMES Ranula is a common lesion of the mouth floor, resulting from rupture of the salivary gland duct and extravasation of mucin, usually associated with local trauma. Higher prevalence among young people and children is observed. Treatment options include marsupialization, excision of the gland involved, and micromarsupialization, the less invasive technique. A 28-year-old lactating female patient without previous oral lesions was complaining of "lump in the mouth." Intraoral examination showed a bluish-floating increase of volume in the right mouth floor crossing midline, associated with ulcer near the occlusion line, with clinical diagnosis of ranula. Micromarsupialization was the treatment of choice, and after 8 months, there was complete regression of the lesion without recurrence. This technique is a good treatment option because of its simplicity of execution and low invasiveness, being prioritized in patients like the one from this case report.
EXUBERANT CEMENTO-OSSIFYING FIBROMA OF THE MAXILLA. BERNARDO CORREIA LIMA, SABRINA MORELLI, MARIA APARECIDA CAVALCANTE, BRUNO AUGUSTO ^A BENEVENUTO DE ANDRADE, ALINE CORRE ABRAHAO, MICHELLE AGOSTINI and, MARIO e ROMANACH Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, welldefined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 £ 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size.
IDIOPATHIC BONE CAVITY ASSOCIATED WITH OSSEOUS DYSPLASIA: CASE REPORT. NATHALIA HERNANI FERREIRA, NAYARA GOBARA, JHEINIS STEFANY PASCUINELI DUARTE, LETICIA ALECRIM SOUZA, VANIA LOUREIRO, VICTOR e PEREZ TEIXEIRA and, JOSE NARCISO ROSA ASSUNC ¸ AO JUNIOR A 46-year-old female patient with melanoderma was admitted to the stomatology outpatient clinic with a protruding buccal and lingual cortical bone in the maxillary and mandibular bones. In the physical examination, the mucous membranes remained intact. When palpating, we noticed bone crepitation in the maxilla and mandible bones. The panoramic x-rays showed welldefined radiolucent images without any radiopaque halos extending from the right mandibular ramus to the molar region on the left. In the maxilla, though, the lesions extended to both sides of
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
ABSTRACTS
e106
leukoplakia, confirmed by histopathology, which indicated intense epithelial dysplasia. The patient was referred for surgical treatment. The patient in this case was not exposed to oral cancer risk factors. Therefore, it reinforced the need of a detailed intraoral examination to detect early potentially malignant lesions.
A CASE REPORT OF OSTEOSARCOMA IN THE MANDIBLE. ANA MARIA DIAS DA ^ NIO RODRIGUES, RODRIGO COSTA, EUGE RESENDE, LUISA AGUIRRE BUEXM, FERNANDO DIAS, ADRIANA TEREZINHA NEVES NOVELLINO and, SIMONE DE QUEIROZ CHAVES LOURENCO ¸ The report describes a case of mandibular osteosarcoma in a 25-year-old black male patient complaining of increase of volume in mandible with evolution of 4 months. The anamnesis stated a previous history of mucoepidermoid carcinoma in the left retroauricular region treated by parotidectomy 18 years ago. Physical examination revealed the swelling of the left body of the mandible with face asymmetry and an expansive increase of volume in the buccal region of the mandible, extending to vestibule depth, associated with pain on palpation and paresthesia. Panoramic radiograph revealed a poorly defined radiolucent image without sclerotic border, with destruction of the periodontal ligament corresponding to tooth 36. Incisional biopsy was performed, and the histopathologic report was compatible with osteosarcoma. The patient was referred for oncology treatment. Osteosarcomas in the mandible are extremely rare, and this case justifies investigation as the patient had already presented another type of tumor in the proximal region.
EXTENSIVE SIALOLIPOMA IN THE MOUTH FLOOR OF AN 11-YEAR-OLD CHILD: A CASE REPORT. ERASMO BERNARDO MARINHO, EALBER CARVALHO MACEDO LUNA, FABRICIO BITU SOUSA, KARUZA MARIA ALVES PEREIRA, EVELINE TURATTI and, ROBERTA BARROSO CAVALCANTE An 11-year-old boy was referred to our department complaining of painless swelling in the neck and floor of the mouth with an evolution time of approximately 2 months. Extraoral examination revealed a soft tumefaction on the right side of the sublingual region with normal surface color. Intraoral examination revealed a soft tumefaction on the anterior right side of the floor of mouth with normal surface color. Panoramic radiograph and complete blood count ruled out infection of odontogenic origin. Negative aspiration puncture ruled out cystic lesions. Salivary gland tumor was considered as diagnostic hypothesis. Incisional biopsy under local anesthesia was planned. However, surgical procedure was favorable, and the lesion was completely removed. Histologic sections showed mature adipocytes septated by delicate bundles of collagen fibers and interspersed by islands of salivary parenchyma, obtaining a histopathologic conclusion of sialolipoma. No evidence of recurrence was observed after 19-month follow-up.
MICROMARSUPIALIZATION AS TREATMENT OF CHOICE FOR RANULA IN LACTATING. ANA LUISA CABRAL DOS SANTOS, ALYNE AMORIN DE ARAUJO, LIVIAN TOMELIN MARTINS, SILVIA PAULA DE OLIVEIRA, JESSIE
OOOO January 2020 CAPOBIANGO SOARES DE MOURA, LUISA AGUIRRE BUEXM and, ALESSANDRA OLIVEIRA FERRANI GOMES Ranula is a common lesion of the mouth floor, resulting from rupture of the salivary gland duct and extravasation of mucin, usually associated with local trauma. Higher prevalence among young people and children is observed. Treatment options include marsupialization, excision of the gland involved, and micromarsupialization, the less invasive technique. A 28-year-old lactating female patient without previous oral lesions was complaining of "lump in the mouth." Intraoral examination showed a bluish-floating increase of volume in the right mouth floor crossing midline, associated with ulcer near the occlusion line, with clinical diagnosis of ranula. Micromarsupialization was the treatment of choice, and after 8 months, there was complete regression of the lesion without recurrence. This technique is a good treatment option because of its simplicity of execution and low invasiveness, being prioritized in patients like the one from this case report.
EXUBERANT CEMENTO-OSSIFYING FIBROMA OF THE MAXILLA. BERNARDO CORREIA LIMA, SABRINA MORELLI, MARIA APARECIDA CAVALCANTE, BRUNO AUGUSTO ^A BENEVENUTO DE ANDRADE, ALINE CORRE ABRAHAO, MICHELLE AGOSTINI and, MARIO e ROMANACH Cemento-ossifying fibroma (COF) is a benign fibro-osseous neoplasm that commonly presents as a slow-growing, welldefined mixed radiolucent-radiopaque lesion, located in the posterior mandible of women in their third and fourth decades of life. A 59-year-old male patient was referred complaining of an asymptomatic 8 £ 7 cm swelling of progressive growing in the last 5 years located in the posterior region of the maxilla. Panoramic radiograph showed a well-defined, predominantly radiopaque lesion with marked cortical bone expansion and maxillary sinus involvement. Microscopic evaluation showed proliferation of cellular fibroblastic stroma containing mineralized trabeculae of varying size and occasional concentric calcifications. There was no continuity between the tumor and surrounding normal cortical bone. The final diagnosis was COF. The patient was submitted to conservative surgery, and no recurrence was observed after 6 months of follow-up. COF of the maxilla may present as a painless and well-defined fibro-osseous tumor of large size.
IDIOPATHIC BONE CAVITY ASSOCIATED WITH OSSEOUS DYSPLASIA: CASE REPORT. NATHALIA HERNANI FERREIRA, NAYARA GOBARA, JHEINIS STEFANY PASCUINELI DUARTE, LETICIA ALECRIM SOUZA, VANIA LOUREIRO, VICTOR e PEREZ TEIXEIRA and, JOSE NARCISO ROSA ASSUNC ¸ AO JUNIOR A 46-year-old female patient with melanoderma was admitted to the stomatology outpatient clinic with a protruding buccal and lingual cortical bone in the maxillary and mandibular bones. In the physical examination, the mucous membranes remained intact. When palpating, we noticed bone crepitation in the maxilla and mandible bones. The panoramic x-rays showed welldefined radiolucent images without any radiopaque halos extending from the right mandibular ramus to the molar region on the left. In the maxilla, though, the lesions extended to both sides of